Exhibitionistic Disorder

Medically reviewed by Dr. Andrea Cziffer Paul , MD, Julie Dodson, MA, LCSW, and Laura Angers Maddox, NCC, LPC

Overview

Exhibitionistic disorder may sometimes be confused with exhibitionism, but the two have critical differences. Exhibitionism is characterized as a fetish where an individual has the urge to perform sexual acts before an audience. Exhibitionism does not meet the criteria for exhibitionistic disorder because the behavior may only be performed for a consenting adult audience and does not cause distress for the individuals partaking in it or the consensual audience.

People with exhibitionistic disorder may prefer to expose themselves to people without their consent with the motivation to shock, frighten, arouse, or impress an unsuspecting audience or individual. They may have difficulty controlling their compulsion¹ and may not intend to engage in sexual activity with those to whom they expose themselves.

This is typically referred to as indecent exposure, which is the act of intentionally exposing one's genitals, buttocks, or breasts in public or in the presence of others in a manner considered offensive, lewd, or inappropriate according to societal norms and legal standards. While the behaviors associated with exhibitionistic disorder can be distressing and harmful, they stem from a mental health condition that requires treatment.

Exhibitionistic disorder is classified as a type of paraphilia—a group of disorders involving intense, recurring sexual fantasies and behaviors involving non-consenting adults, inanimate objects, or children. In addition to exhibitionistic disorder, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) recognizes voyeuristic, fetishistic, transvestic, sexual sadism, sexual masochism, frotteuristic, and pedophilic disorders under the category of paraphilias.

Note that just because an individual has a non-conforming sexual preference doesn’t necessarily mean they have a form of paraphilia or mental health disorder. The critical difference is that paraphilic disorders, including exhibitionistic disorder, often cause psychological distress to the person(s) involved, injure or harm others, or interfere with an individual’s ability to function in daily life.

Symptoms

The process of determining which condition explains a person's behavior can be challenging. The symptoms of exhibitionistic disorder can vary between people, but there are a few common signs that clinicians look for when reaching a diagnosis:

A deep-seated, potentially compulsive urge to shock, frighten, or excite another person sexually by showing their genitalia.
The individual acts on that urge or has a history of high-risk sexual behavior in public.
The individual has a disregard for the emotional and physical boundaries² of others.
The exhibitionistic desires and behaviors negatively interfere with daily life and relationships for the individual or those exposed to their behavior.

Further criteria for a clinical diagnosis of exhibitionistic disorder include the following symptoms and signs:

The individual’s exhibitionist behaviors are consistent over six months or more.
The individual experiences extreme sexual arousal when showing their genitals to non-consenting strangers.
Exhibitionist desires and behaviors disrupt work, school, relationships, and social activities.
The behavior causes severe distress to the individual or others.
Another physical or mental condition does not cause the behavior.

While more studies may be beneficial to definitively connect particular personality traits or lifestyle preferences with exhibitionistic disorder, some research indicates that people with the condition may experience lower life satisfaction, engage in excessive use of substances, and display hypersexualized behavior and preoccupations like more frequent sexual interest, arousal, and activity. For example, individuals with this condition may use pornography or masturbate enough to interfere with daily life.

Diagnosis typically requires that these behaviors cause significant distress or impairment in social, occupational, or other important areas of functioning and are not solely due to the direct effects of substance use or another medical condition.

Exhibitionistic disorder can be accompanied by one or more mental health challenges, although there is little research to indicate which are most prevalent. Common comorbidities may include depression and anxiety. Other paraphilic disorders ,such as frotteuristic disorder and substance use disorders are also considered typical. Bipolar disorder, attention-deficit hyperactivity disorder (ADHD), antisocial personality disorder (ASPD),³ and other conduct disorders may also occur.

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Causes

The exact causes of exhibitionistic disorder are unknown, but the scientific community posits several hypotheses. The most predominant theories center around childhood development, but there are also a few biological and psychological possibilities.

Childhood development theories

Risk factors for paraphilias, such as exhibitionistic disorder, may be related to psychological development in childhood. For example:

Difficulty developing self-awareness and managing emotions
A childhood environment featuring significant conflict, low supervision, lack of affection, and other dysfunctional circumstances
Childhood trauma, such as sexual, physical, and emotional abuse, which may create behaviors where the individual exploits or abuses others
Disruption of or dysfunctional models of sexual development through adolescence

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Biological theories

Like other theories on the causes of exhibitionistic disorder, more research is needed before an absolute, direct connection can be made between the condition and a biological cause. However, there are indications that biology may play a role:

Testosterone levels may play a biological role in exhibitionistic and other paraphilic disorders.
Monoamine neurotransmitter levels of dopamine, serotonin, and norepinephrine may be a potential cause of paraphilias such as exhibitionistic disorder.
Some studies suggest there may be a connection between Huntington’s Disease and paraphilia as a symptom—although further research is needed.
Some instances of traumatic brain injury may play a role in the cause and development of exhibitionistic disorder.

Treatments

Although some people may not seek treatment until their behavior has legal ramifications, treatment by a mental health professional is essential to help individuals with exhibitionistic disorders manage and cope. This condition may be treated with a combination of psychotherapy,⁴ medications, and adjunctive treatments on a per-case basis. Treatment may involve a combination of psychotherapy, medication, and behavior modification techniques. Psychotherapy may focus on understanding and managing the impulses, while medications such as SSRIs can help manage underlying mood disorders or impulsivity.

Therapy

Several therapeutic methods may be used in the treatment of exhibitionistic disorder, including but not limited to the following:

Cognitive-behavioral therapy (CBT):⁵ CBT may help individuals uncover the roots of their exhibitionist urges to address them in healthier ways. It can provide the individual with coping skills and techniques for reframing their thoughts to reduce exhibitionist behaviors.
Group therapy: Healthy social support may help individuals cope with the shame and denial often associated with exhibitionistic behaviors. Group therapy may also prevent relapse while engaging in cognitive restructuring.
Orgasmic reconditioning: In this process, a client may learn to substitute fantasies of exposing themselves with fantasies of more appropriate sexual behavior while masturbating. These exercises do not happen with the therapist present.
Couples therapy: Couples therapy may help one’s spouse or partner understand the disorder and provide support. Couples therapy may also facilitate effective communication and coping strategies.

Medication

Although no medical cure exists for exhibitionistic disorder, certain medications may help treat its symptoms or co-occurring conditions. For example, some selective serotonin reuptake inhibitors (SSRIs) used for mood disorders such as depression. Selective serotonin reuptake inhibitors may be prescribed to reduce sexual desire and impulsivity and aid progress in psychotherapy.

Antiandrogens (medications that reduce testosterone) may also be prescribed to curb sexually compulsive tendencies by blocking the uptake and metabolism of testosterone. However, these medications are not commonly used due to serious side effect risks.

Doctors might prescribe GnRH analogues to lower testosterone levels. These are available in long-acting injectable formats. These medications have serious side effects, and treatment should be supervised carefully by a physician.

Consult a medical doctor before starting, changing, or stopping a medication for any condition. The above information is not a replacement for medical advice or diagnosis.

The BetterHelp platform is not intended for any information regarding which drugs, medication, or medical treatment may be appropriate for you. The content is providing generalized information, not specific for one individual. You should not take any action without consulting with a qualified medical professional.

Other treatment options

Other adjunctive treatments for exhibitionistic disorder may include working with the individual to help them form healthy relationships and function healthily in society. Criminal convictions or prison time can be common for individuals with exhibitionistic disorder, so therapy involving communication skills, workplace functioning, and other practical daily life applications can be beneficial.

Therapy may also include designated support from friends and family to help the individual focus on recovery. Loved ones may assist by taking precautions to ensure the individual’s internet usage is limited, that they are accompanied in public spaces, or that they have a daily routine to support a healthy lifestyle. A case manager may be helpful for this step.

Resources

There are various resources for therapeutic intervention for those with exhibitionistic disorder that come in unique forms. Individuals may undergo court-appointed in-person sessions, meet with others in a support group, or both. Some prefer speaking to a therapist online through a virtual platform like BetterHelp. Online therapy can be beneficial for individuals experiencing shame about the disorder or who aren’t comfortable talking to a therapist face-to-face or in a group setting.

For more online support, the Institution for Sexual Wellness offers a wealth of resources on its website for people undergoing treatment for paraphilias of all kinds, including exhibitionistic disorder. Visit their website for self-assessments, a glossary of terms, a treatment overview, and educational materials.

The National Alliance on Mental Illness (NAMI) offers a wide range of resources for patients, families, and communities on its website. You may also reach NAMI via phone at 800-950-NAMI.

Like NAMI, Mental Health America offers outreach and support programs, public education programs, and mental health screenings for individuals and their families. Visit their website or call 800-969-6642 for more information.

If you are experiencing sexual abuse or have experienced assault, note that the Rape, Abuse, and Incest National Network (RAINN) has a hotline dedicated to supporting individuals experiencing sexual assault, harassment, or intimate partner violence. You can contact them anytime by calling 800-656-HOPE (4673) or using the online chat.

For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357).

Please see our Get Help Now page for more immediate resources.

Research

Research on exhibitionistic disorder is limited, and more current studies are required for more insight into its etiology, characteristics, and treatment. However, research in the last couple of decades provided some valuable information for individuals with the disorder and their loved ones.

For example, a 2005 study published in the Journal of Clinical Psychology measured the overall psychological condition of 25 males between 14 and 68 years to determine which comorbidities were most commonly found within the group.

The researchers found that the most typical manifestation of the condition was exposing oneself while operating a motor vehicle, and 92% of participants were currently affected by an Axis I disorder—most commonly substance use disorder, major depressive disorder, and compulsive sexual behavior. 40% of participants were diagnosed with a personality disorder, 52% had thoughts of suicide, and 36% had been arrested for exhibitionism in the past.

A more current 2023 paper published in the National Library of Medicine outlines the case study of a 33-year-old male who sought outpatient treatment for exhibitionistic disorder. Throughout his treatment, the patient tried many different medications in addition to psychotherapy to reduce his symptoms but found no relief. Typically, serotonergic antidepression medications are the standard pharmacological treatment for paraphilias such as exhibitionistic disorder because of their higher rates of efficacy.

In the case of this individual, bupropion, an antidepressant that impacts noradrenaline and dopamine activity, proved effective in reducing his urges to act upon exhibitionistic thoughts and compulsions. Current research of this type is vital for uncovering more diverse treatment options for people with exhibitionistic disorder and other paraphilic disorders.

Statistics

75% of individuals with comorbidities to exhibitionistic disorder achieve symptom reductions

More studies are needed to understand the benefits of therapy for exhibitionistic disorder. However, cognitive-behavioral therapy (CBT) has been proven effective in treating frequently comorbid conditions like anxiety, depression, and substance use disorders in 75% of individuals. ¹

¹American Psychiatric Association

Research on exhibitionistic disorder and other paraphilias is currently limited because of small sample sizes, unreliability of self-assessments, and outdated methodology. Still, there are some reliable studies on how paraphilias affect the general population, who is most at risk, and the best treatment options. Below are some of these statistics:

Exhibitionistic disorder affects approximately 2% to 4% of the male population—prevalence among women is rare.
Roughly 30% of arrested male sex offenders have exhibitionistic tendencies, and up to 50% of those may re-offend.
Symptoms of exhibitionistic disorder most commonly emerge before 18 years of age and are less prevalent among those aged 50 and over.

Associated terms

Updated on September 4, 2024.

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