Voyeuristic Disorder

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a person can be diagnosed with voyeuristic disorder if they:

• Are 18 years or older
• Have had recurring and intense sexual arousal (e.g., sexual urges, fantasies, or other behaviors) from observing an unsuspecting person who is naked, getting undressed, or participating in sexual activity
• Have acted on their voyeuristic urges
• Have displayed symptoms for at least six months

According to the American Psychiatric Association, if an individual fulfills the diagnostic criteria based on the distress they feel, such distress must be internal and not the result of societal condemnation. 

The Diagnostic and Statistical Manual of Mental Disorders also notes that a person doesn’t have to accept their paraphilic tendencies to meet diagnostic criteria. A diagnosis can also be made if someone denies these tendencies. If someone is distressed or impaired by the urge to engage in an atypical sexual interest, they can be diagnosed with voyeuristic disorder. A person who has been caught engaging in voyeurism with non-consenting people but labels their behavior as an accident may also be diagnosed with voyeuristic disorder because they may currently be ignoring or denying the stress accompanying their actions. 

Although symptoms often start presenting during adolescence, with the average age of manifestation being 15, an official mental health diagnosis cannot be made until a person is at least 18 years old. This requirement helps professionals differentiate the disorder from the sexual curiosity adolescents may display. 

If the voyeurism is consensual, it likely does not rise to the level of voyeuristic disorder. As stated by the American Psychiatric Association, the Diagnostic and Statistical Manual of Mental Disorders “clearly distinguishes between atypical sexual interests and mental disorders involving these desires or behaviors”. 

Voyeuristic disorder can negatively impact a person’s mental health and relationships. Individuals diagnosed with this condition may experience shame, distress, and isolation as a result of their disorder. In some cases, a person with voyeuristic disorder may develop other mental health conditions, such as depression, anxiety, or substance use disorders. In addition, they may experience sexual dysfunction when engaging in sexual activity themselves, particularly if they do not have an outlet for their sexual urges. Some people with a paraphilic disorder struggle to become sexually aroused without the behaviors associated with their condition.

No one cause has been found for voyeuristic disorder. However, it has been linked to the following potential risk factors: 

• Childhood sexual abuse
• Hypersexuality (high sex drive)
• Substance misuse
• Antisocial personality disorder (ASPD) 
• Negative social influences
• Poor mental health

Men are two to three times more likely to engage in voyeurism than women. There may also be a possible association between internet sex addiction and voyeuristic disorder. Research has shown that voyeurs are often the youngest child in their family and have fewer sisters. They often have a significant relationship with their parents, but their parents may not have a happy marital relationship. 

People who engage in voyeurism may be likelier to be underdeveloped socially and sexually, and they are less likely to get married than others. 50% of voyeurs may believe that healthy sexual relations are not an option for them, so they fantasize about sexual activity that is more obtainable.

When voyeuristic interests are not acted on or only initiated with consenting parties, they do not necessarily require treatment unless they cause an individual distress. While treatment for voyeuristic disorder may sometimes start following legal issues, proactive mental health care is crucial and can include therapies like cognitive-behavioral therapy (CBT),³ which focuses on altering destructive behaviors and managing compulsive sexual urges. Individuals experiencing symptoms of voyeuristic disorder are encouraged to seek psychological evaluation and treatment early. Treatment may include therapy, medication, and support groups. 

Medication

Selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant, may be used to treat a person with voyeuristic disorder. However, if the condition is severe and the individual isn’t responding to the SSRIs, anti-androgen medications that reduce testosterone levels and reduce a person’s sex drive may be considered, such as leuprolide or medroxyprogesterone acetate. Lowering a person’s sex drive may allow for more efficient and effective cognitive restructuring during therapy. For these medicines to be prescribed, the individual must offer informed consent. In addition, blood tests can be periodically administered to monitor liver function and testosterone levels.     

Other treatment options

Support groups may be used to supplement the treatment process. By connecting with others who experience the same urges, individuals with voyeuristic disorder may be less stigmatized and learn new strategies to manage their behavior.   

A person with voyeuristic interests may also find ways to appropriately engage in the behavior, such as joining communities where they can participate in consensual voyeurism. This strategy can be a way to responsibly channel their sexual interests respectfully and legally. 

Self-care

Self-care can be a critical option for people living with voyeuristic disorder. Working on self-care at home in combination with therapy and medication can be an effective way to reduce symptoms and improve mental health. A few self-care strategies include the following: 

• Exercise: Exercise is an effective way to improve mental well-being on a daily basis, as it can increase endorphins in the brain, which offers a mood boost and can improve mental health overall. At least 30 minutes of exercise daily can be sufficient. 
• Healthy eating: Having a healthy diet can be another way to improve mental health. Healthy foods like fish, leafy green vegetables, fruits, and whole grains can be a way to improve mental health. 
• Relaxing activities: Relaxing activities like mindfulness, meditation, and yoga may be a helpful way to channel energy into something healthier and may distract individuals from unhealthy urges. In addition, mindfulness has been associated with reduced anxiety, stress, and depression symptoms. 
• Healthy kink communities: Having a healthy place to express one’s sexual desires and kinks consensually and with other people interested in similar kinks can be a way to reduce urges to partake in this activity unhealthily or illegally. 

Self-care, when combined with medication and therapy, can be an effective way to cope with symptoms at home. 

A trained mental health professional can provide knowledge and support for someone with voyeuristic disorder. A therapist can help clients learn more about the condition and develop coping skills and strategies to modify unwanted behavior. Not all therapists are equipped or certified to treat sex-related conditions, so it can be crucial to seek out a professional with the appropriate credentials and training. If the right therapist isn’t available locally, you can use online therapy platforms such as BetterHelp to connect with one out of thousands of professionals from home via phone, video, or live chat sessions.  

Support groups can also be a valuable resource for patients. Sex Addicts Anonymous is a 12-step recovery program for people experiencing addictive sexual behavior. Sexaholics Anonymous is another organization based on the principles of Alcoholics Anonymous. The goal of Sexaholics Anonymous is to help members stop lusting and become ‘sexually sober.’ Meetings are available in person, through email, and over the phone. 

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

For those experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7. Please also see our Get Help Now page for more immediate resources.

To learn more about what influences people to engage in voyeuristic behavior, researchers interviewed 17 incarcerated men who had a conviction of voyeurism. Three key pathways to behavior were identified by creating the Descriptive Model of Voyeuristic Behavior: 

• Sexual gratification: Participants engaged in voyeurism as a way to achieve sexual satisfaction.
• Maladaptive connection seeking: Participants used voyeurism to connect with others and most often sought relationships with adolescents.
• Access to inappropriate persons: Participants wanted to access intimate parts of someone’s life that they normally couldn’t access.

The authors of this study also noted that every participant in the study displayed at least one early risk factor, such as emotional dysregulation, poor mental health, poor emotional support, or maladaptive coping. 

Another study explored the experiences of men convicted of voyeurism. It discerned three overarching motivations that drove the participants in the behavior, including surrogate intimacy, escape from reality, and an overwhelming habit. The author suggested that her findings demonstrate the need for compassion-focused therapy and acceptance and commitment therapy to allow clients to develop psychological flexibility to manage their voyeuristic urges more effectively.

Below are several significant statistics on voyeuristic disorder:

• In a collection of data provided by studies of incarcerated sex offenders, approximately 12% of males and 4% of females reported engaging in at least one episode of voyeuristic behavior, with the rate of male to female voyeurs ranging from 2:1 to 3:1. 
• While voyeuristic interests are relatively common in the general population, it is the compulsive, distressing, and non-consensual aspects that characterize voyeuristic disorder.
• A single voyeur may commit multiple acts of voyeurism. In a study of 411 men, 62 of the men identified as voyeurs self-reported 29,090 acts of voyeurism against 26,648 survivors.  
• One study found that a combination approach of medication and psychotherapy could be highly effective in treating paraphilic disorders like voyeuristic disorder. Cognitive-behavioral therapy can be one of these methods, helping clients reframe their mindset and separate themselves from their urges.