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Exhibitionism

Exhibitionism

Introduction

Exhibitionism is a sexual disorder wherein a person feels the constant urge to expose his/her genitalia to unsuspecting strangers or in public places. In most cases, exposure of genitalia is also accompanied by touching of genitals and masturbation. An exhibitionist believes that his actions will surprise or sexually gratify himself as well as the viewer. He may be aware of the shock value of exhibitionistic acts but rarely imagines that his acts can infuriate or scare the victim. Exhibitionism is primarily observed in men who make women or children their victims. Although most exhibitionists don’t inflict any other harm on the victims, at times they can initiate contact or molest their victim. In such situations, exhibitionism is referred to as exhibitionistic disorder.

Risk factors

Exhibitionism can have lasting impact on one’s personal and social life. As most exhibitionists refrain from exposing in their places of work, they can’t avoid exposing to colleagues, subordinates or superiors in random social situations. If left unchecked and the condition complicates by other paraphilia, exhibitionists can develop sadistic tendencies and sexually abuse or molest their victims. These criminal tendencies develop due to a lacking impulse inhibition in an exhibitionist. Also, as the underlying causes of exhibitionism can be psychological disorders or chronic depression; an exhibitionist may be at a risk of developing lifestyle complications if left untreated. In some cases, exhibitionism remains the exclusive way of achieving sexual satisfaction and normal relationships become impossible.

Causes

As a sexual disorder which is deep rooted in a person’s psyche, the typical causes of exhibitionism pertain to psychological and physiological factors. A person may develop exhibitionistic tendencies any time in life and the disorder is not directly associated with sexual development. Men are more likely to have this disorder as compared to women. In contemporary culture, it is also believed that women expose everything except genitalia; thereby circumventing the need for exhibitionistic tendencies. Commonly acknowledged causes of exhibitionism are-

  • Hormonal Imbalance: The male reproductive hormone, Testosterone is known to be the primary cause of sexually deviant behavior in men. With over production of testosterone, men can develop paraphilia and sexual tendencies which may lead to achievement of sexual gratification without intercourse.
  • Traumatic brain injury: Injury to certain parts of brain can impair impulse control in men and exhibitionistic tendencies can develop significantly after physical recovery.
  • Emotionally abusive childhood: An emotionally scarring and abusive childhood can lead to cognitive dissociation and moral impairment in a person. As a result, they expect exposure of genitalia as a stimulus which is expected to result in sexual acts. This underlying cause can complicate exhibitionism and even develop into other sexual disorders.
  • Substance abuse: Excessive intake of alcohol or recreational drugs can also lower social inhibitions, thereby causing exhibitionistic tendencies to develop in a person.

Diagnosis

The diagnostic criteria of exhibitionism entails that the patient must experience exhibitionistic urges and act upon them recurrently for at-least a period of six months. Exhibitionistic urges must also interfere with normal social, inter-personal and professional life. As this paraphilia is easily exposed due to the nature of the disorder, patients can’t deny to its existence. However, based on the severity of the disorder, following categories of exhibitionism have been identified –

  • Fantasizing: These exhibitionists merely contend with fantasizing about exposing their genitalia in public and never act upon their fantasies.
  • Pure exhibitionists: These exhibitionists like to expose themselves or masturbate from a distance. They don’t touch or harm their victims in any other way.
  • Exclusive exhibitionists: This is a very rare condition wherein a person is expected to derive sexual satisfaction only by acts of exhibitionism and is unable to form normal romantic relationships.
  • Exhibitionist criminals: This is the most dangerous category of exhibitionist as at a pathological level, they are known to have other paraphilia too. They not only expose themselves to non-consenting children or adults, they also proceed to sexually abuse or molest their victims.

Treatment

As is the case with other paraphilia, exhibitionism can also be treated with a combination of medical and psychiatric treatments. Although, no treatment is known to completely cure exhibitionism; patients have been able to manage exhibitionistic tendencies after seeking professional help.

  • Cognitive behavioral therapy: This is the most preferred treatment in cases where fantasizing exhibitionism or pure exhibitionism exists and the person wants to consciously control it. This therapy can be conducted at individual or group level.
  • Behavioral restructuring: Aversion therapy and other techniques are adopted to dissociate the feeling of sexual satisfaction from the act of exposing genitalia in public.
  • Medicinal treatment: The frontline treatment procedure pertains to prescribing antidepressants, anti-anxiety medicines and Selective Serotonin Reuptake Inhibitors (SSRIs) to the exhibitionists to curtail the urges.
  • Hormonal treatment: This treatment is adopted in severe cases where anti-androgens are prescribed to the patient in order to reduce the symptoms and urges of exhibitionism.