Examples of nondisclosing individuals include those who have exposed themselves repeatedly to unsuspecting persons on separate occasions but who deny any urges or fan- tasies about such sexual behavior and who report that known episodes of exposure were all accidental and nonsexual. Others may disclose past episodes of sexual behavior involv- ior. Since these individuals deny having urges or fantasies involving genital exposure, it such impulses. Such individuals may be diagnosed with exhibitionistic disorder despite their negative self—report. Recurrent exhibitionistic behavior constitutes sufficient support motivated behavior is causing harm to others (Criterion B).
”Recurrent” genital exposure to unsuspecting others (i.e., multiple victims, each on a separate occasion) may, as a general rule, be interpreted as three or more victims on sep- arate occasions. Fewer victims can be interpreted as satisfying this criterion if there were multiple occasions of exposure to the same victim, or if there is corroborating evidence of a strong or preferential interest in genital exposure to unsuspecting persons. Note that multiple victims, as suggested earlier, are a sufficient but not a necessary condition for di- agnosis, as criteria may be met by an individual’s acknowledging intense exhibitionistic sexual interest with distress and / or impairment.
The Criterion A time frame, indicating that signs or symptoms of exhibitionism must have persisted for at least 6 months, should also be understood as a general guideline, not a strict threshold, to ensure that the sexual interest in exposing one’s genitals to unsuspect- ing others is not merely transient. This might be expressed in clear evidence of repeated behaviors or distress over a nontransient period shorter than 6 months.
The prevalence of exhibitionistic disorder is unknown. However, based on exhibitionistic sexual acts in nonclinical or general populations, the highest possible prevalence for exhi- bitionistic disorder in the male population is 2%—4%. The prevalence of exhibitionistic dis- order in females is even more uncertain but is generally believed to be much lower than in males.
Adult males with exhibitionistic disorder often report that they first became aware of sex— ual interest in exposing their genitals to unsuspecting persons during adolescence, at a somewhat later time than the typical development of normative sexual interest in women or men. Although there is no minimum age requirement for the diagnosis of exhibitionis— tic disorder, it may be difficult to differentiate exhibitionistic behaviors from age-appro- priate sexual curiosity in adolescents. Whereas exhibitionistic impulses appear to emerge in adolescence or early adulthood, very little is known about persistence over time. By def- inition, exhibitionistic disorder requires one or more contributing factors, which may change over time with or without treatment; subjective distress (e.g., guilt, shame, intense sexual frustration, loneliness), mental disorder comorbidity, hypersexuality, and sexual impulsivity; psychosocial impairment; and / or the propensity to act out sexually by expos- ing the genitals to unsuspecting persons. Therefore, the course of exhibitionistic disorder is likely to vary with age. As with other sexual preferences, advancing age may be associ- ated with decreasing exhibitionistic sexual preferences and behavior.
Temperamental. Since exhibitionism is a necessary precondition for exhibitionistic dis- order, risk factors for exhibitionism should also increase the rate of exhibitionistic disor- der. Antisocial history, antisocial personality disorder, alcohol misuse, and pedophilic sexual preference might increase risk of sexual recidivism in exhibitionistic offenders.
Hence, antisocial personality disorder, alcohol use disorder, and pedophilic interest may be considered risk factors for exhibitionistic disorder in males with exhibitionistic sexual preferences.
Environmental. Childhood sexual and emotional abuse and sexual preoccupation/hyper— sexuality have been suggested as risk factors for exhibitionism, although the causal rela- tionship to exhibitionism is uncertain and the specificity unclear.
Exhibitionistic disorder is highly unusual in females, whereas single sexually arousing ex- hibitionistic acts might occur up to half as often among women compared with men.
Functionai Consequences of Exhibitionistic Disorder
The functional consequences of exhibitionistic disorder have not been addressed in re- tress over these preferences.