Nondisclosing individuals include, for example, individuals known to have been spy- ing repeatedly on unsuspecting persons who are naked or engaging in sexual activity on separate occasions but who deny any urges or fantasies concerning such sexual behavior, and who may report that known episodes of watching unsuspecting naked or sexually ac- tive persons were all accidental and nonsexual. Others may disclose past episodes of ob— sustained sexual interest in this behavior. Since these individuals deny having fantasies or impulses about watching others nude or involved in sexual activity, it follows that they would also reject feeling subjectively distressed or socially impaired by such impulses. De- spite their nondisclosing stance, such individuals may be diagnosed with voyeuristic dis— order. Recurrent voyeuristic behavior constitutes sufficient support for voyeurism (by behavior is causing harm to others (by fulfilling Criterion B).
”Recurrent” spying on unsuspecting persons who are naked or engaging in sexual ac- tivity (i.e., multiple victims, each on a separate occasion) may, as a general rule, be inter- preted as three or more victims on separate occasions. Fewer victims can be interpreted as satisfying this criterion if there were multiple occasions of watching the same victim or if there is corroborating evidence of a distinct or preferential interest in secret watching of naked or sexually active unsuspecting persons. Note that multiple victims, as suggested earlier, are a sufficient but not a necessary condition for diagnosis; the criteria may also be met if the individual acknowledges intense voyeuristic sexual interest.
The Criterion A time frame, indicating that signs or symptoms of voyeurism 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 secretly watching unsuspecting naked or sexually active others is not merely transient.
Adolescence and puberty generally increase sexual curiosity and activity. To alleviate the risk of pathologizing normative sexual interest and behavior during pubertal adoles- cence, the minimum age for the diagnosis of voyeuristic disorder is 18 years (Criterion C).
Voyeuristic acts are the most common of potentially law-breaking sexual behaviors. The population prevalence of voyeuristic disorder is unknown. However, based on voyeuris- tic sexual acts in nonclinical samples, the highest possible lifetime prevalence for voyeuris— tic disorder is approximately 12% in males and 4% in females.
Adult males with voyeuristic disorder often first become aware of their sexual interest in secretly watching unsuspecting persons during adolescence. However, the minimum age for a diagnosis of voyeuristic disorder is 18 years because there is substantial difficulty in differentiating it from age-appropriate puberty-related sexual curiosity and activity. The persistence of voyeurism over time is unclear. Voyeuristic disorder, however, per defini- tion requires one or more contributing factors that may change over time with or without treatment: subjective distress (e.g., guilt, shame, intense sexual frustration, loneliness), psychiatric morbidity, hypersexuality, and sexual impulsivity; psychosocial impairment; and / or the propensity to act out sexually by spying on unsuspecting naked or sexually ac- tive persons. Therefore, the course of voyeuristic disorder is likely to vary with age.
Temperamental. Voyeurism is a necessary precondition for voyeuristic disorder; hence, risk factors for voyeurism should also increase the rate of voyeuristic disorder.
Environmental. Childhood sexual abuse, substance misuse, and sexual preoccupation/ hypersexuality have been suggested as risk factors, although the causal relationship to voyeurism is uncertain and the specificity unclear.
Voyeuristic disorder is very uncommon among females in clinical settings, while the male- to-female ratio for single sexually arousing voyeuristic acts might be 3:1.