Conduct disorder and antisocial personality disorder. Conduct disorderinadolescents and antisocial behaviors, and the specific sexual interest in secretly watching unsuspect- ing others who are naked or engaging in sexual activity should be lacking.
Substance use disorders. Substance use disorders might involve single voyeuristic ep- isodes by intoxicated individuals but should not involve the typical sexual interest in se- cretly watching unsuspecting persons being naked or engaging in sexual activity. Hence, recurrent voyeuristic sexual fantasies, urges, or behaviors that occur also when the indi— vidual is not intoxicated suggest that voyeuristic disorder might be present.
Known comorbidities in voyeuristic disorder are largely based on research with males suspected of or convicted for acts involving the secret watching of unsuspecting nude or sexually active persons. Hence, these comorbidities might not apply to all individuals with voyeuristic disorder. Conditions that occur comorbidly with voyeuristic disorder include hypersexuality and other paraphilic disorders, particularly exhibitionistic disorder. De- pressive, bipolar, anxiety, and substance use disorders; attention-deficit/hyperactivity disorder; and conduct disorder and antisocial personality disorder are also frequent co- morbid conditions.
Diagnostic Criteria 302.4 (F65.2)
A. Over a period of at least 6 months, recurrent and intense sexual arousal from the ex- posure of one's genitals to an unsuspecting person, as manifested by fantasies, urges, or behaviors.
B. The individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify whether:
Sexually aroused by exposing genitals to prepubertal children
Sexually aroused by exposing genitals to physically mature individuals
Sexually aroused by exposing genitals to prepubertal children and to physically
Specify if:
In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to expose one’s genitals are restricted.
In full remission: The individual has not acted on the urges with a nonconsenting per- son, and there has been no distress or impairment in social, occupational, or other ar- eas of functioning, for at least 5 years while in an uncontrolled environment.
The subtypes for exhibitionistic disorder are based on the age or physical maturity of the non- consenting individuals to whom the individual prefers to expose his or her genitals. The non- consenting individuals could be prepubescent children, adults, or both. This specifier should help draw adequate attention to characteristics of victims of individuals with exhibitionistic disorder to prevent co-occuiring pedophilic disorder from being overlooked. However, indi- cations that the individual with exhibitionistic disorder is sexually attracted to exposing his or her genitals to children should not preclude a diagnosis of pedophilic disorder.
The ”in full remission” specifier does not address the continued presence or absence of ex- hibitionism per se, which may still be present after behaviors and distress have remitted.
The diagnostic criteria for exhibitionistic disorder can apply both to individuals who more or less freely disclose this paraphilia and to those who categorically deny any sexual attraction to exposing their genitals to unsuspecting persons despite substantial objective evidence to the contrary. If disclosing individuals also report psychosocial difficulties because of their sexual attractions or preferences for exposing, they may be diagnosed with exhibitionistic disorder. In contrast, if they declare no distress (exemplified by absence of anxiety, obsessions, and guilt or shame about these paraphilic impulses) and are not impaired by this sexual interest in other important areas of functioning, and their self—reported, psychiatric, or legal histories indicate that they do not act on them, they could be ascertained as having exhibitionistic sexual interest but not be diagnosed with exhibitionistic disorder.