Potential differential diagnoses for exhibitionistic disorder sometimes occur also as co- morbid disorders. Therefore, it is generally necessary to evaluate the evidence for exhibi- tionistic disorder and other possible conditions as separate questions.
Conduct disorder and antisocial personality disorder. Conduct disorder in adolescents antisocial behaviors, and the specific sexual interest in exposing the genitals should be lacking.
Substance use disorders. Alcohol and substance use disorders might involve single exhibitionistic episodes by intoxicated individuals but should not involve the typical sex- ual interest in exposing the genitals to unsuspecting persons. Hence, recurrent exhibition- istic sexual fantasies, urges, or behaviors that occur also when the individual is not intoxicated suggest that exhibitionistic disorder might be present.
Known comorbidities in exhibitionistic disorder are largely based on research with indi- viduals (almost all males) convicted for criminal acts involving genital exposure to non- consenting individuals. Hence, these comorbidities might not apply to all individuals who qualify for a diagnosis of exhibitionistic disorder. Conditions that occur comorbidly with exhibitionistic disorder at high rates include depressive, bipolar, anxiety, and substance disorders; and antisocial personality disorder.
Diagnostic Criteria 302.89 (F65.81)
A. Over a period of at least 6 months, recurrent and intense sexual arousal from touching or rubbing against a nonconsenting person, as manifested by fantasies, urges, or be- haviors.
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 it:
In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to touch or rub against a noncon- senting person 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 ”in remission” specifier does not address the continued presence or absence of frot- teurism per se, which may still be present after behaviors and distress have remitted.
The diagnostic criteria for frotteuristic disorder can apply both to individuals who relatively freely disclose this paraphilia and to those who firmly deny any sexual attraction from touch- ing or rubbing against a nonconsenting individual regardless of considerable objective evi- dence to the contrary. If disclosing individuals also report psychosocial impairment due to their sexual preferences for touching or rubbing against a nonconsenting individual, they could be diagnosed with frotteuristic disorder. In contrast, if they declare no distress (demon- strated by lack of anxiety, obsessions, guilt, or shame) about these paraphilic impulses and are not impaired in other important areas of functioning because of this sexual interest, and their psychiatric or legal histories indicate that they do not act on it, they could be ascertained as having frotteuristic sexual interest but should not be diagnosed with frotteuristic disorder.
Nondisclosing individuals include, for instance, individuals known to have been contest any urges or fantasies concerning such sexual behavior. Such individuals may re- port that identified episodes of touching or rubbing against an unwilling individual were all unintentional and nonsexual. Others may disclose past episodes of touching or rubbing this. Since these individuals deny having fantasies or impulses about touching or rubbing, impulses. Despite their nondisclosing position, such individuals may be diagnosed with frotteuristic disorder. Recurrent frotteuristic behavior constitutes satisfactory support for cally motivated behavior is causing harm to others (by fulfilling Criterion B).