Exhibitionism is characterized by the achievement of sexual excitement through genital exposure, usually to an unsuspecting stranger. It may also refer to a strong desire to be observed by other people during sexual activity. Exhibitionistic disorder involves acting on these urges with a nonconsenting person or experiencing significant distress or functional impairment because of such urges and impulses.
Exhibitionism is a form of paraphilia, but most people who have exhibitionism do not meet the clinical criteria for a paraphilic disorder, which require that a person's behavior, fantasies, or intense urges result in clinically significant distress or impaired functioning or cause harm to others (which in exhibitionism includes acting on the urges with a nonconsenting person). The condition must also have been present for ≥ 6 months before the diagnosis can be made.
Although the true prevalence is difficult to ascertain, the estimated prevalence in men is up to 8% (1, 2); prevalence appears to be lower in women (3 to 6%). Based on self-report studies of targets (also called victims), the majority of whom are female, between 30 and 59% of people have been the victim of exhibitionistic acts over a lifetime. Few females are diagnosed or charged criminally with exhibitionistic disorder. Thomas et al (3) suggest that sex differences in sociosexuality may contribute.
Exhibitionists (usually male) may masturbate while exposing or fantasizing about exposing themselves to others. They may be aware of their need to surprise, shock, or impress the unwilling observer. The target is almost always a female adult or a child of either sex. Actual sexual contact is rarely sought, and physical harm to the unsuspecting witness is unusual. For some people, exhibitionism is expressed as a strong desire to have other people watch their sexual acts. What appeals to such people is not the act of surprising an audience but rather of being seen by a consenting audience. People with this form of exhibitionism may make pornographic films or become adult entertainers. They rarely experience distress or impairment due to this desire and thus may not have a psychiatric disorder.
Onset is usually during adolescence; occasionally, the first act occurs at a wider range of ages from preadolescence to middle age.
Approximately 30% of apprehended male sex offenders are exhibitionists (4). The vast majority of those with exhibitionism do not act on their urges (ie, engage in physically aggressive sexual behaviors) (5).
Although many exhibitionists marry, their marriages are often troubled by poor social and sexual adjustment, including frequent sexual dysfunction (see Male Sexual Function and Dysfunction and Female Sexual Function and Dysfunction).
Exhibitionists may also have a personality disorder (usually antisocial) or conduct disorder (6).
General references
1. Långström N, Seto MC. Exhibitionistic and voyeuristic behavior in a Swedish national population survey. Arch Sex Behav. 35(4):427-435, 2006. doi: 10.1007/s10508-006-9042-6
2. Dominguez SF, Jeglic EL, Calkins C, Kaylor L. Frotteurism and exhibitionism: an updated examination of their prevalence, impact on victims, and frequency of reporting. J Sex Aggression. 2024;1–18. https://doi.org/10.1080/13552600.2024.2352403
3. Thomas AG, Stone B, Bennett P, et al. Sex differences in voyeuristic and exhibitionistic interests: Exploring the mediating roles of sociosexuality and sexual compulsivity from an evolutionary perspective. Arch Sexual Behav. 50:215102162, 2021. doi: 10.1007/s10508-021-01991-0
4. Bader SM, Schoeneman-Morris KA, Scalora MJ, Casady TK. Exhibitionism: findings from a Midwestern police contact sample. Int J Offender Ther Comp Criminol. 2008;52(3):270-279. doi:10.1177/0306624X07307122
5. Páv M, Sebalo I, Brichcín S, Perkins D. Outcome Evaluation of a Treatment Program for Men with Paraphilic Disorders Convicted of Sexual Offenses: 10-Year Community Follow-up. Int J Offender Ther Comp Criminol. 2025;69(10-11):1370-1386. doi:10.1177/0306624X231165416
6. Grant JE. Clinical characteristics and psychiatric comorbidity in males with exhibitionism. J Clin Psychiatry. 66(11):1367-1371, 2005. doi: 10.4088/jcp.v66n1104.
Diagnosis of Exhibitionistic Disorder
Psychiatric assessment
Clinical criteria for the diagnosis of exhibitionistic disorder from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-5-TR) include the following (1):
Patients experience recurrent and intense sexual arousal from the exposure of one's genitals to an unsuspecting person, as manifested by fantasies, urges, or behaviors.
Patients have acted on their sexual urges with a nonconsenting person, or these sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The condition has been present for ≥ 6 months.
When making the diagnosis, the clinician must specify whether the patient is sexually aroused by exposing their genitals to prepubescent children or to physically mature individuals, or both.
Diagnosis reference
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed, Text Revision. American Psychiatric Association Publishing; 2022:783-788.
Treatment of Exhibitionistic Disorder
Psychotherapy and support groups
Selective serotonin reuptake inhibitors (SSRIs)
Sometimes other medications (mainly antiandrogens, rarely bupropion)Sometimes other medications (mainly antiandrogens, rarely bupropion)
When laws are broken and sex offender status is conferred, the treatment of exhibitionistic disorder usually begins with psychotherapy, support groups, and SSRIs (1, 2). There is at least 1 report of bupropion being effective in a patient who was unresponsive to SSRIs (). There is at least 1 report of bupropion being effective in a patient who was unresponsive to SSRIs (3).
If SSRIs are ineffective and the disorder is severe, medications that reduce testosterone levels and consequently reduce libido should be considered. These medications are referred to as antiandrogens, although the most commonly used medications do not actually block the effects of testosterone. These medications include gonadotropin-releasing hormone (GnRH) agonists (eg, leuprolide) and depot medroxyprogesterone acetate; both decrease pituitary production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Full, informed consent and appropriate monitoring of liver function and serum . These medications include gonadotropin-releasing hormone (GnRH) agonists (eg, leuprolide) and depot medroxyprogesterone acetate; both decrease pituitary production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Full, informed consent and appropriate monitoring of liver function and serumtestosterone levels are required.
Recidivism rates of up to approximately 40% have been reported (4). The effectiveness of treatment is monitored based on self-report, penile plethysmography, and arrest records.
Treatment references
1. Garcia FD, Thibaut F. Current concepts in the pharmacotherapy of paraphilias. Drugs. 71(6):771-790, 2011. doi: 10.2165/11585490-000000000-00000
2. Thibaut F. Pharmacological treatment of paraphilias. Isr J Psychiatry Relat Sci 49(4):297-305, 2012. Isr J Psychiatry Relat Sci. 2012;49(4):297-305. PMID: 23585467
3. Vayısoğlu S. Symptoms of exhibitionism that regress with bupropion: A case report. . Symptoms of exhibitionism that regress with bupropion: A case report.Front Psychiatry. 2023;13:1079863. doi:10.3389/fpsyt.2022.1079863
4. Firestone P, Kingston DA, Wexler A, et al. Long-term follow-up of exhibitionists: psychological, phallometric, and offense characteristics, J Am Acad Psychiatry Law. 34(3):349-359, 2006. PMID: 17032959
Key Points
Most people with exhibitionist behaviors do not meet the clinical criteria for an exhibitionistic disorder.
Up to 30% of apprehended male sex offenders are exhibitionists; sex offenses often recur.
Diagnose exhibitionistic disorder only if the condition has been present for ≥ 6 months and if patients have acted on their sexual urges with a nonconsenting person, or their behavior causes them clinically significant distress or impairs functioning.
Many people with exhibitionistic behaviors do not seek treatment; treat patients who have committed a sexual offense with psychotherapy and SSRIs first; if additional treatment is needed and if informed consent is obtained, treat with antiandrogen medications.
Drugs Mentioned In This Article
