Much of what we know about the psychology of paraphilic disorders— conditions characterized by abnormal sexual desires— is based on research from the 1980s. Research at that time focused on understanding the early childhood experiences that led to inappropriate sexual cognitions.
The leading theory proposes that deviant sexual behavior is learned through stimulus/response conditioning starting in childhood. Initially, a person becomes sexually aroused to an inappropriate object or behavior, and then continues to repeat the scenario. Over time, the deviant sexual behavior becomes associated with pleasure and sexual gratification and a paraphilic disorder develops. Most people with atypical sexual interests do not have a mental disorder however, it becomes a clinically diagnosable paraphilic disorder if the person feels mental anguish or inflicts distress on someone else as a result of their behavior1.
Exhibitionistic disorder is a condition encompassed by paraphilic disorder. People with exhibitionistic disorder have a need to expose their genitals to other people (typically strangers caught off guard) in order to gain sexual satisfaction2. Exhibitionism is considered a "hands off" disorder because there is no physical contact with the victims, although most victims report psychological distress from the incident.
Exhibitionist behaviors usually start in the first decade of adulthood and are most commonly a male who exposes his genitalia to women, or children (male or female). In the U.S., about 50% of exhibitionist are married3. People rarely seek treatment for exhibitionism unless they are in legal trouble or having marital problems as a result of their behavior. The prevalence of exhibitionism is difficult to estimate since it is often underdiagnosed and underreported.
Through a survey of over 600 heterosexual men in their early 20s, researchers in West Virginia found several childhood risk factors that contribute to exhibitionism urges. Respondents who shared a bath with a female, or allowed a partner to look at their genitals, or were allowed to be nude in his mother's presence appeared to condition the experiences as pleasurable and sexually arousing4. The researchers hypothesize that these childhood nudity situations normalize exhibitionism in the individual's mind.
Upon finding the initial exhibition sexually arousing, the individual is inclined to repeat the exposure, further conditioning the experience. The individual then fantasizes about engaging in exhibitionist behavior and these mental urges continue to condition the sexual pleasure derived from exposing oneself. Typically, the urges become more powerful and may be linked to a certain mood (i.e. stressed, anxious, bored), location, or type of person. Exhibitionists are generally unable to explain why locations, feelings, or people trigger the sexually deviant behavior because they are unaware of the conditioning that led to the disorder.
Other theories point to increased levels of testosterone that cause paraphilics to become hypersexual, exhibiting behaviors or thoughts that are excessively concerned with sexual activity. In a 1989 study of sex hormone levels of sexual deviants, male exhibitionist sexual offenders had lower levels of estradiol and testosterone, but higher levels of free testosterone compared to nonviolent nonsex offenders5. This suggests exhibitionist behavior may result from the need to satisfy an increased sexual drive.
Similarly, psychopharmalogical treatments have attempted to the suppress libido of sexual deviants by interacting with sex hormones. Drugs with antiandrogenic properties are antagonistic to the hormones that regulate one's sex drive. In a clinical study, men who took an antiandrogen drugs for eight years showed a moderate reduction in hypersexuality, libido, ability for erection, and orgasm5. Upon completion of the drug therapy, testosterone levels returned to baseline within two months and paraphilic sexual urges resurfaced.
Other drug therapies such as androgen-depleting synthetic steroids function similarly to antiandrogens by lowering testosterone levels. In an epidemiological study of 20 male sexual offenders, a type of androgen-depleting synthetic steroid affected attentiveness to stimuli formerly associated with sexual arousal; the frequency of attentiveness diminished and behavioral response was inhibited6. Further research is needed to understand the biological processes and how drugs can alter hypersexuality.
Despite the advances in brain imaging, there are no MRI studies regarding deviant sexual behavior. Funding should be allocated to investigate the components of the brain contributing to sexual urges. Studies that use a larger sample size of exhibitionist may improve the existing knowledge on the origins of this disorder.
By Abby Johnston
1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
2. Hypersexual Disorders (2013). DSM 5: Understanding Exhibitionistic Disorder. [online] Retrieved from: http://www.hypersexualdisorders.com/hypersexual-disorders/dsm-5-understanding-exhibitionistic-disorder/ [Accessed: 16 Sep 2013]. http://www.minddisorders.com/Del-Fi/Exhibitionism.html#b
3. Encyclopedia of Mental Disorders (2013). Exhibitionism - children, causes, DSM, effects, therapy, drug, person, people. [online] Retrieved from: http://www.minddisorders.com/Del-Fi/Exhibitionism.html#b [Accessed: 16 Sep 2013].
4. Swindell, S. J. (2011). Correlates of Exhibition-like Experiences in Childhood and Adolescence: A Model for Development of Exhibitionism in Heterosexual Males. Sexual Addiction & Compulsivity, 18(3), 135-156.
5. Lang, R. A., Langevin, R., Bain, J., Frenzel, R., & Wright, P. (1988). Sex hormone profiles in genital exhibitionists.Annals of Sex Research, 2(1), 67-75. doi:10.1007/BF00850680
6. Murray, J. B. (1988). Psychopharmacological therapy of deviant sexual behavior.The Journal of General Psychology, 115(1), 101-110. doi:10.1080/00221309.1988.9711093