Exhibitionism Health Article

Definition

Exhibitionism is a mental disorder characterized by a compulsion to display one's genitals to an unsuspecting stranger. The Diagnostic and Statistical Manual of Mental Disorders,also known as the DSM-IV-TR,classifies exhibitionism under the heading of the "paraphilias," a subcategory of sexual and gender identity disorders. The paraphiliasare a group of mental disorders marked by obsessionwith unusual sexual practices or with sexual activity involving nonconsenting or inappropriate partners (such as children or animals). The term paraphiliais derived from two Greek words meaning "outside of" and "friendship-love."

In the United States and Canada, the slang term "flasher" is often used for exhibitionists.

Description

Exhibitionism is described in theDSM-IV-TRas the exposure of one's genitals to a stranger, usually with no intention of further sexual activity with the other person. For this reason, the term exhibitionism is sometimes grouped together with expression, "voyeurism," ("peeping," or watching an unsuspecting person or people, usually strangers, undressing or engaging in sexual activity) as a "hands-off" paraphilia. This contrasts with the "hands-on disorders" which involve physical contact with other persons.

In some cases, the exhibitionist masturbates while exposing himself (or while fantasizing that he is exposing himself) to the other person. Some exhibitionists are aware of a conscious desire to shock or upset their target; while others fantasize that the target will become sexually aroused by their display.

Causes

Several theories have been proposed regarding the origins of exhibitionism. As of 2002, however, none are considered conclusive They include:

• Biological theories. These generally hold that testosterone, the hormone that influences the sexual drive in both men and women, increases the susceptibility of males to develop deviant sexual behaviors. Some medications used to treat exhibitionists are given to lower the patients' testosterone levels.
• Learning theories. Several studies have shown that emotional abusein childhood and family dysfunction are both significant risk factors in the development of exhibitionism.
• Psychoanalytical theories. These are based on the assumption that male gender identity requires the male child's separation from his mother psychologically so that he does not identify with her as a member of the same sex, the way a girl does. It is thought that exhibitionists regard their mothers as rejecting them on the basis of their different genitals. Therefore, they grow up with the desire to force women to accept them by making women look at their genitals.
• Head trauma. There are a small number of documented cases of men becoming exhibitionists following traumatic braininjury (TBI) without previous histories of alcohol abuse or sexual offenses.
• A childhood history of attention-deficit/hyperactivity disorder (ADHD). The reason for the connection is not yet known, but researchers at Harvard have discovered that patients with multiple paraphilias have a much greater likelihood of having had ADHD as children than men with only one paraphilia.

In general, psychiatrists disagree whether exhibitionism should be considered a disorder of impulse control or whether it falls within the spectrum of obsessive-compulsive disorders (OCDs). Further research into the anatomical structure and neurochemistry of the brain may help to settle this question.

As of 2002, there are no genes that have been associated with an increased risk of exhibitionism or other paraphilias. Such chromosomal abnormalities as Klinefelter's syndrome (where males have an extra X chromosome and are usually sterile) were at one time thought to be a risk factor for the development of paraphilias, but research has not yet proved a connection.