Throughout medical history, different opinions and theories about exhibitionism have given rise to controversies around the disorder. Currently, about 4% of all people are believed to suffer from exhibitionism, or roughly 1 in 25 individuals. A very common disorder, people with exhibitionism suffer from serious impulse control issues.
Stereotypes and misunderstandings of exhibitionism are common, but new insights are changing the way people think about the disorder. New research is revealing neurological and hormonal patterns, and a new day for exhibitionists may be around the corner.
Exhibitionism is the act of exposing one’s naked body to others. The motivation for exhibitionism is often sexual, but there are other motivations patients may have, such as personal amusement. The act of exposing oneself to others is certainly an illegal one and this often leads to negative outcomes for untreated exhibitionists. Great stigma and embarrassment often leads many patients to avoid seeking treatment.
Typically, exhibitionists are young men and women who lack significant sexually intimate experiences, although there are patients who have maintained intimate relationships.
They may choose clothing that allows them to quickly uncover themselves without worrying about the dangers of being discovered.
The flashing behavior serves as a crude courtship display for the patient. The exhibitionist sees the act of exposing their genitals as a sort of courtship display and hopes the flashing will arouse their target. Despite repeated efforts, the exhibitionist does not receive the reciprocation often desired. The exhibitionist is not discouraged by this and continues to expose themselves to others.
Incarceration, a common consequence of exhibitionism, may aggravate symptoms. Many countries have sex offender registries that all persons convicted of sex crimes must join. A sex offender status bears incredible stigma on any labeled individual. Patients who have been convicted of crimes may find it difficult to obtain employment or maintain relationships.
Exhibitionism is, at its core, a form of impulse control disorder. Like pyromania and addiction, the exhibitionist is characterized by the failure to regulate their behavior. Exhibitionists do not always expose themselves because they “want” to. They simply can’t find a way to prevent themselves from displaying the sort of repugnant behavior that characterizes their condition. The impulses are beyond their control.
The symptoms of exhibitionism are essentially flashing behaviors. Patients will search for potential victims at any time of day and seek to flash them. The behavior is repeated regardless of the effects it has on others or themselves. The exposure gives the victim a feeling of satisfaction and power. The psychological rewards inspire the patient to continue the behavior no matter what happens as a result.
Fantasies and idealization of exposing oneself to others is common among those who suffer from exhibitionism. They may find themselves too afraid of the response to flashing others to actually bother going through with the act. In such a case, the symptoms manifest themselves as mere thoughts and do not extend into the real world. Patients at this level of severity tend to experience fewer negative outcomes and may not even recognize their condition as pathological. However, it is absolutely important that the patient learns to control their thinking before it produces actual impulsive behavior.
Exhibitionism is often co-morbid with other psychiatric disorders. Patients experience great anxiety and frustration over their situation. Many of the psychiatric disorders found among exhibitionists are in fact impulse control disorders. Many exhibitionists also have pyromania, alcoholism, and other issues to deal with. The co-morbidity of these impulse disorders can make the prognosis for patients much worse.
Like many psychological disorders, the causes of exhibitionism are quite diverse.
Any number of traumatic or life changing events has the potential to trigger the onset of exhibitionism. For example, a patient may have been abused as a child and adapted to the abuse by exposing their genitals to others. Others may develop exhibitionism later due to a poor understanding of how to appeal to the opposite sex. However, not all persons who develop exhibitionism are sexually motivated.
The exhibitionist sees his exposure as a way to humiliate others and frighten them. He may expose himself to women who pass by him at night or perform other lewd acts. This particular form of exhibitionism is strongly associated with antisocial personality traits, but it can occur separate of antisocial personality disorder.
While most research into the causes of exhibitionism have focused on psychology, there is promising research regarding neurological and endocrinological factors. It is known that exhibitionists tend to display a number of abnormalities within their hormone profile. Typically, these patients will display higher levels of testosterone and dopamine, but lower levels of acetylcholine. Testosterone is known to play a major role in sexual aggression, so researchers often believe it may be responsible for the feelings those with exhibitionism experience. Dopamine is also known to play an important role in human sexuality.
Generally, persons with high dopamine levels tend to display exceptionally strong preferences for sexual fetishism. Although it may appear as though both biomarkers are working independently of each other, the way these hormones interact in exhibitionism isn’t particularly clear. Testosterone can increase dopamine levels by preventing the breakdown of dopamine. This may explain the hormonal anomaly found in exhibitionists. Other possible causes currently explored are brain damage and congenital conditions.
Regions of the brain associated with self control, aggression and sexual arousal show abnormal blood flow and activity in exhibitionists. Particularly, parts of their frontal cortex do not seem to function correctly. For example, the ventromedial frontal cortex, a region associated with moral decisions, is less active in exhibitionists. That might explain why many patients continue their behavior regardless of the way others perceive them.
Another key area of neurological differences is seen in the orbitofrontal cortex. This brain region deals with disgusting and repulsive behavior. In a healthy individual, the orbitofrontal cortex will display a negative reaction to disgusting behavior such as flashing, but in exhibitionists the orbitofrontal cortex doesn’t appear to produce this reaction. A lack of disgust is emerging as a potentially important factor in the development of exhibitionism, but controversy still surrounds this assertion.
Despite decades of academic and medical discourse, there is still considerable controversy over exactly what causes exhibitionism and how to best handle patients who are afflicted with it. Many therapists believe the disorder should be regarded as purely psychological with no discussion of neurological factors, but others see exhibitionism as a disorder occurring primarily at a neural level. Regardless of the controversy over causes, experts certainly agree on the symptoms of exhibitionism.
Many patients are only first recognized when they are arrested and often do not comply with the advice of their psychiatrist. Medicine may be used to control symptoms, but most professionals will try to treat their patient using behavioral modification. The psychiatrist begins by trying to look at the root of the exhibitionism and help the patient understand how to contend with whatever is causing the distress.
Therapists will often attempt to help their patients by “adjusting” their sexuality to include more acceptable preferences. For instance, a therapist might help a patient begin to associate sexual desire with actual contact with another individual rather than simply exposing oneself. When this method fails, psychiatric means may be used.
When behavior modification fails, a psychiatrist may use medication to treat the ailment. Medicine with the intended effect of reducing the sexual drive of the patient is most commonly used, but other options might be considered. A particularly common solution is the use of dopamine antagonists. Dopamine antagonists may make it easier for a person to control their sexual appetite when confronted with tempting stimuli. The medications frequently prescribed are considered extreme, but there are situations where even they do not provide a solution for the problem at hand.
There are times when absolutely nothing seems to work. Under these circumstances, doctors may attempt to use shock therapy as a means of controlling an exhibitionist. Usually, shock therapy is applied to parts of the brain believed to be involved in sexuality. The ventromedial frontal cortex, nucleus accumbens, and orbitofrontal cortex are often targets during this sort of procedure. An old method of controlling psychiatric disease, shock therapy can be incredibly effective if used to target the right parts of the brain.
The prevention of sexual disorders is considered to be well understood.
Exhibitionism is generally caused by trauma and abuse during childhood. Preventing child abuse is important for preventing the onset of exhibitionism, but there are many difficulties in accomplishing this goal. Child abuse is seldom reported to the authorities and may continue for years without anyone being aware of it. It is still possible to prevent exhibitionism even in those who are chronically abused in adulthood.
Adults who are at risk of developing exhibitionism can be helped before they develop the condition. Lonely adults with poor social skills are especially likely to become exhibitionists, so therapists may help them develop social skills before such an event can occur. Therapists may attempt to teach these social skills by role playing, but others will simply discuss how to properly interact with others. The improvement of social skills can lead to better relationships with desired sexual partners.
Exhibitionism is often a consequence of hypersexuality, a disorder characterized by excessive sexual desire, which means that doctors can prevent the condition by treating hypersexuality before it produces exhibitionism. The general treatment for hypersexuality suppresses sexual desires so much that it becomes impossible for someone with a paraphilia to continue to experience symptoms.
Special drugs designed to reduce sexual arousal are commonly used, but psychiatrists must be careful before they use them. Serious side effects may result from these medications. Some of the drugs may reduce testosterone levels or dopamine levels. This can result in other issues such as depression or even physical disorders as the hormonal profile of the patient is damaged.