Indecent Exposure: Exhibitionism

Exhibitionism, commonly referred to as flashing, is characterized by the achievement of sexual excitement through genital exposure, usually to an unsuspecting stranger. It also refers to a strong desire to be observed by others, specifically during active masturbation in front of the victim. The key features of true exhibitionism include situations when the victim is unwilling, the subject is sexually aroused by the shock or surprise of the victim, and no further sexual contact is desired.

Exhibitionism is one of the three most common criminal sexual offenses. The other two are voyeurism (Peeping Toms) and pedophilia (child molesters). It is virtually impossible to estimate the prevalence of exhibitionism in the general population, but exhibitionists constitute about one-third of all sex offenders. An estimated 35% of exhibitionists will return to the behavior after a conviction and sentence. They have the highest rate of recidivism of all sexual offenders. Additionally, studies have demonstrated the exhibitionists do have a tendency to commit even more deviant sexual behaviors.

Most exhibitionists are male and their victims are usually female adults or children. Female exhibitionists are relatively rare, and these individuals have been known to take employment where exhibitionism can be practiced as part of a job (the topless waitress). Forget the stereotype of a "dirty old man in a raincoat" flasher. Most males arrested for exhibitionism are in their late teens or early twenties. Exhibitionism appears to have its onset during the mid 20s. Occasionally, the first exhibitionist act occurs during preadolescence; or the behavior may not be displayed until middle age. Incidents decrease with age. Exhibitionism, like most paraphilias, is rarely found in men over 50 years of age. Statistically, most exhibitionists are married, but the marriage is frequently sexually dysfunctional. Exhibitionist behavior will intensify during times of stress or when the subject has free time.

Exhibitionists use a number of tactics to attract unsuspecting victims. While most incidents are carried out in public places, some suspects prefer to select more isolated areas (on a park bench or while driving a car). Many exhibitionists do not make attempts to hide their identity; this is an additional risk-taking behavior that heightens their sexual arousal.

Recorded exhibitionism cases demonstrate that 63% of offenders expose their penises, 51% are observed masturbating, 15% use obscene language, 11% verbally express desires for sex, and 21% express desires for sex nonverbally. Exhibitionists, in most instances, will admit that they are terrified of the concept of actual contact with the intended victim. Only 11% of all exhibitionism cases have involved any attempt to touch the victims. Reactions from the victims are obviously quite varied and include running away, laughter, verbally attacking the suspect, and feelings of anger, shock, fear, and embarrassment. Exhibitionists thrive on these reactions. However, negative feedback by the victim (such as laughter) may result in further hostility or violence by the suspect as feelings of inadequacy are escalated.

The Legal Aspect

The laws regarding indecent exposure can vary widely by state and are frequently conflicting as well as convoluted in nature (we will not address breast-feeding in this article!). The definition of indecent exposure has changed throughout the history of law enforcement. What is considered indecent is often socially defined. Indecent exposure is typically charged as a misdemeanor offense. A person who commits indecent exposure in the presence of a minor will most likely face criminal charges, especially if masturbation was involved. Lawmakers have encountered numerous problems trying to create and implement laws which relate to different societal and cultural values. Indecent exposure can obviously have varying effects, depending on its intent and context. Some states define indecent exposure as being nude in the presence of anyone of the opposite sex other than your spouse. There are current indecent exposure laws being considered at the federal level. These laws would increase the penalties for indecent exposure and mandate that those convicted of this crime be immediately added to the national sex offender registry.

The Mental Health Perspective

Exhibitionism is a mental disorder characterized by a compulsion to display one's genitals to non-consenting strangers for sexual arousal or gratification. Exhibitionism falls under the psychiatric category of paraphilias. Paraphilias are sexual feelings or behaviors that may involve sexual partners that are not human, not consenting, or that involve suffering by one or both partners. Exhibitionism is the exposure of one's genitals to another and is considered a "hands-off" paraphilia (in contrast with the "hands-on disorders" which involve physical contact with other persons).

The criterion of the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) for the diagnosis of exhibitionism is that the individual has experienced intense sexual urges and arousal or behavior involving the exposure of their genitals to strangers for at least six months. Additionally, the individual has either acted upon these urges or they cause significant personal distress or interpersonal difficulty.

Most cases of exhibitionism are based on psychological rather than physical causes. Exhibitionists often experience intense feelings of anger, hostility, or shame. They also have a deep sense of inadequacy. There is a need to prove their virility. Their actions are to elicit some kind of reaction in their victims; any reaction is better than being ignored.

More Than a Nuisance – Are Exhibitionists Dangerous?

There are three groups of exhibitionists. The first type of offender is generally inhibited, introverted, or socially adequate. He is frequently anxious, impulsive, obsessional, and sexually confused. The second group is that of individuals who are unaware of their actions due to mental retardation, an organic brain disorder, and/or extreme alcohol intoxication. These two groups are generally more dangerous to themselves than they are to others.

The third group of exhibitionists demonstrates significantly more psychopathology. The sexual culmination is more important than the shock value of exposing oneself, and always involves masturbation. This offender has a more assaultive character. He often has concurrent paraphilias which may include voyeurism, pedophilia, scatologia (compulsive use of obscene language), and frotteurism (touching and rubbing against a non-consenting person). A number of these individuals (approximately 10%) escalate into a hands-on sexual contact of victims as opposed to the typical hands-off exhibitionistic behavior. It is individuals in this third group who are more likely to progress onto more aggressive sexual offenses, including rape or the sexual assault of a minor.

Treatment

Most exhibitionists do not receive treatment until they are arrested, the individual s sex offender status is confirmed and the court orders such treatment. 20% to 50% of men arrested for exhibitionism are re-arrested within two years. Treatment generally includes psychotherapy, support groups, antidepressant medications, and possible hormonal therapy.

Several different types of psychotherapy have been found helpful in treating exhibitionism: cognitive-behavioral therapy, orgasmic reconditioning, group therapy, 12-step programs for sexual addicts, and couple or marriage therapy (if the offender is married).

Antidepressant therapy, specifically selective serotonin reuptake inhibitors (SSRIs) such as Prozac, can be effective in treating exhibitionism and other paraphilias. Decreased levels of serotonin in the brain result in an increased sex drive; SSRIs regulate serotonin levels. If SSRIs are ineffective, hormonal therapies and/or antiandrogens should be considered. The most widely prescribed hormonal treatment for people with exhibitionism is medroxyprogesterone acetate (Depo-Provera), which decreases the level of circulating testosterone, thus reducing the sex drive as well as aggression. Luteinizing hormone-releasing hormone agonists, referred to as pharmacological castration (Trelstar), block the uptake and metabolism of testosterone. Surgical castration is effective in significantly reducing levels of testosterone in blood plasma; however, this is generally reserved for more serious sex offenders than exhibitionists.

Discussion

A mooning at a high school football game does not, in itself, constitute exhibitionism, or does flashing one s breasts at Mardi Gras. However, these acts may violate the rights and/or values of others, and are technically illegal. True exhibitionists take it farther. They are not normal members of society. They are unpredictable. They operate on uncontrollable impulses and work off of uncontrollable impulses. Exhibitionists can, and often, do proceed to more aggressive and violent crimes. Time will tell how indecent exposure and public lewdness laws will be amended. In the meantime, Americans must keep their pants on.

By the way, how many of you have responded to an indecent exposure call, and ever seen anything of real interest, other than some comic relief?

Hyperlinks:

Exhibitionism

http://www.medicinenet.com/script/main/art.asp?articlekey=38086

Exhibitionism Treatment

http://www.minddisorders.com/Del-Fi/Exhibitionism.html

Are Exhibitionists Dangerous?

http://www.uplink.com.au/lawlibrary/Documents/Docs/Doc81.html

State by State Indecent Exposure and Public Lewdness Statutes

http://www.nudist-resorts.org/statutes.htm

*Bio: Pamela Kulbarsh, RN, BSW has been a crisis psychiatric nurse with San Diego's Psychiatric Emergency Response Team (PERT) for seven years, and currently rides with the San Diego County Sheriff s Department, Encinitas Station. She is also a member of the county's Psychiatrist Disaster Team, Emergency Medical Reserve Corps, and Elder Death Review Team. Pam has been a frequent guest speaker related to psychiatric emergencies and has published articles in both law enforcement and nursing magazines.

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