Exhibitionistic Disorder DSM-5 302.4 (F 65.3)

Exhibitionistic Disorder DSM-5 302.4 (F 65.3)

This Article Is Part of A Series For Paraphilic Disorders

Fetishistic Disorder Frotteuristic Disorder
Pedophilic Disorder Sexual Masochism Disorder
Sexual Sadism Disorder Transvestic Disorder
Voyeuristic Disorder

DSM-5 Category: Paraphilic Disorders


The American Psychiatric Association (APA) classifies the condition of Exhibitionistic Disorder as a mental health illness that centers on a need to expose one’s genitals to other people. The audience of this type of behavior is usually unsuspecting strangers; the result is sexual satisfaction for the exhibitionist. Exhibitionistic Disorder is classified under the larger category of Paraphilic Disorders. The term paraphilia refers to an intense sexual interest outside of normal genital stimulation. The majority of exhibitionists are males; and those with the disorder may deliberately arrange to be observed while having sex with other people. The behavior may be deliberate or unconscious; and the disorder may begin to manifest in the late teens or early adulthood. The DSM-5 does indicate that although all people with exhibitionistic disorder have a pattern of sexual conduct called exhibitionism; not all exhibitionists qualify for this diagnosis (American Psychiatric Association, 2013). The DSM-5 clarifies and emphasizes that the definition for exhibitionistic disorder is separate from the definition for exhibitionism as a general pattern of behavior (Zucker, 2013).

Symptoms of Exhibitionistic Disorder

The specific criteria for such a diagnosis are contained in the new fifth edition of an APA reference guide called the Diagnostic and Statistical Manual of Mental Disorders.

The DSM-5 states that the behaviors associated with Exhibitionistic Disorder will have occurred over a period of six months, are recurrent and result in intense sexual arousal from the exposure of one’s genitals to a stranger or unsuspecting individual. It is an uncontrollable sexual urge that is deliberately intended for an unconsenting person. Exhibitionistic Disorder results in significant clinical distress and impairs social, occupational and/or other normal life functions. It is important for the diagnostician to determine whether the exposure behavior is specific to children or adults; and the environment in which it is most likely to occur.

An accurate diagnosis of Exhibitionistic Disorder as defined by the DSM-5 must begin with a complete patient history that includes an assessment of his (or her) mental status; and physical as well as neurologic examinations. This is done as a first step to assist in the evaluation while ruling out other major physiological or psychological pathologies. A full battery of tests would include behavioral analysis, risk assessment, physiologic measurements and neuropsychological tests. As well, sexual arousal must be taken into consideration; both from the view of self-reporting as well as through the use of genital measures. A psychological workup will take into account any evidence of substance abuse and cormorbid disorders. The patient’s attitude about his (or her) behavior and feelings about the offense and the victim must also be taken into account.

Daily Life

The most important thing to know about living with Exhibitionistic Disorder; or attempting to support this individual as they try to build a normal life; is that it is a life-long disorder with a high rate of recidivism. It is a fact, the behavior is difficult to modify and/or control.

Families or loved ones of individuals with this disorder should begin by creating a healthy schedule and environment in which substances such as drugs, alcohol, nicotine and even caffeine are not available. As well, it would be advisable that internet access be limited. Attendance at regular therapy sessions is critical; not only for any opportunity to reduce the behavior but also as a measure of coping. Realistically, lifelong maintenance is the most pragmatic expectation and therapy will help the individual recognize triggers to the behavior; as well as create alternative scenarios for prevention.

However, the DSM-5 does include a caveat regarding the life-long presence of this illness. According to their explanation; a person who has been socially, occupationally and clinically functioning without either acting on the feelings of exhibitionistic disorder AND have not shown evidence of these urges may be considered to be in full remission.

Treatment of Exhibitionistic Disorder

Exhibitionistic Disorder as iterated in the DSM-5 requires a treatment regimen that is drawn from use in addressing other paraphilic disorder. It is generally a combination of psychotherapeutic and pharmacological options.

A wide variety of experimental psychotherapy treatment formats have been implemented to address this disorder over the past several decades. For example, behavioral techniques that paired negative consequences with episodes of exposing – such as shame aversion had previously been utilized with some success. But these techniques have been ethically questionable; and nonaversive techniques have come to replace this tactic.

However, in the last decade it has become evident that paraphilia in general and Exhibitionistic Disorder specifically may affect a wide variety of people; and it may present along a continuum of severity. Therefore, treatment options are developed according to the needs of the individual; or on a case-by-case basis (Brunell, Staats, Barden, & Hupp, 2011). The most common psychotherapeutic alternatives in use today include individual and/or group therapy, and marital and/or family therapy.

Adults with exhibitionistic disorder have had success in group therapy sessions that target social skills and interventions that address ancillary offenses. Group therapy has also aided inhibited adolescents by providing the skill set to address shyness as a symptom of exhibitionistic disorder; and one-on-one therapy sessions have been helpful for all with this disorder ((Strack, Millon, 2013). However, the reality is that exhibitionistic disorder has been found to have one of the highest recidivist rates of all sexual offenses. Too, behavioral techniques have shown limited promise.

Again, paraphilia disorders in general; and exhibitionistic disorder specifically; may present with comorbid signs of depression or mood disorders; and or substance abuse (Marcinko, Jakšic, Ivezic, et al. 2014). In this case, therapy may begin in the form of inpatient treatment; particularly when the individual is homicidal, disabled or suicidal. The latter is more likely in the event of arrest or incarceration. Too, treatment may require a team of medical professionals from more than one expertise. At times, surgical interventions – while a last resort – may be suggested.

Pharmacotherapy will probably accompany psychotherapy. Physicians may prescribe antidepressant/anti-anxiety drugs; especially SSRIs (selective serotonin reuptake inhibitors). If these do not prove effective in reducing exhibitionistic behaviors, fantasies and urges then antiandrogens – or medications that achieve their effects by blocking male sex hormone testosterone or lowering the body’s normal level of testosterone production - may be prescribed.


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Brunell, A.; Staats, S.; Barden, J. & Hupp, J. (2011). Narcissism and academic dishonesty: The exhibitionist dimension and lack of guilt. Personality and individual differences: 50: pp. 323-328.

Marcinko, D.; Jakšic, N.; Ivezic, E.; Skocic, M.; Surányi, Z.; Loncar, M. (2014). Pathological Narcissism and Depressive Symptoms in Psychiatric Outpatients: Mediating Role of Dysfunctional Attitudes. Journal of Clinical Psychology: Vol. 70, Iss. 4, pp. 341 – 352.

Strack, S.; Millon, T. (2013). Personalized psychotherapy: a treatment approach based on Theodore Millon's integrated model of clinical science. Journal of personality: Vol. 81, Iss.6: pp. 528 – 541.

Zucker, K. (2013). DSM-5: call for commentaries on gender dysphoria, sexual dysfunctions, and paraphilic disorders. Archives of sexual behavior. Vol. 42, Iss. 5, pp. 669 – 674.

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