Portrait of an Exhibitionist.

Exhibitionism has been viewed through many lenses, from the perspectives of sexual deviance, forensic psychiatry, psychopathology, psychological dynamics, feminism, behaviorism, and psychopharmacology. Starting from the description of one psychotherapy patient, the aim of this paper is to synthesize this disparate literature. The findings of the synthesis include an estimate of the lifetime male prevalence of exhibitionism, 2-4%, peaking in late adolescence. Insecure attachment, sexual abuse in childhood, substance abuse, and sexual dysfunction are acknowledged risk factors. Motives behind the act of genital exposure remain obscure, constructed of both sexual and non-sexual impulses. The usual response of women victims is alarm and disgust. Successful treatment relies on a strong therapeutic alliance with specific psychological and psychopharmacological interventions - comparative effectiveness not yet determined. In conclusion, precedents for exhibitionism vary. The frequency of the behavior usually wanes with age and, while exhibitionists may pose a risk to others, they usually do not. There is, as yet, no gold standard treatment; the recommendation for therapists is to respond to individual facets of the patient's circumstances and history.

Androgen deprivation treatment of sexual behavior.

Gonadotropin-releasing hormone agonists are underutilized in patients seeking diminution of problematic sexual drives. This chapter reviews the literature on surgical castration of sex offenders, anti-androgen use and the rationale for providing androgen deprivation therapy, rather than selective serotonin reuptake inhibitors or more conservative interventions, for patients with paraphilias and excessive sexual drive. Discussions of informed consent, side effects, contraindications and case examples are provided.

Recognition and management of addictive sexual disorders: guide for the primary care clinician.

With greater awareness of sexual exploitation, professional sexual misconduct, and the sexual issues of public figures, a growing awareness of the problem of sexual addiction is emerging. As a result of public awareness, more cases will be brought to the attention of primary care providers. When primary care providers are confronted by problematic sexual behavior that fits the parameters of addictive illness, they should know what the implications are in order to make appropriate clinical decisions and to evaluate treatment approaches. The purpose of this article is to summarize the nature of the problem, to review critical issues in assessment, to provide treatment options, and to suggest critical factors for monitoring progress.

Clorimipramina no tratamento do exibicionismo: relato de dois casos / Chlorimipramine treatment of exhibitionism: a two-cases report

Foram estudados dois casos de exibicionismo do HC da FMB-UNESP. Um deles tinha o diagnóstico de distúrbio obsessivo-compulsivo (DOC) primário e o exibicionismo como um impulso claramente egodistônico. No outro caso, o diagnóstico de DOC näo pôde ser feito. No entanto, ambos apresentaram melhora dos sintomas com uso de um antidepressivo serotoninérgico, a clorimipramina

Behavioral treatment of zoophilic exhibitionism.

We describe here a case of zoophilic exhibitionism involving a mildly mentally retarded man who masturbated in front of large dogs of either sex. Unlike most exhibitionists, he did not expose himself to women, and unlike most zoophiles, he never desired direct sexual contact with animals. His paraphilia, however, was responsive to a behavioral program comprising masturbatory satiation, covert sensitization, and stimulus control procedures.

The treatment of exhibitionists: a focus on sexual deviance versus cognitive and relationship features.

Two studies compared treatment of exhibitionists aimed at either: (1) modifying deviant sexual preferences; or (2) changing cognitions, enhancing relationship and interpersonal skills, and improving awareness of relapse prevention issues. Recidivism rates of these two programs were compared with each other and with the rates observed in untreated offenders. Results supported the focus on broader cognitive and social issues. Clearly exhibitionists can be treated effectively.

Managing hypersexual disorders in brain-injured clients.

Three case studies involving hypersexuality in brain-injured clients are illustrated. Two cases involved the inappropriate touching of the opposite sex, and the third case involved exhibitionism. In one case of touching, feedback was used to decrease inappropriate touching. In the other case of touching, scheduled massage was used to shift stimulus control to an appropriate setting. In the case of exhibitionism, a combination of self-monitoring, private self-stimulation and dating-skills training were used to suppress the behaviour.

Interruption in the maintenance of compulsive sexual disorder: two case studies.

Sexual offenses and disorders are at times compulsive in nature. It is hypothesized that compulsive sexuality is a function of a history of interrupted or frustrated approach behavior. Two case studies involving compulsive features were treated by preventing such interruptions and delays. An A-B-A-B single-case experimental design on one of the two case studies provided some support for the hypothesized relationship. Implications for assessment and treatment are examined and the mechanisms underlying the hypothesized relationship are discussed.

Adolescent exhibitionists: theory and therapy.

In the absence of an agreed etiology or preferred treatment for exhibitionism the author reviews his clinical experience in working with adolescent boys who have indecently exposed themselves. A retrospective analysis indicates that the implicit theories that informed clinical practice construed exhibitionism as social behaviour rather than psychological symptom and placed it in a clear development context. It is argued that adolescent exhibitionism can be viewed as a "strategic interaction" that is characteristically adolescent. Using the individual adolescent's account of his misconduct it may be possible to determine the particular "game" in which he is engaged. This formulation can lead to clinical interventions which will best foster a future change of strategy and reduce the prospects of re-offending. Three clinical vignettes illustrate this model in action. Finally the theoretical limitations and practical difficulties associated with this way of understanding adolescent exhibitionists are discussed.

Private exposure and covert sensitization in the treatment of exhibitionism.

The present report describes the treatment of a long standing exhibitionism case by covert sensitization and private exposure in front of his wife within an A-BC-B-BC-C single case experimental design. The therapeutic phase of the treatment lasted 10 weeks. Results show that the combination of covert sensitization and private exposure seems to be an interesting technique for married exhibitionists and their wives. Covert sensitization was used to eliminate deviant fantasies and private exposure seemed to have rendered exhibitionism socially acceptable. The various measures of subjective responses indicated that there were no exhibitionist activities during baseline and treatment nor during the year's follow-up, and the patient has been asymptomatic for more than 2 years, as confirmed by a recent follow-up visit. Controlled studies with larger groups of patients are now needed to prove the efficacy of this active, nonaversive and economical treatment for exhibitionists and their wives.

Female exhibitionism.

Although genital exhibitionism has traditionally been almost exclusively associated with males, similar behavior may occur in certain women with a particular set of life circumstances and precipitants. A case report is presented of a woman whose emotional deprivation led to feelings of rejection and the inability to develop empathic relationships. Her self-esteem relied on success in her profession, and when she lost her position, she sought validation through exhibitionism. Despite the widely held view that genital exhibitionism producing arousal and stimulation in the subject occurs only in men, this case demonstrates that such phenomena may exist in women as well.

[Ambulatory psychotherapy of sex offenses]. / Ambulante Psychotherapie bei sexuellen Delinquenz.

We present the theoretical basis and results of a comprehensive research project concerning the psychotherapeutic treatment of sexual offenders in an ambulant setting. The therapeutic sample (n = 86) consists of patients with the following symptoms: exhibitionism, child molestation and sexual aggressive acts towards women. Data concerning the sexual deviant symptomatology, the general and sexual socialization and the actual psycho-social situation are demonstrated. The sexually deviant symptoms is considered in regard to basic personality deficits and general life-coping strategies of the patients. Concerning the therapeutic procedure and process we emphasize the importance of a concept focussing the individual patient and the psychodynamic function of his deviant symptom. The results at the end of therapy and at follow-up (average 2 1/2 years) are presented. Finally we discuss a concept for the decentralized psychotherapeutic supply of these patients.