This chapter discusses diagnostic issues that differentiate exhibitionism and similar sexual compulsive disorders from other paraphilias and presents a comprehensive behavioral treatment approach that emphasizes the role of such paraphilias as maladaptive attempts at the regulation of anxiety and/or depression.
For the sake of descriptive convenience, paraphilias are classified in DSM-IV-TR as sexual disorders. Exhibitionism is defined in DSM-IV-TR as meeting the following two criteria: recurrent, intense sexually arousing fantasies, sexual urges, or behaviors that involve exposing one's genitals to an unsuspecting stranger over a period of at least 6 months; and the fantasies, sexual urges or behaviors caused clinically significant distress or impairment in social, occupational, or other important areas of functioning. Exhibitionism is classified under the general category of paraphilias. This chapter discusses theories of paraphilias, followed by a description of the addiction model, which was originally applied to alcoholism and drug addiction, but has been expanded to include maladaptive behaviors that involve some repetitive form of indulgence for a short-term pleasure that leads to longer term adverse effects. The biological model for addictions is briefly discussed, followed by an overview of obsessive-compulsive and related anxiety disorders. Sexual compulsive disorder is then discussed as a variant of obsessive-compulsive disorders. The chapter's section on how a paraphilia develops is followed by an outline of the diagnosis of sexual compulsive disorders through the clinical interview and psychological testing. A description of treatment approaches focuses on behavior therapy and ongoing offender group treatment. Two case studies are presented, one involving an extensive history of making obscene phone calls and exhibitionism and the other involving harassing phone calls intended to lead to consensual sex. 53 references