Portrait of an Exhibitionist
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Portrait of an Exhibitionist Mary V. Seeman 1 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract
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. Keywords Kurt Freund . Paraphilia . Exhibitionism . Therapy . Technology
Introduction From 1970 to 1985, Dr. Kurt Freund and I worked at the same psychiatric institute in Toronto, Canada. Dr. Freund was a well-known Czech behavioral sexologist who emigrated to Canada in 1968 [1, 2]. While still living in what was then Czechoslovakia, he pioneered the psychophysiological measurement of male sexual arousal using phallometry (also known as penile plethysmography), which measured penile tumescence in response to specific visual stimuli. This became the standard method for evaluating the paraphilias and monitoring treatment
* Mary V. Seeman [email protected]
1
Department of Psychiatry, University of Toronto, 260 Heath St. W. Suite #605, Toronto, ON M5P 3L6, Canada
Psychiatric Quarterly
response, and it continues to this day to influence research and clinical practice in the interdisciplinary science of sexology. During the 15 years of our association, Dr. Freund referred many men with paraphilia to me, perhaps because he thought that a woman therapist could be helpful for conditions that he christened “courtship disorders” [3]. Freund’s courtship disorder theory does not explain all paraphilias but works well for exhibitionism [4], which was the diagnosis of the majority of the men referred to me. Exhibitionists are acknowledged to be a heterogeneous group of individuals, and no overarching causative explanation is likely to apply to all. Dr. Freund knew that. Nevertheless, when examining the four phases of general courtship rituals: a) search for and decision about potential sexual partners; (b) pretactile interaction such as smiling and conve
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