Exposing one's genitals to unfamiliar members of the opposite sex as a preferred or sole method of sexual gratification, without further sexual acts imposed on the other party, is called exhibitionism. The behavior of patients may be limited to exposing the genital area or may involve on-the-spot masturbation leading to ejaculation. The prevalence of this condition is unknown. The vast majority of patients are male, but some believe there are also a small number of female exhibitionists who repeatedly expose their breasts or, even fewer, their external genitalia. The peak age of onset is between 25 and 35 years.

bubble_chart Etiology

Unknown. Some analyze from the perspective of race and ontogeny, suggesting that exhibitionistic symptoms represent the release of primitive behaviors. Others believe the causes of exhibitionism are closely related to environmental factors, associating it with parental "seduction." Such individuals often observed varying degrees of parental nudity during childhood, though a definitive causal link remains uncertain. When it first appears in middle-aged or elderly individuals, organic factors may be involved.

bubble_chart Clinical Manifestations

The common characteristic of such patients is obtaining sexual satisfaction by exposing their genitals to the opposite sex. Before exposure, they often experience increasing anxiety and tension. The locations and times for exposure are usually at dusk or in the evening when there are still people around, often choosing places where they can easily escape or more secluded corners, such as streets, alleys, cinemas, or parks. When a stranger of the opposite sex approaches, they suddenly expose their genitals, often an erect penis, causing the other person to panic, ridicule, or scold, which provides them with sexual satisfaction. Some may also masturbate simultaneously but do not engage in any other inappropriate behavior toward the opposite sex. This behavior often occurs periodically or intermittently.

The diagnostic criteria for exhibitionism in CCMD-2-R are as follows: ① Meeting the diagnostic criteria for sexual perversion; ② Repeatedly experiencing strong urges and sexual excitement associated with exposing one's genitals to unfamiliar members of the opposite sex over a period of more than six months; ③ Having acted on these urges.

bubble_chart Treatment Measures

Witzig (1970) once used psychotherapy with unsatisfactory results. Electric shock aversion therapy reportedly had some effect, but overall, the treatment outcomes were not ideal. Strict requirements and enhanced supervision can reduce the frequency of exhibitionist behavior.

bubble_chart Prognosis

Some may completely reform after the first offense due to fear of legal consequences, but repeated offenders are often difficult to correct. The prognosis is poor for children exhibiting exhibitionist behavior. Those who relapse into exhibitionist behavior but have good heterosexual adjustment often have a favorable prognosis. Individuals with a history of other criminal behaviors have a poor prognosis.

bubble_chart Differentiation

The diagnosis of this condition needs to be differentiated from temporal lobe epilepsy automatism. ① Exhibitionism involves premeditated acts, whereas temporal lobe epilepsy typically occurs suddenly; ② Exhibitionism often takes place in secluded areas, intersections, or dark places to facilitate escape, while temporal lobe epilepsy episodes usually happen in front of others, with the individual remaining motionless during exposure, making them easily apprehended; ③ Exhibitionism targets strangers, whereas epileptic episodes can occur in any setting, even in front of family or neighbors; ④ Temporal lobe epilepsy often has a history of major or atypical seizures, with deep electrodes, especially sphenoidal electrodes, showing abnormal brain waves, and antiepileptic drugs proving effective; ⑤ Exhibitionists are fully conscious during the act, whereas patients with temporal lobe epilepsy cannot recall the incident afterward.