143 Voyeurism (302.82)

DSM-IV-TR criteria

• Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the act of observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity.
• The person has acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.
• These activities have caused distress, impaired work, social or personal functioning.

Associated features

• Voyeurism, a form of paraphilias, refers to the achievement of sexual gratification by observing or spying on unsuspecting people, especially while they dress, undress, or engage in sexual activity. The observers, often known as “Peeping Tom’s”, may not feel guilt or remorse when intruding upon other individuals’ privacy. Voyeuristic individuals may rationalize their behavior, claiming “no harm, no foul.” Voyeurism is considered a crime in several states, but the definition of voyeurism varies from state to state.
• This clip shows the story of when a person is caught acting on voyeurism.

• The voyeur may wait outside their victims window and masturbate to the subject undressing, taking a shower, or even a couple having sex. They also may wait until afterwards to masturbate while replaying the incident in their mind.
• The voyeur may risk injury by assuming precarious positions to catch a preferred view of their target.

Child vs. adult presentation

Lack of maturity and understanding prevents children from being diagnosed with Voyeurism.

Gender and cultural differences in presentation

• Men are much more likely to be diagnosed with Voyeurism than women. There does not seem to be any differences with cultural presentation of Voyeurism. However, with the social nature of the prohibited activity it appears to be an important facctor in the sexual arousal pertaining to Voyeurism.
• Voyeurs tend to harbor feelings of inadequacy and to lack social and sexual skills.

Epidemiology

• The onset for the disorder is normally before the age of 15 years.
• Some studies have shown that men express voyeuristic tendencies more often than women, but the disorder is not unique to males (American Psychiatric Association). The prevalence rate of this abnormality is not known. Some research suggests that people in the U.S. are showing more voyeuristic characteristics due to the increase in reality television shows being aired.

Etiology

There are some differing opinions on the origins of voyeuristic behavior. One opinion is derived from Freudian psychoanalytic studies; this theory places an emphasis on child abuse and the harboring of traumatic childhood memories. Voyeuristic tendencies may be rooted in childhood. (Lane, R.). A different approach to voyeurism is expressed in the cognitive-behavioral approach. An Orgasm is labeled as a reinforcer that can lead to voyeuristic or exhibitionistic behaviors. An orgasm is defined as “The peak of sexual excitement, characterized by strong feelings of pleasure and by a series of involuntary contractions of the muscles of the genitals, usually accompanied by the ejaculation of semen by the male.” The nature of the orgasm teaches, reinforces, and conditions some individuals to the point that they acquire a desire to engage in voyeuristic activities. (Schwartz, M.).

Empirically supported treatments

Successful treatment requires a desire from the individual to change his/her voyeuristic tendencies. Behavioral therapy is most commonly used for voyeurs. The person is instructed in ways to control the impulses that cause these actions (Schwartz, M.). The physician may suggest alternative means of sexual gratification to help change patterns of thinking that lead to voyeurism. Other treatment options would include psychoanalytic therapy (Lane, R.). The therapist would help to uncover the underlying thoughts that are causing the voyeuristic thoughts or tendencies. Support groups and the use of SSRIs and Antiandrogens are also a common treatment for individuals suffering from voyeurism.

Prognosis

• Once voyeurism behaviors take place, they typically do not stop. Over time, it may become the main form of sexual gratification for the voyeur. The course of voyeurism tends to be chronic.
• The prognosis for eliminating voyeurism tends to be poor because individuals with this disorder typically have no desire to change their patterns of behavior.
• Since voyeurism involves non-consenting partners and is against the law in many jurisdictions, the possibility of embarrassment may deter some individuals.