Voyeuristic disorder

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at July 29, 2016
StartDiseasesVoyeuristic disorder

Voyeurism, also known as peeping comes from a French term meaning “one who looks.” A voyeur is an individual who becomes sexually aroused when observing an unsuspecting person who is naked, undressing, or engaging in a sexual act. Voyeuristic disorder occurs when the urge is acted upon or the ability to function is impaired as a result of voyeuristic urges and fantasies.

Contents

Definition & Facts

Clinicians and researchers refer to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, to diagnose and classify mental disorders. According to the DSM-5, voyeuristic disorder is one of a group of mental disorders known as paraphilia.

Paraphilia, also known as sexual perversion or sexual deviation, is defined as intense sexual urges involving unusual objects, activities, or situations that are not usually considered sexually arousing by others, and which cause significant impairment to the person or harm to another non-consenting person.

It should be noted that most people with atypical sexual interests do not have a mental disorder. Diagnosis of a disorder requires that the sexual desire involves those unwilling or unable to give legal consent, or that the individual feels distress over the interest itself rather than over society’s disapproval of the act. Diagnosis of the disorder occurs when the activity is recurrent, intense, and lasts six months or longer.

Watching pornographic videos or visiting adult websites is not considered voyeurism because it does not involve the secrecy and power imbalance of watching an unsuspecting person. Those suffering from the disorder are likely to run into problems with the law and experience relationship problems. Voyeuristic disorder is most common among men and usually begins in adolescence or early adulthood with onset typically occurring by 15 years of age.

Symptoms & Complaints

Rather than merely the nudity or sexual act that is being observed, it is the act of watching someone secretly and the potential danger of being caught that the voyeur finds arousing. Subjects of voyeurism are usually strangers and although there may be a sexual fantasy of meeting the stranger, very rarely is physical contact actually pursued.

Voyeurs may choose to view their subjects directly or take photos or videos to watch at a later time. Common methods include peeking through an unnoticed space, or using a cell-phone, mini-camera, telescope, binoculars, or mirrors. Voyeurs may masturbate while they are watching or may use memories of peeping to pleasure themselves after the fact. 

An individual with voyeuristic disorder often finds that secret observation becomes the preferred and sometimes exclusive method of sexual activity. He may spend so much time seeking out opportunities that it interferes with work, social activities, and other daily responsibilities. Voyeurs usually feel that there is nothing wrong with their behavior, and since it’s done secretly it often goes relatively unnoticed by others. 

Causes

While there are several schools of thought regarding the causes of this disorder, there is no scientific consensus. It is thought that it is often initially a random or accidental viewing that triggers the arousal. Once a person with this condition repeats the act several times, it can be very difficult for him or her to stop and often becomes a chronic condition.

Other possible risk factors include family dysfunction, childhood sexual abuse, and substance abuse. Voyeurs may have unusually high testosterone levels or neuropsychological deficits and may also suffer from exhibitionistic disorder, depression, bipolar disorder, anxiety disorder, or antisocial personality disorder.

Diagnosis & Tests

Prognosis is typically poor because voyeurs often have no desire to change their behavior. Although the definition of voyeurism and severity of prosecution varies, it is a crime in most states. Diagnosis and treatment typically occur only after the person has been caught and is often the result of a court-order.

Treatment & Therapy

In order for treatment to be successful, the individual must first recognize that he has a problem and have a desire to change it. The most common treatment is behavioral therapy such as psychotherapy (talk therapy) which must be done with or under the observation of a qualified mental health professional. During this therapy, patients identify the triggers that cause voyeuristic urges and work to learn healthier and more acceptable ways to handle their sexual desires.

Therapy may also involve relaxation techniques to reduce sexual impulses. As an alternative, psychoanalysis may be used in an effort to identify a traumatic unconscious experience that could be the cause of the disorder. It is thought that bringing the experience to the conscious mind and allowing the patient to actively work through it may help to resolve the issue.

Often, pornography is used as a more appropriate outlet since it removes the element of unknowing victim. Support groups and structured sex-addiction programs (such as twelve-step programs) may also be helpful.

When the patient is in a relationship it is often necessary for both parties to participate in therapy. The other partner will need to learn how to stop any enabling behaviors and may need to seek individual therapy to address the fact that he or she has chosen a person with voyeuristic disorder and deal with any underlying issues that this may bring up. For treatment to be effective, both partners need to accept the problem and learn how to adjust.

When therapy alone is not sufficient, a patient may be prescribed selective serotonin reuptake inhibitors (SSRIs). These antidepressants are commonly used for depression and other mood disorders, and work by increasing serotonin levels in the brain. Their efficacy in treating paraphilias is inconclusive.

If SSRIs are not effective, other drugs such as leuproreline and medroxyprogesterone acetate may be prescribed to reduce testosterone levels and further alter sex drive (chemical castration). Patients must give informed consent for this treatment and it requires that a physician monitor and periodically administer liver function tests and tests for bone density and hormone levels throughout the treatment period.

Prevention & Prophylaxis

Prevention of voyeuristic disorder is extremely difficult due to its secretive nature. The clear societal definition and prosecution of voyeurism will deter some from acting on their urges. Those who suspect that they may have a problem are well advised to avoid locations and situations where the activity is likely to occur, and to seek help as early as possible.

Others can help to prevent themselves from being the subject of voyeurism by consciously closing curtains and drawing blinds, thereby reducing opportunities for observation.