One-Fourth of Exhibitionists Commit Additional Sex Offenses

One-Fourth of Exhibitionists Commit Additional Sex Offenses

Psychiatric News November 17, 2006
Volume 41 Number 22 Page 22
©American Psychiatric Association

Joan Arehart-Treichel

Exhibitionists should not be considered simply a bother by the
criminal-justice system, because they have a fairly high recidivism rate.

Also, some eventually engage in more serious sexual offenses than exposing themselves.

Exhibitionists are often viewed as nuisances who get a thrill out of exposing themselves and shocking onlookers. However, many are not as innocuous as some people may think, a new Canadian study has revealed.

The study was published in the September Journal of the American Academy of Psychiatry and the Law. The lead investigator was Philip Firestone, Ph.D., a professor of psychology at the University
of Ottawa, and the senior investigator was John Bradford, M.D., director of forensic psychiatry there.

The relative paucity of research on exhibitionism and the weaknesses inherent in previous studies spurred Firestone, Bradford, and their group to conduct this inquiry.

The study included 208 male exhibitionists who were assessed at the Royal Ottawa Hospital Sexual Behaviors Clinic between 1983 and 1996. They were determined to be exhibitionists in one of three ways: they had been diagnosed so by a psychiatrist according to DSM-IV criteria, they had been convicted of exhibitionism by the courts, or they had sought psychiatric help after engaging in exhibitionism.

The subjects were assessed for alcohol abuse, dimensions of sexual functioning, psychopathy, and sexual preferences as measured by phallometry. Such preferences included, for example, desire to
have consenting sex with an adult, rape an adult, commit incest, or have sex with a minor. They were then followed for 13 years on average to see how many would re-offend, and if so, what form it
would take. Finally, using assessment results and other information, the scientists looked to see whether those who re-offended differed from those who did not.

Forty-nine (24 percent) of the study sample went on to commit another sexual offense, including 19 (9 percent) who graduated to contact offenses such as sexual touching or sexual assault.
Thirty-one percent reoffended either sexually or with nonsexual violent behavior. And 39 percent reoffended in some manner, be it sexually, violently, or in some other fashion.

Those exhibitionists who reoffended (by committing a sexual offense or by engaging in violent nonsexual behaviors or in another criminal manner) were apt to have less education and to score higher on alcohol abuse, psychopathy, and pedophilic tendencies (as measured via phallometry) compared with exhibitionists who did not reoffend.

That a significant number of their subjects were attracted to children and not to adults surprised him, Firestone told Psychiatric News. Nor did he expect that a physiological response to/preference for children would predict sexual, violent, or criminal recidivism. Thus, 'Risk evaluators should consider utilizing a deviant phallometric response to children as a risk factor for recidivism,' he concluded.

In Bradford’s opinion, however, 'the most significant finding was that exhibitionists cannot be dismissed as simply being a nuisance by the criminal-justice system, because they have substantial
recidivism rates. Perhaps more important is that a number of them escalate into more serious sex offenses involving ‘hands-on’ sexual contact of victims as opposed to the typical ‘hands off’ exhibitionistic behavior...'

'The implications for psychiatrists,' Bradford added, 'are that they have a responsibility to ensure that exhibitionists they see and diagnose have the proper sexual-behaviors assessment and a proper risk evaluation. Clearly not all psychiatrists are adequately trained in the assessment and treatment of the sexual deviations or the paraphilias.'

The research was funded in part by the Royal Ottawa Hospital Research Fund.

'Long-Term Follow-up of Exhibitionists: Psychological, Phallometric, and Offense Characteristics' is posted at