Voyeuristic disorder is characterized by sexual arousal from observing an unsuspecting person who is naked or engaging in sexual activity. Commonly called “peeping toms,” voyeurs may use cameras or binoculars to spy on nonconsenting individuals and engage in masturbation. In order to qualify as a mental disorder, this behavior must be enacted on unwilling participants or cause clinically significant distress or impairment.
What Is Voyeuristic Disorder?
Voyeuristic disorder is a subcategory of paraphilic disorders (an intense and persistent sexual interest in atypical sexual targets or activities), which causes significant distress, functional impairments, and/or harm to self or others. Voyeuristic disorders also commonly involve fantasizing about watching others who are naked or engaging in sexual activity.
However, it’s important to note that these fantasies are considered normative urges as a part of sexual development, particularly during adolescence. Additionally, consenting adults who enjoy watching others or being watched while engaging in sexual activity do not necessarily have a voyeuristic disorder.
Voyeurism becomes problematic when fantasies are enacted on unwilling participants or the behavior becomes compulsive. Sexually active adults who consistently have recurring urges to invade other people’s privacy, particularly if voyeurism is the only way in which arousal can occur, may meet the criteria for voyeuristic disorder. A common impairment associated with voyeuristic disorder is sexual dysfunction when the voyeuristic behavior is not present.
The more exclusively an individual’s arousal centers on the act of observing a non-consenting person undressing or engaging in sexual acts, the more likely it is that voyeurism will cause illegal or inappropriate behavior to occur. Voyeuristic acts are the most common form of law breaking sexual behaviors.
While the prevalence of voyeuristic disorders is not known, statistics show that it disproportionally affects men over women at roughly a three to one ratio. That makes it three times more likely to occur in men. An estimated 12% of men may meet the clinical criteria for a voyeuristic disorder compared to 4% of women.1
Symptoms & Criteria of Voyeuristic Disorder
The main symptom of a voyeuristic disorder is recurrent and intense sexual arousal from observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activities. However, in the absence of fixation, mental distress, or unwilling participants, this arousal would not be classified as a mental disorder.
Also, a person with voyeuristic disorder is often only able to achieve arousal when invading someone’s privacy and may feel shame and distress at the atypical focus of their sexual desire.
To be diagnosed with voyeuristic disorder you must:1
- Be at least 18 years old
- Have experienced voyeuristic fantasies, urges, or behaviors for at least 6 months
- Have acted on these urges with a non-consenting person
- Have sexual urges or fantasies that cause clinically significant distress and impairment in social, occupational, or other important areas of functioning
In order to be diagnosed with a voyeuristic disorder, the person must experience ongoing (at least six months) and intense sexual arousal from either the fantasy or the act of observing a nonconsenting person who is naked, partially disrobed, or sexually active.
Most often, a voyeuristic disorder is diagnosed when an individual has been caught breaking the law, receiving a citation, and having been remanded to psychological treatment. Occasionally, partners or family members of the individual may refer them for treatment after witnessing inappropriate behavior.
Causes & Triggers of Voyeuristic Disorder
While there is no conclusive evidence regarding the causes and triggers of voyeuristic disorder, it has been linked to childhood sexual abuse, substance misuse, and hypersexuality. Ultimately, there is no conclusive evidence regarding causation or prevalence of co-occurrence. Typically, voyeuristic behavior develops during adolescence; however, voyeurism isn’t recognized as a mental health diagnosis until adulthood, as the disorder may be difficult to discern from normative and age-appropriate sexual curiosity.1
Impacts of Voyeuristic Disorder On Individuals & Relationships
A voyeuristic disorder can cause feelings of shame, emotional distress, fear of judgment, and isolation, all of which negatively impact relationships. The partners of individuals with voyeuristic disorder may also feel inadequate, unattractive, or worried about the implications of the voyeuristic interest. Sexual dysfunction can occur (e.g. erectile dysfunction or delayed ejaculation) when no outlet for voyeuristic urges is present, which may lead individuals or couples to seek treatment.
However, voyeuristic desires to observe other people during sexual activity can be channeled appropriately with like-minded individuals within the fetish or lifestyle communities. Voyeurism in a consensual group context and/or with a like-minded partner can provide a healthy outlet for voyeuristic urges.
Treatment of Voyeuristic Disorder
For individuals with a voyeuristic disorder, psychotherapy is the most common treatment approach. When utilized in conjunction with therapy, some medications have been shown to effectively reduce compulsive behavior associated with the disorder. Voyeuristic interests in and of themselves do not require treatment unless inappropriate or illegal behavior is occurring and/or the sexual impulses are causing significant impairment or distress.
Sex Therapy
Receiving counseling from a certified sex therapist who specializes in paraphilias will ensure a knowledgeable and non-judgmental approach to treating a voyeuristic disorder. They will likely offer coaching on mindfulness and behavioral techniques that either an individual or couple can explore. Co-occurring psychological conditions, such as mood disorders or hypersexuality, will also be assessed and treated.
You can expect the sex therapist to ask for a detailed sexual and psychosocial history to assess the contributing factors to the voyeuristic interest, as well as its expression through urges, fantasies, and behaviors. They will explore the onset and context of the symptoms, especially any situational details or cues that have escalated voyeuristic thoughts or urges.
Cognitive Behavioral Therapy (CBT)
Sex therapists with CBT training will employ cognitive restructuring techniques to identify and change thoughts and behaviors. They may utilize aversion therapy or guided imagery to reduce interest in voyeuristic behavior. Studies have shown CBT to be an effective treatment for this disorder, particularly when utilized in conjunction with drug therapy.
Medication
- Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) such as Prozac/fluoxetine can help with co-occurring mood disorders, such as depression or anxiety, while simultaneously lowering sex drive. A lowered sex drive can help with the impulsivity associated with voyeuristic thoughts and behaviors; however, without therapy, this does not directly address the voyeuristic urge.
- Antiandrogens: Medroxyprogesterone acetate and cyproterone acetate are members of a class of drugs that can be used to temporarily lower circulating testosterone levels. Doing this reduces sex drive and allows for more effective therapy techniques and cognitive restructuring.
Support Groups
Attendance of a support group can augment the effectiveness of other treatment approaches as well. Connecting with others who experience similar urges may reduce social stigma and isolation, and improve your ability to integrate coping skills.
How to Get Help for Voyeuristic Disorder
If you or your partner has a voyeuristic interest, seeking psychological help with a knowledgeable and nonjudgmental professional is an important step towards taking control of your sexual impulses and channeling them into healthy and consensual behavior. That said, most individuals who suffer from a voyeuristic disorder only seek psychological treatment when legally forced to do so.
When consulting a therapist for the psychological treatment of sexual issues, make sure that your mental health practitioner is AASECT (American Association of Sexuality Educators Counselors and Therapists) certified. “Sex therapist” and “sex therapy” are not protected terms, meaning anyone can call themselves a sex therapist when marketing themselves. Additionally, most mental health licensure requirements contain little or no instruction in human sexuality. AASECT certified providers receive an additional 18-24 months of training and a minimum of 300 additional hours of supervision in sex specific psychological issues.
Typical rates for an AASECT certified sex therapist are on the upper end of private pay therapy rates in your area. Most sex therapists see individual clients for 45-60 minute sessions at rates between $120-$180, and couples for 75-90 minute sessions at rates between $190-$310. These rates may vary widely based on the availability of certified sex therapists in your area and general mental health costs in your state.
5 Ways to Cope With Voyeuristic Disorder
For those living with a voyeuristic disorder, there are methods of coping and managing its symptoms. Remember that partners are more likely to be supportive and understanding when your behavior is not secretive. Most importantly on the path to overcoming the condition, seek out help from a certified sex therapist who can guide you through additional strategies.
Here are five coping strategies that work well for those with voyeuristic disorder:
- Talk honestly with your partner(s) about your sexual urges and fantasies.
- Consult with a certified sex therapist to explore your options for reducing compulsive behaviors and co-occurring mental health conditions
- Minimize the use of alcohol and other inhibition lowering substances, which may increase the occurrence of inappropriate acts or urges
- Seek a community of other individuals struggling with a voyeuristic disorder or who have been successful in channeling their urges, fantasies, and behaviors into a consenting sexual forum
- Remember that a voyeuristic disorder is more effectively treated the sooner it is addressed.
Voyeuristic Disorder vs. Other Mental Health Disorders
While other disorders may present similarly to voyeuristic disorder, it’s important to know the differences to get the best care possible. Here are some terms and disorders that may be confused with voyeuristic disorder, and their characteristic differences:
Voyeuristic Disorder vs. Voyeurism
Voyeurism is an outdated term utilized prior to the updated Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It was classified as an impulse control disorder, not a paraphilia. The crucial difference in this new terminology is that a voyeuristic disorder designation requires there to be significant distress, impairment, or harm accompanying the pattern of sexual behavior. Voyeurism is also a broader colloquial term used to describe the enjoyment of observing others engaged in sexual activity.
Voyeuristic Disorder vs. Conduct Disorder & Antisocial Personality Disorder
Conduct disorder in adolescents and antisocial personality disorder in adults are characterized by norm-breaking behavior, which may include behavior that is included in the definition of a voyeuristic disorder. However, the sexual arousal element does not exist in conduct disorder or antisocial personality disorder, and additional behaviors would be present.
Voyeuristic Disorder vs. Substance Use Disorders
Alcohol and substance use disorders may involve a single voyeuristic episode. However, recurrent sexual fantasies, ,and behaviors related to watching unsuspecting persons would be absent when the individual is not intoxicated.
Evolution of Voyeuristic Disorder as a Mental Health Diagnosis
Voyeuristic disorder has been included in the Diagnostic and Statistical Manual of Mental Disorders (DSM) under various iterations since its inception in 1952. Initially voyeurism was classified as a sexual deviation under psychopathic personality disorders, indicating that anyone with these urges was unlawful and/or psychotic.2
The forensic usage of this diagnosis to categorize the criminal behavior of sexual predators continues to have useful applications. However, the paraphilic diagnoses, including voyeuristic disorder, have been criticized as an attempt to control deviant behavior and arguably do not meet the criteria for true mental health diagnoses. Paraphilic diagnoses have been used to pathologize, stigmatize and discriminate against those who engage in alternative sexual practices. Sexual arousal stemming from the surreptitious observation of nude or sexually engaged individuals does not constitute a pathological urge.
Throughout subsequent editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) discernment was slowly made between consensual sexual practices which do not cause distress as compared to harmful urges, fantasies or behaviors which would constitute a psychological disorder requiring treatment. However, a lack of valid data or scientific consensus regarding the etiology of voyeuristic disorder continues to make this diagnosis controversial.
