194 - 6D31 Voyeuristic disorder

6D31 Voyeuristic disorder

575 Paraphilic disorders Voyeuristic disorder Essential (required) features • A sustained, focused and intense pattern of sexual arousal – as manifested in persistent sexual thoughts, fantasies, urges or behaviours – that involves observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity, is required for diagnosis. • The individual must have acted on these thoughts, fantasies or urges, or be markedly distressed by them. Additional clinical features • Voyeuristic disorder should not be diagnosed among children, and is not typically diagnosed among adolescents. Sexual curiosity is typical during adolescence, and observation of others may occur impulsively or opportunistically rather than representing a recurrent pattern of sexual arousal. • The act of observing in voyeuristic disorder is for the purpose of achieving sexual excitement, and does not necessarily involve an attempt to initiate sexual activity with the person being observed. Orgasm by masturbation may occur during the voyeuristic activity or later in response to memories of what the individual has seen. More recently, so-called “video voyeurs” have been described who use video equipment to record individuals in public or private places where there is an expectation of privacy. • The diagnosis of voyeuristic disorder is generally not adequately supported when the evidence indicating a sustained, focused and intense pattern of sexual arousal consists solely of a single or very limited number of instances of voyeuristic behaviour, as there may be other explanations for specific occurrences (e.g. intoxication, opportunity). In the absence of a report of the individual’s sexual thoughts, fantasies or urges, examples of other forms of evidence supporting the presence of a voyeuristic arousal pattern include a preference for specific types of pornography; preference over other forms of sexual behaviour; or planning and repeatedly seeking out opportunities to engage in voyeuristic behaviour. Boundary with normality (threshold) • By definition, voyeuristic disorder specifically excludes consensual voyeuristic behaviours that occur with the consent of the individual being observed. 6D31 Paraphilic disorders | Voyeuristic disorder

Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders Course features • Individuals with voyeuristic disorder often report the onset of voyeuristic sexual interest during adolescence. • Voyeuristic disorder is relatively stable after young adulthood, but sexual thoughts, fantasies, urges and behaviours may change over time, such that an individual who was assigned a diagnosis of voyeuristic disorder no longer meets the diagnostic requirements. Developmental presentations • Advancing age may be associated with decreasing paraphilic sexual arousal and decreasing behavioural manifestations of voyeuristic disorder due to increased impulse control and decreased sexual drive. Sex- and/or gender-related features • Voyeuristic disorder is much more prevalent among men. Boundaries with other disorders and conditions (differential diagnosis) Boundary with compulsive sexual behaviour disorder Both voyeuristic disorder and compulsive sexual behaviour disorder may involve repetitive sexual impulses, urges or behaviours that result in marked distress or impairment. Voyeuristic disorder is characterized by sexual impulses, urges or behaviours that are manifestations of a sustained, focused and intense pattern of sexual arousal that involves stimuli such as observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity. In contrast, compulsive sexual behaviour disorder is characterized by a persistent pattern of failure to control sexual impulses, urges or behaviours, regardless of the focus of sexual arousal. If an individual with voyeuristic disorder is able to exercise some degree of control over the behavioural expressions of the arousal pattern, an additional diagnosis of compulsive sexual behavioural disorder is generally not warranted. Boundary with disorders due to substance use Episodes of impulsive or disinhibited sexual behaviour, including voyeuristic behaviour, may occur during substance intoxication. Such episodes may not be a manifestation of a sustained, Paraphilic disorders | Voyeuristic disorder