Gender and Sexual Disorders 485
Voyeurism: Watching Others
Voyeurism is the paraphilia characterized by sexual fantasies, urges, or be-
haviors that involves observing someone who is in the process of undress-
ing, is nude, or is engaged in sexual activity. The person being watched
has neither consented to nor is aware of being observed (see Table 11.3).
As with exhibitionism, for voyeurism to be a disorder, the person’s urges
and fantasies must cause distress or relationship problems, or the person
must have acted on those fantasies and urges.
The voyeur rarely has physical contact with the observed person.Moreover, voyeurism is distinguished from looking at pornography or
watching nude dancing; voyeurism involves observing someone who does
not know that he or she is being observed. A man with this disorder might
use binoculars to “spy” on a woman, masturbating while observing her
through her window as she undresses, or might plant hidden cameras and
watch the video later or via an Internet feed.
Frotteurism: Touching a Stranger
Frotteurism(from the French, frotter, “to rub”) is characterized by recurrent, in-
tense, sexually arousing fantasies, sexual urges, or behaviors that involve touching
or rubbing against a nonconsenting person (see Table 11.3). As with exhibitionism
and voyeurism, the urges and fantasies must cause distress or relationship problems,
or the man must have acted on those fantasies and urges. This diagnosis has two
types: men who like to rub, and men who like to touch (“touchers”). On crowded
public transportation, men with frotteurism try to stand or sit next to attractive
females and rub their genitals against the victims’ buttocks, thighs, or crotch, often
while fantasizing that they are having consensual sex, as Charles, in Case 11.3, did.
When discovered, men with frotteurism fl ee from the train or bus.
CASE 11.3 • FROM THE OUTSIDE: Frotteurism
Charles was 45 when he was referred for psychiatric consultation by his parole offi cer follow-
ing his second arrest for rubbing up against a woman in the subway. According to Charles,
he had a “good” sexual relationship with his wife of 15 years when he began, 10 years ago, to
touch women in the subway. A typical episode would begin with his decision to go into the
subway to rub against a woman, usually in her 20s. He would select the woman as he walked
into the subway station, move in behind her, and wait for the train to arrive at the station. He
would be wearing plastic wrap around his penis so as not to stain his pants after ejaculat-
ing while rubbing up against his victim. As riders moved on to the train, he would follow the
woman he had selected. When the door closed, he would begin to push his penis up against
her buttocks, fantasizing that they were having intercourse in a normal, noncoercive manner.
In about half the episodes, he would ejaculate and then go on to work. If he failed to ejaculate,
he would either give up for that day or change trains and select another victim. According
to Charles, he felt guilty immediately after each episode, but would soon fi nd himself rumi-
nating about and anticipating the next encounter. He estimated that he had done this about
twice a week for the last 10 years and thus had probably rubbed up against approximately a
thousand women.
(Spitzer et al., 2002, pp. 164–165)Voyeurism: Watching Others
his wife that he would immediately tell her if he had urges to expose himself or if he had done
so. He had agreed to take a lie detector test any time she requested it. He had a signed agree-
ment with his wife that he would live separately from her if his exhibitionism relapsed. He
reported that this behavioral contracting intervention was helpful in assisting him to refrain
from exposing himself, but had not stopped his [other compulsive sexual behaviors]. He also
still had recurrent urges to expose himself as well. He reported that his hypersexual fantasies,
urges, and activities distracted him for 1 to 2 hours a day although he currently denied a high
frequency of genital/sexual behavior.
(Kafka, 2000, pp. 493–494)People with voyeurism tend not to have physical
contact with the people they observe.David Young-Wolff/Photo EditVoyeurism
A paraphilia characterized by sexual
fantasies, urges, or behaviors that involve
observing someone who is in the process of
undressing, is nude, or is engaged in sexual
activity, when the person being observed has
neither consented to nor is aware of being
observed.Frotteurism
A paraphilia characterized by recurrent,
intense, sexually arousing fantasies, sexual
urges, or behaviors that involve touching or
rubbing against a nonconsenting person.