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The Guardian - AU
The Guardian - AU
National
Donna Lu Science writer

Voyeurism: when does it become a condition and can it be treated?

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Voyeuristic disorder is an intense sexual arousal from watching an unsuspecting person who is naked, getting undressed or engaging in sexual activity. Photograph: liebre/Getty Images

A New South Wales high school teacher who was jailed in July for secretly filming up the skirts of his female students has had his prison sentence overturned on appeal.

A judge ruled that Eric Wong, formerly a science teacher at Cammeraygal High School in Sydney, would not be able to access the necessary treatment for his voyeuristic disorder in prison and that a two-year intensive correction order, a custodial sentence served in the community, would be more beneficial to community safety.

What is voyeuristic disorder?

Voyeuristic disorder is recognised as a condition in the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5) and in the World Health Organization’s International Classification of Diseases (ICD-10).

It falls under the umbrella of paraphilic disorders. “These are disorders of deviant sexual arousal,” said Dr Richard Furst, a forensic psychiatrist who has provided expert evidence in numerous NSW criminal matters. “Ones people would be most familiar with are things like paedophilia or … sexual sadism disorder, where a person gets arousal from inflicting pain and often killing someone as part of a sexual act.”

Paraphilias usually result in some impairment or clinically significant distress, according to Lee Knight, a senior lecturer in forensic mental health at the University of NSW.

Voyeuristic disorder is defined by intense sexual arousal from watching an unsuspecting person who is naked, in the process of getting undressed, or in the process of engaging in sexual activity. “The key is that [the other party is] unsuspecting,” Knight said. “The person must have acted on the urges … or it must have caused them clinically significant distress”, which can include interactions with the criminal justice system, or problems in relationships or in the workplace.

Prof Jayashri Kulkarni, a psychiatrist at Monash University, said voyeuristic disorder was a controversial area because of the distinction between “what is considered to be acceptable titillation by watching other people indulging in sexual activities as compared to what is not acceptable”.

“It’s going to depend on whether there’s harm and distress involved to self or others, or humiliation,” she said.

“The difference between just having some voyeurism or actually having a disorder is when it causes subjective distress or impacts on work and relationships,” Kulkarni said. “That’s very different to the perusal of porn … or other expressions of their fantasies that are under the person’s control.”

Voyeuristic disorder and the law

Experts say that not all people with voyeuristic disorder will necessarily commit criminal offences.

“If they … see a psychiatrist or a psychologist and try to engage in treatment without coming to the attention of the criminal justice system, that would be one preventive mechanism [against offending],” Furst said. “It’s not a really common group coming to the attention of police.”

Kulkarni said: “Prevention is always tough work because it requires for the individual to identify themselves and that can be tricky in itself.”

But people who are convicted of committing voyeurism offences, such as recording an intimate image of another person without their consent, are likely to have the disorder, Knight said. The people with voyeuristic disorder he treats in clinical practice are mostly individuals who have acted on their urges.

“The difficulty is when you’ve got people who have antisocial personality disorder and they don’t have subjective distress. That’s more difficult because then they’re more likely to engage in unlawful behaviours and not have remorse,” Kulkarni said.

Why do some people develop voyeuristic disorder?

What causes voyeuristic disorder and other paraphilias is “not very well understood”, Furst said. “It’s probably to do with interplay between hormonal development and sexual development and socialisation.”

“Sometimes people describe different sexual practices as stemming from insecurities, sense of inadequacies, and sometimes it’s about an early life trauma story … emotional, physical or sexual,” Kulkarni said. “All of these life events can then shape sexuality and it can be that voyeurism is [seen as] a safer form of sexuality than actually putting oneself out there.”

How is voyeuristic disorder treated?

“In severe cases, where it’s overwhelming and the person feels that they are unable to control it, we can use medications that reduce libido significantly,” Knight said. This includes the drug cyproterone acetate, which reduces testosterone levels in the body.

“We also use antidepressants which have got an anti-libidinal side-effect … we think it probably [also] helps with obsessionality,” Knight said, adding that it potentially improves behaviours such as the obsessive collection of numerous images.

Clinicians also use psychotherapy to examine early life traumas or other factors that may have prevented an individual from having healthy sexual relationships, as well as offence-specific cognitive behaviour therapy (CBT).

“We use CBT … to treat empathy deficits, to treat anger issues, to look at things like a relapse prevention plan – how can we ensure that they don’t go down an offence cycle again,” Knight said.

But Furst believes psychological programs have not been hugely successful in reducing reoffending, citing research suggesting that they do not significantly reduce sex offence recidivism rates, which range between 12% and 15% globally.

“Anything that we can do to reduce [the number of] victims and more victimisation is what keeps us working in this field as clinicians,” Knight said.

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