ICD-116D31	VOYEURISTIC DISORDER Voyeuristic disorder
ICD-10F65.3	Voyeurism
DSM-5-TRF65.3	Voyeuristic Disorder

1. Definition and nosology

Voyeurism (ICD-11: 6D31 Voyeuristic Disorder; DSM-5-TR: F65.3) — persistent and intense sexual arousal from secretly observing undressing, nakedness, sexual activity of non‑consenting persons; patient experiences distress from these fantasies or acts upon them with non‑consenting individuals.

2. History

Voyeurism has been described in the clinical literature in parallel with exhibitionistic disorder (6D30).

3. Epidemiology

• Prevalence: the population prevalence of the disorder is unknown; based on voyeuristic acts in non-clinical samples, DSM-5-TR gives a highest possible lifetime prevalence of ~12% in males and ~4% in females (Långström N., Seto M.C. Arch Sex Behav 2006, n=2450). Most people with voyeuristic behaviour do not meet criteria for the disorder.
• Comorbid other paraphilic disorders.
• Internet voyeurism (hidden camera, “upskirt”) is developing.

4. Aetiology and pathogenesis

General etiology for paraphilic disorders.

5. Clinical features

• Observing unsuspecting individuals naked or during sexual activity without their consent.
• Typical context — window, dressing rooms, public places.
• “Upskirting” — the modern form.
• Legal consequences.

6. Diagnosis

6.1 Unified diagnostic criteria

A. ≥6 months repeated sexual arousal from observing non-consenting individuals.

B. The patient has acted on fantasy or experiences distress.

C. Age ≥18 (DSM-5-TR; normal curiosity in adolescents is an exception).

6.2 Source-specific clarifications

• DSM-5-TR requires a 6-month duration; ICD-11 sets no duration criterion — it speaks of a “sustained, focused and intense pattern of arousal”.
• WFSBP 2020.

6.3 Diagnostic algorithm

1. Clinical interview.
2. Comorbidity.
3. Risk assessment.

6.4 Differential diagnosis

7. Examination and assessment

• Clinical interview.
• Risk scales.

8. Treatment

1. WFSBP 2020 step‑by‑step algorithm (same as 6D30):
   • CBT for relapse prevention;
   • SSRI high dose;
   • Antiandrogen;
   • GnRH in the most severe case.
2. Legal-medical coordination.

Treatment methods

Same as 6D30.

9. Prognosis

Reduction of relapse with evidence-based treatment.

10. Myths and misconceptions

Myth 1: “Voyeurism is harmless; the victim remains unaware”

Evidence: Trauma if victim evident; consent violation sexual crime.

Myth 2: “Pornography use is voyeurism”

Evidence: Consensual production and consumption — voyeurism absent; clinical diagnosis focuses on those without consent.

Myth 3: “Internet voyeurism is only new; it has no clinical significance”

Evidence: “Upskirting”, hidden camera — sexual crime; requires clinical and legal intervention.

Myth 4: “Treatment is ineffective”

Evidence: CBT and pharmacotherapy are effective.

11. Sources

1. WHO. ICD-11. 6D31 Voyeuristic disorder. 2024.
2. APA. DSM-5-TR. 2022.
3. Thibaut F., Cosyns P., Fedoroff J.P. et al.; WFSBP Task Force on Paraphilias. The World Federation of Societies of Biological Psychiatry (WFSBP) 2020 guidelines for the pharmacological treatment of paraphilic disorders. World J Biol Psychiatry 2020;21(6):412–490.