688 Paraphilic Disorders
tic sexual acts in nonclinical samples, the highest possible lifetime prevalence for voyeuris-
tic disorder is approximately 12% in males and 4% in females.
Development and Course
Adult males with voyeuristic disorder often first become aware of their sexual interest in
secretly watching unsuspecti ng persons during adolescence. However, the minimum age
for a diagnosis of voyeuristic disorder is 18 years because there is substantial difficulty in
differentiating it from age-appropriate pubert y-related sexual curiosity and activity. The
persistence of voyeurism over time is unclear. Voyeuristic disorder, however, per defini-
tion requires one or more contributing factors that may change over time with or without
treatment: subjective distress (e.g., guilt, sh ame, intense sexual fr ustration, loneliness),
psychiatric morbidity, hypersex uality, and sexual impulsivit y; psychosocial impairment;
and/or the propensity to act out sexually by spying on unsuspecting naked or sexually ac-
tive persons. Therefore, the course of voyeuristic disorder is likely to vary with age.
Risk and Prognostic Factors
Temperamental. Voyeurism is a necessary precondition  for voyeuristic disorder; hence,
risk factors for voyeurism sh ould also increase the rate of voyeuristic disorder.
Environmental. Childhood sexual abuse, substance misuse, and sexual preoccupation/
hypersexuality have been suggested as risk fa ctors, although the causal relationship to
voyeurism is uncertain and the specificity unclear. 
Gender-Related Diagnostic Issues
Voyeuristic disorder is very uncommon among females in clinical settings, while the male-
to-female ratio for single sexually ar ousing voyeuristic acts might be 3:1.
Differential Diagnosis
Conduct disorder and antiso cial personality disorder. Conduct disorder in adolescents