Practice Support

Fifty Shades of Sexual Offending – Part I

Voyeuristic Disorder
Dr Julia, I received six weeks starting from June 19.
My heart sank as I read the SMS on my phone. Part of me felt angry, and part of me felt sad, and discouraged. What was so evil about his behaviour that landed him with a six-week jail sentence? After remission for good behaviour and public holiday, he should be out in four weeks. Four weeks, or 28 days, for giving in to his urges and earning him a criminal record, which will be with him forever. For every job that he applies for in the future, he would have to declare his criminal conviction. I could feel the weight of a criminal record hanging over his head, together with the shame and guilt he felt after he was arrested by the police for taking “upskirt photos”.
Sexual Offending
Sexual offending consists of an array of sex-related behaviour that breaches the law, and can range from non-contact behaviour like taking upskirt photos/videos, to touching a non-consenting individual, and serious crimes like sexual penetration and forcible rape.
A number of sexual paraphilias are related to sexual offending, eg voyeurisim, exhibitionism, frotteurism, paedophilia, sadism, masochism and fetishism. “The term paraphilia denotes any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners” (APA, 2013, p685). Like a spectrum, sexual paraphilias manifest themselves in different shades of sexual perversion and seriousness when being acted out.
Para = Abnormal
Philia = Liking; love for something
What are Paraphilic Disorders?
Paraphilic Disorders in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (“DSM-5”), are a group of disordered sexual liking or preferences:
Voyeuristic Disorder • spying on others in private activities
Exhibitionistic Disorder • exposing the genitals
Frotteuristic Disorder • touching or rubbing against a non-consenting individual
Sexual Masochism Disorder • undergoing humiliation, bondage, or suffering
Sexual Sadism Disorder • inflicting humiliation, bondage, or suffering
Paedophilic Disorder • sexual focus on children
Fetishistic Disorder • using non-living objects or having a highly specific focus on non-genital body parts
Transvestic Disorder • engaging in sexually arousing cross-dressing
A paraphilic disorder is a paraphilia that is currently causing distress or impairment to the individual or a paraphilia whose satisfaction has entailed personal harm, or risk of harm, to others. A paraphilia is a necessary but not a sufficient condition for having a paraphilic disorder, and a paraphilia by itself does not necessarily justify or require clinical intervention
- (APA, 2013, p685-686).
Paraphilic Disorders and Offending
Paraphilic disorders are relatively common and in general noxious. The paraphilic behaviour in itself may or may not be illegal, but becomes problematic when pursued inappropriately – at the wrong place and with the wrong (non-consenting) person, with its indulgence causing impairment in functioning or breaking the law; necessitating clinical intervention and legal sanctions.
Part I of “Fifty Shades of Sexual Offending” will focus on Voyeuristic Disorder.
“Peeping Tom”
Our society has become increasingly voyeuristic with the increased opportunities for people to post their “lives” online (eg photos and videos; reality shows). These “exhibitionists” in a way invite and encourage the “voyeurs”. Decades ago, we had movies like The Rear Window which brought to light our intrinsic, curious desire to peep and pry into other people’s lives.
The term “Peeping Tom” refers to a pruriently prying person. Tom the tailor allegedly peeped at Lady Godiva, who lived in the 11th century, when she rode naked on a horse through the town as a condition to plead with her husband to relieve the heavy burden of taxes he had imposed upon the citizens of the Coventry in a British legend. The legend says that Tom was struck blind by his misdeed.
Most individuals do not have strong urges or fantasies to peep at others sexually. For those who do excessively, they are commonly referred to as “voyeurs”. Online forums, chatrooms and YouTube have become easy platforms for people of all ages to satiate their voyeuristic instinct, openly in front of the screen of a computer or mobile phone, without hiding. Pornography-viewing is widely considered a form of voyeurism.
Voyeuristic Disorder
Voyeuristic Disorder is a paraphilic/psychosexual disorder in which an individual derives sexual pleasure and gratification from looking at naked bodies and genital organs, observing the disrobing or sexual acts of others. There is a persistent and intense atypical sexual arousal pattern that is accompanied by clinically significant distress or impairment. The act of looking or peeping is undertaken for the purpose of achieving sexual excitement, usually followed by masturbation and orgasm. 
Instead of peeping in situ using high-powered binoculars, with advances in technology such as camera phones and pin-hole cameras, voyeurs can now record the private moments with their devices: taking upskirt photos of unsuspecting individuals on escalators, or filming women in various states of undress in toilets and changing rooms. Voyeuristic behaviour is on the rise.
The new vocabulary “upskirt” is both a verb (the practise of capturing an image/ video of an unsuspecting and non-consenting person in a private moment) and a noun (ie the actual voyeuristic photos or videos made; referred as “voyeur photography”).
The lifetime prevalence of voyeuristic disorder is estimated to be 12 per cent in males and four per cent in females. Causes of voyeurism are unknown. Adolescence and puberty are the period where sexual curiosity and activity increase, and teenagers displaying such interest and behaviour are considered normal and age-appropriate. Learning theory suggests that an initially random or accidental observation of an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity, may lead to sexual interest and arousal; with each successive repetition of the peeping act reinforcing and perpetuating the voyeuristic behaviour.  
Assessment and Diagnosis
Assessment of Voyeuristic Disorder is done by taking a detailed history of one’s psychosexual development which covers paraphilic sexual fantasies, urges and propensity to act out sexually, hypersexuality, sexual impulsivity; psychiatric comorbidities, psychosocial impairment and subjective distress. Psychometric testing looking at personality attributes and psychopathologies, as well as psychophysiological measures like penile plethysmography are employed occasionally.
Diagnostic Criteria of Voyeuristic Disorder (302.82)
1. Over a period of at least six months, recurrent and intense sexual arousal from observing an unsuspecting person who is naked, in the process of disrobing or engaging in sexual activity, as manifested by fantasies, urges, or behaviours.
2. The individual has acted on these sexual urges with a non-consenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
3. The individual experiencing the arousal and/or acting on the urges is at least 18 years of age.
A diagnosis of Voyeuristic Disorder is made only when “peeping” is a preferred or exclusive means of sexual gratification which fulfills the criteria listed above. 

Voyeuristic Disorder whilst a Paraphilic Disorder, also shares features of Impulse Control Disorders, notably Sexual Compulsivity. Individuals diagnosed with Voyeuristic Disorder often score very high on scales that measure impulsivity. They also may have co-existing social anxiety disorder, are socially inept and experience difficulties dating females (ie Courtship Disorder). Their voyeuristic activities may increase when there are life stressors, and acting out becomes a maladaptive coping strategy. Some voyeurs may become depressed with their out-of-control behaviour, experiencing guilt and shame. Their low mood may cloud their judgment and reduce their impulse control further, which often puts them in potentially hazardous situations of being apprehended.
Voyeuristic Disorder and Offending
Voyeuristic acts are the most common of potentially law-breaking sexual behaviours. Voyeurism is a criminal act in many jurisdictions. The basic tenet of laws against voyeuristic acts concerns protecting the privacy of people who appear in public from being the object of sexual thoughts. Although a voyeur can be male or female, men are commonly the perpetrators in the peeping acts/upskirt, with women being the victims.
While most voyeurs film for self-gratification (i.e. using upskirt materials for fantasy and masturbation), there are offenders who make upskirt photos and videos specifically for uploading onto the internet (e.g. fetish and pornographic websites and video-sharing sites like YouTube) for monetary profit. Recently, there was such a female offender in Singapore who was convicted over taking and selling voyeuristic videos online to make a profit. The latter would not be diagnosed as suffering from Voyeuristic Disorder.
Voyeuristic behaviour in situ is usually classified as a misdemeanour with minor legal penalties. However, it would appear that voyeuristic crimes committed with the use of a recording device fare much worse. While a voyeur will not be struck blind for the peeping act/or taking upskirt, the legal consequence could be dire.
Upskirt is considered a “serious” crime in Singapore as it intrudes upon the privacy of unsuspecting and non-consenting individuals. Offences typically take place on escalators, in fitting rooms, public toilets or shower rooms; with the offenders trying to capture what is underneath the “skirts” or private moments of the victims with a recording device which may or may not be disguised.
In order to achieve their purposes, some voyeurs may go to great lengths to “plan” their crimes; some succumb to temptation and act on the spur of the moment (a moment of folly) without thinking about the consequences, while others conceive the idea from voyeuristic websites. The degree of planning and premeditation may reflect the severity of the disorder (more compulsivity than impulsivity in the act) and that treatment is desperately needed, rather than the degree of criminality. One may ask: Why is upskirt so appealing that sufferers would risk apprehension, career, reputation and getting a criminal record? No sane individuals would do that.
In Singapore where “everything cannot”, a voyeur potentially can be charged with a number of offences, depending on how the offences took place (eg Chapter 224 of the Penal Code: s 441 & 447 – criminal trespass; and s 509 – outrage of modesty; Chapter 107 of the Films Act: s 29 – possession, transmission (sharing or uploading) and distribution of the upskirt).
Police statistics regarding insult of modesty as quoted in the Straits Times (8 May 2017) suggested there were 634 cases in 2014, 597 cases in 2015 and 540 cases in 2016.
Over the years, I have assessed a considerable number of “voyeurs” with upskirt behaviour, who were arrested, warned, prosecuted, fined, and incarcerated. Most of them were first-timers, ie arrested and charged for the first time, although they may have a long history of peeping/ upskirt behaviour since their teens. They were mostly non-violent when they committed their crimes. They commonly reported a history of excessive masturbation and pornography use.
Treatment of Voyeuristic Disorder
Without treatment, voyeurs tend to repeat their behaviour and may become repeat offenders.
The voyeurs I have assessed expressed that they have tried many, many times to stop their voyeuristic behaviours by restraining or distracting themselves. They reported they were constantly preoccupied by the thoughts and the urges to act out. They reported intense sexual urges and fantasies before their act (ie shooting upskirts photos), and a sense of relief and satisfaction afterwards. They used the upskirt photos/videos to masturbate. However, the relief was short-lived before their next compulsive venture, leading to a vicious cycle. They noticed the impulsive-compulsive nature of their voyeuristic activities as well as their excessive masturbation. Despite knowing the harmful legal consequences, they often operated on an “auto-pilot” mode and gave in to their urges, similar to behavioural addictions like gambling.
Both pharmacotherapy (medication that reduce impulsivity and urges) and psychotherapy (cognitive-behavioural therapy that targets erroneous beliefs, aversive conditioning, and covert sensitization) have been found effective in treating Voyeuristic Disorder and Sexual Compulsivity. Equipping voyeurs with pro-social coping skills, social skills to expand their social circle, as well as developing new hobbies to distract them from excessive voyeuristic activities, are found to be effective in reducing their likelihood of reoffending.
Punishment vs Rehabilitation
Getting apprehended for upskirt is more a norm than an exception in this group, as it is just a matter of time that the offender would be careless or daring enough to invite apprehension. Police arrest usually serves as a final “wake-up call” that breaks the offending pattern, accompanied with a great sense of shame and embarrassment. Many of these voyeurs are amenable to treatment.
From my clinical experience, Voyeuristic Disorder is more than Voyeurism which is perceived by many as a deviant sexual preference, a choice. Most of the sufferers of Voyeuristic Disorder who came for my assessment reported their urges to upskirt and use the materials to masturbate as overwhelming, to the extent that they gave in to temptation without considering the grave consequences of their acts. In addition to having to deal with their urges, they also experience a tremendous amount of guilt, shame and self-loathing about their perversion. Many were unaware that it is a clinically diagnosable condition until they were sent for psychiatric assessment, and that effective treatment is available to manage and minimise acting out behaviour.
Some years ago I assessed a young gentleman who was arrested for upskirt. He was a university student, very active in the student sports community. However, every time when exams were approaching or when there was a major sport competition, he would feel very stressed and masturbated excessively; he also developed “a habit of taking upskirt photos” to cope. Every morning after he woke up, he would feel the urge to go out to find his “targets”.
Although he knew it was very risky to take upskirt on MRT escalators, he felt compelled to satiate his urges and gratification, and was oblivious to his surroundings (eg passers-by security staff and CCTV) and the risk of being arrested. He could still feel the thrill and excitement, but he no longer enjoyed the act. It had become more like a compulsion. One morning, after a few unsuccessful attempts, he became very frustrated, let down his guard and blatantly captured upskirt while on an escalator. He was arrested.
The upskirt he took was opportunistic, inoffensive and blurry. He never uploaded or shared his upskirt on social media. He filmed for personal viewing only, and the images were deleted after use (ie masturbation).
The young man greatly regretted his behaviour. Luckily, he was given probation which he successfully completed. He was prescribed medication to manage his mood and urges to act out, and attended psychotherapy to work on his voyeuristic behaviour and learn more effective coping skills. He has since graduated from university, and has not breached the law with upskirt behaviour again.

Going Forward
Voyeuristic Disorder is a mental disorder. It is in itself the manifestation of the mental affliction. In addition to being a sexual perversion, symptoms of impulsivity and compulsivity are usually present which may take away a sufferer’s full control over his action. Taking upskirt is only the first half of the story. Offenders usually use the upskirt to masturbate excessively – ie Sexual Compulsivity. The anticipation of being able to use the upskirt to masturbate makes the upskirt behaviour more compulsive, addictive and rewarding. This aspect has been seldom fully understood and reiterated by mental health professionals in the Courtroom when a diagnosis of Voyeuristic Disorder is being challenged in upskirt crimes.
In recent years, maybe because of an apparent increase (sensationalized media reports) in upskirt offenders, it would appear that incarceration has become the predominant norm in sentencing, despite the fact that the core characteristics of voyeurs, psychiatric diagnoses, nature and circumstances of the offence resemble their predecessors who were granted and successfully completed their probation and Community Sentence.  
Voyeurs are essentially not bad people; they have a mental condition that has become out of control. With appropriate treatment, most voyeurs are able to contain and modify their inappropriate behaviour accordingly.
It is hoped that the criminal justice system can consider the plight of these sufferers and grant them a sentence that is conducive to their treatment and rehabilitation, regardless of their age. This compassionate stand does not mean accepting their perverted behaviour and rendering them “victims”, or minimising the psychological damage etched on the victims. The writer is aware of the gradation of planning and premeditation when taking upskirt which may result in different degrees of culpability and capacity for rehabilitation. It could be that the writer has encountered offenders with better prospects of rehabilitation, as filtered in the referral process.
Perhaps an offender can be mandated for an assessment and treatment, with a review of the assessment outcome and treatment progress, before being prosecuted. A Mandatory Treatment Order, or a Short Detention Order, coupled with a Community Service Order would serve both punishment and rehabilitation purposes.

Dr Julia Lam
    Consultant Forensic Psychologist
    Forensic Psych Services
    E-mail: [email protected]
APA. (2013). Diagnostic and Statistical Manual of Mental Disorders. (5th ed). American Psychiatric Association.