Examining risk of escalation: A critical review of the exhibitionistic behavior literature

• We examined male exhibitionistic behavior and subsequent contact sexual offending.
• 5–10% of exhibitionistic perpetrators escalated to contact sexual offending.
• Approximately 25% recidivated with a subsequent exhibitionistic offense.
• Methodological limitations and remedies for the reviewed articles are discussed.

While forensic mental health professionals frequently are asked to assess the risk that exhibitionistic offenders will increase the severity of their sexual offending, disparate perspectives exist reflecting the perceived dangerousness of those who engage in exhibitionistic behavior. The present paper critically reviews the literature regarding the reported link between male exhibitionistic behavior and contact sexual offending in 12 peer-reviewed, English-language studies published since 1981. A history of exhibitionistic behavior was prevalent in a minority of perpetrators of various contact sexual offenses. Over an average follow-up period of greater than five years, an estimated 5–10% of exhibitionistic perpetrators were found to escalate to contact sexual offending, while approximately 25% recidivated with a subsequent exhibitionistic offense. The most supported risk factor for escalation was a general clustering of antisocial behavior, including a history of sexual and nonsexual convictions. Common methodological limitations of the research and recommendations for improved validity are provided, along with suggestions for future research directions.