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Disorders - E
Encopresis
Encopresis is the repeated passage of faeces in inappropriate places. Encopresis should be diagnosed if inappropriate passage of faeces occurs repeatedly (e.g., at least once per month over a period of several months) in an individual who has reached the developmental age when faecal continence is ordinarily expected (4 years). The faecal incontinence may have been present from birth (i.e., an atypical extension of normal infantile incontinence), or may have arisen following a period of acquired bowel control. Encopresis should not be diagnosed if faecal soiling is fully attributable to another health condition (e.g., aganglionic megacolon, spina bifida, Demência), congenital or acquired abnormalities of the bowel, gastrointestinal infection, or excessive uso of laxatives.
Encopresis with constipation or overflow incontinence
Encopresis is the repeated passage of faeces in inappropriate places occurring repeatedly (e.g., at least once per month over a period of several months) in an individual who has reached the developmental age when faecal continence is ordinarily expected (4 years). The faecal incontinence may have been present from birth (i.e., an atypical extension of normal infantile incontinence), or may have arisen following a period of acquired bowel control. Encopresis com constipation and overflow incontinence is the most common form of faecal soiling, and involves retention and impaction of faeces. Stools are typically — but not always — poorly formed (loose or liquid) and leakage may range from occasional to continuous. There is often a history of toilet avoidance leading to constipation.
Encopresis without constipation or overflow incontinence
Encopresis is the repeated passage of faeces in inappropriate places occurring repeatedly (e.g., at least once per month over a period of several months) in an individual who has reached the developmental age when faecal continence is ordinarily expected (4 years). The faecal incontinence may have been present from birth (i.e., an atypical extension of normal infantile incontinence), or may have arisen following a period of acquired bowel control. Encopresis sem constipation and overflow is not associated com retention and impaction of faeces, but rather reflects reluctance, resistance or failure to conform to social norms in defecating in acceptable places in the context of normal physiological control over defecation. Stools are typically of normal consistency and inappropriate defecation is likely to be intermittent.
Enuresis
Enuresis is the repeated voiding of urine into clothes or bed, which may occur during the day or at night, in an individual who has reached a developmental age when urinary continence is ordinarily expected (5 years). The urinary incontinence may have been present from birth (i.e., an atypical extension of normal infantile incontinence), or may have arisen following a period of acquired bladder control. In most cases, the behaviour is involuntary but in some cases it appears intentional. Enuresis should not be diagnosed if unintentional voiding of urine is due to a health condition that interferes com continence (e.g., diseases of the nervous system or musculoskeletal transtornos) or by congenital or acquired abnormalities of the urinary tract.
Single episode depressive disorder
Episódio depressivo único is characterised by the presence or history of one depressive episódio when there is no history of prior depressive episodes. A depressive episódio is characterised by a period of depressed mood or diminished interest in activities occurring most of the day, nearly every day during a period lasting at least two weeks accompanied by other symptoms such as difficulty concentrating, feelings of worthlessness or excessive or inappropriate guilt, hopelessness, recurrent thoughts of death or suicide, changes in appetite or sleep, psychomotor agitation or retardation, and reduced energy or fatigue. There have never been any prior manic, hypomanic, or mixed episodes, which would indicate the presence of a bipolar transtorno.
Single episode depressive disorder, currently in full remission
Episódio depressivo único, currently in completa remissão is diagnosed when the completa definitional requirements for one depressive episódio have been met in the past and there are no longer any significant mood symptoms. There is no history of depressive episodes preceding the episódio under consideration.
Single episode depressive disorder, currently in partial remission
Episódio depressivo único, currently in parcial remissão, is diagnosed when the completa definitional requirements for a depressive episódio have been met and there is no history of prior depressive episodes. The completa definitional requirements for a depressive episódio are no longer met but some significant mood symptoms remain.
Single episode depressive disorder, severe, with psychotic symptoms
Episódio depressivo único, grave, com psychotic symptoms is diagnosed when the definitional requirements for Episódio depressivo único are met and the atual episódio is grave and there are delusions or hallucinations during the episódio. A depressive episódio is characterised by a period of depressed mood or diminished interest in activities occurring most of the day, nearly every day during a period lasting at least two weeks accompanied by other symptoms such as difficulty concentrating, feelings of worthlessness or excessive or inappropriate guilt, hopelessness, recurrent thoughts of death or suicide, changes in appetite or sleep, psychomotor agitation or retardation, and reduced energy or fatigue. In a grave depressive episódio, many or most symptoms of a Depressive episódio are present to a marked degree, or a smaller number of symptoms are present and manifest to an intense degree. The individual has serious difficulty continuing to function in most domains (personal, family, social, educational, occupational, or other important domains). In a grave depressive episódio, many or most symptoms of a Depressive episódio are present to a marked degree, or a smaller number of symptoms are present and manifest to an intense degree. The individual has serious difficulty continuing to function in most domains (personal, family, social, educational, occupational, or other important domains).
Single episode depressive disorder, severe, without psychotic symptoms
Episódio depressivo único, grave, sem psychotic symptoms is diagnosed when the definitional requirements for Episódio depressivo único are met and the atual episódio is grave and there are no delusions or hallucinations during the episódio. A depressive episódio is characterised by a period of depressed mood or diminished interest in activities occurring most of the day, nearly every day during a period lasting at least two weeks accompanied by other symptoms such as difficulty concentrating, feelings of worthlessness or excessive or inappropriate guilt, hopelessness, recurrent thoughts of death or suicide, changes in appetite or sleep, psychomotor agitation or retardation, and reduced energy or fatigue. In a grave depressive episódio, many or most symptoms of a Depressive episódio are present to a marked degree, or a smaller number of symptoms are present and manifest to an intense degree. The individual has serious difficulty continuing to function in most domains (personal, family, social, educational, occupational, or other important domains).
Single episode depressive disorder, mild
Episódio depressivo único, leve, is diagnosed when the definitional requirements of a Depressive episódio are met and the episódio is of leve severity. A depressive episódio is characterised by a period of depressed mood or diminished interest in activities occurring most of the day, nearly every day during a period lasting at least two weeks accompanied by other symptoms such as difficulty concentrating, feelings of worthlessness or excessive or inappropriate guilt, hopelessness, recurrent thoughts of death or suicide, changes in appetite or sleep, psychomotor agitation or retardation, and reduced energy or fatigue. In a leve depressive episódio, the individual is usually distressed by the symptoms and has some difficulty in continuing to function in one or more domains (personal, family, social, educational, occupational, or other important domains). There are no delusions or hallucinations during the episódio.
Single episode depressive disorder, moderate, with psychotic symptoms
Episódio depressivo único, moderado, com psychotic symptoms is diagnosed when the definitional requirements of a depressive episódio have been met, there is no history of prior depressive episodes, the episódio is of moderado severity, and there are delusions or hallucinations during the episódio. A depressive episódio is characterised by a period of depressed mood or diminished interest in activities occurring most of the day, nearly every day during a period lasting at least two weeks accompanied by other symptoms such as difficulty concentrating, feelings of worthlessness or excessive or inappropriate guilt, hopelessness, recurrent thoughts of death or suicide, changes in appetite or sleep, psychomotor agitation or retardation, and reduced energy or fatigue. In a moderado depressive episódio, several symptoms of a depressive episódio are present to a marked degree, or a large number of depressive symptoms of lesser severity are present overall. The individual typically has considerable difficulty functioning in multiple domains (personal, family, social, educational, occupational, or other important domains).
Single episode depressive disorder, moderate, without psychotic symptoms
Episódio depressivo único, moderado, sem psychotic symptoms is diagnosed when the definitional requirements of a depressive episódio have been met, there is no history of prior depressive episodes, the episódio is of moderado severity, and there are no delusions or hallucinations during the episódio. A depressive episódio is characterised by a period of depressed mood or diminished interest in activities occurring most of the day, nearly every day during a period lasting at least two weeks accompanied by other symptoms such as difficulty concentrating, feelings of worthlessness or excessive or inappropriate guilt, hopelessness, recurrent thoughts of death or suicide, changes in appetite or sleep, psychomotor agitation or retardation, and reduced energy or fatigue. In a moderado depressive episódio, several symptoms of a depressive episódio are present to a marked degree, or a large number of depressive symptoms of lesser severity are present overall. The individual typically has considerable difficulty functioning in multiple domains (personal, family, social, educational, occupational, or other important domains).
Single episode depressive disorder, unspecified severity
Episódio depressivo único, não especificado severity is diagnosed when the definitional requirements of a depressive episódio have been met, there is no history of prior depressive episodes, and there is insufficient information to determine the severity of the atual depressive episódio. A depressive episódio is characterised by a period of depressed mood or diminished interest in activities occurring most of the day, nearly every day during a period lasting at least two weeks accompanied by other symptoms such as difficulty concentrating, feelings of worthlessness or excessive or inappropriate guilt, hopelessness, recurrent thoughts of death or suicide, changes in appetite or sleep, psychomotor agitation or retardation, and reduced energy or fatigue. The symptoms are associated com at least some difficulty in continuing com ordinary work, social, or domestic activities.
Episode of harmful use of alcohol
An episódio of uso of alcohol that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others. Harm to health of the individual occurs due to one or more of the following: (1) behaviour related to intoxicação; (2) direct or secondary toxic effects on body organs and systems; or (3) a nocivo route of administration. Harm to health of others includes any form of physical harm, including trauma, or mental transtorno that is directly attributable to behaviour due to alcohol intoxicação on the part of the person to whom the diagnosis of single episódio of nocivo uso applies. This diagnosis should not be made if the harm is attributed to a known padrão of alcohol uso.
Episode of harmful use of caffeine
An episódio of caffeine uso that has caused damage to a person’s physical or mental health. Harm to health of the individual occurs due to one or more of the following: (1) direct or secondary toxic effects on body organs and systems; or (2) a nocivo route of administration. This diagnosis should not be made if the harm is attributed to a known padrão of caffeine uso.
Episode of harmful use of cannabis
An episódio of uso of cannabis that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others. Harm to health of the individual occurs due to one or more of the following: (1) behaviour related to intoxicação; (2) direct or secondary toxic effects on body organs and systems; or (3) a nocivo route of administration. Harm to health of others includes any form of physical harm, including trauma, or mental transtorno that is directly attributable to behaviour due to cannabis intoxicação on the part of the person to whom the diagnosis of single episódio of nocivo uso applies. This diagnosis should not be made if the harm is attributed to a known padrão of cannabis uso.
Episode of harmful use of cocaine
An episódio of uso of cocaine that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others. Harm to health of the individual occurs due to one or more of the following: (1) behaviour related to intoxicação; (2) direct or secondary toxic effects on body organs and systems; or (3) a nocivo route of administration. Harm to health of others includes any form of physical harm, including trauma, or mental transtorno that is directly attributable to behaviour due to cocaine intoxicação on the part of the person to whom the diagnosis of single episódio of nocivo uso applies. This diagnosis should not be made if the harm is attributed to a known padrão of cocaine uso.
Episode of harmful use of dissociative drugs including ketamine or PCP
An episódio of uso of a dissociative drug, including Ketamine and PCP, that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others. Harm to health of the individual occurs due to one or more of the following: (1) behaviour related to intoxicação; (2) direct or secondary toxic effects on body organs and systems; or (3) a nocivo route of administration. Harm to health of others includes any form of physical harm, including trauma, or mental transtorno that is directly attributable to behaviour due to intoxicação com a dissociative drug, including Ketamine and PCP, on the part of the person to whom the diagnosis of single episódio of nocivo uso applies. This diagnosis should not be made if the harm is attributed to a known padrão of uso of dissociative drugs, including Ketamine and PCP.
Episode of harmful use of hallucinogens
An episódio of hallucinogen uso that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others. Harm to health of the individual occurs due to one or more of the following: (1) behaviour related to intoxicação; (2) direct or secondary toxic effects on body organs and systems; or (3) a nocivo route of administration. Harm to health of others includes any form of physical harm, including trauma, or mental transtorno that is directly attributable to behaviour due to hallucinogen intoxicação on the part of the person to whom the diagnosis of single episódio of nocivo uso applies. This diagnosis should not be made if the harm is attributed to a known padrão of hallucinogen uso.
Episode of harmful use of MDMA or related drugs, including MDA
An episódio of uso of MDMA or related drugs, including MDA, that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others. Harm to health of the individual occurs due to one or more of the following: (1) behaviour related to intoxicação; (2) direct or secondary toxic effects on body organs and systems; or (3) a nocivo route of administration. Harm to health of others includes any form of physical harm, including trauma, or mental transtorno that is directly attributable to behaviour due to intoxicação com MDMA or related drugs, including MDA, on the part of the person to whom the diagnosis of single episódio of nocivo uso applies. This diagnosis should not be made if the harm is attributed to a known padrão of uso of MDMA or related drugs, including MDA.
Episode of harmful use of multiple specified psychoactive substances
An episódio of uso of multiple specified psychoactive substances or medications that are not included in the other substance classes specifically identified under transtorno Due to Substance uso that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others. Harm to health of the individual occurs due to one or more of the following: (1) behaviour related to multiple substance intoxicação or psychoactive medication uso; (2) direct or secondary toxic effects on body organs and systems; or (3) a nocivo route of administration. Harm to health of others includes any form of physical harm, including trauma, or mental transtorno that is directly attributable to behaviour due to multiple substance intoxicação or psychoactive medication uso on the part of the person to whom the diagnosis of single episódio of nocivo uso of multiple specified psychoactive substances applies. This diagnosis should not be made if the harm is attributed to a known padrão of uso of the multiple psychoactive substances.
Episode of harmful use of nicotine
An episódio of nicotine uso that has caused damage to a person’s physical or mental health. Harm to health of the individual occurs due to one or more of the following: (1) direct or secondary toxic effects on body organs and systems; or (2) a nocivo route of administration. This diagnosis should not be made if the harm is attributed to a known padrão of nicotine uso.
Episode of harmful use of non-psychoactive substances
An episódio of uso of a non-psychoactive substance that has caused damage to a person’s physical or mental health. Harm to health of the individual occurs due to direct or secondary toxic effects on body organs and systems or a nocivo route of administration. This diagnosis should not be made if the harm is attributed to a known padrão of non-psychoactive substance uso.
Episode of harmful use of opioids
An episódio of opioid uso that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others. Harm to health of the individual occurs due to one or more of the following: (1) behaviour related to intoxicação; (2) direct or secondary toxic effects on body organs and systems; or (3) a nocivo route of administration. Harm to health of others includes any form of physical harm, including trauma, or mental transtorno that is directly attributable to behaviour due to opioid intoxicação on the part of the person to whom the diagnosis of single episódio of nocivo uso applies. This diagnosis should not be made if the harm is attributed to a known padrão of opioid uso.
Episode of harmful use of other specified psychoactive substance
An episódio of uso of a specified psychoactive substance or medication that is not included in the other substance classes specifically identified under transtornos Due to Substance uso that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others. Harm to health of the individual occurs due to one or more of the following: (1) behaviour related to substance intoxicação or psychoactive medication uso; (2) direct or secondary toxic effects on body organs and systems; or (3) a nocivo route of administration. Harm to health of others includes any form of physical harm, including trauma, or mental transtorno that is directly attributable to behaviour related to substance intoxicação or psychoactive medication uso on the part of the person to whom the diagnosis of single episódio of nocivo uso of outro especificado psychoactive substance applies. This diagnosis should not be made if the harm is attributed to a known padrão of uso of the specified psychoactive substance.
Episode of harmful use of sedatives, hypnotics or anxiolytics
An episódio of uso of a sedative, hypnotic or anxiolytic that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others. Harm to health of the individual occurs due to one or more of the following: (1) behaviour related to intoxicação; (2) direct or secondary toxic effects on body organs and systems; or (3) a nocivo route of administration. Harm to health of others includes any form of physical harm, including trauma, or mental transtorno that is directly attributable to behaviour due to sedative, hypnotic or anxiolytic intoxicação on the part of the person to whom the diagnosis of single episódio of nocivo uso applies. This diagnosis should not be made if the harm is attributed to a known padrão of sedative, hypnotic or anxiolytic uso.
Episode of harmful use of stimulants including amphetamines, methamphetamine or methcathinone
An episódio of uso of a stimulant including amphetamines, methamphetamine and methcathinone that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others. Harm to health of the individual occurs due to one or more of the following: (1) behaviour related to intoxicação; (2) direct or secondary toxic effects on body organs and systems; or (3) a nocivo route of administration. Harm to health of others includes any form of physical harm, including trauma, or mental transtorno that is directly attributable to behaviour due to stimulant intoxicação on the part of the person to whom the diagnosis of single episódio of nocivo uso applies. This diagnosis should not be made if the harm is attributed to a known padrão of stimulant including amphetamines, methamphetamine and methcathinone uso.
Episode of harmful use of synthetic cannabinoids
An episódio of uso of a synthetic cannabinoid that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others. Harm to health of the individual occurs due to one or more of the following: (1) behaviour related to intoxicação; (2) direct or secondary toxic effects on body organs and systems; or (3) a nocivo route of administration. Harm to health of others includes any form of physical harm, including trauma, or mental transtorno that is directly attributable to behaviour due to synthetic cannabinoid intoxicação on the part of the person to whom the diagnosis of single episódio of nocivo uso applies. This diagnosis should not be made if the harm is attributed to a known padrão of synthetic cannabinoid uso.
Episode of harmful use of synthetic cathinones
An episódio of synthetic cathinone uso that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others. Harm to health of the individual occurs due to one or more of the following: (1) behaviour related to intoxicação; (2) direct or secondary toxic effects on body organs and systems; or (3) a nocivo route of administration. Harm to health of others includes any form of physical harm, including trauma, or mental transtorno that is directly attributable to behaviour due to synthetic cathinone intoxicação on the part of the person to whom the diagnosis of single episódio of nocivo uso applies. This diagnosis should not be made if the harm is attributed to a known padrão of synthetic cathinone uso.
Episode of harmful use of unknown or unspecified psychoactive substances
An episódio of uso of an unknown or não especificado psychoactive substance that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others. Harm to health of the individual occurs due to one or more of the following: (1) behaviour related to intoxicação or abstinência; (2) direct or secondary toxic effects on body organs and systems; or (3) a nocivo route of administration. Harm to health of others includes any form of physical harm, including trauma, or mental transtorno that is directly attributable to behaviour due to substance intoxicação or abstinência on the part of the person to whom the diagnosis of single episódio of nocivo uso applies. This diagnosis should not be made if the harm is attributed to a known padrão of uso of the unknown or não especificado psychoactive substance.
Episode of harmful use of volatile inhalants
An episódio of volatile inhalant uso or unintentional exposure (e.g., occupational exposure) that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others. Harm to health of the individual occurs due to one or more of the following: (1) behaviour related to intoxicação; (2) direct or secondary toxic effects on body organs and systems; or (3) a nocivo route of administration. Harm to health of others includes any form of physical harm, including trauma, or mental transtorno that is directly attributable to behaviour due to volatile inhalant intoxicação on the part of the person to whom the diagnosis of single episódio of nocivo uso applies. This diagnosis should not be made if the harm is attributed to a known padrão of volatile inhalant uso.
Schizophrenia
Esquizofrenia is characterised by disturbances in multiple mental modalities, including thinking (e.g., delusions, disorganisation in the form of thought), perception (e.g., hallucinations), self-experience (e.g., the experience that one's feelings, impulses, thoughts, or behaviour are under the control of an external force), cognition (e.g., impaired attention, verbal memory, and social cognition), volition (e.g., loss of motivation), affect (e.g., blunted emotional expression), and behaviour (e.g., behaviour that appears bizarre or purposeless, unpredictable or inappropriate emotional responses that interfere com the organisation of behaviour). Psychomotor disturbances, including Catatonia, may be present. Persistent delusions, persistent hallucinations, thought transtorno, and experiences of influence, passivity, or control are considered core symptoms. Symptoms must have persisted for at least one month in order for a diagnosis of Esquizofrenia to be assigned. The symptoms are not a manifestation of another health condition (e.g., a brain tumour) and are not due to the effect of a substance or medication on the central nervous system (e.g., corticosteroids), including abstinência (e.g., alcohol abstinência).
Schizophrenia, continuous
Symptoms fulfilling all definitional requirements of Esquizofrenia have been present for almost all of the illness course over a period of at least one year, com periods of subthreshold symptoms being very brief relative to the overall course.
Schizophrenia, continuous, currently symptomatic
All definitional requirements for Esquizofrenia, continuous in terms of symptoms and duration are currently met, or have been met within the past one month.
Schizophrenia, continuous, in full remission
All definitional requirements for Esquizofrenia, continuous in terms of symptoms and duration were previously met. Symptoms have ameliorated such that no significant symptoms remain. The remissão may have occurred in response to medication or other treatment.
Schizophrenia, continuous, in partial remission
All definitional requirements for Esquizofrenia, continuous in terms of symptoms and duration were previously met. Symptoms have ameliorated such that the diagnostic requirements for the transtorno have not been met for at least one month, but some clinically significant symptoms remain, which may or may not be associated com functional impairment. The parcial remissão may have occurred in response to medication or other treatment.
Schizophrenia, first episode
Esquizofrenia, first episódio should be used to identify individuals experiencing symptoms that meet the diagnostic requirements for Esquizofrenia (including duration) but who have never before experienced an episódio during which diagnostic requirements for Esquizofrenia were met.
Schizophrenia, first episode, currently symptomatic
All definitional requirements for Esquizofrenia, first episódio in terms of symptoms and duration are currently met, or have been met within the past one month.
Schizophrenia, first episode, in full remission
All definitional requirements for Esquizofrenia, first episódio in terms of symptoms and duration were previously met. Symptoms have ameliorated such that no significant symptoms remain. The remissão may have occurred in response to medication or other treatment.
Schizophrenia, first episode, in partial remission
All definitional requirements for Esquizofrenia, first episódio in terms of symptoms and duration were previously met. Symptoms have ameliorated such that the diagnostic requirements for the transtorno have not been met for at least one month, but some clinically significant symptoms remain, which may or may not be associated com functional impairment. The parcial remissão may have occurred in response to medication or other treatment.
Schizophrenia, multiple episodes
Esquizofrenia, multiple episodes should be used to identify individuals experiencing symptoms that meet the diagnostic requirements for Esquizofrenia and who have also previously experienced episodes during which diagnostic requirements were met, com substantial remissão of symptoms between episodes. Some attenuated symptoms may remain during periods of remissão, and remissions may have occurred in response to medication or other treatment.
Schizophrenia, multiple episodes, currently symptomatic
All definitional requirements for Esquizofrenia, multiple episodes in terms of symptoms and duration are currently met, or have been met within the past one month.
Schizophrenia, multiple episodes, in full remission
All definitional requirements for Esquizofrenia, multiple episodes in terms of symptoms and duration were previously met. Symptoms have ameliorated such that no significant symptoms remain. The remissão may have occurred in response to medication or other treatment.
Schizophrenia, multiple episodes, in partial remission
All definitional requirements for Esquizofrenia, multiple episodes in terms of symptoms and duration were previously met. Symptoms have ameliorated such that the diagnostic requirements for the transtorno have not been met for at least one month, but some clinically significant symptoms remain, which may or may not be associated com functional impairment. The parcial remissão may have occurred in response to medication or other treatment.
Exhibitionistic disorder
Exhibitionistic transtorno is characterised by a sustained, focused and intense padrão of sexual arousal—as manifested by persistent sexual thoughts, fantasies, urges, or behaviours—that involves exposing one’s genitals to an unsuspecting individual in public places, usually sem inviting or intending closer contact. In addition, in order for Exhibitionistic transtorno to be diagnosed, the individual must have acted on these thoughts, fantasies or urges or be markedly distressed by them. Exhibitionistic transtorno specifically excludes consensual exhibitionistic behaviours that occur com the consent of the person or persons involved as well as socially sanctioned forms of exhibitionism.