The essential feature is spending considerable time repetitively seeking out viewing opportunities. All sexual activity is related to voyeurism for a person with the most severe form. The voyeur does not seek sexual contact with those he is observing. The disorder must be differentiated from normal sexual curiosity between persons who know each other. Sadomasochistic fantasies and sexual behavior between consenting adults is very common.
Masochistic activity tends to be ritualized and chronic.
For most practitioners, the humiliation and beating are simply acted out in fantasy, with participants knowing that it is a game and carefully avoiding actual humiliation or injury. However, some masochists increase the severity of their activity as time goes on, potentially leading to serious injury or death. Masochistic activities may be the preferred or exclusive mode of producing sexual excitement. Activities with a partner include bondage, blindfolding, spanking, flagellation, humiliation by means of urination or defecation on the person, forced cross-dressing, or simulated rape. The intent is to enhance orgasm, but accidental deaths occasionally result from this activity.