Fetishism (Treatments)

Almost always the treatment must be long-term if it is to be effective. Treatment approaches have included traditional psychoanalysis, hypnosis, cognitive and behavior therapy as well as pharmacotherapy. Some prescription medicines help to decrease the compulsive thinking associated with the paraphilias. This allows concentration on counseling without as strong a distraction from the paraphiliac urges. Increasingly, the evidence suggests that combining drug therapy with cognitive behavior therapy can be effective, although research on the outcome of these therapies has been incomplete and often appear not to have been successful. More recently, a class of drugs called antiandrogens that drastically lower testosterone levels temporarily have been used in conjunction with these forms of treatment. The drug lowers the sex drive in males and reduces the frequency of sexually arousing mental imagery. This helps the individual concentrate on counseling. Increasingly, the evidence suggests that combining drug therapy with cognitive behavior therapy can be effective.

The level of sex drive is not consistently related to the behavior of paraphiliacs and that high levels of circulating testosterone do not predispose a male to paraphilias. That said, hormones such as medroxyprogesterone acetate (Depo-Provera) and cyproterone acetate help decrease the level of circulating testosterone thus reducing sex drive and aggression and resulting in reduction of frequency of erections, sexual fantasies and initiations of sexual behaviors including masturbation and intercourse. Hormones are typically used in tandem with behavioral and cognitive treatments. Antidepressants such as fluoxetine (Prozac) have also successfully decreased the sex drive but have not effectively targeted sexual fantasies.