Fetishistic disorder is an intense sexual attraction to either inanimate objects or to body parts not traditionally viewed as sexual, coupled with clinically significant distress or impairment.
The term "fetishism" originates from the Portuguese word feitico, which means "obsessive fascination." Most individuals find particular nongenital bodily features attractive, indicating that some level of fetishism is a normal feature of human sexuality. However, fetishistic arousal may become a problem when it interferes with normal sexual or social functioning, or when sexual arousal is impossible without the fetish object.
According to the DSM-5, fetishistic disorder is characterized as a condition in which there is a persistent and repetitive use of or dependence on nonliving objects (such as undergarments or high-heeled shoes) or a highly specific focus on a body part (most often nongenital, such as feet) to reach sexual arousal. Only through use of this object, or focus on this body part, can the individual obtain sexual gratification. In earlier versions of the DSM, fetishistic disorder revolving around nongenital body parts was known as partialism; in the latest version, partialism was folded into fetishistic disorder.
Since fetishes occur in many normally developing individuals, a diagnosis of fetishistic disorder is only given if there is accompanying personal distress or impairment in social, occupational, or other important areas of functioning as a result of the fetish. People who identify as fetishists but do not report associated clinical impairment would be considered to have a fetish but not fetishistic disorder.
Common fetish objects include undergarments, footwear, gloves, rubber articles, and leather clothing. Body parts associated with fetishistic disorder include feet, toes, and hair. It is common for the fetish to include both inanimate objects and body parts (e.g., socks and feet). For some, merely a picture of the fetish object may cause arousal, though many with a fetish prefer (or require) the actual object in order to achieve arousal. The fetishist usually holds, rubs, tastes, or smells the fetish object for sexual gratification or asks their partner to wear the object during sexual encounters.
Inanimate object fetishes can be categorized into two types: form fetishes and media fetishes. In a form fetish, the shape of the object is important, such as high-heeled shoes. In a media fetish, the material of the object, such as silk or leather, is important. Inanimate object fetishists often collect the object of their favor.
Fetishistic disorder is a much more common occurrence in males than in females—in fact, the DSM-5 indicates that it appears almost exclusively in males.
Fetishism falls under the general category of paraphilic disorders, which refers to intense sexual attraction to any objects or people outside of genital stimulation with consenting adult partners.
The sexual acts of people with fetishistic disorder are characteristically focused almost exclusively on the fetish object or body part. Sexually active adults without fetishistic disorder—or adults with a specific fetish that causes them no distress—may at various times become aroused by a particular body part or an object and make it a part of their sexual interaction with another person, but not fixate on it. In many cases, a person with fetishistic disorder can only become sexually aroused and reach orgasm when the fetish is being used, often feeling intense shame or distress about their inability to become aroused using "typical" stimuli. In other instances, a sexual response may occur without the fetish, but at a diminished level, which may cause shame or relationship tension.
The diagnostic criteria for fetishistic disorder, as catalogued in the DSM-5, includes:
- For a period of at least six months, the person has recurrent, intense, sexually arousing fantasies, urges, or behaviors involving nonliving objects (such as female undergarments and shoes) or a highly specific focus on nongenital body part(s).
- The fantasies, sexual urges, or behaviors cause significant distress or impair social, occupational, or personal functioning.
- The fetish objects are not articles of clothing used in cross-dressing and are not designed for tactile genital stimulation, such as a vibrator.
Paraphilias such as fetishistic disorder typically have an onset during puberty, but fetishes can develop prior to adolescence. No cause for fetishistic disorder has been conclusively established.
Some theorists believe that fetishism develops from early childhood experiences, in which an object was associated with a particularly powerful form of sexual arousal or gratification. Other learning theorists focus on later childhood and adolescence and the conditioning associated with masturbation and puberty.
Behavioral learning models suggest that a child who is the victim or observer of inappropriate sexual behaviors may learn to imitate or later be reinforced for the behavior. Compensation models suggest that these individuals may be deprived of normal social sexual contacts, and thus seek gratification through less socially acceptable means.
In cases involving males, some experts have suggested that fetishistic disorder may stem from doubts about one’s own masculinity, potency, or a fear of rejection and humiliation. By using fetishistic practices to exert control over an inanimate object, the theory goes, an individual may safeguard himself from or compensate for feelings of inadequacy.
Fetishistic fantasies are common and in many cases harmless. According to the DSM definition, they should only be treated as a disorder when they cause distress or impair a person's ability to function normally in day-to-day life.
Fetishistic disorder tends to fluctuate in intensity and frequency of urges or behavior over the course of an individual’s life. As a result, effective treatment is usually long-term. Though the DSM-5 does not specify particular treatments, successful approaches have included various forms of therapy as well as medication therapy (such as SSRI's or androgen deprivation therapy). Some prescription medications may help to decrease the compulsive thinking associated with fetishistic disorder. This allows a patient to concentrate on counseling with fewer distractions.
Increasingly, evidence suggests that combining drug therapy with cognitive behavioral therapy can be effective, although research on the outcome of these therapies remains inconclusive. A class of drugs called antiandrogens can drastically lower testosterone levels temporarily, and have been used in conjunction with other forms of treatment for fetishistic disorder. This medication lowers sex drive in males and thus can reduce the frequency of sexually arousing mental imagery.
The level of sex drive is not consistently related to the behavior of those with fetishistic disorder, and 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, potentially reducing sex drive and aggression—and, in the case of an individual with fetishistic disorder, potentially resulting in a reduction of the frequency of erections, sexual fantasies, and initiation of sexual behaviors, including masturbation and intercourse. Hormones are typically used in tandem with behavioral and cognitive treatments. Antidepressants such as fluoxetine (Prozac) may also decrease sex drive but have not been shown to effectively target sexual fantasies themselves.
Some research suggests that cognitive-behavioral models may be effective in treating people with paraphiliac disorders. Aversive conditioning, for instance, involves using negative stimuli to reduce or eliminate a behavior. One approach, called covert sensitization, entails the patient relaxing and visualizing scenes of deviant behavior, followed by a visualization of a negative event. Another approach, known as assisted aversive conditioning, is similar to covert sensitization, except the negative event is made real (for example, a foul odor is pumped in the air by the therapist). In both treatments, the goal is for the patient to associate the deviant behavior with the negative event (either the visualized event, or the foul odor).
Reconditioning techniques center on immediate feedback given to the patient so that the behavior will change right away. For example, a person might be connected to a biofeedback machine that is linked to a light, then taught self-regulation techniques that will keep the light within a specific range of color. They then practice doing this while being exposed to sexually stimulating material. Masturbation training might focus on separating the pleasure of masturbation and climax from the deviant behavior.