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.
According to the DSM-5, fetishistic disorder is 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.
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, or when sexual arousal is impossible without the fetish object. People who identify as fetishists but do not report associated clinical impairment would be considered to have a fetish but not fetishistic disorder. Most individuals find particular nongenital bodily features attractive, indicating that some level of fetishism is a normal feature of human sexuality.
The term "fetishism" originates from the Portuguese word feitico, which means "obsessive fascination." Only through the use of this object, or focus on this body part, can the individual obtain sexual gratification.
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.
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.
The sexual acts of people with fetishistic disorder are characteristically focused almost exclusively on the fetish object or body part. 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.
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.
The diagnostic criteria for fetishistic disorder, as catalogued in the DSM-5, include:
- 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 parts.
- 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.
Fetishistic disorder can fluctuate in intensity throughout the lifespan.
Research indicates that nearly anything can become the object of a fetish. The most prevalent body fetishes are for feet, hands, hair, obesity, tattoos, and piercings. The most prevalent fetish objects are shoes, gloves, and (soiled) underwear, leather, rubber, skirts, gloves, and wearing diapers.
A sexual fetish is not unhealthy by definition, but if it causes prolonged, intense distress in a person, it may then be considered a fetishistic disorder. A festishistic disorder can make someone feel as if they’re no longer in control of their lives. A man who incorporates a fetish into his romantic relationship with a consenting partner does not necessarily display unhealthy behavior. But if the man is so consumed by his fetish that he is no longer sexually attracted to his partner and can only be aroused by his fetish item, then that is likely a sign of an unhealthy fetish.
Limited research indicates that individuals often have more than one fetish. One small study found that of 48 individuals with fetishistic disorder, 17 had only one fetish, nine had two fetishes, 12 had three fetishes, six had four fetishes, and others had up to nine fetishes.
Fetishes typically become apparent to an individual during or even prior to puberty. Sexual fetishes almost exclusively develop in males.
While estimates are that as much as 10 percent of the population may have some type of fetish, fetishistic disorder appears to be rare, with less than 1 percent of the population in psychiatric care for the condition.
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 theories include childhood experiences; biological factors, such as abnormal brain development; and cultural factors, as studies have shown different rates of fetishism in cultures that approach sexuality differently from each other.
One neurological idea about the cause of foot fetishes comes from the fact that the region in the brain that processes sensory information from the feet is adjacent to the area that processes sensory information from the genitals. This idea, advanced by neurologist Vilayanaur Ramachandran, postulates that there may be some “neural crosstalk” between the two brain areas. Body parts whose cortical representation is further away from that of the genitals are less likely to be fetishized, as feet are the most common fetish.
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.
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.
While a number of therapy-based and medication-based treatments can help control symptoms of fetishistic disorder, patients should know that there have historically been limitations on the degree to which therapy and medication, or a combination of the two can help. These therapies typically treat the symptoms—anxiety, shame, relationship problems—that bring a patient in to be treated, but many people with fetishes may retain a desire for their fetish item long-term. A primary outcome of the various therapies is to help patients cope better.
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. Increasingly, evidence suggests that combining drug therapy with cognitive behavioral therapy can be effective, although research on the outcome of these therapies remains inconclusive. This allows a patient to concentrate on counseling with fewer distractions.
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.
Cognitive-behavioral models of therapy may be effective in treating people with paraphiliac disorders. These include sensitization, aversive conditioning, and reconditioning. 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.
A class of drugs called antiandrogens can temporarily lower testosterone levels 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. Antidepressants such as fluoxetine (Prozac) may also decrease sex drive but have not been shown to effectively target sexual fantasies themselves. Hormones are typically used in tandem with behavioral and cognitive treatments.
Some of the therapeutic treatments for fetishistic disorder include aversive conditioning and sensitization. Covert sensitization entails the patient relaxing and visualizing scenes of deviant behavior, followed by the visualization of a negative event.
Another approach, known as assisted aversive conditioning, is similar to covert sensitization, but amplified in that 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 new input, e.g. the odor).