Before the release of the DSM-5 in 2013, this disorder was known as Fetishism. In the DSM-5, it is now known as Fetishistic Disorder and is classified as a Paraphilic Disorder, which requires the presence of a paraphilia that is causing significant distress or impairment or involves personal harm or risk of harm to others. A paraphilia involves intense and persistent sexual interest (recurrent fantasies, urges or behaviours of a sexual nature) that centre around children, non-humans (animals, objects, materials), or harming others or one’s self during sexual activity. Sometimes this sexual interest focuses on the person’s own erotic/sexual activities while in other cases, it focuses on the target of the person’s sexual interest. To be diagnosed with a Paraphilic Disorder, the paraphilia needs to be causing significant distress or impairment, or involve personal harm or risk of harm to others. You can have a paraphilia, but not have a paraphilic disorder. It is only when it causes impairment, harm or the risk of harm that it becomes a clinical diagnosis.
Symptoms of Fetishistic Disorder include:
- Throughout at least six months, a person has had recurrent and intense sexual arousal from fantasies, sexual urges or behaviours from either the use of non-living objects or a highly specific focus on non-genital body parts.
- The fantasies, sexual urges and behaviours are causing clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The fetish objects are not limited to articles of clothing used in cross-dressing (as is a transvestic disorder) or devices specifically designed for genital stimulation (such as a vibrator).
Clinicians can specify if the fetish is a:
- Body part(s)- often includes feet, toes, and hair.
- Non-living object(s)- Frequently, fetish objects include shoes (men’s or women’s), and women’s underwear, panties or bras. They may be made of particular materials such as leather or rubber. It is common for a person with a fetish not to be able to achieve orgasm without involving their fetish object in the sexual act (e.g., by getting their partner to wear the fetish object).
They can also specify if the disorder is:
- In a controlled environment- usually applicable to people who are living in institutions or other settings where opportunities to engage in fetishistic behaviours are restricted.
- In full remission- there has not been distress or impairment in social, occupational or other areas of functioning for at least five years while in an uncontrolled (non-institutional) environment.
How common is Fetishistic Disorder?
The prevalence of Fetishistic Disorder in the general population is unknown. Paraphilias often have an onset during puberty, but fetishes can develop before this time. Once developed, they tend to be long-lasting but can fluctuate in intensity and frequency over time.
What are the risk factors for Fetishistic Disorder?
Risk factors have not yet been identified for this disorder.
What other disorders or conditions often occur with Fetishistic Disorder?
This disorder may occur with other paraphilic disorders and hypersexuality (having extremely frequent or suddenly increased sexual urges or sexual activity).
How is Fetishistic Disorder treated?
Because those with this disorder can feel extremely embarrassed or shameful, they rarely seek professional treatment. When they do so, psychotherapy is the most common treatment.
Cognitive-behavioural therapy can be used where the therapist helps the person discover the underlying cause of the behaviour and then works with the person to teach skills to manage the sexual urges in more healthy ways. This may include the use of aversion therapy and different types of imagery/ desensitisation in which the person imagines themselves in the situation and then experiencing a negative event to reduce future interest in participating in the fetishistic activities. Cognitive restructuring (identifying and changing the thoughts that drive the behaviour) and thought stopping techniques may also be used.
Medications that target the compulsive thinking (similar to those found in an Obsessive-Compulsive Spectrum Disorder), antidepressants and anti-anxiety medications can also be used in conjunction with therapy.
Credit: Kathryn Patricelli, MA., for Northern Wyoming Mental Health Center, Inc., 2018.