Fetishistic disorder is characterized by the persistent use of traditionally non-sexual body parts or inanimate objects to reach sexual arousal.1 Commonly fetishized body parts include feet or hair, and commonly fetishized objects include articles of clothing, such as shoes or undergarments. Fetishes only become a mental disorder when they cause significant distress, impairment, or harm to self or others.
Fetishistic disorder is most often diagnosed through self-report of symptoms to a mental health practitioner, such as a psychiatrist, psychologist, or psychotherapist. Treatment is possible through conversations with your partner and support from a certified mental health professional.
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What Is a Fetish?
A fetish involves the repetitive use or dependence on a non-living object (shoes, leather) and/or a traditionally non-sexual body part (feet, hair) in order to achieve sexual satisfaction. Sexual fetishes frequently include both inanimate objects and body parts (legs in latex, feet in boots). The fetish object may create sexual arousal through any or all of the senses, including feel, smell, or appearance. Over time, people may also acquire extensive collections of fetish objects.
Fetishes involving inanimate objects fall into two general categories: form fetishes and media fetishes. Form fetishes center on the size, shape, and appearance of an object, whereas media fetishes focus on the texture or feel of an object. An object may fall into both categories, as is the case for a latex fetish—latex has both a specific appearance and a unique texture. An individual’s fetish may focus on the form or media aspects of an object more strongly in order to achieve sexual gratification.
Are Fetishes Normal?
Yes, sexual fetishes are quite normal, and many people have them. There is nothing inherently wrong or bad about having fetishes, and they can be enjoyed within a consensual sexual relationship. Fetishes may emerge at any point in time, but many people first notice them around puberty or late adolescence. They may evolve throughout adulthood.
Kink Vs. Fetish
Although people sometimes use the terms interchangeably, a kink refers to a sexual preference that’s typically considered less mainstream (although this is inherently subjective), but that someone doesn’t need to have this preference met to receive sexual enjoyment. But when someone has a fetish, they generally rely on that fetish to become aroused or achieve orgasm.
What Is Fetishistic Disorder?
Fetishistic disorder is a subcategory of paraphilic disorders, which occur when a paraphilia causes significant distress, functional impairment, and/or harm to self or others. During masturbation, the fetish object may be held, tasted, smelled, or used to stimulate the genitals. Some people with fetishistic disorder may prefer solitary sexual activity even when in a reciprocal partner relationship. Others may incorporate the fetish object in partnered sexual activity, often by asking a partner to wear or touch the object in order to achieve arousal.
When Is a Fetish “Disordered”?
Most people who have fetishistic interests do not experience significant distress or cause harm and would therefore not be classified as having a disorder. With fetishistic disorder, fetish objects are required or strongly preferred in order for arousal to occur. The more exclusively an individual’s arousal centers on a particular object or body part, the more likely it is that fetishism will cause distress in the form of sexual anxiety or relational issues. A common impairment associated with fetishistic disorder is sexual dysfunction when the preferred object or body part is not present.
How Common Is Fetishistic Disorder?
While many people have fetishes, the exact prevalence of people meeting the clinical criteria for fetishistic disorder is unknown. This is likely due to the shame, stigma, and societal taboo surrounding paraphilias. However, research shows that men are more likely to have this condition than women.2
Common Types of Fetishes
There are countless kinds of fetishes. Feet, underwear, and shoes are among some of the most common types. Other parts of the body, including hair, wearing certain kinds of makeup, body piercings, navels, noses, arms, and legs can also be fetishized.
Examples of common fetishes include:
- Lingerie
- Leather
- Certain clothing colors or materials
- Costumes
- Body fluids
- Non-sexual objects used sexually
Symptoms of Fetishistic Disorder
The main symptom of fetishistic disorder is a recurrent and intense sexual arousal from either the use of nonliving objects or a highly specific focus on nongenital body part(s), manifesting as fantasies, urges, or behaviors. A person with fetishistic disorder may feel sexual shame and distress at the atypical focus of their sexual desire.1
Symptoms of fetishistic disorder include:1
- Recurrent and intense sexual arousal from inanimate objects or nongenital body parts, persisting for at least six months
- These feelings cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
- The fetish objects are not limited to objects or devices specifically designed for the purpose of genital stimulation (sex toys, such as vibrators or dildos).
Sexually active adults may occasionally become aroused by objects or by traditionally non-sexual body parts, but in the absence of fixation and mental distress, this attraction would not be classified as fetishistic disorder.
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What Causes Fetishes to Develop?
Fetishes typically develop with the onset of puberty. Some theorists believe that fetishistic interests arise due to an object or body part’s association with a person’s earliest experiences of sexual arousal or masturbation.There is no conclusive evidence regarding what causes or triggers fetishistic disorder.
Impacts of Fetishistic Disorder on Individuals & Relationships
Fetishistic disorder commonly leads to shame and emotional distress in people who experience this type of arousal. Internal conflict and fear of judgment can lead to isolation and difficulty finding or honestly communicating in sexual relationships. Additionally, partners of those with fetishistic disorder may feel inadequate, unattractive or worried about the implications of a fetishistic interest.
Sexual dysfunction often occurs when the fetishistic object is not present. erectile dysfunction (ED) or delayed ejaculation (DE) may lead individuals or couples to seek treatment.
How Is Fetishistic Disorder Diagnosed?
Some people first come to terms with their fetishistic disorder via their own self-reporting or self-diagnosing. These individuals can readily identify the distress associated with having their fetish, and have likely done some of their own research. A mental health professional, such as a psychologist or therapist, can accurately diagnose fetishistic disorder using the criteria outlined in the DSM-5.
Treatment of Fetishistic Disorder
Sex therapy with a certified therapist who specializes in paraphilias is the best form of treatment for fetishistic disorder. A certified sex therapist may utilize cognitive behavioral therapy (CBT) to identify and change the fetishistic behaviors. CBT has been proven to be effective for treating fetishistic disorder in combination with medication.
Sex Therapy
Sex therapy with a certified sex therapist who specializes in paraphilias will ensure a knowledgeable and non-judgmental approach to psychotherapy. A sex therapist will take a detailed sexual and psychosocial history to assess for factors that contribute to the fetishistic interest and its expression through urges, fantasies and behaviors.
The therapist will explore the onset and context of the symptoms being experienced, especially any changes in the situations or cues that have escalated fetishistic thoughts or urges. They will then likely offer coaching on mindfulness and behavioral techniques that either an individual or couple can explore. Co-occurring psychological conditions, such as mood disorders or hypersexuality, will also be assessed and treated.
Cognitive Behavioral Therapy (CBT)
Sex therapists with CBT training will employ cognitive restructuring techniques to identify and change thoughts and behaviors. They may utilize aversion therapy or guided imagery to reduce interest in fetishistic objects. Studies have shown CBT to be an effective treatment for fetishism disorder when utilized in conjunction with medication.
SSRIs
Selective serotonin reuptake inhibitors (SSRIs) such as Prozac (fluoxetine) can help with co-occurring mood disorders, such as depression or anxiety, lowering sex drive. Many people who take SSRIs will experience sexual side effects, often including diminished interest in sex. A lowered sex drive can help with the impulsivity associated with fetishistic thoughts and behaviors, however, does not directly address the fetishistic urge without therapy.
Antiandrogens
Medroxyprogesterone acetate and cyproterone acetate are members of a class of drugs called antiandrogens that can be used to lower testosterone levels temporarily in order to reduce sex drive and allow for more effective therapy. These drugs help reduce the levels of circulating testosterone and prime the recipient for cognitive restructuring therapy techniques.
How to Get Help for Fetishistic Disorder
Most people who suffer from fetishistic disorder do not seek treatment due to embarrassment or fear of judgment. If you or your partner has a fetishistic interest that causes significant distress or impairment, seeking psychological help with a knowledgeable and nonjudgmental professional is an important first step.
Make Sure You Find an AASECT-Certified Therapist
When consulting a therapist for the psychological treatment of sexual issues, make sure that your mental health practitioner is AASECT (American Association of Sexuality Educators Counselors and Therapists) certified. “Sex therapist” and “sex therapy” are not protected terms, meaning that anyone can call themselves a sex therapist in their marketing. Additionally, most mental health licensure requirements contain little or no instruction in human sexuality. AASECT certified providers receive an additional 18-24 months of training and a minimum of 300 additional hours of supervision in sex-specific psychological issues.
Cost of Sex Therapy
Typical rates for an AASECT certified sex therapist are on the upper end of private pay therapy rates in your area. Most sex therapists see individual clients for 45-60 minute sessions at rates between $120-$180 and couples for 75-90 minute sessions at rates between $190-$310. These rates may vary widely based on the availability of certified sex therapists in your area and on general mental health costs in your state.
You can find an AASECT certified sex therapist by visiting an online therapist directory where you can sort by specialty and insurance coverage.
How to Get Rid of a Fetish
There are many coping methods and steps to take to manage fetishistic disorder.
If you are suffering from fetishistic disorder, make sure to:
- Talk honestly with your partner(s) about your sexual urges and fantasies. Partners are more likely to be supportive and understanding when your behavior is not secretive or dishonest.
- Consult with a certified sex therapist to explore your options for reducing compulsive behaviors and co-occurring mental health conditions.
- Seek a community of other individuals struggling with fetishistic disorder or who have been successful in channeling their urges, fantasies and behaviors into a non-distressing sexual forum.
- Remember that, like most mental health conditions, fetishistic disorder is more effectively treated the sooner it is addressed.
Fetishistic Disorder Vs. Other Disorders
Fetishistic disorder is often misconstrued with fetishism or fetishistic behavior. It is also confused with other similar sexual disorders, including transvestic disorder and sexual masochism disorder.
Fetishistic Disorder Vs. Fetishism
Fetishism is an outdated term utilized prior to the updated Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The crucial difference in this new terminology is that Fetishistic disorder requires there be significant distress, impairment or harm accompanying the pattern of sexual behavior in order to be designated as a mental disorder.
Fetishistic Disorder Vs. Sexual Masochism Disorder
Sexual masochism disorder is a paraphilia in which the element of domination or humiliation associated with a fantasy or activity may be the core factor in fetishistic behavior. As with any paraphilia, significant impairment or distress must be present in order to classify as a disorder.
Fetishistic Disorder Vs. Fetishistic Behavior
Individuals who self-identify as fetish practitioners or fetishists but do not report distress, impairment or harm to self or others are not classified as having a mental disorder.
Evolution of Fetishistic Disorder as a Mental Health Diagnosis
Fetishistic disorder has been included in the Diagnostic and Statistical Manual of Mental Disorders (DSM) under various iterations since its inception in 1952. Paraphilic diagnoses, especially fetishistic disorder, have been criticized as an attempt to control deviant behavior and arguably do not meet the criteria for true mental health diagnoses. Paraphilia diagnoses have been used to pathologize, stigmatize and discriminate against those who engage in alternative sexual practices. Fetishistic sexual interests, while atypical in their focus, do not constitute pathology or inherently cause harm.
Throughout subsequent editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM), discernment was slowly made between consensual sexual practices which do not cause distress as compared to harmful urges, fantasies or behaviors which would constitute a psychological disorder requiring treatment. However, a lack of valid data or scientific consensus regarding the etiology of fetishistic disorder continues to make this diagnosis controversial.
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