Sexual fetishism
Sexual fetishism or erotic fetishism is a sexual fixation on a nonliving object or nongenital body part.[1] The object of interest is called the fetish; the person who has a fetish for that object is a fetishist.[2] A sexual fetish may be regarded as a non-pathological aid to sexual excitement, or as a mental disorder if it causes significant psychosocial distress for the person or has detrimental effects on important areas of their life.[1][3] Sexual arousal from a particular body part can be further classified as partialism.[4]
For other uses, see Fetishism (disambiguation).Sexual fetishism
Definitions[edit]
In common parlance, the word fetish is used to refer to any sexually arousing stimuli, not all of which meet the medical criteria for fetishism.[5] This broader usage of fetish covers parts or features of the body (including obesity and body modifications), objects, situations and activities (such as smoking or BDSM).[5] Paraphilias such as urophilia, necrophilia and coprophilia have been described as fetishes.[6]
Originally, most medical sources defined fetishism as a sexual interest in non-living objects, body parts or secretions. The publication of the DSM-III in 1980 changed that by excluding arousal from body parts in its diagnostic criteria for fetishism. In 1987, a revised edition of the DSM-III (DSM-III-R) introduced a new diagnosis for body part arousal, called partialism. The DSM-IV retained this distinction.[6] Martin Kafka argued that partialism should be merged into fetishism because of overlap between the two conditions,[6] and the DSM-5 subsequently did so in 2013.[1] The ICD-10 definition (World Health Organization's International Classification of Diseases) is still limited to non-living objects.[3]
Diagnosis[edit]
The ICD-10 defines fetishism as a reliance on non-living objects for sexual arousal and satisfaction. It is only considered a disorder when fetishistic activities are the foremost source of sexual satisfaction, and become so compelling or unacceptable as to cause distress or interfere with normal sexual intercourse.[3] The ICD's research guidelines require that the preference persists for at least six months, and is markedly distressing or acted on.[19]
Under the DSM-5, fetishism is sexual arousal from nonliving objects or specific nongenital body parts, excluding clothes used for cross-dressing (as that falls under transvestic disorder) and sex toys that are designed for genital stimulation. In order to be diagnosed as fetishistic disorder, the arousal must persist for at least six months and cause significant psychosocial distress or impairment in important areas of their life. In the DSM-IV, sexual interest in body parts was distinguished from fetishism under the name partialism (diagnosed as Paraphilia NOS), but it was merged with fetishistic disorder for the DSM-5.[1]
The ReviseF65 project has campaigned for the ICD diagnosis to be abolished completely to avoid stigmatizing fetishists.[20] Sexologist Odd Reiersøl argues that distress associated with fetishism is often caused by shame, and that being subject to diagnosis only exacerbates that. He suggests that, in cases where the individual fails to control harmful behavior, they instead be diagnosed with a personality or impulse control disorder.[20]
Treatment[edit]
According to the World Health Organization, fetishistic fantasies are common and should only be treated as a disorder when they impair normal functioning or cause distress.[3] Goals of treatment can include elimination of criminal activity, reduction in reliance on the fetish for sexual satisfaction, improving relationship skills, reducing or removing arousal to the fetish altogether, or increasing arousal towards more acceptable stimuli. The evidence for treatment efficacy is limited and largely based on case studies, and no research on treatment for female fetishists exists.[21]
Cognitive behavioral therapy is one popular approach. Cognitive behavioral therapists teach clients to identify and avoid antecedents to fetishistic behavior, and substitute non-fetishistic fantasies for ones involving the fetish. Aversion therapy and covert conditioning can reduce fetishistic arousal in the short term, but requires repetition to sustain the effect. Multiple case studies have also reported treating fetishistic behavior with psychodynamic approaches.[21]
Antiandrogens may be prescribed to lower sex drive. Cyproterone acetate is the most commonly used antiandrogen, except in the United States, where it may not be available. A large body of literature has shown that it reduces general sexual fantasies. Side effects may include osteoporosis, liver dysfunction, and feminization. Case studies have found that the antiandrogen medroxyprogesterone acetate is successful in reducing sexual interest, but can have side effects including osteoporosis, diabetes, deep vein thrombosis, feminization, and weight gain. Some hospitals use leuprorelin and goserelin to reduce libido, and while there is presently little evidence for their efficacy, they have fewer side effects than other antiandrogens. A number of studies support the use of selective serotonin reuptake inhibitors (SSRIs), which may be preferable over antiandrogens because of their relatively benign side effects. Pharmacological agents are an adjunctive treatment which are usually combined with other approaches for maximum effect.[21]
Relationship counselors may attempt to reduce dependence on the fetish and improve partner communication using techniques like sensate focusing. Partners may agree to incorporate the fetish into their activities in a controlled, time-limited manner, or set aside only certain days to practice the fetishism. If the fetishist cannot sustain an erection without the fetish object, the therapist might recommend orgasmic reconditioning or covert sensitization to increase arousal to normal stimuli (although the evidence base for these techniques is weak).[21]
Occurrence[edit]
The prevalence of fetishism is not known with certainty. Fetishism is more common in males.[17] In a 2011 study, 30% of men reported fetishistic fantasies, and 24.5% had engaged in fetishistic acts. Of those reporting fantasies, 45% said the fetish was intensely sexually arousing.[22] In a 2014 study, 26.3% of women and 27.8% of men acknowledged any fantasies about "having sex with a fetish or non-sexual object". A content analysis of the sample's favorite fantasies found that 14% of the male fantasies involved fetishism (including feet, nonsexual objects, and specific clothing), and 4.7% focused on a specific body part other than feet. None of the women's favorite fantasies had fetishistic themes.[23] Another study found that 28% of men and 11% of women reported fetishistic arousal (including feet, fabrics, and objects "like shoes, gloves, or plush toys").[24] 18% of men in a 1980 study reported fetishistic fantasies.[17]
Fetishism to the extent that it becomes a disorder appears to be rare, with less than 1% of general psychiatric patients presenting fetishism as their primary problem. It is also uncommon in forensic populations.[17]
Clothing fetishism and fetish-related