Fetishism
Definition
Fetishism is a form of paraphilia, a disorder that is characterized by recurrent intense sexual urges and sexually arousing fantasies generally involving non-human objects, the suffering or humiliation of oneself or one's partner (not merely simulated), or children or other non-consenting persons. The essential feature of fetishism is recurrent intense sexual urges and sexually arousing fantasies involving specific objects. While any object may become a fetish, the distinguishing feature is its connection with sex or sexual gratification. A diagnosis of fetishism is made only if an individual has acted on these urges, is markedly distressed by them, or if the fetish object is required for gratification.
For some people with a paraphilia such as fetishism, paraphilic fantasies or stimuli may be necessary for erotic arousal and are always included in sexual activity, or the presence of the fetish object may occur only episodically. For example, the fetish object may only be necessary for arousal during periods of stress , and at other times, the person is able to function sexually without the fetish or stimuli related to the fetish.
Description
As stated, a fetish is a form of paraphilia, and in fetishism, the affected person has created a strong association between an object and sexual pleasure or gratification. A fetish is not simply a pleasant memory—it is a dominant component of most sexual situations. Most fetishes are objects or body parts. Common fetishes involve items of clothing, stuffed animals, or other non-sexual objects. Body fetishes may involve breasts, legs, buttocks, or genitals.
A person with a fetish often spends significant amounts of time thinking about the object of the fetish. Further, the object is intimately related to sexual pleasure or gratification. In the extreme, the presence of the fetish object is required for sexual release and gratification.
Causes and symptoms
Causes
The cause of the association between an object and sexual arousal may be adolescent curiosity or a random association between the object and feelings of sexual pleasure. A random association may be innocent or unappreciated for its sexual content when it initially occurs. For example, a male may enjoy the texture or tactile sensation of female undergarments or stockings. At first, the pleasurable sensation occurs randomly, and then, in time and with experience, the behavior of using female undergarments or stockings as part of sexual activity is reinforced, and the association between the garments and the sexual arousal is made. A person with a fetish may not be able to pinpoint exactly when his or her fetish began. A fetish may be related to activities associated with sexual abuse .
Symptoms
Early symptoms for a fetish involve touching the object of desire. The amount of time spent thinking about the fetish object may increase. Over time, the importance of the fetish object expands. In the extreme, it becomes a requirement for achieving sexual pleasure and gratification.
Demographics
How many people have a fetish and the extent to which the fetish influences their lives and sexual activities are not accurately known. In some rare instances, people with fetishes may enter the legal system as a result of their fetishes, and those cases may be counted or tracked.
Paraphilias such as fetishism are uncommon among females, but some cases have been reported. Females may attach erotic thoughts to specific objects such as items of clothing or pets, but these are uncommon elements in sexual activity. Virtually no information is available on family patterns.
Diagnosis
A diagnosis of a paraphilia involving a fetish is most commonly made by taking a detailed history or by direct observation. The diagnosis is made only if a person has actually obtained sexual gratification by using the fetish object, or has been markedly distressed by the inability to use such an object if contact with the fetish object is needed for sexual success. Occasionally discussing admiration for a particular object or finding an object to be arousing does not indicate a diagnosis of fetishism.
Treatments
In the earliest stages of behavior therapy, fetishes were narrowly viewed as attractions to inappropriate objects. Aversive stimuli such as shocks were administered to persons undergoing therapy. This approach was not successful. People with fetishes have also been behaviorally treated by orgasmic reorientation, which attempts to help them develop sexual responses to culturally appropriate stimuli that have been otherwise neutral. This therapy has had only limited success.
Most persons who have a fetish never seek treatment from professionals. Most are capable of achieving sexual gratification in culturally appropriate situations. As of 2002, American society seems to have developed more tolerance for persons with fetishes than in the past, thus further reducing the already minimal demand for professional treatment.
Prognosis
The prognosis for eliminating a fetish is poor because most people with a fetish have no desire to change or eliminate it. Most cases in which treatment has been demanded as a condition of continuing a marriage have not been successful. Most fetishes are relatively harmless in that most do not involve other persons or endanger the person with the fetish. Persons with a fetish rarely involve non-consenting partners.
The personal prognosis for a person with a fetish is good if the fetish and related activities do not impact others or place the person with the fetish in physical danger.
Prevention
Most experts agree that providing gender-appropriate guidance in culturally appropriate situations will prevent the formation of a fetish. The origin of some fetishes may be random associations between a particular object or situation and sexual gratification. There is no way to predict such as association.
Resources
BOOKS
Gelder, Michael, Richard Mayou, and Philip Cowen. Shorter Oxford Textbook of Psychiatry. 4th ed. New York: Oxford University Press, 2001.
Kohut, John J., and Roland Sweet. Real Sex: Titillating but True Tales of Bizarre Fetishes, Strange Compulsions, and Just Plain Weird Stuff. New York: Plume, 2000.
Wilson, Josephine F. Biological Foundations of Human Behavior. New York: Harcourt, 2002.
PERIODICALS
Chalkley, A. J., and G. E. Powell. "The clinical description of forty-eight cases of sexual fetishism." British Journal of Psychiatry 142 (1983): 292-295.
FitzGerald, W. A. "Explaining the variety of human sexuality." Medical Hypotheses 55, no. 5 (2000): 435-439.
Nersessian E. "A cat as fetish: a contribution to the theory of fetishism." International Journal of Psychoanalysis 79 (Pt 4) (1998): 713-725.
Reed, G. S. "The analyst's interpretation as fetish." Journal of the American Psychoanalytical Association 45, no. 4 (1998): 1153-1181.
Weiss, J. "Bondage fantasies and beating fantasies." Psychoanalytic Quarterly 67, no. 4 (1998): 626-644.
Wise, T. N. and R. C. Kalyanam. "Amputee fetishism and genital mutilation: case report and literature review." Journal of Sexual and Marital Therapy 26, no. 4 (2000): 339-344.
L. Fleming Fallon, Jr., M.D., Dr.P.H.
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