Fetishistic Disorder DSM-5 302.81 (F65.0)
This Article Is Part of A Series For Paraphilic Disorders
DSM-5 Category: Paraphilia
Introduction
The etymology of the word Fetish is from Latin, Facere, which means “to make”, which evolved into Factitius, “made by art”, from which the Portuguese word Feitico was derived, or in French, Fetiche, which led to the English Fetish. A Fetish in this context was defined as “Something irrationally revered” - an object in which power or force was concentrated. The first recorded use of the word Fetishist to indicate an object of desire, someone who is aroused due to a body part, or an object belonging to a person who is the object of desire was in 1897 (Harper, 2014). There are those to whom an object or body part has the power to captivate and enthrall. Such a focus itself is not considered a disorder, unless it is accompanied by distress or impairment. Fetishistic Disorder is a DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition), diagnosis assigned to individuals who experience sexual arousal from objects or a specific part of the body which is not typically regarded as erotic. Almost any body part or object can be a Fetish. Examples include: clothes, shoes, stockings, gloves, hair, or latex (Comfort,1987). Fetishists may use the desired article for sexual gratification in the absence of a partner, by touching, smelling, licking, or masturbating with it (Meston & Frohlich, 2013). Fetishism is seen almost exclusively in men, and 25% of men with Fetishes are homosexual (Meston and Frohlich, 2013). In some cases, Fetishistic Disorder is a result of Classical and Operant Conditioning. One possible Scenario: A neutral stimulus, such as a pair of knee high leather boots are worn by a woman. Foreplay begins, and the boots are removed to the accompaniment of growing sexual desire, which is an unconditioned response. The association between the unconditioned response of sexual desire during foreplay turns the previously neutral stimulus of knee high leather boots into a conditioned stimulus. Through repeated trials, e.g. sexual encounters, the boots produce a conditioned response of sexual arousal through the sensory stimuli of the smell, appearance, and texture of the boots. Sex may not be as satisfying, or erection may not even be possible unless leather boots are present. Operant Conditioning can occur as the person will experience anticipatory pleasure or reinforcement from the process of coming into contact with the boots.
Symptoms of Fetishistic Disorder
According to the DSM-5, there are three criterion for Fetishistic Disorder, and four specifiers that can be applied:
A. Over a six month period, the individual has experienced sexual urges focused on a non-genital body part, or inanimate object, or other stimulus, and has acted out urges, fantasies, or behaviors.
B. The fantasies, urges, or behaviors cause distress, or impairment in functioning.
C. The Fetishistic object is not an article of clothing employed in cross dressing, or a sexual stimulation device, such as a vibrator.
- Specifiers for the diagnosis of Fetishistic Disorder include the type of stimulus which is the focus of attention.
- Body Part(s) (non-genital or erogenous areas of the body - e.g.,feet or hair). This is also referred to as Partialism- preoccupation with a part of the body rather than the whole person.
- Non-living Object(s) e.g. shoes or boots.
- Other- situations or activities- e.g.- smoking during sex.
Other specifiers are:
- In a controlled environment where Fetishistic Disorder cannot readily be engaged in, such as an institutional setting.
- In remission: No distress or impairment of functioning for a five year period, exclusive of a controlled environment (American Psychiatric Association, 2013).
Onset
The DSM-5 notes that Fetishistic Disorder typically emerges at the onset of puberty, or less typically, prior to adolescence. The severity of the disorder can wax and wane over the lifespan, and is noted to appear almost exclusively in males (American Psychiatric Association, 2013).
Prevalence
The DSM-5 does not specify the prevalence of Fetishistic Disorder (American Psychiatric Association, 2013).
Risk Factors
The DSM-5 does not specify risk factors for the development of Fetishistic Disorder. (American Psychiatric Association, 2013). As noted in Introduction, Fetishistic Disorder can result from Classical and Operant Conditioning associated with an early sexual encounter.
Comorbidity
The DSM-5 indicates that Fetishistic Disorder can be comorbid with Hypersexuality and other paraphillias. Fetishistic Disorder can also occur in the context of a neurological disorder, though this is rare (American Psychiatric Association, 2013).
Treatment for Fetishistic Disorder
The DSM-5 does not specify treatment options for Fetishistic Disorder (American Psychiatric Association, 2013). If the etiology of the disorder is a learned behavior, CBT (Cognitive Behavioral Therapy) using a form of systematic desensitization- gradual exposure to the Fetishistic object, coupled with a neutral response, rather than a sexual response may work to lower or eliminate sexual arousal associated with an object.
Impact on Functioning
Fetishistic Disorder can impact intimate relationships. If the Fetish is absent from a sexual encounter, it can result in sexual dysfunction, such as inability to achieve or maintain an erection (American Psychiatric Association, 2013). It is noted that paraphillias in general, including fetishism, are correlated with general psychosocial impairment, including being victims of physical abuse, lower educational level, inpatient admissions mental health or substance abuse treatment, disability, unemployment, involvement with criminal justice, increased risk of STI's (Sexually Transmitted Infections) and comorbid mental health disorders (Marsh, Odlaug, Thomarios, Davis, Buchanan, Meyer, & Grant, 2010). Criminal behavior may be involved with Fetishistic Disorder, such as breaking and entering to steal articles of clothing, or unwanted contact, such as touching a a strange woman's feet in public. The individual with Fetishistic Disorder may experience guilt, shame, and humiliation if they are unable to contain their desires and act out in public.
Differential Diagnosis
There are several diagnostic rule-outs for the clinician to consider. In the DSM -5, disorders such as
Transvestic Disorder, Sexual Masochism, and Fetishistic behavior without Fetishistic Disorder (American Psychiatric Association, 2013). Tranvestic disorder specifically involves a man dressing in typical woman's clothing, whereas Fetishistic disorder would involve handling, smelling, and masturbating with an article of woman’s clothing. Woman may also wear men's clothes with little or no social stigma. Sexual Masochism involves sexual gratification from the infliction of pain or discomfort on another. An article used for Masochistic behaviors, such as a ligature for restraint, may acquire independent Fetishistic properties, but the act of restraint with a ligature during sexual activity and becoming aroused from the discomfort of ones partner is a Masochistic act, and a different diagnosis. There are also individuals who use Fetishes for sexual arousal with a partner who is agreeable to the behavior, and do not experience distress or impairment of sexual functioning, in which case the behavior does not reach the clinical threshold of a disorder.
References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. (5th Edition). Washington, DC.
Comfort, A. (1987). The Joy of Sex: A Gourmet Guide to Lovemaking. Chapter 6: Problems. Pocket Books: NY.
Harper, D. (2014). Fetish. The Online Etymology Dictionary. Retrieved March 21, 2014 from http://www.etymonline.com/index.php?term=fetish
Marsh, P.J., Odlaug, B.L., Thomarios, N., Davis, A.A., Buchanan, S.N., Meyer, C.S., Grant, J.E., (2010). Paraphilias in adult psychiatric inpatients. Annals of Clinical Psychiatry. 22(2):129134.
Meston, C. ( 2013). The Sexual Psychophysiology Laboratory. Fetishes. The University Of Texas at Austin. Retrieved March 21, 2014 from http://homepage.psy.utexas.edu/HomePage/Group/MestonLAB/HTM %20files/Resources_msd_para.htm
Help Us Improve This Article
Did you find an inaccuracy? We work hard to provide accurate and scientifically reliable information. If you have found an error of any kind, please let us know by sending an email to contact@theravive.com, please reference the article title and the issue you found.
Share Therapedia With Others