8.119: Fetishism (302.81)

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DSM-IV-TR criteria

A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the use of nonliving objects (e.g., female undergarments).
B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The fetish objects are not limited to articles of female clothing used in cross-dressing (as in Transvestic Fetishism) or devices designed for the purpose of tactile genital stimulation (e.g., a vibrator).

Associated Features

May be employed or undertake volunteer work to enable behavior to be practiced. For example, taking a job in a shoe shop in the case of a shoe fetish.
Early symptoms for a fetish involve excessive touching of 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.
The word fetish comes from the French fe’tiche, which is thought to derive from the Portuguese feitico, meaning “magic charm.”
Fetishism is related to the paraphilia, partialism, which is where people are excessively aroused by a particular body part, such as the feet, breasts, or buttocks.

Gender and cultural differences in presentation

Child vs. adult presentation

Fetishism typically begins by adolescents, although the fetish may have been endowed with special significance earlier in childhood, therefore, children and adults present with this Paraphilia.

Epidemiology

Etiology

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.

Empirically supported treatments

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.