Sexual fetishism
Sexual fetishism is a sexual fixation on anything not considered sexual by its respective nature. The object of interest is called the fetish; the person who has a fetish is a fetishist. A sexual fetish may be regarded as a mental disorder if it causes significant psychosocial distress for the person or has detrimental effects on important areas of their life. Sexual arousal from a particular body part can be further classified as partialism.
Medical definitions restrict the term sexual fetishism to objects or body parts. In common language, fetish is also used for a sexual interest in specific activities, people, types of people, substances, or situations.
Definitions
The word fetish is commonly used for any sexually arousing stimuli, not all of which meet the medical criteria for fetishism. This broader usage of fetish covers parts or features of the body, objects, situations and activities. Paraphilias such as urophilia, necrophilia and coprophilia have been described as fetishes.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, the revised DSM-III-R introduced a new diagnosis for body part arousal called partialism. The DSM-IV retained this distinction. Martin Kafka argued that partialism should be merged into fetishism because of overlap between the two conditions. The DSM-5 subsequently did so in 2013.
Types
In a review of 48 cases of clinical fetishism in 1983, fetishes included clothing, rubber and rubber items, footwear, body parts, leather, and soft materials or fabrics.A 2007 study counted members of Internet discussion groups with the word fetish in their name. Of the groups about body parts or features, 47% belonged to groups about feet, 9% about body fluids, 9% about body size, 7% about hair, and 5% about muscles. Less popular groups focused on navels, legs, body hair, mouth, and nails, among other things. Of the groups about clothing, 33% belonged to groups about clothes worn on the legs or buttocks, 32% about footwear, 12% about underwear, and 9% about whole-body wear such as jackets. Less popular object groups focused on headwear, stethoscopes, wristwear, pacifiers, and diapers.
Erotic asphyxiation is the use of choking to increase the pleasure in sex. The fetish also includes an individualized part that involves choking oneself during the act of masturbation, which is known as auto-erotic asphyxiation. This usually involves a person being connected and strangled by a homemade device that is tight enough to give them pleasure but not tight enough to suffocate them to death. This is dangerous due to the issue of hyperactive pleasure seeking which can result in strangulation when there is no one to help if the device gets too tight and strangles the user.
Devotism involves being attracted to disability or body modifications on another person that are the result of amputation for example. Devotism is only a sexual fetish when the person who has the fetish considers the amputated body part on another person the object of sexual interest.
Cause
Fetishism and paraphilias in general usually becomes evident during puberty, but may develop prior to that. No single cause for fetishism has been conclusively established. Currently widely accepted etiological models hypothesize paraphilias to originate from a complex set of neurological, social, and cultural factors in a given person. Different paraphilias may have different causes, and there is no guarantee that two persons with the same paraphilias as the other would be interested in the same aspects of it or have the same ultimate cause for its development.From a personality perspective, fetishists in studies generally report higher levels of introversion, impersonal sexual activity such as masturbation and less satisfaction with life and relationships. Hypersexual behavior increased the odds ratio for some fetishes and paraphilias, with a ratio of 4.6 in males and 25.6 in females, according to a 1996 Swedish study.
Some explanations invoke classical conditioning. In several experiments, men have been conditioned to show arousal to stimuli like boots, geometric shapes or penny jars by pairing these cues with conventional erotica. According to John Bancroft, conditioning alone cannot explain fetishism, because it does not result in fetishism for most people. He suggests that conditioning combines with some other factor, such as an abnormality in the sexual learning process. Social learning theories which combine social cognition and operant conditioning have also been proposed as an explanation for how fetishes may be learned, with the hypothesis being that fetishism is induced by the brain mistaking the object of arousal as a culturally appropriate source of sexual desire due to the unique experiences of the fetishist. Men who report being sexually rejected often are more likely to develop partialism and fetishism towards other objects such as undergarments, which is believed to be a reaction where the person learns overtime to value the non-human parts of potential partners as a social response.
Theories of sexual imprinting propose that humans learn to recognize sexually desirable features and activities during childhood. Fetishism could result when a child is imprinted with an overly narrow or incorrect concept of a sex object. Ethological imprinting has also been a suggested cause.
Imprinting seems to occur during the child's earliest experiences with arousal and desire, and is based on "an egocentric evaluation of salient reward- or pleasure-related characteristics that differ from one individual to another."
Neurological differences may play a role in some cases. Vilayanur S. Ramachandran observed that the region processing sensory input from the feet lies immediately next to the region processing genital stimulation, and suggested an accidental link between these regions could explain the prevalence of foot fetishism. This has been disputed by a meta-analysis and experiment done by a 2013 study, showing a lack of correlation between foot stimulation, other stimulation to areas, and erotic behavior, though it did not explicitly rule in or out the potential of another brain area responsible for eroticism. The study concluded that neurological mechanisms regarding fetishism are poorly understood.
Temporal lobe injuries and epilepsy have been linked to subsequent development of paraphilia in rare cases. In one case, an anterior temporal lobectomy relieved an epileptic man's fetish for safety pins.
Various explanations have been put forth for the rarity of female fetishists. Most fetishes are visual in nature, and males are thought to be more sexually sensitive to visual stimuli. Roy Baumeister suggests that male sexuality is unchangeable, except for a brief period in childhood during which fetishism could become established, while female sexuality is fluid throughout life.
Diagnosis
Under the DSM-5, fetishism is sexual arousal from nonliving objects or specific nongenital body parts, excluding clothes used for cross-dressing 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, but it was merged with fetishistic disorder for the DSM-5.The ReviseF65 project campaigned for the International Classification of Diseases ’s fetish-related diagnoses to be abolished completely to avoid stigmatizing fetishists. On 18 June 2018, the WHO published ICD-11, in which fetishism and fetishistic transvestism are now removed as psychiatric diagnoses. Moreover, discrimination against fetish-having and BDSM individuals is considered inconsistent with human rights principles endorsed by the United Nations and The World Health Organization.
Treatment
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. On 18 June 2018, the WHO published ICD-11, in which fetishism and fetishistic transvestism are now removed as psychiatric diagnoses. Moreover, discrimination against fetish-having and BDSM individuals is considered inconsistent with human rights principles endorsed by the United Nations and The World Health Organization.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.
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.
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, 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.
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.