Fetishistic Disorder

The DSM-V outlines specific diagnostic criteria for a person’s symptoms to rise to the level of receiving a fetishistic disorder diagnosis. These symptoms include:

• High levels of sexual arousal incited by a part of the human body that isn’t genitalia or by an inanimate object that is not inherently sexual in nature (i.e., one cannot receive a diagnosis of fetishistic disorder for associating sexual arousal with a vibrator or dildo)
• Recurring sexual fantasies, urges, or behavior related to the body part or object that continue for at least six months
• Anxiety and other unpleasant feelings (e.g. guilt, shame) associated with the sexual fetish
• Experiencing significant distress or impairment related to the fetish (or the feelings it provokes) that significantly impact a person’s relationships, ability to work, or other areas of their daily life

There may be exceptions to the above symptoms that would exempt an individual from receiving a fetishistic disorder diagnosis. If the inanimate object linked to sexual arousal and fixation is an item of clothing often socially associated with another gender, the person might receive a diagnosis of transvestic disorder⁵ (commonly referred to as cross-dressing), another type of paraphilic disorder. The shame and other negative feelings around the sexual fetish also can’t be primarily related to societal perceptions of the fetish. 

Other symptoms associated with fetishistic disorder

Individuals with fetishistic disorder may experience the below symptoms, but not everyone with the disorder will experience these symptoms, and they are not necessary to receive a diagnosis.

• Sexual arousal caused by photos and videos of the object or body part
• Diminished sexual pleasure when the object or body part is not involved in sexual activity
• Inability to become sexually aroused without thinking about the object or body part
• Requiring the actual physical presence of the object or body part to become aroused
• If the fetish is an object, acquisition and collection of such objects, which may be kept hidden out of shame
• Experiencing more sexual pleasure when incorporating the object or body part into solo sexual activity, which can lead to a preference for solo sexual activity over partnered sexual activity
• Tensions in intimate relationships linked to the sexual fixation

It is not uncommon for sexually active adults to be sexually aroused by non-sexual objects or body parts, which suggests that there may be some inherent component in human brain structures or hormonal systems that can lead to sexual fetishes. However, there is a significant difference between consistently experiencing sexual arousal from an object or body part and meeting the diagnostic criteria for fetishistic disorder. 

No conclusive evidence exists for what factors may cause a fetish to develop into fetishistic disorder, though some psychological and neurological research has indicated possible causes that have led to several theories, including the following. 

Childhood experiences

Fetishistic disorder may be linked to childhood experiences in which a specific object or body part is associated with a person’s first experience of sexual arousal or masturbation. This theory is consistent with evidence that indicates fetishistic disorder can sometimes develop before a person goes through puberty.

Serotonin levels 

There is limited evidence indicating that people with paraphilic disorders, including fetishistic disorder, may have higher levels of serotonin. Increased serotonin levels have been linked to obsessive behaviors that can impair functioning. 

Brain differences

Feet are the most common body part associated with fetishism. Neuroscientists have discovered that the part of the brain that processes sensory data from the feet is located right next to the part of the brain that processes sensory data from the genitals, implying that the brain may more readily associate sexual arousal with feet than with other non-sexual body parts.

The goal of treatment for fetishistic disorder is not necessarily to stop sexual arousal associated with an object or body part but to address the concerns stemming from unpleasant thoughts or feelings around the sexual fetish and any complications resulting from the fetish, including intimate relationship challenges. Education can foster a more empathetic and supportive environment, both for those directly affected and within the broader community.

Medication

Some medications have been found to be effective in reducing symptoms of fetishistic disorder, though their efficacy is often linked to a combination of medication use and therapy attendance. Medications used to treat fetishistic disorder may include the following: 

• Selective serotonin reuptake inhibitors (SSRIs): SSRIs are antidepressants that may be prescribed to treat depression or anxiety. A decreased sex drive is a side effect of some SSRIs, which may address symptoms of fetishistic disorder for some people. 
• Testosterone-lowering drugs: These forms of medication can lower a person’s testosterone levels. Lower levels of testosterone can be linked to a reduction in overall sex drive. While reduced sex drive may not be desirable in the long term, it can be used temporarily to make cognitive restructuring and sex therapy techniques more accessible for a client. 

Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis. 

Self-care

Often, the primary concern with fetishistic disorder is not the reduction or elimination of sexual arousal associated with the fetish object or body part but the distress, shame, and dysfunction the arousal can be linked to. Therefore, self-care can be a crucial component of recovering from fetishistic disorder. 

Understanding that one’s sexual desires are not inherently wrong or bad, even if they are considered socially unusual, can lead to decreased self-blame and guilt and less disruption associated with the fetish. Acts of self-love, such as journaling about what one likes about oneself or taking time out of one’s day to participate in activities one enjoys, may build up a person’s self-confidence and combat shameful feelings linked to their sexual desires. 

Because of the high levels of shame associated with fetishistic disorder, clients experiencing symptoms may feel too embarrassed to seek treatment. Online therapy through a platform like BetterHelp may be a helpful resource for people with these concerns. Through a legitimate online therapy platform, clients can connect with licensed and credentialed therapists via the internet and attend sessions in their homes via phone, video, or live chat. 

Various organizations can provide additional information about fetishistic disorder and answer questions from patients and their partners. The Institute for Sexual Wellness works to de-stigmatize and treat several paraphilic disorders, including fetishistic disorder. The peer support group Sexual Compulsives Anonymous (SCA) works to connect people who may experience mental health disorders related to sexual compulsion, which is a key symptom of some paraphilic disorders and related mental disorders. 

Researchers have not determined a conclusive cause for the development of fetishistic disorder. However, one study discussed the possibility that fetishistic disorder could result from unintentional classical conditioning involving the repeated association of non-sexual objects with sexual pleasure. 

As an example, a person may have developed fetishistic disorder related to viewing stockings as a sexual object. They may have had repeated sexual encounters involving stockings to the point where they began to associate sexual pleasure with stockings. For this reason, they may struggle to experience as much pleasure without the presence of stockings. While this situation may not evolve into fetishistic disorder, and there may be other causes that could prompt disorder development, it’s possible that it can lead to experiencing fetishistic disorder symptoms. 

Another study found that, out of all of the proposed methods for treating fetishistic disorder, cognitive-behavioral therapy is the most promising and is associated with the most significant long-term efficacy. This finding could be due to the primary concern of fetishistic disorder not being the fetish itself. The individual’s perception of the fetish and cognitive restructuring could lead to alleviated anxiety and shame around sexual desire. 

Below are several statistics on fetishistic disorder:

• One study found that roughly 16% of a representative population sample expressed interest in fetishism, masochism, voyeurism, and frotteurism. However, the study did not say whether or not this interest rose to the level of a clinical disorder. 
• The majority of people experiencing fetishistic disorder are male. 
• Behavioral, cognitive, and psychoanalytic strategies are the most common treatment methods for fetishistic disorder and other paraphilic disorders.