Most of us regularly have sexual thoughts and urges; sexuality is a unique and personal part of life. Our physical desires can manifest themselves in specific ways, and sometimes in the form of a sexual fetish, which is an attraction toward an inanimate object (or objects) or part of the body that isn’t genitalia.
When one’s fetish begins to take over and prevents them from thriving socially, professionally, or within their relationships, fetishistic disorder can develop. Fetishistic disorder is one of 8 sexually-based conditions known as paraphilic disorders.
Treatment for fetishistic disorders can help clients practice harm reduction practices. A trained sex therapist can help clients to control and even understand their fetishes without shame, offering people suffering from fetishistic disorder the tools they need to manage their desires effectively.
When Does a Fetish Become a Disorder?
Kinks and fetishes are sometimes mistakenly thought of as non-conventional or immoral sexual acts. In actuality, it’s estimated that 1 in 6 people has a fetish, and most can satisfy their desires with healthy, consensual sexual expression.
That’s why fetishes aren’t considered to be problematic or categorized as a disorder, unless they create clinically significant anxiety and disruptions or have the potential to cause harm to oneself or others. Thus, fetishistic disorder is the persistent use of nonsexual body parts or inanimate objects for sexual arousal, to the point of disrupting your everyday life.
Signs of Fetishistic Disorder
Fetishistic disorder is found almost exclusively in male patients, but women can develop the condition, as well. The first indications of an unhealthy fetish (resulting in fetishistic disorder) may first be noticed as early as one’s teenage years when puberty begins and an individual becomes sexually active.
The individual may interact with the inanimate object or body part by feeling it, smelling it, or stimulating their genitals with it. The object of desire is usually the cause of sexual arousal, sometimes by only thought alone.
Common signs of fetishistic disorder include:
- Experiencing intense sexual arousal stemming from a part of the body that is not genitalia, or from an inanimate object
- Recurring urges, mental images, or fantasies about the fetish that last longer than 6 months
- Anxiety, shame, or confusion related to the fetish and one’s desires for it
- Disruptions to the individual’s day-to-day life due to their fetish, including complications at home, work, or within interpersonal relationships
Someone’s fetish may also become a source of gratification or temporary stress relief during times of anxiety. However, when these recurring urges become significantly disruptive, the fetish, and the individual’s desire for it, can lead to feelings of shame, rather than satisfaction.
Without treatment, the effects of fetishistic disorder can lead to negative outcomes, and potentially damaging thoughts and emotions related to one’s sexuality, identity, and ability to enjoy sexual activity healthily.
What Is Fetishistic Disorder in the DSM-5?
Fetishistic disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is diagnosed when someone’s fetish(es) affect their mental health, or another aspect of their well-being for a period longer than 6 months.
Other specific criteria are as follows:
- Recurrent, intense, or compulsive desire for sexual arousal from an inanimate object or a nongenital body part
- The sexual desire manifests as fantasies, urges, or erratic behaviors
- Recurring anxiety and significant loss of functioning as a result of the fetish.
- The item that the person uses for sexual desires is not used because of cross-dressing (if compulsive or disruptive, this could be an indication of transvestic disorder).
However, objects used for sexual stimulation, such as a vibrator, aren’t considered in the diagnostic criteria for fetishistic disorder.
What Are Paraphilias?
Paraphilias are persistent and recurrent sexual interests, urges, fantasies, or behaviors of abnormal intensity involving objects, activities, or situations that are atypical or potentially harmful to oneself or others. Essentially, paraphilia evolves from a fetish, but only when the fetish is the cause of harm to the individual and/or someone else.
What Is the Difference Between Paraphilia and Fetishism?
Fetishistic disorder is actually one of 8 paraphilic disorders — all of which involve sexual fantasies or urges that can negatively affect oneself or others, along with daily functioning. Some can involve non-consenting partners, self-harm, or harm toward others.
Aside from fetishistic disorder, the other 7 paraphilic disorders are:
- Exhibitionistic disorder: Having recurring sexual fantasies, urges, or behaviors related to exposing one’s genitals to strangers
- Sexual masochism disorder: Having sexual fantasies, urges, or behaviors involving physical suffering or punishment inflicted on oneself
- Sexual sadism disorder: Having sexually-charged fantasies, desires, or behaviors related to inflicting a form of pain on another individual
- Transvestic disorder: Compulsive, urges, or erratic behaviors related to cross-dressing for sexual arousal, to the point of causing clinically significant distress or loss of functioning
- Frotteuristic disorder: Recurrent sexual fantasies, desires, or behavioral patterns involving rubbing, fondling, or otherwise touching a non-consenting person
- Pedophilic disorder: Feeling of sexual attraction to children, becoming sexually aroused by the thought of being sexually active with a child
- Voyeuristic disorder: Having or acting on sexual urges and fantasies that involve spying on an unaware and non-consenting person(s).
As is the case with fetishistic disorder, an individual must experience the signs and symptoms regularly, and for at least 6 months, in order to be diagnosed with any of the other 7 paraphilic disorders.
Is There Treatment for Fetishistic Disorder?
Fetishistic disorder is highly treatable. However, due to the taboo surrounding sexual topics, a significant barrier preventing access to care might be the client’s feelings of shame.
It should be stressed that no matter the source of the fetish, a mental health professional offers compassion, understanding, and progress. The symptoms of fetishistic disorder can be managed, and over time, even resolved.
There are three primary treatment options for individuals with fetishistic disorder. All three approaches may be utilized by a highly-specialized sex therapist, or the client may see multiple providers who offer a team-based treatment plan.
The following are the most commonly-used methods to treat fetishistic disorder:
1) Sex Therapy
A sex therapist can offer clients an understanding and non-judgmental approach to psychotherapy treatment. When working together with a sex therapist, clients will explore their sexual and larger psychological history.
This process helps improve the client’s self-awareness and can allow sexual therapists to identify any factors and events that may have contributed to the client’s fetish and their corresponding urges, fantasies, and behaviors.
Together, a client and therapist will explore when these symptoms were first experienced. Then, a sex therapist will teach new coping strategies, such as mindfulness or behavioral techniques for the individual (or couple) to implement.
A sex therapist may also test for other conditions, especially mood disorders or hypersexuality, which could explain a client’s strong sexual urges, thoughts, or behaviors.
2) Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy (CBT) is perhaps the most universally-applicable therapy method and may be offered and utilized by a dually-certified sex therapist. CBT is used to help clients learn to lessen their desires and urges related to their fetish.
If the fetish isn’t harmful to oneself or others, the individual’s therapist may use CBT to teach them how to moderate their sexual behavior, finding ways to be satisfied, while remaining aware of other aspects of their daily lives. CBT uses cognitive restructuring to gradually change thoughts and behaviors. This might include guided imagery to reduce interest in fetishistic objects.
CBT is often employed in combination with another successful treatment method: Medication management.
Psychiatric providers will often prescribe a selective serotonin reuptake inhibitor or SSRI—a type of antidepressant. Common names for SSRIs include Prozac, Zoloft, Lexapro, Celexa, and Paxil. SSRIs can assist in lowering a client’s sex drive, helping them to make more immediate improvements to their sexual behavior. SSRIs can also be used for treating co-occurring conditions, such as depressive disorders or anxiety disorders.
While medication can help in lowering someone’s sex drive and impulses related to their fetish, it doesn’t address the root of their fetishistic urges. As a result, therapy and medication management together can be the most successful treatment route.
Other prescriptions that might be given to clients include the drugs Medroxyprogesterone acetate and cyproterone acetate, which help reduce a client’s testosterone levels, setting the stage for more effective CBT and/or sex therapy treatment.
Having a fetish is on the broad spectrum of healthy sexuality. But if a fetish is affecting an individual’s life (or someone else’s) negatively, it might be time to check in with a mental health professional.
Regardless of the embarrassment or shame many of us feel surrounding sexual topics, it’s important to seek treatment and find professional support for fetishistic disorder if your recurring thoughts or desires are a source of concern.