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Sexual fetishism
Classification and external resources
Foot fetishism is one of the most common fetishes
ICD-10	F65
ICD-9	302.81
MeSH	D005329

Sexual fetishism, or erotic fetishism, is the sexual arousal a person receives from a physical object, or from a specific situation. The object or situation of interest is called the fetish; the person who has a fetish for that object/situation is a fetishist.^[1] A sexual fetish may be regarded as an enhancing element to a romantic/sexual relationship "achieved in ordinary ways (e.g. having the partner wear a particular garment)" or as a mental disorder/disorder of sexual preference if it causes significant psychosocial distress for the person or has detrimental effects on important areas of their life.^[2] Arousal from a particular body part is classified as partialism.^[3]

Overview[link]

The word fetish derives from the French fétiche, which comes from the Portuguese feitiço ("spell"), which in turn derives from the Latin facticius (“artificial”) and facere ("to make"). A fetish is an object believed to have supernatural powers, or in particular, a man-made object that has power over others. Essentially, fetishism is the attribution of inherent value or powers to an object. The terms "erotic fetish" and "sexual fetish" were first introduced by Alfred Binet.^[4][5] Sometimes, the word fetish may be thought synonymous to "sexual fetish" (for example, when used in pornography based on sexual fetishes).

If a sexual fetish causes significant psychosocial distress for the person or has detrimental effects on important areas of their life, it is diagnosable as a paraphilia in the DSM and the ICD.^[2] Many people embrace their fetish rather than attempting treatment to rid themselves of it.^[vague]

In a review of the files of all cases over a 20-year period which met criteria for non-transvestic fetishes in a teaching hospital, 48 cases were identified, and the objects of their fetishes included clothing (58.3%), rubber and rubber items (22.9%), footwear (14.6%), body parts (14.6%), leather jackets and vests, and leather items (10.4%), and soft materials and fabrics (6.3%).^[6]

Types[link]

Alfred Binet, a French psychologist, lawyer and hypnotist, proposed that fetishes be classified as either "spiritual love" or "plastic love". "Spiritual love" occupied the devotion for specific mental phenomena, such as attitudes, social class, or occupational roles; while "plastic love" referred to the devotion exhibited towards material objects such as animals, body parts, garments, textures or shoes.

The existential approach to mental disorders developed in the 1940s and influenced a view that fetishes had complex personal meanings beyond the general categories of psychoanalytical treatment.^{[citation needed]} For instance, the Austrian neurologist and logotherapist Viktor Frankl once noted the case of a man with a sexual fetish involving, simultaneously, both frogs and glue.^[7] However, Frankl's logotherapy is but one of dozens of psychological systems or methods of psychotherapy that compete with psychoanalysis.

The concept of spiritual love is not accepted globally because it is impossible to fully define what exactly is "spiritual love." Mental phenomena, attitudes, and social class are all things that can be obsessed over, but it is hard to prove that they would be a sexual obsession. It is also hard to incorporate any "idea" into a sexual act or stimulation. However, a mental obsession, such as an idea or excessive thought, can be progressed into a "plastic love." For example, role playing. If a person has a mental obsession with cowboys, their partner could dress up as a cowboy to make it a real thing or "plastic love."

Psychological origins and development[link]

Early psychology assumed that fetishism either is being conditioned or imprinted or the result of a strong emotional (e.g., traumatic) or physical experience. Often, these experiences were experienced in early childhood. For example, an individual who has been physically abused could either have a sexual obsession with intercourse, or they could be completely terrified by even the idea of being touched. It is assumed that those who have been sexually abused create an obsession with being touched or touching others, and possibly even abuse someone else. Physical factors like genetic disposition are another common possible explanation. In the following, the most important theories are presented in chronological order:

Alfred Binet suspected fetishism was the pathological result of associations. Accidentally simultaneous presentation of a sexual stimulus and an inanimate object, he argued, led to the object being permanently connected to sexual arousal.

The sexologist Magnus Hirschfeld followed another line of thought when he proposed his theory of partial attractiveness in 1920. According to his argument, sexual attractiveness never originates in a person as a whole but always is the product of the interaction of individual features. He stated that nearly everyone had special interests and thus suffered from a healthy kind of fetishism, while only detaching and overvaluing of a single feature resulted in pathological fetishism. Today, Hirschfeld's theory is often mentioned in the context of gender role specific behavior: females present sexual stimuli by highlighting body parts, clothes or accessories; males react to them.

Sigmund Freud believed that sexual fetishism in men derived from the unconscious fear of the mother's genitals, from men's universal fear of castration, and from a man's fantasy that his mother had had a penis but that it had been cut off. He did not discuss sexual fetishism in women.

In 1951, Donald Winnicott presented his theory of transitional objects and phenomena, according to which childish actions like thumb sucking and objects like cuddly toys are the source of manifold adult behavior, amongst many others fetishism.^[8]

The use of a transitional object in infancy is a healthy experience (Winnicott, 1953). To understand the origin of a fetish object and of fetishism, the infant’s use of the transitional object and of transitional phenomena in general must be studied (Winnicott, 1953).

In his article ‘Transitional objects and phenomena’, Winnicott says about fetish: “Fetish can be described in terms of a persistence of a specific object or type of object dating from infantile experience in the transitional field, linked with the delusion of a maternal phallus” (Winnicott, 1953). In other words, a specific object or type of object, dating from an experience during the period where the mother gradually pulls back as an immediate provider of satisfaction of the child’s desires, persists as a characteristic in adult sexual life.

Before this transitional phase, the child believes that his own wish creates the object of his desire (specifically the qualities of his mother that fulfill his needs), which brings with it a sense of satisfaction. During this phase the child gradually adapts to the (frustrating) realization that the object cannot be controlled to serve the child's needs.

The transitional object is always the result of a gratifying relationship with the mother, specifically with the maternal body. It stands for the satisfying qualities that the object (the mother/ father) of the first relationship the child has. The child adapts to the impact of the realization that the mother is not always there to ‘bring the world to him’ through fantasizing about the object of his desire while using an object (a teddy bear, a piece of cloth). He creates an illusion of the previous object. In relation to the transitional object the infant passes from (magical) omnipotent control to control by manipulation (involving muscle eroticism and co-ordination pleasure).

In opposition to this, the fetish represents the impossibility of pleasure with the body of the mother or the paternal body in the case of females. Fetishism, although less abundant in occurrence in the female psyche, or of a different nature, is not the monopoly of men. The transitional object may eventually develop into a fetish object and so persist as a characteristic of the adult sexual life (Winnicott, 1953). Normally, the child gains from the experience of frustration during the transitional phase, although the infant can be disturbed by a close adaptation to need that is continued too long or is not allowed its natural decrease.

Behaviorism traced fetishism back to classical conditioning and came up with numerous specialized theories. The common theme running through all of them is that sexual stimulus and the fetish object are presented simultaneously causing them to be connected in the learning process. This is similar to Binet's early theory, though it differs in that it specifies association to classical conditioning and leaves out any judgment about pathogenicity. The super stimulus theory stressed that fetishes could be the result of generalization. For example, it may only be shiny skin that arouses a person at first, but in time more common stimuli, such as shiny latex, may have the same effect. The problem with such a theory was that classical conditioning normally needs many repetitions, but this form would require only one. To account for this the preparedness theory was put forward; it stated that reacting to an object with sexual arousal could be the result of an evolutionary process, because such a reaction could prove to be useful for survival. In pointing to how conditioned sexual behavior can persist over time, one may cite how, in 2004, when quails were trained to copulate with a piece of terry cloth, their conditioning was sustained through ongoing repetition.^[9]

Because classical conditioning seemed to be unable to explain how the conditioned behavior is kept alive over many years, without any repetition, some behaviorists came up with the theory that fetishism was the result of a special form of conditioning, called imprinting. Such conditioning happens during a specific time in early childhood in which sexual orientation is imprinted into the child's mind and remains there for the rest of his or her life.

Various neurologists pointed out that fetishism could be the result of neuronal cross links between neighboring regions in the human brain. For example, in 2002 Vilayanur S. Ramachandran stated that the region processing sensory input from the feet lies immediately next to the region processing sexual stimulation.

Today, psychodynamics has parted with the idea of proposing one explanation for all fetishes at the same time. Instead, it focuses on one form of fetishism at a time and the patients' individual problems. Over the past decades, various case studies have been published in which fetishism could successfully be linked to emotional problems. Some argue that a lack of parental love leads to a child projecting its affection to inanimate objects, others state in consent with Freud's model of psychosexual development that premature suppression of sexuality could lead to a child getting stuck in a transitory phase. One of Freud’s defense mechanisms, displacement, is the redirection of an impulse onto a substitute target. Someone who feels uncomfortable with their sexual desire for a real person may therefore substitute a fetish.^[10]

Modern theory and treatment[link]

Psychologists and medical practitioners regard fetishism as normal variations of human sexuality^{[citation needed]}. Even those orientations that are potential forms of fetishism are usually considered unobjectionable as long as all people involved feel comfortable. Only if the diagnostic criteria presented in detail below are met is the medical diagnosis of fetishism justified. The leading criterion is that a fetishist is ill only if he or she suffers from the addiction, not simply because of the addiction itself.

Diagnosis[link]

According to the ICD-10-GM, version 2005, fetishism is the use of inanimate objects as a stimulus to achieve sexual arousal and satisfaction; in most cases said object is required for sexual gratification. The corresponding ICD code for fetishism is F65.0. The diagnostic criteria for fetishism are as follows:

• Unusual sexual fantasies, drives or behavior occur over a time span of at least six months. Sometimes unusual sexual fantasies occur and vanish by themselves; in this case any medical treatment is not necessary.
• The affected person, their object or another person experience impairment or distress in multiple functional areas. Functional area refers to different aspects of life such as private social contacts, job, etc. It is sufficient for the diagnosis if one of the participants is being hurt or mistreated in any other way.

It must be noted that a correct diagnosis in terms of the ICD manual stipulates hierarchical proceeding. That is, first the criteria for F65 must be fulfilled, then those for F65.0. As criteria are not repeated in substages this can be mistakable to laymen or medics that have not been educated in the use of this manual. Furthermore, it must be noted that according to the ICD, an addiction to specific parts or features of the human body and even "inanimate" parts of corpses, under no circumstances are fetishism, even though some of them may be forms of paraphilia.

According to the DSM-IV-TR, fetishism is the use of nonliving objects as a stimulus to achieve sexual arousal or satisfaction. (This only applies if the objects are not specifically designed for sexual stimulation (e.g., a vibrator).) The corresponding DSM-code for fetishism is 302.81; the diagnostic criteria are basically the same as those of the ICD. In the DSM manual, all diagnostic criteria are given in the corresponding section of the text book, i. e., here no hierarchical processing is needed.

Both definitions are the result of lengthy discussions and multiple revisions. Still today, arguments go on whether a specific diagnosis fetishism is needed at all or if paraphilia as such is sufficient. Some^[who?] demand that the diagnosis be abolished completely to no longer stigmatize fetishists, e. g. project ReviseF65. Others^[who?] demand that it be specified even more to prevent scientists from confusing it with the popular use of the term fetishism. And other researchers^[who?] argue that it should be expanded to cover other sexual orientations, such as an addiction to words or fire. Most physicians^[who?] would not say that a man who finds a woman attractive because she is dressed in high heels, lacy stockings or a corset has an abnormal fetish.

Treatment[link]

There are three possible treatments for fetishism: cognitive behavior therapy and psychoanalysis or simply a behavior supervision on proportional timing while not practicing any sexual activity for not activating the fetish.

Cognitive behavior therapy[link]

Cognitive behavior therapy seeks to change a person's behavior without analyzing how and why it has shown up. Rather than focusing on the origins of fetishes, cognitive behavior therapy is built on the empirical study of interventions that alleviate the distress associated with them.

Cognitive behavior therapy primarily focuses on helping patients tune in to automatic thoughts that affect patients' mood and behavior. As patients become more aware of their automatic thoughts, they learn to alter irrational thoughts and resolve contradictions that lead to distress. A common goal of cognitive therapy in the treatment of fetishes is helping the patient realize the irrationality of identifying with a disliked fetish, a form of cognitive globalization that often leads to self-judgment.

The following is not cognitive behavior therapy and should not be confused with it: One therapeutic technique is aversive conditioning, which entails presenting patients with a displeasing stimulus with the fetish as soon as sexual arousal starts. Another therapeutic technique is called thought stopping, in which the therapist asks the patient to think of the fetish and suddenly cries out "stop!". The patient will be irritated, their line of thought broken. After analyzing the effects of the sudden break together, the therapist will teach the patient to use this technique by him or herself to interrupt thoughts about the fetish and thus avoid the undesired behavior.

Medication[link]

Various pharmaceutical drugs are available that inhibit the production of sex steroids, especially male testosterone and female estrogen. By cutting down the level of sex steroids, sexual desire is diminished. Thus, in theory, a person might gain the ability to control their fetish and reasonably process their own thoughts without being distracted by sexual arousal. Also, the application may give the person relief in everyday life, enabling them to ignore the fetish and get back to daily routine. Other research has assumed that fetishes may be like obsessive-compulsive disorders, and has looked into the use of psychiatric drugs (serotonin reuptake inhibitors and dopamine blockers) for controlling paraphilias that interfere with a person's ability to function.

Although ongoing research has shown positive results in single case studies with some drugs, e. g. with topiramate,^[11] there is not yet any medicament that tackles fetishism itself. Because of that, physical treatment is only suitable to support one of the psychological methods.

See also[link]

Wikimedia Commons has media related to: Sexual fetishism

References[link]

Further reading[link]

• Bienvenu, Robert, The Development of Sadomasochism as a Cultural Style in the Twentieth-Century United States, 2003, Online PDF under Sadomasochism as a Cultural Style
• Gates, Katharine (1999). Deviant Desires: Incredibly Strange Sex. Juno Books. ISBN 1-890451-03-7. 
• Kaplan, Louise J. (1991). Female Perversions: The Temptations of Emma Bovary. New York: Doubleday. ISBN 0-385-26233-7. 
• Love, Brenda (1994). The Encyclopedia of Unusual Sex Practices. Barricade Books. ISBN 1-56980-011-1. 
• Steele, Valerie (1995). Fetish: Fashion, Sex, and Power. Oxford University Press. ISBN 0-19-509044-6. 
• Utley, Larry; Autumn Carey-Adamme (2002). Fetish Fashion: Undressing the Corset. Green Candy Press. ISBN 1-931160-06-6.