What is Fetishism?

Fetishism is sexual excitement with use of inanimate objects. Fetishism is a mental health disorder classified by DSM criteria. The disorder usually presents with intense sexual arousal, excitement and erotic fantasies involving inanimate objects for at least 6 months. Moreover, the disorder can cause a variety of behavior changes and interferes with normal social behavior and interpersonal relationships. In rare cases, the fetish can be so intense that it also interferes with work.

Fetishism is not a rare disorder. While the exact number of people who dabble into this type of behavior is not known, it is estimated that at least 1-5 percent of the population has some degree of fetishism. Most fetishists tend to be males. Fetishism tends to peak in early adolescence and continues as long as the individual is sexually active. Both men and women while masturbating may fantasize about a fetish object or they may rub, suck, wear or insert the item(s) into their body orifices. In most cases, fetishism is a solitary sexual behavior but it is not unusual for couples to practice fetishism. Some people smell the fetish or may ask the sexual partner to wear the object during sexual activity. It is believed that close to 30% of couples practice fetishism in their sexual relationships- however, the fetish is controlled and does not affect their personal lives.

One may develop a fetish to any number of objects but the most common are rubber, plastic, shoes, leather, underwear, hair, high heel shoes, boots, stockings and clothing. In many cases, the fetish is so strong that without it, the individual may be unable to achieve a sexual satisfaction. Practicing fetishism is not illegal but when the individual starts to combine it with other sexual disorders like voyeurism or pedophilia, then it results in criminal behavior.

It is widely believed that fetishism is a learned behavior and not something, that is genetically acquired. Individuals with fetishes often tell of physical or sex abuse during childhood.  Many males who have fetishes also practice other sexual behaviors like masochism, sadism and transvestism

People who are into fetishism enjoy the behavior and find it erotic. Thus, most people never willingly seek help.  Some individuals run into trouble with the law and are required to seek help. The treatment of fetishism is a combination of cognitive behavior therapies and medications.  Common drugs used to treat fetishes include drugs which reduce sexual hormones and anti anxiety agents. In most cases, therapy is not required for fetishes.

Paraphilia- disorder of sexual preference

Paraphilia is a medical term to denote sexual deviation, sexual perversion or a disorder of sexual preference. Unlike curiosity, paraphilia is characterized by repetitive, strong sexual arousal to unusual stimuli (not always sexual). Not all Paraphilias as such are illegal (like cross-dressing), but some like pedophilia are considered criminal.

The recognition of paraphilia as deviant sexual behavior was established by Von Krafft Ebbing in 1886. Since then the study of paraphilias has been exhaustive in the field of forensic psychiatry. Today, paraphilias are bona fide disorders recognized in the category of sexual and gender identify disorders in the DSM IV.

For some unknown reason paraphilias occur almost exclusively in males. The paraphilia often starts during early puberty and is almost fully developed by the end of the 2^nd decade of life. Men in all cultures have been reported to develop different paraphilias. In many cases, multiple paraphilias may co-exist at the same time. At least 5-10 percent of men have as many as 5-7 paraphilias.

In most cases, the individual never seeks help and is only seen by health professional after legal troubles starts. To make a diagnosis of a paraphilia one must have intense and recurrent sexual fantasies or sexual urges that usually involve inanimate objects, children, and non-consenting adults. The behavior is often associated with torment or humiliation of others. In addition, the activity must have lasted at least 6 months and caused significant emotional distress and difficulties in interpersonal relationships.

Some of the common paraphilias include:

• Pedophilia –sexual activity involving children
• Exhibitionism -exposing one's genitalia
• Fetishism  is a love for specific objects like underwear or pantyhose
• Frotteurism is rubbing against strangers (esp. in crowded places)
• Sexual masochism (pain or humiliation of self
• Sexual sadism which involves pain or humiliation of others
• Transvestic fetishism –involves wearing clothes of the opposite sex
• Voyeurism involves peeping

Other rare paraphilias include:

- Telephone scatologia- making obscene sexually explicit phone calls

- Necrophilia- have love of dead bodies

- Zoophilia is having sex with animals

- Corprophilias is love of fecal material

- Urophilia is love of urine

The majority of paraphiliacs also have other issues like a history substance abuse, personality disorders, history of aggression and most are loners. Even after diagnosis is made, paraphiliacs are not motivated to undergo treatment. Most become non-complaint because in fact there are no good treatments for these disorders. The few motivated patients can be helped with cognitive behavior therapy to reduce the sexual urges.

Drug therapy is often used with psychosocial treatments for maximal benefit. The commonly used drugs to diminish the sex drive include provera, lupron and androcur. In addition, SSRIs are also used to decrease the sexual urges. There are no real data on prognosis but anecdotal reports suggest that treatment is difficult and relapses are common.  Most people with paraphilia remain addicted to these behaviors and often end up with legal problems. The majority eventually remain incarcerated.