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.

Exhibitionism 101

Exhibitionism is the revelation of one's sexual organs to non-consenting strangers chiefly for personal erotic excitement or pleasure. Exhibitionism is also known in lay terms as “flashing".

Exhibitionism is a bona fide psychiatric disorder include in DSM IV. The diagnostic criteria for exhibitionism entail that the individual has experienced strong sexual urges/arousal when exposing his/her genitals to strangers for at least 6 months.  Going to New Orleans and flashing the breasts once or twice would not be considered exhibitionism by this criteria. Moreover the individual has either acted upon these urges or they also cause significant personal distress or interpersonal difficulties.

In most cases, the exhibitionist will expose genitals to strangers but in some cases may also actively masturbate in front of the victim. It is the shock of the victim that induces the sexual arousal for the exhibitionist. Usually there is no physical contact with the victim but this also depends on circumstances. Evidence today indicates that there are also aggressive exhibitionists who will touch or grab the victim.

Exhibitionists are quite cunning individuals and usually employ tricks to attract the unsuspecting victim to a certain area. Usually isolated areas are selected but more often than not, the exhibitionist rarely makes any attempt to hide his/her identify. It is this risk factor that is critical for achieving sexual arousal.

The real number of exhibitionists in the general population is unknown but among sex offenders, it appears that almost 30% have exhibitionist tendencies. While the majority of culprits are males, there are reports that exhibitionism is also common in females. This is common at adult dancing parlors and strip tease bars. Moreover, wearing of skimpy clothes, revealing outfits or see though clothes is also considered exhibitionism-but somehow society rarely complains when it is the female who is the offender!

Exhibitionism usually first surfaces in early teenage years and peaks in the adolescence years. The victims of exhibitionists are usually adult females or children. Most exhibitioners are married or engaged in steady relationships but when closely examined, these individuals do have some degree of sexual dysfunction within the relationship. Although exhibitionism is primarily seen in the younger age groups, it also occurs in the elderly- albeit at a much lower incidence.

Often individuals with exhibitionist tendencies are involved into voyeurism frotterism and have some degree of pedophilic interests.

The majority of individuals with exhibitionism tendencies only come to treatment when they are in legal difficulties or arrested. The treatment of such behaviors is cognitive behavior therapy coupled with SSRI to decrease the sex drive. Those who are aggressive may also be considered for hormonal sex drive reducing medications.

 
The prognosis of these individuals is poor. The therapies often fail because the individuals are non-compliant and relapses are common. Most end up incarcerated or labeled as sexual deviants and have difficulty adjusting to normal life.

Body dysmorphic Disorder and Plastic Surgery!

In today’s society, an increasing number of women are seeking cosmetic surgery to correct physical flaws in their body. While having a “nip and a tuck” here and there is perfectly acceptable, there are some women who are addicted to cosmetic surgery. Statistics reveal that more than 20 percent of women seek multiple cosmetic procedures and at least 15 percent never receive any satisfaction. 

Studies now show that some people -both men and women, who repeatedly seek cosmetic surgery, may be afflicted with a mental disorder known as body dysmorphic disorder. In these people, the simple “nip and tuck” or “Botox” injection does absolutely nothing to satisfy their mind.

In people with body dysmorphic disorder, every minor flaw on their body is perceived as a huge imperfection that leads to a lot of anxiety and stress. These individuals become so fixated with their physical beauty that they become dysfunctional when they view their body.

Typically, these individuals become heavy users of cosmetic surgery. Unfortunately, the majority of plastic surgeons never consider the emotional component and continue to perform more procedures as it is a source of income for them. Rather than recommending these patients for some type of psychological counseling, these unfortunate individuals are sliced and diced everywhere on their body.

It is believed that in the USA alone close to 8 percent of people have body dysmorphic disorder who need treatment.

In a recent study done at Rhode Island and Philadelphia hospitals, doctors observed that less than 2 percent of patients with body dysmorphic disorder were relieved of their symptoms after plastic surgery. One quarter of patents did improve but in some, the symptoms of body dysmorphic disorder actually worsened after the procedures. The study authors mentioned that these people cannot be treated with a scalped or a Botox syringe, but need something else.

"Physicians need to be aware that psychiatric treatments for BDD such as serotonin reuptake inhibitors and cognitive behavioral therapy appear to be effective for what can be a debilitating disorder," the researchers wrote.

Electricity can improve memory!

Now that we know that no drugs can improve memory, researchers have been looking at more exotic methods to stimulate the brain. Recently scientists from the famed British University, Oxford, revealed that tiny electrical current to the brain could make one better at learning maths. They observed that when the parietal lobe of the brain was shocked, the ability of volunteers to solve mathematical problems improved. They suggest that perhaps this technique may help people who struggle with numbers (dyscalculia).

There are many people who have trouble with basic numbers, and this affects their ability to perform even the most basic maths and managing money. Some neuroscientists speculate that perhaps certain chemicals within the parietal lobe play a crucial role in memory.

Previous studies have shown that when magnetic field is applied to certain parts of the brain, it can disrupt electrical activity and lead to temporary difficulties in solving math problems. Therefore, these investigators applied electrical current to stimulate the parietal lobe in a small number of students. The electrical current was minor and had no untoward effects on other brain function. As the current was employed, the students performed much better at mathematical problems than those who were given no electrical current. In addition, the direct of the current was also very important. When the current was given in the wrong direction, their ability to solve problems declined drastically.

The study also revealed that the positive benefits were long lasting and persisted beyond 6 months. 

Dr Cohen Kadosh, lead investigator said, "We are not advising people to go around giving themselves electric shocks, but we are extremely excited by the potential of our findings and are now looking into the underlying brain changes. We have shown before that we can induce dyscalculia, and now it seems we might be able to make someone better at maths, so we really want to see if we can help people with dyscalculia. Electrical stimulation is unlikely to turn you into the next Einstein, but if we're lucky it might be able to help some people to cope better with maths."

This study is very intriguing and may perhaps open the door to the treatment of other mental and neurological disorders like addiction or memory loss following a stroke.

Said Dr Chambers of Cardiff University, "This is still an exciting new piece of research, but if we don't know how selective the effects of brain stimulation are then we don't know what other brain systems could also be affected, either positively or negatively."

Final point: While the study is exciting, one should note that electrical therapy (ECT) has been used to treat depression for several decades. So before you start lining up for electrical therapy, remember that even though the current in ECT therapy is slightly high, the majority of people have one major side effect- memory loss, which is sometimes permanent. Until further studies are done on this type of therapy, people who cannot count their money are better off asking others to shop for them.

The urge to steal- kleptomania: Part 2

Like all things in mental health, the cause of kleptomania remains a puzzle. It is believed to be to an abnormality in one the brain neurotransmitters called serotonin. Kleptomania is rare but the actual numbers of people affected remain unknown. Less than 5% of people caught for shoplifting are kleptomaniacs. The disorder usually starts in early childhood and peaks in the 2^nd decade of life. Risk factors for kleptomania include head trauma, life stress, having a family member with a mental health disorder (mood disorder, addiction or impulsivity). Doctors use the criteria stated in DSM to make a diagnosis of kleptomania. If kleptomania is untreated, it usually leads to legal, financial and emotional problems. Most kleptomaniacs know that stealing is wrong but are powerless to resist the urge to steal. Many of them are left with residual feelings of remorse, disgrace, embarrassment and self-loathing. Often kleptomania is associated with other disorders like alcohol and drug abuse, eating disorders, compulsive gambling, social isolation, depression, anxiety and suicidal thoughts.

Kleptomania is difficult to overcome with self-treatment at home. There are no standard treatments for the disorder and doctors use a combination of medications and psychotherapy to help overcome the impulse to steal. Even though medications like anti depressants and mood stabilizers are used, there is no clinical evidence that these medications help overcome kleptomania. Moreover, the same medication does not work in all individuals. Most of the medications relieve stress, cause generalized sedation and diminish the urge to steal. The major thrust of treatment is psychotherapy. Cognitive behavioral therapy has been used to identify unhealthy negative behaviors and replace them with healthy positive attitudes. CBT can gradually help people overcome kleptomania, but the treatment is long term and expensive.

To prevent relapse, individuals are urged to develop a support system. This may means educating one's self about the disorder, adopting healthy attitudes, learning to relax and remaining focused. Since the cause of kleptomania is unknown, it is difficult to prevent it. The best way to treat it is to seek help early. Overall, the prognosis of kleptomania depends on the severity of the condition. Those in the early stages can overcome the disorder but those with a long history often end up in legal and financial problems.