Sexual fetishism is a sexualfixation on anything not considered sexual by its respective nature.[1] The object of interest is called thefetish; the person who has a fetish is afetishist.[2] A sexual fetish may be regarded as amental disorder if it causes significantpsychosocial distress for the person or has detrimental effects on important areas of their life.[1][3]Sexual arousal from a particular body part can be further classified aspartialism.[4]
Medical definitions restrict the termsexual fetishism to objects or body parts.[1] In common language,fetish is also used for a sexual interest in specific activities, people, types of people, substances, or situations.[5]
The wordfetish is commonly used for any sexually arousing stimuli, not all of which meet the medical criteria for fetishism.[5] This broader usage offetish covers parts or features of the body (includingobesity andbody modifications), objects, situations and activities (such assmoking orBDSM).[5]Paraphilias such asurophilia,necrophilia andcoprophilia have been described as fetishes.[6]
Originally, most medical sources definedfetishism as a sexual interest in non-living objects, body parts or secretions. The publication of theDSM-III in 1980 changed that, by excluding arousal from body parts in its diagnostic criteria for fetishism. In 1987, the revisedDSM-III-R introduced a new diagnosis for body part arousal calledpartialism. TheDSM-IV retained this distinction.[6]Martin Kafka argued that partialism should be merged into fetishism because of overlap between the two conditions.[6] TheDSM-5 subsequently did so in 2013.[1]
A submissive man worshipping a woman's foot, fromDresseuses d'Hommes (1931)
In a review of 48 cases of clinical fetishism in 1983, fetishes includedclothing (58.3%),rubber and rubber items (22.9%),footwear (14.6%),body parts (14.6%),leather (10.4%), and soft materials or fabrics (6.3%).[7]A 2007 study counted members of Internet discussion groups with the wordfetish in their name. Of the groups about body parts or features, 47% belonged to groups about feet (podophilia), 9% aboutbody fluids (includingurophilia,scatophilia,lactaphilia,menophilia,mucophilia), 9% about body size, 7% about hair (hair fetish), and 5% about muscles (muscle worship). Less popular groups focused on navels (navel fetishism), legs, body hair, mouth, and nails, among other things. Of the groups about clothing, 33% belonged to groups about clothes worn on the legs or buttocks (such as stockings or skirts), 32% about footwear (shoe fetishism), 12% about underwear (underwear fetishism), and 9% about whole-body wear such as jackets. Less popular object groups focused on headwear, stethoscopes, wristwear,pacifiers, and diapers (diaper fetishism).[5]
Erotic asphyxiation is the use of choking to increase the pleasure in sex. The fetish also includes an individualized part that involves choking oneself during the act of masturbation, which is known as auto-erotic asphyxiation. This usually involves a person being connected and strangled by a homemade device that is tight enough to give them pleasure but not tight enough to suffocate them to death. This is dangerous due to the issue of hyperactive pleasure seeking which can result in strangulation when there is no one to help if the device gets too tight and strangles the user.[8]
Devotism involves beingattracted to disability or body modifications on another person that are the result of amputation for example. Devotism is only a sexual fetish when the person who has the fetish considers the amputated body part on another person the object of sexual interest.[9]
The sensory regions for the feet and genitals lie next to each other, as shown in thiscortical homunculus.
Fetishism and paraphilias in general usually becomes evident during puberty, but may develop prior to that.[1] No single cause for fetishism has been conclusively established.[10] Currently widely accepted etiological models hypothesize paraphilias to originate from a complex set of neurological, social, and cultural factors in a given person.[11] Different paraphilias may have different causes, and there is no guarantee that two persons with the same paraphilias as the other would be interested in the same aspects of it or have the same ultimate cause for its development.[12][13]
From apersonality perspective, fetishists in studies generally report higher levels ofintroversion, impersonal sexual activity such asmasturbation and less satisfaction with life and relationships.Hypersexual behavior increased theodds ratio for some fetishes and paraphilias, with a ratio of 4.6 in males and 25.6 in females, according to a 1996 Swedish study.[14][15]
Some explanations invokeclassical conditioning. In several experiments, men have been conditioned to show arousal to stimuli like boots, geometric shapes or penny jars by pairing these cues with conventional erotica.[16] According toJohn Bancroft, conditioning alone cannot explain fetishism, because it does not result in fetishism for most people. He suggests that conditioning combines with some other factor, such as an abnormality in the sexual learning process.[10]Social learning theories which combinesocial cognition andoperant conditioning have also been proposed as an explanation for how fetishes may be learned, with the hypothesis being that fetishism is induced by the brain mistaking the object of arousal as a culturally appropriate source of sexual desire due to the unique experiences of the fetishist. Men who report being sexually rejected often are more likely to developpartialism and fetishism towards other objects such asundergarments, which is believed to be a reaction where the person learns overtime to value the non-human parts of potential partners as a social response.[17]
Theories ofsexual imprinting propose that humans learn to recognize sexually desirable features and activities during childhood. Fetishism could result when a child is imprinted with an overly narrow or incorrect concept of a sex object. Ethological imprinting has also been a suggested cause.[18][19]
Imprinting seems to occur during the child's earliest experiences with arousal and desire, and is based on "an egocentric evaluation of salient reward- or pleasure-related characteristics that differ from one individual to another."[20]
Neurological differences may play a role in some cases.Vilayanur S. Ramachandran observed that the region processing sensory input from the feet lies immediately next to the region processing genital stimulation, and suggested an accidental link between these regions could explain the prevalence offoot fetishism.[21] This has been disputed by a meta-analysis and experiment done by a 2013 study, showing a lack of correlation between foot stimulation, other stimulation to areas, and erotic behavior, though it did not explicitly rule in or out the potential of another brain area responsible for eroticism.[22] The study concluded that neurological mechanisms regarding fetishism are poorly understood.
Various explanations have been put forth for the rarity of female fetishists. Most fetishes are visual in nature, and males are thought to be more sexually sensitive to visual stimuli.[27]Roy Baumeister suggests that male sexuality is unchangeable, except for a brief period in childhood during which fetishism could become established, whilefemale sexuality is fluid throughout life.[28]
Under theDSM-5, fetishism is sexual arousal from nonliving objects or specific nongenital body parts, excluding clothes used forcross-dressing (as that falls undertransvestic fetishism) andsex toys that are designed for genital stimulation. In order to be diagnosed asfetishistic disorder, the arousal must persist for at least six months and cause significantpsychosocial distress or impairment in important areas of their life. In theDSM-IV, sexual interest in body parts was distinguished from fetishism under the namepartialism (diagnosed asParaphilia NOS), but it was merged with fetishistic disorder for the DSM-5.[1]
The ReviseF65 project campaigned for theInternational Classification of Diseases (ICD)’s fetish-related diagnoses to be abolished completely to avoidstigmatizing fetishists.[29] On 18 June 2018, the WHO (World Health Organization) publishedICD-11, in which fetishism and fetishistic transvestism (cross-dressing for sexual pleasure) are now removed as psychiatric diagnoses. Moreover, discrimination against fetish-having andBDSM individuals is considered inconsistent with human rights principles endorsed by the United Nations and The World Health Organization.[30]
According to theWorld Health Organization, fetishistic fantasies are common and should only be treated as a disorder when they impair normal functioning or cause distress.[3] Goals of treatment can include elimination of criminal activity, reduction in reliance on the fetish for sexual satisfaction, improving relationship skills, reducing or removing arousal to the fetish altogether, or increasing arousal towards more acceptable stimuli. The evidence for treatment efficacy is limited and largely based oncase studies, and no research on treatment for female fetishists exists.[31]
Cognitive behavioral therapy is one popular approach. Cognitive behavioral therapists teach clients to identify and avoid antecedents to fetishistic behavior, and substitute non-fetishistic fantasies for ones involving the fetish.Aversion therapy andcovert conditioning can reduce fetishistic arousal in the short term, but requires repetition to sustain the effect. Multiple case studies have also reported treating fetishistic behavior withpsychodynamic approaches.[31]
Antiandrogens may be prescribed to lower sex drive.Cyproterone acetate is the most commonly used antiandrogen, except in the United States, where it may not be available. A large body of literature has shown that it reduces general sexual fantasies. Side effects may includeosteoporosis,liver dysfunction, and feminization. Case studies have found that the antiandrogenmedroxyprogesterone acetate is successful in reducing sexual interest, but can have side effects including osteoporosis,diabetes,deep vein thrombosis, feminization, and weight gain. Some hospitals useleuprorelin andgoserelin to reduce libido, and while there is presently little evidence for their efficacy, they have fewer side effects than other antiandrogens. A number of studies support the use ofselective serotonin reuptake inhibitors (SSRIs), which may be preferable over antiandrogens because of their relatively benign side effects. Pharmacological agents are an adjunctive treatment which are usually combined with other approaches for maximum effect.[31]
Relationship counselors may attempt to reduce dependence on the fetish and improve partner communication using techniques likesensate focusing. Partners may agree to incorporate the fetish into their activities in a controlled, time-limited manner, or set aside only certain days to practice the fetishism. If the fetishist cannot sustain an erection without the fetish object, the therapist might recommend orgasmic reconditioning orcovert sensitization to increase arousal to normal stimuli (although the evidence base for these techniques is weak).[31]
Theprevalence of fetishism is not known with certainty. Fetishism is more common in males.[27] In a 2011 study, 30% of men reported fetishistic fantasies, and 24.5% had engaged in fetishistic acts. Of those reporting fantasies, 45% said the fetish was intensely sexually arousing.[32] In a 2014 study, 26.3% of women and 27.8% of men acknowledged any fantasies about "having sex with a fetish or non-sexual object". A content analysis of the sample's favorite fantasies found that 14% of the male fantasies involved fetishism (includingfeet, nonsexual objects, and specific clothing), and 4.7% focused on a specific body part other than feet. None of the women's favorite fantasies had fetishistic themes.[33] Another study found that 28% of men and 11% of women reported fetishistic arousal (including feet, fabrics, and objects "like shoes, gloves, or plush toys").[34] 18% of men in a 1980 study reported fetishistic fantasies.[27]
Fetishism to the extent that it is seen as a disorder appears to be rare, with less than 1% of general psychiatric patients presenting fetishism as their primary problem. It is also uncommon in forensic populations.[27]
The wordfetish derives from theFrenchfétiche, which comes from thePortuguesefeitiço ("spell"), which in turn derives from theLatinfacticius ("artificial") andfacere ("to make").[35] A fetish is an object believed to have supernatural powers, or in particular, a human-made object that has power over others. Essentially, fetishism is the attribution of inherent value or powers to an object.Fétichisme was first used in an erotic context byAlfred Binet in 1887.[36][37] A slightly earlier concept was Julien Chevalier'sazoophilie.[38]
Alfred Binet suspected fetishism was the pathological result ofassociations. He argued that, in certain vulnerable individuals, an emotionally rousing experience with the fetish object in childhood could lead to fetishism.[39]Richard von Krafft-Ebing andHavelock Ellis also believed that fetishism arose from associative experiences, but disagreed on what type of predisposition was necessary.[40]
The sexologistMagnus Hirschfeld followed another line of thought when he proposed his theory ofpartial 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 oftransitional 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. He speculated that the child'stransitional object became sexualized.[41]
Human fetishism has been compared toPavlovian conditioning of sexual response in other animals.[20][42][43] Sexual attraction to certain cues can be artificially induced inrats. Both male and female rats will develop a sexual preference for neutrally or even noxiously scented partners if those scents are paired with their early sexual experiences.[20] Injectingmorphine oroxytocin into a male rat during its first exposure to scented females has the same effect.[20] Rats will also develop sexual preferences for the location of their early sexual experiences, and can be conditioned to show increased arousal in the presence of objects such as a plastic toy fish.[20][42] One experiment found that rats which are made to wear a Velcro tethering jacket during their formative sexual experiences exhibit severe deficits in sexual performance when not wearing the jacket.[20] Similar sexual conditioning has been demonstrated ingouramis,marmosets andJapanese quails.[20]
Possibleboot fetishism has been reported in two different primates from the same zoo. Whenever a boot was placed near the first, acommon chimpanzee born in captivity, he would invariably stare at it, touch it, become erect, rub his penis against the boot, masturbate, and then consume his ejaculate. The second, aguinea baboon, would become erect while rubbing and smelling the boot, but not masturbate or touch it with his penis.[44]
^ab"Fetishism, F65.0"(PDF).The ICD-10 Classification of Mental and Behavioural Disorders: Clinical descriptions and diagnostic guidelines. World Health Organization. p. 170. Archived fromthe original(PDF) on 23 March 2014. Retrieved2 March 2014.
^Milner, J. S., & Dopke, C. A. (1997). Paraphilia Not Otherwise Specified: Psychopathology and theory. In D. R. Laws and W. O'Donohue (Eds.),Sexual deviance: Theory, assessment, and treatment. New York: Guilford.
^abcdScorolli, C.; Ghirlanda, S.; Enquist, M.; Zattoni, S.;Jannini, E. (2007). "Relative prevalence of different fetishes".International Journal of Impotence Research.19 (4):432–437.doi:10.1038/sj.ijir.3901547.PMID17304204.
^Chalkley, A. J.; Powell, G. E. (1983). "The clinical description of forty-eight cases of sexual fetishism".British Journal of Psychiatry.142 (3):292–95.doi:10.1192/bjp.142.3.292.PMID6860882.S2CID37994356.
^Ventriglio, Antonio; Bhat, P. S.; Torales, Julio; Bhugra, Dinesh (22 November 2008)."Sexuality in the 21st century: Leather or rubber? Fetishism explained".Medical Journal, Armed Forces India.75 (2):121–124.doi:10.1016/j.mjafi.2018.09.009.ISSN0377-1237.PMC6495465.PMID31065177.Gosselin et al.10 noted that those who had a rubber fetish and those with a leather fetish scored high on introversion when compared with those with sadomasochistic tendencies. They had normal socioeconomic variations. Weinberg et al.8 studied 262 foot fetishist members of a society. He reported that among homosexual men, foot fetish was not uncommon. The prevalence data are often limited and not easy to extrapolate from case series or case reports. In a summary of 2450 individuals in Sweden, it was found that men and those who had lower levels of satisfaction with life and used drugs or alcohol were more likely to have fetishistic behaviours.11, 12 Langstrom et al.13 observed transvestic fetishism in 0.4% of women and 2.8% of men. These individuals (with fetish) showed higher rates than expected rates of separation from their parents in childhood and also showed high levels of arousal and masturbation.
^Ventriglio, Antonio; Bhat, P. S.; Torales, Julio; Bhugra, Dinesh (22 November 2008)."Sexuality in the 21st century: Leather or rubber? Fetishism explained".Medical Journal, Armed Forces India.75 (2):121–124.doi:10.1016/j.mjafi.2018.09.009.ISSN0377-1237.PMC6495465.PMID31065177.Another possibility that has been put forward is that of social learning (which incorporates both operant conditioning and social cognition5). La Torre [17] showed that men who had experienced rejection in a relationship were more likely to rate pictorial stimuli or pictures of women's garments and body parts.
^Mitchell, W., Falconer, M., & Hill, D. (1954). "Epilepsy with fetishism relieved by temporal lobectomy".The Lancet.264 (6839):626–630.doi:10.1016/s0140-6736(54)90404-3.PMID13202455.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^Ahlers, C. J., Schaefer, G. A., Mundt, I. A., Roll, S., Englert, H., Willich, S. N., & Beier, K. M. (2011). "How unusual are the contents of paraphilias? Paraphilia-associated sexual arousal patterns in a community-based sample of men".The Journal of Sexual Medicine.8 (5):1362–1370.doi:10.1111/j.1743-6109.2009.01597.x.PMID19929918.S2CID205894747.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^Joyal, C. C., Cossette, A., & Lapierre, V. (2014). "What Exactly Is an Unusual Sexual Fantasy?".The Journal of Sexual Medicine.12 (2):328–340.doi:10.1111/jsm.12734.PMID25359122.S2CID33785479.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^Winnicott, D. W. (1953)Übergangsobjekte und Übergangsphänomene: eine Studie über den ersten, nicht zum Selbst gehörenden Besitz. (German) Presentation 1951, 1953. In:Psyche 23, 1969.
^abZamble, E., Mitchell, J. B., & Findlay, H. (1986). "Pavlovian conditioning of sexual arousal: Parametric and background manipulations".Journal of Experimental Psychology: Animal Behavior Processes.12 (4):403–411.doi:10.1037/0097-7403.12.4.403.PMID3772304.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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