DSM5: Understanding Fetishistic Disorder

Fetishistic disorder is a mental health condition that centers on the employment of inanimate objects as a source of sexual satisfaction or the fulfillment of sexual fantasies or urges. The Diagnostic and Statistical Manual of Mental Disorders, which provides the basic roadmap for diagnosing mental illness in the US, includes this condition along with a group of illnesses called paraphilic disorders.

The latest edition of the Diagnostic and Statistical Manual, known in the mental health community by the abbreviation DSM 5, partially redefines the symptoms that qualify for a fetishistic disorder diagnosis. DSM 5 also differentiates between fetishistic disorder and fetishism, a pattern of sexual behavior that doesn’t necessarily qualify as a mental disorder.

Fetishism Basics

Fetishism and several other unusual patterns of sexual behavior form a category of conditions called paraphilias. Psychiatrists and other doctors once used the term paraphilia to describe the mental disturbances currently known as paraphilic disorders.

Now, the term applies to atypical or abnormal behaviors that can potentially involve or lead to mental illness, but don’t constitute an illness in and of themselves. In fact, while many people affected by paraphilias experience harm as a result of their sexual needs or inflict harm upon others, some people who engage in these behaviors function well, meet all of their social and personal obligations, and never pose a threat to anyone else.

Fetishists may use one or more objects as part of sexual activities that they undertake on their own or with a partner. Objects often used for this purpose include shoes, women’s undergarments or other items made from materials such as leather, latex or silk. Some individuals develop a form of fetishism called form fetishism and place an emphasis on the size and shape of the objects they use.

Other individuals develop a form of fetishism called media fetishism, which places an emphasis on the textures of the objects used for gratification. Although true fetishists typically incorporate inanimate objects into their sexual practices, some people develop a fetish-like mindset toward parts of the human body not normally directly associated with sexual activity.

Transvestism, also known as cross-dressing, was once viewed as a specific form of fetishism.

However, experts in the field now view it as its own distinct form of paraphilia.

Fetishistic Disorder Basics

Fetishistic disorder entered the ranks of recognized mental illness in May 2013 when DSM 5 was published by the American Psychiatric Association. It appears in people who participate in fetishism-based sexual practices, but stands apart from the basic practice of fetishism because it produces harm in the individual or in other people who are unwilling participants in fetishistic activity.

Self-harm in a fetishist classically appears as mental anguish or distress that comes from an internal conflict rather than a conflict with social morals or judgments. Harm to others can involve the infliction of mental anguish or distress, the infliction of physical injury, or any other activity that violates a person’s right or body boundaries.

In order to qualify for a diagnosis, an affected individual must also participate in fetishistic activities, engage in fetishism-based fantasies, or experience clear fetishistic urges for six months or longer. In addition, a person’s fetishistic practices must involve something other than the cross-dressing practices associated with transvestism, or the use of vibrators or other inanimate objects commonly used as sexual aids.

The definition of fetishistic disorder only addresses practices involving inanimate objects; it does not address the use of the human body in fetishistic practices.

Treatment Considerations

Treatments for fetishistic disorder (or any other mental health condition) are not contained in the Diagnostic and Statistical Manual, which exists specifically to help doctors identify psychiatric/psychological problems in their patients. However, other sources besides the DSM do address treatment considerations.

The University of Texas’s Sexual Psychophysiology Laboratory lists psychotherapeutic treatment options common to all paraphilic disorders that include aversion therapy, orgasm reconditioning and covert sensitization; all of these options belong to a larger framework of related techniques known as cognitive behavioral therapy.

Medication-based options for the treatment of fetishistic disorder and other paraphilic disorders include anti-anxiety/antidepressant drugs called SSRIs and a number of different hormone therapies that achieve their effects by lowering the potential for sexual arousal, or the potential for sexual performance in response to sexual arousal. Examples of available hormonal treatments include estrogen and testosterone-lowering drugs called antiandrogens.