Fetishistic disorder is an intense sexual attraction to either inanimate objects or to body parts not traditionally viewed as sexual, coupled with clinically significant distress or impairment.
According to the DSM-5, fetishistic disorder is a condition in which there is a persistent and repetitive use of or dependence on nonliving objects (such as undergarments or high-heeled shoes) or a highly specific focus on a body part (most often nongenital, such as feet) to reach sexual arousal.
Since fetishes occur in many normally-developing individuals, a diagnosis of fetishistic disorder is only given if there is accompanying personal distress or impairment in social, occupational, or other important areas of functioning as a result of the fetish, or when sexual arousal is impossible without the fetish object. People who identify as fetishists but do not report associated clinical impairment would be considered to have a fetish but not fetishistic disorder. Most individuals find particular nongenital bodily features attractive, indicating that some level of fetishism is a normal feature of human sexuality.
The term "fetishism" originates from the Portuguese word feitico, which means "obsessive fascination." Only through the use of this object, or focus on this body part, can the individual obtain sexual gratification.
For some, merely a picture of the fetish object may cause arousal, though many with a fetish prefer (or require) the actual object in order to achieve arousal. The fetishist usually holds, rubs, tastes, or smells the fetish object for sexual gratification or asks their partner to wear the object during sexual encounters.
Inanimate object fetishes can be categorized into two types: form fetishes and media fetishes. In a form fetish, the shape of the object is important, such as high-heeled shoes. In a media fetish, the material of the object, such as silk or leather, is important. Inanimate object fetishists often collect the object of their favor.
Fetishistic disorder is a much more common occurrence in males than in females—in fact, the DSM-5 indicates that it appears almost exclusively in males.
In earlier versions of the DSM, fetishistic disorder revolving around nongenital body parts was known as partialism; in the latest version, partialism was folded into fetishistic disorder.
The sexual acts of people with fetishistic disorder are characteristically focused almost exclusively on the fetish object or body part. In many cases, a person with fetishistic disorder can only become sexually aroused and reach orgasm when the fetish is being used, often feeling intense shame or distress about their inability to become aroused using "typical" stimuli. In other instances, a sexual response may occur without the fetish, but at a diminished level, which may cause shame or relationship tension.
Sexually active adults without fetishistic disorder—or adults with a specific fetish that causes them no distress—may at various times become aroused by a particular body part or an object and make it a part of their sexual interaction with another person, but not fixate on it.
The diagnostic criteria for fetishistic disorder, as catalogued in the DSM-5, include:
- For a period of at least six months, the person has recurrent, intense, sexually arousing fantasies, urges, or behaviors involving nonliving objects (such as female undergarments and shoes) or a highly specific focus on nongenital body parts.
- The fantasies, sexual urges, or behaviors cause significant distress or impair social, occupational, or personal functioning.
- The fetish objects are not articles of clothing used in cross-dressing and are not designed for tactile genital stimulation, such as a vibrator.
Fetishistic disorder can fluctuate in intensity throughout the lifespan.
Research indicates that nearly anything can become the object of a fetish. The most prevalent body fetishes are for feet, hands, hair, obesity, tattoos, and piercings. The most prevalent fetish objects are shoes, gloves, and (soiled) underwear, leather, rubber, skirts, gloves, and wearing diapers.
A sexual fetish is not unhealthy by definition, but if it causes prolonged, intense distress in a person, it may then be considered a fetishistic disorder. A festishistic disorder can make someone feel as if they’re no longer in control of their lives. A man who incorporates a fetish into his romantic relationship with a consenting partner does not necessarily display unhealthy behavior. But if the man is so consumed by his fetish that he is no longer sexually attracted to his partner and can only be aroused by his fetish item, then that is likely a sign of an unhealthy fetish.
Limited research indicates that individuals often have more than one fetish. One small study found that of 48 individuals with fetishistic disorder, 17 had only one fetish, nine had two fetishes, 12 had three fetishes, six had four fetishes, and others had up to nine fetishes.
Fetishes typically become apparent to an individual during or even prior to puberty. Sexual fetishes almost exclusively develop in males.
While estimates are that as much as 10 percent of the population may have some type of fetish, fetishistic disorder appears to be rare, with less than 1 percent of the population in psychiatric care for the condition.
Paraphilias such as fetishistic disorder typically have an onset during puberty, but fetishes can develop prior to adolescence. No cause for fetishistic disorder has been conclusively established.
Some theories include childhood experiences; biological factors, such as abnormal brain development; and cultural factors, as studies have shown different rates of fetishism in cultures that approach sexuality differently from each other.
One neurological idea about the cause of foot fetishes comes from the fact that the region in the brain that processes sensory information from the feet is adjacent to the area that processes sensory information from the genitals. This idea, advanced by neurologist Vilayanaur Ramachandran, postulates that there may be some “neural crosstalk” between the two brain areas. Body parts whose cortical representation is further away from that of the genitals are less likely to be fetishized, as feet are the most common fetish.
Some theorists believe that fetishism develops from early childhood experiences, in which an object was associated with a particularly powerful form of sexual arousal or gratification. Other learning theorists focus on later childhood and adolescence and the conditioning associated with masturbation and puberty.
Behavioral learning models suggest that a child who is the victim or observer of inappropriate sexual behaviors may learn to imitate or later be reinforced for the behavior. Compensation models suggest that these individuals may be deprived of normal social sexual contacts, and thus seek gratification through less socially acceptable means.
Fetishistic fantasies are common and in many cases harmless. According to the DSM definition, they should only be treated as a disorder when they cause distress or impair a person's ability to function normally in day-to-day life.
While a number of therapy-based and medication-based treatments can help control symptoms of fetishistic disorder, patients should know that there have historically been limitations on the degree to which therapy and medication, or a combination of the two can help. These therapies typically treat the symptoms—anxiety, shame, relationship problems—that bring a patient in to be treated, but many people with fetishes may retain a desire for their fetish item long-term. A primary outcome of the various therapies is to help patients cope better.
Fetishistic disorder tends to fluctuate in intensity and frequency of urges or behavior over the course of an individual’s life. As a result, effective treatment is usually long-term. Increasingly, evidence suggests that combining drug therapy with cognitive behavioral therapy can be effective, although research on the outcome of these therapies remains inconclusive. This allows a patient to concentrate on counseling with fewer distractions.
The level of sex drive is not consistently related to the behavior of those with fetishistic disorder, and high levels of circulating testosterone do not predispose a male to paraphilias. That said, hormones such as medroxyprogesterone acetate (Depo-Provera) and cyproterone acetate help decrease the level of circulating testosterone, potentially reducing sex drive and aggression—and, in the case of an individual with fetishistic disorder, potentially resulting in a reduction of the frequency of erections, sexual fantasies, and initiation of sexual behaviors, including masturbation and intercourse.
Cognitive-behavioral models of therapy may be effective in treating people with paraphiliac disorders. These include sensitization, aversive conditioning, and reconditioning. Reconditioning techniques center on immediate feedback given to the patient so that the behavior will change right away. For example, a person might be connected to a biofeedback machine that is linked to a light, then taught self-regulation techniques that will keep the light within a specific range of color. They then practice doing this while being exposed to sexually stimulating material. Masturbation training might focus on separating the pleasure of masturbation and climax from the deviant behavior.
A class of drugs called antiandrogens can temporarily lower testosterone levels and have been used in conjunction with other forms of treatment for fetishistic disorder. This medication lowers sex drive in males and thus can reduce the frequency of sexually arousing mental imagery. Antidepressants such as fluoxetine (Prozac) may also decrease sex drive but have not been shown to effectively target sexual fantasies themselves. Hormones are typically used in tandem with behavioral and cognitive treatments.
Some of the therapeutic treatments for fetishistic disorder include aversive conditioning and sensitization. Covert sensitization entails the patient relaxing and visualizing scenes of deviant behavior, followed by the visualization of a negative event.
Another approach, known as assisted aversive conditioning, is similar to covert sensitization, but amplified in that the negative event is made real (for example, a foul odor is pumped in the air by the therapist). In both treatments, the goal is for the patient to associate the deviant behavior with the negative event (either the visualized event, or the new input, e.g. the odor).
Ugonjwa wa fetish ni kuvutiwa sana na vitu visivyo na uhai au sehemu za mwili ambazo kwa kawaida hazionekani kuwa za kingono, pamoja na shida au udhaifu mkubwa wa kliniki. "Kulingana na DSM-5, ""kosa la fetish"" ni hali ambayo kuna matumizi ya kudumu na ya mara kwa mara au utegemezi wa vitu visivyo hai (kama vile nguo za ndani au viatu vya juu) au lengo maalum sana kwenye sehemu ya mwili (mara nyingi nongenital, kama vile miguu) kufikia msisimko wa kijinsia." Kwa kuwa fetishes hutokea katika watu wengi wanaositawi kawaida, utambuzi wa ugonjwa wa fetish hutolewa tu ikiwa kuna usumbufu wa kibinafsi au udhaifu katika maeneo mengine muhimu ya kijamii, ya kazi, au ya utendaji kama matokeo ya fetish, au wakati msisimko wa kingono hauwezekani bila kitu cha fetish. Watu ambao hutambulika kama fetishists lakini hawajaripoti kasoro ya kliniki inayohusiana itachukuliwa kuwa na fetish lakini sio ugonjwa wa fetishistic. Watu wengi hupata sifa fulani za kimwili zisizo za kiasili kuwa zenye kuvutia, jambo linalodokeza kwamba kiwango fulani cha fetishism ni sehemu ya kawaida ya ngono ya kibinadamu. Neno "fetishism" linatokana na neno la Kireno feitico, linalomaanisha "kuvutiwa sana". Ni kupitia tu kutumia kitu hiki, au kukazia fikira sehemu hii ya mwili, kwamba mtu aweza kupata kuridhika kingono. Kwa wengine, picha tu ya kitu cha fetish inaweza kusababisha msisimko, ingawa wengi wenye fetish hupendelea (au wanahitaji) kitu halisi ili kufikia msisimko. Kwa kawaida mtu anayetamani ngono na mtu mwingine huchukua, kutikisa, kuonja, au kunusa kitu hicho ili kupata raha ya kingono, au humwomba mwenzi wake avale kitu hicho wakati wa ngono. Fetishes ya kitu asiye na uhai inaweza kugawanywa katika aina mbili: fetishes fomu na fetishes vyombo vya habari. Katika fetish ya umbo, umbo la kitu ni muhimu, kama vile viatu vyenye visigino virefu. Katika fetish ya vyombo vya habari, nyenzo ya kitu, kama vile hariri au ngozi, ni muhimu. Mara nyingi watu wanaopenda vitu visivyo na uhai hukusanya vitu wanavyopenda. Ugonjwa wa fetishism ni kawaida zaidi kwa wanaume kuliko kwa wanawake, kwa kweli, DSM-5 inaonyesha kwamba inaonekana karibu tu kwa wanaume. Katika DSM ya awali, ugonjwa wa fetish uliozunguka sehemu za mwili zisizozalishwa ulijulikana kama partialism; katika toleo la hivi karibuni, partialism ilifungwa katika ugonjwa wa fetish. Matendo ya kingono ya watu wenye ugonjwa wa fetishism kwa kawaida huelekezwa karibu tu kwenye kitu cha fetish au sehemu ya mwili. Katika visa vingi, mtu mwenye ugonjwa wa fetish anaweza tu kuamsha kingono na kufikia orgasm wakati fetish inatumiwa, mara nyingi akihisi aibu kubwa au shida juu ya kutokuwa na uwezo wa kuamsha kwa kutumia vichocheo vya kawaida. Katika visa vingine, majibu ya kingono yanaweza kutokea bila fetish, lakini kwa kiwango kilichopungua, ambacho kinaweza kusababisha aibu au mvutano wa uhusiano. Watu wazima wanaofanya ngono bila ugonjwa wa fetish au watu wazima wenye fetish maalum ambayo haisababishi shida wanaweza wakati mwingine kuchochewa na sehemu fulani ya mwili au kitu na kuifanya kuwa sehemu ya mwingiliano wao wa kingono na mtu mwingine, lakini sio kuweka juu yake. "Kifungu cha utambuzi wa ""kosa la fetish"" ni: Kwa kipindi cha miezi sita, mtu ana mara kwa mara, nguvu, ngono arousing fantasies, matakwa, au tabia kuhusisha vitu zisizo hai (kama vile wanawake nguo za ndani na viatu) au lengo maalum sana juu ya sehemu za mwili nongenital." - Ndoto, matamanio ya kingono, au tabia husababisha huzuni kubwa au kudhoofisha utendaji wa kijamii, wa kazi, au wa kibinafsi. - Vitu vya fetish si vitu vya mavazi vinavyotumiwa katika kuvaa mavazi ya jinsia tofauti na havikusudiwi kwa kuchochea viungo vya uzazi kwa kugusa, kama vile vibrator. Ugonjwa wa fetish unaweza kubadilika-badilika kwa nguvu katika maisha yote. Utafiti unaonyesha kwamba karibu kila kitu kinaweza kuwa kitu cha kupendwa na mtu. Vipenzi vya mwili vinavyopendwa sana ni miguu, mikono, nywele, kunenepa kupita kiasi, michoro, na kupasua viungo. Vitu vinavyopendwa sana ni viatu, glavu, na nguo za ndani (zilizochakaa), ngozi, mpira, suruali, glavu, na kuvaa vitambaa. Fetish ya ngono si mbaya kwa ufafanuzi, lakini ikiwa husababisha shida ya muda mrefu, kali katika mtu, basi inaweza kuchukuliwa kuwa ugonjwa wa fetish. Ugonjwa wa kichaa waweza kumfanya mtu ahisi kana kwamba hawezi tena kudhibiti maisha yake. Mwanamume anayeingiza jambo la kimapenzi katika uhusiano wake wa kimapenzi na mwenzi anayekubaliana naye si lazima aonyeshe tabia isiyo ya afya. Lakini ikiwa mtu huyo amechukuliwa na fetish yake hivi kwamba havutiwi tena na mwenzi wake wa ngono na anaweza kuchochewa tu na kitu chake cha fetish, basi hiyo ni ishara ya fetish isiyo na afya. Utafiti mdogo unaonyesha kwamba mara nyingi watu wana zaidi ya tamaa moja ya kimapenzi. Utafiti mmoja mdogo uligundua kwamba kati ya watu 48 wenye ugonjwa wa fetish, 17 walikuwa na fetish moja tu, tisa walikuwa na fetish mbili, 12 walikuwa na fetish tatu, sita walikuwa na fetish nne, na wengine walikuwa na fetish tisa. Kwa kawaida mtu huanza kuwa na tamaa za ngono wakati wa kubalehe au hata kabla ya kubalehe. Mapendezi ya kingono hutokea karibu tu kwa wanaume. Ingawa takwimu zinaonyesha kwamba asilimia 10 ya watu wanaweza kuwa na aina fulani ya fetish, ugonjwa wa fetish unaonekana kuwa nadra, na chini ya asilimia 1 ya watu wanahudumiwa kwa sababu ya ugonjwa huo. Paraphilias kama vile ugonjwa wa fetishistic kwa kawaida huanza wakati wa kubalehe, lakini fetishes zinaweza kuendeleza kabla ya ujana. Hakuna kisababishi cha ugonjwa wa fetish ambacho kimethibitishwa kwa uhakika. Baadhi ya nadharia ni pamoja na uzoefu wa utotoni, mambo ya kibiolojia, kama vile maendeleo ya ubongo isiyo ya kawaida, na mambo ya kitamaduni, kama vile masomo yameonyesha viwango tofauti vya fetishism katika tamaduni ambazo zinakaribia ngono tofauti kutoka kwa kila mmoja. "Kama ilivyoelezwa hapo juu, ""fetichi ya miguu"" ni hisia inayotokana na eneo la ubongo linalohusika na habari za hisia kutoka kwa miguu, na eneo linalohusika na habari za hisia kutoka kwa viungo vya uzazi." Wazo hili, lililopitishwa na mtaalamu wa neva Vilayanaur Ramachandran, linadokeza kwamba huenda kukawa na "mzunguko wa neva" kati ya maeneo mawili ya ubongo. Sehemu za mwili ambazo uwakilishi wa cortical ni mbali zaidi na ile ya viungo vya uzazi ni chini ya uwezekano wa kuwa fetishized, kama miguu ni fetish ya kawaida. Baadhi ya wanatheolojia wanaamini kwamba fetishism huanzia katika uzoefu wa utotoni, ambapo kitu fulani kilihusianishwa na aina fulani yenye nguvu ya kuamsha au kuridhisha kingono. Wanatheolojia wengine wa kujifunza hukazia fikira utoto wa baadaye na ujana na hali inayohusiana na kujichezea ngono na kubalehe. Mifano ya kujifunza tabia inadokeza kwamba mtoto ambaye ni mhasiriwa au mtazamaji wa tabia zisizofaa za kingono anaweza kujifunza kuiga au baadaye kuimarishwa kwa tabia hiyo. Mifano ya fidia inadokeza kwamba watu hawa wanaweza kuondolewa mawasiliano ya kawaida ya kijamii ya kingono, na hivyo kutafuta kuridhika kupitia njia zisizokubaliwa kijamii. Ndoto za kimapenzi ni za kawaida na katika visa vingi hazina madhara. Kulingana na DSM, ugonjwa huu unapaswa kutibiwa kama ugonjwa wakati unaosababisha shida au kudhoofisha uwezo wa mtu wa kufanya kazi kwa kawaida katika maisha ya kila siku. Ingawa matibabu kadhaa ya matibabu na dawa zinaweza kusaidia kudhibiti dalili za ugonjwa wa fetish, wagonjwa wanapaswa kujua kuwa kumekuwa na mipaka ya kihistoria juu ya kiwango ambacho matibabu na dawa, au mchanganyiko wa hizo mbili, zinaweza kusaidia. Matibabu haya kwa kawaida hutibu dalili - wasiwasi, aibu, matatizo ya uhusiano - ambayo huleta mgonjwa kutibiwa, lakini watu wengi wenye fetishes wanaweza kudumisha hamu ya kitu cha fetish yao kwa muda mrefu. Matokeo makuu ya matibabu mbalimbali ni kuwasaidia wagonjwa kukabiliana vizuri zaidi. Ugonjwa wa fetishism huwa na kutofautiana katika nguvu na mzunguko wa matakwa au tabia katika mwendo wa maisha ya mtu binafsi. Kwa hiyo, kwa kawaida matibabu yenye matokeo huchukua muda mrefu. Kwa kuongezeka, ushahidi unaonyesha kwamba kuchanganya tiba ya dawa na tiba ya tabia ya utambuzi inaweza kuwa na ufanisi, ingawa utafiti juu ya matokeo ya matibabu haya bado haujathibitisha. Hilo humwezesha mgonjwa kukazia fikira mashauri bila kuingiliwa na mambo mengi. Kiwango cha hamu ya ngono haihusiani na tabia ya wale walio na ugonjwa wa fetish, na viwango vya juu vya testosterone zinazozunguka hazimfanya mwanamume awe na paraphilia. Kwa kuongezea, homoni kama vile medroxyprogesterone acetate (Depo-Provera) na cyproterone acetate husaidia kupunguza kiwango cha testosterone inayozunguka, uwezekano wa kupunguza hamu ya ngono na unyanyasaji, na katika kesi ya mtu mwenye ugonjwa wa fetish, uwezekano wa kupunguza mzunguko wa erections, fantasies za ngono, na kuanzisha tabia za ngono, pamoja na masturbation na ngono. Mifano ya tiba ya utambuzi na tabia yaweza kuwa yenye matokeo katika kutibu watu wenye matatizo ya paraphilia. Hizi zinatia ndani kujihisi, kujihisi kuwa na chuki, na kujihisi kuwa na chuki tena. Mbinu za kurekebisha hali ya moyo hutegemea maoni ya papo hapo yanayotolewa kwa mgonjwa ili tabia yake ibadilike mara moja. Kwa mfano, mtu anaweza kuunganishwa na mashine ya biofeedback ambayo imeunganishwa na mwanga, kisha kufundishwa mbinu za kujidhibiti ambazo zitaweka mwanga ndani ya safu maalum ya rangi. Kisha wao hujifunza kufanya hivyo huku wakionyeshwa habari zenye kuchochea kingono. Mazoezi ya kujigamba yaweza kukazia kutenganisha raha ya kujigamba na kilele kutoka kwa tabia isiyo ya kawaida. Dawa za kulevya za aina ya antiandrogens zinaweza kupunguza kiwango cha testosterone kwa muda na zimetumiwa pamoja na aina nyingine za matibabu ya ugonjwa wa fetish. Dawa hii hupunguza hamu ya ngono kwa wanaume na hivyo inaweza kupunguza mzunguko wa picha za akili za kuamsha kingono. Dawa za kukandamiza kama vile fluoxetine (Prozac) zinaweza pia kupunguza hamu ya ngono lakini hazijaonyeshwa kuelekeza kwa ufanisi mawazo ya kingono yenyewe. Kwa kawaida homoni hutumiwa pamoja na matibabu ya tabia na ya utambuzi. Baadhi ya matibabu ya ugonjwa wa fetishism yanatia ndani kutaka kuwa na tabia mbaya na kuwa na hisia. Uwezo wa siri unahusisha mgonjwa kupumzika na kutafakari matukio ya tabia isiyo ya kawaida, ikifuatiwa na kutafakari tukio hasi. Njia nyingine inayojulikana kama assisted aversive conditioning ni sawa na sensitization ya siri, lakini imeimarishwa katika tukio hilo hasi linafanywa kuwa halisi (kwa mfano, harufu mbaya hupumua hewa na mtaalamu). Katika matibabu yote mawili, lengo ni kwa mgonjwa kuhusisha tabia ya kupotoka na tukio hasi (ama tukio la kuona, au pembejeo mpya, kwa mfano. harufu).