Fetishism is a sexual obsession or behaviour focused on an inanimate object or body parts for sexual satisfaction.
Having a fetish – or many fetishes – is a normal part of sexual behaviour. However, a fetish is a disorder when it adversely affects your sexual, social and emotional functioning and is damaging to your relationship. This includes when sexual gratification and arousal is impossible without the fetish object.
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.
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. Though the DSM-5 does not specify particular treatments, successful approaches have included various forms of therapy as well as medication therapy (such as SSRI’s or androgen deprivation therapy). Some prescription medications may help to decrease the compulsive thinking associated with fetishistic disorder. This allows a patient to concentrate on counseling with fewer distractions.
Increasingly, evidence suggests that combining drug therapy with cognitive behavioral therapy can be effective, although research on the outcome of these therapies remains inconclusive. A class of drugs called antiandrogens can drastically lower testosterone levels temporarily, 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.
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. Hormones are typically used in tandem with behavioral and cognitive treatments. Antidepressants such as fluoxetine (Prozac) may also decrease sex drive but have not been shown to effectively target sexual fantasies themselves.
Some research suggests that cognitive-behavioral models may be effective in treating people with paraphiliac disorders. Aversive conditioning, for instance, involves using negative stimuli to reduce or eliminate a behavior. One approach, called covert sensitization, entails the patient relaxing and visualizing scenes of deviant behavior, followed by a visualization of a negative event. Another approach, known as assisted aversive conditioning, is similar to covert sensitization, except 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 foul odor).
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.