Merck Manual

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Fetishistic Disorder

(Fetishism)

By

George R. Brown

, MD, East Tennessee State University

Last full review/revision Jul 2019| Content last modified Jul 2019
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Fetishism is use of an inanimate object (the fetish) as the preferred method of producing sexual excitement. However, in common parlance, the word is often used to describe particular sexual interests, such as sexual role-playing, preference for certain physical characteristics, and preferred sexual activities or objects. Fetishistic disorder refers to recurrent, intense sexual arousal from use of an inanimate object or from a very specific focus on a nongenital body part (or parts) that causes significant distress or functional impairment.

Fetishism is a form of paraphilia, but most people who have fetishism do not meet the clinical criteria for a paraphilic disorder, which require that the person's behavior, fantasies, or intense urges result in clinically significant distress or functional impairment. The condition must also have been present for ≥ 6 months.

There are many fetishes; common fetishes include aprons, shoes, leather or latex items, and women’s underclothing. The fetish may replace typical sexual activity with a partner or may be integrated into sexual activity with a willing partner. Minor fetishistic behavior as an adjunct to consensual sexual behavior is not considered a disorder because distress, disability, and significant dysfunction are absent. More intense, obligatory, and highly compulsive fetishistic arousal patterns and behaviors may cause problems in a relationship or become all-consuming and destructive in a person’s life.

Fetishes may include clothing of the opposite sex (eg, women's undergarments), but if sexual arousal occurs mainly from wearing that clothing (ie, cross-dressing) rather than using it in some other way, the paraphilia is considered transvestism.

Treatment of fetishistic disorder may include psychotherapy, drugs, or both. Selective serotonin reuptake inhibitors have been used with limited success in some patients who request treatment.

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