The paraphiliac focus in fetishistic disorder (formerly known as fetishism) involves the eroticization of nonliving objects and/or body parts for sexual gratification. Among the more common non-living fetish objects are women’s underpants, bras, stockings, shoes, boots, or other wearing apparel. An individual with a fetish for a body part (e.g., feet, hair) will eroticize a non-genital body part during sexual encounter. It is not uncommon for sexualized fetishes to include both inanimate objects and body parts (e.g., dirty socks with feet). Fetishistic disorder can be a multisensory experience, including holding, tasting, rubbing, inserting, or smelling the fetish object while masturbating, or preferring that a sexual partner wear or utilize a fetish object during sexual encounters. In the treatment-seeking samples observed, this disorder occurs almost exclusively in males; women generally do not exhibit this disorder, and more information is needed to determine whether this disorder occurs to any significant degree within the female sex.

The person with fetishism frequently masturbates while holding, rubbing, or smelling the fetish object or may ask the sexual partner to wear the object during their sexual encounters. Usually the fetish is required or strongly preferred for sexual excitement, and in its absence there may be erectile dysfunction in males.

Many individuals who self-identify as fetishist practitioners do not necessarily report clinical impairment in association with their fetish-associated behaviors. Such individuals could be considered as having a fetish but not fetishistic disorder. A diagnosis of fetishistic disorder requires clinically significant distress or impairment in functioning resulting from the fetish.

Specific Symptoms of Fetishism

  • Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the use of nonliving objects (e.g., female undergarments).
  • The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • The fetish objects are not limited to articles of female clothing used in cross-dressing (as in transvestic fetishism) or devices designed for the purpose of tactile genital stimulation (e.g., a vibrator).

Specifiers added to the diagnosis of fetishistic disorder:

  • Body part(s)
  • Nonliving object(s)
  • Other

When assigning a diagnosis, a clinician will also specify if:

  • In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to engage in fetishistic behaviors are restricted.
  • In full remission: There has been no distress or impairment in social, occupational, or other areas of functioning for at least 5 years while in an uncontrolled environment.

This entry has been updated for 2013 DSM-5 criteria; diagnostic code: 302.81