The paraphilic focus of fetishistic disorder involves the persistent and repetitive use of or de as primary elements associated with sexual arousal (Criterion A). A diagnosis of fetishistic dis- (Criterion B). Common fetish objects include female undergarments, male or female footwear, rubber articles, leather clothing, or other wearing apparel. Highly eroticized body parts asso- ciated with fetishistic disorder include feet, toes, and hair. It is not uncommon for sexualized fetishes to include both inanimate objects and body parts (e.g., dirty socks and feet), and for this reason the definition of fetishistic disorder now re-incorporates partiulism (i.e., an exclusive focus on a body part) into its boundaries. Partialism, previously considered a paraphilia not otherwise specified disorder, had historically been subsumed in fetishism prior to DSM-Il].
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 concurrent fulfillment of both the behaviors in Criterion A and the clin- ically significant distress or impairment in ftmctioning noted in Criterion B.
Fetishistic disorder can be a multisensory experience, including holding, tasting, rubbing, inserting, or smelling the fetish object while masturbating, or preferring that a sexual part- ner wear or utilize a fetish object during sexual encounters. Some individuals may acquire extensive collections of highly desired fetish objects.
Usually paraphilias have an onset during puberty, but fetishes can develop prior to ado- lescence. Once established, fetishistic disorder tends to have a continuous course that ﬂuc- tuates in intensity and frequency of urges or behavior.
Knowledge of and appropriate consideration for normative aspects of sexual behavior are important factors to explore to establish a clinical diagnosis of fetishistic disorder and to distinguish a clinical diagnosis from a socially acceptable sexual behavior.
Fetishistic disorder has not been systematically reported to occur in females. In clinical samples, fetishistic disorder is nearly exclusively reported in males.
Functional Consequences of Fetishistic Disorder
Typical impairments associated with fetishistic disorder include sexual dysfunction during romantic reciprocal relationships when the preferred fetish object or body part is unavailable during foreplay or coitus. Some individuals with fetishistic disorder may pre- fer solitary sexual activity associated with their fetishistic preference(s) even while in- volved in a meaningful reciprocal and affectionate relationship.
Although fetishistic disorder is relatively uncommon among arrested sexual offenders with paraphilias, males with fetishistic disorder may steal and collect their particular fe- tishistic objects of desire. Such individuals have been arrested and charged for nonsexual antisocial behaviors (e.g., breaking and entering, theft, burglary) that are primarily moti- vated by the fetishistic disorder.
Transvestic disorder. The nearest diagnostic neighbor of fetishistic disorder is transves- tic disorder. As noted in the diagnostic criteria, fetishistic disorder is not diagnosed when fetish objects are limited to articles of clothing exclusively worn during cross-dressing (as in transvestic disorder), or when the object is genitally stimulating because it has been de~ signed for that purpose (e.g., a vibrator).
Sexual masochism disorder or other paraphilic disorders. Fetishes can co-occur with other paraphilic disorders, especially ”sadomasochism” and transvestic disorder. When an individual fantasizes about or engages in ”forced cross-dressing” and is primarily sex- ually aroused by the domination or humiliation associated with such fantasy or repetitive activity, the diagnosis of sexual masochism disorder should be made.