Sexual fetishism



Sexual fetishism, or erotic fetishism, is the sexual attraction to materials and objects not conventionally viewed as being sexual in nature; the term was first introduced by Alfred Binet, the psychologist better known for inventing IQ testing. Fetishism is diagnosable as a paraphilia in the DSM and the ICD, but many people embrace their fetishes rather than seek treatment to attempt to be rid of them. Body parts may also be the subject of sexual fetishes (also known as partialism) in which the body part preferred by the fetishist takes a sexual precedence over the owner. Sexual fetishism may be regarded as a disorder of sexual preference, or as an enhancing element to a relationship.

In a review of the files of all cases over a 20 year period who met criteria for an non-transvestic fetishes in a teaching hospital, 48 cases were identified, and the objects of their fetishes included clothing (58.3%), rubber and rubber items (22.9%), footwear (14.6%), body parts (14.6%), leather and leather items (10.4%), and soft materials and fabrics (6.3%).

Types
Alfred Binet proposed a dualism of "spiritual love" and "plastic love" in which to categorize the fetishes. "Spiritual love" occupied the devotion for specific mental phenomena, for example; attitudes, social class, or occupational roles; while "plastic love" referred to the devotion exhibited towards material objects such as body parts, textures or shoes. The existential approach to mental disorders developed in the 1940's and influenced a view that fetishes had complex personal meanings beyond the general categories of psychoanalytical treatment. For instance, the Austrian neurologist and existential therapist Viktor Frankl once noted the case of a man with a sexual fetish involving simultaneously both frogs and glue.

Psychological origins and development
Modern psychology assumes that fetishism either is being conditioned or imprinted or the result of a strong emotional (traumatic) experience. But also physical factors like brain construction and heredity are considered possible explanations. In the following, the most important theories are presented in chronological order:

Alfred Binet suspected fetishism was the pathological result of associations. Accidentally simultaneous presentation of a sexual stimulus and an inanimate object, thus his argument, led to the object being permanently connected to sexual arousal. About 1900, a sexologist named Havelock Ellis brought up the revolutionary idea that already in early childhood erotic feelings emerged and that it was the first experience with its own body that determined a child's sexual orientation. Psychiatrist Richard von Krafft-Ebing consented to Binet's theory in 1912, recognizing that it predicted the observed wide variety of fetishes but unsure why these particular associations persisted over the whole of a lifetime while other associations changed or faded. In his eyes, the only possible explanation was that fetishists suffered from pathological sexual degeneration and hypersensitivity.

Sexologist Magnus Hirschfeld followed another line of thought when he proposed his theory of partial attractiveness in 1920. According to his argumentation, sexual attractiveness never originated in a person as a whole but always was the product of the interaction of individual features. He stated that nearly everyone had special interests and thus suffered from a healthy kind of fetishism, while only detaching and overvaluing of a single feature resulted in pathological fetishism. Today, Hirschfeld's theory is often mentioned in the context of gender role specific behavior: females present sexual stimuli by highlighting body parts, clothes or accessories; males react to them.

Havelock Ellis' theory of erotic symbolism, according to which unusual sexual practice symbolically replaced normal sexual intercourse, and his thoughts about erotic thoughts in children, had laid the foundations for psychoanalyst Sigmund Freud. In 1927, Freud stated that fetishism was the result of a psychological trauma. A boy, longing to see his mother's penis, averts his eyes in horror when he discovers that she has none. To overcome the resulting castration anxiety he clings to the fetish as a substitute for the missing genital. Freud never commented on the idea of female fetishists.

In 1951, Donald Winnicott presented his theory of transitional objects and phenomena, according to which childish actions like thumb sucking and objects like cuddly toys are the source of manifold adult behavior, amongst many others fetishism.

The use of a transitional object in infanthood is a healthy experience (Winnicott, 1953). To understand the origin of a fetish object and of fetishism, the infant’s use of the transitional object and of transitional phenomena in general must be studied (Winnicott, 1953).

In his article ‘Transitional objects and phenomena’, Winnicott says about fetish: “Fetish can be described in terms of a persistence of a specific object or type of object dating from infantile experience in the transitional field, linked with the delusion of a maternal phallus” (Winnicott, 1953). In other words, a specific object or type of object, dating from an experience during the period where the mother gradually pulls back as an immediate provider of satisfaction of the child’s desires, persists as a characteristic in adult sexual life.

Before this transitional phase, the child believes that his own wish creates the object of his desire (specifically the qualities of his mother that fulfill his needs), which brings with it a sense of satisfaction. During this phase the child gradually adapts to the (frustrating) realization that the object can not be controlled to serve the childs’ needs.

The transitional object is always the result of a gratifying relationship with the mother, specifically with the maternal body. It stands for the satisfying qualities that the object (the mother) of the first relationship the child has. The child adapts to the impact of the realization that the mother is not always there to ‘bring the world to him’ through fantasizing about the object of his desire while using an object (a teddy bear, a piece of cloth). He creates an illusion of the previous object. In relation to the transitional object the infant passes from (magical) omnipotent control to control by manipulation (involving muscle eroticism and co-ordination pleasure).

In opposition to this, the fetish represents the impossibility of pleasure with the body of the mother. The transitional object may eventually develop into a fetish object and so persist as a characteristic of the adult sexual life (Winnicott, 1953). Normally, the child gains from the experience of frustration during the transitional phase. Though, the infant can be disturbed by a close adaptation to need that is continued too long or is not allowed it’s natural decrease.

The fetish describes ‘the object that is employed on account of a delusion of a maternal phallus, while the transitional object refers to the illusion of a maternal phallus (Winnicott, 1953).

Behaviorism traced fetishism back to classical conditioning and came up with numerous specialized theories. The common theme running through all of them is that sexual stimulus and the fetish object are presented simultaneously causing them to be connected in the learning process. This is similar to Binet's early theory, though it differs in that it specifies association to classical conditioning and leaves out any judgment about pathogenicity. The super stimulus theory stressed that fetishes could be the result of generalization. For example, it may only be shiny skin that arouses a person at first, but in time more common stimuli, such as shiny latex, may have the same effect. The problem with such a theory was that classical conditioning normally needs many repetitions, but this form would require only one. To account for this the preparedness theory was put forward; it stated that reacting to an object with sexual arousal could be the result of an evolutionary process, because such a reaction could prove to be useful for survival. In pointing to how conditioned sexual behavior can persist over time, one may cite how, in 2004, when quails were trained to copulate with a piece of terry cloth, their conditioning was sustained through ongoing repetition.

Because classical conditioning seemed to be unable to explain how the conditioned behavior is kept alive over many years, without any repetition, some behaviorists came up with the theory that fetishism was the result of a special form of conditioning, called imprinting. Such conditioning happens during a specific time in early childhood in which sexual orientation is imprinted into the child's mind and remains there for the rest of his or her life.

Various neurologists pointed out that fetishism could be the result of neuronal cross links between neighboring regions in the human brain. For example, in 2002 Vilaynur S. Ramachandran stated that the region processing sensory input from the feet lies immediately next to the region processing sexual stimulation.

Today, psychodynamics has parted with the idea of proposing one explanation for all fetishes at the same time. Instead, it focuses on one form of fetishism at a time and the patients individual problems. Over the past decades, various case studies have been published in which fetishism could successfully be linked to emotional problems. Some argue that a lack of parental love leads to a child projecting its affection to inanimate objects, others state in consent with Freud's model of psychosexual development that premature suppression of sexuality could lead to a child getting stuck in a transitory phase.

Modern theory
Most of the sexual orientations popularly called fetishism are regarded as normal variations of human sexuality by psychologists and medical doctors. Even those orientations that are potential forms of fetishism are usually considered unobjectionable as long as all involved persons feel comfortable. Only if the diagnostic criteria presented in detail below are met, the medical diagnosis of fetishism is justified. The leading thought is that a fetishist is ill only because he or she suffers from their addiction, not simply because of the addiction itself.

Diagnosis
According to the ICD-10-GM, version 2005, fetishism is the use of inanimate objects as a stimulus to achieve sexual arousal and satisfaction. The corresponding ICD code for fetishism is F65.0. The diagnostic criteria for fetishism are as follows: It must be noted that a correct diagnosis in terms of the ICD manual stipulates hierarchical proceeding. That is, first the criteria for F65 must be fulfilled, then those for F65.0. As criteria are not repeated in substages this can be mistakable to laymen or medics that have not been educated in the use of this manual. Furthermore, it must be noted that according to the ICD, an addiction to specific parts or features of the human body and even "inanimate" parts of corpses, under no circumstances are fetishism, even though some of them may be forms of paraphilia.
 * Unusual sexual fantasies, drives or behavior occur over a time span of at least six months. Sometimes unusual sexual fantasies occur and vanish by themselves; in this case any medical treatment is not necessary.
 * The affected person, her object or another person experience impairment or distress in multiple functional areas. Functional area refers to different aspects of life such as private social contacts, job, etc. It is sufficient for the diagnosis if one of the participants is being hurt or mistreated in any other way.

According to the DSM-IV, fetishism is the use of inanimate objects or parts of the human body as a stimulus to achieve sexual arousal and satisfaction. The corresponding DSM-code for fetishism is 302.81, the diagnostic criteria are the same as those of the ICD. That means that ICD and DSM diverge in their interpretation of fetishism with respect to body parts. This can lead to misunderstandings when evaluating publications that come from different countries and use different diagnostic manuals. In the DSM manual, all diagnostic criteria are given in the corresponding section of the text book, here no hierarchical processing is needed.

Both definitions are the result of lengthy discussions and multiple revisions. Still today, arguments go on whether a specific diagnosis fetishism is needed at all or if paraphilia as such is sufficient. Some demand that the diagnosis be abolished completely to no longer stigmatize fetishists, e. g. project ReviseF65. Others demand that it be specified even more to prevent scientists from confusing it with the popular use of the term fetishism. And then again, ever and anon researchers argue that it should be expanded to cover other sexual orientations, such as an addiction to words or fire. Most physicians would not say that a man who finds women attractive because she is dressed in high heels, lacy stockings or a corset has an abnormal fetish.

Treatment
There are two possible treatments for fetishism: cognitive therapy and psychoanalysis, though treatment does not have to be necessary. Both may be complemented by additional treatments.

Cognitive therapy
Cognitive therapy seeks to change the patient's behavior without analyzing how and why it shows up. It is based on the idea that fetishism is the result of conditioning or imprinting.

One possible therapy is aversive conditioning: the patient is being confronted with his fetish and as soon as sexual arousal starts, exposed to a displeasing stimulus. It is reported that in earlier times painful stimuli such as electric shocks have been used as aversive stimulus. Today a common aversive stimulus are photographs that show unpleasing scenes such as penned in genitals. In a variant called assisted aversive conditioning, an assistant releases abominable odors as aversive stimulus.

Another possible therapy is a technique called thought stop: the therapist asks the patient to think of his fetish and suddenly cries out "stop!". The patient will be irritated, his line of thought broken. After analyzing the effects of the sudden break together, the therapist will teach the patient to use this technique by himself to interrupt thoughts about his fetish and thus prevent undesired behavior.

Psychoanalysis
Psychoanalysis tries to spot the traumatic unconscious experience that caused the fetishism in first instance. Bringing this unconscious knowledge to consciousness and thus enabling the patient to work up his trauma rationally and emotionally shall relieve him from his problems. As opposed to cognitive therapy, psychoanalysis tackles the cause itself.

There are versatile attempts at this analyzing process, including talk therapy, dream analysis and play therapy. Which method will be chosen depends upon the problem itself, the patient's attitude and reactions to certain methods and the therapist's education and preference.

This type of treatment is rarely used.

Medication
Pharmaceutical treatment consists of various forms of drugs that inhibit the production of sex steroids, above all male testosterone and female estrogen. By cutting down the level of sex steroids, sexual desire is diminished. Thus, in theory, a patient might gain the ability to control his fetish and reasonably process his own thoughts without being distracted by sexual arousal. Also, the application may give the patient relief in everyday life, enabling him to ignore his fetish and get back to daily routine. Other research has assumed that fetishes may be like obsessive-compulsive disorders, and has looked into the use of psychiatric drugs (serotonin uptake inhibitors and dopamine blockers) for controlling paraphilias that interfere with a person's ability to function.

Although ongoing research has shown positive results in single case studies with some drugs, e. g. with topiramate, there is not yet any medicament that tackles fetishism itself. Because of that, physical treatment is only suitable to support one of the psychological methods.

Surgery
In few cases, brain surgery has turned out to be a remedy for fetishism. It must be noted, however, that these surgical engagements were always due to other diagnosis like epilepsy and the relief of fetishism was a mere side effect. Though some consider brain construction a possible cause for fetishism, surgery is never considered a possible treatment.

Gender
Most of the material on fetishism is in reference to heterosexual men, with most of the objects fetishized being high-femme items such as lingerie, hosiery, and heels. Until recently there was little mention of women ever having fetishes.

However, the visual map of fetishes linked below flags several clusters as having a number of women admirers, such as corsetry and some of the medical-related fetishes. The preferences of women fetishists are not necessarily a mirror image of those of male fetishists; just because many men are attracted to women in high heels does not necessarily mean there are many women attracted to men in construction boots.

The book Female Perversions, which also discussed corsetry and self-cutting, in part discusses "female transvestism". It gave examples both of women who became excited by dressing in a "butch" way, i.e. the mirror image of male transvestite fetishism, and of women who became aroused by dressing in a very "femme" way, or parallel to male transvestite fetishism.