Fetishes and Fetishistic Disorder: When Is a Fetish a Problem?

In the introduction to this series, I described a question I was once asked: "Is it abnormal to be obsessed with shaved heads?" I explained that this kind of very specific attraction is called a fetish in sexology. Some people are drawn to shaved heads, others to feet, hands or hairless bodies, and others to materials or objects such as leather, rubber or particular outfits. They can find pleasure in seeing, touching or imagining that thing without needing sex at all.

The key question is: is this abnormal? The short answer is: mostly not. This article explains when it is worth getting extra support. It is part of the Paraphilic Disorders series.

How common are fetishes?

A survey of Canadian adults (Joyal & Carpentier, 2017) found that about 44.5% had experienced fetishistic sexual desires and about 26% had tried acting on them. Interestingly, these desires were found in women as often as, or more often than, in men. These figures make it clear that fetishes are part of the diversity of human sexuality, not something only "strange people" have.

That is why the World Health Organization's ICD-11 removed fetishism from its list of disorders. It is considered a condition (6D36) only when there is marked distress or a risk of injury.

Fetishistic disorder in DSM-5-TR

DSM-5-TR (2022) diagnoses it when:

1. There is intense, recurrent sexual arousal from using non-living objects or from a highly specific focus on non-genital body parts, lasting at least 6 months.
2. The interest causes clinically significant distress or impairment in social, work or other important areas of life.
3. The objects are not limited to clothing used in cross-dressing (which is a separate condition) or devices designed to stimulate the genitals, such as sex toys, which are covered in Sex toys and safe masturbation.

Clinicians specify whether it involves body parts, objects or something else, and may add "in a controlled environment" or "in full remission". The difference from cross-dressing is explained in Transvestic disorder and how it differs from being transgender.

A preference vs a condition that needs treatment

The last row is especially important. When a fetish leads to acts towards people who have not consented, it is no longer a preference. It is a violation, and it may overlap with voyeuristic disorder or frotteuristic disorder.

Preference

• Adds pleasure but is not the only source
• Partner knows and is comfortable
• Moderate time and money
• Within consent

Seek advice

• Cannot be aroused without it
• Repeated arguments with a partner
• Preoccupation costing money or work
• Violates others, e.g. secret filming, stealing items

vs

ICD-11 removed fetishism from its list of disorders.

Why do fetishes develop?

There is no single answer. A widely accepted idea is that sexual arousal becomes linked to things encountered during sexual development, especially in adolescence, through associative learning and reinforcement by pleasant feelings. One theory points out that the brain areas that process sensation from the feet and the genitals lie next to each other, but this remains a hypothesis. What is clear is that no one chooses to have a fetish, and trying to suppress it or hate yourself for it usually makes the distress worse.

How to talk about a fetish with your partner

• Choose a relaxed moment, not during sex.
• Describe it as your own feeling, for example "I find ... exciting", rather than as a demand.
• Give your partner the right to say no, and look for a middle ground you are both comfortable with.
• Reassure your partner that they matter more than any object or detail.

Read more practical guidance in Sexual fantasies: are they normal and how to talk with your partner and Common couple problems and how to talk them through.

1. 1Pick a timeWhen relaxed, not during sex
2. 2Share your feelings"I feel excited by…" rather than demanding
3. 3Allow them to say noFind middle ground you are both comfortable with
4. 4Reaffirm what mattersYour partner matters more than any object or detail

Assessment and treatment

When a fetish causes distress or affects your life, care focuses mainly on psychological therapy and sex therapy.

• Sex therapy and couples therapy help broaden the ways you experience sexual pleasure and reduce dependence on a single thing. Techniques such as sensate focus help couples become close again without pressure.
• CBT helps when there is preoccupation, shame or behaviour you cannot stop.
• Checking for related problems, such as depression, anxiety or erection problems with a physical cause.

Medication is rarely needed for this condition, except for some people whose behaviour puts others at risk, and then only under a psychiatrist's care.

When to seek help

If you feel distressed, your relationship is starting to suffer, or your interest is taking you close to violating others, that is the time to talk to a professional. See When to see a clinical sexologist. If you are in severe distress, call 1323, Thailand's free mental-health hotline (Thai language; ask for English support).

Dr. Kris Clinic offers sex-positive, non-judgmental clinical sexology consultations at the clinic and online, including in English, with referral to a psychiatrist when needed. The goal is not to erase your preferences, but to help you live with them comfortably and safely for everyone.