Fetishism

Definition
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The term "fetishism" was coined in the late 1800s. It originates from the Portuguese word feitico, which means "obsessive fascination". There is a degree of fetishistic arousal in most normal individuals who find particular bodily features attractive. However, fetishistic arousal is generally considered a problem when it interferes with normal sexual or social functioning and where sexual arousal is impossible without the fetish object.

Fetishism is characterized as a disorder when there is a pathological assignment of sexual fixation, fantasies or behaviors toward an inanimate object -- frequently an item of clothing -- such as underclothing or a high-heeled shoe -- or to nongenital body parts -- such as the foot. Only through use of this object can the individual obtain sexual gratification. The fetishist usually holds, rubs or smells the fetish object for sexual gratification or asks their partner to wear the object during sexual encounters. Fetishism is a more common occurrence in males, and the causes are not clearly known. Fetishism falls under the general category of paraphilias, abnormal or unnatural sexual attractions.

Inanimate object fetishes can be categorized into two types: form fetishes and media fetishes. In a form fetish, the object and its shape are important, such as high-heeled shoes. In a media fetish, the material of the object is important, such as silk or leather. Inanimate object fetishists often collect the object of their favor. In some cases, the fetishism is severe enough to inspire the fetishist to acquire objects of his desire through theft or assault. Fetishists smell, rub or handle these objects while masturbating or ask their sex partners to wear the objects; male fetishists may be unable to get erections without the presence of the objects. Nearly all fetishists are male, though some women also exhibit fetishism.

Aside from those listed above, other common objects used by fetishists are panties, bras, slips, stockings, other intimate apparel, footwear and gloves. Common materials other than those listed above also include rubber and fur. For some, merely a picture of the fetish object may arise the fetishists, though most prefer or require the actual object. It is not about the person who has worn the object, rather it is about the object itself. Examples of animate fetish objects include hair, legs and buttocks.

Fetishism excludes cross-dressing and objects specially designed for sexual use such as vibrators and dildos.

Symptoms

The sexual acts of fetishists are characteristically depersonalized and objectified, with the focus being exclusively on the fetish. Non-fetishists may at various times become aroused by a particular body part or an object and make it a part of their sexual interaction with another person, but they do not fixate on it.

In general, the fetishist can only become sexually aroused and orgasmic when the fetish is being used. In other instances, a response may occur without the fetish, but at a diminished level. When the fetish object is not present, the fetishist fantasizes about it.

The diagnostic criteria for fetishism includes:

* Repeatedly for a period of at least six months, the patient has recurrent, intense sexually arousing fantasies, urges or behaviors involving nonliving objects (such as female undergarments and shoes).
* The fantasies, sexual urges or behaviors cause significant distress or impair social, occupational or personal functioning.
* The fetish objects are not articles of clothing used in cross-dressing as in transvestite fetishism and are not designed for tactile genital stimulation such as a vibrator.

Other features of fetishism include:
* Employment or volunteer work to enable fetish behavior, for example, a job in a shoe shop in the case of a shoe fetish

Some disorders such as mental retardation and dementia have similar or even the same symptoms. The clinician, therefore, in her diagnostic attempt needs to rule out other potential disorders to establish a precise diagnosis.

Common types of fetishism

* Amputee fetishism
* Breast fetishism
* Corset fetishism (Tightlacing)
* Diaper fetishism
* Foot fetishism
* Food fetishism
* Furry fetishism/Toonophilia
* Glove fetishism
* Infantilism
* Leather fetishism
* Medical fetishism
* Pregnancy fetishism
* Rubber fetishism
* Boot fetish
* Spandex fetishism
* Stocking fetishism
* Swimcap fetishism
* Tickling fetishism
* Transvestic fetishism
* belly button fetish

Causes

The cause of fetishistic behavior as a pattern of sexual gratification cannot be explained easily.

Some theorists believe that fetishism develops from early childhood experiences, in which an object was associated with a particularly powerful form of sexual arousal or gratification. Other learning theorists focus on later childhood and adolescence and the conditioning associated with masturbation activity. Studies show that fetishists have poorly develop social skills, are isolated in their lives and have a diminished capacity for establishing intimacy.

Behavioral learning models suggest that a child who is the victim or observer of inappropriate sexual behaviors learns to imitate and is later reinforced for the behavior. Compensation models suggest that these individuals are deprived of normal social sexual contacts and thus seek gratification through less socially acceptable means. In the far more common cases, involving males, the patterns suggest that causes stem from doubts about ones own masculinity, potency, and a fear of rejection and humiliation. By his fetishistic practices and the mastery over an inanimate object, the individual apparently safeguards himself and also compensates for some of his feelings of inadequacy.

Treatment

Almost always the treatment must be long-term if it is to be effective. Treatment approaches have included traditional psychoanalysis, hypnosis, cognitive and behavior therapy as well as pharmacotherapy. Some prescription medicines help to decrease the compulsive thinking associated with the paraphilias. This allows concentration on counseling without as strong a distraction from the paraphiliac urges. Increasingly, the evidence suggests that combining drug therapy with cognitive behavior therapy can be effective, although research on the outcome of these therapies has been incomplete and often appear not to have been successful. More recently, a class of drugs called antiandrogens that drastically lower testosterone levels temporarily have been used in conjunction with these forms of treatment. The drug lowers the sex drive in males and reduces the frequency of sexually arousing mental imagery. This helps the individual concentrate on counseling. Increasingly, the evidence suggests that combining drug therapy with cognitive behavior therapy can be effective.

The level of sex drive is not consistently related to the behavior of paraphiliacs and that high levels of circulating testosterone do not predispose a male to paraphilias. That said, hormones such as medroxyprogesterone acetate (Depo-Provera) and cyproterone acetate help decrease the level of circulating testosterone thus reducing sex drive and aggression and resulting in reduction of frequency of erections, sexual fantasies and initiations of sexual behaviors including masturbation and intercourse. Hormones are typically used in tandem with behavioral and cognitive treatments. Antidepressants such as fluoxetine (Prozac) have also successfully decreased the sex drive but have not effectively targeted sexual fantasies.

Research suggests that cognitive-behavioral models are effective in treating paraphiliacs: Aversive conditioning involves using negative stimuli to reduce or eliminate a behavior. Covert sensitization entails the patient relaxing, visualizing scenes of deviant behavior followed by a negative event such as getting his penis stuck in the zipper of his pants. Assisted aversive conditioning is similar to covert sensitization except the negative event is made real most likely in the form of a foul odor pumped in the air by the therapist. The goal is for the patient to associate the deviant behavior with the foul odor and take measures to avoid the odor by avoiding said behavior.

Thought stopping is another technique used to control fetishism. The therapist first determines the patient's other types of other attractions and fantasies. The therapist asks the patient to think about the fetish fantasy; once the fantasy is conjured, the therapist yells, "Stop!" At this point the patient immediately switches to the earlier agreed upon fantasies. This process is repeated several times in the presence of the therapist. Another technique used to control fetishism is fantasy reshaping, a modification of the thought-stopping process.

Reconditioning techniques center on immediate feedback to the patient so behavior will change right away. For example, a person might be connected to a biofeedback machine that is connected to a light and taught to keep the light within a specific range of color while the person is exposed to sexually stimulating material. Or masturbation training might focus on separating pleasure in masturbation and climax from the deviant behavior.

Sources:

* National Institutes of Health
* National Library of Medicine
* Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition
* PsychNet-UK


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The Safest Sex (page 1)

Ah, sexual fantasy. It has one big advantage over sexual reality: You have total control over everything that happens. You won't be humiliated or suffer at the hands of a brutish lover unless, of course, that's what you want.

Consider the possibilities. Your fantasy partner can be a celebrity, the guy who works down the hall, or your best friend's mate. You enjoy complete choice of venue: a tropical island, an elevator, a tree swing. And the activity in question can range from romantic, longing glances to sexual gymnastics that would strain a circus contortionist.

So perhaps the most surprising fact about our fantasies is this: The sexual scenario we most often imagine is the ordinary, non-kinky intercourse with a past or current lover. Despite the potential for limitless freedom, our fantasies generally stay firmly tethered to reality.

Don't worry if you assumed most fantasies were a bit more risque. Even in today's tell-all culture, sexual fantasies remain one of our last taboos, something that people simply don't discuss.

"We tell each other almost everything--our sexual habits, who we lust for, how much money we make," notes Columbia University psychiatrist Ethel Person, M.D., author of By Force of Fantasy. "But I do not know the sexual fantasies of my closest friends. We regard fantansies as too revealing. They're treasured possessions, yet we're ashamed of them."

Even psychologists long found sexual fantasy vaguely disreputable, ignoring the topic almost entirely for the first half of the century. But the last two decades have produced a flurry of new information, say University of Vermont psychologist Harold Leitenberg, Ph.D., and South Carolina's Kris Henning, Ph.D. And it turns out that a lot of what we thought we knew is wrong.

Imaginary Lovers

The misconceptions about sexual fantasies began with Freud himself. In 1908 he declared that "a happy person never fantasizes, only a dissatisfied one." Later thinkers embroidered this theme, developing what has become known as the deficiency theory.

"People still believe that fantasies are compensation for lack of sexual opportunity," says Leitenberg. "That if your sex life was adequate, you wouldn't have to fantasize."

But the data show that, if anything, frequent fantasizers are having more than their share of fun in bed. They have sex more often, engage in a wider variety of erotic activities, have more partners, and masturbate more often than infrequent fantasizers, Leitenberg and Henning report in Psychological Bulletin.

The association between fantasies and a healthy sex life is so strong, in fact, that it's now considered pathological not to have sexual fantasies.

And no wonder. Researchers studying sexual fantasies confirm that everyone has them, from adolescence onward. Well, almost everyone: About five percent of men and women say they have never had a sexual fantasy (or won't admit to it). Person believes that these fantasy-free folks are getting a vicarious fix elsewhere--from movies, for example. Or else they simply aren't paying attention to their own thoughts.

Most adults say they first remember fantasizing between the ages of 11 and 13. From there they quickly pick up speed. Sexual fantasies and thoughts are most common in hormone-addled teens and young adults. In one study, researchers asked people at random times during the day whether sex had crossed their minds during the past five minutes. Among 14- and 15-year-olds, 57 percent of boys and 42 percent of girls said yes. Affirmative responses were less common with increasing age: among 56-to 64-year-olds, 19 percent of men and 12 percent of women answered yes.

Once you get beyond age, though, it's hard to predict whether a given person has lots of fantasies. Attempts to identify a "fantasy-prone" type of individual have been woefully unsuccessful. Even religious and political views provide few clues. Conservatives have just as many fantasies as liberals--despite the fact that, according to one study, nearly half of conservative Christians feel sexual fantasies are "morally flawed or unacceptable."

The devout aren't the only ones who have mixed feelings. One in four people feel strong guilt about their fantasies, reports Leitenberg. Most of this hand-wringing "involves people who feel guilty about fantasizing while making love to their partners," he says. Even among sexually adventurous groups like college students, 22 percent of women and 8 percent of men said they usually try to repress the feelings associated with fantasy.

Guilt also strikes when fantasy and personal ideology collide. "There are people who feel that their sexual fantasies are not a part of them," Person says. "The CEO of a Fortune 500 company may have masochistic fantasies of being tied to a bed, and he might be perfectly comfortable because he sees that as respite from having to be in control; whereas some feminists are ashamed because they have masochistic fantasies and they feel that the fantasies are contrary to their political beliefs."

Such guilt exacts a heavy toll. Those who fret over their fantasies have sex less often and enjoy it less, even though the content of their fantasies is no different from those of the guilt-free.

But even unusual and "deviant" fantasies give little reason for concern in healthy individuals. It's true that we sometimes use fantasies as a springboard for later sexual hijinks. But the path from fantasy to deviance is anything but direct.

Rape fantasies, for instance, are far more common than rapes themselves. And as an extreme example, consider that only 22 percent of child molesters say they had sexual fantasies about kids before their first molestation. So unusual fantasies are a concern only when they become compulsive or exclusive, or for individuals "in whom the barrier between thought and behavior has been broken," say Leitenberg and Henning.

Exactly why your fantasies differ from those of your friends is not well understood. But theories abound. Certainly personal experience and the things we see, hear, and read about enter the mix.

External stimuli like sexy advertisements or scantily clad passersby, in fact, may be responsible for the off-noted observation that men fantasize more than women. In a sample of college students, researchers found that men fantasized or thought about sex 7.2 times a day, compared to 4.5 for women. For each sex, two of those fantasies were internally triggered. But men reported twice as many externally provoked thoughts.

Our favorite internally triggered fantasies probably attain preferred status through classical conditioning, the sane process that had Pavlov's dogs drooling at the sound of a bell. Fantasies that accompany orgasms are particularly reinforced, for instance, making them more arousing next time around. From there "we embellish them, change them," says Person. "They're like an evolving series." Scenarios that don't accompany arousal are discarded.

While the most common fantasies involve routine sex with a past, present, or imaginary partner, that's not to say that we don't occasionally give our fantasy muscles a more strenuous workout. In addition to those decidedly "vanilla" scenarios, Leitenberg and Henning describe three other primary flavors of fantasy:

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The Safest Sex(page 2)

o Novel or "forbidden" imagery. This includes unconventional settings, questionable partners like strangers or relatives, and ligament-straining positions worthy of the Kama Sutra. Or as Dr. Seuss once asked (albeit in a somewhat different context): "Would you, could you, in a boat? Could you, would you, with a goat?"

o Scenes of sexual irresistibility. Here the emphasis is on seductive power: overcoming the reluctance of an initially indifferent man or woman through sheer animal magnetism. Or the irresistibility may take numerical form in fantasies involving multiple partners.

o Dominance and submission fantasies. In these, sexual power is expressed either ritualistically--in sadomasochistic activities--or through physical force, as in rape fantasies. Such fantasies are surprisingly common. Person reports that 44 percent of men have had fantasies of dominating a partner. Other studies found that 51 percent of women fantasized about being forced to have sex, while a third imagined: "I'm a slave who must obey a man's every wish."

None of this means, of course, that real-world rape victims "really want it." "Women who find submission fantasies sexually arousing are very clear that they have no wish to be raped in reality," say Leitenberg and Henning. In their fantasies, women control every aspect of what occurs. And their scenarios are far less brutal than real-life attacks. Typically the fantasy involves an attractive man whose restraint is simply overwhelmed by the woman's attractiveness. These fantasies serve the same psychological purpose as scenes of irresistibility. "It's different means to the same end" says Leitenberg. "We want to be desired."

Incidentally, researchers find little difference in the fantasies of hetero- and homosexuals--except in the gender of participants.

Harlequin and Hefner

It doesn't take a Ph.D. to figure out that the fantasies of men and women differ. Just look at the fantasy scenarios that publishers push.

Men have Playboy: big-busted women exposing their attributes, in almost clinical detail, from a variety of angles and positions. For women, on the other hand, there are tales like The Bridges of Madison County and cookie-cutter Harlequin romances. The covers may depict heaving bosoms and Fabio's muscular physique, but the sex always comes packaged within an emotional, passionate romance.

While all this may change as sexual roles and cultural attitudes change, fantasies still fall along those gender lines. When male and female college students were asked to write out in detail three fantasies they had, women were more likely to describe romance and commitment while men mentioned a greater number of sexual acts.

In another study of 300 college students, 41 percent of the women but only 16 percent of the men--said that while fantasizing they focused on the "personal or emotional characteristics of the partner." Men, however, were four times as likely to focus on their fantasy partner's physical characteristics. Sociobiologists argue that these discrepancies represent evolved behavioral differences between men and women. But even if that's true, Leitenberg observes, there are certainly cultural pressures for women not to think about sex outside of a committed relationship, lest they be labeled a "slut."

The romance/genitalia dichotomy isn't the only major differences in male and female fantasies, report Leitenberg and Henning. Here are some others:

1) Men are more likely to imagine themselves doing something to a woman, and their fantasies focus on her body. Women, on the other hand, tend to envision something being done to them and to concentrate more on their partner's interest in her.

2) Male fantasies more often involve sex with two or more partners at one time. In one study, a third of men had fantasies about sex with multiple partners--twice the number of women. Guys are also more likely to switch partners in mid-fantasy.

3) Both sexes imagine overpowering a partner or being forced to submit to another's wishes. But men are more likely to have domination fantasies, while women tend to see themselves submitting to a partner's sexual wishes. One researcher reports that 13 percent of women but only 4 percent of men said that their favorite fantasy was being forced to have sex.

4) Men have a greater variety of fantasies. Asked to check off all those they had experienced in the past three months (on a list of 55), male collegians indicated 26 of them. Women listed only 14.

Dream On

There's still a lot no one knows about sexual fantasies. Is the frequency and range of fantasies similar in other cultures? How does the content of fantasies change over one's lifetime? And what happens when we act on our fantasies? Does it spoil them--or make them more vivid? "We have no idea," admits Leitenberg.

But what we do know is proof enough that fantasies are an essential part of our sexual repertoire. Far from being a sign of sexual inadequacy or deprivation, fantasies are associated with a healthy, happy sex life. "The people who have the most sexual problems fantasize least," Leitenberg notes.

Indeed, fantasy's power to arouse us--some folks say they can achieve orgasm solely from sexual thoughts, or "thinking off" -- proves that the brain is as potent a sexual organ as one's genitalia. And though most erotic thoughts are relatively ordinary, our more imaginative flights allow us to explore our sexuality without risk of physical harm or social rejection. Consider this finding: Imagining having sex with your current lover is a popular fantasy when you're not engaged in sexual activity--while imagining sex with a new partner is a popular fantasy during intercourse.

Most of us need no further justification for fantasy beyond the fun factor. "Sexual fantasy is a natural part of being human" says Leitenberg. "It's pleasurable. So why not fantasize?"


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The quick fix: can therapy work in just a few sessions?

THOUGH HE WAS the father of the most time-consuming of therapies, psychoanalysis, legend has it that Sigmund Freud cured the composer Gustav Plahler's impotence during a stroll around a lake.

The notion that a psychological difficulty could be remedied in a single session sounds gimmicky, and yet, some say short-term therapy is the best way to deal with a stark reality: About 40 percent of people who consult a therapist never go back. Advocates of single-session, or planned short-term therapy, which typically lasts three to five sessions, maximize the potential of brief encounters. (Short-term therapies may incorporate techniques from cognitive-behavioral therapy, which usually lasts about 10 sessions.)

"A patient's motivation is highest at the first session. We can capitalize on that," says Monte Bobele, a leading advocate of the technique and a professor of psychology at Our Lady of the Lake University in San Antonio. Instead of discussing all aspects of past and present life, brief psychotherapy seeks to empower clients while generating a few simple solutions. "We have a slogan at my clinic: 'Every case has the potential to be a single-session case,'" says Bobele. "This assumption completely changes the way we think about patients. We have a much greater sense of urgency."

Bobele treated one middle-aged woman whose health problems were spiraling out of control. During the course of her one and only session, he suggested she make a daily blood-pressure measuring schedule and stick to it. She soon reported feeling much better and was monitoring her diabetes. A few months later, she had quit smoking and drinking. "Making one small change had a snowball effect," says Bobele.

Evidence abounds that planned short-term psychotherapies are generally as effective as long-range varieties, regardless of the therapist's theoretical orientation. Researchers suspect that therapists engaged in brief psychotherapy make a more conscious effort to ensure that the clinical work will affect the client's way of thinking and behaving.

But critics question how long such a "Band-Aid" approach could last, and are troubled by how well it plays into the hands of those eager to cut healthcare costs.

"Therapists are not magicians," says Paul Brinich, a psychology professor at the University of North Carolina at Chapel Hill. "It's not sufficient to focus on the symptoms without understanding their origins--after all, no good physician would reduce a patient's fever without trying to understand its cause."

Because the roots of their problems are personal and private, patients can't be expected to open up to a stranger in a few hours' time, Brinich says. "The attempt to make treatment shorter is understandable, but I haven't figured out a way to speed up people's ability to trust and reveal the conflicts in their lives."

The exception, Brinich says, is when a patient has a problem that stems from a lack of knowledge as opposed to an inner conflict. "A recently-widowed father came to me, distressed because his two-year-old continued to knock down his CDs. After explaining a bit about child development, I advised him to move the discs out of reach. It worked like a charm."

DRIVE-BY THERAPY

A Single Session Could Help If You:

* Have a very specific problem, such as a new health diagnosis.

* Wonder if a particular situation and your reaction to it is normal.

* Have dealt successfully with life problems in the past.

* Have faith that your troubles could be addressed by a brief intervention.

Longer-Term Therapy Is a Better Bet If You:

* Want to understand your patterns of behavior and how they developed.

* Have had repeated difficulties with family and romantic relationships.

* Would like to accomplish more, but consistently shoot yourself in the foot.

* Are suicidal, psychotic, or suffer from a condition requiring medication.

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Daily LlamasDaily Llamas

Dogs may be man's best friend, but llamas are clearly gunning for second place, at least with therapists. The camel-like creatures, who normally call the mountains of South America home, have suddenly become a popular remedy for combating stress and behavioral problems.

In Rupert, Idaho, a pilot project uses llamas to teach teen offenders to develop affection and concern for other creatures. Meanwhile, in White Rock, British Columbia, the Llama Therapeutic Group offers stress management sessions and plans to set up corporate accounts.

Then there's psychotherapist George Appenzeller, Ph.D., who in 1989 incorporated the mammals into his South Carolina practice to treat abused and neglected children, including those with attention deficit disorder. His program includes wilderness excursions in which each kid grooms, feeds, and hikes with a llama companion. Why llamas and not, say, wildebeests? "Llamas are very calm and accepting," says Appenzeller. "They stick together and take care of each other without giving up their individuality, so you could say they're good role models." And, he adds, they're well-mannered: "You have to push a llama pretty far before he'll spit on you."

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