Fetish - Causes, Diagnosis, and Treatments

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General Information

The basic idea of a sexual fetish is the sexual arousal and satisfaction through an inanimate object, the fetish. The most common sexual fetish is foot fetish, as well as shoe fetish including Women's Boots fetish. 

Causes of Sexual Fetish

- Psychoanalysists theorize that an individual with a paraphilia is repeating or reverting to a sexual habit that arose early in life. They believe these usually relate to early childhood experience, which involves a psychological or psychosexual catalyst. Certain individuals discover pleasure and gratification as a coping mechanism to deal with stress. The memory becomes a fixation until it converts into repetitive behavior.

- Behaviorists suggest paraphilia begins through a process of conditioning, e.g. non-sexual objects can be associated with intense sexual pleasure and if repeated often enough can result in the person preferring these circumstances to normal contact.

However, according to people with certain fetish themselves, the above two explanations do not fully explain why they have certain fetish.  Therefore, more research is need for discover the causes of certain sexual fetish.

Diagnosis of Sexual Fetish

The diagnostic criteria for a certain sexual fetish are as follows:

* 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.

Treatment of Sexual Fetish

There are two possible treatments for fetishism: cognitive therapy and psychoanalysis. Both may be supported by an additional medicinal treatment.

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. The therapy is not able to change the patient's sexual preference itself but can only suppress the resulting unwanted behavior.

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 tries to spot the traumatic unconscious experience that caused the fetishism in first instance. Bringing this unconscious knowledge to conscience and thus enabling the patient to work up his trauma rationally and emotionally shall relieve the 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.

Strictly speaking, in psychoanalysis a fetish is the last thing a small boy sees before discovering that women do not have a penis. The erotic excitement of a boy's first observation of a girl or woman undressing becomes traumatic when he discovers that castration is a real threat after all. What had become increasing arousal is suddenly turned to horror. The child then fixates on the moment of heightened arousal just before the trauma. This is usually an undergarment or feet, but it could be anything.

In the strictest definition, secondary sexual displays--such as breasts and buttocks--cannot be considered fetishes.


Medicinal treatment comprises various forms of drugs that inhibit the production of sex steroids, above all male testosterone and female estrogen. By cutting the level of sex steroids, sexual desire is diminished. Thus, the patient gains the ability to concentrate on his fetish and reasonably process his own thoughts without being distracted by sexual arousal. Also, the application may give the patient relief in every day's life, enabling him to ignore his fetish and get back to daily routine.

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.


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.

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