Sexuality Stack Exchange Archive

Is a fetish a sign of dysfunction?

Generally speaking, is a fetish harmful, or a sign of dysfunction? If I, or someone I know, has a fetish, is this reason to be concerned? When, if ever, is it appropriate to seek professional help?

Answer 51

You should distinguish dysfunction from past experience. A fetish is only dysfunctional if it negatively impacts the person with it, by definition of dysfunction. In this sense, most fetishes are not dysfunctional.

Wikipedia says that “No cause for fetishism has been conclusively established,” and that classical conditioning or sexual imprinting have been suggested as causes.

It is possible that some fetishes are created out of a traumatic event, but most people I’ve talked to say that they were just always interested in it, and felt that their fetish was not created, but discovered. We do not know the real cause of fetishes, but most people treat them simply as a personal interest and are not negatively impacted by them.

Answer 331

It’s worth remembering that “fetish” is a term that is sometimes used clinically, but also frequently used colloquially to refer to an unusually intense interest or preference, as in “a cleanliness fetish” or “an Alan Rickman fetish”.

Similarly, many things are fetishized in some contexts, but not in others. For example, a certain piece of clothing might be fetishized in one culture or subculture, commonplace in another, and totally unheard of in a third. A fetish for short skirts might be mildly scandalous in 1950s Europe, totally unacceptable in Taliban-controlled Afghanistan, and utterly unremarkable in modern Los Angeles.

Given the essentially infinite range of possible fetishes, and the way each culture and each individual approaches their interest in and exploration of their fetishes, there can be no objective, universal declaration that fetishes are, by their nature, dysfunctional. A more relative answer is needed:

A fetish is dysfunctional if it leads to dysfunction in the fetish holder.

If a person’s fetish leads to harm for themselves or others, we could reasonably say that it is dysfunctional. However, if the person continues to be a happy, healthy, non-disruptive member of society, their fetish is not dysfunctional.

Answer 233

TL;DR:

It depends on what the fetish is, whether it causes problems in your life outside of your sexual relations, and a number of other factors.

Fetishes that don't involve physical injury, nonconsenting persons, criminal activity, or potentially injurious amounts of violence are largely considered harmless. There is nothing wrong with being turned on by clowns, or feet, or people dressed in mascot costumes, or reasonable amounts of BDSM, or whatever else you like, as long as it doesn't result in or involve any of the following:

When Does a Fetish Become a Problem?

This is a complicated issue, and to address it, we need to look at the diagnostic criteria psychologists and psychiatrists use.

These definitions, diagnostic criteria, and descriptions are contained in a book called the DSM, or the Diagnostic and Statistical Manual of the American Psychological Association.

If you're not comfortable with the clinical terminology, you can ignore the words "diagnostic criteria" and imagine that it says "definition". That's what we're really interested in here: when is a fetish defined as a paraphiliac disorder?

What is the Diagnostic and Statistical Manual of the American Psychological Association?

In my answer, I will refer to the definitions of paraphilias as described in the DSM, and I will do so at considerable length. For those who don't know, the DSM is the book psychologists and psychiatrists use to diagnose mental illnesses.

The version of the DSM I own is the DSM-IV, or in other words, the fourth edition of the DSM. The DSM-IV is now outdated, but only slightly, because the fifth edition, or DSM-V, was recently published. Since I only have access to the DSM-IV, I will have to rely on it. As I understand it, the portions of the DSM which we are interested in here have not been substantially revised in the fifth edition, so this shouldn't be a problem.

The Complete Answer:

Why Should We Pay Attention to the DSM?

Because "dysfunction" and "disorder" are technical terms, and they describe specific medical conditions. If you wanted to know the answer to a question like "What is cancer?", you would ask a doctor or other medical professional. If you wanted to know what a carburetor is, you would ask a mechanic. We're talking about psychological disorders, so we need to ask what psychologists and psychiatrists say about it.

The book psychologists and psychiatrists use to identify and diagnose mental illnesses is the DSM. Therefore, there is no better place to turn for information about this subject than the DSM.

How Does the DSM Work?

In general, the DSM describes a given condition, then the criteria by which the condition is diagnosed, then provides the diagnostic codes, and in some cases, lists variations on the primary condition. It also provides statistical data on each of the conditions described, such as how common the condition is, how many people with a given condition fall into different categories, and so on. It does not explain how these conditions should be treated.

Very broadly, the diagnostic criteria include things like the duration of the condition, what effects the condition has on different aspects of the patient's daily life, and sometimes, a list of possible symptoms is provided. Most of the time, and with most conditions, a formal diagnosis requires that the patient meet a certain number of criteria.

For example, a diagnosis of "Major Depressive Episode", commonly referred to as a bout of depression, requires that the patient report at least five out of 9 possible symptoms, and that the symptoms persist for at least two weeks. In addition, the diagnosis requires that the symptoms are not better explained by another diagnosis, that they are not the result of a medical condition or drug, and that they are not the result of reasonable mood changes related to normal upsetting events like bereavement at the loss of a loved one.

Now that we know how the DSM is supposed to be used, we can turn to the subject at hand. For the sake of brevity, I can't describe the diagnostic criteria for every sexual fetish treated as a disorder. Therefore, I will provide a single example, discuss it at length, and try to summarize the rest of the information as best I can.

I think it makes sense to focus on the paraphilia1 described as Sexual Masochism Disorder.

What Does the DSM Say About Sexual Masochism Disorder?

The DSM lists Sexual Masochism Disorder as a mental illness, and has done so since the late 60's.

From Wikipedia's entry on Sexual Masochism Disorder:

Sexual masochism disorder is the condition of experiencing recurring and intense sexual arousal in response to enduring extreme pain, suffering, or humiliation. It may occur either with or without asphyxiophilia, the experience of sexual arousal from restricted breathing.

The World Health Organization broadly agrees with this assessment:

Sadomasochism appears in the current version of the International Classification of Diseases (ICD-10) of the World Health Organization. It refers to the “preference for sexual activity that involves bondage or the infliction of pain or humiliation” (p. 172), and divides sadomasochism into masochism and sadism according to whether the individual prefers to be the recipient or provider of it. The ICD-10 specifies that mild forms of sadomasochism “are commonly used to enhance otherwise normal sexual activity” (p. 172), and that the diagnosis would apply only if the behavior is preferred or required for sexual gratification. The condition is classified as one of the disorders of sexual preference, which includes the paraphilias (p. 170).

The relevant page of the DSM-IV, showing the description of the condition:

enter image description here

It is important to note that this does not mean that anyone who enjoys BDSM is dysfunctional, nor does it mean that there is anything wrong with enjoying BDSM. The paraphilia only becomes a disorder if it meets the following criteria:

A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the act (real, not simulated) of being humiliated, beaten, bound, or otherwise made to suffer.

B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The "Differential Diagnosis" part of the chapter on paraphilias describes what is meant by criterion B, and since criterion B is part of the diagnosis of every single paraphiliac disorder, understanding this is very important for the purposes of this question:

A paraphilia must be distinguished from the nonpathological use of sexual fantasies, behaviors, or objects as a stimulus for sexual excitement in individuals without a paraphilia. Fantasies, behaviors, or objects are paraphiliac only when they lead to clinically significant distress or impairment (e.g., are obligatory, result in sexual dysfunction, require participation of nonconsenting individuals, lead to legal complications, interfere with social relationships).
[emphasis in the original text]

What Other Fetishes are Listed as Paraphilias in the DSM?

Other sexual fetishes listed as psychological disorders within the category of paraphilias in the DSM are as follows2:

The criteria for diagnosing the paraphilias listed above are broadly similar to the criteria for diagnosing Sexual Masochism Disorder, although the terms of the criteria are obviously tailored to the specific behaviors, fantasies, and sexual urges associated with the paraphilia in question. The duration criteria is always "at least 6 months", and in every case, it is necessary for the fantasies, behaviors, or sexual urges to "cause clinically significant distress or impairment in social, occupational, or other important areas of functioning".

How Do Fetishes Start?

We don't really know. As the previous answer said, there hasn't been much research on the subject. The DSM confirms this:

Although paraphilias are rarely diagnosed in general clinical facilities, the large commercial market in paraphiliac pornography and paraphernalia suggests that its prevalence in the community is likely to be much higher.

However, it seems that paraphiliac fetishes often begin early in life:

Certain of the fantasies and behaviors associated with paraphilias may begin in childhood or early adolescence but become better defined and elaborated during adolescence and early adulthood. Elaboration and revision of paraphiliac fantasies may continue over the lifetime of the individual...

The disorders tend to be chronic and lifelong, but both the fantasies and the behaviors often diminish with advancing age in adults. The behaviors may increase in response to psychosocial stressors, in relation to other mental disorders, or with increased opportunity to engage in the paraphilia.

What Makes Paraphiliac (i.e., Dysfunctional) Fetishes Different From Other Fetishes?

Most fetishes are harmless. Paraphiliac fetishes are not. The Diagnostic Features section of the chapter on paraphilias sums up the difference very well. I have added line breaks and emphasis for the sake of clarity and readability.

Paraphiliac imagery may be acted out with a nonconsenting partner in a way that may be injurious to the partner (as in Sexual Sadism or Pedophilia). The individual may be subject to arrest and incarceration. Sexual offenses against children constitute a significant proportion of all reported criminal sex acts, and individuals with Exhibitionism, Pedophilia, and Voyeurism make up the majority of apprehended sex offenders.

In some situations, acting out the paraphiliac imagery may lead to self-injury (as in Sexual Masochism). Social and sexual relationships may suffer if others find the unusual sexual behavior shameful or repugnant or if the individual's sexual partner refuses to cooperate in the unusual sexual preferences.

In some instances, the unusual behavior (e.g., exhibitionist acts or the collection of fetish objects) may become the major sexual activity in the individual's life. These individuals are rarely self-reported and usually come to the attention of mental health professionals only when their behavior has brought them into conflict with sexual partners or society.
[Emphasis mine]

Summary:

In general, for a paraphilia to be considered a psychological disorder, it must persist for at least 6 months, and it must "cause clinically significant distress or impairment in social, occupational, or other important areas of functioning". It is also important to say that the overwhelming majority of fetishes are not considered to be indicative of dysfunction, and are certainly not considered to be actual disorders.

Footnotes

1 The DSM defines paraphilia as follows:

[R]ecurrent, intense sexually arousing fantasies, sexual urges, or behaviors generally involving 1) Nonhuman objects, 2) the suffering or humiliation of oneself or one's partner, or 3) children or other nonconsenting persons, that occur over a period of at least 6 months (Criterion A). For some individuals, paraphiliac fantasies or stimuli are obligatory for erotic arousal and are always included in sexual activity. In other cases, the paraphiliac preferences occur only episodically (e.g., perhaps during periods of stress), whereas at other times the person is able to function sexually without paraphiliac fantasies or stimuli. The behavior, sexual urges, or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion B).

2 The quotes in parentheses are the brief summary descriptions given in the DSM.

3 The more thorough description goes into more detail. The paraphilia is specifically related to:

"the act of observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity".
[Emphasis mine]

4 There is an additional criterion for Fetishism:

"The nonliving objects are not limited to articles of female clothing used in cross-dressing (as in Transvestic Fetishism) or devices designed for the purpose of tactile genital stimulation (e.g., a vibrator)."

5In the case of Pedophilia too, there is an additional criterion: the patient must be at least 16 years old, and at least 6 years older than the child or children whom the patient is fantasizing about, having sexual urges towards, or engaging in sexual behaviors. It also requires that the diagnosing physician record which gender(s) the patient is attracted to; whether the attraction is limited to incest; and whether the patient is exclusively attracted to children, or also attracted to adults.

6The criteria for Exhibitionism specify that the person to whom the patient exposes his or her genitals must be:

"an unsuspecting stranger".

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