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Fetishistic Disorder

  • Fetishistic disorder, also known as fetishism, involves sexual arousal focused on nonliving objects or specific nongenital body areas.
    • Associated with the use of particular objects or clothing, enhancing sexual experiences (APA, 2013).
    • Common objects include:
    • Female underclothes
    • Stockings
    • High-heeled shoes or boots
    • Lingerie
    • Fabrics like rubber, leather, nylon, or silk
    • Individuals may require the presence of fetish objects during masturbation or intercourse to achieve sexual excitement (e.g., achieving an erection).
    • Fetish objects might be:
    • Held
    • Seen
    • Smelled
    • Worn by a partner
  • Diagnostic Criteria (DSM-5):
    • A. For a duration of at least 6 months, recurrent and intense sexual arousal from:
    • Use of nonliving objects
    • A highly specific focus on nongenital body parts
    • Manifested through fantasies, urges, or behaviors.
    • B. The fantasies, sexual urges, or behaviors must cause clinically significant distress or impair functioning socially, occupationally, or in other important areas.
    • C. The fetish objects are not restricted to clothing used in cross-dressing (transvestic disorder) or devices designed for tactile genital stimulation (e.g., vibrator).
    • Additional Specification:
    • Controlled environment or in full remission.
    • Specified based on the body part, nonliving object, or other.
  • Example Clarification:
    • A husband who enjoys his wife's high heels and is not distressed is not considered to have fetishistic disorder.
    • If the husband resorts to stealing shoes for an erotic purpose, a diagnosis may be warranted.

Frotteuristic Disorder

  • Frotteuristic disorder, or frotteurism, focuses on sexual arousal from physical contact with non-consenting individuals.
    • Engaging in sexual contact often in crowded places such as:
    • Bars
    • Subway trains
    • Sidewalks
    • Types of contact include:
    • Light rubbing against another person (e.g., genitals)
    • More extensive contact (e.g., groping)
    • Post-contact: the individual may fantasize about a long-term relationship with the victim after the incident (Gunturu et al., 2015).
  • Diagnostic Criteria (DSM-5):
    • A. For a duration of at least 6 months, recurrent sexual arousal from:
    • Touching or rubbing against a nonconsenting person
    • Manifested through fantasies, urges, or behaviors.
    • B. Acting on these urges with a nonconsenting person or experiencing clinical distress/functional impairment.
    • Specify conditions:
    • If in a controlled environment or in full remission.
  • Preference:
    • Individuals tend to seek crowded settings to find victims for frotteuristic behavior.

Pedophilic Disorder

  • Pedophilic disorder involves sexual attraction towards prepubescent children, commonly under the age of 13 years.
    • Important distinction: not synonymous with child molestation.
    • A child molester might not have sexual attraction towards children but may engage in sexual acts due to various reasons (e.g., lack of mature partners, intoxication, cognitive deficits).
    • Overlap in feelings of power associated with both pedophilic disorder and child molestation traits.
  • Diagnostic Criteria (DSM-5):
    • A. For a duration of at least 6 months, recurrent sexual fantasies, urges, or behaviors involving sexual activity with a prepubescent child.
    • B. The individual has acted on these sexual urges, or they cause marked distress or difficulties.
    • C. Age criteria:
    • Individual must be at least 16 years of age and at least 3 years older than the child.
    • Additional Specification:
    • Whether attraction is exclusive to children or nonexclusive, and whether incestuous or with non-family members.
    • Specify condition: if in controlled environment or in full remission.
  • Behavioral manifestations of pedophilic disorder may include:
    • Observation
    • Exposure
    • Fondling
    • Oral sex
    • Penetration
  • Controversial nature surrounding defining a pedophilic individual:
    • A 20-year-old having sex with a 15-year-old could be viewed variably depending on the stance against age-of-consent laws.
  • Case Example:
    • Genarlow Wilson's conviction for aggravated child molestation at 17, having oral sex with a 15-year-old, and subsequent reduction of sentence by the Georgia Supreme Court.
  • Common victim targets:
    • Preferred typically young girls aged 5 to 13.
    • Some individuals target boys, especially under age 6 (Blackman & Dring, 2016).
  • Rationalization of behavior:
    • Some believe that sexual interactions benefit the child educationally or sensually (Rush Burkey & ten Bensel, 2015).
  • Guidance on abusive behavior:
    • Grooming children for sexual favors through attention, gifts, or threats about safety and security (Elliott, 2015).
  • Subtypes of individuals with pedophilic disorder (Fanetti et al., 2015):
    • Preferred victim category (male, female, or both)
    • Relationship to victim (incestuous or not)
    • Nature of sexual arousal (limited to children or varying age groups)
    • Sexual orientation (homosexual, heterosexual, bisexual)
    • Aggressiveness lack or presence during acts.

Sexual Masochism and Sexual Sadism

  • Focus of sexual masochism is the desire to experience humiliation or suffering.
  • Focus of sexual sadism is to inflict humiliation or suffering on others.
  • Sexual Masochism:
    • Key elements involve:
    • Desire to suffer during sexual activities (bondage, pain, infantilism, humiliation, oxygen deprivation)
    • Fulfillment can occur through personal actions or involving another person.
    • Severity of inflicted pain can vary significantly.
  • Sexual Sadism:
    • Involves desires to inflict suffering, often mirroring masochistic elements.
    • Focused on controlling individuals during sexual acts.
  • Diagnostic Criteria (DSM-5):
    • Sexual Masochism Disorder:
    • A. Over a duration of at least 6 months, recurrent sexual arousal from:
      • Being humiliated, beaten, bound, or made to suffer (manifested as fantasies, urges, or behaviors).
    • B. Causing clinically significant distress or impairment in functioning.
    • Sexual Sadism Disorder:
    • A. Same as masochism but focuses on suffering inflicted on others.
    • B. Acting upon urges or experiencing significant distress.
    • Additional Details:
    • Clarify if conditions are controlled or in full remission and specify if involving asphyxlophilia.
  • Interaction between sadism and masochism may result in a singular individual experiencing both roles (sadomasochism).
    • Severity may range from mild (e.g., slapping) to severe (e.g., rape, mutilation).
  • Notable Case Example:
    • Wolfgang Priklopil kidnapping 10-year-old Natascha Kampusch, holding them captive and enforcing sadomasochistic acts.