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.