Sexual Fetishism - Modern Theory and Treatment - Diagnosis

Diagnosis

According to the ICD-10-GM, version 2005, fetishism is the use of inanimate objects as a stimulus to achieve sexual arousal and satisfaction; in most cases said object is required for sexual gratification. The corresponding ICD code for fetishism is F65.0. The diagnostic criteria for fetishism 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, their 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.

A correct diagnosis in terms of the ICD manual stipulates hierarchical proceeding. That is, first the criteria for F65 must be fulfilled, then those for F65.0. As criteria are not repeated in substages this can be mistakable to laymen or medics that have not been educated in the use of this manual. Furthermore, according to the ICD, an addiction to specific parts or features of the human body and even "inanimate" parts of corpses, under no circumstances are fetishism, even though some of them may be forms of paraphilia.

According to the DSM-IV-TR, fetishism is the use of nonliving objects as a stimulus to achieve sexual arousal or satisfaction. (This only applies if the objects are not specifically designed for sexual stimulation (e.g., a vibrator).) The corresponding DSM-code for fetishism is 302.81; the diagnostic criteria are basically the same as those of the ICD. In the DSM manual, all diagnostic criteria are given in the corresponding section of the text book, i. e., here no hierarchical processing is needed.

Both definitions are the result of lengthy discussions and multiple revisions. Still today, arguments go on whether a specific diagnosis fetishism is needed at all or if paraphilia as such is sufficient. Some demand that the diagnosis be abolished completely to no longer stigmatize fetishists, e. g. project ReviseF65. Others demand that it be specified even more to prevent scientists from confusing it with the popular use of the term fetishism. And other researchers argue that it should be expanded to cover other sexual orientations, such as an addiction to words or fire. Most physicians would not say that a man who finds a woman attractive because she is dressed in high heels, lacy stockings or a corset has an abnormal fetish.

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