Fetishes in mental health is a topic that is often overlooked and understudied due to the taboo nature of fetishization. When we create an open dialogue around uncomfortable topics, we can challenge the misconceptions associated with conditions that are part of our world. It would be impossible to speak about the presence of fetishes without speaking about sex. Sex talk may elicit discomfort, shame, fear, or anxiety; these feelings are valid but often serve as a barrier. For this blog, let’s intend to delve into sexual health with openness and increased awareness. Sexual health is a priority to discuss as we attempt to normalize the presence of fetishes in society, better understand what they mean for different people, and create a level of acceptance around fetishes. Some use kinks and fetishes interchangeably, defined as arousal from non-sexual body parts or inanimate objects. Fetishes are defined as a disorder when there is a disruption to your emotional state from engaging in the fetish. The emotional disturbance to your internal state could include shame, embarrassment, guilt, anxiety, frustration, etc.
Fetishes are harmful when they create distress and negatively impact the quality of life within social, work, and daily functioning. Fetishes are diverse and offer a wide range of interests and preferences. A few include objects and body parts, like hands, feet, hair, and lingerie, which people find attractive and experience arousal. Sensory fetishes may involve different textures, scents, fabrics, or sounds which elicit pleasure and arousal. Fetishes around power dynamics like dominance and submission or consensual non-consent play may create excitement around control, authority, and safe surrender. The variety of dynamics with fetishes may also include role-playing and fantasies around the dynamics of imaginative relationships like doctor/patient, teacher/student, etc. The necessary components of exploring fetishes are consent, safety, and open communication.
The complexity of mental health intersects with fetishes when the following set of characteristics exist for six months: intense sexual arousal stemming from a body part that is not genitalia or forms an inanimate object, recurring urges and fantasies, anxiousness related to the fetish, and disruptions to home, work, and relationships. The root cause for the fetishistic disorder is unknown, although thought to result from biological, cultural, cognitive, and interpersonal processes. There is some data to support that fetishes developing during puberty, mainly in men, may result from childhood trauma, exposure to sexual activity at an early age, or biologically having higher serotonin levels. The conditioning and learning process of associating an object, scenario, or body part with pleasure will reinforce the association over time, resulting in the development of a fetish. Whether intentional or accidental, exposure to sexual behaviors during sensitive developmental stages will shape sexual health, arousal, and interests in life. Some people develop fetishes as a coping mechanism for expressing emotions, managing trauma, expressing desires, escaping reality, or being in control. We can’t ignore the influence of media like pornography, movies, literature, and online forums that also inform fetishes which may shape narratives and perceptions of different types of arousal. Considering we’re all unique individuals, let’s acknowledge that we live in a world that highlights what society deems acceptable sexual activity and shames what people find unusual. People will also have genetic predispositions to certain personality traits and temperaments that shape their sexual preferences. People struggling with the fetishistic disorder may avoid seeking care if they think there isn’t anything wrong with their fetish, it’s not causing harm, or if there is significant shame around the fetish, it may lead them to avoid treatment entirely.
Having a fetish is not inherently concerning as long as it is consensual. Consent is required when involving another person in a fetish or kink. Consent can include safe words, boundaries, or limitations and allows for increased respect when exposure to harm is high. When both parties feel safe, they can lower their guard while their body is vulnerable. The more common fetish of BDSM includes bondage which involves restraints, cuffs, and tape to limit movement leading one person to be in control and the other to be in a vulnerable state. Discipline is the exploration of rules that will lead to either punishment or reward. Dominance and submission include the dominant taking a more assertive role over the submissive, voluntarily releasing control. Sadism is inflicting consensual pain, humiliation, or sensations on the partner. Lastly, masochism is the pleasure from receiving consensual pain, humiliation, or experiencing sensations from the partner. Setting a boundary can include exploring bondage with cuffs but not with tape over the mouth.
Establishing firm limits in advance allows for a deep understanding of the boundary before intimacy. Consent must be informed and involve some enthusiasm, which can be withdrawn anytime. The withdrawal of consent can include a full stop or pause using a safety word. Safety words can be as clear and direct as “stop” or abstract, such as “pineapple.” The agreed-upon safety word will ensure everyone’s well-being while safely exploring fetishes. A foundation of trust and respect is necessary when releasing control of your body or taking control of another’s physical body. The level of vulnerability during fetish exploration leads to increased intimacy, exploration of power dynamics, and personal growth.
Safe sex is great sex! We all have varying desires, urges, and fantasies, which can be explored with curiosity and openness. Mindfulness around intimacy and fetishes is a healthy way to embrace our differences with compassion. When fetishes are disruptive and meet the criteria for a mental health condition by the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-V), they should be handled with high sensitivity and sex experts. Diagnoses that are under paraphilia disorders include exhibitionistic disorder, which is having fantasies or urges about exposing genitals to strangers, frotteurism disorder which includes sexual urges or behaviors that involve touching a non-consenting person, pedophilic disorder, which is feeling aroused by children, a voyeuristic disorder which is acting on or being in distress by urges involving an unaware and non-consenting person who is undressed or engaging in sexual behavior. When one of the total eight paraphilia disorders is diagnosed, it isn’t uncommon for others to be present simultaneously. It’s often not the presence of a fetish but how a fetish is fulfilled that makes it maladaptive. When the fetish disorder is causing harm to others, especially children, and is illegal, we condemn them and strongly encourage seeking immediate care. The combination of both psychotherapy and medication management allows for fetishistic disorder and paraphilia conditions to work towards harm reduction. The limited information on paraphilia and fetishistic disorder leaves many unanswered questions and a lot unknown. As a community, let’s encourage the ongoing discussion of safe sexual health to build increased awareness and compassion around the presence of fetishes.