Sexuality and Disability, Vol. 20, No.

2, Summer 2002 (

2002)

Fetishes and Their Associated Behavior

L. F. Lowenstein, M.D.1,2

This article provides an overview as to the definition and history of fetishes. The paper reviews early and recent research regarding fetishes and explores behaviors often associated with fetishes. In addition, various types of fetishes are examined, including a number of fetishes that are unique to people with disabilities. Finally, coming from a psychoanalytical perspective, a number of treatment approaches are reviewed and discussed.
KEY WORDS: fetishes; fetish behavior; sexual stimulation.

INTRODUCTION There are a number of definitions of fetishes. One of the psychological definitions is that a fetish is an object providing sexual gratification It is also often defined as a form of perversion in which sexual gratification is obtained from other than the genital parts of the body. A more detailed and expanded definition is that fetishism is a condition wherein non living objects are used as the exclusive or consistently preferred method of stimulating sexual arousal. There are many different kinds of fetishisms and many are socially acceptable. Among fetishisms that are acceptable is the use of perfumes, seductive clothes and mementos. Usually the fetishist obtains sexual excitation by kissing, tasting, fondling, or smelling the object. It appears that most fetishists are males and most use such objects while masturbating alone or with another. It is often used as a form of foreplay which progresses towards coitus. In fetishism purely, however, the fetishists action or behaviour takes primary attention. Psycho-analytic theory attempts to explain fetishes in the light of the Oedipus Complex, castration fear and the splitting of the Ego but there are no
1 2

Allington Manor, Psychological Service Fair Oakes, Eastleigh, Hampshire, England. Address correspondence to: Dr. L. F. Lowenstein, Allington Manor, Allington Lane, Fair Oak, Eastleigh, Hampshire, England SO50 7DE. 135
0146-1044/02/0600-0135/0 2002 Human Sciences Press, Inc.

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palpable facts that can be offered as proof (Samuels, 1996; Marocco, 1997; Rivera, 1997; Eby, 1999; David, 1999; Schkolnik, 2000; Bass, 2001). Among the objects frequently sought as fetishistic are shoes, bras, and panties, etc. Sometimes in a search for fetishist objects housebreaking occurs as the individual searches for womens used bras or panties. This will be discussed in crimes associated with fetishes. Among treatment approaches used to combat fetishes are aversive conditioning including nausea inducing drugs and mild electric shock associated with the object of the fetish or the fantasy of it. Many fetishists are impotent without the use of their object or procedures leading to excitement. Without fetishist objects being present erectile failure frequently results. As already mentioned theft is often involved as the fetishist seeks clothing from washing lines or from houses where a female resides. The exact incidence of this need for fetishist objects is not known and frequently kept secret by individuals. It tends to begin during adolescence or even before. It persists for most of the individuals life. Frequently such individuals are shy and socially withdrawn. They may well be ashamed of their dependence on their particular fetish, and hence attempt to keep their fetish secret.

EARLIEST RESEARCH The work of Rachman (1966) showed how an individual could be conditioned to a womans boot by it being associated with a nude and attractive female. A further study by Rachman and Hodgson (1968) showed how conditioning again led to fetishes being developed. The questions that remained unanswered however, are which individuals are likely to develop a need for fetish type behaviour and why.

LATER RESEARCH Later research may be divided into the following categories: 1. Types of fetishes. 2. Causes of fetishes. a) Explanation via psycho-analytic theories. b) Causes explained on the basis of non psycho-analytic theories. 3. Criminality and fetishes.

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TYPES OF FETISHES Types of fetishes may be divided into the following categories: A. Transvestite type fetishes. B. Disabled fetishes. C. Other fetishes.

Transvestite-type Fetishes Two pieces of research were noted in the literature in connection with fetishism associated with transvestism. Allnut et al. (1996) investigated the comorbidity of alcoholism and specific paraphilias including sexual sadism, fetishism, incest, paedophilia, exhibitionism and transvestism. They studied 728 adults, all males. Rapists were included although by definition this was not strictly a paraphilic disorder. Each individual underwent a 90 minute clinical interview and sexual behaviour assessment which included the Michigan Alcoholism Screening Test. Results showed that most of the sexual sadists were alcoholics. Alcoholism in association with sexual sadists was statistically significant as compared to transvestites, rapists, paedophilias, and incest offenders. Transvestism had the lowest relative rate of alcoholism. Categorising of transvestite type fetishism was attempted by Freund et al. (1996). The study attempted to differentiate two clinical types of fetishism, fetishism proper and transvestism, and to determine if transvestites were truly fetishistic. Transvestites were further divided into gender-conforming and gender-nonconforming groups according to their score on gender identity scale. These groups were compared using a self-report scale measuring true fetishistic behaviour and interests, and a set of questionnaires regarding their childhood history, parental characteristics, and emotional closeness with their parents. In addition, the penile responses of a subtest of fetishes and transvestites were recorded while they were presented with visual depictions of female and male pubic regions and potentially fetishistic objects such as nylon stockings, female and male shoes, panties, male underwear, female and male feet. The fetishists proper and the transvestite subgroups did not differ from each other in terms of self-reported fetishism interests or childhood and family histories. Moreover, there were no differences between these groups and their penile responses to the potentially fetishistic stimuli they were most aroused by. The results suggest that transvestites were in fact fetishists and they were difficult to distinguish from other fetishists.

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Disabled Fetishes It appeared that disabled women and girls were a common focus of fetishism for men due to their relative immobility making them especially vulnerable to sexual abuse (Elm, 1997). A study by Waxman-Fiduccia (1999) focused on still photographs of physically disabled women who had involved themselves in erotica and pornography as sex workers, entrepreneurs, and relationship seekers. The photographs were described as both perverse and exploitative of these women. Amputee fetishism and genital mutilation fetishists were noted by Wise and Kalyanam (2000). A case was presented of a 49 year old man who amputated his penis following instructions that he had obtained from the internet. The individual had a long-standing amputee fetish which evolved into eroticized genital mutilation. The transformation of the preferred fetish occurred in the setting of a depression due to environmental stressors. The literature about amputee fetishism, also called apotemnophilia, contains other cases of genital mutilation. Aguilera (2000) discussed sexual attraction to disabled individuals by devotees, that is, individual who were sexually aroused or interested specifically in people with disabilities, and responses to that attraction. Countless Internet websites, many run by females, sell devotee material, such as photographs, videos and used crutches for fetishists in that area. Finally Elman (2001) suggested that because disabled women and girls inherited ascriptions of pasivity and weakness, pornographers and others sometimes selected them to portray as ultimate compliance sex objects.

Other Fetishes It is difficult to distinguish between food fetishism such as eating disorders and other kinds of food preferences or dislikes. Arsuaga (1997) noted that some eating disorders related to sexuality. Sawyer (1996) noted that some men suffered from identification with mothers and most especially large breasts which could be considered a fetish object. Attraction to uniforms as part of fetishistic behaviour and fantasy were noted by Bhugra and de Silva (1996) due to the role of perceived power in uniforms being worn. Cross-dressing has already been referred to under transvestism. Cole (1999) presented the case history of the psychotherapy of the heterosexual male cross-dresser. Unusual as it may be the child as a fetish in Munchausen by Proxy was noted by Hotchkiss (1997). Here a mother used her child as a fetish in a compulsive relationship with a paediatrician. Foot fetish is a very common form of fetishistic behaviour as noted by Giannini et al. (1998). The authors reviewed historical literature and hypothesised a relationship between epidemics of sexu-

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ally transmitted diseases and foot fetishism. An exponential increase was noted during the period of the current AIDS epidemic. Pantyhose fetishes are also very common as noted by Lothstein (1997). He suggested that the wearing of pantyhose by males served a range of functions including, but not limited to, repairing psychic structures, and expression and defence against underlying aggression, enabling the development of symbol formation, allaying anihilation and separation anxiety. Pantyhose was considered a second skin for protection purposes. It was even considered a magic skin approach and inherent within it a psycho-analytic theory viewpoint. Anal and sadomasochistic sadism were noted by Schteingart-Gitnacht (1998). Here again was a psycho-analytic study which considered anal fetishism a form of chaotic anality based on the social evils of our time. In the past decade, fetishism has been increasingly applied to a wide variety of behaviour and mentation and is not limited to males. The author drawing on a lengthy analysis of a female patient suggests a fetish is not always an inanimate object. Living objects such as cats can become fetishes. He further offers the idea that fetishism belongs on a continuum with a whole gamut of phenomena which involves the need for a transitional object which is given the endowment of magical properties. All these phenomena have in common the use of an outside object bestowed by magic and illusion to control anxiety. A combination of fetishes were studied by Furnham and Haraldsen (1998). They studied four types of paraphilia; fetishism, paedophilia, sexual sadism and voyeurism. A factor analysis of this study revealed a clear and logical factor structure for aetiology and cure items. It was vital to know the cause according the these investigators in order to have success in the treatment. This view is likely to be contradicted by behaviourists who consider the immediate situation without the need for knowing causes as a primary objective in therapy. A study by Eby (1999) indicated that Hemingway, the famous fiction writer had a lifelong erotic obsession with hair. Consumer capitalism has also been ignored as a possible fetish by Billig (1999). He re-examined Marxs notion of commodity fetishism and argued that this concept offered much for an understanding of the psychology of consumer capitalism. This has been studied in some detail by the author of this paper (Lowenstein, 1996, unpublished stud). The term onomania has been used to describe this type of fetish.

CAUSES Psychoanalytic Approaches Most research regarding causes of fetishes are based on psycho-analytic theories which are of course unproveable except for those who have a belief in

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psycho-analysis whether it be Freudian or some follower of Freud. Most studies including that of Marucco (1996a) explained fetishes via the Oedipus complex which occurred when confronted with castration threats. This they considered to lead to the emergence of a fetish. Also included is a splitting of the ego (Marucco, 1996b). Other investigators or theorists such as Rosen (1996) again emphasised that fetishes are due to an extraordinary severe castration complex which can be traced back to the young child but will continue uninterruptedly into adult life. Such a fetish then helps to regulate the flow of sexual excitation (Samuels, 1996). Freud, and later Rivera (1997) a follower of Freud, considers that fetishes are unconscious elements and are concrete forms of unconscious fantasies. Fetishes appear to resolve the Oedipus complex and fear of castration (Marucco, 1997). Kaplan (1997) considers fetishes a perversion for enhancing sexual excitation. In the case of males mothers play an important part in apparently serving as fetish objects according to Carignan (1999). Such feelings originated in early traumas related to the mother in the case of males, who on the whole have a greater need for fetishes than females. Fetishes appear to act as a fantasy instrument for enhancing not only sexuality or desire but also an escape from reality (Schkolink, 2000). Finally in a recent work by Bass (2001) the views expressed that fetishes do not arise from the splitting of the ego as advocated by Marucco earlier, but is a defence of some kind against pure expression of sexuality.

Causes or Explanation of Fetishes Through Nonpsychoanalytic Theories A longitudinal study by Massie and Szajnberg (1997) considered a man at the age of 30 who recalled the onset of sexual fetishes in his 5th or 6th year of life. The case provided unusual information about the manner in which early childhood events, objectively documented or recalled, explained current mental states in relation to fetishes. It indicated how early life experiences influence later sexual development. Despite the occasional case there is still considerable deficit in aetiological research as noted by Zucker and Blanchard (1997). One study indicated that temporal lobe epilepsy or a dysfunction in this area was associated with fetishisms El-Badri and Robertshaw (1998). In such cases anti-convulsant medication, such as Carbamazepine, could be beneficial for some individuals whose fetishism is associated with EEG evidence of epileptic activity involving temporal lobes. An emphasis on those suffering from fetishes, possibly suffering from traumatised childhood experiences such as having a martyr as a mother led to two male individuals developing fetishes where they considered a sexual relationship with a woman as damaging to that woman. They used masochistic

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fantasies to reassure themselves that they were not hurting a real partner (Weiss, 1998). Fetishes it was noticed were almost totally permanent once established. Such fetishes were developed in early childhood and led to early sexual arousal (Munroe & Gauvain, 2001). A case of foot fetish and shoe fetish in a 6 year old girl was studied by Hopkins (2000). The cause of such a fetish was that she had been a victim of terrifying, life threatening assaults by her father who had died before she was 4 years of age. It seemed probable that she had had, possibly only in fantasy, an incestuous relationship with him. She also as a matter of course identified herself with a male figure.

CRIMINALITY AND FETISHES There is relatively little psychological investigation of the phenomena of criminality and fetishes. One study by Marshall and Fernandez (1998) discussed the treatment of sexual offenders. This will be considered later in the area of treatment of sexual offender. Two types of sexual burglaries were discussed by Schlesinger and Revitch (1999). These considered 1) fetish burglaries with overt sexual dynamics; and 2) voyeuristic burglaries, in which the sexual element was often covert and far more subtle. The authors Schlesinger and Revitch examined the incidents of (sexual) burglaries by 52 sexual murderers aged 1746 years. The sexual dynamics of certain criminal offenders, it was noted, often went unrecognised. Sexually motivated crimes such as fetishistic burglaries, were generally conceptualised as serious offences that led to more aggressive violent acting-out (McCann, 2000). A study of a 16 year old male with borderline personality problems showed how sexually motivated burglaries became violent and aggressive while carrying out these burglaries. As already mentioned the treatment of fetishes can be extremely difficult due to its origin in early childhood and a constant practising of fetishistic behaviour often related to the gratification of sexual activities such as masturbation.

TREATMENT OF FETISHES An anonymous investigator (1997) examined the causes of fetishism as well as recent treatment approaches for different types of fetishes. Male and female fetishists were considered. The study consisted of 70 males and 6 females aged 1534 years possessing fetishes related to sexual behaviour deemed harmful or disturbing. Types of treatment used combined directive guidance and behaviour modification with cognitive-rational emotive approaches of over 14 sessions. Results showed that out of 76 individuals, 7 failed to make progress,

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while the remainder responded very favourably and experienced a reduction in harmful effects as a result of their fetish. The importance of understanding the aetiology of the psycho-pathology of fetishes were considered by Adshead (1997). This was especially the case in the treatment of male transvestic fetishism. Forms of conditioning especially aversive unconditioned stimulus/stimuli counter-conditioning were emphasised in the treatment of a 26 year old male prone to inappropriate acting-out behaviour towards women due to a fetish (Junginger, 1997). In contrast psycho-analytic treatment was preferred by other investigators and therapists such as Marucco (1997). The importance of self-reliance and will-power in successful treatment of offences were noted by Twohig and Futnham (1998). This large study consisted of 100 participants. Such individuals were eager to find a cure for their fetishistic behaviour. Cognitive or behavioural approaches in the treatment of paraphilias in a form of sexual offenders was considered most important by Marshall and Fernandez (1998). The programme involved a three-tiered treatment approach to offenders who were presently incarcerated, another group who had previously been incarcerated and another group who had never been sent to prison. Treatment components of the programme targeted two areas: offence specific and offence related targets. Offence specific targets included overcoming denial and minimisation, enhancing victim empathy, changing distorted attitudes and beliefs, modifying inappropriate fantasies, and developing a sound relapse prevention plan. Another study by De Silva (1998) tended to treat those who relied on the fetish object and other paraphiliac elements. The first step was to attempt to eliminate the paraphilia. The next was to consider the incorporating of the paraphilia into the couples sexual relationship in a limited and controlled way. Drug treatment such as anti-convulsant medication (Corbamazepine) was used with some success on individuals suffering from epilepsy combined with fetishistic behaviour (El-Badri & Robertshaw, 1998). Finally, Skogerbo (1998) considered fetishes to be a form of obsessive-compulsive related disorder and treated this condition through serotonergic drugs.

A STUDY OF 20 CONSECUTIVE REFERRALS FOR FETISHISM Problem As one who has worked as an Expert Witness and clinical, forensic psychologist for some years, one has had referred cases of fetishism. These persons came into conflict with the law for various reasons. Unfortunately a number of individuals were given a prison sentence despite the fact that some form of

Fetishes and Their Associated Behavior Table 1. Relevant Analysis of 20 Males Suffering from Fetishes Serious relationship problem with a maternal figure. Early association of fetish with sexual fantasies of behaviour. Fetish viewed as a turn on for sexual behaviour.

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therapy was recommended by the psychologist. Others were given the opportunity of receiving treatment outside the prison system.

Subjects Over a 15 year period 20 consecutive referrals were made, all males aged 1847 by solicitors and the courts (Table 1). The object of the referral essentially was to obtain why the particular fetish was manifested and to give some idea on how to deal with it via therapy.

Procedure The analysis of these individuals consisted of: 1. In-depth interviewing to ascertain the type of fetish manifested (Table 2) and under what conditions, and to ascribe some cause or origin for the fetish if possible. 2. Assessing the personality of these individuals through objective and projective personality testing. The test used was the Eysenck Personality Inventory, an objective test measuring neuroticism, introversion/ extroversion, psychoticism, impulsiveness, empathy and venturesomeness. Also measured is a lie score which would provide the validity required on an objective test. Additionally the Lowenstein version of the Thematic Apperception Test objectified was administered.

Table 2. Types of Fetishes Panties and other underclothes Feet or shoes Various sadomasochistic behaviour patterns including cross-dressing but being heterosexual. 8 5 7

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Case Illustration Example 1

Mr S was attracted to the feet, and shoes worn by young women and children. He was arrested by the police following a number of complaints about his touching and feeling the feet of the complainants or the complainants children. The psychologist discovered in the course of his interview with him, that he had as a young child often sat at the feet of his mother while she stroked and fondled his head. During this process of affection he often caught glimpses of her vaginal area from time to time when his mother was in a short nightdress and was not wearing panties. He became aroused by this but did not masturbate or touch his genitals.

Example 2
Mr W was arrested when a number of panties and a number of other female garments which had been reported missing in the neighbourhood were found in his possession. He had stolen these garments during the night and early morning hours from washing lines near where he lived and had been seen by one of the persons to whom the panties belonged. He traced this fetish back to his childhood when he became aroused by handling and smelling a pair of panties his sister had made him sniff.

Treatment The diagnosis used, following the in-depth interview and objective and projective testing, combined cognitive and behaviour therapy. Rational emotive therapy also played a significant role. The individual was encouraged to engage in his fetish with a partner who agreed to participate with him, or enjoyed the excitement it produced in the subject. This excitement was then translated into more acceptable procedures including dactile or oral of coital sexual behaviour. In the case of the panty fetish, the individual was encouraged to buy these and other relevant garments, rather than steal them, and he utilised these for the purpose of mutual sexual gratification. In the case where there was no partner available, the treatment consisted of rational, cognitive discussions as to the avoidance of behaviour likely to lead to further attention by the police. No efforts were made to de-condition the fetish object, but rather to avoid police involvement as a result of the fetish behaviour. It was very much encouraged that the individual develop an appropriate relationship with a partner ready to accept the need for his fetish, and to make this a part of their sexual relationship (Table 3).

Fetishes and Their Associated Behavior Table 3. Results of Treatment: Adjustment of Fetish (13 years follow-up) Well adjusted (no further police involvement) Moderately adjusted (no further police involvement) Poorly adjusted (further police involvement)

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CONCLUSIONS 1. From the result it is strongly recommended that individuals who come into contact with the police due to fetish behaviour should be treated outside the prison system rather than be incarcerated. In prison often little or no psychological treatment is available and the fetish behaviour is associated in the minds of the unknowledgable with paedophile behaviour, often subjecting the prisoner to abuse at the hands of sexual deviants, homosexuals or aggressive paedophile haters. 2. A combination of cognitive and behaviour therapy as well as rational emotive therapy was capable of improving the majority of individuals whose fetish had led to police involvement. 3. The most important ancilliary to treatment success was finding and being accepted by a partner despite the fetish. This gave the person with the fetish the opportunity of being able to follow the fetish while at the same time enjoying a full relationship both sexual and otherwise. 4. Dealing with the problems revealed under the neuroticism scores on the Eysenck Personality Inventory and other testing helped to reduce a number of symptoms associated with fethistic behaviour. More often there was a combination of anxiety, worry, feelings of guilt as well as paranoid ideation and self-destructive behaviour associated with fetishism. REFERENCES
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