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Understanding Fetishism

Fetishism is an idiosyncratic sexual preference that emanates from strong fantasies for the person to seek out gratification. These fetishistic activities are very unique to the individual and are a prerequisite for reaching a level of sexual gratification. A fetish is an specific sexual obsession that a person has with an object or a part of the body. The person has an obsessional relationship with the object. A sexual fetish may be regarded as a non-pathological aid to normal sexual excitement, or as a mental disorder if it causes significant distress for the person or has negative consequences important areas of his life.

Early Theories on Causes of a Sexual Fetish

Some theoreticians believe that, in certain predisposed individuals, an emotionally rousing experience with the fetish object in childhood could lead to fetishism. For instance, a young boy who spends a great deal of time at his mother’s feet as she cooks and serves meals could develop a foot fetish. No one has yet been able to describe what the nature of that predisposition might be.

In 1951, psychoanalyst Donald Winnicott presented his theory of transitional objects, according to which child-like behaviors like thumb sucking and objects like teddy bears are sources of security for the child as he begins the terrifying prospect of separating from mother to explore the world around him. Many adults never let go of their transitional objects and are the source of many adult behaviors, amongst them fetishism. A transitional object became sexualized in adult life.

Fetishism may occur when a child is “overlaid” with an “incorrect” concept of a sex object. Imprinting seems to occur during the child’s earliest experiences with arousal and desire, and is based on an idiosyncratic evaluation of reward- or pleasure characteristic that differ from one person to another. No cause for fetishism has been conclusively established.


A fetish, per se, is not a disorder. People come for treatment for fetishes only when fetishistic activities are the exclusive source of sexual satisfaction, are emotionally unacceptable to the individual, are obsessional to the point of in interfering with normal work or living activities, or interferes with intimacy with a partner or normal sexual intercourse.

Treatment for Sexual Fetish

Fetishistic fantasies are common and should only be treated as a disorder when they impair normal functioning or cause distress to the individual. The goals of treatment for fetishes are many:

  • Elimination of criminal activity
  • Reduction in reliance on the fetish for exclusive sexual satisfaction,
  • Developing better social skills so the person learns to value people more than objects,
  • Diminishment of the displeasure of the obsessive urges,
  • Diminishment of shame
  • Sex education and the cultivation of healthy intimacy and sexual skills
  • Overcome addiction to sexual euphoria in favor of intimacy-related sexual satisfaction
  • Freedom from compulsion
  • Self-understanding and self-acceptance

Mastery of Fantasy Life

What distinguishes a healthy fetish from an unhealthy fetish is the amount of time the person spends in sexual fantasy. For the fetishist, time spent in their heads thinking about the fetish can be more interesting and exciting than real life. Engaging in the fantasy itself sets off powerful chemicals in the brain that makes it a high that little else in the addicts life can match, including the sexual act itself. A fantasy, while not a substance or even a tangible behavior, can still be an extremely potent drug. For some, life in the “erotic haze” masks depression, agitation, shame, inadequacy, loneliness, boredom. Like a magic elixir, it makes all bad things go away. The problem, of course, is that the person never learns to use higher coping skills to deal with unpleasant inner states.

Once fetishists start fantasizing, they find it nearly impossible to stop to turn their attention to something else. The fantasy becomes an “erotic haze” that overtakes the person’s mind. He is virtually a prisoner of it. While fixated on their fantasies, they still must negotiate the day-to-day realities of living.

This is a GRAVE NEGATIVE CONSEQUENCE for achieving quality of life. If you’re supposed to be playing with your children or having special time with your spouse or being engrossed in your career and your fantasies keep distracting you from these activities, you’re living life like a zombie. You’re only half alive.

Part of my  therapy for sex addiction involves very specific cognitive/behavioral techniques to help them master their fantasies rather than the other way around. The result is enhanced self-esteem, a new awareness and appreciation of life, nature and human beings, and a new appreciation for being alive.


Dorothy Hayden, LCSW has 20 years of experience treating sex and porn addicts, love addiction, codependency, fetishes, sadomasochism, "kink friendly", crossdressers and their wives, partners of sex addicts. She has been interviewed on "HBO", "20/20" and Anderson Cooper 360. Ms. Hayden has authored the book "Total Sex Addiction Recovery - A Guide to Therapy"

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