Underwear Fetishism

 

 

Ruwan M Jayatunge M.D.

Underwear Fetishism is a paraphilic disorder that can cause distress for the person who is affected by it and frequently leads to societal condemnation and rejection. Underwear Fetishism is contradictive of normal sexual behavior and some view Underwear Fetishism as OCD-related sexual ideation. 

Fetishism has been recognized as a sexual variation for over 100 years and has very often been considered a disorder in all of its presenting forms (Martin, 2016). The German Psychiatrist Richard Von Krafft-Ebing identified paraphilias in 1886. The Buddhist Jathaka stories describe Fetishism in a young man named “Kema” (Jayatunge, 2014).

Kafka (2003) defined paraphilias as disorders characterized by an alteration of sexual preference, volitional impairment, and an increase in sexual drive-oriented behaviors. Paraphilias are persistent, unconventional, and problematic sexual interests that exist on a continuum. Briken & Basdeskis-Jozsa (2010) highlight those individuals with paraphilias may experience negative factors such as low self-esteem, social anxiety, social skills impairment, depressive symptoms, and socially deviant behavior.

Fetishistic behavior can involve stealing or buying undergarments and having an obsessive fixation with erotic fantasies. They cannot become sexually aroused or reach orgasm without the object and feel unable to control their need for the fetish. They are experiencing sexual arousal from undergarments (arousal from the smell of used women's panties or voyeuristic excitement viewing it).  Often, they prefer solitary sexual activities associated with their fetishistic and sexualized fantasies.

Fetishists become aroused by stealing the object, viewing the object, or masturbating with the object. During masturbation, the fetish object may be held, tasted, smelled, or used to stimulate the genitals. They often feel guilty about their disorder and these fantasies, sexual urges and behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning in the person. Men appear to report greater interest in paraphilic activities than do women. 

Patients with fetishism often show a strong interest in non-genital body parts. Female undergarments and shoes are among the most frequently preferred fetish objects. The person becomes sexually aroused by wearing or touching the object. Most fetishists do not intend to cause harm to other people.

Paraphilic disorder such as underwear Fetishism is associated with acts that are deviations from socially accepted sexual behavior. Paraphilias are persistent and recurrent sexual interests, urges fantasies, or behaviors of marked intensity involving objects, activities, or even situations that are atypical in nature.

the International Classification of Mental Diseases (ICD-10th, World Health Organization 1992), paraphilias were classified in the “Sexual and Gender Identity Disorders. In the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) the term paraphilia is defined as “an intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physiologically mature, consenting human partners.”

In the DSM-5 these criteria should be addressed in the presence of three main aspects: first, the sexual arousal by deviant sexual stimuli, second, the negative consequences for the individual or the society and, finally, the fact that the person acts on his or her urges or that the urges or fantasies cause significant distress, interpersonal difficulty or impairment in functioning.

Fetishism is described in both the medical and legal literature. The term "fetishism" originates from the Portuguese word feitico, which means "obsessive fascination." People with the fetishistic disorder may not be able to function sexually without their fetish. The fetish may replace the typical sexual activity with a partner or may be integrated into sexual activity with a willing partner. The fetishistic disorder tends to fluctuate in intensity and frequency of urges or behavior over the course of an individual’s life. The existing literature indicates that people with fetishistic disorder often report a lack of self-esteem, a difficult childhood, and intrapsychic conflicts.

The etiology of fetishism is not known. The experts believe a combination of neurobiological, interpersonal, and cognitive processes all play a role. The level of an individual's sex drive is not consistently related to paraphiliac behavior. Paraphilias occur primarily in males with an average onset between ages 8 and 12. They are a lifelong condition. 

Some researchers began reporting a series of findings linking paraphilias with brain structure and function. Two reported cases of fetishism have been associated with abnormalities in the temporal lobe.  According to Wise (1985) temporal lobe epilepsy and temporal lobe tumor are linked to the development of fetishism. Some experts believe that temporal lobe dysfunction and fetishism. They surmise that hippocampal agenesis is associated with hypersexuality and can be treated with carbamazepine.

Biological explanations have included the notion that perhaps paraphilia is related to hormones. However, research has failed to show relationships between circulating hormonal levels and atypical sexual fantasies, urges, or behaviors

In 1927 Freud argued that a fetish is a special form of penis substitute. Freud described fetishism as a defense against castration anxiety arising from the perception of the female genitals.  According to Freud fetishism is a special kind of split within the subject, one that allows the male to sustain two incompatible assertions.

Some theorists believe that fetishism develops from early childhood experiences, in which an object was associated with a particularly powerful form of sexual arousal or gratification. A psychodynamic model of paraphilias may complement and add meaning to a neurodevelopmental model by viewing the paraphilic fantasies and behaviors as sexualized forms of defence against underlying personality difficulties, anxieties, or conflicts, particularly those concerning emotional intimacy

Although the etiology of paraphilias is unknown, it is probably a learned behavior. The classical conditioning explanation for the origination of paraphilia seems to be the most widely accepted theory.

The main symptom of Fetishistic Disorder is a recurrent and intense sexual arousal from either the use of nonliving objects or a highly specific focus on the non-genital body parts. Sexual fetishists frequently need to be touching, smelling, or looking at their unique object or engaging in fantasy about it in order to function sexually alone or with a partner. Fetishistic Disorder is most often diagnosed through self-report of symptoms.

The treatment of Fetishistic Disorder is challenging. Due to stigma the patients rarely seek professional treatment. Treatment is focused on decreasing the arousal to deviant sexual behavior. Treatment includes medication (antidepressants- Selective serotonin reuptake inhibitors and anti-anxiety medications) can also be used in conjunction with psychotherapy.  Clinical success has been reported in behavioral therapy, social skills training, sex education, and cognitive behavioral therapy (CBT). The CBT is regularly followed by psychosocial education, family system treatment, multimodal treatment, and multisystemic therapy. Some therapists use Sensate focus therapy which was developed by Masters and Johnson in the 1960s to treat Fetishistic Disorder. Lijian Wu – a prominent EMDR therapist highlights using (Eye Movement Desensitization and Reprocessing) EMDR for fetish disorders. 

  

References

Briken, P., & Basdeskis-Jozsa, R. (2010). When sexual behavior gets out of control. Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz, 53, 313- 318.

Fedoroff J.P. (2022). The paraphilias, in The New Oxford Textbook of Psychiatry (ed 2). Edited by Gelder M, Andreasen N, Lopez-Iber Jr, et al.

Freud, Sigmund (1927). “Fetishism,” Standard Edtio. XXI.

Kafka, M. P. & Hennen, J. (2003). Hypersexual desire in males: Are males with paraphilias different from males with paraphilia-related disorders? Sexual Abuse: A Journal of Research and Treatment, 15, 307-321.

Lackamp, J. M., Osborne, C., Wise, T. N., Baez-Sierra, D., & Balgobin, C. (2016). Treatment of Paraphilic Disorders. Practical Guide to Paraphilia and Paraphilic Disorders, 43.

Masiran R. (2018). Fetishism in ADHD: an impulsive behaviour or a paraphilic disorder?. BMJ case reports, 2018, bcr2018226212.  

Masuda, K., Ishitobi, Y., Tanaka, Y., & Akiyoshi, J. (2014). Underwear fetishism induced by bilaterally decreased cerebral blood flow in the temporo-occipital lobe. BMJ case reports.

"Paraphilic Disorders". Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Philadelphia, Pennsylvania: American Psychiatric Publishing. 2013. pp. 685–686.

Weiderman, M (2003). "Paraphilia and Fetishism". The Family Journal. Thousand Oaks, California: SAGE Publications. 11 (3): 315–321.