Sexuality and Disability, Vol. 20, No.

2, Summer 2002 (䊚 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, tast-
ing, 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 fetishist’s 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
Allington Manor, Psychological Service Fair Oakes, Eastleigh, Hampshire, England.
2
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 䉷 2002 Human Sciences Press, Inc.

136 Lowenstein

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 women’s used bras or panties. This will be discussed
in crimes associated with fetishes.
Among treatment approaches used to combat fetishes are aversive condi-
tioning 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 individual’s life. Frequently such indi-
viduals 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 condi-

tioned to a woman’s boot by it being associated with a nude and attractive
female. A further study by Rachman and Hodgson (1968) showed how condi-
tioning again led to fetishes being developed. The questions that remained un-
answered 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.
Fetishes and Their Associated Behavior 137

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 co-
morbidity of alcoholism and specific paraphilias including sexual sadism, fe-
tishism, 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 Alco-
holism Screening Test. Results showed that most of the sexual sadists were
alcoholics. Alcoholism in association with sexual sadists was statistically sig-
nificant 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 gen-
der-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.
138 Lowenstein

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 Ka-
lyanam (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 “apo-
temnophilia,” contains other cases of genital mutilation.
Aguilera (2000) discussed sexual attraction to disabled individuals by de-
votees, 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 some-
times 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 trans-
vestism. 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 com-
pulsive 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-
Fetishes and Their Associated Behavior 139

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 protec-
tion 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 fetish-
ism 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 vari-
ety 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 voy-
eurism. A factor analysis of this study revealed a clear and logical factor struc-
ture 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 with-
out 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 Marx’s notion of
“commodity fetishism” and argued that this concept offered much for an under-
standing 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
140 Lowenstein

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. Fe-
tishes appear to resolve the Oedipus complex and fear of castration (Marucco,
1997). Kaplan (1997) considers fetishes a perversion for enhancing sexual exci-
tation. 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 instru-
ment 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 epi-
leptic 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 rela-
tionship with a woman as damaging to that woman. They used masochistic
Fetishes and Their Associated Behavior 141

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) dis-
cussed the treatment of sexual offenders. This will be considered later in the
area of treatment of sexual offender. Two types of sexual burglaries were dis-
cussed 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 17–46 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 ag-
gressive while carrying out these burglaries. As already mentioned the treat-
ment of fetishes can be extremely difficult due to its origin in early childhood
and a constant practising of fetishistic behaviour often related to the gratifica-
tion 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 fe-
males aged 15–34 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,
142 Lowenstein

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 aver-
sive 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 con-
sisted 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 Fer-
nandez (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. Treat-
ment 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 be-
liefs, modifying inappropriate fantasies, and developing a sound relapse preven-
tion 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 para-
philia 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 psy-
chologist 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 143

Table 1. Relevant Analysis of 20 Males Suffering from Fetishes

Serious relationship problem with a maternal figure. 15

Early association of fetish with sexual fantasies of behaviour. 18
Fetish viewed as a “turn on” for sexual behaviour. 20

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

Subjects

Over a 15 year period 20 consecutive referrals were made, all males aged
18–47 by solicitors and the courts (Table 1). The object of the referral essen-
tially 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 Person-
ality Inventory, an objective test measuring neuroticism, introversion/
extroversion, psychoticism, impulsiveness, empathy and venturesome-
ness. 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 8

Feet or shoes 5
Various sadomasochistic behaviour patterns including cross-dressing but being heterosexual. 7
144 Lowenstein

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 gar-
ments which had been reported missing in the neighbourhood were found in his posses-
sion. He had stolen these garments during the night and early morning hours from wash-
ing 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 relation-
ship (Table 3).
Fetishes and Their Associated Behavior 145

Table 3. Results of Treatment:

Adjustment of Fetish (1–3 years follow-up)

Well adjusted (no further police involvement) 11

Moderately adjusted (no further police involvement) 7
Poorly adjusted (further police involvement) 2

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 be-
haviour, 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 be-
ing 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 fetish-
ism.

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