Fetishes and the DSM: When Is a Kink a Mental Health Issue?

Tied in the cuffsSexual behavior is inextricably linked to cultural norms, and the latest version of the Diagnostic and Statistical Manual of Mental Disorders—psychiatry’s diagnostic bible—makes this readily apparent. Although sexual kinks are still a source of cultural controversy, their taboo status is steadily lifting, and the DSM-V treats unusual sexual behavior differently than previous versions of the manual.

Changing Sexual Norms

A little over a century ago, Sigmund Freud, modern psychiatry’s godfather, argued that clitoral orgasms were a sign of immature sexuality. For Freud, healthy adult sexuality meant nothing less than a vaginal orgasm. Contemporary sex researchers now emphasize the fact few women can reach orgasm with vaginal stimulation alone, and sex therapists frequently advise people having trouble with orgasm to focus on the clitoris. There have been other advances in thinking, of course, when it comes to sexuality. Until 1973, homosexuality was listed as a disorder in the DSM. Contemporary psychologists and psychiatrists now condemn conversion therapy, a treatment designed to “cure” homosexuality.

Contemporary sexual fetishes run the gamut. Many people have engaged in or acted on some form of sexual fetish at one time or another, and groups dedicated to advocating for the rights of those with unusual sexual interests have sprung up all over the Internet. More and more sex researchers recognize these behaviors as part of a sexual continuum and not necessarily indicative of a mental health issue.

The DSM-V’s Stance

Like their predecessors, contemporary mental health professionals frequently wrestle with the intersection of cultural norms and mental health, and the new DSM reflects this ongoing dialogue. Previous editions of the manual listed atypical sexual behaviors as diagnoses. For example, the DSM-IV listed the behavior of sexual masochism as a disorder. The new version, however, is largely silent on behavior, and defines fetishes as problematic only when they cause significant distress. Thus, masochistic behavior is now termed sexual masochism disorder only when the behavior causes problems for the individual.

When Is a Kink a Problem?

So when does a sexual kink cross the line into a disorder diagnosis? Some sexual behavior is inherently disordered, according to the new manual. For example, pedophilia remains a diagnosis because it’s impossible to act on a sexual attraction to children without breaking the law or causing harm to others. But for those who are blissfully dedicated to feet, bondage, or garter belts, the manual no longer defines the behavior itself as a problem. Instead, the so-called disorder is partially in the eye of the beholder. If your sexual fetish causes serious problems in your romantic relationships or significant personal distress, it may be time to consult a professional. Otherwise, the creators of the DSM-V are content to allow people to engage in whatever sexual behavior they want to without finding issue.

Ongoing Controversy

Not everyone is happy with the changes to the manual. Sex-positive writers and researchers point to the fact the new book still provides a list of sexual fetishes, which serves to label some sexual behaviors as inherently deviant even when they don’t cause problems. And the fact the DSM has changed its approach to diagnosis doesn’t mean every mental health professional has followed suit. The American Association of Sexuality Educators, Counselors, and Therapists publishes a list of therapists who adopt a nonjudgmental stance toward kinks. People who engage in non-normative sexual practices such as swinging, polyamory, and sexual fetishism report that they often struggle to find professionals who don’t view their behavior as deviant.

References:

  1. Paraphilic disorders [PDF]. (n.d.). Arlington: American Psychiatric Publishing.
  1. Parry, W. (2013, May 30). Normal or not? A sexual attraction to objects. LiveScience.com. Retrieved from http://www.livescience.com/36982-is-fetish-normal-dsm5.html
  1. Savage, D. (n.d.). Finding a sex-positive therapist isn’t always easy. Creative Loafing Charlotte. Retrieved from http://clclt.com/charlotte/finding-a-sex-positive-therapist-isnt-always-easy/Content?oid=3043389

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  • brynn j

    brynn j

    September 1st, 2013 at 5:21 AM

    my thought has always been that it would cross over into “disorder” territory when you have to hurt someone or get hurt yourself to enjoy something sexually. . . is that kind of on target?

  • jj

    jj

    September 1st, 2013 at 10:57 AM

    @brynn – no, not if it’s consensual. Hopefully those individuals would be self-aware enough and caring enough to use safewords and everything like that. Otherwise it can get dangerous. But a certain kind of pain can be essential for a certain kind of pleasure.

  • brynn j

    brynn j

    September 3rd, 2013 at 3:57 AM

    sorry jj I was not even thinking about it that way, pain never equates pleasure to me but if that’s your thing and your partner agrees and she/he likes it too, then to each his own and that shouldn’t be labeled as wrong

  • Everett

    Everett

    December 4th, 2013 at 4:01 PM

    I’m a 52 yr old male, that has an overwhelming foot fetish, that I can’t explain…
    I don’t have any idea where my love for women’s feet come from. But at times, it annoys me..I’m constantly looking down during the summer months for pretty feet in sandals.

  • Jan Beauregard, Ph.D.

    Jan Beauregard, Ph.D.

    February 2nd, 2014 at 6:19 AM

    I have seen harmless fetishs and I have seen people so preoccupied that it crosses over into sexual addiction. The trouble with “safe words” is that there are cases where someone is so in a trance like state that they are dissociative. I have had many clients sustain body injuries because someone dissociated during the sexual act and kept going despite their partners objection. If someone must endure extreme pain to feel pleasure that is what Patrick Carnes would term “cross wiring” and often there is trauma work to be done here. So while I see myself as “sex positive” I would not sanction physical harm in this area any more than I would tolerate bulimia in a client who says she feels pleasure in vomiting or a cutter who says they are euphoric after cutting.

  • El M.

    El M.

    January 16th, 2017 at 6:25 AM

    Dr. Beauregard, although I understand that individuals who entertain BDSM activities rely upon a certain protocol to engage in “safe” sex, I would like to know about what drives the interests in extreme (bold, italic, underlined) BDSM that includes genital mutilation, borderline (if not, actual) necrophilia, torture, and snuff. I was married to a man who hid his interests in extreme bondage and torture for over 14 years and actually engaged in very expensive events where groups of people gathered to act out their fantasies with random and unknown participants. Of course, I am long-since divorced, but the level of violence that this man was entertaining caused me to become violently ill – even today, my gorge still rises when I recollect the imagery that I discovered that he had admitted interest in.
    Personally, I believe that “anything goes as long as its consensual,” has been a huge mistake. A foot fetish is quite different than extreme bondage and torture. Typically, there really isn’t physical, emotional, spiritual, or psychological harm in looking at someone’s feet. The DSM V is an overall mess………….

  • Kris

    Kris

    May 4th, 2015 at 12:21 AM

    I think we must be careful in our new era of acceptance and enlightenment, not to forget that many forms of objectified sex are unhealthy to a persons growth and well being, if not harmful to their relationships. I’m not talking about any particular type, just that a steady diet of sex for sex sake and lack of connection CAN be a manifestation of a serious emotional problem – consensual or not.

  • Frank

    Frank

    January 20th, 2016 at 5:15 PM

    There is no such thing as a “fetish” as this term was based on a fraud when it was coined by the nineteenth century psychologist Alfred Binet after he APPROPRIATED it and redefined its context. The whole point of the erroneous term “fetish” was promoted for the purposes of stigmatizing behavior the establishment wanted to marginalize. So please stop using this archaic term! The Everett fellow who is drawn to female lower extremities is not alone as this is one of the biggest things that the establishment try to suppress because the female foot has spiritual and medicinal value among with the ancient healing art of reflexology and ancient Goddess Worship. He says that he does not know where this draw comes from but I do as I have discovered that ancient societies used to engage in a very different form of spirituality that centered around Goddess Worship and one of the biggest rituals they used to engage in was female foot worship. So this was hard wired into us as this practice went on for at least thousands of years. We are living in an anomalous era where the female foot is marginalized and any attention to to them is taught as “an illness” [ which is what the contrived term “fetish” was meant to further instil. ] Modern day traditions in India still practice various forms of this and incorporate female foot worship in a number of their spiritual rituals. Gurus note that “worshiping the female foot with ‘spiritual emotion’ activates the Goddess principle” so there is quite a lot of evidence that the draw towards the female foot including their worship is not only natural but was actually part of an original and authentic spirituality that has since been lost. I would urge people to not let themselves be defined by terms coined by a few academics and to use critical thinking.

  • todd t.

    todd t.

    June 11th, 2016 at 4:50 PM

    sex and fetishism as amental disorder are the christians way and the ordinary peoples way of describing people who do anything but the normal plain way of having sex. so if you have sex too much you are labeled as having a sex addiction. if you have a heel fetish like me you are labled as having a mental disorder. peoplel always label anything outside of the quote unquote norm, thank goodness for mags like skin two

  • Frank

    Frank

    January 21st, 2016 at 5:04 PM

    Something else about the female foot that is often overlooked but greatly explains their allure is the fact that its curvature along the arch side corresponds to the feminine shape of the female form. So it should not be too surprising that there is a significant interest in the area. There are also pheromones in sole perspiration.

  • Frank

    Frank

    January 21st, 2016 at 8:56 PM

    The term fetish is basically a type of pejorative describing behavior most of which cannot be legitimately described as a mental disorder. The DSM is quite arbitrary as it often adds or removes classifications which are not even objectively diagnosed as there are no lab tests. The act of arbitrarily labeling any perceived behavior, particularly when classifying it as a mental disorder, is often the start of the stigmatization of the said behavior. When terms are concocted on such flimsy foundation they do not deserve the respect of being used or adopted by the masses because those few in positions of self styled “authority” who concocted the terms do not legitimately speak for the actual population groups that they are attempting to describe as only the people being described are in a better position to speak about their experiences and or supposed condition.

  • todd t.

    todd t.

    June 11th, 2016 at 5:01 PM

    now the line should be drawn at the harmul problems men who molest children yes thats bad that is not a so called fetish that is a dangerous decided disease and so forth, but heel fetishes and liking ladies in certain types of garment fetishes and dominatrix etc thats just adding fantasy to sex. that is not dangerous. but underage sex and the whole kids thing is sickening. that is where the mental illness can be put in. b ut those people at some time in there life like michael jackson who was abused as a child, he became his abuse and it became a learned response . those types of people should be kept away from society. and the whole sexual addiction is bull ***. fantasy sex between two adults is nothing weird . it is just noot your plain jane normal boring ordinary sex

  • Pawan

    Pawan

    August 27th, 2016 at 12:11 AM

    Can a guy with feet fetish become a father??

  • rob

    rob

    October 31st, 2016 at 1:21 AM

    Why are there no therapist available to help someone with a diaper fetish or age regression therapy? Or can I not be helped?

  • The GoodTherapy.org Team

    The GoodTherapy.org Team

    October 31st, 2016 at 9:35 AM

    Hi Rob,
    Thank you for reaching out. Please know there is help available! You can search for a therapist near you on the GoodTherapy.org directory here:https://www.goodtherapy.org/find-therapist.html

    You can also call the GoodTherapy.org support team for assistance finding a therapist. We are available Monday through Friday, 8 a.m. – 4 p.m. Pacific at 888-563-2112, ext. 1.

    We are wishing you all the best in your search and your healing! ♥

    Warm regards,
    The GoodTherapy.org Team

  • rob

    rob

    January 16th, 2017 at 9:37 PM

    Are there any banes of doctors I can contact?

  • The GoodTherapy.org Team

    The GoodTherapy.org Team

    January 17th, 2017 at 9:17 AM

    Hi Rob,
    If you do a search through our therapist directory (www.goodtherapy.org/find-therapist.html), you will likely find therapists in your area to contact. Please keep in mind that GoodTherapy.org is an exclusive directory. If you have trouble finding a professional in your area, don’t be discouraged–it may mean you’ll have better luck doing a Google search or asking for a referral from a trusted health professional, such as your doctor.

    Best wishes,
    The GoodTherapy.org Team

  • El Ma

    El Ma

    January 18th, 2017 at 4:45 AM

    When I type about “spiritual” damages as a result of personal preferences or practices, I am not, not, NOT referencing religion. The human “spirit” is that spark of humanity that experiences empathy, compassion, pity, and genuine passion. Passion doesn’t have to relate to sex, one iota.
    So, it might be a wise option to contemplate what our own issue bring to any table of intimacy. I know, from personal experience, that the ex’s “interests” and subsequent activities caused such extreme anxiety for me that I could never have remained associated with anyone (him, or anyone else) that entertained that level of sexual violence. There has to be – HAS to be – some point where an “interest” damages the human spirit.
    And, the folks that are so defensive about their personal interests need to relax, take stock, and learn to not care what anyone else views their interests as. However, keeping one’s specific interests private and on a need-to-know-basis for a partner’s benefit is essential. People don’t need to know everything about us. They really don’t, unless whatever it is might have a negative impact upon THEIR lives.

    The reason that the ex never told me about his interests in extreme sexual violence is because I made it very clear, before we dated, that I did not, and never would, tolerate violence within a relationship. In order for him to gain access to my finances, he chose to hide those interests and pretend that he was someone that he really wasn’t. Otherwise, I would never have become involved with him.

  • danny

    danny

    April 22nd, 2017 at 10:11 PM

    i’m 17 years old i have this urge with touching people like touching there hair, poking them,touching there back, and touching there ear. i don’t know if it’s fetishes or kink or a disorder. i have been looking into it but can’t found nothing so if someone know what i have text me i want it to stop having this urges

  • Barb

    Barb

    May 27th, 2017 at 11:41 AM

    I’m currently dealing with a guy who has a pantyhose/pantyhosed foot fetish. It’s annoying. I don’t mind wearing them except when it’s hot out or too warm. Wearing them in sticky weather has about the same effect as laying around in a wet bathing suit, which you’re not really supposed to do. Our relationship was fine for the first six months because we met in the fall. As soon as the weather changed and I didn’t want to wear them in the summer he started getting really angry saying I had led him on that I was into his fetish. I mean, they’re clothing, right? We live in a place it’s cold most the year. I tried to explain this, but it’s just gone from bad to worse. I was very upset to find he didn’t care I was developing yeast infections from wearing them in hot weather. I try to explain this and he just automatically went to “you’re making this up.” Here’s my point: If you’re so obsessed with a garment and having sex with someone that’s wearing them, isn’t that in and of itself a mental disorder? Why do we have to dance around this and say, “Oh no, it’s ok, it’s perfectly normal and it doesn’t mean anything and isn’t associated with anything.” There has to be a reason for this preoccupation. If not, it IS a mental disorder. Especially since it’s a known obsession that everyone around us knows about because he’s basically hit up every female in our group (before I met him) to engage in some form of play which involves their feet, pantyhosed feet or just plain them wearing pantyhose and sending him pictures. Please, people who impose your fetishes on another person and get upset at them when they aren’t in the mood to participate, don’t make them feel bad and tell them they’re not open minded. You have a serious obsession that is ruining your interpersonal relationships and you can’t properly connect with another individual if it’s the clothing or one specific body part that’s getting you off. I don’t care if you don’t want to admit it’s a mental health disorder, but what else could that be? I’ve had sex with many men and this one guy is a mess when it comes to sex. Everyone else I’ve been with can climax properly and don’t need to have other objects involved. There’s definitely something a little off with the wiring in your brain (I read one live science article that said in our brain the feet are located next to sex organs. I’m not a neurologist, so it didn’t really make sense to me, but it seems there’s something to it. There are websites dedicated to fetishes and plenty of people you can go to for gratification with pantyhose or feet because they share the same kink. Don’t try to impose it on a non-fetishist. It doesn’t make sense to us and it will only lead to unhappiness after a while. If I could understand WHERE this obsession came from, I might be a little more forgiving…something about a second grade teacher letting him touch her leg is the most I can get out of him. Help! I’m about ready to call it a day with this guy. Is there any advice you can give or things I can tell him because he’s had one failed relationship after another and I am pretty sure it’s all down to this particular sex kink.

  • janet s

    janet s

    April 15th, 2018 at 9:20 PM

    I understood a fettish to be a sexual stimulation that is essencial for you to be able to respond sexually. Is that right? Can you also get a fettish for a particular person.

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