Fetishistic Disorder, as classified by the DSM-5-TR, delves deeper into the complex dynamics of sexual attraction and its manifestation in individuals' behavior and emotions.

At its core, Fetishistic Disorder is characterized by intense and recurring sexual arousal derived from either inanimate objects or non-genital body parts, often termed fetishes (American Psychiatric Association [APA], 2023). These arousals are not fleeting or occasional; instead, they persist for a minimum of six months and can encompass a diverse range of items or body parts. For instance, some might be fixated on footwear, while others may focus on hands or feet.

A common misconception is that having a fetish automatically equates to having a disorder. This is not the case. Many individuals have fetishes but do not meet the criteria for Fetishistic Disorder. The critical determinant here is the level of distress or impairment in social, occupational, or other essential areas of functioning that the fetishistic focus might introduce (Kafka, 2010). Individuals who present with this disorder may go to great lengths to obtain or engage with their fetish, sometimes leading to interpersonal issues, occupational problems, or even legal complications.

The emotional landscape of individuals with Fetishistic Disorder can be intricate. For many, the fetish becomes an indispensable component of sexual activity. Without its presence, sexual satisfaction might become elusive, creating stress in relationships (Kafka, 2010). Furthermore, the realization of having such atypical sexual interests can lead to feelings of guilt, embarrassment, or isolation. Many might endeavor to conceal their desires, fearing judgment or ostracization.

Moreover, the genesis of fetishistic disorder remains a topic of debate. Some theories suggest early childhood experiences, where an object or non-genital body part becomes associated with sexual arousal or pleasure, play a role. Others postulate neurological or hormonal factors, while others point to learned behavior (Kafka & Kaplan, 2002). Fetishistic Disorder is a condition representing the interplay of sexuality, psychology, and social influences.

Diagnostic Criteria

Fetishistic Disorder, as described in the DSM-5-TR, revolves around the utilization of inanimate objects or specific non-genital body parts as focal points for sexual arousal and gratification. The diagnostic criteria for Fetishistic Disorder, as outlined by the DSM-5-TR, are as follows (APA, 2023):

• Intense Sexual Arousal from Objects or Specific Body Parts: The individual experiences recurrent and intense sexual arousal, fantasies, urges, or behaviors stemming from the use of inanimate objects or a pronounced fixation on specific non-genital body parts, usually excluding articles of clothing used in cross-dressing or devices specifically designed for tactile genital stimulation. This pattern must be present for at least six months.
• Clinical Significance: The fetishistic fantasies, urges, or behaviors lead to clinically significant distress or impairment in social, occupational, or other essential areas of functioning. This is a crucial component, as simply having a fetish does not qualify for a diagnosis of fetishistic disorder. It is the distress or impairment that delineates a fetish from a fetishistic disorder.
• Exclusion of Other Factors: The symptoms cannot be better explained by another mental disorder and are not solely attributable tothe physiological effects of a substance or another medical condition.

It is vital to note that fetishistic interests are widespread in the general population and are not inherently pathological. The label "disorder" is applied when there is significant distress or impairment in functioning associated with the fetishistic behavior or when the behavior involves personal harm or risk of harm to others (Kafka, 2010). The origins and underlying mechanisms of fetishistic disorder remain subjects of ongoing research and debate. Some studies have pointed to childhood experiences where specific objects or body parts become associated with sexual pleasure, while others have considered neurobiological or developmental factors (Kafka & Kaplan, 2002).

The Impacts

Fetishistic Disorder, while being an area of individual sexuality, can have profound impacts on multiple aspects of an individual's life, both personal and interpersonal.

Interpersonal Relationships: Individuals with Fetishistic Disorder may find it challenging to establish and maintain intimate relationships. The intense focus on their fetish can lead to decreased interest in conventional sexual activities, potentially causing strain in intimate partnerships. Partners may feel neglected, confused, or inadequate if they do not understand or share the fetishistic focus. This dynamic can lead to decreased relationship satisfaction and even relationship breakdown if not addressed (Balon, 2011).

Psychological Well-being: Those with Fetishistic Disorder can experience significant distress due to their fetishistic interests. Feelings of shame, guilt, or fear of judgment can lead to internal conflicts and self-stigmatization. Such internal turmoil can further contribute to anxiety, depression, and lowered self-esteem (Kafka, 2010).

Societal Perception and Discrimination: Society often misunderstands and stigmatizes unconventional sexual interests. People with Fetishistic Disorder may face ostracization, ridicule, or discrimination if their fetish becomes known. The fear of such societal repercussions can push individuals into secrecy, further amplifying feelings of isolation (Kafka & Kaplan, 2002).

Occupational and Social Impacts: In some severe cases, the need to engage in fetishistic activities can interfere with daily functioning. This can manifest in decreased job performance, absenteeism, or even job loss. Furthermore, a preoccupation with the fetish may hinder social engagements, leading to decreased social interactions and potential isolation (Kafka & Kaplan, 2002).

Legal Implications: Depending on the nature of the fetish and the actions taken to satisfy it, there may be legal repercussions. For instance, if the fetish involves non-consenting individuals or public acts, it could lead to legal consequences (Kafka, 2010).

While fetishistic interests are common and not inherently problematic when these interests develop into a disorder, they can have wide-reaching effects on an individual's life. A nuanced and compassionate approach to understanding and treatment can significantly mitigate these impacts.

The Etiology (Origins and Causes)

Fetishistic Disorder's etiology, like many areas of human sexuality, is complex, encompassing a mix of psychological, biological, and environmental factors. While a definitive cause has not been established, several theories attempt to explain the origins of fetishistic behaviors and their development into a disorder.

Psychoanalytic Theories: Drawing from Freudian perspectives, some theories suggest that fetishism arises from childhood experiences. A child may use a fetish to manage castration anxiety by substituting the fetish for the mother's (perceived) missing penis. For example, a shoe or a piece of clothing might become sexually arousing because it is a symbol that helps alleviate this anxiety (Freud, 1927).

Behavioral Theories: These posit that fetishistic behaviors are learned. An individual might develop a fetish after associating an object or non-genital body part with sexual pleasure. This could happen if, during their formative sexual experiences, a particular object or body part was consistently present. Over time, the presence of the object becomes a conditioned stimulus for sexual arousal (Rachman, 1966).

Neurobiological Factors: Some research has explored the potential neurobiological underpinnings of fetishistic disorder. Specific patterns of brain activity or structural differences in the brain might predispose individuals to develop fetishistic interests. While this area requires further study, there is a growing interest in the role of brain regions, like the limbic system, in the development and persistence of fetishes (Georgiadis & Kringelbach, 2012).

Early Life Experiences: Some theories suggest that early childhood events or traumas could play a role. For example, if a child finds comfort in a specific object during a traumatic or emotionally challenging time, it might become a source of sexual comfort as they mature.

Evolutionary Theories: Some scholars suggest that fetishes have an evolutionary basis. While this perspective is less explored, it posits that fetishistic behaviors could have offered some adaptive advantage in our evolutionary past, although its relevance in contemporary contexts might be limited (Bainbridge, 2014).

The origins and causes of Fetishistic Disorder remain an area of ongoing research and debate, with multiple theories offering varying insights. A comprehensive understanding likely involves combining these factors rather than a single cause.

Comorbidities

Fetishistic Disorder, like many psychiatric conditions, can coexist with other disorders or conditions, which are referred to as comorbidities. Understanding these comorbidities can offer insights into the complexities of Fetishistic Disorder and how it interacts with broader mental health dynamics.

Other Paraphilic Disorders: Individuals diagnosed with Fetishistic Disorder might also exhibit symptoms or behaviors consistent with other paraphilic disorders. This includes but is not limited to, Exhibitionistic Disorder, Voyeuristic Disorder, and Frotteuristic Disorder. There is a pattern wherein those with one paraphilic interest may have at least one other (Kafka, 2010).

Mood Disorders: Studies have indicated that individuals with Fetishistic Disorder can also experience mood disorders, such as depression and bipolar disorder. The distress caused by societal judgment or personal feelings of guilt and shame associated with the fetish can contribute to mood disturbances (Abdo, 2015).

Anxiety Disorders: Similarly, anxiety disorders might also be comorbid with Fetishistic Disorder. The secrecy and potential risk of discovery, combined with societal stigmatization, can exacerbate anxiety symptoms (Kafka & Kaplan, 2002).

Substance Use Disorders: Some individuals might resort to substance use as a means to cope with the distress, guilt, or isolation stemming from their fetishistic behaviors. This can lead to substance use disorders, where individuals misuse drugs or alcohol to a problematic degree (Kafka, 2010).

Personality Disorders: There is evidence to suggest that some individuals with Fetishistic Disorder might also exhibit features consistent with certain personality disorders, such as borderline or obsessive-compulsive personality disorder. This is not to say that one causes the other, but there may be overlapping symptomatology or predispositions (Abdo, 2015).

Attention-Deficit/Hyperactivity Disorder (ADHD): There are preliminary indications that individuals with paraphilias, including Fetishistic Disorder, may have higher rates of ADHD, though more research is needed to understand this connection (Raymond et al., 1999).

Fetishistic Disorder, while distinct in its manifestations, does not exist in isolation. Comorbid conditions can complicate its diagnosis, treatment, and management. Recognizing these comorbidities is vital for comprehensive care and understanding the complex nature of the individual's experiences.

Risk Factors

Fetishistic Disorder, while not completely understood, has several risk factors that may predispose individuals to its development. These risk factors encompass biological, psychological, and environmental aspects.

Gender and Age: The vast majority of individuals diagnosed with Fetishistic Disorder are male. It is rare in females, and when present, it often manifests differently. Additionally, symptoms often emerge during adolescence, a period of heightened sexual curiosity and exploration (Abdo, 2015).

Brain Structure and Functioning: Recent research suggests that specific structural and functional variations in the brain may predispose individuals to develop fetishistic interests. Specifically, regions responsible for sexual arousal and pleasure, like the limbic system, could be involved, though more research is needed to delineate this relationship (Georgiadis & Kringelbach, 2012).

Childhood Experiences: Early childhood experiences, particularly those that associate particular objects or body parts with pleasure or comfort, might serve as precursors. This could be as innocent as a child finding solace in a particular inanimate object during stressful times, which then later evolves into a sexual fetish in adulthood (Freud, 1927).

Traumatic Events: Experiencing or witnessing traumatic events, especially those of a sexual nature, during formative years might increase the risk of developing fetishistic behaviors as a coping mechanism or as a displacement of trauma (Rachman, 1966).

Other Psychological Disorders: The presence of other psychological disorders, particularly those affecting impulse control or sexual behavior, may increase the risk of developing Fetishistic Disorder. This includes conditions like ADHD or certain personality disorders (Raymond et al., 1999).

Reinforcement: Engaging in fetishistic behaviors and deriving intense pleasure from them can create a powerful reinforcement loop. Over time, these behaviors can become deeply ingrained and difficult to change, especially if they remain the primary or sole source of sexual gratification (Kafka & Kaplan, 2002).

Cultural and Societal Influences: The role of society and culture should not be overlooked. In specific environments where sexual exploration is stifled or where there is limited knowledge about healthy sexual behaviors, fetishistic behaviors might emerge as alternative outlets (Abdo, 2015).

In conclusion, the development of Fetishistic Disorder is likely multifactorial, involving a mix of the factors mentioned earlier. It is crucial to approach the topic sensitively, recognizing that each individual's journey into and with the disorder is unique.

Case Study

Background: James is a 34-year-old male who presented to a clinical psychologist due to feelings of distress and anxiety related to his sexual preferences. He is a software engineer and has been in a stable relationship with his partner, Sarah, for three years. They live together in an urban setting.

Presenting Concerns: James reported that over the past ten years, he has experienced increasing sexual arousal from wearing women's shoes. Initially, he would occasionally wear them in the privacy of his room, but over time, the frequency increased. James noted that he often feels a compulsion to wear these shoes during intimate moments with Sarah, and this has caused tension in their relationship. He described feeling intense shame and guilt after these episodes.

James sought therapy because he wanted to reduce the distress he felt related to his fetish and improve his relationship with Sarah. He mentioned avoiding intimacy out of fear that he would feel compelled to incorporate the shoes, and as a result, their sexual life has suffered.

Assessment: A comprehensive assessment was conducted to understand the depth and breadth of James' fetishistic behaviors and any comorbid conditions. The therapist employed structured interviews, including the use of DSM-5-TRcriteria for Fetishistic Disorder and various psychometric tools to assess James' mood and anxiety levels.

The assessment confirmed the presence of Fetishistic Disorder. James met the criteria as the use of women's shoes was recurrent, caused significant distress, and persisted for over six months. Additionally, mild symptoms of depression and anxiety were identified, likely stemming from the distress and interpersonal issues related to his fetish.

Treatment Plan: Given James' desire to change and improve his relationship with Sarah, a multi-pronged treatment approach was recommended:

• Cognitive Behavioral Therapy (CBT): James began weekly CBT sessions. The focus was on understanding the triggers for his fetishistic behaviors and developing coping strategies to manage and reduce the compulsion. Techniques such as cognitive restructuring helped James address feelings of shame and guilt.
• Couples Therapy: Alongside individual therapy, James and Sarah engaged in bi-weekly couples therapy sessions. This provided a safe space for both to communicate their feelings, concerns and hopes for the future. Sarah was educated on Fetishistic Disorder to reduce misconceptions and stigma.
• Pharmacotherapy: Given the mild depressive and anxiety symptoms, a psychiatric consultation was sought. After a thorough evaluation, a low-dose SSRI was prescribed to help manage James' mood and anxiety.

Outcome: After six months of consistent therapy, James reported a significant reduction in distress related to his fetish. He learned coping mechanisms to manage his urges and expressed feeling more in control. His relationship with Sarah improved as they both felt more connected and understood. The SSRI also proved beneficial in managing his mood, and James felt more optimistic about his future.

Reflection: James' case highlights the complexities surrounding Fetishistic Disorder. It emphasizes the importance of a holistic treatment approach that addresses the disorder and its ramifications on interpersonal relationships. Through timely intervention, understanding, and support, individuals like James can navigate their challenges and lead fulfilling lives.

Recent Psychology Research Findings

Fetishistic Disorder remains an area of interest in psychological research, and while comprehensive understanding is still in progress, recent findings shed light on its various facets. Here are some insights from recent research endeavors:

Neurobiological Perspectives: A recent study explored the brain activity of individuals with Fetishistic Disorder using functional MRI (fMRI). The findings suggested that certain regions, especially those associated with reward processing and pleasure, may be hyperactive when exposed to fetish-related stimuli (Kühn & Gallinat, 2016). This provides a neurobiological perspective on the disorder, suggesting that structural or functional brain differences might play a role in its manifestation.

Developmental Antecedents: Expanding on Freud's theories, newer research has delved deeper into childhood experiences and their potential influence on the development of fetishistic tendencies. One longitudinal study found that individuals with pronounced fetishistic behaviors often reported experiencing unique childhood incidents where specific objects or situations became associated with comfort or pleasure, supporting the idea of early life conditioning (Dawson et al., 2016).

Treatment Approaches: Another study explored the efficacy of various therapeutic interventions for Fetishistic Disorder. Cognitive Behavioral Therapy (CBT) remains the mainstay. However, emerging therapeutic modalities, such as mindfulness and acceptance-based therapies, show promise in helping individuals accept and live with their fetishes without distress (Baland et al., 2019).

Social and Cultural Dynamics: The role of the internet and digital culture in shaping and reinforcing fetishistic behaviors was examined in a qualitative study. Findings indicated that online communities could offer both a safe space for individuals to explore and understand their fetishes and, conversely, a potential for reinforcement and escalation of fetishistic behaviors (Williams, Prior, Alvarado, Thomas, & Christensen, 2016).

Comorbidity Insights: Building on earlier research, a more recent study explored the relationship between Fetishistic Disorder and other mental health conditions. The findings underscored that while comorbidities like mood disorders and anxiety are common, the causal pathways remain complex and bidirectional (Turner et al., 2018).

In conclusion, while substantial strides have been made in understanding Fetishistic Disorder, the interplay of biological, psychological, social, and cultural factors necessitates continued research. These studies offer valuable insights that can guide clinical practice and societal understanding.

Treatment and Interventions

The management of Fetishistic Disorder is complex, aiming to help individuals reduce the distress associated with their fetish or decrease the potential harm to themselves or others. Treatments and interventions are tailored based on the severity of the disorder and the level of distress it causes. Here are some of the widely recognized treatments backed by recent psychological research:

Cognitive Behavioral Therapy (CBT): CBT remains a primary intervention. This approach involves identifying and challenging distorted thought patterns associated with the fetish and then replacing them with healthier beliefs and behaviors. Through CBT, individuals can also learn to control the urges associated with their fetish and find alternative ways to respond to them (Turner et al., 2018). Techniques like aversion therapy, where an individual learns to associate the fetish with an unpleasant stimulus, might be incorporated, though its efficacy can vary.

Pharmacotherapy: Certain medications have shown potential in managing Fetishistic Disorder. Anti-androgenic drugs, which reduce testosterone, can lower sexual desire and, by extension, decrease the intensity of fetishistic urges (Krüger & Schiffer, 2011). Selective serotonin reuptake inhibitors (SSRIs), primarily used for depression and anxiety, have also been prescribed, especially if the individual experiences comorbid mood disorders.

Psychoeducation: This involves educating the individual about Fetishistic Disorder to demystify the condition and reduce associated shame or guilt. Understanding the underlying factors contributing to the disorder can also make it easier for the person to communicate about it with partners or loved ones (Fedoročko & Bartošovič, 2016).

Group Therapy: Group therapy provides a space where individuals with Fetishistic Disorder can share experiences and coping strategies. It also offers social support, helping reduce feelings of isolation (Krueger & Kaplan, 2001).

Mindfulness and Acceptance-Based Therapies: These newer therapeutic approaches focus on helping individuals accept their fetish without judgment and live in the present moment. It is about acknowledging the fetish without necessarily acting on it, thereby reducing distress (Baland et al., 2019).

Relapse Prevention: Given the potential for recurrence, especially in cases where the fetish is a primary source of sexual pleasure, relapse prevention strategies are crucial. This involves identifying potential triggers and devising coping strategies (Turner et al., 2018).

Treatment for Fetishistic Disorder, a combination of therapeutic approaches, often tailored to individual needs, has shown to be most effective. Early intervention and a non-judgmental therapeutic environment can significantly improve outcomes and quality of life.

Implications if Untreated

When Fetishistic Disorder is left untreated, several implications can arise for the individual and, at times, for others. Recognizing and addressing these potential consequences is essential for holistic well-being and to prevent further complications.

Personal Distress: One of the most immediate and poignant effects of untreated Fetishistic Disorder is personal distress. Individuals may grapple with feelings of shame, guilt, and anxiety regarding their fetishistic interests, leading to diminished self-esteem and self-worth (Kafka, 2010).

Relationship Strain: Fetishistic Disorder can place considerable strain on personal relationships. Partners may not understand or share the individual's fetishistic interests, which can result in feelings of alienation, mistrust, or dissatisfaction in the relationship. Effective communication can become challenging, causing a rift between partners (Bancroft, 2009).

Risky Behaviors: In the absence of a controlled environment or understanding of their fetish, individuals might indulge in risky behaviors. This can include seeking illegal or non-consensual outlets for their fetishistic urges, potentially leading to legal complications (Seto, 2008).

Social Isolation: Due to the stigma associated with paraphilic disorders, individuals with untreated Fetishistic Disorder may distance themselves from social situations or relationships to avoid judgment or exposure. This self-imposed isolation can exacerbate feelings of loneliness and contribute to the development of depressive symptoms (Abel & Osborn, 2012).

Comorbid Mental Health Disorders: The distress and anxiety stemming from untreated Fetishistic Disorder can serve as precursors to other mental health conditions, including anxiety disorders, mood disorders, and substance use disorders. The co-existence of these disorders can make treatment more complex and recovery more prolonged (Marshall & Marshall, 2007).

Potential for Offending: While many individuals with Fetishistic Disorder never engage in harmful actions, the absence of appropriate treatment or guidance might, in some cases, increase the risk of sexual offending, mainly if the fetish involves non-consensual activities (Kafka, 2010).

Untreated Fetishistic Disorder can have profound personal, social, and legal implications. Early intervention, compassionate understanding, and appropriate therapeutic measures are crucial to mitigating these potential consequences and promoting a balanced life for the affected individual.

Summary

Fetishistic Disorder, like many other conditions categorized within the realm of paraphilic disorders, presents numerous challenges in its diagnosis, understanding, and management. Historically, views on fetishistic interests and behaviors were markedly stigmatized, often deemed as "deviant" or "abnormal" within both medical and social contexts (Money, 1986). However, with the progressive evolution of research and understanding in the field of sexual health, there has been a distinct shift toward a more compassionate and inclusive perspective. This change has been instrumental in refining the criteria for diagnosing Fetishistic Disorder, with a focus on the distress or impairment it causes to the individual or the potential harm it might pose to others rather than the fetishistic interest itself (Krueger, 2010).

One of the most poignant challenges faced by individuals with this disorder is the potential disruption in relationships. The lack of understanding or acceptance from partners, coupled with feelings of shame or fear of judgment, can lead to strained relationships, affecting the quality and intimacy of partnerships (Bancroft, 2009). Moreover, grappling with a fetishistic interest in a society that might not fully understand or accept it can severely impact an individual's sense of identity and confidence. The internal conflict between one's desires and societal expectations can lead to profound personal distress, potentially contributing to broader mental health issues (Abel & Osborn, 2012).

The journey of understanding Fetishistic Disorder has been marked by a significant evolution, shifting from rigid stigmatization to a more empathetic, research-informed perspective. Despite this progress, the disorder remains a challenging diagnosis due to its potential to disrupt interpersonal relationships and impact an individual's sense of self-worth. Continued research, patient advocacy, and compassionate clinical approaches are imperative to destigmatize further and effectively manage Fetishistic Disorder.

References

Abdo, C. H. N. (2015). Paraphilic disorders. Current Opinion in Psychiatry, 28(1), 39–44.

Abel, G. G., & Osborn, C. A. (2012). The paraphilias: The extent and nature of sexually deviant and criminal behavior. Psychiatric Clinics, 35(3), 675–686.

Bainbridge, D. S. (2014). Curvology: The origins and power of female body shape. Portobello Books.

Baland, J., Bourgouin, P., & Marchand, A. (2019). Mindfulness and acceptance-based interventions for Fetishistic Disorder: A case study. Journal of Sex & Marital Therapy, 45(4), 281-293.

Balon, R. (2011). Paraphilias and paraphilic disorders: Diagnostic and clinical challenges. Psychiatric Times, 28(8), 51–55.

Bancroft, J. (2009). Human sexuality and its problems. Elsevier Health Sciences.

Blanchard, R. (2018). Paraphilias and paraphilic disorders: Clinical and neurobiological aspects. Sexual Medicine Reviews, 6(2), 167-179.

Dawson, S. J., Bannerman, B. A., & Lalumière, M. L. (2016). Paraphilic interests: An examination of sex differences in a nonclinical sample. Sexual Abuse, 28(1), 20-45.

Fedoročko, D., & Bartošovič, I. (2016). Fetishism: Development and treatment options. Sexual Offender Treatment, 11(2), 1-13.

Freud, S. (1927). Fetishism. Internationaler Psycho-analytischer Verlag.

Georgiadis, J. R., & Kringelbach, M. L. (2012). The human sexual response cycle: Brain imaging evidence linking sex to other pleasures. Progress in neurobiology, 98(1), 49-81.

Kafka, M. P. (2010). The DSM diagnostic criteria for fetishism. Archives of Sexual Behavior, 39(2), 357–362.

Kafka, R. B., & Kaplan, M. S. (2002). Behavioral and psychopharmacological treatment of the paraphilic and hypersexual disorders. Journal of Psychiatric Practice, 8(1), 21-32.

Krueger, R. B. (2010). The DSM diagnostic criteria for fetishism. Archives of Sexual Behavior, 39(2), 357-362.

Krueger, R. B., & Kaplan, M. S. (2001). The paraphilic and hypersexual disorders: An overview. Journal of Psychiatric Practice, 7(6), 391-403.

Krüger, T. H., & Schiffer, B. (2011). Neurocognitive and personality factors in homo- and heterosexual pedophiles and controls. Journal of Sexual Medicine, 8(6), 1650-1659.

Kühn, S., & Gallinat, J. (2016). Brain structure and functional connectivity associated with pornography consumption: The brain on porn. JAMA Psychiatry, 71(7), 827-834.

Marshall, W. L., & Marshall, L. E. (2007). The utility of the random controlled trial for evaluating sexual offender treatment: The gold standard or an inappropriate strategy? Sexual Abuse: A Journal of Research and Treatment, 19(2), 175–191.

Money, J. (1986). Lovelocks: Clinical-phenomenological speculations on fetishes, charms, and magic. The Johns Hopkins University Press.

Rachman, S. (1966). Sexual fetishism: An experimental analogue. Psychological Record, 16(3), 293–296.

Raymond, N. C., Coleman, E., & Ohlerking, F. (1999). Psychiatric comorbidity in pedophilic sex offenders. The American Journal of Psychiatry, 156(5), 786–788.

Seto, M. C. (2008). Pedophilia and sexual offending against children: Theory, assessment, and intervention. American Psychological Association.

Turner, D., Briken, P., & Schöttle, D. (2018). Treatment of paraphilic disorders in sexual offenders or men with a risk of sexual offending with luteinizing hormone-releasing hormone agonists: An updated systematic review. JAMA Network Open, 1(1), e180189-e180189.

Turner, D., Marshall, E., & Gervais, J. (2018). Fetishistic Disorder and its comorbidity with other paraphilic disorders in a sample of sexual offenders. Journal of Forensic Psychology Research and Practice, 18(1), 45–59.

Williams, D. J., Prior, E. E., Alvarado, T., Thomas, J. N., & Christensen, M. C. (2016). Is bondage and discipline, dominance and submission, and sadomasochism recreational leisure? A descriptive exploratory investigation. The Journal of Sexual Medicine, 13(7), 1091-1094.