Fetishistic Disorder
The husband's behavior best fits with Fetishistic disorder, characterized by persistent and intense sexual arousal focused on non-genital body parts (in this case, women's feet) that causes distress or impairment in functioning. 1, 2
Diagnostic Criteria and Clinical Features
Fetishistic disorder involves recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the use of non-living objects or specific non-genital body parts over a period of at least 6 months. 3, 4, 2
Key diagnostic elements include:
Sexual arousal specifically focused on non-genital body parts (such as feet) or non-living objects (such as women's undergarments), with the collection of thousands of images and masturbation to these images indicating the recurrent and intense nature of the arousal pattern. 1, 2
The behavior causes clinically significant distress or impairment in social, occupational, or other important areas of functioning, as evidenced by the marital conflict brought to counseling. 2
The condition occurs predominantly in males and typically begins in adolescence, though this 24-year-old patient's age of onset is not specified. 4, 2
Differential Diagnosis Considerations
Fetishistic disorder must be distinguished from other paraphilic disorders based on the specific focus of sexual arousal:
Voyeuristic disorder involves sexual arousal from observing unsuspecting individuals who are naked, disrobing, or engaging in sexual activity—not from viewing images of specific body parts. 1
Frotteuristic disorder involves sexual arousal from touching or rubbing against a non-consenting person, not from viewing images. 1
Sexual masochism involves sexual arousal from being humiliated, beaten, bound, or otherwise made to suffer. 1
Sexual sadism involves sexual arousal from the psychological or physical suffering of another person. 1
Important Clinical Distinction: Partialism
The specific focus on feet represents what was historically termed "partialism"—an exclusive focus on a specific body part—which was previously classified separately but is now considered a specifier of fetishistic disorder. 5
Partialism involves sexual arousal characterized by an exclusive focus on part of the body, and was reintegrated as a type of fetishism rather than remaining a separate paraphilia NOS category. 5
The operational criteria for paraphilias include an atypical focus involving human subjects (self or others), which encompasses body part fetishes like podophilia (foot fetishism). 5
Assessment Approach
Accurate diagnosis requires integration of multiple sources of clinical information, given the limitations and biases of self-report through clinical interview alone. 1
Critical assessment elements:
The presence of thousands of collected images indicates the recurrent and persistent nature of the sexual interest, meeting the temporal criterion of at least 6 months. 3, 4
The wife's discovery and the couple seeking counseling demonstrates that the behavior is causing relationship distress and impairment in social functioning. 2
Paraphilias are often comorbid with other sexual, mood, and personality disorders, requiring comprehensive psychiatric evaluation. 1
Common Diagnostic Pitfalls
Do not confuse fetishistic disorder with normal sexual variation or preference—the diagnosis requires that the behavior causes significant distress or functional impairment, or involves non-consenting persons. 2
In clinical settings, patients with fetishistic disorders are often referred because of legal troubles or relationship conflicts rather than self-presenting for treatment, making collateral information from partners particularly valuable. 2
The distinction between a fetish (attraction to an object or body part) and fetishistic disorder (which causes distress or impairment) is critical—not all fetishes constitute a disorder. 2