October 05, 2022

Fetish case studies and thinking

Examples of fetishism

A 16-year-old boy has a sexual desire for women’s flat high heels. He has collected several pairs of these shoes and secretly treasured them. Later, she was discovered by her mother and brought to the clinic.

During the meeting, the boy said that he would have a sexual physical reaction to women’s shoes of this type, such as penile-erection-up.

Asked when he was first impressed with such shoes? The boy’s answer was: the earliest, in the kindergarten middle class, was about four years old at the time, playing on the ground, the kindergarten aunt was playing the piano, the boy saw the aunt High heels, flat style. At that time, I felt very beautiful and impressed. I wanted to get close to this aunt, but I didn’t dare to express the closeness. There was no sexual desire and physical reaction. In the future, after about 13 or 14 years old, I will have a sexual desire and physical reaction to such high heels.

During the meeting, I joked: If grandma wears these shoes, do you still have sexual desire?

The boy replied: There is no more.

I give him an explanation, and he can still accept it: You seem to like high heels, but in fact, you like that aunt in your heart, and you want to get close to the aunt, but since then, you have not dared to get close to the aunt.

The boy replied: Yes. I don’t dare to talk or deal with girls now.

The boy seemed a little embarrassed during the meeting, and he didn’t even dare to express closeness to his mother. It can be seen that the relationship between the boy and his mother is also relatively distant.

In a later meeting, the boy said that he had also seen text descriptions of sex between men and women on the Internet. He could convert the words into images in his heart and imagine that he would kiss and hug a woman. When he thought of this, his thoughts suddenly shifted to high heels.

I jokingly said to him: If you and a girl are in love with each other, would you take the initiative to take off her underwear and then see her sexual organs, so that you have sex with them?

The boy replied: This is too shocking, I have never dared to think like this.

I said: If a girl takes the initiative to take off her underwear, what will you do next?

Boy: I will run away, but I feel like I have missed another chance…

I asked: Why are you running away?

Boy: Because when I think about it this way, I feel my neck tightens, my hair gets stuck, I feel flustered and frightened.

I asked: When you feel your neck is tight and flustered, do you have a physical reaction?

Boy: Yes, yes.

I explained: It seems that you are not only fear, but also shock and excitement about sex.

Boy: Yes.

I said: In the future, every time you think like this, when these reactions occur, will you decide to let yourself continue to think about it or not to think about it?

Boy: Let me try.

Briefly analyze

From the above example, it can be roughly seen: The boy loves “high heels” on the surface, but actually loves the “aunt”. The high heels are only a partial feature of the overall aunt. Substituting parts for the whole is one of the characteristics of the primary thinking process. Of course, the boy is not limited to that aunt’s high heels, but instead (or even extended) for other women’s high heels.

According to Freud’s point of view, the sexual drive of children, when they are not able to continue to develop their mothers or aunts to bet on libido, they are stuck on “high heels”. With the help of “high heels”, this boy can release his libido. This is the stagnation of its psychological development.

The main point of psychotherapy is to resume the mental development of children who have been stagnated. Libido, like a flood, when the normal channel is blocked, it floods the abnormal channel. Therefore, the method of treatment should be to first let the patient control their abnormal sexual behavior and prevent it from flooding turbulently. In this way, sexual energy will accumulate, making it uncomfortable. At the same time, dredge his normal channels and let sexual energy flow out along the normal channels. Let libido shift from betting on high heels to betting on women and their sexual organs. This can be achieved by encouraging patients to engage in free-associative sexual fantasies.

According to the theory of object relations, the interaction between the boy and his mother may have problems. Lack of maternal love in childhood, so I suddenly felt fascinated by the closeness and happiness of the kindergarten aunt. In the absence of maternal love, boys are more withdrawn. They rarely have good friends to exchange ideas and moods, and they have no courage and experience to deal with girls. The personality defects caused by his psychological development in the pre-Oedipal period made it difficult for him to deal with the sexual confusion he encountered when he entered the Oedipal period. Follow-up psychotherapy should encourage the boy to increase the communication with his peers, have more friends, and explore the mystery of sex with friends. At the same time, he encouraged him to gradually increase contacts with female classmates. Through such communication, it helps to enrich their personality and make up for lags or defects in personality development.


Sexual psychological disorder has a bad name in the past called “sexual perversion”. The name “sexual perversion” itself is discriminatory, reflecting people’s moral (value) judgment and rejection of this type of behavior. It was later changed to “sexual deviation”, which is more neutral. However, since “sexual deviation” is regarded as a group of diseases listed in the diagnostic criteria, it still reflects people’s disapproval of such behaviors. Since it is a “disease”, it means that the “patient” must be treated, and the “patient” must accept the transformation of others.

Not only is sexual psychology abnormal, in fact, many items in the diagnostic criteria of personality disorder also reflect people’s moral judgments.

Homosexuality, because there is no effective treatment method, and does not harm others and society, based on these two reasons, it is deleted from the diagnostic criteria for mental disorders. Since then, homosexuals have been “normalized”.

Fetishism, if it does not harm others, is just a kind of personal “sexual preference”. If you don’t steal other people’s items, it can be accepted, respected, and “normalized”. Now the things they love, such as the underwear worn by women, are sold online. Therefore, fetishists can get what they want reasonably and legally through online shopping. Of course, if you steal someone’s personal belongings, you can diagnose “theft” or “impulse control disorder”.

Nowadays, there are many sex tools in sex shops, among them there are various models of artificial penis. Who bought these items and used them in the end? Obviously, they should be used by women for sexual pleasure. So, if women prefer to obtain sexual pleasure mainly through simulated penis or oscillators, should they also be diagnosed as “fetishism”?

In terms of sexual behavior, there are huge individual differences. Many years ago, people only accepted “penis-vaginality-sex-coital”, other methods were considered “sexual perversions”, only accepted “missionary sex-coital position” as the standard position, and other methods Sexual position is considered non-standard and abnormal.

Now that society has developed, it has become more and more open, and multiple values ​​exist at the same time. Therefore, when judging sexual behavior, people’s acceptance and tolerance are getting wider and wider, which leads to a narrower and narrower range of “sexual perversion” behavior. If this continues, in the future, many behaviors that were originally considered to be “sexual expressions” may be regarded as normal sexual behaviors in the future.

With the progress of society, the group standard of human behavior becomes less and less important, the most important thing is to respect the differences between individuals. When respect and acceptance are put in the first place, there will be more and more “normal people”, and fewer and fewer “patients” who originally need to be treated and reformed.

Therefore, I dare to predict: after homosexuality, fetishism may be removed from the diagnostic criteria for mental disorders in the future.