Which diagnosis best fits duration, episodicity, and exclusions?
A
Fetishistic disorder
Over ≥6 months, recurrent and intense sexual arousal from either the use of non-living objects or a highly specific focus on non-genital body part(s), as manifested by fantasies, urges, or behaviours
AOver ≥6 months, recurrent and intense sexual arousal from either the use of non-living objects or a highly specific focus on non-genital body part(s), as manifested by fantasies, urges, or behaviours
BOver ≥6 months, recurrent and intense sexual arousal from cross-dressing, as manifested by fantasies, urges, or behaviours
Additional criteria
AB. Fantasies, urges, or behaviours cause clinically significant distress or impairment C. Fetish objects are not limited to articles of clothing used in cross-dressing or devices designed for genital stimulation
BB. Fantasies, urges, or behaviours cause clinically significant distress or impairment
Key features
AA. Over ≥6 months, recurrent and intense sexual arousal from either the use of non-living objects or a highly specific focus on non-genital body part(s), as manifested by fantasies, urges, or behaviours B. Fantasies, urges, or behaviours cause clinically significant distress or impairment C. Fetish objects are not limited to articles of clothing used in cross-dressing or devices designed for genital stimulation
BA. Over ≥6 months, recurrent and intense sexual arousal from cross-dressing, as manifested by fantasies, urges, or behaviours B. Fantasies, urges, or behaviours cause clinically significant distress or impairment
Common specifiers
ABody parts; Nonliving objects; In a controlled environment; In remission
BWith fetishism; With autogynephilia; In a controlled environment; In remission
Differential flags
ATransvestic disorder (cross-dressing specifically; overlapping in some individuals); Sexual masochism/sadism (the fetish involves suffering rather than objects/body parts); OCD (intrusive thoughts about objects; not sexually arousing)
BGender dysphoria (persistent gender incongruence; not primarily sexual arousal; may overlap); Non-distressing cross-dressing or drag (cultural/social; no sexual arousal or distress - not a disorder); Fetishistic disorder (object arousal without specific cross-dressing theme)