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
Presence of obsessions (recurrent/persistent intrusive thoughts/urges/images + attempts to suppress or neutralise), compulsions (repetitive behaviours/mental acts driven by rigid rules aimed at reducing distress/feared event), or both
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. Presence of obsessions (recurrent/persistent intrusive thoughts/urges/images + attempts to suppress or neutralise), compulsions (repetitive behaviours/mental acts driven by rigid rules aimed at reducing distress/feared event), or both B. Obsessions/compulsions are time-consuming (>1 hr/day) or cause clinically significant distress/impairment C. Not attributable to physiological effects of a substance or another medical condition
Common specifiers
ABody parts; Nonliving objects; In a controlled environment; In remission
BWith good or fair insight; With poor insight; With absent insight / delusional beliefs; Tic-related
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)
BGAD (worry is ego-syntonic, future-focused, realistic - OCD obsessions are ego-dystonic, intrusive, irrational); OCPD (ego-syntonic perfectionism without obsessions/compulsions); MDD (rumination is mood-congruent, not intrusive; no compulsions)