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Despite the growing interest in the experiences of transgender individuals, the phenomenon of fetishization of transgender bodies and identities has been overlooked. The present study was aimed at investigating the experiences of fetishization of transgender and nonbinary (TGNB) people. Participants in the current study represent a sample of 142 TGNB volunteers from the community who answered the prompt: "If you feel comfortable, could you describe your experience of being fetishized?" Using thematic analysis, we developed three overarching themes relevant to the experiences of fetishization of TGNB participants: (1) context of fetishization; (2) negative experiences of fetishization; and (3) positive or ambiguous experiences of fetishization. The results demonstrated that, in most cases, fetishization was understood by TGNB people as a negative experience of sexual objectification, although some individuals experienced fetishization as a positive experience, perceiving the sexual desire of the other person or living it as a kink. Consistent with the integrated theory of dehumanization, the results demonstrated that both sexual objectification and minority stress contributed to participants' understanding of fetishization for TGNB individuals. Implications for clinical work with TGNB individuals are discussed.

The ostensibly bizarre crime of braid-cutting invited occasional alienist inferences from the late 1850s onwards, until it entered mid-1880s police profiles and forensic-psychiatric taxonomies as a corollary of perversion, specifically sadism and fetishism. Cases were rare, but were reported as late as the mid-1930s and enduringly cited as encompassing a staple variety of fetishism. This note briefly reconstructs entries in German, French and English forensic psychiatry, sexual psychopathology and psychoanalysis.

Introduction: Recently the guidelines for the diagnosis of paraphilic disorders in the International Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11), have been published., Aim: This article analyzes legal, regulatory, and policy issues relevant to the potential effects of the changes for the classification of paraphilic disorders in the ICD-11 in Germany., Methods: A forensic and a legal expert in Germany worked with other international experts to conduct this evaluation using an assessment guide provided by the World Health Organization., Main Outcome Measures: Possible effects of the changes for the classification of paraphilic disorders in the ICD-11 on forensic practice, health systems, adjudication of individuals who have committed a sexual offense, and the provision of treatment in Germany., Results: Results highlight the special situation of medical confidentiality in the German health system that facilitates the establishment of preventive networks for the treatment of pedophilic patients. The ICD-11 guidelines will help to clarify the boundary between pedophilic disorder and crimes of child sexual abuse. These will also establish a boundary with other paraphilic diagnostic concepts. We describe the central construct of criminal responsibility in the German legal system in relation to paraphilic disorders, the prominent role of expert witnesses, and the differences in the conceptualization of medical confidentiality within the health care system and within the legal system., Clinical Implications: The ICD-11 proposals for paraphilic disorders provide a clearer differentiation, as compared with ICD-10, between variants of normal sexual behavior and sexual behavior that involves a non-consenting person or entity. Particular patterns of sexual preference that are not of relevance to public health, the health care system, or the legal system, such as masochism and fetishism, will no longer be named psychiatric entities and will, therefore, be regarded as private behaviors and destigmatized., Strengths & Limitations: The assessment shows the specific legal situation in Germany for the treatment of paraphilic patients in a sexual medicine, psychiatric, and legal discourse. However, it was done only by a small number of experts., Conclusion: A conclusion of the analysis was that the more specific and narrower definitions in the ICD-11 diagnostic guidelines, compared with those in ICD-10, particularly for pedophilic disorder and coercive sexual sadism disorder, will result in a reduction in false-positive diagnoses. It is unlikely that significant unintended and negative consequences will occur as a result of implementing the ICD-11 guidelines for paraphilic disorders. Briken P, Boetticher A, Krueger RB, et al. Current Legal Situation for Patients with Paraphilic disorders and Implications of the ICD-11 for Paraphilic Disorders for Germany. J Sex Med 2019;16:1615-1622., (Copyright © 2019 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Adults with paraphilic infantilism may desire to wear diapers or engage in infant-like role play. Erotic target identity inversions (ETII) and childhood maltreatment have been hypothesized to cause regressive interests. To evaluate these two etiological hypotheses, we surveyed the online adult baby/diaper lover community. Data from 1904 cis-gender men revealed a prevalence of pedophilic interests comparable with the general male population, arguing against ETIIs as common in paraphilic infantilism. In contrast, self-reported childhood neglect and abuse were highly prevalent, suggesting that infantilism might be correlated with childhood maltreatment. Additionally, some participants described repetition and/or sexualization of negative childhood experiences.

Paraphilic disorders range from nearly normal behaviour to a behaviour which may be considered as destructive or menacing to the society at large. In accordance with Diagnostic and Statistical Manual of Mental Disorders-V, the terms Paraphilia and Paraphilic disorders, denote different interpretations. Multiple paraphilias connected to childhood either directly or indirectly has been documented in scientific literature. Paraphilic Infantilism, Diaperism and Pedophilia constitute major portion among them. Paraphilic infantilism denotes paraphilic desire of being a baby. Diaperism deals with fetishistic behaviour in relation to diapers and pedophilia stands for sexual attraction towards children. Behaviourally these three paraphilias do share some characteristics and show overlapping of certain features, but psychologically they are diverse. In a number of literature on digital media, the terms have been used interchangeably or are described in a manner that creates confusion. However, when described individually they are precisely written, hence it necessitates to be elaborated collectively to surpass the current trends of mixing them. The review focuses on behavioral, developmental, psychological and legal aspects of these paraphilias., (Copyright © 2018 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

This paper defends the concept of 'fetishism' as an explanatory parameter in sociological theorizing on Durkheimian grounds, while at the same time paying due attention to important insights regarding the role of objects in social life, originating from Actor-Network Theory (ANT). It critically assesses the current critique of the concept of fetishism propagated by ANT protagonist Bruno Latour. Latour and suggests a compromise between these two 'schools'. First, to place the paper firmly in context, I analyse some examples of modern fetishism and outline the themes of the ensuing discussion. Next, I turn to Durkheim, seeking to develop a distinct interpretation of the concept of the social and of fetishism, and then point to some of Durkheim's shortcomings and attempt to make room for Latourian perspectives. Finally, I critically assess Latour's dismissal of forms of social 'explanation' and of the concept of fetishism., (© London School of Economics and Political Science 2016.)

Human sexual instincts can become fixated on a wide variety of targets, resulting in behaviours ranging from harmless fetishism to child abuse. The recent flood of investigations into historic cases in the UK has brought child protection issues to the top of the news agenda and shown that society is still far from addressing these problems in a rational, evidence-based way maximising harm reduction.

This paper focuses on the analyst's "presencing" (being there) within the patient's experiential world and within the grip of the psychoanalytic process, and the ensuing deep patient-analyst interconnectedness, as a fundamental dimension of analytic work. It engenders new possibilities for extending the reach of psychoanalytic treatment to more disturbed patients. Here patient and analyst forge an emergent new entity of interconnectedness or "withness" that goes beyond the confines of their separate subjectivities and the simple summation of the two. Using a detailed clinical illustration of a difficult analysis with a severely fetishistic-masochistic patient, the author describes the kind of knowledge, experience, and powerful effects that come into being when the analyst interconnects psychically with the patient in living through the process, and that relate specifically to the analyst's compassion., (© 2013 The Psychoanalytic Quarterly, Inc.)

This paper is a critical reconsideration of Freud's analysis (1907) of Wilhelm Jensen's novella Gradiva: A Pompeian Fantasy (1903). Freud's interest was aroused by the parallels between Jensen's presentation of dreams and Freud's model of dream formation just published in The Interpretation of Dreams (1900). Freud also acclaims Jensen's presentation of the formation and "cure" of his protagonist's delusion about a marble bas-relief of a woman walking. This paper argues for the centrality of the phenomenon of fetishism, briefly considered but excluded from Freud's analysis. The fantasy of Gradiva as "the necessary conditions for loving" (Freud 1910, pp. 165-166) is also a key thesis of the essay, which makes use of the newly translated Freud-Jensen correspondence contained in this article's Appendix., (© 2013 The Psychoanalytic Quarterly, Inc.)

This study provided a descriptive and quantitative comparative analysis of data from an assessment protocol for adolescents referred clinically for gender identity disorder (n = 192; 105 boys, 87 girls) or transvestic fetishism (n = 137, all boys). The protocol included information on demographics, behavior problems, and psychosexual measures. Gender identity disorder and transvestic fetishism youth had high rates of general behavior problems and poor peer relations. On the psychosexual measures, gender identity disorder patients had considerably greater cross-gender behavior and gender dysphoria than did transvestic fetishism youth and other control youth. Male gender identity disorder patients classified as having a nonhomosexual sexual orientation (in relation to birth sex) reported more indicators of transvestic fetishism than did male gender identity disorder patients classified as having a homosexual sexual orientation (in relation to birth sex). The percentage of transvestic fetishism youth and male gender identity disorder patients with a nonhomosexual sexual orientation self-reported similar degrees of behaviors pertaining to transvestic fetishism. Last, male and female gender identity disorder patients with a homosexual sexual orientation had more recalled cross-gender behavior during childhood and more concurrent cross-gender behavior and gender dysphoria than did patients with a nonhomosexual sexual orientation. The authors discuss the clinical utility of their assessment protocol.

Introduction: Several theories, including psychodynamic theories, sexual imprinting and early conditioning have been formulated to explain sexual development. Empirical data, however, remain insufficient for a thorough evaluation of these theories., Aim: In this study, we test the hypothesis that a critical period exists for the acquisition of sexual preferences, as suggested by empirical findings in birds and mammals (sexual imprinting)., Methods: An Internet questionnaire was used., Main Outcome Measures: We gather data from individuals with a sexual preference for pregnant and/or lactating women, under the hypothesis that pregnancy or lactation may become sexually attractive in adulthood following an exposure to pregnant or lactating women in infancy., Results: We find that these preferences are more common in older siblings, i.e., in individuals who have been exposed to more maternal pregnancy and lactation. This result is independent of respondent and sibling sex. In addition, only maternal pregnancies and lactations experienced between 1.5 and 5 years of age are associated with the preferences., Conclusions: We discuss our findings in relation to theories of sexual development and to earlier reports of birth order effects on sexual behavior. We suggest that this age range may constitute a sensitive period for the acquisition of sexual preferences., (© 2010 International Society for Sexual Medicine.)

This paper illustrates the breadth and depth of the spectrum of perversion and perversity as currently represented in the psychoanalytic literature, raises questions about recent tendencies to include a host of diverse-seeming phenomena under the same conceptual umbrella, and strives to demonstrate what these phenomena have in common that justifies lumping them together under the same rubric. One end of this spectrum is represented by the employment of simple fetishes introduced into a sexual scene in order to promote sexual arousal. Moving along the continuum, one encounters increasing complex behavioral patterns including the enactment of scripts that actualize one's perverse fantasies, including the assumption of complementary roles (e.g. sadomasochism) that equally serve the needs, and represent the desires, of both parties involved. A unique clinical entity, 'perverse modes of relatedness,' lies on the extreme end of the spectrum, representing the reification of the relationship as it becomes little more than a vehicle to take possession and control one's object for the gratification of one's sole needs and desires. What each of these phenomena share in common is both the insertion of a thing or condition - ranging from a simple fetishistic object to an elaborate style of relating that reduces the other into pawn played upon the pervert's chessboard, between the two 'relating' objects as well as a less than honest relationship with reality.

There has been a long-standing need for a diagnostic manual that documents the unique pathological behaviors of lesbians. The Dyke Diagnostic Manual (DDM) is meant to supplement mainstream classification systems used to identify problematic behaviors in heterosexuals. This article presents thirteen uniquely lesbian conditions that are nowhere to be found in heterosexist diagnostic systems. The DDM may help to reduce the pain and suffering found in many lesbian relationships where one or both partners are afflicted.

A case is reported of a 36-year-old male, found dead in his locked room, lying on a bed, dressed in his mother's clothes, with a plastic bag over his head, hands tied and with a barrel wooden cork in his rectum. Two pornographic magazines were found on a chair near the bed, so that the deceased could see them well. Asphyxia was controlled with a complex apparatus which consisted of two elastic luggage rack straps, the first surrounding his waist, perineum, and buttocks, and the second the back of his body, and neck. According to the psychological autopsy based on a structured interview (SCID-I, SCID-II) with his father, the deceased was single, unemployed and with a part college education. He had grown up in a poor family with a reserved father and dominant mother, and was indicative of fulfilling DSM-IV diagnostic criteria for alcohol dependence, paraphilia involving hypoxyphilia with transvestic fetishism and anal masturbation and a borderline personality disorder. There was no evidence of previous psychiatric treatment. The Circumstances subscale of Beck's Suicidal Intent Scale (SIS-CS) pointed at the lack of final acts (thoughts or plans) in anticipation of death, and absence of a suicide note or overt communication of suicidal intent before death. Integration of the crime scene data with those of the forensic medicine and psychological autopsy enabled identification of the event as an accidental death, caused by neck strangulation, suffocation by a plastic bag, and vagal stimulation due to a foreign body in the rectum.

Abstract Pornography, if understood to involve the depiction of sexual activity, organs, and experiences, is perhaps as old as human civilization itself. Historically linked to various technological innovations, pornography viewing in the Internet age has reached epic proportions, with large numbers of individuals taking advantage of ease of access, affordability, and presumed anonymity to explore sexual material online. Within the mental health professions substantial research exists on the effects of viewing general pornography; however, the distinctive effects of the marriage of pornography and cyberspace is only beginning to be examined. In addition to reviewing some historical and statistical material about pornography and the relevant psychiatric and psychoanalytic literature, four detailed clinical vignettes are presented to illustrate the types of problems related to Internet pornography use that are being presented to practicing psychotherapists.

The fetish objects in these case histories were unique enough, and the attraction to the objects strong enough, that the individuals could clearly track their interest from early childhood through adulthood. It is much easier to retrieve remote, explicit memories, such as events (eg, a party where balloons popped) or playing with objects, than to recall the process of sexual development with no distinct markers in the individual's history. Because these distinct experiences predated identified sexuality, became a focus of attention for the individual, and then were incorporated into the individual's sexual interests and masturbatory fantasies, it was possible to accurately track the patterns of sexual arousal. We were also able to clearly identify how these men attempted to blend their deviant interests into sexual relationships with partners and the consequences of their efforts. If we are to understand how sexual interests develop, a number of obstacles need to be overcome. Sexual interest has to be openly discussed. Parents need to appreciate how the early sexual interests of their children can go awry, contaminate their adult relationships, and lead to problematic lives. Researchers need a means of understanding how to communicate with children about their earliest interests, sexual interests, and sexual behaviors in a nonjudgmental manner. Until then, tracking unusual interests that lead to erotic interests is the first step in the overall process of understanding how sexual interest develops and is assimilated, either successfully or unsuccessfully, into an individual's adult sexual life.

Compulsive cybersex has become a significant problem for many men and women who have fallen prey to the accessibility, affordability, and anonymity of online sexual behaviors. Some patients develop problems with compulsive cybersex due to predisposition or accidental conditioning experiences. Other compulsive users of cybersex present with underlying trauma, depression, or addiction. Three case studies highlighted obsession, compulsion, and consequence in the pathogenesis of compulsive cybersex. While men and women differ somewhat in their use of cybersex, both genders exhibit maladaptive coping, conditioned behavior, dissociative reenactment of life trauma, courtship disorder, intimacy dysfunction, and addictive behavior. Comprehensive treatment of compulsive cybersex would include the following components: relapse prevention, intimacy enhancement, lovemap reconstruction, dissociative states therapy, arousal reconditioning, and coping skills training. Thanks to recent treatment advances in several fields, help is available for those caught in the dark side of the net.

This article reviews current developments in psychiatric assessment of sex offenders for criminal courts. These developments are characterized by constantly changing laws and increasing neurobiological findings about paraphilias. Psychiatrists must prepare their reports taking into account the tension between psychopathological, neurobiological, and normative aspects of their judgement. The complexity of such assessments can best be demonstrated by narratives. This narrative concerns a 47-year-old patient who killed eight women after strangling them and masturbating or having intercourse with the unconscious victims. He explained in detail six of these crimes and gave ample information about his history, sexual development, fantasies, and a number of other sexual crimes he had committed. From this information a plausible explanation of his development to sexual fetishism and from there to sadism could be derived. Brain MRI displayed gliotic scars in the frontal lobe and right hippocampus. Consequences of the various findings on psychiatric assessment of legal culpability are discussed in this paper, concluding that a differentiated approach to the assessment is possible only from a psychopathological point of view in which behaviour, clinical features, and motivations are analysed.

Blanchard's (J Nerv Ment Dis 177:616-623, 1989) theory of autogynephilia suggests that male-to-female transsexuals can be categorized into different types based on their sexuality. Little previous research has compared the sexuality of male-to-female transsexuals to biological females. The present study examined 15 aspects of sexuality among a non-clinical sample of 234 transsexuals and 127 biological females, using either an online or a paper questionnaire. The results showed that, overall, transsexuals tended to place more importance on partner's physical attractiveness and reported higher scores on Blanchard's Core Autogynephilia Scale than biological females. In addition, transsexuals classified as autogynephilic scored significantly higher on Attraction to Feminine Males, Core Autogynephilia, Autogynephilic Interpersonal Fantasy, Fetishism, Preference for Younger Partners, Interest in Uncommitted Sex, Importance of Partner Physical Attractiveness, and Attraction to Transgender Fiction than other transsexuals and biological females. In accordance with Blanchard's theory, autogynephilia measures were positively correlated to Sexual Attraction to Females among transsexuals. In contrast to Blanchard's theory, however, those transsexuals classified as autogynephilic scored higher on average on Sexual Attraction to Males than those classified as non-autogynephilic, and no transsexuals classified as autogynephilic reported asexuality.

An attempt is made to compare two psychoanalytic concepts which by 'belonging' to different psychoanalytic groups have come to be defined and used differently. The paper is also an inquiry into the possibility of a comparative psychoanalytic method. The two concepts are 'repression' and 'splitting of the ego' and an examination is made of the semantic similarities and differences. Some clinical material is offered that adds indicative clinical evidence to test the semantic comparison. The aim is to answer the question: Are the terms simply alternative ones for similar clinical phenomena? The paper offers one method which could provide an answer. It represents a general method for clarifying and maybe reconciling the differing points of view of competing psychoanalytic schools.

The presence of inappropriate sexual behaviors in individuals with autistic disorder is one of the important factors disturbing their social adaptation and distressing their families and environment. Therefore, appropriate management of these behaviors seems necessary. This case report describes a 13-year-old male with diagnosis of autistic disorder and fetishistic behavior. His fetishistic behavior was treated successfully using mirtazapine 15 mg/day. The clinical picture and efficacy of mirtazapine will be discussed.

This paper challenges the view that food, or the patient's own body, functions as a transitional object for bulimics during the binge-purge cycle or symptomatic equivalents of self-harm. The author proposes that the bulimic patient's actions in and on her body more closely approximate the use of a fetish, which temporarily enhances a deficient and unstable body image and assuages separation anxiety, but does not promote progressive development. To illustrate these distinctions, the author presents an analysis of a self-mutilating bulimic patient who used her body as a fetish until a more integrated "me" evolved within the "shared skin" of her treatment. At that point, a transitional object and an idealizing selfobject fantasy were created, and the patient was able to engage the question of "not me," relinquish her self-mutilation, and resume the process of separation and growth.

The aim of this study was to estimate the relative frequency of Fetishes in a large sample of individuals. Using the Internet as a data source, we examined 381 discussion groups. We estimate, very conservatively, that at least 5000 individuals were targeted. The relative frequency of each preference category was estimated considering (a) the number of groups devoted to the category, (b) the number of individuals participating in the groups and (c) the number of messages exchanged. The three measures agree both parametrically (Cronbach's alpha=0.91) and non-parametrically (Kendall's W=0.94, P<0.01). Preferences for body parts or features and for objects usually associated with the body were most common (33 and 30%, respectively), followed by preferences for other people's behavior (18%), own behavior (7%), social behavior (7%) and objects unrelated to the body (5%). Feet and objects associated with feet were the most common target of preferences. These findings provide the first large database in an area, where the knowledge is particularly scarce.

Following an introductory review of the main developments in the psychoanalytic thinking on perversion, the author focuses on her own understanding of perversion and its treatment, based on the psychoanalytic treatment of patients with severe sexual perversions. This paper uses the term 'autotomy' (borrowed from the field of biology) to describe perversion formation as an 'autotomous' defence solution involving massive dissociative splitting in the service of psychic survival within a violent, traumatic early childhood situation; thus, a compulsively enacted 'desire for ritualised trauma' ensues. The specific nature of the perverse scenario embodies the specific experiential core quality of the traumatic situation. It is an actual repetition in the present of the imprint of a past destructive experience which is pre-arranged and stage-managed; it thus encounters haunting scenes of dread or psychic annihilation while, at the same time, controlling, sanitising and disavowing them. Hence, the world of severe perversion is no longer oedipal, but rather the world of Pentheus, Euripides's most tragic hero--a world dominated by a mixture of a mother's madness, devourment, destruction and rituals of desire. According to this view, the (difficult) psychoanalytic treatment of perversion focuses on patient-analyst interconnectedness--brought about by the analyst's 'givenness to being present' or 'presencing'--at a deep, primary level of contact and impact (the emphasis being on the ontological dimension of experience). This evolving therapeutic entity creates and actualises a new, alternative experiential-emotional reality within the pervert's alienated world, eventually generating a change in the perverse essence. The author illustrate this approach with three clinical vignettes.

Some people cannot obtain satisfaction from ordinary sexual relationships; instead they prefer alternative methods. They are referred to in psychiatric terminology as paraphiliacs. Fetishism is a type of paraphilia in which a person is sexually attracted to objects and some body parts. Most fetishists do not intend to cause harm to other people, but may have problems when others become involved in the problem. Underlying personality disorders extending through childhood are thought to be the source of the etiology. Perverted people do not wish to change their behavior pattern. They never seek treatment from a therapist. Psychological issues obviously play a crucial role in determining the choice of paraphilia and the underlying meaning of the sexual acts. Psychodynamic models (object relations theory, self psychology, drive theory) can shed light on the meaning of a perversion. In this case report, a 22- year-old man with diaper fetishism is presented. When family dynamics are considered, the mother has been described as psychologically distant from her son. The fetish object was recognized during childhood at around the age of four. During puberty, the fetish object became sexually attractive. Our patient exhibited his first perverted behavior when he was six years old. Later, he could control this behavior. At the age of twelve, the perverted behavior became sexually arousing. This paper emphasizes the diaper fetishism case through the patient's past psychiatric and medical history. Diaper fetishism is discussed in the light of forensic, cognitive and psychodynamic theories.

We used a random sample of 2,450 18-60 year-olds in the general population of Sweden to study the prevalence as well as the social, sexual, and health correlates of transvestic fetishism (sexual arousal from cross-dressing). Almost three percent (2.8%) of men and 0.4% of women reported at least one episode of transvestic fetishism. Separation from parents, same-sex sexual experiences, being easily sexually aroused, pornography use, and higher masturbation frequency were significantly associated with transvestic fetishism. A positive attitude to this sexual practice and paraphilia indicators--sexual arousal from using pain, exposing genitals to a stranger, and spying on others having sex--were particularly strong correlates to the dependent variable.

An animal model of sexual fetishism was developed with male Japanese quail based on persistence of conditioned sexual responding during extinction to an inanimate object made of terrycloth (Experiments 1 and 3). This persistent responding occurred only in subjects that came to copulate with the terrycloth object, suggesting that the copulatory behavior served to maintain the fetishistic behavior. Sexual conditioning was carried out by pairing a conditioned stimulus (CS) with the opportunity to copulate with a female (the unconditioned stimulus or US). Copulation with the CS object and persistent responding did not develop if the CS was a light (Experiment 1) or if conditioning was carried out with a food US (Experiment 2). In addition, subjects that showed persistence in responding to the terrycloth CS did not persist in their responding to a light CS (Experiment 3). The results are consistent with the hypothesis that conditioned copulatory behavior creates a form of self-maintenance that leads to persistent responding to an inanimate object. The development of an animal model of such fetishistic behavior should facilitate experimental analysis of the phenomenon.

Williams syndrome is a rare congenital disease in which the etiological locus is a micro-deletion in chromosome 7. Here, we describe the case of a 22-year-old male who was diagnosed with Williams syndrome at the age of 3 years. As a child, the patient exhibited patterns of behavior characteristic of this syndrome including hyperactivity, attention deficit, and over-friendliness. He also showed persistent interest in construction vehicles, playgrounds, and gloves. He became interested in gloves after watching a television program in which the heroine fought her enemies while wearing gloves. Watching pornographic movies allowed him to attach strong sexual significance to gloves when he was 19 years old. Since that time, he has assaulted women wearing gloves four times to rob them of the gloves. The current paper discusses both the role of the cognitive profile unique to Williams syndrome and that of environmental factors in the development of fetishism in this case.

Based on Bion's work on the 'psychotic and non-psychotic parts of the personality', the author hypothesises the existence of a special type of thought disorder known as 'perverse thought'. First the author presents an overview of the major contributions to the concept of perversion that have a bearing on 'perverse thought'. These include Freud's splitting and disavowal concepts, Klein's projective identification concept, Bion's -K link and Meltzer's transference perversion. Then, by means of a case study and some vignettes, the author illustrates how this thought disorder is configured within the analytic process. The author focuses on three main aspects of this pathology: the specific modality of projective identification in a perverse scheme, the lie and some important clinical events that reveal an attack against knowledge through the formation of the -K link. Perverse thought is an important resistance mechanism in the analytic process. Its clarification is essential, given that its main objective is to attack the knowledge process, and therefore truth, in order to pervert the analytic relationship.

The authors reviewed historical literature and hypothesized a relationship between epidemics of sexually transmitted diseases and foot fetishism. They tested this hypothesis by quantifying foot-fetish depictions in the mass-circulation pornographic literature during a 30-yr. interval. An exponential increase was noted during the period of the current AIDS epidemic. The authors offer reasons for this possible relationship.

Since Freud's original study of fetishism and his description of the genesis of the symptom, many additions and elaborations have been made to those propositions. In the past decade, fetishism has been increasingly applied to a wide variety of behavior and mentation, some with no overt sexual component. In this paper, the author, drawing on his observations made during a very lengthy analysis of a female patient, underscores the need to broaden the applicability of the diagnosis of fetishism but sees value in limiting it to the sexual situation. He suggests that a fetish does not need to be an inanimate object and expresses agreement with those who feel that fetishism is not limited to males. Additionally, he offers for consideration the idea that fetishism belongs on a continuum with a whole gamut of phenomena such as the need for a transitional object, the use of amulets, and the endowment of magical properties to words, ideas, rituals and objects. All these phenomena have in common the use of an outside object bestowed by magic and illusion to control anxiety. The hierarchical level of such anxiety and its ideational content (oedipal versus pre-oedipal) are of less causative value than the ego's inability to master it without resorting to an outside object.

Topic: The relationship of police fantasies and leg fetish to identification with the father in a homosexual male., Purpose: To describe two manifestations of identification with the father in a male homosexual., Source: The author's clinical work., Conclusion: It is important to decode current behavior in light of theory and past history, to help clients move from potentially destructive behavior to satisfying interpersonal interactions.

From a longitudinal study that began at birth, a case is described in which a man at the age of 30 recalls the onset of a sexual fetish in his fifth or sixth year of life. The memories activated and dreams reported during the thirty-year follow-up interview, were synthesised with parent-infant film data and historical information contained in the research record concerning the child's development, his parents' behaviour and traumatic experiences. Taken together they provide a detailed description of the psychological ontogenesis of the fetish. The case provides unusual information about the manner in which early childhood events-objectively documented-interdigitate with intrapsychic processes and mental structuralisation. This also illuminates processes by which memories are retained, condensed, distorted and lost. In addition, information from other participants in the project who reported sexually anomalous histories at the age of 30 raises questions of what can be predicted from early life experiences.

This paper explores the transference dynamics and underlying fantasies of analysands whose characters have been shaped by conflict solutions common to perversion. Giving the impression of a serious engagement for therapeutic ends, these individuals live out in the treatment a sexualized enactment in which the analyst's interventions are transformed into a fetish. This enactment is designed to support a defensive effort to avoid external perceptions that trigger certain fantasies of danger, including that of castration. It is designed also to cancel out interventions of the analyst that become equated with these frightening fantasies. Since the analyst's efforts to explore and interpret this enactment are also turned into a fetish, such a transference poses grave difficulties for the analysis. A technical approach is suggested in which the analyst focuses on the contradiction itself, the operation of the disavowal, the fantasy of danger that motivates the persistent use of disavowal, and the underlying, often vengeful and envious wishes that contribute both to the undermining of the analysis and to the content of the fantasies of danger that provoke so much anxiety.

This study attempted to differentiate two clinical types of fetishism-fetishism proper and tranvestism-and to determine if tranvestites are truly fetishistic. The transvestites were further divided into gender-conforming and gender-noncomforming groups according to their score on a gender identity scale. These groups were compared using a self-report scale measuring fetishistic interests, and a set of questionnaire items regarding their childhood history, parental characteristics, and their emotional closeness with their parents. In addition, the penile responses of a subset of fetishists and tranvestites were recorded while they were presented with visual depictions of female and male public regions and potentially fetishistic objects (nylon stockings, female and male shoes, panties, male underwear, female and male feet). The fetishists proper and the transvestite subgroups did not differ from each other in terms of self-reported fetishistic interest or childhood and family histories. Moreover, there were no differences between these groups in their penile response to the potentially fetishistic stimulus they were most aroused by, relative to the depictions of the pubic region of their preferred gender. These results suggest that transvestites are in fact fetishistic, and that they are difficult to distinguish from fetishists proper.

Assessments of psychodynamic structures and processes implicit in 'The Merchant of Venice' vary considerably according to whether Lacanian or object-relations tenets are applied. Aspects of the play resemble a pattern described in Lacan's seminar on E. A. Poe's story 'The purloined letter': the 'itinerary' of the 'signifier' represented by a roving letter in Poe's story closely matches in outline the adventures surrounding roving rings in Shakespeare's play. Using Poe's story as evidence, Lacan's seminar argues that human identity is a product of 'signifiers', and not vice-versa. This conclusion that human subjectivities are constituted by signifiers does not stand up well in relation to the power of the rings and other signifying physical objects appearing in Shakespeare's play and its source stories. Recently expanded understandings of Freud's ideas about fetishism better explain the often malevolent power of the play's many signifying physical objects. In these the essential potential for damage is to sound personal relations with inner and outer objects of love. Explanations emphasising that distorted object relations and damaged subjectivities may be redeemed accord well with the dramatic and poetic patterns of Shakespeare's play, indicating that it, while portraying painful dilemmas, is still a comedy.

262 respondents from an organization for homosexual foot fetishists provide information from a broader sample than clinical cases and allow examination of the effects of sexual preference on fetishism. Data show a wide range of feet/footwear objects to be arousing. Such interests were often associated with particular types of men, yet interests were subject to change over time. Fetishistic arousal rested on both sensual and symbolic aspects of the fetish. Symbolically, it was the theme of "masculinity" that made male feet/footwear arousing, showing parallels to "femininity" evoked by female feet/footwear for male heterosexual fetishists. For many of the respondents, fetishism did not seem to be a substitute for living persons. Respondents had intimate relationships and were able to incorporate their fetish interests into stable relationships and less intimate ones. Considerable involvement in sadomasochistic practices was also found as was involvement in the gay world. Finally, nothing about a fetishistic interest seemed to preclude the development of subcultural forms around the practice.

Case material from the analysis of a fetishistic cross-dresser is reported. The evolution of a transference perversion and treatment impasse, in the form of the recalcitrant symptom of anal flatulence, is described. The patient's contrasting needs to cling perversely and addictively to the analyst, on the one hand, and to provoke an acting out of the countertransference, on the other, are placed in the context of his dread of rejection and potentially suicidal reaction. The author argues in favour of offering psychoanalysis as a lifeline, but with the condition that the psychoanalytic setting and boundaries are maintained and that gratifications are denied. Limited but precise interpretive psychoanalytic work in the transference was maintained. The relatively good outcome is explained in terms of the provision of safety, survival of the analyst and avoidance of countertransference acting out, which, in the author's view, represents an implicit and mutative transference interpretation, the specific factor in bringing about psychic change. This enabled the patient to recognise and accept the analyst as a 'new' object and, as a consequence, to question and reject his idealisation of the anal universe that he inhabited.