Specific aim 0: Verify or deny the association of fetishism with interictal or sub-ictal epileptiform EEG in the temporal lobe. EEG activity characteristic of interictal spiking has been associated with fetishism, and an increased incidence of fetishism has been reported in temporal-lobe epileptics relative to normals. However, much of this evidence comes from case reports and small studies, many of which were compromised by dubiously vague or inclusive diagnostic criteria. One moderately large study started with a population of epileptics and found an increased incidence of fetishism, but no study on a similar scale has examined the converse relationship, starting with fetishists and quantifying EEG spiking. Self-reported fetishists will be identified from responses to advertisements in clubs and publications intended for fetishists. Fetishism (DSM-III-R 302.81) or transvestic fetishism (DSM-III-R 302.30) will be confirmed by diagnostic interview. Subjects' histories will be examined for any seizure disorders or neurological trauma and EEG will be recorded and examined for spike activity. A group of EEGs from normal volunteers will be analysed along with this data, with the analysts blind to group identity.
Specific aim 1: Assess the effect of the serotonin selective reuptake inhibitor fluoxetine on fetishistic thoughts and behaviours. Subjects who are distressed by their fetishism and who wish to modify their behaviour will be given the option of participating in this phase of the study. Subjects will receive one period of fluoxetine treatment and one period of placebo in a double-blind crossover design, separated by a washout period. The Sexual Outlet Inventory (introduced recently by Kafka), the Yale-Brown Obsessive Compulsive Scale, and the A-State subscale of the State-Trait Anxiety Inventory will be used to measure, respectively, fetishistic and normal components of the total sexual outlet, severity of fetishistic obsessions and compulsions, and level of state anxiety. These will elucidate any effect of fluoxetine on fetishistic outlet independent of effect on total sexual outlet, any obsessive-compulsive character of fetishism, and any function of fetishistic behaviours as mechanisms for anxiety relief.
Specific aim 2: Assess the effect of fluoxetine on the EEG of fetishists. Assuming that fetishism and EEG spike activity are correlated, as has been reported, and assuming that serotonin selective reuptake inhibitors are effective against fetishistic obsessions and behaviours, as has been reported recently in single cases, it is natural to consider whether an SSRI will affect spike activity concomitantly with behaviour. EEG from the subjects in (1) above will be collected and analysed in the same manner as in (0) above.