The interest of this paper lies in the unusual nature of the patient's symptoms and in their apparent relationship to early trauma. The patient was a 6-year-old girl with a foot and shoe fetish who was at first psychotic and convincingly appeared to be a boy. In the course of her psychotherapy it emerged, and was later confirmed, that she had been the victim of terrifying, life-threatening assaults by her father who had died before she was 4 years old. It also seemed probable that she had had an incestuous relationship with him. The paper explores the defensive nature of the girl's psychotic illness and masculine identity, and considers the possibility that her fetishism represented a re-enactment of sexual trauma.

Treatment freed the girl from her presenting symptoms and enabled her to attend a school for normal children.