Unusual sexual fantasies, drives or behavior occur over a time span of at least six months. Sometimes unusual sexual fantasies occur and vanish by themselves; in this case any medical treatment is not necessary.
The affected person, her object or another person experience impairment or distress in multiple functional areas. Functional area refers to different aspects of life such as private social contacts, job, etc. It is sufficient for the diagnosis if one of the participants is being hurt or mistreated in any other way.
People who experience one or more of the symptoms below are considered to have a smoking fetish:
Sexual interest in watching other people smoking.
Recurring intense sexual fantasies involving watching other people smoking.
Recurring intense sexual urges involving watching other people smoking.
However, capnolagnia is not considered a disease but an unusual sexual practice, and many of the fetishists do not seek medical help unless this behavior strongly interferes with their daily lives. The majority of people simply learn to accept their fetish and manage to achieve gratification in an appropriate manner.