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Paraphilia is a sexual disorder where an individual's sexual arousal is dependent upon atypical and extreme sexual fantasies and behavior. Paraphilia differs from fetishism in that the object or source of sexual arousal hinges on something that is either dangerous to the paraphiliac's health or extremely socially unacceptable.
What separates a fetish from a paraphilia is not clearly defined. What is referred to as a fetish in some circles is refered to as a paraphilia in other circles. Some individuals believe that those with a fetish have an intense sexual arousal in the presence of the object or activity of their fetishism. However, presence is not necessary for sexual arousal for a fetish. With a paraphilia, the stimulis is necessary for any type of sexual arousal.
Since what is and is not socially acceptable varies from individual to individual, the best guage for determining whether or not a particular interest is a fetish or a paraphilia is whether or not the sexual behavior has an effect on the health of the individual or their quality of life.