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Transvestic Disorder

Kathryn Patricelli, MA

What is Transvestic Disorder?

Prior to the release of the DSM-5, this disorder was known as Transvestic Fetishism. In the DSM-5, it is now known as Transvestic Disorder and is classified as a Paraphilic Disorder, which requires the presence of a paraphilia that is causing significant distress or impairment, or involve personal harm or risk of harm to others.

A paraphilia involves intense and persistent sexual interest (recurrent fantasies, urges or behaviors of a sexual nature) that center around children, non-humans (animals, objects, materials), or harming others or one's self during sexual activity. Sometimes this sexual interest focuses on the person's own erotic/sexual activities while in other cases, it focuses on the target of the person's sexual interest.

In order to be diagnosed with a Paraphilic Disorder, the paraphilia needs to be causing significant distress or impairment, or involve personal harm or risk of harm to others. You can have a paraphilia, but not have a paraphilic disorder. It is only when it causes impairment, harm or the risk of harm that it become a clinical diagnosis.

Symptoms of Transvestic Disorder include:

  • over a period of at least 6 months, a person has had recurrent and intense sexual arousal from fantasies, sexual urges or behaviors from cross-dressing (most often when a heterosexual male has fantasies about and/or acts out dressing up in woman's clothing).
  • the fantasies, sexual urges and behaviors are causing clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Clinicians can specify:

  • With fetishism - sexually aroused by fabrics, materials or clothing
  • With autogynephilia - if the male is sexually aroused by thoughts or images of himself as female.

They can also specify if the disorder is:

  • In a controlled environment - usually applicable to people who are living in institutions or other settings where opportunities to engage in cross-dressing are restricted.
  • In full remission - there has not been distress or impairment in social, occupational or other areas of functioning for at least 5 years while in an uncontrolled (non-institutional) environment.

How common is Transvestic Disorder?

The prevalence for Transvestic Disorder in the general population is unknown.

It is rare in males and extremely rare in females. Research has found that fewer than 3% of males report having ever seen sexually aroused by dressing in women's clothing.

The first signs of this disorder may appear in childhood and involves general pleasure in dressing in girl's clothing. Then with the arrival of adolescence, dressing in women's clothing brings about sexual desire and penile erection. Often as the boy grows into adulthood, he will report less sexual excitement by cross-dressing, but instead a feeling of comfort or well-being by continuing to cross-dress.

What are the risk factors for Transvestic Disorder?

Risk factors have not yet been identified for this disorder.

What other disorders or conditions often occur with Transvestic Disorder?

This disorder may occur with other paraphilias including fetishism and masochism.

How is Transvestic Disorder treated?

Because those with this disorder can feel extremely embarrassed or shameful, they rarely seek professional treatment on their own, but may do so at the request of a partner. When they do so, psychotherapy is the most common treatment.

Cognitive-behavioral therapy can be used where the therapist helps the person discover the underlying cause of the behavior and then works with the person to teach skills to manage the sexual urges in more health ways. This may include the use of aversion therapy and different types of imagery/desensitization in which the person imagines themselves in the situation and then experiencing a negative event to reduce future interest in participating in the fetishistic activities. Cognitive restructuring (identifying and changing the thoughts that drive the behavior) and thought stopping techniques may also be used.

Medications that target the compulsive urges, antidepressants and anti-anxiety medications can also be used in conjunction with therapy.