Transvestic fetishism

Definition

Transvestic fetishism is defined by the mental health professional's handbook, the Diagnostic and Statistical Manual of Mental Disorders , fourth edition, text revision (2000), which is also called DSM-IV-TR , as one of the paraphilias . The paraphilias are a group of mental disorders characterized by obsession with unusual sexual practices or with sexual activity involving nonconsenting or inappropriate partners (such as children or animals). The essential feature of transvestic fetishism is recurrent intense sexual urges and sexually arousing fantasies involving dressing in clothing associated with members of the opposite sex. Another term for tranvestic fetishism is cross-dressing; people who frequently engage in cross-dressing are sometimes called transvestites. A diagnosis of transvestic fetishism is made only if an individual has acted on these urges or is markedly distressed by them. In other systems of psychiatric classification, transvestic fetishism is considered a sexual deviation.

For some people who are diagnosed with transvestic fetishism, fantasies or stimuli associated with cross-dressing may always be necessary for erotic arousal and are always included in sexual activity, if not actually acted out alone or with a partner. In other patients, cross-dressing may occur only episodically, for example, during periods of stress . At other times the person is able to function sexually without the transvestic fetish or related stimuli.

Description

A person with a transvestic fetish derives sexual gratification from dressing in clothing appropriate for a member of the opposite sex. Almost all patients diagnosed with transvestic fetishism, however, are men dressing as women. This lopsided gender ratio may be partly due to the fact that contemporary Western societies allow women to dress in a wide range of clothing styles influenced by menswear, whereas the reverse is not the case. While it is not at all unusual to see women wearing jeans, tailored trousers, Western-style boots, or even tuxedos in some circumstances, men wearing dresses or high-heeled shoes look distinctly out of place.

A person's participation in transvestism is usually gradual. Over time, a person with a transvestic fetish assumes the role and appearance of a member of the opposite gender. It is important to note that this activity is closely associated with achieving sexual gratification. Persons who have had extensive experience with a transvestic fetish may be difficult to distinguish from members of the opposite sex. A so-called mature transvestic fetish involves adopting all of the mannerisms, clothing, materials and other items associated with persons of the opposite sex.

Causes and symptoms

Causes

The basis for a transvestic fetish is obtaining sexual gratification by dressing in clothing appropriate for the opposite sex. The cause may be adolescent curiosity. A person with a transvestic fetish may not be aware of its roots. Transvestic fetishism sometimes begins when a young boy dresses up in the clothes of an older sister or his mother. The activity is continued because it is enjoyable but the reasons for the enjoyment remain unconscious. In other cases a boy's mother may initiate the cross-dressing by dressing him as if he were a girl. This behavior is sometimes related to the mother's anger at men or to a preference for having daughters rather than sons.

Persons with transvestic fetishes should not be assumed to be homosexual. According to DSM-IV-TR , most men who practice cross-dressing are basically heterosexual in their orientation. Some, however, have occasional sexual encounters with other men.

Symptoms

Early symptoms of transvestic fetishism involve touching or wearing items of clothing that are considered typically feminine. This initial interest may progress to wearing undergarments or other items that can be hidden from the view of others while providing arousal to the wearer. Over time, the extent of dressing in women's clothing expands, sometimes to the point of dressing as a woman on a regular basis. A developed transvestic fetish often involves feminine hair styling and the use of women's cosmetics and accessories.

In some persons diagnosed with transvestic fetishism, the motivation for cross-dressing may change over time from a search for sexual excitement to simple relief from stress, depression, or anxiety.

In some cases, persons with a transvestic fetish discover that they are unhappy with their biological sex, a condition known as gender dysphoria. They may elect to have hormonal and surgical procedures to change their bodies. Some may choose to have gender reassignment surgery. The incidence of gender dysphoria and subsequent gender reassignment among persons diagnosed with transvestic fetishism is not known.

Demographics

Except for sexual masochism , in which the gender ratio is estimated to be 20 males for each female, paraphilias such as transvestic fetishism are practically never diagnosed in females, although a few cases have been reported. Virtually no information is available on family patterns of the disorder.

Diagnosis

Persons with transvestic fetishism may or may not seek psychotherapy on their own account. In some instances, the patient has agreed to consult a psychiatrist because his wife or girlfriend is distressed by the cross-dressing. The actual diagnosis of transvestic fetishism is most commonly made by taking a history or by direct observation. The diagnosis is made only if the patient has been markedly distressed by inability to dress in such a manner or if the disorder is interfering with his education, occupation, or social life. Dressing in women's clothing for such occasions as Halloween or a costume party is not sufficient for a diagnosis of transvestic fetishism.

Treatments

In the earliest period of behavior therapy, transvestic fetishes were narrowly viewed as inappropriate behavior that was confined to a limited range of situations, and were sometimes treated with aversion therapy , usually with electric shocks. This approach was largely unsuccessful. Persons with fetishes have also been treated by using a form of behavioral therapy known as orgasmic reorientation, which attempts to help people learn to respond sexually to culturally appropriate stimuli. This treatment also has had limited success.

Most persons who have a transvestic fetish never seek treatment from professionals. Most are capable of achieving sexual gratification in culturally appropriate situations. Their preoccupation with cross-dressing is viewed as essentially harmless to other persons, since transvestism is not associated with criminal activities or forcing one's sexual preferences on others. As of 2002, American society has developed tolerance for transvestites, thus further reducing the demand for professional treatment.

Prognosis

The prognosis for treatment of transvestic fetishism is poor, as most persons with this disorder do not desire to change. Most cases in which treatment was demanded by a spouse as a condition of continuing in a marriage have not been successful. The prognosis for personal adjustment is good, however, as a person with a transvestic fetish and his related activities do not usually disturb others.

Prevention

Most experts agree that providing gender-appropriate guidance in a culturally appropriate situation will prevent the formation of a transvestic fetish. The origin of some cases of transvestism may be a random association between clothing inappropriate for one's own gender and sexual gratification. There is no reliable way to predict the formation of such associations. Supervision during childhood and adolescence, combined with acceptance of a child's biological sex, may be the best deterrent that parents can provide.

See also Aversion therapy ; Gender identity disorder ; Gender issues in mental health

Resources

BOOKS

Gelder, Michael, Richard Mayou, and Philip Cowen. Shorter Oxford Textbook of Psychiatry. 4th ed. New York: Oxford University Press, 2001.

Kohut, John J., Roland Sweet. Real Sex: Titillating but True Tales of Bizarre Fetishes, Strange Compulsions, and Just Plain Weird Stuff. New York: Plume, 2000.

Wilson, Josephine F. Biological Foundations of Human Behavior. New York: Harcourt, 2002.

PERIODICALS

Dessens, A. B., P. T. Cohen-Kettenis, G. J. Mellenbergh, G. J. Koppe, and K. Boer. "Prenatal exposure to anticonvulsants and psychosexual development." Archives of Sexual Behavior 28, no. 1 (1999): 31-44.

Docter, R. F., J. S. Fleming. "Measures of transgender behavior." Archives of Sexual Behavior 30, no. 3(2001): 255-271.

Green, R. "Family co-occurrence of 'gender dysphoria': ten sibling or parent-child pairs." Archives of Sexual Behavior 29, no. 5 (2000): 499-507.

ORGANIZATIONS

American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. Telephone:(913) 906-6000. Web site: <http://www.aafp.org> .

American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007-1098. Telephone: (847) 434-4000. Fax: (847) 434-8000. Web site: <http://www.aap.org/default.htm> .

American College of Physicians. 190 N Independence Mall West, Philadelphia, PA 19106-1572. Telephone: (800) 523-1546, x 2600 or (215) 351-2600. Web site: <http://www.acponline.org> .

American Medical Association. 515 N. State Street, Chicago, IL 60610. Telephone: (312) 464-5000. Web site: <http://www.ama-assn.org> .

American Psychiatric Association. 1400 K Street NW, Washington, DC 20005. Telephone: (888) 357-7924. Fax(202) 682-6850.

American Psychological Association. 750 First Street NW, Washington, DC, 20002-4242. Telephone: (800) 374-2721 or (202) 336-5500. Web site: <http://www.apa.org> .

American Public Health Association. 800 I Street, NW, Washington, DC 20001-3710. Telephone: (202) 777-2742. Fax: (202) 777-2534. Web site: <http://www.apha.org> .

L. Fleming Fallon, Jr., M.D., Dr.P.H.