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 non-consenting 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.
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.
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.
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.
Except for sexual masochism , in which the gender ratio is estimated to be 20 males for each female, para-philias 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.
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 girl friend 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.
Cross-dressing —Wearing clothing and other attire appropriate to the opposite sex.
Fetishism —A paraphilia in which a person requires a nonliving object (or occasionally a nongenital part of the body, such as the partner’s feet) in order to achieve sexual arousal and satisfaction.
Gender dysphoria —A state of persistent discomfort or depression associated with one’s gender role or biological sex.
Paraphilias —A group of mental disorders that is characterized by recurrent intense sexual urges and sexually arousing fantasies generally involving (1) non-human objects, (2) the suffering or humiliation of oneself or one’s partner (not merely simulated), or (3) children or other non-consenting persons.
Transvestite —A person who derives sexual pleasure or gratification from dressing in clothing of the opposite sex.
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. American society has developed more tolerance for transvestites, thus further reducing the demand for professional treatment.
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.
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.
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L. Fleming Fallon, Jr., M.D., Dr.P.H.