Transvestic disorder
Transvestic disorder is characterized by a longstanding sexual preference for dressing in clothing traditionally associated with a different gender, which causes significant distress or impairment in the individual's life. According to the American Psychiatric Association, this paraphilic disorder is often misunderstood and primarily affects heterosexual men, although it can include individuals of any gender. It's important to note that transvestic disorder differs from cross-dressing done for non-sexual reasons, such as performance in drag shows or cultural practices, where the motivation is not linked to sexual arousal.
The disorder typically manifests in late childhood or early adolescence, and while the exact causes are not definitively known, factors such as familial relationships and early experiences with gender non-conformity may play a role. Individuals with transvestic disorder may experience feelings of guilt and difficulty in relationships, prompting the need for therapeutic interventions. Treatment approaches have evolved from aversive conditioning methods to more contemporary therapies like cognitive behavioral therapy and acceptance and commitment therapy, focusing on reducing distress and finding alternative coping strategies. Overall, understanding transvestic disorder requires a nuanced perspective that respects diverse gender expressions and acknowledges the complexity of individual experiences.
Subject Terms
Transvestic disorder
- TYPE OF PSYCHOLOGY: Psychopathology
SIGNIFICANCE: Transvestic disorder refers to men or women wearing clothing traditionally designed for a different gender; transvestic disorder refers to a longstanding sexual preference for cross-dressing that distresses or impairs the functioning of the individual.
Introduction
As defined in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), transvestic disorder (formerly transvestic ross-dressing, or transvestism) is a paraphilic disorder which describes "people who are sexually aroused by dressing as the opposite sex but who experience significant distress or impairment in their lives—socially or occupationally—because of their behavior." Like most paraphilic disorders, transvestic disorder is poorly understood by the public. Individuals who are members of the LGBTQIA+ community may be sexually attracted to individuals of their own gender, and transgender individuals are those whose gender identity is different from the gender they were assigned at birth—these individuals do not have transvestic disorder unless they engage in compulsive, sexually driven behaviors that interfere with their daily lives. Most individuals diagnosed with this disorder are heterosexual men. The diagnostic criteria listed in the previous version of the DSM-5-TR limited this disorder to men, but this has evolved to include all individuals. In rare cases, individuals with transvestic disorder may develop gender dysphoria (formerly gender identity disorder), or an "incongruence between their experienced or expressed gender and the one they were assigned at birth." Such individuals sometimes develop a desire to live permanently as women.
The way people perceive garments that are traditionally worn by a specific gender is culturally determined. A Scottish man wearing a kilt is not culturally deviant, even though kilts resemble feminine skirts in other cultures. Also, the act of wearing clothes that defy gender norms does not indicate a sexual disorder. Men wearing women's clothing is common in some societies and is frequently portrayed in the entertainment industry. Some films such as Tootsie (1982), Victor Victoria (1982), and Mrs. Doubtfire (1993) and television shows such as M.A.S.H. (1972-1983), Boy Meets World (1993–2000), and Boston Legal (2004-2008) have featured characters who dress in clothing traditionally worn by another gender.
Some men, such as RuPaul, have made a career out of appearing in “drag.” These individuals, called “drag queens,” dress in extravagant makeup, hair, and dresses as performance art. Historically, the Roman emperors Caligula and Nero and actors in Shakespearean theater also engaged in this behavior. Men play all the female roles in kabuki, a traditional type of Japanese theater. Although Caligula and Nero’s reasons for this are unclear, most examples discussed here would not indicate transvestic disorder. Actors playing roles or comedians seeking laughs do not meet the diagnostic criteria for transvestic disorder because their motives for cross-dressing are external and not associated with sexual arousal. Similarly, drag queens or gay men dressing as females at a costume party are not cross-dressing for sexual arousal.
Details and Possible Causes
Transvestic disorder is a paraphilia, or a paraphilic disorder, which is a condition in which intense sexual urges and fantasies center on behaviors or objects other than those seen in typical sexual activities. Other paraphilias include exhibitionism and . For paraphilia to be considered a mental health condition requiring treatment, the deviant fantasies, urges, or behaviors must be persistent (occur over a period of at least six months) and disruptive (cause significant distress, interpersonal difficulty, or employment disruption) to the person's work, relationships, or other aspects of life.
According to American sociologist Frederick L. Whitam, cross-cultural research has shown that when not cross-dressed, heterosexual male individuals exhibiting transvestic disorder symptoms are typically masculine in behavior, whereas the behavior of gay men tends to be more feminine and performative overall. Many heterosexual men who are married with children engage in this behavior only in private. Sexual masochism, the sexual pleasure derived from personal suffering, submission, or humiliation, as in bondage, is an associated feature in some individuals diagnosed with transvestic disorder.
The symptoms of transvestic disorder typically appear in late childhood or early adolescence. Some researchers suggest a biological predisposition for this disorder, but most explanations have involved learned experiences. Many individuals report experiencing difficult family issues, such as an uncomfortable father-son relationship. Some report being praised as children for looking “cute” in female clothing, while others were forced to wear such clothing as punishment. Certainly, many males with transvestic disorder masturbated during adolescence while either wearing female garments or with such garments nearby. Because orgasm is a strong , associating masturbation with other-gender clothing can produce classically conditioned arousal to such clothing.
Wearing another gender's clothes provides a calming effect for individuals with transvestic disorder and often increases in frequency when individuals are stressed. The sexual arousal aspect also decreases as individuals age without lessening urges. Other than a tendency toward introversion and inhibition in relationships, personality profiles are not predictors of the risk of developing transvestic disorder.
Treatment Issues
Like many paraphilic disorders, transvestic disorder is often accompanied by a feeling of guilt about their behavior, and it can damage their sexual relationships, especially if spouses or romantic partners disapprove. Couples therapy is often recommended for that reason. Historically, most therapies have been based on learning model explanations for transvestic disorder. Some therapists have claimed success by strengthening the individual’s confidence and adequacy in male sex roles.
In the past, relatively unsuccessful attempts were made to pair cross-dressing with electrical shock in aversive conditioning procedures. Covert sensitization, in which the individual first imagines engaging in the desired behavior of cross-dressing and then vividly visualizes humiliating outcomes for doing so, was more successful. The negative visualization countered the reinforcing arousal of cross-dressing with a punishing emotional state, thus decreasing sexual excitement.
More modern therapies for transvestic disorder adopt a cognitive behavioral perspective and include harm reduction, acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), and functional analytic psychotherapy (FAP). Harm reduction seeks to reduce the frequency, intensity, and effects of undesired behaviors. ACT helps the patient cope with the underlying distress that triggers the unwanted thoughts or behaviors. DBT and FAP both take an interpersonal approach, focus on identifying the patient's underlying emotional state (strengths and vulnerabilities), and then help the patient find personally acceptable alternatives to the undesired thoughts and behaviors. Little data is available on the efficacy of these therapies, however.
Pharmaceutical treatments may include antiandrogen agents to reduce testosterone levels, antianxiety, and antidepressant medications, which may be best suited to those with concomitant mood disorders or other conditions.
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