What is a transvestic disorder?

Introduction

As defined in psychology, transvestism (formerly termed "transvestic fetishism") is poorly understood by the public, who often confuse it with homosexuality and transsexualism. Homosexuals are either men or women sexually attracted to individuals of their own gender, while transsexualism
is when either men or women feel or express discomfort with their biological gender and persistently identify themselves as being, or wishing to be, another gender. Transvestites may be heterosexual or homosexual, male or female; however, most research has been conducted with heterosexual male transvestites. Transvestic disorder is typically not diagnosed if there are gender identity issues. In rare cases, individuals with transvestic disorder may develop gender dysphoria, a sense of discomfort with their biological sex. Such individuals sometimes develop a desire to live permanently as women.

The garments that constitute cross-dressing are culturally determined. A Scottish man wearing a kilt is not cross-dressing, even though kilts resemble feminine skirts in other cultures. Also, the mere act of cross-dressing does not necessarily indicate transvestism or any sexual disorder. Male cross-dressing is actually common in some societies and is frequently portrayed in entertainment. Some films such as Tootsie (1982), Victor Victoria (also 1982), and Mrs. Doubtfire (1993) and television shows such as M.A.S.H., Boy Meets World, and Boston Legal have featured cross-dressing. Many comedians have used cross-dressing in their acts, including Milton Berle and Dana Carvey. Some men, such as RuPaul, have made a career out of appearing in “drag.” These individuals, called “drag queens,” cross-dress as performance art. Historically, the Roman emperors Caligula and Nero cross-dressed, and cross-dressing was common on the stage in Shakespearean theater. Men play all the female roles in kabuki, a traditional type of Japanese theater. Although Caligula and Nero’s reasons for cross-dressing are unclear, most examples discussed here would not indicate transvestic disorder. Actors playing roles or comedians seeking laughs are not transvestites because their motives for cross-dressing are external and not normally associated with sexual arousal. Similarly, drag queens or male homosexuals dressing as females at a costume party are not cross-dressing for sexual arousal.

Details and Possible Causes

Transvestism is a
paraphilia, 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 voyeurism. For a paraphilia, such as transvestism, to be considered a paraphilic disorder, 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).

According to Frederick L. Whitam, cross-cultural research has shown that when not cross-dressed, heterosexual male individuals exhibiting transvestism appear typically masculine in behavior, whereas the behavior of homosexual male transvestites tends to be more feminine and performative overall. Many heterosexual male transvestites are married and have children, and they cross-dress only in private. Sexual masochism, the sexual pleasure derived from personal suffering, submission, or humiliation, as in bondage, is an associated feature in some transvestites. It is also possible for transvestism to present with fetishism (arousal from objects such as shoes or leather) or with autogynephilia (arousal from visualization of oneself as female).

The urge to cross-dress typically appears in late childhood or early adolescence. Some researchers suggest a biological predisposition for this disorder, but most explanations have involved learned experiences. Many transvestites report experiencing difficult family issues, such as an uncomfortable father-son relationship. Some transvestites report being praised as children for looking “cute” in female clothing, while others were forced to wear such clothing as punishment. Certainly, many male transvestites masturbated during adolescence while either wearing female garments or with such garments nearby. Because orgasm is a strong reinforcer, associating masturbation with opposite-gender clothing can produce classically conditioned arousal to such clothing.

Cross-dressing increases in frequency for transvestites when they are stressed, and it seems to calm them. The sexual arousal aspect also decreases as many transvestites age, without lessening the cross-dressing urge. Cross-dressing apparently helps some individuals escape the strictures of the traditional male role. Therefore, more than just sexual arousal may be involved. Other than a tendency toward introversion and inhibition in relationships, the personality profiles for transvestites and nontransvestites are typically indistinguishable.

Treatment Issues

Unlike many paraphilias, transvestic disorder has little potential to cause physical harm to the individual or others. However, transvestites often feel guilty about their behavior, and it can damage their sexual relationships, especially if spouses or romantic partners disapprove; couples therapy is often recommend for that reason. In addition, cross-dressing is illegal in some jurisdictions, and cross-dressers appearing in public may face legal risks.

Historically, most therapies used with transvestites 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 to pair cross-dressing with electrical shock in aversive conditioning procedures were made. Covert sensitization, in which the individual first imagines engaging in the desired behavior of cross-dressing, 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.

Bibliography

Bloom, Amy. Normal: Transsexual CEOs, Crossdressing Cops, and Hermaphrodites with Attitude. New York: Random, 2002. Print.

Bradford, John M. W., and A. G. Ahmed, eds. Sexual Deviation: Assessment and Treatment. Philadelphia: Elsevier, June 2014. Digital file.

Bullough, Vern L., and Bonnie Bullough. Cross Dressing, Sex, and Gender. Philadelphia: U of Pennsylvania P, 1996. Print.

Newring, Kirk A. B., Jennifer Wheeler, and Crissa Draper. "Transvestic Fetishism: Assessment and Treatment." Sexual Deviance: Theory, Assessment, and Treatment. 2nd ed. Ed. D. Richard Laws and William T. O'Donohue. New York: Guilford, 2008. 285–304. Print.

Rudd, Peggy J. My Husband Wears My Clothes: Crossdressing from the Perspective of a Wife. 2nd ed. Katy: PM, 1999. Print.

Stryker, Susan, and Stephen Whittle, eds. The Transgender Studies Reader 2. New York: Routledge, 2013. Print.

Suthrell, Charlotte A. Unzipping Gender: Sex, Cross-Dressing, and Culture. New York: Berg, 2004. Print.

Whitam, Frederick L. "A Cross-Cultural Perspective on Homosexuality, Transvestism, and Trans-Sexualism." Variant Sexuality. Ed. Glenn Wilson. New York: Routledge, 2014. 176–201. Digital file.