Transvestic Disorder DSM-5 302.3 (F65.1): Symptoms, Treatments

Transvestic disorder is categorized as a paraphilic disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and characterized by the sexual excitement individuals experience when they cross-dress or think about cross-dressing. Men with trasnvestic disorder typically have autogynephilia as well, or the tendency to become sexually aroused when imagining himself as a woman. The fantasies that accompany autogynephilia can focus on either the idea of having female physiological functions (e.g., menstruation), engaging in stereotypical feminine behavior (e.g., wearing pink, sewing, etc.), or having female anatomy (e.g., breasts).

Diagnostic Criteria and Specifications

There are multiple criteria an individual must meet in order for a transvestic disorder diagnosis to be completed:

• The individual experiences intense sexual arousal from cross-dressing, as manifested by fantasies, urges, or acts, for at least 6 months.
• These fantasies, urges, and acts cause clinically significant distress or impairment in social, occupational, or other important areas of life.

There are also certain specifications that should be made in individuals diagnosed with transvestic disorder. Specify if:

• With fetishism: The individual is sexually aroused by fabrics and materials. This presence of fetishism decreases the likelihood of gender dysphoria in men that also have transvestic disorder.
• With autogynephilia: The individual is also aroused by thoughts or images of self as female—the presence of autogynephilia increases the likelihood of gender dysphoria in men who also have transvestic disorder.
• In a controlled environment: The individual lives in an institution or other controlled setting where cross-dressing isn’t possible or is restricted.
• In full remission: There has been no impairment in social, occupational, or other area of functioning for 5 years or more while in an uncontrolled environment.

Risk Factors and Development DSM-5 302.3 (F65.1)?

Nobody is particularly at risk of developing transvestic disorder. And though the exact prevalence of transvestic disorder is unknown, it is rare in males and extremely rare among females. In males, the first signs of the disorder may present as an extreme fascination with a particular item that is typically worn only by women, such as lipstick or a dress. As this progresses, the idea of cross-dressing excites the child. And when puberty hits, cross-dressing starts to cause penile erection. Typically, this sexual excitement lessens overtime but the desire to dress in women’s clothing may remain the same or even grow. Sometimes the course of transvestic disorder is continuous, while at others it occurs in episodes.

Is There Treatment for Transvestic Disorder?

Individuals with transvestic disorder alone do not typically seek treatment. The disorder also does not necessarily demand treatment, unless the affected individual is experiencing severe shame, anxiety, or ridicule due to his sexual interest in and acts of cross-dressing. However, therapy can be used to treat the disorder and it’s negative effects.

Differential Diagnosis

Symptoms of transvestic disorder can be similar to those of fetishistic disorder and gender dysphoria:

• Fetishistic disorder: In order to distinguish this disorder from transvestic disorder, one must pay attention to the specifics of the individual’s thoughts during sexual acts, such as masturbation. For example, are there any thoughts about being a woman or dressing like a woman? There also has to be analysis of the presence of other fetishes, like fabrics and garments, during sexual acts of the like.
• Gender dysphoria: Unlike in gender dysphoria, individuals with transvestic disorder do not typically report a desire to be the opposite gender; they also typically do not have a history of cross-gender behavior, only cross-dressing. Symptoms can coexist though, as can the two disorders.

Criticism Surrounding Caitlyn Jenner

By now, Caitlyn Jenner is a household name. Formerly known as Bruce, the all-American athlete and Olympic gold-medalist, Caitlyn has been in the spotlight for some time now after deciding to transform into a woman. While she says she has always identified more or less as a woman, this came as a big surprise to many, including her family—so they say.

At some point during Caitlyn’s marriage to Kris Kardashian, one of the youngest daughters is said to have walked in on Caitlyn dressed as a woman—she wore a dress as well as high heels. Apparently this occurred frequently throughout his and Kris’ marriage and Caitlyn says that Kris was well aware. But Kris says otherwise.

So, does or did Caitlyn Jenner show signs of transvestic disorder? While Caitlyn did show an interest in cross-dressing, it doesn’t appear that she received sexual arousal from it, which is an essential feature of transvestic disorder. Additionally, Caitlyn did desire becoming the opposite gender, which is atypical of individuals with this disorder. Therefore, it’s safe to say Caitlyn probably never had transvestic disorder. Instead, she identified as a woman and put this into motion to become her truest, happiest self.

Transvestic Disorder is when a person cross-dresses, and it causes them distress. However, when a person cross-dresses without the feelings of anxiety or concern, they are not diagnosed as having Transvestic Disorder. A person with the disorder dresses in the clothing of the other sex and becomes sexually aroused, resulting in feelings of sadness, distress, humiliation and self-condemnation due to their urge to cross-dress. Many times, the emotions are the consequences of a partner’s negative reaction toward the behavior or when the individual doesn’t feel good about it. He may also have worries about rejection in social and professional areas.

Transvestic Disorder is categorized as a paraphilia, which is a group of disorders that are characterized by abnormal sexual activity.

Most people who cross-dress are heterosexual, and it is more common for men to have Transvestic Disorder than women. Cross-dressing often begins in youngsters or in the teenage years. In addition, the person with the disorder for a long time is more likely to have taken the role of a person of the opposite sex. In addition, the person may take on the mannerisms and wear clothing and other items that are associated with the opposite sex.

Signs and Symptoms of Transvestic Disorder

• Feeling the need to cross-dress to be sexually aroused.
• Using cross-dressing for stress relief.
• Inability to achieve sexual arousal unless the person is wearing clothing, accessories or other items of the opposite sex.
• Taking the role of the opposite sex when cross-dressing.
• Continual and powerful sexual feelings come from imagining or dressing in a single or many articles of clothing usually meant for the other sex. These can include a single article like a bra or several items, such as a dress, stockings and heels.
• Patterns of buying clothing and other items of the opposite sex, wearing them and discarding them in an effort to put an end to the behavior.
• The desires or actions are evident for a minimum of half a year and result in serious distress in relationships, careers and exist on a daily basis.
• Because of the distress, many people with the disorder often are not able to function at the workplace.
• Wearing clothes may advance to sexually gratifying himself if the individual is younger. Older individuals usually put off acts like masturbation in an attempt to prolong the process of dressing up.
• People with the disorder, who are intimate with a partner, many times will have sex during or following the cross-dressing.

Cause of Transvestic Disorder

It isn’t known exactly what determines Transvestic Disorder. The disorder has been found in youngsters when they “dress up” before reaching adolescence. The activity may remain the same with no change or increase. The desire for sex usually spikes in puberty. (In some people, their desires are switched to feelings of security, and, in men, it can result in a want to continue the actions for longer periods.) When the individual matures and the behavior is continued, the want to wear clothes of the opposite sex may become even more powerful.

Transvestic Disorder is a rare diagnosis, and the Diagnostic and Statistical Manual (DSM)-5* reports that fewer than three percent of men report that they are sexually aroused by cross-dressing. The disorder is virtually only diagnosed in men, and a majority of them recognize themselves as being attracted to the opposite sex, engaging in sex with the same sex sometimes.

*The DSM is published by the American Psychiatric Association, which lists all classifications of mental disorders.

Treatment of Transvestic Disorder

Transvestic Disorder, because of the feelings of distress and depression that a person experiences, should be treated by a psychologist or psychiatrist. Usually cognitive behavioral therapy is used to treat individuals with the disorder, focusing on negative self-perception. A therapist can work with people with Transvestic Disorder to be able to deal with the distress they may be feeling and find strategies to cope with it. (Many people with Transvestic Disorder do not seek help on their own, but are asked by a partner to get help.)

Antidepressants should be a consideration. It is beneficial for people with the disorder to have a combination of therapy and medication. If they are given psychotropic medications (antidepressants) combined with antiandrogens (for help in minimizing desires and their magnitude), people with the disorder may find relief from their psychical desires and anxiousness.

Therapy may be helpful for heterosexual men who have Transvestic Disorder and want to continue their partnerships with women. Many times, their behaviors interfere with the partnerships. In addition, when people with Transvestic Disorder are also diagnosed with depression or suicidal tendencies, their attendance in therapy is vital.

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