New DSM Expands Definition of Transvestic Disorder

Transvestic disorder is a mental health condition that centers on wearing clothes normally identified with the opposite sex in order to experience sexual gratification. It belongs to a group of conditions called paraphilic disorders, which appear in a reference text used for making mental illness diagnoses throughout the United States called the Diagnostic and Statistical Manual of Mental Disorders.  Transvestic disorder differs from transvestism, an activity also known as cross-dressing. While people who participate in transvestism don’t necessarily feel distress from their activities, people with transvestic disorder do feel a level of distress that interferes with their everyday routines.

Transvestism Basics

Transvestism belongs to a group of sex-related patterns known as paraphilias. People who engage in these patterns have urges and participate in behaviors that are relatively uncommon and frequently viewed as “abnormal.” Some paraphilias don’t disrupt the lives of their practitioners or the lives of other people. However, some paraphilias do cause minor or major disruption, either within the lives of practitioners or in the lives of the targets of paraphilic behaviors. In addition to transvestism, examples of paraphilias include voyeurism, exhibitionism, fetishism, frotteurism, sexual masochism, sexual sadism, and pedophilia.

The overwhelming majority of transvestites are men who wear clothing normally associated with women. According to Bradley University, most of these men have a heterosexual sexual orientation, grow up identifying entirely as boys, and get married to women during adulthood. In most cases, men who engage in transvestism don’t cross-dress the majority of the time or otherwise attempt to live their lives as women. For a number of reasons, women who cross-dress typically have lower social prominence than cross-dressing men. Transvestism qualifies as a paraphilia because people who cross-dress typically experience some sort of sexual satisfaction, at least during the first stages of their involvement in transvestic behaviors.

Transvestic Disorder Basics

When transvestites have partners who accept their cross-dressing behaviors, as well as their cross-dressing fantasies and urges, they commonly experience no distress or mental anguish from their participation in transvestism. However, if they have partners who don’t accept their behaviors, fantasies or urges—or if they otherwise encounter major resistance to their activities—practitioners of transvestism can develop substantial levels of anguish, which can manifest in the form of emotions such as shame or guilt, or mental states such as anxiety or depression.

If this anguish becomes prominent enough to interfere with an affected individual’s ability to participate fully in some aspect of daily life, he or she meets one of the main criteria for a transvestic disorder diagnosis. These criteria appear in the fifth edition of the Diagnostic and Statistical Manual (DSM 5), which was published in May 2013 by the American Psychiatric Association. In addition to life-impairing mental anguish, an affected individual must participate actively in transvestism—or have strong transvestic urges or fantasies—for half a year or longer.

Changes from Earlier Definitions

DSM 5’s predecessor (the fourth edition of the Diagnostic and Statistical Manual, known as DSM IV) did not include a listing for transvestic disorder. Instead, it included a listing for a condition called transvestic fetishism. This term was used because the consensus of scientific and medical thinking at the time of DSM IV’s publication viewed damaging transvestic behaviors as an offshoot of another type of paraphilia, called fetishism, which involves reliance upon inanimate objects for the attainment of sexual satisfaction. In the case of transvestic fetishism, various items of women’s clothing were the inanimate objects identified as the source of sexual release.

DSM 5 makes several changes from the definitions for transvestic mental illness contained in DSM IV. First, it decouples transvestism from fetishism and acknowledges transvestic disorder as a condition that’s separate and distinct from the condition now called fetishistic disorder. DSM 5 also explicitly separates transvestism (cross-dressing) in general from the disruptive transvestic behaviors, urges or fantasies that contribute to the onset of a diagnosable mental health condition. This separation falls in line with a wider change within the manual that reinforces the distinction between paraphilias of all kinds and the mental illnesses that can develop when paraphilias produce a damaging life impact.

Lastly, DSM 5 expands the range of people who can be considered for a transvestic diagnosis. While only heterosexual men could receive a diagnosis for transvestic fetishism in DSM IV, all adults can receive a diagnosis for transvestic disorder according to the terms set forth in DSM 5, including homosexual men and women of any sexual orientation.