Transvestism is a paraphilia in which an individual experiences recurrent, intense sexual arousal from cross-dressing, or dressing as the opposite gender, and in which that person’s urge to do so causes significant distress or impairment in his or her daily life.
Cross-dressing itself is not a disorder, but dressing in the clothes of the opposite gender to experience intense sexual arousal may be, particularly if it causes significant impairment. An individual with transvestic disorder suffers anxiety, depression, guilt, or shame because of their urge toward cross-dressing. These feelings are usually a result of partner disapproval or their own concern about negative social or professional ramifications.
Transvestic disorder is one of several psychiatric disorders characterized as a paraphilia, referring to an intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners. Behaviors such as cross-dressing are considered to be symptoms of a disorder only if they are acted upon in ways that have the potential to cause distress or harm to oneself or others, especially others who have not given their consent.
Symptoms
Cross-dressing in and of itself is not a disorder. Cross-dressing is most common in men, but occurs in both males and females, and often starts in childhood or adolescence. Cross-dressing may include wearing only a single article of clothing typically associated with the opposite gender or a complete outfit, along with hair and makeup. Most people who cross-dress are heterosexual.
To be diagnosed with transvestic disorder, according to the DSM-5, a person must experience persistent and intense sexual arousal from fantasizing about, or acting on, urges to wear one or more pieces of clothing normally worn by the opposite gender. These fantasies or behaviors must have been present for at least six months and cause severe distress to the individual or dysfunction in social, professional, or other significant areas of day-to-day life. The feelings of distress over cross-dressing that characterize transvestic disorder are separate and distinct from gender dysphoria.
A person with transvestic disorder may experience continuous urges to cross-dress, or their desire may fluctuate or occur in a series of episodes. They may become stuck in a negative behavioral pattern of purchasing clothing with the intent of cross-dressing, wearing it during a cross-dressing session, and throwing it away in hopes of quitting. They may also be co-diagnosed with other disorders, including fetishism, in which one is sexually aroused by fabrics, materials, or garments; masochism, in which one experiences sexual gratification at his or her own pain or humiliation; and autogynephilia, in which a man derives sexual pleasure from fantasizing about himself as a woman.
Causes
No specific cause has been determined for transvestic disorder. It has been observed that in childhood, cross-dressing causes excitement which may, after puberty, become sexual excitement. As the person gets older and the behavior is repeated and reinforced, the desire to cross-dress may become stronger even as sexual gratification diminishes.
Treatment
Cross-dressing in and of itself is not a disorder so it does not generally require treatment. Cross-dressers are sometimes referred to therapy by the court system or are brought to therapy by a parent, partner, or spouse. Some cross-dressers seek therapy themselves for other reasons, such as substance abuse, depression, or gender dysphoria, or because they are distressed by their own urges. A person with a history of transvestic disorder is considered to be in remission when their desire to cross-dress has not caused them distress or impaired their daily life in at least five years.
Many times, cross dressing is an expression of associated gender attributes, not a sexual identification issue. These men want to feel feminine qualities such as softness, tenderness, beauty—and need an outlet in a culture that expects a man to be strong, with limited emotional responses.
Over the course of a lifetime the desire to crossdress can up and down in cycles.
People often seek counseling when this desire becomes so intense that it distracts
them from other responsivities, when in creates conflicts in their relationships, or if they are questioning the meaning of the crossdressing in their lives.
The desire to cross-dress usually develops in childhood. Perhaps the parent dressed him like a girl or he may have joined his sisters in dressing up in their mother’s clothes. Regardless, most cross-dressers didn’t just up and decide one day that they enjoyed wearing women’s clothing. It almost always begins in childhood.
Some cross-dressers have developed identity problems from wearing feminine clothing over an extended period of time. It may be considered normal for a man to slip into a woman’s silk nightgown on occasion but when it comes to the point where he begins to feel more comfortable in women’s clothes than men’s, he could be developing an identity crisis.
- One common reason that men choose to cross dress, is for sexual gratification. They may enjoy the sexual excitement that they experience from wearing feminine clothing, and in seeing their feminine image.
- Another reason for cross dressing, is that men want to feel free to express the feminine side of their personality.
I suspect gender dysphoria, which describes a heterogeneous group of persons who express varying degrees of distress with their anatomic sex and sometimes desire secondary opposite-gender sexual characteristics.
- Most cross-dressers do not have transvestic disorder.
- Doctors diagnose transvestic disorder when people are greatly distressed by or cannot function well because of their desire to cross-dress.
- No drugs are reliably effective, but psychotherapy, when needed, may help people accept themselves and control behaviors that could cause problems in their life.
- Heterosexual males who dress in women’s clothing typically begin such behavior in late childhood. This behavior is associated, at least initially, with intense sexual arousal.
Cross-dressers may cross-dress for reasons other than sexual stimulation—for example, to reduce anxiety, to relax, or, in the case of male cross-dressers, to experiment with the feminine side of their otherwise male personalities.
Later in life (sometimes in their 50s or 60s), some men who were cross-dressers only in their teens and twenties develop gender dysphoria. They may seek to change their body through hormones and genital (sex-reassignment) surgery.
When a partner is cooperative, cross-dressing may not hurt a couple’s sexual relationship. In such cases, cross-dressing men may engage in sexual activity in partial or full feminine attire.
When a partner is not cooperative, cross-dressers may feel anxious, depressed, guilty, and ashamed about their desire to cross-dress. In response to these feelings, these men often purge their wardrobe of female clothing. This purging may be followed by additional cycles of accumulating female clothes, wigs, and makeup, with more feelings of guilt and shame, followed by more purges.
A successful relationship with a crossdresser can be stressful to you. I know. You have many fears.
Will he be discovered?
Will our families find out?
Will this affect his job and our financial security?
Will the neighbors learn the secret? Will he be arrested for crossdressing, bringing public embarrassment?
Will it hurt the kids?
Will he turn gay?
Will he have a sex change?
What will become of me?
A trip to the mall is one thing, but a trip to the Ladies’ Room is something entirely different. Being caught in either restroom crossdressed is not the time to argue Constitutional law with a minimum wage security guard who holds your future in his hands and needs to impress his superiors with his efficiency in clearing “perverts” out of the restrooms.
Set rules in advance that are “safe,” and stick to them.
Agree on whether to tell the kids, and if you are the slightest bit concerned of this, don’t tell. Confront the issue of a sex change. He may be confused at first and he may feel pressure to explore this possibility, but the vast majority of crossdressers who have supportive wives resolve their confusion and accept themselves for what they are—crossdressers, not transsexuals. Help him find himself. Above all, be flexible.
Both the crossdresser and his wife must honor the limits they set, but there is room for compromise as you both grow.
The issue of the “secret” he kept from you for decades is difficult to resolve. Many wives feel lifelong hurt about this. But when we discuss this issue in our support groups, the crossdressers almost universally say that they love their spouse so dearly that they could not bring themselves to discuss crossdressing with them before the stress and pain forced them to, or until they were accidentally discovered by the wife or partner.
Think about it. He endured great personal pain, suffering alone in his “closet” his entire life. His greatest fear was of losing your love and companionship. He endured to assure the continuation of the marriage. Yes, he betrayed your trust. But there are far worse betrayals. Most women should be so fortunate.