Transvestic Disorder- The Psychology Behind Cross-Dressing

Introduction:

Transvestic disorder is when a person shows sexual interests and experiences sexual arousal and excitement about dressing up like the opposite sex. In lay terms, it also means “cross-dressing” mainly affects heterosexual or bisexual men who regularly prefer indulging in sexual activities with women and men. The disorder may go unnoticed unless it starts interfering with daily activities. Many who suffer from this disorder are either embarrassed or ashamed of their sexual interests. The transvestic disorder may also affect the person's mental health and urge them to hide their behaviors.

What Is Transvestic Disorder?

Transvestic disorder is an unusual fetish in which the person becomes sexually excited and aroused after wearing clothes of the opposite gender. For example, a man wearing women's clothes. Studies suggest that only men are affected by this order, and a negligible percentage of women are affected by the transvestic disorder. Men with transvestic disorder prefer female clothing, undergarments, and even ornaments. It is partly because most men's clothing styles may not seem inappropriate considering it as the fashion for women. Still, when a man chooses hosiery, makeup, or high-heeled shoes, this seems out of place in society and may seem unusual.

Though the terms “transvestism,” “transsexual,” and “transgender” are often confusing to many, there is a difference:

• A Transsexual Individual: It is a person whose personal gender identity does not correspond with gender at birth. In simple terms, a transsexual person is a person who undergoes a gender change after a surgical procedure.

• A Transgender: A person may cross-dress or may or may not undergo gender change. It is an umbrella term for all individuals who do not feel they conform to their native gender.

• The Transvestic Disorder: It primarily presents in heterosexual men; transvestic disorder is not correlated with homosexuality. Transvestism is a clinical term for cross-dressing. Individuals with the transvestic disorder do not experience a desire to undergo gender change nor experience any incongruence between their native gender and experienced gender.

What Causes the Transvestic Disorder?

Transvestic fetishism usually develops during childhood or adolescence. However, it may also develop later in life if a man has had early sexual experiences with men and becomes sexually aroused by female clothing. In some cases, there are no obvious triggers; at other times, significant traumas or stressors have occurred in a person's past, which lead them to develop this disorder (such as being sexually abused).

• Separation from parents either in early childhood or later.

• Cross-dressing in childhood sometimes causes excitement which may, later, after puberty become sexual excitement.

• A man exploring his sexual identity.

• Boys desire to imitate their mothers and dress up like them in early childhood.

• Same-gender sexual experiences in the past.

• Being sexually aroused on dressing up like a woman.

• Watching pornographic content.

• Increased frequency of masturbation.

What Are the Signs and Symptoms of Transvestic Disorder?

Below are the signs, fantasies, or behaviors of transvestic disorder that persist for at least six months and cause severe distress to their social and professional lives.

• Shame.

• Anxiety.

• Guilt and embarrassment associated with cross-dressing.

• Social anxiety and fear of being accepted in society.

• Sexual excitement on cross-dressing.

• Recurrent desire to wear female clothes (clothes of mother, sister, partner).

• Secretly wearing and getting dressed as a woman.

• Urge to look beautiful as a woman and apply makeup.

• Desire to grow their hair long and wear female wigs.

• Obsession with wearing female ornaments (necklaces, bangles, nose rings).

How Is a Transvestic Disorder Diagnosed?

Transvestic disorder is primarily diagnosed in men after the repeated and reinforced desire to cross-dress. Regular cross-dressing behaviors may interfere with the family environment, professional work, or society by causing humiliation and mental stress. A person with a transvestic disorder may find it difficult to seek help or be in complete denial, stopping the person from seeking help. Generally, their partner (wife or girlfriend) becomes frustrated, irritated, or distressed by the behavior and urges the man to seek a diagnosis.

As such, no particular medical and clinical investigations or tests are done to confirm the diagnosis. However, two main criteria are looked for to confirm the diagnosis:

• Excessive obsession with dressing as a woman.

• Transvestic fetish must usually interfere with daily activities extending from six months to years.

• Merely one or two early childhood instances of dressing up as a girl do not indicate a transvestic disorder. However, recurrent urges to cross-dress in adulthood may be indicative of this disorder.

• Underlying factors like stress are also looked for.

How Is Transvestic Disorder Psychologically Evaluated?

A psychiatrist or psychologist evaluates the condition by asking questions regarding:

• Family's medical and emotional history.

• Incidences in the past and questions on childhood traumas.

• Situational questions to understand their behavioral patterns.

• Questions regarding the intensity, frequency, and triggering factors for cross-dressing urges.

• Observing the behavior of the person when the person is subjected to stress.

• Thoughts and their psychology regarding sexuality.

• Questions to rule out other sexual and paraphilic disorders.

How to Treat Transvestic Disorder?

A person likely to be conflicted by his feelings and emotions regarding the behavior may make the situation difficult to diagnose and treat. Although this disorder does not directly cause any harm or lead to criminal activity, behavioral therapy can help people who have this disorder become more aware of their triggers and learn new coping skills. Cognitive-behavioral therapy also may help teach patients how to react more effectively when they feel the urge to engage in cross-dressing behavior.

• Behavioral Therapy - Therapists usually approach this method to determine the underlying reason and develop strategies for managing their sexual desires more healthily. Aversive treatments (a form of psychological treatment in which the patient repeatedly experiences a stimulus he fears) and other forms of imagery or desensitization, in which the patient imagines his cross-dressing patterns and then experiences an unpleasant occurrence, may be used. Aversive treatments help to lessen the future desire to participate in transvestic behaviors. In addition, psychiatrists may use orgasmic reorientation to teach new sexual responses to culturally acceptable stimuli.

• Cognitive-Behavioral Therapy - Cognitive restructurings, such as identifying and modifying the thoughts that drive the behavior and coping mechanisms, are used to treat the transvestic disorder. This approach can also teach the patient to become aware of events and triggering factors that urge them to cross-dress and advise on new coping mechanisms or distracting activities that could lead to a more productive and healthier response.

• Medications - Antidepressants and anti-anxiety medications are given simultaneously when behavioral and cognitive-behavioral therapies alone are not helpful. Medications also help to treat underlying mental health conditions like depression and stress to help the person cope with the situation better.

Conclusion:

Social attitudes today are beginning to change in regard to sexual orientation. Although the transvestic disorder is not common in clinical settings, psychotherapy treatments can alleviate or prevent further complications when it does happen. In addition, behavioral and cognitive-behavioral therapy has produced the best results for those seeking to change their behavior patterns.