[Analysis of a boy with transvestic tendencies. Contribution to the genesis and dynamics of transvestism].
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Child, Preschool↗
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Treatment of a transvestic fetishist with cognitive-behavioral therapy and supportive psychotherapy: case report.
Transvestic fetishism is a paraphilia marked by recurrent, intense sexually arousing fantasies, sexual urges, or behavior involving cross-dressing, in a heterosexual male. There are many explanations of the pathogenesis, but none are conclusive. Different treatments have been applied, but they generally remain obscure and disappointing. Transvestic fetishists rarely seek psychotherapy, because of their dynamic balance between perversion and intrapsychic disintegration. There are few studies, either qualitative or quantitative, associated with transvestic fetishism in Taiwan. This case report describes an adolescent transvestic fetishist who underwent a brief course of psychotherapy in the outpatient department of a psychiatric center in Taipei. After consultation for one year, he still maintained his deviant sexual behavior but also developed more severe moral anxiety. He was then referred for psychotherapy. Cognitive-behavioral and psychodynamic theories associated with transvestic fetishism were reviewed and applied in both understanding and treating this client. Some temporal effectiveness was achieved with combined cognitive-behavioral and dynamic-oriented supportive psychotherapy. After 18 sessions of psychotherapy over more than 4 months, the client was able to stop his perverse behavior and have fewer sexually arousing fantasies. The prognosis of transvestic fetishism is generally supposed to be pessimistic and have a high rate of recurrence. Some propose that adolescents have a better outcome after treatment. This case report reveals the possibility of change for a transvestic fetishist. However, the long-term effects of the brief course of psychotherapy require further evaluation in the future.
Adolescent↗
Age, transvestism, bondage, and concurrent paraphilic activities in 117 fatal cases of autoerotic asphyxia.
Autoerotic asphyxia is the practice of self-inducing cerebral anoxia, usually by hanging, strangulation, or suffocation, during masturbation. This study investigated the relationships between: asphyxiators' ages; two paraphilias commonly accompanying autoerotic asphyxia, bondage and transvestism; and various other types of simultaneous sexual behaviour. Subjects were two concurrent series totalling 117 males aged 10-56 who died accidentally during autoerotic asphyxial activities. Data concerning sexual paraphernalia at the scene of death or among the deceased's effects were extracted from coronors' files using standardised protocols. Anal self-stimulation with dildos, etc., and self-observation with mirrors or cameras were correlated with transvestism. Older asphyxiators were more likely to have been simultaneously engaged in bondage or transvestism, suggesting elaboration of the masturbatory ritual over time. The greatest degree of transvestism was associated with intermediate rather than high levels of bondage, suggesting that response competition from bondage may limit asphyxiators' involvement in a third paraphilia like transvestism.
Accidents↗
A case of familial heterosexual transvestism.
A brief review of the literature concerning familial transvestism is given. The case history of father-son heterosexual transvestism is presented. The son appears to have been ignorant of his father's transvestism. Early childhood experiences as an aetiological factor seem inadequate to explain the similarities of the two subjects' transvestite behaviour. It is suggested that constitutional factors play a part in the aetiology of heterosexual transvestism.
Adult↗
OCD and transvestism: is there a relationship?
OBJECTIVE: There have been reports of obsessive-compulsive disorder (OCD) patients with comorbid paraphilias. In this paper, two cases of comorbidity between OCD and transvestism are reported with the aim of discussing possible explanations for this association. METHOD: Longitudinal case studies of two patients with OCD and tranvestism according to the DSM-IV were assessed using semi-structured interviews. RESULTS: Both patients presented with OCD and comorbid transvestism with different clinical features and treatment response. The case whose cross-dressing was more egodystonic responded better to treatment. CONCLUSION: It is possible that some cases of transvestism are OCD-related while others are more related to a gender identity disorder. A dimensional approach focusing on common phenomenological and neurobiological substrates is suggested as particularly useful for clinical management and future research of both disorders.
Adult↗
Transvestic fetishism in the general population: prevalence and correlates.
We used a random sample of 2,450 18-60 year-olds in the general population of Sweden to study the prevalence as well as the social, sexual, and health correlates of transvestic fetishism (sexual arousal from cross-dressing). Almost three percent (2.8%) of men and 0.4% of women reported at least one episode of transvestic fetishism. Separation from parents, same-sex sexual experiences, being easily sexually aroused, pornography use, and higher masturbation frequency were significantly associated with transvestic fetishism. A positive attitude to this sexual practice and paraphilia indicators--sexual arousal from using pain, exposing genitals to a stranger, and spying on others having sex--were particularly strong correlates to the dependent variable.
Adult↗
Successful lithium treatment of transvestism associated with manic-depression.
A case of transvestism in a 24-year-old manic-depressive man is described. The behavior had been maintained for 2 years and disappeared soon after lithium treatment was begun. It has not returned during the first year on lithium. Dynamic and behavioral explanations for this unusual therapeutic response are considered. The dynamic explanation involves the assumption that the transvestism was perpetuated by mood-dependent motives that were eliminated by lithium. The behavioral explanation involves the assumption that the manic state itself became an intermittent reinforcer for the transvestism, and the lithium, by eliminating the mania, created a relatively permanent extinction period.
Adult↗
The discrete syndromes of transvestism and transsexualism.
The literature concerning the relationship between transvestism and transsexualism is briefly reviewed. Some workers consider the two conditions to be on a continuum, whereas others feel that they are independent clinical entities. To clarify the relationship between the two syndromes, biographical data were collected and penile volume changes recorded in 29 subjects who identified themselves as transsexuals and 35 who identified themselves as transvestites. In comparison to the transvestite subjects, significantly more transsexuals were younger, were single, cross-dressed fully, and reported homosexual interest, a feminine gender identity, and a desire for a sex-change surgery. In comparison to the transsexual subjects, significantly more transvestites reported heterosexual interest, cross-dressed partially, and had shown fetishistic arousal. It is concluded that transvestism and transsexualism are separate clinical entities.
Adult↗
The clinical syndromes of femmiphilic transvestism.
Thirty-four members of a club established for heterosexual transvestites were interviewed. They were categorized into two groups. Subjects in group I were satisfied with cross-dressing and did not desire additional feminization. Subjects in group II desired to alter their bodily appearance toward female by taking female hormones or by having surgical intervention. Group II transvestites cross-dressed more frequently and had a more intense feminine gender identity and stronger homosexual interests than did group I transvestites. A feminine gender identity appeared to be present from childhood in both groups but to be stronger in group II. Cross-dressing in subjects of both groups often occurred first during childhood and almost always prior to age 15. All subjects showed a period of fetishistic arousal to women's clothes during adolescence. With increasing age, fetishistic arousal diminished or disappeared and the frequency of cross-dressing increased. Terms in the literature used to describe the type of transvestism reported in this study are discussed. It was suggested that the term "femmiphilic transvestism" be used to describe the condition of the subjects of both groups. The term has fewer disadvantages than terms previously suggested.
Age Factors↗
Comparison of transvestism in Australia and America.
Information concerning gender identity, sexual orientation, cross-dressing behavior, fetishism, and bondage was obtained from a questionnaire which was posted to members of two transvestite clubs, one in the United States and one in Australia. This study reports the responses of 136 American and 86 Australian self-designated transvestites who reported a period of fetishism to women's clothes at some stage of development. Characteristics of transvestism of subjects in both countries were remarkably similar; all were male, almost half the subjects first cross-dressed in prepuberty, and in the large majority cross-dressing was well established by late adolescence; intense fetishism was usually experienced during adolescence but waned in later years; in almost a quarter of subjects fetishism ceased, although the desire to cross-dress continued; in many subjects transvestism was associated with fantasies of bondage, usually of the subjects bound while cross-dressed; sexual orientation was predominantly or exclusively heterosexual in more than three-quarters of the subject. Subjects were categorized into two groups. One group, termed nuclear transvestites, were satisfied with cross-dressing. The second group, termed marginal transvestites, desired feminization by hormone ingestion or by surgical intervention. Marginal compared to nuclear transvesites reported significantly stronger feminine gender identity and tended to report a stronger interest in the homosexual direction. The differences appeared to be present from childhood. No significant differences were found between the nuclear and marginal transvestites with regard to characteristics of fetishism, bondage, and cross-dressing except that in the American group marginal transvestites currently cross-dressed more frequently than did nuclear transvestites.
Adult↗
Reversible transvestic fetishism in a man with Parkinson's disease treated with selegiline.
Dopaminergic therapy in patients with Parkinson's disease may change the quality as well as the quantity of sexual interest and behavior. This 72-year-old man had a 37-year history of Parkinson's disease treated with a right thalamotomy and was later treated with levodopa for more than 20 years. Selegiline (5 mg twice daily) was added for motor fluctuations. He developed a frequent impulse to wear women's clothing but did not act on this impulse until his wife died over a year later. He then began to dress in women's clothing an average of once per week. He stated he had never thought of cross-dressing previously. The selegiline was stopped, and his urge to wear women's clothing ceased. Paraphilias are a rare behavioral complication of Parkinson's disease treatment. Other paraphilias have been attributed to dopamine agonists, suggesting that the action of the monoamine oxidase inhibitor responsible for the patient's transvestism in this case was dopamine potentiation. Drug-induced paraphilias and hypersexuality may represent a reversal of the putative premorbid Parkinson's disease personality traits of introversion, cautious behavior, and lack of "novelty-seeking." A biologic basis for transvestism, and paraphilias in general, is not known. Rare clues emerge from cases similar to this one.
Aged↗
Buspirone hydrochloride in the treatment of transvestic fetishism.
The author presents a case report of a 46-year-old man with generalized anxiety disorder and transvestic fetishism who responded to treatment with buspirone. The patient stopped cross-dressing while taking buspirone, but alprazolam had no effect on the frequency of cross-dressing. The author discusses the implications of using buspirone in the treatment of both inhibited sexual desire and transvestic fetishism.
Alcoholism↗
Transvestism: previous findings and new areas for inquiry.
The transvestite is a heterosexual fetishistic cross-dresser. The phenomenology of the disorder reveals individuals to be heterosexual males who have usually married and fathered children. The course of the disorder is unknown. Many transvestites note genital arousal from cross-dressing abates, yet continue episodically to wear women's clothes. A small segment of these individuals become gender dysphoric and seek sexual reassignment. Etiologic explanations include pregenital psychopathology in the genesis of the condition. The treatment for transvestism remains disappointing although behavior modification may offer individuals who wish to change their transvestitic behavior some hope. This review suggests new areas for inquiry and possible research strategies.
Adolescent↗
Prostitution advertisements suggest association of transvestism and masochism.
Previous research and clinical observation have suggested that the sexual interest of many transvestites include involvement in sadomasochistic sexual acts. Through data gathered via prostitution advertisements in print media, we tested the hypothesis that prostitutes welcoming cross-dressing client would be primarily those describing themselves as dominant. The specialty of the prostitute was recorded by coding the advertisements for the presence or absence of the features of dominance, submissiveness, acceptance of cross-dressing clients, and whether the prostitute was a biological male presenting as a woman or quasi-woman. The findings showed that 20% of prostitutes describing themselves as dominant welcomed cross-dressing clients, whereas none of the other subgroups of prostitutes mentioned cross-dressing clients in their advertisements. These findings reinforce other lines of indirect evidence suggesting that, in heterosexual men, the presence of masochism increases the likelihood of transvestism, and vice versa.
Advertising↗
Transvestism in a person with learning disabilities presenting with behavioural problems.
A case of transvestism is reported in a 47-year-old man with learning disabilities. He had developed encephalitis in childhood, which had resulted in moderate learning disabilities and epilepsy, and had been living in institutions from the age of six. He did not have any chance to express his sexual desire and this frustration manifested as aggressive behaviour. Recently, he moved to a community home and his deviant sexual behaviour became apparent. Management of his problems involves organizing a behavioural programme linking his cross dressing with aggressive behaviour.
Encephalitis↗
Motivation for cross-dressing in heterosexual transvestism.
The literature concerning the motivation for cross-dressing in heterosexual transvestism is briefly reviewed. Thirty-three members of a club established for heterosexual transvestites were interviewed. The sensations they derived from cross-dressing and the importance of compulsive and narcissistic aspects in their transvestite behaviour were assessed and compared with those reported by 24 transsexual subjects. While cross-dressed, transvestite and transsexual subjects frequently reported feeling relaxed, comfortable and relieved of masculine demands. Transvestite subjects showed significantly more compulsive and narcissistic aspects in their transvestite behaviour than transsexual subjects. Fetishistic pleasure was infrequently given as a motivation for cross-dressing.
Adult↗
Paradoxical psychotherapy in a case of transvestism.
Paradoxical psychotherapy succeeded in removing the compulsive element and reducing the guilt attached to transvestism in a male transvestite patient. Cross-dressing at home became acceptable to him and the temptation to cross-dress in public ended. Data suggested three independent motivational systems in this patient.
Adult↗
[Synopsis of transvestism and transsexualism (author's transl)].
A general review of literature delivers information about relevant publications pertaining to the question of transvestism and transsexualism. By and large German and Angloamerican literature is quoted on this subject. Consideration has been given to the variations of the syndrome in both males and females. The display of these symptoms is mainly in accordance with the psychopathological structure of the clinical picture. Symptomatologic and psychodynamically related sexual deviations (fetishism, effeminated homosexuality) as well as endogenous psychoses have been considered from a differential diagnostic point of view. The differential nosology characterizes the efforts made in dealing with the heterogenity of the syndromes. Moreover it is indicative of the sexually specific styles of manifestation. In the etiological approach somatogenic (chromosomal, hormonal and cerebral) and psychogenetic types are differentiated. Interesting results in child and family therapy have been mentioned on the latter type. The contributions of psychotherapy, behavior therapy and surgical operations aiming at sexual transformation including their legal repercussions have been given full consideration in the therapy chapter.
Behavior Therapy↗