Transvestic Disorder Fast Facts

Transvestic disorder is a mental health-related issue in which a person is sexually aroused by dressing in clothes traditionally associated with another gender, and their sexual urges or behavior causes them distress.

Transvestism is considered an outdated term. The preferred term for dressing outside of conventional gender norms is cross-dressing.

Cross-dressing is most common in heterosexual men.

Transvestic disorder differs from cross-dressing in that its behavior involves distress. People who cross-dress do not have the disorder unless their symptoms cause them distress or harm to other people.

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Transvestism is considered an outdated term. The preferred term for dressing outside of conventional gender norms is cross-dressing.

What is Transvestic Disorder?

Transvestic disorder is a mental health-related issue in which a person is sexually aroused by dressing in clothing typically associated with another gender. Dressing in this way was once called transvestism, but the currently preferred term is cross-dressing. Cross-dressing in itself is not a mental disorder. It is only considered a disorder when it causes significant psychological, emotional, or physical distress in the person engaging in it.

Symptoms of Transvestic Disorder

Common symptoms of transvestic disorder include:

  • Sexual arousal, fantasies, or urges involving cross-dressing
  • Inability to be aroused by sexual activity not involving cross-dressing
  • The behavior, urges, or fantasies cause distress or impair a person’s ability to function at home, school, or work

Misconceptions About Cross-Dressing

Cross-dressing has long been misunderstood and inaccurately associated with mental illness.

  • Cross-dressing does not correlate with homosexuality. Most people who cross-dress are heterosexual.
  • Cross-dressing is not always associated with sexuality. Some people cross-dress to experiment with identity or gender norms without a sexual component to their behavior. Even when sexual arousal is initially associated with cross-dressing, the association often decreases over time.
  • People who cross-dress are not necessarily transgender or experiencing gender dysphoria. Most people who cross-dress do not feel a disconnection between their gender identity and the gender they were assigned at birth.

What Causes Transvestic Disorder?

The cause of transvestic disorder is unknown, but different factors likely trigger it in different cases. Scientists believe that physical, medical, and psychological factors may all play a role in producing the disorder’s behavior.

Studies have indicated that most people with cross-dressing urges have felt those urges since childhood, but research has not definitively identified any common causal factor that may underlie the behavior.

Is Transvestic Disorder Hereditary?

Some studies have attempted to find an explanation for why sexual disorders such as transvestic disorder sometimes seem to cluster in individual families. While these studies suggest that a genetic component could play a role in the development of the disorders, no specific link between genes and the disorders has been found.

How Is Transvestic Disorder Detected?

Cross-dressing urges usually emerge in late childhood, but in most cases, the urges never cause distress or impairment. Warning signs that the urges may be approaching a diagnosable disorder can include:

  • Unusual preoccupation with sex during childhood
  • Sexual fantasies that cause distress or impairment
  • Only being aroused by cross-dressing fantasies or acts
  • Relationship conflicts caused by the person’s fixation on cross-dressing

How Is Transvestic Disorder Diagnosed?

Diagnosis of transvestic disorder begins by ruling out medical problems that may be causing symptoms. After these exams, if the doctor suspects that transvestic disorder is the cause of the symptoms, they may recommend a psychological or psychiatric assessment.

Diagnostic steps may include:

  • A physical exam. This exam aims to rule out physical conditions that could be causing the symptoms.
  • Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history.

After medical causes are ruled out, medical professionals can consider whether the patient meets the diagnostic criteria for transvestic disorder. These criteria include:

  • The person is consistently aroused by fantasies, urges, or acts that involve cross-dressing.
  • The symptoms cause significant impairment in social situations, work, or elsewhere.
  • The symptoms have been present for at least six months.

It is important to note that being aroused by cross-dressing is not a sign of the disorder. Doctors will consider the diagnosis only if the urges or acts cause distress or impairment.


How Is Transvestic Disorder Treated?

In most cases, cross-dressing urges do not cause distress or impairment and do not require treatment. Treatment is usually only required if the person experiencing the urges is troubled by them and requests treatment. Doctors may also recommend treatment if a person’s urges or activities put them at risk of real physical harm.

Common treatment options for transvestic disorder include:

  • Support groups
  • Cognitive-behavioral therapy, which teaches a person to recognize the situations that trigger their urges and develop new, healthy ways to cope with those situations.

Medications are not typically used to treat transvestic disorder, but antidepressant medications, usually serotonin reuptake inhibitors (SSRIs), are sometimes used to treat co-existent mental health-related issues.

How Does Transvestic Disorder Progress?

In most cases, cross-dressing does not cause harm and doesn’t require treatment.

When cross-dressing rises to the level of transvestic disorder, it can produce emotional and social consequences, such as:

  • Guilt or shame
  • Anxiety or depression
  • Relationship difficulties
  • Social isolation

How Is Transvestic Disorder Prevented?

There is no known way to prevent transvestic disorder. However, treatment may relieve the effects of the disorder and make it less likely that the sufferer will experience severe complications over time.

Transvestic Disorder Caregiver Tips

Some people with transvestic disorder also suffer from other brain and mental health-related issues, a condition called co-morbidity. Here are a few of the issues commonly associated with the disorder:

  • Some people with the disorder also suffer from depression.
  • Some people with the disorder have a co-existing anxiety disorder.
  • People with transvestic disorder sometimes have co-morbid gender dysphoria.

Transvestic Disorder Brain Science

Fetishistic disorder is classified as a paraphilic disorder. These disorders involve sexual arousal induced by unusual situations, objects, or targets of arousal. Common paraphilias include:

  • Masochism
  • Voyeurism
  • Exhibitionism
  • Pedophilia

Paraphilias are not inherently considered to be disorders. Some people have sexual interests or urges that others may regard as unusual but don’t cause distress or harm. Factors that make a paraphilic interest cross the line to a disorder include:

  • The urges or acts are illegal (e.g., pedophilia).
  • The urges or acts involve non-consenting targets (either children or non-consenting adults).
  • The urges or acts have the potential to cause harm.
  • The urges or acts cause significant distress or impairment to the person experiencing them.

Transvestic Disorder Research

Title: Acute Intense Paraphilic Desire (DSM-V) Down-Regulation Via taVNS Modulation [Transcutaneous Afferent Vagus Nerve]

Stage: Not Yet Recruiting

Principal Investigator: Athavan Gananathan, MD

American University Of Montserrat

Montserrat, West Indies

Transcutaneous Afferent Vagus Nerve Stimulation [taVNS] is used to modulate persistent & intense desire control amongst a specific participant group.

The physiologic effects of taVNS stimulation have been extensively researched for over 100 years. Drug-resistant depression (MDD), migraine headaches, pelvic pain modulation, facilitation of motor learning in neonates, post-stroke rehabilitation, and seizures are some of the conditions investigated with favorable results using taVNS intervention. taVNS physiologic & mental effects have been noted to have advantageous therapeutic results on a vast diagnostic spectrum.

A clinical testing program for pre- and post-test was devised as a means to identify & measure treatment effects in specific T3, 4, and early 5 (Tanner) sub-group visual stimulation. The programmatic (software) of the stimulation medium created for this study aims to abate the use of a phallometric device purposed to measure sexual stimulation effects on participants.

Great effort has been assigned to the preservation of visual data to be shared in the investigators’ research center with other researchers internationally. The participant testing platform created for this study allows for full-proof research ethics anonymous & confidential registry & testing process (triple blind).

Aggressive optimum (supra-threshold and below-pain threshold) taVNS is the therapeutic modality of choice to examine desire down-regulation effects using taVNS. DSM-V stock participants must be sub-grouped in the paraphilic categorical structure of the DSM-V.


Title: Optimizing a Multi-Modal Intervention to Reduce Health-Risking Sexual Behaviors: Component Selection

Stage: Recruiting

Principal investigator: Ryan R. Landoll, PhD

Uniformed Services University of the Health Sciences

Bethesda, MD 

The goal of this project is to evaluate the components of the app-based intervention Mission Wellness to reduce health-risking sexual behaviors (HRSBs; e.g., condom non-use, multiple sexual partners) in active-duty US Military members to improve their sexual and reproductive health (SRH) and readiness to serve. Following the multiphase optimization strategy (MOST) framework, factorial component selection experiments (CSEs) will be conducted to evaluate which five experimental intervention components (i.e., Narratives, Skills, Scenarios, Future, and Risk) elicit the greatest improvements in the outcomes of interest given key constraints.

Negative SRH outcomes (e.g., sexually transmitted infections [STIs], unintended pregnancy, STI-related cancers) reduce human performance and undermine military readiness. Service members face unique challenges in maintaining SRH during their military service. HRSBs (e.g., multiple sexual partners, unprotected sexual behavior) offer potential intervention targets to improve SRH. Electronic-health interventions are cost-effective and dynamic and have the potential to reach millions of users as part of an overall strategy for individual behavior and systems change. In civilian populations, e-health interventions have demonstrated success in reducing HRSBs. However, effective HRSB-prevention interventions must consider the specific values, mission, and context of military populations and settings. The MOST framework is used to develop highly effective, efficient, and economic behavioral interventions that are particularly well suited to be used in this context.

This project aims to address this problem by delivering an optimized app-based prevention intervention package ready for evaluation via a subsequent randomized controlled trial (RCT). The specific purpose of this project is to determine which component(s) should be included in the packaged app-based intervention Mission Wellness for US service members based on their effects on the outcomes of interest (i.e., improved knowledge, motivation, and behavior skills related to SRH and reduced HRSBs) in no more than 25 minutes of content. The components tested in the factorial CSEs include Narratives; Skills; Scenarios; Future; and Risk. Each component has two levels: “on” (included) or “off” (not included). The main and interaction effects of components will be measured to determine the components constituting the packaged intervention.


Title: Study of Maintenance of the Efficiency and Adverse Effects of Pharmacological Treatments in Sex Offenders With Paraphilia (ESPARA)

Stage: Not Yet Recruiting

Study Chair: Florence Thibaut, MD/PhD

Hospital Cochin

Paris, France 

This research concerns the evaluation of the maintenance of the efficiency and incidence of adverse effects of pharmacological treatments in sex offenders with paraphilia.

Despite the increasing use of pharmacological treatments in these indications, few data indicate which sex offender populations benefit from which pharmacological treatments and which adverse events are observed, particularly with anti-androgens or antidepressant treatments that are widely used in these subjects. A recent Cochrane study showed that psychodynamic treatment is less effective in terms of sexual delinquency compared to probation alone and has not demonstrated significant efficacy of cognitive-behavioral therapy (CBT) compared to the lack of treatment, except for a study in which anti-androgen therapy was associated with CBT. Another recent study concluded that the tolerance, even of anti-androgenic drugs, was uncertain, as all studies were small and of limited duration. New research is needed in the future. Further research demonstrating the efficacy of SSRIs in treating paraphilic disorders is still required, and long-term studies are lacking. Their use for this indication is still off-label.

As far as the researchers know, this cohort should be the largest population of paraphilic sex offenders studied for the longest time to date in a field where research is insufficient. This large sample receiving routine care and followed for three years should allow for analyzing the maintenance of the effectiveness of the pharmacological treatments received (SSRIs or anti-androgens) and their tolerance. In addition, this analysis of clinical practices should be crucial to improve the knowledge of the indications for these treatments, which could be reviewed concerning their effectiveness and tolerance, especially in the most serious cases of paraphilic sex offenders.

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