A Look at Transvestic Fetishism and Cross-Dressing

A fierce debate is raging both within and outside of the mental health community about whether fetishistic cross-dressing can be classed as a mental disorder or considered a form of sexual deviance. The debate is intense in part because of an alarming gender double standard: women wear stereotypically masculine garments every day with little consequence, and sometimes do so for sexual reasons, though this is not widely understood.

What is considered deviant is entirely socially-prescribed, as are the gender norms that  govern a great deal of male and female behavior. In a culture that rewards men for masculinity and punishes them for attributes relegated to women, it is considered unacceptable and even disordered for men to dress in women’s garments, and especially to find sexual satisfaction from doing so. The very idea is aberrant insofar as it threatens to dismantle what is manly about men, even while there may be, in reality, no actual threat.

The reasons for punishing social stigmas around gendered behaviors may be evolutionary. If men or women begin to behave in ways out of alignment with social prescriptions for their genders, the group becomes unstable, thereby placing its future – i.e., its potential offspring – at risk. Punishing members who defy norms is a long standing mammalian instinct; wolves do it, chimpanzees do it, humans certainly.

Paraphilia

A paraphilia is a condition in which a person’s sexual arousal and gratification is strongly linked to objects or people outside the norm. Sometimes paraphilias are dangerous or illegal, such as in the case of necrophilia or pedophilia, but this is not always the case. For example, there is foot fetishism and nasophilia, attraction to noses. Transvestic fetishism, the term applied to the act of cross-dressing for sexual pleasure, is such an example – a behavior that is neither  dangerous nor illegal.

Transvestic fetishism should not be confused with female impersonation – those who dress in female clothing to entertain – or with transsexualism, those who feel strongly that their sex (biologically assigned genitals) does not match their gender (internal understanding of one’s identity) and so may cross-dress to feel a stronger sense of alignment between the two.

The American Psychiatric Assn. lists transvestic fetishism in latest revision of the manual for diagnosis of mental illnesses, the Diagnostic Manual of Mental Disorders.

Questions of Gender and Sexuality

A predominantly misunderstood fact is that the vast majority of transvestic fetishists are heterosexual men, although some may be bisexual. Associating men who cross-dress with homosexuality is a large part of the stigmatizing force that causes men to remain secretive about their habits even when it may be beneficial for them to tell.  Although all people who find sexual gratification in a particular clothing item associated with the opposite sex (or from dressing entirely as that sex at times) may not feel ashamed or concerned or in any other way suffer undue stress regarding their desires, many others do. This is where a diagnosis may have some benefit.

When an issue is considered to create dysfunction in the life of its bearer, therapy – whether medical, psychological, or a combination – is believed to be a best course of action. An issue is acknowledged to be a dysfunction when it can be shown to cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The Problem of Dysfunction

Here’s an example: A Marine veteran in his early 20s acquired a fetish for wearing women’s underwear. He at first fantasized about it and felt a rush of excitement. When he finally acted on it, he experienced a sexual thrill. In the beginning, he borrowed the undergarments from his lover, but began to keep them and lied when she asked if he’d seen any of her missing panties. His thrill became layered with a psychological tension; lying to his girlfriend and hiding her panties that he felt he could never return. His thrill was heightened when he began to purchase new women’s undergarments for himself that he began to wear under his clothing to work. It was a secret only he knew–until his new girlfriend discovered several pairs of underwear that were not hers. He felt forced to lie again, ending this relationship. In his 30s, his habit had become more than sexual. It felt almost like an addiction, and one he felt a great deal of shame and secrecy about. He began changing in the bathroom at his office before going home to his wife, but one evening he was seen changing under the stall when he dropped a garment. Now someone in his office knew and he felt sick and worthless and burdened by the idea that his homophobic officemate believed him to be gay. At home, his wife knew about his habit but had made it clear that she wanted him to stop. She found his cross-dressing confusing and it frightened her.

In this example, our fetishist can be considered to experience significant distress. What began as a thrilling fantasy with layers of excitement built around its secrecy becomes something he struggles to hide and feels he must lie about, causing him cognitive dissonance and psychological distress. When he is caught, relationships that matter to him end. Relationships with colleagues are eventually compromised and he begins to lose his sense of self-worth, his dignity. He feels more and more that a practice that once held excitement and gratification is now a burden; that it is like an addiction, one that has the power to hurt his marriage and his career.

Not all sexual fetishists and certainly not all transvestic fetishists feel disabled or distressed by their desires, but some do. Anything that may hold this kind of debilitating power—no matter what it is—should be looked at with a compassionate and therapeutic eye, though not necessarily because it is a behavior that society has historically perceived as outside the norm. Only in the last several decades has homosexuality been removed as a diagnosis for a mental disorder by the APA. It is now considered therapeutic best practice to encourage patients to accept their homosexuality.

The benefit of any disabling disturbance bearing a diagnosis is that more people would be able to be treated by trained professionals, more professionals would be able to be adequately trained in the subject, and more insurance companies would pay for the services rendered. The harm of having a mental illness diagnosis for certain paraphilias that are not illegal or dangerous but merely outside the norm is that they perpetuate the stigmatization of marginalized groups and serve to further malign and stereotype individuals who might otherwise have little to no dysfunction without the continued stigmatization. These are cultural problems and although psychology and medicine are institutions, those engines with the greatest power to influence culture, it takes the work of individuals acting on their own to change the tides.