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The DSM Diagnostic Criteria for Transvestic Fetishism

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Abstract

This paper contains the author’s report on transvestism, submitted on July 31, 2008, to the work group charged with revising the diagnoses concerning sexual and gender identity disorders for the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). In the first part of this report, the author reviews differences among previous editions of the DSM as a convenient way to illustrate problems with the nomenclature and uncertainties in the descriptive pathology of transvestism. He concludes this part by proposing a revised set of diagnostic criteria, including a new set of specifiers. In the second part, he presents a secondary analysis of a pre-existing dataset in order to investigate the utility of the proposed specifiers.

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Notes

  1. Specifiers and subtypes are two different ways of refining DSM diagnoses. Subtypes define mutually exclusive and cumulatively exhaustive phenomenological subgroups within a diagnosis; in contrast, specifiers are not meant to be mutually exclusive or cumulatively exhaustive (DSM-IV-TR, p. 1). The purpose of specifiers, according to the DSM-IV-TR, is to “provide an opportunity to define a more homogeneous subgrouping of individuals with the disorder who share certain features” (p. 1).

  2. I have written about this previously. In Blanchard (2005), I stated, “The emphasis placed by many writers on the physical properties of clothing used for cross-dressing (silky textures, striking colors) likely militated against the realization that erotic arousal at the thought of being a woman could arise with no ideas or actions involving women’s apparel at all” (p. 441).

  3. A great deal of transvestite fiction can be accessed over the Internet. It can be found by using search strings like “transvestite fiction” or “transgender fiction” with an Internet search engine. Much of this material, however, is not free. An exception is the free site http://www.fictionmania.tv/index.html, which contains many thousands of elaborately catalogued stories.

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Acknowledgments

The author is a member of the DSM-V Workgroup on Sexual and Gender Identity Disorders. He wishes to thank his colleagues Maxine Petersen, Robert Dickey, and Kenneth J. Zucker for their stimulating conversations, over many years, about cross-gender behavior and ideation in nonhomosexual biological male patients. Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders V Workgroup Reports (Copyright 2009). American Psychiatric Association.

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Authors and Affiliations

  1. Kurt Freund Laboratory, Law and Mental Health Program, Centre for Addiction and Mental Health, 250 College St., Toronto, ON, M5T 1R8, Canada

    Ray Blanchard

  2. Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Ray Blanchard

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  1. Ray Blanchard
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Corresponding author

Correspondence to Ray Blanchard.

Appendix

Appendix

Diagnostic Criteria for Transvestism in DSM-III (1980)

  1. A.

    Recurrent and persistent cross-dressing by a heterosexual male.

  2. B.

    Use of cross-dressing for the purpose of sexual excitement, at least initially in the course of the disorder.

  3. C.

    Intense frustration when the cross-dressing is interfered with.

  4. D.

    Does not meet the criteria for Transsexualism.

Diagnostic Criteria for Transvestic Fetishism in DSM-III-R (1987)

  1. A.

    Over a period of at least six months, in a heterosexual male, recurrent intense sexual urges and sexually arousing fantasies involving cross-dressing.

  2. B.

    The person has acted on these urges, or is markedly distressed by them.

  3. C.

    Does not meet the criteria for Gender Identity Disorder of Adolescence or Adulthood, Nontranssexual Type, or Transsexualism.

Diagnostic Criteria for Transvestic Fetishism in DSM-IV (1994)

  1. A.

    Over a period of at least 6 months, in a heterosexual male, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving cross-dressing.

  2. B.

    The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:

  • With Gender Dysphoria: if the person has persistent discomfort with gender role or identity

Diagnostic Criteria for Transvestic Fetishism in DSM-IV-TR (2000)

  1. A.

    Over a period of at least 6 months, in a heterosexual male, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving cross-dressing.

  2. B.

    The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:

  • With Gender Dysphoria: if the person has persistent discomfort with gender role or identity

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Blanchard, R. The DSM Diagnostic Criteria for Transvestic Fetishism. Arch Sex Behav 39, 363–372 (2010). https://doi.org/10.1007/s10508-009-9541-3

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