2150 words
Abstract
Transvestic Disorder comes about in early childhood and manifests itself in sexually deviant actions. Men suffering from TD who aren’t homosexual, more likely than not, show attraction to themselves dressed in women’s clothing. The signs of TD are noticed at an early age when the individual begins to cross dress. TD is also correlated highly with numerous sexually deviant actions. Fluoxetine and serotonin reuptake blockers may be able to lessen TD since it is an impulsive disorder. With TD being co-morbid with OCD, by treating OCD we can better treat TD itself and give a better quality of life to the patient suffering from the disease. Since autogynephilia and transgenderism are related, measures taken to alleviate TD and autogynephilia could be taken to alleviate symptoms of gender dysphoria, since autogynephilia leads to transgenderism.
Transvestic Disorder and Gender Dysphoria Identification and Prevention
Transvestic disorder is a paraphilic disorder, classified by the American Psychological Association (2013), in which males dress up as women to gain sexual gratification. The individual suffering from TD suffers from compulsions to want to dress as a woman, which causes distress due to the individual not wanting their secret to come out. This then leads to the quality of life of the individual to decrease due to constantly being worried about his secret coming out. TD is diagnosed when a male has sexual feelings and gets sexual arousal from dressing in women’s clothing. It is only diagnosed when these activities are ongoing for at least six months. TD is also similar to another paraphilic disorder called ‘autogynephilia’ (Lawrence, 2011), in which the subject is aroused at the thought of himself being a female, so he, therefore, then begins to dress as a woman to fulfill his sexual desires. Blanchard (1989) proposed that most gender-dysphoric males who do not show sexual arousal to men, instead show sexual arousal to themselves dressed in the opposite sex’s clothing. He concludes that the hypothesis is supported that major types of those men who cross-dress are nonhomosexual, and do so because they become aroused at the thought of dressing as a woman. The DSM V says that autogynephilia is a specifier to transvestic disorder. This is because they are characterized by the same things (American Psychological Association, 2013).
The signs of TD are noticed at very early ages. Most notable are when children begin to cross-dress at or before puberty. This then continues into their adult lives where it begins to be a problem and cause dysfunction due to needing to keep their secret. Dr. Mark Griffiths (2012) states that all though children may engage in transvestic behavior, what differentiates it between an adult suffering from TD is that the child who cross-dresses does so for excitement and pleasure, not for sexual pleasure. Though some researchers say that the disorder is brought on through childhood trauma, i.e., accidental exposure to women’s clothing or exposure to a woman who is undressing. Numerous studies have also concluded that many men who suffer from TD have had to deal with parental separation during childhood.
The American Psychological Association (2013), reports that fewer than 3 percent of males are characterized as having transvestic disorder. TD is most always seen in males, though Moser (2009) noted that in his study using the Autogynephilia Scale for Women (ASW), that out of the 29 respondents that sent back questionnaires, 90 percent would be classified as having autogynephilia. Though, by using a more meticulous definition, only 28 percent were seen to be autogynephilic (Moser, 2009).
Langstrom and Zucker (2005) observed in a sample of 2,450 18 to 60-year-olds in Sweden that transvestic disorder was correlated significantly with being separated from their parents, homosexual relations, higher masturbatory frequency, being easily aroused sexually and pornography use. Also noticed, was a positive attitude in regards to sexual arousal from pain, exposing oneself to a stranger and voyeurism were all positively correlated with TD. Langstrom and Zucker observed how TD is co-morbid with many other paraphilic disorders as well as other deviant behavior. By attempting to treat what TD is correlated with, symptoms of TD can be lessened.
Men suffering from TD and autogynephilia are told that women are the standard of beauty. They then look at themselves in the mirror and see a male and not the standard of beauty they were told of growing up. They then turn to cross-dressing to finally see their “beauty standard” in the mirror but keep it a secret. This strong want to keep their disorder a secret then leads to dysfunction. Men suffering from TD will go to any lengths to hide their secret. This then causes extreme dysfunction in their lives, which leads to a lessened quality of life.
Less than three percent of males suffer from TD in the American population, as such, it is classified as a deviant lifestyle as it deviates from the norm of the population. It causes distress due to them not wanting their secret to be discovered. This, in turn, leads to dysfunction where the individual cannot live their daily lives to the fullest due to their abnormal disorder. It finally leads to danger due to their secret beginning to consume their lives so that they’re not discovered.
There are ways to treat TD. Usmani et al (2012) follow a case study in which a 17-year-old Indian male who had occurring desires to wear his mother’s clothes. He then would masturbate in his mother’s clothes to alleviate himself. This continued on for two years so he could pleasure himself. He was caught by his parents wearing his mother’s clothes and was beaten by them for it. He then said that it is a compulsive behavior and cannot be helped. This case also shows the obsessive compulsive side to TD. They have an urge so strong they cannot help but to do it compulsively to alleviate their sexual desires. He also said that the occurring thoughts then affected his schoolwork as he was so preoccupied with the thought of wearing women’s clothes. All of his brain scans were found to be normal, so what brought on this case in the individual in the case study? He was then diagnosed with TD and prescribed fluoxetine, an antidepressant SSRI. The dose was started at 20 mg and increased by 40 mg once a day for two weeks. In his six-month follow-up, he reported lessened desire to masturbate with women’s clothes (Usmani et al, 2012).
Paraphilias and other related disorders have been thought of as sexual addictions. Though it has been argued that they are not sexual addictions, but are sexual compulsions (Stein et al, S 1992). The researchers reviewed 13 patients who showed signs of TD and were administered serotonin reuptake blockers. The symptoms of those individuals were then divided into paraphilias, non-paraphilic sexual addictions, and sexual addictions. Stein et al discovered that paraphilias had the least improvement with the reuptake blockers whereas sexual compulsions showed the best improvement. They end up concluding that paraphilias and other related disorders are on the impulsive end of the spectrum compared to the compulsive end. These impulsions, then, have those men suffering from TD have the urge to dress in women’s clothes to fulfill their sexual impulsion.
TD is co-morbid with obsessive compulsive disorder (Abdo, Hounie, de Tubino Scanavino, and Miguel, 2001). They used longitudinal case studies in which they assessed two individuals who had OCD as well as TD. They conclude that some cases of TD may be OCD related and not always be caused by gender dysphoria. Since OCD and TD are co-morbid, by treating symptoms of OCD, the want to cross-dress will lessen, which will then lessen the symptoms of TD. Treatments could include SSRI and fluoxetine, as previously stated in the paper. Other treatment for TD should be looked at, such as treatment for OCD due to the co-morbidity between the two. By doing so, feelings of wanting to cross-dress may lessen due to one of the underlying causes (OCD) of TD being treated.
Autogynephlia could also explain transgenderism.Transvestism can be called both a paraphila and a sexual orientation. Lawrence (2004) says that it can explain mid-life MtF transitions, progression from transvestism to transgenderism, the prevalence of other paraphilias among MtF transsexuals and the late development of male intrest in MtF transsexuals. However, when Lawrence says that “Hormone therapy and sex reassignment surgery can be effective treatments in autogynephilic transsexualism”, that is incorrect. The prevalence of suicide attempts among transgenders is 41 percent according to the Williams Institute, UCLA School of Law, in comparison to 4.6 percent for the average population. That’s almost ten times higher than the national average. Clearly, surgery doesn’t do anything to alleviate the feelings of gender dysphoria, and as shown in this paper, therapy and drugs like Prozac can better help to alleviate feelings of gender dysphora in transsexuals due to them being extremely similar to eachother. These two disorders greatly mirror each other. Since Lawrence (2004) observed that there is a progression from transvestism to transgenderism, using similar techniques that work on those with TD may also work on those with gender dysphoria.
Discussion
TD can be helped with the correct therapy as well as right medication. With those, impulsions to wear women’s clothes, as well as impulsions to commit abnormal acts will be greatly lessened and quality of life will be restored to a somewhat normal level. Due to co-morbidity between TD and OCD, treating OCD will, in turn, better help the patient suffering from TD. When more studies are carried out on those suffering from TD, we can see whether or not SSRI drugs and fluoxetine will have the desired effect in alleviation of the symptoms of TD. The individual in the Usmani study reported lessened symptoms and impulsions of cross-dressing, so by identifying which parts of the brain are and were activated during the fluoxetine therapy, we can then better give better care and treatment to those suffering from TD. We can also use some data from TD cases for transgenders, as TD and transgenders have a lot of things in common. With therapy as well as, maybe even fluoxetine (which is just Prozac), and high doses of testosterone/estrogen, this could possibly help to alleviate ‘gender dysphoria’. It could also lower the suicide rate as it’s completely possible that these interventions could fix them mentally.
Conclusion
There is little current literature in treating TD, due to it being a shameful disorder and many men not speaking about what they suffer from. One major way in which to help those with TD is to administer SSRI drugs, in which compulsion to cross-dress, and other attitudes associated with TD lessened. Blanchard (1989) proposed the autogynephilia theory for those transgenders who are not attracted to men. With the obseration by Lawrence (2004) on how autogynephilia and transgenderism are related, this can better help those with transgenderism, as they can get correct help and the right hormones they need, instead of the opposite hormones. SSRI therapy is a good candidate in treating TD, as drastic changes in deviant behavior are seen while the patient is taking the SSRI drug. Seeing as most cases of TD begin in childhood before puberty, by better identifying warning signs of these disorder, we can better treat those children who are at risk of developing these disorders before they become a big problem later in life. As more men come out and say that they suffer from these disorders, more studies can be carried out that corroborate the findings in the studies laid out here. It is extremely promising that these disorders can be treated with common drugs already on the market. In those individuals suffering from TD as well as OCD, by treating the OCD first (which may be an underlying cause) the symptoms of TD may be lessened and the individual may eventually have the ability to lead a life without TD. In using these measures on those with transgenderism, this could possibly alleviate suicide rates and other negative variables associated with these paraphilic disorders and sexual orientations.
References
Abdo, C.H.N., Hounie, A., de Tubino Scanavino, M., & Miguel, E.C. (2001). OCD and transvestism: Is there a relationship?. ACTA Psychiatrica Scandinavica, 103(6
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Blanchard, R. (1989). The Concept of Autogynephilia and the Typology of Male Gender Dysphoria. The Journal of Nervous and Mental Disease, 177(10), 616-623. doi:10.1097/00005053-198910000-00004
Griffiths, M. (2012, February 28) Dressed to thrill? A brief overview of transvestic fetishism. Retrieved from https://drmarkgriffiths.wordpress.com/2012/02/28/dressed-to-thrill-a-brief-overview-of-transvestic-fetishism/
Lawrence AA . Autogynephilia: An Underappreciated Paraphilia . In: Balon R, Hrsg . Sexual Dysfunction: Beyond the Brain-Body Connection. Adv Psychosom Med 2011 ; 135 – 148
Långström, N., & Zucker, K. J. (2005). Transvestic fetishism in the general population: Prevalence and correlates. Journal of Sex and Marital Therapy, 31, 87–95
Moser, C. (2009). Autogynephilia in Women. Journal of Homosexuality, 56(5), 539-547. doi:10.1080/00918360903005212
Stein DJ, Hollander E, Anthony DT, Schneier FR, Fallon BA, Liebowitz MR, Klein DF: Serotonergic medications for sexual obsessions, sexual addictions, and paraphilias. J Clin Psychiatry 1992; 53:267–271
Usmani et al, (2012) Treatment of Transvestic Fetishism With Fluoxetine: A Case Report. Iran J Psychiatry Behav Sci. 2012 Autumn-Winter; 6(2): 100–101
NotPoliticallyCorrect 
Sad to say, this essay mixes and conflates several quite separate and distinct issues… so, to correct the record
1) Tranvestism is a subset of autogynphilia
2) Autogynephilia is a subset of Erotic Target Location Errors which include but are not limited to autopedophilia and apotemnophilia
3) Autogynephilia, like most paraphilias, tends to co-occur with other paraphilias, most notably BD/SM, usually as “submissive” / masochistic.
4) There is NO correlation with OCD and the paraphilias, including autogynephilia. This inclusion in this essay above is a red herring. Attempting to treat autogynephilia as though it was related to OCD is counter productive.
5) There is only one known treatment for paraphilias that reduces its impact… that is chemical castration, which works to reduce libido, as all paraphilias, including autogynephilia, is a subset of conventional sexual function. Ironically, treatment with anti-androgens and cross-sex HRT is just such a treatment. However, though it reduces sexual arousal, it only rarely reducing autogyephilic desire and subsequent gender dysphoria.
6) There are NO known psychogenic causes of any of the paraphilias including autogynephilia. Such hypotheses are a hang-over from the pseudo-scientific ideas of Freud and his ideological descendents. Such ideas as “childhood trauma”, accidental exposure to cross-dressing, etc. as the cause of autogynephilia are pure bunk.
For more (and correct) science information on this and related topics:
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Autogynephilia also leads to transgenderism in older males. See Lawrence 2004.
Yes it is. Which means that transgenderism would fall under this category as well (some cases, of course).
Most paraphilias are sexual compulsions. Paraphilias are co-morbid with each other, I agree.
In some cases, as shown in Abdo et al (2001), transvestism is co-morbid with transvestic disorder. So SOME cases of transgenderism could be co-morbid with OCD.
Usmani et al showed that Prozac alleviated feelings of TD. Some paraphilic disorders are treatable with drugs. Prozac reduced sexual arousal and feelings of TD.
Paraphilias like TD are shown to be compulsive acts. I know that Freud is a hack, but he is somewhat right in some aspects. The studies I cited have a big enough sample to draw the conclusions made. Since some paraphilias, as I’ve shown, can be treated with drugs like Prozac and SSRIs, it shows a biologic component. Of course environmental effects such as exposure to female clothes as a child, may have one who is more inclined to have TD gravitate towards it.
In some late MtF transsexuals, autogynephilia precedes the transgenderism, explains transitions from transvesitsm to transsexualism, the prevalence of other paraphilias amongst transgenders, and explains late interest in men as sexual partners (Lawrence, 2004).
By identifying autogynephilia first and treating it correctly, we can prevent some cases of transgenderism, since in some cases TD and autogynephilia precede transgenderism.
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Still wrong… Any disorder can be co-morbid with any other disorder… but there is NO correlation with OCD and ETLE such as autogynephilia. Please don’t conflate the two. It serves no purpose.
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Maybe you missed this:
Lawrence (2004)
The fact that the two paraphilias show the same symptoms as well as one paraphilia leading to the other (TD leading to TG), this shows that in some cases, as seen above in Lawrence (2004) as is the case with middle-aged men who become TG, autogynephilia can explain those cases.
There is a correlation. It’s obvious, and Lawrence shows the relationship, corroborating Dr. Mchugh’s theory.
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Oh… and referecing McHugh? He is not a scientist, but an anti LGBT activist who substitutes religious bigotry for paliative medicine: https://sillyolme.wordpress.com/2015/06/10/a-wither-spoonful-of-poison/
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Dr. McHugh is most definitely a scientist, just because his views stand opposite of yours doesn’t not make him a scientist. His autogynephilia typology has been corroborated by other researchers not named “Paul McHugh”.
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Ummm…. the typology accepted by ACTUAL sexologiest was developed by Kurt Freund and Ray Blanchard… which you would know if you had bothered to read my essays where I cite just about every one of the relevant papers. McHugh publishes in fake science journals edited by anti-LGBT activists, supported by radical right wing groups like the Witherspoon Institute.
Again, there is NO relationship between Autogynephilia (a term coined by Dr. Blanchard, NOT McHugh) and OCD. If there had been, then it could be treated as such… and would have been… instead of being treated with a very different protocol, as supported by the American Psychiatric Association:
Click to access fulltext.pdf
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You do know that just because something has mainstream backing doesn’t make it the most concrete best bet for a ‘cure’, correct?
Excuse my mistake. I clearly know who invented the autogynephilic typology as it’s in my article.
And I can say that anything showing the opposite of McHugh’s findings are funded by radical left-wing groups. Where would that lead us? The data matters.
See other reply. Attacking McHugh’s ‘supposed’ character says nothing about his work or his research. It’s just a cop-out.
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Please do try to find a left-wing organization that has a)first acknowledged that Autogynephilia is the main cause of late transitioning transsexuality (oh, wait… the whole time you’ve been arguing with me you thought that I dismissed that part? Silly ol’ you… ya should have READ my blog) and then b) bothers, as I do, to point out that autogynephilia is NOT related to OCD, but to Erotic Target Identity Disorders.
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It was an example. You shouldn’t throw things away due to something like that, you should look at the research.
Lawrence (2004) said it.
There are case studies and people with OCD have autogynephilic thoughts. The case study of the boy I cited from Usmani et al showed that he had OCD-like thoughts that drove him to dress in and masturbate in his mother’s clothes to alleviate himself.
It does serve a purpose, because these things can be cured (see Cambridge Textbook of Effective Treatments in Psychiatry).
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Maybe you missed this:
MY WHOLE BLOG !!!! I’m an EXPERT on the subject and know Anne Lawrence, the author you site, personally. Please read:
https://sillyolme.wordpress.com
Quite simply, once again, there is NO RELATIONSHIP between autogynephilia and OCD, none, nada, zip… and suggesting that treating autogynephilia as one would OCD is like treating migraine with an enema… both useless and silly.
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Autogynephilic Behavior Addiction
Who we know, experts on this or that, meaningless. The data matters most and Ive shown the correct data and have drawn the correct conclusions from what Ive cited.
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Which is why you linked to a propoganda film maker and not to real science papers which would say what? That AGP is NOT related to OCD?
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1) TD and autogynephilia are similar. 2) Those with autogynephilia have obsessive compulsive thoughts, to dress like women. 3) Autogynephilia and TD are linked, as shown in my article. Therefore, autogynephilia leads to feelings of OCD. They feel a COMPULSION to dress like women.
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This is NOT a OCD… but a DESIRE… just as straight men have an overwhelming desire to have sex with attractive (and available) women. Desire is powerful. It can drive men to make stupid decisions… like devorcing a good woman to take-up with a young gold-digger… but we don’t say that such men have OCD !!!
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The fact of the matter is, they show a compulsion to dress like women and alleviate themselves doing it.
Transsexuals are “consumed with the need to be female.” (See Comer, 2013. Fundamentals of Abnormal psychology, pg 358). Autogynephilia leads to mid-age transitions for some males (Lawrence, 2004). As you can look up and see for yourself, even transsexualism is treatable (see Tyrer and Silk 2008, Cambridge Textbook of Effective Treatments in Psychiatry, pg. 711).
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Still not evidence of OCD… OCD is treatable with SRIs, AGP is not. Folks have tried that treatment and the results were not promissing. AGP is a paraphilia, NOT a subset of OCD. Please give it up… repetition of false information will never make it true.
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I gave a sound argument and showed how it’s related, still not good enough for you. I know that autogynephelia is a paraphilia. Doesn’t mean that it can’t be co-morbid with autogynephelia (it often is).
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I’m gonna go with Race Realist. Anyone who shouts “MY WHOLE BLOG !!!! I’m an EXPERT on the subject and know Anne Lawrence…” is commanding you to accept their position on a subject. Not gonna happen. Demanding that YOU are THE expert on a subject will only get you ignored. Good work, and way ahead of it’s time.
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