Transvestic Fetishism - Clinicals, Diagnosis, and Management

Sexual and gender identity disorders

Clinicals - History

Fact Explanation
Cross dressing In an individual with transvestic fetishism cross dressing can begins soon after puberty. Initially cross dressing is done only in private, but later on it maybe done in public as well. Most often cross dressing of undergarments under the cover of normal male outer-garments is practiced. Cross dressing
In an individual with transvestic fetishism cross dressing can begins soon after puberty. Initially cross dressing is done only in private, but later on it maybe done in public as well. Most often cross dressing of undergarments under the cover of normal male outer-garments is practiced.
Sexual arousal by cross dressing Fetishism is sexual arousal by inanimate objects. In Transvestic fetishism , sexual arousal in a heterosexual male, is achieved by garments, material and fabric associated with the opposite gender.
cross dressing is the preferred or only means of sexual arousal.
According to DSM-IV, diagnosis of transvestic fetishism requires, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving cross-dressing, in a heterosexual male, over a period of at least 6 months,
Sexual arousal by cross dressing
Fetishism is sexual arousal by inanimate objects. In Transvestic fetishism , sexual arousal in a heterosexual male, is achieved by garments, material and fabric associated with the opposite gender.
cross dressing is the preferred or only means of sexual arousal.
According to DSM-IV, diagnosis of transvestic fetishism requires, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving cross-dressing, in a heterosexual male, over a period of at least 6 months,
Distress or impairment due to sexual preference According to DSM-IV, the fantasies, sexual urges, or behaviors associated to transvestic fetishism cause distress which is clinically significant or impairment in social, occupational, or other important areas of functioning Distress or impairment due to sexual preference
According to DSM-IV, the fantasies, sexual urges, or behaviors associated to transvestic fetishism cause distress which is clinically significant or impairment in social, occupational, or other important areas of functioning
Autogynephilia Autogynephilia is sexual arousal by thought or image of self as female. Some individuals with transvestic fetishism also experience autogynephilia. Autogynephilia
Autogynephilia is sexual arousal by thought or image of self as female. Some individuals with transvestic fetishism also experience autogynephilia.

Clinicals - Examination

Fact Explanation
Mental State Examination: Appearance and Behaviour Appearance is normal and masculine in most affected individuals as cross dressing is done only in secret by most. Even those who cross dress in public tend to be restricted to cross dressing of undergarments with normal male outer clothing. But some individuals may not take precautions against discovery.Complete cross dressing of female garments is observed in very few individuals. Mental State Examination: Appearance and Behaviour
Appearance is normal and masculine in most affected individuals as cross dressing is done only in secret by most. Even those who cross dress in public tend to be restricted to cross dressing of undergarments with normal male outer clothing. But some individuals may not take precautions against discovery.Complete cross dressing of female garments is observed in very few individuals.
Mental State Examination: Speech Speech will be coherent, rational and appropriate. Mental State Examination: Speech
Speech will be coherent, rational and appropriate.
Mental State Examination: Mood Mood maybe euthymic or dysphoric, if the person has significant distress due to his sexual reference. Also mood maybe dysthymic if patient has associated depression, anxiety or obsessive compulsive disorder. Mental State Examination: Mood
Mood maybe euthymic or dysphoric, if the person has significant distress due to his sexual reference. Also mood maybe dysthymic if patient has associated depression, anxiety or obsessive compulsive disorder.
Mental State Examination: Thoughts No abnormalities of form or content of though will be apparent, except in those who have other associated psychiatric disorders. Obsessive thoughts maybe present in some with co-morbid obsessive compulsive disorder. Mental State Examination: Thoughts
No abnormalities of form or content of though will be apparent, except in those who have other associated psychiatric disorders. Obsessive thoughts maybe present in some with co-morbid obsessive compulsive disorder.
Mental State Examination: Perceptions No perceptual abnormalities are associated with transvestic fetishism. Mental State Examination: Perceptions
No perceptual abnormalities are associated with transvestic fetishism.
Mental State Examination: cognitive functions Orientation,attention,concentration and memory will be within normal range. Mental State Examination: cognitive functions
Orientation,attention,concentration and memory will be within normal range.
Mental State Examination: Insight Insight is variable, with most having some insight that the condition is abnormal and some having complete insight including insight regarding symptoms,awareness of having a mental disorder, and need for treatment. Mental State Examination: Insight
Insight is variable, with most having some insight that the condition is abnormal and some having complete insight including insight regarding symptoms,awareness of having a mental disorder, and need for treatment.

Management - Supportive

Fact Explanation
Dignose and treat other mental disorders Transvestic fetishism and especially cross dressing maybe a manifestation of other mental disorder like anxiety or depression with the abnormal behavior manifested as an outlet to stress or anxiety. Dignose and treat other mental disorders
Transvestic fetishism and especially cross dressing maybe a manifestation of other mental disorder like anxiety or depression with the abnormal behavior manifested as an outlet to stress or anxiety.
Improve normal sexual functioning Disorders of sexual preference maybe a manifestation due to poor satisfaction of normal sexual relationships.Sexual counseling will help with difficulties in forming or maintaining healthy relationships with the opposite sex. Improve normal sexual functioning
Disorders of sexual preference maybe a manifestation due to poor satisfaction of normal sexual relationships.Sexual counseling will help with difficulties in forming or maintaining healthy relationships with the opposite sex.
Providing healthy and adaptive coping mechanisms Assessment of role of abnormal sexual relationship in patient's life needs to be done as abnormal behaviors of the disorder maybe a coping mechanism to counteract loneliness , anxiety or depression. Better coping strategies should be introduced and encouraged. Providing healthy and adaptive coping mechanisms
Assessment of role of abnormal sexual relationship in patient's life needs to be done as abnormal behaviors of the disorder maybe a coping mechanism to counteract loneliness , anxiety or depression. Better coping strategies should be introduced and encouraged.
Ensuring support and motivation The individual's motivation for treatment is variable ,but essential, therefore it needs to be sustained with the help of the partner and by giving insight in to disorder and need for treatment. Ensuring support and motivation
The individual's motivation for treatment is variable ,but essential, therefore it needs to be sustained with the help of the partner and by giving insight in to disorder and need for treatment.

Management - Specific

Fact Explanation
Anti androgens and oestrogen Abnormal levels of androgen may contribute to inappropriate sexual arousal therefore these drugs can be used to reduce the sexual drive. Anti androgens and oestrogen
Abnormal levels of androgen may contribute to inappropriate sexual arousal therefore these drugs can be used to reduce the sexual drive.
Serotonin selective reuptake inhibitors (SSRIs) SSRIs are effective at reducing behaviors associated with fetishism and other paraphilias. They are also effective in co-morbid obsessive compulsive disorder. Serotonin selective reuptake inhibitors (SSRIs)
SSRIs are effective at reducing behaviors associated with fetishism and other paraphilias. They are also effective in co-morbid obsessive compulsive disorder.
Psychotherapy Psychoanalysis, psychodynamic psychotherapy and supportive psychotherapy is used though efficacy is not proven to be high.
Psychotherapy is aimed at modifying rather than eliminating the fetishistic behavior.
Psychotherapy
Psychoanalysis, psychodynamic psychotherapy and supportive psychotherapy is used though efficacy is not proven to be high.
Psychotherapy is aimed at modifying rather than eliminating the fetishistic behavior.
Behavioral therapy A variety of behavioral therapies like aversive conditioning, covert sensitization and cognitive behavior therapy can be tried.
Cognitive and behavior therapy as well as rational emotive therapy may improve the fetish behavior.Teaching the patient to translate his fetish sexual excitement to a more socially accepted behavior is the major treatment goal.
Behavioral therapy
A variety of behavioral therapies like aversive conditioning, covert sensitization and cognitive behavior therapy can be tried.
Cognitive and behavior therapy as well as rational emotive therapy may improve the fetish behavior.Teaching the patient to translate his fetish sexual excitement to a more socially accepted behavior is the major treatment goal.

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