Dressed to thrill? A brief overview of transvestic fetishism

There is arguably more debate about whether transvestism can be classed as a disorder and/or sexually deviant than any other paraphilia. Transvestism has traditionally been defined as the cross-dressing in clothes worn by the opposite sex for sexual pleasure. However, there are a number of groups of people who may dress themselves in the clothes of the opposite sex but may experience absolutely no sexual arousal whatsoever. Therefore, those who study paraphilic behaviour are more likely to use the term ‘transvestic fetishism’ to describe the small group of people (typically male but there are some documented female cases in the literature) who derive their sexual pleasure from cross-dressing. Therefore, transvestite groups (where the word simply refers to cross-dressing) may comprise:

  • Transvestic fetishists who cross-dress for sexual pleasure and that in some cases may involve sexual arousal from a very specific piece of clothing
  • Female impersonators who cross-dress to entertain
  • Effeminate homosexuals (who may occasionally cross-dress for fun)
  • Transexuals who cross-dress because they fell they have been biologically assigned to the wrong sex and typically suffer from a gender identity disorder. It has also been speculated that some transsexuals may be psychologically similar to paraphilias such as apotemnophilia (i.e., the desire to be an amputee)

These different groups show that unlike all other paraphilias (e.g., necrophilia, zoophilia, hypoxyphilia), the motivations for cross-dressing may not necessarily be sexually motivated, and therefore are unlikely to be viewed as either deviant or disordered.

In the World Health Organization’s International Classification of Diseases (ICD-10), transvestic fetishism is defined as “the wearing of clothes of the opposite sex principally to obtain sexual excitement and to create the appearance of a person of the opposite sex”. Similarly, the latest version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) defines it as “recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving cross-dressing”. Interestingly, Dr Kirk Newring (Nebraska Department of Correctional Services, USA) and his colleagues think is possible that future books on sexual deviance will not include transvestic fetishism as a sexual deviance, but rather as a sexual variance.

There have been a couple of relatively large-scale studies of transvestism including that of Dr Richard Docter and Dr Virginia Prince (California State University, USA) who surveyed 1,032 transvestites, and Dr Niklas Långström (Centre for Violence Prevention, Karolinska Institutet, Stockholm, Sweden) and Dr Kenneth Zucker (Centre for Addiction and Mental Health, Toronto, Ontario, Canada) who examined tranvestism in a Swedish community survey of 2,540 adults. This, and other research, has suggested there appear to be at least two distinct sub-groups of transvestic fetishists (‘periodic transvestites’ and ‘marginal transvestites’).

  • Periodic transvestites: These transvestites are said to have psychological satisfaction with both their male gender and sexual identity, and with the activity of cross-dressing activity. Furthermore, they have no desire to pursue any other form of feminization.
  • Marginal transvestites: These transvestites experience psychological dissatisfaction with their male gender and sexual identity. The sexual arousal experienced from cross-dressing is typically lower than that of periodic transvestites. They may also engage in other feminization activities including hormone treatment, bodily hair removal, and (in extreme cases) surgical reconstruction. Some marginal transvestites may therefore include transsexuals who cross-dress not only for sexual pleasure but also for gender synchrony.

As with many other paraphilic behaviours, there is a relative lack of data and much of it comes from clinical case studies. Based on the published papers, the data suggest that the majority of transvestic fetishists report cross-dressing in secret before the onset of adolescence. As children, cross-dressing may provide excitement and pleasure but the activity is unlikely to be particularly sexualized (e.g., clothes that belong to females in the house may trigger and/or facilitate highly pleasurable sensory experiences [such as perfumed fragrances] accompanied by feelings of familiarity and comfort. During adolescence, case study evidence suggests that the act of cross-dressing becomes increasingly paired with sexual urges and arousal (e.g., erections, ejaculation) and in some cases it may lead to thoughts of being female in public or in private.

However, some sexologists have speculated that the transvestic behaviour develops via classical conditioning after an accidental exposure to female clothing or a female undressing. Similarly, it has also been suggested transvestic behaviour may be negatively reinforced when it is used as a means coping during times of emotional distress (for instance, a number of studies have reported high rates of parental separation during transvestic men’s childhood). The etiology of transvestism appears to be similar to other paraphilic behaviours (i.e. early conditioning experiences) although there are case studies of parental punishment by humiliation of wearing girls’ clothes leading to transvestism. According to Dr Kenneth Zucker and colleagues such separation may explain the need for transitional objects that many children eventually develop.

Smaller scale studies carried out in the 1970s to the 1990s reported that transvestites were more likely to be heterosexual and married. In 2005, Långström and Zucker’s study of 2,450 Swedes appeared to confirm these earlier findings. The archetypal transvestite was reported as being in his mid-30s, in a steady relationship and having at least one child. Perhaps surprisingly, there were no major socio-demographic differences between transvestic males and non-transvestic males. In Långström and Zucker’s study, nearly 3% of males (n=36) and 0.4% of females (n=5) reported sexual arousal from cross-dressing at least once. The transvestic behaviour occurred more in heterosexual males (85.7%, n=35). This finding was similar to findings of Docter and Prince’s large-scale study of 1,032 transvestites where up to 89% transvestic males identified themselves as heterosexual. Findings from small-scale studies indicate that most men do not tell their wives prior to marriage and when the wives do find out, they tend to tolerate it rather than support it.

Långström and Zucker also examined the co-occurrence of other paraphilic behaviours. The transvestic men were more likely than non-transvestic men to report sexual sadism and/or masochism, exhibitionism, and voyeurism. In a 1981 study of 222 transvestic males, Buhrich and Beaumont reported high rates of bondage fantasies while dressed in women’s clothing. However, over time and into middle age, sexual desires may diminish but the cross-dressing may remain (and therefore would no longer be classed as transvestic fetishism). Most transvestites do not seek professional help (as they do not experience any distress associated with their behaviour) and even with therapy it is unlikely the behaviour will be altered if the person wants to carry on cross-dressing.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Buhrich, N. (1978). Motivation for cross-dressing in heterosexual transvestism. Acta Psychiatrica Scandinavica, 57, 145–152.

Buhrich, N., & Beaumont, T. (1981). Comparison of transvestism in Australia and America. Archives of Sexual Behavior, 26, 589–605.

Docter, R. F., & Prince, V. (1997). Transvestism: A survey of 1032 cross-dressers. Archives of Sexual Behavior, 26, 589-605.

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, V. & Kleinplatz, P.J. (2002). Transvestic fetishism: Psychopathology or iatrogenic effect? New Jersey Psychologist, 52(2), 16-17.

Newring, K.A.B. Wheeler, J. & Draper  (2008). Transvestic fetishism. Assessment and theory. In Laws, D.R. & O’Donohue, W.T. (Eds.), Sexual Deviance: Theory, Assessment and Treatment (Second Edition) (pp.285-305). New York: Guildford Press.

Stoller, R. J. (1971). The term, “transvestism.” Archives of General Psychiatry, 24, 230–237.

Sullivan, C.B.L., Bradley, S.J., & Zucker, K.J. (1995). Gender identity disorder (transsexualism) and transvestic fetishism. In V. B. Van Hasselt & M. Hersen (Eds.), Handbook of adolescent psychopathology: A guide to diagnosis and treatment (pp. 525–558). New York: Lexington Books.

Wheeler, J. Newring, K.A.B. &  Draper, C.  (2008). Transvestic fetishism. Psychopathology and Theory. In Laws, D.R. & O’Donohue, W.T. (Eds.), Sexual Deviance: Theory, Assessment and Treatment (Second Edition) (pp.272-284). New York: Guildford Press.

Zucker, K.J., & Blanchard, R. (1997). Transvestic fetishism: Psychopathology and theory. In D. R. Laws & W. T. O’Donohue (Eds.), Sexual deviance: Theory, assessment, and treatment (First Edition) (pp. 253-279). New York: Guilford Press.

About drmarkgriffiths

Professor MARK GRIFFITHS, BSc, PhD, CPsychol, PGDipHE, FBPsS, FRSA, AcSS. Dr. Mark Griffiths is a Chartered Psychologist and Distinguished Professor of Behavioural Addiction at the Nottingham Trent University, and Director of the International Gaming Research Unit. He is internationally known for his work into gambling and gaming addictions and has won many awards including the American 1994 John Rosecrance Research Prize for “outstanding scholarly contributions to the field of gambling research”, the 1998 European CELEJ Prize for best paper on gambling, the 2003 Canadian International Excellence Award for “outstanding contributions to the prevention of problem gambling and the practice of responsible gambling” and a North American 2006 Lifetime Achievement Award For Contributions To The Field Of Youth Gambling “in recognition of his dedication, leadership, and pioneering contributions to the field of youth gambling”. In 2013, he was given the Lifetime Research Award from the US National Council on Problem Gambling. He has published over 800 research papers, five books, over 150 book chapters, and over 1500 other articles. He has served on numerous national and international committees (e.g. BPS Council, BPS Social Psychology Section, Society for the Study of Gambling, Gamblers Anonymous General Services Board, National Council on Gambling etc.) and is a former National Chair of Gamcare. He also does a lot of freelance journalism and has appeared on over 3500 radio and television programmes since 1988. In 2004 he was awarded the Joseph Lister Prize for Social Sciences by the British Association for the Advancement of Science for being one of the UK’s “outstanding scientific communicators”. His awards also include the 2006 Excellence in the Teaching of Psychology Award by the British Psychological Society and the British Psychological Society Fellowship Award for “exceptional contributions to psychology”.

Posted on February 28, 2012, in Compulsion, Obsessive-Compulsive Disorder, Paraphilia, Psychiatry, Psychology, Sex addiction and tagged , , , , , . Bookmark the permalink. 13 Comments.

  1. Mark,

    After reading this review, I’m a little concerned by the inclusion of ‘transvestic fetishism’ in the ICD and DSM.

    Dysfunction and pathology are, by definition, conditions related to reduced functioning. Harm is central to defining psychological pathology.

    You explain that cross-dressing does not necessarily indicate dysfunction, and that transvestites tend to not seek help because they do not experience any distress from it.

    Isn’t this (and possibly S&M…) simply a less common way of achieving sexual arousal, rather than a pathological condition?


    • Transvestism in and of itself is not in psychiatric manuals. Paraphilias like sadomasochism and transvestism are only included when there is significant distress to the individual as a result of the condition. There is a clear distinction between paraphilias (not necessarily a disorder at all) and paraphilic disorders.

  2. Is there any cure for transvestic fetishism

  3. There’s no cure, because it’s not a disease

  4. Probably most (if not all) transvestism can be accounted for it what has recently been called autogynephilia or crossdreaming. A predominant fetish that lasts for most subjects sexually active lifetime



    • Hello Dr. Griffiths

      Autogynephilia (erotic target location error) and “crossdreaming” (psychosexual expression of transsexualism) must both be rejected in favour of a theory which appreciates the all but universal masochism (the “forced feminization” idiom), that appreciates that the phenomenon is essentially a common fetish and that very few suffer from additional gender issues. I have worked on a model called “masochistic emasculation fetishism”, etiologically constituted in the sexualization of childhood emasculation trauma/PTSD.


  5. The majority of men with a transvestic fetish report that they began cross-dressing before puberty, often before the age of 5. Therefore classifying this condition as merely a sexual phenomenon is misdirected. I would suggest that it is a form of synesthesia where stimulation in one sensory pathway leads to an automatic and involuntary response in a second sensory pathway. Perhaps neural connections were established in early childhood and reinforced through environmental factors which causes to child to believe that girls have it better in life, or that his mother would have loved him more if he was born a girl. Whatever the factors, his brain is programmed to interpret cross-dressing as “contact with a female”. In early childhood he would experience the comfort of contact with his mother, and in adolescence and adulthood it is manifested as sexual arousal, and once the person is older and his testosterone levels wane, then cross-dressing is no longer sexual arousing but continues to produce sensations of well-being, comfort, and social empathy. .

    The clinical “transvestic fetishism” is seen as the sexually arousing stage in the biological condition, where the sensation of “contact with a female” may be interpreted by the individual as, (1) the female in contact is outside of himself, or (2) the female in contact is inside himself (autogynephilia). Whether the condition is a disorder or not is dependent upon the individual’s ability to function productively in society.

    • @WPDP

      “The majority of men with a transvestic fetish report that they began cross-dressing before puberty, often before the age of 5. Therefore classifying this condition as merely a sexual phenomenon is misdirected.”

      False. I was subject to such masochistic emasculation fantasies at that very age, and something I happen to remember explicitly, was the “magical feeling” that accompanied the thoughts. Feelings, with the later discovery of masturbation I recognised as sexual stimulation.

      “Whatever the factors, his brain is programmed to interpret cross-dressing as “contact with a female”.”

      That is not the sexual phenomenology of most (if not all) of the fetishism (masochistic emasculation fetishists) in question. It is sexual arousal by the anxiety in one’s association to symbols of emasculation, which itself discloses the sexualization of emasculation anxiety, for which any pre-existing trans feelings or dysphoria is an adjunct condition of emasculation anxiety.

      “once the person is older and his testosterone levels wane, then cross-dressing is no longer sexual arousing but continues to produce sensations of well-being, comfort, and social empathy.”

      The same psychological internalization for which all sexual properties tend to follow.

  6. Francis Thomas

    I’m Francis Thomas, aka Fiona Edwards. 65,married, crossdresser all my life. Professional classical musician. Need help in going out dressed and possible surgery

  7. Philip Fernandez

    Just thought I’d leave some thoughts on my theories on cross-dressing.

    While cross-dressing does mimic the addiction pattern, I don’t see it as an actual addiction. At least, no more than any sexual identifiers. When a person with this orientation cross-dresses his brain interprets it as actual contact with a female, and his brain releases dopamine, serotonin, and oxytocin (just the same neurotransmitters associated with sexual activity). These neurotransmitters are responsible for his sensations of well-being, pleasure, sexual gratification, bonding, comfort and others. These “feel good” neurotransmitters are the drivers behind the cross-dressing compulsion.

    Cross-dressing is often identified very early in life, often well before puberty. (My first recollections of cross-dressing was at age 3.) So how does the brain get hardwired for this condition?

    If we define synesthesia as a neurological phenomenon in which stimulation of one sensory pathway leads to automatic, involuntary experiences in a second sensory pathway, which are developed during childhood synaptogenesis, then we have a potential mechanism. In the first three years of life our brains develop about 3-5X the number of neural connections than an adult brain. Through the learning process we reinforce some neural pathways and prune other pathways. This would explain why the cross-dresser’s brain is hardwired to respond to wearing women’s clothing as if there was contact with a female. He knows he’s not a female, he knows the clothing doesn’t magically change anything, and he is confused why he finds the experience so wonderful.

    Personal Info: I am a life-long cross-dresser, and I do not believe it has had any adverse effect upon me. I am happily married, with grown children. I have always kept my cross-dressing limited and private, and have enjoyed a good education, good career, and a happy life.

  8. I am really interested in the comments by Philip in particular. I am torn between the standard or prevalent narrative of transgender identity (leaving aside questions of the spectrum) and the possibility of neuro-physiological and addictive descriptions of the phenomenon. Would be very interested to hear more from Philip on this. i am someone who actually experiences my female identity a lot in public ways, which is a difference I guess, though I am not full time or transitioning as of yet at least.

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