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.
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.
Sadism (the act of obtaining sexual arousal through the giving of physical or psychological pain) and masochism (the act of obtaining sexual arousal through the receiving of physical or psychological pain) are paraphilias that are often viewed as two variations of the same phenomenon. However, this blog briefly examines sexual sadism in isolation.
The psychiatrist Richard von Krafft-Ebing is often credited with introducing the term “sadism” in his 1886 sexology book Psychopathia Sexualis deriving the name from the Marquis de Sade, whose French novels often featured such behaviour. Despite the increase in knowledge of (and theorizing about) sexual sadism, the psychopathology of the behaviour is still uncertain, and an all encompassing theory of the etiology of sexual sadism has yet to be developed and empirically tested. Furthermore, the labelling and defining of sexually sadistic behaviour is further complicated by the fact that many people enjoy some form of aggressive behaviour during sex (e.g., spanking, the gentle biting of nipples, love bites) making the label sadomasochism seem somewhat inappropriate.
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders that sexual sadists require “psychological or physical suffering (including humiliation)” of their victims to induce sexual excitement, whereas the World Health Organization’s International Classification of Diseases defines sadism as the “preference for sexual activity that involves bondage or the infliction of pain or humiliation”. However, those that have carried out research in the field claim that such definitions are difficult to apply in practice, resulting in experienced clinicians interpreting screening criteria inconsistently in the diagnosis of sexual sadism.
The situation was complex even when Krafft-Ebing first wrote on the topic. For instance, he described what he believed were distinct subtypes of sexual sadism including (i) lust murder (where sexual arousal is integral to the act of killing), (ii) necrophilia (discussed in a previous blog), (iii) injury to women through flagellation or stabbing, (iv) defilement of women; (iv) other types of assaults on women, such as cutting off their hair; (v) whipping of boys; (vi) sadism toward animals; and (vii) sadistic fantasies without the occurrence of any actual sadistic acts. Another sadistic act that has been reported in more recent times is ‘piqeurism’ where the assailant stabs a female victim (typically breasts or buttocks) and then runs away.
The true prevalence of sexual sadism among the general population is unknown. Alfred Kinsey’s seminal studies of human sexual behaviour in the late 1940s and early 1950s reported that 22% of the males and 12% of the females responded erotically to stories with sadistic themes. Other research studies estimate that 10-20% of couples have engaged in sadomasichistic activities during sex but that much of this is symbolic. However, most of the little research that has been published on sexual sadism tends to be based on sex offenders and sexual killers.
Among sex offenders, the prevalence of sexual sadism is estimated to occur in between 2% and 5% of offences. However, these estimates have been reported to be much higher (as much as 50%) depending upon the criteria that are used to define and diagnose sexual sadism in the first place. Prevalence estimates are further complicated because some in the area note that sadism and masochism are complementary disorders or separate poles of the same disorder. There is certainly a lot of empirical support that sadism and masochism often co-occur such as psychiatrist Dr Andreas Spengler’s study of 245 German sadomasochists published in the Archives of Sexual Behavior. Spengler’s study reported that among his sample, 30% were heterosexual, 31% bisexual and 38% homosexual. Just under a half (43%) developed their sadomasochistic desires after adolescence, and – perhaps surprisingly given the link to compulsive behaviour – sado-masochism was low frequency activity (with a median average of only five SM experiences per year among the respondents).
In a study led by Dr Gene Abel (now Director of the Behavioral Medicine Institute of Atlanta, US), it was reported that 18% of sadists were also masochistic, 46% had raped, 21% had exposed themselves, 25% had engaged in voyeurism and frottage, and 33% had molested children. Similarly, other researchers the Institute of Psychiatry, London) have noted an overlap among various paraphilias. Their sample comprised 87 rubberites, 38 leatherites, 133 sadomasochists, 205 transvestites (including transsexuals) and 25 dominant females. They found that 4% of sadomasochists were also transvestites, 29% of sadomasochists were also fetishists, and 35% of sadomasochists were also fetishists and transvestites. Gosselin and Wilson also reported that the most common objects used by sadists to inflict pain on their sexual partners were belts, whips, canes, shoes and paddles.
There is a wide variety of psychological explanations relating to the etiology of sexual sadism although most recent reviews have claimed there has been little new contemporary theorizing. Most branches of psychology (psychophysiological, psychodynamic, cognitive, behavioural) have developed their own theories but little research has confirmed them. Psychobiological explanations of sexual sadism (including serial sex murderers) that have examined chromosomal, endocrine, hormonal, and/or neurological abnormalities have typically been based on single case studies or very small samples. Therefore results remain tentative and inconclusive.
Early behaviourist theories argued that sexual sadism begins during childhood development. Through both operant and classical conditioning, sexual urges, excitation, and/or arousal are consistently paired with aggressive stimuli. Sexual fantasy and masturbation then reinforce and maintain the sadistic behaviour. Other psychologists claim that personality may play a role in the conditioning process, along with social modelling and disinhibition.
More recently, Dr Malcom MacCulloch (probably best know as Moors murderer Ian Brady’s psychiatrist) claimed that behavioral explanations of the development of sadistic sexual fantasy don’t adequately explain the initial development of sadistic sexual fantasy. McCullogh and his colleagues attempted to explain the initial development of sexual sadism using research on early childhood abuse and animal models of conditioning. They claimed that sadistic fantasies resulted from a combination of early childhood abuse, classical conditioning, and operant conditioning.
Back in 1986, Katie Busch and James Cavanagh (who were both at Rush-Presbyterian-St. Luke’s Medical Center, US) stated that most of the work in this area consisted of unfounded statements unsupported by data, unevaluated case reports lacking rigorous evaluation of other contributory factors, and scientific case reports of individuals or small groups. A recent literature review by Canadian consultant Dr Pamela Yates and colleagues of the current research concluded that: “Regrettably, the same can be said today, over 20 years later”.
Abel, G. G., Becker, J., Cunningham-Rathner, J., Mittelman, M., & Rouleau, J. (1988). Multiple paraphilic diagnoses among sex offenders. Bulletin of the American Academy of Psychiatry and the Law, 16, 153–168.
Busch, K.A., & Cavanagh, J.R. (1986). The study of multiple murder: Preliminary examination of the interface between epistemology and methodology. Journal of Interpersonal Violence, 1, 5–23.
Gosselin, C. C. (1987). The sado-masochistic contract. In G.D. Wilson (Ed.), Variant sexuality: Research and theory (pp. 229–257). Baltimore: Johns Hopkins University Press.
Gosselin, C. C., & Wilson, G. D. (1980). Sexual variations. London: Faber & Faber.
Kinsey, A., Pomeroy, W. B., Martin, C. E., & Gebhard, P. H. (1953). Sexual behavior in the human female. Philadelphia: Saunders.
Langevin, R. (2003). A study of the psychosexual characteristics of sex killers: Can we identify them before it is too late? International Journal of Offender Therapy and Comparative Criminology, 47, 366–382.
MacCulloch, M., Gray, N., & Watt, A. (2000). Brittain’s sadist murderer syndrome reconsidered: An associative account of the aetiology of sadistic sexual fantasy. Journal of Forensic Psychiatry, 11, 401–418.
MacCulloch, M., Snowden, P., Wood, P., & Mills, H. (1983). Sadistic fantasy, sadistic behavior, and offending. British Journal of Psychiatry, 143, 20–29.
Marshall, W. L., & Kennedy, P. (2003). Sexual sadism in sexual offenders: An elusive diagnosis. Aggression and Violent Behavior, 8, 1–22.
Marshall, W. L., & Yates, P. M. (2004). Diagnostic issues in sexual sadism among sexual offenders. Journal of Sexual Aggression, 10, 21–27.
Spengler, A. (1977). Manifest sadomasochism of males: Results of an empirical study. Archives of Sexual Behavior, 6, 441–456
Yates, P.M., Hucker, S.J. & Kingston, W.A. (2008). Sexual sadism: Psychopathology and theory. In Laws, D.R. & O’Donohue, W.T. (Eds.), Sexual Deviance: Theory, Assessment and Treatment. pp.213-23o. New York: Guildford Press.