The DSM Diagnostic Criteria for Transvestic Fetishism
Ray BlanchardAmerican Psychiatric Association 2009
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.
Keywords:
>-bleeped-< Cross-dressing DSM-V
Fetishism
Paraphilia Penile plethysmography
Transvestism
Introduction
On July 31, 2008, I submitted a report on transvestism 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). That report is reproduced
in the remainder of this paper, beginning in the next
section. I havemade no changes to the original text, except for
updating the references.
The original report included my proposal for a revised set
of diagnostic criteria. In the year since I submitted my report,
these diagnostic criteria have been further modified by input
from the Paraphilias Subworkgroup of the Sexual and Gender
Identity Disorders Work Group and from official Advisors to
the Paraphilias Subworkgroup. Thus, the diagnostic criteria
presented later in this paper are somewhat different from the
diagnostic criteria currently being considered by the Paraphilias
Subworkgroup, and they are likely different from the
criteria that will eventually be approved by the DSM-V Task
Force and the Board of Trustees of the American Psychiatric
Association. I have included them because they were part of
my original report, and because they help to document the
evolution of the diagnostic criteria that will eventually form
part of the DSM-V.
Report on Transvestic Fetishism
There are four key elements in the syndrome of Transvestism
(later called Transvestic Fetishism) as described in theDSM.
These four elements are: (1) cross-dressing (2) associated
with sexual arousal (3) in a biological male (4) with a heterosexual
orientation. There are, of course, cross-dressers
who fall outside this definition: homosexual men who crossdress
without sexual arousal and perhaps rare women who
cross-dress with sexual arousal. The existence of these other
groups has no necessary bearing on whether the combination
of male sex, heterosexual orientation, cross-dressing, and
sexual excitement constitutes a distinct syndrome. The consensus
of expert clinicians, for almost a century, has been that
it does. This clinical consensus is supported by the available
epidemiological data (La°ngstro¨m & Zucker, 2005).
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