Transvestic Disorder 703
Specifiers
The presence of fetishism decreases the likelih ood of gender dysphoria in men with trans-
vestic disorder. The presence of autogynephilia increases the likelihood of gender dyspho-
ria in men with transvestic disorder. 
Diagnostic Features
The diagnosis of transvestic diso rder does not apply to all individuals who dress as the op-
posite sex, even those who do so habitually. It applies to individuals whose cross-dressing
or thoughts of cross-dressing are always or of ten accompanied by sexual excitement (Cri-
terion A) and who are emotionally distressed by this pattern or feel it impairs social or in-
terpersonal functioning (Crite rion B). The cross-dressing may involve only one or two
articles of clothing (e.g., for men, it may pertain only to women’s undergarments), or it
may involve dressing completely in the inner and outer garments of the other sex and (in
men) may include the use of women’s wigs and make-up. Transvestic disorder is nearly
exclusively reported in males. Sexual arousal, in its most obvious form of penile erection,
may co-occur with cross-dressing in various wa ys. In younger males, cross-dressing often
leads to masturbation, following which any fe male clothing is removed. Older males often
learn to avoid masturbating or doing anything to stimulate the penis so that the avoidance
of ejaculation allows them to prolong their cr oss-dressing session. Males with female part-
ners sometimes complete a cro ss-dressing session by having intercourse with their part-
ners, and some have difficult y maintaining a sufficient erec tion for intercourse without
cross-dressing (or private fantasies of cross-dressing).
Clinical assessment of distress or impairme nt, like clinical assessment of transvestic