Should Transvestic Fetishism Be Classified in DSM 5? Recommendations from the WPATH Consensus Process for Revision of the Diagnosis of Transvestic Fetishism

Figures & data

TABLE 1 Brief Overview of the Classification of Transvestic Fetishism in the DSM

DSM	Category	Subgroup	Group	Specifiers
I (1952)	Transvestism	Sexual Deviations	Personality Disorders	None
II (1968)	Transvestism	Sexual Deviations	Personality Disorders and Certain Other Nonpsychotic Disorders	None
III (1980)	Transvestism	Paraphilias	Psychosexual Disorders	None
III-R (1987)	Transvestic Fetishism	Paraphilias	Sexual Disorders	None
IV (1994)	Transvestic Fetishism	Paraphilias	Sexual and Gender Identity Disorders	With gender dysphoria
IV-TR (2000)	Transvestic Fetishism	Paraphilias	Sexual and Gender Identity Disorders	With gender dysphoria
V (proposed by Blanchard)	Transvestic Disorder	Paraphilias	Sexual Disorders (without the Gender Identity Disorders, which are classified as a separate group)	With fetishism
				With autogynephilia
V (proposed by WPATH	Transvestic Disorder	Paraphilias	Sexual Disorders	None

TABLE 2 Diagnostic Criteria for 302.3 Transvestic Fetishism in DSM-IV-TR

A. Over a period of at least six months, in a heterosexual male, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving cross-dressing.

B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:

With gender dysphoria: if the person has persistent discomfort with gender role or identity.

TABLE 3 Diagnostic Criteria for Gender Identity Disorder in DSM-IV-TR

A. A strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being of the other sex).

In children, the disturbance is manifested by four (or more) of the following:

(1) repeatedly stated desire to be, or insistence that he or she is, the other sex

(2) in boys, preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypical          masculine clothing

(3) strong and persistent preferences for cross-sex roles in make-believe play or persistent fantasies of being the          other sex

(4) intense desire to participate in the stereotypical games and pastimes of the other sex

(5) strong preference for playmates of the other sex

In adolescents and adults, the disturbance is manifested by symptoms such as the stated desire to be the other sex,      frequent passing as the other sex, desire to live or be treated as the other sex, or the conviction that he or she has      the typical feelings and reactions of the other sex.

B. Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex.

In children, the disturbance is manifested by any of the following: in boys, assertion that his penis or testes are      disgusting and will disappear or assertion that it would be better not to have a penis, or aversion toward      rough-and-tumble play and rejection of male stereotypical toys, games, and activities; in girls, rejection of urinating      in a sitting position, assertion that she has or will grow a penis, or assertion that she does not want to grow breasts      or menstruate, or marked aversion toward normative feminine clothing.

In adolescents and adults, the disturbance is manifested by symptoms such as preoccupation with getting rid of      primary and secondary sex characteristics (e.g., request for hormones, surgery, or other procedures to physically      alter sexual characteristics to stimulate the other sex) or belief that he or she was born the wrong sex.

C. The disturbance is not concurrent with a physical intersex condition.

D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Code based on current age:

302.6 Gender Identity Disorder in Children

302.85 Gender Identity Disorder in Adolescents or Adults

Specify if (for sexually mature individuals)

Sexually Attracted to Males

Sexually Attracted to Females

Sexually Attracted to Both

Sexually Attracted to Neither

TABLE 4 WPATH Proposed Diagnostic Criteria for 302.3 Transvestic Disorder

Category: Paraphilias

A. Recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving cross-dressing.

B. The fantasies, sexual urges, or behaviors are causing clinical distress or impairment in important areas of psychological functioning. The distress is not solely due to external prejudice, stigma, or oppression.

Exclude: Gender dysphoria

TABLE 5 Blanchard's Proposed Diagnostic Criteria for Transvestic Disorder

A. Over a period of at least 6 months, in a heterosexual male, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving cross-dressing.

B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:

With Fetishism (Sexually Aroused by Fabrics, Materials,    or Garments)

With Autogynephilia (Sexually Aroused by Thought or    Image of Self as Female)