Transvestism is a paraphilia in which an individual experiences recurrent, intense sexual arousal from cross-dressing, or dressing as the opposite gender, and in which that person's urge to do so causes significant distress or impairment in his or her daily life.
Crosss-dressing itself is not a disorder, but dressing in the clothes of the opposite gender to experience intense sexual arousal may be, particularly if it causes significant impairment. An individual with transvestic disorder suffers anxiety, depression, guilt, or shame because of their urge toward cross-dressing. These feelings are usually a result of partner disapproval or their own concern about negative social or professional ramifications.
Transvestic disorder is one of several psychiatric disorders characterized as a paraphilia, referring to an intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners. Behaviors such as cross-dressing are considered to be symptoms of a disorder only if they are acted upon in ways that have the potential to cause distress or harm to oneself or others, especially others who have not given their consent.
Cross-dressing in and of itself is not a disorder. Cross-dressing is most common in men, but occurs in both males and females, and often starts in childhood or adolescence. Cross-dressing may include wearing only a single article of clothing typically associated with the opposite gender or a complete outfit, along with hair and makeup. Most people who cross-dress are heterosexual.
To be diagnosed with transvestic disorder, according to the DSM-5, a person must experience persistent and intense sexual arousal from fantasizing about, or acting on, urges to wear one or more pieces of clothing normally worn by the opposite gender. These fantasies or behaviors must have been present for at least six months and cause severe distress to the individual or dysfunction in social, professional, or other significant areas of day-to-day life. The feelings of distress over cross-dressing that characterize transvestic disorder are separate and distinct from gender dysphoria.
A person with transvestic disorder may experience continuous urges to cross-dress, or their desire may fluctuate or occur in a series of episodes. They may become stuck in a negative behavioral pattern of purchasing clothing with the intent of cross-dressing, wearing it during a cross-dressing session, and throwing it away in hopes of quitting. They may also be co-diagnosed with other disorders, including fetishism, in which one is sexually aroused by fabrics, materials, or garments; masochism, in which one experiences sexual gratification at his or her own pain or humiliation; and autogynephilia, in which a man derives sexual pleasure from fantasizing about himself as a woman.
No specific cause has been determined for transvestic disorder. It has been observed that in childhood, cross-dressing causes excitement which may, after puberty, become sexual excitement. As the person gets older and the behavior is repeated and reinforced, the desire to cross-dress may become stronger even as sexual gratification diminishes.
Cross-dressing in and of itself is not a disorder so it does not generally require treatment. Cross-dressers are sometimes referred to therapy by the court system or are brought to therapy by a parent, partner, or spouse. Some cross-dressers seek therapy themselves for other reasons, such as substance abuse, depression, or gender dysphoria, or because they are distressed by their own urges. A person with a history of transvestic disorder is considered to be in remission when their desire to cross-dress has not caused them distress or impaired their daily life in at least five years.