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Transvestic Disorder

  • Definition: Transvestic disorder, also known as transvestism, involves dressing as the opposite gender.
    • Often, this is observed in males who dress as women and fantasize about being female, a phenomenon known as autogynephilia.
  • Distinction from Fetishism:
    • Unlike simple fetishism, sexual arousal in transvestism is not inherently dependent on women's clothing but rather facilitates engagement in the fantasy of being a woman.
  • Forms of Cross-Dressing:
    • Can be secretive, e.g., wearing women's panties under male clothing.
    • Can be overt, as seen in performances by drag queens who wear dresses and apply makeup.
  • Initial Motivations:
    • Primarily for sexual excitement, but may shift over time to alleviate negative feelings such as anxiety or depression, or to enhance attractiveness (Murphy, Bradford, & Fedoroff, 2014).
  • Gender Identity Concerns:
    • Some men with transvestic disorder may become increasingly uncomfortable with their own gender and explore the desire to transition physically into women (refer to gender dysphoria).

DSM-5 Criteria for Transvestic Disorder (Table 11.20)

A. Over a period of at least 6 months, recurrent and intense sexual arousal from cross-dressing, which manifests through fantasies, urges, or behaviors.
B. The sexual urges, fantasies, or behaviors result in clinically significant distress or impairment in social, occupational, or other critical areas of functioning.

  • Specifiers:
    • Specify if behavior occurs in a controlled environment or if the individual is in full remission.
    • Specify if associated with fetishism or autogynephilia.
  • Reference: Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Arlington, VA: American Psychiatric Association (2012).

Voyeuristic Disorder

  • Definition: Voyeuristic disorder, or voyeurism, is characterized by secretly observing others undress or engage in sexual activity without their knowledge (see Table 11.21; APA, 2013).
  • Arousal Mechanism:
    • The individual finds sexual arousal in watching others in vulnerable situations, with excitement derived from the risk of being caught.
  • Common Behavior:
    • Oftentimes, individuals with voyeuristic disorder masturbate while observing or fantasizing about sexual interactions with those they watch.

DSM-5 Criteria for Voyeuristic Disorder (Table 11.21)

A. Over a period of at least 6 months, recurrent and intense sexual arousal from observing an unsuspecting person who is naked, disrobing, or engaging in sexual activity, as evidenced by fantasies, urges, or behaviors.
B. Individual has acted on these urges with a non-consenting person or the urges cause clinically significant distress or impairment in key areas of functioning.
C. The individual experiencing arousal and/or acting on urges is at least 18 years old.

  • Specifiers:
    • Specify if behavior occurs in a controlled environment or if the individual is in full remission.
  • Reference: Diagnostic and Statistical Manual of Mental Disorders (6th ed.), Arlington, VA: American Psychiatric Association (2013).

Atypical Paraphilic Disorders

  • Overview: Atypical paraphilic disorders involve unusual sexual arousal focuses yet can cause distress or impairment (Beech, Miner, & Thornton, 2016).
    • Often diagnosed as other specified paraphilic disorder.
  • Examples of Atypical Paraphilic Disorders (see Table 11.22):
    • Acrotomophilia: Attraction to amputees or being an amputee.
    • Autagonistophilia: Arousal from being observed, filmed, or performing on stage.
    • Autonepiophilia: Pretend behavior of being a baby in diapers.
    • Blastophilia: Attraction to children or wishing to engage sexually with minors.
    • Cynemimetophilia: Arousal in specific performance contexts.
    • Kleptophilia: Sexual pleasure derived from stealing.
    • Klismaphilia: Sexual arousal involving enemas.
    • Narratophilia: Arousal from explicit verbal dialogue.
    • Necrophilia: Sexual attraction to or engagement with corpses.
    • Olfactophilia: Arousal from specific body odors.
    • Partialism: Attraction to specific body parts, such as hair.
    • Symphorophilia: Sexual excitement from observing accidents.
    • Troilism: Involvement of a third party in sexual activities.
    • Urophilia and Coprophilia: Pleasure involving urine and feces, respectively.
    • Zoophilia: Attraction to animals.

Epidemiology of Paraphilic Disorders

  • Commonality: Sexual fantasies involving various unusual themes are prevalent in humans, with voyeurism and fetishism notably common in the general populace (refer to Box 113).
  • Lifetime Experience: Almost 10% of individuals report at least one lifetime act of paraphilic behavior, mainly linked to voyeurism and fetishism, as well as exhibitionism and frotteurism (Joyal & Carpentier, 2016).

Focus On College Students' Sexual Fantasies and Paraphilic Interests

  • Study Overview: Researchers surveyed university populations to extract insights on prevalent sexual fantasies among men and women.
  • Women's Common Fantasies:
    • Romantic involvement in exotic places (27.2%), submissive roles (18.8%), strangers (14.3%), exhibitionism (8.9%), homosexual activities (8.2%), group sex (7.8%), authority figure or celebrity (7.1%), and sexual object fascination (6.3%).
  • Men's Common Fantasies:
    • Voyeurism (13.0%), fetishism (14.0%), threesomes (12.6%), oral sex (11.7%), anal sex (11.7%), public/exotic sexual locations (11.3%), homosexual encounters (8.9%), acquaintance sex (8.5%), and group sex (8.1%).
  • Analysis: Notably, intense sexual fantasies often include emotional connections, and sheer frequency does not indicate the presence of psychopathology.
    • Paraphilic disorders require assessment only when these sexual behaviors or fantasies result in distress or dysfunction.
  • Table 11.23 shows prevalence of various paraphilic behaviors desired by men and women, emphasizing voyeurism and fetishism.

Prevalence Data (Table 11.23)

  • Men vs. Women:
    • Voyeurism: Men - 60.0%; Women - 34.7%.
    • Fetishism: Men - 40.4%; Women - 47.9%.
    • Exhibitionism (Extended): Men - 35.0%; Women - 26.9%.
    • Frotteurism: Men - 34.2%; Women - 20.7%.
    • Masochism: Men - 19.2%; Women - 27.8%.
    • Sadism: Men - 9.5%; Women - 5.1%.
    • Transvestism: Men - 7.2%; Women - 3.3%.
    • Exhibitionism (Strict): Men - 5.9%; Women - 3.4%.
    • Sex with a child: Men - 1.1%; Women - 0.2%.
  • Source: Joyal, C.C. & Carpentier, T. (2016). The prevalence of paraphilic interest and behaviors in the general population: A provincial survey, Journal of Sexual Medicine, pp. 1-11.

Challenges in Defining Prevalence of Paraphilic Disorders

  • Underreporting: Paraphilic disorders are often kept secret due to societal stigma, which inhibits individuals from seeking help or disclosing behaviors to therapists (Wurtele, Simons, & Moreno, 2014).
  • Survey Limitations: Responses may be swayed by a desire to conform to social expectations, making them unreliable for diagnosis.
  • Detection: Many cases come to light during criminal investigations or therapeutic engagements rather than routine reporting.

Gender Differences in Paraphilic Disorders

  • Prevalence: Paraphilic disorders are significantly more common in men. Examples include voyeuristic disorder (12% of men vs. 4% of women) and exhibitionistic disorder (2-4% of men; rare in women).
  • Comorbidity: Paraphilic disorders frequently co-occur with other mental health issues such as anxiety, depression, substance use disorders, and personality disorders (Stinson & Becker, 2015).
  • Implications: Some paraphilic behaviors can escalate to violent actions, such as child molestation or sexual assault, with severe consequences.

Focus On Violence Related to Rape

  • Definition of Rape: Rape, while not classified as a mental disorder, can be linked to psychiatric conditions in the perpetrator and is categorized into various motivations.
  • Categories of Rapists:
    • Some rapists may be motivated by anger towards women or a broader sense of rage and exhibit traits of narcissism or antisocial personality disorder.
    • Estimated Statistics: Approximately 5-10% of rapists engage in acts motivated by sadism, deriving sexual gratification from the suffering of their victims.
  • Nature of Rape:
    • Rape can occur in both marital and dating relationships. Acquaintance rape disproportionately affects female college students, often linked to influences such as alcohol, drugs, and social isolation.
  • Underreporting and Aftermath:
    • A minor fraction of rapes are reported to law enforcement due to fears of repercussions or self-blame. Regardless, victims may face profound psychological consequences, including depression, PTSD, anxiety, sleep disturbances, and interpersonal difficulties (Zinik & Padilla, 2016).