What is the difference between fetishistic and non-fetishistic crossdressing? (The ICD and beyond)

The WHO medical manual says that only crossdreaming crossdressers can become trans women, not the ones that do not get aroused by the idea of being a woman. How did sexual arousal become such a sin?

I have spent some time looking at the American DSM manual here at Crossdreamers. The American psychiatric manual say a lot about how some psychiatrist try to draw the line between different types of cross-gender identification.

There is another manual that is just as interesting, namely the WHO ICD  manual  (International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Version for 2007)

Under "Mental and behavioural disorders" there is a category called "Disorders of adult personality and behaviour", where you will find both transsexualism and crossdressing/crossdreaming categorized as mental illnesses. 

On the difference between transsexuals, crossdreaming crossdressers and non-crossdreaming crossdressers

I am not going to repeat my objection to transsexuals and crossdreamers being classified as ill here. Instead I am going to draw your attention to the fact that this manual classifies crossdreamers (people who get aroused by the idea of being the other sex) as completely separate from other crossdressers. In this manual the crossdreamers are actually overlapping with the transsexuals!

There are three categories of interest to my readers:

• F64.0 Transsexualism
• F64.1 Dual-role transvestism
• F65.1 Fetishistic transvestism

What I find so utterly bizarre is the fact that "fetishistic transvestism", which includes -- I surmise -- crossdressing crossdreamers, is categorized as "a fetish", while the other crossdressers are given "a gender identity disorder". 

Note that "dual-role transvestism" is defined as the  "wearing of clothes of the opposite sex for part of the individual's existence in order to enjoy the temporary experience of membership of the opposite sex, but without any desire for a more permanent sex change or associated surgical reassignment, and without sexual excitement accompanying the cross-dressing." 

The fetishists (crossdreamers), on the other hand, are wearing "clothes of the opposite sex principally to obtain sexual excitement and to create the appearance of a person of the opposite sex."

The dual-role transvestite apparently feels like a woman; the fetishist does not.

How they are able to distinguish between these two types of crossdressers is beyond me. 

I am sure there are crossdressers who are never aroused sexually while crossdressing, but why the absence of arousal in itself is needed for you to have "a gender identity disorder" is just strange. It is as if sexual feelings are incompatible with feeling like a woman.

Some crossdressers report that the arousal that follows crossdressing disappears as they get older. Does that mean that the underlying condition has changed, and that they have moved from one category to the other? And do you need to be asexual to have a gender idenity disorder?

If you have a gender identity disorder you cannot become a trans woman

It gets even more bizarre. "Fetishistic transvestism" can apparently "occur as an earlier phase in the development of transsexualism". The "dual-role transvestism", on the other hand, cannot, even if it is in the same sub-category as transsexualism. In fact dual-role transvestite is defined as being "without any desire for a more permanent sex change".

In other words: The "experts", who have done the best to keep the "tainted" perverts away from the "pure" transsexuals and "dual role transvestites", are now opening the door again, by admitting that crossdreamers -- and only crossdreaming crossdressers -- can become transsexuals.

This is so strange, that I will repeat it once more: 

Male to female crossdressers who do not get turned on by imagining themselves as women have a gender identity disorder, but cannot become trans women. Crossdressers who do get aroused en femme do not have a gender identity disorder, but can become trans women!

The source of all this confusion

I think one explanation for  all this confusion is the fact that the psychiatrists who have written these categories are still caught up in a stereotypical view of women.  This can be the only explanation for using sexual arousal as the most important dimension for dividing crossdressers into sub-categories.

Men who get aroused by imagining themselves as women, are -- according to this way of thinking -- not feminine, because women do not get aroused by imagining themselves as women. Crossdressers who focus on dressing up and copying the behavior and mannerisms of women, on the other hand, do suffer from a gender identity disorder,  because women do love dressing up, paint their nails and have tea parties (or whatever it is women and crossdressers are supposed to do).

Hm.

I have know a few women in my life. As an academic I have studied history, psycho-social development and cultural variation, and I can say with 100 percent certainty that women are sexual beings. They fantasize, they get aroused, they masturbate and they make love, and unless they are asexual or psychologically traumatized, they also like it. Given their superior ability as regards orgasms, you could actually argue that they are more strongly sexually charged than men. (That was actually considered common wisdom in pre-Victorian Europe!)

Then why is sexual arousal removed from our understanding of what it means to be a woman?

I believe we have to look at the way crossdreaming crossdressers are perceived by the doctors. The stories these doctors are told are about men who dress up alone, and who then get aroused by the idea of being a woman and/or having a woman's body. Many of them also live alone, as it may the only way they can find room for this part of their lives.  This, again, means that their only sex life consists of masturbatory fantasies. 

"Aha!" the doctor concludes, "this man is a auto-erotic narcissistic fetishist" (read: "a perverted wanker"). "He has nothing in common with real women!" 

Some crossdreamers probably also believe this themselves: "Doctor, I am a filthy pervert! Help me!"

So what about real women?

What I find puzzling is that these doctors must know that women do masturbate -- alone and a lot. The sales of dildos and vibrators are sky rocketing and they are not all bought by male to female crossdreamers.  Many  women live by themselves as well. The same doctor would not call them auto-erotic narcissists. 

Women also imagine themselves making love to  a man while fantasizing. That is a good thing, isn't it?

So why is the crossdreaming crossdresser a pervert, classified in another category than the non-crossdreaming crossdressers and transsexuals who are suffering from a  "gender identity disorder"?

Could it be that these so-called experts are incapable of putting the life of a crossdreaming crossdresser into its proper social context?

Why do crossdreamers behave as they do?

First: Do crossdreamers primarily get aroused by (1)  the idea of being a woman or having a woman's body or do they get aroused by (2) the idea of having sex as a woman? 

People like Ray Blanchard focus on 1, and it is the fact that they get aroused by the idea of having a woman's body that makes them autogynephiliacs. 

I would focus on the second part of the equation. In nearly all the erotic  transgender fiction fantasies I have read, the crossdreamers end up having sex with someone else. To have sex as a woman, you need a woman's body (or at least a female appearance). Then the change itself becomes erotic by association. To become a woman becomes erotic, because it opens up the possibility of having sex as a woman.

Women love having sex as a woman, but they already have a female body. The idea of having a female body is therefore not as eroticized  as in the case of male to female crossdreamers. 

That being said, women may perfectly well get turned on by admiring their own looks and their own body (i.e suffer from "autogynephilia"). The reason for this is that being beautiful and attractive is an powerful aphrodisiac in itself. The desire of others is a confirmation of your very being, and imagining yourself being desired by others can therefore be an enormous turn-on. That is one of many factors leading women to spend so much money on clothes, make-up and cosmetic surgery.

It should therefore come as no surprise that male to female crossdreamers may get aroused, not only by the idea of having sex, but also by the idea of being sexy. If you are alienated from you male body, the other healthy alternative -- a pride in your own male body -- is not an alternative.

So why are crossdressers doing this alone?

Crossdreaming crossdressers are considered "autoerotic" or "autogynephiliacs" (i.e. people who make love to themselves)  or even "narcissistic" because they often explore these fantasies by themselves.

Isn't that to be expected?

The way their sexuality is stigmatized and pathologized it should come as no surprise to these researchers that the crossdreamers do not always share them with their partner, if they have one. The risk of losing that partner is high, because this is a condition that is so poorly understood.

The fact that at least some of these men seem to be wired for sex as a woman, must also make it harder for them to establish functioning relationships with heterosexual women wired for the same type of sexual behavior. So why does their loneliness make them autoerotic narcissists?

The logic breaks down

Sexual arousal can, as far as I see it, not be used to distinguish one group of crossdressers from another. The obvious question is not: "Why do some crossdressers and trans women get turned on by the idea of being a woman?" The obvious question should be: "Why do some crossdressers and trans women not experience such cross-gender arousal?"

That is a question I find  very hard to answer. 

There are, as far as I can see,  three possible explanations for this. 

The first is that they deceive themselves, in the sense that their arousal is sublimated into a ritual of dress and manners. If they have been told that women are asexual beings, and they are alienated from their own penis, it is possible to be aroused without the telltale sign of an erection. In fact, there are male to female crossdreamers who are proud of the fact that they no longer get an erection, as they fel that this makes them more like women. They are still turned on, though. Maybe some crossdressers are not consciously aware of this kind of excitement.

The other possibility is that they truly are asexual, not in the sense of not being interested in a relationship, but in the sense of having a low libido. That happens.

The third is that they only get excited as a man with a woman. I guess anything is possible, but I must admit I  find this very unlikely.

I welcome any input from knowledgeable crossdressers here, as this is a phenomenon that has to be explained in a theory of crossdressing.

Post-orgasmic anti-climax

I guess the experts behind the manual would argue that I am missing the point. You see, the document adds the following to the definition of the fetishists: 

"Fetishistic transvestism is distinguished from transsexual transvestism by its clear association with sexual arousal and the strong desire to remove the clothing once orgasm occurs and sexual arousal declines."

The point is, I believe, that this proves that this sense of being a woman is sexual, and sexual only. If they had been truly feminine, they would have kept their female clothes on, also after orgasm.

I am not a crossdresser, so there are limits to what I can add here, but from a purely practical point of view, keeping your dress on after orgam seems ...eh... sticky...

However, as a non-crossdressing crossdreamer I recognize the pattern of fantasy and arousal, followed by orgasm and some kind of exhaustion. That is actually quite common in most male bodied persons, and make no mistake about it: crossdreamers and crossdressers may feel like a woman, but their bodies are male. In my case, however, the longing after being a woman does not subside, even if the sexual arousal does. It is there, always! I suspect this is the case among many crossdressers as well.

If arousal associated with crossdressing is an expression of a suppressed female self, you should expect the gender dysphoria to subside somewhat after orgasm, as this orgasm will be an outlet for the sub-conscious feminine self. That would not mean that the sub-conscious feminine self disappeared after orgasm, no more than a regular guy stops being a regular guy after sex.

In other words: Removing feminine attire after orgasm is not in itself proof of this being a different condition than "dual-role transvestism". 

From what I know of non-transgender women, they also feel a need to get out of their feminine attire before going to sleep. Or maybe they just want to put on their pyjamas and crawl up in the sofa with a bucket of ice-cream and a chick flick. I would love to do that!

The Nordics get it right

The fetishistic transvestism paragraph, the one on transvestites, as well as all other "perversions" under F65, have been removed from the manual in all the Nordic countries. Crossdreamers are no longer considered mentally ill in this part of the world.

The Norwegian Directorate of Health said this when it announced its decision to remove fetishes from the manual:

"The Norwegian Directorate of Health puts great emphasis on the fact that interest organisations and research environments for a long time have delivered knowledge showing that many find the diagnoses in themselves offending and [that the diagnoses] contribute to the stigmatization of  the sexuality of groups and individuals. 

"The diagnoses involved are out of date and not in accordance with the scientific standards otherwise found in the ICD-10 manual.

"The content of these diagnoses have not been significantly changed in over 100 years. They were developed on the basis of theories based on the knowledge of that time and its view of sexual variation among humans in society. At best the diagnoses are completely superfluous. At worst they stigmatize minority groups in society."

Head of The Swedish National Board of Health and Welfare, Lars-Erik Holm said was even clearer when Sweden abolished these paragraphs:

"These diagnoses are rooted in a time when everything other than the heterosexual missionary position were seen as sexual perversions"

The role of fetishes

It is the logic behind documents like these that makes me so reluctant to use the world fetish in connection with crossdreaming. For more than 100 years it has been used to label people as mentally ill perverts.

That does not mean that I do not see the value of a discussion of crossdreamers expressing fetishistic traits. As Freud argued in Three Essays on the Theory of Sexuality  all human sexuality has fetishistic aspects. In this respect crossdreamers are no different than other ordinary Joes and Janes (whoever they are). But if we are to do that we have to take the word "fetish" back from the conservative psychiatrists and turn it into something positive. I am not sure if that is feasible, but we can always try.

See also On crossdreaming and autogynephilia as a fetish

The Finns remove crossdressing from their medical manual
The autogynephilia theory... again!

APPENDIX: THE ICD ON GENDER IDENTITY AND CROSSDRESSING

According to the current ICD-11 Alpha Draft, Fetishism, Fetishistic transvestism, Sadomasochism and dual-role transvestism are not yet taken off the list of disorders of psychological development and gender identity.

The full  text can be found here.

F64 Gender identity disorders

F64.0 Transsexualism

A desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one's anatomic sex, and a wish to have surgery and hormonal treatment to make one's body as congruent as possible with one's preferred sex.

F64.1 Dual-role transvestism

The wearing of clothes of the opposite sex for part of the individual's existence in order to enjoy the temporary experience of membership of the opposite sex, but without any desire for a more permanent sex change or associated surgical reassignment, and without sexual excitement accompanying the cross-dressing.

Gender identity disorder of adolescence or adulthood, nontranssexual type 

Excludes:fetishistic transvestism ( F65.1 ) 

F64.2 Gender identity disorder of childhood

A disorder, usually first manifest during early childhood (and always well before puberty), characterized by a persistent and intense distress about assigned sex, together with a desire to be (or insistence that one is) of the other sex. There is a persistent preoccupation with the dress and activities of the opposite sex and repudiation of the individual's own sex. The diagnosis requires a profound disturbance of the normal gender identity; mere tomboyishness in girls or girlish behaviour in boys is not sufficient. Gender identity disorders in individuals who have reached or are entering puberty should not be classified here but in F66.-.

Excludes:egodystonic sexual orientation ( F66.1 )
sexual maturation disorder ( F66.0 ) 

F64.8 Other gender identity disorders

F64.9 Gender identity disorder, unspecified

Gender-role disorder NOS 

...

F65 Disorders of sexual preference
Includes:paraphilias 

F65.1 Fetishistic transvestism
The wearing of clothes of the opposite sex principally to obtain sexual excitement and to create the appearance of a person of the opposite sex. Fetishistic transvestism is distinguished from transsexual transvestism by its clear association with sexual arousal and the strong desire to remove the clothing once orgasm occurs and sexual arousal declines. It can occur as an earlier phase in the development of transsexualism.
Transvestic fetishism 

See also:

• Proposal to the ICD-11 Revision of Chapter V, Mental and Behavioural Disorders, F65 and F64. 
• Revise65
• What happens to crossdressing and crossdreaming in the ICD-11 manual?

This post was originally published over at Sex Gender Body.Some changes and additions have been made..