A test of the dsm‐III‐R'S implicit assumption that fetishistic arousal and gender dysphoria are mutually exclusive

This study sought to determine the proportion of adult, male, heterosexual cross‐dressers who acknowledge both gender dysphoria and at least occasional fetishistic response to cross‐dressing. Subjects were 193 outpatients of the gender identity clinic or behavioral sexology department of a psychiatric teaching hospital. Questionnaire items were used to assess subjects' current level of gender dysphoria and their recent history of sexual response to cross‐dressing. Subjects who reported higher levels of gender dysphoria tended to report lower frequencies of sexual arousal with cross‐dressing (r = ‐.56, p < .0001) and lower frequencies of masturbation with cross‐dressing (r = ‐.62, p < .0001). About half of even the most strongly gender dysphoric subjects, however, acknowledged that they still become sexually aroused or masturbate at least occasionally when cross‐dressing. These findings indicate a need for revision in the DSM‐III‐R's diagnostic criteria for transvestism and gender identity disorders, which presuppose that gender dysphoria and fetishistic reactions are mutually exclusive.