by Mohd Hadi B.

Zainol Shokor 060100829

Transvestic fetishism is defined by DSM-IVTR , as one of the paraphilias . The paraphilias are a group of mental disorders characterized by obsession with unusual sexual practices or with sexual activity involving nonconsenting or inappropriate partners (such as children or animals).

The essential feature of transvestic fetishism is recurrent intense sexual urges and sexually arousing fantasies involving dressing in clothing associated with members of the opposite sex.

Derives sexual gratification from dressing in clothing appropriate for a member of the opposite sex. Almost all patients diagnosed with transvestic fetishism, however, are men dressing as women.

The cause may be adolescent curiosity. Sometimes begins when a young boy dresses up in the clothes of an older sister or his mother. Boy's mother may initiate the cross-dressing by dressing him as if he were a girl. This behavior is sometimes related to the mother's anger at men or to a preference for having daughters rather than sons.

Early symptoms - touching or wearing items of clothing that are considered typically feminine. Progress - wearing undergarments or other items that can be hidden from the view of others. Extent up to the point of dressing as a woman on a regular basis.

In some persons diagnosed with transvestic fetishism, the motivation for cross-dressing may change over time from a search for sexual excitement to simple relief from stress, depression, or anxiety.

The diagnosis is made only if the patient has been markedly distressed by inability to dress in such a manner or if the disorder is interfering with his education, occupation, or social life.

DSM-IV diagnostic criteria for transvestic fetishism:

 Over a period of at least 6 months, in a

heterosexual male, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving cross-dressing.  The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Cognitive-behavioral therapy: therapists apply the technique of "covert sensitization," in which patients' harmful sexual variation is paired with an unpleasant stimulus. Group therapy: This mode of therapy involves breaking through the denial so commonly found in people with paraphilias by surrounding them with other patients who share their illness.

Posthypnotic suggestions that patients would feel nausea and disgust if they engaged in the forbidden behavior. Orgasmic reconditioning: before orgasm, the patient is told to concentrate on a more acceptable fantasy.

Buspirone - Has anxiolytic effect. Fluoxetine - (SSRI) Selectively inhibits presynaptic serotonin reuptake. Medroxyprogesterone - May be used to reduce sex drive. Triptorelin - Lead to reduced sex drive.

The prognosis for treatment of transvestic fetishism is poor, as most persons with this disorder do not desire to change.

Providing gender-appropriate guidance in a culturally appropriate situation will prevent the formation of a transvestic fetish. Acceptance of a child's biological sex.