Gender and Sexual Disorders 489
were surveyed reported that they had appeared in public while dressed as women.
Almost two thirds are married, often with children; you may assume that they hide
their fetish from their wives, but as with Mr. A., in Case 11.6, the wives often know
about the cross-dressing. Most wives are ambivalent about it, and less than a third
accept it (Docter & Prince, 1997).
Assessing Paraphilic Disorders
The paraphilias are usually assessed by examining neurological (sometimes refl ected
by bodily responses), psychological, or social factors. Sexual arousal in men can be
measured by a penile plethysmograph, which is an indirect measure of neurologi-
cal events. The device is placed on a man’s penis and measures penile rigidity. The
man is then shown “normal” and “deviant” stimuli (such as photos of footwear or
whips), and the rigidity of the penis is measured after each stimulus is presented. If
the plethysmograph registers unusual amounts of arousal when the man views devi-
ant stimuli, compared to stimuli that induce arousal in men without a paraphilia,
this response suggests that he has a paraphilia.
In addition, researchers have recorded brain electrical activity while “normal”heterosexual men and men with paraphilias viewed “normal” erotic, “deviant”
erotic (such as typical fetish objects), or neutral stimuli (such as a street scene). Men
with paraphilias showed greater activation in the left frontal lobe (which typically
refl ects the presence of an “approach emotion,” Davidson, 2002) when viewing
deviant erotic stimuli than men without paraphilias, but men without paraphilias
showed greater activation in the right parietal lobe when viewing normal erotic
stimuli (which may refl ect increased attention or other visual processing; Waismann
et al., 2003).
Assessing Paraphilic Disorders
CASE 11.6 • FROM THE OUTSIDE: Transvestic Fetishism
Mr. A., [is] a 65-year-old security guard [married and with grown children], formerly a fi sh-
ing-boat captain.... His fi rst recollection of an interest in female clothing was putting on his
sister’s [underwear] at age 12, an act accompanied by sexual excitement. He continued period-
ically to put on women’s underpants—an activity that invariably resulted in an erection, some-
times a spontaneous emission, and sometimes masturbation, but was never accompanied by
fantasy. Although he occasionally wished to be a girl, he never fantasized himself as one. He
was competitive and aggressive with other boys and always acted “masculine.” During his
single years he was always attracted to girls, but was shy about sex. Following his marriage at
age 22, he had his fi rst heterosexual intercourse.
His involvement with female clothes was of the same intensity even after his marriage.
Beginning at age 45, after a chance exposure to a magazine called Transvestia, he began
to increase his cross-dressing activity. He learned there were other men like himself, and
he became more and more preoccupied with female clothing in fantasy and progressed
to periodically dressing completely as a woman.... Over time [his cross-dressing] has
become less eroticized and more an end in itself, but it still is a source of some sexual
excitement. He always has an increased urge to dress as a woman when under stress; it
has a tranquilizing effect. If particular circumstances prevent him from cross-dressing,
he feels extremely frustrated.
(Spitzer et al., 2002, pp. 257–258)Transvestic Fetishism Gender Identity DisorderGender identity same as biological sex Gender identity opposite of biological sexComfortable with own biological sex Want to be the other sexCross-dress for sexual arousal or to feel
“calmer”Cross-dress for congruence between appearance
and gender identityTable 11.4 • Transvestic Fetishism Versus Gender Identity Disorder