What makes transvestic fetishism a “disorder”? Distress, or harm to others. The paraphilia subworkgroup producing DSM V explain: A paraphilia by itself would not automatically justify or require psychiatric intervention. A paraphilic disorder is a paraphilia that causes distress or impairment to the individual or harm to others…This approach leaves intact the distinction between normative and non-normative sexual behavior, which could be important to researchers, but without automatically labeling non-normative sexual behavior as psychopathological.
According to the DSM, in late onset gender dysphoria the progression is: transvestic fetishism, that is, the subject is aroused by cross-dressing; autogynephilia, arousal by fantasies of self as a woman; gender dysphoria, the desire to live continually as a woman and physically alter the body.
DSM V on transvestic disorder: The presence of autogynephilia increases the likelihood of gender dysphoria in men with transvestic disorder…Some cases of transvestic disorder progress to gender dysphoria. The males in these cases, who may be indistinguishable from others with transvestic disorder in adolescence or early childhood, gradually develop desires to remain in the female role for longer periods and to feminize their anatomy. The development of gender dysphoria is usually accompanied by a (self-reported) reduction or elimination of sexual arousal in association with cross-dressing.
DSM V on gender dysphoria: Adolescents and adults with late-onset gender dysphoria frequently engage in transvestic behavior with sexual excitement. The majority of these individuals are gynephilic or sexually attracted to other posttransition natal males with late-onset gender dysphoria. A substantial percentage of adult males with late-onset gender dysphoria cohabit with or are married to natal females. After gender transition, many self-identify as lesbian…Additional predisposing factors under consideration, [that is, theories without empirical justification] especially in individuals with late-onset gender dysphoria (adolescence, adulthood), include habitual fetishistic transvestism developing into autogynephilia (i.e., sexual arousal associated with the thought or image of oneself as a woman) and other forms of more general social, psychological, or developmental problems.
It is a pity Ray Blanchard was involved in this part of DSM V. He claims transvestism develops into autogynephilia, then gender dysphoria, though not in all cases: there are cross-dressers who are quite happy with their gender and their hobby.
He overlooks distress and denial as a causal factor. Gender dysphoria plus denial manifests first as transvestism, then fantasising about being women, and finally gender dysphoria. We try to make men of ourselves. We cannot admit to ourselves that we are not men. But we cannot deny it completely, so first we compulsively cross-dress, with that extreme distress, repeatedly getting rid of the clothes; then we admit the desire to express female; and finally we cannot resist that desire any more, resisting is just too painful. I retain that distress. I want to be normal, and cannot be.
Which of these subjects may be observed? Only the ones who have developed gender dysphoria, generally: which of the fetishistic transvestites would you examine, as most of them will not develop GD. So my own evidence is of disproportionate value here. I self-identified as fetishistic transvestite, in 1992, when I sought aversion therapy. My psychiatrist Dr Yellowlees thought I showed transsexual tendencies, though I would have denied it, my distress (and so “disorder”) being so great. I am the example of the person who might give a history of developing female embodiment fantasies, which Blanchard calls “autogynephilia”, after gender dysphoria was established.
Now read on: if fetishism develops into gender dysphoria, that is beautiful.