February 25, 2011

Bibliography on paraphilias and the DSM-5

Andrew Hinderliter has put up a very useful bibliography of literature relevant to the current debate on "paraphilias" the DSM-5 (the fifth edition of the American Diagnostic and Statistical Manual of Mental Disorders) over at his asexuality site.

Asexuals are facing some of the same problems as crossdreamers. Since their being does not fit with the gender stereotypes of the day, they often end up being labelled as sick. The DSM-5 includes a separate category for "paraphilias" (read: perversions), and "autogynephilia" is one of them - classified under the heading of transvestic fetishism. Hinderliter's bibliography has a section for writings on transvestism and crossdreaming.


Distress does not equal mental disorder

Here is a quote from a listed letter from the US National Center for Transgender Equality:

"Finally, NCTE believes there is no place in the twenty-first century for a diagnosis of Transvestic Fetishism/Tranvestic Disorder. While there are certainly some individuals who experience psychological distress in relation to their desire to cross-dress – often due to the pervasive social stigma and discrimination against transgender people – this experience no more justifies a psychiatric diagnosis than does 'ego-dystonic homosexuality.' We urge the APA to eliminate this unnecessary and harmful diagnosis in the DSM 5."

Trans activist Andrea James makes the following observation regarding crossdreaming:

"Unconventional sexual behavior that is consensual can reach a level where impulse control needs to be managed, but that should not be thought of as 'curing' the interest itself. There's no need to diagnose or 'cure' harmless sexual interests. It's sad to see that we are well into the 21st century, yet some experts still cling to the idea that 'transvestic fetishism' or other forms of consensual kink are disorders."

How science is used in oppression

"There is a long history, stretching from Phrenology to The Bell Curve, of dubious research that has attempted to give scientific credence to the presumption that people of color are mentally inferior to the white majority.

"Invalidation by mental inferiority has also been used to justify sexism: the claim that women are biologically or hormonally predispositioned to be overly emotional (read: irrational or immature) has been evoked by those who feel that women should defer to men, or who feel that women are not capable of dealing with serious or important matters. For example, the suffragists who fought for women's right to vote were regularly dismissed as suffering from 'hysteria,' which was considered a legitimate mental disturbance at the time.

"...I'll repeat that: any person who does not understand or acknowledge how injurious these transinvalidations are to us, simply does not understand transgenderism. Period. I further contend that any medical or mental health provider who is sincerely concerned with the health, happiness and well-being of gender variant people must make challenging and eliminating these trans-invalidations, both within their professional fields and in society at large, a top priority.

"...Trans-invalidations are also reinforced by the trans-specific diagnoses in the DSM. Two of these—Transvestic Fetishism and GID in Children—were written in such a way that they primarily target people who are not crossgender identified, but who simply crossdress or who are gender nonconforming in other ways. This is abominable. Such diagnoses serve no purpose other than to further stigmatize gender variance."

From perversion to fashion standard

"The fact that there are a certain percentage of heterosexual males who get sexual excitement from cross-dressing doesn't mean those men have a mental disorder, especially when you take into consideration the number of homosexuals and bisexual men who cross-dress as well as the significant subculture of women who cross-dress. Why are heterosexual males singled out for a diagnosis? Clearly it's a specific cultural bias against men who dress as women. In an earlier time in history, women who dressed as men were considered to be abnormal. Today, it's a fashion standard.

"The history of sexual disorders is intertwined with cultural norms. It is not clear why the DSM makes the distinction between normative and non-normative sexual behavior. Historically oral and anal sex were non-normative – today both are accepted by society. Homosexuality and nymphomania are no longer diagnoses, masturbation is now considered to be healthy, while some disorders like female orgasmic disorder describes a syndrome that was once considered to be 'normal.' "

Cause and effect

I would like to add that the reason for me opposing the inclusion of crossdreaming in the DSM is not that crossdreamers never suffer from mental disorders. Actually, I am convinced there is significantly more depression, more compulsive and addictive behavior and more suicides among us than in the population at large.

But this is not because the failure to live up to the scientist's strict standards of normalcy is a disease in itself. The suffering is caused by the lack of respect and acceptance found in parts of the medical community and society. If you are repeatedly given the impression that there is something seriously wrong with you, and that an essential part of your very being is perverted, that leads to embarrassment, shame, guilt and even social ostracism.

This means that the American Psychiatric Association -- which is responsible for the DSM -- is partly causing the suffering it is supposed to cure. The DSM is part of our problem, not the solution.

Further reading

Here are some of my posts on crossdressing, paraphilias and the DSM-5:
Blanchard and the DSM-V, redefining paraphilia
DSM-V: What about autogynephilia?
DSM-V: What others say Petition Opposing the Transvestic Disorder Diagnosis in the DSM-5
Autoandrophilia makes it into the DSM-5
On Moser's critique of Blanchard's autogynephilia theory
Strong resistance against proposed paraphilias in the DSM-5
On grammar, paraphilia and the DSM-5
See also Hinderliter's Asexual Exploration's Blog.


  1. The argument that you give at the bottom is quite similar to arguments given against including "ego-dystonic homosexuality" in DSM-III. Critics asked, "if someone comes to a clinician experiencing considerable distress about being gay, why is a diagnosis of 'ego-dystnoic homosexuality' necessary? Why not just say they have depression or an anxiety disorder? (link to reference)

  2. This is the same thing many people with Aspergers syndrome deal with daily in their lives. They also battle with intense social ostracism and shame owing to their very unsocial and geeky nature which makes them look very awkward at times.
    It can indeed lead to a serious depression which by no means is pathological but just a sorry reaction to how society deals with the issue.
    One thing I have wondered for a long time is whether there is any relation between autism and gender variance atleast in some people. For, there are indeed a lot of autistic people who are also highly gender variant.

  3. Great post! Crossdressing whether for simply expressing one's feminine side or for sexual fetish shouldn't be stigmatized as a mental disorder. It really should be out of the DSM and suspect one day it will.

    As for James, link with autism, well I have an adult son born autistic plus a mother who was epileptic. I am transgendered. So I've often wondered if there is some unique brain rewiring happening in our genes. My son has no desire to express a different gender. Yet his disability causes him to have some slight difficulty with communicating well. People who know he has Aspergers love him because he's a sincerely wonderful soul. Those who don't know find him thick and slow. It's quite sad. So we do what we can to educate people on both our conditions. That's the only way I know to win folks over.

  4. I am torn on about how see myself :

    For about 20 years, almost all my sexual fantasies implied me in nylon stockings or the vision of nylon stockings on a girl with a underlying thought that I would like to be the girl.

    Recently, I understood that despite the fact I fall in love with girls, I prefered by far beeing bottom with a man that top with a girl. I am receptive and I don't like so much beeing active. I stared to be turn out by hair men in the genital area. I don't find me attractive but the vision of a hairy dick make me want to be fucked like a girl. I don't see myself dating a girl and hidding my sexual needs (I want her to know all and let me free to do what I want with men or at least to fuck me once in a while with a strap on dildo as if she ws the man and I was the female). I can not be in a normal relationship in which I could only play the active male in bed. I need to be fucked to be happy.

    So now I wonder if :

    1) I love men and have always loved men and the travestite game was an easy way to cope with my homosexuality without feeling gay (my mother is homophobic and wanted to have a girl) and so if I should date men and may drop all these autogynephiliac fantasies.
    => So a gay in the closet who doesn't dare facing the truth. It seem unlikely as I never wanted to kiss a man so far.

    2) I am an autogynephiliac fetishist who will go deeper and deeper in his fantasies and end up the totaly sex addict and may be change his body to excite myself and to attract men whose role is to help me to feel female
    => So some kind of sexual deviant who preferes sex with himself and use men like dildoes. So someone with a burden to carry ans who will be all his life alone or frustrated.

    3) A man who has the ability to get rid of social norms, education and norms and who can accept that he has a female side while other men can not accept their female side.
    => So someone who should be happy to find sex easily, to feel what other people don't feel and to be a more complete person. To live 2 lifes in one life.

    4) A borderline man who has long time gender question because of his borderline mental structure and who is going deeper in the idea of beeing a woman because his mental structure lost its balance after a break up with a girl whi was some kind of insurance to stay in the normality.

    Who am I ?

    Depends on the day.

    Some days I want to get rid of my fantasies and be a normal man who fancy pussy of dick but who dosn't need to dress.

    Some days I want to stay like I am and have a slightly more feminine body and keep my fantasies.

    Some days I wonder if beeing a true girl with girl's mind would,n't be the best.

    Some days I think that I should have a sex change to have a fake pussy and have sex with men like a women but live like a man.

    This is not easy to handle. I know that I don't want to be a transexual freak. I know thatI only want to be a woman for sex and stockings and that I don't imagine myself beeing dressed for something else than sex (I couldn't go shopping in a supermarket with make up and heels, I would find that unconfortable as make up is rather a burden and high heels a pain after a few meters). But is beeing a woman wearing make up and heels ? I mean some woman never wear them and still love to me women. So I like to be seen as a woman by other people when sex is not in account. I think that I don't care. I like beeing seen as a man but beeing seen as a woman is not a problem.

    I am afraid that suicide is my only way out because if I go deeper and deeper in my fantasy, I will end up sex addict transexual prostitute seen as a FREAK by the society.

  5. @King of Anonymous

    Your post definitely proves the point that labeling people as paraphiliacs causes more pain than it heals.

    But first of all: Transwomen are not freaks. They are women born in a male body. So, if you come to the point where you find peace with your inner woman and realize that you are a woman, that does not make you a freak.

    Still, many do not reach that point, probably because they are somewhere else gender wise. And that is damned confusing. I agree.

    Your various models are ways of approaching a different truth, one that is unlike any of them. Our language is not made for what crossdreamers are.

    For instance: What does homosexual mean? Nowadays it means someone who is exclusively attracted to the male body. If you fall in love with a woman, you are NOT gay.

    Still, in many cultures most -- if not all -- men take part in same-sex activities, even if they fall in love with women. What does that make them?

    Some crossdreamers become addicted to crossdreaming fantasies. But is this because crossdreaming is an addiction (like alcoholism)? Or is it because the inner woman find no way of expressing herself in a loving relationship?

    And what does feminine mean? You are afraid of transitioning, because you do not feel the way women are supposed to feel -- or behave (if I understand you correctly).

    But I know all kinds of sexy and attractive women who do not behave in a stereotypically feminine way.

    It seems many crossdressers and transwomen have painted themselves into a corner, believing that all women look and behave like -- I don't know -- Julia Roberts, I guess. They do not.

    You say: "I am afraid that suicide is my only way out because if I go deeper and deeper in my fantasy, I will end up sex addict transexual prostitute seen as a FREAK by the society."

    I can feel your pain. In fact there are many days where I am in a similar spot. Still, in my experience facing the fantasies and accepting that part of myself, actually helps me handle them in a better way. I truly believe they express something good in us, but that this good thing becomes thwarted due to the fact that it is not accepted by society, nor by ourselves.

    Suicide is so not an option. As long as there is life there is hope. Two of my gay friends are getting married in Church this year. A few year ago that would have been impossible even to contemplate!

    Hold on! You are part of a team here...

  6. For me people who change their sex are people who deadly CONFORM TO NORMS as we are all men and women, and so going from one end to another end makes no sense and will not solve anything.

    They are freaks because :

    1) most don't look attractive women women but like men dressed in women if they have no facial surgery or like clones with unatural faces (look at south american transexual to understand) after they had surgery.

    2) They have strange voices and exagerate what us supposed to be feminine behaviour. They are some sort of caricatures.

    Wanting to cut a part of his own body doesn't sound healthy to me. That's why they are also freaks.

    I know that many cut their penis because the society doesn't allow them to be socialy women and keeping their penis but many are obsesed with cutting their sex and think that it will solve all their problems.

    By freak I mean people with mental issues. I don't tell that we must reject them or that they shouldn't be helped by surgery. I mean that they are in great pain and that it is not just that they are women. They are men with mental issues and will never be women. They could be some sort of weird mix.

    I don't care if I am a paraphile or a pervert. This is just a word.

    My problem is that I can not match love and great sex and that I often change my mind (one day I want to be in love in a woman, another day I want to be a woman...)

  7. "I mean that they are in great pain and that it is not just that they are women. They are men with mental issues and will never be women. They could be some sort of weird mix."

    Of course, a society which does not acknowledge the presence of third and fourth genders will definitely make you feel that you are a "man" with mental issues rather than simply of the intermediate gender.
    And just because you are a mix, does not mean all TGs are. Certainly the transsexuals aren't.
    Learn and read and know a lot before disrespecting someone's gender based on old blind prejudices.
    I know you are hurt and so also many of us are,but by saying all these, you are just conforming to some anti-human standards much like BBL triad.

  8. "most don't look attractive women women but like men dressed in women if they have no facial surgery or like clones with unatural faces (look at south american transexual to understand) after they had surgery."
    Hardly. Where in the world are you? Look at these:

  9. All people are mix as we come from male and female.

    Transexuals (the one who change sex) don't admit this and are world leading conformists who think they are more woman than women (as most women admit to have some masculin parts).

    Many people in your link are not attractive and you don't see the bodies (flat asses, crooked skiny legs, huge feet, masculine height...). Remove the make up and most look poor. And this is probably their best pictures.

    It is funny to see that you don't reply that ugly women are still women and so that ugly men had the right to become ugly transexuals.

    These are the ones who have money for surgery (as most are intellectuals).

    Many others look terrible = like cheap hookers or like asexual grannies.

    Any man above 180cm has no chance to look feminine. All men with muscles or large bones have no chance to look feminine. That makes many people who have no chance to look good in woman.

  10. For me in dealing with my problem i don't actually now what to do. There are days where i feel like I want to be a girl and then there are days that I don't. It also depends on the time of day that I feel.
    There are a lot of times that I feel really stressed when I think about my fantasies and what i should do about them.
    There are times where I feel very open about my fantasies and desires then there are times where I don.'t.
    I have actually created a term for how I feel. I call it "recoiling, or recoiling syndrome". And this is exactly how i feel sometimes. I feel there is a part of me that want to accept this and another that doesn't. When the part of me that doesn't becomes dominated I pull back in my and think that want i want to do is wrong or not right.
    The same is true of the things that i like to look at. There are times where is feel wrong to look at.
    I also want to crossdress and even with that I have strange things with that. I think it is mostly because society ostracizes those that do it.
    Another problem that I have is that right now I am kind of addicted to going on to the site with TG material mostly to get the sexual thrill from it and that i don't know what to do.
    What I worry is that i will get to a point where they will take over. I do know that I have control problems thou.
    I now that having all these things including the crossdreaming not only leads to more stress in my life but more depression too. The thing i wonder is if i give in too my fantasizes will that help any. And if that does how exactly should I do that?

  11. In my neighborhood there is one transwoman that stands out in a crowd. I think she is beautiful.

    She is, however, two meters tall (6.6 feet) and in spite of her feminine appearance, her broad shoulders and body mass makes people take another look, trying to figure out what is "off".

    I am sure she is aware of this, but it seems to me she has decided not to give a damn. She looks happy and is probably more like her true self now than she has ever been. In other words: She has made a choice, weighing the pros and cons.

    I have noticed that many argue that gynephilic transwomen are not real women because they look masculine (cf. Blanchard).

    Many of them actually do look feminine, and the main reason there is a difference between them and the androphilic transsexuals is probably because they normally transition later. Older women tend to look less feminine than younger ones. That does not make them ugly, however.

    I think the fact that they transition regardless proves that they are what they believe they are. They are willing to suffer the ridicule in order to be at peace with themselves.

    But I guess they are also aware of the fact that they do not look like the archetypal cover girl. But then again, most women don't. None of us are living in a perfect world, and we -- the crossdreamers -- definitely aren't.

    And for those who want to transition, having the body of a lumber jack makes it even harder. But that does not make them freaks -- only different.

    They must be prepared to live with people calling them freaks, however, and can I see that that can be a heavy burden, but I'd rather see that the people who call them freaks were not us.

    But is this what causes you so much pain, King? You would like to transition, but believes you would not be able to pass as one?

  12. FTR, I have never heard a single transsexual ever say sh is more feminine than any woman. All transsexual girls have masculine sides and they are not afraid of showing that, much like any woman.

    "Many people in your link are not attractive and you don't see the bodies (flat asses, crooked skiny legs, huge feet, masculine height...)."

    And,also, you cannot call someone who has gender identity of female as a man just because she has a 6feet height or muscles, period. I can bet you that for every transwoman of that shape,there is also a real woman of that shape.

    It is so pathetic that you consider these stupid and trivial aspects when determining if someone is a female or male. A person who himself has gender issues must be definitely aware of these aspects and you seem not to.
    Which means either you are just some cheap troll posing as a transgender in the internet or someone who is so terribly disturbed by his own circumstances that ranting seems to be the best way of coping up for you.

  13. I don't want to change sex bacause :

    1) I don't want to mutilate my body (and cuting a penis is a major mutilation) and be obliged to take dangerous drugs for life

    2) I don't want to be seen by 95% of people as a psycho, a freak, a zoo creature

    3) I want to be sexy and attractive and it happens that I am sexier as a man (I am a sexy man) than as a woman (I would be an average woman with muscular calves which is not attractive at all to me) and this can only be more the case with aging as transexual and women look terrible with aging (an old woman has no sexual power at all while and old man can still remain sexy)

    4) Living non stop as a woman is a burden = make up, non confortable shoes and cothes, beeing harassed and assaulted, beeing less paid at work, the social pressure of beauty, having to be submissive in relations with men...

    So I assume that I am not a transexual and that living in woman would only make my life more complicated and my problems go bigger (less social integration, more love problems...)

    Though, my sexual fantasy is to have a pussy, to be sexy, to wear stockings, to see that i have sexy legs and feets and to be fucked like a woman. I don't like beeing a man in bed.

    Does it mean that I am a TROLL ??!!! SHOCKING !

  14. For me real women who are tall or muscular are not women.

    For me they are asexual, not attractive, they are like men.

    I never imagine them as love partenairs.

    They are like 70 years ols women.

    So I don't want to be a tall and musclar tranny.

    I would like to be what i like = denty elegant feminine bodies with a pink pussy.

    I don't like black women either. They are like aliens to me. Not sexual at all. I could never have sex with a black woman while I had sew with black men.

    I think a way to see if one is a fetishist or a transexual = does he prefer to be a real ugly woman and dress like a grany or to be a sexy man who can be a sexy transvestite ??

  15. Jack, if you were not in love, you would have sex with men, correct ?

    Why don't you wear female clothes with fake breast to have the illusion to gave a female body ?

    I also dream about vagina but a vagina without sexy clothes is not so exciting.

  16. Sometimes, I think about sex change, about how happy I would be if I had a pussy (even a fake one as soon as it can receive dicks) instead of having a penis because I feel 99% passive.

    OK, I can have passive sex with my ass but I don't feel really like a woman. I somewhat feel like a freak who loves what only gay man love while I am not gay = to be the bottom in bed.

    But changing sex just for sex is dumb as sex only last a few hours per week while life in woman last 24 hours per day.

    OK, I could change my body and live as a man without a penis and balls and with a fake pussy. But this is dangerous, it implies to take dangereus medecine, to spend much money and to have zero chances to be in love in a sexy woman (what woman wants a man with a pussy?! May be some butch woman but no sexy feminine want fore sure!). And to change sex, yo uare expected to live as a woman. And I don't want to live as a woman. I juste want a pussy and nice hairless body to feel like a woman in bed.

    Am I alone in this case ?


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