The compulsive crossdresser has two burdens to bear. First, he carries the stigma of requiring an unusual erotic turn-on. Also, he has the experience of being driven toward, rather than choosing when to indulge, his erotic needs.
Not all crossdressers are compulsive. Rather, they have a narrow range of erotic triggers -- usually focused on wearing one or several items of women's clothing. Many crossdressers can function sexually when denied this outlet, but they usually report diminished satisfaction and sometimes lessened interest in sex when such garments are not available to them.
The compulsive crossdresser, however, must have these items to function and he obsesses about their accessibility and frequency of use. Sometimes this drive is so insistent that it occupies time that should be more productively devoted to family relationships or work. He is usually very upset by this burgeoning need but feels helpless to resist it.
If he is partnered and lives with family members, the family often becomes aware of his distress, although they may not know its nature. The fear of discovery or censure adds yet another weight to the pressure on the compulsive crossdresser. He is in a terrible bind. While indulging in the compulsive activity relieves anxiety temporarily, the fear of exposure and the awareness of his lack of self-control ultimately raises his stress level, requiring more engagement in the compulsion. A cycle is set in motion in which behavior, which is voluntary for most crossdressing individuals, becomes compulsive.
Even when discovery of crossdressing is not an issue, most of these men do fear their partner's awareness of their growing preoccupation with sex. In some instances, increased demands on the wife cause her to reject his sexual advances. In other situations, the man indulges increasingly in solitary sex, leaving his wife feeling neglected or giving rise to suspicions that there is another woman in his life. Another issue that arises is the neglect of family participation and/or work obligations. When compulsive crossdressing reaches the magnitude that I have outlined, treatment by a knowledgeable mental health clinician is indicated.
Having any compulsion is difficult. It takes up a lot of time and energy for a relatively small payback -- temporary relief from anxiety. It is often accompanied by shame and secretiveness, doubly so when the compulsion has a sexual component. The psychological aspect of compulsive crossdressing is difficult for most men in a partnered relationship to conceal from wives and family members. Their escalating sexual needs, whether met within the marriage, outside the marriage or alone, create marital pressure and discord. Any secrecy compounds the difficulty as does the tendency to spend increasing time indulging the compulsion.
At this point some crossdressers seek psychological counseling. They may seek it alone or with a partner. Complaints range from fear that the crossdresser is a "sex maniac" to accusations that he is falling out of love with his spouse. It is helpful if both partners at least accept the crossdressing. Then just the compulsivity has to be dealt with.
Understanding that compulsive behavior is a temporary, and ultimately futile, effort to relieve anxiety is essential to treating this condition. Next, one must identify the cause(s) of the anxiety. Ideally, removing the root cause is the most effective and efficient approach. For example, I might suggest improving parenting skills, career counseling, conflict resolution training, stress reduction activities, or environmental manipulation. When anxiety is internalized, the most useful approaches are medication, psychotherapy, marital counseling, and/or improving communication skills.
When either or both individuals do not accept crossdressing in the relationship, treatment is more complex. If the transvestite rejects his own crossdressing, this has to be addressed prior to dealing with his compulsion. In many cases the simple acceptance of his transvestism relieves his compulsion. When his partner rejects his crossdressing his anxiety is fueled by either the need to keep it secret, give it up, or assert his needs in the face of her disapproval. Unless the spouse is involved in treatment and open to examining her disapproval, the source of the anxiety remains and the compulsion is kept alive for the meager relief it provides.
Fortunately, the last unhappy scenario is a relatively infrequent outcome. The essential ingredients are clients open to finding creative solutions before symptoms become overwhelming and a counselor experienced in treating transgender issues, relationship problems and compulsive behaviors.
Dr. Anderson is a therapist in the San Francisco Bay Area. She can be reached at 415-776-0139.