A Comparison of Treated and Untreated 
   Male Crossdressers 


   Jack L. Croughan, M.D.,1,2 Marcel Saghir, M.D.,1 Rose Cohen,1 and Eli 
Robins, M.D.1 
   
   In an interview study of 70 male members of crossdressing clubs, multiple 
comparisons between treated and untreated subjects showed that the two groups 
are more similar than dissimilar.  The only areas of comparison in which the 
treated group significantly differed from the untreated group were in 
fantasizing themselves as females while masturbating, having ever engaged in 
heterosexual intercourse while crossdressed, currently preferring both 
heterosexual intercourse and homosexual behavior while crossdressed, and 
having experienced more adverse consequences from crossdressing.  Further, 
where comparisons are possible, our results are similar to those found in 
prior studies.  All of the subjects were male and the average age of onset is 
prior to 10 years, with virtually all subjects first crossdressing if not in 
childhood then by middle adolescence.  The course is chronic with only 
occasional and usually brief remissions, although there are instances in a 
minority of subjects of periods of remission lasting several months to a few 
years within the context of more than two decades of otherwise continuous 
crossdressing behavior.  The interval between onset and first treatment, if 
any, is several years.  Early in its development, crossdressing is virtually 
always associated with sexual arousal and sexual behavior, usually 
masturbation.  Later, in adult life, it is more frequently associated with 
heterosexual intercourse and only rarely with masturbation as subjects 
approach middle age.  There is a trend toward a more asexual nature to the 
crossdressing during late adult life.  Crossdressing is infrequently 
associated with sadomasochism and not at all with exhibitionism.  Rates of 
unipolar depression and alcoholism were increased in this sample.  The results 
do not support a significant positive association between crossdressing and 
obsessive-compulsive neurosis.  The present study confirms previous findings 
that crossdressing lacks a familial component either with respect to 
crossdressing itself or in association with another disorder. 
   
   This study was supported in part by grant MH 20520-01. 
   
   1Department of Psychiatry, Washington University School of Medicine, St. 
Louis, Missouri 63110.  
   2Jewish Hospital of St. Louis, 2165, Kingshighway, St. Louis, Missouri 
63110. 
   
   KEY WORDS: crossdressers; interview; treatment; diagnosis; family; 
transvestism. 
   
   INTRODUCTION 
   The majority of publications on transvestism focus on discussion of 
theories of etiology or proposals for classification of crossdressing 
behavior.  Some reports provide data about patients who have voluntarily 
sought treatment or who have been referred by the judicial system for 
evaluation.  There are two prior series of articles that report on the results 
of interviews with subjects who were not selected on the basis of being 
patients or court referrals.  Rather, they were members of crossdressing 
social organizations (Buhrich and McConaghy, 1977; Buhrich, 1976, 1977a, 1978) 
or respondents to a request for information in a transvestite publication 
(Prince and Bentler, 1972).  To our knowledge, however, there have not been 
reports that have compared treated and untreated subjects.  In addition, there 
is a series of reports on the results of personality tests with transvestites 
(Bentler and Prince, 1969, 1970; Bentler et al., 1970) that essentially shows 
no significant differences between subjects and controls.  With the exception 
of a few case reports, however, we did not find any studies describing either 
the results of systematic psychiatric interview with subjects or the 
occurrence of psychiatric illness in their families. 
   The purpose of this paper is to present comparative results of a personal 
interview study of treated and untreated male crossdressers.  We want to 
determine whether conclusions based on results from prior studies of patients 
seeking treatment should be modified to account for differences in results 
obtained from subjects who have not sought treatment.  In addition, we present 
information about psychiatric diagnoses in these subjects and their families. 
   METHODS OF PROCEDURE 
   Subjects either were a member of one of two national organizations of 
crossdressing social clubs or were referred as nonmembers by a member of one 
of the clubs.  The clubs provided their members with advice and emotional 
support for crossdressing as well as a means of socialization. 
    Exclusion criteria prior to interview eliminated homosexual drag queens 
and those who had received a transsexual conversion operation.  Subjects 
denying these exclusion criteria were systematically interviewed using both 
closed and open-ended formats and were asked questions regarding the following 
areas: demographic characteristics including age, marital status, usual and 
current occupation, annual income, and residence; medical histories including 
a review of systems, hospitalizations and operations, and psychiatric 
hospitalizations; and symptoms of psychiatric illnesses including anxiety 
neurosis, hysteria, phobic neurosis, obsessional neurosis, depression, mania, 
alcoholism, drug abuse, antisocial personality, and schizophrenia.  
Psychiatric diagnoses were made using specific criteria (Feighner et al., 
1972). 
   Subjects were also asked about family histories of psychiatric illness 
including nervous breakdowns, attempted suicides, completed suicides, 
alcoholism, frequent trouble with the law, drug abuse, and sexual problems 
including homosexuality and crossdressing.  Subjects were asked about 
environments of rearing including presence and absence of parents, broken 
homes by separation, divorce, and death, and global assessments of the 
subjects' opinions about the degree to which they were happy during childhood 
in that environment.  They were also asked questions concerning discipline and 
role modeling for each parent or parental figures.  Specific arrest histories 
were obtained including types and frequencies of arrests relating to sexual 
problems.  Questions relating to early childhood traits including sissiness 
and early thoughts regarding gender dysphoria were asked. 
   Subjects were also asked questions with regard to thoughts and behaviors 
relating to transsexualism.  Extensive data were obtained regarding onset and 
characteristics of crossdressing as well as the association of this behavior 
with sexual arousal, masturbation, and heterosexual and homosexual behavior.  
Information about articles of clothing or accessories used, frequency of the 
use, fantasies associated with crossdressing, and awareness of parents, 
siblings, wives, children, and friends with regard to the subject's 
crossdressing were ascertained.  Questions were asked regarding the 
relationship of alcohol and drug use to crossdressing and the extent to which 
crossdressing had directly or indirectly interfered with subjects' jobs, 
marital and family relationships, and other social relationships.  Subjects 
were asked about the extent to which they had sought medical and psychiatric 
help for problems relating to crossdressing and the extent to which they had 
experienced remissions and exacerbations of crossdressing and related sexual 
behavior.  A life history of heterosexual and homosexual experiences was 
obtained both in association with and in dependent of crossdressing.  
   RESULTS 
   A total of 70 males were interviewed.  Club members accounted for 85% of 
the subjects, with 60% from one club and 25% from another The other 15% of the 
subjects were not members of any crossdressing organization or club.  They 
were referred for interview by members of the two organizations. 
   Table I.  Sociodemographic Characteristics 
                                             Treatment No treatment 
                                             (N = 34)  (N = 36) 
   
   Average age at interview                  41.9      42.9 
   Current marital status 
     Married                                 50%       61% 
     Divorced                                30%       14% 
     Single                                  21%       25% 
   Religion of rearing 
     Roman Catholic                          21%       19% 
     Protestant                              62%       69% 
     Jewish                                   6%        8% 
     None                                    12%        3% 
   Current SMSA 
     Los Angeles                             15%       31% 
     San Francisco                           21%       22% 
     Chicago                                 26%       25% 
     Denver                                  15%        3% 
     Other Midwest Area                      18%        8% 
     Refused                                  6%        3% 
     Foreign                                  0%        8% 
   Highest educational level 
     Attended high school                     9%        6% 
     Graduated high school                   53%       64% 
     Graduated college                       26%       25% 
     Graduated professional/graduate school  12%        6% 
   Occupational rank 
     Unskilled                                9%       11% 
     Semiskilled                              6%       11% 
     Clerical                                 9%       23% 
     Skilled                                 38%       29% 
     Professional/managerial                 38%       26% 
   Annual income (1972) 
     $6,000-9,999                            21%       22% 
     $10,000-14,999                          23%       28% 
     $15,000-19,999                          23%       19% 
     $20,000-29,999                          18%        8% 
     $30,000-50,000                          12%       11% 
     Unemployed                               3%       1l% 
   Table II.  Onset and Frequency of Crossdressing 
                                             Treatment  No treatment 
                                             (N = 34)   (N = 36) 
   Average age at onset                       8.3       11.3 
   Full or partial crossdressing 
   once/week or more at 
     < 10 years old                          29%        19% 
     10-19 years old                         56%        47% 
     20-29 years old                         53%        56% 
     > 30 years old                          71%        58% 
   Past one year                             80%        86% 
   Subjects were separated into treated and untreated subgroups for comparison 
purposes.  A subject was placed into the treated group if he had on one or 
more occasions been seen by a physician, counselor, or other mental health 
professional for problems relating to his crossdressing.  Duration, extent, 
and results of treatment were not used in determining allocation to the 
comparison groups.  Using the above definition, 34 subjects (49%) were placed 
in the treated group and 36 subjects (51%) in the untreated group.  Half of 
those in the treated group were self-referred for treatment (N = 17), the 
other half primarily sought help as a consequence of legal pressures by the 
courts (N = 6) or requests by wives (N = 7), parents (N = 2), or friends (N = 
2).  
   The sociodemographic characteristics of the subjects are displayed in Table 
I.  The sample is of middle age and 95% white.  Approximately one out of four 
had never married and most had been reared as Protestants.  The subjects are 
of higher than average educational level and occupational rank, with higher 
than average income.  There were no significant differences between the 
treated and untreated groups. 
   Table II provides information about age of onset and subsequent frequencies 
of crossdressing.  The difference in average age of onset between the treated 
and untreated groups is not significant.  All but four subjects (6%) first 
crossdressed by age 14 years.  About half of each group wore just 
undergarments the first time, whereas about 10% in each group were fully 
dressed.  The remainder dressed in varying combinations of clothes at onset.  
Both groups (treated and untreated) reported similar frequencies of 
crossdressing during subsequent 10-year intervals. 
   Table III.  Masturbation, Fantasies, and Crossdressing 
                                              Treatment   No treatment 
                                              (N = 34)    (N = 36) 
                                              (%)         (%) 
   Proportion of subjects who masturbated 
   while crossdressed during adolescence      88          69 
     Every time crossdressed                  40          36 
     A majority of the times                  17          24 
     A minority of the times                  43          40 
   Predominant fantasies during masturbation 
   while crossdressed as adolescenta 
     Crossdressing self                       12          14 
     Self as female                           29           6 
     Heterosexual thoughts                    29          25 
     Homosexual thoughts                       0           3 
     No fantasies                             29          53 
   Proportion of subjects who masturbated 
   while crossdressed as an adult             88          69 
     Every time crossdressed                  47          52 
     A majority of the times                  23          24 
     A minority of the times                  30          24 
   Predominant fantasies during masturbation 
   while crossdressed as adultb 
     Crossdressing                            15          19 
     Self as female                           35           8 
     Heterosexual thoughts                    23          22 
     Homosexual thoughts                       3           0 
     No fantasies                             24          51 
   ap < 0.06.  bp < 0.05. 
   The frequencies of masturbation with crossdressing as well as the 
predominant fantasies associated with masturbation and crossdressing at 
different age intervals are shown in Table III.  During adolescence, more than 
half and beyond adolescence about 3/4 of both the treated and untreated groups 
masturbated at least a majority of the times they crossdressed.  During 
adolescence (p < 0.06) as well as later (p < 0.05) subjects in the treated 
group more often fantasized themselves as females than did those in the 
untreated group. 
   The extent to which subjects engaged in various forms of sexual behaviors 
while crossdressed are shown in Table IV.  Approximately half had engaged in 
heterosexual intercourse at some time while crossdressed, whereas about one in 
four had participated similarly in homosexual behavior.  None had been 
involved in exhibitionism in public.  There was a trend for more of the 
subjects in the treated group to have ever engaged in the sexual behaviors 
listed while crossdressed, with a significant difference between the groups 
for heterosexual intercourse (P < 0.05).  Within the year prior to the 
interview, the differences between the groups with regard to preferred sexual 
activity while crossdressed were also significant (p < 0.05).  Most of the 
treated group preferred heterosexual intercourse, whereas about half of the 
untreated group preferred no sexual activity. 
   
   Table IV.  Sexual Behavior and Crossdressing 
                                           Treatment  No treatment 
                                           (N = 34)   (N = 36) 
                                           (%)        (%) 
      Proportion of subjects who engaged 
     in some form of sexual behavior 
     while crossed-dressed                  97         92 
     Masturbation                           94         83 
     Heterosexual intercoursea              62         36 
     Homosexual behavior                    32         22 
     Sadomasochism                           6          3 
   Current preference while crossdressedb 
     Masturbation                            3          3 
     Heterosexual intercourse               59         42 
     Homosexual behavior                    12          0 
     Any of above                            0          8 
     No sex                                 26         47 
   ap < 0.05.  bp < 0.05. 
   
   Table V.  Current Precipitating Factors within Past Year 
                                            Treatment No treatment 
                                            (N = 34)  (N = 36)
                                            (%)       (%) 
   Seeing clothing                          21        17 
   Depressed, bored                         12         6 
   Feeling good                              0         8 
   Tension, conflict                        15        14 
   Desire for sexual arousal and relief      0        11 
   None                                     53        44 
   
   Table VI.  Nonsexual Psychiatric Diagnoses 
                                              Treatment No treatment 
                                              (N = 34)  (N = 36) 
                                              (%)       (%) 
   Anxiety neurosis                            9         3 
   Obsessional neurosis                        3         8 
     Significant interference                  0         3 
     Mild, occasional interference             3         6 
   Depression, unipolar                       35        25 
     Definite                                 24        19 
     Probable                                 12         6 
   Alcoholism                                 26        22 
     Definite                                 18        11 
     Probable                                  9        11 
     Additional heavy drinkers                 6        11 
   Drug use                                   26        19 
     Marijuana only, psychological dependence  3         3 
     Polydrug (nonnarcotic), no interference  24        17 
   Antisocial personality                     18         8 
     Definite                                  6         6 
     Probable                                 12         3 
   Undiagnosed Paranoid schizophrenia          6         3 
   Table VII.  Family History of Psychiatric Diagnosis 
                                               All family members 
                                                     combined 
                       Father  Mother   Brothers Sisters  Treatment No treatment 
                      (N = 69) (N = 69) (N = 62) (N = 73) (N = 143) (N = 130) 
                      (%)      (%)      (%)      (%)      (%)       (%)  
   
 Depression            3        7        5        4        6         4   
 Schizophrenia         3        -        -        -        -         -   
 Alcoholism           14        4        5        -        9         5   
 Sexual deviations     1        -        7        1        -         -   
 Crossdressing         1        -        2        1        1       < 1   
 Homosexuality         -        -        5        -        2         -   
 First-degree family members 
 > 1 above diagnoses  25       12       16        6        -         -
             Total     -        -        -        -       18        10 
   As shown in Table V, only about half of the subjects reported that there 
were factors in the prior year that they felt increased their desire to 
crossdress.  Of those who did report one or more factors, however the majority 
reported that the sight of women's clothing often provoked and increased their 
desire to crossdress.  The treatment group more often reported a form of 
dysphoric mood (depression, boredom, tension, conflict) as a precipitant, 
whereas the untreated group more often reported an increased desire to 
crossdress in association with feeling good or a desire for sexual arousal and 
relief.  The differences approached but did not reach significance (p < 0.10). 
   All but two of the subjects had tried to stop crossdressing on at least one 
occasion.  However, over half of both groups tried stopping only once in their 
lifetime, and less than 30% in each group tried three or more times.  There 
were no differences between the treated and untreated groups regarding 
abstinence from crossdressing.  The longest average period of abstinence for 
both groups was about 1 year. 
   The extent to which subjects reported nonsexual psychiatric diagnoses are 
shown in Table VI.  Some subjects received more than one diagnosis.  All 
diagnoses were made on the basis of lifetime prevalence (Feighner et al., 
1972).  The frequencies of unipolar depression and alcoholism were elevated.  
Mild increases in antisocial personality and possibly also paranoid 
schizophrenia and obsessional neurosis were observed (Goodwin and Guze, 1979). 
   Table VII shows the lifetime prevalences of these same psychiatric 
disorders as well as the sexual deviations in first-degree family members.  
The data do not reveal any evidence for crossdressing as a familial disorder.  
In addition, there was no significant increase in homosexuality.  The usually 
observed general population prevalence ratios for males and females of 1:2 for 
depression and 3-5:1 for alcoholism were observed in this family history data 
also (Goodwin and Guze, 1979). 
   The proportions of subjects who experienced a variety of adverse 
consequences of crossdressing are shown in Table VIII.  Subjects were recorded 
as having adverse consequences if they had been arrested, divorced, had 
experienced some significant interference in their occupation, education, or 
social relationships with others, or had experienced negative thoughts because 
of crossdressing.  Categories were not mutually exclusive.  In all, over 95% 
had either experienced at least one of the consequences listed or had sought 
treatment specifically for their crossdressing behavior.  Treated subjects 
reported that they had experienced significantly more adverse consequences 
than subjects who had not sought treatment (P < 0.05). 
   Table VIII.  Adverse Consequences of Crossdressing 
                                      Treatmenta No treatmenta 
                                      (N = 34)   (N = 36) 
                                      (%)        (%) 
 Arrested Crossdressing               38          8 
 Child molestation                     3          0 
 Divorce                              27          8 
 Interfered with occupation           24          8 
 Interfered with education            18          3 
 Interfered with social relationship 
                      with other men  62         28 
 Interfered with social relationship 
                          with women  41         17 
 Subject objects                      24          8 
 Family objects                       62         53 
 Has lost friends                     18         14 
 Other object                         74         36 
 Feels guilty                         18         25 
   ap < 0.05 
   DISCUSSION 
   All of the subjects interviewed were males.  None of the clubs had female 
members, although wives of members were often encouraged to accompany their 
husbands to the meetings and to club functions as guests.  We are not aware of 
analogous crossdressing organizations that provide similar opportunities to 
females.  This might be because of lack of need.  It is much more possible in 
our culture for women to wear obviously masculine clothing without fear of 
recrimination.  Thus, the need for mutual support and advice as well as a 
protective environment may be nonexistent for females who prefer to wear more 
masculine clothing.  Also, possibly because of biologically or culturally 
induced differences in mechanisms of sexual arousal in males and females, 
there does not appear to be a female entity of crossdressers corresponding to 
males who crossdress for sexual arousal and relief.  Such women are either 
rare, nonexistent, or simply do not bring attention to themselves by seeking 
help, experiencing interference, or coming into significant conflict with 
their family, friends, or society.  Those females who do crossdress and seek 
help or experience conflict are reported to be either homosexual or 
transsexual (Lukianowicz, 1959a; Randell, 1959; Benjamin, 1966; Lester, 1975).  
None seem to correspond to the group of heterosexual males who crossdress 
primarily for purposes of sexual arousal. 
   Regarding other sociodemographic characteristics, the data in Table I 
illustrate the fairly broad range and distribution of the variables described 
for the treated and untreated samples.  Comparable information has been 
previously reported (Turtle, 1963; Buhrich and McConaghy, 1977; Buhrich, 
1977a, 1978; Prince & Bentler, 1972), although our sample was 2-5 years older, 
somewhat more often married, and of slightly higher socioeconomic status. 
   Except for cases of crossdressing associated with psychosis (Ward, 1975; 
Lukianowicz, 1959a, 1962), all authors report an early age of onset 
(Lukianowicz, 1959b; Buckner, 1970; Benjamin, 1966; Stoller, 1968; Turtle, 
1963; Randell, 1975; Prince and Bentler, 1972), on the average by 10 years of 
age and almost always by 15.  None of the four subjects in the current study 
whose crossdressing began after adolescence, however, was diagnosed as 
psychotic. 
   A comparison of the frequency of crossdressing at different age intervals 
did not reveal any significant differences between the treated and untreated 
groups.  The slightly higher proportions prior to 20 years for the treated 
group is probably a reflection of the earlier age of onset.  Exact comparisons 
with other reports are compromised because of differences in data-reporting 
formats.  However, a fairly specific comparison is possible between Buhrich's 
data on crossdressing frequencies in the prior 2 years (Buhrich & McConaghy, 
1977) and our frequencies in the prior 1 year.  Of the subjects in the present 
study, 64% engaged in full crossdressing and 59% in partial crossdressing on 
at least a weekly basis during the 1 year prior to interview.  Corresponding 
figures for full and partial crossdressing from Buhrich's study are 
significantly lower, 29% for each. 
   Regarding sexual arousal and behavior associated with crossdressing, 
Buhrich reported that all of his subjects had shown arousal to women's 
clothes.  (Buhrich & McConaghy, 1977).  Five of our subjects (7%) denied ever 
experiencing arousal with crossdressing.  These same subjects also denied any 
sexual behavior, including masturbation, hetero- or homosexual activities, and 
other forms of sexual or sexually related behavior such as sadomasochism, 
child molestation, rape, or exhibitionism, while crossdressed. 
   Manifestations of arousal most often involve masturbation or heterosexual 
intercourse.  Of the subjects in the current study, 79% reported masturbating 
with crossdressing during adolescence or as an adult.  The comparable figure 
for the period of adolescence from Buhrich's study is 53% (Buhrich & 
McConaghy, 1977).  All but four of our subjects (6%) had masturbated at some 
time while crossdressed.  Nearly half of our subjects (49%) had engaged in 
heterosexual intercourse while crossdressed, and about one in four (27%) had 
participated in some form of homosexual behavior on at least one occasion 
while crossdressed.  There were 4% who had participated in sadomasochistic 
behavior while crossdressed.  Comparable figures were not found in Buhrich's 
(Buhrich McConaghy, 1977) or other reports. 
   Within the year prior to interview, 37% of our subjects stated that they 
preferred not to engage in any sexual activity.  This occurred predominantly 
in the untreated group and in older subjects.  Buhrich reported; similar 
observation of a decrease in arousal as subjects aged, with somewhat lower 
figure of 27% reporting no arousal in the previous months (Buhrich and 
McConaghy, 1977; Buhrich, 1977a).  The fact that Buhrich's subjects were, on 
the average, 3-4 years younger might partly explain his lower figure. 
   With the exception of isolated cases associated with episodes of psychosis 
(Lukianowicz, 1959b; Ward, 1975), the course of crossdressing is consistently 
described as chronic and unremitting (Lukianowicz, 1959b Buhrich, 1978; 
Lebovitz, 1972).  This was certainly evident in the present study, where, on 
the average, subjects had been crossdressing with few exceptions on at least a 
weekly basis for over two decades, with occasional brief periods of remission 
usually lasting from a few months to a few years.  A comparison with Buhrich's 
data (1978) reveals that 54% of his transvestites attempted to discard 
permanently all their women's clothes with 40% discarding them on more than 
one occasion.  Corresponding figures from the present study are 83% and 53%.  
Buhrich also comments that his subjects invariably began crossdressing again 
usually within several weeks.  As previously noted, our subjects were somewhat 
older and, thus, would have had more time in which to try to stop 
crossdressing, thereby perhaps explaining in part our higher percentages.  
Treatment appeared to play virtually no role in bringing about periods of 
abstinence This might have been a consequence of both the types of treatment 
employed and the duration of behavior.  Most of the subjects received 
psychotherapy alone.  This approach has not been found to be very successful; 
instead, electric aversion has been advocated (Marks et al., 1970).  Further 
more, the average elapsed time between onset and first treatment for those who 
received treatment was about 20 years, perhaps making their behavior more 
fixed and resistant to change. 
   Regarding possible associations of crossdressing with other psychiatric 
illnesses, we did not find other studies using systematically applied 
diagnostic criteria for nonsexual psychiatric disorders.  There are isolated 
reports of crossdressing behavior accompanying the course of schizophrenia and 
manic-depressive illness (Lukianowicz, 1959b, 1962; Ward, 1975).  Benjamin 
(1966) comments that the presence of psychotic behavior and frequency of 
diagnoses of psychosis including schizophrenia were observed in, at most, 6-8 
patients out of 150 male crossdressers.  Bentler et al. (1970) comment, on the 
basis of projective tests, that transvestites do not score like 
schizophrenics.  However, he also interprets his findings as indicating that 
his subjects might have a latent thought process disturbance.  Crossdressing 
associated with delusions of menstruation and pregnancy have also been 
mentioned (Lester, 1975, p. 169). 
   In addition to these comments on crossdressing and psychosis, there are a 
few reports about possible associations with nonpsychotic disorders.  A 
possible association of crossdressing with obsessive-compulsive neurosis has 
been discussed many times (Slater and Roth, 1969; Lester, 1975; Lukianowicz, 
1959a; Randell, 1975; Buhrich, 1978).  Lukianowicz (1959a) and Randell (1975) 
have also remarked that crossdressing has been described as being infrequently 
associated with psychopathy.  Benjamin (1966) writes that his subjects' rate 
of alcoholism was low. 
   In the current study, there was an increase of both unipolar depression and 
alcoholism compared with general population prevalences for these disorders.  
There might also have been mild increases of sociopathy, obsessional neurosis, 
and schizophrenia in our subjects (Goodwin and Guze, 1979).  Thus, our 
findings appear to be consistent with prior reports in that there does not 
appear to be any obvious relationship between crossdressing and other 
nonsexual psychiatric diagnoses.  The only category that was increased in our 
sample but not commented on in prior reports was depression.  Dysphoria (i.e., 
a negative mood state) was reported as a precipitant of crossdressing, but 
depression as a syndrome seems unlikely as an etiological factor.  The onset 
of crossdressing in virtually all of the subjects preceded the onset of 
depressive illness.  Beyond etiological considerations, however, the observed 
rates of depression and alcoholism in our sample suggest a need for treatment 
of these disorders. 
   There are two reports of instances of familial transvestism (Liakos, 1967; 
Buhrich, 1977b).  In the present study, there were three subjects who had one 
first-degree family member each, a father, sister, and brother, who was also 
reported to have crossdressed.  Other authors have commented on the 
nonfamilial character of crossdressing (Randell, 1975; Buhrich and McConaghy, 
1977; Buhrich, 1977a; Friedemann, 1966; Edelstein, 1960).  Family history data 
in the current study also failed to substantiate a positive association 
between crossdressing and other psychiatric disorders. 
   Regarding the adverse consequences experienced by our subjects, the data 
suggest that subjects receiving treatment for crossdressing experience or at 
least report more problems associated with crossdressing.  We are not aware of 
other reports in the literature with comparable data. 
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