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Transvestism

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While assessing a 50 year old man for depression , his wife reports that he is wearing her clothes and appears to enjoy it much to her disgust She threaten to abandon him if somthing is not done .Discuss how you will handle the situation

I am struggling with this PMP, any ideas PLease?

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concentrate on the sexual history n sexual problems .rule out gender identity disorder....transvestite,homosexuality

if no GID then refer for sexual counselling marital therapy for the couple.if GID find out what the man wants to do...surgery etc...read from oxford textboook management of same.

if depression treat same

support to family as well if man wants sex change

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i love it when psychiatrists become agents of social control ::)...

to be quite honest... u choose how u get your kicks!!!

at least we're not chasing homosexuals anymore - changing times!!!!

for purposes of pmp... i shall play the game ;)

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concentrate on the sexual history n sexual problems .rule out gender identity disorder....transvestite,homosexuality

if no GID then refer for sexual counselling marital therapy for the couple.if GID find out what the man wants to do...surgery etc...read from oxford textboook management of same.

if depression treat same

support to family as well if man wants sex change

i dont think homosexuality is an ICD10/DSMIV diagnosis.

issues here include:

1.assessing the mental state

2.risk..to himself/wife/or any children in household or neighbourhood

3.social/marital consequences

4.carer burden

DD:

functional

1.dual role transvestism

2.fetishistic transvestism

3.transexualism

4.BPAD-currently hypomanic

5.OCD

organic

1.Frontal lobe syndr

2.FTD

3.TLE

IX

mmse,neuropsychology,eeg,bedside frontal lobe testing,demential work-up are impt

RX

u may find urself discussing the steps to eventual gender reassignment...check the pastest PMP green book for a detailed acct.

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Issues in this case are:

Diagnosis : organic causes , specially if the onset is recent (brain tumor, dementia....), functional causes: mood, psychosis , substance abuse, personality disorder. you need full psychiatric history ,MSE, cognitive assessment, physical examination and other investigation.collateral history from his GP , check any psychiatric or criminal record.usually people with Transvestism are distressed by their behavior because of the impact on their relationships so why this man is happy!!!

Impact on their relationship and why she asked for help now?level of distress on the wife? any psychological distress .

Risk issues: to the wife if is associated with violence or other inappropriate behavior , social embarrassment, disinhibted, kids.

Ethical issues: Autonomy .

engagement if he refuses to get help? not distressed .

Management : depends on his motivation to change

treat comorbid disorders.

familyor couple therapy therapy .

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i dont think homosexuality is an ICD10/DSMIV diagnosis.

nevertheless, you will have to take a history of sexual orientation...

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i dont think homosexuality is an ICD10/DSMIV diagnosis.

It's not, nor should it be. It was taken out of the DSM in 1973, but remained in ICD up until version 10.

There is however F66.1 Egodystonic Sexual Orientation 'the gender identity or sexual preference is not in doubt, but the individual wishes it were different because of associated psychological and behavioural disorders, and may seek treatment in order to change it.'

And F66.2 Sexual Relationship Disorder where the orientation is responsible for difficulties forming relationships.

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You could also consider educating the patient and the partner about the nature of tranvestisism as the most probable diagnosis. In this case he appears to enjoy wearing clothes of the opposite sex which points towards transvestic fetishistism.The aetiology is unknown although genetic, conditioning, brain dysfunction based aetiologies as well as psychoanalytical theories have been put forward. transvestic fetishist creating a 'phalic woman' to get rid of castration anxiety!

There are no long term follow up studies to discuss prognosis relaibly. However the behaviour seems to improve as the patient gets older due to decline in sexual drive.

There is no specific treatment. General procudures used in management would be identifying the the sexual behaviour of concern and describing its wider significance. Strong motivation is required on the part of the patient to engage with therapy. When mood returns to normal the patient could loose the motivation to engage.

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