Case report OCD and transvestism: is there a relationship? Abdo CHN, Hounie A, Scanavino M de T, Miguel EC. OCD and transvestism: is there a relationship? Acta Psychiatr Scand 2001: 103: 471–473. # Munksgaard 2001. Objective: There have been reports of obsessive-compulsive disorder (OCD) patients with comorbid paraphilias. In this paper, two cases of comorbidity between OCD and transvestism are reported with the aim of discussing possible explanations for this association. Method: Longitudinal case studies of two patients with OCD and tranvestism according to the DSM-IV were assessed using semi- structured interviews. Results: Both patients presented with OCD and comorbid transvestism with different clinical features and treatment response. The case whose cross-dressing was more egodystonic responded better to treatment. Conclusion: It is possible that some cases of transvestism are OCD- related while others are more related to a gender identity disorder. A dimensional approach focusing on common phenomenological and neurobiological substrates is suggested as particularly useful for clinical management and future research of both disorders. Carmita Helena Najjar Abdo, Ana Hounie, Marco de Tubino Scanavino, Euripedes Constantino Miguel Department of Psychiatry, University of Sa ˜o Paulo Medical School, Sa ˜o Paulo, Brazil Key words: obsessive-compulsive disorder; transvestism; transvestic fetishism; comorbidity; paraphilias Euripedes C. Miguel, Projeto Transtorno Obsessivo Compulsivo, Rua Ovidio Pires de Campos S/N 4 O - andar sala 4025, Cerqueira Cesar CEP 05403–010, Sa ˜ o Paulo SP, Brazil Accepted for publication November 22, 2000 Introduction Obsessive-compulsive disorder (OCD) is a hetero- geneous disorder characterized by recurrent and intrusive worries and repetitive behaviours usually performed to relieve such worries or the anxiety elicited by them. Recently, sexual and gender identity disorders have been reported in OCD patients, including exhibitionism, fetishism (1) and transsexualism (2). This paper reports the first two cases of OCD and comorbid transvestitism, which involves heterosexual males with recurrent, sexually arousing fantasies or behaviours involving cross- dressing. Our purpose is two-fold: to stimulate physicians to inquire about transvestic behaviours in OCD patients and to discuss possible explana- tions for this association as well as treatment implications. Case reports Case 1 is a 38-year-old male who sought treatment when he was age 36, complaining of obsessive- compulsive symptoms (OCS) which had begun at age 12. At the age of 34 his aggressive obsessions with checking and touching rituals worsened. He also reported cross-dressing once a week since his early adolescence (age 12), which aroused him and led him to masturbation after which he felt guilty. First he used his mother’s clothes and then his wife’s. He denied homosexual desire. He also met current DSM-IV criteria for panic disorder and lifetime criteria for chronic tic disorder and kleptomania. He was treated with clomipramine which improved his OCD (YBOCS from 24 to 7), panic attacks and transvestism. He also experienced a global decrease in his sexual drive, with arousal dysfunction, retarded ejaculation and reduced frequency of intercourse with his wife. His medica- tion was slowly tapered and stopped 24 months later. He was still asymptomatic on his last evaluation (30 months after beginning treatment). Case 2, a 34-year-old single male, sought treat- ment at age 30, complaining of exacerbation of OCS he had developed since age 15. He had severe arranging and checking symptoms, depressive symptoms and met DSM-IV body dysmorphic Acta Psychiatr Scand 2001: 103: 471–473 Printed in UK. All rights reserved Copyright # Munksgaard 2001 ACTA PSYCHIATRICA SCANDINAVICA ISSN 0001-690X 471