Gender Dysphoria Diagnosis to be Moved Out of Sexual Disorders Chapter of DSM-5
December 7, 2012 9 Comments
Protest at 2009 APA Annual Meeting (photo Kelley Winters)
Dr. Jack Drescher, a member of the subworkgroup on Gender Identity Disorders of the DSM-5 Workgroup on Sexual and Gender Identity Disorders, confirmed yesterday that the Gender Dysphoria Diagnosis will be removed from the sexual disorders chapter and placed in a separate category in the Diagnostic and Statistical Manual of Mental Disorders:
GD is supposed to be placed in a chapter of its own, no longer linked with sexual dysfunctions and paraphilias (which will also have chapters of their own)
This reclassification, along with the change in title from Gender Identity Disorder to Gender Dysphoria, is a significant improvement in the diagnostic coding used for access to medical transition care, for trans and transsexual people who need it. Preceding diagnoses of Transsexualism/Gender Identity Disorders were grouped with “psychosexual” disorders in the DSM-III. They were briefly moved to the class of Disorders Usually First Evident in Infancy, Childhood or Adolescence in the DSM-III-R in 1987 but were returned to the sexual disorders chapter in the DSM-IV, and DSM-IV-TR. Community advocates and supportive medical providers have long raised concern that this placement was clinically misleading and reinforced false stereotypes about gender diversity. Gender identity is not specifically related to sexuality, sexual orientation or sexual dysfunction. Political and religious extremists have exploited the sexual disorder grouping in the DSM to sexualize gender diversity and defame trans people as deviant. Trans and transsexual individuals have consequently lost their jobs, homes, families, children, and civil justice.
The DSM-5 working group responsible for sexual and gender diagnoses hinted at a possible change in diagnostic placement in February, 2010, stating
The subworkgroup questions the rationale for the current DSM-IV chapter Sexual and Gender Identity Disorders, which contains three major classes of diagnoses: sexual dysfunctions, paraphilias, and gender identity disorders… Various alternative options to the current placement are under consideration.
The decision to separate the revised Gender Dysphoria category from sexual disorders is consistent with a previous determination by the working group to remove sexual orientation specifiers from the diagnostic criteria. While many shortcomings remain in the proposed Gender Dysphoria diagnosis, this change in placement in the DSM represents forward progress for trans and especially transsexual individuals.
Unfortunately, the DSM-5 Task Force and APA Board of Trustees retained the Transvestic Disorder category in the sexual disorders chapter. Previous known as Transvestic Fetishism, it is grouped with paraphilic diagnoses such as pedophilia and exhibitionism and authored by Dr. Raymond Blanchard of the Toronto Centre for Addiction and Mental Health (formerly called the Clarke Institute of Psychiatry). This punitive and scientifically capricious category maligns many gender variant people, including transsexual women and men, as mentally ill and sexually deviant, purely on the basis of nonconforming gender expression. It is written to promote Blanchard’s unfounded theories of “autogynephilia” and “autoandrophilia” that conflate social and medical gender transition with fetishism. More than 7000 people have signed an online petition, sponsored by the International Foundation for Gender Education (IFGE), calling for the removal of this harmful diagnosis from the DSM.
Copyright © 2012 Kelley Winters, Ph.D., GID Reform Advocates
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Kelly, with this no longer being under the category of sexual disorders, do you feel this will mean that the military will no longer have any reason from allowing trans people to serve openly?
That’s a very important question, Monica. The military never did have a sensible reason for trans discrimination, but I believe that this change will help.
Wow! Yes, this important to me as well. I only need 4 years of service to complete a 20 year commitment. I would actually go from veteran status to “Retired”.
New flash, this is NOT an improvement. It’s called the Diagnostic and Statistical Manual of Mental DISORDERS, ergo anything IN IT is considered a mental disorder.
Call me when it’s taken out of the book altogether. I was born Transsexual. It’s a PHYSICAL BIRTH CONDITION. I’m as mentally healthy as the next person. If a person is unhappy because they’re born with a cleft palate, does that mean they’re mentally “disordered.” No, it means they’re upset because their body doesn’t look the way it should, just as I am.
It is genetic, …therefore is NOT a condition. nor is it a disorder. Gender dysphoria exists in our inherited genes, AND reinforced by the individuals’ socio-economic position during the formative years of early childhood, and it is extremely naive to think otherwise
Thanks, Jannine. Not all trans people need access to medical transition care, but for those of us who do, some kind of diagnostic coding is necessary. I agree that this medical necessity is not a mental illness or condition and would best be served by a coding in a non-psychiatric section of the ICD. That is the next focus for many of us who are concerned with diagnostic policy issues. In the meantime, these harm reduction steps in the DSM-5 will help clarify that our identities are not disordered and that transition care, rather than gender-reparative psychotherapy, is the appropriate treatment. And that’s a good thing.
On the other hand, the second, horribly harmful gender category of Transvestic Disorder in the DSM-5 is a train wreck. It should have been removed from the DSM-5, and I ask everyone in the community and allies to keep the pressure on the APA for removal in the next digital revision– the DSM-5.1.
I have to agree on the need, in some cases, for a diagnosis. Finally, it is no longer the “t-ness” that is the ‘disorder,’ but the “dysphoric” effects of such fundamental mis-identity for many transsexuals.
And thanks so much for the hard work to move this change! Now there is that much more clarity. The DSM can use all the help it can get!
Reblogged this on Everyday Epics and commented:
About time too separate these categories.
DoDI 6130.3, incorporating Change 1, September 13, 2011, “Medical Standards for Appointment, Enlistment, or Induction in the Military Services”, is the ruling regulation. Please note that this regulation is not a law, and is subject to modification at any time by the Executive branch, meaning it is at the discretion of the President.
While the justification for exclusion based upon “Current or history of psychosexual conditions (302), including but not limited to transsexualism, exhibitionism, transvestism, voyeurism, and other paraphilias”, may be removed to a certain extent, we should not forget that genital surgery for the purposes of transition constitutes an additional justification for exclusion: “History of major abnormalities or defects of the genitalia such as change of sex (P64.5) (CPT 55970, 55980), hermaphroditism, pseudohermaphroditism, or pure gonadal dysgenesis (752.7).”
The interesting thing about this is that waivers may also be requested and theoretically granted. Authority to grant waivers rests with the Secretaries of the various departments and the Commandant of the Coast Guard.
Here is an excerpt from something I wrote some time ago:
“While I am an advocate of removal of diagnoses related to gender identity and expression from the DSM, I agree with Mara Keisling that lifting of the DoD medical restrictions that either disqualify one from service or qualify one for separation from service should not be dependent on removal of the diagnoses…”
“If it is in fact the case that it is DoD policy to (as stated in the above referenced DoDI):
“Ensure that individuals under consideration for appointment, enlistment, or induction into the Military Services are: (1) Free of contagious diseases that probably will endanger the health of other personnel. (2) Free of medical conditions or physical defects that may require excessive time lost from duty for necessary treatment or hospitalization, or probably will result in separation from the Service for medical unfitness. (3) Medically capable of satisfactorily completing required training. (4) Medically adaptable to the military environment without the necessity of geographical area limitations. (5) Medically capable of performing duties without aggravation of existing physical defects or medical conditions.”
…then as far as I can see, there is no valid reason why the conditions noted as being unsatisfactory are valid concerns. Any medical expert familiar with the treatment of transgender and/or transsexual patients can tell you that there is no reason why a trans person in good health should not be able to meet the same physical performance requirements of other soldiers and meet the criteria of DoD policy I note here merely on the basis of being trans.”