Maligning Terminology in the DSM: The Language of Oppression


Kelley Winters, Ph.D.

GID Reform Advocates


Of the disrespectful language faced by gender variant people, none is more damaging or hurtful than that which disregards our gender identities, denies affirmed social roles of those who have transitioned, and reduces us to our assigned birth sex. I’m speaking of affirmed transwomen being called “he” and transmen being called “she.” I use the term Maligning Language to describe this specific kind of verbal violence.


Here in Colorado, Governor Bill Ritter signed a historic civil rights bill last month extending public accommodation protection to transgender and gender nonconforming individuals.  This legislation and the trans-community were attacked by Dr. James Dobson and Focus on the Family in a hateful radio ad campaign that invoked our most painful false stereotypes of transwomen:


 “A man in a dress came into the girl’s restroom at school today.” (1)


Even worse, an innocent young affirmed Colorado girl was defamed and ridiculed this year by Denver NBC Affiliate KUSA-TV, because she dared to seek an education in a public elementary school just like other girls (2). The sensational headline,


“Boy Wants to Return to School as a Girl,” (3)


ignited an unprecedented firestorm of condemnation and backlash in the national press toward transitioned youth and their families.


Maligning language contradicts the social legitimacy of transitioned individuals. It denies our humanity and contributes to an environment of intolerance, discrimination and even physical violence. Tragically, such disrespectful conduct is encouraged with the authority of the American Psychiatric Association (APA) in the diagnosis of “Gender Identity Disorder” (GID) in the Diagnostic and Statistical Manual of Mental Disorders (DSM)(4). 


The very name, Gender Identity Disorder, implies “disordered” gender identity: that our identities are themselves disordered or deficient; that our gender identities are not legitimate, but represent perversion, delusion or immature development.   In other words, the current GID diagnosis in the DSM-IV-TR implies that transwomen are nothing more than mentally ill men and vice versa for transmen. This is repeated throughout the diagnostic criteria and supporting text for GID, where our affirmed identities and transitioned roles are termed  “other sex” (with respect to assigned birth sex), and transsexual women are called “males,” and “he.” For example,


“For some males …, the individual’s sexual activity with a woman is accompanied by the fantasy of being lesbian lovers or that his partner is a man and he is a woman.” (p. 577)


Maligning language is repeated in scholarly literature by some of the most prominent authors of the current and pending gender diagnoses. Dr. Ray Blanchard of the Toronto Centre for Addiction and Mental Health (CAMH, previously known as the Clarke Institute of Psychiatry) introduced, “homosexual” and “non-homosexual” transsexualism, to sexology literature in 1989(5).  This language is so convoluted that it’s hard to follow. Heterosexual transwomen attracted to men are labeled as “homosexual,” reducing them to a stereotype of crazy gay “men.” Lesbian or bisexual transwomen attracted to women or both are termed as “non-homosexual,” again maligning us as “men.” 


Dr. Blanchard also labels this second group as “autogynephiliac,” meaning a narcissistic love of one’s self as a woman, and he postulates that the primary motivation for transition for these women is sexual paraphilia.  This demeaning term is advanced in the supporting text for the GID diagnosis in the current DSM (p. 570), and there is broad concern within the transgender community that “autogynephilia” may be canonized as a new diagnostic category in the DSM-V (6). 


Most shocking, Dr. Blanchard maligned all post-operative transsexual women with the following statement to a nationally distributed Canadian newspaper in 2004:


“A man without a penis has certain disadvantages in this world, and this is in reality what you’re creating.” (7)


In May, Dr. Blanchard was appointed by the APA as Chairman of the Subcommittee for Paraphilias in the DSM-V Sexual and Gender Identity Disorders Work Group.  He was also a member of the DSM-IV Subcommittee for Gender Identity Disorders.


There is evidence that mainstream medical and mental health professionals who work with the trans-community are moving away from maligning language. Reviewing presentation and poster abstracts from the 2007 Symposium of the World Professional Association for Transgender Health (WPATH), I counted over 90% of about 140 with language I considered gender neutral or gender affirming.  The most positive examples used wording that was both respectful and clinically descriptive, such as


“transsexual women (post-operative male-to-female transsexuals on oestrogen replacement)”  (8 )


The most objectionable examples labeled research subjects by natal or assigned sex, regardless of gender identity, social gender role or hormonal or surgical status. For instance, straight transsexual women were maligned as


 “Homosexual Transsexual South Korean Males”  (9)


by primary author Dr. Kenneth Zucker, chairman of the DSM-V Sexual and Gender Identity Disorders work group and prior member of the DSM-IV Subcommittee for Gender Identity Disorders. While the latter practice represents the thinking behind the current GID diagnosis in the DSM-IV-TR, there are now many positive counterexamples in the literature to suggest alternative language for the DSM-V. 


The influence of the DSM carries social consequences for all gender variant people, far beyond issues of mental health and medical care. Maligning terminology in the DSM enables and empowers defamatory social stereotypes like “a man in a dress,” “a man without a penis,” or “The Man Who Would be Queen” (10) in the press, the courts, our workplace and our families.  I implore all members of the DSM-V Task Force to consider the harmful consequences of maligning language in the current GID diagnosis and the future DSM-V.



(1) M. Zelinger,  “Radio Ad Causes Anti-Discrimination Bill Controversy,” News Channel 13, , May 21 2008.


(2) K. Winters, “Unprofessional Journalism at KUSA-TV Denver,” , Feb 10 2008.


(3) N. Garcia, “Boy Wants to Return to School as a Girl,’ KUSA-TV, , Feb 7 2008.


(4) American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, Washington, D.C., 2000.


(5) R. Blanchard, “The Classification and Labeling of Nonhomosexual Gender Dysphorias,” Archives of Sexual Behavior, Vol 18(4),  Aug 1989, pp. 315-334.


(6) Z. Symanski, “DSM Section 302.85,” Bay Area Reporter, V. 38, N. 25, , June 19 2008.


(7) J. Armstrong, “The Body Within: The Body Without,” The Globe & Mail, p. F1, , Toronto, June 12 2004.


(8 ) E. Elaut, et al., “Hypoactive sexual desire in transsexual women: prevalence and association with testosterone levels,”  WPATH 20th Biennial Symposium, Chicago IL, September 2007.


(9) K. Zucker, R. Blanchard, T. Kim, C. Pie, C. Lee, “Birth Order and Sibling Sex Ratio in Homosexual Transsexual South Korean Males: Effects of the Male-Preferring Stopping Rule,” WPATH 20th Biennial Symposium, Chicago IL, September 2007.


(10) M. Bailey, The Man Who Would Be Queen: The Science of Gender Bending and Transsexualism, Joseph Henry Press, 2003.


Copyright © 2008 Kelley Winters, GID Reform Advocates


Beyond Denial: GID Diagnostic Criteria and Gender-Conversion Therapies


Kelley Winters, Ph.D.

GID Reform Advocates



On May 9th and 23rd, the American Psychiatric Association (APA) issued statements on “GID and the DSM,” repeating that,


“It is important to recognize that the DSM is a diagnostic manual and does not provide treatment recommendations or guidelines.”(1)


This was in response to concern from the transgender community and allies that the current “gender identity disorder” (GID) diagnosis is biased to facilitate gender-conversion therapies.  These are punitive psychotherapies attempting to change the gender identities of gender variant youth and adults, exemplified in a May 7 National Public Radio interview of Dr. Kenneth Zucker (chairman of the DSM-V Sexual and Gender Identity Disorders work group) which described his therapy regimen for a gender-nonconforming child he diagnosed with gender identity disorder: 


“Bradley would no longer be allowed to spend time with girls. He would no longer be allowed to play with girlish toys or pretend that he was a female character. Zucker said that all of these activities were dangerous to a kid with gender identity disorder.” (2)


Such harsh shame and punishment, for behaviors which would be ordinary or exemplary for other children assigned female at birth, drew outrage from many transitioned individuals who themselves were forced to grow up in painfully incongruent gender roles.


A recent joint statement from the National Center for Trangender Equality and other leading advocacy organizations echoed broad concern about gender-conversion and sexual-orientation-conversion therapies:


“It is inconceivable that in the 21st century any credible scientist or medical professional would recommend any discredited treatment that would attempt to change a person’s core gender identity or sexual orientation. Such treatments have no empirical basis and are harmful”(3).


However, the APA’s denial of any treatment guidance in the Diagnostic and Statistical Manual of Mental Disorders, (DSM) has been repeated often in recent weeks (4) and is stated bluntly on the APA DSM FAQ page,


“No information about treatment is included.” (5)


But does repeating a thing often enough make it true?  In fact, diagnostic nomenclature and treatment are inseparably intertwined.  This is because the efficacy of all drug and psychotherapy treatments are judged according to specific diagnostic criteria listed in the DSM and ICD.  For example, it stands to reason that the efficacy and marketability of a psychopharmacological product could be expediently improved by tweaking DSM diagnostic criteria to favor it’s strengths.  In response to concerns of influence by drug manufacturers on diagnostic nomenclature(6), the APA requires disclosure of financial ties to pharmaceutical corporations by members of the DSM-V Task Force.


What does the the current DSM-IV-TR imply about gender-conversion treatment?  Kids and adults driven deep in the closet by gender-conversion therapies no longer meet the four diagnostic criteria for GID (7) and are emancipated from diagnosis of mental disorder. On the other hand, affirmed youth and adults who are happy and well adjusted after transition remain diagnosable with GID and suffer stigma of mental illness and sexual deviance for the rest of their lives (8,9). Children may be diagnosed with GID strictly on the basis of gender nonconformity, without evidence of gender dysphoria or distress with assigned birth sex (criteria A,B).  Adults and adolescents are implicated with “disordered” gender identity so long as they identify with or pass as other than their assigned birth sex or believe that they were “born the wrong sex” (criteria A,B).  Furthermore, current GID criteria fail to clarify that clinically significant distress or impairment, the basis for defining mental illness in the DSM, should exclude societal or family prejudice or intolerance (criterion D). Therefore, discrimination itself can be used as a basis to label transitioned or gender nonconforming victims as mentally ill.


The APA statement also mentioned the appointment of a new task force, separate from the DSM effort, to “review the scientific and clinical literature on GID treatment” (1). At this date it is not known who is on this treatment task force or what kinds of treatment it will favor. In any case, the problem of treatment bias within the GID diagnostic criteria remains unaffected by the efforts of a separate APA treatment task force.


While the current GID diagnostic criteria do not explicitly recommend gender-conversion therapy, they are certainly biased to favor that harmful treatment approach and to contradict the legitimacy of transition.  This is a major reason the DSM-V is of great importance to the transgender community and supportive mental health care providers. I hope that the DSM-V Task Force will move beyond denial and beyond archaic gender stereotypes in drafting new diagnostic nomenclature that does not harm those it is intended to help.



(1) American Psychiatric Association, “APA STATEMENT ON GID AND THE DSM-V, “ , May 23, 2008,


(2) A. Speigel, “Two Families Grapple with Sons’ Gender Preferences,” National Public Radio, All Things Considered,” , May 7, 2008.


(3) National Center for Transgender Equality (NCTE), Transgender Law and Policy Institute (TLPI), Transgender Law Center (TLC), Transgender Youth Family Allies (TYFA),  , May 28, 2008.  (Disclosure, I was involved in the drafting of this statement)


(4) M. Forstein, “Update on the DSM-V Issue,” , May 15, 2008.


(5) American Psychiatric Association, “Frequently Asked Question About DSM,”


(6) L. Cosgrove, S. Krimsky, M. Vijayaraghavan, L. Schneider, “Financial Ties between DSM-IV Panel Members and the Pharmaceutical Industry,” Psychotherapy and Psychodynamics, Vol 75, No 3, , 2006.


(7) American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, 2000, p. 537.


( 8 ) K. Winters, “Issues of GID Diagnosis for Transsexual Women and Men,” , 2004/2008.


(9) K. Winters, “Issues of Psychiatric Diagnosis for Gender Nonconforming Youth,” , 2004/2008.


Copyright © 2008 Kelley Winters, GID Reform Advocates