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


About Kelley
Dr. Kelley Winters is a writer and consultant on issues of gender diversity in medical and public policy. She is the author of Gender Madness in American Psychiatry: Essays from the Struggle for Dignity (2008) and a past member of the International Advisory Panel for the World Professional Association for Transgender Health (WPATH) Standards of Care, the Global Action for Trans* Equality (GATE) Expert Working Group, and the Advisory Boards for TransYouth Family Allies (TYFA). She was recognized in the 2013 Trans 100 Inaugural List for work supporting the transgender community in the US. Kelley has presented papers and presentations on gender policy issues at annual conventions of the American Psychiatric Association, the American Psychological Association, the American Counseling Association and the Association of Women in Psychology. Kelley wanders the highways of America in an old Mazda, ever in search of comfort food.

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