Balancing Views on Gender Diversity in the DSM-V Process


Kelley Winters, Ph.D.

GID Reform Advocates


A new group of concerned mental health and medical professionals and scholars is calling upon clinicians and researchers supportive of gender transcendent people to press for reform of gender diagnoses in the Diagnostic and Statistical Manual of Mental Disorders [1]. Organized by author and Clinical Social Worker Arlene Istar Lev, they are urging colleagues to write the American Psychiatric Association with recommendations that new members be added to committees responsible for gender nomenclature in the upcoming fifth edition (DSM-V).


The current diagnostic categories of Gender Identity Disorder (GID) and Transvestic Fetishism (TF) have long raised concern within the transgender community. Those who are distressed by their physical sex characteristics or ascribed social gender roles often need access to medically necessary transition care, and these procedures require diagnostic coding that is congruent with the treatment. At the same time, this nomenclature should respect the gender identity and expression of gender variant children, adolescents and adults and not impose stigma of mental illness or sexual deviance on femininity, masculinity or gender variance in themselves.


There are two prevailing views of gender diversity in American psychiatry and psychology. The emerging view is affirming and accepting, as expressed by Dr. Diane Ehrensaft on National Public Radio last May,


“If we allow people to unfold and give them the freedom to be who they really are, we engender health. And if we try and constrict it, or bend the twig, we engender poor mental health.” [2]


The older view is punitive, judging difference as disorder, something to be ashamed of and “fixed.” The current diagnostic categories of Gender Identity Disorder and Transvestic Fetishism in the DSM-IV-TR predominantly reflect these disparaging attitudes toward gender diversity. They go so far as to disrespect transitioned adults and youth with inappropriate maligning pronouns and terms in the diagnostic criteria and supporting text.


The DSM-V is under development by a Task Force appointed by the American Psychiatric Association [3]. The transgender community and allies have expressed growing concern that the Work Group for Sexual and Gender Identity Disorders within this Task Force is not sufficiently representative of affirming, respectful approaches to care for gender variant children, adolescents and adults.  A new collaboration of Professionals Concerned with Gender Diagnoses in the DSM advocates more balance in the DSM-V process.  Arlene Lev summarized,


Addressing the complex issues we are faced with regarding both diagnostic criterion for the therapeutic treatment of human beings experiencing distress related to gender issues and the equally important struggles of a burgeoning community’s efforts towards self-determination and civil rights requires a balanced committee that represents the many perspectives and voices emanating at this seminal moment in history. [4]


The group urges all trans-supportive medical and mental health practitioners and researchers to write the APA DSM-V Task Force and request that the Sexual and GID Work Group be expanded to include more affirming views of gender diversity and transition care. A web resource at [5] provides specific recommendations for nomination with biographical information and sample letters.  For more information, contact



[1] American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, Washington, D.C., 2000.


[2] A. Spiegel, “Two Families Grapple with Sons’ Gender Preferences,” National Public Radio, All Things Considered, May 7, 2008,


[3] American Psychiatric Association, “DSM-V: The Future Manual,”


[4] A. Lev, “Sample Letters to the DSM-V Task Force of the American Psychiatric Association,” Professionals Concerned with Gender Diagnoses in the DSM, 


[5] Professionals Concerned with Gender Diagnoses in the DSM,


Copyright © 2008 Kelley Winters, GID Reform Advocates