Sunday, December 9, 2012

Gender Dysphoria Diagnosis to be Moved Out of Sexual Disorders Chapter of DSM-5 ....... The "D" Switcharoo?

As transgender allies we continue to pay close attention to the new developments on the Diagnostic Statistical Manual, DSM 5 front a leading expert has provided more insight into the development of Gender Dysphoria to get a chapter of its own. 

The Gender Identity Disorder Reform Advocates reported that:

Dr. Jack Drescher, a member of the subworkgroup on Gender Identity Disorders of the DSM-5 Workgroup on Sexual and Gender Identity Disorders, confirmed on December 6 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 aprevious 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.

Other activists are bemoaning the "D" word switcharoo and are not impressed just yet until Gender Identity Disorder is completely removed from the manual. The DSM 5 is slated for release May 2013. 

Planettransgender administrator Kelli Busey sounded off on the switcharoo:

"There are extremes in all communities and ours is no exception. Being radical it seems right that I occupy the one on the far side advocating for our removal lock, stock and barrel from the DSM-5.

I'm also open to others opinions and since it's such a hot button issue, one I felt needed our attention I created a Facebook event that was joined by five thousand people for conversation. Some against some for our removal and some in the middle, but all respected.

Did those of us who wanted our removal succeed? No, most likely we failed despite my best effortsat getting local people out from behind their keyboards. That was somehow my fault. Not the gay communities. We didn't take to the street at key moments and gain the spotlight as they did twenty years ago.

The facts.

The December first 2012 press release from the APA announcing the next bureaucratic step needed to publish the DSM-5 had been taken by the board voting it's approval.

And the world fell over themselves to announce trans people were no longer listed as "disordered" by in the DSM.

Did I miss something in that press release?

The Message From APA President Dilip Jeste, M.D., on DSM-5 offers no specifics, only justifications and denials regarding the process.

So whats up?

The often quoted Med Page published in May following the last public meeting reports what may not up:

"Gender identity disorder. Individuals who believe their biological gender doesn't match their gender identification will no longer be labeled with a disorder. Instead, if they seek psychiatric treatment, they can be labeled with "gender dysphoria."

The workgroup responsible for dealing with the hot-button issue considered a variety of other approaches, addressed later in this article. Ultimately they settled on a formal diagnosis -- potentially qualifying a patient for insurance-paid treatment if they want it -- but with a less pejorative name than "disorder."

So the name might change but what is the difference between the two words and what does it mean to trans people? The free medical dictionary defines....

Gender Identity Disorder:

"The psychological diagnosis gender identity disorder (GID) is used to describe a male or female that feels a strong identification with the opposite sex and experiences considerable distress because of their actual sex."

Gender Dysphoria:

"unhappiness with one's biological sex or its usual gender role, with the desire for the body and role of the opposite sex.

Not much difference between the two words is there?

Please understand this is just conjuncture since no further official information available until the DSM-5 is published in May 2013.
But given that one D word is being substituted for another what's the end result?

We remain pathologized by the APA



Regard or treat (someone or something) as psychologically abnormal or unhealthy

Which in my opinion denies us our rightful place among the worlds well adapted productive citizens.

So try as hard as I may I failed, kind of. Who knows. I did give space to those who wanted conversation. But most importantly, those who wanted our total removal from the DSM as well.
But now its just a waiting game. The APA has what it wants, our undivided attention, our money, the guidelines to normality, acceptability and our chances at success in life.

Certainly we are headed into interesting times as transgender activists especially in the US no longer are prepared to be relegated somewhere else anymore and are making their voices heard, LGB activists need to take note and align ourselves in their efforts if it is that we are working from a truly cohesive LGBTQ mantra if not say so, change organizations names if neccessary to reflect their true position and work within their own parameters and not use the call letters randomly to seem to be inclusive then silent on the other issues ...... take note. 

Our Jamaican advocates are guilty of this invisibility and commensurate reference convenience as not a peep has come from them since this important development has taken place, buggery is far more attractive and commands soundbites more than the struggle for our trans brothers and sisters.

and previous posts: Trans Depathologization: the spark of change and APA offers New Position on Transgender Care

additional reading: Trans Mental Health Study UK 2012

In Canada a Transgender Rights Bill was passed (waiting for royal assent to become law) in Nova Scotia protecting residents their from discrimination in employment and housing for those who have undergone reassignment surgery. See More HERE some say that yet have to see the terms “queen” and “denied GLBT rights” appear alongside each other.

Peace and tolerance



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