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DSM-V To Rename Gender Identity Disorder ‘Gender Dysphoria’
This news turned up in my inbox from the TS Do It Yourself Hormones group on Yahoo.
Jenifur Charne
DSM-V To Rename Gender Identity Disorder ‘Gender Dysphoria’BY CAMILLE BEREDJICK JULY 23 2012 8:00 PM ET
The newest edition of the psychiatric diagnostic manual will do away with labeling transgender people as “disordered.”
The newest edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM, will replace the diagnostic term “Gender Identity Disorder” with the term “Gender Dysphoria,” according to the Associated Press.
For years advocates have lobbied the American Psychiatric Association to change or remove categories labeling transgender people in a psychiatric manual, arguing that terms like “Gender Identity Disorder” characterize all trans people as mentally ill. Based on the standards to be set by the DSM-V, individuals will be diagnosed with Gender Dysphoria for displaying “a marked incongruence between one’s experienced/expressed gender and assigned gender.”
“All psychiatric diagnoses occur within a cultural context,” said Jack Drescher, a member of the APA subcommittee working on the revision. “We know there is a whole community of people out there who are not seeking medical attention and live between the two binary categories. We wanted to send the message that the therapist’s job isn’t to pathologize.”
Homosexuality was diagnosed in the DSM as an illness until 1973, and conditions pertaining to homosexuality were not entirely removed until 1987. According to Dana Beyer, who helped the Washington Psychiatric Society make recommendations on matters of gender and sexuality, the new term implies a temporary mental state rather than an all-encompassing disorder, a change that helps remove the stigma transgender people face by being labeled “disordered.”
“A right-winger can’t go out and say all trans people are mentally ill because if you are not dysphoric, that can’t be diagnosed from afar,” Beyer told the AP. “It no longer matters what your body looks like, what you want to do to it, all of that is irrelevant as far as the APA goes.”
From a legal perspective, the classification of Gender Identity Disorder is extremely harmful to some trans people, but surprisingly beneficial to others.
In one legal case, says San Francisco psychiatrist Dan Karasic, a trans woman from Utah risks losing the children she fathered before her transition. Because she is trans, a lawyer has argued that her GID is a “severe, chronic mental illness that might be harmful to the child.”
But in other cases, a GID diagnosis justifies insurance coverage for gender reassignment surgery and other medical procedures that sometimes accompany a transition. Having a diagnosis is the difference between a necessary medical procedure and something that can be perceived as cosmetic surgery that insurance won’t cover, Drescher says.
Others argue that GID should stay in the DSM in some form because it provides a solid legal defense for transgender people who have experienced discrimination based on their gender identity.
“Having a diagnosis is extremely useful in legal advocacy,” said Shannon Minter, legal director of the National Center for Lesbian Rights. “We rely on it even in employment discrimination cases to explain to courts that a person is not just making some superficial choice … that this is a very deep-seated condition recognized by the medical community.”
Mental health professionals who work with trans clients are also pushing for a revised list of symptoms, so that a diagnosis will not apply to people whose distress comes from external prejudice, adults who have transitioned, or children who simply do not meet gender stereotypes.
Transgender advocates seek new diagnostic termsWritten by Lisa Leff, AP writer Jul 23, 2012
The nation’s psychiatric establishment is overhauling its diagnostic manual for the first time in almost two decades.
Advocates have spent years lobbying the American Psychiatric Association to rewrite or even remove categories typically used to diagnose transgender people, arguing that terms such as “Gender Identity Disorder” and “Transvestic Fetishism” promote discrimination by broad-brushing a diverse population with the stigma of mental illness.
“The label of mental defectiveness really places a burden on trans people to continually prove our competence in our affirmed roles,” Kelley Winters, a Colorado scholar who has helped lead the push for changes, said.
Although the association’s new Diagnostic and Statistical Manual of Mental Disorders is not scheduled to be printed until the end of the year, the updates are taking shape after three rounds of proposed changes.
Professionals who have been part of or closely observing the amendment process say the latest wording, while not going as far as many advocates wanted, respects the broader shift in society’s understanding and acceptance of what it means to be transgender since the last major revision of the manual was published in 1994.
“All psychiatric diagnoses occur within a cultural context,” New York psychiatrist Jack Drescher, a member of the APA subcommittee working on the issue, said. “We know there is a whole community of people out there who are not seeking medical attention and live between the two binary categories. We wanted to send the message that the therapist’s job isn’t to pathologize.”
The most symbolic change under consideration so far for the manual’s fifth edition, known as the DSM-V for short, is a new name for “Gender Identity Disorder,” the diagnosis now given to adults, adolescents and children with “a strong and persistent cross-gender identification.”
In the manual’s next incarnation, individuals displaying “a marked incongruence between one’s experienced/expressed gender and assigned gender” would be diagnosed instead with “Gender Dysphoria,” a term that comes from the Greek word for emotional distress.
Switching the emphasis from a disorder that by definition all transgender people possess to a temporary mental state that only some might possess marks real progress, according to Dana Beyer, a retired eye surgeon who helped the Washington Psychiatric Society make recommendations for the chapter on “Sexual and Gender Identity Disorders.”
“A right-winger can’t go out and say all trans people are mentally ill because if you are not dysphoric, that can’t be diagnosed from afar,” Beyer said. “It no longer matters what your body looks like, what you want to do to it, all of that is irrelevant as far as the APA goes.”
Persuading the psychiatric profession to redefine who and who does not qualify for its care has historical precedent as a civil rights issue.
In 1973, the APA, responding to pressure from the gay and lesbian community, concluded that same-sex attraction was a normal part of human experience, not an illness.
Although it took another 14 years for all conditions related to homosexuality to be lifted from the DSM, the earlier shift is regarded as a major milestone in the gay rights movement, one that paved the way for gays to adopt children, get married and serve in the military.
Like gay men and lesbians before them, transgender people have seen the APA’s language cited to their disadvantage.
Dan Karasic, a San Francisco psychiatrist who has offered suggested changes to the DSM-V through his affiliation with the World Professional Association for Transgender Health, cited a Utah case in which he has been asked to prepare expert witness testimony involving a transgender woman who is at risk of losing the children she fathered before her transition.
“The argument is that one criteria for terminating parental rights is if one parent has a severe, chronic mental illness that might be harmful to the child,” Karasic said. “A lawyer is apparently using that to argue that because the person is trans and has a diagnosis of GID, she should have her parental rights terminated.”
But while there are parallels, achieving what the APA did for gays four decades ago is more complicated for people who identity as transgender, an umbrella term that encompasses transsexuals, cross-dressers and others whose self-concepts otherwise do not align with the male or female label they were given at birth. Unlike sexual orientation, the accepted protocols for treating many patients expressing profound discomfort with their given gender call for medical intervention.
Since at least the 1980s, for example, a diagnosis of Transsexualism or Gender Identity Disorder has been used by doctors, mental health professionals and a growing number of health insurers to justify access to hormones or surgery for patients who decide to physically transition to a new sex. Eliminating it from the DSM-V therefore could make it more difficult for self-identified transsexuals to qualify for treatment.
“Let’s say someone born a woman walks into my surgical office and says, ‘I would like my breasts removed.’ What’s the diagnosis?” Drescher said. “The procedure is a mastectomy, but if there is no diagnosis, it is cosmetic surgery and your insurance won’t pay for it.”
As work on the DSM-V moves forward, lawyers who specialize in representing transgender clients have found themselves in the uncomfortable position of arguing that Gender Identity Disorder needs to stay in the manual in some form. Shannon Minter, legal director of the National Center for Lesbian Rights, said while it’s true the diagnosis has been used against some, it also has benefitted others.
“Having a diagnosis is extremely useful in legal advocacy,” Minter said. “We rely on it even in employment discrimination cases to explain to courts that a person is not just making some superficial choice … that this is a very deep-seated condition recognized by the medical community.”
Along with pushing for a less-loaded name for Gender Identity Disorder, activists and mental health professionals who work with transgender clients also want to see the symptoms revised so the diagnosis is not applied to people whose distress stems from external prejudice, adults who have successfully transitioned to a different gender or children based on sex stereotypes such as aversion to “rough-and-tumble-play” or “typical feminine clothing.”
Kenneth Zucker, a Canadian psychiatrist who chairs the APA Sexual and Gender Identity Disorders Work Group, predicted that with more transgender people coming out at younger ages, and little scientific understanding of what causes someone to be transgender, the debate is likely to continue.
“All of us who work in this field are seeing a huge increase in the number of people who come to see us who have Gender Dysphoria,” Zucker said. “There is clearly a clinical need for there to be specialists in this area, and apart from the philosophical musings, having a diagnosis facilitates that.”
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5 Replies
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I think they have missed something important.
Gender Identity Dysphoria is not the same as Gender Dysphoria.GID means you internal model of body does not match the physical body.
GD means your behavior does not match your physical body.
I have seen people with the opposite gender to the body who seem quite happy with their body and on the other side people with GID who felt the need to change yet they did not behave transgendered.
Wow this is complicated.
The reason why this happens needs to be thoroughly investigated.
transgendered individuals seems to cluster in some places, an example is UK. At a Peth Chameleons outing I noticed over half came from the UK and 4 came from the same area and 2 from the same town. Something in the water??? or the fish? Almost all rivers in the UK have intersex fish, fish and especially amphibians are sensitive to gender bending chemicals in the environment.
Intersex has been seen to cluster in areas of chemically dirty environment, an example of this is in certain areas in South Africa where waste is burnt in open fires and electronic equipment is burnt to separate metals from the plastic to obtain the metals. All those chemicals in the plastics are thrown in the air where it can be breathed in and absorbed .
Civilization today is a gender bending environment .
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As I understand it. WPATH, in their version 7 has done away with the diagnosis or label of gender Identiy disorder and renamed it gender dysphoria, as it is offensive to us/ many to see us as having a disorder.
(I see it as being offensive to veiw us as having a psychiatric condition at all – but hey, without a diagnosis we can’t get the treatment we need).The intersex community finds it offenisve to collect them under the umbrella label of gender dysphoria as it presents them as having a psychiatric problem, which they don’t, intersex have a physical problem, if it can indeed be called that – I don’t..
I myself am recognised by the Australian government now as being female, and I consider myself as about to have genital reconstruction surgery, (even though my letter states it as SRS), not a sex change. After all, who ever heard of a female having surgery to become a female?
In my referal letter to my surgeon, my psychiatrist speaks of me as having a history of gender dysphoria with a diagnosis of GID for the purposes of having the surgery.
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I can’t see what the issue is with Gender Identity Dysphoria (which I can’t find used on the web anywhere) and Gender Dysphoria. But I can see that dropping the word “disorder” is potentially a big step forward in changing attitudes to the gender diverse. I was not alone in feeling that gender diversity should be de-pathologised.
http://forum.tgr.net.au/cms/forum/F347/4491-491Up to now, a diagnosis of Gender Identity Disorder has rested on a psychologist being able to accurately determine the gender inside the “patient’s” head. We have discussed the concept of gender identity elsewhere in the forums.
http://forum.tgr.net.au/cms/forum/F157/4704-704A common view is that defining gender identity labels and then accurately determining gender identity is almost meaningless as it rests entirely on the patient’s reported feelings and their personal understanding of gender. If you say “I feel essentially a woman” it is reasonable to ask “can you explain what you mean by feeling like a woman?”. There is little precision in the terms we use. To have the diagnosis of a disease or disorder resting on self-diagnosis by the patient under such ambiguous terms seemed strange to me. Little seems to have changed in this regard since Sandy Stone wrote about the flawed diagnostic process in 1987!
viewtopic.php?p=20122With the change to definitions there is no longer a disease that is being diagnosed. I think this is potentially a big step forward for the community as a whole. There is no illness to treat – and so the ambiguity in any psychological diagnosis is probably less critical. I hope as a consequence many more gender diverse people will engage in a dialog with the medical profession. Gender diversity can perhaps now be shared without triggering a “treatment” process.
It also follows that if we haven’t got a disease then we don’t have to be cured. In this way we follow the path that the treatment of homosexuality took years before. Without the need for a cure then all surgery associated with gender dyspohoria can be argued to be cosmetic. To the extent that this may affect the affordability of surgical options there is a negative side to not being “sick”. This is an issue that will require careful attention.
However, the wider gender diverse community cannot both have the cake and eat it. Whilst people continue to seek “treatment” then society is unlikely to ever accept us as we are. Like the gay movement before us, we have to present in public as being proud and not ashamed of who we are. Carrying the stigma of needing to be cured sends the opposite message.
Acceptance is something that is of benefit to the entire gender diverse community. Through such a simple thing as redefining the psychological labels applied to us I think we may have moved a step closer to this goal.
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I can see that being someone who needs treatment for a gender disorder could be looked at as someone who is sick by the uninformed. However as long as Transgendered people have to undergo treatment for their personal needs, then the uninformed masses are always going to look at us like we are some sort of wierdo’s. Lets face it we aren’t actually on the study list at school, or the, I really want to find out about that stuff list in most peoples minds. So untill people actually want to know about us they are hardly likely to go out of their way to try and understand why we exist. Harsh thinking I suppose, but reality is always a bitter pill to swallow.
I don’t know why we can’t just be referred to as Gifted Multigendered People, then maybe the uninformed morons will have something to look up to and aspire to be.
Yeah right Pamela!!
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I have to be really honest here. I would rather pay more to transition if it meant that the mental health professionals would just bugger off!
And, yes, I know, it would disadvantage those who have the problem of the lack of funds.I think it would be great if all we needed to do was to amass enough identity points, (the number of points being set by the Department of health and Aging) from the various institutions we deal with, such as banks, utilities, medicare, chemists, councils and so on who recognise and deal with us on a regualr basis and and know us as only a female identity, such as a name change. (perhaps picking up a form from our GPs and having it filled in by these institutions). We could then present this evdience to our GP’s who could then write scripts for hormones for us, with onlne guides from the Department of Health and Aging on correct hormone dossages and so on. For those with a health concession card, they could pick up their discounted meds at discounted price via the PBS.
After providing evidence of being on hormones for 12 months, (having already had our female identity confirmed by the community, not some psychologist or pyschiatrist), then we could then get a direct referral to a surgeon from our GP for SRS.About the only exception to my idea would be those with a pre existing mental health condition. Then again, mental health conditions, such as depression, may not arise if the community were more educated, so that people could come out with less fear. This is where mental health professionals could help us – educate the community – not bother us as though WE had the problem!
We really need to be able to tell the mental health professions to go away, or use them as we want to, or feel the NEED to. For example if people needed asistance coming out, or dealing with emotional traumas involving transitioning. They say that they are there to support us, but the support, as it currently stands, is forced onto us if we want a referal for surgery.
I will be oh so glad to see the last of my pyschiatrist – I never really needed him – except to get an authorization for hormones and my referal letter, because of the current system. Since when do people need an authorization to be themselves?.
As for private insurance – well – it is for pyschological reasons, not cosmetic reasons – so it should be covered by insurance, as there is a need for the body to match the mind – as evidenced by the community who see the discrepency with no input from a mental health professional.
The Human Rights Commission is the one needed to put pressure on the insurance companies to cover us. Transitioning for us is a NEED not a ‘want’.I have a dream, that gender diverse people can be themselves without gaining a label.
Of course, for those who need a lot of help to transition, then they could use the system as it is.post script: since posting the above post I have done a lot of soul searching and talking to friends and family. I think when I was coming out I really needed the help of mental health professionals.
First they ruled out any other possible causes, as my friend Bev pointed out.For the 5 months that I saw the psychologist, she got me past the shame of how I felt – a major obstacle. She also help me deal with any negetivity.
My pychiatrist provided me with the letters I needed that allowed me to change all of my legal documentation with every organization I deal with.
I think I have lived the female life so well now that i am beginning to take it for granted and forget the help the mental health professionals have given me. And yes I will be glad to finish with the psychiatrist, but transitioning was kick started for me by the clinic.
I hope that one day our people will not have to get a label to get treatment. But I am glad that the mental health professionals were there when I was at the end of my tether. I am sorry for any offense that I have given – it must have sounded ungrateful.
The mental health professionals’ hands are as tied as ours. This is the system that we have to work within – the label is terrible, but not getting treatment would be even worse.
A big thank you to those who reminded me of where I was at before transitioning, before I met those mental health professionals.
