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GID Reform Weblog by Kelley Winters

Kelley Winters, Ph.D.
GID Reform Advocates
http://www.gidreform.org

The American Psychiatric Association announced a third and final period of public comment on proposed diagnostic criteria for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), ending June 15.  Criteria for the draft diagnostic categories of Gender Dysphoria in Children and Gender Dysphoria in Adolescents or Adults (formerly Gender Identity Disorder, or GID) are unchanged from the second round proposal in May, 2011. The Sexual and Gender Identity Disorders Workgroup of the DSM-5 Task Force only partially responded to concerns raised about the GID diagnosis by community advocates, allies and care providers. Their specific diagnostic criteria continue to characterize gender identities and expressions that differ from birth-assigned roles as pathological and therefore contradict access to medical transition care, for those who need it, rather than lower its barriers.

Worse yet, the punitive and scientifically capricious diagnosis of Transvestic Disorder (formerly…

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10 thoughts on “

  1. I’m a little confused. I admit I know nothing about this. What I don’t understand is if gender dysphoria isn’t considered an “illness” or “condition”, then why would insurance companies pay for “treatment”? Unfortunately, we have to find a way to work within the broken medical system that exists today instead of waiting for the whole system to change. I hope I’m making sense. I don’t know what the right thing is here. I understand that trans people don’t want to be labelled “mentally ill”, but they also want access to medical interventions. Without a medical diagnosis, insurance companies won’t pay. Hell, even with a diagnosis, they won’t pay! The whole system is so broken.

    • It’s not just a matter of a diagnosis and all the negative fallout that label and accompanying description entails. It is the judgmental and pejorative language that mental health advocates have fought long and hard to remove for other diagnoses. Psychiatric history provides numerous examples of these types of “diagnoses” that were used to vilify and isolate people from “polite society.”.

      Diagnosis can also block treatment. A breast reduction on a cis man is covered for gynecomastia. The same surgery is denied to the trans man under the trans exclusion. A breast augmentation for a cis woman is covered as a prosthesis yet denied for the trans woman. I could go on but I think I have made my point.

  2. Well, I just read the proposed language on the DSM 5 website and it looks like they are trying very hard to be sensitive to trans individuals. Did you read it? I don’t understand what is offensive about the current proposal. There is a “B” section to confirm that the label doesn’t apply unless the person is distressed. The APA appears to be trying to do the right thing to make sure treatments are covered.

    • The working group continues to ignore concerns raised about the GID diagnosis by community advocates, allies and care providers. Their specific diagnostic criteria, moreover, continue to characterize gender identities and expressions that differ from birth-assigned roles as pathological and therefore contradict access to medical transition care, for those who need it, rather than lower its barriers.

      Also check out the diagnosis of Transvestic Disorder (formerly Transvestic Fetishism) – a diagnosis that that falsely stereotypes many transsexual women and men as self-obsessed sexual fetishists.

      The petition I am asking my readers to sign is sponsored by The International Foundation for Gender Education (IFGE) and now has over 6,700 signatures, calling for complete removal of the Transvestic Fetishism/Disorder category from the DSM.

  3. A great quote from Arlene Istar Lev, LCSW, CASAC:

    “The DSM has a long history of diagnosing oppressed people with mental disorders. In order to receive medical treatments, transgender and transsexual people have historically had to prove themselves to be mentally “disordered”; in order to be granted civil rights, transgender and transsexual people must show the world that they actually quite sane. Approval for medical treatments must not depend on being mentally ill, but on being mentally sound enough to make empowered and healthy decisions regarding one’s body and life.”

  4. I am with you in spirit Tam, but I don’t understand why the current language is pejorative or offensive. I read it and nothing stands out to me. I think the entire DSM is suspect because I don’t believe in the mind-body split. But within the context of the current medical system and other DSM criteria, I truly don’t understand why this particular one is considered pejorative and offensive. There is nothing inherently wrong with trans people. I don’t think trans people are ill. But if a trans person is seeking treatment to correct their hormone levels and body, there needs to be some way to categorize and get insurance coverage. It should be up to the individual and his/her doctor. But doctors need to be trained on how to diagnose people and when to recommend treatment. I am not trying to fight with you. I am trying to truly understand. With Gabi, I am torn between wishing she had a LD diagnosis so she would get treatment and accommodations and not wanting her to be stuck with an LD label. I myself am stuck with a DSM label because I chose to let my insurance company pay for some treatment. It’s a catch-22 that we’re all stuck with under the current medical system. Unfortunatley some medical conditions are stygmatized by society and others aren’t. Sucks all around. I hope you know that I’m truly trying to understand so that I can be a strong ally.

    • Here is the “offending” definition of Transvestic Disorder:

      Transvestic Disorder

      A. Over a period of at least 6 months, recurrent and intense sexual arousal from cross‑dressing, as manifested by fantasies, urges, or behaviors.

      B. The fantasies, sexual urges, or behaviors cause marked distress or impairment in social, occupational, or other important areas of functioning.

      Specify if:

      With Fetishism (Sexually Aroused by Fabrics, Materials, or Garments)

      With Autogynephilia (Sexually Aroused by Thought or Image of Self as Female)

      With Autoandrophilia (Sexually Aroused by Thought or Image of Self as Male)

      Both “autogynephilia” and “autoandrophilia” are simply defamatory stereotypes with no justifiable scientific basis.

      I think this alone meets the definition of pejorative (a word or phrase that has negative connotations or that is intended to disparage or belittle – Webster).

      • Tam, I hadn’t even read that one. I was referring to the gender dysphoria diagnostic criteria. I think the DSM criteria are highly controversial and highly politicized, but I don’t think the trans community is being ignored by the committee. When I read the “rationale” section, it looks like quite a few changes came from the public comments. I’m trying to understand the real issues involved. When I read the gender dysphoria criteria I couldn’t figure out what everyone is up in arms about. I don’t think the trans community is being completely ignored by the committee. The good news is that it’s not too late to make changes.

      • By the way, I agree that the transvestic disorder should be dropped. If a person meeting this criteria is truly distressed (I would bet that most are not) and seeking treatment, hopefully they could get help under another DSM category. Lots of food for thought! It brings up all kinds of issues about why the DSM exists in the first place and the process used for updating it. Can you imagine what it’s like to work on one of those committees?! I’m sure it’s hell! =)

  5. Yes, I figured we had a disconnect on the reference. I had a wonderful Psychopathology professor a couple of years ago that did a thorough job covering the political and social impacts of the DSM and, in particular, its negative impact on disadvantaged populations (racial and ethnic minorities, non-english speaking, women, children, poor, etc.). I didn’t have strong feelings about DSM before that class but after gaining a better understanding of the history behind the addition of “culture-bound syndromes” to DSM IV I walked away with a healthy dose of skepticism.

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