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Gender Madness in American Psychiatry Gender Madness in American Psychiatry: Essays from the Struggle for Dignity,
by Kelley Winters (2008)
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Sexual and Gender Diagnoses of the Diagnostic and Statistical Manual (DSM), A Reevaluation , Karasic and Drescher, Eds. (2005)
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Essay Series on Gender Diagnoses in the DSM-V

April 20, 2010

Comments on Proposed Revisions to Gender Diagnoses in the DSM-5

DSM-5 Revisions
Read and post comments at gidreform.wordpress.com.

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

This February, the American Psychiatric Association published its proposed draft revisions for the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for public comment. The period of public review ends today.

Here are summaries for my comments for the proposed diagnostic categories of Gender Incongruence in Children (formerly Gender Identity Disorder), Gender Incongruence in Adults or Adolescents, and Transvestic Disorder (formerly Transvestic Fetishism). The full text of my comments is available on the GID Reform Advocates site. The draft diagnostic criteria from the DSM-5 Task Force are copied at the end of this post.

My comments here were developed to a large extent in prior collaborations and conversations with Dr. Randall Ehrbar , Dr. Nick Gorton, Arlene Lev , Professionals Concerned With Gender Diagnoses in the DSM, and over 110 GID Reform Advocates. I am deeply grateful to them for their passion and thoughtful contributions on these issues and all that they taught me.

Gender Identity Disorder in Children

Full Text

The current Gender Identity Disorder diagnosis imposes harmful stigma of mental illness and sexual disorder on gender variant and nonconforming children, regardless of the presence of gender dysphoria. Simultaneously, it poses barriers to social transition and access to puberty blocking or hormonal transition treatment at a later age, by describing transition itself as symptomatic of pathology. The proposed nomenclature for Gender Incongruence in Children for the DSM-5 contains a number of improvements in the title and diagnostic criteria intended to address both issues. However, these revisions fall short of clarifying that social or medical transition and other nonconformity to a birth- assigned gender do not in themselves constitute mental illness. These revisions obfuscate the clinically significant distress that may result from physical sex characteristics or an assigned social gender role that are incompatible with experienced gender identity: distress that may require medical attention. If there is a specific diagnostic category or criteria set for children in the DSM-5, it should be explicitly based on distress of anatomical or gender role dysphoria and not on gender role nonconformity.

Gender Identity Disorder in Adolescents or Adults

Full Text

The current Gender Identity Disorder diagnosis in the DSM-IV-TR imposes harmful stigma of mental illness and sexual deviance on gender variant and especially transsexual adults and adolescents. Simultaneously, it poses barriers to social transition and access to puberty blocking, hormonal and/or surgical transition care, for those who need them, by describing transition itself as symptomatic of pathology. The proposed nomenclature for Gender Incongruence in Adolescents or Adults for the DSM-5 contains a number of improvements in the title and diagnostic criteria intended to address both issues. However, these revisions fall short of clarifying that social or medical transition and other nonconformity to an assigned gender at birth do not in themselves constitute mental illness. These revisions obfuscate the clinically significant distress that may result from physical sex characteristics or an ascribed social gender role that are incompatible with experienced gender identity: distress that may require medical attention. This diagnostic nomenclature should be explicitly based on distress of anatomical and/or gender role dysphoria (distress or discomfort) and not on gender role nonconformity.

Transvestic Fetishism

Full Text

The DSM-IV diagnostic category of Transvestic Fetishim in the DSM-IV is expanded by the proposed Transvestic Disorder diagnosis to remove exclusions of sexual orientation. It serves to punish gender expression that differs from social expectations of male birth assignment and to worsen barriers to medical transition care for transsexual women who require it. A specifier of “With Autogynephilia” was added to implicate many transsexual women, promoting the controversial theory and deeply offensive stereotype that transwomen transition to satisfy a sexual fetish rather than attain congruence with gender identity. This anachronistic condemnation of gender nonconformity fails to meet a modern definition of mental disorder and should be rejected by the APA and removed entirely from the DSM-5.

Proposed APA Diagnostic Criteria for Gender Incongruence in Adolescents or Adults

A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months duration, as manifested by 2* or more of the following indicators:

  1. a marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or, in young adolescents, the anticipated secondary sex characteristics)
  2. a strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or, in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics)
  3. a strong desire for the primary and/or secondary sex characteristics of the other gender
  4. a strong desire to be of the other gender (or some alternative gender different from one’s assigned gender)
  5. a strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender)
  6. a strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender)

Subtypes

  • With a disorder of sex development
  • Without a disorder of sex development

Proposed APA Diagnostic Criteria for Gender Incongruence in Children

A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months duration, as manifested by at least 6* of the following indicators (including A1):

  1. a strong desire to be of the other gender or an insistence that he or she is the other gender
  2. in boys, a strong preference for cross-dressing or simulating female attire; in girls, a strong preference for wearing only typical masculine clothing and a strong resistance to the wearing of typical feminine clothing
  3. a strong preference for cross-gender roles in make-believe or fantasy play
  4. a strong preference for the toys, games, or activities typical of the other gender
  5. a strong preference for playmates of the other gender
  6. in boys, a strong rejection of typically masculine toys, games, and activities and a strong avoidance of rough-and-tumble play; in girls, a strong rejection of typically feminine toys, games, and activities
  7. a strong dislike of one’s sexual anatomy
  8. a strong desire for the primary and/or secondary sex characteristics that match one’s experienced gender

Subtypes

  • With a disorder of sex development
  • Without a disorder of sex development

Proposed APADiagnostic Criteria for Transvestic Disorder

A. Over a period of at least six months, in a male, recurrent and intense sexual fantasies, sexual urges, or sexual behaviors involving cross-dressing.

B. The fantasies, sexual urges, or behaviors cause clinically significant 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)

Blog Index:

2010Oct15
10 Reasons Why
the TF Diagnosis
Has Got to Go
2010Apr20
Comments on
Draft Revisions
to the DSM5
2010Apr16
Why You
Should Sign
the Petition
2010Feb10
DSM-V
Proposed
Criteria
2010Feb06
Taxing
Medical Necessity
2009Nov03
Update: Statement
on GID & TF
in the DSM-V
2009Jun24
WPATH Presentation:
Revision Suggestions
for Gender Diagnoses
2009May30
Guest Blog
Stop Sexualizing Us!
2009May27
Guest Blog
Aligning Bodies with Minds
2009May23
Call to Action for Affirming APA Position Statements
2009May18
Beyond Conundrum: Strategies for Diagnostic Harm Reduction
2009Apr22
Transvestic Disorder and Policy Dysfunction in the DSM-V
2009Jan24
Book Announcement:
Gender Madness in American Psychiatry
2008Dec16
Guest Blog
What is the Body For?
2008Dec6
Guest Blog
DES's Other Daughters
2008Nov26
The Gender Gulag:
Voices of the Asylum
2008Nov19
Autogynephilia, Infallible
Derogatory Hypothesis
Part 2
2008Nov10
Autogynephilia, Infallible
Derogatory Hypothesis
Part 1
2008Nov02
Disordered Identities,
The Ambiguously Sexual Fetish
2008Oct28
Disallowed Identities,
Disaffirmed Childhood
2008Oct20
Blinded Me With Science:
The Burden of Proof
2008Sep15
Balancing Views on
Gender Diversity
in the DSM-V Process
2008Aug20
Blinded Me with Science:
Devolution of the DSM
2008Aug14
Diagnosis vs. Treatment:
Psychosexual Stigma
2008Aug08
Diagnosis vs. Treatment:
Barriers to Medical Care
2008Jul21
Blinded Me With Science:
Sampling Error
2008Jul16
Top Ten Problems
with the GID Diagnosis
2008Jul07
Disordered Identities:
The Focus of Pathology
2008Jul01
Diagnosis vs. Treatment:
Horns of a False Dilemma
2008Jun24
Maligning Terminology:
Language of Oppression
2008Jun16
Beyond Denial:
GID Diagnostic Criteria and Gender-Conversion Therapies


Read and post comments to this essay series at gidreform.
wordpress.com

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