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Sexual and Gender Diagnoses of the Diagnostic and Statistical Manual (DSM), A Reevaluation , Karasic and Drescher, Eds. (2005) Order from IFGE

the DSM-V will likely impact the lives of all gender variant people through the 2020s

“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.” -Dr. Diane Ehrensaft

DSM-V Task Force Selected by relevance, see www.psych.org/dsmv.asp David J. Kupfer, M.D. (Chair) Thomas Detre Professor and Chair Department of Psychiatry University of Pittsburgh School of Medicine Medical Director and Director of Research Western Psychiatric Institute and Clinic Pittsburgh, PA Darrel A. Regier, M.D., M.P.H. (Vice Chair) Director, Division of Research American Psychiatric Association Executive Director American Psychiatric Institute for Research and Education Arlington, VA William E. Narrow, M.D., M.P.H.M Research Director Division of Research American Psychiatric Association Arlington, VA Sexual and Gender Identity Disorders Work Group Kenneth J. Zucker, Ph.D. (Chair) Former Member, DSM-IV Subcommittee on GID Head, Gender Identity Service Clinic, Child, Youth, and Family Program Centre for Addiction and Mental Health Toronto, Ontario, Canada Gender Identity Disorders Subcommittee Peggy T. Cohen-Kettenis, Ph.D. (Chair) Professor of Medical Psychology Head of the Department of Medical Psychology, VU University Medical Center Director, Gender Dysphoria Expertise Center Amsterdam, The Netherlands Jack Drescher, M.D. Clinical Assistant Professor of Psychiatry, New York Medical College Associate Attending Psychiatrist, St. Luke’s- Roosevelt Hospital Center New York, NY Heino F. L. Meyer-Bahlburg, Dr. rer. nat. Former Member, DSM-IV Subcommittee on GID Professor of Clinical Psychology (in Psychiatry), College of Physicians & Surgeons of Columbia University, Research Scientist New York State Psychiatric Institute New York, NY Friedemann Pfäfflin, M.D., Ph.D. Professor of Psychotherapy Head of the Forensic Psychotherapy Unit Ulm University, Germany former President HBIGDA (WPATH) co-founder, Intl Jour of Transgenderism appointed July 3, 2008* Paraphilias Subcommittee Ray Blanchard, Ph.D. (Chair) Former Member, DSM-IV Subcommittee on GID Professor, Department of Psychiatry University of Toronto Head of Clinical Sexology Services Centre for Addiction and Mental Health Toronto, Ontario, Canada Richard B. Krueger, M.D. Medical Director, Sexual Behavior Clinic New York State Psychiatric Institute, Associate Clinical Professor of Psychiatry Department of Psychiatry Columbia University New York, NY Niklas Långström, M.D., Ph.D. Associate Professor of Child and Adolescent Psychiatry Head of Centre for Violence Prevention Karolinska Institutet Stockholm, Sweden Martin P. Kafka, M.D. Associate Clinical Professor of Psychiatry Harvard University Clinical Associate in Psychiatry McLean Hospital Belmont, MA appointed July 3, 2008* Advisory Panel to the Work Group Not yet announced * Nomination to S/GID work group approved by DSM-V Task Force, per correspondence from Dr. William Narrow on July 3. These appointments are not posted on APA web site at this time.

A Fifth Edition -- Opportunity for Change?

The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) is scheduled for publication by the American Psychiatric Association in 2012. It will be the first major revision of American diagnostic nomenclature for mental disorder since 1994, and the DSM-V will likely impact the lives, civil liberties and medical care of all gender variant people through the 2020s.

The current diagnostic categories of Gender Identity Disorder (GID) and Transvestic Fetishism (TF) in the current DSM have long raised concern within the transgender community. Those who are distressed by their physical sex characteristics or ascribed social gender roles need diagnostic nomenclature that supports the legitimacy of transition and access to medically necessary 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 diversity in themselves.

Task Force and Work Group Appointments and Controversy

The DSM-V is authored by a Task Force, whose highest levels were appointed by the APA (psychiatric) in September, 2007. The Work Groups and Subcommittees, responsible for individual diagnostic categories were named on May 1st, 2008, with some positions still open at present.

There are two prevailing views of gender diversity in American psychiatry and psychology. The emerging view is affirming and accepting. The older view is punitive, judging difference as disorder, something to be ashamed of. The current diagnostic categories of Gender Identity Disorder and Transvestic Fetishism in the DSM-IV and revision IV-TR predominantly reflect the punitive view of gender diversity. They go so far as to disrespect transitioned adults and youth with inappropriate pronouns and gender terms in the diagnostic criteria and supporting text.

The transgender community has expressed growing concern that the work group for Sexual and Gender Identity Disorders in the DSM-V Task Force of the American Psychiatric Association is not sufficiently representative of newer, respectful attitudes toward gender diversity that are widely held by practitioners who work with gender variant adults and youth today. Many transgender advocates and care providers hope to see more balance in this work group, more inclusion of clinical approaches described by Dr. Diane Ehrensaft on National Public Radio, “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.”

DSM-V Timetable

• Work Group and Subcommittee appointment -- early 2008.
• Literature review -- through 2008.
• Draft diagnostic criteria -- Feb/Mar 2009.
• Review, Testing, Comment on proposed diagnostic criteria -- 2009 through 2010.
• Finished diagnostic criteria -- Early 2011.
• Printing and Publication -- 2012.

How to Speak Up

• Add your name and statement to our Advocates Page.
• Add your organization and statement to our Organizations Page.
• Add your Personal Narrative of psychiatric abuse or stereotyping.
• Submit comments and suggestions to the DSM-V Task Force.
• Contact DSM-V Task Force members.
• Check out the Listserves and Web Groups discussing these issues.

Issues for the DSM-V

updated July 16, 2007

Here are ten major concerns with the existing GID diagnostic category that have been raised in recent years. We hope that the GID Subcommittee and Sexual and Gender Identity Disorders Work Group will address these issues in the DSM-V:

1. Focus of pathology on nonconformity to assigned birth sex in disregard to the definition of mental disorder, which comprises distress and impairment.
2. Stigma of mental illness upon emotions and expressions that are ordinary or even exemplary for non-transgender children, adolescents and adults.
3. Lacks clarity on gender dysphoria, defined here as clinically significant distress with physical sex characteristics or ascribed gender role.
4. Contradicts transition and access to hormonal and surgical treatments, which are well proven to relieve distress of gender dysphoria.
5. Encourages gender-conversion therapies, intended to change or shame one’s gender identity or expression.
6. Misleading title of “Gender Identity Disorder,” suggesting that gender identity is itself disordered or deficient.
7. Maligning terminology, including “autogynephilia,” which disrespects transitioned individuals with inappropriate pronouns and labels.
8. False positive diagnosis of those who are no longer gender dysphoric after transition and of gender nonconforming children who were never gender dysphoric.
9. Conflation of impairment caused by societal prejudice with distress intrinsic to gender dysphoria.
10. Placement in the class of sexual disorders.

In addition, the diagnostic category of Transvestic Fetishism (TF), in the Paraphilias section of the DSM, equates crossdressing and expression of femininity by biological males with sexual fetishism and imposes unfair social stigma of perversion. TF does not acknowledge the existence of healthy, well-adjusted male-identified cross-dressers. Many have expressed concern that Transvestic Fetishism serves no constructive therapeutic purpose in the DSM.