Gender Incongruence - Proposed Revisions for DSM-5

[gothique11]

Gender Incongruence to replace Gender Identity Disorder - maybe!

Anyway, the APA DSM-5 diagnosis team has posted its proposed revisions and notes on chances coming up in the new DSM-5.

Here's the linkies.

Oh, and you can click on the tabs labeled, "Proposed  Revision," "Rationale," "Severity," and "DSM-IV"

Proposed  Revision is an outline of the changes they would like to make. Rational contains reasons why they changed what they did as well as notes. Severity is just a basic set of questions for psychatrists to ask to figure out how sever it is. DSM-IV (4) is there for a reference point.


Gender Incongruence (in Adolescents or Adults)
http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=193#

Gender Incongruence (in children)
http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=192#

[Renate]

Wow! This is great stuff!

The change also makes it possible for individuals who have successfully transitioned to "lose" the diagnosis after satisfactory treatment. This resolves the problem that, in the DSM-IV-TR, there was a lack of an "exit clause," meaning that individuals once diagnosed with GID will always be considered to have the diagnosis, regardless of whether they have transitioned and are psychosocially adjusted in the identified gender role.

[Dragon Angel]

I liked this bit in the rationale:

3. It has been recommended by the Workgroup to delete the "perceived cultural advantages" proviso. This was also recommended by the DSM-IV Subcommittee on Gender Identity Disorders (Bradley et al., 1991). There is no reason to "impute" one causal explanation for GI at the expense of others (Zucker, 1992, 2009).

As if, in the case of MTFs, being female had any long-term "cultural" advantages in the real world.  I would say that, practically speaking, it could put you at a cultural disadvantage, glass ceiling and greater chances of being a victim aside.  It's good that this is actually being considered for removal.  I imagine FTMs would also have their own issues with this...but I'll leave that for them to comment on.

I dunno though...maybe it's just my own cynicism at work.

[Julie Marie]

Wow! This is great stuff!

What they are saying in effect is surgical intervention addressing the genitalia (or other areas) will cure the disordered mind.  That of course means the problem does not lie in the mind but rather in the body.  It's what many of us have been saying all along.  And if it is a physical problem and not a mental problem it doesn't belong in a book of mental disorders.

I will take from this something I posted on Zoe Brain's blog and here in another thread,

"I will now be able to say, 'I used to be mentally disordered then I had vaginoplasty and now I'm not.'"
Most people would scratch their heads hearing that. 

And it's the brilliant minds of the task force, reparative therapist Ken Zucker included, who allowed me to come to this conclusion.

[Alyssa M.]

I will take from this something I posted on Zoe Brain's blog and here in another thread,

"I will now be able to say, 'I used to be mentally disordered then I had vaginoplasty and now I'm not.'"
Most people would scratch their heads hearing that.

It makes perfect sense if the disorder of the mind was caused by stress relating to not having a vagina. Wouldn't it be lovely if we could cure all metal disorders so easily?

[spacial]

JulieMarie

If that is what they are saying then it is a positive step forward.

Whatever problems I have in my mind emanate from the ugly bit between my legs.

I'm sure that it the same for most people im my position.

Sadly, I trust these weasels about as far as I can spit.

[Julie Marie]

Just remember, this is only a draft.  You'll have to wait til 2013 to see the approved publication.

[rejennyrated]

Whilst I like the fact that the new exit clause means I no longer get included in the diagnosis I am still of the opinion that total removal is by far and away the best option overall, because as many others have already observed the logic of curing a mental disorder by treating the body seems just a teeny bit cockeyed!

[Alyssa M.]

It might seem cockeyed, but I don't see why that's a problem. One could just as easily say that it seems cockeyed that a condition whose only symptoms are stress, social discomfort, and possibly suicide should be called a medical condition rather than a mental disorder. But who cares? Unless one stigmatizes one over the other, it shouldn't matter on either account.

Nature loves creating exceptions to our rules. In a world that has animals that photosynthesize and plants that don't, indeed a world that has humans with female brains that produce male gametes, why should we have any problem accepting the possibility of a mental disorder that is treated by conventional medicine?

"The world of our imagination is narrower and more special in its logical structure than the world of physical things." -- Max Born

[BunnyBee]

Gender Incongruence seems to subtly move the disorder from the mind to the body, which lines up better with how my mind frames this whole situation.

[Teknoir]

Hmm... Interesting.

It's sounding like "Yeah, it's not a disorder... but there's nothing physical we can diagnose on, and the written guidelines for your treatment have to go somewhere, so we might as well as leave 'em in the book with all the other things we can't physically diagnose in it..."

Lovin' the exit clause. I dig that. "Problem solved" for those that transition fixed the issue, and (also importantly) the oppertunity for continued help for those that transition did NOT fix the issue.

[Vision]

Look at the sections it is still right next to.....

It is obvious that it is still considered to be sexual dysfunction and paraphillia by the committee.

Crap that is less crap is still crap.

[tekla]

You can call a big steaming pile of dog crap whatever you want, it never changes the fact that it smells in the sunlight.

[pheonix]

Look at the sections it is still right next to.....

It is obvious that it is still considered to be sexual dysfunction and paraphillia by the committee.

Crap that is less crap is still crap.

1) Definitely not a paraphelia -- Gender Incongruence is listed separate from those.

2) There is active discussion of moving it elsewhere altogether...

19. The subworkgroup has had extensive discussion about the placement of GI in the nomenclature for DSM-V, as the meta-structure of the entire manual is under review. 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 (see Meyer-Bahlburg, 2009a). Various alternative options to the current placement are under consideration.

[Alyssa M.]

Interesting point about other sections within the Sexual and Gender Identity Disorders category -- consider the following:

*Sexual and Gender Identity Disorders with No Change from DSM-IV
     625.8 Female Hypoactive Sexual Desire Disorder Due to a General Medical Condition
     625.89 Male Hypoactive Sexual Desire Disorder Due to a General Medical Condition
     607.74 Male Erectile Disorder Due to a General Medical Condition
     625.0 Female Dyspareunia Due to a General Medical Condition
     625.89 Male Dyspareunia Due to a General Medical Condition
     625.8 Other Female Sexual Dysfunction Due to a General Medical Condition
     625.89 Other Male Sexual Dysfunction Due to a General Medical Condition
     302.70 Sexual Dysfunction Not Otherwise Specified
     Substance-Induced Sexual Dysfunction

So ...  I guess there are a bunch of other mental disorders that might be treated through conventional medicine. How about that?

[BunnyBee]

There is an analog to physics. The brain is a body part, last I checked.  The only reason we put the treatment of its dysfunction in a different scientific category than the rest of the body is because we have such a limited understanding of how it really works.

[tekla]

Well, there is also the problem that what is a solution for one may not work on the next person.  It's not like a broken bone where there is a standard way to treat it, and it seems to get better all things being equal.

[juliekins]

Lovin' the exit clause. I dig that. "Problem solved" for those that transition fixed the issue, and (also importantly) the oppertunity for continued help for those that transition did NOT fix the issue.

The exit clause exists because the gatekeepers, or psychologists know that we're not coming back post-op anymore, because many of us didn't need them in the first place except to get our letters etc. Since we're not a source of further income to them, they've got nothing to lose by saying that we're cured. Plus, now they can say we're normal and "fixed" all because of them!

Can we ever win?

[rejennyrated]

Plus, now they can say we're normal and "fixed" all because of them!

They must love transpeople. There are so few mental disorders that can actually be fixed. It must be a really depressing job being a shrink... and then suddenly you have a set of patients whom you can appear to cure (becuase they weren't really crazy to start with) - no wonder they want to keep the condition in the list... It gives them at least one thing they can at least appear to succeed with.

Or am I being cynical again?

[Vision]

1) Definitely not a paraphelia -- Gender Incongruence is listed separate from those.

2) There is active discussion of moving it elsewhere altogether...

Sorry but i have to disagree:

Gender Identity Disorders
302.6 Gender Identity Disorder in Children
302.85 Gender Identity Disorder in Adolescents or Adults
302.6 Gender Identity Disorder Not Otherwise Specified

Paraphillias
302.4 Exhibitionism
302.81 Fetishism
302.89 Frotteurism
302.2 Pedophilia
302.83 Sexual Masochism
302.84 Sexual Sadism
302.3 Transvestic Fetishism
302.82 Voyeurism
302.9 Paraphilia Not Otherwise Specified


.85 comes right after .82 - .84 and before .9 so it is definitely right in the middle of them.