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Gender Incongruence - Proposed Revisions for DSM-5

Started by gothique11, February 11, 2010, 05:30:08 AM

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BunnyBee

Quote from: FairyGirl on February 13, 2010, 03:39:59 PM
I have a therapist I really like. She helps me a lot with things, some unrelated to gender issues. That doesn't mean I am mentally ill. My physical condition will be cured soon. I do have psychological issues that stem from having to deal with the physical condition, which I think is normal considering the nature of the affliction. Once the physical condition has been fixed however, that will go a long way towards healing any associated psychological trauma.

There does seem to be a fundamental difference because there are so many variations and ways of looking at this. The only right one is what's right for you, which is why it's impossible to quantify for everyone. There are many types and many cures. Sometimes it's fatal. Sometimes the cure is worse than the disease. I feel quite binary personally, although born on the wrong end physically, which is why I will never feel complete without surgery. That will cure my medical condition, but we all have to determine our own path to happiness.


That puts my own thoughts into words better than I could.  Thank you :).

I feel I am in a very similar place as you, Chloe.

Anyway, this is such a gray area issue.  Most ways of looking at it have some validity.

Um and Alyssa, my oddball way of looking the whole thing is that a mental disorder is a brain issue- just like brain cancer is a brain issue.  The only real difference is stigma.  I'm so used to being stigmatized I don't even understand the aversion to it anymore.

With regard to the question of whether gender incongruity is a mental or physical problem, well I feel the answer is "yes," but I'll let y'all figure it out.  I'll go along with whatever the consensus turns out to be I think.

Sometimes I have a real problem with being able to see both sides of an argument.
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Alyssa M.

Jen, I with your rejection of mind/body dualism. (Well, that's what you were implying.) It's obvious to me that there's a physical cause (though our present understanding of it is at best partial), and that there are significant mental consequences for those that have not transitioned.

Food for thought: the proposed and current definitions of "mental disorder" in the DSM:

http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=465

All changes, even the most longed for, have their melancholy; for what we leave behind us is a part of ourselves; we must die to one life before we can enter another.

   - Anatole France
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Just Kate

Quote from: Natasha on February 12, 2010, 10:36:26 PM
heh ya nothing is set in stone but i doubt the draft will change much.  i'm loving the distinction the committee has made between transsexualism & shall we say ->-bleeped-<-? not "better" but for damn sure different which is something some of us have been saying for years & years.

http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=193#  (click on 'rationale')

emphasis mine.

"16. Although the DSM-IV diagnosis of GID encompasses more than transsexualism, it is still often used as an equivalent to transsexualism (Sohn & Bosinski, 2007). For instance, a man can meet the two core criteria if he only believes he has the typical feelings of a woman and does not feel at ease with the male gender role. The same holds for a woman who just frequently passes as a man (e.g., in terms of first name, clothing, and/or haircut) and does not feel comfortable living as a conventional woman. Someone having a GID diagnosis based on these subcriteria clearly differs from a person who identifies completely with the other gender, can only relax when permanently living in the other gender role, has a strong aversion against the sex characteristics of his/her body, and wants to adjust his/her body as much as technically possible in the direction of the desired sex. Those who are distressed by having problems with just one of the two criteria (e.g., feeling uncomfortable living as a conventional man or woman) will have a GIDNOS diagnosis. This is highly confusing for clinicians. It perpetuates the search for the "true transsexual" only, in order to identify the right candidates for hormone and surgical treatment instead of facilitating clinicians to assess the type and severity of any type of GI and offer appropriate treatment. Furthermore, in the DSM-IV, gender identity and gender role were described as a dichotomy (either male or female) rather than a multi-category concept or spectrum (Bockting, 2008; Bornstein, 1994; Ekins & King, 2006; Lev, 2007; Røn, 2002). The current formulation makes more explicit that a conceptualization of GI acknowledging the wide variation of conditions will make it less likely that only one type of treatment is connected to the diagnosis. Taking the above regarding the avoidance of male-female dichotomies into account, in the new formulation, the focus is on the discrepancy between experienced/expressed gender (which can be either male, female, in-between or otherwise) and assigned gender (in most societies male or female) rather than cross-gender identification and same-gender aversion (Cohen-Kettenis & Pfäfflin, 2009)."


GIDNOS diagnosis huh?

GIDNOS = a non-transsexual GID considered as GID-Not Otherwise Specified

By the old rules maybe, but look at the last part in detail.

The current formulation makes more explicit that a conceptualization of GI acknowledging the wide variation of conditions will make it less likely that only one type of treatment is connected to the diagnosis. Taking the above regarding the avoidance of male-female dichotomies into account, in the new formulation, the focus is on the discrepancy between experienced/expressed gender (which can be either male, female, in-between or otherwise) and assigned gender (in most societies male or female) rather than cross-gender identification and same-gender aversion (Cohen-Kettenis & Pfäfflin, 2009).

It means GID and GIDNOS will both fall under the heading of GI and that individuals will be treated based on individual needs based on the severity of their GI.

This means that rather than perpetuating the search for the "true transsexual" to meet specific criteria for a specific treatment method, instead the current definitions of GI will allow for a broader spectrum of people to experience what we formerly called GID and vary their treatment accordingly.

In a nutshell, the new changes will mean that more treatment options will be connected with the diagnosis of GI!

NEAT!  So our therapists will no longer feel forced or brainwashed into thinking that transition is the only way to fix GID for everyone.  That is a definite positive move.
Ill no longer be defined by my condition. From now on, I'm just, Kate.

http://autumnrain80.blogspot.com
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Yvonne

Quote from: Ashley4214 on February 12, 2010, 07:56:18 PM
The problem comes with those of us who are trans but are actually perfectly happy and content with the gender binary and don't like being made out to be total freaks by the segment of the transgender community that wants to push the boundaries and defy normal far beyond simple binary gender.  ::)

No worries, those peeps that self-proclaim as 'freaks' e.g. 'mental cases', 'crazy', 'bonkers', 'cuckoo', 'nuts', 'deviant' will stay so once the DSM-5 is approved.  Those people that self-identify as 'freaks' will have their chance to remain a "freak" for life in just a few short years from today.  Their wish has been the DSM psychiatrists' command.  It's a done deal.  They asked for it.  They brought this upon themselves & now they've got it.  I fancy they will be celebrating from now on with all the other self-declared 'freaks' whilst people like me remain in the normal, boring part of society.

Me? very happy to be wholly female & part of that latter 'boring & normal' group. :laugh:
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Julie Marie

Quote from: Alyssa M. on February 13, 2010, 05:08:40 PMWhat the hell is wrong with society -- with some of us -- that we're so damned prejudiced against people with mental disorders and afraid to be labeled with that awful stigma?

The problem with society is they think we all need to fit into a certain mold so we're all the same.  People who are different scare them.  So they expanded the list of real mental disorders, such as pedophilia, to include anything the masses doesn't get, considers weird or is freaked out about. 

As long as you being different doesn't hurt anyone, why should anyone else care?  And is being different sufficient reason to classify your difference as a mental disorder? 

It all stems form societal phobias (a mental disorder found in the DSM). "If we accept gays, lesbians, trangenders, etc, it will be the end of a civilized society!  :o  Morality will become a thing of the past! :icon_nervious:  Satan will take over the world!  :icon_peace:

That's where the real problem lies.  But it's easier to try to change a few than the masses.  So our solution is to make anything the masses thinks weird a mental disorder.  :police:
When you judge others, you do not define them, you define yourself.
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Birdie

Ummm... They are accepting us. And treating us. With surgery and hormones. They are not boogey men out to get us and they have certainly not done any of the horrible things that were predicted by people.

We are not in there because we are different or because society hates us. That's just rediculous. We are in there because every symptom of gender dysphoria (or whatever it's supposed to be called) is a mental one. The only people fit to recognise those symptoms are mental health proffesionals.

People can still transition. The world didn't end. You're being over dramatic.
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Just Kate

Quote from: Julie Marie on February 14, 2010, 01:03:31 PM
And is being different sufficient reason to classify your difference as a mental disorder? 

No, but if it is accompanied by distress that is persistent then yes.
Ill no longer be defined by my condition. From now on, I'm just, Kate.

http://autumnrain80.blogspot.com
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BunnyBee

The way I read the revision is this, if you feel distress over the disparity between your internal gender identity and your primary and/or secondary sex characteristics then you have GI.  If you don't feel distress then you can be considered mental disorder free.   

This also means neither surgery nor hormones are necessary to obtain a "cure."  Only whatever it takes to make you feel better.

I like the change, it seems like a better and more reasonable approach.  I only worry with all the open-endedness that there will be more of a tendency for psychs to ask people that happen to already know without any doubt that they must transition to "prove it" moreso than we already did before.  I found that aspect beyond annoying.  I'd hate for it to be worse for future peeps.
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Julie Marie

Quote from: Birdie on February 14, 2010, 02:39:11 PM
Ummm... They are accepting us. And treating us. With surgery and hormones. They are not boogey men out to get us and they have certainly not done any of the horrible things that were predicted by people.

We are not in there because we are different or because society hates us. That's just rediculous. We are in there because every symptom of gender dysphoria (or whatever it's supposed to be called) is a mental one. The only people fit to recognise those symptoms are mental health proffesionals.

People can still transition. The world didn't end. You're being over dramatic.

If the they you are referring to is society in general, they definitely are NOT accepting us.  Every year there is held a Transgender Day of Remembrance.  Why?  Because of all the violence trans people have to face. 

If you are trans you are many times more likely to be the victim of violence than the average person. 

You are far more likely to be unemployed or under-employed if you're trans. 

Many states do not have any trans rights and those that do typically do not enforce them.  In some states you can be fired just because you're trans and it's perfectly legal. 

A high percentage of trans people have been fired once they came out.   Of those who are employed, most do not get medical coverage for transitioning.

Many trans people are rejected by family and friends and co-workers simply because they are trans. 

I wouldn't exactly say we are accepted.

As far as dysphoria is concerned, show me someone who lost their job, their family, their friends, who is discriminated against, who has to live with prejudice who isn't a bit dysphoric about that.  The dysphoria is the result of how we are treated.

What you're saying is like saying if you are unhappy you're locked in prison and being tortured you have a mental disorder because the guards of the prison say we do.

I don't accept the word of someone who says they are a professional just because they have a plaque to prove it.  These so called gender specialists learned about gender identity issues from us.  We taught them all they know about gender incongruence.  So who really is the expert?
When you judge others, you do not define them, you define yourself.
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Birdie

Quote from: Julie Marie on February 14, 2010, 06:19:20 PM
If the they you are referring to is society in general, they definitely are NOT accepting us.

Nope, I was refering to the doctors in charge of the changes to the DSM, as well as the doctors that treat us and refer us to the myriad of specialists that we require. All of the issues you mentioned are issues that I'm acutely aware of, and none of them are the fault of our doctors. Redefining the condition is not the solution to transphobia.

QuoteWhat you're saying is like saying if you are unhappy you're locked in prison and being tortured you have a mental disorder because the guards of the prison say we do.

I'm sorry if I gave the wrong impression. That's not the message I was trying to get across. What I'm saying is if you are at risk of self harm, depression, self-esteem problems, family breakdowns, nervous breakdowns, social disorders, anxiety disorders or suicide because you hate your body, a gender therapist is going to be more help to you than a GP. Also, there is no physical test for Gender Whatever, so unless we want our diagnosis to hinge on our GPs measuring our finger lengths and carrying angles (you have to admit that's a funny mental image) we're going to need to rely on the opinion of people who have far more experience treating Gender Whatever, atleast until there is some serious evidence backing up our claim that it is a biological issue.

QuoteI don't accept the word of someone who says they are a professional just because they have a plaque to prove it.  These so called gender specialists learned about gender identity issues from us.  We taught them all they know about gender incongruence.  So who really is the expert?

All doctors learn about medicine from studying patients. That's pretty much where all medical knowledge comes from. Is there a better way for them to learn about us? Is learning about our condition directly from us a bad thing? I don't actually understand what you're angry about here.
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