June 7, 2011
The Proposed Gender Dysphoria Diagnosis in the DSM-5
gidreform @ 7:43 am
Kelley Winters, Ph.D.
GID Reform Advocates

http://gidreform.wordpress.com/2011/06/07/the-proposed-gender-dysphoria-diagnosis-in-the-dsm-5/

Last month, the American Psychiatric Association (APA) released a second round of proposed diagnostic criteria for the 5th Edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-5). These include two diagnostic categories that impact the trans communities, Gender Dysphoria (formerly Gender Identity Disorder, or GID) and Transvestic Disorder (Formerly Transvestic Fetishism). For decades, the GID diagnosis has drawn protest from trans and transsexual communities, their allies and supportive medical and mental health professionals for its depiction of gender diversity, gender transition and medical transition care as mental illness and sexual deviance. The current diagnostic criteria for GID in the DSM-IV-TR cast difference from stereotypes of birth-assigned gender roles as pathological and are biased to favor harmful gender-reparative psychotherapies that enforce birth-role conformity. However, many community advocates and supportive medical professionals agree that some kind of diagnostic coding is necessary to facilitate access to medical and/or surgical transition care for those trans and transsexual people who need it. There is a need to replace the GID category with diagnostic nomenclature that does not harm those it is intended to help – that is consistent with transition care, for those who need it, rather than contradicting it.

I urge trans community members, friends, care providers and allies to call upon the APA to clarify in the DSM-5 that nonconformity to birth-assigned roles and being victims of societal prejudice are not, in themselves, mental pathology. The current period for public comment to the APA ends June 15.

I preferred the term "gender incongruence", oh well, looks like it is gone.

QuoteHowever, many community advocates and supportive medical professionals agree that some kind of diagnostic coding is necessary to facilitate access to medical and/or surgical transition care for those trans and transsexual people who need it.

There are two letters usually required for physical transition.  HRT and bottom surgery.  Both are letters from a mental health professional to a medical health professional.  For the medical doctors, it's CYA.  I really don't see why there needs to be any specific mention of gender related issues in a manual of mental disorders outside of the fact it gives mental health professionals more work.  Too many use the mental disorder diagnosis as ammunition against us.

The doctors don't need the letters.  Already there is in place implied consent for HRT that requires no letter.  Surgically, doctors already perform FFS and BA, both certainly more noticeable as cross-gender, physical-changing surgeries than bottom surgery.  So doctors could drop the need for letters if they want.  And if they need a CYA, get WPATH to drop the letter requirement and the doctors could prescribe to that.

The fact that the proposed DSM-V-TR has an "exit clause" in it further proves medical intervention is how this condition should be handled, not mental intervention.

"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 (Winters, 2008). The diagnosis will also be applicable to transitioned individuals who have regrets, because they did not feel like the other gender after all. For instance, a natal male living in the female role and having regrets experiences an incongruence between the "newly assigned" female gender and the experienced/expressed (still or again male) gender."