While the current psychiatric classification of "Gender Identity Disorder" in the Diagnostic and Statistical Manual of Mental Disorders has drawn global GLBTQ concern and controversy, the equally defamatory classification of "Transvestic Fetishism" has been largely overlooked by transadvocates and allies.
At the Annual Meeting of the Society for Sex Therapy and Research this month, a "Provisional Report by the DSM-V Workgroup on Sexual and Gender Identity Disorders," was presented by Chairman Kenneth Zucker and a panel of workgroup members. Ray Blanchard, who chairs the Paraphilias Subcommittee, summarized proposals for "Pedohebehpilic Disorder" and "Transvestic Disorder" in the DSM-V.
Charles Moser, Ph.D., M.D., and others have long raised concern about all paraphilia diagnoses in the DSM, however the current diagnostic category of Transvestic Fetishism is particularly stigmatizing and defamatory for male-to-female (MTF) cross-dressers as well as many transsexual women. Unfortunately, Dr. Blanchard's proposal of Transvestic Disorder for the DSM-V offers little to allay these concerns.
Dr. Blanchard proposed that the current diagnosis of Transvestic Fetishism in the DSM-IV-TR be renamed Transvestic Disorder in the DSM-V. While somewhat less pejorative than the present title, Transvestic Disorder would still imply that all cross-dressing represents mental disorder. It would continue to perpetuate this defamatory stereotype.
Additionally, Dr. Blanchard proposes to change the Specifier Options to the diagnosis. The current Transvestic Fetishism diagnosis has a single specifier, "With Gender Dysphoria: if the person has persistent discomfort with gender role or identity." Blanchard's proposal would replace this with a specifier of "Autogynephilia (Sexually Aroused by Thought or Image of Self as Female)."
The term, autogynephilia was coined by Blanchard in 1989, not merely to describe a phenomenon of human sexuality, but rather to promote his derogatory theory that all lesbian, bisexual and asexual transsexual women were motivated to transition by a narcissistic sexual obsession. This word was subsequently associated by author J. Michael Bailey with profoundly defamatory remarks and stereotypes in his 2003 book, The Man Who Would be Queen: The Science of Gender-Bending and Transsexualism.
It is difficult to imagine how a term that has become so offensive and so damaging to the dignity of transwomen could serve any constructive clinical purpose in the DSM-V.
To summarize, Dr. Blanchard's proposal for Transvestic Disorder in the DSM-V fails to address serious issues of unfair social stigma and stereotyping that surround the current Transvestic Fetishism diagnostic category. Moreover, it would worsen these concerns by adding the pejorative term "autogynephilia" as a specifier to the diagnosis.
I ask the elected leadership and Board of Trustees of the American Psychiatric Association to affirm in a public statement that gender identity and expression which differ from assigned birth sex do not, in themselves, constitute mental disorder and imply no impairment in judgment or competence. I urge the DSM-V Task Force to honor this principle in the DSM-V by removing the current category of Transvestic Fetishism and rejecting Dr. Blanchard's proposal to replace it with Transvestic Disorder.
For further reading, you can find an expanded version of this essay with a description of diagnostic criteria at the GID Reform Advocates site.