On May 18, I presented a paper to the Annual Meeting of the American Psychiatric Association on the diagnostic categories of Gender Identity Disorder (GID) and Transvestic Fetishism (TF) in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Coauthored by San Francisco psychologist and community advocate Dr. Randall Ehrbar, our presentation stressed the need to address two issues in the upcoming Fifth Edition of the DSM. First, the GID and TF diagnoses inflict harmful stigma of mental illness and sexual deviance on all trans, gender variant and queer identified individuals who do not conform to their assigned birth-sex, either by inner identity or outer social expression. Second, the GID diagnosis fails to support the medical necessity of hormonal or surgical transition care for those transsexual individuals who need them. In fact, the current GID diagnostic criteria and supporting text contradict both medical and social transition.
Call to Action to Urge Trans-Affirming Position Statements by the APA
In addition to the case for reforming GID and removing the defamatory TF diagnosis in the DSM-V, we also urged the elected leadership of the APA to issue three public position statements in support of human dignity and medical care for trans and gender variant people.
We would like to ask the trans-community, our LGB and straight allies and especially our supportive medical and mental health providers to join us in calling for position statements that gender difference is not disorder, affirming the medical necessity of transition care, and recognizing social gender transition. The American Psychiatric Association has an opportunity today to reclaim its compassion for human dignity and its mandate to do no harm.
In 1973, the American Psychiatric Association made a historic step toward the ultimate declassification of same-sex orientation as mental illness in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Although the actual removal of the homosexuality diagnosis from the DSM occurred in incremental revisions over the following fourteen years, the elected leadership of the APA issued a Position Statement on "Homosexuality and Civil Rights" that had a profound impact on public opinion and defamatory stereotypes. Tragically, the APA has never issued a similar position statement in support of trans and gender variant people.
How can you help?
Please send letters to the President and Board of Trustees of the APA and the President of the Association of Gay and Lesbian Psychiatrists with the following requests:
- We ask the elected leadership and Board of Trustees of the American Psychiatric Association to affirm in a position 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.
- We also ask the APA to follow the example of the American Medical Association and the American Psychological Association with a statement clarifying the medical necessity of hormonal and surgical transition treatments for those who suffer painful distress with their physical sex characteristics that are incongruent with their persistent gender identity.
- Finally, we ask the American Psychiatric Association to follow the example of the American Psychological Association in encouraging legal and social recognition of all people that is consistent with their gender identity and expression. We ask the APA to affirm in a position statement the dignity and legitimacy of individuals who have transitioned their social gender roles, regardless of their physical anatomy or assigned birth sex.
Contact Information:Alan F. Schatzberg, President, American Psychiatric Association Carol A. Bernstein, M.D., President-elect, American Psychiatric Association American Psychiatric Association 1000 Wilson Boulevard Suite 1825 Arlington, VA 22209 email in care of: firstname.lastname@example.org
Board of Trustees, American Psychiatric Associationin care of: Thomas Graham Senior Governance Specialist - Board of Trustees email: email@example.com
Copy to Ubaldo Leli, M.D., President, Association of Gay and Lesbian Psychiatristsemail: firstname.lastname@example.org
Also, please send copies of your letters to me at email@example.com to be posted in an online archive. Include the phrase "APA Gender Position Statements" in your email header.