One of the things that it was felt important to return to was:
No information about treatment is included in DSM. While determining an accurate diagnosis is a first step for the clinician in defining a treatment plan for a patient, DSM contains no recommendations on what that course of treatment should be. That said, DSM is certainly important to those who provide treatment to patients with mental illness, because accurate diagnosis leads to appropriate treatment.
So it is important to note that the DSM does not deal in "how" something is dealt with, only in identifying the particular aspects of a specific diagnosis.
This is critical, because a great many of the fears often spoken about regarding the DSM deal in "well, how does this affect the way I will be treated?". Trans folk are concerned about the impact of things like hormone prescriptions, surgeries, and so forth. There are also those who are claiming that the DSM says that surgery cures one - this is incorrect. It does not, and, indeed, is explicitly not able to do so. It can, however, say that after treatment - whatever that treatment may be - they are cured.
What determines the treatment is subject to a lot of other factors, and the organization that most heavily impacts the lives of trans folk in the United States is the World Professional Association for Transgender Health, or WPATH. WPATH is the organization that is charged with developing the Standards of Care. It just so happens that many members of the team that developed the Revisions here are members of the WPATH. Several of the researchers and people mentioned in previous articles are even past presidents of the organization (the current president is Walter O. Bockting). The members of WPATH work with trans folk on a fairly continuous basis, and in general are responsible for the changes we see presented now in the proposed revisions.
So they will most likely be the same people writing the treatment guidelines, and in light of that, there can be some idea of what it is that will ultimately change within the standards of care currently in place, but given the dramatic shift involved, making any guesses at this point is a crapshoot, in part because the stuff noted here, in the proposed revisions' overall guidelines:
The current process for revising DSM has been guided by four principles. First, the highest priority is clinical utility - that is, making sure the manual is useful to those who diagnose and treat patients with mental illness, and to the patients being treated. Second, all recommendations should be guided by research evidence. Third, whenever possible, DSM-5 should maintain continuity with previous editions. And fourth, no a priori restraints should be placed on the level of change permitted between DSM-IV and DSM-5. The third and fourth principles may seem contradictory, but both principles are necessary - those charged with revising the manual must carefully consider the impact that any changes would have on clinical practice, disorder prevalence and other important factors, while at the same time, considering the diagnostic advances that would be made through implementation of new scientific knowledge and clinical understanding.
In revising DSM, work groups (made up of global experts in various areas of diagnosis) have looked at what elements of the current edition (DSM-IV) are working well, what elements do not meet the needs of clinicians and how best to correct those concerns. For example, the work groups are determining how to better assess the severity of symptoms and how to handle psychiatric disorders that often occur together in the same patient (called co-occurring disorders), such as anxiety and depression. They are focusing on reducing diagnoses currently called "Not Otherwise Specified" in DSM-IV and on improving diagnostic criteria that are not precise. The work groups are also aiming to better specify "treatment targets" for clinicians - helping them identify those symptoms that should be addressed in treatment and for which improvement may be possible.
Additionally, the DSM-5 Task Force has focused on how to include assessment of common symptoms that are not addressed within the diagnostic criteria for a specific illness (for example, symptoms of insomnia that may be experienced by a patient with schizophrenia). One way of addressing these issues is through cross-cutting dimensional assessments.
Given the aspect of looking at what works and what doesn't, and the degree of change involved - especially in light of the tasks of using dimensional assessments and reduction of NOS as well as severity assessment - demonstrates that the current system is considered by the authors to be broken, and quite lacking in the aspects being sought (something I agree with).
The criteria now offered are 6 points, and any 2 of them can used to diagnose gender incongruence, and one significant change made is that there is no longer a requirement that there be any kind of distress or impairment involved.
An example of stress or impairment is the oft heard statement that "I just *had* to have surgery or I'd kill myself". However, there are multiple other forms of persons with Gender Incongruence for whom that surgical aspect is not critical, and for whom functioning in their lives is not a problem. These people lack a clinically significant degree of impairment or stress about themselves, and so have historically been subject to a lack of treatment.
An example here would be the rare but still present person assigned male and masculine at birth, who enjoys and excels in their life as a male, but still possesses an extreme sense of bodily discomfort or dysphoria (what some have called a somatic transsexual as opposed to a social transsexual or the combined somatic and social transsexuals such as myself). So for them, surgical options are needed, but they do not need to "transition" from one social gender role and expression to another. You have men who were born men and identify as men, but have modified their bodies to that of a female. Under the current criteria, these people have had to resort to ways and methods outside the mainstream systems for treatment, placing themselves at risk in doing so, since they cannot get treatment through "regular" channels.
This is reflected in two parts:
2. (e) we have proposed that the "distress/impairment" criterion not be a prerequisite for the diagnosis of GI (see Endnote 15);
15. It is our recommendation that the GI diagnosis be given on the basis of the A criterion alone and that distress and/or impairment (the D criterion in DSM-IV) be evaluated separately and independently. This definitional issue remains under discussion in the DSM-V Task Force for all psychiatric disorders and may have to be revisited pending the outcome of that discussion. Although there are studies showing that adolescents and adults with the DSM-IV diagnosis of GID function poorly, this type of impairment is by no means a universal finding. In some studies, for example, adolescents or adults with GID were found to generally function psychologically in the non-clinical range (Cohen-Kettenis & Pfäfflin, 2009; Meyer-Bahlburg, 2009a). Moreover, increased psychiatric problems in transsexuals appear to be preceded by increased experiences of stigma (Nuttbrock et al., 2009). Postulating "inherent distress" in case one desires to be rid of body parts that do not fit one's identity is, in the absence of data, also questionable (Meyer-Bahlburg, 2009a).
Some things to note here that are important. The authors are not saying that transsexuals are everyone affected herein. Indeed the specifically call out transsexuals separately from other trans folks for "increased psychiatric problems" as the direct result of stigma. Concepts of privilege play into this stigma as well. In short, it is not too far off from the truth to say that cis folk drive us crazy (if I can be forgiven the ableism inherent there). Literally.
They are also saying that issues other than GI that impact a person in terms of impairment or stress be looked at without any regard to the GI as the primary cause, meaning that they are not technically co-morbidities, or something that is off about them due to the GI.
That said, the new criteria are:
1. a marked incongruence between one's experienced/expressed gender and primary and/or secondary sex characteristics (or, in young adolescents, the anticipated secondary sex characteristics) [13, 16]
The rationales for this one are described thusly:
13. In the DSM-IV, there are two sets of clinical indicators (Criteria A and B). This distinction is not supported by factor analytic studies. The existing studies suggest that the concept of GI is best captured by one underlying dimension (Cohen-Kettenis & van Goozen, 1997; Deogracias et al., 2007; Green, 1987; Johnson et al., 2004; Singh et al., 2010).
Meaning that in the current system, there's simply no basis scientifically to support the basis that a person with gender incongruence has both a strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex) and a Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex. Or, from a trans woman's perspective, the DSM-IV authors were making it up as they went along.
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).
What they are saying here is that the current system more or less requires a person to be a transsexual to get a diagnosis of 302.85 (so, if you have that, you are a transsexual, under the current system). On the other hand, so is a butch woman.
This conflicts with the fact that a transsexual person is obviously different from a butch woman, and also the other types of trans folk that are supposed to be included in the diagnosis, but only have part of the whole (one half or the other in the current).
This makes the job of a therapist more difficult and affects their ability to properly aid and treat those with less severe degrees of the same problem that afflicts transsexuals.
Lastly, they point out directly that in the current system, there are only men and women, and nothing in between, when, in reality, people are all over the map (as I explained previously), since gender is a multiple category or spectrum based thing, without an either/or basis. With this in mind, they changed the way that this entire section deals with that, and allow for a greater understanding on the part of therapists.
2. a strong desire to be rid of one's primary and/or secondary sex characteristics because of a marked incongruence with one's experienced/expressed gender (or, in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics) 
This one deals with Gender Identity as I've described it before - that is, the internal awareness of how you wish to be perceived by others. For cis folk, this particular aspect is even more difficult to self know than, say, sex identity is, and it can be reflected in the statement "I want to be a girl" as opposed to the statement "I am a girl". The first one usually describes one's gender identity (meaning, they want to be seen by others as a girl), while the second one describes one's sex identity (meaning they see themselves as a girl). Both Sex identity and Gender Identity are physiologically inherent in the individual by most consensus.
In this case, the person is expressing that they want to be seen as such by others, and have an awareness that part of the reason they are not seen as such is due to the damnable growths of the wrong sex on their body.
This is increasingly more common in children, which is the focus of most of the researchers involved in this work (since it is considered to start at an early age in all persons, even if they only present it in later life (come out or escape denial, the classic late transsexual).
This is supported by the rationale:
17. In referring to secondary sex characteristics, anticipation of the development of secondary sex characteristics has been added for young adolescents. Adolescents increasingly show up at gender identity clinics requesting gender reassignment, before the first signs of puberty are visible (Delemarre-van de Waal & Cohen-Kettenis, 2006; Zucker & Cohen-Kettenis, 2008).
As a kid, perhaps the absolute worst thing I ever experienced in my life -- worse than the testosterone injections and "bodybuilding powders" before it -- was the process of going through puberty. Just thinking about it makes me cry, as it was as if not only had the world decided to make my life hell, but now they were twisting my body. It's like being in a car accident and not being able to stop it, and it goes on for years. Seven of them, on average. In slow motion, like some horrible action movie.
3. a strong desire for the primary and/or secondary sex characteristics of the other gender
This one is pretty direct, and is obviously the sex identity aspect - I'm a girl, so I should have girl parts. As some would say, this is essential to the concept of a "classic transsexual".
4. a strong desire to be of the other gender (or some alternative gender different from one's assigned gender)
Here they step out of the bounds of what has been known in the past, and move into areas that speak to the issues of non transsexual people, which share the same basic underlying issue but to a different degree of severity. They are, of course, speaking to bigendered, agenders, gender queer and similar folk. Most of which have not been able to gain medical treatment that might aid them as a result of the inordinate amount of focus that practitioners (therapists) have as a rule on treating transsexuals.
5. a strong desire to be treated as the other gender (or some alternative gender different from one's assigned gender)
And again, back to the concept of gender identity, with the same reflections as previous.
6. a strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one's assigned gender)
Fairly self explanatory, but very problematic for many in the trans community as a whole. Fortunately, the criteria still requires two aspects to be present.
As the criteria require any two of the 6 to be present, a gender incongruent person could be someone who is assigned masculine but thinks like a girl and wants to be treated like one. And that this person is separated fro a transsexual, but only by the degree of severity of their gender incongruence, as transsexuals are generally postulated to suffer to the greatest severity.
The treatments, again, are still unknown, so what that person might be treated with and how they might be treated, is variable. It could be that they might simply begin living their lives full time, or even part time, or possibly that they won't have any treatment at all, and essentially be a guy we all call she and her. Until such time as there are new standards of care, we won't know.
For the record, I fall into all six of the above criteria.