One of the changes that has people somewhat fearful is the change of all references from sex to gender. The rationale for this is as follows:
The term "sex" has been replaced by assigned "gender" in order to make the criteria applicable to individuals with a DSD (Meyer-Bahlburg, 2009b).
The citation here is of this work: Meyer-Bahlburg, H. F. L. (2009b). Variants of gender differentiation in somatic disorders of sex development: Recommendations for Version 7 of the World Professional Association for Transgendered Health's Standards of Care. International Journal of Transgenderism, 11, 226-237.
Note that this cited article discusses proposed treatments. This tells us that treatments are being considered throughout the process of writing this.
The ostensible reason for doing this is to provide those IS folks who are reared in a gender that conflicts with their sex and/or gender identity a way to correct that, making them, essentially, both IS and TS at the same time. This is a questionable thng in terms of internal community politics, as there are a sizeable number of IS folks who want there to be zero linkage between trans folk and IS folk. Indeed, to many IS folk being linked is considered an insult. That's not universally held mind you, but it's fairly critical, as, right now, they are still considered separate conditions.
This is important because what it does is depathologize the transition process, and pathologize the rearing of the children - in short, it's all the parent's fault. Still not ideal, from a trans perspective, but from an IS perspective a hell of a lot better a result given the issues with DSD overall.
Among the studies cited in the paper there are others done by the same researcher, such as:
Gender development in women with congenital adrenal hyperplasia as a function of disorder severity. Meyer-Bahlburg HF, Dolezal C, Baker SW, Ehrhardt AA, New MI. Arch Sex Behav. 2006 Dec;35(6):667-84. Epub 2006 Aug 11.
What explains discrepant gender identity outcome in 46,XX individuals with 11-hydroxylase deficiency? Meyer-Bahlburg HF. Ann Saudi Med. 2007 May-Jun;27(3):216-7. No abstract available.
Late diagnosed 46,XX child with congenital adrenal hyperplasia (CAH): deciding the gender of rearing. Meyer-Bahlburg HF. J Natl Med Assoc. 2008 Jun;100(6):759-60. No abstract available.
So this is directly related to the problem that was created by the resistance to forced surgery of infants with visible genitalia variance - what do you raise them as when no one can tell you what they are?
Another interesting aspect is the so called "exit clause" (see Kelley Winters' comment on my analysis part 2 for an explanation there). This is a reflection of the intent of the authors involved, and it means that "corrected" persons are, in effect, no longer trans. (on a side note, this also means that the so called "classic transsexuals" are no longer transsexuals, they are now just classic, and, therefore, not being spoken for or on behalf of by most activists who are working on behalf of persons for the most yet to enter treatment or currently in it, as well as those who do not have the ability to "blend in".)
And yes, I did just have to get that in there.
The exit clause reflects certain legal aspects of transition, as well as pragmatic considerations, but it further makes it absolutely clear that the treatment processes are intended to be a cure, whatever final form they may take.
It's also an indication, yet again, that they are paying close attention to the work they are doing here. This is important because the new criteria are so substantially different from the old ones that a great deal more broadly structured treatment outline will need to be considered and ultimately created. As I noted last column, there are no treatment guidelines in the DSM, and this is by intent. Treatment guidelines will have to come from a different organization: WPATH.
Atlanta, Georgia, in 2011, is hosting the biennial meeting of WPATH. Given the timing of all of this, the symposium will most likely focus heavily on determining the nature and extent of the new treatment guidelines for the Standards of Care. It's my personal opinion that any trans person who has any interest in making changes beneficial to more than merely transsexual persons make a point of getting into that area and making yourself known by then.
I also suggest to all trans folk that you take some time to sit with your therapist and make sure they know about this information now. Send then the links to the information and/or print out the rationales and new criteria and *talk with your care provider* -- not as an adversary or someone hostile to your transition (for I hope if your therapist is hostile, that you've fired them, seeing as how they are your employee), but as someone who can benefit from this and who's input here is extremely valuable and of great importance.
Conversely, avoid telling Dr. Phil about it.
This is extremely important, as their input will carry great weight in comparison to the weight of individual trans folk. They are the one's who will be using this, and the introduction of dimensional analysis (read, a test for gender incongruence) will affect very dramatically how they approach the methods of treatment they use.
It's here that the third tab - Severity - enters into the whole fracas, and this tab is extremely important, for it is, in the end, a test for what kind of trans person are you. The practical use for it will be as such, and as a dimensional measure (that is, checking a whole bunch of factors and plotting them as a kind of 3D graph) it will also begin to provide data that will inevitably be used to classify and subtype along a more accurate means (indeed, I used a dimensional model in my "What is Trans*" article).
The Severity tab contains some example questions. The primary testing example of this tool has been called the GIDYQ, with -AA for adolescents and adults typically used as a modifier. It has two versions, one for females, one for males. It's based on a continuum structure - male at one end and female at the other - and uses the questions to determine where a person falls along that scale, in a similar manner to some of the dimensional tests based on the Kinsey scale.
The items were developed by the North American Task Force on Intersexuality Research Protocol Working Group (S. J. Kessler, H. F. L. Meyer-Bahlburg, J. M. Schober, and K. J. Zucker). They were generated based on clinical experience in working with patients with gender dysphoria (both with and without somatic intersexuality), the DSM-IV-TR criteria for GID, and wording modifications from both Cohen-Kettenis and van Goozen (1997) and Docter and Fleming (2001). An effort was made to capture a range of subjective (n : 13 items), social (n = 9 items), somatic (n = 3 items), and sociolegal (n = 2) indicators of gender identity/ gender dysphoria that could be answered in parallel form by both males and females. Each item was rated on a 5-point response scale, with the past 12 months as the time frame. The response options were Always (coded as 1), Often (2), Sometimes (3), Rarely (4), or Never (5).
Items 1, 13, and 27 were reversed scored. For adolescents <18 years of age, the words woman and man were changed to girl and boy, respectively. Items 1-2, 5-10, 16, and 24-27 were considered to be subjective indicators of gender identity/gender dysphoria; Items 3-4, 11, 13-15, and 17-19 were considered social indicators; Items 20-22 were considered somatic indicators; and Items 12 and 23 were considered sociolegal indicators.
As noted in the DSM-V Rationales:
For the current analysis, we coded a symptom as present if the participant endorsed one of the two most extreme response options (frequently or always) and as absent if the participant endorsed one of the three other options (never, rarely, sometimes). This yielded a true positive rate of 94.2% and a false positive rate of 0.7%. Because the wording of the items on the GIDYQ is not identical to the wording of the proposed indicators, further validational work will be required during field trials.
I've provided an example of it on my own site.
You can also purchase one of the studies through amazon.
This assessment is something completely new in terms of the DSM and trans folk, and has significant importance for the day to day lives of the therapists involved (and, therefore, in persons who are trans).
What they do not provide in the DSM is what the scores mean, and a good part of that is because right now, they will mean one thing, while in ten years they may well mean something else. With scoring ranges of between 27 and 135, there's some significant leeway in there, and as has been noted previously, there will be some studies to determine which questions are of the most value and which one's are not - as well as there being new and slightly differently worded questions, made clear in the opening of the Severity Tab and the Rationales tab (as quoted above).
One of the things that's notable is that the test is extremely accurate. There are dimensional measures that are decades old that don't have the accuracy of it.
As such, the final form will replace many of the tools already in use (such as the MMPI) in terms of dealing with trans folk and make the process of getting a diagnosis much easier. However, there is a continued risk that the habit of "figuring out the right answers" will continue in the community, and people will work against the value of the test, fearing that they might somehow be classified wrong (and, in some cases, justly).
So, in closing, when it comes to adolescents (which, in terms of the treatment on a practical basis are the start of puberty as measured by hormonal development, or for general measure, the age of 13) and adults, the new DSM-V PRs have much to be excited about, and much to be concerned about in terms of practical, day to day use, as well as their repercussions in politics.
Most of which will be better known when the more important Standards Of Care are released, since one often overlooked factor here is that the current standards of care won't work worth a damn with these new criteria.