Kelley Winters

DSM-V Task Force Releases Proposed Diagnostic Criteria

Filed By Kelley Winters | February 10, 2010 2:00 PM | comments

Filed in: Living, Transgender & Intersex
Tags: APA, DSM V, gender identity disorder, gid, transgender, transsexual, Transvestic Fetishism

After months of delay, the American Psychiatric Association released proposed diagnostic criteria for the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). A period of public review and comment begins today and ends April 20th. Readers may register and post comments to the dsm5 site through that date. It is especially important that mental health clinicians who work with transitioning clients are heard in this process.

The publication date for the DSM-5 is now scheduled for May, 2013.

The proposed list of gender related diagnoses in the DSM-V are after the jump.

  • 302.6 Gender Identity Disorder in Children, renamed Gender Incongruence (in Children)
  • 302.85 Gender Identity Disorder in Adolescents or Adults, renamed Gender Incongruence (in Adolescents and Adults)
  • 302.6 Gender Identity Disorder Not Otherwise Specified
  • 302.3 Transvestic Fetishism, renamed Transvestic Disorder

Please check the GID Reform Advocates site for updates and views on these draft diagnoses.


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HBS-based complaint in 3... 2... 1...

An awful lot of cites to Zucker articles/studies in there... and I mean awwwfffuull.

Incongruence... yipee, now I feel so, so, healthy and non-disordered. Thank you APA for curing me!

Yes, Zucker is heavily cited, and for good reason: his center in the US has likely seen more trans folk than any other in the US and Canada.

The biggest downside to Zucker is his idea that being trans is a "bad outcome" to gender variance in children.

Zucker is at CAMH in Toronto even though he's a US citizen.

Primarily, the young trans people he's seen are largely ones whose parents are uncomfortable with their cross-gender id and take them to him in hopes of being 'cured', which means most of his studies are useless. He's cited because he's part of the APA committee to rewrite the DSM. You will notice that the primary cite for the 'transvestic fetishism' section is Blanchard. This is on no level an objective group.

Other than the part where they continue to diagnose kids for playing with the wrong toys, I don't see an issue there. That's a pretty big problem though, and it would be nice if GID activists would focus more on protecting children.

The other big problem is transvestic fetishism. While the criteria for gender incongruence and transvestic fetishism may look completely different at first glance, those for the latter essentially cover anyone with male assigned gender and female sexuality. In other words, as the criteria are written (especially the questions for determining severity), any trans woman who is not completely asexual can be diagnosed as an autogynephilic transvestite, if the psychiatrist is so inclined.

At first glance, the proposed changes to GID make some forward progress on dignity and barriers to transition care. However, they don't go far enough in clarifying distress as the focus of diagnosis, rather than difference from expectations of assigned birth sex. Childhood diagnosis is better than it was: with requirement of subcriterion 1A, children cannot be diagnosed purely on the basis of gender role nonconformity. However, its language remains ambiguous around distress as well as sexist, maligning language-- too focused on arcane gender stereotypes. It's not clear to me why young children, not yet concerned with access to puberty-delaying treatment, need any diagnosis at all.

Dimensional diagnosis (those comedic severity questions) is a huge problem across the entire DSM5. The upshot is to remove clear boundaries around who is disordered and who is not, as subthreshold diagnosis can now be considered sorder. Past editors of the DSM oppose this.

Finally, TvFet, renamed "transvestic disorder" with the new specifier of "autogynephilia," is a travesty of medical injustice. I hope that removing it entirely from the DSM will be a priority for transcommunities and allies in coming weeks and months.

battybattybats battybattybats | February 10, 2010 10:43 PM

Hey all maybe you didn't catch this bit from the transvestism revision reason page:

"[11] The word “heterosexual” was removed because some transvestites interact sexually with other males, especially when cross-dressed, and may subjectively perceive themselves as bisexual."

Subjectively perceive themselves? They are ignoring the possibility these people might actually BE bisexual! Maybe they think bisexuals do not in reality exist but are all homosexuals in denial?

Also for the HBS folks they may feel upset about the next bit:

"As a practical matter, the autogynephilic type seems to have a higher risk of developing gender dysphoria. This was confirmed in a secondary data analysis reported by Blanchard (2009c)." Thats from the TRANSVESTISM piece folks.

And note that the paraphilia label still gets applied even if someone is happily content without disstress or impairment in their lives! They just don't get labelled as Disordered.

So if you manage to not suffer any guilt or shame for being gender non-conformist no matter the societal prejudice of your upbringing and happen to find a tolerant community and workplace your not disordered.

And if you never ever ever under any circumstances get aroused while your wearing those clothes and especially if you never ever have sex with someone (even one you love and are in a monogamous relationship with) who finds you attractive in those clothes without first removing every single iota of apparel then your not even a paraphilliac.

But fail to remove those pink socks in your haste or worse dare to wear lingerie of any sort that is not first removed to have sex then apparently thats sick.

I have expanded some preliminary remarks about the proposed DSM-V gender diagnoses at http://www.gidreform.org/blog2010Feb10.html.