Kelley Winters

Transvestic Disorder: The Overlooked Anti-Trans Diagnosis

Filed By Kelley Winters | May 28, 2011 10:00 AM | comments

Filed in: The Movement, Transgender & Intersex
Tags: APA, DSM V, GID, transgender, transsexual, Transvestic Disorder, Transvestic Fetishism

DSM.jpgOn May 5, the American Psychiatric Association released a second round of proposed diagnostic criteria for the 5th Edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-5). These include two categories that impact the trans community: Gender Dysphoria (formerly Gender Identity Disorder) and Transvestic Disorder (formerly Transvestic Fetishism).

While GID has received a great deal of attention in the press and from GLBTQ advocates, the second transvestic category is too often overlooked. This is unfortunate, because a diagnosis of Transvestic Disorder is designed to punish social and sexual gender nonconformity and to enforce binary stereotypes of assigned birth sex. It plays no role in enabling access to medical transition care for those who need it, and it is frequently cited when care is denied.

I urge all trans community members, friends, care providers, and allies to call for the removal of this punitive and scientifically unfounded diagnosis from the DSM-5. The current period for public comment to the APA ends June 15.

The entry in the current DSM on Transvestic Disorder, like the former entry on Transvestic Fetishism, is authored by Dr. Ray Blanchard of the Toronto Centre for Addiction and Mental Health (formerly known as the Clarke Institute). Blanchard has drawn outrage from the transcommunity for his defamatory theory of autogynephilia, asserting that all transsexual women who are not exclusively attracted to males are motivated to transition by self-obsessed sexual fetishism. He is canonizing this harmful stereotype of transsexual women in the DSM-5 by adding an autogynephilia specifier to the Transvestic Disorder diagnosis.

Worse yet, Blanchard has broadly expanded the diagnosis to implicate gender-nonconforming people of all sexes and all sexual orientations, even inventing an autoandrophilia specifier to smear transsexual men. Most recently, he has added an "In Remission" specifier to preclude the possibility of exit from diagnosis. Like a roach motel, there may be no way out of the Transvestic Disorder diagnosis once ensnared.

What You Can Do Now

1. Go to the APA DSM-5 website, click on "Register Now," create a user account, and enter your statement in the box. The deadline for this second period of public comment is June 15.

2. Sign the Petition to Remove Transvestic Disorder from the DSM-5, sponsored by the International Foundation for Gender Education.

3. Demand that your local, national, and international GLBTQ nonprofit organizations issue public statements calling for the removal of this defamatory Transvestic Disorder category from the DSM-5. So far, very few have.

4. Spread the word to your networks, friends, and allies.

More Information

Cross-posted with additional comments at the GID Reform Advocates Blog.

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Kathy Padilla | May 28, 2011 10:34 AM

I'm always amazed at the mental gymnastics transphobic people will engage in in order to paint their own irrationality, prejudice and deficits as normal.

Normally, for something to be a mental illness their has to be some functional deficits - where is the proof for that here?

Just like extending the GID disorder to intersex people or determining that sex discrimination nondiscrimination laws do cover change of sex this seems to speak more of an unhealthy need to control, other and stigmatize on the part of those drafting these nosologies rather than rationality or respect. Isn't it past time we codified what disorders drive their behaviors?

Kathy Padilla | May 28, 2011 10:44 AM

That was of course "do not cover"

Kelly I most sincerely disagree with you and your opinions. You stated

the second transvestic category is too often overlooked. This is unfortunate, because a diagnosis of Transvestic Disorder is designed to punish social and sexual gender nonconformity and to enforce binary stereotypes of assigned birth sex. It plays no role in enabling access to medical transition care for those who need

To begin with those who AREN'T diagnosis as GID/GI have NO need or business transitioning to begin with therefore they don't need help or access to transitionally resources since they are not Transsexuals. ONLY those diagnosis as GID/GI have need of these resources. I will leave a comment for those putting together the newest version of the DSMV but it will be asking them to Keep Transvestic Disorder as it is clearly necessary as evident by the mass amounts of self diagnosed self medicating transgender people.

I happen to believe that those who fly the Transgender flag are society deconstructionist who's sole purpose is to force their do whatever they want third gender agenda upon the rest of the world. To this point they have done a very good job in hijacking the gender Identity diagnosis and in confusing the general population in what constitutes gender Identity and in who suffers from it. They've made great strides in convincing people that anyone who wants to can simply decide they have GID/GI and then WA LA their female, with out a diagnosis or hormone replacement therapy or GRS/SRS or most importantly without following the SOC. This is due for the most part to the fact that those who truly suffer from GID/GI have blended back into society and remain silence, but that is starting to change and more and more TS women of history are coming out of their stealth lives to set the record straight about a condition they once had and to educate the country on the differences between someone who truly has GID/GI and someone who doesn't. I will be among them clearing up the confusion caused by Transgender Inc

Kathy Padilla | May 28, 2011 11:55 AM

It's inspiring that you're able to acknowledge the humanity of those who are different from you and stand in some solidarity against patholization of all others. You make all of us transsexuals seem much more sympathetic to the public.

"happen to believe that those who fly the Transgender flag are society deconstructionist who's sole purpose is to force their do whatever they want third gender agenda upon the rest of the world."

That has to be one of the funniest things I've ever read. Could you elaborate on this "do whatever they want third agenda." Last time I checked, we had a document in this country declaring all people have certain sovereign rights, among them "life, liberty and the pursuit of happiness." Transgendered people have existed since before the dawn of civilization, and last I checked, they've never tried to invade a country, start a war, or attempt a coup. They have as much right to express gender variance as other people have a right to color their hair, or pierce their skin. The vast majority of Transgendered people want nothing more than simple respect and to be treated with dignity. They're not trying to deconstruct society (as if they even possessed the means!) I'm sure you must realize that in some cultures transgendered people are appreciated and even revered, the Fa'afafine of Polynesia, the Native American "Two-Spirits", the Biza'ah of Mexico. Your attitude is so ethnocentric it's laughable. Sure, there are people who do try to avoid the WPATH SOC, self-medicate, and pursue SRS, and virtually none of them ever do it. That's why the satisfaction rate amongst post-ops is so high. It takes a lot more conviction than the promise of a sexual thrill to sign those surgical consent forms... and while we're on the subject, how many SRS surgeons do you know that will even perform surgery on someone who's bypasses the system? Society (least of all the Transsexual segment) has nothing to fear from Transgendered people. It does have something to fear from people like you.

(And lest you think I'm harboring some secret Transgendered "agenda", know that I'm a Transsexual woman about 2 yrs into transition, fully compliant with the SOC, and I've never felt threatened by any transgendered person. Transphobic people... that's another story.)

You're assuming that no therapist would ever be transphobic enough to choose a diagnosis of TF over GID in order to prevent someone from transitioning medically. And assuming that -- should the GID diagnosis ever be removed from the DSM -- TF wouldn't be used against transsexuals in general. And assuming a lot of other things.

Jay Kallio | May 28, 2011 12:13 PM

As a transman I completely support the right of anyone who desires gender transition to seek and be supported in their efforts to obtain all the medical services they need and are entitled to, regardless of some bigoted DSM diagnosis. I deplore the efforts of some people of trans experience to deny the legitimacy and cause of other gender nonconforming people. I stand by all people to obtain justice and all the health care services they need, very much including everyone under the transgender umbrella.

I am proud of and in full agreement with the adoption of "transgender" as a political umbrella term. It does not "co-opt" or "hijack" my personal identity in any way, shape, or form. I will be using "transgender" to describe myself and others in my community so that we have a term that unifies us and furthers our movement to obtain social justice and equal rights and protections under the law, and fight the injustices we all are subject to. I stand by my transvestite, genderqueer, queer, etc., compadres in this struggle. I want them to understand that not all transsexual people hate them, or deride them as "Trangender, Inc.", which does not exist, except as a term used to demonize others and deny their individuality.

I will NOT leave any member of my community behind in this struggle. Injustice in employment, housing, education, opportunity, and public accommodations affects us all, and injustice done to one is done to all, in my book. Their pain and grievances are as legitimate as my own, and it is absurd to me that any would imply otherwise.

Those who attempt to deny others access to needed medical services and deny the legitimacy of their need are on the same side as the conservative right who enjoy oppressing and hating others on the basis of their own judgements and bigotry.

@ Jay I completely respect your right to your opinion. We can agree to disagree and leave it at that. Allow me to retort at your suggesting

" I completely support the right of anyone who desires gender transition to seek and be supported in their efforts to obtain all the medical services they need and are entitled to, regardless of some bigoted DSM diagnosis."

Undiagnosed Individuals don't "Need" Medical Service for Transition they "Want" them to fulfill fantasy.

" I deplore the efforts of some people of trans experience to deny the legitimacy and cause of other gender nonconforming people"

By "gender nonconforming people" you really mean Society Deconstructionist ANd by "deny the legitimacy" what you really mean is anyone who won't stand for or go along with a third gender.

"Those who attempt to deny others access to needed medical services and deny the legitimacy of their need"
Jay I'm assuming of course you can document this Legitimate need right without hijacking a story done on Transsexuals in reference to brain gender ? Didn't think so as Transgender Inc has No medical evidence No Diagnosis except for the one it's stolen from the DSMV covering Transsexuals. So put up or shut up !

"on the same side as the conservative right who enjoy oppressing and hating others on the basis of their own judgements and bigotry." Meaning anyone who's opinion differs from yours or goes against the transgender meme is a bigot and Elitist.....right ?

Hodge Podge | May 28, 2011 4:30 PM

"By "gender nonconforming people" you really mean Society Deconstructionist ANd by "deny the legitimacy" what you really mean is anyone who won't stand for or go along with a third gender."

Why won't you stand for a third gender? How does it even effect you, and how can you justify getting involved unless the people are at serious risk of hurting themselves (which the aren't?)

Do you not see the parallels between you defining who's truly transsexual and transphobes defining who's a "true woman"?

Thank you, Jay, it's always reassuring to see a comment I actually agree with whole-heartedly. :)

Leigh Anne | May 28, 2011 12:29 PM

Transvestic Disorder. Literally: wearing the wrong clothes. Like wearing a white tuxedo to an evening formal event. Known synonym: making a statement.

It seems Kenneth Zucker and Ray Blanchard think that being transsexual is the worst thing in the world, that it MUST be changed, and therefore CAN be changed, by ANY means possible. I think that they should be in prison for child abuse, but by banging this same drum for decades they have somehow risen to prominence in a field where sex reassignment is otherwise widely recognized as appropriate treatment for an innate condition.

I used to like the term dysphoria, because no one knew what it meant, and Iā€™d just say it was the opposite of euphoria, and that would end the conversation. But now that gender has become a synonym for biological sex, the confusion just goes on and on.

The word disorder still grates on me like fingernails on a chalkboard ā€“ for those of you who can remember slate chalkboards.

Leigh Transvestic Disorder doesn't cover diagnosed GID/GI Transsexuals it covers those who don't meet the diagnosis criteria.

In point of fact, Transvestic Disorder very much covers transsexual individuals. Blanchard added specifiers of "autogynephilia" and "autoandrophilia" to encourage concurrent diagnosis of TS women and men. Transsexualism (the diagnostic predecessor to GID) and Transvestism were mutually exclusive in the DSM-III (criterion D) and the DSM-III-R (criterion C). Blanchard, et al., changed this in the DSM-IV (1994) by dropping the exclusion. This was a major focus of the DSM-IV.

Kelley I agree with you but as a practical matter who is going to go see a shrink because they cross dress? I am surrounded by women in traditional men's clothing and I see more than a few men walking about in traditional women's clothing and I doubt seriously if any of them feel the need for psychiatric services.

I suppose you could make a case that some parents might take their children to Blanchard for "a cure" but that will happen whether or not the DSM contains a fetish category.

As I see it the greater issue is the gate-keeping function perpetuated by the SOC. Why should it matter what another person wants to do with their body? No one needs medical sign offs to have tattoos, piercings, breast augmentation, face lifts or many other body altering procedures. If someone wants to have their breasts removed or something done to their genitals then have them sign an informed consent and just get on with it. I guess I'm a radical because if someone wants an arm removed I say have at it but you'll have to live with it and don't blame the surgeon if you decide later it was a mistake. Their is no cure for stupidity.

Children and youth are forced into gender-reparative therapies all over the world, not just in Toronto, as a consequence of the official position of the APA that gender nonconformity is mental and sexual sickness. The impact of this diagnostic category on social justice and civil liberty is enormous. TD is classed in the DSM as a sexual paraphilia, along with pedophilia and exhibitionism. Political/religious extremists constantly refer to this diagnosis, when they malign trans people (especially trans women) as sexually deviant and worse. Whenever you hear rad-right demagogues scream "bathroom bill," in opposition to transinclusive civil rights legislation, you're hearing a consequence of this defamatory diagnosis.

Kelley I doubt children are forced into reparative therapy by the existence of anything in the DSM. Parents do that. There is no test nor qualifying criteria for being a parent. Totally eliminating the DSM, psychiatry and psychology wouldn't stop it.

Actually, if you've ever checked out Pfox's website, they do actually repeatedly point out that being trans is classified as a mental illness known as Gender Identity Disorder. For "homosexuality" they are only able to repeatedly state that it *was* considered a mental disorder. Getting the diagnosis changed, as suggested here, would give ex-gay groups, like Pfox, one less bit of highly damaging ammo to use.

I admit to not knowing who Pfox is. Never been there. I've never seen a psychiatrist either. I have seen a lot of parents train their children to hate. I have seen a lot of parents subject their children to what amounts to reparative therapy.

Pfox (Parents and Friends of Ex-Gays) is the homophobic and exceptionally transphobic equivalent (opposite?) to Pflag.

Thanks. That explains it. I've never met an ex-gay.

Marja Erwin | May 28, 2011 4:32 PM

1. Can people define gender?

I know people mean different things when they refer to gender, but I when I read or hear references to gender, I tend to take it to mean the system of roles assigned to each sex. And that's inherently oppressive. I am trans, I am female and transitioning toward female, and to me feminism and trans activism imply opposing gender, just as they imply opposing patriarchy, misogyny, oppositional sexism, etc.

2. I see two problems with "Transvestic Disorder."

Firstly, it stigmatizes perfectly healthy behavior.

Second, it gives anti-trans therapists a way to hurt genuinely trans patients, by ignoring diagnostic requirements or distorting the patient's history to fit the diagnosis. And that has happened and that has hurt many trans people.

I don't see some therapy as gate keeping I see it as a safety net. As someone who has spent sometime in the community and drove a taxicab I think its safe to say I've seen it all. To deny that transition for some people is nothing more than attempting to turn fetishistic fantasy into reality is simply wrong. While I don't necessarily believe the NCTE survey is reflective of the entire community I do believe it speaks a lot of truth about those who are deeply involved in the LGBT community and identify as transgender.In my experience these are the people most likely to be involved in gender deconstruction, fetshistic behavior, risky sexual practices, and in need of psychological care.It is no wonder that the NCTE survey showed such high numbers across the board especially when it came to pre and post-op suicide numbers. What wasn't surprising for me was that in this community the suicide numbers were actually higher for the post-ops than pre-ops even though I believe they were considerably higher than for those who avoid the community and lifestyle that goes with it.I believe the high numbers in the Transgender community are clearly reflective of the knowledge from within those communities of which doctors most easily prescribe hormones, how to get them illegally or to order them from overseas.I believe these are also the people most in need of mental health access but most likely not able to gain access to it. I constantly try to tell those I know caught up in it to try and get out of it most of life really takes part outside the gay community especially if you want to be successful.I think the dsm5 should add a transgender specific category for those who are to attached to the transgender lifestyle and incapable of moving forward from it into a healthy lifestyle.

Oh my... In my experience, horizontal intolerance, stereotyping and scapegoating among oppressed people do not make a healthy lifestyle. To take ownership of my own social identities, I am a proud parent, woman, transsexual woman, transgender woman (in the broadest, inclusive sense), bi woman, queer woman and hopelessly geeky woman, not to mention a ski bum. I see no conflict between any of these and stand in proud solidarity with all who transcend the boundaries of assigned birth sex. I don't know what in the world a "transgender lifestyle" might be, but I had baked salmon and asparagus for dinner and I think that makes my lifestyle pretty damned healthy.

Therapy can be useful, but only as useful as the therapists. I see a lot of problems with putting our trust into the medical system because there are way too many people in that system unworthy of it.

I've told a story before of having my doctor proscribe me spiro and tell me to consume as much potassium as possible, even giving me a list of high potassium foods I could get at the grocery store. It was my friend who had been self-medicating since 16 (yes, with overseas meds, and no at 16 and without parental support she didn't have the option of going to a doctor) who told me that's the opposite of what I should've been doing and could have caused a heart attacks and/or coma.

Similarly I've had a therapist obsessed with my sexual practices, trying to diagnose me as GID or TF, relying on outdated gender norms. Women have to shave their legs, men can't (even his trans male patient who was a competitive swimmer). Women shouldn't desire sex, except for the validation they receive for receiving male sexual attention. Men should seek women as sexual objects. And so forth. He tried to micromanage his patients romantic and sex lives, molding them into his image under the threat of denial of treatment. It was all couched within more palatable language, but that was the bottom line.

Do you have a love of your life? What would you do if your doctor said they would revoke your GID diagnosis and re-label you TF unless you broke it off with them? Would you resign yourself to a TF diagnosis because the all-knowing doctor said so? Or would you determine that your compelling sense of self that you have felt your whole life is more important than a doctor's approval?

I see a lot of problems in either putting to much trust in people to make the right decisions or in the LGB and transgender community to make the right decisions for everyone.I think once you get into this there is way to much cattiness and competition to out fem the next person or out masculine the next person in the transgender community. Go to groups and listen to the advice they're giving to each other. I know a person put them in front of a computer and they'll spend hours looking at fetish footwear. See them dressed the worst possible clothes and wig yet everyone will tell them to go on hormones except me.I know of another person that paints their nails and will sit there hours looking at them the doctor stopped giving them hormones for failing to make progress in transition. Yet if you asked both these people who are in a transgender support group what they are they'll tell you they're transsexuals.Ask the other group members and they'll tell you they're transsexuals. Guess what they're not transsexuals and neither is the majority of the group.You are right though that not all therapist are created equal met any post-ops that there was no way they should have been given the green light? That's the result of knowing which therapists are easy and transgender community friendly if you can call it that. Between the risk of suicide or making an irreversible choice I'm sorry but I see therapy as a must have safety net.Suicides and surgical mistakes hurt all of us and take away from the validity of needing surgery and the positive outcome of having it. As for if my therapist said I was TF I would seek a second opinion if that therapist said I was TF I guess I'd have to live with it. As for my choice in therapist they've all been female in my logic it takes one to know one can't get any safer than that. There really is no such thing as transgender what there really is, is a bunch of groups of people with different needs that aren't being addressed because of the umbrella and the we know best attitude. I see it as a very dangerous thing that is causing harm and confusion about what those groups are. I also see it as a huge and unjust power grab of people that are already to marginalized to promote an agenda that is inconsistent with what I know and believe to be the truth. Real people are making life changing mistakes and being hurt by both themselves and the transgender agenda it is time to take responsibility not to move forward another step with a failed agenda.

Boy, I certainly agree with you about the disfunction of certain support groups. My big pet peeve is those who foist conformity to sexist tropes -- those hyperfeminine and hypermasculine concepts you're talking about -- as the best path towards passing and tell those who refuse that they are failures.

However, I feel like you're making a few dangerous assumptions here. Perhaps there's more details you're leaving out for brevity, but I'm skeptical of any attempt to distill a person's legitimacy as transsexual based on one or two details that happen to fall into stereotypical transvestic behaviors. I mean, what position are you or I in to determine who is worthy or not worthy of medical access to transition based on such minute characteristics?

I mean, I know plenty of cis women who spend hours perusing websites for fetish footwear (I believe cis women are the primary market for such shoes), would you tell them that that makes them only into their womanhood for the sexual thrill and really supposed to be men? And how many teenage cis girls spend hours playing with nail polish?

But here's my main beef with TF. For the sake of argument, let me temporarily concede that there may be some trans people who should be denied access to medical transition. However, I don't believe there is anything wrong or un-female about having a strong sexuality. Why should sexual response be an indicator of who is or isn't a real woman?

There was an interesting study I found (I can dig it up when I'm not traveling if you're interested), where someone applied diagnosis tools for autogynophilia (TF's diagnostic cousin) to cis women, and found that the majority would fit the criteria for the diagnosis. So how can behavior that is typical among cis women populations be evidence that someone sees themself as a transsexual woman must not really be one?

darksidecat | May 30, 2011 4:10 PM

"Therapy can be useful, but only as useful as the therapists. I see a lot of problems with putting our trust into the medical system because there are way too many people in that system unworthy of it." QFT. As a person with disabilities, I have dealt with my fair share of incompetant and/or pathologizing of everything doctors. Doctors who proscribe medications forbidden in concert wit ha medication I take that I need to live (this is why I have to call a specialist and check every time I start a new medication, because doctors, despite the fact that I make a point of telling them over and over, love to fail to take into account that I cannot always be given treatments typical for my age because I have a chronic illness that usually only affects older people). I have had a doctor offer to give me full hormone blockers and hormones-but only if I want to make my body and hormones conform better to my sex assigned at birth (I have a hormonal condition that causes high testosterone). I have had a psychologist suggest my political beliefs about capitalism are a pathological result of my autism, ditto with my atheism. I had one of my conditions go undiagnosed for six years, risking death and permanent injury, because doctors saw a fat girl and stopped listening. One doctor, when I told him that I slept ten to twelve hours at least a day, told me to "stop lying, you hysterical little girl" (I was fourteen and telling the truth). I have doctors obsess over my blood pressure because I am fat when the same health condition that makes me heavy also makes it damned near impossible to have high blood pressure at the same time and all of my blood pressuring readings put it on the low side of acceptable (as in "if you drop in much more, you will be in physical danger"). Having spent a third of my life dealing with this shit, I have far too much real world experience with doctors to engage in the sort of doctor worship so common in certain circles.

Tobi its a case of you have to meet the person to believe it. I no longer attend the group but I've tried to be open to helping members when I can whether its a place to sleep if they get homeless or if I can help them with finding work. I recently talked to the person and they are now looking at other possibilities for themselves and I think its great for them.I see a huge disconnect between those at the top of the Transgender heap and those at the bottom and what their actual needs are. Like I said I take huge issue with the one size fits all box that transgender is and I think it is causing much more harm than good. I think for those whose transition is a sexual fetish they would be much better served by being in their own group where their needs can be met and they can be studied to find ways that can help them.I think that is the same for every group under the Transgender umbrella and the sooner it is closed and put away the better. I also see a problem with most of the top leaders in the Transgender movement and WPATH being non heterosexual Transsexual women.After reading some of this and other things I'm becoming more convinced they harbor a deep seated animosity towards them because of past standards and I guess now the autogynephilia thing.Its a shame that they are now fast becoming worse than what the problem was before but it does seem to be catching up with them.

I am confused. They harbor a deep resentment against them? Who are the 'they'? Who is the 'them'? Are you saying the les/bi/queer trans women who you see as the leadership of the transgender movement have a resentment against those transitioning for sexual fulfillment? Or they have a resentment against the standards of care? Or something else?

In the quote below Paul Newman expressed his opinion of the significance of being gay. IMO the same comment could be made about being trans whatever flavor of it one identifies as. I.e. it is not all that important. Some of many more important qualities to me include the following:

1. Is a person interesting?
2. Are they dependable?
3. Can they do things in public that do not force everyone to focus on their gender presentation?
4. Are they reasonably intelligent?
5. Can they put their gender issues aside long enough to pay attention to other people to include me?
6. Do we share some interests?
7. Are they able to pull their weight in relationships or are they self-centered leeches?

I think my attitude is similar to many people in the general public. So while the APA and some of our gender theorists love to beat gender discussions to death we'd be well off to put more emphasis on other things.

"...There are so many qualities that make up a human being... by the time I get through with all the things that I really admire about people, what they do with their private parts is probably so low on the list that it is irrelevant."

Nerissa, I love your list of qualities of what makes a good person. Sometimes I meet trans people whom I don't like, and I wonder whether it's internalized transphobia, or jealousy on my part. I suppose I have as much right to dislike someone who is trans as someone who's not.

My comment:

This "disorder" misrepresents trans women and men. It unnecessarily stigmatizes natural gender variation and enforces arbitrary gender norms that change with culture (see also: women and pants in the 19th century) . It is regularly used for insincere purposes, such as disqualifying trans women from transitioning who either identify as lesbian, or whom the therapist does not find attractive. Furthermore, the tiny amount of research done on so-called "autogynephilia" was conducted using poor methodology, breaking ethics codes and using extreme selection bias with small sample sizes.

On Sunday, 5/29, the APA website was not allowing comments to be entered concerning paraphilia of any kind. Maybe this will be corrected soon. Meanwhile sign the petition.

Thanks for pointing this out, Mercedes. Several people have told me they cannot register or post to dsm5.org with the Safari or Firefox browser. I've been accessing it ok with Chrome. Is this your experience as well? (I haven't tried Exploder... I don't do windows)

If folks who are experiencing problems with the APA web server, would let me know what browsers you are using, I will escalate this to the APA. Thanks.

Sorry, I mean, thanks, Dawn. I just tested the dsm-5.org service with a Midori browser, which self-identifies as Firefox, and it worked ok. I've noticed that several people having problems are using macs. Is that true for you? Anyone else having problems commenting to the dsm5.org site, please let me know the operating system and the browser you are using, or email me at kelley@gidreform.org. Thanks.

Thank you very much for posting this, Kelley. There's really not been any worthwhile improvement in this proposed diagnosis, and it remains a serious issue.

I must admit to mixed feelings. I have met people who have had surgery and regretted it. That's very distressing, and I blamed the therapists who just called everyone "transsexual" who said they were. I have also met people who were denied services even though it was obvious to me they are transsexual, because of outmoded stereotypes about what makes a man or a woman, and some ill-defined conclusions about "fetishism."

That being said, I note that I waited for five years to get surgery after beginning to live as a woman, because I wanted to make very, very sure that I wasn't fooling myself. Thirteen years later, I am still satisfied that I made the right decision, despite all of the difficulties.

I also think that, while in some few cases gender dysphoria is a mental illness, as for example a temporary dysphoria induced by psychotropic medication or schizophrenia, I do not believe that most cases of gender dysphoria are a "mental 'illness'." As to those who are argue that unhappiness with one's gender is obviously a case of mental distress, I would note that there are many kinds of unhappiness in the world. To call them all a "mental illness" is obviously wrong. To block access to changing one's circumstances to pursue happiness, on the grounds that such is a "treatment" to be prescribed only by a doctor, is equally ludicrous.

It's ridiculous. There is a world of difference between liking to wear certain clothes and believing that you actually ARE a different sex than the one you were born as.

Gender is a social construct. Sex is immutable. There seems to almost be a campaign from some in the trans community to declare that all people who have some characteristics - culturally created characteristics - traditionally associated with the other sex ARE that sex.

Dressing in female clothes is NOT the same thing as a psychiatric disorder that causes you to claim that you're actually female when you're actually male.

I've often thought that there is a lot of hatred of real women within the trans community, since they co-opt real women, demand the right to intrude in the private places of real women, and they minstrelize women, and dressing up and mimicking the worst of stereotypes.

Hilda Whitby - no real woman would say that.

As for Sex being immutable.... try looking at http://www.usrf.org/news/010308-guevedoces.html

If that's not a natural sex change, then please define sex in biological terms. Chromosomes perhaps?

A 46,XY mother who developed as a normal woman underwent spontaneous puberty, reached menarche, menstruated regularly, experienced two unassisted pregnancies, and gave birth to a 46,XY daughter with complete gonadal dysgenesis.
-- J Clin Endocrinol Metab. 2008 Jan;93(1):182-9


Of course there is one good definition. One true since about week 26 of foetal development. Here it is:

A sex difference in the human brain and its relation to transsexuality. by Zhou et al Nature (1995) 378:68ā€“70.

Our study is the first to show a female brain structure in genetically male transsexuals and supports the hypothesis that gender identity develops as a result of an interaction between the developing brain and sex hormones

Or, in longer form,

Sexual Hormones and the Brain: An Essential Alliance for Sexual Identity and Sexual Orientation Garcia-Falgueras A, Swaab DF Endocr Dev. 2010;17:22-35

The fetal brain develops during the intrauterine period in the male direction through a direct action of testosterone on the developing nerve cells, or in the female direction through the absence of this hormone surge. In this way, our gender identity (the conviction of belonging to the male or female gender) and sexual orientation are programmed or organized into our brain structures when we are still in the womb. However, since sexual differentiation of the genitals takes place in the first two months of pregnancy and sexual differentiation of the brain starts in the second half of pregnancy, these two processes can be influenced independently, which may result in extreme cases in trans-sexuality. This also means that in the event of ambiguous sex at birth, the degree of masculinization of the genitals may not reflect the degree of masculinization of the brain. There is no indication that social environment after birth has an effect on gender identity or sexual orientation.

Now you may say that gender identity caused by physical anatomy is different from "sex". But if so - please give a definition of sex that covers those with 5ARD, 17BHDD, 3BHDD or other sex-changing syndromes, 46XX men and 46XY women, and others.

Or be prepared to defend your own femininity from arrogant arschlocks who would say "no real woman would say that..."... "no real woman would have short hair..." "no real woman wants a career..." and similar statements. Like the one I used for shock value at the beginning of this post, not actually meaning it. They will.

The whole DSM diagnosis setup relating to anything trans involves Skinner Box analysis. Harry Benjamin Syndrome is not a mental disorder, it involves a variation in embryonic development in which (somewhat simplified) the brain zigs while the genital tract development zags. Many of the people who the Blanchard types would diagnose with Transvestic Disorder, whether "autogynephilic" or not, are likely to have some degree of HBS development. More research is needed into issues involving genetics and embryonic development.

To the extent that anyone trans has any psychiatric problem, it is usually related to misguided attempts to suppress their natures, combined with issues of family, religious, and societal rejections and disapprovals. I've heard it fairly accurately described as "culturally induced stress disorder." And the approproiate treatment involves counseling to help the individual recognize and accept their nature.

I am appalled at a few of the comments to this essay, from people who shouldn't be casting stones.

The simple matter is that the DSM is the modern substitute for the Maleficus Maleficarum. It does not hold up to any rigorous standards, and is so inconsistently applied that it must create new categories constantly to allow people to fit into neat little boxes and be medicated. The book, in the hands of poorly trained (and, sadly, well trained, well meaning) diagnosticians has been used to alienate some groups, give crutches to others, and marginalize behaviors deemed undesirable, unless, of course, you are rich enough or famous enough to be tolerated or accepted despite your behaviors.

I cannot say whether there is mental illness, and exactly what should be termed abnormal. Reality TV (and it's adherents) would belong in my personal DSM. I challenge people to remember that last time the DSM was interestingly tested. Check out David Rosenhan's 1973 experiment, and try it yourself.

Ultimately, we should be protesting not for categories of the DSM to exorcised, but for destruction of the entire tome. It is a dangerous tool to often used without any evidence-based practice to prove things we cannot yet prove, such as the idea that we must fit into binary gender categories, that we should be have in prescribed ways, and that deviation from these standards should be narrow, and all behavior outside, circumspect