Kelley Winters

Transvestic Disorder and Policy Dysfunction in the DSM-V

Filed By Kelley Winters | April 27, 2009 9:30 AM | comments

Filed in: Living, Transgender & Intersex
Tags: American Psychiatric Association, crossdressing, DSM V, gender identity disorder, GID, ray blanchard, society for sex therapy and research, transgender, transsexual, Transvestic Fetishism, transvestism

While the current psychiatric classification of "Gender Identity Disorder" in the Diagnostic and Statistical Manual of Mental Disorders has drawn global GLBTQ concern and controversy, the equally defamatory classification of "Transvestic Fetishism" has been largely overlooked by transadvocates and allies.

At the Annual Meeting of the Society for Sex Therapy and Research this month, a "Provisional Report by the DSM-V Workgroup on Sexual and Gender Identity Disorders," was presented by Chairman Kenneth Zucker and a panel of workgroup members. Ray Blanchard, who chairs the Paraphilias Subcommittee, summarized proposals for "Pedohebehpilic Disorder" and "Transvestic Disorder" in the DSM-V.

Charles Moser, Ph.D., M.D., and others have long raised concern about all paraphilia diagnoses in the DSM, however the current diagnostic category of Transvestic Fetishism is particularly stigmatizing and defamatory for male-to-female (MTF) cross-dressers as well as many transsexual women. Unfortunately, Dr. Blanchard's proposal of Transvestic Disorder for the DSM-V offers little to allay these concerns.

Dr. Blanchard proposed that the current diagnosis of Transvestic Fetishism in the DSM-IV-TR be renamed Transvestic Disorder in the DSM-V. While somewhat less pejorative than the present title, Transvestic Disorder would still imply that all cross-dressing represents mental disorder. It would continue to perpetuate this defamatory stereotype.

Additionally, Dr. Blanchard proposes to change the Specifier Options to the diagnosis. The current Transvestic Fetishism diagnosis has a single specifier, "With Gender Dysphoria: if the person has persistent discomfort with gender role or identity." Blanchard's proposal would replace this with a specifier of "Autogynephilia (Sexually Aroused by Thought or Image of Self as Female)."

The term, autogynephilia was coined by Blanchard in 1989, not merely to describe a phenomenon of human sexuality, but rather to promote his derogatory theory that all lesbian, bisexual and asexual transsexual women were motivated to transition by a narcissistic sexual obsession. This word was subsequently associated by author J. Michael Bailey with profoundly defamatory remarks and stereotypes in his 2003 book, The Man Who Would be Queen: The Science of Gender-Bending and Transsexualism.

It is difficult to imagine how a term that has become so offensive and so damaging to the dignity of transwomen could serve any constructive clinical purpose in the DSM-V.

To summarize, Dr. Blanchard's proposal for Transvestic Disorder in the DSM-V fails to address serious issues of unfair social stigma and stereotyping that surround the current Transvestic Fetishism diagnostic category. Moreover, it would worsen these concerns by adding the pejorative term "autogynephilia" as a specifier to the diagnosis.

I ask the elected leadership and Board of Trustees of the American Psychiatric Association to affirm in a public 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. I urge the DSM-V Task Force to honor this principle in the DSM-V by removing the current category of Transvestic Fetishism and rejecting Dr. Blanchard's proposal to replace it with Transvestic Disorder.

For further reading, you can find an expanded version of this essay with a description of diagnostic criteria at the GID Reform Advocates site.

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Nothing positive will come out of the APA as long as reparative therapists like Zucker and crackpots like Blanchard are part of it. They should not only be excluded from policymaking, but be ejected from the APA for abusive practices that harm their patients.

Transgendered people need to reject the system. Seek treatment from doctors who work outside the SOC or self medicate and see our surgeries in Thailand or other areas where we, not psychological abusers, are in charge of our own lives.

As someone who lives in NYC, I feel very fortunate that I have access to Callen Lorde and doctors who do not adhere to SOC and just believe me when I tell them what I need (particularly since I don't fit the criteria under the SOC). However, I am counted among the very small percentage who has access because of proximity to these doctors and centers, with the money and health insurance to access them, and with the socio-economic, cultural, and educational empowerment to find, access, and demand these resources. Critique and reform of the SOC, the DSM, and trans-related medical treatment and diagnostic criteria in general is so important to those who do not have this kind of access. So thank you, Kelley, for doing this work. I agree, we have to look beyond just GID.

We must tell the APA that it is unacceptable and dangerous to have people who advocate reparative therapy and autogynophilia helping to shape diagnostic criteria and categories! I definitely adhere to the school of thought that GID and other trans/gender non-conformity should be removed from the DSM, but understand that these diagnoses are vital to low-income people, people on government assistance, and people in prisons for them to ever have access to trans-related medical treatment (under the current medical/insurance regimes and organization).

I agree with kathygnome that trans/ect people should seek out doctors who do not adhere to the GID/DSM/SOC diagnostic criteria if at all available to them, but it worries me to advocate that people should self-medicate. sometimes that is the only option, but as with any medical treatment, it is best and safest to do under the supervision of a knowledgeable and sympathetic doctor.

Henry Hall | April 27, 2009 5:13 PM

The arguments are overwhelming and, as Audre Lorde wrote "Trying to educate or enlighten the oppressor is a tragic waste of needed energy".

The bottom line is that psychiatry has proven it cannot be trusted in transsexualism. Transsexual and transgender people must reject treatment that involves mental health professionals and seek treatment elsewhere. WPATH and its SOC must be rejected as long as it endorses psychiatry and the DSM as being valid.

This is crazy. They would never put together even a speaking panel on African Americans and psychology without Black representatives, nor would they attempt to discuss women's mental health without speaking to women. They should be seeking out the opinions of trans people for these decisions.

Its patently clear that whatever form of TGism a person has developed, that person clearly is suffering from a variety of mental disorders to boot, NOT just your typical GID/BDD.

The medical establishment needs to pull its head from its patriarchal ass and begin treating TG folks where their issues lie (mentally), rather than brutally mutilating physically healthy bodies to "match" their unhealthy minds.

How can a diagnosis be listed in the DSM yet "cured" through unnecessary body drugging and body mutilations? Whats next gastric bypass for anorexics?


How about letting those gay and lesbian abominations actually love each other? How disgusting, cruel, and unnecessary would that be?

...oh wait, that is silly because just like transsexuality, homosexuality isn't a mental disorder.

Dirt, I am deeply offended by your defamatory characterization of trans, and particularly transsexual, people. These maligning and pathologizing stereotypes ignore the existence of countless thousands of happy, well adjusted, post-transition and post-op individuals. In my experience, gender identity and expression are not disorder, but prejudice and intolerance are. I invite you to meet and get to know a transsexual person in the real world. You will find that we bear little resemblance to these stereotypes. You ask how a diagnosis in the DSM can be wrong. I invite you to read my book.

@Dirt writes: "Its patently clear that whatever form of TGism a person has developed, that person clearly is suffering from a variety of mental disorders to boot, NOT just your typical GID/BDD."

- Actually it is anything but patently obvious, it is not in the least obvious! All the actual evidence points the other way - that there is no mental disorder involved in transgenderism. TGfolk are as much of sound mind as the general population. The situation is strictly comparable with drapetomania.

It should be noted that the classification of transvestism (etc.) as mental disorders has recently been abolished in Sweden effective 2009-1-1. It is only a matter of time before other countries follow their lead.

Actually, if one limits themselves to exposure to trans issues via LGBt blogs it's almost impossible not to come away with the impression that transness causes some forms of insanity or at minimum, immunity to any social skills or acceptance of any diversity of opinion.

At the very least a meanness of spirit that promotes the most anti-social behaviour towards others and internalized self loathing that leads to striking out at members of one's stated cohort.

Yes Virginia, trannys are bloody crazy.