DSM-5 Plays Sleight of Hand With Trans Diagnosis
The American Psychiatric Association has signaled that, with the publication of DSM-5, transgender identity will no longer of itself be classified as a mental disorder, a change that they hope will remove stigma and undercut anti-trans prejudice, but critics have attacked the move as sleight of hand due to changes elsewhere in the manual.
Changing “Gender Identity Disorder” for “Gender Dysphoria”
On Saturday, the APA’s Board of Trustees at a meeting in Washington, D.C., voted to change how it classes trans identity in the forthcoming Diagnostic and Statistical Manual of Mental Disorders (DSM).
Currently, transgender identity is classed as Gender Identity Disorder, and has been labeled as such since the third edition of the DSM published in the 1980s.
This has long been protested by many in the trans community who point out that disorders are associated with symptoms that impede people from living their lives fully and which encroach on their overall well-being. This does not describe the experience of many trans people who are well adjusted and in all respects are both mentally and physically healthy.
They have also argued that, while their gender appearance and identity mismatch may cause them depression and anxiety, those elements can be fixed through gender realignment intervention. However, in order to access such medical intervention, trans people were nearly always required to have a GID diagnosis, hampering them with the stigma of a “mental disorder” that can cost them employment opportunities and which has served to increase anti-trans prejudice.
Now, the APA will classify trans identity under gender dysphoria, which broadly identifies distress over “a marked incongruence between one’s experienced/expressed gender and assigned gender.”
Those who have supported the move say this is akin to the depathologization of homosexuality in 1973.
Labeling Trans People Sexual Deviants with Transvestic Disoder
However, a number of trans groups have said that the APA has essentially played a sleight of hand with this move because while it has seemed to depathologize with “gender dysphoria,” it appears DSM-5 will contain an amended “Transvestic Fetishism” in favor of “Transvestic Disorder,” and that this change is deeply injurious to the diagnostic framework and how it treats trans people.
The move from Transvestic Fetishism to Transvestic Disorder has been backed by Dr. Ray Blanchard, of the Toronto Centre for Addiction and Mental Health, whose work on the board has outraged many in the trans community because he authored a theory of autogynephilia which essentially asserts that all transsexual women who are not exclusively attracted to men have transitioned because of a self-obsessed sexual fetishism, this despite concerns that his theory lacks any solid grounding in fact.
Essentially, the change to Transvestic Disorder compounds a long standing issue with the original Transvestic Fetishism because it has made male-to-female (MtF) trans identity into a “paraphilic” sexual disorder, that is to say that it has been grouped with harmful behaviors such as pedophilia. Such notions continue to feed into the religious right’s false and abhorrent notion that trans identity, and in particular MtF trans people, are sexual deviants who cannot be trusted around children.
While the APA has as a matter of policy rallied against such ideas, the fact that Transvestic Disorder appears to have been framed to perpetuate this autogynephilia theory is deeply disturbing.
Furthermore, it appears that Transvestic Disorder will contain a marker to pathologize trans men and, if early proposals are carried through, adds an “In Remission” specifier — which means there is no way to exit the diagnosis. Potentially, the now broader diagnosis of Transvestic Disorder could pathologize many who identify as trans, and in fact, many who simply class their gender as being fluid.
So on the one hand, gender dysphoria appears to align DSM-V with current moves to affirm trans identity, but on the other, concerns over Tranvestic Disorder’s broad and damaging nature mean that the good found in this change seems to have been undercut.
With the publication of DSM-5 in May of 2013, we will be able to gauge exactly what good and what ill has come out of this major revision.
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