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.


Related Reading:

Will New Diagnostic Criteria End the “Autism Epidemic”?

Did the DSM Create an Epidemic of Asperger’s?

The DSM Gets an Upgrade

Image credit: Thinkstock.

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Kevin Brown
Kevin Brown4 months ago

I have long believed that the "Gender Identity Disorder" diagnosis was simply outdated and somewhat bigoted.

Elizabeth Brawn
Elizabeth Brawn4 months ago

but small progress is still progess

Elizabeth Brawn
Elizabeth Brawn4 months ago

being trans-gender or trans-sexual is not a mental dis-order it is simply that indivuals state of being, sexually

Katrin M.

As an organization that provides medical and health services to hundreds of transgender patients in New York City, we were relieved to see Gender Identity Disorder eliminated from the DSM. The transgender community faces enough hurdles and hardships - they don't need a fabricated disorder that further stigmatizes them. What the transgender community needs is more support and acceptance. We're now one step closer.

John F.
John F.2 years ago

Let me begin by stating that I don't believe that there is anything more " abnormal " with Transgenderism than there is with Fetishism. And yes, I happen to be a ( Heterosexual Boot ) Fetishist. In fact, some research holds that certain types of Transgenderism are also forms of Fetishism.

However, if Transsexualism is to be removed from the next DSM, then correspondingly, so should Fetishism also be removed.

From Huffpost :

The End of Transgender as a Mental Illness
by Dana BeyerExecutive Director, Gender Rights Maryland

"...Now the Board of Trustees of the American Psychiatric Association (APA) has ratified the DSM-5, the fifth edition of what is known colloquially as the "psychiatrists' bible," so as of Dec. 1, trans persons are no longer classified by the medical community as mentally ill..."

All well and good, however if the DSM-5 still classifies Fetishists as " mentally ill ", this is Blatant Discrimination against ALL Fetishists.

Nils Lunde


Beth M.
Beth M.2 years ago

Why doesn't the American Psychiatric Association ask the trans groups their opinions before they (the American Psychiatric Association) make any changes? Guess because it would make sense to ask those who really know the answer.

Danuta Watola
Danuta Watola2 years ago

Interesting article.

Jessica Nielsen
Jessica Nielsen2 years ago

For most people dealing with this issue, it is a disorder, because something happened in the normal course of your life to make you uncomfortable in your body. Most people were not 'born' that way, they were psychologically either conditioned or damaged to feel less than what they are.

For the record, if I could, I would not want to be a woman. But I wouldn't want to be a man either. I really don't identify with either. But God put me in this body because it's how He wanted me to live my life.

Berny p.
Berny p.2 years ago