Hope and Hurt for Trans Americans in the APA’s Proposed DSM Revisions

On Monday, the National Gay and Lesbian Task Force praised the American Psychiatric Association’s (APA) favoring of “gender incongruence” and refutation of “gender identity disorder” (GID) as part of its suggested revisions to the upcoming 5th edition of the Diagnostic Statistical Manual (DSM), a text that is used by clinicians and psychiatrists to diagnose psychiatric illnesses. However, the Task Force notes that there is much work to be done on the problematic diagnostic criteria that still mislabels many trans and gender variant people as having a mental disorder.

From the press release:
 

WASHINGTON, April 12 — The National Gay and Lesbian Task Force today affirmed the American Psychiatric Association’s (APA) refutation of “gender identity disorder” in favor of “gender incongruence,” but calls for the removal of “transvestic disorder” and expresses concerns about other proposed revisions to the upcoming 5th edition of the APA’s Diagnostic and Statistical Manual (DSM).

“We see this revision as an evolutionary step toward removal of all diagnoses related to gender nonconformity in the DSM,” said Jaime Grant, director of the National Gay and Lesbian Task Force’s Policy Institute. “Gender variance is not a psychiatric problem; it’s a natural human variation that in some cases requires medical attention and support.”

The National Gay and Lesbian Task Force released this statement as part of its commentary (linked below) on the latest proposed revisions to the APA’s Diagnostic Statistical Manual.

In their feedback, the Task Force praises the aforementioned shift as being more reflective of current understanding of trans identity and as a move towards “affirming a natural variance in human gender identity”.

However, the Task Force notes that there is still work to be done. Specifically, the Task Force calls for the removal of the defamatory classification of “transvestic disorder” – used to replace “transvestic fetishism” but given the same diagnostic criteria – which singles out transwomen (those that identify female but were birth-assigned male) as essentially being sexually deviant.

It notes that the “very notion that cross-dressing among female-born individuals is never pathological, while cross-dressing among male-born clients has multiple pathological manifestations reeks of a kind of sexism we find astonishing for psychiatry in the 21st century. It is well past time for the removal of disorders associated with disfavored versions of femininity, which call to mind the infamous 19th century diagnosis of ‘hysteria’ in women.”

As such, the Task Force calls for the removal of “transvestic disorder” and its controversial and heavily challenged specifier “autogynophelia.”

The Task Force makes it clear that while the move toward “distress-based” diagnosis in DSM-V should be applauded, strong concerns remain that the guidelines are still vague and that they fundamentally fail to recognize the difference between what is termed “minority stress” – that is to say, the emotional distress that LGBTs face as a marginalized group that is subject to discrimination – and that of stress brought about by “specific gender expression.” The Task Force reiterates a need to make it clear that distress as a result of societal discrimination should not be used as evidence of a mental disorder.

Why are Changes to the DSM Needed?
The blanket categorization of gender variant and trans identity as a disorder creates unnecessary and harmful barriers to surgical and hormonal transition treatments that also reinforces the social stigma that persists surrounding trans issues. The perpetuation of this stigma and the discrimination that many trans patients face in health care is something that the Task Force references in its comments on the proposed DSM-V changes:

Data from the National Gay and Lesbian Task Force/National Center for Transgender Equality’s National Transgender Discrimination Survey compiles questionnaires from 6,500 transgender and gender nonconforming people across the United States. Fifty percent (50%) of our respondents report being forced to educate their medical providers to ensure they received adequate and sensitive care. Nearly half of our sample reports postponing some form of medical care because of the pervasive discrimination they faced at the hands of insensitive or bigoted healthcare providers. Thus, the National Gay and Lesbian Task Force advocates for the full declassification of Gender Incongruence, alongside improvements within the International Classification of Diseases and U.S. health care systems to ensure adequate access for all transgender people seeking medical support to fully embody their gender identity.

The label of mental disorder is also particularly harmful to transitioned individuals who may be happy and functional in every respect following their gender reassignment but are still maligned by the current diagnostic criteria which labels them as having a disorder. This can impact many areas of a trans person’s life, but in particular can be damaging to their career and employment opportunities.

Though seeking to remedy this, the proposed changes to DSM-V, with its good intentioned move from GID to “gender incongruence,” could perpetuate this problem due to ambiguous criterion that also might potentially widen diagnosis to include people that do not even fit the standard definition of gender disphoria. You can learn more about this by going here to read a concise but thorough analysis of the proposed changes as written by Kelley Winters of GID Reform Advocates.

Overall, the proposed revisions show progress toward recognizing transgender and gender variant identity while removing the label of “disorder” and the stigma that comes with it.

That said, these changes add up to only perfunctory alterations that, for LGBT rights advocates, dance around the heart of the issue – namely that gender identity variance is not a pathology. As such, reform advocates will continue to work strongly to push for less ambiguous, less gender binary criteria in the DSM to prevent gender variant persons from being unfairly categorized as having a psychiatric problem when no subjective distress or impaired function is evidenced, and for medical assistance to be refocused from a gatekeeper approach to one of facilitating patient care and support that is outcome orientated.

The release of DSM-V is now scheduled for May, 2013.

To read and make a comment on the DSM revision process, please go to www.dsm5.org by April 20.

You can view the National Gay and Lesbian Task Force’s commentary on DSM-V here which summarizes many of the important positive and negative aspects of the proposed changes in an easily digestible way.

Related Reading:

 


Photo used under the Creative Commons Attribution License, with thanks to brainchildvn.

41 comments

Anna M.
Anna M.7 years ago

...continued

The children are deadly serious and not experimenting. What they wish to do is follow a very well travelled path and it is best done in childhood. The ones doing the experimenting are the psychologists with crazy theories they seek to prove by messing with children's lives.

It has nothing to do with sexual orientation. Gender identity is absolutely independent of sexual orientation; a totally different thing.

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Anna M.
Anna M.7 years ago

the lionheart l.:
> Tough subject more study. My only gripe is; don't bombard
> the children with every irk and quirk, that it means they are
> gay or lesbian. That only adds to their confusion and growing
> pains. Let them enoy their youth free of confusion.

Regrettably you haven't understood a thing. These are children who are very unhappy indeed with having a body that completely conflicts with their needs and feelings. They are not lesbian or gay, and they are not confused, and ignoring it does the opposite of enabling them to enjoy their youth - it causes suicidal isolation and terrible fear of the changes of puberty that will ruin their lives.

You saw the little girl in the video; how can you imagine telling her wait and grow into a man will help her?

> when they
> are older and with more understanding, mature understanding they
> can decide and not experiment with all kinds of sexual stuff not
> healthy for them.

Going through transsexual treatment is not unhealthy. No medical researchers want to be bothered to document it, but the community evidence is that it can lengthen life and reduce ill-health.

> You are only a child once. and if you misuse
> your body in youthful misguided sexual experimentation, it helps
> no one when these kids get sick. They are experimenting at very
> young ages with this sexual orientation issue and we all should
> care about that, whether straight or gay.

Th

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the lionheart l.
.7 years ago

Tough subject more study. My only gripe is; don't bombard the children with every irk and quirk, that it means they are gay or lesbian. That only adds to their confusion and growing pains. Let them enoy their youth free of confusion. when they are older and with more understanding, mature understanding they can decide and not experiment with all kinds of sexual stuff not healthy for them. You are only a child once. and if you misuse your body in youthful misguided sexual experimentation, it helps no one when these kids get sick. They are experimenting at very young ages with this sexual orientation issue and we all should care about that, whether straight or gay.

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Ambrose Merly
Past Member 7 years ago

nice article, great comments.

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Henry Hall
Henry Hall7 years ago

In a nutshell, it is both immoral and unethical to diagnose people who are not mentally ill with a psycho-pathology. Even if it does "facilitate treatment".

Shame on the NGLTF for endorsing the APA's cynical shell game of "Change the name".

It's only a game to the psychologists, not to those whose lives they routinely destroy. They do it with the best of intentions of course, for the road to hell is paved with good intentions and if there is a hell then the GID workgroup members will surely be burning there for eternity.

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 .
.7 years ago

THANKS!

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Anna M.
Anna M.7 years ago

Kindly as this article is, it misses the big point, which is that the changes officially proposed to the DSM on gender identity - and strangely welcomed by the NGLTF, focus the mental illness diagnosis on those who need to change their body, especially with children. Those others currently swept into the stigmatising diagnosis by the current wording will be excused. And yet it is clear that those they intend to continue stigmatising suffer a neurological difference and exhibit none of the usual signs of mental illness, and cannot be "cured" by any treatments that work on mental disorders. When it is applied to children is has long been described as "child abuse".

Unfortunately the chairman of the committee that drew up the official proposals for the American Psychiatric Association has made his entire career in trying to change the gender of such children, with no success (he blames the children and the parents), but intends to continue, and needs them to be classed as mentally ill to allow that. He believes adults could have been "cured" if they had gone to him as children, and co-operated.

Oh, and it isn't only Americans who will be affect, because the manual is copied directly into the UN World Health Organisation International Classification of Disease (ICD) and applied in every country, worldwide.

More...

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Anna M.
Anna M.7 years ago

...Continued

Should you support the call for Gender Incongruity (transsexualism) to be removed completely from the DSM in this revision? I suggest the following is an excellent acid test, stripped of all the prejudices associated with people who suffer the side effects of having gone through the wrong puberty, etc.. Watch this video http://www.youtube.com/watch?v=Qdpad6dtO0Q. If you think the child is a happy little girl you should support removal from the DSM, because right now they would class her as suffering the mental disorder 'Gender Identity Disorder of Childhood', and would, at best, instead of helping her go through puberty and adolescence, and grow up with the other girls her age, with her friends, intend to put her on drugs that will hold he as something like pre-pubertal right through to 16, so they don't have the responsibility of helping her be as she feels she should be, and has always felt. And the only reason they would cause that delay is because she is classed as mentally ill.

See http://sixtyminutes.ninemsn.com.au/stories/858237/my-secret-self if you want to know more about her case.

If you agree about that child, then think about the adults who would have been like that child, years ago, if they, their parents, and their doctors, and wider society had been properly informed - a process that has been greatly hindered by the mental illness diagnosis.

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Vallee Rose
Vallee R7 years ago

Being VERY familiar with the DSM and mental disorders, this is a complicated issue. Personally, people can do what they want. I do believe though that for most individuals previously diagnosed under these terms being discussed, that they do have issues to deal with and a therapist can help. But they aren't necessarily considered to be mental illness issues unless there is clinical depression or something like that. We all need counselors or friends or someone usually when major things in our lives change. Bt just being a transvestite, etc. doesn't make one mentally ill.

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Josephine T.
Josephine T7 years ago

Susan, I too was pegged as "weird" in school - I was thin, small-boned, and just not "a guy". Took me until I was 31 before I learned why. By that time, I'd been in the Army, which "bulked me up".

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