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Gender Dysphoria: Two Steps Forward, One Step Back

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Abstract

The long-awaited DSM-5 has finally been published, generating controversy in many areas, including the revised diagnostic category of Gender Dysphoria. This commentary contextualizes the history and reform of the pathologization of diverse gender identities and expressions, within a larger perspective of examining psychological viewpoints on sexual minority persons, and the problems with continuing to label gender identities and expressions as pathological or disordered.

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Notes

  1. Many are not aware that a residual category for homosexuality remained in the DSM-IV under the category of Sexual Disorders Not Otherwise Specified [NOS]. This category includes three items, the last one was, “Persistent and marked distress about sexual orientation” (DSM-IV-TR. 2000, p. 582); ostensibly this could be used for anyone struggling with sexual orientation, though I suspect it was not often used for heterosexuals struggling with their straightness. This has been removed in the DSM-5.

  2. The phrase “non-transsexual type” referred primarily to male cross-dressers, but in some ways was a foreshadowing of the emergence of diverse gender expressions that might not involve a complete gender transition.

  3. The DSM-5 Field Trials were designed to assess the feasibility, clinical utility, and reliability of the diagnostic criteria by testing it in clinical populations, including mental health clinics, general psychiatry clinics, general medical clinics and solo and small group practices.

References

  • American Medical Association (2008). Resolution 122, removing barriers to care for transgender patients. Chicago, IL: Author. Retrieved on June 16, 2013, from http://www.ama-assn.org/ama1/pub/upload/mm/16/a08_hod_resolutions.pdf.

  • American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders (3rd ed.). Washington, DC: Author.

  • American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders (3rd ed.). Washington, DC: Author.

  • American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: Author.

  • American Psychiatric Association (2008). Statement on Dr. Kenneth Zucker and gender identity disorder. Retrieved on June 16, 2013 from zucker-statement-final-may23-2008apa.

  • American Psychiatric Association (2012). Position statement of access to care for transgender and gender variant individuals. Retrieved on June 16, 2013 from ps2012_transgendercare.

  • American Psychiatric Association (2013). Gender dysphoria: Fact sheet. Retrieved on June 16, 2013, from http://www.psychiatry.org/dsm5.

  • American Psychological Association Task Force on Gender Identity and Gender Variance (2009). Report of the task force on gender identity and gender variance. Washington, DC: Author. Retrieved on June 16, 201,3 from http://www.apa.org/pi/lgbc/policy/transgender.html.

  • Blanchard, R. (2010). The DSM diagnostic criteria for transvestic fetishism. Archives of Sexual Behavior, 39, 363–372.

    Article  PubMed  Google Scholar 

  • Brown, L. (1994). Subversive dialogues: Theory in feminist therapy. New York: Basic Books.

    Google Scholar 

  • Burke, P. (1996). Gender shock: Exploding the myths of male and female. New York: Anchor Books.

    Google Scholar 

  • Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., et al. (2011). Standards of care for the health of transsexual, transgender, and gender nonconforming people, 7th Version. International Journal of Transgenderism, 13, 165–232.

    Article  Google Scholar 

  • DeCuypere, G., Knudson G., & Bockting, W. (2010). Response of the World Professional Association for Transgender Health to the proposed DSM-5 Criteria for Gender Incongruence. Retrieved on June 16, 2013, from http://www.wpath.org/documents/WPATH%20Reaction%20to%20the%20proposed%20 DSM%20-%20Final.pdf.

  • Drescher, J. (2010). Queer diagnoses: Parallels and contrasts in the history of homosexuality, gender variance, and the Diagnostic and Statistical Manual. Archives of Sexual Behavior, 39, 427–460.

    Article  PubMed  Google Scholar 

  • Ehrbar, R. (2010). Lack of consensus on retention or removal of the gender identity disorder diagnosis. International Journal of Transgenderism, 12, 60–74.

    Article  Google Scholar 

  • Ehrbar, R., Winters, K., & Gorton, N. (2009). Revision suggestions for Gender Related Diagnoses in the DSM and ICD. The World Professional Association for Transgender Health (WPATH) 2009 XXI Biennial Symposium, Oslo, Norway. Retrieved on June 16, 2013, from http://www.gidreform.org/wpath2009.

  • Francis, A. (2013). Saving normal: An insider’s revolt against out-of-control psychiatric diagnosis, DSM-5, big pharma, and the medicalization of ordinary life. NY: William Morrow.

    Google Scholar 

  • Green, R. R. (2004). Judd Marmor, M.D. (In Memoriam) (Obituary). Archives of Sexual Behavior, 33, 327–329.

    Article  Google Scholar 

  • Greenberg, G. (2013). The book of woe: The making of DSM and the unmaking of psychiatry. New York: Blue Rider Press.

    Google Scholar 

  • Hegarty, P. (2009). Queerying lesbian and gay psychology’s coming of age: Was history just kid stuff? In M. O’Rourke & N. Giffney (Eds.), The ashgate research companion to queer theory (pp. 514–544). Aldershot, UK: Ashgate.

  • Kitzinger, C. (1993). Teaching psychology of lesbianism: Reviewing the literature. Psychology Teaching Review, 2, 59–61.

    Google Scholar 

  • Lev, A. I. (2004). Transgender emergence: Therapeutic guidelines for working for gender- variant people and their families. New York: Routledge.

    Google Scholar 

  • Lev, A. I. (2005). Disordering gender identity: Gender Identity Disorder in the DSM-IV- TR. The Journal of Psychology and Human Sexuality, 17, 35–69.

    Article  Google Scholar 

  • Lev, A. I., Winters, K., Alie, L., Ansara, Y., Deutsch, M., Dickey, L., et al. (2010). Response to proposed DSM-5 Diagnostic Criteria. Retrieved on June 16, 2013, from http://professionals.gidreform.org.

  • Levy, J., & Koff, B. (2001). “Gay positive” therapy: Is not good enough. In the Family, 7, 9–11.

    Google Scholar 

  • Littrell, J., & Lacasse, J. (2012). Controversies in psychiatry and DSM-5: The relevance for social work. Families in Society, 93, 265–270.

    Article  Google Scholar 

  • Lostracco, M. (2008, May 9). But for today I am a boy. Torontoist. Retrieved on June 16, 2013, from http://torontoist.com/2008/05/but_for_today_i_am_a_boy.

  • Moser, C. (2010). Blanchard’s autogynephilia theory: A critique. Journal of Homosexuality, 57(6), 790–809.

    Article  PubMed  Google Scholar 

  • National Association of Social Workers. (2009). Social work speaks: National association of social workers policy statements, 2009–2012. Washington, DC: NASW Press.

    Google Scholar 

  • National Gay and Lesbian Task Force (2012). Task Force questions critical appointments to APA’s Committee on Sexual and Gender Identity Disorders”. Retrieved on June 16, 2013, from http://thetaskforce.org/press/releases/PR_052808.

  • Oosterhuis, H. (1997). Richard von Krafft-Ebing’s “step-children of nature. Psychiatry and the making of homosexual identity. In V. A. Rosario (Ed.), Science and homosexualities (pp. 67–88). London: Routledge.

    Google Scholar 

  • Plummer, K. (Ed.). (1981). The making of the modern homosexual. London: Hutchinson & Co.

  • Rubin, G. (1984). Thinking sex: Notes for a radical theory of the politics of sexuality. In C. S. Vance (Ed.), Pleasure and danger: Exploring female sexuality (pp. 267–319). Boston: Routledge and Kegan Paul.

    Google Scholar 

  • Society for Humanistic Psychology (2011). Open letter to the DSM-5. Retrieved on June 16, 2013, from http://www.ipetitions.com/petition/dsm5/.

  • Stoller, R. J. (1966). The mother’s contribution to infantile transvestic behavior. International Journal of Psychoanalysis, 47, 384–395.

    PubMed  Google Scholar 

  • Tilsen, J. (2013). Therapeutic conversations with queer youth: Transcending homonormativity and constructing preferred identities. New York: Jason Aronson, Inc.

    Google Scholar 

  • Wilson, K. (1997). Gender as illness: Issues of psychiatric classification. 6th annual ICTLEP transgender law and employment policy conference, Houston Texas. Retrieved on June 16, 2013, from http://www.gidreform.org/kwictl97.html.

  • Winters, K. (2008a). Gender madness in American psychiatry: Essays from the struggle for dignity, text revision. Dillon, CO: GID Reform Advocates.

    Google Scholar 

  • Winters, K. (2008b). Autogynephilia: The infallible derogatory hypothesis, Part 1, GID Reform Advocates. Retrieved June 16, 2013, from http://www.gidreform.org/blog2008Nov10.html.

  • World Professional Association for Transgender Health (2008). Statement of medical necessity. Retrieved on June 16, 2013, from http://www.wpath.org/medical_necessity_statement.cfm.

  • World Professional Association for Transgender Health (2010). Statement urging the de- psychopathologisation of gender variance. Retrieved on June 16, 2013 from, http://www.wpath.org/publications_public_policy.cfm.

  • Wyndzen, M. H. (2003). Autogynephilia and Ray Blanchard’s mis-directed sex-drive model of transsexuality. In All mixed up: A transgendered psychology professor’s perspective on life, the psychology of gender, & “gender identity disorder. Retrieved on June 16, 2013, from http://www.GenderPsychology.org/autogynpehilia/ray_blanchard.

  • Zucker, K. J., & Spitzer, R. L. (2005). Was the Gender Identity Disorder of Childhood diagnosis introduced into DSM-III as a backdoor maneuver to replace homosexuality? A historical note. Journal of Sex and Marital Therapy, 31, 31–42.

    PubMed  Google Scholar 

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Correspondence to Arlene Istar Lev.

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Lev, A.I. Gender Dysphoria: Two Steps Forward, One Step Back. Clin Soc Work J 41, 288–296 (2013). https://doi.org/10.1007/s10615-013-0447-0

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