Gender Dysphoria Will Replace Gender Identity Disorder in New DSM

by Shoshana Tell

On December 1, 2012, the American Psychiatric Association’s (APA) Board of Trustees decided to replace the term gender identity disorder (GID) with gender dysphoria in the new DSM-5, expected to be released in May 2013. Since the DSM-III in 1980, GID has been used to refer to patients whose gender identity does not correspond to their biological sex (i.e. transgendered persons). The new term, gender dysphoria, includes only individuals who feel distressed over the lack of concordance between their gender identity and sex.  In this way, the APA is saying that being transgender in itself is not a disorder. [1]

Jack Drescher, a psychiatrist in the APA subcommittee that evaluated this issue, explained that this change stems from the imperative to stop “pathologiz[ing] all expressions of gender variance just because they were not common or made someone uncomfortable.” [1] In a later interview, Drescher reiterated, “We know there is a whole community of people out there who are not seeking medical attention and live between the two binary categories. We wanted to send the message that the therapist’s job isn’t to pathologize.” [1]

This shift in transgender terminology is reminiscent of the 1973 removal of homosexuality as a mental illness from the DSM. The DSM-II instead included “sexual orientation disturbance,” [2] a disorder which only applied to patients distressed by or conflicted by their homosexuality.  [2]

However, some argue that the removal of GID may in fact harm the transgender community. Many, but not all, transgender individuals pursue hormone treatments and surgery to align their internal gender identity with their physical appearance. Some worry that removing GID as a psychiatric disorder will make it harder for transgender individuals to obtain insurance coverage for such medical interventions. [1]

Is this DSM change a move forward in destigmatizing natural gender variation, or will it present a pragmatic  obstacle for members of the transgender community in financing a desired gender transition?

References

1. Lowder, J. Bryan. Being Transgender Is No Longer a Disorder. Slate. Access at: http://www.slate.com/articles/health_and_science/medical_examiner/2012/12/dsm_revision_and_sexual_identity_gender_identity_disorder_replaced_by_gender.html
2. Drescher, J. Ethical Issues in Treating Gay and Lesbian Patients. Psychiatric Clinics of North America 2002 Sep; 25(3):605-621.

Shoshana Tell is a second year medical student at the Albert Einstein College of Medicine and an EJBM Contributing Editor.

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