DSM-V to replace Gender Identity Disorder with Gender Dysphoric Disorder

[CaptainCourtesy]

In May of 2013, the newest edition of the DSM (version V) will be released. The DSM, a manual used by nearly all practitioners of psychiatry and psychology, identifies the criteria needed in order to diagnose a patient. There are several major alterations in the newest version, but changing Gender Identity Disorder to Gender Dysphoric Disorder is amongst the most important. This issue concerns transsexualism, and takes a major step towards de-stigmatizing this issue. The key difference is this: with Gender Identity Disorder, the focus is on the belief that one is another gender. With Gender Dysphoric Disorder, the focus is on the distress one feels about the belief that one is another gender. The ramifications of this are clear. No longer will transsexualism be considered a mental disorder, rather the distress one feels about their gender confusion is what will be treated. The DSM has been going in the direction of focusing more on the distress or problems with functionality one feels or exhibits, rather than focusing on subjective moral/cultural differences since the DSM-III, released back in 1980, a position that I completely agree with.

Now, there will be several reactions to this alteration. Firstly, as I previously mentioned, this will take a first step towards de-stigmatizing transsexuality and placing it as a gender variant, rather than a mental illness. What will be addressed is the distress and difficulty in functioning surrounding the issue, not the issue itself. Already, in California, one can have their license revoked for attempting to use a form of conversion therapy, trying to convert someone who identifies as transsexual (but does not want to change) to someone who is not transsexual.

Secondly, similar to the de-classifying of homosexuality in 1973, this may assist in reducing the discrimination towards transsexual individuals. Calling them mentally ill... something known to be false amongst most of us in the field, is now being officially legitimized.

Thirdly, and this may be a negative. Many trans folks who wanted to get either HRT (hormone-replacement-therapy) or SRS (sex-reassignment-surgery) could use the GID diagnosis as a medical problem in order to get insurance coverage for the expensive treatments. There are concerns that this may no longer occur, however, I disagree. A diagnosis of GDD will still be a medical diagnosis, and the most successful treatment for issues surrounding transsexualism and the distress surrounding it is still forms of HRT and SRS. Obviously some legal and medical snarls will need to be worked out.

Apparently, the APA is also working on a Manual of Treatment Guidelines that will assist practitioners in treating GDD. I believe they are basing it on the Harry Benjamin Standards of Care, something that I have been using for years.

I took a look at the Gender and Sexuality Task Force section of the DSM-V website, and they have been working on this since 2008. They have a lot of research compiled. Seems to me that they approached this similarly to what they did with homosexuality in 1973. Activists had them look at research. They did and came to the conclusion that I have presented. The most compelling research was both and overall alteration in how the DSM approaches mental illness, looking at it more from a functional and distress oriented standpoint, and the fact that specific research indicates that distress and functionality issues in transsexual people are eliminated >97% of the time with HRT and/or SRS. I can think of no other diagnosis the responds that well to a specific type of treatment.

For me, this won't be too much of an alteration, though I will have to change the diagnosis of a client I work with who has this issue. The Standards of Care that I use have professed Gender Dysphoria for years and I have found it to be the most successful form of treatment. What the alteration in diagnosis does is confirm what I and many others have been doing for quite some time, anyway.

Overall, this is very good news.

Here is one article on the topic:

DSM Revision and sexual identity: Gender identity disorder replaced by gender dysphoria. - Slate Magazine

 

[TaraAnne]

I am concerned a little here you refered to the Harry Benjamin Standards of Care which is now know by (Wpath) The World Professional Association for Transgender Health. The new standards of care are in there as well WPATH - World Professional Association for Transgender Health. I even went back and looked at my letters and no where does it say anything about Gender Dysphoric Disorder. However, they do say I am a transexual. I have always felt that the DSM has been way behind the curve on a number of issue. Plus Health Insurance cannot be denied anymore as well it is illegal because of the affordable care act. So transexuals are not in the least bit worried about what Health Insurance companies have to say! I know I am meeting with them today and my HR because they dropped the ball with my transition and did not check on the Health Insurance. I can assure you from my perspective I was never in distress about anything. I always new exactly what I was!

 

[CaptainCourtesy]

I am concerned a little here you refered to the Harry Benjamin Standards of Care which is now know by (Wpath) The World Professional Association for Transgender Health. The new standards of care are in there as well WPATH - World Professional Association for Transgender Health. I even went back and looked at my letters and no where does it say anything about Gender Dysphoric Disorder. However, they do say I am a transexual. I have always felt that the DSM has been way behind the curve on a number of issue. Plus Health Insurance cannot be denied anymore as well it is illegal because of the affordable care act. So transexuals are not in the least bit worried about what Health Insurance companies have to say! I know I am meeting with them today and my HR because they dropped the ball with my transition and did not check on the Health Insurance. I can assure you from my perspective I was never in distress about anything. I always new exactly what I was!

Yes, the Harry Benjamin Standards of Care are now known as The World Professional Association for Transgender Health. The changes are minimal and I have found the that old form works well.

Gender Dysphoric Disorder is not an official diagnosis... yet... and won't be until May of 2013. That's why there is nothing in your paperwork that indicates that.

Insurance is tricky, but if one has documentation both from the PCP and therapist, after a little wrangling, it usually goes through. Knowing insurance companies, they are never willing to pay for anything, and something new will have to be explained to them. My guess is, though, that it will work out in the end.

The distress may not have been how you felt about what you were, but about how you were treated. That's covered too.

 

[Guy Incognito]

It is certainly laudable that the transgendered will no longer be stigmatized as mentally ill. But the effort to redefine the distress of a transgendered individual as a mental illness is absurd. It's just the normal, understandable emotion of distress. This is the pathologizing of basic human emotions. In other words, bunk.

The transgendered are normal people, not mentally ill.

 

[CaptainCourtesy]

It is certainly laudable that the transgendered will no longer be stigmatized as mentally ill. But the effort to redefine the distress of a transgendered individual as a mental illness is absurd. It's just the normal, understandable emotion of distress. This is the pathologizing of basic human emotions. In other words, bunk.

The transgendered are normal people, not mentally ill.

Distress, severe distress can indicate mental illness surrounding something. This eliminates the mental illness stigma associated with being transsexual.

 

[Jredbaron96]

Good. Very Good.

 

[Guy Incognito]

Distress, severe distress can indicate mental illness surrounding something. This eliminates the mental illness stigma associated with being transsexual.

That is a meaningless statement. How is the distress caused by a hang nail any less of a mental illness than distress caused by being transgendered? It is only different in its cause, and so in that way this diagnosis is a useless tautology; it is not parsimonious.

This is the reverse of the scientific method. It is taking a conclusion (the transgendered must be mentally ill, somehow) and working backwards to justify that conclusion. In so doing, normal and understandable human emotion is pathologies unnecessarily.

 

[RepublicanMcDuc]

That is a meaningless statement. How is the distress caused by a hang nail any less of a mental illness than distress caused by being transgendered? It is only different in its cause, and so in that way this diagnosis is a useless tautology; it is not parsimonious.

This is the reverse of the scientific method. It is taking a conclusion (the transgendered must be mentally ill, somehow) and working backwards to justify that conclusion. In so doing, normal and understandable human emotion is pathologies unnecessarily.

There is a difference in type, severity,and how it affects a person's ability to function. Furthermore, a person physically treating the hang nail one time is likely to have solved the problem. If, however, other issues arise as a result or are exacerbated by the existence of the hang nail, then that is a different matter.

 

[tessaesque]

There is a difference in type, severity,and how it affects a person's ability to function. Furthermore, a person physically treating the hang nail one time is likely to have solved the problem. If, however, other issues arise as a result or are exacerbated by the existence of the hang nail, then that is a different matter.

I'm actually surprised anybody would have to explain this...but kudos to you and CC.

 

[Guy Incognito]

There is a difference in severity and how it affects a person's ability to function.

Sure, so why make a special category for distress that arises from being transgendered? There is nothing about being transgendered in and of itself. Why categorize the distress that some experience because society is intolerant of the transgendered? It is not parsimonious.

It is perfectly reasonable to be distressed because you live in a society that treats you with intolerance because of the fact that your gender is not the normal gender associated with your biological sex. I would think the opposite, it would be quite unusual to not experience distress under those circumstance. Feelings of distress among the transgendered are very sane; it's a normal human reaction and should not be pathologized.

 

[tessaesque]

This lends to an idea I've had for quite some time: Those suffering societal stigmas thrust upon them by ignorance, fear, or indoctrination may need help addressing the duress those stigmas create. Simply being "different" does not necessarily cause you harm, but the reaction of others to your differences can significantly damage your ability to cope.

I've always felt that part of the "mental illness" aspect of homosexuality and transgenderism is the constant barrage of "you're wrong/sick/disturbed" messages that society doles out. When your family and cultural environment assure you that something must be wrong with you then you begin to believe the message. I like that this change to the DSM seems to address the effects of the message.

 

[Guy Incognito]

This lends to an idea I've had for quite some time: Those suffering societal stigmas thrust upon them by ignorance, fear, or indoctrination may need help addressing the duress those stigmas create. Simply being "different" does not necessarily cause you harm, but the reaction of others to your differences can significantly damage your ability to cope.

I've always felt that part of the "mental illness" aspect of homosexuality and transgenderism is the constant barrage of "you're wrong/sick/disturbed" messages that society doles out. When your family and cultural environment assure you that something must be wrong with you then you begin to believe the message. I like that this change to the DSM seems to address the effects of the message.

How unscientific of you. It is lovely that the new edition DSM is slightly less bigoted towards the transgendered than the previous version, but "gender dysphoria disorder" is ad hoc and unnecessary.

 

[tessaesque]

How unscientific of you. It is lovely that the new edition DSM is slightly less bigoted towards the transgendered than the previous version, but "gender dysphoria disorder" is ad hoc and unnecessary.

Says somebody with no expertise in the area.

 

[TaraAnne]

In May of 2013, the newest edition of the DSM (version V) will be released. The DSM, a manual used by nearly all practitioners of psychiatry and psychology, identifies the criteria needed in order to diagnose a patient. There are several major alterations in the newest version, but changing Gender Identity Disorder to Gender Dysphoric Disorder is amongst the most important. This issue concerns transsexualism, and takes a major step towards de-stigmatizing this issue. The key difference is this: with Gender Identity Disorder, the focus is on the belief that one is another gender. With Gender Dysphoric Disorder, the focus is on the distress one feels about the belief that one is another gender. The ramifications of this are clear. No longer will transsexualism be considered a mental disorder, rather the distress one feels about their gender confusion is what will be treated. The DSM has been going in the direction of focusing more on the distress or problems with functionality one feels or exhibits, rather than focusing on subjective moral/cultural differences since the DSM-III, released back in 1980, a position that I completely agree with.

Now, there will be several reactions to this alteration. Firstly, as I previously mentioned, this will take a first step towards de-stigmatizing transsexuality and placing it as a gender variant, rather than a mental illness. What will be addressed is the distress and difficulty in functioning surrounding the issue, not the issue itself. Already, in California, one can have their license revoked for attempting to use a form of conversion therapy, trying to convert someone who identifies as transsexual (but does not want to change) to someone who is not transsexual.

Secondly, similar to the de-classifying of homosexuality in 1973, this may assist in reducing the discrimination towards transsexual individuals. Calling them mentally ill... something known to be false amongst most of us in the field, is now being officially legitimized.

Thirdly, and this may be a negative. Many trans folks who wanted to get either HRT (hormone-replacement-therapy) or SRS (sex-reassignment-surgery) could use the GID diagnosis as a medical problem in order to get insurance coverage for the expensive treatments. There are concerns that this may no longer occur, however, I disagree. A diagnosis of GDD will still be a medical diagnosis, and the most successful treatment for issues surrounding transsexualism and the distress surrounding it is still forms of HRT and SRS. Obviously some legal and medical snarls will need to be worked out.

Apparently, the APA is also working on a Manual of Treatment Guidelines that will assist practitioners in treating GDD. I believe they are basing it on the Harry Benjamin Standards of Care, something that I have been using for years.

I took a look at the Gender and Sexuality Task Force section of the DSM-V website, and they have been working on this since 2008. They have a lot of research compiled. Seems to me that they approached this similarly to what they did with homosexuality in 1973. Activists had them look at research. They did and came to the conclusion that I have presented. The most compelling research was both and overall alteration in how the DSM approaches mental illness, looking at it more from a functional and distress oriented standpoint, and the fact that specific research indicates that distress and functionality issues in transsexual people are eliminated >97% of the time with HRT and/or SRS. I can think of no other diagnosis the responds that well to a specific type of treatment.

For me, this won't be too much of an alteration, though I will have to change the diagnosis of a client I work with who has this issue. The Standards of Care that I use have professed Gender Dysphoria for years and I have found it to be the most successful form of treatment. What the alteration in diagnosis does is confirm what I and many others have been doing for quite some time, anyway.

Overall, this is very good news.

Here is one article on the topic:

DSM Revision and sexual identity: Gender identity disorder replaced by gender dysphoria. - Slate Magazine

Please make sure your patients have continual coverage when it comes to insurance I hit a major snag today that might push back some coverage for two years. I am glad you are using the old standards. The new ones are good but I like the idea of a time line. The new ones allow the patient and therapist to develop their own . My two therapist love it but I spoke them about my concerns as well. I have two my primary asked me to work with a new therapist that was new to Gender Identity and wanted to expand her practice. I cannot complain and it is amazing the relationship we have developed. You are doing amazing work keep doing it you are making a differeance!

 

[Guy Incognito]

Says somebody with no expertise in the area.

That is false.

 

[CaptainCourtesy]

That is a meaningless statement. How is the distress caused by a hang nail any less of a mental illness than distress caused by being transgendered? It is only different in its cause, and so in that way this diagnosis is a useless tautology; it is not parsimonious.

That's easy. By the functional problems that are caused.

This is the reverse of the scientific method. It is taking a conclusion (the transgendered must be mentally ill, somehow) and working backwards to justify that conclusion. In so doing, normal and understandable human emotion is pathologies unnecessarily.

This is looking at things in a complete black/white dichotomy. There is no pathologizing of emotions. The distress that these emotions cause, based on levels of functioning, observation, and self-report are what is being assessed.

 

[CaptainCourtesy]

Sure, so why make a special category for distress that arises from being transgendered? There is nothing about being transgendered in and of itself. Why categorize the distress that some experience because society is intolerant of the transgendered? It is not parsimonious.

It is perfectly reasonable to be distressed because you live in a society that treats you with intolerance because of the fact that your gender is not the normal gender associated with your biological sex. I would think the opposite, it would be quite unusual to not experience distress under those circumstance. Feelings of distress among the transgendered are very sane; it's a normal human reaction and should not be pathologized.

You, of course, are completely missing the point. The distress is measured by difficulty in functioning and self-reporting of problems emanating from the distress.

 

[CaptainCourtesy]

How unscientific of you. It is lovely that the new edition DSM is slightly less bigoted towards the transgendered than the previous version, but "gender dysphoria disorder" is ad hoc and unnecessary.

In your opinion. Of course those who have studied the issue. mental illness in general, and overall psychology, disagree with you.

 

[VanceMack]

Sure, so why make a special category for distress that arises from being transgendered? There is nothing about being transgendered in and of itself. Why categorize the distress that some experience because society is intolerant of the transgendered? It is not parsimonious.

It is perfectly reasonable to be distressed because you live in a society that treats you with intolerance because of the fact that your gender is not the normal gender associated with your biological sex. I would think the opposite, it would be quite unusual to not experience distress under those circumstance. Feelings of distress among the transgendered are very sane; it's a normal human reaction and should not be pathologized.

Perhaps because there are plenty of individuals that are NOT happily, healthily, comfortably converted to their transgendered identity and do still suffer from specific mental illnesses that are exacerbated by (if not created by and in some cases VERY MUCH created by) their gender identity.

 

[hikari]

That is a meaningless statement. How is the distress caused by a hang nail any less of a mental illness than distress caused by being transgendered? It is only different in its cause, and so in that way this diagnosis is a useless tautology; it is not parsimonious.

This is the reverse of the scientific method. It is taking a conclusion (the transgendered must be mentally ill, somehow) and working backwards to justify that conclusion. In so doing, normal and understandable human emotion is pathologies unnecessarily.

If having a hangnail were to result in one of the highest rates of self harm of any group of people then maybe this argument makes sense.

I have had many good friends die from suicide, and I know a few who died from illegal sillicone injections. Get back to me when hangnails cause that.

As to the op, I am one of the few transpeople I know that doesnt sign petitions to get the illness language removed. I firmly believe I am not crazy, but the fact is, GID has made an impact on my life in a very negative way, at least as bad as depression would have for example. The treatment I have recieved has finally allowed me to live my life with a glimmer of happiness, and without the illness model I wouldn't have had the funding to get started.

 

[Guy Incognito]

If having a hangnail were to result in one of the highest rates of self harm of any group of people then maybe this argument makes sense.

I have had many good friends die from suicide, and I know a few who died from illegal sillicone injections. Get back to me when hangnails cause that.

You are incredibly emotional, and so it is not surprising to see you be so unscientific.

But let's just try to be rational. I know, that's probably difficult for you, but just try. Really read the garbage you're spewing. You're saying that being transgendered causes distress. Where does this bigotted viewpoint come from? The transgendered are not prone to distress. Being transgendered is not in and of itself going to give rise to distress.

The transgendered are perfectly normal people, despite your insistence that they are crazy. The distress that the transgendered feel is perfectly rational. There is nothing mentally ill about feeling distress when you are being treated like dirt by a small minded society (you know, people like you, who want to call them crazy). Being transgendered is not a mental illness, no matter how much the pseudoscientists writing the new DSM want to continue to slap that label on them.

 

[Guy Incognito]

Perhaps because there are plenty of individuals that are NOT happily, healthily, comfortably converted to their transgendered identity and do still suffer from specific mental illnesses that are exacerbated by (if not created by and in some cases VERY MUCH created by) their gender identity.

No, there has never been a case where being transgendered has caused a person even the slightest distress. Gender is not a source of distress in and of itself. The distress is caused by an external source, always.

This new DSM label continues the worthless and bigotted implication that there is something wrong with being transgendered in itself, and it is unscientific on its face.

I'd support something called "dysphoria disorder," the feeling of distress caused by a society that treats you like dirt for no rational reason. But simply tacking the label "gender dysphoria disorder" adds nothing of value, because it unparsimoniously distinguishes the mental anguish of the transgendered as if it is somehow different from the mental anguish of "normal" people. There is simply no good reason to make that distinction.

 

[hikari]

You are incredibly emotional, and so it is not surprising to see you be so unscientific.

But let's just try to be rational. I know, that's probably difficult for you, but just try. Really read the garbage you're spewing. You're saying that being transgendered causes distress. Where does this bigotted viewpoint come from? The transgendered are not prone to distress. Being transgendered is not in and of itself going to give rise to distress.

The transgendered are perfectly normal people, despite your insistence that they are crazy. The distress that the transgendered feel is perfectly rational. There is nothing mentally ill about feeling distress when you are being treated like dirt by a small minded society (you know, people like you, who want to call them crazy). Being transgendered is not a mental illness, no matter how much the pseudoscientists writing the new DSM want to continue to slap that label on them.

Nice straw man, but I never called transgender people crazy. I am quite sane, but people who are depressed are sane too, they still have a mental condition that deserves treatment, if they so desire. Use of words like crazy is no way to approach a topic like this.

As a transgender person myself I don't how to make this any more clear but, my dysphoria with the parts I was born with give me quite a bit of distress that has nothing to do with the pressures of society. It bothers me, it wouldn't matter if everyone told me it was fine, I am still not fine with the parts I was born with.

If things were as you characterize then there would be no need for wpath, or srs or anything, all people have to do is treat us better and we won't be distressed with our bodies? Have you ever met any transpeople? I wouldn't get flack from society if I didn't have the distress over my gender. If I acted like I was happy with it and never pursued medical transition then I would avoid the scorn of society and be profoundly unhappy with that life.

I suppose you oppose the new rules on bereavement and depression in the DSM V too.

 

[VanceMack]

No, there has never been a case where being transgendered has caused a person even the slightest distress. Gender is not a source of distress in and of itself. The distress is caused by an external source, always.

This new DSM label continues the worthless and bigotted implication that there is something wrong with being transgendered in itself, and it is unscientific on its face.

I'd support something called "dysphoria disorder," the feeling of distress caused by a society that treats you like dirt for no rational reason. But simply tacking the label "gender dysphoria disorder" adds nothing of value, because it unparsimoniously distinguishes the mental anguish of the transgendered as if it is somehow different from the mental anguish of "normal" people. There is simply no good reason to make that distinction.

Ah. I see where your problem is. You actually believe that every transgendered person is actually at peace with their identity.

 

[Omgitsme]

You are incredibly emotional, and so it is not surprising to see you be so unscientific.

But let's just try to be rational. I know, that's probably difficult for you, but just try. Really read the garbage you're spewing. You're saying that being transgendered causes distress. Where does this bigotted viewpoint come from? The transgendered are not prone to distress. Being transgendered is not in and of itself going to give rise to distress.

The transgendered are perfectly normal people, despite your insistence that they are crazy. The distress that the transgendered feel is perfectly rational. There is nothing mentally ill about feeling distress when you are being treated like dirt by a small minded society (you know, people like you, who want to call them crazy). Being transgendered is not a mental illness, no matter how much the pseudoscientists writing the new DSM want to continue to slap that label on them.

Actually being transgendered can cause distress. When you are born into a sex that you dont identify as it can take a mental toll on you and many people who havent started transitioning attempt or commit suicide. Those people havent been exposed to any sort of hatred or bigotry because they are trans. The distress of being one sex while feeling like the other is what drove them to it.

I actually think gender dysphoric disorder more accurately describes my experiences as being trans then gender identity disorder does.