The existence of Gender Identity Disorder as an official mental disorder is troubling to the trans folks I know. They think of their condition they way most people now think about homosexuality: It’s just another normal way to be a human being that makes people who don’t understand it so afraid that they’ve called it a disorder. Some people are just born into bodies that don’t match their psychological gender.
There are other problems. There is the DSM’s requirement to specify whether the diagnosed individual is attracted to males, females, both, or neither. If homosexuality is not a mental disorder, why should it matter clinically what genders a transsexual is attracted to? Then there’s the fact that GID is in the DSM right next to the sexual disorders like sexual sadism, masochism, and pedophilia. What is the connection?
So in a way, it would be great to get GID removed from the DSM, like homosexuality was in the 1970s. Unfortunately, if GID were not an official mental disorder, insurance companies wouldn’t pay for the expensive surgeries and hormone treatments involved in transitioning. According to my friends, living in a body of the wrong sex is so painful and humiliating that many pre-operation trans folks kill themselves, while suicide is rare for those who do who get the operations. So if you are poor and trans, your life may depend on GID being an official mental disorder.
There may be some changes coming to the diagnosis (see here) in the upcoming DSM-V, and my friends are saying they sound somewhat better. Here’s how they stand right now, in the Diagnostic and Statistical Manual of Mental Disorders IV-TR:
Diagnostic criteria for Gender Identity Disorder
A. A strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex).
In children, the disturbance is manifested by four (or more) of the following:
(1) repeatedly stated desire to be, or insistence that he or she is, the other sex
(2) in boys, preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing
(3) strong and persistent preferences for cross-sex roles in make-believe play or persistent fantasies of being the other sex
(4) intense desire to participate in the stereotypical games and pastimes of the other sex
(5) strong preference for playmates of the other sex
In adolescents and adults, the disturbance is manifested by symptoms such as a stated desire to be the other sex, frequent passing as the other sex, desire to live or be treated as the other sex, or the conviction that he or she has the typical feelings and reactions of the other sex.
B. Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex.
In children, the disturbance is manifested by any of the following: in boys, assertion that his penis or testes are disgusting or will disappear or assertion that it would be better not to have a penis, or aversion toward rough-and-tumble play and rejection of male stereotypical toys, haves, and activities; in girls, rejection of urinating in a sitting position, assertion that she has or will grow a penis, or assertion that she does not want to grow breasts or menstruate, or marked aversion toward normative feminine clothing.
In adolescents and adults, the disturbance is manifested by symptoms such as preoccupation with getting rid of primary and secondary sex characteristics (e.g., request for hormones, surgery, or other procedures to physically alter sexual characteristics to simulate the other sex) or belief that he or she was born the wrong sex.
C. The disturbance is not concurrent with a physical intersex condition.
D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Code based on current age:
302.6 Gender Identity Disorder in Children
302.85 Gender Identity Disorder in Adolescents or Adults
Specify if (for sexually mature individuals):
Sexually Attracted to Males
Sexually Attracted to Females
Sexually Attracted to Both
Sexually Attracted to Neither
Nathen's Miraculous Escape 
August 22, 2010 at 4:50 pm
Definitely a troubling and complicated question. For me, it brings to the forefront the problems the medical industry in the United States faces.
One of the most problematic parts of a socialized healthcare system is the idea that only ‘needed’ things are paid for — this seems obvious, I know — but the effect of this is that someone has to decide what a needed procedure and an unneeded procedure are.
In England’s NHS, that has been a bureaucratic process for transsexual folks. There’s visits with doctors, therapists, a whole panel of people who decide whether or not your identity is strong enough to transition. This puts a whole difficulty out there, because if you’re not feminine enough (Say, you work in construction and enjoy it!), in whatever stereotyped way the board thinks is right, you’ll be denied treatment. Add to this that there are few clinics who deal with this, and you suddenly have an expensive travel problem on top of the already difficult bureaucracy.
In the United States, of course, our healthcare industry is almost entirely privatized, so instead of a gender identity board, the rules are codified into the procedures and policies of insurance companies. They have the financial incentive to say ‘no’ to every procedure they can, and generally calculate the spread cost of their being sued against the cost of providing care, and if they can get away with it, they deny payment.
Some insurance companies have been burned a little, or at least fear being sued enough to provide care — it’s certainly a problem when a patient of yours commits suicide and a court would find that you could have done something about it (Negligence), or even that you acted maliciously and withheld needed care (Gross negligence). Things are starting to change slightly in this way, but not necessarily for the better.
Transsexuality nails this problem squarely in the pain points: It’s an identity, something that is arguably chosen, and therefore okay to deny. However, it does carry a hugely increased risk of suicide and other pathological behavioral problems (unemployment, for one). It’s something that manifests in a statistically disease-like pattern, too, so treating it medically makes sense.
But then there’s the problem of it being listed as a mental, rather than a medical disorder: Because there’s no biological way to determine what someone’s true gender identity is, the current system codifies it as a mental disorder, and only accepts medical treatment as an alleviating relief, rather than as a cure. The implicit notion is that if one could figure out what causes people to identify as a gender that does not match their body, one could ‘cure’ that. But at what point do we want to ‘cure’ people’s identities? This is where the comparison with homosexuality is most poignant.
At what point do we, as a society, pay for the effects of someone’s identity’s interaction with society at large?