Gender Identity Disorder


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

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I posted in February about how the committee that is redesigning the DSM is accepting feedback on their proposed changes. The Diagnostic and Statistical Manual of Mental Disorders is the book used around the world by clinicians to determine what kinds of human suffering count as mental disorders, what symptoms one has to show to qualify as having one of those disorders, and what what can get covered by insurance. The content of this book will shape the lives of those who will interact with the mental health system for the next generation. Being labeled with a mental disorder is a big deal, and which one you get can mean the difference between decent and indecent treatment. Personality Disorder? You’re pretty much screwed. Very few people think they can help you and no insurance will cover you. Adjustment Disorder? PTSD? You’re in luck, most likely. We’re all very hopeful for, and will pay for, your recovery.

If you’re life has in any way been affected by anything labeled a mental disorder, I encourage you to look at the appropriate proposed changes to your future and the future of your loved ones, and write them an email about what you think. You have until April 20, 2010.

Structural, Cross-Cutting, and General Classification Issues for DSM-5
Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence
Delirium, Dementia, Amnestic, and Other Cognitive Disorders
Mental Disorders Due to a General Medical Condition Not Elsewhere Classified
Substance-Related Disorders
Schizophrenia and Other Psychotic Disorders
Mood Disorders
Anxiety Disorders
Somatoform Disorders
Factitious Disorders
Dissociative Disorders
Sexual and Gender Identity Disorders
Eating Disorders
Sleep Disorders
Impulse-Control Disorders Not Elsewhere Classified
Adjustment Disorders
Personality Disorders
Other Conditions that May Be the Focus of Clinical Attention

The Diagnostic and Statistical Manual of Mental Disorders is revised every decade or so, and a revision is under way right now. Up until recently, there has been criticism that the proceedings were taking place in secret. This is not unusual, as I understand it, but it is significant for many people. Mental-health clinicians, for example, have to use the diagnostic categories in the DSM to label their clients, and if the categories and descriptions listed don’t coincide with their experiences or beliefs, this can be quite difficult. It is significant for mental-health clients, too, for complementary and even more personal reasons. What will happen to your diagnosis? In? Out? Changed? These decisions have a big impact on social issues, like stigma, and economic issues, like what insurance companies will pay for.

The DSM committee is proposing, for example, to subsume the diagnosis of Asperger’s Disorder into Autism Disorder. This seems to make a lot of sense, unless you or your child is benefiting from the existence of Asperger’s because of insurance company rules, state regulations, or other regulatory factors.

The content of the DSM is important to people for political reasons, too. For example, the third revision of the DSM eliminated homosexuality as a mental disorder. That was in 1973, for the DSM-III. (We’ve since had the DSM-III-R, DSM-IV, and DSM-IV-TR. They are currently working on the DSM-V.) It may be hard to believe that being gay was an official Mental Disorder, but it was. People were even lobotomized for it: Here, let me “help” you with that unnatural sexual attraction by forcing an icepick in over one of your eyes, through your skull, to twist it in your brain. The removal of homosexuality from the DSM was very controversial in its day, but no one credible is fighting for it to go back in.

That is to say, the DSM can reflect the changing mores of society, which in turn influences the way society sees mental health and illness. This process can effect the quality of a lot of our lives. And now the DSM committee has revealed the changes they are contemplating and is asking for feedback. This is from their website:

“Your input, whether you are a clinician, a researcher, an administrator, or a person/family member affected by a mental disorder, is important to us.  We thank you for taking part in this historic process and look forward to receiving your feedback.”

You almost certainly fall into one of those categories. Take part in this opportunity! Of course, our input being “important” to them does not mean they will pay attention to it, but it can’t hurt to try. The worst that can happen is that you will be better informed about your mental-health system. Here are the categories that they are considering changes in. Click on them to read the proposed changes. To submit feedback, you have to register with them, but it only takes a minute:

Structural, Cross-Cutting, and General Classification Issues for DSM-5
Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence
Delirium, Dementia, Amnestic, and Other Cognitive Disorders
Mental Disorders Due to a General Medical Condition Not Elsewhere Classified
Substance-Related Disorders
Schizophrenia and Other Psychotic Disorders
Mood Disorders
Anxiety Disorders
Somatoform Disorders
Factitious Disorders
Dissociative Disorders
Sexual and Gender Identity Disorders
Eating Disorders
Sleep Disorders
Impulse-Control Disorders Not Elsewhere Classified
Adjustment Disorders
Personality Disorders
Other Conditions that May Be the Focus of Clinical Attention