Tuesday, December 4, 2012

Born This Way - Being Trans Is Not a Mental Disorder

Finally, after decades of effort, the APA has changed the status of transgender from a disorder (Gender Identity Disorder) to gender dysphoria, a more neutral designation that does not imply mental illness. This is great news for all of the trans folk carrying the GID diagnosis, and it's progress toward accepting that transgender is real, that human beings are not confined to an either/or gender binary.

First up a report from Slate on the change from the APA which will be official with the May 2013 publication of the DSM-5. Them, from All in the Mind, a podcast on transgender identity.

Being Transgender Is No Longer a Disorder

The American Psychiatric Association salutes the T in LGBT. 

A transsexual person displays a poster with the picture of a transsexual person who was murdered.
A transsexual person displays a poster with the picture of a transsexual person who was murdered in Uruguay. In May 2013, gender identity disorder will be replaced with the more neutral term gender dysphoria.

The Associated Press reported that the American Psychiatric Association’s Board of Trustees approved certain notable changes to that body’s Diagnostic and Statistical Manual of Mental Disorders on Saturday. The story began with the controversial announcement that Asperger’s syndrome will now be included in the autism spectrum disorder category, but another change buried at the bottom of the piece may prove to be even more divisive—and, if historical precedent is any indication, more influential on society at large.

Since the third edition of the DSM was published in 1980, some version of the diagnosis gender identity disorder has been included to describe patients whose subjective experience of gender does not match their biological sex. The common contemporary term for this group is transgender, the T in LGBT. Sources within the APA now confirm that in the DSM-5, which is due to be published in May 2013, GID will be replaced with the more neutral term gender dysphoria.

Approval of this revision has been years in the making and reflects a narrowing of psychiatrists’ focus to those who experience personal distress over their gender incongruity. Those patients who feel like they need psychological help dealing with their feelings can still seek it out, while those who feel fine need not be marked as ill.

Jack Dresher, a member of the APA group dedicated to considering this issue, explained to the Daily Beast back in 2010 that his subcommittee’s recommendation came from a desire to stop “pathologiz[ing] all expressions of gender variance just because they were not common or made someone uncomfortable.” Moreover, in a recent interview in the Advocate, Dresher acknowledged that “all psychiatric diagnoses occur within a cultural context,” adding that “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.”

As any student of the history of LGBT civil rights can attest, being deemed pathological by the medical establishment is considered to be one of the biggest obstacles to social and legal progress. Indeed, the removal of homosexuality from the DSM in 1973 was a watershed moment for the early gay-rights movement, as it neutralized the argument that gay men and women did not deserve equal treatment because they were somehow sick. Unsurprisingly, many in the transgender community see the label “disorder” as having a similarly restrictive effect on their fight against discrimination. But leaving the fraught term behind may bring some harm along with the good.

As Dresher points out in his thorough analysis (PDF) of the parallels and contrasts between the gay and trans campaigns to escape the bonds of medical judgment, one important difference is the desire of many (but not all) transgender people for hormonal or surgical intervention to better align their bodies with their internal identity. Currently, insurance coverage for these procedures can be justified on the grounds that GID is a medical problem—a disorder—needing treatment. Without that argument, some transgender people—a group that already suffers from a great deal of social and economic marginalization—may now find it more difficult to finance their transitions.

For those gender-variant individuals who do choose to seek treatment, the APA practitioners may soon be prepared to offer more organized care. While Dresher and his subcommittee were debating the differences between disorder and dysphoria, another APA group, called the APA Task Force on Treatment of GID, was busy deciding if enough empirical and clinical data existed to justify the creation of a standard set of “APA Practice Guidelines” for treatment. According to a report published over the summer, the answer was a strong yes. If the APA agrees with the recommendations, guidelines could soon be established for adults, adolescents, and even children. The task force additionally recommended that the APA begin making position statements supporting the “rights of persons of any age who are gender variant, transgender, or transsexual.”
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Born this way: gender identity

Broadcast: Sunday 11 November 2012
For some people the sex they are born with doesn’t correspond to the way they feel. 

Researchers now know there are areas of the brain that differ among men and women and those who are transgender, and new psychiatric guidelines in the upcoming DSM V, due out in May 2013, are expected to acknowledge that.

We hear the moving stories of Craig Andrews and Julie Peters and how their transition to the opposite sex has improved their mental well-being.

Julie Peters: from childhood to now



  • Julie Peters: Born male, lives as a woman. Doctoral candidate in the school of health and social development at Deakin University
  • Craig Andrews: Born female, now lives as a man. Co-ordinator of the FTM Australia network
  • Dr Fintan Harte: Psychiatrist, Head of the Southern Health Gender Dysphoria Clinic Monash University, Melbourne
  • Professor Milton Diamond: Researcher in sexual development and identity, School of Medicine, University of Hawaii 


Presenter: Lynne Malcolm

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