Transgender no longer a ‘disorder’ in US psychiatry manual
The manual used by US psychiatrists to diagnose mental illness no longer lists transgender as a ‘disorder’.
For 20 years the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association (APA) included transgender people under “gender identity disorder”.
However, DSM-5 to be released in May 2013, cites transgender people as having “gender dysphoria” – emotional stress related to gender identity.
APA member Jack Drescher told The Advocate that all psychiatric diagnoses are culturally determined.
“We know there is a whole community of people out there who are not seeking medical attention and live between the two binary categories,” Drescher said.
“We wanted to send the message that the therapist’s job isn’t to pathologize.”
However, some trans advocates in the US are concerned that DSM-5 will affect medical insurance for those who want to medically transition.
The classification of transgender as a mental disorder has been used to prove that being transgender is a psychological problem that can be treated.
Insurance companies justify gender reassignment surgery and hormone treatment on the basis that a “disorder” requires medical treatment.
Sally Goldner, spokesperson for TransGender Victoria, said DSM-5 was “a step in the right direction”.
She said other conditions were not labelled “disorders” but were still covered by insurers.
“We would certainly take the viewpoint that, whatever the name, ultimately we need to be out of the DSM altogether,” Goldner told GNN.
“While never having read the DSM, I often wonder how much of it needs to be there at all – it seems very judgemental and unless someone is at risk of major harm to themselves or others, is it a problem?”
According to the DSM-4, diagnosis for gender identity disorder only applies if the individual demonstrates “significant distress or impairment in social, occupational, or other important areas of functioning.”
In DSM-5, gender dysphoria expands this criterion to include “or with a significantly increased risk of suffering, such as distress or disability.”
Critics point out that the use of the term “distress” implies a struggle to achieve comfort, rather than a pathology, and so the diagnosis does not belong in a manual alongside 'disorders'.
The Gay and Lesbian Alliance Against Defamation (GLAAD) said the media should make note of the historic change, “and acknowledge that ‘Gender Identity Disorder’ (GID) – as well as the idea that trans people are automatically ‘disordered’ – are now antiquated ideas among healthcare professionals.”
The DSM dropped homosexuality from its list of mental illnesses in 1973.