Wednesday, February 10, 2010

A First Look At The DSM V Proposals

The American Psychiatric Association has released the proposals for the DSM V revisions for review and comment today.

There has been considerable concern voiced within the transgender community around both who has been involved in the Sexual and Gender Identity Disorders working groups and some of the pet theories that some of those people may have tried to insert into the DSM V.

I'm very pleased to note that those fears seem to have been allayed in the committee process. Nowhere in there did I find the language of 'Autogynephilia', and in the revisions proposed for Gender Identity Disorder - in fact in this paper by Peggy Cohen-Kettenis, it seems fairly clear why the language of Autogynephilia wasn't adopted.

Overall, I like the proposed changes. They head in the direction of supporting the notion of gender as a spectrum rather than hard categories. Some of Kelly Winters' advocacy for "an exit clause" has also been adopted. Also, a clearer approach to dealing with cases where Gender Identity issues intersect with Intersex conditions has been added.

The term 'Gender Identity Disorder' is to be replaced with 'Gender Incongruity' - an interesting change that addresses the stigmatization criticism that has been levelled at the old terminology.

302.6 Gender Identity Disorder in Children
302.85 Gender Identity Disorder in Adolescents or Adults
302.6 Gender Identity Disorder Not Otherwise Specified

*Note: The really interesting discussions are in the Rationale tabs, which discusses the implications of the changes proposed, as well as what is still under discussion.

**Note: There is still an ongoing discussion as to whether the Gender Incongruity section should remain in the same section of the DSM as the various sexual paraphilias.

Given much of the uproar in the transgender community over the involvement of Blanchard and Zucker in particular on the overarching committee, I think that a collective sigh of relief is in order. It appears that the "pet theories" that both men are associated with that so many find deeply offensive have not been railroaded into place, and in fact the collective wisdom of all the participants has prevailed.

6 comments:

Susanna Boudrie said...

he wording of DSM for is less bad than expected for those diagnosed as transsexuals (Gender Incongruence). But it should not be in DSM at all!

And observe that the the wording is criminal for intersexuals. They have accepted Dreger’s Disorder of Sexual Development!

And the have also open a whole maze of diagnosis with which they can classify people OTHER than transsexuals! As transsexualism is still in the diagnostic manual it is the psychiatrist that have to diagnose you as transsexual, but hi can chose to diagnose you as transvestic fetishist (Blanchard) or Hypersexual Disorder (Kafka). The later means for example that the churches old characterization of masturbation as a sin now is a psychiatric disorder. Transsexualism and Intersexualism must out of DSM!

Susanna Boudrie

Jennifer McCreath said...

autogenephilia has just been replaced with the wording 'transvestic fetish' this is equally as stupid. suggesting that lesbian transwomen are only just men with a fetish would be no different than suggesting that gay cis people are just straight cis people with a fetish. it is a completely ridiculous theory. and the idea that this only applies to lesbian transwomen, but not gay transmen, is also very contradictory. and to continue to link transsexualism with section 302 - the paraphilias, is also completely out of line. the DSM-V is complete rubbish!

MgS said...

@Susanna:

(1) Actually, the DSD subclauses always existed - they were just under the GID Not Otherwise Specified category under the DSM IV.

The proposals have moved them into the primary diagnostic categories and removed the exclusion for people with Intersex conditions.

Since there are a percentage of Intersex people who feel that they were wrongly assigned a gender role as children, this is quite appropriate since these individuals will face many of the same challenges that a transsexual faces as they transition into their chosen gender role.

(2) I disagree with your analysis that the proposed Hypersexual diagnosis could be used with respect to transsexuals - there does not appear to be any significant overlap between HSD and GI diagnostic criteria.

(3) The Transvestic Fetishism diagnosis has always been troubling for transsexuals and other GI clients since it tries to isolate a particular subgroup of cross-gender behaviour. The studies I am familiar with suggest that while there are a few TF types out there, most have significant degrees of non-sexually stimulated GI as well.

(4) Superficially, I would agree that at first blush, the categorization continues the 'masturbation is evil' assumption. However, on closer inspection, it is important to note that the exclusion of sexual arousal while cross-dressed has been removed from the language for GI.

(5) Because of the intersection between the social adjustments that gender transition often means and the involvement of multiple medical professions in the treatment of transsexuals, I don't think that it is likely that transsexuals will be removed from the DSM any time soon - if ever.

Whether or not we like it, the treatment professionals involved remain very cautious and insist upon verification of expressed symptoms from experts in domains that the individual professional may not be qualified to make diagnosis.

(6) The Intersex aren't per se in the DSM, except as a somewhat specialized identifier that to some extent modifies the experience of gender. I won't say I'm terribly comfortable with the terminology either - I would have preferred it to stay with the term 'Intersex'. However, the rationale narrative is unclear on the reasons for this change in terminology.

MgS said...

Jennifer:

The Transvestic Fetishism diagnosis has had some wording related to Autogynephilia added to its narrative.

I agree that this doesn't make a lot of good sense, and because it is apparently entirely derived from work by Blanchard, I don't think it is as broadly substantiated as I would like to see. However, the diagnostic criteria for TF are quite distinct from GI - as much as Blanchard might like to have TF/AG replace GI, I don't think this is likely to ever happen.

I note that in the Rationale for the GI diagnosis, there are still discussions ongoing around moving GI into another chapter of the DSM. I'm hopeful that this will yet come to pass.

Mis said...

302.85 has a newly introduced concept "Assigned Gender". This is not explained and is not simple. Except for non-transsexual non-intersex people.

It is not even clear whether the ambiguity is unintentional, uninformed, callously uncaring, due to lack of awareness of other cultures, intended to give practitioners unlimited discretionary power or simply invidious.

MgS said...

@Mis:

I suggest you spend some time reading the following end notes in the Rationale section:

Endnote 1
Endnote 2
Endnote 14
Endnote 16

I think you will find that it addresses your expressed concerns regarding the use of the term 'assigned gender'.