Archives of Sexual Behavior

, Volume 39, Issue 2, pp 499–513 | Cite as

The DSM Diagnostic Criteria for Gender Identity Disorder in Adolescents and Adults

  • Peggy T. Cohen-KettenisEmail author
  • Friedemann Pfäfflin
Original Paper


Apart from some general issues related to the Gender Identity Disorder (GID) diagnosis, such as whether it should stay in the DSM-V or not, a number of problems specifically relate to the current criteria of the GID diagnosis for adolescents and adults. These problems concern the confusion caused by similarities and differences of the terms transsexualism and GID, the inability of the current criteria to capture the whole spectrum of gender variance phenomena, the potential risk of unnecessary physically invasive examinations to rule out intersex conditions (disorders of sex development), the necessity of the D criterion (distress and impairment), and the fact that the diagnosis still applies to those who already had hormonal and surgical treatment. If the diagnosis should not be deleted from the DSM, most of the criticism could be addressed in the DSM-V if the diagnosis would be renamed, the criteria would be adjusted in wording, and made more stringent. However, this would imply that the diagnosis would still be dichotomous and similar to earlier DSM versions. Another option is to follow a more dimensional approach, allowing for different degrees of gender dysphoria depending on the number of indicators. Considering the strong resistance against sexuality related specifiers, and the relative difficulty assessing sexual orientation in individuals pursuing hormonal and surgical interventions to change physical sex characteristics, it should be investigated whether other potentially relevant specifiers (e.g., onset age) are more appropriate.


Gender identity disorder Transsexualism Gender dysphoria DSM-V 



The authors are members of the DSM-V Workgroup on Sexual and Gender Identity Disorders (Chair, Kenneth J. Zucker, Ph.D.). We thank the other members of the Gender Identity Disorders Subworkgroup (Jack Drescher and Heino F. L. Meyer-Bahlburg) Kenneth J. Zucker, and two Work Group Advisors (Esther Gómez-Gil and Stephen B. Levine) for their valuable contributions to this article. The article also benefited from the discussions at the symposium of the American Psychiatric Association “In or Out?: A Discussion about Gender Identity Diagnoses and the DSM,” San Francisco, May 2009; and WPATH’s symposium “WPATH’s Consensus Statement on Gender Dysphoria and the DSM-V,” Oslo, Norway, June 2009. Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders V Workgroup Reports (Copyright 2009), American Psychiatric Association.


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Copyright information

© American Psychiatric Association 2009

Authors and Affiliations

  • Peggy T. Cohen-Kettenis
    • 1
    Email author
  • Friedemann Pfäfflin
    • 2
  1. 1.Department of Medical PsychologyVU University Medical CenterAmsterdamThe Netherlands
  2. 2.Department of Psychosomatic Medicine and PsychotherapyUniversity of UlmUlmGermany

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