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

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Abstract

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.

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Notes

  1. These criteria do not include the subsequent workgroup discussions. They likely do not reflect the final criteria.

  2. For young adolescents, this criterion also refers to anticipated sex characteristics (Winters, 2009).

References

  • American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.

    Google Scholar 

  • American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: Author.

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

  • Ball, J. (1981). Thirty years experience with transsexualism. Australian and New Zealand Journal of Psychiatry, 15, 39–43.

    Article  PubMed  Google Scholar 

  • Benjamin, H. (1966). The transsexual phenomenon: A scientific report on transsexualism and sex conversion in the human male and female. New York: Julian Press.

    Google Scholar 

  • Blanchard, R. (1989). The concept of autogynephilia and the typology of male gender dysphoria. Journal of Nervous and Mental Disease, 177, 616–623.

    PubMed  Google Scholar 

  • Blanchard, R., Clemmensen, L., & Steiner, B. (1987). Heterosexual and homosexual gender dysphoria. Archives of Sexual Behavior, 16, 139–152.

    Article  PubMed  Google Scholar 

  • Bockting, W. O. (2008). Psychotherapy and the real-life experience: From gender dichotomy to gender diversity. Sexologies, 17, 211–224.

    Article  Google Scholar 

  • Bodlund, O., & Kullgren, G. (1996). Transsexualism—general outcome and prognostic factors: A five-year follow-up study of nineteen transsexuals in the process of changing sex. Archives of Sexual Behavior, 25, 303–316.

    Article  PubMed  Google Scholar 

  • Bodlund, O., Kullgren, G., Sundblom, E., & Höjerback, T. (1993). Personality traits and disorders among transsexuals. Acta Psychiatrica Scandinavica, 88, 322–327.

    Article  PubMed  Google Scholar 

  • Bornstein, K. (1994). Gender outlaw: On men, women and the rest of us. London: Routledge.

    Google Scholar 

  • Bower, H. (2001). The gender identity disorder in the DSM-IV classification: A critical evaluation. Australian and New Zealand Journal of Psychiatry, 35, 1–8.

    Article  PubMed  Google Scholar 

  • Bradley, S. J., Blanchard, R., Coates, S., Green, R., Levine, S. B., Meyer-Bahlburg, H. F. L., et al. (1991). Interim report of the DSM-IV Subcommittee on gender identity disorders. Archives of Sexual Behavior, 20, 333–343.

    Article  PubMed  Google Scholar 

  • Buhrich, N., & McConaghy, N. (1978). Two clinically discrete syndromes of transsexualism. British Journal of Psychiatry, 133, 73–76.

    Article  PubMed  Google Scholar 

  • Bullough, V. L. (2007). Legitimizing transsexualism. International Journal of Transgenderism, 10, 3–13.

    Article  Google Scholar 

  • Cohen-Kettenis, P. T., Delemarre-van de Waal, H. A., & Gooren, L. J. G. (2008). The treatment of transsexual adolescents: Changing insights. Journal of Sexual Medicine, 5, 1892–1897.

    Article  PubMed  Google Scholar 

  • Cohen-Kettenis, P. T., & van Goozen, S. H. M. (1997). Sex reassignment of adolescent transsexuals: A follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 263–271.

    Article  PubMed  Google Scholar 

  • Cole, S. S., Denny, D., Eyler, A. E., & Samons, S. L. (2000). Issues of transgender. In L. T. Szuchman & F. Muscarella (Eds.), Psychological perspectives on human sexuality (pp. 149–195). New York: Wiley.

    Google Scholar 

  • Cole, C. M., O’Boyle, M., Emory, L. E., & Meyer, W. J. (1997). Comorbidity of gender dysphoria and other major psychiatric diagnoses. Archives of Sexual Behavior, 26, 13–26.

    Article  PubMed  Google Scholar 

  • Coleman, E. (2009). Towards version 7 of the World Professional Association for Transgender Health’s Standards of Care: An introduction. International Journal of Transgenderism, 11(1), 1–7.

    Article  Google Scholar 

  • Daskalos, C. (1998). Changes in sexual orientation of six heterosexual male-to-female transsexuals. Archives of Sexual Behavior, 27, 605–614.

    Article  PubMed  Google Scholar 

  • De Cuypere, G., Janes, C., & Rubens, R. (1995). Psychosocial functioning of transsexuals in Belgium. Acta Psychiatrica Scandinavica, 91, 180–184.

    Article  PubMed  Google Scholar 

  • De Cuypere, G., T’Sjoen, G., Beerten, R., Selvaggi, G., De Sutter, P., Hoebeke, P., et al. (2005). Sexual and physical health after sex reassignment surgery. Archives of Sexual Behavior, 34, 679–690.

    Article  PubMed  Google Scholar 

  • de Vries, A. L. C., Kreukels, B., Steensma, T. D., Doreleijers, Th. A. H., & Cohen-Kettenis, P. T. (2009). Psychological functioning of adult and adolescent transsexuals: A MMPI-2 and MMPI-A study. Manuscript submitted for publication.

  • Deogracias, J. J., Johnson, L. L., Meyer-Bahlburg, H. F. L., Kessler, S. J., Schober, J. M., & Zucker, K. J. (2007). The Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults. Journal of Sex Research, 44, 370–379.

    PubMed  Google Scholar 

  • Di Ceglie, D., Freedman, D., McPherson, S., & Richardson, P. (2002). Children and adolescents referred to a specialist gender identity development service: Clinical features and demographic characteristics. International Journal of Transgenderism, 6(1), http://www.symposion.com/ijt/ijtvo06no01_01.htm

  • Diamond, L. M. (2000). Sexual identity, attractions, and behavior among adolescent and young sexual-minority women over a two-year period. Developmental Psychology, 36, 241–250.

    Article  PubMed  Google Scholar 

  • Diamond, L. M., & Butterworth, M. (2008). Questioning gender and sexual identity: Dynamic links over time. Sex Roles, 59, 365–376.

    Article  Google Scholar 

  • Drescher, J. (2009). Queer diagnoses: Parallels and contrasts in the history of homosexuality, gender variance, and the Diagnostic and Statistical Manual. Archives of Sexual Behavior, doi:10.1007/s10508-009-9531-5.

  • Drummond, K. D., Bradley, S. J., Peterson-Badali, M., & Zucker, K. J. (2008). A follow-up study of girls with gender identity disorder. Developmental Psychology, 44, 34–45.

    Article  PubMed  Google Scholar 

  • Ekins, R., & King, D. (2006). The transgender phenomenon. London, Thousand Oaks, New Delhi: Sage.

    Google Scholar 

  • Factor, R. J., & Rothblum, E. D. (2007). A study of transgender adults and their non-transgender siblings on demographic characteristics, social support, and experiences of violence. Journal of Lesbian, Gay, Bisexual and Transgender Research, 3, 11–30.

    Google Scholar 

  • Freund, K., Steiner, B., & Chan, S. (1982). Two types of cross-gender identity. Archives of Sexual Behavior, 11, 49–63.

    Article  PubMed  Google Scholar 

  • Gijs, L., & Brewaeys, A. (2007). Surgical treatment of gender dysphoria in adults and adolescents: Recent developments, effectiveness, and challenges. Annual Review of Sex Research, 18, 178–224.

    Google Scholar 

  • Gómez-Gil, E., Trilla, A., Salamero, M., Godás, T., & Valdés, M. (2009). Sociodemographic, clinical, and psychiatric characteristics of transsexuals from Spain. Archives of Sexual Behavior, 38, 378–392.

    Article  PubMed  Google Scholar 

  • Green, R. (1974). Sexual identity conflict in children and adults. New York: Basic Books.

    Google Scholar 

  • Green, R. (1985). Gender identity in childhood and later sexual orientation: Follow-up of 78 males. American Journal of Psychiatry, 142, 339–341.

    PubMed  Google Scholar 

  • Green, R. (1987). The “sissy boy syndrome” and the development of homosexuality. New Haven, CT: Yale University Press.

    Google Scholar 

  • Grossman, A. H., & D’Augelli, A. R. (2007). Transgender youth and life-threatening behaviors. Suicide and Life-Threatening Behavior, 37, 527–537.

    Article  PubMed  Google Scholar 

  • Hage, J. J., & Karim, R. B. (2000). Ought GIDNOS get nought? Treatment options for nontranssexual gender dysphoria. Plastic and Reconstructive Surgery, 105, 1222–1227.

    Article  PubMed  Google Scholar 

  • Hamburger, C., Stürup, G. K., & Dahl-Iversen, E. (1953). Transvestism: Hormonal, psychiatric and surgical treatment. Journal of the American Medical Association, 152, 391–396.

    PubMed  Google Scholar 

  • Haraldsen, I. R., & Dahl, A. A. (2000). Symptom profiles of gender dysphoric patients of transsexual type compared to patients with personality disorders and healthy adults. Acta Psychiatrica Scandinavica, 102, 276–281.

    Article  PubMed  Google Scholar 

  • Hepp, U., Kraemer, B., Schnyder, U., Miller, N., & Delsignore, A. (2005). Psychiatric comorbidity in gender identity disorder. Journal Psychosomatic Research, 58, 259–261.

    Article  Google Scholar 

  • Hertoft, P., & Sörensen, T. (1979). Transsexuality: Some remarks based on clinical experience In: Sex, Hormones and Behavior. Ciba Foundation Symposium, 62, 165–181.

    Google Scholar 

  • Hughes, I. A., Houk, C., Ahmed, S. F., Lee, P. A., & LWPES/ESPE Consensus Group. (2006). Consensus statement on management of intersex disorders. Archives of Disease in Childhood, 91, 554–563.

    Article  PubMed  Google Scholar 

  • Johnson, T. W., Brett, M. A., Roberts, L. F., & Wassersug, R. J. (2007). Eunuchs in contemporary society: Characterizing men who are voluntarily castrated (Part I). Journal of Sexual Medicine, 4, 930–945.

    Article  PubMed  Google Scholar 

  • Helzer, J. E., Kraemer, H. C., & Krueger, R. F. (2006). The feasibility and need for dimensional psychiatric diagnoses. Psychological Medicine, 36, 1671–1680.

    Article  PubMed  Google Scholar 

  • Kuiper, A. J., & Cohen-Kettenis, P. T. (1998). Gender role reversal among postoperative transsexuals. International Journal of Transgenderism, 2, http://www.symposion.com/ijt/ijtc0502.htm.

  • Lawrence, A. A. (1999). [Letter to the Editor]. Archives of Sexual Behavior, 28, 581–583.

    Google Scholar 

  • Lawrence, A. A. (2003). Factors associated with satisfaction or regret following male-to female sex reassignment surgery. Archives of Sexual Behavior, 32, 299–315.

    Article  PubMed  Google Scholar 

  • Lawrence, A. A. (2005). Sexuality before and after male-to-female sex reassignment surgery. Archives of Sexual Behavior, 34, 147–166.

    Article  PubMed  Google Scholar 

  • Lawrence, A. A. (in press). Sexual orientation versus age of onset as specifiers for the diagnosis of gender identity disorder. Archives of Sexual Behavior.

  • Lawrence, A. A., & Bailey, J. M. (2008). Transsexual groups in Veale et al. (2008) are “autogynephilic” and “even more autogynephilic” [Letter to the Editor]. Archives of Sexual Behavior, 38, 173–175.

    Google Scholar 

  • Lee, T. (2001). Trans(re)lations: Lesbian and female-to-male transsexual accounts of identity. Women’s Studies International Forum, 24, 347–357.

    Article  Google Scholar 

  • Lev, A. I. (2007). Transgender communities: Developing identity through connection. In K. J. Bieschke, R. M. Perez, & K. A. Debord (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, bisexual, and transgender clients (2nd ed., pp. 147–175). Washington, DC: American Psychological Association.

    Google Scholar 

  • Lobato, M., Koff, W. J., Manenti, C., da Fonseca Seger, F., Salvador, J., da Graça Fortes, B., et al. (2006). Follow-up of sex reassignment surgery in transsexuals: A Brazilian cohort. Archives of Sexual Behavior, 35, 711–715.

    Article  PubMed  Google Scholar 

  • Lundström, B. (1981). Gender dysphoria. A social-psychiatric folluw-up of 31 cases not accepted for sex reassignment. Hisings Backa: University of Göteborg Press.

    Google Scholar 

  • Mate-Kole, C., Freschi, M., & Robin, A. (1990). A controlled study of psychological and social change after surgical gender reassignment in selected male transsexuals. British Journal of Psychiatry, 157, 261–264.

    Article  PubMed  Google Scholar 

  • Meyer, W., Bockting, W. O., Cohen-Kettenis, P. T., Coleman, E., DiCeglie, D., Devor, H., et al. (2001). Standards of care for gender identity disorders of the Harry Benjamin International Gender Dysphoria Association, Sixth Version. International Journal of Transgenderism, 5, http://www.symposion.com/ijt/soc_2001/index/htm

  • Meyer-Bahlburg, H. F. L. (1994). Intersexuality and the diagnosis of gender identity disorder. Archives of Sexual Behavior, 33, 21–40.

    Article  Google Scholar 

  • Meyer-Bahlburg, H. F. L. (2009). From mental disorder to iatrogenic hypogonadism: Dilemmas in conceptualizing gender identity variants as psychiatric conditions. Archives of Sexual Behavior, doi:10.1007/s10508-009-9532-4.

  • Meyer-Bahlburg, H. F. L. (in press). Variants of gender differentiation in somatic disorders of sex development. International Journal of Transgenderism.

  • Meyerowitz, J. (2002). How sex changed: A history of transsexuality in the United States. Cambridge, MA: Harvard University Press.

    Google Scholar 

  • Miach, P. P., Berah, E. F., Butcher, J. N., & Rouse, S. (2000). Utility of the MMPI-2 in assessing gender dysphoric patients. Journal of Personality Assessment, 75, 268–279.

    Article  PubMed  Google Scholar 

  • Money, J., & Ehrhardt, A. A. (1970). Transsexuelle nach dem Geschlechtswechsel. In G. Schmidt, V. Sigusch, & E. Schorsch (Eds.), Tendenzen der Sexualforschung (pp. 70–87). Stuttgart: Enke.

    Google Scholar 

  • Money, J., & Gaskin, R. J. (1970/1971). Sex reassignment. International Journal of Psychiatry, 9, 249–269.

    Google Scholar 

  • Nuttbrock, L., Hwahng, S., Bockting, W., Rosenblum, A., Mason, M., Macri, M., et al. (2009). Psychiatric impact of gender-related abuse across the life course of male-to-female transgender persons. Journal of Sex Research, doi:10.1080/00224490903062258

  • Ostrow, M. (1953). Transvestism [Letter]. Journal of the American Medical Association, 152, 167.

    Google Scholar 

  • Pauly, I. (1965). Male psychosexual inversion: Transsexualism. Archives of General Psychiatry, 13, 172–181.

    PubMed  Google Scholar 

  • Pfäfflin, F. (2009). Begutachtung des Transsexualismus. In K. Foerster & H. Dressing (Eds.), Psychiatrische Begutachtung (5th ed., pp. 593–607). München: Urban & Fischer.

  • Pfäfflin, F., & Junge, A. (1992). Nachuntersuchungen nach Geschlechtsumwandlung. Eine kommentierte Literaturübersicht 1961–1991. In F. Pfäfflin & A. Junge (Eds.), Geschlechtsumwandlung. Abhandlungen zur Transsexualität (pp. 149–457). Stuttgart: Schattauer.

    Google Scholar 

  • Pfäfflin, F., & Junge, A. (1998). Sex reassignment. International Journal of Transgenderism. http://www.symposion.com/ijt/books/index.htm#Sex%20Reassignment

  • Rakic, Z., Starcevic, V., Maric, J., & Kelin, K. (1996). The outcome of sex reassignment surgery in Belgrade: 32 patients of both sexes. Archives of Sexual Behavior, 25, 515–525.

    Article  PubMed  Google Scholar 

  • Røn, K. (2002). ‘Either/or’ and ‘both/neither’: Discursive tensions in transgender politics. Signs, 27, 501–522.

    Article  Google Scholar 

  • Ross, M., & Need, J. (1989). Effects of adequacy of gender reassignment surgery on psychological adjustment: A follow-up of fourteen male-to-female patients. Archives of Sexual Behavior, 18, 145–153.

    Article  PubMed  Google Scholar 

  • Ryan, C., Huebner, D., Diaz, R. M., & Sanchez, J. (2009). Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics, 123, 346–352.

    Article  PubMed  Google Scholar 

  • Schroder, M., & Carroll, R. (1999). Sexological outcomes of gender reassignment surgery. Journal of Sex Education and Therapy, 24, 137–146.

    Google Scholar 

  • Seikowski, K., Gollek, S., Harth, W., & Reinhardt, M. (2008). Borderline-Persönlichkeit und Transsexualität. Psychiatrische Praxis, 35, 135–141.

    Article  PubMed  Google Scholar 

  • Singh, D., Deogracias J. J., Johnson, L. L., Bradley, S. J., Kibblewhite, S. J., Owen-Anderson, A., et al. (2009). The Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults: Further validity evidence. Journal of Sex Research, 46, doi:0.1080/00224490902898728.

  • Smith, Y. L., van Goozen, S. H., & Cohen-Kettenis, P. T. (2001). Adolescents with gender identity disorder who were accepted or rejected for sex reassignment surgery: A prospective follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 472–481.

    Article  PubMed  Google Scholar 

  • Smith, Y. L. S., van Goozen, S. H. M., Kuiper, A. J., & Cohen-Kettenis, P. T. (2005). Transsexual subtypes: Clinical and theoretical significance. Psychiatry Research, 137, 151–160.

    Article  PubMed  Google Scholar 

  • Sohn, M., & Bosinski, H. A. G. (2007). Gender identity disorders: Diagnostic and surgical aspects. Journal of Sexual Medicine, 4, 1193–1208.

    Article  PubMed  Google Scholar 

  • Sørenson, T. (1981). A follow-up study of operated transsexual males. Acta Psychiatrica Scandinavica, 63, 486–503.

    Article  Google Scholar 

  • Vance, S. R., Cohen-Kettenis, P. T., Drescher, J., Meyer-Bahlburg, H. F. L., Pfäfflin, F., & Zucker, K. J. (in press). Transgender advocacy groups’ opinions on the current DSM gender identity disorder diagnosis: Results from an international survey. International Journal of Transgenderism.

  • Veale, J. F., Clarke, D. E., & Lomax, T. C. (2008). Sexuality of male-to-female transsexuals. Archives of Sexual Behavior, 37, 586–597.

    Article  PubMed  Google Scholar 

  • Wålinder, J., Lundström, B., & Thuwe, I. (1978). Prognostic factors in the assessment of male transsexuals for sex reassignment. British Journal of Psychiatry, 132, 16–20.

    Google Scholar 

  • Walker, P. A., Berger, J. C., Green, R., Laub, D. R., Reynolds, C. L., & Wolman, L. (1985). Standards of care: The hormonal and surgical sex reassignment of gender dysphoric persons. Archives of Sexual Behavior, 14, 79–90.

    Article  Google Scholar 

  • Wallien, M. S. C., & Cohen-Kettenis, P. T. (2008). Psychosexual outcome of gender-dysphoric children. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 1413–1423.

    Article  PubMed  Google Scholar 

  • Wassersug, R. J., Zelenietz, S. A., & Squire, G. F. (2004). New age eunuchs: Motivation and rationale for voluntary castration. Archives of Sexual Behavior, 33, 433–442.

    Article  PubMed  Google Scholar 

  • Weitze, C., & Osburg, S. (1998). Empirical data on epidemiology and application of the German transsexuals’ act during its first ten years. International Journal of Transgenderism [On-line] Available: http://www.symposion.com/ijt/ijtc0303.htm

  • Wiedeman, G. H. (1953). Transvestism [Letter]. Journal of the American Medical Association, 152, 1153.

    Google Scholar 

  • Winters, K. (2005). Gender dissonance: Diagnostic reform of gender identity disorder for adults. Journal of Psychology and Human Sexuality, 17, 71–89.

    Article  Google Scholar 

  • Winters, K. (2008). Autogynephilia: The infallible derogatory hypothesis, part 2. http://gidreform.wordpress.com/2008/11/19/autogynephilia-the-infallible-derogatory-hypothesis-part-2/

  • Winters, K. (2009, May). Beyond conundrum: Strategies for diagnostic harm reduction. Paper presented at the meeting of the American Psychiatric Association, San Francisco, 2009.

  • World Health Organisation. (1992). The ICD 10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva: Author.

  • Zucker, K. J., & Bradley, S. J. (1995). Gender identity disorder and psychosexual problems in children and adolescents. New York: Guilford Press.

    Google Scholar 

  • Zucker, K. J., Bradley, S. J., Oliver, G., Blake, J., Fleming, S., & Hood, J. (1996). Self-reported sexual arousability in women with congenital adrenal hyperplasia. Journal of Sex and Marital Therapy, 30, 343–355.

    Google Scholar 

  • Zucker, K. J., & Lawrence, A. A. (2009). Epidemiology of gender identity disorder: Recommendations for the Standards of Care of the World Professional Association for Transgender Health. International Journal of Transgenderism, 1, 8–18.

    Article  Google Scholar 

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Acknowledgments

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.

Author information

Authors and Affiliations

  1. Department of Medical Psychology, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands

    Peggy T. Cohen-Kettenis

  2. Department of Psychosomatic Medicine and Psychotherapy, University of Ulm, Ulm, Germany

    Friedemann Pfäfflin

Authors
  1. Peggy T. Cohen-Kettenis
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  2. Friedemann Pfäfflin
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Correspondence to Peggy T. Cohen-Kettenis.

Appendix 1: Diagnostic Criteria of Gender Identity Disorders in the DSM (Adolescent and Adult Criteria)

Appendix 1: Diagnostic Criteria of Gender Identity Disorders in the DSM (Adolescent and Adult Criteria)

DSM-III

Transsexualism (302.5x)

  1. A.

    Sense of discomfort and inappropriateness about one’s anatomic sex.

  2. B.

    Wish to be rid of one’s own genitals and to live as a member of the other sex.

  3. C.

    The disturbance has been continuous (not limited to periods of stress) for at least 2 years.

  4. D.

    Absence of physical intersex or genetic abnormality.

  5. E.

    Not due to another mental disorder, such as Schizophrenia.

Subclassification by predominant prior sexual history:

1 = asexual

2 = homosexual (same anatomic sex)

3 = heterosexual (other anatomic sex)

4 = unspecified

Atypical Gender Identity Disorder (302.85)

This is a residual category for coding disorders in gender identity that are not classifiable as a specific Gender Identity Disorder.

DSM-III-R

Transsexualism (302.50)

  1. A.

    Persistent discomfort and sense of inappropriateness about one’s assigned sex.

  2. B.

    Persistent preoccupation for at least 2 years with getting rid of one’s primary and secondary sex characteristics and acquiring the sex characteristics of the other sex.

  3. C.

    The person has reached puberty.

Specify history of sexual orientation: asexual, homosexual, heterosexual, or unspecified.

Gender Identity Disorder of Adolescence or Adulthood, Nontranssexual Type (GIDAANT) (302.85)

  1. A.

    Persistent or recurrent discomfort and sense of inappropriateness about one’s assigned sex.

  2. B.

    Persistent or recurrent cross-dressing in the role of the other sex, either in fantasy or actuality, but not for the purpose of sexual excitement (as in Transvestic Fetishism).

  3. C.

    No persistent preoccupation (for at least 2 years) with getting rid of one’s primary and secondary sex characteristics and acquiring the sex characteristics of the other sex (as in Transsexualism).

  4. D.

    The person has reached puberty.

Specify history of sexual orientation: asexual, homosexual, heterosexual, or unspecified.

302.85 Gender Identity Disorder Not Otherwise Specified

Disorders in gender identity that are not classifiable as a specific Gender Identity Disorder.

Examples:

  1. 1.

    Children with persistent cross-dressing without the other criteria for Gender Identity Disorder of Childhood

  2. 2.

    Adults with transient, stress-related cross-dressing behavior

  3. 3.

    Adults with the clinical features of Transsexualism of less than 2 years’ duration

  4. 4.

    People who have a persistent preoccupation with castration or penectomy without a desire to acquire the sex characteristics of the other sex

DSM-IV and DSM-IV-TR

Gender Identity Disorder

  1. A.

    A strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being 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.

  2. B.

    Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex.

    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.

  3. C.

    The disturbance is not concurrent with a physical intersex condition.

  4. D.

    The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Code based on current age:

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

Gender Identity Disorder Not Otherwise Specified (302.6)

This category is included for coding disorders in gender identity that are not classifiable as a specific Gender Identity Disorder. Examples include

  1. 1.

    Intersex conditions (e.g., partial androgen insensitivity syndrome or congenital adrenal hyperplasia) and accompanying gender dysphoria

  2. 2.

    Transient, stress-related cross-dressing behavior

  3. 3.

    Persistent preoccupation with castration or penectomy without a desire to acquire the sex characteristics of the other sex

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Cohen-Kettenis, P.T., Pfäfflin, F. The DSM Diagnostic Criteria for Gender Identity Disorder in Adolescents and Adults. Arch Sex Behav 39, 499–513 (2010). https://doi.org/10.1007/s10508-009-9562-y

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