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Archives of Sexual Behavior

, Volume 44, Issue 5, pp 1165–1176 | Cite as

The DSM-5 and the Politics of Diagnosing Transpeople

  • Zowie Davy
Special Section: DSM-5: Classifying Sex

Abstract

In the DSM-5, there has been a change in the diagnosis for transpeople of all ages from Gender Identity Disorder (GID) to Gender Dysphoria (GD), in part to better indicate the distress that transpeople may experience when their gender identity feels incongruent. The Workgroup for Sexual and Gender Identity Disorders, chaired by Kenneth J. Zucker, was employed by the American Psychiatric Association (APA) to update the DSM-5’s GID diagnosis reflecting contemporary scientific knowledge. Additionally, in a pre-publication report to the APA, members of the Workgroup suggested that they would also be concerned with the destigmatization of transpeople while preserving a diagnosis that medical insurance companies would accept for issuing payments for transitioning treatments (Drescher, 2013). The aims of this article are, firstly, to question whether changing the diagnosis lessens the stigmatization of transpeople. I will suggest that the semantic change from GID to GD marks “inverted” gendered expressions as pathological and, thus, continues to stigmatize transpeople. Secondly, the article explores the development of the GD diagnosis, and illustrates how the scientific data this were founded on are contentious. The article then demonstrates how the trans anti-pathologization movement has challenged the perceived pathologizing effects of the DSM-5 classification of GD. The article examines a selection of Western transgender community advocates’ websites, forums, and blogs. From these sources, the article then explores the different narratives of transpeople and political groups who offer details of their praxis, and evidences how the trans anti-pathologization advocates use the available science and human rights discourses to contest the role of psychiatry in the treatment of transpeople.

Keywords

Gender dysphoria DSM-5 Transsexualism Gender Identity Disorder Stigma 

Notes

Acknowledgments

I would like to thank the reviewers and Michael Toze, who commented on earlier drafts of this article. I would also like to acknowledge the European Science Foundation workshop Transgender and Political Science in Europe: A Comparative Approach, in Brussels 2014, when attendees provided valuable comments on a shorter version of the article.

References

  1. Altman, K. (Writer) & H. Croall & E. Wunderman (Directors). (1999). Paradise bent: Boys will be girls in Samoa (H. Croall & A. Elder, Producers). Australia: Angle Pictures.Google Scholar
  2. American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.Google Scholar
  3. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.Google Scholar
  4. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.Google Scholar
  5. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.Google Scholar
  6. Bailey, J. M. (2003). The man who would be queen: The science of gender-bending and transsexualism. Washington, DC: Joseph Henry Press.Google Scholar
  7. Bem, S. L. (1974). The measurement of psychological androgyny. Journal of Consulting and Clinical Psychology, 42, 155–162.PubMedCrossRefGoogle Scholar
  8. Benjamin, H. (1966). The transsexual phenomenon. New York: Julian Press.Google Scholar
  9. Billings, D. B., & Urban, T. (1996). The socio-medical construction of transsexualism. In R. Ekins & D. King (Eds.), Blending genders: Social aspects of cross-dressing and sex-changing (pp. 99–117). London: Routledge.Google Scholar
  10. Blanchard, R. (1989). The concept of autogynephilia and the typology of male gender dysphoria. Journal of Nervous and Mental Disease, 177, 616–623.PubMedCrossRefGoogle Scholar
  11. Blanchard, R. (1991). Clinical observations and systematic study of autogynephilia. Journal of Sex and Marital Therapy, 17, 235–257.PubMedCrossRefGoogle Scholar
  12. Blanchard, R., Clemmensen, L. H., & Steiner, B. W. (1987). Heterosexual and homosexual gender dysphoria. Archives of Sexual Behavior, 16, 139–152.PubMedCrossRefGoogle Scholar
  13. Bockting, W. O., Benner, A., & Coleman, E. (2009). Gay and bisexual identity development among female-to-male transsexuals in North America: Emergence of transgender sexuality. Archives of Sexual Behavior, 38, 688–701.PubMedCrossRefGoogle Scholar
  14. Bolin, A. (1988). In search of Eve: Transsexual rites of passage. New York: Bergin & Garvey.Google Scholar
  15. Bradley, S. J., Blanchard, R., Coates, S., Green, R., Levine, S. B., Pauly, I. B., & Zucker, K. J. (1991). Interim report of the DSM-IV Subcommittee on Gender Identity Disorders. Archives of Sexual Behavior, 20, 333–343.PubMedCrossRefGoogle Scholar
  16. Brain, A. E. (2012). Another part of the puzzle. Retrieved December 22, 2012, from http://aebrain.blogspot.co.uk/.
  17. Burke, M. C. (2011). Resisting pathology: GID and the contested terrain of diagnosis in the transgender rights movement. In P. J. McGann & D. J. Hutson (Eds.), Sociology of diagnosis (Vol. 12, pp. 183–210). Bingley: Emerald Group Publishing.CrossRefGoogle Scholar
  18. Butler, J. (1990). Gender trouble: Feminism and the subversion of identity. New York: Routledge.Google Scholar
  19. Cabral, M. (2015). Malta adopts ground-breaking trans and intersex law [Electronic mailing list message]. Retrieved May 27, 2015, from http://lists.tgeu.org/sympa/arc/trans-info-europe/2015-04/msg00015.html.
  20. Cohen-Kettenis, P. T. (2010). Psychosocial and psychosexual aspects of disorders of sex development. Best Practice & Research Clinical Endocrinology & Metabolism, 24, 325–334.CrossRefGoogle Scholar
  21. Cohen-Kettenis, P. T., & Pfäfflin, F. (2010). The DSM diagnostic criteria for gender identity disorder in adolescents and adults. Archives of Sexual Behavior, 39, 499–513.PubMedCrossRefGoogle Scholar
  22. Cromwell, J. (1999). Transmen & FTMs: Identities, bodies, genders & sexualities. Urbana: University of Illinois Press.Google Scholar
  23. Cuban Multidisciplinary Society for Sexuality Studies. (2010). Statement on depathologization of transsexualism. Retrieved December 19, 2010, from http://ilga.org/ilga/en/article/mg7Y7pB1Rg.
  24. Currah, P., Green, J., & Stryker, S. (2008). The state of transgender rights in the United States of America. San Francisco: National Sexuality Resource Centre.Google Scholar
  25. Davy, Z. (2010a). The disabling affects of a sexed system: An exploration of intersexuality, transgender and sexual and gender citizenship. In R. P. Shuttleworth & T. Sanders (Eds.), Sexuality & disability: Politics, identity and access (pp. 179–195). Leeds: Disability Press.Google Scholar
  26. Davy, Z. (2010b). Transsexual agents: Negotiating authenticity and embodiment within the UK’s medicolegal system. In S. Hines & T. Sanger (Eds.), Transgender identities: Towards a social analysis of gender diversity (pp. 106–126). London: Routledge.Google Scholar
  27. Davy, Z. (2011). Recognizing transsexuals: Personal, political and medicolegal embodiment. Aldershot: Ashgate.Google Scholar
  28. Davy, Z., & Steinbock, E. (2012). ‘Sexing up’ bodily aesthetics: Notes towards theorizing trans sexuality. In S. Hines & Y. Taylor (Eds.), Sexualities: Past reflections and future directions (pp. 266–285). Basingstoke: Palgrave Macmillan.Google Scholar
  29. de Vries, A. L., Doreleijers, T. A., & Cohen-Kettenis, P. T. (2007). Disorders of sex development and gender identity outcome in adolescence and adulthood: Understanding gender identity development and its clinical implications. Pediatric Endocrinology Reviews, 4, 343–351.PubMedGoogle Scholar
  30. Diamond, M. (2000). Sex and gender: Same or different? Feminism & Psychology, 10, 46–54.CrossRefGoogle Scholar
  31. Diamond, M. (2002). Sex and gender are different: Sexual identity and gender identity are different. Clinical Child Psychology and Psychiatry, 7, 320–334.CrossRefGoogle Scholar
  32. Dreger, A. D. (1998). Hermaphrodites and the medical invention of sex. Cambridge, MA: Harvard University Press.Google Scholar
  33. Drescher, J. (2013). Controversies in gender diagnoses. LGBT Health, 1, 9–13.Google Scholar
  34. Drescher, J., & Byne, W. (2012). Introduction to the special issue on “The Treatment of Gender Dysphoric/Gender Variant Children and Adolescents”. Journal of Homosexuality, 59, 295–300.PubMedCrossRefGoogle Scholar
  35. Drescher, J., Cohen-Kettenis, P., & Winter, S. (2012). Minding the body: Situating gender identity diagnoses in the ICD-11. International Review of Psychiatry, 24, 568–577.PubMedCrossRefGoogle Scholar
  36. Eagly, A. H. (2013). Sex differences in social behavior: A social-role interpretation. Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
  37. Ekins, R., & King, D. (2006). The transgender phenomenon. London: Sage.Google Scholar
  38. Elan-Cane, C. (2014). HM passport office. Retrieved May 27, 2015, from http://elancane.livejournal.com/24816.html.
  39. GID Reform Advocates. (2010). Professionals concerned with gender diagnoses in the DSM: Statement on transvestic disorder in the DSM-5. Retrieved May 27, 2015, from http://gidconcern.wordpress.com/statement-on-transvestic-disorder-in-the-dsm-5/.
  40. Gender Identity Research and Education Society (GIRES). (2006). Atypical gender development: A review. International Journal of Transgenderism, 9, 29–44.CrossRefGoogle Scholar
  41. Gender Identity Research and Education Society (GIRES). (2007). Gender development: The inside story. Retrieved December 2, 2007, from http://www.gires.org.uk/Web_Page_Assets/frontframeset.htm.
  42. Gender Identity Research and Education Society (GIRES). (2010). Home page. Retrieved May 27, 2015, from http://www.gires.org.uk/.
  43. Giami, A., & Beaubatie, E. (2014). Gender identification and sex reassignment surgery in the trans population: A survey study in France. Archives of Sexual Behavior, 42, 1491–1501.CrossRefGoogle Scholar
  44. Greenfield, S. (2002). The private life of the brain. London: Penguin.Google Scholar
  45. Grossman, A. H., & D’Augelli, A. R. (2006). Transgender youth: Invisible and vulnerable. Journal of Homosexuality, 51, 111–128.PubMedCrossRefGoogle Scholar
  46. Grossman, A. H., & D’Augelli, A. R. (2007). Transgender youth and life-threatening behaviors. Suicide and Life-Threatening Behavior, 37, 527–537.PubMedCrossRefGoogle Scholar
  47. Hammarberg, T. (2009). Issue paper: Human rights and gender identity: Office of the Commissioner for Human Rights: Council of Europe.Google Scholar
  48. Hare, L., Bernard, P., Sánchez, F. J., Baird, P. N., Vilain, E., Kennedy, T., & Harley, V. R. (2009). Androgen receptor repeat length polymorphism associated with male-to-female transsexualism. Biological Psychiatry, 65, 93–96.PubMedCentralPubMedCrossRefGoogle Scholar
  49. Henningsson, S., Westberg, L., Nilsson, S., Lundström, B., Ekselius, L., Bodlund, O., & Eriksson, E. (2005). Sex steroid-related genes and male-to-female transsexualism. Psychoneuroendocrinology, 30, 657–664.PubMedCrossRefGoogle Scholar
  50. Herschkowitz, N. (2000). Neurological bases of behavioral development in infancy. Brain and Development, 22, 411–416.PubMedCrossRefGoogle Scholar
  51. Hester, D. J. (2004). Intersex(es) and informed consent: How physicians’ rhetoric constrains choice. Theoretical Medicine, 25, 21–49.CrossRefGoogle Scholar
  52. Hird, M. J. (2003). A typical gender identity conference? Some disturbing reports from the therapeutic front lines. Feminism & Psychology, 13, 181–199.Google Scholar
  53. Holmes, G. (1995). Queer cut bodies: Intersexuality & homophobia in medical practice. Retrieved December 1, 1995, from http://www.usc/isd/archives/queerfrontiers/queer/papers/holmes.long.html.
  54. Intersex Society of North America. (1993–2008). Home page. Retrieved October 1, 2008, from http://www.isna.org/.
  55. Kruijver, F. P. M., Zhou, J.-N., Pool, C. W., Hofman, M. A., Gooren, L. J. G., & Swaab, D. F. (2000). Male to female transsexuals have female neuron numbers in a limbic nucleus. Journal of Clinical Endocrinology and Metabolism, 85, 2034–2041.PubMedCrossRefGoogle Scholar
  56. Lawrence, A. A. (2004). Autogynephilia: A paraphilic model of gender identity disorder. Journal of Gay & Lesbian Psychotherapy, 8, 69–87.Google Scholar
  57. Lawrence, A. A. (2011). Further validation of Blanchard’s typology: A reply to Nuttbrock, Bockting, Rosenblum, Mason, and Hwahng (2010) [Letter to the Editor]. Archives of Sexual Behavior, 40, 1089–1091.PubMedCrossRefGoogle Scholar
  58. Lewins, F. (1995). Transsexualism in society. Melbourne: Macmillan Education Australia.Google Scholar
  59. Lorber, J. (1994). Paradoxes of gender. New Haven, CT: Yale University Press.Google Scholar
  60. Maccoby, E. E., & Jacklin, C. N. (1974). The psychology of sex differences. Stanford, CA: Stanford University Press.Google Scholar
  61. Money, J. (1995). Gendermaps. New York: Continuum.Google Scholar
  62. Moser, C. (2010). Blanchard’s autogynephilia theory: A critique. Journal of Homosexuality, 57, 790–809.PubMedCrossRefGoogle Scholar
  63. Newfield, E., Hart, S., Dibble, S., & Kohler, L. (2006). Female-to-male transgender quality of life. Quality of Life Research, 15, 1447–1457.PubMedCrossRefGoogle Scholar
  64. NHS England/Medical Directorate. (2013). Interim gender dysphoria protocol and service guideline 2013/14. London: NHS England.Google Scholar
  65. Nicolosi, J., & Nicolosi, L. A. (2002). A parent’s guide to preventing homosexuality. Downers Grove, IL: InterVarsity Press.Google Scholar
  66. Nuttbrock, L., Bockting, W., Mason, M., Hwahng, S., Rosenblum, A., Macri, M., & Becker, J. (2011). A further assessment of Blanchard’s typology of homosexual versus non-homosexual or autogynephilic gender dysphoria. Archives of Sexual Behavior, 40, 247–257.PubMedCentralPubMedCrossRefGoogle Scholar
  67. Parliamentary Assembly. (2015). Discrimination against transgender people in Europe. Retrieved May 27, 2015, from http://assembly.coe.int/nw/xml/XRef/Xref-XML2HTML-en.asp?fileid=21736&lang=EN.
  68. Pfeffer, C. A. (2014). Making space for trans sexualities. Journal of Homosexuality, 61, 597–604.PubMedCrossRefGoogle Scholar
  69. Phillips, H. (2001). Boy meets girl. New Scientist, 29-42.Google Scholar
  70. Royal College of Psychiatrists. (2013). Good practice guidelines for the assessment and treatment of adults with gender dysphoria.Google Scholar
  71. Rubin, H. (2003). Self-made men: Identity and embodiment among transsexual men. Nashville, TN: Vanderbilt University Press.Google Scholar
  72. SameSame. (2008). Transgender people validated by Aussie research. Retrieved May 27, 2015, from http://www.samesame.com.au/news/local/3161/Transgender-People-Validated-By-Aussie-Research.htm.
  73. Schmall, E. (2012). Transgender advocates hail law easing rules in Argentina. Retrieved May 27, 2015, from http://www.nytimes.com/2012/05/25/world/americas/transgender-advocates-hail-argentina-law.html?_r=0.
  74. Sedgwick, E. K. (1991). How to bring your kids up gay. Social Text, 29, 18–27.CrossRefGoogle Scholar
  75. Serano, J. M. (2010). The case against autogynephilia. International Journal of Transgenderism, 12, 176–187.CrossRefGoogle Scholar
  76. Socarides, C. W. (1978). The sexual deviations and the diagnostic manual. American Journal of Psychotherapy, 32, 414–426.PubMedGoogle Scholar
  77. Speer, S. A. (2013). Talking about sex in the gender identity clinic: Implications for training and practice. Health, 17, 622–639.PubMedGoogle Scholar
  78. Steinbock, E. (2013). On the affective force of “nasty love”. Journal of Homosexuality, 61, 749–765.CrossRefGoogle Scholar
  79. Stone, S. (1991). The empire strikes back: A posttranssexual manifesto. In J. Epstein & K. Straub (Eds.), Body guards: The cultural politics of gender ambiguity (pp. 280–304). New York: Routledge.Google Scholar
  80. Stone, S. (2006). The empire strikes back: A posttranssexual manifesto. In S. Stryker & S. Whittle (Eds.), The transgender studies reader (pp. 221–235). New York: Routledge.Google Scholar
  81. Stop Trans Pathologization. (n.d.). Stop trans pathologization. Retrieved May 27, 2015, from http://www.stp2012.info/old/es.
  82. Stryker, S. (2006). My words to Victor Frankenstein above the village of Chamounix: Performing transgender rage. In S. Stryker & S. Whittle (Eds.), The transgender studies reader (pp. 244–256). New York: Routledge.Google Scholar
  83. Stryker, S. (2008). Dungeon intimacies: The poetics of transsexual sadomasochism. Parallax, 14, 36–47.CrossRefGoogle Scholar
  84. TGEU. (2012). Diagnosing diversity is crazy. Trans people are sane. Retrieved December 1, 2012, from http://www.tgeu.org/TGEU_PR_Diagnosing_diversity_is_crazy_Trans_people_are_sane.
  85. Transgender London. (2011). Not a choice? What causes it? Retrieved May 27, 2015, from http://www.transgenderlondon.com/What%20Causes%20It.htm.
  86. TS-SI. (2008). Genomic association study identifies genetic basis for MtF feminization. Retrieved October 1, 2008, from http://www.ts-si.org/genetics-&-genome/3545-genomic-genetic-basis-mtf-feminization.html.
  87. Ujike, H., Otani, K., Nakatsuka, M., Ishii, K., Sasaki, A., Oishi, T., & Namba, Y. (2009). Association study of gender identity disorder and sex hormone-related genes. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 33, 1241–1244.PubMedCrossRefGoogle Scholar
  88. Valentine, D. (2007). Imagining transgender: An ethnography of a category. Durham, NC: Duke University Press.CrossRefGoogle Scholar
  89. Vance, S. R., Cohen-Kettenis, P. T., Drescher, J., Meyer-Bahlburg, H. F. L., Pfäfflin, F., & Zucker, K. J. (2010). Opinions about the DSM gender identity disorder diagnosis: Results from an international survey administered to organizations concerned with the welfare of transgender people. International Journal of Transgenderism, 12, 1–14.CrossRefGoogle Scholar
  90. Veale, J. F., Clarke, D. E., & Lomax, T. C. (2008). Sexuality of male-to-female transsexuals. Archives of Sexual Behavior, 37, 586–597.PubMedCrossRefGoogle Scholar
  91. Vidal, C. (2012). The sexed brain: Between science and ideology. Neuroethics, 5, 295–303.CrossRefGoogle Scholar
  92. World Professional Association for Transgender Health. (2011). Standards of care for the health of transsexual, transgender, and gender non-conforming people. International Journal of Transgenderism, 13, 165–232.Google Scholar
  93. Wren, B. (2005, April). Thinking post-modern and practicing in the enlightenment: Managing uncertainty in the treatment of transgendered adolescents. Paper presented at the meeting of Clinical Analogies: Thinking Embodied Subjectivity Across Disciplines, University of Lancaster.Google Scholar
  94. Young, I. M. (1990). Throwing like a girl and other essays in feminist philosophy and social theory. Bloomington: Indiana University Press.Google Scholar
  95. Zhou, J.-N., Hofman, M. A., Gooren, L. J. G., & Swaab, D. F. (1995). A sex difference in the human brain and its relation to transsexuality. Nature, 378, 68–70.PubMedCrossRefGoogle Scholar
  96. Zucker, K. J. (2010). Reports from the DSM-V work group on sexual and gender identity disorders. Archives of Sexual Behavior, 39, 217–220.PubMedCrossRefGoogle Scholar
  97. Zucker, K. J. (2013). DSM-5: Call for commentaries on gender dysphoria, sexual dysfunctions, and paraphilic disorders. Archives of Sexual Behavior, 42, 669–674.PubMedCrossRefGoogle Scholar
  98. Zucker, K. J., Owen, A., Bradley, S. J., & Ameeriar, L. (2002). Gender-dysphoric children and adolescents: A comparative analysis of demographic characteristics and behavioral problems. Clinical Child Psychology and Psychiatry, 7, 398–411.CrossRefGoogle Scholar
  99. Zucker, K. J., & Spitzer, R. L. (2005). Was the gender identity disorder of childhood diagnosis introduced into DSM-III as a backdoor maneuver to replace homosexuality? A historical note. Journal of Sex and Marital Therapy, 31, 31–42.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.School of Health and Social CareUniversity of LincolnLincolnUK

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