Gender identity disorder

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Gender identity disorder was a diagnosis in the DSM-IV. It has been replaced with gender dysphoria in the DSM-5.

Gender identity disorder was defined as a disturbance of gender identity, in which a person who has been assigned one gender (usually at birth on the basis of their sex, but compare intersexuality), but identifies as belonging to another gender, or does not conform with the gender role their respective society prescribes to them. It was applied to transgender people.

This feeling is usually reported as "having always been there", although in some cases, it seems to appear in adolescence or even in adulthood, and it has been reported by some as intensifying over time. Since many cultures strongly disapprove of cross-gender behaviour, it often results in significant problems for those affected, and sometimes for their close friends and family members as well. In many cases, discomfort is also reported as stemming from the feeling that one's body is "wrong" or meant to be different.

See also: List of transgender-related topics

Past diagnostic criteria

DSM-IV

The current edition of the Diagnostic and Statistical Manual of Mental Disorders has five criteria that must be met before a diagnosis of Gender Identity Disorder (302.85) can be given: [1]

1. There must be evidence of a strong and persistent cross-gender identification.
2. This cross-gender identification must not merely be a desire for any perceived cultural advantages of being the other sex.
3. There must also be evidence of persistent discomfort about one's assigned sex or a sense of inappropriateness in the gender role of that sex.
4. The individual must not have a concurrent physical intersex condition (e.g., androgen insensitivity syndrome or congenital adrenal hyperplasia).
5. There must be evidence of clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The DSM-IV also provides a code for gender disorders that did not fall into these criteria. This diagnosis of Gender Identity Disorder Not Otherwise Specified (GIDNOS, 302.6) is similar to other "NOS" diagnoses, and can be given for, for example: [2]

1. Intersex conditions (e.g., androgen insensitivity syndrome or congenital adrenal hyperplasia) and accompanying gender dysphoria
2. Transient, stress-related cross-dressing behavior
3. Persistent preoccupation with castration or penectomy without a desire to acquire the sex characteristics of the other sex, which is known as skoptic syndrome

Transvestic fetishism has its own code, as a paraphilia rather than a gender identity disorder.

ICD-10

Gender Identity Disorder

ICD-10	F64
ICD-9
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The current edition of the International Statistical Classification of Diseases and Related Health Problems has five different diagnoses for gender identity disorder: transsexualism, Dual-role Transvestism, Gender Identity Disorder of Childhood, Other Gender Identity Disorders, and Gender Identity Disorder, Unspecified. [3]

Transsexualism has the following criteria:

• The desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make his or her body as congruent as possible with the preferred sex through surgery and hormone treatment.
• The transsexual identity has been present persistently for at least two years.
• The disorder is not a symptom of another mental disorder or a chromosomal abnormality.

Dual-role transvestism has the following criteria:

• The individual wears clothes of the opposite sex in order to experience temporary membership in the opposite sex.
• There is no sexual motivation for the cross-dressing.
• The individual has no desire for a permanent change to the opposite sex.

Gender Identity Disorder of Childhood has essentially four criteria, which may be summarised as:

• The individual is persistently and intensely distressed about being a girl/boy, and desires (or claims) to be of the opposite gender.
• The individual is preoccupied with the clothing, roles or anatomy of the opposite sex/gender, or rejects the clothing, roles, or anatomy of his/her birth sex/gender.
• The individual has not yet reached puberty.
• The disorder must have been present for at least 6 months.

The remaining two classifications have no specific criteria and may be used as "catch-all" classifications in a similar way to GIDNOS.

Since, very often, many people (including doctors, judges etc.) assume that the classifications "transsexual" and "transvestite" can apply only to adults, the F64 section of the ICD-10 is often criticised, especially since the "usually" in "usually accompanied by the wish to make his or her body as congruent as possible " is often ignored as well, and wish for sexual reassignment surgery (SRS) is seen as a requirement for the diagnosis of "transsexualism". However, an increasing number of physicians and therapists are treating transsexual people who have no desire for surgery, sometimes known as "non-op" transsexuals.

Many transgender people, however, do not fit into either of these two categories; for example, transgender people who wish to change their social gender completely, but who do not bother with SRS. This can lead to significant problems with things such as procuring medical treatment and legal change of name and/or gender; in some cases, it may make them completely impossible.

Controversy

Many transgender people do not regard their cross-gender feelings and behaviours as a disorder. They question what a "normal" gender identity or a "normal" gender role is supposed to be. Sometimes, even the very existence of a "normal" gender identity or gender role is examined, and often rejected by sectors of modern gender studies. They often point out that not everyone who is born male is stereotypically masculine, and not everyone born female is stereotypically feminine.

Some people see transgender identity as a means for deconstructing gender. However, not all transgender people wish to deconstruct gender or feel that they are doing so.

Other transgender people object to the classification of GID as a mental disorder on the grounds that there may be a physical cause, as suggested by recent studies about the brains of transsexual people. Many of them also point out that the treatment for this disorder consists primarily of physical modifications to bring the body into harmony with one's perception of mental (psychological, emotional) gender identity, rather than vice versa.

In a landmark publication in December 2002, the British Lord Chancellor's office published a Government Policy Concerning Transsexual People document that categorically states "What transsexualism is not...It is not a mental illness." It would appear to be likely that other countries will follow this lead. Nonetheless, existing psychiatric diagnoses of gender identity disorder or the now obsolete categories of homosexual disorder, gender dysphoria syndrome, true transsexual, etc., continue to be accepted as formal evidence of transsexuality.

Additionally, some youth have been diagnosed with G.I.D. on the basis of their sexual orientation (because they are viewed as "gender non-conforming" due to their sexual attractions and/or dress/manner) and treated against their will in religious residential treatment centers. One of the more well known cases was that of Lyn Duff, a 15-year-old girl from Los Angeles who was forcibly transported to Rivendell Psychiatric Center in West Jordan, Utah, and subjected to aversion therapy in an attempt to change her sexual orientation.

Many people felt that the deletion of homosexuality as a mental disorder from the DSM-III and the ensuing creation of the GID diagnosis was merely sleight of hand by psychiatrists, who changed the focus of the diagnosis from the different desire (of the same sex) to the subversive identity (or the belief/desire for membership of the opposite sex/gender). People who believe this tend to point out that the same idea is found in both diagnoses, that the patient is not a "normal" male or female. As Katharine Wilson, Ph.D, an advocate for GID reform put it "Behaviors that would be ordinary or even exemplary for gender conforming boys and girls are presented as symptomatic of mental disorder for gender nonconforming children."

See also

• Gender identity disorder in children
• Hermaphroditism
• Sexual orientation

External links

• Gender Identity Disorder Criteria - according to the DSM-IV
• Standards of Care for Gender Identity Disorders - published by the Harry Benjamin International Gender Dysphoria Association, includes a description of ICD-10 criteria.
• Health Law Standards of Care for Transsexualism An alternative to the Benjamin Standards of Care proposed by the International Conference on Transgender Law and Employment Policy.
• The Banality of Insensitivity: Portrayals of Transgenderism in Psychopathology - Transsexual psychologist, Madeline H. Wyndzen, discusses how viewing transgenderism as a mental disorder (e.g., GID) leads to systemic biases in the research of sexologists.
• THE LORD CHANCELLOR'S DEPARTMENT Government Policy concerning Transsexual People
• Gender Identity Disorder & Transsexualism - Synopsis of Etiology in Adults provides an alternative to the current classifications of psychiatric disorder and mental illness.
• "Gender Identity Disorder" published by George A. Rekers, Ph.D. in 1995. Claims that gender variance in boys is due to "absent fathers" and that there is a "preventive treatment for transvestism, transsexualism, and some forms of homosexuality". Rekers published a similar article in 1974. [4]
• Conway, Lynn: "Successful Transwomen" and "Successful Transmen" - Lynn Conway's "Success Pages". See Lynn Conway's website for many other resources.
• Gorton et al: "Medical Therapy and Hormone Maintenance for Transgender Men: A Guide for Health Care Providers 2005" - This downloadable 100-page book by Dr. N. Gorton, Dr. J. Buth, and D. Spade, Esq. is specific to health care for transmen, however the perspective it offers is useful more generally.

Sexual Identities

Gender
Androgyny · Boi · Gender identity · Gender identity disorder · Genderqueer · Cisgender · Pangender · Transgender · Transman · Transwoman · Transsexualism

Sexual orientations
Bisexuality · Heterosexuality · Homosexuality · Pansexuality · Asexuality

Other
Butch and femme · Homosexuality and transgender · Polyamory · Swinging · Queer · Womyn

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