Friday, May 9, 2008

Hope for Trans Community With New DSM - V?

The APA has released a statement to activists who have emailed and called concerning the APA Diagnostic Statistical Manual. Activists have been very concerned over some people appointed to the committee who are very transphobic and who would likely keep the label "Gender Identity Disorder" even though moden research shows transgender people are just as healthy as everyone else in the population and are NOT disordered! The Gender Identity Disorders task force, is chaired by Peggy T. Cohen Kettenis, Ph.D. who is rumored to be TG friendly.

This being said our work is not done, Dr. Kenneth Zucker head of the entire Sexual and Gender Identity Disorders committee is very transphobic and believes in "reparative therapy" for transgender children.


May 9, 2008

The American Psychiatric Association has received inquiries about the DSM-V process, particularly concerns raised about the Sexual and Gender Identity Disorders Work Group.

The APA has a long-standing mission to provide guidelines for the diagnosis and treatment of mental disorders, based on the most current clinical and scientific knowledge. Through advocacy and education of the public and policymakers, the APA also affirms it commitment to reducing stigma and discrimination.

The DSM addresses criteria for the diagnosis of mental disorders. The DSM does not provide treatment recommendations or guidelines. The APA is aware of the need for greater scientific and clinical consensus on the best treatments for individuals with Gender Identity Disorder (GID). Toward that end, the APA Board of Trustees voted to create a special APA Task Force to review the scientific and clinical literature on the treatment of GID. It is expected that members of the Task Force will be appointed shortly.

There are 13 DSM-V work groups. Collectively, the work group members will review all existing diagnostic categories in the current DSM. Each work group will be able to make proposals to revise existing diagnostic criteria, to consider new diagnostic categories, and to suggest deleting existing diagnostic categories.

All DSM-V work group proposals will be based on a careful, balanced review and analysis of the best clinical and scientific data. Evidence accumulated from work group members and hundreds of additional advisors to the DSM-V effort will be considered before final recommendations are made.

The Sexual and Gender Identity Disorders Work Group, chaired by Kenneth J. Zucker, Ph.D., will have 13 members who will form three subcommittees:

* Gender Identity Disorders, chaired by Peggy T. Cohen-Kettenis, Ph.D.
* Paraphilias, chaired by Ray Blanchard, Ph.D.
* Sexual Dysfunctions, chaired by R. Taylor Segraves, M.D., Ph.D.

Each subcommittee will pursue its own charge, provide ongoing peer review, and consult with outside experts. The DSM-V is expected to be published in 2012."
(This was a response given to Jessica L. off of Forums)


Sam said...

I think this is one of the things that will constantly be a problem until our health insurance system starts making more sense and doctors start being more reasonable about performing SRS for all people who seem competent to make medical decisions.

Unless there is a diagnosis of a "disorder," people can't get counseling, and people often need counseling either because of discrimination-related trauma or because their doctor requires them to go through it in order to transition.

And health insurance already typically doesn't pay for SRS, but a common strategy when arguing for increased coverage is that it's a medically necessary treatment to correct a "problem," the problem being living in a body that doesn't outwardly "match" gender identity.

As long as the "disorder" label remains a requirement to getting health care this is going to be an issue.

Queers United said...

Sam you are right, many trans people want the stigma of disorder taken off yet for insurance purposes it almost seems necessary. I think many trans activists are not calling for a complete withdrawal from the DSM but rather a revision of the terminology. For example changing "Gender Identity Disorder" to Gender Dysphoria. It would seem better to say trans people are healthy but need to transition and frame the problems they suffer more around society as opposed to because of who they are.

Sam said...

Yes, that makes a lot of sense.

Sophia said...

Personally, instead of it no longer being labeled a disorder at all --- I'd rather it be re-classified from a psychological disorder to a medical one. That way, we can have a stronger case for coverage, on the grounds that the hormones and surgery are targeted at what actually is the problem.

As for counseling -- aside from SOC requirements, the only ones of us who really need that (except maybe a session or two to verify that we are indeed psychologically female) are those of us who suffer from trauma of having been treated differently than cissexual women all our lives. Those who have that problem should receive counseling for that, rather than GID itself. And for the rest of us who don't need counseling for any other reasons -- the SOC should be amended to not require it.

Queers United said...

Sophia if it was classified as medical would it be in the DSM?

Sam said...

DSM includes some medical disorders that cause psychological symptoms, like brain injuries or alzheimer's, and some medical disorders that may interact with psychological disorders (like medically caused sexual dysfunction). It doesn't contain a general list of medical disorders, it just wants to focus on ones that might be relevant to counseling/therapy/psychiatric treatment. The purpose of the DSM is not to say which problems are "medical" and which are "psychological," though.

Classifications of medical disorders are in the ICD, published by the World Health Organization. It currently does have "transsexualism" and "gender identity disorder of childhood" listed as diagnoses, which it defines as discomfort with assigned sex, more or less. The APA and WHO are probably unlikely to cooperate with each other to harmonize their descriptions of trans identity/gender dysphoria.

The DSM and ICR are mainly classification tools; neither says anything about standard of care.

Sam said...

sorry, ICD. The ICD also includes mental disorders, and transsexualism and GID are both classified as mental disorders under "Disorders of adult personality and behaviour." So it's not like their placement in the ICD is that great a step towards seeing it as a medical, not psychological, problem.

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