Diagnostic Controversy
The issues raised in the controversy regarding diagnosis of Gender Dysphoria closely parallels those that were raised regarding the diagnosis of Homosexuality, which was finally declassified as a mental disorder in 1973. Interestingly, at the same time that Homosexuality was removed from the diagnostic system, the diagnosis of Transsexualism was added.
Regardless of the timing, the fact that Transsexualism was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM) is viewed was suspect by many, especially since an American Medical Association task force had concluded in 1972 that psychotherapy was ineffective for transsexual adults and that sex reassignment was more useful. Later revisions of the DSM have retained that diagnosis and classified the condition as Gender Identity Disorder, and most recently as Gender Dysphoria.
Many transgenders and some professionals believe that retaining the Gender Dysphoria diagnosis serves no purpose and only continues to pathologize normal variations in gender expression. Many are especially critical of the diagnosis being given to children, noting that homosexuality (not transgender identity) is the most common post pubertal outcome for children with Gender Dysphoria.
Like the theories about the mental health of homosexuals, theories about the mental health of transgenders also rely heavily on clinical populations. Regarding the removal of homosexuality from DSM Judd Marmor noted that, "If our judgment about the mental health of heterosexuals were based only on those whom we see in our clinical practices we would have to conclude that all heterosexuals are also mentally ill." Furthermore, just because a condition is abnormal, in the sense that it is rare, doesn't mean that it is pathological. (Genius level intelligence and synesthesia are both abnormal.)
Also, theories which pathologized homosexual orientation and those which support the continued diagnosis of Gender Dysphoria as a mental illness are logically flawed in the same way: Not all gays and lesbians have a background of "disordered sexual development" and not all with such backgrounds become homosexual. Likewise, generalization made (for instance) about the background, families and sexual preferences of transgenders are not true of all transgenders and many individuals who do have such background, families and sexual preferences are not transgender.
Taking a different approach, some note that the diagnosis of Gender Dysphoria, like Homosexuality in past decades, may not even meet the definition of a psychiatric disorder. A key point in the de-classification of homosexuality as a mental disorder was the distinction between the distress or impairment experienced by a homosexual and that believed inherent to homosexuality itself. Not all transgenders are distressed or have impairment in functioning as a result of their gender incongruence.
Advocates note that there is nothing pathological about the development of gender identity, whether concordant or discordant with biological or assigned sex, and that any individual pathology is the result of self-hatred and shame reinforced by a transphobic culture. Accordingly, the pathology that exists is within the society and Gender Dysphoria should be seen not as an individual problem but as a psychosocial stressor along with other environmental situations.
Among those who advocate for retaining the diagnosis so that the need for treatment is legitimized, there is much controversy about the specific classification of the diagnosis. Even among those who agree that, because of the psychological distress, a psychiatric diagnosis is warranted, many suggest that the primary symptom and diagnosis should be a Mood Disorder or an Anxiety Disorder related to the stress and trauma of living with Gender Dysphoria in a non-accepting environment.
Others questions whether Gender Dysphoria is not better described as medical condition since a medical diagnosis would be more consistent with the medically necessary treatments which are primarily surgical and hormonal. Though the recent revision of DSM retained Gender Dysphoria as a Psychiatric Disorder, it did finally remove the diagnosis from the chapter of Sexual Disorders.
Though removing the diagnosis of Gender Dysphoria from the DSM will not eliminate all of the stigma and discrimination faced by the transgender population, it will challenge the legitimacy of viewing transgenders as mentally ill and open a dialogue about transgenders in society.
Regardless of the timing, the fact that Transsexualism was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM) is viewed was suspect by many, especially since an American Medical Association task force had concluded in 1972 that psychotherapy was ineffective for transsexual adults and that sex reassignment was more useful. Later revisions of the DSM have retained that diagnosis and classified the condition as Gender Identity Disorder, and most recently as Gender Dysphoria.
Many transgenders and some professionals believe that retaining the Gender Dysphoria diagnosis serves no purpose and only continues to pathologize normal variations in gender expression. Many are especially critical of the diagnosis being given to children, noting that homosexuality (not transgender identity) is the most common post pubertal outcome for children with Gender Dysphoria.
Like the theories about the mental health of homosexuals, theories about the mental health of transgenders also rely heavily on clinical populations. Regarding the removal of homosexuality from DSM Judd Marmor noted that, "If our judgment about the mental health of heterosexuals were based only on those whom we see in our clinical practices we would have to conclude that all heterosexuals are also mentally ill." Furthermore, just because a condition is abnormal, in the sense that it is rare, doesn't mean that it is pathological. (Genius level intelligence and synesthesia are both abnormal.)
Also, theories which pathologized homosexual orientation and those which support the continued diagnosis of Gender Dysphoria as a mental illness are logically flawed in the same way: Not all gays and lesbians have a background of "disordered sexual development" and not all with such backgrounds become homosexual. Likewise, generalization made (for instance) about the background, families and sexual preferences of transgenders are not true of all transgenders and many individuals who do have such background, families and sexual preferences are not transgender.
Taking a different approach, some note that the diagnosis of Gender Dysphoria, like Homosexuality in past decades, may not even meet the definition of a psychiatric disorder. A key point in the de-classification of homosexuality as a mental disorder was the distinction between the distress or impairment experienced by a homosexual and that believed inherent to homosexuality itself. Not all transgenders are distressed or have impairment in functioning as a result of their gender incongruence.
Advocates note that there is nothing pathological about the development of gender identity, whether concordant or discordant with biological or assigned sex, and that any individual pathology is the result of self-hatred and shame reinforced by a transphobic culture. Accordingly, the pathology that exists is within the society and Gender Dysphoria should be seen not as an individual problem but as a psychosocial stressor along with other environmental situations.
Among those who advocate for retaining the diagnosis so that the need for treatment is legitimized, there is much controversy about the specific classification of the diagnosis. Even among those who agree that, because of the psychological distress, a psychiatric diagnosis is warranted, many suggest that the primary symptom and diagnosis should be a Mood Disorder or an Anxiety Disorder related to the stress and trauma of living with Gender Dysphoria in a non-accepting environment.
Others questions whether Gender Dysphoria is not better described as medical condition since a medical diagnosis would be more consistent with the medically necessary treatments which are primarily surgical and hormonal. Though the recent revision of DSM retained Gender Dysphoria as a Psychiatric Disorder, it did finally remove the diagnosis from the chapter of Sexual Disorders.
Though removing the diagnosis of Gender Dysphoria from the DSM will not eliminate all of the stigma and discrimination faced by the transgender population, it will challenge the legitimacy of viewing transgenders as mentally ill and open a dialogue about transgenders in society.