www.BeTreatedWell.com
Gender Identity Disorder Diagnosis
Current explanations of the etiology, distress, and treatment goals for transgendered people closely parallel
those for gay and lesbian people before 1973 when Homosexuality was declassified as a mental disorder. The
new diagnosis of Transsexualism was created despite the fact that in 1972, an American Medical Association
task force had concluded that psychotherapy was ineffective for transsexual adults and that sex reassignment
was more useful. Though transsexuality is classified as a mental disorder for essentially the same reasons,
homosexuality has been excluded from the Diagnostic and Statistical Manual of Mental Disorders (DSM) and what
is now known as Gender Identity Disorder (GID) continues to be included.
The fact that Transsexualism was added to DSM when Homosexuality was removed is viewed as suspect by
many in the field who find the GID diagnosis to be a continued attempt to pathologize any variation in sexual
expression. This argument is further supported by the fact that homosexuality is the most common post
pubertal outcome for children with GID, leading some to suggest that the label of GID in childhood is simply
homosexuality in childhood.
Like the theories about the etiology of homosexuality, theories about the etiology of transgenderism 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 intelligenc
and synesthesia are both abnormal.)
Also, theories which pathologized homosexual orientation and those which support the continued diagnosis of
GID as a mental illness are remarkably similar and equally flawed. Just as not all gays and lesbians have a
background of "disordered sexual development," and not all with such backgrounds become homosexual, the
same is true of transgendered individuals.
Some note that the diagnosis of Gender Identity Disorder, like Homosexuality in past decades, may not meet
the current definition of a psychiatric disorder. Among those who advocate for retaining the diagnosis so that
the need for treatment is legitimized, there is much controversy about the classification of the diagnosis.
Though GID is currently coded in DSM IV as a Clinical Disorder, some questions whether it should instead be
coded as a Developmental Disorder or General Medical Condition. Furthermore, as a Clinical Disorder, GID is
considered a Sexual Disorder. This is a valid question since a physical diagnosis for GID would be more
consistent with surgical and hormonal treatments.
A key point in the de-classification of homosexuality as a mental disorder was the distinction between distress
or impairment experienced by a homosexual and that believed inherent to homosexuality itself. GID is currently
listed as a Sexual Disorder. Even among those who agree that, because of the psychological distress, an Clinical
Disorder 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 GID in a non-accepting
environment.
Also, if there is nothing pathological about the development of gender identity, whether concordant or discordant
with biological or assigned sex, and if any individual pathology is the result of self-hatred and shame, then the
pathology that exists is cultural and GID should be seen not as an individual problem but as a societal
condition. Accordingly, if GID should be any part of the diagnostic system, perhaps it should be only listed as a
psychosocial stressor along with other environmental situations.
Until the diagnosis for GID takes these problems into account, in part by appropriately focusing on the needs of
those with a transgendered identity, the disparate treatment of Homosexuality and Transgenderism is not
justified. Revising the diagnostic category will not eliminate the stigma and discrimination faced by the
transgender population but may challenge its legitimacy, just as it did for homophobia.
Gender Identity Disorder Diagnosis
Current explanations of the etiology, distress, and treatment goals for transgendered people closely parallel
those for gay and lesbian people before 1973 when Homosexuality was declassified as a mental disorder. The
new diagnosis of Transsexualism was created despite the fact that in 1972, an American Medical Association
task force had concluded that psychotherapy was ineffective for transsexual adults and that sex reassignment
was more useful. Though transsexuality is classified as a mental disorder for essentially the same reasons,
homosexuality has been excluded from the Diagnostic and Statistical Manual of Mental Disorders (DSM) and what
is now known as Gender Identity Disorder (GID) continues to be included.
The fact that Transsexualism was added to DSM when Homosexuality was removed is viewed as suspect by
many in the field who find the GID diagnosis to be a continued attempt to pathologize any variation in sexual
expression. This argument is further supported by the fact that homosexuality is the most common post
pubertal outcome for children with GID, leading some to suggest that the label of GID in childhood is simply
homosexuality in childhood.
Like the theories about the etiology of homosexuality, theories about the etiology of transgenderism 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 intelligenc
and synesthesia are both abnormal.)
Also, theories which pathologized homosexual orientation and those which support the continued diagnosis of
GID as a mental illness are remarkably similar and equally flawed. Just as not all gays and lesbians have a
background of "disordered sexual development," and not all with such backgrounds become homosexual, the
same is true of transgendered individuals.
Some note that the diagnosis of Gender Identity Disorder, like Homosexuality in past decades, may not meet
the current definition of a psychiatric disorder. Among those who advocate for retaining the diagnosis so that
the need for treatment is legitimized, there is much controversy about the classification of the diagnosis.
Though GID is currently coded in DSM IV as a Clinical Disorder, some questions whether it should instead be
coded as a Developmental Disorder or General Medical Condition. Furthermore, as a Clinical Disorder, GID is
considered a Sexual Disorder. This is a valid question since a physical diagnosis for GID would be more
consistent with surgical and hormonal treatments.
A key point in the de-classification of homosexuality as a mental disorder was the distinction between distress
or impairment experienced by a homosexual and that believed inherent to homosexuality itself. GID is currently
listed as a Sexual Disorder. Even among those who agree that, because of the psychological distress, an Clinical
Disorder 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 GID in a non-accepting
environment.
Also, if there is nothing pathological about the development of gender identity, whether concordant or discordant
with biological or assigned sex, and if any individual pathology is the result of self-hatred and shame, then the
pathology that exists is cultural and GID should be seen not as an individual problem but as a societal
condition. Accordingly, if GID should be any part of the diagnostic system, perhaps it should be only listed as a
psychosocial stressor along with other environmental situations.
Until the diagnosis for GID takes these problems into account, in part by appropriately focusing on the needs of
those with a transgendered identity, the disparate treatment of Homosexuality and Transgenderism is not
justified. Revising the diagnostic category will not eliminate the stigma and discrimination faced by the
transgender population but may challenge its legitimacy, just as it did for homophobia.
Antonia Caretto, Ph.D., PLLC
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www.BeTreatedWell.com
phone: 248.553.9053
phone: 248.553.9053