www.BeTreatedWell.com Diagnosis of GID
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 intelligence 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.
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 intelligence 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 |
| www.BeTreatedWell.com phone: 248.553.9053 |
| Articles of Interest: Business of Therapy Anxiety Why Gender? Asperger's Disorder Adjustment Disorders Self-Injurious Behavior |
