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    GID Diagnosis Controversy

    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.
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