Opinions About the<i>DSM</i>Gender Identity Disorder Diagnosis: Results from an International Survey Administered to Organizations Concerned with the Welfare of Transgender People

Vance, Stanley R.; Cohen‐Kettenis, Peggy T.; Drescher, Jack; Meyer‐Bahlburg, Heino F. L.; Pfäfflin, Friedemann; Zucker, Kenneth J.

doi:10.1080/15532731003749087

Cited by 53 publications

(28 citation statements)

References 9 publications

(9 reference statements)

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“…Transgender advocates have cited examples of the use of the categorization of transgenderism as a mental illness to the detriment of transgender persons in child custody disputes, employment, access to security clearances, marriage continuation, serving in the military, receiving mental or physical health services, and establishing policies for civil-rights protection (Vance et al, 2009). Winter et al (2009) conducted a world-spanning seven-country study of transprejudice directed at “transwomen” (male-to-female transsexuals) using a 30-item questionnaire and non-orthogonal factor analysis.…”

Section: Arguments For and Against The Mental Disorder Classificationmentioning

confidence: 99%

“…Among mental-health professionals as well as among gender-variant persons the opinions range widely, from recommendations to continue the inclusion of GIVs as “mental disorders” in the DSM to demands for the complete removal of GIVs from the DSM altogether (see, for instance, the findings from a recent survey of transgender advocacy groups' opinions by Vance, Cohen-Kettenis, Drescher, Meyer-Bahlburg, Pfäfflin, & Zucker [2009]), as well as the report on a consensus conference of the World Professional Association for Transgender Health by de Cuypere et al [2009]). The purpose of this paper is to examine concepts, pertinent data, apparent dilemmas, and possible options for the resolution of these dilemmas.…”

Section: Introductionmentioning

confidence: 99%

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From Mental Disorder to Iatrogenic Hypogonadism: Dilemmas in Conceptualizing Gender Identity Variants as Psychiatric Conditions

Meyer‐Bahlburg

2009

Arch Sex Behav

145

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The categorization of gender identity variants (GIVs) as “mental disorders” in the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association (APA) is highly controversial among professionals as well as among persons with GIV. After providing a brief history of GIV categorizations in the DSM, this paper presents some of the major issues of the ongoing debate: GIV as psychopathology versus natural variation; definition of “impairment” and “distress” for GID; associated psychopathology and its relation to stigma; the stigma impact of the mental-disorder label itself; the unusual character of “sex reassignment surgery” as a psychiatric treatment; and the consequences for health and mental-health services if the disorder label is removed. Finally, several categorization options are examined: Retaining the GID category, but possibly modifying its grouping with other syndromes; narrowing the definition to dysphoria and taking “disorder” out of the label; categorizing GID as a neurological or medical rather than a psychiatric disorder; removing GID from both the DSM and the International Classification of Diseases (ICD); and creating a special category for GIV in the DSM. I conclude that--as also evident in other DSM categories--the decision on the categorization of GIVs cannot be achieved on a purely scientific basis, and that a consensus for a pragmatic compromise needs to be arrived at that accommodates both scientific considerations and the service needs of persons with GIVs.

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Section: Arguments For and Against The Mental Disorder Classificationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

From Mental Disorder to Iatrogenic Hypogonadism: Dilemmas in Conceptualizing Gender Identity Variants as Psychiatric Conditions

Meyer‐Bahlburg

2009

Arch Sex Behav

145

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“…The majority of transsexual people tend to reject the notion of being ill (cf. Ault & Brzuzy, 2009;Ehrbar, 2010;Vance et al, 2010). To them, GID is simply a variation within the wide range of gender expressions in humans.…”

Section: Tertium Non Datur In the Debate Of Current Issuesmentioning

confidence: 97%

Tertium non datur– either/or reactions to transsexualism amongst health care professionals: the situation past and present, and its relevance to the future

Nieder

Richter‐Appelt

2011

Psychology & Sexuality

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According to the principle of the excluded third (tertium non datur) the gender binary divides our social life into two options only: male or female. Similarly, either/or reactions also seem to be applied by people dealing professionally with issues of transsexualism, transgenderism or related statuses. For instance, the history of transsexualism is characterised by attempts to classify transsexual people hierarchically and descriptively. The primary intention was to discriminate between different types of transsexualism to prescribe hormonal and surgical treatment for 'real' transsexual people and to recommend psychotherapy aiming at relieving gender dysphoria for all the others. In this regard, from the early beginnings sexologists have argued about the origins of transsexualism, because the type of origin -the professionals assumed -legitimises a specific kind of treatment, for example psychotherapy for psychological issues and somatic cross-sex treatment for biological issues. Consequently, psychoanalysts and biologically orientated professionals have debated at great lengths about state-of-the-art treatment for transsexual people. Furthermore, to pass as a 'real' transsexual, most of the people concerned presented themselves in a very schematic way.The main focus of this article is the long-standing history of either/or reactions in health care professionals dealing with issues of transsexualism and related states. In addition, it elaborates on the iatrogenic influence on the behaviour of transsexual people of the biases of health care professionals. Finally, in highlighting perspectives of recent trans theory, conclusions important for the debate of current issues are drawn and ideas for the future of care are developed.

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“…In this context, many transgender communities demand the "depathologization" of the condition, i.e., replacing its categorization as a "mental disorder" with the classification as a "neurological," "intersex," or "medical" condition, or even removing it entirely from both DSM-V and ICD-11 [34]. The purpose of this chapter is to examine the evidence supporting the interpretation of GID as an intersex condition.…”

mentioning

confidence: 96%

Transsexualism (“Gender Identity Disorder”) – A CNS-Limited Form of Intersexuality?

Meyer‐Bahlburg

2011

Advances in Experimental Medicine and Biology

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Major scientific societies (including the Endocrine Society [16]) as well as public health authorities of various countries are reexamining transsexualism -or, more broadly, gender identity disorder (GID; [1]) -regarding diagnostic categorization, etiology, clinical management, and human rights considerations. In this context, many transgender communities demand the "depathologization" of the condition, i.e., replacing its categorization as a "mental disorder" with the classification as a "neurological," "intersex," or "medical" condition, or even removing it entirely from both DSM-V and ICD-11 [34]. The purpose of this chapter is to examine the evidence supporting the interpretation of GID as an intersex condition.In terms of behavioral or psychological presentation, persons with early-onset GID have much in common with individuals with somatic intersexuality -now subsumed under the category disorder of sex development (DSD; [18]) -who want to change their gender. From early on, they perceive an incongruence between their experienced/expressed gender and their assigned gender and frequently also their sexual anatomy, which may become strong enough to warrant a gender reassignment. However, by definition, individuals with non-DSD GID show no symptoms of somatic intersexuality, and their sex hormone levels appear normal for their assigned gender and age, except for about one-third of natal females with non-DSD GID who have moderately increased androgen levels in the range of hirsute women without genital ambiguity [7,29]. Moreover, findings from studies of peripheral sex steroidrelated nucleotide polymorphisms of steroid receptor or steroid enzyme genes in persons with non-DSD GID [3,4,15,17,33] have been inconsistent or negative.The interpretation of GID as a CNS-limited form of intersexuality would need corroboration by one or more of several lines of evidence, among these (1) genetically based systemic prenatal sex hormone abnormalities that do not markedly affect the reproductive anatomy, but nevertheless influence brain and behavior; (2) abnormal sex hormone levels in the developing brain or respective CNS-limited hormone receptor defects; (3) abnormalities in the genes that interact with sex hormones to bring about the sexual differentiation of the brain; and (4) abnormalities of the neuroanatomic structures that underlie normative sex differences in gendered behavior.While normative sex differences in the neuroanatomy of the human brain are pervasive on diverse structural levels [9,21], the mechanisms of masculinization, feminization, demasculinization, and defeminization of the human brain are not yet well understood. It is clear from extensive research on non-human mammals that both genetic and hormonal factors play a significant role in the sexual differentiation of the brain. For instance, 4,508 genes are actively transcribed in the mouse brain; among these, 257 genes are more highly expressed in males and 355 in females [36]. Most sex-related genes are steroid dependent, but some are independent [10,3...

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Opinions About theDSMGender Identity Disorder Diagnosis: Results from an International Survey Administered to Organizations Concerned with the Welfare of Transgender People

Cited by 53 publications

References 9 publications

From Mental Disorder to Iatrogenic Hypogonadism: Dilemmas in Conceptualizing Gender Identity Variants as Psychiatric Conditions

From Mental Disorder to Iatrogenic Hypogonadism: Dilemmas in Conceptualizing Gender Identity Variants as Psychiatric Conditions

Tertium non datur– either/or reactions to transsexualism amongst health care professionals: the situation past and present, and its relevance to the future

Transsexualism (“Gender Identity Disorder”) – A CNS-Limited Form of Intersexuality?

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