Removing Gender Identity Disorder from the Diagnostic and Statistical Manual of Mental Disorders: A Call for Action

In 2012, the American Psychiatric Association (APA) plans to release the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). In July 2007, APA named a 27-member task force to oversee development of the new edition, which will constitute the first major revision of the document's diagnostic categories since 1994. Gender identity disorder (GID) is probably the most widely contested diagnosis in the current DSM; APA's revision process provides social workers with the opportunity to weigh in on the debate about GID, and it is imperative that we do so. This diagnosis, which is used to justify "treatment" for gender-nonconforming children and for adults seeking sex-change surgery, has implications worldwide, given the influence of the DSM on other diagnostic tools, such as the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (2007). Social workers should support the elimination of GID from the DSM now, as we supported the declassification of homosexuality as a mental illness in the 1970s. Similar to the depathologization of homosexuality, removing GID from the DSM will have wide-ranging and liberatory effects for gender-nonconforming people currently labeled "gender disordered" and for standards of gender expression for the general population. The DSM diagnostic criteria define GID as follows: A. A strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex.) In children, the disturbance is manifested by four (or more) of the following: 1) repeatedly stated desire to be, or insistence that he or she is, the other sex; 2) in boys, preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing; 3) strong and persistent preferences for cross-sex roles in make-believe play or persistent fantasies of being the other sex; 4) intense desire to participate in the stereotypical games and pastimes of the other sex; 5) strong preference for playmates of the other sex. B. Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex. C. The disturbance is not concurrent with a physical intersex condition. D. The disturbance causes clinically significant distress or imPairment in social, occupational, or other important areas of functioning. (APA, 2000, p. 581) GID, HOMOSEXUALITY, AND PSYCHIATRY Gender identity consists of a complex system of beliefs about the subjective self in relation to masculinity and femininity, maleness and femaleness, and culturally prescribed roles assigned to those categories. Gender identity presents itself in gender expression (that is, how people outwardly express masculinity and femininity in everyday life), how people feel in relation to their physically sexed bodies, and how people perceive others' responses to their gender expressions. Because of institutionalized sexism, heterosexism, and homophobia, those whose gender identities do not conform to societal expectations often experience family difficulties, discrimination, bodily harm, underemployment and social isolation. The historical struggle to remove homosexuality from the DSM informs current efforts to eliminate GID. The diagnosis of GID in many ways replaced the "diagnosis" of homosexuality as a mechanism for regulating gender and sexuality in medical terms. For those who express same-sex sexual desire, the former DSM designation of homosexuality as a mental illness resulted in diverse oppressive outcomes. The direct impact of the psychiatric control of those identified as homosexual included, as Terry (1999) noted, "psychiatrists' inhumane use of psychopharmaceuticals, lobotomy, psychoanalysis, and aversion therapy" (p. 368). The diffuse impact of the medicalization of homosexuality continues in a multiplicity of forms of discrimination against gay, lesbian, and bisexual people, including in arguments against same-sex marriage and second-parent adoption. …