Gender identity disorder
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| Gender Identity Disorder | |
| Classification and external resources | |
| ICD-10 | F64.9., F64.8. |
|---|---|
| ICD-9 | 302.85 |
| MedlinePlus | 001527 |
| MeSH | D005783 |
| Transgender topics |
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| Identities |
| Androgyne · Genderqueer · Hijra Third gender / Third sex Transgender · Transman Transwoman · Two spirit · Queer heterosexual |
| Topics |
| Bigender · Cross-dressing Intersexuality · Questioning Transsexualism Gender identity disorder (more) |
| Attitudes |
| Transphobia Gynephilia and androphilia |
| Legal issues |
| Access to amenities |
| Lists |
| LGBT-related films People · Topics |
| Transgender portal |
Gender identity disorder (GID) is the formal diagnosis used by psychologists and physicians to describe persons who experience significant gender dysphoria (discontent with the biological sex they were born with). It is a psychiatric classification and describes the attributes related to transsexuality, transgender identity, and transvestism. It is the diagnostic classification most commonly applied to transsexuals.
Gender identity disorder in children is usually reported as "having always been there" since childhood, and is considered clinically distinct from GID which appears in adolescence or adulthood, which has been reported by some as intensifying over time.[1] Since many cultures strongly disapprove of cross-gender behavior, it often results in significant problems for affected persons and those in close relationships with them. In many cases, discomfort is also reported as stemming from the feeling that one's body is "wrong" or meant to be different.
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[edit] Diagnostic criteria
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The examples and perspective in this article deal primarily with North America and do not represent a worldwide view of the subject. Please improve this article or discuss the issue on the talk page. |
In the United States, the American Psychiatric Association permits a diagnosis of gender identity disorder if four diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, 4thEdition, Text-Revised (DSM-IV-TR) are met. These criteria are:
- Strong and persistent cross-gender identification [...]
- Persistent discomfort about one's assigned sex or a sense of inappropriateness in the gender-role of that sex [...]
- The diagnosis is not made if the individual has a concurrent physical intersex condition.
- Clinically significant distress or impairment in social, occupational, or other important areas of functioning.
If the four criteria are met under the DSM-IV-TR, a diagnosis is made under ICD-9 code 302.85. See the classification and external resources sidebar at right for other diagnostic codes for gender identity disorder.
[edit] Treatment
The World Professional Association for Transgender Health (WPATH, formerly HBIGDA) Standards of Care (Version 6 from 2001) are considered by some as definitive treatment guidelines for providers. Other Standards exist (see those discussed in Standards of care for gender identity disorders, including the guidelines outlines in Gianna Israel and Donald Tarver's classic 1997 book "Transgender Care". Several health clinics in the United States (e.g. Tom Waddell in San Francisco, Callen Lorde in New York City, Mazzoni in Philadelphia) have developed “protocols” for transgender hormone therapy following a “harm reduction” model which is coming to be embraced by increasing numbers of providers. In their 2005 bookMedical Therapy and Hormone Maintenance for Transgender Men, Dr. Nick Gorton et al. suggest a flexible approach based in harm reduction, “Willingness to provide hormonal therapy based on assessment of individual patients needs, history and situation with an overriding goal of achieving the best outcome for patients rather than rigidly adhering to arbitrary rules has been successful.” (See External Links below.)
Formal gender clinics for individuals seeking medical sex reassignment began operating in the 1960s and 1970s, leading to long-term follow-up studies that began appearing in the research literature in the 1980s and 1990s. These studies have examined transsexuals who received clinical approval to undergo reassignment and proceeded to do so.[2][3] The great majority of patients who met clinics' screening criteria reported being satisfied in the long-term with the results.
[edit] Prepubescent children
The question of whether to counsel young children to be happy with their biological sex, or to encourage them to continue to exhibit behaviors that do not conform to gender stereotypes — or to explore a transsexual transition — is controversial. Some clinicians report a significant proportion of young children with gender identity disorder no longer have such symptoms later in life.[4]
[edit] Controversy
Many transgender people do not regard their cross-gender feelings and behaviors as a disorder. People within the transgender community often question what a "normal" gender identity or "normal" gender role is supposed to be. One argument is that gender characteristics are socially constructed and therefore naturally unrelated to biological sex. This perspective often notes that other cultures, particularly historical ones, valued gender roles that would presently suggest homosexuality or transsexuality as normal behavior.[5] Some people see "transgendering" as a means for deconstructing gender. However, not all transgender people wish to deconstruct gender or feel that they are doing so.
Other transgender people object to the classification of GID as a mental disorder on the grounds that there may be a physical cause, as suggested by recent studies about the brains of transsexual people. Many of them[who?] also point out that the treatment for this disorder consists primarily of physical modifications to bring the body into harmony with one's perception of mental (psychological, emotional) gender identity, rather than vice versa.[6]
Although evidence suggests that transgender behavior has a neurological basis, there is no scientific consensus on whether the etiology of transgenderism is mental or physical.[7]
In a landmark publication in December 2002, the British Lord Chancellor's office published a Government Policy Concerning Transsexual People document that categorically states "What transsexualism is not...It is not a mental illness."[8] In May 2009 the government of France has also declared that a transsexual gender identity is not a psychiatric condition in France. [9]
Some people[10] feel that the deletion of homosexuality as a mental disorder from the DSM-III and the ensuing creation of the GID diagnosis was merely sleight of hand by psychiatrists, who changed the focus of the diagnosis from the deviant desire (of the same sex) to the subversive identity (or the belief/desire for membership of the opposite sex/gender).[11] People who believe this tend to point out that the same idea is found in both diagnoses, that the patient is not a "normal" male or female. As Kelley Winters (pen-name Katharine Wilson), an advocate for GID reform put it, "Behaviors that would be ordinary or even exemplary for gender-conforming boys and girls are presented as symptomatic of mental disorder for gender nonconforming children."[7] However, Zucker and Spitzer[12] argue that GID was included in the DSM-III (7 years after homosexuality was removed from the DSM-II) because it "met the generally accepted criteria used by the framers of DSM-III for inclusion".
The GID controversy figured prominently at the 2009 meeting of the American Psychiatric Association in San Francisco, both in presentations in the meeting and in protests outside the meeting; protesters focused on the attitude of the psychiatric community and tried to make the point that GID is not a mental disorder, as well focusing on the role of Kenneth Zucker in leading the DSM-V Task Force on Sexual and Gender Identity Disorders.[13]
[edit] See also
[edit] References
- ^ Nangeroni, Nancy (1996-11). "Medical Dictionary Gender Identity Disorder: What To Do?". GenderTalk. http://www.gendertalk.com/articles/oped/gid_tnt.shtmlDorlands Medical Dictionary. Retrieved on 2008-09-16.
- ^ Green, R., & Fleming, D. T. (1990). Transsexual surgery follow-up: Status in the 1990s. Annual Review of Sex Research, 1, 163–174.
- ^ Gijs, L., & Brewaeys, A. (2007). Surgical treatment of gender dysphoria in adults and adolescents: Recent developments, effectiveness, and challenges. Annual Review of Sex Research, 18, 178-224.
- ^ Spiegel, Alix (2008-05-08). "Q&A: Therapists on Gender Identity Issues in Kids". NPR. http://www.npr.org/templates/story/story.php?storyId=90229789. Retrieved on 2008-09-16.
- ^ Park, Pauline; John Manzon-Santos (2000-10). "Issues of Transgendered Asian Americans and Pacific Islanders". http://www.apiwellness.org/article_tg_issues.html. Retrieved on 2008-09-16.
- ^ "HBIGDA Standards Of Care For Gender Identity Disorders, Sixth Version" (PDF). Standards Of Care For Gender Identity Disorders. Harry Benjamin International Gender Dysphoria Association. 2001-02. http://www.wpath.org/Documents2/socv6.pdf.
- ^ a b Winters, Kelley (2007-09-30). "Issues of GID Diagnosis for Transsexual Women and Men" (PDF). GID Reform Advocates. http://www.gidreform.org/GID30285a.pdf. Retrieved on 2008-09-16.
- ^ "Government Policy concerning Transsexual People". People's rights / Transsexual people. U. K. Department for Constitutional Affairs. 2003. http://www.dca.gov.uk/constitution/transsex/policy.htm.
- ^ "La transsexualité ne sera plus classée comme affectation psychiatrique". Le Monde. 16 May 2009. http://www.lemonde.fr/societe/article/2009/05/16/la-transsexualite-ne-sera-plus-classee-comme-affectation-psychiatrique_1193860_3224.html.
- ^ Arlene Istar Lev (2004). Transgender Emergence: Therapeutic Guidelines for Working with Gender-Variant People and Their Families. Haworth Press. p. 172. ISBN 9780789021175. http://books.google.com/books?id=LwxvazLRmiEC&pg=PA172&dq=homosexuality+dsm-iii+transsexuality&lr=&as_brr=3&as_pt=ALLTYPES&ei=UYgTSpCcGZmalQSVhYTVCQ.
- ^ Rudacille, Deborah (February 2005)). The Riddle of Gender: Science, Activism, and Transgender Rights. Pantheon. ISBN 978-0375421624.
- ^ Zucker KJ, Spitzer RL, 2005, "Was the gender identity disorder of childhood diagnosis introduced into DSM-III as a backdoor maneuver to replace homosexuality? A historical note."Journal of Sex and Marital Therapy 2005 Jan-Feb;31(1):31-42
- ^ Lois Wingerson (May 19, 2009). "Gender Identity Disorder: Has Accepted Practice Caused Harm?". Psychiatric Times. http://www.psychiatrictimes.com/display/article/10168/1415037.
[edit] External links
- Standards of Care for Gender Identity Disorders - published by the Harry Benjamin International Gender Dysphoria Association, includes a description of ICD-10 criteria.
- Health Law Standards of Care for Transsexualism An alternative to the Benjamin Standards of Care proposed by the International Conference on Transgender Law and Employment Policy.
- THE LORD CHANCELLOR'S DEPARTMENT Government Policy concerning Transsexual People
- Gender Identity Disorder & Transsexualism - Synopsis of Etiology in Adults provides an alternative to the current classifications of psychiatric disorder and mental illness.
- Conway, Lynn: "Successful Transwomen" and "Successful Transmen" -Lynn Conway's "Success Pages".
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