A select group of psychologists, psychiatrists and researchers is currently engaged in debate about diagnoses to include, delete and/or add to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which was last updated in 1994. Much of that debate revolves around terminology and definition as it relates to gender.
Ellen Schecter, Ph.D., clinical psychologist in private practice in Hanover, N.H., says, “Gender Identity Disorder (GID) is controversial already. Much like homosexuality being better understood as a normal variation rather than a disorder of individuals and hence removed from the DSM, many â€“ including me â€“ think of gender identity in the same way. The only purpose of keeping GID in the DSM that I can see is that it allows access to treatment. However, the ‘disorder,’ in my view, is the effect of gender non-conformity in a binary-gender society and gender dysphoria and not gender variance itself.”
Judith Bradford, Ph.D., director, Center for Population Research in LGBT Health and co-chair of The Fenway Institute, indicates that defining gender in relation to transgender individuals poses a significant challenge. “The old diagnosis of Gender Identity Disorder made it appear pathological to feel that your birth gender and experienced gender were not the same,” she says. Bradford believes that clinical terminology should allow for “gender expression or gender variance” rather than referring to “gender nonconformity,” a term that assumes a male/female standard that all should meet in order to be mentally healthy. “So the emergent and better mental health diagnosis would be difficulty in accepting one’s feelings about gender variance, rather than being transgender as a diagnosis in itself,” says Bradford.
Changing the definition of gender identity, however, raises concern among some behavioral health providers about the impact on insurance coverage for gender affirming surgery. Rhonda Linde, Ph.D., coordinator of Behavioral Health Training/chief psychologist at Fenway Health says, “Up until this point, a diagnosis of Gender Identity Disorder was the basis for authorization of the surgery. It is unclear how a change in classification may affect this coverage.”
Laura Edwards-Leeper, Ph.D., staff psychologist at the Gender Management Services Clinic (GeMS) Clinic at Children’s Hospital in Boston, works with the transgender population. She believes the DSM task force is heading in the right direction. “We should question if [a diagnosis] should be in the DSM and consider if it is a psychological issue at all,” she says. Edwards-Leeper says that, in many cases, mental health issues subside when a person receives treatment for medical conditions.
Work continues on refining the language and content for the DSM-V, which is expected to be published in May 2013 and is still in field trials, according to the American Psychiatric Association’s Web site.