APA modifies Gender Identity Disorder diagnosis

Dana Beyer (Washington Blade photo by Michael Key)

Advocates welcomed the American Psychiatric Association’s decision on Saturday to remove Gender Identity Disorder from its list of mental disorders.

The APA specifically removed GID from the Diagnostic and Statistical Manuel (DSM) of Mental Disorders and replaced it with Gender Dysphoria.

The organization, which represents more than 36,000 psychiatrists from around the world, has revised the DSM five times since it was founded in 1844. The latest revision process began 15 years ago.

Transgender activist Dana Beyer, who worked on the task force that wrote the new language the APA adopted with the Washington Psychiatric Society, said the removal of GID from the DSM is comparable to the organization’s declassification of homosexuality as a mental illness in 1973.

“What we did in that workgroup and what other activists have been pushing for is reconceptionalizing the state of being trans from a mental illness,” she told the Washington Blade. Beyer added this change will have implications for children who see a therapist for GID to trans activists fighting against what she described as “fundamental opposition” in state legislatures. “We are no longer mentally ill and that has huge implications just as it did for homosexuality in 1973. It’s absolutely game-changing.”

Michael Silverman, executive director of the New York-based Transgender Legal Defense and Education Fund, said opponents of trans rights often used the term “disorder” as a “weapon to deny transgender individuals equal rights and equal treatment.” Doctor Jillian Weiss of Ramapo University in New Jersey agreed as she described the DSM revisions as a “step in the right direction.”

Psychiatrists and other medical providers had begun to commonly diagnose trans patients with GID by the early 1990s — the APA added it to the DSM when it revised it for the third time in 1987. The diagnoses, however, remain controversial among some trans advocates.

Kelley Winters of the group GID Reform Advocates told the Blade the change in title from Gender Identity Disorder to Gender Dysphoria signifies the “problem to be treated is not the person’s identity,” but rather “the distress that is often experienced by those who need access to medical transition care.” She further noted the new terminology remains within what she described as a “manual of disorder.”

She also criticized the APA for not removing the “Transvestic Disorder” category she asserts remains defamatory to cross-dressers and transsexuals in a post on the Bilerico Project on Wednesday.

Winters welcomed, however, the move to change GID to Gender Dysphoria in the DSM.

“This change in title is significant because it actually signals a change of attitude within the APA that our gender identities are no longer considered the focus of pathology,” she told the Blade. “That change is not insignificant. It carries a message. Despite this forward progress, the sad fact remains that trans and especially transsexual folks needing hormonal or surgical transition care are still classified as mentally disordered.”

Advocates remain hopeful the proposed revisions will allow trans people to have increased access to quality health care.

“It is imperative that transgender people who experience dysphoria have access to medical care to treat it. Unfortunately, that has rarely been the case,” Silverman said. “As the American Medical Association has stated, the denial of medical care for patients with Gender Dysphoria is discriminatory and must be stopped.”

Weiss agreed.

“The term ‘disorder’ gave the impression that people with this condition had an illness that made them dangerous or incompetent,” she said. “Of course, there is much to say about this, and whether the change will impact medical and social practices remains to be seen.”