Update: 2012 Submission to the APA on the DSM-5 Draft
In June 2012, OII Australia, together with OII Aotearoa/NZ released a submission to the American Psychiatric Association (APA), regarding the draft Diagnostic and Statistical Manual of Mental Disorders, 5th edition. It extends this position statement, and presents research justifying our position.
Our 2010 position statement, now superseded, follows for reference.
February 2010 Position Statement
- The American Psychiatric Association (APA) is currently rewriting the Diagnostic and Statistical Manual (DSM). This will be its fifth full revision. http://www.dsm5.org/Pages/Default.aspx
- The DSM sets out the diagnostic criteria for all mental illness recognized by the APA.
- Countries outside America use the DSM widely. Australia is one such country. Australian psychiatrists contribute to the DSM and use it as their standard for diagnosis.
- There is no Australian equivalent to the DSM.
- The World Health Organisation also has a diagnostic manual that lays down criteria for mental illness diagnoses. It is called the ICD and is in its tenth revision. http://apps.who.int/classifications/apps/icd/icd10online/
- The ICD 10 has significant differences to the DSM in the classification of some mental disorders. The diagnoses of intersex and transsexualism are two areas where the ICD 10 and the DSM V have significant differences in diagnostic criteria and treatment recommendations.
- Previous versions of the DSM have diagnosed homosexuality (both gay and lesbian) as a mental disorder. This classification was not removed from the DSM by the APA until 1986 despite some other associations removing it as a disorder as early as 1973. http://en.wikipedia.org/wiki/Homosexuality_and_psychology http://psychology.ucdavis.edu/rainbow/HTML/facts_mental_health.HTML
- Transsexualism was included in the DSM in its third revision DSM III as Gender Identity Disorder (GID), and another category was also created in that revision, Gender Identity Disorder Not Otherwise Specified (GIDNOS).
- Intersex individuals cannot be diagnosed as suffering from GID under current guidelines because of “Criterion C: Not Due to an Intersex Condition” (DSM IV page 1081)
- GIDNOS was used in the DSM to diagnose intersex individuals who rejected their birth assignment as suffering from a thought disorder.
- The revision of the DSM now classifies transsexualism as Gender Incongruence. This is thought to be less stigmatizing than “disordered.” http://www.springerlink.com/content/p64152610v67k476/
- Gender Incongruence has three types in the revision.
- Gender Incongruence in Children – http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=192
- Gender Incongruence in Adults – http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=193
- Gender Incongruence not otherwise specified. This is a work in progress. http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=194
- The revision of the DSM continues to pathologize intersex individuals who have rejected their birth assignment as suffering from a thought disorder.
- The DSM V revision goes further than DSM IV as describing intersex as being a Disorder of Sex Development. This despite rejecting “disorder” and using “incongruence.” Because the former is thought to be pathologizing the DSM proposes to “disorder” sex differences rather than call them intersex as they have done in previous versions. (From the draft proposals Subtypes “with a Disorder of Sexual development” ” Without a Disorder of Sexual Development”) http://www.springerlink.com/content/p64152610v67k476/
OII Australia’s Comments:
- OII Australia considers the revision of the DSM to be less acceptable than its predecessor the DSM IV.
- DSM IV was unacceptable to intersex and to OII Australia.
- All versions of the DSM have pathologised intersex who reject their birth assignment or who do not adopt a sex and/or gender binary identity.
- The DSM blames the assigned not the assignor for the rejection of birth assignments. That is, the assigning doctor is never wrong despite the child being born intersex and the sex of the child being unknown. If the child later disagrees with the verdict of the assigning doctor they will be diagnosed with a thought disorder.
- DSM continues to regard unusual bodies and non-conforming sex and/or gender behaviour as at least problematic and consistently as disease. This is in keeping with the DSM’s traditional understanding of sex binary heterosexual relationships as being normal. The APA has run rabid over human sex, sexuality and gender diversity, screaming “disease.”
- The primary mental health issue for intersex is trauma caused by exclusion, marginalization and pathologization of our difference. No version of the DSM attempts to address this.
- The DSM now uses the pathologizing DSD language of the Chicago Conference. The DSM does this despite concluding that Gender Identity Disorder is too stigmatizing. http://www.springerlink.com/content/p64152610v67k476/
Michelle O’Brien, OII international board member, comments:
What is happening here is that people who have (or have been treated for) a ‘Disorder of Sex Development’, and who reject their assignment are now pulled into the main category of GID, as one of two subtypes, people with DSD, as opposed to people without DSD. It is interesting that the rejection of assignment is identified, rather than specific wish/need to live as the ‘other’ gender.
I guess in terms of treatment, this may make some people’s lives easier – if they have a positive desire/will to live as the gender other than that assigned them. On the other hand, people who hated the gender they were assigned, but are as equally uncomfortable as the ‘other’ gender, possibly wishing they didn’t have to deal with all this gender BS anyway, are left in a precarious position.
They reject the assignment made, but in that rejection, if it is not a positive choice for another gender, the treatment options are unclear. Not that there may necessarily need to be treatment. Nevertheless, they get a GID diagnosis. Yet there is no acceptance that if this is a disorder (I personally do not think it is a disorder that rejects a non-consensual gender assignment), it is an idiopathic disorder which arises from misassignment and failure to conform to the reinforcement of that gender.