WPATH (the World Professional Association for Transgender Health) has posted its formal response to the APA’s proposed DSM 5 Criteria – here’s the direct link to the 9-page PDF.
The document points out the following aspects it considers to be “improvements” in the proposed revisions:
- The change in name from Gender Identity Disorder to Gender Incongruence is an improvement. It is less pathologizing as it no longer implies that one’s identity is disordered.
- The proposed criteria are better able to account for the diversity in gender and transgender identities encountered in clinical practice, reflecting the paradigm shift away from a binary understanding and treatment approach toward affirmation of a spectrum of transgender identities.
- Criterion 1, “a strong desire to be of the other gender or an insistence that he or she is of the other gender,” is proposed as required in order to qualify for a diagnosis of Gender Incongruence in Children. This will appropriately prevent children with a gender variant expression without an incongruence between gender identity and sex assigned at birth to receive the diagnosis, which was a common point of critique for DSM IV. […]
- Adding a specifier of “with or without a Disorder of Sex Development” is an improvement over the need to use the “Not Otherwise Specified” diagnosis because individuals with intersex conditions may have a similar experience regarding their gender identity and desire corresponding treatment interventions. In DSM IV-TR, individuals with intersex conditions are specifically excluded from the unqualified diagnosis.
- The removal of the specifier of sexual orientation is a welcome change, acknowledging that gender identity and sexual orientation are two separate components of identity that are often conflated […]
- The proposed diagnosis includes an “exit clause” so that individuals who have successfully resolved their incongruence no longer are considered to have a mental disorder.
WPATH’s criticisms include:
- Inclusion or Removal of the Diagnosis: The discussion whether a diagnosis of Gender Identity Disorder or Gender Incongruence should be included in the DSM or not is not addressed on the APA web site with the proposed revision and its rationale. One of the major arguments put forth by consumer groups for removal of the diagnosis, is that it is not a mental disease or disorder, and that classifying gender variance as such perpetuates stigma attached to gender nonconformity. […]
- Diagnostic Criteria: We generally agree with the accuracy of the wording of the six criteria proposed for adolescents or adults. However, we have a concern about the very broad reach of the criteria. Although an explanation is offered for why only two of the six criteria are needed to fulfil the diagnosis of Gender Incongruence, the need for such a broad definition without a clear link to treatment is questionable. […] Instead of broadening the diagnosis, the WPATH Consensus Group recommends a narrowing of the diagnosis to those who experience distress associated with gender incongruence (Knudson, De Cuypere, & Bockting, in press). […]
- Separate or Combined Diagnoses for Adolescents and Adults: Because, from a clinical perspective, the challenges faced by adolescents are sufficiently different from either children or adults, the WPATH Consensus Group recommended separate diagnostic categories for adolescents and adults rather than combining them, which is currently the case in DSM IV-TR with no change proposed for DSM 5. If these diagnoses will indeed remain combined, we strongly recommend that at least the text draws special attention to the issues faced by adolescents and how these differ from those faced by adults.
- Name of the Diagnosis: Given the above discussion and WPATH’s recommendation for diagnoses based on distress instead of identity, it should come as no surprise that we favor changing the name of the diagnoses from Gender Identity Disorders to Gender Dysphoria. While we think the proposed new name of Gender Incongruence is an improvement, we prefer the term Gender Dysphoria to reflect that a diagnosis is only needed for those transgender individuals who at some point in their lives experience clinically significant distress associated with their gender variance. Moreover, the term incongruence implies that congruence is the norm and that incongruence is per definition problematic, which is not necessarily the case. […]
- Location of the Diagnoses within DSM: The place of the proposed diagnoses in the nomenclature is still unknown and under consideration. Placing Gender Incongruence under “Other Conditions that May be a Focus of Clinical Attention,” as Meyer-Bahlburg (2010) suggested, as long as this does not endanger health insurance coverage of transgender-specific health care, would go a long way in alleviating the criticism of professionals and consumers who advocate depathologization of gender variance and gender variant identities. The WPATH Consensus Group recommends that the diagnosis not be placed with the sexual disorders. We suggest two alternatives: Placement in a chapter of Psychiatric Disorders Related to a Medical Condition (which might ensure better health insurance coverage of transgender-specific medical interventions) or placement in a chapter on childhood-onset disorders (Knudson, DeCuypere, & Bockting, in press).
I read the conclusion of the WPATH Consensus Group for revision of the DSM diagnoses of Gender Identity Disorders as being quite critical; it seems to be saying that the proposals are more stylistic than substantive, and that “the proposed diagnostic criteria are now so broad that almost any transgender person could meet criteria for a mental disorder regardless of whether or not they experience clinically significant distress and desire or need intervention“. The WPATH report views this as a bad thing because it’s likely to pathologise more rather than fewer transgender people.
Cross-posted at Questioning Transphobia