DSM-IV-TR on gender identity "disorder"

Some mental health trade groups currently consider women in our community to be mentally ill. It was not long ago that they also considered homosexuality a mental illness, and it took many years for academics and political activists to debunk all the bogus "science" and get this changed.

In 1973, the American Psychiatric Association voted to remove homosexuality from their Diagnostic and Statistical Manual of Mental Disorders (DSM).

Subsequently, a new diagnosis, "ego-dystonic homosexuality," was created for the DSM's third edition in 1980. This meant someone who had "distress" about their sexual orientation.

Gregory M. Herek, Ph.D. writes:

"The new diagnostic category, however, was criticized professionally on numerous grounds. It was viewed by many as a political compromise to appease those psychiatrists – mainly psychoanalysts – who still considered homosexuality a pathology. Others questioned the appropriateness of having a separate diagnosis that described the content of an individual's dysphoria. They argued that the psychological problems related to ego-dystonic homosexuality could be treated as well by other general diagnostic categories, and that the existence of the diagnosis perpetuated antigay stigma."

In 1986, the diagnosis was removed entirely from the DSM. The only vestige of "ego-dystonic homosexuality" in the revised DSM-III occurred under "Sexual Disorders Not Otherwise Specified," which included persistent and marked distress about one's sexual orientation.

The DSM 4th Edition (DSM-IV) was published in 1994, followed in 2000 by the DSM IV, Text Revision, or DSM-IV-TR. These editions include "transvestic fetishism" and "gender identity disorder" (GID) as disorders.

As Katherine Wilson, Ph.D. notes:

"Recent revisions of the DSM have made these diagnostic categories increasingly ambiguous, conflicted and overinclusive... The result is that a widening segment of gender non-conforming youth and adults are potentially subject to diagnosis of psychosexual disorder, stigma and loss of civil liberty."

The upcoming fight to depathologize gender variance

According to my sources, the DSM-V committees are scheduled to start meeting in 2006, and the projected date of publication of DSM-V is 2010.

For an excellent overview on the DSM's role in pathologizing sexual orientation, check out Facts About Homosexuality and Mental Health on the UC Davis website. There are many similarities in the way psychology views our condition, and it will be useful in creating a long-term strategy for working with progressive psychologists.

See Depathologizing gender identity by Welley Winters, Ph.D. for more on this.

Below are pages from the DSM-IV-TR for those of you who wish to see how these categories are descibed.


DSM entry on gender identity "disorder"


DSM entry on transvestic fetishism


DSM revision process