Gender and the DSM-IV

Many people who read my blog already know, and agree with, the criticisms of the DSM-IV’s treatment of Gender Identity Disorder as a diagnosis. On the one hand, its existence provides a name for something that many people struggle with namelessly, and it can sometimes aid people in accessing help. On the other hand, people are sometimes denied treatment because of the diagnosis and it can add to the stigma in the same way that having homosexuality in the DSM-IV used to add to the stigma of being queer.

However, I was looking at how fucked up and ridiculous the actual language of the diagnosis is today, in terms of people who identify as genderqueer or who otherwise don’t want to “pick a side”:

1. “A strong and persistent cross-gender identification with the opposite gender (aside from desiring any perceived cultural advantage of being the other gender).”

So a person who doesn’t identify with their biological sex but doesn’t identify with the “other” gender does not meet this criteria. Somehow I think that leaves out a large segment of the population the diagnosis is trying to cover.

2. “Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex.”

So the woman who feels uncomfortable being a housewife or a man feeling uncomfortable playing football because of the stereotypical association of these jobs could be diagnosed with GID? Somehow I think that isn’t the population the diagnosis is trying to cover. Or if it is, it is so broad as to potentially include much of the country.

3. “The disturbance is not concurrent with a physical intersex condition.”

OK, fair enough.

4. “The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.”

Which is really the whole point of having a diagnosis in the first place. Any diagnosis. But the problem is, the nature of the DSM-IV is about diagnosing what’s wrong with people, not what’s wrong systemically. Taking GID out could mean people have a harder time “proving” their need to take hormones or have surgery, but leaving the current definition in is not an option because it fails to do what it is supposed to: help identify and label an issue that many people struggle with in a nonjudgmental and culturally appropriate way.

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~ by realsupergirl on March 18, 2009.

3 Responses to “Gender and the DSM-IV”

  1. Interesting.

    It seems that it would be frustrating that having GID in the DSM could be a very useful tool, but that it also proves to be a weapon. What’s that Ani quote? “Every tool can be a weapon if you hold it right.”?

    Curious how/why the diagnosis is a basis for the denial of treatment.

    This is a nice little summary of the problem, but any suggestions for a solution? Thoughts?

  2. as for how it can lead to denying treatment – if insurance companies see it they have been known to drop people from their insurance plan, out of the fear that they will be asked to pay for hormone treatment etc. This obviously doesn’t apply to employer-provided plans.

    I think that one solution is to move the diagnosis out of the realm of mental health entirely and make it an ICD-9 (medical) diagnosis. That would make doctors (hopefully endocrinologists trained in gender issues) the “gatekeepers” of accessing treatment.

    Another solution would be to eliminate the diagnosis entirely, but my fear here would be providers might actually be too quick to want to charge people or insurance for expensive treatment without fully explaining the risks, benefits and options. It would also completely deregulate which treatments are encouraged and discouraged, which means the more expensive ones are likely to be pushed even if they are not the safest.

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