Monday 2 March 2009

Developments at the APA

The Annual American Psychiatric Association Meeting will be held in March May this year. From Psychiatric News February 20, 2009 Volume 44, Number 4, page 13:
The remaining symposium, "In or Out? A Discussion About Gender Identity Diagnoses and the DSM," will focus on diagnostic issues specific to gender identity disorder, particularly the issues of having gender identity disorder listed in DSM-V and the implications of removing it. Several leaders in the transgender community will speak at this symposium.
And from the program:
S6. "In or Out?": A Discussion About Gender Identity Diagnoses and the DSM (DSM Track DM03)

1. The DSM-V Revision Process: Principles and Progress William E. Narrow, M.D.
2. Beyond Conundrum: Strategies for Diagnostic Harm Reduction Kelley Winters, Ph.D.
3. Aligning Bodies With Minds: The Case for Medical and Surgical Treatment of Gender Dysphoria Rebecca Allison, M.D.
4. The Role of Medical and Psychological Discourse in Legal and Policy Advocacy for Transgender Persons in the U.S. Shannon P. Minter, J.D.
Does a condition that manifests as severe psychological distress, but which can be cured only through physical rather than psychiatric intervention really belong in a psychiatric diagnostic manual? The distress is real, and the dysfunction until treatment is given very real, even life-threatening. But what if the condition is actually biological?

There's something even more interesting from my viewpoint, and potentially of at least equal significance:
S10. The Neurobiological Evidence for Transgenderism

1. Brain Gender Identity Sidney W. Ecker, M.D.
2. Transsexuality as an Intersex Condition Milton Diamond, Ph.D.
3. Novel Approaches to Endocrine Treatment of Transgender Adolescents and Adults Norman Spack, M.D.
Dr Ecker was kind enough to draw my attention to this, and the bibliography he sent me will keep me busy for some time. Too bad my PhD's in Computer Science and not NeuroBiology. If it was, I'd have a pretty good beginning of a thesis by now. I'd also be able to attend the meeting, and these two symposia.

Oh well, back to these pesky genetic algorithms, instantiating generics and all the rest. Life's too short!


Anonymous said...

Some more anecdotal evidence from a person who just underwent the surgery--it works! And it appears to have worked for the others I encountered during my convalesence.

MgS said...

Even if we determine that transsexualism in general has biological roots, it makes little sense to me to remove a working definition of it from the DSM.

As Zoe points out, the condition's manifestation is psychological distress, and its treatment is not entirely so.

BUT - dealing with the internal stresses and coping mechanisms that evolve in transsexuals who are trying to succeed in their birth sex is a psychological matter.

AND - the reality is that the primary diagnosis and entry point into treatment will be through the mental health world for the foreseeable future.

Removal from the DSM would leave a vacuum since we have no other diagnostic tool that describes the condition meaningfully. (and, I suspect that a biological test wouldn't necessarily be sufficient to determine if an individual needs to transition or not)

I also see no compelling reason to remove a term from the lexicon which is a key starting point for communication between mental health and physicians who provide the medical care that is such an integral part of the treatment.

Bad hair days said...

Replace Gender Identity Order
Distress from being wrong bodied

GID is defintly a very false diagnosis. First you have to prove you have a constant and working GID, that its that its disordered - by looking at the body. So a mental diagnosis is done by looking at the body. Its wrong in two ways, and that is a fact indipendent of the biological roots. Its just logic.

MgS said...


What you are talking about is a change of nomenclature, which is quite different from delisting.

The wording used in the DSM has changed multiple times since the initial introduction of transvestism in the catalog. Those changes have been in response to clinicians learning that the existing categorizations are inadequate. For example, the previous definition of 'Transsexual' in the DSM III excluded a lot of people who have in fact transitioned. As of the DSM IV, the much broader GID diagnostic category was put in place to attempt to describe a broad range of gender identities outside of the male/female binary.

For a transsexual, there are aspects of the GID diagnosis that do not fit, but we have to recognize that the category is broader than just transsexuals.

Bad hair days said...

No. At least I didn't intend it to be just that.
In the actual wording the cause is called mental.

What I claim is that there is suffering from that (TS), that one could call psychological and that the diagnosis is to that suffering. And the cure to that suffering is hormons, epilation, voice training and grs.

But when it comes to me I'm perfectly OK with getting it completely out of DSM and find a better place and wording then "personality disorder" in the ICD 11.

Anonymous said...

The links say May, not March. Where is it being held?

Unknown said...

As Magnesium Sulfide wrote: “Removal from the DSM would leave a vacuum since we have no other diagnostic tool that describes the condition meaningfully.”

I beg to differ an submit that is not only false but scaremongering intended to intimidate the already cowed. The simple fact is that suitable diagnoses already exist and what is stopping them from being used is mostly the existence of this inappropriate diagnosis written into legitimacy by WPATH and its forebears.

Both somatic (of the body) and psychological (of the mind) diagnoses already exist and there is no need to wait for neurological (of the brain) diagnoses to be developed:

On the somatic side, for transmen we have such ICD-10 diagnoses as N62 Hypertrophy of breast (Gynecomastia ). Transmen typically have morbid breast development, to say they do not is to deny their manhood. Mastectomy is indicated.
On the somatic side, for transwomen we have such ICD-10 diagnoses as Q52.0, Congenital absence of vagina. Any woman born without a vagina, trans or non-trans, need this diagnosis and the association surgical correction.
On the psychological side we have such DSM-IV-TR diagnoses as 995.53 and 995.83 Victim of sexual abuse of child and of adult respectively. Being raised in a wrong gender is sexual abuse, how can anyone suggest that it is not sexual or not abuse? The diagnosis says nothing about whether the abuse is intentional or avoidable.

Which of course begs the issue of “Which gender is the wrong gender?”, to which the response is: The gender (or sex if you wish) of interest here is not the legal sex or social sex, not even the scientific sex, but rather the MEDICAL SEX. And what is a person’s medical sex then? Answer- it is the sex assigned by a medical professional to that person. And what sex does the medical profession assign, and by what criteria? And now we have dug down to the kernel, the real root of the issue. For presently the medical sex is assigned rather like a person’s blood group – on the basis of biological science - which is admittedly enormously complex. But medicine SHOULD serve the interests of the patient, not the interests of science, still less the interests of the medical practitioners.
In short medicine should give transmen a MEDICAL SEX of male and transwomen that of female. FOR NO MORE REASON THAN BECAUSE IT IS IN THE INTEREST.OF THE PATIENT’S HEALTH TO DO SO.

Is it too much to ask that the medical profession serve patients rather than serve science or their own paychecks? Why of course it is not, the only things standing in the way of decent treatment for transfolk are bogus theories about GID and its presence in the DSM. Proven effective medical treatments are not going to be abandoned merely because some charlatan psychobabble theories are debunked.