Thursday, 18 February 2010

Is the APA Playing Politics With Sexual Disorder Definition?

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In mid-February, the American Psychiatric Association released the latest proposed changes to its Diagnostic and Statistical Manual of Mental Disorders (DSM), considered the “Bible” used by mental health professionals in diagnosing patients. In addition to providing a guide for mental health diagnosis, the DSM is crucial in helping third-party payers (insurance companies) determine what they will cover under health insurance policies.

According to a report on Focus on the Family’s website, significant among the proposed changes to the fifth edition of the DSM is the re-labeling of Gender Identity Disorder (GID), also known as transsexualism, to “Gender Incongruity.” A diagnosis dictionary on the website explains that GID occurs “when a person feels as if their biological gender doesn’t accord with who they feel themselves to be,” and is defined by “strong, persistent feelings of identification with the opposite gender and discomfort with one’s own assigned sex.”

The present DSM defines Gender Identity Disorder as a “strong and persistent cross-gender identification,” while the proposed change would remove the term “disorder” and define it as a “marked incongruence between one’s experienced/expressed gender and assigned gender.”

While to the layman’s mind the proposed change may seem like a “distinction without a difference,” some critics argue that the proposal is part of a strategy designed to normalize sexual behaviors that stable societies have traditionally considered aberrations. They note that in 1973, after intense pressure from homosexual activist groups, the APA voted to remove homosexuality from sexual disorders listed in the DSM. More recently, homosexual activists — who now prefer the moniker GLBT (for gay, lesbian, bisexual, and transgender) — insist that labeling transsexualism as a “disorder” is demeaning to a "transgendered” person, and possibly even a violation of his civil liberties.

One such lobbying group, known as the GID Reform Advocates (, argues that diagnosing a sexual deviation as a “disorder” serves only to “reinforce false, negative stereotypes of gender variant people” while failing to “legitimize the medical necessity of sex reassignment surgeries (SRS) and procedures for transsexual women and men who urgently need them.”

One of the foundational issues in the push to downgrade the diagnosis and remove the “disorder” label from transsexualism is concern among “transgendered” individuals that they may lose access to “sex reassignment” procedures — also known as sex-change operations. But the folks at GID Reform Advocates insist that such concerns are unfounded. “In truth,” they insist, “transsexual individuals are poorly served by a diagnosis that both stigmatizes them unconditionally as mentally deficient and undermines the legitimacy of sex reassignment procedures that have been easily dismissed as 'elective' and 'cosmetic' by insurers, governments, and employers.”

Advocates for GID re-classification assure those suffering from transsexual issues that the reform they seek will have the double effect of removing the social stigma from what healthy societies have always considered aberrant behavior, while improving the chances that health insurers will pay for a procedure that has the cumulative effect of convincing individuals they have been transformed into persons of the opposite sex.

Dr. George Rekers, a professor of neuropsychiatry and behavioral science at the University of South Carolina medical school, told that, like its earlier decision to delete homosexuality from its list of sexual disorders, the APA is once again caving in to political pressure. “I think they are bowing to activist groups to downplay the actual psychopathology involved by just calling it gender incongruence,” he said. “They don’t want to go back to put homosexuality as the disorder. Now it looks like they’re backpedaling on Gender Identity Disorder.”

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