From Mental Disorder to Iatrogenic Hypogonadism: Dilemmas in Conceptualizing Gender Identity Variants as Psychiatric Conditions
Submitted on Friday, 23 October 2009
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Abstract The categorization of gender identity variants (GIVs) as “mental disorders” in the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association is highly controversial among professionals as well as among persons with GIV.
After providing a brief history of GIV categorizations in the DSM, this paper presents some of the major issues of the ongoing
debate: GIV as psychopathology versus natural variation; definition of “impairment” and “distress” for GID; associated psychopathology
and its relation to stigma; the stigma impact of the mental-disorder label itself; the unusual character of “sex reassignment
surgery” as a psychiatric treatment; and the consequences for health and mental-health services if the disorder label is removed.
Finally, several categorization options are examined: Retaining the GID category, but possibly modifying its grouping with
other syndromes; narrowing the definition to dysphoria and taking “disorder” out of the label; categorizing GID as a neurological
or medical rather than a psychiatric disorder; removing GID from both the DSM and the International Classification of Diseases
(ICD); and creating a special category for GIV in the DSM. I conclude that—as also evident in other DSM categories—the decision
on the categorization of GIVs cannot be achieved on a purely scientific basis, and that a consensus for a pragmatic compromise
needs to be arrived at that accommodates both scientific considerations and the service needs of persons with GIVs.
- Content Type Journal Article
- Category Original Paper
- DOI 10.1007/s10508-009-9532-4
- Authors
- Heino F. L. Meyer-Bahlburg, Columbia University New York State Psychiatric Institute and Department of Psychiatry 1051 Riverside Drive, Unit 15 New York NY 10032 USA
- Journal Archives of Sexual Behavior
- Online ISSN 1573-2800
- Print ISSN 0004-0002
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