Follow up on DSM-still-considers-trans-folks-"disordered" post

First, thanks to everyone re-tweeted, re-posted, shared links, and commented on my Trans people still “disordered” according to latest DSM blogpost yesterday. The response has been overwhelming, and I'm sorry that I haven't been able to respond to people's comments and questions...



As I alluded to in that post, I was disappointed that the DSM's Transvestic Disorder diagnosis received so little attention at the time. But this latest interest/outrage encourages me that we may be able to work toward completely removing this diagnosis from the next revision of the DSM (DSM-VI?).



There are a few things that I want to add here as a postscript:



1) several people asked me what the official language of Transvestic Disorder is. So I went to the dsm5.org (the official DSM-V site), where all the proposed language once resided, but it is no longer there. Here's the explanation they give:



Because the draft diagnostic criteria posted most recently on www.dsm5.org are undergoing revisions and are no longer current, the specific criteria text has been removed from the website to avoid confusion or use of outdated categories and definitions.



How convenient...



So I went through my past notes and found the following update from May-17-2010. Note: it could have been subsequently updated, so I am not 100% sure this is the final language. In any case, here it is:



Transvestic Disorder



A.    Over a period of at least six months, recurrent and intense sexual fantasies, 

        sexual urges, or sexual behaviors involving cross‑dressing. 



B.     The fantasies, sexual urges, or behaviors cause clinically significant 

         distress or impairment in social, occupational, or other important areas 

         of functioning.



Specify if:



With Fetishism (Sexually Aroused by Fabrics, Materials, or Garments)



With Autogynephilia (Sexually Aroused by Thought or Image of Self as Female)



With Autoandrophilia (Sexually Aroused by Thought or Image of Self as Male)



2) Fascinating shenanigans: This was not the initial language. As I mentioned in my last post, the initial language was specific to "heterosexual males" (cissexist psychiatry jargon for assigned-male-at-birth individuals who are sexually oriented toward women).



Those of us who fought against the initial Transvestic Disorder diagnosis did so on the grounds that it did not serve the trans community (e.g., unlike GID/Gender Dysphoria, it does not provide access to the means to legally and/or medically transition), that it pathologizes gender variance, that it sexualizes trans female/feminine spectrum people's gender identities and expressions, and that it was sexist (in that it singled out trans folks of a specific identity, trajectory and orientation).



In what seemed to be an unprecedented move (although I am not a DSM scholar), the DSM quietly expanded the language in May 2010 (after the period for comments had passed) to include trans people of all identities, orientations & trajectories. Presumably, this was done to avoid accusations that the diagnosis was sexist. So in other words, they used trans activist & advocate criticisms as an excuse to *expand* the diagnosis rather than remove or reform it.



3) Upon reading the above diagnoses, some might cite the requirement that such behaviors must "cause clinically significant distress or impairment in social, occupational, or other important areas of functioning" in order to argue that a trans person is not considered Transvestically Disordered if they do not experience such issues. However, this is not necessarily the case. The "distress or impairment" language is quite vague and open to the psychiatrist/therapists's interpretation. If I am fired from my job because of my manner of dress, and if this causes me distress, I could potentially be diagnosed with Transvestic Disorder. This has historically been a problem with diagnoses targeting gender and sexual minorities (as well as other populations that have been DSM'd), namely, that they do not distinguish between personal distress, and distress that arises secondarily due to social stigma and marginalization.



4) I am curious as to why all these news articles about transgender people supposedly no longer being considered "disordered" in the DSM suddenly appeared in the last few days. As I scoured the internet for such articles, I noticed that most of them were quite short, offered no critical analysis, nor did they seek comments from any trans activist and advocates who have been immersed in challenging the DSM.



This has led me to believe that the DSM must have sent out some kind of press release touting their supposed "trans-friendliness," and that several gay, queer and LGbt outlets that are largely oblivious to the nuances of trans politics simply engaged in copywriting based on the DSM press release. Granted, this is speculation on my part, but I'd love to hear what went down behind the scenes to cause this bizarre flurry of inaccurate news stories...



-julia



++++++++++++++





further postscript added 1:15pm 12-4-12:



via a friend of a friend, I was able to access what I think may be the final Transvestic Disorder language, described as being "Updated April-28-2012":



Transvestic Disorder



A. Over a period of at least 6 months, recurrent and intense sexual arousal from cross‑dressing, as manifested by fantasies, urges, or behaviors.



B. The fantasies, sexual urges, or behaviors cause marked distress or impairment in social, occupational, or other important areas of functioning. 



Specify if:



With Fetishism (Sexually Aroused by Fabrics, Materials, or Garments)



With Autogynephilia (Sexually Aroused by Thought or Image of Self as Female)



With Autoandrophilia (Sexually Aroused by Thought or Image of Self as Male)



Specify if:



In a Controlled Environment



In Remission (No Distress, Impairment, or Recurring Behavior for Five Years and in an Uncontrolled Environment) 



So this is mostly the same except for some word rearrangement in part A, and in the addition "Controlled Environment" and "In Remission" as specifications. This latter language is new to me, so I haven't had a chance to digest it yet. But the thing that immediately jumps out at me is the "In Remission" clause. This seems to expand the diagnosis even further. After all, regardless of one's current sexuality and/or manner of dress, one could still be considered as being Transvestically Disordered, albeit in remission...