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Gender Identity Disorder

Gender identity disorder (GID) is a psychiatric diagnosis that mental health and medical professionals apply to people who were assigned one gender at birth and subsequently identify with another gender or who do not adhere to the gender role associated with their assigned gender. The GID diagnosis appears in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), the American Psychiatric Association's (APA) most recent official listing of psychiatric disorders. A set of GIDs also appears in the World Health Organization's (WHO) International Statistical Classification of Diseases and Related Health Problems (IDC-10). This entry describes the history, current diagnostic criteria, and controversy surrounding GID.

History

GID today is the most recent version of a set of diagnoses that first appeared in American psychiatry in DSM-III in 1980. DSM-III included for the first time a diagnostic group called “Gender Identity Disorders,” comprising “Transsexuality,” “Gender Identity Disorder of Childhood,” and “Transvestic Fetishism.” These diagnoses formalized medical and psychiatric thinking about gender-variant people that dated back to the 19th century, expressed in the work of such early sexologists as Havelock Ellis, Karl Ulrichs, and Magnus Hirschfeld. More recently, GIDs were the product of heightened mid-20th-century interest among a subset of psychiatrists and other medical and mental health professionals in gender variance. Their increased interest was primarily directed at the newly emerging medical and social category of transsexuality.

Since appearing in DSM-III, the gender identity disorder entries have changed with each subsequent DSM revision. The most significant revision was the 1994 combining of “Transsexualism” with “Gender Identity Disorder of Childhood” into one overarching diagnosis, “Gender Identity Disorder.” “Transvestic Fetishism,” once listed among the gender disorders, has been reclassified as a sexual paraphilia. The GID diagnosis today is most associated with transsexual adults and with gender-variant children.

Current Diagnostic Criteria

As outlined in DSM-IV-TR, GID has two basic components that must be present for a diagnosis to be made: (1) There must be both a strong and a persistent cross-gender identification. (2) There must be evidence of persistent discomfort with one's assigned sex or a sense of inappropriateness in the gender role of that sex. The diagnostic text lists specific examples of these criteria as they may manifest in children and in adolescents or adults. The criteria also disallow a diagnosis if an intersex condition is present. The cross-gender identification or behaviors must also be accompanied by significant distress and impairment.

In addition to the main GID diagnosis, the DSM contains a “Gender Identity Disorder Not Otherwise Specified” (GIDNOS) diagnosis. It permits a GID diagnosis for someone who may not fit all the criteria of the primary diagnosis (such residual “not otherwise specified” categories are not unusual in psychiatric diagnostics). Examples provided in the DSM of appropriate GIDNOS diagnoses include people with intersex conditions, people whose cross-gender identification or behaviors may be temporary, and people who may obsess about castration without wanting to change sex.

Controversy

The GIDs have been controversial since they first appeared. Beginning in the mid-1990s, the level of controversy and debate increased, partly because of the work of transgender, intersex, and queer social movements, but also because of critiques made within medical and mental health professions by both individuals and lesbian, gay, bisexual, and transsexual (LGBT) professional organizations.

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