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DSM

DSM is an abbreviation for the Diagnostic and Statistical Manual of Mental Disorders and is the classification system of mental disorders published by the American Psychiatric Association. The DSM contains descriptions and symptoms of disorders and criteria for diagnosing mental health disorders. The DSM is widely used by psychologists and psychiatrists in the United States and internationally to diagnose mental disorders and implement appropriate treatments. The DSM is also used by medical professionals, insurance companies, and the court system to define and diagnose mental disorders. The DSM is reviewed and revised periodically by researchers and clinicians on special task forces and work groups to integrate new knowledge based on the scientific literature. Since the first edition of the DSM in 1952 (DSM-I), there have been five major revisions, with the most recent edition (DSM-5) being published in 2013. It is important to note that the DSM is influenced by, and influences, the World Health Organization’s (WHO) International Classification of Diseases and Health Related Problems (ICD), and gender identity–related diagnoses are intertwined with the medical model of treating gender dysphoria. The DSM plays a significant role in the lives of trans people: It has previously defined the experience of being trans as a mental illness, which has had significant negative impacts by stigmatizing trans individuals. Currently, the fifth version of the DSM (DSM-5) includes the diagnosis of Gender Dysphoria, defined broadly as distress related to the incongruence between one’s sex assigned at birth and current gender identity. Many medical providers require that an individual be diagnosed with gender dysphoria by a licensed mental health clinician in order to be eligible for gender-affirming surgeries or hormone treatment, and insurance companies often require this diagnosis to qualify for coverage of such procedures. This entry first describes the history of gender identity–related diagnoses within the DSM and then discusses current perspectives on the current gender identity–related diagnoses.

DSM-III—Transsexualism

The pathologizing of trans individuals by medical providers and psychiatrists began in the 19th century, with many psychiatrists writing about trans experiences as “pathological” well before the first edition of the DSM (DSM-I) in 1952. Additionally, trans experiences were often misunderstood as being related to sexual orientation and sexual desires. For example, in the 1892 influential text Psychopathia Sexualis, Richard von Krafft-Ebing described trans feminine gender expressions as sexual perversions and fetishes. The first appearance of symptom-based diagnoses related to trans experiences within the DSM occurred in 1980 with the publication of the DSM-III; this version contained the diagnoses Transsexualism, Gender Identity Disorder of Childhood (GIDC), and Atypical Gender Identity Disorder. These three diagnoses were classified as “psychosexual disorders” and relied on the essential feature of incongruence between anatomic sex and gender identity. The revised version of the DSM-III (DSM-III-R) included a few changes to the gender identity–related diagnoses. First, gender identity diagnoses were placed in a subclass of disorders first evident in infancy, childhood, or adolescence. Second, an additional diagnosis was included, termed Gender Identity Disorder of Adolescence and Adulthood, Nontranssexual Type (GIDAANT). GIDAANT was diagnosed among those who did not have a strong desire to receive gender-affirming medical interventions, whereas transsexualism was used for those who did desire such interventions. Interestingly, in the DSM-III-R, there were notable differences between the diagnostic criteria for “boys” and “girls” to receive GIDC. In addition to “persistent and intense distress about being a girl,” children assigned female at birth (AFAB) were required to have a “stated desire to be a boy,” whereas this criterion was not included for children assigned male at birth (AMAB), indicating to some that AMAB children had a “lower threshold” for being diagnosed with GIDC.

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