Coming Soon, to a Psychiatrist Near You

Used to be, GLBT folk were just sick in the head—at least, sick according to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the American Psychiatric Association (APA) Bible, first published in 1952.

At that point in time, homosexuality was considered a pathological behavior, a mental disease that could be diagnosed and treated.

Until 1973, when changing social norms, sheer visibility, and the birth of a politically active gay community pressured the APA Board of Directors nominally to remove “homosexuality” from the DSM, inserting in its place a newly minted ego-dystonic homosexuality, which appeared in 1980’s DSM III.

This diagnosis (302.0) covered “individuals whose sexual interests are directed primarily toward people of the same sex and who are either disturbed by, in conflict with, or wish to change their sexual orientation. This diagnostic category is distinguished from homosexuality, which by itself does not constitute a psychiatric disorder.” (No suggestion that ego-dystonia might be precipitated by the patient’s hostile, homophobic environment.)

This continued stigmatization produced enough backlash that in 1986, the diagnosis was removed entirely.

Very good news for the gay and lesbian population, but it left crossdressers—Transvestic Fetishism (302.81)—adrift and stigmatized in DSM’s “Paraphilias” section.

Transsexualism appeared in DSM III, found today as “Gender Identity Disorder in Adolescents of Adults” (302.85).

Work is currently under way on DSM V, whose planned publication date recently has been announced for May 2013. Many changes are proposed in a number of categories, including some for 302.85. A nominal rearrangement or change in wording concerning a trans individual’s “disorder,” however, still will leave that person on the books as someone damaged and malfunctioning—openly labeled mentally ill, and not fit to claim a place among “normal” men and women.

The same concerted efforts need to be put forth for the acceptance of transgender and transsexual individuals to accomplish what was done in 1973 and 1986 for homosexuals.

APA maintains a DSM-5 Development site listing all proposed draft revisions to DSM Disorders and Criteria, listing multiple areas of interest beyond sex and gender (schizophrenia, mood disorders, dementia, anxiety, eating disorders, etc.) that, when implemented, will impact the public’s medical diagnoses and treatment for years to come.

Make a point of visiting www.dsm5.org to participate in the forum for public feedback. If we don’t stand up to demand changes, remember: The DSM’s got your number.