Revision Suggestions for Gender Related Diagnoses in the DSM and ICD

This paper provides an overview of how gender-related diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Statistical Classification of Diseases and Related Health Problems (ICD) have been used both against transgender individuals and to authorize health care for transgender individuals.   The paper includes recommendations for how both the DSM and ICD both can be updated with diagnostic nomenclature that is respectful of gender diversity and supports appropriate health care for transgender individuals, including hormonal and/or surgical transition-related care. This is particularly timely since the DSM is being updated as a Fifth Edition in 2013 (DSM-V).   The authors begin with the following assumptions:

• We call for an end to discrimination on the basis of gender identity and expression
• Gender identity and expression that differ from assigned birth sex do not, in themselves, constitute a mental disorder or an impairment in competence
• Hormonal, surgical and/or mental health to relieve gender dysphoria are medically necessary
• Public and private insurance must include medically necessary transition treatment
• Legal recognition/documentation for all people that is consistent with their gender identity and expression is a basic civil and human right
• Reform should consider the needs of the full breadth of needs of the transgender community, but as a social justice movement, we must more heavily the needs of those least enfranchised

The authors recommend that “Gender Identity Disorder” be replaced in DSM-V with “Gender Dysphoria”, defined as:

• Strong and persistent distress with physical sex characteristics, or ascribed social gender role, that is incongruent with persistent gender identity
• The distress is clinically significant or causes impairment in social, occupational, or other important areas of functioning, when this distress or impairment is not solely due to external prejudice or discrimination.

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