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Sexual and Gender Identity Disorders | APA’s proposed changes (part 2) – DSM-5

The previous post with the first version of the proposed changes can be found here.

A few notes before the quoted text.

  • The big changes from the last revision (not from the last DSM) are that

1. they’ve dropped ‘gender incongruence’ and gone with ‘gender dysphoria’

2. they have added a ‘B’ criteria of distress and

3. they have added a ‘post-transition’ specifier.

  • Version 5 of the book is due out May 2013
  • the current commenting period will end on June 15, 2011.
  • This is the APA DSM 5 (American Psychiatric Association) site.  The APA “writes” the DSM (Diagnostic and Statistical Manual)
  • It’s important because this will be one of the key tools for how mental health professions view and define gender issues for the coming decade.

The following (in blue) is quoted from the APA site:

_________________________________________________________

Updated May 4, 2011

 Gender Dysphoria (in Adolescents or Adults)**

A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months duration, as manifested by 2* or more of the following indicators: [2, 3, 4]**

1. a marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or, in young adolescents, the anticipated secondary sex characteristics) [13, 16]

2. a strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or, in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics) [17]

3. a strong desire for the primary and/or secondary sex characteristics of the other gender

4. a strong desire to be of the other gender (or some alternative gender different from one’s assigned gender)

5. a strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender)

6. a strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender)

B. The condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning,  or with a significantly increased risk of suffering, such as distress or disability** 

Subtypes

With a disorder of sex development [14]

Without a disorder of sex development

See also: [15, 16, 19]

Specifier**

Post-transition, i.e., the individual has transitioned to full-time living in the desired gender (with or without legalization of gender change) and has undergone (or is undergoing) at least one cross-sex medical procedure or treatment regimen, namely, regular cross-sex hormone treatment or gender reassignment surgery confirming the desired gender (e.g., penectomy, vaginoplasty in a natal male, mastectomy, phalloplasty in a natal female).

Note: Three changes have been made since the initial website launch in February 2010: the name of the diagnosis, the addition of the B criterion, and the addition of a specifier. Definitions and criterion under A remain unchanged.

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SNL contribues to trans-phobia with ‘Estro-Maxx’ parody

Yes, I know its comedy, but NBC’s Saturday Night Live TV show aired a ‘commercial’ for feminizing hormones who’s sole comedic purpose was to laugh at trans women during their transition.  I think it send the message that its OK to laugh at transsexuals and contributes to trans-phobia.

Trans-phobia and any phobia is no small matter.  It creates an ubiquitous message that its OK to make fun of gender variant people.  It leads to shame, hiding, fear and anxiety.

Thoughts?

The Need for Post Transition Support (Part 2)

A follow up to the Mike Penner/Christine Daniels saga.

The LA Times posted a long follow up article on the suicide of Mike Penner/Christine Daniels, the late LA Times sportswriter who transitioned on the job (and which I wrote about in a previous post)

A few things stand out as contributing to the suicide:

  • A very painful separation and divorce from her wife.  Complicating matters was the fact that they worked in the same office and wife expressed her wish to avoid all contact with Christine. (I’m certainly not blaming the wife for contributing to the suicide; I’m just saying that the separation and circumstances were painful for Christine.)  There was also the loss of the wife’s family, who Penner was close to.
  • Being a public figure, she got some harsh (and ignorant) public criticism of her ability to “pass”, which was hard on Christine.
  • Christine being thrust into and accepting the role of spokesperson for transgender issues when she probably wasn’t ready or personally strong enough to deal with the media scrutiny.  Then having disagreements with trans activists who objected to Daniel’s emphasis on appearance in her blog.
  • Daniels withdrew from friends, church and public appearances.
  • Daniels’s mother died.
  • Daniel’s focused on her transitioning as the root of all her problems and tried to de-transition in hopes of reuniting with his wife.

What are the lessons that can be gleaned from this?

  • There is a great need for support during and after transition.  Don’t underestimate the need for supportive people and institutions.  Including friends, family, support groups, therapy, religious institutions, knitting circles, etc…  Its like drinking water in the desert – you have to do it even if you’re not feeling thirsty – if you feel thirsty its too late – you’re already dehydrated.
  • Withdrawing is not the answer.  It will only make things worse.
  • Very often when people find themselves a part of a new group they feel they have to be a spokesperson/activist/possess complete knowledge of said group.   That’s great if you want to do that, but it should be a conscious choice and not an obligation.

Find out about Psychotherapy when dealing with Gender variance in yourself or someone close to you.


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