DSM V

The American Psychiatric Association has just posted the proposed changes to DSM V (Diagnostic and Statistical Manual of Mental Disorders) on their web-site and the have the third iteration of “Gender Dysphoria in Adolescents or Adults” and “Gender Dysphoria in Children” posted. The only thing that they changed from the previous proposals is the name they changed it from “Gender Incongruence” to “Gender Dysphoria” from the DSM IV-TR “Gender Identity Disorder”. They still have it listed as Axis I, which I think is wrong. They write as justification,

We also debated and discussed the merit of placing this condition in a special category apart from (formerly Axis-I) psychiatric diagnoses to reflect its unusual status as a mental condition treated with cross-sex hormones, gender reassignment surgery, and social and legal transition to the desired gender (particularly with regard to adolescents and adults). We chose not to make any decision between its categorization as a psychiatric or a medical condition and wished to avoid jeopardizing either insurance coverage or treatment access (Drescher, 2010).

In both versions 2 and 3 there is a questionnaire on the severity the feeling of being trans. The questionnaire does allow an “out” from the diagnoses which was possible before. The questionnaire measure the distress in your current gender; therefore once you have transitioned your distress will decrease and you will no longer meet the criteria for “Gender Dysphoria”

I believe that it should be removed from the DSM all together and placed in the ICD (International Statistical Classification of Diseases). There is enormous stigma that is tied to having it in the DSM that is used against us. It is also important to remember that the purpose of the DSM and the ICD is to bill the insurance companies, if it is not in the DSM the therapist does not get paid or the doctor if it is not in the ICD. An example is that I have diagnosed with ICD code 272.0 or high cholesterol, if you look at your bill you will see the code number on it. The therapist uses the DSM to look up the best diagnoses that fit the patient symptoms and bills the insurance company, not everything in the DSM is a mental illness. I don’t think that you would classify bet wetting as a mental disorder, but it is listed in the DSM (307.6). Why? Because you might suffer some form of stress over it and go to a therapist about the stress but it does not make you mental ill. The therapist wants to get paid for threating your anxiety so there has to be a code number for bed wetting (Enuresis).