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Springfield, VA, USA. There is an inordinate amount of confusion, some of it undoubtedly self-serving, over distinctions made in the Diagnostic and Statistical Manual of Mental Disorders (DSM) between individuals with Gender Identity Disorder (HBS/Transsexuality) and Crossdressers or Transvestites.
One of the purposes of the TS-Si is to clear up some of the confusion both in the general public and in the media.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), published by the American Psychiatric Association, is the handbook used most often in diagnosing mental disorders in the United States and internationally. The DSM has gone though five major revisions (II, III, III-R, IV, IV-TR) since it was first published. The next version will be the DSM V, due in approximately 2011.
The current text revision of the DSM-IV, called DSM-IV-TR, was published in July 2000. The primary goal was to maintain the currency of the DSM-IV text with the empirical literature up to 1992. Most of the major changes were in the descriptive text, with a handful of changes to correct previous errors and change some diagnostic codes to reflect updates to the ICD-9-CM coding system adopted by the U.S. Government.
The DSM was initially developed to give more objective terms to the field of psychiatry. Included under sexual disorders are:
Sexual Desire Disorders
Sexual Arousal Disorders
Orgasmic Disorders
Sexual Pain Disorders
Sexual Dysfunction Due to a General Medical Condition
Paraphilias are mental disorders characterized by sexual fantasies, urges, or behaviors involving non-human objects (Coprophilia, Fetishism, Transvestic Fetishism), suffering or humiliation (Sexual Sadism, Masochism), children (Pedophilia) or other non-consenting person (Voyeurism, Frotteurism, and Exhibitionism). Note that although Transvestic Fetishism (with other fetishes such as Pedophilia and Voyeurism) are listed under Paraphilias. Gender Identity Disorder is not.
Transvestic Fetishism is defined as when a heterosexual male, over a period of at least six months has recurrent, intense sexual arousing fantasies, sexual urges, or behaviors involving cross dressing (Dressing in clothing suggestive of the opposite gender). Moreover, the fantasies, sexual urges, or behaviors must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. There is a specific exclusion for Gender Dysphoria (Gender Identity Disorder) if the person has persistent discomfort with gender role or identity.
Gender Identity Disorder (a Person Born Transsexual) is defined as a strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex). In children, the disturbance is manifested by four (or more) of the following:
Repeatedly stated desire to be, or insistence that he or she is, the other sex
In boys, preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing
Strong and persistent preferences for cross-sex roles in make-believe play or persistent fantasies of being the other sex
Intense desire to participate in the stereotypical games and pastimes of the other sex
Strong preference for playmates of the other sex. In adolescents and adults, the disturbance is manifested by symptoms such as a stated desire to be the other sex, frequent passing as the other sex, desire to live or be treated as the other sex, or the conviction that he or she has the typical feelings and reactions of the other sex.
The DSM is a guide to what the American Psychiatric Association (APA) terms mental disorders. It is the handbook desktop reference used most often for diagnostics in the US and abroad.
The DSM contains a listing of psychiatric disorders, diagnostic codes, information on the prevalence of each disorder, and diagnostic criteria. The DSM is non-theoretical and does not offer information on causes or treatments.
Mental health professionals use the DSM for a variety of purposes, such as clinical practice, research, and educational purposes. Clinicians also use the DMS-IV to classify patients for billing purposes. The government and many insurance carriers require a specific diagnosis in order to approve payment for treatment.
The DSM has gone though five major revisions, with the most recent major update published in 1994.
The current version is a minor variant published in July 2000 that adds clarifying text (DSM-IV, Text Revision). The primary goal was to maintain the currency of the DSM-IV text with the empirical literature up to 1992.
Most of the changes were in the descriptive text, with some error correction and changed diagnostic codes to reflect updates to the ICD-9-CM coding system adopted by the U.S. Government. It is available from the the DSM-IV-TR web site.
DSM-V publication is planned for 2010/11. The APA Steering Commitee says it is open to suggestions and maintains a web page, DSM-V: The Future Manual.
The Structured Clinical Interview for DSM-IV (SCID) Axis I Disorders (SCID-I) is a semi-structured interview for making the major DSM-IV Axis I diagnoses. The SCID-II is a semi-structured interview for making DSM-IV Axis II: Personality Disorder diagnoses.
The person with Gender Identity Disorder has an innate, persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex. Gender Identity Disorder is manifested by any of the following;
In boys, assertion that his penis or testes are disgusting or will disappear or assertion that it would be better not to have a penis, or aversion toward rough-and-tumble play and rejection of male stereotypical toys, games, and activities;
In girls, rejection of urinating in a sitting position, assertion that she has or will grow a penis, or assertion that she does not want to grow breasts or menstruate, or marked aversion toward normative feminine clothing.
In adolescents and adults, the disturbance is manifested by symptoms such as preoccupation with getting rid of primary and secondary sex characteristics (e.g., request for hormones, surgery, or other procedures to physically alter sexual characteristics to simulate the other sex) or belief that he or she was born the wrong sex.
Gender Identity Disorder is not concurrent with a physical intersex condition.
The individual is suffering clinically significant distress or impairment in social, occupational, or other important areas of functioning. Transsexuality is a disorder not a mental illness.
The distinction between Transvestic Fetishism (crossdressing, transvestism) and Gender Identity Disorder (transsexuality) is noteworthy. Webster’s Dictionary defines a fetish as an object or bodily part whose real or fantasied presence is psychologically necessary for sexual gratification and that is an object of fixation to the extent that it may interfere with complete sexual expression. Synonyms are fixation, mania, preoccupation, and obsession. The definition for a disorder is a physical or mental condition noticeably different from what is generally found or experienced. Synonyms are complaint, complication, and condition.
Transvestic Fetishism occurs in heterosexual (or bisexual) men for whom the cross-dressing behavior is for the purpose of sexual excitement. Aside from cross-dressing, most individuals with Transvestic Fetishism do not have a history of childhood cross-gender behaviors.
Gender Identity Disorder can be distinguished from simple nonconformity to stereo-typical sex role behavior by the extent and pervasiveness of a person born transsexual’s wishes, interests, and activities. This disorder is not meant to describe a child’s nonconformity to stereotypic sex-role behavior as, for example, in "tomboyishness" in girls or "sissyish" behavior in boys. Rather, it represents a profound disturbance of the individual’s sense of identity with regard to maleness or femaleness. Behavior that merely does not fit the cultural stereotype of masculinity or femininity should not be given the diagnosis unless the full manifestism is present, including marked distress or impairment.
Bottom line. Transvestic Fetishism (crossdressing, transvestism) is not Gender Identity Disorder. Gender Identity Disorder and crossdressing or transvestism should not be confused because of a sometimes misleading surface similarity. A Person Born Transsexual is not a Crossdresser; a Transvestite is not a Person Born Transsexual. They are distinctly different beings pursuing totally different ends. To treat all of them together as a single amorphous class is a grievous disservice to both.
Ms. Lisa Jain Thompson is the Co-Founder & President of TS-Si, Inc. She also serves as a Contributing Editor and columnist for the TS-Si website. Ms. Thompson's signed articles contain her own opinions and do not necessarily convey an official position of TS-Si, its partners, or affiliates.
Lisa welcomes your comments. You can use the public form below or send private correspondence via her TS-Si Contact Page. We will not divulge any personal details or place you on a mailing list without your permission.
Ms. Sharon Gaughan is the Co-Founder, VP, and Executive Director of TS-Si, Inc. She also serves as the Managing Editor and columnist for the TS-Si website. Ms. Gaughan's signed articles contain her own opinions and do not necessarily convey an official position of TS-Si, its partners, or affiliates.
Sharon welcomes your comments. You can use the public form below or send private correspondence via her TS-Si Contact Page. We will not divulge any personal details or place you on a mailing list without your permission.
The Diagnostic and Statistical Manual of Mental Disorders (DSM)
Ms. Lisa Jain Thompson
Ms. Sharon Gaughan
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