Fairfax, VA, USA. The American Psychiatric Association (APA) has released the proposed draft diagnostic criteria for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5). The DSM is the standard classification of mental disorders used by mental health and other health professionals.

The DSM serves as a primary diagnostic tool for clinical therapists, researchers, and other medical professionals and as reference by Insurance Companies determining appropriate medical coverage. If what you might think you have is not in the DSM, chances are health insurance won’t pay for it (even if it is, coverage may not be guaranteed).

The DSM-5 work groups will propose final revisions to the diagnostic criteria in 2012. based on public comments to the draft criteria and catalogued findings from field trials. The APA's Assembly and Board of Trustees are charged with final review and approval of the final draft. Release of the approved and final DSM-5 is expected to occur in May 2013.

Disorders and Diagnostic Groups

The DSM-5 draft breaks out the disorders and diagnostic groups as follows:

Structural, Cross-Cutting, and General Classification Issues for DSM-5

Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence

Delirium, Dementia, Amnestic, and Other Cognitive Disorders

Mental Disorders Due to a General Medical Condition Not Elsewhere Classified

Substance-Related Disorders

Schizophrenia and Other Psychotic Disorders

Mood Disorders

Anxiety Disorders

Somatoform Disorders

Factitious Disorders

Dissociative Disorders

Sexual and Gender Identity Disorders

Eating Disorders

Sleep Disorders

Impulse-Control Disorders Not Elsewhere Classified

Adjustment Disorders

Personality Disorders

The APA goal was to provide broad coverage of the psychiatric art within those general classifications.

Sexual and Gender Identity Disorders

The section on Sexual and Gender Identity Disorders (GID) includes a specific subsection for GID that subdivides into the following sections

302.6 Gender Identity Disorder in Children

302.85 Gender Identity Disorder in Adolescents or Adults

302.6 Gender Identity Not Otherwise Specified (not yet published).

The section on GID in Adolescents or Adults relabels GID as Gender Incongruence.

Gender Incongruence (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)

Subtypes

With a disorder of sex development

Without a disorder of sex development

[14, 15, 16, 19].

The American Psychiatric Association (APA) says that

”It is proposed that the name gender identity disorder (GID) be replaced by ‘Gender Incongruence’ (GI) because the latter is a descriptive term that better reflects the core of the problem: an incongruence between, on the one hand, what identity one experiences and/or expresses and, on the other hand, how one is expected to live based on one’s assigned gender (usually at birth) (Meyer-Bahlburg, 2009a; Winters, 2005). In a recent survey that we conducted among consumer organizations for transgendered people (Vance et al., in press), many very clearly indicated their rejection of the GID term because, in their view, it contributes to the stigmatization of their condition”

(Draft DSM 5, Note 1).”

Diagnostic Questionnaire

The diagnosis comes with a diagnostic questionnaire to be used when determining whether GID (Gender Incongruence) actually exists. The questionnaire uses a multiple choice format with no guidance on interpretation and the mapping of answers to a specific diagnoses.

The Diagnostic and Statistical Manual of Mental Disorders (DSM)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 reference is 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.

The DSM has the force of law in a variety of mental health related activities, such as commitment hearings, and is a principal resource used in the development of legislation.

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 official SCID site maintains a list of Frequently Asked Questions (FAQs).

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TS-Si is dedicated to the acceptance, medical treatment, and legal protection of individuals correcting the misalignment of their brains and their anatomical sex, while supporting their transition into society as hormonally reconstituted and surgically corrected citizens.

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