Abstract
Herbert Bower, The Melbourne Clinic and Monash Gender Dysphoria Team, Melbourne, Australia:
I would like to thank Dr Cantor for his interesting although at times somewhat opaque comments. I shall attempt to answer them seriatim.
First: The heading ‘Transsexualism, need it always be a DSM-IV disorder’. Transsexualism (or gender identity disorder (GID)) affects approximately 1:50 000 people in the world, it is not a DSM-IV disorder but defined by many classifications and text books of psychiatry with a common and essential criterion – the strongly held belief by the individual that his or her gender identity contradicts the presenting sexual anatomy.
Second: He accuses the use of GID categories of ‘pathologizing’ the problem. I agree with his opinion and strongly believe in a ‘unitary’ concept of transsexualism. Furthermore, I see it aetiologically as a biological disorder (genetic and hormonal). The vast majority of patients are psychiatrically normal, some, according to their personality structure have responded to a childhood and adolescence trauma of discrepancy between belief, anatomy and a hostile environment with an adjustment disorder. Dr Cantor would call them a ‘subgroup of transsexuals, not disordered’. I would prefer the term ‘psychiatrically normal but transsexuals’.
Third: The phrase ‘their bodies do not match their brains sexually’ used by Dr Cantor, sounds harsh and at the same time lacks definition and I prefer the terminology used in my first paragraph.
In summary, his letter has raised important issues, not referred to by me within the framework of a critical evaluation of the DSM-IV.
While the aetiology of any disorder remains uncertain, arguments about criteria and definition are healthy and attempts to classify, although time-bound, are essential.