Abstract
Sexual and gender diagnoses of the diagnostic and statistical manual (DSM): a reevaluation attempts to provide a range of viewpoints on gender and sexuality issues presently included in the DSM. The discussion is situated in the ongoing revision of the DSM and the critical reviews included in this book have been compiled with the intention of creating an impact on the work groups that are revising diagnoses for the anticipated 2010 publication of DSMV.
The chapters in this text focus specifically on gender identity disorder and the paraphilias. It is interesting to note that none of the contributors to the DSM IV was interested or willing to defend the criticism of the diagnostic criteria for these disorders made by the contributors to the chapters in this text. However, Paul Fink (former president of the American Psychiatric Association) and Robert Spitzer (Chair of DSM III taskforce) provide brief commentaries on gender identity disorder.
Although the editors of the text are psychiatrists the invited contributors come from a range of disciplines. The general theme of these chapters is critical of the current diagnostic categories and of the inclusion of these as mental disorders. In relation to gender identity disorder the overall position is that although these gender characteristics are socially non-conforming they are not necessarily a distressing psychiatric condition. The paraphilias are similarly criticized from the validity of the diagnostic criteria.
Spitzer's commentary outlines his dismissal of the criticisms while advocating an essentialist view of the human condition that regards gender and sexuality variations from social norms as mentally disordered. Fink's argument is primarily based on the position that psychiatrists need to save people from the legal system and that they therefore need to have these diagnoses included in the DSM in order to do this. Because the arguments put forward by both Spitzer and Fink are not only weak but also seem to be based on paternalistic conservative opinion rather than sound theory or science, the effect of their chapters is to enhance the arguments put forward by the other contributors that these diagnoses need to be seriously reconsidered.
A strong case is made for either a major overhaul of the diagnoses or a complete removal from the DSM-V. There is little evidence to suggest that the diagnoses of gender identity disorder and paraphilia correspond with the American Psychiatric Association's own description of mental disorder ‘a clinically significant behavioural or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g. a painful symptom) or disability (i.e. impairment in one or more important areas of functioning) or with a significantly increased likelihood of suffering death, pain, disability or an important loss of freedom’ [1]. While the APA has prided itself on producing an atheoretical manual of diagnostic categories it could be hoped that future editions might demonstrate some attempt at intellectual rigour or at the least some diagnostic categories that have a semblance of the minimal scientific requirements for validity and reliability.
Marie Crowe
Christchurch, New Zealand
© 2007 Marie Crowe