Recommendations for Revision of the DSM Diagnosis of Gender Identity Disorder in Adolescents

Abstract

ABSTRACT As part of a consensus-building process to recommend removal or reform of the DSM diagnoses of gender identity disorders, a work group was charged with developing a consensus statement around the diagnosis for adolescents. Specifically, the work group focused on the following questions: (a) Should there be a separate diagnostic category in the DSM 5 that describes adolescents with gender dysphoria? (b) If so, what are appropriate diagnostic criteria? and (c) If so, should the specific adolescent diagnostic criteria be incorporated within the adult or child diagnosis? After acknowledging the lack of consensus within the mental health field and among transgender advocates as to whether or not there should be a Gender Identity Disorder diagnosis, the work group focused on the issue of what a potential diagnosis should entail. We recommended that the name of the diagnosis should change to reflect the locus of pathology, that is, dysphoria rather than identity. We also recommend that the adolescent criteria be separate from the childhood criteria because of the distinct developmental possibilities and challenges in adolescence. We recommend the following criteria for Gender Dysphoria in Adolescents (all three must be met): (a) clinically significant persistent psychological distress or dysphoria with current or anticipated physical sex characteristics or ascribed social gender role that is incongruent with persistent gender identity; (b) the distress is clinically significant or causes impairment in social, educational/occupational, or other important areas of functioning and is not solely due to external influences such as prejudice, discrimination, social pressures, or benefits; and (c) the symptoms are not better accounted for by another medical condition or mental disorder and are not a result of gender nonconformity or difficulty with cultural norms or a desire to conform to social expectations from peers, parents, and/or social networks. We feel that these criteria will not only improve diagnostic accuracy but will decrease the real or perceived harm inherent in pathologizing identity rather than dysphoria associated with discrepancies between identity and anatomy, anatomy and gender social status, or identity and gender social status.