Are Gender Identity Disorders Mental Disorders? Recommendations for Revision of the World Professional Association for Transgender Health's Standards of Care

• Published in: The international journal of transgenderism 2009-05, Vol.11 (1), p.53-62
• Main Author: Bockting, Walter
• Format: Article
• Language: English
• Subjects: DSM; gender identity disorder; ICD; standards of care
• ISSN: 1553-2739; 1434-4599
• DOI: 10.1080/15532730902799987

Gender identity disorders are included as formal diagnoses in both the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases. The fact that gender identity disorders are classified as mental disorders is increasingly being contested, with some critics arguing for removal (drawing a parallel with the removal of homosexuality as a mental disorder from the DSM in 1974) and others for reform. At the heart of the argument are concerns about a mental health diagnosis pathologizing gender variance and perpetuating the attached social stigma. Some critics argue for coding gender identity concerns requiring medical intervention as physical conditions rather than mental disorders; after all, they argue, hormonal and surgical sex reassignment aim to adapt the body to match the patient's gender identity. However, as of yet, gender dysphoria cannot be detected by any physical anomaly justifying a physical rather than a mental health diagnosis. Even though recent research points toward the role of biology via sexual differentiation of the brain, the etiology of gender dysphoria remains unknown. On the other hand, research justifying the current diagnostic criteria of mental disorder is also limited. This article summarizes the diagnostic criteria and reviews the empirical evidence and scientific debate surrounding these diagnoses, concluding with recommendations for revision of the Standards of Care for Gender Identity Disorders set forth by the World Professional Association for Transgender Health and directions for future research.