Gender Identity Diagnoses: History and Controversies

Abstract

This chapter begins with a review of psychiatric and medical theorizing about transsexualism and transgender presentations since the nineteenth century. Until the middle of the twentieth century, with rare exceptions, transgender presentations were usually classified as “psychopathological.” By the middle of the twentieth century, transsexualism and sex reassignment surgery became more common and more available, leading to greater popular, medical, and psychiatric awareness of the concepts of gender identity and recognition of an increasing number of people wishing to “cross over” from their birth-assigned sex to another. In the twenty-first century, international expert guidelines support transition in carefully evaluated individuals, although the healthcare systems in only a minority of countries now cover needed medical services for sex reassignment.

This chapter then goes on to review the shifting placement of gender identity and gender role diagnoses over time within both the World Health Organisation’s (WHO) International Statistical Classification of Diseases (ICD) and the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual (DSM). In recent years, gender identity diagnoses of both the ICD and DSM have generated several controversies, reflecting not only differing perspectives of mental health professions from those of transgender advocacy groups but also differences of opinion within the lesbian, gay, bisexual, and transgender community (LGBT) itself. These controversies are briefly reviewed. The professionals charged with ICD-11 and DSM-5 revisions have attempted to balance both concerns about retaining access to care and perpetuating the stigma associated with a mental disorder diagnosis. This chapter reviews how the diagnostic classification of disorders related to transgender identity has been an area long characterized by constant shifts in placement and renaming of these diagnoses in various editions of the ICD and DSM. Therefore, another name change and another category move would be more reflective of current thinking in this area of clinical work.