Tuesday, December 4, 2012

Follow up on DSM-still-considers-trans-folks-"disordered" post

First, thanks to everyone re-tweeted, re-posted, shared links, and commented on my Trans people still “disordered” according to latest DSM blogpost yesterday. The response has been overwhelming, and I'm sorry that I haven't been able to respond to people's comments and questions...

As I alluded to in that post, I was disappointed that the DSM's Transvestic Disorder diagnosis received so little attention at the time. But this latest interest/outrage encourages me that we may be able to work toward completely removing this diagnosis from the next revision of the DSM (DSM-VI?).

There are a few things that I want to add here as a postscript:

1) several people asked me what the official language of Transvestic Disorder is. So I went to the dsm5.org (the official DSM-V site), where all the proposed language once resided, but it is no longer there. Here's the explanation they give:

Because the draft diagnostic criteria posted most recently on www.dsm5.org are undergoing revisions and are no longer current, the specific criteria text has been removed from the website to avoid confusion or use of outdated categories and definitions.

How convenient...

So I went through my past notes and found the following update from May-17-2010. Note: it could have been subsequently updated, so I am not 100% sure this is the final language. In any case, here it is:

Transvestic Disorder

A.    Over a period of at least six months, recurrent and intense sexual fantasies, 
        sexual urges, or sexual behaviors involving cross‑dressing. 

B.     The fantasies, sexual urges, or behaviors cause clinically significant 
         distress or impairment in social, occupational, or other important areas 
         of functioning.

Specify if:

With Fetishism (Sexually Aroused by Fabrics, Materials, or Garments)

With Autogynephilia (Sexually Aroused by Thought or Image of Self as Female)

With Autoandrophilia (Sexually Aroused by Thought or Image of Self as Male)

2) Fascinating shenanigans: This was not the initial language. As I mentioned in my last post, the initial language was specific to "heterosexual males" (cissexist psychiatry jargon for assigned-male-at-birth individuals who are sexually oriented toward women).

Those of us who fought against the initial Transvestic Disorder diagnosis did so on the grounds that it did not serve the trans community (e.g., unlike GID/Gender Dysphoria, it does not provide access to the means to legally and/or medically transition), that it pathologizes gender variance, that it sexualizes trans female/feminine spectrum people's gender identities and expressions, and that it was sexist (in that it singled out trans folks of a specific identity, trajectory and orientation).

In what seemed to be an unprecedented move (although I am not a DSM scholar), the DSM quietly expanded the language in May 2010 (after the period for comments had passed) to include trans people of all identities, orientations & trajectories. Presumably, this was done to avoid accusations that the diagnosis was sexist. So in other words, they used trans activist & advocate criticisms as an excuse to *expand* the diagnosis rather than remove or reform it.

3) Upon reading the above diagnoses, some might cite the requirement that such behaviors must "cause clinically significant distress or impairment in social, occupational, or other important areas of functioning" in order to argue that a trans person is not considered Transvestically Disordered if they do not experience such issues. However, this is not necessarily the case. The "distress or impairment" language is quite vague and open to the psychiatrist/therapists's interpretation. If I am fired from my job because of my manner of dress, and if this causes me distress, I could potentially be diagnosed with Transvestic Disorder. This has historically been a problem with diagnoses targeting gender and sexual minorities (as well as other populations that have been DSM'd), namely, that they do not distinguish between personal distress, and distress that arises secondarily due to social stigma and marginalization.

4) I am curious as to why all these news articles about transgender people supposedly no longer being considered "disordered" in the DSM suddenly appeared in the last few days. As I scoured the internet for such articles, I noticed that most of them were quite short, offered no critical analysis, nor did they seek comments from any trans activist and advocates who have been immersed in challenging the DSM.

This has led me to believe that the DSM must have sent out some kind of press release touting their supposed "trans-friendliness," and that several gay, queer and LGbt outlets that are largely oblivious to the nuances of trans politics simply engaged in copywriting based on the DSM press release. Granted, this is speculation on my part, but I'd love to hear what went down behind the scenes to cause this bizarre flurry of inaccurate news stories...



further postscript added 1:15pm 12-4-12:

via a friend of a friend, I was able to access what I think may be the final Transvestic Disorder language, described as being "Updated April-28-2012":

Transvestic Disorder

A. Over a period of at least 6 months, recurrent and intense sexual arousal from cross‑dressing, as manifested by fantasies, urges, or behaviors.

B. The fantasies, sexual urges, or behaviors cause marked distress or impairment in social, occupational, or other important areas of functioning. 

Specify if:

With Fetishism (Sexually Aroused by Fabrics, Materials, or Garments)

With Autogynephilia (Sexually Aroused by Thought or Image of Self as Female)

With Autoandrophilia (Sexually Aroused by Thought or Image of Self as Male)

Specify if:

In a Controlled Environment

In Remission (No Distress, Impairment, or Recurring Behavior for Five Years and in an Uncontrolled Environment) 

So this is mostly the same except for some word rearrangement in part A, and in the addition "Controlled Environment" and "In Remission" as specifications. This latter language is new to me, so I haven't had a chance to digest it yet. But the thing that immediately jumps out at me is the "In Remission" clause. This seems to expand the diagnosis even further. After all, regardless of one's current sexuality and/or manner of dress, one could still be considered as being Transvestically Disordered, albeit in remission...

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  1. Thanks for keeping us updated on this, Julia.

  2. Yes, especially your final comment in your post-script. Thank you for calling this horse puckey for what it is.

  3. "In remission"??? You have got to be f**king kidding me. In f**king remission?? Like a cancer??

    What a load of steaming excrement.

  4. What happened was that the APA announced that the DSM-5 was finalized. At the same time all those stories about trans people no longer being pathologized went out, other stories about how Asperger's Syndrome (and sometimes mentioned PDD-NOS as well) no longer exists and the autistic spectrum will be under a single diagnosis (autism spectrum disorder).

    All of the criteria for all disorders were taken down. There's been a bit of frustration in some online autistic communities because the ASD criteria are no longer accessible. I've also seen some comments about ADHD being removed as well.

    I'm not trying to mitigate the fact that Blanchard and Zucker should not have been allowed anywhere near the DSM-5. What they've done is inexcusable. Just that the particular things you noted happened across the board.

    I was not previously aware of the transvestic disorder diagnosis prior to today, or I would have posted. I am sorry for being out of the loop.

  5. Hello, I am what would recently be represented as an "autogynephiliac". I came across this blog through a quotation of your work here,


    I feel that your trans-friendly interpretation of the fantasies, fails to grasp the experience of the majority of people. For which any such trans' connections are superficially related to a harmless fetish. An irony in gender-dysphoric individuals who desire to be disassociated from "perversity", in turn subject other to a repressed transsexualism.

    I have my own interpretation of the fantasies here,


  6. You are making assumptions about my beliefs and motives in your comments. If you want to see my actual views, I have written extensively - you can find many of my articles here: http://www.juliaserano.com/TSetiology.html

    The most comprehensive article was published in the International Journal of Transgenderism, and I PDF can be found here:

    Best wishes, -j.

  7. Hello again,

    With all due respect, my main interest is in the fantasies themselves, of which besides your quotation linked in my previous message, I have struggled to find anywhere else were they are addressed. In the quote, you account for the masochistic fantasies as a psychosexual expression of repressed female identity. And also through their resemblance to archetypal female fantasies in distinction to the male equivalent.

    I do not think that the fantasies are adequately addressed. In that the resemblance to female fantasies seems superficial, and what would commonly be a masochistic sexualization of emasculation anxiety, for the gender-dysphoric minority is a tendency to interpret the very same fantasies as deriving from their dysphoria.

  8. So I do talk about the fantasies themselves in some of the writings on the describe on the http://www.juliaserano.com/TSetiology.html page. Especially in my book Whipping Girl.

    You said that "the resemblance to female fantasies seems superficial" - frankly, you should spend some time in queer femme circles - I know quite a number of cisgender feminine queer women who experience fantasies and patterns of arousal that you & others might call "autogynephilic."

    I suppose our differences come from the fact that you said: "my main interest is in the fantasies themselves," whereas my main interest is in why are some sexual fantasies considered perverted/paraphilias while others are not? And what are the consequences for groups whose fantasies are deemed deviant?

    As I say in the PDF I link to:

    "To put this sexualization in perspective, consider the following analogy: Many natal women have sexual fantasies about being raped (reviewed in Leitenberg and Henning, 1995). It is one thing to respectfully attempt to explore and understand such rape fantasies. It would be an entirely different thing to insist that there are two subtypes of women—those who have rape fantasies and those who do not; to use the label “autoraptophiles” when describing women who have such fantasies and to insist that they are primarily motivated by their desire to be raped; to include “autoraptophilia” as a modifier in the Diagnostic and Statistical Manual of Mental Disorders; and to encourage the lay public to actively distinguish between those women who are “autoraptophiles” and those who are not. Such actions would undoubtedly have a severe, negative impact on women (who are already routinely sexualized and marginalized in our culture). Yet, proponents of autogynephilia have argued that transsexual women should be viewed and treated in an analogous manner. Such a view would surely add to the sexualization and discrimination that MTF spectrum people already face, and potentially jeopardize lesbian-, bisexual- and asexual-identified transsexual women’s access to medical and legal sex reassignment."

    To me, that is the crux of the point. But perhaps you disagree. Anyway, like I said, I've thought and written about this subject a lot over the last 10 years. Feel free to read what I have written. Or if you disagree with or are disinterested in my perspective on this issue, so be it. Lord knows there is plenty of disagreement to go around with regards to this topic... :)

    Best wishes, -j.

  9. What I mean by the superficial resemblance to female fantasies, is that the fantasies really look to fundamentally function by way of the association of one's self to the anxiety of emasculation, of which feminine symbolism is it's supreme object. Furthermore I see this as directly disclosing the etiology of the fantasies, whereby the possibility of gender issues are an adjunct condition of the sexualized emasculation anxieties/trauma.