Kirsten Andersen

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EXCLUSIVE: APA still considers transgenderism a mental disorder, just changed the name

Kirsten Andersen
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ARLINGTON, VA, December 7, 2012, (LifeSiteNews.com) – This week saw bold headlines proclaiming that the American Psychiatric Association (APA) is set to remove “gender identity disorder” from its directory of mental illnesses. The coverage was met with elation by gay and transsexual activists, but in an exclusive interview with LifeSiteNews.com, Dr. Kenneth Zucker, chairman of the task force that proposed the change, said all the excitement may be overblown.

The DSM-V, the latest version of the Diagnostic and Statistical Manual of Mental Disorders, will reclassify “gender identity disorder” as “gender dysphoria.” The new guidelines say patients will be diagnosed with “gender dysphoria” if they display “a marked incongruence between one’s experienced/expressed gender and assigned gender.” 

Many observers have interpreted the reclassification as a possible move toward dropping transsexualism from the APA’s list of mental disorders as it did homosexuality in 1973. But Dr. Zucker, who heads a gender identity clinic in Toronto and chairs the APA’s committee on gender identity disorders, told LifeSiteNews that’s not the case.

“I’ve seen a lot of banner headlines referring to the ‘removal’ of gender identity disorder from the manual,” said Zucker. “I’m not sure that is entirely accurate. The name has been changed, and I think there’s also been perhaps a shift in the way the diagnosis is being conceptualized, where there’s a greater focus on the incongruence between a person’s desired gender and their somatic sex.”

For years, transsexual activists have lobbied the APA to stop labeling gender identity disorder as a mental illness.  Groups like “GID Reform Now” have staged protests at APA meetings in the past.  Zucker denied that pressure from such groups led to the changes.  He said the task force did discuss the possibility of dropping gender confusion from the DSM, but ultimately decided it should stay in, with some changes.

Dr. Zucker says he doubts gender confusion will ever be dropped entirely from the DSM.  Many transsexuals actually want the APA to keep it in, because a diagnosis of gender identity disorder can justify insurance coverage for hormonal drugs, sex-change operations, and plastic surgery to match a person’s bodily appearance to the sex of their choice. Without a diagnosis of real mental illness, insurance companies may classify such procedures as elective, and deny coverage. 

Some activists also favor DSM labeling because it offers legal reinforcement for transsexuals who wish to sue for discrimination or to obtain special accommodations in the workplace or elsewhere.

“Having a diagnosis is extremely useful in legal advocacy,” Shannon Minter, legal director of the National Center for Lesbian Rights, told The Advocate, a gay journal. “We rely on it even in employment discrimination cases to explain to courts that a person is not just making some superficial choice…that this is a very deep-seated condition recognized by the medical community.”

Deep-seated or not, gender confusion may not be permanent. Zucker says not all people who experience gender confusion will struggle with it for life. He compared the condition to a mental illness like depression, which ranges from the situational to the chronic. 

“For some people,” he said, “major depression is a lifelong condition that never goes away,” he said. “But there are some people where the symptoms can be lessened through therapy or treatment, and for some people, it goes away completely, either through treatment and medication, or on its own.”

“I think it’s the same thing with gender dysphoria,” Zucker said. “For some people, it’s a lifelong condition, and there are some people for whom it comes and goes, or goes away completely.” 

Zucker said he thinks his job as a therapist is to find the treatment that will increase the likeliness that a patient’s gender confusion or ‘dysphoria’ will go away.

For adults, he said, the treatment might be a sex-change operation and hormone therapies, culminating in a transition to living as a different gender.  But for children, Zucker advocates a more conservative approach.  According to Zucker, young children experiencing gender confusion may respond better to therapies that help them embrace their biological sex.

Zucker has come under fire for this view.  Many transsexual activists argue that gender identity is an inborn trait that cannot be changed through therapy. Some, like Trans Youth Family Allies, even advocate for the use of hormone therapies prior to puberty, to prevent gender-confused children from developing the adult characteristics of their biological sex, like breasts or facial hair. In the last five years, a growing number of clinicians have complied. 

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Zucker takes a dim view of this trend. “I take a very developmental approach to the treatment of gender dysphoria,” he said. “I don’t think that gender dysphoria is something that is only going to respond to biomedical treatment. The real question is, when in development does the desire to be the other gender become locked in or fixed?”

Zucker said he thinks that point is well after puberty. “With young children, I think there’s much more pliability,” he said. “Often, the gender dysphoria remits, for whatever reason. These kids don’t grow up wanting to be the other gender. People need to be cognizant that there are other developmental trajectories.”  

Zucker says he thinks the new phrasing is a step in that direction. He likes that the term ‘dysphoria’ makes no assumptions about the long-term prognosis for gender confused individuals.  

“I think that when people…label a child as transgendered , it kind of has the connotation of immutability,” said Zucker. Asked whether such a label might be more harmful than helpful when trying to resolve a child’s gender confusion, Zucker said he thinks it’s still too early to tell. 

“It’s only been in the last few years,” he said, “when parents have said ‘My child is transgendered’ and taken them on Barbara Walters to talk about it.” He expects it will be five or 10 years before there are any large studies on the effects of early labeling on children with gender confusion.

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