Sexual Challenge Chosen

 

When it came to making a decision for a sexual challenge, there was not a hard choice on what we would like to choose. Since I have an in depth study in regards to transgender studies in psychology for the last two years, I felt that this would be our best choice to consider. Along with this particular challenge, we also received homosexuality and transvestite as part of our research. As the challenge was more understood, new insight was understood about both of these additional issues.

The first concern that came up was in regards to homosexuality and how it is not a sexual challenge, per se, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Version, Text Revision (DSM IV-TR). Since its removal in 1973, homosexuality has been a challenge only in light of how it affects the individual and not as a mental health disorder. The second concern we had was in regards to transvestites. With very little information written in regards to transvestites, or Transvestic Fetishism as it known in the DSM IV-TR, we decided that it would be more profitable to discuss transgender more in depth as this paper’s sexual challenge.

History of Gender Identity Disorder

Transgender has had an interesting and somewhat complex history both in and out of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The term “transgender” only came to be in the late twentieth century; however, the precise time of when this term came to be established is unclear. It appears that the histories of the transgender individuals, specifically transsexuals and transvestites, are scantly documented prior to the twentieth century.  Many of the transgender population have rejected even the label “transvestite” because the term “invokes concepts of psychological pathology, sexual fetishism, and obsession, when there is really nothing at all unhealthy about this form of self-expression” (Feinberg, 1996, Riddle-Crilly, 2009).

 The second term in this category is “transsexualism” (or transsexual), and it was coined by Harry Benjamin MD in 1953. Research indicates that Dr. Benjamin is often attributed as being the ‘father of transsexualism’ (as cited in Clarke & Peel, 2007). It was 26 years later in 1979 that Dr. Harry Benjamin published his first Standards of Care, which is now in its sixth edition.  It has been revised to DSM standards as well, known most commonly as the Standards of Care for Gender Identity Disorders. This document is used to understand the parameters within which professionals may offer assistance to those with gender identity issues (WPATH & HBIGDA, 2010).

The final term in the series for transgender studies is the term “transvestite” or “transvestism. The term transvestism was coined by Magnus Hirschfeld MD, a physician, sexologist, and gay rights pioneer (Unknown, 2010), who in 1910 presented this new term that referred to individuals who cross-dressed during his time. This included but was not limited to individuals who identified as drag-queens or drag-kings, transvestites, transsexuals, female illusionists or impersonators (even though many of these terms were not presented for many years later) as well as some “psychotic” individuals who believed that they are members of the opposite sex (Bullough & Bullough, 1977; Moser & Kleinplatz, 2002). This term would become the beginning of a long list of terminology that would ultimately refer to individuals diagnosed with gender identity disorder.

The history of transgender, transsexual, or gender identity disorder has been a roller coaster ride for transgender individuals when it comes to the DSM. In the DSM-I for instance, the term “transgender” did not exist, and the term “transsexualism” had not been identified until a year after the DSM-I had been published (American Psychiatric Association, 1952). In this version of the DSM, the American Psychiatric Association (APA) saw individuals who dressed in opposite sex clothing as “transvestism”, which was classified under Sexual Deviations. Ironically, this has not changed much in terms of societal perceptions, as many people still see transgender individuals as living a deviant lifestyle. In 1968, the APA continued their position that individuals

“…whose sexual interests are directed primarily toward objects other than people of the opposite sex, toward sexual acts not usually associated with coitus, or toward coitus performed under bizarre circumstances as in necrophilia, pedophilia, sexual sadism, and fetishism. Even though many find their practices distasteful, they remain unable to substitute normal sexual behavior for them. This diagnosis is not appropriate for individuals who perform deviant sexual acts because normal sexual objects are not available to them” (American Psychiatric Association, 1968).

It also included that these sexual deviations were diagnosed as mental disorders. It was at this time that the APA chose to call this disorder transvestitism instead of transvestism as it had in DSM-I.

            It was not until fifteen years later in the DSM-III that the APA chose to reclassify transvestitism into four classifications. Including the return of transvestism, the new identifiers were transsexualism, gender identity disorder of childhood, and atypical gender identity disorder (American Psychiatric Association, 1983). It was also during this new version of the DSM that the APA added many new sexual disorders under its new category of “Psychosexual” disorders. When the APA decided it was time for a revision of the DSM-III in the DSM-II-R, they changed the whole thinking of terminology when it came to the newly coined sexual disorders. Heterosexual males who had recurrent intense sexual urges and arousing fantasies involving cross-dressing would be recognized now as suffering from Transvestic Fetishism, which has remained the same in both the DSM-IV and the DSM-IV-TR.

            Although some things did change in the DSM-III-R (1987), others did not. Transsexualism, gender identity disorder of childhood remained in the new DSM; however, atypical gender identity disorder was no longer included and came to be replaced with gender identity disorder of adolescence or adulthood and gender identity disorder not otherwise specified. Sadly, this would not be the change gender variant individuals would be looking for, nor would the diagnostic criteria and diagnoses for individuals who felt that they were born in the wrong body. One other change that had taken place with gender identity disorder (GID) is that it had now been moved from being a sexual disorder to being a disorder usually first evident in infancy, childhood or adolescence.

            In 1994, the American Psychiatric Association felt it was once again time to revamp the DSM, and published the DSM-IV. It was at this time that the removal of transsexualism was considered a positive change and a path toward the right direction; it was also deemed as a “sexual, gender identity disorder type.” This seemed to be the major downfall to the change in the DSM-IV (1994) from the DSM-III-R according to various transgender organizations. With very little change in the DSM-IV-TR (2000) from the previous version, except for the fact that it is no longer included as a sexual disorder, many gender associations have been pushing for a change in the DSM V. According to the most recent reports, a change is coming that will tentatively alter both the name of the disorder as well as its listing in the DSM V (Sexual and Gender, 2010). In a previous research paper, which was completed in 2008, one author wrote,

…it is fortuitous that we as a society and as professionals be able to rehabilitate our thinking to support the betterment of life for the transgender individual by stopping and taking into consideration the damage that we are invoking on these individuals who are unable to simply “change their feelings” about being a transsexual.  By adjusting our conceptual … and changing our mentality to believe that in so doing we can be causing tremendous mental harm, it is the authors opinion that we as psychologists, sociologists, and psychiatrists, must find a way to dissolve the categorizing of transgenders and transsexuals as a disorder. I believe the APA needs to consider disassociating GID as a mental disorder from the DSM-V when released in 2012 (Riddle-Crilly, 2008). 

One additional interesting fact appeared in researching GID as a psychopathological disorder. In the research the author states,

With as many as 3.04 million individuals in the United States living with GID, whether diagnosed or not, it appears that this area needs to be highly addressed in regards of diagnosing people without setting a stigma on them.  Unfortunately, because of our societal norms, a stigma has been set on any mental disorder that we diagnose a patient with, and in an area such as Tulare County, where as many as 4,200 people, who again are or are not diagnosed with GID. Stigmas need to be addressed in order for these individuals to receive treatment as to not harm themselves, such as in the instance of Martina, who earlier this year took her life in Visalia because of the lack of assistance she was unable to find (Riddle-Crilly, 2010). 

The DSM Criteria for Diagnosis and the Sub Categories of the Disorder

In understanding what is involved in diagnosing GID, one needs to be aware of what is written as the current criteria of the DSM-IV-TR. This includes:

A.  A strong persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex). In children, the disturbance is manifested by four (or more) of the following:

  1. Repeatedly stated desire to be, or insistence that he or she is, the other sex.
  2. In boys, preference for cross-dressing or simulating female attire; In girls, insistence on wearing only stereotypical masculine clothing.
  3. Strong and persistent preferences for cross-sex roles in make believe play or persistent fantasies of being the other sex.
  4. Intense desire to participate in the stereotypical games and pastimes of the other sex.
  5. Strong preference for playmates of the other sex.

In adolescents and adults, the disturbance is manifested by symptoms such as a stated desire to be the other sex, frequent passing as the other sex, desire to live or be treated as the other sex, or the conviction that he or she has the typical feelings and reactions of the other sex.

B. Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex.

In children, the disturbance is manifested by any of the following:
In boys, assertion that his penis or testes are disgusting or will disappear or assertion that it would be better not to have a penis, or aversion toward rough-and-tumble play and rejection of male stereotypical toys, games, and activities.
In girls, rejection of urinating in a sitting position, assertion that she has or will grow a penis, or assertion that she does not want to grow breasts or menstruate, or marked aversion toward normative feminine clothing.

In adolescents and adults, the disturbance is manifested by symptoms such as preoccupation with getting rid of primary and secondary sex characteristics (e.g., request for hormones, surgery, or other procedures to physically alter sexual characteristics to simulate the other sex) or belief that he or she was born the wrong sex.

C. The disturbance is not concurrent with physical intersex condition.

D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Code based on current age:

  • 302.6 Gender Identity Disorder in Children
  • 302.85 Gender Identity Disorder in Adolescents or Adults

Specify if (for sexually mature individuals):

  • Sexually Attracted to Males
  • Sexually Attracted to Females
  • Sexually Attracted to Both
  • Sexually Attracted to Neither

Additionally:

302.6 Gender Identity Disorder Not Otherwise Specified

This category is included for coding disorders in gender identity that are not classifiable as a specific Gender Identity Disorder. Examples include:

  1. Intersex conditions (e.g., androgen insensitivity syndrome or congenital adrenal hyperplasia) and accompanying gender dysphoria
  2. Transient, stress-related cross-dressing behavior
  3. Persistent preoccupation with castration or penectomy without a desire to acquire the sex characteristics of the other sex

Part 2 is not included as this was written by another individual.

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