DSM-5 Review and Comments Site

The Montreal Gazette, Canada
By Max Harrold, THE GAZETTE 12/13/2011

MONTREAL - For most sick people in a doctor’s waiting room, a walk-in clinic or the hospital emergency, the etiquette of the receptionist, nurse and doctor is not likely the top priority. Getting better is.

But for people in the years-long process of transitioning genders, the name called out and the pronouns used can be the difference between medical treatment and psychological torture.

302.3 Transvestic Fetishism

DSM-IV

Transvestic Fetishism

A. Over a period of at least 6 months, in a heterosexual male, recurrent, intense sexually arousing fantasies, sexual urges, or 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 Gender Dysphoria: if the person has persistent discomfort with gender role or identity

A. A strong and 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

Transvestic Disorder

A. Over a period of at least six months, in a male, recurrent and intense sexual fantasies, sexual urges, or sexual behaviors involving cross‑dressing. [11]

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

Specify if: [12]

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

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

Changes, or lack thereof, are still under review by the work group.

Gender Incongruence (in Adolescents or Adults) [1]

A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months duration, as manifested by 2* or more of the following indicators: [2, 3, 4]

1. a marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or, in young adolescents, the anticipated secondary sex characteristics) [13, 16]

2. a strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or, in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics) [17]

3. a strong desire for the primary and/or secondary sex characteristics of the other gender

4. a strong desire to be of the other gender (or some alternative gender different from one’s assigned gender)

5. a strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender)

6. a strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender)

Subtypes

With a disorder of sex development

Without a disorder of sex development

[14, 15, 16, 19]

Gender Incongruence (in children) [1]

A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months duration, as manifested by at least 6* of the following indicators (including A1): [2, 3, 4]

1. a strong desire to be of the other gender or an insistence that he or she is the other gender [5]

2. in boys, a strong preference for cross-dressing or simulating female attire; in girls, a strong preference for wearing only typical masculine clothing and a strong resistance to the wearing of typical feminine clothing [6]

3. a strong preference for cross-gender roles in make-believe or fantasy play [7]

4. a strong preference for the toys, games, or activities typical of the other gender [8]

5. a strong preference for playmates of the other gender [9]

6. in boys, a strong rejection of typically masculine toys, games, and activities and a strong avoidance of rough-and-tumble play; in girls, a strong rejection of typically feminine toys, games, and activities [10]

7. a strong dislike of one’s sexual anatomy [11]

8. a strong desire for the primary and/or secondary sex characteristics that match one’s experienced gender [12]

[13, 15]

Subtypes

With a disorder of sex development [14]

Without a disorder of sex development

[19]

Please find below a list of disorders related to the diagnostic category, Sexual and Gender Identity Disorders. The Sexual and Gender Identity Disorders Work Group has been responsible for addressing these disorders. We appreciate your review and comment on these disorders.

*Sexual and Gender Identity Disorders Not Currently Listed in DSM-IV
Hypersexual Disorder
Paraphilic Coercive Disorder
Sexual Interest/Arousal Disorder in Women
Sexual Interest/Arousal Disorder in Men
Genito-Pelvic Pain/Penetration Disorder