Get Early Look atDSM-VDevelopment Process

The definition of gender dysphoria has been the subject of extensive scientific debate in various fields. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V) characterizes gender dysphoria as a psychological condition due to a discrepancy between perceived and assigned gender. The scientific community has engaged in an extensive debate over the years regarding the classification of gender dysphoria, initially characterizing it as a gender identity disorder and subsequently removing it from the category of mental disorder. This paper aims to use bibliometric techniques to analyze scientific productivity and study the evolution of content on gender dysphoria from 1991 to 2022. It provides to map the scientific research production in this field through the science mapping approach highlighting the changes that have taken place over the past three decades.

Gender identity refers to the way humans view themselves and perceive themselves to be attractive both sexually and romantically. It is an individual's appreciation and satisfaction of being heterosexual, bisexual, homosexual, or cisgender. It refers to an individual's sexual understanding of himself and is part of one's identity, which is different from the sexual understanding of oneself. Gender identity disorder means a robust desire of pertinence towards the opposite sex and robustly insistence on this otherness. Avoidance is classified within the framework of cluster 3 of personality disorders, which is identified by The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Hence, one can argue those who have this kind of personality disorder may appear in them withdrawal behavior; and they view themselves as restless, and they feel that they are rejected and despised by others. The researcher argues that homosexuals in Kurdish society are not accepted, and a large majority of people see them as sick, and others as victim due to their vulnerability to social and psychological problems. This study aims at finding relations between gender identity disorder and symptoms of avoidance in homosexual persons. The descriptive and relational methodology is used to intentionally select 108 subjects, 84 males and 24 females. Based on literatures and contemporary studies in the field, the researcher prepares the items of the gender identity disorder, yet for symptoms of avoidance, the researcher relies on and takes its terminologies from The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The terminologies in both variables are presented to groups of experts in education, psychology, and psychiatrics, and for extracting stability from both the measures, (split-half) and (alpha Cronbach’s) is used. After applying the last measures on individuals from the sample of the study, statistics of the data is analyzed using Statistical Package for the Social Sciences (SPSS). The study concludes that there is a robust, positive and significant correlation between gender identity disorder and avoidance symptoms among homosexuals. Based on the results recommendations are also given.

Back to table of contents Previous article Next article LettersFull AccessICD-11 and DSM-5 Classifications: A Survey of Japanese PsychiatristsToshimasa Maruta, M.D., Ph.D., Yutaka Ono, M.D., Ph.D., and Chihiro Matsumoto, M.A.Toshimasa MarutaSearch for more papers by this author, M.D., Ph.D., Yutaka OnoSearch for more papers by this author, M.D., Ph.D., and Chihiro MatsumotoSearch for more papers by this author, M.A.Published Online:1 Dec 2013https://doi.org/10.1176/appi.ps.201300396AboutSectionsView articleSupplemental MaterialPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View articleTo the Editor: The World Health Organization is currently working on the 11th revision of the International Classification of Diseases (ICD-11) (1), and DSM-5 (2) was released in May 2013. Some criticized the process of developing DSM-5 (3). Thus we thought that it would be worthwhile to investigate how Japanese psychiatrists view the ICD and DSM revision processes and how they would like the diagnostic classifications to change.The aim of this study was to clarify how ICD-10 (4) and DSM-IV-TR (5) have been perceived in clinical, administrative, and forensic settings in Japan. In addition, we solicited opinions on the diagnostic classifications proposed for ICD-11. A questionnaire was mailed in February 2011 to 452 members of the council of the Japanese Society for Psychiatric Diagnosis and 80 chief professors from every psychiatry department at universities in Japan. They were asked to provide their opinions and perspectives on issues regarding diagnostic classification in general, rather than on specific disorders or domains in the ICD-10 and DSM-IV-TR.Data were collected from 245 respondents (response rate of 46%), of which 219 were men and 26 were women. The mean±SD age of respondents was 50.0±12.9 years, and the mean length of their experience as a psychiatrist was 23.9±12.4 years. [A table presenting the 12 questions and the responses is available in an online data supplement to this letter.]Survey results appeared to indicate that respondents were rather hesitant about making major changes, such as reorganizing the classification system. The coexistence of two major diagnostic systems, namely the ICD and DSM, has been a concern among many clinicians. The Research Domain Criteria proposed by the National Institute of Mental Health in the United States were favorably seen by Japanese psychiatrists; 74% approved this approach.Hesitation about making major changes was evident in responses to an item about recent molecular genetic research suggesting that bipolar disorder is closer to schizophrenia than to depression. Respondents were not comfortable combining bipolar disorder and schizophrenia as psychotic disorders; instead, 69% agreed that bipolar disorder should continue to be included in the category of mood disorders.Two items asked about the many “not otherwise specified” (NOS) diagnoses and “comorbid” diagnoses that are yielded by the ICD-10 and DSM-IV-TR. Responses indicated a desire that revisions to the classification systems would lead to fewer such diagnoses; however, many respondents acknowledged that NOS and comorbid diagnoses were an unavoidable outcome of using operational diagnostic criteria.These results were obtained from Japanese psychiatrists and therefore cannot be generalized to psychiatrists worldwide. However, we hope that these findings will help inform ICD-11 revision efforts.Dr. Maruta and Ms. Matsumoto are affiliated with the Department of Psychiatry, Tokyo Medical University, Tokyo. Dr. Ono is with the National Center for Cognitive Behavioral Therapy and Research and the National Center of Neurology and Psychiatry, Tokyo.Acknowledgments and disclosuresThe study was supported by a Health Labor Science Research Grant H20-Kokoro-Ippan-007 from the Japanese Ministry of Health, Labor and Welfare. The authors thank the survey participants.The authors report no competing interests.References1 International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders: A conceptual framework for the revision of the ICD-10 classification of mental and behavioural disorders. World Psychiatry 10:86–92, 2011Crossref, Medline, Google Scholar2 Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, Va, American Psychiatric Association, 2013Google Scholar3 Frances A: Whither DSM-V? British Journal of Psychiatry 195:391–392, 2009Crossref, Medline, Google Scholar4 International Statistical Classification of Diseases and Related Health Problems, 10th Revision. Geneva, World Health Organization, 1992Google Scholar5 Diagnostic and Statistical Manual of Mental Disorders, 4th ed, Text Revision. Washington DC, American Psychiatric Association, 2000Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 64Issue 12 December 2013Pages 1279-1280 Metrics Acknowledgments and disclosuresThe study was supported by a Health Labor Science Research Grant H20-Kokoro-Ippan-007 from the Japanese Ministry of Health, Labor and Welfare. The authors thank the survey participants.The authors report no competing interests.PDF download History Published online 1 December 2013 Published in print 1 December 2013

There have been several myths and misconceptions about the dichotomous understanding of sex and gender. While sex is biologically determined, gender and gender identity depend on childhood experiences, upbringing, social expectations, beliefs, family environment, and peer interactions and is socially constructed. Gender dysphoria (GD) is the extreme distress experienced by an individual because of a mismatch between their gender identity and the sex assigned at birth. GD has been an ambiguous category in psychiatry, initially termed as “gender identity disorder” till Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ( DSM-5) considered removal of the term “disorder” to reduce the stigma associated. The critical element in GD is “clinically significant distress” that differentiates it from gender nonconformity. Individuals with GD identify themselves as transgender and frequently are victims of coercive social norms, discrimination, and stigma. This leads to delay in expression of distress, psychiatric mismanagement, and high comorbidity of depression, anxiety, post-traumatic stress, self-harm, and suicidality. Though management involves a holistic multidisciplinary approach including psychotherapy, social support, and gender-reassignment treatments (medical/surgical), there has been considerable debate and ambiguity related to the same. With this background, the article critics the understanding of GD, focuses on the WPATH SOC-7 treatment guidelines, and highlights the role of mental health professionals for better care.

Psychiatry and psychology have a long and highly debated history in relation to gender. In particular, they have attracted criticism for policing the boundaries of ‘normal’ gender expression through gender identity diagnoses, such as transvestism, transsexualism, gender identity disorder and gender dysphoria. Drawing on discursive psychology, this book traces the historical development of psychiatric constructions of ‘normal’ and ‘abnormal’ gender expression. It contextualizes the recent reconstruction of gender in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and its criteria for gender dysphoria. This latest diagnosis illustrates the continued disagreement and debate within the profession surrounding gender identity as ‘disordered’. It also provides an opportunity to reflect on the conflicted history between feminist and transgender communities in the changing context of a more trans-positive feminism, and the implications of these diagnoses for these distinct but linked communities. Psychology and Gender Dysphoria examines debates and controversies surrounding psychiatric diagnoses and theories related to gender and gender nonconformity by exploring recent research, examples of collaborative perspectives, and existing feminist and trans texts. As such, the book is relevant for postgraduate and postdoctoral researchers of gender, feminism, and critical psychology as well as historical issues within psychiatry.

Transgender issues and transgender rights have become increasingly a matter of media attention and public policy debates. Reflecting changes in psychiatric perspectives, the diagnosis of "trans-sexualism" first appeared in the International Statistical Classification of Diseases and Related Health Problems in 1975 and shortly thereafter, in 1980, in the Diagnostic and Statistical Manual of Mental Disorders. Since that time, international standards of care have been developed, and today those standards are followed by clinicians across diverse cultures. In many instances, treatment of older adolescents and adults is covered by national health care systems and, in some cases, by private health insurance. Most recently, the Medicare ban on coverage for gender reassignment surgery was lifted in 2014. In contrast to the relative lack of controversy about treating adolescents and adults, there is no expert clinical consensus regarding the treatment of prepubescent children who meet diagnostic criteria for what was referred to in both DSM-IV-TR and ICD-10 as gender identity disorder in children and now in DSM-5 as gender dysphoria. One reason for the differing attitudes has to do with the pervasive nature of gender dysphoria in older adolescents and adults: it rarely desists, and so the treatment of choice is gender or sex reassignment. On the subject of treating children, however, as the World Professional Association for Transgender Health notes in their latest Standards of Care, gender dysphoria in childhood does not inevitably continue into adulthood, and only 6 to 23 percent of boys and 12 to 27 percent of girls treated in gender clinics showed persistence of their gender dysphoria into adulthood. Further, most of the boys' gender dysphoria desisted, and in adulthood, they identified as gay rather than as transgender. In an effort to clarify best treatment practices for transgender individuals, a recent American Psychiatric Association Task Force on the Treatment of Gender Identity outlined three differing approaches to treating prepubescent gender dysphoric children.

Efforts to Describe Mental Illnesses Continue to Make Progress

A diagnostic questionnaire for childbirth related posttraumatic stress disorder: a validation study

Since the first edition of the Diagnostic and Statistical Manual: Mental Disorders was published in 1952 by the American Psychiatric Association (APA), the manual has gone through a series of revisions: DSM-II in 1968, DSM-III in 1980, DSM-IIIR in 1987, DSM-IV in 1994, and a text revision to the DSM-IV in 2000. For those with a sharp eye, one will note that, subsequent to DSM-I, the manual has had a slightly different name: Diagnostic and Statistical Manual of Mental Disorders. Any clinician, researcher, or policy maker with an interest in psychiatric nosology is keenly aware that the publication of the DSM-III in 1980 was a watershed moment in contemporary psychiatry. By that time, the intellectual and institutional hegemony of psychoanalysis that had dominated the psychiatric landscape had lost some, if not most, of its grip (see Grob, 1991; Paris, 2005; Wilson, 1993). Sketchy psychoanalytic models of at least some psychiatric disorders that were described in the DSM-I and DSM-II were abandoned. The rather vague diagnostic descriptors were replaced by more detailed criteria and, for the majority of conditions described in the DSM-III, an atheoretical approach predominated. As noted in the Introduction to the DSM-III:

Twenty years ago, slightly after the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition was published, we predicted the characteristics of the future Diagnostic and Statistical Manual of Mental Disorders (fifth edition) (). Included in our predictions were how many diagnoses it would contain, the physical size of the Diagnostic and Statistical Manual of Mental Disorders (fifth edition), who its leader would be, how many professionals would be involved in creating it, the revenue generated, and the color of its cover. This article reports on the accuracy of our predictions. Our largest prediction error concerned financial revenue. The earnings growth of the DSM's has been remarkable. Drug company investments, insurance benefits, the financial need of the American Psychiatric Association, and the research grant process are factors that have stimulated the growth of the DSM's. Restoring order and simplicity to the classification of mental disorders will not be a trivial task.

The authors discuss the process that the American Psychiatric Association and its task force, workgroups, and subworkgroup on Gender Identity Disorder (GID) have proceeded with in order to explore the scientific data supporting, refuting, and suggesting change in the diagnosis of Gender Identity Disorder in Adults, Children, and Adolescents in preparation for the publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Discussion includes how the subworkgroup has begun a process of inquiry into the matter with attention to the varieties of positions from around the world, in different organizations, among individuals of different identities, races, ethnicities, genders or gender identities, and different relationships to the issue. How this group has then proceeded with reviews of the literature, consultation with various experts, and the development of a consensus is detailed. The complexities of this type of undertaking are elucidated.

Abstract: This main article for a Philosophy, Psychiatry, & Psychology philosophical case conference is intended to raise philosophical, psychiatric, and public policy issues concerning the relationship between concepts of criminality, mental disorder, and the classification of mental disorders. After introducing the basic problem of the confounding of “vice” and mental disorder concepts in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition—Text Revision, the author summarizes three different cases from the literature that illustrate the problem of the vice–mental disorder relationship. Four general aspects of the conceptual issues are presented to frame the discussion, and general questions in a range of domains are posed for commentators.

طبقه ­بندی اختلال­ های روانی از دیرباز در میان متخصصان سلامت روان، موضوعی مورد مناقشه بوده است. با وجود گسترش قابل ملاحظه­ ی دانش ما در این حوزه در نیم قرن گذشته، فهم اجزا و فرایندهای آن، همچنان ابتدایی است. در این مقاله سه نظام طبقه­ بندی اختلال­ های روانی توصیف می­ شود که هدف هر یک از آن­ ها برای درک و طبقه­ بندی اختلال­ ها با یکدیگر متفاوت است: دو کتابچه راهنمای عمده تشخیصی– راهنمای تشخیصی و آماری اختلالات روانی (DSM)، طبقه­ بندی بین­ المللی بیماری­ ها (ICD) و پروژه معیارهای دامنه تحقیق (RDoC) موسسه­ ی ملی سلامت روان ایالات متحده که با تاکید بر یکپارچگی تحقیقات علوم رفتاری و علوم اعصاب چهارچوبی برای درک عمیق اختلالات روانی ارائه کرده است. برای مقایسه این سه طبقه ­بندی از چهار موضوع کلیدی بهره گرفته شده است: سبب­شناسی، شامل علیت­ های متعدد اختلال روانی؛ طبقه­ بندی یا ابعاد، آیا پدیده ­های مربوطه طبقاتی مجزا هستند یا ابعادی؟؛ آستانه­ ها، که مرز بین اختلال و عدم اختلال را تعیین می ­کنند؛ و هم ­ابتلایی، که دربردارنده­ ی این واقعیت است که افراد مبتلا به بیماری روانی اغلب دارای نیازهای تشخیصی برای شرایط مختلف هستند. اگر چه این نظام­ ها دارای درجه­ های مختلف همپوشانی و ویژگی­ های متمایز هستند، هدف مشترک هر سه آن­ ها کاهش بار رنج ناشی از اختلالات روانی است به وسیله­ ی درک بهتر و طبقه­ب ندی مناسب آن­ ها است.

The chapter has two aims. The first is to give philosophers (or anyone with no background practical experience of mental distress and disorder) a taste of the more formal aspects of psy- chopathology and the classifications of mental disorder used by professionals working in mental health. The materials in this chapter, it should be said straight away, are perhaps more characteristic of medical, nursing, and psychological professional work, than, say, social work. The mater- ials, it is true, are the result of over a hundred years of careful observation and development of ideas (covered in detail in Parts II and III). All the same, just as the concept of mental disorder remains subject to widely different interpretations (the various ‘models’ we explored in Chapter 2), so the classification of these disorders—the particular ‘symptoms’ identified, the groups and classes and clusters into which they are drawn together—remain much debated. The whole enterprise of classification of mental distress and disorder is indeed challenged by some (see, e.g. Kutchins and Kirk, 1997). As with all the materials in this book, then, this chapter is presented, not as a reflection of a settled or final view, but as a focus for critical engagement and collegial development of ideas.

Chief complaint: “I feel like I have the brain of a man. Am I crazy?” On her first visit to a psychiatrist ( J.M.B.), “Ms. C,” a 48year-old woman, asked this question about her confused gender identity. Having also discovered a primary sexual attraction to women, Ms. C was having difficulty reconciling her church’s injunctions against sinful homosexual activities with her sense of herself as fundamentally male. She was dressed in a subtly frilly blouse and leather jacket she called “my leather-and-lace look.” Encircling each wrist were tattooed bracelets, traceries of curlicues and rosebuds that gently contradicted pearl earrings and a delicate gold locket. Born in the early 1950s and raised resolutely as a girl, Ms. C did not learn until she was 23 and married the unusual circumstances of her birth. Her mother finally divulged that she had entered the world with strange-looking genitals—neither male nor female. Doctors told her parents it was best to remove the odd tissue, fashion what remained to look female, and raise her as if nothing unusual had happened. At 6 months, surgeons removed both external tissue and presumed intra-abdominal testicular tissue and fashioned labia around the vaginal entrance she had always had. In grade school, she was told her large abdominal scar resulted from herniorrhaphy. At 12, after starting daily estrogen pills to induce puberty, she developed breasts and feminine curves, although without menarche or an increase in height beyond 5 feet. Her mother said she could not have children but did not explain why. She recalls being a tomboy who preferred boys for playmates. Because of her small stature and feminine appearance, however, boys were not particularly comfortable hanging out with her. Then, as now, she identified with the way males think rather than a sense of being physically male. She dated boys in high school, had a sexual experience with a woman during college, and married a man with whom she enjoyed satisfying marital relations for nearly two decades until they experienced a menage a trois. Her husband fell in love with the other woman, and she kindled awareness of her greater attraction to women than men. The marriage ended, and she embarked upon two long-term lesbian relationships and a struggle with alcoholism. Ms. C found sobriety and her church while that second relationship was unraveling. Welcomed and spiritually nurtured by church members, she felt happy except for increasing discontent with her pastor’s insistence that homosexual desires were her “cross to bear” and her options were either heterosexual marriage or celibacy. On one hand, her personal theology concurred that homosexuality was against God’s plan. On the other, she struggled with identifying herself as either man or woman, a dilemma her pastor could not solve. Ms. C’s childhood medical records had been lost. The psychiatrist asked if she had been karyotyped, given her unusual birth. She did not know. When she was born, chromosome testing was not routinely available. Given medical advice to raise her unquestioningly as a girl, the issue had not resurfaced. The psychiatrist suggested the test, and when results revealed 45,X/ 46,XY chromosomes, 75% the latter, the fragments—the childhood operation, hormones, her short stature, “brain of a man”—fell into place. She immediately reported feeling “less of a freak” now that she had a name—“intersexual”—for her condition.