Dan Karasic - Sexual and Gender Diagnoses of the Diagnostic and Statistical Manual (DSM)

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Sexual and Gender Diagnoses of the Diagnostic and Statistical Manual (DSM): A Reevaluation

Sexual and Gender Diagnoses of the Diagnostic and Statistical Manual (DSM):

A Reevaluation

Dan Karasic, MD
Jack Drescher, MD
Editors

Sexual and Gender Diagnoses of the Diagnostic and Statistical Manual (DSM): A Reevaluation has been co-published simultaneously as Journal of Psychology & Human Sexuality , Volume 17, Numbers 3/4 2005.

First published 2005 by The Haworth Press, Inc
10 Alice Street, Binghamton, NY 13904-1580

This edition published in 2012

by Routledge

2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
711 Third Avenue, New York, NY 10017, USA

Routledge is an imprint of the Taylor & Francis Group, an informa business

Sexual and Gender Diagnoses of the Diagnostic and Statistical Manual (DSM): A Reevaluation has been co-published simultaneously as Journal of Psychology & Human Sexuality , Volume 17, Numbers 3/4 2005.

2005 by The Haworth Press, Inc.

All rights reserved. No part of this work may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, microfilm and recording, or by any information storage and retrieval system, without permission in writing from the publisher.

The development, preparation, and publication of this work has been undertaken with great care. However, the publisher, employees, editors, and agents of The Haworth Press and all imprints of The Haworth Press, Inc., including The Haworth Medical Press and Pharmaceutical Products Press, are not responsible for any errors contained herein or for consequences that may ensue from use of materials or information contained in this work. With regard to case studies, identities and circumstances of individuals discussed herein have been changed to protect confidentiality. Any resemblance to actual persons, living or dead, is entirely coincidental.

The Haworth Press is committed to the dissemination of ideas and information according to the highest standards of intellectual freedom and the free exchange of ideas. Statements made and opinions expressed in this publication do not necessarily reflect the views of the Publisher, Directors, management, or staff of The Haworth Press, Inc., or an endorsement by them.

Cover design by Kerry E. Mack

Library of Congress Cataloging-in-Publication Data
Sexual and gender diagnoses of the Diagnostic and Statistical Manual (DSM): a reevaluation / Dan Karasic, Jack Drescher, editors.
p. cm.
"Sexual and Gender Diagnoses of the Diagnostic and Statistical Manual (DSM): A Reevaluation has been co-published simultaneously as Journal of Psychology & Human Sexuality, Volume 17, Numbers 3/4 2005."
Includes bibliographical references and index.

ISBN-13: 978-0-7890-3213-3 (hard cover)

ISBN-10: 0-7890-3213-9 (hard cover)

ISBN-13: 978-0-7890-3214-0 (soft cover)

ISBN-10: 0-7890-3214-7 (soft cover)

1. Gender identity disorders. I. Karasic, Dan. II. Drescher, Jack, 1951
RC560.G45S49 2005
616.85'83-dc22
2005028903

Sexual and Gender Diagnoses of the Diagnostic and Statistical Manual (DSM): A Reevaluation

Contents

Dan Karasic, MD

Jack Drescher, MD

Darryl B. Hill, PhD

Christina Rozanski, MSW

Jessica Carfagnini, BA

Brian Willoughby, MA

Arlene Istar Lev, LCSW, CASAC

Kelley Winters, PhD

Charles Moser, PhD, MD

Peggy J. Kleinplatz, PhD

Robert L. Spitzer, MD

Paul Jay Fink, MD

Walter O. Bockting, PhD

Randall D. Ehrbar, PsyD

Peggy J. Kleinplatz, PhD

Charles Moser, PhD, MD

Kimberly A. Payne, BA

Elke D. Reissing, PhD

Marie-Andre Lahaie, BA

Yitzchak M. Binik, PhD

Rhonda Amsel, MSc

Samir Khalif, MD

About the Editors

Dan Karasic, MD, is Clinical Professor of Psychiatry at the University of California, San Francisco. He is the psychiatrist for the Transgender Life Care Program at Castro Mission Health Center, and works with the UCSF AIDS Health Project, the Positive Health Practice at San Francisco General Hospital, Bay Area Gender Associates, and research on depression and HIV medication adherence. Dr. Karasic is President of the Association of Gay and Lesbian Psychiatrists.

Jack Drescher, MD, is a Fellow, Training Supervising Analyst at the William Alanson White Institute. He is a Distinguished Fellow of the American Psychiatric Association, Chair of the APAs Committee on GLB Issues and a Past President of the NYC Branch of the APA. Dr. Drescher is author of Psychoanalytic Therapy and the Gay Man (The Analytic Press) and editor of more than a dozen books dealing with gender, sexuality and public health. He edits the Bending Psychoanalysis Book Series (The Analytic Press) and is Editor-in-Chief of the Journal of Gay & Lesbian Psychotherapy . Dr. Drescher is in full-time private practice in New York City.

Foreword

The American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders (DSM) has been used extensively for clinical, research and educational purposes. It is the official nomenclature of the American Psychiatric Association and, as such, has far reaching implications for the diagnosis, treatment, and access to mental health care. In the United States, most insurance companies rely on these diagnoses for insurance reimbursement, which has significant repercussions for access to care.

While these diagnoses provide recognition and access for treatment for a variety of mental disorders, there is the double-edge sword of potentially overpathologizing and stigmatizing individuals with psychological and psychiatric concerns. As such, the DSM has been the source of intense debate since the first major revision with the publication of DSM-III in 1980 and subsequent revisions (DSM-III-R in 1987; DSM-IV in 1994; and DSM-TR in 2000).

Subsequent to the DSM-III, the sexual and gender identity disorders have gone through quite a bit of revision. Some of these changes have been substantive (e.g., removal of homosexuality as a mental disorder in DSM-II and Ego-Dystonic Homosexuality from DSM-III and reformulating the conceptualization of gender identity disorders) whereas others have pertained to minor modifications in criteria or terminology. Whether major or minor changes were made, each had significant implications for diagnosis and treatment.

Since the advent of DSM-III, which introduced more specific criteria and spawned new empirical research on data sets that were able to be used as criteria for revisions, work groups were assigned the task of reviewing the literature and making recommendations for revisions or for further research in resolving discrepancies. While DSM-III and DSM-III-R relied primarily on expert consensus, DSM-IV was developed based on a comprehensive review of the available empirical literature. Field trials were also used to arrive at conclusions. It is the intent that further revisions become more empirically-driven.

While the publication of DSM-V is not anticipated until 2010 or later, the process of revision of DSM is an ongoing process and work groups will soon begin the process of reviewing the literature and discussing potential changes. Understanding that this process has begun, I thought it would be useful to compile a volume of critical reviews of concerns, issues, and recommendations that might have an impact on the next revision of DSM as well as future revisions. Through intense prodding by Charles Moser to commission this work, I invited Jack Dresher to guest edit this volume. He brought on Dan Karasic as co-editor and together they have produced a provocative group of papers on this collection. These papers were carefully peer reviewed and edited.

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