The Future of GID NOS in the DSM 5: Report of the GID NOS Working Group of a Consensus Process Conducted by the World Professional Association for Transgender Health

Abstract

The DSM-IV-TR diagnosis Gender Identity Disorder Not Otherwise Specified (GID NOS) is used to describe individuals who have gender issues but do not meet the current criteria for GID. As part of a consensus process conducted by the World Professional Association for Transgender Health, the authors make the following recommendations for DSM 5: removal from the chapter on sexual disorders, more specific diagnostic criteria, retention of clinical significance criteria, and removal of exclusionary criteria of Intersex/Disorders of Sex Development. Changes to the existing clinical examples were also recommended, suggesting additional clinical examples that encompass a broader range of gender-variance and more commonly found transgender presentations. The diagnosis must reflect the severity of the clinical issues that represent legitimate identity experiences and possible need for gender-confirming treatments.

Keywords:

• Transgender
• transsexual
• gender identity disorder (GID)
• gender identity disorder not otherwise specified (GID NOS)
• gender dysphoria
• cross-dressing
• castration
• intersex
• disorders of sex development
• DSM
• DSM 5
• gender variance
• genderqueer

ACKNOWLEDGMENTS

The authors acknowledge Arlene Istar Lev, LCSW, for her insightful reading of this article and valuable comments. The authors also acknowledge Wilhelm F. Preuss, MD, psychiatrist and clinical sexologist at the Institute of Sex Research and Forensic Psychiatry, University Clinic Hamburg Eppendorf, Hamburg, Germany, for participating in the discussions of the article at the WPATH 2009 XXI Biennial Symposium in Oslo, Norway, June 17–20, 2009.

Katherine Rachlin, PhD is a clinical psychologist and gender specialist in private practice in New York City. She is currently a member of the Board of Directors of the World Professional Association of Transgender Health. Cecilia Dhejne MD, is a consultant psychiatrist and authorized clinical sexologist (NACS) at the Gender Team and at the Center for Andrology and Sexual Medicine Karolinska, University Hospital and Karolinska Institutet, Stockholm, Sweden. George R. Brown, MD, DFAPA, is a professor and associate chairman of psychiatry at East Tennessee State University and the chief of psychiatry at the Mountain Home VAMC in Johnson City, Tennessee.a