LGBTQs and the DSM-5: A Critical Queer Response

Abstract

This article outlines a community-based collaboration in Toronto, Canada that led to an official response to the APA’s call for comments and suggestions regarding diagnostic criteria revisions for the DSM-5 with a focus on disorders that have or may have an impact on the lives of LGBTQ people. We identified two diagnostic categories: gender dysphoria and paraphilias. The diagnostic categories and their respective disorders are deconstructed utilizing a critical queer analysis with recommendations for change. In addition, we explore the limitations of the APA review process itself and politics within the APA and the LGBTQ communities.

KEYWORDS:

• DSM
• LGBT
• pathology
• queer
• sexual minority

Notes

1. See Drescher (2009) for a more detailed account of the history of GIDs and homosexuality.

2. Transsexualism is a condition in which a person identifies with a physical sex different from the one that they were born with or assigned in cases where ambiguity of the child’s sex organs led to assigning them a physical sex. Retrieved from http://www.transunity.com/pages/genderqueer.html.

3. Transgender is the state of one’s gender identity (self-identification as male, female, both, or neither) not matching one’s assigned gender (identification by others as male or female based on physical/genetic sex). Retrieved from http://www.transunity.com/pages/genderqueer.html.

4. A catchall term for gender identities other than masculine or feminine. People who identify as genderqueer may think of themselves as being both masculine and feminine, as being neither masculine nor feminine, as having a combination of masculine and feminine personality characteristics, or as falling completely outside the gender binary. Retrieved from http://www.transunity.com/pages/genderqueer.html.

5. Interestingly, France became the first country in the world to remove transsexualism from an official list of mental illnesses. Gender identity disorders was removed from a social security code article related to “long-term psychiatric diseases” (New York Times, February 13, 2010).

6. Three specifications in relation to the Transvestic Fetishism criteria are “With fetishism (sexually aroused by fabrics, materials, or garments)”; “With autogynephilia (sexually aroused by thought or image of self as female); and “With Autoandrophilia (Sexually Aroused by Thought or Image of Self as Male)” (APA 2010).

7. Three specified types of Exhibitionism are “Sexually attracted to exposing genitals to pubescent or prepubescent individuals (generally younger than age 15); Sexually attracted to exposing genitals to physically mature individuals (generally age 15 or older); equally sexually attracted to exposing genitals to both age groups” (APA, 2010).

8. Paraphilic Disorders Not Elsewhere Classified: These paraphilias meet the criteria for a mental disorder and for Paraphilic Disorders. Examples include, but are not limited to, sexual fantasies, urges, or behaviors associated with Telephone Scatologia Disorder (obscene phone calls), Necrophilic Disorder (corpses), Zoophilic Disorder (animals), Coprophilic Disorder (feces), Klismaphilic Disorder (enemas), and Urophilic Disorder (urine). The fantasies, sexual urges, or behaviors have been present for at least 6 months and cause marked distress or impairment in social, occupational, or other important areas of functioning. (APA, 2012).