Consensus from Differences: Lack of Professional Consensus on the Retention of the Gender Identity Disorder Diagnosis

Abstract

When the World Professional Association of Transgender Health (WPATH) was asked to provide input into the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5) process regarding the revision of the Gender Identity Disorder (GID) diagnosis, it quickly became apparent that there was a lack of professional consensus within the field as to whether or not this diagnosis should be retained and, if so, whether GID is best conceptualized as a mental health disorder or as a non-mental health physical disorder. Addressing this lack of consensus was the first issue the WPATH Consensus Statement work groups faced. By acknowledging the arguments on both sides and accepting the lack of consensus on the retention of the diagnosis, the work groups were able to reach agreement upon recommendations for diagnostic revision, should a diagnosis be retained in DSM 5. Thus, starting from standpoints with fundamental differences, and representing a constituency (WPATH members) with widely different views, it was possible to reach consensus on shared concerns and make substantive recommendations. This article outlines the lack of agreement regarding the existence of a GID diagnosis and arguments on both side of the issue. This fundamental area of disagreement has a long history and is likely to continue to inform the field of transgender health for some time to come.

Keywords:

• DSM
• GID
• transsexual
• diagnosis
• gender identity disorder
• transgender
• WPATH
• consensus statement

Randall D. Ehrbar, PsyD, is a clinical psychologist and sexologist. He specializes in gender and sexuality issues, including GLBT issues, trans-health, and sex therapy. He was a clinician at New Leaf Services for Our Community, a community mental health center serving the LGBT communities in San Francisco, where he led two trans-support groups. He has recently accepted a position at Counseling and Psychological Services of University of Colorado at Boulder. He is also in independent practice. In addition to providing psychotherapy, he is a frequent consultant and guest lecturer on trans issues. Dr. Ehrbar has also supervised and trained other health professionals. He has been actively involved in professional organizations such as the American Psychological Association through publications, scientific presentations, and involvement in governance and public policy. He served as cochair of the WPATH Adolescent Consensus Statement work group.

Notes

1. In this article, the word trans is used as a super-ordinate term referring to the full range of sex and gender diverse people, including transgender, transsexual, and gender variant people. At the same time, I recognize that not all gender diverse or transsexual people self-identify as trans or transgender.

2. “Ableism is a neologism of United States coinage used to describe effective discrimination against people with disabilities in favor of people who are not disabled. An ableist society is said to be one that treats non-disabled individuals as the standard of ‘normal living,’ which results in public and private places and services, education, and social work that are built to serve ‘standard’ people, thereby inherently excluding those with various disabilities. By contrast with the [United States], United Kingdom usage favours ‘Disablism’ to describe the same processes. Other English-speaking nations may use either term or both” (Ableism, n.d.).