Minority Report

The American Psychiatric Association Task Force on Treatment of Gender Identity Disorder published a report this past June.  This report is a policy statement by the task force.  As such, it has interesting political as well as scientific import.  It is a remarkable document.  And that is exactly what I’m doing here, remarking on it.  It is worth reading carefully, twice.

Perhaps the most important statement in this report is,

“While the existence of the diagnosis contributes to the stigma of affected individuals, the unintended result of the APA’s silence is a failure to facilitate full access to care for those diagnosed with GID”

The inclusion of a diagnosis without clear recommendations regarding appropriate medical care in the APA’s DSM has long been a concern to many transactivists.  Within the transactivist circles, the best remedy for this situation has been hotly debated for at least two decades.  Some wanted the APA to remove all reference to transsexuality, transgender, and gender identity, seeing the issue as being analogous to the removal of homosexuality from the DSM in 1973.  Further, they saw the way to increased civil rights was to follow the civil rights and gay rights movements’ example of gaining recognition in the political arena.  Another school of thought was just the opposite, believing that transsexuality is a recognizable medical condition and best belongs in the DSM.  This school argued that access to affordable medical care depended upon having a recognized medical condition.  Further, that recognition of transsexual legal identities and protections from unwarranted and unjust treatment in housing and employment were best pursued by gaining medical recognition of their condition.  The first position may be called the “civil rights” model, while the second may be called, the “medical model”.  Of course, there is the third path, that held to the ideals of both: Civil rights when and where possible, and full medical recognition in all spheres.

The Task Force supports the medical model and recommends that the APA issue a resolution clearly stating that transition, HRT, and SRS are “medically necessary” procedures, paving the way for affordable access to medical care.

The Task Force is to be congratulated and thanked for supporting the medical model so forthrightly.   (I’ve long held to the third path.)

The two types of transsexuals

Although this report was consummately written so as to be non-inflammatory as possible, there were still gems to be gleaned from the text through careful reading.  Specifically, this report fully supports the two type transsexual typology, but using the terms “early onset” and “late onset”.  The report defines “early onset” in such a way that we easily recognize that they are referring to transkids, while “late onset” is used to refer to those whose GID surfaces in adolescence or later.  They further clarify that late onset is associated with “transvestic fetishism” (a form of autogynephilia) and sexual attraction to the opposite natal sex.  Thus, this illustrious group of psychiatrists/psychologists at least tacitly acknowledge the Freund / Blanchard two type taxonomy, along with comments to the effect that the two types need different case management.  There was no need to read between the lines, the existence of and the differences between the two types was clearly articulated.

No word was mentioned about separating the two types into separate diagnostic categories… but perhaps that will come with further research and clinical experience?

Further Reading:  APA’s DSM-V fully supports the two type taxonomy.

References:

William Byne, Susan J. Bradley, Eli Coleman, A. Evan Eyler, Richard Green, Edgardo J. Menvielle, Heino F. L. Meyer-Bahlburg, Richard R. Pleak, D. Andrew Tompkins, “Report of the American Psychiatric Association Task Force on Treatment of Gender Identity Disorder”
https://www.apa.org/pi/lgbt/resources/policy/gender-identity-report.pdf