Dsm-V. Step Right Up And Make Your Predictions. Get It Right And Win A Prize

[Guest KimberlyF]

Coming to a Psych's office near you in 2012 or so...

So what happens with DSM V??? The idea that this is listed as a psych disorder to begin rubs me the wrong way.  And yet I can see this Drs point in the article.  It is a fine line.  

But if it becomes a medical thing I see some major pluses.  First, there would have to be more insurance coverage as this would move out of the vanity/elective surgery into medical necessity category.  Plus a carry letter should be backed by certain Federal protections. And there would be some more willingness on a certain part of the general public to look at the facts or be swayed as public opinion slowly continues to drift our way.

A major con I could see happening is if like the insurance cos set up a TS test from MRIs or something when nobody knows at this point if a negative eliminates legit TSs.  So far it just proves something is up.

http://www.medscape.com/viewarticle/703312

Jack Drescher, MD, from New York Medical College, State University of New York (SUNY)–Downstate New York University and a member of the sexual- and gender identity–disorders work group, explained why gender-identity disorder was put in DSM-III in 1980. "At the time, most psychiatrists didn't believe that there was such a thing as a transsexual as a phenomenon where the treatment is reassignment," he told Medscape Psychiatry. "So the actual motivation for putting it into the diagnostic manual was to try to create access to care."

The guiding principle in medicine is first, do no harm, he said. "The harm of retention of the diagnosis is stigma, and the harm of removal is potential loss of access to care," Dr. Drescher said. "So that's the dilemma, how to create a situation where access can be not only available but increased, and discrimination can be reduced. How we'll resolve that remains to be seen."

[Guest Roxanna L]

My prediction:

The DSM-V will be a step backwards from the DSM-IV, no thanks to Zucker, Blanchard and their posse!

Roxanna

[Guest TracieV3]

My prediction:

The DSM-V will be a step backwards from the DSM-IV, no thanks to Zucker, Blanchard and their posse!

Roxanna

What is happening right now with the two recent studies that prove a physical link to being a transsexual will go along way to help us: http://www.newscientist.com/article/dn20032-transsexual-differences-caught-on-brain-scan.html

Physical prove that can be seen with equipment on live people goes a long way to silencing critics and bigots.

And these to studies did a number of things right, such have transsexuals that had yet to go on HRT. So, the critics cannot say that it is the HRT that made the changes to the transsexuals brains.

DSM is not yet set in stone for next year's publication, and this recent evidence may change things in our favor.

Tracie

[Sally]

We can only hope that it does not make transitioning almost impossible.

Love ya,

Sally

[Guest JaniceW]

One must be very carefull what one wishes for, because you may get it.

Right now GID being listed in the DSM allows a diagnosis code to be assigned and teatment is then available. The diagnosis is recognized by an established medical body (in Psychiatry) and cataloged. If it is removed from the DSM before it is put into either the SNOMED, ICD-9 or ICD-10 code systems then medical services will beome more difficult to receive and life for trans people could become more difficult than it already is.

While I agree that GID should not be a psychiatric diagnosis I am weary of removing it from the DSM until it is established fully in the other medical coding systems.

[Guest TracieV3]

We can only hope that it does not make transitioning almost impossible.

Love ya,

Sally

The two recent studies will help prevent that.

[Guest KimberlyF]

One must be very carefull what one wishes for, because you may get it.

Right now GID being listed in the DSM allows a diagnosis code to be assigned and teatment is then available. The diagnosis is recognized by an established medical body (in Psychiatry) and cataloged. If it is removed from the DSM before it is put into either the SNOMED, ICD-9 or ICD-10 code systems then medical services will beome more difficult to receive and life for trans people could become more difficult than it already is.

While I agree that GID should not be a psychiatric diagnosis I am weary of removing it from the DSM until it is established fully in the other medical coding systems.

I would agree that it needs to shift to a med diagnosis asap, but don't see how dropping it from DSM would change current care since most costs are covered out of pocket or by doctors willing to code things to get past insurance companies. SRS is considered cosmetic/voluntary and can just keep chugging along.

Like in the article I linked even a doc working on DSM V says as it stands most treatment that actually relieves the depression/anxiety or whatever now comes from MDs and not Psychs. In some of the informed consent models, the MD just wants to know the patient is sane. The gender identity is just accepted if everything else in the health history checks.

Kim

[Guest MonikaC]

I think the two recent studies are great. However two studies is not enough to really make an impact. The results need to be repeated by other institutions before credibility can be had in the medical field.

That being said, I personally feel that it shouldn't be removed from the DSM. Yes, there is a physical cause. But one of the principals of modern psychology is that everything psychological is at the same time physical. I think that while it should be looked at, not as a mental disorder, but rather as a physical condition, one should also keep in mind the mental aspect as well. Keep in mind that not everyone who is trans needs to transition to lead a happy and productive life. With therapy, many are able to accept how they are and stop there. Not to mention the suicide rate among the trans population screams for us needing therapy. If it is removed from the DSM, how many would not get the help thy need?

With that in mind, my prediction is that it will stay in the DSM relatively unchanged, but the description may allude to there being physical causes.

Monika

[Guest TracieV3]

I think the two recent studies are great. However two studies is not enough to really make an impact. The results need to be repeated by other institutions before credibility can be had in the medical field.

That being said, I personally feel that it shouldn't be removed from the DSM. Yes, there is a physical cause. But one of the principals of modern psychology is that everything psychological is at the same time physical. I think that while it should be looked at, not as a mental disorder, but rather as a physical condition, one should also keep in mind the mental aspect as well. Keep in mind that not everyone who is trans needs to transition to lead a happy and productive life. With therapy, many are able to accept how they are and stop there. Not to mention the suicide rate among the trans population screams for us needing therapy. If it is removed from the DSM, how many would not get the help thy need?

With that in mind, my prediction is that it will stay in the DSM relatively unchanged, but the description may allude to there being physical causes.

Monika

The studies use MRIs, a very common piece of equipment, so these studies can be repeated in just about any hospital in the industrialized nations.

[Guest MonikaC]

The studies use MRIs, a very common piece of equipment, so these studies can be repeated in just about any hospital in the industrialized nations.

I know they can be repeated without a problem. The question is will they. And will it be in time for the release of the new DSM? Not to mention the fact that even though there have been differences in the brain in transgendered individuals in the MRIs, they haven't proven that is what causes our dysphoria. I'm not trying to be a buzz-kill, but science can be very slow moving. If the new DSM is going to be released in 2012 I just don't see there being enough time for those tests to have any profound impact.

[Drea]

they can be repeated without a problem. The question is will they. And will it be in time for the release of the new DSM?

Not only that, but the repeat study would have to yield the same results.

[Guest TracieV3]

I know they can be repeated without a problem. The question is will they. And will it be in time for the release of the new DSM? Not to mention the fact that even though there have been differences in the brain in transgendered individuals in the MRIs, they haven't proven that is what causes our dysphoria. I'm not trying to be a buzz-kill, but science can be very slow moving. If the new DSM is going to be released in 2012 I just don't see there being enough time for those tests to have any profound impact.

Actually, science has a pretty good idea of the cause. Lack/or not/partial testosterone wash of the brain while in the uterus, depending on if the person is a MtF or a FtM. These MRI scans further prove that with the brains of transsexuals being between male and female brains.

On the point of more studies. It is low risk, with on hand equipment, can be completely quickly, within a few weeks, with potential for good PR.

It is low cost with potential big PR return.

There will likely be more studies.

And physical evidence can go a long way to push for political change.

[Guest TracieV3]

Not only that, but the repeat study would have to yield the same results.

Actually, there were two studies that yielded parallel results.

[Guest mary/jason]

the problem with it being in the DSM in the first place is that, yes it is a psychological disorder, but it's also medical and requires surgical/hormonal correction. if its in the DSM it's definitely being acknowledged as a psych disorder (because it is in a couple of ways) but there aren't any disorders in the DSM that have intense medical interventions as treatment options. if it gets taken out it'll make treatment more available because it wont simply be classified as psych but both, therefore changing the perception that its all in our heads and can be solved with standard therapy.

just because surgery/hormones are psychological needs doesnt mean they aren't also physical (ie necessary).

madison

[Guest MonikaC]

Actually, science has a pretty good idea of the cause. Lack/or not/partial testosterone wash of the brain while in the uterus, depending on if the person is a MtF or a FtM. These MRI scans further prove that with the brains of transsexuals being between male and female brains.

Yes, but having a good idea and having scientific proof are not the same. The MRI scans prove that there are differences in the brains, but they don't really know what those differences mean. From the article: "Guillamon isn't sure whether the four regions are at all associated with notions of gender, but Ivanka Savic-Berglund at the Karolinska Institute in Stockholm, Sweden, thinks they might be." The brain is so complex that it will take a while for them to know exactly what the differences mean.

On the point of more studies. It is low risk, with on hand equipment, can be completely quickly, within a few weeks, with potential for good PR.

It is low cost with potential big PR return.

There will likely be more studies.

Of that, I have no doubt. But will these studies come in time to make a difference for the DSM-V? Depending on when in 2012 it comes out, final changes may need to be done as early as sometime this summer. Studies can be performed by then. But for the team to then analyze the results, write a paper and have it published in a peer reviewed publication, some of which are only quarterly, seems like a lot to ask.

And physical evidence can go a long way to push for political change.

Actually, there were two studies that yielded parallel results.

Yes, but the two studies mentioned in the article were performed on a total of 36 transgendered individuals. That is not large enough of a demographic sample to be able to say that their findings apply to ALL trans people.

the problem with it being in the DSM in the first place is that, yes it is a psychological disorder, but it's also medical and requires surgical/hormonal correction. if its in the DSM it's definitely being acknowledged as a psych disorder (because it is in a couple of ways) but there aren't any disorders in the DSM that have intense medical interventions as treatment options. if it gets taken out it'll make treatment more available because it wont simply be classified as psych but both, therefore changing the perception that its all in our heads and can be solved with standard therapy.

just because surgery/hormones are psychological needs doesnt mean they aren't also physical (ie necessary).

madison

That's a good point. I personally feel that taking it out of the DSM before it is added anywhere else has the potential to limit treatment options. Suddenly in the medical field, our condition wouldn't exist, which could (worst case scenario here) make it so that a doctors malpractice insurance wouldn't cover treatment for GID, which could lead to doctors not wanting to treat us.

If it is in another medical reference as a legitimate disorder, I'm all for taking it out of the DSM as long as therapy is recommended as part of the treatment.

[Guest TracieV3]

1. Yes, but the two studies mentioned in the article were performed on a total of 36 transgendered individuals. That is not large enough of a demographic sample to be able to say that their findings apply to ALL trans people.

2. That's a good point. I personally feel that taking it out of the DSM before it is added anywhere else has the potential to limit treatment options. Suddenly in the medical field, our condition wouldn't exist, which could (worst case scenario here) make it so that a doctors malpractice insurance wouldn't cover treatment for GID, which could lead to doctors not wanting to treat us.

If it is in another medical reference as a legitimate disorder, I'm all for taking it out of the DSM as long as therapy is recommended as part of the treatment.

1. It is a good start.

2. Someone needs to talk to a lawyer experienced with malpractice insurance about this. That is the only way to know either way.

Anyone know any such lawyers that over them a favor to two?

[Guest KimberlyF]

Not only that, but the repeat study would have to yield the same results.

What I thought I read-and I could be totally wrong because I've been really busy these past few weeks and I feel like my head isn't there-but I know there was a study years ago that showed the results in one part of the brain and this was a repeat of that with newer equipment which showed the same results as the first and also in 3 other parts of the brain, so this kinda backs up the first one from a while back. Like I kinda eluded to in my OP, if I were to 'fail' this test it wouldn't change how I felt about myself and I wouldn't stop seeking treatment. It could just put a nice little bow on it for people who think this is a choice or haven't formed an opinion.

And as far as the other stuff (not related to the post quoted), being gay used to be covered under a psych diagnosis and you can be put on meds by your doctor for the stress of being gay and your therapy for depression is covered, etc even though it is not a medical condition that I'm aware. The patients in Informed Consent programs are not being diagnosed with GID. I have a diagnosis of an endocrine disorder. Doctors will continue to treat TS patients. Some to make money and some out of real concern for the community.

Kim