Jump to content
  • Welcome to the TransPulse Forums!

    We offer a safe, inclusive community for transgender and gender non-conforming folks, as well as their loved ones, to find support and information.  Join today!

Archived

This topic is now archived and is closed to further replies.

Ravin

Brief explanation of the new DSM-V and forthcoming ICD-11 diagnostic codes

Recommended Posts

Carolyn Marie

Ravin, one has to register for an account to view the article.

 

Carolyn Marie

Share this post


Link to post
Briana

The article is fairly brief.  Following is the text:

 

Hi. I am Dr Jack Drescher, clinical professor of psychiatry at Columbia University in New York City and Distinguished Life Fellow of the American Psychiatric Association. I am here to talk a bit about my work on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which came out in 2013, and the International Classification of Diseases, 11th edition (ICD-11), which is scheduled for publication in 2018.

 

I was a member of the DSM-5 workgroup on sexual and gender-identity disorders. That committee was charged with revising what the DSM-IV called sexual and gender-identity disorders. My particular sub-workgroup, which focused specifically on gender-identity disorders, was asked to reconcile calls to remove the diagnosis from the DSM because of its stigmatizing nature, similar to the removal of homosexuality as a diagnosis from the DSM-II in 1973.

 

Our workgroup concluded, however, that removal of the diagnosis could be quite problematic because in order to access services, you need a diagnosis. We were caught between access to care and the stigma associated with a psychiatric diagnosis. Stigma is not reason enough to remove a mental disorder diagnosis if one needs one.

 

We decided that we could not simply remove sexual and gender-identity disorders from the manual. Some suggested that we classify it with a V-code. As many of you know, V-codes are used for conditions that are not psychiatric disorders but may come to the attention of a mental health professional. But these conditions are not reimbursable by most insurance companies or by many national healthcare systems, and are not seen as requiring reimbursement. Thus, we could not classify it with a V-code. Instead, we decided to retain the diagnosis but make some changes that would reduce stigma.

Small, Meaningful Changes

 

One way to reduce stigma was to remove the word "disorder." We changed the name from gender-identity disorder to gender dysphoria. Gender dysphoria was a preexisting term in the literature. Many people who work in this area are aware of the term, and many people who opposed having a gender-identity disorder diagnosis were happy with the name change.

 

We also tried to narrow the diagnostic criteria, with the idea that you do not want to give people a diagnosis when they do not want one, and to reduce the number of false positives. We made the diagnostic criteria a bit stricter than in the DSM-IV.

 

Suppose a person with gender dysphoria undergoes treatment and has a legal name change. That person is no longer gender dysphoric. Does that mean that they do not have a diagnosis? True, they do not have symptoms of gender dysphoria, but they would have symptoms if they had not received the treatment. We introduced the notion of a post-transition specifier to the diagnostic manual. A person who has had treatment, who is not dysphoric but used to be dysphoric, can still have a diagnosis code. This was how we solved that problem in the DSM.

 

In addition, we removed the specifier for sexual orientation. There was a time when it mattered, for some reason, whether a person's sexual orientation was involved in making the decision to transition. For example, in the middle of the 20th century, if you were born a man, assigned male at birth, and you were attracted to women but you believed yourself to be a woman and wanted to undergo a transition, you could not tell the doctors that you were attracted to women. The doctors were only involved in making heterosexuals at the end of the treatment. They were not going to make any lesbians or gay men by transitioning people who, at the end, would be attracted to the same gender. That is not the case in terms of how clinicians practice today, but that was the case then. Thus, we removed the sexual orientation specifier because it is irrelevant to clinical work. Those were some of the DSM changes.

 

We also made a slight change at the international level. The World Health Organization's ICD-11 will come out in 2018. There was more flexibility in the ICD compared with the DSM, where a diagnosis is either in or out. The ICD includes all diagnoses, psychiatric and medical. The recommendation, which has been followed, is that the new diagnosis, called gender incongruence, will be moved from the mental disorder section to another chapter, called "Conditions Related to Sexual Health." This allows countries that have national healthcare systems to have a diagnosis code, to continue to provide care for people, and to reduce the stigma of a mental disorder.

 

Transgender people are a highly stigmatized patient population. This is one way to reduce the stigma. In reality, we do not know what causes transgender presentations. We do not know whether it is psychological or medical, just as we do not know why people are cisgender (non-transgender). The change offers a new diagnosis: gender incongruence.

 

Thanks for listening to me. This is Dr Jack Drescher.

Share this post


Link to post
Charlize

Thank you for posting that Ravin and thanks for the copy Briana.  They certainly sounds like positive changes.

 

Hugs,

 

Charlize

Share this post


Link to post
Jani

Thank you.  This is a very good explanation from one of the authors. 

 

Jani  

Share this post


Link to post
Guest

Yet the chattering bigots will still insist that the term "disorder" was removed only in response to intense pressure put upon the medical community by the "LGBT mafia".

Share this post


Link to post
Dev

Just call me Dona Corleone. ;) 

Share this post


Link to post
MaryMary

slightly related to this topic is the fact that people who have mental health problems deserve to be treated with repect and deserve to be able to take care of their health. What always gets to me is that when people say that : " transgender persons are mentally ill" what they are really saying is " I don't care if someone have mental health issues, they are faulty, we need to keep an eye on them and put them in an asylum"

 

I understand that being transgender and / or  having dyphoria is called a disorder and should really be called a "condition" (at least that's the word in french). It makes no sense to call it an "illness". But those who have such illness are often wonderfull people who deserves the help from society.

 

What need to change is that those bigots need to have more empathy. I know that in the united states there's a big religious debate around the topic but I still can't believe that some people can twist a religion soooo much that they use it to attack someone and make their life miserable when is supposed to teach to spread love towards other human beings.

 

I think "the stigma" is a larger topic then just the transgender community. I don't understand why mentally ill people are stigmatized and why atypical people are also stigmatized?

 

We fall right in the middle of all of this..... sadly.

Share this post


Link to post
Jani

Mary, I couldn't agree more with your post.  The stigma that is associated around mental health has held back many from getting the care they need.   And I do see that some religious communities are sorely lacking in empathy.  This is sad.

 

Jani

Share this post


Link to post

  • Recently Browsing   0 members

    No registered users viewing this page.

  • Who's Online   7 Members, 1 Anonymous, 75 Guests (See full list)

    • Ellora
    • DeeDee
    • Susan
    • Susan R
    • G Singh
    • Kirsten
    • QuestioningAmber
  • Topics With Zero Replies

  • Forum Statistics

    • Total Topics
      68,547
    • Total Posts
      620,065
  • Member Statistics

    • Total Members
      5,441
    • Most Online
      8,356

    Noelia
    Newest Member
    Noelia
    Joined
  • Today's Birthdays

    1. MAKAYLA02
      MAKAYLA02
    2. morrv021
      morrv021
      (54 years old)
    3. Ty inCt
      Ty inCt
      (59 years old)
  • Posts

    • Ellora
      If you have insurance, they might have options, and or your doctor, to get a referral for some type of Nutritionist that could help you. Possibly a councilor  could recommend group meetings, perhaps even a trans group that you could join. I know it helps to have a support system in line. Substitute fast food with veggies and fruit. Drink water with all of your meals, good or fast food, drink water. That helps me filling up and it's just plain healthy. Try and eat salad with your meals too, they can be rather tasty. Dont go cold turkey, ease into it, find a comfortable balance. Walk when you can, and ease into that too. Start bringing small weights with your walls after a while. Maybe find people that are willing to walk with you.  During my research of HRT and what would help me see changes, boobie growth, losing weight was one of them. That inspired me, cause I noticed the changes after i lost weight and maintained keeping weight off. The weight distribution has really been shoing this past week.  Other than eating healthy foods, going to a therapist might help you with what is driving you to eat when you are not hungry.  I wish you the best!
    • Ellora
      I do not miss anything (yet), and I dont believe i will. I am doing what I have always wanted to do, so everything that comes with it will be gravy. I get looks, and I enjoy them. I havent been flirted with yet, at least not as far as I know. That might come later when I present more. 
    • Kirsten
      Thank you. 💛💛  
    • Kirsten
      I have yet to find anything I really miss other than the looks from cute girls. Girls are definitely not checking me out anymore. Well maybe except a lesbian but I haven’t noticed that either.  And what’s worse is that that’s been replaced with guys checking me out and flirting. It’s really really weird still for me. Like really weird. lol. 
    • Susan R
      Great topic, Dawn.  I miss both of the things listed above.  I really miss being able to carry heavy things like I once could.  My upper body strength has dwindled.  When moving things like couches, sheets of plywood, etc...I never realized how much of the lifting required me to use my chest to help balance these bulky items.  I can't have ANYTHING touch me anywhere near my chest.  It nearly sends me into orbit when I inadvertently hit my nipples.
    • Kirsten
      It’s hard, but you need to start cutting out the bad foods. Foods high in fat and sugars make you crave more food. It’s why you can sit down and eat an avocado and feel more full and more sustained than when you eat 3x as much of something like Doritos or McDs fries. Your body is being fooled.  Eat as much healthy foods as you can. Nearly 50% of your food every day should be veggies. For someone your size I’d say you should be in the 6-8cups of veggies a day.  My advice, cut out bad and replace with good. Go as fast or slow as you can handle, but create goals no matter how small they may be and stick to them. Eventually you’ll get where you want to. But it’s gonna mean work. And I also recommend a support group. It really helps. A lot. If you stay active with it at least.    Good luck. 
    • Josie Beth
      I really don’t think this is the whole story. There’s just too much that doesn’t add up. He’s not talking or giving a motive for the shooting. Usually killers give a motive once they are caught. She worked retail and didn’t live the lifestyle even though she had a place on a seedy street. She leaned in the passenger side window which implies a passenger. The pace of the interaction was implied as being quick, so that tells me she was killed for being a witness. People don’t usually drive up to a random woman and have a short conversation with her and inexplicably shoot her with a shotgun. Unless it’s a hit.    There’s also a sub culture in the region they don’t mention. It’s common place for people who don’t have cars to flag others down and seek rides, called hacking, basically Uber before there was Uber and definitely cheaper. That’s something the suspect would be interested in if they just had a car accident, a rental van, and needed money. It’s entirely plausible. So was the passenger actually the killer? Was it one of those bait and switch situations where the passenger just killed her and the driver was surprised it happened? He definitely wouldn’t argue with an armed man. Did they threaten the driver and/or promise them protection if they didn’t talk? Was part of the deal to take the shotgun and take the fall if the police came after the driver? I think this was a hit, to take out a witness. Which means that the first killing was probably by the same person and the rabbit hole goes way deeper into the criminal underworld. 
    • Kris-Boston
      MGL Part  I Title 1 Chapter 4  Section 59    Fifty-ninth, "Gender identity'' shall mean a person's gender-related identity, appearance or behavior, whether or not that gender-related identity, appearance or behavior is different from that traditionally associated with the person's physiology or assigned sex at birth. Gender-related identity may be shown by providing evidence including, but not limited to, medical history, care or treatment of the gender-related identity, consistent and uniform assertion of the gender-related identity or any other evidence that the gender-related identity is sincerely held as part of a person's core identity; provided, however, that gender-related identity shall not be asserted for any improper purpose .https://malegislature.gov/Laws/GeneralLaws/PartI/TitleI/Chapter4/Section7 https://www.mass.gov/info-details/massachusetts-law-about-gender-identity-or-expression
    • DawnD
      Hmmm.... Yea I guess you can't beat buzzing up your own hair with a pair of $30 Wal-Mart clippers
    • Kris-Boston
      Less expensive hair cuts vs the salon . 
    • Jani
    • Carolyn Marie
      The right wingers will go crazy over this (I think they already have), but I think its appropriate and a nice touch.   Carolyn Marie
    • Willow
      @Carolyn Marie thank you for sharing this true story.  So much of it describes the way I felt during puberty and at other times during my life.  it was just over a year ago that I finally figured it out and started therapy and sought help.  That's a long time to be depressed and not know why.   Willow  
    • DawnD
      So last weekend I went camping(tents, drinking, bonfire, no restrooms) I was in boy mode as I am not out yet. When natured called as is the case with mass quantities of cheap beer is involved, I found a tree, pulled it out, shook it off after, put it away and went back to fun. It got me thinking if or when I transition to a girl, it will require a little more privacy and toilet paper.(I have camped with girls) I have what I have between my legs, but male parts are so much more convenient in that regard.    It got my thinking what little thing will you miss or do you miss after transitioning? (Let's keep this on the light side, we are all aware of how society can treat us, just little things)   Dawn
    • Jani
      In an effort to make Berkeley more inclusive for its non-binary residents, the city council voted Tuesday night to make the language more gender neutral, following a city clerk review that found that the municipal code primarily contained masculine pronouns.   https://www.washingtonpost.com/dc-md-va/2019/07/18/berkeley-plans-remove-gendered-pronouns-its-municipal-code/?noredirect=on&utm_term=.8248f991c2e8
  • Upcoming Events

×
×
  • Create New...