Report of the American Psychiatric Association Task Force on Treatment of Gender Identity Disorder

Department of Psychiatry, JJ Peters VA Medical Center, Bronx, NY, USA.
Archives of Sexual Behavior (Impact Factor: 3.53). 06/2012; 41(4):759-96. DOI: 10.1007/s10508-012-9975-x
Source: PubMed


Both the diagnosis and treatment of Gender Identity Disorder (GID) are controversial. Although linked, they are separate issues and the DSM does not evaluate treatments. The Board of Trustees (BOT) of the American Psychiatric Association (APA), therefore, formed a Task Force charged to perform a critical review of the literature on the treatment of GID at different ages, to assess the quality of evidence pertaining to treatment, and to prepare a report that included an opinion as to whether or not sufficient credible literature exists for development of treatment recommendations by the APA. The literature on treatment of gender dysphoria in individuals with disorders of sex development was also assessed. The completed report was accepted by the BOT on September 11, 2011. The quality of evidence pertaining to most aspects of treatment in all subgroups was determined to be low; however, areas of broad clinical consensus were identified and were deemed sufficient to support recommendations for treatment in all subgroups. With subjective improvement as the primary outcome measure, current evidence was judged sufficient to support recommendations for adults in the form of an evidence-based APA Practice Guideline with gaps in the empirical data supplemented by clinical consensus. The report recommends that the APA take steps beyond drafting treatment recommendations. These include issuing position statements to clarify the APA's position regarding the medical necessity of treatments for GID, the ethical bounds of treatments of gender variant minors, and the rights of persons of any age who are gender variant, transgender or transsexual.

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    • "The fi rst was in support of access to care (APA, 2012a) while the second puts APA on the record as opposing any form of discrimination against transgender individuals (APA, 2012b). APA also appointed a task force to review and recommend treatment guidelines for transgender individuals (Byne et al., 2012).) For example, in May 2014, the US Department of Health and Human Services (HHS) reversed a long-outdated 1981 ruling that classifi ed medical treatment for gender reassignment as ' experimental ' (USDHHS, 2014). "
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    ABSTRACT: The American Psychiatric Association (APA) recently completed a several year process of revising the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). During that time, there were objections raised to retaining DSM's gender identity disorder diagnoses and calls to remove them, just as homosexuality had been removed from DSM-II in 1973. At the conclusion of the DSM-5 revision process, the gender diagnoses were retained, albeit in altered form and bearing the new name of 'gender dysphoria'. The author of this paper was a member of the DSM-5 Workgroup on Sexual and Gender Identity Disorders and presently serves on the WHO Working Group on Sexual Disorders and Sexual Health. Both groups faced similar tasks: reconciling patients' needs for access to care with the stigma of being given a psychiatric diagnosis. The differing nature of the two diagnostic manuals led to two different outcomes. As background, this paper updates the history of homosexuality and the gender diagnoses in the DSM and in the International Statistical Classification of Diseases and Related Health Problems (ICD) as well as what is expected to happen to the homosexuality and gender diagnoses following the current ICD-11 revision process.
    International Review of Psychiatry 08/2015; 27(5):1-10. DOI:10.3109/09540261.2015.1053847 · 1.80 Impact Factor
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    • "FAMILY PROCESS (Byne et al., 2012, p. 763). Lev (2004) has proposed a " family emergence model " to describe how family systems adapt to GV members in stages that include disclosure, turmoil, negotiation , and finding balance between the child's needs and the larger family's needs. "
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    ABSTRACT: Gender variant (GV) children have a subjective sense of gender identity and/or preferences regarding clothing, activities, and/or playmates that are different from what is culturally normative for their biological sex. Despite increases in rates of GV children and their families presenting at clinics, there is little research on how raising a GV child affects the family as a whole or how families make decisions regarding their care. This study took an ecological-transactional framework to explore the question, "what is the experience of parents who raise a GV or transgender child?" Eight mothers and three fathers of GV male and female children (ages 5-13) referred through a GV support group participated in interviews. Transcripts were analyzed using an adaptation of grounded theory analysis. These parents attempted to pave the way to a nonstigmatized childhood for their GV child, typically through two pathways: rescuing the child from fear of stigma and hurt or accepting GV and advocating for a more tolerant world. Many participants used both pathways to different degrees or shifted paths over time, and the paths selected were related to parents' own understanding of GV and their experiences and backgrounds as well as characteristics of the children they were parenting and the communities they inhabited. Limitations, clinical implications, and future directions are discussed.
    Family Process 01/2015; DOI:10.1111/famp.12128 · 1.73 Impact Factor
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    • "The counselor must take due care not to present these treatments as cure-alls for the client's distress (Byne et al., 2012; Cohen-Kettenis & Gooren, 1999; Harry Benjamin International Gender Dysphoria Association, 1998; Manieri et al., 2008; Sohn & Bosinski, 2007). Comorbid disorders and other difficulties such as family relational problems may have origins outside the realm of what can be rectified by medical treatments, and need to be discussed with the client as possibly necessitating further psychological interventions. "
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    ABSTRACT: This article reviews the historical and present notions of identity, in relation to sexual orientation and gender identity within counseling. It also discusses the link between the historical pathologizing of homosexuality and gender identity, as well as summarizes the implications of the diagnosis of gender dysphoria (GD) as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (5th ed.; DSM-5). The ethics of maintaining GD in the DSM-5 and future diagnostic manuals is discussed. Finally, a brief explanation of the role of the counselor in working with transgender individuals is given.
    Journal of LGBT Issues in Counseling 08/2014; 8(3):248-263. DOI:10.1080/15538605.2014.897296
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