TransYouth Family Allies (TYFA) submitted a professional response to the head honchos at the Diagnostic and Statistical Manual of Mental Disorders review board. TYFA is a national organization that advocates for transgender and gender-varient children/youth and their families. The DSM 5 committee requested input from professionals and the public up until April 20th in response to the new changes being proposed to the 5th edition of the DSM, the “bible” of mental health diagnoses.
This is the language TYFA proposes:
Suggested Diagnostic Criteria for Gender Dysphoria of Childhood: (Lev, et al. 2010A)
A. A distressing sense of incongruence in childhood between the child’s persistent experienced or expressed gender and current physical sex characteristics or assigned gender role, as manifested by the child’s self-report or documentable observation of at least one of the following indicators for a duration of at least 3 months. Incongruence, for this purpose, does not mean gender expression that is nonconforming to social stereotypes of assigned gender role or natal sex.
1. A distress or discomfort with living in the present gender or being perceived by others as the present gender, which is distinct from the experiences of discrimination or the societal expectations associated with that gender.
2. A distress or discomfort caused by deprivation of gender expression congruent with persistent experienced gender or insistence that one has a gender that differs from the present gender. Experienced gender may include alternative gender identities beyond binary stereotypes.
3. A distress or discomfort with one’s current (and/or anticipated) primary or secondary sex characteristics that are incongruent with persistent experienced gender.
4. A distress or discomfort caused by deprivation of primary or secondary sex characteristics that are congruent with persistent experienced gender (including anticipated post-pubertal characteristics).
B. Distress or discomfort is clinically significant or causes impairment in social, educational or other important areas of functioning, and is not due to external prejudice or discrimination.
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Lev, A., Alie, L., Ansara, Y., Deutsch, M., Dickey, L., Ehrbar, R., Ehrensaft, D., Green, J., Meier, S., Richmond, K., Susset, F., Winters, K. (2010A). “Statement on Gender Incongruence in Children in the DSM-5,” Professionals Concerned With Gender Diagnoses in the DSM, http://gidconcern.wordpress.com/statement-on-gender-incongruence-in-children-in-the-dsm-5/
Note: Their proposed diagnostic criteria include “A” (including at least one of 1, 2, 3, and 4) AND “B” to fulfill the diagnosis. For some children, feeling at odds with their bodies and/or assigned gender role can be distressing and debilitating and it may prove beneficial to help the child by way of supportive (NOT denial) therapy and/or hormone blockers to delay onset of puberty while they figure things out. My concerns are with the qualification that distress not be due to outside factors of discrimination (although internal and external factors certainly could happen concurrently). If I am a pre-pubescent teen and severely distressed about my breasts developing because I get a lot of shit for it in school, and I threaten to disfigure myself and never go to school again because of it, then am I in distress about my body, the way my body shows a gender I don’t want it to, or about the way people perceive girls and women in our society? All three? Therapy and hormones may not help as much as feminist action can.
What about the ways in which boys and girls are treated differently in so many situations by families, teachers, and media? Where is the message that it’s okay to be angry if you are a girl? Who will tell a boy it’s okay to be gentle? When has a child exhibiting “cross-gender” behavior been praised or encouraged like children who express very gender-stereotypical behavior?
I’m glad there is some avenue for transgender or gender-varient children to get professional help if they need it. But I wonder if we are doing enough to deal with gender inequities that children see and understand all to well.
