The Riddle of Gender - Deborah Rudacille [112]
In DSM-III, published in 1980, “transsexualism” first appeared as a diagnostic category distinct from transvestic fetishism (cross-dressing for purposes of sexual excitement). The diagnosis was limited to “gender dysphoric individuals who demonstrated at least two years of continuous interest in removing their sexual anatomy and transforming their bodies and social roles.” The concept of gender dysphoria was developed by researchers at Stanford who realized that many of the adult patients presenting for treatment did not fit the profile of “classic” transsexualism. Dr. Norman Fisk, clinical instructor of psychiatry at Stanford School of Medicine and codeveloper of the Stanford Gender Identity Clinic, recalls that when the Stanford program was initiated, “due to inexperience and naivete we went about seeking so-called ideal candidates and a great emphasis was placed upon attempting to exclusively treat only classical or textbook cases of transsexualism.” The classical criteria included a lifelong sense or feeling of being a member of “the other sex,” early and persistent cross-dressing without any associated sexual excitement, and a “dislike or repugnance for homosexual behavior,” says Fisk. “We avidly searched for those patients who, if admitting to homosexual behavior at all, insisted that they always adopted a passive role and avoided the stimulation of their own genitals by their partner,” says Fisk.
As noted previously, researchers eventually realized that prospective candidates for sex reassignment were altering their life histories in order to meet the clinical criteria for “classic” transsexualism, to increase their chances of treatment. Rather than rejecting nonclassic patients outright or acceding to surgery on demand, the Stanford researchers conceived a novel solution. They created a “grooming clinic” for prospective patients, which became a kind of support group, “a group therapy situation in which individuals met on a once-per-month basis to exchange information, opinions, experiences and to mutually share feelings, successes, and failures.” The charm school/support group also enabled the Stanford researchers to develop long-term relationships with attendees and to gain “both time and increasing experience.” As a result of this ongoing follow-up, the staff at the clinic abandoned their previous “rigid and truly unrealistic diagnostic criteria” for transsexualism and developed an alternative diagnosis, “gender dysphoria syndrome.” Gender-dysphoric individuals were described as individuals who were “intensely and abidingly uncomfortable in their anatomic and genetic sex and their assigned gender” and who “functioned far more effectively and comfortably in their gender of choice, as clearly demonstrated by obvious and objective criteria.”
Following evolving psychiatric opinion, DSM-III TR (Text Revision), released in 1987, includes a third, more expansive, category: “Gender Identity Disorder of Adolescence or Adulthood, Non-Transsexual Type (GIDAANT).” The DSM-III TR authors write that GIDAANT “differs from Transvestic Fetishism in that the cross-dressing is not for the purpose of sexual excitement; it differs from Transsexualism in that there is no persistent preoccupation (for at least two years) with getting rid of one’s primary and secondary sex characteristics and acquiring the sex characteristics of the other sex.”
In 1994, the diagnosis of transsexualism was deleted from DSM-IV by combining its diagnostic criteria with those of GIDAANT and absorbing GID of childhood into the category. In “Gender Identity Disorder of Childhood, Adolescence or Adulthood,” the expressed desire for surgery now becomes only one of a number of criteria to be taken into consideration when making a diagnosis. The key elements of the diagnosis in both adults and children are “a strong and persistent cross-gender identification” and “a persistent discomfort with his or her sex and sense of appropriateness in the gender role of that sex.” The disturbance must also be sufficiently obvious or intense to cause