Classification of transsexual people

The classification of transsexual people and people with other gender atypicalities has been done since the mid-1960s. In medicine and psychiatry, terms such as "heterosexual" and "homosexual" have been based on a person's sex assignment at birth, which has prompted the increased use of androphilia and gynephilia to avoid terminological confusion. In social and political contexts classification is often relative to one's desired sex.

Sex Orientation Scale (1966)

Harry Benjamin created the Sex Orientation Scale (SOS) to classify and understand various forms and subtypes of transvestism and transsexualism in biological males.^[1] It was a seven-point scale with three types of transvestism, three types of transsexualism, and one category for typical males. Benjamin's Scale references and uses the Kinsey scale in distinguishing between "true transsexualism" and "transvestism".

Benjamin noted, "It must be emphasized again that the remaining six types are not and never can be sharply separated."^[1] Benjamin added a caveat: "It has been the intention here to point out the possibility of several conceptions and classifications of the transvestitic and the transsexual phenomenon. Future studies and observations may decide which one is likely to come closest to the truth and in this way a possible understanding of the etiology may be gained."^[1]

Diagnostic and Statistical Manual (1980)

The Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association provides a common language and standard criteria for the classification of mental disorders. It is used in the United States and in varying degrees around the world, by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies, and policy makers. The current version is the DSM-IV-TR (fourth edition, text revision). It is organized into a five-part 'axis' system, with the first axis incorporating 'clinical disorders' and the second covering personality disorders and intellectual disabilities. The remaining axes cover related medical, psychosocial and environmental factors, as well as assessments of functioning for children.

The manual evolved from systems for collecting census and psychiatric hospital statistics, and from a manual developed by the United States Army, and was substantially revised in 1980. There have been five revisions since it was first published in 1952, gradually including more mental disorders, although some have been removed and are no longer considered to be mental disorders. The last major revision was the fourth edition ("DSM-IV"), published in 1994, although a "text revision" was produced in 2000. The fifth edition ("DSM-5") is currently in consultation, planning and preparation, due for publication in May 2013.^[2] The International Statistical Classification of Diseases and Related Health Problems (ICD), produced by the World Health Organization (WHO), is another commonly used manual which includes criteria for mental disorders. This is in fact the official diagnostic system for mental disorders in the US, but is used more widely in Europe and other parts of the world. The coding system used in the DSM-IV is designed to correspond with the codes used in the ICD, although not all codes may match at all times because the two publications are not revised synchronously.

The DSM has attracted praise for standardizing psychiatric diagnostic categories and criteria. It has also attracted controversy and criticism. Some critics argue that the DSM represents an unscientific system that enshrines the opinions of a few powerful psychiatrists. There are ongoing issues concerning the validity and reliability of the diagnostic categories; the reliance on superficial symptoms; the use of artificial dividing lines between categories and from 'normality'; possible cultural bias; medicalization of human distress and financial conflicts of interest, including with the practice of psychiatrists and with the pharmaceutical industry; political controversies about the inclusion or exclusion of diagnoses from the manual, in general or in regard to specific issues; and the experience of those who are most directly affected by the manual by being diagnosed, including the consumer/survivor movement. The publication of the DSM, with tightly guarded copyrights, now makes APA over $5 million a year, historically adding up to over $100 million.

DSM-III

Transsexualism was included for the first time in the DSM-III in 1980.^[3]

"Gender Identity Disorder" was a term created in the DSM-III in regard to transsexuals, and the categories were "GID/Children Transsexualism"; "GID/Adolescent and Adult, Non-transsexual type" and "GID/Not Otherwise Specified". Notably, this did not address Late-onset transsexualism, where patients may not have had symptoms as children. Interestingly, in the major revision of the DSM, DSM-III-R, they were placed in the category "Disorders Usually First Evident in Infancy, Childhood or Adolescence". The problem was that it got lost here, as well as the issue of adult onset explained above.^[4]

In the DSM-III, the terms "Homosexual", "Heterosexual", and "Asexual" were used - with quite a bit of confusion.^[4] (These terms were replaced in the DSM-IV by "Attracted to males", "Attracted to Females", "Attracted to Both" and "Attracted to neither.")

DSM-III-R

The DSM-III-R, published in 1987, retained the term transsexualism.^[5] It was located under "Disorders Usually First Evident in Infancy, Childhood or Adolescence".

DSM-IV and DSM-IV-TR

Gender Identity Disorder in Adolescents and Adults replaced the term transsexualism. In the DSM-IV-TR, GID is placed in the category of Sexual Disorders, with the subcategory of Gender Identity Disorders. The names were changed in DSM-IV to "Gender Identity Disorder in Children", "Gender Identity Disorder in Adolescents or Adults", and "Gender Identity Disorder Not Otherwise Specified".

International Statistical Classification of Diseases and Related Health Problems

The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) is according to its publisher, the United Nations-sponsored World Health Organization "the standard diagnostic tool for epidemiology, health management and clinical purposes."^[6] It is known as a health care classification system that provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease. Under this system, every health condition can be assigned to a unique category and given a code, up to six characters long. Such categories can include a set of similar diseases.

The International Classification of Diseases is published by the World Health Organization (WHO) and used worldwide for morbidity and mortality statistics, reimbursement systems, and automated decision support in health care. This system is designed to promote international comparability in the collection, processing, classification, and presentation of these statistics. The ICD is a core classification of the WHO Family of International Classifications (WHO-FIC).^[7]

The ICD is revised periodically and is currently in its tenth revision. The ICD-10, as it is therefore known, was developed in 1992 to track health statistics. ICD-11^[8] is planned for 2015^[9] and will be revised using Web 2.0 principles.^[10] Annual minor updates and triennial major updates are published by the WHO.^[11] The ICD is part of a "family" of guides that can be used to complement each other, including also the International Classification of Functioning, Disability and Health which focuses on the domains of functioning (disability) associated with health conditions, from both medical and social perspectives.

In the ICD-10, transsexualism is located within Gender identity disorders, F64 in ICD-10 Chapter V: Mental and behavioural disorders under the heading "Disorders of adult personality and behaviour".

Blanchard's transsexualism typology (1980s)

Blanchard's transsexualism typology (also Blanchard autogynephilia theory (BAT) and Blanchard's taxonomy) is a psychological typology of male-to-female transsexualism created by Ray Blanchard through the 1980s and 1990s, building on the work of his colleague, Kurt Freund. Blanchard divides male-to-female (MtF or M2F) transsexuals into two different groups: "homosexual transsexuals", who are attracted to men, and "non-homosexual transsexuals", who are "autogynephilic" (sexually aroused by the thought or image of themselves as a woman). The typology does not purport to identify the cause of transsexualism in natal males, but it has some implications for the cause—specifically, that the cause of transsexualism may not be the same for both groups.

Scientific criticism of the research and theory has come from John Bancroft, Jaimie Veale, Larry Nuttbrock, Charles Allen Moser, and others who argue that the theory is poorly representative of MtF transsexuals, reduces gender identity to a matter of attraction, is non-instructive, and that the research cited in support of the theory has inadequate control groups or is contradicted by other data. Supporters of the theory include Anne Lawrence, J. Michael Bailey, James Cantor, and others who argue that there are significant differences between the two groups, including sexuality, age of transition, ethnicity, IQ, fetishism, and quality of adjustment.

The theory has been the subject of protests in the transsexual and larger LGBT community, although it has its supporters. The issues with Blanchard's work were again the subject of criticism with the publication of Bailey's The Man Who Would Be Queen in 2003. In 2005, Blanchard distanced himself from Bailey's affirmation of the scientific certainty of the etiology, expressing that further research was needed before said certainty could be sufficiently justified.^[12]

References