The DSM-5 updates its gender/transgender vocabulary in a positive way, but "autogynephilia" remains

The American psychiatric manual, the DSM-5 (now called DSM-5-TR) has revised the chapter on gender dysphoria. The main changes reflects a more on target and respectful language for describing gender variance. 

• The term “desired gender” is now “experienced gender.“
• The term “cross-sex medical procedure” is now “gender-affirming medical procedure.”
• The term “natal male”/“natal female” is now “individual assigned male/female at birth.”

It seems to me that the doctors writing this chapter are both willing and able to have a constructive dialog with trans people.

I am not saying that the gender dysphoria  text is perfect. Why on earth they continue to use the term “disorders of sex development” for intersex people, given the history of “gender identity disorder”, is beyond me. They did at least include the term “differences of sex development” as an alternative.

You can read the revised introduction to the DSM-5-TR gender dysphoria chapter here. 

Autogynephilia remains

What they have failed to do is to remove the “autogynephilia” diagnosis from the paraphilia chapter. 

The inclusion of this pseudo-scientific term is extremely unfortunate, and reflects the influence of Ray Blanchard on the DSM-5 process. The term is actively used by anti-trans activists to invalidate trans women. Indeed, Blanchard himself is actively helping TERFs and right wing extremist spread their transphobic gospel.

Why words like queer and trans make perfect sense

Yes, umbrella terms like queer and transgender make perfect sense, but maybe not for the reasons many think.

You have probably heard the questions: “Being gay is about sexuality and being trans is about gender identity, so why do the two belong to the same queer community?"

Or: “Trans men and women suffer from gender dysphoria, while drag queens and ‘crossdressers"‘ are just ‘performing’,” so why should being trans be a matter of gender expression instead of identity only?”

Setting the false premise of  “all crossdressers are just performing” aside, these questions are based on a fundamental misunderstanding, namely that membership in the queer and trans communities need to be based on some kind of easy definable common “essence”. 

In the case of “queer” some would argue that that would be sexual orientation, I suppose, and in the case of "transgender," gender identity or gender dysphoria.

I am not denying that there may be biological components to the development of queer and trans identities. In fact, I think it is hard to explain the existence of queer and trans people without such components, given the severe social conditioning found in societies where the cis/het (cisgender and heterosexual) ideal is the norm. Why would anyone chose to be queer or trans, given the kind of harassment we see?

 Yet, I do not think we – or science – have come to a point where such factors can be used to define social groups. Moreover, such litmus tests, if possible, would without doubt be used to invalidate some trans people, which is not a good thing.

In spite of this lack of reliable "DNA tests" for transness and queerness the existing LGBTQ+ and transgender communities represent meaningful alliances. Broad terms like queer and trans make sense at the moment we move from some kind of "objective" idea of what people essentially are over to the social scene. 

Are all transgender people gender dysphoric?

No, the headline is not another variant of the “you cannot be trans if you are not gender dysphoric” meme, often used by transmedicalists and transgender separatists who think they more trans than other trans people.

The headline rather refers to our understanding of the term “gender dysphoric”.

Could it be that the “you have to be dysphoric to be trans” statement is based on a misunderstanding of the term “gender dysphoric”?

Over at CDL Carah Maisie (who is herself a transgender woman) makes this argument on the basis of an analysis of the DSM-5 “gender dysphoria” diagnosis. Her argument is inspired by an article written by Jocelyn Badgley.

The DSM-5 manual and its criteria for being gender dysphoric

The DSM-5 is the current edition of the American psychiatric manual. “Gender dypsphoria” is not seen as a mental illness in the manual, but it is included all the same to ensure that trans people get access to health services and proper insurance.

Carah and Jocelyn list the various criteria that indicate gender dysphoria in the DSM-5, and some of them do indeed refer to a mind/body misalignment:

• A strong desire to be rid of one’s primary and/or secondary sex characteristics
• A strong desire for the primary and/or secondary sex characteristics of another gender

But these are not the only criteria. Others refer to social and societal dysphoria:

• A strong desire to be of another gender
• A strong desire to be treated as another gender

Does the WHO ICD-11 Manual Erase Transgender and Non-binary Identities?

In the new WHO ICD-11 manual the only condition described is gender incongruence. Does this mean that transgender people who are not suffering from this kind of misalignment between experienced and assigned gender will be denied the help they need?

The new edition of the health manual of the World Health Organization no longer considers being transgender a mental illness. Stigmatizing diagnoses like "transvestic fetishism" have been removed.

After my positive review of the treatment of gender incongruence in the new edition of the international WHO health manual, I got an email from one concerned non-binary reader who pointed out that since gender incongruence  – i.e. the experience of a deep mismatch between the experienced gender and assigned gender – is the only symptom of being transgender included in the manual, the medical profession may ignore the suffering experienced by other transgender and non-binary people.

They  argued that the medical gatekeepers may even use the manual to erase other parts of the transgender spectrum, leaving us with what was once called "the classic transsexual" (i.e. those that are able to live up to the "trapped in the wrong body" narrative) as the only "real" transgender people.

They also argued that given the gender stereotypes listed under the gender incongruence in childhood definition, this may even lead to continuation of a system that forces transgender people to live up to the stereotypes.

The threat of a binary backlash

You are not paranoid when they are out to get you, so do understand what this reader is getting at.

Transgender separatists ("HBS", "truscum" or "transmedicalists") may try to use this new edition to argue that they are the only real transgender, that there is no spectrum and that other transgender people should stop calling themselves transgender.

The WHO ICD-11 health manual removes transvestic fetishism. Being trans is no longer a mental illness.

Yesterday the World Health Organization released the new version of its International Classification of Diseases, the ICD-11. The new edition brings some very good news to transgender people.

Being transgender is no longer considered a mental illness by the international medical community (Photo: Wavebreakmedia)

"Transvestic fetishism" is no longer included

First of all, the diagnoses of "transvestic fetishism" and "dual-role transvestism" are no longer included.

Several countries, including the Nordic ones, have already removed the transvestic fetishims of the list of "paraphilias" from their national versions of the ICD-10 , arguing that crossdressing is just an unharmful expression of gender variance, and that including it in the manual causes needless stigmatization and suffering.

According to the WHO crossdressing and crossdreaming are no longer considered  mental illnesses.

Being transsexual is no longer a mental illness

Furthermore, being transsexual (in the sense of suffering from a mismatch between your biological sex and/or expected gender role and your experienced identity) is no longer classified as a mental illness, either.

How psychiatry and psychology have been used to suppress gender variance

We have to stop using psychiatric models and terminology that are clearly bigoted and aimed at upholding outdated views of sex and gender.

Modern psychiatry is moving from bigoted sexism to
more respect for sex and gender diversity
Illustration: Cienpies Design

There is a tendency in the crossdreamer and transgender debates to pretend that we are somehow having a kind of disinterested discussion, where scientific "facts" can be trusted to tell us what is the "objective truth" about sex and gender.

Since psychiatry has claimed the scientific authority over sexuality, sex identity and -- to a certain extent -- cultural gender, this means that we often go to psychiatrists and sexologist to find theories, models and narratives that can explain sex and gender variation.

Psychiatry and psychology are not exact sciences

There is nothing wrong in doing so, per se, as long as we keep in mind that psychiatrists (and psychologists) are like all other human beings: fallible and caught up in the prejudices of their time.

This only becomes a problem when we forget that the presence of a scientific-sounding terminology and a Ph.D. does not stop bigoted crap from being bigoted crap.

Psychiatry and psychology have been used to uphold political and social power-structures for more than a century.

From hysteria to autogynephilia

It wasn't that long ago psychiatrists fully believed that the diagnosis of "hysteria" (being over-emotional, seductive and displaying a lack of self control) could be used to describe the nature of the female sex in general.

It wasn't until 1980 the American Psychiatric Association acknowledged that the "histrionic personality disorder" (a less toxic name for hysteria) was "a caricature of femininity" (Tosh).

In the same way the medical term "nymphomania" was routinely used to invalidate women with a healthy appetite for sex. Since women were not supposed to be sexually aggressive, and many of the male doctors felt threatened by independent women, they used the term "nymphomania" as a scientific sounding way of branding these women "slut". In a similar way the "hysteria" diagnosis had been used to hospitalize and castrate feminists in the late 19th century.

My point is that we have to scrutinize all psychiatric theories about sex and gender to see if they are the product of cultural bigotry as well.

Psychiatry has been used to reinforce traditional gender roles

Having gone through many studies of the history of psychiatry, I am  convinced that diagnoses like "gender identity disorder", "transvestic fetishism", "transvestic disorder" and "autogynephilia" have much in common with "hysteria" and "nymphomania".

What happens to crossdressing and crossdreaming in the ICD-11 manual?

As noted in my previous post, the recent edition of the Amercian psychiatric manual, the DSM-5, has gone a long way towards depathologizing some transgender conditions. Gender dysphoria, for instance, is no longer considered a mental illness.

Peggy Cohen-Kettenis

Note that DSM subworking-group members Peggy T. Cohen-Kettenis and Jack Drescher are also members of the World Health Organization’s Working Group on the Classification of Sexual Disorders and Sexual Health.

This group will address sex and gender diagnoses in WHO's forthcoming revisions of the International Classification of Diseases (ICD-11).  That manual is expected to be published in 2017. The WHO most often follow up changes made in the DSM.

The current manual has two different sections on crossdressing,  one clearly referring to what I call crossdreaming, and one referring to the mythical mirage of the asexual crossdresser. It is all pretty bizarre, if you ask me. (More about this here!)

Some countries have already made changes to the current ICD-10 edition, removing the sections on "transvestism".

In a recent paper the ICD-11 Working Group on the Classification of Sexual Disorders and Sexual Health, states that it "believes it is now appropriate to abandon a psychopathological model of transgender people based on 1940s conceptualizations of sexual deviance and to move towards a model that is (1) more reflective of current scientific evidence and best practices; (2) more responsive to the needs, experience, and human rights of this vulnerable population; and (3) more supportive of the provision of accessible and high-quality healthcare services."

Before the a preliminary WPATH consensus meeting the working group had proposed the term "transsexualism" to "gender incongruence", moving gender incongruence out of the chapter on mental and behavioral disorders, and deleting the categories "dual role transvestism" and "fetishistic transvestism".

In other words: Not only is the ICD-11 process moving in the same positive direction as the DSM; it is taking this process further, suggesting that one removes crossdressing and crossdreaming altogether.

If the ICD-11 takes crossdressing and crossdreaming out of its manual, it will be very hard for the Americans to keep the "transvestic disorder" in the  DSM.

What the DSM-5 says about terms like transgender, transsexual and gender dysphoria

The recent edition of the American psychiatric manual, the DSM-5 distinguishes clearly between the broader umbrella term transgender and the much narrower term transsexual. The text gives, in fact, a pretty good summary of the dominant model of gender variance. It is time transgender people get a chance to read it.

In the transgender debate words like "transgender", "transsexual" and "gender dysphoria" are used often without there being any clear, common understanding of what the terms really mean.

Photo: Janka Dharmasena

Unfortunately sex and gender is one of the most controversial topics around. We need love to thrive and be happy, and any real or perceived threat against the possibility of finding real love and affirmation as a sexual being can therefore be life threatening.

Because of this people seem to be willing to do anything to be included in the category of "normal", to the point of excluding other  people from the transgender community, often by attempting to  take full control over the meaning of essential words.

The purification of the term transgender

This especially applies to so-called transsexual separatists. Some of them redefine the word "transgender" to mean any gender variant person who is not like them ("classic transsexuals" and the HBS tribe). Transgender people can therefore not be "real transsexual women", as they see it.

Lately we have also seen separatists who want to appropriate the word "transgender", in effect redefining it to mean the same as the word "transsexual" (the truscum tribe). The end result is the same: The expulsion of all transgender people who do not adhere to their idea of what it means to be a real woman or a real man.

Are all crossdreamers transsexual? Is Jack?

In a discussion over at Crossdressers.com the concept of crossdreaming has come up, and I see that there are some confusion about what my position is as regards the nature of men and women who get turned on by the idea of being "the opposite sex".

Photo: Erik Reis, photos.com

auto andrea writes:

"He [Jack Molay] propagates a theory that aims to positively accommodate gender-dysphoric autogynephiliacs, by basically reducing the condition to transsexualism. Those autogynephiliacs who have never experienced gender-dysphoria, he implies, are repressed transsexuals."

I can see why auto andrea has come to read me this way, but this is actually not what I say.

What I have said is that all crossdreamers most likely have something in common, and that this "something" most probably has a biological core.

This does not mean that all crossdreamers are transsexuals -- repressed or not repressed. The fact is that I think only a minority of crossdreamers are truly  transsexual, in the sense that they completely identify with their target sex.

Laurence Anyways -- a Transgender Journey

Poster for Laurence Anyways

Laurence Anyways is a French Canadian film from 2012 that should be of great interest to the gender dysphoric side of the crossdreamer community.

Laurence, the protagonist, is transsexual at heart, and finally comes to the conclusion that she can no longer live as he, and wants to come out as a woman.

"I'm not gay," Laurence explains to his girl friend Fred. "It's not that I like men, I'm just not made to be one."

This is not primarily -- or only -- a film about being transsexual. The main focus of the story is the relationship between Laurence and her girl friend Fred, and how the two of them tackle the upheaval of Laurence finding herself.

This is a truly a love story. Fred tries hard to adapt to the new life of the person that she deeply loves.

But this is not a love story of the pink poster Hollywood type. It becomes extremely hard for the two of them to make their love story fit the script the people around them are used to and expect.

It is not a secret that a significant percentage of marriages and love partnerships ends when one of the two transitions. This is a story about the kind of challenges such couples meet and what these challenges do to them.

Melvil Pupaud plays Laurence

The film was made by Xavier Dolan, a Canadian actor and filmmaker.

Here you have an homosexual man making a movie about a gynephilic transsexual woman, who befriends a group of gay drag queens.

Needless to say, Dolan doesn't give a damn about the script written by Ray Blanchard and his crew. I mean that in a good way!

The fact that the movie is made by a gay man may explain, a couple of the few unexpected elements in  the movie.

Some good news from the DSM and the Gender Dysphoria working group

There is some cause for transgender celebration
 in the DSM (photos.com)

The male to female crossdressers and crossdreamers who feel distress from their condition are still to be considered mentally ill by American psychiatry. That is the bad news from the new edition of the DSM-5, The Diagnostic and Statistical Manual of Mental Disorders.

There is some really good news to be found in there as well, though.

The Gender Dysphoria working group has clearly had wiser leadership than the paraphilia working party of Ray Blanchard.

First: gender dysphoria is no longer called a "disorder". It is no longer considered a mental illness (although it is still included in a manual of mental illnesses).

Secondly: they refuse to give in to the notion that there are two distinct types of transsexuals, where one is perverted and the other is not.

Being -- or having been -- a crossdreamer does not disqualify you from being recognized as transsexual.

I have gotten hold of the "Gender Dysphoria" chapter and this is what it says about crossdreamers (in the text referred to as "an individual with transvestic disorder"):

"An individual with transvestic disorder who has also clinically significant gender dysphoria can be given both diagnoses. In many cases of  late-onset gender dysphoria in gynephilic natal males, transvestic behavior with sexual excitement is a precursor."

It is as if the Gender Dysphoria group has looked at all the pain the paraphilia subworkinggroup will cause transsexuals through their Transvestic Disorder text and decided to do something about it.

"Autoandrophilia" did not make it into the DSM-5

The absurdities of  the DSM continues (stockbyte).

I have had a hard time getting a hold of the relevant texts from the new edition of the American psychiatric manual, the DSM.

So much for democratic transparency.

From what I hear, though, it seems "autoandrophilia" did not make it into the DSM.

Someone within the DSM machinery might have concluded that enough is enough. There is no research underpinning this "disorder", so let's leave it out. That would be the optimistic version of what has happened.

I fear, however, that they all believe that female to male crossdreamers do not exist. Because if they knew the female to male variant existed, it would be close to impossible for them to leave "autogynephilia" and male bodied crossdressers and crossdreamers in the manual.

According to my source the "autogynephilia" term remains under the Transvestic Disorder category.

This means that male bodied crossdreamers who feel distress from their gender variance are considered mentally ill, while female to male crossdreamers and crossdressers are not.

Ray Blanchard and the Missing Girlfag (The DSM-5)

Blanchard refuses to let transgender people
out of the DSM (Drawing by Jayna Pavlin)

Ray Blanchard denies the existence of female to male crossdreamers, in spite of including "autoandrophilia" in the DSM-5, and in spite of having described a girlfag in a 1987 paper on transsexual men and women.

Tomorrow the American Psychiatric Association is to publish the fifth edition of the American manual for mental illnesses (DSM-5).

(Update 1: The manual was presented at the APA annual meeting today, but the text has not been published online)

Unless there has been a miracle "autoandrophilia"will be included as a new mental disorder.

"Auotandrophilia" is, as some of my readers will know, Ray Blanchard's term for female bodied persons who get aroused by the idea of being men -- people I call female to male crossdreamers.

Many of them call themselves girlfags. Some, but not all of them, are transsexual. Others, but not all, are crossdressers.

Blanchard refuses to believe in girlfags

In a recent interview Blanchard, who is the leader of the "paraphilia" (perversion) subworkinggroup of the DSM, admits that he had been the one to suggest the inclusion of "autoandrophilia, not because he believes "autoandrophiles" exist, mind you, but because he would like to avoid attacks from feminists.

You read me right. The DSM is going to include a diagnosis for a new mental disorder the leader of the responsible working party, Mr. Blanchard, does not even believe exist.

This is also why he has not presented any scientific research that documents that this "non-condition" is a sexual paraphilia (perversion).

This is a scandal that undermines the legitimacy of the whole DSM-5 enterprise.

Girlfag disbelief

Blanchard's bizarre tactics made one girlfag make the following comment to me in an email:

"First this idiot tells me I am mentally ill. Next he tells me I do not exists. Is this man crazy?"

It would be tempting to include a new disorder for people like Blanchard in the DSM. His obsessive attempts to classify sexual perversions is more than a little disturbing.

However, this is not so much about madness, as it is about a scientific and mental lock-in.

The female to male crossdreamers threaten to undermine his whole autogynephilia vs. homosexual transsexual theory, so he has to deny their existence.

Ray Blanchard lied when including autoandrophilia in the DSM-5 proposal

Cracks appear in Blanchard's facade. 

It turns out it was Ray Blanchard who suggested that "autoandrophilia" should be included in the new edition of the American psychiatric manual, labeling a large number of transsexual men as mentally ill in the process. He now admits that he did so in order to avoid being attacked by feminists. He does not really believe in their existence. 

As some of my readers will remember, the  new proposed version of the DSM-5 include a category called "autoandrophilia" refering to  female bodied persons experiencing sexual arousal when imagining themselves as male.

It now appears it was Dr. Blanchard, the chair of the paraphilia sub-workgroup,  who proposed the inclusion. But he does not believe in it.

Let me quote a recent  interview with Blanchard:

"[Motherboard:] Do you think autoandrophelia, where a woman is aroused by the thought of herself as a man, is a real paraphelia [sic]?

[Blanchard:] No, I proposed it simply in order not to be accused of sexism, because there are all these women who want to say, 'women can rape too, women can be pedophiles too, women can be exhibitionists too.' It’s a perverse expression of feminism, and so, I thought, let me jump the gun on this. I don’t think the phenomenon even exists."

Campaign against pathologization of transgender in medical manuals

The Coordination Team of STP 2012, the International Stop Trans Pathologization Campaign, has published a document called  “Reflections on the ICD Revision Process from a Depathologization and Human Rights Perspective”.

The document includes a good discussion on the way the American manual for mental diseases (DSM-5) and the UN/WHO International Classification of Diseases (ICD) cover transgender issues.

The team argues that both the gender identity disorders and the transvestic fetishism categories ought to be removed from the manuals.

The group is also initiating an International Day of Action for Trans Depathologization, which  will take place on Saturday, October 20th, 2012.

On evolution, autogynephilia and Anne Lawrence 2

I my previous post I presented Anne Lawrence's argument for why male to female trans women who are attracted to women  (referred to as "autogynephiliacs") must be classified as mentally ill.

Or, to be more precise, she asked if the desire for sex reassignment in some men is  to be understood as a mental disorder in terms of a particular classification system of psychiatric conditions.

Her answer is yes; mine is no.

Lawrence's comment,  "Do Some Men Who Desire Sex Reassignment Have a Mental Disorder?", was originally a response to a paper by Dr. Heino F. L. Meyer-Bahlburg of Columbia University.

Dr. Meyer-Bahlburg was kind enough to give me a copy of his own response to Anne Lawrence's text, and I am going to give you a summary of his main arguments here.

A summary of Lawrence

Meyer-Bahlburg gives the following summary of Lawrence's paper (the  text in  brackets [...]  are my comments):

"1. In line with the original sex assignment on the basis of genital appearance at birth, the young child forms a core gender identity (as ‘‘biologically male’’)."

[Actually: Basically both Blanchard, Bailey and Lawrence say that a man is a man if he has a penis. Period.]

"2. Later development includes the activation of erotic heterosexual interest, which involves a mental mechanism responsible for locating erotic targets (females) in the environment external to the self (Freund & Blanchard, 1993). This mechanism is 'natural,' i.e., was developed by way of evolutionary selection. However, in the particular men under discussion, this mechanism fails its natural function; these men become autogynephilic instead of gynephilic, or both, and, thereby, experience a powerful erotic interest in turning their own bodies into facsimiles of their preferred erotic targets (females), thus generating the desire for sex reassignment. This desire to transform the body is an epiphenomenon to the primary mental dysfunction, namely the malfunctioning erotic-target location mechanism."

[In other words: Autogynephilia is the result of a masculine sexuality, not a feminine sex identity.]

On evolution, autogynephilia and Anne Lawrence 1

Dr. Anne Lawrence tells us that "autogynephiliacs" must be considered mentally for evolutionary reasons. I argue that this make no sense.

Some how you have wondered why I keep writing on "gay" and "transgender" animals, arguing that these phenomena are of little relevance to a discussion of crossdreaming or "autogynephilia" (sexual arousal from the idea of having the body of the opposite physical sex).

I have argued that the presentation of "autogynephilia" (AGP) as a mental illness in the autogynephilia theory of Ray Blanchard, J. Michaels Bailey and Anne Lawrence is at least partially based on evolutionary biology and evolutionary psychology. 

This means that the categorization of crossdreaming as a paraphilia (perversion) is ultimately based on the idea that it represents a trait that hinders procreation. 

---

Note that the use of the term "autogynephilia" in this article must not be understood as an endorsement of Ray Blanchard's two-type model of male to female transgender people. Moreover, when I refer to erotic cross-gender fantasies, I normally use the much wider term "crossdreaming", a term that is not dependent on Blanchard's theory.

---

The sanctity of sexual selection

According to this type of thinking sexual selection provides organisms with adaptations related to mating. For male mammals, this theory holds, sexual selection leads to adaptations that help them compete for females. A behavioral adaptation that does not lead to them breeding with females is therefore harmful, and an illness.

They argue that "heterosexual transsexual men" (which is an impolite  reference to people I would call lesbian or gynephilic -- woman loving -- trans women), are mentally ill.  The underlying argument is that "autogynephilia" represent a maladaptation. The natural heterosexual longing for a woman out there has been internalized  as a "erotic target location error".

I believe this explanation for crossdreaming is the end result of reductionistic evolutionary thinking. Their basic model cannot encompass the idea of gynephilic male bodied person wanting to be women, for the simple reason that in this theory sexual orientation equals sex identity. It cannot be otherwise in a theory that argues that sexual selection, and sexual selection  only, explains the survival of the genes of the individual and -- ultimately -- of a species. 

Nature disagrees

I have presented alternative research on the sexuality and gendered behavior of animals to show you that this basic understanding is wrong. A lot of the sexual behavior found among animals (and humans) does not have procreation as a goal. It is, for instance, used as a tool for socialization or for comfort.

None of these alternative theories dismisses the concept of evolution – far from it – but they argue that the survival of a genetic line relies on much more than mere sexual selection.

This research also shows that the social and sexual dynamics of  animals does not  necessarily adhere to the simplistic strong, aggressive, male conquers coy and passive female paradigm. And if the basis for the paradigm is wrong, the conclusions based on this basis are also most likely to be wrong.

Anne Lawrence presents the evolutionary argument

The reason some of you have questioned my interpretation of the basis of the "autogynephilia" theory is that Blanchard, Bailey and Lawrence rarely make such evolutionary arguments. The most important exception has been Blanchard's sibling theory on homosexuality, and that one is not about "autogynephilia" at all, but adaptive advantages to homosexuality.

Well,  Anne Lawrence has let the cat out of the bag. She has written a paper, "Do Some Men Who Desire Sex Reassignment Have a Mental Disorder? Comment on Meyer-Bahlburg (2010)," where the argument is solely based on an evolutionary argument. "Autogynephiliacs" are mentally ill, because their condition does not lead to procreation:

What is the difference between fetishistic and non-fetishistic crossdressing? (The ICD and beyond)

The WHO medical manual says that only crossdreaming crossdressers can become trans women, not the ones that do not get aroused by the idea of being a woman. How did sexual arousal become such a sin?

I have spent some time looking at the American DSM manual here at Crossdreamers. The American psychiatric manual say a lot about how some psychiatrist try to draw the line between different types of cross-gender identification.

There is another manual that is just as interesting, namely the WHO ICD  manual  (International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Version for 2007)

Under "Mental and behavioural disorders" there is a category called "Disorders of adult personality and behaviour", where you will find both transsexualism and crossdressing/crossdreaming categorized as mental illnesses. 

On the difference between transsexuals, crossdreaming crossdressers and non-crossdreaming crossdressers

I am not going to repeat my objection to transsexuals and crossdreamers being classified as ill here. Instead I am going to draw your attention to the fact that this manual classifies crossdreamers (people who get aroused by the idea of being the other sex) as completely separate from other crossdressers. In this manual the crossdreamers are actually overlapping with the transsexuals!

There are three categories of interest to my readers:

• F64.0 Transsexualism
• F64.1 Dual-role transvestism
• F65.1 Fetishistic transvestism

What I find so utterly bizarre is the fact that "fetishistic transvestism", which includes -- I surmise -- crossdressing crossdreamers, is categorized as "a fetish", while the other crossdressers are given "a gender identity disorder". 

Dr. Allen Frances and his arguments against modern psychiatric madness

Doctor Allen Frances has caused uproar with his attack on the new American manual for mental diseases. This is highly relevant for crossdressers and crossdreamers.

Those who have followed this blog for a while know that I am very concerned about the fact that both crossdressing and crossdreaming  (“autogynephilia” and “autoandrophilia”) are classified as mental diseases and are included in the American psychiatric manual (the DSM) as well as the WHO ICD counterpart.

I have argued that these phenomena might as well be the psychological expression of natural human diversity as regards gender and sexuality, and that it is the fact that it is society – including psychiatrists who insist on calling this a perversion or a “paraphilia” – that causes the real mental anguish of these people.

I have also argued that the idea that something is true just because it has been published in a peer reviewed research journal is dangerously naïve. Scientists are regular human beings like the rest of us, with their own personal baggage of prejudices and narrow-mindedness, and if their very world view is wrong it does not matter if they follow strict scientific procedures. The end result will be crap, regardless.

You might think that it is only weirdoes like me (and some obscure French post-modernist philiosophers, maybe) that think this way, but the fact is that these are problems that are discussed intensely among the psychiatrists themselves.

Recently there has been a very interesting discussion going on regarding the new version of the DSM (the DSM 5), instigated by the father of the current version of the psychiatric manual, the DSM IV: Dr. Allen Frances.

Frances argues that American psychiatrist have gone too far towards believing that their diagnoses are scientifically proven descriptions of real phenomena. They are not, he says.

DSM 5 and Transvestic Disorder -- What you can do about it.

Guest Post by Kelley Winters, PhD

Crossposted from the GID Reform Advocates Blog.

On May 5, the American Psychiatric Association released a second round of proposed diagnostic criteria for the 5th Edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-5). These include two categories that impact the trans community: Gender Dysphoria (formerly Gender Identity Disorder) and Transvestic Disorder (formerly Transvestic Fetishism).

While GID has received a great deal of attention in the press and from GLBTQ advocates, the second transvestic category is too often overlooked. This is unfortunate, because a diagnosis of Transvestic Disorder is designed to punish social and sexual gender nonconformity and to enforce binary stereotypes of assigned birth sex. It plays no role in enabling access to medical transition care for those who need it, and it is frequently cited when care is denied. http://www.gidreform.org/blog2010Oct15.html

I urge all trans community members, friends, care providers, and allies to call for the removal of this punitive and scientifically unfounded diagnosis from the DSM-5. The current period for public comment to the APA ends June 15.