From the American Psychiatric Association’s (APA’s) media release:
The American Psychiatric Association today released the proposed draft diagnostic criteria for the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM). The draft criteria represent content changes under consideration for DSM, which is the standard classification of mental disorders used by mental health and other health professionals, and is used for diagnostic and research purposes.
“These draft criteria represent a decade of work by the APA in reviewing and revising DSM,” said APA President Alan Schatzberg, M.D. “But it is important to note that DSM-5 is still very much a work in progress – and these proposed revisions are by no means final.” The proposed diagnostic criteria will be available for public comment until April 20, and will be reviewed and refined over the next two years. During this time, the APA will conduct three phases of field trials to test some of the proposed diagnostic criteria in real-world clinical settings.
Members of 13 work groups, representing different categories of psychiatric diagnoses, have reviewed a wide body of scientific research in the field and consulted with a number of expert advisors to arrive at their proposed revisions to DSM. Among the draft revisions are the following…
One of the things I see that is going to cause a lot of problems on a lot of levels is the failure to remove the diagnosis for Transvestic Fetishism, and beyond the failure to remove the diagnosis, the proposed new inclusion in the diagnosis of autogynephilia:
 There is a need to distinguish different types of transvestism according to the foci of the patient’s erotic interest. Transvestites vary greatly in their overt behavior and in their mental content during sessions of cross-dressing. Some seem quite similar to simple fetishists in their preference for very specific garments and report no conscious thoughts of themselves as female even while dressed in multiple pieces of female attire. Other transvestites, whom Blanchard (1989) has called autogynephiles, are most aroused by the thought or image of themselves as women. As a practical matter, the autogynephilic type seems to have a higher risk of developing gender dysphoria. This was confirmed in a secondary data analysis reported by Blanchard (2009c). The results of that analysis clearly suggested that the addition of the proposed specifiers to the diagnosis of Transvestic Disorder could provide clinically meaningful information as well as data useful for research.
To say the least, autogynephilia is a controversial and disputed diagnosis among trans community. Andrea James, in her article “Autogynephilia”: a disputed diagnosis, she states:
“Autogynephilia” is a sex-fueled mental illness made up by Ray Blanchard. Blanchard defines it as “a man’s paraphilic tendency to be sexually aroused by the thought or image of himself as a woman.”
Support for this disease model of gender variance is almost nonexistent, limited to a tiny online “autogynephilia” support group with fewer than 40 contributors out of a worldwide population of transwomen numbering in the millions. This support group was taken down in early 2005. The disease was also prominently featured in The Man Who Would Be Queen by J. Michael Bailey and has been heavily promoted by Anne Lawrence, a former anesthesiologist who has taken up “autogynephile” as a personal identity.
One of the key concepts in this model is the premise that everyone who is gender variant can be categorized based on one of two “male” sexual interests: homosexuality or paraphilia.
Among the few people who identify with this term, a significant number do not think this is what “autogynephilia” means. These people often interpret the word’s Greek etymology quite literally and think it means an innocent and happy “love of oneself as a woman,” or in apposition to a phobia. This is clearly not how the word is being used in the context of psychology or sexology, so we can dismiss comments from these people as irrelevant to the scientific debate.
Many mental health professionals and theorists question if this is a legitimate or scientifically useful descriptor. See parallels with other discredited illnesses…
It should be noted that Ray Blanchard, Ph.D., is a member of DSM-5′s Sexual and Gender Identity Disorders workgroup. It should also be noted that the attorneys for the Internal Revenue Service (IRS) in O’Donnabhain v. Commissioner of Internal Revenue argued that Rhiannon O’Dannabhain may just have autogynephilia, and as such didn’t deserve to deduct medical expenses related to genital reconstruction surgery.
Stay tuned. I’m sure we’re going to hear lots more about the whole of how the changes proposed to be incorporated into DSM-5 impact trans people, as well as broader LGBT community.