Gender dysphoria: Historical development in psychiatry.

Abstract

Background: Mental health services have experienced an exponential rise in trans-identified client referrals over the past decade. This is in part due to media attention and a rapid spread of information through the Internet and emancipation of the lesbian, gay, bisexual, transgender and intersex (LGBTI) population in general. Objective(s): To review the historical development of gender diagnoses in psychiatry and the paradigm shift in clinical interventions. Method(s): A review of gender diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Disease (ICD) was undertaken along with a review of successive versions of the standards of care (SOC) published by the World Professional Association for Transgender Health (WPATH). Finding(s): A diagnosis relating to gender variance was first listed in DSM-2 (1968) as transvestitism [sic] under the parent category sexual deviations. Diagnoses in the DSM, fifth edition (DSM-5) (2013) are gender dysphoria in children and gender dysphoria in adolescents and adults. The parent category is gender dysphoria. Similarly, a diagnosis relating to gender variance was first listed in the ICD, eighth revision (-ICD-8) (1965) as transvestitism [sic] and again under the parent category sexual deviations. Proposed diagnoses in the ICD, eleventh revision (ICD-11) are gender incongruence of adolescence and adulthood. The proposed diagnosis of 'gender incongruence of childhood' remains controversial. It is proposed to move these diagnoses out of mental and behavioural disorders. Conclusion(s): Gender variance-related diagnoses in psychiatric classification systems have seen progressive depathologization of the condition over the past 7 decades. This is mirrored in changes to the shifting treatment paradigm resulting in less-restrictive access to clinical interventions including hormones and surgery. The changes pose significant clinical challenges for psychiatrists.