Congress Paper Abstract

The gender identity disorder in the DSMIV classification - a critical evaluation

Herbert Bower, MD, DPM, FRC Psych. GIC, Monash University. 

Email: swarne@cinemedia

Surgical sex reassignment has been established as an effective treatment of transsexualism (Gender Identity Disorder). It is virtually the only surgical procedure carried out without preliminary physical, radiological or biochemical investigations to confirm the diagnosis. Consequently, an exact diagnosis rest on the history and mental state examination.

The DSMIV classification, descriptive in its essence, neglects a number of diagnostically significant symptoms and characteristics of classical transsexualism. The initially mentioned four criteria omit the overwhelming desire to have the genitalia altered. The symptomatology does not include important features such as masturbation with fantasy of intercourse with a person of the same anatomical gender, occasional arousal during cross-dressing in the initial phase, lack of sexual interest during adolescence, stressful puberty and an essentially normal child rearing process.

Specifiers do not mention a relative absence of attraction for homosexual males in male-to-female transsexuals. Associative features should include occasional stripping and female impersonation in male patients.

Breast augmentation prior to genital surgery occurs in about one third of male transsexuals.

Under the heading "Prevalence" the recent findings of a 1:1 male to female ratio are of some importance.

Description of the course should include a phase of exaggerated maleness, at times present in male transsexuals.

In the differential diagnosis homosexuality is omitted. Schizophrenia is not considered in detail.

Finally, as the majority of papers on this subject bear the title "Transsexualism" this diagnostic label should, at least in parenthesis, appear as a heading in the DSMIV edition.

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