Methodological Questions in Childhood Gender Identity ‘Desistence’ Research

Kelley Winters, Ph.D.
GID Reform Advocates

An expanded presentation to the 23rd World Professional Association for Transgender Health Biennial Symposium, Feb. 16, 2014, Bangkok, Thailand. (Presented remotely, from Loveland, Colorado, USA)

It is frequently repeated in mental health literature and popular media that the vast majority of children whose gender identity differs from their assigned birth-sex, or who are severly distressed by their birth-sex, will “desist” in their gender identities and gender dysphoria by adolescence. As a consequence, gender dysphoric children are pressed to remain in their birth-assigned roles throughout the world. But are gender dysphoria and diverse gender identities just a phase?

This presentation reexamines research in Canada and The Netherlands that underlies the “desistence” axiom, with respect to methodological rigor and validity of claims.

Methodological Questions in Childhood Gender Identity ‘Desistence’ Research 

Conclusions

(1) Evidence from these studies suggests that the majority of gender nonconforming children are not gender dysphoric adolescents or adults.

(2) It does not support the stereotype that most children who are actually gender dysphoric will “desist” in their gender identities before adolescence.

(3) These studies do acknowledge that intense anatomic dysphoria in childhood may be associated with persistent gender dysphoria and persistent gender identity through adolescence.

(4) Speculation that allowing childhood social transition traps cisgender youth in roles that are incongruent with their identities is not supported by evidence.

(5) These studies fail to examine the diagnostic value of Real Life Experience in congruent gender roles for gender dysphoric children.

References

American Psychiatric Association (2014). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

Byne, W., Bradley, S.J., Coleman, E., Eyler, A.E., Green, R., Menvielle, E.J., Meyer-Bahlburg, H.F.L., Pleak, R.R. & Tompkins, D.A. (2012). Report of the American Psychiatric Association Task Force on Treatment of Gender Identity Disorder. Archives of Sexual Behavior, 41(4):759-796.

Drescher, J. (2013) “Sunday Dialogue: Our Notions of Gender,” New York Times, June 29, http://www.nytimes.com/2013/06/30/opinion/sunday/sunday-dialogue-our-notions-of-gender.html

Drummond, Kelley D.; Bradley, Susan J.; Peterson-Badali, Michele; Zucker, Kenneth J. (2008), “A follow-up study of girls with gender identity disorder,” Developmental Psychology. Vol 44(1), Jan 2008, 34-45.

Kennedy, N. (2012) “Transgender children: more than a theoretical challenge,” Goldsmiths College, University of London, http://academia.edu/2760086/

Reed, B., Rhodes, S., Schofield, P., Wylie, K., (2009) “Gender variance in the UK. Prevalence, incidence, growth and geographic distribution,” GIRES – the Gender Identity Research and Education Society, http://www.gires.org.uk/assets/Medpro-Assets/GenderVarianceUK-report.pdf

Steensma, T.D., Biemond, R., de Boer, F. & Cohen-Kettenis, P.T. (2011). Desisting and persisting gender dysphoria after childhood: A qualitative follow-up study. Clinical Child Psychology & Psychiatry, 16(4):499-516.

Wallien, M.S.C. & Cohen-Kettenis, P.T. (2008). Psychosexual outcome of gender-dysphoric children. J American Academy Child & Adolescent Psychiatry, 47:1413-1423.

Winters, K. (2013) Response to Dr. Jack Drescher and the NY Times About Childhood Transition, GID Reform Weblog, July 5, http://gidreform.wordpress.com/category/childhood-social-transition/

World Professional Association for Transgender Health (2011), Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People: Author. http://www.wpath.org

Today one of the Gleaner's headline rang like a bell here is the story firstly then my comment below that I placed on the Gleaner site which I hope they publish as the debate intensifies especially given last night's discussion on All Angles.

'We Have The Numbers' - Anti-Homosexuality Church Leaders Confident Enough Religious Jamaicans In Island To Prevent Change To Buggery Law

Nedburn Thaffe, Gleaner Writer wrote:

With some 2,050,771 Jamaicans claiming affiliation to a religion, it would appear the church community, which has been standing firm against gay-rights activists in recent days, might be able to put up a formidable defence against those seeking to have the Government repeal the country's buggery law.

Just recently, one prominent clergyman shouted from his pulpit that he was prepared to die to ensure that Jamaica does not succumb to pressure from gay rights activists.

The statement from the executive director of the Church of God in Jamaica, Reverend Lenworth Anglin, followed that of another pastor, Reverend Al Miller, who declared last week that "a group of concerned pastors and leaders" have stated their willingness to mobilise and resist any attempts to tamper with the country's Constitution as it relates to the buggery law.

"We certainly have the numbers," Anglin told The Gleaner yesterday.

Data from the latest Population and Housing Census appear to support Anglin's claim. They indicate that some 129,554 Jamaicans are affiliated with a Church of God denomination.

The Seventh-day Adventist Church alone accounts for some 322,228, making it the denomination with the highest affiliation in numbers in Jamaica.

The Rastafarian religion, which is well known for its intolerance of homosexuality, has an affiliation number of 29,026.

But as the gay community and the Church continue on what appears to be a collision course, yesterday one social commentator who refrained from saying the level of impact the who refrained from saying the level of impact the Church is likely to have in helping to prevent any repeal of the buggery law, stopped just short of saying that recent comments from some clergymen might help to fuel even greater hostility in the minds of Jamaicans towards the gay community.

"Language like 'persons willing to die for' and so on, in my view, is unnecessary language at this point," said Carol Narcisse, who stressed that her views didn't necessarily represent those of the Jamaica Civil Society Coalition (JCSC) of which she is the chairperson.

"This is a discussion that the country needs to have, and it is hoped that the Church will provide an honest, sober position in the public domain, recognising that there is already a tendency towards making this issue being the subject of violence and the subject of harm to Jamaicans who are homosexual."

Added Narcisse: "We live in a democracy where all views will contend; the Church is one group in the society and it has a legitimate voice in the national conversation. However, the Church is not a monolithic group, there are other views within the Church as well."

"We would hope that persons of faith, leaders in the Church community who hold other views and a different approach; an approach that's more promoting of tolerance, an approach that is more promoting of a national discussion about inclusion and the rights of consenting adults, that those voices will come forward and join in the discussion."

She said any discussion going forward must be "sensitive to the fact that we are talking about the lives of human beings."

"We can only hope that we can come through this discussion in a way that does not see greater violence, harm, intolerance and exclusion," Narcisse charged.

Head of the Jamaica Coalition for a Healthy Society Dr Wayne West agreed that "the Church has numbers" and could successfully argue against any repeal of the buggery law, so long as it pitches its argument correctly.

"When a country makes its laws, laws are framed within some sort of philosophy and I think that the Christian theistic world view is the best performing law. I think the Church can certainly argue that the Judeo-Christian world view is better than the secular world view," West said.

"I suppose the Church could certainly argue that a large number of people in Jamaica certainly hold that view."

Gay-rights activist Maurice Tomlinson is currently awaiting a ruling after going to the Constitutional Court to seek a declaration that Television Jamaica, CVM Television and the Public Broadcasting Corporation of Jamaica had breached his constitutional right to freedom of expression when they refused to air a paid advertisement promoting tolerance for homosexuals in Jamaica.

nedburn.thaffe@gleanerjm.com
CONTINUE HERE

My response:

Interesting the fear mongering premised on sheer ignorance the fundamental question is in the very numbers of bodies, how many men with same sex desire be they gay or innately bisexual are hiding within the church? a recent radio discussion involving some prominent theologians and church representatives on "straight spouses" with unsuspecting partners suggest that inside the very church LOCALLY from whose pulpits where these pastors shout from many men (including the some clergy) hide themselves to regularize their lives. And as for sexual abuse of female members and male too and power differentials that another matter altogether for another time.

Will they come out when the time is right and declare who they really are? but given ones inability to live ones truth with convenient homophobic rhetoric we are in for some interesting times ahead. It will boil down to who will stand out and up eventually and stop the deceptions on all sides for that matter and let good sense prevail. UNDERSTANDING is what is needed here.

Besides there are Christian and Rastafarian folks who are tolerant, maybe it is their time to also start speaking up to bring some sense into the mix. The change of the law or reading down of buggery as it now stands is NOT going to suddenly create some avalanche of "Buggerers" that will simply hit every biological born male wearing a pair of pants. What are these people afraid or?

As for Rev Al Miller he has no moral authority to speak on anything for that matter these days, lest we forget his ongoing trial in aiding and abetting a known fugitive to escape the law of the land!? Albeit to a foreign power a that and using a male same gender loving and transgender form of aesthetic expression (cross-dressing) as a form of disguise in carrying out the deception at that yet he comes out swinging against homosexuality, really?!

If this were elsewhere he would be considered a traitor or even charged for treason at that.

Religious intolerance needs to STOP it makes no sense, confusing same gender sex with abuse is one of the main drivers of this as the fear is some infestation or increase in abuse of prepubescent persons when laws already exist to protect them and besides decriminalizing buggery which is what is now postured by the LGBT lobby and not necessarily a full repeal will not take away rights and protections that already exist it will only allow same sex intimacy in a private setting to occur via the all important CONSENT. Paedophilia or any attraction to a prepubescent person or child is a diagnosable deviant sexual disorder, HOMOSEXUALITY however is NOT the same and is innate.

The gender or supposed orientation of the abuser is not important when it comes to sexual abuse, ABUSE IS ABUSE and the law and psycho social responses should go into effect, just yesterday on Newstalk 93FM's Freshstart with host Sharon Hay Webster a rep from the CDA highlighted the need also for forensic psychiatrists in the system to also probe the look of perpetrators as well to avoid repeat offending.

Maybe we can follow the route of the Irish and learn from the path they took where they not only repealed buggery, removed the two ages of consent for homosexual(21) and heterosexual anal sex(18) made it 18 across the board, made privacy a cornerstone for same sex persons but they also added a child defilement clause as an amendment so as to appease the fearmongerers there as well, chaos did not break out there, instead Ireland is stable as she can be.

Some of us are lesbian/gay/bi/transgender/bisexual and everything else in between, it takes all kinds to make the world go round. Yet what is even more disturbing to me is the missing zeal in the anti homosexual campaign we see when it comes to murdered children/adults, spiraling crime and the elderly (recent cases comes to mind), the kids in state lockups with adults not to mention the umpteen missing as well yet plus the homeless on the street yet millions are spent for full paged ads and other perks for pastors for huge salaries but the moral fiber for the real issues on the ground is if not missing is very low.

One wonders if the tactic employed now to rile up a crowd (burrowed in someway from the political directorate) is not to fill collection plates too in a time when the economy is slow as well, popularity seekers at the expense of a minority group, after all it seems to be the only issue that makes a church service hot these days as most of these leaders are empty vessels, when the same congregation are themselves seemingly numb to the other societal ills.

Peace and tolerance

H

Additional materials: Miss Narcisse who was quoted above also had spoken on the issue on a radio show excerpted here ..............

Gay activists on Minority rights

Western Jamaica Clergy want buggery law to remain

Also see a letter in the Gleaner today as well: Church Biased and my post on sister blog GLBTQJA Wordpress on: Church Stands Resolute Against Buggery Backers says Al Miller ………… Love March Movement Lacks Moral Compass says LGBT voice

The problem with the LGBT lobby I have however is that just when it should matter most we are divided and are lacking several pieces of the parts to make the campaigns and messages resonate including credibility on certain fronts. Mixing a secularist agenda into the scheme of the agitation has only sought to anger the religious movement even further something I warned about some time ago and now we have added layers to the debate that have sought only to cloud the issue and extend the debate unnecessarily so.

Hear my short commentary I made on that:

The theologian community have gone as far as to call the homosexual community "dutty" in the recently launched translated King James version to patois of the new testament: The use of Jamaican dialect to further stigmatise homosexuals in the new patois Bible

As I ended my 2012 year in review and given recent happenings with JFLAG shooting itself in the foot - Truth is the ultimate weapon in the war. The LGBT leadership is a reflection of the follower-ship and vice versa if we are to grow the missing vigilance and objective approaches need to be improved. Deception seems to be on all sides take this for example:Dr Wayne West’s continued intellectual dishonesty on fisting felching & chariot racing by homosexuals in Jamaica

Also see: Espeut, West says “Homophobia” was invented to abuse Christians as hate speech as they use the victim ploy here. We have a long way to go it seems barring a miracle and some good sense prevailing.

Tell Me Pastor: Struggling with homosexuality ..............

The Star News feature "Tell Me Pastor" carried this piece below and though I am not a psychologist the letter seems a little off to me but read and see what you make of it, on my other blogs I have long been suspicious of some of these letters too and their authenticity as sometimes they border on sensational. The young man here says he was sexually abused as a boy and that indeed is sad and shocking but what followed has been a rollercoaster ride it seems the pastor's rebuke however is disturbing to me. Read ...............

Dear Pastor,

I am writing to you for your help. I am a male who has never had a happy moment in my life from I was 11. I was sexually abused by a good friend of my family from St Catherine. At that time, I did not understand that if anyone was caught in the act of homosexuality, he would be beaten to death. This happened in the late 1980s. I got to like it so I used to visit the man's house often. It went on for several years because I didn't know homosexuality was wrong. I was innocent to everything around me. This man has messed up my life because homosexuality still affects my life today.

Over the years, I have been with several other men and have also gone to different counsellors but the problem is still starring me in the face. I became a Christian in 1993 but I am still struggling with this situation. I have prayed and fasted for these homosexual feelings to go away, but it has not helped.

In 2001, I met a man. He treated me well and took me to rural Jamaica. He was loving and caring and we became lovers. He told me he had homosexual fantasies, then I decided to stop having sex with him and to change my lifestyle. I stopped calling him and texting him but he continued to text me with sweet words. I prayed to God for a change and was getting there, but because I am weak towards him, I fell back into the devil's track. Sometimes I wonder where is God in my situation. I never thought I would be so unhappy.

One night in the early 90s, at a big tent at a crusade, the preacher called me to the altar and told me someone has tied me down in a bottle. I want to go back to school and start my own business, but I cannot because of lack of funds.

One day I went to Emancipation Park to clear my mind and my phone rang. It was one of my lovers. He was in the presence of some girls. He was touching me up and had an erection. This man was also having sex with one of the girls. I am wondering where God is in my situation.

One day I went to his house and we got into a fight in his van and I dropped out. I have tried many times to break up with this man and we are still having sexual intercourse without condoms. We have done freaky things. His girlfriend doesn't believe we are doing these things. He is bisexual. I know I have done many bad things to him and I am asking him for his forgiveness. His girlfriend told me disgraceful things that I should do to her.

This man has helped me and is very kind to me. I asked him to give me $10,000 and he wants to know if I will pay him back in sex. I am still attending church but Ifeel condemned. Friends have turned their backs on me, but I want to thank God because He has never left me. I am 34 and cannot break free from this disease for more than 23 years now. I have had deep depression and suicidal thoughts. My own brother told me I am dunce and worthless. Please, help me.

R.B.

Pastor responds:

Dear R.B.,

I regret hearing that an adult male, who was a family friend, introduced homosexual practices to you. Unfortunately, you didn't report him and kept going to his house. As you grew up, you became a practising homosexual. That is why most psychologists say homosexuality is something learned. I do not mean to imply this is true in every case.

You felt your sexual partners treated you well and found it difficult to walk away from them. Even after you decided to change, it wasn't for long. You have written a detailed letter and have mentioned the names of individuals. As you can see, I have deleted many of the things that you have said. They are not publishable. Your motive is not just to seek help, but to expose certain individuals with whom you have had affairs.

You claim in the letter that you are a very jealous man. So while you give the impression that you are seeking help, you are really looking for revenge. You are still very much in love with a particular man whose name you have mentioned many times in your letter. I do believe you are carrying a heavy burden and believe in the nonsense that the preacher told you at the crusade meeting that someone has tied you down in a bottle.

I would like to suggest you make an appointment to see a Christian psychologist and ask him/her to help you. If you continue to believe hope is lost and someone, not you, are responsible for your behavior, you will never experience deliverance.

Yes, you were abused as a child. When you became an adult, you knew better and should not blame others for the wrong things you have done. You are responsible for your actions. Nobody has put you in a bottle. The preacher who told you that is wrong and has contributed to messing up your mind.

Pastor

ENDS

In my continued look at this for the pastor Aaron Dumas who is a psychologist and also hosts a program on Power 106fFM at nights to scold the man where he said "Yes, you were abused as a child. When you became an adult, you knew better and should not blame others for the wrong things you have done. You are responsible for your actions. Nobody has put you in a bottle. The preacher who told you that is wrong and has contributed to messing up your mind." I am baffled at this response if abuse was the origin of his struggle taking into account the power differentials that may have existed (going by the letter) between the youth at the time and this adult perpetrator then how in adult life the writer could simply come to some realization without any professional help mentioned in the piece? In power differentials the victim sometimes does not have the opportunity to say no or tell someone else especially a child (going by the letter) he may run into a backlash as other circumstances may have been present to block seeking that kind of redress. It takes years sometimes never for persons to come forward or get comfortable to even talk about the issues involved or to rehash the abuse. Now that he has come forward this is the response from Pastor Dumas? To simply indirectly dismiss the man and he is to supposed change or come to some realization by his own recognizance is unprofessional to me and smacks as a kind of dismissal of this case yet he had no qualms to suggest a christian psychologist imputing a reparative therapy course.

The need for more forensic psychiatry or psychology is clear here too as we must now begin to understand the perpetrator's profiles as well in a bid to address situations like this, we have seen and heard from the Child Development Agency, CDA express this concern as well. The training of staff as well to help children express where abuse may be present. 

Indeed inappropriate initiation is a problem overall but how to properly address these cases on the part of the victim is called into question here via this case especially when the professional handling such a matter is using a Judaeo Christian base given the Diagnostic Statistical Manuals course in categorizing deviant diagnosable behaviour. I am sorry I was not near this individual (if he is real) as I would have suggested a book by a Jamaican man who was abused as well and who documented his travel to recovery:

"The Cries of Men" tell the candid and true personal accounts of rape and sexual abuse from the voices of young Jamaican men."The Cries of Men" shares the candid and true personal account of rape and sexual abuse from the voices of young Jamaican men. By providing an in-depth look into their secret lives, author O'Brien Dennis demonstrates how one act of sexual violence can have a devastating effect on adult survivors.

"The Cries of Men" takes a virgin journey of homophobia in the realm of Jamaica's social fabric. Dennis reveals the powerful and intriguing stories of Jamaican male sexual abuse survivors, but also divulges unknown facts about Jamaican society- including the concept that homosexuality is an evil act, punishable by imprisonment of up to ten years of hard labor. Yet each week in Jamaica, there are over fifteen reported cases of sexual abuse of young men and boys, many more cases go unreported because men fear for their lives if they disclose the abuse. Dennis also provides a list of resources to assist in recovering from sexual abuse.

Being Transgender Is No Longer A Mental Disorder ?...............

UPDATE 06/12/12 - Maybe, at least not yet for some ......... 

Firstly, Last Saturday, the American Psychiatric Association board of trustees approved the latest proposed revisions to the Diagnostic and Statistical Manual of Mental Disorders, what will now be known as the DSM-V. This marks a historic milestone for people who are transgender and gender non-conforming, as their identities are no longer classified as a mental disorder. Homosexuality was similarly declassified as a mental disorder in 1973.

Until now, the term “gender identity disorder” has been used to diagnose people who are transgender. For conservatives, this has provided rhetorical carte blanche to describe the entire trans committee as disordered, delusional, and mentally ill. In some cases, this diagnosis has even been used to discriminate against trans people, with claims that they are unfit parents or employees, as examples. On the other hand, insurance companies have been more willing to cover the expenses associated with transition under this language, because treatment for a disorder is considered medically necessary, rather than cosmetic.

The new manual will diagnose transgender people with “Gender Dysphoria,” which communicates the emotional distress that can result from “a marked incongruence between one’s experienced/expressed gender and assigned gender.” This will allow for affirmative treatment and transition care without the stigma of disorder. Earlier this year, the APA also released new health guidelines for transgender patients, as well as a position statement affirming transgender care and civil rights. Both documents align with a new standard for respecting trans people in the medical community.

It was only after homosexuality was declassified as a mental disorder that ex-gay ministries formed, protesting the medical community’s decision to affirm non-heterosexual orientations. Some dangerous ex-trans ministries exist already and are championed by Focus on the Family, NARTH, PFOX, and other anti-LGBT organizations. It’s possible that these efforts may similarly increase in the wake of this DSM revision. (Think Progress) 

Some transgender advocates see this change in the DSM-V as an important step to removing stigma against transgender people based on false stereotypes about gender identity and expression, as well as the word “disorder.” Transgender people are no longer subject to a lifelong default diagnosis of their mental health. This change follows previous statements from the APA on mental healthcare for transgender people. However, other transgender advocates note the barriers this change may create to accessing health insurance coverage for trans-related medical care, which could already be prohibitively expensive even before the change.

But in an update on TransGriot December 6, 2012 there seems to be some unease within the US trans activist community as the following will bring to bear: some people are contending the trans group didn't get depathologized and in fact the trans community is in an even worse position than they were in previously?

From Naomi Fontanos, executive director of Ganda Filipinas who also sits on the board of World Professional Association for Transgender Health, WPATH:

"To my friends who are asking about the confusing reports about the Diagnostic and Statistical Manual of Mental Disorders (DSM) V of the American Psychiatric Association (APA). Here are the facts:

1. Gender Identity Disorder (GID) will only be replaced with a new name, Gender Dysphoria (GD), which is still classified as a sexual disorder in the DSM. GD will still be used to psychopathologize transgender and gender diverse people of all ages including children.

2. GID was not delisted from the DSM like homosexuality was delisted in 1973.

3. The DSM V will also include Transvestic Disorder that will replace Transvestic Fetishisim. Transvestic Disorder will include anyone who engages in sexual activity and wears the clothing of the gender that one was NOT ASSIGNED to him or her at birth. This diagnosis affects a large portion of transcommunities around the world.

Until GD is removed from the DSM, the fight to depsychopathologize the humanity of transgender people continues!"

Kelley Winters, who has been fighting the GID reform battle for years, had this to say: in her post breaking down the gender diagnoses "Despite retention of the unconscionable Transvestic Disorder category, I believe that the Gender Dysphoria category revisions in the DSM-5 will bring some long-awaited forward progress to trans and transsexual people facing barriers to social and medical transition. I hope that much more progress will follow."

Julia Serano also commented on the DSM-5 controversy.

Earlier this year the APA did offer a new position on transgender care as well, CLICK HERE from GLBTQJA.

Please see as well: Trans Depathologization: the spark of change

Also being watched closely by some activists overseas is the Jenna Talackova mission along with transpeople around the world to get Gender Identity Disorder removed from the next edition World Health Organization's ICD manual.

The International Classification of Diseases manual fight is important because insurance companies use ICD diagnostic codes when it comes time to bill for medical services performed. The renaming of Gender Identity Disorder to the proposed 'Gender Dysphoria' in the imminent publication of the DSM-V manual has also led to international trans activist efforts to get this done before the projected ICD-11 publishing date in 2015.

Here's Jenna's video and a link to her petition calling on the WHO to remove GID from the ICD-11 ..

France in 2010 became the first country to remove transsexuality from its list of mental disorders. The European Parliament in a September 28, 2011 resolution called for the WHO to withdraw gender identity disorders from the list of mental and behavoral disorders, and to ensure a non-pathologising reclassification in the negotiations on the 11th version of the International Classification of Diseases (ICD-11).

APA Board of Trustees Approves DSM-5

At its December meeting today, APA’s Board of Trustees approved the final diagnostic categories and criteria for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The trustees’ action marks the end of the manual’s comprehensive revision process, which has spanned over a decade and included contributions from more than 1,500 experts. These final diagnoses and descriptive criteria will be available when DSM-5 is completed and published in May 2013.

“The Board of Trustees approval of the criteria is a vote of confidence for DSM-5,” said Dilip Jeste, MD, president of APA. “We developed DSM-5by utilizing the best experts in the field and extensive reviews of the scientific literature and original research, and we have produced a manual that best represents the current science and will be useful to clinicians and the patients they serve.”

“We have sought to be very conservative in our approach to revisingDSM-5. Our work has been aimed at more accurately defining mental disorders that have a real impact on people’s lives, not expanding the scope of psychiatry,” said David J. Kupfer, M.D., chair of the DSM-5 Task Force. “I’m thrilled to have the Board of Trustees’ support for the revisions and for us to move forward toward the publication."

The manual will include approximately the same number of disorders as were included in DSM-IV. The manual is composed of three sections:


• Section 1 will give an introduction to DSM-5 with information on how to use the updated manual.


• Section 2 will outline the categorical diagnoses according to a revised chapter organization.


• Section 3 will include conditions that require further research before their consideration as formal disorders, as well as cultural concepts of distress, the names of individuals involved in DSM-5’s development, and other information.


Key decisions made by the Board of Trustees include the following:

• Overall Substantive Changes
o Chapter order
o Removal of multiaxial system


• Section 2 Disorders
o Autism spectrum disorder
o Binge eating disorder
o Disruptive mood dysregulation disorder
o Excoriation (skin-picking) disorder
o Hoarding disorder
o Pedophilic disorder
o Personality disorders
o Posttraumatic stress disorder
o Removal of bereavement exclusion
o Specific learning disorders
o Substance use disorder

• Section 3 Disorders
o Attenuated psychosis syndrome
o Internet use gaming disorder
o Nonsuicidal self-injury
o Suicidal behavioral disorder


• Disorders Not Accepted for Sections 2 or 3
o Anxious depression
o Hypersexual disorder
o Parental alienation syndrome
o Sensory processing disorder

A Message From APA President Dilip Jeste, M.D., on DSM-5

December 1, 2012

I am pleased to announce that DSM-5 has just been approved by APA's Board of Trustees. 

Getting to the finish line has taken a decade of arduous work and tens of thousands of pro-bono hours from more than 1,500 experts in psychiatry, psychology, social work, psychiatric nursing, pediatrics, neurology, and other related fields from 39 countries. We look forward to the book’s 

publication next May.

The goal of the DSM-5 process has been to develop a scientifically based manual of psychiatric diagnosis that is useful for clinicians and our patients. APA’s interest in developing DSM dates back to the organization’s inception in 1844, when one of its original missions was to gather statistics on the prevalence of mental illness. In 1917, the Association officially adopted the first system for uniform statistical reporting called the Statistical Manual for the Use of Hospitals for Mental Diseases, which was adopted successfully by mental hospitals throughout the country. It was expanded into the first Diagnostic and Statistical Manual (DSM) in 1952 and first revised (DSM-II) in 1968. Like the rest of the field in that era, these first two versions were substantially influenced by psychoanalytic theories.

With advances in clinical and scientific knowledge, changes in diagnostic systems are inevitable. 

The World Health Organization’s International Classification of Diseases (ICD)—the standard diagnostic tool for epidemiology, health management, and clinical care used around the world, which covers all medical diagnoses—has been through 10 editions since the late 1800s and is 

now preparing its 11th edition, due in 2015. Likewise, DSM has undergone changes to take into account progress in our understanding of mental illnesses. DSM-III, published in 1980 under the leadership of Dr. Robert Spitzer, and DSM-IV, published in 1994 under the leadership of Dr. 

Allen Frances, represented the state of science of psychiatry at those times and significantly advanced the field.

In the two decades since the publication of DSM-IV, we have witnessed a wealth of new studies on epidemiology, neurobiology, psychopathology, and treatment of various mental illnesses. So, it was time for APA to consider making necessary modifications in the diagnostic categories and 

criteria based on new scientific evidence. But there were, of course, challenges inherent in revising an established diagnostic system.

view/download the statement HERE