Disordering Gender Identity

Abstract The inclusion of Gender Identity Disorder and Transvestic Fetishism in a psychiatric diagnostic nosology is a complex topic that is best understood within the larger context of the history and politics of diagnostic classification systems. The diagnostic labeling of gender-variant individuals with a mental illness is a topic of growing controversy within the medical and psychotherapeutic professions and among many civil rights advocates. An overview of both sides of this controversy is outlined, highlighting questions about the potential damage caused by using psychiatric diagnoses to label sexual behaviors and gender expressions that differ from the norm, and the ethical dilemmas of needing a psychiatric diagnosis to provide legitimacy for transsexuals' right to attain necessary medical treatments. The author reviews the use of diagnostic systems as a tool of social control; the conflation of complex issues of gender identity, emotional distress, sexual desire, and social nonconformity; the reification of sexist ideologies in the DSM; the clinical and treatment implications of diagnosing gender for “gatekeepers”; and some recommendations for GID reform.