The condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning. Disorders of sex development DSD refers to a group of medical conditions e.
Infants born with DSD are often assigned to either a male or female sex by parents and physicians. This assignment may be purely social in nature e.
Surgical gender assignment in infants is controversial and opinions vary on its use. The actual assessment and treatment of an individual with DSD presenting for gender-related concerns is largely the same as other transgender individuals, though there may be unique legal or cultural considerations.
Ruling out Psychiatric Illness. View More. Eric Yarbrough, M. Jeremy Kidd, M. Ranna Parekh, M. I agree. In contrast, gender identity disorder was categorized into four groups including transsexualism and dual-role transvestism in ICD A draft proposal of DSM-5 has been submitted, in which the diagnostic name of gender identity disorder has been changed to gender dysphoria.
Also, it refers to 'assigned gender' rather than to 'sex', and includes disorders of sexual development. Moreover, the subclassifications regarding sexual orientation have been deleted. The proposed DSM-5 reflects an attempt to include only a medical designation of people who have suffered due to the gender disparity, thereby respecting the concept of transgender in accepting the diversity of the role of gender.
In , with the publication of the ICD-9, the diagnosis of transsexualism was first described. American Psychiatric Association. Washington: American Psychiatric Publishing; Washington: American Psychiatric Association; Porto Alegre: Artmed; Arlington: American Psychiatric Publishing; In , the ICD redefined this phenomenon by shifting it into a new separate category: gender identity disorder.
Shorter Oxford textbook of psychiatry. Oxford: Oxford University; This change was the result of studies in previous decades that viewed transsexualism as a gender identification condition unrelated to pathological personality, sexual orientation or paraphilia. Green R, Money J. Transsexualism and sex reassignment. Baltimore: Johns Hopkins; Stoller RJ. Sex and gender. New York: Science House; Valentine D. Imagining transgender: an ethnography of a category.
Durham: Duke University; In North America, the transgender category that emerged covered all gender variations, including people unwilling to submit to body modification procedures. Davidson M. Seeking refuge under the umbrella: Inclusion, exclusion, and organizing within the category transgender.
Sex Res Social Policy. The resulting movement held that variations in gender expression are natural human differences and sought to revise diagnostic criteria focusing on the stigma attached to gender variations and the health disparities they cause.
Bockting W. Transforming the paradigm of transgender health: a field in transition. Sex Relation Ther. The DSM diagnostic criteria for gender identity disorder in adolescents and adults. Arch Sex Behav. The manuals differ in their understanding of the concept of gender and, consequently, of the transgender phenomenon. A comparison of the ICD 12 The ICDWHO proposal expected to be published in , which aims to remove transsexuality from the list of mental and behavioral disorders as it is in the current ICD , is guided by the understanding that the stigma surrounding this condition should be decreased in order to expand access to health care for this population.
The categories related to gender incongruence would remained as Gender Incongruence in Childhood and Gender Incongruence in Adolescence and Adulthood and relocated to a new chapter on sexual disorder and sexual mental health care. As in other areas of medical science, the classification of health phenomena has three purposes. Specifically, it enables better communication between providers and patients regarding symptoms, prognoses and treatments; it ensures that research can be conducted in homogeneous groups of patients; and it allows for epidemiological studies as a basis for research and services planning.
Thus, the aim of this study is to compare the DSM-5 and the ICD diagnostic manuals in a Brazilian sample of transgender persons who seek health services specifically for physical transition.
There are currently four centers qualified to perform such procedures. The exclusion criterion was the presence of comorbidities or cognitive impairments, since these would hinder the response to protocol. No subject was diagnosed with an overlapping DSD.
Participation in the study involved a structured interview lasting approximately 1 hour, which was administered by a trained research assistant. The structured interview used in the study was translated and adapted for the Brazilian population. The original protocol 20 The survey instrument is divided into seven categories: sociodemographic data, gender identity and treatments, diagnostic criteria, marked gender incongruence, stigma and rejection, distress criteria, and disability.
The stigma and rejection, distress criteria and disability categories were directed to the post-transition period. To fulfill the distress criteria, daily suffering sadness, anxiety must have been experienced for at least six continuous months. The intensity of emotion, as well as the intensity of discomfort with sexual characteristics, was assessed using a Likert scale varying from 1 very little to 5 very strong. At this point it is necessary to obtain a formal diagnosis for access to healthcare services.
Data collection was conducted between May and December All patients were invited to participate, and those who agreed were required to sign an informed consent form. A total of transgender individuals were included. Demographic characteristics by current gender identity are shown in Table 3. The ICD diagnostic criteria for transsexualism and the DSM-5 diagnostic criteria for gender dysphoria are grouped and presented in Table 4.
Of the subjects, three did not meet the diagnostic criteria of either classification system ICD or DSM-5 at the time they felt the need to start hormone treatment. Hormone therapy Of the subjects who had undergone some type of body intervention, most claimed to have had it performed without qualified health monitoring at a given moment The level of discomfort with sexual characteristics varied according to gender.
Most participants with male expressed gender reported a strong or very strong level of discomfort with their chest Participants with female expressed gender reported a strong or very strong level of discomfort with their genitals Most of the subjects stated that the feeling of belonging to the other gender was persistent Table 5 , meaning it was present from the first moment they realized the incongruity between their birth-assigned sex and their gender identity, persisting with or without hormonal or surgical interventions.
A minority reported that Table 5 after these post-transition interventions, the sense of incongruity ceased. Only Most of the participants Of the participants,
0コメント