From mental disorder to iatrogenic hypogonadism: dilemmas in conceptualizing gender identity variants as psychiatric conditions.
From mental disorder to iatrogenic hypogonadism: dilemmas in conceptualizing gender identity variants as psychiatric conditions.
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DOI：
10.1007/s10508-009-9532-4
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发表时间：
2010-04
影响因子：
3.8
通讯作者：
Meyer-Bahlburg, Heino F. L.
中科院分区：
文献类型：
--
作者：
Meyer-Bahlburg, Heino F. L.
美国精神病学协会 (APA) 的诊断和统计手册 (DSM) 将性别认同变异 (GIV) 归类为“精神障碍”，这在专业人士和 GIV 患者中存在很大争议。在简要介绍了 DSM 中 GIV 分类的历史之后，本文提出了正在进行的争论的一些主要问题：GIV 作为精神病理学与自然变异； GID“损害”和“困扰”的定义；相关的精神病理学及其与耻辱的关系；精神障碍标签本身的耻辱影响； “变性手术”作为一种精神病治疗的不寻常特征；以及如果疾病标签被删除对健康和心理健康服务的影响。最后，检查了几个分类选项： 保留 GID 类别，但可能修改其与其他综合征的分组；将定义范围缩小为烦躁不安，并将“紊乱”一词从标签中删除；将 GID 归类为神经或医学疾病，而不是精神疾病；从 DSM 和国际疾病分类 (ICD) 中删除 GID；并在 DSM 中为 GIV 创建一个特殊类别。我的结论是，正如 DSM 的其他类别中所表明的那样，关于 GIV 分类的决定不能在纯粹的科学基础上做出，需要就务实的妥协达成共识，既考虑到科学考虑，又考虑到 GIV 患者的服务需求。
The categorization of gender identity variants (GIVs) as “mental disorders” in the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association (APA) is highly controversial among professionals as well as among persons with GIV. After providing a brief history of GIV categorizations in the DSM, this paper presents some of the major issues of the ongoing debate: GIV as psychopathology versus natural variation; definition of “impairment” and “distress” for GID; associated psychopathology and its relation to stigma; the stigma impact of the mental-disorder label itself; the unusual character of “sex reassignment surgery” as a psychiatric treatment; and the consequences for health and mental-health services if the disorder label is removed. Finally, several categorization options are examined: Retaining the GID category, but possibly modifying its grouping with other syndromes; narrowing the definition to dysphoria and taking “disorder” out of the label; categorizing GID as a neurological or medical rather than a psychiatric disorder; removing GID from both the DSM and the International Classification of Diseases (ICD); and creating a special category for GIV in the DSM. I conclude that--as also evident in other DSM categories--the decision on the categorization of GIVs cannot be achieved on a purely scientific basis, and that a consensus for a pragmatic compromise needs to be arrived at that accommodates both scientific considerations and the service needs of persons with GIVs.
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