The gender identity disorder in the DSM-IV classification: a critical evaluation

 

Objective: The DSM-IV classification in its definition and description of the gender identity
disorder omits a number of diagnostically significant features. This paper attempts to correct
the deficiencies.
Method: The text under the headings: ‘Diagnostic features’, ‘Specifiers’, ‘Associated dis-
orders’, ‘Laboratory findings’, ‘Prevalence’, ‘Course’and ‘Differential diagnosis’is subjected
to a detailed scrutiny, using the author’s experience as consultant psychiatrist to the
Monash University Gender Dysphoria Clinic over a period of 25years as source and back-
ground. Results of two studies of male-to-female and female-to-male transsexuals are
given in the Table.
Results: DSM-IV criteria are augmented and the symptomatology focused. The existing
gaps in the delineation of specifiers and associated features are closed by providing addi-
tional clinical material. The description of the course and the differential diagnosis are
enriched.
Conclusions: Although the critical analysis of the DSM-IV classification of the gender
identity disorder has shown the manual to be adequate, it nevertheless has shortcomings
which may impede exact diagnosis.

Key words: DSM-IV, gender identity disorder, transsexual.
Australian and New Zealand Journal of Psychiatry 2001; 35:1–8