DSM V Proposed Revisions: Initial Reactions

The DSM V Proposed Revisions came out this morning which means that us, the general public, are finally able to get a little bit of transparency to what has been a traditionally very secretive process. I went and had a look this morning and, baring my commentary on the secrecy of the DSM V development process, I thought I would share some of my first impressions with some of the diagnoses that I find particularly close to home:

First, Transvestic Fetishism:

* Still requires the individual to be male. Still a hold-back from the DSM IV reinforcing the double standard of acceptable gender bending behaviour.

* Requires "significant distress or impairment." I suppose this is good in that it does not pathologize normal, healthy, nondistressing play. On the other hand, it reminds me of certain "reparative therapy" doctrines which hold that they do not treat homosexuality, per se, but "unwanted homosexuality." Ergo, the DSM V criteria pathologize the behaviour itself rather than stressing that the disorder lies in the discomfort.

* Here's a gem: specifiers towards whether the behaviour is fetishistic (towards the clothing) or from autogynephilia. TS Roadmap for more information regarding autogynephilia and why it is problematic.

Second, Sexual Interest/Arousal Disorder in Women and the same only in men.

* Homosexuality isn't a psychiatric disorder but apparently asexuality is.

Paraphilic Coercive Disorder. If you get off on fantasies of raping people you are psychiatrically disordered but only if:

* You are upset about said sexual urges. or...

* You have raped at least three people. (Rape one or two people, apparently it's okay)

* Also of note: as a DSM V diagnosis, what implications would this have in regards to the ADA. Would sexually motivated rapists be protected by the ADA?

Tourette's Disoder criteria was an improvement:

* Removed the criteria for maximum tic-free period. Tourette's waxes and wanes, this fix is good.

* However, criteria still require onset to be below age 18, which is completely arbitrary and for no real reason other than statistical observation. News flash: there are a lot of Tic Disorder NOS people out there who match a TS diagnosis perfectly except for age of onset.

Gender Incongruance (formerly GID) in Adolescents and Adults:

* Finally, "disorder" is not part of the name.

* Finally, in the eyes of psychiatry, you can be transgender without being gender binary. WIN!

* Finally, you can unquestionably be classified as transgender just by asserting your transgender feelings or stating your wish to transition.

* Not so great: some of the language ("other gender") fails to recognise transgender peoples' actual gender.

* Fail: it's still listed alongside the sexual disorders.

Gender Incongruance in Children:

* Criteria now state that the child absolutely must express a conviction that they are a member of the opposite sex.

* Not so great: Requires transgender children to be gender typical in regards to their target gender.

* Does not recognise nonbinary genders, which is odd given that the adolescent/adult version does.

Asperger's Disorder: It's being eliminated and being merged with vanilla autism.

* Win in terms of recognition that Asperger's is "real autism."

Dissociative Identity Disorder:

* Possible addition of "significant distress or impairment" clause. Cool!

I haven't had a chance to read all of the proposed revisions, just some of the ones I'm particularly interested in. I'll probably write more in depth about some of these changes on a later date or add to this as I read more of the draft DSM V. In the mean time, enjoy!

Edit: My previous claim that the DSM IV diagnosis of mental retardation will still be called "mental retardation" was due to my misreading of the proposed revisions. It was a mistake and has been removed.