On June 28, 1969, at Stonewall Inn, marked history for its three-day riot between lesbians, gays, bisexuals and transsexual (LGBT) and the New York Police Department. This riot began with the police intruding into the LGBT “safe house” and the LGBT community fought back (PBS, 2011), making this the turning point for the LGBT’s first movement for freedom. Sylvia Rivera “was one of those outcast femmy boys and butchy girls… who was a veteran of Stonewall, joined the new Gay Activists Alliance (GAA) and began working furiously to pass a gay rights bill in New York City” (Wilchins, 2002). Wilchins (2002) addresses in her writings that although Rivera’s commitment to the GAA was to help and protect the LGBT community, the transgender community was eliminated, leaving Sylvia to start the Street Transvestite Action Revolutionaries, or STAR. Throughout all of Rivera’s efforts, the transgender community continued to live in the shadows and was neither unseen nor spoken of, until Gender Identity Disorder surfaced in the DSM-III in the 1980’s. The point is, the transgender community has gone through a lot of trials and tribulations throughout the history of their gender variance; which is now less stigmatized due to the many revisions, leading to the DSM V.
The history of Gender Identity Disorder began in 1957 when John William Money studied the sexual consciousness about disorders of sex development and advocated the concept of gender.
“Thereafter the disparity between anatomical sex and gender identity was referred to as the psychopathological condition of gender identity disorder, and this was used for its diagnostic name when it was introduced into DSM-III in 1980. However, gender identity disorder encompasses a spectrum of conditions, and DSM-III -R categorized it into three types: transsexualism, nontranssexualism, and not otherwise specified. The first two types were subsequently combined and standardized into the official diagnostic name of ‘gender identity disorder’ in DSM-IV” (Zasshi, 2012).
“The exact cause of gender identity disorder is not known, but several theories exist. These theories suggest that the disorder may be caused by genetic (chromosomal) abnormalities, hormone imbalances during fetal and childhood development, defects in normal human bonding and child rearing, or a combination of these factors” (WebMD, 2010). Although the causes are unknown, according to L. Fleming Fallon, Jr. in the Encyclopedia of Mental Disorder, (2012), DSM-IV-TR diagnoses are as follows:
-A strong and persistent cross-gender identification
– Repeatedly stating a desire to be, or insistence that he or she is, a member of the other sex.
– Strong preference for wearing clothes of the opposite gender. In boys, displaying a preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing.
– Displaying strong and persistent preferences for cross-sex roles in make-believe play or experiencing persistent fantasies of being a member of the other sex.
– Having an intense desire to participate in the games and pastimes that are stereotypical of the other sex.
– Persistent discomfort with his or her sex or having a sense of inappropriateness in the gender role of one’s birth sex.
– The disturbance is not concurrent with a physical intersex condition, such as hermaphroditism in which a person is born with the genitalia of both male and female.
– The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The transition from Gender Identity Disorder in DSM-IV to Gender Dysphoria in DSM-V in terms of diagnosis is not different, just more clarification. The DSM not only determines how mental disorders are defined and diagnosed, it also affects how people see themselves and how we see each other. “DSM-V aims to avoid stigma and ensure clinical care and access to
insurance coverage that supports mental health for individuals who see and feel themselves to be a different gender than their assigned gender” (APA, 2013). This change is due to respecting the patient and ensuring access for individuals who continue to undergo hormone therapy, related surgery, or psychotherapy or counseling to support their gender transition. “Ultimately, the changes regarding gender dysphoria in DSM-V respect the individuals identified by offering a diagnostic name that is more appropriate to the symptoms and behaviors they experience without jeopardizing their access to effective treatment options (APA, 2013).
Although there is no real cause of the conflict of a person to have a mismatch in their gender and sex, researchers continue to explore this area. The exploration is for hope to find a cause or better treatments to those whom are diagnosed. Had Sylvia Rivera been alive today, she would have seen all her efforts worthwhile, because her main concern is to de-stigmatize the transgender community. Her wishes is for the community to accept and have resources to help those whom are born with the mismatch, which can be found in DSM-V.