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The proposed revisions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) have spurred debate over what illnesses to include in the essential psychiatric handbook. Everything from gender identity disorder to childhood mood swings has come under fire, and it's not the first time. The history of psychiatry is littered with impassioned fights over controversial diagnoses.
Gender identity disorderSlide 2 of 21
Gender identity disorder
Perhaps the most controversial of all current DSM disorders is gender identity disorder. Under the DSM-IV, people who feel that their physical gender does not match their true gender are diagnosed with gender identity disorder (GID). The DSM-5 proposals would revise the criteria for the disorder and change the name to the less-stigmatizing gender incongruence.
But to many, the DSM changes don't go far enough.
"To have gender incongruence in the DSM-5, as they've defined it, still leaves it open to a child being sent to be 'fixed' when a child doesn't have any problems," said Diane Ehrensaft, a clinical psychologist in Oakland, Calif., who specializes in gender identity issues in children.
In fact, the largest controversy over GID is about an area the DSM doesn't cover: treatment. Should kids who feel gender mismatched be allowed to define themselves, or should they be encouraged to identify with their physical gender? Those who argue for the latter see their role as helping kids get comfortable in their own skin. Those who argue for letting the child take the lead, like Ehrensaft, say that forcing a kid to live as an unwanted gender causes depression and anxiety.
Therapies like Ehrensaft's are relatively new, so there are no long-term studies comparing the two approaches. When it comes to examining differences in how the kids turn out, "We don't know," said Kenneth Zucker, a University of Toronto psychologist who advocates teaching kids to identify with their physical gender. "We should know in another 10 years."Slide 3 of 21
Sex addictionSlide 4 of 21
According to the Society for the Advancement of Sexual Health, sex addiction is marked by a lack of control over one's sexual behavior. Sex addicts pursue sex despite negative consequences, can't set boundaries and obsess over sex even when they don't want to think about it. Self-described addicts report that they get no pleasure from their sexual behaviors, only shame.
This disorder has yet to darken the pages of the DSM, and it likely won't be included in the DSM-5, either. Instead, the APA is recommending the addition of a new sexual disorder called hypersexual disorder, which doesn't describe sex as an addiction, but could fit many people who are in treatment.Slide 5 of 21
HomosexualitySlide 6 of 21
In perhaps the most famous psychiatric controversy of all, the APA did away with homosexuality as a mental disorder in 1973 after much protest by gay and lesbian activists. The change wasn't easy, but the weight of the scientific evidence suggested that same-sex attraction was a normal variant of sexuality among well-adjusted people.
Still, the APA included a diagnosis in the 1980 DSM-III called ego-dystonic homosexuality. This category was a compromise with psychiatrists who insisted that some gays and lesbians came to them looking for treatment. "This revision in the nomenclature provides the possibility of finding a homosexual to be free of psychiatric disorder, and provides a means to diagnose a mental disorder whose central feature is conflict about homosexual behavior," explained Robert Spitzer, a member of the APA's task force, in a 1973 position statement.
But ego-dystonic homosexuality was short-lived. The category didn't make sense to many psychiatrists, who argued that anxiety over sexual orientation could fit into already-existing categories, according to UC Davis psychologist Gregory Herek. In 1986, ego-dystonic homosexuality disappeared from the DSM.Slide 7 of 21
Asperger's disorderSlide 8 of 21