Gender identity disorder (GID) is the formal diagnosis used by mental health professionals to describe persons who experience significant gender dysphoria (discontent with the biological sex they were born with). It is a psychiatric classification and describes the attributes related to transsexuality, transgender identity and transvestism. In the United States, the American Psychiatric Association permits a diagnosis of gender identity disorder if four diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, 4thEdition, Text-Revised (DSM-IV-TR) are met.

The criteria for GID are: Long-standing and strong identification with another gender; Long-standing disquiet about the sex assigned or a sense of incongruity in the gender-assigned role of that sex; The diagnosis is not made if the individual also has physical intersex characteristics; and Significant clinical discomfort or impairment at work, social situations, or other important life areas.

Many transgender people and researchers have criticized the classification of GID as a mental disorder for several reasons, including evidence from recent studies about the brains of transsexual people. The treatment for this disorder consists primarily of physical modifications to bring the body into harmony with one’s perception of mental (psychological, emotional) gender identity, rather than vice versa. But critics of GID argue that gender variations are normal occurrences in nature, not a mental disorder. A recently published paper in the International Journal of Transgenderism stated that, of the international organizations surveyed whose concern is the welfare of transgender people, 56 percent felt that the diagnosis should be excluded from the next version of the DSM.

So why not remove it from the DSM? In the survey, the primary reason cited was that, without the diagnosis, transgender health care would not be covered by insurance reimbursement in most countries. Most except the United States, of course, where transgender care is generally not covered by health insurance, diagnosis or not. Thus, many transgender people who are lobbying to get their health insurance companies to help them defray the cost of extremely expensive sex reassignment surgeries. Thus, transgender people truly find themselves caught between principle and pragmatism.

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