Kraus Cynthia
Institute of Social Sciences, Faculty of Social and Political Sciences, University of Lausanne, Quartier Mouline, Geopolis Building, Office 5132, 1015, Lausanne, Switzerland,
Arch Sex Behav. 2015 Jul;44(5):1147-63. doi: 10.1007/s10508-015-0550-0.
The new diagnosis of Gender Dysphoria (GD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013) defines intersex, renamed "Disorders of Sex Development" (DSD), as a specifier of GD. With this formulation, the status of intersex departs from prior editions, especially from the DSM-IV texts that defined intersex as an exclusion criterion for Gender Identity Disorder. Conversely, GD--with or without a DSD--can apply in the same manner to DSD and non-DSD individuals; it subsumes the physical condition under the mental "disorder." This conceptualization, I suggest, is unprecedented in the history of the DSM. In my view, it is the most significant change in the revised diagnosis, and it raises the question of the suitability of psychiatric diagnosis for individuals with intersex/DSD. Unfortunately, this fundamental question was not raised during the revision process. This article examines, historically and conceptually, the different terms provided for intersex/DSD in the DSM in order to capture the significance of the DSD specifier, and the reasons why the risk of stigma and misdiagnosis, I argue, is increased in DSM-5 compared to DSM-IV. The DSM-5 formulation is paradoxically at variance with the clinical literature, with intersex/DSD and transgender being conceived as incommensurable terms in their diagnostic and treatment aspects. In this light, the removal of intersex/DSD from the DSM would seem a better way to achieve the purpose behind the revised diagnosis, which was to reduce stigma and the risk of misdiagnosis, and to provide the persons concerned with healthcare that caters to their specific needs.
《精神疾病诊断与统计手册》（美国精神病学协会，2013年）第五版中对性别焦虑症（GD）的新诊断将间性人（现更名为“性发育障碍”，即DSD）定义为GD的一种特定类型。通过这种表述，间性人的地位与之前版本不同，尤其是与将间性人定义为性别认同障碍排除标准的《精神疾病诊断与统计手册》第四版文本不同。相反，无论是否患有DSD，GD都可以以相同方式适用于患有DSD和未患有DSD的个体；它将身体状况归入精神“障碍”范畴。我认为，这种概念化在《精神疾病诊断与统计手册》的历史上是前所未有的。在我看来，这是修订诊断中最重大的变化，它引发了对间性人/性发育障碍个体进行精神科诊断是否合适的问题。不幸的是，在修订过程中没有提出这个根本性问题。本文从历史和概念角度审视了《精神疾病诊断与统计手册》中为间性人/性发育障碍提供的不同术语，以了解性发育障碍特定类型的重要性，以及我认为与《精神疾病诊断与统计手册》第四版相比，《精神疾病诊断与统计手册》第五版中耻辱感和误诊风险增加的原因。《精神疾病诊断与统计手册》第五版的表述自相矛盾地与临床文献不一致，在诊断和治疗方面，间性人/性发育障碍和跨性别被视为不可通约的概念。有鉴于此，从《精神疾病诊断与统计手册》中删除间性人/性发育障碍似乎是实现修订诊断背后目标的更好方式，该目标是减少耻辱感和误诊风险，并为相关人员提供满足其特定需求的医疗保健服务。
