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DSM-IV versus DSM-5: do the new criteria for gender dysphoria lead to different diagnostic outcomes?

Els Elaut (UGent) , GUNTER HEYLENS (UGent) , Birgit Van hoorde (UGent) , Kariann Baetens (UGent) and GRETA DE CUYPERE (UGent)
Author
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Abstract
Background: In May 2013, new diagnostic criteria for Gender Dysphoria (GD), formerly Gender Identity Disorder (GID, DSM-IV-TR), were introduced in DSM-5 (APA, 2013). Following evidence, both point A (cross-gender identification) and point B clinical indicators (discomfort in his/her sex or sense of inappropriateness in gender role) were merged into the new point A on ‘incongruence between the experienced/expressed and the assigned gender’ (Zucker et al, 2013). The broader spectrum view in the new DSM might lead to a larger number of individuals receiving a diagnosis. Also, the new clinical indicators for GD might capture different aspects of the phenomenon of gender dysphoria, compared to the GID indicators. Objective: The current study wishes (1) to explore whether GID- and GD-criteria lead to divergent diagnostic results (e.g. no diagnosis in DSM-IV but diagnosis in DSM-5), and (2) to evaluate whether the new clinical indicators capture the distress or impairment of gender dysphoric individuals in a better manner compared to the former. Methods: Data were collected as part of the European Network for the Investigation of Gender Incongruence (ENIGI) (Kreukels et al., 2013). Included in the diagnostic protocol are individuals (1) from 17 years and older, (2) who present with symptoms of gender dysphoria, and (3) a desire for genderconfirming interventions. In Ghent, the first 100 individuals included in ENIGI since July 2014 were not only assessed on GID, but also on GD. Results: First, the extent of concordance versus divergence of diagnostic classifications based on both DSM-diagnoses will be presented. Second, based on the six former clinical indicators of GID and the new six indicators of GD, a total score measuring ‘distress or impairment’ will be composited for both diagnoses, allowing comparison between both. Conclusion: As our understanding of the experience of gender dysphoric individuals increases, diagnostic manuals will feel the need to better reflect these experiences in updated diagnostic entities. However, new criteria can ultimately only be tested in clinical practice. A continuing critical reflection of both what we are measuring, as the consequences thereof, remains an essential part of the clinicians work.
Keywords
diagnosis, gender dysphoria, DSM, transgender

Citation

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Chicago
ELAUT, ELS, GUNTER HEYLENS, BIRGIT VAN HOORDE, Kariann Baetens, and GRETA DE CUYPERE. 2016. “DSM-IV Versus DSM-5: Do the New Criteria for Gender Dysphoria Lead to Different Diagnostic Outcomes?” In World Professional Association of Transgender Health, 24th Biennial Scientific Symposium, Abstracts.
APA
ELAUT, E., HEYLENS, G., VAN HOORDE, B., Baetens, K., & DE CUYPERE, G. (2016). DSM-IV versus DSM-5: do the new criteria for gender dysphoria lead to different diagnostic outcomes? World Professional Association of Transgender Health, 24th Biennial scientific symposium, Abstracts. Presented at the 24th Biennial scientific symposium of the World Professional Association of Transgender Health (WPATH 2016).
Vancouver
1.
ELAUT E, HEYLENS G, VAN HOORDE B, Baetens K, DE CUYPERE G. DSM-IV versus DSM-5: do the new criteria for gender dysphoria lead to different diagnostic outcomes? World Professional Association of Transgender Health, 24th Biennial scientific symposium, Abstracts. 2016.
MLA
ELAUT, ELS, GUNTER HEYLENS, BIRGIT VAN HOORDE, et al. “DSM-IV Versus DSM-5: Do the New Criteria for Gender Dysphoria Lead to Different Diagnostic Outcomes?” World Professional Association of Transgender Health, 24th Biennial Scientific Symposium, Abstracts. 2016. Print.
@inproceedings{7204909,
  abstract     = {Background: In May 2013, new diagnostic criteria for Gender Dysphoria (GD), formerly Gender Identity Disorder (GID, DSM-IV-TR), were introduced in DSM-5 (APA, 2013). Following evidence, both point A (cross-gender identification) and point B clinical indicators (discomfort in his/her sex or sense of inappropriateness in gender role) were merged into the new point A on {\textquoteleft}incongruence between the experienced/expressed and the assigned gender{\textquoteright} (Zucker et al, 2013). The broader spectrum view in the new DSM might lead to a larger number of individuals receiving a diagnosis. Also, the new clinical indicators for GD might capture different aspects of the phenomenon of gender dysphoria, compared to the GID indicators.
Objective: The current study wishes (1) to explore whether GID- and GD-criteria lead to divergent diagnostic results (e.g. no diagnosis in DSM-IV but diagnosis in DSM-5), and (2) to evaluate whether the new clinical indicators capture the distress or impairment of gender dysphoric individuals in a better manner compared to the former.
Methods: Data were collected as part of the European Network for the Investigation of Gender Incongruence (ENIGI) (Kreukels et al., 2013). Included in the diagnostic protocol are individuals (1) from 17 years and older, (2) who present with symptoms of gender dysphoria, and (3) a desire for genderconfirming interventions. In Ghent, the first 100 individuals included in ENIGI since July 2014 were not only assessed on GID, but also on GD.
Results: First, the extent of concordance versus divergence of diagnostic classifications based on both DSM-diagnoses will be presented. Second, based on the six former clinical indicators of GID and the new six indicators of GD, a total score measuring {\textquoteleft}distress or impairment{\textquoteright} will be composited for both diagnoses, allowing comparison between both. 
Conclusion: As our understanding of the experience of gender dysphoric individuals increases, diagnostic manuals will feel the need to better reflect these experiences in updated diagnostic entities. However, new criteria can ultimately only be tested in clinical practice. A continuing critical reflection of both what we are measuring, as the consequences thereof, remains an essential part of the clinicians work.},
  author       = {Elaut, Els and HEYLENS, GUNTER and Van hoorde, Birgit and Baetens, Kariann and DE CUYPERE, GRETA},
  booktitle    = {World Professional Association of Transgender Health, 24th Biennial scientific symposium, Abstracts},
  keyword      = {diagnosis,gender dysphoria,DSM,transgender},
  language     = {eng},
  location     = {Amsterdam, The Netherlands},
  title        = {DSM-IV versus DSM-5: do the new criteria for gender dysphoria lead to different diagnostic outcomes?},
  year         = {2016},
}