The Gender Identity Disorder in the DSM-IV Classification: A Critical Evaluation

Objective: The DSM-IV classification in its definition and description of the gender identity disorder omits a number of diagnostically significant features. This paper attempts to correct the deficiencies. Method: The text under the headings: ‘Diagnostic features’, ‘Specifiers’, ‘Associated disorders’, ‘Laboratory findings’, ‘Prevalence’, ‘Course’ and ‘Differential diagnosis’ is subjected to a detailed scrutiny, using the author's experience as consultant psychiatrist to the Monash University Gender Dysphoria Clinic over a period of 25 years as source and background. Results of two studies of male-to-female and female-to-male transsexuals are given in the Table. Results: DSM-IV criteria are augmented and the symptomatology focused. The existing gaps in the delineation of specifiers and associated features are closed by providing additional clinical material. The description of the course and the differential diagnosis are enriched. Conclusions: Although the critical analysis of the DSM-IV classification of the gender identity disorder has shown the manual to be adequate, it nevertheless has shortcomings which may impede exact diagnosis.