But while there are parallels, achieving what the APA did for gays four decades ago is more complicated for people who identity as transgender, an umbrella term that encompasses transsexuals, cross-dressers and others whose self-concepts otherwise do not align with the male or female label they were given at birth. Unlike sexual orientation, the accepted protocols for treating many patients expressing profound discomfort with their given gender call for medical intervention.
Since at least the 1980s, for example, a diagnosis of Transsexualism or Gender Identity Disorder has been used by doctors, mental health professionals and a growing number of health insurers to justify access to hormones or surgery for patients who decide to physically transition to a new sex. Eliminating it from the DSM-V therefore could make it more difficult for self-identified transsexuals to qualify for treatment unless a sex change is someday recognized as a physiological condition.
"Let's say someone born a woman walks into my surgical office and says, 'I would like my breasts removed.' What's the diagnosis?" Drescher said. "The procedure is a mastectomy, but if there is no diagnosis, it is cosmetic surgery and your insurance won't pay for it."
As work on the DSM-V moves forward, lawyers who specialize in representing transgender clients have found themselves in the uncomfortable position of arguing that Gender Identity Disorder needs to stay in the manual in some form. Shannon Minter, legal director of the National Center for Lesbian Rights, said that while it's true the diagnosis has been used against some, it also has benefitted others.
"Having a diagnosis is extremely useful in legal advocacy," Minter said. "We rely on it even in employment discrimination cases to explain to courts that a person is not just making some superficial choice ... that this is a very deep-seated condition recognized by the medical community."
Along with pushing for a less-loaded name for Gender Identity Disorder, activists and mental health professionals who work with transgender clients also want to see the symptoms of it revised so the diagnosis is not applied to people whose distress stems from external prejudice, adults who have successfully transitioned to a different gender, or children based on sex stereotypes such as aversion to "rough-and-tumble-play" or "typical feminine clothing."
Kenneth Zucker, a Canadian psychiatrist who chairs the APA Sexual and Gender Identity Disorders Work Group, predicted that with more transgender people coming out at younger ages, and little scientific understanding of what causes someone to be transgender, the debate is likely to continue.
"All of us who work in this field are seeing a huge increase in the number of people who come to see us who have Gender Dysphoria," Zucker said. "There is clearly a clinical need for there to be specialists in this area, and apart from the philosophical musings, having a diagnosis facilitates that."
Copyright 2012 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.