Consensus from Differences: Lack of Professional Consensus on the Retention of the Gender Identity Disorder Diagnosis

Abstract

When the World Professional Association of Transgender Health (WPATH) was asked to provide input into the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5) process regarding the revision of the Gender Identity Disorder (GID) diagnosis, it quickly became apparent that there was a lack of professional consensus within the field as to whether or not this diagnosis should be retained and, if so, whether GID is best conceptualized as a mental health disorder or as a non-mental health physical disorder. Addressing this lack of consensus was the first issue the WPATH Consensus Statement work groups faced. By acknowledging the arguments on both sides and accepting the lack of consensus on the retention of the diagnosis, the work groups were able to reach agreement upon recommendations for diagnostic revision, should a diagnosis be retained in DSM 5. Thus, starting from standpoints with fundamental differences, and representing a constituency (WPATH members) with widely different views, it was possible to reach consensus on shared concerns and make substantive recommendations. This article outlines the lack of agreement regarding the existence of a GID diagnosis and arguments on both side of the issue. This fundamental area of disagreement has a long history and is likely to continue to inform the field of transgender health for some time to come.