APA Stands Up for Transgender, Gender-Variant Individuals

Deborah Brauser

August 17, 2012

August 17, 2012 — The American Psychiatric Association (APA) has issued official position statements of support for access to healthcare and a repeal of laws and policies that discriminate against individuals who are transgender and gender variant.

In a release, the APA said it will advocate for the removal of barriers to care for gender transition treatment and for the protection of civil rights. The organization has supported lesbian and gay rights since 1973, when it removed homosexuality from the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-II), and now it wants to publicly support the transgender community.

"Transgender and gender variant people are frequently denied medical, surgical, and psychiatric care related to gender transition," notes the APA statement. The new position statements were created by the APA Caucus of Lesbian, Gay, and Bisexual Psychiatrists.

"The APA has officially put itself on record as being in support of these issues. Being transgender should not imply that a person is not a fully capable citizen," Jack Drescher, MD, who is coauthor of the statements and who is a training and supervising analyst at the William Alanson White Institute of Psychiatry, Psychoanalysis and Psychology in New York City, told Medscape Medical News.

Dr. Jack Drescher

The 2 position statements join a recent report from an APA task force published earlier this year in the Archives of Sexual Behavior that lists treatment recommendations for individuals with gender identity disorder (GID).

This treads into thorny territory. Many people, including protestors at the 2009 APA Annual Meeting, have questioned whether GID should be considered a mental disorder and whether it should be included in the upcoming fifth edition of the DSM (DSM-5).

"The motivation for originally putting GID in the manual was to try to create access to care," said Dr. Drescher, who was a consultant on the report.

"But you have sort of 2 conflicting interests: reduction of stigma by removing it from the manual vs access to care, because you can't get medical treatment unless you have a diagnosis. It's complicated."

Discrimination Damaging

"Discrimination and lack of equal civil rights is damaging to the mental health of individuals," writes the APA.

"For example, gender-based discrimination and victimization were found to be independently associated with attempted suicide in a population of transgender individuals, 32% of whom had histories of trying to kill themselves."

Both the American Medical Association and the American Psychological Association have previously released strong policy statements of support for these individuals.

The APA's new Access to Care position statement declares that the organization

  • recognizes that these individuals "can benefit greatly from medical and surgical gender transition treatments";

  • supports public and private health insurance coverage for this treatment; and

  • is against the rejection of this coverage when it has been prescribed by a clinician.

The new discrimination position statement declares that the APA

  • supports all laws that protect the civil rights of these individuals;

  • urges the repeal of any discriminatory laws and policies;

  • opposes discrimination in the areas of healthcare, as well as in employment, housing, and education; and

  • "declares that no burden of proof of such judgment, capacity, or reliability shall be placed upon these individuals greater than that imposed on any other persons."

"Speaking out firmly and professionally against discrimination and lack of equal civil rights is a critical advocacy role that the APA is uniquely positioned to take," writes the organization.

Controversy

Dr. Drescher noted that although the APA has long been an advocate for gay and lesbian civil rights, until now it has not officially released support for the rights of transgender people.

"It was completely silent on transgender issues. These are really the first public position statements that APA has supported. But they oppose stigma of any kind, and these statements are consistent with APA's mission," said Dr. Drescher, who was also chair of the APA's Committee on Gay, Lesbian, and Bisexual Issues from 2000 to 2006.

He noted that he has also been advocating for a task force on treatment recommendations since leaving the committee 6 years ago.

"There are a lot of controversies in this area, not so much with adults but around treatment of children. The Task Force came together and put out a document that was approved by the APA that said that treatment of adults was important. And there's enough literature to justify the development of treatment guidelines," he said.

Dr. Drescher is also part of the Workgroup on Sexual and Gender Identity Disorders for the DSM-5.

"As part of my job there, I did a review of the history of homosexuality being taken out of the DSM, especially because a lot of people in the trans community have been demanding the removal of GID. And I was intrigued by the parallels," he explained.

"On the one hand, I could see that by taking something out, you reduce stigma. But if you take homosexuality out of the manual, gay people don't need anything else other than the diagnoses everyone else has. If you take out gender identity disorder, adults who require treatment don't have any other diagnosis. So it's not exactly the same."

The position statements are available on the APA's Web site.

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