DSM-V. Oh shi-
Wednesday, February 10th, 2010 10:58 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
mothwingThe first drafts of the DSM-V are out.
I can't say that I wouldn't have expected some of what's in there. Still. WOW.
Let's start with something positive: I'm glad they're including Binge Eating as an eating disorder now. That's a good thing. I'm torn on Non-Suicidal Self Injury and wonder why they didn't also list this under paraphilias.
Other than that... Wow.
Let's begin with the fact that they've chosen to dispense with listing "distress" in their criteria as a measure for whether something is a disorder or a mere deviation from an abstract norm. I am not sure what is going to take its place - the way things are looking now, there is no telling where the boundary between clinical condition and deviation from the norm lies, really.
Zucker suggests that the likelihood of social ostracism is supposed to be the boundary for the norm here for his field, and my impression is that it will be really down to the estimation of the psych rather than the patient whether they have a condition that ought to be cured than the patient's distress with their situation.
Nearly all of the criteria regarding GI in children that aren't related directly to the child's experienced gender still don't make sense and are deeply rooted in sexism, though the change in terminology is a good one. WTF is "typical masculine/feminine clothing" for children? What's wrong with cross-gender roles during fantasy play? WTF are "toys, games, or activities typical of the other gender", and what's wrong with rejecting games considered "appropriate" for your own gender?
Also, the shift in focus when it comes to the basis of this diagnosis from Gender Incongruence in adults does not make any sense to me - if behaviour appropriate to a person's gender is irrelevant in adults, why enforce it in children to this degree?
Zucker's paper... where to start. I am not an expert and I'm probably missing many things that are noteworthy, but there is still enough that is really anoying. He fails gender 101 ("if there was a social reason for girls to want to be boys, the same reason would apply to boys wanting to be girls"), it's creepy how he has as test subjects of one study comprised 500 boys who were referred to his clinic and only 79 girls - which to me seems to speak volumes of the inherent sexism of the entire enterprise and the femmephobia it engenders - his insistence that GID is a condition that ought to be cured by changing the individuals gender expression because that will cause their problems to disappear because they won't be socially ostracised anymore... there is so much that's troublesome in that paper, but his insistence that if you fix yourself, your situation will be better because your peers will react more positively to you is probably one of the least sensible I have ever heard. Would he maintain that that's applicable to other condition that cause children to be ostracised by their peers, I wonder?
Gender policing is creepy and superfluous, and it doesn't get better if people start even earlier with this nonsense. I want more freedom to experiment, especially for boys, not less. Most of my childhood friends presented with at least for of these criteria, in girl's cases five. I want back what I had when I was younger. More androgynous clothes for children, more toys that were coded as androgynous rather than marketed towards a specific gender, more room for experimenting. When I was small, nearly all of the male friends I had in kindergarten played more with their dolls than I did - my best friend, a boy called Sebastian, had a dolly that he used to take along everywhere and that was usually integrated into our games, usually in the role of his baby. Most of the girls I was friends dressed in androgynous clothes that would be perceived as "boy clothes" today because they're not sexualised, they played with androgynous and toys coded as "for boys" today, many had more friends who were boys than friends who were girls, and we all wore trousers with tears on the knees. I haven't seen any of that during my internship in kindergarten, and it's a fucking shame.
Edit: another thing I'm wondering here is what the benefit of having those extra criteria at all. I can't imagine that there many people who say that they don't feel their assigned gender is correct for shits and giggles, so surely, that ought to be enough for the medical gatekeepers...?
I guess I ought to shut up about this. I'm a cis ex-psych minor and really not informed enough to join the discussion of these issues.
So. Paraphilias.
The paraphilia-related changes in many areas actually seemed to make things worse rather than improve them. They apparently want to make a distinction between paraphilias and paraphilaic disorders - one being merely ascertained for study purposes, the other being diagnosed.
Not sure what the benefits of ascertaining something in a medical context are, especially in a Diagnosis Manual for Disorders, but fine, if they must. Still, the change in the wording for this is failtastic: for masochism, for example, according to the revising people, the difference between "real, not simulated" harm and ... well, harm, simulated or not, is pointless enough to just drop it altogether. Which means that a lot more people now ought to go see a therapist, because there is no difference between sexual games and reality any more, if I'm reading that correctly.
Also, we have "autogynephilia" (and the continuing absence of autoandrophilia as well as notes to whether ciswomen experience autogynephilia, which they do) rear its ugly head again under "transvestic fetishism". As far as I can see from Blanchard's paper there is no reason for the inclusion of this "condition" at all, really, apart from Blanchard's ownfucking creepy obsession with studies on the sexual fantasies of trans women.
Also, asexual people need to get their heads checked, and so do people who don't enjoy being penetrated, or those people who just like their vanilla sex too much.
Who else needs chocolate cookies?
EDIT: and I'm still trying to get my head around the necessity to list the symptoms of healthy paraphilias in a diagnosis manual for disorders under the title of the disorder it's supposed to diagnose, and I'm still drawing a blank.
Can anyone help me out? I must be missing something here and I hate that.
I can't say that I wouldn't have expected some of what's in there. Still. WOW.
Let's start with something positive: I'm glad they're including Binge Eating as an eating disorder now. That's a good thing. I'm torn on Non-Suicidal Self Injury and wonder why they didn't also list this under paraphilias.
Other than that... Wow.
Let's begin with the fact that they've chosen to dispense with listing "distress" in their criteria as a measure for whether something is a disorder or a mere deviation from an abstract norm. I am not sure what is going to take its place - the way things are looking now, there is no telling where the boundary between clinical condition and deviation from the norm lies, really.
Zucker suggests that the likelihood of social ostracism is supposed to be the boundary for the norm here for his field, and my impression is that it will be really down to the estimation of the psych rather than the patient whether they have a condition that ought to be cured than the patient's distress with their situation.
Nearly all of the criteria regarding GI in children that aren't related directly to the child's experienced gender still don't make sense and are deeply rooted in sexism, though the change in terminology is a good one. WTF is "typical masculine/feminine clothing" for children? What's wrong with cross-gender roles during fantasy play? WTF are "toys, games, or activities typical of the other gender", and what's wrong with rejecting games considered "appropriate" for your own gender?
Also, the shift in focus when it comes to the basis of this diagnosis from Gender Incongruence in adults does not make any sense to me - if behaviour appropriate to a person's gender is irrelevant in adults, why enforce it in children to this degree?
Zucker's paper... where to start. I am not an expert and I'm probably missing many things that are noteworthy, but there is still enough that is really anoying. He fails gender 101 ("if there was a social reason for girls to want to be boys, the same reason would apply to boys wanting to be girls"), it's creepy how he has as test subjects of one study comprised 500 boys who were referred to his clinic and only 79 girls - which to me seems to speak volumes of the inherent sexism of the entire enterprise and the femmephobia it engenders - his insistence that GID is a condition that ought to be cured by changing the individuals gender expression because that will cause their problems to disappear because they won't be socially ostracised anymore... there is so much that's troublesome in that paper, but his insistence that if you fix yourself, your situation will be better because your peers will react more positively to you is probably one of the least sensible I have ever heard. Would he maintain that that's applicable to other condition that cause children to be ostracised by their peers, I wonder?
Gender policing is creepy and superfluous, and it doesn't get better if people start even earlier with this nonsense. I want more freedom to experiment, especially for boys, not less. Most of my childhood friends presented with at least for of these criteria, in girl's cases five. I want back what I had when I was younger. More androgynous clothes for children, more toys that were coded as androgynous rather than marketed towards a specific gender, more room for experimenting. When I was small, nearly all of the male friends I had in kindergarten played more with their dolls than I did - my best friend, a boy called Sebastian, had a dolly that he used to take along everywhere and that was usually integrated into our games, usually in the role of his baby. Most of the girls I was friends dressed in androgynous clothes that would be perceived as "boy clothes" today because they're not sexualised, they played with androgynous and toys coded as "for boys" today, many had more friends who were boys than friends who were girls, and we all wore trousers with tears on the knees. I haven't seen any of that during my internship in kindergarten, and it's a fucking shame.
Edit: another thing I'm wondering here is what the benefit of having those extra criteria at all. I can't imagine that there many people who say that they don't feel their assigned gender is correct for shits and giggles, so surely, that ought to be enough for the medical gatekeepers...?
I guess I ought to shut up about this. I'm a cis ex-psych minor and really not informed enough to join the discussion of these issues.
So. Paraphilias.
The paraphilia-related changes in many areas actually seemed to make things worse rather than improve them. They apparently want to make a distinction between paraphilias and paraphilaic disorders - one being merely ascertained for study purposes, the other being diagnosed.
Not sure what the benefits of ascertaining something in a medical context are, especially in a Diagnosis Manual for Disorders, but fine, if they must. Still, the change in the wording for this is failtastic: for masochism, for example, according to the revising people, the difference between "real, not simulated" harm and ... well, harm, simulated or not, is pointless enough to just drop it altogether. Which means that a lot more people now ought to go see a therapist, because there is no difference between sexual games and reality any more, if I'm reading that correctly.
Also, we have "autogynephilia" (and the continuing absence of autoandrophilia as well as notes to whether ciswomen experience autogynephilia, which they do) rear its ugly head again under "transvestic fetishism". As far as I can see from Blanchard's paper there is no reason for the inclusion of this "condition" at all, really, apart from Blanchard's own
Also, asexual people need to get their heads checked, and so do people who don't enjoy being penetrated, or those people who just like their vanilla sex too much.
Who else needs chocolate cookies?
EDIT: and I'm still trying to get my head around the necessity to list the symptoms of healthy paraphilias in a diagnosis manual for disorders under the title of the disorder it's supposed to diagnose, and I'm still drawing a blank.
Can anyone help me out? I must be missing something here and I hate that.
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no subject
Date: Thursday, February 11th, 2010 12:13 am (UTC)That thing about GI diagnosis in children.... WTF?! Remembering little me at a certain age, playing outside doing things like climbing on trees, dressed in torn jeans and some shirt, my best friends being boys, loving my toy cars, choosing martial arts over ballet, all in all being what you'd call a tomboy. Heck, I nearly refused to attend my dad's wedding because I was supposed to wear a dress instead of my shredded jeans. But GI? Seriously, why can't people let children be children nowadays?!
I didn't dare read Zucker's paper after your reaction, it sounded too much like headache-inducing bullshit. But I do want a chocolate cookie now.
no subject
Date: Thursday, February 11th, 2010 09:01 am (UTC)Drat, I need to find a psych major to explain this to me. Maybe this'd be a good thing to bring up in my next therapy session?
no subject
Date: Thursday, February 11th, 2010 09:37 am (UTC)Seriously, after reading through that yesterday I felt like taking up binge eating as my new hobby. x_x
no subject
Date: Thursday, February 11th, 2010 09:14 pm (UTC)Yup, I agree with your comment. Do ask your therapist! And please post the answers :)
no subject
Date: Thursday, February 11th, 2010 10:45 pm (UTC)I don't know; I have huge issues with the DSM in general. I'm still deeply bothered that one of the criteria for anorexia and bulimia is being underweight; there are a lot of reasons a person with all the mental symptoms and poor nutrition and other physical effects of an eating disorder might not be underweight (for example, medications for other conditions), and I think making the definition hinge on weight is deeply dangerous to treatment.
no subject
Date: Friday, February 12th, 2010 10:41 am (UTC)I think making the definition hinge on weight is deeply dangerous to treatment.
Oh god, yes. I don't know why they want to perpetuate the myth - and I think this certainly contributes to this - that these two conditions are primarily about the person's relation to their weight, that the weight somehow is the problem that needs to be addressed, rather than whatever caused this condition. It's not likely to be a lack of other dieting options.
no subject
Date: Friday, February 12th, 2010 06:25 pm (UTC)Yeah, that's what I meant. I got my terminology confused, sorry.
is there even a term for "boys who are into 'girl things'" that's not a slur?
I don't think so, although a lot of childhood development folks tend to assume they're gay, which...argh. Because gay men all like "woman things"? I thought we were past that. Why can't kids just like what they like and we'll see either when they tell us what they are or when they grow up?
And yeah, tomboys are way less threatening to the gender standard. I know more than a few mothers who would happily let their daughters do all the "boy" things they want, but wouldn't let their sons do most "boy" things because of potential teasing and harassment, etc.
Oh god, yes. I don't know why they want to perpetuate the myth - and I think this certainly contributes to this - that these two conditions are primarily about the person's relation to their weight, that the weight somehow is the problem that needs to be addressed, rather than whatever caused this condition. It's not likely to be a lack of other dieting options.
I don't know, but I suspect they don't want to deal with the skyrocketing number of cases there would be if they take weight out of the equation. The thing is, treatment is much more likely to be successful if it starts early. :/ I guess it's less of an issue for people who pay for their treatment, but under an insurance- or state-funded system, I'm not sure how it would work--but I wouldn't be surprised if people get denied coverage for not being underweight enough, which also reinforces the idea that there isn't a problem.