Saturday, March 20, 2010

OII’s Objections to the APA DSM-V Committee’s Proposals on Intersex

1.) We believe that the term 'disorder of sex development' (DSD) is not the best way to refer to intersex, intersex people or any medical issues they experience.
2.) When an intersex person rejects an assignment made on their behalf at or near birth, or puberty, we do not regard them as having any sort of identity disorder, or gender incongruence.
3.) When a person prefers to identify as intersex, and does not want to conform to any clear gender, we do not regard them as having any sort of identity disorder, or gender incongruence.
4.) In situations where an individual rejects an earlier assignment made without their consent, we regard this as being due to an erroneous earlier assignment, and thereby any problems arising from that as iatrogenic rather than as a psychological disorder or incongruence. When no consent was sought from an individual, when it becomes possible for that person to exercise their choice to reverse such an error, this cannot be considered a disorder or incongruence.
5.) We see no need to further medicalise and stigmatise intersex people by referring to them as necessarily disordered (DSD), and where mistakes in assignment have been made, we see no value in medicalising and stigmatising them further by applying another form of disorder called 'gender incongruence'.
6.) We ask that the same standards applied in the situation for homosexuality starting with the DSM-II revision be applied to intersex; we request that the DSM-V committee recognise that intersex and all intersex expressions of gender identity are part of normal human variation, and that treatment be confined to those genuine medical issues facing intersex people, and issues they themselves seek medical assistance with.
7.) In the case of children where there is some doubt as to which gender assignment will offer the best outcome, once a decision has been made on their behalf, they should be dealt with in a sensitive and flexible way that will allow them to express their own preferences as they get older, and that should be managed in a way that can most effectively accommodate their own choices and decisions. With an awareness of the potentially disastrous consequences of altering children's genitals surgically prior to an age when they can make informed consent, we call for the minimum of non-essential medical treatment and assignment relating to their gender role, presentation and sex characteristics, until they are in a position to decide upon an appropriate gender (or some other arrangement) for themselves.
8.) To summarise: If an intersex child is assigned a gender without their consent, when they come to exercise their own choice for assignment, this cannot be considered a psychological disorder, or gender incongruence.
Also available on OII's website: Click here


  1. this is a great piece of journalism well done

  2. while i agree with most, it really bothers me that you seem to actually ADVOCATE "non-essential medical treatment", even if it's only "the minimum of [it]" (since we all know how greedy surgeons will interprete that call)?!! why don't you call for ZERO non-essential medical treatment?

  3. This is addressed to psychologists, not surgeons.

  4. We do call for ZERO non-consensual medical treatment for intersex children and that is in our Official position. However, the psychologists in question are using the term DSD in their proposed revisions and that includes MANY things that might require some intervention. That is one of the big problems with putting intersex under the DSD umbrella. For example, we have received correspondence from some people born with Cloacal exstrophy (which is a DSD but not intersex) and they insist they want intervention. I hope that answers your questions.

  5. thanks for explaining!

    w.r.t. cloacal exstrophy, as far as i know, this at least partly involves actual medically indicated treatment (as opposed to cosmetic non-essential medical treatment), which of course is something else.

    to my knowledge, it is safe to generally demand ZERO non-essential medical treatment on children, since these treatments are by definition not necessary, and if desired by the persons affected, can be done later in a proper consensual way.

    this would also include e.g. hypospadias "repair", to which you are opposed as well despite it's no "strict intersex diagnosis". on the other hand CAH as a "typical intersex diagnosis" can also partly involve medically indicated treatments in case of salt wasting (while other treatments like "clitoral reduction" or pre-natal dexamethasone "therapy" are classic non-essential cosmetic treatments). therefore, i.m.o. even within a "strict" intersex umbrella, essential and non-essential treatments should be distinguished.

    i fear demanding only a "minimum of non-essential medical treatment" instead of zero might allow for back doors for doctors seeking to continue unwanted and usually irreversible and damaging cosmetic treatments.

  6. Dear Seelenlos,

    You make some very good points and I assure you that for intersex infants we do demand zero intervention that is not a medical necessity. We will have to make sure that people do understand that we speak for intersex people in OII - not for the intersex people in general. However, we don't speak for people with other variations which were never considered to be intersex, many of which are perfectly happy with the DSD pathological definition. We simply do not feel that we as intersex people fit under their umbrella, pathological term at all because we see that the IOC is using this pathological definition to force treatments on athletes. We see that the APA is using this disorder term to further pathologize intersex infants and adults. We see that the DEX controversy is also related to this entrenched legal and medical pathologiziation of intersex and fitting it in a group of variations which have little to do with being intersex.

    Thanks for you comments.

  7. thanks again for clearing up, and for opposing dsm-v! kind regards

  8. Regarding the DSM-V proposals:

    The dishonesty of this behaviorist power-grab is disgraceful!

    It is infinitely more probable that IS babies who reject erroneous gender role hot-housing following surgical interventions are too strongly predetermined via the organization-activation process to be influenced by any attempts at environmental Pavlovian conditioning.

    Instead of recognizing the inadequacy of their own behaviorist dogma the DSM-V sex/gender working group have put the cart before the horse by declaring the physiological to be psychological.

    I suspect the working group would argue that the IS inclusion is to allow health insurance coverage.

    Far better were every surgeon who miss-assigned an Intersex baby forced to pay for the ongoing costs associated with the miss-assignment.

    That way the surgeries would stop overnight!

  9. Eli sebessakwiniApril 9, 2010 at 8:19 AM

    Thank you so much for keeping up the fight! Excellent and concise articulation.
    I imagine that the DSM committee will require a block of psychiatrists - and perhaps an academic paper or two - to take these obvious and reasonable recommendations seriously.