Springfield, VA, USA. The American Psychiatric Association (APA) has named the Work Groups and membership for its coming fifth revision to the Manual for Diagnosis of Mental Disorders (DSM-V). The DSM is a guide to what the APA terms mental disorders. It is the handbook desktop reference used most often for diagnostics in the United States and internationally.

The manual contains a listing of psychiatric disorders, diagnostic codes, information on the prevalence of each disorder, and diagnostic criteria. The APA advertises the DSM as a non-theoretical guide that does not offer information on causes or treatments.

A Short Primer. Conception occurs at the moment sperm fuses with ova. The resulting zygote, not yet an embryo, has no sexual differentiation.

This is how all of us begin, even those of us born in test tubes.

The default condition of a human is female. At the moment of conception we have female configured brains and, without an influx of male hormone, we will be born with a female brain and female sexual anatomy. We call this the standard development pattern.

Sometimes, however, the genetic plan for the developing embryo misfires. The brain’s neurobiology configures first, the body’s later. For a boy to be born, the male hormone testosterone must wash over the undifferentiated fetus at two distinct points in the development.

•  The first is when the human brain locks into its identity. If the male hormone is not present at this time, the neurobiology of the brain will remain configured in the female state.

•  The second crucial point is when the human body develops sexual organs, internal and eternal. If the male hormone is present, for whatever reason, the sexual organs will be male; if the male hormone is not present, the organs will default to female.

So, where do people come from who are misaligned?

It starts with the body plan. Anomalies can occur if there is a mismatch traceable to application of the genomic/genetic blueprint at conception. This can result in confused signals that affect subsequent development.

In a female to male, testosterone can washed over the brain but not over the body so that the person is born with male neurobiology within a female anatomy. In a male to female, testosterone washes over the body but not the brain so that the person is born with female neurobiology in a body with male anatomy.

Mental health professionals use the DSM for a variety of purposes, such as clinical practice, research, and educational purposes. Clinicians also use the DMS-IV to classify patients for billing purposes. The government and many insurance carriers require a specific diagnosis in order to approve payment for treatment.

The DSM has gone though five major revisions since first publication, with the most recent major update published in 1994. 

The current version is a minor variant published in July 2000 that adds clarifying text (DSM-IV, Text Revision). The primary goal was to maintain the currency of the DSM-IV text with the empirical literature up to 1992.

The DSM has its share of critics.

According to Christopher Lane, a scholar at Northwestern University, the DSM has a history of medicalizing what for many people, appear to be common behavioral attributes. Lane chronicled what he calls the "highly unscientific and often arbitrary way" in which widespread revisions were made to the DSM in his book, Shyness: How Normal Behavior Became a Sickness.

Lane notes that by 1987 the DSM removed the key phrase "a compelling desire to avoid," requiring instead only "marked distress". Lane argues that could include concern about saying the wrong thing. "Impairment became something largely in the eye of the beholder, and anticipated embarrassment was enough to meet the diagnostic threshold."

Since the last major edition (DSM-IV), most of the changes have been in the descriptive text, with some error correction and changed diagnostic codes to reflect updates to the ICD-9-CM coding system adopted by the U.S. Government. It is available from the the DSM-IV-TR web site.

Completion of the DSM-V revisions is planned for 2011/12.

The Structured Clinical Interview for DSM-IV (SCID) Axis I Disorders (SCID-I) is a semi-structured interview for making the major DSM-IV Axis I diagnoses. The SCID-II is a semi-structured interview for making DSM-IV Axis II: Personality Disorder diagnoses. The official SCID site maintains a list of Frequently Asked Questions (FAQs).

The TS-Si News Service is a collaborative effort by TS-Si.org editors, contributors, and corresponding institutions. Sources can include the cited individuals and organizations, as well as TS-Si.org staff contributions. Articles and news reports do not necessarily convey official positions of TS-Si, its partners, or affiliates. We welcome your comments. Use the form below to leave a public comment or send private correspondence via the TS-Si Contact Page. We will not divulge any personal details or place you on a mailing list without your permission.


TS-Si is dedicated to the acceptance, medical treatment, and legal protection of individuals correcting the misalignment of their brains and their anatomical sex, while supporting their transition into society as hormonally reconstituted and surgically corrected citizens.

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