The DSM-5 updates its gender/transgender vocabulary in a positive way, but "autogynephilia" remains

The American psychiatric manual, the DSM-5 (now called DSM-5-TR) has revised the chapter on gender dysphoria. The main changes reflects a more on target and respectful language for describing gender variance. 

• The term “desired gender” is now “experienced gender.“
• The term “cross-sex medical procedure” is now “gender-affirming medical procedure.”
• The term “natal male”/“natal female” is now “individual assigned male/female at birth.”

It seems to me that the doctors writing this chapter are both willing and able to have a constructive dialog with trans people.

I am not saying that the gender dysphoria  text is perfect. Why on earth they continue to use the term “disorders of sex development” for intersex people, given the history of “gender identity disorder”, is beyond me. They did at least include the term “differences of sex development” as an alternative.

You can read the revised introduction to the DSM-5-TR gender dysphoria chapter here. 

Autogynephilia remains

What they have failed to do is to remove the “autogynephilia” diagnosis from the paraphilia chapter. 

The inclusion of this pseudo-scientific term is extremely unfortunate, and reflects the influence of Ray Blanchard on the DSM-5 process. The term is actively used by anti-trans activists to invalidate trans women. Indeed, Blanchard himself is actively helping TERFs and right wing extremist spread their transphobic gospel.

It is important to note that the inclusion of this term does not mean that the DSM-5 has adopted Ray Blanchard’s overall theory or view of trans women. Indeed, there is no description of Blanchard’s overall model of gender variance in the manual. 

The gender dysphoria chapter underlines that “autogynephilia” (in the sense of erotic cross-gender or crossdreaming erotic fantasies) may be an expression of gender dysphoria (which is not a mental illness in the DSM-5):

“A predisposing factor under consideration, especially in individuals with postpubertal-onset gender dysphoria (adolescence, adulthood), includes history of transvestism that may develop into autogynephilia (i.e., sexual arousal associated with the thought or image of oneself as a woman).”

The “autogynephilia” diagnosis (“sexually aroused by thoughts or images of self as a woman”) remains under the “Transvestic Disorder” heading, which is a part of the “Paraphilic Disorders” chapter. 

I understand that the DSM-5-TR editors may see erotic crossdreaming or “autogynephilia” as an expression of “transvestic disorder” in the same way as it can be an expression of “gender dysphoria”. In this way “autogynephilia” is not considered a mental illness in and for itself. 

But this is, frankly, meaningless sophistry resulting from too many compromises. The whole “transvestic disorder” chapter should have been removed from the manual, in the same way WHO removed “fetishistic transvestism” from its international ICD-11 health manual.

Members of the relevant ICD-11 working group put it this way back in 2012:

The ICD-11 Working Group on the Classification of Sexual Disorders and Sexual Health believes it is now appropriate to abandon a psychopathological model of transgender people based on 1940s conceptualizations of sexual deviance and to move towards a model that is (1) more reflective of current scientific evidence and best practices; (2) more responsive to the needs, experience, and human rights of this vulnerable population; and (3) more supportive of the provision of accessible and high-quality healthcare services.

The gender dysphoria chapter uses the term "autogynephilia" as a neutral descriptive term of erotic crossdreaming. But it is not a neural term, and the editors of the DSM-5-TR should have understood that, especially now that the term is actively used as a weapon against transgender women.

See also: 

• The Autogynephilia Theory is in Violation of Basic Research and Health Care Ethics
• All you need to know about "autogynephilia"
• The Autogynephilia Theory Debunked by New German Study
• An introduction to the autogynephilia debate
• New Study Dismisses the Autogynephilia Approach to Transgender