Disease models of gender identity and expression

The value-neutral scientific model states that gender identity is a trait and gender expression is a behavior.

Because the expression of gender identities can include medical options, several medicalized disease models have developed. People trained in medicine often conceptualize traits in metaphors of disease and impairment, especially traits that some consider socially undesirable. For instance, American psychiatrists categorized “homosexuality” as a disease until 1973.

Some people in our community have supported disease models for many reasons:

• To make gender diversity more acceptable to others (social desirability)
• To get healthcare providers to help us
• To get our healthcare paid for by governments or private insurers
• To support political or legal goals in the short term
• Self-recognition / sense of belonging
• Self-hatred

Disease models are not value-neutral and are shaped by bias. They look scientific, but they are not because they reveal the bias of those who promote them. Below are just some of the diseases created and used to describe our community within medical and behavioral frameworks.

Psychosexual pathology

These disease models are the least scientific and most damaging. They have roots in the eugenics movement of the 19th century. They see gender diversity as a sex disease of the brain.

• Sexual inversion
• Sexo-aesthetic inversion (Ellis 1913)
• Perversion
• Psychosexual hermaphroditism
• Sexual deviations (DSM-II)
• Paraphilia (Stekel and Money via Krauss and Robinson)
  • Apotemnophilia (pretenders/devotees/wannabes)
• Transvestism (Hirschfeld 1910)
  • Transvestic fetishism
  • Dual-role transvestism
  • Benjamin’s Sex Orientation Scale (SOS or Benjamin scale)
    • Pseudotransvestite
    • Fetishistic transvestite
    • True transvestite
• Transsexualism [as a sexuality]
  • Homosexual transsexual (HSTS)
  • Heterosexual transsexual
  • Asexual transsexual
  • Trans-sexualism with unspecified sexual history
  • Trans-sexualism with asexual history
  • Trans-sexualism with homosexual history
  • Trans-sexualism with heterosexual history
  • Ray Blanchard‘s disease models
    • Erotic target location error (ETLE) (Freund and Blanchard 1993)
    • Erotic Target Identity Inversion (ETII) (Freund and Blanchard 1993)
    • Homosexual transsexual (HSTS)
    • Nonhomosexual transsexual
    • Autogynephilia (AGP)
      • Partial autogynephilia
      • Transvestic autogynephilia
      • Behavioral autogynephilia
      • Physiologic autogynephilia
      • Anatomic autogynephilia
    • Autoandrophilia (AAP)
• Gender identity disorder
• Sexual maturation disorder
• Attraction to transgender people [as a disease]
  • Gynandromophophilia (GAMP)
  • Gynemimetophilia

Psychopathology

These diseases view our community’s traits and behaviors as mental disorders or mental illness.

• Transsexualism (DSM-III)
  • Psychopathia transsexulialis (Cauldwell 1949)
  • Gynemimesis (Money 1984)
  • Benjamin scale (Benjamin 1966)
    • Nonsurgical transsexual
    • Moderate intensity transsexual
      • Secondary transsexual (Person / Ovesey 1974)
    • High intensity transsexual
      • Primary transsexual (Person / Ovesey 1974)
      • True transsexual (Benjamin 1966)
• Gender identity disorder
  • Gender identity disorder in children (GIDC) (DSM-II)
  • Gender identity disorder of adolescence or adulthood, nontranssexual type (GIDAANT) (DSM-III-R 1987)
  • Gender identity disorder, not otherwise specified (GIDNOS) (DSM-IV-TR 2000)
• Gender dysphoria
  • Childhood onset gender dysphoria
  • Rapid onset gender dysphoria (ROGD)
  • Autohomoerotic gender dysphoria
  • Gender dysphoria caused by psychotic delusions
• Gender incongruence
  • Gender incongruence of adolescence or adulthood
  • Gender incongruence of childhood
  • Gender incongruence, unspecified
• Factitious disorders
  • Factitious disorder imposed on self (“sick role”)
    • Munchausen syndrome
    • Munchausen by internet (“cybermunch”)
    • Factitious intersex
    • Factitious transgender (“transtrender”)
  • Factitious disorder by proxy (Munchausen by proxy)
• Somatic symptom disorders
• Body integrity disorders
  • Body integrity identity disorder (BIID)
  • Body integrity dysphoria (BID)

Pathology

These diseases view our community’s traits and behaviors as physical disorders or disabilities, often mismatches between body and mind, spirit, or brain.

• “birth defect” model
• “trapped in the wrong body”
• “brain sex” models
• “neurologically intersex”
• “feminine essence”
• “Harry Benjamin syndrome” (HBS)

References

James A (2006). A defining moment in our history: Examining disease models of gender identity. Gender Medicine. 3. S56. https://doi.org/10.1016/S1550-8579(06)80121-X