The Sexual and Gender Identity Disorders

This paper reviews efforts to incorporate cultural considerations on sexual and gender identity disorders in DSM-IV. An initial literature review revealed very few sources that met the criteria of relevance for the DSM constructions of sexual and gender identity disorders. Cultural caveats were included in introductions to the sexual dysfunctions and paraphilias, but not for the gender identity disorders of DSM-IV. Discussion of the Culture and Diagnosis Work Group's suggestions for revision shows that: (i) we were more successful at getting culturally insensitive statements eliminated from preliminary drafts than in getting culturally sensitive statements included in the final document; and (ii) although cultural considerations were considered important, any challenge to the basic nosological assumptions that underlie the categories themselves went unheeded. The DSM-IV categories of sexual disorder are also taken to task for the inherent notion that while a culturally informed critique may be appropriate for some exotic societies it is irrelevant for our own and for a lack of sensitivity to gender issues that have been well articulated in the literature.