Having read the paper now, I can state more clearly why I still have the same problem. This is an excellent, thorough and highly professional paper. Well done. My issue is with their objective, as stated in the Abstract: "The purpose of this article is to assist mental health professionals in their understanding and conceptualizing of detransition experiences within the existing Diagnostic and Statistical Manual of Mental Disorders (DSM) framework." In other words, the authors want to demonstrate that a particular DSM5 diagnosis applies to a subgroup of detransitioners.
I guess I'm a bit of a rebel but I've never seen any value in such diagnoses. Because the mental health profession has become so medicalized, we now treat mental disorders like disease categories; this means the public tends to view a DSM diagnosis as a static entity much like a chronic disease condition. People suffer from, say, lifelong CPTSD just as they might struggle with hypothyroidism. There might be a drug for it, but there's no cure. We've lost the idea of a neurosis or a psychological complex that might be resolved with introspection, hard work, and emotional growth.
I often hear my clients speak of "my autism" or "my PTSD" in just this way. Yes, it might explain something about them but it's hard work opening them to the idea of moving beyond it. The diagnosis allows them to explain their behaviors or struggles but it doesn't offer a way forward.
(As an aside, I'd point out that the definition of trauma relied upon by the authors of this paper would apply to just about anyone who had a less-than-ideal childhood -- i.e., most people. Here's the definition: "The American Psychological Association (2018) dictionary defines trauma as 'any disturbing experience that results in significant fear, helplessness, dissociation, confusion, or other disruptive feelings intense enough to have a long-lasting negative effect on a person’s attitudes, behavior, and other aspects of functioning. ...'")
For this reason, I believe we disadvantage detransitioners by giving them a new diagnosis. Yes, it's important to acknowledge they've been physically and emotionally harmed by GAC, but that doesn't mean they need a new life-long diagnostic label. I also worry about the parallels between (1) detransitioners who might be encouraged by providers who've read this article to "take some form of social action" and pursue justice against their former providers; and (2) gender dysphoric teens who pursue social justice against a transphobic society (often encouraged by their affirmative therapists). The risk is giving up a growth-inhibiting trans-identity for a new but also constricting identity as a detransitioner bearing a new diagnosis.
On this latter point, I'm conflicted. We need detransitioners to come forward and file lawsuits, and I'm grateful to the ones who have done so. At the same time, whenever I consult with a new detransitioner, I usually think that the best thing they can do is completely leave the realm of gender behind and get on with rebuilding their lives.
Joe, would be curious to hear your thoughts once you have a chance to read the paper. The Spotlight condensed the paper into key themes. The authors engage with the arguments for and against the various positions—and reference literature in other fields that inform how those harmed deal with the trauma of "moral injury."