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Field study supports removing transgender identity from mental disorders in ICD-11

Recent findings suggest classifying health-related categories associated with transgender identity outside of the classification of mental disorders in the ICD-11.

“The proposal for WHO’s ICD-11 is to remove categories related to transgender identity from the Mental and Behavioral Disorders chapter and place them in a new ICD-11 chapter called Conditions Related to Sexual Health, which is conceptualized as a more medically oriented chapter. The ICD-11 proposal names the category gender incongruence and emphasizes the individual’s subjective experience of incongruence between the individual’s experienced gender and the assigned sex,” Rebeca Robles, PhD, of Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, and colleagues wrote. “The proposed diagnostic guidelines note that gender incongruence can be associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning, particularly in disapproving social environments, but neither distress nor functional impairment is a diagnostic requirement.”

Rebeca Robles

Researchers conducted a field study among a sample of transgender adults aged 18 years or older receiving health care services at the Condesa Specialized Clinic in Mexico City (n = 250). Study participants completed interviews focusing on sociodemographic characteristics, medical history related to gender identity and concepts related to gender identity diagnoses proposed for ICD-11 and from DSM-5 and ICD-10 during adolescence.

Overall, 81% of the cohort had been assigned male sex at birth.

Study participants reported first awareness of transgender identity at a mean age of 5.6 years.

The majority of participants (74%) reported using health interventions for body transformation, most commonly hormones (73%), with first such intervention at a mean age of 25 years.

Forty-six percent of those who used hormones initially did so without medical supervision.

Distress associated with gender identity during adolescence occurred in 83% of the cohort, with an average level of distress of 79.9 on a scale of 0 (none at all) to 100 (extreme).

The majority of participants (90%) reported family, social, work or academic dysfunction related to their gender identity, though levels were generally moderate.

Griet De Cuypere

Distress and all types of dysfunction were strongly predicted by experiences of social rejection (OR = 2.29-8.15) and violence (OR = 1.99-3.99), according to multivariate logistic regression models.

Current male gender identity also predicted distress (OR = 3.9).

Asking to be treated as a different gender significantly predicted work or academic dysnfuction (OR = 1.82).

“This field study provides evidence to support one aspect of the WHO proposals — namely, moving health-related categories related to transgender identity out of the classification of mental disorders in ICD-11,” Griet De Cuypere, MD, PhD, of University Hospital, Ghent, Belgium, and Sam Winter, BSc, PGCE, MEd, PhD, of Curtin University, Perth, Australia, wrote in an accompanying editorial. “Many questions remain, such as the case for a diagnostic category, the name and diagnostic guidelines that should be used, the place the diagnosis should occupy in the manual, and, above all, the need for a diagnosis for children, for which other field studies are needed.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.