Depathologising gender diversity in childhood in the process of ICD revision and reform

ABSTRACT

From 2007 on, the World Health Organisation (WHO) has been revising its diagnostic manual, the International Statistical Classification of Diseases and Related Health Problems (ICD), with approval of ICD-11 due in 2018. The ICD revision has prompted debates on diagnostic classifications related to gender diversity and gender development processes, and specifically on the ‘Gender incongruence of childhood’ (GIC) code. These debates have taken place at a time an emergent trans depathologisation movement is becoming increasingly international, and regional and international human rights bodies are recognising gender identity as a source of discrimination. With reference to the history of diagnostic classification of gender diversity in childhood, this paper conducts a literature review of academic, activist and institutional documents related to the current discussion on the merits of retaining or abandoning the GIC code. Within this broader discussion, the paper reviews in more detail recent publications arguing for the abandonment of this diagnostic code drawing upon clinical, bioethical and human rights perspectives. The review indicates that gender diverse children engaged in exploring their gender identity and expression do not benefit from diagnosis. Instead they benefit from support from their families, their schools and from society more broadly.

KEYWORDS:

• Gender diversity in childhood
• depathologisation
• human rights
• ICD revision process
• gender incongruence of childhood

Disclosure statement

Sam Winter was a member of the WHO Working Group on the Classification of Sexual Disorders and Sexual Health (WGSDSH), charged with reviewing trans-specific diagnostic categories in the ICD. Mauro Cabral Grinspan, Adam Smiley, Zhan Chiam and Amets Suess Schwend work in international trans or LGBT organisations. All authors are members of the International Expert Group coordinated by Global Action for Trans Equality (GATE).

ORCID

Amets Suess Schwend http://orcid.org/0000-0003-1844-5414

Notes

1. In this paper, trans is used as an umbrella term for people with gender expressions and identities that differ from the sex assigned at birth, including people who identify themselves as transexual, transgender, non-binary and/or other culturally and contextually specific self-denominations.

2. Depathologisation refers to the removal of diagnostic classifications and clinical practices that conceptualise sexual, gender and bodily diversity as a mental disorder, illness or malformation, as well as to its recognition as a human right and celebration as a relevant contribution to contemporary societies. The depathologisation perspective is based on a human right framework. It is also informed by critical reflections by trans and intersex scholars, and is related to queer, postcolonial, feminist, crip and anti-psychiatric discourses.

3. The Working Group has also proposed the removal of ‘Fetishistic transvestism’ (F65.1) and the category ‘Psychological and behavioural disorders associated with sexual development and orientation’ (F66) from the chapter on Mental and behavioural disorders.

4. The coverage of healthcare in general, and specifically psychological support services, and the role of ICD codes for this coverage depends on the geopolitical context and characteristics of each health system (Stuckler, Feigl, Basu, & McKee, 2010; WHO, 2010).

5. In the ICD-10, Z codes (in the ICD-11 Beta Draft: Q codes) refer to codes included in the ICD chapter ‘Factors related to health status and contact with health services’, which describe social aspects that may impact health, such as social discrimination and exclusion, as well as healthcare procedures and services (e.g. counselling services) that are not related to illness or mental disorder.

6. In the ICD-11 Beta Draft, the codes in the Chapter ‘Factors related to health status and contact with health services’ are listed as ‘Q codes’.