Abstract
ICD-11 (the eleventh edition of the World Health Organization International Statistical Classification of Diseases and Related Health Problems) is due for approval in 2018. For transgender health care, the most important proposals for ICD-11 are as follows: (1) the five ICD-10 diagnoses (most notably Transsexualism and Gender Identity Disorder of Childhood) currently in Chapter 5 (Mental and Behavioural Disorders) will be replaced by two Gender Incongruence diagnoses, one of Adolescence and Adulthood and the other of Childhood (GIC), and (2) these two diagnoses will be located in a new chapter provisionally named Conditions Related to Sexual Health. Debate on the GIC proposal has focused on whether there should be a diagnosis for young children exploring their identity and has drawn on a number of arguments for and against the proposal. The World Professional Association for Transgender Health conducted a survey to examine members’ views concerning the GIC proposal, as well as an alternative framework employing non-pathologizing Z Codes. The survey was completed by 241 (32.6 %) out of 740 members. Findings indicated an even split among members regarding the GIC proposal (51.0 % [n = 123] opposing and 47.7 % [n = 115] supporting the proposal). However, non-US members were overall opposed to the proposal (63.9 % [n = 46] opposing, 36.1 % [n = 26] supporting). Across the sample as a whole, and among those expressing a view about Z Codes, there was substantial support for their use in healthcare provision for children with gender issues (35.7 % [n = 86] of the sample supporting vs. 8.3 % [n = 20] rejecting).
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Acknowledgments
Gail Knudson is President of WPATH (2016–2018), Jamison Green is Past-President of WPATH (2014–2016). Thanks to Annelou de Vries, Simon Pickstone-Taylor, Andrea Martin, and Bean Robinson for their help in reviewing and developing the survey. Sam Winter and Griet De Cuypere have contributed equally to this article and are both Board Members of WPATH.
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One of the authors of this paper, Sam Winter, was a member of the WHO Working Group on Sexual Disorders and Sexual Health generating the GIC proposal, as well as a group producing a counter-proposal incorporating the use of Z Codes (GATE Civil Society Experts Working Group, 2013).
Appendix: The Clinical Description of the Proposed GIC Diagnosis (World Health Organisation, 2015)
Appendix: The Clinical Description of the Proposed GIC Diagnosis (World Health Organisation, 2015)
Gender Incongruence of Childhood is characterized by a marked incongruence between an individual’s experienced/expressed gender and the assigned sex in prepubertal children. It includes a strong desire to be a different gender than the assigned sex; a strong dislike on the child’s part of his or her sexual anatomy or anticipated secondary sex characteristics and/or a strong desire for the primary and/or anticipated secondary sex characteristics that match the experienced gender; and make-believe or fantasy play, toys, games, or activities and playmates that are typical of the experienced gender rather than the assigned sex. The incongruence must have persisted for about 2 years and cannot be diagnosed before age 5. Gender-variant behavior and preferences alone are not sufficient for making the diagnosis.
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Winter, S., De Cuypere, G., Green, J. et al. The Proposed ICD-11 Gender Incongruence of Childhood Diagnosis: A World Professional Association for Transgender Health Membership Survey. Arch Sex Behav 45, 1605–1614 (2016). https://doi.org/10.1007/s10508-016-0811-6
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DOI: https://doi.org/10.1007/s10508-016-0811-6