Gender Incongruence of Adolescence and Adulthood: Acceptability and Clinical Utility of the World Health Organization's Proposed ICD-11 Criteria

• Published in: PloS one Vol. 11; no. 10; p. e0160066
• Main Authors: Beek, Titia F, Cohen-Kettenis, Peggy T, Bouman, Walter P, de Vries, Annelou L C, Steensma, Thomas D, Witcomb, Gemma L, Arcelus, Jon, Richards, Christina, Elaut, Els, Kreukels, Baudewijntje P C
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 24-10-2016; Public Library of Science (PLoS)
• Subjects: Adolescent; Adolescents; Adult; Belgium; Biology and Life Sciences; Child development; Classification; Deviance; Diagnosis; Diagnostic software; Diagnostic systems; Female; Gender identity; Health care; Health care industry; Health sciences; Human rights; Humans; International Classification of Diseases; Male; Medical diagnosis; Medicine and Health Sciences; Mental disorders; Netherlands; People and Places; Placement; Psychiatry; Public health; Research and Analysis Methods; Social Sciences; Teenagers; Transgender people; Transgender persons; United Kingdom; Working groups; World Health Organization; Young Adult; United Kingdom > UK; Netherlands
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0160066

The World Health Organization (WHO) is currently updating the tenth version of their diagnostic tool, the International Classification of Diseases (ICD, WHO, 1992). Changes have been proposed for the diagnosis of Transsexualism (ICD-10) with regard to terminology, placement and content. The aim of this study was to gather the opinions of transgender individuals (and their relatives/partners) and clinicians in the Netherlands, Flanders (Belgium) and the United Kingdom regarding the proposed changes and the clinical applicability and utility of the ICD-11 criteria of 'Gender Incongruence of Adolescence and Adulthood' (GIAA). A total of 628 participants were included in the study: 284 from the Netherlands (45.2%), 8 from Flanders (Belgium) (1.3%), and 336 (53.5%) from the UK. Most participants were transgender people (or their partners/relatives) (n = 522), 89 participants were healthcare providers (HCPs) and 17 were both healthcare providers and (partners/relatives of) transgender people. Participants completed an online survey developed for this study. Most participants were in favor of the proposed diagnostic term of 'Gender Incongruence' and thought that this was an improvement on the ICD-10 diagnostic term of 'Transsexualism'. Placement in a separate chapter dealing with Sexual- and Gender-related Health or as a Z-code was preferred by many and only a small number of participants stated that this diagnosis should be excluded from the ICD-11. In the UK, most transgender participants thought there should be a diagnosis related to being trans. However, if it were to be removed from the chapter on "psychiatric disorders", many transgender respondents indicated that they would prefer it to be removed from the ICD in its entirety. There were no large differences between the responses of the transgender participants (or their partners and relatives) and HCPs. HCPs were generally positive about the GIAA diagnosis; most thought the diagnosis was clearly defined and easy to use in their practice or work. The duration of gender incongruence (several months) was seen by many as too short and required a clearer definition. If the new diagnostic term of GIAA is retained, it should not be stigmatizing to individuals. Moving this diagnosis away from the mental and behavioral chapter was generally supported. Access to healthcare was one area where retaining a diagnosis seemed to be of benefit.