The World Health Organization (WHO) will no longer consider being transgender to be a mental illness. On Saturday, May 25, the member states of WHO voted to adopt revisions to the International Statistical Classification of Diseases and Related Health Problems (ICD) making for what will be the 11th revision (ICD-11). According to the WHO, the process of revision spanned more than a decade, and there are significant changes between ICD-11 and its predecessor, ICD-10.
What it meant to be transgender in ICD-10
While ICD-11 has many changes, one change is particularly significant for the transgender community. In ICD-10, there was an entire section dedicated to Gender Identity Disorders (F64). The Gender Identity Disorders section of ICD-10 included five possible diagnoses: transsexualism, dual-role transvestism, gender identity disorder of childhood, other gender identity disorders and gender identity disorder unspecified. Of these disorders, transsexualism is likely the disorder with which people are most familiar. ICD-10 defined transsexualism as, “A desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one’s anatomic sex, and a wish to have surgery and hormonal treatment to make one’s body as congruent as possible with one’s preferred sex.” To be clear, in ICD-10 transsexualism was considered to be a mental disorder and the above definition is tantamount to saying that being transgender is a mental illness.
What it means to be transgender in ICD-11
In ICD-11, there is no longer a Gender Identity Disorders section and identifying as transgender is no longer considered pathological in and of itself, nor is the desire to transition physically. The ICD-11 instead characterizes gender non-conformity as a sexual health condition which they refer to as Gender Incongruence. Within the Gender Incongruence section, there are three conditions noted: gender incongruence of adolescence or adulthood (HA60), gender incongruence of childhood (HA61) and gender incongruence unspecified (HA6Z). Gender incongruence of adolescence or adulthood can be viewed as replacing what was previously called transsexualism and is defined as, “… a marked and persistent incongruence between an individual´s experienced gender and the assigned sex, which often leads to a desire to ‘transition,’ in order to live and be accepted as a person of the experienced gender, through hormonal treatment, surgery or other health care services to make the individual´s body align, as much as desired and to the extent possible, with the experienced gender.”
Similar definition but different message
The definitions of transsexualism and gender incongruence of adolescence or adulthood do not differ a great deal at first glance, but it is not the outlining of their characteristics that set these two apart. Stated differently, it is not the definition of the terms as much as their strategic selection and placement within ICD-11 that is noteworthy. It’s not that what it means to be transgender has changed in any meaningful way as much as it is that being transgender is no longer being called a ‘disorder’ but is instead being called a ‘condition,’ one that might require medical intervention but is not inherently pathological. The WHO said it best, “Gender incongruence, meanwhile, has also been moved out of mental disorders in the ICD, into sexual health conditions. The rationale being that while evidence is now clear that it is not a mental disorder, and indeed classifying it in this can cause enormous stigma for people who are transgender, there remain significant health care needs that can best be met if the condition is coded under the ICD.”
The potential for positive impact
According to the WHO they currently have 194 member states and the member states have agreed to have the ICD-11 revisions go into effect on January 1, 2022. The decision to adopt these changes is very exciting news for the transgender community in that these changes have the potential to greatly reduce stigma and positively impact the provision of services for transgender individuals around the world.
Diversity & Inclusion I write about LGBTQ+ inclusion, equality, and the Pink Economy.