From disorder to dysphoria,but where to next?

ICD Insights

Reform of established categories describing transgender and gender-nonconforming individuals appear likely with the upcoming release of the 11th Revision of the International Classification of Diseases (ICD). Transsexualism was considered a Gender Identity Disorder and classified as a Mental and Behavioral Disorder in ICD-10. The term ‘Gender Incongruence’ has since been proposed, under the chapter of Conditions Related to Sexual Health in the Beta Draft of ICD-11 (World Health Organization [WHO], 2012). The removal of transsexualism from the Mental and Behavioral Disorder chapter and omission of utilizing disorder linguistically represent a paradigm shift towards acceptance and echo recommendations made by the WHO’s (2013) Executive Board session in 2013. Similarly, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) has removed the term Gender Identity Disorder, while introducing the category of Gender Dysphoria with an emphasis on distress over a marked incongruence between one’s experienced gender and assigned gender (American Psychiatric Association, 2013).

Previous psychopathological models implied a disordered, damaged individual requiring treatment, whereas reclassified terms refer to the mental state of being transgendered within society. Distress is no longer considered inherent with transsexualism, with recognition that transgender individuals can be psychologically healthy. Similar to the shift in attitude towards homosexuality, removal of homosexuality as a mental disorder in 1973 formed a keystone in ameliorating stigma and dissipating the impetus for therapy and institutionalization.

Changes in the stance of governing bodies should be applauded. However, mere reconceptualization of transsexualism highlights the laborious and insufficient progress in recent years. Transsexualism has not featured as an agenda item in the WHO Executive Board session since 2013, and has since been repetitively deferred. Yet, transgender individuals are at greater risk of communicable diseases, mental health disorders, violence, poorer health outcomes and greater barriers to health care. Reparative therapy of transsexualism remains a core treatment in many Member States (WHO, 2013).

Much more is required to ensure principles of health equality, medical ethics and international human rights perpetuate globally for transgender individuals. This correspondence calls for global health leaders to continue the instigated shift and to address system-wide changes on transsexualism in medical education, cultural acceptance and legislative policies in the next WHO Executive Board session. The move from disorder to dysphoria, from disorder to incongruence represents successful global leadership in paving acceptance and facilitates taking the transgender community out of the mental health milieu.