The World Health Organization is making the move to declassify transgender identity as a mental disorder on its international list of medical conditions, with a new study backing it up – a proposal that would remove the decades-old assignment.
The change in status, which has been approved by all committees that have considered it, is now under review for the next version of the WHO codebook, which classifies diseases and has a significant influence on patient treatment worldwide, the New York Times reports. The codebook is called the International Classification of Disease, or ICD.
Geoffrey Reed, a psychologist coordinating the mental health and behavior disorders part of the new codebook and professor at the National Autonomous University of Mexico, says,
The intention is to reduce barriers to care.
An author of the study, he said the proposal to take transgender off the mental disorder list was not being opposed by the WHO. This means it is likely to appear in a revised version of the ICD, the first in over 25 years, set for approval in May 2018.
Removing transgender identity from the mental health label would be a powerful message of acceptance, mental health professionals and transgender advocates say.
Dr. Michael First, professor of clinical psychiatry at Columbia University and the chief technical consultant to the updated IDC, says, “One of the benefits of moving it out of the mental disorder section is trying to reduce stigma.”
However, parts of the proposal are stirring up controversy, as transgender is not intended to be removed from the codebook altogether, but moved into a new category titled, ‘Conditions relatd to sexual health.”
The majority of advocates are in favor of keeping transgender in the IDC in some form, as the designation is widely used for medical billing and insurance coverage of services, as well as in research on treatments and disease. The question is where it should now be categorized.
Dr. Griet De Cuypere, board member of the World Professional Association for Transgender Health and a psychiatrist at the Center of Sexology and Gender at University Hospital in Ghent, Belgium, says, “I think there is a bit of a problem with the idea of putting it in a chapter on sexual health because it has nothing to do with sex.”
The proposal likewise changes the name from “transsexualism” to “gender incongruence,” a name chosen to reflect “a discrepancy between a person’s experienced gender identity and their body,” according to Reed, who was a part of the group that recommended the change.
The term has raised some concern, as “”incongruence” has different connotations across languages. While in English, it sounds neutral, in Spanish it sounds more psychotic, Reed explained. So in Spanish, the term would be “gender discordance,” which in English is negative.
Language differences are but a small part of the issue, and Reed says, “The terminology is difficult because nobody likes anything.” He adds, “One of the people at one of the meetings said we could call this happy unicorns dancing by the edge of the stream and there’d be an objection to it.”
Transgender identity has changed in the Diagnostic and Statistical Manual of Mental Disorders or DSM, the American handbook for psychiatric diagnoses. It went from “sexual deviations” in 1968, to “psychosexual disorders” in 1980 and “sexual and gender identity disorders” in 1994. In the most recent edition, it is “gender dysphoria,” and applies only to transgender individuals who are suffering from dysfunction or distress, according to Dr. Jack Drescher, who serves on the WHO working group and served on a similar working group for DSM.
Drescher, a psychiatrist and psychoanalyst at New York Medical College, says that e supported removing transgender from the DSM, but the ICD is different because it categorizes all diseases and conditions, and retaining a code for transgender is important for those receiving medical care. Inmates have received hormone therapy partly because transgender falls under a medical category, he says.
First adds to the observation, saying that he once received a call from the Internal Revenue Service asking him to support the agency’s move to challenge a tax deduction on a transgender woman for gender reassignment surgery. First declined, and points out that cases like that are going to increase without a diagnostic category.
For the study, Reed and his colleagues interviewed 250 patients at a Mexico City clinic providing transgender health services. They found that most had felt distress related to gender identity as teenagers, but a fifth did not have the same problem. Among those who felt distressed and experienced dysfunction were mostly due to how they were being treated as individuals – rejection or outright attack – and not because of their actual gender identity.
The study found that many transgender people had physical health problems stemming from having to live as a marginalized population, because their lives went on a “slope leading from stigma to sickness,” according to Cuypere, a co-author on an accompanying commentary to the study.
Similar studies are now being conducted across the globe. This study was published in Lancet Psychiatry.
