Gender Dysphoria is no longer considered a mental illness in the ICD-11 - a long-awaited decision finally made in the right direction.
We need to first understand what “gender identity” means in psychology. It refers to one’s psychological sense of one’s gender. Now the term “transgender” refers to a person whose sex assigned at birth does not match their gender identity. It is important to note that gender identity is very different from sexual orientation, which focuses on the types of people one is sexually attracted to.
Some of the people who are transgender - not necessarily all - will experience “gender dysphoria”, which has been defined by the DSM-5 (Diagnostic Statistical Manual that is used to diagnose mental illnesses) as, “the marked incongruence between one’s experienced/expressed gender and their assigned gender, lasting at least 6 months for adolescents and adults”. The ICD-10 (International Classification of Disease formulated by WHO) also recognised gender dysphoria as a mental illness but named it gender identity disorder (GID). Although this distress often begins in childhood, some may not experience it until puberty or later. In contrast, some transgender people may even feel at ease with their bodies, either before or after medical intervention.
Gender dysphoria can affect many aspects of one’s life. Adolescents experiencing gender dysphoria may refuse to go to school due to the pressure of fitting into the stereotypical standards of their sex. For instance, dressing according to their known sex and hiding their gender identity due to fears of harassment. It can also result in dropping out of school, unemployment, and problems with building relationships. Psychological problems like anxiety, depression, self-harm, suicidal attempts, eating disorders, substance abuse, and other complications are also associated with gender dysphoria.
On a larger scale, transgender people often experience discrimination and restricted access to health care and mental health services, which can be strenuous due to the stigma surrounding the condition and the lack of experienced providers.
The American Psychiatric Association noted that “clinically significant distress” is the key element of the diagnosis. However, it was debated by several psychologists that this distress was not inherent in the cross-gender identity. Rather, it is related to the exclusion and discrimination that transgender people experience as they are ostracised from society. Hence, the symptoms seemed to be largely produced by external forces rather than internal.
Upon this reflection, the World Health Organization decided in May 2019 that gender identity disorder will no longer be categorized as a mental illness.
Dr Lale Say, a reproductive health expert at the World Health Organization, stated, "we had a better understanding that this was not actually a mental health condition, and leaving it there (in ICD-10) was causing stigma.”
This instance is reminiscent of the time homosexuality was removed from the ICD in 1990 because they recognized that there is no evidence proving that it needed to be medically cured.
Several interviews with transgender people from Japan, Ukraine, and Indonesia showcase that they are hesitant to undergo the process of legal recognition because it requires them to get a diagnosis of having a mental disorder from a psychiatrist. It doesn’t align with their beliefs because they believe that gender identity isn’t something that needs a diagnosis.
However, if gender identity disorder is no longer considered an illness, insurance companies would refuse to cover the cost of treatments and transgender surgery like hormone therapy and sex reassignment therapy as it may come to be viewed as a cosmetic treatment rather than a medically necessary one.
Dr Lale said, “In order to reduce the stigma, while also ensuring access to necessary health interventions, it was placed in a different chapter.” Therefore, ICD-11 renamed GID as Gender Incongruence and placed it under the “Conditions Related to Sexual Health” chapter. This inclusion of gender incongruence in the latest edition of ICD ensures that transgender people have access to health care with insurance coverage for their treatments, all the while removing the label of “disease” or “illness” that is otherwise immediately engraved on their faces. This is a huge advancement in the field of psychology and progress for the transgender community as the medical industry will now focus on resolving the distress that arises from being cross-gender, rather than “fixing a disorder”. People will come to view transgender people as simply different, rather than diseased.
Although this is a huge win for the transgender community, it is still a flawed stepping-stone. Gender incongruence is far more complex and revolves around several social, biological, and psychological factors for it to be over-simplified and placed into the sexual health category of the ICD-11.
Healthcare still largely remains inaccessible and while this sparks up an important conversation about the trans community, there needs to be attitudinal education to urge people to change their mindsets and become more inclusive and accepting.
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