Volume 1 - Tabular List List of three-character categories Disorders of adult personality and behaviour (F60-F69)F60 Specific personality disorders F61 Mixed and other personality disorders F62 Enduring personality changes, not attributable to brain damage and disease F63 Habit and impulse disorders F64 Gender identity disordersF65 Disorders of sexual preference F66 Psychological and behavioural disorders associated with sexual development and orientation F68 Other disorders of adult personality and behaviour F69 Unspecified disorder of adult personality and behaviour ..... Persons encountering health services in other circumstances (Z70-Z767)Z70 Counselling related to sexual attitude, behaviour and orientation Z71 Persons encountering health services for other counselling and medical advice, not elsewhere classified Z72 Problems related to lifestyle Z73 Problems related to life-management difficulty Z74 Problems related to care-provider dependency Z75 Problems related to medical facilities and other health care Z76 Persons encountering health services in other circumstances Z77 Gender incongruence
Tabular list of inclusions and four-character subcategories F64 Gender identity disorders
F64.0 Transsexualism
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.
F64.1 Dual-role transvestism
The wearing of clothes of the opposite sex for part of the individual's existence, in order to enjoy the temporary experience of membership of the opposite sex, but without any desire for a more permanent sex change or associated surgical reassignment, and without sexual excitement accompanying the cross-dressing.
Gender identity disorder of adolescence or adulthood, nontranssexual type
Excl.: fetishistic transvestism (F65.1)
F64.2 Gender identity disorder of childhood
A disorder, usually first manifest during early childhood (and always well before puberty), characterized by a persistent and intense distress about assigned sex, together with a desire to be (or insistence that one is) of the other sex. There is a persistent preoccupation with the dress and activities of the opposite sex and repudiation of the individual's own sex. The diagnosis requires a profound disturbance of the normal gender identity; mere tomboyishness in girls or girlish behaviour in boys is not sufficient. Gender identity disorders in individuals who have reached or are entering puberty should not be classified here but in F66.-.
Excl.: egodystonic sexual orientation (F66.1)
sexual maturation disorder (F66.0)
F64.8 Other gender identity disorders
F64.9 Gender identity disorder, unspecified
Gender-role disorder NOS F93.8 Other childhood emotional disorders Identity disorder Overanxious disorder Excl.: gender identity disorder of childhood ( F64.2Z77.1) ... Chapter XXI
Factors influencing health status and contact with health services (Z00-Z99) ... Persons encountering health services in other circumstances (Z70-Z767)
...
Z76.9 Person encountering health services in unspecified circumstances
Z77 Gender incongruence
Gender incongruence is characterized by a marked and persistent incongruence between an individual’s experienced gender and the assigned sex. Gender variant behaviour and preferences alone are not a basis for assigning the diagnoses in this group.
Z77.0 Gender incongruence of adolescence and adulthood Gender incongruence of adolescence and adulthood is characterized by 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. The diagnosis cannot be assigned prior the onset of puberty. Gender variant behaviour and preferences alone are not a basis for assigning the diagnosis.Gender identity disorder of adolescence or adulthood, nontranssexual typeExcl.: fetishistic transvestism (F65.1) Z77.1 Gender incongruence of childhoodGender incongruence of childhood is characterized by a marked incongruence between an individual’s experienced/expressed gender and the assigned sex in pre-pubertal children. It includes a strong desire to be a different gender than the assigned sex; a strong dislike on the child’s part of his or her sexual anatomy or anticipated secondary sex characteristics and/or a strong desire for the primary and/or anticipated secondary sex characteristics that match the experienced gender; and make-believe or fantasy play, toys, games, or activities and playmates that are typical of the experienced gender rather than the assigned sex. The incongruence must have persisted for about 2 years, and cannot be diagnosed before age 5. Gender variant behaviour and preferences alone are not a basis for assigning the diagnosis.
Excl.: egodystonic sexual orientation (F66.1)
sexual maturation disorder (F66.0)
Z77.8 Other specified gender incongruence
Z77.9 Gender incongruence, unspecified
Volume 3 - Alphabetical Index
Deviation
...
- sexual F65.9...
- - transvestism F64.1Z77.0
Disorder (of) - see also Disease
... – gender-identity or -role F64.9Z77.9– – childhood F64.2Z77.1
– – effect on relationship F66.2 – – egodystonic F66.1 – – of adolescence or adulthood (nontranssexual)F64.1Z77.0
– – specified NEC F64.8Z77.8 – – uncertainty F66.0 ..... – psychosexual F65.9 – – development F66.9 – – – specified NEC F66.8 –– identity, of childhood F64.2Z77.1
Dysphonia R49.0 – functional F44.4 – hysterical F44.4 – psychogenic F44.4 – spastica J38.3 Dysphoria, gender in children Z77.1
Dyspituitarism E23.3
Gemistocytoma – specified site - see Neoplasm, malignant
– unspecified site C71.9
Gender incongruence Z77.9 – adolescence Z77.0
– adulthood Z77.0
– childhood Z77.1 General, generalized - see condition
Psychosexual identity disorder of childhood F64.2Z77.1
Transsexualism F64.0Z77.0
Transvestism, transvestitism (dual-role)F64.1Z77.0
– fetishistic F65.1
|
|
Current categories in the chapter 5 need to be removed and reinstated with edits as a new category Z77.
Gender incongruence coded in the section on behavioural conditions in the chapter on menatl and behavioural disorders was giving the wrong impression that gender incongruence is linked to mental health.
URC (Nov 15, 2016): this proposal was accepted in 2016
19 March 2017 WHO withdraws the proposal:Reactions against this proposal were addressed to WHO by:
- Global Action for Trans Equality (GATE)
- Grupo Cultura e Sexualidade (CuS)
- Akahata Equipo de Trabajo en Sexualidades y Generos
- Transgender Europe (TGEU)
- STP, International Campaign Stop Trans Pathologization
- International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA)
- Kyrgyz Indigo
- Trans*Coalition in the Post-Soviet Space
- Asia Pacific Transgender Network (APTN)
- Iranti-Org
Conversations were conducted with the different parties indicating the options for moving the relevant categories out of the chapter V of ICD-10, meaning to move the relevant entities to one of the following chapters:
1. Endocrine, nutritional, and metabolic diseases;
2. Diseases of the genitourinary system; or
3. Factors influencing health status and contact with health services.
It was further clarified that, although related, updates to ICD-10 are undertaken separately and distinctly from the process of revision leading towards ICD-11. Updates to ICD-10 can only be undertaken within the existing structure of ICD-10. Updates to ICD-10 are not linked to the revision process for developing ICD-11, nor do they influence the status of proposals for ICD-11. Moreover, any decisions proposed by the Update and Revision Committee to update ICD-10, only become valid with their publication.
The consultation process to date has shown broad agreement that, with regard to the categories related to gender incongruence, moving them out of the “F” Chapter can help to de-psychopathologize the conditions. Within the revision process for developing ICD-11, the proposed development of a new chapter of Conditions Related to Sexual Health provides a category in which the Gender Incongruence categories can be placed separately from mental health conditions, and conditions related to endocrine or urogenital diseases.
It was reiterated that the existing structure of ICD-10 does not allow the creation of this new chapter as part of any update to ICD-10, and that any change within ICD-10 at this stage does not have any impact on the proposal for a new chapter that was developed together for ICD-11. With the approval and release of ICD-11, the Gender Incongruence categories can be placed in the new chapter entitled Conditions Related to Sexual Health”.
Based upon multiple discussions and the feedback WHO has received from numerous stakeholders, it appears that none of these options can be considered favourably.
The decision of WHO, therefore, is to withdraw the proposed change to ICD-10; the update will not be published and the categories will remain within the chapter on Mental and Behavioural Disorders in ICD-10.This decision does not exclude submission of new proposals.