October 1st, 2016

WHO proposes removing transgender from diagnosis list

In recent years, society has witnessed a number of changes related to the transgender population that are leading, for the most part, to some semblance of acceptance. In July, the World Health Organization added its voice to the discussion when it proposed the declassification of transgender identity as a mental disorder in its next version of the International Classification of Diseases-11.

A study out of Columbia University lends support to the move.

Geoffrey M. Reed, Ph.D., professor in the department of psychiatry at Columbia University, conducted a study at a transgender health services clinic in Mexico City. He interviewed 250 patients and learned that some of them had experienced distress related to their gender identity as adolescents; however, approximately one-fifth had not felt rejection or discrimination.

Reed said that changing social views of transgender people might have set the stage for a larger discussion around the issue.

In 2011, the European Parliament passed a unanimous resolution asking WHO to remove transgender identity from the list of mental disorders and to ensure a “non-pathologizing reclassification,” according to Reed.

“So, while there has been very active discussion of several issues related to the WHO’s current proposal – where the category should go, what it should be called, how it should be defined, whether there should be a category for children – there has not been as much resistance as might have been expected to the idea of moving it out of the classification of mental disorders,” he said.

“Perhaps this makes intuitive sense to people, given that the main treatments, such as hormone maintenance treatment and surgeries, when these are desired, are not psychiatric or psychological treatments,” he said.

“Fundamentally, we hope that moving categories related to transgender identity out of the classification of mental disorders will help expand access to care and also improve the quality of care and the quality of training received by health professionals regarding this population.

Health outcomes in this population are very poor compared to the general population and our research supports the view that social rejection and violence are major factors,” said Reed.

“Most routine aspects of the health care of transgender people could be managed in non-specialist settings given appropriate training and less judgmental attitudes on the part of health professionals. Our study highlights the need for continuing laws as well as social policies and programs to reduce stigmatization and violence, as well as supporting the idea that transgender people do not have to receive services in specialized psychiatric settings, which are simply not available in many parts of the word.”

Reed pointed out that nearly half of the participants in this study who had used hormones did so without medical supervision of any kind, subjecting themselves to potentially serious health risks. Broader availability of such treatments in a range of health care settings, including primary care, could help reduce these risks and improve other health outcomes, he said.

Michelle Forcier, M.D., MPH, gender and sexual health services at Rhode Island Hospital, said there is greater recognition that “gender is better viewed as a developmental paradigm, not a psychiatric one.” Not all gender non-conforming people have a mental health component to gender diversity, although some do, she added.

The DSM-5 applies a diagnosis of “gender dysphoria” to only those transgender individuals who experience distress or dysfunction. Forcier agreed and said that gender dysphoria is an accurate diagnosis for those who do experience such difficulties. “But others are comfortable in their brain body regarding gender identity,” she added.

Gender identity is just one of many pieces that comprise every individual, according to Forcier. “No one snowflake is the same. You have to look at gender, not as a universal experience, but something unique to each person.”

The WHO’s revised volume is scheduled for approval in May 2018.

By Phyllis Hanlon

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