1. 6th European Transgender Council 2016 - Bologna
The ICD is making me sick! Putting an end to forced mental health diagnoses for trans* people
Griet De Cuypere
Psychiatrist-Psychotherapist
WPATH Board Member
EPATH Board Member

2. Cis gender, heterosexual woman
Psychiatrist: people like other people
Psychotherapist: family- and systemic therapist, avoiding labeling for adolescents (circularity, development)
30 years of working with trans*people
WPATH – Board member – co-chair of the WPATH ICD meeting (in 2013)
EPATH – Board member (liason between EPATH and WPATH)
Reviewer for the Working Group on the Classification of Sexual Disorders and Sexual Health
→minority, please don’t stigmatize or marginalize me 

3. t WPATH – ICD meeting February 3 – 4, 2013
Co-Chairs: Gail Knudson – Griet De Cuypere
February 3 – 4, 2013

4. Aim of the meeting
Discuss current WHO proposals (made by the Working Group on Sexual Disorders and Sexual Health) for relevant ICD-11 revisions
Deletion of the ICD-10 F66 diagnoses
Deletion of the ICD-10 F65 diagnosis: Fetishistic Transvestism
being one of the several recommended deletions in F65
ICD- 10 F64 Block: Gender Identity Disorders
Gender Incongruence: new name
moving GI from the Mental and Behavioral Disorders Chapter
alternative placement options
Deletion or retention of the ICD-10 GI diagnosis in Childhood
ICD-11 Content forms for GI AA – GI C
Get to a WPATH consensus position on all of the proposed relevant ICD changes

6. Block F66 : Psychological and Behavioural Disorders Associated with Sexual Development and Orientation
F66.0: Sexual maturation disorder
(uncertainty about SOGI, leading to distress)
F66.1: Ego-dystonic sexual orientation
(discomfort about one’s SOGI, leading to desire to change it)
F66.2: Sexual relationship disorder
(SOGI responsible for difficulty in forming/maintaining relationships)
F66.8: Other psychosexual development disorders
F66.9: Psychosexual development disorder, unspecified
Unanimity for deletion (current proposal)

7. ICD-10 F65 diagnosis: Fetishistic Transvestism Pro’s to retain:
can be distressing to themselves and/or partners also negatively affecting social/professional relationships
In absence of distress: substantial personal risk to their careers and to their safety
Other possibility: Obsessive Compulsive disorder or Impulse Control Disorder (with sexually motivated cross-dressing)
Con’s to retain:
Removal on the basis of social stigma and discrimination
Depathologizing consensual or solitary behaviour
Dysfunctional cross-dressers are seldom seen
Outcome of voting on the diagnosis: Deletion 23 (current proposal)
Retention: 4; Abstention: 2

8. Concerning Block F64 : Gender Identity Disorders
F64.0 Transsexualism
Desire to live and be accepted, usually discomfort with anatomy plus desire to change it.
F64.1 Dual-role transvestism
Wearing clothes, temporary role, no desire for permanent change, no sexual excitement
F64.2 Gender identity disorder of childhood
Distress re current assigned sex, insistence/desire re actual sex, matching gender expression.
F64.8 Other gender identity disorders
F64.9 Gender identity disorder, unspecified
Outcome of voting: Removal GID from Ch. 5 (Mental & Behavioural disorders): 27, Retention; 1, Abstention: = current proposal
Rationale for removing: elimination of the psychiatric stigmatization of transgender people – but still access to treatment

9. WPATH ICD Consensus Meeting: Decisions:
Vote on placement and naming chapter as:
Chapter “Sex and Gender”: 19
Chapter: “Gender”: 9;
Abstain: 1.
Conflation of Sex and Gender can be problematic
Current proposal: Conditions related to Sexual Health
Vote on the name “gender incongruence” proposed by the working group: different reactions, suggestions….. New name suggested: “gender/body divergence”.
Current proposal: Gender Incongruence in Adolescence and Adulthood

10. Gender Incongruence of childhood: risks of a diagnosis are discussed – vivid discussion reflected in the voting:
Removal: 14
Retention: 14
Absence: 1

11. WPATH-membership survey (submitted Archives of Sex Behavior)
WPATH is the largest association of professionals in transgender health
Growing number working with children
WPATH want to have a better view of their membership’s ideas on how ICD- 11 should be structured and implemented concerning GI.
WPATH would like to take a second look at the GIC proposal

12. Results
From where?

13. Results
Do you think a disease diagnosis gender incongruence of childhood should be included in ICD-11? N %
Yes
115 48 No
123 51
Blank 3 1

14. Results
Distribution of respondents supporting and opposing the GIC proposal according to the region in which they work
Support
Oppose
N=115 %
N=123
P-value
US - members 89
53.6 77
46.4
.352
Non US-members 26
36.1 46
63.9
.017

15. Results
Distribution of respondents’ views on Z-codes, according to their views on a GIC diagnosis
Support Z Codes
Reject Z Codes N %
P-value
Support GIC 26
22.6 14
12.2
.057
Oppose GIC 60
48.8 5
4.1
<.000

16. “The gender incongruence of childhood” diagnosis revisited: a statement from clinicians and researchers (1)
Regardless of where in ICD-11 the proposed GIC-diagnosis is placed
It pathologises the experiences of young children below the age of puberty who are exploring their identity ( in a number of cultures worldwide: gender diversity)
Many children who express pronounced convictions regarding GI, with supportive families, do not display any level of distress
Different approach with F66 diagnoses (parallel developmental processes linked to sexual orientation)
Alternative: Z-code approach (non-pathologising codes in Chapter 21), similar as for people experiencing discrimination on grounds of their sexual orientation

17. “The gender incongruence of childhood” diagnosis revisited: a statement from clinicians and researchers (2)
Regardless of where in ICD-11 the proposed GIC-diagnosis is placed
GATE proposals: are for facilitating healthcare for gender diverse children below the age of puberty through the use of Z-codes (access to supportive counselling and information services, medical examinations linked to approaching puberty) – in case of distress, these Z-codes could be used as markers attached to generic diagnoses
Arguments for GIC diagnosis (training – research) appear flawed
Key transgender health and rights organisations worldwide have spoken out against this proposal – European Parliament called on the European Commission to “intensify efforts to prevent gender variance in childhood from becoming a new ICD diagnosis”.

18. “The gender incongruence of childhood” diagnosis revisited: a statement from clinicians and researchers (3)
127 signatures from researchers and clinicians
1464 working years in transhealth and rights
825 years of clinical work

19. “The gender incongruence of childhood” diagnosis revisited: a statement from clinicians and researchers (4)
Taking into account all the above:
“We call on WHO to abandon the proposed GIC diagnosis and incorporate the use of Z Codes as a means of facilitating and guiding support for gender diverse children below the age of puberty”.