THE DIAGNOSIS OF transgender should be removed from its current classification as a mental illness, a new study says.
The study is the first field trial to evaluate a proposed change to the place of the diagnosis within the WHO International Classification of Diseases (ICD).
The research, published in The Lancet Psychiatry journal today and led by the National Institute of Psychiatry Ramón de le Fuente Muñiz, involved interviewing 250 transgender people and found that distress and dysfunction were more strongly predicted by experiences of social rejection and violence than by gender incongruence itself.
The study is the first of several field trials and is currently being replicated in Brazil, France, India, Lebanon and South Africa.
“Stigma associated with both mental disorder and transgender identity has contributed to the precarious legal status, human rights violations and barriers to appropriate care among transgender people,” says senior author Professor Geoffrey Reed, National Autonomous University of Mexico.
The definition of transgender identity as a mental disorder has been misused to justify denial of health care and contributed to the perception that transgender people must be treated by psychiatric specialists, creating barriers to health care services.
“The definition has even been misused by some governments to deny self-determination and decision-making authority to transgender people in matters ranging from changing legal documents to child custody and reproduction.”
However, it could be another two years until the classification is changed.
Transgender identity is currently classified as a mental disorder in both of the world’s main diagnostic manuals, the WHO’s ICD-10 and the American Psychiatric Association’s DSM-5.
A major component of the definition of mental disorders is that they are associated with distress and impairment in functioning.
The classification of transgender identity as a mental disorder is increasingly controversial and a WHO Working Group has recommended that transgender identity should no longer be classified as a mental disorder in ICD-11, but should instead come under a new chapter on conditions related to sexual health.
“Our findings support the idea that distress and dysfunction may be the result of stigmatisation and maltreatment, rather than integral aspects of transgender identity,” says lead investigator Dr Rebeca Robles, Mexican National Institute of Psychiatry.
The next step is to confirm this in further studies in different countries, ahead of the approval of the WHO revision to International Classification of Diseases in 2018.
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