Gender Incongruence of Adolescence and Adulthood: Acceptability and Clinical Utility of the World Health Organization’s Proposed ICD-11 Criteria

The World Health Organization (WHO) is currently updating the tenth version of their diagnostic tool, the International Classification of Diseases (ICD, WHO, 1992). Changes have been proposed for the diagnosis of Transsexualism (ICD-10) with regard to terminology, placement and content. The aim of this study was to gather the opinions of transgender individuals (and their relatives/partners) and clinicians in the Netherlands, Flanders (Belgium) and the United Kingdom regarding the proposed changes and the clinical applicability and utility of the ICD-11 criteria of ‘Gender Incongruence of Adolescence and Adulthood’ (GIAA). A total of 628 participants were included in the study: 284 from the Netherlands (45.2%), 8 from Flanders (Belgium) (1.3%), and 336 (53.5%) from the UK. Most participants were transgender people (or their partners/relatives) (n = 522), 89 participants were healthcare providers (HCPs) and 17 were both healthcare providers and (partners/relatives of) transgender people. Participants completed an online survey developed for this study. Most participants were in favor of the proposed diagnostic term of ‘Gender Incongruence’ and thought that this was an improvement on the ICD-10 diagnostic term of ‘Transsexualism’. Placement in a separate chapter dealing with Sexual- and Gender-related Health or as a Z-code was preferred by many and only a small number of participants stated that this diagnosis should be excluded from the ICD-11. In the UK, most transgender participants thought there should be a diagnosis related to being trans. However, if it were to be removed from the chapter on “psychiatric disorders”, many transgender respondents indicated that they would prefer it to be removed from the ICD in its entirety. There were no large differences between the responses of the transgender participants (or their partners and relatives) and HCPs. HCPs were generally positive about the GIAA diagnosis; most thought the diagnosis was clearly defined and easy to use in their practice or work. The duration of gender incongruence (several months) was seen by many as too short and required a clearer definition. If the new diagnostic term of GIAA is retained, it should not be stigmatizing to individuals. Moving this diagnosis away from the mental and behavioral chapter was generally supported. Access to healthcare was one area where retaining a diagnosis seemed to be of benefit.

世界卫生组织（World Health Organization, WHO）目前正在更新其诊断工具《国际疾病分类》（International Classification of Diseases, ICD，WHO, 1992）的第十版。针对术语、分类位置与内容，学界已提出针对《ICD-10》中"易性症（Transsexualism）"诊断标准的修改提案。本研究旨在收集荷兰、佛兰德斯（比利时）及英国的跨性别群体（及其亲属/伴侣）与临床医师对该修改提案，以及"青少年与成人性别不一致（Gender Incongruence of Adolescence and Adulthood, GIAA）"这一ICD-11诊断标准的临床适用性与实用价值的意见。本研究共纳入628名参与者：其中荷兰284人（45.2%）、比利时佛兰德斯地区8人（1.3%）、英国336人（53.5%）。绝大多数参与者为跨性别群体（或其伴侣/亲属，n=522），89名为医疗保健提供者（Healthcare Providers, HCPs），另有17名同时兼具医疗保健提供者与跨性别群体（伴侣/亲属）身份。参与者完成了为本研究开发的在线调查问卷。多数参与者支持提议的"性别不一致"诊断术语，并认为其相较于《ICD-10》中的"易性症"诊断术语有所改进。许多参与者倾向于将该诊断归类于专门的性与性别相关健康章节，或归类为Z编码，仅少数参与者认为该诊断应被排除在《ICD-11》之外。在英国，多数跨性别参与者认为应设立与跨性别身份相关的诊断类别；但若该诊断需从"精神障碍"章节中移除，许多跨性别受访者则倾向于将其完全从ICD中剔除。跨性别群体（及其伴侣与亲属）与医疗保健提供者的应答结果无显著差异。医疗保健提供者普遍对GIAA诊断持积极态度，多数人认为该诊断标准定义清晰，便于在临床工作中使用。许多参与者认为，性别不一致的持续时长（数月）标准过短，需进一步明确界定。若保留GIAA这一新诊断术语，应避免对个体造成污名化。将该诊断从精神与行为障碍章节中移出的提议普遍获得支持。保留该诊断在医疗保健可及性方面似乎存在益处。