The World Health Organization has removed transgender from its category of mental disorders and put it under “sexual health conditions” to much praise, but “gender dysphoria” is in the Diagnostic and Statistical Manual of Mental Disorders (DSM) under the American Psychiatric Association.
The diagnosis of transgender people as having a mental disorder has traditionally served many agendas, most recently President Donald Trump’s signing of a new transgender military ban following the Department of Defence’s report entailing the “risks” of having some transgender people in the military.
But the step taken by the World Health Organization (WHO) on Monday to remove “transgender” from its mental disorder list may help destigmatize the transgender community on a global level.
In its revised International Classification of Diseases (ICD-11) — which was last endorsed in 1990 — WHO acknowledged that defining it as a disease adds to the stigmatization of transgender people, and has now been classified under “sexual health conditions.”
“The purpose of the move is that people need a diagnosis and a diagnosis code in order to access care for healthcare services whether that be through private insurance or a national healthcare system,” said Dr. Jack Drescher, a psychiatry professor at Columbia University who has worked on both the ICD-11 as well as DSM-5, to Oxygen.com.
“People need a diagnosis code to get care, so this allows people to have a code but it’s not a mental disorder code.”
But in the U.S., it still remains a mental disorder.
In 2013, the American Psychiatric Association moved transgender from its list of gender identity disorders to the category of “gender dysphoria,” which refers to a “emotional distress that can result from a marked incongruence between one’s experienced/expressed gender and assigned gender.
"Gender dysphoria" appearing at all in the DSM-V indicates that being transgender is still considered a mental disorder.
“The DSM only has mental disorder codes,” said Dr. Drescher, adding that DSM has kept the “diagnosis in order to keep a code that people needed to access care.”
The APA confirmed to Oxygen.com that an individual would only be diagnosed with gender dysphoria if they are "experiencing significant stress/distress," and that not every transgender person is living with mental illness.
"Gender nonconformity is not in itself a mental disorder," reads the APA fact sheet about its move from "gender identity disorder" to "gender dysphoria." The critical element of gender dysphoria, in its diagnosis, is the presence of clinically significant distress associated with the condition. Diagnostic terms ensure access to insurance coverage and thus facilitate clinical care.
Visibility of the Lesbian Gay Bisexual Transgender Queer (LGBT) community has increased overall in the U.S., contributing to a better treatment across the country, according to Sarah McBride, who is notably the first openly trans person to speak before a major party convention. She is currently the National Press Secretary at Human Rights Campaign (HRC).
“We consistently we see that overwhelming majority 60 - 75% of Americans support LGBTQ non-discrimination protection,” she said to Oxygen.com.
The HRC publishes an annual index measuring treatment of LGBTQ communities in cities and states across the U.S. The most recent index, published in 2017, noted an increase in the number of cities with “perfect score” rating system of LGBTQ inclusion in municipal law, policy and services. Some advocates have expressed their reservations about the HRC's corporate index, citing that it does not include access to trans-bathrooms.
“We also know that roughly 90% of Americans say they know LGBTQ people, and a growing percentage of Americans say they know someone who’s transgender. That number has gone from less than 10% a decade ago to 30-40% now,” said McBride, adding that the best indicator of support for LGBTQ equality stems from knowing someone from the community.
“And so, as more and more Americans get to know more LGBTQ people and particularly for transgender people, we know that the support for equality will only grow and harden.”
McBride also said WHO’s update is a significant step toward the safety and equality for the transgender community worldwide.
“This was the byproduct of work by allies in countries around the world. This clarification and affirmation reinforces here in the U.S. what the DSM did,” she said, adding that for trans people around the world, it affirms that being trans isn’t mental illness and that they deserve access to necessary medical care.
Dr. Drescher is hopeful that this move will lead to a change in American psychiatry.
“Since I knew what was going on with the World Health Organization, I have been informing the APA about it,” he said. “I hope it can be removed.”
[Photo: A transgender woman celebrates at the annual LA Pride Parade on June 10, in Los Angeles. By David McNew/Getty Images]