GATE Trans issues in the process of revision and reform of the International classification of diseases Pathologization Depathologization What it is What it is Why Why By whom ID: 637280
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Slide1
Mauro CabralGlobal Action for Trans* Equality(GATE)
Trans* issues in the process of revision and reform of the
International classification of diseases Slide2
Pathologization
Depathologization
What it
is?
What it
is?
Why?
Why?
By
whom?
By whom?
How?
How?
When?
When?
Pros & Cons
Pros &
Cons? Slide3
What does it mean to re-classify diagnostic categories?
Better definition
Updated language
Narrower criteria
Focus on medical necessity ÷
Improve clinical utility
Improve differential diagnoses ÷
Improve access to healthcare
Improve access to treatment Slide4
What reclassification does not mean
Getting
“cured”.
Loosing access to healthcare.
Changing your gender identity, gender expression and/or sexual orientation,
Not being able to consult with your regular physician,
Not getting access to mental health support. Slide5
ICD
DSM
Produced by an UN agency : WHO
Produced by a national association:
AºA
Free and open resource
Provides
revenue to APA
For
countries and health providers
For countries and psychiatrists
International
development
US dominated development
Approved by World Health Assembly
Approved by Board of Trustees
Ongoing : ICD-11
Done :
DSM V Slide6
ICD
DSM
Covers
all
health
conditions
Covers
only
mental
health conditions Slide7
ICD Revision and Reform Process
Mandated
by
World Health Assembly
(Health Ministers of all WHO Member Countries
)
ICD
-10 completed in 1990
; longest time without revision in history of
ICD
Covers
all areas
of diseases, disorders, and injuries, and health conditions; diagnostic standard for medicine and health
systems
ICD
revision
process involves
WHO-appointed expert Topic Advisory Groups, plus any international professional associations, scientific societies, disease-based groups; and civil society
organizations
Technical
work to be completed
2017
WHA
approval expected
2018Slide8
Revision Steering Group
World Health Assembly
Mental Health
Advisory Group (Chapters F, Z)
Sexual Disorders and Sexual Health Working Group
G-U & Rep Med Advisory
Group (Chapter N)
Internal Medicine Advisory Group (Chapter E)
Endocrinology Working Group
.
ICD Revision Political Structure
for Sexual Disorders and Sexual HealthSlide9
Chapter V. Mental and behavioural disorders
F00
-F09 Organic, including symptomatic, mental disorders
F10
-F19 Mental and
behavioural
disorders due to psychoactive substance
us
F20
-F29 Schizophrenia, schizotypal and delusional disorders
F30
-F39 Mood [affective] disorders
F40
-F48 Neurotic, stress-related and somatoform disorders
F50
-F59
Behavioural
syndromes associated with physiological disturbances and physical factors
F60-F69 Disorders of adult personality and behaviour F70-F79 Mental retardation
F80-F89 Disorders of psychological development F90-F98 Behavioural and emotional disorders with onset usually occurring in childhood and adolescence
F99-F99 Unspecified mental disorder Slide10
F60-F69 Disorders of adult personality and behaviour
F60
Specific personality disorders
F61
Mixed and other personality disorders
F62
Enduring personality changes, not attributable to brain damage and disease
F63
Habit and impulse disorders
F64
Gender identity disorders
F65
Disorders of sexual preference
F66
Psychological and
behavioural
disorders associated with sexual development and orientation
F68 Other disorders of adult personality and behaviour F69
Unspecified disorder of adult personality and behaviour Slide11
Trans-related categories in ICD-10
F64
. Gender identity disorders
F64.0
Transsexualism
F64.1 Dual-role
transvestism
F64.2 Gender identity disorder of childhood
F65. Disorders of sexual preference
F65.1 Fetishistic
transvestism
F66
Pyschological
and
behavioural
disorders associated with sexual development and orientation
F66.0 Sexual maturation disorderF66.1 Egodystonic sexual orientation
F66.2 Sexual relationship disorder Slide12
What it’s the problem with GID?
It’s insensitive to clinically relevant experiences (i.e., suffering
vs
happiness)
It
pathologizes
what people are (instead of diagnosing a problem that people *have*)
It has not exit clause
It’s culturally specific
It restricts access to healthcare and access to legal gender recognition
It’s definition reproduces and reinforce gender, expressive and bodily binaries.
It promotes forced institutionalization and conversion therapy (human rights violations)
It diminishes trans people’s autonomy and self determination Slide13
WHO Proposal (2012)
1. Delete F64, F65 and F66 codes
2. Introduce Gender incongruence
Gender incongruence of childhood
Gender incongruence in adolescence and adulthood
3. Move GI out
of mental and
behavioural
disorders
chapter (V, F codes) to a different chapter
Options:
Chapter IV on Endocrine Diseases (E Codes)
Chapter XIV on Genitourinary Diseases (N Codes)
Stand alone chapter
Chapter on Sexual Health Slide14Slide15
ICD 11 Beta
Chapter
05. Conditions related to sexual health
Sexual Dysfunctions
Gender Incongruence
5A30 Gender incongruence of adolescence and adulthood
5A31 Gender incongruence of childhood
Changes in female genital anatomy
Changes in male genital anatomy Slide16
Gender Incongruence
Gender
incongruence is characterized by a marked and persistent incongruence between an individual’s experienced gender and the assigned sex
.Slide17
GIAA
Gender
Incongruence of Adolescence and Adulthood
is characterized by a marked and persistent incongruence between an individual’s experienced gender and the assigned sex. The diagnosis cannot be assigned prior to the onset of puberty. Gender Incongruence of Adolescence and Adulthood
often leads to a desire to ‘transition’, in order to live and be accepted as a person of the experienced gender. Establishing congruence may include hormonal treatment, surgery or other health care services to make the individual’s body align, as much as desired and to the extent possible, with the experienced gender. Slide18
GIC
Gender
Incongruence of Childhood
is characterized by a marked incongruence between an individual’s experienced/expressed gender and the assigned sex in pre-pubertal children. Slide19
Challenges
Paradigmatic challenges:
sexual difference
Definitional challenges:
gender incongruence & the
pathologization
of gender expression / bodily diversity (to feel vs. to be perceived).
Cisexist
challenge: idealized congruence = health -> ‘compulsory’ transition / stigma, discrimination and violence
Political challenges:
chapter on sexual issues & LG(T)B(I)
Pathologization
-related challenges
: gender incongruence of childhood
Coverage challenges:
ICD
vs.
DSM Slide20
StrategiesInternational networking
( i.e., STP, GATE, TGEU)
Technical input
(i.e., ICD 11 Beta on line; submissions)
Visible Advocacy
(i.e., International Day of Action for Trans
Depathologization
).
Training and communications
Inter-movements alliances
Alliances with health providers / researches
Expert papers
(
i.e
, published on peer review journals)
Research
(i.e.
,
on national versions and uses of ICD; on bibliography). Official Statements on
Depathologization (i.e., Council of Europe, OAS). Legal Depathologization:
Argentina, Malta, Denmakr, Participation in regional and international meetings (i.e., WPATH, EPATH) Actively Monitoring the process (i.e., field tests). Slide21
Strategies Disaggregate the ICD revision and reform process from other forms of LGTB activism (i.e., at the UN Human Rights Council) to avoid backlash at WHO.