Gender incongruence of childhood in the ICD-11: controversies, proposal, and rationale
Abstract
As part of the development of the eleventh revision of the International Classification of Diseases (ICD-11), WHO appointed a Working Group on Sexual Disorders and Sexual Health to recommend changes necessary in the classification of mental and behavioural disorders in ICD-10 that are related to sexuality and gender identity. This Personal View focuses on the Working Group's proposals to include the diagnosis gender incongruence of childhood in ICD-11 and to move gender incongruence of childhood out of the mental and behavioural disorders chapter of ICD-11. We outline the history of ICD and DSM child gender diagnoses, expert consensus, knowledge gaps, and controversies related to the diagnosis and treatment of extremely gender-variant children. We argue that retaining the gender incongruence of childhood category is justified as a basis to structure clinical care and to ensure access to appropriate services for this vulnerable population, which provides opportunities for education and informed consent, the development of standards and pathways of care to help guide clinicians and family members, and a basis for future research efforts.
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There has been great concern that pre-pubertal children who only show gender-variant behaviour but have no gender identity-related problems would erroneously receive a diagnosis and be treated by clinicians and parents as future transgender adults.
“There has been great concern that pre-pubertal children who only show gender-variant behaviour but have no gender identity-related problems would erroneously receive a diagnosis and be treated by clinicians and parents as future transgender adults [133].”
From Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies (2020) · cites this paper as [133]
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Self-citation
- Authors
- Drescher, J., Cohen-Kettenis, P. T., & Reed, G. M.
- Affiliations
- New York Medical College (US)
- World Health Organization (CH)
- Corresponding author
- Drescher, Jack
- Venue
- The Lancet Psychiatry
- Publisher
- Elsevier BV
- Published
- 2016-03
- Volume
- 3
- Issue
- 3
- Pages
- 297-304
- ISSN
- 2215-0366 (ISSN-L)
- OpenAlex
- W2290312481
- Cited by
- 133
- References
- 47
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 13 · 2023: 27 · 2022: 9 · 2021: 8 · 2020: 15 · 2019: 14 · 2018: 13 · 2017: 17 · 2016: 9
- FWCI
- 2.75
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- World Health Organization
- Topics
- Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Sexual Differentiation and Disorders
- Social Sciences › Gender Studies › Gender Roles and Identity Studies
- Keywords
- ICD-11, ICD-10, gender variant children, informed consent, care pathways
- MeSH terms
- Gender Dysphoria, Child, Female, Gender Identity, Humans, Male, International Classification of Diseases
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