6 General adult psychiatry6.5 Psychosexual health
6.5.2 Gender incongruence and legacy gender identity terminology
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Written by Resident Doctor Committee · Published
What ICD-11 changed
The International Classification of Diseases, 11th revision (ICD-11), replaced the ICD-10 gender identity disorders (F64).
Gender incongruence is the new name for this group, and it succeeds transsexualism.
ICD-11 moved the group out of mental and behavioural disorders into the chapter on conditions related to sexual health.
The World Health Organization keeps a health code so people can reach services without trans identity being classed as mental illness.
ICD-10 category | What it meant | ICD-11 position |
|---|---|---|
Transsexualism (F64.0) | Persistent wish to live as the opposite sex, with discomfort about anatomical sex | Gender incongruence of adolescence or adulthood |
Gender identity disorder of childhood (F64.2) | Persistent distress about assigned sex before puberty | Gender incongruence of childhood |
Dual-role transvestism (F64.1) | Temporary cross-gender presentation | Deleted |
Fetishistic transvestism (F65.1) | Cross-dressing with sexual arousal | Deleted |
ICD-11 also deleted egodystonic sexual orientation.
Paedophilia is retained with the paraphilic disorders in the mental disorders chapter.
ICD-11 gender incongruence
Category | Age | Requirement |
|---|---|---|
Of adolescence or adulthood | Not diagnosed before puberty | Marked, persistent difference between experienced gender and assigned sex |
Of childhood | Pre-pubertal child | Persistent mismatch between experienced gender and assigned sex for about two years |
Gender-variant dress, play or preferences alone do not meet the childhood category.
Distress is not required for either ICD-11 diagnosis.
Distress and associated needs
Gender incongruence does not require distress or impairment, and a transgender identity alone is not a mental disorder.
Assess distress, depression, anxiety and safeguarding needs separately, without assuming that they follow from the identity itself.
Cross-dressing
Cross-dressing on its own is behaviour, not a disorder.
ICD-11 has no separate dual-role transvestism or fetishistic transvestism category.
An atypical arousal pattern involving solitary behaviour or consenting adults is considered a paraphilic disorder only when it causes marked distress beyond fear of rejection, or carries significant risk of injury or death.
An arousal pattern neither establishes nor excludes gender incongruence.
Minority stress and protection
Depression, anxiety and self-harm are recorded more often in young people with a gender incongruence diagnosis.
Affirmation of a transgender person's gender identity by others protects mental health and resilience.
Minority stress is added to by concealment, expected rejection, isolation, dead-naming and misgendering.