Gender identity disorder
Gender Identity Disorder (GIS, English gender identity disorder , short GID) is a psychological or medical diagnosis for those with the them not at birth assigned gender identification can. In differential diagnostics in Germany and many other countries, a distinction is made between transsexuality and gender identity disorder - as a psychiatric diagnosis according to the international classification ICD -10 (F64), which may be based on psychopathological abnormalities and diagnoses of a different nature. In the ICD-11 version , which must come into effect by January 2022 at the latest, the diagnosis has changed to “gender-specific deviation”: gender incongruence ( see below ).
Already in 2013 replaced the American Psychiatric Society (APA) in its manual DSM-5 diagnosis gender identity disorder by gender dysphoria ( "gender dysphoria "). According to the DSM, transgender people are not considered to be disturbed, as are non-binary or gender- fluid (gender nonconforming) or gay or lesbian people.
The World Association for Transgender Health (WPATH) pointed out as early as 2010 that a disorder or illness does not describe the person or his identity, but something that the person may have to struggle with. Transsexual, transgender and gender-nonconforming people are therefore not considered to be fundamentally disturbed. Rather, it is suffering from a possibly occurring gender dysphoria that can be diagnosed and treated.
Since "persistent gender dysphoria in childhood and adolescence is often associated with social exclusion and psychiatric comorbidities such as depression as well as self-harming and suicidal behavior", according to Annika Specht and her co-authors, "adequate care for those affected is extremely important".
The World Health Organization (WHO) lists the following definitions in the 10th version of its International Statistical Classification of Diseases and Related Health Problems (ICD-10, in force from 1994):
- In chapter F64 a distinction is made between: “Disorders of gender identity in childhood” (F64.2), “ Transsexualism ” (F64.0), “ Transvestism while maintaining both gender roles ” (F64.1) and “Other” (F64.8) and “Unspecified GIS” (F64.9). For GIS in childhood, the onset of symptoms is required well before puberty. The ICD-10 expressly points out that a mere deviation from cultural gender stereotypes (i.e. mere boyhood in girls or girlish behavior in boys) is not sufficient for this diagnosis. "Transsexualism" (F64.0) may only be diagnosed in adulthood.
- Transvestism while maintaining both gender roles (F64.1) must be distinguished from fetishistic transvestism (F65.1).
- Gender identity disorder in childhood (F64.2) must be distinguished from ego -dystonic sexual orientation (F66.1) and the sexual maturation crisis (F66.0).
In the 11th version of the ICD , the diagnosis “disorders of gender identity” was replaced by the specialist term “ gender incongruence ” as early as 2019 ; ICD-11 will not come into force until January 1, 2022. The diagnosis is not more than mental disorder classified, but as "a state form of sexual health " (condition of sexual health) . A distinction is made according to age :
- HA60: gender-specific deviation during puberty or adulthood (gender incongruence of adolescence or adulthood)
- HA61: gender incongruence of childhood
Criticism of the diagnosis
Some transsexual organizations such as the association Aktion Transsexualität und Menschenrecht criticize the term “gender identity disorder” as unscientific and as an unproven invention of psychoanalysis . His definition does not take into account the knowledge of science that neither sex chromosomes nor genitals of a person can make a clear statement about their gender; the concept of a disorder of gender identity , however, requires the existence of a "biological gender" from which the psyche of the person concerned deviates. Because the gender of a person is far more complex than psychoanalysis claims, the view of transsexual persons as people with the desire “to live and be recognized as belonging to the opposite sex” ( ICD -10: F64) is not a reality corresponding. Therefore, the designation is criticized as well as the associated evaluation of the gender identity of transsexual people as a mental disorder. Here some groups of affected persons see parallels to the pathologization of people with deviating sexual orientation up to the beginning of the 1970s as "sexually disoriented". In addition, the term gender identity disorder is the main trigger for worldwide transphobia, discrimination and human rights violations, in which many states would participate through corresponding legislation (e.g. the Federal Republic of Germany with its transsexual law introduced in 1980 ) by adopting unscientific gender clichés, indirectly or directly with terms how to link gender identity disorder or gender reassignment.
The Yogyakarta principles are cited, which say: "Contrary to other judgments, the sexual orientation and gender identity of a person in and of themselves [...] are not diseases and should therefore not be treated, cured or suppressed."
The interdisciplinary GIS special consultation (adolescent psychiatry, sexual medicine, pediatric endocrinology) set up at the Charité since 2007 diagnosed psychopathological abnormalities in all patients who presented by mid-2008 (aged five to 17 years; twelve male, nine female), which in many Cases led to the award of a further psychiatric diagnosis. As a rule, clear psychopathological abnormalities were also found in the parents. The background problem or “motive for change” among the young people was predominantly a rejected ( ego-dystonic ) homosexual orientation. The latter would have been stopped in their development by measures blocking puberty.
The psychological pathologization accompanying the diagnosis is criticized from the perspective of human rights by transgender people, transgender studies, queer feminism and interdisciplinary gender studies . In 2017, the Working Group on Sexual Disorders and Sexual Health in the World Health Organization (WHO ) worked towards depathologizing transgender people.
Areas that reject this classification
A decree of May 17, 2009 (“ International Day Against Homophobia, Interphobia and Transphobia ”) deleted gender identity disorders from French law. The services provided by the health system were retained. France was the first country to take this step.
The euro Council has called in its resolution 2048 of 22 April 2015 for the legal and social equality of trans people, the 47 member states, among other things, to cancel all classifications as mental disorders in national classifications. The European Parliament had already in 2011 European Commission and the World Health Organization asked to emphasize gender identity disorders from the list of mental and behavioral disorders, and (in the negotiations on the 11th revision of the International Classification of Diseases ICD-11 by 2018) a non-pathologizing Ensure reclassification.
Since January 1, 2017, transsexuality is no longer considered a mental illness in Denmark. Parliament considered this to be discriminatory. Gender reassignment measures will continue to be paid for by health insurance.
- Sophinette Becker: Transsexuality - Gender Identity Disorder . In: Götz Kockott, Eva-Maria Fahrner (Ed.): Sexual disorders . Thieme, Stuttgart / New York 2004, pp. 153–201 ( PDF: 462 kB, 64 pages at lsf-graz.at ( Memento from May 9, 2009 in the Internet Archive )).
- German Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy : S1 guideline: Disorders of gender identity in childhood and adolescence (F64). August 1, 2013 (valid until August 1, 2018; download page )
- Geoffrey M. Reed et al .: Disorders related to sexuality and gender identity in the ICD-11: revising the ICD-10 classification based on current scientific evidence, best clinical practices, and human rights considerations . In: World Psychiatry . tape 13 , no. 3 , October 2016, p. 205–221 , doi : 10.1002 / wps.20354 , PMC 5032510 (free full text) - (English).
- Hertha Richter-Appelt , Timo O. Nieder (Ed.): Transgender Health Care: An Annotated Edition of the Standards of Care of the World Professional Association for Transgender Health. Psychosozial, Giessen 2014, ISBN 978-3-8379-2424-4 (German edition of the Standards of Care 2012: PDF: 3.8 MB, 138 pages at wpath.org).
- Madeline H. Wyndzen: The Banality of Insensitivity: Portrayals of Transgenderism in Psychopathology. In: GenderPsychology.org. Private website, 2004 (English).
- American Psychiatric Association (APA): Transgender People, Gender Identity and Gender Expression. In: APA.org. 2020, section Is being transgender a mental disorder? , accessed on February 22, 2020 (English); Quote: "Many transgender people do not experience their gender as distressing or disabling, which implies that identifying as transgender does not constitute a mental disorder."
American Psychiatric Association (APA): What Is Gender Dysphoria? In: APA.org. Review by Ranna Parekh, February 2016, accessed February 22, 2020; Quote: "Gender dysphoria is not the same as gender nonconformity, which refers to behaviors not matching the gender norms or stereotypes of the gender assigned at birth. [...] Gender nonconformity is not a mental disorder. Gender dysphoria is also not the same being gay / lesbian. [...] Gender dysphoria - as a general descriptive term refers to an individual's discontent with the assigned gender. It is more specifically defined when used as a diagnosis. "
Overview page: Diagnostic and Statistical Manual of Mental Disorders (DSM – 5).
- Eli Coleman, W. Bockting a. a .: Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7. In: International Journal of Transgenderism. Volume 13, No. 4, August 2012, pp. 165-232, here p. 169 (English; doi: 10.1080 / 15532739.2011.700873 ).
- A. Specht, J. Gesing, R. Pfäffle, A. Kiess, A. Körner, W. Kiess: Gender dysphoria in childhood and adolescence . In: Pediatric and Adolescent Medicine . tape 17 , no. 3 , 2017, p. 170-176 , doi : 10.1055 / s-0038-1629413 .
- World Health Organization (WHO): F64: Gender Identity Disorders. ICD-10-WHO Version 2019. In: DIMDI.de . Status: August 24, 2018, accessed on February 22, 2020.
- World Health Organization (WHO): Gender incongruence. ICD-11 for Mortality and Morbidity Statistics (Version 04/2019). In: WHO.int. Retrieved February 22, 2020 (English).
- World Health Organization (WHO): HA60: Gender incongruence of adolescence or adulthood. ICD-11 for Mortality and Morbidity Statistics (Version 04/2019). In: WHO.int. Retrieved February 22, 2020 (English).
- World Health Organization (WHO): HA61: Gender incongruence of childhood. ICD-11 for Mortality and Morbidity Statistics (Version 04/2019). In: WHO.int. Retrieved February 22, 2020 (English).
- American Psychiatric Association : Homosexuality and Sexual Orientation Disturbance: Proposed Change in DSM-II, 6th Printing, page 44: Position statement (retired). APA document no. 730008, 1973, pp. ?? (English; PDF: 463 kB, 5 pages at mut23.de).
- Hirschfeld-Eddy Foundation (ed.): The Yogyakarta Principles: Principles for the application of human rights in relation to sexual orientation and gender identity (= series of the Hirschfeld Eddy Foundation. Volume 1, ). Berlin 2008, p. 28.
- Alexander Korte, David Goecker a. a .: Gender identity disorders in childhood and adolescence . In: Deutsches Ärzteblatt . tape 108 , no. 48 , October 2008, p. 834–841 , doi : 10.3238 / arztebl.2008.0834 ( online at aerzteblatt.de).
- Jonas A. Hamm, Arn Thorben Sauer: Change of perspective: Proposals for human rights and needs-oriented trans * health care . In: Journal for Sexual Research . tape 27 , no. 1 , January 2014, p. 4–30, here p. ?? , doi : 10.1055 / s-0034-1366140 .
- Verena Klein, Franziska Brunner a. a .: Diagnostic guidelines for sexual disorders in the International Classification of Diseases and Related Health Problems (ICD) -11 - Documentation of the revision process . In: Journal for Sexual Research . tape 28 , no. 4 , 2015, p. 363–373, here p. ?? , doi : 10.1055 / s-0041-109281 .
- Maïa de la Baume: Transsexualism No Longer Viewed as Mental Illness in France. In: The New York Times . February 12, 2010, accessed February 25, 2020 .
- Message: In France, transsexuality is no longer a mental disorder. In: ATME-ev.de. May 17, 2009, accessed February 25, 2020 .
- Council of Europe : Resolution 2048 (2015): Discrimination against transgender people in Europe. 2015 (English; PDF 158 kB, 2 pages on semantic-pace.net).
- Christina Laußmann: Council of Europe: Historical resolution for the rights of trans * people passed. In: Magazin.hiv . April 23, 2015, accessed February 25, 2020.
- European Parliament : Resolution of the European Parliament of December 12, 2012 on the situation of fundamental rights in the European Union (2010–2011) (2011/2069 (INI)). Sexual Orientation and Gender Identity Section , Recommendation No. 98. Retrieved February 25, 2020.
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