Icd-11 pdf download

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The ICD maintenance process allows the continuous adaptation of the ICD following the evolution in the understanding of diseases, treatments, and prevention. Most healthcare providers from the UK Positioning of the Diagnosis. Of all response options available, when asked where should the diagnosis go if removed from the mental health chapter, the most frequently selected option by transgender participants was that it should also be removed from the ICD completely Nearly a quarter of the partici- pants had no opinion Among healthcare providers, there was mainly support for the retention of the GIC diagnosis Respondents were asked what they thought of the statement that gender incongruence among children is a psychiatric disorder on a seven point scale from strongly agree 1 to strongly disagree 7.

Frequency Table and Percentage of Column of Responses of Transgender Participants to the Question: In what chapter of the ICD do you think the diagnosis of gender incongruence for children should be included? In line with the results of the transgender participants, the majority of the HCPs When asked in which chapter participants thought a diagnosis of gender incongruence for children should be included, only 7. Over one-third of transgender participants See Table 3.

In the UK, the most frequently selected option of transgender participants was to include a gender incongruence diagnosis as a Z-code In line with the findings for the transgen- der participants, healthcare providers Stigmatization due to a diagnosis Just over a third Just over a third Frequency Table and Percentage of Column of Responses of Transgender Participants to the Question: Do you think that the proposed diagnosis for children will have a greater stigmatising effect i.

Some participants elaborated on this answer. It is a definition for the problems you are experiencing. So having a diagnosis will make people take you more seriously. Problem is until you have that diagnosis. Then everyone looks at you like your kid is only having a tantrum over an extra choco- late. Even if you are no longer experiencing gender incongruence in puberty. It will remain a stigma if we are not careful. Of the HCPs, just over half The most commonly selected response, by a narrow margin, Yet, The others had no opinion In line with the findings for the transgender partici- pants, most healthcare providers Frequency Table and Percentage of Column of Responses of Transgender Participants to the Question: Do you think that a child with gender-incongruent feelings needs gender identity care?

Slightly more TG participants Of the HCPs, Removal distress and impairment criterion Most TG participants combining response options 3 and 4: Most NL In line with the findings for the transgender participants, most healthcare providers UK only - 16 5. Leaving out the HCPs to whom the question was not applicable who did not see children , The responses to this question did not differ statistically between the countries only people to whom the ques- tion was applicable were included.

Half of the HCPs There were no statistically significant differences between the countries. Furthermore, regarding the duration criterion of 2 years, The highest percentage of HCPs No differ- ences were found between the countries.

Of the Dutch HCPs, Table 8. A large number of participants were recruited from the Nether- lands and the United Kingdom and stakeholders from various backgrounds were represented in the sample, including transgender participants, parents of children with gender incongruent feelings, healthcare providers some specialized in transgender health care, others who were not , and individuals who fit more than one category.

Healthcare providers were mostly in favour of retaining the GIC diagnosis within the ICD, although about a quarter of them preferred to remove it in its entirety. This study found more support of healthcare providers for retaining the GIC diag- nosis in ICD, compared to earlier surveys amongst WPATH members all specialized in transgender healthcare where no consensus was reached [6,11], although it should be noted that the samples differed as our sample consisted of healthcare providers both specialized and not-specialized in transgender healthcare.

Most participants from the UK thought that a psy- chiatric diagnosis for gender incongruence could not have a beneficial effect for children and a smaller, but substantial, group disagreed. In other words, their responses might have been based on the idea that if the diagnosis is retained, where they thought the best placement option would be.

Respondents may have also selected the option of leaving the diagnosis within the ICD as they may see having a diag- nosis as the only option for accessing clinical services. On the other hand, participants may ini- tially have favoured removal of the diagnosis first question , but—after seeing the various placement options in the second question—they may have considered the removal unneces- sary and concluded that one of the chapters was an appropriate place for the GIC diagnosis.

Most transgender participants and stakeholders thought the term Gender Identity Disorder should change, and most thought Gender Incongruence was an improvement. Furthermore, most participants reported that they did not consider Gender Incongruence to be a psychiatric disorder or condition and therefore placement in a separate chapter dealing with Gender and Sexual Health the majority response in the Netherlands and in the TG group or as a Z-code the majority response in the UK would be preferable.

The differences between the countries can be at least partially explained by the differences in healthcare sys- tems described in the introduction of this paper. Therefore, this option might be less popular in the Netherlands than in the United Kingdom, where a Z-code is preferable and access to care is unaffected by this change in placement. This shows that recognition of the context of existing healthcare systems within which questions are being answered is important.

However, it was seen as an improvement by Furthermore, in relation to stigma, most transgender participants did not think it was more stigmatizing for children to receive a GI diagnosis than for adolescents or adults. However, this does not indicate the GIC diagnosis itself is not stigmatizing. Most participants thought that a child with gender incongruent feelings needs gender iden- tity related care. This finding at first sight speaks against the argument that a diagnosis is not needed because medical treatment for gender incongruence is not available for prepubertal children e.

It is likely that support and psychological input is seen by participants as useful for children with GIC and their families. Whether or not this type of psychological care is reimbursed, differs across countries and healthcare systems. Although generally, the results from healthcare providers were in line with the results from the transgender participants and stakeholders some differences were found.

While most healthcare providers from the UK thought having a psychiatric diagnosis for gender incongru- ence could have a beneficial effect for children, most transgender participants from the UK disagreed. Interpretation is difficult since the sample size of the healthcare providers from the UK was small. Another difference between the participant groups was that most HCPs thought the stricter GIC criteria to be an improvement, while most TG participants did not.

It is inter- esting that the TG participants have this opinion, as stricter criteria imply that fewer children with gender incongruence will have a diagnosis and that fewer children would experience the potential stigmatizing effects of having a diagnosis. Yet TG participants did not support the stricter criteria and seemed to favour a diagnosis that would include more rather than fewer children.

It may well be that these participants, like many in other quarters, struggle with the balance between avoiding stigma and access to appropriate care. Overall, healthcare providers thought: 1 the GIC criteria were easy to use in their clinic; 2 it was not difficult to determine whether the duration criterion of experiencing two years of gen- der incongruence was fulfilled; and 3 the distinction between slight gender variance and a sit- uation in which the criteria for the diagnosis have been met could be determined properly for children.

One aspect of the proposed GIC diagnosis was seen as more challenging to determine compared to the ICD criteria: most Dutch HCPs thought the fact that children no longer have to express or verbalize GI feelings in the proposed ICD made the criteria more diffi- cult to use than if it were required that they have done so. This suggests that most HCPs are not worried about losing access to care for chil- dren with GI feelings as a result of there not being a diagnosis in ICD However, some HCPs noted that they could continue to help children only if they could make a concurrent diagnosis e.

One possibility to ensure access to care is for HCPs to use deliberate misdiagnosis for example, to give a child with gender incongruent feelings a diag- nosis of anxiety.

This practice of deliberate misdiagnosis is quite common amongst mental health professionals [18,19]. Classification systems and diagnoses were developed as a means of order- ing information, grouping phenomena and providing a language by which to communicate with other clinicians, researchers and patients and their families.

It is widely agreed that diag- nostic criteria should, whenever possible, be based on aetiology. However this is not always possible. For a researcher a diagnosis might be useful in order to study different phenomena. Without it, it can make research more complicated, but not impossible. Because of this, clinical academics may value retaining some kind of diagnosis as part of the classification system.

Transgender people may view things differently. For many years, the psychopathologisation of transgender people has been linked to its categorization as a psychiatric diagnosis.

Transgen- der people have suffered for many years the discrimination and stigmatisation of being consid- ered psychiatric patients by clinicians and wider society.

Unsurprisingly for transgender people a diagnosis may always be linked to stigma and removing it all together makes sense. They may argue that if gay and lesbian people are no longer considered part of a classification system, why then should transgender people be.

For parents of young people with gender incongruence a diagnosis may be linked to support and advice. Many parents with a child with gender incongruence may feel isolated and lost. For those parents having somewhere to attend in order to discuss their distress and concerns is vital. If health services are organised in a way that a diagnosis is necessary for access, for parents a diagnosis will be linked to support and help.

Parents may suggest keeping a diagnosis in order to have access to services, but is this the right reason to keep a diagnosis? This survey did not include one of the most difficult questions to answer: what does a diagnosis mean to you? Future researchers may want to consider this, as it may help to interpret their findings. Limitations Next to the limitations mentioned above regarding the possible influence of the order of response options, wording of the questions and the low response rate.

There are some addi- tional points to consider also. First, the majority of the transgender participants were individu- als who intended to receive, were receiving, or had received gender identity care see S3 Text. This group may be less opposed to GI diagnoses in ICD since they receive d reimbursed medical treatment made possible in the NL at least through a diagnostic code. In other words, people who want to receive, have received, or are receiving medical care are benefitting from the presence of a diagnosis because they are eligible for reimbursed health care.

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