title: 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.
abstract: In the World Health Organization's forthcoming eleventh revision of the International Classification of Diseases and Related Health Problems (ICD-11), substantial changes have been proposed to the ICD-10 classification of mental and behavioural disorders related to sexuality and gender identity. These concern the following ICD-10 disorder groupings: F52 Sexual dysfunctions, not caused by organic disorder or disease; F64 Gender identity disorders; F65 Disorders of sexual preference; and F66 Psychological and behavioural disorders associated with sexual development and orientation. Changes have been proposed based on advances in research and clinical practice, and major shifts in social attitudes and in relevant policies, laws, and human rights standards. This paper describes the main recommended changes, the rationale and evidence considered, and important differences from the DSM-5. An integrated classification of sexual dysfunctions has been proposed for a new chapter on Conditions Related to Sexual Health, overcoming the mind/body separation that is inherent in ICD-10. Gender identity disorders in ICD-10 have been reconceptualized as Gender incongruence, and also proposed to be moved to the new chapter on sexual health. The proposed classification of Paraphilic disorders distinguishes between conditions that are relevant to public health and clinical psychopathology and those that merely reflect private behaviour. ICD-10 categories related to sexual orientation have been recommended for deletion from the ICD-11.
authors.affiliation: Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland.|School of Psychology, Universidad Nacional Autónoma de México, Mexico City, Mexico.
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Reed
authors.affiliation: Department of Psychiatry, New York Medical College, New York, NY, USA.
authors.forename: Jack
authors.initials: J
authors.lastname: Drescher
authors.affiliation: Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York State Psychiatric Institute and New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Krueger
authors.affiliation: Primary Care and Public Health Directorate, Ministry of Health, Manama, Bahrain.
authors.forename: Elham
authors.initials: E
authors.lastname: Atalla
authors.affiliation: Fielding School of Public Health, University of California, Los Angeles, CA, USA.
authors.forename: Susan D
authors.initials: SD
authors.lastname: Cochran
authors.affiliation: Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York State Psychiatric Institute and New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: First
authors.affiliation: Department of Medical Psychology, VU University Medical Centre, and Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands.
authors.forename: Peggy T
authors.initials: PT
authors.lastname: Cohen-Kettenis
authors.affiliation: Instituto Nacional de Psiquiatria Ramón de la Fuente Muñiz, Mexico City, Mexico.
authors.forename: Iván
authors.initials: I
authors.lastname: Arango-de Montis
authors.affiliation: Departments of Medicine and Psychiatry, Weill Cornell Medical College and New York Presbyterian Hospital/Westchester Division, White Plains, NY, USA.
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Parish
authors.affiliation: Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors.forename: Sara
authors.initials: S
authors.lastname: Cottler
authors.affiliation: Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Peer
authors.initials: P
authors.lastname: Briken
authors.affiliation: Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland.
authors.forename: Shekhar
authors.initials: S
authors.lastname: Saxena
keywords: DSM-5; ICD-11; International Classification of Diseases; gender dysphoria; gender incongruence; paraphilic disorders; sexual dysfunctions; sexual health; sexual orientation; transgender