Abstract summary 

The most recent versions of the two main mental disorders classifications-the World Health Organization's ICD-11 and the American Psychiatric Association's DSM-5-differ substantially in their diagnostic categories related to transgender identity. ICD-11 gender incongruence (GI), in contrast to DSM-5 gender dysphoria (GD), is explicitly not a mental disorder; neither distress nor dysfunction is a required feature. The objective was compared ICD-11 and DSM-5 diagnostic requirements in terms of their sensitivity, specificity, discriminability and ability to predict the use of gender-affirming medical procedures.A total of 649 of transgender adults in six countries completed a retrospective structured interview.Using ROC analysis, sensitivity of the diagnostic requirements was equivalent for both systems, but ICD-11 showed greater specificity than DSM-5. Regression analyses indicated that history of hormones and/or surgery was predicted by variables that are an intrinsic aspect of GI/GD more than by distress and dysfunction. IRT analyses showed that the ICD-11 diagnostic formulation was more parsimonious and contained more information about caseness than the DSM-5 model.This study supports the ICD-11 position that GI/GD is not a mental disorder; additional diagnostic requirements of distress and/or dysfunction in DSM-5 reduce the predictive power of the diagnostic model.

Authors & Co-authors:  Robles Rebeca R Keeley Jared W JW Vega-Ramírez Hamid H Cruz-Islas Jeremy J Rodríguez-Pérez Victor V Sharan Pratap P Purnima Shivani S Rao Ravindra R Rodrigues-Lobato María Inés MI Soll Bianca B Askevis-Leherpeux Françoise F Roelandt Jean-Luc JL Campbell Megan M Grobler Gerhard G Stein Dan J DJ Khoury Brigitte B Khoury Joseph El JE Fresán Ana A Medina-Mora María-Elena ME Reed Geoffrey M GM

Study Outcome 

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