Depathologisation of ‘gender incongruence’ in the International Classification of Diseases

In 1990, World Health Organization has included the diagnosis of “gender incongruence” in the International Classification of Diseases (ICD). Its revision process has started a long time ago and should be finalized around 2017 with the final approval by the World Health Assembly.

Categories at stake are:

F64: gender identity disorders

F65: disorders of sexual preference

F66: psychological and behavioral disorders associated with sexual development and orientation


World Health Organization Departments of mental health & substance abuse together with department on reproductive health and research, have appointed an experts working-group on classification of sexual disorders and sexual health.

In terms of actions around the 18th of October, International Action Day for Trans Depathologisation Sarajevo open centre and Trans* BiH group have made a statement.


“We as an informal group of transgender* people from Bosnia and Herzegovina, Trans* BiH, associated with the Sarajevo open centre, believe that the treatment of natural gender diversity as a mental disorder is misinformed, unscientific and adds to the existing stigmatization of transgender people. As such, it has no place in a diagnostic tool of an organization based on the principles of scientific inquiry and universal human rights.

We speak, not as academic experts on gender or healthcare policy makers, but as people who live and breathe the reality of transgender existence. Our voices are the voice of those who experience on their own skin the prejudice, stigmatization and damaging legal, healthcare and social policies.

Labeling gender diversity as a mental illness confirms the false assumption that cisgender male and cisgender female are the only normal gender identities, and thus directly or indirectly sanctions the violent suppression of natural gender diversity as “unnatural.” In countries where mental illness is criminalized and where mentally ill people are dehumanized and denied basic human rights, this diagnosis has dismal consequences.

Children and youth, who are the most disempowered group due to their social and economic status, are at the highest risk of these horrific abuses. Insistence that we categorize or diagnose children at an age when they are just beginning to explore their social environment, when they are becoming aware of their bodies, gender, social roles, and are undergoing intensive growth and development – is irresponsible and damaging. To impose our misinformed norms relating to gender identity and expression and sexual orientation on children is to rob these children of their basic right to develop in a safe, accepting and positively stimulating environment, free of coercion.

We thus place all the burden on those who are neither the cause of the problem nor have the political and social power to fix it, and excuse those whose behavior is the source of the problem.

The term “gender incongruence” is based on an unsupported assumption that there is a solid, invariant connection between gender and assigned physical sex. Mounting scientific evidence indicates that gender and psychical sex are neither simple in their formation and nature, nor inextricable. Thus gender incongruence is an incongruence between what we imagine rather than know gender to be, with whatever meaning we assign to anatomy whose formation we do not fully understand.

Gender roles and underlying assumptions vary widely between cultures, religions, and in time. These man-made rules impose an unnatural binary gender division on humans, whose purpose is above all social and economic, and bears little relation to actual human gender identities.

We are confident that the World Health Assembly will approach the review of the ICD with the same passion and excellence, and dedication to universal human rights and protection of children it applies to other areas of healthcare. Psychiatry, as a branch of healthcare, must also be science-based and rely on scientific evidence rather than varying cultural norms.”

Trans* BiH, 18th October, 2014