Department of Child and Adolescent Psychiatry and Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands.
Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands.
LGBT Health. 2021 Feb-Mar;8(2):133-142. doi: 10.1089/lgbt.2020.0272. Epub 2021 Feb 18.
The World Health Organization general assembly approved the 11th revision of the International Classification of Diseases (ICD) in 2019 which will be implemented in 2022. Gender identity-related diagnoses were substantially reconceptualized and removed from the mental health chapter so that the distress criterion is no longer a prerequisite. The present study examined reliability and clinical utility of gender identity-related diagnoses of the ICD-11 in comparison with the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5, ICD-10, and DSM-IV. Sixty-four health care providers assessed six videos of two children, two adolescents, and two adults referred for gender incongruence. Each provider rated one pair of videos with three of the four classification systems (ICD-11, DSM-5, ICD-10, and DSM-IV-TR). This resulted in 72 ratings for the adolescent and adult diagnoses and 59 ratings for the children's diagnoses. Interrater agreement rates for each instrument ranged from 65% to 79% for the adolescence/adulthood diagnoses and from 67% to 94% for the childhood diagnoses and were comparable regardless of the system used. Only agreement rates for ICD-11 were significantly better than those for DSM-5 for both age categories. Clinicians evaluated all four systems as convenient and easy to use. In conclusion, both classification systems (DSM and ICD) and both editions (DSM-IV and DSM-5 and ICD-10 and ICD-11) of gender identity-related diagnoses seem reliable and convenient for clinical use.
世界卫生组织大会于 2019 年批准了《国际疾病分类》第 11 次修订版，该版本将于 2022 年实施。性别认同相关的诊断被重新概念化并从精神健康章节中删除，因此不再将痛苦标准作为前提。本研究比较了《国际疾病分类第 11 次修订版》（ICD-11）与《精神障碍诊断与统计手册》第 5 版（DSM-5）、《国际疾病分类第 10 次修订版》（ICD-10）和《精神障碍诊断与统计手册》第 4 版修订本（DSM-IV-TR）中性别认同相关诊断的可靠性和临床实用性。64 名医疗保健提供者评估了 6 个关于性别不一致的儿童、青少年和成人的视频。每位提供者使用四种分类系统中的三种（ICD-11、DSM-5、ICD-10 和 DSM-IV-TR）对一对视频进行评分。这为青少年和成年诊断产生了 72 个评分，为儿童诊断产生了 59 个评分。每种工具的组内一致性率在青少年/成年诊断中为 65%至 79%，在儿童诊断中为 67%至 94%，且无论使用哪种系统，一致性率都相当。仅 ICD-11 的一致性率明显优于 DSM-5 两种年龄组的一致性率。临床医生评估了所有四种系统，认为它们都方便易用。总之，两种分类系统（DSM 和 ICD）和两种版本（DSM-IV 和 DSM-5 以及 ICD-10 和 ICD-11）的性别认同相关诊断似乎都可靠且便于临床使用。
