Reliability and Clinical Utility of Gender Identity-Related Diagnoses: Comparisons between the ICD-11, ICD-10, DSM-IV, and DSM-5

Annelou L.C. De Vries*, Titia F. Beek, Karlien Dhondt, Henrica C.W. De Vet, Peggy T. Cohen-Kettenis, Thomas D. Steensma, Baudewijntje P.C. Kreukels

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Purpose: 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. Methods: 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. Results: 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. Conclusion: 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.

Original languageEnglish
Pages (from-to)133-142
Number of pages10
JournalLGBT Health
Issue number2
Publication statusPublished - 1 Feb 2021

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