A working group helping to develop the 11th edition of the International Classification of Diseases (ICD-11) has recommended that all diagnostic codes referencing homosexuality be dropped, echoing policies of the leading U.S. psychiatry and psychology societies.
"It is not justifiable from a clinical, public health, or research perspective for a diagnostic classification to be based on sexual orientation," , of the University of California Los Angeles, and other members of the working group wrote in the .
Earlier this month, the with a similar recommendation. The American Psychiatric Association's fifth edition of its Diagnostic and Statistical Manual of Mental Disorders, released in May 2013, did away with all associations of sexual orientation with mental illness.
Five diagnostic codes pertaining to sexual orientation appear in ICD-10, which is tentatively slated for adoption in the U.S. late next year after long delays.
All carry the designation F66. They include "sexual maturation disorder" (F66.0), described as anxiety or depression due to uncertainty over one's sexual orientation or gender identity, and "ego-dystonic sexual orientation" (F66.1) for individuals who express unhappiness with their sexual preference and wish it were different.
The ICD-10 codes also include F66.2, "sexual relationship disorder," to describe "difficulties in forming or maintaining a relationship with a sexual partner" because of the person's gender identity or sexual orientation.
In a statement, Cochran said this last category could be used to apply a medical diagnosis to a married man who realizes that he is homosexual and, as a result, finds that this causes difficulties with his wife.
Dropping the codes would mean "that gay people can feel free to seek care, to share their concerns, and not fear that they will diagnosed with a mental illness simply because the content is about homosexuality or gender atypicality," Cochran said. "It would mean an end to the medicalization of homosexuality."
She and the other working group members argued that genuine psychiatric problems experienced by gay people, even those connected to their sexual orientation, can be diagnosed and treated without resorting to diagnostic codes devised specially for them.
Such special treatment doesn't make sense, Cochran said. "If a person were short and wished they weren't, that is not a disorder. Or if someone was a lousy singer and wished they weren't, that is not a disorder. In other words, the ICD takes content that is sexual orientation-related and attaches a diagnosis to it in ways that it does not do for other aspects of people."
The group's findings emerged from a review of literature published in recent decades that, in general, has indicated that sexual preferences are formed very early in life and that, while nonheterosexuals tend to report greater distress, it results from "greater experiences of social rejection and discrimination."
Cochran and colleagues acknowledged that the F66 codes "may improve diagnostic accuracy because they can be used for individuals who present with concerns about sexual orientation or gender identity." (As MedPage Today has indicated in a long-running series, ICD-10 is rife with sometimes comically narrow diagnostic categories, such as injuries sustained in a spaceship crash.)
But, they argued, "the existence of these categories may be harmful because they draw attention to content (e.g. to a relationship breakup with a same-sex as opposed to different-sex partner) or individual characteristics that are not clinically meaningful or that pathologize normative reactions."
In addition, the group wrote, "retention of these categories may also be construed as supporting ineffective and unethical treatment that aims to encourage people with a same-sex orientation to adopt a heterosexual orientation or heterosexual behavior."