Russian doctors will remain in the nineties

The Ministry of Health of the Russian Federation has not yet made a decision on the terms and conditions for the transition to the new International Classification of Diseases (ICD-11), Kommersant was told in the department, consideration of this issue has been postponed until 2025. Earlier, the Russian Orthodox Church and a number of deputies called for “withdrawing” from the ICD-11, and Health Minister Mikhail Murashko said that Russia is not obliged to apply the classification “in full”. The main stumbling block was the changes in the ICD related to the medical approach to transsexualism (now it is not a disease, but a condition) and pedophilia (which is proposed to be considered a “pedophilic disorder”). Doctors interviewed by Kommersant called criticism of the ICD-11 “pure populism and disinformation” or “incompetence”.

The International Classification of Diseases is a set of groups of diseases; each disease or condition within the group has its own code. This is a “universal language” in which doctors from different countries can communicate with each other, explains Larisa Popovich, director of the Institute for Health Economics at the Higher School of Economics. Associate Professor of the Department of Psychiatry at RUDN University Roman Suleimanov adds: ICD is a tool for collecting statistics, with the help of which the state budgets certain expenses for the treatment of a particular disorder and exchanges information with other countries.

The tenth version of the classification of diseases (ICD-10) entered into force in 1990. And already in 2000, the World Health Organization (WHO) announced the start of work on the eleventh revision. It lasted 18 years; the new ICD-11 was approved in 2019.

Like the rest of the world, Russia has begun the transition to ICD-11 from January 1, 2022 – according to order of the government of the Russian Federation No. 2900-r. For the so-called transitional period, WHO took three years.

The ICD-10 contained 14,000 codes, while the ICD-11 contained 55,000. For example, the group “Mental, behavioral or neurodevelopmental disorders” was replenished with 15 new diagnoses, including attention deficit hyperactivity disorder (ADHD); dysmorphic disorder (an obsession with correcting flaws in their appearance that are invisible to others); disorder of pathological hoarding; gaming disorder (dependence on computer games).

Also in the ICD-11, a new section “Conditions related to sexual health” has appeared. Transsexualism and hermaphroditism were moved to the “gender inconsistencies” subsection, and the concepts themselves were clarified – they are no longer considered a violation or disorder. Psychiatrist-sexologist Oleg Starostin explains: WHO has introduced such a wording so that people who do not have a psychiatric diagnosis can count on medical assistance – in particular, on gender transition. The wording regarding pedophilia has also changed. In ICD-9 it was defined as “sexual perversion” and ICD-10 as “sexual attraction to children”. And ICD-11 speaks of “pedophilic disorder.”

It is these two changes related to approaches to transsexualism and pedophilia that caused criticism of the ICD-11 in Russia.

In March, the chairman of the patriarchal commission on family issues, protection of motherhood and childhood, Priest Fyodor Lukyanov, spoke in the State Duma with a proposal to “withdraw” from the ICD-11, saying that it was promoting values ​​“alien” to the country. The new classification, he says, considers “various forms of perversion”, in particular pedophilia, “as deviant only if the pedophile feels uncomfortable with it.” State Duma deputy from the Communist Party Irina Filatova, for the same reason, proposed a moratorium on the ICD-11. And some opponents of the new classification reminded that once homosexuality was removed from the ICD-10, after which it was no longer considered a disease.

Roman Suleimanov explains that “pedophilic disorder” is still classified under paraphilias (sexual deviations). ICD-11 adds to the previous definition the clarification that the diagnosis excludes relationships between underage peers. It should also be encoded if an adult is attracted to minors, suffers from awareness and concern about this condition, or performs specific actions in relation to minors. “I don’t see any signs of “normalization” or decriminalization of pedophilia here,” says the associate professor of the Department of Psychiatry at the People’s Friendship University of Russia. “The diagnosis of “pedophilia” is not a synonym for insanity and does not exempt from criminal liability in case of sexual abuse of children. At the same time, timely identification and treatment of people with pedophilic disorder helps to prevent and reduce the number of sexual crimes against children. Speculation that the WHO allegedly “plans to legalize pedophilia” or “crossed out transsexuality and homosexuality from the list of diseases” is pure populism and misinformation.

Oleg Starostin notes that the ICD-11 is based on the most up-to-date scientific data: for its formation, WHO attracted the best experts in the field of science and practice. “The fact that some colleagues do not agree with this speaks of their desire to please the Russian authorities,” the expert believes. “Incompetence cannot be ruled out either. Because qualified professionals in the field of psychiatry and other areas have long relied on the ICD-11.

The situation was again discussed the other day in the State Duma – in connection with the bill banning sex reassignment operations. Then the Minister of Health Mikhail Murashko, in response to the criticism of the deputies, said that our country is not obliged to apply the new ICD-11 “in full”.

“Kommersant” asked the Ministry of Health of the Russian Federation for clarification. They reported that “at present, a decision on the terms and conditions for the final transition to ICD-11 has not been made,” and consideration of this issue has been postponed until 2025.

The agency also referred to the position of the leading experts of the National Medical Research Center for Psychiatry and Narcology. V. P. Serbsky, according to which the term “gender mismatch” is equivalent to the clinical diagnosis of “transsexualism”. “This means that, contrary to public fears, the diagnosis of transsexualism has not been removed from the ICD-11,” the press service of the department said. “The presence of these conditions in both ICD-10 and ICD-11 as in the classifications of diseases implies, that the above conditions will not cease to be considered disorders and will not be converted into variants of the norm. Regardless of which classification is used for statistical accounting – ICD-10 or ICD-11 – patients with these conditions should be provided with medical, including psychiatric care.

Natalia Kostarnova