Categories That Should Be Removed From Mental Disorders Classifications: Perspectives and Rationales of Clinicians From Eight Countries Rebeca Robles, 1 Ana Fres ´ an, 1 Mar´ ıa Elena Medina-Mora, 1 Pratap Sharan, 2 Michael C. Roberts, 3 Jair de Jesus Mari, 4 Chihiro Matsumoto, 5 Toshimasa Maruta, 5 Oye Gureje, 6 Jos ´ e Lu´ ıs Ayuso-Mateos, 7 Zeping Xiao, 8 and Geoffrey M. Reed 9 1 National Institute of Psychiatry Ram´ on de la Fuente Mu ˜ n´ ız 2 All India Institute of Medical Sciences 3 University of Kansas 4 Federal University of S˜ ao Paulo 5 Tokyo Medical University 6 University of Ibadan 7 Universidad Aut´ onoma de Madrid 8 Shanghai Jiao Tong University 9 World Health Organization Objective: To explore the rationales of mental health professionals (mainly psychiatrists and psychol- ogists) from 8 countries for removing specific diagnostic categories from mental disorders classification systems. Method: As part of a larger study, 505 participants indicated which of 60 major disorders should be omitted from mental disorders classification systems and provided rationales. Rationale statements were analyzed using inductive content analysis. Results: The majority of clinicians (60.4%) indicated that 1 or more disorders should be removed. The most common rationales were (a) problematic boundaries between normal and psychopathological conditions (45.9% of total removal recommendations), (b) problematic boundaries among mental disorders (25.4%), and (c) problematic boundaries between mental and physical disorders (24.0%). The categories most frequently recom- mended for deletion were gender identity disorder, sexual dysfunction, and paraphilias, usually because clinicians viewed these categories as being based on stigmatization of a way of being and behaving. A range of neurocognitive disorders were described as better conceptualized as nonpsychiatric medi- cal conditions. Results were analyzed by country and country income level. Although gender identity disorder was the category most frequently recommended for removal overall, clinicians from Spain, India, and Mexico were most likely to do so and clinicians from Nigeria and Japan least likely, prob- ably because of social and systemic factors that vary by country. Systematic differences in removal rationales by country income level may be related to the development, structure, and functioning of health systems. Conclusion: Implications for development and dissemination of the classification The World Health Organization Department of Mental Health and Substance Abuse has received direct support that contributed to the conduct of this study from several sources: The International Union of Psychological Science, the National Institute of Mental Health (USA), the World Psychiatric Association, the Spanish Foundation of Psychiatry and Mental Health (Spain), and the Santander Bank UAM/UNAM endowed Chair for Psychiatry (Spain/Mexico). R. Robles, M. E. Medina-Mora, P. Sharan, M. Roberts, J. Mari J, C. Matsumoto, T. Maruta, O Gureje, J.L. Ayuso-Mateos and Z. Xiao are members of the WHO International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders or of Working Groups that report to the International Advisory Group. G. Reed is a member of the WHO Secretariat, Department of Mental Health and Substance Abuse, WHO. Unless specifically stated, the views expressed in this article are those of the authors and do not represent the official policies or positions of WHO. Please address correspondence to: Geoffrey M. Reed, Department of Mental Health and Substance Abuse, World Health Organization. 20, Avenue Appia, CH-1211 Geneva, Switzerland; e-mail: reedg@who.int JOURNAL OF CLINICAL PSYCHOLOGY, Vol. 71(3), 267–281 (2015) C ⃝ 2014 Wiley Periodicals, Inc. The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication. Published online in Wiley Online Library (wileyonlinelibrary.com/journal/jclp). DOI: 10.1002/jclp.22145