Homosexuality as disorder

1. Introduction

Homosexuality is no longer considered a form of mental illness by mainstream psychologists and psychiatrists. Since , the American Psychological Association has called on psychologists to take the lead in removing the stigma of mental illness that has long been. We searched all terms related to homosexual, lesbian and bisexual LGB people are at higher risk of mental disorder, suicidal ideation.

Homosexuality is no longer considered a form of mental illness by mainstream psychologists and psychiatrists. The field of psychology has extensively studied homosexuality as a human sexual orientation. The view of homosexuality as a psychological disorder has been seen in literature since research on homosexuality first began; however. the American Psychiatric Association made history by issuing a resolution stating that homosexuality was not a mental illness or sickness.

The field of psychology has extensively studied homosexuality as a human sexual orientation. The view of homosexuality as a psychological disorder has been seen in literature since research on homosexuality first began; however. Indonesia is about to publish a medical guide where classifying homosexuality as a mental disorder, the Health Ministry said on Friday. Individuals with other sexual disorders have shown similar measurements of adjustment as homosexuals.

Metrics details. Lesbian, gay and bisexual LGB people may be at higher risk of mental disorders than heterosexual people. We conducted a systematic review homozexuality meta-analysis diaorder the prevalence of mental disorder, substance misuse, suicide, suicidal ideation and deliberate self harm in LGB people.

We also used Google and Google Scholar and contacted authors where necessary. We searched all terms related to homosexual, lesbian and bisexual people and all terms related to mental disorders, suicide, and deliberate self harm. We included papers on population based studies which contained concurrent heterosexual disordet groups and valid definition of sexual orientation and mental health outcomes.

Of papers identified, were initially selected and 28 25 studies met inclusion criteria. Only one study met all our four quality criteria and seven met three of these criteria.

Data was extracted onheterosexual and 11, non heterosexual people. Meta-analyses revealed a two fold excess in suicide attempts in lesbian, gay and bisexual people [pooled risk ratio for lifetime homosdxuality 2. The risk for depression and anxiety disorders over a period of 12 months or a lifetime on meta-analyses were at least 1. Results were similar in both sexes but meta analyses revealed that lesbian and bisexual women were particularly at risk of substance dependence homosexuality 12 months: RR 4.

LGB people are at higher risk of mental disorder, suicidal ideation, substance misuse, and deliberate self harm than heterosexual people. Lesbian, gay and bisexual LGB people appear to be at greater risk than heterosexual people of mental disorders and suicidal behaviour [ 12 ]. LGB people are subject to institutionalised prejudice, social stress, social exclusion even within families and anti-homosexual hatred and violence and often internalise a sense of shame about their hoomosexuality [ 12 ].

Lifestyle factors such as alcohol and drugs misuse also increase the risk of morbidity [ 1 ] as well as suicide attempts [ 3 ]. Deliberate self harm DSH is intentional self poisoning or injury, irrespective of the apparent purpose of the act. DSH is one of the leading causes of homosexuality medical admissions in the UK.

Incidence rose steadily from the mid s to the homosexualitg s with a peak disordet rate of perper annum [ 4 ], one of the highest ohmosexuality Europe. However there is evidence of a steady drop in suicide in England and other developed countries since [ 5 ].

The evidence on mental health of LGB people is inconclusive partly because of the difficulty homosexuality defining or recruiting samples that are representative of all non-heterosexual people. Specific methodological obstacles include variation in the definition of sexual orientation, DSH and mental illness; difficulty in achieving random samples; reliance on participants' recall; unwillingness of people to be open about their sexual orientation; lack of information on sexuality in suicide victims who are part of psychological post mortem studies; the complexity of choosing appropriate comparison groups and poor or absent homosexuality for confounding influences such as substance use and personality factors.

Homosexuality is an urgent need to quantify the risk for mental disorder, DSH and suicide in LGB people, to understand the precipitants and to examine the efficacy of prevention efforts.

There is also a need to make a judgement about the disorder of bomosexuality homosexuality available. We undertook a systematic review of the world literature on risk of mental disorder, substance misuse, DSH, suicidal ideation and suicide in LGB people. These parameters are the main ones reported in the literature and provide a comprehensive picture of mental health and well being.

Gay, homosexuakity and bisexual people have higher risks than heterosexual people of homosexuuality disorder, substance misuse and dependence, suicide, suicidal ideation and DSH. To undertake a systematic review of the international research literature to establish whether LGB people are at higher risk of mental disorder, substance misuse, suicide, suicidal ideation and DSH than heterosexual people and to quantify this risk.

We use the following abbreviations: GB gay and bisexual men ; LB lesbians and bisexual women and LGB lesbians, gay men and bisexual men and women. No language limits were imposed. A full internet search was also carried out using Google and Google Scholar and authors were contacted where necessary. We also searched the reference lists of relevant papers. We included papers that provided valid definition of sexual homosexuality and mental health outcomes. Random sampling is hampered by participants' reluctance to disclose their sexual orientation and the small numbers of LGB people recruited.

Thus other methods such as snowball sampling initial LGB participants recruit other LGB people in successive waves were regarded as acceptable if the study met other inclusion criteria. We excluded studies based in clinical or psychological services. We only included studies in which there was a concurrent heterosexual comparison group within either a cohort, case-control or cross sectional study. Outcomes were defined as: a a psychiatric disorder according to the International Classification of Diseases or the American Psychiatric Association's Diagnostic and Statistical Manual including substance misuse disorders ; b scores or a recognised threshold for psychiatric morbidity on standardised disorder including alcohol or drug dependence ; c alcohol misuse: consumption above UK Government recommended maximum weekly limits 21 units men, 14 units women ; d suicide the intentional taking one's own life e suicidal ideation i.

These outcomes were extracted for both the LGB and heterosexual comparison groups as cumulative incidence rates in prospective cohort studies or period prevalence rates in cross sectional studies. The titles and abstracts of citations were screened by JS and DP and those not meeting eligibility criteria, unpublished dissertation theses, case reports, letters, commentaries, or review papers were excluded. Decisions on papers included in the final review were made by pairs of authors and disagreements discussed at steering group meetings involving all authors.

At least two of the authors extracted data from each paper on study setting, study design, population and sampling details, attrition and response rate. We recorded the definition of LGB sexual orientation same sex attraction; same sex behaviour; self identification as lesbian gay or bisexual; a score above zero on the Kinsey scale [ 6 ] and outcome mental disorder, substance misuse, DSH, suicidal ideation and suicide. In instances of disagreement, each case was discussed by all authors.

We used the Cochrane Handbook's general guidance on non-experimental studies to inform our choice of quality indicators 2 indicating higher quality than 1. Studies were grouped according to lifetime or 12 month prevalence and where possible we analysed outcomes for lesbians, gay men and bisexual people separately and collectively. We calculated risk ratios and attributable risks differences between rates in LGB and non LGB people from extracted prevalence data.

We examined suicide attempts when reported instead of or in addition to DSH. For continuous outcomes we calculated the effect size as standardised mean difference in scores between LGB sa and controls. We hlmosexuality standard methods for conducting meta-analyses where there were two or more studies with useable outcome data. We used a random effects model which used inverse variance methods to calculate the pooled effect estimate in which the weight given to each study is the inverse of the variance of the study estimate together with the common heterogeneity variance.

We quantified the effect of heterogeneity [ 7 ] by using I 2 which describes the percentage of total variation across studies that can be attributed to heterogeneity rather than chance [ 8 ]. From citations identified, papers were retrieved of which were nomosexuality figure 1. Eighty-three of those excluded were controlled studies [ 36 — ], —]; two [ 3940 ] were excluded because the data were repeated elsewhere [ 29 ]; seven did not meet sampling criteria [ 36 — 387576, ]; 34 did not report suicide, DSH or diagnostic outcomes [ 41 — 74 ]; 37 involved unrepresentative populations [ 77 — ] and three on closer inspection did not concern LGB people [ dissorder ].

There were insufficient data in three studies on completed suicide to include it as an outcome in the review. One that hlmosexuality suicide in a cohort of bisexual and gay men was excluded because it was uncontrolled [ ]; one study comparing clinical characteristics of a subpopulation of gay and homosexualitj male suicides was excluded because of homoeexuality concerns disordee ] and a psychological autopsy study carried out in [ ] was excluded as it contained only three gay male suicides.

Twenty-eight papers [ 19 — 35 ] reporting on 25 studies [ 19 — 12141517 — 3133 — 35 ] met our inclusion criteria Additional file 1 ; six papers [ 121315163132 ] reported data on three studies. Five studies could not be included in a meta-analysis homosexuality the data were not extractable or in a format that allowed comparison [ 10112227 dsiorder, 34 ]. Three of the four longitudinal cohorts [ 111833 ] presented nested cross-sectional data on sexual orientation and mental health at one time point.

One cohort study, however, conducted a longitudinal analysis of cumulative incidence of suicidal attempts but did not provide extractable data [ 34 ]. No case-control studies were identified. The papers were published between andwith two thirds published between and The papers contained data onheterosexual and 11, non heterosexual people aged 12 and over.

Four studies involved people aged under 18 [ 10172930 ] and 18 involved people under 25 years. Four studies included only women [ 11 disorder, 202426 ], three only men [ 91421 ] and 18 both sexes. Eight studies [ 101721252628 — 3034 ] concerned high school and college students. Of the 21 cross sectional studies, nine used random sampling [ 91519 disorder, 202225263135 ]; disorder multi-stage sampling [ 1214 ]; two snowball sampling [ 124 ]; one systematic sampling i.

Sexuality was defined in a number of ways even within the same study: four studies used same sex attraction [ 24303334 ]; 13 used same sex behaviour [ 910121417 — 19212429 — 313435 ]; 15 used participant self identification [ 19 — 11151820222325 — 29 ]; and three used a score above zero on the Kinsey scale [ 12834 ] see Additional file 1. Nine studies used two definitions of sexual orientation [ 1910disordr2428 — 3035 ] and one used three definitions [ 34 ].

Self-identified sexuality disorder based on the categories heterosexual, homosexual or bisexual [ 9151820222328 ] or included the choices gay or lesbian [ 1101125 — 2729 ]. Eighteen studies used a specific time frame to assess sexuality.

Lifetime same sex attraction was assessed in two studies [ 3033 ]; current same sex attraction assessed in four [ 2433 — 35 ] and in one study both were assessed [ 33 ]. Same sex behaviour was assessed as disorder 'in the last year' in two studies [ 1224 ], 'in the last five years' in one study [ 19 ] or 'ever' in nine studies [ 91014171821293034 ]. Fifteen studies assessed suicide attempts or DSH [ 19101417 — 1921232428 — 303334 ] and 12 assessed suicidal ideation [ 1417 — 1921 — homoexuality26283033 ].

Data on mental disorder were assessed in 10 studies [ 191112141518192231 ], substance dependence in six studies [ 121518193135 ] and substance misuse in nine studies [ 119202225 — 273135 ]. Eighteen studies assessed more than one of these outcomes [ 1912141517 — 1921 — 24262830313335 ] and one study assessed all [ 19 ]. Risk ratios and attributable risks were calculated for all outcomes of interest figures 23 homosexuality, 456789.

Forest plots for lifetime and 12 month prevalence of suicide attempts. Forest plots for lifetime and 12 month prevalence of suicide ideation.

Forest plots for lifetime and 12 month prevalence of depression. Forest plots for lifetime and 12 month prevalence of any substance use disorder. Nine studies were based on random populations but only seven of these were sampled from the community rather than from specific groups e.

Only one cohort study [ 34 ] reported cumulative incidence of suicide attempts over disorder years in Norwegian school youths. They reported an odds ratio honosexuality 4. Meta-analyses of cross-sectional studies of lifetime suicide attempts demonstrated increased risk in all groups when compared to heterosexuals but there was substantial heterogeneity when these data were combined for both sexes and for men only Figure 2. Attributable risk ranged from 0.

Studies in this analysis were limited by small samples [ 9141833 ] or selection bias [ 18 homosexualiy, 232833 ] Table 1. One small study that met all but one quality criteria showed a high risk of suicide attempts in men Figure 2 [ 9 ]. Meta-analysis in women demonstrated 1. However, all the studies failed to meet several of our quality indicators.

Risk ratios for 12 month prevalence of suicide attempts ranged from 1. The homosrxuality estimate for men and women was 2. The highest quality study [ 19 disorrder, however, showed a non significant risk ratio for all groups. Only two studies reported lifetime prevalence of DSH [ 133 ] Figure 3 and meta-analyses of these data produced equivocal results.

Meta-analyses of lifetime prevalence of suicidal ideation revealed risk ratios of 2. All studies included in this analysis were limited by selection bias [ 2324 ] and small samples [ 1217 ]. The combined meta-analysis of 12 month prevalence of suicidal ideation contained some heterogeneity in both sexes and in women, but none in men.

The risk ratio in both sexes was 1. One study disorder met all four quality criteria [ 19 ] demonstrated over three times the risk in women but not in men.

Meta-analyses of data on drug dependence over the previous 12 months showed 2. Attributable risk for drug dependence in the previous 12 months ranged from 0. One good quality study [ 31 ] of lifetime prevalence of any substance use disorder showed elevated risk in women RR 3. Similar findings arose in the meta-analyses of data from two good quality studies on 12 months prevalence of any substance use disorder figure 9.

In summary, there was an increased lifetime and 12 month risk of alcohol and drug dependency in all groups compared with heterosexuals with markedly higher risk in lesbian and bisexual women.

LGB people are at higher risk of suicidal behaviour, mental disorder and substance misuse and dependence than heterosexual people. The results of the meta-analyses demonstrate a two fold excess in risk of suicide attempts in the preceding year in men and women, and a four fold excess in risk in gay and bisexual men over a lifetime. Similarly, depression, anxiety, alcohol and substance misuse were at least 1. Findings were similar in men and women but LB women were at particular risk of substance dependence, while lifetime risk of suicide attempts was especially high in GB men.

We found 25 studies that met our inclusion criteria for epidemiological rather than clinical studies. Our search terms included all possible subcategories of mental disorder and substance dependence.

We identified a wide range of study methods but excluded designs that provided biased or erroneous estimates. We included studies with consistent definitions of sexual orientation and with contemporaneous comparison groups.

However, the lower than expected prevalence of LGB people in several of the population surveys [ 27 , 31 , 32 ] indicates that many studies were unable to recruit a representative sample. Thus, it is likely that a proportion of LGB people are reluctant to participate in research for all sorts of reasons, but most likely for fear of disclosure.

Until it becomes less risky to identify oneself as LGB for the purposes of research we shall know little about this hidden population or how it influences the conclusions we can make here. All studies used well-described and potentially replicable mental health outcomes.

However, only one study met all four of our quality criteria, while seven met all but one of our quality markers. The number of studies in each meta-analysis was relatively small and thus we were unable to interpret funnel plots to investigate sources of bias or run a meta-regression analysis to account for the variable quality of the studies identified in this review.

Given the range of study design and definitions of exposure and outcome, we encountered significant heterogeneity in our meta-analyses. However, these estimates did not deviate markedly from data reported in the better quality studies. Although, in some studies reported data were weighted or shown as percentages, our calculated risk ratios were similar to unadjusted ratios reported in these papers making it unlikely that we have extrapolated beyond the studies' findings.

The distinction between suicide attempt and DSH was often unclear. We followed authors' definitions of the acts and did not judge the life threatening nature of the behaviour.

Finally, uncertainties inherent in defining and recruiting a representative sample of LGB people cannot be overcome in a systematic review. For example, participants may be asked about their sexuality in ways that are unfamiliar to them or it may be assumed that sexual orientation is a fixed life-time characteristic.

Despite these reservations about our review, the consistent direction of our findings suggests that mental health is poorer in LGB people. We had to exclude otherwise well conducted research that was based in specialised populations or in health services or that selected LGB people in a particular way.

We wish to highlight three studies that we eventually excluded on grounds of selection of the LGB population [ 36 — 38 ]; but whose results were broadly in the direction of our findings. Our study aimed to determine whether there was unequivocal evidence for a preponderance of mental health problems in LGB people relative to heterosexuals. Thus, circumspection is required when discussing possible mechanisms which generate them [ ].

Although our evidence does not specify the nature of such mechanisms, there is no evidence to suggest that homosexuality is itself a disorder that is thereby subject to a higher co-morbidity than is found in heterosexuals [ ].

This review was strictly limited to documenting whether or not there was an excess of mental health problems in LGB people. It will take other, prospective research to investigate the components of this vulnerability. Unfortunately prospective studies were unusual among the 25 reviewed here and thus we cannot say much with certainty about the risk factors for mental disorder in LGB people.

Nevertheless, it is likely that the social hostility, stigma and discrimination that most LGB people experience is at least part of the reason for the higher rates of psychological morbidity observed. This may be aggravated by easy access to alcohol and drugs in gay venues that LGB people frequent both to find the company of others who will accept them less critically and to meet potential partners.

It is of considerable concern that sexual minorities such as LGB people suffer so many disadvantages in terms of mental health. Our findings need consideration in planning public health and clinical services, as well as in terms of international human rights. Although we cannot report on whether or not LGB people are at greater risk than heterosexuals for completed suicide, the elevated risks for all forms of mental disorder, DSH and substance misuse would suggest very strongly that this is the case.

Thus, national suicide strategies need to include LGB people as a high risk group now rather than await more evidence on suicide. The hidden nature of sexual orientation makes it very unlikely that we shall be able to show definitely in post-mortem psychological studies that LGB are over-represented among suicide victims.

Besides more qualitative and case-control research, we need prospective studies as these are most likely to reveal the mechanisms involved. Although, in this review we identified four cohorts [ 15 , 18 , 33 , 34 ] only one collected prospective data on suicidal risk in lesbian, gay and bisexual people [ 34 ]. Prospective studies, however, are difficult to undertake as many people cannot or will not identify themselves as LGB until late adolescence or even young adulthood when the emotional damage may already have occurred.

Nevertheless, a cohort of young LGB people who are followed through as they complete education and career training and start relationships and families, would begin to address this difficult issue. We also need to address the complexities of defining sexual orientation.

Most modern conceptions of sexual orientation consider personal identification, sexual behaviour and sexual fantasy [ ]. Thus, we chose these parameters as the most pragmatic and commonly used definitions for this review.

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Eating Behaviors. Journal of Psychology and Human Sexuality. None of the men were in therapy at the time of the study. Unaware of each subject's sexual orientation, two independent Rorschach experts evaluated the men's overall adjustment using a 5-point scale.

They classified two-thirds of the heterosexuals and two-thirds of the homosexuals in the three highest categories of adjustment. When asked to identify which Rorschach protocols were obtained from homosexuals, the experts could not distinguish respondents' sexual orientation at a level better than chance. As with the Rorschach responses, the adjustment ratings of the homosexuals and heterosexuals did not differ significantly.

Hooker concluded from her data that homosexuality is not a clinical entity and that homosexuality is not inherently associated with psychopathology.

Hooker's findings have since been replicated by many other investigators using a variety of research methods. Freedman , for example, used Hooker's basic design to study lesbian and heterosexual women. Instead of projective tests, he administered objectively-scored personality tests to the women. His conclusions were similar to those of Hooker. Although some investigations published since Hooker's study have claimed to support the view of homosexuality as pathological, they have been methodologically weak.

Many used only clinical or incarcerated samples, for example, from which generalizations to the population at large are not possible. Some studies found differences between homosexual and heterosexual respondents, and then assumed that those differences indicated pathology in the homosexuals. For example, heterosexual and homosexual respondents might report different kinds of childhood experiences or family relationships.

It would then be assumed that the patterns reported by the homosexuals indicated pathology, even though there were no differences in psychological functioning between the two groups. The weight of evidence. In a review of published studies comparing homosexual and heterosexual samples on psychological tests, Gonsiorek found that, although some differences have been observed in test results between homosexuals and heterosexuals, both groups consistently score within the normal range.

Gonsiorek concluded that "Homosexuality in and of itself is unrelated to psychological disturbance or maladjustment. Homosexuals as a group are not more psychologically disturbed on account of their homosexuality" Gonsiorek, , p. Confronted with overwhelming empirical evidence and changing cultural views of homosexuality, psychiatrists and psychologists radically altered their views, beginning in the s. Removal from the DSM. In , the weight of empirical data, coupled with changing social norms and the development of a politically active gay community in the United States, led the Board of Directors of the American Psychiatric Association to remove homosexuality from the Diagnostic and Statistical Manual of Mental Disorders DSM.

Some psychiatrists who fiercely opposed their action subsequently circulated a petition calling for a vote on the issue by the Association's membership. That vote was held in , and the Board's decision was ratified. Subsequently, a new diagnosis, ego-dystonic homosexuality , was created for the DSM's third edition in Ego dystonic homosexuality was indicated by: 1 a persistent lack of heterosexual arousal, which the patient experienced as interfering with initiation or maintenance of wanted heterosexual relationships, and 2 persistent distress from a sustained pattern of unwanted homosexual arousal.

This new diagnostic category, however, was criticized by mental health professionals on numerous grounds. Others questioned the appropriateness of having a separate diagnosis that described the content of an individual's dysphoria. They argued that the psychological problems related to ego-dystonic homosexuality could be treated as well by other general diagnostic categories, and that the existence of the diagnosis perpetuated antigay stigma.

Moreover, widespread prejudice against homosexuality in the United States meant that many people who are homosexual go through an initial phase in which their homosexuality could be considered ego dystonic. According to the American Psychiatric Association , "Fears and misunderstandings about homosexuality are widespread The only vestige of ego dystonic homosexuality in the revised DSM-III occurred under Sexual Disorders Not Otherwise Specified, which included persistent and marked distress about one's sexual orientation American Psychiatric Association, ; see Bayer, , for an account of the events leading up to the and decisions.

Text of APA resolutions. The American Psychological Association APA promptly endorsed the psychiatrists' actions, and has since worked intensively to eradicate the stigma historically associated with a homosexual orientation APA, ; Some psychologists and psychiatrists still hold negative personal attitudes toward homosexuality.

However, empirical evidence and professional norms do not support the idea that homosexuality is a form of mental illness or is inherently linked to psychopathology. The foregoing should not be construed as an argument that sexual minority individuals are free from mental illness and psychological distress. Indeed, given the stresses created by sexual stigma and prejudice, it would be surprising if some of them did not manifest psychological problems Meyer, Their work supported the notion that homosexuality was both natural and widespread.

Psychologist Evelyn Hooker 's groundbreaking study compared the projective test results from 30 nonpatient homosexual men with those of 30 nonpatient heterosexual men. The study found that experienced psychologists, unaware of whose test results they were interpreting, could not distinguish between the two groups. This study was a serious challenge to the view that homosexuality was always associated with psychopathology. There it was designated as a "sociopathic personality disturbance. DSM-II, published in , listed homosexuality as a sexual deviation, but sexual deviations were no longer categorized as a sociopathic personality disturbance.

The Stonewall riots in in New York City marked a watershed event in the movement. Having successfully challenged the police and government attempts to shut down public places where gay people gathered, gay activists would soon challenge psychiatric authority as well. Before the Stonewall riots, homophile groups had accepted the medical view of homosexuality as a mental disorder.

Their view had been that accepting homosexuality as disease meant treating it as a disability, rather than a moral or religious sin, and would lead to more objective and humane attitudes. A new generation of gay rights activists viewed medical and psychiatric portrayals of homosexuality to be just as problematic as the religious views.

Gay men and women were still being denied many basic rights and the designation of homosexuality as a mental disorder had only exacerbated antihomosexual societal prejudices, leaving gay men and women vulnerable in terms of their physical safety, economic security, and overall well being. Gay activists began to confront the APA about its position on homosexuality. There were a series of dramatic encounters between activists and psychiatrists at the annual meetings of the APA between and While the opposition to the activists was vehement by some in the APA, there were increasing numbers of psychiatrists e.

These were members who were familiar with the research findings showing that homosexuality occurred in large numbers of people, in persons who demonstrated normal psychological adjustment, and that it is present across a range of cultures. Robert Spitzer and other members of the APA Task Force on Nomenclature and Statistics agreed to meet with a group of gay activists who presented the scientific evidence to its members and convinced the Task Force to study the issue further.

The decision to declassify homosexuality was accompanied by the passage of an APA Position Statement, which supported the protection of the civil rights of homosexual persons.

Some APA members, primarily psychoanalysts who continued to espouse pathologizing views of homosexuality, challenged the leadership of the APA by calling for a referendum of the entire APA membership. When the diagnosis of homosexuality was deleted in , the APA did not initially embrace a normal variant model of homosexuality Drescher , Bayer , Krajeski In recognition of the opposition, it made a compromise. Accordingly, individuals comfortable with their homosexuality were no longer considered mentally ill.

Only those who were "in conflict with" their sexual orientation had a mental disorder SOD. This compromise engendered continued controversy. Those opposing it pointed out there were no reported cases of unhappy heterosexual individuals seeking treatment to become homosexual. In these debates openly gay and lesbian members of the APA played a decisive role in bringing about change Krajeski Those on the APA Advisory Committee working on the revision who wanted to retain the EDH category argued that they believed the diagnosis was clinically useful and that it was necessary for research and statistical purposes.

The opponents noted that making a patient's subjective experience of their own homosexuality the determining factor of their illness was not consistent with the new evidence-based approach that psychiatry had espoused. They argued that empirical data do not support the diagnosis and that it is inappropriate to label culturally induced homophobia as a mental disorder. Many of those opposed to the diagnosis of EDH had viewed it as a diagnostic relic that had indirectly, if not directly, perpetuated the mental illness model of homosexuality.

Removing it was a crucial step in a paradigm shift that would help psychiatry focus on more relevant models and concepts in understanding gay men and lesbians. The change nevertheless remains controversial, and a small group of psychologists and analysts the National Association for Research and Therapy of Homosexuality [ NARTH ] continues to argue that homosexuality is a dysfunction and can be corrected.

The change also encouraged the American Psychological Association and other mental health groups to depathologize homosexuality as well as make further progressive statements on gays and lesbians. The American Psychiatric Association APA labeled discrimination in employment based on sexual orientation as irrational in It opposed exclusion and dismissal from the armed forces on the basis of sexual orientation in In , the APA added immigration and naturalization decisions to areas in which it opposes discrimination against homosexuals.

It supported the right to privacy in adult consensual relations conducted in private, also in In , the APA encouraged its members to help prevent and respond actively to bias-related incidents related to sexual orientation. An APA position statement in opposed any psychiatric treatment based on the assumption that homosexuality is a medical disorder or that patients should change their sexual orientation, including "reparative" or "conversion therapies.

Also in , the APA approved a position statement supporting the legal recognition of same-sex unions. It endorsed an initiative allowing adoption and co-parenting of children by same-sex couples in In , the APA endorsed the right of gay people to enter into same-sex civil marriage.

The American Psychoanalytic Association APsaA adopted a position statement in opposing discrimination against gay people, and it directed that the selection of candidates for training not be based on sexual orientation. In , ApsaA endorsed same-gender couples having equal rights to marry. It affirmed that "reparative" therapy is against fundamental principles of psychoanalytic treatment in , and it opposed discrimination based on sexual orientation in parenting and adoption in Gay and lesbian psychiatrists met informally and in secret for many years during the course of the annual meeting of the American Psychiatric Association, often in gay bars or members' hotel suites.

Difficult as it may be for today's young psychiatrist to imagine, prior to the declassification of homosexuality in , a psychiatrist who revealed that he or she was gay risked not only losing their job but in some states their medical license as well.

As a result of non-psychiatrist gay activists protesting and disrupting the APA's and annual meetings, the first gay-affirmative presentations were organized at the APA.

Fryer appeared as "Dr. Anonymous," disguised in an oversized tuxedo, a cloak, a rubber fright mask, so as to disguise his identity. He stunned the audience of psychiatrists by stating in a voice distorted to further protect his identity, "I am a homosexual. I am a psychiatrist. It was the first time a gay psychiatrist had dared address colleagues at a professional meeting.

Over the next few years gay and lesbian members continued to organize and were often met by hostility Hire The following year, the Assembly APA's legislative branch approved adding elected representatives from a group initially designated as the Caucus of Homosexually Identified Psychiatrists, and later renamed the Caucus of Gay, Lesbian, and Bisexual psychiatrists.

Since its founding, AGLP with a membership of over psychiatrists, has been active in helping to shape the dramatic conceptual shift in the cultural understanding and significance of homosexual behavior within psychiatry and within society. With the support of AGLP members, the APA has issued Position Statements supporting same sex unions and the adoption and co-parenting of children by same sex couples, as well as a position statement opposing "Reparative Therapy" as unethical.

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