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Within psychiatry, how is homosexuality discussed or classified?

Within psychiatry, how is homosexuality discussed or classified?


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I acknowledge the fact that we currently don't understand the causes of homosexuality nearly well enough, but I have read about the following points:

  • That homosexuality may not be a choice and could have genetic grounds (different studies and views presented in this article).
  • That it may be a result of a traumatic experience (as this article suggests).

Without intentional cause of offense, based on these I am under the impression that homosexuality could potentially be a mental disorder.

Within psychiatry, how is homosexuality discussed or classified?


To add to these great answers, I'll go on and link to this article. It discusses the DSM (as mentioned in other answers), but also includes a discussion of the homosexual classifications in the ICD (which is maintained by the WHO, as opposed to the APA). The ICD is much broader than the DSM, though. "It is distinguished from the DSM in that it covers health as a whole" (Wikipedia).

As with all other answers to this question, the answer from both of the manuals is currently "no" (though it was "yes" for both of these in the past).

However, relating to the mention of homosexuality not being a choice: if someone was homosexual, but wished they weren't (or weren't homosexual, but wished they were), this may classify under ego-dystonic sexual orientation, which is listed under the ICD-10 as a disorder of sexual development and orientation. It is not formally listed under the DSM (though it can still be implied: read the linked Wiki article for more details). This is also discussed in @Chris' answer.

The disorder here wouldn't be the homosexuality per se, but the fact that the sexual orientation clashes with the individuals ideal self image. An example may be something like this case of a homophobic homosexual (the key piece being that someone wants to be different than how they are).


In 1973, the American Psychiatric Association (APA) removed the diagnosis of “homosexuality” from the second edition of its Diagnostic and Statistical Manual (DSM) (Jack Drescher, 2015).

Theories of pathology which declared that some internal defect or external pathogenic agent causes homosexuality, have been rejected, such as the theories of immaturity which considered the homosexuality a "developmental arrest".

It is rare to find a theory of homosexuality that does not draw upon gender beliefs that contain implicit cultural ideas about the “essential” qualities of men and women. Who is a real man? Who is a real woman? Since there weren't scientific evidences to claim: "Homosexuality is a mental disorder", after a vote, Homosexuality has been depathologized.

Accordingly, the answer to your question is no. Homosexuality is not a mental disorder, it's just a normal sexual orientation.

For further informations i suggest: "Out of DSM: Depathologizing Homosexuality" (Jack Drescher) 2015 : LINK:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695779/


Whilst there have been arguments for the idea that homosexuality has a genetic base or a result of malformations of human development, today's consensus is that homosexuality is a normal variant of human behaviour (e.g. Gonsiorek, 1982) [not resulting in - or a result of - psychological disturbances or maladjustment], and therefore it is not a mental disorder.

Homosexuality was considered to be a mental disorder in 1973, but it is not now [as of 1987].

The history

There is an extensive write-up on the history of this on the AGLP Website, and when classifying behaviours as mental disorders, you currently need to refer to the the American Psychiatric Association [APA] publication, Diagnostic and Statistical Manual of Mental Disorders [DSM] and homosexuality had been officially classified as a mental disorder in first DSM [DSM-1] in 1952. However, the APA removed homosexuality from the DSM (AGLP, n.d.).

Presented with data from researchers such as Alfred Kinsey and Evelyn Hooker, the sixth printing of the DSM-II, in 1974, no longer listed homosexuality as a category of disorder.

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. Others failed to safeguard the data collection procedures from possible biases by the investigators - for example, a man's psychological functioning would be evaluated by his own psychoanalyst, who was simultaneously treating him for his homosexuality.

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.

In a review of published studies comparing homosexual and heterosexual samples on psychological tests, Gonsiorek (1982) 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, 1982, p. 74)

(Source: University of California, Davis)

After a vote by the APA trustees in 1973, and confirmed by the wider APA membership in 1974, the diagnosis was replaced with the category of "sexual orientation disturbance" and a related but less public controversy involved what became the DSM-III category of Ego-dystonic Homosexuality [EDH] (Spitzer, 1981).

During the revision process of DSM-III in the mid 1980's EDH also engendered enormous controversy. In these debates openly gay and lesbian members of the APA played a decisive role in bringing about change (Krajeski 1996). 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. The APA Committee agreed with the opponents and the diagnosis of ego-dystonic homosexuality was removed from DSM-III-R (1987).

References

AGLP, n.d. The History of Psychiatry & Homosexuality [Online]
Available at: http://www.aglp.org/gap/1_history

Gonsiorek, J. C., 1982. Results of psychological testing on homosexual populations. In: W. Paul, J. D. Weinrich, J. C. Gonsiorek, & M. E. Hotvedt (Eds.), Homosexuality: Social, psychological, and biological issues (pp. 71-80). Beverly Hills, CA: Sage

Krajeski, J., 1996. Homosexuality and the mental health professions. In: Textbook of Homosexuality and Mental Health, ed. R. Cabaj & T. Stein, pp 17-31. Washington: American Psychiatric Press.

Spitzer, R.L., 1981. The diagnostic status of homosexuality in DSM-III: a reformulation of the issues. American Journal of Psychiatry. 138(2): pp 210-215.
PMID 7457641. DOI: 10.1176/ajp.138.2.210.


The idea that homosexuality is disadvantageous from an evolutionary perspective is, in my view, an example of how cultural bias is confused with biological process. While there is evidence that sexual identity has some genetic basis, it is certainly a complicated feature of our identity that cannot be explained by a single gene, and should not be oversimplified into saying 'gay men had so and so trauma'. To me, that sounds similar to the argument 'vegetarians were never taught to hunt', i.e we're taking a complicated matter and trying to explain it using an argument that is based on shaky and highly individual grounds. It sounds like you're not offering any evidence on this (correct me if I'm wrong), but instead basing your claim off of some stereotypes and anecdotes about gay men. Well, how about gay women? Or bisexual people?

Crucially, we cannot, in a just society, consider homosexuality (or any sexual or gender identity) as a mental disorder, because that denies individuals the right to self-identify. If everyone who is gay is said to have a disorder, then we take away the right of those people to speak for themselves and describe their own experiences.

Finally, we shouldn't base our mental disorders off of the question 'does this help one achieve the goals of living and breeding?' This would be an example of teleological thinking about evolution, that is, assuming that evolution has a specific end goal in mind. Evolution, instead, is a natural process based off of random chance. It does not make sense to assume that what is good for our species (classically, surviving and breeding) should be the same as what is good for an individual member of the species.

I hope this answer was a helpful addition to the discussion.


Not by the standards of the DSM-IV-TR. Other answers discuss the case of homosexuality specifically, but the general principles of psychiatric diagnosis also rule out the idea of homosexuality as a mental disorder.

The DSM-IV-TR characterizes a mental disorder as "a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual [which] is associated with present distress… or disability… or with a significant increased risk of suffering." It also notes that "no definition adequately specifies precise boundaries for the concept of 'mental disorder'… different situations call for different definitions". It states that "there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorder" (APA, 1994 and 2000).

Mental disorders are defined by distress, disability, and suffering, not by nebulous concepts like evolutionary fitness. Likewise, they are not defined by choice or nature or nurture.


For something to be a disorder, it must of itself cause a negative outcome for the individual.

(As an aside: "… there is a recurring theme among men who live a homosexual lifestyle that they had an absence of a father figure and attempt to overcompensate… " Evidence required, please?)

"… as gay couples can not generate offspring… " This statement implicitly assumes that offspring can only be generated as part of a relationship, which is clearly and categorically untrue. Of course two gay people cannot (without medical help) produce offspring, but a gay person is perfectly at liberty to have heterosex if they choose. This may be as part of a relationship (as Kinseyshowed first, homo/hetero preferences are a sliding scale and not binary), because they enjoy heterosex but do not form heterosexual relationships, or simply holding their nose and doing something distasteful because they want the results. In the latter case, "the results" doesn't just include children but also social acceptance in a homophobic social environment.

Naturally it is physically easier for a woman to have heterosex without enjoyment than a man. Even so though, it is perfectly possible for a man to keep a mental fantasy going which does allow him to perform, even if he doesn't find his partner attractive. A genetic cause for homosexuality therefore cannot be "evolved out", because there is no limit to homosexual people of either gender having children. This therefore puts homosexuality into the same category as lefthandedness - a deviation from the majority, certainly, but not one which makes an evolutionary difference.

This all purely relates to whether homosexual people are physically able to conceive children. Survival and life chances are also highly relevant to whether a child prospers though, after the child has been conceived. This is hard to analyse, but studies of outcomes since gay couples have been allowed to adopt suggests that they are at least as good parents as heterosexual couples.

So your proposition fails. Homosexuality cannot be a disorder, because it does not by itself produce any negative outcomes for the individual.



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