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When Homosexuality Stopped Being a Mental Disorder in the DSM

JUL. 26, 2024 


By Brian Dick 


Social and cultural factors shape how mental health disorders are identified, understood, classified, and diagnosed. This can be seen in the ways in which psychiatry has changed its views on homosexuality over time. Prior to the 1970s, most psychiatrists viewed homosexuality as a pathology or a sign of immaturity and stunted growth. Such beliefs were generally reinforced by views of gender that assumed gender differences between men and women were “essential” and universal, instead of social constructions. Thus, it is not surprising that in 1952 when the American Psychiatric Association (APA) published the first edition of the Diagnostic and Statistical Manual (DSM-I), the reference book used to classify mental disorders, homosexuality was included as a “sociopathic personality disturbance,” while the DSM-II (published in 1968) referred to it as a “sexual deviation.”


Due to the use of biased samples, psychiatrists tended to view homosexuality as being very rare. This understanding began to change after Alfred Kinsey and other sexologists found homosexuality to be much more common in the population, although not as high as Kinsey’s reported 10 percent. Gay and lesbian activist disrupted the annual meetings of American Psychiatric Association in 1971 and 1972, arguing that the listing of homosexuality as a mental disorder contributed to the social stigma against homosexuals. The interventions by activists pushed psychiatrists to rethink the classification. In 1973, the APA’s Board of Trustees voted to remove homosexuality from the DSM, a decision supported by 58 percent of the association’s 10,000 members. However, the DSM-II still listed “Sexual Orientation Disturbance,” while the DSM-III, released in 1980, referred to it as “Ego Dystonic Homosexuality.” These labels could be used to justify the employment of conversion therapy, which is no longer practiced due to the harm it causes. Neither classification was justified by the principles of nosology, or classification, employed in the DSM. 




It was only in 1987, with the publication of the revised DSM-III-R, that ego-dystonic homosexuality was removed from the reference book. Theories explaining homosexuality as a pathology or developmental immaturity were replaced by ones that saw it as simply part of normal variations of individuals that shouldn’t be considered a psychopathology. This change in classification helped reduce the social stigma of homosexuality and facilitate the expansion of civil rights for the LGBTQ+ community. Mental health professionals are no longer concerned with the causes of homosexuality or how to treat it; instead, the focus is on providing the best mental health care for LGBTQ+ clients.     


ADDITIONAL READING


When Homosexuality Stopped Being a Mental Disorder


Out of DSM: Depathologizing Homosexuality


“Gay Is Good”: History of Homosexuality in the DSM and Modern Psychiatry


Expanding the Mental Health Workforce in California