Ego-dystonic sexual orientation

[1] Under pressure from members of the psychiatry and psychology fields and mounting scientific evidence that the desire to be heterosexual is a common phase in a gay (including lesbian) or bisexual person's identity development rather than an indication of mental illness, the diagnosis was removed seven years later,[2] but ego-dystonic sexual orientation was added to the ICD-10 in 1990.

[3] The ICD-11, which was approved in 2019 and went into effect in January 2022, does not include any diagnostic categories that can be applied to people on the basis of sexual orientation, bringing the ICD in line with the DSM-5.

"[13][12] That same year, a task force was appointed to develop the DSM-III, led by Robert Spitzer, the psychiatrist who had originally drafted the proposal to replace homosexuality with sexual orientation disturbance.

Spitzer felt that it was important to take "a middle position regarding the pathological status of homosexuality"; nine members of the task force agreed with him and five disagreed, leading to a deadlock.

[14]Leading up to the publication of the DSM-III-R, it had become clear to more and more people that the inclusion of "sexual orientation disturbance" and later "ego-dystonic homosexuality" in the DSM was the result of political compromises rather than scientific evidence, and that neither diagnosis actually met the definition of a disorder.

Critics pointed out that by the same logic, short people unhappy with their height could be considered mentally ill.[1] As the DSM-III revision process neared its completion, a growing number of APA members began advocating for deleting the category of ego-dystonic homosexuality, arguing that it was incompatible with the structure of the manual, had not proved useful in research, represented a "value judgment" that homosexuality was a pathology, and contributed to anti-gay stigma.

[2] Terry Stein, a member of APA's Committee on Gay, Lesbian, and Bisexual Issues, noted that there was a "vast amount of psychological, sociological and historical literature that documents the fact that the wish not to have a pattern of homosexual arousal can be a normative stage for many individuals who are developing a gay or lesbian identity" rather than such feelings being indicative of a mental disorder, and further noted that such an erroneous diagnosis could hinder treatment of the distress.

[15][16] What was notable about this change was that it no longer singled out same-sex attraction as the only form of sexuality that might cause distress worthy of a mental health diagnosis.

[17] The ninth edition of the ICD (ICD-9), published in 1975, retained homosexuality as a category of mental disorder under "Sexual Deviations and Disorders," in contrast with the APA's 1973 decision to remove homosexuality from the DSM, and the authors seemingly rationalized this decision by way of a confusingly worded disclaimer in the introduction to the section: "The limits and features of normal sexual inclination and behaviour have not been stated absolutely in different societies and cultures but are broadly such as serve approved social and biological purposes.

The ICD-11, which was approved in 2019 and went into effect in January 2022, does not include any diagnostic categories that can be applied to people on the basis of sexual orientation, bringing the ICD in line with the DSM-5.

[31][29][32][33] In 2009, an American Psychological Association task force reported that offering appropriate therapeutic interventions to individuals who wish they could change their sexual orientation requires "therapist acceptance, support, and understanding of clients and the facilitation of clients' active coping, social support, and identity exploration and development, without imposing a specific sexual orientation identity outcome.

[1][6] In 2009, a research study revealed that 1 in 6 psychological therapists in the UK had helped clients in reducing their feelings of same-sex attraction or attempting to change their sexual orientation at some point in their career.

"[3] In some countries where homosexuality is criminalized, the medical legacy has been drawn on to help justify harsh penalties for people who engage in same-sex sexual activities.

[7] A member of the board of the ex-gay organization Exodus International (which later repudiated its aims, apologized for the harm caused, and folded) attended a Ugandan seminar to show support for the bill.