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Classification of homosexuality has undergone major changes in different editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association (APA). Although many people consider homosexuality to have been declassified as a mental disorder in 1974 with the seventh printing of the DSM-II, a diagnosis of distress related to one's sexual orientation remained in the manual, under different names, until the DSM-5 in 2013.

Pre-DSM

The DSM's direct predecessor was the Statistical Manual for the Use of Institutions of the Insane, first published in 1918 (by its 10th edition in 1942 it had become called the Statistical Manual for the Use of Hospitals of Mental Diseases).^[1] The Statistical Manual was ambiguous on the topic of homosexuality; it included a condition called "constitutional psychopathic inferiority (without psychosis)" that was described as "a large group of pathological personalities" including "sexual perversions."^[2] Meanwhile, in the 1935 Standard Classified Nomenclature of Disease, homosexuality was classified as a "pathological sexuality" under the category of "psychopathic personality."^[3]

DSM-I

When the APA published the DSM-I in 1952, homosexuality was classified as a "sexual deviation" within the larger “sociopathic personality disturbance” category of personality disorders. The sexual deviation diagnosis included "homosexuality, transvestism, pedophilia, fetishism and sexual sadism" as examples.^[4]

Four years prior to the publication of the DSM-I, the first Kinsey Report was published by Alfred Kinsey and his fellow researchers, which took the world by storm by announcing that "only 50 percent of the adult population is exclusively heterosexual throughout its adult life,"^[5] based on a study of 5,300 men, but the psychiatry field was hostile to the Kinsey Report and the implications that same-sex sexual behavior was far more common than mainstream society had previously believed.^[6] In 1956, psychologist Evelyn Hooker compared the happiness and well-adjusted nature of 30 self-identified homosexual men with 30 heterosexual men and found no difference, which similarly stunned the medical community.^[7] Hooker argued that researchers who claimed homosexuality was a mental disorder were drawing a false correlation by only studying homosexuals who had a history of treatment for mental illness. Meanwhile, a study of 106 homosexual men by Irving Bieber and other researchers, published in 1962, was used to justify the inclusion of homosexuality as a supposed pathological hidden fear of the opposite sex caused by traumatic parent–child relationships, a view that was influential in the medical profession.^[7]

DSM-II

Initial classification

The DSM-II, published in 1968, expanded the "sexual deviation" diagnostic category (now located within the larger category of "personality disorders and certain other nonpsychotic mental disorders") so that different "sexual deviations" were listed under ten individual diagnostic codes: homosexuality, fetishism, pedophilia, transvestitism, exhibitionism, voyeurism, sadism, masochism, other sexual deviation, and unspecified sexual deviation.^[8]^[3] While the DSM-I and its precursor the Statistical Manual included ambiguity in terms of whether homosexuality was a mental disorder, the DSM-II removed that ambiguity and clearly presented homosexuality and the other "sexual deviations" as mental disorders.^[2]

Change to seventh printing

After extensive organizing by gay rights activists, the seventh printing of the DSM-II in 1974 renamed the code "homosexuality" as "sexual orientation disturbance," and added descriptive text that noted that homosexuality "by itself does not constitute a psychiatric disorder" and that the renamed code should be used for "individuals whose sexual interests are directed primarily toward people of the same sex and who are either disturbed by, in conflict with, or wish to change their sexual orientation."^[9] This was considered a major victory by gay activists, because it clearly articulated a shift from considering homosexuality a mental disorder to only characterizing people as unwell if their sexual orientation caused them distress. The change was a compromise between competing schools of thought within the psychiatry field: the view that homosexuality was a pathological condition and the view that homosexuality is a normal variation of sexuality.^[3]^[2]

Background

The activism that resulted in changing the seventh printing of the DSM-II began in earnest in the wake of the Stonewall Uprising in 1969.^[10] Specific protests by gay rights activists against the APA began in 1970, when the organization held its convention in San Francisco.^[11] The activists disrupted the conference by interrupting speakers and shouting down and ridiculing psychiatrists who viewed homosexuality as a mental disorder. At the 1971 conference, gay rights activist Frank Kameny, working with the Gay Liberation Front to demonstrate against the convention, grabbed the microphone and yelled: "Psychiatry is the enemy incarnate. Psychiatry has waged a relentless war of extermination against us. You may take this as a declaration of war against you."^[11] At the 1972 conference, gay psychiatrist John E. Fryer spoke to the audience about what it was like for the many gay psychiatrists in the APA who had to hide their sexuality due to anti-gay prejudice within the field; he wore a mask and a wig and used a voice distorter to conceal his identity.^[12] This activism occurred in the context of a broader anti-psychiatry movement that had come to the fore in the 1960s and was challenging the legitimacy of psychiatric diagnosis. Anti-psychiatry activists protested at the same APA conventions, with some shared slogans and intellectual foundations.^[13]^[14] Psychiatrist Robert Spitzer, who served as technical consultant to the DSM-II Committee on Nomenclature and Statistics, became a go-between in the dispute. Spitzer originally believed that homosexuality belonged in the DSM, but after meeting with gay activists, including a secret group of gay APA members later known as the Association of Gay and Lesbian Psychiatrists, and faced with data from researchers such as Kinsey and Hooker, he drafted the compromise of removing homosexuality itself from the DSM and replacing it with "sexual orientation disturbance."^[2]^[15] After a vote by the APA board of trustees in December 1973, and confirmed by the wider APA membership in 1974, this change was made.^[16] Psychiatrist Richard Green, who had argued forcefully in favor of declassifying homosexuality as a mental disorder, viewed Spitzer’s insistence on including a diagnosis for homosexuals who were distressed by their sexuality as a poorly disguised attempt to maintain anti-homophobic bias in the DSM, and publicly resigned from the APA nomenclature committee over it.^[17] Meanwhile, critics argued that declassifying homosexuality was a result of pressure from gay activists and demanded a referendum among voting members of the APA. The referendum was held in 1974 and the APA's decision was upheld by a 58% majority.^[11]

Despite the retention of "sexual orientation disturbance," gay activists celebrated the removal of homosexuality from the APA's list of mental disorders and declared victory. Kameny, now the head of the Mattachine Society of Washington, said, "This represents the culmination of a decade-long battle," and Ronald Gold of the National Gay Task Force declared, "We've won."^[18]

The APA published a position statement that urged an end to anti-homosexual discrimination and called for decriminalizing private sexual acts between consenting adults. However, the APA also made it clear that it did not endorse the view that homosexuality was a normal variant of sexuality.^[10]

DSM-III

Classification

In the DSM-III, published in 1980, "sexual orientation disorder" was reworked as "ego-dystonic homosexuality" and the overarching categories were reorganized. The DSM-III included the completely new overarching diagnostic category "psychosexual disorders," which was divided into four subcategories:

"gender identity disorders" (e.g., "transsexualism")
"paraphilias" (which included everything previously called "sexual deviations" except for sexual orientation disturbance, with the addition of "zoophilia")
"psychosexual dysfunctions" (e.g., "inhibited sexual desire" and "premature ejaculation")
"other pyschosexual disorders" (which consisted of two diagnoses: "ego-dystonic homosexuality" and "psychosexual disorder not elsewhere classified")^[19]

"Ego-dystonic homosexuality" was defined as having a desire to be heterosexual but not experiencing heterosexual arousal, or experiencing unwanted or distressing homosexual arousal that gets in the way of being heterosexual.^[19]

Background

The decision to include this reworked diagnosis in the DSM-III came after years of continued debate and controversy, both public and private. More and more scientific evidence challenged the assumption that homosexuality was a pathological condition, yet many within the psychiatric field adamantly believed it was.^[20]^[21] Robert Spitzer was chosen to lead the DSM-III's Task Force on Nomenclature, and he continued to feel 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.^[11] Classifications of "homodysphilia," "dyshomophilia," and "homosexual conflict disorder" were discussed, until finally, "ego-dystonic homosexuality" was proposed, along with a conceptual shift: instead of focusing on distress about being homosexual, the new classification was about a desire to be heterosexual and distress at one's inability to achieve that desire.^[3]^[11] A proposal to include additional information such as a note about how internalized homophobia can be a contributing factor eventually swayed enough critics; others, including Richard Green and Richard Pillar, remained adamantly opposed to including homosexuality in the DSM in any form, but they were eventually overruled.^[11]

"Ego-dystonic homosexuality" and its predecessor, "sexual orientation disturbance," both legitimized so-called sexual conversion therapies.

DSM-III-R

Classification

In 1987, the APA published a major revision of the DSM-III (the DSM-III-R), again under the leadership of Robert Spitzer. In this edition, the category of "psychosexual disorders" was renamed "sexual disorders." The subsection "gender identity disorders" was moved to a different category—"disorders usually first evident in infancy, childhood, or adolescence"—and the "paraphilias" subsection was slightly reorganized. Most importantly, the "ego-dystonic homosexuality" classification was removed in favor of including "persistent and marked distress about one’s sexual orientation" as one of three examples within the classification "sexual disorder not otherwise specified."^[22]^[23]

Background

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 rightly pointed out that by the same logic, short people unhappy with their height could be considered mentally ill.^[24] Also influential was the fact that it had been proven that psychological therapies could not "cure" homosexuality.^[25]

Just like in 1974 with the repackaging of "homosexuality" as "sexual orientation disturbance," in 1987 many people saw the removal of "ego-dystonic homosexuality" as the APA removing homosexuality from the DSM, but although the word "homosexuality" was removed, treatment was still provided.^[6] Mental health professionals could—and did—still diagnose LGB people with "sexual disorder not otherwise specified," thanks to the retention of "distress about one's sexual orientation" as part of that diagnostic category.

DSM-IV and DSM-IV-TR

No change was made to the "sexual disorder not otherwise specified" category in either the DSM-IV, published in 1994, or the text revision of the manual in 2000 (the DSM-IV-R). "Persistent and marked distress about sexual orientation" was still included as one of that category's examples.^[26] The overarching section of the manual was renamed "sexual and gender identity disorders" and the "gender identity disorders" subsection was moved back into this section.

DSM-5

The DSM-5, published in 2013, does not include any diagnostic category that can be applied to people based on their sexual orientation. Some scholars have argued that only this can be considered "complete declassification" of non-heterosexual sexual orientations as mental disorders.^[26]

References

^ Clark, Lee Anna; Cuthbert, Bruce; Lewis-Fernández, Roberto; Narrow, William E.; Reed, Geoffrey M. (2017). "Three Approaches to Understanding and Classifying Mental Disorder: ICD-11, DSM-5 , and the National Institute of Mental Health's Research Domain Criteria (RDoC)". Psychological Science in the Public Interest. 18 (2): 72–145. doi:10.1177/1529100617727266. ISSN 1529-1006.
^ ^a ^b ^c ^d De Block, Andreas; Adriaens, Pieter R. (2013). "Pathologizing Sexual Deviance: A History". Journal of Sex Research. 50 (3–4): 276–298. doi:10.1080/00224499.2012.738259. ISSN 0022-4499.
^ ^a ^b ^c ^d Anderson, Joel; Holland, Elise (6 October 2015). "The legacy of medicalising 'homosexuality': A discussion on the historical effects of non-heterosexual diagnostic classifications". Sensoria: A Journal of Mind, Brain & Culture. 11 (1). doi:10.7790/sa.v11i1.405. ISSN 2203-8469.
^ American Psychiatric Association. (1953). Diagnostic and statistical manual of mental disorders.
^ Kinsey, Alfred C.; Pomeroy, Wardell B.; Martin, Clyde E. (1998). Sexual behavior in the human male. Bloomington, Ind.: Indiana University Press. p. 656. ISBN 978-0-253-01923-3. OCLC 606987885.
^ ^a ^b Wyatt-Nichol, Heather (2014). "Sexual Orientation and Mental Health: Incremental Progression or Radical Change?". Journal of Health and Human Services Administration. 37 (2): 225–241. ISSN 1079-3739.
^ ^a ^b Edsall, Nicholas C. (2003). Toward Stonewall: Homosexuality and Society in the Modern Western World. University of Virginia Press. ISBN 978-0-8139-2211-9.^{[page needed]}
^ American Psychological Association. (1968). Diagnostic and statistical manual of mental disorders (2nd ed.).
^ American Psychiatric Association. (1973). Homosexuality and sexuality orientation disturbance: Proposed change in DSM-II, 6th printing, page 44. APA Document Reference No. 730008. https://pages.uoregon.edu/eherman/teaching/texts/DSM-II_Homosexuality_Revision.pdf
^ ^a ^b Drescher, Jack (2010). "Queer Diagnoses: Parallels and Contrasts in the History of Homosexuality, Gender Variance, and the Diagnostic and Statistical Manual". Archives of Sexual Behavior. 39 (2): 427–460. doi:10.1007/s10508-009-9531-5. ISSN 0004-0002.
^ ^a ^b ^c ^d ^e ^f Ronald Bayer. (1987). Homosexuality and American Psychiatry: The Politics of Diagnosis. Princeton University Press.
^ Clendinen, Dudley (5 March 2003). "Dr. John Fryer, 65, Psychiatrist Who Said in 1972 He Was Gay". The New York Times. ISSN 0362-4331.
^ McCommon, B. (2006) Antipsychiatry and the Gay Rights Movement Psychiatr Serv 57:1809, December doi:10.1176/appi.ps.57.12.1809
^ Rissmiller, DJ, D.O., Rissmiller, J. (2006) Letter in reply Psychiatr Serv 57:1809-a-1810, December 2006 doi:10.1176/appi.ps.57.12.1809-a
^ Spiegel, Alix; Glass, Ira (18 January 2002). "81 Words". This American Life. Chicago: WBEZ Chicago Public Radio.
^ Spitzer, R.L. (1981). "The diagnostic status of homosexuality in DSM-III: a reformulation of the issues". Am J Psychiatry. 138 (2): 210–215. doi:10.1176/ajp.138.2.210. PMID 7457641.
^ Bayer, R.; Spitzer, R. L. (1982). "Edited correspondence on the status of homosexuality in DSM-III". Journal of the History of the Behavioral Sciences. 18 (1): 32–52. doi:10.1002/1520-6696(198201)18:1<32::aid-jhbs2300180105>3.0.co;2-0. ISSN 0022-5061. PMID 7040544.
^ "Sick No More". Washington Post. ISSN 0190-8286. Retrieved 15 January 2022.
^ ^a ^b American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.).
^ Bayer, Ronald (1987), Engelhardt, Jr., H. Tristram; Caplan, Arthur L. (eds.), "Politics, science, and the problem of psychiatric nomenclature: a case study of the American Psychiatric Association referendum on homosexuality", Scientific Controversies (1 ed.), Cambridge University Press, pp. 381–400, doi:10.1017/cbo9780511628719.018, ISBN 978-0-521-25565-3
^ Stoller, Robert J.; Marmor, Judd; Bieber, Irving; Gold, Ronald; Socarides, Charles W.; Green, Richard; Spitzer, Robert L. (1973). "A Symposium: Should Homosexuality Be in the APA Nomenclature?". American Journal of Psychiatry. 130 (11): 1207–1216. doi:10.1176/ajp.130.11.1207. ISSN 0002-953X.
^ American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.).
^ Mayes, R.; Horwitz, AV. (2005). "DSM-III and the revolution in the classification of mental illness". J Hist Behav Sci. 41 (3): 249–67. doi:10.1002/jhbs.20103. PMID 15981242.
^ Drescher, Jack (2015). "Out of DSM: Depathologizing Homosexuality". Behavioral Sciences. 5 (4): 565–575. doi:10.3390/bs5040565. ISSN 2076-328X. PMC 4695779. PMID 26690228.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
^ Cochran, Susan D; Drescher, Jack; Kismödi, Eszter; Giami, Alain; García-Moreno, Claudia; Atalla, Elham; Marais, Adele; Vieira, Elisabeth Meloni; Reed, Geoffrey M (2014). "Proposed declassification of disease categories related to sexual orientation in theInternational Statistical Classification of Diseases and Related Health Problems(ICD-11)". Bulletin of the World Health Organization. 92 (9): 672–679. doi:10.2471/blt.14.135541. ISSN 0042-9686. PMC 4208576. PMID 25378758.{{cite journal}}: CS1 maint: PMC format (link)
^ ^a ^b Robles, Rebeca; Real, Tania; Reed, Geoffrey M. (2021). "Depathologizing Sexual Orientation and Transgender Identities in Psychiatric Classifications". Consortium Psychiatricum. 2 (2): 45–53. doi:10.17816/CP61. ISSN 2713-2919.

[1] Clark, Lee Anna; Cuthbert, Bruce; Lewis-Fernández, Roberto; Narrow, William E.; Reed, Geoffrey M. (2017). "Three Approaches to Understanding and Classifying Mental Disorder: ICD-11, DSM-5 , and the National Institute of Mental Health's Research Domain Criteria (RDoC)". Psychological Science in the Public Interest. 18 (2): 72–145. doi:10.1177/1529100617727266. ISSN 1529-1006.

[:1-2] De Block, Andreas; Adriaens, Pieter R. (2013). "Pathologizing Sexual Deviance: A History". Journal of Sex Research. 50 (3–4): 276–298. doi:10.1080/00224499.2012.738259. ISSN 0022-4499.

[:2-3] Anderson, Joel; Holland, Elise (6 October 2015). "The legacy of medicalising 'homosexuality': A discussion on the historical effects of non-heterosexual diagnostic classifications". Sensoria: A Journal of Mind, Brain & Culture. 11 (1). doi:10.7790/sa.v11i1.405. ISSN 2203-8469.

[4] American Psychiatric Association. (1953). Diagnostic and statistical manual of mental disorders.

[5] Kinsey, Alfred C.; Pomeroy, Wardell B.; Martin, Clyde E. (1998). Sexual behavior in the human male. Bloomington, Ind.: Indiana University Press. p. 656. ISBN 978-0-253-01923-3. OCLC 606987885.

[:3-6] Wyatt-Nichol, Heather (2014). "Sexual Orientation and Mental Health: Incremental Progression or Radical Change?". Journal of Health and Human Services Administration. 37 (2): 225–241. ISSN 1079-3739.

[:0-7] Edsall, Nicholas C. (2003). Toward Stonewall: Homosexuality and Society in the Modern Western World. University of Virginia Press. ISBN 978-0-8139-2211-9.^{[page needed]}

[8] American Psychological Association. (1968). Diagnostic and statistical manual of mental disorders (2nd ed.).

[9] American Psychiatric Association. (1973). Homosexuality and sexuality orientation disturbance: Proposed change in DSM-II, 6th printing, page 44. APA Document Reference No. 730008. https://pages.uoregon.edu/eherman/teaching/texts/DSM-II_Homosexuality_Revision.pdf

[:4-10] Drescher, Jack (2010). "Queer Diagnoses: Parallels and Contrasts in the History of Homosexuality, Gender Variance, and the Diagnostic and Statistical Manual". Archives of Sexual Behavior. 39 (2): 427–460. doi:10.1007/s10508-009-9531-5. ISSN 0004-0002.

[:5-11] ^ ^a ^b ^c ^d ^e ^f Ronald Bayer. (1987). Homosexuality and American Psychiatry: The Politics of Diagnosis. Princeton University Press.

[12] Clendinen, Dudley (5 March 2003). "Dr. John Fryer, 65, Psychiatrist Who Said in 1972 He Was Gay". The New York Times. ISSN 0362-4331.

[13] McCommon, B. (2006) Antipsychiatry and the Gay Rights Movement Psychiatr Serv 57:1809, December doi:10.1176/appi.ps.57.12.1809

[14] Rissmiller, DJ, D.O., Rissmiller, J. (2006) Letter in reply Psychiatr Serv 57:1809-a-1810, December 2006 doi:10.1176/appi.ps.57.12.1809-a

[15] Spiegel, Alix; Glass, Ira (18 January 2002). "81 Words". This American Life. Chicago: WBEZ Chicago Public Radio.

[16] Spitzer, R.L. (1981). "The diagnostic status of homosexuality in DSM-III: a reformulation of the issues". Am J Psychiatry. 138 (2): 210–215. doi:10.1176/ajp.138.2.210. PMID 7457641.

[17] Bayer, R.; Spitzer, R. L. (1982). "Edited correspondence on the status of homosexuality in DSM-III". Journal of the History of the Behavioral Sciences. 18 (1): 32–52. doi:10.1002/1520-6696(198201)18:1<32::aid-jhbs2300180105>3.0.co;2-0. ISSN 0022-5061. PMID 7040544.

[18] "Sick No More". Washington Post. ISSN 0190-8286. Retrieved 15 January 2022.

[:6-19] American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.).

[20] Bayer, Ronald (1987), Engelhardt, Jr., H. Tristram; Caplan, Arthur L. (eds.), "Politics, science, and the problem of psychiatric nomenclature: a case study of the American Psychiatric Association referendum on homosexuality", Scientific Controversies (1 ed.), Cambridge University Press, pp. 381–400, doi:10.1017/cbo9780511628719.018, ISBN 978-0-521-25565-3

[21] Stoller, Robert J.; Marmor, Judd; Bieber, Irving; Gold, Ronald; Socarides, Charles W.; Green, Richard; Spitzer, Robert L. (1973). "A Symposium: Should Homosexuality Be in the APA Nomenclature?". American Journal of Psychiatry. 130 (11): 1207–1216. doi:10.1176/ajp.130.11.1207. ISSN 0002-953X.

[22] American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.).

[Revolution-23] Mayes, R.; Horwitz, AV. (2005). "DSM-III and the revolution in the classification of mental illness". J Hist Behav Sci. 41 (3): 249–67. doi:10.1002/jhbs.20103. PMID 15981242.

[24] Drescher, Jack (2015). "Out of DSM: Depathologizing Homosexuality". Behavioral Sciences. 5 (4): 565–575. doi:10.3390/bs5040565. ISSN 2076-328X. PMC 4695779. PMID 26690228.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)

[25] Cochran, Susan D; Drescher, Jack; Kismödi, Eszter; Giami, Alain; García-Moreno, Claudia; Atalla, Elham; Marais, Adele; Vieira, Elisabeth Meloni; Reed, Geoffrey M (2014). "Proposed declassification of disease categories related to sexual orientation in theInternational Statistical Classification of Diseases and Related Health Problems(ICD-11)". Bulletin of the World Health Organization. 92 (9): 672–679. doi:10.2471/blt.14.135541. ISSN 0042-9686. PMC 4208576. PMID 25378758.{{cite journal}}: CS1 maint: PMC format (link)

[:7-26] Robles, Rebeca; Real, Tania; Reed, Geoffrey M. (2021). "Depathologizing Sexual Orientation and Transgender Identities in Psychiatric Classifications". Consortium Psychiatricum. 2 (2): 45–53. doi:10.17816/CP61. ISSN 2713-2919.

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@@ Line 1: / Line 1: @@
 {{Use dmy dates|date=August 2016}}
-Classification of gay, lesbian, and bisexual [[sexual orientation|sexual orientations]] underwent major changes in different editions of ''[[Diagnostic and Statistical Manual of Mental Disorders]]'' (DSM) published by the [[American Psychiatric Association]] (APA). DSM I classified these orientations under "[[paraphilia]]", and DSM II under "sexual orientation disturbance". DSM III further modified this to "[[ego-dystonic]] homosexuality", before finally dropping the subject from DSM-III-R (and subsequent editions).
+Classification of homosexuality has undergone major changes in different editions of the ''[[Diagnostic and Statistical Manual of Mental Disorders]]'' (DSM) published by the [[American Psychiatric Association]] (APA). Although many people consider homosexuality to have been declassified as a mental disorder in 1974 with the seventh printing of the DSM-II, a diagnosis of distress related to one's sexual orientation remained in the manual, under different names, until the [[DSM-5]] in 2013.
+==Pre-DSM==
+The DSM's direct predecessor was the ''Statistical Manual for the Use of Institutions of the Insane'', first published in 1918 (by its 10th edition in 1942 it had become called the ''Statistical Manual for the Use of Hospitals of Mental Diseases'')''.''<ref>{{Cite journal|last=Clark|first=Lee Anna|last2=Cuthbert|first2=Bruce|last3=Lewis-Fernández|first3=Roberto|last4=Narrow|first4=William E.|last5=Reed|first5=Geoffrey M.|date=2017|title=Three Approaches to Understanding and Classifying Mental Disorder: ICD-11, DSM-5 , and the National Institute of Mental Health’s Research Domain Criteria (RDoC)|url=http://journals.sagepub.com/doi/10.1177/1529100617727266|journal=Psychological Science in the Public Interest|language=en|volume=18|issue=2|pages=72–145|doi=10.1177/1529100617727266|issn=1529-1006}}</ref> The ''Statistical Manual'' was ambiguous on the topic of homosexuality; it included a condition called "constitutional psychopathic inferiority (without psychosis)" that was described as "a large group of pathological personalities" including "sexual perversions."<ref name=":1">{{Cite journal|last=De Block|first=Andreas|last2=Adriaens|first2=Pieter R.|date=2013|title=Pathologizing Sexual Deviance: A History|url=http://www.tandfonline.com/doi/abs/10.1080/00224499.2012.738259|journal=Journal of Sex Research|language=en|volume=50|issue=3-4|pages=276–298|doi=10.1080/00224499.2012.738259|issn=0022-4499}}</ref> Meanwhile, in the 1935 ''Standard Classified Nomenclature of Disease'', homosexuality was classified as a "pathological sexuality" under the category of "psychopathic personality."''<ref name=":2">{{Cite journal|last=Anderson|first=Joel|last2=Holland|first2=Elise|date=2015-10-06|title=The legacy of medicalising ‘homosexuality’: A discussion on the historical effects of non-heterosexual diagnostic classifications|url=http://pandora.nla.gov.au/tep/147390|journal=Sensoria: A Journal of Mind, Brain & Culture|volume=11|issue=1|doi=10.7790/sa.v11i1.405|issn=2203-8469}}</ref>''
+==DSM-I==
+When the APA published the [[DSM-I]] in 1952, homosexuality was classified as a "sexual deviation" within the larger “sociopathic personality disturbance” category of personality disorders. The sexual deviation diagnosis included "homosexuality, transvestism, pedophilia, fetishism and sexual sadism" as examples.<ref>American Psychiatric Association. (1953). ''Diagnostic and statistical manual of mental disorders.'' </ref>
+Four years prior to the publication of the DSM-I, the first [[Kinsey Reports|Kinsey Report]] was published by [[Alfred Kinsey]] and his fellow researchers, which took the world by storm by announcing that "only 50 percent of the adult population is exclusively heterosexual throughout its adult life,"<ref>{{Cite book|last=Kinsey|first=Alfred C.|url=https://www.worldcat.org/oclc/606987885|title=Sexual behavior in the human male|last2=Pomeroy|first2=Wardell B.|last3=Martin|first3=Clyde E.|date=1998|publisher=Indiana University Press|isbn=978-0-253-01923-3|location=Bloomington, Ind.|pages=656|oclc=606987885}}</ref> based on a study of 5,300 men, but the psychiatry field was hostile to the Kinsey Report and the implications that same-sex sexual behavior was far more common than mainstream society had previously believed.<ref name=":3">{{Cite journal|last=Wyatt-Nichol|first=Heather|date=2014|title=Sexual Orientation and Mental Health: Incremental Progression or Radical Change?|url=https://www.jstor.org/stable/24459694|journal=Journal of Health and Human Services Administration|volume=37|issue=2|pages=225–241|issn=1079-3739}}</ref> In 1956, psychologist [[Evelyn Hooker]] compared the happiness and well-adjusted nature of 30 self-identified homosexual men with 30 heterosexual men and found no difference, which similarly stunned the medical community.<ref name=":0">{{cite book|last1=Edsall|first1=Nicholas C.|title=Toward Stonewall: Homosexuality and Society in the Modern Western World|date=2003|publisher=University of Virginia Press|isbn=978-0-8139-2211-9}}{{page needed|date=December 2020}}</ref> Hooker argued that researchers who claimed homosexuality was a mental disorder were drawing a [[false correlation]] by only studying homosexuals who had a history of treatment for mental illness. Meanwhile, a study of 106 homosexual men by [[Irving Bieber]] and other researchers, published in 1962, was used to justify the inclusion of homosexuality as a supposed pathological hidden fear of the opposite sex caused by traumatic parent–child relationships, a view that was influential in the medical profession.<ref name=":0" />
 ==DSM-II==
-The DSM-II considered [[homosexuality]] as one form of paraphilia, but in the [[Homosexuality#Seventh printing of the DSM-II, 1974|seventh printing of DSM-II]] homosexuality had shifted to another classification, which is sexual orientation disturbance.  This major change had been preceded by increasing [[1960s in LGBT rights|activities of the LGBT community in the 1960s]], specifically the [[Stonewall riots]] in 1969. These activities continued in [[1970s in LGBT rights|1970]] with the following predominant events:
+=== Initial classification ===
-*As described by Ronald Bayer, a psychiatrist and gay rights activist, specific protests by [[gay rights]] activists against the APA began in 1970, when the organization held its convention in San Francisco.{{Citation Needed|date=January 2021}} The activists disrupted the conference by interrupting speakers and shouting down and ridiculing psychiatrists who viewed homosexuality as a mental disorder. In 1971, gay rights activist [[Frank Kameny]] worked with the [[Gay Liberation Front]] collective to demonstrate against the APA's convention. At the 1971 conference, Kameny grabbed the microphone and yelled: "Psychiatry is the enemy incarnate. Psychiatry has waged a relentless war of extermination against us. You may take this as a declaration of war against you."<ref>Ronald Bayer ''Homosexuality and American Psychiatry: The Politics of Diagnosis'' (1981) Princeton University Press. p. 105</ref> This activism occurred in the context of a broader [[anti-psychiatry]] movement that had come to the fore in the 1960s and was challenging the legitimacy of psychiatric diagnosis. Anti-psychiatry activists protested at the same APA conventions, with some shared slogans and intellectual foundations.<ref>McCommon, B. (2006) [https://web.archive.org/web/20070810054520/http://psychservices.psychiatryonline.org/cgi/content/full/57/12/1809 Antipsychiatry and the Gay Rights Movement] Psychiatr Serv 57:1809, December {{DOI|10.1176/appi.ps.57.12.1809}}</ref><ref>Rissmiller, DJ, D.O., Rissmiller, J. (2006) [https://web.archive.org/web/20070630022511/http://ps.psychiatryonline.org/cgi/content/full/57/12/1809-a Letter in reply] Psychiatr Serv 57:1809-a-1810, December 2006 {{DOI|10.1176/appi.ps.57.12.1809-a}}</ref> Presented with data from researchers such as [[Alfred Kinsey]] and [[Evelyn Hooker]], the seventh printing of the DSM-II, in 1974, no longer listed homosexuality as a category of disorder. 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".<ref>{{cite journal | last1 = Spitzer | first1 = R.L. | year = 1981 | title = The diagnostic status of homosexuality in DSM-III: a reformulation of the issues | url = http://ajp.psychiatryonline.org/cgi/content/abstract/138/2/210 | journal = Am J Psychiatry | volume = 138 | issue = 2| pages = 210–215 | pmid = 7457641 | doi=10.1176/ajp.138.2.210}}</ref>
+The [[DSM-II]], published in 1968, expanded the "sexual deviation" diagnostic category (now located within the larger category of "personality disorders and certain other nonpsychotic mental disorders") so that different "sexual deviations" were listed under ten individual diagnostic codes: homosexuality, fetishism, pedophilia, transvestitism, exhibitionism, voyeurism, sadism, masochism, other sexual deviation, and unspecified sexual deviation.<ref>American Psychological Association. (1968). ''Diagnostic and statistical manual of mental disorders'' (2nd ed.).</ref><ref name=":2" /> While the DSM-I and its precursor the ''Statistical Manual'' included ambiguity in terms of whether homosexuality was a mental disorder, the DSM-II removed that ambiguity and clearly presented homosexuality and the other "sexual deviations" as mental disorders.<ref name=":1" />
-* 1973 – On 15 October the Australian and New Zealand College of Psychiatry Federal Council declares homosexuality not an illness – the first such body in the world to do so; in December the American Psychiatric Association removes homosexuality from its Diagnostic and Statistical Manual of Mental Disorders (DSM-II), based largely on the research and advocacy of [[Evelyn Hooker]].
+=== Change to seventh printing ===
+After extensive organizing by [[gay rights]] activists, the seventh printing of the DSM-II in 1974 renamed the code "homosexuality" as "sexual orientation disturbance," and added descriptive text that noted that homosexuality "by itself does not constitute a psychiatric disorder" and that the renamed code should be used for "individuals whose sexual interests are directed primarily toward people of the same sex and who are either disturbed by, in conflict with, or wish to change their sexual orientation."<ref>American Psychiatric Association. (1973). ''Homosexuality and sexuality orientation disturbance: Proposed change in DSM-II, 6th printing, page 44.'' APA Document Reference No. 730008. https://pages.uoregon.edu/eherman/teaching/texts/DSM-II_Homosexuality_Revision.pdf</ref> This was considered a major victory by gay activists, because it clearly articulated a shift from considering homosexuality a mental disorder to only characterizing people as unwell if their sexual orientation caused them distress. The change was a compromise between competing schools of thought within the psychiatry field: the view that homosexuality was a pathological condition and the view that homosexuality is a normal variation of sexuality.<ref name=":2" /><ref name=":1" />
+=== Background ===
+The activism that resulted in changing the seventh printing of the DSM-II began in earnest in the wake of the [[Stonewall riots|Stonewall Uprising]] in 1969.<ref name=":4">{{Cite journal|last=Drescher|first=Jack|date=2010|title=Queer Diagnoses: Parallels and Contrasts in the History of Homosexuality, Gender Variance, and the Diagnostic and Statistical Manual|url=http://link.springer.com/10.1007/s10508-009-9531-5|journal=Archives of Sexual Behavior|language=en|volume=39|issue=2|pages=427–460|doi=10.1007/s10508-009-9531-5|issn=0004-0002}}</ref> Specific protests by gay rights activists against the APA began in 1970, when the organization held its convention in San Francisco.<ref name=":5" /> The activists disrupted the conference by interrupting speakers and shouting down and ridiculing psychiatrists who viewed homosexuality as a mental disorder. At the 1971 conference, gay rights activist [[Frank Kameny]], working with the [[Gay Liberation Front]] to demonstrate against the convention, grabbed the microphone and yelled: "Psychiatry is the enemy incarnate. Psychiatry has waged a relentless war of extermination against us. You may take this as a declaration of war against you."<ref name=":5">Ronald Bayer. (1987). ''Homosexuality and American Psychiatry: The Politics of Diagnosis.'' Princeton University Press.</ref> At the 1972 conference, gay psychiatrist [[John E. Fryer]] spoke to the audience about what it was like for the many gay psychiatrists in the APA who had to hide their sexuality due to anti-gay prejudice within the field; he wore a mask and a wig and used a voice distorter to conceal his identity.<ref>{{Cite news|last=Clendinen|first=Dudley|date=2003-03-05|title=Dr. John Fryer, 65, Psychiatrist Who Said in 1972 He Was Gay|language=en-US|work=The New York Times|url=https://www.nytimes.com/2003/03/05/us/dr-john-fryer-65-psychiatrist-who-said-in-1972-he-was-gay.html|issn=0362-4331}}</ref> This activism occurred in the context of a broader [[anti-psychiatry]] movement that had come to the fore in the 1960s and was challenging the legitimacy of psychiatric diagnosis. Anti-psychiatry activists protested at the same APA conventions, with some shared slogans and intellectual foundations.<ref>McCommon, B. (2006) [https://web.archive.org/web/20070810054520/http://psychservices.psychiatryonline.org/cgi/content/full/57/12/1809 Antipsychiatry and the Gay Rights Movement] Psychiatr Serv 57:1809, December {{DOI|10.1176/appi.ps.57.12.1809}}</ref><ref>Rissmiller, DJ, D.O., Rissmiller, J. (2006) [https://web.archive.org/web/20070630022511/http://ps.psychiatryonline.org/cgi/content/full/57/12/1809-a Letter in reply] Psychiatr Serv 57:1809-a-1810, December 2006 {{DOI|10.1176/appi.ps.57.12.1809-a}}</ref>
+Psychiatrist [[Robert Spitzer (psychiatrist)|Robert Spitzer]], who served as technical consultant to the DSM-II Committee on Nomenclature and Statistics, became a go-between in the dispute. Spitzer originally believed that homosexuality belonged in the DSM, but after meeting with gay activists, including a secret group of gay APA members later known as the [[Association of LGBTQ Psychiatrists|Association of Gay and Lesbian Psychiatrists]], and faced with data from researchers such as Kinsey and Hooker, he drafted the compromise of removing homosexuality itself from the DSM and replacing it with "sexual orientation disturbance."<ref name=":1" /><ref>{{cite web|last1=Spiegel|first1=Alix|last2=Glass|first2=Ira|date=18 January 2002|title=81 Words|url=http://www.thisamericanlife.org/radio-archives/episode/204/81-words|website=This American Life|publisher=WBEZ Chicago Public Radio|location=Chicago}}</ref> After a vote by the APA board of trustees in December 1973, and confirmed by the wider APA membership in 1974, this change was made.<ref>{{cite journal | last1 = Spitzer | first1 = R.L. | year = 1981 | title = The diagnostic status of homosexuality in DSM-III: a reformulation of the issues | url = http://ajp.psychiatryonline.org/cgi/content/abstract/138/2/210 | journal = Am J Psychiatry | volume = 138 | issue = 2| pages = 210–215 | pmid = 7457641 | doi=10.1176/ajp.138.2.210}}</ref> Psychiatrist Richard Green, who had argued forcefully in favor of declassifying homosexuality as a mental disorder, viewed Spitzer’s insistence on including a diagnosis for homosexuals who were distressed by their sexuality as a poorly disguised attempt to maintain anti-homophobic bias in the DSM, and publicly resigned from the APA nomenclature committee over it.<ref>{{Cite journal|last=Bayer|first=R.|last2=Spitzer|first2=R. L.|date=1982|title=Edited correspondence on the status of homosexuality in DSM-III|url=https://pubmed.ncbi.nlm.nih.gov/7040544/|journal=Journal of the History of the Behavioral Sciences|volume=18|issue=1|pages=32–52|doi=10.1002/1520-6696(198201)18:1<32::aid-jhbs2300180105>3.0.co;2-0|issn=0022-5061|pmid=7040544}}</ref> Meanwhile, critics argued that declassifying homosexuality was a result of pressure from gay activists and demanded a referendum among voting members of the APA. The referendum was held in 1974 and the APA's decision was upheld by a 58% majority.<ref name=":5" />
+Despite the retention of "sexual orientation disturbance," gay activists celebrated the removal of homosexuality from the APA's list of mental disorders and declared victory. Kameny, now the head of the [[Mattachine Society]] of Washington, said, "This represents the culmination of a decade-long battle," and Ronald Gold of the [[National LGBTQ Task Force|National Gay Task Force]] declared, "We've won."<ref>{{Cite news|title=Sick No More|language=en-US|work=Washington Post|url=https://www.washingtonpost.com/archive/lifestyle/1999/12/16/sick-no-more/46bf9377-5fb7-4878-9cac-501f5aa3075d/|access-date=2022-01-15|issn=0190-8286}}</ref>
+The APA published a position statement that urged an end to anti-homosexual discrimination and called for decriminalizing private sexual acts between consenting adults. However, the APA also made it clear that it did not endorse the view that homosexuality was a normal variant of sexuality.<ref name=":4" />
 ==DSM-III==
-In [[DSM-III]], homosexuality had been shifted to a new "[[Ego-dystonic sexual orientation|Ego-dystonic homosexuality]]" classification.
+=== Classification ===
+In the [[DSM-III]], published in 1980, "sexual orientation disorder" was reworked as "[[Ego-dystonic sexual orientation|ego-dystonic homosexuality]]" and the overarching categories were reorganized. The DSM-III included the completely new overarching diagnostic category "psychosexual disorders," which was divided into four subcategories:
+* "gender identity disorders" (e.g., "transsexualism")
+* "paraphilias" (which included everything previously called "sexual deviations" except for sexual orientation disturbance, with the addition of "zoophilia")
+* "psychosexual dysfunctions" (e.g., "inhibited sexual desire" and "premature ejaculation")
+* "other pyschosexual disorders" (which consisted of two diagnoses: "ego-dystonic homosexuality" and "psychosexual disorder not elsewhere classified")<ref name=":6">American Psychiatric Association. (1980). ''Diagnostic and statistical manual of mental disorders'' (3rd ed.).</ref>
+"Ego-dystonic homosexuality" was defined as having a desire to be heterosexual but not experiencing heterosexual arousal, or experiencing unwanted or distressing homosexual arousal that gets in the way of being heterosexual.<ref name=":6">American Psychiatric Association. (1980). ''Diagnostic and statistical manual of mental disorders'' (3rd ed.).</ref>
+=== Background ===
+The decision to include this reworked diagnosis in the DSM-III came after years of continued debate and controversy, both public and private. More and more scientific evidence challenged the assumption that homosexuality was a pathological condition, yet many within the psychiatric field adamantly believed it was.<ref>{{Citation|last=Bayer|first=Ronald|title=Politics, science, and the problem of psychiatric nomenclature: a case study of the American Psychiatric Association referendum on homosexuality|date=1987|url=|work=Scientific Controversies|pages=381–400|editor-last=Engelhardt, Jr.|editor-first=H. Tristram|edition=1|publisher=Cambridge University Press|doi=10.1017/cbo9780511628719.018|isbn=978-0-521-25565-3|access-date=|editor2-last=Caplan|editor2-first=Arthur L.}}</ref><ref>{{Cite journal|last=Stoller|first=Robert J.|last2=Marmor|first2=Judd|last3=Bieber|first3=Irving|last4=Gold|first4=Ronald|last5=Socarides|first5=Charles W.|last6=Green|first6=Richard|last7=Spitzer|first7=Robert L.|date=1973|title=A Symposium: Should Homosexuality Be in the APA Nomenclature?|url=http://psychiatryonline.org/doi/abs/10.1176/ajp.130.11.1207|journal=American Journal of Psychiatry|language=en|volume=130|issue=11|pages=1207–1216|doi=10.1176/ajp.130.11.1207|issn=0002-953X}}</ref> Robert Spitzer was chosen to lead the DSM-III's Task Force on Nomenclature, and he continued to feel 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.<ref name=":5" /> Classifications of "homodysphilia," "dyshomophilia," and "homosexual conflict disorder" were discussed, until finally, "ego-dystonic homosexuality" was proposed, along with a conceptual shift: instead of focusing on distress about being homosexual, the new classification was about a desire to be heterosexual and distress at one's inability to achieve that desire.<ref name=":2" /><ref name=":5" /> A proposal to include additional information such as a note about how internalized homophobia can be a contributing factor eventually swayed enough critics; others, including Richard Green and Richard Pillar, remained adamantly opposed to including homosexuality in the DSM in any form, but they were eventually overruled.<ref name=":5" />
+"Ego-dystonic homosexuality" and its predecessor, "sexual orientation disturbance," both legitimized so-called sexual [[Conversion therapy|conversion therapies]].
 ==DSM-III-R==
-In [[DSM-III-R]], the new "Ego-dystonic homosexuality" classification was also removed and was largely subsumed under "sexual disorder not otherwise specified", which can include "persistent and marked distress about one's sexual orientation.<ref name = "Revolution">{{Cite journal|doi= 10.1002/jhbs.20103|author1=Mayes, R.  |author2=Horwitz, AV.|year=2005|title=DSM-III and the revolution in the classification of mental illness|journal=J Hist Behav Sci|pmid= 15981242|volume=41|issue=3|pages=249–67}}</ref><ref>{{cite web |last1=Spiegel |first1=Alix |date=18 January 2002 |url=http://www.thisamericanlife.org/radio-archives/episode/204/81-words |title=81 Words |first2=Ira |last2=Glass |website=This American Life |location=Chicago |publisher=WBEZ Chicago Public Radio }}</ref>
+=== Classification ===
+In 1987, the APA published a major revision of the DSM-III (the [[DSM-III-R]]), again under the leadership of Robert Spitzer. In this edition, the category of "psychosexual disorders" was renamed "sexual disorders." The subsection "gender identity disorders" was moved to a different category—"disorders usually first evident in infancy, childhood, or adolescence"—and the "paraphilias" subsection was slightly reorganized. Most importantly, the "ego-dystonic homosexuality" classification was removed in favor of including "persistent and marked distress about one’s sexual orientation" as one of three examples within the classification "sexual disorder not otherwise specified."<ref>American Psychiatric Association. (1987). ''Diagnostic and statistical manual of mental disorders'' (3rd ed., rev.).</ref><ref name="Revolution">{{Cite journal|doi= 10.1002/jhbs.20103|author1=Mayes, R.  |author2=Horwitz, AV.|year=2005|title=DSM-III and the revolution in the classification of mental illness|journal=J Hist Behav Sci|pmid= 15981242|volume=41|issue=3|pages=249–67}}</ref>
+=== Background ===
+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 rightly pointed out that by the same logic, short people unhappy with their height could be considered mentally ill.<ref>{{Cite journal|last=Drescher|first=Jack|date=2015|title=Out of DSM: Depathologizing Homosexuality|url=http://www.mdpi.com/2076-328X/5/4/565|journal=Behavioral Sciences|language=en|volume=5|issue=4|pages=565–575|doi=10.3390/bs5040565|issn=2076-328X|pmc=PMC4695779|pmid=26690228}}</ref> Also influential was the fact that it had been proven that psychological therapies could not "cure" homosexuality.<ref>{{Cite journal|last=Cochran|first=Susan D|last2=Drescher|first2=Jack|last3=Kismödi|first3=Eszter|last4=Giami|first4=Alain|last5=García-Moreno|first5=Claudia|last6=Atalla|first6=Elham|last7=Marais|first7=Adele|last8=Vieira|first8=Elisabeth Meloni|last9=Reed|first9=Geoffrey M|date=2014|title=Proposed declassification of disease categories related to sexual orientation in theInternational Statistical Classification of Diseases and Related Health Problems(ICD-11)|url=https://doi.org/10.2471/BLT.14.135541|journal=Bulletin of the World Health Organization|volume=92|issue=9|pages=672–679|doi=10.2471/blt.14.135541|issn=0042-9686|pmc=PMC4208576|pmid=25378758}}</ref>
+Just like in 1974 with the repackaging of "homosexuality" as "sexual orientation disturbance," in 1987 many people saw the removal of "ego-dystonic homosexuality" as the APA removing homosexuality from the DSM, but although the word "homosexuality" was removed, treatment was still provided.<ref name=":3" /> Mental health professionals could—and did—still diagnose LGB people with "sexual disorder not otherwise specified," thanks to the retention of "distress about one's sexual orientation" as part of that diagnostic category.
+== DSM-IV and DSM-IV-TR ==
+No change was made to the "sexual disorder not otherwise specified" category in either the DSM-IV, published in 1994, or the text revision of the manual in 2000 (the DSM-IV-R). "Persistent and marked distress about sexual orientation" was still included as one of that category's examples.<ref name=":7">{{Cite journal|last=Robles|first=Rebeca|last2=Real|first2=Tania|last3=Reed|first3=Geoffrey M.|date=2021|title=Depathologizing Sexual Orientation and Transgender Identities in Psychiatric Classifications|url=https://doi.org/10.17816/CP61|journal=Consortium Psychiatricum|language=en|volume=2|issue=2|pages=45–53|doi=10.17816/CP61|issn=2713-2919}}</ref> The overarching section of the manual was renamed "sexual and gender identity disorders" and the "gender identity disorders" subsection was moved back into this section.
+== DSM-5 ==
+The DSM-5, published in 2013, does not include any diagnostic category that can be applied to people based on their sexual orientation. Some scholars have argued that only this can be considered "complete declassification" of non-heterosexual sexual orientations as mental disorders.<ref name=":7" />
 ==See also==
+* ''[[Diagnostic and Statistical Manual of Mental Disorders]]''
-* [[Anti-LGBT rhetoric]]
+*[[Homosexuality and psychology]]
 * [[Ego-dystonic sexual orientation]]
 * [[Heteronormativity]]
-* [[LGBT]]
-* [[LGBT rights opposition]]
 * [[Timeline of sexual orientation and medicine]]
+*[[Association of gay and lesbian psychiatrists|Association of Gay and Lesbian Psychiatrists]]
 ==References==