The Decision to Remove Homosexuality from the DSM: Twenty Years Later

By Rubinstein, Gidi | American Journal of Psychotherapy, Summer 1995 | Go to article overview
Save to active project

The Decision to Remove Homosexuality from the DSM: Twenty Years Later


Rubinstein, Gidi, American Journal of Psychotherapy


The Decision to Remove Homosexuality from the DSM: Twenty Years Later*

Twenty years have passed since the 1973 APA decision to remove "Ego-syntonic Homosexuality" from the DSM. The question arises, and is here examined, as to whether and to what extent therapists have indeed removed ego-syntonic homosexuality from their lexicon of disorders.

The diagnostic criteria of "Ego-dystonic Homosexuality" (a category eliminated from the revised edition for reasons discussed below) in the DSM-III are well defined. They include the patient's complaint about absence or weakness of heterosexual arousal, as well as a sustained pattern of homosexual arousal that the individual explicitly states is unwanted and a persistent source of disorder. The strictness of the criteria is evident, for example, from the first differential diagnosis required, which excludes homosexuality that is ego-syntonic. Therapists are warned that a patient's own attitude ("I guess life would be easier if I were heterosexual"), or distress resulting simply from a conflict between a homosexual and society, should not be classified as ego-dystonic homosexuality. Therapists' are also warned not to use this diagnostic category for homosexuals who develop a major depression and may then express self-hatred because of their sexual orientation. The factors that predispose to ego-dystonic homosexuality are, according to the DSM-m, those negative societal attitudes toward homosexuality that have been internalized.(1)

Ego-dystonic homosexuality was eliminated from DSM-III-R(2) because "In the United States almost all people who are homosexual first go through a phase in which their homosexuality is ego-dystonic. Furthermore, the diagnosis of ego-dystonic homosexuality has rarely been used clinically and there have been only a few articles in the scientific literature that use the concept. Finally, the treatment programs that attempt to help bisexual men become heterosexual have not used this diagnosis" (p. 426). Persistent and marked distress about one's sexual orientation should be classified, according to DSM-m-R, as "Sexual Disorder Not Otherwise Specified."

It appears then that psychotherapists appear to hold liberal attitudes toward homosexual orientation, at least on the ideological and proclaimed level. Martin,(3) for example, expressed a position entirely in accord with that of the APA,(1,2) contending that when the effects of homophobia are partialed out, few differences remain between homosexuals and heterosexuals.

A similar trend appears in the survey of Gartell et al.,(4) about the attitudes of 908 psychiatrists toward lesbians: Almost all (98%) supported legalizing homosexuality between consenting adults; 66 percent objected to the use of psychiatric labels for the diagnosis of homosexuality among women; 87 percent stated that their conception of mental health includes homosexual-adjusted women; and 66 percent denied that homosexuality among women is pathological or defective.

These attitudes are also in accord with the updated psychological literature regarding human sexuality, which suggests that homophobia--rather than homosexuality--is the problem that has to be treated.(5,6)

Another trend that leads us to believe that therapists would take stances that are not biased in the direction of treating ego-syntonic homosexuality as a disorder is the evident successful adjustment of homosexuals. Several investigators found that nonpatient homosexuals do not differ from nonpatient heterosexuals in their adjustment,(7-9) or even that homosexuals are better adjusted than heterosexuals.(10,11)

The openly liberal attitude of psychotherapists toward homosexuality is not surprising in light of their politically liberal attitudes and secular orientation in the United States(12) as well as in Israel.(13) However, one should keep in mind that the studies suggesting that psychotherapists maintain liberal attitudes refer to the declarative level.

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

The Decision to Remove Homosexuality from the DSM: Twenty Years Later
Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

While we understand printed pages are helpful to our users, this limitation is necessary to help protect our publishers' copyrighted material and prevent its unlawful distribution. We are sorry for any inconvenience.
Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.