The World Health Organization lists egodystonic sexual orientation in the ICD-10, as a disorder of sexual development and orientation. The WHO diagnosis covers when gender identity or sexual orientation is clear, yet a patient has another behavioural or psychological disorder which makes that patient want to change it. F66.1 The diagnostic manual notes that a sexual orientation is not a disorder in itself.
The diagnostic category of "ego-dystonic homosexuality" was removed from the American Psychiatric Association's DSM in 1987 (with the publication of the DSM-III-R), but still potentially remains in the DSM-IV under the category of "sexual disorder not otherwise specified" including "persistent and marked distress about one’s sexual orientation”.
The Medical Council of India uses the WHO classification of ego-dystonic sexual orientation. The Chinese Classification and Diagnostic Criteria of Mental Disorders includes ego-dystonic homosexuality.
Ego-dystonic sexual orientation
Classification and external resources
When the World Health Organization removed the diagnosis of homosexuality as a mental disorder in ICD-10, it included the diagnosis of ego-dystonic sexual orientation under "Psychological and behavioural disorders associated with sexual development and orientation". The WHO's ICD.10 diagnoses Ego-dystonic sexual orientation thus:
The gender identity or sexual preference (heterosexual, homosexual, bisexual, or prepubertal) is not in doubt, but the individual wishes it were different because of associated psychological and behavioural disorders, and may seek treatment in order to change it. (F66.1)
The WHO notes that for codes under F66: "Sexual orientation by itself is not to be regarded as a disorder."
This is often a result of unfavorable and intolerant attitudes of the society or a conflict between sexual urges and religious belief systems.
There are many ways a person may go about receiving therapy for ego-dystonic sexual orientation associated with homosexuality. There is no known therapy for other types of egodystonic sexual orientations. Therapy can be aimed at changing sexual orientation, sexual behavior, or helping a client become more comfortable with their sexual orientation and behaviors. Human rights groups have accused some countries of performing these treatments on egosyntonic homosexuals. One survey suggested that viewing the same-sex activities as compulsive facilitated commitment to a mixed-orientation marriage and to monogamy. Treatment may include sexual orientation change efforts or treatment to alleviate the stress. In addition, some people seek non-professional methods, such as religious counseling or attendance in an ex-gay group.
Disidentify with LGB
A task force commissioned by the APA found that religious identity and sexual orientation identity develop through life, and psychotherapy, support groups, and life events can influence identity development; similarly, self-awareness, self-conception, and identity may evolve during treatment. Psychotherapy, support groups, and life events can change sexual orientation identity (private and public identification, and group belonging), but not actual sexual orientation, emotional adjustment (self-stigma and shame reduction), and personal beliefs, values and norms (change of religious and moral belief, behavior and motivation). The APA has stated that sexual orientation develops across a person’s lifetime".
Gender Wholeness Therapy was designed by an ex-gay Licensed Professional Counselor, David Matheson. "The emphasis in Mr. Matheson's counseling is on helping men — all his clients are male — develop 'gender wholeness' by addressing emotional issues and building healthy connections with other men. He [says] he believe[s] that help[s] reduce homosexual desires.
Gender-affirmative therapy has been described by A. Dean Byrd as follows: "The basic premise of gender-affirmative therapy is that social and emotional variables affect gender identity which, in turn, determines sexual orientation. The work of the therapist is to help people understand their gender development. Subsequently, such individuals are able to make choices that are consistent with their value system. The focus of therapy is to help clients fully develop their masculine or feminine identity".
Several organizations have started retreats led by coaches aimed at helping participants diminish same-sex desires. These retreats tend to use a variety of techniques. Journey into Manhood, put on by People Can Change uses "a wide variety of large-group, small-group and individual exercises, from journaling to visualizations (or guided imagery) to group sharing and intensive emotional-release work." Weekends put on by Adventure in Manhood support "healthy bonding with men, through masculine activity, teamwork, and socialization." Though not specific to gay men, several gay men attended the New Warrior Training Adventure, a weekend put on by Mankind Project, which is a "process of initiation and self-examination that is designed to catalyze the development of a healthy and mature masculine self." Joe Dallas, a prominent ex-gay, leads a monthly five-day men's retreat on sexual purity titled, Every Mans' Battle.
Ego-dystonic sexual orientation and religion
Further information: Religion and homosexuality
Some gay people have turned to pastoral care. Some churches publish specific instructions to clergy on how to minister to gay and lesbian people. These publications include Ministry to Persons with a Homosexual Inclination, produced by the Roman Catholic Church, and God Loveth His Children, produced by The Church of Jesus Christ of Latter-day Saints. In 1994, a church in the Presbyterian Church (USA) held a conference entitled “The Path to Freedom: Exploring healing for the Homosexual.” The APA encourages religious leaders to recognize that it is outside their role to adjudicate empirical scientific issues in psychology.
Mental health practitioners can incorporate religion into therapy by "integrating aspects of the psychology of religion into their work, including by obtaining a thorough assessment of clients’ spiritual and religious beliefs, religious identity and motivations, and spiritual functioning; improving positive religious coping; and exploring the intersection of religious and sexual orientation identities." Researchers have found that for some clients, identity conflicts can be reduced by reading religious texts, which will help clients increase self-authority and focus less on negative messages about homosexuality. Researchers also found that clients made further progress if they came to believe that regardless of their sexual orientation, God still loves and accepts them.
Alternatively, gay and lesbian people may decide to seek out "minority-affirming religious groups", or change churches to those that affirm LGBT people.
(or egodystonic homophobia) refers to negative feeling towards oneself because of homosexuality. This term has been criticized because holding negative attitudes does not necessarily involve a phobia, and the term "internalized stigma" is sometimes used instead. It causes severe discomfort with or disapproval of one's own sexual orientation.
Such a situation may cause extreme repression of homosexual desires. In other cases, a conscious internal struggle may occur for some time, often pitting deeply held religious or social beliefs against strong sexual and emotional desires. This discordance often causes clinical depression, and the unusually high suicide rate among gay teenagers (up to 30 percent of non-heterosexual youth attempt suicide) has been attributed to this phenomenon. Psychotherapy, such as gay affirmative psychotherapy, and participation in a sexual-minority affirming group can help resolve the internal conflict between a religious and a sexual identity.
The label of internalized homophobia is sometimes applied to conscious or unconscious behaviors which an observer feels the need to promote or conform to the expectations of heteronormativity or heterosexism. This can include extreme repression and denial coupled with forced outward displays of heteronormative behavior for the purpose of appearing or attempting to feel "normal" or "accepted". This might also include less overt behavior like making assumptions about the gender of a person's romantic partner, or about gender roles. Some also apply this label to LGBT persons who support "compromise" policies, such as those that find civil unions an acceptable alternative to same-sex marriage.
Some argue that some or most people who are homophobic have repressed their own homosexuality. In 1996, a controlled study of 64 heterosexual men (half claimed to be homophobic by experience and self-reported orientation) at the University of Georgia found that men who were found to be homophobic (as measured by the Index of Homophobia) were considerably more likely to experience more erectile responses when exposed to homoerotic images than non-homophobic men.