Homosexuality and psychology#Declassification

The view of homosexuality as a psychological disorder has been seen in literature since research on homosexuality first began; however, psychology as a discipline has evolved over the years in its position on homosexuality. Current attitudes have their roots in religious, legal, and cultural underpinnings. Some Ancient Near Eastern communities, such as the Israelites, had strict codes forbidding homosexual activity, and when Christianity began, it adopted their Jewish predecessors attitudes surrounding homosexual activities. Among the New Testament authors Paul in particular is notable for his affirmation and reinforcement of such texts in his letters to nascent churches. Later, the Apostolic Fathers and their successors continued to speak against homosexual activity whenever they mentioned it in their writings. In the early Middle Ages the Christian Church ignored homosexuality in secular society; however, by the end of the 12th century, hostility towards homosexuality began to emerge and spread through Europe's secular and religious institutions. There were official expressions condemning the "unnatural" nature of homosexual behavior in the works of Thomas Aquinas and others. Until the 19th century, homosexual activity was referred to as "unnatural, crimes against nature", sodomy or buggery and was punishable by law, sometimes by death.{{cite book|title=Gay and American History: Lesbians and Gay Men in the United States|last=Katz|first=J|publisher=Thomas Crowell|year=1995|location=New York}}

As people became more interested in discovering the causes of homosexuality, medicine and psychiatry began competing with the law and religion for jurisdiction. In the beginning of the 19th century, people began studying homosexuality scientifically. At this time, most theories regarded homosexuality as a disease, which had a great influence on how it was viewed culturally.{{Cite web |date=2009 |title=Report of the American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation |url=http://www.apa.org/pi/lgbt/resources/therapeutic-response.pdf |website=American Psychological Association}} There was a paradigm shift in the mid 20th century in psychiatric science in regards to theories of homosexuality. Psychiatrists began to believe homosexuality could be cured through therapy and freedom of self, and other theories about the genetic and hormonal origin of homosexuality were becoming accepted. There were variations of how homosexuality was viewed as pathological. Some early psychiatrists such as Sigmund Freud and Havelock Ellis adopted more tolerant stances on homosexuality. Freud and Ellis believed that homosexuality was not normal, but was "unavoidable" for some people. Alfred Kinsey's research and publications about homosexuality began the social and cultural shift away from viewing homosexuality as an abnormal condition. These shifting viewpoints in the psychological studies of homosexuality are evident in its placement in the first version of the Diagnostic Statistical Manual (DSM) in 1952, and subsequent change in 1973, in which the diagnosis of ego-dystonic homosexuality replaced the DSM-II category of "sexual orientation disturbance". However, it was not until 1987 in DSM-III-R that it was entirely dropped as a mental disorder.{{cite journal |title=Out of DSM: Depathologizing Homosexuality |last=Drescher |first=Jack |journal= Behavioral Sciences|date=December 2015 |volume=5 |issue=4 |pages=565–575 |doi=10.3390/bs5040565 |pmid=26690228 |pmc=4695779 |doi-access=free }}

A 2016 survey of the European Union Agency for Fundamental Rights found that many medical professionals in countries such as Bulgaria, Hungary, Italy, Latvia, Poland, Romania and Slovakia believe that homosexuality is a disease and that such interpretations continue to exist in professional materials. This goes against Council of Europe Recommendation 2010(5) which recommends that homosexuality not be treated as a disease.{{cite book |title=Professionally speaking: challenges to achieving equality for LGBT people |date=2016 |publisher=European Union Agency for Fundamental Rights |isbn=978-92-9491-007-3 |doi=10.2811/072643 |url=https://fra.europa.eu/en/publication/2016/professionally-speaking-challenges-achieving-equality-lgbt-people |language=en|quote=In some countries, including Bulgaria, Hungary, Italy, Latvia, Poland, Romania and Slovakia, respondents working in healthcare indicate that many healthcare professionals still see homosexuality as a pathological issue. Some medical training material still pathologises homosexuality.|author1=European Union Agency for Fundamental Rights }} As of 2018, homosexuality was popularly considered a disease in Lebanon.{{Cite news |last=Kanso |first=Heba |date=November 9, 2018 |title='I had suicidal thoughts': Gay Lebanese speak out against conversion therapy |url=https://www.reuters.com/article/idUSL2N1XJ1OX/ |access-date=July 6, 2024 |work=Reuters}}

Sigmund Freud's views on homosexuality were complex. In his attempts to understand the causes and development of homosexuality, he first explained bisexuality as an "original libido endowment",{{cite book|title=Three Essays on the Theory of Sexuality|last=Freud|first=Sigmund|publisher=Hogarth Press|year=1953|location=London|title-link=Three Essays on the Theory of Sexuality}} by which he meant that all humans are born bisexual. He believed that the libido has a homosexual portion and a heterosexual portion, and through the course of development one wins out over the other.

Some other causes of homosexuality for which he advocated included an inverted Oedipus complex where individuals begin to identify with their mother and take themselves as a love object. This love of one's self is defined as narcissism, and Freud thought that people who were high in the trait of narcissism would be more likely to develop homosexuality because loving the same sex is like an extension of loving oneself.{{cite book|title=The problem of Homosexuality in modern society|last=Ruitenbeek|first=H.M.|publisher=Dutton|year=1963|location=New York|oclc=733597853}}

Freud believed treatment of homosexuality was not successful because the individual does not want to give up their homosexual identity because it brings them pleasure. He used psychoanalysis and hypnotic suggestion as treatments, but showed little success.{{cite journal|last=Weideman|first=G.|year=1962|title=Survey of Psychoanalytic literature on overt homosexuality|journal=Journal of the American Psychoanalytic Association|volume=10|issue=2|pages=286–409|doi=10.1177/000306516201000210|pmid=14006764|s2cid=28753502}} It was through this that Freud arrived at the conclusion that homosexuality was "nothing to be ashamed of, no vice, no degradation, it cannot be classified as an illness, but a variation of sexual function".{{cite journal|last=Freud|first=Sigmund|title=Letter to an American Mother|journal=American Journal of Psychiatry|year=1951|volume=107|issue=10|pages=786–787|doi=10.1176/ajp.107.10.786|pmid=14819376}} He further stated that psychoanalysts "should not promise to abolish homosexuality and make normal heterosexuality take its place", as he had concluded in his own practice that attempts to change homosexual orientations were likely to be unsuccessful. While Freud himself may have come to a more accepting view of homosexuality, his legacy in the field of psychoanalysis, especially in the United States, viewed homosexuality as negative, abnormal and caused by family and developmental issues. It was these views that significantly impacted the rationale for putting homosexuality in the first and second publications of the American Psychiatric Association's DSM, conceptualizing it as a mental disorder and further stigmatizing homosexuality in society.

Havelock Ellis (1859–1939) was working as a teacher in Australia, when he had a revelation that he wanted to dedicate his life to exploring the issue of sexuality. He returned to London in 1879 and enrolled in St. Thomas's Hospital Medical School. He began to write, and in 1896 he co-authored Sexual Inversion with John Addington Symonds. The book was first published in German, and a year later it was translated into English. Their book explored homosexual relationships, and in a progressive approach for their time they refused to criminalize or pathologize the acts and emotions that were present in homosexual relationships.{{cite book|title=Homosexuality in History|last=Spencer|first=Colin|publisher=Harcourt Brace & Company|year=1995|isbn=978-0-15-100223-8|location=New York|url-access=registration|url=https://archive.org/details/turningstonesmyd0000pare}}

Ellis disagreed with Freud on a few points regarding homosexuality, especially regarding its development. He argued that homosexuals do not have a clear cut Oedipus complex but they do have strong feelings of inadequacy, born of fears of failure, and may also be afraid of relations with women.{{cite book|last=Ellis|first=Havelock|title=If this be sexual heresy...|year=1963|publisher=Lyle Stuart Inc|location=New York}} Ellis argued that the restrictions of society contributed to the development of same-sex love. He believed that homosexuality is not something people are born with, but that at some point humans are all sexually indiscriminate, and then narrow down and choose which sex acts to stick with. According to Ellis, some people choose to engage in homosexuality, while others will choose heterosexuality. He proposed that being "exclusively homosexual"{{cite book|last=Ellis|first=Havelock|title=Psychology of Sex|year=1946|publisher=Emerson Books|location=New York}} is to be deviant because the person is a member of a minority and therefore statistically unusual, but that society should accept that deviations from the "normal" were harmless, and maybe even valuable. Ellis believed that psychological problems arose not from homosexual acts alone, but when someone "psychologically harms himself by fearfully limiting his own sex behavior".

Ellis is often credited with coining the term homosexuality but in reality he despised the word because it conflated Latin and Greek roots and instead used the term invert in his published works. Soon after Sexual Inversion was published in England, it was banned as lewd and scandalous. Ellis argued that homosexuality was a characteristic of a minority, and was not acquired or a vice and was not curable. He advocated changing the laws to leave those who chose to practice homosexuality at peace, because at the time it was a punishable crime. He believed societal reform could occur, but only after the public was educated. His book became a landmark in the understanding of homosexuality.

Alfred Charles Kinsey (1894–1956) was a sexologist who founded the Institute for Sex Research, which is now known as the Kinsey Institute for Research in Sex, Gender and Reproduction. His explorations into different sexual practices originated from his study of the variations in mating practices among wasps. He developed the Kinsey Scale, which measures sexual orientation in ranges from 0 to 6 with 0 being exclusively heterosexual and 6 being exclusively homosexual.{{cite book|last=Geddes|first=Donald Porter|title=An analysis of the Kinsey reports on sexual behavior in the human male and female|year=1954|publisher=Dutton|location=New York}} His findings indicated that there was great variability in sexual orientations. Kinsey published the books Sexual Behavior in the Human Male and Sexual Behavior in the Human Female, which brought him both fame and controversy. The prevailing approach to homosexuality at the time was to pathologize and attempt to change homosexuals. Kinsey's book demonstrated that homosexuality was more common than was assumed, suggesting that these behaviors are normal and part of a continuum of sexual behaviors.

{{See also|Homosexuality in the DSM}}

The social, medical, and legal approach to homosexuality ultimately led to its inclusion in the first and second publications of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM). This served to conceptualize homosexuality as a mental disorder and further stigmatize homosexuality in society. However, the evolution in scientific study and empirical data from Kinsey, Evelyn Hooker, and others confronted these beliefs, and by the 1970s psychiatrists and psychologists were radically altering their views on homosexuality. Tests such as the Rorschach, Thematic Apperception Test (TAT), and the Minnesota Multiphasic Personality Inventory (MMPI) indicated that homosexual men and women were not distinguishable from heterosexual men and women in functioning. These studies failed to support the previous assumptions that family dynamics, trauma, and gender identity were factors in the development of sexual orientation. Many psychologists have differing opinions about same-sex relationships. Some think that it is not healthy at all, some support it, and some cannot support it because of their own personal religious beliefs.{{Cite journal|last=Paul|first=Jeffrey A.|date=February 2017|title=The Varieties of Religious Responses to Homosexuality: A Content and Tonal Analysis of Articles in Pastoral Psychology from 1950 to 2015 Regarding Sexual Minorities|url=http://link.springer.com/10.1007/s11089-016-0717-1|journal=Pastoral Psychology|language=en|volume=66|issue=1|pages=79–101|doi=10.1007/s11089-016-0717-1|issn=0031-2789|s2cid=148425783|url-access=subscription}} Due to lack of supporting data, as well as exponentially increasing pressure from gay rights advocates, the board of directors for the American Psychiatric Association voted to declassify homosexuality as a mental disorder from the DSM-II in 1973, but the DSM retained a diagnosis that could be used for distress due to one's sexual orientation until the DSM-5 (2013).{{Cite journal|last1=Robles|first1=Rebeca|last2=Real|first2=Tania|last3=Reed|first3=Geoffrey M.|date=2021|title=Depathologizing Sexual Orientation and Transgender Identities in Psychiatric Classifications|journal=Consortium Psychiatricum|language=en|volume=2|issue=2|pages=45–53|doi=10.17816/CP61|issn=2713-2919|doi-access=free|pmc=11272317}}

Major psychological research into homosexuality is divided into five categories:

1. What causes some people to be attracted to his or her own sex?
2. What causes discrimination against people with a homosexual orientation and how can this be influenced?{{cite journal |author1=Etengoff C. |author2=Daiute C. | year = 2014 | title = Family Members' Uses of Religion in Post–Coming-Out Conflicts With Their Gay Relative | journal = Psychology of Religion and Spirituality | volume = 6 | issue = 1| pages = 33–43 | doi = 10.1037/a0035198 }}
3. Does having a homosexual orientation affect one's health status, psychological functioning or general well-being?
4. What determines successful adaptation to rejecting social climates? Why is homosexuality central to the identity of some people, but peripheral to the identity of others?{{cite journal |author1=Etengoff C. |author2=Daiute C. | year = 2015 | title = Clinicians' perspectives of religious families' and gay men's negotiation of sexual orientation disclosure and prejudice | journal = Journal of Homosexuality | volume = 62 | issue = 3| pages = 394–426 | doi = 10.1080/00918369.2014.977115 | pmid = 25364980 |s2cid=10971273 }}
5. How do the children of homosexual people develop?

Psychological research in these areas has always been important to counteracting prejudicial attitudes and actions, and to the gay and lesbian rights movement generally.{{cite book|title=Lesbian and Gay Studies: An Introductory, Interdisciplinary Approach|year=2000|isbn=978-0-7619-5417-0|editor-last=Sandfort|editor-first=T.|chapter=Chapter 2|publisher=SAGE Publications }}

{{See also|Biology and sexual orientation|Environment and sexual orientation}}

Although no single theory on the cause of sexual orientation has yet gained widespread support, scientists favor biologically based theories.{{cite journal |doi=10.1542/peds.113.6.1827 |author=Frankowski BL|author2=American Academy of Pediatrics Committee on Adolescence|title=Sexual orientation and adolescents |journal=Pediatrics|volume=113 |issue=6 |pages=1827–32 |date=June 2004|pmid=15173519|url=http://pediatrics.aappublications.org/content/113/6/1827.long|doi-access=free|url-access=subscription}} There is considerably more evidence supporting nonsocial, biological causes of sexual orientation than social ones, especially for males.{{cite journal|last1=Bailey|first1=J. Michael|last2=Vasey|first2=Paul|last3=Diamond|first3=Lisa|author4-link=Marc Breedlove|last4=Breedlove|first4=S. Marc|last5=Vilain|first5=Eric|last6=Epprecht|first6=Marc|title=Sexual Orientation, Controversy, and Science|journal=Psychological Science in the Public Interest|date=2016|volume=17|issue=2|pages=45–101|doi=10.1177/1529100616637616|pmid=27113562|url=https://www.researchgate.net/publication/301639075|doi-access=free}}{{cite book |last=LeVay |first=Simon |date=2017 |title=Gay, Straight, and the Reason Why: The Science of Sexual Orientation |url=https://books.google.com/books?id=HmQFFfa03nkC |publisher=Oxford University Press |isbn=978-0-19-975296-6 }}{{cite book |last=Balthazart |first=Jacques |date=2012 |title=The Biology of Homosexuality |url=https://books.google.com/books?id=3fjGjlcVINkC |publisher=Oxford University Press |isbn=978-0-19-983882-0 }}

{{See also|Societal attitudes toward homosexuality}}

Anti-gay attitudes and behaviors (sometimes called homophobia or heterosexism) have been objects of psychological research. Such research usually focuses on attitudes hostile to gay men, rather than attitudes hostile to lesbians. Anti-gay attitudes are often found in those who do not know gay people on a personal basis.{{cite conference|last=Jensen|first=Jeffrey|date=5 September 1999|title=Affirmation - Homosexuality: A Psychiatrist's Response to LDS Social Services|url=http://www.affirmation.org/jeff.htm|conference=National Affirmation Annual Conference|location=Portland, Oregon|archive-url=https://web.archive.org/web/20030704111036/http://www.affirmation.org/jeff.htm|archive-date=4 July 2003}} There is also a high risk for anti-gay bias in psychotherapy with lesbian, gay, and bisexual clients.{{cite book|title=Textbook of Homosexuality and Mental Health|date=1996|publisher=American Psychiatric Press|isbn=978-0-88048-716-0|editor-last=Cabaj|editor-first=Robert P.|page=[https://archive.org/details/textbookofhomose00caba/page/421 421]|editor-last2=Steine|editor-first2=Terry S.|url-access=registration|url=https://archive.org/details/textbookofhomose00caba/page/421}} One study found that nearly half of its sample had been the victim of verbal or physical violence because of their sexual orientation, usually committed by men. Such victimization is related to higher levels of depression, anxiety, anger, and symptoms of post-traumatic stress.{{Cite journal|last1=Herek|first1=Gregory|last2=Gillis|first2=J|last3=Cogan|first3=Jeanine|last4=Glunt|first4=Eric|date=1997|title=Hate Crime Victimization Among Lesbian, Gay, and Bisexual Adults: Prevalence, Psychological Correlates, and Methodological Issues|journal=Journal of Interpersonal Violence|volume=12|issue=2|pages=195–215|doi=10.1177/088626097012002003|s2cid=145249962|via=SAGE journals}}{{Full citation needed|date=January 2018}} Through the 2015 U.S. Transgender Survey, which was conducted by the National Center for Transgender Equality, transgender people of color were found to face disproportionate discrimination because of their overlapping identities. These forms of discrimination included violence, unreasonable unemployment, unfair policing, and unfair medical treatment.James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). [https://transequality.org/sites/default/files/docs/usts/USTS-Full-Report-Dec17.pdf The Report of the 2015 U.S. Transgender Survey.] Washington, DC: National Center for Transgender Equality.

Research suggests that parents who respond negatively to their child's sexual orientation tended to have lower self-esteem and negative attitudes toward women, and that "negative feelings about homosexuality in parents - decreased the longer they were aware of their child's homosexuality".{{Cite journal|last1=Holtzen|first1=David W.|last2=Agresti|first2=Albert A.|date=1 September 1990|title=Parental Responses to Gay and Lesbian Children: Differences in Homophobia, Self-Esteem, and Sex-Role Stereotyping|journal=Journal of Social and Clinical Psychology|volume=9|issue=3|pages=390–399|doi=10.1521/jscp.1990.9.3.390|issn=0736-7236}}

In addition, while research has suggested that "families with a strong emphasis on traditional values implying the importance of religion, an emphasis on marriage and having children – were less accepting of homosexuality than were low-tradition families",{{cite journal|last1=Newman|first1=Bernie Sue|last2=Muzzonigro|first2=Peter Gerard|date=1993|title=The Effects of Traditional Family Values on the Coming Out Process of Gay Male Adolescents|url=https://www.proquest.com/openview/52cbd3ce308dcd5a4c20ddcea9bf7724/1?pq-origsite=gscholar&cbl=1819054|journal=Adolescence|volume=28|issue=109|pages=213–26|pmid=8456611}} emerging research suggests that this may not be universal. For example, recent{{When|date=January 2018}} research published in APA's Psychology of Religion & Spirituality journal by Chana Etengoff and Colette Daiute suggests that religious family members can alternatively use religious values and texts in support of their sexual minority relative. For example, a Catholic mother of a gay man shared that she focuses on "the greatest commandment of all, which is, love". Similarly, a Methodist mother referenced Jesus in her discussion of loving her gay son, as she said, "I look at Jesus' message of love and forgiveness and that we're friends by the blood, that I don't feel that people are condemned by the actions they have done." These religious values were similarly expressed by a father who is a member of the Church of Jesus Christ of Latter-day Saints who shared the following during his discussion of the biblical prohibition against homosexuality: "Your goal, your reason for being, should be to accept and to love and to lift up ... those in need no matter who they are".

Psychological research in this area includes examining mental health issues (including stress, depression, or addictive behavior) faced by gay and lesbian people as a result of the difficulties they experience because of their sexual orientation, physical appearance issues, eating disorders, or gender atypical behavior.

• Psychiatric disorders: in a Dutch study, gay men reported significantly higher rates of mood and anxiety disorders than straight men, and lesbians were significantly more likely to experience depression (but not other mood or anxiety disorders) than straight women. A research paper from the American Journal of Community Psychology states that individuals who face multiple forms of oppression tend to find their hardships more difficult to manage. In this study, it is noted that LGBTQ+ people who are disabled have reported struggling more with their oppressed statuses.{{Cite journal|last1=McDonald|first1=Katherine E.|last2=Keys|first2=Christopher B.|last3=Balcazar|first3=Fabricio E.|title=Disability, race/ ethnicity and gender: themes of cultural oppression, acts of individual resistance|url=https://onlinelibrary.wiley.com/doi/10.1007/s10464-007-9094-3|journal=American Journal of Community Psychology|year=2007|volume=39|issue=1–2|pages=145–161|doi=10.1007/s10464-007-9094-3|pmid=17294120|s2cid=7293790|url-access=subscription}}
• Physical appearance and eating disorders: gay men tend to be more concerned about their physical appearance than straight men.{{Cite journal|last1=Brand|first1=Pamela|last2=Rothblum|first2=Esther|last3=Solomon|first3=Laura|date=1992|title=A comparison of lesbians, gay men, and heterosexuals on weight and restrained eating|journal=International Journal of Eating Disorders|volume=11|issue=3|pages=253–259|doi=10.1002/1098-108X(199204)11:3<253::AID-EAT2260110308>3.0.CO;2-J}}{{Full citation needed|date=January 2018}} Lesbian women are at a lower risk for eating disorders than heterosexual women.{{Cite journal|last=Siever|first=Michael D.|title=Sexual orientation and gender as factors in socioculturally acquired vulnerability to body dissatisfaction and eating disorders|journal=Journal of Consulting and Clinical Psychology|language=en|volume=62|issue=2|pages=252–260|doi=10.1037/0022-006x.62.2.252|year=1994|pmid=8201061}}
• Gender atypical behavior: while this is not a disorder, gay men may face difficulties due to being more likely to display gender atypical behavior than heterosexual men.{{cite journal|last1=Hiatt|first1=Deirdre|last2=Hargrave|first2=George E.|date=August 1994|title=Psychological Assessment of Gay and Lesbian Law Enforcement Applicants|journal=Journal of Personality Assessment|volume=63|issue=1|pages=80–88|doi=10.1207/s15327752jpa6301_6|pmid=7932031|issn=0022-3891}} The difference is less pronounced between lesbians and straight women.{{cite journal|last1=Finlay|first1=Barbara|last2=Scheltema|first2=Karen E.|date=26 June 1991|title=The Relation of Gender and Sexual Orientation to Measures of Masculinity, Femininity, and Androgyny|journal=Journal of Homosexuality|volume=21|issue=3|pages=71–86|doi=10.1300/J082v21n03_04|issn=0091-8369|pmid=1880402}}
• Minority stress: stress caused from a sexual stigma, manifested as prejudice and discrimination, is a major source of stress for people with a homosexual orientation. Sexual-minority affirming groups and gay peer groups help counteract and buffer minority stress.
• Ego-dystonic sexual orientation: conflict between religious identity and sexual orientation can cause severe stress, causing some people to want to change their sexual orientation. Sexual orientation identity exploration can help individuals evaluate the reasons behind the desire to change and help them resolve the conflict between their religious and sexual identity, either through sexual orientation identity reconstruction or affirmation therapies. Ego-dystonic sexual orientation is a disorder where a person wishes their sexual orientation were different because of associated psychological and behavioral disorders.
• Sexual relationship disorder: people with a homosexual orientation in mixed-orientation marriages may struggle with the fear of the loss of their marriage. Sexual relationship disorder is a disorder where the gender identity or sexual orientation of one of the partners interferes with maintaining or forming of a relationship.

{{See also|Suicide|Suicide among LGBT youth}}

The likelihood of suicide attempts is higher in both gay males and lesbians, as well as bisexual individuals of both sexes, when compared to their heterosexual counterparts.{{Cite journal|doi=10.1300/J035v15n03_06 |title=Gay, Lesbian, and Bisexual College Students |year=2001 |last1=Westefeld |first1=John |first2=Michael |first3=Brian |first4=Steve |journal=Journal of College Student Psychotherapy |volume=15 |pages=71–82 |last2=Maples |last3=Buford |last4=Taylor|issue=3|s2cid=145338147 }}{{Cite journal|vauthors=Fergusson DM, Horwood LJ, Ridder EM, Beautrais AL |title=Sexual orientation and mental health in a birth cohort of young adults |journal=Psychological Medicine |volume=35 |issue=7 |pages=971–81 |date=July 2005 |pmid=16045064 |doi=10.1017/S0033291704004222|hdl=10523/10291 |s2cid=25214272 |hdl-access=free }}{{Cite journal|vauthors=Silenzio VM, Pena JB, Duberstein PR, Cerel J, Knox KL |title=Sexual Orientation and Risk Factors for Suicidal Ideation and Suicide Attempts Among Adolescents and Young Adults |journal=American Journal of Public Health |volume=97 |issue=11 |pages=2017–9 |date=November 2007 |pmid=17901445 |doi=10.2105/AJPH.2006.095943 |pmc=2040383}} The trend of having a higher incident rate among females encompasses lesbians or bisexual females; when compared with homosexual or bisexual males, lesbians are more likely to attempt suicide.[https://www.ucalgary.ca/~ramsay/attempted-suicide-gay-lesbian-all-studies.htm Gay, Lesbian, Bisexual & Transgender "Attempted Suicide" Incidences/Risks Suicidality Studies From 1970 to 2009]

Studies dispute the exact difference in suicide rate compared to heterosexuals with a minimum of 0.8–1.1 times more likely for females{{cite book|title=Homosexualities: a Study of Diversity Among Men and Women|last1=Bell|first1=Alan P|last2=Weinberg|first2=Martin S|date=1979|publisher=Simon and Schuster|isbn=978-0-671-25150-5|location=New York|pages=453–454 (Tables 21.14 & 21.15)|oclc=5126171}} and 1.5–2.5 times more likely for males.{{Cite journal|vauthors=Safren SA, Heimberg RG |title=Depression, hopelessness, suicidality, and related factors in sexual minority and heterosexual adolescents |journal=Journal of Consulting and Clinical Psychology |volume=67 |issue=6 |pages=859–66 |date=December 1999 |pmid=10596508 |doi=10.1037/0022-006X.67.6.859}}{{Cite journal|vauthors=Russell ST, Joyner K |title=Adolescent Sexual Orientation and Suicide Risk: Evidence From a National Study |journal=American Journal of Public Health |volume=91 |issue=8 |pages=1276–81 |date=August 2001 |pmid=11499118 |pmc=1446760 |doi=10.2105/AJPH.91.8.1276}} The higher figures reach 4.6 times more likely in females{{Cite journal|vauthors=Saghir MT, Robins E, Walbran B, Gentry KA |title=Homosexuality. IV. Psychiatric disorders and disability in the female homosexual |journal=The American Journal of Psychiatry |volume=127 |issue=2 |pages=147–54 |date=August 1970 |pmid=5473144 |doi=10.1176/ajp.127.2.147}} and 14.6 times more likely in males.

Race and age play a factor in the increased risk. The highest ratios for males are attributed to young Caucasians. By the age of 25, their risk is more than halved; however, the risk for black gay males at that age steadily increases to 8.6 times more likely. Over a lifetime, the increased likelihoods are 5.7 times for white and 12.8 for black gay and bisexual males. Lesbian and bisexual females have the opposite trend, with fewer attempts during the teenager years compared to heterosexual females. Through a lifetime, the likelihood for Caucasian females is nearly triple that of their heterosexual counterparts; however, for black females there is minimal change (less than 0.1 to 0.3 difference), with heterosexual black females having a slightly higher risk throughout most of the age-based study.

Gay and lesbian youth who attempt suicide are disproportionately subject to anti-gay attitudes, often have fewer skills for coping with discrimination, isolation, and loneliness,{{cite journal|last1=Rotheram-Borus|first1=Mary J.|last2=Hunter|first2=Joyce|last3=Rosario|first3=Margaret|date=1 October 1994|title=Suicidal Behavior and Gay-Related Stress among Gay and Bisexual Male Adolescents|journal=Journal of Adolescent Research|volume=9|issue=4|pages=498–508|doi=10.1177/074355489494007|s2cid=144865384|issn=0743-5584}}{{Cite journal|last1=Proctor|first1=Curtis D.|last2=Groze|first2=Victor K.|date=1 September 1994|title=Risk Factors for Suicide among Gay, Lesbian, and Bisexual Youths|journal=Social Work|language=en|volume=39|issue=5|pages=504–513|doi=10.1093/sw/39.5.504|pmid=7939864|issn=0037-8046}} and were more likely to experience family rejection{{Cite journal|vauthors=Ryan C, Huebner D, Diaz RM, Sanchez J |title=Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults |journal=Pediatrics |volume=123 |issue=1 |pages=346–52 |date=January 2009 |pmid=19117902 |doi=10.1542/peds.2007-3524|s2cid=33361972 }} than those who do not attempt suicide. Another study found that gay and bisexual youth who attempted suicide had more feminine gender roles,{{Cite journal|vauthors=Remafedi G, Farrow JA, Deisher RW |title=Risk factors for attempted suicide in gay and bisexual youth |journal=Pediatrics |volume=87 |issue=6 |pages=869–75 |date=June 1991 |doi=10.1542/peds.87.6.869 |pmid=2034492 |s2cid=42547461 |url=http://pediatrics.aappublications.org/cgi/content/abstract/87/6/869|url-access=subscription }} adopted a non-heterosexual identity at a young age and were more likely than peers to report sexual abuse, drug abuse, and arrests for misconduct. One study found that same-sex sexual behavior, but not homosexual attraction or homosexual identity, was significantly predictive of suicide among Norwegian adolescents.{{Cite journal|vauthors=Wichstrøm L, Hegna K |title=Sexual orientation and suicide attempt: a longitudinal study of the general Norwegian adolescent population |journal=Journal of Abnormal Psychology |volume=112 |issue=1 |pages=144–51 |date=February 2003 |pmid=12653422 |doi=10.1037/0021-843X.112.1.144}}

Government policies have been found to mediate this relationship by legislating structural stigma. One study using cross-country data from 1991 to 2017 for 36 OECD countries established that same-sex marriage legalization is associated with a decline in youth suicide of 1.191 deaths per 100,000 youth, with the impact more pronounced for male youth relative to female youth.{{cite journal |last1=Kennedy |first1=Andrew |last2=Genç |first2=Murat |last3=Owen |first3=P. Dorian |title=The Association Between Same-Sex Marriage Legalization and Youth Deaths by Suicide: A Multimethod Counterfactual Analysis |journal=The Journal of Adolescent Health |date=June 2021 |volume=68 |issue=6 |pages=1176–1182 |doi=10.1016/j.jadohealth.2021.01.033 |pmid=33812751 |s2cid=233028334 |issn=1879-1972}} Another study of nationwide data from across the United States from January 1999 to December 2015 revealed that same-sex marriage is associated with a significant reduction in the rate of attempted suicide among children, with the effect being concentrated among children of a minority sexual orientation, resulting in about 134,000 fewer children attempting suicide each year in the United States.{{cite journal |last1=Raifman |first1=Julia |last2=Moscoe |first2=Ellen |last3=Austin |first3=S. Bryn |last4=McConnell |first4=Margaret |title=Difference-in-Differences Analysis of the Association Between State Same-Sex Marriage Policies and Adolescent Suicide Attempts |journal=JAMA Pediatrics |date=2017-04-01 |volume=171 |issue=4 |pages=350–356 |doi=10.1001/jamapediatrics.2016.4529 |pmid=28241285 |issn=2168-6211|pmc=5848493 }}

{{Main|Sexual orientation identity}}

• Coming out: many gay, lesbian and bisexual people go through a "coming out" experience at some point in their lives. Psychologists often say this process includes several stages "in which there is an awareness of being different from peers ('sensitization'), and in which people start to question their sexual identity ('identity confusion'). Subsequently, they start to explore practically the option of being gay, lesbian or bisexual and learn to deal with the stigma ('identity assumption'). In the final stage, they integrate their sexual desires into a positive understanding of self ('commitment')." However, the process is not always linear{{cite journal|last=Rust|first=Paula C.|date=1 March 1993|title='Coming Out' in the Age of Social Constructionism: Sexual Identity Formation among Lesbian and Bisexual Women|journal=Gender & Society|volume=7|issue=1|pages=50–77|doi=10.1177/089124393007001004|s2cid=145206767|issn=0891-2432}} and it may differ for lesbians, gay men and bisexual individuals.{{cite journal|last1=de Monteflores|first1=Carmen|last2=Schultz|first2=Stephen J.|date=1 July 1978|title=Coming Out: Similarities and Differences for Lesbians and Gay Men|journal=Journal of Social Issues|volume=34|issue=3|pages=59–72|doi=10.1111/j.1540-4560.1978.tb02614.x|issn=1540-4560}}
• Different degrees of coming out: one study found that gay men are more likely to be out to friends and siblings than to co-workers, parents, and more distant relatives.{{cite journal|last=Berger|first=Raymond M.|date=29 October 1992|title=Passing and Social Support Among Gay Men|journal=Journal of Homosexuality|volume=23|issue=3|pages=85–98|issn=0091-8369|pmid=1431083|doi=10.1300/j082v23n03_06}}
• Coming out and well-being: same-sex couples who are openly gay are more satisfied in their relationships.{{Cite journal|author=Berger RM |title=Passing: impact on the quality of same-sex couple relationships |journal=Social Work |volume=35 |issue=4 |pages=328–32 |date=July 1990 |pmid=2392712}} For women who self-identify as lesbian, the more people know about her sexual orientation, the less anxiety, more positive affectivity, and greater self-esteem she has.{{Cite journal|vauthors=Jordan KM, Deluty RH |title=Coming out for lesbian women: its relation to anxiety, positive affectivity, self-esteem, and social support |journal=Journal of Homosexuality |volume=35 |issue=2 |pages=41–63 |year=1998 |pmid=9524921 |doi=10.1300/J082v35n02_03}}
• Rejection of gay identity: various studies report that for some religious people, rejecting a gay identity appears to relieve the distress caused by conflicts between religious values and sexual orientation.{{cite journal | author = Ponticelli C. M. | year = 1999 | title = Crafting stories of sexual identity reconstruction | journal = Social Psychology Quarterly | volume = 62 | issue = 2| pages = 157–172 | doi=10.2307/2695855| jstor = 2695855 }}{{cite book |title=Straight to Jesus: Sexual and Christian Conversions in the Ex-Gay Movement |url=https://www.ucpress.edu/book/9780520245822/straight-to-jesus |last=Erzen |first=Tanya |date=27 June 2006 |publisher=University of California Press |isbn=978-0-520-93905-9}}{{cite journal | author = Thumma S | year = 1991 | title = Negotiating a religious identity: The case of the gay evangelical | journal =Sociological Analysis | volume = 52 | issue = 4| pages = 333–347 | doi=10.2307/3710850| jstor = 3710850 }}Kerr, R. A. (1997). The experience of integrating gay identity with evangelical Christian faith" Dissertation Abstracts International 58(09), 5124B. (UMI No. 9810055). After reviewing the research, Judith Glassgold, chair of the American Psychological Association sexuality task force, said some people are content in denying a gay identity and "there is no clear evidence of harm".{{cite news | last=Simon | first=Stephanie | title=A New Therapy on Faith and Sexual Identity | work=Wall Street Journal | date=7 August 2009 | url=https://www.wsj.com/articles/SB124950491516608883 | issn=0099-9660 |url-access=subscription}}

{{Main|Sexual fluidity}}

Often, sexual orientation and sexual orientation identity are not distinguished, which can impact accurately assessing sexual identity and whether or not sexual orientation is able to change; sexual orientation identity can change throughout an individual's life, and may or may not align with biological sex, sexual behavior or actual sexual orientation.Sinclair, Karen, About Whoever: The Social Imprint on Identity and Orientation, NY, 2013 {{ISBN|9780981450513}}{{cite journal | last1 = Rosario | first1 = M. | last2 = Schrimshaw | first2 = E. | last3 = Hunter | first3 = J. |last4 = Braun | first4 = L. | year = 2006 | title = Sexual identity development among lesbian, gay, and bisexual youths: Consistency and change over time | journal = Journal of Sex Research | volume = 43 | issue = 1| pages = 46–58 | doi=10.1080/00224490609552298| pmc = 3215279 | pmid=16817067}}{{cite journal|first=Michael W.|last=Ross|author2=Essien, E. James |author3=Williams, Mark L. |author4= Fernandez-Esquer, Maria Eugenia. |title=Concordance Between Sexual Behavior and Sexual Identity in Street Outreach Samples of Four Racial/Ethnic Groups|publisher=American Sexually Transmitted Diseases Association|year=2003|pmid=12567166|journal=Sexually Transmitted Diseases|volume=30|issue=2|pages=110–113|doi=10.1097/00007435-200302000-00003|s2cid=21881268|doi-access=free}} Sexual orientation is stable and unlikely to change for the vast majority of people, but some research indicates that some people may experience change in their sexual orientation, and this is more likely for women than for men.

• {{cite journal|last1=Bailey|first1=J. Michael|last2=Vasey|first2=Paul|last3=Diamond|first3=Lisa|last4=Breedlove|first4=S. Marc|last5=Vilain|first5=Eric|last6=Epprecht|first6=Marc|title=Sexual Orientation, Controversy, and Science|journal=Psychological Science in the Public Interest|date=2016|volume=17|issue=2|pages=45–101|doi=10.1177/1529100616637616|url=https://www.researchgate.net/publication/301639075|quote=Sexual fluidity is situation-dependent flexibility in a person's sexual responsiveness, which makes it possible for some individuals to experience desires for either men or women under certain circumstances regardless of their overall sexual orientation....We expect that in all cultures the vast majority of individuals are sexually predisposed exclusively to the other sex (i.e., heterosexual) and that only a minority of individuals are sexually predisposed (whether exclusively or non-exclusively) to the same sex.|pmid=27113562|doi-access=free}}
• {{cite book|author=Dennis Coon |author2=John O. Mitterer |title=Introduction to Psychology: Gateways to Mind and Behavior with Concept Maps and Reviews|publisher=Cengage Learning|isbn=978-1-111-83363-3|year=2012|page=372|access-date=February 18, 2016|url=https://books.google.com/books?id=EYwjCQAAQBAJ&pg=PA372|quote=Sexual orientation is a deep part of personal identity and is usually quite stable. Starting with their earliest erotic feelings, most people remember being attracted to either the opposite sex or the same sex. [...] The fact that sexual orientation is usually quite stable doesn't rule out the possibility that for some people sexual behavior may change during the course of a lifetime.}}
• {{cite book|author=Eric Anderson |author2=Mark McCormack |title=The Changing Dynamics of Bisexual Men's Lives|chapter=Measuring and Surveying Bisexuality|publisher= Springer Science & Business Media|isbn=978-3-319-29412-4|year=2016|page=47|access-date=June 22, 2019|chapter-url=https://books.google.com/books?id=7_AgDAAAQBAJ&pg=PA47|quote=[R]esearch suggests that women's sexual orientation is slightly more likely to change than men's (Baumeister 2000; Kinnish et al. 2005). The notion that sexual orientation can change over time is known as sexual fluidity. Even if sexual fluidity exists for some women, it does not mean that the majority of women will change sexual orientations as they age – rather, sexuality is stable over time for the majority of people.}} The American Psychological Association distinguishes between sexual orientation (an innate attraction) and sexual orientation identity (which may change at any point in a person's life).{{cite web |title=Appropriate Therapeutic Responses to Sexual Orientation|publisher=American Psychological Association|pages=63, 86|date=2009|access-date=February 3, 2015|url=http://www.apa.org/pi/lgbc/publications/therapeutic-response.pdf}}

In a statement issued jointly with other major American medical organizations, the American Psychological Association states that "different people realize at different points in their lives that they are heterosexual, gay, lesbian, or bisexual".{{Cite web|url=http://www.apa.org/pi/lgbc/publications/justthefacts.html|title=Just the Facts About Sexual Orientation & Youth: A Primer for Principals, Educators and School Personnel|year=1999|publisher=American Psychological Association|archive-url=https://web.archive.org/web/20070203183535/http://www.apa.org/pi/lgbc/publications/justthefacts.html|archive-date=3 February 2007|access-date=28 August 2007}} A 2007 report from the Centre for Addiction and Mental Health states that, "For some people, sexual orientation is continuous and fixed throughout their lives. For others, sexual orientation may be fluid and change over time".{{Cite web|url=http://www.camh.net/Publications/Resources_for_Professionals/ARQ2/arq2_question_a2.html

|title=ARQ2: Question A2 – Sexual Orientation

|access-date=28 August 2007

|publisher=Centre for Addiction and Mental Health}} Lisa Diamond's study "Female bisexuality from adolescence to adulthood" suggests that there is "considerable fluidity in bisexual, unlabeled, and lesbian women's attractions, behaviors, and identities".{{Cite journal

|title=Female bisexuality from adolescence to adulthood: Results from a 10-year longitudinal study |last=Diamond |first=Lisa M.

|journal=Developmental Psychology |date=January 2008|volume=44

|issue=1 |url=http://www.apa.org/journals/releases/dev4415.pdf

|pages=5–14|doi=10.1037/0012-1649.44.1.5 |pmid=18194000}}{{Cite news

|title=Bisexual women – new research findings

|publisher=Women's Health News

|date= 17 January 2008

|url=http://www.news-medical.net/?id=34415}}

{{See also|LGBT parenting}}

LGBT parenting is the parenting of children by lesbian, gay, bisexual, and transgender (LGBT) people, as either biological or non-biological parents. Gay men have options which include "foster care, variations of domestic and international adoption, diverse forms of surrogacy (whether "traditional" or gestational), and kinship arrangements, wherein they might coparent with a woman or women with whom they are intimately but not sexually involved".{{cite journal | last1 = Berkowitz | first1 = D | last2 = Marsiglio | first2 = W | year = 2007 | title = Gay Men: Negotiating Procreative, Father, and Family Identities | journal = Journal of Marriage and Family | volume = 69 | issue = 2| pages = 366–381 | doi=10.1111/j.1741-3737.2007.00371.x}}{{Cite news|url=https://www.nytimes.com/2006/03/07/health/07broke.html|title=Many Couples Must Negotiate Terms of 'Brokeback' Marriages|last=Butler|first=Katy|date=7 March 2006|work=The New York Times}}{{cite journal|last=Coleman|first=Eli|date=14 December 1989|title=The Married Lesbian|journal=Marriage & Family Review|volume=14|issue=3–4|pages=119–135|doi=10.1300/J002v14n03_06|issn=0149-4929}}{{Cite journal|author=Büntzly G|year=1993|title=Gay fathers in straight marriages|journal=Journal of Homosexuality|volume=24|issue=3–4|pages=107–14|doi=10.1300/J082v24n03_07|pmid=8505530}}{{Cite book

|chapter-url=https://books.google.com/books?id=yffzsKWvP6AC&pg=PA138

|title=Gay and Lesbian Parents

|first=Frederick W.

|last=Bozett

|chapter=The Heterosexually Married Gay and Lesbian Parent

|page=[https://archive.org/details/gaylesbianparent00bozerich/page/138 138]

|isbn=978-0-275-92541-3

|date=19 August 1987

|publisher=Bloomsbury Academic

|url=https://archive.org/details/gaylesbianparent00bozerich/page/138

}} LGBT parents can also include single parents; to a lesser extent, the term sometimes refers to parents of LGBT children.

In the 2000 U.S. Census, 33% of female same-sex couple households and 22% of male same-sex couple households reported at least one child under eighteen living in their home.{{cite web|url=http://www.apa.org/pi/lgbc/policy/parents.html|title=APA Policy Statement on Sexual Orientation, Parents, & Children|date=28 July 2004|archive-url=https://web.archive.org/web/20070715234854/http://www.apa.org/pi/lgbc/policy/parents.html|archive-date=15 July 2007|access-date=6 April 2007}} Some children do not know they have an LGBT parent; coming out issues vary and some parents may never come out to their children.{{Cite journal|author=Dunne EJ |title=Helping gay fathers come out to their children |journal=J Homosex |volume=14 |issue=1–2 |pages=213–22 |year=1987 |pmid=3655343 |doi=10.1300/J082v14n01_16}}{{cite journal|last=Buxton|first=Amity P.|date=31 March 2005|title=A Family Matter: When a Spouse Comes Out as Gay, Lesbian, or Bisexual|journal=Journal of GLBT Family Studies|volume=1|issue=2|pages=49–70|doi=10.1300/J461v01n02_04|s2cid=142502027|issn=1550-428X}} Adoption by LGBT couples and LGBT parenting in general may be controversial in some countries. In January 2008, the European Court of Human Rights ruled that same-sex couples have the right to adopt a child.{{cite web |url=https://www.hrw.org/news/2008/01/23/europe-gay-adoption-ruling-advances-family-equality |title=Europe: Gay Adoption Ruling Advances Family Equality |date=January 23, 2008 |website=Human Rights Watch |access-date=April 27, 2021}}{{Cite news|url=http://de.euronews.net/2008/01/22/gleichgeschlechtliche-adoptiveltern-gerichtshof-ruegt-frankreich/|title=Gleichgeschlechtliche Adoptiveltern - Gerichtshof rügt Frankreich|date=22 January 2008|work=euronews|language=de|access-date=3 May 2010|archive-date=24 January 2012|archive-url=https://web.archive.org/web/20120124181443/http://de.euronews.net/2008/01/22/gleichgeschlechtliche-adoptiveltern-gerichtshof-ruegt-frankreich/|url-status=dead}} In the U.S., LGBT people can legally adopt, as individuals, in all fifty states.{{Cite web|url=http://www.hrc.org/issues/parenting/adoptions/2375.htm|title=Adoption Laws: State by State|publisher=Human Rights Campaign|archive-url=https://web.archive.org/web/20081118221334/http://www.hrc.org/issues/parenting/adoptions/2375.htm|archive-date=18 November 2008|access-date=9 July 2008}}

Although it is sometimes asserted in policy debates that heterosexual couples are inherently better parents than same-sex couples, or that the children of lesbian or gay parents fare worse than children raised by heterosexual parents, those assertions are not supported by scientific research literature.{{cite web | last=Canadian Psychological Association | title=Brief presented to the Legislative House of Commons Committee on Bill C38 | date=2 June 2005 | url=http://www.cpa.ca/cpasite/userfiles/Documents/advocacy/brief.pdf | archive-url=https://web.archive.org/web/20121013225547/http://www.cpa.ca/cpasite/userfiles/Documents/advocacy/brief.pdf | archive-date=13 October 2012}} There is ample evidence to show that children raised by same-gender parents fare as well as those raised by heterosexual parents. Much research has documented the lack of correlation between parents' sexual orientation and any measure of a child's emotional, psychosocial, and behavioral adjustment. These data have demonstrated no risk to children as a result of growing up in a family with one or more gay parents.{{Cite journal |vauthors=Pawelski JG, Perrin EC, Foy JM, etal |title=The effects of marriage, civil union, and domestic partnership laws on the health and well-being of children |journal=Pediatrics |volume=118 |issue=1 |pages=349–64 |date=July 2006 |pmid=16818585 |doi=10.1542/peds.2006-1279|doi-access=free }} No research supports the widely held conviction that the gender of parents influences the well-being of the child.{{cite journal | last1=Biblarz | first1=Timothy J. | last2=Stacey | first2=Judith | title=How Does the Gender of Parents Matter? | journal=Journal of Marriage and Family | date=1 February 2010 | url=https://is.muni.cz/el/1423/podzim2011/GEN143/um/27498491/_How__does_gender_of_parents_matter_-_Stacey_and_Biblarz.pdf | doi=10.1111/j.1741-3737.2009.00678.x | issn=1741-3737 | volume=72 | issue=1 | pages=3–22| citeseerx=10.1.1.593.4963 }} If gay, lesbian, or bisexual parents were inherently less capable than otherwise comparable heterosexual parents, their children would present more poorly regardless of the type of sample; this pattern has not been observed.{{Cite journal|author=Herek GM |title=Legal recognition of same-sex relationships in the United States: a social science perspective |journal=The American Psychologist |volume=61 |issue=6 |pages=607–21 |date=September 2006 |pmid=16953748 |doi=10.1037/0003-066X.61.6.607 |url=http://psychology.ucdavis.edu/rainbow/html/AP_06_pre.PDF |archive-url=https://web.archive.org/web/20100610164736/http://psychology.ucdavis.edu/rainbow/html/AP_06_pre.PDF |archive-date=10 June 2010 }}

Professor Judith Stacey of New York University, stated: "Rarely is there as much consensus in any area of social science as in the case of gay parenting, which is why the American Academy of Pediatrics and all of the major professional organizations with expertise in child welfare have issued reports and resolutions in support of gay and lesbian parental rights".{{cite web |last1=Cooper |first1=L. |last2=Cates |first2=P. |title=Too high a price: The case against restricting gay parenting |location=New York |publisher=American Civil Liberties Union |page=36 |url=https://www.aclu.org/other/too-high-price-case-against-restricting-gay-parenting }}, as cited in {{cite web | last1=Short | first1=Elizabeth | last2=Riggs | first2=Damien W. | last3=Perlesz | first3=Amaryll | last4=Brown | first4=Rhonda | last5=Kane | first5=Graeme | title=Lesbian, Gay, Bisexual and Transgender (LGBT) Parented Families: A Literature Review prepared for The Australian Psychological Society | date=August 2007 | url=http://www.psychology.org.au/Assets/Files/LGBT-Families-Lit-Review.pdf | access-date=26 December 2009 | archive-date=4 March 2011 | archive-url=https://web.archive.org/web/20110304014530/http://www.psychology.org.au/Assets/Files/LGBT-Families-Lit-Review.pdf | url-status=dead }} These organizations include the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry,{{cite web| url=http://www.aacap.org/cs/root/facts_for_families/children_with_lesbian_gay_bisexual_and_transgender_parents |title= Children with Lesbian, Gay, Bisexual and Transgender Parents | archive-url=https://web.archive.org/web/20100615053143/http://aacap.org/cs/root/facts_for_families/children_with_lesbian_gay_bisexual_and_transgender_parents |date=15 June 2010 | archive-date=15 June 2010 | publisher=American Academy of Child and Adolescent Psychiatry}} the American Psychiatric Association,{{Cite web|url=http://www.psych.org/Departments/EDU/Library/APAOfficialDocumentsandRelated/PositionStatements/200214.aspx|title=Adoption and Co-parenting of Children by Same-sex Couples|publisher=American Psychiatric Association|archive-url=https://web.archive.org/web/20080711183011/http://www.psych.org/Departments/EDU/Library/APAOfficialDocumentsandRelated/PositionStatements/200214.aspx|archive-date=11 July 2008}} the American Psychological Association,{{Cite web|url=http://www.apa.org/about/policy/parenting.aspx|title=Sexual Orientation, Parents, & Children|publisher=American Psychological Association}} the American Psychoanalytic Association,{{Cite web|url=http://www.apsa.org/About_APsaA/POSITION_STATEMENTS/GAY_AND_LESBIAN_PARENTING.aspx|title=Position Statement on Gay and Lesbian Parenting|publisher=American Psychoanalytic Association|archive-url=https://web.archive.org/web/20110928025729/http://www.apsa.org/About_APsaA/POSITION_STATEMENTS/GAY_AND_LESBIAN_PARENTING.aspx|archive-date=28 September 2011}} the National Association of Social Workers, the Child Welfare League of America,{{Cite web|url=http://cwla.org/programs/culture/glbtqposition.htm|title=Position Statement on Parenting of Children by Lesbian, Gay, and Bisexual Adults|publisher=Child Welfare League of America|archive-url=https://web.archive.org/web/20100613072557/http://cwla.org/programs/culture/glbtqposition.htm|archive-date=13 June 2010}} the North American Council on Adoptable Children,{{Cite news|url=http://www.nacac.org/policy/positions.html#Gay|title=NACAC's Positions on Key Issues|date=28 April 2017|work=The North American Council on Adoptable Children|language=en-US|access-date=15 February 2010|archive-date=19 October 2015|archive-url=https://archive.today/20151019205647/http://www.nacac.org/policy/positions.html%23Gay#Gay|url-status=dead}} and the Canadian Psychological Association (CPA). The CPA is concerned that some persons and institutions are misinterpreting the findings of psychological research to support their positions, when their positions are more accurately based on other systems of belief or values.{{Cite web|url=http://www.cpa.ca/cpasite/userfiles/Documents/Marriage%20of%20Same-Sex%20Couples%20Position%20Statement%20-%20October%202006%20(1).pdf|title=Marriage of Same-Sex Couples – 2006 Position Statement|publisher=Canadian Psychological Association|archive-url=https://web.archive.org/web/20121013225622/http://www.cpa.ca/cpasite/userfiles/Documents/Marriage%20of%20Same-Sex%20Couples%20Position%20Statement%20-%20October%202006%20(1).pdf|archive-date=13 October 2012}}

The vast majority of families in the United States today are not the "middle-class family with a bread-winning father and a stay-at-home mother, married to each other and raising their biological children" that has been viewed as the norm. Since the end of the 1980s, it has been well established that children and adolescents can adjust just as well in nontraditional settings as in traditional settings.[https://www.glad.org/wp-content/uploads/2013/06/2009-11-17-doma-aff-lamb.pdf Affidavit of Michael Lamb] in {{cite court|litigants=Gill v. Office of Personnel Management|vol=682|reporter=F.3d | court=1st Circ. | year=2012|url=https://www.govinfo.gov/app/details/USCOURTS-mad-1_09-cv-10309/USCOURTS-mad-1_09-cv-10309-0/summary}}

Most people with a homosexual orientation who seek psychotherapy do so for the same reasons as straight people (stress, relationship difficulties, difficulty adjusting to social or work situations, etc.); their sexual orientation may be of primary, incidental, or no importance to their issues and treatment. Regardless of the issue for which psychotherapy is sought, there is a high risk of anti-gay bias being directed at non-heterosexual clients.

{{See also|Relationship counseling }}

{{Expand section|date=October 2009}}Most relationship issues are shared equally among couples regardless of sexual orientation, but LGBT clients additionally have to deal with homophobia, heterosexism, and other societal oppressions. Individuals may also be at different stages in the coming out process. Often, same-sex couples do not have as many role models for successful relationships as opposite-sex couples. There may be issues with gender-role socialization that does not affect opposite-sex couples.{{cite book|chapter-url=https://books.google.com/books?id=LZusAgAAQBAJ&pg=PA97|title=Relationship Therapy with Same-Sex Couples|last1=Bigner|first1=Jerry|last2=Wetchler|first2=Joseph L.|last3=Buxton|first3=Amity P.|date=14 January 2014|publisher=Routledge|isbn=978-1-317-78689-4|chapter=Paths and Pitfalls: Howe Heterosexual Spouses Cope When Their Husbands or Wives Come Out}}

A significant number of men and women experience conflict surrounding homosexual expression within a mixed-orientation marriage.{{Cite journal|author=Wolf TJ |title=Group psychotherapy for bisexual men and their wives |journal=J. Homosex. |volume=14 |issue=1–2 |pages=191–9 |year=1987 |pmid=3655341 |doi=10.1300/J082v14n01_14 }} Therapy may include helping the client feel more comfortable and accepting of same-sex feelings and to explore ways of incorporating same-sex and opposite-sex feelings into life patterns.{{Cite journal|author=Coleman E |title=Bisexual and gay men in heterosexual marriage: conflicts and resolutions in therapy |journal=J. Homosex. |volume=7 |issue=2–3 |pages=93–103 |year=1981 |pmid=7346553 |doi=10.1300/J082v07n02_11 }} Although a strong homosexual identity was associated with difficulties in marital satisfaction, viewing the same-sex activities as compulsive facilitated commitment to the marriage and to monogamy.{{Cite journal|vauthors=Schneider JP, Schneider BH |title=Marital satisfaction during recovery from self-identified sexual addiction among bisexual men and their wives |journal=J Sex Marital Ther |volume=16 |issue=4 |pages=230–50 |year=1990 |pmid=2079706|doi=10.1080/00926239008405460 }}

{{Main|Gay affirmative psychotherapy}}

Gay affirmative psychotherapy is a form of psychotherapy for gay, lesbian, and bisexual clients which encourages them to accept their sexual orientation, and does not attempt to change their sexual orientation to heterosexual, or to eliminate or diminish their same-sex desires and behaviors. The American Psychological Association (APA) and the British Psychological Society offer guidelines and materials for gay affirmative psychotherapy.{{Cite web|url=http://www.apa.org/pi/lgbc/guidelines.html|title=Guidelines for Psychotherapy with Lesbian, Gay, & Bisexual Clients|publisher=American Psychological Association|archive-url=https://web.archive.org/web/20070208023901/http://www.apa.org/pi/lgbc/guidelines.html|archive-date=8 February 2007}}{{Cite web|url = http://www.bps.org.uk/sites/default/files/images/rep_92.pdf|title = Guidelines and Literature Review for Psychologists Working Therapeutically with Sexual and Gender Minority Clients|website = British Psychological Society|last = British Psychological Society}} Practitioners of gay affirmative psychotherapy state that homosexuality or bisexuality is not a mental illness, and that embracing and affirming gay identity can be a key component to recovery from other mental illnesses or substance abuse. Some people may find neither gay affirmative therapy nor conversion therapy appropriate, however. Clients whose religious beliefs are inconsistent with homosexual behavior may require some other method of integrating their conflicting religious and sexual selves.{{Cite journal

|last=Haldeman

|first=Douglas

|title=When Sexual and Religious Orientation Collide:Considerations in Working with Conflicted Same-Sex Attracted Male Clients

|volume=32

|issue=5

|pages=691–715

|year=2004

|doi=10.1177/0011000004267560

|journal=The Counseling Psychologist|s2cid=145278059

}}

{{See also|Ego-dystonic sexual orientation}}

The American Psychological Association recommends that if a client wants treatment to change their sexual orientation, the therapist should explore the reasons behind the desire, without favoring any particular outcome. The therapist should neither promote nor reject the idea of celibacy, but help the client come to their own decisions by evaluating the reasons behind the patient's goals.{{Cite web|url=http://www.apa.org/pi/lgbc/publications/resolution-resp.html|title=Resolution on Appropriate Affirmative Responses to Sexual Orientation Distress and Change Efforts|publisher=American Psychological Association|archive-url=https://web.archive.org/web/20090811003322/http://www.apa.org/pi/lgbc/publications/resolution-resp.html|archive-date=11 August 2009}} One example of sexual orientation identity exploration is sexual identity therapy.

After exploration, a patient may proceed with sexual orientation identity reconstruction, which helps a patient reconstruct sexual orientation identity. Psychotherapy, support groups, and life events can influence identity development; similarly, self-awareness, self-conception, and identity may evolve during treatment. It can change sexual orientation identity (private and public identification, and group belonging), emotional adjustment (self-stigma and shame reduction), and personal beliefs, values and norms (change of religious and moral belief, behavior and motivation). Some therapies include "gender wholeness therapy".{{Cite news|url=https://www.nytimes.com/2007/02/12/nyregion/12group.html|title=Some Tormented by Homosexuality Look to a Controversial Therapy|last=Luo|first=Michael|date=12 February 2007|work=The New York Times|access-date=28 August 2007|page=1}}

The American Psychiatric Association states in their official statement release on the matter: "The potential risks of 'reparative therapy' are great and include depression, anxiety, and self-destructive behavior, since therapist alignment with societal prejudices against homosexuality may reinforce self-hatred already experienced by the patient. Many patients who have undergone 'reparative therapy' relate that they were inaccurately told that homosexuals are lonely, unhappy individuals who never achieve acceptance or satisfaction. The possibility that the person might achieve happiness and satisfying interpersonal relationships as a gay man or lesbian are not presented, nor are alternative approaches to dealing with the effects of societal stigmatization discussed. APA recognizes that in the course of ongoing psychiatric treatment, there may be appropriate clinical indications for attempting to change sexual behaviors."{{cite web|title=Psychiatric Treatment and Sexual Orientation POSITION STATEMENT|url=http://www.psych.org/Departments/EDU/Library/APAOfficialDocumentsandRelated/PositionStatements/199820.aspx|publisher=American Psychiatric Association|access-date=12 October 2011}}

The American Psychological Association aligns with this in a resolution: it "urges all mental health professionals to take the lead in removing the stigma of mental illness that has long been associated with homosexual orientation"{{cite journal|last=Conger|first=John J.|date=1975|title=Proceedings of the American Psychological Association, Incorporated, for the Year 1974: Minutes of the Annual Meeting of the Council of Representatives.|journal=American Psychologist|volume=30|issue=6|page=633|doi=10.1037/h0078455|issn=0003-066X}} and "Therefore be it further resolved that the American Psychological Association opposes portrayals of lesbian, gay, and bisexual youth and adults as mentally ill due to their sexual orientation and supports the dissemination of accurate information about sexual orientation, and mental health, and appropriate interventions in order to counteract bias that is based in ignorance or unfounded beliefs about sexual orientation."{{cite web|title=Resolution on Appropriate Therapeutic Responses to Sexual Orientation|url=http://psychology.ucdavis.edu/rainbow/html/resolution97_text.html|publisher=American Psychological Association|access-date=12 October 2011|archive-date=21 October 2011|archive-url=https://web.archive.org/web/20111021051113/http://psychology.ucdavis.edu/rainbow/html/resolution97_text.html|url-status=dead}}

The American Academy of Pediatrics advises lesbian, gay, gynandromorphophilic, and bisexual teenagers struggling with their sexuality: "Homosexuality is not a mental disorder. All of the major medical organizations, including The American Psychiatric Association, The American Psychological Association, and the American Academy of Pediatrics agree that homosexuality is not an illness or disorder, but a form of sexual expression. No one knows what causes a person to be gay, bisexual, or straight. There probably are a number of factors. Some may be biological. Others may be psychological. The reasons can vary from one person to another. The fact is, you do not choose to be gay, bisexual, or straight."{{cite web|title=Gay, Lesbian, and Bisexual Teens: Facts for Teens and Their Parents|url=https://healthychildren.org/English/ages-stages/teen/dating-sex/Pages/Gay-Lesbian-and-Bisexual-Teens-Facts-for-Teens-and-Their-Parents.aspx|work=Healthy Children|publisher=American Academy of Pediatrics|access-date=20 December 2016|archive-date=26 October 2017|archive-url=https://web.archive.org/web/20171026122409/https://www.healthychildren.org/English/ages-stages/teen/dating-sex/Pages/Gay-Lesbian-and-Bisexual-Teens-Facts-for-Teens-and-Their-Parents.aspx|url-status=dead}}

In contemporary Adlerian thought, homosexuals are not considered within the problematic discourse of the "failures of life". Christopher Shelley, an Adlerian psychotherapist, published a volume of essays in 1998 that feature Freudian, (post)Jungian and Adlerian contributions that demonstrate affirmative shifts in the depth psychologies.{{Cite book|title=Contemporary perspectives on psychotherapy and homosexualities|last=Shelley, Christopher|date=1998|publisher=Free Association|isbn=1-85343-403-5|oclc=489184072}} These shifts show how depth psychology can be utilized to support rather than pathologize gay and lesbian psychotherapy clients. The Journal of Individual Psychology, the English language flagship publication of Adlerian psychology, released a volume in the summer of 2008 that reviews and corrects Adler's previously held beliefs on the homosexual community.{{Citation needed|date=June 2024}}

• Association of Gay and Lesbian Psychiatrists
• Conversion therapy
• Disability and LGBT identities
• Ego-dystonic sexual orientation
• Homosexuality in DSM
• Minority stress
• Timeline of sexual orientation and medicine
• Neuroqueer theory
• LGBTQ psychology

{{Reflist}}

• American Academy of Pediatrics: "[http://pediatrics.aappublications.org/cgi/content/full/113/6/1827 Sexual Orientation and Adolescents]"
• British Psychological Society National Mental Health Association: "[https://web.archive.org/web/20080116030611/http://www.mentalhealthamerica.net/go/whatdoesgaymean What Does Gay Mean? How to Talk with Kids about Sexual Orientation and Prejudice]"
• [https://web.archive.org/web/20160209095649/http://www.psychotherapy.org.uk/UKCP_Documents/policy/Conversion%20therapy.pdf Conversion therapy: Consensus statement]
• [https://web.archive.org/web/20150123004221/http://www.psychotherapy.org.uk/UKCP_Documents/policy/MoU-conversiontherapy.pdf Memorandum on Conversion Therapy in the UK]

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