Egodystonic sexual orientation is an egodystonic condition. 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 them 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. The American Psychological Association has officially opposed the category of ego-dystonic homosexuality since 1987.
Diagnosis
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.
Treatments
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.
LGB affirming
Gay affirmative psychotherapy helps LGB people to examine and accept their sexual orientation and related sexual relationships. Psychologists understand that homosexuality and bisexuality are not indicative of mental illness. Psychologists are encouraged to recognize how their attitudes and knowledge about homosexual and bisexual issues may be relevant to assessment and treatment and seek consultation or make appropriate referrals when indicated. Psychologists strive to understand the ways in which social stigmatization (i.e., prejudice, discrimination, and violence) poses risks to the mental health and well-being of homosexual and bisexual clients. Psychologists strive to understand how inaccurate or prejudicial views of homosexuality or bisexuality may affect the client’s presentation in treatment and the therapeutic process. Douglas Haldeman has argued that for individuals who seek therapy because of frustration surrounding "seemingly irreconcilable internal differences" between "their sexual and religious selves... neither a gay-affirmative nor a conversion therapy approach indicated," and that " therapists in the religious world refrain from pathologizing their LGB clients... so, too, should gay-affirmative practitioners refrain from overtly or subtly devaluing those who espouse conservative religious identities." Data suggest that clients generally judge therapists who do not respect religiously-based identity outcomes to be unhelpful.
LGB support groups
LGB groups help counteract and buffer minority stress, marginalization, and isolation. They focus on helping a person with ego-dystonic sexual orientation accept their sexual orientation.
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), 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 he believe that help 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 lead 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.
Ex-gay organizations
Main article: Ex-gayFor some ex-gay groups, choosing not to act on one's same-sex desires counts as a success whereas conversion therapists tend to understand success in terms of reducing or eliminating those desires. For example, some ex-gays in mixed-orientation marriages acknowledge that their sexual attractions remain primarily homosexual, but seek to make their marriages work regardless. Ex-gay advocates sometimes compare adopting the label "ex-gay" to the coming out process." Some conservative Christian political and social lobbying groups such as Focus on the Family, the Family Research Council, and the American Family Association actively promote to their constituencies the accounts of change of both conversion therapies and ex-gay groups.
Some ex-gay organizations follow the tenets of a specific religion, while others try to encompass a more general spirituality. Although most ex-gay organizations were started by American evangelical Christians, there are now ex-gay organizations in other parts of the world and for Catholics, Mormons, Jews and Muslims. According to Douglas Haldeman, "This modality is thought to be one of the most common for individuals seeking to change their sexual orientation." Ex-gay ministries typically are staffed by volunteer counselors, unlike reorientation counseling, which is conducted by licensed clinicians.
Ex-gay groups use several different techniques. Love in Action hosts workshops on "child development, gender roles, and personal sexuality," one-on-one Biblical guidance, "a structured environment help establish new routines and healthy patterns of behavior", "challenging written assignments and interactive projects," "family involvement to improve communication... and to facilitate marital reconciliation," and "hiking, camping, canoeing, and rafting." Exodus International considers reparative therapy to be a useful tool, but not a necessary one. Evergreen International does not advocate or discourage particular therapies and states that "therapy will likely not be a cure in the sense of erasing all homosexual feelings."
Sexual orientation change efforts
Main article: Sexual orientation change effortsThe American Psychological Association "encourages mental health professionals to avoid misrepresenting the efficacy of sexual orientation change efforts by promoting or promising
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