Sexual Orientation

What is “sexual orientation”?

Sexual orientation is a term frequently used to describe a person’s romantic, emotional or sexual attraction to another person. A person attracted to another person of the same sex is said to have a homosexual orientation and may be called gay (both men and women), lesbian or bisexual.

Individuals attracted to persons of the opposite sex are said to have a heterosexual orientation. However it’s very simplistic to think that people are either homosexual or heterosexual because sexual orientation falls along a continuum and individuals who are attracted to both men and women are said to be bisexual.

Sexual orientation is different from gender identity, which refers to the internal sense of whether one is male or female. Sexual orientation is a relatively new concept. In fact, although same sex behaviour has always existed, the idea of a homosexual identity or a homosexual person is only about 100 years old.

The concept of sexual orientation refers to more than sexual behaviour: it includes feelings as well as identity. Some individuals may identify themselves as gay, lesbian or bisexual without engaging in any sexual activity. Gay, lesbian, or bisexual people often (but not always) become aware of their sexual orientation at different points in their lives or, to put it more accurately, they come to accept their sexual orientation and view it as an intrinsic part of themselves. Much like heterosexual people do.

Is homosexuality a mental health disorder?

No. All major professional mental health organizations have gone on record to affirm that homosexuality is not a mental disorder. In 1973 the American Psychiatric Association’s Board of Trustees removed homosexuality from its official diagnostic manual, The Diagnostic and Statistical Manual of Mental Disorders, Second Edition (DSM II). The action was taken following a review of the scientific literature and consultation with experts in the field. The experts found that homosexuality doesn’t meet the criteria to be considered a mental  illness.

What causes homosexuality/heterosexuality/bisexuality?

No one knows what causes heterosexuality, homosexuality, or bisexuality. Homosexuality was once thought to be the result of troubled family dynamics or faulty psychological development. Those assumptions are now understood to have been based on misinformation and prejudice.

Currently there is a renewed interest in searching for biological causes for sexual orientation. However, to date there are no replicated scientific studies supporting any specific biological cause. Similarly, no specific psychosocial or family dynamic cause for homosexuality has been identified, including histories of childhood sexual abuse. Sexual abuse does not appear to be more prevalent in children who grow up to identify as gay, lesbian, or bisexual, than in children who identify as heterosexual.

What is ‘coming out’?

Coming out is the term used to describe the experience in which a person identifies himself or herself as LGBT. Coming out is not a one-time event, but a lifelong process of identifying as LGBT to family, friends and other significant members of one’s social world. Each person’s experience in coming out is unique and the process always stimulates anxiety as well as provides challenging possibilities for personal empowerment and emotional growth.

There are many resources available to people coming out. A quick Google search for LGBT support services in your town will yield sources of support.

Does stigma still exist about homosexuality?

Don’t we live in a more enlightened age? Unfortunately, fears and misunderstandings about homosexuality are wide spread and they present daunting challenges to the development and maintenance of a positive self-image in LGBT persons and often to their families as well. Homophobia is a term that refers to the irrational fear and prejudice against homosexual people..

Despite the fact that attitudes and legislation have changed in recent years, homosexuals are still a stigmatised group. Sadly, hate crimes still occur. Regardless of anti-bullying rules, LGBT adolescents can be taunted and humiliated at school. Despite legislation against discrimination and employee support groups, many professionals and employees in all occupations are still fearful of identifying as LGBT in their work settings.

There can be  particular problems for LGBT members of black and ethnic minority populations, and in faith groups.

In 1992, the American Psychiatric Association recognised the power of the stigma against homosexuality and issued the following statement:

“Whereas homosexuality per se implies no impairment in judgement, stability, reliability, or general social or vocational capabilities, the American Psychiatric Association calls on all international health organisations and individual psychiatrists in international health organisations and individual psychiatrists in other countries, to urge the repeal in their own country of legislation that penalised homosexual acts by consenting adults in private. And further the APA calls on these organisations and individuals to do all that is possible to decrease the stigma related to homosexuality wherever and whenever it may occur.”

Such organisational recognition of homophobia has been important in changing attitudes about homosexuality.

Is it possible to change one’s sexual orientation ?

There is no published scientific evidence supporting the efficacy of reparative therapy as a treatment to change one’s sexual orientation, nor is it included in the APA’s Task Force Report, Treatments of Psychiatric Disorders.

More importantly, altering sexual orientation is not an appropriate goal of psychiatric treatment. Some may seek conversion to heterosexuality because of the difficulties that they encounter as a member of a stigmatised group. Clinical experience indicates that those who have integrated their sexual orientation into a positive sense of self-function at a healthier psychological level than those who have not. Gay affirmative psychotherapy may be helpful in the coming out process, fostering a positive psychological development and overcoming the effects of stigmatisation. A position statement adopted by the Board in December 1998 said:

“The American Psychiatric Association opposes any psychiatric treatment, such as “reparative” or “conversion” therapy, which is based upon the assumption that homosexuality per se is a mental disorder, or based upon a prior assumption that the patient should change his/ her homosexual orientation.”

In 2015 a joint Memorandum of Understanding was issued by the NHS and the professional counselling bodies:  ‘That efforts to try to change or alter sexual orientation through psychological therapies are unethical and potentially harmful.’ The MOU can be found here:

Click to access Memorandum-of-understanding-on-conversion-therapy.pdf

Reparative / Conversion therapies are not supported by the NHS and are regarded as unethical by the professional counselling bodies.