Ego-dystonic sexual orientation

Name = Ego-dystonic sexual orientation

Caption =
DiseasesDB =
ICD10 = ICD10|F|66|1|f|60
ICD9 = ICD9|302.0
MedlinePlus =
eMedicineSubj =
eMedicineTopic =
MeshID =

Egodystonic sexual orientation is an egodystonic condition. The World Health Organization lists egodystonic sexual orientation in the ICD-10, under "Psychological and behavioural disorders associated with sexual development and orientation". The WHO describes it 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. (ICD10|F|66|1|f|60)

The WHO applies the following note to the entirety of part F66: "Sexual orientation by itself is not to be regarded as a disorder." [ [ ICD-10] : See part F66.]

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. [cite web
title=Human rights violations against sexuality minorities in India
publisher=People's Union for Civil Liberties
month=February | year=2001|format=PDF
] The "Chinese Classification and Diagnostic Criteria of Mental Disorders" includes ego-dystonic homosexuality, but does not include ego-dystonic heterosexuality, bisexuality, or prepubertal sexuality. [ [ CSSSM ] ] The American Psychological Association has officially opposed the category of ego-dystonic homosexuality since 1987. [ [ Use of Diagnoses “Homosexuality” & “Ego-Dystonic Homosexuality”] August 27 & 30, 1987]

Professional treatments

There are many ways a person may go about receiving therapy for ego-dystonic homosexual orientation. 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 right 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. [ [$=relatedarticles&logdbfrom=pubmed Marital satisfaction during recovery from self-identified sexual addiction among bisexual men and their wives.] ] In addition, some people seek non-professional methods, such as religious counseling or attendance in an ex-gay group.

Behavior Modification

Aversion therapy uses associate negative stimuli with homoerotic pictures and positive stimuli with heteroerotic pictures. A series of 1966 experiments showed promise, and the practice became popular, but it fell out of practice after the reports where shown to be flawed. [Seligman, p. 156] Since 1994, the American Psychological Association has declared that aversion therapy is a dangerous practice that does not work, but it is still in use in some countries.cite web
url =
title = Prayer, punishment or therapy? Being a homosexual in India
accessdate = 2007-08-28
last = Chandran
first = Vinay
year = 2006
month = February
publisher = InfoChange News & Features
quote = While social attitudes are slowly changing [in India] and the anti-sodomy law is being challenged, mental health professionals in many places still offer therapy to homosexuals.


*Conversion therapy uses psychotherapy to turn people's sexual orientation from homosexual to heterosexual. It may be harmful if the client is egosyntonic and does not wish to change their sexual orientation.cite journal
title=Retrospective self-reports of changes in homosexual orientation: A consumer survey of conversion therapy clients
coauthors=Byrd, A. Dean; Potts, Richard W.
publisher=Psychological Reports
month=June | year=2000|volume=86
] American medical associations recommend practitioners avoid the practice.cite web
url =
title = Position Statement on Therapies Focused on Attempts to Change Sexual Orientation (Reparative or Conversion Therapies)
accessdate = 2007-08-28
year = 2000
month = May
publisher = American Psychiatric Association

*Sexual Identity Therapy was designed by Warren Throckmorton and Mark Yarhouse, and is endorsed by Robert L. Spitzer.cite news
url =
title = New ground in debate on 'curing' gays
last = Simon
first = Stephanie
publisher = Los Angeles Times
date = 2007-06-18
accessdate = 2007-10-29
] Its purpose is to help patients line up their sexual identity with their beliefs and values. Therapy involves four phases: (1) assessment, (2) advanced or expanded informed consent, (3) psychotherapy, and (4) social integration of a valued sexual identity. According to a Regent University website, which describes a client's adoption of the "gay affirmative" or "integrative" therapeutic model as a clinical failure, sexual identity therapy is not a form of conversion therapy.cite web
url =
title = Frequently Asked Questions
publisher = Regent University: Institute for the Study of Sexual Identity
accessdate = 2007-10-29

*Group psychotherapy uses group sessions lead by a single psychologist and focuses on conflict surrounding homosexual expression. [ [$=relatedarticles&logdbfrom=pubmed Group psychotherapy for bisexual men and their wives.] ]

*Gender Wholeness Therapy was designed by an ex-gay Licensed Professional Counselor, David Matheson.cite news
first = Michael
last = Luo
title = Some Tormented by Homosexuality Look to a Controversial Therapy
url =
publisher = The New York Times
page = 1
date = 2007-02-12
accessdate = 2007-08-28
] "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.

*Context Specific Therapy was designed by Jeffrey Robinson. It does not work with any one theory of homosexuality, but uses several theoretical backgrounds according to the client's need,cite web
last = Throckmorton
first = Warren
url =
title = What is reparative therapy?
publisher = Self-published
year = 2004
accessdate = 2007-10-29
] and is based on phenomenological research. [cite web
url =
title = NARTH 2003 Annual Conference schedule
publisher = NARTH
date = 2004-04-14
accessdate = 2007-10-29
] It does not seek to change the client's orientation, but instead focuses on diminishing homosexual thoughts and behaviors. It works within the client's own view of God, noting that "individuals who are successful at overcoming homosexual problems are motivated by strong religious values". [cite web
url =
title = What is Context Specific Therapy?
accessdate = 2007-10-29
last = Jeffrey
first = Robinson
publisher = Self-published

*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". [cite journal
url =
title = Homosexuality: Innate and Immutable?
first = A. Dean
last = Byrd
coauthors = Olsen, Stony
year = 2002
publisher = Regent University Law Review
volume = 14
issue = 513
pages = 537
accessdate= 2007-10-29
format = Dead link|date=June 2008 – [ Scholar search]

*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. [ [ APA:Guidelines for Psychotherapy with Lesbian, Gay, & Bisexual Clients] ] 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 [may be] indicated," and that " [just as] therapists in the religious world [should] refrain from pathologizing their LGB clients... so, too, should gay-affirmative practitioners refrain from overtly or subtly devaluing those who espouse conservative religious identities." [cite journal
title=When Sexual and Religious Orientation Collide:Considerations in Working with Conflicted Same-Sex Attracted Male Clients
publisher=The Counseling Psychologist
journal=The Counseling Psychologist
] Data suggest that clients generally judge therapists who do not respect religiously-based identity outcomes to be unhelpful. [cite journal
title=Counseling practices as they relate to ratings of helpfulness by consumers of sexual reorientation therapy
date=Winter 2005
publisher=Journal of Psychology and Christianity

Non-professional methods

Some therapeutic methods are entirely outside the purview of professional health associations, and hence do not have to obey professional ethics guidelines.cite web
url =
title = Youth in the crosshairs: the third wave of ex-gay activism
accessdate = 2007-08-29
author = Cianciotto, J.; Cahill, S.
year = 2006
format = pdf
publisher = National Gay and Lesbian Task Force
] Some of these sources include coaches, religious organizations, and ex-gay groups.


Coaches work like psychologists, but are not licensed and hence do not have to follow ethical guidelines set by professional associations, giving them more room to experiment. One of the largest organizations is the International Healing Foundation, whose motto is "Changing From Gay To Straight Is Possible." [ [ International Healing Foundation] ] They provide classes for people trying to change their orientation, as well as training for those trying to help. "Higher Path Life Coaching" is another organization started by ex-gay Rich Wyler centered in the Virginia area. [ [ Higher Path Life Coaching] ]

One of the more well-known coaches is Richard Cohen, founder of the International Healing Foundation. His television appearances have sparked controversy. He holds male patients in his lap with the patient curled into the fetal position, and also advocates bioenergetic methods involving slamming a pillow with a tennis racket while shouting "Mom! Why did you do this to me?" [cite web
url =
title = Videoclip of Cohen's techniques
accessdate = 2008-08-28
publisher = CNN


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."cite web
url =
title= Journey Into Manhood: A Healing Weekend Hosted by People Can Change
accessdate= 2007-10-01
date= 2006-04-20
publisher= NARTH
] Weekends put on by Adventure in Manhood support "healthy bonding with men, through masculine activity, teamwork, and socialization." [cite web
url =
title = Adventure in Manhood homepage
accessdate = 2007-10-29
publisher = Self-published
] 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." [cite web
url =
title = The New Warrior Weekend
accessdate = 2007-10-29
publisher = Self-published
] Joe Dallas, a prominent ex-gay, leads a monthly five-day men's retreat on sexual purity titled, Every Mans' Battle. [cite news
title=‘Love Won Out’ conference coming to Southern California
publisher=Christian Examiner
date=September 2007

Religious organizations

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.” [cite web
url =
title = OneByOne: About Us
accessdate = 2007-10-29
year = 2006
publisher = Self-published
] Common techniques include worship, meditation, prayer, fasting, church attendance, scripture reading, religious counseling, willpower, and (for Christians) dependence on divine grace through the atonement of Jesus. If the member had same-sex sex, the member may be asked to confess, seek forgiveness, repent, and give restitution. The member may also be asked to observe or stop observing certain rituals or sacraments, or the church may excommunicate the individual.

Ex-gay organizations

For 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 heterosexual marriages acknowledge that their sexual attractions remain primarily homosexual, but seek to make their marriages work regardless. [cite news
author = Anonymous
title = No easy victory
url =
publisher = Christianity Today
date = 2002-03-11
accessdate = 2007-08-28
] Ex-gay advocates sometimes compare adopting the label "ex-gay" to the coming out process."cite journal
last= Peebles
first= Amy E.
year= 2003
month= April
title= It’s Not Coming Out, So Then What Is It? Sexual Identity and the Ex-Gay Narrative
journal=Texas Linguistic Forum
volume= 47
pages= 155–164
accessdate= 2007-08-28
] 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."cite journal
last= Haldeman
first= Douglas C.
year= 2002
month= June
title= Gay Rights, Patient Rights: The Implications of Sexual Orientation Conversion Therapy
journal= Professional Psychology: Research and Practice
volume= 33
issue= 3
pages= 260–264
doi= 10.1037//0735-7028.33.3.260
] Ex-gay ministries typically are staffed by volunteer counselors, unlike reorientation counseling, which is conducted by licensed clinicians.cite journal
publisher=American Psychological Association
journal=Professional Psychology: Research and Practice
title=Initial empirical and clinical findings concerning the change process for ex-gays
month=June | year=2002

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 [ing] 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." [cite web
url =
title = the source
accessdate = 2007-08-28
publisher = Love in Action
] [cite web
url =
title = the journey
accessdate = 2007-08-28
publisher = Love in Action
] Exodus International considers reparative therapy to be a useful tool, but not a necessary one. [cite web
url =
title = Exodus International Policy Statements
accessdate = 2007-08-28
publisher = Exodus International
] Evergreen International does not advocate or discourage particular therapies [cite web
url =
title = Myths
publisher = Evergreen International
accessdate = 2007-10-29
] and states that "therapy will likely not be a cure in the sense of erasing all homosexual feelings."cite web
url =
title = Therapy
publisher = Evergreen International
accessdate = 2007-10-29

See also

* Homosexuality and psychology
* Environment and sexual orientation


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