Homosexuality and psychiatric nosology.

Abstract

At the time that I commenced formal training in psychiatry, in February 1973, homosexuality was a recognized mental disorder in both the second edition of the Diagnostic and statistical manual of mental disorders (DSM), published by the American Psychiatric Association in 1968, and in the Index and glossary of mental disorders published by the National Health and Medical Research Council of Australia in September 1972, based on the Glossary of mental disorders published by the World Health Organization for use with the eighth revision of the International classification of diseases (ICD). In December 1973, the Board of Trustees of the American Psychiatric Association (APA) voted to remove homosexuality from the DSM; that decision was ratified by a referendum of members of the APA. (For the record, 58% of the 10 091 who voted in the referendum supported the decision of the Board of Trustees.) Homosexuality as a specific diagnostic category was retained in Chapter V of the ICD, listing mental disorders, in the ninth revision published in 1978, but was subsequently removed from ICD-10 Classification of mental and behavioural disorders published in 1992. In this brief review I shall describe the status of homosexuality as a distinct diagnosis in several systems of psychiatric classification both prior to and after 1973, with an emphasis on the ICD and DSM systems. Discussion of the social and political factors that contributed to the removal of homosexuality from psychiatric classifications, whether or not it falls within the definition of ‘mental disorder’, as well as a consideration of the clinical arguments advanced by proponents and opponents of that change, is outside the scope of this review. The interested reader is referred to the select bibliography at the end of this article. Early classifications