Abstract
Recent controversies in many countries suggest a need for clarity on same-sex orientation, attraction and behaviour (formerly referred to as homosexuality). Along with other international organizations, the WPA considers sexual orientation to be innate and determined by biological, psychological, developmental and social factors. Over 50 years ago, Kinsey et al1 documented a diversity of sexual behaviours among people. Surprisingly for the time, he described that for over 10% of individuals this included same-sex sexual behaviours. Subsequent population research has demonstrated that approximately 4% of people identify with a same-sex sexual orientation (e.g., gay, lesbian and bisexual orientations). Another 0.5% identify with a gender identity other than the gender assigned at birth (e.g., transgender)2. Globally, this equates to over 250 million individuals. There is a recognized need for moving towards a non-binary gender identity. Psychiatrists have a social responsibility to advocate for a reduction in social inequalities for all individuals, including inequalities related to gender identity and sexual orientation. Despite an unfortunate history of perpetuating stigma and discrimination, it has been decades since modern medicine abandoned pathologizing same-sex orientation and behaviour3. The World Health Organization (WHO) accepts same-sex orientation as a normal variant of human sexuality4. The United Nations Human Rights Council5 values lesbian, gay, bisexual and transgender (LGBT) rights. In two major diagnostic and classification systems (ICD-10 and DSM-5), same-sex sexual orientation, attraction and behaviour are not seen as pathologies. There is considerable research evidence to suggest that sexual behaviours and sexual fluidity depend upon a number of factors6. Furthermore, it has been shown conclusively that LGBT individuals have higher than expected rates of psychiatric disorders7, 8, and once their rights and equality are recognized these rates start to drop9-12. People with diverse sexual orientations and gender identities may have grounds for exploring therapeutic options to help them live more comfortably, reduce distress, cope with structural discrimination, and develop a greater degree of acceptance of their sexual orientation or gender identity. Such principles apply to any individual who experiences distress relating to an aspect of their identity, including heterosexual individuals. Dinesh Bhugra1, Kristen Eckstrand2, Petros Levounis3, Anindya Kar4, Kenneth R. Javate5 1Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; 2Vanderbilt University School of Medicine, Nashville, TN, USA; 3Addiction Institute of New York, New York, NY, USA; 4Calcutta National Medical College & Hospital, Calcutta, India; 5The Medical City, Manila, Philippines
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