Diagnosing Homosexuality in a State Department of Mental Health

Abstract

The American Psychiatric Association's 1973 decision “to eliminate homosexuality per se as a mental disorder” has created interest in the extent to which a person's sexual orientation continues to be used as the basis for psychiatric diagnosis. Records of 359 patients given a DSM II diagnosis of Homosexuality/Sexual Orientation Disturbance between 1973 and 1979 were obtained from the Missouri Department of Mental Health automated data-base. Demographic information and diagnostic trends were studied. In addition, the medical records of a 100-patient subsample were examined for clinical details such as the reason for referral, diagnostic history, and treatment prescribed or administered. Presenting complaints were then compared with actual diagnoses recorded. A steady decline in the use of homosexuality as a psychiatric diagnosis after 1973 was observed. Consistent with prior literature, the data-base sample and clinical subsample were composed primarily of young, unmarried, white males. The chief presenting complaints of the subsample included: depression or suicidal ideation (38%), sexual-orientation problems (17%), behavioral acting out (12%), and substance abuse (10%). In a number of cases, the admission of homosexual preference became the focus of “the problem”. Yet, in nearly two-thirds of the subsample, sexual-orientation problems contributed significantly to the patients' expressed reasons for seeking psychiatric assistance.