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Since the 1973 American Psychiatric Association decision to delete homosexuality from its diagnostic manual, there has been an unprecedented social acceptance of gay men and women in both public and private arenas that was unimaginable during the era when homosexuality was considered a psychiatric illness. Nevertheless, treating homosexuality as if it were a mental illness has resurfaced as a controversial issue. Despite an increased tolerance and acceptance of same-sex relationships, there is still less than total acceptance. Among mental health practitioners, the rejectionist stance is embodied in attempts to remedicalize homosexuality as an illness or psychological deficit. Reparative therapy has recently come to define psychodynami-cally-oriented talking cures that try to change homosexual attractions into heterosexual ones. This paper attempts to demonstrate how a therapist's authority can be used to change a patient's attitudes toward his own same-sex feelings. Depending on the position of ...

This paper offers a psychoanalytic approach to treating gay men. It addresses some of the historical thinking about homosexuality within medicine, psychiatry and psychoanalysis. It presents clinical theory useful in thinking about psychoanalytic psychotherapy with gay men and also provides clinical material to illustrate its points. The clinical examples are confined to gay men because they are representative of the patient population I treat. Some issues may be similar for gay women but that subject needs to be addressed by someone with greater expertise and experience in that area. Finally, the paper shows how this approach differs from what is currently referred to as “reparative therapy of homosexuality” and discusses theoretical and clinical problems inherent in that approach.

The World Health Organization is developing the 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11), planned for publication in 2017. The Working Group on the Classification of Sexual Disorders and Sexual Health was charged with reviewing and making recommendations on disease categories related to sexuality in the chapter on mental and behavioural disorders in the 10th revision (ICD-10), published in 1990. This chapter includes categories for diagnoses based primarily on sexual orientation even though ICD-10 states that sexual orientation alone is not a disorder. This article reviews the scientific evidence and clinical rationale for continuing to include these categories in the ICD. A review of the evidence published since 1990 found little scientific interest in these categories. In addition, the Working Group found no evidence that they are clinically useful: they neither contribute to health service delivery or treatment selection nor provide essential information for public health surveillance. Moreover, use of these categories may create unnecessary harm by delaying accurate diagnosis and treatment. The Working Group recommends that these categories be deleted entirely from ICD-11. Health concerns related to sexual orientation can be better addressed using other ICD categories.L'Organisation mondiale de la Santé est en train de mettre au point la 11e révision de laLa Organización Mundial de la Salud está desarrollando la undécima revisión de laتقوم منظمة الصحة العالمية بوضع المراجعة الحادية عشرة للتصنيف الإحصائي الدولي للأمراض والمشكلات المتعلقة بالصحة (ICD-11)، المخطط نشرها عام 2017. وتم تكليف الفريق العامل المعني بتصنيف الاضطرابات الجنسية وجوانب الصحة الجنسية بمسؤولية مراجعة وإصدار التوصيات بشأن فئات الأمراض ذات الصلة بالميول الجنسية في الفصل المعني بالاضطرابات النفسية والسلوكية في المراجعة العاشرة (ICD-10)، التي تم نشرها عام 1990. ويشمل هذا الفصل فئات التشخيصات المستندة بشكل أساسي على التوجه الجنسي رغم إقرار المراجعة العاشرة للتصنيف الإحصائي الدولي للأمراض والمشكلات المتعلقة بالصحة بأن التوجه الجنسي وحده ليس اضطراباً. وتستعرض هذه المقالة البيّنات العلمية والأساس المنطقي السريري للاستمرار في إدراج هذه الفئات في التصنيف الإحصائي الدولي للأمراض. وتوصلت مراجعة البيّنات التي يتم نشرها منذ عام 1990 إلى وجود قدر ضئيل من الاهتمام العلمي بهذه الفئات. بالإضافة إلى ذلك، لم يجد الفريق العامل أي بيّنات تشير إلى أنها مفيدة سريرياً: لا تسهم في إيتاء الخدمات الصحية أو اختيار العلاج ولا توفر معلومات أساسية لترصد الصحة العمومية. علاوة على ذلك، من الممكن أن يتسبب استخدام هذه الفئات في أضرار غير لازمة عن طريق تأجيل التشخيص الدقيق والعلاج. ويوصي الفريق العامل بحذف هذه الفئات بالكامل من المراجعة الحادية عشرة للتصنيف الإحصائي الدولي للأمراض والمشكلات المتعلقة بالصحة. ويمكن التعامل مع مخاوف الصحة ذات الصلة بالتوجه الجنسي بشكل أفضل باستخدام فئات التصنيف الإحصائي الدولي للأمراض.世界卫生组织正在进行《疾病和有关健康问题的国际统计分类》(ICD-11)的第11次修订,修订版计划于2017年公布。性疾病和性卫生分类工作组负责审查1990年公布的第10次修订(ICD-10)中有关精神和行为障碍章节中与性相关的疾病分类,并提出建议。该章包括主要基于性取向的诊断类别,尽管ICD-10指出性取向本身并不是一种疾病。本文综述了继续在ICD包含这些类别的科学证据和临床理由。针对1990年以来的证据发表一篇综述几乎找不到这些类别有什么科学意义。此外,工作组也没有找到证据表明这些类别在临床上有用:既无益于健康服务交付或治疗选择,对公共卫生监测也没有提供重要信息。此外,使用这些类别可能因为推迟准确的诊断和治疗而产生不必要的伤害。工作组建议在ICD-11中完全删除这些类别。与性取向相关的健康问题可以使用其他ICD类别更好地解决。Всемирная организация здравоохранения разрабатывает 11-ю редакцию

This chapter begins with a review of psychiatric and medical theorizing about transsexualism and transgender presentations since the nineteenth century. Until the middle of the twentieth century, with rare exceptions, transgender presentations were usually classified as “psychopathological.” By the middle of the twentieth century, transsexualism and sex reassignment surgery became more common and more available, leading to greater popular, medical, and psychiatric awareness of the concepts of gender identity and recognition of an increasing number of people wishing to “cross over” from their birth-assigned sex to another. In the twenty-first century, international expert guidelines support transition in carefully evaluated individuals, although the healthcare systems in only a minority of countries now cover needed medical services for sex reassignment.

IntroductionIn 2008, when the diagnostic Work Groups for the DSM-5 wereestablishedandformallyannouncedbytheAmericanPsychiatricAssociation,oneofthefirsttasks wastoreviewtheexistingdiag-nostic categories and to conduct literature reviews. The GenderIdentity Disorders (GID) subwor kgroup was one of three sub-workgroups of the Sexual and Ge nder Identity Disorders WorkGroup.Likeotherworkinggroups,itschargewastoevaluatewhatwas,ifanything,‘‘good’’abouttheexistingdiagnosisofGIDintheDSM-IV-TR and what, if anything, required changes. The sub-workgrouppublishedfourliteraturereviewsinwhichsomeinitialproposals and recommendations were made (Cohen-Kettenis PDrescher,2010; Meyer-Bahlburg, 2010; Zucker,2010). The subworkgroup had feedback from its advisors, fromother professionals, and from the public, including three periodsof APA-sponsored feedback on the DSM-5 website.Around mid-way during the DSM-5 preparation period,which ended on 1 December 2012, the Task Force added to thereview phase two additional committees. One was a ScientificReview Committee (SRC) and the second was a Clinical andPublic Health Committee (CPHC).The SRC was charged with providing feedback on all pro-posed changes to the diagnos tic criteria that were based onempirical evidence. The CPHC was charged with providingfeedback with regard to additional parameters, such as clinicalutility and public health concerns.EachWorkGrouporsubworkgroupoftheDSM-5TaskForcejustifiedtheproposedchangesofdiagnosticcategoriesinareportentitled Memo Outlining Evidence for Change (MOEC). Withthe permission of the American Psychiatric Association, wereproduce here the final version of the MOEC prepared by theGIDsubworkgroup(‘‘inpress’’referenceshavebeenupdatedandtypographical errors corrected). Publication of the MOEC thusmakestransparenttheargumen tationadvancedbythesubwork-group for interested readers. Comments on the proposal arewelcomeintheformofaLettertotheEditorofthisJournal.

Psychiatrists see human immunodeficiency virus (HIV)-infected patients who suffer from several types of psychiatric disorders and personality disorders. These syndromes can arise (1) in people who have had a previous history of a similar illness ; (2) in people in whom the HIV infection exacerbates a borderline condition ; (3) from the stress of the HIV infection and its known prognosis ; and (4) only rarely is a person who is not HIV infected but becomes unduly or unrealistically concerned about acquiring the infection.

The World Health Organization (WHO) is in the process of revising the International Statistical Classifi cation of Diseases and Related Health Problems (ICD) and ICD-11 has an anticipated publication date of 2015. The Working Group on the Classifi cation of Sexual Disorders and Sexual Health (WGSDSH) is charged with evaluating clinical and research data to inform the revision of diagnostic categories related to sexuality and gender identity that are currently included in the mental and behavioural disorders chapter of ICD-10, and making initial recommendations regarding whether and how these categories should be represented in the ICD-11. The diagnostic classifi cation of disorders related to (trans)gender identity is an area long characterized by lack of knowledge, misconceptions and controversy. The placement of these categories has shifted over time within both the ICD and the American Psychiatric Association ’ s Diagnostic and Statistical Manual (DSM), refl ecting developing views about what to call these diagnoses, what they mean and where to place them. This article reviews several controversies generated by gender identity diagnoses in recent years. In both the ICD-11 and DSM-5 development processes, one challenge has been to fia balance between concerns related to the stigmatization of mental disorders and the need for diagnostic categories that facilitate access to healthcare. In this connection, this article discusses several human rights issues related to gender identity diagnoses, and explores the question of whether affected populations are best served by placement of these categories within the mental disorders section of the classifi cation. The combined stigmatization of being transgender and of having a mental disorder diagnosis creates a doubly burdensome situation for this group, which may contribute adversely to health status and to the attainment and enjoyment of human rights. The ICD-11 Working Group on the Classifi cation of Sexual Disorders and Sexual Health believes it is now appropriate to abandon a psychopathological model of transgender people based on 1940s conceptualizations of sexual deviance and to move towards a model that is (1) more refl ective of current scientifi c evidence and best practices; (2) more responsive to the needs, experience, and human rights of this vulnerable population; and (3) more supportive of the provision of accessible and high-quality healthcare services.

Today the Academy of Psychoanalysis and Dynamic Psychiatry welcomes its gay and lesbian members. Yet at the time of its 1956 founding, organized psychoanalytic attitudes toward homosexuality could be reasonably characterized as hostile. First there was a transition from Freud's early views of homosexuality as immature to later neofreudian theories that pathologized same-sex attractions and behavior. Following the 1973 decision of the American Psychiatric Association to remove homosexuality from the DSM, homosexuality is now more commonly regarded as a normal variant of human sexuality. The history of psychoanalytic attitudes toward homosexuality reinforces the impression that psychoanalytic theories cannot be divorced from the political, cultural, and personal contexts in which they are formulated. This history also shows that analysts can take positions that either facilitate or obstruct tolerance and acceptance.

Gay, lesbian, and bisexual (GLB) individuals experience significant stressors as a consequence of society's antihomosexual attitudes. These attitudes include heterosexism, homophobia, moral condemnations of homosexuality, and antigay violence. This article explains these antihomosexual attitudes as well as gender beliefs, gender stress, and the stress of being in the closet.

In 1970, a group of gay activists disrupted the American Psychiatric Association (APA) convention in San Francisco. They accused my profession of perpetuating social prejudice against gay people in...

Reparative therapy has come to generically define talking cures that claim to change an individual's homosexual orientation to a heterosexual one. Although other treatment modalities have also promised to "cure" homosexuality, the history of reparative therapies has become inexorably linked with that of psychoanalysis. This paper reviews the history and theoretical assumptions of psychoanalytically-oriented practitioners, beginning with Freud's juvenilization of gay people to the later analysts who pathologized and attempted to change same-sex attractions. The evolution of reparative therapists from medically concerned practitioners into antigay political activists is also discussed. The evolution of one branch of psychoanalytic theory into an antihomosexual political movement illustrates the permeability of boundaries between clinical issues and political ones. In their open support of antigay legislation, reparative therapists have moved from the traditional psychoanalytic center and have been embraced by conservative religious and political forces opposed to homosexuality. In doing so, they have apparently adopted religious organizational practices themselves, preaching dogma and stifling dissent. The increasing marginalization of reparative therapists from the psychoanalytic mainstream illustrates how psychoanalysis per se is neither gay-affirming nor condemning, although psychoanalytic practitioners may fall into either of these categories.

A 65-year-old woman with bipolar disorder and complicated cardiovascular disease who was on maintenance lithium therapy developed a movement disorder following high doses of trazodone for treatment of an acute depression. When the trazodone was reduced, the involuntary movements promptly ceased. Although the movement disorder could not with certainty be attributed to trazodone alone, the drug at least acted as an eliciting agent.