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. 2016 Sep 22;15(3):299–300. doi: 10.1002/wps.20340

WPA Position Statement on Gender Identity and Same‐Sex Orientation, Attraction and Behaviours

Dinesh Bhugra 1, Kristen Eckstrand 2, Petros Levounis 3, Anindya Kar 4, Kenneth R Javate 5
PMCID: PMC5032493  PMID: 27717266

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, 10, 11, 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.

The WPA believes strongly in evidence‐based treatment. There is no sound scientific evidence that innate sexual orientation can be changed. Furthermore, so‐called treatments of homosexuality can create a setting in which prejudice and discrimination flourish, and they can be potentially harmful13. The provision of any intervention purporting to “treat” something that is not a disorder is wholly unethical.

  1. The WPA holds the view that lesbian, gay, bisexual and transgender individuals are and should be regarded as valued members of society, who have exactly the same rights and responsibilities as all other citizens. This includes equal access to health care and the rights and responsibilities that go along with living in a civilized society.

  2. The WPA recognizes the universality of same‐sex expression, across cultures. It holds the position that a same‐sex sexual orientation per se does not imply objective psychological dysfunction or impairment in judgement, stability or vocational capabilities.

  3. The WPA considers same‐sex attraction, orientation and behaviour as normal variants of human sexuality. It recognizes the multi‐factorial causation of human sexuality, orientation, behaviour and lifestyle. It acknowledges the lack of scientific efficacy of treatments that attempt to change sexual orientation and highlights the harm and adverse effects of such “therapies”.

  4. The WPA acknowledges the social stigma and consequent discrimination of people with same‐sex sexual orientation and transgender gender identity. It recognizes that the difficulties they face are a significant cause of their distress and calls for the provision of adequate mental health support.

  5. The WPA supports the need to de‐criminalize same‐sex sexual orientation and behaviour and transgender gender identity, and to recognize LGBT rights to include human, civil and political rights. It also supports anti‐bullying legislation; anti‐discrimination student, employment and housing laws; immigration equality; equal age of consent laws; and hate crime laws providing enhanced criminal penalties for prejudice‐motivated violence against LGBT people.

  6. The WPA emphasizes the need for research on and the development of evidence‐based medical and social interventions that support the mental health of lesbian, gay, bisexual and transgender 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

References

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  • 2. Gates GJ. How many people are lesbian, gay, bisexual and transgender? http://williamsinstitute.law.ucla.edu.
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  • 5.Office of the United Nations High Commissioner for Human Rights. Born free and equal. Sexual orientation and gender identity in international human rights law. New York and Geneva: Office of the United Nations High Commissioner for Human Rights, 2012.
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