DSM + LGBTQ+ = Shenanigans
Editor’s note: Some terms used herein aren’t great, but for the sake of describing the history should be included. Otherwise, how will we know the history of why they’re bad?
Queer folk and neurodivergence have had a long history together, but they were not always different categories. Much like the increase of complexity in treating neurodivergence versus mental illness, our ideas about LGBTQ+ has evolved significantly over the last few decades. While this could easily be a book in and of itself, let’s go over a brief history of the Diagnostic and Statistical Manual of Mental Disorders, referred to throughout as the DSM.
The first edition of the DSM released in 1952 entirely dismissed the Kinsey Reports, which were a comprehensive yet controversial set of works about human sexuality published four years before. The DSM was instead conservative, and chose instead to lump homosexuality and transvestitism in with pedophilia under the category of “sociopathic personality disturbances.”
An important person in the evolution of the treatment of LGBTQ+ folk in the DSM is Robert Spitzer. He initially held with the DSM-I that any deviation from heterosexuality or cisgender expression should be diagnosable, and thus treatable. To his credit, when approached by a contingent of gay and lesbian members of the American Psychological Association, he moderated his views to a deliberate, and often fraught middle ground of homosexuality not being a mental illness, but anxiety over being LGBTQ+ was and should be diagnosed as such.
The second edition of the DSM released in 1968 updated the term for gay people to “Sexual Orientation Disturbance,” which was then listed under “Personality Disorders and Certain Other Non-psychotic Mental Disorders.” This progress was furthered in 1974 in an update which did not label being homosexual by itself a disorder, but distress at homosexuality and wishing to be heterosexual was a disorder largely from Spitzer’s leadership. Sadly, this political middle ground created an ongoing legacy of treatment at conversion centers.
DSM-III released in 1980 first coined the term “Gender Identity Disorder,” a significant step forwards for transgender people. While the DSM-II started using the Kinsey scale for what we would now call gender dysphoria, the DSM-III rightly placed the emphasis on identity. This edition also moved GID underneath “Disorders Evident in Childhood” which, while accurate, effectively buried the diagnosis away from other, similar issues. Meanwhile, gay people experiencing distress at being gay was upgraded to “Ego-dystonic homosexuality.”
It was clear the inclusion of Ego-dystonic homosexuality was political, rather than scientific, and this was rightly pointed out in several academic debates as not being a mental illness. The DSM-III-R in 1987 removed this entry, nearly removing the ability to label gay people as mentally ill. However, providers could and did use “sexual disorder not otherwise specified” to clinicalize gay people, as distress at being homosexual was still mentioned in this category.
The main changes in the DSM-IV released in 1994 were organization and naming conventions. The term transsexualism was replaced entirely by Gender Identity Disorder, though the definition was largely unchanged. Similarly, a section labeled “Sexual and Gender Identity Disorders” was created, and the ugly “sexual disorder not otherwise specified” was still included.
It was not until the DSM-V, released in 2013 over sixty years after the DSM-I, that being gay was entirely declassified as a mental illness. Further, Gender Identity Disorder was replaced with Gender Dysphoria, recategorizing the issue to be distress at the body not matching their internal desires. Further, sexuality was no longer diagnosed as part of Gender Dysphoria.
Despite ostensibly being based on science, the DSM has had a difficult time removing itself from political views. In its current form, the DSM now finally matches the lived experiences of LGBTQ+ people as well as decades of scientific research. Conversion centers are no longer covered by the DSM as a legitimate strategy, instead considered both unscientific and cruel.
Long may it be so.
