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Chapter 38. Treatment of Lesbian, Gay, Bisexual, and Transgender Patients

Jack Drescher, M.D.; Benjamin H. McCommon, M.D.; Billy E. Jones, M.D., M.S.
DOI: 10.1176/appi.books.9781585623402.316781

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Excerpt

This chapter focuses on some issues raised in the psychiatric treatment of lesbian, gay, bisexual, and transgender (LGBT) patients. Before the 1970s, the psychiatric focus on LGBT patients often aimed to 1) "cure"—that is, change an individual's homosexual orientation to a heterosexual one—or 2) assist those with gender atypical behavior to conform to gender stereotypes. This emphasis began to change in 1973, when the American Psychiatric Association removed homosexuality from the seventh printing of DSM-II (American Psychiatric Association 1968).

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Table Reference Number
TABLE 38–1. Definitions of commonly used terms
Table Reference Number

Homosexuality was removed from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders in 1973.

The causes of heterosexuality, homosexuality, bisexuality, and transgenderism are unknown.

Sexual orientation (the sex to which one is attracted) is a variable independent from gender identity (whether one feels like a man or a woman).

Growing up LGBT is a different cultural experience from growing up as a member of the heterosexual majority.

Expectations of heterosexual normativity are stressful for LGBT individuals and often lead them to hide their sexual identities.

The prevalence of homosexuality in the United States has been estimated at 1%–4%, with rates in large cities two to three times higher.

Some studies have found higher rates of certain psychiatric disorders, including depressive, anxiety, and substance-related disorders, among LGB individuals.

LGB individuals may be more likely to have psychiatric comorbidity and to use psychiatric services.

Sensitivity to sexual orientation is essential to clinical interviewing and thorough psychiatric diagnosis.

DSM-IV-TR allows the diagnosis of identity problem or phase of life problem to be used for concerns about sexual orientation or coming out.

Sexual identity reflects one's relationship (accepting or rejecting) to one's sexual orientation.

Because LGBT patients usually have a history of being shamed, therapists should approach these patients with tact and respect.

Some LGBT patients are members of "double minorities." Working with these patients requires careful clinical attention to cultural issues.

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Sample questions:
1.
Three significant events in the psychiatric diagnostic nomenclature were the removal of homosexuality as a mental disorder and the subsequent temporary inclusions of the categories "sexual orientation disturbance" and "ego-dystonic homosexuality." Which of the following correctly pairs a change with the DSM edition in which it first took effect?
2.
Which of the following statements regarding the prevalence and psychiatric comorbidity of homosexuality is true?
3.
Which of the following statements regarding sexual orientation as addressed in DSM-IV-TR is true?
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