APA Proposes Deletion of Sexual Orientation Diagnoses in ICD-10

The American Psychological Association recommended to the World Health Organization that the category of classifications on psychological and behavioral disorders associated with sexual development and orientation (F66) be deleted from ICD-10.

These recommendations were made to better reflect current scientific knowledge, to better reflect current practice, and to reflect changes in the social understanding of sexual orientation and homosexuality.  In its proposal, the APA wrote “To the extent that an individual may be experiencing difficulties in adjustment relating to the concepts addressed in these diagnoses, alternative diagnoses currently exist that appropriately and accurately define these difficulties (e.g., Adjustment Disorders).  Further the APA summarized the evidence in support of the proposal:

Since ICD-9, positive changes have occurred in the perceptions and legal status of homosexuality in many societies worldwide. Nevertheless, persons with non-heterosexual sexual orientation identities and/or behavior are still subject to societal stigma and discrimination that harm their health. The psychological and behavioral disorders associated with sexual development and orientation in ICD-10 are historically rooted in and support continuing unscientific stigmatization of homosexuality by health professions. Because stigmatization continues, the diagnoses in category F66 are likely to be used to diagnose homosexuality despite its accompanying caution against that practice. Further, use of F66 codes may impede appropriate treatment of underlying disorders (e.g., Major Depression).

No scientifically accepted treatment method has been shown to effectively treat F66 diagnoses. A recent systematic review of the research literature found that insufficient evidence to support sexual orientation change efforts (SOCE) in adults, no evidence that SOCE in children and adolescents affected adult sexual orientation, harm from SOCE, and the benefits that some reported from SOCE were related to non-SOCE aspects of treatment.

Health professionals in nations where the American Psychiatric Association Diagnostic and Statistical Manual is used have operated without ICD F66-like diagnoses for more than 20 years without difficulties emerging. In doing so, they have appropriately used diagnostic codes that reflected the nature of complaints from the standpoint of distressing symptoms.

Supporting documents provided by the APA for its recommendation included the Guidelines for Psychotherapy with Lesbian, Gay, and Bisexual Clients (published by APA in 2000) and the Final Report of the Task Force on Appropriate Therapeutic Responses to Sexual Orientation (published by APA in 2009).