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Sexual Orientation: Royal College of Psychiatrists’ Report

Position Statement PS02/2014

April 2014

Royal College of Psychiatrists London

Approved by the Policy Committee: March 2014

2 http://www.rcpsych.ac.uk

The Royal College of Psychiatrists considers that sexual orientation is
determined by a combination of biological and postnatal environmental
factors.1–3 There is no evidence to go beyond this and impute any kind of
choice into the origins of sexual orientation.

The College wishes to clarify that homosexuality is not a psychiatric
disorder. In 1973 the American Psychiatric Association (APA) concluded
there was no scientifi c evidence that homosexuality was a disorder and
removed it from its diagnostic glossary of mental disorders. The International Classification of Diseases of the World Health Organization followed suit in 1992.

The College holds the view that lesbian, gay and bisexual people are
and should be regarded as valued members of society,  who have exactly
similar rights and responsibilities as all other citizens. This includes equal
access to healthcare, the rights and responsibilities involved in a civil
partnership/marriage, the rights and responsibilities involved in procreating and bringing up children, freedom to practise a religion as a lay person or religious leader, freedom from harassment or discrimination in any sphere and a right to protection from therapies that are potentially damaging, particularly those that purport to change sexual orientation.

Leading therapy organisations across the world have published
statements warning of the ineffectiveness of treatments to change sexual
orientation, their potential for harm and their infl uence in stigmatising
lesbian, gay and bisexual people.4,5

There is now a large body of research evidence that indicates that
being gay, lesbian or bisexual is compatible with normal mental health and
social adjustment. However, it is eminently reasonable that the experiences of discrimination in society and possible rejection by friends, families and others (such as employers), means that some lesbian, gay and bisexual people experience a greater than expected prevalence of mental health and substance misuse problems. Lifestyle issues may be important in some gay men and lesbians, particularly with respect to higher rates of substance misuse.6–8

It is not the case that sexual orientation is immutable or might not
vary to some extent in a person’s life.  Nevertheless, sexual orientation for
most people seems to be set around a point that is largely heterosexual or
homosexual. Bisexual people may have a degree of choice in terms of sexual expression in which they can focus on their heterosexual or homosexual side.

It is also the case that for people who are unhappy about their sexual
orientation – whether heterosexual, homosexual or bisexual – there may be grounds for exploring therapeutic options to help them live more comfortably with it, reduce their distress and reach a greater degree of acceptance of their sexual orientation.

The College believes strongly in evidence-based treatment. There is no
sound scientific evidence that sexual orientation can be changed.

Systematic reviews carried out by both the APA5 and Serovich et al9 suggest that studies which have shown conversion therapies to be successful are seriously methodologically flawed.

Furthermore, so-called treatments of homosexuality can create a
setting in which prejudice and discrimination flourish, and there is evidence that they are potentially harmful.5,10,11 The College considers that the provision of any intervention purporting to ‘treat’ something which is not a disorder is wholly unethical.

The College would not support a therapy for converting people from homosexuality any more than we would do so from heterosexuality.
Royal College of Psychiatrists 3

Sexual orientation

Psychiatrists should be committed to reducing inequalities, not supporting
practices that are explicitly based on pathologising homosexuality. As such, the College remains in favour of legislative efforts to ban such conversion therapies.

Good Psychiatric Practice clearly states: ‘A psychiatrist must provide
care that does not discriminate and is sensitive to issues of gender, ethnicity, colour, culture, lifestyle, beliefs, sexual orientation, age and disability’ (p. 12).12  The College expects all its members to follow Good Psychiatric Practice.


1. Mustanski BS, Dupree MG, Nievergelt CM, et al (2005) A genomewide scan of male sexual orientation. Human Genetics, 116, 272–278.

2. Blanchard R, Cantor JM, Bogaert AF, et al (2006) Interaction of fraternal birth order and handedness in the development of male homosexuality. Hormones and Behavior, 49, 405–414.

3. Bailey JM, Dunne MP, Martin NG (2000) Genetic and environmental influences on sexual orientation and its correlates in an Australian twin sample. Journal of Personality and Social Psychology, 78, 524–536.

4. UK Council for Psychotherapy, British Psychoanalytic Council, Royal College of Psychiatrists, et al (2014) Conversion Therapy: Consensus Statement. UK Council for Psychotherapy.

5. American Psychological Association (2009) Report of the American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation. APA.

6. Gilman SE, Cochran SD, Mays VM, et al (2001) Risk of psychiatric disorders among individuals reporting same sex sexual partners in the National Comorbidity Survey. American Journal of Public Health, 91, 933–939.

7. King M, McKeown E, Warner J, et al (2003) Mental health and quality of life of gay men and lesbians in England and Wales: controlled, cross-section study. British Journal of Psychiatry, 183, 552–558.

8. Bailey JM (1999) Homosexuality and mental illness. Archives of General
Psychiatry, 56, 883–884.

9. Serovich J, Craft S, Toviessi P, et al (2008) A systematic review of the research base on sexual reorientation therapies. Journal of Marital and Family Therapy, 34, 227–238.

10. BBC News (2013) ‘Ex-gay’ group Exodus International shuts down. BBC News, 20 June (http://www.bbc.co.uk/news/world-us-canada-22992714).

11. Harris P (2012) Psychiatrist who championed ‘gay cure’ admits he was wrong. The Observer, 19 May http://www.theguardian.com/world/2012/may/19/

12. Royal College of Psychiatrists (2009) Good Psychiatric Practice (3rd edn) (College Report CR154). Royal College of Psychiatrists.


This guidance (as updated from time to time) is for use by members of the Royal College of Psychiatrists. It sets out guidance, principles and specifi c recommendations that, in the view of the College, should be followed by members. None the less, members remain responsible for regulating
their own conduct in relation to the subject matter of the guidance. Accordingly, to the extent permitted by applicable law, the College excludes all liability of any kind arising as a consequence, directly or indirectly, of the member either following or failing to follow the guidance.



Comments: Now, if you were make a headline from that, what would it look like?

1. Conservative - https://www.facebook.com/johnburton.net/posts/725128484204321?comment_id=725267987523704&notif_t=comment_mention

See here: http://www.charismanews.com/world/43990-people-are-not-born-gay-affirms-royal-college-of-psychiatrists

2. From a gay Christian academic (Dr. Stuart Edser):

The statement on this Christian website is untruthful and is disingenuous. The position of the Royal College of Psychiatrists in the UK is the same as every other developed world psychology and psychiatry professional association. I have read through their position closely and in no way even remotely does it suggest anything like the headline on the facebook share. In fact, it says the opposite. What a disgraceful piece of so-called journalism.

A few points:

  1. It is now incontrovertible through careful and prolonged scientific research, done in public institutions, that human sexuality is determined in large part by genetic influence upon biology and that this occurs in utero, most likely in the third trimester, with influences on androgenic factors being the mechanism by which orientation occurs within brain development;
  2. Such bio-genetic action does not negate the presence of psychological or environmental factors (the latter of which can also be biological) but views them now as playing a smaller role than was hitherto thought;
  3. Such a headline ignores the research and anecdotal evidence (if you talk to just about any gay person) that they felt different as children to all the other children in their life and that this difference became sexualised around the time of puberty when sexuality becomes conscious and salient for the young adolescent;
  4. That a gay sex sexuality becomes a burgeoning force within the young adolescent and is the driving force behind the psychological processes that cause gay sexual identity formation (which occurs over time).

The headline wants to say, ‘see they are not born that way. They can help it. That means they really are sinners and they should stop sinning just like we straight people have to stop sinning. There is no difference between us and them in that respect.’

I cannot begin to unpack what is wrong with that view in my lunchbreak; suffice to say, that it is wrong at every point. This headline is a desperate attempt to perpetuate the judgment of fundamentalists on gay people to declare that because we really dochoose this lifestyle we are sinners, rejecting of God, rejecting of nature, that we are abominations, that our behaviour is morally wrong, that we are deficient and/or sick, and that our relationships are unhealthy, wrong and based in lust not love.

Well, you know what I think about such people and their worldview. I wrote a book and keep a blog about it and these days tend not to pull any punches when I look at the harm and devastation in lives that has been visited upon innocent people by judgmental Christians who care more about their own principles than they do about people.

More in Dr. Edser’s excellent book Being Gay Being Christian: You Can Be Both .

3. From another gay friend:

I agree – my experience is that my earliest desires were 90% male, and that very substantial effort to change that orientation only reduced it a little and didn’t change it. The report seems to agree with this standpoint. One important caveat is that people who are not a 0 or 6 on the Kinsey scale can appear to change – but they were actually bisexual, so the original desires remain but they’ve chosen one side or another – a completely valid choice, but a choice nevertheless that is not available to everyone.

I would be a 1 – or mostly gay
HOWEVER – the headline appears to read the “paper” (which is just a position summary) entirely wrongly!! — “The Royal College of Psychiatrists considers that sexual orientation is determined by a combination of biological and postnatal environmental factors.” — biological means pre-wired?? Or am I going insane?
Ah – that’s the conclusion you came to. Also “There is no evidence that sexual orientation can be changed” — this is borne out by my (and others) experience of ex gay ministries. Have you seen this site? We’d appreciate you publishing a link to it if you could? Whenever appropriate? http://www.insideexgay.org/

HOWEVER – the headline appears to read the “paper” (which is just a position summary) entirely wrongly!! — “The Royal College of Psychiatrists considers that sexual orientation is determined by a combination of biological and postnatal environmental factors.” — biological means pre-wired?? 


And this:

Being homosexual is only partly due to gay gene, research finds

Study finds that while gay men share similar genetic make-up, it only accounts for 40 per cent of chance of a man being homosexual

The DNA double helix

DNA double helix: the study found that gay men shared genetic signatures on part of the X chromosome – Xq28 Photo: GETTY

Homosexuality is only partly genetic with sexuality mostly based on environmental and social factors, scientists believe.

A study found that, while gay men shared similar genetic make-up, it only accounted for 40 per cent of the chance of a man being homosexual.

But scientists say it could still be possible to develop a test to find out if a baby was more likely to be gay.

In the most comprehensive study of its kind, Dr Michael Bailey, of Northwestern University, has been studying 400 sets of twins to determine if some men are genetically predisposed to being gay.

The study found that gay men shared genetic signatures on part of the X chromosome – Xq28.

“But it is not completely determinative; there are certainly other environmental factors involved. “The study shows that there are genes involved in male sexual orientation.

“Although this could one day lead to a pre-natal test for male sexual orientation, it would not be very accurate, as there are other factors that can influence the outcome.”

Dr Alan Sanders, associate Professor of Psychiatry at Northwestern University, who led the study said that it was it was an ‘oversimplification’ to suggest there was a ‘gay gene.’

“We don’t think genetics is the whole story. It’s not. We have a gene that contributes to homosexuality but you could say it is linked to heterosexuality. It is the variation.”

The study builds on work by Dr Dean Hamer from the US National Cancer Institute in 1993 who also found an area of the x chromosome that he believed was linked to male sexual orientation.

Last year Canadian scientists found that the more older male siblings a man has, the greater change he will be gay.

They believe that the immune response produced by a pregnant mother increases with each son, increasing the odds of producing more feminine traits in the developing brain of the foetus.

Each older brother raised the odds that a man was homosexual by one third.

Researchers at the University of California believe that homosexuality can be explained by the presence of epi-marks — temporary switches that control how our genes are expressed during gestation and after birth.

Daryl Bem, a social psychologist at Cornell University, has suggested that the influence of biological factors on sexual orientation may be mediated by experiences in childhood. A child’s temperament predisposes the child to prefer certain activities over others.

Interestingly no similar genes have been discovered which influence female homosexuality.

“No-body has found something like this in women,” he added.

Dr Bailey said environmental factors were likely to have the biggest impact on homosexuality.

He added: “Don’t confuse “environmental” with “socially acquired.” Environment means anything that is not in our DNA at birth, and that includes a lot of stuff that is not social.”

Richard Lane, of Stonewall, said that while studies into the origins of homosexuality have yet to produce firm evidence, they do to point to a biological root.

He said: ‘The thing that’s consistent across all of them is that they all point to sexual orientation being something fundamental to a person rather than the lifestyle choice some opponents of equality repeatedly suggest.’



More… (May 28, 2014)

Americans’ Views on Origins of Homosexuality Remain Split

Most say being gay or lesbian starts at birth

by Justin McCarthy

WASHINGTON, D.C. — In a year when the movement for same-sex marriages continues to make strides across the U.S., Americans remain divided on how people come to be gay or lesbian. More than a third of Americans (37%) believe people become gay as a result of factors such as their upbringing and environment, while 42% say people are born gay. This latter belief is down slightly from 2013, when nearly half (47%) believed people were gay at birth.

These results are from Gallup’s annual Values and Beliefs poll, conducted May 8-11. Americans’ views on this question have evolved over time. When Gallup first asked about the origins of same-sex orientation in 1977, over half of Americans (56%) attributed it to an individual’s upbringing and environment, while 13% believed it to be something a gay person is born with.

This gap in opinions narrowed over the time, and by 2001, Americans were more likely to believe in homosexuality as occurring at birth (40%) for the first time, though only by one percentage point. Since then, Americans have been roughly equally divided over this question, although with some year-to-year fluctuations in the precise percentages. Although this pattern appeared to be changing last year, when the belief that people are born gay rose to an all-time high of 47% after a slight increase in 2012, this year’s slight downtick in the “born with” belief, halted the trend.

The scientific community does not agree on one unified viewpoint regarding the issue of a person’s sexual orientation. According to the American Psychological Association, “there is no consensus among scientists about the exact reasons that an individual develops a heterosexual, bisexual, gay, or lesbian orientation.”

An Increase in the Upbringing and Environment Belief Across Demographics

Though the plurality of Americans believe that being gay is present a birth, there continues to be large differences in perspectives across demographic, religious, and political dimensions. Those with college educations, whites, females, liberals, Democrats, high-income earners, and those who seldom or never attend church are the most likely to believe that being gay or lesbian is something people are born with. Most of these differences among the various demographic groups were evident in previous years, with nonwhites’ belief in the upbringing and environment theory substantially higher this year than last year.

Bottom Line

The contention on this question of a person’s sexual orientation possibly reflects a lack of input from the scientific community, which historically has not shied away from offering its opinion on lesbian, gay, bisexual, or transgender (LGBT) issues and questions. The American Psychiatric Association removed homosexuality from its manual of mental disorders in 1973, giving credence to the nascent gay rights movement at the time.

U.S. public opinion about gays has changed drastically in recent decades on the issues of marriage equality and LGBT acceptance as a whole, possibly related to the fact that three in four Americans say they have a friend, relative, or coworker who has told them that he or she is gay. Though being gay as the result of genetics or other factors before birth has become a considerably more mainstream belief and is now mentioned by a plurality of Americans, it is still one held by slightly less than half of the U.S. population. This disagreement seems likely to continue as long as the scientific community remains agnostic about the question.






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  1. As you are a supposedly Christian site which thinks maturely about the christian faith, I would have thought maturity would demand that we consider what the Bible says.

    One of the loveliest and heart warming phrases in the New Testament is “such were some of you” as amongst the “some of you” were homosexuals.

    This phrase indicates that they no longer are homosexuals and proves that change is possible.

    For me, I will go with that than some secular organisation that is somewhat dubious in its claims and is parroting what the anti-change homosexuals say.

    Any christian who chooses secular over God inspired truth is calling God a liar.

    Posted by Dick Tate | May 29, 2014, 11:28 am