HOMOSEXUALISM: DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS

Tuesday, April 7, 2009 4:49

 

Diagnosis

To apply the term diagnosis to homosexuality raises the same problem as applying it to red hair, left-handedness, or limb amputation, all of which are conditions not usually considered syndromes. All are conditions that are self-declared and do not need a diagnostic workup. In consensual homosexuality the evidence may be observed or the person may report it verbally. Without such direct evidence, there may be no way of inferring it from other aspects of behavior.

When homosexuality is not expressed in action, the only evidence may be the person’s report of homosexual imagery in dreams, daydreams, and fantasy, or of responding erotically to homosexual images and percepts. In some instances, the only evidence, initially, may be symbolic and disguised; overt homosexual imagery, under the inhibiting pressure of guilt, embarrassment, or shame, may be unable to manifest itself directly. Its place is taken by erotic apathy, inertia, or depression, or by some symbolic sexual substitution.

There are no known or measurable somatic correlates of homosexuality which are important diagnostically. In particular, measures of circulating hormonal levels are noncontributory. However, homosexuality may occur in the presence of other syndromes such as hypogonadism, Klinefelter’s (47, XXY) syndrome, and others.

Differential Diagnosis

Extreme cases of effeminate male homosexuality or virilistic lesbianism need to be differentiated from:

transexualism

transvestism

The most common error in differential diagnosis is to confuse homosexuality with:

bisexualism

The next most common error is to confuse homosexuality with accompanying or derivative symptoms or syndromes of behavioral disability such as:

psychosomatic stress reaction

anxiety neurosis

paranoid schizophrenic reaction

body-image neurosis or psychosis

delinquent or criminal character or conduct disorder

masochism, sadism, pedophilia, or other paraphilia

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