Category Archives: sexual identity

November 5, 2013 · 2:05 pm

Does the DSM 5 define pedophilia as a sexual orientation?


In recent weeks I have read a couple of postings suggesting that the new version of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) has taken Pedophilia out of the realm of (psycho)pathology and made it equivalent to sexual orientation (e.g., gay, straight, bisexual, transgendered, etc.). These postings propose that the publisher, The American Psychiatric Association, has decided to normalize pedophilia–something that some believe is mere politics and a sign of further loosening of social mores. Usually, these writers point to the fact that the APA depathologized homosexuality in previous editions and now are going steps further to normalize pedophilia.

But, is this rumor true?

The facts from DSM 5

Pedophilia, or Pedophilic Disorder still exists and is considered a disorder in the family of paraphilias (patterns of abnormal sexual desire or activity). To be diagnosed with Pedophilia, one must meet 3 criteria (summarized)

  • Have sexual fantasies, urges, or behaviors for prepubescent children
  • Either urges cause marked distress, interpersonal difficulty OR the adult has acted on the urges with children
  • Must be at least 16 and seeking those who are at least 5 years younger

So, why the rumors?

Okay, so pedophilia is still a disorder. So, where is the confusion? After listing the criterion, the DSM offers some commentary to further describe the disorder. Here’s where some confusion may enter in as they describe the person who has intense pedophilic urges but who has not acted on them:

“However, if they report an absence of feelings of guilt, shame, or anxiety about these impulses and are not functionally limited by their paraphilic impulses (according to self-report, objective assessment, or both), and their self-reported and legally recorded histories indicate that they have never acted on their impulses, then these individuals have a pedophilic sexual orientation but not pedophilic disorder.” (p. 698)

Meaning?

Unfortunately, “pedophilic sexual orientation” is not defined. By the way, neither do they define any other sexual orientation. The point being that since sexual orientation is outside the purview of  a catalog of psychopathology, it need not be discussed. So, my read of the DSM 5 intent regarding pedophilic urges is this

  • Pedophilia is NOT equated with sexual orientation when the person is acting on the urges or is troubled by them, BUT
  • Those who have these attractions, yet feel no shame about them, function in society to protect children, and have not acted to harm children are not pedophiles but can be listed in a new nonpathology category: pedophilic sexual orientation. thereby, 
  • Opening the door for some to self-identify in a nonpathological manner

Is this cause for alarm?

Short answer. No, this nor the removal of homosexuality as pathology is not evidence of APA’s moral degradation.

Longer answer. this addition/change will create confusion. It does open the door for some crazy thinking and adding the “orientation” language is wrongheaded and may harm the good research being done about sexual orientation. Further, never underestimate the power of some to use this for evil intent.

Remember, the DSM is a catalog of psychopathology, not social pathology, moral pathology or the like. So, if it is possible (and there is evidence to support this) that gay and lesbian people do not experience psychopathology solely as result of their sexual feelings, then it would be right to remove homosexuality as a psychological disorder (no matter how you classify it in terms of morality).

There is another DSM feature that may be more of issue in this debate. As of now, diagnoses are locked into using the criterion, “causes marked distress” as a way of determining the floor for a pathology. Thus, you could possibly experience recurrent and persistent obsessional thoughts and images but not have them cause “marked distress…or significantly interfere with normal routine, social activities…” and therefore NOT be diagnosed with OCD. So, if it is possible to determine that a person with sexual feelings for little children is able to be not disturbed by them AND not act on them, then you wouldn’t give the diagnosis.

See the problem?  Here’s an analogy of sorts: if all 80 year old men have cancer cells in their prostate but never have any symptoms, seek no treatment, and die of other causes, should they be diagnosed with prostate cancer? Denying the existence of the cells doesn’t seem to be the answer even if no treatment is necessary.

To the point: Is there movement in redefining pedophilia?

Not in the mainstream.

It appears that there is an effort to better understand those who are being charged and convicted of child sex offenses. I see a growing research beginning to differentiate between three types of people who commit sex crimes: contact sex offenders (those who directly abuse actual children), internet offenders (those who use or send child pornography), and solicitation offenders (those who use technology to communicate with minors for sexual purposes).  The idea is that there may be differences between these three types and thus arguments for different punishments and treatments. It seems, thus far, that contact sex offenders have far more distortions in empathy for victims, cognitive distortions about self and children while the other two categories seem to have some features that might protect them from becoming contact offenders. NOTE: the data is small at this point and we can’t predict who will and who will not become contact offenders.

Go ahead and worry some

If one could really argue that child porn viewers are not statistically more likely to become offenders against actual children, you can easily imagine someone arguing that virtual child porn (i.e., digital created images of children having sex) harm no one and ought to be legal for the pedophilic orientation individuals. On recent report stated that at any given moment in time there are 750,000 individuals accessing and viewing child porn. And that is with it being a crime. Do we really want to open this door to normalization? No. We want to understand, empathize, restrict, and intervene.

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April 13, 2010 · 3:32 pm

Book idea: Sexual Crises in the Church


Pastors and church leaders have to navigate a variety of sexual crises that may arise in their congregations. These crises may or may not be crises for some churches even while they devastate another community. And surely these are not the only crises a church may face. But matters of sexuality often unnerve the leadership.

What crises am I referring to? Sexual abuse allegations, date-rape, infidelity among attendees and, pastoral (or leader) sexual abuse, couples living together, sex offenders returning to church, sexual addictions, individuals struggling with sexual or gender identity issues, etc.

Where would they turn to get helps in thinking about the various issues, practical pastoral responses (to the individuals involved as well as the entire congregation)? I’m thinking about a one source document that might survey biblical foundations, explore possible responses as well as prevention plans where appropriate. Why wait til the Crisis to consider how one might want to think about it?

Anyone seen such a resource? I’ve got some other writing assignments but I could imagine an edited volume on the topic. Maybe I’ll skip grading today and see if I can start a proposal.

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August 17, 2009 · 11:59 am

The APA on identity therapy and conversion therapy


[Let me wade into something that tends to fire up lots of feelings and lead to controversy. And let me ask all to be civil. Civility seems to be the first thing that disappears when we discuss matters near and dear to our hearts. But let us be different and listen to each other rather than talk at or past each other. As James tells us, let us be quick to listen and slow to speak.]

In recent days media outlets have picked up the story of the American Psychological Association’s release of a report and declaration of their official stance on reparative or conversion therapies for individuals seeking to change their sexual orientation. You can read their press release and find their 100 page research review here. Being a member of the organization, knowing a few of the players in the research side of things, and knowing how easy it is to get caught up in debate and miss some of the finer points, I thought I might make a few comments that may not make it to the public eye.

1. Researchers are beginning to distinguish between sexual identity and orientation. This is a good thing. I dare say that the public lags far behind on this matter. Separating these two different aspects of sexuality allows for individuals to consider and interpret their sexual feelings in accord with their beliefs and NOT as how either the minority or majority of the world tells them to define themselves. This is akin to biracial people determining how they want to self-identify rather than be forced to say they are black or white.  Consider the following quote by one of the players (whom  I don’t know),

The distinction between orientation and identity (or attraction and identity as we often describe it here) is key, in my view, in order for us to understand the experience of those who say they have changed while at the same time experiencing same-sex attraction….I hope we can agree that sexual attraction patterns may be one thing while meaning making aspects may lead two people with the same attraction pattern to identity in disparate ways. (emphasis mine; from http://www.crosswalk.com/blogs/EWThrockmorton/11607271/)

If I understand the relationship between identity and orientation, it would seem that one forms identity from a variety of “data” which leads to an orientation. This is true outside of sexual identity. A number of factors come together for a person to see themself in a particular way (this may include biology, family, life experiences, key “flashbulb” moments, etc) and in cementing that particular identity they develop an orientation towards the world. SO, this may explain why trying to change orientation has little positive effect. Until the person reviews, explores, and reconsiders their identity (something that happens in nearly every counselee I’ve ever worked with) and begins to practice another way of seeing self, not much is going to change in attraction and orientation. Further, what may change is one’s sense of importance (and therefore meaning) of various parts of themself. When my clients explore their identity, it is rare they come to understand that they were completely mis-perceiving their feelings or experiences. Rather, they begin to see those experiences and feelings from a different vantage point.  

2. Change. What constitutes change is still up in the air. Ask a depressed person if they have changed even if they are only 50% less depressed and they will say likely say yes. Ask someone else and they may say “no,  I’m still depressed.” In the realm of sexual orientation, however, many see orientation as all/nothing. All same sex or all opposite sex orientation. Many will tell you this is just not their particular experience. So, IF someone wanted to change their direction of sexual attraction, what standard would they use to determine if change had taken place? Would 50% change be good? Who would decide this?

There is another analogous scenario in psychology. Should psychologists provide weight loss treatment? Given that an extremely large portion of those who lose weight gain it back and more, many have felt it unethical for a psychologist to offer weight loss therapies when they know that success is extremely low. So, how long do you need to keep the weight off to make a treatment worthwhile? How much do you need to lose? Who decides?

My gut feel is that the APA is not accurate in saying that there isn’t evidence that individuals can change. There is some evidence. Not complete change, but let us not deny what is there. Neither are they accurate about their reporting of harm. Harm reports are difficult to objectify. The best research will show you that some are harmed and some are not. Instead of assuming harm, let us evaluate more closely how some are harmed and how some are helped. Just as one might do with the weight loss scenario.  

3.  APA makes an attempt to make room for the work of helping one to find congruence between faith commitments and sexual feelings. This is also a good thing. Now, just how a psychologist does this matters greatly. Does he or she evangelize here? By that I mean (a) encourage a client to choose a different faith or change it to fit one’s sexual feelings, or (b) encourage a client to deny feelings and deny the suffering one might have by choosing not to act on a desire? My personal opininon is that option c (stay neutral) does not exist and is not possible. So, where does that leave us? Informing clients of our personal positions and yet not attempting to force individuals into our view of the situation. In other words, truthful but humble without being demanding.   

This is a divisive topic. Do individuals seeking to change their sexual orientation have the right to try to do so with the help of psychologists? Is change possible? Desirable? Damaging? And of course in trying to answer these questions you have a number of players on each side–each reading the “evidence” the way they would like to see it. You have those who have personal experiences in one direction or another. You have those with political or philosophical agendas. And, on top of that, you have media players interested in creating controversy where they can. I observed this last one myself where a local talk show host did his level best to create differences between two parties that weren’t disagreeing with each other as much he wanted them to.

So, what do you make of the difference between identity and orientation? Is it meaningful? How do we speak of change? Can we admit that it happens for some and not for others no matter our personal opinion whether change is good or not? And finally, can we avoid the “what if…” tendency in our conversations so that we deal with what is happening and not what we fear might happen?

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October 14, 2008 · 10:14 am

Third party to the sexual identity debate?


[Note: please keep comments civil and on point with my questions at the end. We seek constructive and instructive dialog, not debate or lecture]

David Benkof has a stimulating opinion piece in Sunday’s Philadelphia Inquirer on a third way in responding to the gay/straight debate between Judeo-Christians. On one side, folks argue that their gay identity should be embraced (and their same-sex relationships). On the other side, folks argue that the Bible speaks against homosexuality at every turn, thus only heterosexual identity is possible.

Benkof, a man of Jewish faith, suggests a third way in his piece against Soulforce (a group traveling around to Christian colleges to raise awareness of homosexuality as a legitimate part of humanity and the Christian community). He suggests it is possible to have a gay identity but believe that the Bible must be taken seriously and not brushed aside. In his study he does not believe the bible supports gay activity. He is asking that debates about sexual identity include folks similar to himself.

Interesting fellow. You might want to read his wiki entry to get some background. Obviously a controversial fellow for some.

It raises this question: What would healthy, Bible-honoring, dialog look like between those who feel they best identify as gay and those who do not regarding? How would they approach the interpretive act? (Assume for the moment that biblical interpretation is important) How might conservative theologians change their dialogical stance?

I do think one question might be really important. If Benkof believes same sex activity is wrong (and it seems he does) then why does he self-identify by something broken? Is it a parallel when some former alcoholics self-identify as an alcoholic even though they haven’t taken a drink in 20 years? What is the benefit of this self-identification? The drawback?

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July 28, 2008 · 5:47 am

What makes you feel like a ______ (man/woman)?


In a weak moment last week when I couldn’t take NPR or news radio I surfed the local radio stations in my car. Here are two phrases I heard in the span of 5 minutes. I have no idea who the artists are nor am I all that interested…

“Man, I feel like a woman.”
“I’m yo man…” (but something about needing to get down at her place because he had a girl at home)”

Suffice it to say I’m not going back anytime soon to the music on the radio. But, I will admit it got me thinking about how we know what feelings are quintessentially male or female. In the first song the woman feels like a woman because she has the power of attraction but does her own thing. In the second song, I assume the male singer feels like a man because he can sexually please a woman all night long.

What makes us male or female? (No, I’m not talking genetics here.) Sometimes we look at behaviors and interests. Sometimes we look at attitudes or attraction to the opposite sex. But most of the time I think we look at how others perceive us. If they treat us the way we think our gender should be treated (or, is commonly treated even if we don’t like it), then we feel like our gender. When we are invisible to others, treated differently (or so we perceive) based on our interests, behaviors, body type, etc. then we may feel that we are not like most of our gender.

Why is this important to consider? I have clients who have wondered about their orientation due to their feeling different than most of their friends of the same gender.

The simple answer is to assume that God makes a diverse group of males and females and that we ought not interpret our differences as having that much meaning. Of course, we rarely find the simple answer helpful. So what are we to do when we do not feel like others of our gender? Is this a big issue out there or just something we counselors see?

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May 20, 2008 · 5:19 am

APA says sexual orientation isn’t biological but from yet to be determined factors


Last week I commented on sexual identity formation in little kids. It spawned a large number of comments, both on and off topic. Hesitantly, I will make another post on the topic of sexual identity–this time from a brochure published by my own clinical association.

The American Psychological Association (APA) has a pamphlet on sexual orientation and homosexuality designed to aid understanding and reduce prejudice. My friend, John Freeman, gave me this to me and pointed out an interesting line which we’ll look at in a moment. But first, let me summarize the pamphlet

Sexual orientation, according to the APA is

“an enduring pattern of emotional, romantic, and/or sexual attractions to men, women, or both sexes. Sexual orientation also refers to a person’s sense of identity based on those attractions, related behaviors, and membership in a community of others who share those attractions.”

Right away it is clear they don’t really distinguish between attraction and identity and orientation and identity. You see the simple equation: attraction=orientation/identity. This is where Yarhouse’s studies with individuals within a gay affirming church give ample concrete evidence that such an equation is simplistic and mischaracterizes a set of complex issues. The reality is that one may recognize an attractional pull without it forming a private or public identity.

The APA document continues with the following,

“According to current scientific and professional understanding, the core attractions that form the basis for adult sexual orientation typically emerge between middle childhood and early adolescence.”

Again we see the attractions = orientation. This fits with the popular identity development theory that one moves from discomfort with to pride in attractions and accepts orientation as a given. Interpretive assumptions are given short shrift here.

Now to the good stuff. The brochure asks the question: What causes a person to have a particular sexual orientation? And here is their answer,

There is no consensus among scientists about the exact reasons that an individual develops a heterosexual, bisexual, gay, or lesbian orientation. Although much research has examined the possible genetic, hormonal, developmental, social, and cultural influences on sexual orientation, no findings have emerged that permit scientist to conclude that sexual orientation is determined by any particular factor or factors. Many think that nature and nurture both play complex roles; most people experience little or no sense of choice about their sexual orientation.

This is an interesting paragraph. The APA rightly recognizes that no one factor is likely to determine later orientation. In fact, we’re not really at a point where we can say one factor is X% of the equation. There is no equation yet. It doesn’t mean we won’t have a better sense of it in the future, but as of yet, the problem is not merely a biological process. So, this opens the door to choice and manipulation of one’s orientation unless one subscribes to behavioral naturalism–something most of us would not accept in other areas of life. Obviously no one is suggesting that sexual orientation is as transitory as a passing fancy. And yet the APA recognizes that even when folks don’t experience themselves choosing orientation, there is an interpretative and choice element however subtle and slow the process.

At this point the brochure turns to the problem of discrimination and its impact on gay and lesbian people. No matter your beliefs about homosexuality, you ought to recognize that there is great stigma and mistreatment for those so identified (and also for those who may not fit stereotyped roles but do not have a gay identity). Then the brochure covers the question of mental disorder. 

Is homosexuality a mental health disorder? No says the APA and I agree based on the definition of mental illness where it has to cause distress. Not all with a gay identity are distressed, period. This really isn’t the issue.

The brochure goes on but I will mention only one last section. They discuss the validity of therapy intended to change orientation. They state there is, “no scientifically adequate research to show that therapy aimed at changing sexual orientation is safe or effective.” First, this sentence is full of highly charged words whose meaning can be debated: adequate…safe…effective. What constitutes adequate? Safe? Effective? There is some data that is not merely anecdotal suggesting that change is possible and not unsafe (see Yarhouse and Jones’ Ex-Gays(IVP). Now, their data isn’t as strong as it could be, isn’t overwhelmingly positive, but neither can it be denied as an anecdote. On the flip side, there isn’t any adequately scientific data suggestive that change therapies are unsafe and ineffective. Both sides of the research agenda have the same set of weaknesses that one would expect in researching this particular population (i.e., convenience samples).

I agree with the APA that we therapist must respect and person’s right to self-determination. But the APA violates this very principle by disrespecting those who have carefully thought about change. It is a paternalistic stretch to say that every person who wishes to change orientation only does so because of biases or because of a fundamentalist upbringing. The APA wants to be sensitive to a client’s “race, culture, ethnicity, age, gender, gender identity, sexual orientation, religion…” as long as their religion doesn’t guide them to see sexuality in a different light.

All in all, the APA takes a complex set of factors and ends up with, “It just is, so be nice!” I’m all for reducing mistreatment and violations of constitutional rights. But, I expect my scientific organization to spend my dues in a more balanced manner–faithfully representing what is true, whether attractive or not.  

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April 25, 2008 · 8:56 am

Considering sexual identity


Tonight I’m talking to a large group of teens at Monmouth Chinese Christian Church in NJ on the topic of sexual identity. Unlike a good sermon, I have four points: Is sexual identity important? Does God have anything to say about it? How does it get formed and deformed? What can we do to protect our identity and desire.

Should be fun. I’m going to start them out with this question: What words, ideas, images, characteristics, etc. come to mind when you complete the sentence, “A man is…” or “A woman is…”

We all have images and words and ideas that pop into our heads. We have an image of a “manly” man and a “womanly” woman. I want the audience to think for a bit about where those images come from.

What images pop into your head? How do these effect your own evaluation of your manhood or womanhood? Where did that script come from?

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September 26, 2007 · 5:27 am

JesusCreed on “Ex-Gays”


Starting on 10/2 Scot McKnight is going to start a post series at www.jesuscreed.orgon Stan Jones and Mark Yarhouse’s new book, Ex-Gays? Yesterday, he merely announced that he would start the series and it brought on the usual discussions that one encounters when talking about homosexuality, sexual orientation, etc. (e.g., is it right/wrong? Did Jesus say anything about the matter? What is orientation? Does it really change? Why do we give special attention to this particular activity and avoid things like gossip and adultery?). All good questions, but they may miss the actual issues raised by this particular book.

Personal experiences play a huge role in much of the public conversation about sexuality (we all have broken sexual experiences and friends and family with their own experiences). It will be interesting to see whether readers of JesusCreed will be able to consider the merits of the questions that Jones and Yarhouse ask: Is it ever possible for someone to change their sexual orientation using religious means? And, is it harmful to try?

Chapter one lays out the controversy (i.e., the scientific and political claims in the debate, whether sexual orientation is a thing or a construction) and articulates their view of the relationship between science and faith.

Chapter two provides an overview of a Christian/biblical view of sexuality (what it was designed to be and how it is broken). In short, they report that the biblical text gives sexual intercourse a fixed meaning (an good act between husband and wife) rather than have the act defined by the intent of the participants. “Nonreligious persons today are accustomed to thinking that the meaning of their sexual actions are conferred by their intentions for those acts….But the Christian tradition asserts the opposite: that sexually intimate acts have fixed meanings by their very nature” (p. 49).  God provides the boundaries, but given our fallen nature, every aspect of our personhood reflects humanity’s rebellion against God. They then detail both Christian ethical responses to homosexuality as well as pastoral responses by well-known agencies.

Chapters 3 and 4 are the defense of their rationale and methodologies. Of note is the small sample size. But remember, they want to know whether it is ever possible for someone to change orientation through religious means. They do an interesting discussion of what kind of study they wanted to do and what they actually did in the end (chapter five) and why. They also address matters of researcher bias here. Chapters 6-9 explore how one might measure sexual orientation change and report their results.

Whether you agree or disagree with their sexual ethic, agree or disagree with their interpretation of orientation or their view of what makes for a robust empirical finding, you ought to agree that this is a well-written book that attempts to very slowly walk through the issues (scientific, biases, change, identity and orientation) without slandering opponents and yet maintaining their apologetical stance.

A worthy book to read by anyone. Stay tuned to JesusCreed to see how readers there respond to the issues when it gets to the details of the chapters.   

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September 17, 2007 · 10:23 am

Research that brought me to tears


I confess, the other day I got teary over someone’s research (we New Englander men don’t really cry–its a disorder caused by enculturated individualism). Truth be told, I didn’t get choked up by the research but by the man who was reporting it. Mark Yarhouse closed out the annual conference of the Society for Christian Psychology by reporting the history of his research in the area of sexual identity (and its change) and sexual orientation. 9 years ago he began explore these areas. First he and Stan Jones critiqued the pro-gay psychological research and pointed out serious flaws. At the heart of the matter he was concerned about those who acknowledged same sex attraction but because of their deeply-held theological beliefs, did not wish to identify with the gay identity. Mainstream psychology has argued that these folks are suppressing their identity or being suppressed by fundamentalist culture. Isn’t it possible, Mark wondered, that these seemingly healthy individuals could acknowledge their sexual desires and choose not to make their identity or behavior based on desire. In the talk he told us of his attempts to dialog with pro-gay psychologists and psychiatrists. He took some heat, of course, but also gained the respect of others. Most recently, he has been constructing a model for helping clients explore the many facets of their sexual identity and changing what is in their power (how they interpret and respond to same sex attraction) and allowing what they cannot change to be.

Okay, you are probably wondering why this moved me. I was moved because here was a man showing great compassion to these faithful, struggling christians–double minorities in both the world and in the church. He has done this at great cost to himself and has had to hang on to the Lord under significant spiritual warfare. Here is a man not willing to get stuck in the political speak but willing to dialog with those many would consider enemies and to try to hear and understand–even when he knew it wouldn’t change the world. Here is a man willing to explore how people remain faithful to God while trying to understand their brokenness. Finally, I was moved by the love and wisdom shown to Mark in a letter from his sister. She encouraged his faith and reminded him what was true in language fitting of a classic pastoral care author.

Okay, I still can’t express why I was moved. But I wasn’t the only one. The speaker who came up to close the conference was also choked up. It is possible that scientific endeavors show us the hand and face of God. 

Mark’s latest book, Ex-gays? A longitudinal study of religiously mediated change in sexual orientation (IVP) is hot off the press (first author is Stanton Jones).   

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