"Homosexual panic" is a term coined by American psychiatrist Edward J. Kempf in 1920 for a condition of "panic due to the pressure of uncontrollable perverse sexual cravings". [1] Kempf classified this condition as an acute pernicious dissociative disorder, meaning that it involved a disruption in typical perception and memory functions of an individual. In the psychiatrist's honour, the condition has come to also be known as "Kempf's disease". Although homosexuality itself was removed from the APA's DSM in 1973, some form of homosexual panic was retained in the manual until the release of DSM-V in 2013.
In his case studies, Kempf recorded a variety of symptoms that his patients presented with. Psychotic symptoms included hallucinations and delusions, especially those of persecution. Kempf cites Case PD-14, who insisted he had been framed for his behavior and accused his shipmates of conspiring to harm or kill him. Somatic symptoms were also common, including dizziness, nausea, and vomiting. [1] In 1959, author Burton Glick documented mood-related symptoms, such as self-punishment, suicidal ideation, social withdrawal, and feelings of helplessness. Glick noted that patients appeared passive, and demonstrated an "inability to be aggressive". Ultimately, patients became "unable to function at all". [2] Both Glick and Kempf emphasize their patients' lack of aggression towards homosexual individuals. [2] [3] In a study of college-aged men, Henry Harper Hall found that men who exhibited symptoms in line with homosexual panic never acted out towards homosexual individuals; instead, they blamed themselves for their own cravings. [4] Kempf noted that the difference between patients who fared well after their diagnoses and those who did not was the patient's successful "transference" of such homosexual cravings. If a patient was able to transfer these impulses towards another, more socially appropriate target, the patient would begin to feel less inferior and would thus recover. [1]
Spending copious amounts of time with members of the same sex in a confined or limited atmosphere was cited by Kempf as a possible reason for the onset of the disease. Environments where this might occur included but were not limited to army camps, ships, monasteries, schools, asylums, and prisons. Kempf asserted that individuals in these environments who had recently or were currently undergoing stress (due to fatigue, sickness, loss of a love interest, etc.) were more likely to have weak egos. According to the Freudian theory of psychoanalysis, the ego is the part of an individual's mind that mediates between the primitive unconscious and reality. [5] When in such a position, affected individuals would become "eccentric and irritable", tending to feel inferior and weak amongst their companions. [1]
It is important to note that the onset of this condition was not attributed to unwanted homosexual advances. Rather, Kempf stated that it was caused by the individual's own "aroused homosexual cravings". [2] The individual's homosexual feelings as a cause of their symptoms was what differentiated this diagnosis from any other stress-related disorder.
Homosexual panic disorder is a separate diagnosis from acute aggression panic disorder. Glick notes that the difference is explained by differing instinctual drives that motivate each disorder. Patients whose primary motivation is a sexual one are experiencing homosexual panic, whereas patients whose motivation is primarily aggression are experiencing acute aggression panic disorder. [2] As stated above, both Glick and Kempf noted in their accounts of patients that those with homosexual panic disorder were not aggressive toward others. Also in concordance with this, Hart's study concluded that those individuals with homosexual panic who chose to satisfy homosexual urges experienced relief from their symptoms. [4]
Kempf identified the condition after completing 19 case studies during and after World War I at St. Elizabeths Hospital, a government mental institution in Washington, D.C. [6] The case studies lasted months in some cases, and consisted of extensive unstructured patient interviews. Kempf would, over the course of multiple sessions, investigate the personal history of the patient and the events that led up to hospitalization in order to diagnose them with homosexual panic. [1] Among the cases described by Kempf is a "physician ... who later became a brilliant philologist", [1] : 506 born in Ceylon in 1834 to missionary parents, and graduating from Yale Medical School before serving as an army surgeon [1] : 450–451 —an apparent reference to William Chester Minor.[ citation needed ]
The disorder was included in Appendix C of the DSM-I as a supplementary term, [7] which are terms that may be added on to an existing diagnosis to further explain the patient's condition. In order for mental health professionals to apply a diagnosis to a patient, the diagnosis must appear in the current edition of the DSM. [8] The disorder has not appeared in any subsequent editions of the DSM, and thus is not considered a diagnosable condition. [9]
Although homosexuality was removed from the DSM in 1973, the retaining of "sexual orientation disturbance" as a mental disorder lead to legal protection of discrimination. The New York Times, for example, made a psychological exam a requirement for employment - requiring applicants on penalty of perjury to disclose their sexuality. In one case, editor Abe Rosenthal claimed to want to hire a gay journalist, but the newspaper's staff doctor came into his office stating: "you can't hire this man. He's a homosexual." Rosenthal replied that he already knew, to which the doctor responded, "But don't you know that homosexuals are susceptible to homosexual rage?" Thus, it was through psychiatry homosexuals continued to be banned from employment. [10]
Homosexual panic as a mental health disorder is distinct from the victim blaming homosexual panic defense (HPD) (also known as the gay panic defense) within the legal system. Whereas homosexual panic disorder was at one point considered a diagnosable medical condition, the HPD implies only a temporary loss of self-control. [11] The HPD is used to reduce the sentence against the perpetrator of assault or murder of a homosexual individual. In the US trial for the murder of Larry King, the HPD was used by defendant Brandon McInerny, who was convicted of voluntary manslaughter. [12]
Between 2003 and 2017, both Australia (except South Australia) and New Zealand removed the defense. In September 2014, California became the first state to abolish the HPD in the USA. [12]
The absence of homosexual panic from the DSM-5 reflects changing societal attitudes toward homosexuality. Homosexuality as a mental disorder was removed from the DSM in 1973, a significant event in LGBT history. [8] In 2013, 60% of Americans agreed that homosexuality should be accepted by society: an increase from 49% of Americans in 2007. [13] Changing attitudes toward homosexuality have been influenced by LGBT movements in the United States.
The Diagnostic and Statistical Manual of Mental Disorders is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common language and standard criteria. It is an internationally accepted manual on the diagnosis and treatment of mental disorders, though it may be used in conjunction with other documents. Other commonly used principal guides of psychiatry include the International Classification of Diseases (ICD), Chinese Classification of Mental Disorders (CCMD), and the Psychodynamic Diagnostic Manual. However, not all providers rely on the DSM-5 as a guide, since the ICD's mental disorder diagnoses are used around the world, and scientific studies often measure changes in symptom scale scores rather than changes in DSM-5 criteria to determine the real-world effects of mental health interventions.
The gay panic defense or homosexual advance defence is a victim blaming strategy of legal defense, which refers to a situation in which a heterosexual individual charged with a violent crime against a homosexual individual claims they lost control and reacted violently because of an unwanted sexual advance that was made upon them. A defendant will use available legal defenses against assault and murder, with the aim of seeking an acquittal, a mitigated sentence, or a conviction of a lesser offense. A defendant may allege to have found the same-sex sexual advances so offensive or frightening that they were provoked into reacting, were acting in self-defense, were of diminished capacity, or were temporarily insane, and that this circumstance is exculpatory or mitigating.
Hypochondriasis or hypochondria is a condition in which a person is excessively and unduly worried about having a serious illness. Hypochondria is an old concept whose meaning has repeatedly changed over its lifespan. It has been claimed that this debilitating condition results from an inaccurate perception of the condition of body or mind despite the absence of an actual medical diagnosis. An individual with hypochondriasis is known as a hypochondriac. Hypochondriacs become unduly alarmed about any physical or psychological symptoms they detect, no matter how minor the symptom may be, and are convinced that they have, or are about to be diagnosed with, a serious illness.
Histrionic personality disorder (HPD) is defined by the American Psychiatric Association as a personality disorder characterized by a pattern of excessive attention-seeking behaviors, usually beginning in early adulthood, including inappropriate seduction and an excessive desire for approval. People diagnosed with the disorder are said to be lively, dramatic, vivacious, enthusiastic, extroverted and flirtatious.
Hysteria is a term used to mean ungovernable emotional excess and can refer to a temporary state of mind or emotion. In the nineteenth century, female hysteria was considered a diagnosable physical illness in women. It is assumed that the basis for diagnosis operated under the belief that women are predisposed to mental and behavioral conditions; an interpretation of sex-related differences in stress responses. In the twentieth century, it shifted to being considered a mental illness. Many influential people such as Sigmund Freud and Jean-Martin Charcot dedicated research to hysteria patients.
Schizoaffective disorder is a mental disorder characterized by symptoms of both schizophrenia (psychosis) and a mood disorder - either bipolar disorder or depression. The main diagnostic criterion is the presence of psychotic symptoms for at least two weeks without prominent mood symptoms. Common symptoms include hallucinations, delusions, disorganized speech and thinking, as well as mood episodes. Schizoaffective disorder can often be misdiagnosed when the correct diagnosis may be psychotic depression, bipolar I disorder, schizophreniform disorder, or schizophrenia. This is a problem as treatment and prognosis differ greatly for most of these diagnoses. Many people with schizoaffective disorder have other mental disorders including anxiety disorders.
Substance-related disorders, also known as substance use disorders, can lead to large societal problems. It is found to be greatest in individuals ages 18–25, with a higher likelihood occurring in men compared to women, and urban residents compared to rural residents. On average, general medical facilities hold 22% of patients with substance-related disorders, possibly leading to psychiatric disorders later on. Over 50% of individuals with substance-related disorders will often have a "dual diagnosis," where they are diagnosed with the substance use, as well as a psychiatric diagnosis, the most common being major depression, personality disorder, anxiety disorders, and dysthymia.
Adjustment disorder is a maladaptive response to a psychosocial stressor. It is classified as a mental disorder. The maladaptive response usually involves otherwise normal emotional and behavioral reactions that manifest more intensely than usual, causing marked distress, preoccupation with the stressor and its consequences, and functional impairment.
Depersonalization-derealization disorder is a mental disorder in which the person has persistent or recurrent feelings of depersonalization and/or derealization. Depersonalization is described as feeling disconnected or detached from one's self. Individuals may report feeling as if they are an outside observer of their own thoughts or body, and often report feeling a loss of control over their thoughts or actions. Derealization is described as detachment from one's surroundings. Individuals experiencing derealization may report perceiving the world around them as foggy, dreamlike, surreal, and/or visually distorted.
Acute stress reaction and acute stress disorder (ASD) is a psychological response to a terrifying, traumatic or surprising experience. Combat stress reaction (CSR) is a similar response to the trauma of war. The reactions may include but are not limited to intrusive or dissociative symptoms, and reactivity symptoms such as avoidance or arousal. It may be exhibited for days or weeks after the traumatic event. If the condition is not correctly addressed, it may develop into post-traumatic stress disorder (PTSD).
Intermittent explosive disorder is a behavioral disorder characterized by explosive outbursts of anger and/or violence, often to the point of rage, that are disproportionate to the situation at hand. Impulsive aggression is not premeditated, and is defined by a disproportionate reaction to any provocation, real or perceived. Some individuals have reported affective changes prior to an outburst, such as tension, mood changes, energy changes, etc.
Normality is a behavior that can be normal for an individual when it is consistent with the most common behavior for that person. Normal is also used to describe individual behavior that conforms to the most common behavior in society. However, normal behavior is often only recognized in contrast to abnormality. In many cases normality is used to make moral judgements, such that normality is seen as good while abnormality is seen as bad, or conversely normality can be seen as boring and uninteresting. Someone being seen as normal or not normal can have social ramifications, such as being included, excluded or stigmatized by wider society.
Emergency psychiatry is the clinical application of psychiatry in emergency settings. Conditions requiring psychiatric interventions may include attempted suicide, substance abuse, depression, psychosis, violence or other rapid changes in behavior.
Robert Leopold Spitzer was a psychiatrist and professor of psychiatry at Columbia University in New York City. He was a major force in the development of the Diagnostic and Statistical Manual of Mental Disorders (DSM).
Ego-dystonic sexual orientation is a highly controversial mental health diagnosis that was included in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) from 1980 to 1987 and in the World Health Organization's (WHO) International Classification of Diseases (ICD) from 1990 to 2019. Individuals could be diagnosed with ego-dystonic sexual orientation if their sexual orientation or attractions were at odds with their idealized self-image, causing anxiety and a desire to change their orientation or become more comfortable with it. It describes not innate sexual orientation itself, but a conflict between the sexual orientation a person wishes to have and their actual sexual orientation.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is the 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, the taxonomic and diagnostic tool published by the American Psychiatric Association (APA). In 2022, a revised version (DSM-5-TR) was published. In the United States, the DSM serves as the principal authority for psychiatric diagnoses. Treatment recommendations, as well as payment by health care providers, are often determined by DSM classifications, so the appearance of a new version has practical importance. However, some providers instead rely on the International Statistical Classification of Diseases and Related Health Problems (ICD), and scientific studies often measure changes in symptom scale scores rather than changes in DSM-5 criteria to determine the real-world effects of mental health interventions. The DSM-5 is the only DSM to use an Arabic numeral instead of a Roman numeral in its title, as well as the only living document version of a DSM.
Brief psychotic disorder—according to the classifications of mental disorders DSM-IV-TR and DSM-5—is a psychotic condition involving the sudden onset of at least one psychotic symptom lasting 1 day to 1 month, often accompanied by emotional turmoil. Remission of all symptoms is complete with patients returning to the previous level of functioning. It may follow a period of extreme stress including the loss of a loved one. Most patients with this condition under DSM-5 would be classified as having acute and transient psychotic disorders under ICD-10. Prior to DSM-IV, this condition was called "brief reactive psychosis." This condition may or may not be recurrent, and it should not be caused by another condition.
Jack Drescher is an American psychiatrist and psychoanalyst known for his work on sexual orientation and gender identity.
Homosexuality was classified as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM) beginning with the first edition, published in 1952 by the American Psychiatric Association (APA). This classification was challenged by gay rights activists during the gay liberation following the 1969 Stonewall riots, and in December 1973, the APA board of trustees voted to declassify homosexuality as a mental disorder. In 1974, the DSM was updated and homosexuality was replaced with a new diagnostic code for individuals distressed by their homosexuality, termed ego-dystonic sexual orientation. Distress over one's sexual orientation remained in the manual, under different names, until the DSM-5 in 2013.
Other specified dissociative disorder (OSDD) is a mental health diagnosis for pathological dissociation that matches the DSM-5 criteria for a dissociative disorder, but does not fit the full criteria for any of the specifically identified subtypes, which include dissociative identity disorder, dissociative amnesia, and depersonalization/derealization disorder, and the reasons why the previous diagnoses were not met are specified. "Unspecified dissociative disorder" is given when the clinician does not give a reason. The International Statistical Classification of Diseases and Related Health Problems (ICD-10) refers to the diagnosis as "Other dissociative and conversion disorders". Under the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), it was known as "Dissociative disorder not otherwise specified" (DDNOS).
