Is Conservative Religiousness Inherently Associated with Poorer Health for Sexual Minorities?

Results of path analysis involving sexual minority participants (N = 1317) from diverse sociopolitical contexts revealed health outcomes to be associated with internalized homonegativity and the resolution of conflict between religious and sexual minority identities. Contrary to expectations, several markers of religiousness were not directly associated with either improved or worsened health outcomes for depression or anxiety. However, religious activity moderated the influence of internalized homonegativity (IH) on depression such that IH was less strongly related to depression among individuals who frequently attended religious services than among individuals who infrequently attended religious services. These findings have special salience for advancing a more accurate understanding of conservatively religious sexual minorities and directing culturally sensitive research, clinical services, and public policy.

Efficacy and risk of sexual orientation change efforts: a retrospective analysis of 125 exposed men.

BACKGROUND: Voluntary therapeutic interventions to reduce unwanted same-sex sexuality are collectively known as sexual orientation change efforts (SOCE).  Currently almost all evidence addressing the contested question whether SOCE is effective or safe consists of anecdotes or very small sample qualitative studies of persons who currently identify as sexual minority and thus by definition failed to change.  We conducted this study to examine the efficacy and risk outcomes for a group of SOCE participants unbiased by current sexual orientation.       Methods: We examined a convenience sample of 125 men who had undergone SOCE for homosexual-to-heterosexual change in sexual attraction, identity and behavior, and for positive and negative changes in psychosocial problem domains (depression, suicidality, self-harm, self-esteem, social function, and alcohol or substance abuse).  Mean change was assessed by parametric (t-test) and nonparametric (Wilcoxon sign rank test) significance tests.   Results: Exposure to SOCE was associated with significant declines in same-sex attraction (from 5.7 to 4.1 on the Kinsey scale, p <.000), identification (4.8 to 3.6, p < .000), and sexual activity (2.4 to 1.5 on a 4-point scale of frequency, p < .000). From 45% to 69% of SOCE participants achieved at least partial remission of unwanted same-sex sexuality; full remission was achieved by 14% for sexual attraction and identification, and 26% for sexual behavior.  Rates were higher among married men, but 4-10% of participants experienced increased same-sex orientation after SOCE.  From 0.8% to 4.8% of participants reported marked or severe negative psychosocial change following SOCE, but 12.1% to 61.3% reported marked or severe positive psychosocial change.  Net change was significantly positive for all problem domains.   Conclusion: SOCE was perceived as an effective and safe therapeutic practice by this sample of participants.  We close by offering a unifying understanding of discrepant findings within this literature and caution against broad generalizations of our results.

Sexual Minorities who Reject an LGB Identity: Who Are They and Why Does It Matter?

Although some persons with minority sexual orientations do not identify as lesbian, gay, or bisexual (LGB), Minority Stress Theory (Meyer, 2003) has largely been developed utilizing LGB-identified samples. We examined a sample (n = 274) of sexual minorities with diverse religious and sexual identity labels to determine if those rejecting versus adopting an LGB identity were different in terms of religious, sexual, relational, and health characteristics. Results suggested those who reject an LGB identity are more likely to be religiously active, full members of their church, and highly intrinsic and theologically conservative in their religious viewpoint. They further reported having slightly more lifetime heterosexual attractions, fantasies, and behaviors; greater internalized homonegativity; and being more interested in having children and a child-centered family life. They were also more likely to be single and celibate or in a heterosexual relationship. Contrary to expectations, these differences were not associated with health differences in depression, anxiety, and social flourishing. LGB-identified participants did report higher life satisfaction than those rejecting an LGB identity, but this difference was not interpretively meaningful when considered in reference to population norms. We conclude with a discussion of the potential implications of our findings for research, legal and professional advocacy, and clinical care.

Same-Sex Attracted, Not LGBQ: The Associations of Sexual Identity Labeling on Religiousness, Sexuality, and Health Among Mormons.

In the Church of Jesus Christ of Latter-Day Saints (LDS church), beliefs about same-sex sexual attraction are carefully differentiated from beliefs about same-sex sexual behavior and identity, leading some to reject a lesbian, gay, bisexual, or queer (LGBQ) identity label in favor of declining a sexual identity or describing themselves as experiencing same-sex attraction (SSA). Using data from 1,128 sexual minority Mormons recruited from both politically conservative and liberal circles, we examined the relationship between rejecting an LGBQ identity and religiousness, attitudes toward sexuality, and health outcomes. We found that Mormons who reject an LGBQ identity were significantly more religious and less content with their sexuality but had similar health outcomes relative to LGBQ Mormons. We posit that these differences are best understood by differences in group affiliation and support, intersectional experiences with minority stressors, and the lack of generalizability of LGBQ constructs to those who reject an LGBQ identity.

Sex and gender are distinct variables critical to health: Comment on Hyde, Bigler, Joel, Tate, and van Anders (2019).

In this brief comment on Hyde, Bigler, Joel, Tate, and van Anders (2019), we maintain that sex and gender are distinct variables that impact human health in critical ways both individually and interactively. In the life sciences, sex is defined by how an organism is organized with respect to reproduction. Among humans, reproduction requires the union of two distinct gametes. Hence, human sex, in contrast to gender, is an innate and immutable biologically binary trait that is not fundamentally determined or altered by psychosocial factors. The existence of congenital disorders of sex development, typically associated with reduced fertility, does not negate the human sexual binary as defined by the life sciences. Individuals who identify as transgender remain either biological males or females. Diseases that affect both sexes often have different frequencies, presentations, and responses to treatments in males and females; therefore, different preventative, diagnostic, and treatment approaches may be required for males and females. For the sake of all people, especially those who identify as transgender, we must move forward in examining the gender binary without jettisoning the reality and importance of sexual dimorphism in psychology and medicine. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Satisfaction and Health Within Four Sexual Identity Relationship Options.

Using a sample of 1,782 same-sex attracted (SSA) and lesbian, gay, and bisexual (LGB) identified participants, this study examined similarities and differences among those who are (a) single and celibate (SC); (b) single and not celibate (SNC); (c) in a heterosexual, mixed-orientation relationship (MOR); and (d) in a same-sex relationship (SSR). To reduce bias and increase generalizability, an ideologically diverse research team was formed. Participants in SSRs reported higher levels of some amount of satisfaction with their status (95%) compared to those in MORs (80%), those who are SC (42%) and those who are SNC (40%). The SSR group had the least depression and anxiety and the most life satisfaction and physical health, followed by the MOR group, followed by the two single groups. Results from a stepwise regression predicting satisfaction from important aspects of life and relationships identified that meeting needs for connection, intimacy, and mutual understanding was the strongest predictor of satisfaction across all options. Other significant variables included participant-defined authentic sexual expression, resolving conflicts with religion, and reducing depression and anxiety. Results may inform SSA/LGB individuals who are questioning which option fits best for them and help guide therapists who work with these individuals.

Knowing what we do not know about sexual orientation change efforts.

Comments on the original article, "Guidelines for psychological practice with lesbian, gay, and bisexual clients," by the American Psychological Association (see record 2011-19419-001). The present authors notes that the APA has provided a very helpful document for those who do clinical work with individuals experiencing same-sex attractions. Psychologists no doubt need to be familiar with the literature described in these guidelines as a part of ethical practice. However, the present authors register concern regarding how the guidelines address sexual orientation change efforts (SOCE). They focus their critique on how the guidelines portray two issues pertaining to SOCE-effectiveness and harm-and conclude with a proposal to move the discussion forward via science.

Spiritual well-being, dissociation, and alexithymia: examining direct and moderating effects.

In the present study we surveyed 131 adults seeking psychotherapy and pastoral care in an intensive outpatient psychotherapy program for full-time religious workers. We sought to determine whether dissociation and alexithymia are associated with spiritual well-being. We utilized the Dissociative Experiences Scale-II (DES-II), the Toronto Alexithymia Scale (TAS-20), the Spiritual Well-Being Scale (SWB) as well as the subscales of these instruments in a series of linear multiple regression analyses. DES-II total scores were inversely related to SWB total scores. No association was found between alexithymia and SWB, nor did alexithymia moderate the relationship between dissociation and SWB. Subscale analyses revealed that lower SWB and Existential Well-Being (EWB) were associated with greater nonpathological dissociation (DES-NP), which was unrelated to Religious Well-Being (RWB). By contrast, lower RWB was predicted by higher pathological dissociation (DES-T), which displayed no relationship to SWB or EWB. We conclude with a discussion of some implications of these findings.

Homophobia and conservative religion: toward a more nuanced understanding.

The failure of homophobia scales to consider the normative assumptions of religious communities may result in findings that are less useful in addressing this problem. In this study, 155 undergraduate students at a Christian university were surveyed, separately assessing attitudes toward celibate versus sexually active homosexual men and women. Results of multiple regression analyses found that participants who emphasized a person-behavior distinction (an accepted tenet of conservative religious ideology) held more negative attitudes toward lesbian women than those who were comparatively more accepting and did not emphasize such a distinction. However, participants who emphasized the person-behavior distinction held more positive attitudes toward gay men than those who were comparatively more rejecting and did not emphasize such a distinction. These relationships were significant even after accounting for variance attributable to general measures of religious commitment. Attempts to reduce homophobia within conservative religious communities may benefit from a more sensitive approach to their belief systems.

Psychiatric symptoms among prospective bariatric surgery patients: rates of prevalence and their relation to social desirability, pursuit of surgery, and follow-up attendance.

BACKGROUND: There is a very limited empirical literature regarding the psychiatric status of prospective bariatric patients and no studies that examine potential social desirability effects on self-presentation for this patient population. METHODS: The Psychiatric Diagnostic Screening Questionnaire (PDSQ) was utilized to assess the prevalence of 13 DSM-IV Axis I disorders in a sample of 294 bariatric patients attending a presurgical psychological consultation. Marlowe-Crowne Social Desirability Scale (MCSD) was also included for 256 of these patients. Six-month follow-up data for a sub-sample of 64 patients was obtained to compare the extent of presurgical psychiatric symptoms between individuals who did versus did not pursue the surgery and those who attended versus failed to attend post-operative follow-up appointments. RESULTS: The results suggested the presence of an Axis I disorder among half of these patients, with comorbidity present in 29.9% of the sample. Highest prevalence rates were suggested for somatization (29.3%), social phobia (18%), hypochondriasis (15%), and obsessive-compulsive disorder (13.6%). Univariate analyses revealed that only MSCD scores were significantly and negatively related to total symptom levels. Analyses of the follow-up data indicated that patients who pursued the surgery had fewer total symptoms. Patients who attended all of their follow-up appointments tended to be older and weighed more at their presurgical evaluation. CONCLUSION: These findings suggest that significant psychopathology can be found among bariatric patients, and highlight the importance of attending to impression management issues and anxiety spectrum disorders in presurgical psychological evaluations.

Motivational, ethical, and epistemological foundations in the treatment of unwanted homoerotic attraction.

A recent special section of the Journal of Marital and Family Therapy (October, 2000) focusing on the mental health needs of gay, lesbian, and bisexual individuals neglected to address the clinical needs of homosexual persons who desire to increase their heterosexual potential. This article attempts to correct this omission by outlining common motivations for pursuing change, updating the current state of knowledge regarding the effectiveness of change efforts, and providing some ethical guidelines when therapists encounter clients who present with unwanted homoerotic attraction. Finally, to assist marriage and family therapists (MFTs) in more deeply understanding divergent perspectives about reorientation treatments, an examination of the role of moral epistemology is presented and some examples of its potential influence are described. MFTs are encouraged to recognize and accept, rather than ignore or deny the valid needs of clients who seek to modify their same-sex attraction.

When therapists do not acknowledge their moral values: Green's response as a case study.

In this rejoinder to Green's (this issue) commentary on my article, I clarify several points of agreement and divergence with his critique. The failure of Green to be forthcoming about the sociopolitical and moral framework that infuses his response is unfortunately all too common in this literature. This places a limitation on the degree to which his comments can be contextually evaluated, though they remain didactically useful. Marriage and family therapists (MFTs) must realize that their underlying belief systems exact a profound influence on their conceptions about what constitutes mental health, valid treatment goals, and the best means to achieve these aims. These value frameworks may or may not be shared by religiously conservative and other clients who seek to develop their heterosexual potential. This has important, but often unrecognized, implications for clinical practice.