Variations in sexual orientation and gender expression represent normal and expectable dimensions of human development. They are not considered to be pathological; therefore, they are not included in the Diagnostic and Statistical Manual of Mental Disorders, and other accepted nosological systems (1). Health promotion for all youth encourages open exploration of all identity issues, including sexual orientation, gender identity, and/or gender expression according to recognized practice guidelines (2). This fosters healthy development, especially for sexual and gender diverse youth, as they integrate their sexual orientation, gender identity, and/or gender expression, into their overall identity without any pre-determined outcome.

“Conversion therapies” (or “reparative therapies”) are interventions purported to alter same-sex attractions or an individual’s gender expression with the specific aim to promote heterosexuality as a preferable outcome (3, 4). Similarly, for youth whose gender identity is incongruent with their sex anatomy, efforts to change their core gender identity have also been described and more recently subsumed under the conversion therapy rubric (5). These interventions are provided under the false premise that homosexuality and gender diverse identities are pathological. They are not; the absence of pathology means there is no need for conversion or any other like intervention. Further, there is evidence that “conversion therapies” increase risk of causing or exacerbating mental health conditions in the very youth they purport to treat (2-5).

Comprehensive assessment and treatment of youth that includes exploration of all aspects of identity, including sexual orientation, gender identity, and/or gender expression is not “conversion therapy” (2). This applies whether or not there are unwanted sexual attractions and when the gender role consistent with the youth’s assigned sex at birth is non-coercively explored as a means of helping the youth understand their authentic gender identity. In the presence of gender dysphoria (distress related to the incongruence between gender identity and sex assigned at birth), the standard of care may involve exploration of living in a different gender role (appropriate to the child or adolescent’s developmental understanding of gender) and/or potential use of affirming gender transition interventions to align anatomical features with one’s gender identity for appropriately assessed pubertal adolescents (6, 7). This follows recognized standards of care and is not considered “conversion therapy.”

The AACAP Policy on “Conversion Therapies”

The American Academy of Child and Adolescent Psychiatry finds no evidence to support the application of any “therapeutic intervention” operating under the premise that a specific sexual orientation, gender identity, and/or gender expression is pathological. Furthermore, based on the scientific evidence, the AACAP asserts that such “conversion therapies” (or other interventions imposed with the intent of promoting a particular sexual orientation and/or gender as a preferred outcome) lack scientific credibility and clinical utility. Additionally, there is evidence that such interventions are harmful. As a result, “conversion therapies” should not be part of any behavioral health treatment of children and adolescents. However, this in no way detracts from the standard of care which requires that clinicians facilitate the developmentally appropriate, open exploration of sexual orientation, gender identity, and/or gender expression, without any pre-determined outcome.

Developed by AACAP’s Sexual Orientation and Gender Identity Issues Committee

References:

1. American Psychiatric Association, Diagnostic and statistical manual of mental disorders: DSM-5. 2013.
2. Adelson, S. L., & the American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI). (2012). Practice parameter on gay, lesbian, or bisexual sexual orientation, gender non-conformity, and gender discordance in children and adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 51, 957– 974. http://dx.doi.org/10.1016/j.jaac.2012.07.004.
3. American Psychiatric Association Commission on Psychotherapy by Psychiatrists. Position Statement on Therapies Focused on Attempts to Change Sexual Orientation (Reparative or Conversion Therapies). Am J Psychiatry. 2000; 157(10):1719-1721.
4. APA Task Force on Appropriate Therapeutic Responses to Sexual Orientation. (2009). Report of the Task Force on Appropriate Therapeutic Responses to Sexual Orientation. Washington, DC: American Psychological Association.
5. Substance Abuse and Mental Health Services Administration, Ending Conversion Therapy: Supporting and Affirming LGBTQ Youth. HHS Publication No. (SMA) 15-4928. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2015.
6. Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., . . . Zucker, K. (2012). Standards of care for the health of transsexual, transgender, and gender nonconforming people (7 ed., Vol. 13, pp. 165-232): International Journal of Transgenderism.
7. Hembree, W. C., Cohen-Kettenis, P., Gooren, L. J., Hannema, S.E., Meyer, W.J., Murad, M.H., Rosenthal, S.M., Safer, J.D., Tangpricha, V., and T’Sjoen, G.G. (2017). Endocrine treatment of Gender dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 102(11), 1-35. doi: doi:10.1210/jc.2017-01658.

#

The American Academy of Child and Adolescent Psychiatry promotes the healthy development of children, adolescents, and families through advocacy, education, and research. Child and adolescent psychiatrists are the leading physician authority on children’s mental health.

Approved by Council February 2018