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Pages 53-88

回应美国心理学联会称同性恋者病态问题不比异性恋者多

(III. Response to APA Claim: There Is No Greater Pathology in the Homosexual Population than in the General Population

JOURNAL OF HUMAN SEXUALITY (Volume 1)

What Research Shows: NARTH’s Response to the APA Claims on Homosexuality

A Report of the Scientific Advisory Committee of the National Association for Research and Therapy of Homosexuality

James E. Phelan, Neil Whitehead, Philip M. Sutton, 2009)

科学文献普遍认同,同性恋族群中病态问题多于异性恋族群;事实上,社会上难有另一个族群,比同性恋者间出现更多有关健康、心理与关系障碍问题。

近日有研究利用系统的定量调查研究方法亦得出同样结论,印证了过去数十年间没那么精密的相关研究。所出现病态问题非单一种类,而是有许多个别不同情况,包括一连串精神健康失调问题,特别是虐待、抑郁、自杀倾向,又如病态冒险、关系破裂比率高,性瘾癖等。没有任何实验性研究显示,如此高比率的病态问题全因(或主要由)社会不认同而引起。

更多精神健康问题

Herrel等(1999)、Fergusson、Horwood与Beautrais(1999)曾分别在青少年与成人间做研究,并发表有关同性恋与心理问题之间关系的报告,刊于《普通精神病学纪要》(Archives of the General Psychiatry);Bailey(1999)在总结此等后设分析研究时说:

上述论同性恋与心理病问题关联之研究,是目前最详尽的已出版数据,而不幸地,两项研究指向同一结论-同性恋者在各种情绪问题上的确有十分高的风险,包括自杀倾向、严重抑郁,及焦虑性失调等(页883)。

Herrel等(1999)并Fergusson(1999)的发现概述如下:

  • 报告指出,同性恋倾向与自杀念头或行为有较强关联(Herell等,873页)。
  • 男同性恋者自杀行为风险十分高,此现象并不纯粹因为滥药、或心理病并发症所致(页867)。
  • 近日有证据指,同性恋与双性恋年青人出现精神健康问题风险较高,尤其在自杀行为及多项情绪失调等问题较大;研究结果支持是项证据(Fergusson,1999:876)。
  • 近日愈多研究认同,已公开自己有同性恋行为、或受同性吸引的年青人,其自杀行为及出现精神健康问题的风险较大(页880)。
  • 同性恋与双性恋年青人出现严重抑郁、普遍焦虑性失调、行为失调、尼古丁瘾癖、滥药或其他瘾癖、多项失调、自杀念头、曾经自杀等风险均较大(页876)。

这里引申一个问题,即上述研究是否仅反映某程度上对同性恋不寛容的国家或社会之情况,诸如美国?事实正好相反,Bailey(1999)总结说,「荷兰一项大规模且严谨的研究[Sandfort,de Graaf,Bijl,and Schnabel,1999]发现结果与此相符」(页883)。荷兰社会以宽容、接受同性恋著称(Sandfort,de Graaf,Biljl,and Schnabel,2001)。

Bailey(1999)认为,同性恋族群中精神健康情况之所以出现更大问题,不仅由于一般所估计的社会歧视压力,也包括以下原因:

同性恋是偏离正常发展的现象,与引发精神问题的其他种种偏差相关。

同性恋者间患精神心理病者比率更高,乃与其性取向相关的生活方式所致…例如与男同性恋相关的行为风险因素…[包括]肛交与滥交(页884)。

Bailey总结说,「若因社会政治之故,禁止研究员凭良心作任何合理推测,是可耻的」(页884)。

Gilman等(2001)曾就美国一项具全国代表性的随机抽样家居调查作研究,受访对象包括125名在过去五年曾有同性恋行为的男女,并4,785名只以异性作性伴侣的男女。参与比率为82.4%。研究员发现,当中女同性恋者(同性吸引,SSA)与女异性恋者(异性吸引,OSA)过去12个月患病率(12-month prevalences,P)与终生风险或胜算比(lifetime risk or odds ratios,LOR)如下:

  • 创伤后精神紧张失调-P: 20.9% SSA vs. 5.9% OSA;LOR = 2.7(SSA > OSA)
  • 焦虑症-P: 40% SSA vs. 22.4% OSA;LOR = 1.8 (SSA > OSA)
  • 严重抑郁-P: 34.5% SSA vs. 12.9% OSA;LOR = 1.9 (SSA > OSA)
  • 自杀念头-LOR = 2.0 (SSA > OSA)
  • 任何情绪问题-P: 35.1% SSA vs. 13.9% OSA;LOR = 2.0 (SSA > OSA)
  • 任何滥用药品问题-P: 19.5% SSA vs. 7.2% OSA;LOR = 2.4 (SSA > OSA)

在男性受访者间,男同性恋者(SSA)与男异性恋者(OSA)间的终生风险或胜算比(LOR)如下:

  • 滥药问题-LOR = 2.8 (SSA > OSA)
  • 倚赖药物问题-LOR = 2.4 (SSA > OSA)
  • 自杀念头-LOR = 2.2(SSA > OSA)

Jorm、Korten、Rodgers、Jacomb与Christensen(2002)亦曾在澳大利亚作一类似调查,也为随机、具全国代表性之家居调查,参与率为58.6%,受访者包括149名自称为同性恋或双性恋者的男女,4,675名异性恋男女。其中同性与双性恋组别之精神健康问题明显较大,病况包括焦虑、抑郁、自杀倾向与其他负面影响。

另一国家研究亦显示,同性恋者整体生活素质较异性恋者低。Sandfort、de Graaf 与Bijl(2003)曾在荷兰作一项随机、且具全国代表性之家居调查,受访者包括125名有同性恋行为的男女,5,873名仅以异性为性伴侣的男女,参与率为69.7%。同性恋男性无论在身体、精神健康、情绪与角色效能、社会效能、生命力等各方面,其生活素质都较异性恋者低。Sandfort等(2003)总结说:

与男异性恋者比较,男同性恋者无论在身体及精神健康表现都较逊,在工作与日常生活方面出现情绪问题较多,与正常社会活动相关的身体及情绪健康问题也较多,活力感也较逊(页18)。

Conron、Mimiaga与Landers(2008)曾为美国麻萨诸塞州公共卫生部作一项以麻萨诸塞州人口为基础的电话访问。从2001年起至2006年,麻萨诸塞州公共卫生部与美国疾病预防及控制中心合作,设立行为风险监察系统,访问共38,910名该州居民;麻萨诸塞公共卫生部更加设问题,比较18至64岁不同性倾向成年人的健康行为及状况。调查进行年间,大部分受访者(97.1%)自认为异性恋者,1.9%认为男或女同性恋者,1%为双性恋者。作者分别比较了同性恋/异性恋者、男/女同性恋者,及异性恋/双性恋者的健康行为及状况。

男女同性恋者健康情况较异性恋者较逊,主要表现在下以方面:

  • 自觉健康欠佳(胜算比1.45)
  • 身体、精神或情绪方面出现障碍,活动因而受限(胜算比1.78)
  • 患哮喘(胜算比1.51)
  • 现正(胜算比2.47)或曾经(胜算比1.67)抽烟
  • 情绪焦虑;在过去30日内逾14日觉得精神紧张(胜算比1.4)
  • 过去30日内曾喝酒过度(胜算比1.29*)
  • 过去30日内曾滥药(胜算比2.98)
  • 曾遭性侵犯(胜算比2.91)

*统计上明显的数字,但因相对标准误差而令估计潜在不稳定。

双性恋者健康情况逊于异性恋者,表现在以下方面:

  • 自觉健康欠佳(胜算比4.44)
  • 焦虑(胜算比3.10)及抑郁(过去30日内逾14日感情绪低落,胜算比2.6)
  • 过去12个月曾有自杀念头(胜算比9.16)
  • 正在抽烟(女士胜算比2.96;男士胜算比2.10*)
  • 曾遭性侵(胜算比3.68);过去12个月曾遭性侵(胜算比4.02*)

*统计上明显的数字,但因相对标准误差而令估计潜在不稳定。

此外,与女异性恋/同性恋者比较,女双性恋者出现以下情况较多:

  • 障碍致活动受限(胜算比5.26)
  • 过去30日内曾滥药(胜算比8.8)
  • 曾受亲密伴侣威胁伤害,或曾受虐(胜算比7.98*)

*统计上明显的数字,但因相对标准误差而令估计潜在不稳定。

至于男双性恋者与男异性恋者比较,则并未出现此三种状况。

其他基于性倾向的差异,则关乎体重。虽然女同性恋者较女异性恋者容易痴肥(胜算比2.23),但男同性恋者反而较少痴肥(胜算比0.42)或过重(胜算比0.57)。异性恋者与双性恋者比较体重方面则不相上下。此外,女双性恋者滥药情况较女异性恋者多(胜算比8.80);但男双性恋者与异性恋者在过度使用药物方面则无此差异。

整体而言,成年同性恋者在多个健康领域均较异性恋者较逊,面对风险也较高。在好几种健康问题上双性恋者情况尤其严重。研究员没有报告同性恋者和双性恋者的健康行为和状况的统计上的比较。需要进一步分析研究,探讨可有哪些临床征状令居于麻萨诸塞的双性恋者(但非同性恋者)在过去12个月更容易抑郁、心脏病、有自杀念头、遭性侵;较男异性恋者更少购买医疗保险、定期作身体或牙科检查;又为何男同性恋者(但非双性恋者)在以下各方面其统计胜算比均较男异性恋者高,包括结直肠癌检查(内窥镜/结肠检查)、使用避孕套、患哮喘、喝酒过度、曾吸烟、因某种障碍使活动受限。

近日一项后设分析亦印证上述研究结果。King等(2008)检视1966年至2005年4月间出版、提及同性恋者患精神病、滥用药品、自杀,并自毁的,共13,706份学术文献;按方法学素质四项条件,其中28份符合最少一项条件,适合作后设分析-即随机取样、参与率逾六成、从一般人口而非单一族群取样,及受访者最少达百人。研究员对这28份高质量的文献进行全面而系统的后设分析,涉及受访者共214,344名异性恋者,并11,971名同性恋者,结果如下:

男士风险比较:

  • 男同性恋者终生曾患抑郁风险较男异性恋者高2.58倍(页77)。
  • 男同性恋者终生曾企图自杀风险较男异性恋者高4.28倍(页74)。
  • 男同性恋者终生曾自毁风险较男异性恋者高2.30倍(页75)。
  • 男同性恋者过去12个月曾出现焦虑较男异性恋者高1.88倍(页78)。
  • 男同性恋者过去12个月曾过度依赖药物较男异性恋者高2.41倍(页80)。

女士风险比较:

  • 女同性恋者终生曾患抑郁风险较女异性恋者高2.05倍(页77)。
  • 女同性恋者终生曾企图自杀风险较女异性恋者高1.82倍(页74)。
  • 女同性恋者终生曾自毁风险较女异性恋者高4.00倍(页79)。
  • 女同性恋者过去12个月曾出现焦虑较女异性恋者高3.50倍(页80)。
  • 女同性恋者过去12个月曾过度依赖药物较女异性恋者高3.42倍(页81)。

King等(2008)的后设分析,还有Herrel(1999)、Fergusson(1999)、Gilman等(2001)、Jorm等(2002)、Sandfort等(2003)并Conron等(2008)清楚显示,同性恋者患严重身体、精神健康风险都远较异性恋者高。

身体与精神健康风险特别范畴

滥用物品

酒精 

在美国,男同性恋者过度依赖药物与酒精问题比率较一般人高许多,自1975年起的研究显示,比率为异性恋族群的两倍(Craig,1987;Fenwick and Pillard,1978;Fifield,1975;Fifield,Latham,and Phillips,1977;Gruskin and Gordon,2006;Hatzenbuehler,Gorbin,and Fromme,2008;Lewis,Saghir,and Robins,1982;Lohrenz,Donnelly,Coyne,and Spare,1978;Meissner and Morton,1977;Saghir and Robins,1973;Sandford et al.,2001;Sandfort,Bakker,Schellevis,and Vanwesenbeeck,2006;Saunders,1984;Weinberg and Williams,1975;Ziebold,1979)。另几位研究员指比率没那么高,如Stall与Wiley(1988)称同性恋者有此问题仅比异性恋者多19%,Smith(1979)则称10%。

Stall 等(2001)曾作一以家居为单位的可能性研究,用电话访问了2,172名居于城巿、并于过去五年内曾与同性发生性行为的男士,他们都居于芝加哥、洛杉矶、纽约及三藩巿某几个邮区,其中85%有同性恋行为男士有饮酒习惯。研究报告指,男同性恋者酗酒情况较一般社会大众高(Ostrow,1990;Ostrow,Beltran,and Joseph,1994)。

女同性恋者亦有同样情况,其酒精消耗量较女异性恋者平均高三倍(Anderson and Hendersonk,1985;Burke,1982;Diamond and Wilsnack,1978;Hughes and Wilsnack,1994;Johnson and Palermo,1992;King and Nazareth,2006;Meads,Buckley,and Sanderson,2007;Nardi,1982;Sandfort et al.,2001,2006;Valanis et al.,2000;Weathers,1980;Wilsanck et al.,2008;Ziebold and Mongeon,1982)。

Cochran、Keenan、Schober 与Mays(2000)曾在美国作一具全国人口代表性的家居单位调查,参与率为79%,样本中有194名男女称在过去一年内有最少一名同性伴侣,2,844名男女则只以异性作性伴侣,Cochran等发现:

活跃的女同性恋者无论在使用酒精的频率与用量、并曾有酗酒问题等方面,都较女异性恋者高许多。研究发现认为,女同性恋者较其他女士风险更高,容易出现与酒精相关之问题。

Cochran等亦报告下以比较数字:

  • 30.3%活跃的女同性恋者称过去一年内「曾最少三天用酒精致情绪亢奋,或醉酒」,女异性恋者比率则为16.6%(页1066)。
  • 8.4%活跃的女同性恋者称过去一年内「平均每周一次(或更多)用酒精致情绪亢奋,或醉酒」,女异性恋者比率则为2.3%(页1066)。
  • 7%活跃的女同性恋者称过去一个月曾豪饮,女异性恋者比率则为2.7%(页1066)。

Drabble 与Trocki(2005)在美国作一具全国人口代表性的家居单位电话访问调查,受访女士中有36人自称女同性恋者,71人称异性恋者但曾与同性发生性关系,50人自称双性恋者,3,723人称异性恋者。其中41.8%女同性恋者及45.6%女双性恋者酗酒,女异性恋者酗酒则为12.7%。酗酒问题在女同性恋者间明显严重,就是在无名者戒酒会(Alcoholics Anonymous)等支持系统内,同性恋者接受辅导的果效也不如异性恋者(Hall,1994)。

同性恋者多喝酒,其情况是那么明显,以至20世纪曾有人针对此想出广告策略。举例说,高氏啤酒公司(Coors Brewing Company)发言人Earl Nissen曾对《广告年代》杂志(Advertising Age)说,男同性恋者喝酒比男异性恋者多一倍,所以放广告也专门针对这个族群,以提高销量(Pruzan,1996)。

Leukefeld、Battjes与Armsel(1990)并Wang、Hausermann、Ajdacic-Gross、Aggleton与Weiss(2007)报告指,男同性恋青年酗酒较异性恋青年普遍。一项后设分析总览18项研究数据后指出,同性恋青少年酗酒风险较异性恋青少年高3.4倍(Marshal et al.,2008)。

至于双性恋者酗酒的数据则众说纷纭,视乎研究性质而定。但基本上,双性恋者酗酒情况一般亦较异性恋者高(Bostwick et al.,2007;Jorm et al.,2002;King and Nazareth,2006;Wilsnack et al.,2008)。

滥药 

一项具美国全人口代表性的研究,曾将同性恋者滥药比率,与全国家居滥药统计数据比较,发现同性恋者滥药比率高于异性恋者(Skinner,1994)。

1985至1988年间,波士顿有研究员对逾400名同性恋者的便利样本作一纵贯性研究,发现当中八成人曾吸食大麻,七成人使用亚硝酸戊酯,六成人吸食古柯碱,三成人使用安非他命,两成人服用迷幻药;研究没同时作异性恋者控制组调查(Seage,1992)。在另一个有1,000名男同性恋者的方便样本里,受访者多滥药-如使用大麻、古柯碱、亚硝酸戊酯等,豪饮者亦多;是项研究并未同时作异性恋者控制组调查(Ostrow et al.,1994)。

亚硝酸戊酯是兴奋剂,同时也放松肛门肌肉。一项研究访问150名男同性恋者,其中57人称过去六个月内最少一次使用亚硝酸戊酯(Goode and Troiden,1979)。另一项研究显示,250名同性恋者中有86%在过去五年内曾嗅亚硝酸戊酯,比例与在亚特兰大、纽约及三藩巿的性病诊所的临床数据相约(86.4%)(McManus,Starrett,and Harris,1982)。异性恋者使用亚硝酸戊酯情况远不及此程度(Newmeyer,1992)。

在男同性恋者中,使用注射或非注射药物比率较高,有17%称以动脉注射用药(Lauritsen,1993)。大多数研究显示,男同性恋者滥用药品比率较男异性恋者高,而女同性恋者滥药情况更高于男同性恋者及女异性恋者。尽管DeBord、Wood、Sher与Good(1998)发现男同性恋者滥药比率与男异性恋者相约,但近期研究发现,此情况在男同性恋者间的确较普遍(Gilman et al.,2001;Sandfort et al.,2001,2006;Wang et al.,2007)。Marshal等(2008)一项后设研究显示,男同性恋者滥药较异性恋者一般滥用药品比率高2.89倍。

据一项具全美女性人口代表性的家居电话访问结果,Drabble与Trocki(2005)发现,女同性恋者使用四氢大麻酚-包括大麻、四氢大麻酚,俗称「草」-与女异性恋者的胜算比为4.70,对女双性恋者胜算比为6.09。

Stall等(2001)曾作一项可能性调查家居电话访问,发现有同性恋行为之男士中,85%称使用酒精,52%称曾滥药以作消遣。

Cochran、Ackerman、Mays与Ross(2004)曾对一个具全国人口代表性样本作研究,评估比较滥药情况,样本包括194名男女同性恋者,及2,844名男女异性恋者,相关报告如下:

  • 37.2%活跃的男同性恋者平生曾使用古柯碱,男异性恋者则为19.5%。
  • 34.7%活跃的男同性恋者平生曾使用迷幻剂,男异性恋者则为18.0%。
  • 30.8%活跃的男同性恋者平生曾使用吸入迷幻剂,男异性恋者则为9.8%。
  • 38.5%活跃的女同性恋者平生曾使用古柯碱,女异性恋者则为12.1%
  • 22.9%活跃的女同性恋者平生曾使用迷幻剂,女异性恋者则为9.9%。
  • 14.3%活跃的女同性恋者平生曾使用吸入迷幻剂,女异性恋者则为5.0%。

Cochran等(2004)总结:「综观各项研究,男女同性恋者滥药问题较普遍。」(页994)

Thided等(2003)曾作一项横断面取样调查,数据于美国七个主要城巿中心收集,受访者包括3,492名曾与同性发生性行为的年青男子,结果显示,男同性恋者中有66%称曾滥药;28%曾滥用三种或以上药物;29%常滥用药物(最少每周一次)。

Craig(1987)提出一个问题,「目前数据并未能显示,究竟同性恋者在感受同性吸引后才滥药,或是在滥药后才感受同性吸引」(页1145)。然而,由于首次同性吸引的平均年龄为十岁(Whitam and Mathy,1986),似乎先感受同性吸引、后来才滥药的可能性较大。

Weinberg(1972)提出,同性恋者的滥药问题可能因社会压力所致,然而美国卫生及人类服务部(DHHS)指,尽管一般认为社会耻感与歧视令男女同性恋者成为滥药、乃至其他种种问题高危一族,但目前研究并未能证实这种说法(DHHS,1994)。

同性恋者滥药情况总结

20世纪研究显示,同性恋者滥药或酗酒比率较一般人高三倍,近2/3同性恋青少年酗酒。在女同性恋者族群之间饮酒问题更严重,这往往是性活动的前奏。

危及健康与生命的高风险行为

艾滋病风险

同性恋者比异性恋者患艾滋病高许多。高风险性行为在同性恋者间之普遍,可见过去20多年的健康风险管理教育彻底失败,目前血清转化现象比率与教育项目开始前几乎一样。

当20世纪,藉异性的性接触感染艾滋病比率其实颇为低,约占病患一成(Huether and McCance,1996)。当时藉同性的性接触染病率风险较异性性接触高约430倍(Odets,1994a),因为同性恋人口染病率较高,同性恋者的性伴侣较多,而经肛门性交感染的风险也远较经阴道感染高。同性恋者一直为美国患艾滋病比率最高族群,据1990年一项报告,三藩巿患病个案里有接近96%为男同性恋者(Ekstrand and Coates,1990)。另一项包括508名三藩巿男同性恋者的跟进研究显示,其中五成人验出艾滋病毒抗体阳性反应(Hays,Turner and Coates,1992)。

在同性恋族群间,无论是否对艾滋病毒抗体呈阳性反应者,其性活动并无甚差别。一项研究分别访问了对抗体呈阴性、及阳性反应两个组别、各121名同性恋者,发觉他们在性伴侣、性行为、所进行活动的风险性上亦无甚差异(Meyer-Bahlburg et al.,1991)。

1990年代其中一项最高风险活动,是在毫无保护措施的情况下肛交:调查显示,男双性恋者中有1/3人在过去六个月内曾在无保护下肛交(McKirnan,Stokes and Doll,1995),2/3人在过去18个月内(Signorile,1995)、23%人在受访前不久曾进行此活动(Myers,Godin,Lambert,Calzavara,and Lacker,1996)。仅12%人称从没在毫无保护的情况下肛交(Myers,Godin,Calzavara,Lambert and Locker,1993)。

加拿大一项对男同性恋者的研究指,在无保护下肛交的情况,各城巿有别:蒙特利尔为57.1%,安大略73.7%,温哥华56.3%(Myers et al.,1993)。其他研究员对此种活动所得数字亦大不同:

  • 64%(Linn et al.,1989)
  • 逾70%(McKusick,Coates,Morin,Pollack and Hoff,1990)
  • 25%(D'Augelli,1992)
  • 41%(Osmond,Page and Wiley,1994)
  • 27%在过去两个月内曾有此行为(Kelly,Sikkema,Winett and Solomon,1995)
  • 95%表示曾最少进行过一次(Offir,Fisher,Williams and Fisher,1993)
  • 52%表示不定期进行,或从没进行(Rotheram-Borus,Hunter and Rosario,1994)

Santinover(1996)在一项研究总结说,约四成男同性恋者肛交时从不戴避孕套。

支持同性恋人士称艾滋病教育有助减低患病风险,但明显地,类似教育活动是失败的(Odets,1994b)。大部分曾受预防艾滋病较高等教育的男同性恋者并不会落实安全性行为。加拿大谈情说性计划(Talking Sex Project)发现,相关教育并不会令同性恋者改变习惯,以减低透过肛交染艾滋病风险(Myers,Godin,Calzavara,Lambert and Locker,1992),研究员总结说,男同性恋者明知道后果,仍不断在没保护措施情况下肛交。

尽管也有研究显示,同性恋者间的染艾滋病风险行为有下降趋势(Ekstrand and Coates,1990;Martin,1987),但有其他研究指出,不一定使用避孕套的比率仍然偏高(McCombs and White,1990),就算部分人士减少高危活动,却也只占少数,与其余大多少进行肛交人口相比可谓凤毛麟角,能减低风险亦有限(McKusick,Horstman,and Coates,1985)。

当艾滋病开始流行时,有研究员发现,当时虽有不少同性恋者作较安全措施,但比率与继续进行高危活动者相差无几(Siegel,Bauman,Christ,and Krown,1988),且当大家消化了艾滋病的消息后,连曾作安全措施者亦渐次松懈,采取一般高危做法(Kelly et al.,1991;CDC,1991)。据一项较长时期的行为研究(1984-1991),在包括310名男同性恋者的样本中,逾1/3曾采取安全措施者回复高危行为,坚持采保护措施者仅9%(deWit,van den Hoek,Sandfort,and van Griensven,1993)。

研究员检视十多个关于回复高风险行为的研究后,总结说:「就是用横断面设计的研究,亦未显示健康教育成功减低[同性恋者]透过性行为感染艾滋病风险。」(Stall,Coates,and Hoff,1988,883页)

不幸地,有关艾滋病教育的相关研究指,男同性恋者在得悉有关健康风险后,鲜有因此改变习惯而得益(Pryor and Reeder,1993)。虽然活跃的男同性恋者具备相关知识比率甚高,却并未减少其高危活动(Kelly et al.,1990)。未能贯彻始终是关键-只要一次意外即足以染病。然而因为病毒感染非眼所能见,部分同性恋者从未意识到其行为风险。再者,艾滋病带菌者潜伏期可长达数年之久,他们可能在不知情的情况下散播病毒。

就算是明知自己感染病毒的男同性恋、双性恋者,不少仍继续滥交行为,并不知会性伴侣。一项研究访问111名染病男子,其中93%为同性恋者,此111名男子称共有929名性伴侣,其中少于6%知道伴侣染病;即此111名男子大部分明知染病,仍随处散播病毒,或最少妄顾伴侣健康,令对方承受高风险(Marks,Richardson,Ruiz and Maldonado,1992)。

另一项调查访问823名男同性恋或双性恋者有关艾滋病知识,当中大部分人有多名性伴侣,且经常滥药,且都很少与伴侣谈及安全性行为问题,仅1%称有做安全措施。受访群体中,在过去六个月内曾有性伴侣之平均人数为11.4人(Linn et al.,1989)。

肛交固是同性恋者感染艾滋病最常途径,但有证据显示,口交亦可能染病(Keet,1992)。有研究员录得男同性恋者借口交染病个案(Lifson et al.,1990)。

就算用避孕套也非完安全,因避孕套有一成失败率(Coldsmith,1987,引述自Martin,1990),还未计算因错误使用致败的比率(Martin,1990)。再者,肛交较阴道性交更容易使避孕套破裂,因为磨擦力较大,再加上其他人体机制所构成的拉力(DHHS,1990);因为肛门原本的生理设计并不为此用途的。

1990年代初,美国东岸有六成、西岸有九成感染艾滋病个案关乎同性恋。在全美染病个案中,27%发生在同性恋人口密度高的三个主要城巿-洛杉矶、纽约、三藩巿;当时研究显示,此三个城巿占全国同性恋人口约两成到五成(Kelly,St. Lawrence and Brasfield,1991)。而同性恋人口集中区域染病率高企,其中三藩巿的卡斯特罗(Castro)与纽约的彻尔西村(Chelsea Village)染病个案尤多(Bartlett,1994)。虽然洛杉矶、纽约与三藩巿被认为是「艾滋病源中心」,但其他较小、同性恋人口不那么集中地区也不无同性恋者感染个案,因为疾病可从病源中心散播至周边较小小区(Ruefli,Yu and Barton,1992)。

1988年起,有研究员长驻西雅图四所同性恋酒吧做研究,完成逾400项调查,其中29%受访者称过去两个月内最少一次在没保护措施情况下肛交。作者指,至1994年,相关比率与1988年时大同小异,尽管公众对艾滋病认识加深不少(Steiner,Lemke and Roffman,1994)。

一项研究在中等规模城巿访问了共526名男同性恋者,其中37%称过去三个月内曾在没保护措施情况下性交(Kelly et al.,1990)。尽管受访对象全都具备相关知识,但仍进行高风险活动,可见男同性恋者的高风险习惯乃源于更深层的心理因素,而非缺乏教育。同性恋倾向本身已成为感染艾滋病、并不安全性行为的高危因素(Kelly,St. Lawrence and Brasfield,1991)。

三藩巿男青年健康研究计划曾对380名18至29岁未婚男子进行家居调查,在男同性恋与双性恋者中,有68%验出艾滋病抗体呈阳性反应;研究员指,相关人士在知道染病后,仍继续进行高风险性活动,由是散播病毒(Osmond et al.,1994)。另一研究员指,同性恋者较常进行不安全性行为,因为他们潜意识想轻生,或这种活动令他们对同性恋群体有更强的认同感(San Francisco Department of Health,1993)。

一项研究在美国16个小巿镇的同性恋酒吧取样,访问了6,000名男子,以评估其性行为与高风险性行为预测值;所谓高风险行为,也包括有多名男性伴侣。该研究指出,受访者对使用保护措施意识薄弱,认为安全性行为不是同性恋族群习惯(Kelly et al.,1995)。尽管此类行为属高风险,受访者仍选择进行「不设防」性活动。研究显示,与20至30岁男同性恋者进行一次不设防肛交,大概每165名从事此类活动人士就有一名感染艾滋病(Satinover,1996)。

美国疾病预防及控制中心的Linda Valleroy医生指,年青男同性恋者感染艾滋病比率较一般年青人高许多(Russell,2001),他们在没保护措施下性交比率也高(Lemp,Hirozawa and Givertz,1994)。

Messina(1992)发现,在街头流连的青少年中,纽约有五成、西雅图有四成人自称同性恋者,其中接近一成已感染艾滋病,估计未验出染病、或没承认者更多;而其余未受感染者亦属高危一族。此类年青人仅占当时人口4%(Messina,1992)。此外,伦敦有研究员亦发现,在街头从事性工作的年青男子中,逾半为同性恋者,在受访50人中有21%确诊患上艾滋病(Rotheram-Borus,Rosario,et al.,1994)。

另一项研究指,纽约巿的男同性恋、双性恋青少年中,在活跃参与性活动后,仅首年会使用避孕套或其他安全措施(Rotheram-Borus,Rosario,et al.,1994)。

Offir等(1993)曾作一定量探索研究,与41名男同性恋者就预防艾滋病行为作开放式讨论,结果发现,大多数人并无固定采取安全措施的习惯,「受访者也没有改变现有习惯的动机」(页62)。其中1/3称曾参与不设防的插入式性交,逾半表示「口交时不愿意用避孕套」(页64)。受访者大多数视此种行为非主流、是当时情况需要,并不认为是健康高风险行为。

另有研究显示,男同性恋者对验出感染艾滋病表现漠不关心,其中2/3自愿作艾滋病测试者甚至不在乎知道结果(Ostrow et al.,1994)。相关研究乃是在1984至1990年间,于芝加哥一多功能艾滋病中心进行,访问1,000名男同性恋者,其中大部分曾在没安全措施情况下性交,并否认为这是高风险行为(McLean,Boulton,Brooks,and Lakani,1994)。

无论有否使用避孕套,肛交与口交仍有染病风险。事实上,美国卫生及人类服务部长曾在《避孕套与性病-尤其艾滋病》(Condoms and Sexually Transmitted Diseases...especially AIDS,1990)里说:

避孕套提供一定保护,但肛交仍是高危活动…就算避孕套没破裂,肛交仍可能导致肛裂流血,令病毒有机会传给伴侣。(页7)

另一项关于男同性恋者使用避孕套的调查指,26%受访者试过最少一次性交时避孕套破裂(D'Augelli,1992)。就算使用避孕套,在一次肛交时避孕套失效比率(破制或滑出)仍然高企(Thompson,Yager and Martin,1993)。

尽管知道风险,仍有同性恋者尝试为不安全性为辩护,例如:

不安全性行为,可能出于良好、高尚动机。尽管强硬派科学家不同意这样做,但诸如「我这是为令你高兴」,或「我觉得这样做才对」等说话并非勉强说项,这也是理由。不安全性行为并非不合理,它自有其合理之处(Davies,Hickson,Weatherburn and Hunt,1993)。

Bruce Parnell在〈鸡奸与耻辱〉(“Sodomy and Stigma”)一文中写道:「我们要知道,总有人做爱时不想戴避孕套,这是合理的。」他认为最佳策略,是鼓励当事人「自己决定何谓恰当行为」(引述自Molenaar,1994,2页)。类似说法,是20世纪同性恋文章主调;而故意在毫无保护下肛交(现在称为barebacking),显示其漠视风险、不顾后果的态度(Parsons and Bimbi,2007;Parsons,Kelly,Bimbi,Muench and Morgenstern,2007)。

一项定量数据显示,许多同性恋者根本不在乎风险-对他们而言,进行不安全性交的重要性远高于患病风险考虑,尽管在那个年代,感染艾滋病的死亡率几近百分百。不保障自己以免染病,不仅因为当事人毫不在意,缺乏信息,或是有扭曲的想法或观感,更在某程度上反映,他们妄顾健康。

男同性恋者常称因沉闷或沮丧而进行不安全性交(Kirp,1995),觉得避孕套有碍亲密,认为这种高风险行为「对他们生命很重要」(Brendstrup and Schmidt,1990)。然而这种妄顾健康的行为,可能令目前约20岁的男同性恋者在20年内超过三分之一的会感染艾滋病离世(Kirp,1995)-这推算已考虑目前抗病毒治疗的发展进程(Yazdanpanah et al.,2002)。

不同活跃的同性恋者纵明知染病风险,仍继续参与不安全性行为,这是完全妄顾健康。有说冒高风险者并不能代表所有同性恋者,但此说必须能提出随机抽样所得数据,或具代表性的取样统计方成立;然而比较有可能的情况是,前述各项研究提及进行高风险活动的同性恋者,已具相当代表性,足以代表大部分男同性恋者的做法。当然,对于此问题,仍有待进一步研究;目前数据并未能显示愿意进行安全性行为、与持续参与高风险性行为男同性恋者其心理状态之别(Siegel,Mesagno,Krown and Christ,1989)。但就算会做安全措施的男同性恋者,也可能在某时间放弃,转而参与高风险性行为。

有研究员指,对安全性行为有扭曲印象,可能是男同性恋者参与高风险性行为的原因。当男同性恋者为自己的高风险行为辩解时,往往忽略事实,提出种种概念偏差的理由(Bauman and Siegel,1987)。在另一项研究里,Brenner(1991)得出稍有差异、但并行不悖的结果-其心理分析研究指,某些男同性恋者似乎在潜意识里希望感染艾滋病。

研究发现,男同性恋者想法有别于男异性恋者,基本上,他们具备更强的女性化特征。一项认知研究曾调查三组、每组38名受访者(三个组别为男异性恋者、女异性恋者、男同性恋者),发现男同性恋者的认知模式明显有别于男异性恋者,却与女异性恋者无大差别(McCormick and Witelson,1991)。

也有认为,男同性恋者妄顾健康的行为,乃源于社会孤立。许多感染艾滋病的同性恋者都与家人失和,独自生活。但有人曾于1984至1991年间在侯斯顿进行一项民族志田野考察,发现在所有感染艾滋病的男同性恋者个案里,除一人外所有人都是独居的;但是艾滋病并非是导致社会隔离的单一因素。该民族志研究第一部分显示,在受访的64个男同性恋者个案中,许多人与家人隔绝非因感染艾滋病所致(Lang,1991)。

随着时间过去,男同性恋者进行不安全性行为比率可有减少?似乎没有。21世纪,确诊感染艾滋病的男同性恋者仍继续进行不安全性行为,为个人与社会带来不少问题,尽管相关教育提升了,社会对同性恋接受程度也较从前高。Van Kesteren、Hospers与Kok(2007)审阅2000年后众研究报告,关于感染艾滋病之男同性恋者性行为风险的,审阅对象包括53项已出版研究,乃关乎男男不安全肛交的横断面、及长期研究报告,个案中男士包括自称同性恋或双性恋者,或一般的男男性交;当事人分两个组别-确诊患艾滋病者,与混合组别。

Van Kesteren等(2007)的研究显示,确诊染病者进行不安全肛交的比率相当高,其中不少伴侣并未染病,或不知道自己是否染病。在混合组别中,确诊染病者进行不安全肛交比率,明显较未染病者高。此外,近年确诊染病人士进行不安全肛交比率有上升趋势。尽管报告显示,确诊染病者进行男男性交时也采取若干措施以减低风险,但每五名染病者中仍有约两名继续进行不安全肛交,他们对其风险是知道的。Schackman等(2008)最近报告亦得出相约结果。

一项国际风险增加调查显示,世界各地男同性恋者感染艾滋病比率较男异性恋者高,连异性恋者多染病的非洲亦然(Baral,Sifakis,Cleghorn and Beyrer,2007)。艾滋病毒抗体呈阳性反应者就算接受逆转录病毒治疗,其存活率平均只延长十年,最多15年(Yazdanpanah et al.,2002)。

女同性恋者与艾滋病

在纽约巿一间性病诊所一项调查显示,女同性恋者中有17%对艾滋病毒抗体呈阳性反应,女异性恋者则有11%,两者有明显差异(Bevier,Chiasson,Heffernan and Castro,1995)。称同性恋者的女士人,多数也是双性恋者,而非纯同性恋者。

三藩巿与柏克莱区一项女同性恋者与双性恋者研究显示,498名受访者中有六人验出对艾滋病抗体呈阳性反应,比率为1.2%,高于一般女性0.35%比率(Lemp,Hirozawa and givertz,1995)。但数据未必准确,因此项调查为街头访问,样本未必具代表性。

三藩巿卫生部(1993)于加里福尼亚州进行另一项关于女同性恋者的调查则显示,受访者中有22%在过去三年曾与一名男士性交,其中47%称并不一定会用避孕套。正如《新闻专题》(Newsline)指:

受访女性中一成有注射式滥药习惯,当中71%会共享针筒。似乎女同性恋者与双性恋者较女异性恋者更常与男同性恋者及男双性恋者性交,并共享针(LaBarbera,1994,9页)。

艾滋病风险总结

20世纪,同性恋者感染艾滋病风险较异性恋者高430倍。自艾滋病开始流行后,染病率曾一度下降;然而研究证据显示,自男同性恋者回复高危性行为模式后,染病率随即上升。大多数男同性恋者未受染病风险阻吓而改变性行为习惯。研究员发现,无论对艾滋病毒抗体呈阳性、或呈阴性反应组别的男同性恋者,其高风险性行为比率并无明显差异。

不安全肛交,在男同性恋者之间很普遍。年青的男同性恋者进行不安全性交者数字甚高,与一般年青人口比较,此族群感染艾滋病比率十分高。尽管有关若干同性恋行为所带来健康风险的知识较从前增加,社会也较接受同性恋者,但同性恋者仍属染病高危族,为个人和社会造成不少问题。

2005年一项研究指,在美国,男同性恋者藉一次不安全性交感染艾滋病的机会比率,较异性恋者高500倍。(数据前设为:男同性恋者人口中25%对艾滋病毒抗体呈阳性反应,[CDC,2005],异性恋人口染病比率则为0.2%[UNAIDS/WHO,2005];而染病人口中,有66%为男同性恋者。)

男同性恋者性伴侣中位数,较异性恋者高三倍(Laumann,Gagnon,Michael and Michaels,1994)。再没有其他人口相约的族群像同性恋者一样,在曾受教育、且明知可能结果的情况下仍然以身犯险。

性病与健康风险

同性恋性行为模式极容易传染疾病、及引发其他健康问题(Fluker,1983)。

据Fluker(1983)并Fluker与Cross(1981)报告指,同性恋者感染性病的比率高、且超越一般比例,一直是医疗诊所性病科常客。

男同性恋者曾患性病比率为75%,而男异性恋者则为16.9%(Laumann et al.,1994)。一项访问逾4,000名同性恋者的独立研究显示,78%受访者曾患一种性病以上(Handsfield,1981)。《斯巴达报告》(The Spada Report),三分之二受访者称曾患性病(Spada,1979)。

不同研究员都认为,男同性恋者较男异性恋者感染性病风险高许多;各报告提及所感染种类诸如:

  • 梅毒、淋病(CDC,1979;Darrow,Barrett,Jay and Young,1981;Fluker,1983)
  • 淋病、梅毒、人类乳头瘤病毒(HPV)(Handsfield and Schwebke,1990)
  • 淋病、梅毒、肛门疣(Judson,Penley,Robinson and Smith,1980)
  • 人类乳头瘤病毒、肛门癌(Surawicz et al.,1995)

一项比较研究指,约30%男同性恋者验出带抗艾滋病毒抗体,男异性恋者则为12%(Corey and Holmes,1980)。1980年西雅图有另一项研究发现(Handsfield,1981),在102个案样本中逾43%乙型肝炎带菌者为男同性恋者,这是不成比例的高,因为男同性恋者人数仅为一般成年男性的2至3%(Laumann et al.,1994;Whitehead and Whitehead,2007)。

此外,男同性恋者亦多患与性病相关的肠胃病(Rompalo,1990),及与肠道细菌病原体感染相关病症,如杆菌性痢疾、梨型虫病、变型虫引起的传染病、寄生虫、线虫等(Fluker,1983;Quinn,1986;Smith and Singer,1994),这在男异性恋者间都较罕见。

侯斯顿一间诊所性病科病人中,男同性恋者尿液样本含细胞巨大型病毒(human cytomegalovirus, HCMV)比率为18%,男异性恋者则为4%(Greenberg et al.,1984)。

同性恋者亦较多感染皮外寄生虫,如虱子(Pthirus pubis)。有研究员指,受访男同性恋者中有69%曾感染皮外寄生虫(Billstein,1989)。Jay与Young(1979)的报告亦指受访同性恋者中有22%曾患疥疮。另一研究则发现,肛交容易导致肛门长期极痕痒(pruritis ani)(MacAlpine,1953)。

男同性某些性活动,亦令他们较一般人面对更大健康风险,相关活动如拳交、嗜粪(coprophilia,或涉及粪便的性活动)、施虐或受虐等性活动,令当事人容易流血;而且通常同时涉及多名参与者。

事实上,肛交有违人体生理设计。阴道会分泌天然润滑液,且出口较寛,而肛门则较干、且出口较窄,所以肛交容易受伤(Ketterer,1983)。阴道除会分泌润滑液外,其道壁亦较大肠壁具弹性、且较清洁,若论不设防的性交,阴道交肯定较肛交安全。因为肛交可能使肛门撕裂,肠道粪便细菌也可能进入伴侣血液(Satinover,1996)。

肛交也可能损害上直肠、撕裂腹膜。不断拉扯肛门使其移位,也会引致排气及排便问题;性交时插入肛门亦可能损坏括约肌,致使长期失禁或便急(Miles,Allen-Mersh and Wastell,1993)。男同性恋者患肛裂、直肠乙状结肠撕裂、阴茎水肿、及痔疮等比率较一般人常许多(Owen,1985),也较多患上卡波西氏肉瘤(Kaposi’s sarcoma)(《刺针杂志》(Lancet),1981,引述自West,1983),而此种病症与艾滋病感染相关。

男同性恋性接触也可能导致无关乎艾滋病的免疫系统失调问题,光是精子抗体交流就足以令免疫系统受明显抑制(Mavligit,1984)。许多同性恋者虽并未出现病症,亦验出高度的免疫系统失调问题(Greenberg et al.,1984)。

女同性恋者也属感染性病及其他健康问题高危一族,举例说,其阴道细菌增生比率就较女异性恋者高2.45倍(Evans,Scally,Wellard and Wilson,2007)。口交在她们中间很普遍,容易患疱疹。因为不少女同性恋者同时有异性的性接触(约八成女同性恋者称曾有异性的性接触),更是面对双重染病风险(Johnson and Palermo,1992)。有异性的性接触经验的女同性恋者,更易患上梅毒与淋病(Ernst and Houts,1984)。此外,与女同性恋者发生异性的性接触多是男同性恋者,觉得心理威胁没异性恋者大,但这令双方感染性病风险更大。

肛口交

Corey与Holmes(1980)的报告指,「男同性恋者的性行为日志显示,其所以感染甲型肝炎,乃经常有口部与肛门接触所致」。(页435)1991加拿大男性调查显示,在曾与同性有性接触的男子中,33.7%曾在过去三个月内作肛口交,40%曾作一般肛交(Myers et al.,1993)。研究没发现异性恋者有此种行为(McWhirter and Mattison,1984)。

自杀

好几项方法论较强的研究显示,自杀倾向与同性恋取向及行为的联系,较异性恋取向及行为更强(Fergusson et al.,1999;Herrell et al.,1999;King et al.,2008)。发现与早前研究吻合。

一项系统研究曾访问57名女同性恋者,及43名单身女异性恋者,发现有23%女同性恋者曾企图自杀,异性恋者则为5%(Saghir,Robins,Walbran and Gentry,1970)。另一项研究配对、比较同性恋及异性恋女囚犯,发现同性恋女囚犯企图自杀比率明显较高(Climent,Ervin,Rollins,Plutchik and Batinelli,1977)。美国卫生及人类服务部一项报告指,全美自杀个案中有逾1/3当事人为男同性恋者,即此族群自杀率较其他人高最少两至三倍。研究员总结说,「接受肛交行为频率增加,这可视为某种形式的回避型应对、或自杀行为」(Ostrow et al.,1994,550)。

一项研究访问52名男同性恋大学生,其中55%表示曾有自杀念头(Schneider,Farberrow and Kruks,1989)。另一项研究审阅三项大型、设计周密的研究,发现男女同性恋者企图自杀率较异性恋比较组别高二至七倍(Saunders and Valente,1987)。虽然企图自杀、或出现自杀念头不等于成功自杀,但肯定增加自杀致死风险;可见同性恋者自杀致死风险较高。

近年一项方法论指导研究,也证实了较早期的研究结果。De Graaf、Sandfort与Ten Have(2006)曾在荷兰作一随机抽样的全国性家居访问,留意该国以包容同性恋者著称(Sandfort et al.,2001),调查参与率为69.7%,样本包括125名有同性恋行为男女,及5,873名有异性恋行为男女,研究发现其风险胜算比(OR)如下:

  • 平生曾有死亡念头(OR 5.93):26.8%男同性恋者平生曾出现死亡念头,男异性恋者比率则为5.8%。
  • 平生曾有自杀念头(OR 7.74):40.2%男同性恋者平生曾出现自杀念头,男异性恋者比率则为7.8%。
  • 平生曾自残(OR 10.23):14.6%男同性恋者平生曾自残,男异性恋者比率则为2.0%。
  • 平生曾有自杀念头(OR 2.12):23.3%女同性恋者平生曾有自杀念头,女异性恋者比率则为2.3%。

Herrell等(1999)据一项全国人口为本越战时代双生儿记录作研究,该记录样本包括103双中年双生兄弟,「都是其中一人在18岁后曾有同性伴侣,而另一人则没有的」;另6,434双兄弟则二人皆不曾有成年同性伴侣,16双兄弟则二人皆有成年同性伴侣。Herrell等发现,「在双生兄弟里,有同性恋倾向者较其无同性恋倾向兄弟曾出现自杀念头比率高近四倍(胜算比4.1)」(页871),「真正曾企图自杀比率则高6.5倍」(页871)。

同性恋青少年自杀情况

研究发现,同性恋者的青少年自杀比率可说是不合比例地高(D'Augelli and Hershberger,1993;Hendin,1992;Prenzlauer,Drescher and Winchel,1992;Rich,Fowler,Young and Benkush,1986)。Gibson(1986)总结说,同性恋与双性恋青少年企图自杀比率较异性恋青少年高三倍;其他研究发现亦相约(D'augelli and Hershberger,1993;Proctor and groze,1994;Remafedi,Farrow and Deisher,1991;Rotheram-Borus,Rosario,et al.,1994;Tielman,Carballo and Hendricks,1991)。

近年有几个方法控制较好的研究(如随机抽选样本、更好的控制组)亦继续显示,自杀行为在同性恋者之间明显较普遍(de Graaf et al.,2006;Fleming,Merry,Robinson,Denny and Watson,2007;Hegna and Wichstrom,2007;Lester,2006;Meads et al.,2007;Safren and Heimberg,1999;Sandfort et al.,2001,2006;silenzio,Pena,Duberstein,Cerel and Knox,2007;Skegg,Nada-Raja,Dickson,Paul and Williams,2003;Warner et al.,2004)。男同性恋者自杀率较男异性恋者高三倍;而女同性恋者的自杀倾向几乎完全关乎其愈严重的情绪病(如抑郁),然而男同性恋者自杀情况则无此等关联。

荷兰曾有一项关于自杀动机的研究(de Graaf et al.,2006),涉及7,000名同性恋倾向人士,发现其中年青人自杀风险高于较年长的同性恋者,可见荷兰的越来越自由化的风气,并未降低年青一代的自杀风险。

近年有更多关于自杀动机的数据供参考,都显示同性恋者的自杀动机,主要为关系破裂、和讨厌自己。而年青人都颇抗拒发现自己属同性吸引倾向,因此年纪需要朋辈确认个人价值和动机,但同性倾向令自己与朋辈似乎格格不入。据D'Augelli(引述自Paul et. al.,2002)一项研究指,当青少年相信自己是同性恋者、却还没告诉任何人时,这时候自杀风险最大。在这期间,平均而言歧视或其他问题的重要性低很多,因此讨厌自己成为最主要自杀动机。

大部分研究显示,恋爱关系破裂、其他关系问题、讨厌自己的同性恋者身分、抑郁、物品瘾癖、社会歧视等俱为同性恋者自杀主因。也有不同研究访问曾企图自杀的同性恋者,试图找出最常见动机,然而数据却往往难以分析,因为各种因素互相影响,也难以分类。部分研究历时长达近30年,不少因素会随时间改变。值得留意的是,社会歧视因素致使自杀的数据值其实很低。诚然,关于社会歧视是否真实的或只是在观感上的,或这究竟是主因或是次要原因等问题,实在有很大疑团。

恋爱关系问题

Bell与Weinberg(1978)发现,曾企图自杀的白人男同性恋者及白人女同性恋者分别有43%及67%由失恋引起的压力所致。另一项与此相关的研究,Bradord、Ryan及Rothblum(1994)发现,在没自杀倾向及行为的同性恋者当中,44%指与情侣关系为最常面对问题。Hendin(1995)专门研究自杀问题,他发现在白人男同性恋者中,遭同性拒绝往往是企图自杀的导火线;然而这也包括恋爱关系以外的拒绝。「同性恋者常将一切不如意事都归咎于遭拒绝,」Hendin总结说:「而很明显,他们的人际关系里,不如意与遭拒绝常是互相关连在一起的。」(页137)

研究员特别留意到,他们有一种为恋爱要生要死的态度,有自杀倾向的年青同性恋者往往抱着「没有你活不下去」的态度谈恋爱。Hillier、Turner与Mitchell(2005)发现,「由于他们身处不太友善环境,有人关心对他们而言尤其重要,失恋因此使人极沮丧」(页44)。Bartholow等(1994)发现,在曾企图自杀的研究样本中,17至20%在过去四个月曾结束一段重要的恋爱关系。在青少年同性恋者间,Remafedi等(1991)发现,19%指恋爱关系问题是曾企图自杀的主因。

与异性恋族群相比,同性恋者有的伴侣高三至四倍(Laumann et al.,1994),令人不禁推想,伴侣多也许是自杀率高其中一个主要因素,然而研究员所得出以下变量,显示问题成因并非那么容易解释。

据Remafedi等(1991)指,有44%受访者最明显的自杀念头或动机,乃因一般关系(与家人、朋友等)出状况或不稳定所致。Bradford等(1994)以另一群组为研究对象,当中34%指家庭问题、10%指与朋友关系为自杀主因。D'Augelli等(2005)则发现,父母不接纳是因素之一。其他研究员则指,青少年同性恋者称人际关系问题是企图自杀主因(Buhrich and Loke,1988;Dube and Savin-Williams,1999;Safren and Heimberg,1999)。

讨厌自己与抑郁

Bell与Weinberg(1978)采取曾企图自杀成年同性恋者的方便样本中,37%「不能接受自己」;Bradford等(1994)的群组则有21%不知如何处理自己的同性恋身分;Remafedi等(1991)的群组也有1/3人有同样问题。D'Augelli(2005)所访问青少年群组里,约一半指因讨厌自己的同性恋身分曾企图自杀。Hammelman(1993)的数据则高至75%。Buhrich与Loke(1988)、并Savin-Williams(1999)亦指,对自己的同性恋身分感不满,是自杀高危因素。

我们知道部分研究员指,若社会能多认同同性恋行为,同性恋者自恨的感觉自然会消除。然而,我们认为这种说法不切实际,因为数据显示,许多较美国对另类生活方式更宽容的国家(如荷兰)的实际情况反映,事实与上述假设并不相符(Sandfort et al.,2001)。此外,自杀也关乎抑郁(Dube and Savin-Williams,1999),而同性恋者抑郁问题亦源于「不接纳自己」、「讨厌自己的同性恋身分」等以外的其他因素,不过上述研究员就算有研究其他抑郁风险因素,也没有如实报告而已。

药品瘾癖

关于同性恋族群的研究显示,药品瘾癖与自杀有关联,同性恋族群的药品瘾癖相当高。Remafedi等(1991)发现,所研究青少年对象中有15%指这为一项变量,可能致使他们企图自杀。另有五项研究(de Graaf et al.,2006;Eisenberg and Resnick,2006;Herrell et al.,1999;Lester,2006;Safren and Heimberg,1999)指,就算剔除药品瘾癖与抑郁因素,光是性倾向一项对自杀倾向也有影响。相反地,de Graaf等(2006)发现,曾企图自杀的女同性恋者(男同性恋者则不然)其行动主因为愈见严重的精神问题,想必为抑郁。

歧视

Friedman、Koeske、Silvestre、Korr与Sites(2006)报告指,欺凌是青少年同性恋者自杀其中一项风险因素;然而,研究假设社会歧视与欺凌是所有同性恋倾向青少年自杀的主因,可惜报告数据并未能支持此推断。

Shaffer、Fisher、Hicks、Parides与Gould(1995)的研究则指,青年少男女同性恋者曾企图自杀个案里,社会歧视往往并非原因。Remafedi等(1991)发现,曾自杀与不曾自杀者,所经验遭歧视程度是一样的,因此总结说,歧视仅对自杀行为起一个很小的因素。Hendin(1995)发现,无证据显示歧视促使人企图自杀。同样地,Hershberger、Scott与D'Augelli(1995)发现,社会歧视加害并非直接导致自杀的主因;此外,就算真发生歧视个案,青少年能自我接纳、并得家人支持等,也能改善情况。研究员总结说,个别人士自寻短见的想法,比社会歧视加害致自杀的风险更高。

Paul等(2002)发现,虽然社会对同性恋的态度不断改变、也更宽容,但自杀风险比率却多年不变,显示社会歧视以外的因素在驱使同性恋者自杀。Warner等(2004)发现,在曾企图自杀的青少年同性恋者当中,曾遭身体袭击与欺凌者,较没自杀倾向的同性恋者群组分别高70%及40%,似乎身体袭击与欺凌是自杀主因。然而此种情况的整体影响力,远较上述其他因素低,可见真正直接因歧视致自杀的个案数字并不高。

Hillier等(2005)并没有将自杀与其他自害行为-包括自残-分开讨论,而研究结果显示,身心曾受虐的群组曾企图自杀比率,较不曾受虐群组高两倍。其中35%受访者指,恐同为他们企图自杀、或有自杀念头因素之一,但研究并未列明真正曾企图自杀者之动机数据,上述样本大都曾有此念头。Friedman等(2006)亦指,遭欺凌是年青人自杀因素之一。

在更宽容同性恋者的荷兰,歧视程度较其他国家小并没令同性恋者自杀率降低,de Graaf等(2006)因此认为,「觉得」遭歧视可能也是自杀主因。Sandfort、Bakker、Schellevis与Vanwesenbeeck(2009)的研究则指,同性恋者自杀完全由于他们的适应方式,他们要保守自己不受社会的耻感影响。Fitzpatrick、Euton、Jones与Schmidt(2005)则发现,另类性别角色,较性倾向为更重要的自杀成因。

自杀率总结

整体而言,前述多项研究指,同性恋者面对亲密关系出问题的比率乃不符寻常地高,而这往往致使他们企图自杀。抑郁与药品瘾癖为自杀成因的主要变量;而歧视的影响力,则似乎较一般估计的低(尽管一般习惯以歧视解释同性恋者自杀之因)。讨厌自己似乎亦是重要因素之一;而社会歧视也并非致使同性恋者讨厌自己的单一因素或主因。按研究员记录,同性恋者自杀数字较一般人高,而在这等个案里,直接或间接因社会歧视致自杀的情况,只占芸芸众多个案的一小部分。正如Bailey(1999)说:「同恋者自杀率愈见上升,但令人惊讶的是,社会反同性恋态度往往并非他们自杀主因,但相关原因仍有待调查。」(页884)

同性恋族群间轻生、或有种种健康问题比率高企,引致愈多身体与精神健康、并道德问题。而此现象似乎并非主要因社会歧视所致,其中较重要因素,似源于同性恋者对自己的观感,及他们对亲密关系破裂的反应;而他们换伴侣的频率也高。

我们也必须考虑若干未辨识因素,其实许多作者已提出相关理论,这些可能因素包括生理或心理(或两者兼有)发展失调、不健康的生活方式等,都是在同性恋群体里常见的。

Bailey(1999)在《普通精神病学纪要》(Archives of General Psychiatry)里指出:「同性恋偏离正常发展,与其他引致精神病的偏差症状相关。」他总结说,社会压力虽可能是压力来源之一,但研究并未显示此为同性恋者患精神病比率偏高的单一、或主要因素。

Bailey认为,导致此情况的另一可能性是,物竞天泽的自然律偏向异性恋,「同性恋可能是发展错误」(页884)。虽然他没有阐述这观点,但他提及有研究指,同性恋源于「不稳定发展」,像左撇子一样是小规模的生理失常。第三个可能原因,则关乎同性恋族群的另类性别角色;男同性恋族群较一般男子更女性化,表现出女性特有的神经敏感性格。

第四个可能因素,在乎同性恋者的「另类生活方式」(尤其滥交、与害怕感染性病)。同性恋族群一般更注重外表吸引力、要求保持体态美,这可能导致男同性恋者饮食失调问题偏高。

Bailey指,必须有更多相关研究,才能渐次理解同性恋与若干精神病学问题的关联,而前提是,相关研究必须不具政治立场,不忌讳进深研究,作不受舆论欢迎的假设(参Byrd,2006,2008)。

心理适应不良研究

我们知道关于这方面的早期文献不及近期研究精确,所做调查主要靠直接询问性取向,未能以稳密问题辨别同性恋倾向的受访者。但我们仍会讨论一下早期研究发现,因为新近用更精确方法的研究,所得结果实与早期研究大同小异。

Hooker(1957)的研究常被引述以「证明」男同性恋者身心问题与其他人无异;其实Hooker的研究设置,并非要探讨这个范畴。她只是比较了几个较小、且经刻意选取的男同性恋者及异性恋者样本,经罗萨克测验(Rorschach protocols)后,独立法官认为两者整体平差并无分别;事实上,是那些法官未能将同性恋者从异性恋者中分辨出来。尽管Hooker的研究显示两个群组大同小异,但所得结果起码部分受经拣选的样本影响,因为研究故意排除有明显身心问题的同性恋者参加,且所用方法仅限于心理投射测试;然而若改用评估受访者潜意识、压抑动机等情况的主题统觉测验,仍是能分辨两者的。

继后不少研究均未能支持Hooker指两者并无整体平差之说,若干研究使用其他心理学测试方法,发现同性恋与异性恋者的心理平差有明显分别。总的来说,这些研究显示,同性恋者似乎与高神经过敏水平明显有关(van den Aardweg,1985);以下简述部分相关研究。

明尼苏达多相人格测验(MMPI)

Loney(1971)让一组据称「正常的同性恋者」接受明尼苏达多相人格测验,发现同性恋者的F量表分数-即偏差、或罕有反应程度-较异性恋者高,这是说,Loney的研究样本,其反应异于一般没患上严重心理病人士。

Manosevitz(1971)在非临床场境让同性恋者及异性恋者受同样测试,发现同性恋者整体表现较异性恋者抑郁、有反社会偏差、女性化(对男士而言)、偏执、焦虑、患精神分裂,社交技巧也较低。Cubitt与Gendreau(1972)比较同性恋与异性恋囚犯的MMPI分数,发现同性恋者整体表现较戏剧性,也更着重自己的形体动作(注意外表与姿态)。

Braaten与Darling(1965)发现,同性恋者的MMPI整体表现有反社会偏差,而隐瞒自己同性恋身分者则社交技巧较低;男同性恋者也较男异性恋者表现得更女性化。

Doidge与Holtzman(1960)曾为准空军成员评估同性恋倾向程度,发现男同性恋者表现较女性化、神经紧张、有反社会偏差、偏执、患精神分裂者较多、有较戏剧性表现,并抑郁,其社交技巧较男异性恋者低,焦虑程度则较高。

Oliver与Mosher(1968)则比较一间看守所内同性恋与异性恋青少年的表现,总结说:「数据显示同性恋者心理适应不良情况较严重。」(页101)

明尼苏达多相人格男女性化量表(MMPI MF)

Lester(1975)发现,七份相关报告中有五份称,男同性恋者的男女性化量表分数较高,即他们较异性恋者表现更女性化。Friberg(1967)在综览众报告后说,「总言之,男同性恋者的女性化分数似乎较男异性恋者高」。(页102)

加里福尼亚心理测验(CPI)

一项研究让66名男异性恋者、并60名男同性恋者接受加里福尼亚心理测验,结果显示男同性恋者的幸福度(Wb)及自控(Sc)方面得分较低,然而在量表5(敏感度)得分则较高。(Hiatt and Hargrave,1994)

人格因素问卷(16 PF)

Evans(1970)据一个小区样本发现,同性恋者的问卷显示,与异性恋者相比,他们情绪较不稳定,认真程度与自控能力都较低,精神比较紧张,意志力较弱,多疑,忧虑将来,但也较自足。Evans留意到,整体而言,同性恋群组仍较接近典型的异性恋群组,过于已确诊神经官能症患者,不过「轻微神经紧张」。

Cubitt与Gendreau(1972)则利用前设样本,发现同性恋者较异性恋者情绪不稳定、怯于冒验,但较敏锐。在检视众研究后,Lester(1975)总结说:「再一次,尽管两者别异模式未必恒常一致,但总的来说,同性恋者有心理适应不良或患神经官能症倾向较大。」(页103)

高夫形容词检核表(Gough Adjective Checklist)

Evans(1971)曾比较同性恋与异性恋者的高夫形容词测试表现,发现同性恋群组所认同项目显示他们自信心较小,主导性不强,求助心态较强,坚忍力弱,较不需要成就与秩序,常贬低自己,也较愿意接受辅导。在男女性化程度量表方面,男同性恋者表现较女性化。此外,同性恋群组选取消极迎形容词较多,关乎个人的形容词较少(即他们的情感牵连性较弱,对自己认识也较浅)。在选取若干积极形容词的数量上,两个群组大致相约,相关词汇包括自我控制、责任、截取、养育、加盟、异性恋倾向、表现癖、自主、野心、改变,与差异。至于男女性化程度量表,男同性恋者的女性化程度得分较高。Evans总结说,整体而言,同性恋者表现较神经紧张。

其他测验

Grygier(1958)据动力人格测验(Dynamic Personality Inventory)比较患上神经官能症的男士,发现当中男同性恋者在以下方面分数较高,包括消极、需要安慰/支持、女性化的自恋、认同女性化的性格,在认同男性化性格方面则分数较低。

Siegelman(1972)曾让同性恋及异性恋者样本作司氏与卡氏神经官能症量表问卷(Scheier and Cattell's Neuroticism Scale Questionnaire,NSQ),总的来说,调查显示同性恋者在温柔、顺从、焦虑等方面分量都较高。Siegelman将之与在「女性化」方面得分较低的受访者比较,发现同性恋者较异性恋者更温柔。一般而言,同性恋者都被评为较神经质,调适力较弱。Siegelman亦比较了归属某同性恋者组织、与不归属任何组织的同性恋者,发现前者更抑郁、更顺从。

Kendrick与Clarke(1967)曾比较同性恋的心理病患者、与没患心理病的异性恋者,发现无论在语意分析量表(Semantic Differential)或凯利方格(George Kelly's repertory grid)测试上,两者在自我观感方面均有明显差别。整体而言,同性恋者对自己较苛刻,对诸如公义、性,或正常等观念看法也较消极。

心理调适不良研究总结

采用正式、有良好控制组、且有效的心理测试,均显示同性恋倾向与若干神经官能症特质有关,如情绪问题或失控等。Lester(1975)在比较同性恋与异性恋者经各种心理测验后相关发现时总结说,「同性恋者的调适力,似乎逊于异性恋者」。(页108)

精神健康与心理失调

目前科学界大都认同,同性恋者患心理病比率较一般人口高很多(Fergusson et al.,1999;Herrell et al.,1999;King et al.,2008;Sandfort et al.,2001)。

同运人士虽承认同性恋者滥药、酗酒、自杀风险比率均较高,却指这全因他们不获社会接纳、遭针对所致。可是研究员并非能显示,社会针对同性恋者与此族群种种失调问题有因果关系。举例说,Hershberger等(1995)发现,社会针对、与同性恋者自杀并无直接关系。Savin-Williams(1994)指,没证据显示诸如言语或身体恶待等压力,与青少年同性恋者种种问题-诸如学业问题、离家出走、滥用药品、卖淫、自杀等有因果关系。

值得留意的是,Ross、Paulsen与Stalstrom(1988)在一项包括荷兰、丹麦、美国的跨文化精神健康比较里,发现各国同性恋者的精神或情绪失调个案并无明显差别。荷兰与丹麦虽较美国更接纳同性恋者,但欧陆国家同性恋者的精神健康问题其严重程度绝不比美国低。

美国女同性恋者健康调查,与加拿大各项调查

于1984至1985年间所做的美国女同性恋者健康调查(NLHCS)提供美国50州共1,925名女同性恋者精神健康资料,被认为当时最全面研究。尽管女同性恋者一般都有社交圈子及支持系统,但研究发现,此族群的问题很大。

受访者中,逾半女士曾考虑自杀,18%曾尝试自杀。41%曾遭强奸或性侵最少一次,加害者主要为男性。19%童年时是乱伦受害人。可见女同性恋者的精神健康问题,至少部分源于过往堪苛经历,过于社会歧视(Bradford et al.,1994;Ryan and Bradford,1993)。

焦虑与抑郁

Atkinson等(1988)发现,男同性恋者无论是否艾滋病带菌,平生曾患焦虑失调比率均较男异性恋者高很多。

Saghir与Robin(1971)发现,同性恋者出现抑郁情况较异性恋者多。Pillard(1988)曾比较包括51名男同性恋者、与包括50名男异性恋者的样本,发现同性恋者患双极性情感疾患(即躁郁症,包括一、二型,及循环性精神病患)发病率明显较频密。

Siegel等(1989)据一个男同性恋艾滋病带菌者群组样本做研究,发现成员明显有各种程度的焦虑,连自称社交方面很正面的成员也难免疫。尽管有人说,焦虑可能源于他们患上艾滋病,然而其他研究却显示另有原因。好几个男同性恋及双性恋艾滋病带菌者群组样本都显示,其抑郁与焦虑程度高,而所涉精神健康问题早在确诊患上艾滋病前已出现。(Weinrich,Atkinson,McCutchan,Grant and HNRC,1995)

Cazzullo等(1990)发现,男同性恋艾滋病带菌但未出现病症者,其心理健康风险较高,然而研究员指,「在感染艾滋病高风险人士中,有研究对象其个人历史显示明显的精神问题倾向」(页290),因此,不仅同性恋带菌者显示有精神健康问题之倾向,连未染病但高风险人士亦有此倾向。

有报告指,男同性恋者无论是否艾滋病带菌者,其出现主要抑郁征状比率均较一般人口高(Atkinson et al.,1988)。一项研究曾比较28名艾滋病带菌但未出现征状、与68名没染病的男同性恋者,发现两个群组患抑郁程度不相上下,无论在研究开始时、或后来跟进也显示同样情况(Jadresic,Riccio,Hawkins and Wilson,1994)。换言之,是否确诊患艾滋病与抑郁程度关系不大。一般而言,确诊患绝症会令人大受打击,但研究显示,同性恋者并未因确诊患病以致抑郁问题更严重;许多男同性恋者无论是否艾滋病带菌,都一直和抑郁问题搏斗;有关方面应多给予援手。

另一项对非裔美国女同性恋非艾滋病带菌者的研究显示,此群组患抑郁情况,与非裔美国男同性恋艾滋病带菌者相约,甚至较非裔美国男同性恋非艾滋病患者严重(Cochran and Mays,1994)。有人认为这是受种族与性别影响,但研究员发现,同性恋者无论男女,其抑郁程度均较前述各项报告所提非裔美国男女、并高加索裔美国男女高。

Nurius(1983)发现,同性恋者较异性恋者常感抑郁。尽管该项研究显示,「无可否认,抑郁与性倾向在数据上有明显关联」(页133),但研究员否认性倾向是抑郁症成因之一。

2000年3月华盛顿曾作一项小区健康调查,显示抑郁与精神健康,是女同性恋者头号关注问题,也是男同性恋者第二号关注问题(头号问题为艾滋病)(“Depression and Mental Health,” n.d.)。

饮食失调与吸引力标准

一项非临床研究访问了250大学生,包括53名女同性恋者,59名男同性恋者,62名女异性恋者,63名男异性恋者;研究员发现,其中男同性恋者与女异性恋者最不满意自己的体态,也最容易出现饮食失调问题。他们指,此二群组均非常看重外表吸引力。相比起来,女同性恋者与男异性恋者则没那么注重外表吸引力,因此也较满意自己的体态,较不容易出现饮食失调问题(Siever,1994)。

Siever的结论印证了较早前多项研究(Berscheid,Walster and Bornstedt,1973;Silberstein,Mishkind,Striegel-Moore,Timko and Rodin,1989);新近多项研究也有同样发现(Ackard,Fedio,Neumark-Sztainer and Britt,2008;Carlat,Camargo and Herzog,1997)。

几项关于饮食失调男患者的临床研究发现,其中1/3患者为同性恋者(Robinson and Holden,1986;Schneider and Agras,1987)。在另一组饮食失调患者中,研究员也发现组内有1/3人称同性恋者(Herzog,Bradburn and Newman,1990)。观乎同性恋者占人口中的百分比,两组内同性恋患者数目皆不合比例地高。

一项暴食症男患者临床研究显示,其中82%人自称同性恋者(Fichter and Hoffman,1990)。

另一项研究比较一个非临床样本内男异性恋与男同性恋大学生,发现男同性恋者现在、或曾经在温习时暴食者,数目明显较异性恋者多(Yager,Kurtzman,Landsverk and Weismeier,1988)。

另有研究发现,女同性恋者较少着重对吸引力的一般标准(Brown,1987),反认为良好体能是外表吸引力之一(Stregel-Moore,Tucker and Hsu,1990)。

整体而言,男同性恋者患饮食失调的比率,与男异性恋者比较,可说是不合比例地高。但女同性恋者与女异性恋者比较则不然。

精神健康失调

1979年一项研究检视53宗男子自行去势的个案,发现当事人无论是否精神失常(精神失常者个案占87%),皆有同性恋的感觉(Fisch,1987)。

无论是近期、或是早期所用方法没那么准确的研究(Ellis,1959,1965;Lester,1975),都印证Fisch的结果。过去十年其中六项独立调查尤其值得留意:

  • 越战退役军人研究(Herrell et al.,1999)
  • 新西兰一项长时期追纵调查(Fergusson et al.,1999)
  • 荷兰一项全国人口基础调查(Sandfort at al.,2001)
  • 荷兰一项不同的调查(Sandfort et al.,2006)
  • 英国米德兰一项调查(Meads et al.,2007)
  • 美国麻省居民一项调查(Conron et al.,2008)

Herrell等(1999)的越战退役军人调查发现,男同性恋军人较其他人自杀率高近三倍;就算连同抑郁、精神健康问题并发等因素一起考虑,这个比率仍是出乎意料地高。

在新西兰研究里(Fergusson et al.,1999),若干数据显示同性恋者间精神健康失调问题,相对异性恋者的胜算比相当高。以下为同性恋者出现相关问题及胜算比:

  • 抑郁,4
  • 一般焦虑失调,2.8
  • 行为失调,3.8
  • 尼古丁瘾癖,5
  • 其他药品滥用或瘾癖,1.9
  • 多项失调,5.9
  • 自杀念头,5.4
  • 曾企图自杀,6.2

就是在权衡其他因素后,同性恋与心理失调之间的关联仍然存在。对同一群组的跟进研究印证了上述发现(Fergusson,Horwood,Ridder and Beautrais,2005)。

尽管一般推断社会歧视,与同性恋者多出现心理失调相关,然而Fergusson等(1999,2005)却提出其他推断:

  • 倾向患精神失调者,更容易成为同性恋者。
  • 非异性恋者所选择的生活方式,往往造成恶果,引致精神健康问题。

Sandfort等(2001)在荷兰一项同性恋者调查中发现,数据上,同性恋者出现以下问题,相对异性恋者的胜算比为:情绪失调,2.93;男同性恋者焦虑失调,2.61;女同性恋者滥用药品,4.05。有两种以上失调问题者(并发症),男女同性恋者相对异性恋者胜算比分别为2.70及2.09。特别失调问题的比率是:

  • 躁郁症,男性5.02,女性1.80
  • 空间恐惧症,男性6.32,女性1.85
  • 强迫症:男性7.18(女性没有)

对于终身患病率(男性和女性分别)比率是:

  • 躁郁症,7.27,0.92
  • 惊恐症,4.21,0.75
  • 空间恐惧症,4.54,0.75*
  • 一般恐惧症,3.61,1.27*
  • 强迫症,6.2,–
  • 酗酒,0.48,2.01
  • 酒精倚赖,1.23,3.59
  • 滥药,1.34,1.88
  • 药物倚赖,2.47,8.04

*数据上胜算比并不明显 

研究员发现,是否感染艾滋病并非影响上述问题胜算比的重要因素。总的来说,一般女性所有的精神失调问题,会发生在男同性恋者身上,情况较一般男性严重;反之,一般男性所有的精神失调问题,则见于女同性恋者身上,情况也较一般女性严重。

Conron等(2008)在一项以人口为基础的性倾向推算研究发现,美国麻省居民:

不同性倾向人士在以下各方面存在差异,包括是否勤保健、整体健康状况、有否作癌症检查、长期病患、长期精神病患、物品倚赖如抽烟、性健康,与暴力受害等。证据显示,成年男女同性恋者在各个健康范畴上其风险都比异性恋者高,而双性恋者健康问题则更严重。(页2)

King与McKeown(2003)发现,在英国,成年同性恋与双性恋中有2/3可能有精神健康问题,而异性恋者的比率则为1/3。Warner等(2004)曾向英国的男女同性恋者作调查,发现若按临床心理学诊断表(Clinical Interview Schedule,CIS-R)标准,其中43%人士患上精神失调问题。同样地,Wang等(2007)曾调查瑞士的同性恋人口,发现其中44%出现精神失调诊断与统计手册表列情况(DSM-III)。

Rekers(2006)一项后设研究显示,荷兰同性恋者中约五至六成平生曾出现精神问题,新西兰同性恋者则有超过七成。Sandfort等(2001)报告指,「荷兰的社会气氛一直对同性恋较宽容」(页89);无论荷兰或新西兰社会都以宽容同性恋、杜绝因性取向或性生活方式而歧视著称。

美国一项研究指,有48%男女同性恋者认为自己目前需要精神健康治疗,异性恋者比率则只为22%。有10%男同性恋、双性恋及跨性别人士曾住院接受精神心理治疗,异性恋者比率则只有4.4%。女性方面,同性恋者曾住院比率为8.7%,异性恋者则为6.8%(Cochran and Cauce,2006)。

Hatzenbuehler等(2008)发现,18岁以下青少年同性恋者中,感抑郁焦虑者较同龄异性恋者多达三至五成,这全因情感制衡失调所致-即相关性倾向无助于其性格模塑发展。研究员推断,社会耻感可能与情感制衡失调相关,却非直接影响。

社会上再难找到人数相约的另一族群,像同性吸引倾向人士那样,出现多样、且程度高的精神心理问题。另外,此族群存在若干自毁心态-尤其愿意作高险性行为-也必源于更深层心理问题,而非单单由于个人经历社会歧视所致。有说歧视与「潜在恐同」是同性恋者精神问题的主要根源,可是并无相关研究能证明此说。

精神健康与失调研究总结

Bailey(1999)对Herrell(1999)与Fergusson等(1999)研究的总结,能以概括众多关于同性恋与异性恋人口精神健康与心理失调问题比较之研究。

两项研究所录同性恋与精神心理问题资料,可能是已出版资料中最详尽的…并得出以下结论:同性恋者出现若干形式的情绪问题潜在风险较大,包括自杀倾向、严重抑郁、焦虑失调等…曾在1973年投票时反对将同性恋剔出精神失调与健康问题表列的专家,可谓反对有理。第二,选择同性恋生活方式者健康难免出现不理想状况,为社会上部分保守派人士发现。第三,有别于上列两种立场,许多人认为同性恋者之所以不快乐、甚至有精神问题,全因社会上普遍存在偏见。以上三种说法都是不成熟的,我们不鼓励在现阶段采取上述任何一种立场。若说反同取态并非同性恋者自杀率上升因素之一,此说实在令人讶异,但仍有待证实(页884)。

总言之,目前有不少经仔细控制、方法准确,样本份量足够的研究,皆清楚显示:与异性恋人口相比,同性恋人口明显存在高风险心理失调问题。 

人际关系

男同性恋者的恋爱关系,通常较异性恋者不稳定,也较少能保持只有一名性伴侣,许多相关研究都显示出这种不稳定的特性。一对同性恋伴侣-一位心理学家和一位精神病学家-曾进行名为「男伴」(The Male Couple)-有关男同性恋伴侣的研究,报告提及的156对伴侣中,仅7对为伴侣忠贞;恋爱关系达五年以上者,都不能保守忠贞。研究发现,样本中近1/3对伴侣同居逾十年,作者指,「大部分恋人…包括所有同居逾五年者,都没有对伴侣一人保持忠贞」(McWhirter and Mattison,1984,285)。

Kurdek与Schmitt(1986)也发现,虽然有的同性恋伴侣关系可以维持,但同居一段日子以后,却往往变成了开放式的关系。Saghir与Robins(1973)的研究指,40岁以上受访男同性恋者中有75%从未试过与恋人维持关系超过一年,仅8%男同性恋者及7%女同性恋者曾维持关系达三年以上。

《男同性恋者报告》(The Gay Report)一书作者对5,000名男女同性恋者进行研究,以开放式及封闭式问卷仔细调查受访者恋爱关系细节,作者总结说,「男同性恋者谈恋爱、乃至共赋同居的过程,有别于男女恋爱(无论结婚与否)」(Jay and Young,1979,339页)。研究员也发现,同性恋关系平均维持两年;Pollak(1985)的估计也相约。

《斯巴达报告》(The Spada Report)也与《男同性恋者报告》一样,让受访者畅所欲言,谈及他们非一般的性爱与关系。调查访问了逾千名来自全美国所有州份的男同性恋者,当中逾半数称有恋人;在报称已有伴侣的受访者中,74%称自己、或伴侣、或二人皆有其他性伴,一名受访者说:「和其他人做爱令我们的关系更稳固。」(Spada,1979,190页)另一个说:「提倡一对一伴侣制度的人,肯定是对自我价值深感怀疑。」他认为,「无论是否关涉性爱,人总不应待在某个封闭单位里」(页190)。相关研究清楚显示,男同性恋者关于一对一伴侣的看法,与异性恋者大相径庭。

Harry(1984)发现,虽然受访男同性恋者中逾半在任何时段内总有恋人,却不等于他们会委身对方,维持一对一关系。正如Henslin与Sagarin(1978)指,「许多[同性恋]伴侣长期同居,主要因为有个伴,和习惯了家居生活种种安排,但却不再同床,各自在外面寻找性伴」(页229)。

1980年代末,洛杉矶有研究员发现,同性恋者平均每年有20名伴侣(Linn et al.,1989)。考虑到同性恋性行为的风险,这数字实在颇大。同样在1980年代末于波士顿进行的另一项研究指,在受访的400多名男同性恋者里,有77%在过去五年内有十个以上性伴侣(Seage,1992)。一项较早期研究指,多名伴侣正是男同性恋关系的特征(Blumstein and Schwartz,1983)。

Berger(1990)报告指,在一个涉及92对同性恋伴侣的样本里,96.4%形容目前关系为一对一,但当中有五成人和固定伴侣进行「安全」性行为,可见他们对这段一对一关系并没有信心,觉得伴侣会在关系以外另有性伴。

Sandfort等(2003)对一个具全国人口代表性的样本进行研究,总结说,「男女同性恋者称有固定伴侣者,较男女异性恋者更少」(页17)。

更近期研究显示,甚至当事人也不惮公开承认,同性伴侣间即使有合法缔约,也较已婚的异性夫妇更容易离异。Andersson、Noack、Seierstad与Weedon-Fekjaer(2006)曾在挪威及瑞典研究2,819名曾与伴侣注册结婚的同性恋者,并222,000名已婚(异姓)夫妇,研究报告如下:

  • 男同性恋伴侣离婚风险比率较一般夫妇高1.35倍。
  • 女同性恋伴侣离婚风险比率较一般夫妇高3.03倍。
  • 「同性婚姻的离婚风险程度比较高」(页262)。
  • 女同性恋伴侣离婚风险比率较男同性恋伴侣高一倍(页262)。

人际关系总结

长期的男同性恋关系,一般都不忠。同性伴侣就算长期同居,但关系往往是开放式的-换言之,并非一对一的。虽然女同性恋伴侣较男同性恋者忠于对方,但亦远远不及一般夫妇关系长久。

Whitehead与Whitehead(2007)总结各项研究指,男女同性恋伴侣保持关系年期的中位数为2.5年。然而关系不稳定,会否因国家不承认同性婚姻所致?一项北欧国家的相关研究(Andersson et al.,2006)推翻了这个假设,在当地,公民结合是合法的,但官方认可的同性恋关系的离婚率仍然远较一般夫妇高。

总言之,研究员比较同性恋伴侣与一般男女恋人开展关系的频密度与持久度,发现同性伴侣关系较不稳定,维持时期也较短,和已婚夫妇比较就更短。据报指,同性恋者较异性恋者常感忧闷,很可能是亲密关系不稳定所致。

滥交-社会新常态

一般认为男同性恋者的性行为极其滥交,相对地,女同性恋者的性伴不仅较男同性恋者少,甚至也较异性恋人士少。然而从对文献的检查,上述看法并不准确,原来同性恋者无论男女,其性伴人数中位数均较异性恋者高三、四倍。

男同性恋圈子中有一种普遍看法,就是非单一性关系不仅正常,而且是健康的。Hoffman(1987)曾写道:「性滥交是美国男同性恋者生活的明显特征」(页45)。但此行为不仅对身体健康与情绪构成很大风险,男同性恋者发现伴侣不忠时也常经历暴怒、被出卖的感觉,都显示此举尽管「正常」(即普遍、典型、是常态,意料之内),却一点不健康。

综观20世纪里众多研究,均指滥交为同性恋一主要特征;但对于滥交的普遍度(无论同性恋或异性恋者间),则难以得到可靠数字估计。大多数文献仅列出平均数或最大值,然而从数学上说,这是误导的,正确统计应靠中位数,但这却难以从数据采得。若据最大值看,平生曾有数以千计的性伴者肯定有性沉溺问题,起码部分人如是,不论他是否同性恋者。

据Saghir与Robins(1971)的研究指,男同性恋者「鲜有忠于其伴侣」(页505)。同性恋生活方式以滥交、拥有多名性伴著称(Kelly et al.,1995)。男同性恋者倾向有多名性伴(Rotheram-Borus and Gwadz,1993),数量也较男异性恋者多(Bell and Weinberg,1978)。同样地,女同性恋者有多名性伴者,也较女异性恋者多(Goode and Haber,1977)。

著名同性恋作者John Rechy说,他曾与7,000多男人性交,明言「在男同性恋世界,[与不同伴侣]有上千次性接触毫不出奇」(Goode and Troiden,1980,58页)。Goode与Troiden的研究显示,「我们的受访者称曾与性交的伴侣数量,按异性恋者标准来说,实在大得惊人」(页52)。一名受访者说,他曾与逾一万人性交。受访者中,仅35%称曾与少于100人性交;42%称曾与约100至499人性交;23%称曾有逾500性伴。相对的,美国意见调查中心(National Opinion Research Center,NORC)指,一般成年异性恋者在18岁后一直有性关系,但过去一年平均仅有1.2名性伴,18岁至今曾有性伴数目平均为7.2人(Smith,1991)。

艾滋病流行初期,据美国疾控中心报告,当时感染艾滋病的男同性恋者平生有多于1,100名性伴(Pryor and Reeder,1993)。有批评指报告自高危的男同性恋者取样,并不能代表所有男同性恋者。但若将异性恋患者样本与同性恋患者比较,则可见同性恋者平生性伴中位数为1,160人,异性恋者则为41人(Guinan,1984)。早在艾滋病发现前就有报告指,曾有男同性恋者有千名性伴的「记录」,一般同性恋者也约有逾百性伴(Masters and Johnson,1979)。「多中心艾滋病世代研究」调研近5,000名男同性恋者,发现大多数人(69至83%)称平生曾有逾50名性伴(Kaslow et al.,1987)。

一项研究以30名正参与戒除性瘾癖小组的男同性恋者为对象,据研究计算,他们平生约经历2,000次不同性接触;同样参加戒除性瘾癖小组的男异性恋者,则平均为500次。他们纵知道患艾滋病的风险,受访男同性恋者仍每月平均有14次不同的性经验。在「成功」完成小组课程的男同性恋者中(即目标是戒除性瘾癖),每月平均也有三次以上不同性经验,数字与刚开始参加小组的男异性恋者相约。然而每月三个同性恋性伴,仍对健康构成很高风险(Fluker,1983)。

据《国际医师与艾滋病关怀联会期刊》(Journal of the International Association of Physicians and AIDS Care),男同性恋者心目中的「一对一」伴侣关系,不一定指仅有一名性伴。Davies等(1993)报告,男同性恋者平均每年有70名性伴。相对地,据Masters与Johnson(1979)统计,男异性恋者平均每年有11名性伴。

Bell与Weinberg(1978)研究一个未必具全美人口代表性的方便样本,指逾40%男同性恋者曾有500名以上性伴,28%有逾1,000名性伴;其中70%称性伴中有五成是仅与之性交一次的男性。

最具美国人口代表性的、关于滥交的调查,大概是美国意见调查中心于芝加哥大学进行的「全国健康与社会生活调查」(Laumann et al.,1994),该研究在1992年里对3,432名人士进行私人访谈,而受访者乃是按区域随机抽样、非机构参与的人口(页xxxi)。Laumann等发现,「当我们替样本分组时,发现有同性伴侣者(自称同性恋或双性恋者)其性伴平均数,较样本内其他性活跃人士的性伴数目都多」(页314)。

由于部分同性恋者-尤其男士-报称平生所有性伴数量极大,计算性伴人数中位数(而非中间数),以比较异性恋与同性恋者情况,比较切实际。举例说,美国健康与社会生活调查显示,在研究进行最后一年,受访同性恋者于该年所有性伴侣数目平均为8个,异性恋者则为1.2个,乃7:1之比(Michael et al.,1994)。而美国男女同性恋者平生性伴数目中位数为2.75,是异性恋者的四倍(Beyrer et al.,1995)。

滥交情况严重,不仅见于美国同性恋者圈子,亦见于其他国家的男同性恋者之间。举例说,亚洲及太平洋岛屿一项研究发现,该区男同性恋者中有95%在过去五年内有多名性伴侣(Choi,Coates,Catania and Lew,1995)。泰国男同性恋者曾有性伴侣总数,也较男异性恋者多(Beyrer et al.,1995)。

Mercer、Hart、Johnson与Cassell(2009)曾作一项全国可能性调查,于1999至2001年间访问英国5,168名男士,发现在过去五内年,受访的男异性恋者、双性恋者及同性恋者之性伴数目中位数分别为2、7与10,可见双性恋者与同性恋者伴侣数目分别高于异性恋者3.5倍及5倍;此结果吻合美国最好的研究(Laumann et al.,1994),也与一般估计同性恋者性伴侣数目约高于异性恋者三至四倍相吻合。

性瘾癖与强迫性交

男女同性恋者有性瘾癖问题,或曾为非礼、强奸,或其他形式性侵犯施害者或受害者,其比率远高于异性恋者,以下将探讨相关研究。

性瘾癖

Quadland与Shattls(1987)发现,其病人性交次数超于所想要的。据称,病人往往因性交太频密而受损害,容易感染艾滋病更不在话下。专门协助同性恋者戒除性瘾癖的傲然机构(Pride Institute)指,同性恋圈子里性瘾癖问题严重(Downtown,1995)。性瘾癖问题专家Jennifer P. Schneider医生也说,在众多性瘾癖个案里,同性恋者所占比例相当高(Schneider,1991,私人访谈)。

据报告,男同性恋者间性瘾癖问题较一般人更普遍(Dodge,Reece,Cole and Sandfort,2004)。Dodge等(2008)比较男同性恋者及异性恋者的性瘾癖强迫程度得分中间数,发现前者在各细项得分都较高,因此总结说,男同性恋者性瘾癖强迫程度一般较男异性恋者高。

强奸/强迫性交

同性恋关系内的强迫性交比率相当高,有研究曾访问34名正在恋爱的女同性恋者、及36名男同性恋者,前者有31%、后者有12%称近期曾遭恋人、或最近一任恋人强迫性交(Waterman,Dawson and Bologna,1989)。

McConaghy与Zamir(1995)发现,在受访的医科学生样本中,同性恋者遭强迫性交,与施加强迫者之性倾向有莫大关联(r = 0.24,p = 0.05),其中1/4男子称曾强迫男伴性交;同样地,也有约1/4女子称曾强迫女伴性交。

一项同性恋关系研究发现,有29%受访者曾被迫进行性接触;在此等接触里,92%涉及没安全措施的肛交,令本已相当高的感染艾滋病风险再增(Kalichman and Rompa,1995)。英国及韦尔斯另一项研究也有类似发现,有28%受访者称曾遭伴侣恐吓性侵、或强迫性交,其中27.6%涉及同性肛交或其他性活动,胁迫者是他们既有性伴(Hickson et al.,1994)。

一项研究访问了310名男同性恋者,其中15%报称曾遭强迫性交(Krahe,Schutze,Fritsche and Waizenbofer,2000),表示曾施加压迫者比率也相约。Ratner等(2003)报告指,受访男同性恋者中有14%称曾在14岁前遭强迫性交。最后,近日一项研究指,受访男同性恋者中有18.5%称曾在不自愿情况下参与性活动(Houston and McKirnan,2007)。然而上述三项研究都没有提供异性恋者的相关数据作比对。

非礼

有研究文献断言,在绝大多数青少年遭非礼个案里,施害者均是成年人,且表面上是异性恋者。然而与整体人口相比对,则发现非礼案的同性恋犯人不合比例地高,因同性恋者一般仅占人口2至3%(已包括双性恋者)。

几项研究显示,娈童犯人中,同性恋者多得不合比例,分别占36%(Freund,Heasman,Racansky,and Glancy,1984)、35%(Freund and Watson,1992),与28%(Erickson,Walbek and Sely,1988),视乎研究而不同。「可见同性恋情欲发现,比异性恋发展出更多娈童癖」(Freund and Watson,1992,34页)。同样地,「同性恋者性接触较…其他群组更频密,…令他们向孩子打主意」(Gebhard,Gagnon,Pomeroy and Christenson,1975,引述自Lester,1975,82页)。

一项研究仔细比较一般公民与军人遭性侵比率(McCarroll,Ursano,Fan and Newby,2004),据统计发现,相关个案大致可分为前青春期与后青春期。12至15岁为后青春期,在美国大多数州份里算作未成年,在这组群里,每千名男女分别有0.4与2.4人曾遭性侵比率分,情况与一般公民及军人相约。若将同性恋者与异性恋者人口比例为3:97此因素一并计算,则男同性恋者涉及后青春期非礼案比率,较异性恋者多5.3倍。

令非礼案研究更复杂的是,非礼案的同性恋犯人其性倾向未必明显(如,有非礼男童的成年男子已娶妻,外界未必将之界定为男同性恋者)。

暴力问题

关于女同性恋伴侣间的暴力问题,所统计比率并不一致,视乎相关研究对暴力的定义。几项研究所得数据分别为52%(Lie and Gentlewainer,1991)、25%(Brand and Kidd,1986)、25至33%(Koss,1990),2/3(Renzetti,1992)或1/3(Berry,1994)受访者有此问题,或31%(Lockhart,White and Causby,1994)。

研究显示,女同性恋者一般较女异性恋者更暴力,犯罪率更高(Ellis,Hoffman and Burke,1990;Owen and Burke,2004);在女囚犯数据有同样情况(Climent et al.,1977)。由于女同性恋者间暴力问题严重,美国抗家暴同盟(National Coalition against Domestic Violence,引述自Lobel,1986)曾出版《指证暴行-女同志家暴叙述》(Naming the Violence: Speaking out about Lesbian Battering),让几名女同性恋者诉说经历,讲她们圈子里的暴力问题。一名女同性恋者谈到女同志酒吧时说:「每次我在那里留连至打烊,都会看到一场暴力剧上演」(页11)。

Brand与Kidd(1986)曾比较75名自认女异性恋者、并55名认女同性恋者数据,两组人在其他各方面背景相约。研究显示,两个组别在遭主要亲密伴侣暴力对待的频密度上,情况并无大差别,其中27%女异性恋曾遭男伴虐打,25%女同性恋者曾遭女伴虐打。换言之,女同性恋者虐打女伴的机会,与男异性恋者虐打女伴一样大。

另一项研究从一个男女混合样本抽取男女同性恋者作观察,其中女同性恋者有48人,男同性恋者50人,其他各方面背景相约。在这个男女混合同性恋者群组里,47%曾对亲密伴侣施暴,而女同性恋者肉体施暴问题较男同性恋者轻(Kelly and Warshafsky,1987)。

Cochran与Cauce(2006)报告指,在美国华盛顿州正因受虐接受治疗的男女同性恋者中,有4.4%人曾于过去一个月内遭受家居暴力,而异性恋受害人则为2.9%。同性恋者平生曾受虐比率为55%,异性恋者则为36%。此研究清晰比较了同一个样本中同性恋者及异性恋者的情况,是较少有的做法。

研究员发现,男同性恋者家暴比率较男异性恋者高(Seligson and Peterson,1992)。Greenwood等(2002)据一个具人口代表性的可能性样本,发现男同性恋关系里的暴力程度,较异性恋族群里的男女关系更高,他说:

在城巿里,男男性交关系过去五年的暴力比率(22.0%),明显高于男女同居关系在过去一年的严重暴力比率(3.4%),及过去一年的完全暴力比率(11.6%)。(1968页)

青少年同性恋者的调适问题

Savin-Williams(1994)发现,青少年同性恋往往也涉及学业问题、离家出走、滥用药品、买淫与自杀;有好几项研究都支持此观点(Ervin,1993;Kourany,1987;Prenzlauer et al.,1992;Remafedi,1987;Rich et al.,1986;Roesler and Deisher,1972;Rotheram-Borus,Hunter and Rosario,1994;Saunders and Valente,1987;Schneider et al.,1989)。同性恋与双性恋青少年离家游荡的风险也较大(Kruks,1991)。

一项较近期研究显示,发展同性恋关系的高中生,其自杀率远高于发展异性恋爱关系学生。Russell与Joyner(2001)曾进行一项具全美人口代表性的研究,其样本包括5,685名青少年男生,并6,254名青少年女生。其中1.1%男生(n = 62)报称正发展同性恋关系,女生则为2.0%(n = 125)(页1277)。研究员发现,青少年男同性恋者曾企图自杀胜算比,较异性恋者高2.45倍;青少年女同性恋者曾企图自杀胜算比,则较女异性恋者高2.45倍。

尽管部分社会科学家指,同性恋青少年之所以有调整问题,全因家长与朋辈压力所致;然而Savin-Williams(1994)指,这种因果解释仅为「假设」,他指,这是「随便将几种压力来源说成直接原因,并无科学实证支持」(页261)。

性活动

「嗜粪症」(「Scat」),指涉及粪便与排泄物的性游戏(即是coprophilia)。「嗜水症」(「Water sports」),则指涉及粪尿与排泄物的性活动。据《男同性恋者报告》,有4%男同性恋者曾在性接触里使用粪尿(Jay and Young,1979)。

「拳交」(「Fisting」或「handballing」),指人将整个拳头甚至前臂塞进另一人的肛门里,通常是[男]同性恋者的性活动(Shook,Whittle and Rose,1985,319页)。尽管拳交为健康构成高风险(感染丙型肝炎、急性结肠病症、腹腔撕裂,甚至死亡),好几个同性恋及性虐组织依然倡导之。

男同性恋者在一年内进行拳交比率各报告有异,分别为15%(Spada,1979)、13%(Jay and Young,1979)、16%(Crosby and Mettey,2004),与5%(McKusick et al.,1985)。相对地,全国人口曾进行此活动者每年仅为0.5%(Richters,Grulich,de Visser,Smith,and Rissel,2003)。在女同性恋者中,曾进行此活动者据报为7%(Roberts,Sorensen,Patsdaughter and Grindel,2000)与9%(Young,1994),阴道拳交的比率则分别为35%与26%。

其他异常性活动

Jay与Young(1979)在《男同性恋者报告》里指,有13%男同性恋者曾进行人兽交。Williams与Weinberg(2003)则指,大多数参与人兽交者主要为同性恋或双性恋者。

总结

研究员指出,男女同性恋者的心理调适问题,与男女异姓恋这者的心理适应问题分别很大。近日研究证实前几十年结果,显示同性恋与精神、情绪健康风险,及部分行为失调相关。尽管部分研究员推断这乃由于社会耻感令同性恋者出现种种问题,但其他研究员发现,耻感对于所出现的问题,其影响力其实相当小。我们相信将来的研究也会印证此结论。有说「研究发现,男女同性恋者的心理调适问题与异性恋者并无二致」(Rothblum,1994,214页),此说在当时不准确,在今天也不准确。

强指同性恋非精神心理问题,是扭曲科学文献结果。此说主要以政治考虑为依靠,其破坏力极大,只会令受影响者延医或不就医,或否认问题,结果加剧受影响人的精神及身体健康风险,甚至可能害命。

全文概要

前述数以百计的研究文献均显示:

  • 同性恋者明知道患艾滋病风险,仍病态地一再进行无保护措施的性行为。
  • 同性恋者感染性病率最高。
  • 无论有否安全措施,许多同性恋性活动皆危及身体健康。
  • 逾1/3男女同性恋者有滥用药品问题。
  • 40%青少年同性恋者曾企图自杀。
  • 同性恋者较异性恋者更容易出现精神心理病,如饮食失调、人格失调、妄想症、抑郁、焦虑。
  • 同性恋关系较异性恋关系更暴力。
  • 社会偏见与歧视并非同性恋者适应失调的主因。

参考

Aaron, W. (1972). Straight: A heterosexual talks about his homosexual past. Garden City, NY:

Doubleday.

Ackard, D. M., Fedio, G., Neumark-Sztainer, D., & Britt, H. R. (2008). Factors associated with disordered

eating among sexually active adolescent males: Gender and number of sexual partners

[Electronic version]. Psychosomatic Medicine, 70, 232–238.

Acosta, F. (1975). Etiology and treatment of homosexuality: A review. Archives of Sexual Behavior, 4, 9–29.

Alexander, L. (1967). Psychotherapy of sexual deviations with the aid of hypnosis. American Journal of

Clinical Hypnosis, 9(3), 181–183.

Allen, C. (1952). On the cure of homosexuality II. International Journal of Sexology, 5, 139–141.

American Counseling Association. (2005). ACA code of ethics. Alexandria, VA: Author.

American Psychiatric Association. (1972). Diagnostic and statistical manual of mental and emotional disorders

(2nd ed.). Washington, D.C.: Author.

American Psychological Association. (2001). American Psychological Association Publication Manual of

the American Psychological Association (5th ed.). Washington, DC: Author.

American Psychological Association. (2002). Ethical principles of psychological and code of conduct.

American Psychologist, 57, 1060–1073.

American Psychological Association. (2008). Answers to your questions: For a better understanding of

sexual orientation and homosexuality. Washington, DC: Author.

Anderson, S., & Henderson, D. (1985). Working with lesbian alcoholics. Social Work, 30, 518–524.

Andersson, G., Noack, T., Seierstad, A., & Weedon-Fekjaer, H. (2006). The demographics of same-sex

marriages in Norway and Sweden. Demography, 43(1), 79–98.

Atkinson, J. H., Grant, I., Kennedy, C. J., Richman, D. D., Spector, S. A., & McCutchan, J.A. (1988).

Prevalence of psychiatric disorders among men infected with HIV: A controlled study. Archives of

General Psychiatry, 45, 859–864.

Bailey, J. M. (1999). Homosexuality and mental illness. Archives of General Psychiatry, 56, 883–884.

Bancroft, J. (1970). A comparative study of aversion and desensitization in the treatment of homosexuality.

In L. E. Burns & J. L. Worsley (Eds.), Behavior therapy in the 1970s: A collection of original

papers (pp. 34–56). Oxford, England: John Wright & Sons.

Bancroft, J. (1974). Deviant sexual behaviour: Modification and assessment. Oxford, England: Clarendon

Press.

Bancroft, J. (1975). Homosexuality and the medical profession: A behaviourist’s view. Journal of Medical

Ethics, 1(4), 176–180.

Baral, S., Sifakis, F., Cleghorn, F., & Beyrer, C. (2007). Elevated risk for HIV infection among men who

have sex with men in low- and middle-income countries 2000–2006: A systematic review. PLoS

Medicine, 4(12), 1901–1911.

Barlow, D. H. (1973). Increasing heterosexual responsiveness in the treatment of sexual deviation: A

review of the clinical and experimental evidence. Behavior Therapy, 4, 655–671.

Barlow, D. H., & Agras, W. S. (1973). Fading to increase heterosexual responsiveness in homosexuals.

Journal of Applied Behavior Analysis, 6, 355–366.

Barlow, D. H., & Durand, V. M. (1995). Abnormal psychology: An integrative approach. New York: Brooks/

Cole.

Barnhouse, T. R. (1984, February 12). What is a Christian view of homosexuality? Circuit Rider, 45.

Bartholow, B. N., Doll, L. S., Joy, D., Douglas, J. M., Jr., Bolan, G., Harrison, J. S., Moss, P. M., &

McKirnan, D. (1994). Emotional, behavioral, and HIV risks associated with sexual abuse among

adult homosexual and bisexual men. Child Abuse and Neglect, 18, 745–761.

Bartlett, J. G. (1994, October). HIV prevention. Baltimore Alternative, 1–24.

Bauman, L. J., & Siegel, K. (1987). Misperceptions among gay men of the risk of AIDS associated with

their sexual behavior. Journal of Applied Social Psychology, 17, 328–349.

Beckstead, A. L. (2001). Cure versus choices: Agendas in sexual reorientation therapy. Journal of Gay and

Lesbian Psychotherapy, 3, 87–115.

Bell, A. P. (1976). Homosexuality, an overview. In R. T. Barnhouse & U. T. Holmes (Eds.), Male and

female: Christian approaches to sexuality (pp. 131–143). New York: Seabury Press.

Bell, A. P., & Weinberg, M. S. (1978). Homosexualities: A study of diversity among men and women. New

York: Simon & Schuster.

Bell, A. P., Weinberg, M. S., & Hammersmith, S. A. (1981). Sexual preference. Bloomington, IN: Indiana

University Press.

Benda, C. E. (1963). Existential psychotherapy of homosexuality. Review of Existential Psychology and

Psychiatry, 3, 133–152.

Benson, H., & Stark, M. (1996). Timeless healing: The power and biology of belief. New York: Scribner.

Benson, P. L., Donahue, M. J., & Erickson, J. A. (1993). The faith maturity scale: Conceptualization,

measurement, and empirical validation. In M. L. Lynn & D. O. Moberg (Eds.), Research in the social

scientific study of religion: Vol. 5 (pp. 1–26). Greenwich, CN: JAI Press.

Berg, C., & Allen, C. (1958). The problem of homosexuality. New York: Citadel Press.

Berger, J. (1994). The psychotherapeutic treatment of male homosexuality. American Journal of

Psychotherapy, 48, 251–261.

Berger, R. M. (1990). Men together: Understanding the gay couple. Journal of Homosexuality, 19,

31–49.

Bergin, A. E. (1969). A self-regulation technique for impulse control disorders. Psychotherapy: Theory,

Research, and Practice, 6, 113–118.

Bergler, E. (1956). Homosexuality: Disease or way of life? New York: Collier Books.

Berry, D. B. (1994). The domestic violence sourcebook: Everything you need to know. Los Angeles:

Lowell House.

Berscheid, E., Walster, E., & Bornstedt, G. (1973). The happy American body: A survey report. Psychology

Today, 7, 119–131.

Beukenkamp, C. (1960). Phantom patricide. Archives of General Psychiatry, 3, 282–288.

Bevier, P. J., Chiasson, M. A., Heffernan, R. T., & Castro, K. G. (1995). Women at a sexually transmitted

disease clinic who reported same-sex contact: Their HIV seroprevalence and risk behaviors.

American Journal of Public Health, 85(10), 1366–1371.

Beyrer, C., Eiumtrakul, S., Celentano, D. D., Nelson, K. E., Ruckphaopunt, S., & Khamboonruang, C.

(1995). Same-sex behavior, sexually transmitted diseases, and HIV risks among young northern

Thai men. AIDS, 9(2), 171–176.

Bieber, I. (1967). Sexual deviations II: Homosexuality. In A. M. Freedman & H. I. Kaplan (Eds.),

Comprehensive textbook of psychiatry (pp. 963–976). Baltimore: Williams and Wilkins.

Bieber, I., & Bieber, T. B. (1979). Male homosexuality. Canadian Journal of Psychiatry, 24, 409–419.

Bieber, I., Bieber, T. B., Dain, H. J., Dince, P. R., Drellich, M. G., Grand, H. G., Grundlach, R. H.,

Kremer, M. W., Rilkin, A. H., & Wilbur, C. B. (1962). Homosexuality: A psychoanalytic study. New

York: Basic Books.

Bieber, T. B. (1971). Group therapy with homosexuals. In H. I. Kaplan & B. J. Sadock (Eds.), Comprehensive

group psychotherapy (pp. 518–533). Baltimore: Williams and Wilkins.

Billstein, S. A. (1989). Human lice. In K. K. Holmes (Ed.), Sexually transmitted diseases (2nd ed). New

York: McGraw-Hill.

Birk, L. (1974). Group psychotherapy for men who are homosexual. Journal of Sex and Marital Therapy,

1, 29–52.

Birk, L. (1980). The myth of classical homosexuality: Views of a behavioral psychotherapist. In J.

Marmor (Ed.), Homosexual behavior (pp. 376–390). New York: Basic Books.

Birk, L., Huddleston, W., Miller, E., & Cohler, B. (1971). Avoidance conditioning for homosexuality.

Archives of General Psychiatry, 25, 314–323.

Birk, L., Miller, E., & Cohler, B. (1970). Group psychotherapy for homosexual men. Acta Psychiatrica

Scandinavica, 218, 1–33.

Blitch, J., & Haynes, S. (1972). Multiple behavioral techniques in a case of female homosexuality. Journal

of Behavioral Therapy and Experimental Psychiatry, 3, 319–322.

Blumstein, P., & Schwartz, P. (1983). American couples: Money, work, sex. New York: William Morrow.

Bostwick, W. B., McCabe, S. E., Horn, S., Hughes, T., Johnson, T., & Valles, J. R. (2007). Drinking

patterns, problems, and motivations among collegiate bisexual women. Journal of American College

Health, 56(3), 285–292.

Braaten, L. J., & Darling, C. D. (1965). Overt and covert homosexual problems among male college

students. Genetic Psychology Monographs, 71, 269–310.

Bradford, J., Ryan, C., & Rothblum, E. D. (1994). National lesbian health care survey: Implications for

mental health care. Journal of Consulting and Clinical Psychology, 62, 228–242.

Brand, P. A., & Kidd, A. H. (1986). Frequency of physical aggression in heterosexual and female homosexual

dyads. Psychological Reports, 59, 1307–1313.

Breedlove, J., Plechash, V., & Davis, D. (1994, March). Once gay, always gay? Focus on the Family, 2–5.

Brendstrup, E., & Schmidt, K. (1990). Homosexual and bisexual men’s coping with the AIDS epidemic:

Qualitative interviews with 10 non–HIV-tested homosexual and bisexual men. Social Science and

Medicine, 30, 713–720.

Brenner, I. (1991). The unconscious wish to develop AIDS: A case report. In C. W. Socarides &

V. D. Volkan (Eds.), The homosexualities and the therapeutic process (pp. 251–275). Madison, CT:

International Universities Press.

Brown, L. (1987). Lesbians, weight, and eating: New analyses and perspectives. In Boston Lesbian

Psychologies Collective, Lesbian psychologies: Explorations and challenges (pp. 294–309). Chicago:

University of Illinois Press.

Brown, L. (1996). Ethical concerns with sexual minority patients. In R. Cabaj & T. Stein (Eds.), Textbook

of homosexuality and mental health (pp. 897–916). Washington, DC: American Psychiatric Press.

Buhrich, N., & Loke, C. (1988). Homosexuality, suicide and parasuicide in Australia. Journal of

Homosexuality, 15, 113–129.

Buki, R. A. (1964). A treatment program for homosexuals. Diseases of the Nervous System, 25(5),

304–307.

Burke, P. (1982, April). Bar use and alienation in lesbians and heterosexual women alcoholics. Paper

presented at the 13th National Alcoholism Forum, Washington, DC.

Byrd, A. D. (2004). Gender complementarity and child-rearing: Where tradition and science agree.

Journal of Law and Family Studies, 6, 213–235

Byrd, A. D. (2006). The malleability of homosexuality: A debate long overdue. In J. Drescher & K. J.

Zucker (Eds.). Ex-gay research: Analyzing the Spitzer study and its relation to science, religion, politics,

and culture (pp. 83–88). New York: Harrington Park Press.

Byrd, A. D. (2008, September 3). Spitzer study critiqued in the Journal of Gay and Lesbian Psychotherapy

7(3), 2003. Retrieved March 7, 2009, from http://www.narth.com/docs/spitzer4.html

Byrd, A. D., & Nicolosi, J. (2002). A meta-analytic review of treatment of homosexuality. Psychological

Reports, 90, 1139–1152.

Byrd, A. D., Nicolosi, J., & Potts, R. W. (2008). Clients’ perceptions of how reorientation therapy and

self-help can promote changes in sexual orientation. Psychological Reports, 102, 3–28.

Byrne, D. E. (2008, September 3). Yet another attempt to discredit the Spitzer study fails. Retrieved

March 7, 2009, from http://www.narth.com/docs/yetanother.html

Cafiso, R. (1983). The homosexual: The advantages of hypnotherapy as treatment. International Journal

of Clinical and Experimental Hypnosis, 24(1), 49–55.

Callahan, E. J., Krumboltz, J. D., & Thoresen, C. E. (Eds.) (1976). Counseling methods. New York: Holt,

Rinehart, and Winston.

Canton-Dutari, A. (1974). Combined intervention for controlling unwanted sexual behavior. Archives

of Sexual Behavior, 3(4), 367–371.

Canton-Dutari, A. (1976). Combined intervention for controlling unwanted sexual behavior: An extended

follow-up. Archives of Sexual Behavior, 5(4), 323–325.

Cappon, D. (1965). Toward an understanding of homosexuality. Englewood Cliffs, NJ: Prentice-Hall.

Caprio, F. S. (1954). Female homosexuality: A psychodynamic study of lesbianism. New York: Citadel

Press.

Carlat, D. J., Camargo, C. A., & Herzog, D. B. (1997). Eating disorders in males: A report on 135 patients.

American Journal of Psychiatry, 154, 1127–1132.

Cautela, J., & Wisocki, P. (1971). Covert sensitization for the treatment of sexual deviations. Psychological

Record, 21, 37–48.

Cazzullo, C. L., Gala, C., Martini, S., Pergami, A., Rossini, M., & Russo, R. (1990). Psychopathologic

features among drug addicts and homosexuals with HIV infection. International Journal of Psychiatry

in Medicine, 20, 285–292.

Centers for Disease Control and Prevention. (1979). STD fact sheet.

Centers for Disease Control and Prevention (1991, November 21). Patterns of sexual behavior change

among homosexual/bisexual men—selected U.S. sites, 1987–1990. Morbidity and Mortality Weekly

Report, 40(46), 792–794.

Centers for Disease Control and Prevention. (2005, June 24). HIV Prevalence, unrecognized infection,

and HIV testing among men who have sex with men—five U.S. cities, June 2004–April 2005.

Morbidity and Mortality Weekly Report, 54(24), 597–601.

Choi, K. H., Coates, T. J, Catania, J. A., & Lew, S. (1995). High HIV risk among gay Asian and Pacific

Islander men in San Francisco. AIDS, 9, 306–308.

Clarkin, J. F., & Levy, K. N. (2004). The influence of client variables on psychotherapy. In M. J. Lambert

(Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (5th ed.) (pp. 194–226).

New York: John Wiley & Sons.

Climent, C. E., Ervin, F. R., Rollins, A., Plutchik, R., & Batinelli, C. J. (1977). Epidemiological studies

of female prisoners. Journal of Nervous and Mental Disease, 164, 25–29.

Clippinger, J. A. (1974). Homosexuality can be cured. Corrective and Social Psychiatry and Journal of

Behavioral Technology, Methods, and Therapy, 20(2), 15–28.

Coates, S. (1962). Homosexuality and the Rorschach test. British Journal of Medical Psychology, 35, 177–190.

Cochran, B. N., & Cauce, A. M. (2006). Characteristics of lesbian, gay, bisexual, and transgender individuals

entering substance abuse treatment. Journal of Substance Abuse Treatment, 30(2), 135–146.

Cochran, S. D., Ackerman, D., Mays, V. M., & Ross, M. W. (2004). Prevalence of nonmedical drug use

and dependence among homosexually active men and women in the U.S. population. Addiction, 99,

989–998.

Cochran, S. D., Keenan, C., Schober, C., & Mays, V. M. (2000). Estimates of alcohol use and clinical

treatment needs among homosexually active men and women in the U.S. population. Journal of

Consulting and Clinical Psychology, 68(6), 1062–1071.

Cochran, S. D., & Mays, V. M. (1994). Depressive distress among African-American men and women.

American Journal of Psychiatry, 151, 524–529.

Cochran, S. D., & Mays, V. M. (2007). Physical health complaints among lesbians, gay men, and bisexual

and homosexually experienced heterosexual individuals: Results from the California Quality

of Life Survey. American Journal of Public Health, 10, 2105.

Coleman, E. (1978). Toward a new model of treatment of homosexuality: A review. Journal of

Homosexuality, 3(4), 345–359.

Comiskey, A. (1988). Pursuing sexual wholeness. Los Angeles: Desert Stream Ministries.

Conger, J. J. (1975). Proceedings of the American Psychological Association, Incorporated, for the year

1974: Minutes of the Annual Meeting of the Council of Representatives. American Psychologist, 30,

620–651.

Conrad, S. R., & Wincze, J. P. (1976). Orgasmic reconditioning: A controlled study of its effects upon

sexual arousal and behavior of adult male homosexuals. Behavior Therapy, 7, 155–166.

Conron, K. J., Mimiaga, M. J., & Landers, S. J. (2008, November 12). A health profile of Massachusetts

adults by sexual orientation identity: Results from the 2001–2006 Behavior Risk Factor Surveillance

System surveys. Commonwealth of Massachusetts, Department of Public Health. Retrieved

March 29, 2009, from http://www.mass.gov/Eeohhs2/docs/dph/health_equity/sexual_orienta

tion_disparities_report.pdf

Consiglio, W. (1991). Homosexual no more: Practical strategies for Christians overcoming homosexuality.

Wheaton, IL: Victor Books.

Consiglio, W. (1993). Homosexual no more: Ministry and therapy for the recovering homosexual. Social

Work and Christianity: An International Journal, 20(1), 46–59.

Corey, L., & Holmes, K. K. (1980). Sexual transmission of hepatitis A in homosexual men. New England

Journal of Medicine, 302, 435–438.

Courage (2006, December 9). Welcome to the Courage community. Retrieved December 2, 2006, from

http://couragerc.net/index.htm

Craig, R. J. (1987). MMPI-derived prevalence estimates of homosexuality among drug-dependent patients.

International Journal of Addictions, 22, 1139–1145.

Crosby, R., & Mettey, A. (2004). A descriptive analysis of HIV risk behavior among men having sex with

men attending a large sex resort. Journal of Acquired Immune Deficiency Syndrome, 37(4), 1496–1499.

Cubitt, G., & Gendreau, P. (1972). Assessing the diagnostic utility of MMPI and 16PF indices of homosexuality

in a prison sample. Journal of Consulting and Clinical Psychology, 39(2), 342.

Cummings, N. (2007). Former APA president Dr. Nicholas Cummings describes his work with SSA

clients. Retrieved April 2, 2007, from http://www.narth.com/docs/cummings.html

Curran, D., & Parr, D. (1957). Homosexuality: An analysis of 100 male cases. British Journal of Psychiatry,

112, 1111–1114.

D’Augelli, A. R. (1992). Sexual behavior patterns of gay university men: Implications for preventing

HIV infection. Journal of American College Health, 41, 25–29.

D’Augelli, A. R., & Hershberger, S. L. (1993). Lesbian, gay, and bisexual youth in community settings:

Personal challenges and mental health problems. American Journal of Community Psychology, 21,

421–448.

D’Augelli, A. R., Grossman, A. H., Salter, N. P., Vasey, J. J., Starks, M. T., & Sinclair, K. O. (2005).

Predicting the suicide attempts of lesbian, gay, and bisexual youth. Suicide and Life-Threatening

Behavior, 35(6), 646–660.

Darrow, W. W., Barrett, D., Jay, K., & Young, A. (1981). The gay report on sexually transmitted diseases.

American Journal of Public Health, 71, 1004–1011.

Davies, B., & Rentzel, L. (1993). Coming out of homosexuality: New freedom for men and women. Downers

Grove, IL: InterVarsity Press.

Davies, P. M., Hickson, F. C. I., Weatherburn, P., & Hunt, A. J. (1993). Sex: Gay men and AIDS. London:

Falmer Press.

Davis, M. (1994, May 22). Protesters blast APA’s position. Philadelphia Inquirer, p. B4.

Davison, G. C. (1976). Homosexuality: The ethical challenge. Journal of Consulting and Clinical

Psychology, 44, 157–162.

Davison, G. C. (1978). Not can but ought: The treatment of homosexuality. Journal of Consulting and

Clinical Psychology, 46(1), 170–172.

Davison, G. C. (1991). Constructionism and morality in therapy for homosexuality. In J. C. Gonsiorek &

J. D. Weinrich (Eds.), Homosexuality: Research implications for public policy (pp. 137–148). Newbury

Park, CA: SAGE Publications.

Davison, G. C., & Wilson, G. T. (1973). Attitudes of behavior therapists towards homosexuality.

Behavior Therapy, 45(5), 686–696.

DeBord, K. A., Wood, P. K., Sher, K. J., & Good, G. E. (1998). The relevance of sexual orientation

to substance abuse and psychological distress among college students. Journal of College Student

Development, 39, 157–168.

DeLeon, P. H. (1998). Proceedings of the American Psychological Association, Incorporated, for the

legislative year 1997: Minutes of the Annual Meeting of the Council of Representatives, August 14

and 17, 1997, Chicago, Illinois; and of the June, August, and December 1997 meetings of the Board

of Directors. American Psychologist, 53, 882–939.

Depression and mental health emerge as major concerns for the community (n.d.). Retrieved April 25,

2009, from http://www.healthyplace.com/gender/depression-and-gender/depression-and-mentalhealth-

emerge-as-major-concerns-for-the-community/menu-id-59/

Derogatis, L. R. (1994). SCL-90-R: Administration, scoring and procedures manual. Minneapolis: National

Computer Systems.

deWit, J. B. F., van den Hoek, J. A. R., Sandfort, T. G. M., & van Griensven, G. J. P. (1993).

Increase of unprotected anogenital intercourse among homosexual men. Public Health Briefs, 83,

1451–1453.

de Graaf, R., Sandfort, T. G., & Ten Have, M. (2006). Suicidality and sexual orientation: Differences

between men and women in a general population-based sample from the Netherlands. Archives of

Sexual Behavior, 35, 253–262.

Diamond, D., & Wilsnack, S. (1978). Alcohol abuse among lesbians: A descriptive study. Journal of

Homosexuality, 4(2), 123–142.

Diamond, L. M. (2003). Was it a phase? Young women’s relinquishment of lesbian/bisexual identities

over a 5-year period. Journal of Personality and Social Psychology, 84(2), 352–364.

Diamond, L. M. (2005a). What we got wrong about sexual identity development: Unexpected findings

from a longitudinal study of young women. In A. M. Omoto & H. S. Kurtzman (Eds.), Sexual

orientation and mental health: Examining identity and development in lesbian, gay, and bisexual people

(pp. 79–94). Washington, DC: APA Books.

Diamond, L. M. (2005b). A new view of lesbian subtypes: Stable versus fluid identity trajectories over

an 8-year period. Psychology of Women Quarterly, 29(2), 119–128.

Diamond, L. M. (2006). Introduction: In search of good sexual-development pathways for adolescent

girls. New Directions for Child and Adolescent Development, 12, 1–7.

Diamond, L. M. (2008). Female bisexuality from adolescence to adulthood: Results from a 10-year

longitudinal study. Developmental Psychology, 44(1), 5–14.

Dodge, B., Reece, M., Cole, S. L., & Sandfort, T. G. M. (2004). Serial compulsivity among heterosexual

college students. Journal of Sex Research, 41, 343–350.

Dodge, B., Reece, M., Herbenick, D., Fisher, C., Satinsky, S., & Stupiansky, N. (2008). Relations between

sexually transmitted infection diagnosis and sexual compulsivity in a community-based sample of

men who have sex with men. Sexually Transmitted Infections, 84(4), 324–327.

Doidge, W., & Holtzman, W. (1960). Implications of homosexuality among Air Force trainees. Journal

of Consulting Psychology, 24, 9–13.

Dor, J. (2001). Structure and perversions. New York: Other Press.

Downton, J. (1995). Overdrive: When is sex too much of a good thing? The Advocate, p. 48.

Doyle, T. L. (1967). Homosexuality and its treatment. Nursing Outlook, 15(8), 38–40.

Drabble, L., & Trocki, K. (2005). Alcohol consumption, alcohol-related problems, and other substance

use among lesbian and bisexual women. Journal of Lesbian Studies, 9(3), 19–30.

Drescher, J. (2001). I’m your handyman: A history of reparative therapies. In A. Shidlo, M. Schroeder,

& J. Drescher (Eds.), Sexual conversion therapy: Ethical, clinical, and research perspectives (pp. 5–24).

Binghamton, NY: Haworth Press.

Drescher, J. (2003). Gold or lead? Introductory remarks on conversions. Journal of Gay and Lesbian

Psychotherapy, 7(3), 1–13.

Dube, E. M., & Savin-Williams, R. C. (1999). Sexual identity development among ethnic sexualminority

male youths. Developmental Psychology, 35, 1389–1398.

Duberman, M. (1991). Cures: A gay man’s odyssey. New York: Dutton.

Duberman, M. (2001). Excerpts from Cures: A gay man’s odyssey. In A. Shidlo, M. Schroeder, &

J. Drescher (Eds.), Sexual conversion therapy: Ethical, clinical, and research perspectives (pp. 37–50).

Binghamton, NY: Haworth Press.

Egan, P. J., & Sherrill, K. (2005). Marriage and the shifting priorities of a new generation of lesbians

and gays. PS: Political Science and Politics, 38(2), 229–232.

Egan, P. J., Edelman, M. S., & Sherrill, K. (2008). Findings from the Hunter College Poll of gays, lesbians,

and bisexuals: New discoveries about identity, political attitudes, and civic engagement. New

York: Hunter College.

Eidelberg, L. (1956). Analysis of a case of a male homosexual. In S. Lorand & B. Balint (Eds.), Perversions:

Psychodynamic and therapy (pp. 279–289). New York: Random House.

Eisenberg, M. E., & Resnick, M. D. (2006). Suicidality among gay, lesbian, and bisexual youth: The role

of protective factors. Journal of Adolescent Health, 39, 662–668.

Ekstrand, M. L., & Coates, T. J. (1990). Maintenance of safer sexual behaviors and predictors of risky

sex: The San Francisco men’s health study. American Journal of Public Health, 80, 973–977.

Eliasberg, W. G. (1954). Group treatment of homosexuals on probation. Group Psychotherapy, 7,

218–226.

Ellis, A. (1956). The effectiveness of psychotherapy with individuals who have severe homosexual problems.

Journal of Consulting Psychology, 20(3), 191.

Ellis, A. (1959). A homosexual treated with rational therapy. Journal of Clinical Psychology, 15(3),

338–343.

Ellis, A. (1965). Homosexuality: Its causes and cure. New York: Lyle Stuart.

Ellis, L., Hoffman, H., & Burke, D. M. (1990). Sex, sexual orientation, and criminal and violent behavior.

Personal Individual Differences, 11, 1207–1212.

Elmore, J. L. (2002). Fluoxetine-associated remission of ego-dystonic male homosexuality. Sexuality and

Disability, 20(2), 149–151.

Erickson, W. D., Walbek, N. H., & Sely, R. K. (1988). Behavior patterns of child molesters. Archives of

Sexual Behavior, 17, 77–86.

Ernst, R. S., & Houts, P. S. (1984). Characteristics of gay persons with sexually transmitted disease.

Sexually Transmitted Diseases, 12, 59–63.

Erwin, K. (1993). Interpreting the evidence: Competing paradigms and the emergence of lesbian and

gay suicide as a social factor. International Journal of Health Services, 23, 437–453.

Erzen, T. (2006). Straight to Jesus: Sexual and Christian conversions in the ex-gay movement. Berkeley,

CA: University of California Press.

Evans, A. L., Scally, A. J., Wellard, S. J., & Wilson, J. D. (2007). Prevalence of bacterial vaginosis in

lesbians and heterosexual women in a community setting. Sexually Transmitted Infections, 83(6),

470–475.

Evans, R. (1970). 16PF questionnaire scores of homosexual men. Journal of Consulting Psychology, 34,

212–215.

Evans, R. (1971). Adjective checklist scores of homosexual men. Journal of Personality Assessment, 35,

344–349.

Feldman, M. P., & MacCulloch, M. J. (Eds.) (1971). Homosexual behavior: Therapy and assessment. New

York: Pergamon Press.

Feldman, M. P., MacCulloch, M. J., & Orford, J. F. (1971). Conclusions and speculations. In M. P.

Feldman, & M. J. MacCulloch (Eds.), Homosexual behavior: Therapy and assessment (pp. 156–188).

New York: Pergamon Press.

Fenwick, R. D., & Pillard, R. C. (1978). Advocate guide to gay health. New York: E. P. Dutton.

Fergusson, D. M., Horwood, L., & Beautrais, A. (1999). Is sexual orientation related to mental health

problems and suicidality in young people? Archives of General Psychiatry, 56(10), 876–880.

Fergusson, D. M., Horwood, L. J., Ridder, E. M., & Beautrais, A. L. (2005). Sexual orientation and

mental health in a birth cohort of young adults. Psychological Medicine, 35, 971–981.

Fichter, M. M., & Hoffman, R. (1990). Bulimia nervosa in the male. In M. M. Fichter (Ed.), Bulimia

nervosa: Basic research, diagnosis, and therapy (pp. 99–111). New York: John Wiley & Sons.

Fifield, L. (1975). On my way to nowhere: Alienated, isolated, drunk. Los Angeles: Gay Community

Services Center and Department of Health Services.

Fifield, L., Latham, J. D., & Phillips, C. (1977). Alcoholism in the gay community: The price of alienation,

isolation, and oppression. Los Angeles: The Gay Community Services Center.

Fine, R. (1987). Psychoanalytic theory. In L. Diamant (Ed.), Male and female homosexuality: Psychological

approaches (pp. 81–95). Washington, DC: Hemisphere.

Finny, J. C. (1960). Homosexuality treated by combined psychotherapy. Journal of Social Therapy, 6(1),

27–34.

Fisch, R. Z. (1987). Genital self-mutilation in males: Psychodynamic anatomy of a psychosis. American

Journal of Psychotherapy, 41, 453–458.

Fitzpatrick, K. K., Euton, S. J., Jones, J. N., & Schmidt, N. B. (2005). Gender role, sexual orientation, and

suicide risk. Journal of Affective Disorders, 87(1), 35–42.

Fleming, T. M., Merry, S. N., Robinson, E. M., Denny, S. J., & Watson, P. D. (2007). Self-reported suicide

attempts and associated risk and protective factors among secondary school students in New

Zealand. Australian and New Zealand Journal of Psychiatry, 41(3), 213–221.

Fluker, J. L. (1976). A 10-year study of homosexually transmitted infection. British Journal of Venereal

Diseases, 55, 155–160.

Fluker, J. L. (1983). The perils of promiscuity. Journal of Psychosomatic Research, 27, 153–156.

Fluker, J. L., & Cross, C. (1981). Homosexuality and sexually transmitted diseases. British Journal of

Hospital Medicine, 26, 265–267.

Fookes, B. H. (1969). Some experiences in the use of aversion therapy in male homosexuality, exhibitionism,

and fetishism-transvestism. British Journal of Psychiatry, 115, 339–341.

Ford, J. G. (2001). Healing homosexuals: A psychologist’s journey through the ex-gay movement and the

pseudo-science of reparative therapy. In A. Shidlo, M. Schroeder, & J. Drescher (Eds.), Sexual conversion

therapy: Ethical, clinical, and research perspectives (pp. 69–86). Binghamton, NY: Haworth Press.

Fordham, F. (1935). An introduction to Jung’s psychology. New York: Harmondsworth/Penguin Books.

Forstein, M. (2001). Overview of ethical and research issues in sexual orientation therapy. In A. Shidlo,

M. Schroeder, & J. Drescher (Eds.), Sexual conversion therapy: Ethical, clinical, and research perspectives

(pp. 167–179). Binghamton, NY: Haworth Press.

Foust, M. (2006, August 14). Ex-homosexuals protest APA’s position on homosexuality. BP News.

Retrieved December 9, 2006, from http://www.sbcbaptistpress.org/bpnews.asp?ID=23786

Fowler, R.D. (1993). Social issues stances: Why APA takes them. APA Monitor on Psychology, April, 2.

Frank, J. D. (1972). Treatment of homosexuals. Paper prepared for National Institute of Mental Health

Task Force on Homosexuality. Baltimore: Johns Hopkins University.

Freeman, W. M., & Meyer, R. G. (1975). A behavioral alteration of sexual preferences in the human

male. Behavior Therapy, 6, 206–212.

Freud, A. (1968). Studies in passivity (1952 [1949–1951]): Part 1 Notes on homosexuality. In The writings

of Anna Freud: Vol. 4. Indications for child analysis and other papers (pp. 245–256). New York:

International Universities Press. (Original work published in 1952.)

Freud, S. (1920a). Beyond the pleasure principle: Vol. 18 (Standard ed.). London: Hogarth Press.

Freud, S. (1920b). The psychogenesis of a case of homosexuality in a woman: Vol. 18 (Standard ed.).

London: Hogarth Press.

Freud, S. (1951). A letter from Freud. American Journal of Psychiatry, 107, 786–787.

Freund, K., & Watson, R.J. (1992). The proportions of heterosexual and homosexual pedophiles among

sex offenders against children: An exploratory study. Journal of Sex and Marital Therapy, 18, 34–43.

Freund, K., Heasman, G., Racansky, I.G., & Glancy, G. (1984). Pedophilia and heterosexuality vs. homosexuality.

Journal of Sex and Marital Therapy, 10(3), 193–200.

Friberg, R. (1967). Measures of homosexuality: Cross validation of 2 MMPI scales and implications for

usage. Journal of Consulting Psychology, 31, 88–91.

Fried, E. (1960). The ego of love and sexuality. New York: Grune and Stratton.

Friedman, M. S., Koeske, G. F., Silvestre, A. J., Korr, W. S., & Sites, E. W. (2006). The impact of genderrole

nonconforming behavior, bullying, and social support on suicidality among gay male youth.

Journal of Adolescent Health, 38, 621–623.

Fry, C., & Rostow, E. (1942). Mental health in college. London: Oxford University Press.

Garnets, L. D., & Kimmel, D. C. (Eds.) (1993). Psychological perspectives on lesbian and gay male experiences.

New York: Columbia University Press.

Gibson, P. (1986, June). Gay male and lesbian youth suicide. Paper presented at the National Conference

on Prevention and Interventions in Youth Suicide, Oakland, CA.

Gilman, S. E., Cochran, S. D., Mays, V. M., Hughes, M., Ostrow, D., & Kessler, R. C. (2001). Risk

of psychiatric disorders among individuals reporting same-sex sexual partners in the National

Comorbidity Survey. American Journal of Public Health, 91, 933–939.

Glover, E. (1960). The roots of crime: Selected papers in psychoanalysis: Vol. 2. New York: International

Universities Press.

Goetze, R. M. (1997) Homosexuality and the possibility of change: A review of 17 published studies.

New Direction Ministries of Canada. Retrieved December 2, 2006, from http://www.newdirection

.ca/research/index.html

Goldberg, A. (2008). Light in the closet: Torah, homosexuality, and the power to change. Los Angeles:

Red Heifer Press.

Golwyn, D. H., & Sevlie, C. P. (1993). Adventitious change in homosexual treatment of social phobia

with Phenelzine. Journal of Clinical Psychiatry, 54(1), 39–40.

Gonsiorek, J. C. (2006). Sexual orientation and mental health: What the behavioral sciences know

about sexual orientation and why it matters. In T. G. Plante (Ed.), Mental disorders of the new millennium:

Vol. 3 (pp. 251–270), Westport, CT: Praeger.

Gonsiorek, J. C., Sell, R. L., & Weinrich, J. D. (1995). Definition and measurement of sexual orientation.

Suicide and Life Threatening Behavior, 25(Suppl.), 40–51.

Gonsiorek, J. C., & Weinrich, J. D. (Eds.). (1991). Homosexuality: Research implications for public policy.

Newbury Park, CA: SAGE.

Goode, E., & Haber, L. (1977). Sexual correlates of homosexual experience: An exploratory study of

college women. Journal of Sex Research, 13, 12–21.

Goode, E., & Troiden, R. R. (1979). Amyl nitrite use among homosexual men. American Journal of

Psychiatry, 136, 1067–1069.

Goode, E., & Troiden, R. R. (1980). Correlates and accompaniments of promiscuous sex among male

homosexuals. Psychiatry, 43, 51–59.

Gordon, A. (1930). The history of a homosexual: His difficulties and triumphs. Medical Journal and

Record, 131, 152–156.

Gorner, P. (2000, May 18). Analysts drop gay therapy discussion reorientation efforts off meeting agenda.

Chicago Tribune, p. A1.

Goyer, P. F., & Eddleman, H. C. (1984). Same-sex rape of nonincarcerated men. American Journal of

Psychiatry, 141, 576–579.

Gray, J. (1970). Case conference: Behavior therapy in a patient with homosexual fantasies and heterosexual

anxiety. Journal of Behavioral Therapy and Experimental Psychiatry, 1, 225–232.

Greenberg, S. B., Linder, S., Baxter, B., Faris, E., Marcus, D. M., & Dreesman, G. (1984). Lymphocyte

subsets and urinary excretion of cytomegalovirus among homosexual men attending a clinic for

sexually transmitted diseases. Journal of Infectious Diseases, 150, 330–333.

Greenspoon, J., & Lamal, P. (1987). A behavioristic approach. In L. Diamant (Ed.), Male and female

homosexuality: Psychological approaches (pp. 109–127). New York: Hemisphere.

Greenwood, G. L., Relf, M. V., Huang, B., Pollack, L. M., Canchola, J. A., & Catania, J. A. (2002).

Battering victimization among a probability-based sample of men who have sex with men. American

Journal of Public Health, 92, 1964–1969.

Greer, W. G, Jr., & Volkan, V. D. (1991). Transitional phenomena and anal narcissism controlling the

relationship with representations of the mother and father: The transference in a case of latent homosexuality.

In C. W. Socarides & V. D. Volkan (Eds.), The homosexualities and the therapeutic process

(pp. 109–141). Madison, CT: International Universities Press.

Gruskin, E. P., & Gordon, N. (2006). Gay/lesbian sexual orientation increases risk for cigarette

smoking and heavy drinking among members of a large Northern California health plan. BMC

Public Health, 6, 241.

Grygier, T. (1958). Homosexuality, neurosis, and “normality.” British Journal of Psychology, 9, 59–61.

Guinan, J. (1984). Heterosexual and homosexual patients with acquired immunodeficiency syndrome.

Annals of Internal Medicine, 100, 213–218.

Hadden, S. B. (1958). Treatment of homosexuality by individual and group psychotherapy. American

Journal of Psychiatry, 114, 810–815.

Hadden, S. B. (1966). Treatment of male homosexuals in groups. International Journal of Group

Psychotherapy, 16(1), 13–22.

Hadden, S. B. (1971). Group therapy for homosexuals. Medical Aspects of Human Sexuality, 5(1),

116–127.

Hadfield, J. A. (1958). The cure of homosexuality. British Medical Journal, 1(2), 1323–1326.

Haldeman, D. C. (1991). Sexual orientation conversion therapy for gay men and lesbians: A scientific

examination. In J. C. Gonsiorek & J. D. Weinrich (Eds.), Homosexuality: Research implications for

public policy (pp. 149–160). Newbury Park, CA: SAGE.

Haldeman, D. C. (1994). The practice and ethics of sexual orientation conversion therapy. Journal of

Consulting and Clinical Psychology, 62, 221–227.

Haldeman, D. C. (2000). Gay rights, patients’ rights: The implementations of sexual orientation

conversion therapy. Paper presented at the meeting of the American Psychological Association,

Washington, D.C.

Haldeman, D. C. (2001). Therapeutic antidotes: Helping gay and bisexual men recover from conversion

therapies. In A. Shidlo, M. Schroeder, & J. Drescher (Eds.), Sexual conversion therapy: Ethical, clinical,

and research perspectives (pp. 117–130). Binghamton, NY: Haworth Press.

Hall, J. M. (1994). The experience of lesbians in Alcoholics Anonymous. Western Journal of Nursing

Research, 16, 556–576.

Hallam, R. S., & Rachman, S. (1972). Some effects of aversion therapy on patients with sexual disorders.

Behaviour Research and Therapy, 10(2), 171–180.

Hammelman, T. L. (1993). Gay and lesbian youth: Contributing factors to serious attempts or considerations

of suicide. Journal of Gay and Lesbian Psychotherapy, 2, 77–89.

Handsfield, H. H. (1981). Sexually transmitted diseases in homosexual men. American Journal of Public

Health, 71, 989–990.

Handsfield, H. H., & Schwebke, J. (1990). Trends in sexually transmitted diseases in homosexually active

men in King County, Washington, 1980–1990. Sexually Transmitted Diseases, 17, 211–215.

Hanson, R., & Adesso, V. (1972). A multiple behavioral approach to male homosexual behavior: A case

study. Journal of Behavioral Therapy and Experimental Psychiatry, 3, 323–325.

Harry, J. (1984). Gay couples. New York: Praeger Publishers.

Harvey, J. F. (1987). The homosexual person: New thinking in pastoral care. San Francisco: Ignatius Press.

Harvey, J. F. (1996). The truth about homosexuality: The cry of the faithful. San Francisco: Ignatius Press.

Hastings, D. W. (1963). Impotence and frigidity. Boston: Little, Brown.

Hatterer, L. J. (1970). Changing homosexuality in the male: Treatment for men troubled by homosexuality.

New York: McGraw-Hill.

Hatzenbuehler, M. L., Corbin, W. R., & Fromme, K. (2008). Trajectories and determinants of alcohol

use among LGB young adults and their heterosexual peers: Results from a prospective study.

Developmental Psychology, 44(1), 81–90.

Hays, R. B., Turner, H., & Coates, T. J. (1992). Social support, AIDS-related symptoms, and depression

among gay men. Journal of Consulting and Clinical Psychology, 60, 463–469.

Hegna, K., & Wichstrom, L. (2007). Suicide attempts among Norwegian gay, lesbian, and bisexual

youths: General and specific risk factors. Acta Sociologica, 50(1), 21–37.

Hemphill, R. E., Leitch, A., & Stuart, J. R. (1958). A factual study of male homosexuality. British

Medical Journal, 1, 1323.

Hendin, H. (1992). Suicide among homosexual men. American Journal of Psychiatry, 149, 1426–1427.

Hendin, H. (1995). Suicide and homosexuality. Suicide in America (pp. 129–146). New York: W. W. Norton.

Henslin, J. M., & Sagarin, E. (Eds.) (1978). The sociology of sex. New York: Schocken Books.

Herek, G. (2002). Gender gaps in public opinion about lesbians and gay men. Public Opinion Quarterly,

66, 40–66.

Herman, S. H., Barlow, D. H., Agras, W. S. (1974). An experimental analysis of classical conditioning as

a method of increasing heterosexual arousal in homosexuals. Behavior Therapy, 5, 33–47.

Herrell, R., Goldberg J., True, W. R., Ramakrishnan, V., Lyons, M., Eisen, S., & Tsuang, M. T. (1999).

Sexual orientation and suicidality: A co-twin control study in adult men. Archives of General

Psychiatry, 56(10), 867–874.

Hershberger, S. L. (2006). Guttman scalability confirms the effectiveness of reparative therapy. In J.

Drescher & K. Zucker (Eds.), Ex-gay research: Analyzing the Spitzer study and its relation to science,

religion, politics, and culture (pp. 137–140). New York: Harrington Park Press.

Hershberger, S. L., Scott, L., & D’Augelli, A. P. (1995). The impact of victimization on the mental

health and suicidality of lesbian, gay, and bisexuals. Developmental Psychology, 31(1), 65–74.

Herzog, D. B., Bradburn, I. S., & Newman, K. (1990). Sexuality in males with eating disorders. In A. E.

Andersen (Ed.), Males with eating disorders (pp. 40–53). New York: Brunner/Mazel.

Hiatt, D., & Hargrave, G. (1994). Psychological assessment of gay and lesbian law enforcement applicants.

Journal of Personality Assessment, 63, 80–88.

Hickson, F. C. I., Davies, P. M., Hunt, A. J., Weatherburn, P., McManus, T. J., & Coxon, A. P. M. (1994).

Gay men as victims of nonconsensual sex. Archives of Sexual Behavior, 23(3), 281–294.

Hillier, L., Turner, A, & Mitchell, A. (2005). The second national report on sexuality, health, and well-being

of same-sex attracted young Australians. Melbourne, Australia: Australian Research Center in Sex,

Health, and Society.

Hoffman, W. H. (1987). Gay plays. New York: Avon Books.

Hooker, E. (1957). The adjustment of the male overt homosexual. Journal of Projective Techniques, 21, 18–31.

Horstman, W. R. (1972). Homosexuality and psychopathology: A study of the MMPI responses of

homosexual and heterosexual male college students. Unpublished doctoral dissertation, University

of Oregon, Eugene.

Houston, E., & McKirnan, D. J. (2007). Intimate partner abuse among gay and bisexual men: Risk correlates

and health outcomes. Journal of Urban Health, 84(5), 681–690.

Huether, S. E., & McCance, K. L. (1996). Understanding pathophysiology. St. Louis, MO: Mosby.

Huff, F. (1970). The desensitization of a homosexual. Behavioral Research Therapy, 8, 99–102.

Hughes, T. L., & Wilsnack, S. C. (1994). Research on lesbians and alcohol: Gaps and implications.

Special focus: Women and alcohol. Alcohol Health and Research World, 18, 202–205.

Human Rights Campaign. (1998, August). Mission impossible: Why reparative therapy and exgay

ministries fail. Retrieved December 23, 2006, from http://www.isupride.org/home/index

.php?option=com_docman&task=doc_download&gid=2

Hunt, M. (1993). The story of psychology. New York: Doubleday.

Jacobi, J. (1969). Case of homosexuality. Journal of Analytical Psychology, 14, 48–64.

Jadresic, D., Riccio, M., Hawkins, D. A., & Wilson, B. (1994). Long-term impact of HIV diagnosis on mood

and substance use: St. Stephen’s cohort study. International Journal of STDs and AIDS, 5, 248–252.

James, E. C. (1978). Treatment of homosexuality: A reanalysis and synthesis of outcome studies.

Unpublished doctoral dissertation, Brigham Young University, Provo, UT.

James, S. (1978). Treatment of homosexuality II. Superiority of desensitization/arousal as compared with

anticipatory avoidance conditioning: Results of a controlled trial. Behavioral Therapy, 9, 28–36.

Janov, A. (1970). The primal scream. New York: Dell Publishing.

Jay, K., & Young, A. (1979). The gay report: Lesbians and gay men speak out about their sexual experiences

and lifestyles. New York: Summit Books.

Johnson, R. H. (1955). Counseling the homosexual. Family Life, 15(9), 5–6.

Johnson, S. R., & Palermo, J. L. (1992). Gynecologic care for the lesbian. In W. R. Dynes & S. Donaldson

(Eds.), Studies in Homosexuality: Vol. 9, Homosexuality and medicine, health, and science (pp. 96–103).

New York: Garland.

Jones, S. L., & Yarhouse, M. A. (2000). Homosexuality: The use of scientific research in the church’s moral

debate. Downer’s Grove, IL: InterVarsity Press.

Jones, S. L., & Yarhouse, M. A. (2007). Ex-gays? A longitudinal study of religiously mediated change in

sexual orientation. Downer’s Grove, IL: InterVarsity Press.

Jorm, A. F., Korten, A. E., Rodgers, B., Jacomb, P. A., & Christensen, H. (2002). Sexual orientation and

mental health: Results from a community survey of young and middle-aged adults. British Journal

of Psychiatry, 180, 423–427.

Judkins, L. R. (1993). Someone to devour. Alliance Life: A Journal of Christian Life and Missions,

128(16), 8–12.

Judson, F. N., Penley, K. A., Robinson, M. A., & Smith, J. K. (1980). Comparative prevalence rates of sexually

transmitted diseases in heterosexuals and homosexual men. American Journal of Epidemiology,

112, 836–843.

Just the Facts Coalition. (2008). Just the facts about sexual orientation and youth: A primer for principals,

educators, and school personnel. Washington, D.C., American Psychological Association. Retrieved

July 31, 2008, from http://www.apa.org/pi/lgbc/publications/justthefacts.html

Kaiser Family Foundation, (2001). Inside-OUT: A report on the experiences of lesbians, gays, and bisexuals

and the public’s views on issues and policies related to sexual orientation (Publication No.

3193). Menlo Park, CA: Author.

Kalichman, S. C., & Rompa, D. (1995). Sexually coerced and noncoerced gay and bisexual men: Factors relevant

to risk for human immunodeficiency virus (HIV) infection. Journal of Sex Research, 32, 45–50.

Karpman, B. (1954). The sexual offender and his offenses: Etiology, pathology, psychodynamics, and

treatment. New York: Julian Press.

Karten, E. (2006). Sexual reorientation efforts in dissatisfied same-sex attracted men: What does it really

take to change? Unpublished doctoral dissertation, Fordham University, New York.

Kaslow, R. A., Ostrow, D. G., Detels, R., Phair, J. P., Polk, B. F., & Rinaldo, C. R., Jr. (1987). The multicenter

AIDS cohort study: Rationale, organization, and selected characteristics of the participants.

American Journal of Epidemiology, 126, 310–318.

Kaye, H. E., Berl, S., Clare, J., Eleston, M. R., Gershwin, B. S., Gershwin, P., Kogan, L. S., Torda, C., &

Wilbur, C. B. (1967). Homosexuality in women. Archives of General Psychiatry, 17(5), 626–634.

Keefe, J. (1987). A sharper focus on homosexuality. In J. F. Harvey (Ed.), The homosexual person: New

thinking in pastoral care (pp. 65–78). San Francisco: Ignatius Press.

Keet, I. P. (1992). Orogenital sex and the transmission of HIV among homosexual men. AIDS, 6,

223–226.

Kelly, C., & Warshafsky, L. (1987). Partner abuse in gay male and lesbian couples. Third National

Conference for Family Violence Researchers, Durham, NC.

Kelly, J. A., Kalichman, S. C., Kauth, M. R., Kilgore, H. G., Hood, H. V., Campos, P. E., Rao, S. M.,

Brasfield, T. L., & St. Lawrence, J. S. (1991). Situational factors associated with AIDS risk behavior

lapses and coping strategies used by gay men who successfully avoid lapses. American Journal of

Public Health, 81, 1335–1338.

Kelly, J. A., Sikkema, K. J., Winett, R. A., & Solomon, L. J. (1995). Factors predicting continued highrisk

behavior among gay men in small cities: Psychological, behavioral, and demographic characteristics

related to unsafe sex. Journal of Consulting and Clinical Psychology, 63, 101–107.

Kelly, J. A., St. Lawrence, J. S., & Brasfield, T. L. (1991). Predictors of vulnerability to AIDS risk behavior

relapse. Journal of Consulting and Clinical Psychology 59, 163–166.

Kelly, J. A., St. Lawrence, J. S., Brasfield, T. L., Lemke, A., Amidei, T., Roffman, R. E., Hood, H. V.,

Smith, J. E., Kilgore, H., & McNeill, C., Jr. (1990). Psychological factors that predict AIDS high-risk

versus AIDS precautionary behavior. Journal of Consulting and Clinical Psychology, 58, 117–120.

Kendrick, D., & Clarke, R. (1967). Attitudinal differences between heterosexually and homosexuallyoriented

males. British Journal of Psychiatry, 113, 95–99.

Kendrick, S., & McCullough, J. (1972). Sequential phases of covert reinforcement and covert sensitization

in the treatment of homosexuality. Journal of Behavioral Therapy and Experimental Psychiatry,

3, 229–231.

Kernberg, O. F. (2002). Unresolved issues in the psychoanalytic theory of homosexuality and bisexuality.

Journal of Gay and Lesbian Psychotherapy, 6(1), 9–27.

Ketterer, W. A. (1983). Medical problems of homosexuals. Medical Aspects of Human Sexuality, 17(10),

55–81.

King, M., & McKeown, E. (2003). Mental health and social wellbeing of gay men, lesbians, and bisexuals

in England and Wales. London: Mind (National Association for Mental Health).

King, M., & Nazareth, I. (2006). The health of people classified as lesbian, gay and bisexual attending

family practitioners in London: A controlled study. BMC Public Health, 6, 127.

King, M., Semlyen, J., Tai, S. S., Killaspy, H., Osborn, D., Popelyuk, D., & Nazareth, I. (2008). A systematic

review of mental disorder, suicide, and deliberate self harm in lesbian, gay, and bisexual people.

BMC Psychiatry, 8, 70.

Kinsey, A. C., Pomeroy, W. B., & Martin, C. E. (1948). Sexual behavior in the human male. Philadelphia:

W. B. Saunders.

Kirp, D. L. (1995, October 1). The nightmare of survival: Examining the dark side of being spared by

the AIDS virus. [Review of the book, In the shadows of the epidemic]. New York Times, p. B22.

Klein, D. (1981, August). Interview with Helen Singer Kaplan. Omni, 72–92.

Klein, F. (1978). The bisexual option. New York: Arbor House.

Konrad, J. (1987). You don’t have to be gay. Newport Beach, CA: Pacific Publishing House.

Koss, M. (1990). The women’s mental health research agenda: Violence against women. American

Psychologist, 45(3), 374–380.

Kourany, R. F. C. (1987). Suicide among homosexual adolescents. Journal of Homosexuality, 13,

111–117.

Kraft, T. (1967). A case of homosexuality treated by systematic desensitization. American Journal of

Psychotherapy, 21(4), 815–821.

Kraft, T. (1970). Systematic desensitization in the treatment of homosexuality. Behavior Research and

Therapy, 8, 319.

Krahe, B., Schutze, S., Fritsche, I., & Waizenhofer, E. (2000). The prevalence of sexual aggression

and victimization among homosexual men—statistical data included. Journal of Sex Research, 37,

142–150.

Kronemeyer, R. (1980). Overcoming homosexuality. New York: Macmillan.

Kruks, G. (1991). Gay and lesbian homeless/street youth: Special issues and concerns. Journal of

Adolescent Health, 12(7), 515–518.

Kryzan, C., & Walsh, J. (1998). The !OutProud!/Oasis Internet survey of queer and questioning youth.

Retrieved July 31, 2006, from http://www.outproud.org/pdf/qys1997reportpub.pdf

Kurdek, L. A., & Schmitt, J. P. (1986). Relationship quality of gay men in closed or open relationships.

Journal of Homosexuality, 12(2), 85–99.

LaBarbera, P. (Ed.) (1994, July). Lambda report. Washington, DC: Author.

Lamberd, W. G. (1969). The treatment of homosexuality as a monosymptomatic phobia. American

Journal of Psychiatry, 126, 512–518.

Lamberd, W. G. (1971). Viewpoints: What outcome can be expected in psychotherapy of homosexuals?

Medical Aspects of Human Sexuality, 5(12), 90–105.

Lambert, M. J., & Ogles, B. M. (2004). The efficacy and effectiveness of psychotherapy. In M. J. Lambert

(Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (5th ed., pp. 139–193).

New York: John Wiley & Sons.

Lang, N. G. (1991). Stigma, self-esteem, and depression: Psycho-social responses to risk of AIDS.

Human Organization, 50, 66–72.

Larson, D. (1970). An adaptation of the Feldman and MacCulloch approach to treatment of homosexuality

by the application of anticipatory avoidance learning. Behavioral Research and Therapy, 8, 209–210.

Lasser, J, S., & Gottlieb, M. C. (2004). Treating patients distressed regarding their sexual orientation:

Clinical and ethical alternatives. Professional Psychology: Research and Practice, 35(2), 194–200.

Laumann, E. O., Gagnon, J. H., Michael, R. T., & Michaels, S. (1994). The social organization of sexuality.

Chicago: University of Chicago Press.

Lauritsen, J. (1993). The AIDS war: Propaganda, profiteering, and genocide from the medical-industrial

complex. New York: Asklepios.

Lemp, G. F., Hirozawa, A. M., & Givertz, D. (1994). Seroprevalence of HIV and risk behaviors among

young homosexual and bisexual men: The San Francisco/Berkeley young men’s survey. Journal of the

American Medical Association, 272, 449–454.

Lemp, G. F., Hirozawa, A. M., & Givertz, D. (1995). HIV seroprevalence and risk behaviors among

lesbians and bisexual women in San Francisco and Berkeley, California. American Journal of Public

Health, 85, 1549–1552.

Lester, D. (1975). Unusual sexual behavior: The standard deviations. Springfield, IL: Charles C. Thomas.

Lester, D. (2006). Sexual orientation and suicidal behavior. Psychological Reports, 99(3), 923–924.

Leukefeld, C. G., Battjes, R., & Armsel, Z. (1990). AIDS and intravenous drug use: Community intervention

and prevention. Washington, DC: National Institute on Drug Abuse.

Lewis, C. E., Saghir, M. T., & Robins, E. (1982). Drinking patterns in homosexual and heterosexual

women. Journal of Clinical Psychiatry, 43, 277–279.

Lie, G. Y., & Gentlewainer, S. (1991). Intimate violence in lesbian relationships: Discussion of survey

findings and practice implications. Journal of Social Service Research, 15, 41–59.

Lifson, A. R., O’Malley, P. M., Hessol, N. A., Buchbinder, S. P., Cannon, L., & Rutherford, G. W.

(1990). HIV seroconversion in two homosexual men after receptive oral intercourse with ejaculation:

Implications for counseling concerning safe sexual practices. Public Health Briefs, 80, 1509–1511.

Linn, L. S., Spiegel, J. S., Mathews, W. C., Leake, B., Lien, R., & Brooks, S. (1989). Recent sexual behaviors

among homosexual men seeking primary medical care. Archives of Medicine, 149, 2685–2690.

Litman, R. E. (1961). Psychotherapy of a homosexual man in heterosexual group. International Journal

of Group Psychotherapy, 11(4), 440–448.

Lobel, K. (Ed). (1986). Naming the violence: Speaking out about lesbian battering. Seattle: Seal Press.

Lockhart, L. L., White, B. W., & Causby, V. (1994). Letting out the secret: Violence in lesbian relationships.

Journal of Interpersonal Violence, 9, 469–492.

Lohrenz, L., Donnelly, J., Coyne, L., & Spare, K. (1978). Alcohol problems in several midwestern homosexual

communities. Journal of Studies on Alcohol, 39, 1959–1963.

London, L. S., & Caprio, F. S. (1950). Sexual deviations: A psychodynamic approach. Washington, DC:

Linacre Press.

Loney, J. (1971). An MMPI measure of maladjustment in a sample of normal homosexual men. Journal

of Clinical Psychology, 27, 486–488.

MacAlpine, I. (1953). Pruritis ani. Psychosomatic Medicine, 15, 499–508.

MacCulloch, M. J., & Feldman, M. P. (1967). Aversion therapy in management of 43 homosexuals.

British Medical Journal, 2, 594–597.

MacIntosh, H. (1994). Attitudes and experiences of psychoanalysis in analyzing homosexual patients.

Journal of the American Psychoanalytic Association, 42, 1183–1207.

Maletzky, B. M., & George, F. S. (1973). The treatment of homosexuality by “assisted” covert sensitization.

Journal of Behavior Research and Therapy, 11(4), 655–657.

Mandel, K. (1970). Preliminary report of a new aversion therapy for male homosexuals. Behavioral

Research and Therapy, 8, 93–95.

Manosevitz, M. (1971). Education and MMPI MF scores in homosexual and heterosexual males.

Journal of Consulting Clinical Psychology, 36, 395–399.

Marks, G., Richardson, J. L., Ruiz, M. S., & Maldonado, N. (1992). HIV-infected men’s practices in

notifying past sexual partners of infection risk. Public Health Reports, 107, 100–105.

Marmor, J. (1975). Homosexuality and sexual orientation disturbances. In A. Freedman, H. Kaplan, &

B. Sadock (Eds.), Comprehensive Textbook of Psychiatry II (2nd ed.). Baltimore: Lippincott Williams

& Wilkins.

Marquis, J. (1970). Orgasmic reconditioning: Changing sexual object choice through controlling masturbation

fantasies. Journal of Behavioral Therapy and Experimental Psychiatry, 1, 263–271.

Marshal, M. P., Friedman, M. S., Stall, R., King, K. M., Miles, J., Gold, M. A., Bukstein, O. G., &

Morse, J. Q. (2008). Sexual orientation and adolescent substance use: A meta-analysis and methodological

review. Addiction, 103, 546–556.

Martin, D. J. (1990). A study to the deficiencies in the condom-use skills of gay men. Public Health

Reports, 105, 638–640.

Martin, J. L. (1987). Impact of AIDS on gay male sexual behavior patterns in New York City. American

Journal of Public Health, 77, 578–581.

Masters, W., & Johnson, V. (1979). Homosexuality in perspective. Boston: Little, Brown.

Mather, N. J. (1966). The treatment of homosexuality by aversion therapy. Medicine, Science, and the Law,

6(4), 200–205.

Mavligit, G. M. (1984). Chronic immune stimulation by sperm alloantigens: Support for the hypothesis

that spermatozoa induces immune deregulation in homosexual males. Journal of the American

Medical Association, 251, 237–241.

Max, L. W. (1935). Breaking up a homosexual fixation by the conditioned reaction technique: A case

study. Psychological Bulletin, 32, 734.

Mayerson, P., & Lief, H. (1965). Psychotherapy of homosexuals: A follow-up study. In J. Marmor (Ed.),

Sexual inversion: The multiple roots of homosexuality (pp. 302–344). New York: Basic Books.

McCarroll, J. E., Ursano, R. J., Fan, Z., & Newby, J. H. (2004). Comparison of U.S. army and civilian

substantiated reports of child maltreatment. Child Maltreatment, 9(1), 103–110.

McCombs, M. S., & White, K. P. (1990, August). Gay men’s risky sex relapse: Research implications,

program designs. Paper presented at the 98th Annual Convention of the American Psychological

Association: Boston.

McConaghy, N. (1969). Subjective and penile plethysmographic responses following aversion-relief and

apomorphine aversion therapy for homosexual impulses. British Journal of Psychiatry, 115, 723–730.

McConaghy, N. (1970). Subjective and penile plethysmograph responses to aversion therapy for homosexuality:

A follow-up study. British Journal of Psychiatry, 117, 555–560.

McConaghy, N. (1975). Aversion and positive conditioning treatments of homosexuality. Behavioral

Research and Therapy, 13, 309–319.

McConaghy, N. (2000, July). The nuances of sexual orientation. Quadrant, p. 5.

McConaghy, N., Armstrong, M. S., & Blaszczynski, A. (1981). Controlled comparison of aversive therapy

and covert sensitization in compulsive homosexuality. Behaviour Research and Therapy, 19(5),

425–434.

McConaghy, N., & Barr, R. E. (1973). Classical, avoidance, and backward conditioning treatments of

homosexuality. British Journal of Psychiatry, 122, 151–162.

McConaghy, N., Proctor, D., & Barr, R. (1972). Subjective and penile plethysmography responses to

aversion therapy for homosexuality: A partial replication. Archives of Sexual Behavior, 2, 65–78.

McConaghy, N., & Zamir, R. (1995). Heterosexual and homosexual coercion, sexual orientation, and

sexual roles in medical students. Archives of Sexual Behavior, 24, 489–502.

McCormick, C. M., & Witelson, S. F. (1991). A cognitive profile of homosexual men compared to

heterosexual men and women. Psychoneuroendocrinology, 16, 459–473.

McKirnan, D. J., Stokes, J. P., & Doll, L. (1995). Bisexually active men: Social characteristics and sexual

behavior. Journal of Sex Research, 32, 65–76.

McKusick, L., Coates, T. J., Morin, S. F., Pollack, L., & Hoff, C. (1990). Longitudinal predictors of

reductions in unprotected anal intercourse among gay men in San Francisco: The AIDS behavioral

research project. American Journal of Public Health, 80, 978–983.

McKusick, L., Horstman, W., & Coates, T. J. (1985). AIDS and sexual behavior reported in San

Francisco. American Journal of Public Health, 75, 493–496.

McLean, J., Boulton, M., Brooks, M., & Lakani, D. (1994). Regular partners and risky behaviour: Why

do gay men have unprotected intercourse? AIDS Care, 6, 331–341.

McManus, T. J., Starrett, L. A., & Harris, J. R. (1982). Amyl nitrite use by homosexuals. Lancet, 1(8270),

503–520.

McWhirter, D. P., & Mattison, A. M. (1984). The male couple: How relationships develop. Englewood

Cliffs, NJ: Prentice-Hall.

Meads, C. A., Buckley, E. J., & Sanderson, P. K. (2007). Ten years of lesbian health survey research in

the UK West Midlands. BMC Public Health, 7, 251.

Mendelsohn F., & Ross, M. (1959). An analysis of 133 homosexuals seen at a university hall health

service. Diseases of the nervous system, 20(6), 246–250.

Mercer, C. H., Hart, G. J., Johnson, A. M., & Cassell, J. A. (2009) Behaviourally bisexual men as a

bridge population for HIV and sexually transmitted infections? Evidence from a national probability

survey. International Journal of STD and AIDS, 20, 87–94.

Meissner, N., & Morton, H. (1977). Alcoholism and the gay community. Vancouver: Vancouver (Canada)

Society for Education, Action, Research and Counseling on Homosexuality.

Mesmer, R. (1992). Homosexuals who change lifestyles. Journal of Christian Healing, 14, 12–18.

Messina, S. (1992). Lesbian, gay, and bisexual youth: At risk and undeserved. Washington, DC: Advocates

for Youth.

Meyer-Bahlburg, H. F. L., Exner, T. M., Lorenz, G., Gruen, R. S., Gorman, J. M., & Ehrhardt, A. A.

(1991). Sexual risk behavior, sexual functioning, and HIV disease progression in gay men. Journal

of Sex Research, 28(1), 3–27.

Michael, R. T., Gagnon, J. H., Laumann, E. O., & Kolata, G. (1994). Sex in America: A definitive survey.

Boston: Little, Brown.

Miles, A. J., Allen-Mersh, T. G., & Wastell, C. (1993). Effects of anoreceptive intercourse on anorectal

function. Journal of the Royal Society of Medicine, 86, 144–147.

Miller, P. M., Bradley, J. B., Gross, R. S., & Wood, G. (1968). Review of homosexuality research (1960–

1966) and some implications for treatment. Psychotherapy: Theory, Research, and Practice, 5, 3–6.

Mintz, E. (1966). Overt male homosexuals in combined group and individual treatment. Journal of

Consulting Psychology, 30, 193–198.

Mitchell, S. A. (2002). The psychoanalytic treatment of homosexuality: Some technical considerations.

Studies of Gender and Sexuality, 3, 23–59.

Moan, C. E., & Heath, R. G. (1972). Septal stimulation for the initiation of heterosexual behavior in a

homosexual male. Journal of Behavior Therapy and Experimental Psychiatry, 3, 23–30.

Moberly, E. R. (1983). Homosexuality: A new Christian ethic. Cambridge: James Clarke.

Mohr, D. C. (1995). Negative outcome in psychotherapy: A critical review. Clinical Psychiatry: Science

and Practice, 2, 1–7.

Mohr, J. W., & Turner, R. E. (1967). Sexual deviations. Applied Therapeutics, 9, 165–168.

Molenaar, J. (1994). The “safe sex” debate: Ten years down the track. GAMMA Project Newsletter, 3(3), 1–2.

Monachello, R. J. (2006). The father and son relationship in homosexual identity development: A phenomenological

study. Unpublished doctoral dissertation, St. Mary’s University, San Antonio, TX.

Monroe, R. R., & Enelow, R. G. (1960). The therapeutic motivation in male homosexuals. American

Journal of Psychotherapy, 14, 474–490.

Moor, P. (2001). The view from Irving Bieber’s couch: “Heads I win, tails you lose.” In A. Shidlo, M.

Schroeder, & J. Drescher (Eds.), Sexual conversion therapy: Ethical, clinical, and research perspectives

(pp. 25–36). Binghamton, NY: Haworth Press.

Morin, G., & Rothblum, G. (1991). Removing the stigma: Fifteen years of progress. American Psychologist,

46(9), 947–949.

Murphy, T. F. (1991). The ethics of conversion therapy. Bioethics, 5, 123–138.

Myers, T., Godin, G., Calzavara, L., Lambert, J., & Locker, D. (1992). HIV, substance use, and related

behavior of gay and bisexual men: An examination of the talking sex project cohort. British Journal

of Addiction, 87, 209–212.

Myers, T., Godin, G., Calzavara, L., Lambert, J., & Locker, D. (1993). The Canadian survey of gay and

bisexual men and HIV infection: Men’s survey. Ottawa, Canada: Canadian AIDS Society.

Myers, T., Godin, G., Lambert, J., Calzavara, L., & Locker, D. (1996). Sexual risk and HIV-testing

behaviour by gay and bisexual men in Canada. AIDS Care: Psychological and Socio-medical Aspects of

AIDS/HIV, 8, 297–310.

Nardi, P. (1982). Alcoholism and homosexuality: A theoretical perspective. In T. Tiebold & J. Mongeon

(Eds.), Alcoholism and homosexuality (pp. 9–25). New York: Haworth Press.

National Association of Social Workers. (2006). Social work speaks: NASW policy statements, 2006–2009

(7th ed.). Washington, DC: Author.

Newman, M., Berkowitz, B., & Owen, J. (1971). How to be your own best friend. New York: Lark.

Newmeyer, J. A. (1992). The sensuous hippie part II: Gay/straight differences in regards to drugs and

sexuality. In W. R. Dynes (Ed.), Homosexuality and medicine, health, and science (pp. 49–55). New

York: Garland.

Nicolosi, J. (1991). Reparative therapy of male homosexuality: A new clinical approach. Northvale, NJ:

Jason Aronson.

Nicolosi, J. (1993). Healing homosexuality: Case studies of reparative therapy. Northvale, NJ: Jason

Aronson.

Nicolosi, J. (in press). Shame and attachment loss: The practical work of reparative therapy. Downer’s

Grove, IL: InterVarsity Press.

Nicolosi, J. (in press). Medication in the treatment of unwanted homosexuality: A case study. Psychological

Reports.

Nicolosi, J., Byrd, A. D., & Potts, R. W. (2000a). Beliefs and practices of therapists who practice sexual

reorientation psychotherapy. Psychological Reports, 86, 689–702.

Nicolosi, J., Byrd, A. D., & Potts, R. W. (2000b). Retrospective self-reports of changes in homosexual

orientation: A consumer survey of conversion therapy clients. Psychological Reports, 86, 1071–1088.

Nottebaum, L. J., Schaeffer, K. W., Rood, J., & Leffler, D. (2000). Sexual-orientation: A comparison study.

Manuscript submitted for publication.

Nurius, P. S. (1983). Mental health implications of sexual orientation. Journal of Sex Research, 19,

119–136.

Odets, W. (1994a, October). Report to the American Association of Physicians for Human Rights.

In E. L. Goldman (Ed.), Psychological factors that generate HIV resurgence in young gay men.

Clinical Psychiatry News, 5.

Odets, W. (1994b). AIDS education and harm reduction for gay men: Psychological approaches for the

21st century. AIDS and Public Policy Journal, 9, 3–15.

Offir, J. T., Fisher, J. D., Williams, S. S., & Fisher, W. A. (1993). Reasons for inconsistent AIDSprevention

behaviors among gay men. The Journal of Sex Research, 30(1), 62–69.

Oliver, W., & Mosher, D. (1968). Psychopathy and guilt in heterosexual and subgroups of homosexual

reformatory inmates. Journal of Abnormal Psychology, 73, 323–329.

Orwin, A., James, S. R., & Turner, R. K. (1974). Sex chromosome abnormalities, homosexuality, and

psychological treatment. British Journal of Psychiatry, 124, 293–295.

Osmond, D. H., Page, K., & Wiley, J. (1994). HIV infection in homosexual and bisexual men 18 to

29 years of age: The San Francisco young men’s health study. American Journal of Public Health, 84,

1933–1937.

Ostrow, D. G. (1990). Behavioral aspects of AIDS. New York: Plenum Medical Books.

Ostrow, D. G., Beltran, E., & Joseph, J. (1994). Sexual behavior research on a cohort of gay men, 1984–1990:

Can we predict how men will respond to intervention? Archives of Sexual Behavior, 23, 531–552.

Otis, M. D., & Skinner, W. F. (2004). An exploratory study of differences in views of factors affecting

sexual orientation for a sample of lesbians and gay men. Psychological Reports, 94, 1173–1179.

Ovesey, L. (1969). Homosexuality and pseudohomosexuality. New York: Science House.

Ovesey, L., Gaylin, W., & Hendin, H. (1963). Psychotherapy of male homosexuality: Psychodynamic

formulation. Archives of General Psychiatry, 9, 19–31.

Owen, S. S., & Burke, T. W. (2004). An exploration of prevalence of domestic violence in same-sex

relationships. Psychological Reports, 95, 129–132.

Owen, W. F., Jr. (1985). Medical problems of the homosexual adolescent. Journal of Adolescent Health

Care, 6, 278–285.

Owensby, N. M. (1940). Homosexuality and lesbianism treated with Metrazol. Journal of Nervous and

Mental Disease, 92, 65–66.

Paloutzian, R. F., & Ellison, C. W. (1991). Manual for the Spiritual Well-Being Scale. Nyack, NY: Life

Advance.

Parsons, J. T., & Bimbi, D. S. (2007). Intentional unprotected anal intercourse among sex who have

sex with men: Barebacking—from behavior to identity. AIDS and Behavior, 11(2), 277–287.

Parsons, J. T., Kelly, B. C., Bimbi, D. S., Muench, F., & Morgenstern, J. (2007). Accounting for the social

triggers of sexual compulsivity. Journal of Addictive Diseases, 26(3), 5–16.

Pattison, E. M., and Pattison, M. L. (1980). “Ex-gays”: Religiously mediated change in homosexuals.

American Journal of Psychiatry, 137, 1553–1562.

Paul, J. P., Catania, J., Pollack, L., Moskowitz, J., Canchola, J., Mills, T., Binson, D., & Stall, R. (2002).

Suicide attempts among gay and bisexual men: Lifetime prevalence and antecedents. American

Journal of Public Health, 92, 1338–1345.

People Can Change. (2006). Survey results: What past “Journeyers” say. Retrieved December 6, 2006,

from http://www.peoplecanchange.com/pdfs/JIM%20survey%20results.pdf

Phillips, D., Fischer, S. C., Groves, G. A., & Singh, R. (1976). Alternative behavioral approaches to the

treatment of homosexuality. Archives of Sexual Behavior, 5, 223–228.

Pillard, R. C. (1988). Sexual orientation and mental disorder. Psychiatric Annals, 18, 52–56.

Pittman, F. S., III, & DeYoung, C. D. (1971). The treatment of homosexuals in heterosexual groups.

International Journal of Group Psychotherapy, 21, 62–73.

Poe, J. S. (1952). The successful treatment of a 40-year-old passive homosexual based on an adaptative

view of sexual behavior. Psychoanalytic Review, 39, 23–33.

Pollak, M. (1985). Male homosexuality. In P. Aries & A. Bejin (Eds.), Western sexuality: Practice and

precept in past and present times (pp. 40–61). New York: Basil Blackwell.

Pomeroy, W. B. (1972). Dr. Kinsey and the Institute for Sex Research. New York: Harper and Row Publishers.

Ponticelli, C. M. (1996). The spiritual warfare of Exodus: A post-positivist research adventure. Qualitative

Inquiry, 2, 198–220.

Ponticelli, C. M. (1999). Crafting stories of identity reconstruction. Social Psychology Quarterly, 62, 157–172.

Pradhan, P. V., Ayyar, K. S., & Bagadia, V. N. (1982). Homosexuality: Treatment by behavior modification.

Indian Journal of Psychiatry, 24, 80–83.

Prenzlauer, S., Drescher, J., & Winchel, R. (1992). Suicide among homosexual youth. American Journal

of Psychiatry, 149, 1416.

Prince, M. (1898). Sexual perversions or vice? A pathological and therapeutic inquiry. Journal of Nervous

and Mental Disease, 25, 237–256.

Proctor, C. D., & Groze, V. (1994). Risk factors for suicide among gay, lesbian, and bisexual youths.

Social Work, 39, 504–513.

Pruzan, T. (1996, April 8). Brewing new ties with gay consumers. Advertising Age, p. 13.

Pryor, J., & Reeder, G. D. (1993). The social psychology of HIV infection. Hillsdale, NJ: Lawrence Erlbaum

Associates.

Quadland, M. C., & Shattls, W. D. (1987). AIDS, sexuality, and sexual control. Journal of Homosexuality,

14, 277–296.

Quinn, T. (1986). Clinical approach to intestinal infections in homosexual men. The Medical Clinics of

North America, 70, 611–634.

Rachman, S. (1961). Sexual disorders and behavioral therapy. American Journal of Psychiatry, 118,

235–240.

Ramsey, R. W., & van Velzen, V. (1968). Behavior therapy for sexual perversions. Behavior Research and

Therapy, 6, 233.

Ratner, P. A., Johnson, J. L., Shoveller, J. A., Chan, K., Martindale, S. L., Schilder, A. J., Botnick, M. R.,

& Hogg, R. S. (2003). Nonconsensual sex experienced by men who have sex with men: Prevalence

and association with mental health. Patient Education and Counseling, 49, 67–74.

Regardie, F. I. (1949). Analysis of homosexuality. Psychiatric Quarterly, 23, 548–566.

Rehm, L., & Rozensky, R. (1974). Multiple behavior therapy techniques with a homosexual client: A

case study. Journal of Behavioral Therapy and Experimental Psychiatry, 5, 53–57.

Reinisch, J. M. (1990). The Kinsey Institute new report on sex. New York: St. Martin’s Press.

Rekers, G. A. (1995). Handbook of child and adolescent sexual problems. New York: Lexington Books.

Rekers, G. A. (2006). An empirically supported rational basis for prohibiting adoption, foster parenting,

and contested child custody by any person residing in a household that includes a homosexuallybehaving

member. St. Thomas Law Review, 18, 325–424.

Remafedi, G. (1987). Adolescent homosexuality: Psychosocial and medical implications. Pediatrics, 79,

331–337.

Remafedi, G., Farrow, J. A., & Deisher, R. W. (1991). Risk factors for attempted suicide in gay and

bisexual youth. Pediatrics, 87, 869–875.

Renzetti, C. M. (1992). Violent betrayal: Partner abuse in lesbian relationships. Newbury Park, CA:

SAGE.

Rich, C. L., Fowler, R. C., Young, D., & Benkush, M. (1986). San Diego suicide study: Comparison of

gays to straight males. Suicide and Life-Threatening Behavior, 16, 448–457.

Richards, P. S., & Bergin, A. E. (1999) Handbook of psychotherapy and religious diversity. Washington,

DC: American Psychological Association.

Richards, P. S., & Bergin, A. E. (2003). Casebook for a spiritual strategy in counseling and psychotherapy.

Washington, DC: American Psychological Association.

Richards, P. S., & Bergin, A. E. (2005). Spiritual strategy for counseling and psychotherapy (2nd ed.).

Washington, DC: American Psychological Association.

Richters, J., Grulich, A. E., de Visser, R. O., Smith, A. M. A., & Rissel, C. E. (2003). Sex in Australia:

Autoerotic, esoteric, and other sexual practices engaged in by a representative sample of adults.

Australian and New Zealand Journal of Public Health, 27, 180–190.

Robertiello, R. C. (1959). Voyage from Lesbos: The psychoanalysis of a female homosexual. New York:

Citadel Press.

Roberts, S. J., Sorensen, L., Patsdaughter, C. A., & Grindel, C. (2000). Sexual behaviors and sexually

transmitted diseases of lesbians: Results of the Boston Lesbian Health Project. Journal of Lesbian

Studies, 4(3), 49–70.

Robinson, B. A. (2006). Public opinion polls on homosexuality: Change, acceptability, cause(s) and employment.

Retrieved April 11, 2007, from http://www.religioustolerance.org/hom_poll2.htm

Robinson, J. W. (1998). Understanding the meaning of change for married Latter-day Saint men with

histories of homosexual activity. Unpublished doctoral dissertation, Brigham Young University,

Provo, UT.

Robinson, P. H., & Holden, N. L. (1986). Bulimia nervosa in the male: A report of nine cases. Psychological

Medicine, 16, 795–803.

Roesler, T., & Deisher, R. W. (1972). Youthful male homosexuality. Journal of the American Medical

Association, 219, 1018–1023.

Rompalo, A. (1990). Sexually transmitted causes of gastrointestinal symptoms in homosexual men.

Medical Clinics of North America, 74, 1633–1645.

Roper, P. (1967). The effects of hypnotherapy on homosexuality. Canadian Medical Association Journal,

96(6), 319–327.

Ross, M. W., & Mendelsohn, F. (1958). Homosexuality in college: A preliminary report on the data

obtained from 143 students seen in a university student health center and a review of pertinent

literature. American Medical Association Archives of Neurology and Psychiatry, 80, 253–263.

Ross, M. W., Paulsen, J. A., Stalstrom, O. W. (1988): Homosexuality and mental health: A cross-cultural

review. Journal of Homosexuality, 15(1/2), 131–152.

Rothblum, E. D. (1994). “I only read about myself on bathroom walls”: The need for research on the

mental health of lesbian and gay men. Journal of Consulting and Clinical Psychology, 62, 213–320.

Rotheram-Borus, M. J., & Gwadz, M. (1993). Sexuality among youths at high risk. Child and Adolescent

Psychiatry Clinics of North America, 2, 415–431.

Rotheram-Borus, M. J., Hunter, J., & Rosario, M. (1994). Suicidal behavior and gay-related stress

among gay and bisexual male adolescents. Journal of Adolescent Research, 9, 498–508.

Rotheram-Borus, M. J., Rosario, M., Mayer-Bahlburg, H. F. L., Koopman, C., Dopkins, S. C., & Davies,

M. (1994). Sexual and substance use acts of gay and bisexual male adolescents in New York City.

Journal of Sex Research, 31, 47–57.

Rubinstein, L. H. (1958). Psychotherapeutic aspects of male homosexuality. British Journal of Medical

Psychology, 31, 14–18.

Ruefli, T., Yu, O., & Barton, J. (1992). Sexual risk taking in smaller cities: The case of Buffalo, New York.

Journal of Sex Research, 29, 95–108.

Russell, S. T. (2001, June 1). Young gays contracting HIV at explosive rate. San Francisco Chronicle,

p. 1.

Russell, S. T., & Joyner, K. (2001). Adolescent sexual orientation and suicide risk: Evidence from a national

study. American Journal of Public Health, 91(8), 1276–1281.

Ryan, C., & Bradford, J. (1993). The national lesbian health care survey: An overview. In L. D. Garents

& D. C. Kimmel (Eds.), Psychological perspectives on lesbian and gay male experiences (pp. 541–556).

New York: Columbia University.

Safren, S. A., & Heimberg, R. G. (1999). Depression, hopelessness, suicidality, and related factors in

sexual minority and heterosexual adolescents. Journal of Consulting and Clinical Psychology, 67,

859–866.

Saghir, M. T., & Robins, E. (1971). Male and female homosexuality: Natural history. Comprehensive

Psychiatry, 12, 503–510.

Saghir, M. T., & Robins, E. (1973). Male and female homosexuality: A comprehensive investigation.

Baltimore: Lippincott Williams & Wilkins.

Saghir, M. T., Robins, E., Walbran, B., & Gentry, K. A. (1970). Homosexuality IV: Psychiatric disorders

and disability in the female homosexuals. American Journal of Psychiatry, 127, 147–154.

San Francisco Department of Health. (1993). A call for a new generation of AIDS prevention for gay

and bisexual men in San Francisco. San Francisco: Author.

Sandfort, T. G. M., de Graaf, R., & Bijl, R. V. (2003). Same-sex sexuality and quality of life: Findings

from the Netherlands Mental Health Survey and Incidence Study. Archives of Sexual Behavior,

32(1), 15–22.

Sandfort, T. G. M., de Graaf, R., Bijl, R. V., & Schnabel, P. (1999). Sexual orientation and mental health:

Data from the Netherlands Mental Health Survey and Incidence Study. Stony Brook, NY: International

Academy of Sex Research.

Sandfort, T. G. M., de Graaf, R., Bijl, R. V., & Schnabel, P. (2001). Same-sex sexual behavior and psychiatric

disorders. Archives of General Psychiatry, 58, 85–91.

Sandfort, T. G. M., Bakker, F., Schellevis, F. G. M., & Vanwesenbeeck, I. (2006). Sexual orientation and

mental and physical health status: findings from a Dutch population survey. American Journal of

Public Health, 96(6), 1119–1125.

Sandfort, T. G. M., Bakker, F., Schellevis, F., & Vanwesenbeeck, I. (2009). Coping styles as mediator of

sexual orientation-related health differences. Archives of Sexual Behavior, 38, 1573–2800.

Satinover, J. (1996). Homosexuality and the politics of truth. Grand Rapids, MI: Baker Books.

Saunders, E. J. (1984). Homosexual recovering alcoholics: A descriptive study. Alcohol Health Research

World, 8, 18–22.

Saunders, J. M., & Valente, S. M. (1987). Suicide risk among gay men and lesbians: A review. Death

Studies, 11, 1–23.

Savin-Williams, R. C. (1994). Verbal and physical abuse as stressors in the lives of lesbian, gay male, and

bisexual youths: Associations with school problems, running away, substance abuse, prostitution,

and suicide. Journal of Consulting and Clinical Psychology, 62, 261–269.

Schackman, B. R., Dastur, Z., Ni, Q., Callahan, M. A., Berger, J., & Rubin, D. S. (2008). Sexually active

HIV-positive patients frequently report never using condoms in audio computer-assisted selfinterviews

conducted at routine clinical visits. AIDS Patient Care and STDs, 22(2), 123–129.

Schaeffer, K. W., Hyde, R. A., Kroencke, T., McCormick, B., & Nottebaum, L. (2000). Religiously motivated

sexual orientation change. Journal of Psychology and Christianity, 19, 61–70.

Schaeffer, K. W., Nottebaum, L., Smith, P., Dech, K., & Krawczyk, J. (1999). Religiously motivated

sexual orientation change: A follow- up study. Journal of Psychology and Theology, 27(4), 329–337.

Schneider, J. A., & Agras, W. S. (1987). Bulimia in males: A matched comparison with females.

International Journal of Eating Disorders, 2, 235–242.

Schneider, M. S., Brown, L. S., & Glassgold, J. M. (2002). Implementing the resolution on appropriate

therapeutic responses to sexual orientation: A guide for the perplexed. Professional Psychology:

Research and Practice, 3, 265–276.

Schneider, S. G., Farberow, N. L., & Kruks, G. (1989). Suicidal behavior in adolescent and adult gay

men. Suicide and Life-Threatening Behavior, 19, 381–394.

Schneider, Y. (2006). The gay gene, going, going . . . gone. Retrieved March 1, 2007, from http://www>

.frc.org/get.cfm?i=IS00D2&v=PRINT

Schrenck-Notzing, A. von (1892). The therapy of suggestion for pathological appearances of the sex

drive. Stuttgart, Germany: Ferdinand Enke.

Schroeder, M., & Shidlo, A. (2001). Ethical issues in sexual orientation conversion therapies: An empirical

study of consumers. Journal of Gay and Lesbian Psychotherapy, 5, 131–166.

Schwartz, M. F., & Masters, W. H. (1984). The Masters and Johnson treatment program for dissatisfied

homosexual men. American Journal of Psychiatry, 141, 173–181.

Schumm, W. R. (2008). Re-evaluation of the “no differences” hypothesis concerning gay and lesbian parenting

as assessed in eight early (1979–1986) and four later (1997–1998) dissertations. Psychological

Reports, 103, 275–304.

Seage, G. R., III (1992). The relation between nitrite inhalants, unprotected anal intercourse, and the

risk of immunodeficiency virus infection. American Journal of Epidemiology, 135, 1–11.

Segal, B., & Sims, J. (1972). Covert sensitization with a homosexual: A controlled replication. Journal of

Consulting and Clinical Psychology, 39, 259–263.

Seligson, M. R., & Peterson, K. E. (1992). AIDS prevention and treatment. Bristol, PA: Hemisphere.

Sell, R. L. (1997). Defining and measuring sexual orientation: A review. Archives of Sexual Behavior,

26(6), 643–658.

Serban, G. (1968). The existential therapeutic approach to homosexuality. American Journal of

Psychotherapy, 22(3), 491–501.

Shaffer, D., Fisher, P., Hicks, R. H., Parides, M., & Gould, M. (1995). Sexual orientation in adolescents

who commit suicide. Suicide and Life-Threatening Behavior, 25(Suppl.), 64–71.

Shealy, A. E. (1972). Combining behavior therapy and cognitive therapy in treating homosexuality.

Psychotherapy: Theory, Research, and Practice, 9, 221–222.

Shechter, R. A. (1992). Treatment parameters and structural change: Reflections on the psychotherapy

of a male homosexual. International Forum of Psychoanalysis, 1, 197–201.

Shidlo, A., & Schroeder, M. (2002). Changing sexual orientation: A consumer’s report. Professional

Psychology: Research and Practice, 33(3), 249–259.

Shidlo, A., Schroeder, M., & Drescher, J. (Eds.) (2001). Sexual conversion therapy: Ethical, clinical, and

research perspectives. Binghamton, NY: Haworth Press.

Shively, M. G., & De Cecco, J. P. (1977). Components of sexual identity. Journal of Homosexuality, 3,

41–48.

Shook, L. L., Whittle, R., & Rose, E. F. (1985). Rectal fist insertion. American Journal of Forensic Medicine

and Pathology, 6, 319–324.

Siegel, E. V. (1988). Female homosexuality: Choice without volition (Psychoanalytic Inquiry Book Series).

Hilldale, NJ: Analytic Press.

Siegel, K., Bauman, L. J., Christ, G. H, & Krown, S. (1988). Patterns of change in sexual behavior

among gay men in New York City. Archives of Sexual Behavior 17(6), 481–497.

Siegel, K., Mesagno, C., Krown, S., & Christ, G. H. (1989). Factors distinguishing homosexual males

practicing risky and safer sex. Social Science and Medicine, 28, 561–569.

Siegelman, M. (1972). Adjustment of male homosexuals and heterosexuals. Archives of Sexual Behavior,

2, 9–25.

Siever, M. D. (1994). Sexual orientation and gender as factors in socioculturally acquired vulnerability

to body dissatisfaction and eating disorders. Journal of Consulting and Clinical Psychology, 62,

252–260.

Signorile, M. (1995, March 5). I’m not sure I want to know the truth. Buffalo News, p. 5.

Silberstein, L. R., Mishkind, M. E., Striegel-Moore, R. H., Timko, C., & Rodin, J. (1989). Men and their

bodies: A comparison of homosexual and heterosexual men. Psychosomatic Medicine, 51, 337–346.

Silenzio, V. M. B., Pena, J. B., Duberstein, P. R., Cerel, J., & Knox, K. L. (2007). Sexual orientation

and risk factors for suicidal ideation and suicide attempts among adolescents and young adults.

American Journal of Public Health, 97(11), 2017–2019.

Silverstein, C. (2003). The religious conversion of homosexuals: Subject selection is the voir dire of psychological

research. Journal of Gay and Lesbian Psychotherapy, 7, 31–54.

Skegg, K., Nada-Raja, S., Dickson, N., Paul, C., & Williams, S. (2003). Sexual orientation and selfharm

in men and women. American Journal of Psychiatry, 160, 541–546.

Skinner, W. F. (1994). The prevalence and demographic predictors of illicit drug use among lesbians and

gay men. American Journal of Public Health, 84, 1307–1310.

Smith, A., & Bassin, A. (1959). Overt male homosexuals in combined group and individual treatment.

Journal of Social Therapy, 5, 225–232.

Smith, M. A., & Singer, C. (1994). Sexually transmitted virus other than HIV and papillomavirus.

Urologic Clinics of America, 19, 47–62.

Smith, T. M. (1979, March). Specific approaches and techniques in the treatment of gay male alcohol abusers

[Monograph]. San Francisco: San Francisco Alcohol Evaluation and Treatment Center.

Smith, T. W. (1991). Adult sexual behavior in 1989: Number of partners, frequency of intercourse, and

risk of AIDS. Family Planning Perspectives, 23, 102–107.

Socarides, C. W. (1978). Homosexuality: Psychoanalytic therapy. New York: Jason Aronson.

Spada, J. (1979). The Spada report: The newest survey of gay male sexuality. New York: Signet.

Spitzer, R. L. (2003). Can some gay men and lesbians change their sexual orientation? 200 participants

reporting a change from homosexual to heterosexual orientation. Archives of Sexual Behavior, 32,

403–417.

Stall, R. D., Coates, T. J., & Hoff, C. (1988). Behavioral risk reduction for HIV infection among

gay and bisexual men: A review of results from the United States. American Psychologist, 43,

878–885.

Stall, R. D., Paul, J. P., Greenwood, G., Pollack, L. M., Bein, E., Crosby, G. M., Mills, T. C., Binson, D.,

Coates, T. J., & Catania, J. A. (2001). Alcohol use, drug use, and alcohol-related problems among

men who have sex with men: The Urban Men’s Health Study. Addiction, 96, 1589–1601.

Stall, R. D., & Wiley, J. (1988). A comparison of alcohol and drug use patterns of homosexual and heterosexual

men: The San Francisco men’s health study. Drug and Alcohol Dependence, 22, 63–73.

Steiner, S., Lemke, A. L., & Roffman, R. A. (1994). Risk behavior for HIV transmission among gay

men surveyed in Seattle bars. Public Health Reports, 109, 563–566.

Stekel, W. (1930). Is homosexuality curable? Psychoanalytic Review, 17, 443–451.

Stevenson, I., & Wolpe, J. (1960). Recovery from sexual deviations through overcoming nonsexual neurotic

responses. American Journal of Psychiatry, 116, 737–742.

Storms, M. D. (1980). Theories of sexual orientation. Journal of Personality and Social Psychology, 5,

783–792.

Striegel-Moore, R. H., Tucker, N., & Hsu, J. (1990). Body image dissatisfaction and disordered eating

in lesbian college students. International Journal of Eating Disorders, 9, 493–500.

Strong, G. (1994). Once I was gay and what I did to change. Social Justice Review, 85(5-6), 75–76.

Surawicz, C. M., Critchlow, C., Sayer, J., Hurt, C., Hawes, S., Kirby, P., Goldbaum, G., & Kiviat, N.

(1995). High grades anal dysplasia in visually normal mucosa in homosexual men. American Journal

of Gastroenterology, 90, 1776–1778.

Tanner, B. A. (1974). A comparison of automated aversive conditioning and a waiting list control in the

modification of homosexual behavior in males. Behavior Therapy, 5, 29–32.

Tanner, B. A. (1975). Avoidance training with and without booster sessions to modify homosexual behavior

in males. Behavior Therapy, 6, 649–653.

Tarail, M. (1961). New treatments for the homosexual. In I. Rubin (Ed.), The third sex (pp. 34–55). New

York: New Book.

Tarlow, G. (1989). Clinical handbook of behavior therapy: Adult psychological disorders. Cambridge,

MA: Brookline Books.

Thiede, H., Valleroy, L. A., MacKellar, D. A., Celentano, D. D., Ford, W. L., Hagan, H., Koblin, B. A.,

LaLota, M., McFarland, W., Shehan, D. A., & Torian, L. V. (2003). Regional patterns and correlates

of substance use among young men who have sex with men in 7 U.S. urban areas. American

Journal of Public Health, 93, 1915–1921.

Thompson, J. L. P., Yager, T. J., & Martin, J. L. (1993). Estimated condom failure and frequency of condom

use among gay men. American Journal of Public Health, 83, 1409–1413.

Thorpe, J. G., Schmidt, E., Brown, P. T., & Castell, D. (1964). Aversion-relief therapy: A new method

for general application. Behaviour Research and Therapy, 2, 71–82.

Throckmorton, W. (1998). Attempts to modify sexual orientation: A review of outcome literature and

ethical issues. Journal of Mental Health Counseling, 20, 283–304.

Throckmorton, W. (2002). Initial empirical and clinical findings concerning the change process for exgays.

Professional Psychology: Research and Practice, 33(3), 242–248.

Tielman, R. A. P., Carballo, M., & Hendricks, A. (1991). Bisexuality and HIV/AIDS: A global perspective.

Buffalo, NY: Prometheus Books.

Tripp, C. A. (1975). The homosexual matrix. New York: Signet.

Truax, R. A., & Tourney, G. (1971). Male homosexuals in group therapy: A controlled study. Diseases of

the Nervous System, 32(10), 707–711.

Tyler, L. (1969). An approach to public affairs: Report of the Ad Hoc Committee on Public Affairs.

American Psychologist, 24, 1–4.

UNAIDS/WHO. (2005, December). AIDS epidemic update: Special report on HIV prevention. Geneva,

Switzerland: Author. Retrieved July 6, 2007, from http://www.unaids.org/epi/2005/doc/EPI

update2005_pdf_en/epi-update2005_en.pdf

U. S. Department of Health and Human Services. (1990). Condoms and sexually transmitted diseases . . . especially

AIDS. (FDA Publication No. 90-4239). Washington, DC: U.S. Government Printing Office.

U. S. Department of Health and Human Services. (1994). Bibliography with abstracts of substance abuse

studies on lesbians, gay men, and bisexuals. (DHHS Publication No. 94-2097). Washington, DC: U.S.

Government Printing Office.

Valanis, B. G., Bowen, D. J., Bassford, T., Whitlock, E., Charney, P., & Carter, R. A. (2000). Sexual

orientation and health: Comparisons in the women’s health initiative sample. Archives of Family

Medicine, 9, 843–853.

van den Aardweg, G. J. M. (1971). A brief theory of homosexuality. American Journal of Psychotherapy,

26, 52–68.

van den Aardweg, G. J. M. (1985). Male homosexuality and the neuroticism factor: An analysis of research

outcome. Dynamic Psychotherapy, 3, 79–87.

van den Aardweg, G. J. M. (1986a). Homosexuality and hope: A psychologist talks about treatment and

change. Ann Arbor, MI: Servant Books.

van den Aardweg, G. J. M. (1986b). On the origins and treatment of homosexuality: A psychoanalytic

reinterpretation. New York: Praeger.

van Kesteren, N. M. C, Hospers, H. J., & Kok, G. (2007). Sexual risk behavior among HIV-positive men

who have sex with men: A literature review. Patient Education and Counseling, 65(1), 5–20.

Wallace, L. (1969). Psychotherapy of a male homosexual. Psychoanalytic Review, 56, 346–364.

Wang, J., Hausermann, M., Ajdacic-Gross, V., Aggleton, P., & Weiss, M. G. (2007). High prevalence

of mental disorders and comorbidity in the Geneva Gay Men’s Health Study. Social Psychiatry and

Psychiatric Epidemiology, 42(5), 414–420.

Warczok, R. (1988) Correlates of sexual orientation in German Democratic Republic. Archives of Sexual

Behavior, 17, 179–188.

Warner, J., McKeown, E., Griffin, M., Johnson, K., Ramsay, A., Cort, C., & King, M. (2004). Rates

and predictors of mental illness in gay men, lesbians, and bisexual men and women: Results from a

survey based in England and Wales. British Journal of Psychiatry, 185, 479–485.

Waterman, C. K., Dawson, L. J., & Bologna, M. (1989). Sexual coercion in gay male and lesbian relationships:

Predictors and implications and support services. Journal of Sex Research, 26, 118–124.

Weathers, B. (1980). Alcoholism and the lesbian community. In C. Eddy & J. Ford (Eds.), Alcoholism

and women (pp. 142–149). Dubuque, IA: Kendall/Hunt.

Weinberg, M. S., & Williams, C. J. (1975). Gay baths and the social organization of impersonal sex.

Social Problems, 23, 124–136.

Weinberg, W. (1972). Society and the healthy homosexual. New York: St. Martin’s Press.

Weinrich, J. D., Atkinson, J. H., Jr., McCutchan, J. A., Grant, I., & HNRC. (1995). Is gender dysphoria

dysphoric? Elevated depression and anxiety in gender dysphoric and nondysphoric homosexual and

bisexual men in an HIV sample. Archives of Sexual Behavior, 24, 55–72.

Weinrich, J. D., & Klein, F. (2002). Bi-gay, bi-straight, and bi-bi: Three bisexual subgroups identified

using cluster analysis of the Klein sexual orientation grid. Journal of Bisexuality, 2, 109–139.

West, D. J. (1977). Homosexuality re-examined. London: Duckworth.

West, D. J. (1983). Homosexuality and lesbianism. British Journal of Psychiatry, 143, 221–226