Friday, August 9, 2019

Clinicians Warned to ‘Be Alert’ to Ramifications of Conversion Therapy

Despite outspoken opposition to conversion therapy—practices that seek to change an individual’s sexual orientation or gender identity—by multiple professional medical organizations, only 18 states, Puerto Rico, and Washington, D.C., have banned conversion therapy for minors. As a result, it is estimated that more than 16,000 LGBTQ adolescents in the United States will undergo conversion therapy with a licensed health care professional by the time they reach 18 years of age, according to the Williams Institute at the UCLA School of Law.

In an article published yesterday in the New England Journal of Medicine, Carl G. Streed Jr., M.D., M.P.H., of Boston Medical Center and colleagues traced the history of the emergence of conversion therapy and later recognition by the medical community of its harmful effects. They cautioned clinicians to “be alert” to the needs of patients who may have received conversion therapy.

“Studies of adults who underwent conversion therapy earlier in life document a range of health risks,” Streed and colleagues wrote. Some of these health risks were highlighted by a 2018 study comparing LGBTQ young adults who had been encouraged to attend conversion therapy with those who had not, the authors noted. The study found youth whose parents or caregivers encouraged conversion therapy or reported being sent to therapists and religious leaders for conversion interventions were more likely to have depression, suicidal thoughts, suicidal attempts, less educational attainment, and less weekly income than those who had not been encouraged to seek or exposed to conversion therapy.

“Clinicians can be alert to the profile of a typical conversion-therapy participant. Patients involved in conversion therapy may not volunteer relevant information to a health care provider and may go out of their way to conceal their participation,” Streed and colleagues wrote. “Many survivors of conversion therapy will need treatment for posttraumatic stress disorder and post-religious trauma.”

Many medical professional organizations have acknowledged the risks of conversion therapy and oppose its use, the authors noted. Since 1998, APA has opposed any psychiatric treatment, such as “reparative” or conversion therapy, which is based upon the assumption that homosexuality is a mental disorder or that a patient should change his/her homosexual orientation. Other medical organizations to voice opposition to the use of conversion therapy include the AMA, the World Psychiatric Association, the American Psychological Association, the American Academy of Pediatrics, and the American College of Physicians.

“Beyond ending harmful practices [of conversion therapy], supporting the acceptance and inclusion of people of all gender identities, gender expressions, and sexual orientations is critical,” Streed and colleagues wrote. Clinicians should take steps to educate themselves about LGBTQ patients, including the ramifications of conversion therapy, they continued.

“According to a draft of the U.S. Joint Statement on Conversion Therapy, a consensus statement being prepared by more than a dozen health care organizations, medical officials should take into account developmental considerations for each stage of the lifespan when caring for patients and should be prepared to offer supportive therapies and provide accurate information and resources for all LGBTQ patients and their families,” they concluded. “We believe it is vital for clinicians to understand both the scientific and the ethical hazards of conversion therapy and appropriate responses for survivors and at-risk patients and to help create supportive environments for all LGBTQ persons.”

For related information, see the Psychiatric News article “SAMHSA Report Calls for End to ‘Conversion’ Therapy for Youth” and APA’s most recent position statement on conversion therapy.

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