Front Matter

Preface: LGBTQ²IAPA

1 Lesbian: The L in LGBTQ²IAPA

Daena L. Petersen, M.D., M.P.H., M.A.

Mary E. Barber, M.D.

Nix Zelin, M.D.

Eric Yarbrough, M.D.

2 Gay: The G in LGBTQ²IAPA

Ahmad A. Mohammad, M.D., M.A.

Eric Yarbrough, M.D.

3 Bisexual: The B in LGBTQ²IAPA

Sarah Noble, D.O.

4 Transgender: The T in LGBTQ²IAPA

Murat Altinay, M.D.

5 Queer: The First Q in LGBTQ²IAPA

Sam Marcus, M.A.

E.K. Breitkopf, M.A.

6 Questioning: The Second Q in LGBTQ²IAPA

Mark Joseph Messih, M.D., M.Sc.

7 Intersex: The I in LGBTQ²IAPA

Adrian Jacques H. Ambrose, M.D., M.P.H., FAPA

8 Asexual: The First A in LGBTQ²IAPA

Selale Gunal

Petros Levounis, M.D., M.A.

9 Pansexual: The P in LGBTQ²IAPA

Victoria Formosa, L.C.S.W.

10 Ally: The Second A in LGBTQ²IAPA

Angeliki Pesiridou, M.D.

Serena M. Chang, M.D.

Assistant Professor of Medicine and Staff Psychiatrist, Cleveland Clinic Foundation, Cleveland, Ohio

Child and Adolescent Psychiatrist, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

Clinical Assistant Professor, Columbia College of Physicians and Surgeons, New York, New York

Doctoral candidate, The New School for Social Research, New York, New York

Associate Director of Psychiatry, Callen-Lorde Community Health Center; Clinical Assistant Professor, Department of Psychiatry and Department of Child and Adolescent Psychiatry, New York University, New York, New York

Psychotherapist, Behavioral Health Department, Callen Lorde Community Health Center, New York, New York

Senior, Hunter College High School; American Museum of Natural History Brown Scholar, New York, New York

Professor and Chair, Department of Psychiatry, Rutgers New Jersey Medical School; Chief of Service, University Hospital, Newark, New Jersey

Doctoral candidate, The New School for Social Research, New York, New York

Child and Adolescent Psychiatry Fellow, University of Rochester Medical Center, Rochester, New York

Resident Physician, Maimonides Medical Center, New York, New York

Medical Director, Outpatient Behavioral Health Einstein Medical Center, Philadelphia, Pennsylvania

Director of Psychiatry, Callen-Lorde Community Health Center, New York, New York

Psychiatric Services Director of HIV Psychiatry and Gender and Sexuality, Berkeley County Mental Health Center, South Carolina Department of Mental Health; Staff Psychiatrist, Berkeley Community Mental Health Center, Moncks Corner, South Carolina

Private practice, New York, New York

Founding member and vice president of the Northeast Student Queer Alliance, Moraga, California

What an acronym!

What are all these letters doing up there? What do they even mean? Are human beings really all that diverse? Well, yes. And probably much more than what this alphabet soup implies and what we have included in the little volume that you are now holding in your hands.

The purpose of this book is to help clinicians (as well as patients, parents, teachers, students, administrators, and anyone else who is interested in how humans operate) master the fundamentals of sexual orientation and gender identity. Building on our previous American Psychiatric Association Publishing books (Petros was the lead editor of The LGBT Casebook, with Jack Drescher and Mary Barber, back in 2012, and Eric wrote the Transgender Mental Health textbook in 2018), we have put together a pocket guide to the wonderful world of gender and human sexuality.

For this new edition, we have asked experts in the field of LGBTQ mental health to reflect on both the scientific literature and their own clinical experience in order to end up with a volume that aims to be informative, practical, and easy to read. The book is organized, very simply, in 10 chapters: lesbians, gay men, bisexuals, transgender people, queers, questioning people, intersex people, asexuals, pansexuals, and allied heterosexuals. Some chapters overlap because it is possible for one individual to identify with several of these identities. Each chapter begins with the psychological and cultural context of that particular facet of human sexuality, which includes history and definitions, as well as the twenty-first-century reality of the people who identify with the title of the chapter. We then address questions that well-meaning people may ask: What would patients, their friends, their parents, their physicians like to know about being X, Y, or Z? Finally, we discuss some common themes that may emerge in counseling and psychotherapy with LGBTQ2IAPA people. And yes, you guessed it, we’ll often abbreviate this terrific—but admittedly messy—acronym.

Society’s understanding of gender and sexual orientation has changed dramatically in the late twentieth and early twenty-first centuries. When the gay civil rights movement symbolically started with the Stonewall Riots in New York City in 1969, LGBTQ people had been living in the closet since ancient times. Since then, a rainbow of gender and sexual identities has blossomed, giving each person the potential to express and identify themselves as they see fit.

Gender, previously thought to be strictly segregated into male and female, is now seen as a spectrum of many and sometimes fluid possibilities. The question is no longer whether someone is male or female but what masculine and feminine traits each of us possesses. We have added terms such as genderqueer, genderfluid, gender nonbinary, intersex, and transgender to our understanding of how people live, love, work, and play.

Sexual orientation has also evolved to encapsulate the diversity of sexual identity, sexual behavior, and sexual attraction. Most people used to identify as straight or gay, but many are now adopting the identities of bisexual, pansexual, asexual, queer, and questioning. Also, how someone identifies does not necessarily imply how they behave sexually or what their sexual attractions may be. For example, men who live on the “down low” identify as straight and sleep with both men and women, and their sexual attraction falls closer to the homosexual than the heterosexual end of the Kinsey scale.

Although the range of individual expression has grown over the past decade, equality and basic civil rights are far from being guaranteed for those who are gender and sexually diverse. Society continues to separate people into categories, placing higher value and protections on those who fit the “traditional” notion of what it means to be human. We hope that this book will demystify some of the complexities of gender and sexuality, making our world a more accepting and inclusive place.

We would like to thank American Psychiatric Association Publishing for the opportunity to present this pocket guide to you and for providing space for topics that are often underrepresented. This book would not be possible without the exceptional contributions, dedication, and passion of our coauthors, who spend their daily work advocating and serving those who are most in need. We are also indebted to our patients, our colleagues, our teachers, and our students, who keep us both exhilarated and on our toes in the office, on the wards, and in the classroom. Finally, we would like to give a shout out to our families of origin and families of community: We love you, and we forgive you if you don’t know the 10 letters in the acronym at the heart of our book.

Newark, New Jersey, and New York City

March 2020