Understanding Sexual Orientation From a Psychological Perspective

Sexual orientation, sometimes called “sexual preference,” describes a person’s pattern of feelings of emotional, romantic, or sexual attraction to men, women, both, or neither sex. According to the American Psychological Association (APA), sexual orientation “also refers to a person’s sense of identity—based on those attractions, related behaviors, and membership in a community of others who share those attractions.”

Decades of clinical research indicate that individual sexual orientations exist along a spectrum ranging from an exclusive attraction to persons of the opposite biological sex to an exclusive attraction to persons of the same biological sex.

Sexual Orientation Categories

The most commonly discussed categories of sexual orientation spectrum are:

• Heterosexual: attraction to persons of the opposite sex.
• Homosexual or gay/lesbian (the preferred terms): attraction to persons of the same sex.
• Bisexual: attraction to both men and women.
• Asexual: not sexually attracted to either men or women.

Less often encountered categories of sexual orientation identities include, “pansexual,” the sexual, romantic or emotional attraction towards people regardless of their biological sex or gender identity, and “polysexual,” the sexual attraction to multiple, but not all, genders.

While these categories of attraction are similar to those applied in cultures worldwide, they are far from the only labels of sexual orientation used today. For example, persons who feel unsure of their sexual attractions may refer to themselves as “questioning” or “curious.”

For over four decades, the American Psychological Association has stressed that homosexuality, bisexuality, and asexuality are not forms of mental illness and are not deserving of their historically negative stigma and resulting discrimination. “Both heterosexual behavior and homosexual behavior are normal aspects of human sexuality,” states the APA.

Sexual Orientation Is Different From Gender Identity

While sexual orientation is about being emotionally or romantically attracted to other people, “gender identity” describes a person’s own internal feelings of being male or female (masculine or feminine); or a blend of both or neither (genderqueer). A person’s gender identity can be the same or different from their biological sex assigned at birth. In addition, people who are “gender dysphoric” may feel strongly that their true gender identity differs from the biological sex assigned to them at birth.

In simpler terms, sexual orientation is about who we want to be with romantically or sexually. Gender identity is about who we feel we are, how we choose to express those feelings, and how we wish to be perceived and treated by other people.

The World Health Organization (WHO) has recognized that many transgender people require professional help in affirming their chosen gender identity when it conflicts with the gender they were assigned at birth. Gender-affirming care, as defined by WHO, encompasses a range of social, psychological, behavioral, and medical interventions. The interventions help transgender people align various aspects of their lives—emotional, interpersonal, and biological—with their gender identity. As noted by the American Psychiatric Association (APA), that identity can run anywhere along a continuum that includes man, woman, a combination of those, neither of those and fluid.

The interventions may range from counseling to changes in social expression to medications, such as hormone therapy. For children, in particular, the timing of the interventions is based on several factors, including cognitive and physical development as well as parental consent. Surgery, including reducing a person’s Adam’s Apple, or aligning their chest or genitalia with their gender identity, is rarely provided to people under 18.

A growing number of state lawmakers view some gender-affirming care as medically unsound for youths and even a form of child abuse. To date, at least 15 states have enacted or are considering laws to prohibit certain gender-affirming treatments for youths and to impose penalties on healthcare professionals who provide them.

A Texas law, for example, bans transgender youth from accessing gender-affirming care and seeks to investigate parents who sought such care for their children. Idaho has made it illegal for medical practitioners to provide gender-affirming care and has created penalties for any individual aiding transgender youth in crossing state lines to seek such care. An Alabama law passed in February not only banned medication for transgender and non-binary youth but ruled that doctors who violate it could face up to 10 years in prison.

However, against the nationwide wave of bills that limit or criminalize gender-affirming care, California Governor Gavin Newsom, in September 2022, signed a new law making California the first state in the nation to create a sanctuary for transgender youth seeking gender-affirming medical care. The law ensures that transgender children who live elsewhere can safely access hormones or puberty blockers in California. Mental health therapists say puberty blockers and hormone therapy can save lives. A recent survey found that nearly 1 in 5 transgender 13- to 24-year-olds have attempted suicide in the past year. The California law also shields families from child abuse investigations or from being criminally prosecuted for seeking gender-affirming care. “Parents know what’s best for their kids,” Newsom said in signing the law. “They should be able to make decisions around the health of their children without fear. We must take a stand for parental choice.”

The new California law faces fierce opposition from those who contend that it violates the “Full Faith and Credit” clause of the U.S. Constitution, which states that the states must respect the “public acts, records, and judicial proceedings of every other state.”

However, the courts have found that the broad clause doesn’t always translate well to specifics. While states may take note of each other’s public acts, they aren’t always expected to give these laws precisely the same effect that they have at home. A Texas fishing license, for example, does not give the license holder the right to fish in all other states.

When and How Sexual Orientation Is Recognized

According to the most recent medical and psychological research, the feelings of emotional, romantic, and sexual attraction that eventually form adult sexual orientation usually emerge between ages 6 and 13. However, feelings of attraction can develop and change at any age, even without any prior sexual experiences. For example, people who practice celibacy or abstinence from sex are still aware of their sexual orientation and gender identity.

Gay, lesbian, and bisexual people may follow different timelines in determining their sexual orientation than heterosexual people. Some decide they are lesbian, gay, or bisexual long before actually having sexual relationships with others. On the other hand, some do not determine their sexual orientation until after having had sexual relationships with persons of the same sex, opposite sex, or both. As the APA points out, discrimination and prejudice can make it hard for lesbian, gay, and bisexual people to accept their sexual orientation identities, thus slowing the process.

It is not uncommon for people to be unsure of their sexual orientation. Some people live their entire lifetimes without ever becoming certain of their exact sexual orientation. Psychologists emphasize that “questioning” one’s sexual orientation is neither uncommon nor a form of mental illness. The tendency for feelings of attraction to shift throughout one's life is known as “fluidity.”

The Causes of Sexual Orientation

Few questions in the history of clinical psychology have been as deeply debated as what causes an individual’s sexual orientation. While scientists generally agree that both nature (our inherited traits) and nurture (our acquired or learned traits) play complex roles, the exact reasons for the various sexual orientations remain poorly defined and even less well understood.

Despite years of clinical research on the question, no single cause or reason for developing a particular sexual orientation has been identified. Instead, researchers believe that each person’s feelings of emotional attraction are influenced by a complex combination of genetic dominance, hormonal, social, and environmental factors. While no single factor has been identified, the possible influence of genes and hormones inherited from our parents indicates that the development of sexual orientation may begin before birth. Some studies have shown that exposure to their parents’ attitudes toward sexual orientation might affect how some children experiment with their own sexual behavior and gender identity.

It was once believed that gay, lesbian, and bisexual sexual orientations were types of “mental disorders” often caused by sexual abuse during childhood and troubled adult relationships. However, this has been shown to be false and based mainly on misinformation and prejudice against so-called “alternative” lifestyles. The most recent research shows no relationship between any of the sexual orientations and psychological disorders.

Can Sexual Orientation Be ‘Changed?’

In the United States, the 1930s brought the practice of various forms of “conversion therapy” intended to change a person’s sexual orientation from gay, lesbian, or bisexual to heterosexual through psychological or religious interventions. Today, all major national mental health organizations consider all forms of conversion or “reparative” therapies to be pseudoscientific practices that are at best ineffective and at worst emotionally and physically harmful.

In addition, the American Psychological Association has found it likely that promoting conversion therapy actually reinforces the negative stereotypes that have led to years of discrimination against lesbian, gay and bisexual people.

In 1973, the American Psychiatric Association officially deleted homosexuality from its Diagnostic and Statistical Manual of Mental Disorders, used by medical professionals to define mental illnesses. All other major health professional organizations have since done the same, thus removing all professional support for the idea that an emotional attraction to persons of the same sex can or even needs to be “changed.”

In addition, the same professional organizations have dispelled the old belief that a person can be “turned” gay. For example, letting young boys play with toys traditionally made for girls, such as dolls, will not cause them to become gay.

Fast Facts About Sexual Orientation

• Sexual orientation refers to a person’s emotional, romantic, and/or sexual attraction to persons of the opposite, same, both, or neither sex.
• “Heterosexuality” is a sexual attraction to persons of the opposite sex.
• “Homosexuality” is a sexual attraction to persons of the same sex.
• “Bisexuality” is a sexual attraction to both sexes.
• “Asexuality” is the lack of sexual attraction to either sex.
• Sexual orientation is different from gender identity.
• A person’s sexual orientation usually emerges between ages 6 and 13.
• The exact causes of a particular sexual orientation are not known.
• Homosexuality is not a form of mental illness.
• Attempts to change a person’s sexual orientation are ineffective and potentially harmful.

Sources

• ”Sexual Orientation, Homosexuality, and Bisexuality“ American Psychological Association. August 8, 2013.
• ”Answers to your questions: For a better understanding of sexual orientation and homosexuality.“ American Psychological Association, 2008.