What Is Sexual Relationship Disorder?

A once-diagnosed condition is no longer regarded as a mental disorder

The term sexual relationship disorder was once used to describe a person who has trouble forming and maintaining a romantic relationship due to their gender identity (the personal sense of one's gender) or sexual orientation (a person's identity about the gender or genders of those they are attracted to).

It was an attempt to characterize this state of emotional distress as a mental disorder, much in the same way as the different types of anxiety disorders.

This term is less commonly used today by psychiatrists and psychologists, and in 2022 it was excluded as a mental condition in the ICD-11 (the global classification system for diseases and disorders).

Depressed and Stressed Young Man Sits on the Edge of Bed at Night, Suffering From Insomnia Because of Sex Problems. His Young Wife Lies Beside Him Feeling Empathy.

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This article describes the characteristics of sexual relationship disorder and explains why is it no longer considered a mental disorder. It also explains how certain aspects of sexual relationship disorder are approached by mental health professionals today.

What Is Sexual Relationship Disorder?

Sexual relationship disorder was introduced as a mental disorder in 1990. At the time, psychologists believed that gender identity or sexual orientation could cause emotional distress in some people who are forming or maintaining a romantic relationship.

The definition was made based largely on research from the 1980s involving gay men in heterosexual marriages.

One such study published in the Journal of Homosexuality in 1982 involved 31 men, all married to women, who expressed attraction to men. All were "closeted" and several engaged in extramarital sex with same-sex partners. Therapy was offered to help the men "feel more comfortable and accepting of their same-sex feelings and to explore ways of incorporating same-sex and opposite-sex feelings into their lives."

After the completion of therapy, 17 of the 31 men decided to end their marriages.

Of the remaining 14, it was suggested that therapy—which approached the men as bisexual rather than gay—helped them feel more comfortable in their marriages and with their sexualities.

Inclusion in the ICD-10

Sexual relationship disorder was included in the 10th edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) in 1990 alongside two other mental disorders:

  • Ego-dystonic sexual orientation: A condition in which a person's sexual orientation or attractions are at odds with their self-image, causing anxiety and the desire to either change their orientation or become more comfortable with it
  • Sexual maturation orientation: A condition in which uncertainty about one's sexual orientation or gender identity causes anxiety or depression

Even at the time of their release, all three definitions were regarded as controversial. Of the three, only ego-dystonic sexual orientation was included in the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders (DSM) from 1980 to 1987.

At the time of the release, the World Health Organization (which publishes the ICD classifications) commented that "Sexual orientation by itself is not to be regarded as a disorder."

Exclusion From ICD-11

Since the publication of the ICD-10, LGBTQI activists and a growing chorus of mental health professionals have argued that sexual relationship disorder only perpetuates homophobia and stigmatizes people with gender fluidity.

The original intention of the ICD-10 was to replace the diagnosis of homosexuality with a list of disorders linked not to sexuality but rather to sexual orientation and gender identity. It was a shift that echoed the American Psychiatric Association's decision to declassify homosexuality as a mental illness in 1987.

History of the DSM and Homosexuality

The DSM-3, first published in 1968, listed homosexuality as a mental illness. While homosexuality was removed from the DSM in 1973, it was replaced by "sexual orientation disturbance" for people in conflict with their sexual orientation. It was not until 1987 that homosexuality was completely removed from the DSM.

In developing the ICD-11, the working committee with the World Health Organization (WHO) recommended that sexual relationship disorder, ego-dystonic sexual orientation, and sexual maturation orientation all be excluded from the latest edition.

Among the rationale for the WHO committee decision:

  • None of the definitions had any usefulness in making clinical decisions.
  • The definitions had no usefulness in collecting data to direct public health services or policies.
  • The classification might lend support to unethical treatments such as conversion therapy (Used to “cure” a person’s sex-same attraction or gender identity).

The committee further stated that "there is no justification for creating a mental disorder category that is specifically based on the co-occurrence of relationship problems with sexual orientation or gender identity issues" when no other causes of relationship problems receive a diagnostic category.

As of January 2022, sexual relationship disorder, ego-dystonic sexual orientation, and sexual maturation orientation are officially no longer part of the ICD classifications.

Alternate Diagnoses

The exclusion of sexual relationship disorder from the ICD-11 is not meant to suggest that people don't struggle with their sexual orientation or gender identity when entering a romantic relationship. But in the end, it is not a person's sexual orientation or gender identity that is at issue.

Moreover, the struggle itself cannot be characterized as a mental disorder unless it causes significant distress or impairment in a person's life socially or occupationally.

To this end, the American Psychiatric Association revised its definition of a category of conditions called paraphilic disorders.

What Are Paraphilic Disorders?

Paraphilic disorders are a broad category of mental conditions in which one of three things occurs:

  • A person feels personal distress about their sexual interests that is not merely due to distress about society's disapproval.
  • A person has sexual desires or behaviors that involve another person's psychological distress, injury, or death.
  • A person has sexual desires involving unwilling participants unable to give legal consent.


Included in the definition, the APA added a subcategory called transvestic disorder in which a person is sexually aroused by dressing as the opposite sex but experiences significant distress by doing so. (Travestitic disorder should not be confused with being transgender, the latter of which is not a mental disorder.)

In any of these situations, counseling and treatment by a licensed therapist or psychiatrist are advised.

Summary

Sexual relationship disorder is an outdated term used to describe a person who has trouble forming and maintaining a romantic relationship due to their gender identity or sexual orientation.

It was a diagnostic category removed from the World Health Organization's ICD classifications in 2022. The WHO and other public health authorities contend that it characterizes romantic problems involving sexual orientation or gender identity are "mental disorders" whereas romantic problems in different-sex relationships are not.

A Word From Verywell

If feelings about your sexual orientation or gender identity are affecting your ability to form and maintain a healthy romantic relationship, therapy can help sort out those feelings. Seek an LGBTQI-friendly therapist who can offer support, guidance, and affirmation. The LGBT National Hotline at 1-888-843-4564 can help.

With that said, being gay, lesbian, bisexual, pansexual, or any other sexual orientation or gender identity does not mean you need therapy. Sexual orientation and gender identity are not disorders. 

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6 Sources
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