The Psychology of Sexual Orientation, Behavior, and Identity: A Handbook.

Edited by Louis Diamant and Richard D. McAnulty. Westport, CT: Greenwood Press, 1995, 522 pages. Cloth, $115.00.

Reviewed by Kurt A. DeBord, Ph.D., Lincoln University, Department of Social and Behavioral Sciences, Jefferson City, MO 65102, and Wayne A. Mayfield, M.A., University of Missouri, Department of Educational and Counseling Psychology, Columbia, MO 65211.

The task of editing a handbook on sexual behavior seems ominous, at best. Such an undertaking requires the ability to draw upon a tremendous amount of expertise in the sexuality literature as well as the skill to summarize and focus the most critical empirical and theoretical works into a form digestible by people with diverse backgrounds. In the book under review, the editors incorporate three major areas of concentration: sexual behavior, sexual orientation, and sexual identity. Given the enormity of the literature in each domain, the success with which the editors and chapter authors distill, organize, and present important information from these content areas is remarkable. Additionally, the book provides a surprisingly broad coverage of issues pertinent to sexual orientation, behavior, and identity, including religion, aging, and legal matters.

More than 40 authors contributed to the 25 chapters of this book, which represents an impressive collaborative effort to explicate the abundance of published theories and studies regarding myriad human sexual desires and behaviors. Initial perusal will leave readers wondering how the editors chose the title. Indeed, a more appropriate title would have resulted from changing the order of the words' orientation and behavior in the original title, because the book is primarily a discussion of sexual behavior, with a secondary emphasis on sexual orientation. This distinction is important to those who anticipate a volume devoted exclusively to issues of sexual orientation, only to find lengthy chapters on such topics as sexual dysfunctions among heterosexual adults, pedophilia, and problems with the classification of pedophilias in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994). This issue aside, readers are promised in the preface an accurate, objective, and thorough discussion of a comprehensive aggregate of topics in sexuality. By and large, the editors deliver just that.

The format for most chapters in the book is straightforward. For example, the authors prepare readers at the beginning of each chapter by giving overviews of the topics, controversies, and research areas that will be discussed. In addition, most chapters include a section where terms significant to the current topic are defined in detail. For instance, in the chapter on primate sexual orientation research, the author ensures that readers know what she means when she refers to primate sexual, copulatory, and affinitive behavior as well as primate heterosexual and homosexual behavior. The extensive review of the primate research in this chapter is made imminently accessible and interesting because of the author's explanatory efforts and writing style. Finally, each set of authors provides well-written sections that summarize their primary findings and conclusions. A glance at the last page of each chapter readily reminds the reader of the major points.

Between previews and summaries, readers will generally find tightly written, up-to-date, thorough reviews and discussions of relevant empirical research and theoretical positions. For example, in one chapter focused primarily upon empirical work, the author examines the biological aspects of sexual orientation and identity by critiquing the merits of numerous studies conducted in the mid-1990s, including two studies published in 1995. With the exception of a couple of chapters, the amount of detail regarding the methodology of reviewed studies is adequately informative without being excessive. Although this amount of detail allows readers to draw their own conclusions, authors frequently provide insightful, extensive sections enumerating the flaws and limitations of the studies conducted in their field of interest. The chapters on reorientation therapy for pedophilia, societal influences on gender roles, and the psychobiology of sexual arousal provide exceptionally thoughtful discussions of the limitations of the research reviewed.

In the chapters focusing more on theory and theoretical applications, comprehensive treatment is typically given to the historical and sociocultural contexts of the theory's development. For instance, the chapter devoted to psychoanalysis and male homosexuality clearly and concisely outlines that school's convoluted evolution in its approach to male homosexuality. Additionally, in the chapter on gender-identity disorders, the author goes to great lengths to describe how the DSM has changed from its third edition to its current form in its classification of gender-identity disorders. Notably, the chapters devoted primarily to theory are consistent in providing equal coverage to competing theories. Finally, chapters dealing with clinical issues and the application of theory regularly include tips, guidelines, and recommendations for confronting real-world problems. The entire section on clinical disorders and the chapter on sexual orientation and the law are exemplary in this regard.

Before we discuss each major section, two additional points regarding the book's content are worth noting: the limited space devoted to bisexuals, women, and racial/ethnic minorities and readership. It is frankly incomprehensible how a book that includes the phrase "the psychology of sexual orientation" in its title would not include at least one chapter concentrating specifically on topics unique to bisexuality. Although there is a chapter written exclusively about lesbian sexualities and one on gay and bisexual men (which essentially lumps the two groups together), minimal effort is given to acknowledging or promoting the importance of a better understanding of this orientation. As far as the attention given to women and racial minorities, repeated disclaimers are made throughout the empirically-based chapters regarding the lack of research conducted specifically with these groups. To the editors' credit, they devote a chapter to the description of one study on African-American sexuality. However, if the editors truly wanted to "fill a void in the literature," as they claim in the preface, they should have sought to include more theoretical work on the sexualities of women and minorities and reduced the attention given exclusively to men. For example, the editors include a chapter exclusively focused on a theory of male homosexuality with no parallel chapter for women. Further, that chapter on psycoanalysis and male homosexuality includes much material that can be found in other sources.

In regard to the issue of readership, the authors' attention to assisting readers with definitions and summaries is invaluable to newcomers to sexuality research and theory. However, the book's target audience is certainly not the general public. In the preface, the editors state that the book should be of interest to researchers, academics, professionals, and students of human sexuality. The book is unquestionably appropriate for all of these groups as a valuable handbook/reference. The extensive reference lists that include many of the latest empirical studies should be extremely useful to anyone interested in beginning research or to those wanting to inform their clinical practice with updated scientific work. But the most likely group to benefit from extensive use of the test would be graduate students in training to become specialists in human sexuality research and clinical practice. Instructors of courses emphasizing such content should not hesitate to consider adopting this book as a primary text.

In reviewing the five major sections of the book, it is worthwhile to note the primary topics of each section: introduction, theoretical explanations of sexual orientation, sexual dysfunctions in nonclinical populations, clinical disorders of sexual behavior and identity, and sexual orientation and social issues. The book's 25 chapters are disproportionately assigned to these sections, with the introduction section containing only 2 chapters.

The introduction begins with a brief chapter intended to provide some historical perspective on the concept of sexual orientation. This chapter is an unfortunate beginning to such a well-written book because of its disjointed thematic content. The section entitled historical perspectives begins with a reference to the work of John Money, and then the DSM, Freud, Kinsey, the ancient Greeks, and the Old Testament, respectively. The discussion is interesting but loosely connected, with an overemphasis on Western culture. In the second chapter, the author discusses the psychobiology of sexual arousal. Common aspects of a variety of models of arousal are highlighted and evaluated with respect to current research findings. Further, an intriguing discussion is presented on the theory that sexual arousal and positive affect exist as overlapping emotional states. Taken together, these two chapters set the stage for the rest of the book's varied content.

The second section, consisting of five chapters, presents five explanations for sexual orientation. The first two overlap most in content but diverge dramatically in their conclusions. With the first chapter, the author attempts to explain how sexual orientation is determined by biological factors. The author is especially thorough in his coverage of studies on twins, chromosome markers, nervous system structure and function, and prenatal hormones. But of all chapters in the book, this author's presentation is the most one sided, with minimal discussion of the limitations of the studies. Further, the 26 footnotes and a few thoughtless comments (e.g., indiscriminate use of "female thinking patterns" and "prove") detract from the message. The following chapter provides an explanation of sexual orientation that incorporates possible interactions between biological and environmental variables. Additionally, the authors include an uncommon acknowledgment of the role of cultural factors. Unlike the preceding chapter, this review of the literature from multiple perspectives is less biased and more attentive to the extant controversies in the area. The author finally proposes an "epigenetic/bisexual potentiality model" that differs significantly from Kinsey's continuum notion of sexual orientation.

The remaining three chapters in this section simply elucidate additional theories regarding the etiology of sexual orientation. The chapter on the psychoanalytic perspective is rich in historical detail. The next two, on learning theory and comparative theory, respectively, are thick with descriptions of models and research. The former is commendable for the authors' consideration of the concept of biological preparedness; the latter, for the author's refusal to make claims about humans based on primates. Nonetheless, the author of the chapter on primate research presents a solid case for the view that humans are not alone in their bisexual and homosexual activity. She does this without making unsubstantiated claims regarding how the observations of other researchers fit into her behavioral classification scheme. If she wasn't able to determine whether the primates were engaging in sexual or nonsexual behavior or whether it was homosexual or heterosexual, she simply states as much. Altogether, the five chapters in this section present divergent and compelling conjectures about the foundations of human sexual orientation.

The third section consists of three chapters covering sexual dysfunctions in nonclinical populations. At this point readers are reminded that the book is fairly comprehensive. After readers finish five chapters on explanations of sexual orientation, it is surprising to discover that the authors devote much of this section and the next to topics unrelated to sexual orientation. The first of these informs readers about the epidemiology of sexual dysfunctions and important assessment and treatment matters related to the dysfunctions. Overall, it is extremely informative. However, even though the chapter title reports that this portion of the text is about heterosexual adults, the authors repeatedly refer to "the general population" in the studies reviewed. Clarity with regard to this issue is critical, as any author in a book of this sort should not equate the two.

The remaining two chapters are designed to inform readers about the sexual concerns of nonheterosexuals. This is the point in the book where the superficial treatment given to bisexuality is exceptionally apparent. The chapter on lesbian sexuality adeptly combines research, social commentary, and logical conjecture to challenge misconceptions of lesbian sex and describe the varied potentials of the same. The authors refresh readers with a few humorous comments but disappoint, at times, with a few overstated generalizations. The chapter describing important issues in sex therapy for gay and bisexual men is generally disappointing. The flow is sometimes poor, and the content is often predictable. Given the predictability, it is surprising that no mention is made of the importance of body image to gay men and how it might affect sexual expression.

The fourth section of the book deals exclusively with clinical disorders of sexual behavior and identity. In the first of six chapters, the author evaluates the current DSM classification schemes for paraphilias. Although the author recognizes the methodological difficulties in studying paraphilias, a strong, empirically-based argument is made that the current schemes classify together largely heterogeneous groups of people. The importance of designing diagnostic criteria that would include paraphilic etiologies is stressed. In another chapter, the authors thoroughly discuss common misconceptions regarding pedophilia. The authors present an ethological model of pedophilia and incorporate into their discussion a consideration of cultural factors that could influence the manifestation of the disorder. In the last portion of this chapter, the authors eloquently articulate how silence, reinforced by society's institutions, helps to perpetuate the victimization of children.

Two additional chapters in this section merit discussion. One provides impressive reviews of the literature on the personality profiles, family dynamics, and arousal patterns of known perpetrators of incest. It details the differences among perpetrators of incest, child molesters, and the general population. The chapter additionally outlines an intelligent multifactorial predictor model of episodes of incest. The last chapter in the fourth section involves the development of gender-identity disorder. A fair amount of coverage is given to the problems, historic and current, with the DSM diagnostic criteria for this disorder. As a foundation for the proposal that biological factors may predispose a person to this disorder, the author provides an attenuated discussion and a table of research findings regarding the biological origins of sexual orientation. Both of these are clearly redundant in a book such as this. Although the chapter is illuminating, it is somewhat problematic. Perhaps most perplexing is the portion of the chapter concentrating on therapeutic interventions with people diagnosed with gender-identity disorder. The author acknowledges that the empirical evaluation of treatments is weak but never discusses the ethicality of proceeding with any intervention. Also included in this section are educative chapters on impulsive sexual behaviors and sexual sadism and masochism.

The final section, called "Sexual Orientation and Social Issues," consists of nine brief chapters that are less empirically based and more narrowly focused than the other chapters. It is surprising to find that the first chapter challenges a standard conception of a homo-, bi-, heterosexual sexual orientation by discussing pedophilia as a sexual orientation. Nonetheless, the authors thoroughly describe the techniques and assessment research on reorientation therapy with pedophiles. Appropriately, the chapter begins with a disclaimer stating that the techniques are not intended for use in altering a homosexual orientation and that the authors support an anti-illness view of homosexuality. This chapter is followed by one entitled "Race and Sexuality in the United States." It describes in detail the results of one large-scale study conducted to compare how African-Americans and White Americans respond to questions regarding their frequency of participation in various sexual activities. Additionally, comparisons along the lines of race and sex are made regarding attitudes of condemnation of homosexuality.

The heterogeneous content of the chapters in this section is refreshing. In addition to the two chapters already described, topics covered in the last portion of the text include sexual orientation and the military, sexuality and religion, and gender roles. A few chapters include thoughtful recommendations for clinical, institutional, and social interventions, such as the chapters on sexuality and disability, sexual orientation and the law, and sexual orientation and aging. Of all the chapters in this section, one stands out. The authors adopt a social constructionist perspective to analyze critically more than 300 safer-sex pamphlets produced since the mid-1980s by government agencies, health organizations, and activists. The chapter also includes a recommendation for social intervention. Its call to "decenter the norms through subversive repetition of discourse sanctioned by the norm" (p. 487) is less predictable than the interventions proposed in other chapters. Overall, this section poses intriguing questions and presents careful consideration of timely and potent social issues relevant to sexual orientation.

Without a doubt, The Psychology of Sexual Orientation, Behavior, and Identity: A Handbook is a comprehensive sexuality text that merits its subtitle Its readability, vast coverage, and detail more than compensate for its flaws and shortcomings. Diamant and McAnulty have succeeded admirably in bringing together an array of sexuality topics that are as interesting as they are timely. This book is a "must read."

Reference

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.