The Global State of Conversion Therapy -A Preliminary Report and Current Evidence Brief

Abstract

The term “conversion therapy” is most widely used to describe practices attempting to change, suppress, or divert one’s sexual orientation, gender identity, or gender expression. Such practices are also called: reorientation therapy, reparative therapy, sexual orientation change efforts, ex-gay/ex-trans therapy, gay cure therapy, or more recently, support for unwanted same-sex attraction or transgender identities. To discover global prevalence of both conversion therapy and various methods of practicing attempted therapy a survey was distributed online. The survey was developed by combining existing measurement tools with newly designed questions to gauge experiences with conversion therapy. The survey consisted of a series of 44 questions covering a range of topics, including personal experience with conversion therapy, types of therapy experienced, long-term impacts, mental health, human rights, faith, and others. The survey was provided in several languages, including English, Arabic, Traditional and Simplified Chinese, and others. Any Hornet user was able to voluntarily participate in the survey. 8092 individuals from over 100 countries participated in the survey, ranging in age from under 18 to 85+. 8092 individuals from over 100 countries participated in the survey, ranging in age from under 18 to 85+. Of the 5820 individuals who responded to the question “Does conversion therapy happen in your country?”, 1851 participants responded “yes,” that they were aware conversion therapy occurs in the country where they live, and 1227 (21.08%) and 1263 (21.70%) responding that they were unsure or maybe, respectively. 1627 (20.09%) of respondents indicated that either they or someone they know (family member, friend, etc.) have been in conversion therapy. The majority of practitioners who led conversion therapy were mental health providers, followed by religious authorities or their associates. These findings with a large global sample reveal that the practice of conversion therapy continues to be utilized around the world despite broad consensus on its harmful effects and lack of scientific justification.

Full text

DOI: 10.31235/osf.io/9ew78
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The Global State of Conversion Therapy - A Preliminary Report
and Current Evidence Brief
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!

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This brief draws on data collected from a collaborative effort between the LGBT
Foundation and Hornet Gay Social Network to conduct a rapid survey of a global, non-
representative sample of LGBTQ+ individuals regarding their exposure to conversion
therapy.
What is so-called “conversion therapy”?
The term “conversion therapy” is most widely used to describe practices attempting to
change, suppress, or divert one’s sexual orientation, gender identity, or gender
expression. Such practices are also called: reorientation therapy, reparative therapy,
sexual orientaion change efforts, ex-gay/ex-trans therapy, gay cure therapy, or more
recently, support for unwanted same-sex attraction or transgender identities.
Throughout history, members of the LGBTQ+ community have been subjected to efforts
to convert or change their identities, either forcefully or by coerced choice . In the US
1
alone, 19 states and numerous local jursidictions have implemented bans on conversion
therapy for minors, and it is estimated that almost 700,000 LGBTQ+ adults have
experienced some form of conversion therapy. More than 75,000 youth (ages 13-17) will
receive some form of conversion therapy before the age of 18 . Countless professional
2
associations and multinational organizations – the American Medical Association
(AMA) , American Psychological Association (APA) , and the Pan American Health
3 4
Organization (PAHO)/World Health Organization (WHO) – have publicly announced
5
opposition to the practice, as it lacks medical and scientific justification, and have
condemned its use around the world. Additionally, 24 countries have taken steps
towards limiting the use of this intervention, from complete bans to those that only
prohibit the practice for minors. But to date, no analysis has looked at the burden of
conversion therapy globally.
The term conversion “therapy” is itself a misnomer, given that this practice has been
shown to have negative long-term health impacts. The practice aims to “convert” the
patient from what is seen to be their homosexual lifestyle, and to eventually have them
Murphy, T. F. (1991). The ethics of conversion therapy. Bioethics, 5(2), 123-138.
1
Christy Mallory, Taylor Brown & Kerith Conron, The Williams Institute on Sexual Orientation and Gender Identity Law, UCLA
2
School of Law, Conversion therapy and LGBT youth (Jan. 2018)
American Medical Association, “LGBTQ Change Efforts (so-called “conversion therapy”) https://www.ama-assn.org/system/files/
3
2019-12/conversion-therapy-issue-brief.pdf
American Psychological Association. (2009). APA task force on appropriate therapeutic responses to sexual orientation. Report of
4
the Task Force on Appropriate Therapeutic Responses to Sexual Orientation, 1-130
Pan American Health Organization (PAHO) (2012) Cures for An Illness that Does Not Exist https://www.paho.org/hq/
5
dmdocuments/2012/Conversion-Therapies-EN.pdf

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pursue a heterosexual, cis-gender identity that adheres to existing social norms and
expectations. Broadly speaking, conversion therapy falls into four distinct categories:
psychotherapuetic, medical, faith-based, and punitive. Practitioners who employ these
approaches range from professional counselors and medical providers with public or
private practices, to religious organizations, parents, school personnel, and even
government agents (police, military, etc.). Numerous studies have found associations
between experiences of conversion therapy and depression , suicidality (Ryan et al
6 7
2018), and other health outcomes (APA 2009). The persistence of these practices
8
remains a stain on the world’s progress toward full equality for LGBTQ+ individuals and
serves to undermine future efforts on this front.
To better combat the practice of conversion therapy, it is first necessary to understand
its scope, geography, and methods.
What is the Status of Conversion Therapy Globally?
A survey was developed and integrated into the online social networking platform
Hornet, and users were prompted to voluntarily participate in a series of questions
regarding numerous topics. The survey was developed by combining existing
measurement tools with newly designed questions to gauge experiences with
conversion therapy. The survey consisted of a series of 44 questions covering a range
of topics, including personal experience with conversion therapy, types of therapy
experienced, long-term impacts, mental health, human rights, faith, and others. The
survey was provided in several languages, including English, Arabic, Traditional and
Simplified Chinese, and others. The survey was made available beginning on April 8,
2020. Any Hornet user was able to voluntarily participate in the survey. !
!
8092 individuals from over 100 countries participated in the survey, ranging in age from
under 18 to 85+. Of the 5820 individuals who responded to the question “Does
conversion therapy happen in your country?”, 1851 participants responded “yes,” that
they were aware conversion therapy occurs in the country where they live, and 1227
(21.08%) and 1263 (21.70%) responding that they were unsure or maybe, respectively.
1627 (20.09%) of respondents indicated that either they or someone they know (family
Ariel Shidlo & Michael Schroeder, Changing Sexual Orientation: A Consumers’ Report, 33 Professional Psychology: Research and
6
Practice 3, 249-59 (2002).
Ryan, C., Toomey, R. B., Diaz, R. M., & Russell, S. T. (2018). Parent-initiated sexual orientation change efforts with LGBT
7
adolescents: Implications for young adult mental health and adjustment. Journal of Homosexuality, DOI:
10.1080/00918369.2018.1538407.
American Psychological Association, supra note 3
8

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member, friend, etc.) have been in conversion therapy. Additional preliminary findings
broken down by topic are included below.
The Practice of Conversion Therapy
Participants report being exposed to a wide array of practices related to conversion
therapy. The breadth of these practices aligns with the previously mentioned
classifications: psychotherapeutic, medical, faith-based, and punitive. Using existing
information about conversion therapy, 28 options were provided in the survey, but since
fourteen individuals who had responded that conversion therapy existed in their country
specified “none of these,” these options may not have been exhaustive in nature.
Perpetrators
The majority of practitioners who led conversion therapy were mental health providers,
followed by religious authorities or their associates. Perhaps most concerning were the
~5% of respondents who indicated that government agents employed these harmful

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techniques. Additionally, 4% of reports involved school personnel, which may put
LGBTQ+ youth at further risk.
Motivation to Seek
Conversion Therapy
Nearly a quarter of
respondents expressed
that they had sought out
conversion therapy on
their own, while the rest
responded that the
decision was largely
outside of their control or
made on their behalf by
their school, family, or
employer. The results for
these questions reflect
patterns similar to those
in the previous section.
This survey did not,
however, ask further
questions regarding
coercion or forced
participation, but given
that there were reports of
punitive measures taken,
it is important to consider
this possibility.

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The Lasting Impact of Conversion Therapy
In addition to the major multilateral organizations that have put forward statements and
recommendations regarding the practice of conversion therapy, countless professional
medical and mental health organizations have denounced the practice. These
resounding condemnations are due to the lack of medical justification for conversion
therapy, the discrimination and pervasive societal bias that such practices perpetuate,
and the vulnerability to long-term, negative health impacts such as depression, anxiety,
substance use disorder, homelessness, suicidal ideation, post-traumatic stress disorder,
and others. Minors are particularly susceptible, given their developing sense of self and
vulnerability to coercion from family, peers, or other authority figures. This survey sought
to collect additional quantitative data on a wide range of impacts resulting from
conversion therapy.
Discussion
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Participants reported being subjected to a range of different conversion therapy
practices, all of which fall under the outlined categories (psychotherapuetic, medical,
religious, and punitive). They also reported an array of practitioners who provided the
therapy. Of particular concern, the indication that government actors are taking an
active role in perpetuating this harmful practice may warrant further investigation. Long-
term health impacts reported by individuals included suicidality, anger, depression,

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unwanted memories, and avoiding reminders of conversion therapy. !
Some limitations of this first
investigative effort to better
understand the global extent
of conversion therapy include
that this initial survey was only
offered in a few languages,
thus participation was limited
to those who know those
languages. Using an
application-based survey
disproportionately selects for
those who have access to the
resources necessary to use
the application, such as a
cellphone or computer,
internet or network, and
others. Furthermore, given
that there are areas of the
world that actively limit,
monitor, or censor the use of
the internet, access to digital
applications may be restricted.
Lastly, individuals who are not
“out” may choose to avoid
using such applications out of
fear for their safety, among
other reasons.
These findings with a large

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global sample reveal that the practice of conversion therapy continues to be utilized
around the world despite broad consensus on its harmful effects and lack of scientific
justification. The results underscore the necessity for continued data collection to better
understand the scope, geography, and methods of conversion therapy practices.
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Authors:!
Tyler Adamson
Sarah Wallach, Johns Hopkins University
Alex Garner, Senior Health Innovation Strategist, Hornet
Marguerite Hanley, Program Director, Tech4HIV!
Sean Howell, CEO, LGBT Foundation
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Special thanks: !
Stef Baral, Chris Beyrer
https://lgbt-token.org/conversion-therapy-research-torture-study/

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Appendix:
Region
Yes
No
Maybe
Unsure
Tot a l
All
1708
1395
1206
1186
5495
Europe
305
524
271
341
1441
LATAM
362
144
193
126
825
Asia
832
649
687
622
2790
N.America
172
37
38
62
309
Africa
37
41
17
35
130
What occurred during your experience of conversion therapy?
n (%)
TempoT Talk therapy or
psychoanalysis
113
(12.99%)
Detention or imprisonment
23
(2.64%
)
Excessive exercise
31
(3.56%)
Forced sex
46
(5.29%
)

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Hypnosis
32
(3.68%)
Physical abuse
27
(3.10%
)
Electric Shock
22
(2.53%)
Practicing celibacy
33
(3.79%
)
Praying and bible study
44
(5.06%)
Forced pregnancy or child-rearing
17
(1.95%
)
Use of drugs, medications, or
hormones
28
(3.22%)
Loss of financial control
25
(2.87%
)
Surgery (ex: castration, transplant,
etc.)
16
(1.84%)
Kidnapping
21
(2.41%
)
Other medical procedures
19
(2.18%)
Group therapy
42
(4.83%
)
Heterosexual sex therapy
28
(3.22%)
Therapy involving parents
24
(2.76%
)
Heterosexual conditioning (ex:
watching heterosexual porn, going to
strip clubs, etc)
23
(2.64%)
Incentive or rewards for “correct”
behavior
22
(2.53%
)
Exorcism
26
(2.99%)
Ritual or superficial cutting
13
(1.49%
)
Same-sex bonding
37
(4.25%)
Use of traditional herbs or
medicine
22
(2.53%
)
Participating in traditionally gender-
specific activities (ex:sports, hunting,
cooking, playing with dolls, etc.)
55 (6.32)
Yoga
23
(2.64%
)
Fasting
44
(5.06%)
None of these
14
(1.61%
)
Who provided or led the conversion therapy?
n (%)
TempoT Public mental health
provider
227
(13.83%)
Public medical provider
96
(5.85%
)

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Private mental health provider
309
(18.83%)
Private medical provider
120
(7.31%
)
Religious authority or who acted on
their behalf
230
(14.02%)
Police, military, or other
government entity
73
(4.45%
)
Traditional Healer
80
(4.88%)
A drug and/or alcohol
rehabilitation
61
(3.72%
)
Conversion therapy camp
78
(4.75%)
School personnel
72
(4.39%
)
Unsure
121
(7.37%)
Parent(s)
114
(6.95%
)
None of these
60
(3.66%)
If you or someone you know has experience with conversion therapy, why did you/
they enter conversion therapy?
n (%)
It was a result of family pressure
325
(21.97%
)
It was their school’s decision
74
(5.0%)
It was a result of community (ex:
neighbors, friends) pressure
163
(11.01%
)
It was recommended by a
mental health or medical
professional
143
(9.66%
)
It was my/their own decision
391
(26.42%
)
It was the government’s decision
60
(4.05%
)
It was their religious leader or religious
community’s decision or
recommendation
176
(11.89%
)
None of these
95
(6.42%
)
It was their employer’s decision
53
(3.58%)
Because of your experience of conversion therapy, have you experienced any of the
following?
n

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TempoT Temporary physical harm
42
Intrusive imagery
30
Permanent physical harm
17
Suicidal thoughts
42
Anger
48
Suicidal attempt(s)
27
Depression
56
Self-hatred
39
Anxiety
59
Helplessness
39
Confusion
54
Shame
57
Guilt
51
Loss of familial relationships
29
Grief
22
Flashbacks
25
Hopelessness
33
Loss of housing
19
Loss of faith
33
Loss of friendships
28
Poor self-esteem
44
Drug and/or substance use
18
Social isolation
40
Loss of employment
19
Difficulties with intimacy
41
None of these
28
In the past month, how
much were you bothered
by:
Not at all
A lit tle bit
Moderatel
y
Quite a bit
Extremel
y
Repeated, disturbing, and
unwanted memories of the
conversion therapy
78 (47.85%)
45
(27.61%)
23
(14.11%)
8 (4.91%)
9 (5.52%)
Repeated, disturbing
dreams of the conversion
therapy
87 (58.78%)
32
(21.62%)
18
(12.16%)
6 (4.05%)
5 (3.38%)
Suddenly feeling or acting
as if the conversion
therapy were actually
happening again (as if you
were actually back there
reliving it)
75 (52.82%)
33
(23.24%)
22
(15.49%)
10 (7.04%)
2 (1.41%)
Feeling very upset when
something reminded you
of the conversion therapy?
60 (43.48%)
42
(30.43%)
20
(14.49%)
12 (8.70%)
4 (2.90%)

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Having strong physical
reactions when something
reminded you of the
conversion therapy (ex:
heart pounding, trouble
breathing, sweating, etc.)?
67 (50.38%)
36
(27.07%)
19
(14.29%)
2 (1.50%)
9 (6.77%)
Avoiding memories,
thoughts, or feelings
related to the conversion
therapy?
58 (43.28%)
33
(24.63%)
21
(15.67%)
11 (8.21%)
11
(8.21%)
Avoiding external
reminders of the
conversion therapy (ex:
people, places,
conversations, activities,
objects, or situations)?
58 (45.67%)
35
(27.56%)
12
(9.45%)
9 (7.09%)
13
(10.24%)
Trouble remembering
important parts of the
conversion therapy?
66 (50.77%)
28
(21.54%)
17
(13.08%)
10 (7.69%)
9 (6.92%)
Having strong negative
beliefs about yourself,
other people, or the world
(ex: having thoughts such
as - I am bad, there is
something seriously wrong
with me, no one can be
trusted, the world is
completely dangerous)?
47 (36.43%)
40
(31.01%)
18
(13.95%)
14
(10.85%)
10
(7.75%)
Blaming yourself or
someone else for the
conversion therapy or what
happened after it?
54 (42.19%)
33
(25.78%)
20
(15.63%)
13
(10.16%)
8
(6.251%)
Having strong negative
feelings such as fear,
horror, anger, guilt, or
shame?
47 (37.60%)
33
(26.40%)
21
(16.80%)
15 (12.0%)
9 (7.20%)
Loss of interest in activities
you used to enjoy?
44 (36.07%)
36
(29.51%)
19
(15.57%)
8 (6.56%)
15
(12.30%)
Feeling distant or cut off
from other people?
37 (30.58%)
32
(26.45%)
23
(19.01%)
14 (11.57%)
15
(12.40%)
Trouble experiencing
positive feelings (ex: being
unable to feel happiness or
have loving feelings for
people close to you)?
43 (36.13%)
29
(24.37%)
24
(20.17%)
15
(12.61%)
8 (6.72%)

! 14
Irritable behavior, angry
outbursts, or acting
aggressively?
35 (29.91%)
42
(35.90%)
19
(16.24%)
11 (9.40%)
20
(8.55%)
Taking too many risks or
doing things that could
cause you harm?
46 (39.66%)
30
(25.86%)
19
(16.38%)
13 (11.21%)
8 (6.90%)
Being "super alert" or
watchful or on guard?
33 (28.70%)
36
(31.30%)
17
(14.78%)
14
(12.17%)
15
(13.04%)
Feeling jumpy or easily
startled?
41 (35.65%)
33
(28.70%)
18
(15.65%)
14
(12.17%)
9 (7.83%)
Having difficulty
concentrating?
28 (24.35%)
38
(33.04%)
17
(14.78%)
16
(13.91%)
16
(13.91%)
Trouble falling or staying
asleep?
33 (28.45%)
37
(31.90%)
16
(13.79%)
12
(10.34%)
18
(15.52%)