background  In spite of the assumption that homosexuality has become more socially acceptable, there is evidence of increased psychopathology among homosexuals.
aim  To provide a theoretical framework that can explain these factors.
method  A literature survey was performed using PsycINFO, Medline and Libis, using as key words homophobia, internalized homophobia and heterosexism. We selected post-1980 published articles about homosexuals. Most of these articles were of Anglo-American origin.
results  Two pathogenic factors play a central role: heterosexism and internalized heterosexism. One hypothesis is that societal stereotyping and the internalization of the image generate variety of symptoms and disorders in homosexuals.
conclusion  Further research is required to test this hypothesis, but in any case the assumption that homosexuals are now readily accepted by society needs to be subjected to critical examination.