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This is a little bit of having it both ways, one of the ways the field attempts to manage issues with overs-diagnosis is by putting things in cultural context, for instance a core part of what makes something a psychiatric illness "does it negatively effect your life."
The line between a healthy person, a neurotic person, someone with obsessive compulsive personality disorder, and obsessive compulsive disorder is in part of how maladaptive it is and how you feel about it.
This is also how you attempt to make sure ADHD, Anxiety, and Depression aren't over diagnosed. Feeling sad sometimes is part of the human experience. Feeling anxious to some extent is adaptive. Not being able to work and live your life because of sadness is pathology.
With homosexuality - if being gay means you are executed, it's much more fair to say that it is pathology adjacent, especially if that unlocks resources for support.
Pedophilia is also an example of something that is overwhelmingly the subject of cultural scorn, but it's wrongness is less to do with obvious organic brain injury and more to do with the fact that nobody thinks it is acceptable. In a different society (like the pederasty ancient societies) it's not pathology. Here and now it's a disease and acknowledging that allows people to get treatment and for the legal system to do its thing when people act.
This is how the west lost shame. If the only 'problem' with homosex is the shame, and legal consequences, the cure is pride and legalization.
I think this may have some unintended consequences.
Or maybe they were intented. Don't feel bad about grooming adolescents into drugs and buggery you're just like the ancients with their catamites.
All cultural contexts are not reasonable. If you need to drug kids that can't pay attention in class and at the same time unstructured recess hours and PE have fallen precipitously over 50 years. When there is recess they're not permitted smear-the-queer or red rover and PE in elementary school that looks like 'mindful stretching' or has had the competitive nature of many of the games / sports removed, perhaps the cultural context is unreasonable.
If you can't close the bath houses during an epidemic and need prophylactic anti-HIV meds because you can't not bugger strangers the cultural milieu that has produced these adverse outcomes needs serious examination. It's as if removing the natural consequences might encourage poor decisions and behaviour.
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