LGBTQ

Exploring one’s gender identity and sexual preferences is an important part of life that all people go through. While some people undergo this process seamlessly, others are left questioning where and how they fit in. For people in the LGBTQ community, exploring gender identity and sexuality can be confusing and frightening. While questioning one’s sexuality is difficult in and of itself, LGBTQ individuals are often subject to discrimination and oppression. Resultantly, LGBTQ people are more likely to have mental health disorders, such as depression and anxiety, than their heterosexual counterparts.[1]

Challenges that LGBTQ individuals often struggle with:

  • Gender Identity: For people in the LGBTQ community, the process of defining one’s gender identity can be tumultuous. Research indicates that the process follows a typical pattern, beginning with one denying their attraction to the same sex. This period of denial can be emotionally exhausting, and can have negative consequences on overall mental health.[2] The denial stage is typically followed by a gradual acceptance of one’s gender identity and experimentation with the same sex. However, negative feelings about one’s gender identity often resurge as significant romantic relationships end.2
  • Bullying at School: Research has shown that LGBTQ youth are more likely than heterosexual youth to be bullied and victimized at school.[3] Even if LGBTQ individuals are not directly bullied, the homophobic attitudes and behaviours of other students can have a negative impact. Some research indicates that LGBTQ youth who are bullied at school engage in more risky behaviours, such as unsafe sex or substance abuse.3
  • Work: LGBTQ individuals face different challenges than heterosexual people when it comes to their jobs. Both historians and the courts have acknowledged that LGBT workers have faced a long history of employment discrimination.[4] As indicated by research, discrimination and harassment in the workplace can negatively impact fair wages and the physical and mental health of LGBTQ individuals.4 Surveys have documented that discrimination is present in hiring processes, job retention, and job promotions.4
  • Romantic Relationships: Internalized homophobia occurs when an LGBTQ individual unknowingly takes on others’ negative attitudes towards LGBTQ people and directs them at him/herself. Research has shown that individuals who experience internalized homophobia are less likely to be satisfied with their romantic relationships.[5] Intimate partner violence is another problem commonly seen in LGBTQ relationships.[6] Some researchers theorize that the psychological stress of being a minority individual contributes to one’s likelihood to perpetrate partner violence.[7] Intimate partner violence can lead to poor mental health outcomes for LGBTQ individuals, such as Depression and Substance Abuse.[8]
  • Having Children: For LGBTQ individuals, the decision to have children comes with different challenges than those faced by heterosexual individuals. LGBTQ individuals and couples have several options to choose from when deciding how to bring a child into their lives, including surrogacy, adoption, and self-insemination. All of these options are costly and many involve lengthy legal proceedings. While Canada does allow same-sex couples to adopt, international options are limited by other countries’ prohibitions of LGBTQ adoptions.[9] While surrogacy is a popular option amongst gay men, it is an expensive process that generally requires the guidance of a specialized agency and lawyers.[10] For lesbian women, medical or self-insemination is a viable option that is also costly. Women who choose this option are often faced with inconsistent pricing, home checks, and legal restrictions on the sexuality of the sperm donor.[11]
  • Family Relationships: Studies have shown that LGBTQ individuals often experience challenging relationships with family members when they “come out.”[12] More specifically, youth who think their parents will react negatively to their sexual orientation or gender identity are more likely to abuse substances.12 Parental rejection has also been linked to poor mental health, depression, attempted suicide, and risky sexual behaviour.12
  • Mental Health: Discrimination, bullying, and homophobic attitudes can have drastic negative effects on LGBTQ individuals. LGBTQ youth are especially at risk for adverse mental health outcomes and have a higher risk of suicide than their heterosexual peers.[13] Depression is another common issue for LGBTQ individuals and is caused in part by social stigmatization.[14]

Canadian Statistics

  • The number of same-sex married couples tripled between 2006 and 2011.[15] This increase occurred after Canada passed the Civil Marriage Act in 2005, whereby same sex marriage was legalized.
  • In 2014, 33% of homosexual and bisexual individuals reported that their days were “quite a bit” or “extremely stressful,” compared to 26.7% of heterosexuals.15
  • Adolescent youth who have been rejected by their families due to their sexual preferences are 8 times more likely to commit suicide than their heterosexual peers.[16]
  • Sixty-eight percent of transsexual youth, 55% of lesbian/gay students, and 42% of gay/bisexual students reported being verbally harassed about their gender identification or sexual orientation.[17]
  • A 2005 study found that gay men were more likely than heterosexual men to have consulted a medical specialist or mental health provider in the prior year.[18]
  • Lesbian women were more likely than heterosexual women to have seen a family doctor in the year prior to the survey.18
  • Forty-six percent of gay and lesbian victims of hate crimes were injured as a result of the incident. Only 25% of heterosexual victims of hate crimes were injured in similar incidents.[19]

Risk Factors for Mental Illness:

Studies from all over the world report that the rate of mental illness is higher amongst the LGBTQ community than in the general population.[20] In recent years, it has been recognized that mental health issues that arise in LGBTQ individuals are often a result of “Minority Stress.” According to the Minority Stress Theory, stigma-related prejudice and discrimination are considered chronically stressful events that can lead to negative health outcomes.[21] Some of the social factors that can contribute to mental health issues amongst LGBTQ individuals are:

  • Interpersonal Victimization[22]
  • Bullying[23]
  • Stigmatization[24]
  • Social Rejection/Isolation23
  • Lack of Social Support23
  • Verbal/Physical/Sexual Abuse23

Mental Health Disorders associated with being LGBTQ:

  • Depression[25]
  • Anxiety Disorders[26]
  • Substance Abuse Disorders21

Does Psychology Work?

Unfortunately, the LGBTQ population faces many risk factors for mental health disorders. Psychological therapy can help support LGBTQ individuals who are experiencing difficulties associated with their sexual orientation, gender identity, relationships and/or environmental and social discrimination and injustice.

  • Cognitive Behavioural Therapy (CBT): CBT can help LGBTQ individuals work through feelings of anxiety, depression, and low self-worth.[27] In addition to adopting new thoughts, CBT can assist LGBTQ people in changing their maladaptive behaviours (such as drinking alcohol in isolation) with more effective ones (such as talking about what is happening).14 Studies have also shown that CBT administered in a group environment can reduce symptoms of Depression, isolation, and can enhance self-esteem in LGBTQ participants.14 One study of CBT showed that after 10 group sessions, gay and bisexual male participants had significant reductions in depressive symptoms, alcohol use problems, sexual compulsivity, and risky sexual behaviours.[28]
  • Emotionally Focused Therapy (EFT): EFT is a type of therapy that can be used for couples, families, and individuals. It focuses primarily on repairing relationships and creating healthier attachments with oneself and with others.[29] This form of therapy embraces a positive view of LGBTQ identities and addresses the negative influences that homophobia, transphobia, and heterosexism have had on the LGBTQ individuals and their relationships with their partners and families. Although EFT has been extensively researched on heterosexual population, EFT has been also successfully used with homosexual couples.[30] This is because the focus of the therapy is on creating a stronger relational bond and connection, which is a basic human need found in every person and is wired in our brains. Helping LGBTQ couples develop strong and healthy relationships and communication styles often serves as a protective function for societal discrimination and various other stressors that happen in life.24
  • Eye Movement Desensitization and Reprocessing (EMDR): As previously mentioned, the minority status of LGBTQ individuals often results in their victimization via discrimination, rejection, and abuse. Although the abuse is not always life-threatening, it is traumatic none-the-less. Traumatic events can lead to the development of Post-Traumatic Stress Disorder (PTSD), a psychological disorder that can cause debilitating fear, intrusive memories, and difficulties bonding with others.[31] Within the LGBTQ community, researchers are recognizing that bullying, family rejection, and verbal threats can result in PTSD symptoms.[32] EMDR is a proven psychological treatment for PTSD.[33] In one study, EMDR was used to successfully work through relationship difficulties experienced by a gay couple as a result of traumatic events.[34]

Tips to Cope with Adversity!

  • Connect with other LGBTQ individuals: Oftentimes, being a part of the LGBTQ community can have a positive impact on mental health, as well as emotional and social wellbeing.[35] LGBTQ individuals report experiencing mutual support, understanding, feelings of safety, and the freedom to express oneself.
  • Talk about your feelings: Coming out as LGBTQ can bring about many emotional challenges. LGBTQ individuals may experience sadness, guilt, shame, fear, and other emotions as a result of exploring and expressing your sexuality and gender identity. Processing difficult feelings can be painful and some people may try to numb them out. Unfortunately, this coping strategy temporarily shuts down these uncomfortable feelings. However, in the long run, you have not changed how you feel. Discussing difficult feelings with a trusted friend, a family member, or health professional is a healthier way to find relief.
  • Find a creative outlet: You may feel repressed or be unable to be yourself in public. You may feel afraid that if you express yourself, people will be unaccepting and cruel. Finding creative forms of expression, such as art, dance, or music, can provide a way for you to show others who you are.

Navigating life as an LGBTQ individual can be challenging on many levels. Dealing with emotional difficulties can be isolating, whereas, the support of a Psychologist can offer hope and comfort. Since the LGBTQ population is at a higher risk for a variety of mental health disorders, Hopewell Psychological offers treatments to address them. We offer individual therapies, as well as therapy for couples, families, and groups in order to strengthen the individual and his/her most important relationships. You deserve to live a happy life and we would love to offer you support on your journey.

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*Psychologists are covered under Insurance Companies in Canada. You will need to check with your insurance company about the specific details regarding your coverage.

References

[1] Fredriksen-Goldsen, Karen I., et al. “The health equity promotion model: Reconceptualization of lesbian, gay, bisexual, and transgender (LGBT) health disparities.” American Journal of Orthopsychiatry 84.6 (2014): 653-663.

[2] Bilodeau, Brent L. and Kristen A. Renn. “Analysis of LGBT identity development models and implications for practice.” New directions for student services 111 (2005): 25-39.

[3] Robinson, J. P. and Espelage, D. L. “Inequities in educational and psychological outcomes between LGBTQ and straight students in middle and high school.” Educational Researcher 40.7 (2011): 315-330.

[4] Pizer, Jennifer C., et al. “Evidence of persistent and pervasive workplace discrimination against LGBT people: The need for federal legislation prohibiting discrimination and providing for equal employment benefits.” Loyola of Los Angeles Law Review 45 (2011): 715-780.

[5] Frost, D. M. and Meyer, I. H. “Internalized Homophobia and Relationship Quality among Lesbians, Gay men, and Bisexuals.” Journal of Counseling Psychology 56.1 (2009): 97-109.

[6] Badenes-Ribera, L., et al. “Intimate Partner Violence in Self-Identified Lesbians: A meta-analysis of its prevalence.” Sexuality Research as Social Policy 12.1 (2015): 47-59.

[7] Edwards, K.M. and Sylaska, K.M. “The Perpetration of Intimate Partner Violence among LGBTQ College Youth: The Role of Minority Stress.” Journal of Youth and Adolescence 42 (2013): 1721-1731.

[8] Houston, E. and McKirnan, D. J. “Intimate partner abuse among gay and bisexual men: Risk correlates and health outcomes.” Journal of Urban Health 84.5 (2007): 681-690.

[9] Mertus, Jennifer. “Barriers, Hurdles, and Discrimination: The current status of LBT intercountry adoption and why changes must be made to effectuate the best interest of the child.” Capital University Law Review 39 (2011): 271-311.

[10] Lev, A. I. “Gay dads: Choosing surrogacy.” Lesbian & Gay Psychology Review 7.1 (2006): 72-76.

[11] Ross, L.E., et al. “Service use and gaps in services for lesbian and bisexual women during donor insemination, pregnancy, and the postpartum period.” Journal of Obstetrics and Gynaecology Canada 28.6 (2006): 505-511.

[12] Ryan, C., et al. “Family Acceptance in Adolescence and the Health of LGBT Young Adults.” Journal of Child and Adolescent Psychiatric Nursing 23.4 (2010): 205-213.

[13] Saewyc, E. M., et al. “School-Based Strategies to Reduce Suicidal Ideation, Suicide Attempts, and Discrimination among Sexual Minority and Heterosexual Adolescents in Western Canada.” International Journal of Child, Youth, and Family Studies 5.1 (2014): 89-112.

[14] Ross, L. E., et al. “Can Talking About Oppression Reduce Depression? Modified CBT Group Treatment for LGBT People with Depression.” Journal of Gay and Lesbian Social Services 19.1 (2007): 1-15.

[15] “Same-Sex Couples and Sexual orientation… by the numbers.” Statistics Canada. 9 Nov. 2016. Web. 1 June 2017.

[16] Ryan, C., et al. “Family Rejection as a Predictor of Negative Health Outcomes in White and Latino Lesbian, Gay, and Bisexual Young Adults.” Pediatrics 123.1 (2009): 346-352.

[17] Kim, Y. and Leventhal, B. “Bullying and Suicide: a review.” International Journal of Adolescent Health 39 (2006): 662-668.

[18] “Study: Health Care use among gay, lesbian, and bisexual Canadians.” Statistics Canada. 19 Mar. 2008. Web. 1 June 2017.

[19] “Pilot survey of hate crime.” Statistics Canada. 1 June 2014. Web. 1 June 2017.

[20] Russell, S. T. and Fish, J. N. “Mental Health in Lesbian, Gay, Bisexual, and Transgender (LGBT) Youth.” Annual Review of Clinical Psychology 28.12 (2016): 465-487.

[21] Kelleher, C. “Minority stress and health: implications for lesbian, gay, bisexual, transgender, and questioning (LGBTQ) young people.” Psychology Quarterly 22.4 (2009): 373-379.

[22] Lehavot, K. and Jane M. S. “The impact of minority stress on mental health and substance use among sexual minority women.” Journal of Consulting and Clinical Psychology 79.2 (2011): 159-170.

[23] Meneses, C. M. and Grimm, N. E. “Heeding the cry for help: Addressing LGBT bullying as a public health issue through law and policy.” University of Maryland Law Journal of Race, Religion, Gender & Class 12 (2012): 140-168.

[24] Almeida, J., et al. “Emotional distress among LGBT youth: The influence of perceived discrimination based on sexual orientation.” Journal of Youth and Adolescence 38.7 (2009): 1001-1014.

[25] Haas, A. P., et al. “Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: Review and recommendations.” Journal of Homosexuality 58 (2011): 10-51.

[26] Cochran, S. D., et al. “Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States.” Journal of Consulting and Clinical Psychology 71.1 (2003): 53-61.

[27] Craig, S. L., et al. “Gay affirmative Cognitive Behavioral Therapy for sexual minority youth: A clinical adaptation.” Clinical Social Work Journal 41 (2013): 258-266.

[28] Pachankis, J. E., et al. “LGB-affirmative Cognitive-Behavioral Therapy for young adult gay and bisexual men: A randomized controlled trial of a transdiagnostic minority stress approach.” Journal of Consulting and Clinical Psychology 83.5 (2016): 875-889.

[29] Hardtke, K. K., et al. “Emotionally Focused Couple Therapy: A full-treatment model well-suited to the specific needs of lesbian couples.” Journal of Couple & Relationship Therapy 9.4 (2010): 312-326.

[30] Allan, R. and Johnson, S. “Conceptual and application issues: Emotionally Focused Therapy with gay male couples.” Journal of Couple & Relationship Therapy (2016): 1-20.

[31] Maercker, A. and Perkonigg, A. “Applying an international perspective in defining PTSD and related disorders: Comment on Friedman (2013).” Journal of Traumatic Stress 26.5 (2013): 560-562.

[32] Alessi, E. J., Martin, J. I., Gyamerah, A., and Meyer, I. H. “Prejudice-related events and traumatic stress among heterosexuals and lesbians, gay men and bisexuals.” Journal of Aggression, Maltreatment & Trauma 22.5 (2013): 510-526.

[33] Davidson, P. R. and Parker, K. “Eye Movement Desensitization and Reprocessing (EMDR): A meta-analysis.” (2001): 305-316.

[34] Reicherzer, S. “Eye Movement Desensitization and Reprocessing in counseling a male couple.” Journal of EMDR Practice and Research 5.3 (2011): 111-120.

[35] Johns, M. M., et al. “LGBT community, social network characteristics, and smoking behaviors in young sexual minority women.” American Journal of Community Psychology 52.1-2 (2013): 141-154.

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