LGBTQIA+ Communities and Mental Health: Finding Help
Reviewed by therapist.com Team
Being part of the LGBTQIA+ community does not mean you have a mental illness. However, people who are LGBTQIA+ frequently face discrimination and disparities that jeopardize their mental health and put them at increased risk for developing a mental health disorder.
LGBTQIA+ stands for Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Intersex, and Asexual. The plus sign encompasses other gender identities and sexualities, such as pansexual, non-binary, genderqueer, and more. Some people use shorter initialisms, such as LGBT or LGBTQ, but they still cover the same diverse groups of people.
You can identify as LGBTQIA+ based on your gender, your sexuality, and/or your sex. But what are the differences between these three terms?
Sex is a category based on chromosomes, hormones, internal and external sex organs, as well as secondary sex characteristics like facial hair. Biological sex is divided into three categories: male, female, and intersex. Intersex individuals have some combination of both traditionally male and traditionally female sex organs, chromosomes, hormone levels, and/or secondary sex characteristics.
It is important to remember that, like gender, sex is socially constructed. Most individuals go their entire lives without ever having their chromosomes or hormones tested, yet they are designated as a specific sex from birth based on genitalia.
Gender is the way we choose to express our identity on a spectrum of masculinity, femininity, and androgyny. Common gender identities include:
- Cisgender: A person’s whose gender identity matches their assigned sex at birth.
- Transgender: A person whose gender identity does not match their assigned sex at birth.
- Non-binary/genderqueer/gender non-conforming: A person who does not subscribe to the male-female binary. Individuals who are non-binary may identify with elements of both masculinity and femininity, with neither masculinity or femininity, or feel as if their gender identity exists outside of any standard conception of gender.
- Genderfluid: A person whose gender identity changes and is not fixed on a single gender identity.
- Queer: An umbrella term used by people who are not cisgender or heterosexual to describe themselves and the LGBTQIA+ community. Although the term has traditionally had a negative connotation to it, many LGBT individuals have reclaimed this word to describe themselves. Because of its potential for offense, though, it should only be used by individuals who use the term to self-identity or to describe others who self-identity as queer.
Sexuality refers to the sexual feelings we have, as well as the sexual activities we participate in. You do not need to have had sex to know what your sexuality is, although your sexual experiences may inform your sexual identity.
Much of the language surrounding sexuality was developed during a time in which society still subscribed to the gender binary, which is the idea that the only two options for gender—man and woman—are inherent opposites.
Today’s understanding of gender is not a binary of two opposite choices, but a spectrum including many choices. It’s important to expand our understanding of sexuality beyond binary definitions of men and women.
Different sexualities include:
- Heterosexual (straight): A person who is attracted to people of the opposite binary gender (women attracted to men, men attracted to women)
- Gay: A person who is attracted to people of the same gender (men attracted to men, women attracted to women)
- Lesbian: A woman who is attracted to other women
- Asexual: A person who does not experience sexual attraction to anyone
- Bisexual: A person who is attracted to more than one gender
- Pansexual: A person who is attracted to all genders
Although the term “homosexual” was historically used to refer to people in the LGBT community, the term is now considered outdated and offensive, so it should not be used.
The United States has a long history of discriminating against the LGBTQIA+ community—and continues to do so to this day. This history of discrimination and oppression continues to contribute to the mental health challenges that LGBTQIA+ people face today.
Western cultures criminalized same-sex relationships severely throughout history, often through the charge of sodomy. By 1714, sodomy laws were in place throughout colonial America.
Illinois became the first state to decriminalize sodomy in 1962. Other state laws against sodomy would remain legal in the United States until the Supreme Court struck them down in Lawrence v. Texas in 2003.
Even when being gay was not viewed as a crime, it was still viewed as “a disease or disorder to which mental health professionals need to attend.”
The American Psychological Association (APA) included a diagnosis for homosexuality as a mental health disorder in its first Diagnostic and Statistical Manual (DSM) in 1952. This pathologizing of sexuality and gender led to inhumane psychological treatments, including electric shock therapy and conversion therapy, in an effort to “cure” gay people.
The APA removed the diagnosis of homosexuality from the DSM in 1973, but conversion therapy is still legal in the majority of states today.
Identifying as LGBTQIA+ had been grounds for discharge from the United States military since its founding, but it was President Eisenhower who explicitly banned LGBTQIA+ people from serving in the federal government in 1953. His executive order claimed they were a security risk on par with “alcoholics and neurotics.”
During the Clinton administration in 1993, the Department of Defense partially reversed Eisenhower’s executive order with what became known as “Don’t Ask, Don’t Tell.” The military was no longer allowed to use a person’s sexual orientation to determine whether they could serve. However, a person in the military would still be discharged if they openly identified as gay or engaged in same-sex acts.
“Don’t Ask, Don’t Tell” remained the law of the land until it was repealed during the Obama administration in 2010. This allowed individuals who identified as gay to serve openly in the military. The Department of Defense updated its policy to allow transgender people to serve openly in the military in 2015.
However, in 2019, the Trump administration reinstated a version of “Don’t Ask, Don’t Tell” for transgender military members only. The Biden administration reversed this policy so trans service members could serve freely once again in 2021.
Human immunodeficiency virus (HIV) damages the body’s ability to protect itself against infection. Left untreated, HIV progresses to acquired immunodeficiency syndrome (AIDS), in which the body develops severe illnesses called opportunistic infections. Life expectancy for people with AIDS ranges from one to three years, depending on treatment.
HIV is transmitted via contact with bodily fluids. In the early 1980s, as HIV began to spread across the U.S., more widespread public attention was brought to this epidemic. At the time, the disease was first noticed in a small cluster of gay men, and the virus became known derogatorily as “the gay plague.”
The HIV/AIDS epidemic disproportionately devastated the LGBTQIA+ community, specifically gay men. Because most of the victims were gay, the Reagan administration did not act swiftly to develop a treatment or cure for HIV/AIDS. Gay activists were left to fend for themselves to create organizations to provide care for victims.
Finally, in 1995, the U.S. government approved a treatment that effectively stopped the AIDS epidemic. By that point, AIDS was the leading killer of men aged 25–44. In 2016, the Centers for Disease Control and Prevention (CDC) estimated that nearly 675,000 people in the U.S. died of AIDS between 1985 and 2013.
Same-sex marriage has been illegal throughout most of U.S. history. It wasn’t until 2004 that Massachusetts became the first state to legalize same-sex marriage. The Supreme Court ruling on Obergefell v. Hodges finally legalized same-sex marriage in all 50 states in 2015.
LGBTQIA+ people still face discrimination and oppression to this day that negatively impact their mental health. Common challenges include homophobia and transphobia, lack of support, and health care disparities.
Homophobia refers to negative attitudes or beliefs against LGBTQIA+ people, which often results in efforts to discriminate against, oppress, or harm a person because of their gender and/or sexuality.
LGBTQIA+ people experience homophobia and transphobia at every level of society. Children and teens are bullied for being gay or expressing their gender identity, often before they have claimed that identity for themselves. Adults face bigoted vitriol and violence. Living in a homophobic and transphobic society can lead to internalized homophobia and transphobia, causing LGBTQIA+ individuals to feel shame and hatred of their own identity.
It’s no wonder, then, that LGBTQIA+ people are three times more likely to develop a mental health disorder than straight people—not because of their identity, but because their identity is not accepted.
Living in a homophobic society translates to a lack of support for one’s identity at every level:
- Familial relationships: Many LGBTQIA+ people face rejection when they come out to their families. This can range from a lack of acceptance to cutting off ties to acts of violence.
- Homelessness: As many as 40% of homeless youth identify as LGBTQIA+. Many LGBTQIA+ people face homelessness due to discriminatory housing practices, lack of family support, and continued criminalization in other countries.
- Lack of legal protections: 27 states lack explicit legal protections for people on the basis of sexuality or gender regarding employment and housing. There is currently no federal law that fully prohibits discrimination on the basis of gender or sexuality.
- Depression: According to Mental Health America, LGBTQIA+ teenagers are “six times more likely to experience symptoms of depression” than straight, cisgender teens. They are also more than twice as likely to feel suicidal and more than four times as likely to attempt suicide than their straight, cisgender counterparts.
Discrimination against LGBTQIA+ people occurs in multiple health care settings. Whether you have a physical health problem, a mental health disorder, or questions about your sexual health, you may face hurdles due to discrimination against your gender and sexuality.
- Health care: Roughly 8% of LGBTQIA+ people, including 27% of transgender people, have been explicitly denied health care because of their gender or sexuality.
- Mental health treatment: Although being gay is no longer viewed as a mental health disorder, conversion therapy is still practiced today. Transgender people in particular continue to face discrimination and stigma for their gender identity. Some people in the mental health community continue to diagnose all transgender people with gender dysphoria, even though gender dysphoria has its own specific diagnosis and is not experienced by all trans people.
- Sexual health education: According to the Human Rights Campaign, less than 5% of surveyed LGBTQIA+ students said they had a health class that included positive representations of LGBTQIA+ relationships and topics. This can lead to a greater incident of sexually transmitted infections (STIs), as individuals who identify as queer may not be informed about safe-sex practices.
If you identify as LGBTQIA+ and struggle with your mental health, help is available now. Click here to find an LGBTQIA+-affirming therapist near you. You deserve to receive mental health care without having to deny your gender identity or sexuality. Your identity is not a mental illness.
One of the best parts about identifying as LGBTQIA+ is the community of love and acceptance that you belong to. There have been LGBTQIA+ people throughout history and throughout the world who have overcome similar challenges to the ones you may be facing. If you want to find a supportive community, consider the following resources:
If you are in crisis and need help now, please call or text one of the following helplines:
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