Although a person’s sexual or romantic orientation or gender identity may not be a source of distress, people who identify as lesbian, gay, bisexual, transgender, queer, questioning, intersex, or any other type of non-conforming sexual or gender identity (known as LGBT, LGBTQ, or LGBTQIA, among others) may find that the social stigma of living as a sexual minority is a source of stress or anxiety. When seeking therapy, whether for issues associated with one’s sexual, romantic, or gender identity or for everyday concerns, finding a qualified mental health professional who has experience and familiarity with issues that confront the LGBTQ community can be critical to successful therapy outcomes.
Despite rapidly growing cultural acceptance of diverse sexual and romantic orientations and gender identifications, oppression, discrimination, and marginalization of LGBTQ people persists. Coping with discrimination and oppression, coming out to one’s family, and sorting out an “authentic” sense of self in the face of social expectations and pressures can lead to higher levels of depression, anxiety, substance use, and other mental health concerns for LGBTQ people.
Research shows that youth who identify as LGBTQ are at an increased risk of suicidal ideation and self-harm, particularly when they also experience discrimination based on their sexual or gender identity. According to a 2007 survey, students who identified as lesbian, gay, or bisexual were almost ten times as likely to have experienced bullying and victimization at school and more than twice as likely to have considered suicide as their heterosexual, non-transgendered classmates within the previous year. Discrimination may take several forms, including social rejection, verbal and physical bullying, and sexual assault, and repeated episodes will likely lead to chronic stress and diminished mental health. Perceived discrimination—the expectation of discrimination—will also lead to diminished mental health. LGBTQ adults, too, may be subject to similar forms of harassment, as well as discrimination with regards to housing, employment, education, and basic human rights.
Of course, many of the issues that LGBTQ people might bring to therapy are those that are common among all people. All couples argue over many of the same things—money, sex, the in-laws, quality time—and all people are subject to the same kinds of daily stressors, such as mood swings, workplace concerns, or low self-esteem.
Though many therapists may be qualified to help, sometimes LGBTQ clients feel more comfortable with an LGBTQ therapist, or at least with a therapist who specializes in or has a great deal of experience with LGBTQ issues. Such therapists are not available in every community, but more and more therapists and counselors are providing distance services by phone or over the Internet, and this may help broaden a person’s search for the right therapist. People considering sex reassignment surgery are often required to seek therapy before undergoing surgery. A specialist in this area, if available, is recommended.
Early editions of the Diagnostic and Statistical Manual identified homosexuality as a mental disorder, until clinical research demonstrated that sexual or romantic attraction to someone of the same sex is a normal, healthy, positive form of human sexuality. Despite the mental health community’s decades-long affirmation of all sexual orientations, sexual orientation change efforts (SOCE) are still provided by some therapists and pursued by some people who feel conflicted about their sexual orientation. Several organizations, including the American Psychological Association and the American Psychiatric Association, oppose sexual orientation change therapy, also known as conversion or reparative therapy, and many states are considering bills to ban the practice. Furthermore, the ethics of the professions of social work, psychology, psychiatry, and marriage and family counseling mandate that therapists provide services to all persons without discrimination.
Gender dysphoria is listed as a psychological condition in the DSM-5 to account for the significant distress a person might experience when a person’s gender identity or expression does not correspond with that person’s physical sex characteristics. In the previous edition, the condition was listed as gender identity disorder, but after receiving criticism about the stigmatizing effect of the word “disorder,” the condition was renamed gender dysphoria to ensure gender noncomformity was not labeled as a mental disorder.
Diagnosis of gender dysphoria in adults requires:
Diagnosis of gender dysphoria in children requires:
Last updated: 05-22-2014
LGBT / Gender and Sexual Identity Issues Articles