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MENTAL HEALTH of sexual minority youth - What psychology says
Youth with minority sexualities face particular threats to their emotional well-being due to stigma, isolation, stress, victimization, and lack of knowledge and sensitivity on the part of care providers.

Stigma

The stigma of having different sexual feelings causes youth to feel rejected by those around them. They find it necessary to separate their social and sexual identities. Stigma leads to increased risk for depression, adjustment problems, and sexual acting out. Some youth turn to drugs or alcohol to manage stigma, deny their sexual feelings, defend themselves against ridicule, attempt to increase their feelings of adequacy, or self-medicate for depression.

Depression can lead to suicide. Some studies have found that suicide attempt rates are 3 to 4 times as high among gay youth as among the youth population in general (although researchers disagree on this point). Rates among those who are further stigmatized due to their feelings of attraction for younger adolescents or children are unknown. Suicide is most common among closeted youth (those who hide their sexuality) and immediately after self-labeling as a member of a sexual minority. Conflict over sexuality and family problems can be precipitating events for suicide attempts.

Stigma leads to impaired psychosocial development and inadequate interpersonal relationships. It is compounded by a lack of support and accurate information, which can lead to maladaptive coping behaviors.

Gay youth who are attracted to younger teens or children are doubly stigmatized. This dual stigma further isolates and marginalizes them, while lack of accurate information and negative internalized stereotypes make it increasingly difficult to develop a more positive identity.

Social and emotional isolation

Realizing their sexuality is different from that of the people around them can cause feelings of loneliness and isolation. These youth often have no one to talk to about their feelings and problems. Continuous vigilance to prevent discovery of their sexuality increases emotional distance and stress. These factors can cause mental health problems, and lead to maladaptive coping behavior. Isolation is a principle contributor to suicide.

Stress

Several stressors threaten mental health: coming out or being discovered, being ridiculed, harassment, sensing others' negative attitudes, extensive pressure to conform to the norm. These stressors increase emotional distress and the potential for depression, multi-problem behaviors, and suicidal ideation. Gay youth report 3 to 4 times as much non-sexuality related stress as straight youth, and 4 times the rate of skipping school because they feel unsafe. Nothing is known about further stress experienced by those who are attracted to younger teens or children.

Victimization

Stigma also leads to victimization in the form of harassment, verbal abuse, physical threats, or assaults, especially for those who are out or whose sexuality is suspected. Youths who experience such abuse may internalize the assaults and blame themselves, intensifying their self-hate. They may also deny or minimize the impact of their abuse, which intensifies their psychological problems. Consequences of such victimization include chronic stress, depression, anxiety, fear, self-blame, poor self-concept, sleep disturbances, somatic symptoms, suicidal ideation, substance abuse.

Their reaction to victimization depends on their degree of self-acceptance or their stage of coming out. Support from others aids their recovery, while stigma hinders it. Unfortunately, many youth victimized for their sexuality must suffer alone since seeking help may lead to further victimization.

Lack of knowledgeable and sensitive responses by care providers

Mental health providers, foster care, and detention facilities often do not provide proper care for youth with different sexual feelings. They may practice denial or minimization when youth express concerns about their sexuality, believing that these feelings are only a phase. Or they may communicate an attitude of rejection, believing that acceptance of them or their sexuality will encourage sickness or bad behavior. Out of lack of knowledge, providers may misdiagnose psychological problems that result from the stigma and isolation, and attribute them to the youth's sexuality.

Youth who are placed in treatment programs due to their attraction to younger teens or children are often coerced into behavioral conditioning methods such as aversion therapy to change their sexual feelings. The report of a U.S. Department of Health and Human Services conference on the health needs of sexual minority youth says that "use of involuntary aversive treatment is a clear violation of ethical standards. In addition, treatment aimed at enforcing strict gender codes which are contrary to one's core identity will likely result in harmful, potentially long-term iatrogenic disorders."1

Such attempts are unsuccessful in the long-term, and contribute to poor self-esteem, mental health problems, guilt, and anxiety. The report also says, "Adolescents who have been exposed to aversive therapies may be mistrustful of further counseling; however, follow-up mental health services are generally warranted to 'undo' psychological damage caused by such ill-advised attempts."2

Unfortunately, however, due to mistrust, youth avoid or delay care until problems are serious, and develop negative attitudes into adulthood about mental health care or seeking help. If they do see care providers, they feel a need to withhold important information about their sexuality. Lack of confidentiality by mental health care providers also causes youth to avoid or delay needed care because they fear rejection, loss of critical relationships, or ejection from home.

Adapted from Caitlin Ryan & Donna Futterman, Lesbian and Gay Youth: Care & Counseling, New York: Columbia University Press, 1998.

1 Ryan & Futterman, p. 63.
2 Ryan & Futterman, pp. 92-93.

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