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Mental health problems can affect anyone at any stage in their life. Research shows that approximately 1 in 4 people in the UK will experience a mental health problem each year* and 1 in 6 people in England will experience a common mental health problem (like anxiety or depression) in any given week*.
But what triggers mental illness? What are the risk factors leading to a mental health condition? Can a mental health problem go away on its own?
Research suggests that lesbian, gay, bisexual, trans and queer (LGBTQ+) people are at higher risk of developing serious mental health problems, so this Pride Month, we’re focusing on some key questions and applying them to the LGBTQ+ community to see what we can find out.
LGBTQ+ people and mental health
It’s important to note that being LGBTQ+ doesn’t necessarily mean someone will have mental health problems, but it may put them at higher risk of experiencing them.
Whilst we know there are many aspects and experiences which contribute to a deterioration in someone’s mental health, one aspect which may play a significant role early in life can be bullying during school years. According to studies, anti-LGBT bullying is still a problem, with 52% of students reporting hearing homophobic insults regularly at school (Stonewall School Report; 2017).
Research shows that childhood experiences of bullying can have long-lasting effects on an individual's mental health well into adulthood*. People who have been bullied during their childhood years are more likely to experience depression and anxiety in later years. Bullying can lead to feelings of low self-esteem, shame, social anxiety and the inability to establish trusting relationships.
A 2018 study by Stonewall found that over the previous year, half of LGBTQ+ people had depression and 3 in 5 have experienced anxiety. These figures are significantly higher than the general population (1 in 4 people each year, or 1 in 6 people each week).
So we should ask the question: what issues do LGBTQ+ people face to put them at higher risk of developing a serious mental health problem? We’ve already discussed bullying and shame as factors, but LGBTQ+ people also regularly face discrimination or prejudice.
One aspect can sometimes be accessing healthcare. Research has found approximately 1 in 8 LGBTQ+ individuals encountered discrimination from healthcare personnel due to their identity and 1 in 7 even avoided seeking healthcare out of concern for discrimination*. Additionally, a 2021 survey found that 70% of trans people reported being impacted by transphobia when accessing general health services.*
Schoen Clinic UK Group is proud of its inclusive culture, where our hospitals and clinics welcome patients of all beliefs, backgrounds and orientations and foster safe environments, free from judgement.
“At Schoen Clinic Chelsea, we see people from all walks of life with mental health conditions, including those within the LGBTQ+ community,” says Adam Bloor, Clinic Director.
“We understand our LGBTQ+ patients may have gone through experiences unique to their community, which may have contributed to developing a mental health condition or eating disorder. That’s why we ensure a safe space for everyone, to talk freely about their experiences without fear of judgement or discrimination.”
The Minority Stress Model (MSM) and mental health
The Minority Stress Model (MSM) is frequently used to explain why sexual and gender minority groups have varying levels of mental health problems.
According to MSM, LGBTQ+ people are more likely to experience stressors like internalised homophobia or transphobia and concealing their sexual orientation or gender identity, as well as external stressors like stigma and discrimination, increases their risk of developing physical and mental health problems.*
It’s not just accessing healthcare which might be a problem for LGBTQ+ people. Their community are also at a higher risk of experiencing 'hate crimes’ which can create and exacerbate mental health issues. Hate crimes are those committed against someone because of a protected characteristic, i.e. their race, sexual orientation, religion, gender identity or disability.
It is documented that members of the LGBTQ+ community are more likely to experience hate crime. Gay men, queer youth, transgender people and members of the black, Asian and minority ethnic (BAME) communities are among the LGBTQ+ groups who are known to be most at risk.
Whilst discussing discrimination, it’s also possible to highlight ‘equality disparities’ and transphobia within the LGBTQ+ community itself. Trans people can face prejudice from gay, lesbian or bisexual people. Forums have even been created to campaign for the removal of ‘Trans’ from the LGBTQ+ umbrella.
In addition, femme-presenting gay men regularly face homophobic remarks from other gay men within the community. Much of this is believed to stem from greater societal expectations of what men and women should be, or how they should behave.
LGBTQ+ people and eating disorders
Mental health isn’t only about depression, anxiety or internalised shame as many instances can lead to a decline in physical health and wellbeing.
It’s important to also discuss LGBTQ+ mental health and the link with eating disorders. According to research by the National Eating Disorder Association (NEDA), more than half of LGBTQ+ youth between the ages of 13-24 have been diagnosed with an eating disorder at some point in their life. Gay, lesbian and bisexual youth may be more likely than their heterosexual counterparts to binge eat and purge as early as age 12.
LGBTQ+ individuals experience unique challenges which may increase their likelihood of having an eating disorder.
Potential risk factors which may play a role in the development of an eating disorder in an LGBTQ+ person can include:
the fear of being rejected or having been rejected by friends, family and co-workers
negative self-perceptions because of sexual orientation, non-binary gender presentation or transgender identity
exposure to violence and the experience of post-traumatic stress disorder (PTSD) are major risk factors for developing an eating disorder
discrimination based on gender identity or sexual orientation
being a target of bullying because of gender or sexual orientation
inner conflict between biological sex and gender identification
inability to conform to certain LGBTQ+ cultural norms about appearance
The Minority Stress Model (MSM) and eating disorders
It is possible that eating disorders can present in LGBTQ+ people in response to external stressors (as previously mentioned in the MSM) as a form of coping mechanism.
Internalising negative messages/being unable to be openly oneself, living in fear of being harassed, stress related to discrimination and living as a runaway or being homeless, can all play a part in the development of an eating disorder.
Another factor to consider when discussing eating disorders in LGBTQ+ people is body dissatisfaction. This links to one of the potential risk factors as the inability to conform to some LGBTQ+ cultural appearance norms.
Research has found a link between the high representation of the ‘ideal physique’ and increased body dissatisfaction. Although diversity in queer representation has improved over the years (with shows like the BBC’s “I Kissed a Boy” successfully highlighting a diverse range of body types and cultures), LGBTQ-specific media has historically portrayed gay people as young, heteronormative (straight presenting) white men with lean, muscular physiques.
These representations create an ‘appearance ideal’ and a pressure to look or act a certain way, damaging not only to the community as a whole but also to individuals. Body dissatisfaction is a proximal risk factor for both eating disorders and disordered eating behaviours within the LGBT community*.
Ending the stigma of mental health in the LGBTQ+ community
The stigma of mental health remains a problem in the LGBTQ+ community and indeed the world. One of the best ways to address this is through education and raising awareness. By providing information about mental health and encouraging open discussions about it, we can help to dispel negative attitudes and move towards a more accepting and supportive society for everyone.
Healthcare organisations can play their role in helping to end discrimination towards LGBTQ+ people reaching out for help. This means ensuring staff are trained in providing appropriate care to LGBTQ+ people, using inclusive language and tailoring treatment to the specific needs of each individual.
It’s also essential that healthcare organisations create safe and affirming spaces for everyone to seek help. This can include training staff on the specific mental health issues which affect certain communities and offering support groups which focus on the unique challenges faced by them.
Treating LGBTQ+ people with mental health conditions
You can’t make a gay person straight and you can’t make a straight person gay. Not understanding this, or trying to deny LGBTQ+ youths from expressing themselves can lead to internalised shame. Accepting people for who they are is the first step toward a brighter future, no matter what their identity or sexual orientation.
Understanding the potential causes of mental health problems in LGBTQ+ people goes a long way to helping treat them. Whilst there is a higher risk of sexual or gender minority people developing anxiety, depression or an eating disorder, help is available from people who truly care.
Adam Bloor says, “We recognise the significance of tailored treatment and are proud to offer personalised mental health and eating disorder services for everyone.
Our priority is to provide a welcoming and inclusive environment for all our patients and we’re committed to supporting everyone on their journey to recovery.”
Where can LGBTQ+ people find help for mental health or eating disorders?
If you’re LGBTQ+ and need support for anxiety, depression, stress, trauma or any other mental health problem, please reach out for help.
If you’re experiencing an eating disorder, it’s always best to begin treatment as early as possible for the best chance of a full recovery.
If you need support for a mental health condition or an eating disorder, Schoen Clinic UK Group is the home of highly specialised treatments, with a wonderfully diverse team of healthcare professionals available to help.
Our locations across the UK provide caring, inclusive environments free from judgement.
This page was reviewed by Adam Bloor, Clinic Director at Schoen Clinic Chelsea on 27th June 2023.
References
McManus, S., Meltzer, H., Brugha, T. S., Bebbington, P. E., & Jenkins, R. (2009). Adult psychiatric morbidity in England, 2007: results of a household survey. The NHS Information Centre for health and social care.
McManus S, Bebbington P, Jenkins R, Brugha T. (eds.) (2016). Mental health and wellbeing in England: Adult psychiatric morbidity survey 2014. Leeds: NHS digital.
Parker LL, Harriger JA. Eating disorders and disordered eating behaviors in the LGBT population: a review of the literature. J Eat Disord. 2020 Oct 16;8:51. doi: 10.1186/s40337-020-00327-y. PMID: 33088566; PMCID: PMC7566158.
https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-020-00327-y
Trans lives survey 2021: Enduring the UK’s hostile environment - https://transactual.org.uk/wp-content/uploads/TransLivesSurvey2021.pdf
https://www.nationaleatingdisorders.org/learn/general-information/lgbtq