LGBTQ+ Mental Health and the Role of Minority Stress

Anti-LGBTQ proponents have historically cited LGBTQ+ people’s high rates of mental health struggles as evidence that LGBTQ+ identities are indicative of underlying mental illness. These claims are false. In fact, research suggests that this kind of homophobic/transphobic rhetoric may actually be a part of what drives LGBTQ+ people’s mental health difficulties.

If you’re an LGBTQ+ person (or if you’re a clinician who works with LGBTQ+ people), it’s important that you know about minority stress. Understanding LGBTQ+ minority stressors—and how they may have impacted you—can improve your mental health by helping you increase your self-understanding and self-compassion.

The Minority Stress Theory of LGBTQ+ Health

Minority stress refers to the stressors that societally marginalized people face because of their marginalized identities. The Minority Stress Theory posits that LGBTQ+ people’s health disparities are caused by minority stressors.^1-3

At this point, years of research support the Minority Stress Theory, reinforcing the idea that LGBTQ+ attractions, behaviors, and identities are inherently healthy. The higher rates of mental health problems that LGBTQ+ people experience appear instead to be side effects of homophobic, transphobic, and otherwise LGBTQ-stigmatizing stressful experiences.

While the theory was initially proposed for gay men specifically, it has since been expanded to include LGBTQ+ people of all sexual orientations and gender identities. It maintains that there are at least four main stressors that LGBTQ+ people experience: experienced discrimination, anticipated discrimination, concealment, and internalized stigma.

Experienced Discrimination

Experienced discrimination is any experience of prejudice that LGBTQ+ people face due to their LGBTQ+ identities. It includes direct, “blatant” harassment or victimization (such as being physically assaulted because you are LGBTQ+), as well as “subtle” or vicarious stigma experiences (such as hearing homophobic jokes or reading news about yet another transgender person being harmed). Research shows that even “small” or “indirect” experienced discrimination can negatively impact mental health.⁴

Importantly, experienced discrimination includes societal-level, structural prejudice, such as anti-LGBTQ+ laws being passed. One study, for example, found that queer youth in unsupportive environments (e.g., fewer LGBTQ-specific nondiscrimination policies in local schools, fewer gay-straight alliances in local schools) were significantly more likely to attempt suicide than queer youth in supportive environments, even when accounting for individual depression, abuse, and bullying histories.⁵ As an LGBTQ+ person, living in a country, state, or community with fewer LGBTQ-affirmative resources can negatively impact your mental health.

Anticipated Discrimination

Anticipated discrimination is the belief that you personally (as an LGBTQ+ person) will experience prejudice. When you repeatedly experience or witness discrimination, it makes sense for you to start to expect it. Anticipated discrimination includes fear of prejudice and hypervigilance in situations where you may experience prejudice.

Hypervigilance can be mentally taxing and distressing.⁶ For example, if you live in a neighborhood where LGBTQ+ people have been verbally harassed, you may experience intense anxiety every time you leave home. Even if you’ve never experienced discrimination directly yourself, anticipated discrimination can greatly interfere with your emotional health.

Concealment

To avoid prejudice, many LGBTQ+ people actively hide their LGBTQ+ identities. LGBTQ+ people may lie about their identities and may purposefully change their voice, gait, or body language to appear straight and cisgender. While they may protect them from experienced discrimination, these concealment efforts are considered another minority stressor.

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Concealment, like hypervigilance, can be immensely cognitively draining and can contribute to mental health difficulties.⁷ Furthermore, concealing one’s identity and authentic self can lead to social isolation, loneliness, or limited social support from LGBTQ+ others. All of these experiences also negatively impact emotional health.

Internalized Stigma

When an LGBTQ+ person lives in a heterosexist and cissexist society, surrounded by messages that demean or invalidate LGBTQ+ identities, they are likely to adopt some of those anti-LGBTQ+ beliefs. This internalized stigma involves devaluing oneself (as an LGBTQ+ person) or other LGBTQ+ people, whether consciously or subconsciously.

Many LGBTQ+ people struggle greatly with shame, because of their past experiences of being shamed repeatedly by family, peers, religious communities, or other cultural groups. Negative self-views and emotionality (as well as chronic experiences of minority stress in general) can lead to engaging in more rumination, which, in turn, contributes to the onset and maintenance of depression, anxiety, and generalized difficulties with emotions.⁸

Other Minority Stressors

Advancing research has identified many other LGBTQ+ minority stressors beyond the original theory, including rejection sensitivity and coming-out stress. Notably, specific populations of LGBTQ+ people face unique LGBTQ+ stressors. For example, based on pervasive biphobic messages that bisexuality isn’t real or is “just a phase,” many bisexual people struggle with identity uncertainty (e.g., self-doubt of their bisexual identity). Nonbinary and genderqueer people are likely to face stigma related to societal expectations about gender binaries, and asexual people are likely to face stigma related to societal expectations about sexuality. Finally, LGBTQ+ people of color, or other LGBTQ+ people with multiple marginalized identities, can face multiple, intersectional minority stressors.

Conclusion

Minority stressors add up; the more stress you experience, the more likely that you will struggle with mental health. Living in supportive environments, having close LGBTQ-affirmative social support, and being a part of LGBTQ+ communities can reduce the impact of minority stress and help LGBTQ+ people live happier lives.⁹ It is also clear that pride in and comfort with your LGBTQ+ identity can positively impact mental health,⁹ as can having self-compassion.¹⁰

To avoid internalized stigma, to have pride in LGBTQ+ identities, and to have compassion for their own mental health struggles, it’s vital that LGBTQ+ people (and their clinicians) understand minority stress and its impact on LGBTQ+ mental health. Identifying the minority stressors that you may have personally experienced as an LGBTQ+ person can help you understand how your environment has impacted your mental health. Knowing that being gay, bi+, trans+, gender nonconforming, or otherwise queer is OK—and not mental illness—can help you thrive.