In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress— explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications. The study of mental health of lesbian, gay, and bisexual (LGB) populations has been complicated by the debate on the classification of homosexuality as a mental disorder during the 1960s and early 1970s. That debate posited a gay-affirmative perspective, which sought to declassify homosexuality, against a conservative perspective, which sought to retain the classification of homosexuality as a mental disorder (Bayer, 1981). Although the debate on classification ended in 1973 with the removal of homosexuality from the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 1973), its heritage has lasted. This heritage has tainted discussion on mental health of lesbians and gay men by associating— even equating— claims that LGB people have higher prevalences of mental disorders than heterosexual people with the historical antigay stance and the stigmatization of LGB persons (Bailey, 1999). However, a fresh look at the issues should make it clear that whether LGB populations have higher prevalences of mental disorders is unrelated to the classification of homosexuality as a mental disorder. A retrospective analysis would suggest that the attempt to find a scientific answer in that debate rested on flawed logic. The debated scientific question was, Is homosexuality a mental disorder? The operationalized research question that pervaded the debate was, Do homosexuals have high prevalences of mental disorders? But the research did not accurately operationalize the scientific question. The question of whether homosexuality should be considered a mental disorder is a question about classification. It can be answered by debating which behaviors, cognitions, or emotions should be considered indicators of a mental

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Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence

Attachment--and loss.

This study describes stress as derived from minority status and explores its effect on psychological distress in gay men. The concept of minority stress is based on the premise that gay people in a heterosexist society are subjected to chronic stress related to their stigmatization. Minority stressors were conceptualized as: internalized homophobia, which relates to gay men's direction of societal negative attitudes toward the self; stigma, which relates to expectations of rejection and discrimination; and actual experiences of discrimination and violence. The mental health effects of the three minority stressors were tested in a community sample of 741 New York City gay men. The results supported minority stress hypotheses: each of the stressors had a significant independent association with a variety of mental health measures. Odds ratios suggested that men who had high levels of minority stress were twice to three times as likely to suffer also from high levels of distress.

Minority stress and mental health in gay men

The Standards of Care (SOC) for the Health of Transsexual, Transgender, and Gender Nonconforming People is a publication of the World Professional Association for Transgender Health (WPATH). The overall goal of the SOC is to provide clinical guidance for health professionals to assist transsexual, transgender, and gender nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfillment. This assistance may include primary care, gynecologic and urologic care, reproductive options, voice and communication therapy, mental health services (e.g., assessment, counseling, psychotherapy), and hormonal and surgical treatments. The SOC are based on the best available science and expert professional consensus. Because most of the research and experience in this field comes from a North American and Western European perspective, adaptations of the SOC to other parts ...

Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7

Although research on coping over the past 30 years has produced convergent evidence about the functions of coping and the factors that influence it, psychologists still have a great deal to learn about how coping mechanisms affect diverse outcomes. One of the reasons more progress has not been made is the almost exclusive focus on negative outcomes in the stress process. Coping theory and research need to consider positive outcomes as well. The authors focus on one such outcome, positive affect, and review findings about the co-occurrence of positive affect with negative affect during chronic stress, the adaptive functions of positive affect during chronic stress, and a special class of meaning-based coping processes that support positive affect during chronic stress.

http://psych415.class.uic.edu/Readings/Folkman,%20Positive%20affect%20&%20coping,%20AmPsy,%202000.pdf

Positive affect and the other side of coping.

This article reviews the development of the construct of sexual health as well as how sexual health has become both part of the public health discourse and a key strategy in promoting overall health and human development. There are many lessons learned from international efforts which can be helpful in formulating a broad sexual health approach to HIV prevention among MSM in the United States.

What is Sexual Health? Articulating a Sexual Health Approach to HIV Prevention for Men Who Have Sex with Men

Existing and Future Educational Needs in Graduate and Postgraduate Education

This paper discusses the successful use of lithium carbonate combined with psychotherapy in two cases of skoptic syndrome, an unusual form of intense obsession and annoyance with body image, especi...

Skoptic syndrome: the treatment of an obsessional gender dysphoria with lithium carbonate and psychotherapy.

Theories of gender transpositions are fundamentally flawed because they often fail to comprise biological, social, familial, and cultural variables which influence the development of sexual behavior and identities in humans. These theories are reminiscent of 19th century views of sexuality which relied on the notion of biological determinism. This approach has been considered reductionistic and has led to conclusions that variations of human sexual expression, such as homosexuality, are deviations from the heterosexual norm. That heterosexuality is considered to be the norm originates from the equation of sexuality to reproductive biology in biomedicine. While there is an impressive body of information on hormonal influence on sexual brain differentiation, prenatal life, and later sexual motor behavior in lower mammals, these findings have not been clearly replicated in primates or humans. Yet, there have been forceful extrapolations to the human from lower mammals (e.g., theories of gender transpositions...

Theories of gender transpositions: A critique and suggestions for further research

Despite the fact that chemical dependency and intimacy dysfunction are inextricably bound, intimacy concerns are rarely addressed in the diagnosis, treatment or aftercare of the chemically dependent person or his or her family members. This article is intened to provide information which will help professionals recognize the connection between intimacy concerns and the drug abuse and dependency problems of their clients-and consequently, help them improve the treatment and rehabilitation of those clients.

Eli Coleman

Papers

What is Sexual Health? Articulating a Sexual Health Approach to HIV Prevention for Men Who Have Sex with Men

Existing and Future Educational Needs in Graduate and Postgraduate Education

Skoptic syndrome: the treatment of an obsessional gender dysphoria with lithium carbonate and psychotherapy.

Theories of gender transpositions: A critique and suggestions for further research

Chemical Dependency and Intimacy Dysfunction