https://www.ncbi.nlm.nih.

gov/pmc/articles/PMC5679422/

Happiness and Sexual Minority Status (2016)

Mieke Beth Thomeer1,4 and Corinne Reczek2,3

Author information Copyright and License information Disclaimer

The publisher's final edited version of this article is available at Arch Sex Behav
See other articles in PMC that cite the published article.

Abstract
We used logistic regression on nationally representative data (General Social Survey, N = 10,668
and N = 6,680) to examine how sexual minority status related to happiness. We considered two
central dimensions of sexual minority status—sexual behavior and sexual identity. We
distinguished between same-sex, both-sex, and different-sex oriented participants. Because
individuals transition between sexual behavior categories over the life course (e.g., from both-
sex partners to only same-sex partners) and changes in sexual minority status have theoretical
associations with well-being, we also tested the effects of transitions on happiness. Results
showed that identifying as bisexual, gay, or lesbian, having both male and female partners since
age 18, or transitioning to only different-sex partners was negatively related to happiness. Those
with only same-sex partners since age 18 or in the past five years had similar levels of happiness
as those with only different-sex partners since age 18. Additional tests showed that the majority
of these happiness differences became non-significant when economic and social resources were
included, indicating that the lower happiness was a product of structural and societal forces. Our
findings clearly and robustly underscored the importance of taking a multi-faceted approach to
understanding sexuality and well-being, demonstrating that not all sexual minority groups
experience disadvantaged happiness. Our study calls for more attention to positive aspects of
well-being such as happiness in examinations of sexual minorities and suggests that positive
psychology and other happiness subfields should consider the role of sexual minority status in
shaping happiness.
An Institute of Medicine report released in 2011 emphasized the need for population-based
research on sexual minority well-being that examined multiple dimensions of heterogeneity
within the sexual minority category. Moreover, this report called for a greater emphasis on
resilience across potentially disadvantaged groups by including positive well-being outcomes,
such as happiness, in order to complement research on stress and stigma outlined in the minority
stress model (Meyer, 2010). Our study was a step toward these goals, contributing to a legacy of
research on minority stress by using nationally-representative data to examine how sexual
identity and sexual behavior were associated with happiness.
Our findings confirmed multiple studies indicating that sexual behavior and sexual identity do
not always directly overlap with one another (i.e., different outcomes depending on whether
examining identity or behavior) (Bostwick et al., 2010; McCabe et al., 2009); considering only
one of the components of sexual orientation but not the other would lead to an incomplete picture
of sexual minority status and happiness. Regarding sexual identity, we found that gay-, lesbian-,
and bisexual-identified adults reported less happiness than heterosexual-identified adults in
baseline models. In other words, we found a clear sexual minority disadvantage in regard to
happiness when considering identity. Yet, our findings regarding sexual behavior and happiness
revealed a more complicated picture. In terms of sexual behavior, analyses revealed no
significant difference in happiness between those with lifelong different-sex partners and two
groups of sexual minorities: those with lifelong same-sex partners and those who transitioned to
only same-sex partners. These findings were somewhat surprising in light of the large number of
previous studies showing that people with any same-sex partners are disadvantaged in terms of
health, economic, and social resources (see Institute of Medicine, 2011; Meyer & Northridge,
2007). In the face of consistent evidence of stigma and discrimination against people with same-
sex partners and the historical, social, and legal struggles faced by this group (Berg et al.,
2013; Lick et al., 2013; Meyer, 2003), our results suggested there may be high resilience among
many individuals with exclusively same-sex partners.
Our findings regarding sexual behavior also demonstrated the unique disadvantages faced by
people who reported sex with both men and women, as well as those who transitioned to only
different-sex partners. These disadvantages among individuals with both-sex partners might be,
in part, due to the stigmatization this group experiences from both society at large and within
broader sexual minority communities (Rust, 2002). Moreover, we found that investigating
lifetime and current measures of the sex of sexual partners revealed important happiness
disparities, which suggested that stability in sex of sexual partners was associated with greater
well-being. For example, it was not the case that all groups with different-sex partners
experienced a happiness advantage; those who transitioned to only different-sex partners
reported lower happiness compared to those with lifelong different-sex partners. At the same
time, not all individuals with transitions in sex of sexual partners experienced a happiness
disadvantage; those who transitioned to only same-sex partners from any different-sex partners
had similar levels of happiness as those with lifelong different-sex partners. Failing to consider
lifetime and current measures together would have obscured the happiness disadvantage among
those who transitioned to different-sex partners as well as the general happiness of those who
transitioned to same-sex partners. Our research suggested that lifelong sexual behavior interacts
with current sexual behavior to associate with present happiness, and we call for careful
reconsideration of past and future research relying on only lifetime or only current measures.
Our study further expanded some prior conceptualizations of the sexual minority group,
highlighting that those with current different-sex partners but histories of same- or both-sex
partners may be disadvantaged. For instance, few past studies categorized adults in heterosexual
marriages as sexual minorities, but our study suggested that if these adults have past same-sex
partnerships, this group may face certain disadvantages that are overlooked. People who
transitioned from both-sex or same-sex partners to exclusively different-sex partners may no
longer be perceived as needing stress-reducing social supports present provided within the
minority community (Rust, 2002). This group may also have faced pressure to act “closeted”
(e.g., only have different-sex partners despite a both-sex or same-sex orientation) and may be
unhappy with their current sexual arrangements (Hernandez, Schwenke, & Wilson, 2011).
Additionally, in line with cumulative disadvantage theory (Dupre, 2007), stress from occupying
a sexual minority status earlier in the life course may accumulate over time, resulting in lower
happiness later in the life course regardless of consistency in status over time. Future studies
should consider how transitions in sexual identity—in conjunction with transitions in sexual
behavior categories—shape happiness.
In a final stage of analysis, we identified how including self-rated health, socioeconomic
resources, and social resources gave further insight into the association between sexual minority
status and happiness. Economic resources appeared to be the most central driver of reported
happiness disadvantages for bisexual-identified people, for those with lifelong both-sex partners,
and for those who transitioned to different-sex partners. This is likely undergirded by complex
and unmeasured social and psychological factors such as stress, mental health, disability, chronic
conditions, discrimination, and community integration that shape access to economic resources
(Lick et al., 2013). This disadvantage may also be a reflection of economic resources as a
fundamental cause ultimately underlying inequality in well-being (Link & Phelan, 1995). Social
resources played a smaller role in explaining happiness disparities by sexual behavior categories,
yet social resources were key in understanding happiness disparities for gay- and lesbian-
identified adults. Health played a minimal role in explaining lower rates of happiness by sexual
minority status, but this may be due to our measures; more comprehensive measures of
morbidity, including disability, number of chronic conditions, and mental health measures,
would likely improve the explanatory power of health.
This study’s unique contributions to research on happiness and sexual minority status using a
nationally representative sample should be considered within the context of several limitations.
First, because of small sample sizes, we pooled 12 years of data collections for the sexual
behavior measure and 6 years for the sexual identity measure. This approach did not allow us to
account for the important social, political, and cultural changes that have occurred for sexual
minorities during this historical period (Eliason & Schope, 2007). Further, more sexual
minorities were surveyed in later study years compared to earlier study years; economic
recessions and other societal changes may have introduced important spuriousness into our
study. We adjusted for year of interview in every model and tested for year interactions, but this
did not necessarily account for important period and cohort effects. Second, our measure of
transitions around sex of sexual partners was limited in that we could not include transitions to
both-sex partners. We call for future studies to continue to interrogate transitions in sex of sexual
partners over the life course, considering multiple dimensions, including timing and duration of
transitions, and whether transitions around sexual behavior correspond with transitions in sexual
identity and/or sexual attraction. Finally, although past studies of sexual minorities found
important gender differences around sexuality (Cochran & Mays, 2015; Thomeer, 2013; Ueno et
al., 2013) and well-being (Rieger & Savin-Williams, 2012), we did not find similar effects with
happiness as an outcome. Notably, however, we found that more females than males were
represented in three of the groups which experienced a happiness disadvantage—those with
lifelong both-sex partners, those who transitioned to only different-sex partners, and those who
identified as bisexual. This suggested that disadvantages faced by sexual minorities may be
especially concentrated among women. We call on future studies to continue to analyze how
gender and sexual minority status interact to shape other well-being outcomes.

Conclusion
Our study moved away from a dichotomous measure of sexual orientation (e.g., only same-sex
partners or only different-sex partners) by examining sexual identity and sexual behavior within
the same study, considering those with both-sex orientations alongside those with same-sex and
different-sex orientations, and articulating how transitions in sex of sexual partners matter for
happiness. Our findings clearly and robustly underscore the importance of taking a multifaceted
approach to understanding sexuality and well-being, demonstrating that not all sexual minority
groups experience disadvantaged happiness. Our study also calls for more attention to positive
aspects of well-being such as happiness in examinations of sexual minorities; incorporating these
positive aspects into the sexual minority literature will facilitate framing happiness as part of
buffer and resilience processes that protect individuals against heightened minority stress. In the
same vein, we suggest that positive psychology and other happiness subfields should consider
the role of sexual minority status in shaping happiness. Our exploration of health,
socioeconomics, and social resources as potential factors that underlie happiness demonstrates
that the lower happiness of certain sexual minority groups is a product of structural and societal
forces.
https://lgbt-token.org/lgbt_happiness_study_launch/

THE LGBT HAPPINESS STUDY

IS THE GLOBAL SURVEY ON
HAPPINESS, SEX AND
QUALITY OF LIFE OF LGBTI
Fa
The LGBT Happiness Study, is the Global Survey on Happiness, Sex and Quality of Life among
LGBTI people is a major global research study for lesbian, gay, bisexual, transgender and
intersex (LGBTI) people aims to give a voice to this community around the world.

Happiness and quality of life are both essential to people’s wellbeing. Yet, in too many countries
LGBTI are seriously compromised due to the stigma, discrimination, violence and even
the criminalisation they are facing. Excess mental stress affects their health, welfare and
prosperity. This marginalisation that the LGBT community is facing creates further economic
inequalities and barriers to accessing health services, including HIV services.

LGBT people face inequalities of standards of living, health, and because of homophobia, face
additional discrimination in education, workplace, and a variety of institutional, governmental,
and societal. Levels of abuse and the burdens of those play out in overall well being. The
happiness study measures this variance across many variables.
In the field of development well being for LGBT is often measured in terms of violence, legal
status, and health–particularly HIV. Mental health and happiness are often overlooked
categories which may play important roles in total wellbeing–including economic and health.

In Africa, Asia, Latin America, evidence on just how much stigma, discrimination, social
and economic inequalities affect the quality of life of LGBTI people is, however, scant. In order
to fill that knowledge gap, a survey is being shared with LGBTI people around the world.

Mental well-being is often thought as on an individual layer, however a variety of societal

attitudes and structures reflection homophobia can place an emotional toll on LGBT. This study
is to exam the mental well being of LGBT persons across the global landscape to compare over-
all happiness and help create impact to improve the lives of LGBT. LGBT adolescents have the
highest rate of suicide attempts, which scientific research indicates is likened to homophobic
atitudes and herosexist discrinimination.

This survey has been developed by a partnership lead by the LGBT Foundation, The United
Nations (UNAIDS), the Universities of Aix-Marseille and Minnesota, as well as LGBT
community partners, Johns Hopkins School of Public Health, and the World Health
Organization.

This innovative study aims to get a wide picture of the issues that affect the lives of
LGBTI people worldwide, covers socio-economic status, outness, social network, happiness,
quality of sexual life. It also informs on LGBT’s daily stigma and discrimination in the streets,
in health-care services and the workplace.

”We want to immerse in what makes the real life of LGBTI community in different parts of the
world. Therefore undertaking a web-based survey with behavioural economics came up
naturally. This type of approach is very much in line with the way LGBTI community is
connected nowadays and creates a large reach with a rich data set” said Erik Lamontagne, Senior
Economist at UNAIDS.

The LGBT Foundation is leading on promoting the survey, in partnership with UNAIDS regional
and country offices, NGOs, voluntary and community organisations. The scale of the survey is
ambitious, aiming to reach up to 27 million LGBTI people. With at least 18 languages, the
survey will cover the lived experiences of LGBTI people in a wide range of countries and from
diverse cultures, including Arabic, Bengali, Chinese, English, Farsi, French, Gujarati, Hindi,
Japanese, Marathi, Portuguese, Russian, Spanish, Thai, Turkish, Ukrainian, and Urdu languages.

“Examining LGBT happiness and often lack of, is critical to eliminate disparities, including
health as well as the relationship between underlying conditions and individual
choices. Advancements to LGBT wellbeing around the world are not equal and nor permanent.
In order to improve health, we need to focus on addressing the conditions at large faced by
LGBT. We want progress in lesbian, gay, bisexual, transgender and intersex health and well-
being. We want it now and having the right data is the only way to measure the success being
made and when it is not. This is a large initiative, where LGBTI people can build the knowledge
to empower and advocate, with an ultimate goal of eliminating stigma and discrimination against
LGBT people,” said Sean Howell, CEO of the LGBT Foundation.

The happiness study is now opened for participation. It takes about 12 minutes to
complete. Be heard. Participation helps make a difference for the LGBTI community
around the world: here
https://pdfs.semanticscholar.org/1f35/4cea53eb866959d963281f8a87691a58f91e.pdf

https://www.researchgate.net/publication/232
552471_Self-acceptance_and_self-
disclosure_of_sexual_orientation_in_lesbian_
gay_and_bisexual_adults_An_attachment_pe
rspective
Self-acceptance and self-disclosure of
sexual orientation in lesbian, gay, and
bisexual adults: An attachment perspective
A model linking attachment variables with self-acceptance and self-disclosure of sexual orientation was tested using
data from 489 lesbian, gay, and bisexual (LGB) adults. The model included the following 4 domains of variables: (a)
representations of childhood attachment experiences with parents, (b) perceptions of parental support for sexual
orientation, (c) general working model of attachment, and (d) LGB variables. Results generally supported the
proposed model. For example, attachment avoidance and anxiety were associated with self-acceptance difficulties,
and avoidance was associated with low levels of outness in everyday life. Parental attachment had an indirect effect
on identity and outness through its associations with parental LGB support and general attachment. Some results
varied depending on participants' gender and parental religious affiliation. (PsycINFO Database Record (c) 2012
APA, all rights reserved)

Discussion
The present study investigated the degree
to which variability in
aspects of LGB experience could be
explained by individual
differences in attachment style and
attachment relationships. The
proposed model, which included both
direct and indirect predictors
of negative LGB identity and public
outness, was largely sup-
ported by data from a geographically
diverse sample of LGB
adults.
Direct Paths to Negative Identity and
Public Outness
Attachment anxiety and avoidance. Results
provided strong
support for the proposition that general
attachment security is
associated with interpersonal behaviors
and internal states related
to LGB identity. Individuals who had
difficulties accepting their
own sexual orientation were more likely
than others to exhibit a
pattern of high avoidance and high
anxiety—a pattern that is
referred to as fearful avoidance (Griffin &
Bartholomew, 1994).
Fearful avoidance engenders a natural
tension between the depen-
dency needs associated with high levels of
attachment anxiety and
the distrust of others associated with high
levels of avoidance.
Thus, although close interpersonal contact
is craved, the potential
negative consequences of such contact are
feared. Given this
relational dynamic, it is not surprising that
fearfully avoidant
participants in the present study were
focused on issues of sexual
orientation acceptance from self and others
to a higher degree than
other participants. Furthermore, the
association of fearful avoid-
ance with identity-related difficulties
seems consistent with evi-
dence that fearful avoidance is linked to
greater than average risk
for depression and other psychological
disorders (Mickelson,
Kessler, & Shaver, 1997). Because
internalized homonegativity
has been linked to depressive
symptomatology (Herek, Cogan,
Gillis, & Glunt, 1998; Meyer, 1995), it
seems possible that the
relation between fearful avoidance and
depression may be at least
partially mediated by negative identity in
LGB individuals.
The results also indicated that avoidance
was negatively asso-
ciated with level of public outness, which
was expected given the
documented inverse relation between
avoidance and self-
disclosure (Bartholomew & Horowitz,
1991; Pietromonaco & Bar-
rett, 1997). Avoidant individuals are less
likely to believe that
others will respond to them in a
trustworthy, sensitive, and accept-
ing manner (Collins & Read, 1990;
Mikulincer, 1998). Thus,
because sharing one’s LGB sexual
orientation can lead to rejection
in a culture that values heterosexuality
over homosexuality, it
makes sense that the avoidant LGB
individuals in our sample were
especially unlikely to come out in their
everyday lives. Although
this strategy may have self-protective
aims, it may limit opportu-
nities for avoidant LGB individuals to
have their sexual orientation
accepted by peers and to meet other LGB
peers. Ironically, in
attempting to avoid rejection because of
antigay stigma, people
high in avoidance may shun the very
activities that could help
them to develop a greater sense of safety
and satisfaction as LGB
individuals. Contrary to our hypothesis,
attachment anxiety was
not associated with public outness.
Although we thought that
individuals high in anxiety might limit
disclosing their sexual
orientation in their everyday lives because
of fears of rejection, the
present results suggested that decisions
about whether or not to
self-disclose has more to do with
willingness to rely on and trust
490 MOHR AND FASSINGER
others (i.e., avoidance) rather than
sensitivity to possible rejection
(i.e., anxiety).
Exploratory analyses revealed that the
association between
avoidance and negative identity was
stronger for men than for
women. In fact, tests on the path
coefficient for men and for
women indicated that the relation between
these two variables was
positive and significant for men but
nonsignificant for women.
Although this finding was not anticipated,
we consider possible
explanations as a way of extending the
application of attachment
theory to aspects of LGB experience. Why
might it be that avoid-
ance, which involves degree of comfort
with closeness and trust in
others’ dependability, is linked to LGB
identity problems in men
but not in women? As discussed earlier,
avoidance may influence
LGB identity by inhibiting participation in
the interpersonally
challenging exploratory tasks associated
with the coming out pro-
cess. Such tasks may be more likely to
elicit feelings of danger in
men than in women, given evidence that
societal sanctions against
homosexuality are more extreme for men
than for women (Garnets
& Kimmel, 1993; Kite & Whitley, 1996).
Because such feelings of
danger are likely to activate the attachment
system, the stronger
link between avoidance and negative
identity in men may be due
to men’s greater perceptions of threat
associated with the explor-
atory tasks of identity formation.
Another possible explanation for the
gender effect is based on
differences between women and men in
the contextual backdrop of
LGB identity formation. Consistent with
male and female gender
role socialization, the beginnings of LGB
identity formation for
women often take place within the context
of relationships and
communities (Schneider, 2001), whereas
for gay men the identity
formation process often begins in the
context of sexual attraction
and experimentation (Garnets & Kimmel,
1993; Gonsiorek, 1995).
Thus, in the first stages of LGB identity
exploration, lesbians may
be more likely than their gay male
counterparts to meet others who
could help facilitate their socialization into
LGB-affirming com-
munities. This possible gender difference
may be particularly
significant for avoidant individuals, who,
as discussed earlier, are
less likely than others to seek social
support. Perhaps these differ-
ences offer some avoidant lesbians a more
seamless transition into
identification with LGB communities and
LGB-affirmative re-
sources compared with avoidant gay men,
thus minimizing the role
of avoidance in LGB identity formation for
women. This discus-
sion suggests that it may be useful to
investigate possible main and
interaction effects for gender and
attachment style in predicting the
likelihood of having contact with LGB-
affirming individuals.
Parental support. We also found evidence
for direct effects of
parental sexual orientation support—
specifically, father sup-
port— on negative identity and public
outness. Although similar
findings have been found in studies of
LGB youth (e.g., Hersh-
berger & D’Augelli, 1995), few studies
have examined such as-
sociations in LGB adults. The present data
did not offer clear
insights into why it was father support and
not mother support that
was directly predictive of the LGB
variables. In exploring the data
for potential explanations, we discovered
that participants reported
significantly lower levels of perceived
father support than per-
ceived mother support. This finding is
consistent with research
suggesting that fathers are more likely than
mothers to encourage
sex-typed behaviors in children (Lytton &
Romney, 1991) and
men are more likely than women to hold
negative attitudes toward
LGB individuals (Kite & Whitley, 1996).
Perhaps fathers tend to
define the ceiling for the levels of family
support provided for
LGB children. This possibility is
underscored by evidence that
fathers are more likely than other family
members to control the
emotional climate of family life (Larson &
Richards, 1994). A
potentially fruitful area for future research
might be the investiga-
tion of the relative contribution of mother
and father variables
(e.g., attitudes, expressed support) to
family dynamics involving a
child’s LGB sexual orientation, as well as
to the emotional adjust-
ment of the LGB child.
Indirect Paths to Negative Identity and
Public Outness
In addition to examining direct paths to the
LGB variables, we
considered possible indirect routes
between the parental variables
and the LGB variables. A number of these
hypothesized paths
were significant. Sexual orientation
support from mothers was
indirectly related to both LGB variables
through its direct relation
with attachment anxiety and avoidance.
For example, as Figure 3
indicates, low levels of perceived mother
support were associated
with high levels of fearful attachment
(high anxiety, high avoid-
ance), which, in turn, were linked to high
levels of negative
identity. Similarly, sexual orientation
support from fathers was
indirectly linked to negative identity
through its direct relation
with attachment anxiety. Findings also
indicated that ratings of
parental caregiving sensitivity in childhood
were related to anxiety
and avoidance. Specifically, ratings of
mother sensitivity were
negatively associated with avoidance, and
ratings of father sensi-
tivity were negatively associated with
anxiety. An interesting
implication of these results is that LGB
individuals’ general work-
ing models of attachment may be
influenced by parental factors
specific to sexual orientation issues (e.g.,
sexual orientation sup-
port) as well as to more general parental
factors (e.g., caregiving
sensitivity). Thus, counselors working with
LGB clients may wish
to consider ways a client’s general
sensitivity to rejection and
capacity for closeness may be related to
both parental sexual
orientation support and general caregiving
history.
As hypothesized, we found indirect routes
for ratings of parents’
caregiving sensitivity in childhood. Mother
and father sensitivity
were positively associated with ratings of
mother and father LGB
support, respectively. This association may
reflect temporal con-
sistency in the quality of the parent– child
relationship (e.g., moth-
ers who were sensitive caregivers for their
young children tend to
respond in a sensitive manner to their
grown children’s LGB
sexual orientation) or a perceptual bias
influencing all ratings
related to a particular parent (e.g.,
individuals who have generally
positive representations of their mothers
tend to give positive
ratings of their mothers as childhood
caregivers and sources of
sexual orientation support). Adaptation of
questions from the
Adult Attachment Interview (George,
Kaplan, & Main, as cited in
Hesse, 1999), for which respondents must
support their claims
about parental relationships with specific
examples, may help to
clarify the nature of the present findings.
For instance, individuals
who claim that their parents are supportive
regarding sexual ori-
entation issues would have to provide
specific examples of sup-
port. If they were not able to provide
examples, then their claims
of parental support could be interpreted as
evidence of perceptual
bias.
Exploratory analyses revealed some
differences based on paren-
tal religious affiliation. Multiple-group
analyses suggested that the
491
SELF-ACCEPTANCE AND SELF-
DISCLOSURE
paths from two of the parental variables
(mother sensitivity and
father support) to attachment anxiety were
weaker for participants
who reported that their parents were
affiliated with antigay reli-
gions. Specifically, the path coefficients
were nonsignificant for
those in the antigay religion group but
significant and negative for
those in the other group. Although these
results were not hypoth-
esized, they point to intriguing possibilities
regarding the role of
institutional homonegativity in LGB
individuals’ working models
of attachment. For example, LGB adults
from families affiliated
with antigay religious institutions may be
more likely than others
to cut off a sense of emotional
connectedness with parents, thereby
limiting the degree to which their working
models of attachment
are influenced by parental relationships.
Working models of such
individuals may be more influenced by
their “families of choice,”
kinship circles defined by LGB support
and emotional ties rather
than by legal, historical, and biological ties
(Weston, 1991). In
contrast, LGB adults who are not from
families affiliated with
antigay religions may be more likely to
remain emotionally con-
nected with parents and thus open to
parental influence.
Finally, a number of the results regarding
the proposed model
suggested a degree of asymmetry in the
effects of the mother and
father variables. Mother sensitivity
predicted avoidance but not
anxiety, whereas the opposite was true for
father sensitivity.
Mother LGB support had indirect but not
direct effects on the LGB
variables, whereas father LGB support had
mostly direct effects on
the LGB variables. It is unclear whether
these differences reflect
true gender dynamics in family systems or
sample specific effects.
It seems possible that these results may
have been influenced by
the moderate multicollinearity from
positive correlations between
the respective pairs of mother and father
variables. Such correla-
tions suggest that it may be useful to create
a model in which there
are mother and father factors to account
for variability unique to
each parent and a parental factor to
account for shared variability.
This approach would resolve
multicollinearity issues and provide
a more refined perspective on the unique
and shared effects of
mother and father variables.
Limitations of the Study
Although the findings of the present study
support the value of
an attachment perspective on dimensions
of LGB experience, it is
important to consider several
methodological shortcomings. First,
our use of a convenience sample limits the
generalizability of the
results to the broader LGB population.
Despite our hopes that
e-mail solicitation would access
individuals typically hidden from
LGB researchers (people of color,
individuals first questioning
their identities), the diversity of our sample
only partially met our
expectations. The sample was
predominantly White and so results
may differ for people of different
racial/ethnic groups, especially
in light of evidence that LGB individuals
of color face unique
issues related to multiple minority status
(Greene, 1997; Morales,
1989). Furthermore, the sample was
composed of individuals who
were open enough about their sexual
orientation to participate in
the study; thus, the present results are not
based on individuals
presumably representing the full range of
developmental statuses
assumed in LGB identity theory.
Relatedly, generalizability of
results is limited by the fact that all
participants were in same-sex
romantic relationships at the time of the
study. It seems likely that
inclusion of single LGB individuals would
have increased repre-
sentation of individuals on the insecure
end of the attachment
spectrum. Also, although we intentionally
recruited a sample that
was diverse in age, it seems plausible that
the results for parental
attachment and support might have been
different for adolescents
and young adults—individuals who are
generally more reliant on
parents for material and emotional
resources than middle-aged and
older adults.
Because this study relied on cross-
sectional data and correla-
tional analyses, it was impossible to assess
the precise role of
attachment in LGB identity formation. We
have theorized that
attachment security influences both
internal processes and external
behaviors related to sexual orientation, but
it is worthwhile to
consider interpretations of the findings that
reverse the direction of
this causal model. For example, Mohr
(1999) hypothesized that
internalized homonegativity may inhibit
the establishment of
same-sex bonds in which intimacy can be
tolerated. From this
perspective, difficulties associated with
LGB identity may ad-
versely affect LGB individuals’ ability to
form secure working
models of attachment. Relatedly, it is
important to note that it is
possible to specify alternatives to the
proposed model that are
equivalent to the proposed model in
goodness of fit. For example,
the proposed model would be equivalent in
fit to a model in which
the positions of parental support for sexual
orientation and general
attachment pattern were reversed. In this
alternative model, the
general attachment variables would
indirectly influence LGB iden-
tity through their relation with parental
support. In support of this
perspective, it seems possible that securely
attached individuals are
more likely than their insecurely attached
counterparts to possess
the interpersonal skills needed to elicit
sexual orientation support
from their parents, given evidence that
attachment insecurity is
associated with interpersonal deficits
(Bartholomew & Horowitz,
1991). In short, longitudinal studies are
critical to gain an under-
standing of the potentially reciprocal
interactions between attach-
ment, parental support, and dimensions of
LGB experience across
the life span.
Another shortcoming of the study involves
our use of measures
for which only limited validity and
reliability evidence was avail-
able. Specifically, we adapted the
measures of perceived parental
caregiving sensitivity and parental LGB
support for the purposes
of the present study. Although the
preliminary validity and reli-
ability evidence was positive, additional
evidence for the psycho-
metric quality of these measures is needed.
Implications of the Study
We believe that the findings from this
study are significant
because they suggest that the process of
coming to terms with
being an LGB person is influenced both by
the interplay of broad
sociocultural factors (e.g., societal
intolerance for homosexuality)
and by factors unique to individuals (e.g.,
attachment histories and
attachment styles). Many of the existing
models of LGB identity
were formulated in response to what was
viewed as a traditional
focus on internal psychological processes
that excluded consider-
ation of societal– contextual influences
(Cass, 1996; Reynolds &
Hanjorgiris, 2000), and, in effect, blamed
distressed LGB individ-
uals for their own victimization. The shift
to a more contextual
view has been critical in defining the
formidable obstacles faced
by LGB individuals in Western society, as
well as the psycholog-
ical processes involved in negotiating
these obstacles, and has
492 MOHR AND FASSINGER
functioned to depathologize predictable
responses to living with a
stigmatized identity. The findings from the
present study contrib-
ute needed complexity to this broader
perspective by suggesting
that individual differences in general
working models of attach-
ment may explain variation in LGB
individuals’ ability to success-
fully manage these difficulties inherent in
the identity formation
process. Furthermore, general attachment
was found to vary as a
function of both general and LGB-specific
parental care variables.
Our results suggest that mental health
professionals who work
with LGB individuals and couples may
profit from considering
points of intersection between LGB
identity, attachment, and op-
pressive contextual conditions in
clients’ lives. For example, prac-
titioners may wish to consider ways that a
client’s process of
coming out is impeded by attachment
insecurity, as well as ways
that a client’s ability to establish intimate
relationships is affected
by her or his strategy for managing a
stigmatized identity. Findings
also suggest that it may be useful to attend
to factors that may
increase the sense of challenge or danger
associated with exploring
an LGB identity (e.g., being a man,
growing up in a family
affiliated with an antigay religious
organization); such factors may
influence relations among attachment
history, general attachment,
current family dynamics, and ability to
manage antigay stigma
effectively. These clinical perspectives are
consistent with present
guidelines for “best practice” in
counseling and psychotherapy
with LGB clients, which highlight the
importance of paying atten-
tion to contextual challenges and to a
range of individual-
differences variables, including cognitive
and emotional difficul-
ties (American Psychological Association,
2000).
Conclusion
Bowlby described life span personality
development as a “set of
alternative pathways of
development” (1973, p. 369) arranged like
an elaborate railway system in which
important experiences— both
positive and negative—act to determine
the degree to which the
path ultimately taken falls within optimum
limits. He believed that
negative experiences,
act so that the points at a junction are shifted
and the train is diverted
from a main [i.e., optimal] line to a branch.
Often, fortunately, the
diversion is neither great nor lengthy so that
return to the main line
remains fairly easy. At other times, by contrast,
a diversion is both
greater and lasts longer or else is repeated; then
a return to the main
line becomes far more difficult, and it may
prove impossible. (p. 370)
Although Bowlby’s focus was clearly on
the effects of separation
and loss with regard to attachment figures,
he noted that diversions
from optimal lines of development can
follow any life crisis or
stressor, especially in youth and with
individuals who are already
on suboptimal pathways. This view of
personality development
speaks to the potential vulnerability of
insecurely attached LGB
individuals to difficulties in the identity
formation process. The
probability of major “derailments” from
optimal trajectories is
heightened for LGB individuals because of
the likelihood of ex-
periencing problems or conflicts related to
sexual orientation in
multiple contexts (e.g., family, friendships,
school, workplace,
religion).
The linking of attachment theory to
theories of LGB identity is
sensible in many ways because of the
shared concern with indi-
viduals’ ability to seek support and
develop a coherent, positive
sense of self in the face of threatening or
challenging circum-
stances. The rich, steadily growing
literature on adolescent and
adult attachment may offer important
perspectives on LGB iden-
tity formation, particularly with regard to
identifying specific
variables that influence individual
trajectories of identity develop-
ment. Although this study explored ways
in which attachment
theory might offer insights into the
complexities of LGB identity
formation, we suggest that the study of
LGB identity may enrich
present work in adult attachment as well.
First, as noted earlier, the process of LGB
identity formation
provides a naturally occurring example of
a developmental phe-
nomenon in which attachment
relationships (parental, romantic,
and peer) frequently play an integral role.
Difficult and threatening
events are an intrinsic feature of LGB
identity formation, given the
societal climate of hostility toward LGB
individuals. Thus, attach-
ment researchers may learn about ways in
which culture, identity,
and attachment interact by investigating
the developmental path-
ways of LGB individuals. The study of the
parent– child relation-
ship may prove to be rewarding in this
regard, particularly in
understanding the processes through which
securely and inse-
curely attached LGB children negotiate the
coming out experience
with their potentially unaccepting parents
(Holtzen, Kenny, &
Mahalik, 1995). We also believe that the
study of LGB identity
development may contribute to a greater
understanding of the role
of attachment in exploratory behavior.
Although Bowlby (1988)
wrote about the interplay between the
attachment and exploratory
systems, relatively little investigation has
been conducted with
regard to adult exploratory behavior from
an attachment perspec-
tive. As Brown (1989) noted, the processes
of LGB identity
development require ventures into
unknown and unpredictable
terrain, where “whatever roadmaps the
dominant culture offered
have been full of wrong turns and
uncharted territories” (p. 452).
Detailed focus on the ways that LGB
individuals navigate these
excursions and cope with the concomitant
anxiety and fear may
yield new insights regarding the role of
attachment security in the
exploratory risk taking that is inherent in
developing one’s human
potential.
https://www.healthyplace.com/blogs/thelifelgbt/2015/01/how-self-acceptance-affects-depression-in-
lgbtq-individuals

How Self-Acceptance Affects Depression in

LGBTQ Individuals
JANUARY 7, 2015 VANESSA CELIS
How can you love yourself and have self-acceptance and yet deny part of your true
identity? Is such a feat even possible? This is a problem that is common among many
people within the lesbian, gay, bisexual, transgender, and queer community (LGBTQ).
Unfortunately, many LGBTQ individuals cannot come out due to safety reasons. If they
were to come out as gay or transgender, they risk the scary chance of getting kicked out
and ending up on the streets. They can even lose their jobs. So while the world proudly
declares that we must be unashamed of our true selves, society’s reaction toward many
LGBTQ people is a contradiction. And it has very negative effects on the mental health
of LGBTQ individuals. A lack of self-acceptance can even worsen depression in LGBTQ
individuals.

Higher Rates of Depression Among LGBTQ Individuals

When you think about it, it isn’t too hard to see why so many LGBTQ people have
issues with mental health. I have experienced this first hand in the several past months
as I’ve experienced depression while struggling to accept my gender identity(I identify
as genderqueer). At first, I was in denial and thought it was just a phase. I tried my best
to fit in and be "normal" in women’s clothes and tried to present myself as very feminine.
This only has worsened my depression and made it harder to love myself. I have slowly
realized that not accepting my gender identity has been dangerous for my mental
health.

LGBTQ Individuals Need Strong Support

While our society has certainly improved when it comes to acceptance of LGBTQ
people, it is far from perfect. There is still rampant homophobia, transphobia, and lack of
education in respect to queer people. There are many people who have no clue about
nonbinary/genderqueer people, for example. They have no idea that people like me
exist. This is why people need a good LGBTQ support system. Whether it comes from
family, friends, counselors, or teachers, we need others to tell us that we are accepted
and loved. Having a good support system certainly helps me with my depression and
anxiety. I cannot imagine my life without my supportive husband and close friends.

Self-Love and Self-Acceptance is Not Easy But It Is

Possible
Now that I’ve accepted my gender identity, I am trying my best to get back on the path
of self-acceptance and self-love. Of course, I still have depression and anxiety, but I feel
like it will be a lot easier to deal with these illnesses now that I am accepting myself. I
am also trying to talk to others like me, which helps me see that I am not alone in my
struggles. It also helps me see that there is nothing wrong with me. I am slowly working
on myself and even though it is not easy, I know that it can be done in time. I am trying
my best to not self-harm and trying to stay away from alcohol, which only fuels my
depression and anxiety. Hopefully, I can help someone along the way if I share my
struggles and experiences, as well.
Find Vanessa on Twitter and Google+
https://journals.sagepub.com/doi/10.1177/001872679404700902
Social Support, Depression, and Self-Acceptance Among Gay Men
John Vincke, Ralph Bolton
First Published September 1, 1994 Research Article
https://doi.org/10.1177/001872679404700902

Article information

Abstract

This study analyzes how low social support of gay men when coming out affects the
reported levels of depression and self-acceptance in a non-clinical sample of Flemish
(Belgium) gay men. The model used is nonrecursive. It incorporates the mutual
causation between depression and self-acceptance. The manipulation of social support
is considered as part of the general process of social control. After delineating the
methodological problems associated with studying the relationship between the
perception of support and depression, it is shown that low social support because one is
gay leads first to depression and then to low levels of gay self-acceptance. Findings are
discussed within the framework of social stress research and the characteristics of the
social context of the setting where the data was collected.

https://psycnet.apa.org/record/2003-08553-010

Self-acceptance and self-disclosure of sexual

orientation in lesbian, gay, and bisexual adults: An
attachment perspective.
Export EXPORT Add To My ListEmailPrint© Request PermissionsShare
Citation
Mohr, J. J., & Fassinger, R. E. (2003). Self-acceptance and self-disclosure of sexual orientation
in lesbian, gay, and bisexual adults: An attachment perspective. Journal of Counseling
Psychology, 50(4), 482-495.
http://dx.doi.org/10.1037/0022-0167.50.4.482

Abstract
A model linking attachment variables with self-acceptance and self-disclosure of sexual
orientation was tested using data from 489 lesbian, gay, and bisexual (LGB) adults. The
model included the following 4 domains of variables: (a) representations of childhood
attachment experiences with parents, (b) perceptions of parental support for sexual
orientation, (c) general working model of attachment, and (d) LGB variables. Results
generally supported the proposed model. For example, attachment avoidance and
anxiety were associated with self-acceptance difficulties, and avoidance was associated
with low levels of outness in everyday life. Parental attachment had an indirect effect on
identity and outness through its associations with parental LGB support and general
attachment. Some results varied depending on participants' gender and parental
religious affiliation. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

https://www.tandfonline.com/doi/abs/10.1300/J461v03n01_04

The Influence of Family Environment

Factors on Self-Acceptance and Emotional
Adjustment Among Gay, Lesbian, and
Bisexual Adolescents
Pamela Darby-Mullins PhD &Tamera B. Murdock MA
Pages 75-91 | Received 29 Apr 2005, Accepted 25 May 2005, Published online: 22 Sep 2008
The quality of an adolescent's family environment has been shown to contribute
to their self-acceptance and emotional adjustment. Studies suggest that sexual
minority adolescents face unique challenges while negotiating family
relationships but few studies have specifically examined the relationships
between these family environments and the adolescent's psychological
adjustment. This study examined general aspects of family functioning (family
cohesion, family expressiveness, family conflict, parental support) and parental
attitudes toward homosexuality as predictors of self-acceptance of sexual
orientation identity and emotional adjustment among 102 gay, lesbian, and
bisexual adolescents ages 15 to 19 years. Family variables did not predict a
significant amount of variance in self-acceptance of sexual orientation identity.
However, measures of general family functioning and parental attitudes toward
homosexuality accounted for significant amounts of variance in emotional
adjustment.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4887282/

Mental Health in Lesbian, Gay, Bisexual, and

Transgender (LGBT) Youth
Stephen T. Russell1 and Jessica N. Fish2

2016
Today’s lesbian, gay, bisexual, and transgender (LGBT) youth come out at younger ages, and public
support for LGBT issues has dramatically increased, so why do LGBT youth continue to be at high risk for
compromised mental health? We provide an overview of the contemporary context for LGBT youth,
followed by a review of current science on LGBT youth mental health. Research in the past decade has
identified risk and protective factors for mental health, which point to promising directions for
prevention, intervention, and treatment. Legal and policy successes have set the stage for advances in
programs and practices that may foster LGBT youth mental health. Implications for clinical care are
discussed, and important areas for new research and practice are identified.

MENTAL HEALTH IN LGBT YOUTH

To organize our review, we start by briefly presenting the historical and theoretical contexts of
LGBT mental health. Next, we provide an overview of the prevalence of mental health disorders
among LGBT youth in comparison to the general population, and various psychosocial
characteristics (i.e., structural, interpersonal, and intrapersonal) that place LGBT youth at risk for
poor mental health. We then highlight studies that focus on factors that protect and foster
resilience among LGBT youth.
Prior to the 1970s, the American Psychiatric Association’s (APA’s) Diagnostic and Statistical
Manual of Mental Disorders (DSM) listed homosexuality as a “sociopathic personality
disturbance” (Am. Psychiatr. Assoc. 1952). Pioneering studies on the prevalence of same-sex
sexuality (Ford & Beach 1951; Kinsey et al. 1948, 1953) and psychological comparisons
between heterosexual and gay men (Hooker 1957) fostered a change in attitudes from the
psychological community and motivated the APA’s removal of homosexuality as a mental
disorder in 1973 (although all conditions related to same-sex attraction were not removed until
1987). Over the past 50 years, the psychological discourse regarding same-sex sexuality shifted
from an understanding that homosexuality was intrinsically linked with poor mental health
toward understanding the social determinants of LGBT mental health. Recent years have seen
similar debates about the diagnoses related to gender identity that currently remain in the DSM
(see sidebar Changes in Gender Identity Diagnoses in the Diagnostic and Statistical Manual of
Mental Disorders).
Minority stress theory (Meyer 1995, 2003) has provided a foundational framework for
understanding sexual minority mental health disparities (Inst. Med. 2011). It posits that sexual
minorities experience distinct, chronic stressors related to their stigmatized identities, including
victimization, prejudice, and discrimination. These distinct experiences, in addition to everyday
or universal stressors, disproportionately compromise the mental health and well-being of LGBT
people. Generally, Meyer (2003) posits three stress processes from distal to proximal: (a)
objective or external stressors, which include structural or institutionalized discrimination and
direct interpersonal interactions of victimization or prejudice; (b) one’s expectations that
victimization or rejection will occur and the vigilance related to these expectations; and (c) the
internalization of negative social attitudes (often referred to as internalized homophobia).
Extensions of this work also focus on how intrapersonal psychological processes (e.g.,
appraisals, coping, and emotional regulation) mediate the link between experiences of minority
stress and psychopathology (see Hatzenbuehler 2009). Thus, it is important to recognize the
structural circumstances within which youth are embedded and that their interpersonal
experiences and intrapersonal resources should be considered as potential sources of both risk
and resilience.
We illustrate multilevel ecological contexts in Figure 2. The young person appears as the focus,
situated in the center and defined by intrapersonal characteristics. This is surrounded by
interpersonal contexts (which, for example, include daily interactions with family and peers) that
exist within social and cultural contexts. The arrow along the bottom of the figure suggests the
historically changing nature of the contexts of youth’s lives. Diagonal arrows that transverse the
figure acknowledge interactions across contexts, and thus implications for promoting LGBT
youth mental health at the levels of policy, community, and clinical practice, which we consider
at the end of the manuscript. We use this model to organize the following review of LGBT youth
mental health.

Figure 2
Conceptual model of contextual influences on lesbian, gay, bisexual, and transgender (LGBT) youth
mental health and associated implications for policies, programs, and practice. The arrow along the
bottom of the figure indicates the historically changing nature of the contexts of youth’s lives. Diagonal
arrows acknowledge interactions across contexts, thus recognizing opportunities for promoting LGBT
youth mental health at policy, community, and clinical practice levels.

Prevalence of Mental Health Problems Among LGBT Youth

Adolescence is a critical period for mental health because many mental disorders show onset
during and directly following this developmental period (Kessler et al. 2005, 2007). Recent US
estimates of adolescent past-year mental health diagnoses indicate that 10% demonstrate a mood
disorder, 25% an anxiety disorder, and 8.3% a substance use disorder (Kessler et al. 2012).
Further, suicide is the third leading cause of death for youth ages 10 to 14 and the second leading
cause of death for those ages 15 to 24 (CDC 2012).
The inclusion of sexual attraction, behavior, and identity measures in population-based studies
(e.g., the National Longitudinal Study of Adolescent to Adult Health and the CDC’s Youth Risk
Behavior Surveillance System) has greatly improved knowledge of the prevalence of LGB
mental health disparities and the mechanisms that contribute to these inequalities for both youth
and adults; there remains, however, a critical need for the development and inclusion of
measures to identify transgender people, which thwarts more complete understanding of mental
health among transgender youth. Such data illustrate overwhelming evidence that LGB persons
are at greater risk for poor mental health across developmental stages. Studies using adult
samples indicate elevated rates of depression and mood disorders (Bostwick et al. 2010, Cochran
et al. 2007), anxiety disorders (Cochran et al. 2003, Gilman et al. 2001), posttraumatic stress
disorder (PTSD) (Hatzenbuehler et al. 2009a), alcohol use and abuse (Burgard et al. 2005), and
suicide ideation and attempts, as well as psychiatric comorbidity (Cochran et al. 2003, Gilman et
al. 2001). Studies of adolescents trace the origins of these adult sexual orientation mental health
disparities to the adolescent years: Multiple studies demonstrate that disproportionate rates of
distress, symptomatology, and behaviors related to these disorders are present among LGBT
youth prior to adulthood (Fish & Pasley 2015, Needham 2012, Ueno 2010).
US and international studies consistently conclude that LGBT youth report elevated rates of
emotional distress, symptoms related to mood and anxiety disorders, self-harm, suicidal ideation,
and suicidal behavior when compared to heterosexual youth (Eskin et al. 2005, Fergusson et al.
2005, Fleming et al. 2007, Marshal et al. 2011), and that compromised mental health is a
fundamental predictor of a host of behavioral health disparities evident among LGBT youth (e.g.,
substance use, abuse, and dependence; Marshal et al. 2008). In a recent meta-analysis, Marshal et
al. (2011) reported that sexual minority youth were almost three times as likely to report
suicidality; these investigators also noted a statistically moderate difference in depressive
symptoms compared to heterosexual youth.
Despite the breadth of literature highlighting disparities in symptoms and distress, relatively
lacking are studies that explore the presence and prevalence of mental health disorders or
diagnoses among LGBT youth. Using a birth cohort sample of Australian youth 14 to 21 years
old, Fergusson and colleagues (1999)found that LGB youth were more likely to report suicidal
thoughts or attempts, and experienced more major depression, generalized anxiety disorders,
substance abuse/dependence, and comorbid diagnoses, compared to heterosexual youth. Results
from a more recent US study that interviewed a community sample of LGBT youth ages 16 to 20
indicated that nearly one-third of participants met the diagnostic criteria for a mental disorder
and/or reported a suicide attempt in their lifetime (Mustanski et al. 2010). When comparing these
findings to mental health diagnosis rates in the general population, the difference is stark: Almost
18% of lesbian and gay youth participants met the criteria for major depression and 11.3% for
PTSD in the previous 12 months, and 31% of the LGBT sample reported suicidal behavior at
some point in their life. National rates for these diagnoses and behaviors among youth are 8.2%,
3.9%, and 4.1%, respectively (Kessler et al. 2012, Nock et al. 2013).
Studies also show differences among LGB youth. For example, studies on LGB youth suicide
have found stronger associations between sexual orientation and suicide attempts for sexual
minority males comparative to sexual minority females (Fergusson et al. 2005, Garofalo et al.
1999), including a meta-analysis using youth and adult samples (King et al. 2008). Conversely,
lesbian and bisexual female youth are more likely to exhibit substance use problems when
compared to heterosexual females (Needham 2012, Ziyadeh et al. 2007) and sexual minority
males (Marshal et al. 2008); however, some reports on longitudinal trends indicate that these
differences in disparities diminish over time because sexual minority males “catch up” and
exhibit faster accelerations of substance use in the transition to early adulthood (Hatzenbuehler et
al. 2008a).
Although not explicitly tested in all studies, results often indicate that bisexual youth (or those
attracted to both men and women) are at greater risk for poor mental health when compared to
heterosexual and solely same-sex-attracted counterparts (Marshal et al. 2011, Saewyc et al.
2008, Talley et al. 2014). In their meta-analysis, Marshal and colleagues (2011) found that
bisexual youth reported more suicidality than lesbian and gay youth. Preliminary research also
suggests that youth questioning their sexuality report greater levels of depression than those
reporting other sexual identities (heterosexual as well as LGB; Birkett et al. 2009) and show
worse psychological adjustment in response to bullying and victimization than heterosexual or
LGB-identified students (Poteat et al. 2009).
Relatively lacking is research that explicitly tests racial/ethnic differences in LGBT youth mental
health. As with general population studies, researchers have observed mental health disparities
across sexual orientation within specific racial/ethnic groups (e.g., Borowsky et al.
2001). Consolacion and colleagues (2004) found that among African American youth, those who
were same-sex attracted had higher rates of suicidal thoughts and depressive symptoms and
lower levels of self-esteem than their African American heterosexual peers, and Latino same-
sex-attracted youth were more likely to report depressive symptoms than Latino heterosexual
youth.
Even fewer are studies that simultaneously assess the interaction between sexual orientation and
racial/ethnic identities (Inst. Med. 2011), especially among youth. One study assessed
differences between white and Latino LGBQ youth (Ryan et al. 2009) and found that Latino
males reported more depression and suicidal ideation compared to white males, whereas rates
were higher for white females compared to Latinas. Although not always in relation to mental
health outcomes, researchers discuss the possibility of cumulative risk as the result of managing
multiple marginalized identities (Díaz et al. 2006, Meyer et al. 2008). However, some empirical
evidence suggests the contrary: that black sexual minority male youth report better psychological
health (fewer major depressive episodes and less suicidal ideation and alcohol abuse or
dependence) than their white sexual minority male counterparts (Burns et al. 2015). Still other
studies find no racial/ethnic differences in the prevalence of mental health disorders and
symptoms within sexual minority samples (Kertzner et al. 2009, Mustanski et al. 2010).
In summary, clear and consistent evidence indicates that global mental health problems are
elevated among LGB youth, and similar results are found for the smaller number of studies that
use diagnostic criteria to measure mental health. Among sexual minorities, there are preliminary
but consistent indications that bisexual youth are among those at higher risk for mental health
problems. The general dearth of empirical research on gender and racial/ethnic differences in
mental health status among LGBT youth, as well as contradictory findings, indicates the need for
more research. Specific research questions and hypotheses aimed at understanding the
intersection of multiple (minority) identities are necessary to better understand diversity in the
lived experiences of LGBT youth and their potentials for risk and resilience in regard to mental
health and well-being (Russell 2003, Saewyc 2011).

Risk Factors
Two approaches are often used to frame and explore mechanisms that exacerbate risk for LGBT
youth (Russell 2005, Saewyc 2011). First is to examine the greater likelihood of previously
identified universal risk factors (those that are risk factors for all youth), such as family conflict
or child maltreatment; LGBT youth score higher on many of the critical universal risk factors for
compromised mental health, such as conflict with parents and substance use and abuse (Russell
2003). The second approach explores LGBT-specific factors such as stigma and discrimination
and how these compound everyday stressors to exacerbate poor outcomes. Here we focus on the
latter and discuss prominent risk factors identified in the field—the absence of institutionalized
protections, biased-based bullying, and family rejection—as well as emerging research on
intrapersonal characteristics associated with mental health vulnerability.
At the social/cultural level, the lack of support in the fabric of the many institutions that guide
the lives of LGBT youth (e.g., their schools, families, faith communities) limits their rights and
protections and leaves them more vulnerable to experiences that may compromise their mental
health. To date, only 19 states and the District of Columbia have fully enumerated antibullying
laws that include specific protections for sexual and gender minorities (GLSEN 2015), despite
the profound effects that these laws have on the experiences of youth in schools
(e.g., Hatzenbuehler et al. 2014). LGBT youth in schools with enumerated nondiscrimination or
antibullying policies (those that explicitly include actual or perceived sexual orientation and
gender identity or expression) report fewer experiences of victimizations and harassment than
those who attend schools without these protections (Kosciw et al. 2014). As a result, lesbian and
gay youth living in counties with fewer sexual orientation and gender identity (SOGI)-specific
antibullying policies are twice as likely to report past-year suicide attempts than youth living in
areas where these policies were more commonplace (Hatzenbuehler & Keyes 2013).
Along with school environments, it is also important to consider youths’ community context.
LGBT youth who live in neighborhoods with a higher concentration of LGBT-motivated assault
hate crimes also report greater likelihood of suicidal ideation and attempts than those living in
neighborhoods that report a low concentration of these offenses (Duncan & Hatzenbuehler
2014). Further, studies show that youth who live in communities that are generally supportive of
LGBT rights [i.e., those with more protections for same-sex couples, greater number of
registered Democrats, presence of gay-straight alliances (GSAs) in schools, and SOGI-specific
nondiscrimination and antibullying policies] are less likely to attempt suicide even after
controlling for other risk indicators, such as a history of physical abuse, depressive
symptomatology, drinking behaviors, and peer victimization (Hatzenbuehler 2011). Such
findings demonstrate that pervasive LGBT discrimination at the broader social/cultural level and
the lack of institutionalized support have direct implications for the mental health and well-being
of sexual minority youth.
At the interpersonal level, an area that has garnered new attention is the distinct negative effect
of biased-based victimization compared to general harassment (Poteat & Russell 2013).
Researchers have demonstrated that biased-based bullying (i.e., bullying or victimization due to
one’s perceived or actual identities including, but not limited to, race, ethnicity, religion, sexual
orientation, gender identity or expression, and disability status) amplifies the effects of
victimization on negative outcomes. When compared to non-biased-based victimization, youth
who experience LGB-based victimization report higher levels of depression, suicidal ideation,
suicide attempts, substance use, and truancy (Poteat et al. 2011, Russell et al. 2012a), regardless
of whether these experiences are in person or via the Internet (Sinclair et al. 2012). Retrospective
reports of biased-based victimization are also related to psychological distress and overall well-
being in young adulthood, suggesting that these experiences in school carry forward to later
developmental stages (Toomey et al. 2011). Importantly, although rates of bullying decrease
over the course of the adolescent years, this trend is less pronounced for gay and bisexual
compared to heterosexual males, leaving these youth vulnerable to these experiences for longer
periods of time (Robinson et al. 2013). Further, these vulnerabilities to SOGI-biased-based
bullying are not unique to LGBT youth: Studies also indicate that heterosexual youth report poor
mental and behavioral health as the result of homophobic victimization (Poteat et al.
2011, Robinson & Espelage 2012). Thus, strategies to reduce discriminatory bullying will
improve well-being for all youth, but especially those with marginalized identities.
Positive parental and familial relationships are crucial for youth well-being (Steinberg & Duncan
2002), but many LGBT youth fear coming out to parents (Potoczniak et al. 2009, Savin-Williams
& Ream 2003) and may experience rejection from parents because of these identities (D’Augelli
et al. 1998, Ryan et al. 2009). This propensity for rejection is evidenced in the disproportionate
rates of LGBT homeless youth in comparison to the general population (an estimated 40% of
youth served by drop-in centers, street outreach programs, and housing programs identify as
LGBT; Durso & Gates 2012). Although not all youth experience family repudiation, those who
do are at greater risk for depressive symptoms, anxiety, and suicide attempts (D’Augelli
2002, Rosario et al. 2009). Further, those who fear rejection from family and friends also report
higher levels of depression and anxiety (D’Augelli 2002). In an early study of family
disclosure, D’Augelli and colleagues (1998) found that compared to those who had not
disclosed, youth who had told family members about their LGB identity often reported more
verbal and physical harassment from family members and experiences of suicidal thoughts and
behavior. More recently, Ryan and colleagues (2009) found that compared to those reporting low
levels of family rejection, individuals who experienced high levels of rejection were dramatically
more likely to report suicidal ideation, to attempt suicide, and to score in the clinical range for
depression.
Finally, some youth may have fewer intrapersonal skills and resources to cope with minority
stress experiences or may develop maladaptive coping strategies as a result of stress related to
experiences of discrimination and prejudice (Hatzenbuehler 2009, Meyer 2003). Hatzenbuehler
and colleagues (2008b)found that same-sex-attracted adolescents were more likely to ruminate
and demonstrated poorer emotional awareness compared to heterosexual peers; this lack of
emotion regulation was associated with later symptoms of depression and anxiety. Similarly,
LGB youth were more likely to experience rumination and suppress emotional responses on days
that they experienced minority stressors such as discrimination or prejudice, and these
maladaptive coping behaviors, including rumination, were related to greater levels of
psychological distress (Hatzenbuehler et al. 2008b).
A solid body of research has identified LGBT youth mental health risk factors at both the
structural or societal levels as well as in interpersonal interactions with family and peers when
they are characterized by minority stress. Less attention has focused on intrapersonal
characteristics of LGB youth that may be accentuated by minority stress, but several new studies
show promising results for identifying vulnerability as well as strategies for clinical practice.

Protective Factors
Despite adversity, most LGBT youth develop into healthy and productive adults (Russell &
Joyner 2001, Saewyc 2011), yet research has focused predominantly on risk compared to
protective factors or resilience (Russell 2005). Here we discuss contextual factors that affirm
LGBT youths’ identities, including school policies and programs, family acceptance, dating, and
the ability to come out and be out.
Studies clearly demonstrate the benefit of affirming and protective school environments for
LGBT youth mental health. Youth living in states with enumerated antibullying laws that include
sexual orientation and gender identity report less homophobic victimization and harassment than
do students who attend schools in states without these protections (Kosciw et al. 2014). Further,
mounting evidence documents the supportive role of GSAs in schools (Poteat et al.
2012, Toomey et al. 2011). GSAs are school-based, student-led clubs open to all youth who
support LGBT students; GSAs aim to reduce prejudice and harassment within the school
environment (Goodenow et al. 2006). LGBT students in schools with GSAs and SOGI resources
often report feeling safer and are less likely to report depressive symptom, substance use, and
suicidal thoughts and behaviors in comparison with students in schools lacking such resources
(Goodenow et al. 2006, Hatzenbuehler et al. 2014, Poteat et al. 2012). The benefits of these
programs are also seen at later developmental stages: Toomey and colleagues (2011) found that
youth who attended schools with GSAs, participated in a GSA, and perceived that their GSA
encouraged safety also reported better psychological health during young adulthood. Further,
these experiences with GSAs diminished some of the negative effects of LGBT victimization on
young adult well-being.
Along with studies that highlight the benefits of enumerative policies and GSAs, research also
demonstrates that LGBT-focused policy and inclusive curriculums are associated with better
psychological adjustment for LGBT students (Black et al. 2012). LGBT-inclusive curriculums
introduce specific historical events, persons, and information about the LGBT community into
student learning (Snapp et al. 2015a,b) and have been shown to improve students’ sense of safety
(Toomey et al. 2012) and feelings of acceptance (GLSEN 2011) and to reduce victimization in
schools (Kosciw et al. 2012). Further, LGBT-specific training for teachers, staff, and
administrators fosters understanding and empathy for LGBT students and is associated with
more frequent adult intervention in biased-based bullying (Greytak et al. 2013, Greytak &
Kosciw 2014). Beyond formal school curriculum and clubs, recent studies document the ways
that such school strategies influence interpersonal relationships within schools through
supportive peers and friends. For example, Poteat (2015) found that youth who engage in more
LGBT-based discussions with peers and who have LGBT friends are more likely to participate in
LGBT-affirming behavior and intervene when hearing homophobic remarks (see also Kosciw et
al. 2012).
At the interpersonal level, studies of LGBT youth have consistently shown that parental and peer
support are related to positive mental health, self-acceptance, and well-being (Sheets & Mohr
2009, Shilo & Savaya 2011). D’Augelli (2003) found that LGB youth who retained friends after
disclosing their sexual identity had higher levels of self-esteem, lower levels of depressive
symptomatology, and fewer suicidal thoughts than those who had lost friends as a result of
coming out. Similarly, LGB youth who reported having sexual minority friends experienced less
depression over time, and the presence of LGB friends attenuated the effects of victimization
(Ueno 2005). Noteworthy is support specifically related to and affirming one’s sexual orientation
and gender identity, which appears to be especially beneficial for youth (compared to general
support; Doty et al. 2010, Ryan et al. 2010). Snapp and colleagues (2015c) found that sexuality-
related social support from parents, friends, and community during adolescence each uniquely
contributed to positive well-being in young adulthood, with parental support providing the most
benefit. Unfortunately, many LGBT youth report lower levels of sexuality-specific support in
comparison to other forms of support, especially from parents (Doty et al. 2010), and transgender
youth report lower social support from parents than their sexual minority counterparts (Ryan et
al. 2010). Studies that explicitly explore the benefits of LGB-specific support show that
sexuality-specific support buffers the negative effects of minority stressors (Doty et al.
2010, Rosario et al. 2009). For example, Ryan et al. (2010) found that parents’ support of sexual
orientation and gender expression was related to higher levels self-esteem, less depression, and
fewer reports of suicidal ideation or suicide attempts.
Romantic relationships are understood as normative and important developmental experiences
for adolescents (Collins et al. 2009), but LGBT youth may experience a number of social barriers
related to dating same-sex partners that may have implications for their development during
adolescence and at later stages of the life course (Frost 2011, Mustanski et al. 2014, Russell et al.
2012b). These barriers include potentially limited access to romantic partners, minority stressors
specific to pursuing relationships with same-sex partners, and the restriction of same-sex
romantic behavior in educational settings. These obstacles, in turn, can steer youth to other social
settings, such as bars and clubs, that may increase risk for poor health and health behavior
(Mustanski et al. 2014). LGB youth report more fear and less agency in finding suitable romantic
partners and dating in general (Diamond & Lucas 2004). Yet findings demonstrate that dating
same-sex partners is related to improved mental health and lower substance use behavior for
LGB youth (Russell & Consolacion 2003, Russell et al. 2002). Results from a three-year
longitudinal study showed that in comparison to LGB youth who dated other-sex partners, those
who dated same-sex partners experienced an increase in self-esteem and a decrease in
internalized homophobia for men and women, respectively (Bauermeister et al. 2010). In a more
recent study, Baams and colleagues (2014) found that the presence of a romantic partner
buffered the effects of minority stress on the psychological well-being of same-sex-attracted
youth.
Finally, coming out as LGBT involves dynamic interplay between intrapersonal development
and interpersonal interaction and disclosure. Research consistently shows that coming out puts
youth at greater risk for verbal and physical harassment (D’Augelli et al. 2002, Kosciw et al.
2014) and the loss of close friends (D’Augelli 2003, Diamond & Lucas 2004); however, studies
of adults who disclose their sexual identities to others show positive psychosocial adjustment
(Luhtanen 2002, Morris et al. 2001) and greater social support from family members (D’Augelli
2002). In a recent study, Russell et al. (2014) found that despite higher risk for LGBT-based
school victimization, those who were out during high school reported lower levels of depression
and greater overall well-being in young adulthood (the results did not differ based on gender or
ethnicity). Further, those who reported greater concealment of their LGBT identity were still
susceptible to victimization but did not show the same benefits in psychosocial adjustment. Such
findings demonstrate the positive benefits of coming out in high school despite the risks
associated with discriminatory victimization (see sidebar Supporting Youth Through Coming
Out).
In summary, there is clear evidence for compromised mental health for LGBT youth, and
research in the past decade has identified both risk and protective factors at multiple levels of
influence. Important gaps remain, for example, in studies that identify intrapersonal strengths or
coping strategies that may enable some LGBT youth to overcome minority stress. Yet this body
of research has begun to provide guidance for action at multiple contextual levels.
Go to:

IMPLICATIONS
Dramatic advances in understanding LGBT youth mental health during the past decade (Saewyc
2011) offer multiple implications for actions. Returning to Figure 2, the contexts that shape the
lives of LGBT youth have corresponding implications for supporting mental health at multiple
levels, from laws to clinical practice. Existing research shows encouraging findings regarding
laws and policies and for education and community programs, yet we are only just beginning to
build a research base that provides strong grounding for clinical practice.
https://www.drugsandalcohol.ie/19666/1/lgbt_lives_dec_2008.pdf
https://lgbt.ie/what-is-lgbt
LGBT stands for lesbian, gay, bisexual and transgender
and along with heterosexual they are terms used to
describe people’s sexual orientation or gender identity.
These terms are explained in more detail here.
Lesbian
A lesbian woman is one who is romantically, sexually and/or emotionally attracted to women. Many
lesbians prefer to be called lesbian rather than gay.
Gay
A gay man is one who is romantically, sexually and/or emotionally attracted to men. The word gay
can be used to refer generally to lesbian, gay and bisexual people but many women prefer to be
called lesbian. Most gay people don’t like to be referred to as homosexual because of the negative
historical associations with the word and because the word gay better reflects their identity.
Bisexual
A bisexual person is someone who is romantically, sexually and/or emotionally attracted to people of
genders both the same and different to their own.
Transgender or Trans
Transgender an umbrella term used to describe people whose gender identity (internal feeling of
being male, female or non-binary) and/or gender expression, differs from the gender they were
assigned at birth. Not everyone whose appearance or behaviour is gender-atypical will identify as a
transgender person.
Gender Identity
One’s gender identity refers to whether one feels male, female or non-binary (regardless of one’s
biological sex). Gender expression refers to outwardly expressing one’s gender identity.
Transgender people typically live or wish to live full time as members of a gender other than that
assigned at birth. Transgender people often choose to undergo a social transition, which may
involve changing their name, pronouns, appearance, and official gender markers. They may also
pursue a medical transition, which can involve medical interventions, such as hormone therapy or
surgery, to make their bodies fit with their gender identity and help ease gender dysphoria.
Transvestite or cross-dressing individuals are thought to comprise the largest transgender sub-
group. Cross-dressers sometimes wear clothes considered appropriate to a different gender. They
vary in how completely they dress (from one article of clothing to fully cross-dressing) as well as in
their motives for doing so.
Gender Reassignment
Gender Reassignment also called transitioning, is the process of changing the way someone’s
gender is lived publicly and can be a complex process. People who wish to transition often start by
expressing their gender identity in situations where they feel safe. They typically work up to living
full-time in a different gender, by making gradual changes to their gender expression.
Connecting with other transgender people through peer support groups and transgender community
organisations is also very helpful for people when they are going through the transition process.
Transitioning differs for each individual and may involve changes in clothing and grooming, a name
change, change of gender on identity documents, hormonal treatment, and surgery.
Coming Out
Coming Out is the term used by lesbian, gay, bisexual and transgender people and the wider queer
community to describe their experience of discovery, self-acceptance, openness and honesty about
their LGBT identity and their decision to disclose, i.e. to share this with others when and how they
choose.
Sexual Orientation
Sexual Orientation refers to an enduring pattern of emotional, romantic, and/or sexual attractions to
men, women, or multiple genders. Sexual orientation also refers to a person’s sense of identity
based on those attractions, related behaviours, and membership in a community of others who
share those attractions.
Homophobia
Homophobia refers to fear of or prejudice and discrimination against lesbian, gay and bisexual
people. It is also the dislike of same-sex attraction and love or the hatred of people who have those
feelings. The term was first used in the 1970s and is more associated with ignorance, prejudice and
stereotyping than with the physiological reactions usually attributed to a ‘phobia’. While homophobic
comments or attitudes are often unintentional, they can cause hurt and offence to lesbian, gay and
bisexual people.
Transphobia
Transphobia refers to fear of or prejudice and discrimination against people who are transgender or
who are perceived to transgress norms of gender, gender identity or gender expression. While
transphobic comments or attitudes are often unintentional, they can cause hurt and offence to
transgender people.
Biphobia
Biphobia refers to the intolerance, hatred or erasure of bisexual people. The term describes an
aversion to bisexuality (or any non-monosexuality) and is fueled by negative attitudes and myths
surrounding bisexuality.
Definitions adapted from More Than a Phase (Pobal, 2006), For a Better Understanding of Sexual
Orientation (APA, 2008) and Answers to Your Questions About Transgender Individuals and Gender
Identity (APA, 2006)
IN THIS SECTION
About LGBT Ireland
Confidentiality
Contact Us
Terms and Conditions
Meet the Staff
LGBT (or GLBT) is an initialism that stands for lesbian, gay, bisexual, and transgender. In use since
the 1990s, the term is an adaptation of the initialism LGB, which was used to replace the term gay in
reference to the LGBT communitybeginning in the mid-to-late 1980s.[1] Activists believed that the
term gay community did not accurately represent all those to whom it referred.
The initialism has become adopted into the mainstream as an umbrella term for use when labeling
topics pertaining to sexuality and gender identity. For example, the LGBT Movement Advancement
Project termed community centres, which have services specific to those member of the LGBT
community, as "LGBT community centers", in a comprehensive studies of such centres around
the United States.[2]
The initialism LGBT is intended to emphasize a diversity of sexuality and gender identity-based
cultures. It may be used to refer to anyone who is non-heterosexual or non-cisgender, instead of
exclusively to people who are lesbian, gay, bisexual, or transgender.[3] To recognize this inclusion, a
popular variant adds the letter Q for those who identify as queeror are questioning their sexual
identity; LGBTQ has been recorded since 1996.[4][5] Those who add intersex people to LGBT groups
or organizing use an extended initialism LGBTI.[6][7] The two acronyms are sometimes combined to
form the terms LGBTIQ[8] or LGBT+ to encompass spectrums of sexuality and gender.[9] Other, less
common variants also exist, motivated by a desire for inclusivity, including those over twice as long
which have prompted criticism.[10]
The first widely used term, homosexual, originally carried negative connotations.[dubious – discuss] It was
replaced byhomophile in the 1950s and 1960s,[12][dubious – discuss] and subsequently gay in the 1970s; the
latter term was adopted first by the homosexual community.[13] Lars Ullerstam [sv] promoted use of
the term sexual minority in the 1960s, as an analogy to the term ethnic minority for non-whites.[14]
As lesbians forged more public identities, the phrase "gay and lesbian" became more common.[15] A
dispute as to whether the primary focus of their political aims should be feminism or gay rights led to
the dissolution of some lesbian organizations, including the Daughters of Bilitis, which disbanded in
1970 following disputes over which goal should take precedence.[16] As equality was a priority
for lesbian feminists, disparity of roles between men and women or butch and femme were viewed
as patriarchal. Lesbian feminists eschewed gender role play that had been pervasive in bars, as well
as the perceived chauvinism of gay men; many lesbian feminists refused to work with gay men, or
take up their causes.[17]
Lesbians who held the essentialist view, that they had been born homosexual and used the
descriptor "lesbian" to define sexual attraction, often considered the separatist opinions of lesbian-
feminists to be detrimental to the cause of gay rights.[18] Bisexual and transgender people also sought
recognition as legitimate categories within the larger minority community.[15]
After the elation of change following group action in the 1969 Stonewall riots in New York City, in the
late 1970s and the early 1980s, some gays and lesbians became less accepting
of bisexual or transgender people.[19][20] Critics[Like whom?] said that transgender people were acting
out stereotypes and bisexuals were simply gay men or lesbian women who were afraid to come
out and be honest about their identity.[19] Each community has struggled to develop its own identity
including whether, and how, to align with other gender and sexuality-based communities, at times
excluding other subgroups; these conflicts continue to this day.[20] LGBTQ activists and artists have
created posters to raise consciousness about the issue since the movement began.[21]
From about 1988, activists began to use the initialism LGBT in the United States.[22] Not until the
1990s within the movement did gay, lesbian, bisexual, and transgender people gain equal
respect.[20] This spurred some organizations to adopt new names, as the GLBT Historical Society did
in 1999. Although the LGBT community has seen much controversy regarding universal acceptance
of different member groups (bisexual and transgender individuals, in particular, have sometimes
been marginalized by the larger LGBT community), the term LGBT has been a positive symbol of
inclusion.[3][20]
Despite the fact that LGBT does not nominally encompass all individuals in smaller communities
(see Variants below), the term is generally accepted to include those not specifically identified in the
four-letter initialism.[3][20] Overall, the use of the term LGBT has, over time, largely aided in bringing
otherwise marginalized individuals into the general community.[3][20] Transgender actress Candis
Cayne in 2009 described the LGBT community "the last great minority", noting that "We can still be
harassed openly" and be "called out on television".[23]
In response to years of lobbying from users and LGBT groups to eliminate discrimination, the online
social networking service Facebook, in February 2014, widened its choice of gender variants for
users.[relevant? – discuss][24][25][26]
In 2016, GLAAD's Media Reference Guide states that LGBTQ is the preferred initialism, being more
inclusive of younger members of the communities who embrace queer as a self-
descriptor.[27] However, some people consider queer to be a derogatory term originating in hate
speech and reject it, especially among older members of the community.[28]

Variants
General

2010 pride parade in Plaza de Mayo, Buenos Aires, which uses the LGBTIQ initialism.[29]

Many variants exist including variations that change the order of the letters; LGBT or GLBT are the
most common terms.[20]Although identical in meaning, LGBT may have a more feminist connotation
than GLBT as it places the "L" (for "lesbian") first.[20] LGBT may also include additional Qs for "queer"
or "questioning" (sometimes abbreviated with a question mark and sometimes used to mean
anybody not literally L, G, B or T) producing the variants "LGBTQ" and " LGBTQQ".[30][31][32] In the
United Kingdom, it is sometimes stylized as " LGB&T",[33][34] whilst the Green Party of England and
Wales uses the term LGBTIQ in its manifesto and official publications.[35][36][37]
The order of the letters has not been standardized; in addition to the variations between the
positions of the initial "L" or "G", the mentioned, less common letters, if used, may appear in almost
any order.[20] Longer initialisms based on LGBT are sometimes referred to as "alphabet
soup".[38][39] Variant terms do not typically represent political differences within the community, but
arise simply from the preferences of individuals and groups.[40]
The terms pansexual, omnisexual, fluid and queer-identified are regarded as falling under the
umbrella term bisexual (and therefore are considered a part of the bisexual community).
Some use LGBT+ to mean "LGBT and related communities".[9] LGBTQIA is sometimes used and
adds "queer, intersex, and asexual" to the basic term.[41] Other variants may have a "U" for "unsure";
a "C" for "curious"; another "T" for "transvestite"; a "TS", or "2" for "two-spirit" persons; or an "SA" for
"straight allies".[42][43][44][45][46] However, the inclusion of straight allies in the LGBT acronym has proven
controversial as many straight allies have been accused of using LGBT advocacy to gain popularity
and status in recent years,[47] and various LGBT activists have criticised the heteronormative
worldview of certain straight allies.[48] Some may also add a "P" for "polyamorous", an "H" for "HIV-
affected", or an "O" for "other".[20][49] Furthermore, the initialism LGBTIH has seen use in India to
encompass the hijra third gender identity and the related subculture.[50][51]
The initialism LGBTTQQIAAP (lesbian, gay, bisexual, transgender, transsexual, queer, questioning,
intersex, asexual, ally, pansexual) has also resulted, although such initialisms are sometimes
criticized for being confusing and leaving some people out, as well as issues of placement of the
letters within the new title.[38] However, adding the term "allies" to the initialism has sparked
controversy,[52] with some seeing the inclusion of "ally" in place of "asexual" as a form of asexual
erasure.[53] There is also the acronym QUILTBAG (queer and questioning, intersex, lesbian,
transgender and two-spirit, bisexual, asexual and ally, and gay and genderqueer).[54]
Similarly LGBTIQA+ stands for "lesbian, gay, bisexual, transgender, intersex, queer/questioning,
asexual and many other terms (such as non-binary and pansexual)".[55]
In Canada, the community is sometimes identified as LGBTQ2 (Lesbian, Gay, Bisexual,
Transgender, Queer and Two Spirit).[56] Depending on the which organization is using the acronym
the choice of acronym changes. Businesses and the CBC often simply employ "LGBT" as a proxy for
any longer acronym, private activist groups often employ LGBTQ+,[57] whereas public health
providers favour the more inclusive LGBT2Q+ to accommodate twin spirited indigenous
peoples.[58] For a time the Pride Toronto organization used the much lengthier
acronym LGBTTIQQ2SA, but appears to have dropped this in favour of simpler wording.[59]

Transgender inclusion
The term trans* has been adopted by some groups as a more inclusive alternative to "transgender",
where trans (without the asterisk) has been used to describe trans men and trans women, while
trans* covers all non-cisgender (genderqueer) identities, including transgender, transsexual,
transvestite, genderqueer, genderfluid, non-binary, genderfuck, genderless, agender, non-gendered,
third gender, two-spirit, bigender, and trans man and trans woman.[60][61] Likewise, the
term transsexualcommonly falls under the umbrella term transgender, but some transsexual people
object to this.[20]
When not inclusive of transgender people, the shorter term LGB is used instead of LGBT.[20][62]

Intersex inclusion
Main article: Intersex and LGBT
The relationship of intersex to lesbian, gay, bisexual and trans, and queer communities is
complex,[63] but intersex people are often added to the LGBT category to create an LGBTI
community. Some intersex people prefer the initialism LGBTI, while others would rather that they not
be included as part of the term.[7][64] LGBTI is used in all parts of "The Activist's Guide" of the
Yogyakarta Principles in Action.[65] Emi Koyama describes how inclusion of intersex in LGBTI can fail
to address intersex-specific human rights issues, including creating false impressions "that intersex
people's rights are protected" by laws protecting LGBT people, and failing to acknowledge that many
intersex people are not LGBT.[66] Organisation Intersex International Australia states that some
intersex individuals are same sex attracted, and some are heterosexual, but "LGBTI activism has
fought for the rights of people who fall outside of expected binary sex and gender norms."[67][68] Julius
Kaggwa of SIPD Uganda has written that, while the gay community "offers us a place of relative
safety, it is also oblivious to our specific needs".[69]
Numerous studies have shown higher rates of same sex attraction in intersex people,[70][71] with a
recent Australian study of people born with atypical sex characteristics finding that 52% of
respondents were non-heterosexual,[72][73] thus research on intersex subjects has been used to
explore means of preventing homosexuality.[70][71] As an experience of being born with sex
characteristics that do not fit social norms,[74] intersex can be distinguished from
transgender,[75][76][77]while some intersex people are both intersex and transgender.[78]