LGBTQI+ Mental Health and the role of Minority Stress

Welcome and Happy Pride Month 2025.

I have decided to write this blog specifically for the LGBTQI+ community to introduce a very important concept: minority stress.

As a therapist identifying as part of the LGBTQI+ community myself and working with this community in my practice, I have developed a particular interest in LGBTQI+ mental health and some of the myths that are out there about the LGBTQI+ community when it comes to mental health.

If you have ever googled "LGBTQI+ and mental health" or similar phrases, you are familiar with what comes next - usually some helpful resources coupled with statistics highlighting how LGBTQI+ people experience significantly higher rates of mental health difficulties than the so called "general population". Have you ever wondered why this might be?

The key to answering this question is in understanding minority stress and the role this phenomenon plays in LGBTQI+ lives. Put simply, minority stress refers to the unique stressors that LGBTQI+ people experience in their lives, in addition to normal life stressors, because of their minoritized LGBTQI+ identity and the role of societal stigma about those identities.

Even in societies that are more accepting of LGBTQI+ people, there is still an overwhelming message that being LGBTQI+ is not the norm. This exposes LGBTQI+ people to experiences of stigma, prejudice and discrimination that have a negative impact on mental health. This is true even for people who might not have necessarily experienced overt discrimination. This is the bit that often surprises my clients, because we can often minimise more systemic factors that might not be as obvious as someone shouting homophobic remarks at you in the streets. However, the compounded impact of more subtle stigma and prejudice can be as detrimental as one more overt incident of homophobia.

The bottom-line here is that the mental health disparities we see in LGBTQI+ people are caused by these minority stressors, as outlined in Minority Stress Theory, because of the societal stigma and prejudice about LGBTQI+ identities. So it is not the case that LGBTQI+ people are more unhealthy, but it is the case that LGBTQI+ people experience unique stressors because of their sexuality or gender identity.

These stressors can take many forms but there are four important ones that is worth knowing about and these are: experienced discrimination, anticipated discrimination, concealment and internalised stigma/prejudice.

Experienced discrimination

Experienced discrimination is what it says on the tin. Actual experiences of discrimination, usually fuelled by prejudice, that LGBTQI+ people face in their lives because of an aspect of their LGBTQI+ identities. Discrimination can include more overt experiences of harassment, homophobia, transphobia, or acts of violence related to LGBTQI+ prejudice, as well as more subtle experiences that might not always be directed at you but that still create a sense of being unsafe or judged. This could include homophobic jokes for instance or reading news articles about other gay or transgender people being harmed, which is very relevant at the moment, given the increase in negative media coverage around the LGBTQI+ community.

Experienced discrimination can also include wider societal issues, like an anti-LGBTQI+ law being passed for instance, which will inadvertently impact on your sense of safety in the world. This is why this stuff is important and why it should be everyone's business.

Anticipated discrimination

Anticipated discrimination is the sense of anxiety, dread that can come up for LGBTQI+ people about potentially experiencing discrimination. Sometimes this point is used to blame the distress on a mental health difficulty in the LGBTQI+ person who is struggling. But isn't it understandable to expect further discrimination, when you have grown up with all these negative messages and experiences about what it means to be LGBTQI+ and how society treats you? It makes sense that you'll come to fear prejudice and can become hypervigilant in particular situations where the risk of prejudice may feel greater.

This can really affect our mental health over time as our nervous system becomes hyperactive and our body releases cortisol and other stress-related hormones that can take a toll not only on our mental health but also on our physical health.

Concealment

Living with the effects of experienced or anticipated discrimination can lead to another phenomenon that is very common for people in the LGBTQI+ community: concealing (hiding) your LGBTQI+ identity. This usually happens due to fear, stigma, prejudice both external and internalised, which can lead to you feeling like you have no choice but to hide that part of your identity to stay safe.

Concealment can happen even for people who are generally out and comfortable with their LGBTQI+ identity, in particular settings, like at work for example. Being LGBTQI+ often comes with having to make decisions about “coming out” every time we are in a new environment, with new people. This is because of what we highlighted before about LGBTQI+ identities still not being seen as “the norm” in society, thus leaving the person with these identities in a position of having to come out.

Concealing once identity can lead to significant mental health consequences that can have a detrimental impact on self-esteem and lead to stress and anxiety about having to maintain the secrecy and fears around being found out or being “caught in the lie”. It also affects our ability to access social support, due to the disconnect created by the fact that people don’t know about that part of ourselves.

It is important to distinguish concealment from “outness”. Concealment refers to the active hiding of one’s LGBTQI+ identity, whilst “outness” is usually the degree to which we may decide to come out to people in different settings in our lives, which comes with more of a sense of agency and can be an empowering decision if not fuelled by anxiety but by more of an active choice.

Internalised Stigma

Another important process that can happen for people with a stigmatised or marginalised identity is the process where one can internalise the negative stereotypes and prejudice about themselves and that part of their identity.

This can lead to self-blame and criticism, experiences of shame and embarrassment, anticipation of discrimination and it has a significant impact on self-esteem and self image. It can also often prevent people from seeking help due to shame or a fear of stigma and ultimately lead to poorer outcomes in mental health.

What can help?