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Coming Out: Implications for Health

October 11, 2021 Written by Casey Linke, FNP-C

Today is National Coming Out Day. As anyone in the LGBTQ+ community can relate: coming out is an incredibly nuanced experience that never really ends. Today, I want to focus on one element of coming out that is mentioned less in the media—the idea of coming out to oneself. I also want to highlight why today is important as a day of visibility for the LGBTQ+ folks, as health disparities, especially in the realm of mental health, continue to cause poorer health outcomes for those in the community.

A few examples of mental health disparities among the LGBTQ+ community include:

· LGB adults are more than twice as likely as heterosexual adults to experience a mental health condition

· Transgender indivduals are nearly four times as likely as cisgender individuals to experience a mental health condition

· LGBTQ folks are at significantly heightened risk for PTSD compared to heterosexual and cisgender peers: this is typically due to bullying, homo-, bi-, and transphobia, and being a targeted community for hate crimes

· LGB adults are nearly twice as likely as heterosexual adults to experience a substance use disorder, and transgender individuals are four times as likely, as substance misuse is often used as a coping mechanism or method of self-medication

Many LGBTQ people, particularly those with intersecting racial or socioeconomic identities, experience discrimination, prejudice, denial of civil and human rights, harassment and family rejection—all of which can lead to new or worsened mental health symptoms such as suicidality and persistent feelings of sadness or hopelessness. Positive changes in societal acceptance of LGBTQ people can act as a protective factor for mental health. These positive changes can encourage LGBTQ youth to come out at younger developmental ages. This can be a double-edged sword, as the benefits can only be experienced by youth in supportive environments, and outcomes may fare worse for those who come out to violent, emotionally abusive or rejecting family, friends and/or community. Coming out to oneself (meaning: recognizing and accepting one’s own sexual orientation and/or gender identification) can happen gradually or overnight. Some people realize their sexual attraction or gender identity is different from “the norm” at a very early age; for others, it can take decades to disengage from the homophobic/transphobic and societal biases and feel comfortable identifying as LGBTQ+. Further, coming out to family, friends and community can be traumatic as there is risk for rejection of one’s own identity.

For those who can come out safely to friends and family, there is perhaps some health benefit: a study done in Montreal showed that LGB folks who are “out” to others have lower stress hormone levels and fewer symptoms of anxiety, depression and burnout. As a health care provider and someone who has experienced coming out, I urge anyone considering coming out to friends or family today to be gentle with themselves and make sure you have come out to yourself first. That means reaching a level of healthy acceptance of your sexuality and gender identity, as well as actively working on disbanding any homophobic or transphobic biases that have become engrained in your psyche from living in a homophobic and transphobic society.

I wish you all of the best in your journey. If you ever want a listening ear or dialogue around this topic and more, I love receiving emails at Casey


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