Mental Health in Sexual Minority and Transgender Women

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Key points

  • Sexual minority and transgender women experience increased rates of societal discrimination, harassment, and violence. Minority stress theory links these experiences to increased rates of mental illness and substance use disorders in those groups.

  • For many mental health conditions and substance use disorders, bisexual women are at even higher risk than are lesbians. This is partly attributable to stigmatization of bisexual women in both heterosexual and gay communities.

  • Family acceptance, social

Trauma and minority stress

Minority stress is a term initially used by Brooks2 in her work with lesbian women. She defined it as “a state intervening between the sequential antecedent stressors of culturally sanctioned, categorically ascribed inferior status, resultant prejudice and discrimination, the impact of these forces on the cognitive structure of the individual, and consequent readjustment or adaptational failure.” Meyer3 adopted a similar conceptualization for his minority stress theory, in which he connected

Body Image and Eating Disorders

Although lesbians are more likely to be overweight or obese than heterosexual women,12 studies suggest that they are less likely than heterosexual women of the same body mass index to have body dissatisfaction.13, 14, 15 It is less clear how nonlesbian SMW fare with regard to body image in comparison to heterosexual or lesbian women.

Unfortunately, there are little data on the prevalence of disordered eating or eating disorders in adult SMW. Koh and Ross16 surveyed women from 33 health care

Substance abuse

Several large population-based studies suggest that SMW are at higher risk of cigarette smoking24, 37, 38 and problematic alcohol use or alcohol use disorder24, 39, 40 than are heterosexual women. SMW are also more likely to have used drugs or to have substance use disorders.40, 41 Although some of this is attributable to minority stress, there are other contributory factors, such as social learning. In the United States, gay bars have played a vital role as gathering spaces for LGBT

Barriers to Care

Sexual minority and transgender women face several barriers in accessing quality care. In a survey by Lambda Legal, 28.5% of sexual minority respondents and 73% of transgender respondents reported concerns that medical personnel would treat them differently. In the same survey, 9.1% of sexual minority respondents and 59.1% of transgender respondents said they feared they would be refused medical service.47 Even if they are willing to seek help, sexual minority and transgender people often find

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    This article originally appeared in the Psychiatric Clinics of North America, Volume 40, Issue 2, June 2017.

    Disclosure Statement: The authors have nothing to disclose.

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