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Home » Child and Adolescent Psychiatry

Psychiatric Times. Vol. 28 No. 12
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CHILD AND ADOLESCENT PSYCHIATRY 

Sexual Minority Identity Development

A Review of the Process and Effects

By Cynthia J. Telingator, MD and Kelly T. Woyewodzic, MD | December 16, 2011
Dr Telingator is assistant professor of psychiatry at the Harvard Medical School and director of child and adolescent psychiatry residency training, Cambridge Health Alliance. Dr Woyewodzic is a clinical fellow in psychiatry at the Harvard Medical School and a fellow in child and adolescent psychiatry at the Cambridge Health Alliance. The authors report no conflicts of interest concerning the contents of this article.

As cultural attitudes and mores have evolved, researchers have changed in their approach to identify and understand this population. Initially, much of the research was done with adolescents who were attending community centers for sexual minority youth. It was necessary to use classifications and ask about self-identifying labels, such as gay or lesbian, to capture raw data about this underserved population. For many, these classifications still have a high level of congruence with their sexuality. However, as we begin to understand sexuality better, we find that there is a large degree of variance in sexual desires, fantasies, gender roles, gender identifications, sexual orientations, sexual behaviors, and romantic attractions that these classifications do not capture.4

Over the past decade, there has been a significant decrease in the age at which sexual minority youths are self-identifying. Recent studies have shown that boys are aware of same-sex feelings at about age 10, and girls at about age 11.1 Self-labeling occurs, on average, 5 years after initial awareness. Same-sex contact occurs a year or two before a boy’s gay identification; a girl is more likely to have her first same-sex contact after identifying herself as a lesbian.1 More than ever, sexual minority youth are self-identifying while they are still in high school and living at home, even if they are not sexually active.1

(MORE: Continuation Treatment and Relapse Prevention in Pediatric Depression)

The National Longitudinal Study of Adolescent Health is the most comprehensive survey of adolescents in the United States. Of the approximately 12,000 youth who participated, 7% reported having same-sex attractions or relationships. (This was slightly more common among males.) Youth were not asked specifically about sexual identity but rather about experiences and attractions. This broadened the sample from previous studies.5

Russell and Joyner6 looked at the data of this study to attempt to better understand previous reports of risk of suicidality in sexual minority youth. They found that “regardless of age and family background, males and females who reported same-sex romantic attraction or relationships were more likely than their peers to report suicidal thoughts.” Their results were consistent with those of a 1989 government report, which showed that youths with same-sex orientation were twice as likely as their same-sex peers to attempt suicide and were more likely to report suicidal thoughts than their peers.7

Sexual minority youths with suicidal ideation or who had attempted suicide are more likely to abuse alcohol(Drug information on alcohol) and to feel hopeless, depressed, and victimized.6 They are also more likely to have had a close relative or peer attempt suicide. Furthermore, even though these risk factors are similar to suicide risk factors for all adolescents, “there is a strong link between same-sex sexual orientation and adolescent suicidal thoughts and attempts.” The exact cause is unclear. However, “sexual orientation has an independent association with suicide attempts for males, while for females the association of sexual orientation with suicidality may be mediated by drug use and violence/victimization.”8

Youths who identify as bisexual are 2 to 3 times more likely to attempt suicide than gay and lesbian youths.9 A lack of social support may be one possible cause. Those who acknowledge a more fluid sexual orientation may feel ostracized from both the heterosexual and homosexual communities.

For the adolescent who is also a member of an ethnic minority, the task of identity development becomes more complex. One must concurrently develop a sexual and ethnic identity that differs from the dominant culture. Research has shown these processes occur independently and that these adolescents are at increased risk for stigma and ostracism because of their double minority status.10,11 For some, this may increase the risk of poor mental health outcomes because cultural mores of the ethnic identity may reject their sexual identity more than the dominant culture.

Problems associated with disclosing sexual identity

Asserting one’s sexuality is empowering, but doing so may be riddled with connotations and stereotypes. D’Augelli and Hershberger12 looked at self-identified gay, lesbian, and bisexual youth during the periods of 1987 through 1989 and 1995 through 1997 at community centers. There was some geographical as well as cultural diversity in the study sample. Of the 542 youths, 81% reported experiencing verbal abuse related to being a sexual minority youth, “38% had been threatened with physical attacks, 22% had objects thrown at them, 15% had been physically assaulted, 6% had been assaulted with a weapon, and 16% had been sexually assaulted.”

Youths who are aware of their minority sexual orientation at relatively early ages, who self-identify earlier, and who self-disclose earlier encounter more lifetime victimization.1 Highly effeminate boys are targeted more than others.13

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Also in this Special Report

Eating Disorders in Children and Adolescents

Anxiety Disorders in Children and Adolescents

Continuation Treatment and Relapse Prevention in Pediatric Depression

Sexual Minority Identity Development






 
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