Sexual identity development is a complex, multidimensional, and often fluid process. One must consider cognitive, social, emotional, cultural, and familial complexities among other aspects of the individual’s experience to contextualize a narrative concerning sexual identity development.

Sexual minority youth is a term used to describe adolescents who are not exclusively heterosexual. Definitions and labels ascribed to sexual minority youth may not describe their sexual attractions, relationships, fantasies, or behaviors. It is important to understand an individual’s personal experience as well as his or her self-identification without making assumptions.

The Internet, public discourse about “gay rights,” Gay-Straight Alliances in the schools, and a growing visibility of gay and lesbian role models in the media have helped challenge mainstream notions of what is considered “normal” sexual development. The fluidity of adolescent sexual identity development is as complicated as any aspect of identity development. Adolescents in the 21st century are, in many parts of the world, growing up in a culture that embraces diversity in sexual expression in a manner foreign to their parents’ generation. Despite the fact that sexual minority youth have greater access to resources that provide support than did previous generations, there continue to be schools, communities, and homes in which adolescents still experience rejection, bullying, ostracism, and violence because of their differences from mainstream society.

As child and adolescent clinicians, we often see the most vulnerable youth. This vulnerability occurs secondarily to the complex interactions of adolescents within their family, their culture, and society. Therapy for adolescents should explore friendships and romantic and sexual relationships, as well as attractions. Clinicians should be aware of the research that has shown that there are higher rates of mental health risks in sexual minority adolescent populations. Both protective and risk factors for healthy emotional and physical development need to be understood.

Risk assessment

When assessing risk for sexual minority youth, consider the defenses used to cope with both internal and external stressors. Fear of stigma, rejection, and other ramifications can lead sexual minority adolescents to defensive compartmentalization to protect and hide their sexual identity. This compartmentalization can affect normal development and impede overall identity development.

Compartmentalizing may be a conscious or unconscious mechanism that helps sexual minority adolescents cope with rejection by family members, peers, communities, and religious affiliations. They may fear harm or may already have been the target of violence and emotional abuse. A segment of these youths may be at higher risk for mental health issues because they may not have developed the internal coping mechanisms or they may lack social support and community to help them face these challenges.

Child and adolescent psychiatrists, as well as other clinicians, can play an important role by identifying those who are at risk for mental health problems and by providing support and treatment when needed.

The development of sexual identity

Sexual behavior in adolescence and one’s identity as heterosexual, gay, lesbian, or bisexual may change over time. “The fluidity of sexual desire, behavior, and identity may be a fundamental characteristic of sexuality during the teenage years.”^1(ppxi,323) Complicated cultural and social identities influence sexual identity as well, but not necessarily sexual behavior.

Savin-Williams and Diamond² compared the sexes and looked at sexual identity trajectories among sexual minority youth. They concluded that differences among youths cannot be explained by gender alone. “No singular sexual identity model is capable of representing the diverse trajectories of male and female sexual identity development.”² These researchers found that the context for sexual identity development is more likely to be emotionally oriented for female adolescents and sexually oriented for male adolescents.² Diamond has written extensively on the development of female same-sex orientation. Women appear more likely than men to exhibit situational and environmental plasticity in sexual attractions, behavior, and identifications.³

Developmental considerations

Attitudes toward homosexuality have shifted in our culture and in politics. In 1973, homosexuality was deleted from DSM. This followed the Stonewall Rebellion in 1969, when the visibility of the gay, lesbian, bisexual, and transgendered community was greater in the media. The social movement that began at that time has accelerated with the help of popular culture. Six states have legalized same-sex marriage in the past 5 years.

Although the dominant culture is changing, each adolescent may or may not find like-minded individuals and communities for external support who can help navigate internal conflicts that may arise when one recognizes that one is “different” from the dominant culture and, in most cases, “different” from one’s parents.