Homophobia and its Effects on Self-Image and Substance Abuse

If we looked exclusively at select media outlets, we might assume that society has progressed past its homophobic past. Many cities now celebrate Pride Week, an increasingly number of celebrities openly identify as LGBTQ+, and television shows such as “Queer Eye for the Straight Guy” are popular even in the mainstream. However, bigotry is still a huge problem in society, and people who do not identify as heterosexual are still widely discriminated against. In this piece, I will explore some of the challenges that LGBTQ+ people face and the potential ramifications of homophobia in the context of substance abuse and mental health.

One study of LGBTQ+ college students found that 36% experienced harassment in the past year, 20%  feared for their physical safety, 51% concealed their sexual orientation, and 20% feared for their personal safety[1].This discrimination has an undeniable impact on the mental health of victims. Another study found that LGBTQ+ students as young as the 9th grade were more likely to show symptoms of depression and suicidal ideation than their heterosexual classmates[2]. One in four transgender or transexual teenagers will attempt suicide at some point[3] and are at increased risk of sexual and/or physical violence over the course of their lives[4].

It is not just overt acts of violence that threaten those from an LGBTQ+ background; microaggressions such as using “gay” pejoratively or endorsing heteronormative culture are also linked to increased victimization, depression, anxiety, substance abuse, and suicide[5]. One study of men who identify as gay or bisexual found that they were at an increased risk of substance abuse[6]; it is safe to assume that this is applicable across the whole of the LGBTQ+ spectrum when we examine the stigma that individuals in the community face.

It is now widely recognized that trauma can have a lasting impact on the individual. The effects continue far beyond the event or events which provoked it, and it manifests itself as Post-Traumatic Stress Disorder (PTSD). The popular author and trauma-expert Bessel A van der Kolk refers to PTSD as, “intense emotions at the time of trauma initiating a long-term conditional response”[7]. It is estimated that 16% of children who experience trauma go on to develop PTSD[8], which increases the risk of substance abuse, depression, suicidal ideation, and anxiety[9].

The trauma of discrimination can cause many members of the LGBTQ+ community to internalize this homophobia.  Internalized homophobia is defined by researchers Meyer and Dean as, “the gay (or LGBTQ+) direction of negative social attitudes towards self.[10]” This can manifest itself in many ways, including depression, relationship problems[11], denial of sexuality, substance abuse, and suicidal ideation, amongst many other things[12].

Despite the discrimination members of the LGBTQ+ community face, they are actually more likely to seek institutional help for substance abuse[13]. Studies have found that LGBTQ+ -identified people associate a more “successful” treatment experience with counselors who are more sensitive to issues relating to sexuality[14]. There are multiple ways in which treatment providers who are not themselves member of the LGBTQ+ community can increase their sensitivity. For instance, there are many free training webinars through the Fenway Institute, and there is a free online manual from SAMHSA on providing treatment to LGBTQ+ individuals available online.

Researchers have proposed that connectedness to the LGBTQ+ community can be a key predictor in decreased risk of suicidal behavior for LGBTQ+ people[15]; this is potentially a mediating factor in the feelings of isolation that are precipitated by living in a homophobic society. This is hard to enact solely in a therapeutic environment, but it is still salient that practitioners are aware of this. In order to encourage this, counselors should be aware of local LGBTQ+ support groups and advocacy organizations.

There are many ways in which practitioners can approach the treatment of trauma and PTSD, although in the field of LGBTQ+ people it is especially important that we are aware of the additional challenges which victims of homophobic abuse may have faced throughout their lives. Cognitive Behavioral Therapy has been shown to benefit trauma survivors[16], as has mindfulness. One of the key components of mindfulness is to be more accepting of oneself. This could definitely help ameliorate internalized homophobia[17].

Everyone is entitled to recovery from trauma and to experience mental well-being. There are myriad other suggested ways in which trauma can be treated, ranging from Yoga to pharmaceutical intervention to group therapy and many more. This means that, as treatment providers, we must always make sure to meet our clients’ individual needs and seek to understand the causes that may have led them to where they are currently. To achieve the highest possible level of success, we must familiarize ourselves with the most effective treatment methods for each of the specific groups of people we help.





[1] “Statistics | Lesbian Gay Bisexual Transgender Center | Case Western Reserve University”. Lesbian Gay Bisexual Transgender Center | Case Western Reserve University, 2020, https://case.edu/lgbt/safe-zone/statistics.

[2] Almeida, Joanna et al. “Emotional Distress Among LGBT Youth: The Influence Of Perceived Discrimination Based On Sexual Orientation”. Journal Of Youth And Adolescence, vol 38, no. 7, 2009, pp. 1001-1014. Springer Science And Business Media LLC, doi:10.1007/s10964-009-9397-9. Accessed 26 Aug 2020.

[3] Di Ceglie, D., Freedman, D., McPherson, S., & Richardson, P. (2002). Children and adolescents referred to a specialist gender identity development service: Clinical features and demographic characteristics. International Journal of Transgenderism, 6(1), NP.

[4] Testa, R. J., Sciacca, L. M., Wang, F., Hendricks, M. L., Goldblum, P., Bradford, J., & Bongar, B. (2012). Effects of violence on transgender people. Professional Psychology: Research and Practice, 43(5), 452–459. https://doi.org/10.1037/a0029604

[5] Nadal, Kevin L. “That’s So Gay! Microaggressions And The Lesbian, Gay, Bisexual, And Transgender Community.”. 2013. American Psychological Association, doi:10.1037/14093-000. Accessed 26 Aug 2020.

[6] Ostrow, D.G. Stall, R. (2008) Alcohol, tobacco, and drug use among gay and bisexual men. In Wolitski, R.J., Stall, R., Valdiserri, R.O., Unequal Opportunity: Health Disparities Affecting Gay and Bisexual Men in the United States. New York: Oxford University Press.

[7] Kolk, Bessel. Body Keeps The Score Brain, Mind. Penguin Books, 2015, p. 1.

[8] Kolaitis, Gerasimos. “Trauma and post-traumatic stress disorder in children and adolescents.” European Journal of Psychotraumatology vol. 8,sup4 1351198. 29 Sep. 2017, doi:10.1080/20008198.2017.1351198

[9] Bremner, J Douglas. “Traumatic stress: effects on the brain.” Dialogues in clinical neuroscience vol. 8,4 (2006): 445-61.

[10] Meyer IH, Dean L. Internalized homophobia, intimacy, and sexual behaviour among gay and bisexual men. In: Herek GM, editor. Stigma and sexual orientation: Understanding prejudice against lesbians, gay men, and bisexuals. Thousand Oaks, CA: Sage Publications; 1998. pp. 160–186

[11] Frost, D. M., & Meyer, I. H. (2009). Internalized Homophobia and Relationship Quality among Lesbians, Gay Men, and Bisexuals. Journal of counselling psychology56(1), 97–109. https://doi.org/10.1037/a0012844

[12] “Internalised Homophobia”. Rainbow Project, 2020, https://www.rainbow-project.org/internalised-homophobia.

[13] Cochran BN, Cauce AM. Characteristics of lesbian, gay, bisexual, and transgender individuals entering substance abuse treatment. J Subst Abuse Treat. 2006;30(2):135-146. doi:10.1016/j.jsat.2005.11.009

[14] Matthews, Connie R., and Mary M. D. Selvidge. “Lesbian, Gay, And Bisexual Clients’ Experiences In Treatment For Addiction”. Journal Of Lesbian Studies, vol 9, no. 3, 2005, pp. 79-90. Informa UK Limited, doi:10.1300/j155v09n03_08. Accessed 26 Aug 2020.

[15] Kaniuka, Andrea et al. “Stigma And Suicide Risk Among The LGBTQ Population: Are Anxiety And Depression To Blame And Can Connectedness To The LGBTQ Community Help?”. Journal Of Gay & Lesbian Mental Health, vol 23, no. 2, 2019, pp. 205-220. Informa UK Limited, doi:10.1080/19359705.2018.1560385. Accessed 26 Aug 2020.

[16] Ehlers, Anke, and David Clark. “Early Psychological Interventions For Adult Survivors Of Trauma: A Review”. Biological Psychiatry, vol 53, no. 9, 2003, pp. 817-826. Elsevier BV, doi:10.1016/s0006-3223(02)01812-7. Accessed 26 Aug 2020.

[17] Follette, Victoria et al. “Mindfulness And Trauma: Implications For Treatment”. Journal Of Rational-Emotive & Cognitive-Behavior Therapy, vol 24, no. 1, 2006, pp. 45-61. Springer Science And Business Media LLC, doi:10.1007/s10942-006-0025-2. Accessed 10 Aug 2020.

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