Sexual Orientation and Mental Health: Examining Identity and Development in Lesbian, Gay, and Bisexual People


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Book’s findings are relevant for practicing psychologists
(April 2007 Issue)

"Sexual Orientation and Mental Health:
Examining Identity and Development in Lesbian, Gay, and Bisexual People"
Edited by Allen M. Omoto and
Howard S. Kurtzman
American Psychological Association
Washington, D.C., 2006

By Paul Efthim, Ph.D.

If we take recent research at face value, it looks like we've been getting sexual identity development all wrong.

Consider the following data reported by psychologist Lisa Diamond in a new book on lesbian, gay and bisexual (LGB) populations:

An increasing number of youth and adults, when asked about their sexual orientation, describe themselves as "questioning" or refuse to accept identity labels such as heterosexual, homosexual, or bisexual.
Women who resist labeling their sexual orientation appear just as psychologically healthy as openly identified lesbians and bisexual women.
During the course of an eight-year longitudinal study, 70% of adult women who initially self-identified as non-heterosexual report changing their labeled sexual orientation at least once more after "coming out."

These findings do not mesh smoothly with prevailing ideas about sexual orientation for lesbian, gay, and bisexual individuals. Most stage theories of sexual identity development portray a normative process that begins with initial confusion about one's sexuality and eventually concludes with clarity as one consolidates and claims an identity. However, as Diamond points out, for many women "coming out may be just the beginning of a longer series of ongoing reevaluations and realignments." Sexual questioning, she argues, does not end once you identify as lesbian, gay or bisexual.

Diamond's data also appears to dispute another belief: that it's better to have a sexual identity label than not. Typically, ambivalence about adopting a gay, lesbian or bisexual label is seen as a sign of maladjustment, perhaps due to shame, social pressure or denial. However, the women in Diamond's sample who refuse to categorize themselves as LGB do not look any worse than the labelers on measures of psychological adjustment. This finding, of course, calls for further study and replication. But it is a powerful argument for reexamining the entire concept of sexual orientation to allow more space for fluid and unlabeled identities.

These provocative findings are housed in a larger volume, "Sexual Orientation and Mental Health," ably edited by research psychologists Allen Omoto and Howard Kurtzman. The book's 14 chapters report on a broad range of topics related to LGB youth and adults including sexual behavior, the links between psychosocial processes and health, the unique experiences of LGB ethnic minority groups, the role of religion, work satisfaction and the well-being of children of same-sex couples.

Several findings are particularly relevant for practicing psychologists:

LGB youth are reporting awareness of same-sex attraction feelings at earlier ages now (average age of 10 for boys, 11 for girls), compared to older cohorts (average age 13 or older).
As a result, these youth may be spending more years "in the closet" concealing their self-identification from others.
LGB teenagers are more likely to become pregnant or father a pregnancy than heterosexual peers.
In a recent sample, gay men were five times more likely than straight men to report having attempted suicide at some point in their lifetimes.
Compared to gay men who are "out," gay men who concealed their orientation were found to be at increased risk for accelerated HIV/AIDS disease progression, cancer and other diseases.

The contributors go beyond merely reporting their data by placing it in the context of recent research and offer policy recommendations and directions for further research. Each chapter is well-written and methodologically rigorous.

This book does not offer a comprehensive overview of sexual orientation theories nor does it give much direct guidance for psychotherapy practice. Practitioners would do well to seek out additional books that are more clinically-oriented. However, this fine research compendium is recommended for scholars interested in research on sexuality, policymakers and for practitioners who are interested in strengthening their research base.

Paul Efthim, Ph.D. is a licensed psychologist in full-time practice in Brookline, Mass. He holds a faculty appointment at the Massachusetts School of Professional Psychology.