Living With Social Anxiety Disorder as an LGBTQ Person

Living as an LGBTQ person with social anxiety can be difficult.
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People who are LGBTQ (lesbian, gay, bisexual, transgendered, queer [sometimes labeled "questioning"]) may be at increased risk for social anxiety disorder (SAD) because of the social context in which they develop.

Heterosexual or cisgender individuals (those whose sense of personal identity and gender matches their birth sex) grow up in an environment that is generally accepting of their relationships.

This is often not the case for LGBTQ, who may face prejudice or stigma for doing things others take for granted, such as holding hands or showing affection.

The need to monitor oneself in social situations among LGBTQ sets the stage for the development of social anxiety disorder in individuals who may already be predisposed due to genetics or other environmental factors. Indeed, we know that between 30 and 60 percent of LGBTQ live with anxiety and depression at some point in their lives, and they are 1.5 to 2.5 times at higher risk for these disorders than heterosexual or cisgender individuals.

Development of SAD in LGBTQ

Growing up LGBTQ you probably saw few examples in your culture of how to form a relationship that was relevant to you. In its simplest terms, it's a bit like growing up left-handed in a right-handed world. In more serious terms, it can involve outright violence or hate crimes.

As a result, you learn to read each situation and determine how safe it is to be yourself. This is a natural response to persistent exposure to prejudice and discrimination, but it can lead to shame and anxiety.

The Social Context

Of importance, as well, is the fact that SAD tends to develop in the teenage years, the same time at which LGBTQ may be first encountering shame and ridicule about who they are.

Over time, these external messages may become internalized and shape how you think about yourself. If the outside world is full of negative messages about who you are, eventually you may see yourself as unlovable and flawed. This experience can have powerful long-lasting negative effects on your mental health.

Causes of Social Anxiety in LGBTQ

What is the cause of social anxiety disorder in LGBTQ? While the same factors play a role in the development of SAD as they do in heterosexual/cisgender individuals, the social context in which LGBTQ develop can be a trigger for worsening social anxiety.

As an LGBTQ you may be raised in a world that does not seem to welcome you, and over time, you may find yourself internalizing that message. The development of a core belief that you are not a worthwhile person may then be in part the result of something called minority stress.

Minority stress refers to chronic high levels of stress experienced by groups against whom there is stigma, discrimination, prejudice, and in this case homophobia or transphobia. You may face overt aggression or subtle hints that you are not approved of if you reveal your LGBTQ status. In this way, you learn to stay silent about a part of yourself, which can lead to increased anxiety.

Other Causes

Of course, LGBTQ persons are also at risk for SAD due to the same genetic and environmental factors as the general population. Your predisposition to anxiety due to your heredity, your upbringing, and your early experiences unrelated to LGBTQ status all make it more likely that you will be diagnosed with SAD.

Seeking Help for SAD as an LGBTQ

As an LGBTQ with social anxiety, you may have trouble admitting you need help. It may be doubly hard to approach your doctor, both because your social anxiety makes it hard for you to talk to people and because you feel as though you may be discriminated against for being LGBTQ.

In this way, you may be "coming out to your doctor" in more ways than one—a situation that may just feel too difficult. 

Self-Help

If talking to your doctor feels too hard right now, consider what you can do on your own first to build up confidence, such as joining a support group or trying out a self-help book or online course. LGBTQ with a healthy self-image are less likely to be impacted by minority stress, so it is important that you work on that deep-rooted core belief that you are socially inept or unworthy. While it may feel difficult, building up your confidence will be the first step toward getting help.

Medication

In cases of severe social anxiety, your doctor may prescribe medication such as a selective serotonin reuptake inhibitor (SSRI). Medication is generally used over a prescribed period as a way to jump-start you toward lowering your anxiety. Medication is generally most effective when it is combined with some sort of cognitive work, such as cognitive-behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for social anxiety.

Therapy

CBT for SAD involves identifying core beliefs that cause negative thoughts. By changing the patterns of your thoughts, you learn to see situations in a more realistic manner. If you are going to take part in therapy, it is important to find a therapist who will be supportive of you as an LGBTQ person and understands the context in which you live, as well as one who understands social anxiety disorder specifically. While this might sound like a tall order, there are therapists who fit these criteria.

Trouble may appear if you don't feel safe with your therapist. While it's true there are still some therapists who view LGBTQ as a mental illness to be cured, they are becoming less common. Talk to your therapist about how your experience of anxiety may be different as an LGBTQ person and make sure there is a good fit before agreeing to begin therapy.

Risk for Other Problems

If you are LGBTQ with social anxiety disorder, you are also at risk for other problems such as substance abuse. In particular, research showed that lesbian women were more likely than their heterosexual peers to develop substance abuse. Some LGBTQ may also cope in unhelpful ways, such as by engaging in risky sexual activities as a way to manage problems in developing relationships or to avoid facing difficult feelings. If you're LGBTQ with SAD, it's important to seek help early to avoid developing other related problems.

Helping LGBTQ People With SAD

Think of that person just as you would any other person with social anxiety disorder. Tell that person that you love and appreciate them just as they are. You can also help by finding resources for your friend or family member, such as support groups, group therapy, or self-help resources. Also—don't ignore a person's request to be called by a certain name or referred to in a certain way. What might seem like a small thing to you may very well be a large part of that person accepting their identity.

Recognize that the act of disclosing one's status as LGBTQ to family and friends may cause anxiety, particularly among those already living with SAD. Use inclusive language and be open and friendly to show your support to your friend or family member, so that they know you are a person in whom they can confide.

A Word From Verywell

Social anxiety relates to how you think other people see you. It makes you self-conscious. Being LGBTQ also makes you prone to social anxiety out of the fear you will be judged by others. If you are LGBTQ living with social anxiety, find someone you trust to reach out to for help. As your confidence grows and your anxiety is reduced, see how you might give back by working to reduce stigma or help others in your community.

Sources:

Anxiety and Depression Association of America. Understanding Anxiety and Depression for LGBTQ People.

Sweet, Matt. ​Depression and Anxiety in LGBTQ People: What You Need to Know.

Bolton S-L, Sareen J. Sexual orientation and its relation to mental disorders and suicide attempts: Findings from a nationally representative sample. Can J Psychiatr. 56(1): 35-43.

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