Patients identifying as LGBTQ are over-represented in mental health services. They also face many psychosexual and relationship difficulties, disrupted attachments and sexual shame. This is partly due to two major factors: non-existent same-sex sex education, and the LGBTQ community being ostracised, in the past and also in the present day.
The LGBTQ community history is filled with trauma: homosexuality was once a mental disorder and illegal in some countries. The HIV/AIDS epidemic added to the community trauma history. And today, we are observing a new epidemic of Chemsex which is a symptom internalised homo-negativity festering in many patient’s subconscious.
The LGBTQ community is very diverse in terms of their self-identified sexuality, sexual practices and relationship systems. Presentations also vary according to where the patient lives: some countries and cities offer more opportunities for a thriving LGBTQ sexuality and relationships than others.
Clinicians need to employ a multi-faceted approach with robust understanding of the psychosocial, psychological, psychosexual, relationship, cultural and sub-cultural elements of the patient’s presentations.