Gender studies, Interviews, Politics & society, Social dimensions, Understanding self-injury

Understanding self-harm in LGBTQ+ people

Special thanks to Annie and Dimitri for sharing their story.

Prevalence

“I first self harmed when I was 12 years old. I’ve always used cutting as my method. It was the only thing able to quiet my mind and let me focus on a single thing (cleaning, the pain, taking care of the wounds, etc). My self-harm got worse as I got older and whilst this was for a multitude of reasons, one was that I was upset with myself that I had come out before I should have”, explains Annie*, 23, who came out to her family as bisexual before realizing she was lesbian and asexual. Annie is not an isolated case: like her, many LGBTQ+ people struggle with self-injury, and studies show they are more at risk of depression, anxiety, suicidal behaviors and non-suicidal self-injury (NSSI) than heterosexual or cisgender people1, 2.

But rates also differ within the LGBTQ+ community itself. The acronym refers to a great diversity of people, and includes different sexual orientations, that is to say to what gender someone is attracted to (lesbians, gays and bisexual) or how they experience this attraction (asexual, aromantic, for example); and whether someone identifies as a man, a woman, a mix or both, or none of them (transgender, queer, non-binary etc.). We can’t generalize the findings of one sexual orientation or gender identity to the community as a whole. Take suicide attempts for example, less than 5% of the general population have attempted suicide3, compared to 10-20% of lesbians, gays, and bisexual adults; and 40% of transgenders3. Rates of self-injury follow the same pattern. About 30% of sexual minorities, and 47% of gender minorities (transgenders and non-binaries), have self-injured, compared to 15% of heterosexual and/or cisgender4 people. 

Other factors are associated with NSSI. The following is a list of elements that can increase the risk of self-injury among LGBTQ+ people:

  • Being trans-man4, 5.
  • Being bisexual, and to a lesser extent people who question their orientation1, 4. Together, bisexual and questioning people are 2 times more likely to engage in NSSI than lesbians and gays6.
  • Being a teenager. Age is a strong indicator among sexual minorities, meaning that the difference between the prevalence of self-injury among non-heterosexual and heterosexual adolescents is much higher than the difference between non-heterosexual and heterosexual adults1, 4, 6
  • Being a woman2, 4 
  • Being from a racial minority or multiracial4
  • Having a low socioeconomic status4

Causes

“There are unique challenges that the LGBTQIA community face”, explains Annie. Yet, while LGBTQ+ people share similarities, they remain unique individuals. Each gender identity or sexual orientation also differs from one another, and reasons behind self-injury can also be diverse and should not be assumed. Some are specific to a sexual orientation or gender identity, and some are not.

Minority stress

Minority groups experience stigma, discrimination, violence, and rejection, which can affect their mental health and well-being. This is the minority stress theory. Minority stress can impact LGBTQ+ people in every area of their life, such as academic, professional, medical, and familial3, 4. Many LGBTQ+ youth face rejection by their own family and those who were abandoned or disowned make up 40% of homeless youth7. Dimitri*, a 23 year old (trans)man, recalls the difficulties he faced in being accepted by his family: “I started questioning in my early teens, and came out multiple times over the years due to my parents being military and eastern european, thus very non-accepting. I ultimately came out and stood my ground right before starting hormone replacement therapy a few years ago. It was very difficult to say the least”. This is particularly sad given the protective role family support can have. Transgender and gender-non conforming people who still have strong family relationships after coming out have a lower suicide rate3 for example.

Some sexual orientations also face stronger stigma. Bisexual people are more at risk of self-injury because of biphobia, which can lead them to being rejected both by heterosexual and homosexual people4. Annie also explains that “asexual and aromantic orientations […] are some of most likely to experience discrimination”, suggesting that other orientations that are lesser known could also experience stigma. Yet everyone’s experience is different. Dimitri doesn’t feel discriminated against for his aromanticism, for example. “I never came out as aromantic because it doesn’t really impact much and [my parents] never pressured me into dating”, he told me. This shows that while stats such as those about discrimination or self-injury can help better target those in need, we should keep in mind that everyone’s experience is different, and is shaped by many factors such as culture, past events, or families and friends. Stats about “who” suffers should also not be used as a way to get around asking “why” they suffer and “how” can we reduce stigma in our society.

Society’s lack of acceptance can also lead to internalized homophobia or transphobia, and expected rejection. Some people for example might not come out from fear of discrimination or disappointing their parents6 and secrecy can prevent someone from experiencing stigma. When I asked Dimitri about whether he suffered from discrimination because of his gender identity, he told me he didn’t. “I keep to myself generally so not really, but if I were more social and open about the fact that I am trans most probably. Eastern Europe isn’t the friendliest place to be open about anything, not that I mind.” Annie’s experience is rather similar: “I currently don’t suffer from stigma or discrimination but that’s because I have the protection of the closet. No one in real life knows about my gender and sexual identity”, she explains.

Mental health issues

LGBTQ+ people who injure themselves may also face double stigma, as mental health is still heavily stigmatized, even among heterosexual cisgender people. Annie points out that mental health issues should not be ignored among the LGBTQ+ community. “There is a higher rate of neurodivergence amongst LGBTQIA people, I myself have ADHD and likely have ASD, which adds extra challenges”. It is important to take into account mental health struggles as they can have tragic consequences. 65% of trans with mental health conditions that affect major life activities attempt suicide (way above the already high 40% average of suicide attempts among trans)3. But we should be careful about not getting sexual orientation or gender identity mixed up with mental disorders. Homosexuality and gender non-conformity are still considered an illness by many people, who might assume that self-injury is another symptom of this illness, or that LBTQ+ people are emotionally weak8. Homosexuality was even included as a “sexual deviation” in the DSM until 19739. Annie experienced the stigma around LGBTQ+ being perceived as a disease, which led her to keep her asexuality hidden. “I’m an asexual lesbian. I’m comfortable and happy with this identity however I haven’t told anyone in real life. I’m scared of the judgement as asexuality is very misunderstood and I’m scared of perpetuating the stereotype that all bisexual people are confused.”

Dealing with identity stress

“I knew I was “different” when I was around 5 years old. I had my first crush on another girl when I was 8. I initially thought I was bisexual when I was 11 and maintained that identity until I was around 18,” remembers Annie. “I came out at 16 to my mum via a letter and then to my sister when I was 17 during a conversation. It was hard for me to come out because, at the time, I didn’t realise that I was coming out as the wrong thing. I thought the nervousness I was feeling was just “coming out” nerves.” Discovering and exploring a gender identity or sexual orientation can be stressful, especially when it is experienced as a “difference”. People who are questioning may be more at risk of self-injury because of stress related to their identity6. But Annie’s case also shows that better understanding your sexual orientation can help relieve that stress. She explains: “I never felt sexual attraction but I was told all my life that I was a “late bloomer” and would find the “right one” however once I reached 18 and had yet to desire a sexual relationship with anyone, I started to think that I might be asexual. I found an asexual subreddit and it was mind blowing. I’ve identified as asexual since then. Since finding out that my asexual, as well as other reasons, my self harm has reduced quite significantly.” Transitioning can also improve the mental health and social life of transgenders, but while their suicide risk is reduced post-transition, it remains higher than that of cisgender people3, 5. Therefore, unfortunately, coming out or transitioning doesn’t always improve people’s mental health. “My identity and coming outs had little to no contribution to this,” explains Dimitri.

Some forms of self-injury are specific to transgender people, as it can be used as an attempt to reduce gender dysphoria, as a form of distraction or by harming body parts that are considered incompatible with the identified gender2. Self-injury can also be a way to reappropriate the body and to identify with it2. 

Distress not related to being LGBTQ+

But it is important not to assume the reasons behind someone’s self-injury, as it is not always related to their gender identity or sexual orientation2. Annie started cutting at the age of 12 to quiet her mind. “I also believed that I deserved to be hurt due to childhood trauma, unrelated to my gender and sexuality”. Similarly, gender identity was not a reason for self-injury for Dimitri: “I wouldn’t say my self-harm is related to my experience as a LGBT person, no. Maybe aside from the aspect of weight loss resulting in less chest dysphoria, but I wouldn’t call that self-harm related necessarily.” Dimitri’s strict upbringing was difficult both as a trans-man but also simply as a teenager. “My self-injurious behavior started around 9 if I remember correctly, hitting initially, then cutting around 11 but I quit it quickly because I couldn’t afford my parents finding out”, he explains. “At first it was used to blunt emotions or stop racing thoughts because I was expected to not display any strong emotion and to not have any behaviour, thought or opinion they disapproved of. It was a way to force myself into that headspace in emergency situations. Through the years I also started undereating as a way of self-harm, developed celiac due to stress, started cutting again at 18 as I lived alone, then moved to also consuming gluten intentionally.” 

Positivity

Just as self-injury isn’t always related to being LGBTQ+, being LGBTQ+ doesn’t necessarily mean struggling with loneliness, rejection and mental health issues. As the self-harm support organization Make Space explained in a report published in 2021: “Being queer is not inherently difficult. […] Making queerness something that is only ever bad or sad denies the nuance, complexity, and joy of queerness”8. This feeling is shared by zine creator sarah tea-rex, who wrote in her zine “Out of Order”10: “I was gathering research on queer and trans youth and all the rhetoric confined our lives to that of victims. It was all about how we’re more likely to experience depression, drug abuse, self-harm, bullying, homelessness, and feel like there’s nobody out there for us to turn to. […] The research doesn’t speak to how I found community, how my friends became an intimate family of trust and support, how we formed a Gay-Straight Alliance to raise awareness”. For many LGBTQ+ people, art and creativity can be a way to express themselves and create a sense of community. While we need to help people when they experience struggle, discrimination and mental health issues, we shouldn’t reduce people to their struggle. Just like someone who struggles with self-injury is not merely a “cutter”. They are an individual, with interests, opinions, passions, experiences, and who happen to cut at a difficult time in their life. Truly being there for someone means being there for better or for worse. Being there for only the good times would be opportunistic, while being there only for the bad times could be an attempt to seem morally virtuous.

If you are experiencing difficulties with your mental health and would like resources and support specifically crafted for LGBTQ+ people, you’ll find below a list of organizations. Each of these organizations have been individually selected and are supported by local or national public institutions.

  • AUSTRALIA: Twenty10 offers support, training, and organizes events for LGBTQ+ people. They welcome Aboriginal people.
  • CANADA: LGBT Youthline provides phone and chat peer support for 2SLGBTQ+ people (supports two-spirit Native Americans).
  • FRANCE: SOS homophobie is an organization dedicated to promote the rights of LGBT people. They offer phone and chat support.
  • IRELAND: LGBT Ireland has two helplines, one for LGBT people and one dedicated to the family of a transgender person. They also offer chat support and online peer support groups. Belong To provides resources to 10-24 LGBTQ+ people and supports youth groups.
  • NEW ZEALAND: OutLine is a mental health organization which provides phone and chat support with trained volunteers from the LGBTQ+ community. They offer support for indigenous / Māori people (takatāpui and fa’afafine).
  • UNITED STATES: The Trevor Project is a suicide prevention organization for LGBTQ+ young people. They offer 24/7 support, whether by chat or phone call.
  • UNITED KINGDOM: MindOut, a LGBTQ mental health service which provides resources and online support. The LGBT Foundation offers a helpline everyday.

*The names of the interviewees have been replaced by pseudonyms to preserve their anonymity.

References

[1] Batejan, K. L., Jarvi, S. M., & Swenson, L. P. (2015). Sexual orientation and non-suicidal self-injury: a meta-analytic review. Archives of Suicide Research, 19(2), 131-150. https://doi.org/10.1080/13811118.2014.957450

[2] Morris, E. R., & Galupo, M. P. (2019). “Attempting to dull the dysphoria”: Nonsuicidal self-injury among transgender individuals. Psychology of Sexual Orientation and Gender Diversity, 6(3), 296–307. https://psycnet.apa.org/doi/10.1037/sgd0000327

[3] Haas, A. P., Rodgers, P. L., & Herman, J. L. (2014). Suicide Attempts among Transgender and Gender Non-Conforming Adults. https://williamsinstitute.law.ucla.edu/wp-content/uploads/Trans-GNC-Suicide-Attempts-Jan-2014.pdf

[4] Liu, R. T., Sheehan, A. E., Walsh, R. F. L., Sanzari, C. M., Cheek, S. M., & Hernandez, E. M. (2019). Prevalence and correlates of non-suicidal self-injury among lesbian, gay, bisexual, and transgender individuals: A systematic review and meta-analysis. Clin Psychol Rev., 74. https://doi.org/10.1016%2Fj.cpr.2019.101783

[5] Marshall, E., Claes, L., Bouman, W. P., Witcomb, G. L., & Arcelus, J. (2016). Non-suicidal self-injury and suicidality in trans people: A systematic review of the literature. International Review of Psychiatry, 28(1), 58-69. https://doi.org/10.3109/09540261.2015.1073143

[6] Fraser, G., Wilson, M. S., Garisch, J. A., Robinson, K., Brocklesby, M., Kingi, T., O’Connell, A., & Russell, L. (2018). Non-Suicidal Self-Injury, Sexuality Concerns, and Emotion Regulation among Sexually Diverse Adolescents: A Multiple Mediation Analysis. Archives of suicide research, 22(3), 432-452. https://doi.org/10.1080/13811118.2017.1358224

[7] Reddy, N., Silver, C., & Whitlock, J. (2016). The Relationship between NSSI and LGBTQ Identities. Cornell University. https://www.selfinjury.bctr.cornell.edu/perch/resources/the-relationship-between-nssi-and-lgbtq-identities.pdf

[8] Make Space. (2021). Support and Solidarity: Supporting LGBTQ+ People with Experience of Self-Harm. https://static1.squarespace.com/static/5fa28350d56dca07ddad836a/t/62697eb68ec65809d4044670/1651080887578/Support+and+Solidarity+%E2%80%94+Make+Space+%E2%80%94+July+2021.pdf

[9] Drescher, J. (2015). Out of DSM: Depathologizing Homosexuality. Behavioral Sciences, 5(4), 565–575. https://doi.org/10.3390%2Fbs5040565

[10] tea-rex, s. (2009). Out of Order: Queer and Trans Youth Resistance. https://sarahtearex.wordpress.com/zines/out-of-order/