Coming out of the closet is one of the most significant and personal milestones in the life of a member of the LGBTQIA+ community.
For many, coming out can be an empowering experience. For others, it can be a painful process, shaped by rejection, loss of relationships, harassment, or violence.
Compared to previous decades, more people are coming out as LGBTQIA+. and they’re doing it at younger ages. The percentage of adults who identify as LGBTQIA+ doubled from 3.5% in 2012 to 7.6% in 2023. And while youth historically came out as gay in their early to mid-20s, the median age is now 17.
LGBTQIA+ individuals may have more confidence in living their truth, but for many the stigma, political backlash, and discrimination they face continues to undermine and threaten their mental health.
The process of coming out of the closet is rarely linear, but ultimately, it can be an important first step toward living an authentic life.
Understanding the origins of LGBTQIA+ identity
For a species driven to reproduce, theories abound on why same-sex attraction persists among human societies and throughout the animal kingdom.
One leading theory suggests that the same genetic factors linked to same-sex attraction may increase the likelihood of heterosexual relatives having more children. For example, a large-scale study in 2018 found that women who are related to gay men often have more children than average.
The first recorded depiction of same-sex intimacy dates back to Mesolithic rock art dating back to 9600 BCE that shows paired men in intimate poses. Written accounts of same-sex relationships appeared in Egypt more than 4,400 years ago.
However, the modern concept of “being gay” as a core identity didn’t emerge until the late 19th century.
The introduction of anti-sodomy laws in Germany prompted significant public and scientific debate about same-sex attraction. The rise of sexology, an interdisciplinary field, prompted researchers to study whether sexuality was not just a behavior but part of a person’s identity.
At the same time, the theory that same-sex attraction was a mental disorder also took hold. Conversion therapy — which began in the late 19th century and became widespread in the 20th — used methods such as hypnosis, electric shocks, and nausea-inducing drugs to try to create negative associations with same-sex attraction.
This harmful practice was discredited after 1973, when the American Psychiatric Association stopped including homosexuality in its list of mental disorders. Since then, mounting evidence has shown that conversion therapy is ineffective and usually does more harm than good.
In the early 1990s, the idea that there is a “gay gene” was introduced in a landmark study that found a link between a genetic marker on the X chromosome and male homosexuality in some families.
However, this finding could not be consistently replicated and a major genetic analysis in 2019 confirmed that there are no single “gay” or “straight” genes. Rather, sexual orientation is shaped by hundreds, even thousands of genetic variants as well as environmental and social factors.
This begs the question: if sexuality were a choice, why would biology play any role at all?
The impacts of staying in the closet
Sometimes, it can feel easier to stay concealed than come out as gay to family members, coworkers, and friends. While coming out of the closet can be a powerful and affirming experience, it also carries significant risks in how individuals are perceived by those around them.
- Rejection, loss of relationships, or social isolation
- Harassment and discrimination at home, school, or work
- Loss of financial or housing support, especially for gay youth
- Exposure to threats, violence, or abuse
LGBTQIA+ people in the US are five times more likely to experience violence, including rape and sexual assault, than non-LGBTQIA+ people. Black lesbians and transgender women of color face the highest rates of fatal violence.
Gay youth are particularly vulnerable when coming out. More than half of LGBTQIA+ middle or high school students experience bullying, and they are 120% more likely to experience homelessness than their non-LGBTQIA+ peers.
Living a life of concealment, however, can result in a number of psychological tolls that can impact an individual’s mental and physical health.
- Chronic stress and anxiety: Living in a hypervigilant state of fear of being discovered as gay can lead to anxiety, difficulty, relaxing, and even symptoms of post-traumatic stress disorder (PTSD.)
- Depression and low self-esteem: Internalizing negative societal attitudes can result in feelings of shame and self-loathing.
- Social isolation: Keeping personal information from friends, family, and colleagues can lead to loneliness and sense of disconnection from others.
- Internalized stigma: Repeatedly suppressing one’s identity can make it harder to accept oneself and increase psychological distress.
- Impaired self-expression: Living an inauthentic life is linked to poorer mental health outcomes.
Individuals who conceal their sexual identities are at higher risk for depression, anxiety, and substance use disorders. Plus, they are at an increased risk of suicidal thoughts and behaviors.
Navigating coming out of the closet
Coming out of the closet is a metaphor to describe revealing one’s true self to others. It is typically a gradual process that unfolds over time and often in stages. While everyone’s experience is unique, key phases of coming out can include:
- Self-recognition and identity confusion: Individuals begin to question or suppress their sexual orientation or gender identity, stirring up feelings of confusion, denial, or anxiety.
- Identity comparison and tolerance: While they may start to accept the possibility that they are gay, they may also grapple with social isolation as they realize they are different from peers or family.
- Identity acceptance: They may grow more comfortable with their identity as they seek out information, support, and community resources.
- Disclosure to others: This can be gradual as positive and negative reactions from individual people either encourage further self-expression or prompt a hasty retreat.
- Socialization and community: Connecting with other LGBTQIA+ people may give them a sense of belonging and pride.
- Positive self-identification and integration: The feeling of living more authentically allows them to live openly to form relationships and support others in their community.
Supporting mental health during and after coming out of the closet
While the coming out process can be potentially affirming, it can also be a period marked by significant psychological distress.
For many LGBTQIA+ individuals, finding community is essential to navigating the often difficult journey of coming out. Common support networks and techniques include:
- Family, friends, and allies who show unconditional support and advocacy
- LBTQIA+ peer support groups, such as the LGBT National Help Center
- Participating in Pride events, advocacy, or volunteering
Sometimes, however, persistent feelings of sadness, excess fear, and traumatic symptoms can interfere with daily functioning and increase the risk of self-harm or suicidal ideation.
Other warning signs that it’s time to seek professional help include intense mood swings, withdrawing from friends and family, changes in sleep or appetite, or using alcohol or drugs to cope.
Clinicians trained in LGBTQIA+ care can provide a safe and supportive space to heal. Evidence-based treatment options include:
- Therapy: Modalities like cognitive-behavioral therapy and trauma-informed approaches can be effective in managing symptoms of depression, anxiety, and PTSD.
- Medication management: Antidepressants can manage symptoms of moderate to severe depression or anxiety.
- Transcranial magnetic stimulation (TMS): A non-invasive, FDA-cleared treatment for major depressive disorder that uses magnetic fields to stimulate underactive brain cells.
- Spravato® (esketamine): A nasal spray medication that can provide rapid symptom relief for adults with treatment-resistant depression.
Key Takeaways
- The coming out process is complex and deeply personal. It unfolds in stages and is shaped by unique social, cultural, and familial factors.
- Concealment or staying in the closet carries significant mental health risks that can lead to chronic stress, anxiety, depression, low self-esteem, social isolation, and a higher risk of substance use and suicidal ideation.
- Coming out can expose individuals to elevated risks of bullying, homelessness, violence, and discrimination.
- Mental health support is crucial during and after coming out. These include therapy, medication, and advanced treatments like TMS and Spravato.
Looking for mental health care services near you?
Pacific Mind Health offers medication management, therapy, and interventional treatments like transcranial magnetic stimulation (TMS) and Spravato (esketamine) at our Los Angeles offices. Our experienced clinicians provide compassionate, evidence-based care to help you feel better.
Ready to take the next step? Schedule a consultation and start your mental health journey today.
