Psychiatric disorders and risky sexual behaviour

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7278.111/a (Published 13 January 2001) Cite this as: BMJ 2001;322:111

Paper did not mention sexual orientation

  1. Peter Meacher (pmeacher{at}montefiore.org), family physician
  1. South Bronx Health Center for Children and Families, 871 Prospect Avenue, Bronx, NY 10459, USA
  2. Springburn Health Centre, Glasgow G21 1TR

    EDITOR—The paper by Ramrakha et al on risky sexual behaviour in young adults did not mention sexual orientation.1 It met its stated objective but would have had a much greater impact if it had included a discussion of sexual orientation.

    Lesbian, gay, and bisexual adolescents face tremendous challenges growing up in a culture that is almost uniformly antihomosexual. They face an increased risk of medical and psychosocial problems that are not caused by their sexual orientation but by society's negative reaction to it. In response to the external pressure and isolation they often face, lesbian and gay young people are more vulnerable than others to psychosocial problems including substance abuse, depression, failure at school, early relationship conflicts, and homelessness. They are three times more likely to attempt suicide than heterosexual young people. One in four young adults living on the streets of the United States identify themselves as lesbian, gay, bisexual, or transsexual.2 A survey conducted at the Hetrick-Martin Institute in New York city found that among those young gay men rejected by their families, 44% had suicidal ideation, and 41% of the lesbians and 34% of the gay male youth had attempted suicide.

    Lesbian and gay young adults have few positive role models. Internalised homophobia can be considered a major stressor for these young people. It is compounded by stigma, which relates to expectations of rejection and discrimination, and by actual experiences of discrimination and violence. These three factors have been shown to have a significant independent association with various mental health measures.3

    It is estimated that 33-52% of gay and bisexual youth have had unprotected sexual intercourse within the past 6 to 12 months, and recent studies in New York and elsewhere suggest that higher risk sex is increasing among gay male youth. Finally, even governmental organisations in the United States are acknowledging that the lesbian and gay community has unmet healthcare needs.4

    I work as a family physician in the South Bronx, a community with some of the highest rates of HIV infection in the United States, and I am the director of a non-profit community activist group advocating improved access to quality care for the local lesbian, gay, bisexual, and transsexual population. The major barrier to such access is the real or perceived homophobia of the healthcare system propagated by physicians and staff who at best ignore and dismiss the lesbian, gay, bisexual, and transsexual community in research and practice. Sexual orientation, identity, and behaviour must be included in any research looking at risky sexual behaviour in young adults.


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    Risky sexual behaviour is part of two disorders examined

    1. Peter von Kaehne (vkaehne{at}doctors.org.uk), general practitioner
    1. South Bronx Health Center for Children and Families, 871 Prospect Avenue, Bronx, NY 10459, USA
    2. Springburn Health Centre, Glasgow G21 1TR

      EDITOR—I have read the article of Ramrakha et al,1 but I am perplexed by it. According to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, criteria for a manic episode include, under B (6), an increase in goal directed (sexual) behaviour, under B (7), excessive involvement in pleasurable activities that have a high potential for painful consequences, including sexual indiscretions. Criteria for hypomanic episodes are similar. The criteria for “301.7 Antisocial Personality Disorder” include, under A (5), reckless disregard for the safety of self or others.

      An increased incidence of sexual promiscuous and risk taking behaviour are therefore not only expected but actually the main diagnostic criteria for two of the examined conditions.


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