Bisexual Mental Health

By Fiona Watson, RCPsych Library and Archives Manager and Dr Mike Smith, CT2 Psychiatry

As part of our celebrations around Pride Month we would like to draw your attention to one of the less well-known mental health concerns in the LBGTQIA community: bisexual mental health. For reasons that have yet to be satisfactorily explained, many studies show that bisexual people suffer from worse mental health than lesbian and gay communities, although the discrepancy is still not as marked as it is for trans people. 

This blog post attempts to briefly summarise some useful information around bisexual mental health. We will discuss bisexuality and then move on to the specific issues that face bisexual communities and may be causing some of the mental health problems. Lastly, we will try to offer some suggestions, for concrete actions, we can all take to help. 

On a personal note 

This is a subject we both feel strongly about and we have seen the high prevalence of mental health issues in our bisexual friends, loved ones and wider communities. Some of the themes we’ll talk about further on, such as the likelihood of bisexual people to be ‘out’ to those around them, is played out in our own stories: 

Fiona: I knew I was bisexual from the age of 14 but didn’t come out to my (perfectly accepting) family until I was in my late twenties. I have marched in the London Pride parade twice but have struggled to come out in my workplaces. Not because I think I will face more serious discrimination than the occasional microaggression but because as a bisexual person dating someone of the opposite sex, people assume you are heterosexual. It is difficult to correct that point of view without seeming like you are oversharing. I have also hidden my bisexuality in predominantly lesbian groups out of (likely unfounded) fear of facing biphobia.  

Mike: It took me until my mid-twenties to come to accept that I was bi, for a variety of reasons including experiences of homophobia whilst growing up. I’ve been fortunate enough to have a supportive group of bi friends and a generally positive response to coming out from friends and loved ones outside that group. Like many bi people I’ve encountered delegitimising viewpoints about my sexuality; either that I was “actually” gay or that my attraction to men was something that needed to be “fixed”, as one former friend took it upon himself to try to do.  

How many people are bisexual? 

This really depends on what you mean by “bisexual”, as sexual orientation comprises identity, attraction and behaviour and some may have related but different identities such as pansexual, omnisexual or queer. The statistics are different depending on the definition used: 

From these stats we can see that people who define themselves as bisexual are actually a minority of those that experience attraction to more than one gender. If you experienced attraction to only one member of the same (or opposite gender) in your lifetime would you define yourself as bisexual? If not, how many would it take? What about if you were attracted to more than one gender but it never progressed to a relationship? Considering these questions can help you understand why some people struggle to formulate and communicate their sexual identity. 

Being ‘out’ 

Studies show that bisexual people are also much less likely to be ‘out’ to those around them. 75% of gay and lesbian adults say all or most of the important people in their lives are aware of their sexual orientation and only 4% are not “out” to any of the important people in their lives. In comparison, only 19% of bisexual people said they were out to the important people in their lives and 54% are out to some or only a few people. You can read about the research on the Pew Research Center website. 

These issues around deciding how to identify and what to tell those around you about your sexuality may feed into the mental health issues bisexual people experience.  

Bisexual mental health 

We know that people who identify as non-heterosexual are at higher risk of mental health difficulties compared to heterosexual people, as shown in a 2016 meta-analysis of 12 UK population health surveys. 

But what about bisexuals specifically? Much early research missed out bisexual individuals, by either pooling with other sexual minorities, or by classifying them as homosexual or heterosexual based on the gender of their current partner and this has only recently begun to change. 

What we do have from research is that this is a group with a greater than average burden of mental health issues. Bisexuals have a higher risk of depression, anxiety, eating disorders,  suicidality and substance use compared both to the general population, and to lesbian or gay individuals.  

Possible reasons  

Whilst lesbian, gay and bisexual people will have many shared experiences, it is worth considering the ways in which being bi is different. Some of the most common points of discussion in bisexual communities are bisexual erasure, bisexual privilege and biphobia 

Bisexual erasure is defined as ‘the tendency to ignore, remove, falsify, or reexplain evidence of bisexuality in history, academia, the news media, and other primary sources. In its most extreme form, bisexual erasure can include the belief that bisexuality itself does not exist’. This idea is often justified by the belief that bisexuality is a phase and people will eventually settle as either heterosexual or homosexual. A 2017 Stonewall report found that three in four bisexual school pupils had never been taught about bisexuality 

Bisexual privilege is the idea that bisexual people have the option to avoid the stigma associated with same sex attraction by ignoring it and pursuing fulfilling relationships with the opposite sex. They do not have to accept the fact that every time in their life they act as a couple in public they will be outing themselves and potentially facing discrimination. On the other hand, “passing” as heterosexual in this way can come at the cost of erasing their own identity and so is a double-edged sword. 

Bisexuality carries stigma (biphobia) in both heterosexual and lesbian or gay communities. This includes negative stereotypes of bisexual people as, for instance, hypersexual, disregarding their sexuality in favour of believing they simply wish to be more promiscuous. They are also seen as less likely to remain loyal in a relationship because they unable to find fulfillment with a partner of only one of the genders they feel attraction for. Surveys have suggested that public attitudes towards bisexuals are more negative than towards lesbian or gay people. However, happily this is shifting to become more positive over time, in line with public perception of homosexuality more generally, at least in the US, where much of the relevant research has been conducted.  

Studies show that this discrimination is linked to poor mental health outcomes. Scores on a tool designed to look at bi-specific forms of discrimination, the Anti-Bisexual Experiences Scale, have been shown to relate to mental health outcomes. 

 Bisexual individuals may also experience  internalised biphobia, shame and identity uncertainty stemming from exposure to wider cultural attitudes. They can feel isolated, not gay enough to be comfortable in LGBT communities and yet not belonging to mainstream culture either.  Research around acculturation has shown those who split their allegiance between cultures or have no community have worse mental health outcomes. Practically, this may mean, for example, bisexual individuals are less comfortable accessing either mainstream or LGBTQIA mental health services. 

What can we do to support bisexual mental health? 

The most basic thing we can do to help bisexual people is to better understand the issues facing them. This is particularly true for mental health professionals, who are figures of authority and may see bisexual people at particularly challenging time in their lives. Bisexuals have reported negative interactions with mental health professionals, such as the suggestion being made that bisexuality is not a healthy, stable identity. Professionals can support their service users by not enacting negative attitudes found within the wider culture. 

Access to bi-specific support can be helpful. As with other sexual minorities, bisexual people can benefit both from support from within the bisexual community, as well as bi-affirmative support from outside of it. Information and resources are available online through groups such as Bi Community News and  The Bisexual Index 

Finally, the literature on bisexual-specific mental health is currently sparse, and further work is needed to clarify the reasons for mental distress and disorder in this group, and what can be done to help. 

Further reading 

Bisexuality and Mental Health information (PDF) from Manchester based group Biphoria 

Personal story - Being bisexual and my mental health challenges  

5 common mental health issues if you are bisexual