10th October every year is World Mental Health Day; a day during which we can acknowledge the struggles of millions of people around the world with their mental health and bring understanding and compassion to their suffering.
Much of what you will see about mental health today will focus on anxiety and depression, and the importance of talking to others if you are having a hard time. This is important, as anxiety and depression are some of the most common ways in which people find their mental health gets in the way of their day-to-day lives. But what about those less commonly spoken about mental illnesses? Those that are still shrouded in shame, social rejection and misunderstanding?
Here, I address a few conditions that are less frequently spoken about, many of which are experienced disproportionately by those from gender- and sexuality-diverse groups.
Beyond anxiety and depression
We have come a long way in the understanding of anxiety and depression and whilst we still have miles to go, they are some of the less stigmatised conditions to discuss.
Eating disorders
Eating disorders are more common than many people realise and stretch far beyond the expected population of teenage girls. Gay and bisexual men are at higher risk of body image issues and eating disorders than their straight male counterparts1. Trans people of all genders are at an elevated risk of developing eating disorders2. Anorexia and bulimia nervosa are known to place sufferers at a higher risk of death3 as a consequence of complications of the illness or from sufferers taking their own lives.
Eating disorders are often mocked or ignored, especially in people whose body types do not fit the expectations of someone with a restrictive eating disorder, and disordered eating behaviour is widely normalised as diets, ‘wellness programmes’ and other forms of restrictive eating. This can make it incredibly hard for those with eating disorders to recover.
Borderline Personality Disorder
Although it has now been removed from the Diagnostic and Statistical Manual (DSM), the internationally recognised list of mental illnesses and disorders, Borderline Personality Disorder (BPD) diagnosis provides a lot of people with a clear way of understanding a range of distressing mental and emotional health issues due to severely impaired ability to regulate emotions. People with this diagnosis can really struggle with self-esteem and relationships with others, and experience deep depression and severe anxiety which, as a result, can result in self-harm and suicide. It shares many features in common with autism and there have been many reports of women and trans/gender non-conforming people being diagnosed with BPD when autism would be a better fit for their experiences.
BPD is a particularly stigmatised condition and as with other disorders such as narcissistic personality disorder, sufferers are demonised for their difficulties in relationships. Their problems are pathologised and it can be hard to find understanding.
Obsessive Compulsive Disorder
Often mischaracterised as the desire to have highly organised spaces and clean things a lot, Obsessive Compulsive Disorder is a significantly more complex issue than just liking all the labels in your tin cupboard to face outwards.
Compulsive behaviours often arise for people who have obsessive intrusive thoughts that are often extremely distressing for the person with OCD. For people who have the widely recognised compulsive cleaning behaviour that people associate with OCD, it is often a coping strategy for intrusive thoughts about themselves or their loved ones becoming unwell or dying due to contamination.
Some people with OCD may experience what is known as ‘Pure O’ – obsessive intrusive thoughts without compulsive behaviours as a coping strategy. Intrusive thoughts often focus on something that evokes fear, shame or disgust. Sex and sexuality can be a focus of obsessive intrusive thoughts, such as those affected experiencing intrusive thoughts that they may be gay or transgender when they are not. Such is the social stigma still on being gay or transgender, this is a source of deep shame for some, and thoughts about being gay feature in the intrusive thoughts of around 11% of people with a diagnosis of OCD4.
Schizophrenia, psychosis and hearing voices
These three things are not the same but are often rolled together by those unaware of the differences. According to the Hearing Voices Network, if you hear voices, see things that others do not or have similar sensory experiences, you are far from alone. Between 3% and 10% of the population sees or hears things that others do not regularly, and it’s significantly more for those who have such experiences as occasional phenomena.
Psychosis is a state in which a person is considered to have an abnormal interpretation of reality. Schizophrenia is a condition in which psychosis is persistent. These are some of the most stigmatised mental illnesses and whilst there are countless films and TV shows that use people with psychosis as the villains who hurt or even kill other people, in reality, people with psychotic illnesses are far more likely to be the victims of violent crimes than the perpetrators.
Certain types of drug use can be a risk factor for developing psychotic illnesses, including the drugs that are often associated with chemsex such as Mcat (mephedrone) and Tina (crystal meth). Knowing your way around what to do if you’re experiencing psychosis symptoms whilst using party drugs can help to keep you and your friends safe.
The bottom line
Mental health is so much more than talking to someone if you’re feeling sad. A better understanding of the range of mental illnesses that can affect people can help to destigmatise these conditions and pave the way for people to speak out and seek help.
This is a tiny handful of conditions that can affect people and focuses on queer people in particular. If you have any concerns about your own mental health or that of the people you care about, you can call SANEline on 0300 304 7000 (4.30 pm–10.30 pm every day).
1Nodin, N., Peel, E., Tyler, A., Rivers, I., 2015. The RaRE Research Report: LGB&T Mental Health – Risk and Resilience Explored (Report). PACE (Project for Advocacy Counselling and Education), London.
2Diemer, E.W., White Hughto, J.M., Gordon, A.R., Guss, C., Austin, S.B., Reisner, S.L., 2018. Beyond the Binary: Differences in Eating Disorder Prevalence by Gender Identity in a Transgender Sample. Transgender Health 3, 17–23. https://doi.org/10.1089/trgh.2017.0043
3Suokas, J.T., Suvisaari, J.M., Gissler, M., Löfman, R., Linna, M.S., Raevuori, A., Haukka, J., 2013. Mortality in eating disorders: A follow-up study of adult eating disorder patients treated in tertiary care, 1995–2010. Psychiatry Research 210, 1101–1106. https://doi.org/10.1016/j.psychres.2013.07.042
4Bhatia, M.S., Kaur, J., 2015. Homosexual Obsessive Compulsive Disorder (HOCD): A Rare Case Report. J Clin Diagn Res 9, VD01–VD02. https://doi.org/10.7860/JCDR/2015/10773.5377