June is Pride Month in the U.S., a time for the LGBTQIA+ community to celebrate, connect, and advocate for their rights and, for some, to come out as queer. In this article, Mindpath Health’s Anoopinder Singh, MD, explains how coming out can be a liberating milestone and why we should understand the experiences and challenges that follow, including changes in mental health, navigating new types of discrimination, and the need for ongoing support and self-care.

what happens when you come out anoop singh, MD Mindpath Health

Coming out can be a big milestone for many, though not everyone in the LGBTQIA+ community chooses this route. But what happens after you come out, after the rainbow paint washes off, and we return to our daily lives? Here are some things that may happen after coming out.

1. Your mental health journey may change.

Living your true identity can have positive impacts on your mental health. Many studies show that for transgender people, accessing gender-affirming care, like hormone therapy or surgery, has a dramatic positive effect on their mental distress and quality of life, including reducing rates of anxiety and depression. It takes a lot of energy and mental stress to live with gender dysphoria, and coming out and receiving gender-affirming care can ease that stress. Studies show that the stress of living a ‘double life’ while closeted can raise rates of depression and anxiety, and coming out can alleviate those symptoms.

However, coming out may also increase stress. Discrimination has negative effects on psychological well-being, and coming out may expose you to more of this. This is especially true for LGBTQIA+ people of color or those who belong to racial, ethnic, cultural, and social minorities or lower socioeconomic groups. You might find yourself needing different forms of mental health care post-coming out, such as a psychiatrist who is competent in working with the queer community and a therapist who understands LGBTQIA+ discrimination.

When it comes to medication, coming out can affect which ones are right for you. If you decide to start hormone replacement therapy, some forms of HRT can increase mood swings and anxiety, which a change in medication can help manage.

It’s important to stay connected with your psychiatrist and therapist through the process of coming out to receive the best mental health care.

2. You may have to navigate new types of stigma and discrimination.

Once you come out, you may be the subject of new scrutiny from your communities and the world around you. That may look like navigating anti-queerness in your family, workplace, or religious community, and all of that comes with new stress and heightened risk for depression and anxiety. Some people must prepare for scenarios of vulnerability or disadvantage after coming out, including violence, homelessness, rejection or repugnance, abuse, loss of employment, loss of support, and exclusion from legal and policy protections. Stigma and discrimination can be even more intense for queer youth, with LGBTQIA+ youth experiencing a 120% higher risk of some form of homelessness, with up to 40% of homeless youth identifying as queer. The 2019 GLSEN National School Climate Survey showed that 86% of LGBTQIA+ youth reported being harassed or assaulted at school, significantly impacting their mental health.

Many queer folks experience religious discrimination after coming out, including rejection by the church community and even messages about ‘sinfulness’ and damnation. Religious trauma occurs when religion is used to instill a sense of shame and worthlessness in a person and is particularly prevalent for queer folks raised in religious settings. Religious trauma shares symptoms with post-traumatic stress disorder (PTSD), and though it’s not an official diagnosis, many clinicians use a trauma-informed approach to treat it.

Navigating new forms of stigma and discrimination once you come out can increase stress and rates of mental illnesses such as depression and anxiety, and working with a psychiatrist and therapist can be a vital support.

3. You will probably end up coming out again.

As you go through life and meet new people, start new jobs, and move to new cities, you may find yourself coming out repeatedly. Many people who choose to live openly as members of the LGBTQIA+ community find themselves having to re-explain who they are to new people. We live in a very heteronormative world, where the “default” experience is straight and cis.

Many people experience changes in the way they understand their own sexual and gender identity, and the label you found the first time you came out might not apply forever. You might end up coming out to yourself and your loved ones repeatedly over time, each time as the most authentic version of yourself. It’s perfectly normal for members of the LGBTQIA+ community to explore different labels over time and to hop around the Kinsey Scale. One of the harms of living in an anti-queer world is a lack of exposure to all the different queer identities available to us, and finding the right label often takes time. Working with a trusted, queer-competent therapist can be key to exploring your identity post-coming out.

Tips for the LGBTQIA+ Community and Allies

1. Allow close family members and friends to learn how to support you. Lack of acceptance and support from close loved ones after coming out can be hurtful and may lead to self-stigmatization and guilt for some. Families and loved ones must also follow their own journeys to acceptance, so it may be helpful to give them time and space to do so.

2. Stay connected and seek help. Regularly talk with friends and others in your support system. Seek peer support, including LGBTQIA+-friendly support groups. Reach out to those you trust to seek help and guidance or to discuss difficult or distressing feelings or emotions without fear or judgment. This can help instill a sense of belongingness and community after coming out.

3. Explore safely. As you explore sexuality or gender expression, be aware that not all ‘safe spaces’ may be safe. Don’t feel pressured to engage in high-risk sexual or drug use behaviors.

4. Maintain healthy routines. Prioritize your self-care routine. Regular exercise, a balanced diet, and adequate sleep are essential for physical and mental well-being. Practice mindfulness or engage in hobbies to manage stress and improve overall health.

5. Support others. Offer support to other LGBTQIA+ members. Listen, reassure, and show that you care. Providing support to others can boost self-esteem and self-confidence and promote mental health.

Visit mindpath.com to learn more about gender-affirming mental health treatment options and start your path to mental wellness.

Anoopinder Singh, MD, FAPA

San Francisco, CA

Dr. Anoopinder Singh is a board-certified psychiatrist. Dr. Singh uses a holistic approach to treat college and university students and adults with ADHD, co-morbid disorders, mood disorders, OCD, psychotic disorders, and trauma. He has worked in disaster psychiatry outreach, the Medical Reserve Corps, and foreign and local governments, providing psychological first-aid services in the aftermath of disasters in the United ... Read Full Bio »

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