From Homosexinfo

Psychiatry: Homosexual Behaviors among the Mentally Ill

Although homosexuality is not considered a mental illness, various mentally ill individuals are more likely to engage in homosexual behavior than mentally normal individuals, as documented below. One wonders why?

Borderline personality disorder

Borderline personality disorder is a pervasive pattern of instability of interpersonal relationships, self-image, affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts such as gambling, spending money irresponsibly, binge eating, substance abuse, engaging in unsafe sex, driving recklessly, or displaying recurrent suicidal behavior, gestures, threats, or self-mutilating behavior (DSM-IV-TR). Several studies have reported a relative overrepresentation of homosexuals and bisexuals among individuals with borderline personality disorder:

• Zubenko et al. described some samples of individuals with borderline personality disorder.¹ In a sample of men, 57% of them were homosexual. In another sample of men, 21% were homosexual, 5% bisexual and 11% suffered from various paraphilias. In yet another sample, 53% of the men were homosexual and so were 11.5% of the women.
• Stone mentioned that in a sample of individuals with BPD, 9.8% of the men and 1.4% of the women were exclusively homosexual;² he did not report data about the proportion that manifested bisexual interests. The proportion of exclusively homosexual women in this sample is greater than the proportion of exclusively homosexual women in probability samples of the general population.
• Dulit et al. reported that in a sample of individuals with BPD, the proportions of heterosexuals, homosexuals, and bisexuals among men were 44%, 22%, and 26%, respectively, whereas these proportions among women were 73%, 3%, and 11%, respectively (sexual orientation could not be determined in some individuals).³
• In a sample of men, 16.7% of the men with BPD were homosexual vs. 1.7% of controls.⁴
• Molina Ramos et al. have also documented an association of homosexuality with BPD.⁵

Mentally ill homeless individuals

Nonheterosexuals are relatively overrepresented among homeless female adolescents/women (with increased mental disorders).^{6, 7} and mentally ill mentally ill homeless men:

• Susser et al. studied 122 mentally ill homeless men in a New York City shelter.⁸ Among 122 men, 65 (53%) were sexually active, 56 with women and 20 with men (11 who had sex with both women and men were counted in each group).
• In another examination of 39 mentally ill homeless men, of which three-fourths had a schizophrenia-spectrum disorder, 26 reported any sexual activity during the previous 6 months; 23 reported sex with women, and 9 reported sex with men.⁹

Schizophrenia and general mental illness

Nonheterosexuals are relatively overrepresented among mentally ill patients, especially schizophrenics:

• In sample of 170 consecutively seen mentally ill inpatients without BPD, only 78% of the men and 89% of the women were heterosexual.¹⁰
• In an examination of 157 adolescent males (ages 14-17 years) in a mental hospital, of which 42 had psychopathy, 49 had mental retardation, and 66 had schizophrenia, 61% of the total manifested homosexual behavior or desire.¹¹
• In an examination of 145 mental patients in Melbourne, 55.2% had schizophrenia, 15.9% reported intravenous drug use, and 20% reported multiple sexual partners in the previous year.¹² 12.6% of the men reported homosexual behavior (9.2% reported anal sex), about half of the men reported sex with a prostitute, and 19% of the women reported sex with a bisexual man.
• Cournos et al. studied 95 schizophrenics. 10% of the patients had engaged in homosexual activity in the preceding 6 months and 22% during their lifetime; the frequency was similar among men and women.¹³ The patients also reported heterosexual behavior.
• Although less than 1% of the general population has schizophrenia, in a sample of 561 women (95% identifying as lesbian, others identifying as bisexuals or non-identifying) who were predominantly white, highly educated, urban, and between 25 and 50 years of age, 3% had been diagnosed with schizophrenia or psychosis;¹⁴ most psychoses are schizophrenias.

Schizophrenics manifest an increased likelihood of a variety of sexual delusions/hallucinations and unusual sexual behaviors, including homosexual behaviors.^{15, 16, 17, 18, 19, 20, 21}

Eating disorders

Homosexual men are relatively overrepresented among male patients with eating disorders.^{22, 23, 24, 25} Male homosexuals are more likely to manifest eating disorder symptoms compared to heterosexual men even after controlling for depression, self-esteem and comfort with sexual orientation.²⁶

Homosexual and heterosexual women likely have a similar prevalence of eating disorders.²⁷ In a population-based study of adolescents (36,320 students in grades 7 through 12), more homosexual than heterosexual girls reported a positive body image (42.1% vs. 20.5%), but these two groups did not differ with respect to frequent dieting, binge eating, or purging behaviors.²⁸

References

1. ^ Zubenko GS, George AW, Soloff PH, et al. Sexual practices among patients with borderline personality disorder. Am J Psychiatry 1987;144(6):748-52.
2. ^ Stone MH. Homosexuality in patients with borderline personality disorder. Am J Psychiatry 1987;144(12):1622-3.
3. ^ Dulit RA, Fyer MR, Miller FT, et al. Gender differences in sexual preference and substance abuse of inpatients with borderline personality disorder. J Pers Disord 1993;7(2):182-5.
4. ^ Paris J, Zweig-Frank H, Guzder J. Psychological factors associated with homosexuality in males with borderline personality disorder. J Pers Disord 1995;9:56-61.
5. ^ Molina Ramos R, Carrasco Perera JL, Perez Urdaniz A, et al. [Factors associated to the diagnoses of borderline personality disorder in psychiatric out-patients]. Actas Esp Psiquiatr 2002;30(3):153-9.
6. ^ Reid SD. Drug use, sexual behaviour and HIV risk of the homeless in Port-of-Spain, Trinidad. West Indian Med J 1999;48(2):57-60.
7. ^ Noell JW, Ochs LM. Relationship of sexual orientation to substance use, suicidal ideation, suicide attempts, and other factors in a population of homeless adolescents. J Adolesc Health 2001;29(1):31-6.
8. ^ Susser E, Valencia E, Miller M, et al. Sexual behavior of homeless mentally ill men at risk for HIV. Am J Psychiatry 1995;152(4):583-7.
9. ^ Sohler N, Colson PW, Meyer-Bahlburg HF, et al. Reliability of self-reports about sexual risk behavior for HIV among homeless men with severe mental illness. Psychiatr Serv 2000;51(6):814-6.
10. ^ Dulit RA, Fyer MR, Miller FT, et al. Gender differences in sexual preference and substance abuse of inpatients with borderline personality disorder. J Pers Disord 1993;7(2):182-5.
11. ^ Isaev DD. [Sexual deviations and perversions in schizophrenia, psychopathies and oligophrenia in male adolescents]. Zh Nevropatol Psikhiatr Im S S Korsakova 1987;87(10):1522-7.
12. ^ Thompson SC, Checkley GE, Hocking JS, et al. HIV risk behaviour and HIV testing of psychiatric patients in Melbourne. Aust N Z J Psychiatry 1997;31(4):566-76.
13. ^ Cournos F, Guido JR, Coomaraswamy S, et al. Sexual activity and risk of HIV infection among patients with schizophrenia. Am J Psychiatry 1994;151(2):228-32.
14. ^ Welch S, Collings SC, Howden-Chapman P. Lesbians in New Zealand: their mental health and satisfaction with mental health services. Aust N Z J Psychiatry 2000;34(2):256-63.
15. ^ Sigal M. Relationship between presumed etiological factors and clinical picture in 100 schizophrenic males. Psychiatr Clin (Basel) 1978;11(3):139-46.
16. ^ Akhtar S, Thomson JA, Jr. Schizophrenia and sexuality: a review and a report of twelve unusual cases--part I. J Clin Psychiatry 1980;41(4):134-42.
17. ^ Akhtar S, Thomson JA, Jr. Schizophrenia and sexuality: a review and a report of twelve unusual cases--Part II. J Clin Psychiatry 1980;41(5):166-74.
18. ^ Chan AO, Lim LE, Ong SH. A review of outrage of modesty offenders remanded in a state mental hospital. Med Sci Law 1997;37(4):349-52.
19. ^ Danielian AK. [Psychotic disorders of sexual and erotic content in different diseases]. Zh Nevrol Psikhiatr Im S S Korsakova 2002;102(2):34-9.
20. ^ Gottesman, II, Groome CS. HIV/AIDS risks as a consequence of schizophrenia. Schizophr Bull 1997;23(4):675-84.
21. ^ Gray R, Brewin E, Noak J, et al. A review of the literature on HIV infection and schizophrenia: implications for research, policy and clinical practice. J Psychiatr Ment Health Nurs 2002;9(4):405-9.
22. ^ Carlat DJ, Camargo CA, Jr. Review of bulimia nervosa in males. Am J Psychiatry 1991;148(7):831-43.
23. ^ Carlat DJ, Camargo CA, Jr., Herzog DB. Eating disorders in males: a report on 135 patients. Am J Psychiatry 1997;154(8):1127-32.
24. ^ Mangweth B, Pope HG, Jr., Hudson JI, et al. Eating disorders in Austrian men: an intracultural and crosscultural comparison study. Psychother Psychosom 1997;66(4):214-21.
25. ^ French SA, Story M, Remafedi G, et al. Sexual orientation and prevalence of body dissatisfaction and eating disordered behaviors: a population-based study of adolescents. Int J Eat Disord 1996;19(2):119-26.
26. ^ Russell CJ, Keel PK. Homosexuality as a specific risk factor for eating disorders in men. Int J Eat Disord 2002;31(3):300-6.
27. ^ Moore F, Keel PK. Influence of sexual orientation and age on disordered eating attitudes and behaviors in women. Int J Eat Disord 2003;34(3):370-4.
28. ^ French SA, Story M, Remafedi G, et al. Sexual orientation and prevalence of body dissatisfaction and eating disordered behaviors: a population-based study of adolescents. Int J Eat Disord 1996;19(2):119-26.