In thinking about treatment options for people with bipolar disorder who are also gay, lesbian, bisexual, or transgender (GLBT), an issue that frequently arises has to do with disclosure around sexual identity and preference. The ease and comfort with which people are able to “come out” to family, friends, and treatment providers varies greatly and is influenced by the setting. Many in the GLBT community have met with repeated prejudice and stigma. Some have experienced the loss of important relationships (parents disowning them, excommunication from certain religious organizations, severed friendships, job discrimination, etc.) as a result of disclosing their sexual identity.
If someone is experiencing a serious mood episode, the issue of disclosure in an unfamiliar setting with strangers, an inpatient unit, partial hospital program, group, etc., can add an additional stress, as well as a barrier to treatment.
The issue of disclosure is a highly personal one, and requires the development of a safe and trusting relationship with the person’s practitioner (psychiatrist/therapist/counselor) and treatment team (if we’re talking an inpatient unit, PHP, IOP, etc). Sometimes this relationship is found, but other times prejudice and discrimination are apparent in the treatment setting.
Inclusion of significant others, family, and supportive friends in psycho-education groups, therapy sessions, etc. needs to occur in the same manner as it does for non-GLBT individuals.
To feel comfortable, some may specifically seek out practitioners who specialize in working with GLBT people, or who themselves are out. Additionally, some self-help groups, such as AA, will have meetings specifically targeted to the GLBT communities.