For Teachers & Professionals

Sexuality in Young People who have Psychiatric Problems – Part 1

According to the World Health Organization, globally, one in seven individuals aged between 10 and 19 years old experiences a mental disorder, accounting for 13% of the global burden of disease in this age group. Depression, anxiety and behavioural disorders are among the leading causes of illness and disability among adolescents. Adolescence is a crucial period for developing social and emotional habits important for mental well-being. They learn coping skills, problem-solving skills, how to manage emotions and to explore their identity. The more risk factors adolescents are exposed to, the greater the potential impact on their mental health. They are subject to multiple stress factors like peer and media influence, bullying, quality of family life and type of parenting, if not interpersonal parental violence and being victims of physical, psychological and emotional violence. All these and other factors are recognized risks to mental health. 

Some adolescents are at greater risk of mental health conditions due to their living conditions, stigma, discrimination or exclusion, or lack of access to quality support and services. These include adolescents living in humanitarian and fragile settings such as adolescents with chronic illness, autism spectrum disorder, an intellectual disability or other neurological condition, pregnant adolescents, adolescent parents, or those in early or forced marriages, orphans, and adolescents from minority ethnic or sexual backgrounds or other discriminated groups. Mental health counselling and psychological support are necessary.

What remains less frequently discussed, though equally important given that young people who have psychiatric problems are more likely to endure difficulties during their sexual and gender identity development and present more risk-taking behaviours, are topics such as sexuality and gender identity. The path to sexual development might be more challenging for those adolescents who have a psychiatric disorder because factors associated with the disorder (e.g. low self-esteem, enduring mental health-related stigma and social exclusion) may interfere with the ability to form relationships and obtain sexual experiences. For example, adolescents who struggle with personality disorder and trauma or ADHD are more likely than their peers to engage in sexually risky behaviour and to experience teenage pregnancy, sexual harassment and re-traumatization. Anxiety and autism spectrum disorders may lead to social exclusion and adolescents who are in sexual diversity groups (LGBTIQ) are more likely to suffer emotional and physical health concerns.

Given these challenges, youth with mental health disorders should have opportunities to converse about these challenges and seek and receive help. Of course, there are situations such as a severe manic episode or psychosis, where it is less relevant. However, some form of attention for some patients is recommended. 

So, what should psychiatrists or other clinicians do?

1. Regularly address sexuality

If the patient’s conditions permit it, psychosexual history should be routinely asked. Another topic to discuss is the sexual side effects of psychotropic medications given that the prevalence of sexual dysfunctions mirrors that of adults taking the same medications. Communication about the sexual side effects of medication is essential to increase patient adherence to psychotropic medication treatment and should be initiated as part of the standard protocol by medical doctors.

2. Take into consideration gender identity and gender nonconformity

Adolescence is preeminently a period of identity formation, and that includes sexual identity. Unfortunately, the number of young people who are struggling with it is increasing. The mental health practitioner working with adolescents should create a safe environment to enable young patients to talk about their sexual identity. A lot of young adolescents are in a period called “questioning”. Giving psychosexual education may help dispel some fog.

3. Overcome barriers

Lack of awareness about this topic is frequently given as a reason why providers do not talk about sexuality with their patients, as well as a lack of knowledge about the topic. It is necessary to search for articles, books and programs to keep oneself updated. Adding some sexual education and communication skills courses to the curriculum may help overcome this barrier.

Another problem is the concern about the patient's supposed feelings of shame or discomfort. A lot of young patients, contrary to most adults, may effectively feel discomfort while talking about sexuality with adults and not peers. Feelings of discomfort are most likely to occur when there is no understanding of the purpose of the discussion, when young patients are feeling judged or when the patients do not trust that the conversation is private. Addressing these may be a good start. For LGBTQ youth a lack of inclusive language during healthcare visits may lead to feeling a lack of acceptance. Acknowledging the importance of names and pronouns, for example, is fundamental at the beginning of the conversation. It is also easier for young patients to discuss gender identity and sexuality-related topics if their healthcare provider is comfortable with such topics. 

REFERENCES

Adolescent mental health. (2021, November 17). World Health Organization (WHO). Retrieved September 24, 2022, from https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health 

Sara L. Bungener, Laura Post, Inez Berends, Thomas D. Steensma, Annelou L.C. de Vries, Arne Popma, Talking About Sexuality With Youth: A Taboo in Psychiatry?, The Journal of Sexual Medicine, Volume 19, Issue 3, 2022, Pages 421-429, ISSN 1743-6095, https://doi.org/10.1016/j.jsxm.2022.01.001.