Gay and lesbian teenagers have increased rates of assault, suicide, substance abuse, and homelessness.  These can reflect homophobic attitudes expressed by others as well as internalized feelings of self-hatred, write Drs. James Lock and Brian N. Kleis.  Lock, of Stanford University School of Medicine, and Kleis, of Children's Health Council, Palo Alto, California, discuss teens and homophobia in an article in the June issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

Gay and lesbian youth experience frequent verbal and sometimes physical assault because of their sexual orientation: In one study, 80% reported verbal insults, 44% were threatened with violence, 31% were chased or followed, and 17% said they were physically assaulted.

The term "homophobia," when used by psychiatrists, refers to irrationally negative attitudes toward homosexual people.  Homophobia can be internalized in a gay person as part of an identity struggle caused by the emotional stress of self-acceptance and the social process of "coming out," Lock and Kleis explain.

Young adolescents, especially boys, are concerned about the physical changes of puberty and may develop homophobia in association with anxiety about their masculinity.  At this age, teenagers may need nothing more than information about sexual development, anatomy, and behavior.

If adolescents express homophobia with physical or verbal assaults, "it will be necessary to work with families, schools, and police to contain the behavior while its origins are explored in therapy," Lock and Kleis write.

Adolescents who have already determined that they are gay or lesbian can become depressed or act out; they may be truant or run away from home, or they may project hostile feelings onto family members.

Older adolescents are more independent of their families and more interested in peer support groups.  Those who are uncomfortable with openly gay peers may do better with individual therapy, as well as literature and films that "provide structure, privacy, and some psychological distance," Lock and Kleis comment.

Gay teens with homophobic attitudes "need assistance managing the effects of persistent attacks by social institutions on their self-esteem and hopes for a successful career," they write.

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