Bisexual people occupy a peculiar position in conversations about LGBTQ mental health. They are nominally included in the acronym, consistently represented in population surveys, and numerically one of the largest groups within the LGBTQ umbrella — and yet their specific experiences are frequently rendered invisible, minimized, or collapsed into either gay or straight frameworks. This invisibility has measurable mental health consequences that are distinct from those faced by gay and lesbian people.

What Bisexual Erasure Looks Like

Bisexual erasure is the tendency to deny, dismiss, or ignore bisexuality as a real and stable orientation. It shows up in the assumption that a bisexual person in a relationship with someone of a different gender has "chosen" to be straight, or that a bisexual person in a same-gender relationship is "actually gay." It shows up in comments about bisexuality being a phase, a form of confusion, or a transitional identity on the way to something more definitive. It shows up in lesbian and gay spaces that treat bisexual people with suspicion — as less committed, as likely to leave for the privileges of heterosexuality, as fundamentally undependable. It shows up in heterosexual spaces where bisexuality is either exoticized or simply not acknowledged as real. Bisexual people often find themselves belonging fully to neither community and navigating biphobia from multiple directions simultaneously.

The Mental Health Data

Research consistently documents that bisexual people experience worse mental health outcomes than both heterosexual and gay or lesbian people on many measures. A large-scale study from the University of Pittsburgh found that bisexual people had higher rates of depression, anxiety, and suicidal ideation than gay or lesbian participants — not just compared to heterosexual people, but compared to other sexual minority groups. This is sometimes called the bisexual paradox: a group that is part of an already marginalized community experiencing even more pronounced distress. The primary driver appears to be the specific form of minority stress bisexual people face, which includes the double rejection of not being fully accepted in either straight or gay communities.

The Role of Community Belonging

Social support is one of the most powerful buffers against mental health problems. For LGBTQ people, community belonging — having others who share your experience, who see you clearly, who validate your identity — is a key component of that support. Bisexual people often struggle to find that belonging. Gay and lesbian social spaces, while nominally inclusive, frequently engage in the very erasure that bisexual people are trying to escape. This leaves many bisexual people without a coherent community to turn to, which reduces access to the social support that buffers stress. The Trevor Project's national survey data has documented that bisexual youth report feeling less connected to LGBTQ community than gay and lesbian youth, which corresponds with higher rates of depression and anxiety.

A Brief Tangent on Research Methodology

One reason bisexual-specific data has been slow to accumulate is that many studies historically collapsed sexual minority populations into a single group or compared gay and lesbian people to heterosexual people while treating bisexual participants as too small a category to analyze separately. This methodological choice meant that the specific experiences of bisexual people were invisible in the data for decades. Researchers and advocates have spent considerable effort pushing for disaggregated reporting — breaking out bisexual data separately — which is why the field has better information now than it did fifteen years ago.

Bisexuality in Relationships

In relationships, bisexual people navigate a set of assumptions that neither gay nor straight people typically encounter in the same way. In different-gender relationships, their bisexual identity may be treated as irrelevant or inconvenient by partners who are uncertain what it means for them. In same-gender relationships, they may face pressure to identify as gay or lesbian to be taken seriously within queer communities. The ongoing visibility of their bisexual identity can require active effort and explanation regardless of relationship context. This kind of constant identity management is exhausting and is itself a form of minority stress.

Affirmation Without Erasure

Affirming care for bisexual clients means several specific things. It means not assuming that a person's relationship structure defines their orientation. It means not treating bisexuality as a transitional state or a source of uncertainty about the client's "real" identity. It means being curious about the specific forms of erasure and biphobia the person has encountered — from straight communities, from gay and lesbian communities, and sometimes from within their own family or friend groups. And it means helping clients build a relationship with their own identity that does not depend on external validation that is often withheld.