Sexual-minority individuals frequently experience mental and physical health challenges, often in response to discrimination, hostility, and violence (Meyer, as cited in Heath & Mulligan, 2008) . As the research community begins to tease out the differences between the different sexual minority groups, a clear pattern of difference begins to emerge between the experiences of lesbian/gay individuals and bisexuals.
The Experiences of Bisexual People
Balsam and Mohr (2007) determined that when compared to lesbian and gay individuals, bisexual people tended to show increased identity confusion, to feel a lesser sense of community, and to disclose their bisexuality (come out) less frequently. They credited the identity confusion primarily to a dearth of visible bisexual role models and the social pressures to claim an identity that falls within the gay/straight binary .
Bisexual individuals sometimes fluctuate in the language they use to self-identify, often in light of the sex of their partner at a given point, but the vast majority of research has found bisexuality or some other form of non-monosexuality to be stable in nature , .
Bisexuals may refrain from coming out to avoid the stigma, and often find that others simply assume that they are straight or gay based on the sex of their partner or partners , , . In particular, bisexual individuals who have opposite/other sex partners are often invisible as sexual minorities, as heterosexuality tends to be the cultural assumption of default , , .
The internalized belief that bisexuality is somehow lesser or something of which one should be ashamed is often called internalized biphobia, in the vein of previous research on internalized racism and homophobia , .
Internalized homophobia has been shown to have many mental health implications, including anxiety, low self-esteem, shame, depression, substance use, and suicidality .
Although the research on internalized biphobia is newer, similar results have been presented.
Bisexual Mental Health
Lewis, Derlega, Brown, Rose, and Henson (2009) summarized the varied findings in bisexual mental health during the past 15+ years of research on the subject.
Common themes of distress and social support challenges arose across all of the works to date, which they referred to as “sexual minority stress” (p. 971). Lewis et al. (2009) found that, while bisexuals are less frequently the victims of antigay violence (often due to their invisibility as members of the LGBT community; see also See & Hunt, 2011), they often suffer from greater orientation-related stress than their lesbian/gay counterparts do , .
Both Lewis et al. and Bostwick (2012) found modest results suggesting an increase in depression in bisexuals as compared to lesbians/gays (both established a history of support for increased depression in lesbians/gays compared to heterosexuals). In both cases, the researchers asserted the belief that greater significance would come with larger sample sizes (bisexual subsample of 78, Lewis et al., 2009 ; bisexual subsample of 47, Bostwick, 2012 ).
In addition to depression, research has revealed a number of other experiences that are heightened in or unique to bisexuals when compared to heterosexual and homosexual populations. Sarno and Wright (2013) found that bisexuals experience “the microaggression Alien in Own Land” (p. 69); that is, the assumption by others that the subject is straight more often than lesbians/gays, and as a result experienced significantly greater identity confusion .
Stonewall research also found that bisexuals suffered insidious assumptions and microaggressions at work such as “the frequent conception of bisexuality as a ‘failure to choose,’ [leading] to bisexual people being stereotyped as indecisive and disorganized” (as cited in See & Hunt, 2011, p. 292), which could directly impact the potential for professional advancement. However, being closeted at work has been found to decrease work satisfaction and performance .
A frequent finding in the research on opinions about bisexuals (including several of the studies previously referenced) is a pervasive belief that bisexuals are inherently promiscuous or unfaithful , . Hoang, Holloway, and Mendoza (2011), in a study with 99 bisexual women, sought to explore whether there was validity to the stereotypes, and, if so, under what conditions.
Their findings revealed that internalized biphobia, in addition to hindering bisexual identity congruence, pride, and acceptance, increased the likelihood of infidelity. Statistically, their participants reported significantly higher numbers of relationships with males than females, which the researchers credited to social pressures to conform to heteronormativity .
Interestingly enough, the bulk of the infidelity that was committed tended to be while the women were in relationships with men, “which challenges the stereotype that bisexual women inevitably cheat on their lesbian partners, with men” (Hoang et al., 2011, p. 34).
Essentially, it is the external and subsequently internalized biphobia that helps bring hurtful stereotypes and expectations to fruition.
The Challenges and Concerns of Bisexual People
One of the concerns regarding bisexual health is the lack of awareness in the mental and medical health communities about what bisexuals actually need . (See our earlier post, 5 Ways to Support Your LGBQ & Gender Non-Conforming Clients in Session.)
Bisexual health concerns may differ from those of heterosexuals and homosexuals, as they and their providers need to be informed about how to maintain sexual health with partners of various sexes.
“Samantha” reported that the doctor at her undergraduate university, in response to hearing that Samantha identified as bisexual, gave her a puzzled look and responded, “So, um, do you need condoms or not?” Samantha also complained that several therapists she had seen had also seemed confused at best, and disbelieving and passively negating, at worst, about her bisexuality.
Bisexuality is difficult to define, is often ostracized by both heterosexual and homosexual communities, and, as a result, is often accompanied by increased mental health concerns.
Many bisexual individuals seek to find support within the gay and lesbian community only to be turned away based on distrust and stereotypes.
Such rejection can lead to a bevy of negative implications that would best be mitigated by a structured community of their own. These concerns are sometimes compounded by ill-informed or uninformed mental and medical health practitioners.
While it is not possible to force widespread abandonment of antibisexual sentiments, improvements in mental and physical health understanding can go a long way toward improving the wellbeing of bisexuals as a group.
This article was adapted from “Rust Revisited: An Update on Lesbians’ Opinions and the Implications for Bisexual Women” by Wesh, 2014.
This article was originally published on April 19, 2016.
 Heath, M., & Mulligan, E. (2008). ‘Shiny happy same-sex attracted women seeking same’: How communities contribute to bisexual and lesbian women’s well-being. Health Psychology Review, 17, 290–302. http://dx.doi.org/10.5172/hesr.422.214.171.1240
 Balsam, K. F., & Mohr, J. J. (2007). Adaptation to sexual orientation stigma: A comparison of bisexual and lesbian/gay adults. Journal of Counseling Psychology, 54, 306–319. http://dx.doi.org/10.1037/0022-0126.96.36.1996
 Diamond, L. (2008). Female bisexuality from adolescence to adulthood: Results from a 10-year longitudinal study. Developmental Psychology, 44, 5–14. http://dx.doi.org/10.1037/0012-16188.8.131.52
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 Ochs, R. (1996). Biphobia: It goes more than two ways. In B. A. Firestein (Ed.), Bisexuality: The psychology and politics of an invisible minority (pp. 240–259). Newbery Park, CA: Sage.
 Ochs, R. (2011). Why we need to “get bi”. Journal of Bisexuality, 11, 171–175. http://dx.doi.org/10.1080/15299716.2011.571983
 Hoang, M., Holloway, J., & Mendoza, R. H. (2011). An empirical study into the relationship between bisexual identity congruence, internalized biphobia, and infidelity among bisexual women. Journal of Bisexuality, 11, 23–28. http://dx.doi.org/10.1080/15299716.2011.545285
 Weber-Gilmore, G., Rose, S., & Rubenstein, R. (2011). The impact of internalized homophobia on outness for lesbian, gay, and bisexual individuals. The Professional Counselor: Research and Practice, 1, 163–175. http://dx.doi.org/10.15241/gwv.1.3.163
 Lewis, R. J., Derlega, V. L., Brown, D., Rose, S., & Henson, J. M. (2009). Sexual minority stress, depressive symptoms, and sexual orientation conflict: Focus on the experience of bisexuals. Journal of Social and Clinical Psychology, 28, 971–992. http://dx.doi.org/10.1521/jscp.2009.28.8.971
 See, H., & Hunt, R. (2011). Bisexuality and identity: Double-edged sword: Stonewall research into bisexual experience. Journal of Bisexuality, 11, 290–299. http://dx.doi.org/10.1080/15299716.2011.571995
 Bostwick, W. (2012). Assessing bisexual stigma and mental health status: A brief report. Journal of Bisexuality, 12, 214–222. http://dx.doi.org/10.1080/15299716.2012.674860
 Sarno, E., & Wright, J. (2013). Homonegative microaggressions and identity in bisexual men and women. Journal of Bisexuality, 12, 63–81. http://dx.doi.org/10.1080/15299716.2013.756677
 Mohr, J., & Rochlen, A. (1999). Measuring attitudes regarding bisexuality in lesbian, gay male, and heterosexual populations. Journal of Counseling Psychology, 46, 353–369. http://dx.doi.org/10.1037//0022-0184.108.40.2063
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