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FMR 42 Sexual orientation and gender identity and the protection of forced migrants 9

Mental health challenges of LGBT forced migrants

Ariel Shidlo and Joanne Ahola

Many LGBT forced migrants have significant and sometimes incapacitating psychological
scars. Mental health providers can assist in documenting the psychological impact of anti-
LGBT persecution and its impact on the ability to secure refugee status.

Lesbian, gay, bisexual and transgender (LGBT) social anxiety, traumatic brain injury and
forced migrants around the world report a substance abuse. LGBT forced migrants may
history of multiple traumatic events across also suffer from two types of Post-Traumatic
their lifespan. The range of events includes Stress Disorder: PTSD and complex PTSD. PTSD
verbal, emotional, physical and sexual abuse includes the symptom triad of re-experiencing
and assault, harassment, shunning, spitting, traumatic events, numbing and avoidance of
discrimination in housing and employment, thinking about these events, and hyper-arousal.
destruction of property, blackmail, forced Those who have a history of cumulative trauma
prostitution, forced heterosexual marriage, may suffer from the symptoms not only of PTSD
corrective rape1 and coerced sexual but also of complex PTSD which include self-
orientation conversion interventions. Those destructive behaviour, amnesia, intense shame,
who from a young age are perceived by difficulties with intimacy, experiencing bodily
others as behaving in gender non-conforming pains in response to psychological distress, and
ways are targeted starting in childhood.2 despair about finding loving relationships.

LGBT persons who are victims of sexual Adjudicators expect coherent, consistent and
orientation and gender identity (SOGI)- sequential accounts of persecution. But a
based violence seldom find comfort in their persons survival of persecution sometimes
families, either because they are not out to necessitates amnesia and denial of the impact
their families or because their families join and severity of traumatic events. Memories of
in their persecution. LGBT forced migrants trauma may be stored as fragments images,
are distinct from other persecuted groups in sounds, smells and physical sensations
that their families of origin often contribute rather than as a verbal narrative, and this
to the abuse. Many LGBT forced migrants poses challenges to recounting a history
report emotional, verbal, physical and sexual of persecution. Furthermore, repeated
violence at the hands of their family. A Peruvian retelling of a history of persecution can be
woman who was non-gender conforming was, re-traumatising for the forced migrant and
from an early age, emotionally and physically cause secondary trauma to advocates and
abused by her family; she was not allowed to adjudicators. When a mental health provider
eat with the rest of the family and, unlike her is available they can utilise techniques that
siblings, was not given a bed to sleep in. A may minimise the level of re-traumatisation.3
Colombian woman reported feeling sad, angry
and isolated when, after an anti-LGBT assault Assessing SOGI
by the police, she could not go to her family In the absence of a safe environment, many
for help and emotional support as that would LGBT individuals are not able to work through
have necessitated coming out to her family. the internal processes necessary to allow
them to integrate the multiple aspects of their
Psychological consequences sexuality. Instead, these processes may slow
Many suffer from significant mental health down or become frozen until they reach the
consequences as a result of a lifetime of relative safety of a new host country. Because
cumulative trauma. Common diagnoses are the coming-out process may only begin to
recurrent depression, dissociative disorders, unfreeze many years after arrival in the host
panic disorder, generalised anxiety disorder, country, some individuals may have difficulty