1 CHAPTER ONE INTRODUCTION In order to understand the culture of a population, it is essential to have a firm understanding of that group's history.

Sexual minorities, including gay men, lesbian women, and individuals who are bisexual, have a long history of persecution and are consistently targets of prejudice, stereotypes, and discrimination (Tygart, 2000; Yang, 1997). The earliest accounts of violence against individuals who were known to engage in romantic or sexual practices with a member of the same gender are documented as early as 1075 BC, when the Code of the Assyrians established the punishment for a man caught having "intercourse with his brother-inarms" was castration (Arkenberg, 1998). More prominent in todays culture is the Abrahamic law passed in 550 BC forbidding sexual relations of people of the same gender, cited in The Bible. If a man also lie with mankind, as he lieth with a woman, both of them have committed an abomination: they shall surely be put to death; their blood shall be upon them (Leviticus 20:13, New King James Version). Although there is disagreement among religious leaders as to the interpretation of such passages, this Judeo-Christian value remains strongly held by individuals of traditional, orthodox, or conservative faiths (CITE). Amnesty International (2001) reports more than 70 countries around the world continue to punish individuals who engage in homosexual behavior with beatings, flogging, life imprisonment, and death. Although most Western societies no longer condone violence against sexual minorities, lesbians, gay males, and bisexual persons continue to have unequal protection in the eyes of the law. (CITE and give examples) Over the span of 40 years, the laws have been slowly evolving as civil rights for sexual minorities has come into focus in the United States. The movement

2 toward equal rights and protections for sexual minorities began in the 1970s, following the successful civil rights movement for Black Americans. The resistance. legislation withholding equal rights to individuals who are LGBT in the United States is frequently supported and financed by religious organizations. Major contributors supporting anti-LGBT legislation in the United States include Focus on the Family and the Church of Ladder Day Saints (California Independent Expenditure Committee Campaign Statement, 2008). Define homophobia. Discrimination Mental health professionals have a strained history with sexual minorities. In the first edition of the American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders (DSM-I, 1952), homosexuality is listed as a mental illness. For more than three decades, same-sex sexual orientation has been declassified as a diagnosable mental illness within the fields of professional psychology and psychiatry. Conversion therapies were designed to help individuals with same-sex attractions live a heterosexual lifestyle. These therapies were not only unsuccessful, they were psychologically harmful and at times physically painful to patients. Although there is a significant correlation between sexual minorities and mental health problems, there continues to be a great deal of bias and confusion in the mental health field about the relationship between sexual orientation and mental health (Herek & Garnets, 2007). QUOTE FROM PAGE 354? Understanding Prejudice against the LGB Population

3 Herek (1989) pointed out that, although other racial, ethnic, or religious minorities suffer from similar prejudices, the impact of overt discrimination and intolerance is unique to gay men and lesbian women as government, religious, and social institutions often condone prejudices held against them. For example, denying gay men and lesbian women the right to marry sends the message to the public that discrimination against this particular group is, at some level, acceptable. Research has revealed differences in attitudes toward homosexuality based on factors such as gender, religiosity, and political orientation (Herek, 2002; Hicks & Lee, 2006; Schulte & Battle, 2004). The political climate surrounding views on homosexuality tend to be dependent on the populations religious views and the resulting cultural values (Buchanan, Dzelme, Harris, & Hecker, 2001; Morrow, 2003; Pew Forum on Religion and Public Life, 2003; Pew Forum on Religion and Public Life; 2008). Some research has found that religion underpins opposition to homosexuality, more so than political affiliation, ethnicity, or socioeconomic status (Pew Forum on Religion and Public Life, 2003). There are potential geographic differences in the acceptance and expression of bisexuality that may be related to religious communities. Hoburg, Konik, Williams, and Crawford (2004) noted that male heterosexual students from North Eastern colleges were more than twice as likely to admit to same-sex attraction than students attending a university in the North West. The current anti-gay movement in reaction to the recent push for civil rights creates additional hardships for LGBT individuals (Cianciotto & Cahill, 2006; Rotosky, Riggle, Horne, & Miller, 2009). Whitley (2001) reported similar findings of negative attitudes toward gay men and lesbian women, noting that the best predictors of these attitudes were gender (i.e., men held more

4 negative attitudes than women), endorsement of gender role norms, negative attitudes toward women, and sexist beliefs. Some researchers believe that it is the unequal protection of rights and liberties for individuals that contribute to a homophobic and transphobic culture (The National Coalition of Anti-Violence Programs [NCAVP], 2009). Within a homophobic and transphobic culture, discriminatory practices and even violence become more acceptable. Homophobic beliefs permeate the culture of the United States so completely that most Americans recognize this homophobic atmosphere by the end of elementary school (Dworkin & Yi, 2003). Condoned negative attitudes risk being acted upon in the form of physical aggression (DAugelli, CITE). In the past few years, there has been a strong anti-LGBT backlash in response to increased civil rights for persons of sexual minority status (Levitt, Ovrebo, Anderson-Cleveland, Leone, Jeong, Arm, et al., 2009). Hate Crimes and Bullying Violence against lesbian, gay, bisexual, and transgender (LGBT) individuals is on the rise (NCAVP, 2009). A hate crime can be defined as one in which the victim is selected because of his or her actual or perceived race, color, religion, disability, sexual orientation, or national origin (Department of Justice, 1990; Conklin,1992). The motivation behind hate crimes is to terrorize or intimidate an entire community by seeking to injure one member of that community (Marzullo & Libman, 2009). Hate crimes differ from other crimes in several ways: (1) they typically involve excessive violence, (2) the perpetrator does not generally know their victim personally, (3) the crime or attack is not planned in advance, (4) these crimes are typically committed by young, White males, and (5) thee crime often involves more than one offender (Downey & Stage, 1999). Hate crimes against lesbians, gay males, and bisexual persons often

5 occur because the perpetrators are homophobic and are attempting to send a message to the broader community. The National Coalition of Anti-Violence Programs (NCAVP) provides a comprehensive examination of violent crimes against lesbian, gay, bisexual, and transgender (LGBT) people in North America. The coalition is partnership of 35 anti-violence organizations that gather detailed information concerning anti-LGBT violence in their region each year. Violence is a "physical force exerted for the purpose of violating, damaging, or abusing" (American Heritage Dictionary of the English Language, 2000). In 2008, the regions reporting to the NCAVP include the cities of Chicago, IL; Columbus, OH; Houston, TX; Kansas City, MO; Los Angeles, CA; Milwaukee, WI; New York and Rochester, NY: and San Francisco. Additional data was reported by Colorado, Michigan, Minnesota, and Pennsylvania. These regions reported a 26% increase in violent acts committed against LGB men and women reported in the last two years (from 1,579 to 2,424). Anti-LGBT violence reported to the NCAVP includes incidents such as verbal abuse, assault with or without a weapon, sexual assault, and murder. Sexual assault crimes against LGBT people have been on the rise the past three years. Reports of anti-LGBT sexual assault increased 48% in the last year (94 in 2007; 138 in 2008). The number of murders known to be a result of anti-LGB violence increased 28% from last year (from 21 to 29). Twenty-nine murders in one year is the highest number ever reported. This number was matched once before in 1999, the year following the violent murder of Matthew Sheppard for being an openly gay man. The Federal Bureau of Investigation (FBI) collects data related to sexual orientationbased hate crimes. Although, the number of anti-LGB crimes is under-reported and data related to crimes related to gender identity are not collected at the federal level. Anecdotal evidence

6 provides several reasons why the number of orientation-based crimes is underestimated. Foremost, LGB victims may not report these crimes to local authorities because they do not wish to be identified as a sexual minority in a police report. In addition to individuals lack of reporting orientation-motivated crimes, law enforcement responding to such incidents may not perceive the crime to be hate-motivated or may not have protocols in place to report such hate crimes. Lastly, crimes against individuals of multiple minority identities can be oversimplified by the FBI and categorized as a multiple bias attack (Marzullo & Libman, 2009). Bullying The challenges unique to lesbian, gay, and bisexual youths are mostly caused by cultural and institutional victimization as well as direct attacks (DAugelli, 1998, p. 206). Impact of Violent Acts The abundant evidence of anti-LGBT prejudice and violence across the United States fails to appreciate the impact these crimes have on the LGBT community and the impact these hate crimes have on the whole country. The motivation behind hate crimes is to terrorize or intimidate an entire community by seeking to injure one member of that community (Marzullo & Libman, 2009). Violence targeted at people because of their perceived sexuality can be damaging to their health, both psychologically and physically. The impact of bias-motivated violence on the LGBT community is multitudinous. Victimization of lesbian women, gay men, and bisexual individuals (LGB) has been linked to a number of problems for the victim following the attack. Victimization (i.e., ridicule, physical attacks) during childhood for LGB individuals has been associated with a number of mental health problems (Remafedi, Farrow & Deisher, 1991; Shaffer, Fisher, Hicks, Parides & Gould, 1995). Rivers (1996) stated that LGB youths who experience victimization due to their

7 sexual orientation are at greater risk for suicidal behavior. George and Behrendt (1988) suggested that victimized LGB individuals with lower self-esteem evidence difficulties in maintaining intimate relationships. Herek (1994) also reported that criminal victimization has negative effects on the victims of such crime, such as depression and anxiety, sleep disturbances, suicidal ideation) and interpersonal difficulties. Some research suggests that hate crime victimization is more psychologically detrimental than traditional crime victimization. Herek, Gillis, and Cogan (1999) indicate that hate crime victims report more symptoms of depression, anger, anxiety, and posttraumatic stress than victims of traditional crimes and participants who did not experience victimization. These findings are consistent with the notion that identity related stressors are experienced more negatively and are more closely tied to mental disorder. Therefore, exploring victimization based on sexual identity may be instrumental for understanding the relationship between same-sex attraction and mental health outcomes. The patterns of victimization among LGB individuals have been compared to that of rape victims (Rivers & DAugelli, 2001). In fact, victims of hate crime assaults are often blamed and characterized as deserving their attack in much the same way that rape victims (Herek, 1994). However, along with the direct impact that victimization has on an individual, secondary victimization (i.e., being outed) is also a problem for LGB individuals. They may often find themselves in situations of discrimination from those who learned about their sexual orientation because of the attack. This scenario may lead to further deleterious consequences such as loss of employment, child custody, or relationships (Herek, 1994). Further, the impact of secondary victimization may prevent reporting of some hate crimes.

8 Victimization (i.e., ridicule, physical attacks) during childhood for LGB individuals has been associated with a number of mental health problems (Remafedi, Farrow & Deisher, 1991; Shaffer, Fisher, Hicks, Parides & Gould, 1995). Rivers (1996) stated that LGB youths who experience victimization due to their sexual orientation are at greater risk for suicidal behavior. George and Behrendt (1988) suggested that victimized LGB individuals with lower self-esteem evidence difficulties in maintaining intimate relationships. Impact of Stigma and Prejudice Internalized homophobia. Anti-LGBT stigma can be internalized by sexual minorities. Internalized homophobia may be detrimental to an individuals sexual identity development, the quality of their romantic relationships, self-esteem, and psychological wellbeing (Frost & Meyer, 2009; Herek, Gillis, & Cogan, 2009; Sherry, 2007; Szymanski, 2009). Mental Health Needs Public health research consistently documents mental health differences between heterosexual and homosexual or bisexual adolescents. Specifically, studies indicate that adolescents with same-sex attractions are more likely than those without such attractions to report mental health problems (Fergusson, Horwood, & Beautrais, 1999; Noell & Ochs, 2001; Remafedi, French, Story, Resnick, & Blum, 1998). Researchers in this area have long held that the poor mental health outcomes of those with a stigmatized status may be resultant from external stressors such as discrimination and internalized homophobia. Teasdale and Bradley-Engen (2010) utilize the social stress model to explain the vulnerability to mental health problems that individuals with same-sex attractions have when compared to individuals with opposite-sex attractions. The social stress model states that mental

9 health difficulties are positively correlated with the level of stress experienced by an individual and mediated by that individual's level of social support. Oetjen and Rothblum (2000) found that perceived social support from friends was the strongest predictor of variation in depressive symptoms among lesbians. Similarly, Vincke and Bolton (1994) found that low levels of social support associated with the gay male identity resulted in higher levels of depressive symptoms and less self-acceptance. In addition, Hershberger et al. (1997) found that the loss of friends resulting from the disclosure of sexual identity was a significant predictor of suicide attempts. Indeed the lack of social support experienced by many gay teens may be a significant predictor of mental health problems. Specifically, in-depth interviews and questionnaires with both youth and adults reveal that homosexual and bisexual individuals are more likely than their heterosexual counterparts to report negative mental health outcomes, such as depressive symptoms, suicidal ideation and attempts, anxiety, and substance abuse (Fergusson et al., 1999; Noell & Ochs, 2001; Remafedi et al., 1998; Savin-Williams, 1994). Moreover, this association between mental health and sexual orientation appears to be independent of childhood sociodemographic and family functioning factors, such as maternal age, education, ethnicity, family size, family socioeconomic scale, quality of early parentchild interactions, frequency of parental change, parental conflict, and history of parental offending (Fergusson et al., 1999, p. 878). Data from the National Comorbidity Study indicate that respondents who reported having at least one same-sex romantic partner had higher prevalence rates of anxiety, mood, and substance abuse disorders over the previous year, and over their lifetimes, when compared to heterosexual respondents (Gilman et al., 2001).

10 Similarly, Cochran and Mays (2000), using data from the third National Health and Nutrition Survey, found that individuals reporting any same-sex partner were more likely than other individuals to have used mental health services during the year prior to interview. There is some evidence suggesting that the relationship between mental health and samesex attraction is conditioned by gender. Specifically, Cochran and Mays (2000) reported that gay males are significantly more likely than heterosexual men to experience major depression and panic attacks, while lesbians are more likely than heterosexual women to report substance abuse disorders. Lesbian, gay, and bisexual individuals seek therapy at higher rates than the general population (Cochran, 2001; DAugelli, 2002). LGBT persons are at an increased risk for suicide and self-injurious behaviors (Alexander & Clare, 2004). LGBT persons report higher rates of substance use and abuse (Cochran & Mays, 2006). Link this specifically to the problem. Although LGBT individuals seek out therapy at a higher rate than the heterosexual population, counselors continue to receive inadequate training in sexual minority competencies (Bidell, 2003). This is especially true related to training related to the unique experiences of bisexual men and women Defining Bisexuality In research investigating the psychological well-being of lesbian, gay and bisexual individuals rates of depression and anxiety are highest among those individuals who identify as bisexual (DAugelli, 2003). Bisexuality challenges the dichotomous view of gender and sexuality. Historically bisexuality was thought to be a temporary stage in adolescent development or a step towards developing a lesbian or gay identity (Firestein, 2008).

11 Within the heterosexual community, partners who share their bisexuality in a monogamous relationship may be viewed as untrustworthy (Firestein, 2008). Sometimes their partner may feel they could not adequately satisfy their emotional or sexual needs. Within lesbian and gay communities bisexuality is often challenged as a valid sexual identity (Eliason, 1997). Bisexuals who internalize these biphobic beliefs are more likely to experience mental health problems (Herek, 2007; Herek & Garnets, 2007). Although bisexual individuals will continue to struggle with internalized biphobia throughout their life their bisexual identity is considered to be stable (Diamond, 2003; Diamond, 2008). Research focused on understanding the experiences of lesbian, gay, and bisexual (LGB) people has been increasing in professional literature. A significant amount of this research groups these three groups together and may understate important differences of each group. Research focusing exclusively on the experiences of individuals who identify as bisexual is needed. Research in the area of bisexuality is increasing, yet they continue to be grouped in with gay and lesbian research without considering the unique experiences and discrimination they may endure (Balsam & Mohr, 2007; Klein, 1995). This research is important to educate psychologists about the social climate regarding bisexuality and how that impacts an individuals development (APA, 2000; APA, 2002a; APA, 2002b). The need for a more affirmative approach to understanding how bisexuals experience the world is needed (Bradford, 2004).

12 Specifically, further researching the experiences of bisexual individuals will inform more affirmative therapeutic interventions that are much needed for sexual minorities (APA Task Force on Appropriate Therapeutic Responses to Sexual Orientation, 2009; Dworkin, 2001). THEORY Attribution theory seeks to understand how people interpret the world around them. In psychology, attribution theory specifically analyzes how people explain other peoples behavior as well as their own. Causal attribution describes the causes people ascribe for peoples behavior. Heider (1958) describes two main explanations as to the reason for individual behavior, internal or dispositional causes and external or situational causes. Attributing a persons behavior to their personality or character would be an example of an internal cause, whereas an external causal attribution would focus on the context of the individuals environment to explain their behavior. Another example of an internal cause of behavior would be genetics. In general, when a person uses an external attribution to interpret an individuals behavior that individual may not held to the same level of accountability as the person whose behavior is interpreted using an internal attribution. External attributions focus on environmental factors to understand individual behaviors. External factors are understood to be beyond the individuals control, whereas internal factors are believed to be within an individuals control. In this study, we will utilize Weiner's attribution theory of controllability to examine beliefs about the origins of sexual identity. According to attribution theory, individuals who perceive homosexuality as a choice, learned, or environmental tend to have a more negative affect toward homosexuals and are less likely to support policies deemed as gay rights. Individuals who perceive sexual orientation as biological or genetic in origin tend to have a more

13 positive affect toward sexual minorities and are more likely to support gay rights (Haider-Markel & Joslyn, 2008; Hegarty & Pratto, 2001; Sakalli, 2002). Previous research has not connected attribution theory and its related bias to the additional prejudice experienced by the smaller subsets of sexual minorities, specifically individuals who identify as bisexual. This paper is interested in the opinions of the public, as to the causation attribution for why some individuals are bisexual. To what extent, if any, does attribution influence their prejudice or discrimination towards individuals who are bisexual? Purpose of the Study (should flow naturally from the literature discussed in the INTRO) There is a significant lack of research in the unique experiences of bisexual individuals. Little research has been conducted evaluating the influence of geographical location. Dworkin (2002) stated that it is psychologists responsibility to promote social justice for LGBT individuals. This study Research Hypotheses (should flow naturally from the literature discussed in the INTRO) 1. It is hypothesized that self-identified bisexuals who live in urban cities will be different from those that live in rural areas. 2. It is hypothesized that self-identified bisexuals who live in the Midwestern United States or Southern United States experience different rates of discrimination than those that live in the Northeastern or Western United States. Assumptions The following are the assumptions for the proposed study: 1. Participants will complete the questionnaires in a consistent and honest manner. 2. The measures used in the study assess the intended constructs.

14 Discrimination leads to _____________, which leads to _____________________, which leads to _______________________ . . . (and so on).

15 CHAPTER TWO LITERAURE REVIEW Brief introduction to epidemiological research in sexual minorities. Sexual minorities include... back that up with research. Psychoanalytic research in the early 20th century replaced the idea of multiple nonnormative "inversions" with the totalizing concept of "homosexuality" (Sullivan, 2003, p. 103). This trend has persisted in modern-day research and consequently, most of the research reviewed in this paper use categories of gay, lesbian, and bisexual. Most studies asked respondents to selfidentify and assessed their past sexual experiences. In general, there is a lack of research on gay, lesbian, and other queer-identified individuals (Cochran, 2001, MORE). Few government health agencies have sponsored national studies to measure mental health in sexual minority populations. In those national studies that have collected data on sexual minority populations, sexual minorities tend to be under-sampled, resulting in low statistical power (McKenzie et al., 2002). The gap in research may be a resulted of the strained relationship history between psychiatry and the gay and lesbian communities. Homosexuality was pathologized by the American Psychiatric Association in the first three publications of the Diagnostic and Statistical Manual (DSM-III; 19??). Subsequently psychologists and psychiatrists application or misapplication of reparative therapies further damaged the strained relationship (King & Bartlett, 1999). Research in the area of sexual minorities frequently clump sexual minorities together, or exclude smaller groups of sexual minorities, such as individuals who identify as bisexual or transgender, to increase the statistical power of their empirical findings. The consequences of

16 ignoring these groups in empirical research are twofold, the mental health is sexual minorities is limited, the needs of smaller groups of sexual minorities are misunderstood and underestimate/may be missing/opportunities to help. This study may help inform training in "gay affirmative" therapies and anti-bullying and anti-homophobia policies. Sexual Orientation Because of the social stigma around same-sex orientation, the estimated number of sexual minorities living in the United States have been inexact (Cochran, 2001). Recent national-based surveys have included items addressing the respondents sexual orientation. The census data collected from the 2000 and 2005 United States census estimate there are 8.8 million lesbian, gay, and bisexual individuals living in the United States, approximately 3% of the total population. Sexual Orientation and Mental Health Outcomes Research in the field of psychology, psychiatry, sociology, public health, and a number of other disciplines consistently link poor mental health outcomes to sexual orientation (Cochran & Mays, 209; Eisenberg & Wechsler, 2003; Hatzenbuehler, McLaughlin, & Nolen-Hoeksema, 2008; Koh & Ross, 2006; Mathews, et al., 2002; Savin-Williams & Ream, 2003). Poor mental health outcomes liked to sexual orientation include, but are not limited to, depression, anxiety, substance use disorders, and suicidality (Hatzenbuehler, 2009). Bagley and Tremblay (2000) note a British law that "forbade the use of public funds for counseling and support of homosexual youth in schools and in some health and social service settings. They also observed there was "virtually no relevant British research on [sexual minorities and mental health]" at the time of their research (Bagley & Tremblay, 2000, p. 111).

17 These observations support the empirical results, which show that the United Kingdom has among the highest prevalence of poor mental health outcomes among gay men. Public health research consistently documents mental health differences between heterosexual and homosexual or bisexual adolescents. Specifically, studies indicate that adolescents with same-sex attractions are more likely than those without such attractions to report mental health problems (Fergusson, Horwood, & Beautrais, 1999; Noell & Ochs, 2001; Remafedi, French, Story, Resnick, & Blum, 1998). Researchers in this area have long held that the poor mental health outcomes of those with a stigmatized status may be resultant from external stressors such as discrimination and internalized homophobia. Cochran et al. (2003) evaluated the psychopathology and the utilization of mental health services by self-identified lesbians, gays, and bisexuals (LGB) in the United States. Cochran et al. used data from the MacArthur Foundation National Survey of Midlife Development in the United States (MIDUS; Brim et al., 1996) to examine the relationship between mental health and sexual orientation. MIDUS asked respondents to identify their sexual orientation, answer questions about their mental health, and to answer questions about using mental health services that year. An important limitation to note is that only 73 of the more than 30,000 repsondents identified as LGB and many respondents failed to note their sexual orientation. Using the small sample size, Cochran et al. found the LGB respondents noted significantly higher rates of mental health morbidity, comorbidity, and mental health service utilization. Specifically, the LGB respondents reported significantly higher rates of anxiety, mood, and substance use disorders. The greatest difference between male respondents who identified as gay or bisexual and their heterosexual counterparts was reported in their levels of panic disorder and depression. The gay or bisexual male respondents reported higher rates of current psychological distress and

18 retrospective reports of mental health morbidity in adolescence. For women, the extreme difference between the lesbian or bisexual women and their heterosexual counterparts was reported in the rate of generalized anxiety disorder. According to the researchers, 20% of men and 24% of women of the self-identified LGB group met criteria for two or more psychological disorders in the past year. These comorbidity rates, an indicator of illness severity and service utilization, were found to be three to four times higher in the LGB population when compared to heterosexual counterparts. Although only 2.4% of the respondents identified as LGB, they did constitute 7% of the group of respondents who utilized mental health treatment. In a more recent study, researchers explored differences between lesbian, bisexual, and heterosexual women regarding mental health issues in the United States (Koh & Ross). Among the sample of 1304 women (524 lesbians, 134 bisexuals, and 637 heterosexuals), the researchers found that minority sexual orientation significantly influenced the probability of experiencing emotional stress. In particular, they found that bisexual women were twice as likely as lesbian women to have an eating disorder. They also discovered that a womans level of outness correlated significantly with experiencing mental health problems. Lesbians who were not open about their sexual orientation and bisexuals that had disclosed their sexual orientation with others were more than twice as likely to have experienced suicidal ideation in the past 12 months. The womens level of outness also correlated significantly with past suicide attempts, lesbians and bisexual women who were not out were more likely than heterosexual women to have reported at least one suicide attempt in their past. Social Stigma, Sexual Orientation, and Mental Health Outcomes Teasdale and Bradley-Engen (2010) utilize the social stress model to explain the vulnerability to mental health problems that individuals with same-sex attractions have when

19 compared to individuals with opposite-sex attractions. The social stress model states that mental health difficulties are positively correlated with the level of stress experienced by an individual and mediated by that individual's level of social support. Oetjen and Rothblum (2000) found that perceived social support from friends was the strongest predictor of variation in depressive symptoms among lesbians. Similarly, Vincke and Bolton (1994) found that low levels of social support associated with the gay male identity resulted in higher levels of depressive symptoms and less self-acceptance. In addition, Hershberger et al. (1997) found that the loss of friends resulting from the disclosure of sexual identity was a significant predictor of suicide attempts. Indeed the lack of social support experienced by many gay teens may be a significant predictor of mental health problems. Specifically, in-depth interviews and questionnaires with both youth and adults reveal that homosexual and bisexual individuals are more likely than their heterosexual counterparts to report negative mental health outcomes, such as depressive symptoms, suicidal ideation and attempts, anxiety, and substance abuse (Fergusson et al., 1999; Noell & Ochs, 2001; Remafedi et al., 1998; Savin-Williams, 1994). Moreover, this association between mental health and sexual orientation appears to be independent of childhood sociodemographic and family functioning factors, such as maternal age, education, ethnicity, family size, family socioeconomic scale, quality of early parentchild interactions, frequency of parental change, parental conflict, and history of parental offending (Fergusson et al., 1999, p. 878). Data from the National Comorbidity Study indicate that respondents who reported having at least one same-sex romantic partner had higher prevalence rates of anxiety, mood, and

20 substance abuse disorders over the previous year, and over their lifetimes, when compared to heterosexual respondents (Gilman et al., 2001). Similarly, Cochran and Mays (2000), using data from the third National Health and Nutrition Survey, found that individuals reporting any same-sex partner were more likely than other individuals to have used mental health services during the year prior to interview. There is some evidence suggesting that the relationship between mental health and samesex attraction is conditioned by gender. Specifically, Cochran and Mays (2000) reported that gay males are significantly more likely than heterosexual men to experience major depression and panic attacks, while lesbians are more likely than heterosexual women to report substance abuse disorders. Lesbian, gay, and bisexual individuals seek therapy at higher rates than the general population (DAugelli, 2002). LGBT persons are at an increased risk for suicide and selfinjurious behaviors (Alexander & Clare, 2004). LGBT persons report higher rates of substance use and abuse (Cochran & Mays, 2006). Link this specifically to the problem. Although LGBT individuals seek out therapy at a higher rate than the heterosexual population, counselors continue to receive inadequate training in sexual minority competencies (Bidell, 2003). This is especially true related to training related to the unique experiences of bisexual men and women The 12-month prevalence of suicide ideation attempts among gay and bisexual adolescent males was even higher than the lifetime prevalence among adult men. These findings reinforce the theory that younger sexual minority men and women are at higher risk for mental illness and suicidal behaviors and that "minority sexual orientation and gender atypicality are early magnets for mistreatment" (Cochran, 2001, p.937).

21 These findings reinforce a "model in which being a [gay, lesbian, or bisexual youth] at risk of suicidal behavior involves four factors--increased drug and alcohol risk, increased sexual activity risk, increased risk of becoming the victim of violence, and increased risk of becoming defensively violent" (Bagley & Tremblay, 2000, p.115). Drug and alcohol abuse are both the cause and effect of anxiety and depression. Furthermore they may contribute physical health outcomes such as risky sexual behavior and attempted suicide in adult gay men (Botnick et al., 2002; Paul et al., 2002; Diaz et al., 2001). Bisexuality Bisexuality as a concept has been around since Categories of sexuality (gay vs. bisexual) and the methods of identifying those categories also influence health outcome data. Bisexual youth are of particular interest because more students typically report bisexuality or relationships with/attraction to both genders rather than exclusively same-gender sexual identities. Furthermore, bisexual students tend to report fewer protective factors than gay or lesbian students (Saewyc et al., 2009). Consequently, bisexual youth are often two or more times as likely to experience certain negative mental health outcomes than their gay and lesbian counterparts (Robin et al., 2002; Balsam et al., 2005). Robin et al. (2002) observed a 16.5% suicide attempt rate for Vermont youth with samesex partners only and 43.5% for those with partners of both sexes. These data suggest the need to research bisexual youth and adults as a separate group. Individuals with sexual minority identities who hold strong traditional religious values have the additional challenge of reducing the dissonance between these two identities (Beckstead & Morrow, 2004).

22 LGBT individuals response to the anti-LGBT client is dependent on a number of individual factors (Floyd & Bakeman, 2006; Szymanski, 2009). Huh? In addition to religious conflicts, individuals from minority cultures struggle more with their bisexual identity (Blackwood, 2000; Crawford, Allison, Zamboni, & Soto, 2002; Gamson & Moon, 2004; Israel, 2004; Szymanski & Gupta, 2009). Women are believed to have more fluid sexualities than men and are considered by some researchers to be inherently bisexual (Kinnish, Strassberg, & Turner, 2005). A number of popular misconceptions about bisexuality stem from the belief that bisexuality, unlike homosexuality, is not biologically determined. BISEXUAL MISCONCEPTIONS. BIPHOBIA. Common misperceptions of individuals who are bisexual include the idea that individuals who identify as bisexual are just 'acting out.' Internalized negative stereotypes impact internalized biphobia. Bisexuals are psychologically maladjusted, since they do not fit into the dichotomized view of sexuality (Fox, 2003). Stigma from both sides, gay community and the heterosexual community. Attribution Theory or Biological Determinism Causal attribution is the explanation people use to describe the cause or causes of the behavior of individuals. Heider (1958) describes two main causal attributions for individual behavior, internal or external causes. Internal causes for behavior may include genetics, personality, Attribution theory is complex. When an individual's behavior or lifestyle can be attributed to a biological explanation, prejudice, and discrimination is reduced. MORE.

23 Individuals who believe that sexuality is biologically determined attribute the behavior to biology and express less prejudice toward the individual. MORE. Weiner, 1985 & Weiner, 1995 (BOOK) Feather, 1996 Whitley, 1990 Crandall et al., 2001 Hegarty and Pratto, 2001 & Hegarty, 2002 Sakalli, 2002 Haider-Markel & Joslyn, 2008 Lewis, 2009 Research Questions and Hypotheses Prior researchers have clearly demonstrated the linke between sexual orientation and mental health outcomes (cite; cite; cite). Additionally, prior researchers have provided evidence for the relationships between (cite; cite; cite), as well as (cite; cite; cite) reflecting the complexity of sexual identity. Finally, relationships between sexual orientation and mental health difficulties brought on by stigmatization and oppression have been well documented (cite; cite; cite). These bodies of literature formed the basis for the following research questions and hypotheses. Research question 1. The first research question was, Which variables are significant predictors of prejudice against bisexuals? It was hypothesized that essentialist beliefs about sexual orientation would be a significant predictor of prejudice against bisexuals. Reseach question 2. The second research question was, Which variables

24 CHAPTER THREE METHODS Participants Individuals who self-identify as bisexual and are at least 18-years-old will be eligible to participate in the proposed study. Instrumentation There will be an X amount of questionnaires for the participants to complete, including: a) the Demographics Questionnaire, b) X, c) Y, and d) Z. It is expected that the four questionnaires will require approximately 20 minutes to complete. Informed Consent (see Appendix F). An Informed Consent was created Demographics Questionnaire (see Appendix A). A Demographics Questionnaire was created to collect information about the participants sex, gender, age, etc. Assessment Tool One (see Appendix B). The Assessment Tool One was developed as Research Design The research design for the proposed study will be Procedures Data for the study will be collected via an online survey. Participants will be recruited using Data Analysis Data analysis will involve Limitations

25 CHAPTER IV RESULTS Level of Prejudice The first hypothesis was that

26 CHAPTER V DISCUSSION The present study explored sexual orientation, bisexuality, and causal attribution.

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