The persistence of mental health hardships among gay and bisexual men, which endure even as LGBTQ people gain greater acceptance and civil rights, can be explained at least in part by the corrosive effects of status consciousness, competitiveness and racism within the gay community itself.

Those are the striking and potentially controversial findings of a study published in January in the Journal of Personality and Social Psychology that may broaden appreciation of the unique stressors faced by gay and bisexual men.

Gay and lesbian people have a more than fourfold higher rate of suicide than the general population. Among transgender people, the gulf is even wider. LGBTQ people are more than twice as likely as heterosexuals to experience depression and anxiety and to misuse substances, which can all fuel HIV risk.

Over the last two decades, an expanding body of scholarship has attributed these disparities to anti-LGBTQ stigma.

“But that argument feels not totally complete for many LGBTQ people,” says John Pachankis, an associate professor of public health and psychiatry at Yale and the lead author of the new study.

Travis Salway, an assistant professor of social epidemiology at Simon Fraser University in British Columbia, says the excessive suicide rate among sexual and gender minorities is “too large of a disparity for it to be explained, certainly by chance and probably by even one factor”.

Past research into such mental health disparities, both academics said, has typically overlooked drags on mental health that may come from within sexual and gender minority subcultures.

John Pachankis. Photograph: Chris Cassidy

In 2017, the journalist Michael Hobbes bucked this trend in a deep dive for HuffPost into what he called an epidemic of gay loneliness. The article’s popularity among gay and bisexual men was a testament to a hunger for narratives that validate persistent feelings of unease about gay culture.

Pachankis’s paper represents the field of psychology catching up with something that to many has long been painfully self-evident: gay men can be awfully hard on each other. Moreover, as the paper suggests, the pressure to keep up with the Joneses can be profoundly taxing in ways unique to this segment of the population.

Sources of stress

A small handful of papers have laid the groundwork for exploring the deleterious effects of stressors within the gay community. Pachankis’s study is the most rigorous yet.

The five-year study is based on five psychological studies, including four meticulously designed experiments with nine cohorts of gay and bisexual men.

Pachankis and his colleagues found that the stress gay and bisexual men reported experiencing related to their community’s preoccupation with sex, status and competition, as well as racism within their ranks, was associated with compromised mental health, especially for those lower on the gay-status totem pole.

These connections held even when the investigators controlled for traditional factors tied to the stress of being a stigmatized sexual minority as well as general life stress.

Pachankis’s research suggests factors such as physique, income and race can be major sources of anxieties

The study culminated with a series of experiments in which gay and bisexual men participated in a chat room with other men. When the participants experienced rejection from gay or bisexual men they perceived to be of superior status, because of a higher level of masculinity, attractiveness and income, this proved particularly stressful.

Such a status imbalance did not intensify feelings of rejection if the higher-status man was straight.

Rejection from gay and bisexual peers, Pachankis found in a follow-up study soon to be published in the Annals of Behavioral Medicine, was also associated with an increased likelihood that men would engage in sex that put them at risk for HIV.

This finding reveals an apparent blind spot in HIV prevention. The preponderance of stress-related psychological research about HIV risk among men who have sex with men has focused on stress related to anti-LGBTQ stigma and not on the effects, for example, of receiving persistent rejections and cutting or racist remarks on hook-up apps.

“In the HIV-risk article,” Pachankis says, “we repeatedly mention, ‘Why not look at the people gays are actually having sex with as sources of stress?’”

As the Journal of Personality and Social Psychology paper describes, men in all global cultures are inclined toward competitiveness and driven by a need to prove their manhood. Thus, any subculture composed entirely of the male sex – think the NFL or a frat house – is likely to be intrinsically status conscious.

Within gay male culture, such competition is compounded by the fact that members compete for social and sexual gain and for sex with each other.

Pachankis’s research suggests factors such as physique, income and race can be major sources of compare-and-despair anxieties that have become ever-more insidious as Instagram and apps such as Grindr and Scruff quantify with often excruciating and demoralizing precision where men stand in the pecking order.

Additionally, unlike their straight counterparts, sexual minority men can assess their own personal sexual status using standards they would apply to potential partners. This can create a mental feedback loop and give rise to a kind of sexual arms race. Body-conscious gay men often go to extensive lengths to outmatch competitors and attract higher-status men.

I would hope this set of findings would never compromise the drive for LGBTQ equality John Pachankis

Such efforts can give rise to body dysmorphia, eating disorders and harmful use of anabolic steroids, says Aaron Blashill of San Diego State University, who researches body image among men who have sex with men.

Local men in his studies rarely report, he says, “‘I had a really difficult week because someone called me a fag.’ It’s much, much more common that folks are talking about intraminority stressors of a lot of dating apps, judgment, and sexual racism within the community.”

‘No silver bullet’

Historically, most psychological research into health and mental health disparities among sexual minorities has focused on the trauma of growing up and living in a homophobic society.

In 1957, psychologist Evelyn Hooker published a groundbreaking study that found homosexuals were psychologically healthy, comparable to heterosexuals in that regard. Such research would contribute to the watershed de-listing of homosexuality as a mental disorder by the American Psychiatric Association in 1973.

Starting in the mid-1990s, researchers began to recognize that sexual minorities experience disproportionate rates of anxiety and substance use disorders, suicidal behaviors and ideations and depression, compared with heterosexuals.

A model poses for a photo to illustrate anxiety. Photograph: Chris Black/Getty Images

In 2003 Ilan H Meyer, a University of California, Los Angeles psychiatric epidemiologist, established what is known as minority stress theory, which explains health and mental health disparities between sexual and gender minorities and the general population as a function of anti-LGBTQ stigma and prejudice.

Minority stress theory has proved influential in shaping LGBTQ civil rights campaigns and court cases as well as a prevailing media narrative that focuses on the harms a heterosexist, transphobic society inflicts on queer people.

Pachankis’s Personality and Social Psychology paper introduces a new paradigm he calls the “gay community stress theory” and which is meant to complement minority stress theory. The new theory provides a framework to explore many seldom-studied aspects of gay life that shape mental health.

“This paper and this work on intra-gay community stress,” Meyer says, “is definitely pointing to a problem that LGBTQ advocates and community centers and people who deal with therapy or reducing distress in these communities need to pay attention to.”

Pachankis, Meyer and others have nevertheless expressed concern that the new findings may be misconstrued or even deliberately misread and manipulated to serve an age-old narrative characterizing homosexuality as inherently damaging.

Pachankis pursued this line of research reluctantly, he says, after hearing repeated mention of the themes that would color his study from patients and participants in research. As a stigma researcher, the last thing he wanted was to provide society with a new basis for casting gay and bisexual men in a negative light.

“I would hope this set of findings would never compromise the drive for LGBTQ equality,” he says. “Every minority group must face stressors from within.”

“There may be people who try to misinterpret what this study means but the study’s findings also can support our work,” says Lambda Legal senior attorney Omar González-Pagán, who was on the legal team behind the supreme court case that legalized same-sex marriage in 2015.

Travis Salway says Pachankis’s work represents “a very healthy process we need to go through as a community whereby we look inward and ask, ‘Hey, how are we doing around treating one another?’ And if we’re not doing a great job, there’s no silver bullet. But let’s at least start talk about it, rather than pretend that everything is Pollyanna.”

Skyler Jackson, a postdoctoral fellow under Pachankis who studies intersectionality, says he hopes that “in addition to making a splash in the general arena of LGBTQ health – and gay and bisexual men’s health specifically – gay community stress theory may generate new research directions among many other populations that are at risk for intraminority stress.”

To counter the impression that membership in the gay world is overwhelmingly deleterious, Pachankis emphasizes gay men’s considerable resilience and creativity in the face of great hardship and the myriad means by which gay men provide mutual caring and support against life stressors.