One of the limitations of my work as a registered psychotherapist is that I am not allowed — nor am I equipped — to deliver mental health diagnostics. Unless the people I work with arrive to therapy with a diagnosis, like Tan and Stephen who are respectively taking medication for ADHD and depression, I cannot offer official labels to the patterns they are experiencing. This being said, I can frequently observe traits of this or that neurodivergence in my clients. Officially diagnosed — or diagnosable — or not, these personality traits definitely have an impact on people’s lives, and on their capacity to connect with others. So many of these conditions are underdiagnosed when they are not accompanied by other mental development issues, especially if the symptoms are on the mild side. For people who are assigned female at birth, many conditions are diagnosed even less frequently.
The purpose of this section is most certainly not for you to self-diagnose. However, in a book on queer men and loneliness, I figured I would be doing a disservice to my communities if I assumed that every queer man who is navigating the scene is neurotypical. From what I have heard and observed, it is definitely not the case. And although it can be very difficult to get an adult diagnosis of autism or ADHD, a good place to start if you are questioning would be to talk with your family doctor, or with a mental health professional who has the tools to offer a diagnosis, like a psychiatrist.
Autism.
Autism, or the Autism Spectrum Disorder (ASD), is a very wide spectrum of conditions that are caused by variations in the development of the brain. While there is not only one autism, but many different subtypes, most people with ASD will typically experience challenges with social skills, display an aptitude for repetitive tasks and have a more limited field of interest. People on the spectrum can also be very affected by certain artificial noises, lights, or smells, as well as display and express emotions differently than their neurotypical counterparts. Although the word “autism” is attached to a lot of stigmas, the condition can be quite easy to live with, especially when not combined with other intellectual disabilities. Different, after all, does not mean less than or broken.
Because autism is such a wide spectrum, there was a brief period during which certain people were diagnosed with Asperger’s Syndrome instead of autism. The history behind the Asperger’s Syndrome and Dr. Hans Asperger, who gave his name to the condition, is very dark and the term has been removed from the Diagnostic and Statistical Manual of Mental Health (DSM) in 2013. Asperger’s only difference from autism was a lack of language and cognitive delay. Even though it is well known that these are not symptoms every individual on the autism spectrum experiences. For this reason, many autistic activists deemed Asperger’s to be an ableist term, used only to distinguish people who were more lightly affected by ASD. To classify people in “functioning” versus “not functioning” categories, instead of viewing autism as the wide spectrum that it is. Dr. Hans Asperger, while never officially a member of the Nazi Party, was known for his eugenics views and his role in identifying children with disabilities that needed to be sent to Spiegelgrund, a children’s ward in Vienna, where they would be subjected to experimentation or would be euthanized. For all these reasons, I will not use this term in this book, and encourage you to do the same.
According to research, the number of people living with ADS varies from 1 in 60 to 1 in 90. We also know that it is wildly underdiagnosed in people who are assigned female at birth, for whom the symptoms can differ a bit. Additionally, the autism spectrum includes some people with additional developmental disabilities and lower than average intelligence, and others with average and above-average intelligence, making it hard to detect and diagnose. People with ASD can be faced with very opposing stereotypes, with some being thought of as having a low IQ and poor intellect, while others are expected to possess savant-like abilities. The latter has frequently been depicted in pop media culture; in TV shows like The Big Bang Theory (Sheldon Cooper), Glee (Brittany S. Pierce) or The Good Doctor (Dr. Shaun Murphy), in books like Harry Potter (Hermione Granger) or in movies like The Imitation Game (Alan Turing). The reality, however, is that people with ASD are placed everywhere on the spectrum of intelligence.
In 2017, Rita George and Mark A. Stokes, both from Deakin University in Australia, found that the experience of sexuality among people with ASD has a tendency to be less heteronormative. According to their research, between 20% and 40% of their subjects with ASD reported non-heterosexual orientation, with higher rates of asexuality, bisexuality and homosexuality. While these numbers are higher than in the general population, they are definitely not high enough to indicate any causation; meaning that we cannot affirm from these numbers that autism causes homosexuality. There are plenty of queer people who are not on the spectrum of autism, and likewise, many autistic people who identify as heterosexual. One part of a potential explanation for this correlation might be that autistic people, who care about social norms and understand them less, may be freer to explore their sexuality without the societal pressure of having to perform heterosexuality than non-autistic people. As for gender, Elin Skagerberg and her colleagues in 2015 found that about 50% of trans and non-binary people in their research scored mild to high on the ASD scales. This, again, is not enough to point towards causation. Once again, there are plenty of trans folks who are not autistic, and plenty of autistic people who are not trans. Based on the earliest theory, these results are even less surprising. Especially if we accept the premise that a big part of gender, gender norms and gender roles are social constructs. Of course, these are only two studies and the topic needs to be explored more, but it seems prudent to think that many of the people in our communities may be unknowingly living with ASD. Perhaps lighter on the spectrum, or displaying only some traits of autism. This might render their capacity to navigate the complex social conventions of gay interactions and gay dating much harder.
People with autism tend to learn most of their social skills by imitating others, or what they see in the media. Depending on their social skills levels, this might make their presence slightly awkward when first getting to know them. Especially if they are nervous, or meeting a lot of people at the same time. In a gay scene — or on dating apps — where there is the illusion of abundance, it can be easy to swipe left and simply ignore a slightly awkward person, without giving a chance if they are not “perfect” right away. It is much easier to get to know people with ADS in small groups or one on one settings than in a large party with a lot of strangers and loud noises. Furthermore, most people with ADS do not mind being told directly, but kindly, when one of their behaviours is disruptive. Most of them will actually prefer a direct approach to confusing or unclear non-verbal, ironic, or passive-aggressive communication. With a little bit of patience, people with ASD can become amazing friends or partners.
I had the chance to learn more about queer autistic men, the gay scene, and HIV from one of my former colleagues who was living with ASD himself. He reported that many autistic gay men were grateful for the safety that dating apps procured when meeting new people, while also frustrated that their conversations on them were often less than fruitful. He reported that some people with ADS tend to learn some rigid conversation patterns, which is not surprising when considering how redundant conversations can feel on a dating app like Grindr, instead of following the vague instruction to “just be themselves.” On the apps, many gay men with ASD found it easier to obtain sex than to obtain a meaningful relationship since, once again, the sexual conversation patterns on dating apps tend to be even more predictable and repetitive. “What are you into?” they ask, not always because they are interested in the answer, but because they know this is a question that comes quickly and regularly in this scenario. Or that keeps the conversation flowing for at least a few more messages. My colleague also cautioned me on the prevalence of drinking and drug use in queer men with ASD. As drugs, and especially alcohol, are often consumed to serve as “social lubricant,” many autistic gay men will feel the need to be drunk or high when navigating social settings. While this can be fun, even useful, from time to time, it can also be detrimental to their physical, emotional, mental and social health.
If you or anyone you know think they might be on the autism spectrum, you can find some more resources online or through your doctor. While an adult diagnosis of ASD is difficult to obtain, there is not always a need for an official diagnosis to learn more about the condition and seek out support and resources.
Attention Deficit (Hyperactive) Disorder—AD (H) D.
Attention Deficit Hyperactive Disorder (ADHD) is a very common mental condition that is most often than not associated with children, even if the condition continues in adulthood. It can come with hyperactive traits, or not (ADD) making it harder to diagnose for people who do not display hyperactivity, and for people who are assigned female at birth. The actual prevalence in Canada is between 2.5 and 4%, but since the term has been trending on social media, especially on TikTok, we have been experiencing a wave of people who are seeking a diagnosis in recent years. Unlike with autism, there are no studies showing that ADHD is more predominant in the queer communities than in the general population. However, queer kids who have been assigned male at birth may have been underdiagnosed if they presented with less “typically masculine” hyperactive symptoms, or if they found coping strategies to achieve good grades at school despite their condition.
While many people think of ADHD only as a disorder that prevents people from focusing or paying attention, ADHD affects many more aspects of life, including social interactions and interpersonal relationships. People with ADHD tend to act impulsively, saying yes to a lot of projects, for example, and either get overwhelmed by the number of things to do, or uninterested in previous activities when a new shiny object arrives. This can give the impression that they are unreliable, or simply make them disappear for long periods of time. For those who get overwhelmed with projects and can’t seem to tackle any of them, depression is often an outcome. Especially if, when younger, they were able to channel their hyperactivity into the illusion of being an overachiever. These depressive periods, which are too rarely linked by professionals with ADHD — especially in adulthood —, can leave them isolated for long periods of time. A lack of impulse control can also make it harder for them to regulate their emotions and their reactions while in social settings. This can make them appear disorganized, aggressive, overly sensitive, intense, or disruptive, all traits that can push people away and can lead to the development of social anxiety.
For people with ADHD, it will always be difficult to focus on something with long-term benefits, like settling down and working on a school paper ahead of time, instead of something that will offer them immediate rewards, like posting a new photo on Instagram. This tendency can make them the most exciting person to be around on one night, if they focus their attention on you, and an almost complete stranger the next day, when they have to finish one million tasks for work. This constant quest for dopamine can also make them more susceptible to developing bad relationships with drugs and alcohol, which can also affect their relationships with friends or romantic partners.
Social interactions, especially dating, often demand time, dedication, attention and focus. Making it harder for people with ADHD, who can be the life of a party, to be fit for one-on-one connections. Since it is an invisible and underdiagnosed disability, many adults with ADHD can be suffering with what they think is loneliness, depression, burnouts, anxiety or simply a feeling of “not being as good as everyone else.” And all of these feelings can definitely affect their capacity to make, but especially maintain, meaningful connections. Even when they know their behaviours are hurting their loved ones. Because of this, undiagnosed or untreated ADHD is often felt like a defect of a character flaw.
Because of the nature of the medication prescribed for ADHD, it can be very difficult to advocate for a diagnosis as an adult. Especially without presenting with the typical hyperactivity since childhood. Additionally, because of the nature of the symptoms, many people are experiencing kinship to ADHD. Truth be told, who doesn’t prefer an immediate reward than a delayed long term benefit? This leaves people living with ADHD having to compete for resources with people who self-diagnosed after hearing influencers oversimplify the condition on social media. Many people with ADHD also find themselves having a hard time jumping through all the administrative hoops that can get in the way of receiving proper treatment. If you think you might have ADHD, find more information online or talk to your doctor.
Borderline Personality Disorder — BPD
Borderline Personality Disorder (BPD), is a mental health condition that impacts the way a person feels about themselves and others. It commonly includes low self-esteem and body image issues, difficulty regulating emotions and managing behaviours and, most importantly for this book, difficulty in keeping stable and reliable relationships. People living with BPD commonly have an intense fear of abandonment, and can rarely tolerate being alone. However, because of their difficulty in managing feelings and behaviours, they tend to accidentally push people away. Notably through frequent mood swings, inappropriate anger reactions, or by putting the people they love (or the status of an emerging relationship) on an unmaintainable pedestal.
Some of the other symptoms that are frequently seen in BPD are a rapid shift in self-identity — that can go from feeling on top of the world one moment to less than nothing the next —, a rapid shift in life goals and life values, thinking a new project or a new life philosophy will magically solve all their problems, periods of stress or paranoia that can leave them out of touch with reality, impulsive and risky behaviours like drugs or gambling, but also like quitting a job on impulse or sabotaging other successes, ongoing feelings of emptiness and suicidal threats or behaviour of self-injury. While this list can feel very long and dire, many people with BDP get better with knowledge, medication and treatment and can learn to live a very satisfying life.
Research estimates that about 1–2% of the population lives with BPD. However, it seems that queer people are almost twice as likely than their straight counterparts to be diagnosed with the condition, making the prevalence within the queer community at 2–4%. Although some risk factors for BPD come for hereditary predispositions, it can also develop from a stressful childhood. While it is not very difficult to imagine that queer people would generally have a more stressful childhood, we also need to note that not every person who had a difficult childhood will develop BPD. Dr. Craig Rodrigues-Seijas, however, suggest in two studies published in 2020 and 2021 that there could be biases in the overdiagnosis of BPD amongst sexual minorities. His first research even suggests that when presenting a professional clinician with two identical case studies in which one fake patient is gay while the other one is straight, the queer person would be diagnosed with BPD and the straight one would be diagnosed with something else. Like an anxiety disorder, for example. Regardless of the bias, it appears clear that an important number of queer people seek professional help because of suffering that seems aligned with the symptoms described earlier.
In terms of the effect on their social life, people with Borderline Personality Disorder often find it very difficult to trust others. They are also more likely than people without the condition to look for signs of rejection in people who surround them. For example, instead of feeling only mildly annoyed at being dismissed by a coworker who is too busy to have a conversation with them, they could experience strong feelings of rejection. They could react with uncontrollable bursts of anger or with unfounded fear that they have done something terribly wrong and that they are worthless. In both cases, the relationship with this co-worker might get seriously damaged, without them even knowing what happened. This pattern can be even more prevalent when a person with BPD puts the other on a pedestal, something that people living with this condition tend to do frequently. It is also common for a person with BPD to put so much pressure on a new relationship that their new partner or friend will suffocate. And at the first sign that this new partner needs to set some boundaries, the person with BPD will feel hurt to their core. Potentially using impulsive anger to cover for their poor sense of self.
People with BPD, who normally have some sense of awareness that their behaviour can be perceived as uncommon, also tend to stay much too long in toxic or abusive relationships. Having internalized — or gaslighted into thinking — that all their relationship problems come from them. The fear of rejection and loneliness can be so great that people with BPD will come back over and over again into a relationship with someone who “tolerates” them, or does not reject them right away. This can lead to a worsening of BPD symptoms, as well as other mental health issues.
If a person you love has BPD, make sure you take some time to set clear and just boundaries — with their consent —, and that you respect those boundaries. Both for yourself and for them. Do not use empty threats as a tool for changing their behaviour and if possible, try to avoid responding to their anger with anger of your own. While there can be a tendency to feel like you are constantly walking on eggshells or having to comfort and validate them, remember that you can act yourself around them, especially if there is good communication between the two of you and they feel secure in your love for them. Unlike autism and ADHD, borderline personality disorder tends to be diagnosed mostly in young adults, so a later diagnosis is more easily attainable. If you think you might have BPD, find more information online and talk with your doctor.
Vincent Francoeur 