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. Author manuscript; available in PMC: 2025 Oct 4.
Published in final edited form as: J Community Appl Soc Psychol. 2023 Aug 23;33(6):1564–1579. doi: 10.1002/casp.2739

What should I say? Online dating and disclosure experiences of adults with mental illness in long-term romantic relationships

Catherine H Stein 1, Frances J Griffith 1, Melissa F Rudd 1, Maria A Kalantzis 1
PMCID: PMC12494174  NIHMSID: NIHMS2058186  PMID: 41048883

Abstract

The present study examined accounts of online and in-person dating experiences from adults with mental illness who are in long-term romantic relationships (N = 23). In focus group discussions, participants described their views of advantages and disadvantages of online dating and in-person dating, how they constructed online dating profiles, decisions about disclosure of their mental health conditions to current romantic partners, and advice about dating for other people coping with mental illness. Overall, participants reported feeling less comfortable with online dating than in-person dating. A majority of the sample reported that they intentionally excluded information about their mental health status from their online dating profiles. Present findings identified themes from participant accounts about disclosure of their mental illness to their romantic partners that included spontaneous or intentional disclosure, situational or circumstantial disclosure, delayed disclosure due to lack of information, and avoided disclosure. Adults' advice to others with mental illness centred on how to maintain romantic relationships. The importance of research focused on the lived experience of adults with mental illness in long-term romantic relationships and practical implications of present findings are discussed.

Keywords: disclosure, long-term romantic relationships, mental illness, online dating, online dating profiles

1 |. INTRODUCTION

Adults coping with mental illness typically face considerable challenges in finding and maintaining romantic relationships. People with mental illness must often contend with social and individual barriers such as stigma, discrimination, lack of resources and mental health symptoms that make engaging in intimate relationships difficult (Boysen, 2022; Cloutier, Francoeur, Samson, Ghostine, & Lecomte, 2021). Although online dating platforms have radically changed how adults establish romantic relationships (Rosenfeld, Thomas, & Hausen, 2019), little is known about how adults with psychiatric disabilities navigate disclosing their mental health conditions when constructing online profiles or their overall experiences with online dating. Moreover, few studies have focused on the lived experience of adults in long-term committed romantic relationships to understand different approaches that people use in making decisions about mental health disclosures to their partners. Studies that examine the accounts of people who have successfully established romantic relationships serve to counter dominant cultural stereotypes about adults with mental illness and have direct implications for interventions focused on intimate social relationships.

2 |. ONLINE DATING AND DISCLOSURE

It is estimated that somewhere between 20% and 40% of adults in the United States report having met their romantic partner online, with online dating having replaced family and friends as the primary method of finding a mate (Rosenfeld et al., 2019). Online dating sites range from those intended for short-term flirtation or sex to sites intended for long-term partnerships, and niche sites intended for individuals from diverse backgrounds, such as adults who identify as having a mental illness (Lemel, 2016). Online dating may confer unique benefits compared with offline dating, such as greater access to potential partners, but it may also come with unique risks, such as deception from potential partners and risks of cyberstalking (Eichenberg, Huss, & Küsel, 2017). Online dating also differs from in-person dating in that online dating often includes an intense and rapid exchange of initial messages and pivotal changes in modality from text to phone/video to face-to-face contact.

In general, online daters attempt to balance authenticity and desirability in creating their online profiles (Ellison, Heino, & Gibbs, 2006; Whitty, 2008), sometimes including minimal deception (Toma, Hancock, & Ellison, 2008). Selected self-presentation (SSP) is widespread online as individuals curate their online profiles to present what they think is the most desirable version of themselves (Ellison, Hancock, & Toma, 2011). Individuals use SSP to enhance their attractiveness and status in creating online dating profiles (Toma & Hancock, 2010). Gibbs, Ellison, and Heino (2006) found that participants' self-reports of the amount, intent and valence of self-disclosure significantly predicted their perceived success in online dating, and honesty in profiles was generally negatively related to perceived success. In a literature review, Mazur (2017) posited that creating online dating profiles may offer unique advantages to people with physical and psychiatric disabilities since one can choose whether and how to present one's disabilities to potential partners in an online profile. In a survey study of people with and without disabilities, Porter, Sobel, Fox, Bennett, and Kientz (2017) found that participants had higher expectations that a ‘visible’ disability, such as a physical disability, would be disclosed in one's online dating profile than an ‘invisible’ disability, such as a mental illness. These authors conclude that individuals with disabilities must navigate a complex set of individual and social expectations in pursuit of romantic relationships online and that more research is needed to understand online disclosure decisions for individuals with disabilities.

3 |. CONCEALABLE STIGMATIZED IDENTITIES AND DISCLOSURE

Concealable stigmatized identities (CSI) refer to a social identity that can be kept hidden from other people that is associated with social devaluation (Quinn & Chaudoir, 2009). CSI covers a broad range of identities that include those associated with stigmatized physical illness such as HIV/AIDS or substance abuse, events/circumstances such as prior incarceration or intimate partner violence, and serious mental illness such as schizophrenia spectrum and depressive or obsessive–compulsive disorders. What is common to CSI is that the identity is not readily apparent to other people, is socially devalued, is associated with negative stereotypes and can put the individual at risk for prejudice, discrimination and social exclusion (Quinn & Earnshaw, 2011).

Researchers have theorized that concealing a stigmatized identity has a variety of benefits such as increasing a sense of belonging and preventing social prejudice and discrimination (Cook, Germano, & Stadler, 2016; Goffman, 1963). However, empirical studies on the benefits of concealment of CSI offer mixed results. For example, there is some evidence that concealing stigmatized identities is associated with a sense of social isolation and withdrawal (Keene, Cowan, & Baker, 2015), and that concealment can lead to self-stigmatizing thoughts (Zhao, Zhang, & Yu, 2008). Alternatively, some research suggests that active concealment such as lying or social isolation to avoid identity detection is generally associated with higher levels of self-reported psychological well-being than is identity disclosure (Quinn, Weisz, & Lawner, 2017). Further research on CSI is needed to understand how the ability to conceal a specific stigmatized identity may play a role in an individual's disclosure decisions. For example, people who are experiencing debilitating psychiatric symptoms may be limited in their ability to hide their mental illness regardless of a desire to do so, and therefore, concealment may not be an option.

In the past decade, several conceptual models have been proposed to describe individual decisions about the disclosure of private information or concealable stigmatized identities (Afifi & Steuber, 2009; Chaudoir & Fisher, 2010; Pentronio, 2010). These conceptual models posit various characteristics and/or circumstances that motivate self-disclosure or perpetuate concealment of sensitive information. For example, communication privacy management theory (CPM) focuses on ways that family members manage privacy boundaries of individual and family information both inside and outside of the family unit (Pentronio, 2010). The disclosure processes model (DPM) posits circumstances in which interpersonal disclosures may be beneficial (Chaudoir & Fisher, 2010). The risk revelation model (RRM) may be particularly relevant to mental health disclosure as it proposes that individuals make disclosure decisions based on their assessment of the risk associated with revealing private information for the individual, the other person or the relationship (Afifi & Steuber, 2009). In this model, conditions for disclosure involve: (1) the need for personal catharsis; (2) the perceived need or right of the recipient to know; (3) pressure by others to reveal the information, and/or (4) the level of communication efficacy, or the ability to talk about sensitive information in a way that will produce a positive outcome (Afifi & Steuber, 2009). Although the RRM approach provides a useful framework of conditions that may impact disclosure, research is needed to understand how the specific stigmatized identity of serious mental illness may shape the disclosure process.

4 |. PRESENT STUDY

The present study examined accounts of dating among adults in long-term, committed romantic relationships who self-identified as having a serious mental illness. In focus group discussions, study participants offered their views of online and in-person dating, discussed how they constructed their online dating profiles, and described the nature of their disclosures about their mental illness to current romantic partners. These adults also offered dating advice for other people coping with mental illness. In the present study, we purposefully focused on adults who reported currently being in long-term relationships to examine their accounts of dating and mental health disclosure to partners. Although adults with mental illness who are not in romantic relationships certainly have important perspectives, they may or may not have had dating experience or have had to make decisions about mental health disclosures to partners. Adults with mental illness who are successfully navigating a relationship with a romantic partner have had some extended experience with dating and have had to make decisions about whether to disclose or conceal their mental health condition to their partner. Given their ability to sustain a long-term romantic relationship, we believe that these adults have important insights to share about the process of dating and mental health disclosure.

Based on previous research, we hypothesized that adults with mental illness would report that they limited or avoided including information about their mental health status in their online dating profiles. Guided by existing disclosure models and concealable stigmatized identities concepts, we examined participants' accounts of their decision-making strategies related to disclosure of their mental illness to their current romantic partners. We hypothesized that there would be a range of motivations reflected in participants' accounts of disclosure or concealment of their mental illness to their partner.

5 |. METHOD

5.1 |. Participants and procedure

The present sample consisted of 23 adults living in the United States who reported having a serious mental illness, having met their partner online or in-person, and currently being in a committed romantic relationship for at least 1 year. Characteristics of the present study sample are summarized in Table 1.

TABLE 1.

Participant demographic characteristics (N = 23).

Characteristics Number (%)
Gender
 Female 14 (60.9)
 Male 5 (21.7)
 Non-binary 4 (17.4)
Race/ethnicity
 White 17 (73.9)
 BIPOC 4 (17.4)
 Multiracial 2 (8.7)
Education
 High school diploma/GED 5 (21.7)
 Some college/Associates 6 (26.1)
 Bachelors 7 (30.4)
 Postgraduate degree 5 (21.7)
Employment status
 Full-time 10 (43.5)
 Part-time 4 (17.4)
 Not employed 8 (34.8)
 Student 1 (4.3)
Annual income
 <$30,000 11 (47.8)
 $31,000–70,000 7 (30.4)
 $71,000–110,000 4 (17.4)
 >$110,000 1 (4.3)
Marital statusa
 Not married 13 (56.5)
 Married 9 (39.1)
Living situation
 Co-habiting 20 (86.9)
 Separate household 3 (13.0)
Monogamous relationshipb
 Yes 20 (86.9)
 No 3 (13.0)
Number of children
 0 19 (82.6)
 1 1 (4.3)
 2 3 (13.0)
Age
 M = 31.6 years (SD = 11.2)
Length of relationship with partner
 M = 6.2 years (SD = 5.7)
Primary psychiatric diagnosis
 Mood disorder 5 (21.7)
 Dissociative disorder 5 (21.7)
 Schizophrenia-related disorder 4 (17.4)
 Borderline personality disorder 3 (13.0)
 Posttraumatic stress disorder 3 (13.0)
 Anxiety or OCD-related disorder 2 (8.7)
 Eating disorder 1 (4.3)
Number of psychiatric hospitalizations
 0 6 (26.1)
 1–2 8 (34.8)
 ≥3 9 (39.1)
Receiving treatment for mental health
 Yes 21 (91.3)
 No 2 (8.7)
Taking medication for mental health
 Yes 18 (78.3)
 No 5 (21.7)
Partner has psychiatric diagnosis
 Yes 15 (65.2)
 No 8 (34.8)
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a

One participant did not report marital status.

b

Participants in polyamorous relationships described relationship with primary partner only.

The Institutional Review Board of Bowling Green State University approved the research. Individuals were informed about the study through posts on different social media sites. A brief description of the study and requirements for participation was posted on various websites that had support groups, forums, or chats focused on dating and/or mental health issues (e.g., dating/mental health subreddits on reddit.com; Facebook mental health support groups; specialized dating sites). Researchers contacted website administrators for permission to post a description of the study on their website when needed. Eligibility requirements for the research included being 18 years of age or older, living in the United States, having a diagnosed mental illness and being in a committed romantic relationship of a year or longer. Adults who expressed interest in the study provided their contact information and completed a short telephone screening interview to learn more about the study and determine whether they were eligible for the research. Of the 69 individuals who emailed about their interest in the research in response to social media posts, 29 adults went on to complete telephone screenings for the study. A total of 28 of these 29 adults who completed the phone screening were eligible for the study. Of these 28 individuals, 23 took part in focus group interviews. The five individuals who declined or could not participate in focus groups did not differ significantly from the 23 focus group participants in primary demographic characteristics (i.e., gender, age, relationship characteristics or mental health diagnosis).

Eligible adults attended one of six focus groups, each lasting approximately 60–90 min, conducted online using a secure video conferencing platform. Focus groups contained between three and six participants and were facilitated by pairs of researchers with extensive knowledge of the focus group interview protocol. Three of the six focus groups were composed of participants who met their partners online (n = 11), and three focus groups were composed of participants who met their partners in-person (n = 12). The size and composition of focus groups were based whether participants met their partner online or in-person and participants' availability to meet at specific dates and times. Upon completion of their focus group, each participant received a $10 gift card as a token of appreciation for their participation in the study. All focus groups were recorded, and the audio recordings were transcribed verbatim. Participant ID numbers were used in data analysis and pseudonyms are used in the presentation of study findings to protect the confidentiality of participants.

6 |. MEASURES

6.1 |. Dating focus group interview protocol

A semi-structured focus group interview protocol was developed for the present study. After introductions by group facilitators, each participant was asked to introduce themselves, describe the length of their current relationship and how they met their partner. Focus group participants were asked to discuss their dating experiences, their views of online and in-person dating, information they included in their online dating profiles, their decisions about disclosing their mental health conditions to their partners, the ongoing nature of their relationships as they navigate their mental illness, and any advice they had for other adults with mental illness who are dating.

6.2 |. Data analysis and researcher positionality

A team of seven researchers conducted the qualitative analysis of the focus group transcripts using a content analysis approach (Miles, Huberman, & Saldana, 2018) that incorporated both inductive, or ‘bottom-up’, and deductive, or ‘top-down’, processes (Braun & Clark, 2020). The data analytic process was deductive in the sense that it was informed by focus group interview questions, which grew out of a review of the scholarly literature and the identification of perceived gaps in existing research knowledge. Our approach is grounded in constructivist principles that acknowledge that data analysis in qualitative research is shaped by pre-existing knowledge of the literature (Charmaz, 2011; Ramalho, Adams, Haggard, & Howe, 2015). The data analytic process was inductive as participants' accounts from focus groups drove the identification of codes, emergent themes and overarching concept categories. Atlas.ti Windows (Version 22.1.3; Hwang, 2008) was used to assist in the organization and management of focus group transcripts.

All seven research team members repeatedly read focus group transcripts and engaged in an iterative process of identification, comparison and refinement of themes. Participants' accounts reflected their dating and mental health disclosure experiences and advice that they had for others. As an initial step in data analysis, content codes were generated for patterns of meaning in participant accounts that consisted of words, sentences or larger portions of verbatim text. These initial codes were compared within and across the six focus group transcripts by the research team. An initial codebook was developed that included codes with operational definitions and representative quotes. In the next step of the coding process, we grouped, modified and refined initial coding categories to generate emergent themes. Researchers met regularly to discuss, interpret and further refine themes using transcript data to support data analytic claims. Cross-checking methods (Polkinghorne, 2007) that consisted of regular review of codes and themes by subsets of the research team were conducted to further interpret and refine codes and theme categories. An iterative process of selective coding was then undertaken to connect and codify themes into overarching conceptual categories. Throughout the data analytic process, discrepancies among researchers in code, theme and/or overarching conceptual categories were reviewed by subsets of research team members and differences were resolved by group discussion and consensus by the entire research team (Edwards, Dattilo, & Bromley, 2004).

Throughout the data collection and analysis process, research team members reflected on their own position with respect to the focus of the present study. In terms of background characteristics, a majority of the research team identified as White (six White and one multiracial team member), female (five female, one male and one non-binary team member), and currently married or in a long-term relationship (four team members in a relationship and three members not in a romantic relationship). In selecting focus group facilitators, we made sure that at least one of the two co-facilitators for each focus group was currently in a long-term romantic relationship to potentially align with study participants. During focus group introductions, facilitators described their relationship status and if partnered, whether they met their current partner online or in-person. Some members of the research team personally identified as having a mental health condition and chose to disclose their mental health status to participants in focus groups. We were not able to discern any noticeable differences in the overall length or content of focus groups in which facilitators did or did not disclose information about their mental health status. Focus group facilitators who had a mental health condition and chose to disclose it in focus group introductions were motivated by authenticity in the research context (Manning, 1997). Research team members discussed their backgrounds, perspectives and experiences relevant to the study throughout the process of data analysis to make potential implications for the research process explicit.

7 |. RESULTS

7.1 |. Views of online and in-person dating

A total of 22 of the 23 participants in the sample described having experience with dating online. In comparing online and in-person dating, some participants (31.8%; n = 7) described views of online dating as more comfortable, safe or genuine than in-person dating. These participants described how speaking to people remotely allowed them to feel safe during the initial stages of the relationship. Participants also explained that online dating allowed them to seek out people who had similar life experiences. As Joe described, ‘I want to connect with others like myself because of the understanding factor…they have been through [a] similar place of mind and situations’.

Half of the sample (50%; n = 11) described connections made online through common interests with their partners. These participants recalled listing their hobbies and passions in online dating profiles or joining social media communities themed around their interests. Some participants (40.9%; n = 9) also felt that they just had good luck with online dating. These adults described being pleasantly surprised that they found their partners through online platforms or felt that they had unexpectedly positive experiences with dating online.

However, many participants' accounts (86.3%; n = 19) described views of online dating as less comfortable, safe or genuine than in-person dating. Participants discussed how online dating can result in less emotional closeness than in-person dating. They felt that getting to know someone online is slower or more challenging than getting to know someone in-person. For example, Joe stated, ‘So, you start communicating [online] without knowing anything about each other, except, you know the stuff that is on the profiles, and half of that is a lie anyway’. A number of participants (40.9%; n = 9) described specific negative views or experiences of online dating. These adults described having unsatisfying dates with people they met online or not having any online dating opportunities. Noah said, ‘I have not really had any luck’ with online dating, and Lisa noted, ‘I am on a couple of sites, but I do not find it very useful’. Some adults in the present study (31.8%; n = 7) also described challenges with online dating due to mental illness. Individuals with mental health symptoms such as impulsive decision-making described how online dating platforms sometimes exacerbated their symptoms. For example, Luke stated, ‘I could just tell anybody what I was thinking [online] the second I thought it instantly, which was not healthy for me’.

In their discussion of dating practices, about a third of the sample (36.3%; n = 8) specifically articulated views of in-person dating as more comfortable, safe or genuine than online dating. These participants recalled experiences in which in-person dates and conversations enabled them to make quicker or more genuine connections with potential partners. Some participants described a lack of knowledge and comfort with online dating platforms and preferred to meet potential partners through mutual friends. Over 20% of the sample (n = 5) also described a preference for physical presence of a partner when on a date. These participants preferred making a physical or intimate connection with potential partners or doing activities together in-person. A small group of participants (13.6%; n = 3) described the disadvantages of in-person dating that included past experiences of in-person rejection or mental health stigma that were barriers to in-person dating. A total of four participants (18.1%) had no preference between in-person and online dating.

7.2 |. Mental illness disclosure in online dating profiles

Most participants (n = 20) shared their experiences with creating an online dating profile. Over half of these participants (60%; n = 12) said that there were times that they purposefully chose to exclude disclosure of their mental illness. As Jasmine described, ‘I think the closest that I got to talking about it [my mental illness] was I mentioned one of my interests was psychology, but I did not come out and say…I have these diagnoses’. Participants described the stigma of mental illness and their preference for privacy among reasons for excluding information about their mental illness from their online profiles. Some participants described this as an advantage of online self-presentation. A smaller group of participants (40%; n = 8) reported times that they had included information about their mental illness in their online dating profile. Among reasons for including mental health information online, participants described personal goals of being open and frank about their mental illness identity and experiences. Grace stated, ‘My depression is actually something that I definitely talk about on the Internet, because I think that it [depression] is so stigmatized that we cannot talk about it and then we cannot normalize’.

7.3 |. Disclosure of mental illness to current partner

A total of 23 participants shared their accounts about mental illness disclosure to current partners and their disclosure decisions are characterized in three overarching categories: situational or circumstantial disclosure; spontaneous or intentional disclosure; and delayed or avoided disclosure. Some participants described making more than one type of disclosure decision across time. Operational definitions, frequency of occurrence in participant accounts and representative quotes for disclosure themes are found in Table 2.

TABLE 2.

Mental health condition disclosure themes (N = 23).

Category Theme Definition n (%) Representative quotesa
Situational or circumstantial disclosure Disclosure as a result of symptoms or medications Partner learns about participant's mental health condition from participant's symptoms/medications 9 (39.1) ‘I was having extreme memory loss,…mood swings, and flashbacks, but that was just a part of my every day…and, of course, he noticed them’.—Sam
Disclosure as a result of circumstances Partner knows about the participant's mental health condition due to circumstances or setting 4 (17.4) ‘So, for me, because my partner and I met on a DID [dissociative identity disorder] forum, it was already obvious that we both had DID’.—Jules
Spontaneous or intentional disclosure Spontaneous disclosure Participant spontaneously discloses mental health condition through casual conversation 9 (39.1) ‘So, I…didn't really have a sit-down conversation with my partner…I think they also experienced mental health stuff so we just kind of casually were able to talk about some of [our mental health challenges]’. —Taylor
Intentional disclosure Participant explicitly discloses mental health condition through purposeful conversation 4 (17.4) “I told my boyfriend about three or four weeks after we started dating, and I knew I had to have a sit-down conversation about it’. —Sandy
Delayed or avoided disclosure Delayed disclosure due to lack of knowledge Participant delays disclosure primarily due to a lack of knowledge about their mental health condition 9 (39.1) ‘I had kind of a sense that I had borderline personality disorder, but I didn't really look into it…After I had received the diagnosis…, I was like, wow, this makes a lot of sense, and I [was] able to tell her, “Hey, this is what's really going on.”‘ —Jamie
Avoided disclosure Participant significantly delays or avoids disclosure of mental health condition or symptoms 5 (21.7) ‘I have been actively avoiding a very serious conversation [about mental health issues] for going on ten years now’. —Eva
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a

Pseudonyms were used throughout this paper to protect the confidentiality of participants.

About half of sample participants (n = 13) described situational disclosure, in which their mental health condition was already apparent to their partners without an explicit conversation. About 40% of participants (n = 9) described disclosure as a result of symptoms/medications. For some participants, more obvious symptoms of their mental health condition rendered intentional conversational disclosure unnecessary. As Sam noted, ‘My partner saw that I have obsessive-compulsive disorder. I wash my hands till they are bleeding. Everyone sees that’.

In addition to mental health symptoms, some participants (17.3%; n = 4) also described disclosure as a result of circumstance. These circumstances included membership in online communities centred around the participant's mental health condition or in-person mental health treatment groups. For example, Lisa disclosed that her husband already knew about her mental health diagnosis prior to meeting her due to her openness in her online community. Whether because of participants' visible psychiatric symptoms, psychiatric medications or external circumstances, these participants described how their partners knew something about their mental health condition early in the relationship without the need for explicit conversations.

Over half of study participants (n = 13) stated that their disclosure of their mental illness to their current partners took the form of either spontaneous or intentional conversations. Approximately 40% (n = 9) of participants described engaging in spontaneous disclosure about their mental health condition in the context of casual conversation. As Douglas remarked: ‘When we [my partner and I] met up in-person and we started talking about our lives and our general history, just a get-to-know-you chat, it became pretty obvious that both of us had some not-so-great history and trauma in our past…obviously mental illness will be included [in the conversation]’.

In contrast, some adults (17.3%; n = 4) described engaging in intentional disclosure in conversation, in which they had a planned discussion about their mental health condition with their partner. Jasmine explained, ‘Around the third or fourth date…I said, Okay, listen, we need to have a talk just so that you can never claim I have never told you. These are my diagnoses. This is what it means to me. This is how it manifests’. These adults described the importance of making their mental health condition known to their partner early in the development of their romantic relationship.

Some participants described delaying disclosure about their symptoms or diagnosis until later in their relationship with their partner. Approximately 40% of participants (n = 9) explained that they delayed disclosure due to lack of knowledge of their own mental health condition or symptoms. They reported that they either did not yet have a formal psychiatric diagnosis or felt that they lacked information about their mental health condition to share with their partner. As Noah described, ‘I had a sense that I had borderline personality disorder, but I did not really look into it and I did not seek out diagnosis, and after I had received the diagnosis…being able to tell her, hey, this is what is really going on, and it is difficult for me to really control sometimes’.

Some participants (21.7%; n = 5) described that they simply avoided disclosure of their mental illness to their partner for some time during their relationship. As Jennifer explained, ‘My family is packed full of mental health issues, so it always seemed somewhat normal to me…So, I did not bring anything up to my husband about it [my diagnosis] until after my daughter was born’.

7.4 |. Advice for others

Most adults (78.3%; n = 18) responded to a focus group question about advice they might like to share about romantic relationships for other people with a serious mental health condition. In the present study, advice is defined as general information, guidance or recommendations about dating that participants thought would be useful for people living with mental illness. Four advice themes were identified in participants' accounts: build relational self-awareness; remember that you are more than your diagnosis; strive for honest and open communication; and develop relational boundaries and goals.

A majority of participants (61.1%; n = 11) gave advice to others that focused on the need for people with mental illness to build relational self-awareness, such as increasing their self-reflection skills and knowledge of how healthy relationships operate. Jules said, ‘You have to not just look at what is going on [in your romantic relationship] but try to see what is going on underneath…’ Several participants (38.8%; n = 7) gave the advice to others to remember that you are more than your diagnosis. Participants discussed that one's mental health diagnosis should not be a barrier to finding a loving relationship. In Linda's view, ‘You cannot scare away…the right person’.

Eight participants (44.4%) offered advice related to partner relationships and encouraged others to strive for open and honest communication. Some participants (33.3%; n = 6) suggested that people with mental illness should develop boundaries and specify roles with their romantic partners. These adults felt that not every aspect of one's life needed to be shared with a romantic partner. Lily stated, ‘It is important when you are in a relationship to understand that there are parts of [your mental health struggles] that you should be talking about with a therapist…What you expect from your therapist…should be different from what you expect from your partner’.

8 |. DISCUSSION

The present study described the dating and disclosure experiences of adults in long-term committed romantic relationships who self-identified as having a serious mental illness. Overall, participants' accounts suggested that they felt less comfortable with online dating than in-person dating and enumerated a variety of advantages and disadvantages of dating online. A majority of adults in the present study reported times that they did not include information about their mental health status in their online dating profiles. Participants described strategies for disclosing details about their mental illness to their romantic partners that included spontaneous or intentional disclosure, situational or circumstantial disclosure, delayed disclosure due to lack of information and avoided disclosure.

8.1 |. Online dating and disclosure

Some participants in the present study expressed the advantage that online dating gave them a sense of safety during the initial stages of seeking romantic relationships that included the ability to selectively withhold personal information. Previous research suggests relational affordances of computer-mediated technology include the potential for greater attention to message construction and exchange than on physical appearance and non-verbal cues in interpersonal interactions (Walther & Whitty, 2021). Consistent with prior research, some participants in the present study felt that having time to think about and prepare exchanges with potential partners was preferable to the spontaneity of in-person dating. Advantages of online dating expressed by study participants also included the ability to connect with potential partners with shared interests, and simply having ‘good luck’ finding a partner online.

Despite the fact that about half of the sample had met their current partner online, participants generally preferred in-person dating to online dating. Some adults in the study felt that interpersonal exchanges online were slower or more challenging than in-person exchanges and some questioned the accuracy of personal information exchanged online. Participants' accounts of online dating also highlight some mental health-related challenges not described in previous literature, such as difficulty with managing impulsivity in online exchanges, feelings of loss of boundaries when answering intimate questions via text, and pragmatic struggles of dealing with online dating sites due to memory loss. It appears that some aspects of online technology such as the ability to text a response to others instantaneously might exacerbate certain mental health symptoms. Study findings suggest that risks and benefits of online dating for people with mental illness may depend on personal preferences, mental health symptoms and technical features of the dating platform.

Adults in the present study, like other people who construct online dating profiles, were cognizant of a need to engage in impression management and include information about themselves that would increase their desirability to other people to maximize positive outcomes (Whitty, 2008). Prior research on general attitudes towards people with mental illness suggests that not disclosing one's mental health status in dating profiles may be an overall effective strategy. For example, Boysen, Morton, and Nieves (2019) found that adults (n = 163) generally became less willing to engage in a relationship with an attractive partner after discovering that the person had a mental health condition. Disclosing one's mental health condition comes with interpersonal risks that include stigmatization, rejection or disappointment (Boysen et al., 2019; Seeman, 2013; Willems, Finkenauer, & Kerkhof, 2020).

8.1.1 |. Disclosure to current partner

Adults in the present study generally opted to disclose their mental health status to their current romantic partners, with over half of the sample reporting that they either had spontaneous or intentional conversations about their mental illness with partners. Present findings are consistent with research on disclosures to partners of other types of CSI such as HIV status (Derlega, Winstead, Greene, Serovich, & Elwood, 2002). However, adults in the present study noted situational or circumstantial types of disclosure in which their psychiatric symptoms made their mental health condition obvious to others or in which they met their current partner in the context of online or in-person groups related to mental health. Prior research on CSI typically considers a wide range of stigmatized identities and assumes that all concealable identities are equally capable of being hidden, regardless of symptom severity or circumstance. Present findings suggest that psychiatric symptoms are not always ‘concealable’ and that disclosure decisions are not always volitional. Camacho, Reinka, and Quinn (2020) highlight the need for research that examines the inter-sectionality of possessing both a concealable and visible stigma. However, present findings suggest that a more nuanced consideration of concealable stigmatized identities is needed to consider ways that a specific concealable identity may be more or less apparent in different circumstances and at different levels of symptom severity across time. If replicated, present findings have important implications for theoretical models of disclosure since models typically assume that disclosure or concealment is at the discretion of the person (Afifi & Steuber, 2009; Chaudoir & Fisher, 2010). Present findings highlight the need to study disclosure and concealment decisions within the context of specific CSI to better understand how the nature of these identities themselves shape the level of personal control about decisions over self-disclosure.

Some adults in the present study discussed delaying or avoiding disclosure in their current romantic relationships and some participants attributed their delay to a lack of information about their mental illness. The RRM of disclosure posits that communication efficiency, defined as the ability to articulate the disclosure in ways that increase the probability of a positive outcome, can motivate disclosure of sensitive personal information (Afifi & Steuber, 2009). Although the rates of discussion about psychiatric diagnosis between mental health professionals and their clients have increased in the past decade, information that clients receive about their mental illness is often limited or non-existent (Milton & Mullan, 2014). Decisions about disclosure or concealment of participants' mental health status may sometimes be less related to communication efficiency strategies and more related to a lack of specific information about mental illness to share with partners. Concealment decisions for people with mental illness can simply be a result of not having accurate mental health information to disclose to partners. Such findings speak to a continued need for mental health professionals to provide information and psychoeducation to individuals coping with mental illness (Motlova et al., 2017).

In the present study, participants' advice to other people did not specifically focus on disclosure decisions per se but rather focused on advice about how to maintain romantic relationships. Advice offered by participants to other people with mental illness generally acknowledged that romantic relationships take work, and romantic relationships where one or both partners have mental illness typically take more work. These adults had specific advice about the importance of individual qualities in a romantic relationship such as cultivating a sense of identity beyond having a mental illness and also offered advice about important relationship skills such the need for open and honest communication between couples. These adults' advice to others generally reflected the long-term nature of their romantic relationships and placed relatively little emphasis on disclosures about their mental health status in the course of their relationship. It may be that mental health disclosure decisions are a relatively small aspect of relationships for people with mental illness in committed long-term relationships.

8.2 |. Study limitations

Although present study findings are intriguing, they are limited in several respects. The study consisted of a relatively small, non-random sample of primarily White women who provided retrospective accounts of their initial contact and disclosure of their mental health status with current romantic partners. Overall, previous studies suggest no consistent gender differences in the frequency of online self-disclosures (Nguyen, Sun Bin, & Campbell, 2012). However, prior research suggests that women are more likely than men to participate in health research (Glass et al., 2015) and women may generally have different interpersonal disclosure patterns than men (Dindia & Allen, 1992). The sample was heterogeneous with respect to self-reported age, length of romantic relationship and psychiatric diagnosis. The demographic characteristics of the present sample should be noted in evaluating study findings.

In the present study, no information was collected about the nature and perceived severity of participants' psychiatric symptoms, and it is likely that the sample varied in the degree to which their mental health symptoms were ‘visible’ or ‘concealable’ to others. The size and composition of focus groups and co-facilitator introductions also may have shaped the nature of discussion among participants in unknown ways. Information about the timing of disclosure decisions with current partners was not collected. In addition, all participants learned about the research via online venues. Various types of psychiatric diagnoses were reported by participants in the sample that included dissociative identity disorder (DID). Although there is some concern about the representation of DID and other psychiatric disorders on social media (Giedinghagen, 2023), recent studies of trauma and research on DID support groups have increased the understanding of DID within the mental health community (Brand et al., 2016; Christensen, 2022). Information about psychiatric diagnosis in the present research was obtained from participant self-report and findings should be considered within this context.

The present study specifically focused on adults with mental illness in long-term relationships to describe accounts of people who had some experience dating and faced decisions about mental health disclosure or concealment with their romantic partner. The present research cannot speak to the dating and disclosure experiences of adults with mental illness who are not in romantic relationships. Future research using larger samples with specific types of mental health conditions is needed to contextualize and extend present findings.

It is important to note that a majority of sample participants reported that their current romantic partner was also coping with mental illness. For a variety of reasons, we intentionally limited the present research to disclosure experiences reported by participants about their current partners regardless of their partners' mental health status. There is some prior evidence to suggest that individuals with a psychiatric diagnosis are more likely to have married partners with a psychiatric condition as compared with individuals with non-psychiatric conditions (Nordsletten, Larsson, & Crowley, 2016). However, additional research is needed to understand the prevalence rate in the United States of romantic relationships where both partners have a psychiatric diagnosis. Multiple perspectives research studies are needed to examine benefits and challenges that accompany these types of relationships for both members of the couple.

8.3 |. Practical implications

Through our research design and sample selection, we explicitly acknowledge that people with mental illness can and do establish long-term romantic relationships. The present study demonstrates how researchers can amplify the voices and legitimize the experiences of disenfranchised groups (Stein & Mankowski, 2004). Despite its limitations, the present study reminds researchers and practitioners of the relevance of romantic relationships in the lives of people with mental illness and the potential for interpersonal connections in a digital world (Redmond et al., 2010; Virtzberg, Rofe, & Rudrick, 2014). The benefits of being in a long-term intimate relationship, mutual support and enacting the valued social roles of relationship partners cannot be overestimated for adults with serious mental illness (Hunt & Stein, 2012; Simon, 2014).

The proliferation of online dating sites in general including those specifically marketed to adults with mental illness suggests that people with mental health conditions are already investigating online dating options (Lemel, 2016). The present research highlights the need to systematically understand ways that adults with mental illness navigate online and in-person dating and romantic relationships. Cross-sectional and longitudinal research is needed to identify relevant individual, social and relationship factors that characterize successful romantic relationships for adults with mental illness. Studies are needed that specifically examine the level of ‘concealability’ of concealable stigmatized identities in relation to the disclosure process for adults with serious mental illness. Such research is essential to the development of informed interventions on social relationships for adults with mental health conditions. Present findings underscore a need for professionals to engage with adults with psychiatric disabilities about their views of online and in-person dating and help them to enumerate advantages and disadvantages based on their expectations, mental health symptoms and personal preferences. The present research serves as an important first step for researchers and practitioners interested in helping adults with mental illness to establish and navigate romantic relationships.

ACKNOWLEDGEMENTS

We thank the adults who participated in this study for sharing their experiences. We extend our appreciation to Rachel Redondo, Sarah Russin, Sharon Simon, Zachary Silverman, Emily Tilstra-Ferrell and Kevin Walker for their assistance with data collection and analysis.

Footnotes

CONFLICT OF INTEREST STATEMENT

The authors declare that they have no conflict of interest.

DATA AVAILABILITY STATEMENT

Portions of deidentified data available upon request.

REFERENCES

  1. Afifi T, & Steuber K (2009). The Revelation Risk Model (RRM): Factors that predict the revelation of secrets and the strategies used to reveal them. Communication Monographs, 76, 144–176. [Google Scholar]
  2. Boysen GA (2022). Mental illness and mate value: Evidence for reduced mate value among romantic partners perceived as having mental illness. Evolutionary Behavioral Sciences, 16, 261–275. 10.1037/ebs0000255 [DOI] [Google Scholar]
  3. Boysen GA, Morton J, & Nieves T (2019). Mental illness as a relationship dealbreaker. Stigma and Health, 4, 421–428. 10.1037/sah0000157 [DOI] [Google Scholar]
  4. Brand BL, Sar V, Stavropoulos P, Kruger C, Korzekwa M, Martinez-Toboas A, & Middleton W (2016). Separating fact from fiction: An empirical examination of six mythis about dissociative identity disorder. Harvard Review of Psychiatry, 24, 257–270. 10.1097/HRP.0000000000000100 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Braun V, & Clark V (2020). One size fits all? What counts and quality practice in (reflective) thematic analysis? Qualitative Research in Psychology, 18, 328–352. 10.1080/14780887.2020.1769238 [DOI] [Google Scholar]
  6. Camacho G, Reinka MA, & Quinn DM (2020). Disclosure and concealment of stigmatized identities. Current Opinion in Psychology, 31, 28–32. [DOI] [PubMed] [Google Scholar]
  7. Charmaz K. (2011). A constructivist grounded theory analysis of losing and regarding a valued self. In Wertz FJ, Cahrmaz K, McMullenm LM, Josselson R, Andersand R, & McSpannen E (Eds.), Five ways of doing qualitative analysis: Phenomenological psychology, grounded theory, discourse analysis, narrative research, and intuitive inquiry (pp. 165–204). New York, NY: Guilford Press. [Google Scholar]
  8. Chaudoir SR, & Fisher JD (2010). The disclosure processes model: Understanding disclosure decision making and postdisclosure outcomes among people living with a concealable stigmatized identity. Psychological Bulletin, 136, 236–256. 10.1037/a0018193 [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Christensen EM (2022). The online community: DID and plurality. European Journal of Trauma & Dissociation, 6, 100256–100257. 10.1016/j.ejdt.2021.100257 [DOI] [Google Scholar]
  10. Cloutier B, Francoeur A, Samson C, Ghostine A, & Lecomte T (2021). Romantic relationships, sexuality, and psychotic disorders: A systematic review of recent findings. Psychiatric Rehabilitation Journal, 44, 22–42. 10.1037/prj0000409 [DOI] [PubMed] [Google Scholar]
  11. Cook JE, Germano AL, & Stadler G (2016). An exploratory investigation of social stigma and concealment in patients with multiple sclerosis. International Journal of Multiple Sclerosis Care, 18, 78–84. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Derlega VJ, Winstead BA, Greene K, Serovich J, & Elwood WN (2002). Perceived HIV-related stigma and HIV disclosure to relationship partners after finding out about the seropositive diagnosis. Journal of Health Psychology, 7, 415–432. [DOI] [PubMed] [Google Scholar]
  13. Dindia K, & Allen M (1992). Sex differences in self-regulation: A meta-analysis. Psychological Bulletin, 112, 106–124. [DOI] [PubMed] [Google Scholar]
  14. Edwards DJ, Dattilo FM, & Bromley DB (2004). Developing evidence-based practice: The role of case-based research. Professional Psychology Research and Practice, 35, 589–597. [Google Scholar]
  15. Eichenberg C, Huss J, & Küsel C (2017). From online dating to online divorce: An overview of couple and family relationships shaped through digital media. Contemporary Family Therapy, 39(4), 249–260. 10.1007/s10591-017-9434-x [DOI] [Google Scholar]
  16. Ellison N, Heino R, & Gibbs J (2006). Managing impressions online: Self-presentation processes in the online dating environment. Journal of Computer-Mediated Communication, 11, 415–441. 10.1111/j.1083-6101.2006.00020.x [DOI] [Google Scholar]
  17. Ellison NB, Hancock JT, & Toma CL (2011). Profile as promise: A framework for conceptualizing veracity in online dating self-presentations. New Media and Society, 14, 45–62. 10.1177/1461444811410395 [DOI] [Google Scholar]
  18. Gibbs JL, Ellison NB, & Heino RD (2006). Self-presentation in online personals: The role of anticipated future interaction, self-disclosure, and perceived success in internet dating. Communication Research, 33, 152–177. 10.1177/0093650205285368 [DOI] [Google Scholar]
  19. Giedinghagen A (2023). The tick in TikToc and (where) all systems go: Mass social media induced illness and Munchausen's by internet as explanatory models for social media associated abnormal illness behavior. Clinical Child Psychology and Psychiatry, 28, 270–279. [DOI] [PubMed] [Google Scholar]
  20. Glass DC, Kelsall HL, Slegers C, Forbes AB, Loff B, Zion D, & Fritschi L (2015). A telephone survey of factors affecting willingness to participate in health research surveys. BMC Public Health, 15, 1017. 10.1186/s12899-015-2350-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Goffman E. (1963). Stigma: Notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice-Hall. [Google Scholar]
  22. Hunt MG, & Stein CH (2012). Valued social roles and measuring mental health recovery: Examining the structure of the tapestry. Psychiatric Rehabilitation Journal, 35, 441–446. 10.1037/h0094577 [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Hwang S. (2008). Utilizing qualitative data analysis software: A review of Atlas.ti. Social Science Computer Review, 26, 519–527. 10.1177/0894439307312485 [DOI] [Google Scholar]
  24. Keene DE, Cowan SK, & Baker AC (2015). “When you're in a crisis like that, you don't want people to know”: Mortgage strain, stigma and mental health. American Journal of Public Health, 105, 1008–1012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Lemel R. (2016). From mass marketing to a niche strategy: The evolution of online dating sites. Allied Academies International Internet Conference, 18, 93–97. [Google Scholar]
  26. Manning K. (1997). Authenticity in constructivist inquiry: Methodological considerations without prescription. Qualitative Inquiry, 3, 93–115. [Google Scholar]
  27. Mazur E. (2017). Diverse disabilities and dating online. In Identity, sexuality, and relationships among emerging adults in the digital age (pp. 150–167). Hershey, PA: IGI Global. [Google Scholar]
  28. Miles M, Huberman A, & Saldana J (2018). Qualitative data analysis: A methods sourcebook. Thousand Oaks: Sage Publications. [Google Scholar]
  29. Milton AC, & Mullan BA (2014). Communication of a mental health diagnosis: A systematic synthesis and narrative review. Journal of Mental Health, 23, 261–271. 10.3109/09638237.2014.951474 [DOI] [PubMed] [Google Scholar]
  30. Motlova LB, Balon R, Beresin EV, Brenner AM, Coverdale JH, Guerrero APS, … Roberts LW (2017). Psychoeducation as an opportunity for patients, psychiatrists, and psychiatric educators: Why do we ignore it? Academic Psychiatry, 41, 447–451. 10.1007/s40596-017-0728-y [DOI] [PubMed] [Google Scholar]
  31. Nguyen M, Sun Bin Y, & Campbell A (2012). Comparing online and offline self-disclosure: A systematic review. Cyberpsychology, Behavior and Social Networking, 15, 103–111. [DOI] [PubMed] [Google Scholar]
  32. Nordsletten AE, Larsson H, & Crowley JJ (2016). Patterns of nonrandom mating within and across 11 major psychiatric disorders. JAMA Psychiatry, 73, 354–361. 10.1001/jamapsychiatry.2015.3192 [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Pentronio S. (2010). Communication privacy management theory: What do we know about family privacy regulation. Journal of Family Theory and Review, 2, 175–196. [Google Scholar]
  34. Polkinghorne DE (2007). Validity issues in narrative research. Qualitative Inquiry, 13, 471–486. [Google Scholar]
  35. Porter J, Sobel K, Fox S, Bennett C, & Kientz J (2017). Filtered out: Disability disclosure practices in online dating communities. Proceedings of the ACM on Human-Computer Interaction, 1, 1–13. 10.1145/3134722 [DOI] [Google Scholar]
  36. Quinn DM, & Chaudoir SR (2009). Living with a concealable stigmatized identity: The impact of anticipated stigma, centrality, salience, and cultural stigma on psychological distress and health. Journal of Personality and Social Psychology, 97, 634–651. 10.1037/a0015815 [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Quinn DM, & Earnshaw VA (2011). Understanding concealable stigmatized identities: The role of identity in psychological, physical, and behavioral outcomes. Social Issues Policy Review, 5, 160–190. [Google Scholar]
  38. Quinn DM, Weisz BM, & Lawner EK (2017). Impact of active concealment of stigmatized identities on physical and psychological quality of life. Social Science Medicine, 192, 14–17. 10.1016/j.socscimed.2017.09.024 [DOI] [PubMed] [Google Scholar]
  39. Ramalho R, Adams P, Haggard P, & Howe K (2015). Literature review and constructivist grounded theory methodology. Forum: Qualitative Social Research, 16, 19. [Google Scholar]
  40. Redmond C, Larkin M, & Harrop C (2010). The personal meaning of romantic relationships for young people with psychosis. Clinical Child Psychology and Psychiatry, 15, 151–170. 10.1177/1359104509341447 [DOI] [PubMed] [Google Scholar]
  41. Rosenfeld MJ, Thomas RJ, & Hausen S (2019). Disintermediating your friends: How online dating in the United States displaces other ways of meeting. Proceedings of the National Academy of Science, 116, 17753–17758. 10.1073/pnas.1908630116 [DOI] [Google Scholar]
  42. Seeman MV (2013). When and how should I tell? Personal disclosure of a schizophrenia diagnosis in the context of intimate relationships. Psychiatric Quarterly, 84, 93–102. 10.1007/s11126-012-9230-6 [DOI] [PubMed] [Google Scholar]
  43. Simon RW (2014). Twenty years of the sociology of mental health: The continued significance of gender and marital status for emotional well-being. In Johnson R, Turner R, & Link B (Eds.), Sociology of mental health (pp. 21–51). Cham: Springer Briefs in Sociology. Springer. 10.1007/978-3-319-07797-0 [DOI] [Google Scholar]
  44. Stein CH, & Mankowski ES (2004). Asking, witnessing, interpreting, knowing: Conducting qualitative research in community psychology. American Journal of Community Psychology, 33, 21–25. [DOI] [PubMed] [Google Scholar]
  45. Toma CL, & Hancock JT (2010). Looks and lies: The role of physical attractiveness in online dating self-presentation and deception. Communication Research, 37(3), 335–351. 10.1177/0093650209356437 [DOI] [Google Scholar]
  46. Toma CL, Hancock JT, & Ellison NB (2008). Separating fact from fiction: An examination of deceptive self-presentation in online dating profiles. Personality & Social Psychology Bulletin, 34, 1023–1036. 10.1177/0146167208318067 [DOI] [PubMed] [Google Scholar]
  47. Virtzberg D, Rofe T, & Rudrick A (2014). Free online dating site for people with mental illness. Psychiatric Services, 65, 1178. 10.1176/appi.ps.650705 [DOI] [PubMed] [Google Scholar]
  48. Walther JB, & Whitty MT (2021). Language, psychology, and new new media: The hyperpersonal model of mediated communication at twenty-five years. Journal of Language and Social Psychology, 40, 120–135. [Google Scholar]
  49. Whitty MT (2008). Revealing the ‘real’ me, searching for the ‘actual’ you: Presentations of self on an internet dating site. Computers in Human Behavior, 24(4), 1707–1723. 10.1016/j.chb.2007.07.002 [DOI] [Google Scholar]
  50. Willems YE, Finkenauer C, & Kerkhof P (2020). The role of disclosure in relationships. Current Opinion in Psychology, 31, 33–37. 10.1016/j.copsyc.2019.07.032 [DOI] [PubMed] [Google Scholar]
  51. Zhao JY, Zhang B, & Yu G (2008). Effects of concealable stigma for learning disabilities. Social Behavior and Personality International Journal, 36, 1179–1188. [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

Portions of deidentified data available upon request.

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