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jakayla-toney-oveZZ4O_6_Y-unsplash.jpgSexual and gender minority (SGM) people experience higher levels of adverse experiences within their families and during childhood compared to their heterosexual and cisgender peers (Austin, Herrick, & Proescholdbell, 2015; 2016). More recent research highlights both emotional and physical neglect as common adverse childhood experiences (ACEs) reported by SGM adults (Bond et al., 2021; Schnarrs et al., 2019). Gender diverse adults face additional disparities in emotional abuse, emotional neglect, and physical neglect compared to sexually diverse adults (Bond et al., 2021; Schnarrs et al., 2019; Suarez et al., 2021).
It is important to consider factors beyond the family that contribute to poor health in SGM populations. Current research has expanded the ACEs Framework to include adverse community environments (Ellis & Dietz, 2017; Ellis, Dietz, & Chen, 2022). The Pair of ACEs Tree Framework suggests that social factors, such as community violence, lack of opportunity, discrimination, community violence, and poverty are the “root causes” of disproportionate ACEs exposure among racial and ethnic minority populations. The Pair of ACEs Tree is an important conceptual framework for understanding the relationship between the social and family environments for SGM young people as it provides an ecological lens for understanding ACEs exposure.
Individuals experiencing intersecting oppressions related to minority sexual and gender identity, along with racial/ethnic identity, report a greater prevalence of ACEs (Blosnich & Anderson, 2014; Tran, Henkhaus, & Gonzales, 2022). For example, among SGM young adults, those who identify as people of color reported greater exposure to childhood abuse and neglect compared to those who identified as non-Hispanic White individuals (Charak et al., 2019).
Moreover, bisexual individuals, especially women, report more exposure to childhood emotional abuse and neglect, resulting in greater emotion dysregulation and anxiety and depressive symptoms in adulthood (Charak et al., 2019). While focused on differences by sexual orientation and race/ethnicity, these findings underscore the critical importance of considering intersecting identities that may account for demographic differences between groups, alongside ACEs in understanding health disparities.
Bernard and colleagues (2020) advocate for expanding the current ACEs Framework as well by integrating exposure to racism in early life (Bernard et al., 2020). Not only did they call out racism as a driver of disparities in ACE exposure in Black youth, but also argued that exposure to racism in early life should be considered an ACE category. Similar arguments are being made by scholars regarding SGM populations, with calls for the assessment of ACEs to include unique early adversities related to SGM identity, such as SGM-specific bullying, religious trauma, and family rejection (Kroppman et al., 2020; Jones & Worthen, 2023; Schnarrs et al., 2023). Further, Schnarrs et al. (2022) suggest examining cisheterosexism (i.e., socio-political system that privileges heterosexual and cisgender identities while marginalizing SGM people) as the underlying mechanism that explains higher ACEs exposure in SGM youth and exposure to cisheterosexism in broader society to be considered a unique ACE for these populations (Schnarrs et al., 2022). This conceptualization has been validated in racially and ethnically diverse samples of SGM adults (Charak et al., 2023).
This call from researchers acknowledges the potential role of exposure to challenging social and structural factors during early life in shaping health and well-being over the life course.  On a macro-, systems-level, it is important to also acknowledge the legal challenges faced by youth with gender expansive identities, particularly bills targeting gender-affirming health care (Barbee et al., 2022). These challenges can add to the difficulties experienced by youth, emphasizing the broader societal context impacting their well-being, and reflecting the social environments in which ACEs occur and for which there may be inadequate protections against discrimination or other ACEs for SGM youth (Tebbe et al., 2022). Exploring the impact of these legal challenges is vital for our understanding of how policies influence health outcomes in marginalized populations. Despite these challenges, research so far suggests that social support, such as support from the family system or close social connections to those who share their identities, may serve as a protective element against the long-term effects of ACEs, specifically in later life (Bockting et al., 2019; Dorri et al., 2023).
In addition, those who experience greater degrees of childhood adversity are likely to face trauma exposure in adulthood (e.g., revictimization in intimate relationships), compounding the effects of the earlier trauma (Charak et al., 2019). SGM people exposed to trauma early are at increased risk of exposure to trauma and trauma-related diagnosis in adulthood (Livingston et al., 2019). This is further compounded by the continuation of cisheterosexism throughout adulthood. Indeed, recent work suggests that cisheterosexism contributes to PTSD symptomology above and beyond trauma exposure (Charak et al., 2023).
Increasingly, scholars call for an expansion of conceptual models and measurement of early life adversity to include experiences of oppression given their deleterious impact on health and traumatic stress (Holmes, Facemire, & DaFonseca, 2016). Moreover, these expansive ACEs Frameworks should be integrated with the current theory regarding SGM health disparities, including the Minority Stress Model (Meyer, 2003) and newer extensions regarding social safety proposed by Diamond and Alley (Diamond & Alley, 2022). While research has long considered the implications of school bullying, religious trauma, and violence on the mental health and well-being of SGM youth, it has yet to determine long-term implications. This necessitates a reconsideration of exposure to cisheterosexism as an ACE by identifying effects on psychological and general well-being and the potential biological repercussions of exposure to cisheterosexism in early life, and over the life course.
About the authors
Donovan Edward (All Pronouns) is a Doctoral Candidate in the Georgia Southern University Doctorate of Clinical Psychology (Psy.D.) program. Additionally, they work as a research coordinator for the Palo Alto Veterans Institute for Research. Donovan's research and clinical interests are broadly in the realm of traumatic stress, the intersection of minority stress and LGBTQIA+ individuals, and developing and adapting trauma-focused psychotherapies to LGBTQIA+ people.

Selime Salim (she/her/hers) is a clinical psychology post-doctoral fellow. Her research program investigates sexual violence and associated outcomes through a social-ecological lens. Using a minority stress-informed approach, she is interested in examining how antibisexual stigma (both enacted and internalized) contributes to sexual violence risk and exacerbates post-assault recovery among bisexual+ women.

Dr. Ruby Charak (she/her/ella) is currently an Associate Professor of Psychology at the University of Texas Rio Grande Valley. Dr. Charak’s program of research is aimed at identifying the risk and protective factors associated with child trauma, revictimization experiences, and related traumatic stress reactions. With a keen awareness of the unique challenges faced by LGBTQIA+ and racially and ethnically diverse individuals, Dr. Charak is strongly committed to working with underrepresented groups, ensuring that her research is inclusive and culturally sensitive. 
Phillip W. Schnarrs, PhD (he/him/his) is an Associate Professor and Associate Chair for research in the Department of Population Health at The University of Texas at Austin Dell Medical School. He is also the inaugural director of The Texas Insitute for Sexual and Gender Minority Health Research and currently serves as co-chair of the ISTSS Sexual Orientation and Gender Diversity Special Interest Group. Phillip is a public health scientist with expertise is community engaged research and LGBTQ+ health - specifically HIV prevention and care, mental health, early life adversity, and addiction/recovery. 
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