For many in the LGBTQ+ community, June is a time to celebrate Pride. The inaugural Pride parade was a commemoration of the police-led raid on the Stonewall Inn, a gay bar, that sparked the Stonewall Riots. Pride was a call for greater rights, equality, and safety, and it remains so today. The history of Pride highlights the trauma faced daily by LGBTQ+ folks—and their resilience.
In the United States, people who identify as lesbian, gay, or bisexual are more likely than heterosexuals to experience potentially traumatic events including adverse childhood experiences (Blosnich & Andersen, 2015; Friedman et al., 2011), interpersonal violence in adulthood, and other traumas, such as the unexpected loss of a loved one (Roberts, Austin, Corliss, Vandermorris, & Koenen, 2010). Within the lesbian, gay, and bisexual community, people of color (Arreola et al., 2005; Balsam et al., 2010; Dunbar, 2006) and bisexuals (Walters, Chen, & Breiding, 2013) tend to disproportionately bear the burden of trauma exposure. Risk is even higher in the transgender population. Indeed, one study found that 98% of transgender individuals were exposed to at least one potentially traumatic event, while 91% were exposed to multiple lifetime potentially traumatic events (Shipherd, Maguen, Skidmore, & Abramovitz, 2011).
Sexual and gender minorities also face additional stress in the form of discrimination, microaggressions, internalized stigma, anticipatory stigma, and identity concealment, collectively referred to as minority stress (Meyer, 2003). Traumatic and minority stressors have been implicated as sources of sexual orientation and gender identity-related mental and physical health disparities (Andersen, Zou, & Blosnich, 2015; Blosnich & Andersen, 2015; Frost, Lehavot, & Meyer, 2013; Eaton, 2014; McLaughlin, Hatzenbuehler, Xuan, & Conron, 2012). Minority stress has been shown to predict symptoms of depression, anxiety, and substance use disorders (e.g., Lee, Gamarel, Bryant, Zaller, & Operario, 2016), suicidality (e.g., Mereish, Katz-Wise, & Woulfe, 2017), and posttraumatic stress (e.g., Reisner et al., 2016). In addition, minority stress may serve to increase risk of trauma exposure and revictimization (Murchison, Boyd, & Pachankis, 2017; McConnell & Messman-Moore, 2018). Mental health professionals working with LGBTQ+ clients must be aware of how trauma and experiences of minority stress may be impacting their clients.
There is unfortunately little literature to guide clinicians toward providing minority-stress informed care for LGBTQ+ clients, although treatments models are beginning to emerge (e.g., Burton, Wang, & Pachankis, 2019). A number of resilience and positive coping factors have been identified, however, which may help clinicians promote health and well-being for LGBTQ+ clients dealing with the cumulative impact of trauma and minority stress. Social and community-level factors that can be targeted include social support, community connectedness, friend and family acceptance, and engagement in activism, while individual factors include hope, self-acceptance, and identity pride (e.g., Bariola et al., 2015; Craney, Watson, Brownfield, & Flores, 2018; Matsuno & Israel, 2018; Shilo, Antebi, & Mor, 2015; Toomey, Ryan, Diaz, & Russell, 2018).
Thus, Pride is a time for the LGBTQ+ community to come together and celebrate their resilience. During Pride, trauma researchers and clinicians can raise awareness of the impact of trauma and minority stress on the LGBTQ+ community and work to ameliorate these stressors. There remains great need for trauma researchers to include the voices of LGBTQ+ trauma survivors in their work, to identify risk and protective factors for trauma in this population, and to develop empirically-supported and culturally appropriate treatments for LGBTQ+ trauma survivors. Clinicians should strive to engage in trauma- and minority stress-informed intervention with LGBTQ+ clients, and utilize Pride month as an annual reminder to reflect on ways to make therapy a safe and inclusive place for LGBTQ+ clients.
References
Andersen, J. P., Zou, C., & Blosnich, J. (2015). Multiple early victimization experiences as a pathway to explain physical health disparities among sexual minority and heterosexual individuals. Social Science & Medicine, 133, 111-119. doi: 10.1016/j.socscimed.2015.03.043.
Arreola, S. G., Neilands, T. B., Pollack, L. M., Paul, J. P., & Catania, J. A. (2005). Higher prevalence of childhood sexual abuse among Latino men who have sex with men than non-Latino men who have sex with men: Data from the Urban Men’s Health Study. Child Abuse & Neglect, 29, 285-290. doi: 10.1016/j.chiabu.2004.09.003
Balsam, K. F., Lehavot, K., Beadnell, B., & Circo, E. (2010). Childhood abuse and mental health indicators among ethnically diverse lesbian, gay, and bisexual adults. Journal of Consulting and Clinical Psychology, 78, 459-468. doi: 10.1037/a0018661
Bariola, E., Lyons, A., Leonard, W., Pitts, M., Badcock, P. & Couch, M. (2015). Demographic and psychosocial factors associated with psychological distress and resilience among transgender individuals. American Journal of Public Health, 105, 2108-2116. doi: 10.2105/AJPH.2015.302763
Blosnich, J. R., & Andersen, J. P. (2015). Thursday’s child: The role of adverse childhood experiences in explaining mental health disparities among lesbian, gay, and bisexual US adults. Social Psychiatry and Psychiatric Epidemiology, 50, 335-338. doi: 10.1007/s00127-014-0955-4
Burton, C. L., Wang, K., & Pachankis, J. E. (2019). Psychotherapy for the spectrum of sexual minority stress: Application and technique of the ESTEEM treatment model. Cognitive and Behavioral Practice, 26, 285-299. doi: 10.1016/j.cbpra.2017.05.001
Craney, R. S., Watson, L. B., Brownfield, J., & Flores, M. J. (2018). Bisexual women’s discriminatory experiences and psychological distress: Exploring the roles of coping and LGBTQ community connectedness. Psychology of Sexual Orientation and Gender Diversity, 5, 324-337. doi: 10.1037/sgd0000276
Dunbar, E. (2006). Race, gender, and sexual orientation in hate crime victimization: Identity politics or identity risk? Violence & Victims, 21, 323-337. doi: 10.1891/088667006780644604
Eaton, N. R. (2014). Transdiagnostic psychopathology factors and sexual minority mental health: Evidence of disparities and associations with minority stress. Psychology of Sexual Orientation and Gender Diversity, 1, 244-254. doi: 10.1037/sgd0000048
Friedman, M. S., Marshal, M. P., Guadamuz, T. E., Wei, C., Wong, C. F., Saewyc, E. M., & Stall, R. (2011). A meta-analysis of disparities in childhood sexual abuse, parental physical abuse, and peer victimization among sexual minority and sexual nonminority individuals. American Journal of Public Health, 101, 1481-1494. doi: 10.2105/AJPH.2009.190009
Frost, D. M., Lehavot, K., & Meyer, I. H. (2015). Minority stress and physical health among sexual minority individuals. Journal of Behavioral Medicine, 38, 1-8. doi: 10.1007/s10865-013-9523-8
Lee, J. H., Gamarel, K. E., Bryant, K. J., Zaller, N. D., & Operario, D. (2016). Discrimination, mental health, and substance use disorders among sexual minority populations. LGBT Health, 3, 258-265. doi: 10.1089/lgbt.2015.0135
Matsuno, E., & Israel, T. (2018). Psychological interventions promoting resilience among transgender individuals: Transgender resilience intervention model (TRIM). The Counseling Psychologist, 46, 632-655. doi: 10.1177/0011000018787261
McConnell, A. A., & Messman-Moore, T. L. (2018). Hazardous drinking, antibisexual prejudice, and sexual revictimization among bisexual women: A moderated mediation model. Psychology of Violence, advance online publication. doi: 10.1037/vio0000211
McLaughlin, K. A., Hatzenbuehler, M. L., Xuan, Z., & Conron, K. J. (2012). Disproportionate exposure to early-life adversity and sexual orientation disparities in psychiatric morbidity. Child Abuse & Neglect, 36, 645-655. doi: 10.1016/j.chiabu.2012.07.004
Mereish, E. H., Katz-Wise, S. L., & Woulfe, J. (2017). Bisexual-specific minority stressors, psychological distress, and suicidality in bisexual individuals: The mediating role of loneliness. Prevention Science, 18, 716-725. doi: 10.1007/s11121-017-0804-2
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674-697. doi: 10.1037/0033-2909.129.5.674
Murchison, G. R., Boyd, M. A., & Pachankis, J. E. (2017). Minority stress and the risk of unwanted sexual experiences in LGBQ undergraduates. Sex Roles, 77, 221-238. doi: 10.1007/s11199-016-0710-2
Reisner, S. L., White Hughto, J. M., Gamarel, K. E., Keuroghlian, A. S., Mizock, L., & Pachankis, J. E. (2016). Discriminatory experiences associated with posttraumatic stress disorder symptoms among transgender adults. Journal of Counseling Psychology, 63, 509-519. doi: 10.1037/cou0000143
Roberts, A. L., Austin, S. B., Corliss, H. L, Vandermorris, A. K., & Koenen, K. C. (2010). Pervasive trauma exposure among US sexual orientation minority adults and risk of posttraumatic stress disorder. American Journal of Public Health, 100, 2433-2441. doi: 10.2105/AJPH.2009.168971
Shilo, G., Antebi, N., & Mor, Z. (2015). Individual and community resilience factors among lesbian, gay, bisexual, queer, and questioning youth and adults in Israel. American Journal of Community Psychology, 55, 215-227. doi: 10.1007/s10464-014-9693-8
Shipherd, J. C., Maguen, S., Skidmore, W. C., & Abramovitz, S. M. (2011). Potentially traumatic events in a transgender sample: Frequency and associated symptoms. Traumatology, 17, 56-67. doi: 10.1177/1534765610395614
Toomey, R. B., Ryan, C., Diaz, R. M., & Russell, S. T. (2018). Coping with sexual orientation-related minority stress. Journal of Homosexuality, 65, 484-500. doi: 10.1080/00918369.2017.1321888
Walters, M. L., Chen, J., & Breiding, M. J. (2013). The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 Findings on Victimization by Sexual Orientation. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.