Research roundup: Traumatic events and the LGBTQ community

Research shows that members of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community are more likely to experience potentially traumatizing events (Roberts et al., 2010), mental and physical health problems (Mimiaga et al., 2009), and discrimination due to their perceived sexual identity throughout their lifetime (Friedman et al., 2011; Katz-Wise & Hyde, 2012).

Several new studies on the impact of traumatic events on the mental health and functioning of LGBTQ individuals highlight the importance of providing a safe, sexually affirming space in mental health treatment for LGBTQ individuals, especially if they are receiving treatment related to traumatic events. Taking steps to ensure patients are comfortable coming out to their therapists, addressing negative ideas related to LGBTQ identity in session, and teaching effective coping skills for stressors related to discrimination are all beneficial strategies for improving treatment outcomes for members of this community.

In the summaries below, we use terms related to sexuality and gender identity used by the authors of the studies.

Scheer, J.R., Harney, P., Esposito, J., & Woulfe, J.M. (2019). Self-reported mental and physical health symptoms and potentially traumatic events among lesbian, gay, bisexual, transgender, and queer individuals: The role of shame. Psychology of Violence. Advance online publication. http://dx.doi.org/10.1037/vio0000241

This study examined the effects of potentially traumatic events exposure and shame on the mental and physical health of LGBTQ individuals. Previous research indicates that people exposed to interpersonal forms of trauma report greater shame-proneness (Andrews, Brewin, Rose & Kirk, 2000). With this in mind, the researchers sought to determine whether shame mediates the relationship between exposure to potentially traumatic events and negative mental and physical health symptoms in LGBTQ individuals.

The study defines shame as “feelings of inferiority and powerlessness that are directly tied to social ostracism and trauma” (Taylor, 2015). It also differentiates between impersonal and interpersonal trauma, such as natural disasters versus intimate partner violence respectively.

Participants were recruited from more than 100 LGBTQ-specific, trauma-specific, or combination listservs and included 218 self-identified LGBTQ adults ages 18–78 who reported having experienced at least one potentially traumatic event in their lifetime. Of the participants, 40% identified as people of color, 40% identified as transgender and/or gender-nonconforming (TGNC), and 64% identified as nonmonosexual (queer, bisexual, pansexual, etc.).

Along with demographic information, participants reported on their lifetime exposure to potentially traumatic events (both impersonal and interpersonal), their depression symptoms over the past two weeks, posttraumatic stress disorder (PTSD) symptoms over the past month, substance use in the past six months, sexual risk behavior over the past month, chronic health conditions over the past year, and somatic symptoms over the past week. Shame over the past year was also measured by the Shame subscale of the Personal Feelings Questionaaire-2.

Results indicated that exposure to both impersonal and interpersonal potentially traumatic events were positively correlated with shame, depression symptoms, PTSD symptoms, substance use, chronic health conditions, and somatic symptoms. Impersonal, but not interpersonal, potentially traumatic events exposure was positively correlated with sexual risk behavior. Shame was also positively correlated with depression symptoms, PTSD symptoms, substance use, sexual risk behavior, and somatic symptoms.

The researchers found that participants who identified as people of color reported greater exposure to interpersonal potentially traumatic events and shame than White participants. TGNC participants reported greater exposure to both interpersonal and impersonal potentially traumatic events, along with greater somatic and depressive symptoms than cisgender participants.

Finally, further analyses found that shame partially mediated the relationship between exposure to potentially traumatic events and negative mental and physical health symptoms. This indicates that exposure to such events is associated with greater levels of shame, and that greater levels of shame in turn is associated with worse mental and physical health symptoms.

The authors specifically suggest that cognitive behavioral therapy-based interventions targeting internalized discrimination or group therapy focused on building a sense of community can be especially beneficial to patients struggling with shame or negative beliefs about LGBTQ identity.

Sullivan, T.J., Feinstein, B.A., Marshall, A.D., & Mustanski, B. (2017). Trauma exposure, discrimination, and romantic relationship functioning: A longitudinal investigation among LGB young adults. Psychology of Sexual Orientation and Gender Diversity, 4(4), 481-490. http://dx.doi.org/10.1037/sgd0000249

While romantic relationships can serve as a source of support against discrimination (Graham & Barnow, 2013), increased lifetime experience with trauma may sensitize individuals to the harmful effects of more recent discrimination, leading to decreased relationship functioning (Feinstein, Marshall & Mustanski, 2017). The authors sought to examine the direct effects of discrimination on romantic relationship functioning for LGBT young adults, as well as whether trauma exposure moderated those associations.

Participants were recruited from the Chicago area using email advertisements, flyers, and incentivized peer recruitment. Participants were ages 16–20 years old, and either identified as LGBT, queer, or questioning, reported being attracted to the same gender, or reported having engaged in same-sex sexual behavior. Data collection for the 248 participants occurred in annual waves from 2007–2014.

The current study uses data from the wave 7 and wave 8 follow-ups and required that participants reported being in a relationship at both points. Eighty-six individuals met all criteria and were included in analyses. 64% of the sample identified as female, while 70% identified as lesbian or gay, and 52% identified as Black or African American. At wave 8, 52% reported that they had been in their current relationship for one to three years.

At wave 7, researchers measured trauma exposure using the Computerized Diagnostic Interview Schedule—Version IV, which assesses exposure to potentially traumatic events, including sexual assault or being in a serious accident. Researchers also measured experiences of discrimination based on sexual orientation in the past six months using a 10-item questionnaire, which included questions such as whether they were treated differently in social settings because of their sexual orientation. At both waves, overall relationship satisfaction was measured using the 7-item Relationship Assessment Scale, along with two individual items to assess relationship commitment and trust.

Analyses found that the effect of discrimination on general relationship satisfaction was marginally significant and suggested that higher reported levels of discrimination were associated with slight increases in satisfaction. Trauma exposure alone did not have a significant effect. However, trauma exposure significantly moderated the association between discrimination and relationship satisfaction, such that discrimination was only associated with increased satisfaction for participants with low exposure to trauma. The same held true for the relationship between discrimination and commitment, but not discrimination and trust.

This study provides evidence that some LGB young adults may respond to discrimination with resilience in the form of increases in positive romantic relationship functioning. However, this was not the case with sexual minority young adults who had more extensive trauma histories.

In addition to recommending future research on individual differences in responses to discrimination, the authors emphasize the importance of teaching effective coping skills to use in response to sexual orientation-related stress.

Ovrebo, E., Brown, E.L., Emery, H.E., Stenersen, M., Schimmel-Bristow, A. & Steinruck, R.E. (2018). Bisexual invisibility in trauma: PTSD symptomology, and mental health care experiences among bisexual women and men versus lesbians and gay men. Journal of Bisexuality, 18(2), 168-185. https://doi.org/10.1080/15299716.2018.1458682

Bisexual individuals often experience discrimination not only from society in general, but also from within the LGBTQ community (Israel & Mohr, 2004). Previous studies have found bisexual people to be more likely to report certain types of trauma and serious psychological distress than heterosexual, gay, or lesbian individuals (Walters et al., 2013; Ward, Dahlhamer, Galinsky & Joestl, 2014).

Informed by these findings, the authors of this study sought to examine whether bisexual women and men experience interpersonal trauma (IPT) and PTSD symptomology differently from lesbians and gay men. They also investigated whether bisexual women and men differ from lesbians and gay men in choosing to come out to their mental health professionals or in overall satisfaction with the mental health care they receive.

Researchers recruited participants via survey descriptions on their own social media pages and on relevant Reddit forums, and links sent to more than 200 sexual minority organizations. 569 participants completed the survey, and the 404 participants who reported experiencing at least once incidence of IPT in their lifetime were included in the study. Other eligibility requirements included being age 18 or older, a resident of the United States, cisgender, and a member of a sexual minority population. 42% of participants identified as gay, 20% as lesbian, and 39% as bisexual.

Participants were asked demographic questions and about any experiences with mental health treatment and interpersonal violence (IPV). The IPV questions asked about examples of the most commonly reported types of IPV, the recency and frequency of such experiences, number of lifetime experiences, age they experienced their first incident, and which type of incident had been the most significant or traumatic to them. Finally, participants who had experienced at least one form of IPV in their lifetime were asked 20 questions from the DSM-5 PTSD Checklist.

Results indicated no significant differences based on sexual orientation for variables surrounding the most recent IPT event, the age of first IPT experience, the number, or type of IPT experiences each participant reported. No significant differences were found regarding total amount of PTSD symptoms in participants based on sexual orientation. However, when separated by gender, bisexual women reported experiencing IPT more recently than lesbians. No such difference existed between gay and bisexual men.

Bisexual men, bisexual women, and gay men, were significantly less likely than lesbians to seek mental health services. Lesbians and gay men were also more likely to come out to their therapists than bisexual women and men. Importantly, participants who were out to their therapists rated their overall satisfaction with services higher than those who were not. Finally, there was no significant difference in the overall satisfaction with mental health services between gay or lesbian and bisexual participants.

This study points to the benefits of working to ensure that bisexual individuals can feel comfortable coming out to their therapists. Based on other recent research, the authors of this study specifically recommend lesbian and gay targeted training experiences and multicultural courses to inform practice with bisexual individuals (Alessi, Dillon & Kim, 2015; O’Shaughnessy & Spokane, 2013). There is little information on specific strategies for creating bisexual-affirming treatment, so this study also serves as a call for more research specifically focused on bisexual individuals and mental health care.

APA’s professional practice guidelines can help psychologists working with specific populations or in particular areas, including members of the LGBTQ community. For a list of the guidelines, visit the professional practice guidelines webpage.