Publications of Interest

Childhood Trauma’s Impact on Sexual and Gender Minorities

Lynn Hazard, POI Editor

For the second quarter, the overall theme is childhood trauma’s impact on sexual and gender minorities. There is a higher risk for polyvictimization and serious adverse mental health outcomes for these groups. The trauma field around the world is gradually increasing research in this area.

Clements-Nolle, K., Lensch, R., Baxa, A., (2018). Sexual Identity, Adverse Childhood Experiences, and Suicidal Behaviors. Journal of Adolescent Health, 62(32), pp. 198-204. DOI: 10.1016/j.jadohealth.2017.09.022 To link to this article:

Abstract: PURPOSE: The objective of this study was to examine the influence of sexual identity and adverse childhood experiences (ACEs) on suicidal behaviors in a population-based sample of high school students. METHODS: A two-stage cluster random sampling design was used to recruit 5,108 students from 97 high schools. A total of 4,955 students (97%) provided information that allowed for classification of sexual identity into three groups: (1) lesbian, gay, or bisexual (LGB) (10%); (2) not sure (4.6%); and (3) heterosexual (85.4%). Five measures of childhood abuse and household dysfunction were summed, and the ACE score was categorized as 0, 1, 2, and 3-5 ACEs. Weighted logistic regression was used to assess the influence of sexual identity, ACEs, and their interaction on suicide ideation and attempts in the past 12 months. RESULTS: Compared with heterosexual students, those who were LGB and were not sure had higher odds of suicide ideation and attempts. There was also a graded relationship between cumulative ACE exposure and suicidal behaviors. Although sexual identity/ACE interaction was not observed, LGB/not sure students who experienced a high number of ACEs were disproportionately affected. Compared with heterosexual students with 0 ACE, LGB/not sure students with 0 ACE (adjusted odds ratio [AOR] = 3.32, 95% confidence interval [CI] = 1.96-5.61), 1 ACE (AOR = 6.58, 95% CI = 4.05-10.71), 2 ACEs (AOR 13.50, 95% CI = 8.45-21.58), and 3-5 ACEs (AOR = 14.04, 95% CI = 8.72, 22.62) had higher odds of suicide ideation. A similar pattern was observed for suicide attempts. CONCLUSIONS: LGB and students not sure of their sexual identity with greater exposure to ACEs have disproportionately high levels of suicide ideation and attempts. Trauma-informed interventions for these populations are warranted.

Gartner, R.E. & Sterzing, P.R. (2018). Social Ecological Correlates of Family-Level and Environmental Microaggressions Toward Sexual and Gender Minority Adolescents. Journal of Family Violence 33(1), pp. 1-16. DOI: 10.1007’s10896-017-9937-0. To link to this article:

Abstract: Microaggressions are associated with mental and behavioral health problems and are common experiences for sexual and gender minority adolescents (SGMA). Little is known about the social ecological correlates of family-level interpersonal and environmental microaggressions for SGMA. Utilizing a national sample of SGMA (N = 1,177), this study (a) identified the frequencies of family-level interpersonal and environmental microaggressions by participant demographics and (b) examined individual-, family-, and structural-level factors associated with interpersonal and environmental microaggressions. Outness to parents, a transgender or genderqueer identity, and higher levels of gender role non-conformity were associated with higher frequencies of interpersonal microaggressions. Higher levels of family-level child maltreatment and religiosity were associated with higher frequencies of interpersonal and environmental microaggressions. State-level non-discrimination protections were associated with lower frequencies of environmental microaggressions. Suggestions for increased individual-level support for gender non-binary adolescents as well as family targeted preventive strategies are discussed. Areas for future research are highlighted.

Cárdenas, M., Barrientos, J., Meyer, I., (2018). Direct and Indirect Effects of Perceived Stigma on Posttraumatic Growth in Gay Men and Lesbian Women in Chile. Journal of Traumatic Stress, 31(1), pp. 5-13. Published by the International Society for Traumatic Stress Studies. DOI: 10.1002/jts.22256 To link to this article:

Abstract: This study examined the direct and indirect effects of perceived stigma on posttraumatic growth (PTG) in a sample of gay men and lesbian women in Chile, with coping strategies (positive reappraisal, social support seeking, and active coping strategies) as intermediate variables. Data from 467 gay men (57.4%) and lesbian women (42.6%) were analyzed. A respondent‐driven sampling (RDS) method was used. The hierarchical regression analysis indicated the important predictive role of active coping, β = .23, and positive reappraisal, β = .45, in PTG, R2 = .31, p < .001, f2 = 0.16. Results revealed that, in the presence of positive reappraisal coping as an intermediate variable, partial indirect effects are detected between perceived stigma and PTG. Seeking instrumental social support did not produce indirect effects between perceived stigma and PTG, whereas active coping produced partial indirect effects. These findings suggest that the positive reappraisal of a traumatic experience is essential for reporting personal growth. Implications of these more complex relations for counseling interventions and further research are discussed.

McConnell, E.A. (2018). Risking It Anyway: An Adolescent Case Study of Trauma, Sexual and Gender Identities, and Relationality. Journal of Issues in Mental Health Nursing, 15 January 2018, pp. 73-82. DOI: 10.1080/01612840.2017.1400134 To link to this article:

Abstract: This article presents the case of a Chinese–American adolescent with a significant trauma history who was questioning her sexual and gender identities. The implications of the client’s intersecting identities for case conceptualization and treatment are considered within the framework of affirmative practices for sexual and gender minority (SGM) clients. The impacts of stress and trauma on this client’s experiences—and SGM clients more broadly—are also considered, particularly with respect to how this client understood and negotiated her experiences of relational trauma. This case is intended to illustrate some best practices with SGM clients within an intersectional framework which underscores the importance of multiple salient cultural identities.

Wright, A.L. (2018). Relationship Between Obesity, Childhood Sexual Abuse, and Attitudes Toward Obesity in Sexual-Minority Women. Journal of Gay & Lesbian Mental Health. DOI: 10.1080/19359705.2018.1429975 To link to this article:

Abstract: Sexual-minority women (SMW) are more likely to be overweight, have a history of childhood sexual abuse (CSA), and have more positive attitudes toward obesity compared to their heterosexual counterparts. In this exploratory study, the author sought to identify any associations between CSA, obesity, and attitudes toward obesity among SMW. Eighty-five SMW completed a survey assessing their weight, history of CSA, and attitudes toward obesity. An ordered logistic regression (OLS) and an analysis of variance (ANOVA) revealed CSA to be negatively correlated with BMI, as well as no association between SMW’s attitudes toward obesity and CSA nor BMI. Lastly, SMW did not report significantly different attitudes toward BMI based on their own BMI and history of CSA. This study provides evidence that SMW, particularly those residing within the Deep South, are at high risk for both CSA and for obesity, and highlights the importance of developing future culturally tailored weight loss programs designed specifically for SMW with histories of trauma.

Giovanardi, G., Vitelli, R., Vergano, C.M., (2018). Attachment Patterns and Complex Trauma in a Sample of Adults Diagnosed with Gender Dysphoria. Frontiers in Psychology 2018. DOI: 10.3389/fpsyg.2018.00060 To link to this article:

Abstract: The current study investigated attachment representations and complex trauma in a sample of gender dysphoric adults. Although it has been proven that the psychological wellbeing of gender diverse persons is largely mediated by family acceptance and support, research on their relationships with parental figures is scarce. A total of 95 adults took part in the study. The attachment distribution was as follows: 27% secure, 27% insecure and 46% disorganized. Regarding early traumas, 56% experienced four or more traumatic forms. Further, gender dysphoric adults showed significantly higher levels of attachment disorganization and polyvictimization, relative to controls. Comparisons of subgroups, defined by natal gender, showed that trans women, compared to control males, had more involving and physically and psychologically abusive fathers, and were more often separated from their mothers; trans men, relative to female controls, had more involving mothers and were more frequently separated from and neglected by their fathers. The research has several implications for treatment, clinical health psychology, family support and education.

Taylor, S.W., Goshe, B.M., Marquez, S.M., (2017). Evaluating a Novel Intervention to Reduce Trauma Symptoms and Sexual Risk Taking: Qualitative Exit Interviews with Sexual Minority Men with Childhood Sexual Abuse. Journal of Psychiatry, Health, & Medicine, 23(4), pp. 454-464. DOI: 10.1080/13548506.2017.1348609 To link to this article:

Abstract: Childhood sexual abuse (CSA) continues to affect sexual minority men (SMM) at disproportionate levels and contributes to multiple negative health outcomes, including sexual-risk taking and HIV acquisition. This paper presents qualitative evaluative feedback from SMM (N = 9) who participated in a 10-session Cognitive Behavioral Therapy-Trauma and Sexual Health (CBT-TSH) intervention to reduce CSA-related posttraumatic stress reaction and distress. The treatment was designed to increase accurate sexual risk appraisals and to improve self-care health behaviors related to HIV/STI acquisition. The researchers identified four emerging themes: (1) motivation to participate, (2) response to cognitive therapy, (3) process of change, and (4) considerations for intervention improvement. These qualitative findings provide useful feedback on the acceptability of an innovative program that integrates CBT for trauma related to CSA with sexual risk-reduction counseling.

Crump, L. & Byers, E.S. (2017). Sexual well-being of sexual minority women in dating relationships who have experienced childhood sexual abuse and/or adolescent and adult sexual victimization. The Canadian Journal of Human Sexuality, Vol. 26(2), pp. 163-173. DOI: 10.3138/cjhs.262-a4 To link to this article:

Abstract: Few studies have examined the sexual sequelae of child sexual abuse (CSA) for sexual minority women (SMW), particularly SMW in dating relationships. We examined the impact of CSA on several aspects of sexual well-being. Participants were 299 SMW in a non-cohabiting dating relationship who completed an online survey that assessed CSA, adolescent and adult sexual victimization (AASV) and their behavioural, motivational, and cognitive-affective sexual responses. Four groups were formed based on sexual abuse experiences before the age of 14: No lifetime sexual abuse (NSA Group); AASV only (AASV Group); CSA limited to fondling (CSAfon Group); and, CSA involving attempted/completed vaginal, oral and/or anal penetration (CSApen Group). Women in the CSAfon and CSApengroups were significantly more likely to report having experienced AASV (77% and 56%, respectively) than were women in the AASV and NSA groups (32%). Women in the CSApenGroup reported significantly lower sexual desire and sexual satisfaction, and more frequent negative automatic sexual thoughts than women in the other groups but no differences in their frequency of sexual behaviours, sexual duration, sexual esteem, or sexual anxiety. The AASV Group did not differ from the NSA Group on any of the sexual well-being variables. Overall, women in all four groups generally reported positive sexual well-being. These results suggest CSA involving attempted/completed penetration with or without subsequent AASV negatively affects only some aspects of SMW’s sexual well-being. They also suggest SMW who have experienced sexual abuse can and do enjoy healthy sexual well-being within the context of a dating relationship.