by A. Alex McConnell, MA
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.
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