According to the minority stress model, sexual minorities face chronic social stress resulting from their stigmatized identity (Meyer, 2013). This includes experiencing discrimination, rejection, victimization, and internalized negative societal attitudes.
The accumulation of these minority stressors is believed to partially explain the higher rates of mental health issues among sexual minorities.
Key Points
Rationale
Prior research demonstrates that sexual minorities face unique stressors related to their sexual orientation, known as minority stress (Meyer & Frost, 2013). This includes experiencing external discrimination, trauma, rejection, and internalized stigma or shame.
The accumulation of these minority stressors puts sexual minorities at higher risk for mood, anxiety, and substance use disorders (Cochran, Mays, & Sullivan, 2003).
Given the link between adverse life events and OCD development (Ceschi et al., 2011), along with sexual minorities’ elevated rates of trauma exposure (Roberts et al., 2010),OCDmay be more common in this population.
Indeed, studies using student samples have found higher rates of self-reported OCD diagnosis among sexual minority groups compared to heterosexuals (Pelts & Albright, 2015; Przedworski et al., 2015). However, no research has examined how the presentation of OC symptoms may differ.
Examining nonclinical samples also aids in early OCD detection, as most cases are initially undiagnosed in the community (Glazier, Calixte, et al., 2013).
Overall, this research explores an understudied mental health outcome in an at-risk group.
Method
Participants provided information on sexual orientation, gender, race, ethnicity, marital status, and employment status. These were dichotomized for correlation analyses.
Independent samples t-tests,chi-square tests, and profile analysis were used.
Measures
515 nonclinical undergraduates completed self-report measures of OC symptoms, trauma exposure, and posttraumatic stress.
Sample
89.8% heterosexual, 7.6% bisexual, 2.0% gay/lesbian. Mean age 19.2 years. 56.1% female, 42.9% male. 60.2% White, 21.8% Black.
Results
Results showed that sexual minorities reported significantly more severe obsessive-compulsive (OC) symptoms overall compared to heterosexuals.
Specifically, sexual minorities endorsed greater severity of “unacceptable thoughts” OC symptoms related to violence, sex, or religion. This difference remained even after controlling for trauma exposure and posttraumatic stress symptoms in the analyses.
In addition to more severe symptoms, sexual minorities exceeded the suggested cutoff score on the Dimensional Obsessive-Compulsive Scale (DOCS) for probable OCD at a higher rate than heterosexuals.
Based on the cutoff score of 18, 37.7% of sexual minorities met the criteria for probable OCD, compared to only 21.8% of heterosexual participants.
This indicates that sexual minorities were nearly twice as likely to be characterized as having clinically significant OC symptoms or probable OCD based on the self-report measure.
Insight
These results suggest sexual minorities experience elevated rates of OC symptoms, especially surrounding unacceptable or taboo thoughts. The findings are consistent with the notion thatstigma and shamemay sensitize sexual minorities to intrusive thoughts linked to potential social rejection.
The higher prevalence of probable OCD also aligns with previous research showing greater vulnerability for OCD diagnosis in sexual minority groups.
Minority stress increases the risk for OCD in sexual minorities. Stigmatized OC symptoms like unacceptable thoughts may be sensitized because they expect increased social rejection.
This may lead to overreaction and avoidance behaviors that inadvertently reinforce the obsessive thoughts.
Strengths
Limitations
Implications
Mental health providers treating sexual minorities with OCD face dual responsibilities:
Research shows clinical trainees often misdiagnose less common OCD presentations like sexual/violent obsessions (Glazier et al., 2013; 2015).
Thus providers should take care to accurately assess unacceptable obsessive thoughts in this population rather than dismissing them.
However, rumination around sexual orientation is common during identity development. Distinguishing normal questioning from OCD requires a nuanced functional analysis regarding the ego-dystonic nature of intrusive thoughts.
Overall, mental health professionals must appreciate the interplay between OCD and minority stress for sexual minorities to deliver sensitive, ethical services.
References
Primary reference
Pinciotti, C. M., & Orcutt, H. K. (2021). Obsessive-compulsive symptoms in sexual minorities.Psychology of Sexual Orientation and Gender Diversity, 8(4), 487–495.https://doi.org/10.1037/sgd0000437
Other references
Abramowitz, J. S., Deacon, B. J., Olatunji, B. O., Wheaton, M. G., Berman, N. C., Losardo, D., … & Hale, L. R. (2010). Assessment of obsessive-compulsive symptom dimensions: Development and evaluation of the Dimensional Obsessive-Compulsive Scale.Psychological assessment, 22(1), 180.
Ceschi, G., Hearn, M., Billieux, J., & Van der Linden, M. (2011). Lifetime exposure to adverse events and reinforcement sensitivity in obsessive–compulsive prone individuals.Behaviour Change, 28(2), 75-86.
Cochran, S. D., Mays, V. M., & Sullivan, J. G. (2003). Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States.Journal of Consulting and Clinical Psychology, 71(1), 53-61.
Gray, M. J., Litz, B. T., Hsu, J. L., & Lombardo, T. W. (2004). Psychometric properties of the life events checklist.Assessment, 11(4), 330-341.
Meyer, I. H. (2013). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence.Psychology of Sexual Orientation and Gender Diversity, 1(S), 3-26.
Pinciotti, C. M., & Orcutt, H. K. (2020). Obsessive–compulsive symptoms in sexual minorities.Psychology of Sexual Orientation and Gender Diversity, 8(4), 487–495.
Roberts, A. L., Austin, S. B., Corliss, H. L., Vandermorris, A. K., & Koenen, K. C. (2010). Pervasive trauma exposure among U.S. sexual orientation minority adults and risk of posttraumatic stress disorder.American Journal of Public Health, 100(12), 2433-2441.
Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013).The PTSD checklist for DSM-5(PCL-5).
Keep Learning
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
