We examined psychache, or intolerable emotional suffering, in a sample of lesbian, gay, and bisexual (LGB) young adults who identified as religious. Using a minority stress framework, we hypothesized internalized heterosexism (IH) would positively relate to psychache. We also hypothesized that positive religious coping (PRC) would moderate or lessen this association. Finally, we examined whether negative religious coping (NRC) moderated or mediated the relation between IH and psychache. A sample of 617 LGB young adults who identified as religious completed an online survey assessing IH, religious coping, and psychache. Consistent with our hypothesis, IH was significantly related to psychache. IH was also significantly, positively correlated with both PRC and NRC, suggesting that individuals use both forms of religious coping in relation to experiencing IH. Results suggested that NRC, but not PRC, was correlated with psychache. Contrary to our hypotheses, neither PRC nor NRC moderated the relation between IH and psychache. NRC did, however, mediate the relation between IH and psychache. Results suggest clinicians working with LGB individuals may want to attend psychache, in addition to other types of psychological distress, and that they may target their interventions toward reducing the use of NRC. Public Significance StatementThis study found that internalized heterosexism was related to psychache, or intense emotional pain that has been found to predict suicidality. This relation was mediated by negative religious coping. Practitioners may seek to help clients reduce their use of negative religious coping to help reduce psychache.