A minority stress—emotion regulation model of sexual compulsivity among highly sexually active gay and bisexual men.

Abstract

Objective Sexual compulsivity represents a significant public health concern among gay and bisexual men given its co-occurrence with other mental health problems and HIV infection. The purpose of this study was to examine a model of sexual compulsivity based on minority stress theory and emotion regulation models of mental health among gay and bisexual men. Method Gay and bisexual men in New York City reporting at least nine past-90-day sexual partners (n = 374) completed measures of distal minority stressors (i.e., boyhood gender nonconformity and peer rejection, adulthood perceived discrimination), hypothesized proximal minority stress mediators (i.e., rejection sensitivity, internalized homonegativity), hypothesized universal mediators (i.e., emotion dysregulation, depression and anxiety), and sexual compulsivity. Results The hypothesized model fit the data well (RMSEA = 0.05, CFI = 0.98, TLI = 0.95, SRMR = 0.03). Distal minority stress processes (e.g., peer rejection) were generally found to confer risk for both proximal minority stressors (e.g., internalized homonegativity) and emotion dysregulation. Proximal minority stressors and emotion dysregulation, in turn, generally predicted sexual compulsivity both directly and indirectly through anxiety and depression. Conclusions The final model suggests that gay-specific (e.g., internalized homonegativity) and universal (e.g., emotion dysregulation) processes represent potential treatment targets to attenuate the impact of minority stress on gay and bisexual men's sexual health. Tests of interventions that address these targets to treat sexual compulsivity among gay and bisexual men represent a promising future research endeavor.

LGB-affirmative cognitive-behavioral therapy for young adult gay and bisexual men: A randomized controlled trial of a transdiagnostic minority stress approach.

“…His mom comes to take him away.” For each vignette, participants’ responses to the anxiety scale are multiplied by their expectation scale score and an average of the 14 resulting scores is taken. Previous uses of this scale have yielded associations with depression, social anxiety, substance use, and sexual compulsivity (Feinstein, Goldfried, & Davila, 2012; Pachankis et al, 2015). Internal consistency was α = 0.91 in the present study.…”

“…Some of these processes are specific to being gay or bisexual, such as internalized homophobia (Newcomb & Mustanski, 2010), stigma-based rejection sensitivity (Pachankis, Goldfried, & Ramrattan, 2008), and sexual orientation concealment (Pachankis, 2007; Pachankis et al, 2008). These cognitive, affective, and behavioral minority stress processes are associated with mental health problems and several health risk-behaviors, such as alcohol use, sexual compulsivity, and condomless anal sex (Feinstein, Goldfried, & Davila, 2012; Newcomb & Mustanski, 2011; Pachankis, Hatzenbuehler, & Starks, 2014; Pachankis, Rendina, Restar, Ventuneac, & Parsons, 2015). Yet other cognitive, affective, and behavioral processes disrupted by gay and bisexual men’s stigma exposure are not specific to being gay or bisexual, and serve as universal risk factors for mental health problems (Hatzenbuehler, 2009).…”

Gay-Related Rejection Sensitivity as a Risk Factor for Condomless Sex

“…One pathway through which stigma might operate to influence HIV risk is chronic hypervigilance, especially in the form of expectations of gay-related rejection (2). Although gay-related rejection sensitivity has been associated with a wide range of adverse behavioral health outcomes highly correlated with HIV risk, such as substance use and sexual compulsivity (3, 4), its relationship with risky sexual behaviors has not been directly assessed. Thus, the present study sought to clarify the role of rejection sensitivity as a predictor of condomless sexual encounters among gay and bisexual men.…”

“…Across a series of studies, gay-related rejection sensitivity has been linked to a wide range of adverse mental and behavioral health outcomes, including depression, social anxiety, sexual compulsivity, and substance use (2–4, 6). Although limited research has examined the relationship between gay-related rejection sensitivity and risky sexual behaviors, existing evidence suggests that the two might be closely linked.…”

Enhancing HIV prevention and care among men who have sex with men: insights from social psychology

“…All of these behaviours aim to reduce threat in one way or another but they can actually undermine sexual health outcomes. Sexual compulsivity is predicted by emotion dysregulation, internalised homophobia and problematic attachment styles 8. Sexual compulsivity is more prevalent in MSM than in heterosexual men, and more prevalent in HIV-positive than in HIV-negative MSM 9.…”