Internalized heterosexism and posttraumatic stress disorder symptoms: The mediating role of shame proneness among trauma-exposed sexual minority women.

Abstract

Sexual minority women are more likely to experience negative mental health outcomes, including posttraumatic stress disorder (PTSD), than heterosexual women. Meyer’s (2003) minority-stress theory posits that this elevated risk of psychopathology results from stressors specific to the experience of holding a minority identity, and Hatzenbuehler (2009) suggested that these effects may be mediated by general psychological risk factors. Internalized heterosexism is conceptually and empirically linked to shame proneness, and both are associated with PTSD symptoms. Applying Meyer’s and Hatzenbuehler’s theories, in this study, we investigated the indirect effect of internalized heterosexism on PTSD symptomatology through shame proneness among 326 trauma-exposed sexual minority women recruited online. Analyses indicated that internalized heterosexism significantly and positively predicted PTSD symptomatology. In addition, internalized heterosexism had an indirect effect on PTSD symptoms through increased shame-related withdrawal tendencies, but not through shame-related negative self-evaluations. Clinical and policy considerations, including the need for systemic interventions focused on decreasing negative messages about sexual minority identities, as well as individual interventions targeting withdrawal behaviors in the treatment of PTSD among sexual minority women, are discussed.

Association Between Shame and Posttraumatic Stress Disorder: A Meta‐Analysis

“…A forest plot of the associations between shame and PTSD symptoms for all studies can be found in Figure 2. From this plot, three effect sizes were identified as statistical outliers (Babcock Fenerci & DePrince, 2018;Lancaster & Erbes, 2017;Straub et al, 2018). The results of analysis of the heterogeneity of variance were nonsignificant, Q(24) = 18.23, p = .792, I 2 = 0.00%, 95% CI [0.00%, 31.91%], indicating minimal betweenstudy variance.…”

“…We used the effect size for the overall scale if effect sizes for multiple subscales were reported (Harman & Lee, ). Averages were calculated for studies that reported more than one shame outcome (Dorahy et al., ) or on multiple shame subscales without a total score (Neufeld, Sikkema, Lee, Kochman, & Hansen, ; Straub, McConnell, & Messman‐Moore, ; Zerach & Levi‐Belz, ). Borenstein, Hedges, Higgins, and Rothstein () suggest the weighting of average effect sizes; however, recent work has shown that this may create potential bias by introducing a third, confounding variable in a random‐effects meta‐analysis (Shuster, ).…”

Intersectional insights from an MDMA-assisted psychotherapy training trial: An open letter to racial/ethnic and sexual/gender minorities

“…This may be mediated by the internalization of stigma. According to minority stress theory (Meyer, 2003), internalized homophobia/transphobia is predictive of various forms of psychopathology, including PTSD symptoms, psychological distress, and substance abuse (Puckett & Levitt, 2015;Puckett, Mereish, Levitt, Horne, & Hayes-Skelton, 2018;Straub, McConnell, & Messman-Moore, 2018).…”

Bisexual Women’s Experiences of Stigma and Verbal Sexual Coercion: The Roles of Internalized Heterosexism and Outness

“…Adequate internal reliability (Cronbach’s α = .82) has been reported for scores on the IHP-R in LGBQ adult samples (Herek et al, 2009). Further, the IHP-R has been used as a measure of internalized heterosexism with bisexual women (e.g., Straub et al, 2018) and validity of scale scores has been supported by positive associations with identity concealment and expectations of rejection among sexual minority women (Mason & Lewis, 2015). A mean score for 5 items is calculated, where higher scores indicate greater levels of internalized heterosexism.…”