Lecture 2; Sexual orientation, sexual identity, and sexual minority stress in LGBT people

sexual identity

"Post-gay": Some evidence that younger same-sex attracted people are identifying more with nontraditional labels (i.e. queer, pansexual, demisexual, asexual) (Russell, 2012; Savin-Williams, 2014). We found queer and pansexual identities were most common among those who are non-cisgender, cisgender women, and younger cohorts (Morandini et al., 2016) Pansexual = Bisexual Queer = Mostly homosexual BUT some bisexual and exclusively homosexual too

Cass (1979): Stages of homosexual identity development

Assumes sexual identity is acquired through a developmental process Individuals motivated to seek congruence between sexual/romantic attractions and personal and public identity Movement through six stages required for full integration of "homosexual" identity into sense of self Each stage involves challenges/tasks, resolution of which leads to the next stage An individual may choose not to develop further at any stage ("identity foreclosure"). Growth occurs when individuals attempt to resolve inconsistency between perception of self and others. Length of time differs from person to person

Stress-Ameliorative factors

Connectedness with LGBQ community (group-level coping) Allows experience of social environments where not stigmatised Support against stigma and discrimination Disconfirmation of negative stereotypes about other LGB's Allows social comparisons with like others (Meyer, 2003)

Distal Stressors: Prejudice events

Do experiences of discrimination account for LGB mental health disparities? Sexual Minority-specific Victimization = "Frequency of being teased/bullied, hit/beaten up, treated unfairly in last 6 months due to being perceived as gay/lesbian" • Burton, Marshal, Chrisholm, Sucato & Friedman, 2013 N=197; 14-19 years old; 70% female; 29% sexual minority 6 month interval from Wave 1 - Wave 2, Controlling for depression Wave 1 & age, race, gender.

Distal Stressors: Prejudiced events

Exist on a continuum - violence/"hate crimes" through to anti-gay slurs and acts of social exclusion • Formal (i.e., legal/Institutional discrimination): Sodomy laws, marriage act, employment discrimination etc. • Informal: Exclusion by family/peer group/religious community, anti-gay verbal and physical victimisation etc. Verbal harassment (61%); sexual harassment (47%), physical harassment (28%) physical assault (14%) (GLSEN, 1999; Kosciw, Diaz & Greytak, 2009) Prejudiced events → > trauma, hyper vigilance to threat, > perceptions of vulnerability, > social marginalisation Stress related psychopathology

Sexual identity development: Milestones in sexual identity development (e.g. Savin-Williams & Diamond, 2000)

First awareness of same-sex attractions (late childhood-early adolescence) Testing / exploration in which youths seek info about LGBQ lifestyles, communities, and/or engage in experimentation with same-sex contact Privately adopting a sexual orientation label Disclosing sexual identity to others "coming out" Becoming involved in a same-sex relationship Much variability in timing of milestones Again sex differences in sexual identity trajectories.

Distal Stressors

National Epidemiologic Survey on Alcohol and Related Conditions (Total N=34653; N=577 LGBs), a longitudinal, nationally representative study Constitutional amendment banning gay marriage on the ballot 2004 - 2005 elections no increases for heterosexuals living in states with constitutional amendments

Evelyn Hooker (1957)

empirical challenge to notion that homosexuality a form of psychopathology Compared matched sample of 30 homosexual vs. 30 heterosexual males using a battery tests of psychological adjustment and psychopathology No difference between homosexual vs. heterosexual men Sharpened critique of psychodynamic models Homosexuality removed as a disorder from DSM-II in 1973

Sexual orientation:

"An enduring pattern of emotional, romantic, and/or sexual attractions to men, women or both sexes."

"What is sexual orientation and do women have one?"

"If we insist that women have sexual orientations and that sexual orientation must have the same mechanism for both sexes, this leads us to the odd conclusion that most women with heterosexual identities and preferences have a bisexual orientation." Bailey (2009, p. 59)

orientation and mental health Marmor (1980)

"The basic issue ... is not whether some or many homosexuals can be found to be neurotically disturbed. In a society like ours where homosexuals are uniformly treated with disparagement or contempt—to say nothing about outright hostility—it would be surprising indeed if substantial numbers of them did not suffer from an impaired self-image and some degree of unhappiness with their stigmatized status. ... It is manifestly unwarranted and inaccurate, however, to attribute such neuroticism, when it exists, to intrinsic aspects of homosexuality itself." (p. 400)

Sexual orientation as sexual arousal pattern

- Provides input which orients attraction, behavior, and sexual identity - Sexual arousal pattern inferred via a number of indicators

Challenges to the minority stress hypothesis

1. Correlational / mostly cross-sectional studies (can't infer causality) 2. Non-representative sampling 3. Failure to delineate the mechanisms via which minority stress > mental health difficulties (Hatzenbuehler, 2009) 4. Are mental health discrepancies among male sexual orientation groups illusory due to inappropriate group comparisons? (Savin-williams et al., 2011) • Are cross-sex comparisons are more suitable for situations in which nonheterosexual men are assessed on sexually dimorphic variables - such as depression?

Cass (1979): Stages of homosexual identity & development

1. identity confusion - "Who am I?" (first awareness of same-sex attractions, am I gay?, inner turmoil (responses = denial, repression, rejection) 2. identity comparison - "maybe I am gay" (tentative commitment to homosexuality, social alienation, grieve losses (responses = accept, reframe attraction as temporary, attempt to change / deny LGB identity[identity foreclosure]) 3. identity tolerance - "I'm not the only one" (accepts likely LGB & seeks out others to combat isolation, positive experiences lead to further commitment to identity, negative can lead to foreclosure) 4. identity acceptance - "I will be ok" (increased contact with other homosexuals, positive connotation of LGB identity, task it to deal with incongruence between private and public view of self, selective disclosures of sexual identity or compartmentalize (foreclosure)). 5. identity pride - "I've got to let people know who I am" (Being "out" to others very important, homosexual identity becomes primary identity, immersing self in gay culture, often leads to activism - negative views of heterosexuality, unexpected positive responses to disclosure may lessen negative view of majority) 6. identity synthesis - "sexual identity one part of me" (Sexual identity no longer seen as sole identity, one part of self, personal and public sexuality is unified)

Gender inversion hypothesis

2d:4d ratio

Sexual orientation identity:

A [socially-recognised] label (e.g., gay, lesbian, bisexual) for one's sexual orientation that may or may not accurately reflect one's sexual orientation or match previous or ongoing sexual contact.

LGBQ Mental Health: The psychoanalytic model

DSM (1952): sociopathic personality disturbance DSM-R (1968): sexual deviation

Homosexuality and Evolution

How can a trait that seems to inhibit the likelihood of offspring remain in the population? • kin-selection (direct resources to kin to enhance inclusive fitness) • genes for homosexuality > reproductive success in heterosexuals • reciprocal altruism - same sex alliances decrease costly competition (Miller, 2000)

Sexual orientation and mental health

Lifetime prevalence of mental health problems in lesbian, gay and bisexuals vs. heterosexual counterparts (n=11,971) • Depression & Anxiety: Suicidal ideation: • Suicide attempts: • Substance misuse: (King et al, 2008)

Internalised homophobia & mental health

Meta-analysis (Newcomb & Mustanski, 2010) 31 studies - 1987 to 2006 (n=5831) Investigated association between IH and psychological distress, depression & anxiety Modest positive association between IH and psychological distress & depression across studies No gender differences in impact Limitations: Studies included are cross-sectional / correlational Most undertaken in non-random samples Conclusions: Overall support MINORITY STRESS HYPOTHESIS

Gender inversion hypothesis: Evidence Physiological

On average, gay men and lesbian women show a range of sex atypical biological and behavioural traits. • LeVay (1991) neuroanatomical differences between gay vs. straight men in INAH3 • finger lengths, 2d:4d (gay men feminised ratios) (e.g. Lippa, 2003) • mixed support of masculinised 2d:4d in lesbian women (e.g. Brown, 2003; Singh, 1999)

Gender inversion hypothesis: Evidence Behavioural

On average, gay men and lesbian women show a range of sex atypical biological and behavioural traits. • self-rated masculinity-femininity, occupational interests (Lippa, 2005, 2008) • childhood gender non-conformity • Retrospective (e.g. Rieger, 2008) and prospective (Zucker, 2008) studies • Androphilic natal males adopt feminine gender roles across cultures (Vasey, 2016)

Female erotic plasticity

Women more likely to be non-exclusively than exclusively same-sex attracted - vice versa in men. • Women more likely to experience shifts in sexual identity, attraction, and behavior overtime than are men (i.e. sexually fluid) (Kinnish et al., 2005; Diamond, 2005; 2008) • Stable lesbians; Fluid lesbians; Fluid non-lesbians (Diamond, 2005; 2008) • More so than in men, women's same-sex attractions emerge in the context of close/intimate relationships (Diamond, 2003) • Same-sex attraction may emerge unexpectedly later in life after successful heterosexual functioning (and without prior awareness of samesex sexuality)

Stigma consciousness & Concealment

expectations of negative reactions to one's stigmatized status (stigma consciousness) Hyper vigilance to threat and signs of rejection based on SO Linked to social anxiety and depression in LGBs More strongly predictive of psychological distress than objective instances of victimization (Ross, 1985) - Concealment of one's sexual orientation Constant self-monitoring to hide one's status Engenders fear of discovery, - However- Outness not consistently linked to improved wellbeing - contingent on tolerance of one's social environment

Proximal Stressors: Internalised homophobia

the internalisation of negative societal attitudes about homosexuality/bisexuality (internalized homophobia/biphobia). • Discomfort disclosing sexual orientation • Disconnectedness from other LGB's • Discomfort with same-sex sexual behaviour • Attempts to change one sexuality (in extreme cases) • Inner conflict, lowered self-esteem, selfdeprecating attitudes (Williamson, 2000) Correlates • Age • Religiosity • Lower income • Rural locality (in men) (Morandini et al., 2015) • Anti-effeminacy attitudes in gay men (Sanchez & Villian,2012)

The Australian Longitudinal Study of Women's Health

• Higher rates of smoking, alcohol abuse and illicit drug use amongst lesbian and bisexual women (Hillier, De Visser, Kavanagh & McNair, 2003) • Younger lesbian and bisexual women higher depression, anxiety, & self-harm / suicidality (McNair, Kavanagh, Agius & Tong, 2005)

How is sexual orientation determined Fraternal birth order

• Latter born sons more likely to be gay • Mothers develop immunity to H-Y Antigen (Blanchard, 2001)

Gender inversion hypothesis: Evidence

• On average, gay men demonstrate a range of sex atypical biological and behavioural traits Behavioural • self-rated masculinity-femininity, occupational interests (Lippa, 2005, 2008) • childhood gender non-conformity • Retrospective (e.g. Rieger, 2008) and prospective (Zucker, 2008) studies • Androphilic natal males adopt feminine gender roles across cultures (Vasey, 2016) Physiological • LeVay (1991) neuroanatomical differences between gay vs. straight men in INAH3 • finger lengths, 2d:4d (gay men feminised ratios) (e.g. Lippa, 2003) What about mental health outcomes? Should we expect gay men and heterosexual women to exhibit similar patterns of mental health outcomes? When heterosexual women used as reference group no mental health disparity in gay and bisexual men (Savin-Williams, 2011)

Measures Physiological (genital arousal)

• Penile Plethysmography (PPG): measurement of circumference of the penis via strain gauge. • Vaginal Photoplethysmography (VGA): device that contains a light source, and a light detector. The light source illuminates the capillary bed of the vaginal wall (increased vasocongestion increases reflected light). - fMRI - Pupil dilation

Sexual arousal patterns in men

• Sexual arousal pattern is the best candidate for a male's sexual orientation (Bailey, 2009) • Traditionally thought to be bimodally distributed • Recent studies find that some men do have bisexual arousal patterns, although relatively rare (Rieger et al., 2012; 2015; Rosenthal et al., 2012) • Some evidence of "mostly" gay and "mostly" straight arousal patterns in men (Rieger et al., 2013; Bailey, 2016 [under review])

What is sexual identity ?

• Sexual identity refers to a label and self identity adopted by an individual to communicate the most salient aspect of their sexuality (SavinWilliams, 2011) • Traditionally this relates to their sexual orientation, and conforms to the social categories of lesbian/ gay, bisexual or straight • Increasingly people are adopting sexual identities which not only reference sexual orientations, but also encompass other aspects of their sexuality − "Queer": defies normative categories of homosexual vs. bisexual vs. straight − "Pansexual": sexual or romantic attraction to people regardless of their gender expression (masculinity or femininity), gender identity, or biological sex − "Sapiosexual": sexually attracted to intelligence − "Kink": interested in unconventional sexual practices, concepts or fantasies − "Demisexual": sexual attraction only in the context of a romantic bond

How is sexual orientation determined Genetics

• Twin studies e.g. Bailey & Pillard (1991) • 52% concordance in sexual orientation between MZ twins (male) • 22% concordance in sexual orientation between DZ twins (male) • Molecular genetics • Hamer (1993; 1995) X linked marker (Xq28 region) of male homosexuality • Bailey in press. (2014) replicated Xq28 findings

the aetiology of lesbianism- Genetics

• Twin studies e.g. Bailey et al. (1993) • 48% concordance in sexual orientation between MZ twins (female) • 16% concordance in sexual orientation between DZ twins (female) However Bailey et al., 2000.... • 24% concordance in sexual orientation between MZ twins (female) • 12% concordance in sexual orientation between DZ twins (female) • Prenatal hormone levels (e.g. congenital adrenal hyperplasia (MeyerBahlburg, 2008)

Proximal Stressors

› "Internal stress processes that have their grounding in the realities of stereotypes, prejudice and discrimination" (Meyer, 2003) › "Traits due to victimisation" or "persecution-produced traits" (Allport, 1958) Three proximal stressors identified by Meyer 2003:

Longitudinal Studies of Sexual Identity Amongst Women: A Challenge to linear models

› Most models of sexual identity development are based on retrospective data amongst samples of gay men who report exclusive same-sex attraction (e.g. Cass,1979). › Ignore women and bisexuals › Longitudinal study, over 8 years (T1 = year 0; T4 = year 8), n=89 same-sex attracted women (Diamond, 2005) › Myth 1> Exclusive homosexuality is the norm: Most lesbians identified at T1 reported some opposite sex attractions and at least 1 opposite sex sexual encounter by T4. Coexisting opposite sex attractions were the norm NOT the exception. › Myth 2 > Sexual identity is stable after coming out: 70% reported changes in sexual identity after "coming out" (e.g. lesbian > bisexual) › Myth 3 > Commitment to a stable identity label is normal and optimal: Many preferred to remain "unlabeled" with regards to sexual identity and were comfortable with ongoing fluidity (challenges assumption that adoption of sexual identity label is a necessary endpoint for healthy psychosexual adjustment).