A Qualitative Analysis of the Context and Characteristics of Trauma Exposure Among Sexual Minority Survivors: Implications for Posttraumatic Stress Disorder Assessment and Clinical Practice

Objective: Sexual minority individuals are exposed to traumatic harms unique to the shared cultural experience of living under conditions of identity-based stigma, discrimination, and marginalization. However, the context and characteristics by which this culture shapes traumatic experiences among sexual minority people are poorly specified in the research literature, leaving even well-intentioned mental health professionals inadequately prepared to treat sexual minority trauma survivors in a culturally affirming, tailored, and evidence-based manner. Method: To begin to address this gap, we conducted a thematic analysis of descriptions of 52 Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) Criterion A (traumatic) events described by sexual minority participants during administration of the Clinician-Administered PTSD Scale for DSM-5. Results: Probing for identity relatedness of Criterion A trauma produced a rich and reliable (κ = .83-.86) coding scheme reflecting the cultural context and characteristics of these experiences. Conclusions: Clinicians working with sexual minority and other marginalized trauma survivors should specifically assess for the role of culture in traumatic experiences to inform case conceptualization and treatment plans supporting recovery of the whole survivor. Clinical Impact Statement We describe specific and reliable patterns of overlap between experiences of trauma and discrimination among sexual minority trauma survivors, assessed with a brief and widely accessible clinical tool. Results serve as concrete guidance for clinicians to consider when assessing and addressing the role of culture in posttraumatic stress disorder with patients marginalized based on their sexual identity.