Obsessive-Compulsive Symptoms in Sexual Minorities

Public significance statement The current study suggests that sexual minorities endorse more severe obsessive-compulsive symptoms of unacceptable thoughts related to violence, sex, or religion. Cognitive-behavioral and minority stress frameworks explain why sexual minorities may paradoxically endorse the most socially stigmatized obsessive-compulsive symptoms. Sexual minorities experience unique stress in the form of external discriminatory, microaggressive, and traumatic events; and internalized stigma and homophobia, expectations of social rejection, and identity discomfort and concealment. The accumulation of these identity-based stressors is believed to explain the increased incidence of psychopathology in this population. Among a variety of mental health disorders, obsessive-compulsive (OC) disorder may be more prevalent in sexual minorities. Because specific domains of OC symptoms are more associated with internal and external shame and stigma and because OC symptoms are maintained and exacerbated through overreactivity to and avoidance of intrusive thoughts, it was predicted that more stigmatized presentations of OC symptoms would be endorsed more severely by sexual minorities. Consistent with predictions, in a sample of 515 nonclinical undergraduates, OC symptoms of unacceptable thoughts related to violence, sex, or religion were endorsed significantly more by sexual minorities compared with heterosexuals, even after controlling for the effects of trauma exposure and posttraumatic stress symptoms. Unexpectedly, contamination symptoms were endorsed significantly less by sexual minorities. Merging cognitive-behavioral and minority stress frameworks, the findings suggest that sexual minorities may paradoxically experience the OC symptoms linked to stigma and shame that they are trying to avoid, perhaps because of an adapted sensitivity to social stigma and stressors. Implications for research and clinical interventions are discussed.