1) Sexual minority youth face greater mental health challenges than their heterosexual peers, including higher rates of depression, substance abuse, suicidality, and victimization. 2) A study of 26 sexual minority youth and 26 matched heterosexual youth found that the sexual minority youth had significantly higher levels of anxiety, depression, paranoia, somatization, general psychological distress, suicidality, and loneliness. 3) Different defense mechanisms correlated with symptoms for each group - for sexual minority youth, higher principalization correlated with lower interpersonal sensitivity, and higher turning anger inward correlated with higher interpersonal sensitivity and depression.

1. Sexual Minority Youth: Mental
Health Issues
Mark A. Biernbaum, Ph.D.
University of Pittsburgh

2. Difficulties in doing Research on
Sexual Minority Youth (SMY)
• Poor experimental control
• small sample sizes
• questionable generalizability
• lack of cultural diversity
• questions concerning the way sexual orientation is defined and
measured
• Problems in recruiting/finding SMY
• Problematic cultural conceptions of adolescence
• Erotophobia and cultural ambivalence regarding adolescent sexuality
• Negative cultural attitudes towards homosexuality

3. Demograhpics (Savin-Williams, 1995)
Ages Males Females
First homosexual
attraction
9.6 (3.6) 10.1 (3.7)
First homosexual
fantasy
11.2 (3.5) 11.9 (2.9)
First homosexual
activity
13.1 (4.3) 15.2 (3.1)
First heterosexual
activity
13.7 (3.6) 13.6 (3.6)
Age at first disclosure
16.0 (2.4) 16.0 (1.8)

4. Sexual Minority Youth and
Psychopathology
• SMY, when compared to their heterosexual
peers, have demonstrated significantly higher
levels of:
• Depression
• Hopelessness
• Substance use and abuse
• Anxiety disorders
• Conduct disorder
• Psychiatric comorbidity
• Suicidal ideation and attempts

5. Sexual Minority Youth and
Suicidality
• Over the last decade, several large, well-
executed studies have demonstrated
increased risk for suicide in SMY
• Higher levels of suicidal ideation
• Higher numbers of suicide attempts
• Higher levels of potential lethality
• It is estimated that SMY may comprise 30%
of all completed adolescent suicides

6. Risk Factors Associated with
Psychopathology and Suicidality in SMY
• Lower levels of social support; higher levels of loneliness/isolation
• Alarmingly high levels of victimization
• Internalized Homophobia
• Conflicts/Problems with peers and family
• Depression
• Substance Abuse
• Feminine gender role identification in gay males
• Younger age at first disclosure
• Initiation of homosexual sexual activity at a younger age
• Sexual Abuse
• History of criminality/arrests

7. Victimization of SMY
• Pilkingon & D’Augelli, 1995:
• 221 SMY, all under 22, from 14 different urban areas;
Victimization associated with age at first awareness, gender
atypicality, age, level of fear regarding community of residence,
level and length of disclosure
• 80% reported verbal attacks
• 44% reported threats of physical attacks
• 23% reported vandalism
• 33% had objects thrown at them
• 30% were chased or followed
• 17% were physically assaulted
• 10% were assaulted with a weapon
• 22% were sexually assaulted

8. Internalized Homophobia
• Definition: set of negative attitudes and affects regarding
homosexuality in self and in others; normal developmental event
• Why?
• 1. Raised with the assumption of heterosexuality
• 2. High cultural levels of homophobia in majority culture and within
all subcultures
• Associated with: depression, lower self-esteem, suboptimal coping
styles, psychological integrity, interpersonal relations,
distrust/loneliness, under/over achievement, impaired sexual
functioning, unsafe sexual practices, domestic violence, substance
abuse, eating disorders, borderline personality features, suicidality

9. Coming Out
• Stages:
• Initial Awareness
• Eroticization of feelings of “differentness”
• Exploration of meaning of sexual minority status
• Coming to terms with sexual minority status/Successful integration
• Issues: Process can take years/decades to complete; high levels of
variability in coping with process both across and within individuals;
disclosure increases risk of victimization, lack of disclosure increases
risk of psychological fragmentation; for many, the process is not a
choice (gender atypicality); influenced by many variables, including
race/ethnicity, gender, religiousity, social class; internalized
homophobia; usually assessed by retrospective report

10. Purposes of Present Investigation
• Add to empirical literature on psychopathology risk in SMY
• Investigate the association between defense mechanisms and levels of
psychopathological symptom severity in SMY versus matched
heterosexual youth
• Current sample drawn from larger sample (n = 435) of college youth
in Seattle
• Why?
– Replication of previous findings; adding to scarce literature
– many coming-out models and psychoanalytic theory hypothesize
that certain defenses may be more prominent/influential during
this period: denial, repression, reaction formation, projection,
identification with the aggressor, turning anger inward

11. Methods
• Current sample: 26 SMY matched to 26
heterosexual peers
• Matching variables: age, race, level of
education, security of attachment
• When more than 1 heterosexual subject met
matching criteria, actual match was chosen
at random

12. Sample Characteristics/Matching Procedures
Heterosexual Homosexual % Match
Sex: Male
Female
12
16
12
16
100%
Age: 18-19
20-21
22-25
18
6
4
18
6
4
100%
Educ.: Lower
Upper
20
8
19
9
96%
Race: White
Non-white
Unspecified
23
4
1
23
3
2
93%
Attach: Secure
Insecure
13
15
13
15
93%

13. Measures
• Simple Demograhpics: sex, age, year in school; optional
= sexual orientation (84% reported) & race (86% reported)
• Adult Attachment Questionnaire: Attachment
security independent of all demographic variables, including
orientation, by chi-square
• Defense Mechanism Inventory: Principalization,
Reversal, Projection, Turning Anger Outward, Turning Anger Inward
• Brief Symptom Inventory: depression, anxiety,
paranoia, hostility, interpersonal sensitivity, somaticization, obsession-
compulsion, phobic anxiety, psychoticism, additional items, general
symptom severity

14. Additional Subscales Created
• Suicidality: 4 BSI items, drawn from two different
subscales; standardized item alpha = .82
• Loneliness: 3 BSI items drawn from two different
subscales; standardized item alpha = .84

15. Results: Defense Mechanisms
Heterosexual SMY z-score Probability
Principalization 45.5 (6.4) 46.0 (6.3) -0.25 .807
Projection 40.5 (5.0) 39.6 (6.1) -0.53 .606
Reversal 37.6 (7.4) 37.1 (8.8) -0.42 .683
Anger Out 40.6 (8.8) 39.0 (8.9) -0.13 .906
Anger In 35.9 (6.4) 38.3 (9.2) -1.26 .214
* Differences based on Wilcoxin Signed Ranks Tests for paired samples, using Exact
method to calculate z-scores/probability. All two-tailed

16. Defenses and Symptoms: Correlations
Sexual Minority Youth
Defense Symptom r probability
PRN Interpersonal
Sensitivity
-.38 .04
PRN Paranoia
-.38 .05
PRN Phobic Anxiety
-.53 .004
TAI Interpersonal
Sensitivity
.49 .009
TAI Depression
.39 .04
TAI Psychoticism
.38 .05
TAO Paranoia
.49 .008

17. Defenses and Symptoms: Correlation
Heterosexual Youth
Defenses Symptoms r probability
Reversal Obsession-
Compulsion
.38 .04
Reversal Somaticazation .39 .04

18. Symptom Severity: Group Differences
Syptom Hetero SMY z-score p-value
Anxiety 48.8 (15.3) 53.9 (13.1) -1.08 .036
Depression 44.8 (24.5) 54.9 (17.9) -1.72 .044
Somaticizing 37.1 (24.9) 50.4 (16.7) -2.05 .02
Obs-Comp 50.2 (12.2) 54.1 (13.9) -1.53 .065
*Paranoia 38.6 (16.9) 48.6 (12.4) -3.11 .001
Psychoticism 44.5 (21.8) 53.1 (16.5) -1.60 .056
GSI 53.5 (3.2) 55.2 (4.1) -1.91 .028

19. Symptom Severity: Additional Scales
Symptom Hetero SMY z-score p-value
Suicidality 0.8 (0.8) 1.2 (1.1) -1.83 .033
Loneliness 1.3 (1.0) 1.8 (1.3) -1.46 .08