Minority Stress and Concealment in Trauma-Exposed Sexual and Gender Minorities

 Journal of Counseling Psychology | 2025, Vol. 72, No. 3, p. 211-222

Daily Minority Stressors, Threat Appraisal, and Identity Concealment Among Trauma-Exposed Sexual Minority Women and Transgender and Gender-Diverse People

Jillian R. Scheer; Department of Psychology, University of Rhode Island

Skyler D. Jackson; Department of Social and Behavioral Sciences, Yale School of Public Health

Cory J. Cascalheira; Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States

Kriti Behari; Department of Psychology, Syracuse University

Emily C. Helminen; Center for Alcohol and Addiction Studies, Brown University School of Public Health

Abigail W. Batchelder; Department of Psychiatry, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine; The Fenway Institute, Fenway Health, Boston, Massachusetts, United States

Tami P. Sullivan; Department of Psychiatry, Yale University School of Medicine

“Sexual minority women (SMW) and transgender and genderdiverse (TGD) people—those who not only face heterosexism but also gender-related oppression—navigate complex decision-making processes about concealing their stigmatized sexual and gender identities.. Identity concealment refers to purposefully avoiding or refraining from disclosing personal information that may be perceived as shameful. There have been recent calls to decolonize White-dominated, Western narratives around concealment (e.g., that disclosure should be prioritized) and instead to examine psychosocial factors that are associated with concealment. Few studies have examined psychosocial determinants of concealment in SMW and TGD people who may face multiple forms of oppression (e.g., heterosexism, cissexism, sexism). Moreover, SMW and TGD people are more likely to experience direct or indirect exposure to actual or threatened death, serious injury, or sexual violation, which could enhance their motivation to seek safety by concealing their identities. This underrepresentation of SMW and TGD people in research focused on concealment perpetuates the centering of cisgender men in sexual and gender minority literature. Moreover, no study has identified when and under which conditions trauma-exposed SMW’s and TGD people’s concealment fluctuates day-to-day” (p. 212). 

“Bridging minority stress, social safety, and stress and coping theories, this study responds to calls for research that advances knowledge of heterogeneity in daily identity concealment among vulnerable and understudied sexual and gender minority subgroups, namely, trauma-exposed SMW and TGD people We conducted a 14-day experience sampling study and examined between- and within-person minority stressors and threat appraisal and trait-based avoidance coping as predictors of daily concealment. Furthermore, we examined trait-based avoidance coping as a moderator of the links from daily minority stressors and threat appraisal to concealment. We hypothesized that experiencing more daily minority stressors, as well as higher average minority stressors over a recent 2-week period (i.e., recent cumulative minority stressors), would be positively associated with concealment. Additionally, we hypothesized that appraising daily threat and higher average threat levels over the same 2-week period (i.e., recent cumulative threat) would also be positively associated with concealment. Greater trait-based avoidance coping was expected to be associated with greater daily concealment, over and above daily and recent cumulative minority stressors and threat appraisal. We also anticipated that trait-based avoidance coping would moderate the links from daily minority stressors and threat appraisal to concealment” (p. 213).

“Participants were 57 SMW and TGD people (Mage = 28.42, SD = 10.10; range 18–72 years; see Table 1). Eligible participants identified as SMW or TGD people, were at least 18 years old, reported a Criterion A traumatic event (posttraumatic stress disorder Diagnostic Scale for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition), spoke English, lived in the United States, could complete daily surveys, had a functional email address, and reported not receiving past-6-months inpatient psychiatric support. Data are from a pilot daily diary study of SMW and TGD people; data were collected between 2021 and 2022. The Institutional Review Board at Syracuse University approved study procedures. Participants were recruited via social media, listservs, and organizations serving sexual and gender minority people and trauma survivors” (p. 214). The Daily Sexual Minority Stressors Scale was used to measure minority stress and threat appraisal, while concealment was measured by asking participants to indicate whether they concealed their sexual or gender identity that day. 

“Trauma exposed SMW and TGD people reported situationally varying daily concealment as around 36% of the variability in daily concealment was due to within-person changes over time. This study also demonstrated that situational variability in minority stressors and perceived threat predicted same-day identity concealment, independent of one’s own average levels of minority stressors and perceived threat. That is, regardless of one’s tendency to experience stigma or perceive threat, day-to-day experiences of stressors and threat appraisal increase the likelihood that trauma-exposed SMW and TGD people will conceal their identity” (p. 217).

“Findings also indicated significant random variability in the links from within-person minority stressors and threat appraisal to daily concealment, suggesting that there were individual differences in this association—perhaps due to one’s tendency to use avoidance coping. Indeed, those who tended to use avoidance to cope with general stressors, on average, were more likely to conceal their sexual or gender identities, independent of the effects of daily and average levels of minority stressors and threat appraisal. Those who were less (vs. more) likely to use general avoidance strategies to cope with stressors were more likely to conceal their identities on days marked by elevated minority stressors and perceived threat. Findings support efforts to decolonize narratives of concealment as inherently adaptive or maladaptive by enhancing our understanding of psychosocial contexts surrounding concealment” (p. 217).

“Reflecting the values of counseling psychology, it is essential to reduce inequities and improve structural and social climates, such as by increasing antidiscrimination protections, given the prevalence of minority stressors and perceived lack of safety reported by trauma-exposed SMW and TGD participants. Participants reported perceiving that a situation, an individual, or an environment was unsafe due to their sexual minority identity on 25.9% of days over a 2-week period. Counseling psychologists working with trauma-exposed SMWand TGD people should avoid prioritizing disclosure. Instead, they should explore the impact of acute and chronic experiences of stigma and lack of safety on concealment. 

Interventions aimed at enhancing discriminative thinking and coping flexibility could benefit trauma-exposed SMW and TGD people with habitual avoidance coping patterns who may conceal their identities regardless of the presence of enacted stigma or perceived threat. Addressing avoidance rooted in generalized fear might involve perceptual discrimination training to improve discernment of subtle features that distinguish dangerous situations from neutral situations. Counseling psychologists who provide opportunities for trauma-exposed SMW and TGD people to confront uncontrollable and feared stigmarelated stimuli through exposure-based interventions might help reduce generalized avoidance through inhibitory learning. 

Informed by this study’s findings, it is critical for counseling psychologists to consider the dynamic interplay between psychosocial contexts and individual behaviors when exploring the role of concealment among trauma-exposed SMW and TGD people. Trauma-exposed SMW and TGD people who do not typically rely on avoidance coping may perceive stigma as an opportunity to prevent future threat by concealing their identities, rather than viewing it as an unavoidable danger. Therefore, interventions should include psychoeducation on identity concealment as a goal-directed, safety strategy used to navigate hostile social climates. Counseling psychologists could work with trauma-exposed SMW and TGD people to explore ways of accessing health-promoting benefits from identity disclosure—such as a sense of belonging, pride, and identity affirmation—without disregarding their intentions and motivations to conceal. Considering the acute, dynamic, and cumulative impacts of stigma on concealment, as demonstrated in this study, just-in-time adaptive interventions could prompt SMW and TGD people to assess the costs and benefits of concealing sexual and gender identities in stigmatizing and unsafe contexts, consider the role of avoidance in concealment, and access affirmative support” (p. 218-219). 

“Findings from this study should be interpreted in light of limitations. This was a small pilot study of 57 trauma-exposed SMW and TGD people. Future work is needed to build on this proof-of concept study to advance understanding of individual, situational, and environmental drivers of identity concealment in these groups. Despite recruiting nationwide, this study did not consider the impact of region-, state-, or county-specific factors in the day-to-day variation in concealment. In addition, causal inferences cannot be established due to our focus on same-day associations and oncedaily assessments. The limited sample size for this study prevented examining differences in how stigma cues and concealment vary by sexual identity, gender identity, or race/ethnicity. We also used one item to assess daily threat appraisal related to sexual identity (aligned with the DSMSS), without considering daily threat appraisal related to identifying as a cisgender woman, TGD person, or with another minoritized identity. Further, this item demonstrated small-to-strong relationships with other DSMSS items at both the within- and between-person levels, which may limit our ability to capture the nuanced variability in daily threat appraisal relative to other minority stressors measured by the DSMSS. Future research is needed to develop a multi-item subscale to better isolate and examine the construct of perceived sexual identity-related threat in daily life among trauma-exposed SMW and TGD people. Future studies should build on these preliminary findings by assessing concealment in the context of other daily stressors as well as motivations for concealment among trauma-exposed SMW and TGD people. 

Future studies might examine the influence of structural stigma on daily concealment and whether avoidance coping—in general and across specific domains (e.g., self-blame, denial)—moderates this association. Additional work is needed to assess whether this study’s findings generalize to sexual and gender minority people more broadly, including sexual minority men and those who do not report trauma exposure. Future studies are needed to identify whether trauma-exposed SMWand TGD people conceptualize concealment as a form of experiential versus active avoidance and to assess thwarted attempts at concealment in the context of sexual minority stressors and perceived threat. Studies might also consider the extent to which daily concealment is salient, voluntary, associated with positive or negative health outcomes, and considered to be affirming among trauma-exposed TGD people” (p. 219).