Minority Stress Theory

2. MINORITY STRESS
THEORY (MST)
Presented By
Ayesha Azam
Mudassar Hussain

3. Not my fault I was born gay
19 year old boy commits suicide Due to Homophobic Bullying
* Avinshu, known as Avi by his friends, uploaded the post on July 2, around 10 pm and switched
his phone off. Next day, his body was found on the beach near his resident by the locals.
*

4. Not my fault I was born gay
19 year old boy commits suicide Due to Homophobic Bullying
* Avinshu, known as Avi by his friends, uploaded the post on July 2, around 10 pm and switched
his phone off. Next day, his body was found on the beach near his resident by the locals.
*
“Everyone knows I am a boy. But the way I walk, think and
talk is like a girl. People in India do not like that. Please do
not blame my family. Help them. We are poor. I love my
mom, dad and sister. I thank them for supporting me. It is
not my fault that I was born gay.”

6. Aim
To give the class an idea and understanding about the
Sexual Minority Stress Theory of LGBTQ+

7. Seq
LGBTQ Terms
Historical Background
Theoretical Background
Minority Stress
MST Assumptions
MST Process
MST Limitation
Alternative Model
Critical Analysis
Criticism
Applications
MST in Pakistan
Scale on MST
Researches
Conclusion

8. What Does LGBTQ Mean?
• LGBTQ is an acronym for lesbian, gay, bisexual, transgender and queer or questioning.
These terms are used to describe a person’s sexual orientation or gender identity. “Queer
Community” or “Rainbow Community” also used to describe LGBTQ people.
• Lesbian, A lesbian is a female homosexual: a female who experiences romantic love or
sexual attraction to other females.
• Gay, Gay is a term that primarily refers to a homosexual person or the trait of being
homosexual. Gay is often used to describe homosexual males, but lesbians may also be
referred to as gay.
• Bisexual, Bisexuality is romantic attraction, sexual attraction or sexual behavior toward
both males and females, or romantic or sexual attraction to people of any sex or gender
identity; this latter aspect is sometimes termed pansexuality.

9. Conti….
• Transgender, Transgender is an umbrella term for people whose gender identity differs from what
is typically associated with the sex they were assigned at birth. It is sometimes abbreviated to trans.
• Queer, Queer is an umbrella term for sexual and gender minorities that are not heterosexual or
cisgender. Queer was originally used pejoratively against those with same-sex desires but,
beginning in the late-1980s, queer scholars and activists began to reclaim the word.
• Gender Non-Conforming, refers to people who do not follow other people’s ideas or
stereotypes about how they should look, or act based on the female or male sex they were
assigned at birth.

10. Historical Background
• In early 1960s and 1970s, the social movement arises regarding the mental health of LGB
related to the classification of homosexuality as a mental disorder in DSM. The result of this
gay affirmative perspective, in 1973, in the second addition of DSM homosexuality was
removed. “Is homosexuality a mental disorder?” has been operationalized as “do
homosexuals have higher prevalence of mental disorder?” than heterosexual population.
• Later, if LGB people are at relatively higher risk of mental health issues then it is needed to
find out the factors that led them towards these issues as well as factors that may play part in
reducing those issues.
• To address the stress of minority individuals based on the assumptions of social constructive
approach of disorders, Minority Stress Theory (MST) was proposed by Meyer in 2003.

11. What is Minority Stress?
• Minority stress refers to a conceptual model that defines stressors fixed in the social
position of sexual minority individuals as causes of health related circumstances, such as
mental disorder, psychological distress, physical disorders, health behaviors (e.g.,
smoking Drug abusing), and more generally a sense of wellbeing (Mayer, 2003).
• The minority stress theory suggests that because of stigma, prejudice and discrimination
lesbian, gay, bisexual, and transgender people experience more stress than do
heterosexual and that this stress can lead to mental and physical disorders.
• MST stated that “sexual minorities face unique and hostile stressors (e.g., homophobic
victimization) related to their sexual minority identity; consequently, these stressors
have negative effects on their health” (Meyer, 2003).

12. Minority Stress Theory
• MST stated that minority status of an individual regarding his sexual orientation, ethnicity and
gender is considered as one of the circumstances in the environment that expose him/her to the
stressors that ultimately lead him towards mental health problems.
• But the identification of oneself with his own minority group also provides an individual the
opportunity of social support and affiliation that may reduce the level of stress (Meyer, 2003).
• Minority stress theory proposes that sexual minority health disparities can be explained in large
part by stressors induced by a hostile, homophobic culture, which often results in a lifetime of
harassment, maltreatment, discrimination and victimization.
• The model was originally conceptualized for sexual minorities.
• Minority stressor including experiences of prejudice, homophobia , sexual stigma expectations
of rejection, hiding, concealing, internalized homophobia and coping processes (Meyer, 2003)

13. Theoretical Background
• MST follow the Stress model of Dohrenwend (2000) to explain the processes
involved in minority stress.
• Explained stress in the context of strengths and vulnerabilities existing in the
environment as well as in an individual.
• Elaboration of Social stress theory that explains that people with minority status are
more exposed to environmental stimuli and vulnerable to stress as they have lower
coping strategies that lead to the mental health issues.
• The basis of MST is not found in one theory rather a combination of various
sociological and psychosocial theories.
• Boswell suggests that societal mistreatment, violence, and discrimination causes
stress, psychological difficulties, shame and guilt, self-destructive behaviors, mood
disturbance, dissociative conditions, personality and behavior disorders were
symptoms of the mental illness of transsexualism. (Boswell, 1991).

14. Social Psychological Theories
• Provide the basis for intergroup relationship and their impact on the health
of minority groups.
• Social identity and Self-categorization theories: provide the
psychological grounds to understand intergroup relations and their impact
on the self.
• Social comparison theory: Interactions with others are crucial for the
development of a sense of self and well-being.
• Symbolic interaction theory and Social evaluation theory: Negative
regard from others leads to negative self-regard.
• Human beings learn about themselves by comparing themselves with
others.

15. Social Theories
• Concerned with the isolation from societal structures, norms, values
and institutions.
• Durkheim theory of normlessness (1951): stated normlessness as a
cause of distress.
• Moss’s (1973): incongruent in information and minority’s person own
experience in the society, lead negative impact on the health of that
minority individual.
• Pearlin (1982) emphasis of Merton’s theory of social stress, consider
society as a stressor, minority person will be the victim of these
conflicts because society provides structures to only majority groups

16. Conti..
• Allport’s concept:
• Prejudice as harmful for environment for the minority person leads to
adverse effects.
• these effects, which he called “traits due to victimizations,”.
• Negative regard from others and harm to the minority person is self-
evident.
• Unifying concept of stress theory:
• Lazarus and Folkman (1984): “mismatch” between the individual and his
or her experience of society as the essence of all social stress.
• Selye (1982): harmony with one’s environment as the basis of healthy
living.
• Allison (1998): if individual is a member of a stigmatized minority group,
the disharmony between the individual and the dominant culture can
resultant stress significant

17. Amalgamation of Social and Social Psychological Theories
Social Theories
concerned with the isolation from
societal structures, norms, values and
institutions.
• Durkheim theory of normlessness
(1951)
• Moss’s incongruent information
(1973)
• Pearlin’s emphasis of Merton’s
theory of social stress, Society as a
stressor (1982)
Social Psychological Theories
provide the basis for intergroup
relationship and their impact on the
health of minority groups.
• Social identity and self-
categorization
• Social comparison theory
• Symbolic interaction theory
• Social evaluation theory

18. Division 44 of American Psychological Association
• The Society for the Psychological Study of Lesbian, Gay and Bisexual Issues was
founded in 1985 as a Division of the American Psychological Association, to represent
sexual orientation issues within and beyond the Association.
• The official name as it stood in 2004 still does not include “Transgender,” suggesting DIV
44 is woefully behind the learning curve regarding the complex relationships involving
aspects of gender variance and sexuality.
• On November 20, 2017 APA Div. 44 again change its name from Society for the
Psychological Study of Lesbian, Gay, Bisexual, and Transgender Issues to Society for the
Psychology of Sexual Orientation and Gender Diversity (APA, 2017).

19. Extension of MST from LGB to LGBT
• Initially this theory was developed just for LGB community.
• Testa, Habarth, Peta and Bockting (2015) planned the extension in MST in transgenders
and gender nonconforming (TGNC) based on the assumptions and concepts of MST
• Different studies were done to find the significant relationship of transgenders and TGNC
with minority stress
• Both LGB and TGNC individuals face same internalized homophobia, concealment, and
expectation of rejections
• In 2018 Meyer in a session acknowledged the mentioned extension of theory of MST. He
emphasized the genuine addition of non-affirmation gender identity as distal stressor and
considered it as an important component

20. Extension of MST from LGBT to Other Minorites
• Racism is a mental health hazard to all people of color in western nations.
• MST, which was first described in relation to the LGBT community, explains that ethnic
minorities also face three additional types of stress not experienced by the majority.
• The first is the objective experience of racial abuse, secondly, “perceived stigma” or the
expectation of discrimination which leaves them on edge, and finally the internalization of
negative attitudes fostering a sense of inferiority within them.
• These combine to form a toxic cocktail that chips away at a migrant’s psychological well-
being.

21. Basic Assumptions of Minority Stress Theory

22. Minority Stress is Unique
Minority Stress is unique, because it is not a stressor that is experienced by everyone. For
example, starting a new job can be stressful for anyone but starting a new job and being
afraid to mention your spouse for fear of being fired is a combined stressor that individuals
in same-sex relationships experience.

23. Minority Stress is Chronic
Minority Stress is chronic, because it remains a relatively stable presence in someone’s life
due to underlying social and cultural structures. A stressful day at work can be ended when
you clock out. Sometimes the stress of work may follow some individuals home, but there
is relief. However, for individuals living in a racist, sexist, heterosexist, or cissexist society,
there is little room for escape from that situation.

24. Minority Stress is Socially Based
Minority Stress is socially based, in that it is about more than individuals. Rather, Minority Stress
stems from social processes, institutions, and structures beyond the individual events or conditions
that characterize general stressors.
For example, a transgender woman might experience stress, as anyone experiences stress, when
visiting the doctor. But that same transgender woman may have to deal with a medical record that
does not recognize her affirmed gender identity and that could cause her to be continually
misgendered during her doctor’s appointment – an added degree of stress caused by a medical
institution that influences the behavior of medical professionals and staff.

25. Four years before he killed himself, 16-year-old Bobby Griffith wrote
in his diary: "I can't let anyone find out that I'm not straight. It would
be so humiliating. My friends would hate me, I just know it. They
might even want to beat me up. . . . I guess I'm no good to anyone . . .
not even God. Life is so cruel, and unfair. Sometimes I feel like
disappearing from the face of this earth
In the predawn hours of August 27, 1983, two months after his twentieth birthday, Bobby
Griffith killed himself (Meyer, 1995)

26. Minority stress theory distinguishes between
Distal and Proximal stress processes.
Distal stress processes are external to the minority
individual, including experiences with rejection,
prejudice and discrimination.
Proximal stress processes are internal include fear
of rejection, previous experiences with prejudice,
and disliked one's own minority group following a
prejudice event.

27. Minority Stress Process (Meyer, 2003)

28. Three Primary principles
Leading to chronically high levels of stress that cause poor health outcomes include:
1. Minority status leads to increased exposure to distal stressors.
2. Minority status leads to increased exposure to proximal stressors, due to distal
stressors.
3. Minority individuals suffer adverse health outcomes, which are caused by exposure
to proximal and distal stressors.

29. Limitations Identified by Bailey (2019)
According to Baily Minority Stress Model deserve Reconsideration , not rust extension.
• It should predict the mental health risks in non-heterosexual individuals who grow up in
intolerant or stigmatizing individual. MST don’t talk about it rather presenting the
opposing evidence in this argument.
• Netherlands, a highly tolerant culture, have higher emotional disorders in non-
heterosexuals
• MST reliance is on self-reported data to quantify stigmatization. The accuracy of this data
may influence by individual temperament
• Do non-heterosexuals who report more experiences of stigmatization tend to develop
more neuroticism? Or do non-heterosexuals who experience more symptoms of
neuroticism also tend to elicit more experience of stigmatization?
• It seems predictable that psychiatric symptoms could make affected individuals more
likely to experience of stigmatization.

30. Alternative Model (Zuker, Lawrence & Kreukels, 2016)
• An alternative model that recognizes temperament postulating a reversed direction of
effect. They stated that person with mental illness experiences more stigmatization as they
are inclined to believe that they do.
• If he/she displays deviant or unusual behaviours it will generate stigmatization.
Alternatively, he/she has more tendency to perceive neutral events as stigmatization
• If Feinstein’s ideas of RS role in self-reported stigmatization lead to minority stress is
correct, it gives the whole reconsideration of MST. RS is detectable early in development.
In future, Lawrence suggested that the role of temperament will eventually be accepted
globally by researchers.
• Bailey proposed that although the minority stress has emerged from societal oppression.
But it would be shameful for all non-heterosexual individuals, if the socio-political
concerns prevented researchers from conscientious considerations of any reasonable
hypotheses (Bailey, 2019).

31. Critical Evaluation
• Parsimony
• Theory is very parsimonious in the fact that the explanations of minority stress and its
outcomes are easily understandable
• Logical Consistency
• The theory explains the associations of distil and proximal stressors with mental health
outcomes. There is logical consistency in said associations.
• Generalization/Scope
• Initially made to address issues of the Lesbian, Gay, and Bisexual (LGB) population
• Research is readily extending the application of theory onto various minorities including,
Transgender and Gender Non-Conforming (Alessi, 2014) individuals, queer (Meyer, 2020)
and autistic population
• Empirical Evidence
• Within group
• Between group

32. Criticism
• Methodological Limitations
• Correlational Studies
• Lack of experimental and longitudinal studies
• Lack of studies aiming for complete replication
• Focus on Negative Experience
• Lessor focus on positive factors present around minority populations
• Different Outcomes for Different Minorities
• Racial minorities
• Biological Reasons for Stressors
• Genetic predisposition to depression and anxiety

33. APPLICATIONS OF MST

34. Social Level
• Court Room Briefs
• Meyer was an expert witness in the Perry v. Schwarzenegger trial, testifying on the mental
health impact on gay couples denied the right to marry. His testimony relied on empirical
studies showing that gays and lesbians encounter a disproportionate level of stress and mental
health difficulties because of discrimination, and that these stresses amplify the social stigma
that makes them more susceptible to depression, suicide and substance abuse.
• Policy Makers
• Anti-harassment laws for LGBTQ
• Gay Marriage legalization in various countries
• Social Organizations
• National level anti-prejudice programs
• Work-Place
• Providing a safe space while at work while minimizing distil stressors

35. Individual Level
• Based on how individual minorities react to distil stressors and what mental health
outcomes are, clinician can sort out an intervention plan.
HAVE YOU EVER WORKED WITH A
CLIENT WHO IDENTIFIED AS
TRANSGENDER?

36. Multilevel Approach to Stigma
(Cook, Purdie-Vaughns, Meyer, & Busch, 2014)

37. Intrapersonal level Interventions
Intrapersonal interventions target the way people think, feel, or behave.
• Intrapersonal interventions targeting members of stigmatized groups
• Education and counseling
• Expressive-writing
• Belonging
• Value affirmation
• Intrapersonal interventions targeting non-stigmatized groups
• Education
• Cognitive dissonance

38. Interpersonal level Interventions
• Interpersonal interventions targeting members of stigmatized groups
• Information processing
• Community and rehabilitation
• Interpersonal interventions targeting non-stigmatized groups
• Information processing
• Intergroup contact

39. Structural level Interventions
• Structural interventions targeting members of stigmatized groups
• Community diversity values
• Legal/policy intervention
• Structural interventions targeting members of non-stigmatized groups
• Advertising
• Mass media
• Educational intervention

41. LGB affirmative Treatment (Alessi, 2014)
• First half
• Examining four minority stress components
• prejudice events stigma, internalized homophobia and sexual orientation
concealment
• Second half
• Assessed for
• interpersonal, social, coping, emotional regulation and cognitive processes.
• Integrated approach to therapy including
• CBT
• Psychodynamic psychotherapy
• LGB affirmative therapy

42. Framework for Clinical Work with Transgender and
Gender Nonconforming Clients. (Hendricks & Testa, 2012)
• Based on the minority stress model they suggested clinicians to
• Increase their understanding of gender non-normative paradigm
• Better understand their clients.
• Another factors that the authors pointed out is that the clinicians
• Must understand the feelings of hurt that trans individuals have felt due to the gender
identity disorder diagnosis that has been existing in DSM.
• The authors suggested group level coping which is supported by the Meyer’s
conceptualization that people when they identify with alike individuals, they cope
better

43. Minority Stress in Context to Pakistan
• The minority communities have been in Pakistan amicably since independence and
playing their active role in the development of society especially in education and
health sectors.
• Despite being living in encouraging environment as good and responsible citizens, the
minority communities have been facing inequality, discrimination and victimization by
both the state and society. These minorities have been marginalized in almost every part
of life including employment, education, and top of all-the religious freedom.
• The minorities, especially the Christians have some serious issues about their security and
often mention that they have been targeted especially under Blasphemy Law in which
they have been prosecuted in the name of religion.
• Most of these blasphemy cases have been found out to be the result of personal enmity
and religious vendettas (Khalid & Rashid, 2019).

44. Scales Based on Theory
• The sexual minority stress scale (SMSS) developed by Iniewicz et al, (2017)
• Internalized Homophobia (IH), Expectations of Rejection (ExR), Concealment
(Clm), and Sexual Minority Negative Events (SMNE)
• Couple-Level Minority Stress Scale (Delozier et al, 2020)
• Extended to include couple specific dynamics including
• (1) Couple-Level Stigma;
• (2) Couple-Level Discrimination;
• (3) Seeking Safety as a Couple;
• (4) Perceived Unequal Relationship Recognition;
• (5) Couple-Level Visibility;
• (6) Managing Stereotypes about Same-Sex Couples;
• (7) Lack of Integration with Families of Origin;
• (8) Lack of Social Support for Couples.

45. Researches

46. Level of depression among adolescents of religious minorities and
their dominant counterparts in Pakistan (Iqbal et al, 2012)
• In this study researchers investigated the level of depression among religious minority
adolescents (Christian and Hindu) in comparison with their major dominant community
(Muslims) in Pakistan.
• The results showed that religious minorities in Pakistan are inclined to have higher level
of depression than their dominant counterparts (Muslims adolescents)

47. Suicides Among Lesbian and Gay Male Individuals: Findings From
the National Violent Death Reporting System (Lyons et al, 2019)
• This study intend to describe the characteristics and precipitating circumstances of suicide
among lesbian and gay male decedents when compared with non-lesbian and non-gay
male decedents.
• Findings highlighted differences in the characteristics of suicide among lesbian and gay
male and non-lesbian and non-gay male decedents.
• Suicidal rate were 10% higher in LGBT peoples than other communities.
• The majority of lesbian, gay, bisexual, or transgender decedents were identified as gay
male (53.9%), followed by lesbian (28.0%), transgender (10.4%), and bisexual (7.5%).

49. Perceived Stress: A Comparative Study of Student Nurses from
Mainstream And Minority Religious Group In Pakistan (Ahmed &
Mushtaq, 2014)
• The objective of the present study is to investigate the difference between the minority
student nurses and their dominant counterparts in Karachi, Pakistan, in their scores of
perceived stress.
• Result indicates that there is a statistically significant mean difference in the scores of
perceived stress between Christian and Muslim student nurses (t= -3.103, df= 554, plus
than .002). Findings of this study identify that the level of perceived stress in nursing
students who belong to minority groups significantly higher than their dominant
counterparts.

50. Effects of Minority Stress, Group-Level Coping, and Social Support
on Mental Health of German Gay Men (Sattler et al, 2016)
• In the current study, the minority stress theory was investigated in German gay men.
• It was hypothesized that minority stressors would positively predict mental health
problems and that group-level coping and social support variables would moderate these
predictions negatively.
• Results showed that Minority stressors positively predicted mental health problems.
Group-level coping did not interact with minority stressors, with the exception of
disclosure and homopositivity interacting marginally with some minority stressors.
• Further, only two interactions were found for social support variables and minority stress,
one of them marginal. Gay and non-gay social support inversely predicted mental health
problems. In addition, disclosure and homopositivity marginally predicted mental health
problems.

51. Transgender minority stress and mental health outcomes among
hijras in India (Parikh-Chopra, 2018).
• This study assessed transgender minority stress, mental health outcomes, social support,
and coping strategies among hijras in India.
• The findings suggest that hijras experience minimal transgender minority stress that
affects their mental health outcomes, indicating that they are a well-functioning group.
• Prejudice and everyday discrimination were the two primary transgender minority
stressors research participants reported.
• Results of the qualitative portion suggest that the research participants have available
support systems, such as their guru, hijra community, and NGOs, to help minimize the
effects of transgender minority stress on mental health

52. Conclusion

53. Conclusion
• The minority stress theory has been useful and productive theory to understand and
address disparities in the health outcomes among Minorities.
• The theory points to social stress process caused by prejudice and stigma, such as
experience of victimization of different types, ranging from harassment to hate crimes,
and internalization of negative attitude.
• The theory also points to the importance of considering resiliency factors such as
social support and coping resources-in considering causes of health outcome.
Ultimately according to this theory health outcomes are determined by the balance of
positive (coping and social support) and negative (Stressors) effects.
• Future work must take this balance into account to better understand and improve the
health and wellbeing to minorities and other like communities.