Minority Stress

Queer neurodivergent people face compounding minority stressors.

Transgender people may find themselves living in constant fear of verbal or physical harassment. While a healthy mind can deal with this kind of pressure for short periods, over time this perpetual sense of danger is likely to develop into a debilitating form of social anxiety.

As we come to understand depression in the transgender community more accurately, it’s become clear that the major cause is what’s referred to as “minority stress;” that is, “stressors induced by a hostile, homophobic culture, which often results in a lifetime of harassment, maltreatment, discrimination and victimization.” The good news, then, is that as social relations and culture change over time, negative attitudes toward transgender people may be reduced, which will then reduce the stressors which trigger anxiety and depression.

When Worlds Collide – Mental Illness Within the Trans Community — Lionheart

One of the most prominent theoretical and explanatory frameworks of sexual minority health risk is the minority stress model. The concept of minority stress stems from several social and psychological theoretical orientations and can be described as a relationship between minority and dominant values and resultant conflict with the social environment experienced by minority group members (Meyer, 1995; Mirowsky & Ross, 1989; Pearlin, 1989). 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 (Marshal et al., 2008; Meyer, 2003) and may ultimately impact access to care.

The Meyer (2003) minority stress model — minority stress processes in lesbian, gay and bisexual populations — is based on factors associated with various stressors and coping mechanisms and their positive or negative impact on mental health outcomes. Significantly, many of the concepts in the model overlap, representing their interdependency (Meyer, 2003; Pearlin, 1999). The model describes stress processes, including experiences of prejudice, expectations of rejection, hiding, concealing, internalized homophobia and ameliorative coping processes (Meyer, 2003). Stressors such as homophobia or sexual stigma that may arise from the environment require an individual to adapt but also cause significant stress, which ultimately affects physical and mental health outcomes (Dohrenwend et al., 1992).

Underlying the concept of minority stress are assumptions that stressors are unique (not experienced by nonstigmatized populations), chronic (related to social and cultural structures) and socially based (social processes, institutions and structures) (Meyer, 2003). While this theory has been applied to other populations, including women, immigrants, the impoverished and racial/ethnic minorities, there is still much room for additional investigation among sexual minority populations, as they do not have as rich a history in sociological investigation (Meyer et al., 2008).

A strong correlation may be drawn between (a) minority stress theory, which underscores stress processes (experience of prejudice, expectations of rejection, internalized homophobia) and ameliorative coping processes (Meyer, 2003); and (b) a greater likelihood for psychological distress and physical health problems among gay and bisexual men and other sexual minority populations. Stress theory provides a useful framework to explain and examine health disparities and the role of homophobia as a sociological paradigm that views social conditions as a cause of stress for members of disadvantaged social groups, which in turn can increase risk for HIV, among other risk factors (Aneshensel, Rutter, & Lachenbruch, 1991; Dressler, Oths, & Gravlee, 2005). Interestingly, there continues to be a small and growing body of research examining community and population samples that suggests a significant relationship between minority stressors and deleterious behavioral and mental health outcomes such as HIV risk among gay and bisexual men (Hatzenbuehler et al., 2008).

The minority stress perspective

The minority stress model posits that social disadvantage and marginalization results in an increased burden, which in turn can result in mental and physical health disparities (Meyer et al., 2002; Frost et al., 2015). Predominantly, it has been used to investigate the health disparities seen in the queer community. The focus in the minority stress model shifts away from there being something inherent about LGBTQ+ communities and focuses instead on the experiences that sexual and gender minorities have within society. It sounds cliché, but it was a light-bulb moment—it was a lens through which I could reflect on an entire lifetime of experiences and make them coherent for once. Yet, as an idea, minority stress ran counter to the literature which associated the traits of autism itself with suicidality (Mikami et al., 2009), centered suffering as inherent to autism (Baron-Cohen and Bolton, 1993), or focused on the specific thinking styles of autistic people as causative of poor mental health—as if autistic people exist in a societal blackhole, and would still suffer in the absence of our entire social structure.

It is not hard to see the potential utility for the minority stress model when you pause and take stock of how autistic people are treated in society. The minority stress model captures the some of the complexity of existing while autistic. Autistic people are stereotyped—and the vast majority of stereotypes are negative (Wood and Freeth, 2016). Autistic people face employment discrimination, higher unemployment, and underemployment, as well as experiencing bullying in the workplace (Shattuck et al., 2012; Baldwin et al., 2014). Autistic children are more likely to be excluded from schools (Timpson and Great Britain, 2019). In the United Kingdom (UK), one-third of autistic people have access to neither employment or welfare payments (Redman, 2009), while 12% of Welsh autistic adults report experiencing homelessness (Evans, 2011). Statistics show disproportionate use of force against autistic people and those with learning disability in the UK (Home Office, 2018), while a third to half of all incidents involving the use of excessive force by police involves a disabled person (Perry and Carter-Long, 2016)—experiences which will obviously be further compounded by institutional racism (Holroyd, 2015). Autistic individuals are more likely to experience (poly)victimization, including being four times more likely to experience physical and psychological abuse from adults as children, 27 times more likely to experience teasing, and seven times more likely to experience sexual victimization (Weiss and Fardella, 2018). At the extreme end of the victimization—autistic children are more likely to die to filicide (Lucardie, 2005). Autistic lives are marked by an often-astounding excess stress burden across the life span.

Considering the study by Hirvikoski et al. (2016), I chose to study mental health and minority stress because people like me were (and still are) dying to suicide in their droves. To be clear, wanting a better future for my community is a value, and my work embodied it from the very beginning. I was propelled by values. How can you belong to a community who is actively suffering, and not want to make it better anyway that you can?

I found that exposure to minority stress does predict significantly worse well-being and higher psychological distress in the autistic community (Botha and Frost, 2020), including exposure to victimization and discrimination, everyday discrimination, expectation of rejection, expectation of rejection, outness (disclosure), concealment (masking of autism), internalized stigma, and it explains a large and significant proportion of the variance—in lay-man’s terms—the constant marginalization of autistic people is contributing to high rates of poor mental health. Aside from this, I noticed that despite being normally distributed (and not containing outliers), the mean psychological distress score was above the cut-off for indicating severe psychological distress (Kessler et al., 2003). Between the sadness of these findings and being exposed to all of these disturbing accounts of autism I considered (albeit briefly), giving up on academia all together without pursuing my Ph.D.

In the end, my thesis (Botha, 2020) showed that autistic community connectedness buffered against some of the effects of minority stress and was related to better mental health over time. Yet, I worry constantly that by trying to measure a function of autistic community connectedness, that I objectified it, in a way not dissimilar to the way people objectify autistic people—especially if others come to conflate the function of autistic community connectedness with its value. I studied autistic community connectedness, because I was worried that to only study minority stress would be to see only the worst of what happened to autistic people, and not appreciate our lives as a whole—which are much bigger than our trauma. But, to me, the numbers only explain a mechanism—the real joy, the real value, and the beauty of the autistic community was captured in my very first study. Autistic people talked about the autistic community with such a warmth, brightness, and with hope. The vibrant stories of belongingness, friendships, and political strength tell you exactly what you need to know about the value of such a community. This is something, that its function cannot, and should not even tell you.

Frontiers | Academic, Activist, or Advocate? Angry, Entangled, and Emerging: A Critical Reflection on Autism Knowledge Production

everyone's walking in a straight line
I can't seem to fit in
I won't even try
to be like them
what is it like?
to just be accepted for being yourself
and not having to come out 
of your comfort zone

so here, here I am

we are the people you see on TV
that can't seem to shut up
that never seem pleased
our entire existence is still part of debates
when breathing is political 
then you just don't 
believe in slow progress
and take your faith in own hands 

So here, here I am

don't hold me up

everyone's walking in a straight line
I can't seem to fit in
I won't even try
to be like them
what is it like?
to just be accepted (here I am)

--Queer Line (Non-Binary / LGBTQIA+ song) by Eyemèr

Why are there greater mental health stresses on autistic people from gender-minority groups? To quote from the research paper,

“The increased rates of mental health problems in these minority populations are often a consequence of the stigma and marginalisation attached to living outside mainstream sociocultural norms (Meyer 2003). This stigma can lead to what Meyer (2003) refers to as ‘minority stress’. This stress could come from external adverse events, which among other forms of victimization could include verbal abuse, acts of violence, sexual assault by a known or unknown person, reduced opportunities for employment and medical care, and harassment from persons in positions of authority (Sandfort et al. 2007).”

Ann’s Autism Blog: Autism, Transgender and Avoiding Tragedy

As evidenced by the minority disability movement, autism is increasingly being considered part of the identities of autistic people. Autistic individuals thus constitute an identity-based minority and may be exposed to excess social stress as a result of disadvantaged and stigmatized social status. This study tests the utility of the minority stress model as an explanation for the experience of mental health problems within a sample of high-functioning autistic individuals (N=111). Minority stressors including everyday discrimination, internalised stigma, and concealment significantly predicted poorer mental health, despite controlling for general stress exposure. These results indicate the potential utility of minority stress in explaining increased mental health problems in autistic populations. Implications for research and clinical applications are discussed.

(PDF) Extending the Minority Stress Model to Understand Mental Health Problems Experienced by the Autistic Population

The theory posits that minority individuals face unique and persistent stressors, such as discrimination, prejudice, and stigma, that can lead to negative health outcomes, such as depression, anxiety, and cardiovascular disease, through the activation of physiological and psychological stress responses (Millar and Brooks 2022). Identifying as neuroqueer can intensify such stress and impact one’s mental health (George and Stokes 2018;Hall et al. 2020). A study conducted by the Trevor Project found suicide rates to be significantly higher among autistic LGBTQ+ youth than non-autistic youth (Lhant 2022).

Neurodivergence is also an LGBTQ+ topic: Making space for “neuroqueering” in the outdoors

Previous literature indicates higher levels of mental distress among sexual minorities (Sandfort et al. 2001) and gender minority groups (Hepp et al. 2005). The increased rates of mental health problems in these minority popula- tions are often a consequence of the stigma and marginalization attached to living outside mainstream sociocultural norms (Meyer 2003). This stigma can lead to what Meyer (2003) refers to as ‘minority stress’. This stress could come from external adverse events, which among other forms of victimization could include verbal abuse, acts of violence, sexual assault by a known or unknown person, reduced opportunities for employment and medical care, and harassment from persons in positions of authority (Sandfort et al. 2007). Minority stress levels are further perpetuated by internal stresses, such as the anticipation of adverse events, the vigilance this anticipation requires, the internalization of negative social attitudes (Herek 2015), efforts to conceal one’s sexual orientation and gender-identity, and pressure to conform to societal expectations.

Victimization and ostracization by peers of one’s own gender group during early developmental stages when gender segregation is at its peak, can increase the likelihood of experiencing significant affective, cognitive and behavioural consequences for gender non-conforming individuals in adulthood (Zucker 2005). Results from the current study suggested that having GDT had the most extreme adverse effect on mental health. Thus, adverse mental health consequences may be more severe for autistic individuals from a gender minority group when com- pared to autistic individuals from a sexual minority group, and results from the current study suggested that having GDT had the most extreme adverse effect on mental health.

A Quantitative Analysis of Mental Health Among Sexual and Gender Minority Groups in ASD | SpringerLink

Being transgender or gender diverse implies no impairment in judgment, stability, reliability, or general social or vocational capabilities; however, these individuals often experience discrimination due to a lack of civil rights protections for their gender identity or expression. As a result, transgender and gender diverse persons face challenges in their marriage, adoption and parenting rights, are regularly discharged from uniformed services and/or rejected from enlisting due to their gender identity, and have difficulty revising government identity documents. Incarcerated transgender and gender diverse persons suffer risks to their personal safety and lack access to comprehensive healthcare. Furthermore, transgender and gender diverse individuals may be inappropriately assigned space in gender-segregated facilities such as inpatient psychiatric units, homeless shelters, and residential treatment programs. Transgender and gender diverse people are frequently harassed and discriminated against when seeking housing or applying to jobs or schools and are often victims of violent hate crimes.

Position Statement on Discrimination Against Transgender and Gender Diverse Individuals

Our findings support the minority stress model. Prevention needs to confront social structures, norms, and attitudes that produce minority stress for gender-variant people; enhance peer support; and improve access to mental health and social services that affirm transgender identity and promote resilience.

Stigma, Mental Health, and Resilience in an Online Sample of the US Transgender Population | AJPH | Vol. 103 Issue 5

I've got one fatal flaw
I'm a compulsive liar
If I don't love you
I will tell you anything
And even if I love you
I'll always be conniving
I'll always be negotiating with the truth

And I can trace the habit
To when I was eleven
And I thought boys were pretty
And I couldn't tell no one

It opens at a young age
That all-protective closet
Just lock the door
And settle in among the raincoats
The longer you stay in there
The more you'll get distorted
The more contorted all your lies will have to be

Don't wait a moment longer:
Stand up and turn the doorknob
And I'll tell you my secret
If you will tell me yours

--Compulsive Liar by Ezra Furman

Transition from nowhere to nowhere
Here I come again
Nobody cares if you're dying 'til you're dead
Ambition leads nowhere
I dream of going right back to bed
Nobody cares if you're dying 'til you're dead

And if it's not enough to keep the lights on
Let 'em turn the lights off
Broken spirit and a bad cough
Turn 'em off, turn 'em off
And when you’re really at the end of your rope
No, you don’t take the night off
Too many demons to fight off
Cut me off, cut me off

Remember I tried to ask what it means to be a man?
They threw me in the back of a truck and they tied my hands

--Transition from Nowhere to Nowhere by Ezra Furman

For more songs—and perspective—on dysphoria, minority stress, and queer and neurodivergent mental health, check out our playlist ”Chronic Neurodivergent Depressed Queer Punk: Punk Rock, the Social Model of Disability, and the Dream of the Accepting Community”.

Main Takeaways

• The primary aim of the minority stress model is to explain disparities in health between majority and stigmatized minority groups.
• Social disadvantage can translate into health disparities.
• Decreased social standing leads to stigmatized minority groups being exposed to more stressful life situations, with simultaneously fewer resources to cope with these events.
• Transgender people may find themselves living in constant fear of verbal or physical harassment.
• As social relations and culture change over time, negative attitudes toward transgender people may be reduced, which will then reduce the stressors which trigger anxiety and depression.
• The concept of minority stress stems from several social and psychological theoretical orientations and can be described as a relationship between minority and dominant values and resultant conflict with the social environment experienced by minority group members.
• 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.
• A strong correlation may be drawn between minority stress theory and a greater likelihood for psychological distress and physical health problems.
• Stress theory provides a useful framework to explain and examine health disparities and the role of homophobia.
• There is a significant relationship between minority stressors and deleterious behavioral and mental health outcomes.
• The minority stress model posits that social disadvantage and marginalization results in an increased burden, which in turn can result in mental and physical health disparities.
• Autistic individuals are more likely to experience (poly)victimization.
• Autistic lives are marked by an often-astounding excess stress burden across the life span.
• Exposure to minority stress does predict significantly worse well-being and higher psychological distress in the autistic community.
• The constant marginalization of autistic people is contributing to high rates of poor mental health.
• Autistic community connectedness buffered against some of the effects of minority stress and was related to better mental health over time.
• The increased rates of mental health problems in these minority populations are often a consequence of the stigma and marginalisation attached to living outside mainstream sociocultural norms.
• This stress could come from external adverse events, which among other forms of victimization could include verbal abuse, acts of violence, sexual assault by a known or unknown person, reduced opportunities for employment and medical care, and harassment from persons in positions of authority.
• Autistic individuals constitute an identity-based minority and may be exposed to excess social stress as a result of disadvantaged and stigmatized social status.
• Suicide rates are significantly higher among autistic LGBTQ+ youth than non-autistic youth.
• Minority stress levels are further perpetuated by internal stresses, such as the anticipation of adverse events, the vigilance this anticipation requires, the internalization of negative social attitudes, efforts to conceal one’s sexual orientation and gender-identity, and pressure to conform to societal expectations.
• Prolonged Adaptation Stress Syndrome is what happens when someone pretends to be something they’re not on an everyday basis.

Bird, You Can Fly

So the time has come
For your soul to finally belong
Stop the facade
Though the world is not ready for you and I

You're starting your life
From this moment now 
Bird you can fly
Bird you can fly
You're breaking out
Out of your shell today 

You're starting your life
From this moment now 
Bird you can fly
Bird you can fly
You're breaking out
Out of your shell today 

Kid, you'll be fine
You're not a girl
You're not a boy
Nor am I

Kid, you'll be fine
You're not a girl
You're not a boy
Nor am I

Kid, you'll be fine
You're not a girl
You're not a boy
Nor am I

Kid, you'll be fine
You're not a girl
You're not a boy
Nor am I

Kid, you'll be fine
You're not a girl
You're not a boy
Nor am I

--Bird, You Can Fly (Non-Binary Song) by Eyemèr

Transform

If you loved me
I wouldn't have to run away
I wouldn't have to hide away
Through this life

If I could transform
And change the way I am right now
I'd be
Exactly what you want to see

If you loved me
I wouldn't have to be sad
I could smile and you'd be glad
That I'm from this life

If I could transform
I wouldn't have to be afraid
I wouldn't have to be unmade
From this life

I don't want special treatment
I don't want attention
I just want to coexist
On the realm that you play on

Open up your heart
Take me as I am
Love me, hate me, break my heart
Just let me live

Well, if you loved me
I wouldn't have to be sad
I could smile and you'd be glad
That I'm from this life

(If I could) Transform
And I don't have to be afraid
I wouldn't have to be unmade
From this life
Life

Well, if you loved me
I wouldn't have to be sad
I could smile and you'd be glad
That I'm from this life

If I could transform
I wouldn't have to be afraid
I wouldn't have to be unmade
From this life

Life!
Transform!

Give yourself a combo plate (Combo plate)
Transform
Transform, transform, everybody transform

If we could transform
We wouldn't have to be afraid
We wouldn't have to be unmade
From this life

If we could transform
And change the way we are right now
It'd be
Much, much, too easy

Can you take those thoughts away?
Can't you see I'm fine?
Warm your heart, don't you see
It's just the same as mine?

Am I naive?

--Transform by Steam Powered Giraffe

The Malfunction Isn’t Us, It’s all the Clamor and the Fuss

Raise your hand if you’re not from a mold (yeah me)
Varied strings are worth more than gold

Mah-ah-ah-ah-ahl function away
Mah-ah-ah-ah-ahl function away
Malfunction! Malfunction! Malfunction!
...
Their Malfunction isn’t us, it’s all the clamor and the fuss

I’m about to pick you up
get you back up on your feet
you don’t need to worry love
Even if we’re incomplete

Come on baby open up
Pull out the wires and trim the fluff
Be yourself sounds so cliche
But hey let's do it anyway

We’re functioning just fine, we’re alive

At this junction of dysfunction we are arrive


What’s your Malfunction?

Don’t be scare, It don’t matter how you wear your hair

What’s your Malfunction?

Bring it forth perfect’s a bore for what it’s worth


Curvy, skinny, or bizarre

The best shape is who you are


Raise your hand if you’re not from a mold (yeah me)

Varied strings are worth more than gold


Mah-ah-ah-ah-ahl function away
Mah-ah-ah-ah-ahl function away
Malfunction! Malfunction! Malfunction!

Feel the fires as they tickle your face
Watch and learn as they make you feel disgrace
Ones and zeroes left over, left out to haunt

Comb them in and let them want

I want more from this stupid life
Do you want more from this stupid life? (oh yeah)
Ones and zeroes, ones and zeroes, ones and zeroes

Add them up, take them up, show them

I’m functioning just fine I’m alive
At my junction of dysfunction we arrive

What’s their Malfunction?
It’s a start; Can we teach them not to fall apart?
Their Malfunction isn’t us, it’s all the clamor and the fuss

When I say that I love you, dammit Janet, take it as truth
Everything’s a little broken

To be pristine well you must be jokin’

Mah-ah-ah-ah-ahl-function away
Mah-ah-ah-ah-ahl-function away

-- Malfunction