1 - (IOP 26) Identity-related Stress and Obsessive-compulsive Disorder Symptoms in Sexual and Gender Minority Individuals: Testing the Cognitive Behavioral-minority Stress Model

Background: Obsessive-compulsive disorder (OCD) is more prevalent and may present uniquely among sexual and gender minority (SGM) individuals, potentially due to the impact of minority stress – unique identity-based stressors including harassment, victimization, internalized stigma, and rejection expectations. Pinciotti and Feinstein (2025) developed the cognitive behavioral-minority stress model of OCD among SGM individuals to synthesize existing theory and research on minority stress and the cognitive behavioral model for the development and maintenance of OCD. The present work tested this model in a large sample of SGM individuals with OCD.

Method: Analyses included 463 SGM individuals (99.1% sexual minority [SM], 34.8% gender minority [GM]) with OCD recruited from the community and clinical settings to participate in the “Pride OCD Study,” the first study designed specifically for SGM individuals with OCD. Participants completed a battery of self-report assessments of minority stress and OCD. In line with the proposed theoretical model, structural equation models tested sequential pathways in which early life experiences/critical incidents and minority stressors were proposed to lead to inflated responsibility beliefs (Obsessive Beliefs Questionnaire [OBQ]); and inflated responsibility beliefs and minority stressors were proposed to lead to the presence and content of contamination, responsibility for harm/injury/bad luck, unacceptable thoughts, and symmetry symptoms (Dimensional Obsessive Compulsive Scale [DOCS]).

Results: For SM individuals, OBQ-Responsibility was associated with harassment/discrimination (β=0.18) and stressful life experiences (β=0.15), and OBQ-Responsibility was subsequently associated with all OCD dimensions as predicted. Contamination symptoms were associated with internalized negativity (β=0.15) and rejection sensitivity (β=0.14); unacceptable thoughts were associated with harassment/discrimination (β=0.13), identity-based sexual assault (β=0.11), internalized negativity (β=0.11), and rejection sensitivity (β=0.13); and symmetry symptoms were associated with rejection sensitivity (β=0.16). For GM individuals, contrary to predictions, OBQ-Responsibility was not associated with early life experiences nor minority stressors and was only associated with responsibility for harm (β=0.32) and unacceptable thoughts (β=0.22). These dimensions were also associated with identity-based physical assault (β=0.22 and 0.26, respectively), and symmetry symptoms were associated with identity-based sexual assault (β=-0.28) and internalized negativity (β=0.22).

Discussion: This study represents several firsts: the first study specifically designed for SGM individuals with OCD, the first to directly examine associations among minority stressors and OCD symptoms, and the first to test the newly developed cognitive behavioral-minority stress model. Using the largest known sample of SGM individuals with OCD to date, we found early support for the cognitive behavioral-minority stress model, including evidence for the specific minority stressors most salient to OCD phenomena. Implications and future directions will be discussed.