Abstract

Sexual minority individuals experience higher rates of psychopathology, such that sexual minority people are nine times more likely to receive a diagnosis or treatment for obsessive-compulsive disorder (OCD) compared to heterosexual people. Poor emotion regulation capacity is a risk factor for OCD, but little is known about sexual orientation differences in dimensions of emotion regulation and how dimensions of emotion regulation relate to OCD severity among sexual minority people. The aims of the current study include 1) comparing sexual minority to heterosexual people on OCD severity and emotion regulation capacity upon admission to treatment for OCD, and 2) examining emotion regulation in relation to OCD severity among sexual minority people. Participants (N = 470) were adults in partial hospital/residential treatment with an average stay of 59.7 days (SD = 25.3), including 22 % sexual minority people. Sexual minority people reported a lower emotion regulation capacity. Among the largest three subgroups (heterosexual, bi+, and gay/lesbian), bi+ individuals reported a lower emotion regulation capacity compared to heterosexual but not gay/lesbian people. Results suggest there are sexual orientation differences in emotion regulation capacity, and that bi+ people have the most difficulty with ER. There is a need for OCD treatment to directly target emotion regulation strategies and be affirming of sexual minority identities.

Current study

Understanding similarities and differences in risk factors for OCD severity between people of different sexual orientations has the potential to advance our understanding of the mechanisms underlying disparities in OCD and to inform treatment targets for populations at increased risk. Thus, the current study aimed to examine differences in ER, its subdomains, distress tolerance, and OCD symptom severity between sexual minority and heterosexual individuals. First, we compared all sexual minority individuals (inclusive of gay, lesbian, bisexual, pansexual, asexual, and queer individuals, as well as those who indicated that their sexual orientation was not listed) to heterosexual individuals. We hypothesized that sexual minority individuals would report worse emotion regulation (total scores and all subdomain scores) and worse OCD severity. Then, to be able to draw more nuanced conclusions, we compared the three largest sexual orientation groups in our sample (heterosexual, gay/lesbian, and bi+) on emotion regulation, distress tolerance, and OCD severity, hypothesizing that bi+ individuals would demonstrate worse emotion regulation (total scores and all subdomain scores) and greater OCD severity compared to both heterosexual and gay/lesbian individuals. Last, if sexual orientation differences in OCD severity were identified in our sample, we planned to examine whether they persisted after accounting for emotion regulation and distress tolerance.

Conclusions

Our finding, suggest that sexual minority people report lower emotion regulation capacity and distress tolerance at program admission for partial hospital/residential treatment for OCD compared to heterosexual people. Given that sexual orientation, emotion regulation, and distress tolerance were each associated with OCD symptom severity, we highlight the importance of considering these factors in treatment. First, providers of exposure and response prevention (ERP), the first-line treatment for OCD, should consider addressing the impacts of minority stressors while targeting negative cognitions, obsessions, and resulting compulsions. In general, research has demonstrated the efficacy of targeting minority stressors to improve mental and behavioral health among sexual minority individuals (Pachankis et al., 2020, 2022). However, it remains unknown whether targeting minority stressors would improve OCD severity. While ERP may overtly or covertly target emotion regulation, it may be important to more directly target specific emotion regulation strategies in ERP for sexual minority people, especially difficulties accessing strategies perceived as effective and accepting negative emotions as well as distress tolerance.

Last, our results highlight that bi+ individuals experience significantly worse emotion regulation capacity, including distress tolerance, than heterosexual individuals. Treatment recommendations for bi+ individuals with OCD include special attention to implementing identityaffirming care, seeing as bi+ people face additional stress compared to gay/lesbian and heterosexual people. When addressing emotion regulation skills and distress tolerance, providers should directly incorporate modules related to minority stress and how it may exacerbate OCD symptoms. Our untested hypothesis, which warrants future inquiry, is that minority stressors impact OCD severity among sexual minority people. Identity-affirming treatment, which acknowledges and targets the impact of minority stressors for sexual minority people, may help alleviate the disparities found in our sample.