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Measurement and correlates of internalized homophobia: A factor analytic study

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We developed a scale to measure internalized homophobia in men who have sex with men, which is comprised of items derived from theoretical and clinical reports of internalized homophobia. Two hundred two men who have sex with men and who attend "Man to Man" sexual health seminars in a midwestern U.S. city completed the scale at baseline. Orthogonal factor analysis revealed four dimensions of internalized homophobia: public identification as gay, perception of stigma associated with being homosexual, social comfort with gay men, and the moral and religious acceptability of being gay. Factor scoring of these dimensions indicated that they were associated significantly with relationship satisfaction, duration of longest relationship, extent of attraction to men and women, proportion of social time with gay people, membership of gay/bisexual groups, HIV serostatus, and disclosure of sexual orientation. Internalized homophobia is measurable and consists of four dimensions that are associated significantly with low disclosure, shorter length of and satisfaction with relationships, lower degree of sexual attraction to men and higher degree of attraction to women, and lower social time with gay people.
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Measurement and correlates of internalized homophobia: A
factor analytic study
ArticleinJournal of Clinical Psychology · January 1996
DOI: 10.1002/(SICI)1097-4679(199601)52:1<15::AID-JCLP2>3.0.CO;2-V·Source: PubMed
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Body
Image
of
Eating
Disorder
Subjects
15
WATT,
R.
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&
ANDREWS,
D. P.
(1981).
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Adaptive probit estimation
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Cur-
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ROSEN,
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(1988).
A
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WILMWTH,
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E.,
LEITENBERG,
H.,
ROSEN,
J.
C.,
FONCARDO,
K.
M.,
&
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l,
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MEASUREMENT AND CORRELATES OF INTERNALIZED HOMOPHOBIA:
A FACTOR ANALYTIC STUDY
MICHAEL
W.
ROSS
School
of
Public Health
University
of
Texas
B.
R.
SIMON
ROSSER
Program in Human Sexuality
University
of
Minnesota
We developed a scale to measure internalized homophobia in men who have
sex with men, which is comprised
of
items derived from theoretical and
clinical reports
of
internalized homophobia. Two hundred two men who
have sex with men and who attend “Man to Man” sexual health seminars
in a midwestern
U.S.
city completed the scale at baseline. Orthogonal factor
analysis revealed four dimensions
of
internalized homophobia: public iden-
tification as gay, perception of stigma associated with being homosexual,
social comfort with gay men, and the moral and religious acceptability
of
being gay. Factor scoring
of
these dimensions indicated that they were
associated significantly with relationship satisfaction, duration
of
longest
relationship, extent
of
attraction to men and women, proportion
of
social
time with gay people, membership
of
gay/bisexual groups,
HIV
serostatus,
and disclosure
of
sexual orientation. Internalized homophobia is measurable
and consists
of
four dimensions that are associated significantly with low
disclosure, shorter length of and satisfaction with relationships, lower degree
of
sexual attraction
to
men and higher degree
of
attraction to women, and
lower social time with gay people.
Internalized homophobia is a central construct in the symptomatology and treat-
ment of gay men and lesbians. Cabaj
(1988)
argues that it is the main dynamic in neurosis
in homosexual people, with ego-dystonic homosexuality, previously
a
diagnostic category,
being described as dissatisfaction with being homosexual and as being associated with
low self-esteem and self-hatred. Thus, the diagnostic category
of
ego-dystonic homosex-
uality included what currently is described as internalized homophobia. Cabaj suggests
that internalized homophobia will affect symptomatology, transference, and counter-
transference in psychotherapy with homosexual people. In addition, Kahn
(1991)
has
noted that theories of homosexual identity formation are based on the assumption that
The “Man to Man” seminars were funded by a grant
from
the AIDS/STDs Program
of
the Minnesota
Correspondence should be addressed
to
Dr.
Michael
Ross,
Center
for
Health Education Research and
Department of Health.
Development, School of Public Health, University of Texas, PO Box
20186,
Houston, TX
77225.
16
Journal
of
Clinical Psychology, January 1996,
Vol.
52,
No.
1
internalized homophobia is a reaction to societal homonegativism that must be resolved
for adequate psychological integration of the individual’s sexuality to occur. She argues
that this will occur by changing the meanings attached to homosexuality, such that these
will take on more positive meanings.
Cabaj distinguishes between external homophobia, the stigma associated with being
homosexual, and internalized homophobia, the reaction to that homonegativism. It is
conceived of as
a
continual variable. Coleman, Rosser, and Strapko
(1992)
note that
although self-identification as gay or lesbian indicates
a
degree of self-acceptance, it
does not leave the individual immune to the prevalent external societal homophobia.
While the term “homophobia” has the widest currency, it is a set of negative attitudes
and beliefs about homosexuality, rather than a phobia as classically understood (Herek,
1984a, 1984b;
Shields
&
Harriman,
1984).
Internalized homophobia is described as the
internalization of negative attitudes and assumptions about homosexual people (Sophie,
1987).
Malyon
(1982)
has conceptualized internalized homophobia as being both con-
scious and unconscious, which makes homosexuality ego-alien. He argues that the first
stage of psychotherapy in gay people is to identify the presence and nature of inter-
nalized homophobia.
The psychological characteristics associated with internalized homophobia have been
described
as
lower self-acceptance, lower ability to self-disclose to heterosexual and other
homosexual persons (Kahn,
1991),
low self-esteem, self-hatred, self-doubt, belief in one’s
inferiority, acceptance of popular myths about homosexuality, beliefs that others will
be rejecting on the basis of one’s sexuality, and self-imposed limits on one’s aspirations
(Cabaj,
1988).
Cabaj has listed the specific beliefs that characterize internalized homo-
phobia as being that older gay men are lonely and sad; that given the choice, gays would
elect to be heterosexual; that gays can’t have lives
as
fulfilling
as
those of their heterosexual
counterparts; and that there are social phobias about interacting in gay environments.
With regard to behavior, Coleman et al.
(1992)
add to this list that hypersexual behavior,
anonymous sex, avoidance
of
relationships, avoidance of intimacy, and substance use
can serve the function of escaping confrontation with one’s own homophobia. Further,
Gonsiorek
(1988)
reports that an additional manifestation is that gay people hold
themselves to higher standards of conduct compared with heterosexuals and that one
of
the most sensitive indicators is the way in which individuals view other members of
the homosexual community.
The attributed impact of internalized homophobia is broad. Both Remafedi
(1987)
and Gonsiorek
(1988)
note that it is
a
major problem for adolescents, and Dunne
(1987)
reports that it is
a
significant variable in disclosure in gay fathers. Cabaj
(1989)
sees it as
a significant variable in substance abuse in gay and bisexual men. Thus, while there is
general agreement about the theoretical importance of internalized homophobia, there has
been little operationalization of the construct. Although Kahn
(1991)
reports on an
18-
item questionnaire based on myths related to homosexuality, no data on the content or
psychometrics
of
the scale are provided. Kahn found that internalized homophobia was
related significantly and negatively to feminist orientation and discomfort in disclosing
sexual orientation in lesbians. Nicholson and Long
(1990)
studied
89
HIV seropositive
Canadian gay men and used the Nungesser Homosexual Attitudes Inventory (NHAI) as
a measure of homophobic prejudice. They found that there was a relationship between
internalized homophobia and self-blame-related coping and avoidance coping styles. The
NHAI is based on three subscales, which comprise attitudes toward one’s own homosex-
uality, toward other homosexuals, and toward disclosure, which had alpha coefficients
of
.68
to
.94.
The
34
items were based on self-reports of homophobic prejudice and
have not been subject to factor analysis, although they were chosen from a larger pool
of items by item analysis. Because of the lack of a scale based on both the theoretical and
clinical components of internalized homophobia and the need to assess concurrent valid-
ity
of
any scale, we determined to develop a scale to measure internalized homophobia
Internalized Homophobia
17
and to measure the relationship of internalized homophobia to sexual attraction, rela-
tionship satisfaction and length, social interaction with gay people, and disclosure.
METHOD
Subjects and Procedure
Participants in the study were all males over
18
years of age who responded to an
opportunity to attend one of four “Man-to-Man Sexual Health Seminars”
in
1993.
These
seminars were advertised as an opportunity for “men who have sex with, or are attracted
to, other men” to explore issues of “intimacy between men.” Because the term “homosex-
ually active” was seen as potentially threatening to some interested participants, “men
who are attracted to other men” was added to relieve participants
of
the need
to
iden-
tify themselves by their behavior. Advertisements noted that the seminars were free (being
paid for by a grant from the Minnesota Department of Health), included a dinner, and
were conducted by licensed psychologists who specialize in human sexuality. The first
and third seminars were conducted on a Friday-Saturday and the second and fourth
on a Saturday-Sunday, all at the University of Minnesota. Of the 202 seminar par-
ticipants,
36
attended the first seminar,
54
the second,
57
the third, and
55
the fourth.
Initial recruitment targeted homosexually active men in difficulty by soliciting referrals
from Program in Human Sexuality clients; from other therapists, medical practitioners,
and HIV clinics; and from service agencies that target individuals at risk for HIV (such
as the Minnesota AIDS Project).
As
a consequence, the study sample could be expected
to be skewed toward those who are experiencing psychological and psychosexual prob-
lems:
21
Yo
of the sample was recruited through the above sources. Advertising in local
gay and community magazines (GAZE, Equal Times), pamphleting and posters at gay
events (the Gay, Lesbian, and Transgender Pride Festival), and gay venues and churches
recruited the remainder of the participants.
Interested participants could register by providing a name (real or false), and con-
firmation of reservation was sent to each participant who registered in advance. In ad-
dition, registrations were accepted at the time
of
the workshop on an as-available basis.
Registration was conditional on the person signing a consent form that indicated that
he was over
18
years of age, knew he would be exposed to sexually explicit material,
and knew, if he chose to be involved in the research study, that he could refuse
to
answer
any question and could withdraw from the study at any time. When participants had
registered and received a name tag, they were to participate separately in the research/
evaluation component of the seminar. All participants signed the research form, and
none refused any part
of
the questionnaires. The baseline questionnaires took about
20
minutes to complete, the post-seminar,
15
minutes. Post-seminar questionnaires were
handed out in the seminar
30
minutes before its conclusion.
Data for the “Man-to-Man” seminar were collected at baseline, post-seminar, and
at
2
months follow-up. To assess behavioral change, data on sexual and drug behavior
in the previous 2 months were collected at baseline and 2-month follow-up: The data
reported on here are the baseline data. Demographic and relationship data were col-
lected at baseline, along with responses to research questions that assessed knowledge
and attitudes with regard to comfort with sexuality, safer sex, condom use, assertiveness,
mental health, and self-esteem.
Data analysis consisted of subjecting the items
of
the internalized homophobia scale
at baseline to factor analysis (principal component analysis followed by varimax rota-
tion to simple structure). Subscales were computed by multiplying the item score by
the factor loading after recoding those items scored in
a
reverse direction. Intercorrela-
tions were calculated using Pearson product-moment correlation coefficients, and in-
ternal reliabilities by Cronbach’s alpha coefficient, while comparisons of group means
were carried out using t-test.
18
Journal
of
Clinical Psychology, January
1996,
Vol.
52,
No.
I
RESULTS
Completed data for baseline and post-seminar responses were available for
184
men.
The majority were college graduates
(33.7%)
or had
a
graduate degree or professional
qualification
(31.7%).
Mean age was
37.0
years,
SD
=
9.3
years. The factor analysis
of the baseline data produced seven factors with eigenvalues
>
1.
However, several of
these were monofactors
or
factors with fewer than three unique items or with loadings
>
.30,
so
the data were re-rotated on the basis of a scree test and four factors extracted,
which accounted for
45.1’70
of the variance. These four factors (listed in Table
1)
pro-
duced readily interpretable dimensions
of
(1)
public identification as gay;
(2)
perception
of
stigma associated with being gay;
(3)
social comfort with gay men; and
(4)
moral
and religious acceptability of being gay. The scales computed from these dimensions
had internal reliabilities (coefficient alpha) of
.85,
.69,
.64,
and
.62,
respectively.
The subscales’ correlations with the measures of validity are presented in Table
2.
There were
a
number of significant associations; public identification as being gay
Table
1
Factor Structure
of
the Internalized Homophobia Scale
Factor
1:
Public Identification as Gay
23.
11.
25.
12.
21.
10.
19.
8.
1.
3.
I
am not worried about anyone finding out that
I
am gay.
I
feel comfortable discussing homosexuality in
a
public setting.
Even if
I
could change my sexual orientation,
I
wouldn’t.
It is important to me to control who knows about my homosexuality.
I
feel comfortable about being homosexual.
I
feel comfortable about being seen in public with an obviously gay person.
I
would prefer to be more heterosexual.
I
don’t like thinking about my homosexuality.
Obviously effeminate homosexual men make me feel uncomfortable.
It would not be easier
in
life to be heterosexual.
(23.8%
of variance)
Factor
2:
Perception of Stigma Associated with Being Gay
17.
I
worry about becoming
old
and gay.
18.
I
worry about becoming unattractive.
15.
Society still punishes people for being gay.
13.
Most people have negative reactions to homosexuality.
24.
Discrimination against gay people is still common.
20.
Most people don’t discriminate against homosexuals.
(9.1
Qo
of
variance)
Factor
3:
Social Comfort with Gay Men
6.
I
feel comfortable in gay bars.
4.
Most of my friends are homosexual.
5.
I
do not feel confident about making an advance to another man.
9.
When
I
think about other homosexual men,
I
think of negative situations.
7.
Social situations with gay men make me feel uncomfortable.
2.
I
prefer to have anonymous sexual partners.
(6.4%
of variance)
Factor
4:
Moral and Religious Acceptability of Being Gay
14.
Homosexuality is not against the will of God.
22.
Homosexuality is morally acceptable.
26.
Homosexuality is as natural as heterosexuality.
16.
I
object if an anti-gay joke is told in my presence.
(5.8%
of variance)
.71
.13
.69
.61
.60
-
.59
-
.59
-
.41
.36
-
.67
.76
.71
.59
.44
.44
-
.41
.62
.59
-
.55
-
.54
-
.50
.48
.65
.60
.56
.42
Internalized Homophobia
19
Table
2
Variables Associated with Internalized Homophobia Factors
~ ~~ ~
Public Stigma Comfort Acceptability
Correlations
Duration longest relationship
Extent
of
attraction to men
Extent of attraction to women
Relationship satisfaction
Proportion of social time with gays
Openly gay/bisexual in personal life
Openly gaylbisexual at work
Number known with HIV/AIDS
HIV seropositive
HIV seronegative
Belong gay/bi group
Do not belong gay/bi group
Means on scales
-
.23*
-
.26*
.35**
-
.26*
.39**
-
.57**
-
.64**
-
.35**
13.45
18.18**
16.27
20.48.
.I6
-
.05
.01
.25*
-
.04
.07
.13
-
.03
10.57
10.27
10.09
10.21
-
.01
-
.32**
.27**
-
.29**
.53**
-
.36**
-
.27**
-
.30**
8.42
11.93**
1
I
.05
12.35*
-
.25*
-
.17*
.24*
-
.08
.09
-
.19*
-
.08
-
.14
3.45
4.15
3.77
4.51*
was associated with all eight measures, and social comfort with other gay men was
associated with seven of the eight. Moral and religious acceptability of being gay was
associated with four of eight measures, while perception of stigma associated with being
gay was only associated with relationship satisfaction. HIV seropositive respondents
(12/153)
were significantly lower on r-test on public identification
of
being gay and on
social comfort with other gay men. There was
a
similar pattern
on
belonging to a gay
or bisexual group, with the addition of moral and religious acceptability of being
gay.
Factor intercorrelations were factor
1
with factor
2,
-
.35
(p
<
.OOOl),
with factor
3,
.45
(p
<
.OOOl),
with factor
4,
.35
(p
<
.OOOl);
factor
2
with factor
3,
-
.27
@
<
.001),
with factor
4,
-
.03
(ns);
and factor
3
with factor
4,
.24
(p
<
.002).
DISCUSSION
These data must be interpreted with the caveat that they are based on samples of
gay men who have volunteered for seminars on sexual health, and as such the sample
is biased toward those who have accepted to some degree their sexual orientation. Fur-
ther, the sample is of moderate size and may not be typical
of
gay men outside of the
midwestern region of the United States. It appears to be skewed toward the better
educated and mature. These cautions aside, it is apparent that internalized homophobia
is measurable and that empirically it is categorized by four distinct dimensions, all of
which are moderately intercorrelated.
The results
of
the factor analysis presented in Table
1
suggest that these four dimen-
sions measure
(1)
concern about public identification about being gay;
(2)
concern about
the stigma associated with being considered unattractive (in the gay world) and the stigma
associated with being gay outside the gay world. (These first two items, which measure
the former, were a separate factor in the five-factor solution.);
(3)
social comfort with
other gay men; and
(4)
the moral and religious acceptability of being gay. Theoretical
conceptions of internalized homophobia stress the internalization of anti-homosexual
sentiment as resulting in concern about being identified and discomfort with one’s iden-
tification, and if a person does exhibit internalized homophobia, then discomfort with
other gay men (and preference for anonymous sexual encounters) would be anticipated.
This is consistent with perception of stigma associated with being gay, identified by
Ross
20
Journal
of
Clinical Psychology, January
1996,
Vol.
52,
No.
1
(1983,
1985)
as being associated with heterosexual marriage of homosexual men, as being
unrelated to the
actual
level of societal discrimination experienced, but significantly
associated with the
anticipated
discrimination. These data suggested that it was the
perception and anticipation
of
negative response to sexual orientation, rather than the
actual response, which were associated with discomfort and attempting to downplay
or
hide orientation, and the present data confirm that the perception of stigma associated
with being gay is a component of internalized homophobia. The final dimension ex-
tracted indicates that a moral or religious concern about the acceptability of being gay
is, independent of societal stigma,
a
factor in internalized homophobia. These four
dimensions of internalized homophobia are consistent with the previous literature on
internalized homophobia and, more importantly, indicate that internalized homophobia
in homosexually active men can both be measured empirically and exhibit internal
consistency.
The four subscales that make up the Internalized homophobia scale also exhibit
significant concurrent validity when compared with the criterion measures in Table
2.
It is clear that the two subscales with the most consistent reponse are those that measure
concern with public identification as being gay, and comfort in gay social contexts. To
a lesser extent, moral and religious concerns about homosexuality also are associated
with a majority of these measures. Because the variables selected for measurement of
concurrent validity are all theoretically or clinically identified outcomes
of
internalized
homophobia, the consistency of these correlations with the Internalized Homophobia
Scale subscale scores is further evidence that
this
scale does tap the clinical construct
of internalized homophobia. The association of high Public identification, and Social
comfort with gay people, is probably an epidemiological function of the fact that HIV
seroprevalence in Minnesota is predominantly in the population identified as gay.
These data do suggest that the clinical construct of internalized homophobia is
measurable and psychometrically has both internal reliability and concurrent validity.
Nevertheless, these data should be replicated using large and more divergent popula-
tions, and, if possible, in samples in which internalized homophobia has been diagnosed
independently as
a
further clinical validation. The present data suggest that internalized
homophobia is
a
measurable construct and that its major dimensions are Public iden-
tification as being gay, Perception
of
stigma associated with being gay, Moral and
religious acceptability of being gay, and Social comfort with gay men. These dimen-
sions are associated with variables that have been identified clinically as associated with
internalized homophobia.
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SOCIAL MALADJUSTMENT INDICATORS
IN PTSD PATIENTS FAMILIES
OF
ORIGIN
CHARLES
G.
WATSON, PATRICIA
E.
D.
ANDERSON
AND
LEE
P.
GEARHART
Department
of
Veterans Affairs Medical Center
St. Cloud, Minnesota
We compared the frequencies with which
PTSD
patients, psychiatric con-
trols, and hospital employee controls reported that their fathers, mothers,
and oldest siblings
of
each sex had been incarcerated
or
had received
psychiatric/psychological
treatment. We also compared estimates
of
the
number of psychiatric hospitalizations, incarcerations, courses
of
outpatient
treatment, treatment sessions, and days of institutionalization undergone
by the relatives. Only a chance number of significant differences appeared,
which suggests that general psychosocial maladjustment in one’s family
of
origin does
not
appear
to
increase trauma survivors’ risk for
PTSD.
A
thorough knowledge
of
the relationship between a psychiatric disorder and
psychopathology in its victims’ families of origin is important to a good understanding
of its etiology. Two recent studies (True et al.
1993;
Watson, Anderson,
&
Gearhart,
unpublished) suggest that a moderately genetic predisposition to post-traumatic stress
disorder (PTSD) is passed along within families. This raises a question as to whether
the presence
of
other psychiatric disorders or psychosocial maladjustment problems in
a trauma survivor’s family of origin increases hidher risk for PTSD. The literature on
this question is inconsistent. Kulka et al.
(1988,
p.
F-10)
reported that a family history
of mental illness increased risk for PTSD in Vietnam war veterans, but Speed, Engdahl,
Schwartz, and Eberly
(1989)
found no relationship between a family history of psychiatric
disorder and PTSD in their World War I1 prisoners. Emery, Emery, Shama, Quiana,
and
Jassani
(1991)
reported a high incidence of alcoholism in the parents of their PTSDs,
but their results conflict with Davidson, Smith and Kudler’s
(1989)
on this point. Davidson
et al. also found that their PTSD patients’ families of origin had exaggerated levels of
This research was supported by the Department of Veterans Affairs Medical Research Service. Requests
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... However, the logic of internalized stigma is transferable to other traits. Internalized homonegativity has been concretized as "accepting society's negative evaluation of homosexuality as warranted, and consequently harboring negative attitudes toward oneself and one's own homosexual desires" (Herek, 2009, p. 445), and is measured by how far subjects agree with statements such as "I would prefer to be solely or more heterosexual" (Ross & Rosser, 1996). One can say that the modern construct of internalized homonegativity-and internalized stigma in general-represents a fusion of the three feelings of shame, self-derogation, and self-hate described by Goffman. ...
... To assess internalized stigma, I used a version of the revised Internalized Homonegativity Scale (Smolenski, Diamond, Ross, & Rosser, 2010) that was originally developed by Ross and Rosser (1996). The question asked of respondents was, "How do you feel about your sexual orientation?" and to answer it the participants had to rate five statements using a seven-point Likert scale that ranged from "Does not apply to me" to "Applies to me." ...
Article
Inspired by the question of why some gay and bisexual men hide same-sex affection when in public, this study integrates the concept of minority stress into Noelle-Neumann’s spiral of silence theory and Goffman’s interaction order to build an integrated model explaining why some people avoid nonverbal stigma expression in public. It is hypothesized that perceived stigma, prejudice events, and internalized stigma will result in a greater tendency to hide male same-sex affection. An empirical study involving n = 25,884 gay and bisexual men in Germany showed that higher levels of perceived stigma and internalized stigma were associated with a greater tendency to hide male same-sex affection when in public. However, being a victim of prejudice events did not substantially predict whether individuals hide their male same-sex affection. Findings are discussed in terms of their generalizability and implications for the underlying theory.
... La presenza di omofobia nelle persone omosessuali può essere causa di bassa autostima, atteggiamenti di tipo passivo, difficoltà di tipo relazionale, isolamento e autoesclusione sociale, sensi di colpa e vergogna, sintomi di tipo depressivo o ansioso, angoscia, abuso di alcool e droghe, tentativi di suicidio. Ross (1996) ha definito l'atteggiamento omonegativo interiorizzato come il prodotto delle norme omofobe ed eterosessiste presenti nella società e come il principale responsabile dei disagi psicologici di gay e lesbiche. Per chiarire quali elementi costituivano gli atteggiamenti omonegativi interiorizzati, Ross e Rosser (1996) hanno analizzato i fattori sottostanti la presenza di omofobia interiorizzata nei gay statunitensi e hanno osservato quattro dimensioni: l'identificazione pubblica come gay, la percezione della stigmatizzazione associata all'orientamento sessuale, l'importanza del conforto sociale tra gay e le opinioni riguardo l'accettazione morale e religiosa dell'essere omosessuale. ...
... Conceptually Broad "Homosexuality is deviant" Some Items Include Distress "For the most part, I do not care who knows I am gay" "I wish I were heterosexual" Internalized Homophobia Scale (IHP-R; Ross & Rosser, 1996) "I am proud to be gay" "I believe it is wrong for men to be attracted to each other" IH Subscale of the Lesbian, Gay, and Bisexual Identity Scale (LGBIS; Mohr & Kendra, 2012) 3 ...
Article
Full-text available
Internalized homonegativity (IH) is widely recognized to negatively influence the health of lesbian, gay, bisexual, and queer/questioning (LGBQ +) individuals. It is not clear, however, the role that religiousness may play in the relationship between IH and health or how differing conceptualizations of IH or health may influence this relationship. We conducted a multi-level meta-analysis of 151 effect sizes from 68 studies to examine the relationship between IH and health as well as what may moderate this relationship. Results suggested that IH was consistently and negatively related to health (r = − .28). Analyses suggest that IH was most strongly related to mental health and well-being, evidencing a relatively weaker (though still negative) relationship with physical or sexual health. Analyses of different ways to measure IH suggest that scales that conceptualize IH to include distress (e.g., the Internalized Homonegativity Inventory) report stronger relationships with health than scales that conceptualize IH orthogonally from distress (e.g., the Internalized Homonegativity scale of the Lesbian, Gay, Bisexual Identity Salience Scale [LGBIS]). We failed to find significant moderation effects for religiousness, though it was hard to evaluate this relationship due to the poor quality of most measures of religiousness. We encourage researchers to use measures of IH that conceptualize IH orthogonally from distress (e.g., the LGBIS) and to use more nuanced measures of religiousness (e.g., religious belief, religious activity). We also encourage researchers to focus on how IH impacts less-often studied measures of health (e.g., physical health, suicidality).
... Self-Stigma Questionnaire (WSSQ; Lillis et al., 2010), the Internalized Homophobia Scale 8 (IHS; Ross & Rosser, 1996), and the Internalized Homonegativity Inventory (IHNI; 9 ...
Article
The present study developed the Muscularity Bias Internalization Scale (MBIS), a measure of muscularity bias internalization, which assesses the extent to which an individual endorses muscularity-based stereotypes and engages in negative self-evaluations due to muscularity. In Study 1, a pool of candidate items was developed. By using exploratory factor analysis (EFA) on a sample of 300 Chinese adult men (M age = 29.98 years, SD = 7.81), 14 items from the item pool were retained. The 14-item MBIS contained three factors. In Study 2, the second sample of 300 Chinese adult men (M age = 29.50 years, SD = 7.50) was used to confirm the factor structure of the MBIS, as well as to examine its reliability and validity. Confirmatory factor analysis (CFA) further confirmed the three-factor structure of the MBIS with a good model fit. The MBIS showed high internal consistency reliability and high two-week test-retest reliability. The MBIS also showed good construct validity with measures of drive for muscularity, muscularity-oriented disordered eating, and muscle dysmorphia symptoms. The newly developed MBIS may help understand the role of muscularity bias internalization in the development and maintenance of muscularity-oriented body image and muscularity-oriented disordered eating.
... Returning to the subject of the conceptual uncertainty surrounding internalized homophobia, there was a contrast between the way that internalized homophobia is operationalized, and the way self-stigma was characterized in this study. For example, a near-ubiquitous operationalization of internalized homophobia to date has been a desire to change one's sexual orientation and/or actual efforts to do so (note that although some of these references appear dated, these measures remain in use; [16,17,[31][32][33]). However, this study illuminated reasons for wanting to change their sexual orientation other than due to self-stigma; a significant number of the participants who articulated these desires or behaviors did so due to the desire to escape stigma (such as wanting to be accepted by their family), or for practical reasons, such as finding it easier to find a romantic partner. ...
Article
Full-text available
Many adolescents with diverse sexual orientations lead happy and fulfilled lives. However, evidence consistently suggests elevated rates of mental health difficulties in this population relative to heterosexual peers, and internalization of stigma (i.e., self-stigma) is implicated in these elevated rates. This study aimed to understand and describe the lived experience of self-stigma with respect to participants’ sexual orientations. To do this, N = 21 semi-structured interviews were conducted with adolescents aged 14–18 who are attracted to the same gender, asking about how their stigma experiences affected their views of their sexual orientation, and themselves. A community reference group of young people with diverse sexual orientations was also consulted in the development of the study, and interpretation of the themes. Through thematic analysis of the self-stigma data and the consultation process, four themes were developed: (1) stigma is a precursor to self-stigma; (2) acceptance is a precursor to self-acceptance; (3) contents of self-stigma, characterized by two subthemes: (i) self-shame (comprised of feelings of abnormality, self-disgust and/or being a ‘bad’ person) and (ii) self-invalidation; and (4) self-stigma is painful and can be damaging. There is a contrast between the way that internalized homophobia is operationalized, and the way self-stigma was characterized in this study with young people, and conceptualizing and measuring self-stigma may need to be updated. Based on the analysis, we suggest four ways to address self-stigma and its impacts: (1) individual intervention; (2) increasing acceptance in families and communities; (3) providing respectful and normalizing sexuality education and information; and (4) overcoming community stigma.
... • Internalized homophobia [98,99] • Gay-related stigma [100] • Racial and ethnic identity devaluation [101] • ...
Article
Background Sexual minority men experience intimate partner violence (IPV) at rates similar to those reported by heterosexual women in the United States. Previous studies linked both IPV victimization and perpetration to HIV risk and seroconversion; however, less is known about the impact of IPV on HIV testing, sexually transmitted infection (STI) testing, pre-exposure prophylaxis (PrEP) uptake, and the persistence of PrEP use among sexual minority men experiencing IPV. Although prior work suggests that IPV may influence HIV prevention behavior, experiences of IPV are so highly varied among sexual minority men (eg, forms, frequency, and severity; steady vs casual partnerships; perpetration vs receipt; and sexual vs physical vs psychological violence) that additional research is needed to better understand the impact that IPV has on HIV risk and protective behaviors to develop more effective interventions for sexual minority men. Objective This study aims to contribute to our understanding of the antecedents of IPV and the direct and indirect pathways between perpetration and receipt of IPV and HIV or STI risk behavior, STIs, and use of PrEP among sexual minority men experiencing IPV. Methods This mixed methods study has 2 phases: phase 1 involved formative qualitative interviews with 23 sexual minority men experiencing IPV and 10 key stakeholders or providers of services to sexual minority men experiencing IPV to inform the content of a subsequent web-based cohort study, and phase 2 involves the recruitment of a web-based cohort study of 500 currently partnered HIV-negative sexual minority men who reside in Centers for Disease Control and Prevention–identified Ending the HIV Epidemic priority jurisdictions across the United States. Participants will be followed for 24 months. They will be assessed through a full survey and asked to self-collect and return biospecimen kits assessing HIV, STIs, and PrEP use at 0, 6, 12, 18, and 24 months. They will also be asked to complete abbreviated surveys to assess for self-reported changes in key study variables at 3, 9, 15, and 21 months. Results Phase 1 was launched in May 2021, and the phase 1 qualitative interviews began in December 2021 and were concluded in March 2022 after a diversity of experiences and perceptions were gathered and no new ideas emerged in the interviews. Rapid analysis of the qualitative interviews took place between March 2022 and June 2022. Phase 2 recruitment of the full cohort began in August 2022 and is planned to continue through February 2024. Conclusions This mixed methods study will contribute valuable insights into the association that IPV has with HIV risk and protective behaviors among sexual minority men. The findings from this study will be used to inform the development or adaptation of HIV and IPV prevention interventions for sexual minority men experiencing IPV. International Registered Report Identifier (IRRID) DERR1-10.2196/41453
... In Mexico, stigma among MSM has been explored qualitatively [11,13] or been restricted to one type of stigma, such as internalized (e.g., assessed with the Internalized Homophobia scale) [34,37,[48][49][50][51] or enacted stigma (e.g., via Experiences of Homophobia or other scales) [36-38, 48, 52], with stigma often being an incidental rather than primary focus of inquiry. Moreover, there is minimal evidence that any sexuality-based stigma scale has been thoroughly validated among MSM in Mexico. ...
Article
Full-text available
Cisgender gay, bisexual, and other men who have sex with men (MSM) in Mexico experience disparities in sexual health outcomes, perhaps most notably in HIV prevalence, HIV testing and status awareness, and condom use. Sexual behavior stigma, underpinned by socio-structural factors specific to Mexico (e.g., machismo), uniquely shapes these sexual health disparities. However, few reliable, valid measures are available to document, track, and ultimately mitigate sexual behavior stigma in this context. Exploratory and confirmatory factor analyses were performed on responses to a 13-item sexual behavior stigma scale from 15,681 MSM recruited online across Mexico. Associations with extracted factors were tested to assess construct validity. Three subscales were identified in exploratory factor analysis and validated in confirmatory factor analysis: “stigma from family and friends” (α = 0.65), “anticipated healthcare stigma” (α = 0.84), and “general social stigma” (α = 0.70). External construct validity was indicated through each subscale’s strong association (all p < 0.001) with perceived community intolerance of MSM and perceived community discrimination toward people living with HIV. These subscales show promise as reliable, valid measures for assessing sexual behavior stigma among MSM in Mexico, and as tools for documenting and tracking sexual behavior stigma trends, comparing regional burdens of sexual behavior stigma, and tracking the progress of stigma-mitigation interventions among MSM in Mexico. Future research is needed to understand the extent to which each subscale is differentially associated with sexual (and other) health outcomes, which can inform the development and implementation of uniquely tailored stigma-mitigation, HIV-prevention, HIV-care, and other needed interventions for MSM in Mexico.
... Research has demonstrated that internalized homonegativity is a multifactorial construct [4][5][6]. For example, according to the Measure of Internalized Sexual Stigma for Lesbians and Gay Men (MISS-LG) [7], internalized homonegativity comprises three fundamental dimensions: "identity (an enduring propensity to have a negative self-attitude as sexual minority and to consider sexual stigma as a part of a value system and identity), social discomfort (the fear of public identification as a lesbian or gay man in the social context, and disclosure in private and professional life), and sexuality (the pessimistic evaluation of intimate gay or lesbian relationships' quality and duration and a negative conception of gay or lesbian sexual behaviors)" [7]. ...
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Background The mediators of the association between familial attitudes toward sexual orientation and internalized homonegativity among lesbian, gay, and bisexual (LGB) individuals have not been well examined. Methods A cross-sectional survey study was carried out to examine the (i) associations of familial sexual stigma and family support with internalized homonegativity among young adult LGB individuals in Taiwan, and (ii) mediating effect of self-identity disturbance and the moderating effect of gender. Self-identified LGB individuals (N = 1000; 50% males and 50% females; mean age = 24.6 years) participated in the study. Familial sexual stigma, family support, self-identity disturbance, and internalized homonegativity were assessed. Structural equation modeling was used to examine relationships between the variables. Results The results indicated that familial sexual stigma was directly associated with increased internalized homonegativity, and indirectly associated with increased internalized homonegativity via the mediation of self-identity disturbance among LGB individuals. Family support was indirectly associated with decreased internalized homonegativity via the mediation of low self-identity disturbance. The direct association between family support and internalized homonegativity was only found among lesbian and bisexual women but not among gay and bisexual men. Conclusions Program interventions for familial sexual stigma, family support, and self-identity disturbance are warranted to help reduce internalized homonegativity among LGB individuals.
Article
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We assessed pathways between sexual minority stigma and condomless anal intercourse (CAI) among two samples of Black South African men who have sex with other men (MSM). Two cross-sectional surveys were conducted in Tshwane, South Africa; one among 199 Black MSM and another among 480 Black MSM. Men reported on external and internalized experiences of sexual minority stigma, mental health, alcohol use, information-motivation-behavioral skills (IMB) model constructs, and CAI. Structural equation modeling was used to test whether external and internalized stigma were directly and indirectly associated with CAI. In both studies, external stigma and internalized stigma were associated with CAI through IMB model constructs. These results suggest a pathway through which stigma contributes to HIV risk. For HIV prevention efforts to be effective, strengthening safer sex motivation and thus decreasing sexual risk behavior likely requires reducing sexual minority stigma that MSM experience and internalize.
Article
Background We investigated associations of intersectional stigma subgroups with alcohol and marijuana use among Black and Latino sexual minority young men. Subgroups included Minimal Stigma (low to no stigma), Select Social Stigma (occasional stigma in social relationships), Multiform Heterosexism (internalized and interpersonal heterosexism from family/friends), Multiform Racism (racism across diverse contexts), Compound Stigma (frequent, ubiquitous racism and heterosexism). Methods Cohort of Black and Latino sexual minority cisgender young men (n=414; baseline ages 16 to 25) surveyed semiannually 2016 to 2019. Generalized estimating equations integrated with latent class analysis modeled linear and quadratic age effects and association of stigma subgroups with past 6-month alcohol use, marijuana use, unhealthy drinking, and marijuana use disorder symptoms. Results All past 6-month substance use peaked between ages 21 to 23 years old. Across all ages and relative to Minimal Stigma, odds of drinking were higher in every subgroup and highest in Compound Stigma (OR=2.72, 95% CI 1.17-6.35); unhealthy drinking was higher in every subgroup and highest in Multiform Heterosexism (β=3.31, 95% CI 1.92-3.89); marijuana use disorder symptoms were higher in most subgroups and highest in Compound Stigma (β=1.30, 95% CI 0.76-1.85). Marijuana use odds did not differ among groups. Conclusion By examining intersectional stigma subgroups, we identified subgroups for whom substance use was elevated during a development period when use tends to be highest. Young men experiencing stigma patterns characterized primarily by heterosexism or heterosexism together with racism may be especially at risk for developing unhealthy drinking behaviors and marijuana use disorder symptoms.
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The relationship between actual societal reaction (SR) and putative societal reaction (PSR) to homosexuality was investigated in two cultures, Sweden and Australia, which were similar with regard to socio‐economic factors but dissimilar with regard to attitudes toward homosexuality. It was predicted that there would be no correlation between SR and PSR, that there would be differences between the two countries on PSR but not SR, and that these dimensions of societal reaction would be confirmed by factor analysis. One hundred seventy‐six Swedish and 163 Australian homosexual males were administered scales measuring the actual or expected reaction to individuals or classes of individuals. They also responded to questionnaire items measuring acceptance of their homosexuality. Results indicated that there was a different direction of relationship between SR and PSR for each country and that there were significant differences between the two cultures on PSR but not SR, indicating that PSR is probably the critical variable measuring differences in adjustment as a result of societal pressures. PSR was also related to several factors measuring psychological adjustment. The findings have implications with regard to mechanisms underlying societal reaction in homosexual men and their influence on psychological adjustment and the factorial basis of societal reaction and its measurement.
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The relationship was examined between self-esteem, social support, internalized homophobia, and coping strategies used by HIV-positive (HIV+) gay men (N = 89) and between the use of coping strategies and mood state. Multiple regressions were conducted with avoidant (escape avoidance, accepting responsibility) and proactive (seeking social support, planful problem solving) coping serving as criterion variables. Greater homophobia and less self-esteem predicted avoidant coping, whereas less homophobia and less time since diagnosis predicted proactive coping. Greater time since diagnosis, less avoidant coping, less homophobia, and greater self-esteem predicted better mood state and accounted for 50% of the total variance.
Article
Homosexually active men and women are no more immune than anyone else from various types of sexual dysfunction and underlying psychopathology. Intimacy fears and conflicts, ignorance, alcohol and drug dependence and relationship issues exemplify the type of issues influencing dysfunction regardless of sexual orientation, although membership of a stigmatized minority sexuality may exacerbate causes of sexual dysfunction. The effects of discordant lifestyle and identity, homosexual identity formation, dysphoria and internalized homophobia on sexual functioning are three examples of these factors of specific relevance to being homosexual in this culture. The effects of AIDS, difficulties arising from the mechanics of safer sex and the psychosexual effects of oppression on healthy sexual functioning all indicate how factors important to (but not caused by) minority sexuality status may influence sexuality functioning. The importance of neither perceiving homosexuality solely in terms of pathology on the one hand, nor refusing to recognize unhealthy sexual functioning on the other, is emphasized throughout. Models of sexuality must be inclusive, positive and communicated to the client if future sexual dysfunction is to be limited. Finally, the role of the therapist in community development, as well as individual intervention, is addressed. Primary health care interventions are required not only to address the specific issues affecting homosexual men and women, but also to promote a more positive approach to sexuality for all.
Article
Cass' model (1979) of identity development and her Stage Allocation Measure (1984a) were assessed to determine their utility in describing the subjective experience of coming out as a lesbian and whether proposed stages could be tied to behavioral correlates of the Openness Questionnaire (Graham, Rawlings, & Girten, 1985). The process was considered in terms of a woman's differentiation from her family, sex-role attitudes, and levels of internalized homophobia. Eighty-one lesbians anonymously completed questionnaires. The results suggest that subjective labeling and behavior are congruent, but that rate of progression through stages does not imply integration of behavior. Four patterns of identity development were identified which suggest that relevant stages, speed of development, and stage attainment are characteristic of certain women. Intergenerational intimidation was significantly related to stage development, sex-role attitudes, openness behavior, and levels of internalized homophobia.
Article
The mental health concerns of gay and lesbian adolescents are best understood within the context of cultural limitations, including a problematic conceptualization of adolescence, homophobia, and erotophobia. Within this framework, background information about homosexuality is presented; and the special social pressures and psychologic problems of gay and lesbian youth are discussed, with particular attention paid to internalized homophobia, developmental issues, and the "coming-out" process. Differences between gay and lesbian mental health issues are highlighted. Finally, practical suggestions regarding treatment planning are provided.
Article
Though there is no correlation between mental illness and homosexuality, there are unique concerns that play a role in symptomatology and psychotherapy around neurotic and characterological issues in gay patients. Homophobia, both in the therapist and in the patient, external and internalized, is the significant "hidden" factor. Lack of training around transference and countertransference issues with gay patients and lack of teaching about homosexuality in training programs contribute to the difficulties encountered in psychotherapy with gay people. There are some problems and concerns specific to being homosexual that may bring patients to therapy: "coming-out," deciding on sexual orientation, desire to change orientation, and a unique "AIDS neurosis." The therapist needs to have an objective knowledge of the gay community and be willing to examine personal beliefs and reactions to work effectively with gay patients.
Article
This paper presents suggestions for therapists working with women who are having difficulty accepting their attractions to other women, lesbian behavior and identity, or both, with the goal of promoting self-acceptance and reducing internalized homophobia. After a discussion of the therapeutic relationship, several coping strategies which have been used successfully by many women are described and therapeutic applications are offered. These strategies include cognitive restructuring, avoiding a negative identity, adopting an identity label, self-disclosure, meeting other lesbians, and habituation to lesbianism. Finally, behavioral indications of success or failure to achieve the goal of self-acceptance are presented.
Article
This paper describes the treatment of seven gay fathers who were concerned about revealing their sexual identity to their children. A time-limited group was established for the purpose of developing strategies to help them past this juncture in their development as gay men. Role playing of specific situations was the modality chiefly employed. Discussions of the effects of internalized homophobia were also held. At the conclusion of the group (eight sessions) all participants rated the experience as "highly useful." Follow-up data are presented at 6 months.
Article
Homophobia, a term often used to describe hostile reactions to lesbians and gay men, implies a unidimensional construct of attitudes as expressions of irrational fears. This paper argues that a more complex view is needed of the psychology of positive and negative attitudes toward homosexual persons. Based upon a review of previous empirical research, a model is proposed that distinguishes three types of attitudes according to the social psychological function they serve: (1) experiential, categorizing social reality by one's past interactions with homosexual persons; (2) defensive, coping with one's inner conflicts or anxieties by projecting them onto homosexual persons; and (3) symbolic, expressing abstract ideological concepts that are closely linked to one's notion of self and to one's social network and reference groups. Strategies are proposed for changing attitudes serving each of the functions. The importance of distinguishing attitudes toward lesbians from those focused on gay men is also discussed.