text:
UFDC Home myUFDC Home | Help
The Intersection of Ethno-Cultural Identity, Sexual Orientation and Traumatic Stress in Adult African-American Gay Men
Permanent Link: http://ufdc.ufl.edu/UFE0042124/00001
Title: The Intersection of Ethno-Cultural Identity, Sexual Orientation and Traumatic Stress in Adult African-American Gay Men
Physical Description: 1 online resource (133 p.)
Creator: Wynn, Richmond
Publisher: University of Florida
Subjects / Keywords: african, black, culture, gay, identity, intersectionality, multicultural, stress
Human Development and Organizational Studies in Education -- Dissertations, Academic -- UF
Genre: Mental Health Counseling thesis, Ph.D.
bibliography ( marcgt )
theses ( marcgt )
government publication (state, provincial, terriorial, dependent) ( marcgt )
born-digital ( sobekcm )
Electronic Thesis or Dissertation
Abstract: The purpose of study was to examine the relationship between ethno-cultural identity, sexual orientation and traumatic stress in adult African American gay men. These constructs were measured by the African Self-Consciousness Scale ? Short Form, the Modified Gay Identity Questionnaire, and select subscales of the Trauma Symptom Inventory. Quantitative methods were employed. Data was collected by surveying a national sample of adult African American gay men via snowball sampling through an electronic mail link to the survey. Pearson correlation and multiple regression analysis were used to analyze the data. Results revealed no statistically significant relationship between African self-consciousness and gay identity. However, statistically significant positive relationships were found between gay identity acceptance and traumatic stress and gay identity pride and traumatic stress. These results have important implications for understanding identity development in African American gay men.
General Note: In the series University of Florida Digital Collections.
General Note: Includes vita.
Bibliography: Includes bibliographical references.
Source of Description: Description based on online resource; title from PDF title page.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility: by Richmond Wynn.
Thesis: Thesis (Ph.D.)--University of Florida, 2010.
Local: Adviser: West-Olatunji, Cirecie.
Local: Co-adviser: Miller, M David.
Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2010
System ID: UFE0042124:00001
This item has the following downloads:
THE INTERSECTION OF ETHNO-CULTURAL IDENTITY, SEXUAL ORIENTATION
AND TRAUMATIC STRESS IN ADULT AFRICAN AMERICAN GAY MEN
RICHMOND DAVID WYNN
A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
2010 Richmond David Wynn
To my partner
I thank my committee members, Drs. Cirecie West-Olatunji, David Miller, Ana
Puig, Erica McCray, and Shari Robinson for their guidance and support throughout my
doctoral studies. I am most grateful to my chair, Dr. Cirecie West-Olatunji, for being a
mentor, advisor, and role model. I thank Drs. Peter Sherrard and Carlos Hernandez for
assisting me during the early phases of this process. I offer heartfelt appreciation to my
partner, Diego M. Pagan Ortiz, for his enduring love, patience and support. Finally, I
extend my deepest thanks to all of the men who participated in this study.
A C K N O W LE D G M E N T S ......... ............................ ................................ .... ............... 4
LIS T O F TA B LE S .................................................................................................. 7
LIST OF ABBREVIATIONS ................................................................ 8
A B S T R A C T ........................................................................................... ..... 9
1 IN T R O D U C T IO N .................................................................................................... 1 0
Population and Parameters .................... .............................. 10
Problem Statem ent ........... .................. ......... ........................................ 10
Research Questions .................... .............................. 14
Hypotheses ......................... ........................ 15
Definition of Terms .............. ............................... 16
Significance of the Study .............................. .................. 17
Limitations of the Study ............ ......... .................. ......... 17
2 REVIEW OF THE LITERATURE ................ ......... ......... ............... 19
Further Delineation of the Problem .......... ...... ......... ....................... 19
African American Culture ......... ............................. ........ 28
G ay Ide ntity ............................... .............. ...... 32
Intersectionality of Identity ............... ..... .............................. 35
Family Acceptance ............... .. ........ .................. 36
Religion and Spirituality ................................ .................... 38
Traumatic Stress Theory..................... .... ......................... 39
History of Traumatic Stress .................. ................... 39
Etiology of Traum atic Stress................................................ .................... 41
Race-Based Traumatic Stress............................................... 43
Traumatic Stress in African American Gay Men ............................................ 48
S u m m a ry .............. ..... ............ ................. ............................................... 4 9
3 METHODOLOGY ............................ ....... ................. 52
Research Method ................ ......... ....................... 52
P population and S getting ............................ .......... ................ .. .......... 52
Instrum entation .......................................................................................... 53
African Self-Consciousness Scale (ASC) .................................................. 53
Gay Identity Questionnaire (GIQ) ................................................. 55
Trauma Symptom Inventory (TSI) ................... ......... ........................ 56
S u m m a ry ................................. ................... ........ ...... ....... ............... 5 7
Lim stations ........................... .................. 58
Data Collection Procedures .............. ............. ............ ............... 58
D ata A nalysis............................................... 58
4 R E S U L T S .................................................................................................. 6 3
Research Questions ................ ......... ......... ......... 63
Hypotheses .................................................... 64
Participant Descriptive Information ......... ......... .................. 65
Data Analyses and Results ......... .. ........................ 66
Limitations of the Study .................................................................. ......... ...... ........ 79
5 DISCUSSION ................. ......... ................. 89
Summary of Significant Findings ................. .............. ........ 89
Implications for Theory...... .......................... ......... 90
Implications for Practice.............................. ............... 92
Future Research ................. ........ ................ 95
S u m m a ry ................................................................................................... 9 9
A INFORMED CONSENT .................................... ........ 101
B RECRUITMENT EMAIL ..................... ............... ........ 102
C DEMOGRAPHIC FORM .................................................. 103
D THE AFRICAN SELF-CONSCIOUSNESS SCALE (SHORT-FORM) ................... 106
E MODIFIED GAY IDENTITY QUESTIONNAIRE ............ .................. 109
F TRAUMA SYMPTOM INVENTORY ....................................... 115
R E FE R E N C E S .............................. .............. ...... 116
BIOGRAPHICAL SKETCH ..................... ........ ................. 133
Table page
2.1 African American culture ...................... ...................... 51
3.1 African self-consciousness scale Four factors.............. ................................ 60
3.2 Stages of homosexual identity formation................................. ...... ............ ... 61
3.3 Trauma symptom inventory subscales ........................................ 62
4.1 Distribution of participants by age range ................................. ...... ............ ... 82
4.2 Distribution of participants by highest level of education completed................... 82
4.3 Distribution of participants by current occupation .................. ...... ............ 83
4.4 Distribution of participants by income level.............................. ... ............ 83
4.5 Descriptive statistics ........ .......... ......... ............... ....... ........ 84
4.6 Results of Pearson correlation analyzing the relationship between African
self-consciousness and gay identity ..... .................... ............. 85
4.7 Results of multiple regression of ethno-cultural identity, gay identity and
hyperarousal .............................. ...................... 86
depression ............... .. .......... ........ ................. .............. 86
intrusive experiences .......... .......... .......................... ............... 86
4.10 Results of multiple regression of ethno-cultural identity, gay identity and
defensive avoidance ........... ........... ......................... ............... 87
4.11 Results of multiple regression of ethno-cultural identity, gay identity andn
d is s o c ia tio n .................................................. ................. 8 7
sexual concerns ...................................... ........... 87
dysfunctional sexual behavior................. ............. .. ............... 88
GIQIDCONF/COMP
GIDTOL
GIDACC
GIDPRIDE
GIDSYN
African self-consciousness
Gay identity confusion and comparison
Gay identity tolerance
Gay identity acceptance
Gay identity pride
Gay identity synthesis
Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy
Chair: Cirecie West-Olatunji
Major: Mental Health Counseling
The purpose of study was to examine the relationship between ethno-cultural
identity, sexual orientation and traumatic stress in adult African American gay men.
These constructs were measured by the African Self-Consciousness Scale Short
Form, the Modified Gay Identity Questionnaire, and select subscales of the Trauma
Symptom Inventory. Quantitative methods were employed. Data was collected by
surveying a national sample of adult African American gay men via snowball sampling
through an electronic mail link to the survey. Pearson correlation and multiple
regression analysis were used to analyze the data. Results revealed no statistically
significant relationship between African self-consciousness and gay identity. However,
statistically significant positive relationships were found between gay identity
acceptance and traumatic stress and gay identity pride and traumatic stress. These
results have important implications for understanding identity development in African
American gay men.
This chapter introduces the parameters of this study including the population
under investigation. An explanation of the problem is provided along with research
questions, hypotheses as well as the significance and limitations of this study.
Population and Parameters
This study investigated the relationship between adult (18 years old or older)
African American gay men's ethno-cultural identity and sexual orientation identity and
examined the effects that this relationship has on their experience of traumatic stress.
This study uses a culture-centered approach to better explore the compounded effect of
negotiating ethno-cultural and sexual orientation identities. Further, the culture-centered
focus of this study attempts to reveal unequal power relations and understand the
impact of systemic oppression in African American gay men's identity development
(Tillman, 2002).
Major advances in civil rights, particularly for African Americans have created a
social environment that is more accepting of cultural differences, yet many ethno-
culturally diverse people continue to be discriminated against or marginalized in their
daily experiences (Bryant-Davis & Ocampo, 2005; Carter, 2007; Friedman & Marsella,
1996; Utsey, Bolden & Brown, 2001). Similarly, despite being de-pathologized by the
American Psychiatric Association in 1973, homosexuality remains stigmatized in many
societies around the world including the United States (Crawford et al., 2002; Israel &
Selvidge, 2003; 2001; Morin & Rothblum, 1991; Savin-Williams, 1994). It has been
suggested that belonging to a group whose identity is stigmatized can result in chronic
stress and also lead to mental disorders (Berg, Mimiaga, & Safren, 2008; Mays &
Cochran, 2001; Carter, 2007; Huebner & Davis, 2007; Israel & Selvidge, 2003; Meyer,
2003; Savin-Williams, 2001). Moreover, belonging to multiple stigmatized identity
groups can be especially challenging and even debilitating (Fukuyama & Ferguson,
2000; Greene, 2001). This is evidenced in African American gay men's efforts to
negotiate their ethno-cultural and sexual orientation identities.
Many African American gay men experience prolonged stress in their efforts to
integrate their ethno-cultural and sexual orientation identities (David & Knight, 2008;
Hatzenbuehler, Nolen-Hoeksema, & Erickson, 2008; Huebner & Davis, 2007; Meyer,
1995; Rosario, Rotheram-Borus & Reid, 1996; Zamboni & Crawford, 2007). This stress
is in large part due to the homophobia they face in society, but particularly in the African
American community (Boykin, 2005; Brown, 2005). Other contributing factors include
the lack of acceptance from their families (Carpineto, Kubicek, Weiss, Iverson & Kipke,
2008; Wise, 2001), the discrimination by religious institutions (Griffin, 2006; Miller, 2007)
as well as their experiences of marginalization in the predominantly White, gay
community (Greene, 2001; Parks, 2001).
African American gay men may experience the stress of not completely belonging
to either their ethno-cultural group or their sexual orientation group leaving them at risk
for isolation, feelings of estrangement, and increased psychological vulnerability
(Martinez & Sullivan, 1998). Additionally, they are often subjected to emotional,
psychological and physical violence from those who do not approve of or understand
their identity expression (Huebner, Rebchook & Kegeles, 2004; Meyer, 1995). Identity
development of African American gay men is further complicated by: (a) their
internalization of mainstreamed pejorative views of LGBT concerns that inhibit their
expression of identity and (b) prevailing and systemic heterosexist attitudes in society
that create ecosystemic obstacles to identity integration (Frable, 1997; Greene, 2001).
Inspired by Social Identity Theory (Tajfel, 1978) that addressed the relationship of
the individual to the group and the origins of intergroup conflict, models that explain
identity development among ethnic and racial groups (Cross, 1995; Helms, 1995;
Phinney, 1992) and sexual minorities (Cass, 1979; Minton & McDonald, 1984; Troiden,
1979) describe stages that individuals move through in achieving a positive ethnic or
gay identity. Although these models have furthered the understanding of identity
development, they have been criticized for suggesting that growth is linear and bound
by well-defined categories that are uncharacteristic of the human experience (Martinez
& Sullivan, 1998). Moreover, the current conceptualization of these models lack
sufficient integration of multiple identities and overlook the stress that is associated with
the developmental process. As such, they tend to over-generalize and can be
inadequate when shaping an understanding of how African American gay men
formulate their identities (Fukuyama & Ferguson 2000).
It has been suggested that the stressors that African American gay men
experience have a cumulative effect and often result in symptoms such as intrusive
recollections of racist and homophobic events, psychic numbing as a way to manage
their emotions and hypervigilance about their safety (DiPlacido, 1998; Meyer, 2003).
This chronic stress often leads to anxiety, depression, suicidal ideation as well as an
increase in addictive behavior (Israel & Selvidge, 2003; Savin-Williams, 2001). This
symptomatology describes the diagnostic criteria for posttraumatic stress disorder
(PTSD) as outlined in the Diagnostic and Statistical Manual of mental disorders, 4th
edition, TR (DSM-IV-TR) (American Psychiatric Association, 2000). However,
experiences of discrimination including racism and homophobia are not included in the
DSM-IV-TR as precipitants to traumatic stress.
The DSM-IV-TR is used by mental health professionals to diagnose and treat
mental disorders (Eriksen & Kress, 2006; Mead, Hohenshil & Kusum, 1997; Seligman,
1999). PTSD was added to the DSM in 1980 (Halpern & Tramontin, 2007; Scaer, 2001).
The addition of this diagnostic category legitimized certain events as traumatic
(Burstow, 2005), informed how trauma should be understood (Becker, 1995; Danieli,
1998; Herman, 1997), and guided mental health treatment for traumatized individuals
(Becker; Danieli; Eriksen & Kress; Herman). In addition, the inclusion of PTSD in the
DSM enabled mental health providers to receive insurance reimbursement for the
treatment of trauma (Burstow; Cosgrove, 2005; James & Gilliland, 2005; McLaughlin,
Scholars have criticized the DSM-IV-TR's definition of traumatic stress for being
too narrow. Herman, (1992) argued that women who were victims of prolonged
repeated trauma through domestic violence, experienced symptoms of traumatic stress.
Researchers investigating race-based stress also challenged the DSM-IV-TR diagnostic
criteria for traumatic stress asserting that repeated exposure to race-based
discrimination often results in the development of traumatic stress syndrome (Bryant-
Davis & Ocampo, 2005; Carter, 2007; Friedman & Marsella, 1996; Utsey, Bolden &
Brown, 2001). Although these experiences meet the criteria for traumatic stress, they
are not conceptualized in this manner. Instead, those who experience traumatic stress
in ways that do not meet the DSM-IV-TR's narrow definition are further marginalized
and their presenting problems are pathologized. Furthermore, their access to trauma-
specific mental health services is limited because their presenting problems do not meet
the DSM-IV TR criteria for traumatic stress (Bryant-Davis & Ocampo, 2005; Carter,
2007; Cosgrove, 2005; Friedman & Marsella, 1996; Herman, 1992; Utsey, Bolden &
Brown, 2001).
The purpose of this study was to investigate the relationships between ethno-
cultural identity, sexual orientation identity and traumatic stress in African American gay
men. A review of the literature related to African American culture, gay identity
development and traumatic stress theory is provided in chapter 2. Chapter 3 outlines
the methods that were used in this study including procedures for data collection and
analysis. Chapter 4 provides the results of this study and chapter 5 offers a discussion
of the findings.
1. What is the relationship between ethno-cultural identity and gay identity in African
American men?
2. What is the relationship between ethno-cultural identity, gay identity and
hyperarousal in African American men?
depression in African American men?
intrusive experiences in African American men?
defensive avoidance in African American men?
dissociation in African American men?
7. What is the relationship between ethno-cultural identity, gay identity and sexual
concerns in African American men?
dysfunctional sexual behavior in African American men?
Null hypotheses developed for each of the research questions are as follows:
Hol: There will be no significant relationship between ethno-cultural and gay
identities in African American gay men.
Ho2: There will be no significant relationship between ethno-cultural
identity, gay identity and hyperarousal in African American men.
identity, gay identity and depression in African American men.
identity, gay identity and intrusive experiences in African American men.
identity, gay identity and defensive avoidance in African American men.
identity, gay identity and dissociation in African American men.
identity, gay identity and sexual concerns in African American men.
identity, gay identity and dysfunctional sexual behavior in African American
* Bisexual A term generally applied to individuals who experience emotional,
relational, and sexual attraction that is not limited by gender (Rust, 2001).
* Ethno-Culture -A group's individual and collective ways of thinking, believing,
and knowing, which includes their shared experiences, consciousness, skills,
values, forms of expression, social institutions, and behaviors (Tillman, 2002).
* Gay A term generally applied to men who experience emotional, relational, and
sexual ties to other men (Gonsiorek, 1995).
* Homophobia Negative feelings, attitudes, actions or behaviors toward people
who are or perceived as lesbian, gay, bisexual or transgender (Kitzenger, 1996).
* Lesbian A term generally applied to women who experience emotional,
relational, and sexual ties to other women (Brown, 1995).
* MSM Men who have sex with men Refers to all men who have sex with men
regardless of how they identify themselves (gay, bisexual, heterosexual) (CDC,
* Queer A term that is embraced by individuals who do not identify with traditional
labels for gender identity or sexual orientation (Carroll, 2010).
* Race Refers to social demographic rankings used to distribute social rewards,
economic resources, access, and opportunity (Frable, 1997).
* Racism The belief that the characteristics and values of one's racial group are
superior to that of other racial groups which is reflected in differential treatment,
promotion of stereotypes, and limited access and opportunity (Carter, 2007).
* Stress A person-environment, biopsychosocial interaction, wherein
environmental events are appraised first as either positive or unwanted and
negative. If negative, mechanisms to cope and adapt are identified. When coping
and adaptation fail, stress responses are experienced (Carter, 2007).
* Traumatic Stress Emotionally painful events that are negative and out of one's
control that result in avoidance, arousal, intrusion, anxiety and depression (Carter,
* Transgender An umbrella term for persons who have a gender identity that is
not traditionally associated with their biological sex (Carroll, 2010).
Significance of the Study
By exploring the relationship between ethno-cultural and sexual orientation
identities and traumatic stress, this study provides a clearer understanding of the unique
experiences of African American gay men and the role of identity development in the
presence of traumatic stress symptoms. This research may also serve as a foundation
for culturally relevant lesbian, gay, bisexual, and transgender (LGBT) theory
development. Specifically, this study attempts to expand knowledge of identity
development, traumatic stress, and research methodologies to investigate the
experiences of African American gay men.
This study contributes to the literature on gay identity development by illuminating
the experience of African American gay men. The majority of studies on this topic have
used qualitative research methods. Although qualitative approaches allow the specific
voices of the participants to be heard, they are limited in their ability to generalize
findings to the larger population. By utilizing quantitative research methods, this study
surveys a broader audience and gives voice to the larger African American gay
Limitations of the Study
While this study will reveal the relationship between ethno-cultural, identity, sexual
orientation identity and traumatic stress in African American gay men, it will not capture
all of the factors that may influence that relationship. For example, the ways in which
African American gay men negotiate their identities in different environments such as
the workplace and social settings will not be addressed in this study. Having openly gay
family members may influence the identity development in African American gay men;
however, this factor is not included as a variable in the research design.
Purposeful, convenience, and snowball sampling may limit the diversity of the
sample by selecting individuals who participate in formal support groups and those who
belong to certain social networks. Use of electronic mail to link to the survey is also a
limitation in that it excludes potential participants who either do not have access to this
technology or are uncomfortable with its use.
The purpose of this chapter is to provide an overview of the literature relevant to
this study. Literature related to the following topics will be presented: (a) African
American culture, (b) gay identity, (c) intersectionality of identity, (d) traumatic stress,
and (e) traumatic stress in African American gay men.
Further Delineation of the Problem
In 1973, the American Psychiatric Association depathologized homosexuality
stating that it was no longer considered a psychiatric disorder reflecting a pathological
development process (Morin & Rothblum, 1991). This change was the result of research
findings as well as the persistent pleas from professionals and activists. Despite this
major advancement, homosexuality remains stigmatized leading to higher rates of
mental health problems such as major depression, generalized anxiety, substance
abuse and suicidal ideation among lesbian, gay and bisexual people (Berg, Mimiaga, &
Safren, 2008; Mays & Cochran, 2001).
Using data from the MacArthur Foundation National Survey of Midlife
Development in the United States (MIDUS), Cochran, Sullivan, and Mays (2003)
observed that gay and bisexual men were three times more likely to meet DSM-IV-TR
criteria for major depression and 4.7 times more likely to meet criteria for panic disorder
than heterosexual men. Further, gay and bisexual men were more likely than
heterosexual men to meet criteria for two or more disorders.
Differences in mental health disorders among women in this study were less
common than those among men. Generalized anxiety disorder was the only disorder
that appeared more prevalent among lesbian and bisexual women than among
heterosexual women. However, like the gay and bisexual men, they were more likely
than heterosexual women to be diagnosed with two or more disorders. These findings
are consistent with those using data from other population-based studies such as the
National Household Survey on Drug Abuse (Cochran & Mays, 2000) and the National
Comorbidity Survey (Gilman et. al., 2001) that have found higher prevalence of mental
disorders among homosexually active men and women than with heterosexually active
men and women. These studies suggest that the increase in the prevalence of mental
disorders in homosexual men and women may be attributable to the stress of coping
with social stigmatization. Other studies addressing the mental health concerns of LGBT
people focusing on anti-gay victimization (Comstock, 1989; D'Augelli, 1992; Garnets,
Herek et.al., 1997; Herek, 1993; Otis & Skinner, 1996), substance abuse (Berg,
Mimiaga, & Safren, 2008; Cochran, et. al., 2004; Stall, et. al., 2001; Greenwood, et. al.,
2000), suicide (Fergusson, Horwood, & Beautrais, 1999; Garafalo et. al., 1999), and
involvement in the mental health service delivery system (Cochran, Sullivan, & Mays,
2003; Walters, Simoni, & Horwath, 2001) provide further evidence of the negative
impact of marginalization on this vulnerable population.
Studies show that peer and stranger-based anti-gay victimization including verbal
assault, threats, and physical violence is a common experience for the LGBT population
(Comstock, 1989; D'Augelli, 1992; Garnets, Herek et.al., 1997; Herek, 1993; Otis &
Skinner, 1996). Lesbian and gay youth in particular report experiencing familial abuse,
harassment, and maltreatment upon disclosing their sexual orientation (D'Augelli, 1998;
Savin-Williams, 1994). These studies found that survivors of bias-motivated
victimization suffered from increased levels of depression, anxiety, and anger and they
also evidenced symptoms of traumatic stress.
Openly lesbian and gay college students also report frequent experiences of
verbal abuse and being threatened with violence from other students as well as overt
and subtle discrimination from faculty, staff, and administrators (D'Augelli, 1992). In
addition to the ongoing concern about their safety, some students admitted to changing
their lives to avoid harassment, abuse, and violence. These changes included avoiding
certain locations, avoidance of openly lesbian or gay people, and developing a distorted
or restricted presentation of self (denying that they are involved in a romantic
relationship or suggesting that they are dating opposite sex partners). While there are
significant psychological consequences for those students who are victimized by anti-
gay violence, the costs for those who hide their sexual orientation because of fear of
discrimination are just as profound including emotional stresses, social difficulties, and
academic problems (D'Augelli, 1992).
Studies suggest that many LGBT people use illicit substances at greater
frequencies than their heterosexual counterparts. It has been reported that heavy or
problematic use of substances is related to early adverse life events such as parental
substance abuse and trauma, connection to the gay subculture where bars and
nightclubs serve as safe socializing venues, and experiences of marginalization,
discrimination, and victimization (Berg, Mimiaga, & Safren, 2008; Cochran, et. al., 2004;
Stall, et. al., 2001; Greenwood, et. al., 2000). In a study investigating co-morbidity in a
sample of lesbians, Bostwick, Hughes, and Johnson (2005) found a significant
relationship between both lifetime and discrimination-related depression and alcohol
dependence symptoms. McKirnan et. al., (2006) found that for young men who have
sex with men (MSMs), increased tobacco use was partially attributable to psychosocial
variables such as depression, having few safe social outlets, and limited access to
healthcare. Finally, gay and bisexual men report using methamphetamine to increase
sensory experiences during sexual activity and to escape unpleasant emotions, to
combat isolation and loneliness and to avoid social conflict (Halkitis, Parsons, & Wilson,
Suicide is cited as the third leading cause of death among Americans aged 15-24
(Anderson, 2002). Studies show that lesbian, gay, bisexual identity and questioning of
one's sexual orientation is an independent predictor of suicide attempts particularly
among adolescents (Fergusson, Horwood, & Beautrais, 1999; Garafalo et. al., 1999).
LGBT youth have consistently reported having thoughts of suicide and attempting
suicide at three times the rate of their heterosexual peers (McDaniel, Purcel, &
D'Augelli, 2001; D'Augelli, Hershberger, & Pilkington, 2002). Studies reveal that
hopelessness, hostility, low social support from family and friends, poor self-concept,
psychological and physical abuse, and an overall lack of a sense of belonging are
positively correlated with suicidal ideation in LGBT youth (Savin-Williams & Ream,
2003; Rutter, 2007; Rutter & Soucar, 2002; ).
The challenges that LGBT people face in their involvement in the mental health
services delivery system is gaining increased attention in empirical research. The bias
that LGBT people face in the mental health service delivery system often results in
misdiagnosis, ineffective interventions, and underutilization of services (Cochran,
Sullivan, & Mays, 2003; Walters, Simoni, & Horwath, 2001). Luckstead, (2004) provides
a summary of a multi-year research project commissioned in 1997 by the Substance
Abuse and Mental Health Services Administration (SAMHSA) and the federal
Department of Health and Human Services (DHHS) regarding the experiences, needs,
and recommendations of LGBT people living with serious mental illnesses. This study
revealed that little attention was given to LGBT issues in community mental health. In
addition, many mental health providers held homophobic attitudes and promoted
stereotypes about LGBT people. Discussions of healthy sexuality were non-existent and
sexuality was only talked about in terms of problems such as unwanted pregnancies
and sexually transmitted infections. This study further revealed that gay-affirmative
therapists and programs generally did not provide service to people with serious mental
illnesses. Bisexual and transgender identities were completely misunderstood, which
led to further marginalization of members of these groups (Luckstead, 2004).
Additional findings from the SAMHSA and DHHS study that are consistent with
other studies on the utilization of mental health services by LGBT people include
marginalization and harassment by peers and the tendency for therapists and programs
to minimize or overemphasize LGBT identity as the presenting problem. In addition,
mental health practitioners are typically unaware of the extent to which their clients are
impacted by family conflict or abuse that is related to their LGBT identity, as a result,
they often pathologize adaptive behavior such as the formation of kinship bonds among
unrelated individuals also known as fictive kinship (Chatters, Taylor, & Joyakody, 1994).
Furthermore, mental health practitioners typically have little knowledge of affirmative
LGBT community resources that can provide additional support for their clients
(Matthews & Selvidge, 2005; Walters, et. al., 2001). Studies confirm that LGBT clients in
the mental health system need special attention that is relevant to their needs. They
also stress the importance of creating an environment that is free from bias and
harassment, where staff is caring and affirmative, and where there is a healthy
expression and discussion of sexuality (Berg, Mimiaga, & Safren, 2008; Luckstead,
2004; Matthews & Selvidge, 2005).
Previous attempts to address these specific mental health concerns have focused
on the need for gay people to develop a positive gay identity where coming out
(acknowledging one's gay identity to significant others) is considered optimal for their
mental health (Fassinger, 1991; Floyd & Bakeman, 2006; Halpin & Allen, 2004;
McDonald, 1982; Rosario, et. al., 2001; Rowen & Malcolm, 2002). These studies used
gay identity development models as their theoretical framework (Cass, 1979; Minton &
McDonald, 1984; Troiden, 1979). While these models have been helpful in
understanding gay identity development in general, they are limiting because they focus
primarily on White, middle-class men and overlook the influence of culture in the identity
development process. Moreover, these models fail to address the complexity of coping
with multiple oppressed identities.
Managing multiple identities is a task that is faced by various culturally diverse
LGBT individuals, including ethnically diverse people (Chan, 1995; Fukuyama &
Ferguson, 2000; Garrett & Barret, 2003), women (Brown, 1995), the elderly (Reid,
1995), and those with disabilities (Whitney, 2006). Members of these groups are often
forced to develop ways of negotiating their identities that exist outside the mainstream
(Fukuyama & Ferguson; Loiacano, 1989). Like many LGBT people, they may keep their
sexual orientation hidden, pretend to be heterosexual, or choose to be asexual. They
may also avoid discussion of romantic relationships or use opposite sex gender
pronouns when referring to romantic interests or partners. In addition to these coping
strategies, culturally diverse LGBT people have the task of managing other oppressed
identities such as race, gender, class and ability. They respond to the shifting salience
of identity depending on the social, familial, and community context and are forced to
cope with being invisible members within specific social reference groups in order to
receive the benefits of group membership (Fukuyama & Ferguson). For example, they
may minimize their sexual orientation identity in order to receive support that buffers
racism. This is especially relevant for African American gay men.
The challenges that African American gay men face in identity development have
been documented in the literature that addresses homophobia in the African American
community (Boykin, 2005; Brown, 2005; Carpineto, Kubicek, Weiss, Iverson & Kipke,
2008; Wise, 2001) and racism in the gay community (Greene, 2001; Parks, 2001). The
literature also suggests that social stigma, discrimination and victimization such as
being cut off from their families, being discriminated against in their communities and
facing potential violence (Greene, 2001; Parks, 2001; Rosario, Schrimshaw & Hunter,
2004), results in greater prevalence of depression, substance abuse and HIV infection
rates among this population in comparison to White gay and African American
heterosexual men (Crawford, Allison, Zamboni & Soto, 2002; Hatzenbeuhler, Nolen-
Hoeksema & Erickson, 2008; Huebner & Davis, 2007; Israel & Selvidge, 2003; Savin-
Williams, 2001). While all LGBT people, regardless of cultural identity are stigmatized in
society (Crawford et al., 2002; Israel & Selvidge, 2003; Savin-Williams, 2001), facing
multiple oppressions exacerbates stress levels and further complicates the identity
development process (Crawford et al.).
Multicultural counseling theory (MCT) (Pedersen & Ivy, 1993) highlights the
importance of considering the sociopolitical and environmental context of clients'
concerns in case conceptualization, diagnosis and treatment. MCT emphasizes
exploration of multicultural constructs, and mandates competencies that address
counselor attitudes, knowledge, and skills (Sue, Arredondo, & McDavis, 1992). Despite
the profession's emphasis on multicultural competence over the past three decades,
counselors continue to evidence difficulty in effectively conceptualizing and intervening
with clients who experience multiple forms of systemic oppression, such as racism,
classism, homophobia, and sexism (Arredondo, Tovar-Blank, & Parham, 2008). The
concept of intersectionality addresses the nuanced complexities of multiple identities
that cannot be sufficiently captured using conventional identity development models,
such as racial (Helms, 1995; Sue & Sue, 2008) and gay/lesbian (Cass, 1979; Minton &
McDonald, 1984).
Previous attempts to explain identity development among African American gay
men have illuminated the complexities of negotiating their ethno-cultural and sexual
orientation identities (Crawford et al., 2002; Frable, 1997; Greene, 1997; Parks, Hughes
& Matthews, 2004; Rosario, Schrimshaw & Hunter, 2003; Salazar & Abrams, 2005;
Wise, 2001). While these efforts have provided significant insight into the challenges
inherent in coping with intersecting identities, they have not situated this complex
developmental task within the context of traumatic stress. As a result, they have
overlooked the influence that stress has on African American gay men's health and
well-being and their ability to successfully negotiate their intersecting identities. In
addition, the psychological distress that African American gay men experience is often
misdiagnosed in the mental health system, the sociopolitical realities of their lives are
overlooked, and they are further marginalized (Cosgrove, 2005).
Recent studies addressing stress in gay men have found significance between
stress and coping patterns (David & Knight, 2008); HIV risk behavior, substance abuse
and depressive symptoms (Haatzenbuehler, Nolen-Hoeksema & Erickson, 2008);
mental health problems (Meyer, 2003); and self-esteem and problem behaviors
(Rosario, Rotheram-Borus & Reid, 1996). Studies have also shown that stress
contributes to sexual problems in gay men such as communication difficulties,
performance concerns (erectile and orgasmic disorders), sexual knowledge deficits, and
negative sexual attitudes (Bancroft, et. al., 2005; Standfort & deKeizer, 2001; Zamboni
& Crawford, 2007). Despite their significance, these studies failed to adequately
address the influence of culture in the development of stress and in stress coping
Traumatic stress theory has been useful in understanding the psychological,
physiological and emotional impact of traumatic events. Furthermore, it explains the
sequelae that manifest in individuals post-trauma. The DSM-IV-TR (American
Psychiatric Association, 2000) describes the symptomatology of traumatic stress by the
diagnostic criteria for posttraumatic stress disorder (PTSD). PTSD is characterized by
exposure to a single traumatic event in which a person experiences or witnesses an
event that threatens death or serious injury and the person's response involves intense
fear, helplessness or horror.
Scholars have criticized these criteria as too narrow and have suggested
broadening the definition of traumatic stress to include the repeated exposure to
stressors and traumatic events such as domestic violence (Herman, 1992) and racism
(Bryant-Davis & Ocampo, 2005; Carter, 2007; Friedman & Marsella, 1996; Utsey,
Bolden & Brown, 2001). Similarly, the definition of traumatic stress may be extended to
include the reaction to heterosexism and homophobia that LGBT individuals experience
from rejection and discrimination for those who live openly and through self-
concealment and emotional inhibition for those who do not (DiPlacido, 1998). This
review of the literature focuses on the ways in which African American gay men's
experiences of racism and homophobia compound their experience of traumatic stress.
African American Culture
In order to understand African American culture, it is important to differentiate race
and culture. Race is a socially constructed phenomenon that uses skin color to
determine social privilege and access to resources. Culture on the other hand, can be
defined as a group's collective way of knowing that involves beliefs, shared
experiences, social institutions, values, forms of expression and behaviors (Tillman,
An explanation of African American culture in the literature began in the 1960s
and early 1970s when African American psychologists (Azibo, 1983; Nobles, 1976;
White, 1972) began writing about the Afrocentric worldview and how it differed from the
Eurocentric worldview. Prior to these works, African Americans were marginalized in
scientific literature and depicted by scientists as intellectually and morally inferior to
Whites. Comparative studies in physical anthropology, the theory of Eugenics, The Bell
Curve, and the Binet Intelligence Scales promoted the myth of African American
inferiority; which justified racism and supported continued oppression (Guthrie,
1976/1998). Over the past 20 years, African American scholars have advanced the
understanding of African American culture through the field of African American studies
and the study of African American psychology (Bellgrave & Allison, 2006).
Before African American psychology was recognized as a discipline, White
(1972) challenged the use of traditional theories to study African Americans. He
asserted that the incorrect use of traditional theories to study African Americans
resulted in the weakness-dominated and inferiority-oriented conclusions. He believed
that African Americans should define their paradigms.
In his writings on African philosophy, Nobles, (1980/1991/ 2004) illuminated the
ways in which African perspectives of religion, unity, time, death/immortality, and kinship
were maintained by African Americans. Nobles also advanced the understanding of
African American culture through his writings on the conceptualization of the self in
which he states that the individual self cannot exist independently from the collective
self.
Akbar, (1991) described mental conditions that result from African Americans'
attempts to function in an oppressive and alien environment. His descriptions of
disorders such as alien-self disorder, behaving in ways that contradict one's natural
disposition and anti-self disorder, identification with the oppressor and hostility toward
one's own cultural group furthered the discussion of the effects of oppression on the
lived experience of African Americans. His other works address holistic human
psychology and understanding the unique psychological functioning of African
Americans.
Contributing to the conversation on culturally appropriate ways to view African
Americans, Azibo, (1989) developed the Azibo nosology, a system for diagnosing
diseases and disorders among African Americans with psychological problems. A
departure from the DSM-IV-TR, this system addresses disorders that may exist among
African Americans due to cultural, historical, and societal factors. Questions have been
raised about the applicability of this nosology and whether it can be used in clinical
Kambon, (1998) contributed to the understanding of African American culture
through his study of the components and correlates of the African personality. He
developed the African Self-Consciousness Scale (Baldwin & Bell, 1985) which assesses
how African Americans feel about African/African American culture and issues related to
racism. Findings from his research suggest that family orientation, commitment to the
African American community, and emotional and intellectual stimulation characterize
individuals with a high Africentric cultural consciousness (Hamlet, 1998).
Promoting an appreciation for human diversity and social change, Myers' (1988)
writings on an optimal worldview examine the oppression of African Americans and
other marginalized groups. Her theory encourages investigation of both human behavior
and social roles. Myers notes that one's ontology is influenced by how the world is
perceived. She suggests that the Eurocentric worldview places importance on
individualism and materialism and views external knowledge as the basis of all
knowledge. She contends, however, that the African worldview that is based on the
ideas that reality is both spiritual and material, communalism and collectivism are
valued over individualism, and self-knowledge is the foundation for all knowledge is an
optimal worldview.
Through their various contributions, these scholars have advanced the
understanding of African American culture. This culture is characterized by significant
kinship bonds including fictive kin (non-relatives who are embraced as family) (Chatters,
Taylor, & Joyakody, 1994), resilience and a strong spiritual/ religious orientation (Sue &
Sue, 2008). In addition, authenticity, balance, communalism (focus on the
interrelatedness of people), collectivism (priority given to the group rather than the
individual), cooperation, creativity, sensitivity to affect and emotional cues, harmony,
and unity are values that shape the African American experience (Kambon, 1998;
Parham, White & Ajamu, 2000). A description of the dimensions of African American
culture is provided in Table 2.1.
It is important to note that many African Americans form their identities from
elements of both Afrocentric and Eurocentric cultures, which is in part, the result of
living in a multicultural society (Bellgrave & Allison, 2006). However, racism and
systemic oppression have had a significant negative impact on the racial/cultural identity
of African Americans (Carter, 2007). Racial identity development models purported by
Cross, (1971, 1991, 1995) and Helms, (1990), describe psychological and emotional
stages that African-Americans move through toward acceptance of their racial/cultural
identity. This process involves first denying their Blackness and aligning with Whites,
confronting that denial, embracing an ethnocentric worldview, displaying a greater
sense of acceptance of self and others, and finally, using their personal identities as
agents for change. According to Phinney, (1991), racial/cultural identity achievement is
associated with self-esteem and adjustment. In African American culture, achievement
of positive racial/cultural identity is often supported by intergenerational family units that
provide emotional, psychological, social and financial resources that aid them in coping
with systemic oppression (Nobles, 1997; Sudarkasa, 1997).
Achievement of a positive racial/cultural identity also incorporates a state of
mental health that is free of psychological ailments and supports an individual's growth
and ability to reach their full potential (Parham, White & Ajamu, 2000). Psychologically
healthy African Americans interpret the African American ethos, the emotional bond
created by shared cultural heritage and life experiences into their lives (Parham, White
& Ajamu, 2000). Further, psychologically healthy African Americans are resourceful and
enterprising in their approach to life and are grounded in their African American makeup
(Parham, White & Ajamu, 2000).
Gay Identity
Often referred to as the "hidden minority" (Atkinson & Hackett, 1988), gay
individuals continue to be marginalized in society. Consequently, they may encounter a
myriad of mental health concerns, such as chronic stress, affective disorders, substance
abuse, eating disorders, and suicidal ideation (Israel & Selvidge, 2003; Savin-Williams,
2001). Moreover, hostility and victimization in schools (Parks, 2001; Stone, 2003),
informal heterosexism in the workplace (Lyons, Brenner & Fassinger, 2005), and harsh
judgments by traditional Western religious organizations (Barret & Barzan, 1996) can
impede identity development.
Several researchers have developed theoretical models that describe identity
formation among sexual minorities (Cass, 1979; Coleman, 1981; Dank, 1971; Hencken
& O'Dowd, 1977; Lee, 1977; Minton & McDonald, 1984; Plummer, 1975; Troiden,
1979). In general, these models lay out stages that lead to an eventual positive gay
identity. They are marked by a general sense of feeling different, an awareness of
same-sex attraction, individual realization that his or her attraction can be labeled as
homosexual, and an eventual acceptance of a gay identity that is punctuated by
"coming out" (disclosure of one's sexual identity) to significant others.
Cass (1979) developed one of the earliest and most cited models of homosexual
identity development. This model describes six stages of developing a positive
homosexual identity. They include: (1) identity confusion, feeling different from peers
and in denial of one's attraction to the same sex; (2) identity comparison, break in denial
and beginning to examine the differences between self and heterosexuals, increase in
feelings of social alienation; (3) identity tolerance, beginning to make a commitment to
self-identify as homosexual, continues to present as heterosexual, seeks social support
within the gay community; (4) identity acceptance, embracing homosexual identity,
immersion into the gay community, developing sense of pride; (5) identity pride; loyalty
and satisfaction in homosexual identity, strong sense of pride; and (6) identity
synthesis, emotional, mental, spiritual and sexual integration, develops holistic view of
Like Cass, Coleman (1981) published a linear five stage homosexual identity
development model that focused on the stages of the coming out process. During this
time, coming out was considered to be one of the most important aspects in developing
a positive gay identity and gaining social acceptance. The five stages of this model
included: (1) pre-coming out, a preconscious awareness of homosexual identity; (2)
coming out, beginning to tell others about one's homosexual identity; (3) exploration,
social networking and partner seeking within a homosexual context; (4) first relationship,
seeing one's self as being able to carry out a loving homosexual relationship; and (5)
integration, characterized by sexual exploration and the establishment of relationships.
Minton and McDonald (1974) described a three-stage process that involves
progression from an egocentric interpretation of homoerotic feelings (awareness of
one's uniqueness) to an internalization of the normative assumptions about
homosexuality (heightened awareness of possibly possessing a homosexual identity
and the corresponding awareness of the societal attitudes about homosexuality) to a
stage where societal norms are critically evaluated and a positive gay identity is
achieved (separation of particular norms from general principles upon which all norms
are based).
Troiden's (1979) ideal-typical model of homosexual identity formation differed from
the linear stage models in that it described individual movement through the stages of
identity development as a horizontal spiral that progressed up, down, back and forth.
The stages included: (1) sensitization, a prepubescent stage that is marked by feelings
of marginalization and being different from peers; (2) identity confusion, reflection on the
idea that feelings and behavior could be regarded as homosexual, inner turmoil and
anxiety increase; (3) identity assumption, self-definition as homosexual, identity
tolerance and acceptance, regular association with other homosexuals and involvement
in the homosexual subculture; and (4) commitment, self acceptance of homosexual
identity and entering a same-sex love relationship.
Identity development models are useful in understanding certain developmental
tasks that individuals may encounter. Both racial and sexual identity development
models receive criticism for suggesting that growth is linear and bound by well-defined
categories that are uncharacteristic of human development (Martinez & Sullivan, 1998).
Racial identity development models fail to acknowledge the role of sexual orientation
and homophobia in identity formation. Homosexual identity development models
overlook the influence of race and racism in the evolving gay identity and they only
recognize one's positive gay identity after acknowledgement of one's sexual orientation
to significant others (Martinez & Sullivan, 1998). Fukuyama and Ferguson (2000) point
out that a primary limitation of exclusively recognizing single identities is that individuals
who embrace multiple identities are often invisible members within specific social
reference groups. Furthermore, one's salience of identity, the identity that emerges into
one's awareness, often depends on one's social, familial, and community context.
Theories that do not acknowledge multiple cultural identities obscure the complexity of
identity integration. In response to increasing criticism of these identity development
models, scholars called for consideration of multiple identities among the LGBT
population. This identified gap led to conversations about the intersectionality of identity
(Fukuyama & Ferguson; Greene, 1997; Icard, 1996; Israel & Selvidge, 2003; Savin-
Williams, 2001).
Intersectionality of Identity
Gay African Americans often experience exclusion from the mainstream LGBT
culture and from their ethnic and familial communities, leaving them at risk for isolation,
estrangement, and increased psychological vulnerability (Martinez & Sullivan, 1998).
The loss of the expected communal support and fictive kinship (Chatters, Taylor, &
Joyakody, 1994), which are central to African American culture, has a profound impact
on their well-being and their identity development (Bridges, Selvidge & Matthews, 2003;
Greene, 2001; Parks, 2001; Wise, 2001). In addition, coming out as gay is often viewed
as an assault on the traditional masculine gender role and therefore considered
counterproductive to the success of African American culture (Bridges, Selvidge &
Matthews, 2003; Greene, 2001; Parks, 2001; Wise, 2001). Other considerations that
further complicate the identity integration trajectory in African American gay men include
the fear of violence, fear of AIDS, and an overall fear of compounding oppressions
(Martinez & Sullivan, 1998).
In Christian's (2005) qualitative study of three self-identified Black, gay men,
several themes emerged that illustrate how these men manage their multiple identities.
Being Black was cited as important beyond being gay. The Down Low (DL) or secretive
gay life was embraced, which is characterized by silence of their sexual identity among
family and in the community and enhanced by a masculine appearance or persona.
Finally, distinctions were made between sexual preference (simply being attracted to
other men), and the gay lifestyle (alluding to the effeminate, flamboyant stereotype). In
some cases African American gay men believe that they must be homophobic in order
to separate their sexual identity from their black male identity so that they can be
accepted and maintain a high ranking in the hierarchy of men (Brown, 2005). While
coming out is purported by some theorists to be the pinnacle of gay identity
development, for African American gay men it may add yet another oppression to be
managed in their lives. Therefore, they may identify as gay and choose not to come out
or they may choose not to embrace a gay label at all.
Family Acceptance
Many African American gays experience the black community as homophobic
(Bridges, Selvidge & Matthews, 2003; Greene, 2001; Parks, 2001). Some seek
validation in the predominantly white, gay community where they face the possibility of
experiencing racism while negating the support that would ordinarily be available to
them in the Black community (Icard, 1996). The Black community generally provides a
sense of solidarity against racism that may be reinforcing for African American gay men.
However, they are less likely to experience that solidarity if their sexual orientation
becomes known or is openly discussed; if they "come out". In fact, they may even be
ostracized. Although African American gay men have historically been key figures in
their families, they often become devalued once the code of silence about their
homosexuality is broken (Carpineto, Kubicek, Weiss, Iverson & Kipke, 2008; Icard,
1996; Wise, 2001).
Many in the black community view homosexuality as a lack of masculinity or
manhood (Icard, 1996; Wise, 2001). Black masculinity denotes a form of male behavior
or expression that for some incorporates certain physical attributes and material
possessions and for others incorporates more intrinsic qualities. The behavior can vary
depending on the situation and the variables involved. Black manhood also implies
understanding this state of being in relation to family, community, and society (Wise,
2001). Because of their sexual orientation, African American gay men are depicted as
anything but masculine and because of the ridicule from their peers, and the silencing
from their families, their masculinity is compromised (Bridges, Selvidge & Matthews,
2003; Greene, 2001; Parks, 2001). African American gay men have been depicted as
having a triple consciousness; being a black man within the context of white society,
being a black man within the context of the black community, and being a black man
who is also a sexual minority (Wise, 2001).
African Americans have a long history of strong connections to religion and
spirituality as sources of strength, particularly as a buffer against racism (Bowen-Reid &
Harrell, 2002; Greene, 2001; Parks, 2001). However, the traditional African American
church has either ignored or denigrated its LGBT members leaving them spiritually
empty with fewer coping skills and a smaller support network (Greene, 2001; Griffin,
2006; Parks, 2001). In a qualitative study of African American men, AIDS, and the Black
church (Miller, 2007), participants described the hostile environment that they
experienced in many Christian denominations. Despite the unwelcoming experience,
some of the participants in this study revealed that they viewed church as an extension
of their families and have remained in these congregations and found ways to integrate
their sexual orientation identity with their religious identity, usually by forming unofficial
subgroups of other gay men who are also involved in the church. Other participants
reported that they eventually left those churches not because of their demeaning
homophobic environments, but because of their church's apathetic response to the
AIDS crisis.
Religious guilt, rejection by the church community, and fear of eternal damnation
are sources of traumatic stress and often motivate gay people to seek a solution (Tozer
& Hayes, 2004). Those of this mindset hold their religious or spiritual identity as
essentially as their sexual orientation (Haldeman, 2002). For some African American
gay men, changing their sexual orientation may seem more feasible and less
troublesome than trying to let go of their religious beliefs and communities (Haldeman,
2002). Many gay men engage in heterosexual relationships or commit to celibacy in
order to manage the stress of their conflicting identities, even though studies show that
these choices have been, for the most part, unsatisfactory and unsuccessful
(Haldeman, 2002).
Traumatic Stress Theory
History of Traumatic Stress
In 1883, surgeon Herbert Page pioneered the study of traumatic stress (Trimble,
1981) through a published rebuttal to a previous study done by John Eric Erichsen, a
European surgeon whose report about the victims of railway accidents attributed their
symptoms such as loss of memory, difficulty concentrating, anxiety, and nightmares in
the absence of physical injuries to an organic rather than a psychological cause
(Weisaeth, 2002). Page posited that the symptoms were of a psychological nature and
labeled this condition "nervous shock" (Trimble, 1981).
Also in the late 1800s, French neurologist Jean-Martin Charcot explored patients'
unexplained physical and/or emotional symptoms which he termed hysteria (Halpern &
Tramontin, 2007). Charcot theorized that hysteria was the result of the emotional impact
of a traumatic incident. Physician Pierre Janet and psychiatrist Sigmund Freud and their
colleagues expanded Charcot's theory of hysteria. Janet, (1929/1965) introduced the
concept of dissociation as part of hysteria and traumatic stress stating that hysteria was
"characterized by the retraction of the field of personal consciousness and a tendency to
the dissociation and emancipation of the systems of ideas and junctions that constitute
personality" (p. 332). Janet believed that hysteria developed because of mental
weakness. Freud, on the other hand, believed that hysteria resulted from repressed
memories of traumatic events (Trimble, 1981).
In a collaborative effort, Freud and Viennese psychoanalyst Josef Breuer
investigated hysterical symptoms and began to follow the thread of memory back to
traumatic experiences (Breuer & Freud, 1893/1962). Further investigation led Freud to
the conclusion that women's hysterical symptoms resulted from premature sexual
experiences (Freud, 1896/1962). He later recanted this claim because of the
unacceptable societal implications of sexual abuse and as a result, the investigation of
traumatic stress was largely abandoned (Herman, 1997). Despite the lull in the
scientific inquiry of traumatic stress, the field evolved and eventually became known as
"traumatic neurosis"; a term coined by German neurologist Hermann Oppenheim in
1911 (Figley, 1988; Trimble, 1981).
The study of the psychological impacts of war (Halpern & Tramontin, 2007)
furthered the development of the field of traumatic stress. American physician Abram
Kardiner studied World War I and World War II veterans and attempted to create a
systematic description of the features of traumatic neurosis (Kardiner & Spiegel, 1947).
His work eventually became the foundation for the diagnostic description of
posttraumatic stress disorder (PTSD) (Herman, 1997). The field of trauma was
advanced through work on the traumatic stress outcomes among veterans of World War
II (Lifton, 1967) and the Vietnam War (Figley, 1978).
Traumatic stress received increasing attention from the Vietnam veterans' and the
women's movements in the mid 1970s (Herman, 1997; van der Kolk & van der Hart,
1989). The increased awareness of traumatic stress from these movements resulted in
the designation of posttraumatic stress disorder as a mental illness in the third edition of
the American Psychiatric Association's Diagnostic and Statistical Manual of Mental
Disorders (DSM-III) in 1980 (Burstow, 2003; van der Kolk & van der Hart). The inclusion
of PTSD in the DSM-III increased interest in traumatic stress and engendered the
systematic study of trauma and trauma treatment (van der Kolk & McFarlane, 1996;
Zimmerman & Mattia, 1999). In general, the DSM-III informed how trauma was to be
understood (Becker, 1995; Danieli, 1998; Herman) and influenced the development of
traumatic stress theory (Rosenthal & Wilson, 2003).
Etiology of Traumatic Stress
Trauma is a psychophysical experience that affects the body as well as the mind
(Rothschild, 2000; Scaer, 2001). It causes changes in the brain and interferes with
normal functioning (Kira, 2001). During a traumatic event, the brain releases hormones
that trigger the body's nervous systems to respond by fight, flight, or freezing
(Rothschild, 2000; van der Kolk, 1996). In addition, the area of the brain that is
responsible for speech production is suppressed which creates a "speechless terror" in
response to trauma (van der Kolk, 1996, p.234). The release of hormones during a
traumatic event also suppresses brain functioning that regulates memory (Scaer, 2001;
van der Kolk, 1996). While some traumatized people can remember the traumatic
events in detail, others remember very little and experience physical sensations or
emotional reactions that are contextually incongruent (Rothschild, 2000). Trauma also
affects information processing which can result in dissociation or psychic numbing
(Friedman & Marsella, 1996). Primary dissociation limits cognitions of the reality of the
traumatic experience. Secondary dissociation anesthetizes individuals from the feelings
related to the trauma. Tertiary dissociation characterizes the development of distinct
ego states that contain the traumatic experience (van der Kolk, van der Hart & Marmar,
1996). Psychic numbing produces feelings of detachment from others and a restricted
range of affect (American Psychiatric Association, 2000). Hyperarousal is another
feature of traumatic stress, which results in sleep difficulty, irritability, anger and difficulty
concentrating, hypervigilance and an exaggerated startle response (American
Psychiatric Associatioin, 2000). Traumatic events are stored in the brain and re-
experienced with the same degree of intensity as the original event (Rothschild, 2000;
Scaer, 2001; van der Kolk, 1996). Repeated exposures to trauma results in complex
syndromes involving affect dysregulation, cognitive distortions, destructive behavior
toward self and others and learning disabilities (van der Kolk, 1996).
Traumatic stress is debilitating emotionally, psychologically and physiologically
(Friedman & Marsella, 1996; van der Kolk & McFarlane, 1996). Individuals who have
experienced trauma often avoid situations that have the potential to trigger traumatic
memories or flashbacks. They also develop strategies that, if triggered, will minimize
their emotional and psychological response (Friedman & Marsella, 1996; van der Kolk &
McFarlane, 1996). Major depression and generalized anxiety typically accompany
PTSD (Friedman & Marsella, 1996). Research shows that individuals who have had
previous depressive episodes are at increased risk for developing PTSD (Frist &
Tasman, 2004). Hypervigilance resembles generalized anxiety disorder in that
individuals have a heightened awareness of trauma stimuli; in its severe form, it can
resemble panic and paranoia (Friedman & Marsella, 1996). Finally, avoiding and
psychic numbing can have deleterious effects on relationships and lead to isolation and
loneliness (Friedman & Marsella, 1996).
The DSM-IV-TR (American Psychiatric Association, 2000) describes the
symptomatology of traumatic stress by the diagnostic criteria for PTSD. PTSD is
characterized by exposure to a traumatic event in which a person experiences or
witnesses events that threaten death or serious injury and the person's response
involves intense fear, helplessness or horror; the traumatic event is re-experienced by
intrusive recollections of the event; persistent avoidance or numbing of stimuli
associated with the event and persistent symptoms of increased arousal. The diagnostic
criteria also include duration of disturbance for one month or more and it causes
clinically significant disturbance or impairment in functioning. Sources of trauma,
according to the DSM-IV-TR, include exposure to combat, imprisonment, physical and
sexual abuse, death, victimization by crime or natural disasters, major accidents and
serious injury (American Psychiatric Association, 2000) as well as medical interventions
(Scaer, 2001). This definition of trauma legitimizes certain events as traumatic,
describes the effects of trauma on the traumatized individual and is used to inform and
guide mental health treatment for traumatized individuals (Becker, 1995; Burstow, 2005;
Danieli, 1998; Eriksen & Kress, 2006; Herman, 1997; Rothschild, 2000; van der Kolk &
McFarlane, 1996). Critics of the DSM-IV-TR state that the emphasis on physically
dangerous events in the diagnostic criteria for PTSD is narrow and overlooks individual
perception (Rothschild, 2000) as well as other precipitants to traumatic stress such as
racism, harassment, and oppression (Bryant-Davis & Ocampo, 2005; Burstow, 2003;
Carter, 2007; Halpern & Tramontin, 2007; Herman, 1997).
Race-Based Traumatic Stress
Over the last decade, scholars have argued for a more inclusive definition of the
sources of trauma to include exposure to experiences such as domestic violence
(Herman, 1992) and racism (Bryant-Davis & Ocampo, 2005; Carter, 2007; Friedman &
Marsella, 1996; Utsey, Bolden & Brown, 2001). Other scholars (Brown, 1995; Guilfus,
1999; Lewis, 1999; Root, 1992) have suggested that limiting the definition of trauma to a
physically dangerous events) is inadequate particularly for members of oppressed
groups. Burstow, (2003/ 2005) recommended a "radical departure" from the DSM-IV-
TR's framework for trauma and from psychiatry itself, which in her view, is
disempowering and stigmatizing. She suggests that trauma and traumatic events should
be conceptualized in context and viewed on a continuum in which everyone is located.
Herman (1992) first extended the definition of trauma by highlighting the
experiences of women who were victims of prolonged repeated trauma through
domestic violence. She discussed the commonalties of their experiences with those of
combat veterans and political prisoners. Herman also identified societal factors that
exacerbate the effects of trauma such as harsh judgment and condemnation by others
for exhibiting the symptoms of trauma as well as misdiagnosis and negative attitudes
from the mental health system.
Researchers investigating the relationship between racism and traumatic stress
Bolden & Brown, 2001) also challenged the DSM-IV-TR diagnostic criteria for traumatic
stress. They argued that the stress from exposure to racism, which may be unrelated to
a single event or cause an immediate threat to survival, often results in the development
of traumatic stress syndrome. Furthermore, the study of transgenerational trauma,
which is trauma that is passed down from one generation to another (Dass-Brailsford,
2007), offers insight into the extended effects of racism on the African American
experience. Transgenerational trauma has been studied in children of Holocaust
survivors (Danieli, 1998), families of war veterans (Aarts, 1998; Bernstein, 1998;
Rosenheck & Fontana, 1998), indigenous peoples (Duran, Duran, Yellow Horse Brave
Heart, & Yellow Horse-Davis, 1998; Raphael, Swan & Martinek, 1998), and survivors of
child abuse and domestic violence ( Gardner, 1999; Herman, 1992; Schechter, Brunelli,
Cunningham, Brown & Baaca, 2002; Walker, 1999).
African Americans have experienced race-based traumatic stress from the history
of slavery and legal segregation in the United States (Carter, 2007). The residual effects
of this oppression remain embedded in everyday life. Racist encounters, both direct and
subtle continue to occur interpersonally (e.g., microaggressions, verbal assaults, use of
symbols), systemically (i.e., application of stereotypes and limiting access to resources)
and culturally (i.e., enforcing Eurocentric values) (Carter, 2007). Utsey, Bolden and
Brown (2001) identified six racism-related reactions that African Americans experience
as a result of prolonged exposure to racism and oppression: (a) race-related trauma, (b)
racism-related fatigue, (c) anticipatory racism reaction, (d) race-related distress, (e)
racism-related frustration, and (f) racism-related confusion.
Race-related trauma is the spiritual, psychological and physiological impact of
being the victim of, witness to or learning of the actual or attempted threat to one's
person based on race or skin color. Symptoms include intrusive thoughts, nightmares,
anxiety, fear, sleeplessness and depression (Utsey, Bolden & Brown, 2001).
Racism-related fatigue is the psychological and physiological exhaustion that
African Americans experience from exposure to racism and from combating oppression
on a regular basis. The exhaustion can be debilitating and can interfere with activities of
daily living such as working, participating in and attending to family commitments and
other relationships (Utsey, Bolden & Brown, 2001).
Anticipatory racism reaction is a functional defense mechanism that African
Americans develop after being victimized by racism. It involves maintaining a state of
hypervigilance in order to protect oneself from anticipated racist incidents. Maintaining
this high level of awareness increases anxiety and becomes more stressful than the
anticipated racist encounter (Utsey, Bolden & Brown, 2001).
Race-related distress develops from exposure to chronic racism and results in
psychological and physical problems (Bowen-Reid & Harrell, 2002; Utsey, Bolden &
Brown, 2001). Psychological manifestations include the inability to concentrate, intrusive
thoughts about specific racists encounters, anxiety and depression. Physical symptoms
include headaches, muscle tension, digestive problems, and sleep difficulty. In addition,
race-related distress weakens the immune system resulting in increased susceptibility
to illness ranging from the common cold to hypertension, stroke and cancer (Bowen-
Reid & Harrell, 2002; Utsey, Bolden & Brown, 2001).
Racism-related frustration is the result of powerlessness that African Americans
feel from acts of racism and oppression. Anger, irritability, disappointment, and
dissatisfaction often follow when racist encounters are not resolved. These feelings are
then magnified when new racist events are experienced (Utsey, Bolden & Brown, 2001).
Racism-related confusion is a reaction to ongoing racist encounters in which
African Americans question their identity in an oppressive society. They begin to look at
events and individuals differently and they question their reality. Moreover, they
question their abilities and often internalize their oppression (Utsey, Bolden & Brown,
Scholars have demonstrated how members of oppressed and stigmatized groups
are negatively affected by the stress of their daily lives (Bryant-Davis & Ocampo, 2005;
Carter, 2007; Friedman & Marsella, 1996; Utsey, Bolden & Brown, 2001). LGBT
Americans face similar oppression and stigma in the form of heterosexism and
homophobia that result in chronic stress (David & Knight, 2008; Haatzenbuehler, Nolen-
Hoeksema & Erickson, 2008; Meyer, 2003; Rosario, Rotheram-Borus & Reid, 1996;
Zamboni & Crawford, 2007). Thus, this framework is useful in understanding the effects
of stress on their mental, emotional and physical health. Moreover, this understanding
of the relationship between oppression and stress provides greater insight into the lives
of LGBT African Americans who experience the combined stress of heterosexism,
homophobia and racism.
Using traumatic stress theory to investigate gay African American identity
development requires an awareness of its limitations. First, the DSM-IV-TR
nomenclature does not consider ethno-cultural variables in the understanding, diagnosis
and treatment of PTSD. The influence of religion and cultural beliefs on the meaning
and subjective experience of trauma is overlooked. Second, it fails to address the
relationship between systemic oppression and traumatic stress that plagues those who
live on the margins of society (Carter, 2007; Bryant-Davis & Ocampo, 2005; Friedman &
Marsella, 1996). Third, verbal, emotional and psychological abuse, blocked access to
resources and social alienation, which create extreme stress and represent a threat to
survival, do not currently qualify as precipitants to PTSD. Although the response to
these experiences mirror those outlined in the DSM-IV-TR nomenclature for PTSD such
as intense fear, helplessness or horror, intrusive recollections, persistent avoidance and
psychic numbing and persistent symptoms of increased arousal, they do not meet the
criteria for traumatic stress. Because the traumatic nature of these experiences is not
recognized, the psychological distress that individuals face from these conditions is
often misdiagnosed, they are denied access to adequate mental health resources, the
sociopolitical realities of their lives are overlooked and they are further marginalized
(Cosgrove, 2005).
Traumatic Stress in African American Gay Men
African American gay men live with chronic stress in their daily lives. They face
systemic oppression that impacts their psychological well-being and threatens their
survival (Meyer, 2003). They experience employment, housing and legal discrimination
and are often marginalized in education and health care settings (Mays & Cochran,
2001). These men also face possible rejection by their families (Icard, 1996; Wise,
2001), from religious institutions (Greene, 2001; Griffin, 2006; Parks, 2001) and are at
increased risk for psychological, emotional and physical violence (Huebner, Rebchook
& Kegeles, 2004). Studies show that internalized homophobia, stigma and events of
discrimination and violence predict psychological distress in gay men (David & Knight,
2008; Mays & Cochran, 2001; Meyer, 1995).
Gay African Americans experience sexual identity stress that is exacerbated by
racism in both the larger society and within the predominantly white gay community
(Greene, 2001; Parks, 2001; Wise, 2001; Zamboni & Crawford, 2007). Studies have
shown that African American gay men experience increased levels of heterosexist and
race-based stress (Crawford, Allison, Zamboni, & Soto, 2002; Hayes, 1996). In a study
of stress and coping among older gay men, David & Knight (2008) found lower levels of
sexual identity disclosure, higher levels of homonegativity and disengaged coping
among older African American men than with their White counterparts. Because of
these difficulties, gay African Americans are often conflicted in the process of identity
formation and experience increased levels of depression, anxiety, suicidal ideation,
substance abuse and high-risk sexual behavior (Hatzenbeuhler, Nolen-Hoeksema &
Erickson, 2008; Huebner & Davis, 2007; Israel & Selvidge, 2003; Savin-Williams, 2001).
Gay African Americans' experience of racism and homophobia results in a sense
of never being a part of any group completely, leaving them at risk for isolation, feelings
of estrangement, and increased psychological vulnerability (Martinez & Sullivan, 1998).
They experience the stress of not belonging on a daily basis and they are subject to
emotional, psychological and physical violence from those who do not approve of their
identity expression. As a result, they experience intrusive recollections of racist and
homophobic events, psychic numbing as a way to manage their emotions and they are
hypervigilant about their safety and monitor their speech, their mannerisms and their
interests so that their sexual identity is not disclosed (David & Knight, 2008; Mays &
Cochran, 2001; Meyer, 1995). This chronic stress often leads to a number of mental
health problems (Israel & Selvidge, 2003; Savin-Williams, 2001). While using traumatic
stress theory to understand these difficulties has limitations, it is an effective framework
for developing a more accurate conceptualization of problems and creates opportunities
for effective culture-centered interventions (Wynn & West-Olatunji, 2009).
African American gay men are regularly confronted with racism and homophobia.
These stressful events are cumulative and lead to isolation, impaired functioning and
identity confusion. The symptomatology mimics the criteria for traumatic stress as
outlined in the DSM-IV-TR such as fear, helplessness or horror, intrusive recollections,
persistent avoidance and psychic numbing and hyperarousal; yet, the current DSM-IV-
TR nosology does not acknowledge the traumatic nature of persistent exposure to racist
and homophobic events. Failure to include racism and homophobia as predictors of
traumatic stress further reinforces stereotypes of African American gay men and
supports the systemic oppression that keeps them on the margins of society. A more
inclusive, culture-centered model of traumatic stress would improve the accuracy of
case conceptualization, diagnosis and treatment (Wynn & West-Olatunji, 2009). In
addition, it would provide a framework for these men to understand their own challenges
with identity development in a manner that does not reinforce shame and self-loathing.
Finally, by acknowledging the serious impact that traumatic stress has on this
population, the field of mental health will advance and offer greater access to resources
that would assist African American gay men in the successful development of their
Table 2.1. African American culture
Dimension Description
Balance and The assumption that all aspects of oneself are inextricably
Harmony connected. This includes balance between mental, physical
and spiritual states and living in harmony with nature.
Imbalance in one domain is reflected in other domains.
Kinship Bonds
Religion/Spirituality
Sensitivity to Affect
and Emotional Cues
Time Orientation
Verve and Rhythm
Interdependence, cooperation and prioritizing the group over
the individual. Individual identity is connected to group
identity. Competition is minimized and harmony and group
cohesion are maximized.
Strong commitment to nuclear family, extended family and
fictive kin (non-relatives who are embraced as family). The
strong kinship bond may be reflected in frequent contact with
family members, multiple generations of a family living in one
home or nearby, and extended family members assuming
parental or care giving roles for their relatives.
Using storytelling and music to transmit cultural information
from one generation to the next.
Belief in a force greater than oneself that may also include
adherence to rituals such as attending church, regular
prayers, celebrating religious holidays, and participating in
church-related outreach; a primary resource for coping with
stressful life events such as racism, illness and other adverse
An extended sensitivity to the emotional and affective states
of self and others. This includes consideration for other
people and is related to the orientation towards collectivism
and strong kinship bonds. There is an emphasis on
empathizing with others and being open to emotional
expression.
Flexibility with time and considering the past and present as
equally important as the future.
Rhythm and creativity may be seen in movement, posture,
speech patterns and learning styles. Verve suggests a
preference for multiple and changing stimuli versus a singular
one that is routine.
Bellgrave & Allison, 2006; Boykin, 1983; Boykin & Ellison, 1995; Chatters, Taylor, &
Joyakody, 1994; McAdoo, 1993; Nobles, 2004; Sue & Sue, 2008)
The purpose of this study was to examine the relationship between ethno-cultural
identity, sexual orientation identity and traumatic stress in African American gay men.
The purpose of this chapter is to provide an overview of the methods that were used in
this study. A description of research methods, population and setting, instrumentation,
data collection procedures, data analyses, and limitations of the study will be provided.
Survey methods were used to acquire data for this study. A demographic data
form (Appendix A), the African Self-Consciousness Scale Short Form, (ASCS),
(Baldwin & Bell, 1985, Appendix B), the Gay Identity Questionnaire (GIQ), (Brady, 1994,
Appendix C) and the Trauma Symptom Inventory, (TSI), (Briere, 1995, Appendix D)
were distributed to a sample of African American gay men via an electronic mail (email)
link to the survey. Correlation and multiple regression statistical methods were used to
analyze the data. A power analysis was conducted to determine the number of
participants needed in this study (Cohen, 1988). To achieve power of .80 and a small
effect size, a total sample size of N=148 is required (Cohen, 1988, p. 385). Participants
were informed of the purpose and procedures of this study as well as their rights, risks
and benefits of participating.
Population and Setting
Approval to conduct this study was obtained from the university's institutional
review board. Historically, it has been difficult to recruit gay African American men for
participation in research studies. Therefore, convenience and snowball sampling
methods were used. Participants were recruited from social networks. In addition,
members of national black gay organizations such as the Black AIDS Institute, the Black
Gay Network, the National Black Justice Coalition, and the National Black Gay Men's
Advocacy Coalition were invited to participate by mailing the membership coordinators
of these groups with information about the study and requesting that it be distributed to
their membership. The use of anonymous, electronic surveys ensured participant
confidentiality and no identifying information was solicited. Incentives were not provided
for participation in this study. Data collection lasted 14 weeks. The Statistical Package
for the Social Sciences (SPSS v.18) program was used for data analysis.
Three instruments were used in this study: the African Self-Consciousness Scale -
Short Form (ASC), the Gay Identity Questionnaire (GIQ) modified and the Trauma
Symptom Inventory (TSI). Each instrument or its subscales with the exception of the
Identity Pride subscale of the GIQ, have reliability scores of at least .70, which is
typically considered acceptable (Constantine & Ponterotto, 2006).
African Self-Consciousness Scale (ASC)
The ASC scale is a 42-item questionnaire designed to assess the Black
personality construct of African self-consciousness (Baldwin & Bell, 1985). Selected
from an original pool of 130 items, these 42 items ranked highest among expert judges
(psychologists) in how well they reflected the ASC four factors (see Table 3.1). The
items were also rated in terms of six manifest or expressive dimensions believed to be
relevant to important aspects of African American life. They include education, family,
religion, cultural activities, interpersonal relations, and political orientation.
The reliability estimate for the ASC was obtained using the test-retest method. A
sample of 109 Black college students enrolled in general psychology courses at Florida
Agricultural and Mechanical University (FAMU) were administered the scale on two
separate occasions six weeks apart. The items were randomly reordered on the second
administration to control for practice and order effects. Positive and negative items were
also randomly reordered on the second administration. The Pearson product-moment
correlations coefficient used in this analysis generated a reliability coefficient of r (107)
=.90, p<.001 (Baldwin & Bell, 1985).
The ASC items alternate from negative phrasing with regard to African Self-
Consciousness (low scores index the ASC construct) to positive phrasing with regard to
African Self-Consciousness (high scores index the ASC construct). Odd numbered
items are negatively weighted for the ASC construct, while even numbered items are
positively weighted for the ASC construct. Responses are given according to the
following Likert-type scaling system: Strongly Disagree= 1-2; Disagree= 3-4; Agree= 5-
6; Strongly Agree= 7-8. Even numbered items are scored by computing their scaled
values directly, whereas odd numbered items are scored as the reverse of their scaled
values (8=1, 7=2, 6=3, etc.). The total ASC score can be computed as either sum of the
scores or as the overall mean of the scores (Baldwin & Bell, 1985).
The ASC Short Form is a 20-item questionnaire taken from the original 42-item
ASC developed by Kambon and Associates (1996; Baldwin and Bell, 1985). The ASC
Short Form is organized around four ASC Subfactors/subscales and consists of the five
items representing the highest item-loadings on each of the factors. The ASC
Subfactors are F1-Collective African Identity, F2-Resistance/Defense Against Anti-
African Forces, F3-Value for Africentric Institutions and Cultural Expressions, and F4-
Value for African Culture (Kambon, 1998). Around 90% of the original items loaded on
the four factors, accounting for nearly 76% of the variability. Cronbach's Alpha
coefficients for the full scale ASC range from .79 to .82, while test-retest reliability
coefficients covering intervals from six weeks up to nine months occur well within the
high 80s to low 90s range (Baldwin and Bell, 1985; Kambon, 1998).
The ASC is structured such that even-numbered items are positively keyed for
ASC and odd-numbered items are negatively keyed for ASC. Thus, for positive keyed
items, high scores (above 4) are indicative of strong/high ASC, and for negative keyed
items, low scores (4 and below) are indicative of strong/high ASC. Therefore, negative
(odd numbered) item scores must be transposed to their ASC weights or values. For
example, a negative weighted score of 1 is converted/transposed to 8, a 2 to 7, 3 to 6,
etc. (i.e., for negative weighted items 1=8, 2=7, 3=6, 4=5, 5=4, 6=3, 7=2, 8=1).
Gay Identity Questionnaire (GIQ)
The original version of the GIQ consists of 45 true-false items that measure
respondents' stage of homosexual identity formation (HIF) proposed by Cass (1979)
(see Table 3.2). The original sample included 225 White, middle-class male
respondents residing in southern California in 1983. The median age of the respondents
was 28.8 years and all reported that they had homosexual thoughts, feelings or
engaged in homosexual behavior (Brady, 1998).
The internal consistency scores for the original GIQ are not available for the first
two stages due to too few respondents in the pilot test, which may be the result of
difficultly in recruiting subjects for a study on gay identity who do not yet identify as gay
(Brady & Busse, 1994).
Additionally, the reliability score for the fifth stage, Identity Pride, is weak (r = .48).
Brady & Busse (1994) hypothesize that this stage does not represent a distinct
developmental stage but rather a process of development between stage four, Identity
Acceptance and stage six, Identity Synthesis.
Rogers (1998) modified the GIQ in an effort to improve the instrument's reliability
and to better identify participants' levels of gay identity. A six-point Likert scale ranging
from 1=Strongly Disagree to 6= Strongly Agree replaced the original True/False scale.
The responses were summed and mean calculated which provided a score for each of
the six stages rather than a single stage designation. The reliability scores reported in
Table 3.2 are based on a sample of 237 gay men.
Trauma Symptom Inventory (TSI)
The 100 item-TSI is a general test of trauma symptoms that are rated on a 4-point
scale of frequency of occurrence over the past 6 months (0=Never, 1 =Rarely,
2=Occasionally, 3=Often). The TSI takes a response perspective of trauma and does
not ask about precipitating events (Fernandez, 2001). The TSI consists of 10 clinical
scales, which evaluate the symptomatology of traumatized individuals. The five
subscales of the TSI that are consistent with the DSM-IV-TR criteria for PTSD will be
used for this study. In addition, the sexual concerns and dysfunctional sexual behavior
subscales will also be used due to their relevance to the study. They are described in
Table 3.3.
The psychometric properties of the TSI were analyzed on four samples,
standardization sample n=828, university students n=279, clinical sample n=370 and
Navy recruits n=3,659. The student and clinical samples were predominantly female.
Analysis of the TSI's predictive validity revealed that it accurately predicted PTSD as
outlined in the DSM-IV-TR in 91% of the cases (Fernandez, 2001).
The three instruments proposed for use in this study, the ASC, the GIQ-modified,
and the TSI are psychometrically sound. In addition, they are consistent with the
constructs outlined in chapter 2 of this study. Therefore, they are appropriate for use in
this study.
The ASC is based on Africentric theory (Baldwin, 1981) and has been used in
studies on Africentric psychology (Baldwin & Bell, 1985; Baldwin, Brown, & Rackley,
1990; Baldwin, Duncan, & Bell, 1992; McCowan & Alston, 1998). The data suggest that
a reliable relationship exists between high levels of African self-consciousness and
positive psychological functioning and behavior in African American people (Baldwin &
Bell, 1985).
The GIQ offers a valid assessment of gay men in the later stages of HIF. It has
been used in a number of studies with gay men as well as lesbians with significant
results (Halpin & Allen, 2004; Levine, 1997; Marszalek, Cashwell, Dunn & Jones, 2004;
Rowen & Malcolm, 2002). The modified version of the GIQ improved its reliability and its
ability to identify participants' levels of gay identity. Use of the GIQ in a study measuring
gay identity in African American men will contribute to the generalizability of the
The TSI is internally consistent, demonstrates good convergent validity and is
useful in quantifying the diagnostic information for assessing PTSD. The TSI's response
perspective to trauma, avoiding the narrow focus on only a few possible precipitating
events to trauma, is consistent with the construct of traumatic stress as presented in this
study.
Purposeful, convenience and snowball sampling limits the diversity and selection
of individuals for the sample by selecting those who participate in formal support groups
and those who belong to certain social networks. Using electronic mail to link to the
surveys is a limitation in that it excludes potential participants who either do not have
access to this technology or are uncomfortable with its use.
Data Collection Procedures
The ASC, the GIQ and the TSI were distributed to eligible participants via a link
through electronic mail.
The data were entered into SPSS v.18 and analyzed. For the first research
question, the relationship of ethno-cultural identity and gay identity was tested with
Pearson product-moment correlation.
1. What is the relationship between cultural identity and gay identity in African
For the remaining research questions, (2-8) multiple regression was used to
analyze the data in order to understand the relationship between the three variables.
sexual concerns in African American men?
Table 3.1. African self-consciousness scale Four factors
Factor Description
Collective African Identity A psychological disposition reflecting a sense of
and Self-Fortification African identity and a tendency to engage in activities
that affirm one's African identity. (e.g., Pro-Black/Back
empowering actions like promoting African history and
cultural activities, Black organized/collective activities,
Black economic and political activities/Nguzo Saba,
Resistance Against
Anti-African Forces
Value for African-Centered
importance of Institutions and
Value for African Culture
(Baldwin & Bell, 1985)
A psychological disposition reflecting a tendency to
resist, by any means necessary, any and all
information which may be perceived
(experienced/interpreted) as anti-African/anti-Black, or
as a threat to African/Black survival in any way, shape
or form. (e.g., Rejects White supremacy and actively
combats it in all areas of experience.)
A psychological disposition reflecting a belief in the
Africentric/pro-Black-oriented/empowering Cultural
organizations-institutions, practices, etc., that are
under African/Black control based on African cultural
definitions. (e.g., practicing African cultural rituals,
celebrations, commemorations, etc.)
A psychological disposition reflecting a firm belief in
the value/importance of traditional African cultural
forms (practices, products-artifacts, etc.) for Africans
(in America).
Table 3.2. Stages of homosexual identity formation
Stage Description
Identity Confusion (r=.78) Feeling different and initial awareness that a
heterosexual identity does not fit.
Identity Comparison (r=.86)
Identity Tolerance (r=.74)
Identity Acceptance (r=.84)
Identity Pride (r=.57)
Identity Synthesis (r=.76)
(Cass, 1979; Rogers, 1998)
Attempts to pass as heterosexual while
keeping gay identity separate.
Alienation from the heterosexual world and an
increased desire to connect with the gay
Increased contact with the gay community,
passing as heterosexual when needed and
beginning to disclose gay identity to others
Immersion in gay culture, strong sense of
identity with the gay community, social activism
and increase disclosure of sexual identity.
Letting go of us versus them and sense of
pride is integrated into gay identity.
Table 3.3. Trauma symptom inventory subscales
Hyperarousal (a= .87)
Depression (a = .90)
Intrusive experiences (a = .90)
Defensive avoidance (a = .88)
Dissociation (a = .88)
Sexual concerns (a = .89)
Dysfunctional sexual behavior
(a = .89)
Jumpiness, tension and heightened awareness of
trauma stimuli. Sleep difficulty, irritability, anger and
Sadness and hopelessness
Flashbacks and nightmares of traumatic experiences
Cognitive and behavioral avoidance of trauma stimuli
Psychic numbing; limits the cognitions and feelings
related to the trauma
Negative thoughts and feelings during sex, confusion
regarding sexual issues and shame regarding sexual
Indiscriminate sexual contact, getting into trouble
because of sexual behavior and using sex to combat
internal distress
(Briere, 1995; Briere, Elliott, Harris & Cotman, 1995)
This study examined the relationship between ethno-cultural identity, sexual
orientation and traumatic stress in adult African American gay men. The purpose of this
chapter is to provide a summary of the study including sampling procedures and
instrumentation. Participant descriptive information will also be presented. Finally, the
statistical analyses and findings of the study in relation to the research questions and
hypotheses will be discussed.
Snowball sampling was used to recruit adult African American gay men from social
networks for participation in this study. Participants completed an on-line survey that
included 17 demographic questions, the African Self-Consciousness Scale Short Form,
the Modified Gay Identity Questionnaire, and 7 subscales of the Trauma Symptom
Inventory. Data was analyzed using Pearson correlation and multiple regression
equations.
Participant Descriptive Information
A total of 152 people participated in the study. Forty-eight were deleted prior to
analysis due to gender (Female) (4), racial/ethno-cultural background (White) (4), or
incomplete surveys (40). Therefore, a total of 104 participant responses were valid and
used for analysis.
The age ranges with the highest frequencies include the 46-50 age range (17.3%),
the 41-45 and 20-25 age ranges (15.4%), and the 31-35 age range (14.4%). The
distribution of participants by age range is presented in Table 4.1.
The ethno-cultural backgrounds of the participants are as follows: African
American/Black (Non-Latino) (79%), Afro Caribbean (14%), African (Born on the
continent of Africa) (6%), Multiracial/Multiethnic (4%), and other (1%). Seventy -nine
percent of the sample described their sexual orientation as gay, while 18.3% chose
same-gender loving as a description of their sexual orientation. Other participants
identified their sexual orientation as bisexual (3.8%) or Queer (1.9%). Participants
described their current relationship status as follows: single (67%), partnered (25%),
married (4%), and divorced (4%).
Demographic data were also collected on participants' religious affiliation.
Eighteen percent reported no religion, 68% identified as Christian, 2% as Buddhist, and
11% as other. One participant did not respond to this item. Forty-seven percent of
participants reported that religion is very important, 26% reported that religion is not
important, and 25% reported that religion is somewhat important. Two participants did
not respond to this item. Forty percent of participants reported seldom attendance at
religious services, 29% reported attending religious services often, 17% reported
attending religious services sometimes, and 14% reported never attending religious
The geographic region of the United States in which participants were raised as
well as their current geographic region was also examined. Over half of the participants
(59%) reported being raised in the South and 64% reported currently living in this
region. Participants who reported being raised in the Northeast make up 17% of the
sample; 14% reported currently living in this region. While 15% of participants reported
being raised in the Midwest, 16% reported currently living in this region. Finally, 7% of
participants reported being raised in the West and 5% reported currently living in this
region.
Other demographic questions examined the highest level of education of the
participants (see Table 4.2), current occupation (see Table 4.3), and income level (see
Table 4.4).
Data Analyses and Results
The following is a presentation of the research questions as well as a description
of the analyses and the results in relation to the null hypotheses. Descriptive statistics
are provided in Table 4.5.
Question 1. What is the relationship between ethno-cultural identity and gay
identity in African American men?
Preliminary analyses using Pearson correlation coefficient revealed a high
correlation (a=.83) between the confusion (GIDCONF) and comparison (GIDCOMP)
subscales of the Gay Identity Questionnaire. Therefore, a composite variable
(GIDCONF/COMP) was formed.
A Pearson correlation coefficient was calculated for the relationship between
participants' level of African self consciousness (ASC) and stage of gay identity (see
Table 4.6). The test revealed that there was no statistically significant correlation
between ASC and GIDCONF/COMP(r (78) = -.171, p>.05). Therefore, there is no
association between African self consciousness and gay identity confusion/comparison.
There was no statistically significant correlation between ASC and GIDTOL(r (83) = -
.068, p>.05). Therefore, there is no association between African self consciousness and
gay identity tolerance. There was no statistically significant correlation between ASC
and GIDACC (r (85) = -.080, p>.05). Therefore, there is no association between African
self consciousness and gay identity acceptance. There was no statistically significant
correlation between ASC and GIDPRIDE (r (84) = .146, p>.05). Therefore, there is no
association between African self consciousness and gay identity pride. Finally, there
was no statistically significant correlation between ASC and GIDSYN (r (86) = -.033,
p>.05). Therefore, there is no association between African self consciousness and gay
identity synthesis.
The first hypothesis proposed that there is no relationship between African self-
consciousness and gay identity. The hypothesis was supported by the results, which
showed that there was no statistically significant correlation between African self-
consciousness and gay identity. This finding is inconsistent with other studies
addressing intersectionality of identity (Crawford, Allison, Zamboni & Soto, 2002;
Hatzenbeuhler, Nolen-Hoeksema & Erickson, 2008; Huebner & Davis, 2007; Israel &
Selvidge, 2003; Savin-Williams, 2001) that suggest a negative relationship exists
between ethno-cultural identity and gay identity. One explanation for why this study did
not find a significant correlation between African self-consciousness and gay identity
may be because this study had a small sample size; therefore limiting the power
needed to detect a relationship.
The concept of intersectionality addresses the nuanced complexities of multiple
identities that cannot be sufficiently captured using conventional identity development
models, such as racial (Helms, 1995; Sue & Sue, 2008) and gay/lesbian (Cass, 1979;
Minton & McDonald, 1984). Studies report that many African American gay men choose
to keep their ethno-cultural and gay identities separate (Christian, 2005; Brown, 2005).
According to the literature, the Black community generally provides a sense of solidarity
against racism that may be reinforcing for African American gay men. However, they
are less likely to experience that solidarity if their sexual orientation becomes known or
is openly discussed; if they "come out". In fact, they may even be ostracized. Although
African American gay men have historically been key figures in their families, they often
become devalued once the code of silence about their homosexuality is broken
(Carpineto, Kubicek, Weiss, Iverson & Kipke, 2008; Icard, 1996; Wise, 2001).
However, 55% of the men in this study scored in the high range on both African
self-consciousness and gay identity pride suggesting that there are many African
American gay men who are more successful at integrating their identities. This study
reflects the need for more insight into the factors that support identity integration, as well
as those that inhibit it in African American gay men.
Question 2. What is the relationship between ethno-cultural identity, gay identity,
and hyperarousal in African American men?
Regression equation: Hyperarousal'= -8.144 + .081(ASC) +
.135(GIDCONF/COMP)- .290(GIDTOL) + .262(GIDACC) + .264(GIDPRIDE) -
.071(GIIDSYN)
A multiple regression was conducted with the following predictor variables: ASC,
GIDCONF/COMP, GIDTOL, GIDACC, GIDPRIDE, and GIDSYN, with hyperarousal as
the outcome variable (see Table 4.7). The model produced an R2 of .257, which was
statistically significant, (F(6,63) = 3.641, p = .05). ASC, GIDCONF/COMP, GIDTOL,
GIDACC, GIDPRIDE, and GIDSYN can account for 25.7% of the variance in
hyperarousal. ASC, GIDCONF/COMP, GIDTOL, and GIDSYN had non-significant
effects. GIDACC was positively related to hyperarousal (B = .262, t = 2.772, p = .007).
GIDPRIDE was positively related to hyperarousal (B = .264, t = 2.143, p = .036).
The second hypothesis states that there will be no significant relationship between
ethno-cultural identity, gay identity and hyperarousal in African American men. This
hypothesis is partially supported. The gay identity confusion/comparison, the gay
identity tolerance, and the gay identity synthesis stages of gay identity development had
non-significant effects on hyperarousal.
However, the gay identity acceptance and the gay identity pride stages were
positively related to hyperarousal, which suggests that the more open African American
gay men are to themselves and others about their gay identity, the more likely they are
to experience hyperarousal. This finding is supported by the literature reflecting African
American gay men's experiences of being hypervigilant about their safety, monitoring
their speech, their mannerisms, and their interests as a way of managing disclosure of
their sexual identity (David & Knight, 2008; DiPlacido, 1998; Mays & Cochran, 2001;
Meyer, 2003). In addition, Cochran, Sullivan, and Mays (2003) observed that gay and
bisexual men were 4.7 times more likely to meet criteria for panic disorder than
heterosexual men.
Question 3. What is the relationship between ethno-cultural identity, gay identity
and depression in African American men?
Regression equation: Depression'= -9.966 + .025(ASC) +.093(GIDCONF/COMP) -
.289(GIDTOL) + .351(GIDACC) + .487(GIDPRIDE) .032(GIDSYN)
GIDCONF/COMP, GIDTOL, GIDACC, GIDPRIDE, and GIDSYN, with depression as the
outcome variable (see Table 4.8). The model produced an R2 of .227, which was
depression. ASC, GIDCONF/COMP, GIDTOL, and GIDSYN had non-significant effects.
GIDACC was positively related to depression (B = .351, t = 3.368, p = .001). GIDPRIDE
was positively related to depression (B = .487, t = 3.747, p = 0.001).
The third hypothesis states that there will be no significant relationship between
ethno-cultural identity, gay identity and depression in African American men. This
hypothesis is partially supported. Three of the 5 stages of gay identity development,
gay identity confusion/comparison, gay identity tolerance, and gay identity synthesis
were not significantly related to depression.
Two stages of gay identity development, gay identity acceptance and gay identity
pride were positively related to depression in African American gay men, which
suggests that the more accepting they are about their gay identity, the more likely they
are to experience depression. This is consistent with the literature on the prevalence of
depression in gay men. Studies show that gay and bisexual men are 3 times more likely
to meet DSM-IV-TR criteria for major depression than their heterosexual counterparts
(Cochran, Sullivan & Mays, 2003; Crawford, Allison, Zamboni & Soto, 2002;
Selvidge, 2003; Savin-Williams, 2001). Other studies reveal that a lesbian, gay, bisexual
identity and questioning of one's sexual orientation is an independent predictor of
suicide attempts particularly among adolescents (Fergusson, Horwood, & Beautrais,
1999; Garafalo et. al., 1999).
and intrusive experiences in African American men?
Regression equation: Intrusive Experiences'= -12.931 + .069(ASC)
+.052(GIDCONF/COMP) -.230(GIDTOL) + .302(GIDACC) + .327(GIDPRIDE) +
.057(GIDSYN)
GIDCONF/COMP, GIDTOL, GIDACC, GIDPRIDE, and GIDSYN, with intrusive
experiences as the outcome variable (see Table 4.9). The model produced an R2 of
.216, which was statistically significant, (F(6,73) = 3.348, p = .05). ASC,
GIDCONF/COMP, GIDTOL, GIDACC, GIDPRIDE, and GIDSYN can account for 21.6%
of the variance in intrusive experiences. ASC, GIDCONF/COMP, GIDTOL, and GIDSYN
had non-significant effects. GIDACC was positively related to intrusive experiences (B =
.302, t = 3.434, p = .001). GIDPRIDE was positively related to intrusive experiences (B
= .327, t = 2.978, p = .004).
The fourth hypothesis states that there will be no significant relationship between
ethno-cultural identity, gay identity and intrusive experiences in African American men.
This hypothesis is partially supported. Analysis revealed no significant relationship
between intrusive experiences and the gay identity confusion/comparison, the gay
identity tolerance, and the gay identity synthesis stages of gay identity development.
A significant relationship was found between intrusive experiences and the gay
identity acceptance and the gay identity pride stages of gay identity development
reflecting African American gay men's experiences with negative events related to their
acceptance of and pride in their gay identity. This is discussed in the literature on the
effects of homophobic events on the LGBT population such as anti-gay victimization
including verbal assault, threats, and physical violence, as well as familial abuse,
harassment, and maltreatment (Comstock, 1989; D'Augelli, 1992; DiPlacido, 1998;
Garnets, Herek et.al., 1997; Herek, 1993; Meyer, 2003; Otis & Skinner, 1996).
and defensive avoidance in African American men?
Regression equation: Defensive Avoidance'= -14.198 + .094(ASC)
GIDCONF/COMP, GIDTOL, GIDACC, GIDPRIDE, and GIDSYN, with defensive
avoidance as the outcome variable (see Table 4.10). The model produced an R2 of
of the variance in defensive avoidance. ASC, GIDCONF/COMP, GIDTOL, and GIDSYN
had non-significant effects. GIDACC was positively related to defensive avoidance (B =
.280, t = 2.583, p = .012). GIDPRIDE was positively related to defensive avoidance (B =
.415, t = 3.069, p = .003).
The fifth hypothesis proposed that there will be no significant relationship between
ethno-cultural identity, gay identity and defensive avoidance in African American men.
This hypothesis is partially supported in that there was no significant relationship
between defensive avoidance and the gay identity confusion/comparison, the gay
There was significance in the relationship between defensive avoidance and the
gay identity acceptance and the gay identity pride stages of gay identity development
suggesting that even at later stages of gay identity development, African American gay
men may be avoiding gay-related trauma stimuli. Similar results are reported in the
literature. For example, in a study on lesbian and gay male undergraduates' experience
of harassment and fear on campus, lesbian and gay college students admitted to
changing their lives to avoid harassment, abuse, and violence. These changes included
avoiding certain locations, avoidance of openly lesbian or gay people, and developing a
distorted or restricted presentation of self (denying that they are involved in a romantic
relationship or suggesting that they are dating opposite sex partners) (D'Augelli, 1992).
Studies also suggest that substance abuse in the LGBT population is an attempt to
escape unpleasant emotions, to combat isolation and loneliness and to avoid social
conflict (Berg, Mimiaga, & Safren, 2008; Cochran & Mays, 2000; Gilman et. al., 2001;
Greenwood, et. al., 2000; Halkitis, Parsons, & Wilson, 2003; Stall, et. al., 2001).
and dissociation in African American men?
Regression equation: Dissociation'= -9.351 + .014(ASC) +.057(GIDCONF/COMP)
-.051(GIDTOL) + .256(GIDACC) + .424(GIDPRIDE) + .054(GIDSYN)
GIDCONF/COMP, GIDTOL, GIDACC, GIDPRIDE, and GIDSYN, with dissociation as
the outcome variable (see Table 4.11). The model produced an R2 of .223, which was
dissociation. ASC, GIDCONF/COMP, GIDTOL, and GIDSYN had non-significant
effects. GIDACC was positively related to dissociation (B = .256, t = 2.748, p = .008).
GIDPRIDE was positively related to dissociation (B = .424, t = 3.642, p = .001).
The sixth hypothesis, there will be no significant relationship between ethno-
cultural identity, gay identity and dissociation in African American men was partially
supported. There was no significant relationship between dissociation and the gay
identity confusion/comparison, the gay identity tolerance, and the gay identity synthesis
stages of gay identity development.
Dissociation was positively related to the gay identity acceptance and the gay
identity pride stages of gay identity development. Dissociation, also known as psychic
numbing is one way that LGBT people manage the painful emotions associated with
belonging to a marginalized social identity group (DiPlacido, 1998; Meyer, 2003).
and sexual concerns in African American men?
Regression equation: Sexual Concerns= -10.626 + .051(ASC)
+.0135(GIDCONF/COMP) .088(GIDTOL) + .280(GIDACC) + .415(GIDPRIDE) +
GIDCONF/COMP, GIDTOL, GIDACC, GIDPRIDE, and GIDSYN, with sexual concerns
as the outcome variable (see Table 4.12). The model produced an R2 of .221, which
was statistically significant, (F(6,73) = 3.460, p = .05). ASC, GIDCONF/COMP, GIDTOL,
GIDACC, GIDPRIDE, and GIDSYN can account for 22.1% of the variance in sexual
concerns. ASC, GIDCONF/COMP, GIDTOL, and GIDSYN had non-significant effects.
GIDACC was positively related to sexual concerns (B = .290, t = 3.070, p = .003).
GIDPRIDE was positively related to sexual concerns (B = .285, t = 2.422, p = .018).
The seventh hypothesis, there will be no significant relationship between ethno-
cultural identity, gay identity and sexual concerns in African American men was partially
supported. There was no significant relationship between sexual concerns and the gay
The gay identity acceptance and the gay identity pride stages of gay identity
development were positively related to sexual concerns. Recent studies addressing
stress in gay men found significance between stress and sexual problems such as
communication difficulties, performance concerns (erectile and orgasmic disorders),
sexual knowledge deficits, and negative sexual attitudes (Bancroft, et. al., 2005;
Standfort & deKeizer, 2001; Zamboni & Crawford, 2007).
and dysfunctional sexual behavior in African American men?
Regression equation: Dysfunctional Sexual Behavior= -3.462 + .015(ASC)
GIDCONF/COMP, GIDTOL, GIDACC, GIDPRIDE, and GIDSYN, with dysfunctional
sexual behavior as the outcome variable (see Table 4.13). The model produced an R2 of
of the variance in dysfunctional sexual behavior. ASC, GIDCONF/COMP, GIDTOL, and
GIDSYN had non-significant effects. GIDACC was positively related to dysfunctional
sexual behavior (B = .251, t = 2.969, p = .004). GIDPRIDE was positively related to
dysfunctional sexual behavior (B = .240, t = 2.276, p = .026).
The eighth hypothesis proposed that there will be no significant relationship between
ethno-cultural identity, gay identity and dysfunctional sexual behavior in African
American gay men. This hypothesis was partially supported. There was no significant
relationship between dysfunctional sexual behavior and the gay identity
confusion/comparison, the gay identity tolerance, and the gay identity synthesis stages
of gay identity development.
There was a significant positive relationship between dysfunctional sexual
behavior and the gay identity acceptance and the gay identity pride stages of gay
identity development. This finding suggests that at these stages of gay identity, African
American gay men may engage in indiscriminate sexual contact, get into trouble
because of sexual behavior, and use sex to combat internal distress. Other studies
have found that the discrimination; expectations of rejection, and internalized
homophobia that is often associated with all stages of gay identity was positively related
to dysfunctional sexual behavior such as HIV risk behavior (unprotected sex) (Diaz, et.
al., 2001; Hatzenbeuhler, Nolen-Hoeksema & Erickson, 2008; Mays & Cochran, 2001;
Meyer, 1995; Rosario, Rotheram-Borus & Reid, 1996).
In summary, Pearson correlation analysis found no association between African
self-consciousness and gay identity. Regression analyses found that African self-
consciousness was not a predictor of traumatic stress in African American gay men.
While the analysis did not reveal a significant relationship between African self-
consciousness and gay identity, the literature suggests that a negative relationship
exists. The small sample size of this study, which limits the power needed to detect a
relationship, should be considered when interpreting this result.
Regression analyses found that African self-consciousness was not a predictor of
traumatic stress in African American gay men. While the results of this analysis did not
show a significant relationship between African self-consciousness and traumatic
stress, the researcher does not assume that participants are not affected by race-based
stressors; the literature suggests otherwise (Greene, 2001; Parks, 2001; Wise, 2001;
Zamboni & Crawford, 2007). The results may; however, suggest that the stress from
their gay identity is currently more salient. In addition, they may also have support from
other African Americans who help to buffer the effects of racism.
Similarly, three of the five stages of gay identity, gay identity
confusion/comparison, gay identity tolerance, and gay identity synthesis did not predict
traumatic stress in African American gay men. The gay identity confusion/comparison
and the gay identity tolerance reflect earlier phases of gay identity development where
men may not identify themselves as gay and may not participate in a study of this
nature. Seventy -nine percent of the sample described their sexual orientation as gay
and 18.3% chose same-gender loving (Manago & Howcott, 2006) as a description of
their sexual orientation. In addition, the snowball sampling method used to recruit
participants limits the diversity of the sample.
The lack of significance in the relationship between gay identity synthesis and
traumatic stress may also reflect a lack of diversity in the sample. However, this stage of
development is characterized by letting go of the us versus them perspective and a
sense of pride is integrated into one's gay identity. Thus, the men in this stage of gay
identity development may be less affected by the stressors of living as a member of a
marginalized social identity group.
Two stages of gay identity, gay identity acceptance and gay identity pride were
positively related to each of the dimensions of traumatic stress (hyperarousal,
depression, intrusive experiences, dissociation, sexual concerns, and dysfunctional
sexual behavior). Therefore, when controlling for all other variables, gay identity
acceptance and gay identity pride are making a significant unique contribution to the
prediction of traumatic stress in African American gay men.
Gay identity acceptance made the strongest unique contribution in predicting
intrusive experiences (3= .598) and depression (3= .582). Of the participants with the
highest scores on gay identity acceptance 38.2% scored in the mid range on African
self consciousness and 34.4% scored in the high range on African self consciousness.
Gay identity pride made the strongest unique contribution in predicting depression (3=
.476) and dissociation (3= .464). Of the participants with the highest scores on gay
identity pride, 40% scored in the mid range on African self consciousness and 55%
scored in the high range on African self consciousness.
The gay identity acceptance stage is marked by an emerging self-acceptance of
one's gay identity, passing as heterosexual when necessary, and beginning to disclose
one's gay identity to others. The gay identity pride stage is characterized by immersion
in gay culture, engagement in activism, and increased disclosure of one's gay identity.
The significance found between these stages of gay identity and traumatic stress
suggests that men with a less integrated identity and those who are immersed in gay
culture, are engaged in activism, and are more open about their gay identity, experience
increased stress. It is important to note that there is no causal relationship between gay
identity and traumatic stress. These findings reflect the stress that is involved in
belonging to a marginalized social identity group.
Limitations of this study include the sampling methods, use of technology to
administer the survey, participant self-reporting bias, and the impact of the sample size
on analyses.
Snowball sampling was used to recruit African American gay men from social
networks. This sampling method limits the diversity of the sample by selecting those
who belong to certain social networks; thereby, negatively affecting the generalizability
of the results. In addition, this sampling method limited the researcher's ability to
calculate the response rate.
Another limitation is the use of electronic mail to distribute the link to the survey. It
excluded potential participants who either do not have access to this technology or are
uncomfortable with its use.
Participant self-reporting bias is also a limitation of this study. The DSM-IV-TR
(American Psychiatric Association, 2000) describes the symptomatology of traumatic
stress by the diagnostic criteria for PTSD. PTSD is characterized by exposure to a
traumatic event in which a person experiences or witnesses events that threaten death
or serious injury and the person's response involves intense fear, helplessness or
horror. The survey did not assess whether participants had experienced any events that
meet the current DSM-IV-TR definition of traumatic stress. Thus, the researcher is
unable to verify whether participants' responses accurately reflect their experiences of
traumatic stress related to either their identity as African Americans or their identity as
gay men.
This study reflects African American gay men's voices from different age groups,
various occupations and income levels, different religious affiliations and from all
regions of the United States. However, the small sample size (N=104), is a limitation
that impacts the power of the analysis, which may limit the ability to detect relationships
between variables.
Intersectionality of identity is gaining increased attention in the literature. Another
limitation of this study is the lack of significance in the relationship between African self-
consciousness and gay identity. This is further explored in the recommendations for
future research.
Table 4.1. Distribution of participants by age range
Range in years Frequency Percent
20-25 16 15.4
26-30 6 5.8
>70 1 1.0
Note: Data were missing for 2 respondents
Table 4.2. Distribution of participants by highest level of education completed
Frequency Percent
High school diploma/equivalent 7 6.7
Business or trade school 2 1.9
Some college 19 18.3
Associate or two-year degree 12 11.5
Bachelor's or four-year degree 13 12.5
Some graduate/professional school 11 10.6
Graduate or professional degree 40 38.6
Table 4.3. Distribution of participants by current occupation
Arts/Entertainment 4 3.8
Business 11 10.6
Communications 2 1.9
Counseling 2 1.9
Education 13 12.5
Education Administration 3 2.9
Government 2 1.9
Healthcare 4 3.8
Hotel/Hospitality 3 2.9
Information Technology 2 1.9
Insurance Industry 4 3.8
Legal 2 1.9
Management 9 8.7
Non-profit 4 3.8
Public Health 5 4.8
Religion 1 1.0
Retired 4 3.8
Self Employed 3 2.9
Social Work 1 1.0
Student 13 12.5
Transportation 2 1.9
Travel Industry 1 1.0
Unemployed 2 1.9
Table 4.4. Distribution of participants by income level
Less than $10,000 15 14.4
$10,000- $24,999 13 12.5
$25,000 $34,999 9 8.7
$35,000 $49,999 23 22.1
More than $75,000 18 17.3
Table 4.5. Descriptive statistics
N Minimum Maximum Mean Std. Deviation
Statistic Statistic Statistic Statistic Statistic
African Self-Consciousness 90 77.00 136.00 103.6889 12.84011
Gay Identity Confusion 94 7.00 23.00 9.3830 3.21992
Gay Identity Comparison 93 7.00 32.00 10.7634 4.59300
Gay Identity Tolerance 96 6.00 25.00 12.2813 4.82691
Gay Identity Acceptance 99 7.00 40.00 18.8485 9.50442
Gay Identity Pride 97 7.00 34.00 21.0515 5.60017
Gay Identity Synthesis 97 8.00 65.00 27.5670 8.34904
TSI Hyperarousal 97 .00 18.00 7.8866 4.65447
TSI Depression 96 .00 23.00 6.8958 5.72985
TSI Intrusive Experiences 98 .00 20.00 6.6224 4.80660
TSI Defensive Avoidance 100 .00 27.00 10.0700 5.89171
TSI Dissociation 96 .00 26.00 7.8958 5.11238
TSI Sexual Concerns 98 .00 26.00 7.8878 5.16507
TSI Dysfunctional Sexual 95 .00 25.00 8.3789 4.40304
Table 4.6. Results of Pearson correlation analyzing the relationship between African self-consciousness and
GIDCONF/COMP
Sig. (2-tailed)
.534 .460
.458*
-.518*
**. Correlation is significant at the 0.01 level (2-tailed).
Table 4.7. Results of multiple regression of ethno-cultural identity, gay identity and
hyperarousal
1 (Constant)
Unstandardized
Coefficients
B Std. Error
-8.144 5.943
-.290 .171
a. Dependent variable: Hyperarousal
(Constant)
a. Dependent variable: Depression
intrusive experiences
a. Dependent variable: Intrusive experiences
Table 4.10. Results of multiple regression of ethno-cultural identity, gay identity and
defensive avoidance
Model Coefficients
1 (Constant) -14.198 6.672
ASC .094 .049
GIDCONF/COMP .048 .114
GIDTOL -.088 .202
GIDACC .280 .108
GIDPRIDE .415 .135
GIDSYN .023 .088
a. Dependent variable: Defensive avoidance
a. Dependent variable: Dissociation
sexual concerns
a. Dependent variable: Sexual concerns
1 (Constant) -3.462 5.197
a. Dependent variable: Dysfunctional sexual behavior
The purpose of this chapter is to discuss the significant findings regarding ethno-
cultural identity, sexual orientation and traumatic stress in adult African American gay
men. A summary of the findings will be presented. Additionally, implications for theory
and practice, as well as limitations of the study, and future research will be discussed.
Summary of Significant Findings
This study examined the stress experienced by African American gay men at
different stages of gay identity. Analyses detected a positive relationship between 2 of
the 5 stages of gay identity (gay identity acceptance and gay identity pride) and each of
the dimensions of traumatic stress (hyperarousal, depression, intrusive experiences,
defensive avoidance, dissociation, sexual concerns, and dysfunctional sexual behavior).
The significance found between gay identity acceptance and gay identity pride and
traumatic stress suggests that men with an emerging, less integrated identity (gay
identity acceptance stage), and those whose gay identity is more salient (gay identity
pride stage), experience traumatic stress. The gay identity acceptance stage
involves greater acceptance of and ambivalence about one's gay identity. It also
includes occasional passing as heterosexual. In essence, as one embraces his gay
identity, the reality of his membership in a marginalized social identity group creates
increased stress especially when considering the potential for isolation, discrimination,
and violence. The pride stage is a more solidified identity that is marked by increased
disclosure of one's gay identity, immersion in gay culture, and activism. Men in this
stage are more likely to be the target of anti-gay bias, discrimination, and violence thus,
creating a more stressful existence.
These findings are consistent with studies (Comstock, 1989; D'Augelli, 1992;
Garnets, Herek et.al., 1997; Herek, 1993; Otis & Skinner, 1996; Savin-Williams, 1994)
addressing the stress that results from familial abuse, harassment, maltreatment, gay-
victimization as well as more subtle forms of discrimination after disclosure of one's gay
identity. Research shows that African American gay men live with chronic stress in their
daily lives. They face systemic oppression that impacts their psychological well-being
and threatens their survival (Meyer, 2003). They experience employment, housing and
legal discrimination and are often marginalized in education and health care settings
(Mays & Cochran, 2001). These men also face possible rejection by their families
(Icard, 1996; Wise, 2001), from religious institutions (Greene, 2001; Griffin, 2006; Parks,
2001) and are at increased risk for psychological, emotional and physical violence
(Huebner, Rebchook & Kegeles, 2004). Studies show that internalized homophobia,
stigma and events of discrimination and violence predict psychological distress in gay
men (David & Knight, 2008; Haatzenbuehler, Nolen-Hoeksema & Erickson, 2008; Mays
& Cochran, 2001; Rosario, Rotheram-Borus & Reid, 1996; Zamboni & Crawford, 2007).
Implications for Theory
Traumatic stress theory was used as a theoretical framework for this study. The
symptoms of traumatic stress describe the diagnostic criteria for posttraumatic stress
disorder (PTSD) as outlined in the DSM-IV-TR (American Psychiatric Association,
2000). However, experiences of discrimination including racism and homophobia are
not included in the DSM-IV-TR as precipitants to traumatic stress. The results of this
study reveal a positive relationship between gay identity acceptance and traumatic
stress and gay identity pride and traumatic stress, which shows that even at advanced
stages of gay identity development, participants in this study experience stress related
to their identity as gay men. These results offer empirical evidence in support of
expanding the definition of traumatic stress to include belonging to marginalized identity
groups, which has also been suggested by scholars investigating the traumatic effects
of racism (Bryant-Davis & Ocampo, 2005; Carter, 2007; Friedman & Marsella, 1996;
Utsey, Bolden & Brown, 2001).
Expanding the definition of traumatic stress to include those who live on the
margins of society as a result of discrimination and systemic oppression, as well as
those who are exposed to verbal, psychological, and emotional abuse as suggested by
Herman (1992), would legitimize their experiences. It would also provide a theoretical
framework for counselors to better understand and conceptualize presenting problems
and to develop appropriate interventions. In addition, those confronting traumatic stress
that results from discrimination, systemic oppression, and abuse would have greater
access to mental health resources to support their treatment and recovery.
This study also highlights the need for more sophisticated identity development
models. Current models that explain identity development among ethnic and racial
groups (Cross, 1995; Helms, 1995; Phinney, 1992) and sexual minorities (Cass, 1979;
Minton & McDonald, 1984; Troiden, 1979) lay out stages that lead to positive
ethnic/racial and gay identities. However, they have been criticized for suggesting that
growth is linear and bound by well-defined categories that are uncharacteristic of the
human experience (Martinez & Sullivan, 1998). Moreover, the current conceptualization
of these models lack sufficient integration of multiple identities and overlook the stress
that is associated with the developmental process. As such, they tend to over-
generalize and can be inadequate when shaping an understanding of how African
American gay men formulate their identities (Fukuyama & Ferguson 2000).
One of the instruments used in this study, the Gay Identity Questionnaire, is based
on the gay identity development model designed by Cass (1979). Results reveal that
participants experience significant stress as they gain acceptance of and pride in their
gay identity. These findings suggest that while the model captures an individual's level
of acceptance of their gay identity, it does not address the influence of other identities,
the sociopolitical context of their development, or the stress that is involved in the
Minton & McDonald, 1984). An appreciation of intersectionality requires an
acknowledgement of the existence of multiple identities. In addition, it necessitates an
understanding of oppression, both internal and external, and its role in identity
development. Finally, an awareness of traumatic stress and its effects is essential in
understanding the challenges inherent in negotiating intersecting identities.
Implications for Practice
Implications of the findings from this study mandate transformation of the
counseling profession. This transformation involves embracing the social justice and
advocacy aspects of counselor identity and requires counselor competence in culture-
centered assessment, case conceptualization, and intervention. This transformation
also incorporates an understanding of intersectionality of identity as well as the role of
traumatic stress in African American gay men's identity development.
It has been suggested that belonging to a group whose identity is stigmatized can
result in chronic stress and also lead to mental disorders (Berg, Mimiaga, & Safren,
2008; Mays & Cochran, 2001; Carter, 2007; Huebner & Davis, 2007; Israel & Selvidge,
2003; Meyer, 2003; Savin-Williams, 2001). Moreover, belonging to multiple stigmatized
identity groups can be especially challenging and even debilitating (Fukuyama &
Ferguson, 2000; Greene, 2001). Results of this study reveal that African American gay
men experience traumatic stress at the gay identity acceptance and gay identity pride
These findings offer opportunities for the counseling profession to embrace a
better understanding of African American gay men's identity development and to
disseminate this knowledge. For example, the core competencies set forth by the
American Counseling Association and its divisions, the Association for Multicultural
Counseling and Development and the Association for Lesbian, Gay, Bisexual, and
Transgender Issues in Counseling should reflect the attitudes, knowledge, and skills
necessary to effectively address traumatic stress in this population. This knowledge
may be disseminated through journal publications, conference presentations, and
through social justice and advocacy activities.
A key component of emotional and psychological health is the ability to advocate
on one's own behalf and that of other marginalized individuals. As such, leaders in
counseling have called for the integration of social justice and advocacy into counselor
identity (Ivey, 2003; Lewis et al., 2003). Moreover, there is a need to expand the
understanding of social justice in multicultural competence (West-Olatunji, 2010).
Counselors can engage in social justice and advocacy by lobbying for revisions to the
DSM-IV-TR to include experience of marginalization and discrimination as precipitants
to traumatic stress. This action would not only benefit African American gay men, other
marginalized social identity groups would benefit as well. Additionally, counselors can
advocate for changes in social and political structures that keep African American gay
men on the margins of society. In addition to addressing this issue on a systemic level,
counselors have opportunities to incorporate this knowledge into their individual and
group work with clients.
In order to better understand African American gay men's identity development, it
is critical that counselors conduct more comprehensive, culture-centered assessments.
Use of culture-centered approaches in assessment and case conceptualization requires
an awareness of the sociopolitical context of African American gay men's lives and
incorporates an understanding of how they are affected by the stress of coping with
multiple oppressed identities (Wynn & West-Olatunji, 2009). With a better understanding
of the identity development trajectory of African American gay men, counselors can
develop more effective interventions leading to better outcomes.
This study underscores the importance of counselors exploring the coming out
process with their African American gay male clients. They should not assume that all
gay men will choose to disclose their gay identity to others, nor should they assume that
if they do decide to come out that their lives will be less stressful. In fact, results of this
study suggest that they may experience increased levels of stress after disclosing their
identity. With this knowledge, counselors can develop interventions that help African
American gay male clients improve their coping skills and build resources for additional
In addition to understanding the dynamics of identity development and coming out
from a culture-centered perspective, counselors should also be skilled at facilitation of
critical consciousness so that African American gay men become aware of their social
positioning and the sociopolitical context of their concerns (Goodman & West-Olatunji,
2009; .Ivey, 2003; Lewis, Lewis, Daniels, & D'Andrea, 2003). These interventions are
critical for increasing agency and, ultimately, resilience.
Finally, in order to create a safe, therapeutic environment, it is critical that
counselors are aware of their own attitudes toward African American gay men.
Counselors can explore their attitudes and beliefs by expanding their personal
boundaries to include interaction with this population and by engaging in professional
development activities that assist them in confronting their biases.
Recommendations for future research with African American gay men include
recruiting a larger, more diverse (different stages of gay identity) sample. Also,
enhancing the research design to explore intersetionality of identity, assess for previous
exposure to traumatic events, and inquire about the salience of identity would provide
rich data for analysis. Studies that address African American gay men's experience of
religion, as well as their current geographic location, and their involvement in the mental
health services delivery system would open avenues for a better understanding of the
factors that influence their identity development process.
A larger, more diverse sample of African American gay men may be obtained by
sampling attendees at events such as the annual Black Gay Pride celebrations that are
held in multiple cities throughout the United States. In addition, the use of existing
research databases would provide the responses needed to achieve maximum
statistical power. This study did not reveal a significant relationship between African
self-consciousness and gay identity; however, the literature suggests that a negative
relationship exists. Expanding the sample size would increase the power of the analysis
and may detect a relationship.
Recruitment of a diverse sample that represents different stages of gay identity
development should also be considered for future research. No significance was found
in the relationships between gay identity confusion/comparison and traumatic stress and
gay identity tolerance and traumatic stress. These stages reflect early phases of gay
identity development where men may not identify themselves as gay and may not
participate in a study of this nature. Seventy -nine percent of the sample described their
sexual orientation as gay and 18.3% chose same-gender loving, a term embraced by
many African Americans (Manago & Howcott, 2006), as a description of their sexual
orientation. The lack of significance in the relationship between gay identity synthesis, a
more integrated identity, and traumatic stress may also reflect a lack of diversity in the
sample.
Future studies should assess African American gay men's exposure to traumatic
events that meet the current DSM-IV-TR definition of traumatic stress in order to rule
out traumatic experiences that are not related to ethnicity, race, or sexual orientation. In
addition, studies should investigate the degree to which traumatic stress affects the
lives of African American gay men and highlight the effect of the stress on their
Fukuyama and Ferguson (2000) asserted that gay people, particularly the
culturally diverse, who are managing multiple identities, respond to the shifting salience
receive the benefits of group membership. An inquiry into the ways in which African
American gay men negotiate their identities in different environments such as the
workplace and social settings could be the focus of future studies. This would provide
more information about the shifting salience of identity and offer insight into what African
American gay men may need in order to maintain a more consistent expression of their
identity. African American culture endorses strong kinship bonds within the nuclear
family, the extended family, and with fictive kin (Bellgrave & Allison, 2006; Boykin, 1983;
Boykin & Ellison, 1995; Chatters, Taylor, & Joyakody, 1994; McAdoo, 1993; Nobles,
2004). As such, future studies should examine the role of family dynamics in the identity
development process of African American gay men.
2006; Parks, 2001). In this study, 68% of the participants identified their religion as
Christian and 47% reported that religion is very important. Given the current anti-gay
climate in many religious communities, as well as the importance that religion holds for
many African American gay men, future studies investigating the relationship between
religion, spirituality, and gay identity might be particularly fruitful.
Other demographic data from this study offer information about African American
gay men that can be explored in further research. For example, 64% of participants live
in the Southern region of the United States. This area is underrepresented in the
literature on gay identity and related issues. As such, an increase in studies, both
quantitative and qualitative, investigating quality of life for African American gay men in
the South would increase knowledge about this population and fill a current gap in the
The challenges that gay people face in their involvement in the mental health
that gay people face in the mental health service delivery system often results in
Sullivan, & Mays, 2003; Walters, Simoni, & Horwath, 2001). Research that examines
the experiences of African American gay men in the mental health services delivery
system would offer insight into how to improve access to services and how to enhance
diagnosis, intervention, and treatment.
Finally, use of qualitative methodology can illuminate the concerns of African
American gay men and may identify possible risk factors that make them vulnerable as
well as the protective factors that support their resilience. Such inductive investigations
might advance knowledge about the relationship between intersectionality of identity,
traumatic stress, and African American gay men. Outcomes of such studies might
enhance counselors' understanding, conceptualization, and treatment of African
American gay men. Results may also further inform quantitative research. Utilizing a
culture-centered methodological framework in research design and implementation as
well as in data interpretations (Tillman, 2002; West-Olatunji, 2005) might reduce the
influence of cultural bias in research inquiry that contributes to the systemic oppression
of marginalized groups.
This chapter provided a discussion of the results of this study, the implications for
theory and practice, its limitations, and recommendations for future research. The
findings indicated no association between African self-consciousness and gay identity.
However, this is inconsistent with the current literature on intersectionality of identity and
may be explained by the small sample size limiting the power to detect a relationship.
findings are consistent with current literature on gay identity development and stress
and reflect the need for ongoing support, as well as additional resources, throughout the
identity development process for African American gay men.
This study underscores the need to reconsider the theoretical framework of
traumatic stress. The results support broadening the definition to include experiences of
marginalization and discrimination, particularly related to gay identity, as precipitants to
traumatic stress. Additionally, identity development theories should be revised to
incorporate the intersectionality of multiple identities, as well as an understanding of the
stress involved in living as a member of one or more marginalized identity groups.
Implications for practice involve improving culture-centered assessment, case
conceptualization, and treatment. In addition, the practice of mental health counseling
can be strengthened by integrating social justice and advocacy into counselor identity.
Future research should embrace culture-centered approaches. In addition, the
inclusion of a comprehensive history of traumatic experiences in the research design
will further clarify the influence of ethnicity, race, and gay identity on the experience of
traumatic stress in this population. Research that focuses on salience of identity, the
role of religion, and implications of geographical location, may provide avenues for a
greater understanding of the factors that influence identity development in African
In conclusion, this study provides insight into the identity development of African
American gay men and offers empirical evidence of the stress that is involved in the
process. It is the hope of the researcher that this study will inform and enlighten and
lead to further research that illuminates the lived experience of African American gay
UFIRB #2010-U-076
Protocol Title: The Intersection of Ethno-Cultural Identity, Sexual Orientation, and
Traumatic Stress in Adult African American Gay Men
Please read this consent document carefully before you decide to participate in
The purpose of this study is to investigate the relationship between ethno-cultural
identity, sexual orientation, and traumatic stress in adult African American gay men. You
will be asked to complete a demographic questionnaire and a brief survey. The time
required to complete this survey is approximately 30 45 minutes. There are no known
risks or direct benefits from participation in this study. Compensation will not be
provided. Your identity will remain anonymous.
Your participation in this study is completely voluntary and there is no penalty for not
participating. You have the right to withdraw from the study at anytime without
consequence.
If you have questions about the study, please contact me: Richmond Wynn, MS,
Doctoral Candidate, Counselor Education Program, School of Human Development and
Organizational Studies in Education (SHDOSE) College of Education University of
Florida 1204 Norman Hall PO Box 117046 Gainesville, FL 32611-7046 rwynn@ufl.edu.
Or, you can contact my faculty advisor: Cirecie A. West-Olatunji, Ph. D. Counselor
Education Program, School of Human Development and Organizational Studies in
Education (SHDOSE) College of Education University of Florida 1204 Norman Hall PO
Box 117046 Gainesville, FL 32611-7046 (352) 273-4324 (office) (352) 846-2697 (fax)
cwestolatunji@coe.ufl.edu. If you wish to know more about your rights as a research
participant in the study, please contact the IRB02 Office, Box 112250, University of
Florida, Gainesville, FL 32611-2250; phone 392-0433.
RECRUITMENT EMAIL
My name is Richmond Wynn, a doctoral candidate in the Counselor Education Program
at the University of Florida in Gainesville, Florida, and I am seeking participants for my
dissertation research. The UF Institutional Review Board has approved this study.
The purpose of this study is to better understand African American gay men's
experiences of traumatic stress in their identity development process. You must be 18
years of age or older in order to participate. Your participation will contribute to the
understanding of African American gay men's unique identity development experiences.
The survey will take approximately 30 minutes to complete.
Clicking the link below will direct you to an electronic informed consent agreement
followed by the survey. Participation in this study is anonymous (i.e., you will not be
asked to disclose any identifying information, nor will your responses be connected to
any identifying information) and the survey service will not track your Internet Protocol
(IP) address. Further, you may discontinue participation at any time.
If you have any questions about this study, or would like to be informed of its findings,
please contact me, Richmond Wynn, at rwynn(@ufl.edu. If you would like to speak with
my primary advisor about the study, please contact Dr. Cirecie West-Olatunji at
cwestolatunji@coe.ufl.edu.
To participate in this study please click on this link
https://www.surveymonkey.com/s/DZ8FW5Q or copy and paste the link into the
address block of your Web browser.
I appreciate your time and consideration!
Richmond Wynn, MS
Doctoral Candidate, Counselor Education Program
School of Human Development and Organizational Studies in Education (SHDOSE)
1204 Norman Hall PO Box 117046
DEMOGRAPHIC FORM
(1) Male LJ Female LJ Transgender LJ Other LJ (please
indicate)
(2) Date of birth
(3) Please indicate your racial/cultural background.
LO African (Born on the continent of Africa)
LO African American/Black (Non-Latino)
LO Afro Caribbean
LJ Latino American (Non African American/Black)
LO Multiracial/Multiethnic (please indicate)
LO Other (please indicate)
(4) What is the highest education level you have completed?
LO Elementary school (K-5th grade)
LO Middle school (6th-8th grade)
LO Some high school
LO High school diploma/equivalent
LJ Business or trade school
LO Some college
LJ Associate or two-year degree
LJ Bachelors or four-year degree
LJ Some graduate/professional school
LO Graduate or professional degree
(5) What is your current occupation?
(6) What is your current religious affiliation?
LO No religion
LJ Buddhist
LJ Christian
LJ Hindu
LO Jewish
LO Muslim
(7) How often do you attend religious services? Seldom LO Sometimes LO Often LJ
(8) How important is your religion to you?
Not Important LJ Somewhat Important LJ Very Important LJ
(9) How would you describe the primary geographical region in which you were raised?
Northeast LJ South LO Midwest LJ West LJ
(10) How would you describe the primary geographical region in which you currently
live?
(11) What is the racial/cultural composition of the community listed in #10?
Mostly African American/Black LO MulticulturalO Mostly White LJ
(12) Are you: a United States citizen LJ a permanent resident of the US LO or a
Resident AlienO
(13) How many ethnic organizations do you belong to? 1 L 20 30 40 50 5+L0
(15) How would you describe your current income level?
LO Less than $10,000
LJ $10,000 to $24,999
LO $25,000 to $34,999
LO More than $75,000
(16) Please check the term that best describes your sexual orientation
LJ Gay (Males who experience the desire for warmth and affection from other males)
LO Same gender loving (A term embraced by many men of color to describe males
who experience the desire for warmth and affection from other males)
LO Bisexual (The desire to experience warmth and affection that is not limited to
gender)
L Heterosexual (The desire to experience warmth and affection from someone
whose gender is different from your own)
L Other (please indicate)
(17) Please describe your current relationship status
L Single
L Partnered
L Married
L Divorced
L Separated
L Widowed
THE AFRICAN SELF-CONSCIOUSNESS SCALE (SHORT-FORM)
INSTRUCTIONS: The following statements reflect some beliefs, opinions and attitudes of Black people.
Read each statement carefully and give your honest feelings about the beliefs and attitudes expressed.
Indicate the extent to which you agree or disagree using the following scale.
1 = Very Strongly 2 = Strongly Disagree 3 =Moderately 4 = Slightly Disagree
Disagree Disagree
5= Slightly Agree 6 = Moderately Agree 7 = Strongly Agree 8 = Very Strongly
Note that the higher the number you choose for the statement, the more you Agree with that statement;
and conversely, the lower the number you choose, the more you Disagree with that statement. Also, there
are no right or wrong answers, only the answer that best expresses your present feelings about the
statement. Please respond to ALL of the statement (do not omit any). Bubble-in your choices in the
space provided.
ANSWER CHOICES 1 2 3 4 5 6 7 8
PLEASE CHOOSE ONLY
5. Blacks in America should O O O O O O O O
try harder to be American
than practicing activities
that link them up with their
African cultural heritage.
6. Regardless of their O O O O O O O O
interests, educational
background and social
achievements, I would
prefer to associate with
Black people than with non-
Blacks.
7. It is not a good idea for O O O O O O O O
Black students to be
required to learn an African
9. It is not within the best O O O O O O O O
interest of Blacks to depend
on Whites for anything, no
matter how religious and
decent they (the Whites)
purport to be.
10. Black children should O O O O O O O O
be taught that they are
African people at an early
11. White people, generally O O O O O O O O
speaking, are not opposed
to self-determination for
12. As a good index of self- O O O O O O O O
respect, Blacks in America
should consider adopting
traditional African names for
themselves.
13. AWhite/European or O O O O O O O O
Caucasian image of God
and the "holy family"
(among others considered
close to God) are not such
bad things for Blacks to
worship.
14. Blacks born in the O O O O O O O O
United States are Black or
African first, rather than
American of just plain
15. Black people who talk in O O O O O O O O
a relatively loud manner,
show a lot of emotions and
feelings, and express
themselves with a lot of
movement and body motion
are less intelligent than
Blacks who do not behave
this way.
16. Racial consciousness O O O O O O O O
and cultural awareness
based on traditional African
values are necessary to the
development of Black
marriages and families that
can contribute to the
liberation and enhancement
of Black people in America.
19. I have difficulty O O O O O O O O
identifying with the culture
of African People.
20. It is intelligent for Blacks O O O O O O O O
in America to organize to
educate and liberate
themselves form White-
American domination.
21. There is no such thing O O O O O O O O
as African culture among
Blacks in America
22. It is good for Black O O O O O O O O
husbands and wives to help
each other develop racial
consciousness and cultural
awareness in themselves
and their children.
24. It is good for Blacks in O O O O O O O O
America to wear traditional
African-type clothing and
hairstyles if they desire to
do so.
25. I feel little sense of O O O O O O O O
commitment to Black
people who are not close
friends or relatives.
be taught to love all races
of people, even those races
who do harm to them.
28. Blacks in America who O O O O O O O O
view Africa as their
homeland are more
intelligent than those who
view America as their
homeland.
29. If I saw Black children O O O O O O O O
fighting, I would leave them
to settle it alone.
APPENDIX E
MODIFIED GAY IDENTITY QUESTIONNAIRE
Instructions: Please read each of the following statements carefully and then
indicate the degree of your agreement or disagreement with each statement
by circling the rating that best reflects your response to the statement.
Mildly Mildly
Disagree Disagree Agree
Agree Agree
1) I probably am
sexually attracted
equally to men and
2) I live a homosexual
lifestyle at home,
while at work/school I
do not want others to
know about my
lifestyle.
3) My homosexuality
is a valid private
identity that I do not
want made public.
4) I have feelings I
would label as
homosexual.
5) I have little desire
to be around most
heterosexuals.
6) I doubt that I am
homosexual, but still
am confused about
how I am sexually.
7) I do not want most
heterosexuals to
know that I am
8) I am very proud to
be gay and make it
known to everyone
around me.
9) I don't have much
heterosexuals and
can't say that I miss
10) I generally feel
comfortable being the
only gay person in a
group of
11) I'm probably
homosexual, even
though I maintain a
heterosexual image in
both my personal and
public life.
12) I have disclosed
to 1 or 2 people (very
few) that I have
homosexual feelings,
although I'm not sure
I'm homosexual.
13) I am not as angry
about treatment of
gays because even
though I've told
everyone about my
gayness, they have
responded well.
14) I am definitely
homosexual but I do
not share that
knowledge with most
Strongly Mildly
Disagree Disagree Disagree
Mildly Strongly
Agree Agree Agree
15) I don't mind if
homosexuals know
that I have
homosexual thoughts
and feelings, but I
don't want others to
16) More than likely
I'm homosexual,
although I'm not
positive about it yet.
17) I don't act like
most homosexuals
do, so I doubt that I'm
homosexual, but I'm
not sure yet.
19) I am openly gay
and fully integrated
into heterosexual
20) I don't think that
21) I don't feel as if
I'm heterosexual or
22) I have thoughts I
23) I don't want
people to know that I
may be homosexual,
if I am homosexual or
24) I may be
homosexual and I am
upset at the thought
25) The topic of
homosexuality does
not relate to me
personally.
26) I frequently
confront people about
their irrational,
homophobic (fear of
homosexuality)
feelings.
27) Getting in touch
with homosexuals is
something I feel I
need to do, even
though I'm not sure I
want to.
28) 1 have
and feelings but I
doubt that I'm
29) I dread having to
deal with the fact that
I may be homosexual.
Strongly Mildly Mildly Strongly
Disagree Disagree Disagree Agree Agree Agree
30) I am proud and
open with everyone
about being gay, but 1 2 3 4 5 6
it isn't the major focus
of my life.
31) I probably am
heterosexual or non-
sexual.
32) I am
experimenting with
my same sex
because I don't know 1 2 3 4 5 6
what my sexual
preference is.
33) I feel accepted by
homosexual friends
and acquaintances;
even though I'm not
sure I'm homosexual.
express to others,
anger over
heterosexuals' 1 2 3 4 5 6
oppression of me and
other gays.
35) I have not told
most of the people at
work that I am 1 2 3 4 5 6
36) I accept but would
not say I am proud of
the fact that I am
definitely 1 2 3 4 5 6
37) I cannot imagine
sharing my
homosexual feelings
with anyone.
38) Most
heterosexuals are not
credible sources of
help for me.
40) I engage in
sexual behavior I
41)1 am not about to
stay hidden as gay for
anyone.
42) I tolerate rather
than accept my
and feelings.
43) My heterosexual
friends, family and
associates think of
me as a person who
happens to be gay,
rather than as a gay
44) Even though I am
homosexual, I have
not told my family.
with everyone, but it
doesn't make me feel
all that different from
APPENDIX F
TRAUMA SYMPTOM INVENTORY
The licensing agreement with the publisher, Psychological Assessment Resources,
permits a total of three survey items to be published from this instrument.
Instructions: Please circle the one answer that best indicates how often each of the
following experiences has happened to you in the last 6 months.
Circle 0 if your answer is NEVER; it has not happened at all in the last 6 months.
Circle 1 or 2 if it has happened in the last 6 months, but has not happened often.
Circle 3 if your answer is OFTEN; it has happened often in the last 6 months.
Defensive Avoidance Subscale
Staying away from certain people or places because they reminded you of something
Sexual Concerns Subscale
Confusion about your sexual feelings
Dysfunctional Sexual Behavior Subscale
Having sex that had to be kept a secret from other people
Aarts, P. G. H. (1998). Intergenerational effects in families of World War II survivors
from the Dutch East Indies: Aftermath of another Dutch War. In Y. Danieli (Ed.),
International handbook of multigenerational legacies of trauma (pp. 175-187).
New York: Plenum.
Akbar, N. (1991). Mental disorders among African Americans. In R. Jones (Ed.), Black
psychology. Berkeley, CA: Cobb & Henry.
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental
Disorders-Text Revision (4th ed.). Washington, DC: Author.
Anderson, R. N. (2002). Deaths: Leading causes for 2000. Hyattesville, MD: National
Center for Health Statistics.
Arredondo, P., Tovar-Blank, Z. G., & Parham, T. A. (2008). Challenges and promises of
becoming a culturally competent counselor in a sociopolitical era of change and
empowerment. Journal of Counseling and Development, 86, 261-268.
Atkinson, D. R. & Hackett, C. (1988). Counseling non-ethnic American minorities.
Springfield, IL: Charles C. Thomas.
Azibo, D. (1983). Some psychological concomitants and consequences of the black
personality: mental health implications. Journal of Non-White Concerns in
Personnel and Guidance, 11, 59-66.
Azibo, D. (1989). African-centered theses on mental health and a nosology of
Black/African personality disorder. Journal of Black Psychology, 15(2), 173-214.
Baldwin, J. A. (1981). Notes on an Africentric theory of black personality. The Western
Journal of Black Studies, 5, 172-179.
Baldwin, J. A. & Bell, Y. R. (1985). The African self-consciousness scale: An Africentric
personality questionnaire. Psychology of Black Americans, 9(2), 61-68.
Baldwin, J. A., Brown, R., & Rackley, R. (1990). Some socio-behavioral correlates of
African self-consciousness in African American college students. The Journal of
Black Psychology, 17(1). 1-17.
Baldwin, J. A., Duncan, J. A., & Bell, Y. R. (1992). Assessment of African self-
consciousness among black students from two college environments. In K. A.
Burlew, W. C. Banks, H. P. McAdoo, & D. A. Azibo (Eds.), Africa American
psychology; Theory, research, and practice. Newbury Park, CA: Sage.
Bancroft, J., Carnes, L., Janssen, E., Goodrich, D. & Long, J. S. (2005).Erectile and
ejaculatory problems in gay and heterosexual men. Archives of Sexual Behavior,
34, 285-297.
Barret, R., & Barzan, R. (1996). Spiritual experiences of gay men and lesbians.
Counseling & Values, 41, 4-16.
Becker, D. (1995). The deficiency of the concept of posttraumatic stress disorder when
dealing with victims of human rights violations. In R. J. Kleber, C. R. Figley, & B.
P. R. Gersons(Eds.), Beyond trauma: Cultural and societal dynamics (pp. 99-
110). New York: Plenum Press.
Bellgrave, F. Z. & Allison, K. W. (2006). African American psychology: From Africa to
America. Thousand Oaks, CA: Sage.
Berg, M. B., Mimiaga, M. J., & Safren, S. A. (2008). Mental health concerns of gay and
bisexual men seeking mental health services. Journal of Homosexuality, 54(3),
293-306. doi: 10.1080/00918360801982215
Bernstein, M. M. (1998). Conflicts in adjustment: World War II prisoners of war and their
families. In Y. Danieli (Ed.), International handbook of multigenerational legacies
of trauma (pp. 119-124). New York: Plenum.
Bostwick, W. B., Hughes, T. L., & Johnson, T. (2005). The co-occurrence of depression
and alcohol dependence symptoms in a community sample of lesbians. Journal
of Lesbian Studies, 9(3), 7-18. doi:10.1300/J155v09n03_02
Bowen-Reid, T. L., & Harrell, J. P. (2002). Racist experiences and health outcomes: An
examination of spirituality as a buffer. Journal of Black Psychology,28(1), 18-36.
Boykin, A. W. (1983). The academic performance of Afro-American children. In J.
Spence (Ed.), Achievement and achievement motives (pp. 324-371). San
Francisco, CA: W. Freeman.
Boykin, A. W., & Ellison, C. M. (1995). The multiple ecologies of black youth
socialization: An Afrographic analysis. In R. L. Taylor (Ed.), African American
youth: Their social and economic status in the United States (pp. 93-129).
Westport, CT: Praeger.
Boykin, K. (2005). Beyond the down low: Sex, lies and denial in Black America. New
York: Carroll & Graf.
Brady, S. (1998). Gay Identity Questionnaire. In C.M. Davis, W. L. Yarber, R.
Bauserman, G. Schreer, & S. L. Davis (Eds), Handbook of Sexuality-Related
Measures (pp. 373-375). Thousand Oaks, California: Sage Publications, Inc.
Brady, S., & Busse, W. J. (1994). The Gay Identity Questionnaire: A brief measure of
homosexual identity formation. Journal of Homosexuality, 26(4), 1-22.
Breuer, J., & Freud, S. (1962). Studies on hysteria. On the psychical mechanism of
hysterical phenomena: Preliminary communication. In J. Strachey (Ed. & trans.),
The standard edition of the complete psychological works of Sigmund Freud (Vol.
2, pp. 3-17). London:Hogarth Press. (Original work published 1893).
Bridges, S. K., Selvidge, M. M. D. & Matthews, C. R. (2003). Lesbian women of color:
Therapeutic issues and challenges. Journal of Multicultural Counseling and
Development, 31, 113-130.
Briere, J. (1995). Trauma symptom inventory professional manual. Lutz, Florida:
Psychological Assessment Resources, Inc.
Briere, J., Elliot, D. M., Harris, K., Cotman, A. (1995). Trauma symptom inventory:
Psychometrics and association with childhood and adult victimization in clinical
samples. Journal of Interpersonal Violence, 10(4), 387-401.
Bridges, S. K., Selvidge, M. M. D., & Matthews, C. R. (2003). Lesbian women of color:
Brown II, E. (2005). We wear the mask: African-American contemporary gay male
identities. Journal of African American Studies, 9(2), 29-38.
Brown, L. (1995). Not outside the range. In C. Caruth (Ed.), Trauma: Explorations in
memory (pp. 100-112). Baltimore: Johns Hopkins University Press.
Brown, L. S. (2005). Lesbian identities: Concepts and issues. In A. R. D'Augelli & C. J.
Patterson (Eds.), Lesbian, gay, and bisexual identities over the lifespan, (pp. 3-
23). New York: Oxford University Press.
Bryant-Davis, T. & Ocampo, C. (2005). Racist incident-based trauma. The Counseling
Psychologist, 33(4), 479-500. doi: 10.1177/0011000005276465
Burstow, B. (2003). Toward a radical understanding of trauma and trauma work.
Violence Against Women, 9, 1293-1317.
Burstow, B. (2005). A critique of posttraumatic stress disorder and the DSM. Journal of
Humanistic Psychology, 45, 429-445.
Carpineto, J., Kubicek, K., Weiss, G., Iverson, E. & Kipke. M. D. (2008). Young men's
perspectives on family support and disclosure of same-sex attraction. Journal of
LGBT Issues in Counseling, 2(1), 53-80. doi: 10.1080/15538600802077533
Carroll, L. (2010). Counseling sexual and gender minorities. Upper Saddle River, NJ:
Carter, R. T. (2007). Racism and psychological and emotional injury: Recognizing and
assessing race-based traumatic stress. The Counseling Psychologist, 35(1), 13-
105. doi: 10.1177/0011000006292033
Cass, V. C. (1979). Homosexual identity formation: Testing a theoretical model. Journal
of Homosexuality, 4, 219-235.
CDC (2009). HIV/AIDS and men who have sex with men (MSM). Centers for Disease
Control. Retrieved January 1, 2010 from http://www.cdc.gov/hiv/topics/msm/
Chan, C. S. (1995). Issues of sexual identity in an ethnic minority: The case of Chinese
American lesbians, gay men, and bisexual people. In A. R. D'Augelli, & C. J.
Patterson (Eds.), Lesbian, gay, and bisexual identities over the lifespan (pp. 87-
101). New York: Oxford University Press.
Chatters, L. M., Taylor, R. J., & Joyakody, R. (1994). Fictive kinship relations in Black
extended families. Journal of Contemporary Family Studies, 25, 297-312.
Christian, T. Y. (2005). Good Cake: An Ethnographic Trilogy of Life Satisfaction among
Gay Black Men. Men and Masculinities, 8(2), 164-174.
Cochran, S. D., Ackerman, D., Mays, V. M., & Ross, M. W. (2004). Prevalence of
nonmedical drug use and dependence among homosexually active men and
women in the US population. Addiction, 99, 989-998. doi:10.1111/j.1360-
0443.2004.00759.
Cochran, S. D. & Mays, V. M. (2000). Relation between psychiatric syndromes and
behaviorally defined sexual orientation in a sample of the US population.
American Journal of Epidemiology, 151(5), 516-523.
Cochran, S. D., Sullivan, J. G., & Mays, V. M. (2003). Prevalence of mental disorders,
psychological distress, and mental services use among lesbian, gay, and
bisexual adults in the United States. Journal of Consulting and Clinical
Psychology, 71(1), 53-61.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.).
Hillsdale, NJ: Lawrence Earlbaum Associates, Inc.
Coleman, E. (1981). Developmental stages of the coming out process. Journal of
Homosexuality, 7(2), 31-43.
Comstock, G. D. (1989). Victims of anti-gay/lesbian violence. Journal of Interpersonal
Violence, 4, 101-106.
Constantine, M. G. & Ponterotto, J. G. (2006). Evaluating and selecting psychological
measures for research purposes. In F. T. L. Leong & J. T. Austin (Eds.), The
Psychology Research Handbook (2nd ed., pp.104-113). Thousand Oaks, CA:
Sage Publications.
Cosgrove, L. (2005). When labels mask oppression: Implications for teaching
psychiatric taxonomy. Journal of Mental Health Counseling, 27, 283-296.
Crawford, I, Allison, K.W., Zamboni, B. D. & Soto, T. (2002). The influence of dual-
identity development on the psychosocial functioning of African American gay
and bisexual men. The Journal of Sex Research, 39 (3), 179-189.
Cross, W. E. (1995). The psychology of nigrescence: Revising the Cross model. In J.
Ponterotto, J. Manuel Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook
of multicultural counseling (pp. 93-122). Thousand Oaks, CA: Sage Publications.
Cross, W.E., Jr. (1971). The Negro-to-black conversion experience. Black World 20(9),
Cross, W. E., Jr. (1991). Shades of black: Diversity in African-American identity.
Philadelphia: Temple University Press.
Dank, B. M. (1971). Coming out in the gay world. Psychiatry, 34, 180-197.
Danieli, Y. (1998). Introduction: History and conceptual foundations. In Y. Danieli (Ed.),
International handbook of multigenerational legacies of trauma (pp. 1-20). New
York: Plenum.
Dass-Brailsford, P. (2007). A practical approach to trauma: Empowering interventions.
Los Angeles: Sage.
D'Augelli, A.R. (1992). Lesbian and gay male undergraduates' experiences of
harassment and fear on campus. Journal of Interpersonal Violence, 7(3), 383-
D'Augelli, A. R. (1998). Developmental implications of victimization of lesbian, gay, and
bisexual youths. In G. M. Herek (Ed.). Stigma and sexual orientation:
Understanding prejudice against lesbians, gay men, and bisexuals.
Psychological perspectives on lesbian and gay issues (pp. 187-210). Thousand
Oaks, CA: Sage.
D'Augelli, A. R., Hershberger, S. L., & Pilkington, N. (2002). Suicidality patterns and
sexual orientation-related factors among lesbian, gay, and bisexual youths.
Suicide and Life-Threatening Behavior, 31, 250-264.
David, S. & Knight, B. G. (2008). Stress and coping among gay men: Age and ethnic
differences. Psychology and Aging, 23(1), 62-69. doi: 10.1037/0882-
7974.23.1.62
Diaz, R. M., Ayala, G., Bein, E., Henne, J., & Marin, B. V. (2001). The impact of
homophobia, poverty, and racism on the mental health of gay and bisexual
Latino men: Findings from 3 US cities. American Journal of Public Health, 91,
DiPlacido, J. (1998). Minority stress among lesbians, gay men, and bisexuals: A
consequence of heterosexism, homophobia, and stigmatization. In G. Herek
(Ed.), Stigma and sexual orientation: Understanding prejudice against lesbians,
gay men, and bisexuals (pp. 138-159). Thousand Oaks, CA: Sage.
Duran, E., Duran, B., Yellow Horse Brave Heart, M., & Yellow Horse-Davis, S. (1998).
Healing the American Indian soul wound. In Y. Danieli (Ed.), International
handbook of multigenerational legacies of trauma (pp. 341-354). New York:
Plenum.
Eriksen, K., & Kress, V. E. (2006). The DSM and the professional counseling identity:
Bridging the gap. Journal of Mental Health Counseling, 28, 202-217.
Fassinger, R. E. (1991). The hidden minority: Issues and challenges in working
with lesbian women and gay men. The Counseling Psychologist, 19, 157-176.
Fergusson, D. M., Horwood, L. J., & Beautrais, A. L. (1999). Is sexual orientation related
to mental health problems and suicidality in young people? Archives of General
Psychiatry, 56, 876-880.
Fernandez, E. (2001). [Review of the test Trauma Symptom Inventory]. In B. S. Plake &
J. C. Impara (Eds.), The fourteenth mental measurements yearbook (pp. 1289-
1290). Lincoln, NE: Buros Institute of Mental Measurements.
Figley, C. R. (1988). Toward a field of traumatic stress. Journal of Traumatic Stress, 1,
Floyd, F. J. & Bakeman, R. (2006). Coming -out across the life course: Implications of
age and historical context. Archives of Sexual Behavior, 35(3), 287-298. doi:
Frable, D. E. S. (1997). Gender, racial, ethnic, sexual, and class identities. Annual
review of psychology, 48, 1139-162.
Freud, S. (1962). The aetiology of hysteria. In J. Strachey (Ed. & Trans.), The standard
edition of the complete psychological works of Sigmund Freud (Vol. 3, pp. 191-
221). London:Hogarth Press. (Original work published 1896)
Friedman, M. J. & Marsella, A. J. (1996). Posttraumatic stress disorder: An overview of
the concept. In A. J. Marsella, M. J. Friedman, E. T. Gerrity & R. M. Scurfield
(Eds.). Ethnocultural aspects of posttraumatic stress disorder: Issues, research
and clinical applications (pp.11-32). Washington, D.C.: American Psychological
Frist, M. B. & Tasman, A. (Eds.) (2004). DSM-IV-TR mental disorders: Diagnosis,
etiology and treatment (pp. 926-925). Hoboken, NJ: John Wiley & Sons.
Fukuyama, M. A., & Ferguson, A. D. (2000). Lesbian, gay, and bisexual people of color:
Understanding cultural complexity and managing multiple oppressions. In R. M.
Perez, K. A. DeBord, & K. J. Bieschke (Eds.), Handbook of counseling and
psychotherapy with lesbian, gay, and bisexual clients (pp. 81-105). Washington,
DC: American Psychological Association.
Gardner, F. (1999). Transgenerational processes and the trauma of sexual abuse.
European Journal of Psychotherapy, Counseling & Health, 2, 297-308.
Garnets, L., Herek G. M., & Levy, B. (1990). Violence and victimization of lesbians and
gay men: Mental health consequences. Journal of Interpersonal Violence, 5,
Garofalo, R., Wolf, R. C, Wissow, L. S., Woods, E. R., & Goodman, E. (1999). Sexual
orientation and risk of suicide attempts among a representative sample of youth.
Archives of Pediatrics and Adolescent Medicine, 153, 487-493.
Garrett, M. T., & Barret, B. (2003). Two spirit: Counseling Native American gay, lesbian
and bisexual people. Journal of Multicultural Counseling and Development, 31,
Gilfus, M. (1999). The price of the ticket. Violence Against Women, 5, 1238-1257.
Gilman, S. E., Cochran, S. D., Mays, V. M., Hughes, M., Ostrow, D., & Kessler, R. C.
(2001). Prevalences of DSMIII-R disorders among individuals reporting same-
gender sexual partners in the National Comorbidity Survey. American Journal of
Public Health, 91, 933-939.
Gonsiorek, J. C. (1995). Gay male identities: Concepts and issues. In A. R. D'Augelli &
C. J. Patterson (Eds.), Lesbian, gay, and bisexual identities over the lifespan (pp.
24-47). New York: Oxford University Press.
Goodman, R. D. & West-Olatunji, C. A. (2009). Applying critical consciousness:
Culturally competent disaster response outcomes. Journal of Counseling and
Development, 87(4), 458-465.
Greene, B. (2001). Heterosexism and racism among African Americans: The
connections and considerations for African American lesbian and bisexual
women: A clinical psychological perspective. Rutgers Law Review, 54, 931-957.
Greene, B. (1997). Ethnic minority lesbians and gay men. In B. Greene (Ed.), Ethnic
and cultural diversity among lesbians and gay men (pp. 216-239). Thousand
Greenwood, G. L., White, E. W., Page-Shafer, K., Bein, E., Osmond, D. H., Paul, J. &
Stall, R. D. (2001) Correlates of heavy substance use among young gay and
bisexual men: the San Francisco Young Men's Health Study. Drug and Alcohol
Dependence, 61, 105-112.
Guthrie, R. V. (1998). Even the rat was white: A historical view of psychology (2nd ed.)
Needham Heights, MA: Allyn & Bacon. (Original work published in 1976)
Griffin, H. L. (2006). Their own receive them not: African American lesbians and gays in
Black churches. Cleveland, OH: The Pilgrim Press.
Haldeman, D. C. (2002). Gay rights, patient rights: The implications of sexual orientation
conversion therapy. Professional Psychology: Research and Practice, 33(3),
260-264. doi: 10.1037/0735-7028.33.3.260
Halkitis, P. N., Parsons, J. T., & Wilson, L. (2003). Factors related to methamphetamine
use among gay and bisexual men in New York City. Journal of Drug Issues,
33(2), 413-432.
Halpern, J., & Tramontin, M. (2007). Disaster mental health: Theory and practice.
Belmont: CA. Thompson Brooks/Cole.
Halpin, S. A. & Allen, M. W. (2004). Changes in psychosocial well-being during stages
of gay identity development. Journal of Homosexuality 47(2), 109-126. doi:
10.1300/J082v47n02_07
Hamlet, J. D. (1998). Afrocentric visions: Studies in culture and communication.
Thousand Oaks, CA: Sage.
Hatzenbuehler, M. L., Nolen-Hoeksema, S. & Erickson, S. J. (2008). Minority stress
predictors of HIV risk behavior, substance use and depressive symptoms:
Results from a prospective study of bereaved gay men. Health Psychology,
27(4), 455-462. doi: 10.1037/0278-6133.27.4.455
Hayes, R. A. (1996). Differences in social support, coping, and attitudes toward
homosexuality between African-American and Caucasian men living with HIV.
Dissertation Abstracts International: Section B: The Sciences & Engineering,
56(9-B), 5171.
Helms, J. E. (1995). An update of Helm's White and people of color racial identity
models. In J. Ponterotto, J. Manuel Casas, L. A. Suzuki & C. M. Alexander
(Eds.), Handbook of multicultural counseling (pp. 93-122). Thousand Oaks, CA:
Hencken, J. D., & O'Dowd, W. T. (1977). Coming out as an aspect of identity formation.
Gai Saber, 1(1), 18-22.
Herek, G. M. (1993). Documenting prejudice against lesbians and gay men on campus:
The Yale Sexual Orientation Survey. Journal of Homosexuality, 25(4), 15-30.
Herek, G, M., Gillis, J. R., Cogan, J. C., & Glunt, E. K. (1997). Hate crime victimization
among lesbian, gay, and bisexual adults: Prevalence, psychological correlates,
and methodological issues. Journal of Interpersonal Violence, 12(2), 195-215.
Herman, J. (1997). Trauma and recovery. New York: Basic Books.
Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and
repeated trauma. Journal of Traumatic Stress, 5(3), 377-391.
Huebner, D. M. & Davis, M. C. (2007). Perceived antigay discrimination and physical
health outcomes. Health Psychology, 26(5), 627-634. doi: 10.1037/0278-
6133.26.5.627
Huebner, D. M., Rebchook, G. M. & Kegeles, S. M. (2004). Experiences of harassment,
discrimination and physical violence among young gay and bisexual men.
American Journal of Public Health, 94(7), 1200-1203.
Icard, L. D. (1996). Assessing the Psychosocial Well-Being of African American Gays: A
Multidimensional Perspective. Journal of Gay & Lesbian Social Services, 5(2/3),
Israel, T., & Selvidge, M. M. D. (2003). Contributions of multicultural counseling to
counselor competence with lesbian, gay and bisexual clients. Journal of
Multicultural Counseling and Development, 31, 84-98.
Ivey, A. E. (2003). Social justice: A long-term challenge for counseling psychology. The
Counseling Psychologist, 31, 290-298. doi: 10.1177/0011000003031003004
James, R. K., & Gilliland, B. E. (2005). Crisis intervention strategies (5th ed.). Belmont,
CA: Brooks/Cole.
Janet, P. (1965). The major symptoms of hysteria (2nd ed.). New York: Hafner
Publishing Company. (Original work published 1929)
Kambon, K. K. (1998). African/Black psychology in the American context: An African-
centered approach. Tallahassee, FL: Nubian Nation Press.
Kardiner, A., & Spiegel, H. (1947). War stress and neurotic illness (2nd ed.). New York:
Hoeber, Inc.
Kira, I. A. (2001). Taxonomy of trauma and trauma assessment. Traumatology, 7, 73-
Kitzinger, C. (1996). Speaking of oppression: Psychology, politics and the language of
power. In E. D. Rothblum & L. A. Bond (Eds.), Preventing heterosexism and
homophobia (pp.3-19). Thousand Oaks, CA: Sage.
Lee, J. A. (1977). Going public A study in the sociology of homosexual liberation.
Journal of Homosexuality, 3, 49-78.
Levine, H. (1997). A further exploration of the lesbian identity development process and
its measurement. Journal of Homosexuality 34(2), 67-78.
Lewis, T. (1999). Living beside. Toronto, Canada: McGilligan Books.
Lewis, J. A., Lewis, M. D., Daniels, J. A., & D'Andrea, M. J. (2003). Community
counseling: Empowerment strategies for a diverse society (3rd ed.). Pacific
Grove, CA: Brooks/Cole-Thomson.
Lifton, R. J. (1967). Death in life: Survivors of Hiroshima. New York: Random House.
Loiacano, D. K. (1989). Gay identity issues among black Americans: Racism,
homophobia, and the need for validation. Journal of Counseling and
Development, 68, 21-25.
Lyons, H. Z., Brenner, B. R., & Fassinger, R. E. (2005). A multicultural test of the theory
of work adjustment: Investigating the role of heterosexism and fit perceptions in
the job satisfaction of lesbian, gay, and bisexual employees. Journal of
Counseling Psychology, 52, 537-548. doi: 10.1037/0022-0167.52.4.537
Luckstead, A. (2004). Lesbian, gay, bisexual, and transgender people receiving
services in the public mental health system: Raising issues. Journal of Gay and
Lesbian Psychotherapy, 8(3/4), 25-42. doi 10.1300/J236v08n03_03
Manago, C. & Howcott, T. (2006). Why the term same gender loving. Retrieved June
20, 2010 from http://terryhowcott.com/greenspace.asp?id=151
Martinez, D. G., & Sullivan, S. C. (1998). African-American gay men and lesbians:
Examining the complexity of gay identity development. Journal of Human
Behavior in the Social Environment, 1(2/3), 243-264.
Marszalek, J. F., III, Cashwell, C. S., Dunn, M. S. & Jones, K. H. (2004). Comparing gay
identity development theory to cognitive development: An empirical study.
Journal of Homosexuality 48(1), 103-123. doi: 10.1300/J082v48n01_05
Matthews, C. R. & Selvidge, M. M. D. (2005). Lesbian, gay, and bisexual clients'
experiences in treatment for addiction. Journal of Lesbian Studies, 9(3), 79-90.
doi:10.1300/J155v09n03_08
Mays & Cochran (2001). Mental health correlates of perceived discrimination among
lesbian, gay, and bisexual adults in the United States. Journal of Public Health,
91(11), 1869-1876.
McAdoo, H. P. (1993). The social cultural contexts of ecological developmental family
models. In P. Boss, W. Doheerty, & W. Schyumm (Eds.), Sourcebook of family
theories and methods: A contextual approach (pp. 298-301). New York: Plenum.
McCowan, C. J., & Alston, R. J. (1998). Racial identity, African self-consciousness, and
career decision making in African American college women. Journal of
McDaniel, J. S., Purcell, D., & D'Augelli, A. R. (2001). The relationship between sexual
orientation and risk for suicide: Research findings and future directions for
research and prevention. Suicide and Life Threatening Behavior, 17, 84-105.
McDonald, G. J. (1982). Individual differences in the coming out process for gay men:
Implications for theoretical models. Journal of Homosexuality, 8(1), 47-60.
McKirnan, D. J., Tolou-Shams, M., Turner, L., Dyslin, K., & Hope, B. (2006). Elevated
risk for tobacco use among men who have sex with men is mediated by
demographic and psychosocial variables. Substance Use & Misuse, 41, 1197-
1208. doi: 10.1080/108260805000514503
McLaughlin, J. E. (2002). Reducing diagnostic bias. Journal of Mental Health
Counseling, 24, 256-269.
Mead, M. A., Hohenshil, T. H., & Kusum, S. (1997). How the DSM system is used by
clinical counselors: A national study. Journal of Mental Health Counseling, 19,
Morin, S. F. & Rothblum, E. D. (1991). Removing the stigma: Fifteen years of progress.
American Psychologist, 46(9), 947-949.
Meyer, I. H. (2003). Prejudice, social stress and mental health in lesbian, gay and
bisexual populations: Conceptual issues and research evidence. Psychological
Bulletin, 129(5), 674-697. doi: 10.1037/0033-2909.129.5.674
Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and
Social Behavior, 36, 38-56.
Myers, L. J. (1988). Understanding an Afrocentric world-view: Introduction to an optimal
psychology. Dubuque, IA: Kendall/Hunt.
Miller Jr., R. L. (2007). Legacy denied: African American gay men, AIDS, and the black
church. Social Work, 52(1), 51-61.
Minton, H. L., & McDonald, G. J. (1984). Homosexual identity formation as a
developmental process. Journal of Homosexuality, 9, 91-104.
Nobles, W. (1976). Extended-self: Rethinking the so-called Negro self-concept. Journal
of Black Psychology, 11(2), 15-24.
Nobles, W. (1980). African philosophy: Foundations for black psychology. In R. Jones
(Ed.), Black psychology. New York: Harper & Row.
Nobles, W. (1997). African American family life: An instrument of culture. In McAdoo, H.
P., (Ed.), Black families (3rd ed., pp. 83-93). Thousand Oaks, CA: Sage.
Nobles, W. W. (1991). African philosophy: Foundations for black psychology. In R.
Jones (Ed.), Black psychology (3rd ed., pp. 47-63). Berkeley, CA: Cobbs &
Henry.
Jones (Ed.), Black psychology (4th ed., pp. 47-63). Berkeley, CA: Cobbs &
Otis, M. D., & Skinner, W. F. (1996). The prevalence of victimization and its effect on
mental well-being among lesbian and gay people. Journal of Homosexuality, 30,
93-121.
Parham, T. A., White, J. L., & Ajamu, A. (2000). The psychology of Blacks (3rd ed.).
Upper Saddle River, NJ: Prentice Hall.
Parks, C. W. (2001). African American same-gender-loving youth and families in urban
schools. Journal of Gay and Lesbian Social Services, 13, 41-56.
Parks, C, Hughes, T., & Matthews, A. (2004). Race/ethnicity and sexual orientation:
Intersecting identities. Cultural Diversity and Ethnic Minority Psychology, 10 (3),
Pedersen, P. B., & Ivey, A. (1993). Culture-centered counseling and interviewing skills:
A practical guide. Westport, CT: Praeger.
Phinney, J. S. (1992). The multigroup ethnic identity measure: A new scale for use with
diverse groups. Journal of Adolescent Research, 7, 156-176.
Phinney J. (1991. Ethnic identity and self-esteem: A review and integration. Hispanic
Journal of Behavioral Science (13), 193-208.
Plummer, K. (1975). Sexual stigma: An interactionist account. London: Routledge &
Kegan Paul.
Raphael, B., Swan, P., & Martinek, N. (1998). Intergenerational aspects of trauma for
Australian Aboriginal people. In Y. Danieli (Ed.), International handbook of
multigenerational legacies of trauma (pp. 327-339). New York: Plenum.
Reid, J. D. (1995). Development in late life: Older lesbian and gay lives. In A. R.
D'Augelli & C. J. Patterson (Eds.), Lesbian, gay, and bisexual identities over the
lifespan (pp. 216-240). New York: Oxford University Press.
Rogers, R.R. (1998). The impact of gay identity and perceived milieu toward gay
employees on job involvement and organizational commitment of gay men
(Doctoral dissertation). Available from ProQuest Dissertations and Theses
database. (UMI No. 9820217)
Root, M. (1992). Restructuring the impact of trauma on personality. In L. Brown & M.
Ballour (Eds.), Personality and psychopathology (pp. 108-118). New York:
Guilford.
Rosario, M., Rotheram-Borus, M. J., & Reid, H. (1996). Gay -related stress and its
correlates among gay and bisexual male adolescents of predominantly Black and
Hispanic background. Journal of Community Psychology, 24,136-159.
Rosario, M., Schrimshaw, E. W. & Hunter, J. (2004). Ethnic/racial differences in the
coming out process of lesbian, gay and bisexual youths: A comparison of sexual
identity development over time. Cultural Diversity and Ethnic Minority
Psychology, 10(3), 215-228.
Rosario, M., Hunter, J., Maguen, S., Gwadz, M., & Smith, R. (2001). The coming-out
process and its adaptational and health-related associations among gay, lesbian,
and bisexual youths: Stipulation and exploration of a model. American Journal of
Community Psychology, 29(1), 133-160.
Rosenheck, R., & Fontana, A. (1998a). Transgenerational effects of abusive violence on
the children of Vietnam combat veterans. Journal of Traumatic Stress, 11, 731-
Rosenthal, B. S., & Wilson, W. C. (2003). The association of ecological variables and
psychological distress with exposure to community violence among adolescents.
Adolescence, 38, 459-479.
Rothschild, B. (2000). The body remembers. New York, NY: W.W. Norton & Company,
Rowen, C. J. & Malcolm, J. P. (2002). Correlates of internalized homophobia and
homosexual identity formation in a sample of gay men. Journal of Homosexuality,
43(2), 77-92.
Rust, P. C. (2001). Two many and not enough: The meanings of bisexual identities.
Journal of Bisexuality, 1(1), 33-68.
Rutter, P. A. (2007). Young adult suicide and sexual orientation: What should
counselors know? Journal of LGBT Issues in Counseling, 1(3), 33-48.
Rutter, P., & Soucar, E. (2002). Youth suicide risk and sexual orientation. Adolescence,
37(146), 289-299.
Salazar, C., & Abrams, L. (2005). Conceptualizing identity development in members of
marginalized groups. Journal of Professional Counseling: Practice, Theory, &
Research, 33, 47-59.
Savin-Williams, R. C. (2001). A critique of research on sexual-minority youths. Journal
of Adolescence, 24, 5-13.
Savin-Williams, R. C. (1994). Verbal and phsyical abuse as stressors in the lives of
lesbian, gay male, and bisexual youths: Associations with school problems,
running away, substance abuse, prostitution, and suicide. Journal of Consulting
and Clinical Psychology, 62(2), 261-269.
Savin-Williams, R. C., & Ream, G. L. (2003). Suicide attempts among sexual-minority
male youth. Journal of Clinical Child & Adolescent Psychology, 32(4), 509-522.
Scaer, R. C. (2001). The body bears the burden: Trauma, dissociation and disease.
Binghamtom, NY: Haworth Press.
Schechter, D. S., Brunelli, S. A., Cunningham, N., Brown, J., & Baca, P. (2002). Mother-
daughter relationships and sexual abuse: A pilot study of 35 days. Bulletin of the
Menninger Clinic, 66, 39-60.
Seligman, L. (1999). Twenty years of diagnosis and the DSM. Journal of Mental Health
Stall, R., Paul, J. P., Greenwood, G., Pollack, L. M., Bein, E., Crosby, G. M., Mills, T. C.,
Binson, D., Coates, T. J. & Catania, J. A. (2001) Alcohol use, drug use and
alcohol-related problems among men who have sex with men: The Urban Men's
Health Study. Addiction, 96, 1589-1601.
Sandfort, T. G. M., & de Keizer, M. (2001). Sexual problems in gay men: An overview of
empirical research. Annual Review of Sex Research, 12, 93-120.
Stone, C. B. (2003). Counselors as advocates for gay, lesbian, and bisexual youth: A
call for equity and action. Journal of Multicultural Counseling & Development, 31,
Sudarkasa N. (1997) African American families and family values. In McAdoo, H. P.,
(Ed.), Black families (3rd ed., pp. 9-40). Thousand Oaks, CA: Sage.
Sue, D. W., Arredondo, P., & McDavis, R. J. (1992). Multicultural counseling
competencies and standards: A call to the profession. Journal of Counseling &
Sue, D. W., & Sue, D. (2008). Counseling the culturally diverse: Theory and practice (5th
ed.). New York: Wiley & Sons.
Tajfel, H. (1978). Social categorization, social identity and social comparison. In H.
Tajfel (Ed.), Differentiation between social groups: Studies in the social
psychology of intergroup relations (pp.61-76). London: Academic Press.
Tillman, L. C. (2002). Culturally sensitive research approaches: An African American
perspective. Educational Researcher, 31(9), 3-12.
Tozer, E. E. & Hayes, J. A. (2004). Why do individuals seek conversion therapy? The
Counseling Psychologist, 32(5), 716-740. doi: 10.1177/0011000004267563
Trimble, M. R. (1981). Post-traumatic neurosis: From railway spine to whiplash. New
York: John Wiley & Sons.
Troiden, R. R, (1979). Becoming homosexual: A model gay identity acquisition.
Psychiatry: Journal for the Study of Interpersonal Processes, 42, 362-373.
Utsey, S. O., Bolden, M. A., & Brown, A. L. (2001). Visions of revolution from the spirit
of Frantz Fanon: A psychology of liberation for counseling African Americans
confronting societal racism and oppression. In J. G. Ponterotto, J. M. Casas, L.
A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (2nd
ed., pp. 311-336). Thousand Oaks, California: Sage Publications, Inc.
van der Kolk, B. A. (1996). The body keeps the score: Approaches to the psychobiology
of posttraumatic stress disorder. In B. A. van der Kolk, McFarlane, A. C. & L.
Weisaeth (Eds.), Traumatic stress (pp.214-241). New York: The Guilford Press.
van der Kolk, B. A., & McFarlane, A. C. (1996). The black hole of trauma. In B. A. van
der Kolk, McFarlane, A. C. & L. Weisaeth (Eds.), Traumatic stress (pp.3-23).
New York: The Guilford Press.
van der Kolk, B. A., & van der Hart, 0. (1989). Pierre Janet and the breakdown of
adaptation in psychological trauma. American Journal of Psychiatry, 146, 1530-
van der Kolk, B. A., van der Hart, O. & Marmar, C. R. (1996). Dissociation and
information processing in posttraumatic stress disorder. In B. A. van der Kolk,
McFarlane, A. C. & L. Weisaeth (Eds.), Traumatic stress (pp.303-327). New
York: The Guilford Press.
Walters, K. L., Simoni, J. M., & Horwath, P. F. (2001). Sexual orientation bias
experiences and service needs of gay, lesbian, bisexual, transgendered, and
two-spirited American Indians. Journal of Gay and Lesbian Social Services,
13(1/2), 133-149.
Weisaeth, L. (2002). The European history of traumatology. Journal of Traumatic
Stress, 15, 443-452.
West-Olatunji, C. (2010). Use of advocacy competencies with culturally diverse clients.
In M. J. Ratts, R. L. Toperek, & J. A. Lewis, & (Eds), ACA advocacy
competencies (pp. 55-64). Alexandria, VA: American Counseling Association.
West-Olatunji, C. A. (2005). Incidents in the lives of Harriet Jacobs's children-A readers
theater: Disseminating the outcomes of research on the Black experience in the
academy. In J. E. King (Ed.), Black education: A transformative research and
action agenda for the new century (pp. 329-340). Mahwah, New Jersey:
Lawrence Erlbaum Associates.
White, J. L. (1972). Toward a black psychology. In R. Jones (Ed.), Black psychology.
New York; Harper & row.
Whitney, C. (2006). Intersections of identity Identity development among queer
women with disabilities. Sexuality and Disability, 24, 39-52. doi:
Wise, S. J. (2001). Redefining black masculinity and manhood: Successful black gay
men speak out. Journal of African American Men, 5(4), 3-23.
Wynn, R., & West-Olatunji, C. (2009). Culture-centered case conceptualization using
NTU psychotherapy with an African American gay male client. Journal of LGBT
Issues in Counseling, 2(4), 308-325. doi 10.1080/15538600802501995
Zamboni, B. D. & Crawford, I. (2007). Minority stress and sexual problems among
African American gay and bisexual men. Archives of Sexual Behavior, 36,569-
578. doi: 10.1007/sl0508-006-9081
Zimmerman, M., & Mattia, J. I. (1999). Is posttraumatic stress disorder underdiagnosed
in routine clinical settings? Journal of Nervous & Mental Disease. 187, 420-428.
Richmond David Wynn was born in 1967 in Cocoa, Florida. In 1990, he received a
Bachelor of Science degree in sociology from the University of Florida. He received a
Master of Science degree in health specializing in mental health and addiction
counseling from the University of North Florida in 1997. He is a licensed mental health
counselor and certified addictions professional in the State of Florida.
THE INTERSECTION OF ETHNO-CULTURA L IDENTITY, SEXUAL ORIENTATION AND TRAUMATIC STRESS IN ADULT AFRICAN AMERICAN GAY MEN By RICHMOND DAVID WYNN A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 2010 1
2010 Richmond David Wynn 2
To my partner 3
ACKNOWLEDGMENTS I thank my committee member s, Drs. Cirecie West-Olatunji, David Miller, Ana Puig, Erica McCray, and Shari Robinson fo r their guidance and support throughout my doctoral studies. I am most grateful to my c hair, Dr. Cirecie West-O latunji, for being a mentor, advisor, and role model. I thank Dr s. Peter Sherrard and Carlos Hernandez for assisting me during the early phases of this process. I offer heartfelt appreciation to my partner, Diego M. Pagan Ortiz, for his endur ing love, patience and support. Finally, I extend my deepest thanks to all of the men who participated in this study. 4
TABLE OF CONTENTS page ACKNOWLEDG MENTS .................................................................................................. 4LIST OF TABLES ............................................................................................................ 7LIST OF ABBR EVIATIONS ............................................................................................. 8ABSTRACT ..................................................................................................................... 9 CHAPTER 1 INTRODUC TION .................................................................................................... 10Population and Pa rameters .................................................................................... 10Problem Stat ement ................................................................................................. 10Research Q uestions ............................................................................................... 14Hypotheses ............................................................................................................. 15Definition of Terms .................................................................................................. 16Significance of the Study ........................................................................................ 17Limitations of the Study ........................................................................................... 172 REVIEW OF THE LITERATU RE ............................................................................ 19Further Delineation of the Probl em ......................................................................... 19African American Cultur e ........................................................................................ 28Gay Identity ............................................................................................................. 32Intersectionality of Ident ity ...................................................................................... 35Family Acc eptance ........................................................................................... 36Religion and Sp iritualit y .................................................................................... 38Traumatic Stress Theory ......................................................................................... 39History of Traum atic St ress .............................................................................. 39Etiology of Traumatic Stress ............................................................................. 41Race-Based Traumatic Stress .......................................................................... 43Traumatic Stress in Afri can American Gay M en ..................................................... 48Summary ................................................................................................................ 493 METHODOL OGY ................................................................................................... 52Research Method ................................................................................................... 52Population and Setting ............................................................................................ 52Instrument ation ....................................................................................................... 53African Self-Conscious ness Scale (ASC) ......................................................... 53Gay Identity Questi onnaire ( GIQ) ..................................................................... 55Trauma Symptom Inv entory (T SI) .................................................................... 56Summary ................................................................................................................ 57 5
Limitations ............................................................................................................... 58Data Collection Procedures .................................................................................... 58Data Anal ysis .......................................................................................................... 584 RESULT S ............................................................................................................... 63Research Q uestions ............................................................................................... 63Hypotheses ............................................................................................................. 64Participant Descripti ve Inform ation ......................................................................... 65Data Analyses and Result s ..................................................................................... 66Limitations of the Study ........................................................................................... 795 DISCUSSI ON ......................................................................................................... 89Summary of Signifi cant Findi ngs ............................................................................ 89Implications for Theory ............................................................................................ 90Implications fo r Practi ce .......................................................................................... 92Future Res earch ..................................................................................................... 95Summary ................................................................................................................ 99 APPENDIX A INFORMED CO NSENT ........................................................................................ 101B RECRUITMENT EMAIL ........................................................................................ 102C DEMOGRAPHIC FORM ....................................................................................... 103D THE AFRICAN SELF-CONSCIOUSN ESS SCALE (SHORT -FORM) ................... 106E MODIFIED GAY IDENTI TY QUESTIONNA IRE .................................................... 109F TRAUMA SYMPTOM INVENTORY ...................................................................... 115REFERENCES ............................................................................................................ 116BIOGRAPHICAL SK ETCH .......................................................................................... 133 6
7 LIST OF TABLES Table page 2.1 African Amer ican cult ure .................................................................................... 513.1 African self-consciousness scale Four factors ................................................. 603.2 Stages of homosexua l identity fo rmation ............................................................ 613.3 Trauma symptom inv entory sub scales ............................................................... 624.1 Distribution of par ticipants by age range ............................................................ 824.2 Distribution of participants by hi ghest level of educat ion comple ted ................... 824.3 Distribution of participant s by current occupatio n ............................................... 834.4 Distribution of partici pants by income level ......................................................... 834.5 Descriptive statisti cs ........................................................................................... 844.6 Results of Pearson correlation anal yzing the relationship between African self-consciousness an d gay ident ity ................................................................... 854.7 Results of multiple regression of ethno-cultural identity, gay identity and hyperarous al ....................................................................................................... 864.8 Results of multiple regression of ethno-cultural identity, gay identity and depression .......................................................................................................... 864.9 Results of multiple regression of ethno-cultural identity, gay identity and intrusive exper iences .......................................................................................... 864.10 Results of multiple regression of ethno-cultural identity, gay identity and defensive av oidance ........................................................................................... 874.11 Results of multiple regression of et hno-cultural identity, gay identity andn dissociat ion ......................................................................................................... 874.12 Results of multiple regression of ethno-cultural identity, gay identity and sexual concerns .................................................................................................. 874.13 Results of multiple regression of ethno-cultural identity, gay identity and dysfunctional sex ual behavior............................................................................. 88
LIST OF ABBREVIATIONS ASC African self-consciousness GIQIDCONF/COMP Gay identit y confusion and comparison GIDTOL Gay identity tolerance GIDACC Gay identity acceptance GIDPRIDE Gay identity pride GIDSYN Gay identity synthesis 8
9 Abstract of Dissertation Pr esented to the Graduate School of the University of Florida in Partial Fulf illment of the Requirements for t he Degree of Doctor of Philosophy THE INTERSECTION OF ETHNO-CULTURA L IDENTITY, SEXUAL ORIENTATION AND TRAUMATIC STRESS IN ADULT AFRICAN AMERICAN GAY MEN By Richmond David Wynn August 2010 Chair: Cirecie West-Olatunji Major: Mental Health Counseling The purpose of study was to examine the relationship between ethno-cultural identity, sexual orientation and traumatic stress in adult African American gay men. These constructs were measured by the African Self-Consciousness Scale Short Form, the Modified Gay Identit y Questionnaire, and select subscales of the Trauma Symptom Inventory. Quantitat ive methods were employed. Data was collected by surveying a national sample of adult Afri can American gay men via snowball sampling through an electronic mail link to the survey. Pearson correlation and multiple regression analysis were used to analyze the data. Results revealed no statistically significant relationship between African se lf-consciousness and gay identity. However, statistically significant positive relationships were found between gay identity acceptance and traumatic stress and gay ident ity pride and traumatic stress. These results have important implications for understanding identity devel opment in African American gay men.
CHAPTER 1 INTRODUCTION This chapter introduces the parameter s of this study including the population under investigation. An expl anation of the problem is pr ovided along with research questions, hypotheses as well as the significance and limitations of this study. Population and Parameters This study investigated the relations hip between adult (18 years old or older) African American gay mens ethno-cultural identity and sexual orientation identity and examined the effects that this relationship has on their experience of traumatic stress. This study uses a culture-centered approach to better explore the compounded effect of negotiating ethno-cultural and sexual orientati on identities. Further, the culture-centered focus of this study attemp ts to reveal unequal power relations and understand the impact of systemic oppression in African American gay mens identity development (Tillman, 2002). Problem Statement Major advances in civil rights, particularly for African Americans have created a social environment that is more accepti ng of cultural differences, yet many ethnoculturally diverse people continue to be discr iminated against or marginalized in their daily experiences (Bryant-Davis & Ocampo, 2005; Carter, 2007; Friedman & Marsella, 1996; Utsey, Bolden & Brown, 2001). Similarl y, despite being de-pathologized by the American Psychiatric Association in 1973, hom osexuality remains stigmatized in many societies around the world including the United States (Crawford et al., 2002; Israel & Selvidge, 2003; 2001; Morin & Rothblum, 1991; Savin-Williams, 1994). It has been suggested that belonging to a gr oup whose identity is stigmatized can result in chronic 10
stress and also lead to mental disorder s (Berg, Mimiaga, & Safren, 2008; Mays & Cochran, 2001; Carter, 2007; Huebner & Davis, 2007; Israel & Selvidge, 2003; Meyer, 2003; Savin-Williams, 2001). Mo reover, belonging to multiple stigmatized identity groups can be especially challenging and even debilitating (Fukuyama & Ferguson, 2000; Greene, 2001). This is evidenced in Af rican American gay mens efforts to negotiate their ethno-cultural and sexual orientat ion identities. Many African American gay men experience prolonged stress in their efforts to integrate their ethno-cultural and sexual orientation identi ties (David & Knight, 2008; Hatzenbuehler, Nolen-Hoeksema, & Ericks on, 2008; Huebner & Davis, 2007; Meyer, 1995; Rosario, Rotheram-Borus & Reid, 19 96; Zamboni & Crawford, 2007). This stress is in large part due to the homophobia they face in society, but particularly in the African American community (Boykin, 2005; Brown, 2005). Other contributing factors include the lack of acceptance from t heir families (Carpineto, Kubice k, Weiss, Iverson & Kipke, 2008; Wise, 2001), the discriminati on by religious institutions (Griffin, 2006; Miller, 2007) as well as their experiences of marginal ization in the predominantly White, gay community (Greene, 2001; Parks, 2001). African American gay men may experience t he stress of not completely belonging to either their ethno-cultural group or their sexual orientat ion group leaving them at risk for isolation, feelings of estrangemen t, and increased psychological vulnerability (Martinez & Sullivan, 1998). Additionally, t hey are often subjected to emotional, psychological and physical violence from those who do not approve of or understand their identity expression (Huebner, Rebchook & Kegeles, 2004; Meyer, 1995). Identity development of African American gay men is further complicated by: (a) their 11
internalization of mainstreamed pejorative vi ews of LGBT concerns that inhibit their expression of identity and (b) prevailing and s ystemic heterosexist attitudes in society that create ecosystemic obstacl es to identity integration (Frable, 1997; Greene, 2001). Inspired by Social Identity Theory (Tajfel, 1978) that addressed the relationship of the individual to the group and the origins of intergroup conflict, models that explain identity development among ethnic and raci al groups (Cross, 1995; Helms, 1995; Phinney, 1992) and sexual minorities (Cass, 1979; Minton & McDonald, 1984; Troiden, 1979) describe stages that individuals move through in achieving a positive ethnic or gay identity. Although these models hav e furthered the underst anding of identity development, they have been criticized for suggesting that growth is linear and bound by well-defined categories that are uncharacteristic of the human experience (Martinez & Sullivan, 1998). Moreover, the current conceptualization of these models lack sufficient integration of multip le identities and overlook the stress that is associated with the developmental process. As such, they tend to over-generalize and can be inadequate when shaping an understanding of how Afri can American gay men formulate their identities (Fukuyama & Ferguson 2000). It has been suggested that the stressors that African American gay men experience have a cumulative effect and oft en result in symptoms such as intrusive recollections of racist and homophobic events, psychic numbing as a way to manage their emotions and hypervigilance about their safety (DiPlacido, 19 98; Meyer, 2003). This chronic stress often leads to anxiety, depression, suicidal ideation as well as an increase in addictive behavior (Israel & Selvidge, 2003; Savin-Williams, 2001). This symptomatology describes the diagnostic cr iteria for posttraumatic stress disorder 12
(PTSD) as outlined in the Diagnostic and Stat istical Manual of mental disorders, 4th edition, TR (DSM-IV-TR) (A merican Psychiatric Association, 2000). However, experiences of discrimination including ra cism and homophobia are not included in the DSM-IV-TR as precipitants to traumatic stress. The DSM-IV-TR is used by mental health professionals to diagnose and treat mental disorders (Eriksen & Kress, 2006; Mead, Hohenshil & Kusum, 1997; Seligman, 1999). PTSD was added to the DSM in 1980 (Halpern & Tramontin, 2007; Scaer, 2001). The addition of this diagnostic category l egitimized certain events as traumatic (Burstow, 2005), informed how trauma shou ld be understood (Becker, 1995; Danieli, 1998; Herman, 1997), and guided mental health treatment for traum atized individuals (Becker; Danieli; Eriksen & Kress; Herman). In addition, t he inclusion of PTSD in the DSM enabled mental health providers to re ceive insurance reimbursement for the treatment of trauma (Burstow; Cosgrove 2005; James & Gilliland, 2005; McLaughlin, 2002). Scholars have criticized the DSM-IV-TRs definition of traumat ic stress for being too narrow. Herman, (1992) argued that women who were vi ctims of prolonged repeated trauma through domestic violence, expe rienced symptoms of traumatic stress. Researchers investigating race-based stre ss also challenged the DSM-IV-TR diagnostic criteria for traumatic stress asserting that repeated exposure to race-based discrimination often results in the development of traumatic st ress syndrome (BryantDavis & Ocampo, 2005; Carter, 2007; Fri edman & Marsella, 1996; Utsey, Bolden & Brown, 2001). Although these exper iences meet the criteria for traumatic stress, they are not conceptualized in this manner. In stead, those who experience traumatic stress 13
in ways that do not meet t he DSM-IV-TRs narrow definition are further marginalized and their presenting problems are pathologized. Furthermore, their access to traumaspecific mental health services is limited because their presenting problems do not meet the DSM-IV TR criteria for traumatic stress (Bryant-Davis & Ocampo, 2005; Carter, 2007; Cosgrove, 2005; Friedman & Marsella 1996; Herman, 1992; Utsey, Bolden & Brown, 2001). The purpose of this study was to inve stigate the relationships between ethnocultural identity, sexual orientation identit y and traumatic stress in African American gay men. A review of the liter ature related to African American culture, gay identity development and traumatic stress theory is provided in chapter 2. Chapter 3 outlines the methods that were used in this study including procedures for data collection and analysis. Chapter 4 provides the results of this study and chapter 5 offers a discussion of the findings. Research Questions 1. What is the relationship between ethno-cultural identity and gay identity in African American men? 2. What is the relationship between et hno-cultural identity, gay identity and hyperarousal in Afri can American men? 3. What is the relationship between et hno-cultural identity, gay identity and depression in African American men? 4. What is the relationship between ethnocultural identity, gay identity and intrusive experiences in African American men? 5. What is the relationship between et hno-cultural identity, gay identity and defensive avoidance in African American men? 14
6. What is the relationship between et hno-cultural identity, gay identity and dissociation in Afri can American men? 7. What is the relationship between ethno-cu ltural identity, gay identity and sexual concerns in African American men? 8. What is the relationship between et hno-cultural identity, gay identity and dysfunctional sexual behavio r in African American men? Hypotheses Null hypotheses developed for each of the research questions are as follows: Ho1: There will be no significant relati onship between ethno-cultural and gay identities in African American gay men. Ho2: There will be no significant relationship between ethno-cultural identity, gay identity and hyperar ousal in African American men. Ho3: There will be no significant re lationship between ethno-cultural identity, gay identity and depres sion in African American men. Ho4: There will be no significant relationship between ethno-cultural identity, gay identity and intrusive ex periences in African American men. Ho5: There will be no significant relationship between ethno-cultural identity, gay identity and defensive avoidance in African American men. Ho6: There will be no significant relationship between ethno-cultural identity, gay identity and dissociation in African American men. Ho7: There will be no significant relationship between ethno-cultural identity, gay identity and sexual c oncerns in African American men. Ho8: There will be no significant relationship between ethno-cultural 15
identity, gay identity and dysfunctional sexual behavior in African American men. Definition of Terms Bisexual A term generally applied to individuals who experience emotional, relational, and sexual attraction that is not limited by gender (Rust, 2001). Ethno-Culture A groups individual and collectiv e ways of thinking, believing, and knowing, which includes their shar ed experiences, consciousness, skills, values, forms of expression, social institutions, and behaviors (Tillman, 2002). Gay A term generally applied to men who ex perience emotional, relational, and sexual ties to other men (Gonsiorek, 1995). Homophobia Negative feelings, attitudes, ac tions or behaviors toward people who are or perceived as lesb ian, gay, bisexual or transgender (Kitzenger, 1996). Lesbian A term generally applied to wo men who experience emotional, relational, and sexual ties to other women (Brown, 1995). MSM Men who have sex with men Refers to all men who have sex with men regardless of how they identify themselv es (gay, bisexual, heterosexual) (CDC, 2009). Queer A term that is embraced by indivi duals who do not ident ify with traditional labels for gender identity or se xual orientation (Carroll, 2010). Race Refers to social demographic rankings used to distribute social rewards, economic resources, access, and opportunity (Frable, 1997). Racism The belief that the characteristi cs and values of ones racial group are superior to that of other racial groups wh ich is reflected in differential treatment, promotion of stereotypes, and limited access and opportunity (Carter, 2007). Stress A person-environment, biopsychos ocial interaction, wherein environmental events are appraised first as either positive or unwanted and negative. If negative, mechanisms to c ope and adapt are identified. When coping and adaptation fail, stress responses are experienced (Carter, 2007). Traumatic Stress Emotionally painful events that are negative and out of ones control that result in avoidance, arousal, intrusion, anxiety and depression (Carter, 2007). Transgender An umbrella term for persons who have a gender identity that is not traditionally associated with t heir biological sex (Carroll, 2010). 16
Significance of the Study By exploring the relationship between ethno-cultural and sexual orientation identities and traumatic stress, this study provides a clearer understanding of the unique experiences of African American gay men and the role of identity development in the presence of traumatic stress symptoms. This research may also serve as a foundation for culturally relevant lesbian, gay, bisexual, and transgender (LGBT) theory development. Specifically, this study a ttempts to expand k nowledge of identity development, traumatic stress, and resear ch methodologies to investigate the experiences of African American gay men. This study contributes to the literature on gay identity development by illuminating the experience of African Amer ican gay men. The majority of studies on this topic have used qualitative research methods. Although qualitative approaches allow the specific voices of the participants to be heard, t hey are limited in their ability to generalize findings to the larger population. By utilizi ng quantitative research methods, this study surveys a broader audience and gives voice to the larger African American gay community. Limitations of the Study While this study will reveal the relationshi p between ethno-cultural identity, sexual orientation identity and traumatic stress in African Amer ican gay men, it will not capture all of the factors that may in fluence that relationship. Fo r example, the ways in which African American gay men negotiate their ident ities in different environments such as the workplace and social settings will not be addressed in this study. Having openly gay family members may influence the identity development in African American gay men; however, this factor is not included as a variable in the research design. 17
18 Purposeful, convenience, and snowball samp ling may limit the diversity of the sample by selecting individuals who partici pate in formal support groups and those who belong to certain social networ ks. Use of electronic mail to link to the survey is also a limitation in that it excludes potential participants who either do not have access to this technology or are uncom fortable with its use.
CHAPTER 2 REVIEW OF THE LITERATURE The purpose of this chapter is to provide an overview of the lit erature relevant to this study. Literature related to the fo llowing topics will be pr esented: (a) African American culture, (b) gay identity, (c) intersectionality of identity, (d) traumatic stress, and (e) traumatic stress in African American gay men. Further Delineation of the Problem In 1973, the American Psychiatric A ssociation depathologiz ed homosexuality stating that it was no longer considered a psych iatric disorder reflecting a pathological development process (Morin & Rothblum, 1991). This change was the result of research findings as well as the persistent pleas from professionals and acti vists. Despite this major advancement, homosexuality remains stigmatized leading to higher rates of mental health problems such as major depr ession, generalized an xiety, substance abuse and suicidal ideation amon g lesbian, gay and bisexual people (Berg, Mimiaga, & Safren, 2008; Mays & Cochran, 2001). Using data from the Ma cArthur Foundation National Survey of Midlife Development in the United States (MIDUS), Cochran, Sullivan, and Mays (2003) observed that gay and bisexual men were th ree times more likely to meet DSM-IV-TR criteria for major depression and 4.7 times more likely to meet criteria for panic disorder than heterosexual men. Further, gay and bisexual men were more likely than heterosexual men to meet criteria for two or more disorders. Differences in mental health disorders among women in this study were less common than those among men. Generalized anx iety disorder was the only disorder that appeared more prevalent among lesb ian and bisexual women than among 19
heterosexual women. However, like the gay and bisexual men, they were more likely than heterosexual women to be diagnosed with two or more di sorders. These findings are consistent with those us ing data from other populati on-based studies such as the National Household Survey on Drug Abuse (Cochran & Mays, 2000) and the National Comorbidity Survey (Gilman et. al., 2001) that have found higher prevalence of mental disorders among homosexually active men and women than with heterosexually active men and women. These studies suggest that t he increase in the prevalence of mental disorders in homosexual men and women may be attributable to t he stress of coping with social stigmatization. Other studies addr essing the mental healt h concerns of LGBT people focusing on anti-gay victimization (Com stock, 1989; DAugelli, 1992; Garnets, Herek et.al., 1997; Herek, 1993; Otis & Skinner, 1996), substance abuse (Berg, Mimiaga, & Safren, 2008; Cochran, et. al., 2004; Stall, et. al., 2001; Greenwood, et. al., 2000), suicide (Fergusson, Horwood, & Beautr ais, 1999; Garafalo et. al., 1999), and involvement in the mental health service delivery system (Cochran, Sullivan, & Mays, 2003; Walters, Simoni, & Horwath, 2001) pr ovide further evidence of the negative impact of marginalization on this vulnerable population. Studies show that peer and stranger-based anti-gay victimization including verbal assault, threats, and physical violence is a common experience for the LGBT population (Comstock, 1989; DAugelli, 1992; Garnets, Herek et.al ., 1997; Herek, 1993; Otis & Skinner, 1996). Lesbian and gay youth in parti cular report experiencing familial abuse, harassment, and maltreatment upon disclosing their sexual orientation (D'Augelli, 1998; Savin-Williams, 1994). These studies found that survivors of bias-motivated 20
victimization suffered from increased levels of depression, anxiety, and anger and they also evidenced symptoms of traumatic stress. Openly lesbian and gay college students also report frequent experiences of verbal abuse and being threat ened with violence from other students as well as overt and subtle discrimination from faculty, staff, and administrators (DAugel li, 1992). In addition to the ongoing concern about their sa fety, some students ad mitted to changing their lives to avoid harassment, abuse, and vi olence. These changes included avoiding certain locations, avoidance of openly lesbia n or gay people, and developing a distorted or restricted presentation of self (denyin g that they are invo lved in a romantic relationship or suggesting that they are dat ing opposite sex partner s). While there are significant psychological consequences fo r those students who ar e victimized by antigay violence, the costs for those who hide their sexual orientation because of fear of discrimination are just as pr ofound including emotional stresses, social difficulties, and academic problems (DAugelli, 1992). Studies suggest that many LGBT people use illicit substances at greater frequencies than their heterosex ual counterparts. It has been reported that heavy or problematic use of substances is related to early adverse life events such as parental substance abuse and trauma, connection to the gay subculture where bars and nightclubs serve as safe socializing v enues, and experiences of marginalization, discrimination, and victimization (Berg, Mimiaga, & Safren, 2008; Cochran, et. al., 2004; Stall, et. al., 2001; Greenwood, et. al., 2000). In a study investigating co-morbidity in a sample of lesbians, Bostwick, Hughes and Johnson (2005) found a significant relationship between both lifetime and discr imination-related depression and alcohol 21
dependence symptoms. McKirnan et. al., (2006) found that for young men who have sex with men (MSMs), increased tobacco use was partially attributable to psychosocial variables such as depression, having few sa fe social outlets, and limited access to healthcare. Finally, gay and bisexual men r eport using methamphetamine to increase sensory experiences during sexual activity and to escape unpleasant emotions, to combat isolation and loneliness and to avoid social conflict (Halkitis, Parsons, & Wilson, 2003). Suicide is cited as the third leading cause of death among Americans aged 15 (Anderson, 2002). Studies show that lesbian, gay, bisexual identity and questioning of ones sexual orientation is an independent predictor of suicide attempts particularly among adolescents (Fergusson, Horwood, & B eautrais, 1999; Garafalo et. al., 1999). LGBT youth have consistently reported hav ing thoughts of suicide and attempting suicide at three times the rate of thei r heterosexual peers (McDaniel, Purcel, & DAugelli, 2001; DAugelli, Hershberger, & Pilkington, 2002). Studies reveal that hopelessness, hostility, low social support fr om family and friends, poor self-concept, psychological and physical abuse, and an over all lack of a sense of belonging are positively correlated with suicidal ideation in LGBT youth (Savin-Williams & Ream, 2003; Rutter, 2007; Rutter & Soucar, 2002; ). The challenges that LGBT people face in th eir involvement in the mental health services delivery system is gaining increased attention in empirical research. The bias that LGBT people face in the mental health service delivery system often results in misdiagnosis, ineffective interventions, and underutilization of services (Cochran, Sullivan, & Mays, 2003; Walter s, Simoni, & Horwath, 2001) Luckstead, (2004) provides 22
a summary of a multi-year research pr oject commissioned in 1997 by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the federal Department of Health and Human Services (DHHS) regarding the experiences, needs, and recommendations of LGBT people living with serious mental illnesses. This study revealed that little attention was given to LG BT issues in community mental health. In addition, many mental health providers held homophobic attit udes and promoted stereotypes about LGBT people. Discussions of healthy sexuality were non-existent and sexuality was only talked about in terms of problems such as unwanted pregnancies and sexually transmitted infections. This st udy further revealed that gay-affirmative therapists and programs generally did not provide service to people with serious mental illnesses. Bisexual and tr ansgender identities were completely misunderstood, which led to further marginalization of me mbers of these gr oups (Luckstead, 2004). Additional findings from the SAMHSA and DHHS study that ar e consistent with other studies on the utilizatio n of mental health services by LGBT people include marginalization and harassment by peers and the tendency for therapists and programs to minimize or overemphasize LGBT identity as the presenting prob lem. In addition, mental health practitioners are ty pically unaware of the extent to which their clients are impacted by family conflict or abuse that is re lated to their LGBT identity, as a result, they often pathologize adaptive behavior such as the formation of kinship bonds among unrelated individuals also known as fictive kinship (Chatters, Taylor, & Joyakody, 1994). Furthermore, mental health practitioners typically have little knowledge of affirmative LGBT community resources that can prov ide additional support for their clients (Matthews & Selvidge, 2005; Walters, et. al., 2001). Studies confirm that LGBT clients in 23
the mental health system need spec ial attention that is rele vant to their needs. They also stress the importance of creating an environment th at is free from bias and harassment, where staff is caring and affi rmative, and where there is a healthy expression and discussion of sexuality (B erg, Mimiaga, & Sa fren, 2008; Luckstead, 2004; Matthews & Selvidge, 2005). Previous attempts to address these specific mental health concerns have focused on the need for gay people to develop a positive gay identity where coming out (acknowledging ones gay identity to significant others) is considered optimal for their mental health (Fassinger, 1991; Floyd & Bakeman, 2006; Halpin & Allen, 2004; McDonald, 1982; Rosario, et. al., 2001; Ro wen & Malcolm, 2002). These studies used gay identity development models as their theor etical framework (Cass, 1979; Minton & McDonald, 1984; Troiden, 1979). While these models have been helpful in understanding gay identity development in general, they are limiting because they focus primarily on White, middle-cla ss men and overlook the influenc e of culture in the identity development process. Moreover, these models fail to address the complexity of coping with multiple oppressed identities. Managing multiple identities is a task that is faced by various culturally diverse LGBT individuals, including ethnically diverse people (Chan, 1995; Fukuyama & Ferguson, 2000; Garrett & Barret, 2003), wo men (Brown, 1995), the elderly (Reid, 1995), and those with disabilities (Whitney, 2 006). Members of these groups are often forced to develop ways of negotiating their i dentities that exist outside the mainstream (Fukuyama & Ferguson; Loiacano, 1989). Like many LGBT people, they may keep their sexual orientation hidden, pretend to be heterosexual, or choose to be asexual. They 24
may also avoid discussion of romantic relationships or use opposite sex gender pronouns when referring to romant ic interests or partners. In addition to these coping strategies, culturally diverse LGBT people have the task of managing other oppressed identities such as race, gender, class and abilit y. They respond to the shifting salience of identity depending on the social, familial, and community context and are forced to cope with being invisible members within specif ic social reference groups in order to receive the benefits of group membership (Fuk uyama & Ferguson). For example, they may minimize their sexual ori entation identity in order to receive support that buffers racism. This is especially relevant for African American gay men. The challenges that African American gay men face in identity development have been documented in the literature that addresses homophobia in the African American community (Boykin, 2005; Brow n, 2005; Carpineto, Kubicek, Weiss, Iverson & Kipke, 2008; Wise, 2001) and racism in the gay comm unity (Greene, 2001; Parks, 2001). The literature also suggests that social stigma discrimination and victimization such as being cut off from their families, being discr iminated against in their communities and facing potential violence (Greene, 2001; Par ks, 2001; Rosario, Schrimshaw & Hunter, 2004), results in greater prevalence of depr ession, substance abuse and HIV infection rates among this population in comparison to White gay and African American heterosexual men (Crawford, Allison, Zamboni & Soto, 2002; Hatzenbeuhler, NolenHoeksema & Erickson, 2008; Huebner & Davi s, 2007; Israel & Selvidge, 2003; SavinWilliams, 2001). While all LGBT people, regardle ss of cultural identity are stigmatized in society (Crawford et al., 2002; Israel & Se lvidge, 2003; Savin-Williams, 2001), facing 25
multiple oppressions exacerbates stress le vels and further complicates the identity development process (Crawford et al.). Multicultural counseling theory (MCT) (Pedersen & Ivy, 1993) highlights the importance of considering t he sociopolitical and environment al context of clients concerns in case conceptualization, diagnosis and treatment. MCT emphasizes exploration of multicultural constructs and mandates competencies that address counselor attitudes, knowledge, and skills (Sue, Arredondo, & McDavis, 1992). Despite the professions emphasis on multicultural competence over the past three decades, counselors continue to evidence difficulty in effectively conceptualizing and intervening with clients who experience multiple forms of systemic oppression, such as racism, classism, homophobia, and sexism (Arredondo, Tovar-Blank, & Parham, 2008). The concept of intersectionality addresses the nuanc ed complexities of multiple identities that cannot be sufficiently captured using conventional identity development models, such as racial (Helms, 1995; Sue & Sue, 2008) and gay/lesbian (Cass, 1979; Minton & McDonald, 1984). Previous attempts to explain identity development among Af rican American gay men have illuminated the complexities of negotiating their ethno-cultural and sexual orientation identities (Crawfor d et al., 2002; Frable, 1997; Greene, 1997; Parks, Hughes & Matthews, 2004; Rosario, Schrimshaw & Hunter, 2003; Salazar & Abrams, 2005; Wise, 2001). While these effort s have provided signif icant insight into the challenges inherent in coping with intersecting identit ies, they have not situated this complex developmental task within the context of tr aumatic stress. As a result, they have overlooked the influence that stress has on African American gay mens health and 26
well-being and their ability to successfully negotiate their intersecting identities. In addition, the psychological distress that Afri can American gay men experience is often misdiagnosed in the mental health system, the sociopolitical realities of their lives are overlooked, and they are further marginalized (Cosgrove, 2005). Recent studies addressing stress in gay men have found significance between stress and coping patterns (David & Knight, 2008); HIV risk behavior, substance abuse and depressive symptoms (Haatzenbuehler, Nolen-Hoeksema & Erickson, 2008); mental health problems (Meyer, 2003) ; and self-esteem and problem behaviors (Rosario, Rotheram-Borus & Reid, 1996). Studies have also shown that stress contributes to sexual problems in gay men such as communication difficulties, performance concerns (erectile and orgasmic di sorders), sexual knowledge deficits, and negative sexual attitudes (Bancroft, et. al., 2005; Standfort & deKeizer, 2001; Zamboni & Crawford, 2007). Despite their significance, these studies failed to adequately address the influence of culture in the development of stress and in stress coping patterns. Traumatic stress theory has been useful in understanding the psychological, physiological and emotional impact of traumat ic events. Furthermore, it explains the sequelae that manifest in individuals post-trauma. The DSM-IV-TR (American Psychiatric Association, 2000) describes the symptomatology of traumatic stress by the diagnostic criteria for posttraum atic stress disorder (PTSD). PTSD is characterized by exposure to a single traumatic event in which a person experiences or witnesses an event that threatens death or serious injury and the persons response involves intense fear, helplessness or horror. 27
Scholars have criticized these criter ia as too narrow and have suggested broadening the definition of tr aumatic stress to include the repeated exposure to stressors and traumatic events such as dom estic violence (Herman, 1992) and racism (Bryant-Davis & Ocampo, 2005; Carter, 200 7; Friedman & Marsella, 1996; Utsey, Bolden & Brown, 2001). Similarly, the definition of traum atic stress may be extended to include the reaction to heter osexism and homophobia that LGBT individuals experience from rejection and discrimination for those who live openly and through selfconcealment and emotional inhibition for those who do not (DiPlacido, 1998). This review of the literature fo cuses on the ways in which African American gay mens experiences of racism and homophobia compound their experience of traumatic stress. African American Culture In order to understand African American culture, it is impor tant to differentiate race and culture. Race is a socially constr ucted phenomenon that uses skin color to determine social privilege and access to res ources. Culture on t he other hand, can be defined as a groups collective way of knowing that involves beliefs, shared experiences, social institutions, values, forms of expression and behaviors (Tillman, 2002). An explanation of African American cult ure in the literature began in the 1960s and early 1970s when African American psychologists (A zibo, 1983; Nobles, 1976; White, 1972) began writing about the Afrocentri c worldview and how it differed from the Eurocentric worldview. Prior to these wor ks, African Americans were marginalized in scientific literature and depicted by scientists as intellectually and morally inferior to Whites. Comparative studies in physical anthropology, the theory of Eugenics, The Bell Curve, and the Binet Intelligence Scales promoted the myth of African American 28
inferiority; which justif ied racism and supported c ontinued oppression (Guthrie, 1976/1998). Over the past 20 y ears, African American schol ars have advanced the understanding of African Americ an culture through the field of African American studies and the study of African American p sychology (Bellgrave & Allison, 2006). Before African American psychology wa s recognized as a discipline, White (1972) challenged the use of traditional theories to study African Americans. He asserted that the incorrect use of traditi onal theories to study African Americans resulted in the weakness-dominated and inferiority-oriented conclusions. He believed that African Americans s hould define their paradigms. In his writings on African philosophy, Nobles, (1980/1991/ 2004) illuminated the ways in which African perspectives of religion, unity, time, death/immortality, and kinship were maintained by African Americans. Nobles also advanced the understanding of African American culture thr ough his writings on the concept ualization of the self in which he states that the indi vidual self cannot exist independently from the collective self. Akbar, (1991) described mental conditions that result from African Americans attempts to function in an oppressive and alien environment. His descriptions of disorders such as alien-self disorder, behaving in ways that contradict ones natural disposition and anti-self diso rder, identification with the oppressor and hostility toward ones own cultural group furthered the discu ssion of the effects of oppression on the lived experience of African Americans. His other works address holistic human psychology and understanding the unique psyc hological functioning of African Americans. 29
Contributing to the conversation on cult urally appropriate ways to view African Americans, Azibo, (1989) developed the Azibo nosology, a system for diagnosing diseases and disorders among African Americans with psychological problems. A departure from the DSM-IV-TR, this system addresses disorders that may exist among African Americans due to cult ural, historical, and societal factors. Questions have been raised about the applicability of this nosolog y and whether it can be used in clinical settings. Kambon, (1998) contributed to the under standing of African American culture through his study of the components and corr elates of the African personality. He developed the African Self-Consciousness Scal e (Baldwin & Bell, 1985) which assesses how African Americans feel about African/Afri can American culture and issues related to racism. Findings from his research suggest t hat family orientati on, commitment to the African American community, and emotional and intellectual stimulation characterize individuals with a high Africentric cu ltural consciousness (Hamlet, 1998). Promoting an appreciation for human divers ity and social change, Myers (1988) writings on an optimal worl dview examine the oppression of African Americans and other marginalized groups. Her theory encour ages investigation of both human behavior and social roles. Myers notes that ones ont ology is influenced by how the world is perceived. She suggests that the Euroc entric worldview places importance on individualism and materialism and views ex ternal knowledge as the basis of all knowledge. She contends, however, that the Af rican worldview that is based on the ideas that reality is both spiritual and material, communalism and collectivism are 30
valued over individualism, and self-knowledge is the foundation for all knowledge is an optimal worldview. Through their various contributions, these scholars have advanced the understanding of African American culture. This culture is c haracterized by significant kinship bonds including fictiv e kin (non-relatives who are embraced as family) (Chatters, Taylor, & Joyakody, 1994), resilience and a str ong spiritual/ religious orientation (Sue & Sue, 2008). In addition, authenticity, balance, communalism (focus on the interrelatedness of people), collectivism (pri ority given to the group rather than the individual), cooperation, creat ivity, sensitivity to affect and emotional cues, harmony, and unity are values that shape t he African American experience ( Kambon, 1998; Parham, White & Ajamu, 2000 ). A description of the dim ensions of African American culture is provided in Table 2.1. It is important to note t hat many African Americans form their identities from elements of both Afrocentric and Eurocentric cu ltures, which is in part, the result of living in a multicultural society (Bellgra ve & Allison, 2006). However, racism and systemic oppression have had a significant negativ e impact on the racial/cultural identity of African Americans (Carter, 2007). Raci al identity development models purported by Cross, (1971, 1991, 1995) and Helms, (1990) describe psychological and emotional stages that African-Americans move through toward acceptance of their racial/cultural identity. This process involves first denyi ng their Blackness and aligning with Whites, confronting that denial, embracing an ethnoc entric worldview, displaying a greater sense of acceptance of self and others, and finally, using their per sonal identities as agents for change. According to Phinney, (1991), racial/cultural identity achievement is 31
associated with self-esteem and adjustment. In African Amer ican culture, achievement of positive racial/cultural identity is often su pported by intergenerati onal family units that provide emotional, psychological, social and financial resources that aid them in coping with systemic oppression (Nobl es, 1997; Sudarkasa, 1997). Achievement of a positive racial/cultural identity also incorporates a state of mental health that is free of psychological ailments and supports an individuals growth and ability to reach their full potential (Parham, White & Ajamu, 2000). Psychologically healthy African Americans interpret the African American ethos, the emotional bond created by shared cultural her itage and life experienc es into their lives (Parham, White & Ajamu, 2000). Further, psyc hologically healthy African Americans are resourceful and enterprising in their approach to life and ar e grounded in their African American makeup (Parham, White & Ajamu, 2000). Gay Identity Often referred to as the hidden minor ity (Atkinson & Hackett, 1988), gay individuals continue to be marginalized in society. Consequently, they may encounter a myriad of mental health concerns, such as chronic stress, affective disorders, substance abuse, eating disorders, and suicidal ideation (Israel & Selvidge, 2003; Savin-Williams, 2001). Moreover, hostility and victimizati on in schools (Parks, 2001; Stone, 2003), informal heterosexism in the workplace (Lyons, Brenner & Fassinger, 2005), and harsh judgments by traditional Western religious organizations (Barret & Barzan, 1996) can impede identity development Several researchers have developed theor etical models that describe identity formation among sexual minorities (Cass, 1979; Coleman, 1981; Dank, 1971; Hencken & ODowd, 1977; Lee, 1977; Minton & McDonal d, 1984; Plummer, 1975; Troiden, 32
1979). In general, these models lay out stages that lead to an eventual positive gay identity. They are marked by a general sens e of feeling different, an awareness of same-sex attraction, individual realization t hat his or her attraction can be labeled as homosexual, and an eventual acceptance of a gay identity that is punctuated by coming out (disclosure of ones sexual identity) to significant others. Cass (1979) developed one of the earliest and most cited models of homosexual identity development. This model descri bes six stages of developing a positive homosexual identity. They include: (1) identit y confusion, feeling different from peers and in denial of ones attraction to the same se x; (2) identity comparison, break in denial and beginning to examine the differences between self and heterosexuals, increase in feelings of social alienation; (3) identity tolerance, beginning to make a commitment to self-identify as homosexual, continues to pres ent as heterosexual, seeks social support within the gay community; (4) identity acc eptance, embracing homosexual identity, immersion into the gay community, developing s ense of pride; (5) identity pride; loyalty and satisfaction in homosexual identity, strong sense of pride; and (6) identity synthesis, emotional, mental, spiritual and sexu al integration, develops holistic view of self. Like Cass, Coleman (1981) published a linear five stage homosexual identity development model that focused on the stages of the coming out process. During this time, coming out was considered to be one of the most important aspects in developing a positive gay identity and gaining social ac ceptance. The five stages of this model included: (1) pre-coming out, a preconsciou s awareness of homosexual identity; (2) coming out, beginning to tell others about ones homosexual identity; (3) exploration, 33
social networking and partner seeking within a homosexual context; (4) first relationship, seeing ones self as being able to carry out a loving homos exual relationship; and (5) integration, characterized by sexual exploration and the esta blishment of relationships. Minton and McDonald (1974) described a th ree-stage process that involves progression from an egocentric interpretati on of homoerotic feelings (awareness of ones uniqueness) to an internalizati on of the normative assumptions about homosexuality (heightened awareness of possi bly possessing a homosexual identity and the corresponding awareness of the societ al attitudes about homosexuality) to a stage where societal norms are critically evaluated and a positive gay identity is achieved (separation of particular norms from general principles upon which all norms are based). Troidens (1979) ideal-typica l model of homosexual identi ty formation differed from the linear stage models in that it described individual movement through the stages of identity development as a horizontal spiral that progressed up, down, back and forth. The stages included: (1) sensitization, a prepubescent stage that is marked by feelings of marginalization and being different from peer s; (2) identity confusion, reflection on the idea that feelings and behavior could be re garded as homosexual, inner turmoil and anxiety increase; (3) identity assumption, self-definition as homosexual, identity tolerance and acceptance, regular associat ion with other homosexuals and involvement in the homosexual subculture; and (4) comm itment, self acceptance of homosexual identity and entering a same-sex love relationship. Identity development models are useful in understanding certain developmental tasks that individuals may encounter. Both ra cial and sexual id entity development 34
models receive criticism for suggesting that growth is linear and bound by well-defined categories that are uncharacteristic of hum an development (Martinez & Sullivan, 1998). Racial identity development models fail to acknowledge the role of sexual orientation and homophobia in identity formation. Ho mosexual identity dev elopment models overlook the influence of race and racism in the evolving gay identity and they only recognize ones positive gay identity after ac knowledgement of one s sexual orientation to significant others (Marti nez & Sullivan, 1998). Fukuya ma and Ferguson (2000) point out that a primary limit ation of exclusively recognizing singl e identities is that individuals who embrace multiple identities are often invisible members within specific social reference groups. Furthermore, o nes salience of identity, t he identity that emerges into ones awareness, often depends on ones soci al, familial, and community context. Theories that do not acknowledge multiple cultural identities obscure the complexity of identity integration. In response to increas ing criticism of thes e identity development models, scholars called for consideration of multiple identities among the LGBT population. This identified gap led to conversati ons about the intersec tionality of identity (Fukuyama & Ferguson; Greene, 1997; Icard, 1996; Israel & Selvidge, 2003; SavinWilliams, 2001). Intersectionality of Identity Gay African Americans often experience exclusion from the mainstream LGBT culture and from their ethnic and familial communities, leaving them at risk for isolation, estrangement, and increased psychological vu lnerability (Martinez & Sullivan, 1998). The loss of the expected communal support and fictive kinship (Chatters, Taylor, & Joyakody, 1994), which are central to African American culture, has a profound impact on their well-being and their identity develop ment (Bridges, Selvidge & Matthews, 2003; 35
Greene, 2001; Parks, 2001; Wise, 2001). In addition, coming out as gay is often viewed as an assault on the traditional masculine gender role and therefore considered counterproductive to the success of Afri can American culture (Bridges, Selvidge & Matthews, 2003; Greene, 2001; Pa rks, 2001; Wise, 2001). Other considerations that further complicate the identity integration trajectory in Af rican American gay men include the fear of violence, fear of AIDS, and an overall fear of compounding oppressions (Martinez & Sullivan, 1998). In Christians (2005) qualitative study of three self-identified Black, gay men, several themes emerged that illustrate how these men manage their multiple identities. Being Black was cited as important beyond bei ng gay. The Down Low (DL) or secretive gay life was embraced, which is characterized by silence of their se xual identity among family and in the community and enhanced by a masculine appearance or persona. Finally, distinctions were made between sexu al preference (simply being attracted to other men), and the gay lifestyle (alluding to the effeminate, flambo yant stereotype). In some cases African American gay men believe that they must be homophobic in order to separate their sexual identity from their black male identity so that they can be accepted and maintain a high ranking in the hierarchy of men (Brown, 2005). While coming out is purported by some theorists to be the pinnacle of gay identity development, for African American gay men it may add yet another oppression to be managed in their lives. Therefor e, they may identify as gay and choose not to come out or they may choose not to embrace a gay label at all. Family Acceptance Many African American gays experience the black community as homophobic (Bridges, Selvidge & Matthews, 2003; Gr eene, 2001; Parks, 2001). Some seek 36
validation in the predominantly white, gay co mmunity where they face the possibility of experiencing racism while ne gating the support that would ordinarily be available to them in the Black community (Icard, 1996). The Black community generally provides a sense of solidarity against raci sm that may be reinforcing fo r African American gay men. However, they are less likely to experience that solidarity if their sexual orientation becomes known or is openly discussed; if th ey come out. In fa ct, they may even be ostracized. Although African American gay m en have historically been key figures in their families, they often become devalu ed once the code of silence about their homosexuality is broken (Carpineto, Kubicek, Weiss, Iverson & Kipke, 2008; Icard, 1996; Wise, 2001). Many in the black community view hom osexuality as a lack of masculinity or manhood (Icard, 1996; Wise, 2001). Black mascu linity denotes a form of male behavior or expression that for some incorporates certain physical attributes and material possessions and for others incorporates more intrinsic qualities. The behavior can vary depending on the situation and t he variables involved. Black manhood also implies understanding this state of being in relation to family, community, and society (Wise, 2001). Because of their sexual orientation, African American gay men are depicted as anything but masculine and because of the ridi cule from their peers, and the silencing from their families, their masculinity is compromised (Bridges, Selvidge & Matthews, 2003; Greene, 2001; Parks, 2001). African American gay men have been depicted as having a triple consciousness; being a black man within the context of white society, being a black man within the context of the black community, and being a black man who is also a sexual minority (Wise, 2001). 37
Religion and Spirituality African Americans have a long history of strong connections to religion and spirituality as sources of st rength, particularly as a buffer against racism (Bowen-Reid & Harrell, 2002; Greene, 2001; Pa rks, 2001). However, the tr aditional African American church has either ignored or denigrated its LGBT member s leaving them spiritually empty with fewer coping skills and a smalle r support network (Greene, 2001; Griffin, 2006; Parks, 2001). In a qualitat ive study of African Americ an men, AIDS, and the Black church (Miller, 2007), participants descri bed the hostile environment that they experienced in many Christian denominations. Despite the unwelcoming experience, some of the participants in this study rev ealed that they viewed church as an extension of their families and have remained in t hese congregations and found ways to integrate their sexual orientation identit y with their religious identity, usually by forming unofficial subgroups of other gay men w ho are also involved in the church. Other participants reported that they eventually left thos e churches not because of their demeaning homophobic environments, but because of t heir churchs apathetic response to the AIDS crisis. Religious guilt, rejection by the church community, and fear of eternal damnation are sources of traumatic stress and often motivate gay people to seek a solution (Tozer & Hayes, 2004). Those of this mindset hold their religious or spiritual identity as essentially as their sexual orientation (H aldeman, 2002). For some African American gay men, changing their sexual orientat ion may seem more feasible and less troublesome than trying to let go of their religious beliefs and communities (Haldeman, 2002). Many gay men engage in heterosexual re lationships or commit to celibacy in order to manage the stress of t heir conflicting identities, ev en though studies show that 38
these choices have been, for the most part, unsatisfactory and unsuccessful (Haldeman, 2002). Traumatic Stress Theory History of Traumatic Stress In 1883, surgeon Herbert Page pioneered the study of traumatic stress (Trimble, 1981) through a published rebuttal to a previ ous study done by John Eric Erichsen, a European surgeon whose report about the victims of railway accidents attributed their symptoms such as loss of memory, difficult y concentrating, anxiety, and nightmares in the absence of physical injuries to an organic rather than a psychological cause (Weisaeth, 2002). Page posited t hat the symptoms were of a psychological nature and labeled this condition nerv ous shock (Trimble, 1981). Also in the late 1800s, French neurologist Jean-Martin Charcot explored patients unexplained physical and/or emotional symptoms which he termed hysteria (Halpern & Tramontin, 2007). Charcot theorized that hysteria was the resu lt of the emotional impact of a traumatic incident. Physician Pierre J anet and psychiatrist Sigmund Freud and their colleagues expanded Charcots theory of hysteria. Janet, (1929/1965) introduced the concept of dissociation as part of hysteria and traumatic stre ss stating that hysteria was characterized by the retraction of the field of personal consciousness and a tendency to the dissociation and emancipation of the systems of ideas and junctions that constitute personality (p. 332). Janet believed that hysteria developed because of mental weakness. Freud, on the other hand, believed that hysteria resulted from repressed memories of traumatic events (Trimble, 1981). In a collaborative effort, Freud and Viennese psychoanalyst Josef Breuer investigated hysterical symptoms and began to follow the thread of memory back to 39
traumatic experiences (Breuer & Freud, 1893/1962). Further in vestigation led Freud to the conclusion that womens hysterical symptoms resulted from premature sexual experiences (Freud, 1896/1962). He later recanted this claim because of the unacceptable societal implications of sexual abuse and as a result, the investigation of traumatic stress was largely abandoned (Herman, 1997). Despite the lull in the scientific inquiry of traumatic stress, the field evolved and eventually became known as traumatic neurosis; a term coined by German neurologist Hermann Oppenheim in 1911 (Figley, 1988; Trimble, 1981). The study of the psychological impacts of war (Halpern & Tramontin, 2007) furthered the development of the field of traumatic stress. American physician Abram Kardiner studied World War I and World War II veterans and attempted to create a systematic description of the f eatures of traumatic neurosis (Kardiner & Spiegel, 1947). His work eventually became the foundat ion for the diagnostic description of posttraumatic stress disorder (PTSD) (H erman, 1997). The field of trauma was advanced through work on the traumatic stre ss outcomes among veterans of World War II (Lifton, 1967) and the Vi etnam War (Figley, 1978). Traumatic stress received increasing attent ion from the Vietnam veterans and the womens movements in the mid 1970s (He rman, 1997; van der Kolk & van der Hart, 1989). The increased awareness of traumatic stress from thes e movements resulted in the designation of posttraumatic stress disorder as a mental illness in the third edition of the American Psychiatric Associations Di agnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980 (Bur stow, 2003; van der Kolk & v an der Hart). The inclusion of PTSD in the DSM-III increased inte rest in traumatic stress and engendered the 40
systematic study of trauma and trauma treatment (van der Kolk & McFarlane, 1996; Zimmerman & Mattia, 1999). In general, the DSM-III inform ed how trauma was to be understood (Becker, 1995; Danieli, 1998; Herman) and influenced the development of traumatic stress theory (R osenthal & Wilson, 2003). Etiology of Traumatic Stress Trauma is a psychophysical experience that affects the body as well as the mind (Rothschild, 2000; Scaer, 2001). It causes c hanges in the brain and interferes with normal functioning (Kira, 2001). During a traum atic event, the brain releases hormones that trigger the bodys nervous systems to respond by fight, flight, or freezing (Rothschild, 2000; van der Kolk, 1996). In addition, the area of the brain that is responsible for speech production is suppre ssed which creates a speechless terror in response to trauma (van der Kolk, 1996, p.234). The release of hormones during a traumatic event also suppresses brain functi oning that regulates memory (Scaer, 2001; van der Kolk, 1996). While some traumat ized people can remember the traumatic events in detail, others remember very li ttle and experience physical sensations or emotional reactions that are contextually incongruent (Rothschild, 2000). Trauma also affects information processing which can resu lt in dissociation or psychic numbing (Friedman & Marsella, 1996). Primary dissociation limits cognitions of the reality of the traumatic experience. Secondar y dissociation anesthetizes individuals from the feelings related to the trauma. Tertiary dissociation characterizes the deve lopment of distinct ego states that contain the tr aumatic experience (van der Ko lk, van der Hart & Marmar, 1996). Psychic numbing produces feelings of det achment from others and a restricted range of affect (American Psychiatric A ssociation, 2000). Hyperarousal is another feature of traumatic st ress, which results in sleep difficult y, irritability, anger and difficulty 41
concentrating, hypervigilance and an ex aggerated startle response (American Psychiatric Associatioin, 2000). Traumatic events are stored in the brain and reexperienced with the same degree of intensity as the original event (Rothschild, 2000; Scaer, 2001; van der Kolk, 1996). Repeated ex posures to trauma results in complex syndromes involving affect dysregulation, cognitive distortions, destructive behavior toward self and others and learning disabilities (van der Kolk, 1996). Traumatic stress is debilitating emoti onally, psychologically and physiologically (Friedman & Marsella, 1996; van der Kolk & McFarlane, 1996). Individuals who have experienced trauma often avoid situations t hat have the potential to trigger traumatic memories or flashbacks. They also develop strategies that, if triggered, will minimize their emotional and psychological response (Friedman & Marsella, 1996; van der Kolk & McFarlane, 1996). Major depression and gener alized anxiety typically accompany PTSD (Friedman & Marsella, 1996). Resear ch shows that individuals who have had previous depressive episodes are at in creased risk for developing PTSD (Frist & Tasman, 2004). Hypervigilance resembles g eneralized anxiety disorder in that individuals have a heightened awareness of trauma stimuli; in its severe form, it can resemble panic and paranoia (Friedman & Marsella, 1996). Finally, avoiding and psychic numbing can have deleterious effects on relationships and lead to isolation and loneliness (Friedman & Marsella, 1996). The DSM-IV-TR (American Psychiatric Association, 2000) describes the symptomatology of traumatic stress by the diagnostic criteria for PTSD. PTSD is characterized by exposure to a traumatic event in which a person experiences or witnesses events that threat en death or serious injury and the persons response 42
involves intense fear, helplessness or horror; the traumatic event is re-experienced by intrusive recollections of the event; persistent avoidance or numbing of stimuli associated with the event and persistent symptoms of incr eased arousal. The diagnostic criteria also include durati on of disturbance for one month or more and it causes clinically significant dist urbance or impairment in func tioning. Sources of trauma, according to the DSM-IV-TR, include expos ure to combat, imprisonment, physical and sexual abuse, death, vi ctimization by crime or natural disasters, major accidents and serious injury (American Psychiatric Associat ion, 2000) as well as medical interventions (Scaer, 2001). This definition of trauma l egitimizes certain events as traumatic, describes the effects of tr auma on the traumatized individual and is used to inform and guide mental health treatment for traumatized individuals (Becker, 1995; Burstow, 2005; Danieli, 1998; Eriksen & Kr ess, 2006; Herman, 1997; Rothschild, 2000; van der Kolk & McFarlane, 1996). Critics of the DSM-IV-TR state that the emphasis on physically dangerous events in the diagnostic criteria for PTSD is narrow and overlooks individual perception (Rothschild, 2000) as well as other precipitants to traumatic stress such as racism, harassment, and oppression (Bryant-D avis & Ocampo, 2005; Burstow, 2003; Carter, 2007; Halpern & Tramontin, 2007; Herman, 1997). Race-Based Traumatic Stress Over the last decade, scholar s have argued for a more inclusive definition of the sources of trauma to include exposure to experiences such as domestic violence (Herman, 1992) and racism (Bryant-Davis & Ocampo, 2005; Carter, 2007; Friedman & Marsella, 1996; Utsey, Bolden & Brown, 200 1). Other scholars (Brown, 1995; Guilfus, 1999; Lewis, 1999; Root, 1992) have suggested that limiting the definition of trauma to a physically dangerous event(s) is inadequate particularly for members of oppressed 43
groups. Burstow, (2003/ 2005) recommended a radical departure from the DSM-IVTRs framework for trauma and from psych iatry itself, which in her view, is disempowering and stigmatizing. She suggests that trauma and traumatic events should be conceptualized in context and viewed on a c ontinuum in which everyone is located. Herman (1992) first extended the definit ion of trauma by highlighting the experiences of women who were victims of prolonged repeated trauma through domestic violence. She discussed the commonalties of their experiences with those of combat veterans and political prisoners. Herman also identified so cietal factors that exacerbate the effects of trauma such as harsh judgment and condemnation by others for exhibiting the symptoms of trauma as well as misdiagnosis and negative attitudes from the mental health system. Researchers investigating the relationship between racism and traumatic stress (Bryant-Davis & Ocampo, 2005; Carter, 200 7; Friedman & Marsella, 1996; Utsey, Bolden & Brown, 2001) also challenged the DSM-I V-TR diagnostic criteria for traumatic stress. They argued that the stress from expo sure to racism, which may be unrelated to a single event or cause an immediate threat to survival, often results in the development of traumatic stress syndrome. Furthermore, the study of transgenerational trauma, which is trauma that is passed down from one generation to another (Dass-Brailsford, 2007), offers insight into the extended e ffects of racism on the African American experience. Transgenerational trauma has been studied in children of Holocaust survivors (Danieli, 1998), families of war veterans (Aarts, 1998; Bernstein, 1998; Rosenheck & Fontana, 1998), indigenous peoples (Duran, Du ran, Yellow Horse Brave Heart, & Yellow Horse-Davis, 1998; Raphael, Swan & Martinek, 1998), and survivors of 44
child abuse and domestic violence ( Gardner, 1999; Herman, 1992; Schechter, Brunelli, Cunningham, Brown & B aaca, 2002; Walker, 1999). African Americans have experienced racebased traumatic stress from the history of slavery and legal segregation in the United States (Carter, 2007). The residual effects of this oppression remain embedded in everyday life. Racist encount ers, both direct and subtle continue to occur interpersonally (e.g ., microaggressions, verbal assaults, use of symbols), systemically (i.e., application of stereotypes and limiting access to resources) and culturally (i.e., enforcing Eurocentric values) (Carter, 2007). Utsey, Bolden and Brown (2001) identified six racism-related reactions that African Americans experience as a result of prolonged exposure to racism and oppression: (a) race -related trauma, (b) racism-related fatigue, (c) anticipatory racism reaction, (d) race-related distress, (e) racism-related frustration, and (f ) racism-related confusion. Race-related trauma is the spiritual, psychological and physiological impact of being the victim of, witness to or learning of the actual or attempted threat to ones person based on race or skin color. Sympto ms include intrusive thoughts, nightmares, anxiety, fear, sleeplessness and depre ssion (Utsey, Bolden & Brown, 2001). Racism-related fatigue is the psycholog ical and physiologica l exhaustion that African Americans experience from exposure to racism and from combating oppression on a regular basis. The exhaustion can be debili tating and can interfere with activities of daily living such as working, participati ng in and attending to family commitments and other relationships (Utsey, Bolden & Brown, 2001). Anticipatory racism reaction is a functional defense mechanism that African Americans develop after being victimized by ra cism. It involves maintaining a state of 45
hypervigilance in order to pr otect oneself from anticipated ra cist incidents. Maintaining this high level of awareness increases anx iety and becomes more stressful than the anticipated racist encounter (U tsey, Bolden & Brown, 2001). Race-related distress develops from exposure to chronic racism and results in psychological and physical problems (BowenReid & Harrell, 2002; Utsey, Bolden & Brown, 2001). Psychological mani festations include the inabilit y to concentrate, intrusive thoughts about specific racists encounters, anxiety and depression. Physical symptoms include headaches, muscle tension, digestive problems, and sleep difficulty. In addition, race-related distress weakens the immune syst em resulting in increased susceptibility to illness ranging from the common cold to hypertension, stroke and cancer (BowenReid & Harrell, 2002; Utse y, Bolden & Brown, 2001). Racism-related frustration is the result of powerlessness that African Americans feel from acts of racism and oppression. Anger, irritability, disappointment, and dissatisfaction often follow when racist encounters are not resolved. These feelings are then magnified when new racist events are exper ienced (Utsey, Bolden & Brown, 2001). Racism-related confusion is a reaction to ongoing racist encounters in which African Americans question their identity in an oppressive society. They begin to look at events and individuals differently and they question their reality. Moreover, they question their abilities and often internalize their oppression (Utsey, Bolden & Brown, 2001). Scholars have demonstrated how member s of oppressed and stigmatized groups are negatively affected by the stress of their daily lives (Bryant-Davis & Ocampo, 2005; Carter, 2007; Friedman & Marsella, 1996; Utsey, Bolden & Brown, 2001). LGBT 46
Americans face similar oppression and stigma in the form of heterosexism and homophobia that result in chronic stress (D avid & Knight, 2008; Haatzenbuehler, NolenHoeksema & Erickson, 2008; Meyer, 2003; Rosario, Rotheram-Borus & Reid, 1996; Zamboni & Crawford, 2007). Thus, this framew ork is useful in und erstanding the effects of stress on their mental, emotional and ph ysical health. Moreov er, this understanding of the relationship between oppression and stress provides greater insight into the lives of LGBT African Americans who experienc e the combined stress of heterosexism, homophobia and racism. Using traumatic stress theory to inve stigate gay African American identity development requires an awareness of its limitations. First, the DSM-IV-TR nomenclature does not consider ethno-cultural variables in the understanding, diagnosis and treatment of PTSD. The influence of re ligion and cultural bel iefs on the meaning and subjective experience of trauma is over looked. Second, it fails to address the relationship between systemic oppression and tr aumatic stress that plagues those who live on the margins of society (Carter, 2007; Bryant-Davis & Ocampo, 2005; Friedman & Marsella, 1996). Third, verbal, emotional a nd psychological abuse, blocked access to resources and social alienation, which creat e extreme stress and repr esent a threat to survival, do not currently qualify as precip itants to PTSD. Although the response to these experiences mirror those outlined in the DSM-IV-TR nomenclat ure for PTSD such as intense fear, helplessness or horror, in trusive recollections, persistent avoidance and psychic numbing and persistent symptoms of increased arousal they do not meet the criteria for traumatic stress. Because the traumatic nature of these experiences is not recognized, the psychological distress that individuals face from these conditions is 47
often misdiagnosed, they are denied access to adequate mental health resources, the sociopolitical realities of t heir lives are overlooked and they are further marginalized (Cosgrove, 2005). Traumatic Stress in Afri can American Gay Men African American gay men live with chronic stress in their daily lives. They face systemic oppression that impacts their psyc hological well-being an d threatens their survival (Meyer, 2003). They experience em ployment, housing and legal discrimination and are often marginalized in education and health care settings (Mays & Cochran, 2001). These men also face possible reject ion by their families (Icard, 1996; Wise, 2001), from religious institutions (Greene, 2001; Griffin, 2006; Par ks, 2001) and are at increased risk for psychological, emotional and physical violence (Huebner, Rebchook & Kegeles, 2004). Studies show that inter nalized homophobia, stigma and events of discrimination and violence predi ct psychological distress in gay men (David & Knight, 2008; Mays & Cochran, 2001; Meyer, 1995). Gay African Americans experience sexual identity stress that is exacerbated by racism in both the larger society and wit hin the predominantly white gay community (Greene, 2001; Parks, 2001; Wise, 2001; Zamboni & Crawford, 2007). Studies have shown that African American gay men experience increased levels of heterosexist and race-based stress (Crawford, Allison, Zamboni, & Soto, 2002; Hayes, 1996). In a study of stress and coping among older gay men, Davi d & Knight (2008) found lower levels of sexual identity disclosure, higher le vels of homonegativity and disengaged coping among older African American men than with their White counterparts. Because of these difficulties, gay African Americans are often conflicted in t he process of identity formation and experience increased levels of depression, anxiety, suicidal ideation, 48
substance abuse and high-risk sexual behavio r (Hatzenbeuhler, Nolen-Hoeksema & Erickson, 2008; Huebner & Davis, 2007; Israel & Selvidge, 2003; Savin-Williams, 2001). Gay African Americans experience of racism and homophobia results in a sense of never being a part of any group completely, l eaving them at risk for isolation, feelings of estrangement, and increased psychological vul nerability (Martinez & Sullivan, 1998). They experience the stress of not belonging on a daily basis and they are subject to emotional, psychological and physical violence from those who do not approve of their identity expression. As a re sult, they experience intrusiv e recollections of racist and homophobic events, psychic numbing as a way to manage their emotions and they are hypervigilant about their safe ty and monitor their speech, their mannerisms and their interests so that their sexu al identity is not disclosed (David & Knight, 2008; Mays & Cochran, 2001; Meyer, 1995). This chronic st ress often leads to a number of mental health problems (Israel & Selvidge, 2003; Sa vin-Williams, 2001). Wh ile using traumatic stress theory to understand these difficulties has limitations, it is an effective framework for developing a more accurate conceptualiz ation of problems and creates opportunities for effective culture-centered interv entions (Wynn & West-Olatunji, 2009). Summary African American gay men are regularly confronted with racism and homophobia. These stressful events are cumulative and l ead to isolation, impaired functioning and identity confusion. The symptomatology mimi cs the criteria for traumatic stress as outlined in the DSM-IV-TR such as fear, helpl essness or horror, intrusive recollections, persistent avoidance and psychic numbing and hyperarousal; yet, the current DSM-IVTR nosology does not acknowledge the traumati c nature of persistent exposure to racist and homophobic events. Failure to includ e racism and homophobia as predictors of 49
traumatic stress further rein forces stereotypes of African American gay men and supports the systemic oppression that keeps them on the ma rgins of society. A more inclusive, culture-centered model of traumatic stress wo uld improve the accuracy of case conceptualization, diagnosis and treat ment (Wynn & West-O latunji, 2009). In addition, it would provide a framework for these men to understand their own challenges with identity development in a manner that d oes not reinforce shame and self-loathing. Finally, by acknowledging the serious im pact that traumatic stress has on this population, the field of mental health will ad vance and offer greater access to resources that would assist African American gay m en in the successful dev elopment of their identity. 50
51 Table 2.1. African American culture Dimension Description Balance and Harmony The assumption that all aspects of oneself are inextricably connected. This includes bal ance between mental, physical and spiritual states and living in harmony with nature. Imbalance in one domain is reflected in other domains. Collectivism Interdependence, cooperation and pr ioritizing the group over the individual. Individual identity is connected to group identity. Competition is mi nimized and harmony and group cohesion are maximized. Kinship Bonds Strong commitment to nuclear family, extended family and fictive kin (non-relatives who are embraced as family). The strong kinship bond may be reflected in frequent contact with family members, multiple generations of a family living in one home or nearby, and extended family members assuming parental or care giving ro les for their relatives. Orality Using storytelling and music to transmit cultural information from one generation to the next. Religion/Spirituality Belief in a force greater than oneself that may also include adherence to rituals such as attending church, regular prayers, celebrating religious holidays, and participating in church-related outreach; a prim ary resource for coping with stressful life events such as racism, illness and other adverse conditions. Sensitivity to Affect and Emotional Cues An extended sensitivity to the emotional and affective states of self and others. This includes consideration for other people and is related to the orientation towards collectivism and strong kinship bonds. There is an emphasis on empathizing with others and being open to emotional expression. Time Orientation Flexibility with time and considering the past and present as equally important as the future. Verve and Rhythm Rhythm and creativit y may be seen in movement, posture, speech patterns and learning styles. Verve suggests a preference for multiple and chang ing stimuli versus a singular one that is routine. Bellgrave & Allison, 2006; Boykin, 1983; Boyki n & Ellison, 1995; Chatters, Taylor, & Joyakody, 1994; McAdoo, 1993; Nobles, 2004; Sue & Sue, 2008)
CHAPTER 3 METHODOLOGY The purpose of this study was to examin e the relationship between ethno-cultural identity, sexual orientation identity and trau matic stress in African American gay men. The purpose of this chapter is to provide an overview of the methods that were used in this study. A description of research method s, population and setting, instrumentation, data collection procedures, dat a analyses, and limitat ions of the study will be provided. Research Method Survey methods were used to acquire dat a for this study. A demographic data form (Appendix A), the African Self-Consci ousness Scale S hort Form, (ASCS), (Baldwin & Bell, 1985, Appendix B), the Gay Identity Questi onnaire (GIQ), (Brady, 1994, Appendix C) and the Tr auma Symptom Inventory, (TSI), (Briere, 1995, Appendix D) were distributed to a sample of African American gay men via an electronic mail (email) link to the survey. Correlation and multiple regression statistical methods were used to analyze the data. A power analysis was conducted to determine the number of participants needed in this study (Cohen, 1988). To achieve power of .80 and a small effect size, a total sample size of N=148 is required (Cohen, 1988, p. 385). Participants were informed of the purpose and procedures of this study as well as their rights, risks and benefits of participating. Population and Setting Approval to conduct this study was obtai ned from the universit ys institutional review board. Historically, it has been difficult to recruit gay African American men for participation in research studies. Ther efore, convenience and snowball sampling methods were used. Participants were recr uited from social ne tworks. In addition, 52
members of national black gay organizations such as the Black AIDS Institute, the Black Gay Network, the National Black Justice Co alition, and the National Black Gay Mens Advocacy Coalition were invited to participat e by emailing the membership coordinators of these groups with information about the study and requesting that it be distributed to their membership. The use of anonymous, electronic surveys ensured participant confidentiality and no identifying information was solicited. Incentives were not provided for participation in this study. Data collect ion lasted 14 weeks. The Statistical Package for the Social Sciences (SPSS v.18) program was used for data analysis. Instrumentation Three instruments were used in this st udy: the African Self-Consciousness Scale Short Form (ASC), the Gay Identity Q uestionnaire (GIQ) modified and the Trauma Symptom Inventory (TSI). Each instrument or its subscales with the exception of the Identity Pride subscale of the GIQ, have reli ability scores of at least .70, which is typically considered acceptable (C onstantine & Ponterotto, 2006). African Self-Consciousness Scale (ASC) The ASC scale is a 42-item questi onnaire designed to assess the Black personality construct of African self-consci ousness (Baldwin & Bell, 1985). Selected from an original pool of 130 items, these 42 items ranked highest among expert judges (psychologists) in how well t hey reflected the ASC four fa ctors (see Table 3.1). The items were also rated in terms of six manifest or expressi ve dimensions believed to be relevant to important aspects of African American life. They includ e education, family, religion, cultural activities, interpersonal relations, and political orientation. The reliability estimate for the ASC wa s obtained using the test-retest method. A sample of 109 Black college st udents enrolled in general psychology courses at Florida 53
Agricultural and Mechanical University (F AMU) were administered the scale on two separate occasions six weeks apart. The it ems were randomly reordered on the second administration to control for practice and order effects. Positive and negative items were also randomly reordered on the second admin istration. The Pearson product-moment correlations coefficient used in this analysis generated a reliability coe fficient of r (107) =.90, p<.001 (Baldwin & Bell, 1985). The ASC items alternate from negative phrasing with regard to African SelfConsciousness (low scores index the ASC constr uct) to positive phrasing with regard to African Self-Consciousness (high scores i ndex the ASC construc t). Odd numbered items are negatively weighted for the ASC co nstruct, while even numbered items are positively weighted for the ASC construct. Responses are given according to the following Likert-type scaling system: Strongly Disagree= 1-2; Disagree= 3-4; Agree= 56; Strongly Agree= 7-8. Even numbered items are scored by computing their scaled values directly, whereas odd numbered items are scored as the reverse of their scaled values (8=1, 7=2, 6=3, etc.). The total ASC score can be computed as either sum of the scores or as the overall mean of t he scores (Baldwin & Bell, 1985). The ASC Short Form is a 20-item questionnaire taken from the original 42-item ASC developed by Kambon and Associates (1996; Baldwin and Bell, 1985). The ASC Short Form is organized around f our ASC Subfactors/subscales and consists of the five items representing the highest item-loadings on each of the factors. The ASC Subfactors are F1-Collective African Ident ity, F2-Resistance/Defense Against AntiAfrican Forces, F3-Value for Africentric Institutions and Cultural Expressions, and F4Value for African Culture (Kambon, 1998). Around 90% of the orig inal items loaded on 54
the four factors, accounting for nearly 76% of the variability. Cronbachs Alpha coefficients for the full scale ASC range from .79 to .82, while test -retest reliability coefficients covering intervals from six week s up to nine months occur well within the high 80s to low 90s range (Baldwin and Bell, 1985; Kambon, 1998). The ASC is structured such that even-numbered items are positively keyed for ASC and odd-numbered items are negatively keyed for ASC. Thus, for positive keyed items, high scores (above 4) are indicative of strong/high ASC, and for negative keyed items, low scores (4 and below) are indicati ve of strong/high ASC. Therefore, negative (odd numbered) item scores must be transposed to their ASC weights or values. For example, a negative weighted score of 1 is conv erted/transposed to 8, a 2 to 7, 3 to 6, etc. (i.e., for negative weight ed items 1=8, 2=7, 3=6, 4= 5, 5=4, 6=3, 7=2, 8=1). Gay Identity Questionnaire (GIQ) The original version of the GIQ consis ts of 45 true-false items that measure respondents stage of homosexual identity formation (HIF) proposed by Cass (1979) (see Table 3.2). The original sample included 225 White, middle-class male respondents residing in southern California in 1983. The median age of the respondents was 28.8 years and all reported that they had homosexual thoughts, feelings or engaged in homosexual behavior (Brady, 1998). The internal consistency scores for the original GIQ are not available for the first two stages due to too few respondents in the pilot test, which may be the result of difficultly in recruiting subjects for a study on gay identity who do not yet identify as gay (Brady & Busse, 1994). Additionally, the reliability sco re for the fifth stage, Identit y Pride, is weak (r = .48). Brady & Busse (1994) hypothes ize that this stage does not represent a distinct 55
developmental stage but rather a process of development between stage four, Identity Acceptance and stage six, Identity Synthesis. Rogers (1998) modified the GIQ in an effort to improve the instruments reliability and to better identify participants levels of gay identity. A six-point Likert scale ranging from 1=Strongly Disagree to 6= Strongly Agree replaced th e original True/False scale. The responses were summed and mean calculat ed which provided a score for each of the six stages rather than a single stage desig nation. The reliability scores reported in Table 3.2 are based on a sample of 237 gay men. Trauma Symptom Inventory (TSI) The 100 item-TSI is a general test of tr auma symptoms that ar e rated on a 4-point scale of frequency of occurrence over t he past 6 months (0=Never, 1=Rarely, 2=Occasionally, 3=Often). The TSI takes a response perspective of trauma and does not ask about precipitating events (Fernandez, 2001). The TSI consists of 10 clinical scales, which evaluate the symptomatology of traumatized individuals. The five subscales of the TSI that are consistent with the DSM-IV-TR criteria for PTSD will be used for this study. In addition the sexual concerns and dysfunctional sexual behavior subscales will also be used due to their rele vance to the study. They are described in Table 3.3. The psychometric properties of the TSI were analyzed on four samples, standardization sample n=828, university st udents n=279, clinical sample n=370 and Navy recruits n=3,659. The student and clinic al samples were predominantly female. Analysis of the TSIs predictive validity re vealed that it accurately predicted PTSD as outlined in the DSM-IV-TR in 91% of the cases (Fernandez, 2001). 56
Summary The three instruments proposed for use in this study, the ASC the GIQ-modified, and the TSI are psychometrically sound. In addition, they are consistent with the constructs outlined in chapter 2 of this study Therefore, they are appropriate for use in this study. The ASC is based on Africentric theory (Baldwin, 1981) and has been used in studies on Africentric psychology (Baldwin & Bell, 1985; Baldwin, Brown, & Rackley, 1990; Baldwin, Duncan, & Bell, 1992; McCow an & Alston, 1998). The data suggest that a reliable relationship exists between high levels of African self-consciousness and positive psychological functioning and behavio r in African American people (Baldwin & Bell, 1985). The GIQ offers a valid assessment of gay men in the later stages of HIF. It has been used in a number of studies with gay men as well as lesbians with significant results (Halpin & Allen, 2004; Levine, 1997; Marszalek, Cashwell, Dunn & Jones, 2004; Rowen & Malcolm, 2002). The modified version of the GIQ improved its reliability and its ability to identify participants levels of gay identity. Use of the GIQ in a study measuring gay identity in African American men will co ntribute to the generalizability of the instrument. The TSI is internally consistent, dem onstrates good convergent validity and is useful in quantifying the diagnostic informati on for assessing PTSD. The TSIs response perspective to trauma, avoi ding the narrow focus on only a few possible precipitating events to trauma, is consistent with the construct of traumatic stress as presented in this study. 57
Limitations Purposeful, convenience and snowball sampling limits the diversity and selection of individuals for the sample by selecting those who participate in formal support groups and those who belong to certain social networks. Using electronic mail to link to the surveys is a limitation in that it excludes potential participants who either do not have access to this technology or ar e uncomfortable with its use. Data Collection Procedures The ASC, the GIQ and the TSI were distribut ed to eligible participants via a link through electronic mail. Data Analysis The data were entered into SPSS v.18 and analyzed. For the first research question, the relationship of ethno-cultural identity and gay identity was tested with Pearson product-moment correlation. 1. What is the relationship between cultur al identity and gay identity in African American men? For the remaining research questions, (2-8) multiple regression was used to analyze the data in order to understand the re lationship between the three variables. 2. What is the relationship between et hno-cultural identity, gay identity and hyperarousal in Afri can American men? 3. What is the relationship between et hno-cultural identity, gay identity and depression in African American men? 4. What is the relationship between et hno-cultural identity, gay identity and intrusive experiences in African American men? 58
5. What is the relationship between et hno-cultural identity, gay identity and defensive avoidance in African American men? 6. What is the relationship between et hno-cultural identity, gay identity and dissociation in Afri can American men? 7. What is the relationship between et hno-cultural identity, gay identity and sexual concerns in African American men? 8. What is the relationship between et hno-cultural identity, gay identity and dysfunctional sexual behavio r in African American men? 59
Table 3.1. African self-consciousness scale Four factors Factor Description Collective African Identity A psychological disposition reflecting a sense of and Self-Fortification African identity and a tendency to engage in activities that affirm ones African ident ity. (e.g., Pro-Black/Back empowering actions like pr omoting African history and cultural activities, Black organized/collective activities, Black economic and political activities/Nguzo Saba, etc.) Resistance Against A psychological disposition reflecting a tendency to Anti-African Forces resist, by any means necessary, any and all information which may be perceived (experienced/interpreted) as anti-African/anti-Black, or as a threat to African/Black survival in any way, shape or form. (e.g., Rejects White supremacy and actively combats it in all areas of experience.) Value for African-Centered A psychological disposition reflecting a belief in the importance of Institutions and Africentric/pro-Black-or iented/empowering Cultural Expressions organizations-instit utions, practices, etc., that are under African/Black control based on African cultural definitions. (e.g., practicing African cultural rituals, celebrations, commemorations, etc.) Value for African Culture A psychological disposition reflecting a firm belief in the value/importance of tr aditional African cultural forms (practices, products-art ifacts, etc.) for Africans (in America). (Baldwin & Bell, 1985) 60
Table 3.2. Stages of hom osexual identity formation Stage Description Identity Confusion (r=.78) Feeling different and initial awareness that a heterosexual identity does not fit. Identity Comparison (r=.86) Attempts to pass as heterosexual while keeping gay identity separate. Identity Tolerance (r=.74) Alienati on from the heterosexual world and an increased desire to connect with the gay community. Identity Acceptance (r=. 84) Increased contact with the gay community, passing as heterosexual when needed and beginning to disclose gay identity to others Identity Pride (r=.57) Immersion in gay culture, strong sense of identity with the gay community, social activism and increase disclosure of sexual identity. Identity Synthesis (r=.76) Letting go of us versus them and sense of pride is integrated into gay identity. (Cass, 1979; Rogers, 1998) 61
62 Table 3.3. Trauma symptom inventory subscales Scale Description Hyperarousal ( = .87) Jumpiness, tension and heightened awar eness of trauma stimuli. Sleep difficulty, irritability, anger and difficulty concentrating Depression ( = .90) Sadness and hopelessness Intrusive experiences ( = .90) Flashbacks and nightma res of traumatic experiences Defensive avoidance ( = .88) Cognitive and behaviora l avoidance of trauma stimuli Dissociation ( = .88) Psychic numbing; lim its the cognitions and feelings related to the trauma Sexual concerns ( = .89) Negative thoughts and feelings du ring sex, confusion regarding sexual issues and shame regarding sexual activities Dysfunctional sexual behavior Indiscriminate sexual contact, ge tting into trouble ( = .89) because of sexual behav ior and using sex to combat internal distress (Briere, 1995; Briere, Elli ott, Harris & Cotman, 1995)
CHAPTER 4 RESULTS This study examined the relationship between ethno-cultural identity, sexual orientation and traumatic stress in adult African American gay men. The purpose of this chapter is to provide a summary of t he study including sampling procedures and instrumentation. Participant descriptive in formation will also be presented. Finally, the statistical analyses and findings of the study in relation to the research questions and hypotheses will be discussed. Research Questions 1. What is the relationship between ethno-cultural identity and gay identity in African American men? 2. What is the relationship between et hno-cultural identity, gay identity and hyperarousal in Afri can American men? 3. What is the relationship between et hno-cultural identity, gay identity and depression in African American men? 4. What is the relationship between ethnocultural identity, gay identity and intrusive experiences in African American men? 5. What is the relationship between et hno-cultural identity, gay identity and defensive avoidance in African American men? 6. What is the relationship between et hno-cultural identity, gay identity and dissociation in Afri can American men? 7. What is the relationship between ethno-cu ltural identity, gay identity and sexual concerns in African American men? 63
8. What is the relationship between et hno-cultural identity, gay identity and dysfunctional sexual behavio r in African American men? Hypotheses Null hypotheses developed for each of the research questions are as follows: Ho1: There will be no significant relati onship between ethno-cultural and gay identities in African American gay men. Ho2: There will be no significant relationship between ethno-cultural identity, gay identity and hyperar ousal in African American men. Ho3: There will be no significant re lationship between ethno-cultural identity, gay identity and depres sion in African American men. Ho4: There will be no significant relationship between ethno-cultural identity, gay identity and intrusive ex periences in African American men. Ho5: There will be no significant relationship between ethno-cultural identity, gay identity and defensive avoidance in African American men. Ho6: There will be no significant relationship between ethno-cultural identity, gay identity and dissociation in African American men. Ho7: There will be no significant relationship between ethno-cultural identity, gay identity and sexual concerns in African American men. Ho8: There will be no significant relationship between ethno-cultural identity, gay identity and dysfunctional sexual behavior in African American men. Snowball sampling was used to recruit adul t African American gay men from social networks for participation in this study. Part icipants completed an on-line survey that included 17 demographic questions, the African Self-Consciousness Scale Short Form, 64
the Modified Gay Identity Q uestionnaire, and 7 subscale s of the Trauma Symptom Inventory. Data was analyzed using Pear son correlation and multiple regression equations. Participant Descrip tive Information A total of 152 people participated in the study. Forty-eight were deleted prior to analysis due to gender (Female) (4), racial/e thno-cultural backgroun d (White) (4), or incomplete surveys (40). Ther efore, a total of 104 participant responses were valid and used for analysis. The age ranges with the highest frequencie s include the 46-50 age range (17.3%), the 41-45 and 20-25 age ranges (15.4%), an d the 31-35 age range (14.4%). The distribution of participants by age range is presented in Table 4.1. The ethno-cultural backgrounds of the participants are as follows: African American/Black (Non-Latino) (79%), Afro Caribbean (14% ), African (Born on the continent of Africa) (6%), Mu ltiracial/Multiethnic (4%), an d other (1%). Seventy nine percent of the sample described their sexu al orientation as gay, while 18.3% chose same-gender loving as a description of thei r sexual orientation. Other participants indentified their sexual orientation as bisexual (3.8%) or Queer (1.9%). Participants described their current relationship status as follows: single (67% ), partnered (25%), married (4%), and divorced (4%). Demographic data were also collected on participants religious affiliation. Eighteen percent reported no religion, 68% identified as Christian, 2% as Buddhist, and 11% as other. One participant did not respond to this item. Forty-seven percent of participants reported that religion is very im portant, 26% reported th at religion is not important, and 25% reported that religion is somewhat impor tant. Two participants did 65
not respond to this item. Forty percent of participants reported seldom attendance at religious services, 29% reported attending religious services often, 17% reported attending religious services sometimes, and 14% reported never attending religious services. The geographic region of the United States in whic h participants were raised as well as their current geographic region was also examined. Over half of the participants (59%) reported being raised in the South and 64% reported currently living in this region. Participants who repor ted being raised in the Nort heast make up 17% of the sample; 14% reported currently living in this region. While 15% of participants reported being raised in the Midwest, 16% reported current ly living in this region. Finally, 7% of participants reported being raised in the West and 5% reported currently living in this region. Other demographic questions examined th e highest level of education of the participants (see Table 4.2), current occupati on (see Table 4.3), and income level (see Table 4.4). Data Analyses and Results The following is a presentation of the re search questions as well as a description of the analyses and the results in relation to the null hypotheses. Descriptive statistics are provided in Table 4.5. Question 1 What is the relationship betwe en ethno-cultural identity and gay identity in African American men? Preliminary analyses using Pearson correlation coefficient revealed a high correlation ( =.83) between the confusion (GI DCONF) and comparison (GIDCOMP) 66
subscales of the Gay Identity Questionna ire. Therefore, a composite variable (GIDCONF/COMP) was formed. A Pearson correlation coefficient was ca lculated for the relationship between participants level of African self consci ousness (ASC) and stage of gay identity (see Table 4.6). The test revealed that there was no statistically significant correlation between ASC and GIDCONF/COMP(r (78) = -. 171, p>.05). Theref ore, there is no association between African self conscious ness and gay identity confusion/comparison. There was no statistically significant correlation between ASC and GIDTOL(r (83) = .068, p>.05). Therefore, ther e is no association between Af rican self consciousness and gay identity tolerance. There was no statistically significant correlation between ASC and GIDACC (r (85) = -.080, p>.0 5). Therefore, there is no association between African self consciousness and gay identity acceptanc e. There was no statistically significant correlation between ASC and GIDPRIDE (r (84) = .146, p>.05). Therefore, there is no association between African self conscious ness and gay identity pr ide. Finally, there was no statistically significant correlati on between ASC and GIDSYN (r (86) = -.033, p>.05). Therefore, t here is no association between African self consciousness and gay identity synthesis. The first hypothesis proposed that there is no relationship between African selfconsciousness and gay identity. The hypothesi s was supported by the results, which showed that there was no statistically significant correlation between African selfconsciousness and gay identity. This finding is inconsistent with other studies addressing intersectionality of identity (Crawford, Allison, Zamboni & Soto, 2002; Hatzenbeuhler, Nolen-Hoeksema & Erickson, 2008; Huebner & Davis, 2007; Israel & 67
Selvidge, 2003; Savin-Willi ams, 2001) that suggest a negative relationship exists between ethno-cultural identity and gay identity. One explanat ion for why this study did not find a significant correlation between African self-consciousness and gay identity may be because this study had a small samp le size; therefore limiting the power needed to detect a relationship. The concept of intersectionality addresses the nuanced complexities of multiple identities that cannot be sufficiently captur ed using conventional id entity development models, such as racial (Helms, 1995; S ue & Sue, 2008) and gay/lesbian (Cass, 1979; Minton & McDonald, 1984). Studies report that many Afric an American gay men choose to keep their ethno-cultural and gay identitie s separate (Christian, 2005; Brown, 2005). According to the literature, the Black communi ty generally provides a sense of solidarity against racism that may be reinforcing for African American gay men. However, they are less likely to experience that solidarity if their sexual orientation becomes known or is openly discussed; if they c ome out. In fact, they ma y even be ostrac ized. Although African American gay men have hi storically been key figures in their families, they often become devalued once the code of silenc e about their homosexuality is broken (Carpineto, Kubicek, Weiss, Iverson & Kipke, 2008; Icard, 1996; Wise, 2001). However, 55% of the men in this study scored in the high range on both African self-consciousness and gay identity pride suggesting that there are many African American gay men who are more successful at integrating their identities. This study reflects the need for more insight into the fact ors that support identity integration, as well as those that inhibit it in African American gay men. 68
Question 2. What is the relationship between ethno-cultural identity, gay identity, and hyperarousal in Afri can American men? Regression equation: Hyperarou sal= -8.144 + .081(ASC) + .135(GIDCONF/COMP) .290(GIDTOL) + .262(GIDACC) + .264(GIDPRIDE) .071(GIIDSYN) A multiple regression was conducted with the following pr edictor variables: ASC, GIDCONF/COMP, GIDTOL, GIDACC, GIDPR IDE, and GIDSYN, with hyperarousal as the outcome variable (see Table 4.7). The model produced an R2 of .257, which was statistically significant, (F(6,63) = 3. 641, p = .05). ASC, GI DCONF/COMP, GIDTOL, GIDACC, GIDPRIDE, and GIDSYN can account for 25.7% of the variance in hyperarousal. ASC, GIDCONF/COMP, GID TOL, and GIDSYN had non-significant effects. GIDACC was positively related to hyper arousal (B = .262, t = 2.772, p = .007). GIDPRIDE was positively related to hyperarous al (B = .264, t = 2.143, p = .036). The second hypothesis states that there will be no significant relationship between ethno-cultural identity, gay identity and hyperarousal in Af rican American men. This hypothesis is partially suppor ted. The gay identity conf usion/comparison, the gay identity tolerance, and the gay identity synthesis stages of gay identity development had non-significant effect s on hyperarousal. However, the gay identity acceptance and the gay identity pride stages were positively related to hyperarousal, which suggests that the more open African American gay men are to themselves and others about thei r gay identity, the more likely they are to experience hyperarousal. This finding is s upported by the literature reflecting African American gay mens experiences of being hypervigilant about their safety, monitoring 69
their speech, their mannerisms, and their inte rests as a way of managing disclosure of their sexual identity (David & Knight, 2008; DiPlacido, 1998; Mays & Cochran, 2001; Meyer, 2003). In addition, Cochran, Sulliv an, and Mays (2003) observed that gay and bisexual men were 4.7 times more likely to meet criteria for panic disorder than heterosexual men. Question 3. What is the relationship between ethno-cultural identity, gay identity and depression in African American men? Regression equation: Depression= -9. 966 + .025(ASC) +.093(GIDCONF/COMP) .289(GIDTOL) + .351(GIDACC) + .487(GIDPRIDE) .032(GIDSYN) A multiple regression was conducted with the following pr edictor variables: ASC, GIDCONF/COMP, GIDTOL, GIDACC, GIDPR IDE, and GIDSYN, with depression as the outcome variable (see Table 4.8). The model produced an R2 of .227, which was statistically significant, (F(6,73) = 3. 581, p = .05). ASC, GI DCONF/COMP, GIDTOL, GIDACC, GIDPRIDE, and GIDSYN can account for 22.7% of the variance in depression. ASC, GIDCONF/COMP, GIDTOL, and GIDSYN had non-significant effects. GIDACC was positively related to depression (B = .351, t = 3.368, p = .001). GIDPRIDE was positively related to depression (B = .487, t = 3.747, p = 0.001). The third hypothesis states that there wil l be no significant relationship between ethno-cultural identity, gay identity and depression in Afri can American men. This hypothesis is partially support ed. Three of the 5 stages of gay identity development, gay identity confusion/comparison, gay identity tolerance, and gay identity synthesis were not significantly related to depression. 70
Two stages of gay identity development, gay identity acceptance and gay identity pride were positively related to depression in African American gay men, which suggests that the more accepting they are about their gay identity, the more likely they are to experience depression. This is consistent with the literature on the prevalence of depression in gay men. Studies show that gay and bisexual men are 3 times more likely to meet DSM-IV-TR criteria for major depr ession than their heterosexual counterparts (Cochran, Sullivan & Mays, 2003; Crawfo rd, Allison, Zamboni & Soto, 2002; Hatzenbeuhler, Nolen-Hoeksema & Erickson, 2008; Huebner & Davis, 2007; Israel & Selvidge, 2003; Savin-Williams, 2001). Other studies reveal that a lesbian, gay, bisexual identity and questioning of ones sexual or ientation is an indep endent predictor of suicide attempts particularly among adoles cents (Fergusson, Horwood, & Beautrais, 1999; Garafalo et. al., 1999). Question 4 What is the relationship between et hno-cultural identity, gay identity and intrusive experiences in African American men? Regression equation: Intrusive Ex periences= -12.931 + .069(ASC) +.052(GIDCONF/COMP) .230(GIDTOL) + .302(GIDACC) + .327(GIDPRIDE) + .057(GIDSYN) A multiple regression was conducted with the following pr edictor variables: ASC, GIDCONF/COMP, GIDTOL, GIDACC, GID PRIDE, and GIDSYN, with intrusive experiences as the outcome variable (s ee Table 4.9). The model produced an R2 of .216, which was statistically signific ant, (F(6,73) = 3.348, p = .05). ASC, GIDCONF/COMP, GIDTOL, GIDACC, GIDPRID E, and GIDSYN can account for 21.6% of the variance in intrusive experiences ASC, GIDCONF/COMP, GIDTOL, and GIDSYN 71
had non-significant effects. GIDA CC was positively related to intrusive experiences (B = .302, t = 3.434, p = .001). GIDP RIDE was positively related to intrusive experiences (B = .327, t = 2.978, p = .004). The fourth hypothesis states that there will be no signif icant relationship between ethno-cultural identity, gay i dentity and intrusive experiences in African American men. This hypothesis is partially supported. A nalysis revealed no significant relationship between intrusive experiences and the gay identity confusion/co mparison, the gay identity tolerance, and the gay identity synthesis stages of gay identity development. A significant relationship was found bet ween intrusive experiences and the gay identity acceptance and the gay identity pride stages of gay identity development reflecting African American gay mens experienc es with negative events related to their acceptance of and pride in their gay identity. This is discussed in the literature on the effects of homophobic events on the LGBT population such as anti-gay victimization including verbal assault, threats, and physical violence, as well as familial abuse, harassment, and maltreatment (Comstock, 1989; DAugelli, 1992; DiPlacido, 1998; Garnets, Herek et.al., 1997; Herek, 1993; Meyer, 2003; Otis & Skinner, 1996). Question 5 What is the relationship between et hno-cultural identity, gay identity and defensive avoidance in African American men? Regression equation: Defensive Avoidance= -14.198 + .094(ASC) +.048(GIDCONF/COMP) .088(GIDTOL) + .280(GIDACC) + .415(GIDPRIDE) + .023(GIDSYN) A multiple regression was conducted with the following pr edictor variables: ASC, GIDCONF/COMP, GIDTOL, GIDACC, GID PRIDE, and GIDSYN, with defensive 72
avoidance as the outcome variable (s ee Table 4.10). The model produced an R2 of .209, which was statistically signific ant, (F(6,73) = 3.218, p = .05). ASC, GIDCONF/COMP, GIDTOL, GIDACC, GIDPRID E, and GIDSYN can account for 20.9% of the variance in defensive avoidanc e. ASC, GIDCONF/COMP, GIDTOL, and GIDSYN had non-significant effects. GIDA CC was positively related to defensive avoidance (B = .280, t = 2.583, p = .012). GIDP RIDE was positively related to defensive avoidance (B = .415, t = 3.069, p = .003). The fifth hypothesis proposed that there will be no significant relationship between ethno-cultural identity, gay identity and defensive avoidance in African American men. This hypothesis is partially supported in that there was no significant relationship between defensive avoidance and the gay i dentity confusion/co mparison, the gay identity tolerance, and the gay identity synthesis stages of gay identity development. There was significance in the relati onship between defensive avoidance and the gay identity acceptance and the gay identity pride stages of gay identity development suggesting that even at later stages of gay identity development, African American gay men may be avoiding gay-related trauma stimuli. Similar results are reported in the literature. For example, in a study on lesbian and gay male undergraduates experience of harassment and fear on campus, lesbian and gay college students admitted to changing their lives to avoid harassment, abus e, and violence. These changes included avoiding certain locations, avoidance of openly lesbian or gay people, and developing a distorted or restricted presentat ion of self (denying that they are involved in a romantic relationship or suggesting that they are dating opposite sex part ners) (DAugelli, 1992). Studies also suggest that substance abuse in the LGBT populati on is an attempt to 73
escape unpleasant emotions, to combat isol ation and loneliness and to avoid social conflict (Berg, Mimiaga, & Safren, 2008; Co chran & Mays, 2000; Gilman et. al., 2001; Greenwood, et. al., 2000; Halkitis, Parsons & Wilson, 2003; Sta ll, et. al., 2001). Question 6 What is the relationship between et hno-cultural identity, gay identity and dissociation in African American men? Regression equation: Dissociation= -9 .351 + .014(ASC) +. 057(GIDCONF/COMP) .051(GIDTOL) + .256(GIDACC) + .424(GIDPRIDE) + .054(GIDSYN) A multiple regression was conducted with the following pr edictor variables: ASC, GIDCONF/COMP, GIDTOL, GIDACC, GIDPR IDE, and GIDSYN, with dissociation as the outcome variable (see Table 4.11). The model produced an R2 of .223, which was statistically significant, (F(6,73) = 3. 501, p = .05). ASC, GI DCONF/COMP, GIDTOL, GIDACC, GIDPRIDE, and GIDSYN can account for 22.3% of the variance in dissociation. ASC, GIDCONF/COMP, GIDTOL, and GID SYN had non-significant effects. GIDACC was positively related to di ssociation (B = .256, t = 2.748, p = .008). GIDPRIDE was positively related to dissociat ion (B = .424, t = 3.642, p = .001). The sixth hypothesis, there will be no significant re lationship between ethnocultural identity, gay identity and dissociation in African American men was partially supported. There was no significant rela tionship between dissociation and the gay identity confusion/comparison, the gay identit y tolerance, and the gay identity synthesis stages of gay identity development. Dissociation was positively related to the gay identity acceptance and the gay identity pride stages of gay identity development. Dissociation, also known as psychic 74
numbing is one way that LGBT people manage the painful emotions associated with belonging to a marginalized social ident ity group (DiPlacido, 1998; Meyer, 2003). Question 7 What is the relationship between et hno-cultural identity, gay identity and sexual concerns in African American men? Regression equation: Sexual Co ncerns= -10.626 + .051(ASC) +.0135(GIDCONF/COMP) .088(GIDTOL) + .280(GIDACC) + .415(GIDPRIDE) + .023(GIDSYN) A multiple regression was conducted with the following pr edictor variables: ASC, GIDCONF/COMP, GIDTOL, GIDACC, GIDPRID E, and GIDSYN, with sexual concerns as the outcome variable (see Tabl e 4.12). The model produced an R2 of .221, which was statistically significant, (F(6,73) = 3. 460, p = .05). ASC, GI DCONF/COMP, GIDTOL, GIDACC, GIDPRIDE, and GIDSYN can account for 22.1% of the variance in sexual concerns. ASC, GIDCONF/COMP, GIDTOL, and GIDSYN had non-significant effects. GIDACC was positively related to sexual conc erns (B = .290, t = 3.070, p = .003). GIDPRIDE was positively related to sexual c oncerns (B = .285, t = 2.422, p = .018). The seventh hypothesis, there will be no significant relationship between ethnocultural identity, gay identity and sexual conc erns in African American men was partially supported. There was no significant relations hip between sexual concerns and the gay identity confusion/comparison, the gay identit y tolerance, and the gay identity synthesis stages of gay identity development. The gay identity acceptance and the gay identity pride stages of gay identity development were positively related to se xual concerns. Recent studies addressing stress in gay men found significance betw een stress and sexual problems such as 75
communication difficulties, performance conc erns (erectile and orgasmic disorders), sexual knowledge deficits, and negative se xual attitudes (Banc roft, et. al., 2005; Standfort & deKeizer, 2001; Zamboni & Crawford, 2007). Question 8 What is the relationship between et hno-cultural identity, gay identity and dysfunctional sexual behavior in African American men? Regression equation: Dysfunctional Se xual Behavior= -3.462 + .015(ASC) +.030(GIDCONF/COMP) .173(GIDTOL) + .251(GIDACC) + .240(GIDPRIDE) + .072(GIDSYN) A multiple regression was conducted with the following pr edictor variables: ASC, GIDCONF/COMP, GIDTOL, GIDACC, GIDPR IDE, and GIDSYN, with dysfunctional sexual behavior as the outcome variable (see Table 4.13). The model produced an R2 of .141, which was statistically signific ant, (F(6,73) = 1.994, p = .05). ASC, GIDCONF/COMP, GIDTOL, GIDACC, GIDPRID E, and GIDSYN can account for 14.1% of the variance in dysfunctional sexual behavior. ASC, GIDCONF/COMP, GIDTOL, and GIDSYN had non-significant effects. GIDACC was positively related to dysfunctional sexual behavior (B = .251, t = 2.969, p = .004). GIDPRIDE was positively related to dysfunctional sexual behavior (B = .240, t = 2. 276, p = .026). The eighth hypothesis proposed that there will be no signif icant relationship between ethno-cultural identity, gay identity and dysfunctional sexual behavior in African American gay men. This hypothesis was parti ally supported. There was no significant relationship between dysfunctional se xual behavior and the gay identity confusion/comparison, the gay identity toler ance, and the gay identity synthesis stages of gay identity development. 76
There was a significant positive relationship between dysfunctional sexual behavior and the gay identity acceptance and the gay identity pride stages of gay identity development. This finding suggests that at these stages of gay identity, African American gay men may engage in indiscriminat e sexual contact, get into trouble because of sexual behavior, and use sex to combat internal distress. Other studies have found that the di scrimination; expectations of rejection, and internalized homophobia that is often associ ated with all stages of gay i dentity was positively related to dysfunctional sexual behavior such as HI V risk behavior (unprotected sex) (Diaz, et. al., 2001; Hatzenbeuhler, Nolen-Hoeksema & Erickson, 2008; Mays & Cochran, 2001; Meyer, 1995; Rosario, Rotheram-Borus & Reid, 1996). In summary, Pearson correlation analysis found no association between African self-consciousness and gay identity. Regr ession analyses found that African selfconsciousness was not a predict or of traumatic stress in African American gay men. While the analysis did not reveal a signifi cant relationship between African selfconsciousness and gay identity, the literatur e suggests that a negative relationship exists. The small sample size of this study which limits the power needed to detect a relationship, should be considered when interpreting this result. Regression analyses found that African self-consciousness was not a predictor of traumatic stress in African American gay men. While the results of this analysis did not show a significant relationship between African self-consciousness and traumatic stress, the researcher does not assume that participants are not affected by race-based stressors; the literature suggests otherwise (Greene, 2001; Parks, 2001; Wise, 2001; Zamboni & Crawford, 2007). The results may; however, suggest that the stress from 77
their gay identity is currently more salient. In addition, they may also have support from other African Americans who help to buffer the effects of racism. Similarly, three of the five st ages of gay identity, gay identity confusion/comparison, gay identity tolerance, and gay identity synthesis did not predict traumatic stress in African American gay m en. The gay identity confusion/comparison and the gay identity tolerance reflect earlier phases of gay identity development where men may not identify themselves as gay and may not participate in a study of this nature. Seventy nine percent of the sample described thei r sexual orientation as gay and 18.3% chose same-gender loving (Manago & Howcott, 2006) as a description of their sexual orientation. In addition, the snowball sampling method used to recruit participants limits the diversity of the sample. The lack of significance in the relationship between gay identity synthesis and traumatic stress may also reflect a lack of dive rsity in the sample. However, this stage of development is characterized by letting go of the us versus them perspective and a sense of pride is integrated into ones gay id entity. Thus, the men in this stage of gay identity development may be less affected by t he stressors of living as a member of a marginalized social identity group. Two stages of gay identity, gay identity acceptance and gay identity pride were positively related to each of the dimens ions of traumatic stress (hyperarousal, depression, intrusive experiences, dissociat ion, sexual concerns, and dysfunctional sexual behavior). Therefore, when contro lling for all other variables, gay identity acceptance and gay identity pride are making a significant unique contribution to the prediction of traumatic stress in African American gay men. 78
Gay identity acceptance made the str ongest unique contribution in predicting intrusive experiences ( = .598) and depression ( = .582). Of the pa rticipants with the highest scores on gay identity acceptance 38 .2% scored in the mid range on African self consciousness and 34.4% scored in the high range on African self consciousness. Gay identity pride made the strongest unique contribution in predicting depression ( = .476) and dissociation ( = .464). Of the participants with the highest scores on gay identity pride, 40% scored in the mid range on African self consciousness and 55% scored in the high range on Afri can self consciousness. The gay identity acceptance stage is ma rked by an emerging self-acceptance of ones gay identity, passing as heterosexua l when necessary, and beginning to disclose ones gay identity to others. T he gay identity pride stage is characterized by immersion in gay culture, engagement in activism, and increased disclosure of ones gay identity. The significance found between these stages of gay identity and traumatic stress suggests that men with a less integrated i dentity and those who are immersed in gay culture, are engaged in activism, and are more open about their gay identity, experience increased stress. It is import ant to note that there is no causal relationship between gay identity and traumatic stress. These findings reflect the stress that is involved in belonging to a marginalized social identity group. Limitations of the Study Limitations of this study include the sa mpling methods, use of technology to administer the survey, participant self-reporti ng bias, and the impact of the sample size on analyses. Snowball sampling was used to recruit African American gay men from social networks. This sampling method limits the diversity of the sample by selecting those 79
who belong to certain social networks; ther eby, negatively affecting the generalizability of the results. In addition, this sampling method limited the researchers ability to calculate the response rate. Another limitation is the use of electronic mail to distribute the link to the survey. It excluded potential participants w ho either do not have access to this technology or are uncomfortable with its use. Participant self-reporting bias is also a limitation of this study. The DSM-IV-TR (American Psychiatric Association, 2000) de scribes the symptomatology of traumatic stress by the diagnostic criteria for PTSD. PTSD is characterized by exposure to a traumatic event in which a person experienc es or witnesses events that threaten death or serious injury and the persons response involves intense fear, helplessness or horror. The survey did not assess whether pa rticipants had experienced any events that meet the current DSM-IV-TR def inition of traumatic stress. Thus, the researcher is unable to verify whether participants responses accurately reflect their experiences of traumatic stress related to either their identit y as African Americans or their identity as gay men. This study reflects African American gay mens voices from different age groups, various occupations and income levels, di fferent religious affiliations and from all regions of the United States. However, the small sample si ze (N=104), is a limitation that impacts the power of the analysis, which may limit t he ability to detect relationships between variables. Intersectionality of identity is gaining incr eased attention in the literature. Another limitation of this study is the lack of signifi cance in the relationship between African self80
consciousness and gay identity. This is fu rther explored in the recommendations for future research. 81
Table 4.1. Distribution of participants by age range Range in years Frequency Percent 20-25 16 15.4 26-30 6 5.8 31-35 15 14.4 36-40 9 8.7 41-45 16 15.4 46-50 18 17.3 51-55 7 6.7 56-60 8 7.7 61-65 4 3.8 >70 1 1.0 Note: Data were missing for 2 respondents Table 4.2. Distribution of participants by highest level of education completed Frequency Percent High school diploma/equivalent 7 6.7 Business or trade school 2 1.9 Some college 19 18.3 Associate or two-year degree 12 11.5 Bachelors or four-year degree 13 12.5 Some graduate/professional school Graduate or professional degree 11 40 10.6 38.6 82
Table 4.3. Distribution of partici pants by current occupation Frequency Percent Arts/Entertainment 4 3.8 Business 11 10.6 Communications 2 1.9 Counseling 2 1.9 Education 13 12.5 Education Administration 3 2.9 Government 2 1.9 Healthcare 4 3.8 Hotel/Hospitality 3 2.9 Information Technology 2 1.9 Insurance Industry 4 3.8 Legal 2 1.9 Management 9 8.7 Non-profit 4 3.8 Public Health 5 4.8 Religion 1 1.0 Retired 4 3.8 Self Employed 3 2.9 Social Work 1 1.0 Student 13 12.5 Transportation 2 1.9 Travel Industry Unemployed 1 2 1.0 1.9 Note: Data were missing for 7 respondents Table 4.4. Distribution of participants by income level Frequency Percent Less than $10,000 15 14.4 $10,000 $24,999 13 12.5 $25,000 $34,999 9 8.7 $35,000 $49,999 23 22.1 $50,000 $74,999 25 24.0 More than $75,000 18 17.3 Note: Data were missing for 2 respondents 83
84 Table 4.5. Descriptive statistics N Minimum Maximum Mean Std. Deviation Statistic Statistic Statistic Statistic Statistic African Self-Consciousness 90 77.00 136.00 103.6889 12.84011 Gay Identity Confusion 94 7.00 23.00 9.3830 3.21992 Gay Identity Comparison 93 7.00 32.00 10.7634 4.59300 Gay Identity Tolerance 96 6.00 25.00 12.2813 4.82691 Gay Identity Acceptance 99 7.00 40.00 18.8485 9.50442 Gay Identity Pride 97 7.00 34.00 21.0515 5.60017 Gay Identity Synthesis 97 8.00 65.00 27.5670 8.34904 TSI Hyperarousal 97 .00 18.00 7.8866 4.65447 TSI Depression 96 .00 23.00 6.8958 5.72985 TSI Intrusive Experiences 98 .00 20.00 6.6224 4.80660 TSI Defensive Avoidance 100 .00 27.00 10.0700 5.89171 TSI Dissociation 96 .00 26.00 7.8958 5.11238 TSI Sexual Concerns 98 .00 26.00 7.8878 5.16507 TSI Dysfunctional Sexual Behavior 95 .00 25.00 8.3789 4.40304
Table 4.6. Results of Pearson correlation analyzing the relationship between African self-consciousness and gay identity ASC GIDCONF/COMP GIDTOL GIDACC GIDPRIDE GIDSYN ASC Pearson Correlation 1 -.171 -.068 -.080 .146 -.033 .129 .534 .460 .181 .759 GIDCONF/COMP Pearson Correlation -.171 1 .653 ** .458 ** -.147 .055 Sig. (2-tailed) .129 .000 .000 .176 .610 N 80 89 89 88 86 87 GIDTOL Pearson Correlation -.068 .653 ** 1 .643 ** -.157 -.168 Sig. (2-tailed) .534 .000 .000 .134 .108 N 85 89 96 95 92 93 GIDACC Pearson Correlation -.080 .458 ** .643 ** 1 -.518 ** -.448 ** Sig. (2-tailed) .460 .000 .000 .000 .000 N 87 88 95 99 95 95 GIDPRIDE Pearson Correlation .146 -.147 -.157 -.518 ** 1 .352 ** Sig. (2-tailed) .181 .176 .134 .000 .001 N 86 86 92 95 97 93 GIDSYN Pearson Correlation -.033 .055 -.168 -.448 ** .352 ** 1 Sig. (2-tailed) .759 .610 .108 .000 .001 N 88 87 93 95 93 97 **. Correlation is significant at the 0.01 level (2-tailed). 85
Table 4.7. Results of multiple regressi on of ethno-cultural i dentity, gay identity and hyperarousal Model Unstandardized Coefficients Standardized Coefficients t Sig. B Std. Error Beta 1 (Constant) -8.144 5.943 -1.370 .175 ASC .081 .041 .217 1.960 .054 GIDCONF/COMP .135 .109 .212 1.243 .218 GIDTOL -.290 .171 -.296 -1.698 .094 GIDACC .262 .094 .507 2.772 .007 GIDPRIDE .264 .123 .275 2.143 .036 GIDSYN -.071 .077 -.124 -.934 .354 a. Dependent variable: Hyperarousal Table 4.8. Results of multiple regressi on of ethno-cultural i dentity, gay identity and depression Model Unstandardized Coefficients Standardized Coefficients t Sig. B Std. Error Beta 1 (Constant) -9.966 6.413 -1.554 .125 ASC .025 .047 .055 .521 .604 GIDCONF/COMP .093 .110 .122 .847 .400 GIDTOL -.289 .194 -.243 -1.490 .141 GIDACC .351 .104 .582 3.368 .001 GIDPRIDE .487 .130 .476 3.747 .000 GIDSYN -.032 .084 -.046 -.377 .707 a. Dependent variable: Depression Table 4.9. Results of multiple regression of ethno-cultural identity, gay identity and intrusive experiences Model Unstandardized Coefficients Standardized Coefficients t Sig. B Std. Error Beta 1 (Constant) -12.931 5.420 -2.386 .020 ASC .069 .040 .184 1.731 .088 GIDCONF/COMP .052 .093 .081 .562 .576 GIDTOL -.230 .164 -.231 -1.401 .165 GIDACC .302 .088 .598 3.434 .001 GIDPRIDE .327 .110 .382 2.978 .004 GIDSYN .057 .071 .100 .803 .425 a. Dependent variable: Intrusive experiences 86
Table 4.10. Results of multiple regression of ethno-cultural identity, gay identity and defensive avoidance Model Unstandardized Coefficients Standardized Coefficients t Sig. B Std. Error Beta 1 (Constant) -14.198 6.672 -2.128 .037 ASC .094 .049 .205 1.916 .059 GIDCONF/COMP .048 .114 .061 .417 .678 GIDTOL -.088 .202 -.072 -.437 .663 GIDACC .280 .108 .452 2.583 .012 GIDPRIDE .415 .135 .395 3.069 .003 GIDSYN .023 .088 .032 .260 .796 a. Dependent variable: Defensive avoidance Table 4.11. Results of multiple regression of ethno-cultural identity, gay identity and dissociation Model Unstandardized Coefficients Standardized Coefficients t Sig. B Std. Error Beta 1 (Constant) -9.351 5.737 -1.630 .107 ASC .014 .042 .036 .339 .736 GIDCONF/COMP .057 .098 .083 .578 .565 GIDTOL -.051 .173 -.048 -.292 .771 GIDACC .256 .093 .476 2.748 .008 GIDPRIDE .424 .116 .464 3.642 .001 GIDSYN .054 .075 .089 .720 .474 a. Dependent variable: Dissociation Table 4.12. Results of multiple regression of ethno-cultural identit y, gay identity and sexual concerns Model Unstandardized Coefficients Standardized Coefficients t Sig. B Std. Error Beta 1 (Constant) -10.626 5.803 -1.831 .071 ASC .051 .043 .126 1.190 .238 GIDCONF/COMP .135 .099 .196 1.355 .179 GIDTOL -.163 .175 -.152 -.930 .356 GIDACC .290 .094 .533 3.070 .003 GIDPRIDE .285 .118 .309 2.422 .018 GIDSYN .040 .076 .064 .519 .605 a. Dependent variable: Sexual concerns 87
88 Table 4.13. Results of multiple regression of ethno-cultural identity, gay identity and dysfunctional sexual behavior Model Unstandardized Coefficients Standardized Coefficients t Sig. B Std. Error Beta 1 (Constant) -3.462 5.197 -.666 .507 ASC .015 .038 .045 .404 .688 GIDCONF/COMP .030 .089 .051 .333 .740 GIDTOL -.173 .157 -.190 -1.102 .274 GIDACC .251 .084 .541 2.969 .004 GIDPRIDE .240 .105 .305 2.276 .026 GIDSYN .072 .068 .137 1.059 .293 a. Dependent variable: D ysfunctional sexual behavior
CHAPTER 5 DISCUSSION The purpose of this chapter is to discu ss the significant findings regarding ethnocultural identity, sexual orientation and tr aumatic stress in adult African American gay men. A summary of the findi ngs will be presented. Additional ly, implications for theory and practice, as well as limitat ions of the study, and future research will be discussed. Summary of Significant Findings This study examined the st ress experienced by Afri can American gay men at different stages of gay identity. Analyses detected a positive relationship between 2 of the 5 stages of gay identity (gay identity a cceptance and gay identity pride) and each of the dimensions of traumatic stress (hyper arousal, depression, in trusive experiences, defensive avoidance, dissociation, sexual conc erns, and dysfunctional sexual behavior). The significance found between gay identit y acceptance and gay identity pride and traumatic stress suggests that men with an emerging, less integrated identity (gay identity acceptance stage), and those whose gay identity is more salient (gay identity pride stage), experience traumatic stre ss. The gay identity acceptance stage involves greater acceptance of and ambiva lence about ones gay identity. It also includes occasional passing as heterosexual. In essence, as one embraces his gay identity, the reality of his membership in a marginalized social identity group creates increased stress especially when considering t he potential for isolatio n, discrimination, and violence. The pride stage is a more solid ified identity that is marked by increased disclosure of one's gay identity, immersion in gay culture, and activism. Men in this stage are more likely to be the ta rget of anti-gay bias, discrimination, and violence thus, creating a more stressful existence. 89
These findings are consistent with st udies (Comstock, 1989; DAugelli, 1992; Garnets, Herek et.al., 1997; Herek, 1993; Otis & Skinner, 1996; Savin-Williams, 1994) addressing the stress that re sults from familial abuse, harassment, maltreatment, gayvictimization as well as more subtle forms of discrimination after disclosure of ones gay identity. Research shows that African Amer ican gay men live with chronic stress in their daily lives. They face systemic oppression that impacts their psychological well-being and threatens their survival (Meyer, 2003). They experience employment, housing and legal discrimination and are often marginal ized in education and health care settings (Mays & Cochran, 2001). These men also face possible rejection by their families (Icard, 1996; Wise, 2001), from religious institutions (Greene, 2001; Griffin, 2006; Parks, 2001) and are at increased risk for psychol ogical, emotional and physical violence (Huebner, Rebchook & Kegeles, 2004). Studies show that internalized homophobia, stigma and events of discrimi nation and violence predict p sychological distress in gay men (David & Knight, 2008; Haatzenbuehler, Nolen-Hoeksema & Erickson, 2008; Mays & Cochran, 2001; Rosario, Rotheram-Borus & Reid, 1996; Zamboni & Crawford, 2007). Implications for Theory Traumatic stress theory was used as a theoretical framework for this study. The symptoms of traumatic stress describe the diagnostic criter ia for posttraumatic stress disorder (PTSD) as outlined in the DSM-IV-TR (American Psychiatric Association, 2000). However, experiences of discriminat ion including racism and homophobia are not included in the DSM-IV-TR as precipitants to traumatic stress. The results of this study reveal a positive relationship betwe en gay identity acceptance and traumatic stress and gay identity pride and traumatic stress, which shows that even at advanced stages of gay identity development, participants in this study experience stress related 90
to their identity as gay men. These result s offer empirical evidence in support of expanding the definit ion of traumatic stress to include belonging to marginalized identity groups, which has also been suggested by schol ars investigating t he traumatic effects of racism (Bryant-Davis & Ocampo, 2005; Carter, 2007; Friedman & Marsella, 1996; Utsey, Bolden & Brown, 2001). Expanding the definitio n of traumatic stress to include those who live on the margins of society as a result of discr imination and systemic oppression, as well as those who are exposed to verbal, psycholog ical, and emotional abuse as suggested by Herman (1992), would legitimize their experiences. It would also provide a theoretical framework for counselors to better underst and and conceptualize presenting problems and to develop appropriate interventions. In addi tion, those confronting traumatic stress that results from discrimination, systemic oppression, and abuse would have greater access to mental health resources to support their treatment and recovery. This study also highlights the need for more sophisticated identity development models. Current models that explain identity developm ent among ethnic and racial groups (Cross, 1995; Helms, 1995; Phinney, 1992) and sexual minorities (Cass, 1979; Minton & McDonald, 1984; Troiden, 1979) lay out stages that lead to positive ethnic/racial and gay identities. However, t hey have been criticized for suggesting that growth is linear and bound by well-defined cat egories that are unchar acteristic of the human experience (Martinez & Sullivan, 1998). Moreover, the current conceptualization of these models lack sufficient integration of multiple ident ities and overlook the stress that is associated with the developmental process. As such, they tend to over91
generalize and can be inadequate when shap ing an understanding of how African American gay men formulate their identities (Fukuyama & Ferguson 2000). One of the instruments used in this study, the Gay Identi ty Questionnaire, is based on the gay identity development model desi gned by Cass (1979). Results reveal that participants experience significant stress as they gain acceptance of and pride in their gay identity. These findings suggest that whil e the model captures an individuals level of acceptance of their gay identity, it does not address the influence of other identities, the sociopolitical context of their developm ent, or the stress that is involved in the process. The concept of intersectionality addresses the nuanced complexities of multiple identities that cannot be sufficiently captur ed using conventional id entity development models, such as racial (Helms, 1995; Sue & Sue, 2008) and gay/lesbian (Cass, 1979; Minton & McDonald, 1984). An appreciation of intersectionality requires an acknowledgement of the existenc e of multiple identities. In addition, it necessitates an understanding of oppression, both internal a nd external, and its role in identity development. Finally, an awareness of traumatic stress and its effects is essential in understanding the challenges inherent in negotiating intersecting identities. Implications for Practice Implications of the findings from th is study mandate transformation of the counseling profession. This transformation in volves embracing the social justice and advocacy aspects of counselor identity and requires counselor competence in culturecentered assessment, case c onceptualization, and intervent ion. This transformation also incorporates an understanding of intersecti onality of identity as well as the role of traumatic stress in African Americ an gay mens identity development. 92
It has been suggested that belonging to a gr oup whose identity is stigmatized can result in chronic stress and also lead to mental disorders (Berg, Mimiaga, & Safren, 2008; Mays & Cochran, 2001; Carter, 2007; H uebner & Davis, 2007; Israel & Selvidge, 2003; Meyer, 2003; Savin-Willia ms, 2001). Moreover, belonging to multiple stigmatized identity groups can be especially chall enging and even debilitat ing (Fukuyama & Ferguson, 2000; Greene, 2001). Resu lts of this study reveal that African American gay men experience traumatic stre ss at the gay identity accept ance and gay identity pride stages of gay identity development. These findings offer opportunities for the counseling profession to embrace a better understanding of African American gay mens identity development and to disseminate this knowledge. For example, the core competencies set forth by the American Counseling Association and its divisions, the Association for Multicultural Counseling and Development and the Associat ion for Lesbian, Gay, Bisexual, and Transgender Issues in Counseling should reflect the attitudes, knowledge, and skills necessary to effectively address traumatic stress in this population. This knowledge may be disseminated through journal public ations, conference presentations, and through social justice and advocacy activities. A key component of emotional and psychologi cal health is the ability to advocate on ones own behalf and that of other marginalized individuals. As such, leaders in counseling have called for the integration of social justice and advocacy into counselor identity (Ivey, 2003; Lewis et al., 2003). Moreover, there is a need to expand the understanding of social justice in multicul tural competence (West-Olatunji, 2010). Counselors can engage in social justice and adv ocacy by lobbying for revisions to the 93
DSM-IV-TR to include experience of marginalization and discriminat ion as precipitants to traumatic stress. This action would not only benefit African American gay men, other marginalized social identity groups would be nefit as well. Additionally, counselors can advocate for changes in social and political structures that keep African American gay men on the margins of society. In addition to addressing this iss ue on a systemic level, counselors have opportunities to incorporate th is knowledge into their individual and group work with clients. In order to better understand African American gay mens identity development, it is critical that counselors conduct more co mprehensive, culture-centered assessments. Use of culture-centered approaches in assessm ent and case conceptualization requires an awareness of the sociopolit ical context of African American gay mens lives and incorporates an understanding of how they ar e affected by the stress of coping with multiple oppressed identities (Wynn & West-Olatunji, 2009). With a better understanding of the identity development trajectory of African Amer ican gay men, counselors can develop more effective interventi ons leading to better outcomes. This study underscores the importance of counselors exploring the coming out process with their African American gay male c lients. They should not assume that all gay men will choose to disclose their gay identity to others, nor should they assume that if they do decide to come out that their lives will be less stressful. In fact, results of this study suggest that they may experience increas ed levels of stress after disclosing their identity. With this knowledge, counselors can develop interventions that help African American gay male clients improve their c oping skills and build resources for additional support. 94
In addition to understanding the dynamics of identity development and coming out from a culture-centered perspective, counselors should also be skilled at facilitation of critical consciousness so that African Amer ican gay men become aware of their social positioning and the sociopolitical context of their concerns (Goodman & West-Olatunji, 2009; .Ivey, 2003; Lewis, Lewis, Daniels, & DAndrea, 2003). These interventions are critical for increasing agency and, ultimately, resilience. Finally, in order to create a safe, ther apeutic environment, it is critical that counselors are aware of their own attit udes toward African American gay men. Counselors can explore their attitudes and beliefs by expanding their personal boundaries to include interaction with this population and by engagi ng in professional development activities that assist them in confronting their biases. Future Research Recommendations for future research with African American gay men include recruiting a larger, more diverse (differ ent stages of gay identity) sample. Also, enhancing the research design to explore intersetionality of identity, assess for previous exposure to traumatic events, and inquire about the salienc e of identity would provide rich data for analysis. Studies that address African American gay mens experience of religion, as well as their current geographic lo cation, and their involvement in the mental health services delivery system would open avenues for a better understanding of the factors that influence their identity development process. A larger, more diverse sample of Afri can American gay men may be obtained by sampling attendees at events such as the annual Black Gay Pride celebrations that are held in multiple cities throughout the United States. In addition, the use of existing research databases would provide the responses needed to achieve maximum 95
statistical power. This study did not reveal a significant relationship between African self-consciousness and gay identity; however the literature suggests that a negative relationship exists. Expanding the sample si ze would increase the power of the analysis and may detect a relationship. Recruitment of a diverse sample that r epresents different stages of gay identity development should also be considered for fu ture research. No significance was found in the relationships between gay identity c onfusion/comparison and traumatic stress and gay identity tolerance and traumatic stress. These stages reflect early phases of gay identity development where m en may not identify themselves as gay and may not participate in a study of this nature. Sevent y nine percent of the sample described their sexual orientation as gay and 18.3% chose same-gender loving, a term embraced by many African Americans (Manago & Howcott, 2006), as a description of their sexual orientation. The lack of significance in t he relationship between gay identity synthesis, a more integrated identity, and traumatic stress may also reflect a lack of diversity in the sample. Future studies should assess African Am erican gay mens exposure to traumatic events that meet the cu rrent DSM-IV-TR definition of trau matic stress in order to rule out traumatic experiences that are not related to ethnicity, race, or se xual orientation. In addition, studies should investigate the degr ee to which traumatic stress affects the lives of African American gay men and high light the effect of the stress on their functioning. Fukuyama and Ferguson (2000) asserted that gay people, particularly the culturally diverse, who are managing multiple identities, re spond to the shifting salience 96
of identity depending on the social, familial, and community context and are forced to cope with being invisible members within specif ic social reference groups in order to receive the benefits of group membership. An inquiry into the ways in which African American gay men negotiate their identities in different environments such as the workplace and social settings could be the focu s of future studies. This would provide more information about the shifting salience of identity and offer insight into what African American gay men may need in order to maintain a more consistent expression of their identity. African American culture endorses strong kinshi p bonds within the nuclear family, the extended family, and with fictive kin (Bellgrave & Allison, 2006; Boykin, 1983; Boykin & Ellison, 1995; Chatters, Taylor, & Joyakody, 1994; McAdoo, 1993; Nobles, 2004). As such, future studies sh ould examine the role of fa mily dynamics in the identity development process of Af rican American gay men. African Americans have a long history of strong connections to religion and spirituality as sources of st rength, particularly as a buffer against racism (Bowen-Reid & Harrell, 2002; Greene, 2001; Pa rks, 2001). However, the tr aditional African American church has either ignored or denigrated its LGBT member s leaving them spiritually empty with fewer coping skills and a smalle r support network (Greene, 2001; Griffin, 2006; Parks, 2001). In this study, 68% of t he participants identifi ed their religion as Christian and 47% reported that religion is very important. Given the current anti-gay climate in many religious communities, as we ll as the importance t hat religion holds for many African American gay men, future studi es investigating the relationship between religion, spirituality, and gay identit y might be particularly fruitful. 97
Other demographic data from this study of fer information about African American gay men that can be explored in further rese arch. For example, 64% of participants live in the Southern region of the United States. This area is underrepresented in the literature on gay identity and related issues. As such, an increase in studies, both quantitative and qualitative, investigating quality of life for African American gay men in the South would increase knowledge about th is population and fill a current gap in the literature. The challenges that gay people face in t heir involvement in the mental health services delivery system is gaining increased attention in empirical research. The bias that gay people face in the mental health service delivery system often results in misdiagnosis, ineffective interventions, and underutilization of services (Cochran, Sullivan, & Mays, 2003; Walter s, Simoni, & Horwath, 2001) Research that examines the experiences of African American gay m en in the mental health services delivery system would offer insight into how to im prove access to services and how to enhance diagnosis, intervention, and treatment. Finally, use of qualitative methodology c an illuminate the concerns of African American gay men and may identify possible risk factors that make them vulnerable as well as the protective factor s that support their resilience. Such inductive investigations might advance knowledge about the relationship between intersectionality of identity, traumatic stress, and African American gay men. Outcomes of such studies might enhance counselors understandi ng, conceptualization, and treatment of African American gay men. Results may also furt her inform quantitative research. Utilizing a culture-centered methodological framework in research design and implementation as 98
well as in data interpretations (Tillman, 2002; West-Olatunji, 2005) might reduce the influence of cultural bias in research inquiry that contributes to the systemic oppression of marginalized groups. This chapter provided a discussion of the re sults of this study, the implications for theory and practice, its limitations, and re commendations for future research. The findings indicated no association between Af rican self-consciousness and gay identity. However, this is inconsistent with the current literature on intersec tionality of identity and may be explained by the small sample size li miting the power to detect a relationship. Summary Statistically significant positive rela tionships were found between gay identity acceptance and traumatic stress and gay ident ity pride and traumatic stress. These findings are consistent with current literat ure on gay identity development and stress and reflect the need for ongoing support, as well as additional resources, throughout the identity development process fo r African American gay men. This study underscores the need to recons ider the theoretical framework of traumatic stress. The result s support broadening the definition to include experiences of marginalization and discrimination, particularly related to gay identity, as precipitants to traumatic stress. Additionally, identity development theories should be revised to incorporate the intersectionality of multiple identities, as well as an understanding of the stress involved in living as a member of on e or more marginaliz ed identity groups. Implications for practice involve impr oving culture-centered assessment, case conceptualization, and treatment In addition, the practice of mental health counseling can be strengthened by integrating social just ice and advocacy into counselor identity. 99
100 Future research should embrace cultur e-centered approaches. In addition, the inclusion of a comprehensive history of tr aumatic experiences in the research design will further clarify t he influence of ethnicity, race, and gay identity on the experience of traumatic stress in this population. Research that focuses on salience of identity, the role of religion, and implications of geogr aphical location, may provide avenues for a greater understanding of the fa ctors that influence identity development in African American gay men. In conclusion, this study provides insight into the identity development of African American gay men and offers empirical evidence of the stress that is involved in the process. It is the hope of the researcher that this study will inform and enlighten and lead to further research that illuminates t he lived experience of African American gay men.
APPENDIX A INFORMED CONSENT UFIRB #2010-U-076 Protocol Title: The Intersection of Ethno-Cultural Iden tity, Sexual Orientation, and Traumatic Stress in Adult African American Gay Men Please read this consent document carefully before you decide to participate in this study. The purpose of this study is to investi gate the relationship between ethno-cultural identity, sexual orientation, and traumatic stress in adult Af rican American gay men. You will be asked to complete a demographic q uestionnaire and a brief survey. The time required to complete this survey is appr oximately 30 45 minutes. There are no known risks or direct benefits from participation in this study. Compensation will not be provided. Your identit y will remain anonymous. Your participation in this study is completely voluntary and there is no penalty for not participating. You have the right to withdr aw from the study at anytime without consequence. If you have questions about the study, please contact me: Richmond Wynn, MS, Doctoral Candidate, Counselor Education Program, School of Human Development and Organizational Studies in E ducation (SHDOSE) College of Education University of Florida 1204 Norman Hall PO Box 117046 Gainesville, FL 32611-7046 rwynn@ufl.edu. Or, you can contact my faculty advisor: Cirec ie A. West-Olatunji, Ph. D. Counselor Education Program, School of Human Development and Or ganizational Studies in Education (SHDOSE) College of Education Un iversity of Florida 1204 Norman Hall PO Box 117046 Gainesville, FL 32611-7046 ( 352) 273-4324 (office) (352) 846-2697 (fax) cwestolatunji@coe.ufl.edu If you wish to know more about your rights as a research participant in the study, please contact the IRB02 Office, Box 112250, University of Florida, Gainesville, FL 32611-2250; phone 392-0433. 101
APPENDIX B RECRUITMENT EMAIL Greetings! My name is Richmond Wynn, a doctoral candidat e in the Counselor Education Program at the University of Florida in Gainesville, Florida, and I am seeking participants for my dissertation research. The UF Institutional Review Board has approved this study. The purpose of this study is to bet ter understand African American gay mens experiences of traumatic stress in their identity development process. You must be 18 years of age or older in order to participate. Your participation will contribute to the understanding of African Amer ican gay mens unique identit y development experiences. The survey will take approximately 30 minutes to complete. Clicking the link below will direct you to an electronic informed consent agreement followed by the survey. Participation in this study is anonymous (i.e., you will not be asked to disclose any identifying information, nor will your responses be connected to any identifying information) and the survey serv ice will not track your Internet Protocol (IP) address. Further, you may discont inue participation at any time. If you have any questions about this study, or would like to be informed of its findings, please contact me, Richmond Wynn, at rwynn@ufl.edu If you would like to speak with my primary advisor about the study, please contact Dr. Cirecie West-Olatunji at cwestolatunji@coe.ufl.edu To participate in this study please click on this link https://www.surveymonkey.com/s/DZ8FW5Q or copy and paste the link into the address block of your Web browser. I appreciate your time and consideration! Sincerely, Richmond Wynn, MS Principal Investigator Doctoral Candidate, Counselor Education Program School of Human Development and Organiza tional Studies in Education (SHDOSE) College of Education University of Florida 1204 Norman Hall PO Box 117046 Gainesville, FL 32611-7046 102
APPENDIX C DEMOGRAPHIC FORM (1) Male Female Transgender Other _________________ (please indicate) (2) Date of birth _______________ (3) Please indicate your racial/cultural background. African (Born on the continent of Africa) African American/Black (Non-Latino) Afro Caribbean Latino American (Non African American/Black) Multiracial/Multiethnic (please indicate) ________ ____________________ Other (please indi cate) _______________ ______________ (4) What is the highest education level you have completed? Elementary school (K-5th grade) Middle school (6th-8th grade) Some high school High school diploma/equivalent Business or trade school Some college Associate or two-year degree Bachelors or four-year degree Some graduate/professional school Graduate or professional degree (5) What is your current occupation? ____________ ______________________ (6) What is your current religious affiliation? No religion Buddhist Christian Hindu Jewish 103
Muslim Other (please indicate) ____________________________________ ____________ (7) How often do you attend religious services? Seldom Sometimes Often (8) How important is your religion to you? Not Important Somewhat Important Very Important (9) How would you describe the primary geogr aphical region in which you were raised? Northeast South Midwest West (10) How would you describe the primary geographical region in which you currently live? Northeast South Midwest West (11) What is the racial/cultural composition of the community listed in #10? Mostly African American/Black Multicultural Mostly White (12) Are you: a United States citizen a permanent resident of the US or a Resident Alien (13) How many ethnic organizations do you belong to? 1 2 3 4 5 5+ (14) How many ethnic organizations do you belong to? 1 2 3 4 5 5+ (15) How would you describe your current income level? Less than $10,000 $10,000 to $24,999 $25,000 to $34,999 $35,000 to $49,999 $50,000 to $74,999 More than $75,000 (16) Please check the term that best describes your sexual orientation Gay (Males who experience the desire for warmth and affection from other males) Same gender loving (A term embraced by many men of color to describe males who experience the desire for warmth and affection from other males) Bisexual (The desire to experience warmt h and affection that is not limited to gender) 104
105 Heterosexual (The desire to experi ence warmth and affection from someone whose gender is different from your own) Other (please indica te) ________________________ ____________________ (17) Please describe your cu rrent relationship status Single Partnered Married Divorced Separated Widowed Other (please indica te) ________________________ ____________________
APPENDIX D THE AFRICAN SELF-CONSCIOU SNESS SCALE (SHORT-FORM) INSTRUCTIONS: The following statements reflect some beliefs, opinions and attitudes of Black people. Read each statement carefully and give your honest feelings about the beliefs and attitudes expressed. Indicate the extent to which you agree or disagree using the following scale. 1 = Very Strongly Disagree 2 = Strongly Disagree 3 =Moderately Disagree 4 = Slightly Disagree 5= Slightly Agree 6 = Moderately Agree 7 = Strongly Agree 8 = Very Strongly Agree Note that the higher the number you c hoose for the statement, the more you Agree with that statement; and conversely, the lower the num ber you choose, the more you Disagree with that statement. Also, there are no right or wrong answers, only the answer that best expresses your present feelings about the statement. Please respond to ALL of the statement (do not omit any ). Bubble-in your choices in the space provided. ANSWER CHOICES PLEASE CHOOSE ONLY ONE. 1 2 3 4 5 6 7 8 5. Blacks in America should try harder to be American than practicing activities that link them up with their African cultural heritage. OOOOOO O O 6. Regardless of their interests, educational background and social achievements, I would prefer to associate with Black people than with nonBlacks. OOOOOO O O 7. It is not a good idea for Black students to be required to learn an African language. OOOOOO O O 9. It is not within the best interest of Blacks to depend on Whites for anything, no matter how religious and decent they (the Whites) purport to be. OOOOOO O O 10. Black children should be taught that they are African people at an early age. OOOOOO O O 11. White people, generally speaking, are not opposed to self-determination for Blacks. OOOOOO O O 12. As a good index of selfrespect, Blacks in America OOOOOO O O 106
should consider adopting traditional African names for themselves. 13. A White/European or Caucasian image of God and the holy family (among others considered close to God) are not such bad things for Blacks to worship. OOOOOO O O 14. Blacks born in the United States are Black or African first, rather than American of just plain people. OOOOOO O O 15. Black people who talk in a relatively loud manner, show a lot of emotions and feelings, and express themselves with a lot of movement and body motion are less intelligent than Blacks who do not behave this way. OOOOOO O O 16. Racial consciousness and cultural awareness based on traditional African values are necessary to the development of Black marriages and families that can contribute to the liberation and enhancement of Black people in America. OOOOOO O O 19. I have difficulty identifying with the culture of African People. OOOOOO O O 20. It is intelligent for Blacks in America to organize to educate and liberate themselves form WhiteAmerican domination. OOOOOO O O 21. There is no such thing as African culture among Blacks in America OOOOOO O O 22. It is good for Black husbands and wives to help each other develop racial consciousness and cultural awareness in themselves and their children. OOOOOO O O 24. It is good for Blacks in America to wear traditional African-type clothing and hairstyles if they desire to OOOOOO O O 107
108 do so. 25. I feel little sense of commitment to Black people who are not close friends or relatives. OOOOOO O O 27. Black children should be taught to love all races of people, even those races who do harm to them. OOOOOO O O 28. Blacks in America who view Africa as their homeland are more intelligent than those who view America as their homeland. OOOOOO O O 29. If I saw Black children fighting, I would leave them to settle it alone. OOOOOO O O
APPENDIX E MODIFIED GAY IDENTITY QUESTIONNAIRE Instructions: Please read each of the following statements carefully and then indicate the degree of y our agreement or disagreement with each statement by circling the rating that best reflec ts your response to the statement. Strongly Disagree Disagree Mildly Disagree Mildly Agree Agree Strongly Agree 1) I probably am sexually attracted equally to men and women. 1 2 3 4 5 6 2) I live a homosexual lifestyle at home, while at work/school I do not want others to know about my lifestyle. 1 2 3 4 5 6 3) My homosexuality is a valid private identity that I do not want made public. 1 2 3 4 5 6 4) I have feelings I would label as homosexual. 1 2 3 4 5 6 5) I have little desire to be around most heterosexuals. 1 2 3 4 5 6 6) I doubt that I am homosexual, but still am confused about how I am sexually. 1 2 3 4 5 6 7) I do not want most heterosexuals to know that I am definitely homosexual. 1 2 3 4 5 6 109
Strongly Disagree Disagree Mildly Disagree Mildly Agree Agree Strongly Agree 8) I am very proud to be gay and make it known to everyone around me. 1 2 3 4 5 6 9) I dont have much contact with heterosexuals and cant say that I miss it. 1 2 3 4 5 6 10) I generally feel comfortable being the only gay person in a group of heterosexuals. 1 2 3 4 5 6 11) Im probably homosexual, even though I maintain a heterosexual image in both my personal and public life. 1 2 3 4 5 6 12) I have disclosed to 1 or 2 people (very few) that I have homosexual feelings, although Im not sure Im homosexual. 1 2 3 4 5 6 13) I am not as angry about treatment of gays because even though Ive told everyone about my gayness, they have responded well. 1 2 3 4 5 6 14) I am definitely homosexual but I do not share that knowledge with most people. 1 2 3 4 5 6 110
111 Strongly Disagree Disagree Mildly Disagree Mildly Agree Agree Strongly Agree 15) I dont mind if homosexuals know that I have homosexual thoughts and feelings, but I dont want others to know. 1 2 3 4 5 6 16) More than likely Im homosexual, although Im not positive about it yet. 1 2 3 4 5 6 17) I dont act like most homosexuals do, so I doubt that Im homosexual. 1 2 3 4 5 6 18) Im probably homosexual, but Im not sure yet. 1 2 3 4 5 6 19) I am openly gay and fully integrated into heterosexual society. 1 2 3 4 5 6 20) I dont think that Im homosexual. 1 2 3 4 5 6 21) I dont feel as if Im heterosexual or homosexual. 1 2 3 4 5 6 22) I have thoughts I would label as homosexual. 1 2 3 4 5 6
Strongly Disagree Disagree Mildly Disagree Mildly Agree Agree Strongly Agree 23) I dont want people to know that I may be homosexual, although Im not sure if I am homosexual or not. 1 2 3 4 5 6 24) I may be homosexual and I am upset at the thought of it. 1 2 3 4 5 6 25) The topic of homosexuality does not relate to me personally. 1 2 3 4 5 6 26) I frequently confront people about their irrational, homophobic (fear of homosexuality) feelings. 1 2 3 4 5 6 27) Getting in touch with homosexuals is something I feel I need to do, even though Im not sure I want to. 1 2 3 4 5 6 28) I have homosexual thoughts and feelings but I doubt that Im homosexual. 1 2 3 4 5 6 29) I dread having to deal with the fact that I may be homosexual. 1 2 3 4 5 6 112
113 Strongly Disagree Disagree Mildly Disagree Mildly Agree Agree Strongly Agree 30) I am proud and open with everyone about being gay, but it isnt the major focus of my life. 1 2 3 4 5 6 31) I probably am heterosexual or nonsexual. 1 2 3 4 5 6 32) I am experimenting with my same sex because I dont know what my sexual preference is. 1 2 3 4 5 6 33) I feel accepted by homosexual friends and acquaintances; even though Im not sure Im homosexual. 1 2 3 4 5 6 34) I frequently express to others, anger over heterosexuals oppression of me and other gays. 1 2 3 4 5 6 35) I have not told most of the people at work that I am definitely homosexual. 1 2 3 4 5 6 36) I accept but would not say I am proud of the fact that I am definitely homosexual. 1 2 3 4 5 6
Strongly Disagree Disagree Mildly Disagree Mildly Agree Agree Strongly Agree 37) I cannot imagine sharing my homosexual feelings with anyone. 1 2 3 4 5 6 38) Most heterosexuals are not credible sources of help for me. 1 2 3 4 5 6 39) I am openly gay around heterosexuals. 1 2 3 4 5 6 40) I engage in sexual behavior I would label as homosexual. 1 2 3 4 5 6 41) I am not about to stay hidden as gay for anyone. 1 2 3 4 5 6 42) I tolerate rather than accept my homosexual thoughts and feelings. 1 2 3 4 5 6 43) My heterosexual friends, family and associates think of me as a person who happens to be gay, rather than as a gay person. 1 2 3 4 5 6 44) Even though I am definitely homosexual, I have not told my family. 1 2 3 4 5 6 45) I am openly gay with everyone, but it doesnt make me feel all that different from heterosexuals. 1 2 3 4 5 6 114
APPENDIX F TRAUMA SYMPTOM INVENTORY The licensing agreement with the publisher, Psychological Assessment Resources, permits a total of three survey items to be published from this instrument. Instructions: Please circle the one answer that best indicates how often each of the following experiences has happened to you in the last 6 months. Circle 0 if your answer is NEVER ; it has not happened at all in the last 6 months. Circle 1 or 2 if it has happened in the last 6 months, but has not happened often. Circle 3 if your answer is OFTEN ; it has happened often in the last 6 months. __________________ _______________________ 0 1 2 3 Never Often Defensive Avoidance Subscale Staying away from certain people or plac es because they reminded you of something Sexual Concerns Subscale Confusion about your sexual feelings Dysfunctional Sexual Behavior Subscale Having sex that had to be kept a secret from other people 115
REFERENCES Aarts, P. G. H. (1998). Inte rgenerational effects in familie s of World War II survivors from the Dutch East Indies: Aftermath of another Dutch War. In Y. Danieli (Ed.), International handbook of multige nerational legacies of trauma (pp. 175). New York: Plenum. Akbar, N. (1991). Mental disorders among Af rican Americans. In R. Jones (Ed.), Black psychology Berkeley, CA: Cobb & Henry. American Psychiatric Association. (2000). Diagnostic and Statistica l Manual of Mental Disorders-Text Revision (4th ed.). Washington, DC: Author. Anderson, R. N. (2002). Deaths: Leading causes for 2000 Hyattesville, MD: National Center for Health Statistics. Arredondo, P., Tovar-Blank, Z. G., & Parham, T. A. (2008). Challeng es and promises of becoming a culturally com petent counselor in a soci opolitical era of change and empowerment. Journal of Counseling and Development, 86, 261. Atkinson, D. R. & Hackett, C. (1988). Counseling non-ethnic American minorities Springfield, IL: Charles C. Thomas. Azibo, D. (1983). Some psychological c oncomitants and consequences of the black personality: mental health implications. Journal of Non-White Concerns in Personnel and Guidance, 11 59. Azibo, D. (1989). African-centered thes es on mental health and a nosology of Black/African personality disorder. Journal of Black Psychology, 15 (2), 173. Baldwin, J. A. (1981). Notes on an Afri centric theory of black personality. The Western Journal of Black Studies 5, 172. Baldwin, J. A. & Bell, Y. R. (1985). The African self-consci ousness scale: An Africentric personality questionnaire. Psychology of Black Americans, 9 (2), 61. Baldwin, J. A., Brown, R., & Rackley, R. (1990). Some socio-behavioral correlates of African self-consciousness in Af rican American college students. The Journal of Black Psychology, 17 (1). 1. Baldwin, J. A., Duncan, J. A., & Bell, Y. R. (1992). Assessment of African selfconsciousness among black students from two college environments. In K. A. Burlew, W. C. Banks, H. P. McAdoo, & D. A. Azibo (Eds.), Africa American psychology; Theory, research, and pr actice. Newbury Park, CA: Sage. 116
Bancroft, J., Carnes, L., Janssen, E., Goodr ich, D. & Long, J. S. (2005).Erectile and ejaculatory problems in gay and heterosexual men. Archives of Sexual Behavior 34, 285 297. Barret, R., & Barzan, R. (1996). Spiritua l experiences of gay men and lesbians. Counseling & Values, 41, 4. Becker, D. (1995). The defici ency of the concept of posttr aumatic stress disorder when dealing with victims of human right s violations. In R. J. Kl eber, C. R. Figley, & B. P. R. Gersons(Eds.), Beyond trauma: Cultural and societal dynamics (pp. 99 110). New York: Plenum Press. Bellgrave, F. Z. & Allison, K. W. (2006). African American psychology: From Africa to America Thousand Oaks, CA: Sage. Berg, M. B., Mimiaga, M. J., & Safren, S. A. (2008). Mental health concerns of gay and bisexual men seeking m ental health services. Journal of Homosexuality, 54 (3), 293 306. doi: 10.1080/00918360801982215 Bernstein, M. M. (1998). Conflicts in adjustment: World War II prisoners of war and their families.In Y. Danieli (Ed.), International handbook of multigenerational legacies of trauma (pp. 119). New York: Plenum. Bostwick, W. B., Hughes, T. L., & Johnson, T. (2005). The co-occurrence of depression and alcohol dependence symptoms in a community sample of lesbians. Journal of Lesbian Studies, 9 (3), 7 18. doi:10.1300/J155v09n03_02 Bowen-Reid, T. L., & Harrell, J. P. (2002). Racist experienc es and health outcomes: An examination of spirituality as a buffer. Journal of Black Psychology,28 (1), 18. doi: 10.1177/ 0095798402028001002 Boykin, A. W. (1983). The ac ademic performance of Afro-A merican children. In J. Spence (Ed.), Achievement and achievement motives (pp. 324). San Francisco, CA: W. Freeman. Boykin, A. W., & Ellison, C. M. (1995). The multiple ecologies of black youth socialization: An Afrographic analysis. In R. L. Taylor (Ed.), African American youth: Their social and economi c status in the United States (pp. 93). Westport, CT: Praeger. Boykin, K. (2005). Beyond the down low: Sex, lies and denial in Black America New York: Carroll & Graf. Brady, S. (1998). Gay Identity Questionnaire. In C.M. Da vis, W. L. Yarber, R. Bauserman, G. Schreer, & S. L. Davis (Eds), Handbook of Sexuality-Related Measures (pp. 373 375) Thousand Oaks, California: Sage Publications, Inc. 117
Brady, S., & Busse, W. J. (1994). The Gay I dentity Questionnaire: A brief measure of homosexual identity formation. Journal of Homosexuality 26(4), 1. Breuer, J., & Freud, S. (1962). Studies on hysteria. On the psychical mechanism of hysterical phenomena: Preliminary communicati on. In J. Strachey (Ed. & trans.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 2, pp. 3). London:Hogarth Press. (O riginal work published 1893). Bridges, S. K., Selvidge, M. M. D. & Matthew s, C. R. (2003). Lesbian women of color: Therapeutic issues and challenges. Journal of Multicultural Counseling and Development, 31, 113. Briere, J. (1995). Trauma symptom inventory professional manual. Lutz, Florida: Psychological Assessment Resources, Inc. Briere, J., Elliot, D. M., Harris, K., Co tman, A. (1995). Trauma symptom inventory: Psychometrics and association with childho od and adult victimization in clinical samples. Journal of Interpersonal Violence, 10 (4), 387 401. Bridges, S. K., Selvidge, M. M. D., & Matthews, C. R. ( 2003). Lesbian women of color: Therapeutic issues and challenges. Journal of Multicultural Counseling and Development, 31, 113. Brown II, E. (2005). We wear the mask: Af rican-American contemporary gay male identities. Journal of African American Studies, 9 (2), 29 38. Brown, L. (1995). Not outside the range. In C. Caruth (Ed.), Trauma: Explorations in memory (pp. 100). Baltimore: Johns Hopkins University Press. Brown, L. S. (2005). Lesbian identities: Concepts and issues. In A. R. DAugelli & C. J. Patterson (Eds.), Lesbian, gay, and bisexual identities over the lifespan, (pp. 3 23). New York: Oxford University Press. Bryant-Davis, T. & Ocampo, C. ( 2005). Racist incident-based trauma. The Counseling Psychologist, 33 (4), 479. doi: 10.1177/0011000005276465 Burstow, B. (2003). Toward a radica l understanding of trauma and trauma work. Violence Against Women, 9 1293. Burstow, B. (2005). A critique of pos ttraumatic stress disorder and the DSM Journal of Humanistic Psychology, 45, 429. Carpineto, J., Kubicek, K., We iss, G., Iverson, E. & Kipke. M. D. (2008). Young mens perspectives on family support and discl osure of same-sex attraction. Journal of LGBT Issues in Counseling, 2 (1), 53. doi: 10.1080/155386008 02077533 118
Carroll, L. (2010). Counseling sexual and gender minorities Upper Saddle River, NJ: Pearson Carter, R. T. (2007). Racism and psychological and emotional injury: Recognizing and assessing race-based traumatic stress. The Counseling Psychologist, 35 (1), 13 105. doi: 10.1177/ 0011000006292033 Cass, V. C. (1979). Homosexual identity formation: Testing a theoretical model. Journal of Homosexuality, 4, 219. CDC (2009). HIV/AIDS and men who have sex with men (MSM). Centers for Disease Control. Retrieved January 1, 2010 from http://www.cdc.gov/hiv/topics/msm/ Chan, C. S. (1995). Issues of sexual identity in an ethnic minority: The case of Chinese American lesbians, gay men, and bisexual people. In A. R. DAugelli, & C. J. Patterson (Eds.), Lesbian, gay, and bisexual identities over the lifespan (pp. 87 101). New York: Oxford University Press. Chatters, L. M., Taylor, R. J., & Joyakody, R. (1994). Fictive kinship relations in Black extended families. Journal of Contemporary Family Studies, 25, 297. Christian, T. Y. (2005). G ood Cake: An Ethnographic Trilogy of Life Satisfaction among Gay Black Men. Men and Masculinities, 8 (2), 164 174. Cochran, S. D., Ackerman, D., Mays, V. M., & Ross, M. W. (2004). Prevalence of nonmedical drug use and dependence among homosexually active men and women in the US population. Addiction 99, 989-998. doi:10.1111/j.1360 0443.2004.00759. Cochran, S. D. & Mays, V. M. (2000). Relation between psychiatric syndromes and behaviorally defined sexual orientation in a sample of the US population. American Journal of Epidemiology, 151 (5), 516. Cochran, S. D., Sullivan, J. G., & Mays, V. M. (2003). Prevalence of mental disorders, psychological distress, and mental se rvices use among lesbian, gay, and bisexual adults in the United States Journal of Consulting and Clinical Psychology, 71 (1), 53. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Earlbaum Associates, Inc. Coleman, E. (1981). Developmental stages of the coming out process. Journal of Homosexuality, 7 (2), 31. 119
Comstock, G. D. (1989). Victims of anti-gay/lesbian violence. Journal of Interpersonal Violence, 4 101. Constantine, M. G. & Ponter otto, J. G. (2006). Evaluati ng and selecting psychological measures for research purposes. In F. T. L. Leong & J. T. Austin (Eds.), The Psychology Research Handbook ( 2nd ed., pp.104 ). Thousand Oaks, CA: Sage Publications. Cosgrove, L. (2005). When labels mask oppr ession: Implications for teaching psychiatric taxonomy. Journal of Mental Health Counseling, 27 283. Crawford, I, Allison, K.W., Zamboni, B. D. & Soto, T. (2002). The influence of dualidentity development on the psychosocial functioning of African American gay and bisexual men. The Journal of Sex Research, 39 (3), 179. Cross, W. E. (1995). The psychology of nigrescence: Revising the Cross model. In J. Ponterotto, J. Manuel Casa s, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (pp. 93) Thousand Oaks, CA: Sage Publications. Cross, W.E., Jr. (1971). The Negr o-to-black conversion experience. Black World 20(9), 13-27. Cross, W. E., Jr. (1991). Shades of black: Diversity in African-American identity. Philadelphia: Temple University Press. Dank, B. M. (1971). Coming out in the gay world. Psychiatry, 34 180. Danieli, Y. (1998). Introduction: History and c onceptual foundations. In Y. Danieli (Ed.), International handbook of multige nerational legacies of trauma (pp. 1). New York: Plenum. Dass-Brailsford, P. (2007). A practical approach to trauma: Empowering interventions. Los Angeles: Sage. D'Augelli, A.R. (1992). Lesbian and gay male undergraduates' experiences of harassment and fear on campus. Journal of Interpersonal Violence, 7 (3), 383 395. D'Augelli, A. R. (1998). Devel opmental implications of victimization of lesbian, gay, and bisexual youths. In G. M. Herek (Ed.). Stigma and sexual orientation: Understanding prejudice against lesbians, gay men, and bisexuals. Psychological perspectives on lesbian and gay issues (pp. 187). Thousand Oaks, CA: Sage. 120
D'Augelli, A. R., Hershberger, S. L., & Pilk ington, N. (2002). Suicidality patterns and sexual orientation-related factors among lesbian, gay, and bisexual youths. Suicide and Life-Threatening Behavior, 31 250. David, S. & Knight, B. G. (2008). Stress and coping among gay men: Age and ethnic differences. Psychology and Aging, 23(1), 62 69. doi: 10.1037/08827974.23.1.62 Diaz, R. M., Ayala, G., Bein, E., Henne, J., & Marin, B. V. (2001). The impact of homophobia, poverty, and racism on the me ntal health of gay and bisexual Latino men: Findings from 3 US cities. American Journal of Public Health, 91, 927. DiPlacido, J. (1998). Minority stress among lesbians, gay men, and bisexuals: A consequence of heterosexism, homophobia, and stigmatization. In G. Herek (Ed.), Stigma and sexual orientation: Unde rstanding prejudice against lesbians, gay men, and bisexuals (pp. 138). Thousand Oaks, CA: Sage. Duran, E., Duran, B., Yellow Horse Brave Heart, M., & Yell ow Horse-Davis, S. (1998). Healing the American Indian soul wound. In Y. Danieli (Ed.), International handbook of multigenerati onal legacies of trauma (pp. 341). New York: Plenum. Eriksen, K., & Kress, V. E. (2006). The DSM and the professional c ounseling identity: Bridging the gap. Journal of Mental Health Counseling, 28, 202. Fassinger, R. E. (1991). The hidden minority: Issues and challenges in working with lesbian women and gay men. The Counseling Psychologist 19, 157. Fergusson, D. M., Horwood, L. J., & Beautrais, A. L. (1999). Is sexual orientation related to mental health problems and suicidality in young people? Archives of General Psychiatry, 56, 876. Fernandez, E. (2001). [Review of the test Trauma Symptom Inventory]. In B. S. Plake & J. C. Impara (Eds.), The fourteenth mental measurements yearbook ( pp. 1289 1290 ). Lincoln, NE: Buros Institute of Mental Measurements. Figley, C. R. (1988). Toward a field of traumatic stress. Journal of Traumatic Stress, 1 3. Floyd, F. J. & Bakeman, R. (2006). Coming out across the life course: Implications of age and historical context. Archives of Sexual Behavior, 35 (3), 287. doi: 10.1007/s10508-006-9022-x Frable, D. E. S. (1997). Gender, racial, ethnic, sexual, and class identities. Annual review of psychology, 48, 1139. 121
Freud, S. (1962). The aetiology of hyster ia. In J. Strachey (Ed. & Trans.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 3, pp. 191 221). London:Hogarth Press. (Ori ginal work published 1896) Friedman, M. J. & Marsella, A. J. (1996). Posttraumatic stre ss disorder: An overview of the concept. In A. J. Marsella, M. J. Fr iedman, E. T. Gerrity & R. M. Scurfield (Eds.). Ethnocultural aspects of posttraumatic stress disorder: Issues, research and clinical applications (pp.11). Washington, D.C.: American Psychological Association. Frist, M. B. & Tasman, A. (Eds.) (2004). DSM-IV-TR mental disorders: Diagnosis, etiology and treatment (pp. 926 925). Hoboken, NJ: John Wiley & Sons. Fukuyama, M. A., & Ferguson, A. D. (2000). Lesbian, gay, and bi sexual people of color: Understanding cultural complexity and man aging multiple oppressions. In R. M. Perez, K. A. DeBord, & K. J. Bieschke (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, and bisexual clients (pp. 81) Washington, DC: American Psychological Association. Gardner, F. (1999). Transgenerational processes and the trauma of sexual abuse. European Journal of Psychother apy, Counseling & Health, 2 297. Garnets, L., Herek G. M., & Levy, B. (1990). Violence and vi ctimization of lesbians and gay men: Mental health consequences. Journal of Interpersonal Violence, 5 366 383. Garofalo, R., Wolf, R. C, Wissow, L. S., Woods, E. R., & Goodman, E. (1999). Sexual orientation and risk of suicide attempts among a representative sample of youth. Archives of Pediatrics and Adolescent Medicine, 153, 487. Garrett, M. T., & Barret, B. (2003). Two spirit: Counseling Na tive American gay, lesbian and bisexual people. Journal of Multicultural C ounseling and Development, 31, 131. Gilfus, M. (1999). The price of the ticket. Violence Against Women 5 1238. Gilman, S. E., Cochran, S. D., Mays, V. M., Hughes, M., Os trow, D., & Kessler, R. C. (2001). Prevalences of DSMIIIR disor ders among individuals reporting samegender sexual partners in the National Comorbidity Survey. American Journal of Public Health, 91, 933. Gonsiorek, J. C. (1995). Gay male identities: Concepts and issues. In A. R. DAugelli & C. J. Patterson (Eds.), Lesbian, gay, and bisexual identities over the lifespan (pp. 24). New York: Oxford University Press. 122
Goodman, R. D. & West-Olat unji, C. A. (2009). Applyi ng critical consciousness: Culturally competent disaster response outcomes. Journal of Counseling and Development, 87 (4), 458. Greene, B. (2001). Heterosexism and ra cism among African Americans: The connections and considerations for Afri can American lesbian and bisexual women: A clinical psyc hological perspective. Rutgers Law Review, 54, 931. Greene, B. (1997). Ethnic mi nority lesbians and gay men. In B. Greene (Ed.), Ethnic and cultural diversity among lesbians and gay men (pp. 216). Thousand Oaks, CA: Sage. Greenwood, G. L., White, E. W., Page-Shafer, K., Bein, E., Osmond, D. H., Paul, J. & Stall, R. D. (2001) Correlates of heavy substance use among young gay and bisexual men: the San Francisco Young Mens Health Study. Drug and Alcohol Dependence 61, 105. Guthrie, R. V. (1998). Even the rat was white: A historical view of psychology (2nd ed.) Needham Heights, MA: A llyn & Bacon. (Original work published in 1976) Griffin, H. L. (2006). Their own receive them not: Afric an American lesbians and gays in Black churches. Cleveland, OH: The Pilgrim Press. Haldeman, D. C. (2002). Gay right s, patient rights: The implicat ions of sexual orientation conversion therapy. Professional Psychology: Research and Practice, 33 (3), 260-264. doi: 10.1037/0735.33.3.260 Halkitis, P. N., Parsons, J. T., & Wilson, L. (2003). Factor s related to methamphetamine use among gay and bisexual men in New York City. Journal of Drug Issues, 33(2), 413. Halpern, J., & Tr amontin, M. (2007). Disaster mental health: Theory and practice. Belmont: CA. Thompson Brooks/Cole. Halpin, S. A. & Allen, M. W. (2004). Changes in psychos ocial well-being during stages of gay identity development. Journal of Homosexuality 47 (2), 109. doi: 10.1300/J082v47n02_07 Hamlet, J. D. (1998). Afrocentric visions: Studies in culture and communication. Thousand Oaks, CA: Sage. Hatzenbuehler, M. L., Nolen-Ho eksema, S. & Erickson, S. J. (2008). Minority stress predictors of HIV risk behavior, subs tance use and depressive symptoms: Results from a prospectiv e study of bereaved gay men. Health Psychology, 27(4), 455. doi: 10. 1037/0278-6133.27.4.455 123
Hayes, R. A. (1996). Differences in so cial support, coping, and attitudes toward homosexuality between Afri can-American and Caucasi an men living with HIV. Dissertation Abstracts International: Se ction B: The Sciences & Engineering, 56(9-B), 5171. Helms, J. E. (1995). An update of He lm's White and people of color racial identity models. In J. Ponterotto, J. Manuel Casa s, L. A. Suzuki & C. M. Alexander (Eds.), Handbook of multicultural counseling ( pp. 93) Thousand Oaks, CA: Sage. Hencken, J. D., & ODowd, W. T. (1977). Coming out as an as pect of identity formation. Gai Saber, 1 (1), 18 22. Herek, G. M. (1993). Docum enting prejudice against lesbi ans and gay men on campus: The Yale Sexual Orientation Survey. Journal of Homosexuality, 25 (4), 15 30. Herek, G, M., Gillis, J. R., C ogan, J. C., & Glunt, E. K. (1997). Hate crime victimization among lesbian, gay, and bisexual adults: Pr evalence, psychological correlates, and methodological issues. Journal of Interpersonal Violence, 12 (2), 195. doi: 10.1177/ 088626097012002003 Herman, J. (1997). Trauma and recovery New York: Basic Books. Herman, J. L. (1992). Comp lex PTSD: A syndrome in su rvivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5 (3), 377 391. Huebner, D. M. & Davis, M. C. (2007). Pe rceived antigay discrim ination and physical health outcomes. Health Psychology, 26 (5), 627 634. doi: 10.1037/02786133.26.5.627 Huebner, D. M., Rebchook, G. M. & Kegeles, S. M. (2004) Experiences of harassment, discrimination and physical violence among young gay and bisexual men. American Journal of Public Health, 94 (7), 1200-1203. Icard, L. D. (1996). Assessing the Psychosoc ial Well-Being of African American Gays: A Multidimensional Perspective. Journal of Gay & Lesbian Social Services, 5 (2/3), 25. Israel, T., & Selvidge, M. M. D. (2003). Contributions of multicultural counseling to counselor competence with lesbia n, gay and bisexual clients. Journal of Multicultural Counseling and Development, 31 84 98. Ivey, A. E. (2003). Social justice: A longterm challenge for counseling psychology. The Counseling Psychologist, 31, 290-298. doi: 10.1177/0011000003031003004 124
James, R. K., & G illiland, B. E. (2005). Crisis intervention strategies (5th ed.). Belmont, CA: Brooks/Cole. Janet, P. (1965). The major symptoms of hysteria (2nd ed.). New York: Hafner Publishing Company. (Original work published 1929) Kambon, K. K. (1998). African/Black psychology in the American context: An Africancentered approach Tallahassee, FL: Nubian Nation Press. Kardiner, A., & Spiegel, H. (1947). War stress and neurotic illness (2nd ed.). New York: Hoeber, Inc. Kira, I. A. (2001). Taxonomy of trauma and trauma assessment. Traumatology, 7 73 86. Kitzinger, C. (1996). Speaki ng of oppression: Psychology, politics and the language of power. In E. D. Rothblum & L. A. Bond (Eds.), Preventing heterosexism and homophobia (pp.3). Thousand Oaks, CA: Sage. Lee, J. A. (1977). Going public A study in the sociology of hom osexual liberation. Journal of Homosexuality, 3 49. Levine, H. (1997). A further ex ploration of the lesbian identity development process and its measurement. Journal of Homosexuality 34 (2), 67. Lewis, T. (1999). Living beside Toronto, Canada: McGilligan Books. Lewis, J. A., Lewis, M. D., Daniels, J. A., & DAndrea, M. J. (2003). Community counseling: Empowerment strategies for a diverse society (3rd ed.) Pacific Grove, CA: Brooks/Cole-Thomson. Lifton, R. J. (1967). Death in life: Survivors of Hiroshima New York: Random House. Loiacano, D. K. (1989). Gay identity issues among black Americans: Racism, homophobia, and the need for validation. Journal of Counseling and Development, 68, 21 25. Lyons, H. Z., Brenner, B. R., & Fassinger, R. E. (2005) A multicultural test of the theory of work adjustment: Investi gating the role of heterosex ism and fit perceptions in the job satisfaction of lesbian, gay, and bisexual employees. Journal of Counseling Psychology, 52, 537 548. doi: 10.1037/0022-0167.52.4.537 Luckstead, A. (2004). Lesbian, gay, bise xual, and transgender people receiving services in the public mental health system: Ra ising issues. Journal of Gay and Lesbian Psychotherapy, 8 (3/4), 25. doi 10.1300/J236v08n03_03 125
Manago, C. & Howcott, T. (2006). Why the term same gender loving. Retrieved June 20, 2010 from http://terryhowcott.com/ greenspace.asp?id=151 Martinez, D. G., & Sullivan, S. C. (1998). African-American gay men and lesbians: Examining the complexity of gay identity development. Journal of Human Behavior in the Social Environment, 1 (2/3), 243 264. Marszalek, J. F., III, Cashwe ll, C. S., Dunn, M. S. & Jones K. H. (2004). Comparing gay identity development theory to cogniti ve development: An empirical study. Journal of Homosexuality 48 (1), 103. doi: 10.1300/J082v48n01_05 Matthews, C. R. & Selvidge, M. M. D. (2005). Lesbian, gay, and bisexual clients experiences in treatment for addiction. Journal of Lesbian Studies, 9 (3), 79. doi:10.1300/J155v09n03_08 Mays & Cochran (2001). Mental health correlates of perceived di scrimination among lesbian, gay, and bisexual adu lts in the United States. Journal of Public Health, 91(11), 1869. McAdoo, H. P. (1993). The soci al cultural contexts of ec ological developmental family models. In P. Boss, W. D oheerty, & W. Schyumm (Eds.), Sourcebook of family theories and methods: A contextual approach (pp. 298 301). New York: Plenum. McCowan, C. J., & Alston, R. J. (1998). Racial identity, African self-consciousness, and career decision making in Af rican American college women. Journal of Multicultural Counseling and Development, 26 28. McDaniel, J. S., Purcell, D., & D'Augelli, A. R. (2001). The relationship between sexual orientation and risk for suicide: Resear ch findings and future directions for research and prevention. Suicide and Life Threatening Behavior, 17 84. McDonald, G. J. (1982). Indivi dual differences in the coming out process for gay men: Implications for theoretical models. Journal of Homosexuality, 8 (1), 47. McKirnan, D. J., Tolou-Shams, M., Turner, L., Dyslin, K., & Hope, B. (2006). Elevated risk for tobacco use among men who hav e sex with men is mediated by demographic and psychosocial variables. Substance Use & Misuse, 41 1197 1208. doi: 10.1080/108260805000514503 McLaughlin, J. E. (2002). Reducing diagnostic bias. Journal of Mental Health Counseling, 24, 256. Mead, M. A., Hohenshil, T. H., & Kusum, S. (1997). How the DSM system is used by clinical counselors: A national study. Journal of Mental Health Counseling, 19 383. 126
Morin, S. F. & Rothblum, E. D. (1991). Removing the stigma : Fifteen years of progress. American Psychologist, 46 (9), 947. Meyer, I. H. (2003). Prejudice, social stress and mental health in lesbian, gay and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129 (5), 674. doi: 10.1037/0033-2909.129.5.674 Meyer, I. H. (1995). Minority stre ss and mental health in gay men. Journal of Health and Social Behavior, 36 38. Myers, L. J. (1988). Understanding an Afrocentric world-view: Introduction to an optimal psychology. Dubuque, IA: Kendall/Hunt. Miller Jr., R. L. (2007). Legacy denied: Afri can American gay men, AIDS, and the black church. Social Work, 52(1), 51. Minton, H. L., & McDonald, G. J. (1984). Homosexual identity formation as a developmental process. Journal of Homosexuality, 9, 91 104. Nobles, W. (1976). Extended-self: Rethinki ng the so-called Negro self-concept. Journal of Black Psychology, 11 (2), 15. Nobles, W. (1980). African philosophy: Foundat ions for black psychology. In R. Jones (Ed.), Black psychology New York: Harper & Row. Nobles, W. (1997). African American family life: An instrument of cult ure. In McAdoo, H. P., (Ed.), Black families ( 3rd ed., pp. 83). Thousand Oaks, CA: Sage. Nobles, W. W. (1991). African philosophy: Foundations for black psychology. In R. Jones (Ed.), Black psychology ( 3rd ed., pp. 47). Berkeley, CA: Cobbs & Henry. Nobles, W. W. (2004). African philosophy: Foundations for black psychology. In R. Jones (Ed.), Black psychology (4th ed., pp. 47-63). Berkeley, CA: Cobbs & Henry. Otis, M. D., & Skinner, W. F. (1996). The prevalence of vict imization and its effect on mental well-being among lesbian and gay people. Journal of Homosexuality, 30, 93. Parham, T. A., White, J. L., & Ajamu, A. (2000). The psychology of Blacks (3rd ed.). Upper Saddle River, NJ: Prentice Hall. Parks, C. W. (2001). Afric an American same-gender-loving youth and families in urban schools. Journal of Gay and Lesbian Social Services, 13, 41. 127
Parks, C, Hughes, T., & Matt hews, A. (2004). Race/ethnici ty and sexual orientation: Intersecting identities. Cultural Diversity and Ethnic Minority Psychology, 10 (3), 241. Pedersen, P. B., & Ivey, A. (1993). Culture-centered counseling and interviewing skills: A practical guide Westport, CT: Praeger. Phinney, J. S. (1992). The mu ltigroup ethnic identity measur e: A new scale for use with diverse groups. Journal of Adolescent Research, 7, 156. Phinney J. (1991. Ethnic i dentity and self-esteem: A re view and integration. Hispanic Journal of Behavioral Science (13), 193. Plummer, K. (1975). Sexual stigma: An interactionist account. London: Routledge & Kegan Paul. Raphael, B., Swan, P., & Mart inek, N. (1998). Intergenerati onal aspects of trauma for Australian Aboriginal people. In Y. Danieli (Ed.), International handbook of multigenerational lega cies of trauma (pp. 327). New York: Plenum. Reid, J. D. (1995). Development in late lif e: Older lesbian and gay lives. In A. R. DAugelli & C. J. Patterson (Eds.), Lesbian, gay, and bisexual identities over the lifespan (pp. 216). New York: Oxford University Press. Rogers, R.R. (1998). The impact of gay identity and perceived milieu toward gay employees on job involvement and or ganizational commitment of gay men (Doctoral dissertation) Available from ProQuest Dissertations and Theses database. (UMI No. 9820217) Root, M. (1992). Restructuring the impact of trauma on personality. In L. Brown & M. Ballour (Eds.), Personality and psychopathology (pp. 108). New York: Guilford. Rosario, M., Rotheram-Borus, M. J., & Re id, H. (1996). Gay r elated stress and its correlates among gay and bisexual male ad olescents of predominantly Black and Hispanic background. Journal of Communi ty Psychology, 24, 136 159. Rosario, M., Schrimshaw, E. W. & Hunter, J. (2004). Ethnic/racial differences in the coming out process of lesbian, gay and bi sexual youths: A comparison of sexual identity development over time. Cultural Diversity and Ethnic Minority Psychology, 10 (3), 215 228. Rosario, M., Hunter, J., Maguen, S., Gwadz, M., & Smith, R. (2001). The coming-out process and its adaptational and health-related associations among gay, lesbian, and bisexual youths: Stipulati on and exploration of a model. American Journal of Community Psychology, 29 (1), 133. 128
Rosenheck, R., & Fontana, A. (1998a). Transgenerational effects of abusive violence on the children of Vietnam combat veterans. Journal of Traumatic Stress, 11 731 742. Rosenthal, B. S., & Wilson, W. C. (2003). The association of ecological variables and psychological distress with exposure to community violence among adolescents. Adolescence, 38, 459 479. Rothschild, B. (2000). The body remembers. New York, NY: W.W. Norton & Company, Inc. Rowen, C. J. & Malcolm, J. P. (2002). Correlates of internalized homophobia and homosexual identity formation in a sample of gay men. Journal of Homosexuality, 43(2), 77. Rust, P. C. (2001). Two many and not enough: The meanings of bisexual identities. Journal of Bisexuality,1 (1), 33. Rutter, P. A. (2007). Young adult suicide and sexual orientation: What should counselors know? Journal of LGBT Issues in Counseling, 1 (3), 33. Rutter, P., & Soucar, E. (2002). Youth suicide risk and sexual orientation. Adolescence, 37(146), 289. Salazar, C., & Abrams, L. (2005). Conceptualizing identity development in members of marginalized groups. Journal of Professional Couns eling: Practice, Theory, & Research, 33 47 59. Savin-Williams, R. C. (2001). A critique of research on sexual-minority youths. Journal of Adolescence, 24, 5 13. Savin-Williams, R. C. (1994). Verbal and phsyical abuse as stressors in the lives of lesbian, gay male, and bisexual youths : Associations with school problems, running away, substance abuse, prostitution, and suicide. Journal of Consulting and Clinical Psychology, 62 (2), 261 269. Savin-Williams, R. C., & Ream, G. L. (2003) Suicide attempts among sexual-minority male youth. Journal of Clinical Child & Adolescent Psychology, 32 (4), 509. Scaer, R. C. (2001). The body bears the burden: Traum a, dissociation and disease. Binghamtom, NY: Haworth Press. Schechter, D. S., Brunelli, S. A., Cunningham, N., Brown, J., & Baca, P. (2002). Motherdaughter relationships and sexual abus e: A pilot study of 35 days. Bulletin of the Menninger Clinic, 66 39. 129
Seligman, L. (1999). Twenty ye ars of diagnosis and the DSM. Journal of Mental Health Counseling, 21, 229. Stall, R., Paul, J. P., Greenwood, G., Pollack, L. M., Bein, E., Crosby, G. M., Mills, T. C., Binson, D., Coates, T. J. & Catania, J. A. (2001) Alcohol use, drug use and alcohol-related problems among men who have sex with men: The Urban Mens Health Study. Addiction 96, 1589. Sandfort, T. G. M., & de Keizer M. (2001). Sexual problems in gay men: An overview of empirical research. Annual Review of Sex Research 12, 93 120. Stone, C. B. (2003). Counselor s as advocates for gay, lesb ian, and bisexual youth: A call for equity and action. Journal of Multicultural Counseling & Development, 31, 143. Sudarkasa N. (1997) African American families and family values. In McAdoo, H. P., (Ed.), Black families ( 3rd ed., pp. 9). Thousand Oaks, CA: Sage. Sue, D. W., Arredondo, P., & McDavis, R. J. (1992). Multicultural counseling competencies and standards: A call to the profession. Journal of Counseling & Development, 70, 477. Sue, D. W., & Sue, D. (2008). Counseling the culturally diverse: Theory and practice (5th ed.). New York: Wiley & Sons. Tajfel, H. (1978). Social cat egorization, social identity an d social comparison. In H. Tajfel (Ed.), Differentiation between social gr oups: Studies in the social psychology of intergroup relations (pp.61 76). London: Academic Press. Tillman, L. C. (2002). Culturally sensitive research approaches: An African American perspective. Educational Researcher, 31 (9), 3 12. Tozer, E. E. & Hayes, J. A. (2004). Why do individuals seek conversion therapy? The Counseling Psychologist, 32 (5), 716 740. doi: 10.1177/0011000004267563 Trimble, M. R. (1981). Post-traumatic neurosis: From railway spine to whiplash. New York: John Wiley & Sons. Troiden, R. R, (1979). Beco ming homosexual: A model gay identity acquisition. Psychiatry: Journal for the Study of Interpersonal Processes, 42 362 373 Utsey, S. O., Bolden, M. A., & Brown, A. L. (2001). Visions of revolution from the spirit of Frantz Fanon: A psychology of liberat ion for counseling African Americans confronting societal racism and oppression. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (2nd ed., pp. 311 336). Thousand Oaks, California: Sage Publications, Inc. 130
van der Kolk, B. A. (1996). The body keeps the score: Approaches to the psychobiology of posttraumatic stress diso rder. In B. A. van der Ko lk, McFarlane, A. C. & L. Weisaeth (Eds.), Traumatic stress (pp.214). New York: The Guilford Press. van der Kolk, B. A., & McFarl ane, A. C. (1996). The black hol e of trauma. In B. A. van der Kolk, McFarlane, A. C. & L. Weisaeth (Eds.), Traumatic stress (pp.3). New York: The Guilford Press. van der Kolk, B. A., & van der Hart, O. (1989). Pierre Janet and the breakdown of adaptation in psychological trauma. American Journal of Psychiatry, 146, 1530 1540. van der Kolk, B. A., van der Hart, O. & Marmar, C. R. (1996). Dissociation and information processing in posttraumatic stre ss disorder. In B. A. van der Kolk, McFarlane, A. C. & L. Weisaeth (Eds.), Traumatic stress (pp.303). New York: The Guilford Press. Walters, K. L., Simoni, J. M., & Horwath, P. F. (2001) Sexual orientation bias experiences and service needs of gay, le sbian, bisexual, transgendered, and two-spirited American Indians. Journal of Gay and Lesbian Social Services, 13(1/2), 133. Weisaeth, L. (2002). The Euro pean history of traumatology. Journal of Traumatic Stress, 15, 443. West-Olatunji, C. (2010). Use of advocacy competencies with cu lturally diverse clients. In M. J. Ratts R. L. Toperek, & J. A. Lewis, & (Eds), ACA advocacy competencies (pp. 55 64). Alexandria, VA: American Counseling Association. West-Olatunji, C. A. (2005). Incidents in the lives of Harriet Jacobss children-A readers theater: Disseminating the outcomes of re search on the Black experience in the academy. In J. E. King (Ed.), Black education: A transformative research and action agenda for the new century (pp. 329) Mahwah, New Jersey: Lawrence Erlbaum Associates. White, J. L. (1972). Toward a blac k psychology. In R. Jones (Ed.), Black psychology. New York; Harper & row. Whitney, C. (2006). Intersections of i dentity Identity development among queer women with disabilities. Sexuality and Disability, 24, 3952. doi: 10.1007/s11195-005-9002-4 Wise, S. J. (2001). Redefin ing black masculinity and m anhood: Successful black gay men speak out. Journal of African American Men, 5 (4), 3 23. 131
132 Wynn, R., & West-Olat unji, C. (2009). Cultur e-centered case conceptualization using NTU psychotherapy with an African American gay male client. Journal of LGBT Issues in Counseling, 2 (4), 308. doi 10.1080/1553860080 2501995 Zamboni, B. D. & Crawford, I. (2007). Minority stress and sexual problems among African American gay and bisexual men. Archives of Sexual Behavior, 36 ,569 578. doi: 10.1007/s10508-006-9081 Zimmerman, M., & Ma ttia, J. I. (1999). Is posttraumat ic stress disorder underdiagnosed in routine clinical settings? Journal of Nervous & Mental Disease. 187 420.
BIOGRAPHICAL SKETCH Richmond David Wynn was born in 1967 in Co coa, Florida. In 1990, he received a Bachelor of Science degree in sociology from the University of Florida. He received a Master of Science degree in health spec ializing in mental health and addiction counseling from the University of North Florida in 1997. He is a licensed mental health counselor and certified addictions prof essional in the State of Florida. 133