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. Author manuscript; available in PMC: 2026 May 26.
Published in final edited form as: J Trauma Stress. 2026 Apr 25;39(3):517–528. doi: 10.1002/jts.70072

Co-occurring daily minority stressors and dissociation among trauma-exposed sexual minority women, transgender, and nonbinary people

Kriti Behari 1, Emily C Helminen 2, Michelle J Zaso 1, Jillian R Scheer 3
PMCID: PMC13199747  NIHMSID: NIHMS2171318  PMID: 42034599

Abstract

Sexual minority women, transgender people, and nonbinary (SMW/TNB) people experience disproportionately high rates of traumatic stressors (e.g., child abuse, sexual violence), which are associated with adverse trauma-related mental health outcomes, such as dissociation. SMW/TNB people also experience ongoing stressors related to their minoritized sexual and/or gender identities (e.g., discrimination). Dissociation has been associated with minority stressors in studies primarily using single–time point, cross-sectional approaches. Reliance on single–time point approaches may obscure how minority stressors and trauma-related outcomes, like dissociation, covary within individuals and unfold over time. We conducted a secondary analysis of data from a 14-day daily diary study with trauma-exposed SMW/TNB participants (N = 57) to examine whether variations in daily minority stressors were associated with same-day fluctuations in dissociation. Results indicated minority stressors and dissociation significantly covaried over the 14-day study period. Multilevel models showed that participants’ reports of higher-than-average daily minority stressors were associated with same-day reports of higher-than-average dissociative symptoms, B = 0.24, 95% CI [0.07, 0.41], p = .007. Participants also reported small decreases in dissociation levels over the study period, B = −0.05, 95% CI [−0.08, −0.02], p = .004. The findings highlight the importance of considering the health impacts of consistent state elevations in dissociation associated with minority stressors for SMW/TNB people. Future time-varying approaches should investigate temporal sequencing of minority stressors and dissociation, assess whether minority stressors relate to dissociation independent of trauma exposure, and explore whether trauma exposure characteristics (e.g., identity-relatedness of trauma) moderate this association.

Sexual and gender minority (SGM) people (i.e., individuals who identify as lesbian, gay, bisexual, transgender, nonbinary, queer, intersex, asexual, or with other non-heterosexual or noncisgender identities) are 1.5–3 times more likely to have posttraumatic stress disorder (PTSD) compared to cisgender, heterosexual (i.e., straight) people (Marchi et al., 2023; Scheer et al., 2023). This elevated risk is present, in part, because SGM people experience dis-proportionate exposure to traumatic stressors that meet Criterion A for PTSD as defined in the Diagnostic and Statistical Manual for Mental Disorders (5th ed.; DSM-5; American Psychiatric Association [APA], 2013; Roberts et al., 2010). Criterion A traumatic stressors include experiences that involve witnessing death, being threatened with death or serious injury (e.g., being threatened by a weapon), experiencing serious injury (e.g., physical attack motivated by bias), or sexual violence (e.g., childhood physical or sexual abuse, sexual assault; APA, 2013).

Beyond elevated trauma exposure, SGM people routinely face stigma-related stressors tied to their sexual and/or gender identity (termed minority stressors). Although some minority stressors meet Criterion A (e.g., anti-SGM–motivated physical assault), many do not fall within the Criterion A definition, including discrimination, harassment, rejection, and social exclusion, nor do internal stressors, such as anticipating stigma-based rejection, managing identity concealment, and internalized heterosexism (Brooks, 1981; Meyer, 2003). Minority stress theory posits that minority stressors are group-specific (i.e., unique to SGM people), chronic, embedded in social structures and interpersonal contexts, and are risk factors for adverse mental health outcomes. Minority stress theory has served to explain links between minority stressors and associated negative health outcomes, including PTSD, for SGM people (Alessi et al., 2013). Extensions of this framework propose that, in addition to increased stress exposure resulting from stigma, minority stressors deteriorate mental health by elevating general cognitive (e.g., helplessness), emotional (e.g., emotional dysregulation), and social processes (e.g., social isolation) that confer risk for adverse mental health outcomes (Hatzenbuehler, 2009).

Several theoretical frameworks have described how identity-related stressors function similarly to traumatic stressors despite not always being considered Criterion A traumatic events. Race-based traumatic stress theory and feminist theory have conceptualized the psychological impact of ongoing negative experiences related to a person’s minoritized identity as “insidious” and “normative” trauma (Brown, 2003; Root, 1992). These frameworks highlight the chronic and cumulative nature of identity-related stressors and their capacity to erode selfhood, undermine safety and control, and contribute to substantial social, economic, and health consequences (Cénat, 2023). Empirical findings are consistent with theories that minority stressors are trauma-like, showing that higher exposure to both external (e.g., heterosexist discrimination, antitransgender bias) and internal (e.g., expectations of rejection) minority stressors is positively associated with PTSD symptom severity, even after accounting for prior trauma exposure (Bandermann & Szymanski, 2014; Barr et al., 2022; Reisner et al., 2016; Szymanski & Balsam, 2011). However, far less is known about how minority stressors relate to specific trauma-related symptoms, such as dissociation.

Dissociation is a cluster of symptoms characterized by disruptions in awareness, memory, perception, and a sense of self or reality (APA, 2013). Common dissociative symptoms include depersonalization (i.e., out-of-body experiences), derealization (i.e., feelings of unreality and altered time), analgesia (i.e., reduced pain sensitivity), gaps in awareness and memory, confusion, constricted attention, withdrawal, and detachment (Lanius et al., 2012). Clinically, dissociation is important because it is associated with more severe PTSD presentations, higher levels of functional impairment, and elevated comorbid psychopathology, including depressive symptoms, suicidality, and self-harm (M. S. Burton et al., 2018; Carlson et al., 2012). Dissociation may also interfere with trauma-focused treatment by reducing emotional engagement and impeding the adaptive processing of traumatic experiences. People who experience dissociation may have difficulty tolerating or remaining present during exposure-based interventions, such as imaginal or in vivo exposures, potentially limiting inhibitory learning related to trauma cues and, consequently, lowering treatment effectiveness (Cloitre et al., 2012; Kleindienst et al., 2016; Spitzer et al., 2007).

Dissociation can occur as a response to stressful or threatening situations. The human threat-response system generally exhibits a range of physiological, psychological, and behavioral responses to stressful or threatening situations that mobilize the person for self-defense (i.e., “fight”) or escape (i.e., “flight”). However, overwhelming threat, such as from a traumatic event, can elicit the over- or undermodulation of this system (Lanius et al., 2012). In some cases, excessive activation of the threat response results in sustained hyperarousal (e.g., hypervigilance, aggression), whereas in situations perceived as inescapable, excessive inhibition may occur, characterized by immobilization, emotional numbing, and dissociation—often described as the “freeze” response. Although dissociation may be adaptive in the context of acute, inescapable threat, it may also become a maladaptive posttraumatic adaptation wherein a broader range of daily or chronic stressors are appraised as threatening and trigger dissociation responses (Perry et al., 1995; Stiglmayr et al., 2008).

Although emotion-focused models describing how minority stressors function as insidious trauma (Cardona et al., 2022) do not explicitly examine dissociation, they may, nevertheless, provide a helpful lens for understanding the association between minority stress and dissociation. Cardona et al. (2022) proposed that chronic, compounding minority stressors may result in maladaptive emotional processing styles among SGM people due to a repeated invalidation of emotional and affiliative needs across the lifespan. Invalidation may occur through early adversity (e.g., childhood environments that dismiss or punish gender and/or sexual identity), interpersonal contexts (e.g., rejection, minimization of distress about minority stressors by family members, peers, partners, or outright physical harm), and systemic forces (e.g., institutional nonrecognition of identities, discriminatory policies, social norms that delegitimize experiences of SGM people). Repeated experiences of invalidation communicate to SGM people that their emotions, perceptions, or core sense of self are unacceptable, unsafe, or lack legitimacy. Consequently, chronic invalidation may undermine SGM people’s ability to understand, trust, and use emotional experiences as meaningful signals of their needs. Accurate emotional responses to life events (e.g., anger or sadness at repeated minority stressors) may then become associated with helplessness, a loss of control, and overwhelm. As dissociation commonly occurs in contexts characterized by helplessness and inescapability (M. S. Burton et al., 2018; Lanius et al., 2012), it may then emerge concurrently with minority stressors as an automatic response to reduce emotional intensity and protect from overwhelm (Cavicchioli et al., 2021; Jones et al., 2018; Kecala et al., 2023).

Emerging research has demonstrated positive associations between minority stressors and dissociation in community SGM samples. Qualitative research with sexual minority women suggests that heterosexist harassment may elicit emotional distancing and dissociative responses (Moradi et al., 2019). In another study, identity-based discrimination was associated with dissociative symptoms in a university-based sample of trauma-exposed, treatment-seeking SGM participants, with stronger associations observed among participants who reported interpersonal identity-related trauma compared to those who reported non–identity-related trauma (Keating & Muller, 2020). Additional studies document associations between dissociation and transgender-specific stressors, including discrimination, victimization, sexual objectification, and body-related depersonalization among transgender and nonbinary individuals (Lane et al., 2025; Pradell et al., 2024; Taber & Stults, 2025).

Despite being conceptualized as a stress-sensitive state response to threats (e.g., minority stressors; Perry et al., 1995; Stiglmayr et al., 2008), extant studies on dissociation and minority stressors have relied on retrospective, single–time point, cross-sectional designs (Keating & Muller, 2020; Lane et al., 2025; Moradi et al., 2019; Pradell et al., 2024; Taber & Stults, 2025). This limits conclusions about whether the association between minority stressors and dissociation is relatively stable or varies within people over time. Identifying dynamic stressor–dissociation patterns requires repeated assessments, such as those afforded by intensive longitudinal methods (ILM). Although prior ILM studies show that minority stressors and dissociation each fluctuate at the daily level (Heron et al., 2018; Mason et al., 2017), no work to date has examined whether they co-occur within the same day, leaving it unclear whether minority stressors reliably coincide with elevations in dissociation (i.e., when participants experience minority stressors, do they also experience dissociation?). ILM designs, such as daily diary studies, also reduce recall bias common in single–time point designs (Iida et al., 2023), which is particularly important given dissociation-related memory disturbances (McKinnon et al., 2016). Demonstrating state elevations in dissociation that co-occur with minority stressors among trauma-exposed SGM people could provide preliminary support for dissociation as a state-like, stress-sensitive, and potentially modifiable intervention target.

Understanding dissociation in the context of minority stressors may be most relevant among specific SGM subgroups, namely, sexual minority women, transgender people, and nonbinary people (SMW/TNB; please see the Supplementary Materials for a note on terminology). Compared to cisgender heterosexual people and cisgender sexual minority men, SMW/TNB people experience higher rates of traumatic stressors. In large national samples, 48% of transgender adults, 46% of cisgender SMW, and 55% of nonbinary respondents reported sexual or physical violence, compared to 34% of cisgender sexual minority men (Meyer et al., 2021; Wilson & Meyer, 2022). Similarly, 45% of transgender adults, 43% of cisgender SMW, and 41% of nonbinary respondents reported childhood sexual abuse, compared to 29% of cisgender sexual minority men. Childhood abuse and sexual violence are associated with a higher risk of developing PTSD symptoms, specifically dissociation (Kessler et al., 2017; Vonderlin et al., 2018), increasing the likelihood that dissociation is present in daily life for SMW/TNB people. Indeed, recent evidence suggests that compared to other groups, SMW/TNB people report elevated PTSD symptoms (Scheer et al., 2023; Helminen et al., 2026), including dissociation (Joshi et al., 2026; Lane et al., 2025). Further, SMW/TNB people experience minority stressors at higher rates, with 56% of transgender adults, 48% of cisgender SMW, and 54% of nonbinary respondents reporting chronic minority stressors in the past year compared to 34% of cisgender sexual minority men (Meyer et al., 2021; Wilson & Meyer, 2022). These data suggest that dissociation may be especially important to examine among SMW/TNB people, not because the hypothesized processes are unique to this group but because the convergence of elevated dissociation-linked trauma exposure and chronic minority stressors may heighten vulnerability to stress-sensitive dissociation and observation of day-to-day co-occurrence.

Thus, efforts to understand the daily co-occurrence of minority stressors and dissociation among SMW/TNB people are theoretically and clinically important. Theoretically, demonstrating daily covariation between minority stressors and dissociation supports conceptualizations of minority stressors as trauma-like and dissociation as stress-sensitive, helping advance state models of dissociation and highlighting the potential for dissociation to be an intervention target, especially among SMW/TNB people. Clinically, dissociation is associated with higher levels of PTSD symptom severity, higher functional impairment, and poorer treatment response (M. S. Burton et al., 2018; Cloitre et al., 2012; Kleindienst et al., 2016; Lanius et al., 2012). Given the pervasiveness of minority stressors for SMW/TNB people, co-occurring dissociation may signal frequent trauma-related responses in daily life, suggesting the importance of explicitly assessing and addressing dissociation when treating minority stressor–related distress, including outside trauma-focused treatment.

The present study aimed to examine the concurrent association between daily minority stressors and same-day dissociation among trauma-exposed SMW/TNB people through a secondary analysis of data from an existing daily diary dataset. We hypothesized a fixed, within-person association between daily minority stressors and same-day dissociation such that participants would report concurrent elevations in daily minority stressors and same-day dissociation.

METHOD

Participants

Data for the present study were drawn from a larger dataset. Data for the parent study were collected between 2021 and 2022 as part of a 14-day daily diary study examining the feasibility and acceptability of using ILM to assess minority stressors, coping behaviors, and stress-sensitive health outcomes for trauma-exposed SMW/TNB people (N = 57) (Scheer et al., 2023, 2024). Participants were eligible if they (a) reported sexual minority identity; (b) reported gender identity as cisgender woman, transgender, and/or nonbinary; (c) were 18 years of age or older; (d) reported exposure to at least one traumatic stressor; (e) had not received inpatient psychiatric care in the past 6 months; (f) spoke English; (g) currently resided in the United States; and (h) had reliable internet and email access. Participants were recruited from across the United States through social media, listservs, and SGM community organizations, using a recruitment strategy to maximize the sample’s geographic diversity by targeting the four most populous cities in the United States, 20 randomly selected small urban areas (i.e., cities of 100,000 people or more), and 20 randomly selected rural counties (i.e., counties of 250,000 people or less; C. L. Burton et al., 2020).

Procedure

Eligible participants electronically consented to study procedures, then immediately completed a baseline survey via Qualtrics. Since automated (i.e., “bots”) and fraudulent responders in internet-based studies have posed significant threats to data integrity (Guy et al., 2024), we implemented bot and fraud detection tactics (Shaw et al., 2025), along with a manual review of responses (Scheer et al., 2024). Participants were emailed the first daily dairy survey within 2 weeks of completing the baseline survey. Daily survey links were sent using a predefined schedule (i.e., a once-daily, 5–10 min survey sent at 6:00 p.m. Eastern Time for 14 days). Participants had 24 hr to complete each daily survey; those who missed five consecutive daily surveys were not sent additional daily surveys. Participants could earn up to $35 (USD) on an electronic gift card for completing surveys ($10 for the baseline survey, $1 for each daily survey). They also earned bonuses for completing the first seven daily surveys ($5) and all 14 daily surveys ($6).

Measures

Past traumatic stressors

To assess study eligibility, traumatic stressor exposure was measured at baseline using the PTSD Diagnostic Scale for DSM-5 (PDS-5; Foa et al., 2016). The PDS-5 asks participants to select all traumatic stressors they have experienced from a list (i.e., serious life-threatening illness, physical assault, sexual assault, military combat or living in a war zone, child abuse, accident, natural disaster, and other trauma [with space for a brief description]). Participants indicated their index trauma by selecting the “single traumatic experience [that] is on [their] mind and currently bothers [them] the most.”

Daily dissociation

Daily dissociation was measured using a three-item scale that was shown to capture dissociation variability over a 2-week timeframe in a prior ILM study with an adult sample (Mason et al., 2017). Items (e.g., “From 6 p.m. yesterday to 6 p.m. today, did you feel out of touch with yourself?”) asked respondents to rate dissociative symptoms on a scale from 1 (not at all) to 5 (extremely). Responses were recoded as 0–4 to ensure meaningful 0 values and summed to create a total score, with higher scores indicating greater dissociation (possible range: 0–12). The original study demonstrated good internal consistency (Cronbach’s α = .85). In the present study, the average Cronbach’s alpha across study days was .80.

Daily minority stressors

Daily minority stressors were assessed using an eight-item measure developed for use in ILM studies examining sexual minority stigma–related stressors (Heron et al., 2018). Participants were given the prompt, “From 6 p.m. yesterday to 6 p.m. today, please rate how much this experience describes something that happened to you because you identify as a sexual minority” and presented with items (e.g., “I was verbally harassed by someone”) to rate on a scale of 0 (not at all) to 6 (a lot). As recommended by prior research, the minority stress measure was recoded to mitigate overabundance of zero values for individual items and to avoid assuming that a higher score indicates a higher frequency of occurrence when a participant may have intended to indicate severity (Braitman et al., 2021; Livingston et al., 2020). For each item, responses of 0 were retained as 0, and responses of 1–6 were recoded as 1. Dichotomized scores were then summed to obtain the number of types of minority stressors reported each day (possible range: 0–8). Previous research has demonstrated good internal consistency (Cronbach’s α = .85; Heron et al., 2018) and sufficient within-person variation to detect fluctuations in daily diary studies (intraclass correlation coefficient [ICC] = .25; Braitman et al., 2021). The measure has also demonstrated convergent validity (r = .54) with a single-item assessment of negative sexual minority-related experiences (Braitman et al., 2021). In the present sample, the average Cronbach’s alpha across study days was .79.

Data analysis

Sample size targets for the parent study were based on prior ILM studies examining similar constructs and populations (e.g., Wolford-Clevenger et al., 2021), which ranged from nine participants (28 reports) to 51 participants (21 reports), yielding 252–1,071 within-person observations as sufficient to detect small-to-medium fixed effects in Level 1 models at an alpha level of .05 (Arend & Schäfer, 2019).

Analyses were conducted in IBM SPSS (Version 29.0.2.0). There were no significant patterns of missingness, χ2(10, N = 684) = 9.76, p = . 462 (Little, 1988). Skewness (0.26, SE = 0.09) and kurtosis (−0.86, SE = 0.19) for daily dissociation were within range (plus or minus 2.0) to assume normality for multilevel models (MLMs; Heck et al., 2022; Kim, 2013).

Daily diary data were comprised of a multilevel data structure of daily observations (Level 1) nested within participants (Level 2). The predictor (minority stressors) and outcome (dissociation) variables were assessed at the within-person level (Level 1), with the daily diary surveys serving as the unit of analysis. An MLM was used to accommodate the two-level (between-person, within-person) data structure, as MLMs account for clustering of measurements within persons by including the participant as a random effect. MLMs also account for nonindependence of repeated measurements by assuming autocorrelated residuals (Bolger & Laurenceau, 2013). All assumptions regarding residuals (normality, linearity, and homogenous variance) were met for the analytic model. ICCs for daily minority stressors, ICC = .54, and dissociation, ICC = .68, indicated adequate within-person variability for multilevel analyses (see Supplementary Figure S1 for daily covariation of minority stressors and dissociation by participant). An MLM was estimated to assess associations between daily minority stressors and daily dissociation. The model utilized restricted maximum likelihood estimation for model parameters, which provides unbiased estimates of variance and covariance parameters by applying a penalty to the degrees of freedom when estimating variance components (Corbeil & Searle, 1976; IBM, 2021).

Between-person and within-person variance in daily minority stressors were distinguished by splitting variance into two orthogonal components (Bolger & Laurenceau, 2013; Iida et al., 2023). We grand mean–centered the minority stressors variable by subtracting the grand mean of scores across all participants and time points from each raw score. Next, the between-person component was created by calculating person means of the grand mean–centered minority stressor scores. Finally, the within-person component was created by subtracting the between-person component from the grand mean–centered minority stressor scores. The between- and within-person components of the minority stressors measure were included as fixed-effect predictors in the model.

Traumatic stressors (e.g., car accident) that occurred throughout the daily diary phase were considered as a potential covariate but excluded due to low endorsement (1.9%). Daily general stress was included as a covariate, as ILM research has demonstrated associations between general stress and dissociation (Stiglmayr et al., 2008). General and minority stressors were not strongly correlated in the present study (r = .24), suggesting that participants interpreted them as distinct constructs. In line with best practices for ILM, elapsed time (study day) was included in all models given the possibility of measurement reactivity effects (Bolger & Laurenceau, 2013; Iida et al., 2023; König et al., 2022). Reported results are consistent with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines (von Elm et al., 2007).

This study was originally conducted as part of the first author’s master’s thesis project and included a priori plans to examine the moderation effects of three baseline trauma exposure variables (age of onset, chronicity, and PTSD symptom severity) on the association between daily minority stressors and daily dissociation. We deviated from this plan here by excluding these moderation analyses based on concerns with power. Readers interested in the original analyses are referred to the publicly available master’s thesis manuscript (Behari, 2024). Study procedures were approved by the Syracuse University Institutional Review Board.

RESULTS

Sample characteristics

After bot and fraudulent responder detection screening for the parent study, 59 verified participants remained. Two participants did not initiate daily surveys after completing the baseline survey (Scheer et al., 2024), resulting in an analytic sample of 57 SMW/TNB people (Mage = 28.4, SD = 10.1, range: 18–72 years; Table 1). Overall, participants completed 688 daily surveys (86.2% of 798 possible surveys). Over one third of the sample (35.1%) identified with multiple gender identity labels, 28.1% of participants were cisgender women, and most participants were White (63.2%).

TABLE 1.

Baseline sociodemographic characteristics

Sociodemographic characteristics n %
Gender identity
 Multiple gender identity labelsa 20 35.1
 Cisgender or transgender woman 17 29.8
 Transgender man or transmasculine 8 14.0
 Another identity (e.g., genderqueer, gender fluid, demi-girl) 7 12.3
 Nonbinary 5 8.8
Sex assigned at birth
 Female 49 86.0
 Male 7 12.3
 Intersex 1 1.8
Sexual identity
 Multiple sexual identity labelsb 28 49.1
 Bisexual or pansexual 14 24.6
 Lesbian or gay 8 14.0
 Queer 7 12.3
Race and Ethnicity
 White 36 63.2
 Biracial or Multiracial 9 15.8
 Asian American 7 12.3
 Black or African American 1 1.8
 Native Hawaiian or other Pacific Islander 1 1.8
 Latine or Hispanic 3 5.3
Income
 Under $9,999 13 22.8
 $10,000 – $24,999 18 31.6
 $25,000 – $49,999 11 19.3
 $50,000 – $74,999 7 12.3
 Above $75,000 7 12.3
 Missing 1 1.8
U.S. region
 West 20 35.1
 Northeast 13 22.8
 South 12 21.1
 Midwest 12 21.1
Relationship status
 Partnered 35 61.4
 Single or casually dating 22 38.6
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Note: N = 57. Groups are ordered by sample size.

a

Includes participants who selected two or more gender identities.

b

Includes participants who selected two or more sexual identities.

Association between daily minority stressors and same-day dissociation

The multilevel model examined the association between daily minority stressors and same-day dissociation (Table 2). There was a significant within-person effect such that on days when participants reported higher-than-average minority stressors, they also reported higher-than-average dissociation, B = 0.24, 95% confidence interval (CI) [0.07, 0.41], p = .007. Daily general stress was positively associated with daily dissociation such that on days when participants reported higher general stress, they also reported higher dissociation, B = 0.28, 95% CI [0.14, 0.43], p < .001. There was also a significant effect of time such that participants reported decreasing levels of dissociation over the study period, B = −0.05, 95% CI [−0.08, −0.02], p = .004.

TABLE 2.

Parameter estimates for the multilevel model predicting daily dissociation from daily minority stressors

Variable Estimate 95% CI SE df t z p a
Fixed effects (intercepts, slopes)
 Intercept 4.60*** [3.88,5.32] 0.36 78.49 12.76 < .001
 Day −0.05** [−0.08,−0.02] 0.02 202.22 −2.88 .004
 Within-person daily minority stressors 0.24** [0.07,0.41] 0.08 27.62 2.91 .007
 Between-person daily minority stressors 0.50 [−0.05,1.05] 0.27 54.17 1.82 .074
 Daily general stress 0.28*** [0.14,0.43] 0.08 590.93 3.75 < .001
Random effects (variances/covariances)
 Level 2 (between-person)
  Intercept 5.85*** [3.95,8.68] 1.18 4.98 < .001
  Within-person minority stressors 0.08 [0.02,0.32] 0.06 1.44 .150
  Intercept and within-person minority stressors 0.03 [−0.37,0.42] 0.20 0.14 .891
 Level 1 (within-person)
  Residual 2.57*** [2.28,2.90] 0.16 16.42 < .001
  Autocorrelation 0.10* [0.00,0.19] 0.05 1.99 .047
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Note. N = 57 persons, n = 14 days, n = 688 observations. CI = confidence interval.

a

All p values are two-tailed except in the case of variances, where one-tailed p values are used (as variances are constrained to be nonnegative).

*

p < .05.

**

p < .01.

***

p < .001.

DISCUSSION

The present study examined whether daily minority stressors were concurrently associated with same-day dissociation among trauma-exposed SMW/TNB people. The results supported our hypothesis such that on days when participants reported higher minority stressors relative to their own average, they also reported higher-than-average daily dissociation. This association remained even after adjusting for daily general stress, indicating that minority stressors account for some unique variance in day-to-day fluctuations in dissociation over and above general stress and PTSD symptom severity. Notably, most participants (87.7%) reported experiencing at least one minority stressor in just 2 weeks of daily diary assessments, which aligns with prior research demonstrating that minority stressors are, unfortunately, ubiquitous in the lives of SMW/TNB people (Livingston et al., 2020).

These findings build upon prior research using single–time point designs that has demonstrated significant positive associations between minority stressors and dissociation (e.g., Keating & Muller, 2020) and suggest that trauma-exposed SMW/TNB people may experience repeated, state elevations in dissociation alongside minority stressors. Additionally, the observed within-person, day-level covariation suggests that dissociation may function as a state-like, and potentially stress-sensitive, response rather than a stable trait, highlighting its promise as a modifiable target.

Further, as the measure used to assess daily minority stressors does not include stressors that meet DSM-5 PTSD Criterion A (Heron et al., 2018), the current findings suggest that non–Criterion A minority stressors may, nonetheless, co-occur with trauma-related outcomes, such as dissociation, consistent with conceptualizations of minority stress as trauma-like (Brown, 2003; Root, 1992). The pervasive and unavoidable nature of minority stressors, compounded by the repeated invalidation of emotional responses toward them in interpersonal, community, and institutional contexts, may lead SMW/TNB people to experience minority stressors as overwhelming threat, increasing the likelihood of co-occurring “freeze” or dissociation responses. Although these correlational findings do not permit causal inference, the day-to-day co-occurrence of minority stressors and dissociation is consistent with emotion-focused and threat-response models that identify chronic social threat and inescapability as conditions associated with dissociative responses (Cardona et al., 2022; Lanius et al., 2012).

The findings suggest that trauma-exposed SMW/TNB people regularly experience dissociation such that the assessment and treatment of dissociation in clinical settings may be especially important for SMW/TNB clients, particularly given that dissociation is related to high levels of impairment and comorbid psychopathology (e.g., depressive symptoms, suicidality; Carlson et al., 2012; Killeen & Brewerton, 2023). Dissociation can also impede treatment effectiveness, perhaps making it important to address prior to other symptoms (Cloitre et al., 2012; Kleindienst et al., 2016). Intervention techniques aimed at reducing dissociation often focus on improving present-moment awareness and emotional awareness (Bailey & Brand, 2017; Ford, 2013). Self-monitoring interventions, thus, might be useful therapeutic tools to reduce symptoms of dissociation (Korotitsch & Nelson-Gray, 1999). Indeed, our finding of a slight symptom reduction over the 14-day study period suggests that monitoring dissociation could contribute to its reduction (i.e., measurement reactivity; König et al., 2022). Dissociation-focused self-monitoring interventions could prompt clients to regularly log dissociative symptoms throughout the day to promote increased present-moment awareness and potentially reduce dissociative symptoms over time.

Elevations in daily dissociation related to daily minority stressors suggest that it may also be important to improve SMW/TNB people’s coping resources for minority stressors (e.g., self-compassion, identity-affirming treatments; Helminen et al., 2023; Pachankis et al., 2022). Further, clinicians must seek to cultivate culturally sensitive and affirming relationships with their SMW/TNB clients, as in-session experiences of minority stressors may precede elevations in state dissociation symptoms, possibly hindering the therapeutic benefits of ongoing treatment. Although individual-level coping resources are essential to mitigate the effects of stigma and discrimination resulting from ongoing experiences of minority stress, the importance of societal and policy efforts toward enacting protections for all SGM people cannot be overlooked. Research shows that living in U.S. states without protective policies amplifies the association between SGM status and the prevalence of past–12-month psychiatric disorders compared to living in states with protective policies (Hatzenbuehler et al., 2010). Social inclusion and protection are imperative for salubrious mental health outcomes for SGM people (Diamond & Alley, 2022), and policy efforts to support SGM people can lead to improved health outcomes and healthcare access (Hatzenbuehler, 2023). The high frequency of daily minority stressors and co-occurring dissociation reported by participants in the present study demonstrates the urgent need for structural change for SGM people.

The present findings should be considered in light of several limitations related to generalizability and measurement. The sample included mostly White participants, limiting generalizability. Future studies should include samples with more racial and ethnic diversity to understand associations between multiple types of identity-related stressors and dissociation, which may be particularly important given extant research linking racial discrimination to dissociation (Kirkinis et al., 2021; Polanco-Roman et al., 2016). Further, all participants in the present sample experienced previous trauma exposure, limiting our ability to understand whether minority stressors and dissociation similarly covary for non–trauma-exposed SMW/TNB people or whether prior trauma exposure is a precondition for the association between minority stressors and dissociation. Previous research suggests that minority stressors might be more strongly associated with dissociation among SGM people who experience identity-related trauma compared to those who report non–identity-related trauma (Keating & Muller, 2020). As data regarding identity-related trauma were not available in this dataset, future research should examine whether exposure to identity-related trauma moderates the association between minority stressors and same-day dissociation for SMW/TNB people and, more generally, whether this association is especially likely for subgroups of trauma-exposed SMW/TNB people. Future research may also advance understanding by examining whether the appraisal of minority stressors as overwhelming or inescapable threat in the moment affects the association between minority stressors and dissociation.

Finally, minority stressors and dissociation were measured at the same time point, precluding conclusions about their temporal sequencing. The minority stressor variable involved retrospective reports of a discrete event, whereas ratings of dissociation involved reporting on an internal experience. Some research suggests that reports of internal experiences likely reflect a momentary rating at the time the survey was taken, as people may simply report in-the-moment feelings (Stone et al., 1998). Thus, ratings of dissociation may be more likely to indicate participants’ internal experiences at the time they completed each survey, whereas reports of discrete minority stress events likely spanned the entire 24-hr period. From this view, it might be more likely that minority stressors preceded dissociation. Nevertheless, further research should examine the temporal sequencing of minority stress and dissociation, particularly using ILM designs with multiple reports per day and/or minority stress induction paradigms (Helminen et al., 2024; Seager van Dyk et al., 2021) to probe whether and when minority stressors trigger dissociation for SMW/TNB people.

This study found that daily minority stressors were associated with same-day elevations in dissociation in a sample of trauma-exposed SMW/TNB people, thus suggesting that daily minority stressors and dissociation co-occur over time. Future research should assess minority stressors and dissociation with multiple assessments per day to better estimate their temporal sequencing and consider how past trauma exposure, trauma type, and appraisals of minority stressors affect this association. Clinicians serving trauma-exposed SMW/TNB people could consider interventions that target coping with minority stressors and the reduction of dissociation symptoms. Societal policies also must enact protections for SMW/TNB people to lighten the dis-proportionate burden of trauma exposure and minority stressors experienced by this population.

Supplementary Material

Supp material

Additional supporting information can be found online in the Supporting Information section at the end of this article.

Funding information

Yale University Women’s Faculty Forum Seed Grant; PI: Scheer; Yale University’s Fund for Lesbian and Gay Studies

Footnotes

OPEN PRACTICES STATEMENT

The study reported in this article was not formally pre-registered. However, study aims and hypotheses were pre-specified as part of a master’s thesis project prior to accessing or analyzing the dataset. Study data are available via request to the corresponding author at kbehari@syr.edu.

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