Posttraumatic Stress Disorder and Emotion Regulation Difficulties among Sexual Minority Adults in Residential Substance Use Disorder Treatment

Background: PTSD rates are higher among lesbian, gay, bisexual, and other sexual minority individuals (LGB+), compared to heterosexual individuals. PTSD also frequently co-occurs with substance use disorders (SUDs). However, little is known about comorbid PTSD-SUD among LGB+ individuals. Further research is important given elevated rates of PTSD and SUD among LGB+ individuals and to inform culturally responsive practice.

Objectives: This cross-sectional study examined trauma exposure, PTSD severity, and emotion regulation (ER) difficulties among LGB+ and heterosexual individuals in residential SUD treatment. We hypothesized that LGB+ individuals would report more trauma exposure and more severe PTSD and ER difficulties compared to heterosexual peers. We also hypothesized that adding ER difficulties to the hierarchical regression model would attenuate the contribution of sexual minority status to PTSD symptom severity.

Results: Cross-sectional data were collected via questionnaires from 132 adults receiving residential SUD treatment (M age = 39.79 [SD = 12.26] years; 35% women, 65% men; 49% White, 40% Black, 11% multiracial/another race). Eighteen percent of the sample identified as LGB+ (29% gay or lesbian, 63% bisexual, and 8% other), and 82% identified as heterosexual. Consistent with hypotheses, LGB+ participants reported larger numbers of traumatic events (p < 0.01) and more severe PTSD symptoms (p < 0.01) and ER difficulties (p < 0.05). Controlling for trauma exposure, the association between sexual minority status and PTSD symptom severity became non-significant after adding ER difficulties to the model.

Conclusion: This suggests that ER may play an important role in the relationship between sexual minority status and PTSD severity in individuals with SUD.