Sexuality and trauma: Intersections between sexual orientation, sexual functioning, and sexual health and traumatic events

This special issue of the Journal of Trauma & Dissociation offers six empirical examinations of the intersection between sexuality (including sexual orientation, sexual functioning, and sexual health) and trauma. The articles in this special issue can be subdivided into the following three themes: sexual functioning and posttraumatic sequelae in combat veterans, the effects of childhood maltreatment and trauma on adolescents and young/emerging adults, and identity-based victimization and posttraumatic stress among subpopulations of LGBTQ+ individuals. What follows is an overview of the articles in each theme.

Sexual functioning and posttraumatic sequelae in military veterans

DiMauro, Renshaw, and Blais (2018) investigated associations between sexual trauma victimization and mental health and sexual behavior outcomes in female veterans. Female veterans who experienced sexual trauma reported lower sexual satisfaction and increased negative mental health outcomes, including posttraumatic stress disorder (PTSD) symptoms and suicidality. Sexual satisfaction, but not sexual function, was found to have a significant indirect effect on the association between trauma type and negative mental health outcomes. The finding that sexual satisfaction, and not sexual functioning, is impactful in the trajectory between victimization and outcomes, suggests that helping veterans to develop a sense of peace with their sexual satisfaction no matter how things are “working” may be key to healing from sexual trauma.

Bhalla and colleagues (2018) examined the relationship between potentially morally injurious events (PMIEs) and sexual anxiety (SA) in male combat veterans. Participants who were exposed to PMIEs were found to have higher levels of SA even when controlling for other combat exposure. In particular, the authors found that only morally injurious events that included “transgressions by self” and “perceived betrayal” were associated with SA. In addition, emotional numbing stood out among PTSD symptom clusters in explaining the partial mediation between PMIEs and SA. These results suggest that helping veterans to experience and accept their internal emotional experiences may be a key factor in sexual healing.

Both of these studies focus on traumatic situations involving harm caused by other people within a military context. Within the military, members depend upon one another for survival, and so may be subject to specific adaptive responses in the context of betrayal trauma. Rejecting parts of oneself in the form of being dissatisfied or disconnected from oneself sexually, or numbing parts of one’s emotional experience may help to survive the initial trauma, but cause sexual difficulties in the longer term.

Effects of childhood maltreatment and trauma on adolescents and young/emerging adults

Tyler and Schmitz (2018) examined differences in trauma victimization and difficulties in acquiring resources necessary to survive (e.g., food, shelter, and money) among LGB and heterosexual homeless adolescents and emerging adults. The authors used a “life stress framework,” which accounts for several points of impact in terms of trauma victimization (i.e., compounding effect of trauma experienced in childhood followed by additional victimization in adolescence). LGB youth were found to experience more trauma, both in childhood and while homeless in adolescence, than their heterosexual peers. LGB youth were also found to be worse-off in their ability to find shelter than their heterosexual counterparts, and also were significantly more likely to exchange sex for resources, another level of hardship that homeless LGB youth face compared to heterosexual homeless youth. These findings suggest that it may be beneficial to create specific strategies targeting LGB youth to help them feel safe accessing resources and that take into account their unique needs and experiences.

Fava, Bay-Cheng, Nochajski, and Bowker (2018) investigated sexual health trajectories of youth with histories of childhood trauma. Using a longitudinal dataset with five waves, spanning participants from early adolescence to emerging adulthood, the authors employed a latent-class growth analysis to determine trajectories of sexual health development. The authors determined that a three-class model fit best: a resilient class who evinced stable levels of sexual health over time, a survival class who evinced initially high levels of sexual health but tapered-off over time, and an improving class who evinced initially low levels of sexual health but increased over time. Among their exciting findings was that individuals in the improving class (with the lowest levels of sexual health) reported engaging in fewer sexual behaviors in relation to the individuals in resilient and survival classes (higher levels of sexual health), demonstrating that a higher quantity of sexual behavior is not necessarily a valid indicator of sexual health. The authors reached the hopeful conclusion that despite varying starting points, processes, and experiences over time, a common, even favorable outcome (i.e., sexual health) is within reach.

Both of these papers focusing on the impacts of early life traumas suggest the import of examining different pathways of harm and resilience among young people. Both also suggest that these pathways need to be considered within a context, rather than treated solely as individual differences. If we can respond to young people who have been victimized (or better yet, prevent victimization), by honoring and respecting their sexual orientation and healthy sexual development, perhaps we will more often see a favorable outcome.

Identity-based victimization and posttraumatic stress among subpopulations of LGBTQ+ individuals

Shipherd, Ruben, Livingston, Curreri, and Skolnik (2018) describe treatment-seeking behavior and treatment preferences among LGBT veterans who experienced at least one traumatic event based on their LGBT identity. In this pilot study, the majority of participants sought treatment either exclusively at Veterans Health Administration (VHA) facilities or a combination of VHA and non-VHA facilities, with the majority preferring posttraumatic stress-specific treatment at VHA facilities. LGBT veterans in this sample who sought VHA-only treatment were more satisfied with the care they received than those who sought treatment at only non-VHA facilities, a finding that was contrary to the authors’ hypothesis. The authors’ investigation is an important addition to this issue given the relative dearth of literature on LGBT veterans.

Cramer et al.’s (2018) article addresses hate crime victimization rates as well as associated mental health phenomena among LGBTQ+ individuals who are members of a sexuality special interest group (BDSM practitioners). Consistent with their hypotheses, participants who reported hate crime victimization reported more interpersonal incidents than non-interpersonal crimes (e.g., burglary and theft). Their paper is a substantial contribution to the literature concerning mental health status and victimization in LGBTQ+ individuals who identify as BDSM practitioners.

Both of these papers enhance this special issue in their attention to subpopulations that are often overlooked in the literature on trauma and sexuality. We hope that these papers inspire additional researchers to expand upon and delve deeper into these nascent territories.

The topics of sexuality and sexual trauma are often fraught with silencing and shame. Several of the studies presented in this special issue point to the effects of this silencing. The avoidance, numbing, and dissatisfaction with one’s sexuality contribute to a range of negative outcomes including increased risk of suicide. Taken together, these works underscore the importance of creating spaces where people are seen and respected as their full sexual selves, and where the impacts of past harms are wholly recognized. We commend the authors of the articles contained in this special issue for their contributions.