Bisexual women experience higher rates of rape and post-traumatic stress disorder (PTSD) prevalence compared to heterosexual and lesbian women. In addition, bisexual women experience unique antibisexual stigma and minority stress, which are associated with post-trauma outcomes. The aim of the current study was to test trauma-related shame as a mechanism in the relations of self-blame and bisexual minority stress (i.e., antibisexual stigma and internalized binegativity) with rape-related PTSD symptom. The sample consisted of 192 cisgender bisexual women (ages 18–35 years) who reported an experience of rape since the age of 18. Results from path analysis conducted in Mplus indicated that trauma-related shame mediated the link between self-blame and rape-related PTSD severity, as well as the links from antibisexual stigma and internalized binegativity to rape-related PTSD severity. There was also an indirect serial effect from antibisexual stigma to internalized binegativity to shame to PTSD severity. Thus, findings highlight the mechanistic role of trauma-related shame in rape-related PTSD symptoms. We identified two risk pathways: (a) general/universal risk from self-blame about rape and shame to PTSD severity and (b) group-specific risk from bisexual minority stress and shame to PTSD severity. Results indicate that reducing trauma-related shame may be an important target to improve post-rape outcomes. Finally, stigma associated with rape and sexual violence as well as antibisexual stigma must be eradicated to improve post-trauma outcomes among bisexual survivors.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
2.
AmstadterA. B.VernonL. L. (2008). Emotional reactions during and after trauma: A comparison of trauma types. Journal of Aggression Maltreatment & Trauma, 16(4), 391–408. https://doi.org/10.1080/10926770801926492
3.
ArnettJ. E.IIIFrantellK. A.MilesJ. R.FryK. M. (2019). Anti-bisexual discrimination as insidious trauma and impacts on mental and physical health. Psychology of Sexual Orientation and Gender Diversity, 6(4), 475–485. https://doi.org/10.1037/sgd0000344
4.
BadourC. L.ResnickH. S.KilpatrickD. G. (2017). Associations between specific negative emotions and DSM-5 PTSD among a national sample of interpersonal trauma survivors. Journal of Interpersonal Violence, 32(11), 1620–1641. https://doi.org/10.1177/0886260515589930
5.
BhuptaniP. H.MessmanT. L. (2023). Role of blame and rape-related shame in distress among rape victims. Psychological Trauma Theory Research Practice and Policy, 15(4), 557–566. https://doi.org/10.1037/tra0001132
6.
BlevinsC. A.WeathersF. W.DavisM. T.WitteT. K.DominoJ. L. (2015). The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. Journal of Traumatic Stress, 28, 489–498. https://doi.org/10.1002/jts.22059
7.
BreitenbecherK. H. (2006). The relationships among self-blame, psychological distress, and sexual victimization. Journal of Interpersonal Violence, 21(5), 597–611. https://doi.org/10.1177/0886260506286842
8.
BrewsterM. E.MoradiB. (2010). Perceived experiences of anti-bisexual prejudice: Instrument development and evaluation. Journal of Counseling Psychology, 57(4), 451–468. https://doi.org/10.1037/a0021116
9.
BrooksV. R. (1981). Minority stress and lesbian women. Free Press.
10.
ChenJ.WaltersM. L.GilbertL. K.PatelN. (2020). Sexual violence, stalking, and intimate partner violence by sexual orientation, United States. Psychology of Violence, 10(1), 110–119. https://doi.org/10.1037/vio0000252
11.
DeCouC. R.LynchS. M.WeberS.RichnerD.MozafariA.HugginsH.PerschonB. (2023). On the association between trauma-related shame and symptoms of psychopathology: A meta-analysis. Trauma Violence & Abuse, 24(3), 1193–1201. https://doi.org/10.1177/15248380211053617
12.
DworkinE. R. (2020). Risk for mental disorders associated with sexual assault: A meta-analysis. Trauma Violence & Abuse, 21(5), 1011–1028. https://doi.org/10.1177/1524838018813198
13.
DworkinE. R.GilmoreA. K.Bedard-GilliganM.LehavotK.GuttmannovaK.KaysenD. (2018). Predicting PTSD severity from experiences of trauma and heterosexism in lesbian and bisexual women: A longitudinal study of cognitive mediators. Journal of Counseling Psychology, 65(3), 324–333. https://doi.org/10.1037/cou0000287
14.
DworkinE. R.JaffeA. E.Bedard-GilliganM.FitzpatrickS. (2023). PTSD in the year following sexual assault: A meta-analysis of prospective studies. Trauma Violence & Abuse, 24(2), 497–514. https://doi.org/10.1177/15248380211032213
15.
DworkinE. R.MenonS. V.BystrynskiJ.AllenN. E. (2017). Sexual assault victimization and psychopathology: A review and meta-analysis. Clinical Psychology Review, 56, 65–81. https://doi.org/10.1016/j.cpr.2017.06.002
16.
DyarC.FeinsteinB. A.LondonB. (2014). Dimensions of sexual identity and minority stress among bisexual women: The role of partner gender. Psychology of Sexual Orientation and Gender Diversity, 1(4), 441–451. https://doi.org/10.1037/sgd0000155
17.
DyarC.FeinsteinB. A.SarnoE. L.PirogS.NewcombM. E.WhittonS. W. (2021). Prospective associations between bi+ minority stressors and internalizing symptoms: The mediating roles of general and group-specific processes. Journal of Consulting and Clinical Psychology, 89(10), 845–855. https://doi.org/10.1037/ccp0000689
18.
DyarC.LondonB. (2018). Longitudinal examination of a bisexual-specific minority stress process among bisexual cisgender women. Psychology of Women Quarterly, 42(3), 342–360. https://doi.org/10.1177/0361684318768233
19.
EdwardsK. M.TurchikJ. A.DardisC. M.ReynoldsN.GidyczC. A. (2011). Rape myths: History, individual and institutional-level presence, and implications for change. Sex Roles, 65(11–12), 761–773. https://doi.org/10.1007/s11199-011-9943-2
20.
Evans-PolceR. J.KcomtL.VelizP. T.BoydC. J.McCabeS. E. (2020). Alcohol, tobacco, and comorbid psychiatric disorders and associations with sexual identity and stress-related correlates. American Journal of Psychiatry, 177(11), 1073–1081. https://doi.org/10.1176/appi.ajp.2020.20010005
21.
FeinsteinB. A.DyarC.PachankisJ. E. (2019). A multilevel approach for reducing mental health and substance use disparities affecting bisexual individuals. Cognitive and Behavioral Practice, 26(2), 243–253. https://doi.org/10.1016/j.cbpra.2017.10.003
22.
FeiringC.TaskaL. S. (2005). The persistence of shame following sexual abuse: A longitudinal look at risk and recovery. Child Maltreatment, 10(4), 337–349. https://doi.org/10.1177/1077559505276686
23.
FlandersC. E.AndersonR. E.TarasoffL. A. (2020). Young bisexual people’s experiences of sexual violence: A mixed-methods study. Journal of Bisexuality, 20(2), 202–232. https://doi.org/10.1080/15299716.2020.1791300
24.
FlandersC. E.LeBretonM.RobinsonM. (2019). Bisexual women’s experience of microaggressions and microaffirmations: A community-based, mixed-methods scale development project. Archives of Sexual Behavior, 48(1), 143–158. https://doi.org/10.1007/s10508-017-1135-x
25.
FlandersC. E.RossL. E.DobinsonC.LogieC. H. (2017). Sexual health among young bisexual women: A qualitative, community-based study. Psychology and Sexuality, 8(1–2), 104–117. https://doi.org/10.1080/19419899.2017.1296486
26.
ForkusS. R.RaudalesA. M.RafiuddinH. S.WeissN. H.MessmanB. A.ContractorA. A. (2023). The Posttraumatic Stress Disorder (PTSD) Checklist for DSM-5: A systematic review of existing psychometric evidence. Clinical Psychology Science and Practice, 30, 110–121. https://doi.org/10.1037/cps0000111
27.
FrazierP. A. (2003a). Rape Attribution Questionnaire. University of Minnesota.
28.
FrazierP. A. (2003b). Perceived control and distress following sexual assault: A longitudinal test of a new model. Journal of Personality and Social Psychology, 84(6), 1257–1269. https://doi.org/10.1037/0022-3514.84.6.1257
29.
FriedmanM. R.DodgeB.SchickV.HerbenickD.HubachR.BowlingJ.GoncalvesG.KrierS.ReeceM. (2014). From bias to bisexual health disparities: Attitudes toward bisexual men and women in the United States. LGBT Health, 1(4), 309–318. https://doi.org/10.1089/lgbt.2014.0005
30.
GhabrialM. A. (2019). “We can shapeshift and build bridges”: Bisexual women and gender diverse people of color on invisibility and embracing the borderlands. Journal of Bisexuality, 19(2), 169–197. https://doi.org/10.1080/15299716.2019.1617526
31.
HarmanR.LeeD. (2009). The role of shame and self-critical thinking in the development and maintenance of current threat in post-traumatic stress disorder. Clinical Psychology & Psychotherapy, 17(1), 13–24. https://doi.org/10.1002/cpp.636
32.
HatzenbuehlerM. L. (2009). How does sexual minority stigma “get under the skin”? A psychological mediation framework. Psychological Bulletin, 135(5), 707–730. https://doi.org/10.1037/a0016441
33.
HequembourgA. L.DearingR. L. (2013). Exploring shame, guilt, and risky substance use among sexual minority men and women. Journal of Homosexuality, 60(4), 615–638. https://doi.org/10.1080/00918369.2013.760365
34.
HollidayR.HolderN.SurísA. (2018). Reductions in self-blame cognitions predict PTSD improvements with cognitive processing therapy for military sexual trauma-related PTSD. Psychiatry Research, 263, 181–184. https://doi.org/10.1016/j.psychres.2018.03.007
35.
KennedyA. C.ProckK. A. (2018). I still feel like I am not normal”: A review of the role of stigma and stigmatization among female survivors of child sexual abuse, sexual assault, and intimate partner violence. Trauma Violence & Abuse, 19(5), 512–527. https://doi.org/10.1177/1524838016673601
36.
KlineN. K.BerkeD. S.RhodesC. A.SteenkampM. M.LitzB. T. (2021). Self-blame and PTSD following sexual assault: A longitudinal analysis. Journal of Interpersonal Violence, 36(5–6), n3153–n3168. https://doi.org/10.1177/0886260518770652
37.
KossM. P.GidyczC. A. (1985). Sexual experiences survey: Reliability and validity. Journal of Consulting and Clinical Psychology, 53(3), 422–423. https://doi.org/10.1037//0022-006x.53.3.422
38.
La BashH.PapaA. (2014). Shame and PTSD symptoms. Psychological Trauma Theory Research Practice and Policy, 6(2), 159–166. https://doi.org/10.1037/a0032637
39.
LitmanL.RobinsonJ.AbberbockT. (2017). TurkPrime.com: A versatile crowdsourcing data acquisition platform for the behavioral sciences. Behavior Research Methods, 49(2), 433–442. https://doi.org/10.3758/s13428-016-0727-z
LongS. M.UllmanS. E.LongL. M.MasonG. E.StarzynskiL. L. (2007). Women’s experiences of male-perpetrated sexual assault by sexual orientation. Violence and Victims, 22(6), 684–701. https://doi.org/10.1891/088667007782793138
42.
MereishE. H.PoteatV. P. (2015). A relational model of sexual minority mental and physical health: The negative effects of shame on relationships, loneliness, and health. Journal of Counseling Psychology, 62(3), 425–437. https://doi.org/10.1037/cou0000088
43.
Messman-MooreT. L.LongP. J. (2000). Child sexual abuse and revictimization in the form of adult sexual abuse, adult physical abuse, and adult psychological maltreatment. Journal of Interpersonal Violence, 15(5), 489–502. https://doi.org/10.1177/088626000015005003
44.
Messman-MooreT. L.WalshK. L.DiLilloD. (2010). Emotion dysregulation and risky sexual behavior in revictimization. Child Abuse & Neglect, 34(12), 967–976. https://doi.org/10.1016/j.chiabu.2010.06.004
45.
MeyerI. 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. https://doi.org/10.1037/0033-2909.129.5.674
46.
MuthénL. K.MuthénB. O. (1998-2017). Mplus User’s Guide.(8th ed.). Los Angeles, CA: Muthén & Muthén.
47.
ØktedalenT.HagtvetK. A.HoffartA.LangkaasT. F.SmuckerM. (2014). The trauma related shame inventory: Measuring trauma-related shame among patients with PTSD. Journal of Psychopathology and Behavioral Assessment, 36(4), 600–615. https://doi.org/10.1007/s10862-014-9422-5
48.
ØktedalenT.HoffartA.LangkaasT. F. (2015). Trauma-related shame and guilt as time-varying predictors of posttraumatic stress disorder symptoms during imagery exposure and imagery rescripting—A randomized controlled trial. Psychotherapy Research, 25(5), 518–532. https://doi.org/10.1080/10503307.2014.917217
49.
PachankisJ. E.McConochaE. M.ClarkK. A.WangK.BehariK.FetznerB. K.BrisbinC. D.ScheerJ. R.LehavotK. (2020). A transdiagnostic minority stress intervention for gender diverse sexual minority women’s depression, anxiety, and unhealthy alcohol use: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 88(7), 613–630. https://doi.org/10.1037/ccp0000508
50.
PaulR.SmithN. G.MohrJ. J.RossL. E. (2014). Measuring dimensions of bisexual identity: Initial development of the Bisexual Identity Inventory. Psychology of Sexual Orientation and Gender Diversity, 1(4), 452–460. https://doi.org/10.1037/sgd0000069
51.
Peter-HageneL. C.UllmanS. E. (2018). Longitudinal effects of sexual assault victims’ drinking and self-blame on posttraumatic stress disorder. Journal of Interpersonal Violence, 33(1), 83–93. https://doi.org/10.1177/0886260516636394
52.
PreacherK. J.HayesA. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879–891. https://doi.org/10.3758/brm.40.3.879
53.
ResickP. A.GalovskiT. E.UhlmansiekM. O.ScherC. D.ClumG. A.Young-XuY. (2008). A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence. Journal of Consulting and Clinical Psychology, 76(2), 243–258. https://doi.org/10.1037/0022-006X.76.2.243
54.
RobertsA. L.AustinS. B.CorlissH. L.VandermorrisA. K.KoenenK. C. (2010). Pervasive trauma exposure among US sexual orientation minority adults and risk of posttraumatic stress disorder. American Journal of Public Health, 100(12), 2433–2441. https://doi.org/10.2105/AJPH.2009.168971
55.
RobertsT. S.HorneS. G.HoytW. T. (2015). Between a gay and a straight place: Bisexual individuals’ experiences with monosexism. Journal of Bisexuality, 15(4), 554–569. https://doi.org/10.1080/15299716.2015.1111183
56.
RogersA. H.SeagerI.HainesN.HahnH.AldaoA.AhnW. Y. (2017). The indirect effect of emotion regulation on minority stress and problematic substance use in lesbian, gay, and bisexual individuals. Frontiers in Psychology, 8, 1881. https://doi.org/10.3389/fpsyg.2017.01881
SalimS. R.McConnellA. A.MessmanT. (2023). Sexual victimization outcomes and adjustment among Bisexual Women: A Review of the quantitative literature. Trauma Violence & Abuse, 24(3), 1503–1521. https://doi.org/10.1177/15248380211073837
59.
SaraiyaT.Lopez-CastroT. (2016). Ashamed and afraid: A scoping review of the role of shame in post-traumatic stress disorder (PTSD). Journal of Clinical Medicine, 5(11), 94. https://doi.org/10.3390/jcm5110094
60.
SerpeC.BrownC.CrissS.LamkinsK.WatsonL. (2020). Bisexual women: Experiencing and coping with objectification, prejudice, and erasure. Journal of Bisexuality, 20(4), 456–492. https://doi.org/10.1080/15299716.2020.1820421
61.
SigurvinsdottirR.UllmanS. E. (2016). Sexual orientation, race, and trauma as predictors of sexual assault recovery. Journal of Family Violence, 31(7), 913–921. https://doi.org/10.1007/s10896-015-9793-8
62.
SigurvinsdottirR.UllmanS. E.CanettoS. S. (2020). Self-blame, psychological distress, and suicidality among African American female sexual assault survivors. Traumatology, 26(1), 1–10. https://doi.org/10.1037/trm0000195
63.
SolomonD. T.CombsE. M.AllenK.RolesS.DiCarloS.ReedO.KlaverS. J. (2021). The impact of minority stress and gender identity on PTSD outcomes in sexual minority survivors of interpersonal trauma. Psychology and Sexuality, 12(1–2), 64–78. https://doi.org/10.1080/19419899.2019.1690033
64.
StraubK. T.McConnellA. A.Messman-MooreT. L. (2018). Internalized heterosexism and posttraumatic stress disorder symptoms: The mediating role of shame proneness among trauma-exposed sexual minority women. Psychology of Sexual Orientation and Gender Diversity, 5(1), 99–108. https://doi.org/10.1037/sgd0000263
65.
TaylorJ.PowerJ.SmithE.RathboneM. (2020). Bisexual mental health and gender diversity: Findings from the ‘Who I Am’ study. Australian Journal of General Practice, 49(7), 392–399. https://doi.org/10.3316/informit.305562114289674
66.
TipswordJ. M.Brown-IannuzziJ. L.JonesA. C.FloresJ.BadourC. L. (2022). Avoidance coping partially accounts for the relationship between trauma-related shame and PTSD symptoms following interpersonal trauma. Violence Against Women, 28(1), 107–125. https://doi.org/10.1177/1077801220988350
67.
VidalM. E.PetrakJ. (2007). Shame and adult sexual assault: A study with a group of female survivors recruited from an East London population. Sexual & Relationship Therapy, 22(2), 159–171. https://doi.org/10.1080/14681990600784143
68.
WoulfeJ. M.MereishE. H.Katz-WiseS. L. (2022). Social support as a mediator of anti-bisexual prejudice and posttraumatic stress disorder symptoms. Journal of Trauma & Dissociation, 23(1), 124–139. https://doi.org/10.1080/15299732.2021.1989107
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
