Childhood gender nonconformity and youth sexual orientation associated with childhood abuse and post-traumatic stress disorder in US youth

Objective: Gay, lesbian, and bisexual youth have higher exposure to childhood abuse than heterosexuals, but it is unknown if risk of post-traumatic stress disorder (PTSD) is elevated as a consequence, nor is it known whether childhood gender nonconformity partly accounts for childhood abuse disparities. Method: We examined whether lifetime probable PTSD was elevated in minority sexual orientation youth using self-report questionnaire data from the 2007 wave of the Growing Up Today Study (n=9294, mean age=22.7), a longitudinal cohort of US youth. We then assessed whether childhood abuse partly accounted for sexual orientation disparities in PTSD, and whether gender nonconformity before age 11 accounted for sexual orientation disparities in abuse. Results: Sexual orientation minorities had PTSD prevalences 1.5 to 2 times higher than heterosexuals. For most types of abuse, childhood gender nonconformity did not mediate the association between sexual orientation and abuse, but instead was independently associated with abuse victimization. Rates of sexual abuse (17.4% versus 9.4%), physical abuse (21.1% versus 14.7 %), and PTSD (21.8% versus 35.5%) were elevated in youth in the top decile of childhood gender nonconformity compared with youth below median nonconformity. Child abuse victimization disparities partly accounted for PTSD disparities by both sexual orientation and childhood gender nonconformity. Conclusion: Health care practitioners working with youth should be aware that both childhood gender nonconformity and minority sexual orientation are associated with elevated risk of child abuse and PTSD. It is essential that prevention and treatment measures for this vulnerable population be developed, implemented, and tested for efficacy.