Abstract
OBJECTIVE: Sexual minority women (SMW) are at high risk of traumatic events and developing posttraumatic stress disorder (PTSD). The minority stress model suggests that SMW face significant mental health impacts from minority-specific discrimination (i.e., heterosexism). This study examines the impact of heterosexism on PTSD risk, controlling for trauma exposure, and tests coping strategies as potential risk and protective factors. METHOD: We analyzed data from 324 young bisexual and lesbian women (aged 18-25 years; all were assigned a female at birth) with trauma histories. An analysis of direct and indirect effects assessed the impact of coping behaviors (i.e., avoidant and approach) on the association between heterosexism and PTSD severity, considering total trauma exposure. A prediction model using support vector regression identified coping behaviors predicting PTSD severity. RESULTS: The analysis revealed that heterosexism had a direct positive association with PTSD severity (B = 3.572, p < .001, 95% CI [1.487, 5.656]), with an indirect effect through avoidant coping behaviors (B = 2.776, 95% CI [1.387, 4.243]). Approach coping behavior did not serve as a protective factor (p = .091). The prediction analysis found that denial and self-blame, along with trauma and heterosexism exposure, best predicted PTSD severity (r = 0.65; p < .001). CONCLUSIONS: These findings highlight avoidant coping behaviors' role in the relationship between heterosexism and PTSD severity among SMW. Clinicians should consider interventions to reduce avoidant coping (denial and self-blame) when treating PTSD in SMW, given ongoing heterosexism exposure. (PsycInfo Database Record (c) 2025 APA, all rights reserved).