Developing a Measure of Implicit Internalized Stigma Among Queer People

Background and Purpose: Queer people continue to face mental health disparities, including depression, anxiety, and suicidal ideation and behavior. A significant factor contributing to these disparities is internalized stigma, which occurs when a minority group internalizes negative social views about their identity. Among queer people, they may have negative self-attitudes, such as believing that their identities or desires are abnormal, immoral, or psychopathological. Although some individuals might be consciously aware of internalized stigma, many are unaware of this pernicious influence that exists on the margins of awareness and is activated automatically—known as implicit internalized stigma. However, this implicit dimension of internalized stigma is largely neglected in research and clinical practice with queer people, and no valid and reliable instruments are available to measure this phenomenon. With funding from NIMHD, this study sought create an implicit internalized sexual minority stigma instrument.

Methods and Results: To develop the instrument, we used an Affective Misattribution Procedure (AMP) approach. The AMP is a computer-administered sequential priming procedure that measures implicit attitudes toward social groups. In the AMP, participants are first presented with a prime (e.g., a picture of a heterosexual or same-sex couple), followed by an affectively neutral image (e.g., a Tibetan word). Participants are then asked to judge the meaning of the Tibetan word using positive and negative response options (e.g., “normal” or “abnormal”). Participants’ responses are influenced by the primes because participants appraise the neutral stimulus (Tibetan word) more positively when the prime image presented is inherently positive to the participant rather than negative, which indicates that affective reactions to the primes are being mistakenly attributed to the neutral stimuli.

An initial pool of 342 images of couples was compiled from a stock photography provider and then narrowed to 118 images. A sample of 100 participants recruited through Mechanical Turk, an online crowdsourcing service, viewed each image and then rated the couple’s attractiveness, intimacy/closeness, naturalness, and happiness. Mean ratings and standard deviations were used to balance the images of couples across the 3 sexual orientation groups: heterosexual, same-sex women, and same-sex men. The images were narrowed to a final set of 10 images per sexual orientation group with racial/ethnic diversity. Images for the neutral stimuli were compiled using common words in Tibetan (e.g., again: འངའིན). Response options for the measure were generated based on a literature review and interviews with 3 experts with clinical, conceptual, and/or empirical expertise on sexual minority stigma, which provides evidence of content validity. Thematic analysis of interview data revealed various dimensions of internalized stigma. Four pairs of response options were constructed, which represent dominant internalized stigma dimensions: appealing/unappealing, normal/abnormal, moral/immoral, and pleasant/unpleasant. The final measure consists of 120 trials (40 trials for each sexual orientation group, 10 trials for each response option).

Conclusions and Implications: This study used rigorous, best-practices in creating a sexual orientation version of the AMP to measure implicit internalized stigma among queer people. The instrument has initial evidence of content validity, and data collection is underway regarding convergent validity, predictive validity, and reliability.