Initial Validation of a Measure of Implicit Internalized Stigma Among Queer People

Background and Purpose: Queer people face substantial mental health disparities, and internalized stigma (negative societal attitudes internalized about one’s identity) contributes to these disparities. Some queer people have negative internalized self-attitudes, such as believing that their identities are abnormal or immoral. Many of these attitudes exist outside of conscious awareness and are activated automatically—known as implicit internalized stigma. Implicit internalized stigma has been neglected in research and clinical practice with queer people, perhaps because no valid and reliable instruments were available to measure this phenomenon. Therefore, we created a measure of implicit internalized sexual minority stigma. The purpose of this study was to evaluate the psychometric evidence of a new measure of implicit internalized stigma among queer people, the Implicit Internalized Sexual Orientation Stigma Affect Misattribution Procedure (Internal-SOS-AMP). We examined the content validity, convergent validity, divergent validity, and reliability of the Internal-SOS-AMP.

Methods: The Internal-SOS-AMP is a computer-administered sequential priming procedure that measures implicit attitudes. Participants were 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 then judged the meaning of the Tibetan word using positive and negative response options (e.g., “normal” or “abnormal”). Participants’ responses were influenced by the primes because participants appraised the neutral stimulus (Tibetan word) more positively when the prime image presented were inherently positive to the participant rather than negative. The Internal-SOS-AMP (1) consisted of images of heterosexual couples, same-sex women couples, and same-sex men couples; and (2) measured four dimensions of stigma across these groups: appealing/unappealing, normal/abnormal, moral/immoral, and pleasant/unpleasant. A national sample of 500 queer adults completed two waves of data collection, with measures of implicit internalized stigma, explicit internalized stigma, and affirmation of queer identity.

Results: Confirmatory factor analysis (CFA) was used to evaluate two models: (1) A one-factor model with all 8 of the Internal-SOS-AMP scores as indicators of one underlying construct, and (2) a two-factor model where internalized stigma was specified as two constructs based on gender (stigma regarding queer women and stigma regarding queer men). Results showed that the two-factor model met multiple pre-stated model fit criteria (CFI, TLI, RMSEA, and SRMR) whereas the one-factor model only met one criteria. This indicates that although implicit attitudes toward queer men and women are highly correlated, implicit internalized stigma differentiated by gender more accurately reflects the data.

Results also showed evidence of convergent validity as implicit internalized stigma scores showed small but significant positive associations with explicit internalized stigma (r = .092 to .157). Regarding divergent validity, implicit internalized stigma was inversely related to affirmation of a queer identity (r = -.114 to -.187). Internal consistency reliability of the Internal-SOS-AMP scores were good, ranging from α = .80 to 84.

Conclusions and Implications: The creation and initial validation of the Internal-SOS-AMP used rigorous, best practices to measure implicit internalized stigma among queer people. The Internal-SOS-AMP has initial evidence of content validity, convergent validity, divergent validity, and reliability.