Let's get real: Identity concealment, burnout, and therapeutic relationship quality among psychology trainees with concealable stigmatized identities.

Identity concealment thwarts psychological needs of authenticity and belonging, both of which are important for mental health and relationship building. Through the lens of minority stress theory and relational-cultural theory, the present study examined whether identity concealment in the workplace by psychology trainees is indirectly associated with greater burnout and poorer therapeutic relationship quality. To test this hypothesis, a parallel mediation analysis was conducted on data from 335 clinical and counseling psychology doctoral trainees with concealable stigmatized identities using Hayes's (2018) PROCESS macro. As expected, identity concealment at a practicum or internship site was negatively associated with authenticity and belonging, both of which were negatively associated with burnout and positively associated with therapeutic relationship quality. Furthermore, identity concealment was associated with lower therapeutic relationship quality and greater burnout indirectly through lower authenticity and lower belonging. Findings suggest trainees who engage in more identity concealment at their clinical training sites may be at increased risk for burnout and poorer relationships with clients due to limited opportunities for authenticity and belonging. Future research is encouraged to longitudinally examine the impact of identity concealment on professional burnout and relationships, as well as potential protective factors. Such knowledge can support the development of interventions and policies that foster safer, more welcoming work environments for trainees with concealable stigmatized identities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

O te peinas, o te haces rolos: Intersectional discrimination, identity conflict, and mental health among Latinx sexual minoritized adults.

OBJECTIVES: People of color with minoritized sexual identities (e.g., lesbian, gay, bisexual, queer) experience identity-based challenges from outside and within their communities. Through the integrative lens of minority stress theory and intersectionality, the present study examined identity conflict, also known as conflicts in allegiances-the perceived incongruence between one's sexual and ethnic identities-as a statistical mediator of the association between intersectional discrimination (heterosexist discrimination experienced within the Latinx community and ethnic discrimination experienced within the lesbian, gay, bisexual, transgender, and queer [LGBTQ +] community) and mental health outcomes (depression and anxiety). METHOD: A cross-sectional sample of 452 Latinx sexual minoritized adults living in the United States participated in the study. The PROCESS macro (Model 4; Hayes, 2018) was used to test the hypothesis that heterosexist discrimination experienced within the Latinx community and ethnic discrimination experienced within the LGBTQ + community are associated with depression and anxiety indirectly through identity conflict. In each mediation model, outness to family was included as a covariate, along with participant age, education, generation status, and language preference. RESULTS: Approximately 37% of participants had clinically significant depression scores and 54% had clinically significant anxiety scores. As expected, experiences of intersectional discrimination (i.e., Latinx heterosexist discrimination and LGBTQ + ethnic discrimination) were indirectly associated with depression and anxiety through higher levels of identity conflict. CONCLUSIONS: Findings increase awareness of unique psychosocial factors that may underlie mental health inequities affecting Latinx adults with minoritized sexual identities. Such knowledge can facilitate the development of culturally responsive interventions that best support this diverse population by addressing intersectional minority stressors. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Mediating effects of a weight-inclusive health promotion program on maladaptive eating in women with high body mass index.

Research shows that individuals with a body mass index (BMI) over 30 have experienced an 11-fold increase in restrictive eating and a 7-fold increase in binge eating since the 1990s. Most health promotion programs for higher-weight individuals have not been developed with the high eating disorder risk for this population in mind. The purpose of current study was to test two hypothesized mechanisms underlying improvement in maladaptive eating patterns shown in a weight-inclusive health promotion program designed for women with BMIs at or above 30. Participants (N = 40) were primarily White (93 %), 30-45 years old (M = 39.83, SD = 4.34) with BMIs ranging from 30 to 45 kg/m2 (M = 37.42, SD = 3.58). Using the MEMORE macro, we tested a parallel mediation model hypothesizing that internalized weight stigma and intuitive eating would explain improvements on two subscales from the Three-Factor Eating Questionnaire-R18 after a 6-month program. Total effects of the program on uncontrolled (b = -3.76, SE = 0.64, p < .0001) and emotional eating (b = -1.79, SE = 0.34, p < .0001) were significant. The indirect effects (IE) of internalized weight stigma on uncontrolled eating (IE = 1.59, SE = 0.79, 95 % CI = 0.46, 3.49) and emotional eating (IE = 0.67, SE = 0.40, 95 % CI = 0.11, 1.68) were also significant. Likewise, the IEs of intuitive eating on uncontrolled eating (IE = 2.09, SE = 0.70, 95 % CI = 0.60, 3.38) and emotional eating (IE = 1.03, SE = 0.43, 95 % CI = 0.08, 1.82) were significant. These findings indicate that weight-inclusive health promotion programs that directly address weight bias and eating according to cues from the body may help higher-weight individuals improve maladaptive eating patterns via reductions in internalized weight stigma and increases in intuitive eating.

Status, sexual capital, and intraminority body stigma in a size-diverse sample of gay men.

Gay men are more likely than heterosexual men to experience social pressure based on body weight, shape, and muscularity, which may drive disparities in body image concerns and eating disorders. Utilizing a sample of 1723 gay men living in the United States, the present study examined whether sociodemographic factors (used as proxies for status and sexual capital) and frequency of attending gay-specific establishments or gatherings (community involvement) were associated with gay men's experiences of negative or discriminatory pressures based on body size and shape specifically from other gay men (intraminority body stigma). Experiences of intraminority body stigma were significantly more common among gay men who identified as higher-weight (r = 0.28), less masculine (r = -0.21), less wealthy (r = -0.21), younger (r = -0.21), or people of color (ds = 0.25-0.28). Furthermore, indicators of low status and sexual capital were indirectly associated with less frequent community involvement via more frequent experiences of intraminority body stigma. In addition to frequency, the valence of interactions between gay men should be considered when assessing body image and eating disorder risk in this population. Future research is encouraged to examine intraminority body stigma as an intersectional source of intraminority stress to inform prevention and treatment efforts for gay men.

An examination of theory-based suicidal ideation risk factors in college students with multiple marginalized identities.

Social marginalization increases the risk of suicidal ideation (SI) among individuals with diverse identities, yet research examining the effects of marginalization has focused on one identity. Emerging adulthood is a critical period of identity development and the age group with the highest rates of SI. Considering the challenges of living in potentially heterosexist, cissexist, racist, and sizeist environments, we tested whether possessing multiple marginalized identities was associated with severity of SI through factors proposed in the interpersonal-psychological theory (IPT) and the three-step theory (3ST) of suicide and if mediation paths were moderated by sex. A sample of 265 college students completed a cross-sectional online survey assessing SI and constructs related to IPT and 3ST. The number of marginalized identities was generated by adding minoritized sexual orientation, race/ethnicity other than non-Hispanic White, body mass index >25 kg/m2, sexual attraction to same sex but identified as heterosexual, and gender-fluid identity. In IPT multiple mediation analyses, possessing more marginalized identities was associated with SI severity through burdensomeness and hopelessness, but not belonging. Indirect paths through burdensomeness and belonging were moderated by sex. For 3ST, possessing more marginalized identities was associated with SI severity through hopelessness and psychological pain, but not social connection or meaning in life. Future research should consider intersecting social identities and test mechanisms by which multiply marginalized college students develop resilience to SI risk factors, such as support within their marginalized groups, to inform suicide assessment and intervention efforts on college campuses. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Co-occurring suicidal ideation and alcohol-related problems: An intersectional analysis of Native American and White adults with minoritized sexual identities.

BACKGROUND: Disparities in suicidal ideation (SI) and alcohol use disorder (AUD) are evident in both Native American and minoritized sexual identity groups, relative to non-Hispanic White and heterosexual groups. However, Native Americans report lower drinking and binge drinking rates than White adults. Persons with intersecting identities, specifically Native Americans with minoritized sexual identities, may be at greater risk for SI and drinking, binge drinking, and AUD than White and Native American heterosexual adults. METHODS: Five years (2015-2019) of National Survey of Drug Use and Health data were combined (N = 130,157). Multinomial logistic regressions tested racial (Native American vs White) and sexual identity (lesbian/gay/bisexual vs heterosexual) differences in odds of SI, drinking, and co-occurring SI + drinking, versus neither SI/drinking. Subsequent analyses examined SI + binge drinking, and SI + AUD. RESULTS: Compared to White heterosexual adults, Native American heterosexual adults reported lower co-occurring SI + drinking odds, whereas Native American sexual minoritized adults reported higher odds. Native American sexual minoritized groups showed greater co-occurring SI + binge drinking odds and greater co-occurring SI + AUD odds compared to White heterosexual adults. Native American sexual minoritized adults showed greater SI only compared to White sexual minoritized adults. Sexual minoritized Native Americans showed higher odds of co-occurring SI + drinking, binge drinking, and AUD than White heterosexual adults. CONCLUSIONS: Native American sexual minoritized groups showed higher likelihood of co-occurring SI + drinking, binge drinking, and AUD relative to both White and Native American heterosexual adults. Disparities warrant outreach for suicide and AUD prevention for Native American sexual minoritized adults.

Development and Validation of the Gay-Specific Intraminority Stigma Inventory (G-SISI): Initial Evidence Underpinned by Intraminority Stress Theory.

There is currently a lack of measures testing intraminority stress within gay men. Therefore, the current study sought to develop and psychometrically test the Gay-Specific Intraminority Stigma Inventory (G-SISI). Based on a content review of the literature and a panel of experts, a pool of items assessing gay men's perceived exposure to a range of discriminatory attitudes from other gay men was generated. Utilizing a randomly split sample of 1723 gay men between the ages of 19 and 79 years, an exploratory factor analysis was first performed (n = 861). The remaining unexamined data were then used to conduct a confirmatory factor analysis (n = 862). The results support a six-factor model: (1) Age Stigma, (2) Socioeconomic Stigma, (3) Gay Non-Conformity Stigma, (4) Racial Stigma, (5) Gender Expression Stigma, and (6) Body Stigma. Cronbach's alpha for the total scale was 0.90 and for the subscales ranged from 0.60 to 0.85. Sociodemographic factors and measures of community involvement were differentially associated with the G-SISI subscales, providing evidence of construct validity. The findings demonstrate initial support for the dimensionality and validity of the G-SISI, which targets modifiable factors (e.g., identity-based stigma) that may increase stress and reduce community coping resources among gay men with diverse identities.

A critical examination of disparities in eating disorder symptoms by sexual orientation among US adults in the NESARC-III.

OBJECTIVE: Sexual minoritized persons evidence higher prevalence of eating disorders than heterosexual persons, yet it is unclear which specific symptoms drive these disparities. Empirical evidence also documents the importance of considering subclinical eating disorder presentations, as well as potential differentiation in expression of eating disorder symptoms based on gender. The current study complements that of Kamody et al. (2020), who examined sexual orientation-based disparities in eating disorder diagnoses using a nationally representative sample of the US adult population. METHOD: Using the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), we compared the prevalence of eating disorder symptoms across sexual minority status separately for men and women. RESULTS: Sexual minoritized men were more likely than heterosexual men to report body mass index (BMI) < 18.5 kg/m2 (odds ratio [OR] = 1.76), thus, being screened into questions about restrictive eating. Sexual minoritized women were more likely than heterosexual women to endorse ever engaging in a binge-eating episode (OR = 2.25) and engaging in weekly binge eating for at least 3 months (OR = 1.58), thus, being screened into follow-up questions about binge eating. Sexual minoritized men were more likely than heterosexual men to fear gaining weight even when at their lowest weight (OR = 4.35) and experience a loss of control when overeating (OR = 3.13). DISCUSSION: Sexual orientation-based disparities in eating disorder symptom endorsement were nuanced when stratifying the entire sample by gender. Findings expand previous research on disparities in clinical/diagnosed eating disorders, highlighting the importance of assessing symptomology beyond diagnosis, as well as the intersectional influence of sexual orientation and gender, in both research and practice.

Parents' Perceptions of and Responses to School-Based Body Mass Index Screening Programs-A Systematic Review.

BACKGROUND: Evidence for the effectiveness of state-mandated body mass index (BMI) screening programs in the United States has been inconclusive, and potential unintended consequences of the programs have been debated. The present review aims to understand parents' perceptions of and responses to school-based BMI screening, and to highlight racial/ethnic differences. METHODS: We systematically identified studies published January 2003-May 2019 examining parent and/or youth perceptions of and/or responses to US school-based BMI screening. RESULTS: A total of 16 studies were included in the review. Studies suggested that while parents largely found BMI screening helpful, they held concerns regarding stigma, lack of privacy, and unhealthy behaviors and attitudes resulting from school-based screening. Furthermore, parents did not frequently follow-up with health care providers, although they reported some healthy behavior changes. CONCLUSIONS: Our review highlights existing parent perceptions of school-based BMI screening including the potential for healthy behavior change and important concerns regarding weight-stigma and disturbed eating attitudes/behaviors. Additionally, racial/ethnic differences in screening preferences and experiences were found. Limitations of existing literature included a need to understand youths' experiences and a lack of standardized, reliable outcomes research. Implications for future research and the role of parents, schools, and providers are discussed.

Impact of Status-Based Rejection Sensitivity on Depression and Anxiety Symptoms in Gay Men.

Status-based rejection sensitivity refers to the anxious expectation and tendency to perceive rejection in ambiguous social scenarios based on one's minority identification. This study evaluates the implications of sensitivity to rejection based on sexual orientation identity on negative mental health outcomes. Current minority stress models include rejection sensitivity as a factor that may contribute to adverse negative psychosocial outcomes in LGBT persons. This study evaluates the role of rejection sensitivity alongside demographically relevant predictors such as age, race, education, and level of sexuality disclosure in predicting the presence of significant depression and anxiety scores among a sample of gay men. Results indicate that rejection sensitivity, sexuality openness, and anxiety were significant predictors of depression symptoms, whereas age and depression were significant predictors of anxiety symptoms. This study supports the role of rejection sensitivity as a contributor to negative mental health outcomes among gay men, particularly as it pertains to internalizing mental health disorders.

Does a Common Ingroup Identity Reduce Weight Bias? Only When Weight Discrimination Is Salient.

Compared to many other forms of social bias, weight bias is pervasive, socially accepted, and difficult to attenuate. According to the common ingroup identity model, strategies that expand group inclusiveness may promote more positive intergroup attitudes and behaviors, particularly when people are aware of unjust treatment of others included within their shared identity. Considering that most people are not aware of the social justice issue of weight discrimination, we hypothesized that a common ingroup identity would be effective in reducing weight bias primarily when unfair weight-based treatment was made salient (i.e., that fat people experience discrimination in employment). Participants were randomly assigned to conditions following a 3 (discrimination salience: weight discrimination, height discrimination, control) × 2 (group identity: common ingroup, control) design and completed an evaluative measure of weight bias. Results revealed a significant interaction, showing that when weight discrimination was salient, participants in the common ingroup identity condition reported less weight bias than participants in the group identity control condition. When a common ingroup identity was emphasized, weight bias was lower when weight discrimination was salient compared to when height discrimination was salient and the control condition in which nothing about discrimination was mentioned. These results were not moderated by participant weight. This study demonstrates that a common ingroup identity can be effective in reducing weight bias if a cue is provided that fat people experience disparate and unjust outcomes in employment. Given the serious consequences of weight bias for health and well-being, and the relative ease of implementing this prejudice-reduction intervention, the common ingroup identity model has potential application for reducing weight bias in a range of real-world settings. However, these findings should be considered preliminary until they are replicated in well-powered and pre-registered future research.

An attitude of gratitude: The effects of body-focused gratitude on weight bias internalization and body image.

Internalized weight bias and body dissatisfaction are associated with a number of negative psychological and physical health outcomes. The current study examined the effectiveness of body-focused gratitude, through a short writing exercise, as a strategy to reduce internalized weight bias and improve body image. Young adults (Mage = 22.71, SD = 2.08, 51.2% female) were randomly assigned to either a body gratitude condition (n = 185) or a control condition (n = 184). Results indicated that participants in the gratitude condition reported significantly lower weight bias internalization and significantly more favorable appearance evaluation and greater body satisfaction when compared to the control condition. These effects were in the small range (ds = 0.27-0.33), and neither gender nor BMI moderated these effects. These findings provide preliminary support for body-focused gratitude writing exercises as an effective individual-level strategy for both reducing internalized weight bias and improving body image.

What's Weight Got to Do With It? Mental Health Trainees' Perceptions of a Client With Anorexia Nervosa Symptoms.

This study examined the effect of client body mass index (BMI) on diagnostic impressions and perceptions of mental health trainees. Participants read a vignette of a mock female client presenting for treatment with symptoms of anorexia nervosa. Participants were randomly assigned to one of three conditions in which the client was described as "underweight," "normal weight," or "overweight." Results revealed that participants assigned to the "underweight" condition diagnosed the client with anorexia nervosa or atypical anorexia nervosa more frequently than participants assigned to the "overweight" or "normal weight" conditions. There was no difference based on client BMI when the more general diagnosis of other specified feeding or eating disorder (OSFED; previously known as eating disorder not otherwise specified [EDNOS]) was included, however. Participants in the "overweight" and "normal weight" conditions recommended fewer therapy sessions for the client than participants in the "underweight" condition. Furthermore, participants more strongly endorsed weight-based stereotypes to describe the client when she was "overweight" than "normal weight" or "underweight." Contrary to hypotheses, however, participants reported moderately positive attitudes toward treating the client regardless of BMI. These preliminary findings support initiatives aimed at providing training on weight stigma and eating disorders to mental health professionals.

Imagine that! The effect of counterstereotypic imagined intergroup contact on weight bias.

OBJECTIVE: Higher body-weight people are highly stigmatized and face prejudice and discrimination across a number of domains. Further, experiences of weight stigmatization are associated with a host of negative physical, psychological, and social consequences. However, less is known about effective means for reducing weight bias. One strategy that has shown some success in prejudice reduction, yet is relatively untested for weight bias, is imagined intergroup contact. The purpose of this study was to investigate the effect of counterstereotypic imagined intergroup contact on weight bias. METHOD: Participants were randomly assigned to 1 of 2 experimental conditions or a control group. In the experimental conditions, participants were asked to imagine interactions with either a counterstereotypic (e.g., confident, attractive) or stereotypic (e.g., unattractive, insecure) "obese" person. Participants then completed the Anti-fat Attitudes Questionnaire (dislike subscale; Crandall, 1994; Quinn & Crocker, 1999), the Universal Measure of Bias-Fat (negative judgment and social distance subscales; Latner et al., 2008), and the Fat Phobia Scale. RESULTS: Results indicated that participants in the counterstereotypic condition reported lower levels of weight bias (dislike, negative judgment, and social distance) than participants in the stereotypic and control conditions. CONCLUSION: These findings highlight the potential usefulness of counterstereotypic imagined contact to reduce weight bias. (PsycINFO Database Record

Do media portrayals of obesity influence support for weight-related medical policy?

OBJECTIVE: The purpose of this research was to examine the impact of nonstigmatizing visual portrayals of obesity on support for a discriminatory weight-based medical policy. METHOD: Participants read an online news story about a policy to deny fertility treatment to obese women that was accompanied by a nonstigmatizing, stigmatizing, or no image of an obese couple. A balanced discussion of the policy was presented, with information both questioning the policy as discriminatory and supporting the policy because of weight-related medical complications. RESULTS: Results revealed that participants who viewed the nonstigmatizing image were less supportive of the policy to deny obese women fertility treatment and recommended the policy less strongly than participants who viewed the stigmatizing image. Furthermore, weaker perceptions of medical risk mediated the effect of the nonstigmatizing image on policy ratings. CONCLUSION: The findings indicate that simply eliminating stigmatizing media portrayals of obesity may help reduce bias.

Understanding the relations between different forms of racial prejudice: a cognitive consistency perspective.

Research on racial prejudice is currently characterized by the existence of diverse concepts (e.g., implicit prejudice, old-fashioned racism, modern racism, aversive racism) that are not well integrated from a general perspective. The present article proposes an integrative framework for these concepts employing a cognitive consistency perspective. Specifically, it is argued that the reliance on immediate affective reactions toward racial minority groups in evaluative judgments about these groups depends on the consistency of this evaluation with other relevant beliefs pertaining to central components of old-fashioned, modern, and aversive forms of prejudice. A central prediction of the proposed framework is that the relation between "implicit" and "explicit" prejudice should be moderated by the interaction of egalitarianism-related, nonprejudicial goals and perceptions of discrimination. This prediction was confirmed in a series of three studies. Implications for research on prejudice are discussed.

Implicit and explicit prejudice toward overweight and average-weight men and women: testing their correspondence and relation to behavioral intentions.

The authors examined prejudice toward overweight men and women. Participants (N = 76) indicated their perceptions, attitudes, behavioral intentions, and implicit associations toward an average-weight or overweight man or woman. Results indicated the presence of explicit and implicit antifat prejudice, with male participants showing greater negativity toward overweight targets. Analyses of covariance indicated that overweight targets received greater derogation than did their average-weight counterparts, regardless, for the most part, of the target's gender. With one exception, no significant relations emerged between explicit and implicit measures of weight bias. The authors discuss limitations of the study and implications for future research.