Objective:LGBT veterans experience high rates of trauma, discrimination, and minority stress. However, guidelines for case conceptualization and treatment remain limited. The aim of the current study was to examine the experiences of trauma and other high impact experiences among LGBT veterans to inform case conceptualization and treatment. Method: We recruited 47 LGBT veterans with a history of exposure to LGBT-related Criterion A trauma and performed semistructured interviews about their experiences in trauma treatment, barriers to engagement, and treatment needs and preferences. We used thematic analysis of qualitative codes guided by inductive and deductive approaches to characterize the variety of trauma and high impact experiences reported. Results: LGBT veterans disclosed a range of clinically relevant stressors, including Criterion A traumatic events, minority stress, and microaggression experiences, including interpersonal and institutional discrimination perpetrated by fellow service members/veterans, citizens, therapy group members, and health care providers. Conclusion: These data provide a unique account of LGBT veteran's identity-related trauma and concomitant interpersonal and institutional discrimination, microaggression experiences, minority stress, and traumatic stress symptoms. Findings highlight existing service gaps regarding evidence-based treatments for the sequalae of trauma, discrimination, microaggressions, and minority stress. In addition, we noted past and present issues in military and health care settings that may lead to or exacerbate trauma-related distress and discourage treatment seeking among LGBT veterans. We provide suggestions for clinical work with LGBT veterans and encourage ongoing research and development to eliminate remaining service gaps.
Clinical Impact StatementLGBT veterans are exposed to higher rates of trauma than their nonveteran LGBT counterparts and non-LGBT veterans. They also must cope with other highly impactful experiences such as discrimination, microaggressions, and minority stress. Reactions to these events may create overlapping symptom clusters that may interfere with trauma treatment and recovery, especially under circumstances of persistent threat (e.g., ongoing discrimination). Existing empirically supported trauma treatments were not developed for LGBT veterans, or to treat discrimination, microaggressions, or minority stress; treatments that address these latter concerns are not trauma-focused. This work highlights the critical need for further research and development to meet this population's treatment needs.
