Identity-Related Stress and Obsessive-Compulsive Disorder in Sexual and Gender Minority Individuals: A Test of the...

Pinciotti and Feinstein's (2025) cognitive behavioral-minority stress model of obsessive-compulsive disorder (OCD) proposes to explain the development, presentation, and maintenance of OCD among sexual and gender minority (SGM) individuals. Extrapolating from extant theory and research about the development and maintenance of OCD and, separately, the influence of identity-based stressors on psychopathology among SGM individuals, this model proposes that a combination of early life experiences and identity-based stressors lead to a general predisposition of inflated responsibility to prevent harm, and these beliefs and identity-based stressors subsequently lead to the presence and content of OCD symptoms. Although the cognitive behavioral-minority stress model is grounded in existing theory and research, it has not yet been directly tested. Accordingly, the present study used structural equation models to evaluate this theory in 463 SGM individuals with OCD (Mage = 27.3, 89% female). Inflated responsibility was associated with all OCD symptom dimensions for sexual minority (SM), but only two symptom dimensions for gender minority (GM) individuals. Internalized stigma exhibited unique associations with OCD symptoms for both SM and GM individuals, highlighting its relevance to OCD. Among SM individuals, rejection sensitivity also evidenced associations with OCD symptoms, whereas among gender minority individuals, identity-based physical assault was most consistently associated with OCD symptoms. Findings support the influence of minority stress on OCD symptoms and provide preliminary support for the cognitive behavioral-minority stress model of OCD among SGM individuals. Implications and limitations are discussed, and guidance is offered regarding next steps for this research informed by findings from the present study.