Hypervigilance, minority stress, and health
Stigma, discrimination, self-hate, and survival mode
LGBTQ people face disparities in virtually every facet of life. Lower access, more restrictions, more scrutiny, and more bad outcomes. A trans rights organization, a4te.org, lists information about disparities in all of these categories:
Violence victimization, healthcare, insurance, education, employment, the justice system (police, courts, jails, prison), housing, sports, substance abuse, military service, veterans’ rights and benefits, family support, religion, identity documents, privacy, immigration and asylum, and travel and airport security.
I’m sure we’ve missed some.
For every one of these categories, we could talk about how LGBTQ people, especially trans and nonbinary people, have it worse. We experience more homelessness, less employment, more harassment and violence from police, more family rejection, etc.
This is compounded exponentially if someone is LGBTQ plus one or more other minority statuses (by race, ability, neurotype, immigration status, etc.). I’ll save intersectionality theory for another post.
Every single one of these things impacts health for better or worse. And all of these have been negatively affected in 2025 by executive orders and state-level laws, either directly or indirectly.
But why do these disparities exist? Why do we have it worse?
These disparities are not inevitable. There is nothing inherently wrong with being LGBTQ. Instead, the disparities are due to stigma and discrimination.
To understand where these disparities come from—what causes them—we need to talk about stigma, discrimination, and minority stress. Let’s talk through a simplified version of stigma theory and the minority stress model.
We start with a difference. Not all differences matter. For example, are your earlobes connected at the bottom or not? Check if you don’t know.
This difference does not matter in society at all; there’s no social preference for one or the other. You may not even have known which type of earlobes you have. Or your partner has. (I think his are unattached? Mine are attached.)
That’s a difference that doesn’t make a difference, at least not in this country.
Stigma —> Discrimination
However, we socially label some differences as lesser, worse, bad, or not good in some way. That labeling or marking it as worse is stigma.1
When we stigmatize something, discrimination follows—words, actions, policies, or lack of policies, etc. These treat people with that stigmatized difference worse: rejecting, excluding, not accommodating, tolerating, or failing to include.
Stigma —> Discrimination —> Minority Stress
That stigmatization and discrimination together cause minority stress.2 This can be external. For example, bullying, bans on healthcare, rescinding passports, and preventing people from serving in the military.
It can also be internalized, meaning we come to believe all the negative things they are saying about us. This can be done consciously or unconsciously. For example, I am happy that I’m trans, but I have also accepted worse treatment from people because, at a deep level, I have felt unworthy.
Stigma —> Discrimination —> Minority Stress —> Worse Health
That minority stress and its consequences lead to worse 1) mental and physical health, and 2) less healthcare access. For example, the stress itself puts our bodies into survival mode, or fight/flight/freeze/fawn mode, as if we are constantly ready to fight off a lion.
All bodies spend some time in survival mode, but ideally, we regulate our emotional states and complete the stress cycle. Ultimately, we can get back to relaxation.3
But if you’re constantly in survival mode, you have stress hormones (cortisol) flooding your body without pause, which harms all the body’s systems. This leads to worse health.4
This stress also means we worry about and anticipate stigma and discrimination. We may stress a lot about airport security because we have to show an ID that doesn’t match our appearance. We may skip or delay going to the doctor until our symptoms advance. We’ve been called the wrong name, or had providers assume we are straight and not ask the correct questions, or we've heard stories from friends about their poor treatment at the health center. Or providers have refused to touch us and looked at us in disgust. Yes, really.
When I first came out, I delayed going to the dentist until I had a broken tooth. I was fearful of how they would treat me when I showed them my updated name and gender marker on my insurance. (They turned out to be nonchalant about it.)
Stigma —> Discrimination —> Minority Stress —> Minority group identity —> Pride & Resilience —> Better Health
At the same time, the stigmatized difference, the minority status, can lead to good things like a minority group identity, with community pride and resilience. I’ve found so much love, acceptance, and celebration in the queer and trans communities. I take pride in my identities and experience joy, fun, connection, and belonging like I never did before. Being my queer, trans self has opened me up enough to heal.
The minority stress itself also forces us to build resilience, the ability to bounce back and cope with hard things. (People also critique the concept of resilience, which I can tackle another time—they aren’t wrong, IMO.)
Together, pride and resilience improve health. Or at least lessen some of the health impacts from minority stress.
Stigma —> LGBTQ Disparities
Minority stress theory, in a nutshell, says that it’s the stigma that ultimately causes disparities, and not LGBTQness itself.
There’s nothing wrong with being LGBTQ.
Being LGBTQ does not put us in survival mode. It’s society’s treatment of LGBTQ people that puts us in survival mode.
Stigma —> LGBTQ
In theory, if you remove the stigma, the disparities will disappear. Because then, the difference is just a difference. Not worse, not better.
Just another part of the natural, beautiful variety of humanity.
Pic: David M. Frost, Ilan H. Meyer, Minority stress theory: Application, critique, and continued relevance, Current Opinion in Psychology, 2023;Volume 51:101579. https://doi.org/10.1016/j.copsyc.2023.101579
Goffman E. Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs, NJ: Prentice-Hall, 1963.
Brooks VR. Minority Stress and Lesbian Women. Lexington Books; 1981.
Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. Sep 2003;129(5):674-697. doi:10.1037/0033-2909.129.5.674
Meyer IH. Resilience in the study of minority stress and health of sexual and gender minorities. Psychology of Sexual Orientation and Gender Diversity. 2015;2(3):209-213. doi:10.1037/sgd0000132
Testa RJ, Habarth J, Peta J, Balsam K, Bockting W. Development of the Gender Minority Stress and Resilience Measure. Psychology of Sexual Orientation and Gender Diversity. 2015;2(1):65-77. doi:10.1037/sgd0000081
Nagoski E, Nagoski A. Burnout: The Secret to Unlocking the Stress Cycle. First edition. Ballantine Books, 2019.
Harvard Health Publishing. Understanding the stress response: Chronic activation of this survival mechanism impairs health. Available at https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response Accessed Jul 19, 2025. Last updated April 3, 2024.
Appreciate you sooooo much.