Religious Trauma Continues to Affect Millions of LGBTQ+ Americans

 

Religious trauma can occur when a religious community or official uses a person's spiritual beliefs to impact their well-being, decision-making, and actions. For LGBTQ+ individuals, religious trauma can stem from a conflict between their authentic selves and the teachings of their faith community. This can lead to feelings of shame, rejection, guilt, and isolation. For those who depart from their faith, by embracing their Queer identity, it can feel as though “the rug gets pulled out from under you,” one woman explains.

“Your life requires gradual reconstruction,” she continued. “It’s about reconstructing your self-identity and beliefs. One important new belief is that being LGBTQ+ is acceptable.”

Regarding treatment, LGBTQ+ affirming counselors begin by guiding her patients in self-care.

“Rather than relying solely on God for care, I help them become self-reflective and manage their emotions from their own viewpoints instead of through biblical perspectives,” she noted.

From there, she introduces techniques aimed at addressing trauma responses, such as documenting negative messages absorbed during upbringing and transforming them into positive affirmations.

“For example, the thought, ‘My life is a trial, leading to hell,’ can shift to, ‘My life is an adventure and a journey,’” she remarked.

Additionally, she assists patients in relaxation through breathing exercises and body scan meditations, among other methods. In some instances, she suggests combining these strategies with medication.

Discussions Among Mental Health Professionals

As more LGBTQ+ individuals share their experiences with religious trauma, mental health experts are debating how it should be categorized in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the reference guide for coding and diagnosing mental health conditions by the American Psychiatric Association.

In the most recent edition, the DSM-5-TR, religious trauma falls under the category of “Religious or Spiritual Problem,” classified as a Z code rather than an official mental disorder. Z codes are included at the end of the DSM, recognized as “other conditions that may be a focus of clinical attention.” Additional examples include various types of “Child Psychological Abuse,” “Unsheltered Homelessness,” and “Victim of Terrorism or Torture.”

Koenig is collaborating with a group of public health experts and psychiatrists at Harvard University to expand the Z code “Religious or Spiritual Problem” to include “Moral Problems,” such as moral injury.

Moral injury, presently not listed in the DSM, can occur when an individual feels they have acted contrary to their morals and values, leading to guilt, shame, or a deep sense of betrayal. This concept has been applied to veterans and, more recently, to healthcare professionals who felt they could not provide adequate care during the Covid-19 pandemic.

“For centuries, religion has been manipulated and wielded as a weapon against LGBTQ individuals,” stated Koenig. “Moral injury, especially for religious LGBTQ people, can generate a lifetime of shame and guilt. This can lead to long-term mental health challenges, such as suicide, depression, and anxiety, as individuals may become trapped in this experience for years or even decades.”

Koenig emphasized the importance of incorporating both “Religious or Spiritual Problem” and “Moral Problem”—currently under review by a DSM committee—as a Z code. He argued that including moral injury would enable providers to gather more precise data and offer more tailored interventions, such as determining the appropriateness of pastoral support for those in distress. It would also facilitate better documentation of the sources of a patient’s trauma, distinguishing between the impact of familial or community religious beliefs and the separate notion that being LGBTQ+ is immoral.

“For religious individuals who identify as LGBTQ+, it isn’t limited to Christianity,” he noted. “It’s the entire moral framework of the culture, passed down through generations, that has perpetuated this condemnation.”

The process of introducing a new disorder or code into the DSM mandates submitting a thorough proposal to the manual’s steering committee, which is then reviewed and sent to the American Psychiatric Association’s board of trustees for approval.

“Establishing it as a Z code would validate the issue and catalyze funding support, leading to increased financial resources for research, which would enhance our understanding of treatment for those facing moral injuries like religious trauma,” Koenig added.

A subsequent step would be reclassifying “Religious or Spiritual Problem” from a Z code to an official disorder in the DSM. While Koenig remains uncertain about his position on this, as the process could be exhaustive and lengthy, people like Marlene Winell strongly advocates for its inclusion as a recognized disorder. "Currently, many therapists are not well-informed about this issue. They may conduct an intake with a new client and discuss topics like family dynamics, educational background, or substance misuse, but they generally avoid addressing religion," she mentioned. "If it were officially recognized in the DSM, it would receive more attention, and the millions of individuals grappling with it throughout the country could access better support."

In an NBC interview Marlene Winell emphasized that classifying religious trauma as a disorder in the DSM would enhance its legitimacy among healthcare professionals, enabling individuals experiencing this kind of trauma to articulate their struggles. She also anticipated that this recognition would lead to increased research in the field and the inclusion of religious trauma in university psychology programs.

Drescher, who participated in the APA committee that in 2013 transitioned the term "gender identity disorder" to "gender dysphoria" in the DSM to reduce stigma, disagrees with Winell's perspective.

"We don't require diagnoses to comprehend what's happening. ... Medicalizing social issues is how homosexuality was initially categorized as a mental disorder," Drescher pointed out, noting that it wasn't removed from the DSM until 1973. "The idea that we might now convert anti-LGBTQ sentiments into psychiatric diagnoses troubles me."

He cautioned that this could allow future generations to "simply flip the switch" and once again pathologize homosexuality.

Although Drescher—who has over forty years of experience in psychiatry—doesn't hold high hopes for transforming the beliefs of current anti-LGBTQ church leaders who are "set in their ways," he remains optimistic about what lies ahead.

" Younger religious individuals don’t view LGBTQ people as adversaries. They recognize them as friends, neighbors, and fellow members of their congregations," he stated.

"As the new generation matures, LGBTQ individuals within religious communities will encounter increased acceptance instead of stigma and the need to conceal their identities. A reduction in hiding leads to better self-esteem and potentially less anxiety, depression, and other mental health challenges."

Meanwhile, mental wellness initiatives serving the LGBTQ+ community, such as the Mental Wellness Movement, are partnering with Queer-centric spiritual support communities to provide an holistic approach to meeting the needs of the LGBTQ+ community and their allies.

If you or someone you know is in crisis, call or text 988 to reach the Suicide and Crisis Lifeline or chat live at 988lifeline.org. You can also visit SpeakingOfSuicide.com/resources for additional support.