Violence on the self: Exploring the intersection of trauma and identity among sexual and gender minorities from a neurobiological and developmental perspective to advance our understanding of PTSD, moral injury, and dissociation symptoms

Sexual and gender minority (SGM) individuals navigate identity development within social contexts marked by stigmatization, marginalization, and oppression, and are disproportionately exposed to identity-based stressors and trauma. Such exposures have been associated with alterations in self-experience and elevated rates of trauma-related psychopathology. Through a developmental and neurobiological perspective, this review examines how minority stress and trauma may intersect with early relational dynamics and identity development to shape self-experience and mental health outcomes. We first synthesize contemporary frameworks of sexual and gender identity development, highlighting critical periods during which self-experience may be particularly vulnerable to social invalidation, concealment, and relational threat. We then examine minority stress within evolving models of trauma and posttraumatic stress disorder (PTSD), arguing that these frameworks must be integrated with minority stress theory to accurately characterize SGM mental health and inform clinical practice. We further propose the Minority Stress Multi-Level Self Model (MS-MSM), which provides an integrative framework through which embodied, relational, and narrative dimensions of self-experience can be examined as dynamically coordinated, differentially affected, and potentially decoupled under conditions of minority stress, attachment-related vulnerability, and insidious trauma. From this vantage point, chronic minority stress may become trauma-relevant when identity-based stressors disrupt integrative self-processes, with potential manifestations including moral injury, negatively valenced self-referential processing, dissociative symptoms, as well as altered functioning of neurobiological systems supporting self, salience, threat, and emotion regulation. Together, this integrative review aims to inform future research and more precise, affirming, and effective approaches to assessment, treatment, and prevention.