Minority Stress and Resilience Experiences in Adolescents and Young Adults With Intersex Variations/Differences of Sex Development

Minority stress is an important contributor to mental health disparities among sexual and gender minority communities. Adolescents and young adults (AYA) with intersex variations/differences of sex development (I/DSD) frequently experience mental health symptoms which may be influenced by minority stressors. This study explored minority stress and resilience experiences of AYA with I/DSD and evaluated the applicability of the current minority stress and resilience models to this population. Twenty AYA with I/DSD ages 16-39 were recruited from clinical and community sites in the United States and the Netherlands. Participants completed a semistructured interview informed by the gender minority stress and resilience model domains, with additional exploratory questions on stress and resilience experiences thought to be unique to this population. Confirmatory and open thematic coding was conducted on both existing and novel domains. Themes related to established minority stress and resilience experiences were present in AYA with I/DSD. In addition, I/DSD-specific distal and proximal stressors and resilience factors were identified. Distal stressors included stressful health care experiences, medical stress, condition secrecy, and erasure; proximal stressors included body-related stress and interpersonal stress. Novel resilience factors identified included activism, social support and acceptance, psychosocial/medical support, self-acceptance, openness and agency, and posttraumatic growth. Themes were confirmed across settings, genders, and clinical conditions. AYA with I/DSD often experience minority stress from heteronormative, cisnormative, and nondisabled assumptions and biases. Group-specific stressors relate to medical stress/trauma and secrecy. Health care providers should be attentive to creating a nonpathologizing space supporting agency and openness.