The Rejection Sensitivity Model As A Framework For Understanding Sexual Minority Mental Health
The Rejection Sensitivity Model As A Framework For Understanding Sexual Minority Mental Health
https://doi.org/10.1007/s10508-019-1428-3
TARGET ARTICLE
Abstract
Sexual minorities are disproportionately affected by mental health problems (e.g., depression, anxiety, substance use disorders,
suicidality). Minority stress theory and the psychological mediation framework have become the predominant conceptual
models used to explain these disparities, and they have led to substantial advances in research on stigma-related stress and
mental health. However, the field’s reliance on these models has limited the extent to which other theories have been considered
as potential frameworks for further advancing our understanding of sexual minority mental health. In this article, I discuss
how the rejection sensitivity (RS) model can be used to complement and extend minority stress theory and the psychological
mediation framework by: (1) emphasizing the role of perception in stigma-related experiences; (2) acknowledging the unique
consequences of different anticipatory emotions; (3) describing additional mechanisms linking proximal minority stressors
to mental health; and (4) further specifying the temporal order of these processes. I conclude by discussing the importance
of attending to developmental processes in research on sexual orientation-related RS and describing important directions for
future research.
Keywords Rejection sensitivity · Minority stress · Sexual minority · Gay, lesbian, and bisexual · Sexual orientation
13
Vol.:(0123456789)
Archives of Sexual Behavior
Observer’s
reactions
Cognitive-social learning history Long-term
Prior experiences of rejection outcomes
Predominant Conceptual Models Guiding Research psychopathology. Research has also supported the psychologi-
on Sexual Minority Mental Health cal mediation framework, demonstrating that the associations
between stigma-related stressors and mental health problems
In the past 15 years, there has been remarkable growth in are mediated by general psychological processes (Hatzenbue-
research on sexual minority mental health, much of which has hler, Nolen-Hoeksema, & Dovidio, 2009; Mustanski & Liu,
been guided by two conceptual models—minority stress theory 2013) and group-specific processes (Feinstein, Goldfried, &
(Meyer, 2003) and the psychological mediation framework Davila, 2012).
(Hatzenbuehler, 2009). Minority stress theory was developed Although minority stress theory and the psychological medi-
to explain why the prevalence of mental health problems was ation framework have led to substantial advances in research
higher among sexual minorities compared to heterosexuals, on stigma-related stress and mental health, the field’s reliance
and it proposed that this was due to the additional burden of on these models has limited the extent to which other theories
stress that sexual minorities experience because of their stig- have been considered as frameworks for understanding the pro-
matized social status. Several types of minority stress were cesses contributing to negative mental health outcomes among
described along a distal–proximal continuum; distal minority sexual minorities. One model that can be used to complement
stressors were defined as objective events (e.g., discrimination, and extend these models to further advance our understanding
violence), whereas proximal minority stressors were defined of sexual minority mental health is the RS model (Downey &
as subjective processes that rely on perceptions and apprais- Feldman, 1996). In the next section, I describe the RS model,
als (e.g., internalization of stigma, expectations of rejection, its variations, and their empirical support.
concealment of one’s sexual orientation). Research has since
demonstrated that each of these minority stressors is associ- The Rejection Sensitivity Model
ated with negative mental health outcomes (Bostwick, Boyd,
Hughes, West, & McCabe, 2014; Hatzenbuehler, Nolen-Hoek- The RS model (Downey & Feldman, 1996) was developed to
sema, & Erickson, 2008; Herek, Gillis, & Cogan, 1999; Mays explain how rejection from significant others can influence
& Cochran, 2001; Newcomb & Mustanski, 2010; Riggle, Ros- thoughts, feelings, and behaviors in subsequent close relation-
tosky, Black, & Rosenkrantz, 2017). ships (see Fig. 1). Downey and Feldman conceptualized RS as a
Building on minority stress theory, the psychological cognitive–affective processing disposition to anxiously expect,
mediation framework was developed to explain how minor- readily perceive, and intensely react to rejection. They proposed
ity stressors influence mental health (Hatzenbuehler, 2009). It that early experiences of rejection can lead to expectations of
proposed that distal minority stressors activate general psycho- future rejection and to placing high importance on avoiding
logical processes that confer risk of psychopathology, including rejection. In turn, they proposed that this can lead to hyper-
cognitive processes (e.g., hopelessness, pessimism, negative vigilance for signs of rejection, readily perceiving rejection
self-schemas), affective processes (e.g., maladaptive coping in the presence of minimal or ambiguous cues, and intensely
and emotion regulation), and social processes (e.g., isolation). reacting to perceived rejection. RS has also been described as a
The psychological mediation framework primarily focused defensive motivational state that functions to protect individu-
on general psychological processes, but it acknowledged that als from rejection by preparing them to detect and respond to
group-specific processes (e.g., internalized stigma, expecta- social threat (Downey, Mougios, Ayduk, London, & Shoda,
tions of rejection, sexual orientation concealment) may also 2004; Romero-Canyas, Downey, Berenson, Ayduk, & Kang,
explain the associations between distal minority stressors and 2010). Although RS may develop as a form of self-protection,
13
Archives of Sexual Behavior
it can become maladaptive if it is activated indiscriminately, Nesdale, 2013). However, most research on RS continues
in response to minimal threat, in situations in which strategic to focus on anxious expectations of rejection.
behavior would be more functional, or when efforts to prevent
rejection undermine other goals (Romero-Canyas et al., 2010). Extending the Rejection Sensitivity Model
In fact, RS can create a self-fulfilling prophecy in which indi- to the Experiences of Stigmatized Groups
viduals behave out of fear, in turn eliciting rejection from others
(Downey, Freitas, Michaelis, & Khouri, 1998). The original conceptualization of RS focused on the influence
Since its development, the RS model has received sub- of rejection on subsequent close relationships, but it has also
stantial empirical support. For example, research has dem- been extended to account for the consequences of rejection
onstrated that rejection from parents and peers is associated based on membership in a stigmatized group (referred to as
with greater RS (Downey, Khouri, & Feldman, 1997; Feld- status-based RS; Chan & Mendoza-Denton, 2008; London,
man & Downey, 1994), that RS is associated with a lower Downey, Romero-Canyas, Rattan, & Tyson, 2012; Mendoza-
threshold for detecting social threat (Olsson, Carmona, Denton, Downey, Purdie, Davis, & Pietrzak, 2002). The con-
Downey, Bolger, & Ochsner, 2013) and more readily per- struct of status-based RS acknowledges that “…direct or vicari-
ceiving intentional rejection in others’ ambiguous behavior ous experiences of mistreatment, prejudice, discrimination, and
(Downey & Feldman, 1996), and that RS is associated with exclusion based on membership in a devalued social group
heightened reactivity to rejection-related cues (Burklund, can communicate rejection….Such rejection, especially when
Eisenberger, & Lieberman, 2007; Downey et al., 2004). experienced as painful and distressing, can generate anxious
Research has also demonstrated that RS is associated with expectations that future status-based rejection will occur…”
negative mental health outcomes (e.g., depression, anxi- (Mendoza-Denton et al., 2002, p. 897). For example, Mendoza-
ety, loneliness) in cross-sectional and longitudinal studies Denton et al. found that African-American students who were
(Gao, Assink, Cipriani, & Lin, 2017), suggesting that it higher in race-based RS reported more frequent experiences
may play a role in the etiology and maintenance of mental of race-based negative events and stronger feelings of aliena-
health problems. Further, research has provided support for tion and rejection following them. Additionally, London et al.
several mechanisms linking RS to mental health, such as (2012) found that women who were higher in gender-based
information processing biases (e.g., generating and select- RS detected gender-based rejection more often and engaged in
ing more negative interpretations for ambiguous situations; behaviors to prevent rejection (e.g., self-silencing) more often,
Normansell & Wisco, 2017), deficits in social problem- which led them to feel more alienated and less motivated. These
solving (e.g., viewing social problems as threats to one’s findings demonstrate that members of stigmatized groups have
well-being and taking an avoidant approach to dealing with unique rejection-related concerns and that the consequences of
problems; Kraines & Wells, 2017), and stress generation their anxious expectations of rejection extend to their interper-
(e.g., generating stress that is dependent on one’s own sonal functioning and well-being.
behaviors or characteristics; Liu, Kraines, Massing-Schaf-
fer, & Alloy, 2014). There is also evidence that experiences Rejection Sensitivity and Its Consequences
of rejection are associated with depression for individuals for Sexual Minorities
who are high in RS, but not for those who are low in RS,
suggesting that the consequences of rejection are greater Both minority stress theory (Meyer, 2003) and the psycho-
for individuals who are more sensitive to rejection (Ayduk, logical mediation framework (Hatzenbuehler, 2009) describe
Downey, & Kim, 2001). These findings highlight the vari- expectations of rejection as a proximal minority stressor, and
ous ways in which RS can influence mental health through numerous studies have tested its role in sexual minority mental
diverse cognitive, affective, and behavioral processes. health (e.g., Hatzenbuehler et al., 2008; Liao, Kashubeck-West,
Although the RS model initially focused on anxious Weng, & Deitz, 2015; Mohr & Sarno, 2016; Puckett, Mar-
expectations of rejection, it was later revised to acknowl- oney, Levitt, & Horne, 2016; Puckett, Surace, Levitt, & Horne,
edge that expectations of rejection can also be accompanied 2016; Velez & Moradi, 2016; Velez, Watson, Cox, & Flores,
by other anticipatory emotions such as anger (Downey, 2017). However, RS is distinct from expectations of rejection
Bonica, & Rincon, 1999; London, Downey, Bonica, & in that it reflects both a cognitive process (i.e., the perceived
Paltin, 2007). In the revised RS model, it was proposed likelihood of rejection) and an affective process (i.e., concern
that anxious and angry expectations of rejection would or anxiety about rejection). This is a critical distinction given
have different behavioral consequences (social withdrawal recent evidence that expectations of rejection are only weakly
and aggression, respectively; Downey et al., 1999; Lon- correlated with their accompanying affect (Zimmer-Gembeck,
don et al., 2007), and subsequent research has supported Nesdale, Webb, Khatibi, & Downey, 2016). Ayduk and Gyurak
this hypothesis (London et al., 2007; Zimmer-Gembeck & (2008) illustrated the importance of attending to both cognition
13
Archives of Sexual Behavior
and affect by describing “…that individuals who are high in Of note, most research on sexual orientation-related RS has
RS do not merely expect rejection (as, e.g., telephone solici- focused on sexual minority men and there has been limited
tors do) but also feel threatened by the possibility of rejection attention to potential gender differences. In an exception, Fein-
(which telephone solicitors do not)” (p. 2021). Based on the RS stein et al. (2012) did not find a significant difference in sexual
model, it is the combination of expecting rejection and being orientation-related RS between gay men and lesbian women.
highly concerned about it that triggers the RS dynamic and Further, they did not find a significant gender difference in the
leads to negative consequences. Of note, minority stress theory associations between sexual orientation-related RS and mental
acknowledged that expectations of rejection can be accompa- health problems. However, they used an adapted version of the
nied by vigilance, and the psychological mediation framework GRRSS, which was designed to capture situations in which
acknowledged that RS may be a proximal minority stressor, but gay men experience concerns about rejection. As such, it may
neither described the RS dynamic in detail. not have adequately reflected the unique situations in which
Pachankis, Goldfried, and Ramrattan (2008) were the first lesbian women experience similar concerns. As noted, Dyar
to extend the construct of status-based RS to sexual minori- et al. (2016) developed a measure of sexual orientation-related
ties (specifically, gay men). They developed a measure of RS specifically for sexual minority women (the Sexual Minor-
gay-related RS (the Gay-Related Rejection Sensitivity Scale ity Women Rejection Sensitivity Scale [SMWRSS]). Despite
[GRRSS]) and demonstrated that it was associated with paren- a strong correlation between the SMWRSS and the GRRSS,
tal rejection, internalized stigma, and unassertive interpersonal only the SMWRSS continued to predict anxiety symptoms
behavior. They also demonstrated that gay-related RS medi- when both measures were included in the same models. These
ated the association between parental rejection and internal- findings highlight the importance of using group-specific meas-
ized stigma, suggesting that it may function as a mechanism ures of RS to understand the consequences of RS in specific
through which early experiences of rejection influence attitudes populations.
toward one’s own sexual orientation. Since then, their measure There has also been a lack of attention to potential differ-
of gay-related RS has been adapted to measure sexual orienta- ences in sexual orientation-related RS between gay/lesbian and
tion-related RS among gay men and lesbian women (Feinstein bisexual individuals. In an exception, Dyar et al. (2016) found
et al., 2012) and a novel measure of RS has been developed to that bisexual women reported lower sexual orientation-related
capture the unique rejection-related concerns of sexual minor- RS than lesbian women. However, they did not statistically
ity women (Dyar, Feinstein, Eaton, & London, 2016). compare the groups and, although their measure was developed
Research on sexual orientation-related RS has also dem- specifically for sexual minority women, it did not include items
onstrated that it is associated with negative mental health out- that reflected the unique situations in which bisexual women
comes including depression, social anxiety, generalized anxiety, experience concerns about rejection. Regardless, Dyar et al.
and posttraumatic stress (Cohen, Feinstein, Rodriguez-Seijas, (2018) also found that sexual orientation-related RS and other
Taylor, & Newman, 2016; Dyar et al., 2016; Dyar, Feinstein, rejection-related stressors mediated the association between
Eaton, & London, 2018; Feinstein, Davila, & Dyar, 2017; Fein- discrimination and internalizing symptoms for both lesbian and
stein et al., 2012), and that it mediates the associations between bisexual women. As such, the antecedents and consequences
discrimination and mental health problems (Dyar et al., 2018; of sexual orientation-related RS may be similar for lesbian and
Feinstein et al., 2012). In samples of sexual minority men, the bisexual women. Of note, in a recent study, Dyar and London
consequences of sexual orientation-related RS also extend to (2018) created two items to specifically assess RS related to
substance use (Pachankis, Hatzenbuehler, & Starks, 2014) and one’s bisexual identity. They found that more frequent posi-
sexual outcomes (e.g., condomless sex, sexual compulsivity; tive experiences related to one’s bisexual identity were associ-
Pachankis et al., 2015; Wang & Pachankis, 2016). Although few ated with a decrease in RS, which in turn was associated with
studies have examined the mechanisms underlying these associa- decreases in depression and anxiety. In sum, given the lack
tions, one study found that gay men who were higher in RS used of attention to within-group heterogeneity in studies of sexual
more disengaged coping strategies in response to discrimination, orientation-related RS, it will be important for future studies
which in turn contributed to their depression and anxiety (Fein- to continue to examine differences among subgroups of sexual
stein et al., 2017). Additionally, in a sample of sexual minority minorities.
women, Dyar et al. (2018) found that sexual orientation-related
RS contributed to other rejection-related processes (e.g., preoc- The Rejection Sensitivity Model as a Framework
cupation with stigma, motivation to conceal one’s sexual orien- for Understanding Sexual Minority Mental Health
tation, difficulty developing a positive sexual identity), which
in turn contributed to depression and anxiety. Consistent with Minority stress theory (Meyer, 2003) and the psychological
the broader literature on RS, these findings suggest that sexual mediation framework (Hatzenbuehler, 2009) provide impor-
orientation-related RS can influence mental health through vari- tant conceptual models for understanding why sexual minori-
ous cognitive, affective, and behavioral processes. ties are at increased risk of mental health problems as well as
13
Archives of Sexual Behavior
the processes linking discrimination and violence to negative than others to perceive rejection in a given situation). This
mental health outcomes in this population. The RS model can conceptualization is consistent with transactional models of
be used in conjunction with these models to further advance stress (e.g., Lazarus & Folkman, 1984) and prejudice (e.g.,
our understanding of the processes that contribute to negative Major, McCoy, Kaiser, & Quinton, 2003), which emphasize
mental health outcomes among sexual minorities. In this sec- the roles of individual differences in the perception of stress
tion, I describe four ways that the RS model can be used to and prejudice. Perception may be particularly important in this
further advance our understanding of sexual minority mental day and age, given that contemporary prejudice often manifests
health including by: (1) emphasizing the role of perception in subtler forms than it did in the past (Morrison & Morri-
in stigma-related experiences; (2) acknowledging the unique son, 2002; Walls, 2008). While some experiences of rejection
consequences of different anticipatory emotions (e.g., anxiety, provide clear evidence of prejudice, others are ambiguous.
anger); (3) describing additional mechanisms linking proximal For example, microaggressions have been described as “…
minority stressors to mental health; and (4) further specifying subtle forms of discrimination, often unconscious or uninten-
the temporal order of these processes. tional, that communicate hostile or derogatory messages, par-
Prior to discussing the role of perception in stigma-related ticularly to and about members of historically marginalized
experiences, it is critical to emphasize that the RS model posi- social groups” (Nadal, Whitman, Davis, Erazo, & Davidoff,
tions early experiences of rejection as the primary etiological 2016, p. 488). Given the subtle and often ambiguous nature
factor in the development of RS (Downey & Feldman, 1996). of microaggressions, perceptions of microaggressions may be
Consistent with the proposed etiology of RS, sexual minori- particularly susceptible to individual differences (e.g., negative
ties are disproportionately affected by adverse childhood expe- emotionality; Lilienfeld, 2017). However, previous research
riences including childhood sexual abuse, parental physical has largely neglected the role of individual differences in shap-
abuse, and peer victimization (e.g., Friedman et al., 2011), ing perceptions of microaggressions. Based on the RS model,
and previous cross-sectional research has found that parental some members of stigmatized groups are more likely than
rejection (Pachankis et al., 2008) and discrimination (Feinstein others to perceive ambiguous situations as evidence of rejec-
et al., 2012) are associated with sexual orientation-related RS. tion and, as such, to attend to them and to experience negative
Although longitudinal research is needed to test the roles of consequences. In sum, by emphasizing the role of perception
parental rejection and discrimination in the etiology of sexual in experiences of rejection and discrimination, scholars can
orientation-related RS, these findings are consistent with the develop a more precise understanding of the extent to which
conceptualization of RS as a consequence of early experiences different cues are likely to elicit perceptions of rejection and in
of rejection. turn negative consequences for sexual minorities.
Still, while RS is rooted in early experiences of rejection, a Second, the RS model highlights the importance of consid-
central tenet of the RS model is that individuals who are high in ering the specific affective experiences that accompany expec-
RS readily perceive rejection. In other words, they are primed tations of rejection. As described earlier, it is the combination
to detect rejection in the presence of minimal or ambiguous of expecting rejection and being highly concerned about it that
cues, and they enter social situations on the lookout for signs of triggers the RS dynamic and leads to negative consequences.
rejection. As such, even though early experiences of rejection In light of this, measuring expectations of rejection without
are hypothesized to be the cause of RS, once an individual has measuring the accompanying affective experience may not
developed the disposition to anxiously expect, readily perceive, capture the experience that is most likely to lead to negative
and intensely react to rejection (Downey & Feldman, 1996), consequences. The RS model also proposes that expecta-
they are at risk of interpreting ambiguous social situations as tions of rejection can be accompanied by different anticipa-
evidence of rejection and having a more intense reaction to the tory emotions (e.g., anxiety, anger), each of which has unique
perceived rejection. For example, if a gay man sits next to some- consequences (Downey et al., 1999; London et al., 2007). For
one on a bus and the person moves to a different seat, the situ- example, while anxious expectations of rejection tend to lead
ation is ambiguous (i.e., it is unclear why the person moved). to social withdrawal, angry expectations of rejection tend to
The gay man’s affective reaction is likely to be stronger if he lead to aggression (London et al., 2007; Zimmer-Gembeck &
perceives it as a sign of rejection (e.g., he assumes the person Nesdale, 2013). Although previous research has demonstrated
moved because of his sexual orientation) than if he does not that sexual orientation-related RS is associated with unassertive
perceive it as a sign of rejection (e.g., he assumes the person interpersonal behavior, research has yet to examine the con-
moved because they wanted more space). In this scenario, the sequences of expectations of rejection accompanied by anger
gay man’s perception of the situation plays an important role among sexual minorities.
in his experience and reaction. Angry expectations of rejection may be particularly relevant
By acknowledging the role of perception in experiences to the experiences of sexual minorities given that anger is a
of rejection, the RS model recognizes the subjective nature common response to disrespect and injustice (Miller, 2001;
of these experiences (i.e., that some people are more likely Smart Richman & Leary, 2009), especially when it is believed
13
Archives of Sexual Behavior
to be related to one’s social identity (Wang, Leu, & Shoda, its negative effects (Brosschot, Gerin, & Thayer, 2006). Given
2011). Previous research has found that sexual orientation- that people who are high in RS are more likely to recall nega-
related discrimination and victimization are not only asso- tive socially relevant information (Mor & Inbar, 2009), this
ciated with anxiety but also with anger (Herek et al., 1999; memory bias may serve to prolong the negative consequences
Lewis, Mason, Winstead, & Kelley, 2017; Swim, Johnston, & of perceived rejection after the social interaction has ended.
Pearson, 2009), which in turn is associated with negative health In sum, attention and memory play important roles in the RS
outcomes (e.g., alcohol-related problems; Lewis et al., 2017). dynamic and, as such, they may also have an influence on other
Research on coping with discrimination has also found that proximal minority stress processes.
some sexual minorities engage in behaviors that reflect anger in Finally, the RS model can be used to further advance our
response to discrimination (e.g., getting into an argument with understanding of the temporal sequence through which proxi-
the person, attacking others’ ignorant beliefs; Ngamake, Walch, mal minority stressors influence sexual minorities’ mental
& Raveepatarakul, 2014). Despite accumulating support for health. In the psychological mediation framework, discrimi-
the role of anger in sexual minorities’ experiences of discrimi- nation is proposed to lead to diverse cognitive, affective, and
nation, angry expectations of rejection have yet to be studied social processes that confer risk of psychopathology. However,
in this population. The distinction between different affective the psychological mediation framework situates all of these
responses associated with expectations of rejection has the general psychological processes at the same point in the causal
potential to answer important questions about sexual minori- chain (i.e., as mediators of the associations between distal
ties’ experiences of and reactions to stigma-related stressors. minority stressors and psychopathology). In contrast, the RS
Third, the RS model can be used to further advance our model describes a specific chain of events, in which anxious
understanding of the mechanisms linking proximal minor- expectations of rejection—again, a specific proximal minority
ity stressors to mental health. As noted, the psychological stressor—lead to perceptions of rejection, then cognitive–affec-
mediation framework was developed to explain how minority tive reactions, then behavioral reactions and consequences (see
stressors influence mental health (Hatzenbuehler, 2009), but Fig. 1). As such, once an individual who is high in RS detects
it largely focused on the mechanisms linking distal minority rejection, their cognitive and emotional reactions are more
stressors (e.g., discrimination) to mental health. It noted that intense and, as a result, they engage in behaviors that can have
proximal minority stressors may also contribute to the general negative consequences for their interpersonal functioning and
psychological processes that confer risk of psychopathology well-being (e.g., taking an avoidant approach to dealing with
(Hatzenbuehler, 2009), but it did not expand on the mechanisms problems, generating additional stress, engaging in behaviors
linking proximal minority stressors to mental health. The RS that elicit rejection). Clarifying the temporal sequence of this
model describes various ways in which anxious expectations casual chain has important implications for intervening to dis-
of rejection—a specific proximal minority stressor—can influ- rupt the chain of events and, in turn, to reduce its negative con-
ence mental health. sequences. Based on the RS model, intervening at the level of
While some of the proposed mechanisms in the RS model cognitive–affective reactions has the potential to prevent behav-
are similar to those in the psychological mediation framework ioral reactions as well as subsequent behavioral consequences.
(e.g., intense cognitive and emotional reactions), others are
unique. For example, the RS model suggests that individuals Developmental Considerations
who are high in RS are not only primed to detect rejection,
they are also more likely to attend to and remember it once it In the broader literature on RS, scholars have attended to devel-
has been detected. Specifically, they automatically experience opmental processes in several ways. RS has been studied across
a sense of threat in contexts in which rejection is possible, and the lifespan, including during childhood (e.g., Downey, Lebolt,
this highly aroused negative emotional state narrows their atten- Rincón, & Freitas, 1998; Zimmer-Gembeck, Nesdale, Ferst-
tional focus (Ayduk et al., 2000). Berenson et al. (2009) found erer, & Wilson, 2014), adolescence (e.g., Hafen et al., 2014;
that RS was associated with disruption of goal-directed atten- Marston, Hare, & Allen, 2010; Norona et al., 2018; Purdie
tion by social threat cues, suggesting that an attentional bias & Downey, 2000), and adulthood (e.g., Nowland, Talbot, &
toward threat may be a mechanism linking RS to its negative Qualtar, 2018), and several studies have found that RS tends
consequences. Previous research has also found that focusing to decrease throughout adolescence and into early adulthood
attention away from arousing aspects of rejection can attenu- (Hafen et al., 2014; Marston et al., 2010; Norona et al., 2018).
ate hostile and angry feelings (Ayduk, Mischel, & Downey, However, there is also evidence of individual variability in the
2002) and that strategic attention deployment can be protective extent to which RS changes over time, and for some people, it
against the negative consequences of RS (Ayduk et al., 2000), can increase (Hafen et al., 2014). Previous research has identi-
highlighting the potential for attentional strategies to disrupt the fied several factors that contribute to increases in RS over time,
RS dynamic. Scholars have also proposed that repeated activa- such as peer rejection (London et al., 2007) and symptoms of
tion of the cognitive representation of a stressor can exacerbate depression and anxiety (Marston et al., 2010), and increases in
13
Archives of Sexual Behavior
RS are associated with interpersonal difficulties (Hafen et al., behave in ways that undermine their chances of maintaining a
2014; Norona et al., 2018). Together, these findings highlight supportive and satisfying close relationship” (p. 1328). While
the importance of attending to developmental processes to the social environment has been improving for sexual minori-
understand antecedents and consequences of RS. ties in the U.S. (Pew Research Center, 2017), they continue to
From a developmental perspective, peer relationships (and experience prejudice and discrimination at the individual and
peer acceptance in particular) become increasingly important structural levels. As such, the social world is not benign for
during adolescence (Brown, 2004). Adolescence is also a criti- sexual minorities and it is possible that RS continues to serve
cal time for sexual identity development, as sexual minorities a protective function for them, at least in certain contexts. For
typically meet several milestones during this developmental example, being primed to detect subtle cues of rejection may
period (e.g., initial awareness of same-sex attractions, first help sexual minorities avoid unsafe situations. This may be
sexual experience with a same-sex partner; Calzo, Antonucci, especially important for sexual minority youth, who generally
Mays, & Cochran, 2011; Floyd & Stein, 2002). Further, sexual have less control over their environment than adults, and sexual
minorities are most likely to experience discrimination and vic- minorities who live in more hostile social environments. Fur-
timization early in their development, and these experiences ther, sexual minorities may experience some interpersonal rela-
tend to decrease across adolescence and into early adulthood tionships as affirming and others as hostile, in which case their
(e.g., Birkett, Newcomb, & Mustanski, 2015; Pachankis, Sul- anxious expectations of rejection may be maladaptive in one
livan, Feinstein, & Newcomb, 2018; Swann, Forscher, Bet- context and adaptive in another. Of note, it has been suggested
tin, Newcomb, & Mustanski, 2018). Given that adolescents that the anticipation of a stressor can be beneficial because it
contend with novel challenges (Brown, 2004) and that sexual can allow an individual to prepare to cope (Feldman & Hayes,
minority adolescents contend with unique stressors (see Gold- 2005). As such, RS may be adaptive if it prepares an individual
bach & Gibbs, 2017), sexual orientation-related RS may be to cope with potential rejection. However, while RS may serve
particularly relevant during this developmental period. a protective function for sexual minorities in certain contexts,
In contrast to the broader literature on RS, there has been it can still have negative consequences for their mental health,
limited attention to developmental processes in the literature and there is a critical need to understand the extent to which RS
on sexual orientation-related RS. In an exception, Pachankis is adaptive versus maladaptive across individuals and contexts.
et al. (2018) examined trajectories of stigma-related experi-
ences and mental health over eight years in a sample of young Interventions to Reduce Sexual Orientation‑Related
gay and bisexual men. They found that all of the stigma-related Rejection Sensitivity
experiences (including sexual orientation-related RS as well as
discrimination, internalized stigma, and sexual orientation con- A number of interventions have been developed to reduce
cealment) decreased over the course of the eight years. How- sexual minority stress and its consequences, most of which are
ever, symptoms of depression remained stable and symptoms in the early stages of efficacy testing (for a review, see Chau-
of social anxiety increased, suggesting that participants’ cir- doir, Wang, & Pachankis, 2017). Given that RS is rooted in
cumstances may have improved, but more time may have been early experiences of rejection, interventions that seek to reduce
needed for their mental health to improve as well. Additionally, stigma and improve attitudes toward sexual minorities, espe-
one study examined trajectories of sexual identity development cially among their parents (e.g., Huebner et al., 2013), have
and their associations with minority stress and mental health the potential to prevent or disrupt the development of sexual
in adulthood among sexual minority men (Rendina, Carter, orientation-related RS. Further, interventions that bolster cop-
Wahl, Millar, & Parsons, 2018). They found that faster progres- ing resources also have the potential to reduce sexual orienta-
sion from initial awareness of same-sex attraction to adopting tion-related RS. For example, the ESTEEM intervention was
and disclosing a sexual minority identity was associated with designed to reduce mental and behavioral health problems
higher levels of discrimination, emotion dysregulation, anxiety among young gay and bisexual men by targeting minority stress
and depression, and sexual compulsivity in adulthood, but it as well as universal risk factors (e.g., emotion regulation, unas-
was not associated with RS or internalized stigma. They sug- sertiveness; Pachankis et al., 2014). In a randomized controlled
gested that RS and internalized stigma may be less influenced trial, ESTEEM led to significant reductions in depression, alco-
by developmental processes than discrimination and mental/ hol use problems, and condomless sex compared to a waitlist,
behavioral health. and participants who received the intervention also reported
Scholars have also acknowledged that RS may develop as a significant reductions in minority stress, including sexual ori-
form of self-protection, which has particular relevance for the entation-related RS (Pachankis et al., 2015).
experiences of sexual minority youth. Specifically, Downey ESTEEM utilizes various techniques to address minority
and Feldman (1996) acknowledged that RS may develop as a stress, such as facilitating awareness, regulation, and accept-
form of self-protection, but that “When activated in a relatively ance of emotional experiences, restructuring maladaptive
benign social world, rejection sensitivity may lead people to cognitions, and empowering assertive communication (for
13
Archives of Sexual Behavior
a detailed description, see Burton, Wang, & Pachankis, in of eight years (Pachankis et al., 2018). These findings highlight
press). Of particular relevance to sexual orientation-related the importance of using longitudinal designs to capture the
RS, ESTEEM utilizes an ambiguous picture exercise, in which fluctuating nature of RS and its influence on mental health.
clients are presented with an image of an individual poten- Further, a strength of the RS model is its temporal specific-
tially being socially rejected and they are asked to consider ity, but longitudinal research is needed to test the sequence of
non-rejection-based explanations for what is occurring in the cognitive, affective, and behavioral reactions involved in the
picture. While preliminary evidence supports the use of these RS dynamic.
techniques to reduce sexual orientation-related RS (Pachankis Third, the cues that trigger anxious expectations of rejection
et al., 2015), additional testing is needed prior to dissemina- differ across populations, and additional research is needed to
tion and implementation. Further, the broader literature on RS capture the specific situations that elicit anxious expectations
points to additional intervention strategies for reducing RS, of rejection among subgroups of sexual minorities. Previous
such as identifying and challenging negatively biased interpre- research has documented unique stigma-related experiences
tations of ambiguous situations (Normansell & Wisco, 2017) among bisexual individuals (Bostwick & Hequembourg, 2014;
and problem-solving therapy to improve documented deficits in Brewster & Moradi, 2010; Feinstein & Dyar, 2017), sexual
social problem-solving associated with RS (Kraines & Wells, minorities of color (Balsam, Molina, Beadnell, Simoni, & Wal-
2017). However, the efficacy of these additional approaches for ters, 2011), and sexual minority youth (Goldbach & Gibbs,
reducing RS remains in question. 2017), but existing measures of sexual orientation-related RS
may not capture the situations that trigger anxious expectations
Limitations and Future Directions of rejection among these specific populations. Further, the cues
that trigger anxious expectations of rejection may be different
Throughout this article, I have described the RS model and its from those that trigger angry expectations of rejection. Given
potential to advance our understanding of sexual minorities’ the lack of attention to angry expectations of rejection among
mental health. However, it is important to acknowledge that sexual minorities, this reflects an important direction for future
research on sexual orientation-related RS is still in its infancy research.
and important questions remain. In this section, I briefly Fourth, scholars have acknowledged the need to attend to the
describe some of the methodological and conceptual limita- social context in which rejection occurs in order to understand
tions of existing research on sexual orientation-related RS. By RS and its consequences (Romero-Canyas et al., 2010). Despite
acknowledging these limitations, I hope to inspire scholars to advances in our understanding of sexual orientation-related
continue to study sexual orientation-related RS and its influ- RS, little is known about the extent to which contextual fac-
ence on mental health. tors influence anxious expectations of rejection among sexual
First, despite advances in the measurement of sexual orienta- minorities. For example, do the consequences of perceived
tion-related RS (e.g., the development of measures for specific rejection depend on contextual factors such as who enacted
sexual minority populations), our understanding of the extent to the rejection (e.g., a friend, a family member, a stranger),
which sexual minorities perceive rejection in ambiguous social whether it was overt or covert, and whether it was personally
situations is limited to their self-report. In contrast, the broader or vicariously experienced? Do sexual minorities anxiously
literature on RS has used diverse experimental paradigms to expect rejection from in-group members (e.g., others sexual
examine the associations between self-reported RS and aspects minorities) as well as out-group members (i.e., heterosexuals)?
of perception, attention, memory, affect, and behavior. As such, Fifth, despite accumulating evidence that sexual orientation-
it will be important for future research on sexual orientation- related RS is associated with negative mental health outcomes,
related RS to incorporate experimental paradigms to validate few studies have examined the underlying mechanisms (for
previous findings and to examine aspects of the RS model that exceptions, see Dyar et al., 2018; Feinstein et al., 2017). The
have not been investigated among sexual minorities (e.g., per- broader literature on RS has identified several underlying
ception, attention, memory). mechanisms (e.g., information processing biases, deficits in
Second, most of the research on sexual orientation-related social problem-solving, stress generation; Kraines & Wells,
RS has been cross-sectional, limiting our understanding of the 2017; Liu et al., 2014; Normansell & Wisco, 2017), which
extent to which RS fluctuates and influences changes in men- could help explain how RS influences sexual minorities’ mental
tal health over time among sexual minorities. In an exception, health. Further, given the role of attention (Ayduk et al., 2000)
Feinstein et al. (2017) found that gay men’s anxious expecta- and memory (Mor & Inbar, 2009) in the RS dynamic, it will
tions of rejection varied from week to week, and this weekly be important for future research on sexual orientation-related
fluctuation had a significant influence on their responses to dis- RS to test these biases and their influence on sexual minority
crimination and their mental health. Further, as noted, another mental health. Research has also identified coping strategies
recent study found that young gay and bisexual men’s anxious that racial minorities use to cope with anxious expectations
expectations of rejection significantly decreased over the course of rejection (e.g., avoiding out-group members, disengaging
13
Archives of Sexual Behavior
from domains in which one’s group is stereotyped, becoming Ethical approval This article does not contain any studies with human
involved in organizations that bring members of one’s group participants or animals performed by the author.
together; Mendoza-Denton et al., 2002), and these could also
help explain how sexual orientation-related RS influences men-
tal health.
Sixth, few studies have examined individual differences
References
in the associations between sexual orientation-related RS Ayduk, O., Downey, G., & Kim, M. (2001). Rejection sensitivity and
and negative mental health outcomes (i.e., moderators). In an depressive symptoms in women. Personality and Social Psychol-
exception, one study found that sexual orientation-related RS ogy Bulletin, 27, 868–877.
was associated with depression for gay/lesbian individuals who Ayduk, O., & Gyurak, A. (2008). Applying the cognitive-affective pro-
cessing systems approach to conceptualizing rejection sensitivity.
reported low levels of parental acceptance, but not for those Social and Personality Psychology Compass, 2, 2016–2033.
who reported high levels of parental acceptance (Feinstein, Ayduk, O., Mendoza-Denton, R., Mischel, W., Downey, G., Peake, P.
Wadsworth, Davila, & Goldfried, 2014). There is also evidence K., & Rodriguez, M. (2000). Regulating the interpersonal self:
that self-regulation abilities (e.g., abilities to manipulate atten- Strategic self-regulation for coping with rejection sensitivity. Jour-
nal of Personality and Social Psychology, 79, 776–792.
tional focus and to delay gratification) can buffer the extent Ayduk, O., Mischel, W., & Downey, G. (2002). Attentional mechanisms
to which RS leads to negative outcomes (Ayduk et al., 2000, linking rejection to hostile reactivity: The role of “hot” versus
2002), but this has not been studied among sexual minorities. “cool” focus. Psychological Science, 13, 443–448.
As such, it will be important for future research to continue Balsam, K. F., Molina, Y., Beadnell, B., Simoni, J., & Walters, K.
(2011). Measuring multiple minority stress: The LGBT People
to examine potential moderators of the associations between of Color Microaggressions Scale. Cultural Diversity and Ethnic
sexual orientation-related RS and mental health (e.g., peer and Minority Psychology, 17, 163–174.
romantic partner support, the centrality of one’s sexual orienta- Berenson, K. R., Gyurak, A., Ayduk, O., Downey, G., Garner, M. J.,
tion to one’s identity). Mogg, K., … Pine, D. S. (2009). Rejection sensitivity and dis-
ruption of attention by social threat cues. Journal of Research in
Personality, 43, 1064–1072.
Conclusions Birkett, M., Newcomb, M. E., & Mustanski, B. (2015). Does it get
better? A longitudinal analysis of psychological distress and vic-
timization in lesbian, gay, bisexual, transgender, and questioning
In sum, the RS model is well-suited to further advance our youth. Journal of Adolescent Health, 56, 280–285.
understanding of sexual minorities’ mental health. Its focus on Bostwick, W. B., Boyd, C. J., Hughes, T. L., & McCabe, S. E. (2010).
the social origins of stress is consistent with the predominant Dimensions of sexual orientation and the prevalence of mood and
anxiety disorders in the United States. American Journal of Public
conceptual models in the field (e.g., minority stress theory, the Health, 100, 468–475.
psychological mediation framework). Further, it builds on these Bostwick, W. B., Boyd, C. J., Hughes, T. L., West, B. T., & McCabe,
models in several important ways, including by emphasizing the S. E. (2014). Discrimination and mental health among lesbian,
role of perception in stigma-related experiences, acknowledg- gay, and bisexual adults in the United States. American Journal of
Orthopsychiatry, 84, 35–45.
ing the unique consequences of different anticipatory emotions, Bostwick, W., & Hequembourg, A. (2014). ‘Just a little hint’: Bisexual-
describing additional mechanisms linking proximal minority specific microaggressions and their connection to epistemic injus-
stressors to mental health, and further specifying the temporal tices. Culture, Health & Sexuality, 16, 488–503.
order of these processes. By drawing on diverse conceptual Brewster, M. E., & Moradi, B. (2010). Perceived experiences of anti-
bisexual prejudice: Instrument development and evaluation. Jour-
models, scholars can develop a more comprehensive under- nal of Counseling Psychology, 57, 451–468.
standing of the factors that influence sexual minorities’ mental Brosschot, J. F., Gerin, W., & Thayer, J. F. (2006). The perseverative
health and identify novel targets for clinical intervention. cognition hypothesis: A review of worry, prolonged stress-related
physiological activation, and health. Journal of Psychosomatic
Acknowledgements I would like to thank several people for provid- Research, 60, 113–124.
ing comments on earlier drafts of this article, including Drs. Joanne Brown, B. B. (2004). Adolescents’ relationships with peers. In R. Lerner
Davila, Christina Dyar, Brian Mustanski, Michael Newcomb, and John & L. Steinberg (Eds.), Handbook of adolescent psychology (pp.
Pachankis. 363–394). Hoboken, NJ: Wiley.
Burklund, L. J., Eisenberger, N. I., & Lieberman, M. D. (2007). The
face of rejection: Rejection sensitivity moderates dorsal anterior
Funding The author’s time was supported by a grant from the National cingulate activity to disapproving facial expressions. Social Neu-
Institute on Drug Abuse (K08DA045575). The content is solely the roscience, 2, 238–253.
responsibility of the author and does not necessarily represent the offi- Burton, C. L., Wang, K., & Pachankis, J. E. (in press). Psychotherapy
cial views of the funding agency. for the spectrum of sexual minority stress: Application and tech-
nique of the ESTEEM treatment model. Cognitive and Behavioral
Compliance with Ethical Standards Practice.
Calzo, J. P., Antonucci, T. C., Mays, V. M., & Cochran, S. D. (2011).
Conflict of interest Brian A. Feinstein declares that he has no conflict Retrospective recall of sexual orientation identity development
of interest. among gay, lesbian, and bisexual adults. Developmental Psychol-
ogy, 47, 1658–1673.
13
Archives of Sexual Behavior
Chan, W., & Mendoza-Denton, R. (2008). Status-based rejection sen- Feldman, G., & Hayes, A. (2005). Preparing for problems: A measure
sitivity among Asian Americans: Implications for psychological of mental anticipatory processes. Journal of Research in Personal-
distress. Journal of Personality, 76, 1317–1346. ity, 39, 487–516.
Chaudoir, S. R., Wang, K., & Pachankis, J. E. (2017). What reduces Floyd, F. J., & Stein, T. S. (2002). Sexual orientation identity forma-
sexual minority stress? A review of the intervention “toolkit”. tion among gay, lesbian, and bisexual youths: Multiple patterns
Journal of Social Issues, 73, 586–617. of milestone experiences. Journal of Research on Adolescence,
Cohen, J. M., Feinstein, B. A., Rodriguez-Seijas, C., Taylor, C. B., 12, 167–191.
& Newman, M. G. (2016). Rejection sensitivity as a transdiag- Friedman, M. S., Marshal, M. P., Guadamuz, T. E., Wei, C., Wong, C. F.,
nostic risk factor for internalizing psychopathology among gay Saewyc, E. M., & Stall, R. (2011). A meta-analysis of disparities in
and bisexual men. Psychology of Sexual Orientation and Gender childhood sexual abuse, parental physical abuse, and peer victimi-
Diversity, 3, 259–264. zation among sexual minority and sexual nonminority individuals.
Downey, G., Bonica, C., & Rincon, C. (1999). Rejection sensitiv- American Journal of Public Health, 101, 1481–1494.
ity and adolescent romantic relationships. In W. Furman, B. B. Gao, S., Assink, M., Cipriani, A., & Lin, K. (2017). Associations
Brown, & C. Feiring (Eds.), The development of romantic rela- between rejection sensitivity and mental health outcomes: A meta-
tionships in adolescence (pp. 148–174). New York: Cambridge analytic review. Clinical Psychology Review, 57, 59–74.
University Press. Goldbach, J. T., & Gibbs, J. J. (2017). A developmentally informed
Downey, G., & Feldman, S. I. (1996). Implications of rejection sen- adaptation of minority stress for sexual minority adolescents. Jour-
sitivity for intimate relationships. Journal of Personality and nal of Adolescence, 55, 36–50.
Social Psychology, 70, 1327–1343. Hafen, C. A., Spilker, A., Chango, J., Marston, E. S., & Allen, J. P.
Downey, G., Freitas, A. L., Michaelis, B., & Khouri, H. (1998). The (2014). To accept or reject? The impact of adolescent rejection sen-
self-fulfilling prophecy in close relationships: Rejection sensitiv- sitivity on early adult romantic relationships. Journal of Research
ity and rejection by romantic partners. Journal of Personality on Adolescence, 24, 55–64.
and Social Psychology, 75, 545–560. Hatzenbuehler, M. L. (2009). How does sexual minority stigma “get
Downey, G., Khouri, H., & Feldman, S. (1997). Early interpersonal under the skin”? A psychological mediation framework. Psycho-
trauma and adult attachment: The mediational role of rejection logical Bulletin, 135, 707–730.
sensitivity. In D. Cicchetti & S. Toth (Eds.), Rochester sympo- Hatzenbuehler, M. L., Nolen-Hoeksema, S., & Dovidio, J. (2009). How
sium in developmental psychopathology, Vol. VIII: The effects of does stigma “get under the skin”? The mediating role of emotion
trauma on the developmental process (pp. 85–114). Rochester, regulation. Psychological Science, 20, 1282–1289.
NY: University of Rochester Press. Hatzenbuehler, M. L., Nolen-Hoeksema, S., & Erickson, S. J. (2008).
Downey, G., Mougios, V., Ayduk, O., London, B. E., & Shoda, Y. Minority stress predictors of HIV risk behavior, substance use,
(2004). Rejection sensitivity and the defensive motivational sys- and depressive symptoms: Results from a prospective study of
tem: Insights from the startle response to rejection cues. Psycho- bereaved gay men. Health Psychology, 27, 455–462.
logical Science, 15, 668–673. Herek, G. M., Gillis, J. R., & Cogan, J. C. (1999). Psychological seque-
Dyar, C., Feinstein, B. A., Eaton, N. R., & London, B. (2016). Devel- lae of hate-crime victimization among lesbian, gay, and bisex-
opment and initial validation of the Sexual Minority Women ual adults. Journal of Consulting and Clinical Psychology, 67,
Rejection Sensitivity Scale. Psychology of Women Quarterly, 945–951.
40, 120–137. Huebner, D. M., Rullo, J. E., Thoma, B. C., McGarrity, L. A., & Mac-
Dyar, C., Feinstein, B. A., Eaton, N. R., & London, B. (2018). The kenzie, J. (2013). Piloting lead with love: A film-based intervention
mediating roles of rejection sensitivity and proximal stress in the to improve parents’ responses to their lesbian, gay, and bisexual
association between discrimination and internalizing symptoms children. Journal of Primary Prevention, 34, 359–369.
among sexual minority women. Archives of Sexual Behavior, Kerridge, B. T., Pickering, R. P., Saha, T. D., Ruan, W. J., Chou, S. P.,
47, 205–218. Zhang, H., … Hasin, D. S. (2017). Prevalence, sociodemographic
Dyar, C., & London, B. (2018). Bipositive events: Associations with correlates and DSM-5 substance use disorders and other psychi-
proximal stressors, bisexual identity, and mental health among atric disorders among sexual minorities in the United States. Drug
bisexual cisgender women. Psychology of Sexual Orientation and Alcohol Dependence, 170, 82–92.
and Gender Diversity, 5, 204–219. King, M., Semlyen, J., Tai, S. S., Killaspy, H., Osborn, D., Popelyuk, D.,
Feinstein, B. A., Davila, J., & Dyar, C. (2017). A weekly diary study & Nazareth, I. (2008). A systematic review of mental disorder, sui-
of minority stress, coping, and internalizing symptoms among cide, and deliberate self harm in lesbian, gay and bisexual people.
gay men. Journal of Consulting and Clinical Psychology, 85, BMC Psychiatry, 8, 70. https://doi.org/10.1186/1471-244X-8-70.
1144–1157. Kraines, M. A., & Wells, T. T. (2017). Rejection sensitivity and depres-
Feinstein, B. A., & Dyar, C. (2017). Bisexuality, minority stress, and sion: Indirect effects through problem solving. Psychiatry, 80,
health. Current Sexual Health Reports, 9, 42–49. 55–63.
Feinstein, B. A., Goldfried, M. R., & Davila, J. (2012). The relation- Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping.
ship between experiences of discrimination and mental health New York: Springer.
among lesbians and gay men: An examination of internalized Lewis, R. J., Mason, T. B., Winstead, B. A., & Kelley, M. L. (2017).
homonegativity and rejection sensitivity as potential mecha- Empirical investigation of a model of sexual minority specific and
nisms. Journal of Consulting and Clinical Psychology, 80, general risk factors for intimate partner violence among lesbian
917–927. women. Psychology of Violence, 7, 110–119.
Feinstein, B. A., Wadsworth, L. P., Davila, J., & Goldfried, M. R. (2014). Liao, K. Y.-H., Kashubeck-West, S., Weng, C.-Y., & Deitz, C. (2015).
Do parental acceptance and family support moderate associations Testing a mediation framework for the link between perceived
between dimensions of minority stress and depressive symptoms? discrimination and psychological distress among sexual minor-
Professional Psychology: Research and Practice, 45, 239–246. ity individuals. Journal of Counseling Psychology, 62, 226–241.
Feldman, S., & Downey, G. (1994). Rejection sensitivity as a media- Lilienfeld, S. O. (2017). Microaggressions. Perspectives on Psychologi-
tor of the impact of childhood exposure to family violence on cal Science, 12, 138–169.
adult attachment behavior. Development and Psychopathology,
6, 231–247.
13
Archives of Sexual Behavior
Liu, R. T., Kraines, M. A., Massing-Schaffer, M., & Alloy, L. B. (2014). Nowland, R., Talbot, R., & Qualter, P. (2018). Influence of loneliness
Rejection sensitivity and depression: Mediation by stress genera- and rejection sensitivity on threat sensitivity in romantic relation-
tion. Psychiatry, 77, 86–97. ships in young and middle-aged adults. Personality and Individual
London, B., Downey, G., Bonica, C., & Paltin, I. (2007). Social causes Differences, 131, 185–190.
and consequences of rejection sensitivity. Journal of Research on Olsson, A., Carmona, S., Downey, G., Bolger, N., & Ochsner, K. N.
Adolescence, 17, 481–506. (2013). Learning biases underlying individual differences in sen-
London, B., Downey, G., Romero-Canyas, R., Rattan, A., & Tyson, sitivity to social rejection. Emotion, 13, 616–621.
D. (2012). Gender-based rejection sensitivity and academic self- Pachankis, J. E., Goldfried, M. R., & Ramrattan, M. E. (2008). Exten-
silencing in women. Journal of Personality and Social Psychology, sion of the rejection sensitivity construct to the interpersonal func-
102, 961–979. tioning of gay men. Journal of Consulting and Clinical Psychol-
Major, B., McCoy, S., Kaiser, C., & Quinton, W. (2003). Prejudice and ogy, 76, 306–317.
self-esteem: A transactional model. European Review of Social Pachankis, J. E., Hatzenbuehler, M. L., & Starks, T. J. (2014). The influ-
Psychology, 14, 77–104. ence of structural stigma and rejection sensitivity on young sexual
Marston, E. G., Hare, A., & Allen, J. P. (2010). Rejection sensitivity minority men’s daily tobacco and alcohol use. Social Science and
in late adolescence: Social and emotional sequelae. Journal of Medicine, 103, 67–75.
Research on Adolescence, 20, 959–982. Pachankis, J. E., Rendina, H. J., Restar, A., Ventuneac, A., Grov, C., &
Mays, V. M., & Cochran, S. D. (2001). Mental health correlates of Parsons, J. T. (2015). A minority stress-emotion regulation model
perceived discrimination among lesbian, gay, and bisexual adults of sexual compulsivity among highly sexually active gay and
in the United States. American Journal of Public Health, 91, bisexual men. Health Psychology, 34, 829–840.
1869–1876. Pachankis, J. E., Sullivan, T. J., Feinstein, B. A., & Newcomb, M. E.
McCabe, S. E., Hughes, T. L., Bostwick, W. B., West, B. T., & Boyd, (2018). Young adult gay and bisexual men’s stigma experiences
C. J. (2009). Sexual orientation, substance use behaviors and and mental health: An 8-year longitudinal study. Developmental
substance dependence in the United States. Addiction, 104, Psychology. https://doi.org/10.1037/dev0000518.
1333–1345. Pew Research Center. (2017). Changing attitudes on gay marriage.
Mendoza-Denton, R., Downey, G., Purdie, V. J., Davis, A., & Pietrzak, Retrieved from http://www.pewfor um.org/fact-sheet/changing-
J. (2002). Sensitivity to status-based rejection: Implications for attitudes-on-gay-marriage/.
African American students’ college experience. Journal of Per- Puckett, J. A., Maroney, M. R., Levitt, H. M., & Horne, S. G. (2016a).
sonality and Social Psychology, 83, 896–918. Relations between gender expression, minority stress, and mental
Meyer, I. H. (2003). Prejudice, social stress, and mental health in les- health in cisgender sexual minority women and men. Psychology
bian, gay, and bisexual populations: Conceptual issues and research of Sexual Orientation and Gender Diversity, 3, 489–498.
evidence. Psychological Bulletin, 129, 674–697. Puckett, J. A., Surace, F. I., Levitt, H. M., & Horne, S. G. (2016b).
Miller, D. T. (2001). Disrespect and the experience of injustice. Annual Sexual orientation identity in relation to minority stress and men-
Review of Psychology, 52, 527–553. tal health in sexual minority women. LGBT Health, 3, 350–356.
Mohr, J. J., & Sarno, E. L. (2016). The ups and downs of being lesbian, Purdie, V., & Downey, G. (2000). Rejection sensitivity and adolescent
gay, and bisexual: A daily experience perspective on minority girls’ vulnerability to relationship-centered difficulties. Child Mal-
stress and support processes. Journal of Counseling Psychology, treatment, 5, 338–349.
63, 106–118. Rendina, H. J., Carter, J. A., Wahl, L., Millar, B. M., & Parsons, J. T.
Mor, N., & Inbar, M. (2009). Rejection sensitivity and schema-congru- (2018). Trajectories of sexual identity development and psycho-
ent information processing biases. Journal of Research in Person- logical well-being for highly sexually active gay and bisexual men:
ality, 43, 392–398. A latent growth curve analysis. Psychology of Sexual Orientation
Morrison, M. A., & Morrison, T. G. (2002). Development and validation and Gender Diversity. https://doi.org/10.1037/sgd0000308.
of a scale measuring modern prejudice toward gay men and lesbian Riggle, E. D. B., Rostosky, S. S., Black, W. W., & Rosenkrantz, D. E.
women. Journal of Homosexuality, 43, 15–37. (2017). Outness, concealment, and authenticity: Associations with
Mustanski, B., & Liu, R. T. (2013). A longitudinal study of predictors LGB individuals’ psychological distress and well-being. Psychol-
of suicide attempts among lesbian, gay, bisexual, and transgender ogy of Sexual Orientation and Gender Diversity, 4, 54–62.
youth. Archives of Sexual Behavior, 42, 437–448. Romero-Canyas, R., Downey, G., Berenson, K., Ayduk, O., & Kang,
Nadal, K. L., Whitman, C. N., Davis, L. S., Erazo, T., & Davidoff, K. C. N. J. (2010). Rejection sensitivity and the rejection-hostility link
(2016). Microaggressions toward lesbian, gay, bisexual, transgen- in romantic relationships. Journal of Personality, 78, 119–148.
der, queer, and genderqueer people: A review of the literature. Smart Richman, L., & Leary, M. R. (2009). Reactions to discrimination,
Journal of Sex Research, 53, 488–508. stigmatization, ostracism, and other forms of interpersonal rejec-
Newcomb, M. E., & Mustanski, B. (2010). Internalized homophobia tion: A multimotive model. Psychological Review, 116, 365–383.
and internalizing mental health problems: A meta-analytic review. Swann, G., Forscher, E., Bettin, E., Newcomb, M. E., & Mustanski, B.
Clinical Psychology Review, 30, 1019–1029. (2018). Effects of victimization on mental health and substance
Ngamake, S. T., Walch, S. E., & Raveepatarakul, J. (2014). Validation of use trajectories in young sexual minority men. Development and
the Coping with Discrimination Scale in sexual minorities. Journal Psychopathology. https://doi.org/10.1017/S0954579418001013.
of Homosexuality, 61, 1003–1024. Swim, J. K., Johnston, K., & Pearson, N. B. (2009). Daily experiences
Normansell, K. M., & Wisco, B. E. (2017). Negative interpretation bias with heterosexism: Relationships between heterosexist hassles and
as a mechanism of the relationship between rejection sensitivity psychological well-being. Journal of Social and Clinical Psychol-
and depressive symptoms. Cognition and Emotion, 31, 950–962. ogy, 28, 597–629.
Norona, J. C., Tregubenko, V., Boiangiu, S. B., Levy, G., Scharf, M., Velez, B. L., & Moradi, B. (2016). A moderated mediation test of minor-
Welsh, D. P., & Shulman, S. (2018). Changes in rejection sensitiv- ity stress: The role of collective action. The Counseling Psycholo-
ity across adolescence and emerging adulthood: Associations with gist, 44, 1132–1157.
relationship involvement, quality, and coping. Journal of Adoles- Velez, B. L., Watson, L. B., Cox, R., Jr., & Flores, M. J. (2017). Minor-
cence, 63, 96–106. ity stress and racial or ethnic minority status: A test of the greater
13
Archives of Sexual Behavior
risk perspective. Psychology of Sexual Orientation and Gender attitudes and mood depend on rejection sensitivity and relationship
Diversity, 4, 257–271. history. Australian Journal of Psychology, 66, 8–17.
Walls, N. E. (2008). Toward a multidimensional understanding of het- Zimmer-Gembeck, M. J., Nesdale, D., Webb, H. J., Khatibi, M., &
erosexism: The changing nature of prejudice. Journal of Homo- Downey, G. (2016). A longitudinal rejection sensitivity model of
sexuality, 55, 20–70. depression and aggression: Unique roles of anxiety, anger, blame,
Wang, J., Leu, J., & Shoda, Y. (2011). When the seemingly innocuous withdrawal, and retribution. Journal of Abnormal Child Psychol-
“stings”: Racial microaggressions and their emotional consequences. ogy, 44, 1291–1307.
Personality and Social Psychology Bulletin, 37, 1666–1678.
Wang, K., & Pachankis, J. E. (2016). Gay-related rejection sensitivity as Publisher’s Note Springer Nature remains neutral with regard to
a risk factor for condomless sex. AIDS and Behavior, 20, 763–767. jurisdictional claims in published maps and institutional affiliations.
Zimmer-Gembeck, M. J., & Nesdale, D. (2013). Anxious and angry
rejection sensitivity, social withdrawal, and retribution in high
and low ambiguous situations. Journal of Personality, 81, 29–38.
Zimmer-Gembeck, M. J., Nesdale, D., Fersterer, J., & Wilson, J. (2014).
An experimental manipulation of rejection: Effects of children’s
13