Identity and Psychosis Risk in Sexual Minority Youth: Temporal Dynamics of Identity and Suspiciousness Through Experience Sampling Methodology.

Abstract

Background and hypotheses: Sexual minority youth are at increased risk for psychotic experiences, potentially due to identity-related difficulties. We hypothesized that sexual minority youth would report greater identity difficulties, and that these difficulties would be associated with heightened suspiciousness in daily life. Finally, we examined whether these associations differ between sexual minority and heterosexual adolescents.

Study design: Experience Sampling Method (ESM) and questionnaire data were collected from 1913 Flemish adolescents (aged 11-20). Identity functioning was assessed using a validated questionnaire (Erikson Psychosocial Stage Inventory, EPSI) and momentary assessments via ESM. Suspiciousness was also measured through ESM. Multilevel linear regression models tested within- and between-person associations between identity functioning and suspiciousness, and explored moderation by sexual minority status.

Study results: Sexual minority participants reported significantly lower identity synthesis, higher identity confusion, and greater momentary identity difficulties. At the within-person level, lower momentary identity functioning predicted higher suspiciousness both concurrently and at subsequent time points. Suspiciousness also predicted later identity difficulties, indicating a bidirectional relationship. Sexual minority status moderated these effects: Identity confusion was more strongly associated with suspiciousness in sexual minority youth, while identity synthesis appeared protective only in heterosexual youth.

Conclusions: Identity difficulties are closely linked to suspiciousness in adolescents, particularly among sexual minority youth. The bidirectional relationship suggests a reinforcing cycle that may increase vulnerability to psychotic experiences. These findings stress the need for preventive interventions that address identity integration during adolescence, especially for sexual minority adolescents navigating identity development in a heteronormative context.