Unraveling psychosis risk in sexual minorities: temporal dynamics of social defeat and suspiciousness in adolescence.

BACKGROUND Previous research suggests that sexual minorities are at higher risk for psychotic experiences, possibly due to repeated social defeat experiences. However, empirical research investigating this hypothesis is largely lacking. This study examined how experiences of "feeling excluded" and "not belonging" impact the prospective development of psychotic experiences in an adolescent sexual minority group, defined here as non-heterosexual attraction to others. METHODS Experience sampling method (ESM) data from 1913 Flemish adolescents (aged 11-20) in the SIGMA study were analyzed. They reported their momentary feelings of exclusion when alone, belonging when in the company of others (both operationalizations of social defeat), and suspiciousness. Multilevel linear regression models tested the bidirectional, within- and between-person associations between social defeat and suspiciousness, and the effects of sexual minority status. RESULTS Lower feelings of belonging when in company significantly predicted higher suspiciousness at the next beep [95% CI: -0.03, -0.01], whereas increased feelings of exclusion when alone did not. Moreover, suspiciousness did not significantly predict feelings of exclusion and belonging at the next beep, confirming the direction of effect. Sexual minority participants reported generally lower belonging in social settings [95% CI: -0.68, -0.29] and higher suspiciousness [95% CI: 0.16, 0.57], but not higher feelings of exclusion. The interaction between social defeat and sexual minority status was not significant, indicating no differential sensitivity to social defeat experiences. CONCLUSIONS The experience of "not fitting in" when in company may be the most poignant social factor increasing risk for psychotic experiences in sexual minority youth. The findings highlight the need for inclusive environments where sexual minority individuals feel supported and integrated.