A Call to Analyze Sex, Gender, and Sexual Orientation in Psychopathology Research: An Illustration with ADHD and Internalizing Symptoms in Emerging Adults

We have historically ignored sex/gender and conducted sex- and gender-neutral psychopathology research. There is a clear need to analyze potential differences and similarities between individuals with various sexes, genders, and sexual orientations in psychopathology research. Specifically, we need to stop ignoring sex, gender, and sexual orientation, conduct analyses that go beyond the binary, and analyze these important variables for generalizability even when the primary research question is not about sex, gender, and sexual orientation. In the current study we examined ADHD and internalizing symptoms in a community sample to compare different ways to analyze data and better understand differences and similarities across groups. We predicted that a richer understanding of sex/gender differences would emerge when we compared sex and gender minority (SGM) participants to cisgender heterosexual women (CHW) and men (CHM) rather than conducting binary analyses. Emerging adults (<i>N</i> = 2,938; ages 18-29 years) completed an online survey, responding to demographic items, as well as ADHD and internalizing symptoms. Binary analyses using biological sex and gender identity yielded no differences in ADHD symptoms, and the expected female preponderance in internalizing symptoms. However, when analyzed across three groups, individuals in the SGM group reported higher levels of ADHD and internalizing symptoms compared with the other two groups. Notably, no differences emerged for internalizing symptoms across CHW and CHM when the SGM group was included. This is compelling evidence that analyzing sex, gender, and sexual orientation more systematically and precisely in psychopathology research is warranted.