A client sits across from me describing, for the third session in a row, a symptom his physicians can’t explain. Chest tightness that isn’t cardiac. Stomach pain that isn’t gastrointestinal. A jaw he’s been told he clenches in his sleep so hard he’s cracked a molar. He’s had the workup. Everything comes back clean.
What doesn’t come back clean, eventually, is the story underneath it: a childhood inside a high-control Evangelical church, a family for whom his sexuality was never a private fact but a standing crisis, and twenty-some years of a body that has been asked to carry what his voice was never permitted to say. He is not malingering. He is not imagining the pain. His body has been telling a truth his household would not let him speak, for longer than he can remember choosing to stay silent.
This pattern — LGBTQ+ and transgender clients whose religious upbringing, usually though not exclusively from a Judeo-Christian framework, produced years of enforced self-erasure that later surfaces as physical symptoms — is common enough in clinical practice that it deserves to be named directly rather than treated as a coincidental overlap of two unrelated struggles.
High Religiosity as a High-Conflict System
Family systems theory gives us useful language here, even outside a religious context: differentiation of self, the capacity to hold onto your own identity and values while remaining emotionally connected to a family or group, sits on a spectrum. Low differentiation means the individual’s sense of self gets absorbed into the group’s expectations; disagreement isn’t just uncomfortable, it’s experienced by the system as a threat to the whole.
High-religiosity environments, particularly ones organized around strict interpretations of sexuality and gender, often function as very low-differentiation systems by design. The individual’s job is not to have a separate self so much as to correctly express the group’s shared self. When a child or adolescent in that system begins to recognize that they are gay, bisexual, transgender, or otherwise outside the framework the family and community have built their entire moral architecture around, the system doesn’t experience this as one person’s private development. It experiences it as a rupture in the whole — which is precisely why the conflict that follows is so often disproportionate to anything the young person has actually done. They haven’t harmed anyone. They have simply become visible as different, inside a system that treats difference as danger.
This is where authenticity and belonging get set up as mutually exclusive, often for the first time in a person’s life, and often at an age before they have any other framework for choosing between them.
The Cost of Constant Self-Disregard
Faced with that bind, most young people in these systems don’t choose authenticity. They can’t; the material and relational stakes are too high, and the nervous system of a child or teenager is not built to sacrifice attachment for self-expression. What they choose instead, almost universally, is disregard — a practiced, repeated overriding of their own internal experience in favor of what the family or community needs them to be.
This is not a single decision made once. It’s a posture, rehearsed daily, sometimes for decades: noticing an attraction and immediately suppressing the noticing; feeling a mismatch between one’s body and one’s assigned gender and learning to not feel it, or to feel it only in private, or to feel it and immediately narrate it as sin, sickness, or a trial to be endured. Each instance is small. The accumulation is not. Clients often describe this less as hiding a secret and more as a kind of internal amputation practiced so continuously that they stopped noticing they were doing it.
Buddhist psychology, which is central to how I approach this work, offers a useful distinction here that’s worth naming explicitly, because it’s easy to confuse the two. Interbeing — the recognition that we are not isolated selves but relational, interconnected beings — is not the same thing as the self-erasure demanded by a high-control system. Interbeing describes a chosen, mutual interdependence; what happens in these families is closer to enmeshment enforced through fear, where connection is conditional on disappearance. One is a spiritual orientation toward relationship. The other is coercion wearing relationship’s clothing. Clients who have only ever experienced the second often need real help distinguishing it from the first before “connection” or “belonging” can be trusted as concepts again at all.
Where the Inauthenticity Goes: Somatization
The body does not have an infinite capacity to hold what the voice isn’t allowed to say. When authentic experience is chronically suppressed rather than expressed or even privately acknowledged, that suppression doesn’t disappear — it moves. Clinically, this shows up as somatization: physical symptoms without a clear medical cause, or medical symptoms substantially amplified by chronic nervous system dysregulation.
The mechanism isn’t mysterious. Chronic identity-related suppression functions as a sustained, low-grade threat response — the nervous system treats “if I am known, I may be rejected or harmed” as an ongoing danger, not a one-time event, for years at a stretch. Sustained sympathetic activation has well-documented downstream effects: gastrointestinal disruption, tension headaches and jaw clenching, chest tightness, chronic fatigue, autoimmune flare patterns in people already predisposed. None of this requires the client to be consciously aware of what they’re suppressing. Many clients in this pattern present initially as having no idea why their body is doing what it’s doing, because the suppression itself was so early and so total that it no longer registers as an active choice — it registers as simply how they are.
This is also, clinically, why talk therapy alone sometimes underperforms with this population in the early stages of treatment. A client who has spent two decades disconnecting from bodily and emotional signal as a survival strategy often cannot simply be asked to “notice their feelings” and comply — the noticing itself was the thing they trained themselves out of. Somatic awareness work, done slowly and with real attention to pacing, is frequently necessary groundwork before the more narrative parts of treatment can land.
What This Means Clinically
A few things follow from understanding this pattern as a coherent whole rather than a set of coincidentally overlapping issues.
First, the physical symptoms are not a detour from the “real” clinical work. They are frequently the most honest data in the room — the place where years of enforced inauthenticity finally became undeniable, even to a client who has otherwise gotten quite skilled at not noticing. Treating the somatic presentation with the same seriousness as the identity material, rather than as a side effect to be managed separately, tends to produce better outcomes than treating them sequentially.
Second, clients from these backgrounds often need explicit help separating spirituality from the specific system that harmed them. Religious trauma is not the same thing as an inability to have any spiritual life at all, and clients are frequently relieved to learn that the two can be decoupled — that leaving behind a coercive framework doesn’t necessarily mean leaving behind meaning, ritual, or a relationship to something larger than themselves, if those things are wanted.
Third, the work of re-differentiation — learning to hold a self that doesn’t dissolve the moment it conflicts with a group’s expectations — is often slow, and slower still when the client’s formative experience taught them that differentiation itself was the original sin. Patience with that pace is not a delay in treatment. It is the treatment.
The client I described at the start of this piece did not, in the end, need a cardiologist or a gastroenterologist to explain what his body had been doing. He needed permission, extended slowly and repeatedly, to notice what he had spent a lifetime being told was too dangerous to feel. The jaw unclenched, gradually, only after the rest of him was finally allowed to speak.
By: Mx. Love C. Dialogos, LMFT
