Internal and external mediators of women's sexual abuse in childhood

Prevalence of childhood sexual abuse among incarcerated males in county jail

OBJECTIVE

The current study examined the prevalence and characteristics of childhood sexual abuse in a jailed-based population.

METHODOLOGY

A retrospective, self-reported survey was administered over an 8-week period to a random sample of 100 men who were incarcerated in a county jail in Southeastern Texas. The survey included questions about childhood sexual experiences before and after puberty, drug history and use, and sexual risk-taking behaviors.

RESULTS

Of the 100 male inmates who participated in this study, 59% reported experiencing some form of sexual abuse before puberty, and all such instances occurred before or at the age of 13 years. The first episode of childhood sexual abuse began at an average age of 9.6 years (SD = 2.4), and ended at an average age of 13.0 years (SD = 2.3). Kissing and touching without intercourse (64%) was the common pattern of sexual abuse experience reported. The total number of perpetrators was 165, with 10% male and 90% female. Friends (n = 72) and family (n = 56) were the most frequent perpetrators.

CONCLUSION

Childhood sexual abuse may be more prevalent among inmates than among males in the general population. These results show a high percentage of inmates who report a history of childhood sexual abuse; this rate is higher than those reported by other studies for incarcerated males. The findings support the belief held by professionals in the criminal justice field that a significant number of incarcerated males may have been victims of sexual abuse.

Childhood sexual abuse, social support, and psychological outcomes: a loss framework

OBJECTIVE

The objectives of the study were: (a) to develop a scale to assess CSA-related loss among a college sample of CSA survivors (CSALM), (b) to examine the measure's convergent validity through associations among depression, alexithymia, coping, and social support, and (c) to test whether social support moderates the relation between multiple experiences of CSA and loss.

METHOD

The study involved a survey methodology and included college-age women (n=116) reporting CSA experiences.

RESULTS

Based on the Sexual Victimization Questionnaire (SVQ; [Finkelhor, D. (1979). Sexually victimized children. New York: The Free Press]), 90% of the sample reported CSA before age of 12, 12.3% (n=15) reported CSA before age 12 with an adult over 16, and 42.2% (n=49) reported CSA after age 12 with an adult. Exploratory Factor Analysis of the CSALM revealed a three-factor solution: (a) Loss of Optimism, (b) Loss of Self, and (c) Loss of Childhood. Convergent validity of several scales was evidenced through associations with depression, alexithymia, coping, and social support. Social support from family and friends was found to moderate the association between CSA experiences and loss dimensions.

CONCLUSIONS

Findings provide preliminary psychometric support for the CSALM, a tool that will be useful in future investigations of loss among college-age CSA survivors. Findings also support using a loss framework to understand the current mental health of these survivors.

Does a History of Childhood Sexual Abuse Affect Sexual Outcomes in Breast Cancer Survivors?

Purpose

Little is known about a history of childhood sexual abuse (CSA) in breast cancer survivors and its relationship to sexual functioning after cancer. As part of a larger survey study examining sexuality and intimacy in breast cancer survivors, we conducted in-person interviews with a subsample of participants.

Methods

A total of 147 women in Los Angeles, CA, and Washington, DC, completed a structured interview that addressed sexual socialization and a history of sexual abuse. Trained female interviewers conducted the interviews. Descriptive statistics and regression analyses were used to examine the prevalence of CSA, and its potential impact on sexual health and functioning.

Results

One in three women reported at least one CSA incident. Among women who had experienced CSA, 71% reported a single incident, and 22% reported a penetrative form of sexual contact. In multivariate regression analyses examining physical and psychological aspects of sexuality and body image, CSA was not a significant predictor of physical discomfort. However, a history of penetrative CSA was a significant predictor of psychological discomfort (P = .02).

Conclusion

The prevalence of CSA in this sample was similar to the general population literature on this topic. In this small sample, a past history of CSA did not contribute significantly to the physical discomforts associated with sexual intimacy after breast cancer; however, our findings suggest that a past history of penetrative CSA is associated with increased psychological discomfort, and may warrant additional examination in future research.

Mediators of the link between childhood sexual abuse and emotional distress: a critical review

A history of childhood sexual abuse (CSA) is a risk factor for adult emotional distress, including symptoms of depression, anxiety, dissociation, and trauma. However, CSA is likely associated with adult distress indirectly through an impact on mediating variables. In a review of the empirical literature, the authors found support for the roles of shame or self-blame, interpersonal difficulties, and avoidant coping strategies as mediators. In addition, emotional distress appears to mediate links between CSA and other adverse outcomes, such as alcohol abuse and revictimization. The authors conclude with a number of methodological and conceptual recommendations.

The role of disclosing child sexual abuse on adolescent adjustment and revictimization

The role of disclosing child sexual abuse on adolescent survivors' symptomatology and the presence of additional unwanted sexual experiences was investigated in a subsample of 111 adolescents from the National Survey of Adolescents who reported child sexual abuse. Results indicated that prompt disclosure of sexual abuse to an adult moderated the influence of penetration during the abuse on the number of symptoms at assessment. Thus, prompt disclosure buffered the influence of more severe abuse. Disclosure also had a main effect on the likelihood of further victimization. Participants who told an adult promptly after the abuse were less likely to report additional unwanted sexual experiences.

Many ways of telling: expanding conceptualizations of child sexual abuse disclosure

OBJECTIVE

The aim of this study was to explore influences that inhibit or promote child sexual abuse (CSA) disclosure.

METHOD

Face-to-face in-depth interviews of 24 female and male survivors of CSA were conducted, using the Long-Interview method to trace disclosure processes. Verbatim transcriptions of the interviews were analyzed by hand and by using a computerized data analysis system (N*Vivo). The results of this investigation identified several patterns of disclosure. Prolonged engagement, persistent observation, negative case analysis, and peer debriefing were among the techniques used to ensure the trustworthiness of data.

RESULTS

Through analysis of the interview data, previously undefined dimensions of disclosure emerged. First, three frequently used categories of 'accidental, purposeful, and prompted/elicited' disclosure types accounted for 42% of disclosure patterns in the study sample. However, over half the disclosure patterns described by research participants did not fit these previously established definitions. Results of the study facilitated expanding conceptualization of additional disclosure patterns to include behavioral and indirect verbal attempts, disclosures intentionally withheld, and disclosures triggered by recovered memories.

CONCLUSIONS

The author concludes that these supplementary definitions integrate complex facets of disclosure derived within the context of human development, memory and environmental influences. This expanded conceptualization provides professionals with a broader framework to understand and respond to child victims and adult survivor's disclosures more effectively.

Childhood trauma and adult interpersonal functioning: a study using the Core Conflictual Relationship Theme Method (CCRT)

OBJECTIVE

This study aimed to examine the long-term correlates of childhood trauma in regard to interpersonal functioning in adulthood.

METHOD

One hundred and nineteen (N=119) subjects from the Austen Riggs Follow-along Study were included in the study. The Traumatic Antecedent Interview scoring method was used to assess 10 types of childhood trauma. Two additional positive variables were also assessed. Interpersonal patterns in adulthood were assessed using the Core Conflictual Relationship Theme Method.

RESULTS

Subjects reporting childhood physical abuse had a higher prevalence of the wish to be hurt, and experienced others as strict and stern. Those reporting physical neglect had a higher prevalence of the need to be comforted. Subjects who had experienced significant separations during childhood later felt less self-confident in interpersonal situations. Results also showed that subjects who had access to a caretaker/confidant had less need for love. A number of additional findings were nominally significant but did not remain so after correction for multiple comparisons.

CONCLUSIONS

The findings indicate that internalized thoughts and affects regarding childhood traumatic events may still play a role long after the time period of the events. Results also suggest that a continuous measurement approach to the study of traumata may provide information not captured by a dichotomous approach.

Disclosure, reactions, and social support: findings from a sample of adult victims of child sexual abuse

Information about abuse characteristics, disclosure, and current social support was collected through semistructured interviews and questionnaires from 122 adult women reporting exposure to child sexual abuse by someone close. Women who used an active disclosure strategy in childhood reported more physical and violent abuse. Moreover, women who reported more severe abuse had more often received negative reactions from the social network. Furthermore, a relation was found between current social support and positive-but not negative-reactions.

Differences in trauma symptoms and family functioning in intra-and extrafamilial sexually abused adolescents

This study investigated to what extent abuse-related symptoms and family functioning are related to intra- or extrafamilial sexual abuse. One hundred adolescents (12 to 18 years old) were recruited shortly after disclosure of the abuse. Information from the participants was obtained through self-report questionnaires and a semistructured interview. Fifty-three percent of the adolescents reported clinically significant symptoms. Data did not support the idea that intrafamilial sexually abused adolescents report more symptoms than extrafamilial sexually abused adolescents. Type of abuse did not account for the differences and variety of reported symptoms or for differences in family functioning. Family functioning-in particular, lack of cohesion- was an independent contributor to internalizing trauma-related problems.

Correlates of adolescent reports of sexual assault: findings from the National Survey of Adolescents

This study examines how key demographic variables and specific child sexual assault (CSA) incident characteristics were related to whether adolescents reported that they had told anyone about an alleged sexual assault. The study also investigates whether there were differences in the correlates of CSA disclosure as a function of gender and race/ethnicity. A national household probability sample of 4,023 adolescents was interviewed by telephone about childhood experiences, including CSA history. Significant gender and racial/ethnic differences were obtained in rates of CSA disclosure: Sexually abused boys and African American youth were less likely to report telling anyone they had been sexually abused. Separate regression models examining correlates of CSA disclosure yielded differences as a function of gender and race/ethnicity.

Coping with incest: the relationship between recollections of childhood coping and adult functioning in female survivors of incest

One hundred and one adult female survivors' recollections of coping with childhood incest, abuse characteristics, and current functioning in adulthood were studied. Analyses controlling for characteristics of the trauma indicated that recollections of using avoidance coping and seeking social support were related to poor adult functioning whereas recollections of using distancing coping were related to better functioning. As a set of variables, abuse characteristics also predicted a significant amount of variance in adult functioning. Implications for future research were discussed.

How well does cognitive-behavioral therapy treat symptoms of complex PTSD? An examination of child sexual abuse survivors within a clinical trial

Are brief cognitive-behavioral treatments for posttraumatic stress disorder (PTSD) also effective for the wider range of symptoms conceptualized as complex PTSD? Female rape victims, most of whom had extensive histories of trauma, were randomly assigned to cognitive-processing therapy, prolonged exposure, or a delayed-treatment waiting-list condition. After determining that both types of treatment were equally effective for treating complex PTSD symptoms, we divided the sample of 121 participants into two groups depending upon whether they had a history of child sexual abuse. Both groups improved significantly over the course of treatment with regard to PTSD, depression, and the symptoms of complex PTSD as measured by the Trauma Symptom Inventory. Improvements were maintained for at least 9 months. Although there were group main effects on the Self and Trauma factors, there were no differences between the two groups at posttreatment once pretreatment scores were covaried. These findings indicate that cognitive-behavioral therapies are effective for patients with complex trauma histories and symptoms patterns.

Why children tell: a model of children's disclosure of sexual abuse

OBJECTIVE

The present study investigated variables associated with delay of disclosure of child sexual abuse and tested a model of time to disclosure.

METHOD

Data were obtained for 218 alleged child sexual abuse victims whose cases had been referred to District Attorneys' Offices. Five variables were posited to influence the delay between an abusive event and children's disclosure of that event to a reporting adult: child's age, gender, type of abuse experienced (intrafamilial or extrafamilial), perceived responsibility for the abuse, and fear of negative consequences of disclosure. These variables were used to create a model of factors influencing children's disclosure of sexual abuse.

RESULTS

Results indicated that age, type of abuse, fear of negative consequences, and perceived responsibility all contributed to predicting time to disclosure. There was significant support for the model, suggesting that children who were older, came from incestuous families, felt greater responsibility for the abuse, and feared negative consequences of disclosure took longer to disclose.

CONCLUSIONS

Children's cognitive appraisal of others' tolerance of disclosure of child sexual abuse, and their own perceptions of responsibility for the abuse, are crucial to the decision to disclose. When evaluating children for possible sexual abuse, developmental, cognitive, and socio-emotional factors need to be taken into consideration.

Social reactions to child sexual abuse disclosures: a critical review

Recent studies have examined disclosure of child sexual abuse to determine the correlates and consequences of telling others about this form of victimization. The present article reviews the current empirical literature on disclosure and reactions to adult survivors to assess what is known about the process of disclosure and whether telling others is therapeutic and leads to positive outcomes. Most studies assessing social reactions in detail have concerned adult survivors retrospectively reporting on their disclosures of child sexual abuse. Few empirical studies have been conducted in this area but research suggests that few victims tell anyone about child sexual abuse as children, and that the type of reactions to disclosure vary according to when disclosure occurs (childhood or adulthood), the extent and nature of the disclosure, and the person to whom one discloses. Clear evidence shows that negative social reactions are harmful to survivors' well-being, but better assessment of specific reactions and their effects are needed in theoretically-based studies to evaluate how these responses affect survivors' recovery in the context of other variables. Suggestions for future research on social reactions of others to adult survivors disclosing child sexual abuse are presented.

The process of coping following child sexual abuse:a qualitative study

This research employed both quantitative and qualitative approaches to studying the immediate and long-term coping strategies adopted by survivors of child sexual abuse, focusing on how strategies evolve over time. Qualitative findings showed that coping with child sexual abuse is not static, but changes over time. The narratives of these nonclinical survivors suggest that an adaptive outcome may be associated with a particular evolution of strategies across time, i.e., survivors reported coping predominantly by engaging in psychological escape methods initially, and then adopting cognitive appraisal and positive reframing strategies in the longer term. It appears that coping processes can affect psychological outcome following child sexual abuse. This study offers insight into the evolution of coping methods associated with an adaptive outcome.

Forensic evaluation of trauma syndromes in children

There are significant differences between a clinical evaluation and a forensic evaluation [289-291]. These differences must be kept solidly in mind in performing the evaluation. The forensic evaluator needs to assess the validity of complaints, including the possibility of malingering and the child's ability to describe symptoms accurately, the connection between the symptoms and a given incident, and the potential long-term sequelae of a trauma. The goal of the interview is not to treat, but to obtain information. Assessing the validity of complaints is perhaps the greatest challenge. This requires obtaining and reconciling data from numerous sources, including interviews with the child and parents, and information from other sources, as well as rating scales and validity testing. One must be very cautious in asking leading questions and using standardized PTSD protocols, lest they teach the parents and child about the symptoms of PTSD and thereby distort the information they provide as a result. The forensic interviewer should consider what will be needed when called to testify in court. What data will convince the jury? How might the opposing attorney challenge the assessment? What scientific studies support the findings and conclusions concerning the diagnosis, functional impairment, and validity. The precise DSM-IV-TR diagnosis is not always key in a forensic evaluation. What is essential is establishing the connection between the trauma and ensuing emotional problems. All of the symptoms the individual has as a result of the trauma become important, whether or not they contribute to fulfillment of DSM-IV-TR criteria. This contrasts with a clinical evaluation in which one needs to demonstrate the existence of a DSM-IV-TR diagnosis for reimbursement purposes. Finally, the forensic evaluator should be familiar with current practice guidelines for examination of children with PTSD. Any deviation may need to be explained in court [264,292].

Relationship of attributional style, depression, and posttrauma distress among children who suffered physical or sexual abuse

This study examined the relationship of attributional style, posttrauma, and depressive symptoms among children who have suffered either physical or sexual abuse. Ninety-eight children (67 physically abused, 31 sexually abused) were administered a depression inventory, the Post-Traumatic Stress Disorder-Reaction Index (PTSD-RI), and Children's Attributional Style Questionnaire (CASQ). With regard to group differences, the sexual abuse group scored significantly higher on the PTSD-RI, whereas the physical abuse group scored higher on the CASQ Composite for Negative Events. Results also indicated that attributional style predicted depression beyond the variance accounted for by abuse type (i.e., physical or sexual). However, the best predictor of PTSD-RI scores was an interaction effect between abuse type and negative attributional style. Clinical implications of these findings for children who suffer abuse are discussed.

Social support and problem-solving as moderators of the relationship between childhood abuse and suicidality: applications to a delinquent population

The purpose of the current study was to examine the relationship between childhood abuse, social support, and problem-solving appraisal within a juvenile delinquent sample. Hierarchical regression analyses were used to assess whether childhood abuse, social support, and problem-solving appraisal were independently predictive of suicidality, and further, whetherproblem-solving appraisal and social support moderated the childhood abuse-suicidality relationship. Childhood sexual abuse was found to be an independent predictor of suicidal ideation and behavior. In addition, both problem-solving confidence and social support moderated the relationship between childhood abuse and suicidal ideation. The results of this study underscore the importance of both problem-solving appraisal and social support to suicidality in adolescents with a history of abuse.

Trying to understand why horrible things happen: attribution, shame, and symptom development following sexual abuse

This study concerns the nature of specific attributions for sexual abuse and their relation to psychological distress over time. Participants (80 children and 57 adolescents) were seen within 8 weeks of discovery of the abuse and 1 year later They described why they believed the abuse happened, rated the extent to which internal and external attributions for the abuse event applied to them, and completed measures of general attribution styleforeveryday events, shame for the abuse, and symptoms of depression, PTSD, and self-esteem. Parents and teachers rated behavior problems. Abuse-specific internal attributions were consistently related to higher levels of psychopathology and were particularly importantforpredicting PTSD symptoms and parent and teacher reports of internalizing behavior problems, even after controlling for age, gender, abuse events, and general attributional style. Shame also was an important predictor of symptom level and mediated the relation between abuse-specific internal attributions and PTSD symptoms.

The link between recurrent maltreatment and offending behaviour

This article considers recurrent maltreatment and offending behaviour. The sample was 60 males and 19 females (11 to 18 years) resident within a secure institution in England and considered a risk to themselves and/or others. Overall, 20.8% had not experienced maltreatment, 6.5% had experienced a single incident, 11.7% were repeat victims (same perpetrator), 6.5% were revictimised (different perpetrators), and more than half (54.5%) had suffered both repeat and revictimisation. Of those who had committed a violent and/or sexual crime, 74% had experienced some form of revictimisation, compared to 33% of those who committed nonviolent offences. Those young people most likely to have committed violent and/or sexual crimes were those who had been victims of recurrent extrafamilial maltreatment (many of whom had also experienced recurrent intrafamilial maltreatment). Thus, in this sample, revictimisation was associated with serious crimes. However, these findings are preliminary, and prospective research with a larger sample is needed.

Attributions and adjustment following child sexual and physical abuse

Individuals who experience child physical orsexual abuse are at greater risk for adjustment problems. However, the heterogeneity of symptomatology observed across individuals following child abuse suggests that outcome is determined by multiplefactors. The authors review literature examining the relationships among childhood physical or sexual abuse, attributions, and adjustment. Implications for application and future research are discussed.

Differences between sexually abused and non-sexually abused adolescent girls in foster care

This descriptive study examines the differences between sexually abused and non-sexually abused adolescent females in the foster care system who were participating in an independent living program. Fifty-four percent of the 190 girls met the criteria for being categorized as sexually abused. Those who experienced sexual abuse had also experienced significantly more of other types of child maltreatment. In addition, those who had been sexually abused were much more likely to be living in a congregate living setting, such as a group home or residential center, than those who were not sexually abused. The girls who had been sexually abused exhibited significantly more behavioral difficulties, including internalizing and externalizing problems, with 51% of them having clinically significant scores on the Youth Self-Report version of the Child Behavior Checklist. When co-occurrence of substance use and mental health problems were examined, sexually abused girls were significantly more likely than the non-sexually abused girls to meet the established criteria.

Psychological functioning and family discord among African-American adolescent females with and without a history of childhood sexual abuse

OBJECTIVES

The aim was to examine the rate of childhood sexual abuse along with the factors (age of abuse onset, type of perpetrator, and duration of the abuse), as well as the relationship of these factors to psychological functioning among females with a history of childhood abuse. Second, to determine whether levels of psychological functioning and family discord differ among females with and without a history of childhood sexual abuse.

METHOD

A cross-sectional design was used. Two hundred and forty-nine adolescent females were recruited from a community-based health program. Two trained female interviewers administered an anonymous survey that assessed childhood sexual abuse, psychological functioning, and family environment.

RESULTS

Fifty-seven (22.9%) of those surveyed reported childhood sexual abuse, of which 44.3% were intrafamilial and 55.7% were interfamilial. Age at onset ranged from 3 years to 17 years; 62.5% reported that the sexual abuse occurred 1 to 4 times; 27.9% reported a duration ranging from 1 year to 13 years; and 9.6% reported a duration of 1 month to 7 months. Multiple regression analysis revealed that a greater duration predicted higher levels of depression and lower levels of self-esteem among females with a history of sexual abuse. Females with a history of childhood sexual abuse scored significantly lower on measures of self-esteem and mastery, and significantly higher on measures of physical and emotional abuse.

CONCLUSIONS

Results indicate that adolescent females with a history of childhood sexual abuse suffer an array of negative sequelae that include psychological and family distress.

Predicting the child-rearing practices of mothers sexually abused in childhood

OBJECTIVE

Although empirical investigations have established a relationship between childhood sexual abuse and numerous long-term consequences, surprisingly little research has addressed the possible effects of childhood victimization on the later child-rearing practices of adult survivors. The present study examined hypothesized predictors of three parenting styles among adult survivors of sexual abuse as compared with adult children of alcoholic parents.

METHOD

Forty-five clinical outpatients completed a questionnaire battery assessing experiences of childhood abuse, current economic and social resources, and parenting attitudes and practices. The child-rearing practices of participants were compared with those reported by a community sample of 717 mothers. Additional analyses examined the extent to which sexual abuse and its adult sequelae predicted the parenting behaviors reported by the present sample.

RESULTS

Both sexual abuse survivors and children of alcoholics reported significantly higher rates of permissive parenting practices than mothers in the community sample. Multiple regression analyses further revealed unique relationships between sexual abuse and parenting, over and above the variance explained by physical abuse, current socioeconomic status, and the experience of growing up in an alcoholic home. Mothers' sexual abuse severity, social support satisfaction, and dysfunctional parenting attitudes moderated several of these relationships.

CONCLUSIONS

The present findings suggest that sexual abuse and its adult sequelae may have negative consequences for the parenting practices of survivors, particularly for survivors' ability to provide their children with appropriate structure, consistent discipline, and clear behavioral expectations. Implications for the psychosocial development of survivors' children are discussed.

Incest and women of color: a study of experiences and disclosure

Clinical literature on incest trauma assumes a homogeneity of experience of all incest survivors including women of color. Experiences relating to community, culture, and family need to be acknowledged as salient aspects of the experiences of women of color who are also incest survivors. Twelve participants were interviewed regarding their experiences related to disclosure and coping. Participants described value systems, community mindedness, social attitudes, negative consequences amongst other social and cultural issues as factors affecting incest disclosure. Participants described cognitive reframing, determination and separation from the perpetrator as ways of coping with incest.

[Resilience factors in the victims of sexual abuse: state of affairs]

OBJECTIVE

The aim of this literature review is to examine factors leading to the recovery of child sexual abuse survivors.

METHOD

This paper provides a definition of resilience and presents the individual and environmental protective factors. A methodological examination of the studies is carried through.

RESULTS

Researchers have documented that 20% to 44% of adult who were sexually abused during their childhood show no apparent signs of negative outcome. However, very few studies as been interested in resilient women and their protective mechanisms. Recent research on protective factors reveal that searching for support, disclosing the abuse and giving a meaning to the abuse are all adaptative cognitive strategies. Furthermore, the perception of benefits and having an external attributional style are both related to less psychological distress. Social support, in general and after the revelation, also appears as a determinant of resilience. However, avoidance, even if victims find it very useful, proves to be a non-adaptative strategy, which may lead to be a catalyst to victims' symptomatology. Definitional problems and the lack of longitudinal studies limit the conclusions that can be drawn.

CONCLUSION

The rare studies involving resilient victims show that social support as well as certain cognitive coping strategies may lead to recovery. However the extent of their contribution remains unknown.

Personality traits of women with a history of childhood sexual abuse

This study examined relationships between specific dimensions of childhood sexual abuse and personality traits in adulthood. Study participants were 74 hospitalized female psychiatric patients with a self-reported history of childhood sexual abuse. Characteristics of childhood sexual abuse were obtained from a structured life-events interview. Personality was measured with the NEO-Five-Factor Inventory (NEO-FFI), which yields scores on neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness. We hypothesized that parental abuse, intercourse, and the combination of these two childhood sexual abuse characteristics would be associated with personality traits. Supporting this hypothesis, women who were abused by a parent had lower scores on openness to experience than women who were abused by someone else. Patients whose abuse history included both parental abuse and intercourse had very low extraversion scores. Our findings suggest that there are associations between personality traits and childhood sexual abuse characteristics in psychiatric patients. Specifically, women who experienced intercourse by a parent may be more introverted and less open to experience than women whose sexual abuse history does not include parental incest.

Delay in disclosure of childhood rape: results from a national survey

OBJECTIVE

This study sought to gather representative data regarding the length of time women who were raped before age 18 delayed prior to disclosing such rapes, whom they disclosed to, and variables that predicted disclosure within 1 month.

METHOD

Data were gathered from 3,220 Wave II respondents from the National Women's Study (Resnick, Kilpatrick, Dansky, Saunders, & Best, 1993), a nationally representative telephone survey of women's experiences with trauma and mental health. Of these, 288 retrospectively reported at least one rape prior to their 18th birthday. Details of rape experiences were analyzed to identify predictors of disclosure within 1 month.

RESULTS

Fully 28% of child rape victims reported that they had never told anyone about their child rape prior to the research interview; 47% did not disclose for over 5 years post-rape. Close friends were the most common confidants. Younger age at the time of rape, family relationship with the perpetrator, and experiencing a series of rapes were associated with disclosure latencies longer than 1 month; shorter delays were associated with stranger rapes. Logistic regression revealed that age at rape and knowing the perpetrator were independently predictive of delayed disclosure.

CONCLUSIONS

Delayed disclosure of childhood rape was very common, and long delays were typical. Few variables were identified that successfully predicted disclosure behavior, but older age and rape by a stranger were associated with more rapid disclosure. This suggests that the likelihood of disclosure in a given case is difficult to estimate, and predictions based on single variables are unwarranted.

Relations between coercive strategies and MMPI-2 scale elevations among women survivors of childhood sexual abuse

The relationship between coercion strategies used by perpetrators of childhood sexual abuse (CSA) and elevations of CSA survivors on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) was investigated. Participants were 151 women survivors of CSA in outpatient treatment at a university-based community mental health center. Scores on the MMPI-2 clinical scales and the Keane posttraumatic stress disorder (PTSD) scale were examined. Main effects were found for promised or received rewards on several clinical scales and the PTSD scale of the MMPI-2, independent of the presence of force. Specifically, the presence of such rewards was associated with significantly higher levels of symptomatology on Paranoia (Pa), Psychasthenia (Pt), Schizophrenia (Sc), and PTSD (Pk). There were no main or interaction effects noted for the presence of actual or threatened force on any of the scales.

Emotional abuse, self-blame, and self-silencing in women with irritable bowel syndrome

OBJECTIVE

The purpose of this study was to investigate the presence of emotional abuse and two psychosocial constructs (self-blame and self-silencing) in a sample of women diagnosed with irritable bowel syndrome (IBS) relative to a comparison sample of women diagnosed with inflammatory bowel disease (IBD).

METHODS

Women diagnosed with IBS (N = 25) were compared with women diagnosed with IBD (N = 25) on measures of history of abuse, self-blame, and self-silencing.

RESULTS

It was found that women in the IBS sample scored significantly higher on emotional abuse, self-blame, and self-silencing than did women in the IBD sample. These three variables were also found to be significantly intercorrelated in both the IBS and IBD samples. Finally, emotional abuse was significantly higher in IBS patients than in IBD patients beyond the differences accounted for by physical and/or sexual abuse history.

CONCLUSIONS

These findings empirically demonstrate an association between IBS and emotional abuse, as well as a possible connection with psychosocial variables, that may mediate the connection between emotional abuse and functional bowel symptoms. We suggest that these variables be further evaluated in the context of clinically relevant research on IBS.

Contextualizing the effects of childhood sexual abuse on adult self- and social functioning: an attachment theory perspective

OBJECTIVE

This retrospective survey study explored the hypothesis that multiple maltreatment and loss experiences in early childhood would interfere with the formation of secure attachments, creating (1) an increased vulnerability to childhood sexual abuse (CSA), and (2) adult problems in self- and social functioning.

METHOD

Data were collected from 687 undergraduates on an urban, commuter campus. They were analyzed by means of between group (individuals with and without CSA histories) and within group (individuals with CSA histories) path analytic models.

RESULTS

The number of maltreatment and loss experiences encountered in early childhood predicted greater CSA frequency in childhood and increased maltreatment in adulthood in the form of more frequent reports of sexual, physical, and emotional abuse. Childhood maltreatment and loss experiences also predicted poor adult self-functioning in the form of higher levels of depression and lower levels of self-esteem. Self-blame in response to CSA and maltreatment in adult relationships also predicted poorer adult self- and social functioning for individuals with CSA histories.

CONCLUSIONS

Findings support both direct and mediational effects of childhood maltreatment and loss experiences on adult self- and social functioning and are consistent with predictions derived from attachment theory.

Psychologists' beliefs about the prevalence of childhood sexual abuse: the influence of sexual abuse history, gender, and theoretical orientation

OBJECTIVE

This study examined the influence of sexual abuse history, gender, theoretical orientation, and age on beliefs about the prevalence of childhood sexual abuse among clinical and counseling psychologists.

METHOD

A mail survey design was used in this study. Participants were randomly selected from the American Psychological Association membership database. There were 615 psychologists who completed self-report measures on beliefs about the prevalence of childhood sexual abuse and demographic characteristics.

RESULTS

Overall, clinicians' scores on the prevalence of childhood sexual abuse were moderate. There were significant gender differences on beliefs, suggesting that women were more likely believe that childhood sexual abuse is a common occurrence compared to men. Multiple regression analysis indicated that clinician characteristics (history of sexual abuse, gender, and theoretical orientation) were significantly related to beliefs about the prevalence of childhood sexual abuse. However, these characteristics only accounted for a small amount of the overall variance predicting beliefs.

CONCLUSIONS

These results suggest that clinicians do not hold extreme beliefs regarding the prevalence of childhood sexual abuse. Moreover, certain clinician characteristics are associated with their beliefs, which in turn, may impact their clinical judgment and treatment decisions. Furthermore, much of the variance was unaccounted for in the model indicating that psychologists' beliefs are complex and are not unduly influenced by their personal characteristics. Implications for clinical practice and future research are discussed.

Factors related to the reporting of childhood rape

OBJECTIVE

The aim of this study was to examine whether there would be differences in reported versus unreported cases of childhood rape on incident characteristics including life threat, physical injury, identity of the perpetrator, frequency of assault(s), and rates of posttraumatic stress disorder or major depression.

METHOD

In a telephone interview, a national probability sample of 4,008 (weighted) adult women was screened for a history of completed rape in childhood. Respondents were also assessed for DSM-III-R diagnoses of major depressive episode and/or posttraumatic stress disorder (PTSD). Three hundred forty-one (8.5%) of these women were victims of at least one rape prior to the age of 18, for a total of 437 completed rapes. Of these 437 rape incidents, 52 (11.9%) were reported to the police or other authorities.

RESULTS

Significant differences were obtained between reported versus nonreported cases on incident characteristics, including life threat, physical injury, identity of the perpetrator. Reported cases were more likely to involve life threat and/or physical injury, and were more likely to have been committed by a stranger than nonreported cases. No significant differences between reported and nonreported cases were found concerning whether the rape involved a single incident versus series of events, or rates of PTSD or major depression.

CONCLUSIONS

Findings suggest that different characteristics are associated with reported versus unreported cases of childhood rape. Since few cases of childhood rape are actually reported to the authorities, it appears that we may be missing valuable information. Implications for research and clinical intervention are discussed.

On being invisible in the mental health system

The author provides a case study of her daughter's sexual abuse as a child and subsequent experiences as a chronically mentally ill client in the mental health system. Information from 17 years of mental health records and anecdotal accounts are used to illustrate the effects of the abuse, her attempts to reach out for help, and the system's failure to respond. There is evidence that a significant subset of psychiatric patients were severely sexually traumatized in childhood. Yet standard interview schedules consistently neglect to ask questions about such abuse, appropriate treatment is seldom available, and clients are often retraumatized by current practices. Psychiatry's historic resistance to addressing abuse as etiology is being challenged today by powerful economic, political, and professional forces leading to the emergence of a new trauma-based paradigm.

Age and gender differences in children's and adolescents' adaptation to sexual abuse

OBJECTIVE

How children manifest psychological distress following the discovery of sexual abuse requires a better understanding of individual differences in developmental capacities and vulnerabilities. This study examined how age at the time of the abuse discovery and gender of victim are related to psychological distress.

METHOD

One hundred and sixty-nine participants (96 children, 73 adolescents) were interviewed within 8 weeks of discovery of the abuse. Multivariate analyses were used to examine how age at discovery, and gender, with abuse characteristics as covariates, were related to shame, attribution style, depression, self-esteem, and traumatic events sequelae.

RESULTS

Adolescents compared to children report a higher level of depressive symptoms, negative reactions by others, and lower levels of self-esteem, social support, and sexual anxiety. Girls compared to boys report higher levels of intrusive thoughts, hyperarousal, sexual anxiety, personal vulnerability, and perceiving the world as a dangerous place and lower levels of eroticism.

CONCLUSIONS

These findings suggest the importance of considering individual differences in age and gender for understanding patterns of symptom expression. Treatment strategies need to reflect these individual differences in adjustment, such as targeting issues of sexual anxiety for girls and self-esteem for adolescents.

The prevalence and circumstances of child sexual abuse: changes across a decade

OBJECTIVE

This study reports the prevalence of child sexual abuse of African American and European American women and compares the circumstances of these incidents to data collected a decade ago.

METHOD

Stratified probability sampling was used to recruit comparable samples of African American and European American women in Los Angeles County for a larger study of women's sexual decision making. Incidents of contact abuse were obtained from women 18 to 36 years old in 1994 and compared to women with those demographic characteristics from a comparable 1984 dataset. The prevalence of abuse, characteristics of the victim, assault, alleged perpetrator, disclosure, and long-term effects by ethnic group affiliation were assessed.

RESULTS

Of the total sample, 34% reported at least one incident prior to age 18. Ethnic differences were found with respect to prevalence, location of abuse, and number of incidents of rape. While comparisons made with the 1984 dataset revealed no significant difference in prevalence rates over the 10 year period, changes in circumstances were noted.

CONCLUSIONS

Although the prevalence of child sexual abuse in Los Angeles County remained fairly stable, several circumstances of abuse underwent change. These characteristics are discussed in relation to how sexual abuse among ethnically diverse samples in Los Angeles County has changed over a decade and how these differences can help better tailor prevention messages to different communities.

Cognitive coping styles of women sexually abused in childhood: a qualitative study

OBJECTIVE

The aim was to investigate cognitive coping strategies used by a nonclinical sample of women with a history of childhood sexual abuse, to examine whether cognitive appraisals affected their current coping strategies and psychological well-being.

METHOD

Qualitative research methods were used to enable the sample to convey their own ideas about factors and meanings they attributed to their experience of child sexual abuse. The sample of 40 was drawn from one of two stratified sub samples randomly selected from electoral rolls for interview in 1989 and re-interviewed in 1995. One sub sample had reported childhood sexual abuse and the other had reported none. Inductive content analysis and coding of themes were carried out using appropriate software and supplemented by quantitative interview data.

RESULTS

Six main coping strategies were identified and then assessed to determine their mediating influence on psychiatric disorder, self-esteem and self reported difficulties experienced as adults. Overall, abuse characteristics did not predict outcome but women who "deliberately suppressed" the abuse incidents were more likely to have low self-esteem and women who "reframed" were significantly less likely to have a psychiatric diagnosis.

CONCLUSIONS

Some cognitive coping strategies employed after experiencing child sexual abuse impinge on later psychological well-being or subsequent relationships with other people. One of the more challenging findings to come out of the study was that women who "reframed" the sexual abuse event were more likely to have favorable mental health outcomes but were also more likely to report that their own child had been sexually abused.

Childhood sexual abuse and couples' relationships: female survivors' reports in therapy groups

Therapy videotapes from five therapy groups for female child sexual abuse (CSA) survivors were analyzed for emerging themes of couples' difficulties reported by clients. Subsequently, the thematic categories were applied to sessions selected from an additional four groups and then correlated with CSA-specific variables. The two most frequent relationship themes were difficulties with emotional communication or intimacy, and polarized positions on control. Whereas these two themes were correlated with survivors' CSA characteristics, sexual difficulties were correlated with survivors' level of current traumatic symptomatology. Results are discussed in terms of implications for the treatment of CSA survivors and their partners.

The abuse clarification process in the treatment of intrafamilial child abuse

One aspect of treatment for child abuse and neglect addresses the attributions that the child victim, offender, nonoffending parents, and other family members have about the occurrence of the maltreatment. This paper describes a formal approach for abuse clarification to be used with families in which maltreatment has occurred. The four primary components of the abuse clarification process are: (a) clarification of the abusive behaviors; (b) offender assumption of responsibility for the abuse; (c) offender expression of awareness of the impact of the abuse on the child victim and family; and, (d) initiation of a plan to ensure future safety. The process of abuse clarification is described and suggestions made for appropriate use of the procedure.

Dysfunctional cognitions and adult psychological functioning in child sexual abuse survivors

Two studies explored the relationship between cognitions and long-term symptoms in adult child sexual abuse (CSA) survivors. In Study 1, an American sample of 43 survivors completed questionnaires assessing attributional style and dysfunctional beliefs in cognitive themes affected by victimization, as well as measures of posttraumatic symptoms. Survivors' attributions of negative events were more internal, stable, and global than those of 29 comparison subjects without a history of CSA. However, only the globality scale was significantly related with severity of long-term symptoms. High correlations between dysfunctional beliefs concerning safety, trust, esteem, or intimacy, and posttrauma symptoms were found. The latter finding was replicated in Study 2 with a German sample of 35 CSA survivors, even when controlling for frequency of abuse.

Social support and coping strategies as mediators of adult adjustment following childhood maltreatment

Structural equation modelling (SEM) was used to examine whether coping efforts and social support mediate the long-term sequelae of child maltreatment. The hypothesized SEM fit the data well and indicated that the association between previous childhood sexual and physical maltreatment and current psychological adjustment appeared to be strongly mediated by social support and coping strategies. In this sample of 302 female and male university students, most of whom reported at least one episode of childhood maltreatment, perceived social support and ways of coping with earlier maltreatment appeared essential to an understanding of the relationship between childhood maltreatment and later adjustment.

Disclosure patterns of sexual abuse and psychological functioning at a 1-year follow-up

This study describes the disclosure processes of a sample of 68 sexually abused girls, with a focus on the manner in which abuse was revealed--on purpose, accidentally, or resulting from a precipitating event. This categorization is a more descriptive conceptualization of the disclosure process than has been proposed or assessed in previous studies. The circumstances surrounding disclosure are found to be related to long term psychological functioning. Children who disclosed accidentally were younger, experienced abuse for shorter durations, and received the most therapy. At follow-up, children who purposely disclosed had greater anxiety and greater difficulties coping. Discussion focuses on ways in which identifying and encouraging the least traumatic methods of disclosure would contribute to better outcomes for victims of sexual abuse.

School age children's coping with sexual abuse: abuse stresses and symptoms associated with four coping strategies

Strategies used by 84 sexually abused children, ages 7 to 12, to cope with their abuse were evaluated, along with child abuse-related symptoms, parent-reported behavioral symptoms, and teacher-reported behavioral symptoms. Principal components analysis of coping yielded four strategies that were labeled avoidant coping, internalized coping, angry coping, and active/social coping. Each coping strategy was found to be associated with a unique set of abuse characteristics, abuse-related social environment, and symptoms. In contrast to findings with adult survivors and adolescents, use of avoidant coping strategies among school-age children was found to be related to fewer behavioral problems, although it was also associated with greater sexual anxieties. Internalized coping was found to be associated with increased guilt and PTSD hyperarousal symptoms. Active/social coping was the only strategy found to be unrelated to symptoms, but neither was it associated with measured benefits. In contrast to some clinical opinion that externalizing blame and venting anger is a helpful strategy, angry coping was found to be associated with a wide range of behavioral and emotional problems as rated by the child's home-room school teacher. Results are discussed in terms of a proposed mediational model.