Child abuse: betrayal and disclosure

Perceived Community Belonging as a Moderator: Effects of Childhood Abuse on Health and Well-Being Among Middle-Aged and Older Canadians

This study examined the moderating role of perceived community belonging in the relationship between childhood abuse and health and well-being outcomes among Canadian individuals aged 55 and older. Using data from the 2014 Canadian General Social Survey (n = 14,416), multiple linear regression models revealed that women who experienced either childhood physical or sexual abuse reported poorer self-rated general and mental health, as well as lower life satisfaction, compared to those without such histories. The most pronounced effects were observed among women who experienced both types of abuse. For men, a similar pattern was evident only for those who experienced childhood physical abuse. Notably, among women, a strong sense of community belonging lessened the negative effects of both types of childhood abuse on all examined outcomes. These findings underscore the protective role of perceived community belonging against the consequences of childhood abuse for older women. They illuminate the crucial role of gerontological social workers and scholars in promoting community integration and support. Focusing on these areas, especially for those with traumatic histories, can potentially improve their overall health and well-being.

Association between childhood maltreatment and callous-unemotional traits in youth: A meta-analysis

Callous-unemotional (CU) traits (i.e., lack of remorse or guilt, callous lack of empathy, deficient concern for the feelings of others) in youth with conduct problems confer risk for a particularly severe and persistent form of antisocial behaviour. Previous research has linked childhood maltreatment as a potential risk factor for CU traits, both primary (i.e., genetically underpinned) and secondary (i.e., environmentally influenced) variants, but findings have been inconsistent, and the association has not yet been tested in a meta-analysis. To address this gap, we conducted a meta-analysis to assess the nature and strength of the associations between childhood maltreatment and its subtypes with CU traits and potential variants (i.e., primary and secondary CU traits). A systematic search identified 29 eligible studies including 9,894 participants (42% female) between the ages of 3 and 18 years (Mage=14.22 years, SD = 1.07). Results revealed a significant moderate positive association between childhood maltreatment and CU traits. All subtypes of maltreatment bar sexual abuse were significantly associated with CU traits. However, it was not possible to compare primary and secondary CU traits directly due to inconsistencies in how they are defined. The limitations posed by current research signal the need for clinical and operational guidelines on how to define primary and secondary CU traits. Additionally, prospective longitudinal, genetically informed research is needed to clarify if maltreatment is a causal risk factor for CU traits.

Laypeople's perceptions of the effects of event repetition, reporting delay, and emotion on children's and adults' memory

For crimes such as child abuse and family violence, jurors' assessments of memory reports from key witnesses are vital to case outcomes in court. Since jurors are not experts on memory, the present research measured laypeople's (i.e., non-experts') beliefs about how three key factors affect witnesses' memory reports for an experienced event: how frequently an event was experienced (repeated, single), the delay between experiencing and reporting the event, and the emotional valence of the event. Across two studies, lay participants completed an online survey that measured their beliefs about each factor. In Study 1, 51 participants completed a survey about how the three factors affect children's memory. In Study 2, another 51 participants completed a survey about how the three factors affect adult's memory. Across both studies, delays were believed to worsen memory, and emotion was believed to improve memory. Beliefs about single and repeated events showed different patterns across the studies. In Study 1, participants' beliefs about children's memory for repeated experience were variable. In Study 2, participants believed that adults' memory was worse for repeated events than single events. Overall, laypeople demonstrated many accurate beliefs about memory, but showed some confusion about children's memory for repeated events.

Factors Associated With Impeding the Reintegration of Incest Survivors: A Qualitative Study in Selected Safe Homes in Nepal

BACKGROUND

Incest is a globally prevalent phenomenon and is defined as sexual relations between closely related family members. Despite being a criminal offense irrespective to the gender and age incest is a prevalent issue in Nepal. Incest survivors are sheltered in safe homes for specific periods and reintegrated into their families following their healing. This research aims to explore the challenges and issues involved in the reintegration of incest survivors and investigate how the interconnected perceptions of families and individuals relate to the incest survivors' successful reintegration.

METHODS

This qualitative study was conducted in three districts of Nepal. Fourteen incest survivors, five service providers from safe homes, and 22 community members were purposefully and theoretically selected. Semi-structured interviews were carried out to collect the study data, which were subsequently coded and analyzed using a grounded theory approach.

RESULTS

The results indicate the importance of the reintegration of incest survivors, as staying in a safe home may not offer a long-term solution for these individuals. However, reintegration is challenging without acceptance and support from the survivors' families and communities, the survivors' readiness to reintegrate, and agreement from the survivors' safe homes. Factors found to influence the unsuccessful reintegration of survivors included family fragmentation, socio-economic status, family resistance, the survivor-perpetrator relationship, survivors' interests, fears, and the possibility of repeated incidents, harmful social norms and cultural practices, community intervention, and negative perceptions.

CONCLUSION

This study found that factors associated with impeding the reintegration of incest survivors are found in survivors, their families, and their communities. Creating harmonious family systems, providing education on gender equality, empowering women to fight against all sorts of abuse, and governmental assurances on the implementation of legal aid, human rights, ratified conventions on child rights and women's rights may help prevention of incest, and address the reintegration challenges of incest victims.

"They Aren't Going to Do Jack Shit": Text-Based Crisis Service Users' Perceptions of Seeking Child Maltreatment-Related Support From Formal Systems

Many of the children reported to child protective services (CPS) exhibit signs and symptoms that allow others to recognize their abuse or neglect and intervene; others, especially adolescents, must disclose their experiences to be identified. Relatively little is known about young people's disclosure experiences, but individual, interpersonal, and cultural factors appear to influence when and how young people disclose. Technology-facilitated approaches, such as text- or chat-based hotlines or crisis services, may be one way to help young people share their maltreatment experiences and seek help. The current study contributes to the small body of literature that includes nonsexual maltreatment disclosures and sheds some light on how to support young people during their disclosures. We conducted a qualitative content analysis of all conversations from a text-based crisis service that resulted in a report to CPS (n = 244). Many of the texters had previously sought support from their peers or parents, and some had engaged with more formal systems. Many young people were hesitant to reach out to formal systems in the future, in part because of negative experiences during past disclosure experiences. Young people may be more likely to seek support through their preferred communication medium, so providing text- and chat-based communication may be one way to encourage and facilitate disclosure. As these resources become increasingly available, determining best practices for receiving disclosures through technology-facilitated platforms will be critical.

Children’s needs during disclosures of abuse

A Narrative Literature Review was conducted providing a comprehensive overview of children’s barriers to disclose during investigations of child abuse. Patterns in the literature were categorized as themes and include: rapport and relationship with the interviewer, feeling in control and prepared, communication, physical abilities, mental health, environment, family dynamics, culture and individual uniqueness. Using a combination of a critical analyses approach and drawing from personal background experiences and knowledge in working with children during disclosures, the themes are expanded upon as a discussion that explores what children may therapeutically need during their disclosures of abuse within the forensic interview. Some practice implications are incorporated with the intent to generate further thinking about addressing children’s needs during investigations of child abuse. Working with multidisciplinary teams in Child and Youth Advocacy Centres is discussed and may be a resource for understanding children’s needs during disclosures of abuse.

Use of Self-Figure Drawing as an Assessment Tool for Child Abuse: Differentiating between Sexual, Physical, and Emotional Abuse

Child abuse is a worldwide phenomenon with adverse short- and long-term mental and physical negative consequences, with a huge gap between the prevalence of child abuse and disclosure rates. The study aimed to examine and validate the self-figure drawing as an assessment tool to differentiate between three forms of child abuse, i.e., child sexual abuse (CSA), child physical abuse (CPA), and child emotional abuse (CEA). Following the ethical approval, 1707 Thai children (13–18 years old) from the general population (schools) were asked to complete a self-report anonymous questionnaire consisting of four measures (Demographics, Childhood Trauma Questionnaire (CTQ), The Medical Somatic Dissociation Questionnaire (MSDQ), and The Disclosure of Trauma Questionnaire (DTQ)). After completion, they were asked to draw themselves. There was a significantly positive link between the reluctance to disclose and the experience of abuse, indicating that the more severe the abuse the higher the reluctance to disclose. The findings broaden the knowledge of movement and symbols as representations of inner personal conflictual material. Additionally, it substantiates self-figure drawing as an assessment tool and assists practitioners in early child abuse detection.

Children's Disclosures of Physical Abuse in a Population-Based Sample

Few studies have explored the disclosure of child physical abuse although child sexual abuse disclosure has been widely studied and debated for years. The present study explores the characteristics of child physical abuse disclosures and compares them to previously published findings on child sexual abuse disclosure from the same data. The data consist of a representative sample of 11,364 sixth and ninth graders. Participants responded to a wide variety of questions concerning experiences of violence, including child physical abuse and child sexual abuse, in the Finnish Child Victim Survey conducted in 2013. Within this sample, the prevalence of child physical abuse was 4.1%. Children reporting abuse experiences also responded to questions regarding disclosure, reactions encountered during disclosure, and potential reasons for nondisclosure. Findings show that most of the children who disclosed physical violence had disclosed to their mother. The overall disclosure rate of child physical abuse was 74%. However, only 42% had disclosed to adults, and even fewer had reported their experiences to authorities (12%). The most common reason for nondisclosure was that the youth did not consider the experience sufficiently serious to report (53%). These findings were largely in line with the child sexual abuse disclosure rates in our previous study. Analyses of variables associated with disclosing to an adult indicate that the strongest factors predicting disclosure to an adult are younger age, female gender, no previous experiences of child physical abuse, and parents knowing who their child spends her or his spare time with. Implications for further research and practice are discussed.

Factors affecting disclosure time of sexual abuse in children and adolescents

BACKGROUND

The aim of this study is to determine the factors affecting early and delayed disclosure time of child sexual abuse (CSA). Early disclosure of CSA is considered to be crucial for child protection.

METHODS

A total of 125 sexually abused children and adolescents, who had been evaluated by child adolescent psychiatry and forensic medicine specialists, were enrolled in this study. Files of medical and criminal data were analyzed retrospectively and synchronously by child adolescent psychiatrist and forensic medicine specialist authors who had evaluated victims using the standard procedures of Düzce University Faculty of Medicine Child Abuse Assessment Council. Univariate and multivariate logistic regression analyses were conducted to evaluate predictors.

RESULTS

Delayed disclosers were found to be younger than early disclosers. Among the delayed disclosers, there were also more victims of intrafamilial CSA, fewer victims of penetration, and fewer voluntary disclosures. Multivariate logistic regression revealed that "younger age" and "intrafamilial CSA" were independent predictors of delayed disclosure of CSA.

CONCLUSIONS

The results of our study contribute to an understanding of the factors related to delayed disclosure and underline the need for age-appropriate education and prevention programs targeted to increase the awareness of sexual abuse, particularly intrafamilial abuse, and to promote voluntary disclosure in children and adolescents, especially for younger age groups. The education of potential recipients of CSA and further education of professionals is extremely important in order to support children and adolescents' voluntary disclosure of CSA.

Resilience in the Aftermath of Childhood Abuse? Changes in Religiosity and Adulthood Psychological Distress

Of all the forms of adversity experienced during childhood, childhood abuse is known to have the largest impacts on mental health. Yet, we have a limited understanding of factors that may cushion the blow of these early insults, and it remains unclear whether stability or increases/decreases in religiosity facilitate or hinder the ability of religion/spirituality to act as a buffer. Using two waves of MIDUS data, results suggest that increases in positive religious coping (seeking comfort through religion/spirituality) during adulthood buffer the association between childhood physical and emotional abuse on psychological distress, while decreases in religious comfort exacerbate it. Religious attendance had no discernible buffering effect. Taken together, results show that the stress-moderating effects of religion depend on changes in religious coping processes over the life course.

Factors influencing the perceived credibility of children alleging physical abuse

Adults' assessments of the credibility of children's reports are affected by factors including the frequency of abuse, reporting delays and the child's age. The present study examined whether similar factors affect the perceived credibility of children reporting physical abuse, which is more common than sexual abuse. Two hundred and eight mock jurors read a simulated transcript of a child reporting physical abuse to police and made credibility ratings. Within each transcript, abuse frequency (once, repeated), reporting timing (recent, delayed), police question type (open, closed) and child age (6 or 10 years) were manipulated. The child was considered more credible when the abuse was only experienced once and reported shortly after it occurred, and when prompted with open questions. The child's age did not affect credibility judgments. Current findings support recommendations to prioritise open questions with children and provide evidence for extension of the benefits of open questions to children's credibility.

Disclosure in Undocumented Families and School Mental Health Clinics

The following describes the case of Miguel and a missed diagnosis in an undocumented minor. Miguel Estrada (all names changed to protect identity) was a 10-year-old boy of Central American origin initially seen at age 8 years in our university outpatient child psychiatry clinic. During the initial evaluation with a native Spanish-speaking provider, his mother, Mrs. Estrada, reported behavioral problems beginning at age 5 with diagnoses of attention-deficit/hyperactivity disorder and intellectual disability; a trauma history was denied. Over the subsequent 2 years, Miguel continued treatment in our outpatient service and later transitioned to our school-based clinic. At the intake visit, Mrs. Estrada explained (with the assistance of his school paraprofessional educator and translator) that they crossed the United States/Mexico border illegally when Miguel was 5 years old. Miguel's behavioral problems began when Immigration and Customs Enforcement officials separated him from his parents, his father was deported, and he was exposed to harsh conditions. During his parents' detention, he was transitioned to five failed foster placements with escalating behavioral problems that eventually led to a 3-month psychiatric residential stay. During the initial visit to the school psychiatric clinic a trauma history was again denied by Miguel and his mother. Ten months into treatment in the school-based psychiatric clinic, Miguel reported hearing a male voice and a motorbike throughout the day, and the diagnosis of a psychotic disorder was entertained. Upon questioning, Mrs. Estrada disclosed that a shooting occurred in their country of origin and prompted their flight to the United States; she stated, "He hears the voice of the men who came on motorbikes and shot at the family home." She explained that Miguel was in the home at the time of the incident and the target was his father. Reexperiencing surfaced with the Marjorie Stoneman Douglas High School massacre on February 14, 2018; Miguel no longer felt safe at school and was fearful of being shot. Chronic posttraumatic stress disorder was diagnosed, and treatment with a selective serotonin reuptake inhibitor and trauma-focused cognitive-behavioral therapy was recommended. Mrs. Estrada preferred trauma-focused cognitive-behavioral therapy; however, the school's clinicians were not trained in this treatment modality and were unable to provide regular psychotherapy sessions. Six months later Miguel continued to report attenuated symptoms of posttraumatic stress disorder.

School and program related factors influencing disclosure among children participating in a school-based childhood physical and sexual abuse prevention program

BACKGROUND

School-based child abuse prevention programs were created to provide knowledge so that children can recognize abuse, teach skills that decrease children's risk for abuse, normalize the disclosure process, and provide a pathway for children who may be experiencing abuse to report the abuse.

OBJECTIVE

The purpose of this study was to explore school and program factors that trainers in a school-based prevention program believed were associated with disclosure among youth from kindergarten through 12th grade.

PARTICIPANTS AND SETTING

This study is based on eighteen trainers and administrators who work with the Play it Safe!® school-based program in Dallas-Fort Worth area.

METHODS

Using the qualitative case study method, in-depth interviews were conducted.

RESULTS

Data analysis revealed three factors that influenced disclosure: school, school personnel, and program features. The school-related factor was time allotted to the training. The school personnel-related factors were disengagement, ambiguity concerning abuse, prior history with children, and professionals' personal history of abuse. Finally, the program-related factors were the core messages of the training, providing specific examples, and repetition of the program. To date, there is a dearth of studies that explore the role that schools and school personnel play in the disclosure process.

CONCLUSION

Child abuse has devastating effects on children's physical, social, emotional, and psychological well-being. Understanding more about schools, personnel, and program-related factors that lead to disclosure, which are more amenable to change, is critical to ensuring the safety of children.

Reluctance Versus Urge to Disclose Child Maltreatment: The Impact of Multi-Type Maltreatment

Child maltreatment is a major public health issue in Israel. According to a recent Israeli national epidemiological survey, approximately half of Jewish and Arab girls and boys between the ages 12 and 17 experienced at least one type of child maltreatment, at any severity level. The purpose of the present study was to investigate the influence of multi-type maltreatment on Israeli children and youth survivors' reluctance versus urge to disclose; with the effects of gender, age, and ethnicity taken into account. The study is important since non-disclosure has deleterious effects in terms of continuation of the abuse, delays in criminal prosecution and commencement of treatment. A self-report questionnaire incorporating the following instruments was administered: the Juvenile Victimization Questionnaire, the Childhood Trauma Questionnaire, and the Disclosure of Trauma Questionnaire. The sample consisted of 6,253 Jewish and Arab children and youth who reported experiencing at least one lifetime child maltreatment event. Study results indicated that children and youth's reluctance to disclose is positively associated with their emotional reactions to disclosure, as well as with higher instances of child maltreatment exposure; whereas urge to talk is negatively correlated with their emotional reactions to disclosure.

Childhood Trauma Questionnaire (CTQ) correlations with prospective violence assessment in a longitudinal cohort

Retrospective recall-based measures administered to adults, like the Childhood Trauma Questionnaire (CTQ), are commonly used to determine experiences of childhood trauma in the home. However, the CTQ has not been compared with prospective measures of childhood violence exposure, whether at home or in the community. We evaluated the relationships between young adults' responses to the CTQ and their prospective self-reports of exposure to violence in childhood and adolescence. Participants were 127 (93% African American, 47% male) urban young adults in a longitudinal birth cohort study examining effects of prenatal substance exposure and environmental factors on development. Participants completed the Violence Exposure Scale for Children-Revised (VEX-R), a 21-item self-report measure of experience of/witness to interpersonal violence, administered face to face at 9, 10, and 11 years using cartoon pictures, and via audio-computer assisted self-interview at 12, 14, and 16 years. Participants also completed the CTQ, a 28-item, 5-scale screening measure, during a young-adult follow-up (ages 18-23). Using Pearson Correlation coefficients, VEX-R total scores significantly correlated with the sum of CTQ scales, r = .33, p < .01, and 3 (physical, emotional, and sexual abuse) of the 5 CTQ subscales, showing a moderate linear association. This study suggests that the CTQ serves as a reasonable retrospective assessment of prospectively ascertained childhood trauma exposure. The differences may be accounted for by disparities in domains assessed. (PsycINFO Database Record

Willingness to disclose child maltreatment: CSA vs other forms of child abuse in relation to gender

The aim of the study was to examine the role of gender in willingness to disclose childhood sexual abuse (CSA) compared to other forms of abuse (physical, emotional and neglect) in young adolescents. Willingness was examined through two terms: reluctance- the level of unwillingness or disinclination to disclose, and urge-the need to share in order to get rid of unbearable feelings. The sample consisted of 3,156 boys (n = 1,544) and girls (n = 1,612) between the ages of 11-16 who reported having been abused at least once during their life. Participants were divided into three groups: experiencing other than CSA, sexual abuse with no physical contact, and sexual abuse with physical contact. Regarding measures, a self-report questionnaire incorporating the following instruments was administered: Demographics, the Juvenile Victimization Questionnaire (JVQ), and the Disclosure of Trauma Questionnaire (DTQ). Study results indicated that CSA victims were more reluctant to disclose than victims of other than CSA forms of abuse. The more severe the CSA (physical contact) the lower was the willingness to disclose. Boys were more reluctant than girls to disclose sexual abuse whether or not it involved physical contact. Reluctance to disclose was positively associated with emotional reactions to disclosure while urge to talk was negatively correlated with emotional reactions to disclosure.

Disclosure of physical, emotional and sexual child abuse, help-seeking and access to abuse response services in two South African Provinces

Physical, emotional and sexual child abuse are major problems in South Africa. This study investigates whether children know about post-abuse services, if they disclose and seek services, and what the outcomes of help-seeking behaviour are. It examines factors associated with request and receipt of services. Confidential self-report questionnaires were completed by adolescents aged 10-17 (n = 3515) in South Africa. Prevalence of frequent (>weekly) physical abuse was 7.4%, frequent emotional abuse 12.4%, and lifetime contact sexual abuse 9.0%. 98.6% could name one suitable confidante or formal service for abuse disclosure, but only 20.0% of abuse victims disclosed. Of those, 72% received help. Most common confidantes were caregivers and teachers. Of all abuse victims, 85.6% did not receive help due to non-disclosure or inactivity of services, and 14.4% received help: 4.9% from formal health or social services and 7.1% through community vigilante action. Emotional abuse, sexual abuse and female gender were associated with higher odds of help-seeking. While children in South Africa showed high knowledge of available services, access to and receipt of formal services among abused children was low. Notably fewer children received help from formal services than through community vigilante action. Urgent action is needed to improve service access for child abuse victims.

Abuse Characteristics and Individual Differences Related to Disclosing Childhood Sexual, Physical, and Emotional Abuse and Witnessed Domestic Violence

Many adult survivors of childhood abuse hide their victimization, avoiding disclosure that could identify perpetrators, end the abuse, and bring help to the victim. We surveyed 1,679 women undergraduates to understand disclosure of childhood sexual, physical, and emotional abuse, and, for the first time, witnessed domestic violence, which many consider to be emotionally abusive. A substantial minority of victims failed to ever disclose their sexual abuse (23%), physical abuse (34%), emotional abuse (20%), and witnessed domestic violence (29%). Overall, abuse-specific factors were better predictors of disclosure than individual-level characteristics. Disclosure of sexual abuse was related to experiencing more frequent abuse (by the same and by multiple perpetrators), being more worried about injury and more upset at the time of the abuse, and self-labeling as a victim of abuse. Disclosure of physical abuse was related to experiencing more frequent abuse (by the same and multiple perpetrators), being less emotionally close to the perpetrator, being older when the abuse ended, being more worried and upset, and self-labeling as a victim. Disclosure of emotional abuse was associated with being older when the abuse ended, and being more worried and upset. Disclosure was unrelated to victim demographic characteristics or defensive reactions (dissociative proneness, fantasy proneness, repressive coping style, and temporary forgetting), except that among physical and emotional abuse victims, repressors were less likely to disclose than non-repressors. Disclosure of witnessing domestic violence was not significantly related to any factors measured.

Aspects of social support and disclosure in the context of institutional abuse - long-term impact on mental health

Background

The psychological sequelae of institutionalized abuse and its long-term consequences has not been systematically documented in existing literature in regarding social support once disclosure has been made. Reporting abuse is crucial, in particular for adult victims of childhood IA within the Catholic Church. Nevertheless, there is ongoing controversy about the benefits of disclosure. Our study examines the interaction of disclosure and subsequent social support in relation to mental health. We look into the times of disclosure, the behaviour during the disclosure to a commission as adults, different level of perceived social support, and the effect on mental health.

Methods

The data were collected in a sample of financially compensated adult survivors who experienced institutionalized abuse during their childhood, using instruments to measure perceived social support, reaction to disclosure, PTSD, and further symptoms.

Results

High levels of perceived social support after early disclosure result in a higher level of mental health and contribute to less emotionally reactive behaviour during disclosure of past institutionalized abuse. Highly perceived levels of social support seem to play a crucial role in mental health, but this inference may be weakened by a possible interference of a lasting competence in looking for social support versus social influences.

Conclusion

Future research should thus disentangle perceived social support into the competence of looking for social support versus socially influenced factors to provide more clarity about the positive association of perceived social support and mental health.

Young Victims Telling their Stories of Sexual Abuse in the Emergency Department

Among young children, child sexual abuse is a common type of maltreatment. Child sexual abuse (CSA) is an important national public health problem that has a devastating impact on the emotional and psychological makeup of the child, family, and society. The purpose of this analysis is to explore the young victim's own stories of disclosure of child sexual abuse and is an exploratory case study using reported assault histories of victims of CSA between the ages of 6 and 14, taken in the immediate wake of the assault. The data were extracted from the hospital records of child victims treated in an emergency department between 2006 and 2010. This qualitative research, using thematic analysis, explored the stories of sexual abuse for children as told by them. Two themes emerged regarding the experience of sex abuse and the immediate outcomes on the children: (1) Abuse Circumstances, which included the child's level of awareness of child sexual abuse, predisposing factors, and the perpetrator's preparation (physical, behavioral, and verbal tactics), and (2) Physical/Psychological Suffering associated with disclosure. These have important implications for all service and health care providers.

Effects of the child-perpetrator relationship on mental health outcomes of child abuse: it's (not) all relative

The present study was conducted to better understand the influence of the child-perpetrator relationship on responses to child sexual and physical trauma for a relatively large, ethnically diverse sample of children and youth presenting for clinical evaluation and treatment at child mental health centers across the United States. This referred sample includes 2,133 youth with sexual or physical trauma as their primary treatment focus. Analyses were conducted to ascertain whether outcomes were dependent on the perpetrator's status as a caregiver vs. non-caregiver. Outcome measures included psychiatric symptom and behavior problem rating scales. For sexual trauma, victimization by a non-caregiver was associated with higher posttraumatic stress, internalizing and externalizing behavior problems, depression, and dissociation compared to youth victimized by a caregiver. For physical trauma, victimization by a non-caregiver was also associated with higher posttraumatic symptoms and internalizing behavior problems. The total number of trauma types experienced and age of physical or sexual trauma onset also predicted several outcomes for both groups, although in disparate ways. These findings are consistent with other recent studies demonstrating that perpetration of abuse by caregivers results in fewer symptoms and problems than abuse perpetrated by a non-caregiving relative. Thus, clinicians should not make a priori assumptions that children and adolescents who are traumatized by a parent/caregiver would have more severe symptoms than youth who are traumatized by a non-caregiver. Further exploration of the role of the perpetrator and other trauma characteristics associated with the perpetrator role is needed to advance our understanding of these findings and their implications for clinical practice.

Fear of the perpetrator: a major reason why sexual assault victims delayed presenting at hospital

OBJECTIVE

To identify the reasons for presentation of sexual assault more than 72 h after the incidents at Newcastle Hospital, South Africa.

METHODS

A retrospective analysis of 534 medical records of victims seen between 2005 and 2009 at the hospital's sexual assault service centre.

RESULTS

Overall, 219 (41%) of the victims presented at the hospital more than 72 h after the alleged sexual assault, mainly for fear of the perpetrator (37.4%). Females constituted 87%, and rape with vaginal penetration was the most common form of sexual assault reported (74%). Tests of significance showed a positive association between fear of the perpetrator and delayed presentation at hospital. Age under 9 years and being scared of what relatives would say about alleged sexual assault were also associated with delayed presentation.

CONCLUSIONS

Attention needs to be focused on educating society on the importance of reporting sexual assault incidents promptly in order for victims to benefit from appropriate medical treatment.

Sexual revictimization: double betrayal and the risk associated with dissociative amnesia

This study aimed to identify new treatment targets in order to develop more empirically informed initiatives to prevent sexual revictimization. A retrospective Web-based survey employing a mixed-methods design attracted a self-selecting sample of 481 community respondents, 183 of whom indicated a history of childhood sexual abuse. Seventy-four percent were females whose ages ranged from 16 to 69 years (mean = 31.2 years). Betrayal trauma referred to CSA committed by a trusted perpetrator (often caregivers). Disclosure experiences in childhood were reported though open-dialogue boxes. Double betrayal referred to high-betrayal trauma being combined with a negative response to a disclosure. This was associated with both higher incidences of prior psychogenic amnesia for CSA and sexual revictimization in later life. The findings have implications for educating the guardians of children about the prevalence and implications of CSA as well as the importance of early recognition and appropriate responding.

Sexual revictimization in adult women: examining factors associated with their childhood and adulthood experiences

Using data collected from a sample of adult women (n = 234), this study examined the relationship between the experience and disclosure of childhood sexual abuse and subsequent adult sexual violence. Multivariate analyses revealed that physical force during the childhood sexual abuse experience was significant in both children's decisions to disclose as well as in adult revictimization experiences. Furthermore, childhood disclosures were significantly associated with adulthood disclosures about revictimization, but only when there was no action following the childhood disclosure. The implications for enhancing training and education about understanding and responding to children and women's disclosures about sexual violence are discussed.

Characteristics of response to experimental pain in sexually abused women

OBJECTIVES

Women with a history of sexual abuse (SA) commonly report greater pain symptoms. It is still unclear whether enhanced pain susceptibility is the result of altered pain processing and response. Therefore, this pilot study aimed to explore pain sensitivity to experimentally induced pain and associated psychology in women with a history of severe SA.

METHODS

Twenty-one survivors of severe, long-lasting SA and 21 control women underwent experimentally induced heat pain and completed psychological questionnaires. Pain measures included heat pain thresholds, pain intensity ratings, and pain tolerance in response to contact heat, painful stimulation delivered to the volar forearm. Questionnaires included somatization (Brief Symptom Inventory), personality traits including harm avoidance, novelty seeking, and reward dependence (Cloninger tridimensional personality questionnaire), and levels of dissociation (Dissociative Experiences Scale).

RESULTS

SA women had elevated heat pain thresholds (45.7±2.2°C vs. 43.9±3.1°C; P=0.042) and higher pain intensity ratings (on a 0 to 100 scale: 80.0±26.6 vs. 51.2±27.7; P=0.001). In addition, they had lower tolerability to painful tonic stimulation, greater somatization, and larger harm avoidance scores. Regression analyses showed that higher pain intensity ratings in SA women associated with greater tendency for harm avoidance but not with levels of dissociation.

DISCUSSION

Women with a history of severe SA seem to have a paradoxical pattern of experimental pain response, characterized by both higher pain thresholds and increased pain intensity ratings. This pattern is associated with the personality trait of harm avoidance. Models that might account for these findings are discussed.

Childhood sexual abuse severity and disclosure as predictors of depression among adult African-American and Latina women

A history of childhood sexual abuse (CSA) has been associated with adult depression, but data on abuse severity and disclosure are scant, particularly among low-income ethnic minorities. CSA often co-occurs with other adversities, which also increase the risk of depression. This study examined the peritrauma variable of abuse severity and the posttrauma variables of disclosure and self-blame as predictors of current depression symptoms in 94 low-income African-American and Latina women with histories of CSA. After controlling for nonsexual childhood adversity and adult burden (i.e., chronic stress), severe CSA overall was associated with higher depression scores, especially among Latinas who disclosed their abuse. Depression symptoms among African-American women were highest in those who disclosed and reported high levels of self-blame at the time of the incident. The link between depression and specific peri- and post-CSA factors in minority women may help guide future interventions.

Child sexual abuse: community concerns in urban Tanzania

The aim of this study was to explore community perceptions about child sexual abuse in Tanzania. Thirteen focus group discussions were conducted with adult community members. The core category, children's rights challenged by lack of agency, was supported by eight categories. Aware but distressed portrayed feelings of hopelessness, lack of trust in the healthcare and legal systems reflected perceived malpractice, decreased respect for children's rights referred to poor parental care and substance abuse, myths justifying CSA illustrated cultural beliefs to rationalize child sexual abuse, disclosure threatened by fear of stigma and discrimination aligned the manifestations that prevent disclosure, actions driven by economic circumstances described the economical dependence of victims, urging a change in procedures reflected informants' wish to ally with local governance and pressure groups, and willingness to act indicated the community's role in supporting victims. The study showed how lack of agency calls for efforts to increase children's human rights at all levels.