Childhood sexual experiences with adults. A comparison of reports by women psychiatric patients and general-practice attenders

Disrupting Identity through Visible Therapy: A Feminist Post-structuralist Approach to Working with Women who have Experienced Child Sexual Abuse

This article draws on feminism and post-structuralism to theorize a narrative framework for developing and critiquing therapeutic practices with women who have experienced child sexual abuse. I argue that both objectivism and relativism provide poor guides for conducting therapy and that it is only through situating our knowledges precisely that more liberatory therapy practices may be developed. This approach, termed ‘visible therapy’, is used to directly and explicitly challenge normative constructions of women, child sexual abuse and therapy. I argue that it is necessary to explicate the embedded assumptions produced through practices of abuse, and which serve to construct children's experiences of that abuse, in order to ward against their reproduction within therapy relationships. I demonstrate that it is through situating and explicating the operations of power that the authenticity of experience and identity may be questioned and women's ongoing positioning as guilty victims may be challenged. Thus, I am concerned not with who women ‘really are’ but with how they come to know and be known through practices of both abuse and therapy. This, then, is about making the tactics of abuse and therapy visible. Problems are not located within individuals, but rather within the narratives which situate both past and current relationships but which, through reiteration, obscure their own social production. I conclude that it is only when categorical identity is no longer assumed that progressive therapy practices with women who have been sexually abused can be developed and maintained.

The extent and effects of violence among psychiatric in-patients

Actual and perceived safety of male and female in-patients in an inner-city psychiatric hospital were examined. Using semi-structured interviews, 59 inpatients were asked to report on their direct experiences of physical or sexually threatening behaviour towards them during their admission. Of the sample, 75% reported unwanted physical or sexual experiences: female patients were significantly more likely than males to report sexual harassment. Most incidents were not reported to staff and both staff and patients appeared to perceive the ward environment as safe despite fairly high levels of verbal and physical aggression. This study has implications for the way that ‘violent incidents' in psychiatric hospitals are defined and recorded and raises questions about the provision of women-only space in hospitals.

Sexual Abuse and Psychological Disorders: The Role of Cognitive Processes

A history of sexual abuse is reported by a large proportion of women with psychological disorders. Cognitive approaches to therapy for this group aim to change the dysfunctional cognitions that are associated with abusive experiences, but often lack a clear model of the psychological processes that might be involved. This study examines the relationship between the overt cognitive correlates of sexual abuse (self-denigratory beliefs) and the covert correlates (information-processing bias). Women with psychological disorders who reported a history of sexual abuse had greater levels of self-denigratory beliefs and of information-processing bias than women who had a history of abuse but had no psychological disorder. The difference in overt self-denigratory cognitions was partly explained by the clinical women's higher level of covert information-processing bias. The information-processing bias appears to reflect a specific schema, which involves beliefs about the individual having been “contaminated” by the abusive experience. Therapeutic implications are discussed, including targets for treatment and evaluation. Further research is needed, to allow these cognitive correlates to be understood in relation to different psychological syndromes and symptoms.

Negative and positive childhood experiences across developmental periods in psychiatric patients with different diagnoses - an explorative study

BACKGROUND

A high frequency of childhood abuse has often been reported in adult psychiatric patients. The present survey explores the relationship between psychiatric diagnoses and positive and negative life events during childhood and adulthood in psychiatric samples.

METHODS

A total of 192 patients with diagnoses of alcohol-related disorders (n = 45), schizophrenic disorders (n = 52), affective disorders (n = 54), and personality disorders (n = 41) completed a 42-item self-rating scale (Traumatic Antecedents Questionnaire, TAQ). The TAQ assesses personal positive experiences (competence and safety) and negative experiences (neglect, separation, secrets, emotional, physical and sexual abuse, trauma witnessing, other traumas, and alcohol and drugs abuse) during four developmental periods, beginning from early childhood to adulthood. Patients were recruited from four Psychiatric hospitals in Germany, Switzerland, and Romania; 63 subjects without any history of mental illness served as controls.

RESULTS

The amount of positive experiences did not differ significantly among groups, except for safety scores that were lower in patients with personality disorders as compared to the other groups. On the other side, negative experiences appeared more frequently in patients than in controls. Emotional neglect and abuse were reported in patients more frequently than physical and sexual abuse, with negative experiences encountered more often in late childhood and adolescence than in early childhood. The patients with alcohol-related and personality disorders reported more negative events than the ones with schizophrenic and affective disorders.

CONCLUSIONS

The present findings add evidence to the relationship between retrospectively reported childhood experiences and psychiatric diagnoses, and emphasize the fact that a) emotional neglect and abuse are the most prominent negative experiences, b) adolescence is a more 'sensitive' period for negative experiences as compared to early childhood, and c) a high amount of reported emotional and physical abuse occurs in patients with alcohol-related and personality disorders respectively.

Psychosis, victimisation and childhood disadvantage: evidence from the second British National Survey of Psychiatric Morbidity

BACKGROUND

Adverse early circumstances may be more common in people who later develop psychotic disorders.

AIMS

To use data from the second British National Survey of Psychiatric Morbidity to examine associations between psychotic disorders and a number of early victimisation experiences.

METHOD

Psychiatric disorders were identified through structured assessment of adults resident in private households in Britain (n=8580). Respondents were asked whether they had experienced selected events displayed on cards.

RESULTS

Compared with respondents with other psychiatric disorders or with none, the prevalence of every experience bar one was significantly elevated in those with definite or probable psychosis. The largest odds ratio was for sexual abuse. Controlling for depressed mood somewhat reduced the odds ratios for the individual experiences.

CONCLUSIONS

In people with psychosis, there is a marked excess of victimising experiences, many of which will have occurred during childhood. This is suggestive of a social contribution to aetiology.

Childhood experience of sexual abuse among Hong Kong Chinese college students

OBJECTIVES

This study aimed to explore the prevalence rate and profiles of abusers and victims of child sexual abuse in a Chinese society.

METHOD

A convenience sample of 2,147 Hong Kong Chinese college students completed questionnaires which included items on definitions of child sexual abuse, recall of sexual abuse experience before age 17, information about the sexual abuse incidents, and personal demographics.

RESULTS

The overall prevalence rate for various forms of child sexual abuse was 6%, with the rates being higher for females than for males. The average age of the victims at the time of the sexual abuse was 11 years old, with a majority of them experiencing sexual abuse during their teenage years. The average age of the abusers as estimated by the victims was 24 years old, and only 28% of the abusers were strangers to the victims. Males were about three times more likely than females to be sexually abused by their friends, whereas females were about twice more likely than males to be sexually abused by strangers. Only 39% of the victims reported their sexual victimization to others, and 56% of the reported incidents were not followed up.

CONCLUSIONS

As compared to Western studies, the present study showed lower rates for more intimate or severe forms of child sexual abuse. The Chinese victims were more reluctant to disclose their sexual victimization than their Western counterparts. Limitations and practical implications of the study are also discussed.

Sexual and physical abuse of chronically ill psychiatric outpatients compared with a matched sample of medical outpatients

Because there are few controlled studies, we aimed to determine the prevalence of sexual and physical abuse reported by psychiatric outpatients compared with matched controls. The sample consisted of 158 outpatients with major mental disorders including schizophrenia and bipolar disorder who responded to a semi-structured interview (response rate = 64.8%) and who were individually matched for gender, age, and ethnicity with 158 outpatients who had never been treated for psychiatric illness. They answered questions about whether and when they had ever been sexually or physically abused, and about the type and circumstances of abuse. Abuse was more common during adulthood (16 years or older); 45 psychiatric patients (28.5%) were sexually abused and 43 (27.3%) were physically abused. Compared with the controls, patients were significantly more likely to report a history of sexual or physical abuse during adulthood (chi2 = 5.15, df = 1, p = .02; chi2 = 4.09, df = 1, p = .04 respectively). During adulthood, female patients were significantly more likely to be sexually and physically abused than male patients, and those sexually abused were significantly more likely to report a history of sexual abuse during childhood. However, patients were not significantly more likely to report a history of sexual or physical abuse during childhood compared with the controls. These findings demonstrate that psychiatrically ill patients are vulnerable to sexual and physical abuse during adulthood and underscore psychiatrists' responsibility to routinely inquire about abuse experiences.

The prevalence of a history of child sexual abuse among adults visiting family practitioners in Israel

OBJECTIVE

To determine the prevalence of a history of child sexual abuse (CSA) in a random sample of adult patients presenting for routine health care to family practice clinics in Israel.

METHOD

One thousand and five randomly selected patients aged 18 to 55, attending 48 clinics, participated in this questionnaire study.

RESULTS

Twenty-five percent indicated that they had been sexually abused as children. More women reported CSA (p < .0001 ) than men, as did women originating from Western countries (p = .02) and those with more than 12 years of education (p = .01). There were no significant associations between CSA and the other socio-demographic variables examined. Fondling was the most common and intercourse the least common activity experienced. Forty-five percent of the perpetrators were previously known. The mean age at which the child sexual abuse began varied between 10 and 14. Only 45% of the subjects had ever told anyone about the experience.

CONCLUSIONS

Since no other prevalence study has been reported to date in Israel, these findings suggest that as in other Western countries CSA is a relatively common problem. Family physicians and other health professionals should be aware of this high prevalence and its known potential for initial and long-term deleterious outcomes.

Long-term effects of childhood sexual abuse: objective and subjective characteristics of the abuse and psychopathology in later life

This study investigates the association between objective and subjective characteristics of childhood sexual abuse and psychopathology in later life. The sample consists of 404 Dutch female adults who had been sexually abused in their childhood or adolescence. The participants were recruited by means of articles about childhood sexual abuse in major Dutch newspapers. The characteristics and severity of the sexual abuse were assessed with the Questionnaire Unwanted Sexual Experiences in the Past (QUSEP). General psychopathology was measured with the Symptom Checklist (SCL-90), the degree of dissociation was measured with the Dissociation Questionnaire (DIS-Q). Stepwise multiple regression analyses showed a moderate association between psychopathology and objective characteristics of the abuse, such as number of different types of abusive events and the duration of the abuse. However, more strongly associated with later psychopathology were variables reflecting coping style, such as the degree of self-blame, and circumstantial factors, such as the emotional atmosphere in the family of origin and the reactions after disclosure. Whether or not the abuse was incestuous did not explain additional variance in later psychopathology.

The Educational Needs of Occupational Therapists Who Work with Adult Survivors of Childhood Sexual Abuse

This study aimed to examine the education and training needs of occupational therapists who work with adult survivors of childhood sexual abuse (CSA). Two sample groups were used: occupational therapy pre-registration courses and occupational therapists working in mental health settings. Two postal surveys were designed in order to elicit both quantitative and qualitative data. Seventeen courses and 43 occupational therapists responded from around the United Kingdom.

The results indicated that although most of the occupational therapy courses offered some form of education around CSA issues, this had been available for a relatively short period of time (generally for less than 5 years). However, the majority of occupational therapists who responded were senior staff with more than 5 years' clinical experience who had not received such education as students. Consequently, the education offered differed greatly from that of 5 years ago. All the occupational therapists felt that their current level of knowledge could be improved. Recommendations regarding prospective educational requirements and further research are made.

Victims and perpetrators of child sexual abuse

BACKGROUND

This article aims to inform clinicians of current thinking in the area of victims and perpetrators of child sexual abuse. It covers prevalence data as well as identification, effects and interventions with victims, and also characteristics, assessment and treatment of perpetrators.

METHOD

The review is based on manual searches and the authors' own clinical experience.

RESULTS

All clinicians should be aware of signs and symptoms that raise the possibility that someone has been or is being sexually abused, and also of the possibilities of abuse of boys and of women as abusers. Methods of intervening are discussed, both in relation to victims and perpetrators. The importance of thoroughness when assessing perpetrators is emphasised because of their tendency to deny and/or minimise their offending. The demands of this work are underlined in a section on the necessary qualifications and characteristics of therapists working in this area.

CONCLUSIONS

Despite the lack of agreement in definitions and outcome measures used in research there are some positive findings in relation to clinical efficacy. In particular, the need for long-term treatment with those offenders who are more seriously deviant has been supported by recent research. There is a need for continuing attempts to standardise definitions and measures to aid realistic comparison of research results.

Childhood sexual abuse: a risk factor for postpartum depression?

While the link between childhood sexual abuse and adult psychiatric disorder has been documented, such research has not looked at any association with postpartum depression. Admissions to the Mercy Mother-Baby Unit are reviewed with respect to a possible link, with case examples presented. An aetiological model is proposed and clinical implications are highlighted.

Childhood unwanted sexual events and degree of psychopathology of psychiatric patients: research with a new anamnestic questionnaire (the CHUSE)

By means of a recently constructed anamnestic instrument, the questionnaire Childhood Unwanted Sexual Events (the CHUSE), the incidence of childhood experiences with sexual threat and/or abuse is investigated among 152 female psychiatric patients. The construction and applicability of the questionnaire are described. A Guttman scale-analysis shows a unidimensional construct (severity of the sexual abuse) for the CHUSE. Within this psychiatric population, sexually abused women report significantly more psychopathological symptoms than non-abused women. The correlation between severity of the abuse and severity of the psychopathological symptoms is investigated. The use of questionnaires concerning sexual abuse is compared with the more common interview techniques, and suggestions for future research are given.

Childhood sexual experiences with adults: adult male psychiatric patients and general practice attenders

BACKGROUND

Sexual abuse of male children is now believed to be common, and there may be links to adult psychiatric disorders.

METHOD

Recollections of sexual experiences with adults in childhood were studied systematically in 115 men attending general practice surgeries and 100 male psychiatric patients.

RESULTS

The latter reported more frequent and more serious events before the age of 13 than the general practice attenders. No significant difference was detected for events between the ages of 13 and 15.

CONCLUSIONS

Childhood sexual abuse before the age of 13 may be associated with later psychiatric disorders, although the nature of the association remains uncertain. The possible significance of such experiences should be considered when assessing men with mental disorders.