Sexual assault history and eating disorder symptoms among White, Hispanic, and African-American women and men

Sexual Assault Victimization and Eating Disorders Among College-enrolled Men

Sexual assault victimization and eating disorder rates are high among college populations and have significant psychological, physiological, and social outcomes. Previous research has found a positive relationship between experiences of sexual assault and eating disorder symptoms; however, these analyses have primarily focused on female students. Using data from the 2017-2018 Healthy Minds Study, the aim of this study was to investigate the relationship between experiencing a sexual assault within the previous 12 months and screening positive for an eating disorder among cisgender college-enrolled men. It was hypothesized that college-enrolled men who report experiencing a sexual assault within the previous 12 months would be more likely to screen positive for an eating disorder. Analyses were conducted using a sample of 14,964 cisgender college-enrolled men. Among the sample, nearly 4% reported a sexual assault within the previous 12 months and nearly 16% screened positive for an eating disorder. Results from logistic regression analyses indicated that college-enrolled men who reported experiencing a sexual assault in the previous 12 months, compared to those who did not, had significantly greater odds of screening positive for an eating disorder (OR = 1.40, p < .01). Analyses also indicated that college-enrolled men who identified as gay, queer, questioning, or other sexual orientation and reported experiencing a sexual assault in the previous 12 months had greater odds of screening positive for an eating disorder (OR = 2.50, p < .001) compared to their heterosexual peers who did not experience a sexual assault in the previous 12 months. These results indicate that eating disorders may be a negative outcome among college-enrolled men who have experienced a sexual assault, particularly among sexual minority men. Thus, mental health professionals need to be adequately prepared to treat the underserved population of men who experience an eating disorder and who have experienced sexual assault.

Sexual Harassment, Sexual Assault, and Physical Activity Among U.S. Military Service Members in the Millennium Cohort Study

Sexual harassment (SH) and sexual assault (SA) continue to be a focus of prevention efforts in the U.S. military because of the prevalence and potential to affect the health and readiness of service members. Limited research exists on the association of SH and SA with coping behaviors, such as physical activity, within the military. Data including self-reported SA, SH, and physical activity were obtained from the Millennium Cohort Study, a longitudinal cohort study designed to examine the impact of military service on the health and well-being of service members. A hierarchical regression approach was applied to examine the association between SH or SA and subsequent physical activity levels. Hierarchical regression showed that, among those self-reporting recent SA, the odds of medium-high (300-449 min/week) and high physical activity levels (≥450 min/week) were significantly increased. Although the magnitude of these associations was attenuated with an increasing amount of adjustment, the odds of high physical activity levels remained statistically significant in the fully adjusted model (medium-high: odds ratio [OR] = 1.72, 95% confidence interval [CI] = [1.08, 2.73]; high: OR = 1.58, 95% CI = [1.02, 2.44]). We observed statistically significant negative associations between recent SH and medium-high physical activity levels in adjusted models (OR = 0.70, 95% CI = [0.54, 0.91]). The current results demonstrate that SA is generally associated with increased levels of physical activity among military service members. Analyzing the relationship between sexual trauma and physical activity is valuable because of the high prevalence of SH and SA in the military, long-term health implications including physical and emotional well-being, and potential impact on military readiness.

Sexual assault victimization and psychopathology: A review and meta-analysis

Sexual assault (SA) is a common and deleterious form of trauma. Over 40years of research on its impact has suggested that SA has particularly severe effects on a variety of forms of psychopathology, and has highlighted unique aspects of SA as a form of trauma that contribute to these outcomes. The goal of this meta-analytic review was to synthesize the empirical literature from 1970 to 2014 (reflecting 497 effect sizes) to understand the degree to which (a) SA confers general risk for psychological dysfunction rather than specific risk for posttraumatic stress, and (b) differences in studies and samples account for variation in observed effects. Results indicate that people who have been sexually assaulted report significantly worse psychopathology than unassaulted comparisons (average Hedges' g=0.61). SA was associated with increased risk for all forms of psychopathology assessed, and relatively stronger associations were observed for posttraumatic stress and suicidality. Effects endured across differences in sample demographics. The use of broader SA operationalizations (e.g., including incapacitated, coerced, or nonpenetrative SA) was not associated with differences in effects, although including attempted SA in operationalizations resulted in lower effects. Larger effects were observed in samples with more assaults involving stranger perpetrators, weapons, or physical injury. In the context of the broader literature, our findings provide evidence that experiencing SA is major risk factor for multiple forms of psychological dysfunction across populations and assault types.

Sexual Abuse and Eating Disorders in a Community Sample of Mexican American Women

The purpose of this study was to examine the association between sexual abuse and eating disorders in a voluntary community sample of Mexican American women. Eighty eating disorder cases were compared to 110 healthy controls on presence of sexual abuse and on characteristics of the abuse. The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision) and the Eating Disorder Examination were used to determine diagnoses and psychiatric comorbidity. Results indicated that compared to controls, cases were more likely to report sexual abuse and had experienced more instances and longer duration of abuse. For the majority of cases, sexual abuse occurred before onset of eating disorder symptoms. There was no relationship between sexual abuse and type of eating disorder or psychiatric comorbidity. Sexual abuse seems to be a risk factor for disordered eating in Mexican Americans. Prolonged abuse and revictimization may increase this risk.

Sexual assault in the military

Military sexual assault is a pervasive problem throughout the military services, despite numerous initiatives to end it. No doubt the military's lack of progress stems from the complexity of sexual assaults, yet in order to develop effective strategies and programs to end sexual assault, deep understanding and appreciation of these complexities are needed. In this paper, we describe the root causes and numerous myths surrounding sexual assault, the military cultural factors that may unintentionally contribute to sexual assault, and the uncomfortable issues surrounding sexual assault that are often ignored (such as the prevalence of male sexual assault within the military). We conclude by offering a broad, yet comprehensive set of recommendations that considers all of these factors for developing effective strategies and programs for ending sexual assault within in the military.

Childhood Trauma, Adult Sexual Assault, and Adult Gender Expression among Lesbian and Bisexual Women

Several studies have demonstrated that lesbian and bisexual women are more likely than heterosexual women to report childhood abuse and adult sexual assault. It is unknown, however, which sexual minority women are most likely to experience such abuse. We recruited adult sexual minority women living in the US through electronic fliers sent to listservs and website groups inviting them to complete an online survey (N=1,243). We examined differences in both childhood abuse and adult sexual assault by women's current gender identity (i.e., butch, femme, androgynous, or other) and a continuous measure of gender expression (from butch/masculine to femme/feminine), adjusting for sexual orientation identity, age, education, and income. Results indicated that a more butch/masculine current self-assessment of gender expression, but not gender identity, was associated with more overall reported childhood trauma. Although one aspect of gender expression, a more butch/masculine gender role, was associated with adult sexual assault, feminine appearance and a femme gender identity also significantly predicted adult sexual assault. These findings highlight the significance of gender identity and expression in identifying women at greater risk for various abuse experiences.

Cancer screening and history of sexual violence victimization among U.S. adults

BACKGROUND

Little is known about the effect a history of sexual violence (SV) victimization has on the likelihood of reporting screening tests for cancer. This study investigates the association between SV victimization and cancer screening behaviors.

METHODS

We analyzed data from the 2006 Behavioral Risk Factor Surveillance System (BRFSS) from 11 states and 1 territory (U.S. Virgin Islands) that administered the SV module to describe demographic characteristics, quality of life, health status, cancer screening behaviors, healthcare coverage, and use of healthcare services for 58,665 women and men who reported SV victimization compared to women and men who did not. The SV victimization measure includes unwanted touching, exposure to sexual material, or ever experiencing completed or attempted unwanted sex. Statistical significance was determined using chi-square tests and multivariate logistic regression models.

RESULTS

Multivariate logistic regression results presented as adjusted proportions showed SV victimization was significantly associated with mammography screening for women (74.0 % victims vs. 77.1% nonvictims, p=0.02). SV victimization was not associated with cancer screening among men. Fewer women reporting SV victimization had healthcare insurance, a personal doctor or healthcare provider, and received regular checkups within the past 1-12 months. Fewer men reporting SV victimization had healthcare coverage.

CONCLUSIONS

These data suggest that SV victimization may have a negative association on overall healthcare use, including breast cancer screening for women. Healthcare providers should consider SV victimization as a potential barrier for women who report not being up-to-date with mammography.

From the margins to the center: ethnic minority women and the mental health effects of sexual assault

The trauma of sexual assault is heightened for many women by the interlocking experience of societal traumas such as racism, sexism, and poverty. The mental health effects of sexual assault are mediated by race and ethnicity. The investigators explore the experiences of African American, Asian American, Latina, and Native American female survivors of sexual assault. The sociohistorical context of intergenerational trauma in the lives of ethnic minorities is a part of the context for the contemporary experience of sexualized violence. Racial and ethnic dynamics related to sexual assault prevalence, mental health effects, and disclosure are examined. Literature related to cultural beliefs, community attitudes, and perceived social support in relation to sexualized violence are also reviewed. Finally, practice, research, and policy implications are discussed.

Rape treatment outcome research: empirical findings and state of the literature

This article reviews empirical support for treatments targeting women sexually assaulted during adolescence or adulthood. Thirty-two articles were located using data from 20 separate samples. Of the 20 samples, 12 targeted victims with chronic symptoms, three focused on the acute period post-assault, two included women with chronic and acute symptoms, and three were secondary prevention programs. The majority of studies focus on posttraumatic stress disorder (PTSD), depression, and/or anxiety as treatment targets. Cognitive Processing Therapy and Prolonged Exposure have garnered the most support with this population. Stress Inoculation Training and Eye Movement Desensitization and Reprocessing also show some efficacy. Of the four studies that compared active treatments, few differences were found. Overall, cognitive behavioral interventions lead to better PTSD outcomes than supportive counseling does. However, even in the strongest treatments more than one-third of women retain a PTSD diagnosis at post-treatment or drop out of treatment. Discussion highlights the paucity of research in this area, methodological limitations of examined studies, generalizability of findings, and important directions for future research at various stages of trauma recovery.

Sexual assault and disordered eating in Asian women

The link between sexual assault and disordered eating has yet to be clarified, especially for ethnic minority populations. Asian women, in particular, report low rates of both sexual assault and eating disorders compared to their Western counterparts, and studies suggest that these rates may be conservative. The literature indicates that there are cultural attitudes that contribute to non- and underreporting of sexual assault by Asian women and that these sociocultural factors may have an important role in the development of eating disorders as a response to sexual victimization. Research illustrates a relationship between sexual assault and eating disorders; eating disorders may serve as coping mechanisms for survivors of sexual assault by providing a mechanism for comfort, numbing, and distracting in an effort to rid the painful feelings in response to the assault. To stimulate future research, this article reviews the current literature on the development of eating disorders following a sexual assault and on the sociocultural factors linking both phenomena in Asian women, and offers avenues for investigation to increase our understanding of these relationships.

Inscriptions of violence: societal and medical neglect of child abuse--impact on life and health

OBJECTIVE

A sickness history from General Practice will be unfolded with regard to its implicit lived meanings. This experiential matrix will be analyzed with regard to its medico-theoretical aspects.

METHOD

The analysis is grounded in a phenomenology of the body. The patient Katherine Kaplan lends a particular portrait to the dynamics that are enacted in the interface between socially silenced domestic violence and the theoretical assumptions of human health as these inform the clinical practice of health care.

RESULTS

By applying an understanding of sickness that transcends the mind-body split, a concealed and complex logic emerges. This logic is embedded in a nexus of the impact of childhood abuse experience and the medical disinterest in subjective experiences and their impact on selfhood and health. Its core is twofold: the violation of embodiment resulting from intra-familial abuse and existential threat, and the embodiment of violation resulting from social rules and the theoretically blinded medical gaze.

CONCLUSION

A considerable medical investment, apparently conducted in a correct and consistent manner as to diagnostic and therapeutic measures, results in the complete incapacitation of a young physician.

The association of abuse and symptoms suggestive of chronic prostatitis/chronic pelvic pain syndrome: results from the Boston Area Community Health survey

OBJECTIVE

To determine the effect of reported sexual, physical, or emotional abuse on the symptoms suggestive of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and to determine the effect of race/ethnicity on these patterns.

METHODS

The Boston Area Community Health (BACH) survey used a multi-stage stratified cluster sample to randomly sample 5,506 adults aged 30-79 from the city of Boston. BACH recruited 2,301 men (700 Black, 766 Hispanic, and 835 White). Interviewers administered questions approximating the National Institutes of Health chronic prostatitis symptom index (CPSI), and symptoms suggestive of CP/CPPS were measured by the definition of perineal and/or ejaculatory pain and CPSI pain score of 4+. Questions about previous abuse were obtained from a validated self-administered questionnaire during the home visit. Logistic regression was used to determine the effect of abuse on the likelihood of a man having symptoms suggestive of CP/CPPS.

RESULTS

The prevalence of symptoms suggestive of CP/CPPS was 6.5%. Men who reported having experienced sexual, physical, or emotional abuse had increased odds (1.7-3.3) for symptoms suggestive of CP/CPPS. Previous abuse increased both the pain and urinary scores from the CPSI.

CONCLUSION

Symptoms suggestive of CP/CPPS are not uncommon in a community-based population of men. For men presenting with symptoms suggestive of CP/CPPS, clinicians may wish to consider screening for abuse.

The association between self-reported lifetime history of forced sexual intercourse and recent health-risk behaviors: findings from the 2003 National Youth Risk Behavior Survey

PURPOSE

To expand the understanding of the association between recent health-risk behaviors and a history of forced sexual intercourse, using a nationally representative sample of female and male high school students.

METHODS

Data were from the 2003 National Youth Risk Behavior Survey, a nationally representative biennial survey of U.S. high school students. Lifetime history of forced sex, recent physical dating violence, and health-risk behaviors (substance use, diet-related behaviors, violence-related behaviors, and health promoting behaviors) were assessed. Analyses were stratified by gender and controlled for grade and race/ethnicity.

RESULTS

Of students surveyed, 8.9% reported ever being forced to have sex. One in eight females and one in 16 males experienced forced sex in their lifetime. For females and males, a history of forced sex was associated with experiencing physical dating violence and suicidal ideation in the 12 months preceding the survey and with substance use in the previous 30 days. Female victims were not as likely as female nonvictims to have participated in team sports during the previous 12 months. Male victims were more likely than male nonvictims to have fasted for more than 24 hours to lose weight during the previous 30 days.

CONCLUSIONS

A lifetime history of forced sex is associated with recent dating violence and participation in unhealthy behaviors. Services and intervention programs for victimized youth should address health concerns that have been linked to sexual assault. Such programs would provide opportunities for early intervention with lasting implications for improved health.

Sexual abuse history: prevalence, health effects, mediators, and psychological treatment

OBJECTIVE

Lifetime history of sexual abuse is estimated to range between 15% and 25% in the general female population. People who are sexually abused are at greater risk for a whole host of physical health disorders that may occur many years after the abusive incident(s). Despite the high prevalence of this trauma and its association with poor health status, abuse history often remains hidden within the context of medical care. The aims of this review are to determine which specific health disorders have been associated with sexual abuse in both women and men, to outline the types of sexual abuse associated with the worst health outcome, to discuss some possible explanations and mediators of the abuse/health relationship, to discuss when and how to talk about abuse within a clinical setting, and to present evidence for which psychological treatments have been shown to improve the mental health of patients with past sexual abuse.

METHOD

To meet these objectives, we have reviewed a wide literature on the topic of sexual abuse.

RESULTS

We demonstrate that abuse appears to be related to greater likelihood of headache and gastrointestinal, gynecologic, and panic-related symptoms; that the poor health effects associated with abuse are also seen in men; that abuse involving penetration and multiple incidents appears to be the most harmful, and that exposure-type therapies with and without cognitive behavioral therapy hold promise for those with abuse history.

CONCLUSION

We need more research examining psychological treatments that might be efficacious in treating the physical health problems associated with sexual abuse history.

Does It Matter What You Call It? The Relationship Between Labeling Unwanted Sexual Experiences and Distress

Using cross-sectional data from 2 samples of women attending a university (N = 1,395), the author examined the relationship among women's labeling of their unwanted sexual experiences (USEs) with dating partners and a variety of psychological and school-related outcomes. Three competing path analysis models were tested to determine whether the distress associated with sexual victimization stems from the USE itself, from the woman's self-definition as a victim, or from both. The best-fitting model indicates that labeling is irrelevant to the determination of negative outcomes and that it is the USE itself that is associated with psychological and school-related distress. These results suggest that labeling cannot be considered a valid criterion for determining who has experienced sexual victimization.

Sexual Trauma and Pregnancy: A Conceptual Framework

In this paper, we propose that a history of sexual traumatization is associated with pregnancy complications and poor pregnancy-related outcomes. We further hypothesize that this relationship is mediated by the sequelae of trauma (psychopathology, health problems, and increased negative health behaviors). We review the literature linking sexual trauma with psychopathology, health, and health behavior and then outline the impact of these variables on pregnancy. Based on this review, we draw conclusions about the potential impact of sexual trauma on pregnancy outcomes. We suggest future directions for this area of research and discuss the clinical implications of this association, including the development of prenatal intervention and prevention programs.

Understanding a link between sexual harassment and eating disorder symptoms: a mediational analysis

Using data from 3 samples of working women and men, the present study examines the association between sexual harassment and eating disorder symptoms by studying the processes that may underlie this relationship. The results of structural equation modeling suggest a link between sexual harassment and eating disorder symptoms among women and indicate that this relationship is mediated by psychological distress, self-esteem, and self-blame. Further, sexual harassment was found to predict eating disorder symptoms among women even when experiences of sexual assault were included in the model. No relationship was found between sexual harassment and eating disorder symptoms among men. The theoretical and clinical implications of these results are discussed.

A meta-analytic examination of the relationship between child sexual abuse and eating disorders

OBJECTIVE

This study had two goals. The first was to assess the magnitude and consistency of the relationship between child sexual abuse (CSA) and eating disorders (ED). The second was to examine methodological factors contributing to the heterogeneity of this relationship.

METHOD

Meta-analysis was used to examine both questions. Fifty-three studies were included in the analysis.

RESULTS

A small, significant positive relationship between CSA and ED emerged. The relationship was marked by heterogeneity. Effect sizes were largest when CSA was the grouping variable, the Eating Disorders Inventory (EDI) or the Eating Attitudes Test (EAT) was used as the measure of eating disorders, and nonclinical groups were compared with clinical samples.

DISCUSSION

Models of CSA and ED need to more clearly specify what aspects of ED (e.g., body image or binge eating) are most influenced by which types of CSA. These specific relationships then need to be examined empirically.

Arriving at readiness to recover emotionally after sexual assault

The purpose of this grounded theory study was to discover behaviors and processes that lead survivors of sexual assault to seek help with emotional recovery. The substantive theory Arriving at Readiness was developed from interviews with 11 women survivors of sexual assault. Eleven categories, each containing several strategies, form the theory. The core variable is arriving at readiness. The findings clarify why survivors often delay obtaining help with emotional recovery. The theory can be used as a tool to make it more likely survivors will be identified and receive help that is responsive to their needs.

Victimization of women and its impact on assessment and treatment in the psychiatric emergency setting

An understanding of victimization is critical to the practice of emergency psychiatry. Victimization histories are disturbingly common among women presenting to the PES, particularly among frequent service users. The sequelae of victimization are both psychological and physical and often impair health and functioning across numerous domains. PTSD, BPD, and substance-use disorders are often seen among women with victimization histories, which can be particularly challenging for PES providers. Screening for trauma on PES presentation or history should not be overlooked in any person, including severely mentally ill, homeless, disabled, or elderly women. PES clinicians should remember to ask about victimization and pose questions privately in a direct and an open-ended format while conveying empathic validation. Clinical assessment of women with victimization histories in the PES should be guided by the principles of standard emergency psychiatry and be informed by an understanding of trauma. This includes a working knowledge of trauma dynamics, adherence to sound professional boundaries, and care not to retraumatize patients or re-enact perpetrator-victim dynamics. Voyeurism and regression should be avoided, particularly when eliciting trauma history. The PES should be a place for screening and acute intervention, not for conducting intensive trauma therapy. In the PES, the focus should remain on triage and treatment priorities, those of safety and stabilization, and carefully evaluating for substance use and psychosis. The PES ideally provides a "holding environment" that affords a balance of nurturing, limits, consistency, and communication. A basic knowledge of cognitive-behavioral interventions affording "crisis survival strategies," such as DBT, can be particularly useful to PES clinicians. Clinicians also need to monitor issues of countertransference and the potential to be dismissive to these women with complex, comorbid, and chronic problems and diseases. The role for the use of psychotropic medication in PES cohorts with victimization histories should target acute symptoms. Involving regular providers of these decisions is advised to coordinate care and minimize splitting and risks of polypharmacy. Although the SSRIs are effective in symptom management of disorders related to victimization, patients must be reminded of the side-effect profile, particularly sexual dysfunction and withdrawal and discontinuation syndromes.

Medical profile of women Veterans Administration outpatients who report a history of sexual assault occurring while in the military

To profile differences in current physical symptoms and medical conditions among women users of Veterans Administration (VA) health services with and without a self-reported history of sexual assault sustained during military service, we conducted a cross-sectional analysis of a nationally representative, random sample of women veterans using VA outpatient services (n = 3632). A self-administered, mailed survey asked whether women had sustained sexual assault while in the military and requested information about a spectrum of physical symptoms and medical conditions. A history of sexual assault while in the military was reported by 23% of women VA users and was associated with current physical symptoms and medical conditions in every domain assessed. For example, women who reported sexual assault were more likely to indicate that they had a "heart attack" within the past year, even after adjusting for age, hypertension, diabetes, and smoking history (OR 2.3, 95% CI 1.3-4.0). Among women reporting a history of sexual assault while in the military, 26% endorsed > or = 12 of 24 symptoms/conditions, compared with 11% of women with no reported sexual assault while in the military (p < 0.001). Clinicians need to be attuned to the high frequency of sexual assault occurring while in the military reported by women VA users and its associated array of current physical symptoms and medical conditions. Clinicians should consider screening both younger and older patients for a sexual violence history, especially patients with multiple physical symptoms.

Conceptualizing vulnerable populations health-related research

BACKGROUND

A conceptual model for vulnerable populations research relates resource availability and relative risk to health status. The model has a population-based focus that places responsibility for the collective health status of its citizens with the community. Vulnerable populations are social groups who experience limited resources and consequent high relative risk for morbidity and premature mortality. There is considerable research evidence to support the major relationships in the model. Conceptual links that need additional research are identified.

CONCLUSIONS

The implications for research include a variety of methodological problems related to recruiting and retaining participants, instrumentation, and data collection. Research designs are needed that move beyond descriptive and epidemiological approaches to interventional and outcome studies. Ethical considerations take on special significance with vulnerable populations.

An examination of racial and ethnic differences within a sample of Hispanic, white (non-Hispanic), and African American Medicaid-eligible pregnant substance abusers. The MOTHERS Project

White (n = 213), African American (n = 210), and Hispanic (n = 104) Medicaid-eligible, chemically-dependent, pregnant women were interviewed during their stay in stay in publicly-funded detoxification centers in Massachusetts. Comparisons of demographic, psychosocial, and substance abuse variables revealed significant intergroup differences in almost all instances. There appears to be as much heterogeneity within the treatment population subgroup of pregnant women as there is across different treatment populations. Ramifications of the observed differences for treatment planning and service provision are discussed.

Disordered eating behaviors and bone-mineral density in women who misuse alcohol

Because lower bone-mineral density is one potential physiological consequence of eating disorders and chronic alcohol misuse, the risk for osteoporosis may be compounded in women who have both conditions. This study investigated the frequency of eating disorders in 25 women who misuse alcohol and compared bone-mineral density between those with and without multiple disordered eating behaviors. Disordered eating behaviors were assessed through the EAT-26 (Eating Attitudes Test) and a structured interview addressing binge eating, purging, and other weight-control behaviors. Bone-mineral density was measured using dual energy x-ray densitometry. Although only one woman met the DSM-III-R criteria for a current eating disorder, 12% had past histories suggestive of anorexia nervosa and 40% had multiple disordered eating behaviors with bulimic features. Bone-mineral density of the femoral neck was 9.3% greater in women with multiple disordered eating behaviors (p < or = .05).