Long-term effects of childhood sexual exploitation

The Etiologic, Theory-Based, Ontogenetic Hierarchical Framework of Alcohol Use Disorder: A Translational Systematic Review of Reviews

Modern nosologies (e.g., ICD-11, DSM-5) for alcohol use disorder (AUD) and dependence prioritize reliability and clinical presentation over etiology, resulting in a diagnosis that is not always strongly grounded in basic theory and research. Within these nosologies, DSM-5 AUD is treated as a discrete, largely categorical, but graded, phenomenon, which results in additional challenges (e.g., significant phenotypic heterogeneity). Efforts to increase the compatibility between AUD diagnosis and modern conceptualizations of alcohol dependence, which describe it as dimensional and partially overlapping with other psychopathology (e.g., other substance use disorders) will inspire a stronger scientific framework and strengthen AUD's validity. We conducted a systematic review of 144 reviews to integrate addiction constructs and theories into a comprehensive framework with the aim of identifying fundamental mechanisms implicated in AUD. The product of this effort was the Etiologic, Theory-Based, Ontogenetic Hierarchical Framework (ETOH Framework) of AUD mechanisms, which outlines superdomains of cognitive control, reward, as well as negative valence and emotionality, each of which subsume narrower, hierarchically-organized components. We also outline opponent processes and self-awareness as key moderators of AUD mechanisms. In contrast with other frameworks, we recommend an increased conceptual role for negative valence and compulsion in AUD. The ETOH framework serves as a critical step towards conceptualizations of AUD as dimensional and heterogeneous. It has the potential to improve AUD assessment and aid in the development of evidence-based diagnostic measures that focus on key mechanisms in AUD, consequently facilitating treatment matching.

Trauma Exposure and Alcohol Use in Battered Women

The purpose of the present study was to examine the relationship between battering severity and alcohol use among battered women. The study used multiple regression analyses to examine predictive relationships between three forms of trauma exposure—childhood physical and sexual abuse and domestic violence—and alcohol use. This study is among the first to investigate these relationships, using a sample of 78 battered women drawn from both shelter and nonresidential community agencies. Both battering severity and childhood sexual abuse were positively correlated with alcohol use. Multiple regression analysis showed that childhood sexual abuse was the stronger predictor when collinearity was controlled.

Family trauma through generations: incest and domestic violence in rural Sweden in the nineteenth century

Two generations of a family who lived in mid-nineteenth rural Sweden are described. Domestic violence was a common feature in the first generation family. The salient feature there was undoubtedly the incestuous father-daughter relationships. The way incest appeared in Sweden about 150 years ago, the role of local authorities, and the serious consequences to those victimized is analyzed with reference to both the cultural context of that time and to modern theories of incest. Seemingly puzzling violence committed by a second generation family member is related to the domestic violence in the previous generation. Due to the extraordinary character of the incest cases and the specific church council sessions in which the incest case was treated, aspects of family life normally hidden behind curtains of conventions were made public. Reaction patterns drawn from this case indicate a patriarchal system of oppression and badly-directed considerations.

Differential symptom pattern of post-traumatic stress disorder (PTSD) in maltreated children with and without concurrent depression

OBJECTIVE

The present study attempted to examine specific differences in the Post-Traumatic Stress Disorder (PTSD) symptomatology among abused children with and without concurrent depression.

METHOD

PTSD and depressive symptoms were identified that discriminate between 98 children divided into three groups: (1) abused children with PTSD, (2) nonabused children who meet criteria for Major Depressive Disorder (MDD), and (3) abused children with both PTSD and MDD.

RESULTS

Analyses revealed that nine items reflecting depressive symptomatology, primarily vegetative symptoms, differentiated the diagnostic groups (PTSD-only, MDD-only, and the combined group). A discriminant analysis revealed that the sum of responses to the nine significant items adequately predicted diagnostic classification for those with PTSD and depression, but did not correctly diagnose any in the combined group. Analyses also revealed that three post-trauma symptoms, including psychological amnesia, flashbacks/reenactments, and sleep difficulties, discriminated between the groups. The PTSD-only group reported more episodes of psychological amnesia while the PTSD and MDD group experienced more flashbacks.

CONCLUSIONS

For the sample of abused children examined, these results illuminate differences with respect to PTSD symptom presentation for those children with PTSD who have a concurrent depressive disorder and their nondepressed counterparts. Children with PTSD who have a concurrent depression report greater levels of intrusive PTSD-related symptoms.

Patterns among sexual assault victims seeking treatment services

The validity and reliability of research on the nature and extent of sexual assault tends to be affected by different definitions, methodologies, and measurements. As a result, two important aspects of sexual assault associated with patterns of symptom expression and therapeutic interventions are not often reflected in the research; the severity of the assault, including the duration of the abuse, and the age at the time of the assault and the gender of the victim. This research is based on intake forms from Hawai;i's only statewide provider of services to the victims of sexual assault. The analyses reveal that significant differences exist between male and female victims, by age and by assault characteristics, including the type of sexual assault, use of force and injury, length of assault, and the relationship between victim and offender.

On being invisible in the mental health system

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

Childhood abuse and sexual revictimization in a female Navy recruit sample

To examine effects of childhood abuse on adult rape, 1,887 female Navy recruits were surveyed. Overall 35% of recruits had been raped and 57% had experienced childhood physical abuse (CPA) and/or childhood sexual abuse (CSA). Controlling for CPA, rape was significantly (4.8 times) more likely among women who had experienced CSA than among women who had not. In contrast, CPA (controlling for CSA) was unrelated to likelihood of adult rape. Alcohol problems and number of sex partners were examined as mediators. Although both variables predicted rape, their effects were independent of the effects of CSA. Finally, despite ethnic group differences in the prevalence of victimization, the predictors of rape did not differ significantly across ethnic groups.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Packing for the Journey: Safe Closure of Therapeutic Relationships With Abuse Survivors

1 Safe closure of a therapeutic relationship is needed because neither healer nor client can be a "stranger" again. 2 A "failed termination" may overshadow the therapeutic gains that were made during the working phase, constituting a "retraumatization." 3 Closure, as opposed to termination, involves a unique, individualized mutual transformation of the therapeutic relationship into a "real relationship."

Minority adolescent mothers who reported childhood sexual abuse and those who did not: perceptions of themselves and their relationships

Perceptions of two groups of minority adolescent mothers (those who reported childhood sexual abuse and those who did not) were examined by analyzing their responses to four open-ended questions. Responses of sexually abused (SA) and non-sexually abused (NSA) respondents were studied, and themes that emerged from the data were derived. The responses from the groups were compared, and major thematic differences between the two groups identified. Distinct differences between the SA (n = 51) and NSA groups (n = 60) were detected in their responses to questions that related to their perceptions of themselves, their sexuality, and their relationships with men. Both SA and NSA groups had positive feelings about being parents, although the SA group expressed feelings of anxiety about the safety of their children.

Emerging themes in preclinical research on alcohol and aggression

Animal research into the alcohol-aggression relationship is based on a need to understand this relationship in people, and its success depends on the degree to which animal models can provide appropriate parallels to relevant human phenomena. Comparisons of human and animal literature suggest that parallels may be found for the following: alcohol enhances aggression in some, but not all individuals; consumption increases the probability of victimization (being attacked by a conspecific); alcohol reduces anxiety, and socially stressed individuals show increased voluntary consumption; alcohol reduces avoidance of threatening situations or stimuli and may place individuals at greater risk of being attacked; both anxiety reduction and decreased avoidance of threat may increase the probability of involvement in violent situations. These findings suggest that a variety of mechanisms may be involved in alcohol enhancement of aggression. Differences in effects of alcohol on human, as opposed to animal, aggression may reflect specific human capabilities. Although high doses of alcohol consistently reduce aggression in laboratory animals, this may reflect motoric and sedative effects that are not relevant for human behavior, in which verbal aggression and aggression involving the use of weapons make motor capability less important. Human voluntary alcohol consumption may also reflect response to stressors that also simultaneously promote aggression, a situation not paralleled by animal studies in which the drug is administered rather than voluntarily consumed. Nonetheless, obtained parallels suggest that animal experimentation using ecologically relevant situations can provide highly generalizable analyses of the alcohol-aggression relationship.

Symptoms of female survivors of child sexual abuse

Women who suffered sexual abuse as children often experience a variety of physical and psychosocial symptoms as adults. Identifying this pattern of symptoms might assist health professionals in recognizing and treating nonreporting survivors of child sexual abuse. In this study, the Adult Survivors of Incest (ASI) Questionnaire (Brown & Garrison, 1990) was used to determine the symptoms and contributing factors for 22 adult survivors of child sexual abuse. Six physical symptoms were experienced by 50% of the subjects, and over 75% of the subjects experienced 11 psychosocial symptoms. The number of physical symptoms correlated significantly with other victimizations (r = .59) and number of psychosocial symptoms (r = .56). The findings suggest that the ASI Questionnaire was effective in identifying patterns of symptoms and contributing factors of adult survivors of child abuse. Additional study is needed to determine the usefulness of this questionnaire in identifying nonreporting survivors in clinical situations.

The experience of childbirth for survivors of incest

The purpose of this research was to discover what experiences, including feelings, women who are survivors of incest have during childbirth. The recognition that the childbirth experience may trigger memories of incest that will then alter the course of childbirth was the framework for the study. This exploratory research was undertaken using a phenomenological approach. The six participants were obtained through networking and issues surrounding confidentiality and consent were of a high priority. The data consists of transcripts of taped, one to two hour, in-depth interviews. During interviews each woman recalled her experiences and feelings during and surrounding childbirth. Qualitative analysis was undertaken, the findings indicating that memories of previous abuse may be provoked by childbirth but that it is a very individualised response. The effect of these memories on the childbirth experience is also variable but does occur. Privacy, control and touch are important aspects of these women's childbirth experiences. The results and interpretation of findings presented in this report centre around the labour and delivery experiences of the women. The variety of women's needs demonstrated in this project emphasise the importance of individualised care by midwives and doctors involved in the care of childbearing women.

Repeat deliberate self-harm: a link with childhood sexual abuse?

The purpose of this study was to identify whether a past history of childhood sexual abuse is a risk factor for repeated Deliberate Self-Harm (DSH). The study was a 6-month prospective study of 178 patients responsible for 190 consecutive cases of DSH seen during a 3-month censoring period. Patients were identified by review of the in-patient and accident and emergency (A&E) records of all cases of DSH at the A&E department of a major teaching hospital. Patients with a history of childhood sexual abuse showed a marked clustering of four major risk factors for repeat DSH (unemployment, past deliberate self-poisoning, self-injury and psychiatric illness) and were significantly more likely to repeat DSH within the 6-month follow-up period.

HIV vulnerability and the adult survivor of childhood sexual abuse

The purpose of this article is to sensitize clinicians working in the field of childhood physical/sexual abuse to the connection between untreated childhood traumatization and HIV high-risk behaviors. The characteristic abuse symptoms of chronic depression, sexual compulsivity, revictimization, and substance abuse are identified as barriers to HIV education and intervention for survivors. An overview of the existing HIV/child abuse connection research, an illustrative case history and a discussion regarding the clinical implications of these connections are offered.

Empowerment support with adult female survivors of childhood incest: Part I--Theories and research

This report is concerned with the concept of empowerment support as a nursing intervention that facilitates the development of mastery, competence, self-worth, and control in the adult female survivor of childhood incest. Empowerment support has been derived from Orem's theory of nursing system. In that theory, empowerment support is encompassed in particular "methods of helping." Theories and research that relate to incest trauma and empowerment support are discussed from an interdisciplinary perspective.

Factors associated with long-term depressive symptoms of sexual assault victims

Of 63 sexual assault victims who were a mean 7.9 years postevent, almost two thirds (60%, n = 38) demonstrated some degree of depression. Over half (56%, n = 35) the sample also reported a history of childhood sexual abuse. Three factors had a significant positive association with higher levels of depression: nondisclosure of the assault to significant others due to concerns about stigma; the presence of children living with the victim; and a civil lawsuit pending. One factor, currently being sexually active, had a significant negative association with depression. Results are discussed from the perspective of depression, a common pathway by which unresolved sexual trauma is expressed.

Barriers to disclosure among sexually abused male children. Implications for nursing practice

This article identifies, through a critical review of current research, several factors that may account for the reluctance of male children to disclose details of sexual abuse. The factors then are related to implications for practice and research that are relevant for child and adolescent mental health nurses.