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

Predicting disclosure latency in substantiated cases of child sexual abuse

OBJECTIVE

Children who experience sexual abuse (CSA) often delay disclosure, thus impeding early interventions. This study explores predictors of disclosure latency in a sample of forensically substantiated cases.

METHODS

Court files were analyzed for a total of 124 cases of CSA. The ground truth of the alleged victims' statements had been substantiated by at least one inclusion criterion-an evaluation of the alleged victims' statement as credible by psychological experts applying Statement Validity Assessment (SVA), or the conviction of the suspected offender by the court. Six possible predictors of disclosure latency were tested individually and in a joint negative binomial regression model.

RESULTS

Younger age of the child at abuse onset and intrafamilial (vs. extrafamilial) child-perpetrator relationships (including stepparents) were associated with prolonged disclosure latency. No predictive evidence was found for the child's gender, severity of abuse, or offender's usage of violent or nonphysical strategies to prevent disclosure.

CONCLUSION

This study contributes to understanding the processes of disclosure by reassessing formerly identified predictors of disclosure latency in a sample of forensically substantiated cases. Results are in line with suggestions to further develop effective prevention programs for younger children (e.g., for elementary school) and to explicitly discuss the issue of intrafamilial abuse.

A Behaviour Sequence Analysis of Serial Killers' Lives: From Childhood Abuse to Methods of Murder

The aim of the current research was to provide a new method for mapping the developmental sequences of serial killers' life histories. The role of early childhood abuse, leading to types of serial murder and behaviours involved in the murders, was analysed using Behaviour Sequence Analysis. A large database (n = 233) of male serial killers with known childhood abuse (physical, sexual, or psychological) was analysed according to typologies and crime scene behaviours. Behaviour Sequence Analysis was used to show significant links between behaviours and events across their lifetime. Sexual, physical, and psychological abuse often led to distinct crime scene behaviours. The results provide individual accounts of abuse types and behaviours. The present research highlights the importance of childhood abuse as a risk factor for serial killers' behaviours, and provides a novel and important advance in profiling serial killers and understanding the sequential progression of their life histories.

Cognitive mediators of the relationship between adverse childhood experiences and adult psychopathology: A systematic review

This is the first review to rigorously examine the mediating role of cognitive factors in the relationship between childhood trauma and subsequent adult psychopathology, and highlight areas for future research. A database search (Child Development & Adolescent Studies, ERIC, Global Health, PsycARTICLES, and PsycINFO) was conducted to identify empirical studies on cognitive factors, explaining the relationship between different types of adverse childhood experiences and adult psychopathology across clinical and nonclinical populations. A narrative synthesis and appraisal of the methodological quality of the studies was conducted. Ninety-eight mediation studies were identified, comprising 4,137 clinical and 28,228 nonclinical participants. Despite great variation in methodological quality of the studies, our narrative synthesis suggests that cognitive factors mediate the relationship between early trauma and later psychopathology. This finding is consistent across different measures of traumatic experiences, psychopathology, and cognitive mediators. Cognitive mediators represent potentially valuable intervention targets for (non)clinical patients who have experienced childhood adversity. Future studies are needed to (a) establish longitudinal causal connections, and (b) assess the effect of interventions that specifically target cognitive change in patients with different levels and types of pathology.

Attributions of Blame among Victims of Child Sexual Abuse: Findings from a Community Sample

According to the attribution theory, negative outcomes of child sexual abuse (CSA) are thought to vary depending on whether CSA victims attribute the abuse to internal or external factors, respectively, self-blame and perpetrator-blame. Therefore, the purpose of this study was to identify abuse characteristics and attitudes that influence blame attributions among CSA victims from a community sample. Data from respondents with a history of CSA (N = 1,496) have been used in predicting blame attributions; perpetrator-blame, self-blame, or both. Results from a multinomial logistic regression analysis showed that attitudes toward gender roles had a significant effect on blame: victims were more likely to blame themselves when they endorsed more conservative gender attitudes than victims with more liberal attitudes. Implications for this finding are discussed.

Early life sexual abuse is associated with increased suicide attempts: An update meta-analysis

Suicide is an emerging, yet preventable global health issue associated with significant mortality. Identification of underlying risk factors and antecedents may inform preventive strategies and interventions. This study serves to provide an updated meta-analysis examining the extent of association of early life sexual abuse with suicide attempts. Using the keywords [early abuse OR childhood abuse OR sexual OR rape OR molest* OR violence OR trauma OR PTSD] AND [suicid* OR premature OR unnatural OR deceased OR died OR mortality], a preliminary search on the PubMed, Ovid, PsychINFO, Web of Science and Google Scholar databases yielded 12,874 papers published in English between 1-Jan-1988 and 1-June-2017. Of these, only 47 studies were included in the final meta-analysis. The 47 studies (25 cross-sectional, 14 cohort, 6 case-control and 2 twin studies) contained a total of 151,476 subjects. Random-effects meta-analysis found early life sexual abuse to be a significant risk factor for suicide attempts, compared to baseline population (pooled OR 1.89, 95% CI: 1.66 to 2.12, p < 0.001). Subgroup analyses of cross-sectional and longitudinal studies showed similar findings of increased risk as they yielded ORs of 1.98 (95% CI: 1.70 to 2.25, p < 0.001) and 1.65 (95% CI: 1.37 to 1.93, p < 0.001), respectively. In both cross-sectional and longitudinal studies, childhood sexual abuse was consistently associated with increased risk of suicide attempts. The findings of the present study provide strong grounds for funding public policy planning and interventions to prevent sexual abuse and support its victims. Areas for future research should include preventive and treatment strategies and factors promoting resilience following childhood sexual abuse. Future research on the subject should have more robust controls and explore the differential effects of gender and intra-versus extra-familial sexual abuse.

Children's disclosures of sexual abuse in a population-based sample

Most previous studies on disclosing child sexual abuse (CSA) have either been retrospective or focused on children who already have disclosed. The present study aimed to explore the overall CSA disclosure rate and factors associated with disclosing to adults in a large population-based sample. A representative sample of 11,364 sixth and ninth graders participated in the Finnish Child Victim Survey concerning experiences of violence, including CSA. CSA was defined as having sexual experiences with a person at least five years older at the time of the experience. Within this sample, the CSA prevalence was 2.4%. Children reporting CSA experiences also answered questions regarding disclosure, the disclosure recipient, and potential reasons for not disclosing. The results indicate that most of the children (80%) had disclosed to someone, usually a friend (48%). However, only 26% had disclosed to adults, and even fewer had reported their experiences to authorities (12%). The most common reason for non-disclosing was that the experience was not considered serious enough for reporting (41%), and half of the children having CSA experiences did not self-label their experiences as sexual abuse. Relatively few children reported lacking the courage to disclose (14%). Logistic regression analyses showed that the perpetrator's age, the age of the victim at the time of abuse, and having no experiences of emotional abuse by the mother were associated with disclosing to an adult. The results contribute to understanding the factors underlying children's disclosure patterns in a population-based sample and highlight the need for age-appropriate safety education for children and adolescents.

Posttraumatic symptom profiles among adult survivors of childhood sexual abuse: A longitudinal study

In the present study, our aim was to examine longitudinal posttraumatic stress symptom (PTSS) trajectories in a Norwegian sample of adults who had experienced sexual abuse during childhood, and to identify predictors of PTSS-trajectory belongingness. The sample consisted of 138 adult survivors of childhood sexual abuse (96.4% women, mean age=42.9years, mean age at the first abuse=5.9 years), recruited from support centers for sexual abuse survivors. The majority (78.3%) reported penetrative abuse, and a large proportion of the sample reported that the perpetrator was a biological parent (38.4%) or someone they trusted (76.1%), reflecting a high severity level of the abusive experiences. Latent Profile Analyses revealed the best overall fit for a two PTSS-trajectories model; one trajectory characterized by sub-clinical and decreasing level of PTSS (54.9%), and the other by high and slightly decreasing level of PTSS (45.1%). Increased odds for belonging to the trajectory with clinical level symptoms was found among those who reported higher levels of exposure to other types of childhood maltreatment (OR=3.69, p=0.002), sexual abuse enforced by physical violence (OR=3.04, p=0.003) or threats (OR=2.56, p=0.014), very painful sexual abuse (OR=2.73, p=0.007), or who had experienced intense anxiety, helplessness or fear during the abuse (OR=2.97, p=0.044). Those in the trajectory with clinical level PTSS reported lower levels of perceived social support and more relational difficulties compared to those in the sub-clinical PTSS trajectory. In conclusion, different longitudinal PTSS trajectories can be found among adult survivors of childhood sexual abuse. Significant predictors of PTSS-trajectory belongingness are discussed alongside their potential implications for preventive efforts and clinical interventions.

Gender Norms and Age-Disparate Sexual Relationships as Predictors of Intimate Partner Violence, Sexual Violence, and Risky Sex among Adolescent Gang Members

Unequal gender norms and age-disparate sexual relationships can lead to power imbalances and are also associated with intimate partner violence (IPV), sexual coercion and violence, and sexual risk behaviors. The present study examined these variables from both victim and perpetrator perspectives among adolescent gang members. Age-disparate sexual relationships were defined as sex partners 5 or more years older among female participants and 5 or more years younger among male participants. Participants were recruited from a mid-sized Midwestern city and completed a 60-90-min audio computer-assisted self-interview in a community-based setting. Participants in this study included 107 female gang members (68 % African-American, 19 % Latina; mean age, 17.6) and 169 male gang members (62 % African-American, 28 % Latino; mean age, 17.7). As hypothesized, endorsing unequal gender norms toward women was significantly related to IPV victimization among female participants and perpetration among male participants, and engagement in group sex in the past month among both female and male participants (ps < 0.05). Additionally, unequal gender norms were significantly related to male participants' perpetrating rape (p < 0.05). As hypothesized, female gang members who had been in age-disparate sexual relationships were significantly more likely to have experienced more IPV and report being raped and males gang members who had age-disparate sexual relationships were significantly more likely to perpetrate IPV in the past year and perpetrate rape (ps < 0.05). Age-disparate sexual relationships were also significantly related to being gang raped among female gang members and participating in a gang rape among male gang members, and engaging in group sex among both female and male gang members (ps < 0.05). Female participants who had been in age-disparate sexual relationships were more likely to have been pregnant (ps < 0.05). It is essential for researchers and public health practitioners to create programs for female adolescents to reduce or avoid risky situations, such as inability to negotiate condom use with older sex partners. Additionally, programs must be developed for both female and male gang members to help them understand and identify unequal gender norms, and interpersonal and sexual coercion/violence. Early intervention will also be necessary as these adolescent gang members are already engaged in extremely high-risk, coercive, and violent behaviors.

Depression and PTSD in Survivors of Male Violence: Research and Training Initiatives to Facilitate Recovery

Male violence is an enduring feature of women's lives from childhood through old age. The review covers child sexual abuse, rape, and partner violence with emphasis on the prevalence of violence, its mental health consequences, the course of recovery, and mediators and moderators of traumatic impact. The primary focus is depression and posttraumatic stress disorder, the two major diagnostic entities through which postassault emotions and behaviors have been conceptualized and measured. The effects of psychiatric conceptualizations of victimization and patterns of individual recovery are critically reviewed. The PTSD paradigm as the sole foundation for most victimization research is also debated. Following the review, mental health services for victimized women are examined. The article concludes with public policy recommendations to improve the availability and accessibility of mental health services with emphasis on reaching those survivors who are less likely to consult the formal system.

Disclosure as Discourse

Conventional frameworks conceptualizing children's disclosures of sexual abuse are helpful in drawing links between the dynamics of abuse and its subsequent reporting (e.g. Summit, 1983) and in articulating developmental impediments to disclosure (e.g. Bussey & Grimbeek, 1995). But these models underemphasize the discursive (and, hence, social) basis of children's reports in that patterns of disclosure are depicted as individualistic phenomena. This article proposes a discursive reformulation of children's reports of sexual abuse. The concept of co-construction is applied to the research traditions of conversation analysis (e.g. Nofsinger, 1991), the discourse action model (Edwards & Potter, 1992), narrative analysis (e.g. Bruner, 1991), positioning theory (e.g. Harré & van Langenhove, 1992) and cultural discourses (e.g. Burman, 1995) to theorize children's reports of sexual abuse as socially situated collaborations. The implications of a discursive approach for concerns of power and social justice are discussed.

Psychosocial Correlates of Sexual Assault among Mexican American and White Non-Hispanic Adolescent Females

Data were obtainedfrom a nonclinical sample of 1,121 Mexican American and White non-Hispanic adolescent females. Three hundred and three female participants who reported being sexually assaulted were compared to 793females who reported no history of sexual assault on a number of psychosocial characteristics. Male participants were excluded due to small N. White non-Hispanic adolescent females were twice as likely to report sexual assault as Mexican American adolescentfemales. Although rates of sexual assault differed across ethnicity, ethnicity did not influence the relationship between sexual assault and psychosocial characteristics of victims. Results did indicate, however; that sexual assault victims reported more emotional distress, more social isolation and more deviant behavior than nonvictims. Likewise, sexual assault victims reported poorer school adjustment, were more likely to affiliate with deviant peers, and were more likely to come from homes in which there was parental substance use and family conflict.

The Debate about Delayed Memories of Child Sexual Abuse

The debate about delayed memories of child sexual abuse has generated strong emotions and has polarized many psychologists and members of the public. At times, individuals have adopted absolute positions without adequate knowledge of the complex issues involved. This article provides information about the current debate regarding the veracity of delayed memories of child sexual abuse, describes the historical context in which this controversy occurs, discusses the growth and development of psychotherapy for trauma survivors, and reviews the theoretical and empirical literature relevant to abuse memories. The article also outlines recommendations about foundations of knowledge and interventions that will help psychologists engage in competent and ethical practices with clients and generates an initial set of recommendations for future research, training, and social change.

EXPERIENCE OF FORCED SEX AND SUBSEQUENT SEXUAL, DRUG, AND MENTAL HEALTH OUTCOMES: AFRICAN AMERICAN AND HISPANIC WOMEN IN THE SOUTHEASTERN UNITED STATES

OBJECTIVES

This cross-sectional study examined African American and Hispanic women's (N = 1,509) self-reports of unwanted forced sex and its association with behavioral and mental health outcomes after the event.

METHODS

Twenty percent of the women had experienced forced sex (1st occurrence at age 15 years or younger for 10%, 1st occurrence at older than 15 years of age for 10%).

RESULTS

Regardless of when forced sex 1st occurred, women were more likely to have engaged in unprotected vaginal and anal sex, to have had multiple unprotected sex partners, to have sexually transmitted infections, to have reported binge drinking and illicit drug use, and to exhibit distress and have received mental health counseling.

CONCLUSIONS

Forced sex may have wide-ranging behavioral and mental health consequences years later.

Neurological changes in brain structure and functions among individuals with a history of childhood sexual abuse: A review

OBJECTIVE

Review literature focused on neurological associations in brain structure among individuals with a history of childhood sexual abuse (CSA).

METHODOLOGY

A review of literature examining physiological irregularities in brain structures of individuals with a history of CSA was conducted.

RESULTS

Results revealed that a history of CSA was associated with irregularities in the cortical and subcortical regions of the brain. These irregularities have been recognized to contribute to various cognitive, behavioral, and psychological health outcomes later in life. Age of CSA onset was associated with differential neurological brain structures.

CONCLUSION

Mental and behavioral health problems such as anxiety, depression, substance abuse, dissociative disorders, and sexual dysfunction are associated with CSA and may persist into adulthood. Research depicting the associations of CSA on neurological outcomes emphasizes the need to examine the biological and subsequent psychological outcomes associated with CSA. Early intervention is imperative for CSA survivors.

The dead end of domestic violence: spotlight on children's narratives during forensic investigations following domestic homicide

The current study provides an in-depth exploration of the narratives of children who witnessed their father killing their mother. This exploration was conducted using a thematic analysis of the children's forensic interviews based on seven investigative interviews that were conducted with children following the domestic homicide. Investigative interviews were selected for study only for substantiated cases and only if the children disclosed the domestic homicide. All of the investigative interviews were conducted within 24h of the domestic homicide. Thematic analysis revealed the following four key categories: the domestic homicide as the dead end of domestic violence, what I did when daddy killed mommy, that one time that daddy killed mommy, and mommy will feel better and will go back home. The discussion examines the multiple layers of this phenomenon as revealed in the children's narratives and its consequences for professionals within the legal and clinical contexts.

The behavior patterns of abused children as described in their testimonies

The aim of the current study is to identify how children describe their behavior during abuse and to explore their behavior further with respect to the type of the abuse (physical or sexual), frequency of abuse (single or multiple incidents), familiarity with the suspect, and children's age and gender, with the assumption that this information may have a significant effect on the children's recovery process. The study involved 224 transcripts of interviews with alleged victims aged 5-14 in Israel. The sample was randomly selected from all of the forensic investigations with children that were conducted in Israel in 2011. The results show that abuse type has a strong effect on children's behavior, with children in the sexual abuse group reporting more fight and flight behavior and children in the physical abuse group reporting more self-change behavior. This finding was interacted with the severity of abuse variable, with children in the sexual abuse group reporting less flight behavior and an increase in the self-change behavior with the highest level of severity of abuse (touch under the clothes and penetration). Investigative interviews with children can be a significant source of information for practitioners within the clinical context. The current study stresses the consequences that abuse can have on children's behavior during these incidents and the implications for the therapy process with the children.

The narratives of abused children who have survived attempted filicide

Child abuse is a social problem that receives much attention from policy makers, practitioners, and researchers. This alarming phenomenon generates many consequences for children, their families, and society as a whole; one tragic consequence of child abuse is filicide. Because of the unfortunate circumstances surrounding such events, children are hushed by their perpetrators, whether abusers or killers, and we are thus denied the opportunity to hear their voices and to promote understanding of the phenomenon. The aim of the current study is to explore in depth the patterns and themes that can be found in the narratives of children who survived a murder attempt by one of their parents. Content analysis was performed on seven investigative interviews with children using thematic analysis. Five key categories were determined based on the children's narratives: (a) many bad things have happened to me, (b) this was not the first time I was abused by my parent, (c) I am concerned about my parent, (d) I am alive thanks to my siblings, and (e) it is hard to remember what exactly happened. This study contributes to the understanding of child physical abuse and filicide. The discussion integrated conclusions for policy makers and practitioners who seek methods of addressing child abuse as well as determining whether and how filicide can be prevented.

Developmental trauma disorder: pros and cons of including formal criteria in the psychiatric diagnostic systems

BACKGROUND

This article reviews the current debate on developmental trauma disorder (DTD) with respect to formalizing its diagnostic criteria. Victims of abuse, neglect, and maltreatment in childhood often develop a wide range of age-dependent psychopathologies with various mental comorbidities. The supporters of a formal DTD diagnosis argue that post-traumatic stress disorder (PTSD) does not cover all consequences of severe and complex traumatization in childhood.

DISCUSSION

Traumatized individuals are difficult to treat, but clinical experience has shown that they tend to benefit from specific trauma therapy. A main argument against inclusion of formal DTD criteria into existing diagnostic systems is that emphasis on the etiology of the disorder might force current diagnostic systems to deviate from their purely descriptive nature. Furthermore, comorbidities and biological aspects of the disorder may be underdiagnosed using the DTD criteria.

SUMMARY

Here, we discuss arguments for and against the proposal of DTD criteria and address implications and consequences for the clinical practice.

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.

Assessing reporting patterns of child sexual abuse within the Catholic Church using discontinuities in model parameter timeseries

Prior to 2002, little was known about sexual abuse within the Catholic Church. After the Boston Globe broke the story about John Geoghan - a priest in the Boston Archdiocese who was accused of abusing numerous children, convicted of one count of indecent assault, and eventually murdered in prison - the Church had many questions to answer. To this end, the United States Conference of Catholic Bishops (USCCB) commissioned John Jay College of Criminal Justice to research the nature and scope, as well as the causes and context of child sexual abuse within the Catholic Church. This research analyzes the data from the John Jay studies using a new quantitative technique, capable of adjusting for distortions introduced by delays in abuse reporting. By isolating discontinuities in model parameter timeseries, we determine changes in reporting patterns occurred during the period 1982-1988. A posteriori to the analysis, we provide some possible explanations for the changes in abuse reporting associated with the change-point. While the scope of this paper is limited to presenting a new methodological approach within the frame of a particular case study, the techniques are more broadly applicable in settings where reporting lag is manifested.

Exploring resiliency factors of older African American Katrina survivors

Through this qualitative study the author explores the resiliency processes demonstrated by older African American Hurricane Katrina survivors who relocated in the aftermath of the storm and were consequently faced with difficult challenges. In-depth interviews were used to assess the multidimensional characteristics of resiliency that enabled these older adults to deal with adversity. These findings highlight distinct processes reflecting resiliency: (a) Trusting in a higher power, and the importance of (b) living in the present, (c) activating resources, (d) creating community, and (e) doing for others. The author concludes this study with suggestions on how these findings may inform social work practice with older adults.

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.

Foundations of posttraumatic stress disorder: Does early life trauma lead to adult posttraumatic stress disorder?

The effects of childhood abuse are diverse, and although pathology is not the only outcome, psychiatric illness, including posttraumatic stress disorder (PTSD), can develop. However, adult PTSD is less common among those who experienced single-event traumas as children than it is among those who experienced childhood abuse. In addition, PTSD is more common among adults than children who experienced childhood abuse. Such evidence raises doubt about the direct, causal link between childhood trauma and adult PTSD. The experience of childhood trauma, and in particular abuse, has been identified as a risk factor for subsequent development of PTSD following exposure to adult trauma, and a substantial literature identifies revictimization as a factor that plays a pivotal role in this trajectory. The literature on the developmental effects of childhood abuse and pathways to revictimization, when considered in tandem with the biological effects of early stress in animal models, may provide some explanations for this. Specifically, it seems possible that permanent sensitization of the hypothalamic–pituitary–adrenal axis and behavioral outcomes are a consequence of childhood abuse, and these combine with the impact of retraumatization to sustain, perpetuate, and amplify symptomatology of those exposed to maltreatment in childhood.

Intimate partner violence and HIV among drug-involved women: contexts linking these two epidemics--challenges and implications for prevention and treatment

Intimate partner violence (IPV) and HIV are two serious overlapping public health epidemics that disproportionately affect drug-involved women. This article reviews research that has identified a number of contexts that may explain the links between IPV and HIV transmission risks. These contexts include sexual coercion, fear of violence, negotiation of condom use, extradyadic relationships, disclosure of sexually transmitted infections or HIV seropositivity to intimate partners, drug involvement of women and their male partners, low social status of drug-involved women, relationship dependencies, and sex ratio imbalances. The article focuses on how the bidirectional relationship between IPV and HIV risks may be mediated by a history of childhood sexual abuse and post-traumatic stress disorder. Also addressed are the challenges that substance user treatment programs face in dealing with female clients who experience IPV and the implications for HIV prevention.

Abuse and parental characteristics, attributions of blame, and psychological adjustment in adult survivors of child sexual abuse

The purpose of this study was to examine the influence of abuse and parental characteristics on attributional content and determine the relative contribution of different attributions of blame in predicting psychological symptomatology among adult survivors of childhood sexual abuse. One hundred eighty-three female undergraduates with a history of childhood sexual abuse completed self-report questionnaires. Abuse characteristics were significantly related to attributions. Family- and perpetrator-blame accounted for significant variability in psychological symptomatology, beyond the contributions of abuse characteristics, family environment, and self-blame. Implications for research and treatment are discussed.

Adult Coping with Childhood Sexual Abuse: A Theoretical and Empirical Review

Coping has been suggested as an important element in understanding the long-term functioning of individuals with a history of child sexual abuse (CSA). The present review synthesizes the literature on coping with CSA, first by examining theories of coping with trauma, and, second by examining how these theories have been applied to studies of coping in samples of CSA victims. Thirty-nine studies were reviewed, including eleven descriptive studies of the coping strategies employed by individuals with a history of CSA, eighteen correlational studies of the relationship between coping strategies and long-term functioning of CSA victims, and ten investigations in which coping was examined as a mediational factor in relation to long-term outcomes. These studies provide initial information regarding early sexual abuse and subsequent coping processes. However, this literature is limited by several theoretical and methodological issues, including a failure to specify the process of coping as it occurs, a disparity between theory and research, and limited applicability to clinical practice. Future directions of research are discussed and include the need to understand coping as a process, identification of coping in relation to adaptive outcomes, and considerations of more complex mediational and moderational processes in the study of coping with CSA.

Traumaentwicklungsstörung: Pro und Contra

Es wird die aktuelle Diskussion um die Aufnahme der Diagnose einer Traumaentwicklungsstörung in das DSM-V aufgegriffen und die Pro- und Contraargumente einer solchen Diagnose gegenübergestellt. Befürworter der Traumaentwicklungsstörung argumentieren, dass viele gut erforschte Traumafolgen mit der Diagnose einer Posttraumatischen Belastungsstörung nur unzureichend beschrieben werden. Gerade Opfer von schweren und sequentiellen Kindheitstraumata entwickeln häufig eine Breitbandsymptomatik mit vielen komorbiden psychischen Störungen. Die klinische Evidenz zeigt, dass diese sehr schwer zu behandelnde Patientengruppe von einem spezifischen traumatherapeutischen Zugang profitiert. Gegen diese Diagnose spricht, dass mit der Einführung einer solchen Diagnose, die in den Diagnosesystemen verlangte rein deskriptive Beschreibung von Symptomen verlassen wird und ätiologische Aspekte in den Vordergrund treten, zudem könnten komorbide Störungen mit ihren biologischen Aspekten übersehen werden. Abschließend werden Implikationen, die sich aus einer solchen Diagnose ergeben, erörtert. Dabei wird auch eine dimensionale Erfassung dieser Symptomatik angedacht.

Is there an "abortion trauma syndrome"? Critiquing the evidence

The objective of this review is to identify and illustrate methodological issues in studies used to support claims that induced abortion results in an "abortion trauma syndrome" or a psychiatric disorder. After identifying key methodological issues to consider when evaluating such research, we illustrate these issues by critically examining recent empirical studies that are widely cited in legislative and judicial testimony in support of the existence of adverse psychiatric sequelae of induced abortion. Recent studies that have been used to assert a causal connection between abortion and subsequent mental disorders are marked by methodological problems that include, but not limited to: poor sample and comparison group selection; inadequate conceptualization and control of relevant variables; poor quality and lack of clinical significance of outcome measures; inappropriateness of statistical analyses; and errors of interpretation, including misattribution of causal effects. By way of contrast, we review some recent major studies that avoid these methodological errors. The most consistent predictor of mental disorders after abortion remains preexisting disorders, which, in turn, are strongly associated with exposure to sexual abuse and intimate violence. Educating researchers, clinicians, and policymakers how to appropriately assess the methodological quality of research about abortion outcomes is crucial. Further, methodologically sound research is needed to evaluate not only psychological outcomes of abortion, but also the impact of existing legislation and the effects of social attitudes and behaviors on women who have abortions.

Child abuse: betrayal and disclosure

OBJECTIVE

The current study tested several hypotheses about disclosure of childhood sexual, physical, and emotional abuse derived from Betrayal Trauma Theory [Freyd, J. J. (1996). Betrayal trauma: The logic of forgetting childhood abuse. Cambridge, MA: Harvard University Press]. We predicted that the duration of time from abuse to its disclosure would vary as a function of victim-perpetrator closeness.

METHODS

Data collected from 202 undergraduate participants using a survey methodology were submitted to logistic regression analyses. The relative variance explained by other variables was also examined.

RESULTS

Compared to survivors of emotional abuse (EA) who were in not very close (NVC) victim-perpetrator relationships, EA survivors in very close (VC) victim-perpetrator relationships were significantly more likely to wait 1 or more years to disclose, or never to disclose, than to wait a period of time less than 1 year (OR=2.65). Further, survivors of physical abuse (PA) in VC victim-perpetrator relationships were significantly more likely to wait 1 or more years to disclose their abuse, if it was disclosed at all, than PA survivors of NVC victim-perpetrator relationships (OR=3.99). Results for sexual abuse were not significant.

CONCLUSIONS

For EA and PA, VC victim-perpetrator relationships predicted longer durations of time from abuse to its disclosure than NVC victim-perpetrator relationships.

PRACTICE IMPLICATIONS

Although delayed disclosure may support necessary (albeit abusive) attachments with caregivers, it may also prolong the abuse and prevent receipt of support. Increased awareness that VC victim-perpetrator relationships may predict longer durations of time from abuse to its disclosure, and that these delays may serve a functional purpose, can help guide supportive and empathic responses to traumatic disclosures.

The Sexual Well-Being of Women Who Have Experienced Child Sexual Abuse

The present study examined the association between child sexual abuse (CSA) and a range of positive and negative aspects of women's sexual well-being. We also investigated the extent to which women's cognitive-affective sexual appraisals mediated these relationships. Participants were 272 female community college and university students. CSA involving fondling only was generally not associated with adverse sexual outcomes. However, the women who had experienced CSA involving sexual penetration or attempted sexual penetration were (a) more likely to be sexually revictimized in adulthood; (b) more likely to have engaged in casual sex, unprotected sex, and voluntary sexual abstinence; and (c) reported fewer sexual rewards, more sexual costs, and lower sexual self-esteem. These findings held over and above the effects of nonsexual abuse in childhood, and as predicted, sexual self-esteem partially or fully mediated most of these relationships. Nonsexual abuse in childhood and adult sexual victimization were also uniquely associated with a number of adverse sexual outcomes. However, outcomes were not worse for women who had experienced CSA involving actual or attempted sexual penetration and sexual assault in adulthood. The results highlight the fact that CSA is a serious and widespread problem with significant implications for adult women's sexual functioning.

Female sexual-offenders: personality pathology as a mediator of the relationship between childhood sexual abuse history and sexual abuse perpetration against others

OBJECTIVE

The goal was to examine, in an all female sample, possible mechanisms for the relationship between a history of childhood sexual abuse and the likelihood of perpetrating sexual abuse as an adult. It was hypothesized that Borderline and Antisocial Personality Disorder tendencies would mediate the relationship between these two forms of abuse.

METHOD

One hundred forty two female participants (61 sex-offenders and 81 non-sex offenders) were recruited from a woman's prison in the Midwest. The participants completed measures that included a childhood history of sexual abuse, socially desirable responding, primary and secondary psychopathy, and Borderline Personality Disorder tendencies.

RESULTS

Participants in the sexual-offender group reported more frequent instances of childhood sexual abuse (p<.05, M=16.4, SD=7.2) than participants in the non-sex offender group (M=12.2, SD=7.7). Consistent with past research, childhood sexual abuse was related to Borderline Personality Disorder tendencies (r=.36, p<.01). However, discriminant function analyses did not reveal support for our mediational hypotheses. Finally, the results indicated that participants in the sexual-offender group experienced childhood sexual abuse for a greater duration of time (p<.05, M=27.8, SD=20.5 months) than participants in the non-sex offender group (M=16.6, SD=10.4).

CONCLUSIONS

This study replicated previous research conducted on all male samples suggesting that the nature of the sexual abuse suffered in childhood is an important variable in predicting future sexual abuse perpetration.

The effect of childhood trauma on later psychological adjustment

This study examined whether adult attachment and cognitive distortion mediate the relationship between childhood trauma and psychological adjustment. The participants were 219 students (40 men and 117 women) enrolled in a university degree. Participants completed the Childhood Trauma Questionnaire, which assessed retrospective accounts of childhood trauma; the Relationships Scales Questionnaire, which measured two dimensions of adult attachment (model-of-self and model-of-other); the Cognitive Distortions Scale, which measured internal attributions and perceptions of controllability; and the Trauma Symptom Inventory, which assessed posttraumatic symptoms and was used in this study to measure psychological adjustment. Results supported the hypothesis that model-of-self and cognitive distortion are related constructs. The influence of model-of-self on psychological adjustment however was only via its effect on cognitive processes. In other words, a negative model-of-self influenced cognitive distortion, which in turn influenced the expression of symptoms in adults reporting a history of childhood trauma. The implications for therapy were considered.

Filial dependency and recantation of child sexual abuse allegations

OBJECTIVE

Controversy abounds regarding the process by which child sexual abuse victims disclose their experiences, particularly the extent to which and the reasons why some children, once having disclosed abuse, later recant their allegations. This study examined the prevalence and predictors of recantation among 2- to 17-year-old child sexual abuse victims.

METHOD

Case files (n = 257) were randomly selected from all substantiated cases resulting in a dependency court filing in a large urban county between 1999 and 2000. Recantation (i.e., denial of abuse postdisclosure) was scored across formal and informal interviews. Cases were also coded for characteristics of the child, family, and abuse.

RESULTS

A 23.1% recantation rate was observed. Multivariate analyses supported a filial dependency model of recantation, whereby abuse victims who were more vulnerable to familial adult influences (i.e., younger children, those abused by a parent figure and who lacked support from the nonoffending caregiver) were more likely to recant. An alternative hypothesis, that recantations resulted from potential inclusion of cases involving false allegations, was not supported.

CONCLUSION

Results provide new insight into the process by which children reveal interpersonal trauma and have implications for debates concerning the credibility of child sexual abuse allegations and treatment in dependency samples.

The prevalence of unwanted and unlawful sexual experiences reported by Danish adolescents: results from a national youth survey in 2002

AIM

To obtain current data about child sexual abuse in Denmark and to assess abused children's own perception of early sexual experiences, which are unlawful according to the Danish Penal Code.

METHODS

Multimedia computer-based self-administered questionnaires (CASI) were completed by a national representative sample of 15-16-y-olds. Child sexual abuse was defined according to the penal code and measured by questions defining specific sexual activities, the relationship between the older person and the child, and the youth's own perception of the incident.

RESULTS

Among 5829 respondents, 11% reported unlawful sexual experiences, 7% of boys and 16% of girls. Only 1% of boys and 4% of girls felt that they "definitely" or "maybe" had been sexually abused.

CONCLUSION

A relatively high percentage of Danish adolescents have early, unlawful sexual experiences. However, young people's own perception of sexual abuse tends to differ from that of the authorities, or their tolerance of abusive incidents is high. Gender differences were found in factors predicting perception of abuse.

The abuse-related beliefs questionnaire for survivors of childhood sexual abuse

OBJECTIVE

To evaluate the psychometric properties of a new measure, the Abuse-Related Beliefs Questionnaire (ARBQ), designed to assess abuse-related beliefs among adult survivors of childhood sexual abuse (CSA). Study 1 examined the structure of the scale, and Study 2 evaluated its reliability and validity.

METHOD

One hundred and seventy female CSA survivors recruited into a group psychotherapy intervention study were administered the ARBQ in Study 1. A subsample of 45 women completed the ARBQ again 12 months later. In Study 2, 70 women from a health maintenance organization who identified themselves as survivors of CSA completed the ARBQ along with the Trauma Symptom Checklist-40 (TSC-40) and the Symptom Checklist 90R (SCL-90-R).

RESULTS

Three reliable ARBQ subscales emerged in Study 1: Guilt, Shame, and Resilience. Twelve-month test-retest reliability was high (r=.60-.64). The internal consistency of the subscales was further supported in Study 2, and validity was demonstrated by moderate to high correlations with the distress measures.

CONCLUSIONS

The results indicate that the ARBQ has good psychometric characteristics, supporting the feasibility of its use in measuring abuse-related beliefs in research on survivors of CSA. A next step for validation of the ARBQ would be to evaluate its sensitivity in measuring changes in studies of interventions for treating CSA survivors.

Association of sexual revictimization with sexuality and psychological function

This study explores the associations of sexual revictimization (experiencing sexual abuse in childhood and adulthood) in a sample of 230 African American women who are low-income. Data indicate that women who experience sexual revictimization are more at risk for emotional stress and psychological pathology than women with no history of abuse. In addition, women who are revictimized appear to be at greater risk for emotional problems than women sexually abused only as a child or sexually assaulted only as adults. Revictimization also appears to be associated with an increased probability of engaging in prostitution, even higher than women with childhood- or adult-only victimization, who showed increased probability when compared to women never abused. Finally, women who are revictimized showed increased HIV risk, in that they were 4 times less likely than other women to consistently use condoms, but no more likely to be in monogamous relationships or less likely to have multiple partners.

Severity of child sexual abuse, post- traumatic stress and risky sexual behaviors among HIV-positive women

Child sexual abuse (CSA) has been shown to enhance risk for HIV infection and other adverse outcomes. However, most studies examine the effects of a single incident of CSA rather than the full burden of abuse over the life span in predicting these adverse outcomes. A multi-dimensional approach was used in this study to examine the severity of abuse as a predictor of post-traumatic stress, depression, sexual symptoms, and risky sexual behaviors in a multi-ethnic sample of 147 HIV-positive women. Multivariate models indicated that experiencing both intrafamilial and extrafamilial CSA, adult sexual abuse (ASA) and Latina ethnicity predicted PTSD symptoms. ASA also predicted sexual trauma symptoms. Also, CSA and adult re-victimization contributed independently to risk for PTSD and sexual trauma symptoms, but not for risky sexual behaviors. The results support the need for interventions for HIV-positive women that address the full burden of abuse experienced and its sequelae.

Ecological influences on the sequelae of child maltreatment: a review of the literature

Numerous studies indicate that child maltreatment increases the risk for the development of internalizing and externalizing behavior problems. Great variations in outcome, however, have been noted among victims of maltreatment. From an ecological perspective, this review examines how the effects of maltreatment may be influenced by the contexts in which children develop, including their families, peer groups, schools, and communities. The literature reviewed suggests that contextual factors not only influence the incidence of maltreatment but also may moderate its developmental effects, thereby accounting for some of the heterogeneity in the outcomes associated with abuse and neglect. Closer examination of the influence contextual factors exert on the psychosocial sequelae of maltreatment will better inform the interventions, treatments, and public policies directed toward the maltreated population. Methodological considerations for conducting research in this area are also discussed.