Health risk behaviors and medical sequelae of childhood sexual abuse.

The relationship between childhood sexual abuse and subsequent health risk behaviors and medical problems was examined in 511 women who had used a family practice clinic in a rural midwestern community during a 2-year period (1988 and 1989). These women completed a questionnaire that assessed various health risk behaviors--smoking, drinking, drug abuse, number of sexual partners, and age at first intercourse--and a medical symptom checklist that assessed 38 medical problems related to major systems of body function, the somatization scale from the SCL-90, a screen for sexual abuse, and a brief measure of social support. The results indicated that sexually abused women, who represented 22.1% of the sample, reported significantly more medical problems, greater levels of somatization, and more health risk behaviors than did the nonabused women. More severe abuse (for example, penetration or multiple abusers) correlated with more severe problems. Extent of social support correlated inversely with the number of gynecologic problems reported in the sexually abused group. Fewer than 2% of the sexually abused women had discussed the abuse with a physician. To identify and assist victims of sexual abuse, physicians should become experienced with nonthreatening methods of eliciting such information when the medical history is obtained.     

Mental health problems and medically unexplained physical symptoms in adult survivors of childhood sexual abuse: an integrative literature review

People sexually abused in childhood are at higher risk than non-abused people of medically unexplained symptoms such as irritable bowel syndrome or chronic pain, with mental ill health and high healthcare use. Friction and frustration, with high, unproductive healthcare costs, can often develop between these patients and health-care professionals such as general practitioners and nursing staff. The aim of this integrative literature review was to seek a sound evidence base from which to develop helpful interventions, improve relationships and identify gaps in knowledge. It found some theories about interconnections among childhood sexual abuse mental health and medically unexplained symptoms, such as 'somatization' or 'secondary gain', were used prejudicially, stigmatizing survivors. Conflicting theories make more difficult the search for effective interventions. Researchers rarely collaborated with sexual abuse specialists. Emphasis on identifying key risk factors, rather than providing support or alleviating distress, and lack of studies where survivors voiced their own experiences, meant very few targeted interventions for this group were proposed. Recommendations to enable effective interventions include making abuse survivors the prime study focus; qualitative research with survivors, to assist doctors and nursing staff with sensitive care; case histories using medical records; prospective studies with sexually abused children; support for the growing field of neurobiological research.     

Perspectives on surviving childhood sexual abuse

This paper begins by examining sexual victimization and professional 'thinking sets' in relation to abuse. It goes on to offer an exploration of the literature in the area of childhood sexual abuse and its survival, and attempts to marshal some of this literature into naturally occurring conceptual groups with connecting theoretical threads. A summary of the theoretical paradigms which seem to produce dominant perspectives on the area is made. A cautionary discussion is introduced regarding the deterministic nature of the influence of these perceptual viewpoints upon research and therapeutic activity. Implications for nursing practice and education are drawn.     

Long-term consequences of childhood physical and sexual abuse

Psychiatric nurses are confronted daily with individuals who are suffering from the consequences of trauma. Physical and sexual abuse is associated with acute psychiatric symptomatology in children and may progress to a spectrum of psychiatric and medical disorders in adults, ranging from the extreme adaptive reactions seen in multiple personality disorder and refractory psychosis to intermediate adaptive reactions present in borderline personality disorder to more delimited reactions manifest in chronic headaches and unremitting pelvic pain. Subjects sampled in inpatient, outpatient, psychiatric, medical, criminal, and community settings describe the link between histories of widespread abuse and various intractable and common disorders. This article presents the state-of-the-are knowledge of the long-term sequelae of childhood physical and sexual abuse by critically reviewing the initial uncontrolled investigations and mounting evidence from controlled studies.     

Homeopathy in survivors of childhood sexual abuse

The objective of this review was to ascertain the incidence of childhood sexual abuse: to ascertain the long-term effects of childhood sexual abuse and to collate the experiences of homeopaths in caring for survivors. Childhood sexual abuse (CSA) is common with a high percentage of homeopathic patients giving a positive history. It is associated with many common clinical conditions, particularly pelvic pain. Survivors are more likely to present for medical help and to be hospitalised. Homeopaths have found work with such patients to be difficult, with cases being complex and multi-layered. New models for case-analysis have been developed.     

Theoretical perspectives on the health problems of adults who experienced childhood sexual abuse

With the wide variety of health problems reported by adults who experienced childhood sexual abuse (CSA), and no universality for any of them, it is vital that treatment and research be theory-based. The purpose of this article is to review the highlights of major theories, models, and conceptual frameworks found in the literature that explain the relationship of CSA with adult health problems, along with their associated moderating or mediating variables. The theories vary in their scope (macro, middle range, or micro), and in the health problems they explain, from purely psychosocial to both physical and psychosocial problems.     

Relationships between childhood sexual abuse and substance use and sexual risk behaviors during adolescence: An integrative review

Background

Childhood sexual abuse (CSA) is thought to be a precursor to substance use and sexual risk behaviors during adolescence. To inform adolescent prevention efforts, information is needed to explicate the nature of the relationships between CSA and these health risks. The aim of this study was to summarize the current literature on the associations between a history of CSA and substance use and sexual risk behaviors during adolescence.

Methods

We conducted a systematic literature search and an integrative review.

Results

Current evidence implicates CSA as a robust precursor to the use of a wide variety of substances and multiple sexual risk behaviors during adolescence.

Conclusion

Screening for CSA in adolescents at risk and incorporating strategies that enhance CSA recovery in adolescent prevention programs are warranted. Future research that includes longitudinal designs, uses multiple methods of assessment, and identifies pathways between CSA and adolescent health risks is recommended.     

Mental health: counselling sexual abuse survivors.

Some nurses are now becoming involved in helping adult survivors of child sexual abuse to overcome problems caused by an early abusive relationship. Developing a therapeutic partnership between victim and counsellor is a fundamental part of resolving such problems. Using a psychodynamic perspective, the author examines the effects of child sexual abuse on female survivors, and discusses the benefits of group therapy and individual counselling in helping the survivor to come to terms with the abuse.     

Incest: the family context. Understanding and detecting childhood sexual abuse.

The recorded incidence of child abuse is higher than many nurses might imagine, and adult incest survivors often suffer long-term psychological effects. An awareness of the characteristics marking families where abuse takes place can alert nurses to such cases--both past and present.     

Experiences of women healing from childhood sexual abuse

Childhood sexual abuse has affected the lives of countless survivors who seek help within the health care system. Despite extensive research and clinical work, many survivors do not receive adequate help. This research aimed to add to the body of clinical knowledge by reporting on the experiences of childhood sexual abuse survivors who have achieved a measure of healing. Findings from a naturalistic study of 14 female survivors of childhood sexual abuse are presented. The character of healing, the relationship of context with healing, what facilitated healing, and what impeded healing are discussed.     

The interaction between genetic risk and childhood sexual abuse in the prediction of adolescent violent behavior

A rich line of empirical research has indicated that antisocial behaviors are the result of genetic factors and environmental factors working interactively. The current study uses this knowledge base as a springboard to examine the effects of childhood sexual abuse and genetic risk in the prediction of adolescent violent delinquency. To address this issue, data from the National Longitudinal Study of Adolescent Health were analyzed. The results of the analyses reveal that childhood sexual abuse interacts with genetic risk to predict involvement in violent delinquency for males. The effects of childhood sexual abuse and genetic risk as well as the interaction between the two are unrelated to violent delinquency for females. Implications of the study are discussed.     

The proactive sexual health history

Family physicians must proactively address the sexual health of their patients. Effective sexual health care should address wellness considerations in addition to infections, contraception, and sexual dysfunction. However, physicians consistently underestimate the prevalence of sexual concerns in their patients. By allocating time to discuss sexual health during office visits, high-risk sexual behaviors that can cause sexually transmitted diseases, unintended pregnancies, and unhealthy sexual decisions may be reduced. Developing a routine way to elicit the patient's sexual history that avoids judgmental attitudes and asks the patient for permission to discuss sexual function will make it easier to gather the necessary information. Successful integration of sexual health care into family practice can decrease morbidity and mortality, and enhance well-being and longevity in the patient.     

A comparative study among college students of sexual abuse in childhood.

A disproportionate random sample (200 women, 400 men) of students attending a major university was invited to participate in a mailed survey to study differences in self-efficacy, coping, and well-being between men and women who were sexually abused in childhood and those who were not. A total of 271 students (111 women, 160 men) responded by returning the completed survey. Fifty percent of the women and 22% of the men in the sample reported one or more unwanted sexual experiences in childhood. Multivariate analysis of variance (MANOVA) techniques to analyze differences in self-efficacy, coping (confrontive, emotive, palliative), and well-being between women and men who reported childhood sexual abuse and those who did not showed significant interaction effects by sex for abuse (F = 2.609, P = .025, df 5,263) and significant effects by sex (F = 3.356, P = .006), but no significant differences for abuse alone. Univariate F tests were significant (F = 5.386, P = .021) for palliative coping with abused men reporting the highest scores, abused and nonabused women having the highest scores on emotive coping (F = 9.049, P = .003), and nonabused men and women having highest scores on well-being (F = 7.276, P = .007). A second MANOVA was performed on data from 245 students (nonabused and those who reported contact sexual abuse). Significant interaction effects by sex for abuse (F = 2.259, P = 0.49, df 5,237) and main effects for abuse (F = 3.225, P = .008) were found. Although abused men scored lowest on well-being, both abused men and abused women scored higher on emotive coping and lower on well-being than nonabused subjects. These are new findings with implications for developing and testing nursing interventions for this vulnerable group of young adults.     

Overcoming sequelae of childhood sexual abuse with stress management

The immense stress associated with experiencing and surviving childhood sexual abuse directly influences coping, immune function and overall health. Lifelong overuse of maladaptive coping strategies results in impaired adjustment to stress. The purpose of this research was to re-examine if stress management education would be effective in improving coping skills for this population. Two 4-week series of stress management workshops were completed by 32 adult survivors who completed the ways of coping questionnaire before and after the training. Four categories of coping showed significant change. Stress management education is an effective and cost-efficient approach that gives adult survivors an empowering set of tools for their healing journey.     

Towards malecentric communication: sensitizing health professionals to the realities of male childhood sexual abuse survivors

This article extends earlier reports of an ongoing qualitative inquiry on childhood sexual abuse survivors' experiences with health professionals. In this paper, we aim to enhance understanding of male survivors' experience. While male and female participants express similar anxieties and fears about their encounters with health professionals, there are gender-based differences related to the perceptions of victimhood and manhood; guilt and shame; homophobia; disclosure of abuse; and the expression of vulnerability. The implications of these differences for sensitive health care practice are analyzed within the context of gender relationships and the differential socialization of men. Malecentric communication is proposed as a method for addressing the specific experiences of male survivors in their encounters with health professionals.