Eating disturbance and sexual trauma in childhood and adulthood.

OBJECTIVE: This study examined the relationship between sexual trauma and eating disorder behavior, taking into account the effects of developmental stage of the victim and the effects of multiple sexual assaults. METHOD: Four groups of adult women took part in this study. Subjects were either victims of childhood sexual abuse, victims of rape in adulthood, victims of both childhood sexual abuse and rape, and controls who were not traumatized sexually. All subjects were assessed with semistructured interviews and self-report inventories that assessed eating disorder behavior, general psychopathology, and impulsivity. RESULTS: Victims of childhood sexual abuse differed from controls on measures of eating disorder behavior and individuals who had experienced both childhood sexual abuse and rape in adulthood were most likely to display eating disorder-related psychopathology. Victims of childhood sexual abuse also distinguished themselves with high levels of eating disorder behavior plus multiple forms of impulsive self-destructive behavior. DISCUSSION: This study provides additional support for the association between childhood sexual abuse and eating disorder behavior. Childhood sexual abuse may be particularly linked to the presence of binge eating behavior and several other forms of impulsive self-destructive behavior.     

Sexually Assaulted Males: 115 Men Consulting a Counseling Service

The nature of sexual assault on men and their help seeking following the assault was investigated. All men were seen at least once for face-to-face counseling at SURVIVORS, a counseling service for male victims. Data on 115 men were analyzed: 69 were assaulted while under age 16. Mean time from assault to contact with SURVIVORS was 16.4 years. 51 men (44%) were assaulted more than once. The assailant was known to the victim in all but 16 cases. 100 men (87%) were assaulted by at least one man, 7 (6%) by a man and a woman, and 8 (7%) by women. Forced anal penetration took place in 88. 27 men (23%) feared for their lives during the assault. 88 men (79%) sought no help and only 17 men (15%) reported to police. For victims assaulted under the age of 16, the assault was more likely to be their first sexual experience and they were more likely to delay contact with SURVIVORS for more than 17 years. They were also less likely to report to police. Victims assaulted by more than one person were more likely to have been assaulted by strangers, by women, and to have suffered physical harm. They were less likely to have experienced the assault as their first sexual experience.     

Victim resistance to rape: The relationship of previous victimization,demographics, and situational factors

The relationship between degree of resistance to sexual assault and a victim's demographic characteristics, her previous experience with violence, and situational characteristics of the assault were investigated. Victim responses during the assault were characterized as no resistance, verbal resistance, or physical resistance. Demographic characteristics and prior experience with violence did not discriminate degree of resistance. However, victim resistance was significantly predicted by six of the assault characteristics. Victims showed greater resistance if the assailant was a friend or relative, if the assailant made verbal threats, and if he physically restrained or injured her. Greater resistance was also associated with less sexual abuse.This research was supported by NIMH grant MH 29750 from the National Center for Prevention and Control of Rape.     

Repeated sexual victimization and trauma change during the acute phase of the sexual assault trauma syndrome

Victimization studies indicate that the risk of sexual assault is significant for women in America today and that sizable numbers of women are sexually assaulted more than once during their lives. This study proposed and tested alternative hypotheses about repeated sexual victimization and trauma change during the acute phase of the sexual assault trauma syndrome. Panel interview data were collected during a two-year period on 184 female victims (14 years and older) admitted to a sexual assault treatment center for initial and follow-up services. Controlling for initial trauma level and time between assessments, prior assault victims were more traumatized than first assault victims at follow-up. Prior and first assault victims had different patterns in short-term trauma change, with only the first assault victims decreasing in trauma. Prior mental health or substance abuse problems partially explained the observed effect of prior sexual assault on trauma change. Prior sexual assault, however, continued to affect trauma significantly in the condition where the repeated assault victim also had prior mental health or substance abuse problems at the time of the current assault.     

Witness competency in people with mental retardation: Implications for prosecution of sexual abuse

Victims with mental retardation have been excluded from the legal system based on the belief that they are incompetent to provide accurate, reliable testimony. Such restrictions contribute to the increased risk that people with mental retardation will be victimized. This article examines the complexity surrounding definitions of competency, as well as the mythology which serves to de-emphasize the abilities of victims to testify against an alleged perpetrator. The implications of the presumption of incompetency are highlighted through the example of sexual abuse. Empirical evidence and recent court cases are used to argue that people with mental retardation deserve access to the same standards of competency as the rest of the population.     

Elderly residents at risk for being victims or offenders

The phenomenon of elderly sexual offenders is poorly catalogued, and is especially complex. In institutions, elderly people are often unrecognized victims of sexual abuse but are also at great risk for doing abuse toward vulnerable victims like children. The lack of attention to an elder's basic needs can endanger or impair not only his or her health or safety but also that of other people living close together. In this article, for the first time we describe an episode of sexual abuse realized by an institutionalized patient toward a young visitor. This specific risk factor in a residential care home for elderly may lead to a variety of negative behavioral outcomes, including the perpetration of child sexual offending. As the elderly population will increase tremendously in the next years, it is necessary to better understand the motivations and psychological factors relating to elderly sex offenders, to prevent these offenses, and to define standards for surveillance of residents who are potential perpetrators.     

Country watch: Peru

Estudio para la Defensa de Los Derechos de la Mujeri (DEMUA), a legal aid nongovernmental organization in Peru, organized a workshop to sensitize and train judges on sexual violence from a gender perspective and assess judges' perceptions of the problem. A total of 42 judges and seven staff members from the Judicial Control Office participated. Some participating judges maintained a formalistic approach to the law, which states sexual abuse is aggravated only if weapons were used and more than one perpetrator was involved and requires evidence of bodily harm for a rape charge, while others were less stringent about their interpretations. The latter group of judges tended to view sexual abuse as a crime that deprives victims of their liberty and harms their physical, sexual, and psychological health. 57% of participating judges indicated, at the end of the workshop, that the laws should be changed in terms of preventing and punishing sexual offenses and making marital rape a crime and wanted reassessment of the criteria for aggravated assault.     

Maltreatment and Behavioral Characteristics of Youth Who Are Deaf and Hard-of-Hearing

This paper summarizes the available literature on child abuse and neglect among children with disabilities in general and considers children who are deaf and hard-of-hearing within this larger rubric given the low prevalence rates of children who are deaf and hard-of-hearing among the disabled population. This procedure allows for comparisons between disabilities as well as abused and non-abused children who are deaf and hard-of-hearing. Maltreatment data on children who are deaf and hard-of-hearing in a large epidemiological study of the prevalence of child maltreatment among children with disabilities are summarized. Children who are deaf and hard-of-hearing comprised 6.1% of the disabled population who were identified as victims of maltreatment. Their most prevalent form of maltreatment was neglect, followed by physical abuse and sexual abuse. Although children who are deaf and hard-of-hearing are significantly more likely to be maltreated by immediate family members, placement in a residential school is a risk factor for sexual and physical abuse. Maltreated children who are deaf and hard-of-hearing exhibit significantly more behavior problems including Post Traumatic Stress Disorder related behaviors than nonmaltreated peers.     

Multimodal therapy for survivors of sexual abuse with developmental disabilities: An evaluation of treatment effectiveness

When examining the statistical data on people who have been sexually abused/assaulted, there tends to be a disproportionately large number of victims who have developmental disabilities. Yet, as a group, people with developmental disabilities also tend to have the fewest treatment resources available. Whereas there may be several reasons for this lack of resources, the question of treatment efficacy seems to arise whenever the needs of people with developmental disabilties are discussed. The following article summarizes the results of a group for survivors of sexual abuse/assault with developmental disabilities which utilized a multimodal approach to address specific treatment goals. Based upon the qualitative evaluations of the authors, it appeared that all of the participants exhibited some degree of positive therapeutic response. Further evaluation of a multimodal approach is suggested. Creative Community Living Services, Inc.     

Adult sexual orientation and attraction to underage persons

A random sample of 175 males convicted of sexual assault against children was screened with reference to their adult sexual orientation and the sex of their victims. The sample divided fairly evenly into two groups based on whether they were sexually fixated exclusively on children or had regressed from peer relationships. Female children were victimized nearly twice as often as male children. All regressed offenders, whether their victims were male or female children, were heterosexual in their adult orientation. There were no examples of regression to child victims among peer-oriented, homosexual males. The possibility emerges that homosexuality and homosexual pedophilia may be mutually exclusive and that the adult heterosexual male constitutes a greater risk to the underage child than does the adult homosexual male.     

Sexual assault patterns among women with and without disabilities seeking survivor services

INTRODUCTION: The primary research questions were 1) how do sexual assault patterns differ for women with disabilities as compared with women without disabilities and 2) how do patterns differ among women with different disabilities? METHODS: Study data were derived from initial encounters of 16,672 women survivors of sexual assault who sought state-funded sexual assault survivor services in Massachusetts from 1987 through 1995. Bivariate analyses and fixed effects logistic regression models compared sexual assault patterns including survivor responses for women with and without disabilities and among women with 5 different single disabilities. RESULTS: More than 10% of survivors reported > or =1 disability. If a woman had a history of a previous assault or was > or =30 at time of assault, she was significantly more likely to report a disability as compared to the referents (no history of assault or <30). Among women with a single disability, a survivor who delayed seeking services > or =6 months was more likely to have a mental health disability. In contrast, a survivor who had a cognitive disability was more likely to report sooner than 6 months compared with a survivor with other single disabilities. CONCLUSIONS: Differences were found between disabled and nondisabled groups as well as among women with different single disabilities. Some findings, such as those suggesting differential access, may require disability group-specific interventions, whereas other variations can be addressed at the individual client level. State-funded sexual assault survivor service providers may use these findings to improve outreach and service provision strategies.     

SEXUAL ABUSE AND THE SUBSEQUENT DEVELOPMENT OF ALCOHOL PROBLEMS

The literature on sexual abuse and alcohol problems has beenreviewed. Various methodological issues are relevant in determiningwhether there is merely an association or also a causal relationship.These include the definition of sexual abuse, the degree andtiming of abuse, the methods of data collection, sample selection,the presence or absence of control groups, possible recall bias,difficulties with prospective studies for this subject, andthe definition of alcohol misuse or dependence. Results withcommunity and victim samples are conflicting, but studies onsamples of problem drinkers suggest an association between severealcohol problems and previous sexual abuse, at least in women.The association may be especially strong for earlier and moresevere forms of sexual abuse. Possible mechanisms for an associationwere examined and are: (1) sexual abuse as a cause of alcoholmisuse; (2) alcohol misuse predisposing people to sexual assault;(3) sexual assault and alcohol misuse both resulting from anotherfactor; (4) sexual abuse predisposing to other conditions associatedwith alcohol misuse; and (5) an artefactual association. Regardlessof the role of sexual abuse in causing alcohol problems, theavailable evidence suggests that victims of sexual abuse maypresent to services with more problematical patterns of drinkingand more concurrent psychiatric disorder.     

Child Sexual Abuse: Comprehensive Assessment In the Pediatric Health Care Setting

Cases of child sexual abuse are being identified with increasing frequency in pediatric health care settings Medical practitioners, however, often report being unprepared to offer the psychological and protective service assessments these cases require in addition to medical evaluation and treatment An interdisciplinary model for sexual abuse assessments is described Three components--emergence response consultative services, and a specialty clinic--are outlined Special problems which arise in the assessment of sexual abuse in the health care setting are discussed These revolve the role of medical evidence, stereotyping of sexual abuse victims, and impediments to child protection The implications of the increasing demand for sexual abuse services for the training of new professionals are considered.     

Physical disability: The long-term effects of child sexual abuse

Purpose of the Study: To determine if there was a relationship between a physical disability and accessing memories of childhood sexual abuse. Procedure: Literature review, personal exploration, interviews of professionals in the field of disability and child sexual abuse, along with asmall study of adult women with acquired physical disabilities, utilizing a questionnaire and debriefing interviews. Findings: There are a variety of issues and responses, and states of readiness to deal with a history of child abuse that occur when confronting a new physical disability. However there is a commonality, that memories can be triggered. Conclusion: The shock of becoming physically disabled can trigger memories of trauma. Excerpted from Physical Disability: The Long Term Effects of Child Sexual Abuse, an Investigative Project, Sonoma State University, Rohnert Park, California.     

Violence in the community: a health service view from a UK Accident and Emergency Department

A retrospective analysis of information recorded on victims of assault, who attended the Accident and Emergency department of Chorley and South Ribble Hospital over a 1 y period, was performed in order to describe the epidemiology of violent assault. During the year 735 (1.7%) of the patients attending A&E were identified as being victims of assault (71% were male). Victims were predominantly in their late teens and early 20s (median age 23 y, inter-quartile range 17 to 32 y). They attended at weekends (44% on Saturday or Sunday) and predominantly between the hours of 8 pm and 4 am (54%). Minor injuries were the most frequent (43%) while 21% of victims sustained lacerations and 11% had a fracture. The commonest site of injury was to the neck, face and throat (55%). The crude rate of attendance following violent assault for Chorley District was 4.67 per 1000 population per year. Information routinely collected by A&E departments can be used to describe the epidemiology of violence in the community. Further work is required to ascertain the optimal method of collection and dissemination of this information.     

Sexual assault in the lives of urban sex workers: a descriptive and comparative analysis

This exploratory study contributes to the sparse literature on sexually assaulted sex workers. We examined 462 sexual assault cases seen at an emergency department-based sexual assault service and reported to the police between 1993 and 1997. More than one fifth of victims were sex workers. We compared them to other victims on victim characteristics, assault characteristics, and medical-legal findings. Relative to other victims, sex workers were younger, had lower incomes, and were more likely to be heroin and/or cocaine users. They suffered a greater number of injuries and forensic samples collected from their bodies were more likely to test positive for sperm and/or semen. These victims were also less likely to have been using alcohol and/or marijuana prior to the assault and to be emotionally expressed during the medical- legal examination. The substantial proportion of sex workers in the study population suggests that attention to their particular needs should be an important part of hospital-based sexual assault services. Clinical implications and directions for future research are discussed.     

Professional responsibility: Confronting sexual abuse of people with disabilities

Confronting sexual abuse of people with disabilities has recently become a challenge for health professionals. This paper discusses issues of professional responsibility in three areas; clinical, management, and personal issues. Prevention of sexual assault is seen as a primary professional obligation. An outline is offered for development of a systematic approach to deal with the problems of sexual abuse within an institutional setting.     

Attraction to Sexual Violence Towards Women,Sexual Abuse of Children,and Non-Sexual Criminal Behavior: Testing the Specialist vs. Generalist Models in Male College Students

A sample of 492 college men anonymously completed an expanded version of the Sexual Experiences Survey, the revised Attraction to Sexual Aggression Scale, and the Marlowe-Crowne Social Desirability Scale Short Form to investigate the relations among perpetration of sexual violence (including rape and sexual assault), attraction to sexual violence, attraction to childhood sexual abuse, and attraction towards other crimes while controlling for the impact of social desirability. Analyses indicated that attractions towards sexual violence, general criminality, and childhood sexual abuse were all significantly interrelated. In addition, sexual assault perpetrators reported higher levels of all three types of attraction as compared to nonperpetrators whereas rape perpetrators reported higher levels of attraction to sexual aggression and criminality. Clinical and research implications are discussed.     

A Training Course for Psychologists: Learning to Assess (Alleged) Sexual Abuse Among Victims and Perpetrators Who Have Intellectual Disabilities

People with intellectual disabilities (ID) are at greater risk of being a victim of sexual abuse and may also be more predisposed to perpetrating sexual abuse. Although the prevalence of sexual abuse among people with ID is difficult to determine, it is clear that there are serious consequences for both victims and perpetrators, and professional support is needed. Psychologists play an important role in the assessment of sexual abuse in both victims and perpetrators and require specific knowledge and skills to execute the assessments. We therefore developed a training course for psychologists aimed at increasing their (applied) knowledge of sexual abuse and the related assessment process in people with ID. In a five-day training course, sessions focusing on theories about diagnostic models were combined with sessions focusing on the assessment of sexual abuse of victims and perpetrators. The effectiveness of the training course was determined in terms of (applied) knowledge via the administration of a study-specific questionnaire including a hypothetical case vignette before, immediately after, and six months after completion of the course. The results show that the knowledge of the psychologists related to sexual abuse and the assessment process for sexual abuse increased significantly, and remained above pre-test level at six-month follow-up. These results are promising, but more research is needed to see if the increased (applied) knowledge in turn leads to application in practice and better care for both victims and perpetrators.