The reported prevalence of physical and sexual abuse among a sample of children and adolescents at a public psychiatric hospital

In this retrospective analysis of inpatient charts, a total of 298 children and adolescents admitted to a public psychiatric hospital over a 1-year period were examined for the prevalence of reported histories of physical or sexual abuse. Physical abuse was reported in 15% of the cases, while sexual abuse occurred in 13%. A variety of comparisons were made examining possible differences in gender, age, race, diagnosis, and personality trait disturbance among the abused and nonabused patients. Relative to known prevalence rates as reported to child protective agencies, physical or sexual abuse occurred much more frequently among our sample of patients, suggesting the need for careful assessment of such histories upon admission and during treatment.     

Recovered memories of abuse in women with documented child sexual victimization histories

This study provides evidence that some adults who claim to have recovered memories of sexual abuse recall actual events that occurred in childhood. One hundred twenty-nine women with documented histories of sexual victimization in childhood were interviewed and asked about abuse history. Seventeen years following the initial report of the abuse, 80 of the women recalled the victimization. One in 10 women (16% of those who recalled the abuse) reported that at some time in the past they had forgotten about the abuse. Those with a prior period of forgetting—the women with recovered memories—were younger at the time of abuse and were less likely to have received support from their mothers than the women who reported that they had always remembered their victimization. The women who had recovered memories and those who had always remembered had the same number of discrepancies when their accounts of the abuse were compared to the reports from the early 1970s.     

Perceptions of sexuality as related to sexual functioning and sexual risk in women with different types of childhood abuse histories

Perceptions of one's sexuality, self-reported sexual functioning, and sexual risk were examined in a community sample of 148 women with histories of either childhood sexual abuse (n = 26), both childhood sexual and physical abuse (n = 44), and neither form of abuse (n = 78). Controlling for depression and anxiety, the groups did not differ on sexual desire, arousal/orgasm, sexual pain, or masturbation. Women with abuse histories reported more negative affect during sexual arousal and reported more lifetime vaginal intercourse partners than nonabused women. In addition, the abuse samples reported more negative perceptions of their sexuality in their worst psychological states using the Structural Analysis of Social Behavior (SASB) method than did women with no abuse history. An interpersonal focus and more precise abuse labeling are recommended, potentially revising our assumptions about symptom clusters and treatment.     

Cumulative trauma: The impact of child sexual abuse,adult sexual assault,and spouse abuse

The present study investigated the relationship between trauma symptoms and a history of child sexual abuse, adult sexual assault, and physical abuse by a partner as an adult. While there has been some research examining the correlation between individual victimization experiences and traumatic stress, the cumulative impact of multiple victimization experiences has not been addressed. Subjects were recruited from psychological clinics and community advocacy agencies. Additionally, a nonclinical undergraduate student sample was evaluated. The results of this study indicate not only that victimization and revictimization experiences are frequent, but also that the level of trauma specific symptoms are significantly related to the number of different types of reported victimization experiences. The research and clinical implications of these findings are discussed.     

Educational,occupational, and relationship histories of men who were sexually and/or physically abused as children

Ninety men (mean age 26) at an urban Northeastern university were administered a self-report assessment of their early sexual and physical abuse experiences, and their educational, occupational, relationship, and substance abuse histories. Subjects were classified as sexually abused according to criteria used by Wyatt (1985) and Finkelhor (1979). Sixteen men (17.8%) experienced sexual abuse alone, 22 men (24.4%) physical abuse alone, 15 men (16.7%) both sexual and physical abuse, and 37 men (41.1%) were classified as nonabused. Of the 31 men who reported sexual abuse, 24 (77.4%) were contact, the rest noncontact. Sexually abused men reported significantly greater difficulties than nonabused men at all levels of education: grade school, high school and college. They also reported more negative job experiences and more negative experiences in relationships. Physically abused men showed a similar but less pervasive pattern of difficulties. Substance abuse was significantly more prevalent among both sexually and physically abused men than among nonabused subjects.     

Parental caring as a possible buffer against sexual revictimization in young adult survivors of child sexual abuse

This study examined whether parental caring provided a buffer against the revictimization effect. Nine hundred and seventy-four undergraduate women provided information about child sexual abuse, physical abuse, and whether they witnessed violence between their parents during childhood. They also reported whether they had ever been the victim of sexual assault in adulthood, and offered their perceptions of the degree of care they received as a child from each parent. Results indicated that women who had been sexually abused in childhood were twice as likely to be sexually assaulted in adulthood and that women with 2 or more types of childhood trauma were 3 times as likely to be sexually revictimized. Parental caring was not found to buffer against the revictimization effect.     

MMPI-2 F scale elevations in adult victims of child sexual abuse

The present study assessed whether the Minnesota Multiphasic Personality Inventory—2 (MMPI-2) F scale elevations may reflect genuine trauma-related distress and/or psychopathology, rather than malingering, in a clinical sample of adult child sexual abuse (CSA) victims. Eighty-eight women seeking outpatient treatment for CSA after-effects participated. Self-report measures of dissociation, posttraumatic stress, depression, and family environment individually correlated significantly with F, and collectively accounted for 40% of its variance. Dissociation was the strongest predictor. Findings suggest that high F elevations may reflect genuine problem areas often found among CSA victims, rather than symptom overreporting.     

Post-traumatic stress disorder in child sexual abuse survivors: A literature review

Research to date has failed to identify a unique syndrome describing the sequelae of child sexual abuse (CSA). Recently, however, some researchers have suggested Post-Traumatic Stress Disorder as the diagnosis which best fits the syndrome commonly seen in CSA survivors. Research examining the consequences of CSA in terms of the applicability of a PTSD diagnosis is reviewed. Additionally, based on findings of significant relationships between PTSD and traumatic exposure in other trauma groups, this review also examines studies which have investigated relationships between exposure and symptom development among CSA survivors. Finally, conclusions regarding the applicability of PTSD to CSA survivors and suggestions for future research are offered.This article was accepted for publication under the Editorship of Charles R. Figley.     

Parental response to child sexual abuse trials involving day care settings

This study examined the stress responses of parents to whether or not their child testified in a sexual abuse trial against defendants from a day care center. Parents completed a questionnaire and the SCL-90-R. Impact of Events scale, and Life Events Survey. Parents of 17 testifying children presented higher symptoms of psychological distress than parents of 50 nontestifying children sexually abused in day care centers. In addition, the reported stress was higher in fathers than mothers. Following disclosure of their child's sexual abuse, stressful life events of death in family, loss of income, and separation were associated with parents of testifying children.     

Child sexual abuse, peer sexual abuse, and sexual assault in adulthood: a multi-risk model of revictimization

This study explored the predictors and consequences of sexual assault occurring after the age of 16 years in a nonclinical sample of women. Child sexual abuse occurring before the age of 16 years was the only predictor of later sexual assault among comorbid risk factors. Peer sexual abuse, number of perpetrators, age at time of sexual abuse, and severity of sexual abuse did not increase the risk for later sexual assault. Adult sexual assault victims showed lower levels of mental health functioning than did survivors of child or peer sexual abuse. We discuss a specificity model of revictimization and the differential effects of child, peer, and adult sexual trauma on the developmental trajectory of sexual violence and psychosocial functioning.     

Sexual abuse in childhood and postoperative depression in women with breast cancer who opt for immediate reconstruction after mastectomy

INTRODUCTION

Breast reconstruction is routinely offered to women who undergo mastectomy for breast cancer. However, patient-reported outcomes are mixed. Child abuse has enduring effects on adults’ well-being and body image. As part of a study into damaging effects of abuse on adjustment to breast cancer, we examined: (i) whether women with history of abuse would be more likely than other women to opt for reconstruction; and (ii) whether mood problems in women opting for reconstruction can be explained by greater prevalence of abuse.

PATIENTS AND METHODS

We recruited 355 women within 2-4 days after surgery for primary breast cancer; 104 had mastectomy alone and 29 opted for reconstruction. Using standardised questionnaires, women self-reported emotional distress and recollections of childhood sexual abuse. Self-report of distress was repeated 12 months later.

RESULTS

Women who had reconstruction were younger than those who did not. Controlling for this, they reported greater prevalence of abuse and more distress than those having mastectomy alone. They were also more depressed postoperatively, and this effect remained significant after controlling for abuse.

CONCLUSIONS

One interpretation of these findings is that history of abuse influences women''s decisions about responding to the threat of mastectomy, but it is premature to draw inferences for practice until the findings are replicated. If they are replicated, it will be important to recognise increased vulnerability of some patients who choose reconstruction. Studying the characteristics and needs of women who opt for immediate reconstruction and examining the implications for women''s adjustment should be a priority for research.     

Sexual and physical abuse among Korean female inpatients with schizophrenia

The study reports the prevalence and correlates of sexual and physical abuse in a sample of 100 female inpatients with schizophrenia in South Korea. Clinical assessment interviews consisted of the Positive and Negative Syndrome Scale, the Scale for the Assessment of Positive Symptoms, an interview assessing history of sexual and repeated physical abuse, and demographic and psychosocial factors. Lifetime prevalence of severe sexual or physical abuse was 52%. Compared with nonabused patients (n = 48), the abused patients (n = 52) showed more nonpsychotic symptoms (i.e., anxiety, depression) and higher levels of distress, but no difference in psychotic symptoms. This study failed to note significant differences in positive symptoms addressed in previous Western studies.     

The multi-institutional validation of the new screening index for physical child abuse

Background/Purpose

There is currently no evidence-based screening instrument to assist in the detection of physical child abuse patients. The screening index for physical child abuse (SIPCA) was previously developed as a potentially new tool for this need. It is a scale that assigns point values, on the basis of variable weights from logistic regression models, to age and patterns of injuries (including fracture of base or vault of skull, contusion of eye, rib fracture, intracranial bleeding, multiple burns), with higher scores indicating greater suspicion for abuse. The purpose of this study is to validate this new tool in another independent data set.

Methods

A cross-sectional hospital discharge database from 1961 hospitals in 17 states is used (n = 58558). Children aged 14 years or younger with International Classification of Diseases, Ninth Revision, Clinical Modification codes 800 to 959 are included for analysis. Child abuse cases are identified by E codes and certain International Classification of Diseases, Ninth Revision, Clinical Modification codes in the 995.5x range. Screening index for physical child abuse performance is evaluated by discrimination (receiver operating characteristic) and goodness of fit (pseudo r²).

Results

A total of 447 abused patients (0.76%) was identified. The receiver operating characteristic of SIPCA in this data set is 0.89 as compared with 0.86 in the development data set. The pseudo r² of SIPCA in this data set is 0.26 as compared with 0.28 in the development data set. A SIPCA score of 3 has a sensitivity of 86.6% and a specificity of 80.5% for detecting physical abuse; raising the threshold to a score of 4 improves the specificity to 93.1% but at a loss of sensitivity to 71.8%.

Conclusions

The validity of the new SIPCA instrument is supported by its performance in an independently derived data set. A score of 3 on SIPCA represents a balanced trade off in the sensitivity and specificity of the instrument in detecting physical abuse and is an optimal threshold above which to begin considering abuse in differential diagnosis. Application of the instrument could assist clinicians in detecting physical child abuse cases among pediatric trauma patients.     

Urinary symptoms in child sexual abuse

Many common genitourinary complaints may be related to sexual abuse. We report five patients referred to a Pediatric Nephrology Clinic who demonstrate some of the symptoms and signs caused by abuse, such as dysuria, genital and urinary tract infections, voiding dysfunction, and genital trauma. Difficulties in eliciting histories are described. Although these genitourinary complaints may be due to a variety of etiologies, sexual abuse should not be overlooked. Suggestions for a management approach are made.     

Childhood abuse experiences and combat-related PTSD

Current literature on the etiology of combat-related PTSD strongly implicates combat trauma exposure as a primary etiological factor. However, studies of premilitary variables have produced conflicting results, perhaps in part due to methodological inconsistencies and failure to employ standardized measures. The present study examines one premilitary variable, childhood physical abuse history. Using a standardized measure developed by child abuse researchers, forty-five percent of veterans with PTSD were identified as recipients of abusive physical punishment during childhood. A positive correlation between physical abuse history and severity of combat-related PTSD was found. These preliminary findings set the stage for further investigation of the child abuse variable and underscore the need for treatment of veterans with combat-related PTSD which addresses developmental traumagenic events.A version of this paper was presented at the Seventh Annual Meeting of the International Society for Traumatic Stress Studies at Washington, DC, October 26, 1991, 11:30 a.m.Correspondence concerning this paper should be addressed to the first author at 7507 18th Avenue NE, Seattle, Washington 98115.     

Chiropractic leadership in the eradication of sexual abuse

Health practitioners work under fiduciary constraint, and are obligated to favour patient needs over all others and in particular their own. The principles of professionalism demand that professionals take great care to ensure that boundaries are maintained safely to provide an optimal setting in facilitating patient care. Boundary violations cause serious harm to the patient. Any romantic or sexual activity between parties is the most serious form of boundary violation. The chiropractic profession is included in the list of disciplines which are at an increased risk for boundary violations. The authors propose a four stage protocol which is designed to offer all parties maximal protection beginning with undergraduate professional education and then mandatory continuing education for registrants in professional practice. The protocol would affect all aspects of professional life including training in boundaries and jurisdictional regulation.     

Do child sexual abuse experts hold pro-child beliefs?: A survey of the international society for traumatic stress studies

As psychologists become increasingly involved in child sexual abuse cases, professional concerns have been expressed about their partisan orientation as child advocates. A survey was administered to examine the beliefs about child sexual abuse and children's capabilities as witnesses held by a sample (N=340) from the International Society for Traumatic Stress Studies (ISTSS). Multivariate analyses of variance suggest that female ISTSS members generally have stronger beliefs in the credibility of child witnesses than male members. Additionally, ISTSS members who work with victims of sexual assault generally have stronger beliefs in the credibility of children than members who work with veterans or other sufferers of traumatic stress reactions. Moreover, ISTSS members from southern geographical regions are less likely than respondents from other regions to endorse items in a manner that has favorable implications for a child witness. Beliefs of ISTSS respondents do not differ as a function of their educational background. Implications for the role of child sexual abuse experts in the legal system are discussed.This article was accepted for publication under the Editorship of Charles R. Figley.     

Relating Body Image to Psychological and Sexual Functioning in Child Sexual Abuse Survivors

Cognitive-affective body image variables and their relation to long-term psychological and sexual functioning were investigated in a community sample of 57 female adult child sexual abuse (CSA) survivors and 47 comparison subjects. The Body-Self Relations Questionnaire and the Body Esteem Scale were administered to assess cognitive-affective body image. Group comparisons indicated that, after controlling for actual weight status, survivors evaluated their health more negatively and reported less body esteem regarding their sexual attractiveness than comparison subjects. Body image variables related to health and sexual attractiveness significantly explained variance on symptom measures that reflect the diverse CSA long-term sequelae. Results suggest the need for careful assessment of body image disturbances and the development of effective interventions targeting body image in the treatment of CSA survivors.     

Relations Between Coercive Strategies and MMPI-2 Scale Elevations Among Women Survivors of Childhood Sexual Abuse

The relationship between coercion strategies used by perpetrators of childhood sexual abuse (CSA) and elevations of CSA survivors on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) was investigated. Participants were 151 women survivors of CSA in outpatient treatment at a university-based community mental health center. Scores on the MMPI-2 clinical scales and the Keane posttraumatic stress disorder (PTSD) scale were examined. Main effects were found for promised or received rewards on several clinical scales and the PTSD scale of the MMPI-2, independent of the presence of force. Specifically, the presence of such rewards was associated with significantly higher levels of symptomatology on Paranoia (Pa), Psychasthenia (Pt), Schizophrenia (Sc), and PTSD (Pk). There were no main or interaction effects noted for the presence of actual or threatened force on any of the scales.