Dysfunctional Cognitions and Adult Psychological Functioning in Child Sexual Abuse Survivors

Two studies explored the relationship between cognitions and long-term symptoms in adult child sexual abuse (CSA) survivors. In Study 1, an American sample of 43 survivors completed questionnaires assessing attributional style and dysfunctional beliefs in cognitive themes affected by victimization, as well as measures of posttraumatic symptoms. Survivors' attributions of negative events were more internal, stable, and global than those of 29 comparison subjects without a history of CSA. However, only the globality scale was significantly related with severity of long-term symptoms. High correlations between dysfunctional beliefs concerning safety, trust, esteem, or intimacy, and posttrauma symptoms were found. The latter finding was replicated in Study 2 with a German sample of 35 CSA survivors, even when controlling for frequency of abuse.     

Hippocampal Volume and Memory Performance in a Community-Based Sample of Women with Posttraumatic Stress Disorder Secondary to Child Abuse

Childhood abuse is linked to posttraumatic stress disorder (PTSD), which follows abuse survivors into adulthood. This study identified the neuropsychological and neuromorphological sequelae of PTSD among prepubescently abused women. Right-handed women aged 20-40 years were placed into PTSD and abuse, abuse only, and normal control groups (n = 17 per group). Participants were screened for trauma history and psychiatric symptoms, demographically matched, and given neuropsychological tests and a magnetic resonance scan of their brain. Women with PTSD did not express significant deficits in memory performance or hippocampal volume when compared with the abuse and normal control groups.     

An Affect-Management Group for Women with Posttraumatic Stress Disorder and Histories of Childhood Sexual Abuse

Systematic research on effective treatment for survivors of childhood sexual abuse with posttraumatic stress disorder (PTSD) is virtually non-existent. The aim of the present study was to compare the effectiveness of an affect-management treatment (AM) group to a wait list control condition for female survivors of childhood sexual abuse with PTSD. Forty-eight female survivors of childhood sexual abuse with PTSD were randomly assigned to either a 15-week affect-management treatment group or to a wait list control condition. All subjects received individual psychotherapy and pharmacotherapy for the duration of the study, and for at least 1-month prior to the study. Controlling for pretreatment scores, subjects who completed the affect-management treatment group (n = 17) reported significantly fewer posttreatment symptoms of PTSD and dissociation than subjects in the wait list control condition (n = 16). Our findings suggest that an affect-management group treatment is beneficial as an adjunct to individual psychotherapy and pharmacotherapy for survivors of childhood sexual abuse with PTSD.     

Effects of Guided Imagery on Memory Distortion in Women Reporting Recovered Memories of Childhood Sexual Abuse

We tested whether having participants imagine unusual childhood events inflates their confidence that these events happened to them, and tested whether this effect is greater in women who report recovered memories of childhood sexual abuse than in women who do not. Participants were pretested on how confident they were that certain childhood events had happened to them before being asked to imagine some of these events in the laboratory. New confidence measures were readministered. Although guided imagery did not significantly inflate confidence that early childhood events had occurred in either group, the effect size for inflated confidence was more than twice as large in the control group as in the group with recovered memory. These data suggest that individuals can counteract memory distortions potentially associated with guided imagery, at least under some conditions.     

Identifying Subtypes of Women Survivors of Childhood Sexual Abuse: An MMPI-2 Cluster Analysis

This paper investigated subtypes of women childhood sexual abuse (CSA) survivors through a cluster analysis of their Minnesota Multiphasic Personality Inventory-2 (MMPI-2) clinical and validity scales. Participants were 117 women in outpatient treatment for CSA aftereffects at a university-affiliated community mental health center. Three well-fitting MMPI-2 cluster solutions were evaluated with discriminant analyses and MANOVAs; a 5-cluster solution was deemed optimal. Follow-up analyses demonstrated significant between-cluster differences on the Impact of Event Scale, Beck Depression Inventory, Dissociative Experiences Scale, and nearly all Symptom Checklist-90-Revised subscales. No differences emerged when comparing clusters on the Family Environment Scale and their CSA characteristics. Implications were considered for research and clinical practice, using the MMPI-2 with 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.     

Revictimization and Interpersonal Resource Loss Predicts PTSD Among Women in Substance-Use Treatment

Child physical abuse (CPA) and child sexual abuse (CSA) were hypothesized to be associated with revictimization and interpersonal resource loss in adulthood. These adulthood experiences were, in turn, hypothesized to increase risk for current posttraumatic stress disorder (PTSD). High-risk women were recruited from an innercity drug and alcohol treatment center (N = 105). Interpersonal resource losses, partner-produced physical assault, adulthood rape, CPA, and CSA had direct effects on PTSD. CPA and CSA also had indirect effects on PTSD through rape, which, in turn, predicted PTSD. Results suggest that the traumatic origins of current PTSD among substance-using women are multifaceted and support the importance of considering interpersonal coping resources in evaluating and treating female substance users.     

Resiliency and Adult Adaptation in Women with and Without Self-Reported Histories of Childhood Sexual Abuse

This study investigated the relationship of protective factors (PF) to adult adaptation in a nonclinical sample consisting of 264 undergraduate women: two groups without childhood sexual abuse (CSA), high (n = 109) and low (n = 99) on PF; and two groups with CSA, high (n = 17) and low (n = 27) on PF. The first hypothesis that higher levels of PF would be significantly associated with higher levels of functioning for all individuals was supported by the data. The second hypothesis that the women with CSA and higher levels of PF would appear similar in adaptation to those without CSA was also supported. The findings further suggest that though the protective factors were beneficial for most individuals, they were significantly more helpful for those with CSA.     

Convergent Validity of Three Posttraumatic Symptoms Inventories Among Adult Sexual Abuse Survivors

We examined the convergent validity of three posttraumatic symptoms inventories, the civilian version of the Mississippi Scale for Combat-Related PTSD (CM-PTSD), the Trauma Symptom Checklist-40 (TSC-40), and the Response to Childhood Incest Questionnaire (RCIQ), in a sample of 52 adult sexual abuse survivors. The significant and moderate to strong correlations (r = .6 or higher) among these inventories supported their convergent validity. Comparison with other studies also suggests that these instruments can adequately discriminate clinical from nonclinical populations.     

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.     

Posttraumatic Stress Disorder and Substance Abuse: Use of Research in a Clinical Setting

The goal of the present investigation was to evaluate whether the process of assessing posttraumatic stress disorder (PTSD) in substance abuse/dependence inpatients (N = 95) as part of a research protocol influenced the diagnostic assessment conducted by clinical staff. The prevalence of current crime-related PTSD (CR-PTSD) observed with a research interview was 40% (n = 38), whereas the rate of current CR-PTSD documented in (the same) patients' discharge summaries was 15% (n = 14). An even lower CR-PTSD prevalence rate of 8% (n = 5) was obtained from a new sample of patient discharge summaries (N = 59) collected after the cessation of the research project. On chart intake reports, clinical staff documented a history of sexual and/or physical assault in approximately one-half of these patients, but PTSD was not evaluated. PTSD appears to be under-diagnosed by clinical staff in patients with substance use disorders.     

Assessing the Association Between Childhood Sexual Abuse and Adult Sexual Experiences in Women with Sexual Difficulties

Self‐report instruments for assessing sexual well‐being in women with sexual difficulties have not to date been explicitly validated among women with a history of childhood sexual abuse (CSA). Given an extensive literature suggesting psychological differences between women with and without a history of CSA, it is possible that sexual well‐being has a different meaning for these groups. Without validated scales, it is difficult to evaluate the impact of early sexual trauma on adult sexuality. The present study assessed whether the factor structure of widely used measures of sexual well‐being were consistent across women experiencing sexual difficulties, with and without an abuse history, and to estimate effect sizes for the statistical effect of CSA on sexual well‐being in this population. A sample of women with and without a history of CSA (N = 238) completed the Female Sexual Function Index and the Sexual Satisfaction Scale for Women. Structural equation models indicated generally consistent factor structures across groups, suggesting good construct validity. Effect size estimates indicated medium to large (0.53–0.72) effects of CSA on sexual well‐being for women with sexual difficulties. These findings support and extend research regarding the potential effects of CSA that may inform treatment for this population.     

Shame-Proneness as a Diathesis for Dissociation in Women with Histories of Childhood Sexual Abuse

This study examined whether shame-proneness is associated with dissociation among abused women. Participants were 99 hospitalized women with and without reported histories of childhood sexual abuse. Hypotheses were that childhood sexual abuse and shame-proneness would each be associated with dissociation, and that the relationship between sexual abuse and dissociation would be greater among women with higher shame-proneness. Multiple regression analysis indicated that shame-proneness was independently related to dissociation, but childhood sexual abuse was not. As predicted, the combination of shame-proneness and childhood sexual abuse was associated with dissociation.     

Relationship Between Attachment Style and Posttraumatic Stress Symptomatology Among Adults Who Report the Experience of Childhood Abuse

This study examines the relationship between adult attachment style and posttraumatic stress symptomatology in a volunteer sample of adults who reported the experience of childhood abuse. Sixty-six individuals completed measures of abuse history, attachment style, and posttraumatic stress symptomatology. Results indicated that 76% of participants endorsed one of the three insecure attachment styles (dismissing, fearful, or preoccupied). Analyses of variances revealed that those who displayed fearful and preoccupied attachment styles, which represent a negative view of the self, had the highest mean scores on posttraumatic symptoms. Correlational analyses revealed a significant positive relationship between negative view of self and posttraumatic stress symptomatology, but not between negative view of other and posttraumatic stress symptomatology. Regression analyses indicated that having a negative view of self was most highly associated with posttraumatic stress symptoms, followed by a history of physical abuse. The regression analysis further indicated that negative view of other was unrelated to posttraumatic stress symptoms.     

Posttraumatic Stress Disorder and Family Functioning in Adolescent Cancer

Twenty three adolescents with a history of cancer, 27 physically abused adolescents, and 23 healthy, nonabused adolescents were administered structured posttraumatic stress disorder (PTSD) interviews and self-report questionnaires regarding family functioning. Thirty five percent of adolescent cancer subjects met criteria for lifetime PTSD as compared to only 7% of the abused adolescents: 17% of the cancer subjects and 11% of the abuse subjects met criteria for current PTSD. Adolescents with cancer viewed their mothers and fathers as significantly more caring and more protective than the comparison and abused adolescents. Cancer subjects who met criteria for lifetime PTSD save their families as significantly more chaotic than those who did not have PTSD. Eighty three percent of cancer subjects who had lifetime PTSD also had mothers who had PTSD.     

Relationships of Dissociation and Childhood Abuse and Neglect with Heart Rate in Delinquent Adolescents

This study examined the relationship of dissociative symptoms, abuse and neglect, and gender to mean heart rate (HR) in two types of interviews. Participants were 25 female and 16 male delinquent adolescents. Dissociative symptoms and abuse and neglect were assessed by structured interviews. Participants were randomized to one of two conditions, to describe either their most stressful life experience or their free association thoughts. Greater dissociative symptoms were associated with lower mean HR, whereas abuse and neglect, being a girl, and participating in the free association task were associated with higher mean HR. The finding that high levels of dissociative symptoms may be related to a suppression of autonomic physiological responses to stress support Bremner's conceptualization (J. D. Bremner, 1999) that dissociative symptoms comprise one of two subtypes of the acute stress response, differing physiologically as well as subjectively from a predominantly hyperarousal or intrusive symptom response.     

Social Attitudes Toward Traumatized Men and Women: A Vignette Study

This study investigated social beliefs about gender-appropriate reactions to trauma. Ninety-three men and 179 women completed vignette measures of attitudes toward victims, the Bem Sex Role Inventory, and the Trauma History Questionnaire. Participants evaluated male victims less favorably than female victims. Women responded more positively toward all victims than men. Participants regarded female crime victims more positively than their male counterparts, but did not distinguish between male and female natural disaster victims. Feminine-sex-typed women rated victims more favorably than masculine-sex-typed individuals. There was a positive relation between personal trauma exposure and attitudes toward male victims among male participants. These findings contribute to an understanding of factors influencing the social reactions experienced by traumatized men and women, and have implications for clinical practice and psychoeducation.     

Childhood Abuse and Sexual Revictimization in a Female Navy Recruit Sample

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

Posttraumatic Stress Disorder, Self- and Interpersonal Dysfunction Among Sexually Retraumatized Women

This study assessed self and interpersonal dysfunction as well as posttraumatic stress disorder (PTSD) among three groups of women: women sexually assaulted in both childhood and adulthood, women sexually assaulted only in adulthood and women who were never assaulted. Rates of PTSD were high and equivalent in the two assault groups. However, retraumatized women were more likely to be alexithymic, show dissociation scores indicating risk for dissociative disorders, and to have attempted suicide compared to the other two groups, who did not differ from each other. Additionally, only the retraumatized women experienced clinically significant levels of interpersonal problems. The findings suggest that formulations more inclusive than PTSD are required to capture the psychological difficulties experienced by this population. Treatment implications are discussed.