A meta-analysis of disparities in childhood sexual abuse, parental physical abuse, and peer victimization among sexual minority and sexual nonminority individuals

Objectives. We compared the likelihood of childhood sexual abuse (under age 18), parental physical abuse, and peer victimization based on sexual orientation.Methods. We conducted a meta-analysis of adolescent school-based studies that compared the likelihood of childhood abuse among sexual minorities vs sexual nonminorities.Results. Sexual minority individuals were on average 3.8, 1.2, 1.7, and 2.4 times more likely to experience sexual abuse, parental physical abuse, or assault at school or to miss school through fear, respectively. Moderation analysis showed that disparities between sexual minority and sexual nonminority individuals were larger for (1) males than females for sexual abuse, (2) females than males for assault at school, and (3) bisexual than gay and lesbian for both parental physical abuse and missing school through fear. Disparities did not change between the 1990s and the 2000s.Conclusions. The higher rates of abuse experienced by sexual minority youths may be one of the driving mechanisms underlying higher rates of mental health problems, substance use, risky sexual behavior, and HIV reported by sexual minority adults.The number of substantiated annual cases of childhood (i.e., under age 18) physical abuse in the United States declined 52% between 1992 and 2007, and cases of childhood sexual abuse declined 53% during the same period.¹ Criminal victimization of students in school declined 60% between 1995 and 2005.² Although these represent public health success stories, the abuse of children and adolescents is still a major problem. Child welfare agencies confirmed 79 866 cases of physical abuse and 56 460 cases of sexual abuse in the United States during 2007.³ One nationally representative sample found that 17% of youths reported having been the victim of moderate or frequent bullying at school during the prior 2 months,⁴ and another found that 13% experienced being hit, kicked, pushed, shoved around or locked indoors during the same time period.⁵Children and adolescents who experience sexual abuse are more likely to experience depression and dysthymia, borderline personality disorder, somatization disorder, substance abuse disorder, posttraumatic stress disorder, dissociative identity disorder, or bulimia nervosa; to attempt suicide; to become pregnant earlier; to engage in HIV sexual risk behaviors; to perform poorly at school; to be arrested for sex crimes; or to commit other criminal offenses.^6–10 Children and adolescents who experience parental physical abuse are more likely to experience similar psychological, substance use, behavioral, and criminal problems.^11–15 Outcomes of peer victimization among children and adolescents include depressive, anxiety, and drug abuse disorders, suicidal ideation, social isolation, psychosomatic symptoms, poor school performance, and delinquency.^16–20 In addition, these types of abuse are associated with negative psychological, behavioral, and physical outcomes in adulthood.^21–23 Risk markers of childhood abuse include the characteristics of parents (e.g., substance abuse, history being victims of physical or sexual abuse, social isolation, low self-esteem), families (e.g., marital conflict, spousal abuse, financial stress), the individuals themselves (e.g., emotional, psychological, or physical disabilities; low self-esteem; an inability to defend oneself; lack of social skills), and environments (e.g., negative school atmosphere, low socioeconomic status).^24–26One risk factor for experiencing these types of abuse may be sexual orientation. Studies suggest that sexual minority youths (i.e., youths who experience same-sex attractions or self-label as gay, lesbian, or bisexual, or who engage in same-sex sexual activity), compared with sexual nonminority youths, are more likely to experience sexual abuse, parental physical abuse, and peer victimization during childhood.^27–42 However, these studies vary in effect sizes, measurement of abuse and sexual orientation, the group being compared with heterosexuals (e.g., gays, lesbians, and bisexuals combined vs comparing groups individually; combining males and females vs comparing gender individually), sampling and recruitment strategies, and the decade in which the studies were conducted. Thus, relying on any one study to determine whether sexual orientation is a risk factor for child abuse, as well as determining the robustness of the difference in child abuse rates, is problematic. However, if sexual minority youths suffer greater rates of violence victimization, this phenomenon could be one explanation for the existence of substantial health disparities that exist among sexual minority adult populations.⁴³This meta-analysis therefore addressed the following question: are sexual minority adolescents more likely than sexual nonminority adolescents to experience childhood sexual abuse, parental physical abuse, and peer victimization? Beyond examining disparities, we tested the possible moderating role of bisexuality status because data suggest that bisexual adolescents are at greater risk than are gay and lesbian adolescents for engaging in certain risk behaviors^44,45; the decade of survey administration because rates of violence perpetrated against sexual minority youths relative to heterosexuals may have decreased over recent decades⁴⁶; the dimension used to measure sexual orientation (i.e., behavior or identity) because disparities in abuse between sexual minority and sexual nonminority individuals may be greater when sexual minority status is based on self-identification as gay, lesbian, or bisexual than when it is based on same-sex or both-sex sexual activity⁴⁴; and gender because this variable has been shown to moderate the association between sexual orientation and both substance use⁴⁴ and suicide attempts⁴⁷ in sexual minority youths.     

监管场所中有童年期躯体情感虐待史羁押人员的心理干预效果分析

目的 改善监管场所羁押人员中有童年期躯体情感虐待史者的心理健康水平,并对心理干预的效果进行研究评估.方法 经过虐待史调查和心理评估,建立羁押人员心理团体咨询小组,同时建立19个配对对照组,由注册心理咨询师进行8次团体辅导心理,比较干预前后及干预组与对照组心理测量结果的差异.主要用症状自评量表(SCL-90)总分及因子分得分差值进行评估.结果 干预组经心理干预后,前后自身对照各因子得分差值有统计学意义;对照组前后大多数因子分差值没有统计学意义;而干预组与配对对照组比较,干预前后2次SCL-90评估中大多数因子分差值有统计学意义.结论 对监管场所中有童年期躯体情感虐待史的羁押人员进行一定的系统的心理干预是需要的,能有效地改善其心理健康水平.     

Storying childhood sexual abuse

A theoretical framework that explains how survivors of childhood sexual abuse tell others about their abuse experiences is presented. Data are drawn from open-ended interviews conducted with 74 individuals who experienced ongoing childhood sexual abuse by a family member or close acquaintance. Grounded theory methods were used to develop the framework. The psychosocial problem shared by the participants is that childhood sexual abuse both demands and defies explanation. The core psychosocial process used in response to this problem is storying childhood sexual abuse. The framework includes five processes, and the stories associated with each process vary in their nature and function. The processes and associated stories are (a) starting the story: the story-not-yet-told, (b) coming out with the story: the story-first-told, (c) shielding the story: the story-as-secret, (d) revising the story: the story-as-account, and (e) sharing the story: the story-as-message. Clinical applications of the framework are discussed.     

Primary health care for adult survivors of childhood sexual abuse

Abstract: Increasing numbers of adults have been seeking help for childhood sexual abuse in recent years. Dearth of services led to the formation of a resource network from a range of health and welfare services in an inner region of Melbourne. Information gathered through the network indicates that adult survivors presented to primary health agencies in distinct ways. Some sought help primarily for sexual abuse, while others sought help for physical or emotional problems, with sexual abuse remaining masked. Yet others were prevalent in welfare settings, such as women's refuges. Generalist workers in such settings had varied levels of expertise in providing adequate help. When seeking to refer their patients because of concerns about suicide, they found appropriate referral difficult. Public sector mental health workers did not readily undertake work in childhood sexual abuse, and medical practitioners were relatively unaware about the relevance of childhood sexual abuse to physical and emotional ill-health.     

Management of childhood sexual abuse

Childhood sexual abuse is increasingly recognized as a major problem in the United States. These children are frequently seen by the primary care provider, and physicians must be able to evaluate them. Common presentations for sexually abused children include direct allegations, suspicions by the caretaker, unexplained vaginal trauma or bleeding, sexually transmitted disease, and a wide spectrum of behavioral problems including sexual promiscuity and runaway behavior. The interview and physical examination must be performed in a quiet, private area and sufficient time allocated to allow a thorough evaluation. All sexual abuse must be reported to the local child abuse authorities. Any abnormalities must be carefully described and treated. Evidence collected should be handled according to a protocol and given to authorities. Postexamination counseling should include explanation of findings, legal implications of sexual abuse, and anticipatory guidance about common psychological sequelae of abuse.     

Childhood sexual,physical, and psychological abuse and their relationship to comorbid psychopathology in bulimia nervosa

We examined the relationship between childhood sexual, physical, psychological, and “multiple” abuse (i.e., abuse in more than one form) and comorbid Axis I and personality psychopathology among women with a lifetime history of bulimia nervosa (BN group; n = 80) and a control group of noneating-disordered women (n = 40). Subjects were recruited primarily by newspaper advertisement. They participated in structured clinical interviews for diagnosis of Axis I and personality pathology, and they completed child abuse questionnaires in the interview setting. At odds with prediction, child abuse in various forms was not associated with the presence of lifetime comorbid Axis I disorders in general (i.e., 1 or more) or disorder classes in particular (mood, alcohol/substance use, anxiety) among BN subjects, although sexual, psychological, and multiple abuse were associated with the diagnosis of a higher total number of Axis I conditions. A history of psychological and multiple abuse (but not physical or sexual abuse alone) among BN subjects was strongly associated with the presence of personality disorder diagnoses, especially those in the “anxious-fearful” cluster (Cluster C). Finally, we found that when a personality disorder was present in addition to the Axis I conditions in question, significant relationships emerged between abuse and Axis I pathology, particularly for psychological and multiple abuse. In general, control group findings were in accord with BN group findings, indicating that our findings were not specific to eating-disordered women. Our results suggest that childhood abuse, particularly psychological abuse and abuse in multiple forms, increase the likelihood of lifetime comorbid Axis I disorders and personality pathology among bulimic patients. Eating-disordered women with a history of child abuse may thus represent a subgroup of patients requiring especially intensive intervention. © 1994 by John Wiley & Sons, Inc.     

Self-reported childhood sexual and physical abuse and adult HIV-risk behaviors and heavy drinking

CONTEXT: Although studies of clinical samples have identified links between childhood abuse, especially sexual abuse, and adult health-risk behaviors, the generalizability of these findings to the population and the relative importance of different types of abuse in men and women are not known. OBJECTIVE: To estimate the risk of self-reported adult HIV-risk behaviors and heavy drinking that is associated with self-reported childhood histories of physical and/or sexual abuse for men and women in a general-population sample, after controlling for age and education. A second objective is to determine whether, among women, early and chronic sexual abuse is associated with heightened risk compared to later or less extensive abuse. DESIGN: A population-based telephone survey, the 1997 Washington State Behavioral Risk Factor Surveillance System (BRFSS), asked a representative sample of adults whether they had ever been physically or sexually abused in childhood, and if so, the age at first occurrence and number of occurrences. The survey also asked about levels of alcohol use and, for those under 50 years, about HIV-risk behaviors. PARTICIPANTS: Three thousand four hundred seventy-three English-speaking non-institutionalized civilian adults in Washington State. MAIN OUTCOME MEASURES: Self-reported HIV-risk behaviors in the past year and heavy drinking in the past month. RESULTS: We identified associations between reported abuse history and each health-risk behavior that we examined. For women, early and chronic sexual abuse (occurring without nonsexual physical abuse) was associated with more than a 7-fold increase in HIV-risk behaviors (odds ratio [OR], 7.4; 95% confidence intervals [CI] 2.4 to 23.5); and any sexual abuse, combined with physical abuse, was associated with a 5-fold increase in these risk behaviors (OR, 5.0; 95% CI, 2.2 to 11.5). For women, only combined sexual and physical abuse was associated with heavy drinking (OR, 6.2; 95% CI, 2.2 to 16.9). Physical abuse alone was not associated with either health-risk behavior for women. For men, any sexual abuse was associated with an 8-fold increase in HIV-risk behaviors (OR, 7.9; 95% CI, 1.8 to 35.1). Physical abuse alone was associated with a 3-fold increase in risk of HIV-risk behaviors (OR, 3.2; 95% CI, 1.3 to 7.9) and a similar increase in risk of heavy drinking (OR, 3.2; 95% CI, 1.8 to 5.5). Although only 29% of the women and 19% of the men who were asked about HIV-risk behaviors reported any history of childhood abuse, these accounted for 51% and 50% of those reporting HIV-risk behaviors, respectively. For heavy drinking the corresponding figures were 25% of the women and 23% of the men reporting any abuse, who accounted for 45% and 33% of those reporting heavy drinking, respectively. CONCLUSIONS: Efforts to prevent or remediate adult health-risk behaviors should consider the possibility of a history of childhood abuse, as one third to one half of those reporting HIV-risk behaviors or heavy drinking in a general-population survey also reported childhood abuse.     

Sexual and physical abuse: a threat to reproductive and sexual health

According to the cross-cultural data, violence has two fundamental certainties: 1) that the overwhelming majority of perpetrators are men; and 2) that the targets are usually women. Sexual and physical abuse subsume a wide variety of violent behaviors, some of which are legally recognized as criminal acts. Evidence indicates that the most invisible of all is child sexual abuse, in which nonreporting of crime is prevalent. Although there appears to be no simplistic response to the question as to why men are violent towards women, it is noted that it involves several contributing factors. These include inequalities between women and men at the societal level, and cultural norms and expectations about behaviors of women and men at another level. In terms of the identity of the perpetrators, research has found that a large majority of perpetrators are socialized for violence. The effects of violence on the sexual and reproductive health of the victim are multiple and long lasting. For example, physical consequences of rape include sexually transmitted diseases and HIV infection, as well as unwanted pregnancy, miscarriage, unsafe abortion, homicide, and suicide. With respect to the psychological consequences, the most common symptoms are anxiety, depression, sexual dysfunction, and difficulties with interpersonal relationships. In view of this, there is a need for a long-term management of victims of sexual abuse.     

Cumulative abuse experiences, physical health and health behaviors

PURPOSE: Our purpose was to investigate the complex relationship between a range of lifetime abuse experiences with current physical health and health behaviors. METHODS: Between October 1998 and May 1999, interviews were conducted with 557 ethnically diverse women seen at two urban primary care centers. Seven forms of abuse were measured: childhood physical and sexual abuse, past physical and sexual intimate partner violence (IPV), and recent emotional, physical, and sexual IPV. Severity was measured for six of these forms. Multiple non-specific physical symptoms were measured with a modified PRIME-MD, and four health behaviors were ascertained. RESULTS: Approximately 10% of women never experiencing abuse reported multiple non-specific physical symptoms, compared with 25.8% to 78.4% of women reporting a range of abuse experiences. Increases in recent IPV, past IPV, child abuse, and economic hardship were associated with increases in reported symptoms. Women who experienced IPV were more likely to report smoking cigarettes, binge drinking, and having poor nutritional habits. CONCLUSIONS: Recent IPV is associated with physical symptoms and risky health behaviors beyond the effects of child abuse, past IPV, and economic disadvantage. Understanding a person's IPV experiences may inform interventions for health behaviors, such as smoking cessation programs.     

Relationships between bulimia,childhood sexual abuse,and family environment

Prior studies investigating the relationship between childhood sexual abuse and bulimia have yielded mixed to weak empirical support for such an association. The current research, utilizing relatively restrictive definitions of abuse and bulimia, obtained significant associations between bulimia, sexual abuse, and a chaotic family environment in female college students. Among abuse victims, severity of abuse was also associated with bulimia. Although some analyses suggested that a chaotic family environment moderated the abuse—bulimia association, sexual abuse, and family environment appeared to combine in an additive manner to increase the probability of bulimia. © 1994 by John Wiley & Sons, Inc.     

Enhancing the health care experiences of adult female survivors of childhood sexual abuse

This article addresses the medical issues presented by women who were sexually abused in childhood and provides a detailed and direct link between the existing literature and its implications for the medical system. A profile of the sexual abuse survivor is given, including child sexual abuse (CSA) characteristics and sequelae that influence the adult female survivor's health. Post-traumatic Stress Disorder is outlined as part of a complex interplay of physiological and psychological symptomatology that can compromise the CSA survivor's ability to access health care treatment and forge a positive provider/patient relationship. This article emphasizes that effective treatment with sexual abuse survivors must include interdisciplinary collaboration among health care professionals. Management of the CSA patient, a case vignette illustrating salient themes, and finally, guidelines for the health care practitioner are presented.     

Etiological correlates of vaginismus: sexual and physical abuse,sexual knowledge,sexual self-schema,and relationship adjustment

This study investigated the role of sexual and physical abuse, sexual self-schema, sexual functioning, sexual knowledge, relationship adjustment, and psychological distress in 87 women matched on age, relationship status, and parity and assigned to 3 groups--vaginismus, dyspareunia/vulvar vestibulitis syndrome (VVS), and no pain. More women with vaginismus reported a history of childhood sexual interference, and women in both the vaginismus and VVS groups reported lower levels of sexual functioning and a less positive sexual self-schema. Lack of support for traditionally held hypotheses concerning etiological correlates of vaginismus and the relationship between vaginismus and dyspareunia are discussed.     

The relation of abuse to physical and psychological health in adults with developmental disabilities

Background

People with developmental disabilities are at disproportionately high risk of abuse. Although considerable evidence exists on the health-related consequences of abuse in the general population, little is known about those consequences in people with developmental disabilities.

童年期性虐待对青少年认知功能和心理健康影响及其机制

童年期性虐待(CSA)是一个世界性的公共卫生问题,它不仅对受害者儿童期身心健康产生不利影响,而且与其成人期的生活、工作、健康与行为息息相关;当前在中国缺乏行之有效预防控制CSA措施的前提下,本综述通过分析国内外CSA发生状况,探讨童年期性虐待经历对青少年身心健康的影响及其可能机制,以期敲响中国预防CSA的警钟,也为进一步对CSA受害者身心健康影响的深入研究提供参考。     

Prevalence of childhood sexual abuse and physical trauma in an HIV-positive sample from the deep south

We examined prevalence and predictors of trauma among HIV-infected persons in the Deep South using data from the Coping with HIV/AIDS in the Southeast (CHASE) study. Over 50% of CHASE participants were abused during their lives, with approximately 30% experiencing abuse before age 13, regardless of gender. Caregiver characteristics were associated with childhood abuse. Abuse is related to increases in high-HIV-risk activities. The findings help explain why people engage in such high-risk activities and can provide guidance in designing improved care and prevention messages.