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.     

The cortisol response during physiological sexual arousal in adult women with a history of childhood sexual abuse

Many women with a history of childhood sexual abuse (CSA) experience difficulties becoming sexually aroused. This study measured cortisol and physiological sexual arousal during exposure to sexual stimuli in women with and without a history of CSA. Childhood sexual abuse survivors showed a smaller decrease in cortisol during sexual arousal than the nonsexually abused, control group potentially due to an increase in cortisol in some of the participants in the CSA group. Physiological sexual arousal was weaker in CSA survivors compared to women with no history of sexual abuse and posttraumatic stress disorder symptoms showed characteristics consistent with mediation for the relationship between a history of CSA and inhibited sexual arousal responses.     

The long-term sequelae of sexual abuse: Support for a complex posttraumatic stress disorder

This study examined the relationship between childhood sexual abuse and symptoms of a newly proposed complex posttraumatic stress disorder or disorder of extreme stress not otherwise specified (DESNOS). Compared to 34 women without histories of sexual abuse, 74 survivors of sexual abuse showed increased severity on DESNOS symptoms of somatization, dissociation, hostility, anxiety, alexithymia, social dysfunction, maladaptive schemas, self-destruction, and adult victimization. In addition, a logistic regression found that a complex of symptoms representing DESNOS was significantly related to a history of sexual abuse. Consistent with other studies, the results of this study provide support for the idea that symptoms of DESNOS characterize survivors of sexual abuse.     

Resilience and Mental Health in Adult Survivors of Child Abuse Associated with the Institution of the Austrian Catholic Church

In recent years, reports of institutional abuse within the Catholic Church have emerged and research on the consequences on mental health is in its beginnings. In this study, we report findings on current mental health and resilience in a sample of adult survivors of institutional abuse (N = 185). We compared 3 groups of survivors that differed regarding their current mental health to investigate aspects of resilience, coping, and disclosure. The majority of the sample was male (76.2%), the mean age was 56.28 (SD = 9.46) years, and more than 50.0% of the sample was cohabiting/married. Most of the survivors reported severe mental health problems. Known protective factors (education, social support, age) were not associated with mental health in our sample. Our findings corroborate that institutional abuse has long‐term effects on mental health. We found that fewer emotional reactions during disclosure, task‐oriented coping, and optimism were associated with better mental health. The study was limited by a cross‐sectional design, but we conclude that the kind of institutional abuse reported is especially adverse, and thus typical protective factors for mental health do not apply. Future research should focus on intrapersonal factors and institutional dynamics to improve treatment for persons affected by institutional abuse.     

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.     

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.     

Personality constellations in patients with a history of childhood sexual abuse

Although childhood sexual abuse (CSA) appears to have an impact on personality, it does not affect all survivors the same way. The goal of this study was to identify common personality patterns in women with a history of CSA. A national sample of randomly selected psychologists and psychiatrists described 74 adult female patients with a history of CSA and a comparison group of 74 without CSA using the Shedler-Westen Assessment Procedure-200 (SWAP-200), a Q-sort procedure for assessing personality pathology. Q-factor analysis identified four personality constellations among abuse survivors: Internalizing Dysregulated, High Functioning Internalizing, Externalizing Dysregulated, and Dependent. The four groups differed on diagnostic, adaptive functioning, and developmental history variables, providing initial support for the validity of this classification. The data have potential methodological and treatment implications.     

The Correlates of Male Adults' Perceptions of Their Early Sexual Experiences

This study investigates the relationship between men's perceptions of their earliest sexual experiences and adult psychosocial functioning. Twenty men who identified themselves as sexual abuse survivors were compared with 20 men who would be classified as sexual abuse survivors by common research definitions, but do not identify themselves as survivors, and to 20 men who reported only noncoercive childhood sexual experiences with peers. Men who self-identified as survivors reported nearly twice the level of psychological distress, and were twice as likely to have utilized mental health services as the other two groups. The current article also examines differences in perpetrator and event characteristics.     

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.     

Memory Functioning in Adult Women Traumatized by Childhood Sexual Abuse

Memory impairment has been reported in some studies of patients with combat-related posttraumatic stress disorder (PTSD) and in rape victims with PTSD. The authors tested whether explicit memory impairment was evident in adult women who were traumatized by severe sexual abuse in childhood. The California Verbal Learning Test (Delis, Kramer, Kaplan, & Ober, 1987) and the Benton Visual Retention Task (Benton, 1974) were administered to 22 female adult survivors of childhood sexual trauma and to 20 demographically and educationally similar nonvictimized women. No evidence was found of explicit memory impairment in the abuse survivors. Furthermore, neither PTSD severity, dissociative symptom severity, nor extent of preexisting amnesia for childhood trauma contributed to the variance in memory functioning. Additional studies are needed to determine the extent to which impaired explicit memory functioning is a common feature of posttraumatic stress syndromes.     

Posttraumatic distress, alcohol disorders, and recurrent trauma across level 1 trauma centers

BACKGROUND: Injured survivors of individual and mass trauma receive their initial evaluation in acute care. Few investigations have comprehensively screened for posttraumatic stress disorder (PTSD) symptoms and related comorbidities across sites. METHODS: This investigation included 269 randomly selected injury survivors hospitalized at two level 1 trauma centers. All patients were screened for PTSD, depressive, and peritraumatic dissociative symptoms during their surgical inpatient admission. Prior traumatic life events and alcohol abuse/dependence also were assessed. RESULTS: In this study, 58% of the patients demonstrated high levels of immediate posttraumatic distress or alcohol abuse/dependence. Regression analyses identified greater prior trauma, female gender, nonwhite ethnicity, and site as significant independent predictors for high levels of posttraumatic distress. CONCLUSIONS: High levels of posttraumatic distress, recurrent trauma, and alcohol abuse/dependence were present in more than half of acute care inpatients. Early mental health screening and intervention procedures that target both PTSD and alcohol use should be developed for acute care settings.     

Losing a loved one to homicide: Prevalence and mental health correlates in a national sample of young adults

The present study examined the prevalence, demographic distribution, and mental health correlates of losing a loved one to homicide. A national sample of 1,753 young adults completed structured telephone interviews measuring violence exposure, mental health diagnoses, and loss of a family member or close friend to a drunk driving accident (vehicular homicide) or murder (criminal homicide). The prevalence of homicide survivorship was 15%. African Americans were more highly represented among criminal homicide survivors. Logistic regression analyses found that homicide survivors were at risk for past year posttraumatic stress disorder (OR = 1.88), major depressive episode (OR = 1.64), and drug abuse/dependence (OR = 1.77). These findings highlight the significant mental health needs of homicide survivors.     

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.     

Effects of Trauma-Focused Research on Recent Domestic Violence Survivors

This study investigated the impact of trauma-focused research on domestic violence survivors. At the end of a survey assessing psychological distress, abuse severity, coping self-efficacy (CSE), and cognitions, questionnaire items were utilized to assess participants' levels of gain, unexpected upset, and regret of participation. Participants were 55 women who had recently experienced abuse by a partner. Forty-five percent reported positive gain from participation, 25% reported they were more upset than anticipated, and a minority of women (6%) expressed regret for participation. Results indicated that women who were more upset than expected scored significantly higher on depression, PTSD, and number of lifetime traumas, and significantly lower on CSE. Implications for enhancement of consent form documents and debriefing procedures are addressed.     

The Long-Term Mental Health Consequences of Child Sexual Abuse: An Exploratory Study of the Impact of Multiple Traumas in a Sample of Women

The current study examined exposure to multiple traumas as mediators of the relationship between childhood sexual abuse and negative adult mental health outcomes. Participants were 174 women interviewed in the third wave of a longitudinal study of the consequences of child sexual abuse. Child sexual abuse victims reported a lifetime history of more exposure to various traumas and higher levels of mental health symptoms. Exposure to traumas in both childhood and adulthood other than child sexual abuse mediated the relationship between child sexual abuse and psychological distress in adulthood. There were also some significant direct effects for child sexual abuse on some outcome measures. Results point to the importance of understanding the interconnected nature of trauma exposure for some survivors.     

Burn abuse: a four-year study

Data are presented for 139 children assessed for abuse by burning, and findings are contrasted with previous reports in the literature. The results support assertions that burn abuse is most prevalent among children under 3 years of age, and is usually perpetrated by a caretaker who is young, single and poorly educated. The data do not support findings from other studies that boys outnumber girls as victims. Previous reports that immersion burns constitute the major burn type are also contradicted by the present study and results are examined in terms of sampling techniques. A disproportionate number of alleged abusers in this study are female, a finding which is discussed relative to the average age of the victim and the events reported as precipitating abuse. This study indicates that burn abuse is most common in families of two or more children, and that the youngest child is at highest risk.     

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.     

The course of mental health disorders after a disaster: predictors and comorbidity

Current longitudinal disaster studies usually focus only on posttraumatic stress disorder (PTSD), although some studies have shown that increased risks for other disorders and comorbidity is common. To obtain an insight into the course of postdisaster psychopathology, a community sample of survivors of the Enschede fireworks disaster was followed from 2-3 weeks to 4-years postdisaster. Diagnostic interviews (Composite International Diagnostic Interview [CIDI]; World Health Organization, 1997) and childhood stressor interviews were administered at 2-years postdisaster (n = 260); the CIDI was repeated at 4-years postdisaster (n = 201, response rate 77.3%). At 2-years postdisaster many survivors (40.6%) suffered from PTSD (21.8%), specific phobia (21.5%), and/or depression (16.1%). These disorders were highly comorbid. At 4-years postdisaster, prevalence significantly diminished. Instead of full recovery, diagnostic classifications shifted in several survivors over time. This resulted in low rates of PTSD but still elevated rates of depression and specific phobia. The course of the 3 entangled disorders of PTSD, depression, and specific phobia was further studied by constructing 4 groups of survivors based on the diagnostic status at 2- and 4-years postdisaster: healthy, recovered, chronic, and delayed-onset. Initial depressive symptoms, maternal dysfunction, childhood physical abuse, and disaster exposure were found to discriminate between the groups and predict long-term psychopathology.     

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.     

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.