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.     

Factors influencing recall of childhood sexual abuse

Selective literatures providing perspective on recall of childhood sexual abuse memories are reviewed. These include known patterns of autobiographical memories in adulthood, metacognitive mechanisms, interpersonal influences, and automatic cognitive processing which can influence judgments and reports of memory recall in children and adults. Some factors in adult experience such as mood state, presence of emotional disorders, past and current relationships, and participation in psychotherapy which can influence autobiographical memory and recall of childhood events are delineated. Available studies directly exploring recovered memories of childhood abuse are considered in light of these studies. Finally, some applications to clinical work and suggestions for future research are outlined.     

Childhood sexual abuse as a precursor to depression and self-destructive behavior in adulthood

Childhood sexual abuse (CSA) as a predictor of depression and self-destructive behaviors in adulthood was examined relative to other traumatic stressors in childhood and adulthood with special attention to sex differences. In a college sample of 173 men and 265 women, 16% of male (n=28) and 24% of female respondents (n=63) reported having been sexually abused as children. CSA, ranging from unwanted kissing and fondling to unwanted sexual intercourse, predicted depression, chronic self-destructiveness, self-harm ideation, acts of self-harm, suicide ideation, and suicide attempts, for both men and women. The more frequent and severe the sexual abuse and the longer its duration, the more depression and self-destructiveness reported in adulthood. Other stressors predicted these effects less consistently but their occurrence in combination with CSA contributed to the negativity of long-term outcomes. Study results affirm previous findings of a relationshop between CSA and depression and self-destructiveness in adult females and extend them to males.     

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.     

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.     

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.     

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.     

Effects of context and question type on endorsement of childhood sexual abuse

Use of contextual information and behaviorally specific questions have been found to detect higher rates of child sexual abuse (CSA); however, no study has examined the use of contextual information or question type within 1 study. This study examined 236 college students randomly assigned to 1 of 4 conditions: noncontext/label questions, noncontext/specific questions, context/label questions, context/specific questions. Reported history of CSA did not differ across presentation of videotaped contextual information. However, respondents endorsed behaviorally specific questions significantly more (32%) than label questions (9%). Results suggest that researchers and clinicians attempting to detect childhood victimization history should utilize multiple behaviorally specific screening questions.     

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.     

The experience of sexual trauma

The present research was designed to describe women's experience of sexual trauma and its aftermath as it relates to difficulties in coping with the trauma. A small, but heterogeneous, sample of survivors seeking treatment was interviewed in an unstructured format and encouraged to present their story of what had happened and what it had meant to them. The definition and examples of 14 themes are presented. They provide evidence that sexual trauma confronts the individual with affects and meanings which are extremely difficult to manage and which may have long-term effects. The themes are discussed in reference to general psychological processes involved in the response to acute stress, the cultural context of sexual trauma, and the implications for the psychotherapeutic treatment of sexual trauma victims.     

Victimization history and victim-assailant relationship as factors in recovery from sexual assault

The present study investigated the psychological aftermath of sexual assault in a probability sample of university women, with an emphasis on how various aspects of a victim's lifetime sexual assault history and their relationship with their assailant(s) mediate posttraumatic recovery. Victims were almost twice as likely as nonvictims to meet given criteria for a psychiatric case. Surprisingly, date rape victims were as distressed as victims of chronic childhood assault, possibly because of the ambiguous nature of the assault circumstance. Also, repeated victimization was related to denial, a symptom of posttraumatic stress. Denial was discussed in regard to the likelihood of its increasing the risk of revictimization.     

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.     

Predicting PTSD in Women with a History of Childhood Rape

The impact of factors that predispose childhood rape victims to develop posttraumatic stress disorder (PTSD) is important in understanding both the impact of childhood rape and the development of PTSD as a psychological disorder. The present study attempted to determine which crime, perpetrator, victim, and aftermath characteristics are related to PTSD status. A national representative sample of women (N = 3,220) were interviewed about their history of rape, trauma-related variables, and PTSD status. Consistent with research on crime victims, life threat and physical injury discriminated PTSD status in a sample of childhood rape victims. In addition, two other domains were related to PTSD development: (1) testification about rape and (2) rape types. The present findings are discussed in relation to previous research.     

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.     

The effect of childhood sexual assault history on outpatient cognitive processing therapy for military sexual trauma‐related posttraumatic stress disorder: A preliminary investigation

History of childhood sexual assault (CSA) may result in poorer emotion regulation and interpersonal functioning, potentially affecting the tolerability and effectiveness of evidence‐based treatments (EBTs) for posttraumatic stress disorder (PTSD). Survivors of military sexual trauma (MST) have an increased incidence of CSA; however, research examining the role of CSA in EBTs for veterans with MST‐related PTSD is limited. Data from 32 (9 male; 23 female) veterans with MST‐related PTSD were used from a previously conducted randomized clinical trial examining the efficacy of an outpatient PTSD EBT (i.e., cognitive processing therapy [CPT]). Self‐rated PTSD symptom severity was assessed at pretreatment, during treatment, and up to 6 months following treatment completion. Number of CPT sessions attended and treatment completion were also examined. Using a hierarchical linear modelling approach, results indicated both veterans with and without a history of CSA were found to benefit from CPT, and history of CSA did not significantly predict treatment response. Additionally, number of sessions attended and treatment completion did not significantly vary based on history of CSA. These preliminary findings provide support for the tolerability and efficacy of outpatient CPT in veterans with MST‐related PTSD regardless of CSA history.     

Coping with incest: the relationship between recollections of childhood coping and adult functioning in female survivors of incest

One hundred and one adult female survivors' recollections of coping with childhood incest, abuse characteristics, and current functioning in adulthood were studied. Analyses controlling for characteristics of the trauma indicated that recollections of using avoidance coping and seeking social support were related to poor adult functioning whereas recollections of using distancing coping were related to better functioning. As a set of variables, abuse characteristics also predicted a significant amount of variance in adult functioning. Implications for future research were discussed.     

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.     

Male sexual health during adolescence and young adulthood: contemporary issues

The sexual health of young men is often neglected by health care systems that assume healthy developmental trajectories. Clinical morbidities and sexual concerns are not uncommon among sexually emerging young men. Sexually-transmitted infections, transient sexual dysfunction and lack of screening for genitourinary abnormalities contribute to this morbidity. This article discusses common sexual issues and concerns of adolescents and young adult men encountered in a clinical practice devoted to men in this age group. The holistic model of care is described. Key issues and updated clinical approaches are discussed.Health care services and education focused on the sexual health of young men improves early detection of disease, prevents morbidity and promotes healthier sexual lifestyles.     

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 process of coping with sexual trauma

In coping with sexual trauma, a survivor must come to understand the emotional impact of the trauma so that she is no longer preoccupied or driven by negative feelings, and must grapple with the meaning of the trauma until an adaptive resolution is achieved. In this paper, we present a conceptual system that we believe characterizes the coping process of recovery from sexual trauma. We present clinical examples of the use of the system from a psychotherapy group for female incest survivors, and the system's preliminary reliability results in measuring the coping process.