Interpersonal and family functioning of female survivors of childhood sexual abuse

The empirical literature that addresses the association between childhood sexual abuse (CSA) and the interpersonal functioning of female survivors within their adult family context is critically examined. Specifically, research on relationship difficulties, problems in attachment, marital conflict and divorce, secondary traumatization, sexual dysfunction, maternal attitudes and functioning, and the heightened risk for having children who themselves are sexually abused is reviewed. There is converging evidence in both clinical and community samples that, compared to other women, female CSA survivors do experience more relationship problems and more problems in sexual functioning. Based on community samples, there is an indication that CSA survivors experience problems in marital functioning and attachment. Beyond this, little sound research has addressed the issues of secondary traumatization, maternal attitudes, maternal functioning, or intergenerational patterns of abuse. The use of specificity designs, improved sampling strategies, and standardized, psychometrically strong measures in future research would greatly improve the quality of our knowledge on the interpersonal and family functioning of CSA survivors.     

Randomized trial of cognitive-behavioral therapy for chronic posttraumatic stress disorder in adult female survivors of childhood sexual abuse

The authors conducted a randomized clinical trial of individual psychotherapy for women with posttraumatic stress disorder (PTSD) related to childhood sexual abuse (n = 74), comparing cognitive-behavioral therapy (CBT) with a problem-solving therapy (present-centered therapy; PCT) and to a wait-list (WL). The authors hypothesized that CBT would be more effective than PCT and WL in decreasing PTSD and related symptoms. CBT participants were significantly more likely than PCT participants to no longer meet criteria for a PTSD diagnosis at follow-up assessments. CBT and PCT were superior to WL in decreasing PTSD symptoms and secondary measures. CBT had a significantly greater dropout rate than PCT and WL. Both CBT and PCT were associated with sustained symptom reduction in this sample.     

童年期性侵犯受害女性的性健康状况

目的:评估童年期受性侵犯受害女性的性健康状况,并与没有受性侵犯的女性比较分析.方法:采用横断法方式,通过问卷调查从多方面搜集数据.性健康状况,分别由正性自我概念(性自尊、性效能、性满意)和负性自我概念(性焦虑、性抑郁、性惧怕)加以测量.并以情境性自我概念(性动机和性意识)补充数据的分析.结果:共1025人完成问卷,74...     

Coping strategies in female survivors of childhood sexual abuse from two Canadian and two New Zealand cultural groups

Individuals from some minority cultures are at greater risk of experiencing childhood sexual abuse (CSA) and are also at heightened risk of negative outcomes from abuse. Coping strategies, which may mediate the relationship between CSA and outcomes, are also impacted by culture. This study examined the use of coping strategies in female survivors of CSA across 4 cultural groupings from 2 countries-86 European Canadians, 40 Native Canadians, 129 European New Zealanders, and 35 Māori New Zealanders-who all completed the Coping Responses Inventory. The 4 groups differed significantly on 7 of the 8 Coping Responses Inventory scales (Logical Analysis, Positive Reappraisal, Problem Solving, Cognitive Avoidance, Acceptance or Resignation, Seeking Alternative Rewards, Emotional Discharge). Whereas New Zealanders differed significantly from Canadians (p<.001), Europeans did not differ significantly from indigenous cultural groups, nor did nationality and culture grouping interact (p>.05). The profile of coping in New Zealand Europeans was relatively flat, with average scores across coping types close to the mean of the t-score distribution. Māori New Zealanders produced a similar profile, with only slight increases on 2 scales of avoidant coping. The findings raise questions about the extent to which generalizations can be made about there being either a "Western/European" culture or a particular "indigenous" culture. This in turn also raises the issue of whether cross-validation and replication of findings are needed if the findings are to be applied outside of the country in which the data were gathered.     

A review of individual psychotherapy outcomes for adult survivors of childhood sexual abuse

This review examines the current literature on individual psychotherapy outcomes with adult survivors of childhood sexual abuse. As compared to the literature on treatment with victims of sexual trauma in adulthood, fewer researchers have explored the field of psychotherapy outcome with this population, particularly with regard to individual treatments. For this reason, a review of psychotherapy outcome for adult survivors of child sexual abuse is needed. This review first presents issues salient to the study of treatment with this population, such as prevalence, short-term impact, and long-term sequelae of childhood sexual trauma. Next, the eight studies that have been published on individual psychotherapy for this population are presented and evaluated according to both efficacy and effectiveness criteria for a methodologically sound study. Last, directions for future research with this population include continued integration of efficacy and effectiveness methodology, use of multi-method/multi-rater assessment data, as well as further investigation of interpersonal variables such as the therapeutic alliance.     

A pilot study of psychodynamic psychotherapy for adult survivors of childhood sexual abuse

Clinical samples of child sexual abuse survivors report a variety of psychiatric symptoms and interpersonal difficulties. The treatment outcome literature for this population is often incomplete due to numerous methodological constraints. The purpose of this study was to evaluate the effectiveness of an open trial of individual short‐term, psychodynamic psychotherapy with a naturalistic sample of adult survivors of childhood sexual abuse. Sexual abuse survivors demonstrated significant improvement in symptomatic distress, level of functioning and dynamic personality variables according to self‐report measures and clinical rating scales. Abuse survivors developed positive therapeutic alliances, which remained high throughout the course of treatment, and comparable to the non‐abused clinical sample. Sexual abuse survivors' response to treatment was similar to that of non‐abused patients, with the potential for greater change in feelings about the self. These findings demonstrate that psychodynamic psychotherapy may be useful for childhood sexual abuse survivors presenting with depressive symptoms and interpersonal difficulties. Copyright © 2004 John Wiley & Sons, Ltd.     

Introduction to the special section on adult survivors of childhood sexual abuse.

Sexual abuse researchers need to use more complex models of abuse and more sophisticated research designs for studying long-term effects and for evaluating treatment programs. The articles that comprise this special section integrate the study of sexual abuse with perspectives on adult victimization, developmental psychopathology, and attachment theory and also offer specific methodological suggestions for improving research on long-term effects and therapy with the abuse survivor.     

Affect management in group therapy for women with posttraumatic stress disorder and histories of childhood sexual abuse

Affect dysregulation is pervasive among women with histories of childhood sexual abuse. It is an important aspect of the clinical presentation of posttraumatic stress disorder (PTSD), a disorder that frequently characterizes survivors of childhood abuse. Based on distinctions between approach and avoidance orientations to coping, there is controversy regarding whether initial treatment for trauma survivors should employ an exposure-based approach to increase affect or an affect-management approach to reduce it. In this article, we review theoretical and empirical literature regarding affect dysregulation and its relations with childhood sexual abuse and PTSD. We then describe a new affect-management group for adult survivors of childhood sexual abuse that is based on a stage approach to the treatment of trauma. This group emphasizes skill acquisition, symptom reduction, and patient stabilization. Affect-management strategies such as mindfulness, crisis planning, and challenging distorted thinking are presented to patients. Preliminary research findings support the use of this treatment.     

Performance of female college students and sexual abuse survivors on the Brief Symptom Inventory

The relation between childhood molestation and current adjustment, as measured by the Brief Symptom Inventory (BSI), was examined among women college students. Results suggest that the normative data available for the BSI are inappropriate for interpreting the performance of women college students and, particularly, students who have survived sexual abuse. © 1996 John Wiley & Sons, Inc.     

Sleep disturbances and childhood sexual abuse

OBJECTIVE: This longitudinal, prospective study examined the relationship between childhood sexual abuse and later sleep problems in adolescence while taking into account cooccurring psychopathology that is closely related to sleep disruption [e.g., depression and posttraumatic stress disorder (PTSD)]. METHOD: Sleep disturbances in 147 females (78 sexually abused; 69 comparison) were assessed 10 years after disclosure of substantiated abuse. The follow-up protocol included self-report questions regarding typical sleeping patterns and sleep disturbances as well as measures of depression, PTSD, and lifetime victimization histories. RESULTS: Sleep disturbances correlated significantly with both depression and PTSD. Hierarchical regression analysis showed that sexually abused participants reported significantly greater rates of sleep disturbances than comparison participants above and beyond depression and PTSD. Sleep disturbances were related to revictimization rates independent of sexual abuse, depression, and PTSD. CONCLUSIONS: Assessments of sleep disturbances should be integrated into standard of care for adolescents who have experienced sexual abuse.     

Psychological sequelae of sexual abuse in childhood.

A questionnaire survey was carried out in one practice to determine the relationship between sexual abuse in childhood and subsequent psychological morbidity. Out of 418 women who replied (62% response rate), 60 (14%) admitted experiencing some form of sexual abuse as a child. Twenty of these (33%) were found to have a record of some form of psychological problem in adult life, compared with 14% of a sample of the non-abused respondents and 20% of the non-respondents. In particular, 54% of 13 women who had experienced oral, genital or anal penetration or attempted penetration had psychological morbidity recorded. There was no relationship, however, between sexual abuse and psychosexual or marital problems in later life.     

Family characteristics and long-term effects of childhood sexual abuse

OBJECTIVES. This study investigated the role of family variables in the development of psychological problems in childhood sexual abuse (CSA) survivors, contributing to the debate between the 'abuse related' perspective, which assumes a direct causal link between abuse and later problems, and the 'family dysfunction' perspective, which assumes that these problems are caused by the dysfunctional nature of families in which abuse occurs. The two questions of central concern were: (1) whether maladaptive family dynamics and CSA were each associated with later adjustment; and (2) whether these associations acted independently of one another. DESIGN. A retrospective cohort study comparing sexually abused and non-abused participants matched one-to-one on demographic variables. METHODS. The 64 clinical participants were recruited by sending questionnaires to clients on a psychological therapy waiting list, and 44 students were recruited from questionnaires made available at University Health Centres. Participants completed measures of psychological and sexual adjustment, family functioning, and construing. Multiple linear regression models investigated overall and independent associations between abuse, family circumstances, and adjustment in adulthood. RESULTS. There was only weak evidence for the influence of CSA, independently of family environment, on later psychological distress and sexual adjustment, but strong evidence for the influence of aspects of family environment, independent of abuse, on later psychological distress, sexual adjustment, self-esteem, body image, and sexual attitude. CONCLUSIONS. The findings provide support for the 'family dysfunction' perspective on the long-term effects of CSA.     

Internal and external mediators of women's sexual abuse in childhood

A community sample of 111 women's retrospective reports of childhood sexual abuse was examined in an effort to understand the circumstances and coping strategies that mediated the immediate and lasting effects of those stressful experiences. Aspects of single or multiple abuse incidents were captured in 11 variables, each reflecting 1 of 3 domains: circumstances of abuse, mediators, and outcomes (the negative effects of abuse). Observed variable simultaneous path analysis models revealed several direct and mediated influences on the outcomes. Long-term negative outcomes of abuse were directly affected by a close relationship to the perpetrator and severity of abuse from the circumstance of abuse domain, and immediate negative responses, self-blame, and nondisclosure regarding the incident from the mediational domain. The importance of examining factors that mediate the negative effects of child sexual abuse is discussed.     

Dissociative experiences during sexual behavior among a sample of adults living with HIV infection and a history of childhood sexual abuse

Little attention has been given to the occurrence of dissociative symptoms during sexual behavior in adults who have experienced childhood sexual abuse (CSA). For this study, 57 adults living with HIV infection who had experienced CSA and were entering a treatment study for traumatic stress completed study assessments and clinical interviews, including a 15-item scale of dissociative experiences during sexual behavior. Predictor variables included Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnoses of posttraumatic stress disorder (PTSD) and dissociative disorders, rape by an intimate partner, duration of CSA, number of perpetrators of CSA, and current sexual satisfaction. A multiple regression analysis was conducted to identify significant associations between predictors and dissociation during sex. Mean differences by clinical diagnosis were also examined. Results indicated that PTSD, dissociative disorders, rape by an intimate partner, duration of CSA, and number of perpetrators of CSA were associated with increased dissociation during sexual behavior. Dissociation during sex likely increases vulnerability to sexual revictimization and risky sexual behavior. Standard behavioral prevention interventions may be ineffective for sexual situations when dissociation occurs, and prevention efforts should be integrated with mental health care for those who have experienced CSA.     

Effect of childhood sexual abuse on gynecologic care as an adult

The study sought to evaluate whether childhood sexual abuse (CSA) experiences significantly affect the gynecologic care received as an adult. A self-administered questionnaire including eight questions on CSA was completed by 85 women exposed to CSA and 170 matched-control women. Women exposed to CSA experienced gynecologic examinations as anxiety-provoking significantly more often and sought more treatment for acute gynecologic problems; 43.5% of these women experienced memories of the original abuse situation during gynecologic consultations. Gynecologic care is particularly distressing for women exposed to CSA.     

Self-definition as a survivor of childhood sexual abuse among navy recruits

This study explored how specific childhood sexual experiences (CSEs) might be related to self-identification as a victim of sexual abuse and to gender differences in self-defined victimization. Hierarchical logistic regression was used to estimate the relationship of demographic and CSE characteristics with self-definitions. The characteristics most strongly associated were threats-force, incest, and younger age at the time of the experience. Men were less likely than were women to acknowledge abuse and to report CSE characteristics indicative of abuse. Women were more likely to identify themselves as victims the more CSEs they reported involving sexual penetration. Finally, in an analysis of familial abuse, men were more likely to define themselves as victims if the perpetrator was also male.     

An evaluation of cognitive processing therapy for the treatment of posttraumatic stress disorder related to childhood sexual abuse

This study compared the effectiveness of cognitive processing therapy for sexual abuse survivors (CPT-SA) with that of the minimal attention (MA) given to a wait-listed control group. Seventy-one women were randomly assigned to 1 of the 2 groups. Participants were assessed at pretreatment and 3 times during posttreatment: immediately after treatment and at 3-month and 1-year follow-up, using the Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale (D. Blake et al., 1995), the Beck Depression Inventory (A. T. Beck, R. A. Steer, & G. K. Brown, 1996), the Structured Clinical Interview for the DSM-IV (R. L. Spitzer, J. B. W. Williams, & M. Gibbon, 1995; M. B. First et al., 1995), the Dissociative Experiences Scale-II (E. M. Bernstein & F. W. Putnam, 1986), and the Modified PTSD Symptom Scale (S. A. Falsetti, H. S. Resnick, P. A. Resick, & D. G. Kilpatrick, 1993). Analyses suggested that CPT-SA is more effective for reducing trauma-related symptoms than is MA, and the results were maintained for at least 1 year.     

Tattoos, childhood sexual abuse and adult psychiatric disorder in women

Summary Background: Tattoos in women have been described in clinical samples as being associated with psychopathology, child sexual abuse (CSA), personality problems or alcohol abuse. Method: A random community study of New Zealand women being primarily investigated to assess the coping strategies of those reporting CSA gathered information about tattoos, and indicators of different types of psychosocial problems. Results: Women with tattoos were more likely to be younger, to drink more alcohol, to have more psychiatric symptoms and to show borderline personality features than were the non tattooed women. They were also more likely to report CSA. Conclusions: Tattoos in women are statistically linked to CSA, and to later psychopathology in some women.