Personal history of childhood abuse among clinicians

Self-affirmation and False Allegations: The Effects on Responses to Disclosures of Sexual Victimization

The rise of the #MeToo movement highlights the prevalence of sexual victimization and gives a voice to victims who may have been silent before. Nevertheless, survivors or victims of sexual violence who come forward may be blamed or not believed. These reactions are evident both with adult and child victims. Further, fears about false accusations of sexual misconduct may negatively impact responses to disclosures. This study aimed to examine gender differences in perceptions toward the #MeToo movement, and the extent to which these translate into a skeptical response to disclosure. Further, we wanted to explore whether proximity to false allegations of sexual violence was linked with more negative responses and whether use of self-affirmations may decrease the likelihood of such a response. Through an online survey (N = 235) on Amazon's Mechanical Turk, we assessed participants' exposure to and perceptions of the #MeToo movement. Further, we asked them about their proximity to sexual violence (victimization or perpetration) and to false allegations. Using a threat manipulation (news article about false accusation) and a self-affirmation exercise, we studied the effects of both variables on responses to disclosure. Results indicated that after reading an article about a false accusation, male participants were more likely to blame a victim of childhood sexual abuse and to perceive the abuse as less harmful, compared with female participants. Further, we found that self-affirmation was linked with more supportive responses to a disclosure. These findings highlight the threatening nature of false accusations of sexual violence for men, and how this threat may shape the narrative regarding sexual violence. Opportunities to use self-affirmation to change this narrative to a more supportive one are discussed.

Empowerment or Threat: Perceptions of Childhood Sexual Abuse in the #MeToo Era

The rise of the #MeToo movement has shed light on the prominence of sexual violence, and its victims who often remain silent. Despite increasing awareness, victims or survivors of sexual violence who disclose may be faced with negative reactions such as disbelief or blame. Such reactions extend to child victims of sexual abuse. This study aimed to shed light on gender differences in responses to sexual violence against a backdrop of #MeToo. Through an online survey (N = 253) on Amazon's Mechanical Turk, we assessed participants' exposure to and perception of the #MeToo movement. In addition, we measured proximity to a victim or perpetrator of sexual violence. The effect of these variables on participants' response to a disclosure of childhood sexual abuse was examined. Results indicated that men are more likely to perceive the movement as threatening than women. Furthermore, a discrepancy in proximity to sexual violence emerged, with women more likely to know a victim and men more likely to know a perpetrator. In response to a disclosure of childhood sexual abuse, men were more likely to respond in a skeptical manner than women. Positive perceptions of the #MeToo movement translated into more supportive responses to a disclosure. Proximity to a victim of sexual violence did not impact how people responded to a disclosure, but proximity to a perpetrator was associated with a more negative response. Although the aim of this movement is to give a voice to victims of sexual violence, it may trigger a defensive response from men, which makes them more skeptical toward disclosures of victimization.

Values-based practice: how can history taking help psychiatrists explore the values involved in clinical decision-making?

Values-based practice (VBP) is a framework of clinical theory and skills to facilitate a good process whereby the (often conflicting) values involved in clinical decision-making can be recognised and balanced productively. Many of these values come from the personal histories of the patient and of the clinician, and the traditions and history of psychiatry. New developments in science lead to increasing choice and increasing complexity of values. Therefore, psychiatrists will need more skills in this area, as reflected by the inclusion of VBP in the Royal College of Psychiatrists’ training curricula. This article describes some tools for understanding and navigating this value diversity in applying science to clinical practice during history taking.

Adverse Childhood Experiences in Trainees and Physicians With Professionalism Lapses: Implications for Medical Education and Remediation

PURPOSE

Unprofessional behavior, which can include failure to engage, dishonest and/or disrespectful behavior, and poor self-awareness, can be demonstrated by medical trainees and practicing physicians. In the authors' experience, these types of behaviors are associated with exposure to adverse childhood experiences (ACEs). Given this overlap, the authors studied the percentage of ACEs among trainees and physicians referred for fitness-for-duty evaluations and patterns between the types of ACEs experienced and the reason for referral.

METHOD

A final sample of 123 cases of U.S. trainees and physicians who had been referred to a Midwestern center for assessment and/or remediation of professionalism issues from 2013 to 2018 was created. Included professionalism lapses fell within 3 categories: boundary violation, disruptive behavior, or potential substance use disorder concerns. All participants completed a psychosocial developmental interview, which includes questions about ACE exposure. Overall rate of reported ACEs and types of ACEs reported were explored.

RESULTS

Eighty-six (70%) participants reported at least 1 ACE, while 27 (22%) reported 4 or more. Compared with national data, these results show significantly higher occurrence rates of 1 or more ACEs and a lower occurrence rate of 0 ACEs. ACEs that predicted reasons for referral were physical or sexual abuse, feeling unwanted or unloved, witnessing abuse of their mother or stepmother, or caretaker substance use.

CONCLUSIONS

In this sample, ACE exposure was associated with professionalism issues. Remediating individuals with professionalism issues and exposure to ACEs can be complicated by heightened responses to stressful stimuli, difficulties with collaboration and trust, and decreased self-efficacy. Adoption of a trauma-informed medical education approach may help those that have been impacted by trauma rebuild a sense of control and empowerment. The findings of this study may be useful predictors in identifying those at risk of problematic behavior and recidivism before a sentinel event.

The effects of gender, personal trauma history and memory continuity on the believability of child sexual abuse disclosure among psychologists

Gender, a personal history of trauma and attitudes towards continuous vs recovered memories of abuse significantly impact the believability of Child Sexual Abuse (CSA) disclosures in community samples. Yet, whether these variables influence the believability of CSA disclosure and subsequent clinical decisions made by practicing psychologists is underexplored. A vignette of trauma disclosure from a hypothetical adult client was presented via an online survey to 292 registered psychologists. Participants rated the believability of the disclosure, answered an open-ended item regarding treatment planning, and completed the Brief Betrayal Trauma Survey to measure personal trauma history. Results indicated that female psychologists believed disclosures significantly more than male psychologists and that disclosures comprised of continuous memories were believed more than recently recovered memories. A significant interaction between gender and personal trauma history was also revealed. Female psychologists believed disclosures regardless of their personal trauma history, while male psychologists with a personal history of trauma believed disclosures significantly more than male psychologists without personal trauma history. Reported believability of the disclosure, while unrelated to treatment planning, was associated with a reported intention to validate the client's experience. The results support that, similar to community samples, gender and a personal trauma history impact psychologist believability of CSA disclosure. The research further supports that psychologist level of belief then translates into clinical implications.

Individual risk factors for physician boundary violations: the role of attachment style, childhood trauma and maladaptive beliefs

OBJECTIVE

The assessment and remediation of boundary-challenged healthcare professionals is enhanced through examination of individual risk factors. We assessed three such factors--attachment style, childhood trauma and maladaptive beliefs--in 100 attendees (mostly physicians) of a CME professional boundaries course. We propose a theoretical model which draws a causal arc from childhood maltreatment through insecure attachment and maladaptive beliefs to elevated risk for boundary violations.

METHODS

We administered the Experiences in Close Relationship Questionnaire (ECR-R), Childhood Trauma Questionnaire (CTQ), and Young Schema Questionnaire (YSQ) to 100 healthcare professionals (mostly physicians) attending a CME course on professional boundaries. Experts rated participant autobiographies to determine attachment style and early adversities. Correlations and relationships among self- and expert ratings and between different risk factors were examined.

RESULTS

Five percent of participants reported CTQ total scores in the moderate to severe range; eleven percent reported moderate to severe emotional neglect or emotional abuse. Average attachment anxiety and attachment avoidance were low, and more than half of participants were rated “secure” by experts. Childhood maltreatment was correlated with attachment anxiety and avoidance and predicted expert-rated insecure attachment and maladaptive beliefs.

CONCLUSION

Our findings support a potential link between childhood adversity and boundary difficulties, partly mediated by insecure attachment and early maladaptive beliefs. Furthermore, these results suggest that boundary education programs and professional wellness programs may be enhanced with a focus on sequelae of childhood maltreatment, attachment and common maladaptive thinking patterns.

Individual risk factors for physician boundary violations: the role of attachment style, childhood trauma and maladaptive beliefs

OBJECTIVE

The assessment and remediation of boundary-challenged health care professionals is enhanced through examination of individual risk factors. We assessed three such factors - attachment style, childhood trauma and maladaptive beliefs - in 100 attendees (mostly physicians) of a continuing medical education (CME) professional boundaries course. We propose a theoretical model that draws a causal arc from childhood maltreatment through insecure attachment and maladaptive beliefs to elevated risk for boundary violations.

METHODS

We administered the Experiences in Close Relationships Questionnaire Revised (ECR-R), Childhood Trauma Questionnaire (CTQ) and Young Schema Questionnaire (YSQ) to 100 health care professionals attending a CME course on professional boundaries. Experts rated participant autobiographies to determine attachment style and early adversities. Correlations and relationships between self-ratings and expert ratings and among different risk factors were examined.

RESULTS

One fifth of participants reported moderate to severe childhood abuse; sixty percent reported moderate to severe emotional neglect. Despite this, average attachment anxiety and attachment avoidance were low, and more than half of participants were rated "secure" by experts. Childhood maltreatment was correlated with attachment anxiety and avoidance and predicted expert-rated insecure attachment and maladaptive beliefs.

CONCLUSIONS

Our findings support a potential link between childhood adversity and boundary difficulties, partly mediated by insecure attachment and early maladaptive beliefs. Furthermore, these results suggest that boundary education programs and professional wellness programs may be enhanced with a focus on sequelae of childhood maltreatment, attachment and common maladaptive thinking patterns.

A global perspective on child sexual abuse: meta-analysis of prevalence around the world

Our comprehensive meta-analysis combined prevalence figures of childhood sexual abuse (CSA) reported in 217 publications published between 1980 and 2008, including 331 independent samples with a total of 9,911,748 participants. The overall estimated CSA prevalence was 127/1000 in self-report studies and 4/1000 in informant studies. Self-reported CSA was more common among female (180/1000) than among male participants (76/1000). Lowest rates for both girls (113/1000) and boys (41/1000) were found in Asia, and highest rates were found for girls in Australia (215/1000) and for boys in Africa (193/1000). The results of our meta-analysis confirm that CSA is a global problem of considerable extent, but also show that methodological issues drastically influence the self-reported prevalence of CSA.

How nurses' experiences of domestic violence influence service provision: study conducted in North-west province, South Africa

This study was undertaken to determine whether nurses' experiences of domestic violence (DV) influence their management of DV and rape cases. In total, 212 nurses were interviewed in two South African health districts using a standardized questionnaire. We measured sociodemographic characteristics, quality of care in the areas of rape and DV management, and experiences of DV in their own lives and amongst family and friends. A total of 39% nurses reported having experienced either physical or emotional abuse themselves and 40.6% amongst family and friends. Having personally experienced DV had no influence on DV identification and management. Those with experience from friends and family were more likely to have provided better care for patients who presented after DV (mean quality of care score = 23.1), while nurses who reported no personal experience of DV, either in their own lives or among family and friends, had a lower quality of care score of 19.8 (P = 0.02). Having ever intervened in a domestic dispute was associated with higher quality of care (P < 0.001). This suggests that the greater degree to which nurses identify with DV and intervene, the more likely they are to provide higher quality of care. Training of nurses in DV must try to build such empathy.

Report of workplace violence by Hispanic nurses

Workplace violence (WPV) against nursing professionals is common. This pilot study explored the association between WPV and victim characteristics including the interpersonal risk factor of prior childhood or adult violence and gender characteristics among 90 Hispanic nurses practicing in Texas. Personal factors such as the nurses' age, clinical setting worked, years of experience, and basic education were not found to be associated with WPV. Gender and a history of violence were found to be significantly associated with WPV. Recommendations include recognition of history of childhood and/or adult violence and gender as risk factors in orientation and health care-training programs for violence prevention.

When is the personal professional in public child welfare practice? The influence of intimate partner and child abuse histories on workers in domestic violence cases

OBJECTIVE

The objective of this article is to examine children's services workers' (CSWs') personal histories of abuse and their influence on professional responses to allegations of domestic violence.

METHOD

Using an anonymous questionnaire, data were collected from CSWs in two large urban counties in Southern California who participated in a domestic violence training program (n=303). It was hypothesized that CSWs' responses to domestic violence cases would be affected by personal histories of abuse and the degree to which the CSWs identified with battered women.

RESULTS

Approximately one-half of the respondents reported experiencing physical and/or sexual violence by an intimate partner. One-third of respondents reported physical abuse, and 22%, sexual abuse during childhood. The experience of childhood sexual abuse, especially for female CSWs, was associated with increased support for removal of children whose mother is being abused. Those CSWs with a history of partner violence who identified with battered women were less likely to approve of removing children from the battered mother than were CSWs without partner abuse history or identification with battered women.

CONCLUSIONS

Our findings provide support for expanded training efforts that recognize the ongoing impact of victimization on CSWs' professional functioning.

Memory of childhood sexual abuse among clinicians: characteristics, outcomes, and current therapy attitudes

This paper reports preliminary data on a sample of therapists with memory of childhood sexual abuse. Therapists who reported experiencing childhood sexual abuse (CSA, n = 131) were compared with therapists who suspected sexual abuse but had no memories (n = 24) on variables related to abuse characteristics, outcomes, and perceived difficulties working with clients with a CSA history. Therapists who suspected abuse, in contrast to those who made definite reports, were more likely to report that the perpetrator was a family member, that their CSA did not involve physical contact, that there was alcoholism in their families of origin, and that the CSA had negative effects on their relationships with their own children, ability to trust others, sexual satisfaction, and work life. Therapists who suspected abuse also reported more difficulty treating CSA clients because of interpersonal pulls during sessions, arousal without memories of abuse, and some countertransferential behaviors. These findings indicate that issues related to personal trauma should be addressed during training and practice.

Defining the severity of workplace violent events among medical and non-medical samples. A pilot study

The purpose of this study was to describe and compare medical and non-medical individuals' violence severity rank for 13 commonly cited events illustrative of workplace violence. One hundred thirty-six college students were provided a short checklist of 13 violent events in the workplace to determine the violence severity rank for each event. Two groups of college students with (n = 69) and without (n = 67) medical background participated. Student and registered nurses (medical group) agreed on the violence severity ranking of all 13 often-cited workplace violence events. Non-medical and medical groups, however, did not always agree on the degree of violence severity, especially for physical and sexual workplace violence events. Differences between groups may be explained by the possibility that nurses are socialized or desensitized in practice to possibly accept some workplace violence events as "part of the job." Gastroenterology nurses can benefit from this study by raising their sensitivity to and awareness of workplace violence in the practice setting.

Emotional responses to child sexual abuse: a comparison between police and social workers in Hong Kong

OBJECTIVE

Research on specific emotional responses of professionals to child sexual abuse (CSA), other than the overwhelming feeling, is currently lacking in the child welfare literature. This study examines the initial responses to CSA of police and social workers in Hong Kong.

METHOD

Based on their recall of the first child sexual abuse incident, 28 police officers and 86 social workers from 10 training sessions on child sexual abuse in Hong Kong indicated how strong they felt about their emotions in 10 categories of 37 responses.

RESULTS

Among the 37 emotional responses, police and social workers showed significant differences in only seven responses: (1) embarrassment with the perpetrator; (2) ambivalence about rescuing the child or preserving the family; (3) fear of being inadequate in handling the situation; (4) titillation in response to our involuntary physiological responses to words and descriptions of sex acts; (5) feelings of revenge because the behavior was bad or immoral; (6) empathy with the child's condition; and (7) ambivalence about helping or punishing the perpetrator. In both groups, "anger at the perpetrator" and "empathy with the child's condition" were the most strongly felt emotions.

CONCLUSIONS

Although these two professional groups were not significantly different in most of the emotional responses to their first child sexual abuse incidents, police were more likely to have ambivalent and revenge feelings, while social workers were more likely to have discomfort feelings. Limitations of this research project include sampling procedure, self-report biases, and effect of training.

Childhood abuse recollections in a nonclinical population: forgetting and secrecy

OBJECTIVE

This study investigated the relationship of interrupted memories of childhood abuse with the secrecy of the abuse.

METHODOLOGY

Fifteen hundred people were randomly selected from the membership of the American Counseling Association and sent a questionnaire regarding childhood abuse history. Four hundred and twenty-three usable questionnaires were returned and analyzed.

RESULTS

Thirty-two percent of the sample reported childhood abuse. Fifty-two percent of those reporting abuse also noted periods of forgetting some or all of the abuse. On the two survey items assessing secrecy, 76% of respondents reporting childhood abuse indicated there had been a time when no one but themselves and their abuser knew about the abuse; 47% indicated that an abuser tried to get them to keep the abuse secret. Forty percent endorsed both secrecy items. Respondents who reported forgetting abuse also reported one or both elements of secrecy more frequently than those who reported continuous memories of abuse.

CONCLUSION

These findings are consistent with those of other studies that suggest that, among adults reporting childhood abuse, the experience of forgetting some or all abuse is common. Secrecy of the abuse appears to be associated with the experience of forgetting childhood abuse for many individuals.

Psychologists' beliefs about the prevalence of childhood sexual abuse: the influence of sexual abuse history, gender, and theoretical orientation

OBJECTIVE

This study examined the influence of sexual abuse history, gender, theoretical orientation, and age on beliefs about the prevalence of childhood sexual abuse among clinical and counseling psychologists.

METHOD

A mail survey design was used in this study. Participants were randomly selected from the American Psychological Association membership database. There were 615 psychologists who completed self-report measures on beliefs about the prevalence of childhood sexual abuse and demographic characteristics.

RESULTS

Overall, clinicians' scores on the prevalence of childhood sexual abuse were moderate. There were significant gender differences on beliefs, suggesting that women were more likely believe that childhood sexual abuse is a common occurrence compared to men. Multiple regression analysis indicated that clinician characteristics (history of sexual abuse, gender, and theoretical orientation) were significantly related to beliefs about the prevalence of childhood sexual abuse. However, these characteristics only accounted for a small amount of the overall variance predicting beliefs.

CONCLUSIONS

These results suggest that clinicians do not hold extreme beliefs regarding the prevalence of childhood sexual abuse. Moreover, certain clinician characteristics are associated with their beliefs, which in turn, may impact their clinical judgment and treatment decisions. Furthermore, much of the variance was unaccounted for in the model indicating that psychologists' beliefs are complex and are not unduly influenced by their personal characteristics. Implications for clinical practice and future research are discussed.

The prevalence of child sexual abuse: integrative review adjustment for potential response and measurement biases

This integrative review synthesizes the finding of 16 cross-sectional surveys (25 hypotheses) on the prevalence of child abuse among nonclinical, North American samples. It is essentially a research literature on sexual abuse; only one of the studies assessed physical abuse, and there has not yet been a single study of prevalent child emotional abuse nor neglect. The following summative inferences were made: (1) response rates diminished significantly over time, M = 68% prior to 1985 and M = 49% for more recent surveys, p < .05; (2) unadjusted estimates of the prevalent experience among women and men of childhood sexual abuse was 22.3% and 8.5%, respectively; (3) study response rates and child abuse operational definitions together accounted for half of the observed variability in their abuse prevalence estimates, R2 = .500, p < .05; (4) female and male child sexual abuse prevalence estimates adjusted for response rates (60% or more) were respectively, 16.8% and 7.9%, and adjusted for operational definitions (excluding the broadest, noncontact category) they were 14.5% and 7.2%; (5) after adjustment for response rates and definitions, the prevalence of child sexual abuse was not found to vary significantly over the three decades reviewed. Given the large human costs, both personal and social, of child abuse, and the identified gap in the requisite knowledge needed to steer effective preventive and treatment interventions, it is time to invest in a large, methodologically rigorous, population-based study of child abuse which, if it does nothing else, spares no expense in ensuring very high participation.

Services for adults who have experienced child sexual assault: improving agency response

Adults who experienced child sexual assault are likely to be present in all parts of the health and welfare systems both as clients and as staff. Research studies and accounts by survivors indicate that their experiences of seeking help are often not positive. In failing to acknowledge and deal with the issue of childhood sexual assault for adult clients and to be aware of its correlation with current problems, the health and welfare system reflects the larger society by avoiding knowledge of the impact of violence and abuse on health and well-being. This paper begins with an overview of studies on the prevalence of childhood sexual assault in adult populations and in clinical populations and of literature on the long term consequences of child sexual assault. It goes on to consider, with particular reference to an Australian context, how service providers can respond to the needs of survivors within their own agencies and notes the resources they may need to do this well.