Predicting long-term outcomes for women sexually abused in childhood: contribution of abuse severity versus family environment

Childhood trauma is associated with altered white matter microstructural organization in schizophrenia

It has been reported that childhood trauma (CT) is associated with reductions in fractional anisotropy (FA) in individuals with schizophrenia (SZ). Here, we hypothesized that SZ with high levels of CT will show the greatest reductions in FA in frontolimbic and frontoparietal regions compared to healthy controls (HC) with high trauma levels and participants with no/low levels of CT. Thirty-seven SZ and 129 HC with CT experience were dichotomized into groups of 'none/low' or 'high' levels. Participants underwent diffusion-weighted MRI, and Tract-based spatial statistics were employed to assess the main effect of diagnosis, main effect of CT severity irrespective of diagnosis, and interaction between diagnosis and CT severity. SZ showed FA reductions in the corpus callosum and corona radiata compared to HC. Irrespective of a diagnosis, high CT levels (n = 48) were related to FA reductions in frontolimbic and frontoparietal regions compared to those with none/low levels of CT (n = 118). However, no significant interaction between diagnosis and high levels of CT was found (n = 13). Across all participants, we observed effects of CT on late developing frontolimbic and frontoparietal regions, suggesting that the effects of CT severity on white matter organization may be independent of schizophrenia.

Traumatic Experiences in Childhood and Maternal Depressive Symptomatology: Their Impact on Parenting in Preschool

The goal of this study is to describe and analyze the relationship between childhood trauma and depressive symptoms and its relation to the parental interactions of mothers (19-47 years) with their 3-4 year old preschool children. Parental interactions, traumatic experiences in mothers' childhood, and current depressive symptoms were measured using the Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO), the Childhood Trauma Questionnaire Short Form (CTQ), and the Beck Depression Inventory (BDI-I), respectively. A nonclinical sample of 81 Chilean mothers with their children was used. Results show that the presence of trauma in mothers' childhood has an impact on parenting; specifically, mothers with an emotional neglect experience showed greater difficulties in adequately promoting autonomy in their children.

Does Maternal Support Mediate or Moderate the Relationship between Sexual Abuse Severity and Children's PTSD Symptoms?

Maternal support and abuse severity are often considered to be vital factors in predicting children's functioning following childhood sexual abuse (CSA); however, much of the prior research has examined support and abuse severity as main effects, without consideration of how these factors may interrelate to predict children's post-CSA functioning. Further, even though mediators and moderators are conceptually distinct, maternal support has been theorized to be both a mediator and a moderator of symptoms, and it is unclear if support acts as either among sexually abused children. The aim of the present study was to investigate whether caregiver-reported maternal support mediates or moderates the relationships between sexual abuse severity and children's trauma-related symptoms. The study included 235 treatment-seeking children ages 3-16 (M = 8.85, SD = 3.77) and their non-offending mothers. Contrary to expectations, caregiver-rated maternal support did not mediate nor moderate the relationship between abuse severity and children's symptoms (range r² =.002 -.03). Caregiver-rated maternal support may play a small role in mitigating sexually abused children's trauma symptoms. Irrespective of abuse severity, children with less supportive mothers may not be at heightened risk for experiencing higher levels of trauma-related difficulties.

The Lived Experiences of Non-Offending Fathers with Children Who Survived Sexual Abuse

A non-offending father figure plays an integral role in the healing process of a child who survived sexual abuse. However, becoming aware of the sexual abuse can significantly affect non-offending father figures and therefore impact their ability to properly support and care for the survivor. We sought to better understand the non-offending father figures' reactions to the aftermath of sexual abuse of their children. Using an existential-phenomenological approach, we offered a platform for non-offending father figures to share their stories. Through the interviews, we found five major themes, which include: "Guilt, anguish, and stigma", "Hypervigilance and competing demands of fathering", "Who can we trust?", "Refocusing on the family", and "Picking up the pieces". Based on this and previous studies, non-offending father figures experience psychological pain in the aftermath of the disclosure of sexual abuse, they deal with competing demands of various fatherly roles, and they prioritize supporting the family through the healing process. The findings suggest that the psychological well-being of the non-offending father figures can benefit the family. Therefore, mental health treatment protocols addressing father figures' needs can contribute to a sexual abuse treatment model that encourages paternal involvement in the care of children with a sexual abuse history.

Pathways from childhood sexual abuse to trait anxiety

BACKGROUND

Children exposed to sexual abuse are at risk for developing several psychological and behavioral difficulties during adulthood. Here, direct and indirect effects of family conflict, insecurity within the family system (manifested as disengagement and/or preoccupation), and negative feelings provoked by childhood sexual abuse (CSA) on trait anxiety scores were analyzed with structural equation modeling. Both Finkelhor and Browne's traumagenic dynamics model and Davies and Cummings Emotional Security Theory were applied.

METHODS

A total of 168 female college student survivors of CSA participated in this study. Information regarding each participant's abuse was obtained from a self-reported questionnaires. Emotional security was assessed with the Security in the Family System scale. To assess negative feelings regarding abuse and trait anxiety, Children's Impact of Traumatic Events Scale-Revised and State-Trait Anxiety Inventory were applied, respectively.

RESULTS

Level of family conflict was found to directly relate to emotional insecurity and trait anxiety. In addition, preoccupation strategies were found to be directly related to trait anxiety. Conversely, disengagement strategies were indirectly related to anxiety through the negative feelings provoked by abuse. Experience with other types of abuse and/or neglect was also related to emotional insecurity and feelings provoked by CSA. Meanwhile, continuity of abuse only correlated with feelings provoked by abuse.

CONCLUSIONS

Strong relationships between family conflict, emotional insecurity, negative feelings provoked by CSA and trait anxiety were observed. These results suggest that treatment of CSA survivors should focus on improving security within the survivors' family system and reducing negative feelings provoked by abuse.

Domestic Violence Between Childhood Incest and Re-victimization: A Study Among Anti-violence Centers in Italy

The study focuses on a specific problem in the area of child sexual abuse (CSA), which is still under-researched: the relationship between incest and adult female re-victimization treatment within the ambit of domestic violence in Italian centers. About 112 anti-violence centers were contacted, but only 13 participated and only 16 psychologists were interviewed to reconstruct the biographies of 32 victims. The study aimed to examine if and how the service centers recognized and dealt with the problem of re-victimization among survivors based on psychologists' narrations. Findings showed that the description of perpetrators revealed not only sexual abuse was perpetrated, but also psychological and physical abuse. About half of mothers did not come to their daughters' aid and those who cooperated with the abusers had mostly suffered from CSA at a time in their life. Only three mothers did help their daughters in contacting the anti-violence centers. However, most of the service centers were not concerned with the relationship between incest and domestic re-victimization, while those who considered the problem, dealt with it only on the practitioner-patient level. In addition, despite the psychologists used professional and empathetic language, they disclosed their high emotional involvement and a genuine bewilderment. A discussion on the need to standardize the psychotherapeutic support given to these re-victimized women was presented, with a critique to the un-discriminated de-pathologization approach adopted by almost all anti-violence centers. In particular, we wanted to underline the fact that, although, this approach is useful in treating victims who were not abused during infancy, it could be insufficient for women who suffered from incest.

Violência sexual na adolescência, perfil da vítima e impactos sobre a saúde mental

Resumo Este trabalho objetiva analisar os impactos do abuso sexual na adolescência sobre variáveis relacionadas à saúde mental e identificar as características das vítimas. Para tanto, utiliza-se a metodologia do Propensity Score Matching a partir dos microdados da Pesquisa Nacional de Saúde do Escolar 2015. Os resultados mostram que o jovem violentado tem um perfil comportamental, familiar e socioeconômico singular, a destacar pelo fato de que tem mais chances de já ter utilizado álcool e drogas, de ser alvo de bullying, estar em distorção idade-série, encontrar-se empregado e não ter pretensão de continuar estudando. Do ponto de vista familiar, tem pouco acompanhamento dos pais e menos chance de morar com a mãe. As estimativas revelam que o abuso sexual na adolescência pode aumentar em 13,3% a chance do jovem reportar sentimento frequente de solidão, em 7,5% a chance de ter poucos ou nenhum amigo e em 9,5% a chance de relatar insônia frequente por motivo de preocupação. Foram constatadas ainda diferenças significativas dos efeitos em mulheres e homens, sendo os impactos sobre solidão e insônia maiores para o primeiro grupo e sobre número de amigos maiores para o segundo.

Cancer Victim Identity for Individuals with Histories of Cancer and Childhood Sexual Abuse

Identifying as a 'cancer victim' has been linked to adverse psychosocial sequelae in individuals who have been diagnosed with cancer. Being a childhood sexual abuse (CSA) survivor may predispose individuals towards a "victim" identity in general. The aim of this study was to determine the prevalence of identifying as a 'cancer victim' among CSA survivors who were diagnosed with cancer as adults, and to explore psychological factors associated with identification as a cancer victim. 105 adults reporting both a history of CSA and of having been diagnosed with cancer as an adult were recruited through Amazon Mechanical Turk. Variables assessed included CSA severity, abuse-related powerlessness, general mastery, and cancer victim identity. Fifty-one percent of the sample endorsed a cancer victim identity. Path analysis revealed that abuse-related powerlessness was related to decreased feelings of general mastery, which was in turn associated with cancer victim identification (x² = .12, DF = 1, p < .73; RMSEA = .00; SRMR = .01: Bentler CFI = 1.0). From a clinical perspective, the results suggest that increasing general mastery in CSA survivors in the cancer setting may be an important mechanism for attenuating the risk for developing a cancer victim identity and, presumably, for downstream adverse psychosocial sequelae.

The Psychiatric Consequences of Child and Adolescent Sexual Abuse

INTRODUCTION

The purpose of this study was to investigate the psychiatric consequences of sexual abuse and its associated factors in children and adolescents referred to our child and adolescent psychiatry clinic from official medico-legal units.

METHODS

All victims of sexual abuse (n=590) aged 1-18 (mean: 13.56±3.38) referred from forensic units to Ondokuz Mayis University Child and Adolescent Psychiatry Clinic over a period of 2 years [boys: 83 (14.1%); girls: 507 (85.9%)] were included. Child and adolescent psychiatry and forensic medicine specialists evaluated all the cases. The Wechsler Intelligence Scale for Children-Revised Form (WISC-R) and the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version-Turkish Version (K-SADS-PL-T) were applied.

RESULTS

Abuse-related psychiatric diagnoses (of which 45.9% were major depressive disorder and 31.7% were post-traumatic stress disorder cases) were made in 75.2% of the cases. In 80.3% of the cases, the perpetrators were known to their victims [incest, n=91 (15.1%)], and intercourse took place in 48.8%. Although gender and age were not significantly associated with the appearance of any psychiatric disorders, severity of abuse (e.g., intercourse; p=.006), additional physical assault (p<.001), and incest (p<.001) had a significant correlation with psychiatric disorders. To explore the predictive value of multiple factors in the appearance of any sexual assault-related psychiatric disorder, a logistic regression model was used to determine the best linear combination of age, gender, abuse severity, incest, involvement of any other victim, additional physical assault, and length of time from first abuse to first psychiatric evaluation. This combination of variables (occurrence of incest, additional physical assault, and a long duration from first abuse to first psychiatric evaluation) significantly predicted the appearance of a psychiatric disorder of any kind (χ²=55.42; df=7; n=522; p<.001).

CONCLUSION

Our findings reveal that the occurrence of incest, additional physical assault, and a long duration from first abuse to first psychiatric evaluation predict higher rates of sexual abuse-related psychiatric disorders.

Role Confusion and Disorientation in Young Adult-Parent Interaction Among Individuals With Borderline Symptomatology

Borderline symptoms are thought to emerge from the interaction of temperamental factors and environmental stressors. Both parental invalidation and attachment disorganization have been hypothesized to play an etiological role. However, to date the quality of parent-child interaction has not been observed directly. In this study, 120 young adults were assessed for features of borderline personality disorder on the SCID II, for severity of childhood maltreatment on interview and self-report measures, and for disturbance in parent-child interaction during a videotaped conflict discussion task. Borderline traits, as well as suicidality/self-injury specifically, were associated with more role confusion and more disoriented behavior in interaction with the parent. Among young adults with recurrent suicidality/self-injury, 40% displayed high levels of role confusion compared to 16% of those who were not suicidal. Neither form of disturbed interaction mediated the independent effect of childhood abuse on borderline symptoms. A parent-child transactional model is proposed to account for the findings.

An Investigation of Depression, Trauma History, and Symptom Severity in Individuals Enrolled in a Treatment Trial for Chronic PTSD

OBJECTIVE

To explore how factors such as major depressive disorder (MDD) and trauma history, including the presence of childhood abuse, influence diverse clinical outcomes such as severity and functioning in a sample with posttraumatic stress disorder (PTSD).

METHOD

In this study, 200 men and women seeking treatment for chronic PTSD in a clinical trial were assessed for trauma history and MDD and compared on symptom severity, psychosocial functioning, dissociation, treatment history, and extent of diagnostic co-occurrence.

RESULTS

Overall, childhood abuse did not consistently predict clinical severity. However, co-occurring MDD, and to a lesser extent a high level of trauma exposure, did predict greater severity, worse functioning, greater dissociation, more extensive treatment history, and additional co-occurring disorders.

CONCLUSION

These findings suggest that presence of co-occurring depression may be a more critical marker of severity and impairment than history of childhood abuse or repeated trauma exposure. Furthermore, they emphasize the importance of assessing MDD and its effect on treatment seeking and treatment response for those with PTSD.

Disclosure of Child Sexual Abuse: The Case of Pacific Islanders

A number of factors influence the disclosure of child sexual abuse by survivors. While the influence of race and ethnicity on disclosure patterns is getting more attention, little has been written on abused children of Pacific Islanders, due in part to both lack of relevant data and a relatively small Pacific Islander population in the United States. Drawing on interviews with Pacific Islander women who were sexually abused in childhood and who delayed revealing their victimization, we explore the reasons for delayed disclosure. Findings suggest that cultural norms and family dynamics affect disclosure decisions. Concerns for the family and self-blame were the most common reasons for delay and lack of disclosure. We discuss implications of the findings and make policy recommendations.

Do child abuse and maternal care interact to predict military sexual trauma?

OBJECTIVE

The present research tested the hypothesis that maternal care moderates the relationship between childhood sexual abuse and subsequent military sexual trauma (MST).

METHOD

Measures of childhood sexual abuse, maternal care, and MST were administered to 197 Iraq and Afghanistan war veterans.

RESULTS

After accounting for gender, age, and the main effects of maternal care and childhood sexual abuse, the maternal care x childhood sexual abuse interaction was a significant predictor of MST (odds ratio = .28, β = -1.26, 95% confidence intervals of .10, .80). As hypothesized, rates of MST were higher among veterans who reported childhood sexual abuse and low levels of maternal care (43%) compared with veterans who reported childhood sexual abuse and high levels of maternal care (11%).

CONCLUSION

These findings suggest that high levels of maternal care may act as a protective factor against future revictimization among military service members. These findings have the potential to inform both prevention and intervention efforts.

Sexual Issues in Treating Trauma Survivors

The effect of interpersonal trauma on sexuality can be profound. The field of sexual trauma is complex empirically and clinically, with contradictory theories and conflicting data. Research definitions and treatment protocols for child sexual abuse are very imprecise. There are no firm, empirically proven guidelines for treating men and women who have been sexually abused as children or adolescents. Overt sexual abuse (OSA) in children and adolescents is defined here as molestation, rape, or incest. Research has shown that OSA may, but does not necessarily, lead to sexual dysfunction in adulthood. The effects of OSA are worsened by concurrent types of family of origin abuse, such as emotional abuse or physical abuse. One factor that seems related to the varying impact of OSA on adult sexuality is the patients’ family of origin experience with nonsexual Milestones of Sexual Development. Without positive experiences with touch, trust and empathy, the ability to relax and be soothed, and power, the effects of OSA are potentiated and complicated. Sexuality is embodied, so experiences with touch are particularly important when working with OSA. A three-color Body Map technique which assesses stored associations to touch is provided. The concept of developmental sexual trauma (DST) is introduced as a way to label traumagenic family events which potentiate OSA or negatively effect sex but which are not explicitly sexual in origin. Strategies to assess and treat OSA are reviewed. Body Maps are recommended to assess and treat sexual trauma.

Untangling the relative contribution of maltreatment severity and frequency to type of behavioral outcome in foster youth

Within maltreatment research, type, frequency, and severity of abuse are often confounded and not always specifically documented. The result is samples that are often heterogeneous in regard to maltreatment experience, and the role of the different components of maltreatment in predicting outcome is unclear. The purpose of the present study was to identify and test the potential unique role of type, frequency, and severity of maltreatment to elucidate each variable's role in predicting outcome behavior. Data from 309 youth in foster care (ages 8-22) and their caregivers were collected using the Modified Maltreatment Classification System and the Behavioral Assessment System for Children, 2nd Edition (BASC2), to measure maltreatment exposure and behavioral outcome respectively. A measurement model of the BASC2 was completed to determine model fit within the sample data. A second confirmatory factor analysis (CFA) was completed to determine the unique contributions of frequency and severity of maltreatment across four types of abuse to externalizing, internalizing, and adaptive behavior. The result of the CFA determined good fit of the BASC2 to the sample data after a few modifications. The result of the second CFA indicated that the paths from severity to externalizing behavior and adaptive behavior (reverse loading) were significant. Paths from frequency of abuse were not predictive of behavioral outcome. Maltreatment is a complex construct and researchers are encouraged to examine components of abuse that may be differentially related to outcome behavior for youth. Untangling the multifaceted nature of abuse is important and may have implications for identifying specific outcomes for youth exposed to maltreatment.

Child sexual abuse

This article begins by defining sexual abuse, and reviews the literature on the epidemiology of child sexual abuse (CSA). Clinical outcomes of CSA are described, including health and mental health. An outline is given of all the services often involved after an incident of CSA, and the need for coordination among them. Treatment strategies and evidence-based recommendations are reviewed. Challenges around dissemination and implementation, cultural considerations, and familial dynamics are described. Possible future directions are discussed.

Childhood sexual abuse and adult developmental outcomes: findings from a 30-year longitudinal study in New Zealand

OBJECTIVES

Childhood sexual abuse (CSA) has been associated with many adverse medical, psychological, behavioral and socioeconomic outcomes in adulthood. This study aims to examine the linkages between CSA and a wide range of developmental outcomes over a protracted time period to age 30.

METHODS

Data from over 900 members of the New Zealand birth cohort the Christchurch Health and Development Study were examined. CSA prior to age 16 was assessed at ages 18 and 21 years, in addition to: mental health, psychological wellbeing, sexual risk-taking behaviors, physical health and socioeconomic outcomes to age 30.

RESULTS

After statistical adjustment for confounding by 10 covariates spanning socio-demographic, family functioning and child factors, extent of exposure to CSA was associated with increased rates of (B, SE, p): major depression (0.426, 0.094, <.001); anxiety disorder (0.364, 0.089, <.001); suicidal ideation (0.395, 0.089, <.001); suicide attempt (1.863, 0.403, <.001); alcohol dependence (0.374, 0.118, <.002); and illicit drug dependence (0.425, 0.113, <.001). In addition, at age 30 CSA was associated with higher rates of PTSD symptoms (0.120, 0.051, .017); decreased self-esteem (-0.371, 0.181, .041); and decreased life satisfaction (-0.510, 0.189, .007). Childhood sexual abuse was also associated with decreased age of onset of sexual activity (-0.381, 0.091, <.001), increased number of sexual partners (0.175, 0.035, <.001); increased medical contacts for physical health problems (0.105, 0.023, <.001); and welfare dependence (0.310, 0.099, .002). Effect sizes (Cohen's d) for the significant outcomes from all domains ranged from .14 to .53, while the attributable risks for the mental health outcomes ranged from 5.7% to 16.6%.

CONCLUSIONS

CSA is a traumatic childhood life event in which the negative consequences increase with increasing severity of abuse. CSA adversely influences a number of adult developmental outcomes that span: mental disorders, psychological wellbeing, sexual risk-taking, physical health and socioeconomic wellbeing. While the individual effect sizes for CSA typically range from small to moderate, it is clear that accumulative adverse effects on adult developmental outcomes are substantial.

High-risk sexual behaviors among depressed Black women with histories of intrafamilial and extrafamilial childhood sexual abuse

OBJECTIVE

National estimates of childhood sexual abuse histories among black women range from 34% to 40%. Poor outcomes in adulthood, including impaired psychiatric functioning (e.g., depression), high-risk sexual behaviors (e.g., unprotected sex, exchange of sex for money or drugs), and lifetime sexually transmitted infections are robustly associated with sexual abuse histories. In the current study, we examined the relationships of intrafamilial and extrafamilial perpetration of childhood sexual abuse to high-risk sexual behaviors and sexually transmitted infections among black women.

METHODS

We conducted a secondary analysis of data from 60 black women who participated in a depression treatment trial in a community mental health center.

RESULTS

Our results demonstrated that intrafamilial perpetration of childhood sexual abuse, as compared to extrafamilial perpetration, was more strongly associated with high-risk sexual behaviors in a clinical sample of depressed black women. There were no significant associations between intrafamilial or extrafamilial perpetration of childhood sexual abuse and sexually transmitted infections.

CONCLUSIONS

These findings suggest that characteristics of childhood sexual abuse among depressed black women may be important factors for health professionals to consider when conducting clinical assessments and providing treatment.

Borderline symptoms and suicidality/self-injury in late adolescence: prospectively observed relationship correlates in infancy and childhood

The primary objective was to assess whether prospectively observed quality of parent-child interaction in infancy and middle childhood contributed to the prediction of borderline symptoms and recurrent suicidality/self-injury in late adolescence. Adolescents (mean 19.9 years) from 56 families participating in a longitudinal study since infancy (retention rate 74%) were assessed on the SCID-II for symptoms of borderline personality disorder (BPD), including suicidality/self-injury. Early clinical risk was indexed by clinical referral to parent-infant services. Attachment security and parent-child interaction were assessed from videotape at 18 months and 8 years. Severity of childhood abuse was rated from interview and self-report measures. Maternal withdrawal in infancy was a significant predictor of both borderline symptoms and suicidality/self-injury in late adolescence. Disorganized controlling child behavior at age 8 contributed independently to the prediction of borderline symptoms. The effect of maternal withdrawal was independent of, and additive to, variability explained by severity of childhood abuse. Borderline symptoms and suicidality/self-injury may be preceded developmentally by disturbed interactions as early as 18 months of age. A parent-child transactional model is proposed to account for the findings.

The childhood sexual abuse among youth in three Asian cities: Taipei, Shanghai, and Hanoi

The article describes the prevalence and risk factors of childhood sexual abuse (CSA) among youth in Hanoi, Shanghai, and Taipei. Data used in this study are from the Three-City Asian Study of Adolescents and Youth, 2006-2007. Descriptive analysis and logistic regression models were used. The self-reported lifetime prevalence of CSA was 5.2% in Taipei, 1.3% in Shanghai, and 0.5% in Hanoi. The overall prevalence was 2.2% for females and 1.7% for males. The average age of first CSA was 10.5 years. Household instability, migration before age 14, and low maternal warmth were found to be positively associated with CSA, whereas discussing problems with father and being close to mother were negatively associated with CSA, after adjusting for sociodemographic characteristics. Our findings suggested the importance of prevention programs for preteen aged children, public education to raise awareness, and further prospective studies to identify various risk markers for CSA in Asia.

Family environment, personality, and psychological symptoms in adults sexually abused as children

The current study examined the relationships between family environment characteristics, personality traits, and current psychological symptoms in adults with a history of child sexual abuse. Family environment characteristics, personality traits, and psychological symptoms in 18 abused and 18 nonabused college students were examined using ANOVAs and MANOVAs. Pearson product moment correlations were also performed. Results indicated significantly more dysfunctional family environment characteristics (inflexibility, poor cohesion, family dissatisfaction, and poor family communication) in the abused versus the nonabused group. There were significantly higher levels in the personality traits of neuroticism and openness to experience in the abused group; however, there were no significant differences in psychological symptoms when comparing the two groups. The implications of the results and areas of future research are discussed.

Childhood sexual abuse characteristics, intimate partner violence exposure, and psychological distress among women in methadone treatment

Traumatic experiences and their biopsychosocial sequelae present complex challenges in substance use treatment. For women with substance use problems, childhood sexual abuse (CSA), intimate partner violence exposure (IPV), posttraumatic stress disorder (PTSD), and overall psychological distress are often co-occurring concerns. To address gaps in knowledge and to strengthen practice regarding these critical issues in substance use treatment, we drew upon cross-sectional and longitudinal data from baseline and 12-month interviews with a random sample of 416 women in methadone treatment to examine relationships between CSA characteristics, particularly the presence of force and involvement of family, IPV, and mental health concerns. Although CSA involving force and family was not associated with IPV as hypothesized, it was associated with increased risk of PTSD and overall psychological distress. The multivariate findings underscore the psychological vulnerabilities associated with CSA involving force and family and suggest that drug use and financial circumstances may be important targets to reduce IPV risk.

Substance use coping as a mediator of the relationship between trauma symptoms and substance use consequences among incarcerated females with childhood sexual abuse histories

Rates of substance use and maltreatment are alarmingly high among incarcerated women. Although the direct link between trauma and substance use has been established, less is known about potential mediators. Thus, we examined substance use coping as a mediator between trauma symptoms and substance use consequences among a sample of incarcerated females (N = 111) who were survivors of childhood sexual abuse. Trauma symptoms predicted the severity of substance use consequences, with this relationship being mediated fully by avoidance coping (e.g., using substances to cope). Overall, trauma histories are important in predicting outcomes but must be examined in the context of current coping behaviors and substance use. Findings (data collected in 2007/2008) may help promote interventions that target patterns of coping and/or emotional avoidance among trauma survivors with substance use problems in incarcerated populations. The study's limitations are noted.

Childhood sexual abuse severity reconsidered: a factor structure of CSA characteristics

To address the lack of empirically grounded measures of childhood sexual abuse severity, a survey of self-report items was developed following a thorough review of the childhood sexual abuse literature. An exploratory factor analysis was conducted using data collected from a convenience sample of college students that included 275 females and males with a history of childhood sexual abuse. The solution produced seven factors interpreted as the following: (a) less intrusive forms of childhood sexual abuse (e.g., sexual invitations, kissing), (b) more intrusive forms of childhood sexual abuse (e.g., oral sex, intercourse), (c) humiliation/fear, (d) childhood sexual abuse involving photography, (e) familiarity with the perpetrator, (f) physical force/rape, and (g) active digital penetration. Correlations among these factors further suggested the existence of two relatively independent second-order factors, one based on the levels of physical intrusiveness and the other composed of the psychological/emotional factors. While arguably the most common measurement of severity, physical intrusiveness had little association with critical factors such as humiliation, fear, and association with the perpetrator. Consequently, physical intrusiveness appears to be an inadequate stand-alone measure of childhood sexual abuse severity. These results are proposed to lay the groundwork for an improved, more comprehensive measure of childhood sexual abuse severity.

The Emotion Dysregulation Model of Anxiety: a preliminary path analytic examination

Both temperamental (e.g., behavioral inhibition) and environmental (e.g., family emotional environment) factors are associated with etiology and maintenance of anxiety; however, few studies have explored mechanisms through which these risk factors operate. The present study investigation of a developmental model of anxiety (i.e., the Emotion Dysregulation Model of Anxiety; EDMA) that hypothesizes that emotion dysregulation is the mechanism through which temperamental and emotion parenting variables relate to anxiety. Emerging adults (N=676, M age=19.5) retrospectively reported on behavioral inhibition and emotion parenting factors in childhood, and current emotion regulation skills and symptoms of anxiety. Results of path analyses provide initial support for the EDMA. Emotion dysregulation fully mediated the relationship between behavioral inhibition and anxiety and partially mediated the relationship between family emotional environment and anxiety.

Predicting long-term outcomes for women physically abused in childhood: contribution of abuse severity versus family environment

OBJECTIVE

Child physical abuse (CPA) has been associated with adverse adult psychosocial outcomes, although some reports describe minimal long-term effects. The search for the explanation for heterogeneous outcomes in women with CPA has led to an examination of a range of CPA-related factors, from the severity of CPA incidents to the childhood family environment. This study compares several models for predicting adult outcomes: a multidimensional CPA severity scale, the presence or absence of CPA, family environment, and childhood stresses.

METHODS

The effect of CPA on adult outcomes was examined among 290 community-dwelling women raised in 2-parent families. Standardized measures and a focused interview were used to collect data, with siblings as collateral informants.

RESULTS

Comparison of a multidimensional CPA severity scale to a dichotomous measure of the presence or absence of CPA showed that the severity scale did not have greater predictive value for adult outcomes than the dichotomous measure. Childhood family environment scales considerably attenuated the predictive value of the dichotomous measure of CPA, exerting a greater mediating effect on outcomes than did childhood stresses.

CONCLUSIONS

The specific characteristics of a CPA experience may be less important than the occurrence of CPA and the woman's childhood family environment for predicting long-term psychosocial outcomes.

PRACTICE IMPLICATIONS

The presence of child physical abuse is substantial and continues to increase, but the clinical significance of abuse on adult outcomes is unclear. The findings of the current study lend credence to the idea that family stresses and resources other than CPA may be crucial in understanding long-term effects in women. Hence treatment and support for victims of CPA might benefit from clinicians' exploration of the family environment.

Child sexual abuse: seven years in practice

The purpose of this study was to determine the socio-demographic characteristics of sexually abused children. The records of 101 cases of child sexual abuse (CSA) were retrospectively evaluated. Socio-demographic characteristics of the victims, type of sexual abuse, and psychiatric diagnosis were studied. Of the victims, 56.4% (n = 57) were female and 43.6% (n = 44) were male. The mean age was 9.57 +/- 3.5, with a range of 4-17 years. Ninety-three (92.1%) of the victims had been admitted as part of the legal process. The majority (66.3%) of the victims had been abused by an acquaintance, while 33.7% had been abused by a stranger. Anal or vaginal penetration was reported in 48.5% of the cases. Post-traumatic stress disorder was the most common (54.5%) psychiatric diagnosis established after sexual abuse. Descriptive data related to the abused children and an understanding of the consequences of CSA will help authorities in planning prevention.

The influence of attachment on perceived stress and cortisol response to acute stress in women sexually abused in childhood or adolescence

The long-term implications of sexual abuse in childhood or adolescence (CSA) have been relatively well documented regarding attachment (disorganized attachment in childhood, unresolved trauma in adulthood), stress reactions (altered patterns of stress reactivity under experimental conditions), and psychopathology. Attachment has been shown to mediate the implications of CSA, namely on psychopathology. The implication of attachment on stress responses of abused persons has not been documented. Twenty-seven 20-46 years old women who had experienced episodes of CSA, and 17 controls have been interviewed using the Adult Attachment Interview. Sixty-three percent of abused women presented an unresolved trauma (12% for the controls). Thirty-six women (14 controls and 22 abused) came again to the laboratory for a session involving an experimental stress challenge (TSST). Subjects provided repeated appreciations of perceived stress on visual analogue scales and saliva samples were collected to assay cortisol levels. Whereas abused women with unresolved trauma showed the highest levels of perceived stress, they simultaneously presented the most suppressed cortisol reactions (there were significant post hoc differences between "unresolved abused" and controls on the increase of perceived stress and on cortisol recovery after the acute stress). It is suggested that important stressful experiences (such as CSA), especially when they have not been psychologically assimilated, may cause a disconnection, during subsequent mildly stressful circumstances, between the perception of stress and natural defensive body reactions.

Benefits of a contextual approach to understanding and treating complex trauma

The conceptual framework and treatment rationale of contextual therapy are described. Contextual therapy was specifically fashioned for survivors of prolonged child abuse (PCA). It is grounded in the observation that contexts beyond abuse trauma, especially restrictions in psychological development stemming from growing up in an ineffective family environment, appreciably impact the adjustment of many PCA survivors. Contextual therapy proposes that remediation of developmental gaps commonly manifested by PCA survivors is essential to equip them to (a) benefit from rather than be debilitated by trauma processing and (b) move beyond symptom reduction to the attainment of adequate social and occupational functioning.

Characteristics of sexual abuse in childhood and adolescence influence sexual risk behavior in adulthood

Childhood and adolescent sexual abuse has been associated with subsequent (adult) sexual risk behavior, but the effects of force and type of sexual abuse on sexual behavior outcomes have been less well-studied. The present study investigated the associations between sexual abuse characteristics and later sexual risk behavior, and explored whether gender of the child/adolescent moderated these relations. Patients attending an STD clinic completed a computerized survey that assessed history of sexual abuse as well as lifetime and current sexual behavior. Participants were considered sexually abused if they reported a sexual experience (1) before age 13 with someone 5 or more years older, (2) between the ages of 13 and 16 with someone 10 or more years older, or (3) before the age of 17 involving force or coercion. Participants who were sexually abused were further categorized based on two abuse characteristics, namely, use of penetration and force. Analyses included 1177 participants (n=534 women; n=643 men). Those who reported sexual abuse involving penetration and/or force reported more adult sexual risk behavior, including the number of lifetime partners and number of previous STD diagnoses, than those who were not sexually abused and those who were abused without force or penetration. There were no significant differences in sexual risk behavior between nonabused participants and those who reported sexual abuse without force and without penetration. Gender of the child/adolescent moderated the association between sexual abuse characteristics and adult sexual risk behavior; for men, sexual abuse with force and penetration was associated with the greatest number of episodes of sex trading, whereas for women, those who were abused with penetration, regardless of whether the abuse involved force, reported the most episodes of sex trading. These findings indicate that more severe sexual abuse is associated with riskier adult sexual behavior.

Psychometric evaluation and comparison of three retrospective, multi-item measures of childhood sexual abuse

OBJECTIVE

To evaluate and compare the psychometric qualities of three retrospective, multi-item measures of childhood sexual abuse (CSA): the CSA Frequency Scale, CSA Count Index, and CSA Multiple Characteristics Index.

METHODS

Two samples of women 20-50 years old who experienced CSA were recruited from a family practice clinic (N=132) and the community (N=19). The measures were designed to represent the three most commonly used approaches for multi-item measurement of past CSA, as determined by a review of literature. Items were derived from a self-administered instrument from a larger study. The CSA Frequency Scale was evaluated for test-retest reliability, internal consistency, and criterion-related validity. The CSA Count and CSA Multiple Characteristics Indexes were evaluated for content specification, indicator specification, indicator collinearity, external validity, criterion-related validity, and test-retest reliability. Criterion-related validity variables were (a) physical and psychosocial symptomatology and (b) depression.

RESULTS

Upon evaluation, all three measures met criteria for satisfactory quality, with one exception: external validity for both indexes. When compared across test-retest reliability and criterion-related validity results, none of the measures proved superior. Intraclass correlation coefficients for test-retest reliability ranged from .92 to .94; correlations with the criterion-related validity variables ranged from r=.36 to .41.

CONCLUSIONS

The results support the continued use of established scales similar to the CSA Frequency scale. In addition, the results suggest further development and standardization of indexes similar to the CSA Count and Multiple Characteristics Indexes is warranted.

Childhood sexual abuse and HIV risk among crack-using commercial sex workers in San Salvador, El Salvador: a qualitative analysis

This article explores the relationship between childhood sexual abuse (CSA) and later HIV risk. It draws on qualitative, in-depth interviews with 40 women who either used crack or engaged in commercial sex work in the greater metropolitan area of San Salvador, El Salvador, 28 of whom experienced CSA. Although the relationship between CSA and later HIV risk has been clearly demonstrated, the processes that lead women who have experienced CSA to experience HIV risk are unclear. The theoretical model presented here incorporates the psychological effects of CSA, particularly stigmatization, as well as its social consequences and the larger context of poverty in which these women live. The meanings women draw from past abuse experiences and their rationale for choices made help explain the association between CSA and later risk as mediated through sex work and crack addiction. Self-report data gathered in this study indicate that HIV prevalence may be considerably higher in this high-risk population than Salvadoran national rates.

Family environment in Hispanic college females with a history of childhood sexual abuse

This study sought to examine the family environments of a sample of Hispanic women who reported childhood sexual abuse. Eighteen women, taken from a larger college sample, were individually interviewed and administered the Family Environment Scale (FES; Moos & Moos, 1994). Cultural values and the relationship of family characteristics to the individual's experience of sexual abuse were explored. The abused women obtained significantly higher scores on the Achievement-Orientation subscale of the FES than the normative group. Qualitative data revealed some patterns in these families regarding sexual discussions and poor conflict resolution skills. Implications for treatment of Hispanic victims are discussed.