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Carretier E, Jourdan M, Duchesne S, Flouriot J, Lachal J, Moro MR. Disclosure of sexual abuse by adolescents treated in a psychiatry department. L'ENCEPHALE 2024:S0013-7006(24)00043-5. [PMID: 38523028 DOI: 10.1016/j.encep.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 12/12/2023] [Accepted: 12/22/2023] [Indexed: 03/26/2024]
Abstract
OBJECTIVES The aim of the study is to describe the population of adolescents who have disclosed sexual abuse to a health professional during their care in a psychiatric department. We also want to discuss the circumstances that enable adolescents to make this disclosure. METHODS This single-center retrospective observational study is based on the mandatory reports (n=139) sent by a Paris adolescent psychiatry department between 2005 and 2021 after patients disclosed previous sexual abuse. R® (3.6.1) and RStudio® (1.2.5001) software were used for statistical analysis. RESULTS Girls accounted for almost all the adolescents who disclosed (95.7%). First abuse occurred around the age of 12 years and was first disclosed to a health professional a mean of 3.5 years later; 66 (47.5%) patients were admitted for inpatient care during their follow-up. The most common diagnoses were depression, eating disorders, posttraumatic stress disorders, and other anxiety disorders. Before disclosing to a health professional, most of these adolescents had already talked about it, mainly to a family member (69.8%) or peers (24.7%). CONCLUSION This is the first study in France on the reporting of sexual abuse after its disclosure by adolescents being treated in a psychiatry unit. Our results show that child sexual abuse is rarely reported and that health care professionals are far from being the first recipients of these disclosures. We recommend routine screening for sexual abuse in adolescent psychiatry units, improved training for staff receiving these disclosures, and consideration of how best to coordinate medical, social, and legal services for these adolescents.
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Affiliation(s)
- Emilie Carretier
- Laboratoire de psychologie clinique psychopathologie psychanalyse, Paris Cité University, PCPP, 92100 Boulogne-Billancourt, France; Paris-Saclay University, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France.
| | - Marine Jourdan
- Département de médecine légale, université Paris Sorbonne Cité, Paris, France; Service de médecine légale et pénitentiaire, centre hospitalo-universitaire Pontchaillou, Rennes, France
| | - Sophie Duchesne
- Service de gynecologie-obstétrique - maison des femmes, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Paris, France
| | - Julien Flouriot
- Département de psychiatrie et de médecine addictologique, site Lariboisière Fernand-Widal, AP-HP GHU Nord, 75010 Paris, France
| | - Jonathan Lachal
- Paris-Saclay University, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France; Service de psychiatrie de l'enfant et de l'adolescent, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France; Université Clermont-Auvergne, 63000 Clermont-Ferrand, France
| | - Marie-Rose Moro
- Laboratoire de psychologie clinique psychopathologie psychanalyse, Paris Cité University, PCPP, 92100 Boulogne-Billancourt, France; Paris-Saclay University, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France; Maison des adolescents - maison de Solenn, hôpital Cochin, AP-HP, 75014 Paris, France
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Rancher C, Hanson R, Williams LM, Saunders BE, Smith DW. Longitudinal predictors of children's self-blame appraisals among military families reported for family violence. CHILD ABUSE & NEGLECT 2024; 147:106596. [PMID: 38071942 PMCID: PMC10842802 DOI: 10.1016/j.chiabu.2023.106596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 10/27/2023] [Accepted: 12/01/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Although children's self-blame appraisals are recognized as important sequelae of child victimization that contribute to subsequent adjustment problems, little is known about the factors that predict their development and longitudinal course. OBJECTIVE The current study examines the stability and longitudinal predictors of children's self-blame appraisals among a sample of children reported for family violence. PARTICIPANTS AND SETTING Children (N = 195; 63 % female) aged 7 to 17 years (Mage = 12.17) were recruited as part of a longitudinal assessment of families referred to the United States Navy's Family Advocacy Program due to allegations of child physical abuse, sexual abuse, or intimate partner violence. METHODS Children completed assessments on self-blame at 3 time points (baseline, 9-12 months, and 18-24 months) and baseline measures of their victimization experience, caregiver-child conflict, and depression. RESULTS In univariate analyses, victimization that involved injury (r = 0.29, p < .001), the number of perpetrators (r = 0.23, p = .001), the number of victimization types (r = 0.32, p < .001), caregiver-child conflict (r = 0.36, p < .001), and depression (r = 0.39, p < .001) were each positively associated with baseline self-blame. When examined in a single longitudinal multilevel model, results indicated only caregiver-child conflict (b = 0.08, p = .007) and baseline depression (b = 0.06, p = .013) predicted increases in self-blame. CONCLUSION Findings suggest clinicians and researchers may consider assessment of victimization characteristics, caregiver-child relationships, and depression symptoms to identify children most at risk for developing self-blame appraisals.
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Affiliation(s)
- Caitlin Rancher
- National Crime Victims Research and Treatment Center, Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
| | - Rochelle Hanson
- National Crime Victims Research and Treatment Center, Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Linda M Williams
- Wellesley Centers for Women, Wellesley College, Wellesley, MA, USA
| | - Benjamin E Saunders
- National Crime Victims Research and Treatment Center, Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Daniel W Smith
- National Crime Victims Research and Treatment Center, Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Mauny P, Guessoum SB, Moro MR, Radjack R, Carretier É. How parents experience their adolescent's disclosure of previous sexual abuse: a qualitative study. BMC Psychiatry 2023; 23:916. [PMID: 38057770 PMCID: PMC10698959 DOI: 10.1186/s12888-023-05410-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 11/27/2023] [Indexed: 12/08/2023] Open
Abstract
INTRODUCTION Parents whom adolescents disclose sexual abuse face both a personal traumatic experience, and the need to support their child who is going through a grueling period and needs them. Many quantitative studies exploring the psychological impact of disclosure on parents have been conducted, but few have used qualitative methods. The objective of this study is to explore parents' experiences of their adolescent's disclosure of sexual abuse during psychiatric care, identify the possible beneficial factors and shortcomings, share this knowledge, and improve interventions for these families. METHODS We conducted semi structured interviews with parents whose children disclosed sexual abuse during their psychiatric care in Paris and analyzed these interviews using a phenomenological framework (interpretative phenomenological analysis). RESULTS This study analyzed 13 semi structured interviews of 9 mothers and 4 fathers whose children were then aged 14 to 17 years. Qualitative analysis uncovered three themes: (1) Parents: alerts and search for support; (2) Between parents and adolescents: a disruption in relationships linked to the disclosure and its legal consequences; (3) Disclosure at the family level: the possible reactivation of a traumatic past and the search for a new equilibrium. CONCLUSIONS Considering the parental experience is essential in caring for adolescent patients after they disclose sexual abuse. The need for parental or family psychological support should be systematically assessed. Possible resurgence of parental trauma requires psychiatrists' careful consideration.
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Affiliation(s)
- Philippe Mauny
- APHP, Cochin Hospital, Maison de Solenn, Paris, F-75014, France.
- Paris Est Créteil University, Créteil, France.
| | - Sélim Benjamin Guessoum
- APHP, Cochin Hospital, Maison de Solenn, Paris, F-75014, France
- Paris-Saclay University, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, F-94807, France
- Paris Cité University, PCPP, Boulogne-Billancourt, F-92100, France
- Pôle Psychiatrie de l'Adolescent, Institut MGEN, La Verrière, France
| | - Marie Rose Moro
- APHP, Cochin Hospital, Maison de Solenn, Paris, F-75014, France
- Paris-Saclay University, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, F-94807, France
- Paris Cité University, PCPP, Boulogne-Billancourt, F-92100, France
| | - Rahmeth Radjack
- APHP, Cochin Hospital, Maison de Solenn, Paris, F-75014, France
- Paris-Saclay University, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, F-94807, France
- Paris Cité University, PCPP, Boulogne-Billancourt, F-92100, France
| | - Émilie Carretier
- Paris-Saclay University, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, F-94807, France
- Paris Cité University, PCPP, Boulogne-Billancourt, F-92100, France
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Jouriles EN, Sitton MJ, Adams A, Jackson M, McDonald R. Non-supportive responses to adolescents who have experienced sexual abuse: Relations with self-blame and trauma symptoms. CHILD ABUSE & NEGLECT 2022; 134:105885. [PMID: 36179384 DOI: 10.1016/j.chiabu.2022.105885] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Youth who have experienced sexual abuse sometimes also experience non-supportive responses, such as accusations of lying, from people in their family and social environment. Little is known about how such responses from different sources (caregivers, friends, other adults) correlate with one another and operate together in the prediction of youth problematic thinking, such as self-blame, and trauma symptoms. OBJECTIVE To better understand how non-supportive responses from different sources relate to one another and contribute to youth problems following sexual abuse. PARTICIPANTS AND SETTING Participants were 475 youths (Mage = 13.57, SD = 1.77) brought to a children's advocacy center in the southern United States. METHODS Participants completed measures of non-supportive responses from caregivers, friends, and other adults. They also completed measures of abuse-specific self-blame and trauma symptoms. RESULTS Non-supportive responses from caregivers, friends, and other adults correlated with each other and with abuse-specific self-blame and trauma symptoms (correlations ranged from 0.12 to 0.18; all p values <.001). Results of regression analyses indicated that only non-supportive responses from caregivers contributed independently to abuse-specific self-blame, whereas non-supportive responses from caregivers and friends contributed to trauma symptoms. CONCLUSIONS In the aftermath of sexual abuse, non-supportive responses from caregivers and friends relate to youth trauma symptoms. Assessing non-supportive responses broadly across the social network can be useful in understanding youth adjustment following sexual abuse.
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Affiliation(s)
- Ernest N Jouriles
- Department of Psychology, Southern Methodist University, P.O. Box 750442, Dallas, TX 75275-0442, USA.
| | - Melissa J Sitton
- Department of Psychology, Southern Methodist University, P.O. Box 750442, Dallas, TX 75275-0442, USA
| | - Adrianna Adams
- Department of Psychology, Southern Methodist University, P.O. Box 750442, Dallas, TX 75275-0442, USA
| | - Mindy Jackson
- Dallas Children's Advocacy Center, 5351 Samuell Blvd., Dallas, TX 75228, USA
| | - Renee McDonald
- Department of Psychology, Southern Methodist University, P.O. Box 750442, Dallas, TX 75275-0442, USA
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Jouriles EN, Johnson E, Rancher C, Johnson JLC, Cook K, McDonald R. Adolescents Who Have Been Sexually Abused: Trauma Symptoms and Self-Blame while Waiting for Treatment. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022:1-10. [PMID: 35486470 DOI: 10.1080/15374416.2022.2051527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Adolescents who have been sexually abused commonly experience trauma symptoms, and many are referred for trauma-based treatment. However, they sometimes spend considerable time on waitlists before beginning treatment. This study examines the course of trauma symptoms among adolescents who have been sexually abused and are waiting for treatment, and the extent to which self-blame for the abuse predicts trauma symptoms at the beginning of treatment. METHOD Participants were 127 adolescents (89.0% female, Mage = 13.61 years; 53.2% identified as Hispanic) at a Children's Advocacy Center in the southern United States. All had reported being sexually abused. Participants reported on their trauma symptoms and self-blame appraisals at a screening assessment (T1), and trauma symptoms were re-assessed at the beginning of treatment (T2). RESULTS The mean level of trauma symptoms declined over time for the total sample. Regression analyses indicated that greater self-blame for the abuse at T1 was associated with higher levels of trauma symptoms at T2, even when controlling for T1 trauma symptoms and other correlates of T2 trauma symptoms. Higher levels of trauma symptoms at T1 and adolescent sex (female) were also associated with higher levels of trauma symptoms at T2. CONCLUSIONS Findings suggest that assessing for self-blame for sexual abuse may be important in triage and treatment planning for youth with trauma symptoms after experiencing sexual abuse.
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Affiliation(s)
| | - Emily Johnson
- Department of Psychology, Southern Methodist University, Texas, USA
| | - Caitlin Rancher
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, South Carolina, USA
| | | | | | - Renee McDonald
- Department of Psychology, Southern Methodist University, Texas, USA
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Medical approach to children who may have been sexually abused-a narrative review. Int J Impot Res 2020; 33:210-216. [PMID: 32943771 DOI: 10.1038/s41443-020-00353-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 08/10/2020] [Accepted: 09/04/2020] [Indexed: 11/08/2022]
Abstract
The medical approach to children who may have been sexually abused involves several issues and aspects that need to be considered. The medical examination of children with suspected sexual abuse is important, but a detailed medical history from the child and the parents or caretakers is always part of every thorough examination. It can take a long time until victims disclose their abuse and physical signs of abuse may no longer be visible at the time of examination. If the physical examination is performed non-acutely, only 2.2% of sexually abused girls show diagnostic signs of injury. An experienced examiner should ideally perform the examination in suspected sexual abuse of children. Knowledge of the current literature is of importance, as the interpretation of findings has changed over the past decades and it can be difficult to differentiate between normal variants, symptoms of other medical problems, and signs of sexual assault. Furthermore, sexual abuse of children presents in various form, not necessarily leading to physical injuries. Since 1992, Adams et al. publish a regularly updated system for the classification of anogenital findings in children with suspected sexual abuse, including a detailed list of physical findings and infections related to sexual abuse. The purpose of this article is to summarize important aspects of the medical approach to children with suspected sexual abuse according to the current literature.
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Kellogg ND, Koek W, Nienow SM. Factors that prevent, prompt, and delay disclosures in female victims of child sexual abuse. CHILD ABUSE & NEGLECT 2020; 101:104360. [PMID: 31981932 DOI: 10.1016/j.chiabu.2020.104360] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/21/2019] [Accepted: 01/07/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Several studies conducted in clinical and non-clinical settings have described why and when children disclose sexual abuse. Yet, there is incomplete understanding of how adolescents and young children may differ in factors that delay, prompt and deter disclosure that could inform strategies for clinical practice and prevention. OBJECTIVE The aim of this study was to identify factors that prevent, prompt, and delay disclosure among pediatric patients presenting for acute and non-acute medical evaluations of sexual abuse or assault, and to examine any differences in disclosure tendencies among female adolescents and pre-adolescents. PARTICIPANTS AND SETTING A chart review of a consecutive sample of pediatric patients presenting to the emergency department or outpatient clinic identified 601 patients who were diagnosed with sexual abuse and were willing to answer examiner questions about their disclosure. METHODS Data collection included attainment of patient narratives which were utilized to gather information about abuse disclosures. Recursive abstraction was applied to categorize patient statements for further analysis, while Pearson chi square and logistic regression were utilized for quantitative data. RESULTS Young age (<11 years) at abuse onset was the strongest predictor of, and fear of consequences to self was the most common reason for, disclosure delay in both adolescent and pre-adolescent females. Severity of abuse, adult perpetrator, and self-blame predicted delays only in pre-adolescent females. CONCLUSIONS Social and moral development during middle childhood likely has a strong influence on disclosure tendency. Strategies to promote disclosure should consider reducing fear of consequences associated with the adult-child paradigm.
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Affiliation(s)
- Nancy D Kellogg
- Department of Pediatrics, Division of Child Abuse, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, United States; The Children's Hospital of San Antonio Center for Miracles, 315 North San Saba, Suite 201, San Antonio, TX, 78207, United States.
| | - Wouter Koek
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, United States.
| | - Shalon M Nienow
- Department of Pediatrics, Division of Child Abuse, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, United States; The Children's Hospital of San Antonio Center for Miracles, 315 North San Saba, Suite 201, San Antonio, TX, 78207, United States; The Chadwick Center for Children and Families at Rady Children's Hospital, 3665 Kearny Villa Road, Suite 500, San Diego, CA, 92123, United States; Department of Pediatrics, Division of Emergency Medicine, University of California San Diego, 3020 Children's Way, MC 5159, San Diego, CA, 92123, United States.
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Bi S, Rancher C, Johnson E, Cook K, McDonald R, Jouriles EN. Perceived Loss of Social Contact and Trauma Symptoms among Adolescents Who Have Experienced Sexual Abuse. JOURNAL OF CHILD SEXUAL ABUSE 2019; 28:333-344. [PMID: 30451590 DOI: 10.1080/10538712.2018.1544599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/23/2018] [Accepted: 10/23/2018] [Indexed: 06/09/2023]
Abstract
Child sexual abuse (CSA) is a robust predictor of trauma symptoms. Past research has identified many correlates of trauma symptoms following disclosure of CSA. Theory suggests that loss of social contact may be another important contributor to adolescents' trauma symptoms following CSA. A clinical sample of 166 adolescents (95% female) between 11 and 19 years (M = 13.80, SD = 1.87) reported on perceived loss of social contact, the extent to which the CSA was coercive, appraisals of self-blame for the abuse, supportiveness of a primary non-abusing caregiver, and trauma symptoms. The adolescent's relationship to the abuser, abuse severity and duration were coded from forensic interviews. Results indicated that greater perceived loss of social contact was associated with higher levels of trauma symptoms, even after controlling for other correlates of trauma symptoms and demographic variables. These findings suggest that perceived loss of social contact may be an important variable to consider in assessing and intervening with adolescents who have been sexually abused.
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Affiliation(s)
- Shuang Bi
- a Department of Psychology , Southern Methodist University , Dallas , TX , USA
| | - Caitlin Rancher
- a Department of Psychology , Southern Methodist University , Dallas , TX , USA
| | - Emily Johnson
- a Department of Psychology , Southern Methodist University , Dallas , TX , USA
| | - Katrina Cook
- b Dallas Children's Advocacy Center , Dallas , TX , USA
| | - Renee McDonald
- a Department of Psychology , Southern Methodist University , Dallas , TX , USA
| | - Ernest N Jouriles
- a Department of Psychology , Southern Methodist University , Dallas , TX , USA
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Güven ŞT, Dalgiç Aİ, Erkol Z. Emotional and Psychosocial Problems Encountered by Children Who Have Been Sexually Abused. J Psychosoc Nurs Ment Health Serv 2018; 56:37-43. [PMID: 28990638 DOI: 10.3928/02793695-20170929-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/18/2017] [Indexed: 11/20/2022]
Abstract
The current descriptive analysis sought to identify the emotional and psychosocial problems experienced by children who have been sexually abused. Of 518 children with a history of sexual abuse who applied to the Child Protection Center, 443 were included in the study. Approximately 71.6% of children were subject to sexual abuse entailing penetration, whereas 69% were subject to sexual abuse not entailing penetration. After-effects reported included despair (46.5%), fear of reoccurrence of the incident (52.8%), distrust of others (36.8%), difficulty sleeping (32.7%), negative expectations about the future (32.1%), and self-blame (31.1%). Nurses have crucial roles and functions in the protection, improvement, treatment, and rehabilitation of the health of children who have been sexually abused. [Journal of Psychosocial Nursing and Mental Health Services, 56(2), 37-43.].
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Hawkins R, Teng Sze Wei S. Child Sexual Abuse Attributions Among Undergraduate Psychology Students in Singapore. JOURNAL OF CHILD SEXUAL ABUSE 2017; 26:839-852. [PMID: 28857690 DOI: 10.1080/10538712.2017.1360430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Experimental vignettes were used to investigate attributions relating to child sexual abuse with a focus on the degree of blame allocated to the family and to society, factors thought to be particularly relevant in a collectivist society. One hundred and sixty-two undergraduates in Singapore evaluated media reports describing a case of child sexual abuse. A 2 x 2 x 2 between-subjects design manipulated victim sex, perpetrator sex, and victim-perpetrator relationship. Participants rated the vignettes on degree of blame and prevention potential and rated the abusiveness of the case. Individualism and collectivism attitudes of the participants were also measured. While the highest blame ratings were attributed to perpetrators, significantly more blame was attributed to the family and to society than to the victim. The demonstration of the present attributions of blame to family and to society is a timely finding given recent recommendations to broaden approaches to child abuse prevention by moving away from a reliance on school based child protection programs, which leave the onus on the child to prevent and report abuse, toward a public health approach, which is particularly inclusive of parent and community education approaches . Allocation of some blame to victims, in spite of their status as children, while not a unique finding in victimology research, emphasizes the challenges still to be faced in encouraging the reporting of child sexual abuse.
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Affiliation(s)
- Russell Hawkins
- a Department of Psychology , James Cook University , Carins , Australia
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“Why Didn’t You Tell?” Helping Families and Children Weather the Process Following a Sexual Abuse Disclosure. PARENTING AND FAMILY PROCESSES IN CHILD MALTREATMENT AND INTERVENTION 2017. [DOI: 10.1007/978-3-319-40920-7_3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Medical Care for Children Who May Have Been Sexually Abused: An Update for 2016. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2016. [DOI: 10.1016/j.cpem.2016.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Substance use to regulate intense posttraumatic shame in individuals with childhood abuse and neglect. Dev Psychopathol 2016; 29:737-749. [PMID: 27292103 DOI: 10.1017/s0954579416000432] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Childhood abuse and neglect (CAN) is considered as a risk factor for substance use disorder (SUD). Based on the drinking to cope model, this study investigated the association of two trauma-relevant emotions (shame and sadness) and substance use. Using ecological momentary assessment we compared real-time emotion regulation in situations with high and low intensity of shame and sadness in currently abstinent patients with CAN and lifetime SUD (traumaSUD group), healthy controls with CAN (traumaHC group), and without CAN (nontraumaHC group). Multilevel analysis showed a positive linear relationship between high intensity of both emotions and substance use for all groups. The traumaSUD group showed heightened substance use in low, as well as in high, intensity of shame and sadness. In addition, we found an interaction between type of emotion, intensity, and group: the traumaHC group exhibited a fourfold increased risk for substance use in high intense shame situations relative to the traumaSUD group. Our findings provide evidence for the drinking to cope model. The traumaSUD group showed a reduced distress tolerance for variable intensity of negative emotions. The differential effect of intense shame for the traumaHC group emphazises its potential role in the development of SUD following CAN. In addition, shame can be considered a relevant focus for therapeutic preinterventions and interventions for SUD after CAN.
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Abstract
The medical evaluation is an important part of the clinical and legal process when child sexual abuse is suspected. Practitioners who examine children need to be up to date on current recommendations regarding when, how, and by whom these evaluations should be conducted, as well as how the medical findings should be interpreted. A previously published article on guidelines for medical care for sexually abused children has been widely used by physicians, nurses, and nurse practitioners to inform practice guidelines in this field. Since 2007, when the article was published, new research has suggested changes in some of the guidelines and in the table that lists medical and laboratory findings in children evaluated for suspected sexual abuse and suggests how these findings should be interpreted with respect to sexual abuse. A group of specialists in child abuse pediatrics met in person and via online communication from 2011 through 2014 to review published research as well as recommendations from the Centers for Disease Control and Prevention and the American Academy of Pediatrics and to reach consensus on if and how the guidelines and approach to interpretation table should be updated. The revisions are based, when possible, on data from well-designed, unbiased studies published in high-ranking, peer-reviewed, scientific journals that were reviewed and vetted by the authors. When such studies were not available, recommendations were based on expert consensus.
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Cantón-Cortés D, Cantón J, Cortés MR. Emotional security in the family system and psychological distress in female survivors of child sexual abuse. CHILD ABUSE & NEGLECT 2016; 51:54-63. [PMID: 26686656 DOI: 10.1016/j.chiabu.2015.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 11/06/2015] [Accepted: 11/13/2015] [Indexed: 06/05/2023]
Abstract
The Emotional Security Theory (EST) was originally developed to investigate the association between high levels of interparental conflict and child maladaptative outcome. The objective of the present study was to analyze the effects of emotional security in the family system on psychological distress among a sample of young female adult survivors of child sexual abuse (CSA). The role of emotional security was investigated through the interactive effects of a number of factors including the type of abuse, the continuity of abuse, the relationship with the perpetrator and the existence of disclosure for the abuse. Participants were 167 female survivors of CSA. Information about the abuse was obtained from a self-reported questionnaire. Emotional security was assessed with the Security in the Family System (SIFS) Scale, and the Symptom Checklist-90-Revised (SCL-90-R) was used to assess psychological distress. In the total sample, insecurity (preoccupation and disengagement) was correlated with high psychological distress scores, whereas no relationship was found between security and psychological distress. The relationship between emotional insecurity and psychological distress was stronger in cases of continued abuse and non-disclosure, while the relationship between emotional security and distress was stronger in cases of extrafamilial abuse and especially isolated or several incidents and when a disclosure had been made. No interactive effect was found between any of the three emotional variables and the type of abuse committed. The results of the current study suggest that characteristics of CSA such as relationship with the perpetrator and, especially, continuity of abuse and whether or not disclosure had been made, can affect the impact of emotional security on psychological distress of CSA survivors.
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Affiliation(s)
- David Cantón-Cortés
- Department of Developmental and Educational Psychology, University of Málaga, Spain
| | - José Cantón
- Department of Developmental and Educational Psychology, University of Granada, Spain
| | - María Rosario Cortés
- Department of Developmental and Educational Psychology, University of Granada, Spain
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Haag AC, Zehnder D, Landolt MA. Guilt is associated with acute stress symptoms in children after road traffic accidents. Eur J Psychotraumatol 2015; 6:29074. [PMID: 26514158 PMCID: PMC4626649 DOI: 10.3402/ejpt.v6.29074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/01/2015] [Accepted: 10/05/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Although previous research has consistently found considerable rates of acute stress disorder (ASD) in children with accidental injuries, knowledge about determinants of ASD remains incomplete. Guilt is a common reaction among children after a traumatic event and has been shown to contribute to posttraumatic stress disorder. However, its relationship to ASD has never been examined. OBJECTIVE This study assessed the prevalence of ASD in children and adolescents following road traffic accidents (RTAs). Moreover, the association between peritraumatic guilt and ASD was investigated relying on current cognitive theories of posttraumatic stress and controlling for female sex, age, socioeconomic status (SES), injury severity, inpatient treatment, pretrauma psychopathology, and maternal posttraumatic stress symptoms (PTSS). METHODS One hundred and one children and adolescents (aged 7-16 years) were assessed by means of a clinical interview approximately 10 days after an RTA. Mothers were assessed by questionnaires. RESULTS Three participants (3.0%) met diagnostic criteria for full ASD according to DSM-IV, and 17 (16.8%) for subsyndromal ASD. In a multivariate regression model, guilt was found to be a significant predictor of ASD severity. Female sex, outpatient treatment, and maternal PTSS also predicted ASD severity. Child age, SES, injury severity, and pretraumatic child psychopathology were not related to ASD severity. CONCLUSIONS Future research should examine the association between peritraumatic guilt and acute stress symptoms in more detail. Moreover, guilt appraisals in the acute phase after an accident might be a relevant target for clinical attention.
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Affiliation(s)
- Ann-Christin Haag
- Department of Psychosomatics and Psychiatry, University Children's Hospital, Zurich, Switzerland.,Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | | | - Markus A Landolt
- Department of Psychosomatics and Psychiatry, University Children's Hospital, Zurich, Switzerland.,Children's Research Center, University Children's Hospital, Zurich, Switzerland.,Department of Child and Adolescent Health Psychology, Institute of Psychology, University of Zurich, Switzerland;
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