The role of dissociation in revictimization across the lifespan: A 32-year prospective study

Dissociative Symptoms in Women with Histories of Intimate Partner Victimization: A Focus on Coercive Control

Identifying and contrasting different patterns of intimate partner violence (IPV) (e.g. situational couple violence, coercive controlling violence) is useful for understanding IPV and its connections with health. Applying this approach to dissociation may be fruitful, given theoretical perspectives that predict a specific connection between coercive controlling violence and dissociative symptoms. To address this, community women with divorce histories (N = 188) completed measures to identify patterns of IPV victimization in prior relationships (no direct violence, situational couple violence, coercive controlling violence), and to quantify recent dissociative symptoms and number of depressed days, for comparison. Contrary to predictions, the predicted odds of recent dissociative symptoms did not differ between women who experienced situational couple violence versus coercive controlling violence. However, the latter group had greater odds of recent dissociative symptoms, but not depressed days, compared to women with no histories of direct violence. Further, a continuous measure of coercive control was uniquely associated with increased odds of dissociative symptoms. This study provides preliminary empirical support for a connection between coercive controlling violence and dissociative symptoms, compared to women without histories of direct violence. This deserves further attention given the strong theoretical rationale for this link, and the importance of dissociation for mental health.

Psychometric Properties of the Detachment and Compartmentalization Inventory (DCI) in an Italian Community Sample

The Detachment and Compartmentalization Inventory (DCI) is a valid and reliable self-report instrument that assesses these two distinct forms of dissociative symptoms. However, there is limited research on the cross-cultural validation of the DCI. Therefore, this study aimed to develop an Italian translation of the DCI and examine its internal structure and psychometric properties (including internal consistency, convergent validity, and test-retest reliability) within an Italian-speaking community sample. The sample consisted of 1276 adults (887 females; mean age: 29.57 ± 10.96 years), who completed the DCI and other self-report measures evaluating dissociative experiences and childhood trauma. Confirmatory factor analyses supported the original two-factor model (χ2169 = 1312.80, RMSEA = 0.073, 95%CI 0.069-0.077; CFI = 0.94; TLI = 0.94; SRMR = 0.04). Additionally, the DCI exhibited good internal consistency, test-retest reliability, and convergent validity with another measure of dissociation. The study also confirmed the association between DCI scores and the severity of childhood trauma. Finally, a Receiver Operating Characteristic (ROC) curve analysis demonstrated that the DCI effectively distinguishes individuals who screened positively for dissociative disorders. Overall, these findings indicate that the Italian translation of the DCI possesses satisfactory psychometric properties, suggesting its utility as a screening tool for assessing detachment and compartmentalization experiences.

Dissociation As a Mechanism of Risk for Interpersonal Victimization Among Adolescent Girls

Childhood interpersonal violence exposure (IVE) is associated with repeated victimization in adolescence and adulthood. Research suggests dissociation, a psychological phenomenon characterized by alterations and disruptions to consciousness, memory, and perceptions of the environment, and out-of-body experiences, increases the risk of revictimization. Self-report data from a longitudinal study of 92 violence-exposed adolescent girls from a large, urban area were analyzed to assess whether dissociation predicts polyvictimization or exposure to multiple types of interpersonal violence across adolescence. Participants' mental and interpersonal health was assessed at four in-person laboratory visits scheduled across 3.5 years (i.e., T1-T4). IVE included direct or indirect victimization experienced at home, school, the neighborhood, or town, such as child maltreatment, domestic violence, peer victimization, dating aggression, and community violence. Polyvictimization was operationalized as a composite score of the different types of IVE endorsed by the participant or caregiver. A random-intercept cross-lagged panel model was used to test the bidirectional relationships between dissociation and polyvictimization longitudinally. Cross-lagged regressions were analyzed to determine whether dissociation and polyvictimization predicted subsequent dissociation symptoms and polyvictimization. Concurrent and previous dissociation significantly accounted for polyvictimization at T2, T3, and T4. Polyvictimization did not significantly predict future dissociation symptoms. The results from this study provide support for dissociation's unique contribution to polyvictimization among violence-exposed girls, making it an important target for clinical assessment and treatment.

Insights into child abuse and neglect: Findings from the Minnesota Longitudinal Study of Risk and Adaptation

The Minnesota Longitudinal Study of Risk and Adaptation (MLSRA) is a landmark prospective, longitudinal study of human development focused on a sample of mothers experiencing poverty and their firstborn children. Although the MLSRA pioneered a number of important topics in the area of social and emotional development, it began with the more specific goal of examining the antecedents of child maltreatment. From that foundation and for more than 40 years, the study has produced a significant body of research on the origins, sequelae, and measurement of childhood abuse and neglect. The principal objectives of this report are to document the early history of the MLSRA and its contributions to the study of child maltreatment and to review and summarize results from the recently updated childhood abuse and neglect coding of the cohort, with particular emphasis on findings related to adult adjustment. While doing so, we highlight key themes and contributions from Dr Dante Cicchetti's body of research and developmental psychopathology perspective to the MLSRA, a project launched during his tenure as a graduate student at the University of Minnesota.

Borderline personality disorder and sexuality: causes and consequences of dissociative symptoms

BACKGROUND

Sexual risk behavior in patients diagnosed with borderline personality disorder (BPD) is supposed to be associated with traumatic experiences and dissociative symptoms. Nevertheless, scientific research thereon is scarce which might be due to the high prevalence of sexual trauma and fear of overwhelming patients with explicit sexual content.

METHODS

We investigated a clinical sample of patients diagnosed with BPD (n = 114) and compared them to a sample of matched healthy controls (HC) (n = 114) concerning the dissociative symptoms derealization, depersonalization, and conversion in sexual situations. In a subgroup of patients with BPD (n = 41) and matched HC (n = 40) dissociative symptoms after exposure to an acoustically presented erotic narrative were assessed in the lab. Regression analyses were used to examine the associations between sexual trauma, post-traumatic stress disorder (PTSD), dissociation in sexual situations, and risky sexual behavior.

RESULTS

Patients diagnosed with BPD endorsed higher dissociative symptoms in sexual situations retrospectively and in the lab compared to HC. Regression analyses revealed that depersonalization and conversion symptoms in sexual situations were explained by severity of BPD, while derealization was explained by PTSD symptomatology. Impulsive and sexual behavior with an uncommitted partner were higher in the BPD group and explained by derealization, while conversion showed an inverse association.

CONCLUSION

Our findings highlight the importance of addressing distinct dissociative symptoms in sexual situations when counselling and treating women with BPD. In the long term, this could contribute to a reduction in sexual risk behavior in patients with BPD.

TRIAL REGISTRATION

This analysis is part of a larger ongoing study and was registered prior to accessing the data (Registration trial DRKS00029716).

Elder abuse experienced by older Mexican women with disabilities: a current and retrospective view on domestic violence

The objectives of this study were: 1) to estimate the prevalence of child abuse (CA), intimate partner violence (IPV), and elder abuse (EA) in a representative sample of older Mexican women by status, type, and cause of disability; and 2) to examine the associations of EA with CA, IPV, and disability status. We conducted a secondary data analysis of 21,718 women aged 60 years and older. Older women with disabilities had higher prevalences of CA, IPV, and EA than those with some difficulties or without disabilities. In older women whose disability was acquired at birth or due to aggression, this prevalence was especially high. Older women with disabilities and a history of CA and IPV were twice as likely to suffer EA. Policymakers and government leaders should incorporate the matter of violence against women with disabilities into their public agendas. This should be done while considering the women's various disabilities and causes of disability.

Childhood Maltreatment and Revictimization: A Systematic Literature Review

There is established evidence that childhood/adolescent victimization is associated with victimization in adulthood although the underlying mechanisms are not still clear. The current study aimed to systematically review empirical studies examining potential psychological factors linking childhood maltreatment to victimization in adulthood and the gaps in the literature. Following PRISMA protocol, 71 original studies consisting of a total sample of n = 31,633 subjects were analyzed. Symptom severity for various trauma-related disorders, dissociation, emotion dysregulation, and risky sexual behaviors emerged as potential predictors of revictimization. While these potential risk factors mediate the relationship between childhood maltreatment and adulthood victimization, evidence for additional factors such as social support, attachment styles, maladaptive schemas, and risk detection is very limited. Addressing these intrapersonal risk factors, found by prior studies, in interventions and preventive programs might decrease the probability of revictimization. The interactions between the identified risk factors have not been studied well yet. Hence, more research on mediating risk factors of revictimization is needed.

An assessment of appraisals of dating relationship conflicts and perceptions of appropriate coping strategies with psychologically abusive interactions

Introduction

Stemming from a stress appraisal and coping perspective, the present investigation developed a methodology for assessing how individuals appraise abusive dating relationship conflicts (Study 1) and the implications of such appraisals for informing coping responses to abusive interactions (Study 2).

Methods

Participants ranging in age from 17 to 29 years (Study 1: 102 males, 339 females; Study 2: 88 males, 362 females) completed a survey in which they were presented with a series of 10 scenarios that conveyed relationship conflict cues that were ostensibly aligned with various forms of psychological abuse.

Results

Factor analyses indicated that blatant actions conducted in privacy were differentiated from more ambiguous public forms of psychological abuse, in that the latter were appraised by both males and females as more abusive. Females were further likely to appraise blatant conflicts as more threatening but at the same time more resolvable. Participants who had encountered abuse in their own intimate relationships were especially likely to appraise conflicts as abusive, threatening and uncontrollable. Such appraisals were associated with greater endorsement of avoidant coping strategies in response to an abusive encounter, irrespective of personal relationship experiences.

Discussion

It is suggested that how individuals appraise relationship conflicts may be key to their ability to cope effectively with such encounters or to provide appropriate support to those experiencing psychologically abusive relationships.

Psychological Factors Linked to Intimate Partner Violence and Childhood Maltreatment: On Dissociation as a Possible Bridge Symptom

Intimate partner violence (IPV) is a serious health concern, occurring worldwide in various forms and settings. Over the past years, multiple sources reported an increase of IPV globally, partly related to COVID-19 restrictions. Childhood maltreatment enhances the risk of IPV, possibly via alterations in emotion regulation, attachment, maladaptive core beliefs, dissociation, and psychopathological symptoms. However, studies investigating these associations simultaneously are still needed. This study aimed to investigate association between IPV, childhood maltreatment severity, maladaptive schemata (mistrust, alienation, enmeshment), attachment anxiety, social support, emotion regulation, dissociation, posttraumatic stress disorder (PTSD), and borderline personality disorder (BPD) symptoms. We further explored the complex interplay of all factors, accounting for their shared associations. An anonymous online survey was posted on international online platforms for people experiencing domestic violence and on research platforms. Regression analyses and graph-theoretical network analysis were used to explore associations between all variables. N = 434 participants (40% in treatment) completed the survey. IPV perpetration and victimization were highly correlated. Both were significantly associated with childhood maltreatment severity, early maladaptive schemata, dissociation, BPD features, and PTSD symptoms. When including all variables in one model, IPV was associated with dissociation, which indirectly linked it to childhood maltreatment experiences, PTSD symptoms, withdrawal, and self-blame. Our findings suggest that IPV perpetration and victimization often co-occur. Dissociation may be an important bridge symptom, linking IPV to childhood maltreatment experiences, PTSD symptoms, and maladaptive coping. Prospective studies are needed to corroborate these findings and to establish psychological mechanisms underlying IPV.

Feel-Own-Move: a psychomotor therapy program for victims of intimate partner violence living in shelter homes. Feasibility and effects on mental health, bodily dissociation, and quality of life

Introduction

Intimate partner violence (IPV) is a worldwide concern, impacting victims' mental health, physical health, and quality of life. High rates of posttraumatic stress disorder (PTSD), depression, anxiety, bodily dissociation, and somatic symptoms have been found in victims of IPV, with an important impact on the chronicity of impairments and on the outcomes of psychological interventions. Therapeutic interventions available in shelter homes for victims are scarce in addressing their body-mind needs therefore asking for better empirical research. Thus, the aim of this study was to evaluate the feasibility and effects of Feel-Own-Move (FOM), an 8-week psychomotor therapy program for victims of IPV, on their mental health, levels of bodily dissociation, and general quality of life.

Methods

A within-subject repeated measures design was used to evaluate the intervention effects, and feasibility results were analyzed.

Results

Seventeen women completed the program (mean age 42.8 years, range 21-64). Results showed a significant decrease in levels of bodily dissociation, with FOM having a large effect size. The intervention also had a large effect size at increasing the environment domain of quality of life, although no statistically significant differences were found. FOM ended with excellent rates of reach, adherence, acceptability, and satisfaction. A positive retention rate was also found.

Discussion

In conclusion, FOM seems to be a feasible psychomotor therapy intervention for female victims of IPV living in shelters. Importantly, this program showed to be effective in reducing bodily dissociation among participants, which is suggested to prospectively contribute to their mental health and quality of life.

Risk Factors for Sexual Revictimization and Dating Violence in Young Adults with a History of Child Sexual Abuse

Interpersonal revictimization, through sexual violence and psychological or physical dating violence, is one of the many consequences of childhood sexual abuse (CSA). This study examined how childhood maltreatment, sociodemographic characteristics, mental health, relational factors, and community factors are associated with 1) sexual revictimization 2) psychological dating violence victimization, and 3) physical dating violence victimization in a sample of young adults reporting a history of CSA. A sample of 190 young adults (18-25 y.o.) with self-reported experiences of CSA completed an online survey measuring childhood maltreatment (e.g. neglect, physical abuse, witness to domestic violence), sociodemographic characteristics (e.g. material deprivation, education), mental health (dissociation, posttraumatic stress symptoms), relational factors (e.g. insecure attachment style), and community factors (e.g. neighborhood disadvantage). Hierarchical logistic regressions indicated that once all risk factors were entered in the models, PTSD was positively associated with psychological dating violence, while dissociation was positively associated with physical dating violence. Physical abuse in childhood was positively associated with sexual revictimization. The present study shows the importance of simultaneously considering the impact of multiple characteristics surrounding CSA survivors when evaluating risks of revictimization. Additionally, it highlights the importance of providing CSA survivors with adequate mental health support for trauma-related disorders, as it may be crucial to prevent revictimization.

Interpersonal stress mediates the relationship between childhood trauma and depressive symptoms: Findings from two culturally different samples

OBJECTIVE

Childhood trauma is associated with adulthood depressive symptoms, but very few studies explored potential social and interpersonal mediators behind this association. This study made the first attempt to test the potential mediating effects of interpersonal stress in the associations between childhood betrayal and non-betrayal trauma and depressive symptoms.

METHOD

We analyzed data in a sample of English-speaking adults from diverse backgrounds (from 19 different countries, mainly from Western countries) (N = 468). We then replicated and compared the results with those in another convenience sample of Chinese-speaking younger adults with different cultural backgrounds and mental health status (N = 205).

RESULTS

The results in both samples indicated that (1) childhood betrayal trauma had a stronger relationship with depressive symptoms than childhood non-betrayal trauma and that (2) interpersonal stress was a significant mediator in the relationship between childhood betrayal trauma and depressive symptoms, even when childhood non-betrayal trauma was included as a covariate. The indirect effect of childhood non-betrayal trauma on depressive symptoms through interpersonal stress was not consistent in two samples.

CONCLUSIONS

Our findings point to the importance of taking social and interpersonal contexts into account when investigating, preventing and managing depression in trauma-exposed populations. Early social interventions such as family interventions, interpersonal skills training and building social resources may have the potential to change the trajectory of the development of mental health problems in trauma survivors.

Dissociative experiences among Lebanese university students: Association with mental health issues, the economic crisis, the COVID-19 pandemic, and the Beirut port explosion

BACKGROUND

Dissociative experiences are psychological manifestations characterized by a loss of connection and continuity between thoughts, emotions, environment, behavior, and identity. Lebanon has been facing indescribable events in the last few years, including the COVID-19 pandemic, the Beirut explosion, a crushing economic crisis with the highest inflation rate the country has known in over three decades. The aim of this study was to evaluate the correlation between dissociative experiences and post-traumatic stress symptoms from the economic crisis, the Beirut blast, the COVID-19 pandemic, and other mental health issues in a sample of Lebanese university students.

METHODS

This cross-sectional study enrolled 419 active university students (18-35 years) from all over Lebanon (May and August 2021). The respondents received the online soft copy of a survey by a snowball sampling technique through social media and messaging apps. The questionnaire included sociodemographic data, the Dissociative Experience Scale (DES-II), the PTSD Checklist Specific Version (PCL-S), the Financial Wellbeing Scale, the Beirut Distress Scale, the Lebanese Anxiety Scale, the Patient Health Questionnaire.

RESULTS

The two-factor model of the DES fitted best according to CFI, RMSEA and χ2/df values, but modestly according to TLI. The two factors were absorption and amnesia/depersonalization. Higher stress (Beta = 0.95) and more PTSD from the Beirut blast (Beta = 0.29) and from the economic crisis (Beta = 0.23) were significantly associated with more absorption. A personal history of depression (Beta = 6.03), higher stress (Beta = 0.36) and more PTSD from the Beirut blast (Beta = 0.27) and from the COVID-19 pandemic (Beta = 0.16) were significantly associated with more amnesia/depersonalization.

CONCLUSION

Significant rates of dissociative experiences and their sub-manifestations (amnesia/depersonalization and absorption) were found among Lebanese university students, with remarkable co-occurrence of a traumatic/stressful pattern, whether on an individual (history of PTSD) or a collective level (Post-traumatic manifestations from Beirut blast, COVID-19 pandemic and/or economic crisis), or whether correlated to an acute single event or to certain chronic stressors, or even to a personal history of depression. Such findings must raise the attention to serious mental and psychosocial alteration in the Lebanese national identity.

Mechanisms by which adverse childhood experiences, other traumas and PTSD influence the health and well-being of individuals with eating disorders throughout the life span

BACKGROUND

Multiple published sources from around the world have confirmed an association between an array of adverse childhood experiences (ACEs) and other traumatic events with eating disorders (EDs) and related adverse outcomes, including higher morbidity and mortality.

METHODS

In keeping with this Special Issue's goals, this narrative review focuses on the ACEs pyramid and its purported mechanisms through which child maltreatment and other forms of violence toward human beings influence the health and well-being of individuals who develop EDs throughout the life span. Relevant literature on posttraumatic stress disorder (PTSD) is highlighted when applicable.

RESULTS

At every level of the pyramid, it is shown that EDs interact with each of these proclaimed escalating mechanisms in a bidirectional manner that contributes to the predisposition, precipitation and perpetuation of EDs and related medical and psychiatric comorbidities, which then predispose to early death. The levels and their interactions that are discussed include the contribution of generational embodiment (genetics) and historical trauma (epigenetics), social conditions and local context, the ACEs and other traumas themselves, the resultant disrupted neurodevelopment, subsequent social, emotional and cognitive impairment, the adoption of health risk behaviors, and the development of disease, disability and social problems, all resulting in premature mortality by means of fatal complications and/or suicide.

CONCLUSIONS

The implications of these cascading, evolving, and intertwined perspectives have important implications for the assessment and treatment of EDs using trauma-informed care and trauma-focused integrated treatment approaches. This overview offers multiple opportunities at every level for the palliation and prevention of EDs and other associated trauma-related conditions, including PTSD.

Revictimization Patterns Among Unhoused Youth

Young people experiencing houselessness are at high risk for revictimization. As has been identified in other populations, symptoms of psychological distress may be an indirect pathway by which initial victimization may increase risk for later revictimization among youth experiencing houselessness. The current study used cross-sectional mediation analyses to examine the hypothesis that there would be an indirect effect of interpersonal victimization that occurred before young people left home on subsequent victimization while experiencing houselessness, through posttraumatic stress disorder (PTSD) and depression symptoms. Youth (N = 245) residing in a shelter provided responses during an in-person interview screening prior to participating in a larger clinical study. Relevant to the current study, youth reported victimization experiences before and after leaving home (Childhood Trauma and Juvenile Victimization Questionnaires, respectively), and PTSD and depression symptoms on the Mini International Neuropsychiatric Interview. Results replicated and extended previous findings determining high rates of victimization among houseless young people both before (92%) and after (75%) leaving home. Further, exposure to more types of childhood victimization significantly predicted likelihood of experiencing more types of victimization after leaving home. Significant indirect effects of childhood victimization risk on revictimization after leaving home were found, occurring through both PTSD and depression symptoms. Results are discussed in terms of existing theories of revictimization, with particular emphasis on the state-dependence theory of victimization. These findings have implications for intervention with young people experiencing houselessness, particularly with regard to addressing the consequences of childhood victimization and trauma-informed support systems.

The psychometric properties of the adolescent dissociative experiences scale (A-DES) in a sample of Portuguese at-risk adolescents

Dissociation is a process that often occurs as a sequela of psychological trauma, and it is interrelated with psychological and behavioral problems. In the at-risk adolescent population, dissociation is often underdiagnosed and undertreated. Having reliable measures to assess this phenomenon can help in identifying adolescents at-risk and improve treatment outcomes. This study assessed the psychometric properties of the Adolescent Dissociative Experiences Scale (A-DES) with a sample of 402 Portuguese adolescents recruited from three at-risk populations. Participants completed self-report measures of trauma exposure, posttraumatic symptoms, psychological and behavioral problems, and the A-DES. A subset of the sample also completed test-retest measures. Confirmatory factor analyses revealed a best-fitting 3-factor model. Analyses revealed good internal consistencies and good agreement test-retest reliability for the scale overall and the factor-based sub-scales. Construct and predictive validity was supported with results showing that A-DES discriminates between youth reporting high versus low levels of cumulative trauma exposure and youth who meet or do not meet criteria for a probable PTSD diagnosis. Study findings replicate prior research supporting a 3-factor model of dissociation and the usefulness of A-DES to identify adolescents with dissociative symptoms. Clinical and research implications are discussed.

The revictimization of older Mexican women: understanding the accumulation of multiple victimizations throughout a lifetime

Background

The victimization of women constitutes a human rights violation and a health risk factor. The central objectives of this study were to analyze the probability of revictimization among older adult Mexican women and to examine whether child abuse (CA) and/or intimate partner violence (IPV) are associated with a greater risk of elder abuse (EA) victimization.

Methods

We conducted a secondary data analysis of 18416 women 60 and older, based on data from the National Survey on the Dynamics of Household Relationships (2016), which is national and subnational representative. A descriptive analysis was carried out using retrospective self-reports of victimization experiences (CA, IPV, and EA). The prevalence of victimization and multiple victimizations in the various stages of the lives of women, as well as of revictimization among older adult women were obtained. Bayesian logistic regression models were used to examine the associations between victimization, multiple victimization, and EA victimization.

Results

A total of 17.3% of the older adult women reported EA in the last year; of these, 81.0% had been revictimized and 14.0% reported CA, IPV, and EA. The risk of EA rose among women who reported a combination of psychological and sexual CA, and psychological, physical and sexual CA and psychological and sexual IPV, and a psychological, economic, physical and sexual IPV. EA was higher among women who had suffered more than one type of violence.

Conclusion

CA and IPV, particularly sexual abuse and psychological violence, can be risk factors for EA. Screening tools used to prevent and detect EA should include questions about domestic violence over the course of a person’s lifetime.

Childhood trauma, dissociation, alexithymia, and anger in people with autoimmune diseases: A mediation model

BACKGROUND

Despite research linking dissociation, alexithymia, and anger with childhood trauma and ADs, the investigation addressing the relationships between the potential mediators has not yet been established within the literature.

OBJECTIVE

The present study examined the relationship between childhood trauma and autoimmune disorders, using a multiple mediation model that included dissociation, alexithymia, and anger as hypothesized mediators.

PARTICIPANTS AND SETTING

306 autoimmune patients and 292 self-declared healthy controls were included in the study. They completed self-report questionnaires regarding childhood abuse, alexithymia, dissociation, and anger.

METHODS

Multiple mediation analysis was conducted to investigate the study's proposed model.

RESULTS

The results of the Structural Equation Model (SEM) suggest an indirect relationship between childhood trauma and autoimmune disorders, mediated by dissociation [z = 4.57, p < .01, β = 0.19, 90% CI (0.08-0.10)], alexithymia [z = 10.74, p < .01, β = 0.43, 90% CI (0.08-0.10)], but not by anger [z = 1.58, p = .11, 90% CI (0.08-0.10)].

CONCLUSIONS

These findings are in line with previous studies that show associations between childhood trauma, dissociation, alexithymia, and ADs. They indicate that mental health professionals and medical doctors should assess childhood trauma in autoimmune patients. They also should consider the possible maintaining role of dissociation and alexithymia in the treatment of autoimmune diseases.

Children's behavior problems, caregivers' trauma history, and membership in latent physical abuse trajectory classes: An approach of latent class growth analysis to dating violence victimization

BACKGROUND

Child abuse is a serious social problem in the USA as many children suffer from child abuse and its negative consequences are severe. To prevent future victimization, it is essential to understand unique patterns of child abuse trajectories over time and the factors associated with their victimization.

OBJECTIVE

The primary goal of this study was to identify individual differences in developmental trajectories of alleged physical abuse between the ages of 2 and 12.

PARTICIPANTS AND SETTING

The sample included all children drawn from Longitudinal Studies of Child Abuse and Neglect (LONGSCAN), which is a consortium of five study sites (South, East, Midwest, Northwest, and Southwest).

METHODS

Using the high-risk sample with Child Protective Service record reviews prior to age 4, significant variability in trajectory class membership was observed in the unconditional Latent Class Growth Analysis.

RESULTS

Three trajectory classes were obtained from the data: Early Onset, Late Peak and Non-Victims. The findings showed that children who had an attention problem at age 4 were more likely to become members of both the Early Onset and Late Peak groups, relative to Non-victims. Also, membership in the Late Peak group was predicted by caregivers' childhood physical abuse, supporting for the cycle of physical abuse across generations. Finally, children in the Late Peak group were at the highest risk of being physically, psychologically, and sexually abused in a dating relationship at age 14.

CONCLUSIONS

These results suggest that children's internal and external behavior problems and caregivers' childhood physical abuse are predictive of child abuse trajectory class membership. Parental education programs that increase their knowledge about children with special needs and intervention programs targeting caregivers with a history of physical abuse would be beneficial to prevent child abuse (re)victimization.

The intersection of intimate partner violence and childhood sexual abuse in mother-child dyads

BACKGROUND

Child sexual abuse (CSA) and intimate partner violence (IPV) have been associated with negative consequences for adult victims and their children including a risk of revictimization and intergenerational continuity.

OBJECTIVES

The aim of this study was to document correlates of intergenerational cumulative trauma profiles in mother-child dyads.

PARTICIPANTS AND SETTING

A sample of 997 sexually abused children (mean age = 7.61 years; 79.1% girls) and their mothers was recruited.

METHODS

Latent Class Analysis (LCA) was used to identify classes of cumulative trauma among dyads. Classes were compared on validated measures of psychological functioning for both members of the dyads.

RESULTS

Four distinct classes emerged: CSA Only (43.3%), Intergenerational CSA with Psychological IPV (14.2%), Physical and Psychological IPV with Low Child Exposure (24.0%) and Intergenerational Polyvictimization (18.5%). Comparisons generally revealed lower distress in CSA Only dyads, and higher levels of psychological difficulties in the two most victimized groups. However, the dose-response pattern was not as clear as expected, as the two most victimized groups did not differ in terms of psychological functioning.

CONCLUSIONS

This study shows that higher levels of intergenerational cumulative trauma are associated with increased psychological symptoms in mothers and more dissociation in their sexually abused children. Interventions should be adapted to the specific needs of families to prevent lasting intergenerational difficulties in trauma exposed individuals.

Correlates and Predictors of Mothers' Adaptation and Trauma Symptoms Following the Unveiling of the Sexual Abuse of Their Child

Child sexual abuse (CSA) can severely affect the mental health of children and their parents. While correlates of recovery have been documented in children, factors exacerbating parents' adaptation to their child's unveiling of CSA deserves further attention. Parents' history of abuse has been inconsistently identified as a predictor of their distress in reaction to their child's abuse disclosure. This study proposes a mediation model that explores various processes underlying mother's psychological distress (posttraumatic stress disorder [PTSD], dissociation, and their comorbidity) following their children's unveiling of CSA. It investigates the influence of mother's own CSA, as well as of her exposure to additional forms of past and current victimization, on her reaction to the child's CSA disclosure, while considering coping mechanisms as mediators (avoidance, problem solving, search for social support, and feeling of guilt). Data were collected through self-report measures completed by 298 mothers of children who had recently disclosed CSA. Path analyses revealed that mother's exposure to interparental violence as a child acted as a primary predictor of dissociation and of its comorbidity with PTSD, while a history of CSA was directly and exclusively linked to dissociation. Being exposed to recent partner violence was indirectly related to trauma symptoms, with coping mechanisms acting as mediators. This study outlines the relationship between mother's psychological distress and her cumulative, past, and current exposure to various forms of victimization. Exposure to interparental violence as a child represents a particularly important factor for identifying mothers most in need of support, as it is a significant predictor of dissociation and of its comorbidity with PTSD.

A Review of Mediators in the Association between Child Sexual Abuse and Revictimization in Romantic Relationships

Child sexual abuse (CSA) is a widespread adverse experience that has multiple detrimental impacts in the long-term, affecting mental, sexual, and physical health of survivors. In addition, CSA may impede interpersonal functioning, and be associated with a heightened risk of revictimization. Recent review articles have summarized the possible risk factors associated with sexual revictimization, yet an increasing body of literature suggests that CSA may be a key risk factor for multiple forms (i.e., psychological, physical, sexual) of victimization occurring specifically in the context of intimate relationships, either in adolescence (dating violence) or adulthood (partner violence). Our understanding of the mechanisms linking CSA and dating violence or intimate partner violence is still limited. This systematic review of the literature is aimed at summarizing the identified mediators of the association between CSA and revictimization in romantic relationships in past empirical reports. A total of 18 studies meeting criteria were identified. Apart from PTSD, few potential mediators have been explored in more than one study. In addition, few studies have investigated protective factors that may reduce the risk of revictimization. Several limitations in the current literature were identified including issues related to definitions and measurement. Studies relying on longitudinal designs with representative samples are clearly needed to orient future prevention efforts and break the revictimization trajectory.

Linking experiences of child sexual abuse to adult sexual intimate partner violence: the role of borderline personality features, maladaptive cognitive emotion regulation, and dissociation

BACKGROUND

Child sexual abuse (CSA) has been linked to a higher risk of sexual re-victimization, including sexual intimate partner violence (IPV). The aim of this study was to investigate whether borderline personality disorder (BPD) features, dissociation, and maladaptive cognitive emotion regulation mediate the link between self-reported CSA severity and sexual IPV. Specifically, we were interested in the unique effect of each mediator variable, when accounting for the effect of the other variables.

METHODS

Data was assessed in a cross-sectional anonymous online survey, posted on platforms for people affected by domestic violence, and research platforms of Leiden University. Overall, n = 633 participants completed the survey (including n = 100 participants with CSA and n = 345 reporting at least one incidence of sexual IPV). Multivariate regression analyses and path-analytical modelling were performed for hypothesis testing.

RESULTS

Adult sexual IPV was predicted by more severe CSA, more severe BPD features, higher dissociation, and more maladaptive emotion regulation. Each mediator variable showed a significant effect in the separate mediation models. In the overall model, only dissociation and maladaptive emotion regulation, but not BPD features, mediated the association between CSA and sexual IPV.

CONCLUSIONS

Findings add to the existing literature, suggesting that CSA severity, BPD features, dissociation, and maladaptive emotion regulation are important risk factors for sexual IPV. Given the cross-sectional correlational design of our study, prospective studies are needed to corroborate our findings regarding potential psychological mechanisms underlying sexual re-victimization. Ultimately, this can help developing interventions aimed at breaking the cycle of abuse.

Dissociative symptoms predict risk for the development of PTSD: Results from the National Health and Resilience in Veterans Study (NHRVS)

Dissociative symptoms following trauma exposure, such as derealization (i.e., feeling that one's experience is strange and unreal) and depersonalization (i.e., feeling detached from oneself) have been implicated in the development and maintenance of posttraumatic stress disorder (PTSD). In the current study, we analyzed data from a 3-year prospective cohort study of a nationally representative sample of U.S. veterans to examine whether trait dissociative symptoms, which may impair adaptive emotion regulation following trauma exposure, predict risk for the development of PTSD in trauma-exposed veterans. Results revealed that derealization symptoms predicted a nearly 5-fold increase in relative risk of incident PTSD (relative risk ratio = 4.57, 95% confidence interval = 1.55-13.52), even after adjusting for relevant sociodemographic and trauma-related factors, and severity of PTSD symptoms at baseline. To our knowledge, this study is the first to suggest that trait dissociative symptoms-specifically derealization-may be an important population-based risk factor for the development of PTSD in trauma-exposed U.S. military veterans. These findings add to a body of literature on the prediction of PTSD that largely focuses on stable or immutable risk factors such as sociodemographic and trauma characteristics, or peritraumatic emotional reactions, and underscores the potential clinical utility of assessing, monitoring, and treating derealization symptoms in trauma-exposed U.S. military veterans at risk for PTSD.

A meta-analytic study examining the relationship between alexithymia and dissociation in psychiatric and nonclinical populations

Alexithymia and dissociation have been consistently linked in the literature, particularly in psychiatric populations. Both arise from a disconnection between conscious aspects of self-experiences and perceptions at both the mental self and bodily levels. This results in difficulty integrating thoughts, feelings and experiences into consciousness and memory, negatively impacting emotion awareness/regulation and reflective functioning. We conducted a meta-analysis to examine the strength of the relationship between alexithymia and dissociation in both clinical and non-clinical populations. Studies using two common measures of these constructs were included (i.e., the Toronto Alexithymia Scale - TAS, and the Dissociative Experiences Scale - DES). Analyzing the effect sizes derived from 19 studies (including a total of 4664 participants) revealed moderate to strong relationships between alexithymia and dissociation. The strength of the association was higher in clinical and younger aged non clinical populations. These findings are discussed in the context of treatment recommendations..

Efficacy of EMDR Therapy for Children With PTSD: A Review of the Literature

The rationale is synthesized for the urgency of empirical studies demonstrating the efficacy of eye movement desensitization and reprocessing (EMDR) therapy for children and adolescents with posttraumatic stress disorder (PTSD), symptoms of PTSD, or other trauma-related symptoms. This literature review examined 15 studies (including nine randomized clinical trials) that tested the efficacy of EMDR therapy for the treatment of children and adolescents with these symptoms. All studies found that EMDR therapy produced significant reductions in PTSD symptoms at posttreatment and also in other trauma-related symptoms, when measured. A methodological analysis identified limitations in most studies, reducing the value of these findings. Despite these shortcomings, the methodological strength of the identified studies has increased over time. The review also summarized three meta-analyses. The need for additional rigorous research is apparent, and in order to profit from experiences of the past, the article provides some guidelines for clinicians seeking to conduct future research in their agencies.