Behavioral manifestations of child sexual abuse

The Role of Early Life Stress in HPA Axis and Anxiety

Substantial evidence from various studies suggests a preeminent role for early adverse experiences in the development of psychopathology. The most recent studies reviewed here suggest that early life stressors are associated with an increased risk for anxiety disorders in adulthood. Early life stress predisposes individuals to develop a number of psychiatric syndromes, particularly affective disorders, including anxiety disorders, and is therefore a significant health problem.This review examines the emerging literature on the relationship between stress, hypothalamic-pituitary-adrenal (HPA) axis function, and generalized anxiety disorder (GAD), panic disorder, and phobias and the role of early life stress as an important risk factor for HPA axis dysfunction.The most consistent findings in the literature show increased activity of the HPA axis in depression associated with hypercortisolemia and reduced inhibitory feedback. In addition to melancholic depression, a spectrum of other conditions may be associated with increased and prolonged activation of the HPA axis, including panic, GAD, phobias and anxiety. Moreover, HPA axis changes appear to be state-dependent, tending to improve upon resolution of the anxiety syndrome. Interestingly, persistent HPA hyperactivity has been associated with higher rates of relapse. These studies suggest that an evaluation of the HPA axis during treatment may help identify patients who are at a higher risk for relapse. These findings suggest that this dysfunction of the HPA axis is partially attributable to an imbalance between glucocorticoid and mineralocorticoid receptors. Evidence has consistently demonstrated that glucocorticoid receptor function is impaired in anxiety disorders. Moreover, normal basal cortisol levels and hyper-responsiveness of the adrenal cortex during a psychosocial stressor are observed in social phobics. Finally, abnormal HPA axis activity has also been observed in generalized anxiety disordered patients. Early stressful life events may provoke alterations of the stress response and thus of the HPA axis that can endure during adulthood, predisposing individuals to develop psychopathology.

Speaking With and Without Words-An Analysis of Foster Children's Expressions and Behaviors That Are Suggestive of Prior Sexual Abuse

This exploratory study reports on foster children's informal self-disclosures of previously unknown histories of sexual abuse. Data were collected from 40 children's files, and an inductive thematic analysis of verbal and behavioral expressions was conducted. Findings suggest that foster children's self-disclosures can be fragmented, spontaneous, narrative, or triggered and often occur during everyday activities in the foster family. The children disclose their past by referring to the perpetrator or the severity of the abuse or by acting out, mostly by reenacting sexual abuse experiences. In addition, some children use childish vocabulary focusing on genitals or sexual acts they were involved in or want to be involved in. Last, some foster children seem to be linguistically challenged to disclose that a female person abused them or that they were forced to reciprocate sexually. This study adds to the understanding of the complex process of child sexual abuse disclosure in the context of foster care.

The role of early life stress in adult psychiatric disorders: a systematic review according to childhood trauma subtypes

Early life stress (ELS; sexual abuse, physical abuse, emotional abuse, physical neglect, and emotional neglect) has been the focus of numerous studies. It has been associated with the onset and the severity of psychiatric disorders in adults. The objective of this study was to review the literature on ELS associated with psychiatric disorders in adulthood, seeking to identify whether there are independent effects between subtypes of early stress in triggering psychopathology in adults. We reviewed articles from 2001 to 2011 in four databases (PubMed, SciELO, LILACS, and PsycINFO), with the following key words: child abuse, maltreatment, early life stress, psychiatric disorders, mental disease, and psychopathology. Forty-four articles were selected, and most of these articles demonstrate that the subtypes of ELS are associated with several psychiatric disorders, more specifically: physical abuse, sexual abuse, and unspecified neglect with mood disorders and anxiety disorders; emotional abuse with personality disorders and schizophrenia; and physical neglect with personality disorders. Physical neglect had the weakest association between the subtypes. ELS subtypes in childhood and adolescence can predict the development of psychopathology in adults. Scientific evidence shows that ELS triggers, aggravates, maintains, and increases the recurrence of psychiatric disorders. These results demonstrate the importance of a deeper understanding about the unique effects of ELS subtypes, especially for mental health professionals.

Beyond sexual abuse: the impact of other maltreatment experiences on sexualized behaviors

This study sought to broaden research findings linking maltreatment to sexualized behaviors by investigating whether maltreatment experiences other than sexual abuse predict such behaviors. The sample included 690 children without reported sexual abuse histories who are participants in the LONGSCAN Consortium, a prospective multisite investigation of childhood maltreatment. Child Protective Service reports before age 8 years and caregiver reports on the Child Sexual Behavior Inventory-II at age 8 years were used to examine the relationship between maltreatment timing and type, and sexualized behaviors. Logistic regression analyses suggested that early (< 4) and late (4-8) reports of physical abuse were associated with more sexualized behaviors (odds ratios = 1.9-2.6). The pattern differed by gender, with physical abuse predicting sexual intrusiveness and displaying private parts in boys, and boundary problems in girls. Findings suggest that maltreatment other than sexual abuse, and the developmental periods in which it occurs, may be linked to the development of sexualized behaviors.

Sexual anxiety and eroticism predict the development of sexual problems in youth with a history of sexual abuse

Youth with confirmed histories of sexual abuse (N = 118) were followed longitudinally to examine associations between their initial sexual reactions to abuse and subsequent sexual functioning. Participants were interviewed at abuse discovery (ages 8 through 15) and again 1 and 6 years later. Eroticism and sexual anxiety emerged as distinct indices of abuse-specific sexual reactions and predicted subsequent sexual functioning. Eroticism was associated with indicators of heightened sexuality, including more sexual risk behavior and views of sexual intimacy focused on partners' needs. Sexual anxiety was associated with indicators of diminished sexuality, including few sexual partners and avoidant views of sexual intimacy. Age at abuse discovery moderated some associations, suggesting that the timing of abuse-specific reactions affects trajectories of sexual development. Findings point to the need for a developmental approach to understanding how abuse-specific sexual reactions disrupt sexual development and the need for early interventions promoting healthy sexual development.

Use of the children's attributions and perceptions scale in an underprivileged Spanish sample

The psychometric properties and exploratory factor analysis of the Children's Attributions and Perceptions Scale in two Spanish samples of children were examined (n = 48 from an after-school social care center in a deprived neighborhood, and n = 120 from a school mainly enrolling families of medium socioeconomic status; 49% boys and 51% girls; M age = 10.5 yr., SD = 18.7). A cross-cultural comparative analysis of the Spanish samples and the normative sample was also carried out. Factor analysis supported a 4-factor solution for Spanish populations. Significant differences were found between the Spanish groups in school and the social care centers. The cross-cultural analysis showed that stressful conditions (sexual abuse vs deprivation) produced greater differences than cultural group (Spanish vs American).

Descrição de um processo terapêutico em grupo para adolescentes vítimas de abuso sexual

Pessoas que sofreram abuso sexual na infância ou adolescência carregam seqüelas emocionais provenientes do abuso, em diferentes graus. Este estudo teve como objetivo geral a análise de um processo terapêutico em grupo desenvolvido com adolescentes do sexo feminino, vítimas de abuso sexual intrafamiliar, visando diminuir seqüelas do abuso e melhorar seu repertório de enfrentamento. O processo de quinze sessões foi dividido em quatro fases, com objetivos específicos: (I) Preparação - dessensibilizar para facilitar a auto-exposição; (II) Revelação e exposição de sentimentos - facilitar a revelação do abuso sexual; (III) Aceitação - discutir a aceitação do abuso sexual e seu lugar na história de vida da pessoa; e (IV) Prevenção - facilitar a aprendizagem de comportamentos de autoproteção que impeçam a revitimização. Os resultados mostraram que exposições graduais ao tema feitas em grupo podem facilitar a revelação, a expressão de sentimentos e a aceitação do abuso na história de vida das participantes.

Psychological disturbance associated with sexual abuse in people with learning disabilities. Case-control study

BACKGROUND

The association between sexual abuse, mental health and behavioural problems in people with learning disabilities has not previously been examined in a controlled study.

AIMS

To identify symptoms of psychological disturbance in adults with and without a confirmed history of sexual abuse.

METHOD

The study used a matched (1:1) case-control design comparing 54 adults who had experienced sexual abuse with 54 adults with no reported history of abuse. The two groups were selected from a community population of adults with learning disabilities living in residential care, and compared for selected psychiatric diagnoses and for scores on measures of disturbed behaviour.

RESULTS

Sexual abuse was associated with increased rates of mental illness and behavioural problems, and with symptoms of post-traumatic stress. Psychological reactions to abuse were similar to those observed in the general population, but with the addition of stereotypical behaviour. The more serious the abuse, the more severe the symptoms that were reported.

CONCLUSIONS

The study provides the first evidence from a controlled study that sexual abuse is associated with a higher incidence of psychiatric and behavioural disorder in people with learning disabilities.

Correlates of adolescent reports of sexual assault: findings from the National Survey of Adolescents

This study examines how key demographic variables and specific child sexual assault (CSA) incident characteristics were related to whether adolescents reported that they had told anyone about an alleged sexual assault. The study also investigates whether there were differences in the correlates of CSA disclosure as a function of gender and race/ethnicity. A national household probability sample of 4,023 adolescents was interviewed by telephone about childhood experiences, including CSA history. Significant gender and racial/ethnic differences were obtained in rates of CSA disclosure: Sexually abused boys and African American youth were less likely to report telling anyone they had been sexually abused. Separate regression models examining correlates of CSA disclosure yielded differences as a function of gender and race/ethnicity.

Clinical effects of sexual abuse on people with learning disability: critical literature review

BACKGROUND

There are few publications concerning the psychological reactions of people with learning disabilities to sexual abuse. Most significantly, there are no controlled studies and few which demonstrate a systematic approach to documenting the sequelae of trauma.

AIMS

To critically review the published research in this field.

METHOD

A literature search in peer-reviewed psychiatry, psychology, nursing and social care journals for the years 1974 to 2001 was conducted and 25 studies were reviewed.

RESULTS

Several studies suggest that, following sexual abuse, people with learning disabilities may experience a range of psychopathology similar to that experienced by adults and children in the general population. However, because of methodological limitations, these results are not conclusive.

CONCLUSIONS

Whether people with learning disabilities experience reactions to sexual abuse similar to the general population has yet to be explored by systematic research.

Somatic and psychological problems in a cohort of sexually abused boys: a six year follow up case-control study

AIMS

To obtain information about the health and well being of 108 boys six years after their involvement with the same paedophile.

METHODS

Case-control study of the health records of 93 male victims of a major episode of school based child sexual abuse and 93 matched controls. Interviews with a sample of their general practitioners.

RESULTS

The number and frequency of reported health problems were similar in both cases and controls. However, abused boys were more likely than controls to present with symptoms that persisted for more than a year (31 cases compared with 10 controls).

CONCLUSIONS

Boys who have previously suffered sexual abuse at school did not utilise primary health care services more than a group of age matched controls. They did not present with psychological or somatic problems different from those presented by non-abused boys. However, abused boys were more likely to complain of persistent somatic or psychological problems lasting more than a year. This pattern appeared to persist after the abuse had stopped and the perpetrator imprisoned.

Childhood victimization and alcohol symptoms in females: causal inferences and hypothesized mediators

OBJECTIVE

Previous research has reported a relationship between childhood victimization experiences and alcohol problems in females. This paper has two distinct goals: (1) to determine whether it is appropriate to make a causal inference regarding the association between early child abuse and neglect and alcohol symptoms in females; and (2) to examine five potential mechanisms (depression, worthlessness, social isolation/loneliness, low self esteem, and using alcohol and/or drugs to cope) that may mediate the relationship between child abuse and neglect and alcohol symptomatology.

METHOD

Substantiated cases of child abuse and neglect from 1967 to 1971 were matched on sex, age, race, and approximate social class with nonabused and non-neglected children and followed prospectively into young adulthood. Subjects were administered a 2-h in-person interview, including the NIMH Diagnostic Interview Schedule (DIS-III-R) to assess alcohol use and abuse. Analyses are restricted to females in the sample (N = 582).

RESULTS

Structural equation modeling provides support for the inference that childhood victimization plays a causal role in the development of alcohol symptoms in women. There also is support for the hypothesized mediating role of two mechanisms (depression and using alcohol/drugs to cope), but not for the other mediators.

CONCLUSIONS

Evidence from this prospective study suggests that childhood victimization may be one of the causal factors in the development of alcohol problems in females. Interventions should bedirected at abused and neglected females of all ages to help them to deal with depression and to develop coping strategies to prevent the development of serious alcohol problems.

Posttraumatic stress disorders in children and adolescents

Millions of children are exposed to traumatic experiences each year. Over 30% of these children develop a clinical syndrome with emotional, behavioral, cognitive, social, and physical symptoms called posttraumatic stress disorder. The symptoms of posttraumatic stress disorder fall into three clusters: reenactment of the traumatic event: avoidance of cues associated with the event or general withdrawal; and physiological hyperreactivity. Significant physical and medical problems in childhood, adolescence, and adulthood appear to be related to childhood trauma. Current treatment approaches include postacute psychoeducation, individual psychotherapy, pharmacotherapy, and cognitive-behavioral therapy. Despite increasing attention over the past 10 years, childhood posttraumatic stress disorder remains an understudied public health problem.

Child victims' attributions about being physically abused: an examination of factors associated with symptom severity

The goal of the present study was to examine a conceptual attributional model for the development of psychopathology after child physical abuse. Physically abused or maltreated children referred for treatment completed a series of measures to assess parent-to-child violence, abuse-specific attributions and general attributional style, other potential predictors, and children's psychopathology. Results revealed that the severity of current parent-to-child violence was associated with children's internalizing and externalizing symptoms. Attributions predicted the level of children's psychopathology beyond the variance accounted for by the severity of parent-to-child violence. The severity of parent-to-child violence, attributions about the abuse, general attributional style, and level of family functioning accounted for 28%-63% of the variance in children's abuse-specific, internalizing, and externalizing symptoms. Implications of the findings and research recommendations are discussed.