Child extrafamilial sexual abuse: predicting parent and child functioning

Adolescents Who Have Been Sexually Abused: Trauma Symptoms and Self-Blame while Waiting for Treatment

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.

Vicarious Growth, Traumatization, and Event Centrality in Loved Ones Indirectly Exposed to Interpersonal Trauma: A Scoping Review

It is well-known that interpersonal traumatic events can impact the physical and mental health of those indirectly exposed to the events. Less studied are populations of loved ones who have been indirectly exposed to interpersonal trauma. We conducted a scoping review to synthesize literature related to potential consequences of indirect interpersonal trauma exposure, specifically vicarious traumatization (VT) and vicarious posttraumatic growth (VPTG). We used the Joanna Briggs Institute methodology. Inclusion criteria included: (1) participants were indirectly exposed to the interpersonal trauma of a loved one in adulthood, (2) discussion of VT, VPTG, or related terms, (3) published peer-reviewed empirical journal articles, and (4) available in English. We used a three-step search strategy to find relevant articles. Keywords found from the first two steps were entered into PsycINFO, PsycArticles, PubMed, Scopus, and Web of Science databases. Reference lists of the included articles were also examined. The identified articles were then screened using the inclusion and exclusion criteria. Twenty-eight articles met inclusion and exclusion criteria. Twenty-six articles referenced VT or related terms, one referenced VPTG, and one referenced vicarious trauma keywords. Results of this scoping review are summarized by definitions, measures, key findings, and knowledge gaps. Future research should focus on vocabulary management, diverse samples, and VPTG in this population, including the identification or creation of appropriate measures.

A Dyadic Study of Impacts of Sexual Assault Disclosure on Survivors' Informal Support Relationships

After a sexual assault, victims often disclose their assault to an informal support provider (SP) to receive social support. Ample research exists on social reactions of informal SPs to disclosure and how those reactions affect the victim both positively and negatively, but little research exists on how the disclosure impacts a survivor's support relationships both in the short and in the long term. This qualitative interview study examined 45 ethnically diverse informal support dyads where women disclosed sexual assault to an informal SP (e.g., friend, family, significant other). Assault disclosure was examined to determine its impact on relationship quality of survivors and their SPs. Results revealed positive and negative effects on survivor-SP relationships of assault disclosure and social reactions. In almost all matched pairs (91%), the survivor, SP, or both remarked on how the relationship had changed following disclosure. Family member SPs spoke of survivors' risk-taking and poor relationship choices. Significant others spoke of the toll of supporting survivors who sometimes left their needs unmet and strained their relationships with survivors. Friend SPs often appraised how the survivor engaged in other types of relationships, but overall felt that their relationships had become stronger or closer as a result of the disclosure. Implications of this study include acknowledging that informal supporters, particularly significant others, can experience adverse effects after disclosure, and that help is needed not only for survivors but also for their informal support sources. Future research should continue to investigate both the short-term and longitudinal impacts of sexual assault disclosure on survivors' informal support relationships.

Qualitatively Understanding Mother Fault After Childhood Sexual Abuse

Socially constructed images of motherhood suggest that a "good" mother is caring, nurturing, and selfless-the perfect maternal figure. When these standards are not met, mother blaming (i.e., assigning fault to mothers) occurs even in child sexual abuse (CSA) cases. We collected 312 open-ended responses in total from 108 community-based participants to understand contextual factors that increase and decrease in mother fault in a CSA-related vignette depicting the mother's partner as the perpetrator. Thematic analysis revealed five main themes. Three themes were associated with decreased blame: Lack of Overt Knowledge (i.e., the mother had no direct knowledge of the CSA and thus cannot be blamed), Physical Act (i.e., the mother was not the actual perpetrator; only the perpetrator is responsible for the CSA), and Trust (i.e., the mother should be able to trust her partner). Two themes were associated with increased blame: Covert Knowledge (i.e., the mother was expected to have covert, intuitive knowledge of the CSA) and Mistrust (i.e., the mother should have known better than to trust her partner). Faulting mothers for the CSA of their child may reduce reporting of, and help seeking for, CSA, due to fear of being blamed.

Attributions of Blame among Victims of Child Sexual Abuse: Findings from a Community Sample

According to the attribution theory, negative outcomes of child sexual abuse (CSA) are thought to vary depending on whether CSA victims attribute the abuse to internal or external factors, respectively, self-blame and perpetrator-blame. Therefore, the purpose of this study was to identify abuse characteristics and attitudes that influence blame attributions among CSA victims from a community sample. Data from respondents with a history of CSA (N = 1,496) have been used in predicting blame attributions; perpetrator-blame, self-blame, or both. Results from a multinomial logistic regression analysis showed that attitudes toward gender roles had a significant effect on blame: victims were more likely to blame themselves when they endorsed more conservative gender attitudes than victims with more liberal attitudes. Implications for this finding are discussed.

Child-Parent Relationship Therapy with Extra-Familial Abused Children

Sexual abuse by a perpetrator outside of the family is the most prevalent form of child sexual abuse. It is associated with serious consequences for both the child and his family. Surprisingly, however, the issue of extra-familial sexual abuse has received very little research and clinical attention. The purpose of the current study was to explore the effectiveness of Child-Parent Relationship Therapy (CPRT), which uses nondirective play therapy tools, among parents of extra-familial abused children and their parents. In order to do so, data was collected from 51 parents who participated in CPRT, at three points in time: pretreatment stage, at the beginning of the first meeting; and in the post treatment stage. The data included the parents' reports via three questionnaires: Parenting Stress Inventory (PSI), Compassion Fatigue Self-Test (CFST), Child Behavior Checklist (CBCL). Overall, the results indicated a decrease in internalizing and externalizing symptoms among the children, as well as in parenting stress and in parental secondary trauma symptoms. This study contributes to the literature on interventions with victims of extra-familial child abuse and their parents. Specifically, the results highlight the benefits and importance of involving both parents and children in therapeutic interventions for victims of extra-familial child sexual abuse, with particular emphasis on the benefits of Child-Parent Relationship Therapy.

Impact of Perpetrator Type on Attributions of Mother Fault in Child Sexual Abuse

Blaming nonoffending mothers for child sexual abuse has substantial negative consequences for both the mother and child victim. Although perpetrator type has been shown to influence how much blame and responsibility is placed on nonoffending mothers in child sexual abuse cases, research to date has focused primarily on perpetrators who are strangers to the child or the child's biological father, ignoring the effect of other father-figure perpetrators. The current study examined how differences in perpetrator's relationship to the mother impacted blame, responsibility, cause, and prevention as separate constructs. One hundred and eight participants from an online community sample were randomly assigned to read a vignette describing a child sexual abuse situation with a female victim and one of two perpetrators: the victim's biological father or the mother's boyfriend. Participants assigned significantly higher levels of fault for CSA to the mother when the perpetrator was the mother's boyfriend. Implications and future directions are discussed.

Disclosure and Psychological Well-Being of Sexually Abused Adolescents in Hong Kong

The role of disclosure on psychological well-being of adolescents with child sexual abuse experience was investigated in a subsample of 74 disclosers among 800 adolescents recruited in the community in Hong Kong. The results supported that CSA experiences have differential impact on adolescents' psychological well-being. Family characteristics of the disclosers accounted for only a small amount of the variance in an array of psychological well-being measures. CSA characteristics were robust predictors of disclosers' sexual eroticism and externalizing behavioral symptoms. Disclosers' cognitive appraisal of CSA experience and quality of parental attachment were strong predictors of their self-esteem and internalizing behavioral problems. After controlling for the aforementioned factors, negative disclosure experience still significantly predicted lower self-esteem, higher sexual anxiety, more internalizing behavior, and more severe post-traumatic stress disorder responses. Research to understand the factors that generate negative disclosure experiences is needed for developing effective intervention strategies to mitigate the negative consequences of disclosure.

Female receptivity and secondary traumatization in the family

This paper addresses the question of gendered receptivity to Secondary Traumatic Syndrome (STS) in the family. Unlike other manifestations of distress in the family, where gender comparisons are a matter of course, very few such comparisons are made in studies of STS. Review of the findings of 12 studies, the only studies, to date, that provide data enabling the comparison of STS in males and females, shows that females in the family, whether daughters, wives, or mothers, are consistently more likely than the males, whether sons, husbands, or fathers, to experience the Posttraumatic Stress Disorder (PTSD) symptoms of a traumatized family member without having experienced the traumatic event itself. This pattern pertains to whether the event that precipitated the primary trauma was a collective or individual trauma and whether the STS sufferer was a child or adult or living or not living with the PTSD casualty. The Discussion points out that gender is an important factor in the development of STS, whether in interaction with role, beyond role, or both.

Pregnancy complications in women with childhood sexual abuse experiences

OBJECTIVE

Childhood sexual abuse (CSA) has an estimated prevalence of 20% and has a constantly growing list of known long-term consequences on physical as well as psychological health which may also influence obstetrical care attributed to it. However, scientific data on the association of CSA and pregnancy are sparse. Therefore, the study investigated pregnancy complications in women exposed to CSA.

METHODS

The study was designed as a cohort study comparing 85 women exposed to CSA with 170 matched unexposed women. CSA was identified by interview using modified questions from Wyatt [Child Abuse Negl 9 (1985) 507-519]. Data on pregnancy complications were collected by questionnaire and based on entries in a booklet (Mutterpass) in which all relevant data on pregnancy are documented at each prenatal consultation for any women attending prenatal care in Germany. Statistical analysis was performed with chi square, Fisher's Exact Test, and multiple logistic regression analysis to control the association between CSA and pregnancy complications for confounders significant in univariate analysis, i.e., physical abuse, other adverse experiences during childhood, abuse during pregnancy, substance abuse, and occupation.

RESULTS

Women exposed to CSA were significantly more often hospitalized during pregnancy (41.2%/19.4%; OR 2.91, CI 1.64-5.17). They presented more often complications such as premature contractions (38.8%/20%; OR 2.54 CI 1.43-4.51), cervical insufficiency (25.9%/9.4%; OR 3.36, CI 1.65-6.82), and premature birth (18.8%/8.2%; OR 2.58, CI 1.19-5.59).

CONCLUSION

Therefore, health care providers should adapt prenatal care to the specific needs of women exposed to CSA.

Teacher sexual misconduct: grooming patterns and female offenders

Educator sexual misconduct has received increasing attention over the past decade. The attention has exposed a number of concerning issues, including a lack of formal research in the area and difficulties in recognizing and prosecuting cases. Public responses to high profile cases of sexual misconduct involving female teachers suggest that gender-biased views on sex offenders remain prominent in society. This article will review the literature on female teacher sexual misconduct in addition to what is known about grooming patterns and warning signs. Finally, current dilemmas in resolving cases of educator sexual misconduct will be discussed, and basic prevention strategies will be recommended.

Factors linked to distress in mothers of children disclosing sexual abuse

The aim of the present study is to investigate the variability in clinical level of psychological distress experienced by mothers of sexually abused children by exploring the role of (a) abuse-related variables (length, severity, and identity of perpetrator), (b) a history of childhood sexual abuse and partner violence experienced in the past year, and (c) mothers' coping and feelings of empowerment. Data were collected through self-report measures completed by 149 French-speaking mothers of girls aged 4 to 12 years disclosing sexual abuse. Results revealed that more than half of the mothers reported clinical levels of psychological distress and experienced child sexual abuse, and 1 of 4 mothers experienced physical partner violence. Logistic regression analysis revealed that mother's sexual abuse and partner violence as well as avoidance coping and empowerment contributed to scores reaching clinical levels of psychological distress. In addition, mothers of child victims of intrafamilial sexual abuse are more likely to report clinical levels of distress. Results underscore the importance of evaluating for trauma history and taking coping strategies and empowerment into account in treatment interventions.

Influence of childhood sexual abuse on pregnancy, delivery, and the early postpartum period in adult women

OBJECTIVE

With a prevalence of around 20%, childhood sexual abuse (CSA) is a relevant problem in obstetric care. The aim of our systematic review was to present the current knowledge on the influence of CSA on pregnancy, delivery, and early parenthood.

DATA SOURCES

All English, French, or German primary and secondary literature from the reference lists found after screening the data banks Pubmed, PsycInfo, and Psyndex for publications that include the terms CSA or childhood traumatization and pregnancy, birth, delivery, labor, childbearing, breast feeding, or postpartum, and published after 1970 were reviewed for relevant data.

METHODS OF STUDY SELECTION

Investigations of psychological/medical data banks and cross references revealed 43 relevant studies. Given the paucity of data on this important subject, we opted to review all of these studies.

TABULATION, INTEGRATION, AND RESULTS

Although research projects on this topic are rare and the methodological quality of studies published to date is generally poor, women with a history of CSA seem to present a variety of long-term sequelae referring to pregnancy, delivery, and early parenthood. These sequelae include risk behaviors during pregnancy and disturbance of delivery by sudden memories of sexual abuse situations. Prenatal care is often complicated by the tendency to avoid situations that can trigger memories.

CONCLUSIONS

As effective treatment programs to improve sequelae of CSA are available today, the question of such abuse experiences should be raised as early as possible and adequate interdisciplinary models to care for victimized patients should be established. However, to improve knowledge on the long-term effect of sexual abuse experiences in obstetrical care, methodologically well-designed research projects focusing on the kind and incidence of sequelae, mediating factors as well as prophylactic and therapeutic options are needed.

Predictors of trauma symptomatology in sexually abused adolescents: a 6-month follow-up study

This study examines the natural course of trauma-specific symptoms 6 months after disclosure. Furthermore, this study investigates whether severity and type of abuse (intrafamilial or extrafamilial sexual abuse), negative appraisals, coping strategies, and crisis support measured at time of disclosure can be predictive of trauma symptoms 6 months later. Sixty-five sexually abused Flemish adolescents are reassessed 6 months after disclosure. Information from the participants is obtained through self-report questionnaires. Forty-six percent of the adolescents report clinically significant trauma symptoms. Although internalizing symptoms significantly decreases after 6 months, externalizing symptoms persist. Type or severity of the abuse does not account for differences in symptomatology. Two predictors of ongoing trauma symptomatology are identified: postdisclosure trauma symptomatology and a lack of initial crisis support. Information on the victims' postdisclosure symptomatology as well as information on the initial received social support is critical in understanding which abused adolescents are most at risk for poor outcomes in the long term.

Alleged sexual abuse at a day care center: impact on parents

OBJECTIVE

This report describes the cascade of stressful events and secondary life changes experienced by parents in a case of alleged sexual abuse at a day care program. The study evaluated parents' Posttraumatic Stress Disorder (PTSD) symptoms and general psychological responses to the stressful events 4 years after the alleged abuse, and explored predictive factors of parental distress.

METHODS

A total of 39 parents were interviewed about stressful events, life changes, and social support. Current distress reactions, psychological wellbeing, and locus of control were assessed with a battery of standardized measures.

RESULTS

Hearing about the sexual abuse, testifying in court, hearing the verdict, and being exposed in media reports were all rated by the parents as distressing events. The majority of the parents experienced secondary life changes after the alleged sexual abuse. Four years after the alleged sexual abuse, one-third of the parents reported a high level of PTSD Intrusive symptoms and one-fourth reported a high level of PTSD Avoidance symptoms. There was a significant positive correlation between a measure of psychological wellbeing and PTSD. Secondary life changes and locus of control significantly predicted PTSD.

CONCLUSION

This study demonstrates that the alleged sexual abuse of children in day care and the resulting events in the legal system and the media constitute significant and chronic stressors in the lives of the children's parents. These findings underscore the need to expand the focus of trauma-related sequelae from the child victim to their parents and family.

Predictors of attributions of self-blame and internalizing behavior problems in sexually abused children

BACKGROUND

The purpose of the present study was to identify predictors of two potential sequelae of child sexual abuse, self-blame attributions and internalizing behavior problems.

METHODS

In the study, detailed information was collected on 218 victims of sexual abuse aged 4 to 17, involved in criminal cases, about their background, the abuse, and their mother's reaction following discovery of the abuse.

RESULTS

Increased attributions of self-blame were predicted by the child having a close relationship with the perpetrator, experiencing severe sexual abuse (e.g., long-lasting abuse that involved penetration), perceiving the abuse as disgusting, and coping with the abuse by pretending it was not happening. Similar factors did not emerge as predictors of internalizing behavior problems.

CONCLUSIONS

Results suggest that different child and abuse characteristics predict the two sequelae often associated with childhood sexual abuse. Thus, although self-blame attributions and behavior problems are often considered similar consequences of sexual abuse, there appears a need to distinguish the two types of outcomes following sexual victimization in childhood.

Attributions and adjustment following child sexual and physical abuse

Individuals who experience child physical orsexual abuse are at greater risk for adjustment problems. However, the heterogeneity of symptomatology observed across individuals following child abuse suggests that outcome is determined by multiplefactors. The authors review literature examining the relationships among childhood physical or sexual abuse, attributions, and adjustment. Implications for application and future research are discussed.

Interpersonal functioning among women reporting a history of childhood sexual abuse: empirical findings and methodological issues

A subset of research exploring the long-term impact of child sexual abuse (CSA) has examined the adult interpersonal functioning of female survivors. The present review discusses empirical findings and critical methodological issues related to this important but often overlooked aspect of adult adjustment. Though characterized by several methodological limitations, this literature, as a whole, suggests that early sexual abuse represents a risk factor for a range of interpersonal dysfunction among female survivors, including problems with intimate partner relations, disturbed sexual functioning, and difficulties in the parental role. Suggested methodological improvements for future research include new approaches to the measurement of CSA and interpersonal variables, the need for comprehensive assessment of significant third variables, and the use of more representative sampling strategies.

Sexual abuse characteristics associated with survivor psychopathology

OBJECTIVE

This study was designed to examine predictors of psychopathology in non-clinically referred, sexually abused (SA) children, ages 6-16 years, 30-60 days following abuse disclosure and termination.

METHOD

Eighty SA children were administered a structured diagnostic interview and a variety of rating-scale instruments. Several forms of psychopathology were assessed, including posttraumatic stress, global functioning, anxiety, depression, and externalizing behavior. Abuse interviews also were used to guide the collection of demographic (victim age, gender) and abuse-related information (e.g., frequency of abuse).

RESULTS

Abuse-related factors and demographic variables accounted for greater than half of the variance predicting global functioning, and accurately predicted posttraumatic stress disorder (PTSD) status for 86% of the participants. Also, analyses yielded significant predictors of parent-reported attention problems and sexual behavior. Of additional importance, none of the abuse-related and demographic variables predicted scores on measures of general anxiety, depression, and externalizing behavior.

CONCLUSIONS

Specific demographic and sexual abuse information may, to some extent, be used to identify children who are at increased risk for short-term post-abuse psychopathology. Although the present findings suggest that such information may not be useful in the prediction of general anxiety, depression, and externalizing behavior, demographic and abuse-related variables importantly appear to account for significant variance in the prediction of global functioning, posttraumatic stress, attentiveness, and sexual behavior. Additional research is needed to improve mental health professionals' ability to identify SA children who are at high risk for psychopathology.

Extrafamilial sexual abuse: treatment for child victims and their families

OBJECTIVES

To decrease the emotional distress of child victims of extrafamilial sexual abuse (ESA) and their families. To provide crisis intervention, individual and group treatment in response to an expressed need in the community. To pilot the use of group treatment for child victims of ESA under age 10.

METHOD

This discussion describes intervention with a sample of 246 child victims, ages 2-14 years, and 323 parents who participated in the program from 1984 to 1991. This pilot project operated at a university medical facility and was located off campus in an outpatient child abuse center. Priority was given to child victims under age 7. Child victims and their families were evaluated after investigative interviews by law enforcement agencies were completed. A treatment plan was developed based on clinical assessment. Families participated in crisis counseling, individual treatment for the child victim and/or parent, Children's Treatment Groups, Parent Support Groups, or were referred to other resources. Clinical assessment of treatment progress included weekly case review by child and parent therapists, video analysis and observation of Children's Treatment Group sessions, consultation with parents and collateral contacts.

RESULTS

A family approach and services for parents in addition to intervention for child victims were determined to be key components in facilitating recovery. Clinical observations and client feedback showed positive outcomes for child victims and parents with crisis counseling, Children's Treatment groups, and Parent Support Groups. The extent of intervention ranged from one session to 24 months with an average participation of 6-9 months. Follow up surveys were returned by parents for 48 child victims and results are reported. Themes, parallels in responses, and recovery factors for child victims and parents are discussed.

CONCLUSIONS

The need for intervention and a community-based program was demonstrated by (1) the significant disruption in functioning that occurred for child victims of ESA and their families, (2) the risk for long term sequelae, (3) the high incidence of extrafamilial sexual abuse, and 4) the consistent, large number of requests for services. Family-centered crisis services, Children's Treatment Groups, and Parent Support Groups can be effectively based at child advocacy centers, out patient care clinics, or other community agencies. The results of formal outcome measures and longitudinal studies is needed to determine how child victims and parents benefit from specific treatment modalities and to better guide the use of limited resources.