Coping with incest: the relationship between recollections of childhood coping and adult functioning in female survivors of incest

Who Cares? Service Users' Opinions and Opportunities for Family Involvement in Mental Health Care

Involving families in mental health care can provide benefits to service users, their families and clinicians. However, family involvement is neither uniform nor routine. Understanding the complexities of this involvement is critical to improving application. This study sought to increase current knowledge about service users' opinions and opportunities for family involvement in mental health care. Data were collected from a total of 10 adult participants through 10 individual semi-structured interviews of approximately 30 min each. Findings are reported in accordance with COREQ and EQUATOR guidelines. Thematic analysis identified several consistent themes: respect for service user opinions of family involvement; opportunities for family involvement; negative and positive service user opinions of family involvement. Our findings support previous appeals for routine family involvement in care but extend this charge with the assertion that as important is a customary discussion with service users to ask their opinions about this involvement. Establishing this dialogue prior to treatment commencement has the potential to alleviate or resolve service user concerns and potentially improve and/or increase how families are engaged.

The Role of Coping Behaviors and Intoxication in Trauma Symptomology Subsequent to Sexual Victimization

College women are at an elevated risk for sexual victimization (SV) and secondary physical and psychological consequences. While some women experience negative outcomes such as posttraumatic stress disorder (PTSD), others experience reduced or complete absence of distress following SV. The variation in outcomes may be associated with the victim's level of intoxication, which may in turn affect their processing of and coping with the event. We examined the effects of SV severity on PTSD via coping and intoxication using a moderated mediation analysis among female college students (N = 375). Results demonstrate that coping mediates the association between SV severity and PTSD symptomology; however, intoxication did not moderate these associations. Results suggest that regardless of intoxication, SV severity influences various coping styles and plays an important role in a victim's adjustment post-victimization.

Childhood Sexual Abuse and Coping as Young Adults: The Roles of Attachment and Mattering

This study examined whether a history of childhood sexual abuse (CSA), attachment to mother, father, and friends, and mattering were related to the coping behaviors of 171 male and 85 female, ethnically diverse, low-income, young adults. The 74 survivors of CSA reported lower attachment to father and less mattering to parents than did the 97 who reported no abuse. Compared to male survivors, female survivors reported greater use of problem-focused coping and also perceived their abuse experience, particularly the use of force, as having a more negative impact on them. Stronger attachment to mother and to friends predicted more positive problem-focused coping. Mattering to friends moderated the relation between CSA history and problem-focused coping, with the CSA survivors who reported the highest mattering to friends also using the most problem-focused coping strategies. The role of attachment and mattering in problem-focused coping among young adults, especially those with a CSA history, is discussed.

Children's Coping and Perceptions of Coping Efficacy After Sexual Abuse: Links to Trauma Symptoms

Despite an emphasis on coping following childhood sexual abuse (CSA) to reduce trauma-related symptoms, very few studies have researched the associations between sexually abused children's coping and trauma-related difficulties, and perceived coping efficacy has been largely overlooked. The current study investigated whether children's use and perceived efficacy of avoidant, internalized, angry, and active/social coping strategies were associated with caregiver- and child-reported posttraumatic stress symptoms (PTSS), and caregiver-reported internalizing and externalizing symptoms among 202 sexually abused children (8-12 years; M = 10.47 years, SD = 1.70 years). Children reported using approximately eight types of coping strategies (M = 8.29, SD =2.50). Regression models indicated that internalized and angry coping were associated with child-reported PTSS. In contrast to expectations, none of the types of coping strategies were linked with caregiver's reports of PTSS or internalizing and externalizing symptoms. Interestingly, perceived efficacy of coping was largely unrelated to symptoms, with only perceived efficacy of avoidant coping inversely related to child-reported PTSS. Perceived efficacy was not tied to caregiver's reports of children's symptoms. Coping strategies may be associated with children's, but not caregiver's, reports of children's trauma-related difficulties. Furthermore, perceived efficacy of coping strategies may also be largely unrelated to children's symptoms, or children may have limited insight regarding the efficacy of their coping strategies. To further inform trauma-focused interventions that support effective long-term coping, future research should investigate which coping strategies children perceive to be efficacious, as well as potential reasons why.

Indirect Effects From Childhood Sexual Abuse Severity to PTSD: The Role of Avoidance Coping

Men who have sex with men (MSM) disproportionately experience childhood sexual abuse (CSA) compared with heterosexual men, often resulting in continued trauma-related sequelae, including symptoms of posttraumatic stress disorder (PTSD) such as avoidance. The variability in trauma-related sequelae may be associated with chronicity or duration of CSA. The relationship between duration of CSA and later PTSD symptom severity is not well understood, including the extent coping strategies account for these relationships. We used linear regression to examine these relationships and to assess the indirect effects of avoidance (behavioral disengagement and denial) and adaptive coping strategies on the relationship between CSA duration and adult PTSD symptom severity on a diverse sample included 290 MSM with a history of CSA. In adjusted models, CSA duration was significantly associated with adult PTSD symptom severity (standardized β = .23, p < .000) and with avoidance coping (standardized β = .19, p = .002). Separating this out, behavioral disengagement was significantly associated with CSA duration (standardized β = .20, p = .001) but denial was not. In adjusted analyses assessing indirect effects, avoidance coping partially accounted for the relationship between CSA duration and total trauma symptom severity (standardized β reduced from .23 to .17; Sobel = 2.90, p = .004). Similarly, behavioral disengagement partially accounted for the association between CSA duration and total symptoms (standardized β reduced from .23 to .18; Sobel = 2.68, p = .007). Avoidance coping, and behavioral disengagement specifically, may play a role in the severity of PTSD symptoms experienced by MSM with CSA histories. This work emphasizes the need for clinicians to consider behavioral disengagement in understanding PTSD symptom severity among MSM with histories of CSA.

Coping Strategies and Depression Among College Students Following Child Sexual Abuse in Turkey

The objective of this study was to investigate the relationship between type of coping style and depression in college students with child sexual abuse experience. A total of 1,055 college students completed self-report measures to assess depressive symptoms, coping strategies, and child sexual abuse history. This study was conducted with a subset of 125 college students who reported that they had been sexually abused in childhood. They were divided into depressive and nondepressive groups according to their depressive symptoms. Data was collected with the Childhood Sexual Abuse Measurement, the Beck Depression Inventory, and the Coping Styles of Stress Scale. Family characteristics were measured with a demographic questionnaire. Analyses involved multiple regression to test for predictive effects. Among college students with child sexual abuse histories, parental education level and both problem-focused and emotion-focused strategies significantly explained depression scores.

Evaluation of social and demographic characteristics of incest cases in a university hospital in Turkey

BACKGROUND

Incest is defined as any sexual activity between close blood relatives including step relatives and family members who are forbidden by law to marry. It is a problem that can be seen in all the social classes in developed and undeveloped societies. The World Health Organization classifies this problem as a silent health emergency. Father-daughter incest is reported to be the most common incest type followed by the other types like brother-sister, sister-sister and mother-son incest.

MATERIAL AND METHODS

Subjects for this study were recruited from a sample of incest cases referred to Forensic Medicine Department of Gaziosmanpasa University Medical Faculty Hospital between 2008 and 2012. Data involved social and demographic characteristics and clinical features of victims, perpetrators and the families. The ethical committee of the faculty of medicine approved the study.

RESULTS

The study sample consisted of 43 incest cases (36 females and 7 males) with an age rage 4-40 years. Two third of the victims were under 18 years old. All perpetrators were males. Father - daughter incest (34.9%) was found to be most common incest type followed by brother - sister incest (14%). 75% of the perpetrators were family members and relatives with consanguinity while 25% of them were not consanguineous but faithful and intimate relatives to victims.

CONCLUSIONS

Increasing awareness about incest and its damaging effects is so important and clinicians should keep in mind sexual abuse or incest when examining the risky population. Multidisciplinary approach is necessary for determining short term or long term results and preventing the negative consequences of incest.

Associations between past trauma, current social support, and loneliness in incarcerated populations

Background

Prisoners are a vulnerable population with higher rates of trauma than community populations. Social support is important for both in–prison adjustment and post-release community re-entry. Loneliness, a related construct to social support, has been found to be associated with elevated rates of suicidal ideation and behavior, depression, and hopelessness in incarcerated populations.

Methods

This study explored the relationship of past physical, sexual, and crime-related trauma to current perceived social support and loneliness in a mixed-gender sample of 235 depressed prisoners enrolled in depression treatment studies.

Results

History of any trauma, regardless of type, as well as physical, sexual, and crime-related traumas were associated with lower current perceived social support scores (controlling for gender). Past sexual trauma and crime-related trauma were associated with higher levels of loneliness (controlling for gender), though history of any trauma and physical trauma was not.

Conclusion

Findings suggest that both overall trauma and specific types of trauma are linked to perceived social support and loneliness among incarcerated persons with major depressive disorder. This is the first study, to the authors’ knowledge, that specifically observed a relationship between past trauma and current social support and loneliness in prison populations. Many intervention programs for prisoners encourage them to develop non-criminogenic and substance-free social networks. These programs should be aware that individuals who have experienced interpersonal trauma may have additional interpersonal challenges, and may need strategies to address interpersonal deficits related to trauma exposure.

Electronic supplementary material

The online version of this article (doi:10.1186/2194-7899-2-7) contains supplementary material, which is available to authorized users.

Childhood trauma and the development of paranormal beliefs

Belief in the paranormal is fairly prevalent in the general population. Previous research has shown a link between several personological characteristics and paranormal beliefs. The current study attempted to further investigate this link by replicating previous models that have shown a link between childhood trauma, fantasy proneness, and paranormal beliefs. In addition, the study attempted to expand on this model by including other variables such as stigma, resiliency, and coping style. The study used a sample of 198 undergraduate students. A significant correlation between trauma and paranormal beliefs was found. Partial correlations and path analyses revealed that fantasy proneness and avoidant coping style fully mediate the relationship between trauma and paranormal beliefs. The results imply that researchers need to take into account how a person responds to trauma via the development of coping strategies to accurately understand any observed relationship between trauma and paranormal beliefs.

Predictors of intimate partner violence revictimization: the relative impact of distinct PTSD symptoms, dissociation, and coping strategies

Psychological distress and coping strategies following intimate partner violence (IPV) victimization may impact survivors' risk for future IPV. The current study prospectively examined the impact of distinct posttraumatic stress disorder (PTSD) symptom clusters (reexperiencing, avoidance, numbing, and hyperarousal), dissociation, and coping strategies (engagement and disengagement coping) on IPV revictimization among recently abused women. Women (N = 69) who were seeking services for IPV and experienced their most recent episode of physical IPV between 2 weeks and 6 months prior to study enrollment completed measures of physical IPV, psychological distress, and coping strategies at baseline and at 6-month follow-up. The women averaged 36 years of age and 67% of the sample was African American. Separate Poisson regression analyses revealed that PTSD hyperarousal symptoms, dissociation, engagement coping, and disengagement coping each significantly predicted physical IPV revictimization at the 6-month follow-up (with effect sizes ranging from a 1.20-1.34 increase in the likelihood of Time 2 physical IPV with a 1 SD increase in the predictor). When these significant predictors were examined together in a single Poisson regression model, only engagement and disengagement coping were found to predict physical IPV revictimization such that disengagement coping was associated with higher revictimization risk (1.29 increase in the likelihood of Time 2 physical IPV with one SD increase in disengagement coping) and engagement coping was associated with lower revictimization risk (1.30 decrease in the likelihood of Time 2 physical IPV with one SD increase in engagement coping). The current findings suggest that coping strategies are important and potentially malleable predictors of physical IPV revictimization.

Child sexual abuse survivors with dissociative amnesia: what's the difference?

Although the issue of dissociative amnesia in adult survivors of child sexual abuse has been contentious, many research studies have shown that there is a subset of child sexual abuse survivors who have forgotten their abuse and later remembered it. Child sexual abuse survivors with dissociative amnesia histories have different formative and therapeutic issues than survivors of child sexual abuse who have had continuous memory of their abuse. This article first discusses those differences in terms of the moderating risk factors for developing dissociative amnesia (e.g., age, ethnicity, gender, etc.) and then mediating risk factors (e.g., social support, trait dissociativity, etc.). The differences between the two types of survivors are then explored in terms of treatment issues.

Perception vs. circumstances of the child sexual abuse event in relation to depression and post-traumatic stress symptomatology

The study examined the impact of the circumstances of childhood sexual abuse on post-traumatic stress symptoms and depression among female adult survivors of childhood sexual abuse. The sample consisted of 225 Israeli women divided into two groups according to the identity of the perpetrator (nonfamily perpetrator versus a family member perpetrator). A self-report questionnaire was used consisting of the following scales: demographic variables, the Traumatic Events Questionnaire, Childhood Sexual Experiences Scale, Post-Traumatic Stress Disorder Symptom Scale, and Depression Scale. The findings indicated that the identity of the offender significantly differed between groups only if intercourse had occurred. Women who experienced coerced intercourse scored significantly higher on depression and post-traumatic stress compared to those who experienced other forms of childhood sexual abuse.

Conceptualization of the complex outcomes of sexual abuse: a signal detection analysis

Eighty-five New Zealand based practitioners experienced in treating adults with a history of child sexual abuse participated in an online judgment study of child sexual abuse outcomes using signal detection theory methodology. Participants' level of sensitivity was assessed independent of their degree of response bias when discriminating (a) known child sexual abuse outcomes from behaviors thought to be unrelated to child sexual abuse and (b) direct child sexual abuse effects from subsequent coping strategies. Results demonstrated good sensitivity (accuracy) when identifying child sexual abuse effects from noneffects. When asked to discriminate direct child sexual abuse effects from ways of coping with distress, practitioners' accuracy was reduced, revealing a tendency to identify all effects as coping. Although treatment approaches highlight the pivotal role of identifying coping strategies, practitioners did not perceive maladaptive coping as a distinct clinical feature. Complex abuse cases may benefit from replacing maladaptive coping strategies (e.g., self-harm) with constructive coping (e.g., social support) in order to deliver efficacious practice.

Healing from childhood sexual abuse: a theoretical model

Childhood sexual abuse is a prevalent social and health care problem. The processes by which individuals heal from childhood sexual abuse are not clearly understood. The purpose of this study was to develop a theoretical model to describe how adults heal from childhood sexual abuse. Community recruitment for an ongoing broader project on sexual violence throughout the lifespan, referred to as the Sexual Violence Study, yielded a subsample of 48 women and 47 men who had experienced childhood sexual abuse. During semistructured, open-ended interviews, they were asked to describe their experiences with healing from childhood sexual abuse and other victimization throughout their lives. Constructivist grounded theory methods were used with these data to develop constructs and hypotheses about healing. For the Sexual Violence Study, frameworks were developed to describe the participants' life patterns, parenting experiences, disclosures about sexual violence, spirituality, and altruism. Several analytic techniques were used to synthesize the findings of these frameworks to develop an overarching theoretical model that describes healing from childhood sexual abuse. The model includes four stages of healing, five domains of functioning, and six enabling factors that facilitate movement from one stage to the next. The findings indicate that healing is a complex and dynamic trajectory. The model can be used to alert clinicians to a variety of processes and enabling factors that facilitate healing in several domains and to guide discussions on important issues related to healing from childhood sexual abuse.

Participatory dreaming: a unitary appreciative inquiry into healing with women abused as children

Unitary appreciative inquiry was used to explore healing in the lives of 11 women abused as children using a model of participatory dreaming. Aesthetics, imagery, and journaling were used in a participatory design aimed at the appreciation of healing in the lives of the participants as it related to the abuse. Using Cowling's theory of unitary healing, research and practice were combined within a unitary-transformative framework. Participatory dreaming was useful in illuminating the life patterning in the lives of the women and promoted the development of new knowledge and skills that led to change and transformation, both individually and collectively.

The effects of revictimization on coping and depression in female sexual assault victims

To examine the effects of being revictimized, 555 women completed 2 mail surveys 1 year apart, reporting their experiences of sexual assault, the strategies they used to cope with those experiences, and feelings of depression. Path analyses, controlling for baseline coping and depression, revealed that those who were revictimized during the study reported using more maladaptive and adaptive coping strategies than did those who were not revictimized (β = .11 and β = .16, respectively). Further, women who were revictimized reported more depression than others (β = .15). This effect was explained in part by revictimized women's increased maladaptive coping. Results are consistent with other research showing that all of women's traumatic experiences must be taken into consideration to understand fully how sexual assault influences women's coping and recovery.

Life-course typology of adults who experienced sexual violence

Two qualitative methodologies were used to develop a life-course typology of individuals who had been exposed to sexual violence. Interview narratives of 121 adult women and men who participated in qualitative study of women's and men's responses to sexual violence provided the data. The authors combined a narrative approach (holistic-content and holistic-form analysis) to describe the life courses of the participants and a qualitative person-oriented approach (cross-case analysis) to identify meaningful subgroups within the total sample. The six groups are as follows: (a) life of turmoil, (b) life of struggles, (c) diminished life, (d) taking control of life, (e), finding peace in life, and (f) getting life back to normal. This work exemplifies a promising strategy for identifying subgroups of violence-exposed individuals within a heterogeneous sample. Such a typology could aid the development of treatment approaches that consider both the substance and the structure of an individual's life course, rather than target one specific type of violence.

Coping with child sexual abuse among college students and post-traumatic stress disorder: the role of continuity of abuse and relationship with the perpetrator

OBJECTIVE

The purpose of this study was to examine the effects of child sexual abuse (CSA) on the use of coping strategies and post-traumatic stress disorder (PTSD) scores in young adults, as well as the role of avoidance and approach coping strategies in those PTSD scores in CSA victims. The role of coping strategies was studied by considering their possible interactive effect with the continuity of abuse and the relationship with the perpetrator; the effect of coping strategies on PTSD was also compared between CSA victim and non-CSA victim participants.

METHOD

The sample was comprised of 138 victims of CSA and another 138 participants selected as a comparison group. Data about child sexual abuse were obtained from a questionnaire developed for this purpose. Coping strategies were assessed with the How I Deal with Things Scale (Burt & Katz, 1987), while PTSD scores were assessed with the "Escala de Gravedad de Síntomas del Trastorno de Estrés Postraumático" (Severity of Symptoms of PTSD Scale; Echeburúa et al., 1997).

RESULTS

Participants who had been victims of CSA showed significantly higher PTSD scores and lower approach coping strategies scores. However, differences in avoidance coping strategies between groups were not consistent and did not always follow the expected direction. Only the use of avoidance coping strategies was related to PTSD, participants who used these showing higher scores. The effects of avoidance strategies were stronger in continued than in isolated abuse, in intrafamilial than in extrafamilial abuse and in CSA victims than in non-victims.

CONCLUSIONS

These results confirm the idea of CSA as a high-risk experience that can affect the victim's coping strategies and lead to PTSD to a lesser or greater extent depending on the coping strategy used. Moreover, the role of these strategies varies depending on whether or not the participant is a victim of CSA and on the characteristics of abuse (continuity and relationship with the perpetrator).

PRACTICE IMPLICATIONS

In terms of intervention, a reduction of avoidance-type strategies appears to have a beneficial effect, especially in the case of intrafamilial and/or continued CSA victims. The encouragement of "spontaneous" approach strategies (devised by the victim herself, without counseling) would probably not lead to more positive outcomes in terms of PTSD symptomatology. However, encouraging CSA survivors to engage in therapy aimed at developing effective approach strategies, as other studies have suggested, may help reduce PTSD symptoms.

Adult Coping with Childhood Sexual Abuse: A Theoretical and Empirical Review

Coping has been suggested as an important element in understanding the long-term functioning of individuals with a history of child sexual abuse (CSA). The present review synthesizes the literature on coping with CSA, first by examining theories of coping with trauma, and, second by examining how these theories have been applied to studies of coping in samples of CSA victims. Thirty-nine studies were reviewed, including eleven descriptive studies of the coping strategies employed by individuals with a history of CSA, eighteen correlational studies of the relationship between coping strategies and long-term functioning of CSA victims, and ten investigations in which coping was examined as a mediational factor in relation to long-term outcomes. These studies provide initial information regarding early sexual abuse and subsequent coping processes. However, this literature is limited by several theoretical and methodological issues, including a failure to specify the process of coping as it occurs, a disparity between theory and research, and limited applicability to clinical practice. Future directions of research are discussed and include the need to understand coping as a process, identification of coping in relation to adaptive outcomes, and considerations of more complex mediational and moderational processes in the study of coping with CSA.

Severity of Child Sexual Abuse and Revictimization: The Mediating Role of Coping and Trauma Symptoms

Child sexual abuse (CSA) has consistently been associated with the use of avoidant coping; these coping methods have been associated with increased trauma symptoms, which have, in turn, been linked to increased risk for adult sexual revictimization. Given these previous findings, the purpose of the current study was to test a model that conceptualized the relationships among these variables. Specifically, CSA severity was conceptualized as leading to the use of avoidant coping, which was proposed to lead to maintenance of trauma symptoms, which would, in turn, impact severity of revictimization indirectly. This comprehensive model was tested in a cross-sectional study of a large, geographically diverse sample of college women. Participants were 99 female undergraduates classified as having experienced CSA who completed measures of abuse history, coping style, current levels of trauma symptoms, and adult sexual revictimization. Multivariate path analysis indicated that the data fit the hypothesized model for verbally coercive, but not physically aggressive, revictimization. Specifically, increased CSA severity was associated with the use of avoidant coping, which, in turn, predicted greater levels of trauma symptomatology and severity of sexual coercion in adulthood. Although cross-sectional in nature, findings from this study suggest that coping strategies and trauma symptoms may represent modifiable factors that place women at increased risk for verbally coercive sexual revictimization.

PTSD Symptoms and Self-Rated Recovery Among Adult Sexual Assault Survivors: The Effects of Traumatic Life Events and Psychosocial Variables

Prior research has demonstrated that self-blame is predictive of more posttraumatic stress disorder (PTSD) symptoms and poorer recovery ( Frazier, 2003 ; Koss, Figueredo, & Prince, 2002 ), and perceived control over recovery is associated with less distress ( Frazier, 2003 ) in adult sexual assault (ASA) survivors. A structural equation model was tested to examine the role of traumatic events, self-blame, perceived control over recovery, and coping strategies on PTSD symptoms and self-rated recovery in women ASA survivors. Adaptive coping partially mediated the effects of other traumas, self-blame, and perceived control over recovery on PTSD symptoms and showed a small positive association with increased PTSD symptoms. As hypothesized, maladaptive coping partially mediated the effects of other traumas, self-blame, and perceived control over recovery on both PTSD symptoms and self-rated recovery; greater maladaptive coping was associated with increased PTSD symptoms and lower self-rated recovery. Implications and directions for future research are discussed.

Trauma coping strategies and psychological distress: A meta-analysis

The identification of adaptive and maladaptive coping strategies following traumatic events has been the subject of much scientific inquiry. The current study sought through meta-analysis to evaluate the relationship between the use of approach and avoidance strategies (both problem-focused and emotion/cognitive focused) following trauma and psychological distress. Thirty-nine studies of coping following two types of traumatic events (interpersonal violence and severe injury) were retained in the meta-analysis. There was a consistent association between avoidance coping and distress, overall r = .37, but no association between approach coping and distress, overall r = -.03, but some important moderators existed. Implications of the results for future research regarding coping and trauma recovery are discussed.

Relationship to perpetrator, disclosure, social reactions, and PTSD symptoms in child sexual abuse survivors

This research examined victim relationship to the perpetrator, disclosure characteristics, social reactions, and PTSD in adult survivors' of child sexual abuse (CSA) identified in a convenience sample of 733 college students. Results indicated that relationship to the perpetrator was related to CSA characteristics and outcomes. More negative reactions such as disbelief were observed for those victimized by relatives compared with acquaintance and stranger victims, especially for those disclosing in childhood. Victims of relatives had more PTSD symptoms if they delayed disclosure, received more negative reactions in childhood, and engaged in self-blame at the time of the abuse. Results are discussed in the context of Freyd's (1996) betrayal trauma theory, in order to better understand the traumatic impact of CSA.

Survivors of Childhood Sexual Abuse Diagnosed with Cancer

The incidence of survivors of childhood sexual abuse (CSA) diagnosed with cancer is unknown. It is estimated that one in three women and one in six men in the United States are survivors of CSA. Survivors of CSA diagnosed with cancer are presented with multiple and potentially accumulating traumas. The re-traumatizing nature of a cancer diagnosis and treatment affects all elements of the CSA survivor's care and may impede her/his treatment. To date, the impact of CSA on the medical treatment of people with cancer has been unexplored with the existing studies on female survivors of CSA with cancer focusing on the post-treatment experience and their higher incidence of sexual dysfunction. This article describes the impact of CSA on the cancer treatment of 18 survivors of CSA and the clinical interventions used to address the unique psychosocial needs of this population. Anecdotal information suggests that the survivors of CSA may find aspects of the cancer experience reminiscent of their history of abuse. All 18 survivors of CSA experienced distressing memories of their abuse during their cancer treatment. Fifteen CSA survivors presented traumatic memories that were inaccessible to conscious thought processes prior to their cancer diagnosis. Psychodynamic interventions address issues of disruption in the cancer treatment, non-adherence, and difficulties in relationships with the health care team. Containment of intense affect and distressing thoughts rather than exploration improved CSA survivors' adherence with cancer treatments. The acquisition of self-comforting skills helped CSA survivors feel less re-victimized by their cancer experience. The establishment of an environment of internal and external safety improved communication with the health care team. Health care/psychosocial clinicians' awareness and use of appropriate interventions can minimize the affects of re-traumatization and enhance the CSA survivor's treatment experience.

Spirituality and coping with life stress among adult survivors of childhood sexual abuse

OBJECTIVE

The purpose of this study was to explore the role of spiritual coping in adult survivors' responses to current life stressors. Although there has been research on general coping and adult survivors of childhood sexual abuse (CSA), there has been no work done on spiritual coping behaviour and survivors' current adjustment.

METHOD

One hundred and one adult survivors of childhood sexual abuse volunteered to participate in this study. Survivors were recruited through advertisements placed in various community venues. Survivors completed questionnaires on abuse descriptors, the coping resources of social support and general cognitive appraisal, spiritual coping and current distress. Spiritual coping was assessed in relation to a current negative life event.

RESULTS

In general, spiritual coping predicted the current distress of adult survivors beyond the contribution of demographics, severity of abuse, cognitive appraisal and support satisfaction. For example, self-directed (beta=.27), active surrender (beta=.32), and passive deferral (beta=-.35) significantly contributed to the prediction of anxious mood, [F(15, 60)=3.31, p<.0001], while only spiritual discontent (beta=.26) predicted depressive mood, [F(15, 60)=3.66, p<.0001] beyond the contribution of other factors. Negative forms of spiritual coping (e.g., spiritual discontent) tend to be related to greater distress, while more positive forms of spiritual coping (e.g., spiritual support) were related to less distress. For instance, spiritual discontent coping was related to greater depressive mood, while active surrender coping and religious forgiveness coping (i.e., seeking God's help to relinquish negative emotion) were associated with lower levels of depressive mood.

CONCLUSIONS

The results highlight the importance of making a distinction between negative and positive forms of spiritual coping when investigating the role of spirituality in the current life functioning of adult survivors of childhood sexual abuse.

Paternal and sibling incest: a case report

A case is reported of a female victim of paternal incest, who had also been raped repeatedly by her elder brother for two years. A survey of the literature showed no other report of such a case from Turkey. This does not necessarily mean that the incidence of paternal and sibling incest does not happen, but may indicate that incestuous abuse is not reported or handled without making it known to legal authorities. The victim was first raped by her 16 year-old brother when she was 9 years old. He raped her repeatedly over a period of two years, until he left home. Her father began raping the victim when she was 13 year-old, leaving her pregnant at age 15. He took her to a doctor for a termination of pregnancy. The father continued abuse after the termination. The victim left home to marry a man. The father filed a lawsuit against the man for taking the victim away from home. More openness and awareness of incest in Turkey may encourage the victims to seek help from medical and legal authorities.

Multidimensional assessment of resilience in mothers who are child sexual abuse survivors

OBJECTIVE

There has been relatively little attention given to positive adaptation following childhood sexual abuse (CSA), and typically such resilience has been explored primarily in the intrapersonal domain. This study explored questions about later resilience following CSA within a multidimensional framework by assessing resilience across intrapersonal, interpersonal, and intrafamilial domains.

METHOD

This community sample consisted of 79 mothers with a history of CSA who had a child living at home with them. Participants completed four outcome measures (Center for Epidemiologic Studies--Depression Scale, Parenting Stress Index [PSI] Health Scale, PSI Parenting Competence Scale, and a measure of marital satisfaction). Risk and protective factors examined in relation to outcome included mother's age, socioeconomic status, severity of the CSA experience, coping strategy (avoidance, seeking social support, and problem solving), child characteristics, and spousal/partner support.

RESULTS

Results indicated that when multiple adaptational domains were assessed, mothers showed discrepancies in how adequately they functioned across domains. While severity of the CSA experience was only weakly associated with outcome, use of avoidant coping emerged as a significant risk factor and was strongly and consistently associated with negative outcome across domains. Spousal/partner support was a strong protective factor and buffered the relationship between depressive symptoms and parenting competence. Difficult child characteristics were significantly associated with mothers' perceptions of physical health and parenting competence.

CONCLUSIONS

The findings suggest the importance of comprehensive multimethod assessments of resilience and extend the knowledge of factors associated with positive outcome. The results highlight the need for further research exploring current contextual risk and protective factors associated with resilience in each domain.

Gender differences in social reactions to abuse disclosures, post-abuse coping, and PTSD of child sexual abuse survivors

OBJECTIVE

This research examines the understudied issue of gender differences in disclosure, social reactions, post-abuse coping, and PTSD of adult survivors of child sexual abuse (CSA).

METHOD

Data were collected on a cross-sectional convenience sample of 733 college students completing a confidential survey about their demographic characteristics, sexual abuse experiences, disclosure characteristics, post-abuse coping, and social reactions from others.

RESULTS

Female students reported greater prevalence and severity of CSA, more distress and self-blame immediately post-assault, and greater reliance on coping strategies of withdrawal and trying to forget than male students. Women were more likely to have disclosed their abuse to others, to have received positive reactions, and to report greater PTSD symptom severity, but were no more likely to receive negative reactions upon disclosure than men. Women delaying disclosure had greater PTSD symptom severity, whereas men's symptoms did not vary by timing of disclosure. Additional regression analyses examined predictors of PTSD symptom severity and negative and positive social reactions to abuse disclosures.

CONCLUSIONS

Several gender differences were observed in this sample of college students in terms of sexual abuse experiences, psychological symptoms, coping, PTSD, and some aspects of disclosure and social reactions from others.

Trauma and women

Trauma is extremely prevalent in the lives of women, and the emotional, physical, social, and financial costs are often enduring and pervasive. Given its prevalence, all mental health professionals should receive training in the impact of trauma and learn the principles of its treatment. Although a considerable amount is known about the impact of trauma, much less is known about how to help survivors fully recover, especially women suffering from chronic, complex PTSD. Treatments must-be sensitive to issues of gender. Much research is needed, especially controlled, prospective studies to illuminate normal and pathological responses to trauma. Also needed are large epidemiological studies that compare the genders across trauma types and assess contextual issues of the trauma. We need to learn much more about the individual, family, and community resources that impart resilience, as well as impede recovery. Given the prevalence of violence, it will be impossible to resolve its impact on an individual basis. Interventions also need to be directed at system-level factors that foster violence.