The validity and appropriateness of methods, analyses, and conclusions in Rind et al. (1998): A rebuttal of victimological critique from Ondersma et al. (2001) and Dallam et al. (2001)

Subjective Reactions to First Coitus in Relation to Participant Sex, Partner Age, and Context in a German Nationally Representative Sample of Adolescents and Young Adults

Analysis of a Finnish nationally representative student sample found that subjective reactions to first intercourse (mostly heterosexual; usually in adolescence) were highly positive for boys and mostly positive for girls, whether involved with peers or adults (Rind, 2022). The present study examined the generality of these findings by examining subjective reactions to first coitus (heterosexual intercourse) in a German nationally representative sample of young people (data collected in 2014). Most first coitus was postpubertal. Males reacted mostly positively and uncommonly negatively in similar fashion in all age pairings: boy-girl (71% positive, 13% negative); boy-woman (73% positive; 17% negative); man-woman (73% positive, 15% negative). Females' reactions were more mixed, similar in the girl-boy (48% positive; 37% negative) and woman-man (46% positive, 36% negative) groups, but less favorable in the girl-man group (32% positive, 47% negative). In logistic regressions, adjusting for other factors, rates of positive reactions were unrelated to age groups. These rates did increase, in order of importance, when participants were male, their partners were close, they expected the coitus to happen, and they affirmatively wanted it. Reaction rates were computed from the Finnish sample, restricting cases to first coitus occurring in the 2000s, and then compared to minors' reactions in the German sample. The Finns reacted more favorably, similarly in both minor-peer and minor-adult coitus, with twice the odds of reacting positively. It was argued that this discrepancy was due to cultural differences (e.g., Finnish culture is more sex-positive). To account for the reaction patterns shown in the adolescent-adult coitus, sizably at odds with expectations from mainstream professional thinking, an evolutionary framework was employed.

Reactions to Minor-Older and Minor-Peer Sex as a Function of Personal and Situational Variables in a Finnish Nationally Representative Student Sample

Felson et al. (2019) used a large-scale nationally representative Finnish sample of sixth and ninth graders to estimate the population prevalence of negative subjective reactions to sexual experiences between minors under age 18 and persons at least 5 years older and between minors and peer-aged partners for comparison. They then accounted for these reactions in multivariate analysis based on contextual factors. The present study argued that focusing exclusively on negative reactions short-changed a fuller scientific understanding. It analyzed the full range of reactions in the same sample, focusing on positive reactions. For reactions in retrospect, boys frequently reacted positively to minor-older sex (68%, n = 280 cases), on par with positive reactions to boy-peer sex (67%, n = 1510). Girls reacted positively to minor-older sex less often (36%, n = 1047) and to girl-peer sex half the time (48%, n = 1931). In both minor-older and minor-peer sex, rates of positive reactions were higher for boys vs. girls, adolescents vs. children, when partners were friends vs. strangers or relatives, with intercourse vs. lesser forms of sexual intimacy, with more frequent sex, and when not coerced. Boys reacted positively more often with female than male partners. In minor-older sex, partner age difference mattered for girls but not boys, and the minor's initiating the sex (14% for girls, 46% for boys) produced equally high rates of positive reactions. Most of these factors remained significant in multivariate analysis. The frequency of positive reactions, their responsiveness to context, the similarity in reaction patterns with minor-peer sex, and the generalizability of the sample were argued to contradict the trauma view often applied to minor-older sex, holding it to be intrinsically aversive irrespective of context.

First Postpubertal Same-Sex Sex in Kinsey's General and Prison Male Same-Sex Samples: Comparative Analysis and Testing Common Assumptions in Minor-Adult Contacts

Kinsey's prison male same-sex sample (consisting of prisoners who were gay, bisexual, or had had extensive postpubertal same-sex sex regardless of sexual attractions) was compared with Kinsey's general (i.e., non-prison) same-sex sample (previously analyzed by Rind and Welter, 2016) in terms of reactions to and characteristics of first postpubertal same-sex sex, with a focus on minor-adult contacts. Prison participants had a minor-adult contact as their first postpubertal same-sex sex twice as often as general participants, and their experience involved penetration in three-quarters of cases compared to only half the time for general participants, and it was paid for (i.e., prostitution) three times as often. Despite these differences, reactions to these events by prison and general participants were the same, with combined results of 66% positive reactions (i.e., enjoyed it "much") versus 15% emotionally negative reactions (e.g., shock, disgust, guilt). Results added to those from a series of studies done since 2000 using male same-sex samples in showing that minor-adult same-sex sexual experiences in this population do not conform to the child sexual abuse (CSA) model of trauma and harm. Comparing prison and general participants also showed that the CSA-trauma-crime link often claimed (i.e., where minor-adult sex is said to produce trauma that leads to later criminal behavior) did not hold in the Kinsey same-sex samples, because trauma (the middle element) was mostly missing. This null result for the link alerts that trauma needs to be shown rather than assumed when considering this link. The positive reaction profile obtained was discussed in terms of cultural factors dominant in Kinsey's time.

What if the Child Appears to Enjoy It? Moral Attitudes Toward Adult-Child Sex Among Men With and Without Pedohebephilia

This study attempted to measure cognitions about adult-child sex by approaching the issue from a perspective of moral attitudes. We assessed ratings regarding direct and indirect harmfulness, nonconsent, exploitation, and differences in adults' and children's sexualities based on a description of adult-child sex without apparent child discomfort among an online sample of 120 pedohebephilic and 89 nonpedohebephilic German-speaking men. The results showed that only 7.5% among pedohebephilic men had equal or less permissive attitudes than the average control, while 4.5% of nonpedohebephilic men had equal or more permissive attitudes than the average pedohebephilic man. Both groups did not, however, differ in their appraisal that children may suffer indirect harm via stigmatization. The findings also indicate that the moral perception of adult-child sex shows little differentiation among German-speaking laypeople. We discuss the relevance of these findings for clinical practice and propose ideas for subsequent research.

First Postpubertal Male Same-Sex Sexual Experience in the National Health and Social Life Survey: Current Functioning in Relation to Age at Time of Experience and Partner Age

This study used an important data set to examine long-term adjustment and functioning in men, who as adolescents had sexual experiences with men. The data came from the National Health and Social Life Survey, which used a national probability sample (Laumann, Gagnon, Michael, & Michaels, 1994). Three perspectives were considered, which offered different predictions. From the "child sexual abuse" (CSA) paradigm, which dominates clinical, legal, and lay views, expected was robust evidence for poorer adjustment, given that intense harm is assumed to be intrinsic. From the "mainstream psychological" perspective, derived from the CSA paradigm but more scientifically based, poorer adjustment was also expected, but with less magnitude, given that minor-adult sex is seen as posing a serious risk of harm, which may not universally apply. From the "relevant-empirical" perspective, which infers response to male adolescent-adult same-sex sex from relevant prior empirical research (as opposed to clinical cases or the female experience), expected was little or no evidence for poorer adjustment. Results supported the relevant-empirical perspective. Compared to several control groups (i.e., men whose first postpubertal same-sex sex was as men with other men; men with no postpubertal same-sex sexual experience or child-adult sex), men whose first postpubertal same-sex sex was as adolescents with men were just as well adjusted in terms of health, happiness, sexual functioning, and educational and career achievement. Results are discussed in relation to cultural influences, other cultures, and comparative data from primates.

Young Adult Retrospective Reports of Adverse Childhood Experiences: Prevalence of Physical, Emotional, and Sexual Abuse in Italy

This study sought to understand the prevalence of childhood abuse in Italy using an instrument developed by the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) and adapted to the Italian context. The study participants were 312 young adults, 106 males (34%), and 206 females (64%), aged 18-24 years, from various northwest Italian universities and workplaces, using an ISPCAN Child Abuse Screening Tool retrospective questionnaire (ICAST-R). With reference to comparative data from other countries, the Italian context reveals a high incidence of emotional abuse (62%) followed by physical abuse (44%) and sexual abuse (18%). While males reported more physical abuse, females reported more exposure to sexual and emotional abuse. Moreover, the validity of the ICAST instrument was evaluated. The internal consistency for the three subscales was similar to the findings of previous studies, with Cronbach's alphas ranging from 0.51 for emotional abuse to 0.59 for sexual abuse. We observe that children undergo forms of emotional and physical maltreatment for disciplinary purposes, and for this reason, such abuse is excused. Greater prevention measures should be adopted in this direction. Finally, our study has contributed to the validation of the ICAST-R instrument for use in the Italian context.

Reactions to First Postpubertal Female Same-Sex Sexual Experience in the Kinsey Sample: A Comparison of Minors with Peers, Minors with Adults, and Adults with Adults

This study examined reactions to first postpubertal same-sex sexual experience in the Kinsey female same-sex sample (consisting of females with extensive postpubertal same-sex experience) as a function of participant and partner ages. As such, it complemented the Rind and Welter (2016) study, which examined the same in the Kinsey male same-sex sample. Data were collected by Kinsey interviewers between 1939 and 1961 (M year = 1947). Girls under 18 (M age = 14.9), whose sexual experience was with a woman (M age = 26.3), reacted positively just as often as girls under 18 (M age = 14.1) with peers (M age = 15.0) and women (M age = 22.7) with women (M age = 26.3). The positive-reaction rates were, respectively, 85, 82, and 79 %. In a finer-graded analysis, younger adolescent girls (≤14) (M age = 12.8) with women (M age = 27.4) had a high positive-reaction rate (91 %), a rate reached by no other group. For women (M age = 22.2) with same-aged peers (M age = 22.3), this rate was 86 %. Girls with peers or women had no emotionally negative reactions (e.g., fear, disgust, shame, regret); women with women rarely did. Results contradicted prevailing clinical, legal, and lay beliefs that minor-adult sex is inherently traumatic and would be distinguished as such compared to age-concordant sex. The findings are discussed in terms of the time period in which the sexual experiences occurred.

Reactions to First Postpubertal Male Same-Sex Sexual Experience in the Kinsey Sample: A Comparison of Minors With Peers, Minors With Adults, and Adults With Adults

Rind and Welter (2014) examined first postpubertal coitus using the Kinsey sample, finding that reactions were just as positive, and no more negative, among minors with adults compared to minors with peers and adults with adults. In the present study, we examined first postpubertal male same-sex sexual experiences in the Kinsey same-sex sample (i.e., participants mostly with extensive postpubertal same-sex behavior), comparing reactions across the same age categories. These data were collected between 1938 and 1961 (M year: 1946). Minors under age 18 years with adults (M ages: 14.0 and 30.5, respectively) reacted positively (i.e., enjoyed the experience "much") often (70 %) and emotionally negatively (e.g., fear, disgust, shame, regret) infrequently (16 %). These rates were the same as adults with adults (M ages: 21.2 and 25.9, respectively): 68 and 16 %, respectively. Minors with peers (M ages: 13.3 and 13.8, respectively) reacted positively significantly more often (82 %) and negatively nominally less often (9 %). Minors with adults reacted positively to intercourse (oral, anal) just as often (69 %) as to outercourse (body contact, masturbation, femoral) (72 %) and reacted emotionally negatively significantly less often (9 vs. 25 %, respectively). For younger minors (≤14) with adults aged 5-19 years older, reactions were just as positive (83 %) as for minors with peers within 1 year of age (84 %) and no more emotionally negative (11 vs. 7 %, respectively). Results are discussed in relation to findings regarding first coitus in the Kinsey sample and to the cultural context particular to Kinsey's time.

Assessment of the Harmful Psychiatric and Behavioral Effects of Different Forms of Child Maltreatment

IMPORTANCE

Several widely held beliefs about child abuse and neglect may be incorrect. It is most commonly assumed that some forms of abuse (eg, physical and sexual abuse) are more harmful than others (eg, emotional abuse and neglect); other assumptions are that each form of abuse has specific consequences and that the effects of abuse differ across sex and race.

OBJECTIVE

To determine whether widely held assumptions about child abuse and neglect are valid by testing the hypothesis that different types of child maltreatment (CM) actually have equivalent, broad, and universal effects.

DESIGN, SETTING, AND PARTICIPANTS

This observational study assessed 2292 racially and ethnically diverse boys (1254 [54.7%]) and girls (1038 [45.3%]) aged 5 to 13 years (mean [SD] age, 9.0 [2.0] years) who attended a research summer camp program for low-income, school-aged children from July 1, 1986, to August 15, 2012. Of these children, 1193 (52.1%) had a well-documented history of maltreatment. Analysis was conducted from September 25, 2013, to June 1, 2015.

MAIN OUTCOMES AND MEASURES

Various forms of internalizing and externalizing personality and psychopathologic traits were assessed using multiple informant ratings on the California Child Q-Set and Teacher Report Form as well as child self-reported depression and peer ratings of aggression and disruptive behavior.

RESULTS

Structural analysis showed that different forms of CM have equivalent psychiatric and behavioral effects, ranging from anxiety and depression to rule-breaking and aggression. We also found that nonsexual CM alters 2 broad vulnerability factors, internalizing (β = 0.185; SE = 0.028; P < .001) and externalizing (β = 0.283; SE = 0.023; P < .001), that underlie multiple forms of psychiatric and behavioral disturbance. We show that CM has comparable consequences for boys and girls of different races, and our results allowed us to describe a base rate and co-occurrence issue that makes it difficult to identify the unique effects of child sexual abuse.

CONCLUSIONS AND RELEVANCE

Our findings challenge widely held beliefs about how child abuse should be recognized and treated-a responsibility that often lies with the physician. Because different types of child abuse have equivalent, broad, and universal effects, effective treatments for maltreatment of any sort are likely to have comprehensive psychological benefits. Population-level prevention and intervention strategies should emphasize emotional abuse, which occurs with high frequency but is less punishable than other types of child maltreatment.

Enjoyment and emotionally negative reactions in minor–adult versus minor–peer and adult–adult first postpubescent coitus: A secondary analysis of the Kinsey data

Using the original Kinsey sample, enjoyment and emotionally negative reactions to first postpubescent coitus were examined in relation to whether the coitus occurred as a legal minor (aged under 18) with an adult (5 or more years older), a minor with a peer (within 4 years of age), or an adult with an adult (both 18 or older). These responses were further examined in subdivisions of the minor–adult and adult–adult categories. Given widely held professional and lay assumptions that minor–adult sex is intrinsically traumatic or aversive, tested was whether reactions to minor–adult coitus were characteristically negative, irrespective of gender, and distinctly more negative than minor–peer and adult–adult coitus. In general: minors with adults enjoyed the event as much as minors with peers or adults with adults; boys (i.e., male minors) enjoyed it substantially more than girls, irrespective of partner age; and minors with adults did not have more emotionally negative reactions than the other groups. Younger boys (14 and under) with women (mean ages: 13.37 and 24.27, respectively; mean age difference: 10.90 years), compared to men with peer-aged women (mean ages: 21.76 and 21.58, respectively; mean age difference: 0.18 years), enjoyed the coitus a great deal (the top scale value) significantly more often (63 % vs. 44 %) and had emotionally negative reactions no more often (15 % vs. 12 %). Younger girls (14 and under) with men (mean ages: 13.19 and 26.42, respectively; mean age difference: 13.23 years), compared to women with peer-aged men (mean ages: 22.38 and 23.78, respectively; mean age difference: 1.41 years), enjoyed the coitus a great deal at the same rate (17 % vs. 18 %) and had emotionally negative reactions no more often (18 % vs. 16 %). Assumptions of characteristic trauma or aversiveness in minor–adult first coitus, as well as gender equivalence in response, were contradicted.

Homosexual orientation-from nature, not abuse: A critique of Roberts, Glymour, and Koenen (2013)

Roberts, Glymour, and Koenen (2013), using instrumental variable models, argued that child abuse causes homosexual orientation, defined in part as any same-sex attractions. Their instruments were various negative family environment factors. In their analyses, they found that child sexual abuse (CSA) was more strongly related to homosexual orientation than non-sexual maltreatment was, especially among males. The present commentary therefore focused on male CSA. It is argued that Roberts et al.'s "abuse model" is incorrect and an alternative is presented. Male homosexual behavior is common in primates and has been common in many human societies, such that an evolved human male homosexual potential, with individual variation, can be assumed. Cultural variation has been strongly influenced by cultural norms. In our society, homosexual expression is rare because it is counternormative. The "counternormativity model" offered here holds that negative family environment weakens normative controls and increases counternormative thinking and behavior, which, in combination with sufficient homosexual potential and relevant, reinforcing experiences, can produce a homosexual orientation. This is a benign or positive model (innate potential plus release and reinforcement), in contrast to Roberts et al.'s negative model (abuse plus emotional compensation or cognitive distortion). The abuse model is criticized for being based on the sexual victimological paradigm, which developed to describe the female experience in rape and incest. This poorly fits the gay male experience, as demonstrated in a brief non-clinical literature review. Validly understanding male homosexuality, it is argued, requires the broad perspective, as employed here.

Hebephilia as mental disorder? A historical, cross-cultural, sociological, cross-species, non-clinical empirical, and evolutionary review

Blanchard et al. (2009) demonstrated that hebephilia is a genuine sexual preference, but then proposed, without argument or evidence, that it should be designated as a mental disorder in the DSM-5. A series of Letters-to-the-Editor criticized this proposal as a non sequitur. Blanchard (2009), in rebuttal, reaffirmed his position, but without adequately addressing some central criticisms. In this article, we examine hebephilia-as-disorder in full detail. Unlike Blanchard et al., we discuss definitions of mental disorder, examine extensive evidence from a broad range of sources, and consider alternative (i.e., non-pathological) explanations for hebephilia. We employed Wakefield's (1992b) harmful dysfunction approach to disorder, which holds that a condition only counts as a disorder when it is a failure of a naturally selected mechanism to function as designed, which is harmful to the individual in the current environment. We also considered a harmful-for-others approach to disorder (Brülde, 2007). Examination of historical, cross-cultural, sociological, cross-species, non-clinical empirical, and evolutionary evidence and perspectives indicated that hebephilic interest is an evolved capacity and hebephilic preference an expectable distributional variant, both of which were adaptively neutral or functional, not dysfunctional, in earlier human environments. Hebephilia's conflict with modern society makes it an evolutionary mismatch, not a genuine disorder. Though it should not be classified as a disorder, it could be entered in the DSM's V-code [corrected] section, used for non-disordered conditions that create significant problems in present-day society.

A Meta-Meta-Analysis: Empirical Review of Statistical Power, Type I Error Rates, Effect Sizes, and Model Selection of Meta-Analyses Published in Psychology

This article uses meta-analyses published in Psychological Bulletin from 1995 to 2005 to describe meta-analyses in psychology, including examination of statistical power, Type I errors resulting from multiple comparisons, and model choice. Retrospective power estimates indicated that univariate categorical and continuous moderators, individual moderators in multivariate analyses, and tests of residual variability within individual levels of categorical moderators had the lowest and most concerning levels of power. Using methods of calculating power prospectively for significance tests in meta-analysis, we illustrate how power varies as a function of the number of effect sizes, the average sample size per effect size, effect size magnitude, and level of heterogeneity of effect sizes. In most meta-analyses many significance tests were conducted, resulting in a sizable estimated probability of a Type I error, particularly for tests of means within levels of a moderator, univariate categorical moderators, and residual variability within individual levels of a moderator. Across all surveyed studies, the median effect size and the median difference between two levels of study level moderators were smaller than Cohen's (1988) conventions for a medium effect size for a correlation or difference between two correlations. The median Birge's (1932) ratio was larger than the convention of medium heterogeneity proposed by Hedges and Pigott (2001) and indicates that the typical meta-analysis shows variability in underlying effects well beyond that expected by sampling error alone. Fixed-effects models were used with greater frequency than random-effects models; however, random-effects models were used with increased frequency over time. Results related to model selection of this study are carefully compared with those from Schmidt, Oh, and Hayes (2009), who independently designed and produced a study similar to the one reported here. Recommendations for conducting future meta-analyses in light of the findings are provided.

ISPCAN Child Abuse Screening Tools Retrospective version (ICAST-R): Delphi study and field testing in seven countries

OBJECTIVES

To gain consensus among an ethnically and linguistically diverse group of international child protection experts on the structure and content of a new survey tool for retrospective measurement of child abuse, and to determine the performance of the instrument through an international field trial with young adults.

METHODS

The questionnaire was developed through focus group discussions with international experts, and then subjected to a Delphi study in two waves to determine the perceived importance and translatability of items. The resultant questionnaire was translated into six languages and field tested in seven countries with convenient samples of young adults aged 18-26 years (N=842).

RESULTS

Child maltreatment experts from 28 countries provided input to questionnaire development. Satisfactory agreement on draft item inclusion and exclusion and the translatability of items was gained. The tool includes 15 primary questions about potentially abusive physical, sexual and emotional events, with follow-up questions about perpetrator characteristics, frequency of acts and periods in childhood when the recalled abuse occurred. The field test revealed lifetime prevalence per item usually exceeded 10% (11/15 items; range 2.1-49.5%). Internal consistency (Cronbach's alpha) was moderate to high for each of three item sub-sets (between .61 and .82) and the rates of missing data were low (less than 1.5% for 14 of 15 items). The great majority of respondents nominated either peer and/or adult perpetrators (between 82.3% and 98.2% depending upon the item), and among these, child/adolescent peers and non-family adults (including teachers for emotional and physical acts) were nominated often.

CONCLUSIONS

The ICAST-R is based on consensus from international experts, translates clearly and has satisfactory properties for adoption as a survey tool to estimate prevalence and describe perpetrators and other contextual aspects of child abuse.

PRACTICE IMPLICATIONS

This tool can be utilized in a broad range of cultures and languages and may contribute to improved research practice. Although the core items are limited to just 15 acts of maltreatment, if these behaviorally specific questions are adopted as key indicators and incorporated into comprehensive local, national or regional surveys, eventually there should be greater comparability in survey estimates.

Unwanted early sexual experiences among Belgian and South African university women students

This study examined the unwanted early sexual experiences of 736 South African and 1,587 Belgian women students. The Early Sexual Experiences Checklist was administered to all consenting women students attending orientation programmes at a Belgian and a South African university. Respondents were Belgians (M age = 18.2 yr., SD = 1.0) and South Africans (M age = 19.6 yr., SD = 4.1). Such experiences were found for 31.3% (231) of South African respondents and 14.2% (226) of Belgian respondents. 64% of South African women indicated that such an experience occurred only once, and 65% of Belgian women reported this also. 34% of Belgian and 32% of South African respondents reported not being bothered at all by the unwanted experience at the time the event took place; 23% of Belgian and 36% of South African respondents were extremely bothered by the experience.

Childhood sexual experiences and adult health sequelae among gay and bisexual men: defining childhood sexual abuse

Gay and bisexual men carry the burden of HIV infections in the United States and have high rates of childhood sexual abuse that predict HIV and other health outcomes. This study examined differential effects of forced, consensual, and no childhood sexual experiences (CSE) on health outcomes among a probability sample of adult men who have sex with men (MSM). The forced sex group had the highest levels of psychological distress, substance use, and HIV risk. There were no differences in rates of depression and suicidal ideation between the consensual- and no-sex groups. The consensual- and forced-sex groups had higher rates of substance use and transmission risk than the no-sex group. The forced-sex group, however, had significantly higher rates of frequent drug use and high-risk sex than the consensual group. Findings suggest that forced CSEs result in a higher-risk profile than consensual or no childhood sexual experiences, the kind of risk pattern differs between forced and consensual childhood sexual experiences, and the underlying mechanisms that maintain risk patterns may vary. It is important to clarify risk patterns and mechanisms that maintain them differentially for forced and consensual sex groups so that interventions may be tailored to the specific trajectories related to each experience.

Young women's social and occupational development and mental health in the aftermath of child sexual abuse

We examined social role functioning and depressive symptoms of young adults who were abused as children in data from a longitudinal community sample. Sexually abused women and men were more depressed during their senior year of high school, and this difference was more pronounced 2 years later. We then examined a mediational model to determine whether social functioning explained the course of depressive symptoms over this transitional period. Focusing only on young women, for whom the prevalence of abuse was much higher, results indicated that two-thirds of the effect of abuse on depressive symptoms was explained by experiences and choices in the domains of work, education and intimate relationships. Having less supportive intimate relationships and lower rates of attendance at 4-year colleges were particularly important. Findings reveal the key role played by early adult interpersonal and occupational development in perpetuating the mental health impact of childhood trauma.

National samples, sexual abuse in childhood, and adjustment in adulthood: a commentary on Najman, Dunne, Purdie, Boyle, and Coxeter (2005)

This article comments on the Najman, Dunne, Purdie, Boyle, and Coxeter (2005) study on the relationship between childhood sexual abuse (CSA) and later sexual functioning in an Australian national sample. We note the value of the Najman et al. study, being well conducted and using a generalizable sample, but critique Najman et al.'s interpretation that their study showed "significant impairment" due to the CSA. We computed effect sizes to show that the "effects" were small, and then show using meta-analysis that these small effects were consistent with results in a series of national samples from other countries. We argue that Najman et al.'s causal statement about CSA's "impairment" effect was unwarranted given their lack of causal analysis, the well-established fact in other research that CSA is often confounded with third variables, and the fact that CSA was confounded with a key third variable in Najman et al.'s study. Given the hyperbole that surrounds the issue of CSA, we emphasize the need for researchers to adhere to valid scientific principles in inference and precision when reporting the results of CSA research.

Child sexual abuse

Child sexual abuse is a worldwide concern. It is an insidious, persistent, and serious problem that, depending on the population studied and definition used, affects 2-62% of women and 3-16% of men as victims. Pain and tissue injury from child sexual abuse can completely heal in time, but psychological and medical consequences can persist through adulthood. Associated sexually transmitted diseases (such as HIV) and suicide attempts can be fatal. All physicians who treat children should be aware of the manifestations and consequences of child sexual abuse, and should be familiar with normal and abnormal genital and anal anatomy of children. This aim is best accomplished through training and routine examination of the anus and genitalia of children. Because as many as 96% of children assessed for suspected sexual abuse will have normal genital and anal examinations, a forensic interview by a trained professional must be relied on to document suspicion of abuse.

Childhood and adult sexual abuse, rumination on sadness, and dysphoria

OBJECTIVE

The study addressed the hypothesis that adults reporting sexual abuse are more likely to exhibit a general tendency to ruminate on sadness. The relations between reported abuse, rumination on sadness, and dysphoria were also examined.

METHOD

Undergraduate students (101 women and 100 men) reported on childhood and adult sexual abuse and instances of intimidation, as well as completing the Rumination on Sadness Scale [Journal of Personality Assessment 75 (2000) 404] and the Beck Depression Inventory [Depression: Clinical, Experimental, and Theoretical Aspects, Harper & Row, New York].

RESULTS

Participants who reported more abuse were more likely to report rumination on sadness. Both reports of abuse and of rumination were linked to dysphoria. Overall, causal modeling indicated that two models were equally effective in accounting for the data: (a) victimization leads to dysphoria, with this relation being partly mediated by rumination and (b) victimization leads to dysphoria, which in turn leads to rumination. Both models are consistent with prior research. For men considered separately, both models were equally effective. For women, model a best accounted for the data.

CONCLUSION

One of the pathways by which victimization may lead to depression in adulthood is by encouraging the development of a tendency to ruminate on sadness. Alternatively, victimization may lead to depression by other means, and the experienced depression or dysphoria may foster rumination.

Progress and controversy in the study of posttraumatic stress disorder

Research on posttraumatic stress disorder (PTSD) has been notable for controversy as well as progress. This article concerns the evidence bearing on the most contentious issues in the field of traumatic stress: broadening of the definition of trauma, problems with the dose-response model of PTSD, distortion in the recollection of trauma, concerns about "phony combat vets," psychologically toxic guilt as a traumatic stressor, risk factors for PTSD, possible brain-damaging effects of stress hormones, recovered memories of childhood sexual abuse, and the politics of trauma.

Motivational, ethical, and epistemological foundations in the treatment of unwanted homoerotic attraction

A recent special section of the Journal of Marital and Family Therapy (October, 2000) focusing on the mental health needs of gay, lesbian, and bisexual individuals neglected to address the clinical needs of homosexual persons who desire to increase their heterosexual potential. This article attempts to correct this omission by outlining common motivations for pursuing change, updating the current state of knowledge regarding the effectiveness of change efforts, and providing some ethical guidelines when therapists encounter clients who present with unwanted homoerotic attraction. Finally, to assist marriage and family therapists (MFTs) in more deeply understanding divergent perspectives about reorientation treatments, an examination of the role of moral epistemology is presented and some examples of its potential influence are described. MFTs are encouraged to recognize and accept, rather than ignore or deny the valid needs of clients who seek to modify their same-sex attraction.