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

"Like A Mouse Pursued By the Snake": A Qualitative Metasynthesis on the Experiences of Revictimization Among Women Survivors of Childhood Sexual Abuse and Partner Violence

A metasynthesis was performed on 15 qualitative studies to document the experience of revictimization by an intimate partner among women, based on survivors' perspectives on their sustained childhood sexual abuse and intimate partner violence victimization. Results identified two main conceptual categories: (a) Barriers to action: A belief system reflecting learned helplessness that hinders women's abilities to protect themselves and prevent further abuses, and (b) Broken internal compass: Cognitive elements blurring women's risk evaluation capacities and reference points limiting their ability to break the cycle of revictimization. These findings support the need to examine cognitive distortions and false beliefs in intervention practices and suggest valuable guidelines for practitioners. As the responsibility for violence always lies with the perpetrator, this study should not be interpreted as blaming women for their victimization, but instead, as a way to give women a voice about their experiences and give them a sense of power in the prevention of violence.

Exploring the Experiences of Regional and Rural Revictimized Women in a Group Empowerment Program

Sexual revictimization can have a negative impact on many facets of women's wellbeing, yet limited evidence exists regarding specific interventions that support healing and the reduction of further revictimization. This paper will explore regional and rural women's experience of a group-based empowerment program, the Shark Cage program, in Victoria, Australia. The "Shark Cage" program aims to address revictimization by empowering women and girls to build personal boundaries and assertiveness within the context of gender equality and human rights. Data were collected via participant observations across the 8-week program, in combination with semi-structured interviews with participants (N = 11) pre and post intervention. All participants had access to therapeutic support outside of the program. Findings indicate that the program fostered connections among women with shared experiences of sexual revictimization, reducing feelings of isolation. Participants detailed the benefit of developing and practicing skills in reducing revictimization, such as assertiveness and boundary setting. Program learning and recovery was embedded within a network of embodied emotions, social connections, cultural norms and place-based relations that influenced how participants recovery could be understood, processed and addressed.

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

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

Impacts of child sexual abuse: The mediating role of future orientation on academic outcomes

BACKGROUND

Child Sexual Abuse (CSA) has significant impacts on an individual's physical and mental well-being including substance use, depression, anxiety, post-traumatic stress disorder, relationship issues, as well as sexual revictimization in adulthood. Positive future orientation is associated with higher educational outcomes and successful goal attainment, but CSA survivors have lower educational attainment and less employment opportunities leading to less financial security in adulthood.

OBJECTIVE

Our study seeks to examine whether future orientation mediates the relationship between CSA and academic outcomes using data from the Kaplan Longitudinal and Multigenerational Study (KLAMS).

PARTICIPANTS & SETTING

KLAMS is a U.S. based panel study which captures information about the mental health, relationships, academic outcomes, and deviant behavior of two generations of family members at multiple points in time. In the present study, we use data from two separate interviews with the children (N = 2084) of the original respondents.

METHODS

We estimated a series of regressions using generalized structural equation modeling to examine the relationship between child sexual abuse, future orientation, and three different types of academic outcomes.

RESULTS

Youth who experienced sexual abuse had lower grades in school, were more likely to drop out, and had lower levels of education than children with no history of sexual abuse. Negative future orientation mediated the relationship between child sexual abuse and all three outcomes.

CONCLUSIONS

In support of existing research, we found child sexual abuse has a negative impact on positive future orientation, and positive future orientation contributes to better academic outcomes.

Childhood maltreatment and adulthood victimization: An evidence-based model

There is ample evidence showing that childhood maltreatment increases two to three fold the risk of victimization in adulthood. Various risk factors, including posttraumatic stress disorder (PTSD) symptoms, dissociation, self-blame, and alcohol abuse are related to revictimization. Although previous research examined associations between risk factors for revictimization, the evidence is limited and the proposed models mostly include a handful of risk factors. Therefore, it is critical to investigate a more comprehensive model explaining the link between childhood maltreatment and adulthood (re)victimization. Accordingly, this study tested a data-driven theoretical path model consisting of 33 variables (and their associations) that could potentially enhance understanding of factors explaining revictimization. Cross-sectional data derived from a multi-wave study were used for this investigation. Participants (N = 2156, age mean = 19.94, SD = 2.89) were first-year female psychology students in the Netherlands and New Zealand, who responded to a battery of questionnaires and performed two computer tasks. The path model created by structural equation modelling using modification indices showed that peritraumatic dissociation, PTSD symptoms, trauma load, loneliness, and drug use were important mediators. Attachment styles, maladaptive schemas, meaning in life, and sex motives connected childhood maltreatment to adulthood victimization via other factors (i.e., PTSD symptoms, risky sex behavior, loneliness, emotion dysregulation, and sex motives). The model indicated that childhood maltreatment was associated with cognitive patterns (e.g., anxious attachment style), which in turn were associated with emotional factors (e.g., emotion dysregulation), and then with behavioral factors (e.g., risky sex behavior) resulting in revictimization. The findings of the study should be interpreted in the light of the limitations. In particular, the cross-sectional design of the study hinders us from ascertaining that the mediators preceded the outcome variable.

Pathways from childhood sexual abuse to sexual aggression victimization and perpetration in adolescence and young adulthood: a three-wave longitudinal study

BACKGROUND

Childhood sexual abuse (CSA) has been identified as a risk factor for later sexual aggression perpetration and vulnerability factor for sexual victimization. However, the use of cross-sectional designs, the focus on female victimization and male perpetration, and the lack of evidence from outside North America limit the existing knowledge base.

OBJECTIVE

The study was designed to examine pathways from CSA to sexual revictimization and sexual aggression perpetration after the age of consent.

METHOD

A total of 588 university students in Germany (308 female) took part in a three-wave longitudinal study covering 23 months. At each wave (T1-T3), all participants completed measures of sexual aggression victimization and perpetration. Experiences of CSA were measured at T1.

RESULTS

The rate of CSA was significantly higher for women (20.8%) than for men (12.4%). Rates of sexual victimization for women were 60.9% at Time 1 (since age 14), 22.3% at Time 2 (since T1), and 17.4% at Time 3 (since T2). For men, the rates were 39.2% at Time 1, 15.9% at Time 2, and 14.1% at Time 3. Rates of sexual aggression perpetration for women were 10.6% at Time 1 (since age 14), 3.5% at Time 2 (since T1), and 3.6% at Time 3 (since T2). For men, the rates were 18.0% at Time 1, 6.2% at Time 2, and 3.8% at Time 3. The gender differences in victimization and perpetration were significant only at T1. CSA predicted higher odds of sexual aggression victimization and perpetration cross-sectionally at T1 and indirectly at T2 and T3 via T1. Gender did not moderate the associations.

CONCLUSION

The results confirm previous findings of elevated rates of sexual aggression victimization and perpetration in adolescence and young adulthood in victims of CSA. The implications for understanding and preventing adverse sexuality-related outcomes of CSA are discussed.

Diversity of Profiles and Coping Among Adolescent Girl Victims of Sexual Dating Violence

Sexual dating violence (DV) is common among female adolescents, and victims may experience other forms of DV (physical, psychological, and cyberviolence) and report a history of child sexual abuse (CSA). Heterogeneity of these victimization experiences could influence how adolescent girls' cope. We aimed to identify distinct profiles of victimization experiences among adolescent girls who reported sexual DV and to explore if these profiles were associated to their coping strategies. Of an initial sample of 1,300 female adolescents who completed online questionnaires, 835 (M_age = 16.8 years) reported at least one experience of sexual DV and were included in the analyses. Hierarchical classification with the Two Step analysis revealed four distinct profiles of victimization. A first cluster named Moderate CSA & Cyber-sexual DV (21.4%) is characterized by moderate percentage of all forms of victimization. The second cluster CSA & DV excluding cyber-sexual DV (34.4%) included victims of traditional DV, moderate rates of CSA and no experience of cyber-sexual DV. A third cluster CSA & DV Co-occurrence (20.6%) regrouped victims who have experienced different forms of DV in co-occurrence and CSA. Finally, the fourth cluster, named No CSA & DV Co-occurrence (23.6%) involved victims who have experienced different forms of DV in co-occurrence, but did not report a history of CSA. Analyses revealed significant differences between the profiles on the use of avoidance coping, in their perceived social support, and on help-seeking strategies deployed toward a partner and a health professional. These findings offer cues for prevention and intervention efforts for victimized female adolescents.

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

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

Adapting Adolescent Dating Violence Prevention Interventions to Victims of Child Sexual Abuse

Considering the increased risk of revictimization, adolescents who have experienced child sexual abuse (CSA) are a priority subpopulation for the prevention of dating violence. Yet, intervention programs often focus on psychological symptomology associated with CSA; few tackle issues specific to relational violence. Addressing the relational traumatization of adolescents with a history of CSA is essential to prevent their revictimization. Given specific CSA sequelae related to intimacy and engagement in sexual behaviors, there is a need for tailoring interventions to boy and girl survivors. A case study of a group intervention designed for adolescent girls with a history of CSA was conducted. The context adaptation, based on intervention mapping proposed by Bartholomew and colleagues, served as a theoretical framework. Four steps were taken to ensure that the intervention addressed CSA youth needs: (a) needs assessment, (b) analysis of the conceptual framework of the original program, (c) selection of interventions and developing new interventions, and (d) validation with a committee of practitioners. This approach provided an understanding of risk factors and intervention priorities using the problem logic model. The original program was enhanced by adding four interventions addressing the prevention of dating violence. These interventions were then validated by practitioners before implementation in the setting. The approach underscores the relevance of understanding the needs of the clientele and of adopting a collaborative approach to ensure the proposed interventions are relevant.

Sexual Violence at University: Are Indigenous Students More at Risk?

University-based sexual violence prevalence is worryingly high and leads to many serious consequences for health and academic achievement. Although previous work has documented greater risk for sexual violence among Indigenous Peoples, little is known about university-based sexual violence experienced by Indigenous students. Using a large-scale study of university-based sexual violence in Canada, the current study aims to (1) examine the risk of sexual violence against Indigenous students compared to non-Indigenous students, and (2) to document sexual violence experiences of Indigenous students. Undergraduate students from six universities (N = 5,627) completed online questionnaires regarding their experience and consequences of university-based sexual violence (e.g., forms of sexual violence experiences, gender, and status of the perpetrator, context of the violence, PTSD, disclosure). Findings indicated that compared with their non-Indigenous peers, Indigenous students experienced significantly higher levels of sexual harassment. However, no difference was found for unwanted sexual behaviors, nor for sexual violence contexts. Among Indigenous students, those having experienced sexual violence after age 18 (outside university) were more likely to report university-based sexual violence. Overall, findings highlight that Indigenous students, as well as non-Indigenous students, experience university-based sexual violence. Given their history, Indigenous students may have different needs, so sustainable policies that foster cultural safety on all campuses are clearly needed.

Child Maltreatment and the Child Welfare System as Environmental Factors in the International Classification of Functioning

The WHO defines child maltreatment as any form of neglect, exploitation, and physical, emotional, or sexual abuse, committed against children under the age of 18. Youth involved in the child welfare system report more maltreatment experiences and environmental turbulence (e.g., number of moves, caseworkers), placing them at greater risk for poorer physical and mental health. The International Classification of Functioning, Disability, and Health (ICF) provides a framework to describe health conditions and severity of disabilities for an individual and/or group in the context of environmental factors. The Maltreatment and Adolescent Pathways (MAP) study is a longitudinal study, assessing self-reports on variables (e.g., child maltreatment history, trauma symptoms, dating violence, and substance use) of youth in an urban child protection service system. This study focuses on 11 of the 24 MAP publications that pertain to health and functioning, which can be considered applicable to the ICF framework, following established linking rules. The purpose of this study is to analyze these MAP sub-studies, with maltreatment and involvement in the child welfare system as environmental factors that impact the functioning of child welfare-involved youth. Findings indicate significant relationships across environmental factors (i.e., child maltreatment histories, child welfare system involvement), health conditions (i.e., trauma symptomatology, psychological distress, intellectual disabilities), and functioning problems (i.e., substance use, adolescent dating violence, sexual risk-taking, coping motives, sleep problems). The interrelated nature of these factors in the MAP sub-studies suggests the value of the ICF model to a holistic health view of use to practitioners supporting system-involved youth, clarifying unattended environmental factors in guiding service provision for foster care and/or maltreated youth.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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