Effects of childhood trauma on psychological functioning in adults sexually abused as children

The Impact of Child Sexual Abuse on Men's Sexual Function: A Systematic Review

Child sexual abuse (CSA) is strongly associated with sexual dysfunction. However, research about male survivors' sexual functioning after CSA is lacking. The current systematic review searched for all studies that reported on CSA and sexual function among male survivors to answer the following questions: Do male survivors of CSA experience sexual dysfunctions, and if so, to what extent? Does CSA increase the risk of developing sexual dysfunctions in adulthood among men? Studies were identified by searching seven databases and sources of gray literature. The selection criteria included empirical studies involving a population of adult men who experienced CSA before the age of 18. Studies focused on sexual functioning and sexual development after the abuse. Twelve studies met the selection criteria. While some studies confirmed that CSA is a risk factor for sexual dysfunction in adult male survivors, including low sexual drive, problems with arousal, and difficulties with orgasm and pain, other studies failed to find a correlation between sexual dysfunction and CSA. The wide range in quality, methodology, and definitions of CSA and sexual function presented challenges to consistent analysis of the studies and to determine the impact of CSA. Further research is required to fully understand the effect of CSA on adult men's sexual function.

A practical approach to sexual abuse allegations: Netherlands Expert Committee for Equivocal Sexual Abuse Allegations

Equivocal sexual abuse allegations are those in which the details of the alleged offence(s) are uncertain. The circumstances are ambiguous, there is limited evidence, and it is unclear how police investigations should proceed. This article discusses the challenges such allegations pose for police, prosecution, judges and mental health experts, and advocates for the use of multidisciplinary expert opinion during the investigation. The practical application of this approach by the Netherlands Expert Committee for Equivocal Sexual Abuse Allegations (LEBZ) is described, which has assessed over 900 cases since its inception in 1999. The LEBZ approach represents a significant innovation in police and criminal justice responses to equivocal allegations of sexual assault, which warrants consideration in other jurisdictions.

A Comprehensive Pediatric Acute Sexual Assault Protocol: From Emergency Department to Outpatient Follow-up

OBJECTIVE

Close medical follow-up after pediatric acute sexual assault is recommended and may mitigate adverse consequences and decrease long-term comorbidities. The objectives are to (1) examine adherence to a comprehensive outpatient medical follow-up protocol after evaluation in the emergency department in a pediatric population and (2) identify characteristics associated with patient adherence to inform the utilization of a medical follow-up protocol after pediatric acute sexual assault.

METHODS

A retrospective medical record review was conducted of patients younger than 18 years presenting to the emergency department from January 1, 2010, to December 31, 2013, with a discharge diagnosis suggestive of sexual assault/abuse. We examined differences in demographics, assault characteristics, and medical/legal needs of patients who were evaluated in follow-up versus patients who were not.

RESULTS

Of 182 patients, 60.4% completed follow-up appointments with the child protection center. Younger patients had follow-up rates higher than older patients (70.2% vs 50%; odds ratio [OR], 0.42). For patients where child protective services or law enforcement were called, follow-up rates were 74.2% and 64.7%, respectively (OR, 2.5; OR, 3.1). All patients with anogenital injuries on initial examination were seen in follow-up. The majority of patients who followed-up were accompanied by a caregiver/relative (95%).

CONCLUSIONS

(1) Caregivers should be integrated into the evaluation to facilitate compliance with follow-up; (2) child abuse specialists may be consulted to facilitate specific interventions and recommendations; (3) professionals should work as a multidisciplinary team; and (4) the patient's psychological status should be evaluated, and mental health interventions recommended.

Sexual Abuse and Assault in a Large National Sample of Children and Adolescents

The present study sought to examine features of sexual abuse cases among a U.S. nationally representative sample of 13,052 children and adolescents, ages 0-17 years. The National Survey of Children's Exposure to Violence was collected in three different years (2008, 2011, and 2014) via telephone interviews. Information about sexual abuse and assault was obtained from youth themselves (ages 10-17) or caregivers (for children ages 0-9) using the Juvenile Victimization Questionnaire. Results indicate most offenses are at the hands of other juveniles (76.7% for males and 70.1% for females), primarily acquaintances, and occurring more frequently for adolescents aged 14-17. Whereas girls are mostly abused by males (88.4%), boys are abused by both males (45.6%) and females (54.4%). In 15% of cases, penetration is part of the abuse. Victims report being very afraid in 37.5% of episodes but not at all afraid in 19.8%. Among 10- to 17-year-olds, 66.3% of episodes are not reported to parents or any adult. Police reports occur for 19.1% of all cases. The results in the present study indicate that children and youth are exposed to sexual abuse and assault in varied ways, which require moving beyond conventional stereotypes of the problem.

Traumatic childhood events of parents enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC)

Background: Early life experiences can have a significant impact on an individual's later behaviour, the way they view the world, their beliefs and their success at forming strong interpersonal relationships. These factors may subsequently influence the way that the individual may parent their children, which in turn may have an effect on their child's behaviour, mental health and world view. Research has linked early traumatic life experiences in the parent's childhood to disorganised attachment to their own child. In this paper we describe the data collected from parents enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC) on traumatic events experienced during their childhood, so that it can act as a resource for researchers in the future when considering outcomes on the adult, their children and grandchildren. Methods: Data were collected via multiple questionnaires completed by parents enrolled into the ALSPAC study. During pregnancy and post-delivery, questionnaires were administered between 1990 and 1992 via post to the study mothers and their partners. Data were collected on life events including bereavement, sexual abuse, physical abuse, abandonment, neglect, memories of childhood and accidents. Other reports of traumatic events in childhood were reported by parents using free text. This can be made available to researchers for coding on request.

Are there gender differences in those diagnosed with psychogenic nonepileptic seizures?

OBJECTIVE

The objective of the study was to determine whether male and female populations of patients with psychogenic nonepileptic seizures (PNES) differ, in terms of demographic, social/clinical, and etiological factors as well as psychological measures.

BACKGROUND

Psychogenic nonepileptic seizures are overrepresented by females; therefore, information about PNES in males is limited. Only a handful of studies have examined PNES and gender, and of those, one was a literature review and with the exception of two, most have had small sample sizes. Of the existing literature, differences in abuse type, psychiatric diagnoses, and psychometric results have been observed in the two genders.

METHODS

This is a retrospective study of 51 consecutive males and 97 consecutive females with video-electroencephalogram (video-EEG) confirmed diagnosis of PNES. Patients were examined on demographics (age, education, working status), clinical (seizure frequency, trauma type: sexual, nonsexual, age of first trauma), and psychometric measures. The latter included the State Trait Anger Expression Inventory-2 (STAXI-2), Trauma Symptom Inventory-2 (TSI-2), the Coping Inventory for Stressful Situations (CISS), and the Quality of Life Inventory in Epilepsy-31 (QOLIE-31).

RESULTS

Women reported experiencing significantly more sexual traumas (p=0.007) than men. Women also endorsed significantly higher levels of dissociation (p=0.012) and sexual disturbances (p=0.46). In contrast, men reported significantly greater use of avoidance (p=0.001) as a stress coping strategy and higher levels of depression (p=0.006).

CONCLUSIONS

Gender differences were identified with males reporting a significantly higher use of avoidance (cognitive and behavioral avoidance of stress) and depressive symptoms. Women exhibited significantly higher rates of sexual trauma compared with male counterparts. Consequently, women also had significantly higher rates of trauma symptomatology (dissociation and sexual disturbances) which are often observed in those who have been traumatized sexually. These gender distinctions may support different first-line treatment approaches (e.g., trauma-focused; more traditional cognitive behavioral therapy) depending on the most prominent symptomatology.

Breastfeeding in Women Having Experienced Childhood Sexual Abuse

BACKGROUND

Childhood sexual abuse (CSA) can have a serious effect on general and obstetric health. Breastfeeding includes several triggers for memories of abuse experiences, which will likely influence decisions about breastfeeding and its implementation in daily life. This is important since breastfeeding improves maternal well-being and bonding with the child. Research aim: As breastfeeding strongly influences the long-term health of children, we investigated experiences with breastfeeding in women with a history of CSA.

METHODS

Data on breastfeeding were collected within a research project designed to compare labor and delivery experiences in women with a history of CSA to women without such antecedents. Data from 85 women having experienced CSA and 170 controls pair-matched for maternal age, children's age, and nationality were evaluated. The clinical record of pregnancy and a self-administered questionnaire were used to collect data.

RESULTS

Although the prevalence of breastfeeding was similar in women with and without CSA experiences (96.5% vs. 90.6%), women exposed to CSA more often described complications associated with breastfeeding (77.7% vs. 67.1%, p = .08). Mastitis (49.4% vs. 27.6%, p < .01) and pain (29.4% vs. 18.8%, p = .15) were reported significantly more often by women after CSA. For 20% of women after CSA, breastfeeding was a trigger for memories of CSA. Furthermore, 58% of women with CSA reported dissociation when breastfeeding.

CONCLUSION

In addition to the growing list of potential health consequences of CSA experience, this experience seems to be associated with an increased number of problems when breastfeeding. However, most women with a history of CSA intend to breastfeed despite particular challenges related to CSA. A support protocol tailored to the specific needs of these women during pregnancy and the lactation period may help to improve breastfeeding and the early mother-child relationship.

Sexual Contact in Childhood, Revictimization, and Lifetime Sexual and Psychological Outcomes

Using data from the 2010 to 2011 wave of the National Social Life, Health, and Aging Project-a nationally representative probability sample of older U.S. adults-this study queried distinctive linkages of mild and of severe childhood sexual contact with lifetime sexual and psychological outcomes among women and men aged 60-99 years (N = 3283). In addition, we examined stratification of these associations by sexual revictimization (forced sex and/or harassment). Among women, sequelae of childhood contact seemed consistently negative for the mild rather than severe variant-but only in the co-presence of revictimization-a pattern that may have remained obscured in previous analysis of event effects. Men's results suggested lifelong eroticizing but not psychological effects of this early experience-with the co-presence of revictimization potentially enhancing rather than lowering their mental health. Overall, findings appeared to reflect gendered patterns of risk-with mild childhood contact potentially channeling women but not men into revictimization and finally to elevated sexuality and poor mental health in late life. Early sexual experiences should thus be conceptualized not as singular events, but as part of a lifelong career with regularities and rhythms that may influence their pathogenic potential.

An Empirical Investigation of the Psychological Sequelae of Childhood Sexual Abuse in an Adult Latina Population

This study examined the effects of childhood sexual abuse on perceived social support among Latino women using the Self-In-Relation theoretical orientation and the Comprehensive Model of Trauma Impact to examine the impact of child sexual abuse. Participants included 54 Latina survivors of child sexual abuse seeking mental health services. The relationship between affective distress, interpersonal sensitivity, and perceived social support was investigated. Findings revealed depression was a statistically significant predictor of interpersonal sensitivity, sr (3, 49) = .45, p < .005) and of perceived social support for both Important Person, r (47) = –.34, p < .05, and People in Personal Life, r (47) = –.38, p < .01. Clinical implications are discussed from a Latino cultural perspective.

Mediators of sexual functioning and marital quality in chronically depressed adults with and without a history of childhood sexual abuse

INTRODUCTION

Sexual dysfunction is common among depressed adults. Childhood sexual abuse (CSA) and depressive symptomology are among the risk factors for sexual dysfunction, and these factors may interact to predict adult relationship functioning. Several models have been developed postulating interactions between these variables.

AIM

We tested models of the effects of CSA and elucidate the associations between CSA, sexual dysfunction, depression severity, anxiety, and relationship quality in chronically depressed adults.

METHODS

Baseline data from 808 chronically depressed outpatients enrolled in the Research Evaluating the Value of Augmenting Medication with Psychotherapy study were evaluated using structural equation modeling.

MAIN OUTCOME MEASURES

The Inventory of Depressive Symptomology, self-report version (IDS-SR) assessed depression severity, and the Mood and Anxiety Symptom Questionnaire Anxious Arousal subscale assessed anxiety. Sexual function was assessed with the Arizona Sexual Experiences Scale (ASEX), and the Quality of Marriage Index (QMI) assessed relationship quality for patients in stable relationships.

RESULTS

CSA scores predicted depression severity on the IDS-SR, as well as lower relationship quality and sexual satisfaction. ASEX scores were significantly associated with depression severity but were not correlated with the QMI. Two models were evaluated to elucidate these associations, revealing that (i) depression severity and anxious arousal mediated the relationship between CSA and adult sexual function, (ii) anxious arousal and sexual functioning mediated the association between CSA and depression symptoms, and (iii) when these models were combined, anxious arousal emerged as the most important mediator of CSA on depression which, in turn, mediated associations with adult sexual satisfaction and relationship quality.

CONCLUSIONS

Although CSA predicts lower relationship and sexual satisfaction among depressed adults, the long-term effects of CSA appear to be mediated by depressive and anxious symptoms. It is important to address depression and anxiety symptoms when treating patients with CSA who present with sexual dysfunction or marital concerns.

Childhood sexual abuse and the development of recurrent major depression in Chinese women

BACKGROUND

Our prior study in Han Chinese women has shown that women with a history of childhood sexual abuse (CSA) are at increased risk for developing major depression (MD). Would this relationship be found in our whole data set?

METHOD

Three levels of CSA (non-genital, genital, and intercourse) were assessed by self-report in two groups of Han Chinese women: 6017 clinically ascertained with recurrent MD and 5983 matched controls. Diagnostic and other risk factor information was assessed at personal interview. Odds ratios (ORs) were calculated by logistic regression.

RESULTS

We confirmed earlier results by replicating prior analyses in 3,950 new recurrent MD cases. There were no significant differences between the two data sets. Any form of CSA was significantly associated with recurrent MD (OR 4.06, 95% confidence interval (CI) [3.19-5.24]). This association strengthened with increasing CSA severity: non-genital (OR 2.21, 95% CI 1.58-3.15), genital (OR 5.24, 95% CI 3.52-8.15) and intercourse (OR 10.65, 95% CI 5.56-23.71). Among the depressed women, those with CSA had an earlier age of onset, longer depressive episodes. Recurrent MD patients those with CSA had an increased risk for dysthymia (OR 1.60, 95%CI 1.11-2.27) and phobia (OR 1.41, 95%CI 1.09-1.80). Any form of CSA was significantly associated with suicidal ideation or attempt (OR 1.50, 95% CI 1.20-1.89) and feelings of worthlessness or guilt (OR 1.41, 95% CI 1.02-2.02). Intercourse (OR 3.47, 95%CI 1.66-8.22), use of force and threats (OR 1.95, 95%CI 1.05-3.82) and how strongly the victims were affected at the time (OR 1.39, 95%CI 1.20-1.64) were significantly associated with recurrent MD.

CONCLUSIONS

In Chinese women CSA is strongly associated with recurrent MD and this association increases with greater severity of CSA. Depressed women with CSA have some specific clinical traits. Some features of CSA were associated with greater likelihood of developing recurrent MD.

Girls in residential care: from child maltreatment to trauma-related symptoms in emerging adulthood

The current study examined the association between child maltreatment and trauma-related symptoms in emerging adulthood--over and above the incidence of such symptoms and conduct problems during adolescence--among a sample of female adolescents in residential care. This study used data from a longitudinal study. The sample was composed of 89 adolescent females who were first interviewed at time of admission in a residential center (M(age)=15.33 years, SD=1.31) and later in young adulthood (M(age)=19.27, SD=1.55). At time 1, trauma-related symptoms were assessed with the Trauma Symptom Checklist for Children and conduct problems with a composite measure. At time 2, child maltreatment was assessed retrospectively with the Childhood Trauma Questionnaire, and trauma-related symptoms were reassessed with the Trauma Symptom Inventory-2. Results indicated that child maltreatment, especially emotional abuse and neglect, was related to anxious arousal, depression, and anger in emerging adulthood. This study showed that females from our sample often reported different types of maltreatment during childhood and that these traumatic experiences were significantly associated with poor adult psychological functioning.

Dissociative symptoms over a year in a sample of sexually abused children

This study aims to document the evolution of dissociative symptoms over time in preschoolers who disclose sexual abuse. Specifically, this study explores the frequency of dissociative symptoms as a function of child gender. A follow-up evaluation was conducted 1 year after initial disclosure among a sample of 48 sexually abused children, and their results were contrasted with those of a control group composed of 71 non abused children. Children's dissociative symptoms were evaluated by non-offending parents. Data showed that children reporting sexual abuse displayed a greater frequency of dissociative symptoms than non-sexually abused children at both evaluation times. Further analysis indicated that the evolution of dissociative symptoms in sexually abused children may be gender related. Although a decline in dissociation symptoms over time was evident for sexually abused girls at follow-up, sexually abused boys displayed greater dissociative symptoms. Results are discussed in terms of their implications for interventions for sexually abused children.

Predictors of treatment outcomes among depressed women with childhood sexual abuse histories

BACKGROUND

A notable portion (21%) of female patients receiving treatment for depression in community mental health centers (CMHC) has childhood sexual abuse (CSA) histories. Treatment outcomes in this population are heterogeneous; identifying factors associated with differential outcomes could inform treatment development. This exploratory study begins to address the gap in what is known about predictors of treatment outcomes among depressed women with sexual abuse histories.

METHOD

Seventy women with major depressive disorder and CSA histories in a CMHC were randomly assigned to interpersonal psychotherapy (n = 37) or usual care (n = 33). Using generalized estimating equations, we examined four pretreatment predictor domains (i.e. sociodemographic characteristics, clinical features, social and physical functioning, and trauma features) potentially related to depression treatment outcomes.

RESULTS

Among sociodemographic characteristics, Black race/ethnicity, public assistance income, and unemployment were associated with less depressive symptom reduction over the course of treatment. Two clinical features, chronic depression and borderline personality disorder, were also related to less reduction in depressive symptoms across the treatment period.

CONCLUSION

Our results demonstrate the clinical relevance of attending to predictors of depressed women with CSA histories being treated in public sector mental health centers. Particular sociodemographic characteristics and clinical features among these women may be significant indicators of risk for relatively poorer treatment outcomes.

Post-Traumatic Stress Disorder (PTSD) Symptoms in Adults with Psychiatric Disorders

OBJECTIVE

This study explores unrecognised symptoms related to post-traumatic stress disorder (PTSD) in individuals with a range of psychiatric disorders in the absence of traumatic events. We also examine the association between PTSD symptoms, social interaction with peers and therapeutic alliance with mental health professionals.

METHOD

A purposive sample of 120 adults consecutively referred to the psychology department from September 2008 to September 2010 was included in this study. We used the Minnesota Multiphasic Personality Inventory 2 (MMPI-2) to ascertain the presence of PTSD symptoms, social interaction levels and treatment alliance with health professionals.

RESULTS

Individuals previously undiagnosed with PTSD, referred without any noted traumatic event had high levels of symptoms related to PTSD, as measured by the PK scale of the MMPI-2. The PK scale was significantly correlated with several MMPI-2 clinical scales, the Social Introversion Scale (Si) and the Treatment Alliance Scale (TRT) (p < 0.001).

CONCLUSION

This study demonstrated the presence of symptoms related to PTSD in individuals with a range of psychiatric disorders despite the absence of reported trauma. The presence of symptoms related to PTSD may be associated with an indirect negative impact on social contacts and a poorer therapeutic alliance with mental health professionals. Investigating symptoms of PTSD during a psychological assessment even when trauma is not the presenting complaint is merited in most cases.

The emerging modern face of mood disorders: a didactic editorial with a detailed presentation of data and definitions

The present work represents a detailed description of our current understanding and knowledge of the epidemiology, etiopathogenesis and clinical manifestations of mood disorders, their comorbidity and overlap, and the effect of variables such as gender and age. This review article is largely based on the 'Mood disorders' chapter of the Wikibooks Textbook of Psychiatry http://en.wikibooks.org/wiki/Textbook_of_Psychiatry/Mood_Disorders.

Pre-pubertal stress exposure affects adult behavioral response in association with changes in circulating corticosterone and brain-derived neurotrophic factor

Early-life stress produces a cascade of neurobiological events that cause enduring changes in neural plasticity and synaptic efficacy that appear to play pivotal roles in the pathophysiology of post-traumatic stress disorder (PTSD). Brain-derived neurotrophic factor (BDNF) has been implicated in the neurobiological mechanisms of these changes, in interaction with components of the stress response, such as corticosterone. This study examined the consequences of juvenile stress for behavior during adulthood in association with circulating corticosterone levels and BDNF expression. The experiments examined single exposure to predator scent stress (soiled cat litter for 10 min) as compared to repeated exposure, early in life and later on. Behavioral responses were assessed in the elevated plus maze and the acoustic startle response paradigms at 28, 60 and 90 days of age. Plasma corticosterone was measured and brain areas analyzed for BDNF levels. The results show that juvenile stress exposure increased anxiety-like behavior and startle amplitude and decreased plasma corticosterone. This response was seen immediately after exposure and also long term. Adult stress exposure increased anxiety-like behavior, startle amplitude and plasma corticosterone. Exposure to both early and later life trauma elicited reduced levels of corticosterone following the initial exposure, which were not raised by re-exposure, and elicited significant downregulation of BDNF mRNA and protein levels in the hippocampus CA1 subregion. The consequences of adult stress exposure were more severe in rats were exposed to the same stressor as juveniles, indicated increased vulnerability. The results suggest that juvenile stress has resounding effects in adulthood reflected in behavioral responses. The concomitant changes in BDNF and corticosterone levels may mediate the changes in neural plasticity and synaptic functioning underlying clinical manifestations of PTSD.

Sexual dysfunction in depression and anxiety: conceptualizing sexual dysfunction as part of an internalizing dimension

Sexual dysfunction is often implicated in depression and anxiety disorders, but the current nosology of sexual dysfunction, depression, and anxiety (i.e., DSM-IV) does not adequately address these relationships. Because recent papers (Krueger, R. F., & Markon, K. E. (2006). Reinterpreting comorbidity: A model-based approach to understanding and classifying psychopathology. Annual Review of Clinical Psychology, 2, 111-133) have suggested and provided evidence for latent internalizing and externalizing dimensions that help explain high comorbidity between mental disorders, the current paper suggests that sexual dysfunction might conceptually belong to a latent internalizing factor. To address this, evidence is presented for the relationship among disorders of sexual desire, arousal, and orgasm comorbid with depression and anxiety. A review of sexual disorders is also presented along with a critical examination of the way the current DSM is organized with respect to sexual dysfunction, depression, and anxiety.

Intimate partner violence among Asian immigrant communities: health/mental health consequences, help-seeking behaviors, and service utilization

Intimate partner violence (IPV) is a serious epidemic among Asian immigrant communities. Yet little is known about the scope, nature, and related contextual, cultural, and social factors of IPV among this population. In particular, the lack of research has been evident in examining health and mental health outcomes of IPV and service utilization, revealing notable gaps in health disparities which result in a failure to provide relevant services and law enforcement protection for battered Asian immigrant women. This article examines critically the growing body of literature on IPV among Asian immigrant populations in several areas: (a) the context of IPV: cultural, social, and individual/familial, (b) prevalence of IPV, (c) physical health and increased risk for sexually transmitted disease and HIV/AIDS, (d) mental health consequences and substance use, (e) social support and help-seeking behaviors, and (f) barriers to service utilization. Future directions for practice, policy, and research are discussed.

Women and major depressive disorder: clinical perspectives on causal pathways

BACKGROUND AND AIMS

Epidemiological data on the prevalence of mood disorders demonstrate that major depressive disorder (MDD) is approximately twice as common in women as in men and that its first onset peaks during the reproductive years. We aimed to review key social, psychological, and biological factors that seem strongly implicated in the etiology of major depression and to focus on sex-specific aspects of depression, such as the role of a woman's reproductive life cycle in depressive symptomatology.

METHODS

A review of the literature, from 1965 to present, was conducted.

RESULTS

An integrated etiological model best explains gender and sex differences in depression. Social, psychological, and biological variables must be simultaneously taken into account. These vulnerabilities include (but are not limited to) gender-specific roles in society, life stress such as trauma, a tendency toward ruminative coping strategies, and the effects of sex hormones and genetic factors.

CONCLUSIONS

To effectively treat MDD in women and to prevent the recurrence of illness in vulnerable women, clinicians must understand the sex-specific aspects of mood disorders over the longitudinal course of women's reproductive lives. A biopsychosocial approach should, therefore, be the main focus of future research and practice, to eventually result in an integrated etiological model of depression in women. Based on the prevalence of MDD in women, timely screening, diagnosis, and intervention should be public health priorities.

Effects of multiple maltreatment experiences among psychiatrically hospitalized youth

OBJECTIVE

Relying on indicators coded from information collected routinely during intake assessments at a secure inpatient psychiatric facility, this study examined the extent to which different forms of maltreatment accounted for variations in youths' emotional and behavioral problems.

METHODS

Clinical information was reviewed for a large (N=401) and diverse sample (mean age=13.9 years; 53% male; 54.6% racial/ethnic minority) of youth admitted to a publicly funded psychiatric hospital. Data were drawn from intake narratives, standardized psychopathology rating scales, and psychiatric diagnostic ratings.

RESULTS

Findings provide some support for a hierarchical classification of multiple maltreatment experiences with sexual abuse identified as the specific form of maltreatment most reliably associated with poor adjustment. Support also was obtained for a cumulative classification approach, as the number of different types of maltreatment experiences was linked positively to elevated psychopathology ratings.

CONCLUSIONS

Even in this high-risk, atypical sample, maltreatment experiences account for variation in levels of psychopathology. These results have implications for classifying multiple maltreatment and enhancing clinical care for atypical youth who have been maltreated.

PRACTICE IMPLICATIONS

Clinicians working in youth psychiatric populations should implement maltreatment-specific psychotherapy approaches for maltreated youth, even as adjunctive treatments in a therapeutic milieu.

Exploratory and Confirmatory Factor Analyses of the Structured Interview for Disorders of Extreme Stress

Two studies were conducted to provide the first empirical examination of the factor structure of a revised version of the clinically derived Structured Interview for Disorders of Extreme Stress, a structured interview designed to assess associated features of posttraumatic stress disorder (PTSD) thought to be related to early onset, interpersonal, and prolonged traumatic exposure. Five factors representing demoralization, somatic dysregulation, anger dysregulation, risk/self-harm, and altered sexuality were derived from an exploratory factor analysis conducted with adult trauma survivors in substance abuse treatment. They provided a good fit in a confirmatory factor analysis conducted in a second study with a nonclinical sample of ethnoculturally diverse, socioeconomically disadvantaged, incarcerated adults. Evidence of the derived factors' internal consistency and convergent and discriminant validity is reported. Evidence supported the association of these factors with interpersonal trauma (physical and/or sexual), its repetition, and its earlier onset. Implications for clinical assessment of complex posttraumatic stress disorder are discussed.

Multi-type maltreatment in childhood and psychological adjustment in adolescence: questionnaire study among adolescents in Western Herzegovina Canton

AIM

To determine the prevalence and intercorrelation of different forms of childhood maltreatment and psychological problems in adolescents in Western Herzegovina Canton.

METHOD

A questionnaire study was conducted in March 2003 on a convenient sample of 458 third-grade high-school students (39% boys) aged between 15 and 20 (median age, 17). Data were collected using a sociodemographic questionnaire, Family Adaptability and Cohesion Evaluation Scales III, Child Maltreatment Questionnaire, Youth Self-Report, and Rosenberg Self-Esteem Scale. Sociodemographic and family characteristics and exposure to maltreatment were analyzed as possible predictors of exposure to a particular type of abuse and subsequent psychological adjustment problems.

RESULTS

Out of 458 students, 77% were emotionally abused, 52% physically abused, 30% neglected, 20% witnessed family violence, and 13% of girls and 21% of boys were sexually abused before the age of 14. Significant association between the maltreatment by a mother, father, and other adults were found for emotional and physical abuse and for neglect and witnessing family violence (r=0.413-0.541, P<0.001 for all). Significant correlation was found between all forms of abuse (r=0.163-0.594, P<0.05), except between sexual abuse and witnessing family violence (r=0.048, P=0.351). Almost two-thirds of students were exposed to multi-type maltreatment in childhood. Family characteristics and maltreatment scores significantly predicted anxiety/depression (R=0.456, R(2)=0.076), withdrawal (R=0.389, R(2)=0.049), somatic complaints (R=0.437, R(2)=0.059), social problems (R=0.417, R(2)=0.063), attention deficit and hyperactivity disorder (R=0.368, R(2)=0.045), rule-breaking behavior (R=0.393, R(2)=0.045), aggression (R=0.437, R(2)=0.078) (P<0.001 for all), as well as self-esteem (R=0.371, R(2)=0.035, P=0.003).

CONCLUSION

Most third-grade high-school students in Western Herzegovina Canton were exposed to multi-type maltreatment in childhood, regardless of the war experience. Emotional and physical abuse were most frequently combined forms of maltreatment. Sociodemographic and family characteristics and exposure to some forms of abuse were significant predictors of exposure to other forms of abuse. Exposure to maltreatment in childhood predicted difficulties in psychological adjustment in adolescence.

Dissociation in major depressive disorder: a pilot study

The principal objective of this study was to evaluate the occurrence of various dissociative phenomena in patients with major depressive disorder (MDD) and their possible implications in manifestation and course of depression. We administered the Dissociative Experiences Scale (DES) and a self-questionnaire of life events to 27 patients with MDD and to 40 healthy participants in order to collect information on traumatic events. Patients who scored >or= 20 on the DES were also assessed to determine the presence of dissociative disorder. Patients with MDD reported a significantly higher mean score on the DES than the comparison healthy participants. In all, 12 out of 27 patients with MDD reported childhood trauma, and their mean score on the DES representing absorption and imaginative involvement was significantly higher than that of participants without childhood trauma. Also, 7% of our MDD patients were diagnosed with dissociative disorder during this study. The principal limitations of the study were its small sample size and the use of a nonstandardized trauma measure. These findings indicate that dissociative phenomena should not be overlooked in MDD. Screening methods and structured interview for dissociative disorders are useful in psychiatric and psychological practice. Further studies should analyze the role and clinical consequence of different forms of dissociation experiences.

The legacy of childhood sexual abuse and family adversity

PURPOSE

To describe the process by which childhood adversity influences the life course of survivors of childhood sexual abuse.

DESIGN

A community-based, qualitative, grounded-theory design.

METHODS

In this grounded theory study, data were drawn from open-ended interviews conducted as part of a larger study of women's and men's responses to sexual violence. The current study indicates the experiences of 48 female and 40 male survivors of childhood sexual abuse and family adversity. Data were analyzed using the constant comparison method.

FINDINGS

Participants described a sense of inheriting a life of abuse and adversity. The process by which childhood adversity influences the life course of adult survivors of childhood sexual abuse is labeled Living the Family Legacy. The theory representing the process of Living the Family Legacy includes three major life patterns: (a) being stuck in the family legacy, (b) being plagued by the family legacy, and (c) rejecting the family legacy/creating a new one. Associated with these life patterns are three processes by which participants passed on a legacy to others, often their children: (a) passing on the family legacy, (b) taking a stab at passing on a new legacy, and (c) passing on a new legacy.

CONCLUSIONS

The legacy of abuse and adversity has a profound effect on the lives of survivors of childhood sexual abuse. There are several trajectories by which the influence of childhood adversity unfolds in the lives of adult survivors and by which the legacy is passed on to others.

CLINICAL RELEVANCE

The model representing the theoretical process of Living the Family Legacy can be used by clinicians who work with survivors of childhood sexual abuse and childhood adversity, especially those who have parenting concerns.

The relationship between childhood sexual abuse and adult mental health among undergraduates: victim gender doesn't matter

A large body of research has documented the harmful effects of childhood sexual abuse (CSA) on adult mental health among females, but less work has examined this issue among males. This study examined whether gender moderated the relationship between CSA and adult mental health among a mixed-gender sample of 406 undergraduates. A Pearson chi-square test indicated that a significantly greater proportion of females (41.6%) than males (30.7%) reported a history of CSA. ANCOVAs tested whether gender, CSA status, and their interaction were related to adult mental health symptomatology as measured by Brief Symptom Inventory gender-normed t scores. Participants with a history of CSA reported significantly higher levels of global mental health problems, hostility, paranoid ideation, and psychoticism. The gender by CSA status interaction was not significant for any scale, indicating that the harmful effects of CSA on adult mental health did not vary by gender.

Psychometric evaluation and comparison of three retrospective, multi-item measures of childhood sexual abuse

OBJECTIVE

To evaluate and compare the psychometric qualities of three retrospective, multi-item measures of childhood sexual abuse (CSA): the CSA Frequency Scale, CSA Count Index, and CSA Multiple Characteristics Index.

METHODS

Two samples of women 20-50 years old who experienced CSA were recruited from a family practice clinic (N=132) and the community (N=19). The measures were designed to represent the three most commonly used approaches for multi-item measurement of past CSA, as determined by a review of literature. Items were derived from a self-administered instrument from a larger study. The CSA Frequency Scale was evaluated for test-retest reliability, internal consistency, and criterion-related validity. The CSA Count and CSA Multiple Characteristics Indexes were evaluated for content specification, indicator specification, indicator collinearity, external validity, criterion-related validity, and test-retest reliability. Criterion-related validity variables were (a) physical and psychosocial symptomatology and (b) depression.

RESULTS

Upon evaluation, all three measures met criteria for satisfactory quality, with one exception: external validity for both indexes. When compared across test-retest reliability and criterion-related validity results, none of the measures proved superior. Intraclass correlation coefficients for test-retest reliability ranged from .92 to .94; correlations with the criterion-related validity variables ranged from r=.36 to .41.

CONCLUSIONS

The results support the continued use of established scales similar to the CSA Frequency scale. In addition, the results suggest further development and standardization of indexes similar to the CSA Count and Multiple Characteristics Indexes is warranted.

Early maternal separation alters the response to traumatization: resulting in increased levels of hippocampal neurotrophic factors

Early life adversity predisposes individuals to the development of psychopathology in later life, especially depression and anxiety disorders. Prior history of stressors may also be a vulnerability factor for developing posttraumatic stress disorder (PTSD) in response to trauma. We examined the mechanisms underlying this phenomenon by employing two animal stress models, early maternal separation followed by later time-dependent sensitization (TDS). In animals exposed to adult TDS, those with prior early adversity did not differ from controls on tests of anxiety (elevated plus maze, open field), or HPA function (ACTH and corticosterone levels). However, those with prior early adversity had increased levels of neurotrophic factors (BDNF, NGF and NT-3) in both the dorsal and ventral hippocampus. Although early adversity is known to be associated with negative effects on neuronal function, it may also be associated with an increased ability to respond to subsequent stressors with compensatory mechanisms such as increased neurotrophic factor release.

Relative impact of adverse events and screened symptoms of posttraumatic stress disorder and depression among active duty soldiers seeking mental health care

Symptoms of depression and posttraumatic stress are among the most studied psychological difficulties among soldiers. Such symptoms have been linked to a history of adverse events among both civilians and combat veterans. There is a paucity of research on this topic that can be applied to an active duty clinical population. Intake screening data were reviewed for 1,626 soldiers presenting to an outpatient mental health clinic to identify variables, including history of potentially traumatic experiences, associated with screened symptoms of posttraumatic stress disorder (PTSD) and depression. Demographics such as age, gender, and military rank, as well as number of adverse childhood experiences were significant predictors of screened PTSD and depression. A history of deployment to a combat zone predicted screened PTSD, but not depression. The role of childhood abuse as a risk factor is discussed and highlighted in the etiology of symptoms for soldiers seeking mental health care.

Antidepressants and sexual dysfunction

OBJECTIVE

Many patients with depression suffer from sexual dysfunction and sexual dysfunction is a recognized side-effect of antidepressants. The aim of this review was to examine the prevalence of psychosexual dysfunction associated with antidepressants, and to review treatment options which are specific to the affected component of sexual functioning and antidepressants.

METHOD

Comprehensive literature review using Medline and Cochrane databases.

RESULTS

Up to 70% of patients with depression may have sexual dysfunction. Tricyclic antidepressants, selective-serotonin reuptake inhibitors and venlafaxine are most and the non-serotonergic antidepressants and duloxetine least likely to produce sexual dysfunction. Pharmacological treatment options include antidepressants less likely associated or 'antidotes' to reverse sexual dysfunction.

CONCLUSION

Sexual dysfunction may be a preventable or treatable side-effect of antidepressants. Patients need routinely to be asked about sexual function to identify problems early. If sexual dysfunction is ignored it may maintain the depression, compromise treatment outcome and lead to non-compliance.

Adolescent girls' offending and health-risking sexual behavior: the predictive role of trauma

Several studies have highlighted high levels of risk for girls who have been exposed to traumatic experiences, but little is known about the exact relationship between traumatic experiences and problems with delinquency and health-risking sexual behavior (e.g., precipitory and/or exacerbatory roles). However, numerous short- and long-term detrimental effects have been linked to trauma, delinquency, and health-risking sexual behavior. The utility of diagnostic and experiential trauma measures in predicting the greatest risk for poor outcomes for delinquent girls was examined in this study. Results indicate that the experiential measures of trauma (cumulative and composite trauma scores) significantly predicted adolescent offending and adolescent health-risking sexual behavior, whereas the diagnostic measures of trauma (full and partial diagnostic criteria) did not.

Relational outcomes of childhood sexual trauma in female survivors: a longitudinal study

This longitudinal study examines the effects of childhood sexual abuse (CSA) on the intimate and marital relationships of adult survivors from a sample composed primarily of African American women. In addition, the authors explore the protective role of maternal support. Interview data are collected on 136 women with documented histories of CSA who indicate the quality and nature of their current marital relationships and other interpersonal connections. Results suggest that CSA survivors with poor maternal attachment are more likely to enter into marital or cohabiting relationships. However, more severe sexual trauma in childhood correlates with greater marital dissatisfaction. Good maternal attachment during childhood has a negative main effect on adult interpersonal problems and a buffering effect on the relationship between abuse and marital dissatisfaction. These data can help guide future research on the adult relational outcomes of female CSA survivors, especially among minority populations.

Reported history of child sexual abuse in schizophrenia: associations with heightened symptom levels and poorer participation over four months in vocational rehabilitation

Cross-section research suggests reported childhood abuse in schizophrenia spectrum disorders is linked with graver symptom levels and social dysfunction. To examine this prospectively, we compared biweekly ratings of positive and emotional discomfort symptoms and weekly accounts of hours worked over 4 months of rehabilitation of 12 participants with schizophrenia or schizoaffective disorder and childhood sexual abuse history and 31 with schizophrenia or schizoaffective disorder and no childhood sexual abuse history. Repeated-measures ANOVA revealed the abuse group had consistently higher levels of both symptom components and poorer participation in vocational rehabilitation. A time by group effect was observed for hours of work, with the abuse group working increasingly fewer hours over time. Participants reporting abuse also were more likely to perform poorly on a test of executive function and to have particularly higher levels of hallucinations and anxiety over time. Clinical and theoretical implications are discussed.

Sexual abuse in childhood and sexual dysfunction in adulthood: an Australian population-based study

This study examined self-reported adult sexual functioning in individuals reporting a history of childhood sexual abuse (CSA) in a representative sample of the Australian population. A sample of 1793 persons, aged 18-59 years, were randomly selected from the electoral roll for Australian states and territories in April 2000. Respondents were interviewed about their health status and sexual experiences, including unwanted sexual experiences before the age of 16 years. More than one-third of women and approximately one-sixth of men reported a history of CSA. Women were more likely than men to report both non-penetrative and penetrative experiences of CSA. For both sexes, there was a significant association between CSA and symptoms of sexual dysfunction. In assessing the specific nature of the relationship between sexual abuse and sexual dysfunction, statistically significant associations were, in general, evident for women only. CSA was not associated with the level of physical or emotional satisfaction respondents experienced with their sexual activity. The total number of lifetime sexual partners was significantly and positively associated with CSA for females, but not for males; however, the number of sexual partners in the last year was not related to CSA. CSA in the Australian population is common and contributes to significant impairment in the sexual functioning of adults, especially women. These consequences appear not to extend to the other areas of sexual activity considered in this study.

Predicting immune status in women from PTSD and childhood and adult violence

This study uses a predictive exploratory design to test the relationships between and among childhood maltreatment, intimate partner violence (IPV), posttraumatic stress disorder (PTSD) symptoms, and immune status in abused women. A convenience sample of 126 abused women and 12 nonabused women matched for age and race/ethnicity were recruited. The woman's current smoking habit, history of childhood maltreatment, experience of IPV, and PTSD symptoms predicted immune status. This prediction occurs through both direct and indirect pathways from IPV to immune status and from IPV to immune status through PTSD.

Prevalence and denial of sexual abuse in a male psychiatric inpatient population

While the link between sexual abuse and psychiatric morbidity is well established, there are only a few studies that have investigated the prevalence of sexual abuse in male psychiatric populations and these studies have typically employed designs that ignore methodological issues specific to male sexual abuse. The present study aims to contribute to this research using as methodologically sound approach as possible. Seventy-four male inpatients were interviewed using a questionnaire (J. N. Briere, 1992) about childhood sexual experiences. Approximately one third reported incidents that met this study's criteria for sexual abuse. Many of these men did not label such experiences as "sexual abuse." The results suggest that mental health professionals need to be aware that many of their male patients may have a history of sexual abuse and that potential minimization or denial of it is a barrier to disclosure.

The roles of peritraumatic dissociation, child physical abuse, and child sexual abuse in the development of posttraumatic stress disorder and adult victimization

OBJECTIVE

Previous research has indicated that women who experience childhood physical abuse or childhood sexual abuse are at increased risk for posttraumatic stress disorder (PTSD) and adult victimization. Recently, peritraumatic dissociation (PD) has been suggested as another possible risk factor for PTSD and adult victimization. The purpose of the present study was to investigate the effects of childhood physical and sexual abuse and PD on PTSD and adult victimization.

METHOD

A sample of 467 female college students completed questionnaires about childhood and adult sexual and physical abuse experiences, PD, and PTSD symptoms.

RESULTS

The combined sexual and physical abuse (CA) and sexual abuse only (SA) groups reported significantly higher numbers of PTSD symptoms than the physical abuse only (PA) and no abuse (NA) groups. The CA and PA groups reported significantly more adult sexual and physical victimization than the SA and NA groups. Across all four groups, higher levels of PD were associated with higher levels of PTSD and adult sexual and physical victimization.

CONCLUSIONS

The results of the current study suggest that different types of childhood abuse may lead to different adult problems. The results also indicated that PD may have a broad effect on PTSD development and adult victimization.

Pathways to PTSD, part II: Sexually abused children

OBJECTIVE

The goal of this research was to develop and test a prospective model of posttraumatic stress symptoms in sexually abused children that includes pretrauma, trauma, and disclosure-related pathways.

METHOD

At time 1, several measures were used to assess pretrauma variables, trauma variables, and stress reactions upon disclosure for 156 sexually abused children ages 8 to 13 years. At the time 2 follow-up (7 to 36 months following the initial interview), the children were assessed for posttraumatic stress disorder (PTSD) symptoms.

RESULTS

A path analysis involving a series of hierarchically nested ordinary least squares multiple regression analyses indicated three direct paths to PTSD symptoms: avoidant coping, anxiety/arousal, and dissociation, all measured during or immediately after disclosure of sexual abuse. Additionally, age and gender predicted avoidant coping, while life stress and age at abuse onset predicted symptoms of anxiety/arousal. Taken together, these pathways accounted for approximately 57% of the variance in PTSD symptoms.

CONCLUSIONS

Symptoms measured at the time of disclosure constitute direct, independent pathways by which sexually abused children are likely to develop later PTSD symptoms. These findings speak to the importance of assessing children during the disclosure of abuse in order to identify those at greatest risk for later PTSD symptoms.

Predictors of development of adult psychopathology in female victims of childhood sexual abuse

The purpose of this study is to identify predictors of resilience and adult mental disorders in women with a history of childhood sexual abuse. This cross-sectional study was conducted in a family practice center using adult female (age 18-40) patients. Outcome measures assessed the prevalence of major depressive episode, panic disorder, agoraphobia, substance abuse, posttraumatic stress disorder, borderline personality disorder, bulimia, and suicidality. Seventy-six percent of the 90 women with sufficient data met criteria for at least one adult disorder. Mental health was related to high SES, lack of family alcohol abuse, lower frequency of first perpetrator abuse, and few perpetrators. Specifics of the abuse were associated with development of borderline personality disorder, substance abuse, major depressive episode, suicidality, bulimia, agoraphobia, and panic disorder. Maternal violence against the father, substance abuse within the household of origin, and maternal care and overprotection were also important. The specifics about the abuse and the family environment during childhood are important predictors of adult psychopathology.

Men's pathways to risky sexual behavior: role of co-occurring childhood sexual abuse, posttraumatic stress disorder, and depression histories

Recent reports of sexually transmitted infection-rate increases among men indicate the need for renewed study of male sexual risk behavior to aid development of updated and novel risk reduction interventions. Men who have childhood sexual abuse (CSA) histories consistently report frequent sexual risk behavior. The objective of this sturdy is to explore whether posttraumatic stress disorder (PTSD) and depression are moderators and/or mediators of the association between CSA and sexual risk in adult men. A cross-sectional survey study employing random digit dial recruitment was administered to men aged 18-49 years from Philadelphia County. Two hundred ninety eight men were recruited and screened for CSA history, administered items from the Posttraumatic Stress Diagnostic Scale (PDS) and Center for Epidemiologic Studies- Depression (CES-D), and asked to estimate their number of lifetime sexual partners (LSPs). Effects of sociodemographic characteristics, CSA, PTSD, and depression on the number of LSPs were modeled using Poisson regression. Results show that 197 (66%) men participated; 43 (22%) had CSA histories. CSA was significantly associated with PTSD/depression (P=.03). Four sociodemographic variables (age, race, sexual identity, and education), CSA (incidence rate ratio, IRR=1.47, P<.001), PTSD (IRR=1.19, P=.04), depression (IRR=1.29, P=.001), all 2-way interactions, and the 3-way CSA/PTSD/depression interaction (IRR=11.00, P<.001) were associated with the number of LSPs (R2=0.27). In conclusion, sexual partnership patterns unique to men with CSA histories and comorbid PTSD/depression appear to lead to substantially higher numbers of LSPs. Estimates of this relationship may have been biased toward the null by underreporting that can occur with phone surveys. Cross-sectional studies do not support causal inferences; however, the identification of a moderating and mediating influence of PTSD/depression on the relationship between CSA and sexual risk behavior is important and suggests the need for future studies with larger samples that examine trajectories for CSA, psychiatric illness, and sexual partnerships.

Psychological intimate partner violence: the major predictor of posttraumatic stress disorder in abused women

Intimate partner violence (IPV) significantly impacts women mental and physical wellbeing and therefore represents a worldwide public health problem. A clear association between IPV and increased risk to develop posttraumatic stress disorder (PTSD) has been documented. However, few studies examined how different features of IPV (physical, psychological, sexual) interact with other traumatic stress experiences (physical, psychological and sexual childhood abuse and adulthood victimization by other/s than the partner) in determining PTSD. Women abused by the partner (n=75) were compared with non-abused control women (n=52). Information about sociodemographic profile and relevant personal characteristics was obtained through structured interviews. A comprehensive questionnaire was designed for a face-to-face interview in order to obtain detailed information about duration and frequency of the different types of violent acts above mentioned. The incidence and severity of symptoms of current PTSD were assessed with Echeburua's Severity of Symptom Scale of Posttraumatic Stress Disorder, a structured interview based on DSM-IV criteria. Women suffering from IPV had a significantly higher rate of PTSD symptomatology as compared to control women, whereas childhood abuse variables did not explain PTSD score variance. In addition, the severity of IPV was significantly and positively correlated with the intensity of PTSD symptoms. Women involved in an abusive relationship were more frequently exposed to other experiences of adulthood victimization, suggesting that their higher PTSD vulnerability could be a result of cumulative traumatic experiences. A relevant result of the correlation analysis was the strong, positive association between PTSD and each different type of IPV. In particular, the psychological component of intimate partner violence was the strongest predictor of posttraumatic stress disorder. This study underlines the importance of separating the effects of the different types of intimate partner abuse when taking into account its effects on women mental health.

Retrospective measurement of childhood sexual abuse: a review of instruments

In this comprehensive review of retrospective childhood sexual abuse (CSA) instruments, instruments from studies published between 1986 and 2001 are examined according to administration method, number and specificity of questions, CSA operational definitions, psychometric properties, and the use of scales. It was found that both self-administered and interview instruments range from the vagueness of a single question to the preciseness of multiple, specific questions. Furthermore, the review demonstrated that CSA instruments generally lack standardization. Many are developed for one-time use and others modified when reused. Descriptive CSA instruments have been preferred by researchers and primarily used to measure CSA dichotomously. However, little consensus exists as to how to operationally define CSA. One positive trend is the development of scales that measure CSA as an interval-level variable, allowing for more extensive psychometric data to be collected.

Mental health effects of adolescent trauma exposure in a female college sample: exploring differential outcomes based on experiences of unique trauma types and dimensions

Most studies on the psychological impact of trauma exposure focus on the response to a single type of trauma, with little or no attention paid to the contribution of prior traumatic experiences. The goal of this study was to disentangle some of the confounding effects of multiple trauma exposures by exploring the unique contribution to mental health outcomes made by specific types and dimensions of trauma. This report compares the psychological outcomes of college women who experienced different types of trauma during adolescence, including traumatic bereavement, sexual assault, and physical assault. Young women who had experienced a single event of one of these types were compared with peers who had experienced multiple single events, ongoing sexual and/or physical abuse, as well as those who had experienced no trauma. Results, based on structured clinical interviews, and self-report measures showed that there were some significant differences in mental health outcomes based on trauma type. However, trauma exposure versus no exposure and the cumulative effects of exposure versus one-time experiences played the key roles in differentiating the groups.

Child Sexual Abuse and Number of Sexual Partners in Young Women: The Role of Abuse Severity, Coping Style, and Sexual Functioning

The authors proposed and tested a model describing distinct pathways through which childhood sexual abuse (CSA) may lead to relatively low or high numbers of sexual partners in adulthood. Path analyses were conducted on survey responses of young female US Navy recruits who reported CSA (N=547). Use of avoidant strategies to cope with CSA was expected to produce higher levels of sexual problems and fewer heterosexual sex partners, whereas use of self-destructive coping strategies was expected to result in more dysfunctional sexual behavior and more heterosexual sex partners. As predicted, the effect of CSA on number of sex partners was largely mediated by coping strategies and dysfunctional sexual behavior.

[Current understanding about intergenerational transmission of child sexual abuse]

OBJECTIVE

The aim of this article is to review what is currently understood about intergenerational transmission of child sexual abuse (CSA).

METHOD

CSA transmission is discussed first from the point of view of men CSA survivors who become sexually abusive, and then from the perspective of mothers who survived CSA whose children have been sexually abused. Mechanisms that may help us understand how CSA is transmitted from one generation to another are described. More specifically, focus is given to those mechanisms that might differentiate CSA survivors who break the cycle of abuse from those who perpetuate it.

RESULTS

In light of the research reviewed, it seems that the transmission of CSA is far from inevitable, since one-third of sexually abusive men and half of sexually abused children's mothers mentioned having been sexually abused in their childhood. Because of the retrospective method used in many studies, causal links could not be established. However, some mechanisms have been proposed in order to better understand the phenomenon of CSA. Severity of abuse, attachment relationships with parental figures, as well as dissociative symptoms that follow the abuse were identified. Dissociative symptomatology appeared to be a determining factor in understanding the cycle of CSA.

CONCLUSIONS

More studies on CSA transmission are needed to understand the mechanisms that are involved in that cycle, as well as to develop effective strategies to treat and prevent CSA.