The relationship between traumatic events and dissociation among women with histories of childhood sexual abuse

Attending to dissociation: assessing change in dissociation and predicting treatment outcome

High dissociation has been linked to severe psychopathology. However, relatively little is known about the impact of dissociation on treatment outcome. We sought to examine (a) whether initial levels of dissociation predicted treatment outcome, (b) whether changes in dissociation were associated with changes in other forms of psychopathology, and (c) to what extent individuals with high initial dissociation reported meaningful symptom improvement. Participants (N = 174) were patients at an outpatient trauma clinic. Initial dissociation was significantly associated with general symptom severity. Change in dissociation was significantly and positively associated with change in posttraumatic stress disorder, depression, suicidal ideation, and self-harm. Approximately 40% of high dissociators demonstrated reliable decreases in dissociation during treatment.

The relationships of dissociation and affective family environment with the intergenerational cycle of child abuse

OBJECTIVE

The purpose was to test a model that may explain how physically abused children become physically abusive parents. It was predicted that when the family's affective environment is uncohesive, unexpressive, and conflictual, a history of abuse experiences would be associated with elevated dissociation. It was hypothesized that dissociation would mediate between a childhood history of abuse and the current potential to be physically abusive.

METHOD

Abuse history, affective environment in the family-of-origin, dissociation, and abuse potential were assessed in a sample of 76 mothers with elementary school-age children.

RESULTS

Predictions were supported. Affective Family Environment moderated the relation between abuse history and dissociation, with abuse history relating to greater dissociation primarily when the family environment was conflictual, uncohesive and unexpressive. Further, dissociation significantly mediated the relation between abuse history and abuse potential (Z = 2.19, p < .05).

CONCLUSIONS

Dissociation's strong association with abuse potential may partially explain why only some abused children later perpetuate the cycle of abuse, as those who are not dissociative into adulthood are likely to have lower abuse potential, in contrast to those displaying elevated dissociation. The extent of the dissociation may depend on the affective family environment in which the abuse took place.

The role of depression and dissociation in the link between childhood sexual abuse and later parental practices

Research has yielded contradictory results on the relationship between childhood sexual abuse and later parental functioning. This study was undertaken to specify the link between childhood sexual abuse and maternal parenting, while taking into account mothers' childhood physical and emotional traumas and current depressive and dissociative symptoms. Data were collected through self-report measures completed by 93 French-speaking Canadian mothers of children aged 6 to 11 years referred to Youth Protection Services. Parental behaviors examined included involvement with the child, use of positive reinforcement, lack of monitoring and supervision of the child, inconsistency in applying discipline, and use of corporal punishment. Mothers' perception of the quality of the relationship with her child was also assessed. In addition, history of abuse and neglect, depression and dissociation were respectively measured with the Childhood Trauma Questionnaire, the Diagnostic Interview Schedule Simplified, and the Dissociative Experiences Scale. The short-form of the Marlowe-Crowne Social Desirability Scale was used to control for respondent bias aimed at minimizing their problems. Mothers' current depressive symptoms were not found to predict any of the parental dimensions measured. Results from multiple hierarchical regressions pointed to dissociative symptoms as the key predictor of parental practices and attitudes. More specifically, dissociative symptoms predicted the use of positive reinforcement, lack of monitoring and supervision of the child, inconsistency in applying discipline, and use of corporal punishment. Dissociation also mediated the association between childhood maltreatment (physical and emotional abuse and neglect) and inconsistency in applying discipline. Implications for research and practice are discussed.

Mediators of the link between childhood sexual abuse and emotional distress: a critical review

A history of childhood sexual abuse (CSA) is a risk factor for adult emotional distress, including symptoms of depression, anxiety, dissociation, and trauma. However, CSA is likely associated with adult distress indirectly through an impact on mediating variables. In a review of the empirical literature, the authors found support for the roles of shame or self-blame, interpersonal difficulties, and avoidant coping strategies as mediators. In addition, emotional distress appears to mediate links between CSA and other adverse outcomes, such as alcohol abuse and revictimization. The authors conclude with a number of methodological and conceptual recommendations.

Shame-proneness as a diathesis for dissociation in women with histories of childhood sexual abuse

This study examined whether shame-proneness is associated with dissociation among abused women. Participants were 99 hospitalized women with and without reported histories of childhood sexual abuse. Hypotheses were that childhood sexual abuse and shame-proneness would each be associated with dissociation, and that the relationship between sexual abuse and dissociation would be greater among women with higher shame-proneness. Multiple regression analysis indicated that shame-proneness was independently related to dissociation, but childhood sexual abuse was not. As predicted, the combination of shame-proneness and childhood sexual abuse was associated with dissociation.

Personality traits and symptom reduction in a group treatment for women with histories of childhood sexual abuse

The influence of personality on symptom reduction has not been examined in research on treatments for women with childhood sexual abuse histories, although personality has demonstrated predictive value in other treatment contexts. This study examined personality variables associated with symptom reduction in group therapy for hospitalized women with histories of sexual abuse. Personality was measured with the NEO-Five-Factor Inventory (NEO-FFI), which yields scores on neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness. Among 86 women who participated in either the Women's Safety in Recovery (WSIR) group therapy or treatment as usual, 43 completed assessments of symptom reduction at discharge and 6-month follow-up. We hypothesized that extraversion, agreeableness, and openness to experience would be associated with treatment outcome. Our results showed that agreeableness and extraversion moderated the effect of treatment on symptom reduction. WSIR participants who were less agreeable improved more at discharge and 6-month follow-up than more agreeable WSIR participants. Moreover, women in the WSIR group who were more introverted showed greater symptom improvement at discharge than more extraverted women. Our findings suggest that more introverted, less agreeable patients with sexual abuse histories may indeed benefit from structured group treatments.