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

Borderline personality disorder and sexual abuse: A systematic review

Although sexual abuse (SA) is known to be frequent among borderline personality disorder (BPD) patients, few reviews evaluating that relationship have been published. This systematic review aimed to investigate SA (including adulthood) as a predictor of BPD diagnosis, clinical presentation and prognosis. Studies written in English or Portuguese from January 1997 until January 2017 were identified by searching the following keywords in three international databases: "borderline personality disorder" OR "borderline disorder" AND "sexual abuse" OR "sexual violence" OR "sexual victimization" OR "sexual assault" OR "rape". Forty articles met the eligibility criteria. Overall, SA was found to play a major role in BPD, particularly in women. Childhood sexual abuse (CSA) is an important risk factor for BPD. Adult sexual abuse (ASA) rates are significantly higher in BPD patients compared with other personality disorders (PDs). SA history predicts more severe clinical presentation and poorer prognosis. Suicidality has the strongest evidence, followed by self-mutilation, post-traumatic stress disorder (PTSD), dissociation and chronicity of BPD. Future research should study more ASA and include more males, milder BPD patients and documented or corroborated SA cases. The impact of other traumatic experiences (e.g., emotional abuse) on BPD must also be systematically reviewed.

Parent-child relationship associated with the development of borderline personality disorder: A systematic review

The parent-child relationship (PCR) is considered as a central factor in most contemporary theories on the aetiology of borderline personality disorder (BPD). This systematic review aimed to answer the three following questions: (1) How is the PCR described by BPD participants and their parents in comparison to other normative and clinical groups? (2) Which aspects of the PCR are specifically associated with a BPD diagnosis in adulthood? (3) How can the facets of the PCR identified in the reviewed studies shed light on the general aetiological models of BPD? Forty studies were retained and divided into three categories: perspective of BPD probands, perspective of their parents and perspective of family. Borderline personality disorder participants consistently reported a much more dysfunctional PCR compared to normal controls. Comparisons with participants presenting DSM-IV Axis-I and Axis-II disorders were a lot less consistent. BPD probands rated more negatively the PCR compared to their parents. Low parental care and high parental overprotection may represent a general risk factor for psychopathology, different from normal controls but common to BPD and other mental disorders. An interesting candidate for a specific PCR risk factor for BPD appears to be parental inconsistency, but further studies are necessary to confirm its specificity. Copyright © 2017 John Wiley & Sons, Ltd.

Association of childhood trauma and panic symptom severity in panic disorder: Exploring the mediating role of alexithymia

BACKGROUND

The aim of the present study was to examine the association between childhood trauma (CT), alexithymia, and panic symptom severity in patients with panic disorder (PD). Moreover, the effect of specific subtypes of CT on alexithymia and panic symptom severity was also investigated.

METHODS

142 patients with PD and 146 healthy age-matched and sex-matched controls were enrolled in the study. The Structured Clinical Interview for DSM-IV axis I (SCID-I), Childhood Trauma Questionnaire-28 item Short Form (CTQ-28), Toronto Alexithymia Scale (TAS-20), and Panic Disorder Severity Scale (PDSS) were administered to all subjects. The relationships among CT subtypes, alexithymia, and panic symptom severity were investigated using Pearson's correlation analysis. The types of CT that predict alexithymia and panic symptom severity were also investigated using Regression analyses.

RESULTS

PD patients showed higher scores on reporting all kinds of CT except sexual abuse. In addition, the TAS-20, DIF (difficulty identifying feelings) and DDF (difficulty describing feelings) scores were significantly higher in patients with PD than in controls. Significant positive correlations were noted among CT, alexithymia and panic symptoms severity. Results of regression analyses showed alexithymia as a mediator between the different types of CT and panic disorder severity, except sexual abuse.

LIMITATIONS

Although self-report questionnaires are reliable and widely used, the phenomenon of patients who underreport or overreport their symptoms cannot be ignored.

CONCLUSION

The present study showed that CT and alexithymia are more common in patients with PD and impact the severity of panic symptoms. Results suggest that alexithymia may be an important mediator between CT and panic disorder severity.

The Contribution of Cognitive Strategies to the Resilience of Women Survivors of Childhood Sexual Abuse and Non-Abused Women

This study examines the contribution of four strategies—self-forgiveness, realistic control, unrealistic control, and hope—to the resilience of 100 women survivors of childhood sexual abuse (CSA), as compared with 84 non-sexually abused women. The findings show that CSA survivors exhibited lower resilience, lower self-forgiveness, lower hope, and higher levels of posttraumatic symptoms (PTS). They also indicate that resilience was explained by the participants’ financial status, PTS severity, and two cognitive strategies—self-forgiveness and hope. Finally, PTS and hope mediated the relation between CSA and resilience.

Childhood sexual abuse in adult patients with borderline personality disorder

BACKGROUND

Researchers have found elevated rates of childhood sexual abuse (CSA) in borderline personality disorder (BPD) patients. They have also implicated the role of CSA later in BPD. However, there has been a scarcity of studies regarding this in Indian population.

OBJECTIVES

To profile the occurrence of CSA and its parameters in BPD patients and to document symptomatology of BPD associated with CSA.

MATERIALS AND METHODS

Thirty-six consecutive patients with BPD were administered with a two-staged semi-structured interview by different interviewers with the first stage for collecting sociodemographic details and confirming BPD diagnosis and the second stage for collecting information about CSA.

RESULTS

Of 36 BPD patients, 16 (44.44%) reported a history of definite CSA. The majority of CSA associated with BPD were having characteristics of onset at 7-12 years, <10 occasions of abuse, perpetrator being a close relative or a close acquaintance and genital type of CSA. Identity disturbances (P = 0.0354), recurrent suicidal/self-harm behavior (P = 0.0177), and stress-related paranoid/dissociative symptoms (P = 0.0177) were significantly associated with the presence of CSA while unstable interpersonal relationships (P = 0.001) were significantly associated with the absence of CSA.

CONCLUSION

Significant proportion of BPD patients reported CSA. The specific symptom profile of BPD patients can be used to predict the presence of CSA in these patients, which has a direct implication in the treatment of these patients.

Resilience in Survivors of Child Sexual Abuse: A Systematic Review of the Literature

OBJECTIVE

This review article summarizes empirical research on resilience in survivors of child sexual abuse (CSA) and discusses protective factors that are associated with adaptive functioning in spite of sexual victimization.

METHODS

A literature search to identify studies published up to November 2013 was performed within the databases PsycINFO, MEDLINE/PubMed, Web of Science, and PSYNDEXplus. Additional relevant studies were retrieved using a snowball technique. A total of 37 articles met the inclusion criteria and were included in the final sample.

RESULTS

In the studies included in this review, the percentage of CSA survivors who were found to have a normal level of functioning despite a history of sexual abuse ranged from 10% to 53%. The protective factors that had the best empirical support were found to be education, interpersonal and emotional competence, control beliefs, active coping, optimism, social attachment, external attribution of blame, and most importantly, support from the family and the wider social environment.

CONCLUSIONS

Preventive and clinical interventions for survivors of CSA should utilize psychoeducation and cognitive strategies that are adapted to the developmental level of the victim and that seek to enhance social support from significant others. Future research should focus on longitudinal research designs considering resilience rather as a dynamic process with multiple dimensions in a social and developmental context.

Emotional support and adult depression in survivors of childhood sexual abuse

The goals of this study were to evaluate the effects of emotional support from friends and parents at two time points (adolescence and adulthood) on adult depression in a nationally representative sample of survivors of childhood sexual abuse (CSA), and examine whether the associations were moderated by the identity of the perpetrator (parent/caregiver vs. not). Data were taken from Waves I and IV of the National Longitudinal Study of Adolescent Health (Add Health). The study sample included 1,238 Add Health participants with a history of CSA and an equivalently sized comparison group of individuals with no history of CSA. Parental support was measured using four items from each wave that assessed the warmth of participants' relationships with their parents and their satisfaction with those relationships. Friend support in adolescence was measured using participants' perceptions of how much their friends cared about them and in adulthood using participants' self-reported number of close friends. Depression was measured using a 10-item subscale of the CES-D. Logistic regressions showed that support from friends and parents in adulthood were significantly associated with lower odds of adult depression in CSA survivors who reported non-parent/caregiver abuse. Among survivors of parent/caregiver abuse, emotional support was not significantly associated with adult depression regardless of when or by whom it was provided. In conclusion, emotional support in adulthood from friends and parents is associated with reduced odds of adult depression in CSA survivors, but only in cases where the abuse was perpetrated by someone other than a parent or caregiver.

The role of early life stress in adult psychiatric disorders: a systematic review according to childhood trauma subtypes

Early life stress (ELS; sexual abuse, physical abuse, emotional abuse, physical neglect, and emotional neglect) has been the focus of numerous studies. It has been associated with the onset and the severity of psychiatric disorders in adults. The objective of this study was to review the literature on ELS associated with psychiatric disorders in adulthood, seeking to identify whether there are independent effects between subtypes of early stress in triggering psychopathology in adults. We reviewed articles from 2001 to 2011 in four databases (PubMed, SciELO, LILACS, and PsycINFO), with the following key words: child abuse, maltreatment, early life stress, psychiatric disorders, mental disease, and psychopathology. Forty-four articles were selected, and most of these articles demonstrate that the subtypes of ELS are associated with several psychiatric disorders, more specifically: physical abuse, sexual abuse, and unspecified neglect with mood disorders and anxiety disorders; emotional abuse with personality disorders and schizophrenia; and physical neglect with personality disorders. Physical neglect had the weakest association between the subtypes. ELS subtypes in childhood and adolescence can predict the development of psychopathology in adults. Scientific evidence shows that ELS triggers, aggravates, maintains, and increases the recurrence of psychiatric disorders. These results demonstrate the importance of a deeper understanding about the unique effects of ELS subtypes, especially for mental health professionals.

Shibari: double hanging during consensual sexual asphyxia

We describe a case of shibari, a double hanging sexual asphyxia practice, which ended fatally for one of the two women involved. We present the autopsy findings and a psychiatric and psychometric evaluation of the surviving participant. The survivor had a borderline personality disorder, had suffered sexual abuse as a child, and had a history of illicit substance consumption, self-harm behavior, and sexual dysregulation. This case study raises doubts regarding the safety measures adopted by participants in masochistic practices and the engagement of people with psychiatric disorders in these extremely dangerous games. Further case studies of living participants in such games are likely to shed light on this practice and facilitate treatment.

Pregnancy complicated by opiate addiction and fetal growth restriction

This case describes recovery of fetal growth restriction in utero after treatment for opiate addiction with the long-acting agent methadone. It is followed by discussions by an addiction medicine specialist followed by a maternal-fetal medicine specialist.

Role of childhood traumatic experience in personality disorders in China

BACKGROUND

There has been no large-scale examination of the association between types of childhood abuse and personality disorders (PDs) in China using standardized assessment tools and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. Hence, this study aimed to explore the relationship between retrospective reports of various types of childhood maltreatments and current DSM-IV PDs in a clinical population in China, Shanghai.

METHOD

One thousand four hundred two subjects were randomly sampled from the Shanghai Psychological Counselling Centre. PDs were assessed using the Personality Diagnostic Questionnaire, Fourth Edition Plus. Participants were also interviewed using the Structured Clinical Interview for DSM-IV axis II. The Child Trauma Questionnaire (CTQ) was used to assess childhood maltreatment in 5 domains (emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect).

RESULTS

According to Pearson correlations, childhood maltreatment had a strong association with most PDs. Subsequently, using partial correlations, significant relationships were also demonstrated between cluster B PDs and all the traumatic factors except physical neglect. A strongest positive correlation was found between cluster B PD and CTQ total scores (r = .312, P < .01). Using the Kruskal-Wallis rank sum test, significant differences in 4 groups of subjects (clusters A, B, and C PD and non-PD) in terms of emotional abuse (χ(2) = 34.864, P < .01), physical abuse (χ(2) = 14.996, P < .05), sex abuse (χ(2) = 9.211, P < .05), and emotional neglect (χ(2) = 17.987, P < .01) were found. Stepwise regression analysis indicated that emotional abuse and emotional neglect were predictive for clusters A and B PD, and sexual abuse was highly predictive for cluster B PD; only emotional neglect was predictive for cluster C PD.

CONCLUSION

Early traumatic experiences are strongly related to the development of PDs. The effects of childhood maltreatment in the 3 clusters of PDs are different. Childhood trauma has the most significant impact on cluster B PD.

A protective genetic variant for adverse environments? The role of childhood traumas and serotonin transporter gene on resilience and depressive severity in a high-risk population

Genetic aspects may influence the effect of early adverse events on psychological well being in adulthood. In particular, a common polymorphism within the serotonin transporter gene (5-HTTLPR short/long) has been associated to the risk for stress-induced psychopathology. In the present study we investigated the role of childhood traumas and 5-HTTLPR on measures of psychological resilience and depression in a sample of individuals at a high risk for psychological distress (763 male prisoners). The 5-HTTLPR genotype did not influence resilience and depressive severity. However, a significant interaction was observed between 5-HTTLPR and childhood traumas on both resilience and depressive severity. In particular, among subjects exposed to severe childhood trauma only, the long-allele was associated to lower resilience scores and increased current depressive severity as compared to short/short homozygous. Sex specific effects, difference in type and duration of stressors and the specific composition of the sample may explain discrepancy with many studies reporting the short-allele as a vulnerability factor for reactivity to stress. We here speculated that in males the long-allele may confer lower resilience and therefore higher vulnerability for depressive symptoms in subjects exposed to early stress and currently living in stressful environments.

The impact of childhood sexual abuse on psychological distress among women in New Zealand

PROBLEMS

In order to better understand the long-term impact of child sex abuse, this study examined the association between women's experience of abuse, health symptoms, and psychological distress in adulthood. There is limited information about child abuse outside the United States.

METHODS

Nine hundred sixty-one women participated in a structured interview.

RESULTS

Participants who had experienced abuse (13%) were significantly more vulnerable to psychological distress in adulthood if they were younger, less satisfied with their standard of living, and resided in urban areas.

CONCLUSION

Dissemination and evaluation of therapies for the treatment of sex abuse in the New Zealand context is warranted.

Examining the relationship between childhood sexual abuse and borderline personality disorder: does social support matter?

The relationship between childhood sexual abuse and borderline personality disorder is a prominent issue in the etiological research on borderline personality disorder. This study further explored the relationship between childhood sexual abuse and the development of borderline personality features while evaluating the moderating role of a primary social support source in a sample of 290 female undergraduate students enrolled at a major southeastern university. Consistent with previous research, retrospective self-reports of childhood sexual abuse and low social support were both positively correlated with current borderline personality features. It was hypothesized that the presence of a supportive relationship at the time the childhood sexual abuse occurred would moderate the relationship between childhood sexual abuse and borderline personality features. This moderation hypothesis was not supported in the current study, but post-hoc analyses reveal the need to further examine how we define social support following childhood sexual abuse. This research is a stepping stone toward the prevention of borderline personality disorder following childhood sexual abuse.

Neurobiological and psychiatric consequences of child abuse and neglect

The effects of early-life trauma and its consequences for the treatment of depression are reviewed. The prevalence and clinical sequelae of early sexual and physical abuse, neglect and parental loss are described. An overview of preclinical studies that help guide clinical research and practice is presented. Human clinical studies on the neurobiological consequences of early trauma are summarized. Moderating factors, such as genetic variation and sex differences, are discussed. The few current treatment outcome studies relevant to this research area are described. Guidance for the management of patients with depression and a history of child abuse and neglect are provided. Most patients who have experienced early traumatic experiences are likely best treated with a combination of psychotherapy and pharmacotherapy. This review is dedicated to the memory of Seymour Levine who pioneered the field of early experience research and to a considerable extent inspired the clinical studies described in this review.

Predisposition for borderline personality disorder with comorbid major depression is associated with that for polycystic ovary syndrome in female Japanese population

Polycystic ovary syndrome (PCOS) is a common lifestyle-related endocrinopathy in women of reproductive age and is associated with several mental health problems. We examined the genotypic distributions of IRS-1 Gly972Arg and CYP11B2 -344T/C, which were previously described as influencing PCOS, and assayed the serum levels of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), in a set of female patients with borderline personality disorder (BPD) with comorbid major depressive disorder (MDD) (n = 50) and age-matched control subjects (n = 100), to investigate the predisposition for BPD with MDD. The results showed that the patients were more frequently IRS-1 972Arg variant allele carriers (P = 0.013; OR 6.68; 95% CI = 1.30-34.43) and homozygous for the CYP11B2 -344C variant allele (P = 0.022; OR = 3.32; 95% CI = 1.18-9.35) than the control subjects. The IL-6 level was significantly higher in the patients than in the controls (P < 0.0001). There was no significant difference in the serum TNF-α level between patients with BPD with MDD and the healthy comparison group (P = 0.5273). In conclusion, the predisposition for BPD with MDD is associated with that for PCOS, in the female Japanese population. An elevated serum IL-6 level is considered to be a possible biomarker of BPD with MDD.

Countertransference in the initial visit of women victims of sexual violence

OBJECTIVE: To identify demographic and clinical correlates associated with therapists' countertransference feelings on the first visit of women victims of sexual violence. METHOD: Forty patients were seen by 26 therapists, during 2 consecutive years, at the Center for the Study and Treatment of Psychological Trauma, Hospital de Clínicas de Porto Alegre , Brazil. After the first visit with the patient, the therapist completed the Assessment of Countertransference Scale and the patient was evaluated with the Davidson Trauma Scale, the Standardized Assessment of Personality - Abbreviated Scale, the Beck Depression Inventory, and the Defense Style Questionnaire. RESULTS:The therapists showed a predominance of feelings of closeness (Mean = 5.42, SD = 1.25) in relation to the feelings of indifference (Mean = 1.82, SD = 1.22) and distance (Mean = 1.57, SD = 1.08) [p < 0.001]. Multivariate analyses did not present significant associations between countertransference feelings and clinical characteristics of patients. The gender of the therapists did not influence the pattern of countertransference feelings. In the subgroup of female therapists, we detected an inverse correlation between a higher probability of patients' personality disorders and feelings of closeness in the therapists. CONCLUSION: We did not detect a differential pattern of countertransference feelings associated with specific clinical characteristics. Therapists of both genders presented a similar pattern of feelings of empathy towards women victims of sexual violence, although the gender of the therapist may moderate the feelings evoked by patients with increased likelihood of personality disorders.

Borderline personality disorder and childhood trauma: evidence for a causal relationship

The debate over whether childhood trauma is a causative factor in the development of borderline personality disorder continues in the literature despite decades of research. This review examines this body of literature published from 1995 through 2007 to assess the strength of evidence for such a causal relationship. A unique conceptual approach was used, as we considered the literature in the context of Hill's classic criteria for demonstrating causation. Results of this review suggest that evidence supports the causal relationship, particularly if the relationship is considered as part of a multifactorial etiologic model. Directions for future research and clinical implications are discussed.

La recherche de sens à la suite d’un événement traumatique

Le fait de donner un sens à une expérience traumatique est reconnu comme une étape importante dans le processus d’adaptation des victimes d’événements traumatiques. L’objectif de cet article est d’examiner les différentes facettes de la recherche de sens en intégrant les écrits reliés à plusieurs concepts apparentés à ce phénomène, tels les changements positifs et négatifs perçus et la croissance post-traumatique. La première partie présente trois théories explicatives de la recherche de sens. La seconde partie expose l’état des connaissances empiriques lié à divers types d’événements traumatiques. Finalement, la troisième partie souligne les problèmes méthodologiques inhérents à ce domaine de recherche et propose des pistes de recherches futures.

Detection of malingered PTSD: an overview of clinical, psychometric, and physiological assessment: where do we stand?

Posttraumatic stress disorder (PTSD) is a condition that can be easily malingered for secondary gain. For this reason, it is important for physicians to understand the phenomenology of true PTSD and indicators that suggest an individual is malingering. This paper reviews the prevalence of PTSD for both the general population and for specific events, such as rape and terrorism, to familiarize evaluators with the frequency of its occurrence. The diagnostic criteria for PTSD, as well as potential ambiguities in the criteria, such as what constitutes an exposure to a traumatic event, are reviewed. Identified risk factors are reviewed as a potential way to help differentiate true cases of PTSD from malingered cases. The question of symptom overreporting as a feature of the disease versus a sign of malingering is discussed. We then examine how the clinician can use the clinical interview (e.g., SIRS, CAPS), psychometric testing, and the patient's physiological responses to detect malingering. Particular attention is paid to research on the MMPI and the subscales of infrequency (F), infrequency-psychopathology (Fp), and infrequency-posttraumatic stress disorder (Fptsd). Research and questions regarding the accuracy of self-report questionnaires, specifically the Mississippi Scale (MSS) and the Personality Assessment Inventory (PAI), are examined. Validity, usability, and cutoff values for other psychometric tests, checklists, and physiological tests are discussed. The review includes a case, which shows how an individual used symptom checklist information to malinger PTSD and the inconsistencies in his story that the evaluator detected. We conclude with a discussion regarding future diagnostic criteria and suggestions for research, including a systematic multifaceted approach to identify malingering.

Cumulative stress and substantiated maltreatment: the importance of caregiver vulnerability and adult partner violence

OBJECTIVE

Our goal is to assess the effect of caregiver vulnerabilities, singly and in combination, on the substantiation of child abuse (physical, sexual) and neglect, while controlling for relevant background variables. We test the moderator role of adult partner violence in qualifying the relationship between caregiver vulnerabilities and maltreatment substantiation.

METHOD

Secondary analyses of the 1998 Canadian Incidence Study of Reported Child Maltreatment (CIS) are used to predict child protective service investigation substantiation versus non-substantiation from a range of caregiver vulnerability factors. Involvement in partner violence was examined as a moderator in the relation between caregiver vulnerabilities and maltreatment substantiation. The CIS is an epidemiological survey of first-reported cases to child protective services, using a random sample of child welfare agencies across Canada. Child welfare workers completed a research form on the child, primary caregiver, family, perpetrator, severity and type of maltreatment, as well as services and court outcomes. All maltreatment classifications were assigned according to the Canadian legal definition of child abuse and neglect. Hierarchical logistic regression analyses were used, with stepped entry of: (1) demographic factors, socioeconomic disadvantage, and caregiver's own history of maltreatment; (2) caregiver vulnerability factors; (3) involvement in partner violence; (4) the interaction between caregiver vulnerability and partner violence.

RESULTS

Caregiver substance abuse was found to be the single most potent kind of caregiver vulnerability in predicting maltreatment substantiation. When the total number of vulnerabilities was used as the predictor, prediction across all types of maltreatment increased, especially for substantiated neglect. Analyses also showed that the presence of partner violence in the home exacerbated the effect of caregiver vulnerability on substantiation.

CONCLUSIONS

The total number of caregiver vulnerabilities was the best predictor of the substantiation of child abuse and neglect. This relationship was moderated by the existence of partner violence: high caregiver vulnerability and high partner violence increased the likelihood of substantiation versus non-substantiation. These results suggest that caregiver issues should be considered in tandem with partner relationships. Among child welfare cases, caregiver vulnerability and partner violence are critical targets for child maltreatment prevention and early child protective services intervention.

Childhood antecedents of personality disorder

PURPOSE OF REVIEW

Given the substantial continuity of personality and axis I psychopathology from childhood to adult life, the present review explores whether and how recent research findings support the notion that personality disorders have their developmental precipitants in childhood. Potential childhood personality disorder antecedents will be reviewed from different research areas to enhance an insight into the genesis of a major set of adult psychiatric disorders with profound impact on the daily life.

RECENT FINDINGS

There exists increasing evidence that personality disorders have their origins in early years of life at the observable symptomatic, biological, and genetic levels. A clear need for prospective (behavior genetic) studies, however, exists that will ultimately verify how and when childhood personality disorder features turn into adult maladaptive trait patterns. It is further suggested that these designs require a comprehensive taxonomy for the description of personality disorder antecedents in a developmentally appropriate way.

SUMMARY

The call for a developmental perspective on adult personality disorders in recent debates on the construction of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, has created new avenues for an integrative longitudinal perspective on personality disorders and should stimulate child psychiatrists to consider the significance of emerging personality disorder symptoms at a young age.

Sexual abuse and eating disorder symptoms: the mediator role of bodily dissatisfaction

OBJECTIVE

The relationship between sexual abuse and eating disorders remains controversial; the role of intervening variables has often been neglected in past research. This study aimed at investigating the role of bodily dissatisfaction as a mediator effect on the impact of sexual abuse and the reporting of eating disorder symptoms.

METHOD

In a community sample of 126 young women aged 18 to 30 years, we investigated the links between sexual abuse and eating disorders by means of self-compiled measures, including the Eating Attitudes Test, the Bulimic Investigatory Test of Edinburgh, the Body Attitudes Test (BAT), and the revised Hopkins Symptom Checklist (SCL-90-R).

RESULTS

Those who reported sexual abuse in childhood scored higher at the Eating Attitudes Test, the Bulimic Investigatory Test of Edinburgh, and the BAT, compared with those who denied sexual abuse or experienced sexual abuse at an age after puberty. The experience of bodily dissatisfaction, as measured by the BAT, acted as an intervening variable (mediator) between sexual abuse in childhood and eating disorder symptoms.

CONCLUSION

Although caution is required when reading the conclusions that could be drawn from self-reported measures, sexual abuse before puberty could be considered as a risk factor for the development of eating disorder symptoms, inducing revulsion about the body in ways that may intermix with concerns about body shape, size, and weight.

El suicidio en la España de hoy

Spain presents one of the lowest suicide rates (8.7 per 100,000) but, as well as Ireland, it has also experienced one of the highest rate increases both within Europe and within the world. In our country, it can be observed an increase in the suicide rates from 1975 to 1994, being this increase greater in men than in women. It can also be noted that there was a stabilisation in the following years. Social factors, specially those which have to deal with gender roles and changes in these roles, are the most common explanations. Another possible explanation for the observed increase in mortality due to suicide among young men could be the AIDS epidemic and intravenous drug addiction, that was observed in Spain during the eighties and nineties. Furthermore, we are witnessing an epidemic related to violence against children and women. Literature strongly suggests that child abuse (psychological and sexual) is associated with increased suicide risk in adolescent or adult life. Women experience violence from their intimate partners and have a greater risk of suffering from chronic pain, diverse somatisations, greater substance use like drugs and alcohol, depression and suicide attempt. The association between work precariousness and suicide seems to be due to economic and social and family support factors, which can lead to greater vulnerability to mental health problems. These factors are of great relevance, since Spain presents one of the highest unemployment and temporary employment rates in the European Union. It seems reasonable that, due to the individualism that characterises the contemporary society, its demands and the new role of women in the work market that cause, among others, a greater difficulty in combining work and family life, are factors that could explain the lack of decrease in suicide rates.