Child sexual abuse, attachment style, and depression: the role of the characteristics of abuse

Evaluation of attachment style, parent's attitude, depression and anxiety in adolescents who are sexually abused

Purpose: The aim of this article was to describe the sociodemographic attributes of the adolescents who were sexual abused child and the characteristics of the sexual abuse encountered by adolescents; it was also aimed to compare their attachment styles to their parents, attitudes of their parents, their scale scores of depression and anxiety between healthy control group who haven't had sexual abuse. Materials and Methods: The research sample was formed by 34 adolescents in age range of 13-18 who had sexual abuse and 34 healthy adolescents in age range of 13-18 who haven't had sexual abuse. Sociodemographic data of all adolescents who joined the study were collected. Relationship Scales Questionnaire, Parental Attitude Scale, Children's Depression Inventory, State-Trait Anxiety Inventory were used to compare severity of depression and anxiety, parrental attitudes, the attachment styles to the parents of adolescents who had sexual abuse and adolescents who haven't had sexual abuse. Results: The average age of cases were calculated as 15.29±1.31. The fearful attachment subscale score average of sexual abuse group is significantly higher than the control group. The authoritarian attitude subscale score average of sexual abuse group is significantly higher than the control group. In addition, the depression and state-trait anxiety score average of sexual abuse group is significantly higher than the control group. Conclusion: It is extremely important to define the sociodemographic characteristics, characteristics of abuse and risk factors of children and adolescents who have been sexually abused, to increase mother-child interaction, to have parent trainings for the realization of secure attachment, to adopt a democratic parental attitude in terms of protecting the mental health of children and adolescents.

Development and Validation of the Drama Triangle Scale: Are You a Victim, Rescuer, or Persecutor?

The drama triangle is a theoretical framework to describe and understand the roles (Victim, Rescuer, and Persecutor) that people assume and perpetuate in interpersonal relationships, especially in contexts of "drama" or conflict. The Drama Triangle scale was developed, validated, and psychometrically scrutinized across three independent samples of adults. In Study 1 (N = 326), the initial pool of items was generated based on reviewing the literature. Exploratory factor analysis supported the three-factor structure of Victim (damsel in distress), Rescuer (hero), and Persecutor (villain) roles. In Study 2 (N = 342), confirmatory factor analysis (CFA) produced satisfactory fit indices. In Study 3 (N = 301), another CFA successfully cross-validated the final set of items. Furthermore, tests of convergent, discriminant, and criterion validities evaluated this scale against previously validated external measures of attachment styles, anxiety, stress, depression, positive emotions, and negative emotions. The drama triangle subscales tended to be associated with non-secure attachment styles and higher anxiety, stress, depression, and negative emotions, but results varied depending on the specific drama subscale. The Victim subscale was most strongly connected with undesirable outcomes, supporting the theoretical premise that Victims receive blame from Persecutors and help from Rescuers. This measurement instrument helps to conceptualize, measure, and understand the drama roles of Victim, Rescuer, and Persecutor that people enact in interpersonal relationships. The scale offers theoretical and applied implications for administration in future research on interpersonal conflict, aggression, violence, and other domains.

Childhood maltreatment with school bullying behaviors in Chinese adolescents: A cross-sectional study

OBJECTIVE

Although childhood maltreatment and school bullying are common among Chinese adolescents, their possible connection remains severely under-discussed in this population. This study primarily aims to explore the association between childhood maltreatment experience and school bullying behaviors in a large sample of Chinese teenagers.

METHOD

A school-based sampling survey was implemented with 2579 adolescents in southwest China. Self-administered questionnaire was used to collect relevant information form the participants. Binary Logistic regression models were adopted to estimate the crude and adjusted associations between childhood maltreatment experience and school bullying involvement in general, as well as between different types of child maltreatment and school bullying.

RESULTS

Multivariate Logistic regression models revealed that, for adolescents who had experienced any type of childhood maltreatment, their risk of implicating into school bullying significantly increased (OR=1.75, 95% CI: 1.41-2.16). Further analysis revealed that, for all types of childhood maltreatment and school bullying, only child abuse showed prominent association with bullying victimization: adolescents who reported a history of sexual abuse and emotional abuse were found 4.31 (95% CI: 2.79-6.68) and 2.11 (95% CI: 1.32-3.39) folds of odds for bullying victimization. However, the dose-response association was not apparent between the severity of child abuse and bullying victimization based on subgroup analysis of abused participants.

CONCLUSIONS

Childhood maltreatment, especially sexual abuse and emotional abuse, were significantly associated with increased risk of school bullying victimization among Chinese adolescents. Targeted intervention measures should be designed and implemented to protect the abused adolescents from being bullied at school.

Child Sexual Abuse and Suicidal Ideation: The Differential Role of Attachment and Emotional Security in the Family System

The objective of this study was to analyze the effects of attachment style and emotional security in the family system on suicidal ideation in a sample of young adult female victims of child sexual abuse (CSA). The possible effects of CSA characteristics and other types of child abuse on suicidal ideation were controlled for. The sample consisted of 188 female college students who had been victims of sexual abuse before the age of 18, as well as 188 randomly selected participants who had not experienced CSA. The results showed that both attachment and emotional security were associated with suicidal ideation, even when controlling for both the characteristics of abuse and the existence of other abuses. The strong relationships of emotional security and attachment style with suicidal ideation suggest the importance of early intervention with children who have been sexually abused and their families, in an effort to optimize their attachment style, as well as to decrease emotional insecurity to prevent the onset of symptomatology related to suicidal ideation.

A Profile of Gender-Based Violence Research in Europe: Findings From a Focused Mapping Review and Synthesis

This article reports the findings from a new form of review: a focused mapping review and synthesis. The aim was to create a contemporary, snapshot profile of the nature and scope of gender-based violence (GBV) studies conducted in Europe. GBV is one of the most prevalent human rights violations in the world affecting mainly women and girls. The policy context of GBV in Europe has gathered momentum in recent years, but we do not have a clear picture of how this relates to research activity. Thirteen journals were purposively selected on their likelihood to publish GBV research. All articles published in these journals during 2015 and meeting our inclusion criteria were retrieved. Data were extracted according to (1) types of methodologies used, (2) geographical location of research, and (3) patterns of research activity/interest. Thirty-two articles met the inclusion criteria. Many titles and abstracts were not explicit about the gendered nature of the research which made retrieval and analysis difficult. A range of methodologies were reported, with single-country research conducted more than international collaborations. Intimate partner violence and sexual abuse attracted most research interest. No studies explored female genital mutilation/cutting and only one investigated early and forced marriage. The findings have implications regarding GBV research in Europe, and we explore them in relation to relevant European policy. Researchers can help raise the profile of the gendered nature of most violence-related research by being explicit about this in their publications. Increasing opportunities for cross-national research will help address the global nature of GBV. Tackling GBV requires synergy of empirical evidence and policy to drive the agenda.

Effects of childhood emotional maltreatment on depressive symptoms through emotion dysregulation in treatment-seeking patients with heroin-dependence

BACKGROUND

Although individuals who experience childhood emotional maltreatment (CEM) are more likely to use maladaptive emotion regulation strategies, resulting in vulnerability to depression, no research has examined whether emotion dysregulation may explain the association between CEM and current depressive symptoms in a clinical sample of heroin-dependent individuals.

OBJECTIVES

The current study aimed to assess the direct effect of CEM on current depressive symptoms and its indirect effect via emotion dysregulation in a treatment-seeking sample of males with heroin dependence. In a cross-sectional design, participants (N = 350) completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Difficulties in Emotion Regulation Scale (DERS), the Obsessive-Compulsive Drug Use Scale (OCDUS), and the Beck Depression Inventory-II (BDI-II).

RESULTS

Emotional abuse and neglect severity had significant direct effects on current depressive symptoms and significant indirect effects through emotion dysregulation after controlling for clinical factors related to heroin use.

LIMITATIONS

Study limitations include the cross-sectional design and use of self-report scales.

CONCLUSIONS

Findings suggest emotion dysregulation may increase depressive symptoms in heroin users who experienced CEM. Training in emotion regulation strategies may decrease depressive symptoms in heroin-dependent individuals with CEM. Additional research with a longitudinal design to confirm these results is warranted.

A follow-up study of mental health service utilisation in a cohort of 2433 sexually abused Australian children utilising five years of medical data

BACKGROUND AND OBJECTIVES

There are well established links between child sex abuse (CSA) and a range of mental health adversities in the literature. However, there has been very limited examination of mental health care needs of CSA survivors, indicated by contacts with mental health professionals. Similarly, no existing research has examined rates of prescription of psychopharmacology to CSA survivors. Service utilisation is a vital component of the health landscape, and a clear understanding of the mental health care needs of CSA survivors is central to policy formation regarding mental health funding. Therefore, this study aimed to assess differences in rates of mental health care utilisation and rates of prescription of psychopharmacology during adulthood between individuals with a history of CSA and a comparison sample from the general population without a known abuse history.

PARTICIPANTS, SETTING, AND METHOD

The forensic medical records of 2433 CSA victims identified between 1964 and 1995 were linked to Australian medical and medication-use data accessed between 2010 and 2015, when victims were, on average, aged between 28.78 and 33.78 years. CSA cases were compared to a matched comparison cohort on rates of contact with mental health professionals and prescriptions for mood stabilisers, anxiolytics, antipsychotics, stimulants, analgesics and addiction treatment medication.

RESULTS

CSA was associated with increased levels of attendance at psychiatrists (OR = 1.29, p < .001), psychologists and clinical social workers (OR = 6.68, p < .001) and general practitioners (OR = 1.76, p < .001) for mental health care. CSA was also associated with increased frequency of prescription of all categories of psychopharmacology (ORs ranging from 1.40 to 6.18). Outcomes differed by victim gender and age at abuse. Abused females demonstrated greater overall service and medication utilisation than abused males. Females abused after puberty (age 12 years) had more frequent contacts with general practitioners for mental health care and greater frequency of prescription of psychopharmacology than females abused under age 12 years, including elevated frequency of analgesic and mood stabiliser use. Males abused after puberty also demonstrated higher frequency of service utilisation, including inflated rates of antipsychotic and anxiolytic prescriptions and visits to psychiatrists.

CONCLUSIONS

Experiencing CSA was associated with increased use of psychopharmacology and contact with health professionals for mental health care. Abused females and participants abused after age 12 demonstrated most inflated use of services. These findings have important implications for policy decisions regarding the provision of mental health care to CSA survivors deemed to be at risk of developing mental health difficulties.

Examining Childhood Maltreatment and School Bullying Among Adolescents: A Cross-Sectional Study From Anhui Province in China

Although a body of research has established the relationship between childhood maltreatment and bullying in Western culture backgrounds, few studies have examined the association between childhood maltreatment experiences and bullying in China. Moreover, to date, the relationship between multiple types of childhood maltreatment and cyber bullying is poorly understood. This study examined the association between multiple types of childhood maltreatment (physical abuse, emotional abuse, sexual abuse, physical neglect, and emotional neglect) and multiple forms of school bullying (physical, verbal, relational, and cyber). A cross-sectional study using three-stage random cluster-sampling approach was conducted in Tongling, Chuzhou, and Fuyang, in Anhui Province. Self-reported questionnaires were completed by 5,726 middle school students to assess their school bullying involvement and childhood maltreatment experiences. A multivariable logistic regression analysis was used to explore the relationship between each single type of childhood maltreatment and each single form of school bullying. Each type of childhood maltreatment was associated with increased risk for involvement in each form of bullying as bullies, victims, and bully-victims. Specifically, both childhood physical neglect and emotional neglect were associated with increased risk for involvement in each form of school bullying. Each type of childhood maltreatment was associated with involvement in cyber bullying. Students who experienced multiple types of childhood maltreatment seem to report more forms of school bullying. Furthermore, multiple forms of school bullying caused the co-occurrence of several forms of school bullying. Our results indicated a significant association between school bullying and childhood maltreatment among adolescents. Interventions to reduce school bullying encompassing prevention toward childhood maltreatment might get better results in China.

The neurobiology of safety and threat learning in infancy

What an animal needs to learn to survive is altered dramatically as they change from dependence on the parent for protection to independence and reliance on self-defense. This transition occurs in most altricial animals, but our understanding of the behavioral neurobiology has mostly relied on the infant rat. The transformation from dependence to independence occurs over three weeks in pups and is accompanied by complex changes in responses to both natural and learned threats and the supporting neural circuitry. Overall, in early life, the threat system is quiescent and learning is biased towards acquiring attachment related behaviors to support attachment to the caregiver and proximity seeking. Caregiver-associated cues learned in infancy have the ability to provide a sense of safety throughout lifetime. This attachment/safety system is activated by learning involving presumably pleasurable stimuli (food, warmth) but also painful stimuli (tailpinch, moderate shock). At about the midway point to independence, pups begin to have access to the adult-like amygdala-dependent threat system and amygdala-dependent responses to natural dangers such as predator odors. However, pups have the ability to switch between the infant and adult-like system, which is controlled by maternal presence and modification of stress hormones. Specifically, if the pup is alone, it will learn fear but if with the mother it will learn attachment (10-15days of age). As pups begin to approach weaning, pups lose access to the attachment system and rely only on the amygdala-dependent threat system. However, pups learning system is complex and exhibits flexibility that enables the mother to override the control of the attachment circuit, since newborn pups may acquire threat responses from the mother expressing fear in their presence. Together, these data suggest that the development of pups' threat learning system is not only dependent upon maturation of the amygdala, but it is also exquisitely controlled by the environment. Most notably the mother can switch pup learning between attachment to threat learning in a moment's notice. This enables the mother to navigate pup's learning about the world and what is threatening and what is safe.

Early life maltreatment but not lifetime depression predicts insecure attachment in women

Early life maltreatment (ELM) poses a risk for the development of insecure attachment and depression over the life span, depending on the type of maltreatment (physical, sexual, emotional, neglect) and its severity. The aim of this study was to investigate the influence of ELM and lifetime depression on adult insecure attachment in a female sample (N = 188), consisting of n = 81 women with ELM and n = 107 without ELM. Women with ELM reported significantly higher scores on insecure attachment than women without ELM. A significant interaction effect for ELM × lifetime depression was found: Contradictory to the hypotheses, women with ELM but without lifetime depression scored highest on avoidant attachment, differing significantly from women with ELM and lifetime depression, even though the severity of ELM was higher among women with ELM and lifetime depression and they experienced significantly more severe neglect and sexual abuse, but not physical or emotional abuse. Regression analyses revealed that ELM was the only predictor of avoidant attachment, explaining 15.5% of the variance. Results underline the strong influence of ELM on adult attachment and are of special importance for prevention and intervention programs.

Predictors of Clinical Outcomes in Sexually Abused Adolescents

This cross-sectional, case control study examines the association between child sexual abuse and interpersonal and intrapersonal outcomes among 54 adolescents, examining specific clinical measures (depression, anxiety, dissociation, and posttraumatic stress disorder, attachment patterns, self-esteem, self-disclosure, and family environment characteristics). The research results point to a correlation between sexual abuse and higher levels of the clinical measures. In addition, a correlation was found between sexual abuse and level of avoidant attachment, self-esteem, and family environment characteristics. Stepwise hierarchical regressions were conducted to examine how adolescent attributes predicted depression, anxiety, and dissociation beyond the prediction based on sexual abuse. A combination of self-esteem, anxiety attachment, and family cohesiveness made sexual abuse insignificant when predicting levels of depression, anxiety, and dissociation. This study contributes to characterizing the emotional, personal, and family attributes of adolescents who experienced sexual abuse. It also raises questions about the clinical outcomes usually associated with sexual abuse.

Refusing to Treat Sexual Dysfunction in Sex Offenders

This article examines one kind of conscientious refusal: the refusal of healthcare professionals to treat sexual dysfunction in individuals with a history of sexual offending. According to what I call the orthodoxy, such refusal is invariably impermissible, whereas at least one other kind of conscientious refusal—refusal to offer abortion services—is not. I seek to put pressure on the orthodoxy by (1) motivating the view that either both kinds of conscientious refusal are permissible or neither is, and (2) critiquing two attempts to buttress it.

Sex Offenders Seeking Treatment for Sexual Dysfunction--Ethics, Medicine, and the Law

INTRODUCTION

The treatment of sexual dysfunction in patients with prior sexual offenses poses ethical and legal dilemmas. Sex offenders are not obligated by law to disclose this history to medical professionals. Over 20% of sex offenders experience sexual dysfunction; however, the number of sex offenders seeking evaluation for sexual dysfunction is unknown.

AIMS

The aims of this study were to determine the incidence and characteristics of sex offenders seeking treatment in our clinic; and to review data regarding sex offender recidivism and ethics pertaining to the issue as it relates to treating physicians.

METHODS

Sex offenders were identified via three methods: new patient screening in a dedicated sexual medicine clinic, chart review of those on intracavernosal injection (ICI) therapy for erectile dysfunction (ED), and review of patient's status-post placement of penile prosthesis. Charts were cross-referenced with the U.S. Department of Justice National Sex Offender Public Website. Patient characteristics and details of offenses were collected.

MAIN OUTCOME MEASURES

The main outcome measures used were a self-reported sexual offense and national registry data.

RESULTS

Eighteen male sex offenders were identified: 13 via new patient screening; 3 by review of ICI patients; 1 by review of penile prosthesis data; and 1 prior to penile prosthesis placement. All were primarily referred for ED. Of those with known offenses, 64% were level 3 offenders (most likely to re-offend). The same number had committed crimes against children. All those with complete data had multiple counts of misconduct (average 3.6). Ninety-four percent (17/18) had publicly funded health care. Twelve (67%) were previously treated for sexual dysfunction.

CONCLUSIONS

Registered sex offenders are seeking and receiving treatment for sexual dysfunction. It is unknown whether treatment of sexual dysfunction increases the risk of recidivism of sexual offenses. Physicians currently face a difficult choice in deciding whether to treat sexual dysfunction in sex offenders.