Sexual anxiety and eroticism predict the development of sexual problems in youth with a history of sexual abuse

Etiological Pathways to the Emergence of Preteen Problematic Sexual Behavior: An Exploratory Mediational Model

Studies examining the etiology of problematic sexual behavior (PSB) among pre-teen children often rely on identifying correlational relationships without examining potential causal mechanisms. This study describes an exploratory analysis of a potential mediational model where child sexual abuse (CSA) and child physical abuse (CPA) predict the onset of PSB through their impact on the emergence of posttraumatic stress (PTS) symptoms and self-dysregulation. The caregivers of 189 children between the ages of 3 and 11 years presenting for mental health treatment in the United States completed a battery of measures designed to assess each of the variables in the model. Cross-sectional, regression-based mediational analyses showed that the overall model performed adequately (R = 0.33, R² = 0.11, F = 3.07, p = .004). CSA exerted a direct effect on PSB that was not mediated through either PTS or self-dysregulation. However, no direct effect for CPA was found. Rather, CPA exerted a significant effect on the display of self-dysregulation, which in turn was associated with PSB. These results are discussed in light of clinical implications and directions for further research.

Etiological Perspectives on Problematic Sexual Behavior of Preteen Children: Implications for Treatment

Problematic sexual behavior (PSB) among preteen children is a poorly understood clinical phenomenon that may leave even the most skilled and knowledgeable of clinicians at a loss when attempting to develop an evidence-based treatment approach. Much of this lack of practical direction can be credited to the relatively scarce clinical trial research examining this outcome. Nonetheless, the etiological research on PSB provides clearer directions and suggests the implementation of already well-established interventions may be effective. This paper reviews the current state of the etiological research pertaining to PSB and places these findings within developmental psychopathology, social learning theory, and post-traumatic stress disorder symptomatology frameworks. Specific treatment directives derived from these three viewpoints are then reviewed, including a review of the current evidence base for the treatment of PSB. Finally, a treatment planning algorithm is specified to help clinicians identify the most beneficial approach to treating PSB in a given case.

The Effect of Sexual Concerns on Placement Changes and School Transfers for Youth in the Child Welfare System

Youths in the child welfare system experience high rates of placement changes and school transfers; therefore, prior research focused on variables that may be linked with such disruptions. Indeed, researchers have established that mental health symptoms (e.g., PTSD symptoms) are linked with placement disruptions. However, an important aspect of mental health for youth in the child welfare system has largely been ignored: sexual concerns (e.g., distress, preoccupation). Thus, the present study evaluated whether higher levels of sexual preoccupation and distress among a sample of child welfare-involved youths (N = 124) in a northeastern state predicted placement changes and school transfers above and beyond variables previously linked with these disruptions. Our hypotheses were partially supported such that higher levels of sexual distress were linked with increased odds of experiencing a placement change (OE = 2.60; p <.01). Counter to our hypotheses, higher levels of sexual preoccupation were linked with lower odds of experiencing both placement changes (OE = -2.98; p <.01) and school transfers (OR = 0.18; p < .05). Furthermore, sexual preoccupation and sexual distress were not linked with increased rates of placement changes. The current findings have implications for the assessment of sexual concerns and the prevention of placement changes among youth in the child welfare system.

Die Entwicklung von Sexualität bei Kindern und Jugendlichen mit sexuellen Gewalterfahrungen

Zusammenfassung. Theoretischer Hintergrund: Zu den Folgen sexueller Gewalt gehören neben somatischen und psychischen Folgen auch Veränderungen in der Entwicklung der Sexualität. Fragestellung: Ziel dieses Reviews ist es, einen systematischen Überblick über den aktuellen Forschungsstand bezüglich der Entwicklung von Sexualität bei Kindern und Jugendlichen nach sexuellen Gewalterfahrungen zu geben. Methode: Eine systematische Literaturrecherche wurde in den Datenbanken PubMed, ERIC, Cochrane und PubPsych durchgeführt. Die Folgen von sexueller Gewalt bezüglich der Sexualität wurden systematisch analysiert. Ergebnisse: Es konnten insgesamt 127 Studien zur Sexualität nach sexueller Gewalt identifiziert werden, die acht Unterkategorien zugeordnet werden konnten: Sexuelles Risikoverhalten, Teenagerschwangerschaft, jugendliche Sexualstraftäter_innen, sexuelle Verhaltensauffälligkeiten, sexuelle Überzeugungen, Prostitution, Geschlechtskrankheiten und körperliche Symptome. Diskussion und Schlussfolgerung: Insgesamt zeigt die Literaturrecherche, dass die Sexualität von Kindern und Jugendlichen mit sexuellen Gewalterfahrungen teilweise nur lückenhaft untersucht wurde.

Caregivers' abuse stigmatization and their views of mental health treatment following child sexual abuse

Many families do not utilize mental health services after the discovery of child sexual abuse (CSA), even when trauma-focused treatments are offered at low or no cost. Non-offending caregivers frequently serve as gatekeepers to youths' treatment, and their reactions to CSA may figure into decisions about treatment engagement. The current study examined caregivers' abuse stigmatization (i.e., self-blame and shame about their children's CSA) and associations with two factors predictive of treatment engagement (motivation, obstacles). Participants were recruited from a Child Advocacy Center where they received forensic interviews and were offered services following CSA discovery. Participating caregiver-child dyads included 52 non-offending caregivers (83% biological parents) and their children (69% girls; M_age=10.94, SD_age=2.62). Caregiver abuse stigmatization was associated with higher motivation for treatment but also more obstacles to treatment. Further, abuse stigmatization moderated associations between children's PTSD symptoms and perceived obstacles to treatment with medium effect sizes (M f²=0.287). Among caregivers experiencing high abuse stigmatization, greater child PTSD symptoms were associated with more obstacles to treatment. Among caregivers experiencing low stigmatization, child PTSD was either associated with fewer treatment obstacles or was unrelated to treatment obstacles. Results highlight the potential significance of reducing parents' abuse stigmatization for increasing mental health service utilization following CSA discovery, especially for more symptomatic youth.

Attentional Bias for Sexual Threat Among Sexual Victimization Survivors: A Meta-Analytic Review

The current meta-analysis examined the effects of sexual victimization (SV) on attentional bias for sexual threat. This relationship was also examined among victims of SV with and without a current diagnosis of post-traumatic stress disorder (PTSD). The broader aim was to elucidate potential mechanisms operating between SV and negative health outcomes. As hypothesized, the findings supported a positive relationship between SV and attentional bias toward sexual threat stimuli, and subanalyses indicated that PTSD symptomatology significantly contributed to this association.

Positive and Negative Posttraumatic Change Following Childhood Sexual Abuse Are Associated With Youths' Adjustment

Meanings made of childhood sexual abuse (CSA) experiences are important to psychosocial adjustment. The current study examined adolescents' and young adults' perceptions of posttraumatic change (PTC) in the self, relationships, sexuality, and worldviews attributed to prior CSA experiences. We sought to document the prevalence of positive and negative PTC and examine their unique and joint associations with psychosocial adjustment. Participants included 160 youth with confirmed cases of CSA (73% female; 8-14 years at abuse discovery) who were part of a longitudinal study of the long-term effects of CSA. Six years after discovery, youth were interviewed about their abuse experiences. Interviews were coded for the valence and strength of PTC. The majority of youth reported PTC, and negative changes were more frequent and stronger than positive changes. Controlling for age, gender, abuse severity, and negative PTC, positive PTC was associated with lower abuse stigmatization for all youth. Controlling for age, gender, abuse severity, and positive PTC, negative PTC was associated with greater abuse stigmatization, post-traumatic stress disorder, sexual problems, and dating aggression for all youth. Relations of positive PTC with depression and support from friends and romantic partner were moderated by negative PTC, such that positive PTC was associated with better adjustment for youth with low versus high levels of negative PTC. Results highlight the importance of both negative and positive PTC for understanding meanings made of CSA experiences and their implications for psychosocial adjustment and intervention.

Sexual victimization, alcohol intoxication, sexual-emotional responding, and sexual risk in heavy episodic drinking women

This study used an experimental paradigm to investigate the roles of sexual victimization history and alcohol intoxication in young women's sexual-emotional responding and sexual risk taking. A nonclinical community sample of 436 young women, with both an instance of heavy episodic drinking and some HIV/STI risk exposure in the past year, completed childhood sexual abuse (CSA) and adolescent/adult sexual assault (ASA) measures. A majority of them reported CSA and/or ASA, including rape and attempted rape. After random assignment to a high alcohol dose (.10 %) or control condition, participants read and projected themselves into an eroticized scenario of a sexual encounter involving a new partner. As the story protagonist, each participant rated her positive mood and her sexual arousal, sensation, and desire, and then indicated her likelihood of engaging in unprotected sex. Structural equation modeling analyses revealed that ASA and alcohol were directly associated with heightened risk taking, and alcohol's effects were partially mediated by positive mood and sexual desire. ASA was associated with attenuated sexual-emotional responding and resulted in diminished risk taking via this suppression. These are the first findings indicating that, compared to non-victimized counterparts, sexually victimized women respond differently in alcohol-involved sexual encounters in terms of sexual-emotional responding and risk-taking intentions. Implications include assessing victimization history and drinking among women seeking treatment for either concern, particularly women at risk for HIV, and alerting them to ways their histories and behavior may combine to exacerbate their sexual risks.

Sexual health in women reporting a history of child sexual abuse

OBJECTIVE

The present study examined the association between child sexual abuse (CSA) and sexual health outcomes in young adult women. Maladaptive coping strategies and optimism were investigated as possible mediators and moderators of this relationship.

METHOD

Data regarding sexual abuse, coping, optimism and various sexual health outcomes were collected using self-report and computerized questionnaires with a sample of 889 young adult women from the province of Quebec aged 20-23 years old.

RESULTS

A total of 31% of adult women reported a history of CSA. Women reporting a severe CSA were more likely to report more adverse sexual health outcomes including suffering from sexual problems and engaging in more high-risk sexual behaviors. CSA survivors involving touching only were at greater risk of reporting more negative sexual self-concept such as experiencing negative feelings during sex than were non-abused participants. Results indicated that emotion-oriented coping mediated outcomes related to negative sexual self-concept while optimism mediated outcomes related to both, negative sexual self-concept and high-risk sexual behaviors. No support was found for any of the proposed moderation models.

CONCLUSIONS

Survivors of more severe CSA are more likely to engage in high-risk sexual behaviors that are potentially harmful to their health as well as to experience more sexual problems than women without a history of sexual victimization. Personal factors, namely emotion-oriented coping and optimism, mediated some sexual health outcomes in sexually abused women. The results suggest that maladaptive coping strategies and optimism regarding the future may be important targets for interventions optimizing sexual health and sexual well-being in CSA survivors.

Child sexual abuse and women's sexual health: the contribution of CSA severity and exposure to multiple forms of childhood victimization

Research studies have provided increasing evidence for the potential adverse impact of child sexual abuse on women's sexual health. The present study examined the association between child sexual abuse and sexual health while controlling for various forms of childhood victimization. Self-report questionnaires were administered to 889 young women from the province of Quebec. Results suggest that child sexual abuse survivors were more likely to report having experienced other forms of childhood victimization than were women without child sexual abuse. Women with a history of both child sexual abuse and multiple forms of victimization were at greater risk of experiencing more adverse outcomes, including risky sexual behaviors, sexual problems, and negative sexual self-concept. Regression analyses revealed that child sexual abuse was significantly related to indicators of sexual health outcomes even when controlling for the effect of single forms of victimization. Clinically, interventions optimizing sexual health may be particularly helpful for a subgroup of child sexual abuse survivors.

Early marriage, rape, child prostitution, and related factors determining the psychosocial effects severity of child sexual abuse in Ethiopia

This study was aimed at identifying factors that determine the psychosocial effects severity of child sexual abuse. Data were collected from 318 female children in Ethiopia using the Children's Impact of Traumatic Events Scale-Revised and the Rosenberg Self-Esteem Scale. The results revealed that respondents who survived rape and child prostitution were more symptomatic than those who were married early. Respondents for whom less time had elapsed since their first experience of abuse demonstrated a significantly higher level of post-traumatic stress disorder symptoms, negative reactions by others, self-blame, and guilt than those for whom more time had elapsed since such an experience. The respondents in an intact marital relationship were found to be less symptomatic than their never married and divorced counterparts. Implications for intervention and further investigations are discussed.

Making meaning of traumatic events: youths' strategies for processing childhood sexual abuse are associated with psychosocial adjustment

The need to make meaning of childhood sexual abuse (CSA) is common and often persists long after the abuse ends. Although believed to be essential for healthy recovery, there is a paucity of research on how youth process their CSA experiences. The current study identified individual differences in the ways youth process their CSA and examined associations with psychosocial adjustment. A sample of 108 youth with confirmed abuse histories enrolled in the study within 8 weeks of abuse discovery, when they were between 8 and 15 years old. Six years later, they participated in interviews about their CSA experiences, reactions, and perceived effects. Using a coding system developed for this study, youths' CSA narratives were reliably classified with one of three processing strategies: Constructive (13.9%), Absorbed (50%), or Avoidant (36.1%). Absorbed youth reported the highest levels of psychopathological symptoms, sexual problems, and abuse-specific stigmatization, whereas Constructive youth tended to report the fewest problems. Avoidant youth showed significantly more problems than Constructive youth in some but not all areas. Interventions that build healthy processing skills may promote positive recovery by providing tools for constructing adaptive meanings of the abuse, both in its immediate aftermath and over time.

Childhood sexual abuse, stigmatization, internalizing symptoms, and the development of sexual difficulties and dating aggression

Potential pathways from childhood sexual abuse (CSA) to subsequent romantic intimacy problems were examined in a prospective longitudinal study of 160 ethnically diverse youth with confirmed CSA histories. Participants were interviewed at the time of abuse discovery, when they were 8-15 years of age, and again 1-6 years later. Stigmatization (abuse-specific shame and self-blame) and internalizing symptoms (posttraumatic stress and depressive symptoms), more than abuse severity, explained which youth with CSA histories experienced more sexual difficulties and dating aggression. Stigmatization was found to operate as a predictive mechanism for subsequent sexual difficulties. Internalizing symptoms were not predictive of romantic intimacy problems, although they did show correlational relations with sexual difficulties and dating aggression. Early interventions such as trauma-focused cognitive-behavioral therapy that target stigmatization may be important for preventing the development of sexual difficulties in CSA youth.