Social reactions to child sexual abuse disclosures: a critical review

It's Just a Distance Thing: Affordances and Decisions in Online Disclosure of Sexual Violence Victimization

The Internet offers an alternative context in which personal experiences with sexual violence can be shared. It has been suggested that victims experience lower barriers to disclosing their stories in a digital environment due to an online disinhibition effect and mainly anonymity. However, little is known about the lived experiences of victims who have shared their experiences online regarding these disinhibiting affordances of the Internet. Twenty-three interviews with victims were conducted to understand the digital affordances involved in the online disclosure of sexual victimization. The results suggest that the Internet offers several opportunities (visibility management, asynchronicity, and connectivity) and constraints (lack of non-verbal communication, disclosing online is irreversible, and Internet as a source of triggers) when disclosing sexual violence victimization online. We learn that disclosures are informed by previous experiences and weighed against digital affordances. Victims use multiple platforms or multiple accounts on the same platform and manipulate anonymity and visibility through the settings of online platforms. The Internet offers a potential for informal online peer support. The results have practical implications for victims, clinicians, and support providers for guiding the disclosure process. Furthermore, a re-evaluation and nuance of the online disinhibition theory is suggested. Suggestions for future research are made.

Disclosure of Sexual Trauma to Romantic Partners: Examining PTSD Clusters, Partner Reactions, Perceived Partner Responsiveness, and Relationship Satisfaction

The present study explored the relationship between disclosure of sexual trauma to a romantic partner and relationship satisfaction for individuals who have experienced unwanted or forced sexual contact. We examined whether posttraumatic stress disorder (PTSD) clusters, partner reactions, and perceived partner responsiveness (PPR) mediated that relationship. Relationship satisfaction was significantly, positively correlated with trauma disclosure, positive partner reactions, and PPR, and significantly, negatively correlated with negative partner reactions and the PTSD clusters of avoidance and negative alterations in cognitions and mood. Trauma disclosure had a significant, indirect effect on relationship satisfaction via positive partner reactions and PPR. Findings from this study can be utilized to inform clinical interventions and guide future research for individuals who have experienced sexual trauma.

Child sexual abuse and social identity loss: A qualitative analysis of survivors' public accounts

Emerging evidence suggests that social identities are an important determinant of adaptation following traumatic life experiences. In this paper, we analyse accounts of people who experienced child sexual abuse. Using publicly available talk of people who waived their right to anonymity following successful conviction of perpetrators, we conducted a thematic analysis focusing on trauma-related changes in their social identities. Analysis of these accounts highlighted two themes. The first highlights the acquisition in these accounts of unwanted and damaging identity labels. The second presents child sexual abuse as a key destructive force in terms of important identity work during childhood. Discussion of this analysis centres on the pathological consequences of social identity change. Both the loss of valued identities and the acquisition of aberrant and isolating identities are experienced and constructed as devastating by those affected by child sexual abuse. This has important implications, not only for those impacted by child sexual abuse but for how abuse is discussed in society, and how it is approached by policy makers, educators and individuals working with survivors and their families.

Gender-related stigma toward individuals with a history of sexual or physical violence in childhood

BACKGROUND

Stigma is a key barrier to disclosing traumatic experiences of violence in childhood with adverse consequences for help-seeking behaviour. Disclosing behavior differs by gender and the form of violence experienced. However, there is a lack of comprehensive studies that address societal perceptions of males and females with a history of sexual or physical violence in childhood. Therefore, our aim is to focus on the impact of gender on the perception of individuals who experienced sexual or physical violence in childhood.

METHODS

We conducted a study on a representative sample of the German general population in terms of age and gender. Participants were randomly assigned to brief case vignettes addressing sexual or physical violence in childhood. Analyses base on a sample of n = 659 individuals (50.1% female). Stigma was assessed through examining respondents' readiness to address specific traumas in conversation and respondents' attitudes toward the individuals in the vignettes. Mann-Whitney U tests were applied to check for differences between female and male victims and survivors as well as female and male respondents.

RESULTS

Our results reveal that male victims and survivors face higher negative stereotypes (harm, unpredictability) and evoke communication barriers more often when compared to female victims and survivors, especially in male respondents. Sexual violence is associated with more distinct gender differences than physical violence.

CONCLUSIONS

Findings reflect greater stigma toward male victims and survivors of sexual violence than female ones. Men had a greater tendency to stigmatize - especially toward their same-gender peers. Socially ingrained gender roles may act as a basis for different communication cultures and the notion of victim-perpetrator constellations in which males are not envisaged as victims.

"Nothing Was Done": Experiences of continued sexual abuse after disclosing to a mandated reporter among youth in the United States

BACKGROUND

Disclosing ongoing child sexual abuse (CSA) to a mandated reporter should facilitate youth safety. Unfortunately, youth may continue to experience abuse after disclosure, although little research has examined this phenomenon.

OBJECTIVE

We aimed to understand when and why the child protection process fails after youth disclose to a mandated reporter.

PARTICIPANTS AND SETTING

Hotline support specialists completed an online survey about 124 anonymous hotline chats with youth whose abuse continued after a prior disclosure to a mandated reporter.

METHODS

We thematically analyzed support specialists' open-ended descriptions of information disclosed by the victim in their chat.

RESULTS

In most cases (71 %), the abuse was seemingly not reported or not investigated. Mandated reporters' belief of the victim and minimization of abuse affected reporting decisions. Some mandated reporters tried to address the abuse directly with the perpetrators, endangering victims. Rarely, mandated reporters did not report to respect the victim's wishes. In 24 % of cases, the victim described an investigation that did not result in protection. Victims indicated that investigators "sided to the perpetrator" or said there was not enough evidence. Some victims recanted, often in fear. In 6 % of cases, formal actions were taken but did not provide long-term protection. Victims described temporary cessation of abuse that resumed because their guardian(s) allowed the perpetrator to access them.

CONCLUSIONS

Disclosing to a mandated reporter can engender traumatic experiences without resulting in long-term safety. Professionals need additional training to increase their knowledge of CSA and respond in ways that prioritize physical and emotional safety.

The impact of parental acceptance and childhood maltreatment on mental health and physical pain in Burundian survivors of childhood sexual abuse

BACKGROUND

Parental support has been suggested to mitigate mental and physical consequences following childhood sexual abuse (CSA). However, many CSA survivors experience parental rejection post-CSA.

OBJECTIVE

We aimed to understand the impact of abuse-specific parental acceptance on post-traumatic stress disorder (PTSD) and physical pain in Burundian CSA-survivors. We further assessed the significance of parental acceptance among known risk factors for predicting PTSD.

METHODS, PARTICIPANTS, AND SETTINGS

Participants (N = 131, 80.9 % female, mean age 16.21 years) were recruited via primary health care centers for survivors of sexual violence which survivors approached post-CSA. Survivors reported on PTSD symptoms, daytime/nighttime pain, and adverse childhood experiences in semi-structured interviews. Parental acceptance levels were categorized (acceptance, no acceptance, no contact) for mothers and fathers separately. Kruskal-Wallis tests assessed group differences. Conditional random forests (CRF) evaluated the significance of parental acceptance in predicting PTSD symptom severity.

RESULTS

No significant differences regarding PTSD symptoms and physical pain between levels of maternal acceptance were obtained. Pairwise comparisons revealed significant differences in PTSD symptom severity between paternal acceptance and no acceptance (d = 1.04) and paternal acceptance and no contact (d = 0.81). The CRF identified paternal acceptance as important variable for the prediction of PTSD symptom severity. Even though results were less conclusive, medium effect sizes hint at less pain perception within the paternal acceptance group.

CONCLUSIONS

The results highlight paternal acceptance as a potential risk or protective factor regarding psychological and possibly physical well-being in the aftermath of CSA, even in the context of other known risk factors.

Parent-Child Communication About Potentially Traumatic Events: A Systematic Review

Social support plays an important role in children's well-being after experiencing a potentially traumatic event (PTE). One such source of support is the parent-child relationship, specifically by discussing the event. However, current literature provides no consensus on whether parents and children communicate about PTEs, in what way they might communicate and how this affects the child. Hence the goal of the current study is threefold, to explore: (a) whether parents and children communicate about PTEs, (b) what this communication looks like, and (c) how this affects children's well-being. These questions are answered by means of a systematic literature review. Articles were eligible for inclusion if it was an empirical study on communication between parents and children about a PTE that the child (under 18 years) had experienced. Initial searches in electronic databases provided 31,233 articles, of which 26 were deemed eligible for inclusion. Results show that most parents and children have discussed PTEs, but that this may depend on cultural background. What the parent-child communication looks like depends on various factors such as, age of the child, tone, and child's initiation of discussion. Parental post-traumatic stress symptoms seem to negatively impact communication. The results of the impact of communication are less clear-cut, but it seems to have a predominantly positive effect on the child's well-being, depending on parental sensitivity. Clinicians should be watchful for parental symptoms of post-traumatic stress disorder and can focus on promoting parental sensitivity and responsiveness when discussing PTEs with their child or on creating a joint narrative within families.

Differences Between Girls and Boys in the Disclosure of Sexual Violence

This article addresses the differences between girls and boys in the disclosure of sexual violence. The dataset combines data from the Finnish Child Victim Survey (FCVS) of 2008 (N = 13,459) and 2013 (N = 11,364), focusing on victims of sexual violence, ages 11 to 17 years, from the perspectives of disclosure and gender. Frequency and percentage analysis, cross tabulation, and a Chi-square test were used in the analysis. In the FCVS for both years, around 85% of the victims were girls. In almost two-thirds of the cases, the offender was a relative, friend, or some other known person, while in more than one-third of the cases, the offender was unknown to the victim. The second most common case was that the victim knew the offender, who was not, however, a friend. Sexual violence was found to be, in many ways, gendered. Most of the victims were girls, and most of the offenders were men. There was also a gender difference in the disclosure of experiences. Twenty-one percent of the girls and 45% of the boys reported that they had not told anyone about their experiences. Irrespective of the type of offender, the victims most often (63%) told a peer about their experiences, while 23% told parents, and only 10% told authorities. Moreover, victims reported shame and fear, distrust toward adults, and disbelief that disclosure would be helpful as reasons for not disclosing their experiences. To address this problem, raising awareness of the phenomenon, promoting an atmosphere that supports disclosing experiences of sexual violence, and improving readiness to address them are required.

Child sexual abuse versus adult sexual assault: A review of psychological and neurobiological sequelae

Sexual trauma (ST) occurs with alarming frequency in the United States (U.S.) in the form of both childhood sexual abuse (CSA) and adulthood sexual assault (ASA). It is well-established that the effects of ST are pervasive, and that ST can be a risk factor for the development of several psychiatric disorders. However, the potential for distinct psychological consequences or neural correlates between CSA and ASA has received little attention. Furthermore, despite the high prevalence of sexual revictimization, the combinatorial effects of CSA and ASA are understudied in comparison to each form of ST on its own. In the current review, we present results from both clinical psychology and neuroscience research on the impacts of CSA and ASA, describing major psychological, biopsychosocial, and neuroimaging findings for each form of ST. We further highlight limitations in the current state of the research and needed areas of future research to better understand the distinct, overlapping, and cumulative effects of ST in both childhood and adulthood. The present study summarizes the state of the literature on this critical form of trauma and provides recommendations for future clinical research practices to mitigate the deleterious outcomes of ST.

Child Sexual Abuse within the Catholic Church in Spain: A Descriptive Analysis of its Characteristics and Long-Term Impact

Sexual abuse within the Catholic Church is a serious social issue and a significant public health problem that has caused extensive harm worldwide. In 2022, an independent commission was established in Spain to investigate sexual abuse within the Church. The commission gathered data from 334 victims (82.3% men, 17.7% women), who were predominantly aged between 55 and 74 years old (62.5%). A majority of victims (71.0%) endured sexual abuse involving physical contact, while 21% reported instances of oral, anal, or vaginal penetration. Over half of the victims (57.5%) reported emotional and behavioral issues, as well as functional problems, problems in relationships, sexuality, and cognition, and attributed these difficulties to the abuse. The majority of participants (79.0%) had disclosed the abuse before the study, with the Church taking action in 45.8% of cases. Approximately 8.4% of victims reported the perpetrator was relocated, while 16.2% described institutional efforts to conceal the abuse. In conclusion, victims of sexual abuse within the Catholic Church in Spain faced consequences that had a significant impact on their lives, exacerbated by lack of societal recognition and a prevalent dynamic of cover-up and concealment by the Church.

Understanding how peers respond to online child maltreatment disclosures: A qualitative content analysis of family violence discussions on social media

BACKGROUND

Positive, supportive responses to child maltreatment disclosure are critical for victims to receive appropriate resources and support for healing. Young people often prefer to disclose to their peers, frequently on social media platforms.

OBJECTIVE

We assessed young people's use of TalkLife, an online peer-to-peer support platform, to respond to the disclosure of child maltreatment.

METHODS

We conducted a qualitative content analysis of 1090 comments on childhood maltreatment-related posts on TalkLife between 2013 and 2020. We used an iterative, team-based qualitative content analysis approach to understand how peers responded to maltreatment disclosure.

FINDINGS

Peer responses tended to be supportive, including asking questions about the abuse and offering advice, emotional support, and other positive responses. Most commonly, peers advised the victim to report, focus on their strengths instead of the abuse, reach out to adults for more support, or confront the perpetrator. On occasion, however, peers began an irrelevant discussion, joked about the situation, or even directly attacked the discloser.

CONCLUSIONS

Learning about child maltreatment disclosures on social media builds the foundation for research to assist in identifying and applying interventions on online platforms. Further, these findings can inform programs that teach how to provide healthy responses to child maltreatment disclosures.

Psychologist attitudes towards disclosure and believability of childhood sexual abuse: Can biases affect perception, judgement, and action?

BACKGROUND

The perception of CSA disclosure belief is critical to long-term outcomes for CSA survivors. Despite disclosures often occurring in clinical settings CSA survivors do not always report a sense of clinician belief in response to their disclosure. Ascertaining the factors that influence clinician belief is essential to improving outcomes.

OBJECTIVE

This study examined whether language (i.e., word choice to describe abuse) and ongoing relationship status with a perpetrator impact perceptions of CSA belief amongst psychologists.

METHODS

This 2 × 2 within subject's study examined relationship effects (ongoing verses estranged) and language effects (consensual verses abusive), embedded in fictitious vignettes, on believability. Seventy-five participants completed demographic surveys, rated and discussed belief in four vignettes, and completed validated scales capturing clinician trauma history and CSA myth endorsement.

RESULTS

A significant main effect for relationship was found with ongoing victim-perpetrator relationships being less believed than depictions of estranged relationships (F(1,3) = 15.57, p = .001, h2 = 0.174). While no main effect for language was found (F(1,3) = 0.06, p = .801, h2 = 0.001) content analysis of the open-ended items revealed 80 % of psychologists reported being influenced by the language manipulations. Correlations revealed male psychologists were less likely to believe disclosures and more likely to endorse CSA myths than females, and psychologists who had engaged in trauma training appeared to have heightened disclosure belief and lower myth endorsement.

CONCLUSIONS

While psychologists generally report belief in CSA disclosures they appear to evaluate specific disclosure aspects to inform this level of belief. Issues around social desirability, measure sensitivity, and learning effects are discussed alongside the importance of trauma training for psychologists.

Genetic Decomposition of the Heritable Component of Reported Childhood Maltreatment

Background

Decades of research have shown that environmental exposures, including self-reports of trauma, are partly heritable. Heritable characteristics may influence exposure to and interpretations of environmental factors. Identifying heritable factors associated with self-reported trauma could improve our understanding of vulnerability to exposure and the interpretation of life events.

Methods

We used genome-wide association study summary statistics of childhood maltreatment, defined as reporting of abuse (emotional, sexual, and physical) and neglect (emotional and physical) (N = 185,414 participants). We calculated genetic correlations (rg) between reported childhood maltreatment and 576 traits to identify phenotypes that might explain the heritability of reported childhood maltreatment, retaining those with |rg| > 0.25. We specified multiple regression models using genomic structural equation modeling to detect residual genetic variance in childhood maltreatment after accounting for genetically correlated traits.

Results

In 2 separate models, the shared genetic component of 12 health and behavioral traits and 7 psychiatric disorders accounted for 59% and 56% of heritability due to common genetic variants (single nucleotide polymorphism-based heritability [h2SNP]) of childhood maltreatment, respectively. Genetic influences on h2SNP of childhood maltreatment were generally accounted for by a shared genetic component across traits. The exceptions to this were general risk tolerance, subjective well-being, posttraumatic stress disorder, and autism spectrum disorder, identified as independent contributors to h2SNP of childhood maltreatment. These 4 traits alone were sufficient to explain 58% of h2SNP of childhood maltreatment.

Conclusions

We identified putative traits that reflect h2SNP of childhood maltreatment. Elucidating the mechanisms underlying these associations may improve trauma prevention and posttraumatic intervention strategies.

Development and Validation of the Disclosure Expectancy Scale

Although the disclosure of traumatic experiences is believed to influence trajectories of post-trauma recovery, less is known about individual differences that affect survivors' motivation to share. The current project describes the development and evaluation of the Disclosure Expectancy Scale (DExS), a novel instrument intended to assess survivors' expectations about the potential risks and benefits of disclosure. Items targeting both positive and negative expectancies were generated based on existing research and the authors' clinical experience with various survivor populations. Preliminary analyses in trauma-exposed undergraduates (N = 359) offer support for hypothesized positive and negative expectancy dimensions with evidence for the convergent and discriminant validity of scores. Subsequent evaluation in active-duty, help-seeking military personnel (N = 35) provides further evidence of validity based on correlations with relevant clinical measures. A final regression demonstrating unique effects of initial disclosure expectancies on post-traumatic stress disorder (PTSD) severity following trauma-focused treatment highlights the predictive validity of DExS scores.

Psychological symptoms of adolescent survivors of sexual abuse and characteristics of survivors displaying suicidal and/or self-harming behaviors

We examine the psychological symptoms and suicide attempts and/or self-injury behaviors of survivors of childhood sexual abuse (CSA) according to individual and familial characteristics. The participants of this study included 80 adolescents aged 14-17 years. We show that high psychological symptom scores may indicate that the perpetrator was a family member and that penetration occurred. In addition, most of the participating survivors have experienced numerous problems, largely related to psychological symptoms. Considering the results regarding survivors who had previously attempted suicide, we demonstrate that the perpetrators in these cases were mostly reliable/loved people, while these survivors generally hid the events and were exposed to penetration more often. We conclude that survivors exposed to CSA by a reliable/loved person, blaming themselves, having low social support, and displaying certain symptoms should be followed closely and necessary psychosocial interventions for suicide should be applied.

Facilitators of Sexual Assault Disclosure: A Dyadic Study of Female Survivors and Their Informal Supports

Two-thirds of survivors typically disclose their experience to others at some point following sexual assault, but little in-depth research has addressed factors facilitating disclosure. In the current study, a diverse sample of 45 female sexual assault survivors (75% racial/ethnic minorities) and their 45 informal support providers (SP; e.g., family, friends, romantic partners) were interviewed separately about experiences of disclosure, social reactions, and help-seeking following assault. Disclosure facilitation was expressed by 40 survivors and 31 SPs, of which 28 were matched S/SP dyadic pairs. Narrative data on the overarching thematic category of sexual assault disclosure facilitation was analyzed using descriptive thematic analysis methods. Several themes emerged from the analysis of quotes specific to the facilitation of disclosure, including: individual (e.g., survivor psychological, behavioral, and disclosure recipient factors), interpersonal (e.g., SP-solicited disclosures, helping others, mutual disclosures), and societal (e.g., lack of barriers, formal supports, media). Implications are drawn for future research on facilitators of sexual assault disclosure. Clinical practice implications are provided for professionals supporting survivors and their informal support networks.

Patterns of disclosure and perceived societal responses after child sexual abuse

BACKGROUND

Disclosure of child sexual abuse (CSA) is key for abused children to access help and to protect them and other children.

OBJECTIVE

The aim of this study was to investigate patterns of disclosure of child sexual abuse and how children perceived responses from people they disclosed to.

PARTICIPANTS AND SETTING

Data were collected online in classrooms and during home studies in a national probability-based sample of 3282 third-year students in Swedish high schools in 2020-2021 (the age of the students varied between 16 and 23 years (M = 18,2)).

METHODS

Results are presented with frequencies (n) and percentages (%). Pearson's chi-squared test was used for comparisons between groups.

RESULTS

First, a substantial share of abused girls and most abused boys had not yet told anyone about the abuse, leaving them unable to access protection or rehabilitation. Second, participants who had disclosed sexual abuse had most often turned to a peer, more rarely to an adult, and seldom to a professional or volunteer. Third, although the societal responses that the participants perceived were mixed, more severe abuse was associated with more negative societal responses. Fourth, most participants stated that they did not need any professional support. Fifth, among the minority who had sought help, half were satisfied and a third dissatisfied.

CONCLUSIONS

Results showed that most children with experience of CSA did not have access to the protection, support, and rehabilitation that they have a right to. Preventive measures need to target children and young people, while societal responses after CSA, especially severe CSA, need to be improved.

Understanding Discussions of Sexual Assault in Young Women on a Peer Support Mental Health App: A Content Analysis

Trauma narratives may have been influenced by the Me Too movement, with thousands of individuals disclosing sexual violence stories online. Youth, the largest demographic of online users, may prefer the anonymity of the Internet to discuss experiences of sexual assault. Understanding the ways that young women, especially those experiencing mental health difficulties, discuss their experiences is important as they are at higher risk of revictimization and continued poor mental health. We searched for terms related to acts of sexual assault on a mental health peer-support app, TalkLife, and compared the number of posts during the initial wave of the Me Too movement (October 2017-March 2018) to the same time period in the previous year (October 2016-March 2017). We found a significant increase in posts related to sexual assault of 49.7% between the Pre and Post Me Too time periods (p < .001), controlling for a general increase in posts. A content analysis of 700 randomly selected posts found that a substantial number of young women used TalkLife to discuss their experiences of sexual assault, and these self-disclosures were mostly hopeless or depressing in tone. Additionally, neither the nature nor the number of self-disclosures varied across time points. The negative tone of the self-disclosures in the current study is worrying because the way women talk about their trauma can shape how they understand it, which could lead to negative self-appraisal and continued mental health difficulties. Online spaces have the potential to support young women and facilitate help-seeking, but we must be attentive to how they are used.

Experiences of Women Survivors of Childhood Sexual Abuse in Relation to Nonsupportive Significant Adults: A Scoping Review

Childhood sexual abuse (CSA) is a complex trauma with devastating long-term, negative effects on survivors. This study extended the understanding of experiences of women survivors of CSA in relation to nonsupportive significant adults documented in literature, as to date, there exists no summary in literature on this particular topic. As such, a scoping review was conducted on publications between 1980 and January 2020. A total of 26 733 were selected for analysis in accordance with the search terms. After duplicates were removed and the exclusion criteria were applied, a total of 58 articles were selected for inclusion in the review. Thematic analysis was conducted on the studies included, and three themes were developed pertaining to the experiences of women survivors of CSA in relation to nonsupportive significant adults. Theme 1 identified nonsupportive behaviors experienced before disclosure or discovery of abuse. Theme 2 identified nonsupportive behaviors experienced during or after disclosure or discovery of abuse. Theme 3 identified the long-term negative consequences of nonsupportive experiences. These three themes support the findings of Freyd's betrayal trauma theory and Bowlby's attachment theory, extend on the global knowledge base of this topic, and identify gaps for further exploration.

How can school help victims of violence? Evaluation of online training for European schools’ staff from a multidisciplinary approach

The interventions used to prevent or treat violence against children, particularly sexual abuse, tend to only consider the target audience as their main source of data. We tested the effect of an online training for school staff members in Europe through three studies. In Study I, we interviewed 5 adult women (Mage = 49.2, SD = 5.81) who were victims of sexual abuse during childhood to assess what school could have done during that time to protect them. Through Study II, we collected data on 66 school staff members to assess feasibility (based on quantitative indicators) and to explore the changes they would make to their everyday practice due to the training course (using qualitative analysis). In Study III, we used network analysis to assess to what extent the actions described by school staff in Study II met the needs expressed by the victims in Study I. Findings of Study I revealed new proposals from the victims’ perspective, such as working with the perpetrators. Study II showed the feasibility of training and identified five types of action that school staff members will include in their everyday working dynamics due to the training: detection (e.g., Greater attention to relationships with peers), reporting (e.g., Now I know that suspecting a case of child abuse is enough to report), everyday practices (e.g., Introducing a calming space), changes at school level (e.g., Propose the training course to the school management team) or practices that could belong to more than one category (e.g., Greater awareness of the activities undertaken by the school). Study III provided evidence that some of these changes (e.g., reporting without looking for proof) were in line with some of the victims’ expectations (e.g., listen to the children). We also identified gaps that need to be further developed.

Parenting Stress in Non-Offending Caregivers of Sexually Abused Children

The non-offending caregiver (NOC) population is under studied despite their role in the recovery of child victim-survivors of sexual abuse. Research suggests that NOCs experience significant distress following a child's disclosure of sexual abuse. Trauma has been demonstrated to negatively impact the caregiver-child relationship. This study informs about common NOC stress reactions in response to child sexual abuse (CSA) disclosures and has clinical implications for treating families affected by CSA. Participants included 66 NOCs (age 23-66, M = 41.09, SD = 10.26) who participated in clinical intakes at a CSA treatment program and completed a self-report measure of parenting stress. Depending on the child's age, NOCs were administered either the Parenting Stress Index-fourth edition, Short Form (PSI-4-SF) or the Stress Index for Parents of Adolescents (SIPA). NOCs reported higher than average parenting stress. Statistically significant differences between the clinical and normative samples were found on all PSI-4-SF domains and on majority of SIPA domains. High to Clinically Significant scores were reported by 42% of NOCs for Parent-Child Dysfunctional Interaction. Stress related to their child's social withdrawal was reported by 56% of NOCs. This study provides comparison data for evaluations of NOCs. NOCs may require treatment and family-based approaches are implicated.

Reducing Shame, Promoting Dignity: A Model for the Primary Prevention of Complex Post-Traumatic Stress Disorder

Complex post-traumatic stress disorder (CPTSD) refers to the complex psychological and psychosocial sequelae caused by prolonged interpersonal abuse. Contemporary approaches to CPTSD are dominated by individualized psychological interventions that are long term and costly. However, accumulating evidence indicates that CPTSD is a high prevalence mental illness implicated in significant social problems, with a pattern of lateral and intergenerational transmission that impacts on already disadvantaged communities. Consequently, there have been calls for a public health model for the prevention of CPSTD; however, there has been a lack of clarity as to what this should entail. This article argues that empirical and conceptual shifts framing CPTSD as a shame disorder offers new preventative opportunities. The article presents a series of interconnected literature reviews including a review of available prevalence data on CPTSD, the public health implications of CPTSD, the role of shame and humiliation in CPTSD, and current scholarship on dignity in public policy and professional practice. Drawing on these reviews, this article develops a social ecological model of primary prevention to CPTSD with a focus on the reduction of shame and the promotion of dignity at the relational, community, institutional, and macrolevel. A broad overview of this model is provided with examples of preventative programs and interventions. While the epidemiology of CPTSD is still emerging, this article argues that this model provides the conceptual foundations necessary for the coordination of preventative interventions necessary to reduce to the risk and prevalence of CPSTD.

Use of Self-Figure Drawing as an Assessment Tool for Child Abuse: Differentiating between Sexual, Physical, and Emotional Abuse

Child abuse is a worldwide phenomenon with adverse short- and long-term mental and physical negative consequences, with a huge gap between the prevalence of child abuse and disclosure rates. The study aimed to examine and validate the self-figure drawing as an assessment tool to differentiate between three forms of child abuse, i.e., child sexual abuse (CSA), child physical abuse (CPA), and child emotional abuse (CEA). Following the ethical approval, 1707 Thai children (13–18 years old) from the general population (schools) were asked to complete a self-report anonymous questionnaire consisting of four measures (Demographics, Childhood Trauma Questionnaire (CTQ), The Medical Somatic Dissociation Questionnaire (MSDQ), and The Disclosure of Trauma Questionnaire (DTQ)). After completion, they were asked to draw themselves. There was a significantly positive link between the reluctance to disclose and the experience of abuse, indicating that the more severe the abuse the higher the reluctance to disclose. The findings broaden the knowledge of movement and symbols as representations of inner personal conflictual material. Additionally, it substantiates self-figure drawing as an assessment tool and assists practitioners in early child abuse detection.

Sexual and Physical Assault Before Age 18 and Young Adults' Perception of Unfair Treatment

Research indicates that sexual and physical assault generate negative emotions of shame and anger, undermine self-esteem, and increase interpersonal sensitivity. This in turn may bring about behavioral changes and cognitive bias, which may adversely affect victims' social interactions. The purpose of this study was to examine whether sexual or physical assault before age 18 is associated with a heightened sense of being treated unfairly in early adulthood. A nationally representative sample of young adults age 18-21 (N = 2,770; 49% female) self-reported on whether they had ever been sexually or physically assaulted, whether it first occurred in childhood or adolescence, and how frequently they are treated unfairly in their everyday interactions with other people, as measured by the Everyday Discrimination Scale (EDS). Multivariate regression results indicated that child (≤age 12) physical assault and adolescent-onset (age 13-17) physical assault were associated with higher scores on the EDS for both men and women. Child sexual assault was associated with the EDS for men; adolescent-onset sexual assault was associated with the EDS for women. Violence as a minor was associated with each item of the EDS (e.g., treated with less respect, less courtesy, other people act of afraid of you, etc.). Violence victims attributed their elevated levels of perceived unfair treatment to their gender, race, age, and aspects of their physical appearance. Overall, the results suggest a mechanism through which a history of sexual and physical assault can affect social interactions.

Reactions to the disclosure of intrafamilial childhood sexual abuse: Findings from the National Sexual Assault Online Hotline

INTRODUCTION

For child sexual abuse (CSA) victims, disclosure can be helpful or harmful depending on how recipients respond. Despite a growing body of literature examining reactions to disclosure, little is known about the experiences of current CSA victims, particularly those abused by family.

OBJECTIVE

We aimed to describe and explore the initial disclosure experiences of intrafamilial CSA victims, and whether reactions varied based on the type of disclosure recipient.

PARTICIPANTS AND SETTING

This study utilized anonymous, archival data from the US-based National Sexual Assault Online Hotline (NSAOH), and focused on a sample of 224 intrafamilial CSA victims who had previously disclosed to one type of recipient.

METHODS

NSAOH staff summarized children's disclosure experiences via an open-ended survey field. Data were independently coded using the Social Reactions Questionnaire.

RESULTS

Nearly three-fourths (73%) of children described receiving a negative reaction to disclosure. Negative reactions included distracting or dismissing the victim (33%), not believing the victim (29%), or retaliating or responding violently following disclosure (10%). Children most frequently disclosed abuse to non-offending family (66%), friends (17%), and formal support providers (12%). Relative to friends and intimate partners, victims were more likely to discuss negative reactions from family (49% v 87%, respectively, Cramer's V = 0.33, p < 0.001).

CONCLUSIONS

Disclosing to non-offending family may be unproductive and potentially harmful for some children. This study has implications for disclosure-related planning protocols on anonymous hotlines. Findings underscore the importance of educating the public, and parents in particular, about how to respond to CSA disclosures.

An Exploratory Study on Mental Health, Social Problems and Spiritual Damage in Victims of Child Sexual Abuse by Catholic Clergy and Other Perpetrators

The Catholic Church has faced a large number of complaints against its representatives for sexual crimes that involved children and adolescents as victims. The objective of this study was to characterize the dynamics of this type of event, its characteristics, and its effects in terms of mental health and social consequences, as well as the spiritual damage generated. The sample comprised 182 victims from Spain and Chile, divided into three mutually exclusive groups (n = 40 committed by a representative of the Catholic Church; n = 85 by a family member; n = 57 by a perpetrator outside the family and the Church). The results show that victims of child sexual abuse (CSA) by a representative of the Catholic Church and other perpetrators are similar in many respects (e.g., religiosity, characteristics of the abuse, and mental health and social problems), but that the effects on religiosity are more serious for victims of the clergy, affecting their belief in God. Finally, the extreme decline in belief in God, due to CSA, is an important predictor for most mental health and social problems. Our results show the need to include the Catholic identity, faith and spirituality in the therapeutic context.

Empowerment or Threat: Perceptions of Childhood Sexual Abuse in the #MeToo Era

The rise of the #MeToo movement has shed light on the prominence of sexual violence, and its victims who often remain silent. Despite increasing awareness, victims or survivors of sexual violence who disclose may be faced with negative reactions such as disbelief or blame. Such reactions extend to child victims of sexual abuse. This study aimed to shed light on gender differences in responses to sexual violence against a backdrop of #MeToo. Through an online survey (N = 253) on Amazon's Mechanical Turk, we assessed participants' exposure to and perception of the #MeToo movement. In addition, we measured proximity to a victim or perpetrator of sexual violence. The effect of these variables on participants' response to a disclosure of childhood sexual abuse was examined. Results indicated that men are more likely to perceive the movement as threatening than women. Furthermore, a discrepancy in proximity to sexual violence emerged, with women more likely to know a victim and men more likely to know a perpetrator. In response to a disclosure of childhood sexual abuse, men were more likely to respond in a skeptical manner than women. Positive perceptions of the #MeToo movement translated into more supportive responses to a disclosure. Proximity to a victim of sexual violence did not impact how people responded to a disclosure, but proximity to a perpetrator was associated with a more negative response. Although the aim of this movement is to give a voice to victims of sexual violence, it may trigger a defensive response from men, which makes them more skeptical toward disclosures of victimization.

"It Made Me so Vulnerable": Victim-blaming and Disbelief of Child Sexual Abuse as Triggers of Social Exclusion Leading Women to Homelessness

Although the association between child sexual abuse (CSA) and homelessness among women is well documented, few studies have investigated this topic from a feminist standpoint, examining the impact of sociocultural factors such as rape culture. Based on a qualitative life course approach, individual interviews were conducted with 21 women who experienced both CSA and homelessness. Participants were between 29 to 60 years old (M = 45 years of age). Analyses revealed that CSA disclosure experiences were characterized by victim-blaming and disbelief. Women's traumatic experiences were further aggravated by these types of reactions. Finally, CSA and negative social reactions to women's disclosures of CSA were perceived as the onset of social exclusion, which lead to their homelessness. This study shows how traumatic CSA experiences and negative social reactions to their disclosure can both contribute to social exclusion and isolation, and to homelessness through the internalization of rape myths. These findings support the importance of focusing on CSA prevention to reduce social exclusion and homelessness.

Having permission not to remember: perspectives on interventions for post-traumatic stress disorder in the absence of trauma memory

BACKGROUND

It is possible for people to have post-traumatic stress disorder (PTSD) without memory of the trauma event, such as in drug-facilitated sexual assault. However, there is little evidence available on treatment provision for this population.

OBJECTIVE

This study aimed to address this gap by exploring the experiences of people who have had psychological intervention for PTSD without memories (PwM).

METHOD

Interpretative phenomenological analysis was used to explore the lived experience of nine women with PwM, who had sought psychological assessment/therapy. Participants were recruited via social media and completed semi-structured interviews online/via telephone.

RESULTS

Identified themes concerned two broad areas: (i) the challenges of having therapy whilst lacking memories and (ii) what was helpful in therapy. Challenges included: delayed help-seeking; having emotional/sensory reactions in the absence of recognisable triggers; experiencing therapy as more applicable to remembered trauma (vs. unremembered); and difficulty discussing and processing unremembered trauma. However, participants also described helpful aspects of therapy including: feeling safe and supported; working with emotional and sensory forms of experience; having scientific explanations for trauma and memory; and having 'permission' from therapists not to remember.

CONCLUSIONS

Recommendations for clinicians included: being aware that clients with PwM may have more difficulty accessing treatment and perceive it as less applicable to them; focussing on clients' emotions and sensations (not cognitive memories) in therapy; and supporting clients to develop a more self-compassionate understanding of their experiences and lack of memory, thus supporting them to accept that not remembering is 'permitted'.

HIGHLIGHTS

• Having therapy for unremembered trauma involves unique challenges, but aspects of therapy can still be helpful.• Suggested 'dos and don'ts' for therapists include recognising the additional barriers to treatment, focussing on emotions (not memories), and normalising memory loss.

Experiences of Disclosure and Reactions of Close Ones from the Perspective of Child Sexual Abuse Survivors: A Qualitative Analysis of Gender Specificities

The disclosure of child sexual abuse (CSA) is a complex process that remains partially understood, despite its crucial role in survivors' recovery. Gender specific experiences of disclosure have been little investigated while this information is crucial to better tailor interventions for survivors. This qualitative study aims to 1) explore survivors' experiences in disclosing to close ones, and 2) contrast experiences of male and female survivors. Fifty-one CSA survivors (25 women and 26 men) aged 18 years or older were recruited via community services for survivors. Two main categories emerged from thematic content analysis: 1) experiences of disclosure hindering CSA recovery or 2) ones fostering CSA recovery. Men felt ignored when their close ones were focused on their own emotions of indifference, helplessness and guilt toward CSA. Men felt guilty when confronted with reactions of blame for their own inaction or disempowered when pressured to remain silent or to forgive. Women felt ignored when their close ones showed anger toward their perpetrator. Women felt guilty when they were held accountable for CSA events or disempowered when pressured to take legal actions. Women, but not men, reported feeling considered through caring and heart-to-heart discussions. Recommendations for awareness messages and practitioners are discussed.

Internalization and Opposition to Stigmatized Social Discourse among Incest Survivors

Despite the high prevalence of incest, survivors are reluctant to disclose its existence for reasons such as shame, guilt and the presence of an accusatory and stigmatizing social discourse. The current mixed methods study examined the internal discourses of 13 incest survivors in Israel, reflected in self-reported internal dialogs which emerged during interviews. The qualitative analysis revealed a dialectical tension between two themes - one reflecting an internalization of the social discourse (manifested as quotes taken from social discourse and uttered by the survivors) and the other an agentic discourse (manifested in utterances either resisting the social discourse or showing an empowering advertence to one's own fulcrum). The quantitative analysis showed that for seven participants the internalized social discourse expressions were most frequent, for five the agentic expressions were most frequent, and that for one the discourses were at equilibrium. The ubiquitous sub-themes manifested in the internalized social discourse were: victimhood (feelings of vulnerability and helplessness), survivorship (meaningless existence, despair and hopelessness), negative self-esteem and self-pathology (perception of the self as having pathological psychological problems), and denial/repression of the abuse. The ubiquitous sub-themes manifested in the agentic discourse were: positive self-image and sense of potency, hope, optimism and positive perception of life, and uprising against the parents and institutions that did not give support. The discussion is based on Butler's concept of vulnerability, which suggests how to address the harms inflicted by incest without erasing aspects of the survivors' agency and growth.

Childhood Sexual Abuse: Sibling Perspectives

Despite a recent focus highlighting the systemic impact of childhood sexual abuse (CSA), the needs of nonabused siblings have been largely overlooked. This interpretative phenomenological analysis study explored the lived experience of nonabused adult siblings of survivors of CSA. Semistructured interviews were undertaken with five adult siblings who were, or had been attending a support service. Emergent themes demonstrated the personal and relational impact of CSA on siblings which were captured across five domains: trying to make sense of it all, struggling to provide support, managing the impact on the wider family, feeling silenced and finding a voice, and rescripting the future. Participants struggled to make sense of their sibling's experience, questioning their own memories of happy childhoods, often in the face of limited information about what happened. The impact of the sexual abuse not only affected the sibling relationship but was compounded by the distress of other family members, particularly parents. Participants reported feeling a lack of reciprocity in terms of their own support needs and described ongoing issues arising from the sexual abuse that they believed would likely continue for the rest of their lives. How siblings can be supported through psychoeducation and family therapy is discussed, both for their own needs and those of the entire family.

Presentation of Victims in the Press Coverage of Child Sexual Abuse in Croatia

A content analysis of Croatian daily newspapers was conducted to clarify how these media outlets present CSA victims, any correlation between the use of victim-blaming, stereotyping, and endangering practices for victims, and to determine the predictors of endangering practices while reporting on CSA victims. The analytical matrix for assessing CSA media content was developed after conducting multiple reliability tests with independent coders. After relevancy coding of CSA news stories, content analysis was conducted on a random cluster sample of 1.159 CSA pieces of news published between 2007 and 2016. A binary logistic regression was conducted in order to detect predictors of reporting practices that endanger victims. Victims presented in the news are mostly female, multiple victims, and victims' background information are in line with gender stereotypes. About one-quarter of the news stories used consensual words to describe proven CSA, 20% shifted the responsibility for the abuse onto the victims, and 15% described the victim as permanently damaged. Regarding endangering media coverage practices, 27% of the news disclose the victim's identity (mostly indirectly) while 21% of the news provide details of an abusive event. Predictors of disclosing victim's identity and providing details of an abusive event are emphasized. News reports still contribute to the stigmatization and victimization of the survivors.

"The whole wall fell apart, and I felt free for the first time": Men's perceptions of helpful responses during discussion of child sexual abuse

BACKGROUND

There is a growing awareness of the prevalence and consequences of childhood sexual abuse (CSA) for boys. Disclosure experiences often impact long-term functioning following CSA. Current understanding around disclosure has evolved from a singular act of telling to a broader, reciprocal process that can include discussion. However, there is limited empirical evidence about what constitutes a helpful response from others during the discussion of CSA for men.

OBJECTIVE

This study examines the characteristics of a helpful response during the discussion of CSA among a large sample of men with histories of CSA.

PARTICIPANTS AND SETTING

Participants included 487 men ranging in age from 19 to 84 years (mean = 50.1) who completed an anonymous, one-time online survey as part of a larger project on men's health and well-being. Participants were recruited through research announcements on web sites and discussion boards of national organizations that support adult survivors of CSA.

METHODS

Narrative data from an open-ended prompt were analyzed using qualitative content and inductive thematic analyses over eleven months.

RESULTS

The analysis yielded five superordinate themes on men's perceptions of helpful responses from others during discussions of CSA: (1) experience; (2) personal characteristics; (3) specific actions; (4) therapeutic interventions; and (5) insights.

CONCLUSIONS

Clinicians and health care professionals should convey an awareness of CSA for boys, reach out to men dealing with difficulties tied to early trauma, and implement helpful response strategies in discussions of CSA. Family members, friends, and colleagues within men's social networks can also support recovery with helpful response strategies.

Why do child sexual abuse victims not tell anyone about their abuse? An exploration of factors that prevent and promote disclosure

Disclosure rates of child sexual abuse (CSA) to both social supports and law enforcement are concerningly low, although more research is needed to understand factors that impact disclosure. Thus, the present study examined rates of informal (i.e., to a social support) and formal (i.e., to law enforcement) disclosure of CSA, as well as victims' self-reported experiences with telling others about their own abuse and their perceptions of the overall advantages and disadvantages of disclosure. In all, 76 undergraduate women (who collectively experienced 105 instances of abuse) participated in a semi-structured interview regarding their history of CSA. Results revealed that approximately 50% of cases involved the victim informally disclosing, and only 10% of cases being formally disclosed to authorities. The quantitative and qualitative data shed light on a number of factors that lead victims to not disclose, as well as the identification of factors that may promote a victim to share their abuse with others. The implications for improved prevention and responses to CSA disclosure are discussed.

A Quantitative Study on Gender Differences in Disclosing Child Sexual Abuse and Reasons for Nondisclosure

Despite the available literature on disclosure of child sexual abuse (CSA), little is known about how gender affects disclosure. This article aims to quantitatively examine whether gender differences exist in formal (to legal or child protection authorities) and informal (to a family member or friend) disclosure of CSA and, if so, to assess whether this relation is associated with abuse characteristics and attitudes toward gender roles. The study also aimed to examine whether gender differences exist in reasons not to disclose CSA. Data of a sample of 586 participants, who reported to have experienced CSA committed by a single person, have been used for the analyses. There were no gender differences for formal disclosure, but the informal disclosure rate of CSA was 2.4 times higher for women than men, and this effect remained significant after controlling for abuse characteristics and attitudes, even though the gender difference decreased slightly. Furthermore, women and men reported different reasons for not disclosing CSA in their personal network. Women were more worried than men that family and friends would discover the abuse and reported more insecurity of what to do in this situation. Professionals in the field of CSA should consider a gender perspective when developing guidelines. Men have rarely been the subject of studies of disclosure after CSA. Professionals should focus more on general mental health outcomes of men that are not related with CSA directly, but where the effects of CSA may exert more indirectly through associations with other problems in life.

Untold Stories: Male Child Sexual Abusers' Accounts of Telling and Not Telling about Sexual Abuse Experienced in Childhood

With evidence suggesting that females are more likely to be victims of child sexual abuse (CSA), much of the literature - including that on disclosure - focuses on females. Thus, male victims remain "under-studied". Given this, the aim here is to contribute to the scant knowledge base on the sexual abuse of males and disclosure by focusing on males whose voices are even more rarely heard than those in the general male population: those who have perpetrated CSA. The men whose stories are told here had been convicted of, and imprisoned for, CSA in the United Kingdom (UK). They were part of a sample of 101 incarcerated males, 40 of whom reported at interview that they had been sexually abused in childhood. Eighteen of those 40 men are focused on here as they provided some detail as to whether they had disclosed that abuse in childhood or adulthood, the responses they had received, and also why they had not disclosed. Their narratives shed some much-needed light on the nature of sexual abuse experienced by males, its onset and duration, sexual re-victimization, relationships with perpetrators, the diverse nature of disclosure, the extent to which victims disclose and when, the responses received, and why they do not tell. Little is known of these aspects of male CSA. The implications of the findings are considered together with future research directions.

Attributions of Blame in a Hypothetical Child Sexual Abuse Case: Roles of Behavior Problems and Frequency of Abuse

Youth who are blamed for their sexual abuse may experience increased negative outcomes, such as amplified self-blame. Similarly, blaming nonoffending parents can impede their ability to support their child following disclosure. Understanding the factors that influence how people perceive victim, caregiver, and perpetrator responsibility is imperative for the protection and treatment of families who have experienced sexual abuse. Little research has explored victim and abuse characteristics that influence the perception of sexual abuse. As such, the purpose of this study was to examine the roles of behavior problems and frequency of abuse in the attribution of blame in a hypothetical sexual abuse case. In addition, the relationship between several respondent characteristics and assignment of responsibility were explored as secondary aims. The study used a two (behavior problems: three suspensions in one school semester vs. no mention of behavior problems) by two (one abuse occurrence vs. five abuse occurrences) between-subjects design. Seven hundred forty-two participants read one of the four child sexual abuse (CSA) vignettes and completed measures related to responsibility. ANOVAs revealed those who read a vignette where the youth experienced multiple abuse incidents rated the victim as more responsible regardless of whether or not the youth was described as having behavior problems. Results indicate that respondents may have attributed more blame to the victim due to the belief that she could have done something to stop the abuse after the first incident. The abuse frequency manipulation when combined with the behavior manipulation appeared to relate to how respondents perceived the victim's parents. Males and younger respondents attributed more blame to the victim; however, sexual abuse or assault history did not associate with victim responsibility ratings. Clinical and research implications were discussed.

Factors that prevent, prompt, and delay disclosures in female victims of child sexual abuse

BACKGROUND

Several studies conducted in clinical and non-clinical settings have described why and when children disclose sexual abuse. Yet, there is incomplete understanding of how adolescents and young children may differ in factors that delay, prompt and deter disclosure that could inform strategies for clinical practice and prevention.

OBJECTIVE

The aim of this study was to identify factors that prevent, prompt, and delay disclosure among pediatric patients presenting for acute and non-acute medical evaluations of sexual abuse or assault, and to examine any differences in disclosure tendencies among female adolescents and pre-adolescents.

PARTICIPANTS AND SETTING

A chart review of a consecutive sample of pediatric patients presenting to the emergency department or outpatient clinic identified 601 patients who were diagnosed with sexual abuse and were willing to answer examiner questions about their disclosure.

METHODS

Data collection included attainment of patient narratives which were utilized to gather information about abuse disclosures. Recursive abstraction was applied to categorize patient statements for further analysis, while Pearson chi square and logistic regression were utilized for quantitative data.

RESULTS

Young age (<11 years) at abuse onset was the strongest predictor of, and fear of consequences to self was the most common reason for, disclosure delay in both adolescent and pre-adolescent females. Severity of abuse, adult perpetrator, and self-blame predicted delays only in pre-adolescent females.

CONCLUSIONS

Social and moral development during middle childhood likely has a strong influence on disclosure tendency. Strategies to promote disclosure should consider reducing fear of consequences associated with the adult-child paradigm.

Risk and Protective Factors Related to Early Adverse Life Events in Irritable Bowel Syndrome

BACKGROUND

Irritable bowel syndrome (IBS) is a stress-sensitive disorder of brain-gut interactions associated with a higher prevalence of early adverse life events (EALs). However, it is incompletely understood how trauma severity or disclosure influence the risk of developing IBS or symptom severity.

AIMS

To determine whether (1) IBS patients report a greater number of EALs compared with healthy controls; (2) trauma severity and first age of EAL increase the odds of IBS; (3) confiding in others reduces the odds of IBS; (4) the number, trauma severity, and first age of EAL are associated with symptom severity; (5) sex differences exist.

METHODS

In total, 197 IBS patients (72% women, mean age=30.28 y) and 165 healthy controls (59% women, mean age=30.77 y) completed the Childhood Traumatic Events Scale, measuring severity of EALs and degree of confiding in others. Regression analyses were used to predict IBS status from EALs and association between gastrointestinal symptoms and EALs.

RESULTS

A greater number of EALs [odds ratio (OR)=1.36, 95% confidence interval (CI), 1.14-1.62; P<0.001] and higher perceived trauma severity (OR=1.13, 95% CI, 1.08-1.19; P<0.001) were associated with increased odds of IBS. Confiding in others decreased the odds of having IBS (OR=0.83, 95% CI, 0.72-0.96; P=0.012). The first age of EAL was not predictive of IBS. No sex differences were found.

CONCLUSIONS

Assessing the traumatic severity of EALs and amount of confiding in others is important as they can affect the risk of having IBS. Our findings emphasize early intervention to improve health outcomes in individuals with EALs.

Isn't It All About Victimization? (Intra)cultural Pressure and Cutural Betrayal Trauma in Ethnic Minority College Women

Cultural betrayal trauma theory proposes that intraracial trauma in ethnic minority populations includes a cultural betrayal that contributes to outcomes, such as symptoms of PTSD (posttraumatic stress disorder; posttraumatic stress symptoms [PTSS]), dissociation, and (intra)cultural pressure. Participants (n = 179) were ethnic minority female college students, who completed online questionnaires. The results revealed that when controlling for age, ethnicity, and interracial trauma, intraracial trauma and (intra)cultural pressure affected PTSS and dissociation. There were also indirect effects of cultural betrayal trauma on outcomes through (intra)cultural pressure. The current study can contribute to clinical interventions that address trauma-related mental health in ethnic minority college women.

Believe #metoo: sexual violence and interpersonal disclosure experiences among women attending a sexual assault service in Australia: a mixed-methods study

OBJECTIVES

Sexual abuse is a strong predictor of future psychiatric problems. A more nuanced qualitative understanding of mental health outcomes, in the context of interpersonal responses from family members towards survivors after sexual abuse, may help to better inform prevention and interventions.

DESIGN

A mixed-methods approach included a qualitative timeline method to map and identify contextual factors and mediating emotional responses associated with mental disorder following sexual abuse.

SETTING

Participants were adult survivors of sexual abuse, seeking support from the Sexual Assault Counselling Service, Sydney Local Health District, Australia.

PARTICIPANTS

Thirty women 18 years and older with current or past mental disorder or symptoms were interviewed between August 2015 and May 2016.

OUTCOME MEASURES

A qualitative timeline interview and the Mini-International Neuropsychiatric Interview (MINI, 5.5.0) were applied.

RESULTS

The MINI prevalence of current post-traumatic stress disorder was 96.6% (n=28) and of major depressive disorder was 82.8% (n=24). More than half (53%) reported suicidal ideation at some time in their lives. Women exposed to childhood sexual abuse reported being ignored, not believed, or threatened with retribution on disclosing the abuse to others, usually adult family members, at or close to the time of the violation(s). Participants described experiences of self-blame, betrayal, and psychosocial vulnerability as being the responses that connected negative disclosure experiences with mental disorder. Participant accounts suggest that these reactions created the foundations for both immediate and long-term adverse psychological outcomes.

CONCLUSION

A more in-depth understanding of the type and emotional impact of negative responses to disclosure by parents and other family members, and the barriers to adequate support, validation and trust, may inform strategies to avert much of the longer-term emotional difficulties and risks that survivors encounter following childhood abuse experiences. These issues should receive closer attention in research, policy, and practice.

Grooming Hurts Too: The Effects of Types of Perpetrator Grooming on Trauma Symptoms in Adult Survivors of Child Sexual Abuse

There are a multitude of behaviors that child sexual abusers use to 'groom' children into becoming vulnerable to abuse. In this study of 277 adult survivors of child sexual abuse, participants advised the many ways they were groomed into being abused by up to three perpetrators. The effects of three categories of grooming (Verbal Coercion, Grooming that used Drugs/Alcohol, and Threatening/Violent Grooming) were examined for their effects on trauma symptom severity. Using Linear Regressions, each grooming category had a significant predictive effect on trauma symptom severity. Multiple Linear Regressions revealed that for most trauma symptoms, Threatening/Violent Grooming was a significant predictor of trauma symptom severity, even when other more well-known variables were controlled for (including age at onset of abuse, relationship to perpetrator, and severity of abuse), with a notable exception of verbal coercion as a significant predictor of sexual problems in adulthood (i.e. not satisfied, low drive, overactivity, confusion, bad thoughts or feelings).

An Exploration of Coping with Childhood Sexual Abuse in Arab American Women

This research used a descriptive qualitative approach to explore coping with childhood sexual abuse (CSA) and to identify long-term psychological outcomes among Arab American women. Ten Arab American women participated in the study. Data were collected by individual semi-structured interviews and analyzed using content analysis. Five categories emerged for CSA experience among the participants: CSA characteristics, social support, Arabic culture, coping, and long-term psychological outcomes. Most of the women had experienced familial and contact CSA . and had disclosed their CSA and received different reactions from family and friends. Arabic cultural values influenced the women's experience of CSA and their coping strategy, especially regarding the CSA disclosure and seeking mental health services. The women used a spectrum of strategies to cope with their abuse including seeking support, positive reappraisal,,, accepting responsibilities, avoidance and protective coping. All women experienced negative long-term psychological outcomes of CSA such as flashbacks and low self-esteem. Prior to this research, no known studies have explored coping with CSA experience among Arab American women. Thus, this study can be used to inform practice guidelines to minimize the stigma of CSA and to promote help-seeking behavior for Arab American female CSA survivors and their families.

Perceived Loss of Social Contact and Trauma Symptoms among Adolescents Who Have Experienced Sexual Abuse

Child sexual abuse (CSA) is a robust predictor of trauma symptoms. Past research has identified many correlates of trauma symptoms following disclosure of CSA. Theory suggests that loss of social contact may be another important contributor to adolescents' trauma symptoms following CSA. A clinical sample of 166 adolescents (95% female) between 11 and 19 years (M = 13.80, SD = 1.87) reported on perceived loss of social contact, the extent to which the CSA was coercive, appraisals of self-blame for the abuse, supportiveness of a primary non-abusing caregiver, and trauma symptoms. The adolescent's relationship to the abuser, abuse severity and duration were coded from forensic interviews. Results indicated that greater perceived loss of social contact was associated with higher levels of trauma symptoms, even after controlling for other correlates of trauma symptoms and demographic variables. These findings suggest that perceived loss of social contact may be an important variable to consider in assessing and intervening with adolescents who have been sexually abused.

Posttraumatic Growth in Complex PTSD

Objective: Although efforts have been made to study mechanisms and mediators of posttraumatic growth (PTG - positive sequelae of coping with trauma), little has been done to investigate PTG as a concept in the context of complex PTSD, a disorder recently delineated in ICD11. This article considers PTG in relation to complex PTSD, primarily as associated with childhood sexual abuse. Method: Using clinical case material and available literature, we explore the emergence of PTG in the treatment of patients with complex PTSD and examine factors contributing to its appearance. Results: Despite extensive early traumas, including those associated with histories of ongoing childhood sexual abuse, patients may be capable of PTG. While factors favoring PTG may include temperamental resilience and other as yet ill-defined personality traits, the presence of safe, supportive and enduring therapeutic and extra-therapeutic relationships, appear to address insecure attachments related to trauma and be of considerable importance in fostering possibilities for PTG. Conclusions: While much remains to be learned, encouraging and helping establish varieties of accepting, trusting and nurturing contacts in real world and psychotherapy and introducing and exploring the concept of PTG within therapy, can help patients suffering from complex PTSD address the underlying developmental deficiencies they have endured, facilitate treatment, and promote PTG.

"I Still Feel Like I Am Not Normal": A Review of the Role of Stigma and Stigmatization Among Female Survivors of Child Sexual Abuse, Sexual Assault, and Intimate Partner Violence

Child sexual abuse (CSA), sexual assault (SA), and intimate partner violence (IPV) occur within social contexts that shape how survivors judge themselves and are evaluated by others. Because these are gendered sexual and intimate crimes that violate social norms about what is appropriate and acceptable, survivors may experience stigma that includes victim-blaming messages from the broader society as well as specific stigmatizing reactions from others in response to disclosure; this stigmatization can be internalized among survivors as self-blame, shame, and anticipatory stigma. Stigma and stigmatization play an important role in shaping survivors' thoughts, feelings, and behaviors as they recover; their risk of revictimization; and their help-seeking and attainment process. In this review, we synthesize recent CSA, SA, and IPV research ( N = 123) that examines female survivors' self-blame, shame, internalized stigma, and anticipatory stigma as well as negative social reactions in response to survivors' disclosure. We highlight critical findings as well as implications for research, practice, and policy, and we note gaps in our current knowledge.