Testing Posttraumatic Stress as a Mediator of Childhood Trauma and Adult Intimate Partner Violence Victimization

This study examined whether potential posttraumatic stress disorder (PTSD) mediated the relationships between different forms of childhood trauma (sexual abuse, physical abuse, violence between caregivers) and intimate partner violence (IPV) victimization (psychological, physical, sexual). Participants were 1,150 female nurses and nursing personnel. Path analytic findings revealed potential PTSD partially mediated the relationships between childhood sexual abuse and psychological IPV and childhood sexual abuse and sexual IPV. Potential PTSD did not mediate the relationship between other types of childhood trauma and IPV. This study adds to the literature indicating PTSD as a risk factor for revictimization in the form of adult IPV among women. Screening for and treatment of PTSD among female child sexual abuse survivors could prevent future IPV victimization.     

Effects of Sexual Victimization on Suicidal Ideation and Behavior in U.S. College Women

This study examines the relationship between suicidal ideation and behavior and five types of sexual victimization in a sample of 393 female undergraduate students. Participants completed self-report measures of sexual victimization, hopelessness, suicidal ideation, and suicidal behavior. Adult sexual victimization, but not childhood sexual abuse, predicted current hopelessness and suicidal ideation. Both childhood sexual abuse and adult sexual victimization predicted suicidal behavior. One in four rape victims, in contrast to approximately 1 in 20 nonvictimized women, had engaged in a suicidal act. Vaginal penetration following the threat or use of physical force was a stronger predictor of suicidal behavior than penetration without the use of force and/or force without penetration. The findings point to the importance of inquiring about experiences of sexual victimization when conducting research or treatment with suicidal women as well as the need for suicide risk assessment in programs for victims of sexual violence.     

The Temporal Relations of PTSD Symptoms Among Treatment-Seeking Victims of Sexual Assault: A Longitudinal Study

This prospective study assessed the temporal relationships between the symptom clusters of PTSD in two nonprobability samples of treatment-seeking victims of sexual abuse: rape victims and adult survivors of childhood sexual abuse. Both groups were assessed at three time periods using self-report measures of PTSD symptomology. Findings from two cross-lagged panel analyses indicated weak temporal relationships between the symptom clusters of PTSD; however, avoidance and emotional numbing symptoms were found to exert the strongest cross-lagged effects. Avoidance and emotional numbing symptoms were also found to be the strongest predictor of subsequently meeting caseness for PTSD in both samples. Results suggest that there are minimal cross-lagged effects between the PTSD symptom clusters after three months from traumatic exposure.     

Predicting PTSD symptoms in victims of violent crime: the role of shame, anger, and childhood abuse

To examine the role of cognitive-affective appraisals and childhood abuse as predictors of crime-related posttraumatic stress disorder (PTSD) symptoms, 157 victims of violent crime were interviewed within 1 month post-crime and 6 months later. Measures within 1 month post-crime included previous physical and sexual abuse in childhood and responses to the current crime, including shame and anger with self and others. When all variables were considered together, shame and anger with others were the only independent predictors of PTSD symptoms at 1 month, and shame was the only independent predictor of PTSD symptoms at 6 months when 1-month symptoms were controlled. The results suggest that both shame and anger play an important role in the phenomenology of crime-related PTSD and that shame makes a contribution to the subsequent course of symptoms. The findings are also consistent with previous evidence for the role of shame as a mediator between childhood abuse and adult psychopathology.     

Sexual Assault History and Health-Related Outcomes in a National Sample of Women

This study examined correlates of past-year chronic medical conditions and lifetime contact with health care professionals for mental health and substance abuse problems in women with differing histories of sexual victimization  ( N  = 627)  identified from the National Comorbidity Survey (e.g., assault in childhood, adulthood, or both life phases). Posttraumatic stress disorder (PTSD) and stressful life events were associated with greater odds of chronic medical conditions among women sexually assaulted in childhood only. Additional traumatic events were associated with greater odds of chronic medical conditions among victims of adult sexual assault. Older age and being married were associated with greater odds of lifetime health care professional contact for mental health/substance abuse issues among certain victim subgroups. Stressful life events were related to greater help-seeking for child victims, and traumatic events were related to greater help-seeking in adult victims. Alcohol dependence symptoms and PTSD were each associated with greater odds of lifetime health care professional contact among women victimized in both life phases, whereas depression was related to greater odds of help-seeking for women victimized in one life phase only. Psychosocial factors may play unique roles in health outcomes for women with different sexual assault histories.     

Nonconsensual Sexual Experiences in Precollege Women: Prevalence and Risk Factors

The authors of this study examined the prevalence of nonconsensual sexual experiences in dating situations among a sample of 330 incoming female college students. Results indicated that 38.5% of women reported experiencing at least one form of sexual victimization in dating, ranging from unwanted sexual contact to rape. Victimization was related to history of childhood sexual abuse as well as previous consensual sexual activity. Discussion focuses on the need for education and prevention programs during the secondary school years and counseling assistance for college-age victims.     

The Association of Child Abuse and Eating Disorder Symptomatology

Abstract

Using self-report questionnaires, symptoms of eating disorders were examined in relation to child sexual (CSA), physical (CPA), and emotional abuse (CEA), and adult rape among 301 college women. CPA and adult rape were associated with fear of fatness and bulimic behavior. CEA, family cohesion and expressiveness, and adult rape were related to difficulties recognizing emotional states and satiety. Individuals who reported multiple forms of child abuse or who were revictimized exhibited the highest levels of symptoms. Revictimized women were more likely to report clinical levels of symptoms compared with individuals reporting adult rape without child abuse or child abuse without adult rape. Findings support the assumption that negative experiences in addition to CSA, such as adult rape and other forms of child abuse, influence eating pathology, and suggest a cumulative impact of abuse.     

The Importance of Assessing for Childhood Abuse and Lifetime PTSD in Bariatric Surgery Candidates

For bariatric surgery candidates, history of child abuse and PTSD may be under-recognized or under-reported at pre-surgical evaluation. On a range of clinically relevant factors, we studied 3045 candidates for bariatric surgery: (1) those with a history of childhood abuse compared to those without such history; and (2) among candidates with a history of abuse, those with a lifetime diagnosis of PTSD compared to those without that diagnosis. We compared them on current and lifetime eating disorders, physical health problems, health behaviors, physical functioning, psychosocial functioning, psychiatric disorders, emotional wellness, body satisfaction, and self-esteem. We hypothesized that patients with a history of childhood abuse, and within that group, those with a lifetime PTSD diagnosis, would display greater overall impairment. Patients were interviewed with semi-structured interviews and completed self-report questionnaires. Results showed that (1) patients with a history of childhood abuse exhibited significantly greater impairment than those without abuse; and (2) among candidates with a history of abuse, those with a lifetime history of PTSD displayed significantly greater impairment than those without a PTSD diagnosis. The findings suggest that a history of both childhood abuse and lifetime PTSD should be thoroughly assessed for at pre-surgical evaluation, and that greater attention be paid to the experience of PTSD symptoms in abuse survivors presenting for bariatric surgery.     

Consequences of Child and Adult Sexual and Physical Trauma among Deaf Adults

The purpose of this study was to evaluate the consequences of sexual and physical trauma among a sample of deaf adults. Thirty-two men and 45 women completed the Life Event Checklist (LEC), the Clinician Administered PTSD Scale (CAPS), the Trauma Symptom Inventory (TSI), the Somatoform Dissociation Questionnaire–20 (SDQ–20) and a sociodemographic questionnaire. In this sample, 40.6% of the male participants and 53.3% of the female participants had experienced some type of sexual trauma during their lifetimes. Physical trauma was reported by 75% of males and 71.1% of female participants. For those who had experienced childhood sexual trauma, the odds ratio of revictimization in adulthood was 6.69. Sexual trauma also rarely occurred by itself. Two thirds of all participants with sexual trauma histories also reported some type of physical abuse. Participants with sexual trauma histories displayed significantly more symptoms of PTSD and depression than people without such trauma history. Physical and sexual abuse represent significant problems in the deaf community. The authors include a call for the development of targeted intervention attempts to prevent further victimization in deaf child and adolescent populations.     

Risk factors for child sexual abuse

We review the risk and protective factors for child sexual abuse. Overall, characteristics of perpetrators, victims, and families of victims were moderate to strong risk factors for child sexual abuse. However, it is difficult to distinguish between risk factors for extra-familial and intra-familial child sexual victimization because most of the studies combined these two types of child sexual abuse, although the risk factors for these two types of child sexual abuse most likely differ. Research in this area is difficult because etiological and prevention models of victimization would differ substantially from those of perpetration. Given the low yearly prevalence of child sexual victimization, very large samples would be necessary to obtain sufficient power. Thus, most studies have used lifetime prevalence, which may provide much useful information but which add substantial time confounds. Finally, child sexual victimization is probably a misnomer, as the nature, impact, and etiology of sexual victimization most likely differs over the large age span of childhood and gender. Because improved models and prevention programs require improved etiological models (based on knowledge of risk and protective factors), we hope that this review will focus stakeholders on the need for continued research in this area.     

The Associations of Physical and Sexual Assault with Suicide Risk in Nonclinical Military and Undergraduate Samples

The associations of various forms of sexual and physical assault with a history of suicide attempts and recent suicide ideation were studied in two distinct samples: active duty military and undergraduate students. A total of 273 active duty Air Force personnel and 309 undergraduate students anonymously completed self‐report surveys of assault victimization, emotional distress, belongingness, recent suicide ideation, and previous suicide attempts. Among military personnel, rape, robbery, or violent assault was associated with a nonsignificant trend toward increased risk for suicide attempts, whereas physical abuse or battering as an adult was significantly associated with recent suicide ideation. Among undergraduates, unwanted sexual experiences as an adult and physical or sexual abuse as a child were significantly associated with increased risk for suicide attempt, but only unwanted experiences as an adult was significantly associated with increased risk for suicide ideation. Experiencing multiple forms of assault increased risk for suicide attempts and ideation in both groups. Results suggest that different types of assault contribute differentially to suicide risk in military versus undergraduate populations, but experiencing multiple types of assault is associated with increased risk in both groups.     

Risk factors for male-to-female partner physical abuse

We review the risk and protective factors for male-to-female partner physical abuse and present effect sizes. We distinguish among the various operationalizations of physical aggression (e.g., men in court mandated abuse programs, men identified through a single item on the CTS). Overall, however, several risk factors showed moderate to strong effect sizes. Perpetrator factors include SES, education, history of child sexual victimization, exposure to parental physical and/or verbal aggression, violent adult models in childhood, non-family aggression by parent, elevated levels of state and trait anger and hostility; various personality disorders; various Axis I psychopathology, particularly depression alcohol and drug abuse; deficits in spouse-specific assertiveness; and attitudes that condone abuse. Risk factors for women being victimized included less education, unemployment, and history of child emotional/verbal victimization.     

A review of marital rape

The current paper represents a comprehensive review of marital rape, including its legal history and numerous aspects of its perpetration and victimization. Specifically, this review focuses on theories and forms of marital rape, the scope of the problem, risk factors, resistance strategies, and marital rape's psychological and physical effects, and help-seeking behaviors and interventions for victims. Historically, marital rape has not been recognized as a criminal act; only recently has marital rape become illegal in all 50 states. Marital rape is a serious societal issue that is experienced by 10% to 14% of all married women and 40% to 50% of battered women. Marriages in which marital rape occurs have significantly higher rates of non-sexual violence and marital dissatisfaction, as well as lower ratings of marital quality. Victims who resist marital rape often employ verbal means of resistance. However, most of marital rape victims are either unable or afraid to resist sexual aggression by their husbands. Victims of marital rape experience significant levels of posttraumatic stress disorder (PTSD), depression, gynecological problems, and negative physical health symptoms. Victims of marital rape seek help from a variety of different resources. Seeking help from social service agencies and the law appears to be the most effective behaviors for ending marital rape. Stress inoculation therapy and cognitive processing therapy are promising treatments for victims of marital rape. The literature on marital rape is characterized by considerable methodological problems, and further research is needed to gain a better understanding of this problem.     

How well does cognitive-behavioral therapy treat symptoms of complex PTSD? An examination of child sexual abuse survivors within a clinical trial

Are brief cognitive-behavioral treatments for posttraumatic stress disorder (PTSD) also effective for the wider range of symptoms conceptualized as complex PTSD? Female rape victims, most of whom had extensive histories of trauma, were randomly assigned to cognitive-processing therapy, prolonged exposure, or a delayed-treatment waiting-list condition. After determining that both types of treatment were equally effective for treating complex PTSD symptoms, we divided the sample of 121 participants into two groups depending upon whether they had a history of child sexual abuse. Both groups improved significantly over the course of treatment with regard to PTSD, depression, and the symptoms of complex PTSD as measured by the Trauma Symptom Inventory. Improvements were maintained for at least 9 months. Although there were group main effects on the Self and Trauma factors, there were no differences between the two groups at posttreatment once pretreatment scores were covaried. These findings indicate that cognitive-behavioral therapies are effective for patients with complex trauma histories and symptoms patterns.     

Beziehungsgewalt

The objective of our questionnaire study was to investigate posttraumatic stress disorders of abused women and to analyze differences between affected women suffering from high versus low symptom strain with respect to the duration and intensity of the abuse and to victimization incidences in their childhood. We collected data on characteristics of the abuse relationship, kind and frequency of experienced violence, symptoms of posttraumatic stress disorder (PTSD, PCL-C according to DSM-IV), and comorbid complaints (SCL-90-R). Participants were 71 women with a mean age of 43 years. On average, they had lived in an abusive relationship for 11 years. Two thirds had experience with psychotherapy. All provided information on abuse that may be considered traumatic. 62% suffered from injuries necessitating medical treatment at least once, and half sustained lasting physical damage. With respect to all SCL-90-R scales, the research participants were under significantly higher strain than the normed female sample. PTSD was diagnosed in 58%. Compared to women without PTSD, women with PTSD reported very serious assault, comorbid symptoms as well as physical and sexual victimization in their childhood significantly more often.     

Cognitive processing therapy for chronic PTSD from childhood sexual abuse: A case study

This paper describes a case of chronic Post-traumatic Stress Disorder (PTSD), as described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, 4th edn; American Psychiatric Association, 1994). The client has a long history of childhood sexual abuse (CSA), as well as repeated sexual victimization as an adult and addiction issues. She presented with significant avoidance symptoms, including a highly restricted range of affect and distinct feelings of detachment from others. These symptoms had been greatly reduced by the end of the 17-week therapy including both individual and group modalities. The paper elaborates on theoretical issues, the Cognitive Processing Therapy model (Resick & Schnicke, 1993) as it was adapted for use with survivors of childhood sexual abuse, the various phases of the therapeutic process, and specific examples of therapeutic change with this particularly complicated case.     

Discriminating malingered from genuine civilian posttraumatic stress disorder: a validation of three MMPI-2 Infrequency scales (F, Fp, and Fptsd)

The Infrequency-Posttraumatic Stress Disorder scale (Fptsd), recently created for the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), has demonstrated incremental validity over other MMPI-2 scales in malingered posttraumatic stress disorder (PTSD) detection. Fptsd was developed with combat-exposed PTSD patients, potentially limiting its use with PTSD patients in general. The current study evaluated the MMPI-2's F, Infrequency-Psychopathology scale (Fp), and Fptsd scales in discriminating genuine civilian PTSD among 41 adult victims of child sexual abuse from a group of 39 students instructed to simulate PTSD. Analyses demonstrated Fptsd's incremental validity over F but not over Fp. Based on the two studies examining Fptsd, Fptsd may be more appropriate for combat trauma victims, and Fp may be more appropriate for civilian trauma victims.     

tolerance of nonconformity and its effect on attitudes toward the legalization of prostitution: a multivariate analysis

An increasingly popular clinical impression is that physical victimization plays an important role in the etiology of bulimia. There are few data based studies, however, which have tested this belief. Therefore, data were collected to determine if those who have been victimized are more apt to be bulimic than those who have not been victimized. The four forms of victimization explored were rape, sexual molestation, child abuse and partner abuse. Only child abuse was statistically significantly related to bulimia in the bivariate analyses, although all relationships were in the predicted direction. In the multivariate analysis, severity of bulimic‐like symptoms was regressed on the four forms of victimization and on nine demographic characteristics. Child abuse was the only form of victimization related to the severity of symptoms, when controlling for the effects of the other variables. Contrary to clinical impressions, the effect of sexual molestation on severity of bulimic symptoms was negative, but not statistically significant. Among the demographic characteristics, only the number of sisters had a significant effect. The combined effect of being both bulimic as well as a victim did not increase the likelihood of seeking therapy for an eating disorder. The need for empirical evidence to verify clinical impressions is stressed.     

Gender Differences in Victimization and the Relation to Personality Disorders in Forensic Psychiatry

Gender differences in victimization were retrospectively examined in 218 male and 218 female patients who have been admitted to one of four Dutch forensic psychiatric hospitals between 1984 and 2014. Case files were studied and variables relating to victimization and psychopathology were coded. It was found that the prevalence rates of victimization were higher among female patients than among male patients, both during childhood and adulthood. Childhood sexual abuse was found to be more prevalent among women than men, however, no differences were found for emotional and physical abuse or neglect during childhood. Women with a history of emotional or sexual abuse were significantly more often diagnosed with borderline personality disorder than women without childhood victimization. Men with a history of physical abuse were significantly more often diagnosed with antisocial personality disorder than men without childhood victimization. Clinical and policy implications of this study for forensic practice are discussed.