Long-term correlates of child sexual abuse: Theory and review of the empirical literature

Since Browne and Finkelhor's (1986) seminal review of the impact of child sexual abuse, there has been a dramatic increase in the child sexual abuse literature. Because of this tremendous growth in the literature, a more current review is warranted. The focus of this paper is a review of the long-term correlates of child sexual abuse published since 1987. Sexually abused subjects report higher levels of general psychological distress and higher rates of both major psychological disorders and personality disorders than nonabused subjects. In addition, child sexual abuse survivors report higher rates of substance abuse, binge eating, somatization, and suicidal behaviors than nonabused subjects. Adult survivors of child sexual abuse report poorer social and interpersonal relationship functioning, greater sexual dissatisfaction, dysfunction and maladjustment including high-risk sexual behavior, and a greater tendency toward revictimization through adult sexual assault and physical partner violence. The long-term correlates of child sexual abuse are conceptualized within a theoretical framework based on a theory of emotional avoidance. Although more recent empirical findings have demonstrated improved designs and methodology, these studies continue to be limited in their generalizability. Recommendations for future research are discussed.     

The association between ill-health and abuse: a cross-sectional population based study

The lifetime prevalence of physical, sexual and psychological abuse was studied cross-sectionally in a representative sample of Swedish women. The association between the three kinds of abuse and ill-health, and the relation between magnitude of abuse and various health problems were also investigated. The Abuse Screening Inventory (ASI), measuring experiences of physical, sexual and psychological abuse and including questions on health and social situation, was sent by mail to 6,000 women, randomly selected from the population register. The questionnaire was completed and returned by 4,150 (70%) of 5,896 eligible women. Various kinds of abuse were reported by 1,142 women (27.5%). The prevalence rates were 19.4% for physical abuse, 9.2% for sexual abuse and 18.2% for psychological abuse. Abused women reported more ill-health and a less advantageous social situation than non-abused women. There was an association between magnitude of abuse and health problems. Also a low magnitude of abuse was substantially associated with ill-health.     

Retrospective treatment of incest victims: suggested analytic attitudes.

This paper includes a brief consideration of literature relevant to childhood sexual abuse detection and prevalence. That literature indicates that such detection may be difficult and that the occurrence of childhood sexual abuse is widespread. These findings, as well as a consideration of literature relevant to trauma, stress, and the identification of survivors of sexual abuse, suggest an analytic attitude of receptivity to the hypothesis of the event of sexual abuse as well as the fantasy of sexual abuse. A second analytic attitude suggested concerns diagnosis. Childhood trauma is implicated in the development of BPD, as the majority of borderline patients have experienced the trauma of child abuse. Further, trauma can lead to dissociation as a defense against stress, and multiple personality disorder is an extreme example of dissociation. The analytic attitude suggested here is that the diagnosis of BPD or MPD may be a necessary but not a sufficient explanation when the symptomatology is a defensive reaction to the traumatic event of childhood sexual abuse. Lastly, it is suggested that the abuse may need to be central to the treatment in analytic work with sexually abused victims. This is suggested in light of the importance of recovery and integration of traumatic memories with their associated affects.     

Obscene telephone calls to children: a retrospective field study

Studied a sample of 24 Danish children selected from a larger group of 56 children who had received obscene telephone calls from a single adult offender to ascertain the psychological consequences of this form of sexual abuse. The sample is unusual in that the source of the abuse was the same for all of the children, and none of them had records of prior or concurrent abuse from other sources. Almost all children suffered significant psychological consequences from these calls, those who obeyed the caller's demands experiencing more serious consequences than those who did not. A comparison was made with the consequences suffered by an additional group of 7 children who had experienced direct physical sexual abuse by the same offender.     

Cardiovascular reactions to psychological stress and abuse history: the role of occurrence,frequency, and type of abuse

Background and objectives: Extreme cardiovascular reactions to psychological stress have been associated with traumatic life experiences. Previous studies have focused on the occurrence or frequency of abuse rather than type of abuse. We examined how occurrence, frequency, and the type of abuse history are related to cardiovascular reactivity (CVR) to acute psychological stress. Design: The study consisted of between group and continuous analyses to examine the association between occurrence, type, and frequency of abuse with cardiovascular reactions to acute psychological stress. Methods: Data from 64 participants were collected. Heart rate, systolic blood pressure, and diastolic blood pressure were measured at baseline and during a standard mental arithmetic stress task. Results: Individuals who experienced abuse showed diminished CVR to acute psychological stress; this was driven specifically by the history of sexual abuse. Frequency of abuse did not relate to stress reactions. Conclusions: These findings accord with previous work suggesting a relationship between traumatic life experience and hypoarousal in physiological reactivity and extend previous findings by suggesting the relationship may be driven by sexual abuse.     

Childhood Abuse Types and Physical Health at the Age of 24: Testing Health Risk Behaviors and Psychological Distress as Mediators

This study examines whether adult psychological distress and health risk behaviors mediate the relationship between childhood abuse and physical health in adulthood. A randomly selected population-based sample, with oversampling to include a one-third subgroup of former child protection cases, completed a structured interview. Questions pertained to childhood exposure to abuse, adult psychological distress, physical health, and health risk behaviors. Previous research using this sample had identified three abuse typologies: emotional abuse, sexual abuse, and polyvictimization (physical abuse, emotional abuse, and neglect). All three typologies were significantly associated with poorer self-reported physical health. Psychological distress and health risk behaviors partially mediated the relationship between nonabuse, sexual abuse, polyvictimization, and physical health, and fully mediated the relationship between emotional abuse and physical health. The results of this study indicate that health risk behaviors and symptoms of psychological distress could contribute to some of the long-lasting consequences of childhood abuse on adult physical health.     

Male sexual abuse: A review of effects,abuse characteristics,and links with later psychological functioning

Despite the increasing awareness of sexual victimization involving males, there remain a number of factors (e.g., stigma of homosexuality, male ethic of self-reliance) that continue to contribute to the underreporting of such cases. Nonetheless, there appears to be growing recognition of male sexual abuse as a serious problem with potentially numerous debilitating consequences. The clinical and research literature presently contains a number of articles on issues pertaining to males who have experienced sexual abuse during childhood. The purpose of the present paper is to review some of the more recent literature on the short- and long-term effects commonly found among sexually abused males. These effects, which include depression, self-blame, low self-esteem, anger, anxiety, and sexuality problems, are also compared with findings commonly reported among sexually abused females. In addition to sexual abuse effects, the present paper also reviews a number of important sexual abuse characteristics (e.g., age of abuse onset, duration of the abuse, nature of the sexual activity), examines the relationship of these characteristics to later psychological functioning, and explores gender similarities and differences. Finally, the implications of the findings with regard to treatment interventions are briefly discussed.     

The contribution of temperament, childhood neglect, and abuse to the development of personality dysfunction: a comparison of three models

We examined the contribution of temperament, childhood neglect, and abuse to the development of personality dysfunction as postulated in three different but correlated models of personality: the psychobiological, Vaillant's psychoanalytic, and DSM psychopathology models. Character, defense style, and personality disorder symptomatology (the dependent variables), and temperament, childhood neglect, and abuse (the independent variables) were assessed in 168 depressed outpatients. High harm avoidance (temperament) tended to be the strongest and most consistent risk factor across the three models. Deficient parental care predicted personality dysfunction, however low care was not consistently predictive across all three models. Emotional/psychological abuse and actual physical abuse were risk factors for increasing personality disorder symptomatology only. Childhood sexual abuse was not as predictive of personality dysfunction as might be expected, thereby raising questions as to the importance placed on child sexual abuse as a general risk factor for personality psychopathology.     

Victims of Abuse by Priests: Some Preliminary Observations

This paper describes the results of psychological assessments of 25 adult males who were victims of sexual abuse by Catholic priests as children or early adolescents. Preliminary data suggest that premorbid personality patterns in these victims put them at greater risk for abuse and also exacerbated the effects of their victimization. These observations are considered in the context of prevalent explanatory models of the traumagenic effects of child sexual abuse.     

IMPACT OF CHILD SEXUAL ABUSE ON FEMALES:

In the last decade, it has become clear that the sexual abuse of children is much more prevalent than previously realized and that such abuse has extensive mental health sequelae. Females are reported victims of sexual abuse much more often than males. The peak age of onset of sexual abuse for females is prepubertal—7 or 8 years of age—and the average duration tends to he about 2 years. The basic theme of this article is that there may he directly traceable mechanistic relationships between the impact of sexual abuse on specific psychological and biological developmental processes for females and some of the adult outcomes of that abuse. Specifically, it is proposed that, to understand the long-term impact of sexual abuse, it is necessary to investigate how it may interfere with both the psychological and the biological processes of pubertal development.     

Traumatic events and tonic immobility

Tonic immobility is a basic defense strategy which has not been studied in depth in humans. Data suggest that it may be a relatively frequent phenomenon in victims of rape and sexual abuse, but its occurrence has not been systematically explored in other types of trauma. We carried out a retrospective study in a sample of 100 university students to establish whether tonic immobility varies depending on the nature of the worst trauma experienced, defined subjectively by each participant. Immobility was assessed using the Tonic Immobility Scale and traumas were assessed using the modified Traumatic Events Questionnaire. Seventy percent of the sample had experienced trauma of some kind. There were no significant differences in tonic immobility between different types of trauma (e.g., physical abuse, assault or aggression, serious accident), except that the mean tonic immobility score was significantly higher in the group with trauma due to physical/psychological or sexual abuse than in the group with trauma due to receiving news of the mutilation, serious injury, or violent or sudden death of a loved one. We conclude tentatively that tonic immobility may be typical not only of sexual traumas, but of other kinds of directly experienced traumas as well.     

Dual Marginality: The Impact of Auditory Status and Sexual Orientation on Abuse in a College Sample of Women and Men

This exploratory study examined the relationship between the combination of auditory status and sexual orientation, and experiencing interpersonal violence, as measured by sexual, physical, and psychological abuse. A cross-sectional examination of 1,023 undergraduate students including 222 Deaf and hard-of-hearing students provided the data. Findings revealed that gay, lesbian, and bisexual students who also were Deaf or hard of hearing were more likely to experience sexual, physical, and psychological abuse than those in mainstream majority groups. The combination of auditory minority with sexual minority status for students had the strongest effect for physical and psychological abuse. Implications for policy and future research are provided.     

Risk of sexual revictimization: A theoretical model

Survivors of child sexual abuse suffer serious short- and long-term psychological consequences. Sexual revictimization as an adult is one of the consequences that has been reported. At present, there is no theoretical model identifying the risk factors that result in child sexual abuse survivors being at greater risk of experiencing an adult sexual assault. The proposed model is designed to integrate existing research, stimulate further empirical work, and eventually aid in the development of a program to prevent revictimization. The variables hypothesized to play a mediating role in the pathway to revictimization include: severe psychological symptoms as a consequence of the child sexual abuse, poor coping styles, an insecure attachment style, hyperfemininity, delinquent behavior, drug use, and high risk sexual behavior.     

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.     

“Shepherd My Sheep”: Clerical Readiness to Meet Psychological and Existential Needs from Victims of Sexual Abuse

Consequences of sexual abuse are highly associated with psychological suffering. The minister can be the first person a victim, belonging to a Christian congregation, turns to for support. This study investigated the reported readiness among ministers of the Church of Sweden to disclose ongoing sexual abuse and meet psychological as well as existential needs of victims. Questionnaires were administered to ministers in all dioceses. A majority, 77%, reported that they as professionals had met victims of sexual abuse and they estimated their readiness for this task as high. However, there is still a need to promote further an accepting attitude and to establish cooperation with social authorities and non-confessional professionals.     

HARASSED BODIES

The present study examined the relationships among sexual harassment and body image and eating disturbances using a sample of 195 undergraduate women. Sexual harassment was associated with a variety of eating disorder symptoms, even when controlling for experiences of sexual abuse/assault and physical abuse. Whereas sexual abuse/assault and physical abuse appear to be nonspecific risk factors for such symptoms, sexual harassment was more closely associated with eating disorder symptomatology than other types of psychological distress. The results of structural equation modeling better supported a model in which body image and eating disturbances were outcomes rather than antecedents of sexual harassment. Finally, several analyses indicated that disordered eating may function as a way to cope with the negative emotions associated with sexual harassment.     

The Sexual Self-Perceptions of Young Women Experiencing Abuse in Dating Relationships

Though information about one's sexuality may be inferred from sexual interactions themselves, a sexual sense of self may also be derived from the quality of the intimate relationship more generally. In this study, we examined the sexual self-perceptions of young women in dating relationships (N=108) as a function of whether these relationships were characterized by abuse. Negative sexual self-perceptions were found to be more evident among women who were experiencing physical/psychological abuse or sexual coercion in their current relationships than among women who were not, even after controlling for self-esteem and depressive symptoms. However, positive sexual self-perceptions were unaffected by abuse, and hence may provide young women a basis for establishing healthier relationships in future.     

Effects of trauma and religiosity on self-esteem

Self-esteem is often lower among persons who have experienced trauma, but religiosity may ameliorate these psychological effects. The purpose of this paper was to examine the relationships among religiosity, self-esteem, and childhood exposure to trauma, utilizing data from the National Comorbidity Survey, a large (N = 8,098) nationally representative population survey in the 48 contiguous states of the USA that assessed religious practices, self-esteem, and exposure to trauma. Exposure to trauma in childhood was assessed through self-report of presence or absence of childhood physical abuse, sexual abuse, or neglect. Religiosity was assessed as the sum of responses to 4 self-report items (religious service attendance, use of religion for comfort and guidance, and importance of religion). Self-esteem was assessed on 9 self-report items adapted from the Rosenberg Self-Esteem Scale. Analysis of variance compared scores for persons who reported exposure to childhood abuse and differed in the value they placed on various religious practices on self-esteem. Persons who reported physical abuse, sexual abuse, or neglect in childhood had significantly lower mean self-esteem than those who did not report these events. There was also a main effect for religiosity in a comparison of persons who reported childhood sexual abuse with those who reported none. The High Religiosity group had higher mean self-esteem than the Medium and Low Religiosity groups. There was a significant interaction as those who reported childhood sexual abuse had lower mean self-esteem than peers who reported none in the Low and Medium Religiosity groups. Mean self-esteem for those who reported childhood sexual abuse was comparable to that of those who reported none in the High Religiosity group.     

Exploitation in therapy and counselling: a breach of professional standards

Exploitation in therapy and counselling may occur in only a minority of cases, but when it does, its effects are potentially damaging to both the client and the profession. Exploitation in therapy may take the form of psychological, covert and overt abuse. The most reported form of abuse of the therapeutic relationship is of a sexual nature. However, psychological abuse usually forms the backdrop to sexual exploitation, preceding and perpetuating the sexual involvement. Sexual exploitation in therapy is an abuse of the power imbued in the therapist by nature of his professional role. It allows the therapist a sexual gratification which he would not have been likely to achieve outside the therapeutic relationship. The prevention of sexual exploitation in therapy is an issue of concern to training, employing and professional organisations who seek to maintain high standards of counselling delivery. Determining the variables which may contribute to exploitation is fundamental to avoiding its incidence. This paper discusses the factors underlying the use of therapy and counselling as a medium for therapist abuse. It examines (i) the prevailing conditions for abuse to occur, (ii) how the therapist overcomes client resistance, and (iii) the implications for the maintenance of professional standards.