The effects of perpetrator age and abuse disclosure on the relationship between feelings provoked by child sexual abuse and posttraumatic stress

Abstract

The present study examined the relationship between feelings provoked by child sexual abuse (CSA) and posttraumatic stress disorder (PTSD) symptom scores in a sample of 163 female survivors of CSA. Finkelhor and Browne's traumagenic dynamics model was applied. The interactive effects of provoked feelings with perpetrator age and the existence of abuse disclosure were also studied. Results showed an overall relationship between feelings provoked by CSA and PTSD symptom scores. Feelings of stigma, betrayal, and powerlessness as a result of CSA were associated with PTSD symptom score when the entire group of CSA victims was analyzed. The role of traumatic sexualization was relevant only when analyzed in interaction with the age of the perpetrator and disclosure. The relationship between traumatic sexualization and PTSD symptom scores was only significant when the abuse was committed by an adult perpetrator and when a disclosure was made during the time of abuse, or a short time after the abuse had occurred.     

The effects of perpetrator age and abuse disclosure on the relationship between feelings provoked by child sexual abuse and posttraumatic stress

The present study examined the relationship between feelings provoked by child sexual abuse (CSA) and posttraumatic stress disorder (PTSD) symptom scores in a sample of 163 female survivors of CSA. Finkelhor and Browne's traumagenic dynamics model was applied. The interactive effects of provoked feelings with perpetrator age and the existence of abuse disclosure were also studied. Results showed an overall relationship between feelings provoked by CSA and PTSD symptom scores. Feelings of stigma, betrayal, and powerlessness as a result of CSA were associated with PTSD symptom score when the entire group of CSA victims was analyzed. The role of traumatic sexualization was relevant only when analyzed in interaction with the age of the perpetrator and disclosure. The relationship between traumatic sexualization and PTSD symptom scores was only significant when the abuse was committed by an adult perpetrator and when a disclosure was made during the time of abuse, or a short time after the abuse had occurred.     

The School Functioning of Individuals with Childhood Experiences of Sexual Abuse: Results and Implications of a South African Study

This study investigated the school functioning of individuals with childhood sexual experiences in South Africa. The nature of the study was qualitative, and employed two data collection strategies: in-depth individual interviews with 22 survivors of child sexual abuse and focus interviews with two groups of teachers. The study revealed that participants' emotional reaction to the abuse affected three broad areas of school functioning: concentration, interest in school-related activities and school adjustment. The intensity of these problems varied across participants. The findings are consistent with Finkelhor and Browne's (1986) traumagenic model, which suggests that the experience of child sexual abuse often results in feelings that interfere with one's cognitive development and emotional orientations to the world and causes trauma by distorting the victim's self concept and worldview.     

An Analysis of the Impact of Prison on Women Survivors of Childhood Sexual Abuse

Summary

The prevalence of child abuse histories among incarcerated women has fundamental implications for understanding women's well-being during incarceration. This review of the literature on child sexual abuse and women in prison suggests that incarcerated survivors are likely to be frequently reexposed to the powerful traumatizing processes associated with their early abuse, including traumatic sexualization, powerlessness, stigmatization, and betrayal (Finkelhor & Browne, 1985). Reexposure to these traumagenic dynamics has the potential to trigger traumatic reJivings of imprisoned survivors' pasts, to which survivors respond with a variety of coping strategies often seen in prison, including substance abuse, violence, self-injury, and suicide. The implications of these dynamics and women's responses to them for those who work with incarcerated women, for prison policy, and for research are discussed.     

Spirituality and the Current Adjustment of Adult Survivors of Childhood Sexual Abuse

We explore the role of spirituality in the current adjustment of adult survivors of childhood sexual abuse (CSA). A sample of 101 men and women survivors of CSA completed questionnaires on spirituality (relationship with God or higher power), person factors (blame attributions, self-acceptance, hope), and current adjustment (mood, personal growth, resolution of the abuse). Results indicated that relationship with a benevolent God or higher power is related to the experience of less negative mood and a greater sense of personal growth and resolution of the abuse. Also, relationship with a higher power is related to other person factors such as self-acceptance and hope. Relationship with a benevolent God appears to have an indirect link to depressive mood and resolution of abuse through the mediating pathways of hope and self-acceptance. In contrast, relationship with God appears to have a more direct association to the outcome of personal growth for these survivors .     

A short-term group treatment model for gay male survivors of childhood sexual abuse living with HIV/AIDS

HIV-positive gay male survivors of childhood sexual abuse (CSA) face three layers of trauma: childhood abuse, homophobic oppression, and HIV/AIDS. Additionally, CSA has been shown to increase HIV risk behavior among gay men, and the trauma of HIV infection often parallels the experience of CSA. Effective coping strategies are particularly important for people living with HIV/AIDS in order to adapt to physical, psychological, and social implications of infection. However, coping strategies once adaptive in the context of CSA may become maladaptive in adulthood. Interventions are needed that enhance coping and address CSA for survivors living with HIV/AIDS to protect their own health and to prevent new transmissions. This article presents a group model found to be efficacious for treating gay male survivors of CSA living with HIV/AIDS.     

Child sexual abuse coping and long term psychological adjustment

The aim of the study was to analyze the consequences of Child Sexual Abuse (CSA) on the psychological adjustment of university students, as well as the way in which several avoidance and approach coping strategies affect that adjustment. The sample comprised 1162 students from the University of Granada. Data about CSA was obtained from a questionnaire developed with this aim. We used the How I Deal with Things Scale of Burt and Katz to evaluate coping strategies, whereas depression and self-esteem were assessed with the Beck Depression Inventory and the Rosenberg Self-Esteem Scale, respectively. Subjects who were victims of CSA showed significantly higher scores on depression and lower scores on self-esteem. An analysis of coping strategies revealed that only the use of avoidance strategies was related to psychological adjustment. Subjects who used these strategies obtained higher scores on depression and lower scores on self-esteem. These results confirm the idea of CSA as a risk experience that can affect victims' psychological adjustment, to a greater or lesser extent, according to the coping strategy employed.     

To Add Insight to Injury: Childhood Abuse,Abuse Perceptions,and the Emotional and Physical Health of Young Adults

Although childhood abuse is strongly associated with psychological difficulties, survivors may not perceive their experiences as abusive. Depression, anxiety, dissociation, and physical health complaints may decrease perceptions of abuse and may also be exacerbated by individuals' abuse perceptions. The current study examined abuse perceptions, abuse experiences, and current symptoms among 185 university students. Ninety-six participants repeated the study 1–2 years later. At Time 1, self-labeling as “abused” or “maltreated” was not related to psychological or physical health symptoms. At Time 2, self-labeling as “abused” or “maltreated” was positively related to depression, anxiety, and dissociation. Results indicate that abuse perceptions may change over time and may be connected with emotional and physical symptoms.     

Context matters: the benefits and costs of expressing positive emotion among survivors of childhood sexual abuse

Positive emotions promote adjustment to aversive life events. However, evolutionary theory and empirical research on trauma disclosure suggest that in the context of stigmatized events, expressing positive emotions might incur social costs. To test this thesis, the authors coded genuine (Duchenne) smiling and laughter and also non-Duchenne smiling from videotapes of late-adolescent and young adult women, approximately half with documented histories of childhood sexual abuse (CSA), as they described the most distressing event of their lives. Consistent with previous studies, genuine positive emotional expression was generally associated with better social adjustment two years later. However, as anticipated, CSA survivors who expressed positive emotion in the context of describing a past CSA experience had poorer long-term social adjustment, whereas CSA survivors who expressed positive emotion while describing a nonabuse experience had improved social adjustment. These findings suggest that the benefits of positive emotional expression may often be context specific.     

Sorrow,shame, and self-esteem: Perception of self and others in groups for women survivors of child sexual abuse

Despite evidence that exists about the severity of impact of child sexual abuse (CSA), less has been published about treatment options. Much CSA is enshrouded in secrecy in the context of dysfunctional family dynamics, therefore group work is often recommended as a method of treatment. Although long- and short-term groups are seen as being equally effective, there are few published studies of long-term analytic groups for survivors of CSA. This study was designed to analyse the process of one long-term group. A case is made for using Core Conflictual Relationship Theme (CCRT), a method designed to analyse individual therapy, with reference to group theory. Shifts in self-perception and in relation to others are analysed from the beginning to the end of therapy.     

Cancer Victim Identity for Individuals with Histories of Cancer and Childhood Sexual Abuse

Identifying as a ‘cancer victim’ has been linked to adverse psychosocial sequelae in individuals who have been diagnosed with cancer. Being a childhood sexual abuse (CSA) survivor may predispose individuals towards a “victim” identity in general. The aim of this study was to determine the prevalence of identifying as a ‘cancer victim’ among CSA survivors who were diagnosed with cancer as adults, and to explore psychological factors associated with identification as a cancer victim. 105 adults reporting both a history of CSA and of having been diagnosed with cancer as an adult were recruited through Amazon Mechanical Turk. Variables assessed included CSA severity, abuse-related powerlessness, general mastery, and cancer victim identity. Fifty-one percent of the sample endorsed a cancer victim identity. Path analysis revealed that abuse-related powerlessness was related to decreased feelings of general mastery, which was in turn associated with cancer victim identification (x ² = .12, DF = 1, p < .73; RMSEA = .00; SRMR = .01: Bentler CFI = 1.0). From a clinical perspective, the results suggest that increasing general mastery in CSA survivors in the cancer setting may be an important mechanism for attenuating the risk for developing a cancer victim identity and, presumably, for downstream adverse psychosocial sequelae.     

Child Sexual Abuse History and Feminine Gender-Role Identity

The association between child sexual abuse (CSA) and feminine gender-role identity was examined among 75 women with and 107 without a history of CSA. Undergraduates and hospital employees from a university in the Southern United States completed questionnaires on the internet. Three aspects of feminine identity were assessed, including how much participants identified with feminine versus masculine traits, endorsed stereotypes about women, and viewed themselves as meeting feminine self-standards. Participants with a history of CSA reported greater feminine self-discrepancy and endorsed more derogatory stereotypes about women than the comparison group. CSA was also linked to identifying with more feminine than masculine traits, but only among hospital employees. Results suggest that feminine identity is a meaningful construct to consider in the adjustment of CSA survivors.     

The association between self-consciousness about appearance and psychological adjustment among newly diagnosed breast cancer patients and survivors: the moderating role of appearance investment

This study examined the moderating role of two facets of appearance investment (self-evaluative salience (SES) and motivational salience (MS)) in the relationship between self-consciousness about appearance and psychological adjustment (depression, anxiety and psychological quality of life (QoL)) in a sample of 134 breast cancer patients (68 newly diagnosed patients and 66 survivors). No significant differences were found between groups on body image variables. Among survivors, the associations between self-consciousness about appearance and the outcome variables were only significant at high (depression, psychological QoL) levels and at moderate (psychological QoL) levels of SES. Self-consciousness about appearance contributed to poor adjustment in both groups. This study demonstrates that appearance investment plays a key role in patients' adjustment and highlights the SES-MS distinction. SES seems to be a vulnerability factor for poor adjustment, and MS seems to be a protective factor that helps women cope with changes in appearance.     

Traumatic stress and psychological adjustment in treatment-seeking women sexually abused in childhood: A follow-up

The objective of this study was to assess post-traumatic stress disorder (PTSD), psychological distress, and risk factors among women sexually abused in childhood (CSA) after six months in therapy. Thirty in-treatment CSA survivors reported their abuse history and filled out several questionnaires. Comparisons were made to a non-CSA in-treatment sample. Although, 50% of the CSA women still had PTSD, there was a remarkable decrease in PTSD symptoms (Cohen's d = 1.06). A considerable change in self-worth and in attachment styles was found. It was concluded that CSA survivors benefit much from 6 months of weekly treatment. However, it is recommended that treatment should continue for a still longer period.     

The impact of child sexual abuse on adult interpersonal functioning: A review and synthesis of the empirical literature

The many studies that have examined the long-term impact of child sexual abuse (CSA) on adult functioning have primarily focused on the personal distress of survivors, largely ignoring the impact of CSA on interpersonal relationships. This article reviews empirical findings concerning the interpersonal distress of survivors as expressed in their intimate and sexual relationships. First, current conceptualizations of the relationship between CSA and interpersonal relationships are reviewed, with a focus on the theoretical models that appear to have implications for the long-term interpersonal sequelae associated with CSA. This is followed by a review of the research conducted on intimacy within the area of social psychology and a summary of the empirical findings related to intimacy functioning in CSA survivors. A hypothesized typology of intimacy functioning for survivors is suggested. The effects of CSA on three components of sexuality—sexual dysfunctions, underlying psychological components of sexuality, and sexual orientation—are discussed. Finally, the interpersonal issues believed to be most salient for CSA survivors in the therapeutic setting are discussed, along with implications for the client–therapist relationship. Methodological, assessment, and conceptual issues are discussed throughout. Recommendations for future research and clinical endeavors are suggested.     

Development and Refinement of a Targeted Sexual Risk Reduction Intervention for Women With a History of Childhood Sexual Abuse

Childhood sexual abuse (CSA) is associated with sexual risk behavior in adulthood. Traditional sexual risk reduction interventions do not meet the unique needs of women who have been sexually abused. In the current paper, we describe the four-stage process we followed to develop and refine a targeted sexual risk reduction intervention for this population. First, initial quantitative work revealed that the intervention should address how maladaptive thoughts related to traumatic sexualization, trust, powerlessness, and guilt/shame (traumagenic dynamics constructs) influence current sexual behavior. Second, qualitative interviews with 10 women who reported a history of CSA (M age = 34 years; 90% African American) as well as current sexual risk behavior provided support for targeting maladaptive thoughts associated with these traumagenic dynamics constructs. Third, based on the qualitative and quantitative results, we developed a 5-session, group-delivered intervention to address the maladaptive thoughts that occurred as a result of CSA, as well as the cognitive-behavioral determinants of sexual risk behavior. This intervention drew heavily on cognitive behavioral techniques to address cognitions associated with CSA and the links between these cognitions and current sexual risk behavior. Techniques from trauma-based therapies, as well as motivational techniques, were also incorporated into the intervention. Finally, we refined the intervention with 24 women (M age = 33 years; 79% African American), and assessed feasibility and acceptability. These women reported high levels of satisfaction with the intervention. The resultant intervention is currently being evaluated in a small, randomized controlled trial.     

Levels of Social Support and Coping Strategies in Adult Survivors of Child Sexual Abuse

The study examined the effects of levels of social support and types of coping strategies on the psychological adjustment of adult survivors of childhood sexual abuse. Five hundred students from two universities in the Limpopo Province of South Africa participated in this study (males =115, females = 383). Mixed methods were used for the collection and data analysis. Higher the level of social support received correlated with superior psychological adjustment. The specific types of coping styles adopted did not affect psychological adjustment in the survivors.     

Psychological assessment of adult survivors of childhood sexual abuse within a naturalistic clinical sample

This study investigates the long-term effects of childhood sexual abuse (CSA). Differences between abused and nonabused individuals in psychiatric symptomatology, interpersonal functioning, social and occupational functioning, personality dynamics, and therapeutic alliance were examined. The relationship between abuse severity and long-term effects was also analyzed. Data were gathered from 51 patients seeking individual psychotherapy at a community outpatient clinic. Findings suggested that CSA survivors tend to experience greater psychiatric distress and poorer interpersonal functioning than nonabused clinical controls. No significant differences were found in social and occupational functioning or in alliance developed by the end of the therapeutic assessment process. Abuse severity was significantly related to increased symptomatology and poorer interpersonal functioning. Findings support and extend existing literature and are especially useful for clinicians working with abuse survivors.     

A qualitative study of childhood sexual abuse survivors in Taiwan: toward a transactional and ecological model of coping

In this study, we aimed to explore the experiences of 10 female Taiwanese childhood sexual abuse (CSA) survivors (age range = 20-39 years) to broaden our understanding of the post-abuse coping process in a Chinese sociocultural context. This investigation was grounded on a feminist paradigm, and the consensual qualitative research method (Hill et al., 2005; Hill, Thompson, & Williams, 1997) was utilized as the strategy of inquiry. The transactional and ecological model of coping that emerged from the data describes the dynamic interplay among (a) intrapersonal, interpersonal, and sociocultural factors and (b) the coping process and outcomes of CSA survivors. Implications for research on CSA recovery and culturally appropriate interventions in a collectivistic sociocultural context are discussed.