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.     

Childhood Sexual Abuse and Revictimization In Adolescence and Adulthood

Abstract

Childhood sexual abuse must be seen as a pervasive risk factor in children's lives: No demographic or family characteristics have as yet been identified to rule out the possibility that a child will be or has been sexually abused (Finkelhor, 1993). The adverse consequences of sexual abuse, both immediate and long term, have been documented by a large body of research. After a summary of the main findings from this research, the main objective of the present chapter is to examine the impact of childhood sexual abuse on a particular aspect of psychological functioning: the development of sexual behavior and sexual relationships. In this analysis, special consideration is given to the question of whether individuals who were sexually abused as children are at greater risk of experiencing sexual victimization in later life than individuals without experience of abuse. This question has generated a substantial body of evidence (see Messman & Long, 1996, for a review), and researchers are beginning to understand pathways from the experience of abuse in childhood to revictimization in adolescence and adulthood.     

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.     

SEVERITY OF CHILD SEXUAL ABUSE AND REVICTIMIZATION: THE MEDIATING ROLE OF COPING AND TRAUMA SYMPTOMS

Child sexual abuse (CSA) has consistently been associated with the use of avoidant coping; these coping methods have been associated with increased trauma symptoms, which have, in turn, been linked to increased risk for adult sexual revictimization. Given these previous findings, the purpose of the current study was to test a model that conceptualized the relationships among these variables. Specifically, CSA severity was conceptualized as leading to the use of avoidant coping, which was proposed to lead to maintenance of trauma symptoms, which would, in turn, impact severity of revictimization indirectly. This comprehensive model was tested in a cross-sectional study of a large, geographically diverse sample of college women. Participants were 99 female undergraduates classified as having experienced CSA who completed measures of abuse history, coping style, current levels of trauma symptoms, and adult sexual revictimization. Multivariate path analysis indicated that the data fit the hypothesized model for verbally coercive, but not physically aggressive, revictimization. Specifically, increased CSA severity was associated with the use of avoidant coping, which, in turn, predicted greater levels of trauma symptomatology and severity of sexual coercion in adulthood. Although cross-sectional in nature, findings from this study suggest that coping strategies and trauma symptoms may represent modifiable factors that place women at increased risk for verbally coercive sexual revictimization.     

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.     

Interpersonal Violence Victimization and Sexual Harassment: A Prospective Study of Revictimization

This study examined associations between past interpersonal victimization (including both child and adult victimization) and sexual harassment (SH); and it examined intervening and moderating variables of the association of past victimization with SH, including posttraumatic stress symptoms (PTSS) and job-gender context. In addition, we examined an alternative hypothesis for revictimization that abuse survivors are hyper-sensitive to perceptions of sexual harassment. Employed women residing in Kentucky (U.S.) who had received an order of protection from a male partner and who were followed-up 12 months later (n?=?445, 78 % White, mean age?=?31.98, SD?=?8.60) were selected for this analysis. SH experienced between baseline and follow-up interviews was associated with baseline assessments of child nonsexual assault experiences (r?=?0.24, p?<?0.001) and intimate partner violence victimization (r?=?0.20, p?<?0.000), demonstrating a revictimization effect. PTSS mediated the relationship between child sexual assault, child nonsexual assault and subsequent SH. Further, working in a job with a male supervisor or in a male-dominated workgroup increased associations between child nonsexual abuse and subsequent SH. No support was found for the hyper-sensitivity hypothesis. Findings are consistent with prior research that identifies sexual harassment as a form of interpersonal violence that mental health and victim service providers and researchers should include in their assessment and treatment strategies. Employers should also understand that working in male-dominated work environments compound the risk of sexual harassment for those with prior abuse histories and should be vigilant to reducing these risks.     

Psychophysiological Reactivity to Abuse-Related Stimuli in Sexually Revictimized Women

Prior research shows discrepant findings in relation to psychophysiological reactivity to threat in women with histories of sexual victimization. Women ages 18 to 22 (N?=?123) with histories of sexual abuse were categorized into child sexual abuse (CSA), adult sexual victimization, revictimization, or nonvictimization groups. Low- and high-frequency heart rate variability were measured at baseline and during an Emotional Stroop task of abuse-related words. Revictimized women showed a significant decrease from baseline to task in both parasympathetic and sympathetic measures when compared to the CSA group. The CSA group demonstrated chronic sympathetic activation at both baseline and task, relative to the revictimization group. Groups did not differ on performance (i.e., reaction time) on the Emotional Stroop task (i.e., more threatening stimuli, slower performance). Cardiovascular responses reported might point to biological reactivity patterns needed for women with a history of sexual abuse to cope with abuse-related stimuli.     

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.     

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.     

Where do we go from here? Moving toward an integrated approach to family violence

This article discusses patterns across reviews of the risk and protective factors for each of seven forms of family violence: partner physical, psychological, and sexual abuse; child physical, psychological, and sexual abuse and child neglect. We note that both child and partner literatures have large research bases on risk factors for physical abuse, but relatively few articles on psychological or sexual abuse (or child neglect). In addition, co-occurrence of forms of maltreatment within families is high, but little integrative work has been conducted. We argue that the overlap of both occurrence and risk factors across forms of maltreatment suggests that both etiological and intervention models would be improved by considering all forms of maltreatment more explicitly in a family (rather than dyadic) context.     

Connections Between Childhood Abuse and HIV Infection

This study examined the incidence of childhood sexual and physical abuse in 52 human immuno-deficiency virus (HIV) infected adults. Behaviors and dynamics associated with unresolved childhood abuse (revictimization, sexual compulsivity, chronic depression, and alcohol and other drug abuse) are discussed in light of those behaviors and dynamics that increase a person's risk of exposure to the virus causing Acquired Immune Deficiency Syndrome (AIDS). lnterview results showed that 65% of those infected reported physical or sexual abuse in childhood. The prevalence of adult survivor characteristics was also examined, and responses were compared based on HIV transmission modes. Recommendations for counselors working with HIV-infected clients are also provided.     

Barter

Psychiatric hospitalization and child sexual abuse are linked not simply by the need for the former occasioned by the symptom sequelae of the latter, but, also, by powerful pathogenic processes. Specifically, stigmatization, betrayal, and powerlessness are central themes in both experiences. Because of these similarities, the survivor of child sexual abuse may experience a psychiatric hospitalization as a revictimization experience. In order to avoid or, at least, minimize harm, all involved with the hospitalization of the child abuse survivor need to be aware of these dynamics and be prepared to provide treatment articulated to the needs of the survivor.     

Risk factors for family violence: introduction to the special series

The purpose of this series is to review the strength of risk and protective factors for each of seven forms of family violence: partner physical, psychological, and sexual abuse; child physical, psychological, and sexual abuse and child neglect. Definitions of risk and protective factors are presented, as is the five-stage prevention intervention research cycle. The reviews in this series are designed to provide stakeholders with a convenient summary from which to identify the strengths and weaknesses of the current risk and protective factor knowledge. Such reviews are necessary to allow for the eventual construction of etiological models that can support the development of preventive intervention programs and research into their efficacy.     

Child sexual abuse evaluations: the scientist–practitioner model

The scientist-practitioner model is presented as a format for conducting child sexual abuse evaluations. This model bases conclusions on empirically established relationships between data and the behavior of interest, rather than on subjective opinions. Using empirically derived evidence, the scientist-practitioner defines child sexual abuse as a life event rather than a clinical syndrome, relies on base rates of behavior for distinguishing and understanding differences between nonsexually abused and sexually abused children, and considers issues of instrument sensitivity and specificity when utilizing assessment tools in child sexual abuse evaluations. This model enlists safeguards to keep the evaluator from inappropriately forming cause and effect associations between a child's single response (e.g., behavioral and emotional symptoms, interactions with anatomically detailed dolls, drawing genitalia) and the occurrence of an event (e.g., sexual abuse). © 1998 John Wiley & Sons, Ltd.     

Correlates of Multiple Forms of Victimization in Religion-Related Child Abuse Cases

Abstract

Abuse perpetrated under the guise of religion is a devastating form of child maltreatment that often involves multiple types of victimization. In a large-scale survey of clinicians, we investigated the nature and emotional sequelae of religion-related child sexual abuse cases. We predicted that there would be marked differences between cases involving multiple forms of abuse and those involving only sexual abuse. Our results indicate that as the number of abuses increases, so does the severity of the abusive experience and the seriousness of psychological consequences for the victim. Thus, religion-related abuse is best understood in light of the specific types and combinations of abuses suffered by victims.     

Further Labeling Within the Category of Disability Due to Chemical Dependency Disorder

This paper raises issues of validity and consequences of appending the label Borderline Personality Disorder to chemically dependent women who are adult survivors of child sexual abuse. Parallels between documented sequelae of childhood sexual abuse and DSM-III-R delineated characteristics of Borderline Personality Disorder are noted as is the DSM-III-R insertion of "No information" with respect to Predisposing factors. This clinician suggests that the label Borderline Personality Disorder and its accompanying assumptions function to generate negative expectations regarding both the course and direction of the therapy process. By failing to consider the impact of childhood abuse this label provides neither appropriate diagnosis nor therapeutic directionfor women with a diagnosis of chemical dependency who are adult survivors of childhood sexual abuse.     

Childhood abuse as a risk factor for suicidal behavior in borderline personality disorder

A childhood history of sexual or physical abuse is highly prevalent in borderline personality disorder (BPD) and is associated with self-destructive behavior in clinical and nonclinical samples. Viewing BPD as a "high risk" disorder, we asked if childhood abuse was a risk factor for adult suicidal behavior or if it was related to other known risk factors for suicide in BPD. A semistructured Abuse History was obtained in 61 criteria-defined BPD patients, who were characterized by structured interviews and self-reports for Axis I disorders, Suicide History, BPD severity, hopelessness, impulsivity, impulsive-aggression, and antisocial traits. Occurrence and severity of childhood sexual abuse, but not physical abuse, predicted adult suicidal behavior independent of other known risk factors. The odds of a sexually abused patient attempting suicide in adulthood was over 10 times that of a patient who was never sexually abused. Given a history of childhood sexual abuse, the risk of adult suicidal behavior in BPD was increased by antisocial traits, severity of BPD, hopelessness, or comorbid major depressive episode (MDE).     

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.     

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.     

Prior interpersonal trauma: the contribution to current PTSD symptoms in female rape victims

The purpose of the current study was to disentangle the relationship of childhood sexual abuse and childhood physical abuse from prior adult sexual and physical victimization in predicting current posttraumatic stress disorder (PTSD) symptoms in recent rape victims. The participants were a community sample of 117 adult rape victims assessed within 1 month of a recent index rape for a history of child sexual abuse, child physical abuse, other adult sexual and physical victimization, and current PTSD symptoms. Results from path analyses showed that a history of child sexual abuse seems to increase vulnerability for adult sexual and physical victimization and appears to contribute to current PTSD symptoms within the cumulative context of other adult trauma.