Body image disturbance in patients with borderline personality disorder: Impact of eating disorders and perceived childhood sexual abuse

Body image disturbances occur in women with borderline personality disorder (BPD). Systematic research on these characteristics in well-defined BPD groups is lacking. It is unknown, if the disturbances are related to eating disorders and childhood sexual abuse (CSA), which frequently co-occur in patients with BPD. In the present study, cognitive-affective and behavioral components of body image for 89 female patients with BPD (49 with lifetime eating disorders) and 41 healthy participants were assessed via Body Image Avoidance Questionnaire (BIAQ) and Multidimensional Body-Self Relations Questionnaire (MBSRQ). Within the BPD group, 43 patients reported a history of CSA. Compared to healthy controls, BPD patients reported significantly more negative scores in the BIAQ and the MBSRQ. Both a history of CSA and a comorbid eating disorder were independently associated with an even more negative body image. Results suggest a disturbance of cognitive-affective and behavioral components of body image in female BPD patients.     

Emotions and suicidal ideation among depressed women with childhood sexual abuse histories

Depressed women with sexual abuse histories have a heightened risk of suicidal ideation (SI), which may be only in part attributable to psychiatric symptoms of depression and posttraumatic stress disorder (PTSD). Emotions and SI were studied among 106 women with histories of childhood sexual abuse enrolled in treatment trials for major depression. Assessments were conducted at baseline, 10, 24, and 36 weeks. Sadness, guilt, and shame-proneness were associated with self-reported and observer-rated SI across time after adjusting for depressive and PTSD symptoms, suicide attempt history, and sociodemographic characteristics associated with SI. These findings highlight the need for clinical attention to self-directed negative emotions to potentially reduce suicide-related risk.     

Reality monitoring in adults reporting repressed, recovered, or continuous memories of childhood sexual abuse

People who report either repressed or recovered memories of childhood sexual abuse (CSA) may have deficits in reality monitoring--the process whereby one discriminates memories of percepts from memories of images. Using signal detection methods, the authors found that adults reporting either repressed or recovered memories of CSA were less able to discriminate between words they had seen from words they had imagined seeing than were adults reporting either never having forgotten their CSA or adults reporting no history of CSA. Relative deficits in the ability to discriminate percepts from images (i.e., low d') were apparent on only some tests. The groups did not differ in their criterion--response bias--for affirming having seen versus imagined stimuli.     

Forgetting of prior remembering in persons reporting recovered memories of childhood sexual abuse

Case studies of individuals reporting recovered memories of childhood sexual abuse suggest that some overestimate their prior forgetting of the abuse. People reporting recovered or continuous memories of childhood sexual abuse and control subjects reporting no history of abuse participated in two experiments examining this "forgot it all along" phenomenon. Participants in Experiment 1 were more likely to forget that they had previously recalled a studied item if they were cued to think of it differently on two recall tests than if they were cued to think of it in the same way on the two tests. This effect was stronger for recovered-memory participants than for continuous-memory and control participants. In Experiment 2, participants recalled autobiographical events three times over a period of 4 months. Much as in Experiment 1, they underestimated prior remembering when the events had been recalled in a different emotional frame (positive vs. negative) on the previous occasion. This underestimation was more pronounced for recovered-memory participants than for continuous-memory and control participants.     

Inhibiting retrieval of trauma cues in adults reporting histories of childhood sexual abuse

Are people who report having forgotten their childhood sexual abuse (CSA) characterised by superior ability to inhibit retrieval of disturbing material? To test this hypothesis, we asked adults reporting either repressed, recovered, or continuous memories of CSA or no history of CSA to participate in a directed forgetting experiment (list method). They rated the emotionality of two consecutive lists of trauma‐related and positive words. After the first list, the experimenter instructed participants to forget these words, and to continue rating the remaining words. A surprise recall task revealed robust directed forgetting and valence effects: All groups recalled more words from the second list than from the first list, and recalled more trauma words than positive ones. Participants reporting either repressed or recovered memories of CSA did not exhibit superior forgetting of trauma versus positive words relative to the other two groups. Finally, a subsidiary analysis revealed that participants exhibiting a “repressor” coping style (low self‐reported anxiety plus high defensiveness) did not exhibit superior directed forgetting of trauma words.     

Autobiographical memory specificity in adults reporting repressed,recovered, or continuous memories of childhood sexual abuse

Some psychotherapists believe that adult survivors of childhood sexual abuse (CSA) are characterised by memory deficits for their childhood. Using the Autobiographical Memory Test (AMT), we asked nonabused control participants and participants who reported either continuous, recovered, or repressed memories of CSA to retrieve a specific personal memory in response to either positive or negative cue words from either childhood or adolescence/adulthood. The results indicated that participants who believed they harboured repressed memories of abuse tended to exhibit the greatest difficulty retrieving specific memories from their childhood. Neither posttraumatic stress disorder (PTSD) nor major depression was related to diminished memory specificity.     

Autobiographical memory specificity after manipulating retrieval cues in adults reporting childhood sexual abuse

Traumatized samples have relative difficulty in generating specific autobiographical memories on a cue word task, compared to nonexposed controls. Simultaneously, trauma is associated with highly specific intrusive trauma memories in day-to-day life. Possibly, day-to-day intrusions and memories generated to cue words rely on different retrieval processes, with the former dependent on close associations between retrieval cues and specific memory representations (direct retrieval), and the latter on iterative retrieval cycles through a hierarchical memory system (generative retrieval). This study investigated this distinction using two versions of the cue word task, designed to promote generative and direct retrieval, respectively, in participants with or without a history of child sexual abuse (CSA). The data demonstrated that CSA participants were less specific than nonabused controls to generative retrieval cues, but this difference disappeared with direct retrieval cues. This interaction was stronger in CSA participants with relatively greater posttraumatic stress and remained significant when participants with past or current major depressive disorder were excluded and also when only those participants with corroborated CSA were included.     

Fantasy proneness, but not self-reported trauma is related to DRM performance of women reporting recovered memories of childhood sexual abuse

Extending a strategy previously used by , we administered a neutral and a trauma-related version of the Deese-Roediger-McDermott paradigm to a sample of women reporting recovered (n=23) or repressed memories (n=16) of childhood sexual abuse (CSA), women reporting having always remembered their abuse (n=55), and women reporting no history of abuse (n=20). We found that individuals reporting recovered memories of CSA are more prone than other participants to falsely recalling and recognizing neutral words that were never presented. Moreover, our study is the first to show that this finding even held when trauma-related material was involved. Correlational analyses revealed that fantasy proneness, but not self-reported traumatic experiences and dissociative symptoms were related to false recall and false recognition.     

Forgetting of trauma cues in adults reporting continuous or recovered memories of childhood sexual abuse

According to betrayal trauma theory, adult survivors of childhood sexual abuse (CSA) who were molested by their caretakers (e.g., a father) are especially likely to dissociate ("repress") their memories of abuse. Testing college students, some reporting CSA, DePrince and Freyd (2004) found that those scoring high on a dissociation questionnaire exhibited memory deficits for trauma words when they viewed these words under divided-attention conditions. Replicating DePrince and Freyd's procedure, we tested for memory deficits for trauma words relative to neutral words in adults reporting either continuous or recovered memories of CSA versus adults denying a history of CSA. A memory deficit for trauma words under divided attention was expected in the recovered-memory group. Results were inconsistent with this prediction, as all three groups exhibited better recall of trauma words than neutral words, irrespective of encoding conditions.     

Cognitive processing of trauma cues in adults reporting repressed, recovered, or continuous memories of childhood sexual abuse

Psychologically traumatized people exhibit delayed color naming of trauma words in the emotional Stroop task. Four groups of participants were asked to color name positive words, neutral words, and trauma words; these groups included 15 women who believed that they harbored repressed memories of childhood sexual abuse (CSA), 13 women who reported recovered memories of CSA, 15 women who had never forgotten their CSA, and 12 women who had never been abused. Repressed-memory participants exhibited patterns of interference indistinguishable from those of the nonabused control group participants. Irrespective of group membership, the severity of self-reported posttraumatic stress disorder symptoms was the only significant predictor of trauma-related interference, r(48) = .30, p < .05.     

Additive impact of childhood emotional,physical, and sexual abuse on suicide attempts among low-income African American women

This study examines the association between exposures to multiple forms of childhood abuse (emotional, physical, sexual) and adult suicidal behavior in a sample of low-income, African American women. We hypothesized a linear relation between childhood abuse and risk for making a suicide attempt, such that the more forms of childhood abuse to which a woman was exposed, the greater her risk would be to make a suicide attempt. Logistic regression analyses revealed that, compared to women who did not report any experiences of childhood abuse, women who experienced one, two, or three forms of abuse were 1.83, 2.29, or 7.75 times more likely to attempt suicide, respectively (all statistically significant). Furthermore, compared to women who reported one or two types of abuse, women who reported all three types of abuse were statistically more likely to attempt suicide. These findings have implications for clinicians working with African American women who report either childhood abuse or exhibit suicidal behavior.     

Body satisfaction, sexual self-schemas and subjective well-being in women

The objectification of women's bodies in western culture creates special emphasis on women's representations of embodied aspects of themselves. I argue that women's satisfaction with their bodies is likely to have particularly strong implications for other embodied aspects of self: in this case, representations of their sexual selves. This paper examines the relationships between women's body satisfaction, their sexual self-schemas, and components of subjective well-being in a sample of 91 Australian women aged between 18 and 68. Body satisfaction and dimensions of women's actual sexual self-schemas predicted satisfaction with life, positive and negative affect. The relationships between body satisfaction and both positive affect and satisfaction with life were partially mediated by the positive dimensions of sexual self-schemas. This finding suggests that at least some of the negative consequences associated with body dissatisfaction are due to the negative implications of body dissatisfaction for women's beliefs about their sexual selves.     

Retrieval inhibition of trauma-related words in women reporting repressed or recovered memories of childhood sexual abuse

Several authors have argued that survivors of childhood sexual abuse (CSA) who report to have repressed their traumatic memories are more skilled in forgetting emotional stimuli than survivors who have always remembered the abuse. The current experiment employed a list-wise directed forgetting task to investigate whether women reporting repressed (n = 16) or recovered (n = 23) memories of CSA are better at forgetting disturbing material, relative to women reporting having always remembered their abuse (n = 55) or reporting no history of abuse (n = 20). We found no support for the hypothesis that women reporting repressed or recovered memories of CSA are especially versed in inhibiting retrieval of trauma-related words. Additional analyses revealed that participants characterized by a repressive coping style did not display a superior retrieval inhibition mechanism for negative material.     

Directed forgetting of trauma cues in adults reporting repressed or recovered memories of childhood sexual abuse

An item-cuing directed forgetting task was used to investigate whether women reporting repressed (n = 13) or recovered (n = 13) memories of childhood sexual abuse (CSA) exhibit an avoidant encoding style (and resultant impaired memory) for trauma cues relative to women reporting no CSA experience (n = 15). All participants viewed intermixed trauma (e.g., molested), positive (e.g., confident), and categorized neutral (e.g., mailbox) words on a computer screen and were instructed either to remember or to forget each word. The results provided no support for the hypothesis that people reporting either repressed or recovered memories of CSA are especially adept at forgetting words related to trauma. These groups recalled words they were instructed to remember more often than words they were instructed to forget regardless of whether they were trauma related.     

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.     

False recognition in women reporting recovered memories of sexual abuse

False recognition—the mistaken belief that one has previously encountered a novel item—was examined in four groups of subjects: women reporting recovered memories of childhood sexual abuse, women who believe that they were sexually abused as children but who cannot recall this abuse (the "repressed" group), women who were sexually abused as children and always remembered the abuse, and women with no history of childhood sexual abuse. Subjects were administered a Deese/Roediger-McDermott paradigm. The results suggest that the recovered-memory group was more prone to false recognition than the other groups. In addition, women reporting recovered and repressed memories showed greater reduction in false recognition across study trials than did other subjects, perhaps reflecting strategic changes in performance.     

Sex differences in childhood sexual abuse and suicide-related behaviors

Child sexual abuse and suicide-related behaviors are associated, but it remains unclear if the strength of this association differs in boys and girls. In a systematic review of this association in children and youth, we identified 16 relevant studies, all cross-sectional surveys of students. The association is stronger in boys specific to suicide attempt(s). Adjustments for potential confounding variables explained some, but not all of this sex difference. While additional research would strengthen causal inferences, this sex difference may be influenced by the nature and timing of child sexual abuse as well as the sex of the perpetrator, which in turn shapes the disclosure of these events.     

Body image and risky sexual behaviors: an investigation in a tri-ethnic sample

The impact of negative body image on risky sexual behaviors has not been extensively investigated. The present study examined the relationship between two aspects of body image, appearance shame and appearance investment, and potentially risky behaviors. The study employed a tri-ethnic sample of 1547 women seeking services at two family planning clinics. Logistic regression was utilized to examine the relationship between potential risk behaviors and shame and investment. Results supported that these aspects of body image were significant predictors of inconsistent condom use, having multiple sex partners in the past year, and having sex after drinking alcohol or using drugs, and that demographic variables (e.g., age, marital status, ethnicity) could not fully account for these relationships. The importance of future research investigating the relationships among body image, perceived relationship security, affect-management strategies, and risky sexual behaviors is emphasized.     

Body dissatisfaction,eating disorders,and depression: A developmental perspective

McCarthy (1990) contends that a cultural ideal of thinness (the thin ideal) causes depression and eating disorders to occur more frequently in women than men. She believes eating disorders are a way of coping with depression and hypothesizes that the thin ideal has its greatest impact during puberty when sexual attractiveness becomes important and changes in physical appearance increase the discrepancy between the adolescent girl's actual and ideal body image. The present study used a cross-sectional design of 5th, 8th, and 12th grade males and females (N = 599) to test several predictions from McCarthy's model. As expected, 8th and 12th grade females preferred a thinner than average body shape. They were more dissatisfied with their bodies than males and scored higher on measures of disordered eating. In contrast, before puberty (5th grade) boys were more depressed than their female peers but this pattern was reversed in 8th grade boys and girls. Paralleling changes in depression, disordered eating scores were highest in 8th and 12th grade girls. Both of these findings underscore the role of maturational factors in the onset of eating disorders. Although the sample was ethnically diverse and mainly from middle and low socioeconomic groups, there was a surprisingly high incidence of body dissatisfaction and symptoms of disordered eating. This illustrates the pervasiveness of thinness as a standard of feminine beauty in our society and the damaging effects it can have.