Unresolved Childhood Sexual Abuse and Older Adults: Late-Life Vulnerabilities

Several long-term correlates of childhood sexual abuse (CSA) have been identified, including depression, fear, anxiety, guilt, anger, and poor interpersonal functioning (e.g., Browne and Finkelhor, 1986). However, little is know about how CSA survivors fare in old age. This article addresses the impact of unresolved CSA on late-life (emotional, cognitive, and behavioral) functioning. Three case studies of older adults ages 60 and older who were struggling with unresolved CSA are presented. Two observed stressors (loss of social support and declining health) and one developmental task (reminiscence or life-review) appear to be linked to exacerbated vulnerabilities in older survivors. Specifically, because CSA may arrest specific childhood developmental tasks (e.g., ability to form secure attachments, autonomy) or facilitate development of coping strategies that are maladaptive when outside of an abusive environment (e.g., generalized interpersonal distrust, avoidance, dissociation), the survivor may be at risk for developmental vulnerabilities for dysfunction in adulthood. These vulnerabilities may exacerbate unresolved CSA, particularly when the adult encounters stressors or developmental tasks that exceed his or her capacity for adaptive coping. Recommendations for mental health professionals and future research are suggested.     

Autobiographical Memory Disturbances in Childhood Abuse Survivors

Summary

Clinicians have noted that childhood abuse survivors frequently report that they have forgotten large parts of their childhood. While memory for abusive experiences has attracted a great deal of attention from researchers, other types of memory disturbances may also accompany a history of childhood trauma. Many clinicians report that certain types of sexual abuse, and abuse at certain developmental stages, is more likely to result in reports of gaps in memory for the abuse. However, because information has been mainly collected in clinical populations, the possibility of confounding between abusive experiences and psychological disturbances cannot be ruled out. This article reports on data gathered from a large, epidemiologic study conducted within a health maintenance organization. A history of childhood physical or sexual abuse doubled the prevalence of general autobiographical memory loss for women, while for men, the rate increased 1.5 times over those with no abuse history. Higher rates of autobiographical memory loss were noted where both types of abuse were reported. Further, multiple incidents of sexual abuse, sexual abuse by a relative, and more severe sexual abuse increased reports of autobiographical memory loss. Theoretical perspectives on changes in the memory system that may affect trauma survivors are discussed.     

Unresolved Childhood Sexual Abuse: Are Older Adults Affected?

This article presents case studies and discussions regarding three observed characteristics of unresolved childhood sexual abuse in adult survivors over 65 years of age. Specifically, chronic depression, elder abuse, and the misdiagnoses of residual abuse trauma as dementia or mental illness are compared to parallel issues identified by researchers in younger adult survivors. A brief overview of the childhood abuse literature and recommendations regarding professional training, the development of new services, and additional research are included.     

The inter-generational transmission of trauma: The effects of abuse on the survivor's relationship with their children and on the children themselves

This paper explores some of the potential consequences of childhood abuse in adulthood, in terms of the effects on parenting, and on the child of the abuse survivor. Reference is made, and parallels drawn where appropriate, to the experiences of survivors of the Holocaust in respect of both these themes. the clinical experience of the author vis-à-vis survivors of abuse and parenting has strong similarities to some of the findings of those researching this subject from the perspective of the Holocaust. While the primary focus is on the experiences of survivors of childhood abuse these similarities and parallels are also acknowledged.     

Refusing to be Marginalized: Groupwork in Mental Health Services for Women Survivors of Childhood Sexual Abuse

Childhood sexual abuse is a major aetiological factor in the development of mental health difficulties experienced by women. Although this conclusion is supported by two decades of extensive research, it has had little impact on the provision of mainstream mental health services. It remains exceptional for there to be specialist therapy or counselling provision for women survivors of childhood sexual abuse within statutory mental health services. This represents a serious gap in service provision and, it is argued, results in extended and inappropriate treatment for women survivors using mental health services. In this article, the development of a multi-agency approach to the provision of groupwork for women survivors of childhood sexual abuse within mental health service is described. A women-centred model of groupwork is outlined. Evaluation and funding are discussed. It is argued that, as a time-limited and effective treatment option, groupwork for women survivors of childhood sexual abuse should form a central part of service provision within statutory adult mental health services.     

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.     

Depressive and Anxious Symptomatology Moderate the Relationship Between Childhood Emotional Abuse Severity and Attentional Bias on the Modified Stroop Task

Research has demonstrated that the impact of childhood abuse often outlasts the initial abuse experiences, paving the way for a myriad of psychological difficulties in adulthood. Attentional bias might serve as a pathway from childhood abuse to negative outcomes associated with such experiences. The primary aim of the study was to investigate the impact of childhood emotional abuse (CEA) experiences on the presence of attentional bias in a sample of college women by comparing performance on a modified Stroop task between CEA survivors (n = 28) and a nonabused control group (n = 31). Results suggest that for CEA survivors, psychological symptoms moderated the relationship between CEA severity and attentional bias to specific word types. Results underscore the importance in continued exploration of the relationship among childhood emotional abuse, attentional bias, and concurrent psychopathology. Results also suggest that modification of attentional biases, via cognitive bias modification procedures, could help mitigate the impact of childhood abuse experiences on psychological well-being in adult 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.     

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.     

God died and nobody gave a funeral

When childhood abuse trauma occurs in a Christian environment, the god representation is disrupted. Despite counseling, the impact of the god of childhood on the lives of child abuse survivors is often not resolved. The impact of the accumulation of child abuse trauma can seriously impair the development of the god image or even cause the god image to die. If a member of the family dies, there is a funeral and a period of socially supported grieving. When god dies, no one holds a funeral. The nature of the Christian god representation necessitates that Christian child abuse survivors grieve the loss of their childhood god if they are to resolve spiritual issues.An earlier form of this paper was given at the American Academy of Religion, November 1994.     

Contextualizing and Clarifying Criticisms of Memory Work in Psychotherapy

This article aims to reduce the polarization that has characterized discussion of memory work in psychotherapy. First, the article attempts to help critics of memory work understand the cultural and historical context in which their arguments have been received by practitioners and victim advocates: There are good reasons why attacks on memory work have been viewed with suspicion. Second, the article tries to convince practitioners and victim advocates that there nonetheless are legitimate grounds for concern about some forms of memory work. The goal here is to persuade practitioners whose work includes a focus on childhood trauma to be cautious in their use of memory recovery techniques, without undermining support for survivors of childhood sexual abuse.     

Forgiveness as a mediator of the relationship between PTSD and hostility in survivors of childhood abuse

It was hypothesised that forgiveness mediates the relationship between PTSD and hostility within a population of adult childhood abuse survivors. Of the three components of forgiveness-self, other, and situation-self and situation forgiveness were posited as potent mediators of the PTSD and hostility relationship. No differences in the mediational role of forgiveness in sexual versus physical abuse and female versus male abuse survivors were hypothesised. As posited, overall forgiveness mediated the PTSD-hostility relationship and the forgiveness of self and situation were strong mediators. The theoretical and applied implications of these findings are discussed.     

The Satir Model with Female Adult Survivors of Childhood Sexual Abuse

Child sexual abuse is a recognized problem in the United States and Canada. There are several approaches to therapy with adult survivors of childhood sexual abuse. This article discusses Virginia Satir's model of therapy as it applies to sexual abuse. The emphasis of the Satir model is on transforming the impact of the abuse, no matter how the client chooses to process her relationship with the abuse, and is illustrated through a case study.     

Evidence Supporting an Independent Association between Childhood Physical Abuse and Lifetime Suicidal Ideation

A regionally representative Canadian sample was used to investigate the gender-specific relationship between childhood physical abuse and lifetime suicidal ideation. The prevalence of suicidal ideation was about five times higher in abused men and women compared with their nonabused counterparts. After controlling for five clusters of potentially confounding factors (adverse childhood conditions, socioeconomic factors, health behaviors, psychosocial stressors/chronic illnesses, and mental health), childhood physical abuse was significantly associated with suicidal ideation (OR(adjusted) women = 4.48, 95% CI = 3.32-6.04; men = 3.57, 95% CI = 2.08-6.14). These findings suggest childhood physical abuse is independently associated with suicidal ideation and highlight the importance of providing preventative treatment to childhood abuse survivors.     

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 .     

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.     

Hardiness as a Moderator of Shame Associated with Childhood Sexual Abuse

An adult female sample of childhood sexual abuse survivors (n = 195) were surveyed to determine if hardiness was effective in moderating the negative effects of the perceived trauma and severity of the sexual abuse and internalized shame on relationship intimacy. The results indicated that perception of abuse, severity of abuse, and shame were significantly and negatively related to hardiness. Hardiness was found to have a significant moderating effect on the negative impact of internalized shame and severity of abuse on marital/relationship intimacy.     

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.