Positive Resolution of Childhood Sexual Abuse Experiences: The Role of Coping,Benefit-Finding and Meaning-Making

Resolution of the trauma of childhood sexual abuse (CSA), and the current adjustment of 60 adult female CSA survivors were explored through qualitative and quantitative analyses of their coping strategies, perceived benefits, and meaning-making attempts. While the majority of the women (87%) perceived at least some benefit resulting from coping with the CSA experience, many (29%) found it impossible to make any meaning of their trauma. Specific benefits that were associated with various aspects of positive adjustment (marital satisfaction, better physical health, less isolation) included improved relationships with others, religious or spiritual growth, and improved parenting skills. Some perceived benefits were actually associated with a negative outcome. Increased knowledge of sexual abuse was associated with more isolation and lower marital satisfaction. When positive meaning could be derived from the coping process, the women reported less isolation. Avoidant coping was strongly associated with more depressive symptoms and poorer resolution of abuse issues. Results highlight the importance of considering coping strategies and cognitive restructuring efforts in designing therapeutic interventions with this population. Portions of this paper were presented at the annual meeting of the Midwest Psychological Association, May 2004, Chicago, IL.     

Reasons for Returning to Abusive Relationships: Effects of Prior Victimization

Studies have demonstrated that women with a history of childhood sexual abuse (CSA) are at increased risk of revictimization, but research has not yet examined whether a history of CSA may affect patterns of remaining in or returning to abusive relationships in adulthood. This study examines the impact of a CSA history on decisions to return to abusive relationships in a sample of 104 adult domestic violence survivors. Participants were interviewed about the number of times that they had previously separated from and returned to their abusive partner, the factors that influenced their decision to return (both psychological/internal and environmental/external factors), and their perceived likelihood of returning in the future. As predicted, CSA survivors (n = 34) reported a significantly greater number of past separations than non-CSA survivors (n = 70). CSA survivors were also significantly more likely to report that their decisions to return were influenced by emotional attachment to the batterer. CSA survivors did not perceive themselves to be at greater risk of returning in the future, suggesting that they may be more likely to underestimate their vulnerability to returning to the battering relationship. Clinical implications of the findings are discussed.     

Interpersonal rejection sensitivity in childhood sexual abuse survivors: mediator of depressive symptoms and anger suppression

This study investigated whether interpersonal rejection sensitivity serves a mediating role between childhood sexual abuse (CSA) and three long-term psychological correlates of CSA in adult female survivors: depressive symptoms, anger suppression, and attenuated emotional expression. Interpersonal rejection sensitivity has been shown to be a risk factor for the development of depression and is elevated in CSA survivors. Similarly, attenuated emotional expression, particularly anger, has been related to adjustment difficulties in CSA survivors. Participants in this study were 355 female undergraduates, 34 of whom reported a history of CSA. Results demonstrated that interpersonal rejection sensitivity mediates the relationship between CSA and later depressive symptoms. Interpersonal rejection sensitivity partially mediated the relationship between CSA and anger suppression; however, it did not mediate the relationship between CSA and attenuated emotional expression. These results are examined within the context of the current literature on adult CSA survivors and their implications are discussed.     

Long-Term Effects of Witnessing Marital Violence for Women: The Contribution of Childhood Physical and Sexual Abuse

A sample of 313 college women completed a questionnaire about experiences with violence in childhood and adulthood and adult adjustment and relationship functioning. Nine percent of the women reported having witnessed some type of physical conflict between their parents. Witnessing marital violence was associated with other family mental health risks, childhood physical and sexual abuse, and adult physical assaults by strangers. Women who witnessed marital violence reported more symptoms of posttraumatic stress disorder than other women, after family background and abuse variables were accounted for. Significant interactions between witnessing marital violence and childhood physical abuse were observed for measures of social avoidance and predictability in partner relationships, indicating that the effects of witnessing marital violence depended on the presence of childhood abuse. Implications of these results for research and interventions are discussed.     

Child sexual abuse and adult romantic adjustment: comparison of single- and multiple-indicator measures

This study compared the usefulness of single- and multiple-indicator strategies in a model examining the role of child sexual abuse (CSA) to predict later marital satisfaction through attachment and psychological distress. The sample included 1,092 women and men from a nonclinical population in cohabiting or marital relationships. The single-item measure assessed the presence or absence of CSA. The multiple-indicator measure included items relating to level of force, relationship with perpetrator, number of abusive experiences, and nature of assault. Structural equation modeling indicated that, for research purposes, a dichotomized item provided as much information as a complex measure to predict the relationship between sexual abuse and marital adjustment through attachment representations and psychological distress. However, when analyses were conducted strictly within the CSA victims group, no correlation was found between abuse severity and psychosocial measures. The present results show that in a community sample, CSA may be an important risk factor that develops couple difficulties, regardless of the severity of the trauma.     

The links between religiosity, childhood sexual abuse, and subsequent marijuana use: an empirical inquiry of a sample of female college students

A number of studies indicate that childhood sexual abuse (CSA) has a negative impact on later psychological well-being. It is well documented that experiences of CSA are associated with depression, self-destructiveness, and subsequent substance abuse or alcohol consumption. Compared with women who experienced no such sexual abuse in childhood, women who were victims of sexual abuse in childhood were more likely to be depressed and use drugs or consume alcohol in later life. Analyzing data of 1,569 females derived from the "Longitudinal Study of Violence Against Women," this study examines whether the strain caused by sexual victimization leads to a higher level of subsequent marijuana use and whether religiosity moderates the negative effects of CSA. It was found that CSA was associated with an increased level of marijuana use in high school. However, more proximate sexual victimization (victimization in college) seemed to override the impact of CSA on subsequent marijuana use. Religiosity was found to moderate the effect of CSA on marijuana use in high school. Religiosity was negatively associated with marijuana use in high school as well as the second and fourth collegiate years. Policy implications and promising directions for future research are discussed.     

Patterns of childhood sexual abuse characteristics and their relationships to other childhood abuse and adult health

The purpose of this study was twofold: (a) to cluster women who experienced childhood sexual abuse (CSA) according to their shared patterns of CSA characteristics and (b) to examine differences across clusters on measures of other childhood abuse and adult health. Seven CSA characteristic variables were used for cluster analysis. The seven-cluster solution that emerged ranged from a noncontact extrafamilial CSA cluster that occurred without force only once to the most severe clusters in which penetration by an intrafamilial or extrafamilial abuser occurred multiple times with force. Significant differences among clusters were found for childhood emotional abuse and physical abuse, adult physical and psychosocial symptomatology, and depression. There were no significant differences for health care utilization. The results promote further understanding of which victims of CSA are more likely to have experienced other forms of childhood abuse and which victims are more at risk for poor health in adulthood.     

Intergenerational child abuse and coping

Many studies have investigated the consequences of child sexual abuse (CSA) but few have examined the intergenerational effects of poly- victimization and maladaptive coping. The purpose of this investigation was to examine patterns of maltreatment and maladaptive coping among second-generation CSA survivors. It is hypothesized that: (a) maternal CSA history would be associated with a higher incidence of poly-victimization and maladaptive coping and (b) experiencing more forms of abuse would mediate the relation between maternal CSA history and maladaptive coping behaviors. The method used was a chart review of 139 sexually abused females aged 12 to 17, examining maternal abuse history, maladaptive coping behaviors, and child maltreatment. The results showed that poly-victimization differed as a function of maternal CSA history but maladaptive coping did not. Experiencing more types of abuse was associated with both self-injurious behaviors and substance use. In conclusion, results support the hypothesis that second generation CSA survivors are more likely to experience poly-victimization. Future research should address how intergenerational patterns of abuse might affect presenting symptomatology and treatment outcome.     

Ethnicity and Sexual Orientation as PTSD Mitigators in Child Sexual Abuse Survivors

Purpose and Potential benefits: Research, to our knowledge, has not examined the effect of demographic variables on PTSD symptoms among adult survivors of childhood sexual abuse (CSA). This study explores the relationship between demographic variables and scores of CSA survivors on the Impact of Scale (IES). Participants were 257 women CSA survivors entering outpatient treatment at a university-based mental health center. All participants reported a CSA history and presented with psychological difficulties associated with CSA. The demographic variables investigated were relationship status, religious affiliation, ethnicity, educational level, spousal educational level income, and sexual orientation. Significance tests were used to examine each variable and scores on the Total IES and Avoidance and Intrusion Subscales. Total IES and Intrusion scores differed for sexual orientation and ethnicity in accord with conventional standards of significance ( < .05). Self-reported asexuals indicated fewer intrusive and total PTSD symptoms than heterosexuals, lesbians, and bisexuals. Likewise, Hispanics reported less intrusive PTSD symptoms than Non-Hispanic Caucasians. Our findings invite further exploration of the relationship between ethnicity and sexual orientation and the long-term effects of CSA. A question for empirical investigation is whether asexuality shields against the triggering of CSA memories by a sexual relationship. Another possible area of inquiry is whether particular characteristics of Hispanic culture as a whole serve to moderate the detrimental effects of CSA.     

The Relationships Between Childhood Sexual Abuse,Social Anxiety,and Symptoms of Posttraumatic Stress Disorder in Women

The relationships between childhood sexual abuse, social anxiety, and symptoms of posttraumatic stress disorder were examined in a sample of 313 undergraduate women. Thirty-one percent of the women reported some form of sexual abuse in childhood. Women with a history of sexual abuse reported more symptoms of anxiety, distress in social situations, and posttraumatic stress disorder than other women. Women who experienced attempted or actual intercourse reported more avoidance than women with no history of abuse and women with exposure only, and more PTSD symptoms than all other groups of women. Women who experienced fondling reported more PTSD symptoms than women with no history of abuse. Pressure, age of onset of abuse, abuse by a family friend, and abuse by other perpetrators were all significant abuse characteristics in predicting adult social anxiety. Implications of these results for research and interventions are discussed.     

Acts of Childhood Sexual Abuse: An Empirically Derived Typology

A clinical sample of 165 women survivors in outpatient therapy was surveyed about whether their childhood sexual abuse (CSA) included each of 17 sexual acts. Factor analysis of these acts was conducted. A typology of CSA acts consisting of three factors emerged. Inspection of the acts loading on each factor suggested that they differed primarily in terms of the type of abuse of power implied by them rather than in the nature of the sexual behavior involved. The three factors were named Coerced Complicance (Coercion), Subjugation and Humiliation (Subjugation) and Invasive Objectification (Objectification). Implications for research, theory, and clinical practice, and the need for evaluating the generalizability of the typology to other subpopulations of survivors, are discussed.     

Scale 8 Elevations on the MMPI-2 among Women Survivors of Childhood Sexual Abuse: Evaluating Posttraumatic Stress, Depression, and Dissociation as Predictors

This paper investigated elevations on Scale 8 of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) in women survivors of childhood sexual abuse (CSA) in order to assess whether symptoms of posttraumatic stress disorder, depression, or dissociation account for such elevations. Participants were 73 women seeking outpatient treatment for CSA after-effects at a university-based community mental health center. A stepwise multiple regression analysis was conducted, including measures of commonly reported symptoms in CSA survivors: depression, posttraumatic stress, and dissociation. Regression analyses revealed that the Beck Depression Inventory (BDI) and Dissociative Experiences Scale (DES) accounted for the most variance in Scale 8 scores (59%), with the BDI as the best predictor. The Impact of Event Scale (IES) did not predict Scale 8 scores significantly above that achieved by the model above. Cross-validation results indicated good generalizability. Results suggest that depression and dissociation contribute most to scores on Scale 8. Implications of these findings for the clinical and empirical use of the MMPI-2 with CSA survivors are discussed.     

Exposure to interpersonal violence as a predictor of PTSD symptomatology in domestic violence survivors

This study examines the interrelationships between childhood abuse, exposure to maternal domestic violence, and posttraumatic stress disorder (PTSD) symptomatology in a multiethnic sample of 111 adult female residents of a domestic violence (DV) shelter. Participants completed structured interviews about the DV and their prior violence exposure, as well as the Impact of Event Scale-Revised. As hypothesized, there was high co-occurrence between exposure to maternal DV and childhood physical and sexual abuse, and the frequency of lifetime violence exposure predicted PTSD symptomatology. A series of multiple regressions indicated a more complex pattern of relationships, in which specific forms of prior violence exposure predicted different PTSD symptom dimensions. A history of witnessing maternal DV predicted intrusion symptoms, and a history of childhood sexual abuse predicted hyperarousal symptoms. Ethnicity was not related to levels of violence exposure or to PTSD symptoms. Clinical implications of the findings are discussed.     

Beyond Traditional Definitions of Assault: Expanding Our Focus to Include Sexually Coercive Experiences

Traditionally, studies examining sexual assault have not considered experiences of coerced consensual sex. This study sought to compare women who endorsed experiences of coerced sexual intercourse with women who reported more traditionally defined experiences of sexual assault and with a group of women who had experienced neither sexual assault nor coercion. The authors hypothesized that women who had experienced sexual coercion would show symptom elevations on a measure of interpersonal trauma-related symptoms that were more consistent with sexual assault victims than with non-victims. Among a sample of undergraduate college women (N=300), women who endorsed coerced sexual intercourse (8.7%) were compared to women endorsing experiences meeting the legal definition of rape (21%), women endorsing childhood sexual abuse (11.7%), women reporting both rape and childhood sexual abuse (6.0%), and women reporting no victimization experiences (52.7%). Analysis of the Trauma Symptom Inventory (TSI; Briere, 1995) clinical subscales confirmed that women who reported coerced sexual intercourse endorsed symptoms levels more consistent with the adult rape group than with the non-victim group.     

Sexual offenders’ parental and adult attachments and preferences for therapists’ interpersonal qualities

ABSTRACT

This study explored sex offenders' parental and adult attachment difficulties and assessed the extent to which these were associated with preferences for therapists' interpersonal qualities. One-hundred and twelve adult male child sexual offenders were invited to provide self-report data on their attachment histories, adult attachments and preferences for therapists' interpersonal qualities. A weak relationship between childhood and adulthood secure attachment was found, suggesting that attachment at the time of offending may be more relevant than childhood attachment to the aetiology of sexual offending. Participants valued a range of therapists' qualities previously identified as important for positive treatment change. Therapist trust and genuineness were perceived as particularly important by those with attachment difficulties, demonstrating the need for these qualities in offender programmes where attachment difficulties would be expected. There were some differences in the preferences for therapists' qualities between participants with different adult attachment types, highlighting the importance of responsivity factors in treatment.     

Suicidal and other self‐harming behaviour in offender women: The role of shame,anger and childhood abuse

Purpose. The main aim of the study was to consider the contributions of childhood physical and sexual abuse (CPA and CSA) and different aspects of shame and anger to self‐harming behaviours in 89 women prisoners. A further aim was to examine the mediating roles of shame and anger in any link between childhood abuse and self‐harm. Method. Standardized shame and anger questionnaires and four items assessing self‐harm modified from an impulsive behaviour questionnaire were verbally administered. Women were interviewed to assess the occurrence of physical and sexual abuse in childhood. Results. Over half (57%) the women reported suicidal and other self‐harming behaviours at some time in their lives, with 50% of these occurring just before or during the current sentence. All shame, anger, and abuse variables were significantly related to self‐harm, but only bodily shame showed an independent relationship when all variables were considered together. Bodily shame was most strongly associated with CSA, and a mediational analysis tested these specific links with self‐harm. Both CSA and bodily shame made significant independent contributions to self‐harm; however, bodily shame demonstrated the strongest effect, partially mediating the effect of CSA. Conclusions. This is the first study to demonstrate a significant statistical relationship between shame and self‐harming behaviours in women. The findings have implications for the assessment of the therapeutic needs of women prisoners. Future research directions are discussed.     

Resilience in Sexually Abused Women: Risk and Protective Factors

The goal of this study was to evaluate the contribution of family characteristics (family conflict and cohesion) and abuse characteristics (age at which abuse occurred, abuse severity, and relationship to perpetrator) to resilience (self-acceptance, ability to engage in positive relationships with others, and environmental mastery) in a sample of one hundred and 77 university women who had experienced childhood sexual abuse (CSA). The respondents completed a questionnaire that focused on childhood experiences including family environment in childhood, characteristics of the abuse they had experienced in addition to degree of current resilience defined as their level of well-being (self-acceptance, ability to engage in positive relationships with others, and environmental mastery). The results indicated that family characteristics accounted for 13–22% of the variance in the well-being outcomes. In contrast, abuse characteristics accounted for 3% or less of the variance in the well-being outcomes. The clinical implications of these findings are discussed.     

Relationship Between Dissociative and Medically Unexplained Symptoms in Men and Women Reporting Childhood Sexual Abuse

The relationship between the dissociative and somatic symptoms in a clinical sample of 216 women and 35 men survivors of childhood sexual abuse (CSA) was examined. Symptom patterns were measured by the Dissociative Experiences Scale, the Somatization Scale of the Symptom Checklist 90-Revised (SCL-90-R), and the Hypochondriasis, Hysteria, Health Concerns, and Harris–Lingoes Somatic Complaints Scales of the Minnesota Multiphasic Personality Inventory-2. Somatization and dissociation were related, but not at a great enough magnitude to suggest that somatic symptoms as a generic category are an integral component of dissociation. With the exception of one of the measures of somatization, the SCL-90-R somatization scale, no significant differences were found between men and women CSA survivors in symptom levels. However, the relationship between somatization and dissociation was stronger in women than in men. The findings of this study should be considered preliminary and interpreted with considerable caution, since the scales used probably are of limited validity.     

Memories of childhood sexual abuse: narrative analyses of types, experiences, and processes of remembering

The study explored types of memory for childhood sexual abuse (CSA) in a clinical sample of 30 women and identified factors that led some women (n = 24) to report recovered memories. Questionnaires produced three types of memory: always (n = 6), recovered (n = 14), both (n = 10); however, analysis of narrative data also revealed the use of language that could not be categorized into discrete types. Recovered memories were linked to three categories of experience (cumulative reactions, atypical reactions, and atypical experiences). Subcategories identified specific contexts associated with those experiences. Findings suggest that further research is needed on the phenomenology of memory experiences using language derived from CSA survivors and a better understanding of the long-term process of interpretations of key experiences that result in reports of recovered memories.     

The Relationship of Personal, Family, and Abuse-Specific Factors to Children’s Clinical Presentation Following Childhood Sexual Abuse

Past literature has proposed potential variables (e.g., age, gender, attributional style) that may relate to clinical presentation following childhood sexual abuse (CSA). However, few studies have tested these relationships. The current study examined multiple factors related to clinical presentation following CSA in 101 children and adolescents presenting for treatment at Project SAFE, a parallel group treatment for children/teens and their nonoffending parents. Using clusters developed in a previous study, relationships between proposed variables and pretreatment clinical presentation were examined. Results indicated that attributions about the abuse, parental mental health, and severity of abuse related to the differentiated clinical presentation. These results are important because pinpointing correlates to clinical presentation following CSA helps elucidate differences among those with a history of CSA and gives greater insight into the impact sexual abuse has on children. Knowing these differences may also benefit treatment providers in the development of individual treatment goals during therapy.