Stress, appraisal, and coping in child sexual abuse: A theoretical and empirical review.

A review of theories to predict the mental health effects of child sexual abuse suggests that existing models have not adequately defined stress and coping constructs and have not specified how those variables might interact with other environmental factors. This article outlines a transactional model that conceptualizes sexual abuse as a stressor consisting of a series of abuse events, abuse-related events, and disclosure-related events that each tend to increase risk for maladaptive outcomes. The model also proposes that cognitive appraisals and coping responses mediate the effects of these events, that developmental and environmental factors may moderate relationships between sexual abuse stressors and victim responses, and that victims' initial responses may effect subsequent levels of abuse-related stress. Empirical studies relevant to the major components of this model are reviewed, and the implications of these findings for future research are considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Internal and external mediators of women's sexual abuse in childhood.

A community sample of 111 women's retrospective reports of childhood sexual abuse was examined in an effort to understand the circumstances and coping strategies that mediated the immediate and lasting effects of those stressful experiences. Aspects of single or multiple abuse incidents were captured in 11 variables, each reflecting 1 of 3 domains: circumstances of abuse, mediators, and outcomes (the negative effects of abuse). Observed variable simultaneous path analysis models revealed several direct and mediated influences on the outcomes. Long-term negative outcomes of abuse were directly affected by a close relationship to the perpetrator and severity of abuse from the circumstances of abuse domain, and immediate negative responses, self-blame, and nondisclosure regarding the incident from the mediational domain. The importance of examining factors that mediate the negative effects of child sexual abuse is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The psychological evaluation of child sexual abuse using the Louisville Behavior Checklist and Human Figure Drawing

Accurately detecting victims of child sexual abuse when physical evidence is lacking is a problem frequently faced by clinicians. This study investigated whether Human Figure Drawings and the Louisville Behavior Checklist could be used to accurately identify sexually abused children, mental health clinic-referred children, and community children. Discriminant function analysis indicated that the groups differed significantly on the measures. There was some misclassification of individual children on the basis of their checklist and drawing scores. Results suggested limited support for the Louisville Behavior Checklist but caution in using Human Figure Drawings in the assessment of sexual abuse.     

Childhood abuse, body image disturbance, and eating disorders

Studies have suggested that women who experience child sexual abuse are at risk for developing symptoms related to anorexia nervosa and bulimia. The purpose of the present study was to examine the relationships among childhood sexual and physical abuse, body image disturbance, and eating disorder symptomatology. Of 670 female college students screened for childhood abuse, 29 sexually abused, 32 physically abused, and 29 nonabused women completed measures of eating disorder symptoms, psychological factors thought to be related to eating disorders, and body image distortion. Contrary to previous reports, there was no evidence that child sexual or physical abuse was associated with the development of body image disturbance. Furthermore, the results did not support the hypothesis that child sexual and physical abuse are related to eating disorder symptomatology. It is suggested that subjects who are victims of child sexual abuse and who are receiving psychotherapy manifest higher rates of a number of different types of psychopathology, including eating disorders.     

The relation between methods of coping during adulthood with a history of childhood sexual abuse and current psychological adjustment.

With a community sample of 192 women who had been sexually abused during childhood, the investigators determined if methods of coping in adulthood with the aftermath of child sexual abuse were associated with current symptoms of psychological distress. Multiple regression analyses indicated that disengagement methods of coping with the sexual abuse accounted for unique variance in general psychological distress even after controlling for characteristics of the abuse and methods of coping with other stressors. Disengagement methods of coping were also used more often to deal with the stressful aspects of having been sexually abused than to deal with other stressful events. In contrast, engagement methods of coping were used more often to deal with the other stressors than with sexual abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Suicidal thoughts and behaviours in former sexual abuse victims.

Examined the relationship between childhood sexual abuse and subsequent suicidality in 195 women (mean age 27.4 yrs) presenting to the crisis intervention program of a community health center. As predicted, former sexual abuse victims were considerably more likely to have made at least 1 suicide attempt in the past (55% of the 133 Ss) than were nonabused clients (23% of the 62 Ss) and were more likely to report suicidal ideation upon intake. Sexual abuse was associated with suicide attempts that occurred in childhood or adolescence. Among former sexual abuse victims, greater suicidality was correlated with multiple perpetrators, concurrent physical abuse, and sexual intercourse. Childhood sexual abuse is hypothesized to result in lowered self-esteem, guilt and self-blame, perceived powerlessness, and interpersonal dysfunction—all of which may lead to increased self-destructiveness. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual abuse of boys. Examples of a group-oriented treatment

Although the sexual abuse of boys is much less written and talked about than the sexual abuse of girls, it is thought that one of three victims of abuse is a boy. This article sums up the symptoms and reactions seen in male victims. Whereas women usually react with depression and guilt, men react more with anger. Psychosomatic symptoms are often seen, as well as sexual problems such as homophobia or exaggerated masculinisation. As many as 30-50% of male rapist and child molesters have been molested as children. This makes it important to establish a therapeutic dialogue with these men about what they have been through, so as to avoid the development of such behaviour if possible. Experience from the treatment of male adults who were sexually abused in childhood is described, and placed in relation to the existing literature on the subject.     

Science, policy, and the protection of children.

Child maltreatment is a particular concern for many researchers, practitioners, and policymakers. The articles in this Child Sexual Abuse: Science, Practice, and Policy Issues section, edited by Jeffrey Haugaard, address the issue from several perspectives. Haugaard articulates the difficulties of defining certain types of abuse and of researching ambiguous variables. Karen Saywitz and her coauthors provide an overview of current treatments for child sexual abuse victims. Recent national statistics on child maltreatment and federal efforts to address the problem are described by Olivia Golden. Tom DeLay highlights current problems in the child welfare system and the federal government's role in responding to them. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of child sexual abuse on developing sexuality.

This article reviews theoretical and empirical literature on sexual abuse and focuses on the effects of child sexual abuse on developing sexuality. The issues addressed include (a) prominent family qualities associated with sexual socialization, (b) theoretical formulations that account for the effects of sexual abuse on developing sexuality, and (c) research findings on the impact of child sexual abuse on the sexuality development of child victims and adult survivors. Directions for future research and implications for practitioners are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Autobiographical memory functioning in depression and reports of early abuse.

The authors investigated the memory functioning of depressed women patients with and without a reported history of child physical or sexual abuse using J. M. G. Williams and K. Broadbent's (1986) Autobiographical Memory Test. Whereas latency to recall autobiographical memories was not related to reports of abuse, patients who reported childhood sexual abuse produced more overgeneral memories to positive and negative cues. In addition, patients reporting high levels of avoidance of spontaneous memories of childhood physical or sexual abuse in the past week retrieved more overgeneral memories to positive and negative cues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term sequelae of childhood sexual abuse: Perceived family environment, psychopathology, and dissociation.

105 abused and nonabused women were examined for patterns of adult psychopathology associated with childhood sexual abuse and to test the extent to which these patterns are independent of other pathogenic properties of the family environment. Clinical and nonclinical Ss completed the Family Environment Scale, the MMPI, the Rorschach, and the Stanford Hypnotic Susceptibility Scale. Greater nonspecific impairment among abused women may be a consequence, at least in part, of pathogenic family structure rather than sexual abuse per se. However, MMPI and Rorschach responses suggest sexual abuse may render victims especially vulnerable to specific disturbances involving soma and self. Abuse was associated with greater use of dissociation, but covariance analysis revealed this effect to be accounted for by family pathology. There was no evidence that sexual trauma is associated with hypnotizability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual abuse histories of adolescent male sex offenders: Differences on the basis of the age and gender of their victims.

Childhood sexual abuse has often been implicated in the etiology of adolescent sex offending behavior. Victimization rates in the literature vary according to whether data are collected prior (22%) or subsequent (52%) to treatment. Previous research suggests that the incidence of sexual abuse varies as a function of victim age and gender. Sexual abuse histories were collected from 87 adolescent male sex offenders following an average of 13 months of clinical interactions. Offenders were categorized according to the age and gender of their victims; groups were comparable in age and socioeconomic status. It was found that 75% of adolescent offenders who ever assaulted 1 male child reported sexual abuse in comparison to only 25% of those who assaulted female children, peers, or adults. Results suggest that sexual victimization may be an important explanatory variable for adolescent sexual assaults against male children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors associated with sexual behavior problems in young sexually abused children

OBJECTIVE: To identify variables associated with the presence of sexual behavior problems in young sexually abused children. METHOD: Data were gathered from the clinical records of 100 sexually abused boys and girls ages 3-7 years enrolled in two treatment programs. Information was coded systematically on approximately 350 areas related to the child and family's history and functioning, the sexual abuse experience, and treatment outcome. The children were grouped and compared according to their presenting sexual behavior into three categories: (1) developmentally "expected"; (2) "sexualized/self-focused"; and (3) problematic "interpersonal" sexual behavior. RESULTS: Bivariate and multivariate analyses highlighted five variables which were predictive of sexual behavior problems among sexually abused children. Sexual arousal of the child during his/her sexual abuse, the perpetrator's use of sadism, and a history of physical and emotional abuse differentiated between those children with and without "interpersonal" sexual behavior problems. Who the child blamed for his/her sexual abuse further contributed to the distinction between children whose sexual behavior was exclusively "self-focused" (sexualized) versus "interpersonal." CONCLUSIONS: The five major predictor variables, as well as other variables identified in this study, have potential utility in assessing child risk for negative outcomes and determining referral priorities for sexual abuse treatment. Given that sexual arousal and who the child blames for the abuse are prominent variables associated with sexual problems and self-blame, clinicians will need to ensure that sexually abused children and their caregivers are given specific opportunities to deal with these areas in the supportive context of treatment. Children with sexual behavior problems differ not only in the type and level of sexual behavior they exhibit but in most other areas as well, suggesting a need for differential assessment and individualized treatment approaches.     

Power and affiliation motivation, stress, and abuse in intimate relationships.

The associations among n Power, n Affiliation, inhibition, stressful life events, and infliction and receipt of psychological and physical abuse in intimate relationships were investigated in a sample of 48 male and 107 female college undergraduates. Results indicated that life events that were perceived as being negative were associated with both the infliction and the receipt of abuse for women but not for men. High n Power was significantly associated with the infliction of physical abuse on their partners by men. For women, n Affiliation and activity inhibition moderated the effect that stress has on the infliction of abuse. Highly stressed women with high n Affiliation and low activity inhibition were the most likely to inflict abuse. Length and status of relationship were related to abuse, with abuse occurring most often between more committed couples. Receipt of abuse was highly correlated with infliction of abuse for women but not for men, suggesting that when women strike out they are struck in return. (49 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual abuse treatment for persons with developmental disabilities.

Recent research by the Sexual Abuse and Disability Project at the University of Alberta included a survey of 119 sexual abuse (SA) victims with developmental disabilities (DDs). Their responses indicated that SA treatment services for people with DDs are typically inaccessible, unavailable, and inappropriate. Inadequate treatment services appear to be due to the paucity of qualified professionals in the area of SA and DDs coupled with the slow development of appropriate SA treatment approaches. The application of adapted therapy approaches for people with DDs and examples of adapted SA treatment for children and women abused as children are presented. SA treatment issues for the developmentally disabled are discussed for practitioners' considerations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Association of maternal psychological functioning to pathology in child sexual abuse victims

The purpose of this study was to assess the psychological impact of disclosure of sexual abuse on child victims and their mothers and evaluate whether there was an association between maternal distress and report of child behavioral and psychological problems. Data on child psychological and behavioral problems and maternal psychological functioning were collected at the time of disclosure of sexual abuse and 9 months later for 49 subjects. The study showed the heterogeneity and severity of problems among victims and their mothers at baseline. These problems persisted almost a year later. Maternal distress was strongly correlated with the mothers' assessments of child functioning and was less strongly associated with the children's own assessments of their status. Because the mothers in this study reported high levels of persistent distress for themselves and their children, comprehensive intervention with the family may be an efficient route to child recovery after disclosure of sexual abuse.     

The dynamics of threat and challenge appraisals prior to stressful achievement events.

Research on cognitive appraisal of stressful achievement events has emphasized threat appraisals and anxiety. The present research also focused on challenge and positive emotion. Study 1 used hypothetical scenarios of stressful events. Study 2 explored temporal patterns of appraisal and emotion prior to an exam. Compared with threat appraisals, trait and state challenge appraisals were associated with more confident coping expectancies, lower perceptions of threat, higher positive emotion, and more beneficial perceptions of the effects of appraisal and emotion on performance. Beneficial perceptions of state appraisals were associated with higher exam performance. These findings were interpreted in the context of theoretical perspective on the cognitive appraisal of stressful events and the adaptive functions of challenge and positive emotion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping strategies, self-perceptions, hopelessness, and perceived family environments in depressed and suicidal children.

This study evaluated factors associated with depression and suicidal behavior in 8–13-year-old child psychiatric inpatients. Major differences were found in the correlates of depression and suicidal behavior. Suicidal behavior was associated with a tendency for children to perceive their families as low in control and cohesiveness and high in conflict. Suicidal children also spontaneously generated significantly fewer cognitive mediational strategies for coping with stressful life events than nonsuicidal children. Depression was associated primarily with variables reflecting negative cognitive biases. However, this negative bias was not generalized across all situational contexts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of child sexual abuse on the children of survivors. Implications for forensic nursing

1. Assuming that dysfunctional familial patterns arise from child sexual abuse experiences and that they are learned by the victims' children, there is a potential risk conferred to the children of becoming victims of child sexual abuse. 2. Certain physical manifestations, psychosocial behaviors, and relational patterns typify the personae of adults who experienced sexual abuse as children. 3. Roles of the nurse that might be used to meet the needs of this risk group are varied and target the victims, their children, and the community at large.