Problems in differentiating sexually from nonsexually abused adolescent psychiatric inpatients by self-reported anxiety, depression, internalization, and externalization

To ascertain whether self-reported psychopathology differentiated sexually and nonsexually abused adolescents, the Beck Depression Inventory, Beck Anxiety Inventory, and the Achenbach Youth Self-Report were administered to 111 psychiatric inpatients between 13 and 17 years of age who were diagnosed with various psychiatric disorders. Data about 14 background and clinical characteristics that were purported to be associated with sexual abuse were also collected. Forty (67%) of the 60 girls reported sexually abusive experiences, whereas six (12%) of the 51 boys reported such experiences. None of the scales were correlated with sexual abuse in either sex, and a history of physical abuse was the only characteristic that was significantly correlated with sexual abuse for both sexes. Furthermore, none of the scales was correlated with identity of sexual abuser, age of first abuse, age of last abuse, number of abuses, days of abuse, penile insertion, and the reporting of the abuse to the authorities in the sexually abused girls.     

Prevalence of post traumatic stress disorder and other psychiatric diagnoses in three groups of abused children (sexual, physical, and both)

OBJECTIVE: The purpose of this study was to compare the prevalence of Post Traumatic Stress Disorder and other diagnoses in three groups of abused children, sexual only (N = 127), physical only (N = 43), and BOTH (N = 34). METHOD: The children, aged 7 to 13 years, were referred to the project from several sources at Arkansas Children's Hospital and from associated local agencies. The victims and caregivers were separately administered the Diagnostic Interview for Children and Adolescents, Revised Version (DICA). Additionally, caregivers and classroom teachers completed the Child Behavior Checklist (CBCL). Characteristics of the abuse were obtained from an investigative questionnaire. RESULTS: Both victims and caregivers endorsed high rates of disorders, with caregivers generally giving higher rates than children and boys having more externalizing diagnoses than girls. Children in the BOTH group had more diagnoses overall. Concordance between victims and caregivers was modest. PTSD was significantly comorbid with most affective disorders. On the CBCL, caregivers rated girls less disturbed than boys and the sexually abused only group less disturbed than the other groups. Teachers rated the boys more adversely than girls but did not see differences by abuse group. A younger age of onset of sexual abuse and coercion to maintain secrecy predicted a higher number of total diagnoses. Also, children who were physically abused by males had more diagnoses than those physically abused by females. CONCLUSIONS: Children who have been both physically/sexually abused appear to be at highest risk of psychiatric disturbance. PTSD, though common (circa one-third of victims), is generally comorbid with other affective disorders.     

Gender differences in abused children with and without disabilities

OBJECTIVE: Two questions were posed: (1) What are the proportions of boys and girls in various categories of substantiated child abuse? (2) Do the gender proportions differ for children with and without disabilities? METHOD: Data collected by previous researchers from a demographically representative sample of U.S. child abuse reporting districts was analyzed. This included 1,249 case files involving 1,834 children. The number of girls and boys who did and did not have disabilities was identified for three age categories and for several categories of abuse. Chi-square analyses were used to determine whether there was a relationship between disability and gender for the various age and abuse categories. RESULTS: More boys were physically abused and neglected, but more girls were sexually abused. Boys with disabilities, however, were over-represented in all categories of abuse. Moreover, gender proportions among abused children with disabilities differed significantly from those found among other abused children. Although slightly more than half of abused children without disabilities were girls, 65% of abused children with disabilities were boys. CONCLUSIONS: Boys represented a significantly larger proportion of physically abused, sexually abused, and neglected children with disabilities than would be expected from their respective proportion of abused and neglected children without disabilities. Several possible explanations for the observed gender and disability status interaction are discussed.     

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.     

Psychological functioning and behavior of sexually abused girls.

The psychological functioning and behavior of 46 sexually abused girls (ages 6–14) was compared with that of 46 nonabused girls who were matched on age, race, family income, and family constellation. Sexually abused children demonstrated heightened sexual preoccupation and behavior problems, lower cognitive abilities and school achievement, and more stressful past histories. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Presenting problems of sexually abused girls receiving psychiatric services.

Twenty-three behaviors among those suggested in the literature to be associated with sexual abuse were studied in 195 girls, ages 2–18 years, who were consecutive admissions to three Midwestern mental health agencies. Results indicated that sexually inappropriate behaviors, sleep disturbance, depressed mood, and delinquent behavior occurred more frequently in young abuse victims than in clinic comparisons. Sexually inappropriate behaviors and running away appeared more often in older sexually abused girls, than they appeared in older clinic comparisons. These comparisons of the presenting problems of sexually abused and nonabused girls suggest there are few behavioral "markers' of sexual abuse in clinical samples and that sexual abuse may not be a unique contributing factor in the ontogeny of childhood psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Play therapy behaviors of sexually abused children.

Examined the question of whether there are specific play therapy behaviors associated with children who have been sexually abused, and whether these behaviors differ by sex and age of the children. A survey instrument was developed which listed 140 play therapy behaviors. 21 play therapists participated in a field test to establish external validity. 249 play therapists were also surveyed to identify professionals who provide play therapy. Analysis identified highly interrelated play therapy behaviors of sexually abused girls and boys from ages 3–10 yrs. Suggested use of the play therapy behaviors include assessments to detect sexual abuse and recommendations for child placement and/or court testimony. (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.     

Sexually abused girls' verbalizations in counseling: An application of the client behavior system.

The Client Behavior System was used to evaluate the therapeutic process with 27 sexually abused 7–17-yr-old girls enrolled in psychoeducationally based individual counseling. Based on ratings collected for the session in which the topic of sexual abuse was formally introduced, it was found that girls were more likely to provide abuse-related answers in response to questions pertaining to child sexual abuse, regardless of whether they were treated by a male or female counselor. These findings provide reason to reconsider previous recommendations that sexually abused girls are best treated by female counselors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of tooth loss on the anatomy of the maxilla]

OBJECTIVES: To compare prevalence rates of weight-control behaviors among adolescents with and without chronic illness and to explore the role of familial and other social factors on associations between disordered eating and chronic illness. DESIGN AND SETTING: Survey conducted in public schools in Connecticut. PARTICIPANTS: A representative statewide population-based sample of 9343 7th-, 9th-, and 11th-grade public school students, of whom 1021 reported a chronic illness. MAIN OUTCOME MEASURES: Disordered eating (vomiting, diet pills, and laxatives), dieting, and exercise for weight control; chronic illness status; family structure, family communication, parental caring, parental monitoring, parental expectations, peer support, and sexual and physical abuse. RESULTS: Adolescents with chronic illness were at greater risk for disordered eating than youth without chronic illness, after controlling for sociodemographic variables (girls: odds ratio, 1.59 [95% confidence interval, 1.19-2.14]; boys: odds ratio, 2.22 [95% confidence interval, 1.49-3.32]). Adolescents with chronic illness were less likely to come from 2-parent families; reported lower levels of family communication, parental caring, and parental expectations; and reported more sexual and physical abuse than youth without chronic illness. Male adolescents with chronic illness were more likely to report low peer support and low parental monitoring. Most of these familial-social factors were also associated with an increased prevalence of disordered eating. After familial-social factors were controlled for, however, associations between disordered eating and chronic illness remained statistically significant. CONCLUSIONS: Adolescents with chronic illness are at greater risk for disordered eating behaviors than youth without chronic illness. Factors other than the familial-social factors assessed in this study may be contributing to this increased risk. In the clinical setting, youth with chronic illness need to be screened for disordered eating and familial and other social concerns.     

Abuse characteristics among childhood sexual abuse survivors in therapy: a gender comparison

OBJECTIVE: The goal of this investigation was to examine similarities and differences in childhood sexual abuse (CSA) characteristics between men and women survivors in outpatient psychotherapy utilizing a substantial sample size of men, while examining an extensive range of abuse characteristics. METHOD: Abuse characteristics of 48 men from an outpatient treatment program for adult survivors of CSA in a university-based community mental health center were compared with those of 257 women from the same program. Data on abuse history were collected at admission or as soon thereafter as possible using a structured clinical interview with established reliability. RESULTS: Women were significantly more likely to have been sexually abused by a family member. Men were significantly more likely to report having oral sex performed upon them. Otherwise, no significant gender differences not attributable to anatomical differences (e.g., vaginal vs. anal intercourse) were found. CONCLUSIONS: The findings suggest that very few differences exist in the nature and extent of CSA reported by men and women. Thus CSA perpetrated on boys appears largely comparable in nature and extent to that committed against girls.     

Intellectual stability in children with unilateral brain lesions

Developmental differences in behavior and self-perception were examined in a group of 44 preschool and school-age children referred for evaluation of sexual abuse and 41 comparison children with no history of sexual abuse, matched on age and gender, and from a similar socioeconomic background. Children suspected of having been sexually abused were rated by their parents as having more internalizing and externalizing problems than comparison children. When children rated their self-competence and social acceptance, there were no group differences between children based on their abuse status; however, there was significant within-group variation among the children suspected of having been sexually abused. Preschool children had elevated scores of perceived competence and social acceptance, and school-age children had depressed scores. There were no age differences among the children in the comparison group. The results suggest that among children suspected of abuse, not only does their self-perception vary by their developmental level, but preschool children may respond with elevated perceptions of themselves. Focusing on individual differences in children's response to suspicions of sexual abuse enables us to identify risk and protective factors that contribute to the psychological outcomes of child sexual abuse.     

Psychological testing in evaluation of child sexual abuse

In order to assess the utility of psychological testing in evaluating allegations of child sexual abuse, the empirical literature is reviewed in an attempt to answer two questions. First, are there systematic and significant differences on psychological tests between sexually abused and nonabused children? Second, are these differences on psychological testing a direct result of sexual abuse, or are they a result of other coexisting factors that might cause psychological distress? Cognitive measures, personality inventories, symptomatology checklists, and projective tests with sexually abused children are reviewed. While a variety of standardized instruments have been administered to sexually abused children, relatively few have been utilized in empirical studies. Findings have been mixed, with stronger differences between sexually abused and nonabused children generally found on measures completed by parents than on measures administered directly to children. Sexually abused children often fall between nonabused and psychiatric groups. Use of measures specific to sexual abuse is advocated. While psychological tests may currently have limited use in validating suspected sexual abuse, they may be extremely useful in the clinical treatment of the child.     

Sexual contacts: experiences, thoughts, and fantasies of adult male survivors of child sexual abuse

This study examined the past sexual experiences, as well as the prevalence of sexual thoughts and fantasies concerning the sexual contacts of 35 adult men who were sexually abused during their childhoods. More specifically, their past sexual contacts, thoughts and fantasies of desired sexual contacts, and perceptions of sexual contacts were investigated. A group of 33 adult men with no history of sexual abuse was included for the purpose of comparison. A 72-item questionnaire was used to collect data. The results indicated that male childhood sexual abuse may contribute to the prevalence of sexual thoughts and fantasies about sexual contact with male children and adolescents. Despite the prevalence of sexual thoughts and fantasies about sexual contact with boys, the adult male survivors surveyed claimed not to be accepting of sex between adults and children.     

Routine inquiry into sexual victimization: A survey of therapists' practices.

Surveyed therapists regarding their practices in assessing clients' sexual abuse history. Of the 105 respondents, 51% reported that they routinely ask all clients or most clients about sexual abuse at some time during the course of therapy; 19% reported that they had asked only a few clients or that they never ask clients directly about sexual abuse. Therapists who were younger, who had been in practice for a shorter period of time, and whose current caseload included a high percentage of sexually abused women were most likely to have asked all or most of their clients about having been sexually abused. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Considerations in the psychoanalytic treatment of men who were sexually abused as children.

Examines the literature on sexually abused men and illustrates with clinical examples from individual and group psychoanalytic practice the themes that emerge in working with them. Sexual abuse situations with boys are considered in 3 groups: those involving penetration, those involving inappropriate tactile contact, and those involving noncontact seduction and excitation. The boundary violation inherent in all of these situations is crucial in the treatment of the man who has been abused, as is the familial context of the abuse. Sexual orientation and gender identity, abuse in a familial context, love and sexuality, and transference and countertransference are discussed. For the analyst treating men who were sexually abused, there may be feelings of being overwhelmed by the seductive energy in the analytic relationship and also wishes to reel back and deny the horror of the material being discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Characteristics of sexual abuse associated with greater psychological impairment among children

The psychiatric histories and projective test responses of 102 sexually abused girls (ages 5 to 16) were examined to determine if some particular characteristics of sexual abuse were reliably associated with more serious impairment. Characteristics of abuse significantly associated with greater psychological disturbance were: more than one perpetrator, an early age of abuse onset (before age 7 or 8), and periods of intense and frequent abuse episodes (more than 3 or 4 times per month). What enhanced the child's capacity to recover was the presence of a relatively stable two-parent household. Implications for prognosis and treatment are discussed.     

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)