Sexual abuse, family environment, and psychological symptoms: On the validity of statistical control.

M. R. Nash et al (see record 1993-33781-001) reported on the effects of controlling for family environment when studying sexual abuse sequelae. Sexual abuse history was associated with elevated MMPI and Rorschach scores in a sample of 105 women, but many of the reported differences disappeared when a composite Family Functioning Scale score was used as a covariate. The present article considers the findings of Nash et al in terms of the theoretical and statistical constraints placed on analysis of covariance (ANCOVA) and other partializing procedures. Because family dysfunction is not always causally antecedent to sexual abuse, and given the quasi-experimental quality of most abuse research, the use of covariate techniques to test hypotheses about the causal role of family environment in the impacts of sexual abuse may be ill advised. Analyses of a 2,964-S data set illustrate these concerns. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Life History Assessment of Early Childhood Sexual Abuse in Women.

Life history theory provided a framework for examining the relations among child sexual abuse (CSA), childhood adversity, and patterns of reproductive development and behavior. A community survey that assessed CSA, life history variables (e.g., age of menarche), and social and family background was administered to 623 women (mean age=26.9 years). Independent of social and family background, CSA was associated with earlier age of (a) menarche, (b) first sexual relationship, (c) desire to have children, (d) first childbirth, and (e) lower self-evaluated physical attractiveness. Cluster analyses revealed different patterns of experiential correlates of reproductive development within the group of abused women, suggesting CSA may operate in combination with other childhood circumstances to modify the timing and pattern of individual maturation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A retrospective analysis of shame, dissociation, and adult victimization in survivors of childhood sexual abuse.

The relationship between childhood sexual abuse and victimization in adulthood was studied using a sample of 548 university women, including 56 who reported childhood incidences of incestuous abuse, 98 who reported sexual abuse by a peer or nonfamily member, and 394 who reported no childhood sexual abuse experiences. Possible mediating variables of shame and dissociation were investigated. Chi-square analyses showed that there was a statistically significant association between women who were abused in childhood and adult victimization. Logit regression analyses demonstrated that the odds of revictimization in adulthood were greater for women who were abused in childhood than for those who were not abused. Dissociation was not found to be a predictor of adult victimization, whereas shame was found to be a statistically significant predictor. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.     

Long-term effects of incestuous child abuse in college women: Social adjustment, social cognition, and family characteristics.

This study investigated family and social cognitive characteristics as possible mediators of social adjustment. Subjects were 85 college women, including 29 with a history of sexual abuse by a family member and 56 control subjects with no history of abuse. Results indicated decreased cohesion and adaptability in the family of origin, increased perception of social isolation, and poorer social adjustment among abused subjects. Additional analyses suggested that family characteristics and increased perceptions of social isolation were more predictive of social maladjustment than abuse per se. However, abuse by a paternal figure was related to poorer social adjustment even after significant family and social-cognitive variables were controlled. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.     

Co-occurrence of eating disorders and incest: The role of attachment, family environment, and social competencies.

Childhood attachment, family environment, and adult social competencies were examined to explain the association between sexual abuse and eating disorders (EDs). Female college students (n?=?102) and female clients sexually abused in childhood (n?=?52) completed surveys retrospectively that assessed parental bonds, family environment, and sexual abuse, as well as current self-efficacy, social support, intimacy, adult attachment style, and ED symptoms. Client incest survivors had a higher ED rate (47%) than did sexually abused clients (22%), student incest survivors (24%), or nonabused students (17%). Significant associations were found between family environment, incest, social competencies, and eating disorders. Incest survivors had more dysfunctional families and lower social competencies than did nonabused women. Among incest survivors, those with the lowest levels of social competencies and poorest bonds with their mothers had more ED symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

MMPI, Rorschach, and WAIS: A meta-analytic comparison of reliability, stability, and validity.

We estimated the average reliability, stability, and validity of the Minnesota Multiphasic Personality Inventory (MMPI), Rorschach Inkblot Test, and Wechsler Adult Intelligence Scale (WAIS) from articles published in the Journal of Personality Assessment and the Journal of Clinical Psychology between 1970 and 1981. Following standard psychometric theory, reliability values exceeded stability values, which exceeded validity values. Validity studies based on theory, prior research, or both showed greater effects than did studies lacking a theoretical or empirical rationale. In general, the reliability and stability of all three tests were acceptable and approximately equivalent. The convergent-validity estimates for the Rorschach and MMPI were not significantly different, but both these estimates were lower than the estimate for the WAIS. It appears that both the MMPI and Rorschach can be considered to have adequate psychometric properties if used for the purpose for which they were designed and validated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective investigation of the impact of childhood sexual abuse on the development of sexuality.

The sexual attitudes and activities of 77 sexually abused and 89 comparison women (mean age=20.41, SD=3.38) were assessed 10 years after disclosure in a longitudinal, prospective study of the long-term effects of childhood sexual abuse. Abused participants were more preoccupied with sex, younger at first voluntary intercourse, more likely to have been teen mothers, and endorsed lower birth control efficacy than comparison participants. When psychological functioning earlier in development was examined, sexual preoccupation was predicted by anxiety, sexual aversion was predicted by childhood sexual behavior problems, and sexual ambivalence (simultaneous sexual preoccupation and sexual aversion) was predicted by pathological dissociation. Findings also indicate that biological father abuse may be associated with greater sexual aversion and sexual ambivalence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Women's history of sexual abuse, their sexuality, and sexual self-schemas.

In this study, the authors assessed 48 female survivors of child sexual abuse (CSA) and 71 female control participants using measures of adult sexual function, psychological function (i.e., depression and anxiety), and sexual self-schemas. The primary purpose of this study was to examine whether differences existed between women with and without a history of CSA in the way that they viewed themselves as a sexual person and, if so, whether such differences mediated the link between early unwanted sexual experiences and later adult sexuality. CSA survivors were found to view themselves as less romantic and passionate than women who were not abused. In particular, CSA survivors showed an inverse relationship between romantic/passionate sexual self-schemas and negative sexual affect during sexual arousal. The relationship between CSA and negative sexual affect was independent from symptoms of depression and anxiety, suggesting that the impact of CSA on sexual self-schemas may be independent from the impact that the abuse may have in other areas of the survivor's life. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exploring the nature of the relationship between child sexual abuse and substance use among women

AIMS: This study investigated whether child abuse (CSA) was associated with earlier substance use and greater severity of substance dependence and what aspects of CSA might predict substance abuse. DESIGN: The study compared (a) drug and alcohol treatment clients with and without a history of CSA and (b) CSA survivors outside drug and alcohol treatment who did or did not have current substance abuse. SETTINGS: Semi-structured interviews took place at participants' homes, treatment agencies or the research centre. PARTICIPANTS: Volunteer participants included 100 women recruited from drug and alcohol treatment programmes and 80 CSA survivors recruited through CSA counseling services and medial advertising. MEASUREMENTS: The results focus on data from the Opiate Treatment Index, Severity of Alcohol Dependence Questionnaire, Substance Dependence Scale, Self-Esteem Inventory and self-reported histories of CSA. FINDINGS: There were no differences between CSA survivors and other drug and alcohol treatment clients in their severity of dependence. Women with a history of CSA more frequently identified stimulants as their main problem drug and reported an earlier age of first intoxication and earlier use of inhalants. Among abused CSA survivors outside drug and alcohol treatment, women with current substance abuse had typically been abused during adolescence by someone outside the family, whereas those without current substance abuse were typically abused by family members before adolescence. CONCLUSIONS: The results suggest that adolescence is a crucial time for the influence of CSA experiences on substance abuse.     

Sexual abuse in early versus late childhood: Differing patterns of pathology as revealed on the Rorschach.

Examined retrospectively the Rorschach protocols of 3 groups of girls; 37 sexually abused before their 9th birthday; 43 sexually abused after their 9th birthday; and a control group of 72 patients with no history of abuse. Five Rorschach variables were found to reliably differentiate early- from late-abuse-onset groups. The patterns of group differences revealed that over half of early-abused Ss manifested a preoedipal form of pathology characterized by disturbed cognition, damaged self, and preoccupation with themes of primitive supply and transitional relatedness. Only 12% of late-abused Ss displayed this pattern. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prediction of improvement in treated and untreated patients using the Rorschach prognostic rating scale.

An attempt was made to evaluate the predictive validity for improvement of the Rorschach Prognostic Rating Scale (RPRS) and the MMPI. A group of untreated psychiatric outpatients (N = 40) and a group of outpatients treated with psychotherapy (N = 21) were given the Rorschach and MMPI before their assignment to the treatment or waiting list groups. After a waiting or treatment period of approximately 6 mo., each patient was clinically rated as improved or unimproved. The RPRS was significantly (p     

Sexual and physical abuse in women with fibromyalgia: association with outpatient health care utilization and pain medication usage

OBJECTIVE: To evaluate the relationship between sexual and/or physical abuse and health care usage in patients with fibromyalgia (FM) and identify variables that may influence this relationship. METHODS: We assessed history of sexual/physical abuse, health care utilization, and medication usage, as well as related variables in 75 women with FM using standardized questionnaires, structured interviews, and laboratory pain perception tasks. RESULTS: Fifty-seven percent of FM patients reported a history of sexual/physical abuse. Compared to non-abused patients, abused patients reported significantly greater utilization of outpatient health care services for problems other than FM and greater use of medications for pain (P < or = 0.025). Consistent with our expectations, abused patients also were characterized by significantly greater pain, fatigue, functional disability, and stress, as well as by a tendency to label dolorimeter stimuli as painful regardless of their intensities (P < or = 0.05). Additional analyses suggested that the high frequency of sexual/physical abuse in our patients was associated primarily with seeking health care for chronic pain rather than the FM syndrome itself or genetic factors. CONCLUSION: There is an association in FM patients between sexual/physical abuse and increased use of outpatient health care services and medications for pain. This association may be influenced by clinical symptoms, functional disability, psychiatric disorders, stress, and abnormal pain perception. The relationships among these variables should be further tested in prospective, population-based studies.     

Disclosure of Child Sexual Abuse: What Does the Research Tell Us About the Ways That Children Tell?

The empirical basis for the child sexual abuse accommodation syndrome (CSAAS), a theoretical model that posits that sexually abused children frequently display secrecy, tentative disclosures, and retractions of abuse statements was reviewed. Two data sources were evaluated: retrospective studies of adults' reports of having been abused as children and concurrent or chart-review studies of children undergoing evaluation or treatment for sexual abuse. The evidence indicates that the majority of abused children do not reveal abuse during childhood. However, the evidence fails to support the notion that denials, tentative disclosures, and recantations characterize the disclosure patterns of children with validated histories of sexual abuse. These results are discussed in terms of their implications governing the admissibility of expert testimony on CSAAS. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Symptoms of post-traumatic stress disorder in abused women in a primary care setting

Abuse is a major source of trauma to women, and post-traumatic stress disorder (PTSD) results from exposure to extreme trauma. To describe the relationship between symptoms of PTSD and severity of abuse, an ethnically stratified cohort of 131 abused women in a primary care setting was interviewed. Symptoms of PTSD, both intrusion (i.e., trouble falling asleep, strong waves of feelings about the abuse) and avoidance (i.e., trying not to think or talk about the abuse, staying away from reminders of the abuse), were significantly (p < 0.01) correlated to severity of abuse, regardless of ethnicity. When asked about childhood physical or sexual abuse, women reporting physical abuse had significantly (p < 0.05) higher intrusion scores, whereas those reporting sexual abuse had significantly (p < 0.004) higher avoidance scores. Sixty-five percent of the women reported dreams, flashbacks, or terror attacks and had significantly (p < 0.001) higher mean results on both intrusion and avoidance. The need to offer abused women information about the connection between severity of abuse and symptoms of PTSD is discussed. We recommend that clinicians ask all abused women about dreams, flashbacks, or terror attacks to assess for further symptoms of PTSD.     

Differences among sexually abused and nonabused women from functional and dysfunctional families.

This study identified a previously unexamined group of sexual abuse survivors (those from functional families) and addressed methodological flaws in previous research by examining differences among abused women from functional families, abused women from dysfunctional families, nonabused women from dysfunctional families, and nonabused women from functional families. Measures of depression, anxiety, and interpersonal problems were completed by participants along with a measure of overall distress across a cluster of symptoms associated with childhood sexual abuse. On all four measures, the abused-dysfunctional group reported the highest level of psychological distress. Conversely, the level of psychological distress reported by the abused-functional group did not differ from that of the nonabused-functional or nonabused-dysfunctional groups. Research and counseling implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of childhood sexual abuse and family functioning on four dimensions of women's later parenting

OBJECTIVE: While child sexual abuse and its negative effects have been of increasing interest to researchers and practitioners, more empirical focus has been given to measuring mental health consequences rather than other areas of life functioning such as parenting. Furthermore, recent questions have been raised about whether documented negative effects of abuse stem from the abuse itself or the more general negative family environment which often accompanies it. The aim of the current study was to examine the impact of a history of child sexual abuse and more general family relationship quality on the parenting of a sample of low-income mothers. METHOD: The current study was a secondary analysis of archived data collected by Zuravin (1996) on 518 low-income mothers. Parenting was assessed using measures such as frequency of worry about child problems, views of self as a parent, and how child discipline problems were handled. RESULTS: Child sexual abuse was associated with more negative views of self as a parent and the greater use of physical punishment strategies even after accounting for differences in family-of-origin relationship quality. CONCLUSIONS: The findings indicate that sexual abuse may be a risk factor for more negative views of self as a parent beyond differences between abused and nonabused samples in more general assessments of family-of-origin quality. Implications for future research and intervention are discussed.