Review of Abused women and survivor therapy.

Reviews the book, Abused women and survivor therapy by Lenore E. A. Walker (see record 1994-97960-000). Understanding the problems of abused women has come to the forefront of public attention in recent years. Corresponding to public awareness of the problem has been the developing awareness on the part of therapists of the extent to which abuse occurs among their patients. This book attempts to teach therapists how to identify, assess, and treat women who have been abused. The author proposes modifications in traditional therapy which take into account not only the impact of the form of trauma involved, but also the impact of the traditional socialization of men and women. The book is clearly organized into three sections: Part One, Types of Abuse Against Women; Part Two, Therapist Preparation and Responsibilities; and Part Three, Assessment, Crisis Intervention, and Survivor Therapy. According to the reviewer, this is an excellent book for all therapists who deal with abused women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Child sexual abuse: Critical perspectives on prevention, intervention, and treatment.

Reviews the book, Child sexual abuse: Critical perspectives on prevention, intervention, and treatment edited by Christopher R. Bagley and Ray J. Thomlison (1991). This book is a compilation of a series of literature reviews originally commissioned by Health and Welfare Canada in 1987 and completed in 1988. The individual papers included in this edited version represent a cross section of Canadian academicians, clinicians, and case workers who are integrally involved in the policies and practices regarding child sexual abuse in Canada. The work provides a comprehensive perspective on prevention at the primary, secondary, and tertiary levels. The list of authors is impressive in terms of their expertise and experience. At a time when numerous books on child sexual abuse are appearing on the market, it is nice to see a book that has some unusual aspects. Aside from its distinctly Canadian perspective, the book addresses several important, yet frequently ignored, topics. The book provides an up-to-date review of several core issues: conceptualization of the problem, prevention strategies, impact of sexual abuse, investigative interviewing, treatment outcome studies, and treatment issues for child molesters. The more unique topics include a review of the strategies used to evaluate prevention programs, prevalence rates among a number of special populations, the role of medical practitioners in preventing and intervening in child sexual abuse, and sexual abuse and exploitation among disabled individuals. Overall, I can recommend this book for clinicians and researchers in Canada and elsewhere who are interested in child sexual abuse. This compilation of literature reviews highlights the leading role that Canadian social service agencies have taken in developing programs for sexually abused children and their families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological assessment of sexually abused children for legal evaluation and expert witness testimony.

This article presents the theory and practice behind the psychological assessment of sexually abused children using the posttraumatic stress disorder subcategories for abused children. Measurement of cognitive disturbances including intrusive recollections of the trauma, affective disturbances by simultaneously experienced high arousal and high avoidance symptoms, and observable behavioral changes are described, and practical approaches including case examples are presented. Included in this article is a discussion about the different standards of legal proof that psychologists must meet in the various kinds of child sexual abuse cases that they might be called upon to consult. Psychologists need to know basic child development and have the assessment skills to measure it as well as specialized training in the field of child abuse to avoid the perils of becoming overinvolved in these emotional cases. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The link between childhood trauma and mental illness.

Reviews the book, The link between childhood trauma and mental illness by Barbara Everett and Ruth Gallop (see record 2000-16130-000). This is a very useful book, particularly for novice practitioners and front-line workers who may not have had a supervised experience dealing with abused individuals. The authors set out to provide a practical guide to the care of individuals who have experienced abuse (both sexual and physical) as children, and who present themselves as adults to mental health practitioners, in particular to those who are not practicing in specialized trauma clinics. I believe they have succeeded in their goal. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Child abuse: assessment and intervention

The National Statistics on Child Abuse and Neglect are staggering and rising despite a national objective to decrease domestic violence, of which child abuse is a part. More than 3 million children are abused each year. That figure represents 25 out of every 1,000 children being physically, sexually, or emotionally abused or neglected by their caretakers. It is important to note that 50% of abused children have an abused mother (American Medical Association, 1992). There are immediate as well as long-term sequelae of abuse including emotional and developmental problems, permanent injury, death, and perpetuation of abuse to the next generation. Since fractures are often part of the constellation of injuries seen in the abused child, orthopaedic nurses may encounter these children in a range of settings. Recognizing the signs of abuse is an important step for intervention on behalf of the child.     

Sexual abuse and bulimia: response to inpatient treatment and preliminary outcome

The purpose of this study was to explore the clinical impact of child sex abuse on bulimic patients. Specifically, differences in treatment response and preliminary treatment outcome between hospitalized bulimic patients with and without a reported history of sexual abuse were examined. The patients were evaluated for past history of alleged sexual abuse by investigator-based interview and ratings of severity of sexual abuse were made. Assessments of mood, eating disordered-related attitudes, and eating behaviors were conducted at the start of treatment, weekly during treatment, and three months post discharge. Sixty-one per cent (45) of the 74 patients enrolled in the study reported a history of child sexual abuse. The majority of such events constituted serious and very serious abuse by this study's criteria. The abused subjects exhibited higher levels of depression, anxiety, and eating disordered attitudes at each assessment point relative to nonabused subjects. In addition, abused subjects were more likely to be re-hospitalized in the 3 month post-discharge period. Significant differences in the extent of actual bulimic behaviors were not detected. Both the abused and nonabused bulimic patients demonstrated significant reductions in psychiatric symptomatology from pretreatment to posttreatment, and from posttreatment to follow-up. Contrary to prediction, differences in symptomatology between the very serious, serious, and least serious abused groups were not detected. Results suggest that bulimic patients with reported histories of sexual abuse can be effectively engaged in a conventional eating disorder treatment program, but that such abuse may place patients at a disadvantage owing to higher levels of pretreatment symptom severity. Findings suggest that extended and/or more specific intervention may be warranted for the abused bulimic patient.     

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.     

Review of Secondary traumatic stress and the child welfare professional.

Reviews the book, Secondary traumatic stress and the child welfare professional by Josephine G. Pryce, Kimberly K. Shackelford, and David H. Pryce (see record 2007-05981-000). This book offers a complete examination of an important and often overlooked issue in the field of trauma work—secondary traumatic stress (STS). The authors appear to have written this book in response to a relative dearth of literature in this area as it affects child welfare workers. The research summarized and cited in this book is current, making the book timely and well developed. The easy-to-comprehend writing style of the authors flows and allows readers to be easily drawn into the case scenarios provided. Any professional working in child welfare as a caseworker, investigator, or supervisor, will benefit from reading this book. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Review of Child abuse: New directions in prevention and treatment across the lifespan.

Reviews the book, Child abuse: New directions in prevention and treatment across the lifespan by David A. Wolfe, Robert J. McMahon, and Ray DeV. Peters (see record 1997-30225-000). This edited book offers a diverse collection of chapters that describe innovative approaches to the treatment and prevention of child physical and sexual abuse. Readers can peruse contributions from leaders in the field that depict recent efforts to address the complexity of these problems. This book is a valuable addition to the libraries of researchers, clinicians, and students who are interested in issues related to the treatment and prevention of the physical and sexual abuse of children. It will be especially useful to those already acquainted with the characteristics and consequences of child abuse, who will find their understanding of this topic broadened by its contributions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexually and physically abused foster care children and posttraumatic stress disorder.

Considerable debate exists regarding the possible relationship between child abuse and posttraumatic stress disorder (PTSD). In this study, 3 groups of foster care children were compared. The groups included 50 sexually abused, 50 physically abused, and 50 nonabused foster care children. Participants completed the Child Post-Traumatic Stress Reaction Index, the Childhood PTSD Interview, and the Modified Stroop Procedure (MSP), which included sexual abuse and nonsexual abuse stimuli. The MSP has not been previously used in child abuse research. Results indicated that sexually and physically abused children demonstrated PTSD at a high level. The MSP discriminated between the sexually abused children with PTSD and those without PTSD. Responses to the MSP sexual abuse stimuli resulted in significantly longer color-naming times than responses to nonsexual abuse stimuli. Preadolescents demonstrated more severe PTSD than early adolescent children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Memories of abuse in borderline patients: true or false?

This review will examine issues related to the validity of memories of child abuse in patients with borderline personality disorder (BPD). A large body of research has shown that all memories are distorted by cognitive schema, and that "recovered memories" may be particularly unreliable. Empirical findings on trauma in BPD will be reviewed, as well as the difficulties in verifying trauma histories. Evidence will be examined suggesting that borderline patients have a distorted perception of interpersonal events. Clinical recommendations will be made for the evaluation of memories of abuse in patients with BPD.     

Protection, Dissociation, and Internal Roles: Modeling and Treating the Effects of Child Abuse.

This article presents a theory of the long-term effects of child abuse that emphasizes the development of internal working models of protection. The theory proposes that abused children do not receive adequate caregiver protection and do not form internal representations of an effective protector. As a result, they have ongoing difficulty defending themselves against interpersonal aggression and internal self-criticism. The model integrates current research and theory in attachment behavior, developmental psychopathology, trauma, dissociation, and experiential psychotherapy. It accounts for many of the clinical symptoms presented by adult survivors of child abuse and suggests specific strategies for treatment. The author provides 3 examples of psychotherapy interventions derived from the model, distinguishes protection and "rescuing", and suggests directions for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Shame busting: Incorporating group social skills training, shame release and play therapy with a child who was sexually abused.

Describes trauma in children as resulting when a child is exposed to severe physical or sexual abuse and feels betrayed, overwhelmed, and helpless. A case of a 4-yr-old boy with sexualized and aggressive behavior is presented. In this case, a combination approach drawing from different theoretical approaches was used to help the S deal with shame which resulted from the trauma of being sexually abused. Therapeutic emphasis was placed on reducing the internal anger, helplessness and feelings of unworthiness through a weekly social skills training group which emphasized expressing uncomfortable feelings. Individual play therapy incorporated shame reduction techniques developed by the author. A firm classroom structure and insistence on self responsibility along with loving nurturance from teachers helped the child set limits on acting out behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing suicidality in adults: Integrating childhood trauma as a major risk factor.

Can knowing whether an adult client was abused as a child assist psychologists when assessing suicidality? Reviewing the files of 200 outpatients revealed, in keeping with previous studies, that child abuse was related not only to previous psychiatric admissions and younger age at first treatment and first admission, but also to past and present suicidality. Current suicidality was predicted better by child sexual abuse (experienced on average 20 years previously) than by a current diagnosis of depression. Evidence that abuse histories are not routinely taken, and recommendations for why, and how, taking abuse histories should be integrated into suicide assessment and treatment, are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Confirmation of childhood abuse in child and adolescent cases of multiple personality disorder and dissociative disorder not otherwise specified

The diagnostic validity of multiple personality disorder (MPD) and its association to trauma have been questioned because corroboration of child abuse in studies of patients with MPD is scant. The purpose of this study was to determine on a retrospective basis whether external corroboration of child abuse could be found in a group of patients with MPD and dissociative disorder not otherwise specified. A group of child and adolescent psychiatric inpatients and outpatients was chosen because of the extensive number of collateral records collected on them in a tertiary care setting. This group was also chosen because of the intense interest paid by child protective services and courts to child abuse during the past 15 years. This retrospective chart review confirmed child abuse in eight of nine patients with MPD and in all 12 cases of dissociative disorder not otherwise specified. This study provides further evidence of the association of severe dissociative disorders with trauma, particularly child abuse. Future studies should be prospective and blinded to avoid the possibility of investigator bias, and should include a control group for comparison of base rate of child abuse.     

Depressive symptoms among physically abused and psychiatrically disturbed children.

Examined the relation of physical abuse and depressive symptoms among 79 6–13 yr old child psychiatric inpatients. Childhood depression, hopelessness, and self-esteem were assessed through questionnaire or interview measures administered to the children. 79 25–52 yr old mothers or maternal guardians also completed measures to evaluate their children's dysfunction. As predicted, the 33 physically abused children, compared with the 46 nonphysically abused patient controls, evinced significantly lower self-esteem and greater depression and negative expectations toward their futures. Among abused children, those with both past and current abuse showed more severe symptoms of depression that did those with either past or current abuse only. The differences in depressive symptoms between abused and nonabused children could not be accounted for by differences in child psychiatric diagnosis, age, race, gender, IQ, or severity of psychopathology or parent psychiatric diagnoses, marital, or SES. Results suggest that physical abuse, at least for a psychiatric patient sample, is related to symptoms of depression. The possible basis for this relation and the treatment implications are discussed. (36 ref) (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.