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)     

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.     

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)     

Attribution-based treatment of self-blame and helplessness in sexually abused children.

Reviews a number of attributional distinctions within the concepts of self-blame and helplessness that can be utilized in treatment planning for sexually abused children to make possible simultaneous reduction of guilt and powerlessness. Adaptive and maladaptive subtypes of self-blame and helplessness are separated, often based on their implications for past vs future control. Recommendations are presented for phrasing attributional interventions in language understandable to young children. The formulation is also applied to work on children's ambivalent feelings toward perpetrators and non-offending parents. The role of client education as a therapeutic technique is emphasized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.     

Recognition and posing of emotional expressions by abused children and their mothers.

Twenty abused and 20 nonabused pairs of children (3 to 7 years of age) and their mothers participated in a facial expression posing task and a facial expression recognition task. The expressions produced by subjects were judged on emotion content by naive raters and were coded using Friesen and Ekman's (1984) Emotion Facial Action Coding System (EMFACS). Data analysis indicated that abused children and their mothers pose less recognizable expressions than nonabused children and mothers. Although abused children were less accurate than nonabused children in recognizing emotional expressions, there was no difference in recognition accuracy between the two groups of mothers. A significant correlation between mothers' posing scores and children's recognition scores was also obtained. These results suggest that abused children may not observe easily interpreted voluntary displays of emotion by their mothers as often as nonabused children. This may partially explain the difference in recognition (and production) abilities of abused and nonabused children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physically abused preschoolers' responses to peers' distress.

Response to peers' distress for which they were (target-caused) or were not (bystander) the cause were coded for 11 abused and nonabused preschoolers between the ages of 35 and 67 months. Each child was observed on a playground for an average of 115 min. Consistent with results of research with toddlers, abused preschoolers exhibited more inappropriate responses (aggression and withdrawal) toward distressed peers (bystander incidents) than did nonabused preschoolers. Also, abused children were more likely to cause distress of peers. These findings suggest that even among abused children who have had opportunities to interact with nonabusive caregivers and peers (i.e., regularly attended day care), differences in responses to peers' distress are obtained. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Selective attention to facial emotion in physically abused children.

The ability to allocate attention to emotional cues in the enviromnent is an important feature of adaptive self-regulation. Existing data suggest that physically abused children overattend to angry expressions, but the attentional mechanisms underlying such behavior are unknown. The authors tested 8-11-year-old physically abused children to determine whether they displayed specific information-processing problems in a selective attention paradigm using emotional faces as cues. Physically abused children demonstrated delayed disengagement when angry faces served as invalid cues. Abused children also demonstrated increased attentional benefits on valid angry trials. Results are discussed in terms of the influence of early adverse experience on children's selective attention to threat-related signals as a mechanism in the development of psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A reconceptualization of issues in the treatment of abused women: A case study.

The personality profile of abused women needs to be reconceptualized as a result of living in an abusive situation rather than as the antecedent that provokes abuse from the spouse. The personality traits exhibited by abused women closely parallel symptoms of learned helplessness, a concept that can be used to explain the perception of no alternatives, an inability to effect change, and passivity. A strategy for therapeutic intervention is outlined through a case study that suggests changing faculty beliefs and developing skills prior to instituting change in the abused woman's environment. The case study is significant in its successful modification of the abusive male's behavior even though he never came to therapy. Significant posttherapy decreases in MMPI personality scales as well as mood scales indicate vast personality changes in the client as a result of her successful attempts to change her environment. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Aggression, emotional maladjustment, and empathy in the abused child.

19 abused children between 5 and 10 yrs old were compared with 19 nonabused children on measures of aggression, emotional maladjustment, and empathy. The 2 groups were matched for age, sex, socioeconomic status, developmental age, IQ, language, and race. The abused Ss were found to be significantly lower than the controls on the measure of empathy and higher on measures of emotional maladjustment. They did not differ on the aggression measures. (25 ref) (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.     

Those who broke the cycle: Therapy with nonabusive adults who were physically abused as children.

Based on observations of 10 nonabusive adults who were physically abused as children, it is contended that these Ss differ from abusive adults who were abused as children in significant ways. It is recommended that abused children receive intensive therapy either at the time that the abuse is discovered or at a developmentally more appropriate stage to block persistence of symptoms into adulthood. It is suggested that these nonabusive adults present a constellation of symptoms that may not be recognized as posttraumatic stress syndrome. For both the abused child and the adult a highly interactive course of therapy is recommended, during which the major goal is reparenting. (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)     

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)     

Responses of abused and disadvantaged toddlers to distress in agemates: A study in the day care setting.

Examined responses to distress in agemates in observations of 10 abused toddlers (aged 1–3 yrs) and 10 unabused matched controls (aged 1–3 yrs) from families experiencing stress. Both groups of Ss were from disadvantaged families. Ss were observed in daycare settings. Nonabused, disadvantaged Ss responded to the distress of agemates with simple interest or with concern, empathy, or sadness. Their patterns of response were consistent with findings from other studies of middle-class, nonabused children. Not one abused S showed concern in response to the distress of an agemate. Instead, the abused Ss often reacted to an agemate's distress with disturbing behavior patterns not seen in the control Ss, such as with physical attacks, fear, or anger. Three of the abused Ss alternately attacked and attempted to comfort peers found in distress. Similar aversive and angry responses to distress in others have been described by investigators working with abusing parents. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A longitudinal study assessing trauma symptoms in sexually abused children engaged in play therapy.

Children who have been sexually abused exhibit a variety of emotional, sexual, behavioral, and psychological problems. A great deal of interest has been generated in the use of play therapy as a clinical approach to intervention with sexually abused children. This study explores the effect of play therapy as a primary treatment modality with sexually abused children. The impact of specific traumatic symptoms and overall treatment is examined. Findings indicate that, overall, trauma symptom severity in children decreased after 6 months of play therapy. In addition, anxiety, depression, post-traumatic stress, and sexual distress scores indicated a significant decrease. Additional research is recommended to develop evaluative and systematic guidelines that will further validate the use of play therapy as an empirically supported assessment and treatment tool. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Treatment of sexually abused children and adolescents.

The authors review research demonstrating the variable effects of childhood sexual abuse, the need for intervention, and the effectiveness of available treatment models. The well-controlled treatment-outcome studies reviewed do not focus on sensationalistic fringe treatments that treat sexually abused children as a special class of patients. Instead, studies demonstrate empirical evidence for extending and modifying treatment models from mainstream clinical child psychology to sexually abused children. The authors propose a continuum of interventions to meet the needs of this heterogeneous group. Interventions range from psychoeducation, prevention, and screening, to short-term, abuse focused cognitive-behavioral therapy with family involvement, to more comprehensive long-term plans for multiproblem cases. Last discussed are gaps in the research and suggestions for future research to address the pressing dilemmas faced by clinicians and policymakers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression, developmental level and disclosure in sexually abused children

OBJECTIVE: To investigate the relationship between sexual abuse disclosure, developmental level and psychopathology in children. DESIGN: A retrospective analysis of case records, using chi-square and t-tests for statistical significance. SETTING: Child and Adolescent Unit, Midlands Hospital, Pietermaritzburg. SUBJECTS: One hundred children consecutively admitted for all types of mental health problems. OUTCOME MEASURES: Diagnostic evaluations were made using the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (3rd edition, revised). RESULTS: Forty of the 100 children had been sexually abused, but 14 (35%) of the abused children did not disclose their abuse until after admission. The post-admission disclosure group had a significantly higher mean age (13.71 years) than the pre-admission disclosure group (10.96 years). Also, significantly more post-admission disclosure children received a diagnosis of major depressive disorder than their pre-admission disclosure counterparts. CONCLUSION: The study highlights the issue of sexual abuse disclosure and its relationship to depression and developmental level. Internal psychological and developmental mechanisms appear to influence the disclosure/non-disclosure of sexual abuse.     

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)