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)     

Contingency management is especially efficacious in engendering long durations of abstinence in patients with sexual abuse histories.

Exposure to sexual victimization is prevalent among persons with substance use disorders (SUDs). Contingency management (CM) treatments utilize concrete and relatively immediate positive reinforcers to retain patients in treatment and reduce substance use, and CM may have particular benefits for patients with histories of sexual victimization. Using data from three randomized trials of CM (N = 393), this study evaluated main and interactive effects of sexual abuse history and treatment condition (standard care versus CM) with respect to during treatment outcomes (retention, proportion of negative urine samples submitted, and longest duration of abstinence) and abstinence at a nine-month follow-up. Compared to patients without sexual abuse histories (N = 316), those with sexual abuse histories (N = 77) submitted a significantly higher proportion of negative samples in treatment. In CM, but not in standard care, patients with sexual abuse histories achieved significantly longer durations of abstinence during treatment than those without sexual abuse histories. Although sexual abuse history was not associated with abstinence at nine-month follow-up evaluations, longest duration of abstinence during treatment was significantly associated with this long-term outcome. Results suggest that SUD patients with sexual abuse histories may accrue particular benefits during CM treatment that are associated with long-term abstinence. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Effects of childhood abuse on relapse in a recently homeless substance-dependent veteran population.

The impact of childhood abuse, both childhood sexual abuse (CSA) and childhood physical abuse (CPA), is well documented. Both CSA and CPA have been associated with a number of mental health difficulties, including substance dependence. Though the association between abuse and mental health problems is well documented, what has received little attention is the impact that abuse histories may have on the ability to complete treatment for these problems. This study evaluates the association between abuse and failure to complete treatment due to substance relapse in 70 substance-dependent homeless men served by a Veterans Affairs Domiciliary Residential Rehabilitation and Treatment Program. Demographic and mental health variables were compared with incident rates of sexual and physical abuse as well as with rates of relapse prior to program completion. Contrary to predictions, results found that physical abuse, not sexual abuse, was associated with higher relapse rates. Limitations, implications, and future directions are discussed. (PsycINFO Database Record (c) 2010 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)     

A combined motivation and parent–child interaction therapy package reduces child welfare recidivism in a randomized dismantling field trial.

Objective: A package of parent–child interaction therapy (PCIT) combined with a self-motivational (SM) orientation previously was found in a laboratory trial to reduce child abuse recidivism compared with services as usual (SAU). Objectives of the present study were to test effectiveness in a field agency rather than in a laboratory setting and to dismantle the SM versus SAU orientation and PCIT versus SAU parenting component effects. Method: Participants were 192 parents in child welfare with an average of 6 prior referrals and most with all of their children removed. Following a 2 × 2 sequentially randomized experimental design, parents were randomized first to orientation condition (SM vs. SAU) and then subsequently randomized to a parenting condition (PCIT vs. SAU). Cases were followed for child welfare recidivism for a median of 904 days. An imputation-based approach was used to estimate recidivism survival complicated by significant treatment-related differences in timing and frequency of children returned home. Results: A significant orientation condition by parenting condition interaction favoring the SM + PCIT combination was found for reducing future child welfare reports, and this effect was stronger when children were returned to the home sooner rather than later. Conclusions: Findings demonstrate that previous laboratory results can be replicated in a field implementation setting and among parents with chronic and severe child welfare histories, supporting a synergistic SM + PCIT benefit. Methodological considerations for analyzing child welfare event history data complicated by differential risk deprivation are also emphasized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Jurors’ discussions of a defendant’s history of child abuse and alcohol abuse in capital sentencing deliberations.

We tested a novel theoretical model explaining the psychological processes underlying jurors’ discussions about a defendant’s history of child abuse and alcohol abuse in a capital case. We coded the extent to which jurors used child abuse and alcohol abuse as mitigating factors, as aggravating factors, or argued that they should be ignored. Relying on attribution theory, we coded the extent to which jurors rendered controllable or uncontrollable and stable or unstable attributions regarding the defendant’s history of child abuse and alcohol abuse. Jurors were more likely to argue that child abuse and alcohol abuse should not be used as mitigators or to even use them against the defendant as aggravators than they were to use them as mitigators. Jurors made more controllable than uncontrollable attributions regarding child abuse and more stable than unstable attributions regarding both child abuse and alcohol abuse. The more jurors supported the death penalty, the more they argued to discount child abuse and alcohol abuse as mitigators or use them as aggravators and the more controllable and stable attributions they made. Political orientation predicted discussions and attributions about alcohol abuse, but not child abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to special section on clinical intervention in child sexual abuse.

The purpose of this special section is to further research, clinical practice, and teaching in the area of child sexual abuse. Although most of the articles are written by psychologists and are relevant to research, practice, and teaching by psychologists, the articles have relevance to other professionals as well. The special section is composed of seven articles. The first focuses on the effects of child sexual abuse. The next five articles have relevance for assessment and treatment. The last article focuses on teaching clinical intervention in child sexual abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-Reported Gambling-Related Suicidality Among Gambling Helpline Callers.

Problem gamblers often attribute suicidal ideation or attempts to their gambling. Logistic regression analyses were applied to data from problem gamblers (N = 986) calling a helpline. Problem gamblers reporting gambling-related suicidality (n = 252; 25.6%) were more likely than those denying it (n = 734; 74.4%) to acknowledge family, financial, legal, and mental and substance-related problems. Of problem gamblers acknowledging gambling-related suicidality, those reporting gambling-related suicide attempts (n = 53; 21.5%) were more likely than those denying them (n = 193; 78.5%) to acknowledge gambling-related illegal behaviors, mental health and substance abuse treatment, and family histories of alcohol problems, and were less likely to report prior gambling treatment. The findings suggest that increased gambling severity is associated with gambling-related suicidality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anger expression and adaptation to childhood sexual abuse: The role of disclosure.

Previous research on anger and childhood sexual abuse (CSA) is largely cross-sectional and retrospective. In this study, we prospectively examined the consequences of expressing anger among sexually abused women in contexts of either voluntarily disclosing or not disclosing a previous abuse episode (n = 94). All CSA survivors in the study had documented histories of CSA. These participants and a matched, nonabused sample were asked to describe their most distressing experience while being videotaped to allow coding of anger expression. Approximately two thirds of the CSA survivors voluntarily disclosed a previous abuse experience. Participants completed measures of internalizing symptoms and externalizing symptoms at the time of disclosure and again two years later. The expression of anger was associated with better long-term adjustment (decreased internalizing and externalizing symptoms), but only among CSA survivors who had expressed anger while not disclosing an abuse experience. For CSA survivors who disclosed an abuse experience and for nonabused women, anger expression was unrelated to long-term outcome. These findings suggest that the benefits of anger expression for CSA survivors may be context specific. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

What is so special about male adolescent sexual offending? A review and test of explanations through meta-analysis.

We tested special and general explanations of male adolescent sexual offending by conducting a meta-analysis of 59 independent studies comparing male adolescent sex offenders (n = 3,855) with male adolescent non-sex offenders (n = 13,393) on theoretically derived variables reflecting general delinquency risk factors (antisocial tendencies), childhood abuse, exposure to violence, family problems, interpersonal problems, sexuality, psychopathology, and cognitive abilities. The results did not support the notion that adolescent sexual offending can be parsimoniously explained as a simple manifestation of general antisocial tendencies. Adolescent sex offenders had much less extensive criminal histories, fewer antisocial peers, and fewer substance use problems compared with non-sex offenders. Special explanations suggesting a role for sexual abuse history, exposure to sexual violence, other abuse or neglect, social isolation, early exposure to sex or pornography, atypical sexual interests, anxiety, and low self-esteem received support. Explanations focusing on attitudes and beliefs about women or sexual offending, family communication problems or poor parent–child attachment, exposure to nonsexual violence, social incompetence, conventional sexual experience, and low intelligence were not supported. Ranked by effect size, the largest group difference was obtained for atypical sexual interests, followed by sexual abuse history, and, in turn, criminal history, antisocial associations, and substance abuse. We discuss the implications of the findings for theory development, as well as for the assessment, treatment, and prevention of adolescent sexual offending. (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)     

A comparison of pathological gamblers with and without substance abuse treatment histories.

This study evaluated the prevalence and correlates of substance abuse histories in 341 consecutive admissions to gambling treatment programs. After controlling for gender, income, and site, gamblers with substance abuse treatment histories (SATH; 31%) had more severe problems than gamblers with no substance abuse treatment histories (NSATH) on the Gambling, Alcohol, Drug, Psychiatric, and Employment scales of the Addiction Severity Index. The SATH group had more years of gambling problems and gambled more days in the month prior to initiating gambling treatment. The SATH gamblers were also more likely to be receiving treatment for mental health problems and reported greater lifetime psychiatric distress than NSATH gamblers. These data suggest that pathological gamblers with substance abuse treatment histories may present more persistent and severe gambling dysfunction and psychiatric problems than those without such histories. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Healing the incest wound: Adult survivors in therapy, 2nd edition.

Reviews the book, Healing the incest wound: Adult survivors in therapy, 2nd edition by Christine A. Courtois (see record 2010-06160-000). Similar to the first edition, the second edition is divided into three main sections: Section I gives a broad but in-depth overview of the characteristics and dynamics of incest; Section II provides a breadth of information on the long-term effects, assessment, and diagnosis; and Section III details current evidence-informed best practice in working with survivors of prolonged child sexual abuse. The book presents a wide range of treatment modalities that represent a bevy of both empirically supported and supplemental techniques, from cognitive–behavioral to expressive therapies, such as art or poetry. The second edition of Healing the incest wound is an important read for any practitioner, novice or experienced, working with child sexual abuse survivors. Courtois both provides a solid basis for those beginning work with child sexual abuse survivors and adds to the knowledge of seasoned practitioners by bringing together the most current empirical evidence and clinical wisdom regarding child sexual abuse treatment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Evaluating and overcoming barriers to taking abuse histories.

Psychologists are frequently faced with issues of whether, when, and how to ask clients if they have been abused. Despite the demonstrated relationship between child abuse and adult psychopathology, researchers report that many clinicians still do not routinely inquire about abuse. A questionnaire completed by 63 psychologists and 51 psychiatrists in New Zealand revealed that factors related to reluctance to ask about abuse include the following: more pressing issues, fear of disturbing clients, a diagnosis of schizophrenia, biological etiology beliefs, and fear of inducing "false memories." Significant differences were found between psychologists and psychiatrists on some of these factors. Practice guidelines for enhancing the frequency and efficacy of abuse inquiry are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Recall of childhood trauma: A prospective study of women's memories of child sexual abuse.

One hundred twenty-nine women with previously documented histories of sexual victimization in childhood were interviewed and asked detailed questions about their abuse histories to answer the question "Do people actually forget traumatic events such as child sexual abuse, and if so, how common is such forgetting?" A large proportion of the women (38%) did not recall the abuse that had been reported 17 years earlier. Women who were younger at the time of the abuse and those who were molested by someone they knew were more likely to have no recall of the abuse. The implications for research and practice are discussed. Long periods with no memory of abuse should not be regarded as evidence that the abuse did not occur. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Restitution, Myth, and Reality.

Commenting on a case presentation entitled "Restitution 10," (see record 2005-02680-005), a number of problems are pointed out. The diagnosis of the patient is not properly documented, and the history is marred by probable false memories. The interpretation of Ornduff (2005) that understanding previous experiences of child abuse was helpful to the patient is questioned. An alternative approach, using both psychodynamic and cognitive principles, is suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Co-occurrence of avoidant personality disorder and child sexual abuse predicts poor outcome in long-standing eating disorder.

Few consistent predictive factors for eating disorder have been identified across studies. In the current 5-year prospective study, the objective was to examine whether (a) personality disorder and child sexual abuse predict the course of severity of eating disorder symptoms after inpatient treatment and (b) how the predictors interact. A total of 74 patients with long-standing eating disorder and mean age of 30 years were assessed at the beginning and end of inpatient therapy and at 1-, 2-, and 5-year follow-up. A mixed model was used to examine the predictors. Avoidant personality disorder and child sexual abuse interacted in predicting high levels of eating disorder over a long-term course. These results suggest that eating disorder, avoidant personality disorder, and sequelae after child sexual abuse are potential targets for treatment that need further investigation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between prior sexual abuse and reactions to sexual harrassment: Literature review and empirical study.

This article examines whether individuals who have had prior sexual abuse experiences, including sexual harassment (SH) and child sexual abuse, are hypersensitive to potential SH-related stimuli or overreact to social sexual experiences. Some psychologists and legal scholars suggest that previous sexual abuse or exposure to violence against women produces altered perceptions of current interactions and situations in those women. The review of the extant empirical literature examining such relationships and the findings presented here in an interrelated set of 5 studies provide little general or consistent support for a relationship between prior abuse experiences and current perceptions about SH. Caution is advised in judging either the veracity of an SH complaint or the objectivity of a potential juror's reaction to such a claim on the basis of her prior sexual abuse experiences. The literature review and empirical study lend weight to the irrelevance of such inquiries in judging credibility of SH complainants. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychopathy and Suicidality in Female Offenders: Mediating Influences of Personality and Abuse.

The influence of personality and childhood abuse on suicidal behaviors and psychopathy was examined among female prisoners. Scores on the affective/interpersonal component (Factor 1; F1) and the antisocial deviance (Factor 2; F2) component of psychopathy were obtained from the Psychopathy Checklist-Revised (R. D. Hare, 1991). Suicide attempt and childhood physical and sexual abuse history were coded from interviews and prison files, and personality was assessed using the Multidimensional Personality Questionnaire (A. Tellegen, in press). Suicide attempts were positively associated with F2 and negatively associated with F1, and each factor accounted for unique variance in suicidality. Path analyses demonstrated that personality mediated the effects of physical abuse on F2, but sexual abuse accounted for unique variance in both suicide attempts and F2. Abuse and personality accounted for minimal variance in F1. These results are discussed in relation to the identification of individuals at risk for both self- and other-harm behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)