Childhood sexual and physical abuse and adult self-harm and suicidal behaviour: a literature review

This article reviews the link between childhood sexual and/or physical abuse and adult self-harm, suicidal ideation, and suicidal attempt from 1988 to 1998 in the clinical literature. Despite the methodological and definitional concerns, empirical studies have generally demonstrated more reports of self-harm, suicidal ideation, and suicidal behaviour in clinical and community populations of adults who report sexual and/or physical abuse in childhood than in comparison groups who do not report abuse. Implications for practice include the identification of populations at risk for self-harm or suicide and routine inquiry of abuse histories on admission. Further research into universal definitions of the key terms, standardized measurements of the variables, and longitudinal studies is required.     

Child sexual abuse evaluations: the scientist-practitioner model

This review presents published data on various aspects of gap junction functioning during development. The process of formation of these junctions and their structure, along with relationships between molecular characteristics of connexins and properties of gap junctions channels are considered in detail. Some newly discovered functions of gap junctions in early embryonic development, their participation in the formation of various cellular compartments and in coordinated behavior are discussed; their relationship with other types of cell interactions is also reviewed. Promising problems for further research are outlined.     

Child sex abuse: pretext to a return of sexual repression

This article is based on observations and thoughts during intensive psychotherapeutic work with 997 sexually abused children and their parents after they had been reported to the Confidential Doctor Center Kind in Nood of the VUB (between 1986 and 1994). Without denying the existence of sexual abuse of children, it is important not to exaggerate this phenomena, which can be described as the Child Sexual Abuse Panic Syndrome. Doing this only gives way to denial and indignation or scandalization and revenge, and certainly does not lead to a clear analysis of the problem. Accurate observation enables some existing myths to become unravelled: abusive fathers are seldom power robots, mothers are not always warm-hearted, innocent creatures and children are not black boxes without feeling and sexual desires. The underlying message is about the bitter fight against modernization of sexuality, which seems again experienced as dangerous. However it is fear for a free, adult sexuality that is at the core of sexual exploitation of children, which should encourage caution in professional answers to this delicate issue.     

Child extrafamilial sexual abuse: predicting parent and child functioning

OBJECTIVE: This study evaluated the emotional and behavioral adjustment of parents and children within 3 months and 1 year after the discovery of child extrafamilial sexual abuse. METHOD: Ninety-two case parents (63 mothers, 29 fathers) and 56 children were compared to a nonclinical comparison group of 136 parents (74 mothers, 62 fathers) and 75 children. Parent adjustment was assessed using self-report measures while child functioning was assessed using a combination of child-, parent- and teacher-report measures. RESULTS: Mothers, fathers and sexually abused children experienced clinically significant effects both initially and at 12 months post-disclosure. Children's perceptions of self-blame and guilt for the abuse and the extent of traumatization predicted their self-reported symtomatology at 3 months and 1 year post-disclosure. Child age and gender also significantly contributed to the prediction of many of the child outcome measures. No abuse-related variable was related to any child self-report measure. Mothers' satisfaction in the parenting role, perceived support and intrusive symptoms predicted their initial emotional functioning. Avoidant symptoms, child's internalizing behavior and mothers' initial emotional functioning were significant predictors of longer-term emotional functioning. CONCLUSIONS: Results emphasize the need to address children's abuse-related attributions and underscore the need to expand our focus beyond the child victims to the traumatized families.     

Nonepileptic seizures and childhood sexual and physical abuse

Nonepileptic seizures (NES) must be distinguished from epilepsy to avoid the adverse effects of unnecessary antiepileptic drugs and to initiate appropriate psychiatric treatment. A higher frequency of prior sexual abuse has been suspected in NES, although no prospective controlled study has compared patients with NES and epilepsy. A series of patients with conversion disorder presenting as epilepsy and 140 patients with complex partial epilepsy (CPE) without evidence of conversion were selected from a series of consecutive admissions to a comprehensive epilepsy center. The groups did not differ with respect to age, years of education, race, or marital status, but the percentage of women was greater in the conversion NES group (73.2%) than in the CPE control group (50.7%; p < 0.002). The frequency of a history of sexual or physical abuse was greater in the NES group (32.4%) than in the CPE controls (8.6%; p < 0.000). Severity of sexual but not physical abuse was significantly greater in the NES group relative to controls (p < 0.05). There was a trend for a closer relationship of the perpetrator of sexual abuse to the victim among the NES patients compared with CPE controls (p < 0.1). These results support the impression that childhood abuse is more common among patients with conversion NES than with epilepsy, and suggests that in some cases childhood abuse may be a contributory pathogenetic factor.     

Child abuse: a community problem

Physicians who treat musculoskeletal and neurologic disorders often treat patients who have paresthesias or weakness of a single extremity. Although the diagnosis is often straightforward, cases that are atypical in nature may pose a diagnostic dilemma. This report describes the case of a middle-aged man with symptoms indicative of, though not classic for, a cervical radiculopathy. An extensive investigation was unremarkable and only the eventual rapid progression of symptoms led to the diagnosis of a glioblastoma multiforme. Although this is a deadly form of brain cancer, early recognition provides the best chance for a prolonged and greater quality of life.     

Sexual abuse and alcoholism in a female population

AIMS: (1) To study the prevalence of childhood sexual abuse before the age of 18 years (CSA) and life-time sexual abuse (LSA) in a Swedish female, general population, (2) to analyse associations between CSA and life-time alcohol dependence or abuse (ADA), and (3) to identify possible confounding factors. DESIGN AND PARTICIPANTS: The study was conducted in two phases. Phase 1: an alcohol problem screening questionnaire was sent to 3130 women aged 25-65. The answers were scored. Phase 2: based on the questionnaire scores, a randomly selected stratified sample of 479 women was invited for an interview. Of these, 316 women participated in a structured face-to-face interview. SETTING: A sector of G?teborg city with 100,000 inhabitants. MEASUREMENTS: The interviews focused on substance use and on social, psychological and behavioural characteristics, including experiences of sexual abuse. Clinical psychiatric diagnoses were made according to DSM-III-R. Bivariate analyses and multivariate logistic regression analyses were performed. FINDINGS: The prevalence of CSA and LSA was 9.8% and 13.9%, respectively. CSA increased the risk for life-time ADA and anxiety, but not for depression. When potential confounding factors (e.g. early background factors, depression and anxiety) were adjusted for, CSA under 13 years of age still predicted ADA in multivariate analyses, but CSA under 18 years of age did not. CONCLUSIONS: LSA, and especially CSA under 13 years of age, are factors that should be considered in treatment of women with ADA and in psychiatric treatment of women.     

Relationship of childhood sexual, physical, and combined sexual and physical abuse to adult victimization and posttraumatic stress disorder

OBJECTIVE: Prior research has suggested that women who experience childhood sexual abuse are at increased risk for sexual victimization and Posttraumatic Stress Disorder (PTSD) in adulthood. However, previous studies have paid insufficient attention to the overlap of childhood sexual and physical abuse. In the present study we disentangled the separate and combined effects of childhood sexual and physical abuse by comparing groups of participants who reported contact childhood sexual abuse only (SA), sequelae of childhood physical abuse only (PA), combined childhood sexual and physical abuse (CA), or no child abuse (NA). METHOD: A sample of 475 female college students completed measures of sexual and physical abuse in childhood (before age 15) and adulthood (after age 15), PTSD and trauma symptoms, and demographic variables. Of these participants, 27 were assigned to the SA group, 53 to the PA group, 31 to the CA group, and 211 to the NA group. RESULTS: The highest rate of adult sexual and/or physical victimization was reported by the CA group, followed by the PA group, with lower rates reported by the SA and NA groups. Using adult victimization as a covariate, the analyses revealed that the CA group reported significantly higher rates of PTSD and trauma symptoms compared to the NA group. CONCLUSIONS: The results suggest that prior reports of differences in rates of adult victimization and PTSD between women who experienced childhood sexual abuse and women who did not may be attributable to the inclusion of participants with a history of combined childhood sexual and physical abuse in childhood sexual abuse groups. The importance of separating physical and combined forms of victimization from sexual abuse is discussed.     

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.     

Childhood sexual and physical abuse. Incidence in patients with vulvodynia

From December 1994 to November 1995 an unusual accumulation of Listeria infections occurred at the University Hospital Hamburg-Eppendorf, Germany. Eleven immunosuppressed patients from different departments developed septicemia due to Listeria monocytogenes during hospitalization. In a retrospective study, serotyping and pulsed-field gel electrophoresis revealed that six isolates were identical or genetically related. Four of them had been isolated from renal transplant recipients. Listeria monocytogenes was neither detected in food samples of the renal transplantation ward, nor in stool specimens obtained from the ward staff. There had been no close contacts among the infected patients. Before transplantation, the renal transplant recipients had been dialysed in different dialysis centers. Nosocomial foodborne transmission could not be proven but seems likely.     

Alcohol abuse, alcoholism, and damage to the immune system--a review

Chronic alcohol abuse exacts a major social and medical toll in the United States and other Western countries. One of the least appreciated medical complications of alcohol abuse is altered immune regulation leading to immunodeficiency and autoimmunity. The consequences of the immunodeficiency include increased susceptibility to bacterial pneumonia, tuberculosis, and other infectious diseases. In addition, the chronic alcoholic often has circulating autoantibodies, and recent investigations indicate that the most destructive complications of alcoholism, such as liver disease and liver failure, may have a component of autoimmunity. Current research on altered cytokine balance produced by alcohol is leading to new insights on the regulation of the immune system in the chronic alcoholic. There is also recent development of exciting new techniques designed to improve or restore immune function by manipulation of cytokine balance. Although much remains to be learned, both in the abnormalities produced by alcohol and in the techniques to reverse those abnormalities, current progress reflects a rapidly improving understanding of the basic immune disorders of the alcoholic.     

Protecting women and children from physical, sexual, and psychological abuse

Domestic violence is a serious public health problem. The "epidemic" is becoming too obvious to hide, too widespread to deny, and too much of a health hazard to ignore. The victims are children, women, the elderly, and the society as a whole. Family members, government, educational and penal agencies, civic and medical societies, physicians, and citizens at large are all involved in domestic violence prevention. By having a high index of suspicion, physicians are in an ideal position to prevent, assess, identify, and treat victims of domestic violence and its associated problems.     

Child abuse and psychosis: A literature review and implications for professional practice.

This review summarizes the research demonstrating the relationships of childhood abuse to psychosis and schizophrenia and raises the possibility that the relationships may be causal. Six ways in which the relationship between child abuse and psychosis can be minimized are identified: (a) excluding psychotic individuals from studies; (b) relying on records of childhood abuse rather than asking patients; (c) ignoring relevant studies; (d) reinterpreting psychotic symptoms as nonpsychotic where abuse is identified, thereby avoiding diagnoses such as schizophrenia; (e) positing spurious intervening variables; and (f) adhering rigidly to a biomedical model. Implications for professional practice, at the policy and clinical levels, are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Child sexual abuse as a predictor of psychiatric co-morbidity and its implications for drug and alcohol treatment

Steel factor (SLF) and its cognate receptor, c-kit, have been implicated in the generation of melanocytes from migrating neural crest (NC) cells during early vertebrate embryogenesis. However, the source of SLF in the early avian embryo and its precise role in melanogenesis are unclear. We report here that NC cells themselves express and release SLF protein, which in turn acts as an autocrine factor to induce melanogenesis in nearby NC cells. These results indicate that NC cell subpopulations play an active role in the determination of their cell fate and suggest a different developmental role for the embryonic microenvironment than what has been previously proposed.     

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)     

Effects of alcohol abuse and familial alcoholism on physical health in men and women.

Administered a structured interview measuring 5 categories of physical health (medical history, alcohol-related disorders, trauma history, drug use history, and female-related disorders) to 76 male and 72 female detoxified alcoholics and 50 male and 51 female nonalcoholic controls. Ss were aged 21–62 yrs, and approximately half the Ss had a positive family history (FH) of alcoholism (AC). Results indicate that (1) alcoholics suffer pervasive physical health difficulties, (2) an FH of AC is predictive of health problems in both alcoholics and controls, (3) the effects of alcohol abuse and FH of AC on health are independent and additive, and (4) women may exhibit increased vulnerability to the adverse effects of AC. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship of childhood physical and sexual abuse to adult illness behavior

A sample of 275 undergraduate subjects reported (i) their history of sexual and physical abuse in childhood and (ii) their health care utilization, somatization, and hypochondriasis as an adult. Physical and sexual abuse were recalled by largely separate groups, physical abuse predominating in males and sexual abuse in females. Both types of abuse were followed by a greater number of hospital admissions and surgical procedures in adulthood. Although sexual, and especially physical, abuse were associated with recall of emotionally disturbed parenting, this could not explain their influence on health care utilization because this was unrelated to parenting. Similarly, although abuse was followed by greater somatization and hypochondriasis, these also were unrelated to health care utilization. Physical and sexual abuse in childhood are risk factors, independent of their association with poor parenting, in the development of separate aspects of adult illness behavior.     

Relationship between dissociation, childhood sexual abuse, childhood physical abuse, and mental illness in a general population sample

Piperidine nitroxides have considerable clinical potential, both as antioxidant therapeutic compounds and contrast agents in magnetic resonance imaging. However, their development has thus far been limited by their rapid bioreduction in vivo. Recently, it was reported that polynitroxyl albumin (PNA) can reverse the bioreduction of the reduced 4-hydroxy-2,2,6,6-tetramethylpiperidine-N-oxyl (Tempol) in the rat heart, enabling the performance of high resolution EPR imaging for prolonged time (Kuppusamy et al., Biochemistry 35, 7051-7057 (1996)). In this report, the efficacy of PNA in maintaining Tempol concentrations in vivo in mice was demonstrated, using L-band (1.25 GHz) EPR spectroscopy and imaging. The EPR signal of intravenous Tempol had a half-life of 1.0+/-0.2 min and became undetectable within 6 min. Subcutaneous Tempol, however, decayed at a slower rate (half-life, 5.0+/-0.5 min) suggesting that Tempol had been bioreduced to the corresponding hydroxylamine form, Tempol-H. Subcutaneously injected PNA restored 20% of the Tempol signal in the vicinity of the PNA deposit. In vivo topical EPR imaging demonstrated that the Tempol signal was restored at the site of PNA injection, but not at locations remote from the PNA injection site. The ability of PNA to maintain Tempol in its paramagnetic state in vivo should enable a wide range of therapeutic and diagnostic applications of piperidinyl nitroxides.