Betrayal and revictimization: Preliminary findings.

The link between childhood sexual abuse and subsequent sexual, emotional, and physical revictimization has been widely reported. The literature is limited, however, in its exploration of the extent to which the level of betrayal inherent in a given childhood traumatic experience affects the likelihood of experiencing similar revictimization in adolescence and adulthood. This study assessed revictimization within a betrayal trauma framework among a sample of 271 college students. As predicted, individuals who reported experiencing high-betrayal trauma at any time point (childhood, adolescence, or adulthood) were more likely to report experiences of trauma high in betrayal during adolescence and adulthood. Relative risk ratios suggest that those who experience childhood trauma high in betrayal are 4.31 times more likely to be victimized in adolescence and 5.44 times more likely to be victimized in adulthood. Logistic regression analyses identified rate of childhood high-betrayal traumas and high levels of traumatic symptoms as significant predictors of high-betrayal trauma victimization in adolescence. Finally, participants’ responses to an exploratory self-report measure examining the relationship among revictimization, awareness for interpersonal betrayals, and response to betrayals in interpersonal contexts were analyzed. Preliminary findings indicate that revictimization risk may be linked to inaccurate identification of specific intimate partner betrayals and the inability to engage in proper self-protection. Suggestions for future research and clinical implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correction to Cuevas, Sabina, and Picard (2010).

Reports an error in "Interpersonal victimization patterns and psychopathology among Latino women: Results from the SALAS study" by Carlos A. Cuevas, Chiara Sabina and Emilie H. Picard (Psychological Trauma: Theory, Research, Practice, and Policy, 2010[Dec], Vol 2[4], 296-306). There were citation errors in the last sentence of the first column of text on page 9, and a reference was omitted from the reference list. The sentence should have read: “This result is consistent with other work that has found support for the anxious and dissociative reaction associated with trauma among Latinos and how it may relate to “ataque de nervios” (Hinton, Chong, Pollack, Barlow, & McNally, 2008; Lewis-Fernandez et al., 2002; Schechter et al., 2000; Tolin, Robinson, Gaztambide, Horowitz, & Blank, 2007). (The following abstract of the original article appeared in record 2010-19221-001.) Research on the victimization of Latino women and the subsequent psychological impact has been limited by focusing on individual forms of victimization, primarily partner violence or sexual assault. Another deficiency includes mainly using convenience and/or geographically restricted samples, which impacts the generalizability of the results. To overcome these research limitations, the Sexual Assault Among Latinas (SALAS) study aimed to evaluate the broader scope of victimization among Latino women. The study surveyed a national sample of 2,000 Latino women using random digit dial methodology. Women were asked about various forms of victimization in childhood and adulthood including physical assaults, sexual assaults, stalking, threats, and witnessed violence, as well as psychological symptomatology including depression, anxiety, anger, and dissociation. This analysis found that victimized women were more likely to experience some form of polyvictimization and/or revictimization throughout their lives, with only 36% of victimized women experiencing one form of victimization in childhood or adulthood alone. Furthermore, multiple victimization experiences significantly increased the proportion of women who experienced psychological distress symptoms in the clinical range. For almost all evaluated symptoms, the multiple forms of victimization or varying victimization patterns significantly predicted clinical levels of psychological distress over any specific form or single incident of victimization. The results suggest that victimized Latino women experience multiple forms of victimization and that the evaluation of a broader spectrum of victimization better accounts for pathological symptomatology. Clinical implications for Latino women and future research directions are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Interpersonal victimization patterns and psychopathology among Latino women: Results from the SALAS study.

[Correction Notice: An erratum for this article was reported in Vol 3(1) of Psychological Trauma: Theory, Research, Practice, and Policy (see record 2010-26899-001). There were citation errors in the last sentence of the first column of text on page 9, and a reference was omitted from the reference list. The sentence should have read: “This result is consistent with other work that has found support for the anxious and dissociative reaction associated with trauma among Latinos and how it may relate to “ataque de nervios” (Hinton, Chong, Pollack, Barlow, & McNally, 2008; Lewis-Fernandez et al., 2002; Schechter et al., 2000; Tolin, Robinson, Gaztambide, Horowitz, & Blank, 2007).] [Correction Notice: An erratum for this article was reported in of Psychological Trauma: Theory, Research, Practice, and Policy (see record 2010-26899-001). In the original article there were citation errors in the last sentence of the first column of text on page 9, and a reference was omitted from the reference list. The sentence should have read: “This result is consistent with other work that has found support for the anxious and dissociative reaction associated with trauma among Latinos and how it may relate to “ataque de nervios” (Hinton, Chong, Pollack, Barlow, & McNally, 2008; Lewis-Fernandez et al., 2002; Schechter et al., 2000; Tolin, Robinson, Gaztambide, Horowitz, & Blank, 2007).] Research on the victimization of Latino women and the subsequent psychological impact has been limited by focusing on individual forms of victimization, primarily partner violence or sexual assault. Another deficiency includes mainly using convenience and/or geographically restricted samples, which impacts the generalizability of the results. To overcome these research limitations, the Sexual Assault Among Latinas (SALAS) study aimed to evaluate the broader scope of victimization among Latino women. The study surveyed a national sample of 2,000 Latino women using random digit dial methodology. Women were asked about various forms of victimization in childhood and adulthood including physical assaults, sexual assaults, stalking, threats, and witnessed violence, as well as psychological symptomatology including depression, anxiety, anger, and dissociation. This analysis found that victimized women were more likely to experience some form of polyvictimization and/or revictimization throughout their lives, with only 36% of victimized women experiencing one form of victimization in childhood or adulthood alone. Furthermore, multiple victimization experiences significantly increased the proportion of women who experienced psychological distress symptoms in the clinical range. For almost all evaluated symptoms, the multiple forms of victimization or varying victimization patterns significantly predicted clinical levels of psychological distress over any specific form or single incident of victimization. The results suggest that victimized Latino women experience multiple forms of victimization and that the evaluation of a broader spectrum of victimization better accounts for pathological symptomatology. Clinical implications for Latino women and future research directions are discussed. (PsycINFO Database Record (c) 2011 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 victimization and illicit drug use in middle adulthood.

Using a prospective cohort design, the authors examined in this study whether childhood victimization increases the risk for illicit drug use and related problems in middle adulthood. Court-documented cases of childhood physical and sexual abuse and neglect and matched controls (N = 892) were first assessed as young adults (mean age = 29 years) during 1989-1995 and again in middle adulthood (mean age = 40 years) during 2000-2002. In middle adulthood, abused and neglected individuals were about 1.5 times more likely than controls to report using any illicit drug (in particular, marijuana) during the past year and reported use of a greater number of illicit drugs and more substance-use-related problems compared with controls. The current results reveal the long-term impact of childhood victimization on drug use in middle adulthood. These new results reinforce the need for targeted interventions with abused and neglected children, adolescents, and adults, and particularly for women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using feminist, emotion-focused, and developmental approaches to enhance cognitive-behavioral therapies for posttraumatic stress disorder related to childhood sexual abuse.

A body of research indicates the efficacy of cognitive-behavioral interventions for the treatment of posttraumatic stress disorder (PTSD) subsequent to sexual assault in adulthood. The generalizability of these treatments to women who present with trauma symptoms associated with childhood sexual abuse (CSA) has yet to be shown, however. A number of characteristics and dynamics of CSA that make it unique from sexual assault in adulthood are described, specifically its disruption of normal childhood development, its impact on attachment style and interpersonal relationships, its inescapability, and the stigma attached to it. Then, drawing on the developmental, emotion-focused, and feminist literatures, a number of considerations that would enhance the application of cognitive- behavioral trauma therapies to the treatment of women with PTSD related to CSA are delineated. These considerations relate to providing clients with corrective interpersonal experiences, creating new relationship events, enhancing affect regulation skills before initiating exposure therapy, considering the time elapsed since the abuse, addressing themes of power, betrayal, self-blame, stigma, and sex-related cognitions and emotions, and helping clients develop a feminist consciousness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Mixed psychosocial outcomes of sisters from families with alcoholic parents

To examine intrafamilial differences in adulthood among children of alcoholic parents, 14 women with alcoholic parents and their sisters were assessed for this exploratory study. Reported here is the subset of eight "mixed" sister pairs, one with an impaired adult outcome and the other with a well-adjusted adult outcome. Subjects who scored significantly worse than community norms on depressed mood or social supports or who had a psychiatric diagnosis including substance abuse were categorized as impaired, while the remaining women were categorized as well-adjusted. Both qualitative and quantitative data were collected using a questionnaire and a structured interview. Results showed similarities between the impaired and well-adjusted sisters on individual characteristics, with few differences on characteristics of the parental alcoholism. The most marked differences showed the impaired sisters to score worse than their well-adjusted sisters on characteristics of the home environment and social supports. The impaired women were also more likely to have been physically abused in childhood and to rate the effect of having an alcoholic parent as more negative than the well-adjusted women. Unanticipated findings relating to incest, talents, denial, and racial differences, and their implications for clinicians and researchers, are discussed.     

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)     

Combat exposure and adult psychosocial adjustment among U.S. Army veterans serving in Vietnam, 1965–1971.

This study investigated the relationship between combat exposure and adult antisocial behavior in a sample of 2,490 male Army veterans of the Vietnam War who completed questionnaires about their psychological functioning. After adjustment for history of childhood behavior problems, posttraumatic stress disorder diagnosis, and demographic and military characteristics, it was found that veterans who experienced high and very high levels of combat were twice as likely to report adult antisocial behavior as veterans with no or low levels of combat and were also more likely to meet criteria for antisocial personality disorder. The results indicate that exposure to traumatic events during late adolescence or early adulthood is associated with multiple adult adjustment problems in vocational, interpersonal, and societal functioning. Treatment focusing on the effects of the trauma is likely to be necessary but not sufficient for improving affected veterans' behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical characteristics of adults reporting repressed, recovered, or continuous memories of childhood sexual abuse.

The authors assessed women and men who either reported continuous memories of their childhood sexual abuse (CSA, n = 92), reported recovering memories of CSA (n = 38), reported believing they harbored repressed memories of CSA (n = 42), or reported never having been sexually abused (n = 36). Men and women were indistinguishable on all clinical and psychometric measures. The 3 groups that reported abuse scored similarly on measures of anxiety, depression, dissociation, and absorption. These groups also scored higher than the control group. Inconsistent with betrayal trauma theory, recovered memory participants were not more likely to report abuse by a parent or stepparent than were continuous memory participants. Rates of depression and posttraumatic stress disorder did not differ between the continuous and recovered memory groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Accuracy of adult recollections of childhood victimization, Part 2: Childhood sexual abuse.

Questions have been raised about the accuracy of retrospective self-reported information about childhood sexual abuse. Using data from a prospective-cohorts-design study, a large group of children who were sexually and physically abused or neglected approximately 20 years ago were followed up and compared with a matched control group. Accuracy of adult recollections of childhood sexual abuse was assessed using 4 different measures, completed in the context of a 2-hr in-person interview in young adulthood (N = 1,196). Results indicate gender differences in reporting and accuracy, substantial underreporting by sexually abused respondents in general, good discriminant validity and predictive efficiency of self-report measures for women, and some support for the construct validity of the measures. Implications for researchers and practitioners are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.     

Abuse characteristics among childhood sexual abuse survivors in therapy: a gender comparison

OBJECTIVE: The goal of this investigation was to examine similarities and differences in childhood sexual abuse (CSA) characteristics between men and women survivors in outpatient psychotherapy utilizing a substantial sample size of men, while examining an extensive range of abuse characteristics. METHOD: Abuse characteristics of 48 men from an outpatient treatment program for adult survivors of CSA in a university-based community mental health center were compared with those of 257 women from the same program. Data on abuse history were collected at admission or as soon thereafter as possible using a structured clinical interview with established reliability. RESULTS: Women were significantly more likely to have been sexually abused by a family member. Men were significantly more likely to report having oral sex performed upon them. Otherwise, no significant gender differences not attributable to anatomical differences (e.g., vaginal vs. anal intercourse) were found. CONCLUSIONS: The findings suggest that very few differences exist in the nature and extent of CSA reported by men and women. Thus CSA perpetrated on boys appears largely comparable in nature and extent to that committed against girls.     

Use of a screening instrument in women's health care: detecting relationships among victimization history, psychological distress, and medical complaints

The interactive relationship between psychological distress and physical health is a particularly salient one for women. Routine screening for abuse history and current psychological disturbance is essential in providing comprehensive patient care. The present study examines the utility of a brief screening measure in detecting psychological factors in female patients at a primary care facility. Sixty-nine percent of 108 women screened at a women's health clinic reported a history of trauma and almost half (49%) reported having been sexually harassed. Women presenting to treatment for gynecological problems were more likely to be victims of sexual assault and were more likely to report a history of childhood sexual abuse. In addition, women seeking specialized health care also reported increased rates of stress. Relationships among victimization histories, substance use, and eating disturbances were also found. These data suggest the importance of assessing psychological disturbances and trauma histories as part of a comprehensive medical evaluation.     

Persistent alterations in biological profiles in women with abuse histories: Influence of premenstrual dysphoric disorder.

Objective: To examine dysregulation in biological measures associated with histories of abuse in women and whether women with premenstrual dysphoric disorder (PMDD) differ in their dysregulation. Design: Twenty-five women meeting prospective criteria for PMDD and 42 non-PMDD controls underwent structured interview to determine abuse histories and lifetime Axis I diagnoses, excluding those with current Axis I disorders or using medications. Major Outcome Measures: Plasma cortisol and norepinephrine (NE), heart rate (HR), blood pressure (BP), and vascular resistance index (VRI) were assessed at rest and in response to mental stress. Results: A greater proportion of PMDD women had prior abuse compared with non-PMDD women. Regardless of PMDD status, all abused women had lower plasma NE and higher HRs and tended to have lower plasma cortisol at rest and during stress. Abused women also reported more severe daily emotional and physical symptoms. Greater VRI and BP at rest and during stress were seen only in PMDD women with abuse. Conclusion: There is persistent dysregulation in stress-responsive systems in all abused women that cannot be accounted for by current psychiatric illness or medications, and PMDD women may be differentially more vulnerable to the impact of abuse on measures reflecting α-adrenergic receptor function. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trauma, mental representation, and the organization of memory for mother-referent material

Research on the effects of child maltreatment and exposure to community violence suggests that children who experience these types of traumatic events may be at risk for alterations and biases in attention and memory similar to those that have been observed in adults suffering from traumatic stress reactions. Along these lines, attachment theory posits that representational models of relationships also may act as moderators of similar cognitive biases by selectively guiding children's attention to and processing of interpersonal stimuli. Building upon the trauma and attachment literatures, the present investigation examined the links among trauma, representational models of caregivers, and children's memory for mother-relevant information using an incidental recall task in a sample of maltreated (n = 71) and nonmaltreated (n = 102) children between the ages of 8 and 13 years. Results were consistent with the hypothesis that experiences of trauma and representational models of caregivers are associated with differences in the way children process and retrieve information about positive and negative mother attribute words. In particular, experiences of trauma initially were associated with increased insecurity in children's representational models. Moreover, the interaction of traumatic experience and security of mental representation predicted children's recall for mother attribute words: victimized children with insecure models recalled the highest proportion of negative mother stimuli. Trauma and mental representation did not have a consistent effect on structurally encoded aspects of recall. Results were discussed in terms of the ways in which children who have experienced trauma process information about their worlds. The importance of assessing functioning in multiple developmental domains when studying memory also was discussed.     

Symptom severity and diagnoses related to sexual assault history

The current study examines associations between a history of sexual assault or abuse and severity of symptoms and diagnostic categories in an adult clinical outpatient sample. Twelve of 68 men (18%) and 71 of 120 women (59%) reported a history of sexual trauma. Abuse history was associated with mood and anxiety disorder diagnoses. Women were also more likely to receive these diagnoses; abused women were particularly likely to be diagnosed with an anxiety disorder. Abused subjects showed higher scores on every subscale of the SCL-90-R; there were no interactions between sex and history of abuse. Women scored higher than men on subscales indicating anxiety, phobia, and general distress. The results indicate an association between history of sexual trauma and symptom severity across a broad range of psychopathology, and with mood and anxiety disorders. There is no indication of differential gender effects of sexual assault.     

Cognitive processing of trauma cues in adults reporting repressed, recovered, or continuous memories of childhood sexual abuse.

Psychologically traumatized people exhibit delayed color naming of trauma words in the emotional Stroop task. Four groups of participants were asked to color name positive words, neutral words, and trauma words; these groups included 15 women who believed that they harbored repressed memories of childhood sexual abuse (CSA), 13 women who reported recovered memories of CSA, 15 women who had never forgotten their CSA, and 12 women who had never been abused. Repressed-memory participants exhibited patterns of interference indistinguishable from those of the nonabused control group participants. Irrespective of group membership, the severity of self-reported posttraumatic stress disorder symptoms was the only significant predictor of trauma-related interference, r(48)?=?.30?, p?     

Long-term sequelae of childhood sexual abuse: Perceived family environment, psychopathology, and dissociation.

105 abused and nonabused women were examined for patterns of adult psychopathology associated with childhood sexual abuse and to test the extent to which these patterns are independent of other pathogenic properties of the family environment. Clinical and nonclinical Ss completed the Family Environment Scale, the MMPI, the Rorschach, and the Stanford Hypnotic Susceptibility Scale. Greater nonspecific impairment among abused women may be a consequence, at least in part, of pathogenic family structure rather than sexual abuse per se. However, MMPI and Rorschach responses suggest sexual abuse may render victims especially vulnerable to specific disturbances involving soma and self. Abuse was associated with greater use of dissociation, but covariance analysis revealed this effect to be accounted for by family pathology. There was no evidence that sexual trauma is associated with hypnotizability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)