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.     

Bodily shame as a mediator between abusive experiences and depression.

The role of bodily shame as a mediator between sexual or physical abuse and depression was investigated in a community sample of 101 women who had been followed for 8 years. In general, childhood and adult abuse were related to the occurrence of depression in the study period but when both were considered together, only adult abuse showed an independent association. However, childhood and adult abuse were both independently related to chronic or recurrent depression. Bodily shame was related to childhood abuse, and this association could not be accounted for by bodily dissatisfaction or low self-esteem. Bodily shame, but not childhood abuse, was related to chronic or recurrent depression when both factors were considered together and current depressive symptoms were controlled. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric family history in adolescents with severe asthma

OBJECTIVE: To examine the hypothesis that an association exists between severe asthma and familial affective and anxiety disorders. METHOD: A parent, usually the mother, of 62 adolescents admitted to a tertiary care asthma center was administered the Family History-Research Diagnostic Criteria Interview. Lifetime prevalence rates of psychiatric disorders in first-degree relatives were compared with previously reported rates. RESULTS: In relatives of asthmatic adolescents, rates for depression, mania (females only), substance abuse (males only), and antisocial personality disorder were significantly higher than the rates in the non-ill comparison sample. Rates for substance abuse (males only) and antisocial personality disorder were higher than the rates for relatives of the depressed comparison sample. Rates for anxiety disorders were not higher than rates in epidemiological samples. Rates of attention-deficit hyperactivity disorder (females only) and posttraumatic stress disorder in relatives were higher than in community samples. CONCLUSIONS: These results support the presence of a link between severe asthma and familial affective disorders, posttraumatic stress disorder, antisocial personality disorder, and substance abuse. Whether these disorders are genetically associated with asthma or represent an association with severe asthma because of environmental effects on the growing child is discussed.     

Sexual abuse and the subsequent development of alcohol problems

The literature on sexual abuse and alcohol problems has been reviewed. Various methodological issues are relevant in determining whether there is merely an association or also a causal relationship. These include the definition of sexual abuse, the degree and timing of abuse, the methods of data collection, sample selection, the presence or absence of control groups, possible recall bias, difficulties with prospective studies for this subject, and the definition of alcohol misuse or dependence. Results with community and victim samples are conflicting, but studies on samples of problem drinkers suggest an association between severe alcohol problems and previous sexual abuse, at least in women. The association may be especially strong for earlier and more severe forms of sexual abuse. Possible mechanisms for an association were examined and are: (1) sexual abuse as a cause of alcohol misuse; (2) alcohol misuse predisposing people to sexual assault; (3) sexual assault and alcohol misuse both resulting from another factor; (4) sexual abuse predisposing to other conditions associated with alcohol misuse; and (5) an artefactual association. Regardless of the role of sexual abuse in causing alcohol problems, the available evidence suggests that victims of sexual abuse may present to services with more problematical patterns of drinking and more concurrent psychiatric disorder.     

Long-term effects of sexual victimization in childhood: An attributional approach.

Explored the relation between childhood sexual victimization experience and adult functioning in 103 women (aged 18–56 yrs) who were victimized as children or adolescents and 88 women (aged 18–57 yrs) who were not victimized, who served as controls. Members of both groups completed a questionnaire about their present social, psychological, and sexual functioning; measures included the Beck Depression Inventory, SCL-90, Texas Social Behavior Inventory, Attributional Style Questionnaire, Rotter's Internal–External Locus of Control Scale, and the Marlowe-Crowne Social Desirability Scale. Victimized Ss differed significantly from nonvictims on measures of (a) childhood family and social experiences; (b) adult attributional style; and (c) levels of depression, psychological distress, self-esteem, and sexual problems. Results suggest that the sexually victimized Ss' adult functioning was related most strongly to their attributional style for bad events. Perception of the victimization experience and quality of social support were important factors related to adult functioning. Possible implications for treating women who are experiencing problems related to childhood sexual victimization experiences are discussed. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study

BACKGROUND: The relationship of health risk behavior and disease in adulthood to the breadth of exposure to childhood emotional, physical, or sexual abuse, and household dysfunction during childhood has not previously been described. METHODS: A questionnaire about adverse childhood experiences was mailed to 13,494 adults who had completed a standardized medical evaluation at a large HMO; 9,508 (70.5%) responded. Seven categories of adverse childhood experiences were studied: psychological, physical, or sexual abuse; violence against mother; or living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned. The number of categories of these adverse childhood experiences was then compared to measures of adult risk behavior, health status, and disease. Logistic regression was used to adjust for effects of demographic factors on the association between the cumulative number of categories of childhood exposures (range: 0-7) and risk factors for the leading causes of death in adult life. RESULTS: More than half of respondents reported at least one, and one-fourth reported > or = 2 categories of childhood exposures. We found a graded relationship between the number of categories of childhood exposure and each of the adult health risk behaviors and diseases that were studied (P < .001). Persons who had experienced four or more categories of childhood exposure, compared to those who had experienced none, had 4- to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt; a 2- to 4-fold increase in smoking, poor self-rated health, > or = 50 sexual intercourse partners, and sexually transmitted disease; and 1.4- to 1.6-fold increase in physical inactivity and severe obesity. The number of categories of adverse childhood exposures showed a graded relationship to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life. CONCLUSIONS: We found a strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults.     

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)     

Change experienced during group therapy by female survivors of childhood sexual abuse.

Change during a 20-week group therapy program was researched for 40 women who were survivors of childhood sexual abuse. Results indicated that the women who participated in group therapy, compared with a quasi-experimental control group, decreased significantly on measures of depression, social maladjustment, self-blame, and posttraumatic stress responses, with no significant increases in anger. Scores on the main variables remained stable during assessment and follow-up periods for the women who participated in group therapy. In addition, there were no significantly different patterns of change based on either sexual abuse variables (number of perpetrators, sexual abuse by a father figure, nature of sexual abuse, and duration) or participation in concurrent individual therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Childhood abuse and current psychological functioning in a university counseling center population.

84 university counseling center clients (61 women and 23 men) self-reporting childhood physical, sexual, or emotional abuse (n?=?30) or no childhood abuse (n?=?54) completed 3 measures of psychological functioning. Multivariate analysis of variance revealed that clients reporting abuse were more depressed (with the mean Beck Depression Inventory score in the borderline clinical depression range), had more symptomatology (with the mean Global Severity Index of the Brief Symptom Inventory at about the average level of a psychiatric outpatient population), and scored higher on the Borderline Personality scale of the Millon Clinical Multiaxial Inventory (with the mean base-rate score near the cutoff score for presence of borderline personality features). 19 clients reporting emotional abuse only did not differ on any measure from 11 clients reporting sexual or multiple forms of abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Childhood Sexual and Physical Abuse and the 1-Year Prevalence of Medical Problems in the National Comorbidity Survey.

In a population sample (N = 5,877; ages 15 to 54), the authors found childhood sexual and physical abuse to be associated with the 1-year prevalence of serious health problems for both men and women. The authors also found that participants' psychiatric disorders partially mediated the effects of physical and sexual abuse on adult health. However, childhood abuse continued to independently influence health status after the authors controlled for psychiatric disorders. Contrary to expectations, individuals who experienced a combination of sexual and physical abuse did not have a higher frequency of health problems than those who experienced either type of abuse alone. Implications for these findings are discussed, including possible mechanisms that may account for the association between childhood abuse and adult health problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early family environments and traumatic experiences associated with borderline personality disorder.

Childhood trauma experiences (e.g., sexual abuse, physical abuse, witnessed violence, and early separation experiences) and family environment characteristics were assessed with a questionnaire from a sample of depressed female inpatients; 17 were diagnosed as having borderline personality disorder (BPD), and 19 received no such diagnosis (NBPD). Significantly more BPD individuals than NBPD individuals reported histories of sexual abuse, physical abuse, and witnessed violence. Of these trauma variables, sexual abuse emerged as the only significant predictor of dimensional BPD score, even after physical abuse, subjective depression score, diagnostic differences between groups, and family environment were controlled. Early separation experiences were nonsignificantly different between groups. Although the BPD families were reported to be distinctive for several different family environment characteristics, the control dimension significantly predicted dimensional borderline score even after sexual abuse was controlled. These results suggest that sexual abuse and general family environment need further study for a fuller understanding of BPD symptomatology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Validation d'une traduction fran?aise d'un instrument de mesure des réponses affectoves á la premiére relation sexuelle avec pénétration.

Tested the validity of a self-questionnaire (D. L. Weis; 1983) measuring the affective responses to the first sexual intercourse with a sample of 198 French-Canadian women. This study also explores the affective responses to the first sexual relation with penetration within this same group. Ss answered experimental and original versions of the questionnaire. Results show consistency between cues of content validity and concomitant validity of the original version and the French version, a noticeable temporal stability and a high internal consistency. Results also show the accuracy of the French translation and the validity of the questionnaire on the affective responses to the first sexual relation with penetration. A copy of the French version of the questionnaire is appended. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gastrointestinal tract symptoms and self-reported abuse: a population-based study

BACKGROUND/AIMS: A link between abuse and irritable bowel syndrome (IBS) has been reported in outpatients but remains controversial. No population-based studies have investigated this issue. The aim of this study was to determine the prevalence of abuse and its association with symptoms in a representative community sample. METHODS: An age- and sex-stratified random sample of residents of Olmsted County, Minnesota ranging in age from 30 to 49 years was mailed a valid self-report symptom questionnaire. Abuse was assessed by standard published criteria. RESULTS: Of the 919 responders (74%), the age-adjusted prevalence of any abuse was 41% in women and 11% in men, resulting in an age- and sex-adjusted prevalence of 26%. Symptoms of IBS, dyspepsia, and frequent heartburn were reported by 14%, 23%, and 12%, respectively. There was a significant association between IBS and sexual abuse, emotional or verbal abuse, and abuse in childhood and adulthood. Similarly, dyspepsia and heartburn were both significantly associated with abuse. In the population, 31% had visited a physician for gastrointestinal symptoms; the odds of visiting a physician were highest in those reporting abuse in adulthood and childhood. CONCLUSIONS: Self-reported abuse is common in middle-aged subjects; those who report abuse are more likely to have symptoms consistent with IBS, dyspepsia, or heartburn and to visit a physician for bowel symptoms.     

Autobiographical memory functioning in depression and reports of early abuse.

The authors investigated the memory functioning of depressed women patients with and without a reported history of child physical or sexual abuse using J. M. G. Williams and K. Broadbent's (1986) Autobiographical Memory Test. Whereas latency to recall autobiographical memories was not related to reports of abuse, patients who reported childhood sexual abuse produced more overgeneral memories to positive and negative cues. In addition, patients reporting high levels of avoidance of spontaneous memories of childhood physical or sexual abuse in the past week retrieved more overgeneral memories to positive and negative cues. (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.     

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)     

Selection bias in occupational sperm studies

OBJECTIVE: This study examined well-being and satisfaction with community services in adult survivors of childhood abuse. METHOD: A community sample of 109 individuals, 34 reporting childhood abuse (sexual, physical and/or emotional), completed a questionnaire package as part of a study of community well-being. The package included measures of demographic variables, satisfaction with community services, physical well-being, consumption of drugs (including nicotine & alcohol), loneliness, depression, and life stress. RESULTS: Less than half of those reporting abuse had confided in someone about their experience and only 14.3% had discussed it with a counsellor. The abuse versus no abuse groups did not differ in terms of general living circumstances (e.g., income, marital status, employment status, quality of housing). Despite this, the abuse group reported poorer well-being on several measures. CONCLUSIONS: There are clear limitations to the present data. Nonetheless, the results suggest that those reporting childhood abuse tend to experience poorer well-being than those who do not report abuse, even when the "objective" aspects of their circumstances are similar.     

Pathways from child sexual abuse to adult depression: The role of parental socialization of emotions and alexithymia.

Objective: Depression is common among adult survivors of child sexual abuse (CSA), but the intervening processes responsible for this outcome have not yet been fully delineated. The present study investigated the mediating role of perceived parental emotion socialization and alexithymia (difficulties identifying and describing feelings) in explaining the link between CSA and adult depressive symptoms in female veterans. Method: Cross-sectional data were collected from 110 female veterans who completed self-report questionnaires measuring demographics, sexual victimization history, perceived parental emotion socialization, and current symptoms of alexithymia and depression. Results: Linear regression analyses showed that CSA predicted greater depression, which was partly accounted for by alexithymia. Less positive socialization practices by both parents fully mediated the relationship between CSA and alexithymia. When these factors were examined together in a path model, greater CSA severity predicted perceptions of fewer positive socialization practices by mothers, which, in turn, was associated with greater alexithymia and depression. Conclusions: Perceptions of early positive emotion socialization and current alexithymia may contribute to experience of depression among sexually victimized female veterans. Interventions aimed at targeting emotion regulation skills and perceptions associated with other salient childhood experiences such as emotion socialization by parents could help reduce adult depression among CSA survivors. Furthermore, encouraging positive parenting practices for caregivers of abused children could allay subsequent affective symptoms. (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)