Men who were sexually abused in childhood: Coping strategies and comparisons in psychological functioning

ObjectiveCoping strategies of men who were sexually abused in childhood were examined to ascertain their relationship to clinical diagnoses. Time elapsed since the abuse occurred was examined for its relationship to psychological functioning. Clinical psychopathology of this primary sample of sexually abused men was compared to a community sample of men.MethodsA primary sample of 147 Australian men was recruited from agencies and self-help groups who support adults who were sexually abused in childhood. For comparative purposes a secondary data set that consisted of 1,231 men recruited randomly in an Australian community survey was utilized. Both samples were administered the 28-item General Health Questionnaire (GHQ28). The primary sample was administered the 60-item coping style inventory instrument (COPE).ResultsCoping strategies influenced the possibility of being classified as clinical or nonclinical. The most important strategies associated with better functioning were positive reinterpretation and growth and seeking instrumental social support. Whereas strategies that were more associated with a clinical outcome were themed around internalization, acceptance and disengagement. The sample of men who were sexually abused in childhood was up to 10 times more likely to be classified as “clinical” then the sample of community men. Time elapsed since the abuse occurred did not have a moderating effect on men's psychological functioning.ConclusionsMen who have been sexually abused in childhood are more likely to have clinical diagnoses but coping strategies may play an important part in this outcome. Seeking active assistance appears to be important coping strategy in reframing the experience, however, the timing of this help seeking is not critical.Practice implicationsThe findings reinforce the importance of professionals being aware that men's psychiatric symptoms might be the sequel to past child sexual abuse. Coping strategies that focus on internalization or disengagement are potentially damaging to the men's long-term psychological functioning. Importantly there are coping strategies that appear to have a moderating effect on clinical diagnoses. Focus needs to be given to support services to male victims that provide practical strategies and allow for cognitive reframing to assist men to see their strength and positive growth arising from survival.     

Binge and purge behavior among adolescents: associations with sexual and physical abuse in a nationally representative sample: the Commonwealth Fund survey

OBJECTIVES: (1) To examine associations between binge and purge behavior and sexual and physical abuse among adolescents; (2) to determine if these associations remain significant after controlling for sociodemographic and anthropometric characteristics; and (3) to identify aspects of abuse associated with binge and purge behavior. METHOD: A nationally representative sample of 6728 adolescents in 5th-12th grades completed the Commonwealth Fund Survey of the Health of Adolescent Girls and Boys. RESULTS: Binge and purge behavior was nearly twice as prevalent among girls (13%) as boys (7%), and was significantly associated with all abuse types (physical, sexual, or both). Associations were strongest among individuals who had experienced both physical and sexual abuse [odds ratios 4.28 (girls) and 8.25 (boys)]. Differences in binge and purge behavior by gender and type of abuse across abuse characteristics were limited. A higher percentage of abused youth that did not discuss their abuse reported binge-purge behavior than those who did discuss their abuse. Abused girls and boys who did talk to someone about the abuse most often discussed the abuse with their best friend (42.5% and 18.0%, respectively), their mother (38.8% and 32.2%, respectively), and their friends (27.2% and 19.5%, respectively). DISCUSSION: Being physically and/or sexually abused was associated with greater likelihood for engaging in binge and purge behaviors. Discussing the abuse experience with another person may help to reduce binge-purge behavior, as abused adolescents who did not discuss the abuse were more likely to report binge-purge behavior than those who did discuss their abuse.     

A comparison of sexually abused and non-sexually abused adolescents in a clinical treatment facility using the MMPI-A

OBJECTIVE: In the current study, the adolescent version of the Minnesota Multiphasic Personality Inventory, the MMPI-A, was used to address concerns voiced about the mixing of different developmental ages, use of inadequate comparison groups, and the lack of reliance on reliable and valid measures of psychological, behavioral, and psychosocial problems used in previous studies of sexually abused children and adolescents. METHOD: A total of 107 adolescents in residential treatment (73 boys and 34 girls) were included in the study. Seventy-two of these adolescents had reportedly been sexually abused (42 boys and 30 girls); 35 had not been abused (31 boys and 4 girls). Predictions based on previous research with adolescents were made and tested regarding which MMPI-A validity, clinical, and content scales would differ between the sexually abused and non sexually abused groups of adolescents. RESULTS: Overall, and consistent with many predictions, sexually abused adolescents had both statistically and clinically higher elevations on several MMPI-A scales than did their non-abused counterparts. No scales were more elevated for non-abused adolescents than for abused adolescents. CONCLUSIONS: Sexually abused adolescents in residential treatment, as a group, present with concerns that their non-abused counterparts did not have, or did not share to the same extent. Treatment recommendations based on the MMPI-A scale elevations are provided, limitations of the current study discussed, and directions for further research are suggested.     

Childhood sexual abuse and revictimization in adolescence.

OBJECTIVE: The aim of this study was to examine the link between childhood experiences of sexual abuse and subsequent revictimization in adolescence. METHOD: A sample of 281 female adolescents between 17-20 years of age, who participated in a prevalence survey of unwanted sexual contacts, completed the Sexual Experiences Survey as a measure of unwanted sexual contacts in adolescence and indicated whether or not they had experienced childhood sexual abuse. RESULTS: Childhood experiences of sexual abuse were reported by 8.9% of the respondents, a further 8.5% indicated they were not sure if they had been sexually abused as children. Both abused women and women uncertain about their victimization status were significantly more likely to report unwanted sexual contacts as adolescents than women who did not state abuse. The link between childhood abuse and subsequent victimization was mediated by a higher level of sexual activity among the abuse victims. CONCLUSIONS: The results support existing evidence on the impact of childhood sexual abuse on sexual relationships in subsequent developmental stages and underline the need to consider childhood sexual abuse as a risk factor of adolescent sexual victimization.     

Psychological profiles of sexually abusive adolescents in Ireland

OBJECTIVE: This study aimed to profile the psychological and psychosocial characteristics of a group of Irish adolescents who had sexually abused other youngsters. METHOD: Levels of behavior problems, personal adjustment, anger management, and psychosocial adjustment were compared in 27 Irish adolescents with a history of sexually abusing another youngster (SA group), 20 clinical controls who had significant behavioral problems but no history of sexual offending (CC group), and 29 normal controls who were without significant psychological problems (NC group). Measures used included the Child Behavior Checklist (CBCL), the Youth Self-Report Form (YSR), selected scales from Beckett (1997) Adolescent Sex Offender Assessment Pack (ASOAP), and the Family Environment Scale (FES). RESULTS: Compared with the CC group, the SA group displayed fewer problems overall on the CBCL and the YSR. The SA group showed problems with self-esteem, emotional loneliness, and perspective-taking similar to those of the CC group, but their impulsivity scores were similar to those of the NC group. The locus of control scores of the SA group fell between those of the CC and NC groups. The SA group showed an anger management profile that fell at an intermediate position between those of the NC and CC groups. The SA group showed problematic family functioning in the areas of expressiveness, behavior control, and social support, similar to those of the CC group. Their difficulties with family cohesion were less severe than those of the CC group but worse than those of the NC group. CONCLUSIONS: Overall, the psychological adjustment of adolescents with a history of sexually abusing others was more problematic than that of normal controls but less problematic than that of youngsters who had significant behavioral problems but no history of sexual offending.     

Personality development following sexual abuse

Thirty-seven girls and twelve boys who had been sexually abused at an average of 2.6 years previously were traced and reviewed. The nonoffending parents participated in a structured interview and the children were assessed using the Piers-Harris Self-Concept Scale and the Achenbach Child Behavior Checklist. Each child was matched with a child not known to have been sexually abused and these control children underwent a similar psychological assessment. Interviews with the nonoffending parents found that 76% of the children were thought to be less confident than before, 30% had fewer friends, and 20% were more aggressive. Increased sexual awareness was noted in 24%. School teachers reported that 28% still had behavior problems, 17% had repeated a year at school, and a further 17% had deteriorated in their school work. The sexually abused girls had significantly lower self-esteem than the control girls. There was no difference in self-esteem between the control and the sexually abused boys. There was a higher incidence of stranger assault in the boys compared with the girls. The Child Behavior Checklist completed by the parents, the Teacher Report Form, and the Youth Self-Report of the Child Behavior Checklist showed that a highly significant proportion of sexually abused children fell into the clinical range. Sexual abuse appears to have long-term adverse consequences for many of the victims. This may have implications for their ability to relate to others, for the adult friendships they will make, and eventually for the way they will relate to their own children.     

Interactional effects of marital status and physical abuse on adolescent psychopathology

OBJECTIVE: The purpose of this study was to explore the interactional effects of parental marital disruption and physical abuse on risk for adolescent psychopathology in a nonclinical sample with a randomly selected control group. METHOD: The sample was drawn from 99 community-based adolescents indicated as physically abused by Child Protective Services and 99 randomly selected controls. Nonabused adolescents whose parents were married, abused adolescents whose parents were married, nonabused adolescents with a parental marital disruption, and abused adolescents with a parental marital disruption were compared. Outcome was psychopathology as measured by psychiatric diagnosis based on a best-estimate procedure subsequent to semistructured diagnostic interviewing. RESULTS: Interactional effects of marital disruption and abuse were found for risk for lifetime Attention Deficit Hyperactivity Disorder (ADHD), with parental marital disruption and having been physically abused combining to increase the risk 15 times for diagnosis of lifetime ADHD. Parental marital status alone was not a significant risk factor for adolescent psychopathology, but physical abuse was a significant risk factor for several diagnostic categories. CONCLUSIONS: Future divorce research should include abuse history as a possible confounding variable. Possible reasons for the findings are reviewed and clinical implications are discussed.     

Symptomatology in adolescents following initial disclosure of sexual abuse: The roles of crisis support, appraisals and coping

ObjectiveThe present study examined possible explanations for symptom development and variability in sexually abused adolescents. A theoretical model of sexual abuse, in which appraisal, coping and crisis support play prominent roles, was tested in a clinical group of 100 sexually abused adolescents.MethodParticipants, aged 12–18 years, completed questionnaires regarding severity of abuse, negative appraisals, crisis support, coping strategies, and trauma-related stress symptoms.ResultsSince severity of abuse had no influence on the association between appraisals and symptoms it was eliminated from our model. Structural equation modeling analyses showed a significant interrelationship between the examined concepts. Adolescents who appraised the abuse as more threatening showed more internalizing and externalizing trauma symptoms. Moreover, more negative appraisals were associated with more avoidance as well as with more active coping strategies. Direct crisis support was associated with less negative appraisals and with the use of more active coping strategies.ConclusionsThe study showed that especially the buffering role of crisis support and the role of negative appraisals explained symptom development and variety in sexually abused adolescents.Practice implicationsAdaptation to sexual abuse includes the ways in which adolescents perceive the event as threatening and harmful, how they cope with the abusive experience, and how they receive direct support from their family. Clinicians, therefore, need to expand the focus of their assessments beyond age- and trauma-specific symptoms, to age- and trauma-specific appraisals, coping, and social support. The assessment of these factors should take place as soon as possible after the disclosure of the abuse. Individualized treatment plans and clinical interventions need to be based on these personal and environmental variables, rather than reliance on the influence of abuse-related characteristics, such as the severity or type of abuse.     

Child on child sexual abuse: psychological perspectives

OBJECTIVE: This study describes the emotional and behavioral responses of children who have been sexually victimized by juveniles (CC) 17 years of age and younger compared to child victims of adults (CA) 18 years of age and older. METHOD: A total sample of N = 194 children and adolescents participated in the study, with 26% (n = 51) comprising CC and 74% (n = 143) encompassing CA. The mother/caretaker was administered a demographic form, Achenbach's Child Behavior Checklist (CBCL), and the Family Assessment Measure (FAM-P). The child was given the Family Assessment Measure (FAM-C) and the Trauma Symptom Checklist for Children (TSCC). The clinician completed the Parental Reaction to Incest Disclosure Scale (PRIDS). RESULTS: No differences were found between the two groups for the type of sexual abuse, penetration, or the use of force. CC were younger and more likely to be males who were abused in a school setting, home, or a relative's home by a sibling or a non-related male. CC endorsed clinically significant sexual preoccupations and manifested borderline clinically significant symptomatology. CONCLUSIONS: Children victimized by other children manifested elevated levels of emotional and behavioral problems and were not significantly different from those who had been sexually abused by adults.     

Factors associated with an increased impact of child sexual abuse

Data is presented identifying factors associated with the impact of sexual abuse on children. A group of 369 sexually abused children and a comparison group of 318 children recruited from the community were compared on a parent-completed behavior rating scale. Data describing the abused children were also available from a 38-item symptom checklist completed by the child's social worker. Using a score based on the symptom checklist as the measure of the impact of sexual abuse, 15 variables were in the final regression equation explaining 42% of the variance in impact. Using a score based on parent-generated data, 5 variables were in the final equation explaining 20% of the variance. The significance of the variables in identifying factors associated with an increased impact of abuse is discussed.     

Maternal variables related to sexually abused children's functioning.

OBJECTIVE: The purpose of this study was to explore how mothers' developmental history and current functioning affects their sexually abused children's functioning and recovery. METHOD: A sample of 67 African-American mothers and their sexually abused children participated in this study. Interviews and a range of adult and child measures were administered in order to assess maternal developmental history and current functioning, and child functioning. RESULTS: Mothers' past experiences as children were associated with their children's behavior and general functioning following the sexual abuse. Mothers who experienced more discontinuity of childhood care, who were sexually abused as children, and/or had more problems in their family of origin had children who showed poorer functioning and more behavioral symptomatology. In addition, mothers who currently were experiencing more trauma symptomatology, reported substance abuse, and/or were less able to provide support to their children, had children with more behavior problems and poorer functioning. CONCLUSIONS: The findings from this study point to the impact of mothers' developmental history and current functioning upon the symptomatology of their sexually abused children.     

Adolescent abuse and the development of personal sense of control

The link between adolescent abuse, the adolescent's psychological functioning, and locus of control orientation is explored. Maltreated adolescents experience such problems as low self-esteem, antisocial behavior, and suicidal tendencies. It is argued that the adolescent's locus of control orientation, deriving from his/her experiences in the home, may determine the extent to which the adolescent exhibits problematic behavior and personal maladjustment. Although locus of control in abused adolescents has not been investigated, studies show that individuals who experience the same types of problems evidenced by abused adolescents are more likely to have perceptions of external control. The nature of the relationship between locus of control and abuse may depend upon the duration of the abuse (i.e., long- versus short-term abuse). For example, adolescents who have experienced abusive behavior throughout childhood are expected to be more externally oriented than those adolescents who have been abused for a shorter time. Thus, long-term abused adolescents will be more likely to have perceptions of external control than nonabused adolescents, with short-term abused adolescents falling in the middle. The distinction between short- and long-term abuse in the context of locus of control may be important to consider when designing treatment programs for abused adolescents.     

Sexual Health Education in Massage Therapy Programs: A Survey of Program Directors

Massage therapy program directors completed an online survey to explore sexual education in massage therapy programs. The overall data suggest that program directors are supportive of sexual health education in the training of massage therapists and that such education is integrated into several aspects of their training programs. To enhance sexual health education, massage therapy programs could collaborate with specialists in sex therapy or sexuality education. Massage therapy training may need to include the following topics: working with clients who have been sexually abused, working with transsexual clients, understanding sexual arousal processes, and understanding dynamics between men and women.     

An assessment of the behavior of sexually abused and nonsexually abused children with anatomically correct dolls

The behaviors of two groups of children were observed and recorded in their play with anatomically correct dolls. One group had been determined to have been sexually abused and the other group had not been determined to have been sexually abused. The findings show that significantly more children who had been sexually abused demonstrated sexual behavior(s) with the anatomically correct dolls than did the group of children who had not been sexually abused. These findings suggest that anatomically correct dolls are a useful instrument in sexual abuse investigations.     

Correlates of sexual abuse and smoking among French adults

OBJECTIVE: The goal of this study was to examine the association between sexual abuse (SA) and initiation, cessation, and current cigarette smoking among a large representative adult population in France. METHOD: A random sample size of 12,256 adults (18-75 years of age) was interviewed by telephone concerning demographic variables, health practices and beliefs, and health status--for which SA and tobacco questions were included. Bivariate and multivariate analyses were conducted. RESULTS: Nearly 46% of SA survivors were current smokers compared to 34% of non-abused persons (p<.001). Survivors of SA consumed more cigarettes per day than non-abused individuals (14.5 vs. 12.4, p<.01). Survival analysis showed an increased risk of smoking initiation for respondents abused before 18 (adjusted relative hazard=1.55; p<.0001) with referent to the non-abused group. SA was not found to be a significant predictor of current smoking status among those who began smoking after the first incident of SA. Respondents who were not sexually abused were 1.8 times (95% CI, 1.12-2.99) more likely to quit smoking than people who began smoking after they were sexually abused. CONCLUSIONS: The early identification and treatment of sexually abused persons is critical to decrease smoking among adolescents and adults because of the association of SA with both smoking initiation and decreased cessation rates. It may be more difficult to detect an association between SA and current smoking due to the high rates of smoking and lower rates of quitting among the general French population.     

Self-defining as sexually abused and adult sexual risk behavior: results from a cross-sectional survey of women attending an STD clinic

Objective

Childhood sexual abuse (CSA) is associated with increased sexual risk behavior in adulthood, and this association may be mediated by traumagenic dynamics constructs (i.e., traumatic sexualization, trust, guilt, and powerlessness). However, few studies have investigated whether such relationships hold for women who do not identify as having experienced CSA despite meeting objective criteria that CSA occurred. This study sought to determine whether individuals who met research criteria for CSA and who self-defined as sexually abused differed on traumagenic dynamics constructs and current sexual risk behavior from individuals who met research criteria for CSA and who did not self-define as sexually abused.

Methods

Participants were 481 women recruited from a publicly funded STD clinic. Participants completed a computerized survey assessing childhood sexual experiences and adult sexual risk behavior.

Results

Of the total sample, 206 (43%) met research criteria for CSA. Of the women meeting research criteria for CSA, 142 (69%) self-defined as sexually abused. Women who met research criteria for CSA reported more traumatic sexualization, more trust of a partner, more powerlessness, less sexual guilt, more episodes of unprotected sex, more sex partners, and greater likelihood of sex trading, compared to women who did not meet research criteria for CSA. Among women meeting research criteria, those who self-defined as sexually abused did not differ from those who did not self-define on any of the traumagenic dynamics constructs or on current sexual risk behavior, controlling for CSA characteristics.

Conclusions

Individuals who were sexually abused as children by behavioral research criteria are at risk for engaging in sexual risk behavior as adults, regardless of whether or not they perceive the experience to be CSA. Future research is needed to understand how non-definers perceive these childhood sexual experiences.     

Suicidal phenomena and abuse in adolescents: a review of epidemiological studies

OBJECTIVE: To conduct a systematic review of the international literature to determine whether adolescents who had experienced abuse were more likely to also experience suicidal thoughts and behaviors than other adolescents, and to investigate the nature of this association. METHOD: Reports of community- or school-based studies of adolescents on the association between the prevalence of suicidal phenomena and abuse were searched for via electronic databases, reviewing reference lists and contacting experts in the field. RESULTS: Ten relevant studies were identified. Adolescents who had been physically or sexually abused were significantly more likely to experience suicidal thoughts and behaviors than other adolescents. This association appeared to be direct in most studies in which multivariate analyses were conducted. There is evidence that other factors (e.g., low self-esteem) may play a mediating role in the relationship between abuse and suicidal phenomena. CONCLUSIONS: There is a clear link between abuse and suicidal phenomena occurring during childhood and adolescence.     

Sexual behavior problems in sexually abused children: a preliminary typology

OBJECTIVE: The goal was to develop an empirically derived typology for sexually abused children exhibiting sexual behavior problems to assist practitioners in differential assessment, treatment, and case planning. METHOD: Data were systematically gathered from the clinical records of 100 sexually abused children, aged 3 years to 7 years, enrolled in two treatment programs. Twelve indexes were created corresponding to major areas of child and family history, functioning, and treatment response. After initial sorting into subgroups based on the presence or absence of interpersonal sexual behavior problems, further subdivision was based on hierarchical cluster analysis. RESULTS: Five distinctive sexual behavior profiles emerged: (1) developmentally expected; and developmentally problematic (2) interpersonal, unplanned, (3) self-focused, (4) interpersonal, planned (noncoercive), and (5) interpersonal, planned (coercive). Elements of the child's sexual abuse experience, opportunities to learn/practice problematic sexual behavior, and familial variables best differentiated between the types. CONCLUSIONS: The five types differed not only in child sexual behavior but in most areas of child and family functioning, including treatment outcome. The findings offer support for the development of an empirically-based typology for children with sexual behavior problems utilizing a range of variables which go beyond typical classification systems based on offender and victim characteristics.     

The prevalence and correlates of abuse among children with autism served in comprehensive community-based mental health settings

OBJECTIVE: To determine the demographic and psychosocial correlates of physical and sexual abuse among children with autism. METHODS: Data collected from 1997 to 2000 through the national evaluation of the Comprehensive Community Mental Health Services for Children and their Families Program on 156 children with autism were used. Data included a baseline assessment of child and family psychosocial experiences and presenting problems associated with referral into system-of-care service, demographic information, and a clinical record review to obtain psychiatric diagnosis. Binary and multinomial logistic regression was used to determine the association of different characteristics of children who were abused compared with those who were not abused. RESULTS: Caregivers reported that 18.5% of children with autism had been physically abused and 16.6% had been sexually abused. Physically abused children more likely had engaged in sexual acting out or abusive behavior, had made a suicide attempt, or had conduct-related or academic problems. Sexually abused children more likely had engaged in sexual acting out or abusive behavior, suicidal or other self-injurious behavior, had run away from home, or had a psychiatric hospitalization. In adjusted multivariate models, the relationship between sexual abuse and sexual acting out, running away from home and suicidal attempts persisted. CONCLUSION: Based on the prevalence of abuse and its association with various behaviors, clinicians should be as attuned to the psychosocial histories of children with autism as they are for other children, and consider the potential of abuse when these behaviors are observed.