Brother-sister incest - father-daughter incest: a comparison of characteristics and consequences.

OBJECTIVE: One group of women who were sexually abused by brothers and a second group who were sexually abused by fathers are compared with the intent to identify the differing characteristics of each type of abuse and the effects of the abuse on their adult functioning. Our hypothesis was that there would indeed be differences in the characteristics of the abuse and its effects, and that this would necessitate differing treatment strategies. METHOD: Surveys were distributed to women attending support groups for incest survivors. Of the 62 women completing questionnaires, 14 women (23%) had been sexually abused by a brother. A similar number of women (15) who had been sexually abused by their fathers were chosen from the overall sample for comparison. RESULTS: The absence of the father as a vital force in family life played a key role in the sexual abuse of women by their brothers in every case. The duration of the sexual abuse for brother-abused women and father-abused women was lengthy. The characteristics, including use of force, are equally as serious for sisters as for daughters. The family circumstances surrounding the abuse were examined for both groups and the results yielded a fuller understanding of the incestuous family. Despite an appearance of normalcy, the level of family-wide disturbances, for example substance abuse, mental illness and pervasive family-wide violence were profound for both groups. In this study, we also examine the effects in adulthood of the serious disruption of childhood developmental phases for both brother-abused and father-abused women, taking into account the incidence of substance abuse, depression, suicidality, and eating disorders. CONCLUSIONS: The authors conclude that the characteristics and consequences of brother-sister incest are of equal seriousness to those of father-daughter incest. This would suggest that brother-sister incest is one of the current blind spots in incest research, and one that we cannot afford to ignore. In-depth knowledge of the dynamics and effects of brother-sister incest suggest specific treatment strategies are indeed necessary and these are discussed in this paper.     

Self-reports of forgetting and remembering childhood sexual abuse in a nationally representative sample of US women

OBJECTIVE: The purpose of this article is to describe patterns of forgetting and remembering childhood sexual abuse (CSA) in a nationally representative sample of US adult women. METHOD: The respondents were a national probability sample of 711 women, aged 26 years to 54 years, residing in noninstitutional settings in the contiguous 48 states. In a 1996 face-to-face interview survey, trained female interviewers asked each respondent whether she had experienced any sexual coercion by family members or nonfamily members while growing up; whether she believed that she had been sexually abused (by family members or others); and whether she had ever forgotten the CSA experiences and, if so, how she had subsequently remembered them. RESULTS: Twenty-one and six-tenths percent of respondents reported having sexually coercive experiences while growing up; of these, 69.0% indicated that they felt they had been sexually abused. More than one-fourth of respondents who felt sexually abused reported that they had forgotten the abuse for some period of time but later remembered it on their own. Only 1.8% of women self-described as sexually abused reported remembering the abuse with the help of a therapist or other professional person. CONCLUSIONS: The findings indicate that, among women who report CSA, forgetting and subsequently remembering abuse experiences is not uncommon. According to the women surveyed, however, very few (1.8%) of those who felt abused recovered memories of CSA with help from therapists or other professionals. As one of the few studies of CSA memories in a nationally representative sample, this study suggests that therapist-assisted recall is not a major source of CSA memories among women in the US general population.     

A review of the long-term effects of child sexual abuse.

The existing literature on the long-term sequelae of child sexual abuse is reviewed. The evidence suggests that sexual abuse is an important problem with serious long-term sequelae; but the specific effects of sexual abuse, independent of force, threat of force, or such family variables as parental psychopathology, are still to be clarified. Adult women with a history of childhood sexual abuse show greater evidence of sexual disturbance or dysfunction, homosexual experiences in adolescence or adulthood, depression, and are more likely than nonabused women to be revictimized. Anxiety, fear, and suicidal ideas and behavior have also been associated with a history of childhood sexual abuse but force and threat of force may be a necessary concomitant. As yet, there is insufficient evidence to confirm a relation between a history of childhood sexual abuse and a postsexual abuse syndrome and multiple or borderline personality disorder. Male victims of child sexual abuse show disturbed adult sexual functioning. The relation between age of onset of abuse and outcome is still equivocal. Greater long-term harm is associated with abuse involving a father or stepfather and abuse involving penetration. Longer duration is associated with greater impact, and the use of force or threat of force is associated with greater harm.     

Child maltreatment and perceived family environment as risk factors for adult rape: is child sexual abuse the most salient experience?

OBJECTIVE: Child maltreatment and family functioning were examined as predictors of adult rape in a sample of 925 college women. METHOD: Information was obtained from retrospective self-report questionnaires. Child sexual abuse (CSA) was assessed with the Life Experiences Questionnaire, child emotional abuse (CEA) and physical abuse (CPA) were assessed with the Childhood Trauma Questionnaire, family functioning was assessed with the Family Environment Scale, and adult rape was assessed with the Sexual Experiences Survey. RESULTS: Approximately 17% of women reported a history of any form of child abuse: 8.9% reported CSA, 4.2% reported CPA, and 8.6% reported CEA. Fifteen percent of participants reported a history of rape since age 17. CSA and CEA, but not CPA, were related to adult rape. Experiencing multiple forms of child abuse increased the risk of adult rape. Logistic regression analyses indicated that CSA predicted adult rape (OR=1.9). Further, low levels of family cohesion predicted adult rape only in the absence of CEA (OR=1.2), and low levels of emotional expressiveness in the family predicted adult rape only in the presence of CEA (OR=1.4). CONCLUSIONS: Findings highlight the need to consider multiple forms of child abuse as well as family functioning in relation to the risk of adult sexual victimization. Findings suggest CSA is a risk factor for adult victimization independent of family functioning, and family dysfunction exerts an impact on rape only in relation to CEA.     

Sexual and physical abuse history and adult sexual risk behaviors: relationships among women and potential mediators

OBJECTIVE: While research has supported associations between experiencing abuse and engaging in risky sexual behaviors during adolescence, research regarding these associations among adult women is much more equivocal. In addition, few studies have attempted to identify potential pathways from abuse experiences to sexual risk behaviors. The current study examined the associations between a history of physical or sexual abuse and recent sexual risk behaviors among adult women. Additionally, this study evaluated binge drinking and depressive symptomatology as potential mediators of any relationships between abuse history and sexual risk behaviors. METHODS: A total of 1,428 women between 18 and 40 years of age attending family planning clinic appointments completed a self-report survey regarding their recent sexual behaviors and sexual and physical abuse history. Logistic regressions using backward elimination were conducted to identify factors associated with sexual risk behavior. RESULTS: A history of physical abuse by a romantic partner was associated with several sexual risk behaviors. Few significant associations between intrafamilial physical or sexual abuse and recent sexual risk behaviors were found. Additionally, there was no evidence that these relationships were mediated by binge drinking or depressive symptomatology. CONCLUSIONS: Familial abuse experiences are not necessarily associated with recent sexual risk behaviors among adults. In contrast, physical abuse experiences, particularly those perpetrated by a romantic partner, are associated with engaging in adult sexual risk behaviors among women. However, these associations are not mediated by alcohol use or depressive symptomatology.     

A retrospective study of long-term methods of coping with having been sexually abused during childhood.

Methods of coping with childhood sexual abuse were retrospectively studied in a community sample of 54 adult women who had been sexually abused in childhood. From the time the abuse ended until the present, "denial" and "emotional suppression" were the coping methods most commonly employed of the nine methods measured. One purpose of this study was to determine if the methods used to cope with the aftermath of being sexually abused during childhood were associated with current psychological adjustment beyond what could be predicted by the characteristics of the abusive experience per se. A partial correlation analysis and a multiple regression analysis suggested that avoidant/emotion suppressing coping strategies although frequently used and rated by subjects as helpful, were in fact associated with poorer adult psychological adjustment.     

Association between self-reported health and physical and/or sexual abuse experienced before age 18

OBJECTIVE: The present study evaluated the association between women's health and physical and sexual abuse suffered before age 18. METHODS: A total of 3,568 randomly sampled insured women ages 18-64 completed a telephone interview to assess history of physical only, sexual only, or both physical and sexual abuse before age 18 (Behavioral Risk Factor Surveillance System); and current health (Short Form-36, Center for Epidemiologic Studies-Depression, Presence of Symptoms surveys). Adjusted analyses compared the health of women with physical abuse only, sexual abuse only, or physical and sexual abuse to the health of women without these abuse histories. RESULTS: Poorest health status was observed in women with a history of both physical and sexual child abuse compared to women without these abuse histories. In models that adjusted for age and income, women with both abuse types had increased prevalence of depression (prevalence ratio, 2.16), severe depression (PR, 2.84), physical symptoms (PR range, 1.33 for joint pain to 2.78 for nausea/vomiting), fair/poor health (PR, 1.84), and lower SF-36 scores (3.15-5.40 points lower). Women with physical abuse only or sexual abuse only also had higher prevalence of symptoms and lower SF-36 scores but the associations were not as strong. CONCLUSIONS: This study adds to the literature showing a graded association between multiple adverse events in childhood and adult health.     

Long-term physical and mental health consequences of childhood physical abuse: results from a large population-based sample of men and women

OBJECTIVE: Child maltreatment has been linked to negative adult health outcomes; however, much past research includes only clinical samples of women, focuses exclusively on sexual abuse and/or fails to control for family background and childhood characteristics, both potential confounders. Further research is needed to obtain accurate, generalizable estimates and to educate clinicians who are generally unaware of the link between childhood abuse and adult health. The purpose of this project is to examine how childhood physical abuse by parents impacts mid-life mental and physical health, and to explore the attenuating effect of family background and childhood adversities. METHODS: We analyzed population-based survey data from over 2,000 middle-aged men and women in the Wisconsin Longitudinal Study using self-reported measures of parental childhood physical abuse, mental health (depression, anxiety, anger), physical health (physical symptoms and medical diagnoses), family background, and childhood adversities. RESULTS: Parental physical abuse was reported by 11.4% of respondents (10.6% of males and 12.1% of females). In multivariate models controlling for age, sex, childhood adversities, and family background, we found that childhood physical abuse predicted a graded increase in depression, anxiety, anger, physical symptoms, and medical diagnoses. Childhood physical abuse also predicted severe ill health and an array of specific medical diagnoses and physical symptoms. Family background and childhood adversities attenuated but did not eliminate the childhood abuse/adult health relationship. CONCLUSIONS: In a population-based cohort of middle-aged men and women, childhood physical abuse predicted worse mental and physical health decades after the abuse. These effects were attenuated, but not eliminated, by age, sex, family background, and childhood adversities.     

Sexual abuse during childhood and adolescence among Nicaraguan men and women: a population-based anonymous survey

AIMS: The objective was to describe experiences of sexual abuse occurring before 19 years of age among men and women in León, Nicaragua and to explore the possible association to later sexual risk behavior. METHOD: A sub-sample of literate urban men and women 25-44 years of age was selected from a representative sample of households in León. After an invitation to a public health event, 154 men (53% of the invited) and 213 women (66% of those invited) participated in giving written answers to an anonymous questionnaire. RESULTS: Twenty percent of men and 26% of women reported that they had experienced sexual abuse. Women had been victims of attempted or completed rape twice as often as men, 15% as compared to 7%. Thirty-three percent of the abuse towards boys and 66% of the abuse towards girls was committed by family members. Women who had experienced attempted or completed rape were more likely to later have had a higher number of sexual partners compared to non-abused or moderately abused women. CONCLUSIONS: Sexual abuse of children and adolescents of both sexes is common in Nicaragua. The results underscore the urgent need to address this serious problem more openly, and to make more resources available for the prevention of sexual abuse and for support to victims.     

Assessing the relationship between child sexual abuse and marginal living conditions on HIV/AIDS-related risk behavior among women prisoners

OBJECTIVE: There were two aims in this research. First, to examine the relationships between childhood sexual abuse and HIV drug and sexual risk taking behaviors among female prisoners, and second, to examine the relationship between a marginal adult living context and HIV drug and sexual risk taking behavior among female prisoners. METHOD: The data were collected through face-to-face interviews with a random sample of 500 women at admission to prison in 1994. Differences between women who were sexually abused while growing up (n = 130) were compared to women who reported no sexual abuse (n = 370) along various demographic, and HIV drug and sexual risk taking dimensions. RESULTS: A history of sexual abuse while growing up was associated with increased sexual risk taking behaviors in adulthood. A marginal adult living situation also emerged as an important factor increasing the risk for HIV infection. Examining the co-occurrence of both childhood sexual abuse and adult marginal living context revealed a strong relationship between these two factors and HIV risk taking activities. CONCLUSIONS: The findings indicate that childhood sexual abuse may be a predictor for HIV sexual risk taking behaviors among incarcerated women. The marginal and chaotic adult living style of these women was also associated the extent of their HIV drug and sexual risk taking behaviors. Our research suggests that the co-occurrence of sexual victimization and marginality is a stronger predictor of HIV risk than each variable alone.     

Association between early sexual abuse and adult HIV-risky sexual behaviors among community-recruited women.

OBJECTIVE: The first purpose was to determine whether sexual abuse involving penetration that occurred in childhood only, adolescence only, or both childhood and adolescence differently impacted whether community-recruited women had ever traded sex for money or drugs, their number of recent sex partners, and the number of times they had engaged in recent unprotected sex. The second purpose was to assess the mediating effects of adulthood rape, recent drug use, and recent sex with an injection drug user on these three HIV-risky sexual behaviors. METHOD: Women (n = 1,490) recruited from three US sites were questioned about their childhood and/or adolescent sexual abuse histories, adulthood rape experiences, recent drug use, and adult HIV-risky sexual behaviors via structured interviews. RESULTS: One-third of the women reported having experienced sexual abuse involving penetration in childhood and/or adolescence. Overall, regression analyses indicated a significant relationship between early sexual abuse and adult risky behaviors; rape in adulthood mediated this relationship for all three HIV-risky behaviors. Abuse that occurred in childhood only and abuse that occurred in both childhood and adolescence had a stronger impact on later risky behaviors than did abuse that occurred in adolescence only. CONCLUSIONS: Because childhood constitutes a critical period in individuals' sexual, social, and personal development, sexual abuse precipitated during this time may distort women's constructions of sex and sexuality. Women abused in childhood may therefore engage in HIV-risky sexual behaviors to a greater extent than women abused in adolescence as a result of these disruptions to their development. Rape in adulthood appears to intensify the effects of early sexual abuse,     

Why sexual abuse? An exploration of the intergenerational hypothesis

The issue of sexual abuse in the family backgrounds of offenders and mothers of victims is explored in a clinical sample of 154 cases of intrafamilial sexual abuse. More than a third of the offenders and about half of the mothers had experienced or been exposed to sexual abuse as children. Cases were divided into those where the sexual abuser was the biological father in an intact family, those where he was a stepfather or mother's live-in partner, and those where he was a noncustodial father. In biological father cases, parents were about equally likely to have experienced sexual abuse during childhood, in the stepfather/live-in partner cases, the mother was more likely to have had such an experience, and in the noncustodial father cases, the offender was more likely to have come from a sexually abusive family.     

Child sexual abuse and bulimic symptomatology: relevance of specific abuse variables

OBJECTIVE: This study examined specific aspects of child sexual abuse in relation to symptom severity among hospitalized patients diagnosed with bulimia nervosa. METHOD: Participants were 45 hospitalized bulimic women who reported a history of child sexual abuse. Structured interviews were conducted in order to obtain detailed information regarding specific features of the abusive event(s). Participants also completed instruments that measured depression and eating pathology. RESULTS: There were no significant differences in severity of depression or eating disturbance among women reporting differing abusive experiences including intrafamilial versus extrafamilial abuse, abuse with or without the use of physical force, one versus multiple incidents, early abuse versus abuse occurring after age 14, contact versus noncontact abuse, disclosed versus undisclosed, and combined physical/sexual abuse versus sexual abuse alone. CONCLUSION: The specific characteristics of child sexual abuse are not related to the level of symptomatology for hospitalized bulimic patients. This study suggests that differences in the nature of the abuse may not be as important as the fact that the abuse occurred in the first place.     

The effects of sexual abuse as a child on the risk of mothers physically abusing their children: a path analysis using systems theory

OBJECTIVE: The potential path from sexual abuse as a child to the current risk of physical abuse by mothers was assessed. Ontogenic variables including the experience of the parent's sexual abuse as a child and current depression or substance abuse were expected to have a greater impact on the risk of child abuse than microsystem and exosystem variables such as family functioning, domestic violence, income, community safety, and social support. METHOD: A path analysis using secondary data was conducted to examine these systemic impacts. The sample consisted of 265 women, the majority of whom were African-American with a high school education or GED. The majority of these women were employed, lower socio-economic status, and over 50% of the sample had never been married. RESULTS: Sexual abuse as a child was found to impact maternal depression. Maternal depression and locus of control impacted risk of physical abuse. These two variables accounted for 22% of the variance in the dependent variable. CONCLUSION: These findings indicate that it may not be the experience of sexual abuse itself that has an impact on a mother's risk of physical abuse, but rather whether she is able to resolve that trauma. Her locus of control appears to be important in this resolution. The majority of these women were low-income, urban African-American women; it may be important to focus on locus of control for this population.     

Child sexual abuse prevention programs: do they decrease the occurrence of child sexual abuse?

OBJECTIVE: The primary goal of the current study was to determine whether rates of child sexual abuse differed among undergraduate women who either had or had not participated in a sexual abuse prevention program during childhood. A secondary goal was to determine whether differences emerged in sexual satisfaction or avoidance of sexual activity between those women who had or had not participated in such a program. METHOD: Eight hundred and twenty-five women undergraduates from a New England state university filled out a survey on "sexual experiences" for research credit. Respondents were asked detailed questions regarding past histories of child sexual abuse and participation in school-based prevention programs during childhood. Additionally, they responded to questions about their current sexual satisfaction and sexual behaviors. RESULTS: Sixty-two percent of the sample reported having participated in a "good touch-bad touch" sexual abuse prevention program in school. Eight percent of respondents who reported ever having had a prevention program also reported having been subsequently sexually abused, compared to 14% of respondents who did not ever have a prevention program. No differences were found in adult sexual satisfaction or on behavioral measures of sexual activity between those respondents who had and had not participated in a prevention program. CONCLUSIONS: This is the first study to find that school-based child sexual abuse prevention programs are associated with a reduced incidence of child sexual abuse. Additionally, contrary to concerns voiced in the literature, there was no evidence that prevention programs are associated with decreased sexual satisfaction or avoidance of sex in adulthood. Implications of the results for further study are discussed.     

Symptomatology associated with childhood sexual victimization in a nonclinical adult sample

The current study examined the incidence and long-term effects of sexual abuse in a nonclinical sample of adult women. Approximately 15% of 278 university women reported having had sexual contact with a significantly older person before age 15. On a modified version of the Hopkins Symptom Checklist, these women reported higher levels of dissociation, somatization, anxiety, and depression than did nonabused women. Abuse-related symptomatology was positively associated with the age of the abuser, the total number of abusers, use of force during victimization, parental incest, completed intercourse, and extended duration of time.     

Risk factors for a New Zealand sample of sexually abusive children and adolescents

OBJECTIVE: The aim was to understand variables contributing to the occurrence of sexual offending in children and adolescents. METHOD: Twenty youngsters who had engaged in coercive sexual behavior involving other children were compared to a matched group of clinic-referred youngsters with conduct disorders. Assessments included family histories, interviews, and psychometric measures. RESULTS: There was no group difference in the frequency of experiencing sexual abuse. However, sexually abusive youngsters were more often exposed to adult caregivers with known histories of being sexually abusive. These children had been subjected to multiple distortions of adult attachment, tended to internalize distress, and failed to use available social supports. They were likely to have experienced physical and verbal abuse; children with behavior disorders were more likely to have a parent with a psychiatric illness and to have experienced parental conflict. CONCLUSION: Severely disrupted attachment, in conjunction with family experiences of inappropriate sexual expression, place children and adolescents at risk for sexual offending. Sexually abusive youngsters had less social supports and their offending occurred after a negative emotional experience, when there was opportunity in the form of younger victims. The study suggests an interaction among developmental pathways, coping skills, and immediate proximal variables for the perpetration of sexual abuse by young people.     

Prior incest in mothers of abused children

Previous studies have shown that most abusing parents have a history of physical abuse or neglect in their own childhoods. There is little data on the frequency of prior sexual abuse among parents who physically or sexually abuse their children. Many case reports describe the uncovering of a prior incest experience in a parent during the investigation of the child's current incest accusation, but it is unclear how frequently this occurs. One hundred mothers of abused children were asked about sexual incidents that occurred before age 18; the control group consisted of 500 normal women from the same community who were surveyed during meetings of various voluntary organizations. Age and ethnicity did not differ in the two groups. Of the mothers of abused children, 24% reported a prior incest experience, whereas only 3% of the control women reported prior incest. This eightfold difference was highly significant. The 34 mothers from families where sexual abuse was occurring were no more likely to report prior incest than were the 66 mothers from families where physical abuse occurred. The one case of genital mutilation of a child occurred in a family where both parents had been incest victims. Case studies indicate that the parent who has been an incest victim has inhibitions and fears about tenderness, traceable to the childhood incest experience, which are important in the development of either physical abuse or sexual abuse in the family.     

Psychological impact of childhood sexual abuse on male inmates: the importance of perception.

OBJECTIVE: The current study examined the association between childhood sexual victimization and adult psychiatric disorders among male inmates. It further assessed the association between the perception of an event (as sexual abuse or not) and psychiatric diagnoses. METHOD: A sample of 211 randomly-selected male inmates were interviewed. The Diagnostic Interview Schedule (Version III-R) was used to assess psychiatric diagnoses. An additional questionnaire assessing childhood sexual abuse and perception of childhood sexual abuse was also administered. RESULTS: Forty percent of the inmates met standard criteria for childhood sexual abuse, which far exceeded rates found in the general population. Significant differences were found between inmates who had a history of childhood sexual abuse and those who did not for a variety of psychiatric diagnoses. Forty-one percent of those who met criteria for childhood sexual abuse did not consider themselves to have been abused. Those who did not consider themselves to have been abused had higher rates of alcohol abuse/dependence, while those who considered themselves to have been abused had higher rates of posttraumatic stress and obsessive-compulsive disorder. CONCLUSIONS: This study emphasizes the importance of perception or "cognitive appraisal" of the sexual experience (as abusive or not) and the need for further study regarding the potential mediating role of cognitive appraisal. Other implications of these findings include the need for primary prevention programs designed to reduce childhood sexual abuse, and inmate rehabilitation programs with an emphasis on the connection between victimization and criminality.     

The roles of peritraumatic dissociation, child physical abuse, and child sexual abuse in the development of posttraumatic stress disorder and adult victimization

OBJECTIVE: Previous research has indicated that women who experience childhood physical abuse or childhood sexual abuse are at increased risk for posttraumatic stress disorder (PTSD) and adult victimization. Recently, peritraumatic dissociation (PD) has been suggested as another possible risk factor for PTSD and adult victimization. The purpose of the present study was to investigate the effects of childhood physical and sexual abuse and PD on PTSD and adult victimization. METHOD: A sample of 467 female college students completed questionnaires about childhood and adult sexual and physical abuse experiences, PD, and PTSD symptoms. RESULTS: The combined sexual and physical abuse (CA) and sexual abuse only (SA) groups reported significantly higher numbers of PTSD symptoms than the physical abuse only (PA) and no abuse (NA) groups. The CA and PA groups reported significantly more adult sexual and physical victimization than the SA and NA groups. Across all four groups, higher levels of PD were associated with higher levels of PTSD and adult sexual and physical victimization. CONCLUSIONS: The results of the current study suggest that different types of childhood abuse may lead to different adult problems. The results also indicated that PD may have a broad effect on PTSD development and adult victimization.