The relationship of exposure to childhood sexual abuse to other forms of abuse,neglect, and household dysfunction during childhood

OBJECTIVE: This study assesses the relationship of childhood sexual abuse (CSA) to nine other categories of Adverse Childhood Experiences (ACEs), including childhood abuse, neglect, and multiple types of household dysfunction. METHODS: Retrospective cohort study data were collected from 17,337 adult health plan members who responded to a survey questionnaire. Regression models adjusted for age, race, and education were used to estimate the strength of the association of CSA to each of the other nine ACEs and a graded relationship between measures of the severity of CSA and the number of other ACEs (ACE score). RESULTS: CSA was reported by 25% of women and 16% of men. In comparison with persons who were not exposed to CSA, the likelihood of experiencing each category of ACE increased 2- to 3.4-fold for women and 1.6- to 2.5-fold for men (p < 0.05). The adjusted mean ACE score showed a significant positive graded relationship to the severity, duration, and frequency of CSA and an inverse relationship to age at first occurrence of CSA (p < 0.01). CONCLUSIONS: CSA is strongly associated with experiencing multiple other forms of ACEs. The strength of this association appears to increase as the measures of severity of the CSA increases. The understanding of the interrelatedness of CSA with multiple ACEs should be considered in the design of studies, treatment, and programs to prevent CSA as well as other forms of ACEs.     

Linking childhood sexual abuse and abusive parenting: the mediating role of maternal anger

OBJECTIVE: This study had two primary objectives: First, to examine the association between childhood sexual abuse (CSA) and later parenting characteristics, particularly physical abuse potential, and second, to explore maternal anger as a mediator of the relationship between CSA and adult physical abuse potential. METHOD: Utilized a community sample of low SES participants that included 138 mothers classified as having experienced CSA, and a comparison group of 152 non-sexually abused mothers. Parenting variables examined included the mothers' physical abuse potential, nurturance toward their children, unrealistic developmental expectations of children, as well as frequencies of spanking and general punishment. Data was collected via interview and other self-report measures. RESULTS: Even after controlling for mothers' childhood experience of Physical abuse, CSA significantly predicted adult risk of physically abusing one's own children. Further, maternal anger was confirmed as a mediator of the relationship between having been sexually abused as a child and the potential for physically abusing one's own children. CONCLUSIONS: CSA may be a risk factor for subsequent physically abusive parenting, while anger appears to play a significant role in mediating this relationship. Findings are discussed in the context of current knowledge concerning the impact of child sexual abuse and the processes contributing to abusive parenting.     

Child sexual abuse: relationship between sexual acts and genital findings

A comparison was made between the findings observed during the examination of female victims of sexual abuse with the sexual acts to which the perpetrator confessed to have performed. In Shelby County, TN, during the calendar years 1985-1987, 30 individuals confessed to have sexually assaulted 31 girls. The mean age of the girls was 9.1 years, and that of the offenders was 30 years. In 18 of the 31 cases the offender admitted to vaginal penetration. Specific findings were observed in 11 of these 18 (61%) girls, compared with only 3 of 13 (23%) girls when penetration was denied. Although specific findings were more commonly observed when the perpetrator admitted to vaginal penetration, in 7 of 18 girls (39%) the examiner described normal appearing genitalia (n = 2), or nonspecific abnormalities only (n = 5). The author concludes that all complaints of sexual abuse must be considered potentially valid and should be investigated further, even if the physical examination fails to detect any abnormalities.     

The relationship between sexual abuse and substance abuse among psychiatrically hospitalized adolescents

A comparative study using matched samples was conducted to investigate the relationship between sexual abuse and substance abuse. The sample included 48 adolescent psychiatric inpatients who had been sexually abused (abuse group) and 48 psychiatric inpatients without a known history of such abuse (control group) matched by age, race, sex, and primary psychiatric diagnosis. Statistically significant differences emerged between the groups in several areas. Abuse group subjects indicated more regular use of cocaine and stimulants, greater frequencies of alcohol and drug use, and more reported drunkenness and times high on drugs than their control counterparts. Explanations of the association between substance abuse and sexual victimization are explored. Discussion suggests the possibility of earlier coping strategies being related to later chemical use patterns. Implications for service delivery are offered.     

The association of childhood sexual abuse with depressive symptoms during pregnancy, and selected pregnancy outcomes.

OBJECTIVES: The objectives were: (1) to investigate the association during pregnancy of sexual abuse before the age of 18 on depressive symptomatology in pregnancy, controlling for the presence of negative life events and challenges; and (2) to investigate the association of selected pregnancy outcomes (maternal labor and delivery factors, infant birth weight and gestational age) with sexual abuse before age 18. METHODS: Three hundred fifty-seven primiparous women aged 18 years and older were interviewed between 28-32 weeks gestation with reference to current functioning and past history (Objective 1). Medical record information was abstracted after delivery for pregnancy, labor and delivery factors, and pregnancy outcomes (Objective 2). RESULTS: Thirty-seven percent of the women reported past sexual abuse. Prevalence was not associated with ethnic background, educational level, or hospital payment source. Previously sexually-abused pregnant women reported significantly higher levels of depressive symptomatology, negative life events, and physical and verbal abuse before and during pregnancy. There were no significant associations found between past sexual abuse and labor or delivery variables or newborn outcomes. CONCLUSIONS: Previously sexually-abused pregnant women reported a wider constellation of past and current functioning problems than nonabused women although past sexual abuse was not associated with pregnancy outcome. Prenatal care provides a unique opportunity to evaluate the impact of life history and current life events during pregnancy, and to develop a coordinated intervention plan.     

Revisiting the link between childhood sexual abuse and adult sexual aggression

BackgroundChildhood maltreatment poses a risk factor for adult sexual aggression among men.ObjectiveEfforts were made to examine links between childhood sexual abuse (CSA) and sexual aggression after controlling variance associated with other forms of abuse.Participants and settingThis sample was comprised of men (n = 489) who completed a national survey regarding their history of possible abuse and/or sexual aggression.MethodsMaltreatment indices included CSA, parental and sibling physical abuse, exposure to domestic violence, peer bullying, and family emotional abuse. Self-report indicators of sexual frotteurism, coercion and rape were provided by the Sexual Experiences Survey–Short Form Perpetration.ResultsCSA links with the criterion indicators were relatively stronger (r = 0.36, d = 0.65, p < .001) than those found for non-sexual forms of abuse. CSA accounted for unshared variance in sexual aggression with these effects magnified by the addition of parental physical abuse (d = 2.1) or exposure to domestic violence (d = 2.2). The relative risks of prior acts of rape were elevated by CSA (RR = 4.39, p < .001), parental physical abuse (RR = 3.85, p < 0.001), exposure to domestic violence (RR = 3.81, p < .001), or sibling physical abuse (RR = 2.56, p = 0.007). These risks of completed rape were higher as well among respondents polyvictimized by two (RR = 4.92, p < .001) or more (RR = 8.94, p < 0.001) forms of abuse.ConclusionsMultiple forms of child maltreatment, particularly CSA, were strongly associated with adult sexual aggression in this sample of men from the general population.     

Exposure to childhood sexual and physical abuse and subsequent educational achievement outcomes

OBJECTIVE: This paper examined the relationship between exposure to sexual and physical abuse (CSA and CPA) in childhood and later educational achievement outcomes in late adolescence and early adulthood in a birth cohort of over 1,000 children studied to age 25. METHOD: Retrospective data on CSA and CPA were gathered at ages 18 and 21 and used to form a best estimate of exposure to CSA and CPA. The relationship between CSA, CPA, and self-reported educational outcomes to 25 years was examined using logistic regression models that took into account social background, parental factors, and individual factors. RESULTS: Increasing exposure to CSA and CPA was significantly associated with failing to achieve secondary school qualifications (CSA: B=.53, SE=.13, p<.0001; CPA: B=.62, SE=.12, p<.0001), gaining a Higher School Certificate (CSA: B=-.48, SE=.13, p<.001; CPA: B=-.78, SE=.14, p<.001), attending university (CSA: B=-.29, SE=.13, p<.05; CPA: B=-.45, SE=.13, p<.001), and gaining a university degree (CSA: B=-.54, SE=.18, p<.005; CPA: B=-.64, SE=.17, p<.001). Adjustment for confounding social, parental, and individual factors explained most of these associations. After control for confounding factors, omnibus tests of the associations between CSA and outcomes and CPA and outcomes failed to reach statistical significance (CSA: Wald chi(2) (4)=7.72, p=.10; CPA: Wald chi(2) (4)=8.26, p=.08). CONCLUSIONS: The effects of exposure to CSA and CPA on later educational achievement outcomes are largely explained by the social, family, and individual context within which exposure to abuse takes place.     

The relationship of childhood sexual abuse with later psychological and sexual adjustment in a sample of college women

The purpose of the present study was to explore the relationship of childhood sexual abuse with later psychological and sexual adjustment. Subjects were 383 female college students recruited from undergraduate psychology classes. Each was asked to complete a packet which contained a victimization questionnaire as well as measures of adjustment. A number of small, but significant, relationships were found between a history of childhood sexual abuse and measures of later psychological and sexual adjustment. In light of the relationship between family background and sexual abuse, however, it was questioned whether these associations were due to the sexual abuse per se, or were due to the confounding of sexual abuse with family background. Indeed, once parental supportiveness was controlled, very few significant relationships emerged. There was a trend, however, for the significant correlations to involve the sexual measures rather than the more general adjustment measures. The implications of the current findings, particularly for future research, were discussed.     

Childhood sexual abuse history and role reversal in parenting

OBJECTIVE: This study explored the main and interactive effects of sexual abuse history and relationship satisfaction on self-reported parenting, controlling for histories of physical abuse and parental alcoholism. METHOD: The community sample consisted of 90 mothers of 5- to 8-year-old children. The sample was limited to those mothers currently in an intimate relationship, 19 of whom reported a history of childhood sexual abuse. Participants completed the Child Behavior Checklist, the Parenting Stress Inventory, the Family Cohesion Index, and questions assessing parent-child role reversal, history of abuse and parental alcoholism, and current relationship satisfaction. RESULTS: Results of analyses and multivariate analyses of covariance suggested that sexual abuse survivors with an unsatisfactory intimate relationship were more likely than either sexual abuse survivors with a satisfactory relationship or nonabused women to endorse items on a questionnaire of role reversal (defined as emotional overdependence upon one's child). Role reversal was not significantly predicted by histories of physical abuse or parental alcoholism or child's gender. While parenting stress was inversely predicted by the significant main effect of relationship satisfaction, neither parenting stress nor child behavior problems were predicted by the main effect of sexual abuse history or by the interaction between sexual abuse history and relationship satisfaction. CONCLUSIONS: These results suggest the unique relevance of sexual abuse history and relationship satisfaction in the prediction of a specific type of parent-child role reversal--namely, a mother's emotional overdependence upon her child.     

The sexual abuse of Afro-American and White-American women in childhood

This study examined the prevalence of child sexual abuse in a multi-stage stratified probability sample of Afro-American and white-American women, 18 to 36 years of age, in Los Angeles County. The sample ranged in demographic characteristics by age, marital status, education and the presence of children. Of the total sample of 248 women, 154 (62%) reported at least one incident of sexual abuse prior to age 18, with 57% of Afro-American women and 67% of white-American women having been abused. Sexual abuse before the age of 18 appears to be of equal concern for both ethnic groups, although similarities and differences in the circumstances under which abuse incidents occurred were subtle and deserve attention. The need for identifying contemporary factors that contribute to the prevalence of abuse over the past 40 years is stressed.     

The impact of childhood sexual abuse in anorexia nervosa

OBJECTIVE: The aim of this study was to examine the impact of childhood sexual abuse (CSA) on clinical characteristics and premature termination of treatment in anorexia nervosa (AN). METHOD: The participants were 77 consecutive patients with AN admitted to an inpatient eating disorders unit. The patients were assessed in terms of eating disorder symptoms, general psychopathology, and CSA history at admission to hospital. RESULTS: Thirty-seven patients (48%) reported a history of CSA before the onset of the eating disorder. Individuals with a history of CSA reported significantly greater psychiatric comorbidity, including higher levels of depression and anxiety, lower self-esteem, more interpersonal problems, and more severe obsessive-compulsive symptoms. Patients with the binge-purge subtype of AN (AN-BP) were significantly more likely to report a history of CSA prior to the onset of the eating disorder as compared with patients with the restricting subtype (AN-R) of the illness (65% of the AN-BP patients vs. 37% of the AN-R patients; p<.02). Contrary to our predictions, abused patients were not significantly more likely to dropout of treatment overall. However, patients of the binge-purge subtype (AN-BP) with a history of CSA were significantly more likely to terminate treatment prematurely as compared with the other patients. CONCLUSIONS: Consistent with previous findings, the present results indicate that the prevalence of CSA is high among individuals seeking inpatient treatment for AN. A history of CSA was associated with greater psychiatric disturbance overall and a higher rate of dropout for patients of the binge-purge subtype.     

Dissociation mediates the relationship between sexual abuse and child psychological difficulties

The aim of the present study was to evaluate, using structural equation modeling, a theoretical model in which dissociation is a core process mediating the relationship between childhood sexual abuse (CSA) and internalizing, externalizing, and sexualized behaviour difficulties in children. A total of 290 children aged 2–12 participated in this study in Québec, Canada from 1998 to 2004, including 138 children with histories of CSA and 152 non-abused children. To assess child dissociative symptoms, internalizing and externalizing difficulties, as well as sexualized behaviour difficulties, the Child Dissociative Checklist, the Child Behaviour Checklist and the Child Sexualized Behaviour Inventory were completed by parents. Dissociation mediated the relationship between CSA and internalizing, externalizing, and sexualized behaviour difficulties, with the model explaining respectively 42.5%, 49.9% and 33.9% of the variance of these difficulties. Findings are consistent with a model where dissociation is a common pathway linking CSA and child psycho-sexual difficulties.     

The relationship between sexual abuse and purging: findings from community-wide surveys of female adolescents.

OBJECTIVE: The first objective of this study was to examine the relationship between sexual abuse and a bulimic behavior, namely purging, with a large sample of female adolescents. If sexual abuse was found to be significantly related to bulimia, then the second objective was to determine if the relationship between abuse and purging remained significant when other factors were controlled. METHOD: Two different analyses were conducted to address the questions outlined above--a contingency table chi-square test and a logistic regression analysis. A sample of 7,903 female adolescents was drawn from a large Midwestern state. RESULTS: The results of the bivariate analysis provide evidence that a relationship exists between sexual abuse and purging. However, the relationships between sexual abuse and purging did not remain significant when several other factors, including physical abuse, were included in the analysis. Several individual (a history of physical abuse and religiosity), familial (i.e., family support and parent-adolescent communication), and extra-familial (i.e., other adult support) factors were significantly related to purging. CONCLUSIONS: The data did not find a significant relationship between sexual abuse and purging when individual, familial, and extra-familial variables were included in the logistic regression. Unlike most earlier studies that focused on clinical samples, this study drew from a larger, more representative sample of female adolescents. The identification of significant predictors of purging at the individual, familial, and extra-familial levels suggests the importance of examining multiple levels of the teen's ecology for factors that may influence this behavior.     

The health effects of childhood abuse: four pathways by which abuse can influence health

OBJECTIVES: This article describes four possible pathways by which childhood abuse relates to health problems in adults. METHOD: Literature on the long-term effects of childhood abuse is organized in a health psychology framework describing behavioral, social, cognitive, and emotional pathways. Key studies from the health psychology and behavioral medicine literature are included to demonstrate how these pathways relate to health. RESULTS: Childhood abuse puts people at risk of depression and post-traumatic stress disorder, participating in harmful activities, having difficulties in relationships, and having negative beliefs and attitudes towards others. Each of these increases the likelihood of health problems, and they are highly related to each other. CONCLUSIONS: Childhood abuse is related to health via a complex matrix of behavioral, emotional, social, and cognitive factors. Health outcomes for adult survivors are unlikely to improve until each of these factors is addressed.     

Gender differences in the association between childhood sexual abuse and risky sexual behaviours: A systematic review and meta-analysis

This meta-analytic review examines the association between childhood sexual abuse and risky sexual behaviours with sub-group analyses by gender. Systematic searches of electronic databases including MEDLINE, PubMed, EMBASE, and PsycINFO were performed using key terms. We used a priori criteria to include high quality studies and control for heterogeneities across eligible studies. The review was registered with PROSPERO and used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The final meta-analysis applied fixed-effects model to generate pooled odds ratio (OR). Subgroup analyses were conducted to identify potential methodological moderators. The meta-analysis included 8 eligible studies (N = 38,989, females = 53.1%). The overall syndemic of risky sexual behaviors at adulthood was 1.59 times more common in childhood sexual abuse victims. There was a similar association between childhood sexual abuse in general and subsequent risky sexual behaviors in both females and males. However, in cases of substantiated childhood sexual abuse, there was a greater odds of risky sexual behaviors in females (OR = 2.72) than males (OR = 1.69). The magnitude of association of childhood sexual abuse and risky sexual behaviors was similar for males and females regardless of study time, study quality score and method of childhood sexual abuse measurement. There were nonsignificant overall and subgroup differences between males and females. Childhood sexual abuse is a significant risk factor for a syndemic of risky sexual behaviors and the magnitude is similar both in females and males. More research is needed to explore possible mechanisms of association.     

The abuse-related beliefs questionnaire for survivors of childhood sexual abuse

OBJECTIVE: To evaluate the psychometric properties of a new measure, the Abuse-Related Beliefs Questionnaire (ARBQ), designed to assess abuse-related beliefs among adult survivors of childhood sexual abuse (CSA). Study 1 examined the structure of the scale, and Study 2 evaluated its reliability and validity. METHOD: One hundred and seventy female CSA survivors recruited into a group psychotherapy intervention study were administered the ARBQ in Study 1. A subsample of 45 women completed the ARBQ again 12 months later. In Study 2, 70 women from a health maintenance organization who identified themselves as survivors of CSA completed the ARBQ along with the Trauma Symptom Checklist-40 (TSC-40) and the Symptom Checklist 90R (SCL-90-R). RESULTS: Three reliable ARBQ subscales emerged in Study 1: Guilt, Shame, and Resilience. Twelve-month test-retest reliability was high (r=.60-.64). The internal consistency of the subscales was further supported in Study 2, and validity was demonstrated by moderate to high correlations with the distress measures. CONCLUSIONS: The results indicate that the ARBQ has good psychometric characteristics, supporting the feasibility of its use in measuring abuse-related beliefs in research on survivors of CSA. A next step for validation of the ARBQ would be to evaluate its sensitivity in measuring changes in studies of interventions for treating CSA survivors.     

The long-term impact of childhood sexual abuse in Australian women

OBJECTIVE: The aim of this study was to examine the association between childhood sexual abuse (CSA) and a range of adverse adult outcomes in a community sample of women using multivariate analysis which accounted for a number of potential confounding effects. METHOD: Retrospective study of cross-sectional data on the long-term impact of CSA, collected as part of a larger two-stage case-control study of the possible relationship between CSA and alcohol abuse. Data were appropriately weighted to adjust for the different selection probabilities of cases and controls. RESULTS: Significant associations were found between reporting CSA and experiencing domestic violence, rape, sexual problems, mental health problems, low self-esteem, and problems with intimate relationships even after taking into account a range of family background factors. Women who had experienced abuse involving intercourse were the most vulnerable to these negative outcomes. CONCLUSIONS: The findings indicate that the influence of CSA on adverse long-term effects is mediated and influenced both by the severity of the abuse experiences and by a range of family and social background factors.