Chronic pain and health care utilization in women with a history of childhood sexual abuse

OBJECTIVE: This cross-sectional controlled study investigated the association between chronic pain, health care utilization and a history of childhood sexual abuse. SUBJECTS: Three groups, constituting 80 women in total, were studied (1) attendees at group therapy for individuals who had experienced childhood sexual abuse (n = 26); (2) Two control groups consisting of nonabused (a) psychiatric outpatients (n = 33); and (b) nurses (n = 21). SETTING: The setting was a university affiliated community and tertiary care hospital in London. Ontario. OUTCOME MEASURES: Each subject voluntarily completed questionnaires documenting history of childhood abuse, pain, psychological symptomatology and medical and surgical history. RESULTS: Sixty-nine percent of the women who had experienced childhood sexual abuse reported a chronic painful condition lasting more than three months, compared to 43% of the combined control groups (p = .026). Women who had experienced childhood sexual abuse reported a greater number of painful body areas (p = .003), more diffuse pain and more diagnoses of fibromyalgia (p = .013). They had more surgeries (p = .037), hospitalizations (p = .0004) and family physician visits (p = .046). CONCLUSIONS: Women with a history of childhood sexual abuse reported more chronic pain symptoms and utilized more health care resources compared to nonabused control subjects. Identification of such a history in the patient experiencing persisting pain may be the first step toward a successful combination of medical and psychosocial interventions.     

Reality testing in adult women who report childhood sexual and physical abuse

OBJECTIVE: To better understand how neighborhood and individual factors are related to child maltreatment. METHOD: Using an ecological framework, a multi-level model (Hierarchical Linear Modeling) was used to analyze neighborhood structural conditions and individual risk factors for child abuse and neglect. Parents (n = 400) of children under the age of 18 were systematically selected from 20 randomly selected census-defined block groups with different risk profiles for child maltreatment report rates. Parents were administered the Neighborhood Environment for Children Rating Scales, the Child Abuse Potential Inventory, the Zimet measure of social support, and the Conflict Tactics Scales as a measure of childhood experience with violence. RESULTS: Neighborhood factors of improverishment and child care burden significantly affect child abuse potential after controlling for individual risk factors. However, neighborhood effects are weaker than they appear to be in aggregate studies of official child maltreatment reports. Variation in child abuse potential within neighborhoods is greater than between neighborhoods. However, adverse neighborhood conditions weakened the effects of known individual risk and protective factors, such as violence in the family of origin. CONCLUSIONS: If individual potential for child maltreatment is more evenly distributed across neighborhoods than reported maltreatment, then neighborhood and community play an important, if as yet unspecified, role in child maltreatment. Multi-level models are a promising research strategy for disentangling the complex interactions of individual and contextual factors in child maltreatment.     

Post-traumatic stress disorders in women who experienced childhood incest

Symptoms exhibited in a clinical population of 17 women who had experienced childhood or adolescent incest appear to fit the features of a chronic and/or delayed post-traumatic stress disorder. These women, entering individual therapy an average of 17 years after the abuse had ended, ranged in age from 24 to 44. All regarded their incest experience as the most damaging event of their lives, and had manifested, in adulthood, such symptoms as intrusive imagery of the incest, feelings of detachment or constricted affect, sleep disturbance, guilt, and intensification of symptoms when exposed to events resembling the incest trauma. Treatment included establishment of trust, expression of feelings, guilt reduction through an understanding of family dynamics and acquisition of new, adaptive behaviors.     

Adolescents who experienced sexual abuse: fears, needs and impediments to disclosure

OBJECTIVE: Understanding the impediments that prevented sexually abused adolescents from disclosure to their family or to professionals, and analyzing the responses they received when they did disclose. METHODS: In depth anonymous interviews were conducted in Italy through a toll-free telephone line with 36 young people who experienced sexual abuse in adolescence. A qualitative analysis was carried out of the adolescents' feelings, fears and needs, and of the help received, if any. RESULTS: The main impediments to disclose to a family member were fear of not being believed, shame, and fear of causing trouble to the family. The main impediments for not seeking services were ignorance of the existence/functioning of protective agencies, wish to keep the secret, lack of awareness of being abused, mistrust of adults and professionals, and fear of the consequences of disclosure. When they did disclose to professionals, the teens received very limited support. CONCLUSION: Adolescents need to receive proper information about the risk of being sexually abused and about the help they can receive from their social network and protective agencies. There is a crucial need for appropriate training of professionals.     

Adult outcomes in women who experienced parental violence during childhood

OBJECTIVE: The aims of this work are to analyze the associations between violence suffered at the hands of fathers and mothers in childhood and adolescence and three outcomes in adulthood--having or not having children, marital status, and occupational status--controlling for the possible impact of partner violence. METHOD: This cross-sectional study examined a sample of 510 women, attending various health care and social services facilities in a Northern Italian city. Both quantitative and qualitative data were collected. RESULTS: Almost one quarter of the respondents reported some kind of abuse by one or both parents, and 18.2% had experienced physical and/or sexual violence by a partner or ex-partner; women abused by parents were more likely to experience partner violence. Irrespective of whether they experienced partner violence, women abused by parents were more likely to be childless, divorced or never married, and in a precarious occupational situation. CONCLUSIONS: This study is the first one carried out in Italy on this subject: results largely confirmed the trends found in studies in other countries. However, two of the associations which emerged, namely between parents' abuse and being divorced or never married and between parents' abuse and being childless, are worth noting, since they could be interpreted as failures or, on the contrary, as active and positive choices made by abused women in a difficult context. Qualitative data from case histories provided insights into the violence some women have suffered and its consequences, but also into women's great resilience and strengths.     

PTSD symptom cluster profiles of youth who have experienced sexual or physical abuse

The research examined whether youth (6–17 years old) who were referred for treatment due to sexual, physical, or both types of abuse presented with distinct profiles of PTSD DSM-IV-TR symptom clusters. When examining data for the 749 youth participants, five PTSD symptom cluster profiles were identified with each profile representing approximately 20% of the youth. The five profiles were also differentiated with respect to being referred for physical or sexual abuse, age, parental ratings of internalizing symptoms, and self-reported depression. The youth referred for treatment in the aftermath of child sexual, physical, or both sexual and physical abuse presented with different profiles of PTSD symptom clusters thereby suggesting a need for individualized tailoring of evidenced-based treatments. Two cognitive behavioral approaches, designed for traumatized children and either their nonoffending or offending parents, were described for treating youth with the distinct PTSD profiles.     

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 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.     

Perinatal interventions for mothers and fathers who are survivors of childhood sexual abuse

Childhood sexual abuse (CSA) is a worldwide problem with severe long-term consequences. A history of CSA can impact the childbearing experience of mothers and fathers; affecting their mental health, parenting skills and compromising infant development. Nonetheless, the perinatal period offers huge opportunity for intervention and hope. This literature review collates evidence for perinatal psychosocial interventions targeting both mothers and fathers who are survivors of CSA. Publications dating from 1970 to June 2016 were searched using Medline, Maternity and Infant Health, PsychINFO, PsychArticles, PubMed and the International Bibliography of the Social Sciences (IBSS). There were no perinatal interventions that considered the needs of survivor fathers. Sixteen publications on 9 psychosocial perinatal interventions for CSA survivors were identified. However, no sub-analyses specific to CSA survivors were reported. Trauma-specific perinatal interventions drew from a range of theoretical models and varied widely in format. Generally interventions were associated with improvements in maternal mental health, parenting competence, infant attachment security and positive public health outcomes. They were safe and feasible to implement, acceptable to parents and therapist, and therapists were able to implement protocols with adequate fidelity. Yet current data is hampered by small sample size, inconsistent reporting of CSA rates and outcome measures, scarcity of observational data and longer-term follow-up. Intervention modifications are proposed for CSA survivors in view of their unique childbearing experiences.     

Mental health professionals' attitudes and practices towards male childhood sexual abuse

OBJECTIVE: This study aims to test the hypothesis of Holmes, Offen, and Waller (1997) that mental health professionals are not asking male patients about histories of sexual abuse. It also aims to investigate general attitudes and practices of mental health professionals to the issue of male sexual abuse. METHOD: One hundred and seventy-nine questionnaires were given to nurses, psychologists, and psychiatrists asking 10 questions about their attitudes and practice towards male sexual abuse. RESULTS: The majority of staff questioned rarely inquire about sexual abuse in male patients; staff are generally using ineffective and unsystematic methods of enquiry when they do ask; knowledge of prevalence rates of male sexual abuse are extremely variable; and 2/3 of staff report having had no specific training in assessment/treatment of sexual abuse and a similar number do not feel sufficiently trained to be able to inquire about sexual abuse in male patients. CONCLUSIONS: The study provides evidence for Holmes and colleagues' (1997) hypothesis that men are not being asked about sexual abuse histories. It also highlights a need for training professionals about male sexual abuse.     

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.     

The effects of daily stressors on physical health in women with and without a childhood history of sexual abuse

OBJECTIVE: The primary purpose of the present study was to examine the relationship between daily stressors and physical symptoms in college-age women with a childhood history of sexual abuse and women without a history of childhood sexual abuse. It was hypothesized that women with a history of childhood sexual abuse would be particularly susceptible to the effects of daily stressors on physical symptoms, and would show more covariation between daily stressors and physical symptoms, compared to women without a history of childhood sexual abuse. METHOD: Female college students (n = 491) were screened for histories of childhood (before age 15) and adulthood (after age 15) contact sexual abuse. Of these participants, 18 women with only a history of childhood sexual abuse were assigned to the SA group, and 27 women with no history of childhood or adulthood sexual abuse were assigned to the NA group. These women filled out self-report measures of daily hassles and physical symptoms for 28 consecutive days. RESULTS: During the 5 days preceding a highly stressful day, women in the SA group reported significantly more physical symptoms than during the 5 days preceding a day of low stress. For the NA group, there were no significant differences in reported physical symptoms between high- and low-stress days. CONCLUSIONS: The pattern of results for physical symptoms suggests that women with a history of childhood sexual abuse may be particularly susceptible to the effects of heightened daily stress, and may display this susceptibility in the report of physical symptoms. Possible explanations for these findings are discussed.     

Working with childhood sexual abuse: a survey of mental health professionals

OBJECTIVE: This study aimed to establish the views of a group of mental health professionals from various disciplines working in mental health service in a British hospital about the needs of clients who had experienced childhood sexual abuse. METHOD: Staff members were asked to complete an anonymous survey which asked questions relating to knowledge of sexual abuse and its effects, and the needs of clients and staff in working with this client group. A total of 54 people responded to the survey, 42 were female, 11 male. Most (72%) reported having over 10 years experience working in mental health, working in both in-patient and out-patient settings. RESULTS: While respondents were reasonably knowledgeable about childhood sexual abuse, they were not very comfortable, competent or supported in their work with this client group. There were no differences in responses according to the age or gender of respondents, but less experienced staff were more likely to feel supported. Those that had received training and/or supervision felt significantly more capable in working with this client group. CONCLUSIONS: The study offers some support for the development of specialist training, consultancy and supervision programs for mental health staff in the area of child sexual abuse.     

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.     

Men with childhood sexual abuse histories: Disclosure experiences and links with mental health

BackgroundThere is limited research on the disclosure experiences of men who have experienced childhood sexual abuse and on how such experiences might impact mental health outcomes.ObjectiveThe current study described men’s disclosure experiences and examined the role of disclosure characteristics on mental well-being (internalizing and externalizing behaviors, substance use, resilience).Participants and settingMen (N = 253) from across Canada and the U.S. were recruited through websites for males with sexual abuse histories. Men aged 18–59 years anonymously completed an online study on their sexual abuse, disclosure experiences, and mental health outcomes.ResultsFindings indicated that 77.9% of men disclosed their sexual abuse, although they waited an average of 15.4 years before sharing their experience. Once disclosed, 64.4% of the men reported a positive response (e.g., support), while 35.6% reported a negative response (e.g., blame). Regression analyses indicated that a greater delay in disclosure predicted greater externalizing behaviors (B = .49, p < .05), although this was a small effect (Cohen’s f ² = 0.02). Additional disclosure variables were associated with components of externalizing (aggressive and rule-breaking behaviors) and internalizing (somatic complaints) behaviors.ConclusionsThese results require replication in future studies. However, they do suggest that efforts need to be undertaken to address the barriers that hinder men from disclosing their sexual abuse and to ensure that men are supported once they disclose.     

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.