Child sexual and physical abuse among college students in Singapore and the United States

OBJECTIVES: The purpose of this study was to explore differences in rates and characteristics of child sexual and physical abuse experiences among women in Singapore and the US. METHOD: Participants (N=153) completed an anonymous questionnaire which assessed experiences of childhood sexual and physical abuse, abuse characteristics (e.g., victimization age, severity), and behavioral and subjective reactions to such experiences (e.g., labeling of experiences as abuse, psychological symptomatology). Exposure to other forms of traumatic life events was also assessed. RESULTS: In comparison to Singaporean women, US women were more likely to report a history of child sexual abuse, and to report experiencing more severe forms of sexual abuse. Women in Singapore were more likely than women in the US to report a history of child physical abuse, to report experiencing injury as a result of the abuse, and to disclose the abuse. Singaporean women with a history of child sexual abuse reported elevated psychological symptom levels relative to their nonabused peers and to US women with a history of child sexual abuse, even after controlling for exposure to other types of traumatic events. No significant differences in symptomatology with regard to child physical abuse were observed. CONCLUSIONS: Although preliminary in nature, the present findings are among the first to demonstrate differences in psychological adjustment between sexually abused and nonabused Asian women living in Asia. This study also provides some of the first support for cross-national differences in the psychological adjustment of child sexual abuse survivors.     

Child sexual abuse consequences in community samples of Latino and European American adolescents

ObjectiveResearch investigating the impact of child sexual abuse (CSA) in community samples of adolescents has been limited. This study aims to identify sexual abuse among ethnically diverse high school adolescents of both genders and evaluate their psycho-emotional consequences.MethodThrough the use of self-report instruments, a sample of 223 Latino and European American 16–19-year-old high school students were identified as either victims of CSA or as nonabused. The emotional impact of sexual abuse was also investigated among these ethnically diverse adolescent males and females.ResultsInitial findings revealed that those adolescents who gave inconsistent responses to CSA assessments questions were much more similar in patterns of psychological distress to CSA victims compared to nonabused teenagers. Prevalence analyses revealed that females (45%) were nearly two times more likely to report CSA than males (24%). Latinos (44%) were significantly more likely to experience CSA compared to European Americans (27%), and Latinas (54%) had the highest prevalence overall. Other findings indicated substantial differences in type of perpetrator. While female victims of CSA identified male perpetrators in 91.9% of cases, male victims of CSA identified female perpetrators in 52.9% of cases. Consistent with past research, sexually abused adolescents reported significantly greater psychological distress than their nonabused peers, regardless of gender or ethnic group. Gender differences emerged with females reporting greater psychological symptoms, but these differences were substantially reduced when CSA was controlled. European Americans reported greater anxious arousal symptoms compared to Latinos.ConclusionsOur findings suggest that the prevalence of CSA among adolescents is higher than existing research has noted for both males and females and particularly higher for Latinos compared to European Americans. Perpetration by females upon males may also be higher than research has noted. Our findings also revealed many ethnic and gender similarities and fewer differences in the psychological impact and circumstances of sexual abuse in this diverse sample of adolescents.Practice implicationsThe high prevalence of CSA among adolescent males and particularly Latinas emphasize the need to intervene on a community level and with parents for both prevention and intervention regarding issues of sexual victimization. The numbers of female perpetrators, especially when boys are the targets of abuse, may be higher than previously imagined and thus must be assessed tactfully and thoroughly. This study found that adolescents who reported CSA inconsistently had similar symptoms as those with confirmed CSA and therefore warrant greater attention and more persistent intervention. When treating victims of CSA, the Trauma Symptom Inventory (TSI) is effective in identifying specific areas of emotional distress to treat in sexually abused ethnically diverse male and female adolescents. Culturally relevant prevention efforts are needed for ethnically diverse children of both genders.     

Pregnancy and delivery for women with a history of child sexual abuse

OBJECTIVE: To study whether women with a history of child sexual abuse are at increased risk of delivering low birth weight infants. Secondary aims were to study smoking habits, obstetric complications, health care use, and health complaints during pregnancy among women with a history of child sexual abuse. METHOD: In a case control study, 82 women with birth of a low birth weight infant (< 2500 g) (cases) and 91 women with birth of a normal birth weight infant (controls) were interviewed about experiences of child sexual abuse. RESULTS: Fourteen percent of the women disclosed a history of child sexual abuse involving at least genital touch. Birth of a low birth weight infant was not associated with a history of child sexual abuse (OR 1.03, 95% CI .44-2.40). More women with a history of child sexual abuse were smokers during pregnancy (56% vs. 31%) compared with nonabused women. Abused women reported lower age at menarche and sexual debut. Nonscheduled contacts with the antenatal care clinic and discomfort during pregnancy were more frequent among abused women when controlled for low birth weight. CONCLUSIONS: Women who delivered low birth weight infants were not more likely to have experienced child sexual abuse than women who delivered nonlow birth weight infants. Abused women were unemployed and daily smokers more often than nonabused women. Some of the abused women reported more health complaints, and more use of health care services during pregnancy, but did not have more obstetric complications during pregnancy and delivery.     

Behavioral/emotional indicators of sexual abuse in child psychiatric inpatients: A controlled comparison with physical abuse

Several behavioral and emotional indicators of child sexual abuse were compared for both sexually (n = 29) and physically abused (n = 52) children from a sample of 103 hospitalized psychiatric patients. The measures included (1) scores from a factor-analyzed sexual abuse symptom checklist covering home/community behavior that was rated by parents during a clinical interview and (2) frequency counts of psychological symptoms exhibited by the children during a 3-week period of hospitalization. Results of a 2 (sexual abuse status) X 2 (physical abuse status) X 2 (gender) Multivariate Analysis of Variance indicated that sexually abused children exhibited greater sexual behavior, fear/mistrust/anxiety, and withdrawal at home, and greater sexual behavior, fear/anxiety, and sadness in the hospital than nonabused children. In contrast, there were no significant differences between physically abused and nonabused children, and no significant interactions. Few significant correlations were found between symptoms exhibited at home and in the hospital.     

Child peer sexual abuse: preliminary data on outcomes and disclosure experiences

OBJECTIVE: This study compared experiences of children sexually abused by peers to those of children abused by adolescents/adults. Variables examined included perceived negativity of the abuse, self-reported outcomes, overall psychological functioning, and disclosure. METHOD: An archival data set containing retrospective reports of childhood sexual experiences was culled for instances of sexual abuse by child peers and adolescents/adults. An equivalent nonabused comparison group was identified. The Self-Report Outcome Checklist (SROC; Gilbert, 1994b), the MMPI-Hugo Short Form (Hugo, 1971) and a disclosure survey were also retrieved from these data. RESULTS: Compared to abuse by peers, abuse perpetrated by adolescents/adults was more intrusive and intrafamilial. Both groups rated their experiences as equally negative, and reported equally pervasive outcomes. Those abused by adolescents/adults reported significantly higher scores on the Psychopathic Deviate, Psychasthenia, and Schizophrenia scales compared to nonabused controls; similar findings did not emerge for those abused by child peers. Less than a fourth in either abuse group reported disclosing their experience to a parent. Among those who did not disclose, participants abused by child peers anticipated less support from both parents and more anger from their mothers. CONCLUSIONS: The findings suggest that child peer sexual abuse may be associated with adverse outcomes.     

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.     

The influence of childhood sexual abuse,physical abuse,family environment,and gender on the psychological adjustment of adolescents

OBJECTIVE: The primary aim of the current study was to examine the contributions of sexual abuse, physical abuse, family cohesion, and conflict in predicting the psychological functioning of adolescents. Additional analyses were conducted to determine whether adolescent victims of child sexual abuse and physical abuse perceive their family environments as more conflictual and less cohesive than nonabused adolescents. METHOD: Participants were 131 male and female adolescents, ages 16 years to 18 years, receiving services at a residential vocational training program. Participants completed well established psychological assessment tools to assess abuse history, family environment characteristics, and current adjustment. RESULTS: Physically abused adolescent females perceived their family environments as more conflictual and less cohesive than females without physical abuse, and sexually abused females perceived their family environments as more conflictual and less cohesive than females without sexual abuse. Physically abused adolescent males reported more conflict than males without physical abuse, but did not differ with regard to cohesion. Adolescent males with and without a sexual abuse history did not differ on the family dimensions. Multiple regression analyses revealed that both conflict and cohesion, in addition to a history of sexual and physical abuse, predicted depression and distress. Separate analyses by gender revealed these variables differentially impact adjustment in male and female adolescents. Results of a power analysis indicated sufficient power to detect these differences. CONCLUSIONS: Findings indicate that in addition to child sexual abuse and physical abuse, family conflict and cohesion are risk factors for the development of psychological distress and depression in adolescence. Implications for treatment and directions for future research are discussed.     

Runaway youths and sexual victimization: gender differences in an adolescent runaway population

Running away from home has often been viewed as one of the sequelae to sexual abuse. Our study of 144 adolescent runaways finds that 38% of male runaways (n = 89) and 73% of female runaways (n = 55) report having been sexually abused. The impact of abuse is examined by studying, within each gender group, its relationship to the subject's perceptions of sexual activity, relationships with peers and adults, involvement with delinquent/criminal activities, and physical and emotional complaints. The results of assessing the differences between abused and nonabused adolescents show that both the victimized males and females are more likely to report anxiety and suicidal feelings than are their nonabused counterparts. Male victims of sexual abuse are more likely to report physical symptomatology and fear of adult men. Female victims of sexual abuse are more likely to be confused about sex and to engage in delinquent/criminal activities. Discussion focuses on gender differences and runaway behaviors in relation to sexual victimization with the suggestion that differences in the degree of abuse and the sex of the abuser may explain study findings.     

Behavioral sequelae of physical and/or sexual abuse in adolescents

In a survey of 500 admissions to a short-term residential chemical dependency treatment center for adolescents (ages 12 to 18), 150 adolescents (30%) had been identified as victims of physical and/or sexual abuse. While the abused group had a higher incidence of prior social service and mental health intervention, extraordinarily 68% of these abuse cases had not been reported by children, family, or interviewers prior to the adolescents having entered the chemical dependency residential treatment facility. This chemically dependent, previously abused group was differentiated from a comparison group of nonabused, chemically dependent adolescents, and a second comparison group of nonabused, nonchemically dependent adolescents. Results indicated a higher incidence of acting out behavior, runaways, legal involvement and sexual promiscuity within the abused group.     

Behavioral problems in alleged sexual abuse victims.

This study was conducted to compare the parental assessments of problem behaviors, using the Achenbach Child Behavior Checklist, among alleged sexual abuse victims (n = 81) and an age, race, and gender matched group of nonabused comparison subjects (n = 90). Alleged sexual abuse victims demonstrated significantly higher mean total behavior problem, internalizing and externalizing scores than the comparison sample. Subscale profiles were all in the direction consistent with withdrawal, impairment in social interaction, and sexual problems. Item comparison indicated that sexual abuse victims were more likely to be assessed as having some problem behaviors that have been reported as being indicative of sexual abuse. A significant difference was not obtained on several behaviors that have been previously reported as indicative of sexual abuse. These findings support concerns that sexual abuse victims do exhibit more problem behaviors, but caution must be exercised when interpreting individual behaviors because of their frequency in a nonabused sample.     

Prevalence of childhood physical abuse in adult male veteran alcoholics

Although past research has identified psychological and behavioral consequences for adults who were abused as children, few studies have examined the incidence and consequences of childhood physical abuse among adult alcoholics. The purpose of this study was to assess the prevalence of a childhood history of physical abuse in adult male alcoholics and to determine what differences may exist in the psychological profile and patterns of alcohol abuse in abused and nonabused alcoholics. The study sample was comprised of 100 male alcoholic inpatients from the alcoholism treatment unit at a metropolitan Veterans Administration hospital. Subjects were administered a self-report devised by the authors to assess a history of childhood physical abuse, the Michigan Alcoholism Screening Test (MAST), the Severity of Alcohol Dependence Questionnaire (SADQ), and the Symptom Checklist-90-Revised (SCL-90-R). Findings indicated that approximately one-third of the alcoholics were physically abused as children. Abused alcoholics reported having more severe psychological symptoms and distress than their nonabused counterparts, although they did not differ on the onset, severity, or treatment history for alcohol dependency.     

Incidence and impact of sexual abuse in a child outpatient sample: The role of direct inquiry

From the child psychiatry outpatient department of a university medical center, 64 charts were reviewed in two phases: 29 were randomly selected from outpatient files, and 35 were examined after clinicians were asked to directly query sexual abuse. Although the reported sexual abuse rate for randomly selected charts was quite low (6.9%), reference to sexual abuse history in charts of children who were asked about molestation was 4.5 times more frequent (31.4%; 11.5% of all boys, 50% of all girls). Children with an identified sexual abuse history reported more psychological symptoms, had made more suicide attempts in the past, and were more likely than nonabused children to receive a diagnosis of major depression.     

Self-esteem in abused chemically dependent adolescents

In a random sample of 500 admissions to a residential treatment center for chemically dependent adolescents. 150 cases of physical and sexual abuse had been identified. These adolescents were matched for age, race, and socioeconomic status, with two comparison groups: a group of nonabused chemically dependent adolescents and a group of nonabused, nonchemically dependent adolescents. Self-esteem was measured, utilizing the Tennessee Self-Concept Scale (TSCS), which was administered to all subjects. The abused, chemically dependent adolescents were found to demonstrate significantly lower self-esteem on all subscales when analyzed against these two comparison groups. There were negligible differences within the abused group when the TSCS scores were analyzed according to type of abuse. Aggressive/physically abused adolescents scored higher on the Physical Self subscale and the incest group scored significantly lower on the Identity subscales. These results suggest that abuse is equally devastating, regardless of the type of abuse, e.g., physical, sexual, incest, and has a long-lasting impact on self-esteem.     

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.     

Sexual abuse in young children: its clinical presentation and characteristic patterns

A retrospective record survey was performed using all child clients aged less than 7 years seen at a community mental health center during the period 1982-1984. The total number of 202 children fell into three groups: sexually abused (n = 37), physically abused (n = 35), and nonabused clinical children (n = 130). These groups were compared in order to learn more about sexual abuse in young children. Family background of both abused groups were similar to each other but differed from the nonabused group in having more factors related to family stress than the nonabused group. Clinical presentations of all the children overlapped a great deal symptomatically; however, the sexually abused children had a statistically significant higher frequency of inappropriate sexual behavior than the other two groups. Several characteristics of the abusive patterns suffered by the two abuse groups differed at or near statistical significance: sexually abused children were more often victimized in single acts by nonrelated child perpetrators than were physically abused children.     

The rates of child sexual abuse and its psychological consequences as revealed by a study among Palestinian university students.

OBJECTIVES: The study aimed to achieve the following two objectives: First, it sought to examine the rates of sexual abuse in Palestinian society at three ages (12 years or less, 12-16 years, and 16 + years) by three perpetrators (a family member, a relative, and a stranger). Second, the study sought to assess some psychological implications of sexual victimization. METHOD: A cross-sectional survey was conducted among 652 Palestinian undergraduate students from the Palestinian Authority. A revised version of Finkelhor's scale was utilized to measure sexual abuse, and a revised and culturally adjusted version of Derogatis and Melisaratos' Brief Symptoms Inventory was used to measure nine psychological symptoms. RESULTS: The rates of sexual abuse among Palestinian students fall within the range of the problem in many other societies. Similar rates of abuse were found among female and male students. Moreover, sexually abused participants expressed significantly higher levels of psychoticism, hostility, anxiety, somatization, phobic anxiety, paranoid ideation, depression, obsessive-compulsiveness, and psychological distress compared with their nonabused counterparts. Sexual abuse by different perpetrators at different ages significantly explained between 20.7% and 35.8% of the variance in these psychological symptoms. CONCLUSIONS: The results provide strong support for the argument that sexual abuse exists in Palestinian society, as well as for the hypothesis that sexual abuse has a strong psychological impact on victims. Furthermore, the results highlight the need for further research into different aspects and dimensions of the problem in Arab societies.     

A review of the short-term effects of child sexual abuse

This is the first of a two-part report that critically evaluates empirical studies on the short- and long-term effects of child sexual abuse. With the exception of sexualized behavior, the majority of short-term effects noted in the literature are symptoms that characterize child clinical samples in general. Among adolescents, commonly reported sequelae include sexual dissatisfaction, promiscuity, homosexuality, and an increased risk for revictimization. Depression and suicidal ideation or behavior also appear to be more common among victims of sexual abuse compared to normal and psychiatric nonabused controls. Frequency and duration of abuse, abuse involving penetration, force, or violence, and a close relationship to the perpetrator appear to be the most harmful in terms of long-lasting effects on the child. The high prevalence of marital breakdown and psychopathology among parents of children who are sexually abused makes it difficult to determine the specific impact of sexual abuse over and above the effects of a disturbed home environment. Given the broad range of outcome among sexual abuse victims, as well as the methodological weaknesses present in many of the studies reviewed, it is not possible at this time to postulate the existence of a "post-sexual-abuse-syndrome" with a specific course or outcome.     

A validational study of the structured interview of symptoms associated with sexual abuse (SASA) using three samples of sexually abused, allegedly abused, and nonabused boys

Objective: With the rapid rise of sexual abuse allegations, there is a growing need to develop instruments to help clinicians determine the likelihood that sexual abuse has occurred.Method: This study evaluated the discriminant validity of a structured parent interview regarding emotional, behavioral, and physical symptoms by comparing results among three subsamples of age matched boys: 22 sexually abused boys whose perpetrator confessed, 47 boys evaluated in a sexual abuse clinic but without a history of perpetrator confession and 52 nonabused boys selected after rigorous screening.Results: In comparison with the nonabused (NA) boys, the sexually abused boys were significantly more likely to demonstrate sudden emotional and behavioral changes, frequent stomachaches, more knowledge about sex and sexual activities than expected for age, unusual agressiveness toward playmate or toy's private parts, crying easily, difficulty getting to sleep, and a change to poor school performance. The internal reliability of the SASA was determined to be .83 and scoring of an abbreviated 12-item scale demonstrated a sensitivity of 90.9% and a specificity of 88.5%.Conclusions: The findings suggest that Structured Interview of Symptoms Associated with Sexual Abuse (SASA) is an effective tool which may help in the comprehensive assessment of boys who may have been sexually abused.