Expressions of impaired mentalization and theory of mind within the therapeutic context perspectives of childhood sexual abuse survivors and their therapis

<i>The Child Sex Scandal and Modern Irish Literature: Writing the Unspeakable</i>, by Joseph Valente and Margot Gayle Backus

BackgroundChildhood trauma (CT), a generic term encompassing experiences of severe abuse and neglect during childhood and adolescence, has been established as an important risk factor for the emergence of psychosis. Among the potential pathways involved in the CT-psychosis association, Theory of Mind (ToM) disruption holds a central position. ToM reflects the ability to attribute distinct mental states to oneself and other people, and correctly infer the beliefs, wishes, intentions and dispositions of others in order to predict their behavior and produce proper social responses. ToM is further elaborated in 1st order ToM (ToM1: the ability to understand that someone may hold a false belief about the state of the world) and 2nd order ToM (ToM2: the ability to understand that one person may hold a false belief about the belief of another person). Research shows that patients with schizophrenia-spectrum psychosis (SSP) exhibit marked deficits in ToM. CT may increase SSP risk by disrupting the emergence of normal ToM skills, thus inducing a vulnerability for cognitive errors, perceptual aberrations and impaired reality testing. Our study sought to explore the effect of CT on ToM performance in a group of SSP patients and a healthy control group (HC).MethodsWe compared 63 SSP patients to a healthy control group on measures of CT and ToM. CT (presence of parental antipathy, parental neglect, physical abuse, sexual abuse) was assessed with the Childhood Experience of Care and Abuse Questionnaire (CECA.Q). ToM1 and ToM2 performance was measured with the Perception of Social Inference Test (PESIT). Chi-squared analysis was performed to compare CT rates between SSP patients and HCs. Mann-Whitney U tests were employed to detect differences in ToM between the two groups. Within each group, the impact of CT and polytraumatization (accumulation of different CT types) on ToM performance was examined.ResultsSSP patients displayed significantly higher CT rates (χ2 (1, N = 124) = 34.5, p < .001) and worse ToM performance (ToM1: U = 653,5, p < .001; ToM2: U = 435,5, p < .001) than HCs. SSP inpatients were 11.6 times more likely to have been exposed to severe CT than HCs. Within the SSP group, CT was associated with increased ToM2 deficits (U = 259, p = .020), while polytraumatization was negatively correlated to both ToM1 (rs = -.297, p = .020) and ToM2 (rs = -.341, p = .007) performance. Maternal antipathy (U = 207, p = .036) and neglect (U = 148, p = .017) were the CT subtypes associated with worse ToM2 performance. No similar effects were detected within the HC group.DiscussionOur finding of ToM deficits in SSP patients may indicate a bidirectional association, involving on the one hand a negative effect of psychotic illness on ToM skills, and on the other hand a vulnerability towards psychosis induced by severe, early disruptions in normal ToM acquisition. Worse ToM performance in SSP patients with cumulative CT may signify an additive or synergistic effect of CT and psychosis on ToM skills. The involvement of maternal antipathy and neglect in the aforementioned association highlights the pivotal role of the mother in the development of the child’s capacity to envision distinct mental states in self and others, a prerequisite for self-awareness and self-other individuation. The failure to detect similar effects in HCs may be attributed to the low frequency of CT in this group, potentially restricting the strength of this analysis. On the same matter, another explanation could be that CT by itself is not a sufficient condition for ToM impairment, and only becomes relevant when it acts in synergy with other harmful processes inherent in psychosis.

Whereas childhood trauma is associated with reduced nonsocial cognition in schizophrenia, research on the relationship between childhood trauma and social cognition is limited and mixed. The aim of this study was to examine the association between childhood trauma and theory of mind (ToM) in persons with schizophrenia (n = 68) compared to healthy control participants (n = 70). Childhood trauma was assessed with the Childhood Trauma Questionnaire (CTQ), providing information on physical abuse, emotional abuse, sexual abuse, physical neglect and emotional neglect. ToM was indexed by the Movie for the Assessment of Social Cognition (MASC), which yields scores for total, cognitive and affective ToM, and for three error types (overmentalizing, undermentalizing, no mentalizing). Persons with schizophrenia had elevated rates of childhood trauma and lower ToM scores than healthy controls. In the schizophrenia group, associations between sexual abuse and affective ToM was statistically significant. In regression analyses, physical neglect was found to be the strongest predictor of affective ToM. In healthy controls, childhood trauma was not associated with ToM. Follow-up analyses comparing individuals with/without clinically significant childhood trauma, confirmed the findings for the schizophrenia group. No causal inferences can be made in this cross-sectional study, but the results suggest an illness-specific association between both sexual abuse and physical neglect in childhood, and adult affective ToM in individuals with schizophrenia.

Childhood sexual abuse is a complex trauma with unique trauma-causing factors that could have devastating long-term, negative effects on survivors. To date, little attention has been given to loss and specifically stigmatized or hidden loss as a unique trauma-causing factor. Method: This article reports the findings of a scoping review designed to identify research exploring the losses associated with childhood sexual abuse in women survivors. A systematic search of databases for articles published between 1983 and 2019 were conducted using keywords related to loss and women survivors of childhood sexual abuse. Findings: Twenty studies were selected for review using predefined inclusion criteria: studies that include adult women survivors of childhood sexual abuse, studies that include child/childhood sexual abuse, studies that include stigmatized loss, studies that indicate stigmatized loss in adult women survivors of childhood sexual abuse. Sources were subject to quality appraisal and data were extracted in line with the review question. Discussion and Contribution: Findings acknowledged and extended on Bloom’s model of stigmatized loss and suggested that female survivors of childhood sexual abuse may experience an overall loss of self-efficacy, presenting as a loss of personal agency, interpersonal agency, and sexual agency. The results of this research suggest that loss be considered in support interventions with women self-reporting childhood sexual abuse. It is recommended that further research be conducted to confirm these findings so that they may advocate for inclusion in childhood sexual abuse treatment interventions.

A practical approach to clients who are survivors of childhood sexual abuse

In this article, the authors review 33 empirical studies investigating Posttraumatic Stress Disorder (PTSD) in survivors of childhood sexual abuse (CSA). In many of these studies, researchers also examined the impact of the co-occurring trauma of childhood physical abuse (CPA) in regard to PTSD symptoms. Methodological issues addressed in the review include definition and measurement of both CSA and CPA, assessment of PTSD, and additional aspects of experimental design. In this review, the authors explore the importance of the empirical investigation of the relationship between the level of trauma exposure (e.g., seventy and duration of trauma), and the level of PTSD symptoms. Suggestions for future research are proposed. Since a given survivor may often experience additional types of traumatic events across his or her lifetime, the utility of adopting a multiple-trauma perspective in understanding the impact of stressful life events across the lifespan is explored.

ABSTRACTThe present study examined the possibility of different groups of child sexual abuse (CSA) survivors based on their different patterns of attachment and sexual problems. A sample of 324 CSA survivors and 484 participants who did not report any child maltreatment experiences completed online questionnaires. A cluster analysis on attachment and sexual outcomes revealed that CSA survivors formed two distinct profiles. The first profile included CSA survivors with elevated attachment anxiety and low to moderate scores on attachment avoidance, sexual compulsion, and sexual avoidance. The second profile comprised CSA survivors with high scores on attachment anxiety, attachment avoidance, sexual compulsion, and sexual avoidance. These groups were then compared on CSA severity, gender differences, and other child maltreatment experiences. As compared to CSA survivors of the first profile, survivors from the second profile reported more intrusive and extrafamilial CSA, higher rates of psychological maltreatment and witnessed parental violence, and experienced more personal and couple distress. These results suggest that CSA survivors form a heterogeneous population and that sexual abuse is differentially associated with the complex unfolding of the attachment and sexual systems within two distinct subgroups.

&lt;p&gt;This report presents the findings of a gap analysis of specialized services for victims and survivors of online child sexual exploitation and abuse (CSEA) in Canada. The analysis took place between March and July 2019 and was conducted to identify existing specialized support services for victims of CSEA, their families, and adult survivors of CSEA, as well as gaps in the availability of such services, any promising practices in Canada or elsewhere, and challenges to providing specialized supports for these victims and their families.&lt;/p&gt; &lt;p&gt;Very few support services and treatment practices are specifically related to online CSEA in Canada. Overall, the most promising practices currently offered in Canada are those that address child victims (children and youth up to the age of 18 years) of crime more generally, especially the services provided by the Child and Youth Advocacy Centre network that is expanding across the country, as well as those provided by the longstanding network of service providers that responds to victims of sexual assault. These networks have great potential to provide specialized supports for online CSEA victims and their families. However, they currently lack expertise in online CSEA, and need evidence-based guidance on how to best support these victims; methods demonstrated to be effective for sexual crime victims in general might not be effective or may even be harmful to victims of online crimes.&lt;/p&gt; &lt;p&gt;What is needed is investment in creating the evidence base – that is, data evaluating and verifying the appropriateness and effectiveness of specific support services and approaches to treatment for online CSEA – that would then inform best practices. These best practices could then be conveyed in training for service providers, and integrated into supervision and mentorship structures within organizations. Many of the individuals interviewed for this report are experts in the field of child sexual abuse. Other participants are well versed in providing referrals for clients needing specialized supports for child victims of sexual abuse. However, they did not believe that they had expertise specific to working with victims of online CSEA, and generally did not know of specialized services to which they could refer victims. The extensive and well-established networks of experts in the fields of sexual abuse and child sexual abuse should be mobilized to participate in, and contribute to, research in this area in order to develop evidence-based effective responses for victims of online CSEA.&lt;/p&gt;

&lt;p&gt;This report presents the findings of a gap analysis of specialized services for victims and survivors of online child sexual exploitation and abuse (CSEA) in Canada. The analysis took place between March and July 2019 and was conducted to identify existing specialized support services for victims of CSEA, their families, and adult survivors of CSEA, as well as gaps in the availability of such services, any promising practices in Canada or elsewhere, and challenges to providing specialized supports for these victims and their families.&lt;/p&gt; &lt;p&gt;Very few support services and treatment practices are specifically related to online CSEA in Canada. Overall, the most promising practices currently offered in Canada are those that address child victims (children and youth up to the age of 18 years) of crime more generally, especially the services provided by the Child and Youth Advocacy Centre network that is expanding across the country, as well as those provided by the longstanding network of service providers that responds to victims of sexual assault. These networks have great potential to provide specialized supports for online CSEA victims and their families. However, they currently lack expertise in online CSEA, and need evidence-based guidance on how to best support these victims; methods demonstrated to be effective for sexual crime victims in general might not be effective or may even be harmful to victims of online crimes.&lt;/p&gt; &lt;p&gt;What is needed is investment in creating the evidence base – that is, data evaluating and verifying the appropriateness and effectiveness of specific support services and approaches to treatment for online CSEA – that would then inform best practices. These best practices could then be conveyed in training for service providers, and integrated into supervision and mentorship structures within organizations. Many of the individuals interviewed for this report are experts in the field of child sexual abuse. Other participants are well versed in providing referrals for clients needing specialized supports for child victims of sexual abuse. However, they did not believe that they had expertise specific to working with victims of online CSEA, and generally did not know of specialized services to which they could refer victims. The extensive and well-established networks of experts in the fields of sexual abuse and child sexual abuse should be mobilized to participate in, and contribute to, research in this area in order to develop evidence-based effective responses for victims of online CSEA.&lt;/p&gt;

This study aimed to explore the sexual relationships experienced by a non-clinical group of lesbian women survivors of male perpetrated child sexual abuse (CSA), where the abuse occurred between the ages of eight and 15 years. By adopting a phenomenological approach it was intended that these experiences would be explored through the eyes of the women participating in the study. It was further intended that the study would illuminate an underresearched area, thus offering some guidance to therapists and other professionals working therapeutically with lesbian survivors of CSA. Eight lesbian survivors participated in individual focused interviews, each lasting about one hour. The interviews were audiotaped, transcribed and subjected to stringent content analysis, with referral back to participants for clarification and verification in keeping with the phenomenological tradition. The study identified several issues which appear to be unique to lesbian survivors, namely woman-to-woman sexual assault, ‘negotiated sex’ and lack of sexual spontaneity in relationships where both women are survivors of CSA, and the concept of a double secret: CSA and lesbianism. Overall, however, the study demonstrated a sense of commonality of experience with those of heterosexual women. This in itself was found to be reassuring because it would appear that the therapeutic signposts and approaches commonly looked for and adopted, when working with heterosexual women survivors, are appropriate. Ultimately it is hoped that the study will help therapists and helpers to provide a quality service to lesbian survivors of CSA, based on evidence rather than supposition and stereotype.

The aims of this pilot study were: (a) to test the feasibility of prolonged exposure (PE) therapy conducted by a social worker staff on female patients in methadone program clinics who were survivors of child sexual abuse or rape and (b) to examine preliminary outcomes of PE on posttraumatic stress disorder (PTSD), depression, and illicit drug use at pre- and posttreatment, and up to 12-month follow-ups. Twelve female methadone patients who were survivors of child sexual abuse or rape diagnosed with PTSD were enrolled in 13–19 weekly individual PE sessions. Assessments were conducted at pre-, mid-, and posttreatment, as well as at 3, 6, and 12-month follow-ups. The treatment outcomes measures included PTSD symptoms, depressive symptoms, and illicit drug use. Ten of the 12 study patients completed treatment. PTSD and depressive symptoms showed significant reduction. No relapse to illicit drug use was detected. These preliminary results suggest that PE may be delivered by methadone social workers with successful outcomes. Further research should test the efficacy of PE among methadone patients in a randomized control trial with standard care as the control condition.

Child sexual abuse has been associated with various health and social consequences. Despite the traumatic effects of the abuse, previous studies have revealed that some victims adapt, recover and become resilient. However, literature has emphasised the need for exploring resilience in the context within which it develops. This study therefore set out to explore perceptions of resilience in adult female survivors of child sexual abuse. A case study design utilizing qualitative research methods was adopted. Narrative inquiry was used to collect data from 14 purposively selected survivors of child sexual abuse. Six in-depth interviews were also held with purposively selected service providers. Interviews were audio recorded and transcribed and analysed using themes and quotes. Some participants associated resilience with improved ability to avoid thoughts about the abuse, positive emotional adjustment, increased ability to talk about one’s experience of sexual abuse and feeling hopeful for the future. Survivors shared similarities in personal meanings of the consequences and attributes of resilience which were mainly psychological. They majorly associated resilience with internal attributes including positive emotions. The negative consequences of the abuse force survivors to adopt strategies that enable them to be resilient. Current and previous volumes are available at: https://ajsw.africasocialwork.net HOW TO REFERENCE USING ASWDNET STYLETuryomurugyendo F., Walakira E. J., Revheim C. and Twikirize M. J. (2025). ‘I am a victim without symptoms’: Perceived attributes of resilience for female survivors of child sexual abuse in rural Uganda. African Journal of Social Work, 15(2), 11-22. https://dx.doi.org/10.4314/ajsw.v15i1.2

Examining the relationship between higher educational attainment, trauma symptoms, and internalizing behaviors in child sexual abuse survivors.

ObjectiveThe childhood sexual abuse (CSA) survivor population is substantial and survivors have been identified as part of the population who were under-screened or never-screened for breast, cervical and colon cancer....

The incidence of survivors of childhood sexual abuse (CSA) diagnosed with cancer is unknown. It is estimated that one in three women and one in six men in the United States are survivors of CSA. Survivors of CSA diagnosed with cancer are presented with multiple and potentially accumulating traumas. The re-traumatizing nature of a cancer diagnosis and treatment affects all elements of the CSA survivor's care and may impede her/his treatment. To date, the impact of CSA on the medical treatment of people with cancer has been unexplored with the existing studies on female survivors of CSA with cancer focusing on the post-treatment experience and their higher incidence of sexual dysfunction. This article describes the impact of CSA on the cancer treatment of 18 survivors of CSA and the clinical interventions used to address the unique psychosocial needs of this population. Anecdotal information suggests that the survivors of CSA may find aspects of the cancer experience reminiscent of their history of abuse. All 18 survivors of CSA experienced distressing memories of their abuse during their cancer treatment. Fifteen CSA survivors presented traumatic memories that were inaccessible to conscious thought processes prior to their cancer diagnosis. Psychodynamic interventions address issues of disruption in the cancer treatment, non-adherence, and difficulties in relationships with the health care team. Containment of intense affect and distressing thoughts rather than exploration improved CSA survivors' adherence with cancer treatments. The acquisition of self-comforting skills helped CSA survivors feel less re-victimized by their cancer experience. The establishment of an environment of internal and external safety improved communication with the health care team. Health care/psycho-social clinicians' awareness and use of appropriate interventions can minimize the affects of re-traumatization and enhance the CSA survivor's treatment experience.