Adult Survivors Of Childhood Sexual Abuse Research Articles

Understanding children’s non-disclosure of child sexual assault: implications for assisting parents and teachers to become effective guardians

Purpose– The purpose of this paper is to examine adult survivors’ of childhood sexual abuse (CSA) retrospective reflections on their motives for not disclosing their abuse. The aim was to identify factors that might facilitate early disclosure in order to both enhance the future safety of young people who have experienced sexual victimisation and to offer a means of reducing the numbers of future victims.Design/methodology/approach– This was a retrospective web-based, mixed-methods survey which was completed by 183 adult survivors of CSA. The data presented here is in relation to answers offered in response to an open-ended question which were thematically analysed.Findings– In all, 75 per cent of the survivors of CSA indicated that they had not told anyone of the abuse whilst they were a child. Analysis of the responses revealed five barriers to disclosure which included: a lack of opportunity, normality/ambiguity of the situation, embarrassment, concern for others and a sense of hopelessness. Additionally, some respondents highlighted implicit attempts to disclose and others reported later regret over non-disclosure.Practical implications– A timely disclosure of CSA, which is appropriately responded to, has the potential to reduce the risk for subsequent sexual exploitation/revictimisation, and to foreshorten the predations of offenders. To achieve this, responsible and trusted adults in the lives of children need to learn how to invite a genuine disclosure of CSA.Originality/value– This paper offers practical suggestions for parents and teachers on what signs indicate that an invitation might be warranted and for creating the right context for their invitation to be accepted.

Impact of Traumatic Events on Posttraumatic Stress Disorder among Danish Survivors of Sexual Abuse in Childhood

Childhood sexual abuse can be extremely traumatic and lead to lifelong symptomatology. The present study examined the impact of several demographic, abuse, and psychosocial variables on posttraumatic stress disorder severity among a consecutive sample of treatment-seeking, adult child sexual abuse survivors (N = 480). The child sexual abuse sample was characterized by severe trauma exposure, insecure attachment, and significant traumatization, with an estimated 77% suffering from posttraumatic stress disorder, more than twice the level of the comparison group. Regression analyses revealed risk factors associated with the development of posttraumatic stress disorder in which the strongest predictors being additional traumas, negative affectivity, and somatization. The findings add to existing research confirming the stressful nature of child sexual abuse and the variables that contribute to the development and severity of posttraumatic stress disorder.

Impact of childhood sexual abuse on the emotions and behaviours of adult men from three ethnic groups in the USA

Adult men of different ethnic backgrounds who experienced childhood sexual abuse (CSA) may vary in their reports of the psychological and behavioural impact of CSA on their lives. Empirical studies rarely examine the impact of race/ethnicity or cultural context on the psychological and behavioural struggles of adult male CSA survivors. This study utilised qualitative content analysis to examine the reported CSA-related psychological and behavioural challenges of 150 US men, with equal numbers of Blacks, Latinos and non-Latino Whites. Interview data revealed some ethnic differences: Black men more frequently denied having present day adverse effects than other groups. However, Black men who did report negative consequences of CSA discussed difficulties with substance use and hyper-sexualised behaviour more often than other ethnicities. Latino men reported anger, anxiety, hyper-vigilance, flashbacks and communication problems more often than the other two groups. Black and Latino men also discussed guilt/shame issues and sexual identity concerns more often than Whites did. In contrast, White men more frequently discussed issues related to low self-esteem, loneliness and isolation. These findings suggest that ethnically diverse men may respond differently to CSA experiences and that considerations need to be taken into account when providing healthcare to men with CSA histories.

A Randomized Controlled Trial on Cognitive Restructuring and Imagery Modification to Reduce the Feeling of Being Contaminated in Adult Survivors of Childhood Sexual Abuse Suffering from Posttraumatic Stress Disorder

Background: The feeling of being contaminated (FBC) is a common phenomenon in survivors of childhood sexual abuse (CSA) suffering from posttraumatic stress disorder (PTSD). Thus far, this symptom has been neglected in research and therapy. For this reason, we developed Cognitive Restructuring and Imagery Modification (CRIM), a two-session treatment (lasting 90 and 50 min) that specifically targets the FBC. The present study examined the efficacy of the treatment. Methods: Thirty-four women with CSA-related PTSD (mean age = 37 years) were randomized to either the CRIM group or a waitlist control group. Primary outcomes were intensity, vividness, and uncontrollability of the FBC, associated distress, and PTSD symptoms, which were assessed using the Clinician-Administered PTSD Scale and the Posttraumatic Diagnostic Scale. Outcomes were measured pre- and posttreatment, and at the 4-week follow-up. (M)ANOVAs were used to compare improvements across conditions. Results: All FBC scores yielded a greater reduction in the CRIM group than the waitlist control (WL) group. Between-group effect sizes at follow-up were large and highly significant (intensity: d = 1.52, p < 0.001; vividness: d = 1.28, p < 0.001; uncontrollability: d = 1.77, p < 0.001; distress: d = 1.80, p < 0.001). PTSD symptoms also yielded a greater reduction in the CRIM group than the WL group, with large between-group effect sizes (Clinician-Administered PTSD Scale: d = 0.93, p < 0.001). Conclusions: Our findings support the efficacy of the newly developed CRIM in reducing the FBC and PTSD symptoms in adult survivors of CSA.

Perceptions of Childhood Sexual Abuse Survivors: Development and Initial Validation of a New Scale to Measure Stereotypes of Adult Survivors of Childhood Sexual Abuse

The Childhood Sexual Abuse Stereotypes Scale was developed to assess stereotypes of adult survivors of childhood sexual abuse. Scale items were derived from two studies that elicited cultural and personal beliefs about, and emotions experienced towards adult childhood sexual abuse survivors among university undergraduates. Two scales, Emotions and Characteristics, were developed and administered online to 182 participants. Exploratory factor analysis produced 7 factors, 4 for the Emotions Scale and 3 for the Characteristics Scale. Study 2 replicated this factor structure using confirmatory factor analysis (N = 457). Reliability and validity analyses suggest that the Childhood Sexual Abuse Stereotypes Scale has satisfactory psychometric properties. The Childhood Sexual Abuse Stereotypes Scale can be used to examine stereotypes of legal and health care professionals likely to work with survivors as well as in stereotyping research.

Recovering from childhood sexual abuse: a theoretical framework for practice and research

Research on survivors' experiences of recovering from childhood sexual abuse (CSA) has been limited and focused on those with severe mental health difficulties. This study elicited experiences of recovery from CSA in male and female survivors who have/have not utilized mental health services. The tangible end-point was to propose a theoretical model of personally meaningful recovery. This is a qualitative study, which utilized semi-structured individual interviews following the critical incident technique. Transcripts were analysed using Interpretative Phenomenological Analysis to identify recurrent themes. A total 22 adult survivors of CSA. Main themes identified were: The Affected Self, Factors Hindering Recovery, Factors Enhancing Recovery, The Hurdles of Recovery and the Recovering Self. The affected self included: lack of boundary awareness and self-blame, over self-reliance, over-vigilance and guilt, shame, aloneness and social stigma. The recovering self was characterized by increasing confidence, assertiveness, ability to self-care and self-acceptance, and by embracing vulnerability. These findings have potentially major implications for clinical practice, service provision, policy development and professional training in this field. The importance of disclosure in the healing process seemed paramount and can have major implications for current service protocols.

Tratamiento psicológico de mujeres adultas víctimas de abuso sexual en la infancia: resultados a largo plazo

Child sexual abuse (CSA) is one the most common forms of child victimization. The effects of CSA can extend into adulthood, impacting on physical, psychological, and social functioning and contributing to adult psychopathology. The aim of this paper was to evaluate an individual 12 sessions cognitive-behavioral programme in the treatment of female adult survivors of CSA after implementing it for twenty years in a community setting. The sample consisted of 121 subjects who voluntarily participated in the study. A design with repeated measures (pre-treatment, posttreatment and 1-, 3-, 6- and 12-month follow-up) was used. The success rate regarding posttraumatic stress disorder was of 90.7% in the treatment completers. In spite of the lost patients in the follow-ups (25.58%), the results were maintained in the contacted patients at follow-up (74.42% in the 12-month-follow-up), with a high impact on reducing recidivism. However, the rate of refusals and drop-outs of the treatment was rather high. Therefore it is necessary to develop strategies to improve motivation for treatment. Implications of this study for clinical practice and future research in this field are commented upon.

The Pathways of Problematic Sexual Behavior: A Literature Review of Factors Affecting Adult Sexual Behavior in Survivors of Childhood Sexual Abuse

Research shows that many adult sexual behaviors may be related to childhood sexual abuse (CSA), ranging from withdrawal and dysfunction on one end of the spectrum to hypersexuality and compulsion on the other, but it is unclear why some individuals respond to CSA by withdrawal, fear and anxiety, while others respond with impulsiveness and acting-out behavior. This literature review finds that there are two distinct factors which account for differences in sexual behavior among adult survivors of CSA: (a) the gender of the victim, and (b) the age at onset of victimization. Based on this data, an integrative framework is proposed, incorporating elements of social learning theory and psychoanalytic concepts, to explain the etiology of problematic adult sexual behaviors, as well as corresponding implications for clinical treatment.

Overcoming sequelae of childhood sexual abuse with stress management

The immense stress associated with experiencing and surviving childhood sexual abuse directly influences coping, immune function and overall health. Lifelong overuse of maladaptive coping strategies results in impaired adjustment to stress. The purpose of this research was to re-examine if stress management education would be effective in improving coping skills for this population. Two 4-week series of stress management workshops were completed by 32 adult survivors who completed the ways of coping questionnaire before and after the training. Four categories of coping showed significant change. Stress management education is an effective and cost-efficient approach that gives adult survivors an empowering set of tools for their healing journey.

The Feeling of Being Contaminated in Adult Survivors of Childhood Sexual Abuse and Its Treatment Via a Two-Session Program of Cognitive Restructuring and Imagery Modification

Clinical experiences show that many survivors of childhood sexual abuse (CSA) suffer from a distressing feeling of being contaminated (FBC) even years or decades after the last experience of sexual violence. So far, this symptom has been neglected in research. The aim of this article is to illustrate this symptom and the necessity of a specialized treatment. Phenomenology, consequences, and possible concepts of explanation are described. The article presents a newly developed short-time treatment, cognitive restructuring and imagery modification, to reduce the FBC in adult survivors of CSA. Two case studies on women suffering from chronic CSA-related posttraumatic stress disorder (PTSD) plus the FBC demonstrate the outcome of the two-session program that can easily be integrated in a whole treatment program. They show that the treatment results in a reduction of the FBC and PTSD symptoms after CSA.

Childhood sexual abuse and attachment: An intergenerational perspective

Childhood sexual abuse (CSA) is a recognized risk factor for various negative outcomes in adult survivors and their offspring. We used the Dynamic-Maturational Model of attachment theory as a framework for exploring the impact of maternal CSA on children's attachment relationships in the context of a longitudinal sample of adult survivors of CSA and non-abused comparison mothers and their children. Results indicated that children of CSA survivors were more likely to have extreme strategies of attachment than the children of non-abused mothers. However, because both groups were at socioeconomic risk, both were typified by anxious attachment. Explanations for findings and implications for children's development are explored.

Surviving Child Sexual Abuse: The Relevance to Dental Practice

Child sexual abuse (CSA) occurs in all communities, ethnic backgrounds, religions, cultures, social and economic classes, and is experienced by both males and females. The physical and psychological effects of CSA have significant effects on adult health outcomes. Parallels have been drawn between the physical and emotional environment of dental treatment and features of the CSA experience. Consequently, adult survivors of CSA can find it difficult to tolerate dental treatment, and may repeatedly cancel dental appointments or avoid dental treatment altogether. Awareness of patient characteristics in the dental setting that indicate past CSA include discomfort with body positioning, dislike of being touched, sense of loss of control, fear of judgement and sensitivity to perceived criticism, sensitivity to particular smells and sensitivity to having instruments in the mouth. Some aspects of the dental environment and dental treatment can act as 'triggers' that can take survivors of CSA back to the emotions associated with that event. An understanding of the fears and anxieties this can cause in the dental setting allows the dental team to help the individual cope with the dental experience, improving it for both the patient and the provider. The development of general strategies that foster establishing a positive rapport, sharing control and treating the individual as a partner in the healthcare relationship can cultivate a positive dental experience that can have far reaching effects. The prevalence of child sexual abuse (CSA) is surprisingly high, so adults who have experienced CSA can find it difficult to tolerate dental treatment, and may repeatedly cancel dental appointments or avoid dental treatment altogether.

Child sexual abuse: A critical review of intervention and treatment modalities

Recent years have ushered a growing understanding and a broadening knowledge base of the complexities of child sexual abuse. These complexities are acerbated by the need to account for the specific problem of child sexual abuse (CSA) in the larger context of multi-problem intervention, requiring coordinated multi-disciplinary team efforts as well as sensitive and focused attention to CSA itself. The aim of this paper is to critically examine the literature on several treatment modalities that are utilized by professionals from a range of disciplines treating victims of childhood sexual abuse. Acknowledging recent findings that dissociative disorders among CSA survivors are high compared to survivors of other forms of trauma and that about 80% of adult CSA survivors who were diagnosed with posttraumatic stress disorder actually suffer from dissociative disorders, the author discusses the phenomena of dissociative identity disorder among survivors who were sexually abused. The implications for the development of a therapeutic model are described, including a delineation of the model components.

Positive Resolution of Childhood Sexual Abuse Experiences: The Role of Coping, Benefit-Finding and Meaning-Making

Resolution of the trauma of childhood sexual abuse (CSA), and the current adjustment of 60 adult female CSA survivors were explored through qualitative and quantitative analyses of their coping strategies, perceived benefits, and meaning-making attempts. While the majority of the women (87%) perceived at least some benefit resulting from coping with the CSA experience, many (29%) found it impossible to make any meaning of their trauma. Specific benefits that were associated with various aspects of positive adjustment (marital satisfaction, better physical health, less isolation) included improved relationships with others, religious or spiritual growth, and improved parenting skills. Some perceived benefits were actually associated with a negative outcome. Increased knowledge of sexual abuse was associated with more isolation and lower marital satisfaction. When positive meaning could be derived from the coping process, the women reported less isolation. Avoidant coping was strongly associated with more depressive symptoms and poorer resolution of abuse issues. Results highlight the importance of considering coping strategies and cognitive restructuring efforts in designing therapeutic interventions with this population.

Negotiating Therapeutic Boundaries with Childhood Sexual Abuse Survivors: Choices in Decision-Making

This qualitative study explored therapeutic boundary processes during individual therapy from the perspectives of adult childhood sexual abuse survivors and therapists. Interviews exploring the context, process, and effects of negotiating boundaries were conducted with 11 survivors (8 female and 3 male) after or upon completing individual therapy, and with 11 therapists (8 female and 3 male) who were working with survivors other than those interviewed in this study. Participants reported that their abilities to negotiate boundary modifications were affected by personal beliefs, such as preconceived ideas about the utility of the boundary, and interpersonal relationships that impinge on both survivors' and therapists' capacities to refuse requests for boundary modifications. Although discussion between survivors and therapists about boundary decisions before they are made may not always preclude negative consequences, participants also stated that it is helpful to understand boundaries in the context of th...

Family of origin environments in two clinical samples of survivors of intra-familial, extra-familial, and both types of sexual abuse

Objective: It has been suggested that survivors of ongoing childhood sexual abuse (CSA) tend to have been reared in ineffective family environments that render them particularly vulnerable to maltreatment and which foster psychological difficulties beyond those accounted for solely by their abuse. If this conjecture is valid, one would expect that the family of origin environments of CSA survivors would be disturbed whether their abuser was intra-familial or extra-familial. To assess this hypothesis, two studies compared the childhood family of origin environments and supportive parenting characteristics of a clinical sample of women sexually abused by family members only (the intra-familial group), by non-family members only (the extra-familial group), and by both family and non-family members (the “both” group). Method: Study 1 compared the three groups (total N = 213) using the Family Environment Scale (FES). Study 2 compared groups (total N = 86) on the positive parenting scales of the Exposure to Abusive and Supportive Environments Parenting Inventory (EASE-PI). Results: In Study 1, multivariate analyses indicated significant differences on the independence, cohesion, and conflict subscales of the FES. Pairwise comparisons revealed that the extra-familial group reported significantly higher levels of family independence and lower levels of conflict than the other two groups. In addition, the extra-familial group reported higher levels of cohesion than the intra-familial group. However, the effect sizes of these comparisons were extremely small. In Study 2, multivariate analyses revealed no group differences on the EASE-PI scales. Conclusions: Low effect sizes on the three significant FES scales, non-significance on the remaining seven FES scales, and non-significance on the EASE-PI scales suggest that there is considerable similarity in the family of origin environments of adult female CSA survivors seeking therapy regardless of whether their perpetrators were family members, non-family members, or both family and non-family members.

Assessing the Long-Term Effects of EMDR: Results from an 18-Month Follow-Up Study with Adult Female Survivors of CSA

ABSTRACT This 18-month follow-up study builds on the findings of a randomized experimental evaluation that found qualified support for the short-term effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) in reducing trauma symptoms among adult female survivors of childhood sexual abuse (CSA). The current study provides preliminary evidence that the therapeutic benefits of EMDR for adult female survivors of CSA can be maintained over an 18-month period. Furthermore, there is some support for the suggestion that EMDR did so more efficiently and provided a greater sense of trauma resolution than did routine individual therapy.

Interpersonal rejection sensitivity in childhood sexual abuse survivors: mediator of depressive symptoms and anger suppression.

This study investigated whether interpersonal rejection sensitivity serves a mediating role between childhood sexual abuse (CSA) and three long-term psychological correlates of CSA in adult female survivors: depressive symptoms, anger suppression, and attenuated emotional expression. Interpersonal rejection sensitivity has been shown to be a risk factor for the development of depression and is elevated in CSA survivors. Similarly, attenuated emotional expression, particularly anger, has been related to adjustment difficulties in CSA survivors. Participants in this study were 355 female undergraduates, 34 of whom reported a history of CSA. Results demonstrated that interpersonal rejection sensitivity mediates the relationship between CSA and later depressive symptoms. Interpersonal rejection sensitivity partially mediated the relationship between CSA and anger suppression; however, it did not mediate the relationship between CSA and attenuated emotional expression. These results are examined within the context of the current literature on adult CSA survivors and their implications are discussed.

Clinical Decision-Making Strategies of Marriage and Family Therapists in the Treatment of Adult Childhood Sexual Abuse Survivors

The incidence of childhood sexual abuse (CSA) in the general population, as well as the greater prevalence of CSA survivors among those who enter therapy, mean that therapists are likely to treat sexual abuse survivors in their clinical work. A modified Delphi study was used to collect data to determine how American Association of Marriage and Family Therapy (AAMFT) Approved Supervisors make treatment decisions following client disclosures of CSA. Three rounds of data were collected. The results suggested that there are several issues to address in therapy regardless of treatment modality and disclosure type. Suggestions for treatment were provided depending on the disclosure scenario.

Group treatments for women sexually abused as children: a review of the literature and recommendations for future outcome research

Objective: Adults with a history of sexual abuse often suffer many long-term consequences. It is important that therapists be able to provide effective treatment to address the host of issues that are presented in therapy by adult survivors of childhood sexual abuse (CSA). In order to provide the best possible treatment, therapists should know which treatments are most effective. Method: This paper provides a critique of the outcome research of 13 studies (six uncontrolled and seven controlled) on the treatment of adults who suffered childhood sexual abuse and discusses specific methodological strategies that can enhance the quality of such research in the future. Results: Although many of the studies contain methodological limitations, the results generally indicate that group treatment helps reduce symptomatology in the short-term and at follow-up. Conclusion: Although outcome research has not been published on specific individual or conjoint treatment approaches for adult survivors of CSA, several outcome studies have found group treatment to be effective in the recovery of female CSA survivors.