Childhood Sexual Abuse Exposure Research Articles

Distinctive impacts of sexual trauma versus non-sexual trauma on PTSD profiles in highly trauma-exposed, Black women

BackgroundPrior findings suggest that psychopathology following interpersonal trauma or assaultive violence may present differently from prototypical posttraumatic stress disorder (PTSD). However, whether this is true for sexual trauma (ST) in the context of other salient lifetime traumatic experiences is yet unknown. We predicted that ST exposure may result in higher avoidance and numbing symptoms and blunted fear responses, relative to non-sexual trauma (NST), particularly if ST occurred during childhood. MethodsParticipants were n = 5163 Black women recruited in an urban public hospital. We investigated effects of ST on PTSD symptoms, fear-potentiated startle (FPS) response (n = 285), and amygdala reactivity and habituation to social threat cues with fMRI (n = 95). ResultsST was associated with greater PTSD symptoms (p = 2.64 × 10−21), but this was observed across all symptom clusters. Women who experienced repeated ST in both childhood and adulthood showed greater PTSD (p = .0009) and numbing symptoms (p = .002). In the FPS paradigm, the ST group startled more on all blocks and stimulus types than the NST group (p = .004). Developmental timing of ST did not influence startle magnitude. ST was not associated with amygdala habituation or reactivity. LimitationsGeneralizability is limited to Black women with a high trauma burden. Associations are cross-sectional, limiting causal conclusions. ConclusionWhile survivors of ST may present with more severe PTSD symptoms, their profiles are not characteristically different from similar NST controls. Childhood sexual abuse exposure alone did not result in a unique symptom profile. ST represents a uniquely high-burden stressor with likelihood for more severe posttraumatic outcomes.

Cortisol trajectories measured prospectively across thirty years of female development following exposure to childhood sexual abuse: Moderation by epigenetic age acceleration at midlife

Lasting changes in the hypothalamic-pituitary-adrenal (HPA) axis are a potential indication of the biological embedding of early life adversity, yet, prospective and repeatedly collected data are needed to confirm this relation. Likewise, integrating information from multiple biological systems, such as the HPA axis and the epigenome, has the potential to identify individuals with enhanced embedding of early life adversity. The current study reports results from the Female Growth and Development Study, a 30-year prospective cohort study of childhood sexual abuse (CSA). Females exposed to substantiated CSA and a demographically-similar comparison condition were enrolled and resting state cortisol concentrations were sampled on seven subsequent occasions across childhood, adolescence, and adulthood. Differences in participants’ cortisol trajectories were examined in relation to prior CSA exposure and DNA methylation-derived epigenetic age acceleration at midlife. Bilinear spline growth models revealed a trajectory where cortisol secretion increased until approximately age twenty and then declined into mid-life, consistent with normative trends. However, cortisol concentrations peaked at a lower level and transitioned to the decline phase at an earlier age for females in the CSA condition with increased epigenetic age acceleration. Robustness tests across three independent measures of epigenetic age acceleration demonstrated similar results for lower peak cortisol levels and earlier ages at transition. Results suggest that CSA is associated with significant changes in HPA-axis activity over extended periods of time with these changes most pronounced in females with accelerated epigenetic aging in mid-life. Implications for biological embedding models of early life adversity and adulthood health are discussed.

Male-type depression symptoms in young men with a history of childhood sexual abuse and current hazardous alcohol use

The prevalence of male-type or externalising depression symptoms (e.g., anger, risk-taking, emotion suppression) were examined with cross-sectional online convenience sample of 1,277 help-seeking young men (M=23.64, SD=3.61 years). Almost a quarter (21.9%) of the sample reported childhood sexual abuse (CSA) exposure, and most (68.8%) endorsed past 2-week suicide ideation. All male-type depression symptoms were frequently (>30%) endorsed across the sample, and were positively correlated with past 2-week suicide ideation. An adjusted CSA exposure × alcohol risk interaction (p=.013) indicated elevated male-type depression scores for those with a CSA history and hazardous alcohol use. Results are interpreted in line with young men's adherence to masculine norms, which may be particularly complex for young men reporting a CSA exposure history. Findings support the need for enhanced screening efforts, especially among young men with a history of CSA and hazardous alcohol use, with a need to also improve gender-sensitive service offerings for young men with a CSA exposure history.

Associations of childhood abuse and combat exposure with suicidal ideation and suicide attempt in U.S. military veterans: a nationally representative study

BackgroundMilitary veterans with a history of childhood abuse are at increased risk for suicidality. To date, however, little research has examined whether exposure to childhood abuse may heighten veterans’ susceptibility to the effects of combat exposure and increase risk for suicidal behavior. This study examined whether childhood abuse has an additive or interactive effect on the association between combat exposure and suicide-related outcomes in a national sample of veterans. MethodsData were from the National Health and Resilience in Veterans Study, a nationally representative survey of U.S. veterans (n = 3,157). Analyses compared veterans with/without current suicidal ideation and lifetime suicide attempts (SI/SA) on sociodemographic, military, and clinical characteristics; and examined the unique contribution of childhood physical and sexual abuse and combat exposure, and their interaction, with SI/SA. ResultsAfter adjusting for sociodemographic characteristics and lifetime trauma burden, a significant interaction emerged between childhood sexual abuse and combat exposure predicting SI, such that combat-exposed veterans with histories of abuse were nearly three times more likely to currently be contemplating suicide relative to those without such histories. Childhood sexual abuse predicted lifetime suicide attempt, above and beyond sociodemographic characteristics, lifetime trauma burden, and combat exposure. LIMITATIONS: Cross-sectional design precludes causal inference. ConclusionsResults indicate that childhood sexual abuse exposure may operate both independently and synergistically with combat exposure to increase risk for suicidality among veterans. Findings suggest that veterans who experience childhood sexual abuse represent a subgroup that may be especially vulnerable to experiencing suicidal ideation following combat exposure.

Maternal and Child Sexual Abuse History: An Intergenerational Exploration of Children's Adjustment and Maternal Trauma-Reflective Functioning.

Objective: The aim of the current study was to investigate associations, unique and interactive, between mothers’ and children’s histories of childhood sexual abuse (CSA) and children’s psychiatric outcomes using an intergenerational perspective. Further, we were particularly interested in examining whether maternal reflective functioning about their own trauma (T-RF) was associated with a lower likelihood of children’s abuse exposure (among children of CSA-exposed mothers).Methods: One hundred and eleven children (Mage = 9.53 years; 43 sexual abuse victims) and their mothers (Mage = 37.99; 63 sexual abuse victims) participated in this study. Mothers completed the Parent Development Interview (PDI), which yielded assessments of RF regarding their own experiences of abuse, and also reported on their children’s internalizing and externalizing symptoms.Results: Children of CSA-exposed mothers were more likely to have experienced CSA. A key result was that among CSA-exposed mothers, higher maternal T-RF regarding their own abuse was associated with lower likelihood of child CSA-exposure. Mothers’ and children’s CSA histories predicted children’s internalizing and externalizing symptoms, such that CSA exposure for mother or child was associated with greater symptomatology in children.Conclusion: The findings show that the presence of either maternal or child CSA is associated with more child psychological difficulties. Importantly in terms of identifying potential protective factors, maternal T-RF is associated with lower likelihood of CSA exposure in children of CSA-exposed mothers. We discuss these findings in the context of the need for treatments focusing on increasing T-RF in mothers and children in the context of abuse to facilitate adaptation and reduce the intergenerational risk.

Childhood sexual abuse and two stages of cigarette smoking in African-American and European-American young women

ObjectiveThe aim of the current study was to determine whether the higher rates of childhood sexual abuse (CSA) but lower rates of cigarette smoking in African-American vs. European-American women can be explained in part by a lower magnitude of association between CSA and smoking in African-American women. MethodsData were drawn from a same-sex female twin study of substance use (n=3521; 14.3% African-American). Cox proportional hazards regression analyses using CSA to predict smoking initiation and progression to regular smoking were conducted separately by race/ethnicity. Co-twin status on the smoking outcome was used to adjust for familial influences on smoking (which may overlap with family-level influences on CSA exposure). ResultsAfter adjusting for co-twin status, CSA was associated with smoking initiation in European Americans (hazard ratio (HR)=1.43, 95% confidence intervals (CI): 1.26–1.62) and with smoking initiation ≤16 in African Americans (HR=1.70, CI: 1.26–2.29). CSA was associated with regular smoking onset ≤15 in European Americans (HR=1.63, CI: 1.21–2.18), with no change in HR after adjusting for co-twin status. In the African-American subsample, the HR for CSA was reduced to non-significance after adjusting for co-twin status (from HR=3.30, CI: 1.23–8.89 to HR=1.16, CI: 0.71–1.92 for regular smoking ≤15). ConclusionsCSA is associated with moderate elevation in risk for initiating smoking among African-American and European-American women. By contrast, CSA is associated with elevated risk for (adolescent onset) regular smoking only in European-American women. Furthermore, there is significant overlap between risk conferred by CSA and familial influences on regular smoking in African-American but not European-American women.

Childhood sexual abuse and suicidal behavior: a meta-analysis.

Self-inflicted injuries are one of the major causes of disease burden and death globally. Understanding the extent to which this is associated with childhood sexual abuse (CSA) exposure can help inform prevention strategies. We aimed to quantify to what extent CSA was associated with incident suicide attempts in men and women. We searched 20 health and social science databases from first record until February 2009 and updated the search in Medline from February 2009 to February 1, 2013. Longitudinal studies and cotwin analyses from twin studies in any population from any year were eligible for inclusion. Of 22 235 abstracts screened as part of a series of reviews, 9 studies met the inclusion criteria for this review. Characteristics, effect estimates, and quality data were extracted. Random-effects meta-analysis was used to generate pooled odds ratios (ORs). Seven longitudinal and 2 twin studies with 8733 participants met the inclusion criteria. The overall pooled estimate for longitudinal studies was OR = 2.43 (95% confidence interval: 1.94-3.05), I(2) = 87.5%, P < .0001. The pooled OR from cotwin analysis was 2.65 (95% confidence interval: 0.82-4.49, I(2) = 0%, P = .867). Studies adjusted for a range of confounders, but baseline suicidal behavior was not well-controlled. Too few studies met the inclusion criteria to quantitatively examine sources of heterogeneity. CSA exposure is associated with suicide attempts when a range of different confounders are controlled for, but the temporality of the association is not well established, and the association is highly heterogeneous.

HIV-infected men who have sex with men and histories of childhood sexual abuse: implications for health and prevention.

A personal history of childhood sexual abuse (CSA) is prevalent and deleterious to health for people living with HIV (PLWH), and current statistics likely underrepresent the frequency of these experiences. In the general population, the prevalence of CSA appears to be higher in men who have sex with men (MSM) than heterosexual men, but there are limited data available for HIV-infected MSM. CSA is associated with poor mental and physical health and may contribute to high rates of HIV risk behaviors, including unprotected sex and substance abuse. CSA exposure is also associated with low engagement in care for PLWH. More information is needed regarding CSA experiences of HIV-infected MSM to optimize health and wellbeing for this population and to prevent HIV transmission. This article reviews the epidemiology, implications, and interventions for MSM who have a history of CSA.

PTSD and marital satisfaction in military service members: Examining the simultaneous roles of childhood sexual abuse and combat exposure

Childhood sexual abuse (CSA) is relatively common and is associated with a multitude of negative outcomes in adulthood, including posttraumatic stress disorder (PTSD) and lower marital satisfaction. However, CSA has been understudied in military samples. The purpose of the present study was to examine the relative contributions of CSA and combat exposure to PTSD and marital satisfaction. Two hundred eighteen National Guard/Reserve veterans who deployed overseas between 2001 and 2008 completed self-report measures of CSA, marital satisfaction, combat exposure, and PTSD symptom severity. Data were analyzed using linear regression and path analysis to evaluate a comprehensive model including all variables. CSA accounted for unique variance in PTSD symptom severity independent of combat exposure. CSA also had a negative direct association with marital satisfaction, independent of combat exposure and PTSD symptom severity. In contrast, combat exposure had only a negative indirect association with marital satisfaction via PTSD when all variables were examined simultaneously. CSA accounted for unique variance in both PTSD symptom severity and marital satisfaction in this sample of combat veterans. Clinically, results suggest that assessment and treatment of CSA is indicated for military veterans suffering from PTSD. Further, treatment of CSA may improve marital satisfaction, which may positively affect psychological functioning in the veteran.

Childhood exposure to sexual abuse and partnership outcomes at age 30

In this study, 30-year longitudinal data from the Christchurch Health and Development Study (CHDS) were used to examine the associations between childhood exposure to sexual abuse and intimate relationship outcomes at age 30. In addition, a broad range of early childhood and family confounding factors were tested, and the role of intervening factors from adolescence was explored. The investigation analyzed data from a birth cohort of over 900 New Zealand adults studied to the age of 30. At ages 18 and 21 cohort members reported on any exposure to sexual abuse prior to age 16. This information, along with prospective data gathered in childhood and adolescence, was used to predict partnership outcomes at age 30. After adjustment for early childhood and family factors, exposure to more severe forms of childhood sexual abuse (CSA) was associated with earlier and more frequent cohabitation, higher rates of perpetrated interpartner violence (IPV), and early parenthood, lower relationship satisfaction and investment. Several factors from adolescence partially or fully mediated these associations, notably a history of early consensual sexual intercourse, higher number of sexual partnerships, substance abuse problems, and self-esteem. After adjustment for intervening factors, exposure to CSA remained significantly associated with IPV. The findings support a causal chain process, whereby early childhood and family factors place some individuals at risk for CSA. The extent of CSA exposure is related to adolescent risk taking, which in turn leads to early and more frequent cohabitation, risk of IPV, and lower relationship satisfaction and investment.

Disentangling the Complex Association Between Childhood Sexual Abuse and Alcohol-Related Problems: A Review of Methodological Issues and Approaches

This review describes and evaluates methodological approaches aimed at unraveling the association between childhood sexual abuse (CSA) and later misuse of alcohol, which is complicated by the significant overlap between factors that elevate risk for CSA exposure and those that increase risk for problem alcohol use. We critique methods used to distinguish direct effects of CSA events on alcohol-related outcomes from the effects of risk factors frequently present in families in which CSA exposure occurs (e.g., parental alcohol-related problems). These methods include measurement and adjustment for potentially confounding factors and the use of co-twin designs. The findings across methodological approaches provide support for a CSA-specific risk for alcohol misuse, despite the significant contribution of family background factors to overall risk, but much work remains to be done before a comprehensive model for this association can be proposed. Additional directions for research, including the incorporation of measured genes and the use of longitudinal designs, are proposed to further efforts to model the pathways from CSA to alcohol-related problems.

Posttraumatic stress disorder in adult female survivors of childhood sexual abuse: a comparison study.

This study compared symptoms of posttraumatic stress disorder (PTSD) in a group of 45 adult women in outpatient treatment for childhood sexual abuse (CSA) and a group of 31 women who reported no CSA. The comparison group consisted of women in outpatient treatment for problems in their committed relationships with male living partners. This research also investigated the traumatic impact of dual abuse (both childhood sexual and physical abuse). Standardized assessment instruments were used to measure PTSD, CSA, and childhood physical abuse (CPA). Results indicated that 86.7% of the CSA group met criteria for current PTSD in accordance with the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised; American Psychiatric Association, 1987), compared with 19.4% of the relationship distress group, providing support for CSA as an etiological agent for PTSD. In addition, 89% of the CSA survivors reported CPA. Multivariate analysis revealed that both CSA and CPA exposure variables accounted for a significant portion of the variance in PTSD symptoms in the CSA group.

Posttraumatic stress disorder in a clinical sample of adults sexually abused as children

Forty-seven help-seeking, adult survivors of childhood sexual abuse (CSA) were assessed to examine the relationship between the level of CSA exposure and the subsequent development of posttraumatic stress disorder. CSA exposure was operationalized to include the overall level of exposure, frequency and duration of the abuse, age of onset, use of force, perceived life threat, and the occurrence of penetration. Participants were administered standardized measures of PTSD, including the Structured Clinical Interview of DSM-III-R (SCID). On the SCID, 69% of the survivors met full DSM-III-R criteria for PTSD. Significant correlations were found between several overall exposure measures and PTSD diagnostic status and the intensity of PTSD symptomatology. Similar relationships were identified with the duration and frequency of the abuse, the age of onset, and the use of force. This study is important in that it utilized standardized measures of PTSD and found a significant incidence of PTSD among adult CSA survivors.