Childhood Sexual Trauma Research Articles

Combining seeking safety with sertraline for PTSD and alcohol use disorders: A randomized controlled trial.

The current study marks the first randomized controlled trial to test the benefit of combining Seeking Safety (SS), a present-focused cognitive-behavioral therapy for co-occurring posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD), with sertraline, a front-line medication for PTSD shown to also impact drinking outcomes. Sixty-nine participants (81% female; 59% African American) with primarily childhood sexual (46%) and physical (39%) trauma exposure, and drug dependence in addition to AUD were randomized to receive a partial-dose (12 sessions) of SS with either sertraline (n = 32; M = 7 sessions) or placebo (n = 37; M = 6 sessions). Assessments conducted at baseline, end-of-treatment, 6- and 12-months posttreatment measured PTSD and AUD symptom severity. Both groups demonstrated significant improvement in PTSD symptoms. The SS plus sertraline group exhibited a significantly greater reduction in PTSD symptoms than the SS plus placebo group at end-of-treatment (M difference = -16.15, p = .04, d = 0.83), which was sustained at 6- and 12-month follow-up (M difference = -13.81, p = .04, d = 0.71, and M difference = -12.72, p = .05, d = 0.65, respectively). Both SS groups improved significantly on AUD severity at all posttreatment time points with no significant differences between SS plus sertraline and SS plus placebo. Results support the combining of a cognitive-behavioral therapy and sertraline for PTSD/AUD. Clinically significant reductions in both PTSD and AUD severity were achieved and sustained through 12-months follow-up, Moreover, greater mean improvement in PTSD symptoms was observed across all follow-up assessments in the SS plus sertraline group. (PsycINFO Database Record

Consequences of Child and Adult Sexual and Physical Trauma among Deaf Adults

The purpose of this study was to evaluate the consequences of sexual and physical trauma among a sample of deaf adults. Thirty-two men and 45 women completed the Life Event Checklist (LEC), the Clinician Administered PTSD Scale (CAPS), the Trauma Symptom Inventory (TSI), the Somatoform Dissociation Questionnaire–20 (SDQ–20) and a sociodemographic questionnaire. In this sample, 40.6% of the male participants and 53.3% of the female participants had experienced some type of sexual trauma during their lifetimes. Physical trauma was reported by 75% of males and 71.1% of female participants. For those who had experienced childhood sexual trauma, the odds ratio of revictimization in adulthood was 6.69. Sexual trauma also rarely occurred by itself. Two thirds of all participants with sexual trauma histories also reported some type of physical abuse. Participants with sexual trauma histories displayed significantly more symptoms of PTSD and depression than people without such trauma history. Physical and sexual abuse represent significant problems in the deaf community. The authors include a call for the development of targeted intervention attempts to prevent further victimization in deaf child and adolescent populations.

Childhood sexual trauma and subsequent parenting beliefs and behaviors

Using propensity-matched controls, the present study examines the long-term adjustment of women reporting childhood sexual trauma (CST) at or before the age of 14 in terms of parenting efficacy and parenting behavior. Data for these analyses were obtained from mother reports and from observational protocols from a longitudinal study of low-income, rural families. The novel use of propensity-matched controls to create a control group matched on family of origin variables provides evidence that when women with CST are compared with the matched comparison women, females who experienced CST show poorer functioning across multiple domains of parenting (sensitivity, harsh intrusiveness, boundary dissolution), but not in parenting efficacy. Follow-up moderation analyses suggest that the potential effects of trauma on parenting behaviors are not attenuated by protective factors such as higher income, higher education, or stable adult relationships. Implications for interventions with childhood sexual trauma histories and directions for future study are proposed.

The Effects of Childhood Sexual Abuse and Other Trauma on Drug Court Participants

Within the context of a larger study of drug court participants, this study examined the impact of traumatic experiences on psychiatric distress and on court outcomes. In the analyses, the participants (n = 229) were separated into 3 groups: childhood sexual abuse (CSA; n = 18), other trauma (n = 134), and no trauma (n = 77). The CSA group had higher mean scores on depression, anxiety, panic disorder, social phobia, somatization, and posttraumatic stress disorder than the other trauma group. Path analyses suggest that a history of trauma is a positive predictor of psychiatric distress and negative court events (positive urine screens, sanctions, etc.), with indirect effects on substance abuse severity, and failure in the drug court. These results suggest a need for the initial assessment procedure in drug courts to include a screening for trauma history, including CSA. They also suggest a need for trauma-informed care within drug courts.

Childhood sexual trauma and subsequent parenting beliefs and behaviors

Childhood sexual trauma and subsequent parenting beliefs and behaviors

Compulsive sexual behavior among male military veterans: prevalence and associated clinical factors.

Background and aims: Compulsive sexual behavior (CSB) is highly prevalent among men, often co-occurring with psychiatric disorders and traumatic experiences. Psychiatric disorders and trauma are highly prevalent among military veterans, yet there is a paucity of research on CSB among military samples. The aim of this study was to examine the prevalence of and factors associated with CSB among male military veterans. Methods: Surveys were administered to veterans of Operations Iraqi Freedom, Enduring Freedom, or New Dawn at baseline (n = 258), 3 months (n = 194), and 6 months (n = 136). Bivariate analyses and Generalized Estimating Equations were utilized to estimate associations between CSB and the following variables: psychiatric co-morbidity, childhood physical or sexual trauma, pre- and post-deployment experiences, TV/ Internet usage, and sociodemographics. Associations between CSB and specific PTSD symptom clusters were also examined. Results: CSB was reported by 16.7% of the sample at baseline. Several variables were associated with CSB in bivariate analyses; however, only PTSD severity, childhood sexual trauma, and age remained significant in multivariable GEE models. The PTSD symptom cluster re-experiencing was most strongly associated with CSB. Discussion: This exploratory study suggests that CSB is prevalent amongst veterans returning from combat and is associated with childhood trauma and PTSD, particularly re-experiencing. Conclusions: Further study is needed to identify the mechanisms linking PTSD and CSB, define the context and severity of CSB in veterans, and examine the best ways to assess and treat CSB in VA clinical settings.

Responding to prenatal disclosure of past sexual abuse.

The American College of Obstetricians and Gynecologists recommends that physicians elicit a sexual abuse and rape trauma history for every patient, yet, in practice, physicians still may struggle to understand how best to obtain this history and what clinical obligations arise when a physician inquires and a woman discloses a remote history of childhood or adult sexual trauma during the course of her prenatal care. This commentary offers a practical strategy for responding to sexual trauma disclosure by developing a tailored obstetric care plan for avoiding retraumatization in labor. In this way, obstetricians may avoid causing harm and begin to meet the unique obstetric and psychological needs of sexual trauma survivors during pregnancy and delivery.

Girl Who Wrote to Primo Levi. The “Foreign Body” Speaks

Through the exposition of a clinical case, the author explores how a sexually abused woman can set up strategies for psychic survival to the feeling of catastrophe and how she can attempt to communicate and share it. The clinical case connects childhood sexual abuse trauma and the trauma of surviving concentration camps. The paper refers to two main achievements of Ferenczi's research: (1) the consequences of the traumatic experience and of the disavowal of it, such as dissociation, fragmentation, psychic agony; and (2) the focus on countertransference as emotional sharing and as receptiveness to the deep, unconscious and unspeakable communications, which can transfer to the psychoanalyst through somatic ways.

Capsule Commentary on Walsh et al. Sexual Violence and Mental Health Symptoms Among National Guard and Reserve Soldiers

Walsh et al.1 explored the relationship between sexual violence, PTSD, and depression among National Guard and Reserve soldiers, finding 27–37 % of women and 4 % of men reported experiencing sexual violence at some point in their lives. Rates of sexual violence during the most recent deployment ranged from 0–2.6 %. Moreover, soldiers who had ever experienced sexual trauma had 3.5-fold higher odds of suffering from PTSD; nearly half of PTSD cases could be attributed to life-time sexual violence. The rate of deployment-related sexual trauma in this population-based cohort is lower than that reported in VA samples. A major strength of this study is its large randomized sample that is not drawn from the VA or a treatment-seeking population. That lifetime rates of sexual violence are elevated among female soldiers, and that these experiences increase vulnerability to mental health problems, are important findings both for epidemiological purposes and to enhance treatment efforts. The assessment of sexual violence was done within the context of screening for 21 different traumatic events, and subjects were asked if they have ever “been raped” or “experienced another kind of sexual assault or unwanted sexual contact as a result of force, threat of harm, or manipulation.” As the authors note, this use of single questions may underestimate the prevalence of sexual assault. Further, it would be helpful in future studies to differentiate between childhood sexual abuse and such assault in adulthood. The CDC’s Adverse Childhood Events studies have documented a high prevalence of childhood sexual abuse (17.2 % for women and 6.7 % for men).2 Other research has documented similar or higher rates of childhood sexual abuse, and studies have reported increased risk for individuals with this history for a range of psychiatric and other life difficulties.3,4 Future research would benefit from exploring both the timing and context of sexual violence among soldiers, trying to differentiate the contribution of childhood experiences versus sexual trauma that occurred in adulthood but prior to military service. Walsh and colleagues urge clinicians to assess lifetime sexual violence both in treatment-seeking clients and in all soldiers. While this assessment is likely routine in most psychiatric treatment settings, this research highlights the importance of assessing this domain regularly in primary care settings and in research. Enhancing our ability to conceptualize the many factors that contribute to human suffering is important to improving our assessment and intervention approaches.

Child sexual abuse and the pathophysiology of suicide in adolescents and adults

Child sexual abuse (CSA) is widespread and is associated with various psychopathologies, including Axis I and II disorders, maladaptive and impulsive behaviors, and suicidal behavior in adolescence and adults. The pathophysiology of this association is not well understood; however, it is clear that suicidal behavior in individuals with a history of CSA is a significant social and medical problem that warrants further investigation. An electronic search of the major behavioral science databases (limited to the most recent studies in the last 20 years) was conducted to retrieve studies detailing the social, epidemiological, and clinical characteristics of child sexual trauma and their relation to suicidal behavior in adolescents and adults. Studies indicate that CSA is related to an increase in Axis I and II diagnoses, including depression, post-traumatic stress disorder, conduct disorders, eating disorders, alcohol and drug abuse, panic disorders, and borderline personality disorder. CSA not just related to an increase in impulsivity and risky behaviors, it has also been linked to an increase in suicidality as well. CSA makes both direct and indirect contributions to suicidal behavior. It is a complex process involving multiple variables, which include psychopathology, maladaptive personality features and the direct contribution of CSA itself. Psychopathologies, such as impulsivity and mood and personality disorders, may modulate the relationship between CSA and suicidal behavior. Some preventive measures for decreasing the prevalence of CSA and suicidality may include education as well as increased access to mental health services.

Women Service Members and Family Reintegration

Women are being deployed at increasing rates. This article reviews literature related to the risk and protective factors that explain varied levels of adaptation for servicewomen and their families. Implications suggest that clinicians assess risk factors for female soldiers upon return home such as the number and length of deployments, the presence of mental health challenges, physical injuries including traumatic brain injury, the experience of military sexual trauma, a history of childhood or adult sexual trauma, and the pile-up of additional life stressors that can lead to a cumulative negative effect for women and their families. Clinicians are also encouraged to assess and encourage family strengths that foster resilience such as social support, ongoing communication, family structure that is flexible, and positive appraisal.

Sexual Victimization, Health Status, and VA Healthcare Utilization Among Lesbian and Bisexual OEF/OIF Veterans

ABSTRACTBackgroundMany lesbian and bisexual (LB) women veterans may have been targets of victimization in the military based on their gender and presumed sexual orientation, and yet little is known regarding the health or mental health of LB veterans, nor the degree to which they feel comfortable receiving care in the VA.ObjectiveThe purpose of this study was to examine the prevalence of mental health and gender-specific conditions, VA healthcare satisfaction and trauma exposure among LB veterans receiving VA care compared with heterosexually-identified women veterans receiving.DesignProspective cohort study of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) women veterans at two large VA facilities.ParticipantsThree hundred and sixty five women veterans that completed a baseline survey. Thirty-five veterans (9.6 %) identified as gay or lesbian (4.7 %), or bisexual (4.9 %).Main MeasuresMeasures included sexual orientation, military sexual trauma, mental and gender-specific health diagnoses, and VA healthcare utilization and satisfaction.Key ResultsLB OEF/OIF veterans were significantly more likely to have experienced both military and childhood sexual trauma than heterosexual women (MST: 31 % vs. 13 %, p < .001; childhood sexual trauma: 60 % vs. 36 %, p = .01), to be hazardous drinkers (32 % vs. 16 %, p = .03) and rate their current mental health as worse than before deployment (35 % vs. 16 %, p < .001).ConclusionsMany LB veterans have experienced sexual victimization, both within the military and as children, and struggle with substance abuse and poor mental health. Health care providers working with female Veterans should be aware of high rates of military sexual trauma and childhood abuse and refer women to appropriate VA treatment and support groups for sequelae of these experiences. Future research should focus on expanding this study to include a larger and more diverse sample of lesbian, gay, bisexual, and transgender veterans receiving care at VA facilities across the country.

Childhood sexual trauma in women with interstitial cystitis/bladder pain syndrome: a case control study

Background: The impact of early lifetime trauma on symptomseverity and quality of life of patients with interstitial cystitis/bladderpain syndrome (IC/BPS) has not been fully elucidated. Wewanted to determine and compare the prevalence and impact ofchildhood traumatic events, with an emphasis on childhood sexualabuse, on patient symptoms, quality of life and other biopsychosocialparameters.Methods: Subjects (female patients with IC/BPS and controls withoutIC/BPS) completed psychosocial phenotyping questionnaires,including a demographics/history form, and validated questionnairesfocused on presenting symptoms (IC symptom indices, pain),psychosocial parameters (depression, anxiety, pain catastrophizing,sexual functioning, social support) and quality of life. Participantsalso completed the Childhood Traumatic Events Scale.Results: Questionnaires were completed by 207 IC/BPS patientsand 117 controls matched for age, partner status and education. Itwas found that before 17 years of age, the IC/BPS cases reportedhigher prevalence of “raped or molested” compared to controls(24.0% vs. 14.7%; p = 0.047). Within the IC/BPS group, casesreporting previous sexual abuse endorsed greater sensory pain,depression and poorer physical quality of life at the present timecompared to IC cases without a sexual abuse history. In the controlsonly, those reporting previous sexual abuse endorsed more depression,anxiety, stress, social maladjustment poorer mental qualityof life in the present time. When the analysis was corrected forpotential multiple comparison error, none of the findings remainedsignificant in either the IC/BPS or control groups.Interpretation: Childhood traumatic events, in particular sexualabuse and extreme illness, are reported as more common in IC/BPS patients than controls. Early trauma, such as the occurrenceof sexual abuse, is associated with some differences in patientadjustment (e.g., pain, quality of life, depression) but this impactappears to be, at most, very modest.

Eating Disorders, Post-Traumatic Stress, and Sexual Trauma in Women Veterans

We examine lifetime eating disorders (EDOs) and associations with post-traumatic stress disorder (PTSD) and sexual trauma during various stages of the life course (childhood, during military service, and lifetime) among women veterans. The sample included 1,004 women aged 20 to 52 years who had enrolled at 2 Midwestern Veterans Affairs Medical Centers or outlying clinics completed a retrospective telephone interview. Over 16% reported a lifetime EDO (4.7% had received a diagnosis, and an additional 11.5% self-reported suffering from an EDO). Associations were found between lifetime EDO, PTSD, and sexual trauma. Relationships maintained significance for both diagnosed and self-reported EDOs as well as lifetime completed rape and attempted sexual assaults. Sexual trauma during military service was more strongly associated with lifetime EDOs than childhood sexual trauma. The significant associations found between EDOs, PTSD, and sexual trauma indicate that EDO screening among women veterans with PTSD or histories of sexual trauma may be warranted.

Childhood sexual trauma, cannabis use and psychosis: statistically controlling for pre-trauma psychosis and psychopathology

Recurring evidence seems to suggest that sexual trauma in childhood may moderate associations between cannabis consumption and psychosis. It has also been suggested, however, that poor childhood mental health may explain linkages between these phenomena. The current study, using data from the National Comorbidity Survey-Replication (N=2,355), sought to revaluate the stability of the childhood trauma-cannabis interaction while statistically controlling for pre-trauma psychotic experiences and psychopathology in childhood. Psychotic experiences that occurred before childhood sexual trauma significantly influenced adult psychosis symptomatology (psychosis pre-rape B=0.10; psychosis pre-sexual assault B=0.23). Social phobia (B=0.07) also conferred risk for adult psychosis. Pre-trauma childhood psychopathology, however, did not account for the interaction between childhood sexual trauma and cannabis consumption in a multivariate model. Childhood experiences of rape (B=0.15) and an interaction between cannabis use and childhood sexual assault (B=0.05) independently contributed to adult psychosis. Cannabis use conferred no independent risk. With specific regard to research methodology, the current findings offer further justification for the inclusion of childhood sexual trauma in analyses investigating associations between cannabis use and psychosis.

A latent class analysis of dissociation and posttraumatic stress disorder: evidence for a dissociative subtype.

The nature of the relationship of dissociation to posttraumatic stress disorder (PTSD) is controversial and of considerable clinical and nosologic importance. To examine evidence for a dissociative subtype of PTSD and to examine its association with different types of trauma. A latent profile analysis of cross-sectional data from structured clinical interviews indexing DSM-IV symptoms of current PTSD and dissociation. The VA Boston Healthcare System and the New Mexico VA Health Care System. A total of 492 veterans and their intimate partners, all of whom had a history of trauma. Participants reported exposure to a variety of traumatic events, including combat, childhood physical and sexual abuse, partner abuse, motor vehicle accidents, and natural disasters, with most participants reporting exposure to multiple types of traumatic events. Forty-two percent of the sample met the criteria for a current diagnosis of PTSD. Item-level scores on the Clinician-Administered PTSD Scale. A latent profile analysis suggested a 3-class solution: a low PTSD severity subgroup, a high PTSD severity subgroup characterized by elevations across the 17 core symptoms of the disorder, and a small but distinctly dissociative subgroup that composed 12% of individuals with a current diagnosis of PTSD. The latter group was characterized by severe PTSD symptoms combined with marked elevations on items assessing flashbacks, derealization, and depersonalization. Individuals in this subgroup also endorsed greater exposure to childhood and adult sexual trauma compared with the other 2 groups, suggesting a possible etiologic link with the experience of repeated sexual trauma. These results support the subtype hypothesis of the association between PTSD and dissociation and suggest that dissociation is a highly salient facet of posttraumatic psychopathology in a subset of individuals with the disorder.

Persecutory delusions and childhood emotional abuse in people with a diagnosis of schizophrenia

The present research assesses the frequency of self-reported childhood trauma in individuals with and without persecutory delusions. Comparisons are made between reported childhood emotional, physical and sexual trauma in adults with a diagnosis of schizophrenia, with (n = 36) and without (n = 23) persecutory delusions. Those with persecutory delusions reported significantly higher levels of emotional abuse and there was a trend towards higher levels of emotional neglect. No differences emerged on total trauma score, physical abuse, physical neglect and sexual abuse. The study suggests that over and above a general association between childhood trauma and positive symptoms of psychosis, there may exist a specific link between persecutory delusions and childhood emotional abuse.

The Confusion of Tongues in the Psychoanalytic Relationship

Sándor Ferenczi's Confusion of Tongues paradigm, first introduced to explain the psychological effects of childhood sexual trauma on personality development, also presented a blueprint for a relational view vide of the analytic encounter. We have extrapolated Ferenczi's two-person psychology in his Confusion of Tongues paradigm to discuss the “necessary and sufficient conditions” for an analytic encounter, which can present retraumatization in the psychoanalytic situation. This relational approach monitors the functioning of the analyst as well as the analysand by establishing several important conditions: (1) It is the analyst who provides a different kind of relationship for the analysand to experience; (2) the nature of the relationship is paramount for changes; (3) all transactions in the analytic encounter are functions of the two parties; (4) the analyst must regularly analyze his or her contribution to the relationship; (5) “judicious self-disclosure” is used to differentiate between the traumatic parent image and the empathic analyst; (6) emotional honesty, responsiveness and empathic understanding contribute to resolving the Confusion of Tongues emotional trauma with the parent; and (7) the analyst learns to speak and relate in a “trauma-free” (nonerotic, nonrejecting, etc.) manner.

Long-Term Vagus Nerve Stimulation for Severe Refractory Depression: A Case Study With a Six-Year Follow-Up

Long-Term Vagus Nerve Stimulation for Severe Refractory Depression: A Case Study With a Six-Year Follow-Up

Childhood sexual trauma in women with interstitial cystitis/bladder pain syndrome; a case control study

The impact of early lifetime trauma on symptom severity and quality of life of patients with interstitial cystitis/bladder pain syndrome (IC/BPS) has not been fully elucidated. We wanted to determine and compare the prevalence and impact of childhood traumatic events, with an emphasis on childhood sexual abuse, on patient symptoms, quality of life and other biopsychosocial parameters. Subjects (female patients with IC/BPS and controls without IC/BPS) completed psychosocial phenotyping questionnaires, including a demographics/history form, and validated questionnaires focused on presenting symptoms (IC symptom indices, pain), psychosocial parameters (depression, anxiety, pain catastrophizing, sexual functioning, social support) and quality of life. Participants also completed the Childhood Traumatic Events Scale. Questionnaires were completed by 207 IC/BPS patients and 117 controls matched for age, partner status and education. It was found that before 17 years of age, the IC/BPS cases reported higher prevalence of "raped or molested" compared to controls (24.0% vs. 14.7%; p = 0.047). Within the IC/BPS group, cases reporting previous sexual abuse endorsed greater sensory pain, depression and poorer physical quality of life at the present time compared to IC cases without a sexual abuse history. In the controls only, those reporting previous sexual abuse endorsed more depression, anxiety, stress, social maladjustment poorer mental quality of life in the present time. When the analysis was corrected for potential multiple comparison error, none of the findings remained significant in either the IC/BPS or control groups. Childhood traumatic events, in particular sexual abuse and extreme illness, are reported as more common in IC/BPS patients than controls. Early trauma, such as the occurrence of sexual abuse, is associated with some differences in patient adjustment (e.g., pain, quality of life, depression) but this impact appears to be, at most, very modest.