Experienced Childhood Sexual Abuse Research Articles

Insecure Attachment and Therapeutic Bond as Mediators of Social, Relational, and Social Distress and Interpersonal Problems in Adult Females with Childhood Sexual Abuse History

ABSTRACT Establishing trust is an important part of building the therapeutic relationships and achieving the goal of effective trauma treatment for individuals who have experienced childhood sexual abuse. The current study explored the associations between attachment style, therapeutic bond, distress, and interpersonal problems. This study investigated whether attachment style and therapeutic bond mediated the association between the level of early treatment emotional distress and later treatment interpersonal problems among two groups: clients reporting histories of childhood sexual abuse and clients not reporting histories of childhood sexual abuse. Research indicates that disruption of attachment security as well as the therapeutic relationship is common in survivors of childhood sexual abuse. We explored the mediating role of insecure attachment and the therapeutic bond on the predictive relationship between early treatment emotional distress and the interpersonal difficulties that one experiences in their daily life. For clients with histories of child sexual abuse, the model showed that anxious attachment and avoidant attachment mediated the associations between emotional distress and interpersonal relations. Therapeutic bond was not a significant mediator. For clients without histories of sexual abuse, results showed significant association between emotional distress and interpersonal relations, but insecure attachment or therapeutic bond did not mediate this relationship.

Life within a limited radius: Investigating activity space in women with a history of child abuse using global positioning system tracking.

Early experiences of childhood sexual or physical abuse are often associated with functional impairments, reduced well-being and interpersonal problems in adulthood. Prior studies have addressed whether the traumatic experience itself or adult psychopathology is linked to these limitations. To approach this question, individuals with posttraumatic stress disorder (PTSD) and healthy individuals with and without a history of child abuse were investigated. We used global positioning system (GPS) tracking to study temporal and spatial limitations in the participants’ real-life activity space over the course of one week. The sample consisted of 228 female participants: 150 women with PTSD and emotional instability with a history of child abuse, 35 mentally healthy women with a history of child abuse (healthy trauma controls, HTC) and 43 mentally healthy women without any traumatic experiences in their past (healthy controls, HC). Both traumatized groups—i.e. the PTSD and the HTC group—had smaller movement radii than the HC group on the weekends, but neither spent significantly less time away from home than HC. Some differences between PTSD and HC in movement radius seem to be related to correlates of PTSD psychopathology, like depression and physical health. Yet group differences between HTC and HC in movement radius remained even when contextual and individual health variables were included in the model, indicating specific effects of traumatic experiences on activity space. Experiences of child abuse could limit activity space later in life, regardless of whether PTSD develops.

Weighing Ethical Considerations in Proposed Non-recent Child Sexual Abuse Investigations: A Response to Maslen and Paine’s Oxford CSA Framework

Questions about when it is right for police forces to investigate alleged offences committed in the more or less distant past have become increasingly pressing. Recent widely publicized cases of child sexual abuse (CSA) and exploitation, sometimes involving high profile individuals, have illustrated the ethical, psychological, and forensic complexities of investigating non-recent child sexual abuse. Hannah Maslen and Colin Paine have developed the Oxford CSA Framework to assist police to weigh the various ethical considerations that militate for and against initiating a CSA investigation. While such a tool is to be welcomed, and while there is much that is helpful in Maslen and Paine's approach, we suggest that the Oxford CSA framework could be strengthened. Our first suggestion is to abandon a proposed distinction between a set of considerations that is said to generate a “presumption” in favor of investigation and other considerations that may supplement or oppose this presumption. Our second suggestion is to review the weightings applied to the considerations within the model, which lack clear justification and create problematic effects. Finally, we suggest that referring the Oxford CSA Framework to a panel with lived and professional experience of CSA could serve important procedural justice goals and enhance the Framework's recommendations.

A systematic review of the effectiveness of interventions designed for mothers who experienced child sexual abuse

BackgroundPast experiences of child sexual abuse (CSA) have been shown to have a pernicious effect on the parenting behaviors of mothers. As a result, interventions have been developed to address these effects. However, a systematic synthesis of the effectiveness of such interventions has not been conducted. ObjectiveTo conduct a systematic review of existing literature on interventions that have been developed and evaluated for mothers who experienced CSA. MethodsStudies were located through a sensitive search strategy in nine academic databases and search engines, and through handsearching reference lists of included studies and their subsequent citations. Two authors independently completed screening, full text review, data extraction, and quality appraisal. ResultsSearches revealed a paucity of literature, with four intervention studies located. All four interventions consisted of therapy, with three of these interventions using a group-based format. One of the included intervention studies used reiki as an adjunct to therapy. Decreases in negative mental health symptoms were reported through both validated measures and interviews. No validated measures to assess parenting were used in any intervention, though some qualitative results indicated changes in parenting. Qualitative results also suggested that most mothers were satisfied with the interventions. Studies were of limited quality - none used a randomized trial design, and only one a control group. ConclusionsGiven the limitations of the identified intervention studies for mothers who experienced CSA, there is a clear need to develop evidence-based interventions for this population given the unique detrimental effects of CSA on parenting. Avenues for future intervention development are discussed.

"It's Not a Great Boulder, It's Just a Piece of Baggage": Older Women's Reflections on Healing from Childhood Sexual Abuse.

In this study, we explored older women's reflections on processes of healing related to childhood sexual abuse (CSA). We aimed to answer questions about how childhood trauma was integrated into the life story and to identify factors or coping strategies that aided, or hindered, healing. Participants within this study included 12 women who were aged 60 or older and had reported CSA as adults at the beginning of the research project, 25 years prior. Qualitative interviews were conducted exploring women's reflections on the place of CSA in their lives over time and factors the participants thought were helpful or unhelpful in being able to come to terms with the abuse. Data were analyzed using thematic analysis, which resulted in three themes related to processes of healing. The themes identified were need for resolution, thinking about it differently, and developing agency over disclosure. The findings show that some form of resolution was needed for the women to recover and move on from their experiences of CSA. The two key strategies used to reach this resolution were reframing their experience or drawing upon positive life philosophies. Decisions around disclosure were also an important part of the healing process, with the women developing an agency over if, and how, they talked to people about their experience. Those women who were not able to make sense of their experience continued to be influenced by the negative feelings and memories associated with the experience. Our findings have implications for health professionals working with those who have experienced trauma. They demonstrate that there are a number of ways that people heal from trauma and find personal resolution across their lifespan.

Child sexual abuse among medical school students: experiences and perceptions.

Given that 5-25% of the adult population report child sexual abuse (CSA), most clinicians will care for victims. Data regarding CSA experiences among medical students are limited and the association of medical students' own history of CSA with relevant perceptions has not been previously examined. The aim of this study was to assess CSA perceptions and exposure of medical students, while exploring their associations. For this purpose, a link was created and made available on a site accessed solely by the Athens medical school undergraduates from February 20 to March 20 2019, comprising a 12-item questionnaire to assess the knowledge and past experience of CSA. This was based on a larger published questionnaire, which was translated and adapted. The questionnaire was then transcripted online, and after pilot testing, was disseminated using the Google documents® platform. Out of 261 responses, CSA was reported by 48 participants (18%), of which 39 were women. Thirty five reported contact CSA. Thirty seven victims (77%) reported previous disclosure of the event, but 18 of them were not protected post disclosure. CSA victims were less likely to agree with the perception that most perpetrators are mentally ill or disabled (p = 0.043), and more likely to strongly disagree with the statement that reputable families are protected from sexual abuse (p = 0.019). In agreement with existing data in general populations globally, about one in five medical students had exposure to CSA. In addition, a potential association of their own experiences with shaping perceptions regarding the identity of CSA perpetrators and affected families for medical students is highlighted.

Personality Disorders in Adult Female Child Sexual Abuse Survivors: Dimensions of Personality Pathology and Characteristics of Abuse

The relationship between child sexual abuse (CSA) and later personality disorders (PDs) has been established in numerous studies. However, there are still a number of uncertainties about the specifics of this association. This study further explored the child sexual abuse survivors' (CSASs) vulnerability to PDs by introducing the variable of personality organization (PO) and dimensions of personality pathology as conceptualized by Kernberg, and by including additional variables of CSA characteristics. It was hypothesized that in the CSA group, the occurrence of borderline personality organization (BPO) would be significantly higher than in the non-CSA group and that characteristics of abuse associated with its higher severity would prevail in individuals with BPO. The study group consisted of 329 women who completed measures of PO and experiences of CSA. The results were consistent with formulated hypotheses. Significantly more CSASs than those who did not experience CSA were characterized by close to BPO (cBPO). Moreover, CSASs group differed from the group without the CSA experience with regard to all BPO dimensions. The biggest difference between the CSA and the control group concerned the dimension referring to the difficulties in creating close, intimate relationships. With regard to CSA features, women characterized by cBPO, in contrast to those characterized by neurotic personality organization (NPO), significantly more often reported having experienced CSA more than once, involving physical contact, from more than one offender and from the offender they previously known. The findings of the study support the idea that the optimal treatment approach for CSASs should address both the personality structure and the specificity of the impact of CSA along with its characteristics.

What Helps Children Tell? A Qualitative Meta‐Analysis of Child Sexual Abuse Disclosure

The increasing use of qualitative methodologies to explore experiences of child sexual abuse (CSA) disclosure has led to the need to synthesise these findings. Recent reviews have tended to focus on the barriers to disclosure more than the facilitators or to conflate findings from studies of adults and studies of children and adolescents. This paper focuses on a qualitative meta‐analysis of studies conducted in the past 20 years (1998–2018) that addresses the question of what helps children disclose experiences of CSA. An analysis of 20 studies that met the inclusion criteria suggests that six key themes are important facilitators of disclosure: access to someone you can trust; realising it's not normal; inability to cope with emotional distress; wanting something to be done about it; expecting to be believed; and being asked. These can be conceptualised as representing two key dynamics that help children tell: needing to tell (pressure cooker effect), and opportunity to tell. Professionals and carers can facilitate the process of disclosure through building trusting relationships with children, recognising their distress and initiating conversations with children about their wellbeing.‘A qualitative meta‐analysis of studies conducted in the past 20 years (1998–2018) that addresses the question of what helps children disclose experiences of CSA’Key Practitioner Messages There is a need for the focus to be on what helps children tell rather than what hinders children telling. Children need those around them to notice when they need to talk about themselves and what is happening in their lives – when they are unable to cope with their distress, when they want something done about it. Professionals and adults interacting with children need to ask children about their lives and wellbeing, in order to: help create opportunities for children to tell; help them access someone they can trust; let them know they will be taken seriously; and help them to understand that abusive behaviour is not normal.

Finding a Good Book to Live In: A Reflective Autoethnography on Childhood Sexual Abuse, Literature and the Epiphany

The topic of Childhood Sexual Abuse (CSA) remains a prevalent issue globally and despite the best efforts of welfare organisations, it would seem that as a society we are no closer to a resolution. CSA is a topic that is discussed in vague terms, but the real impact of CSA on the child is rarely divulged, except behind closed doors. This autoethnographic study traces the life and experiences of CSA of the author and how she used literature and writing as a coping mechanism. Using this powerful methodological tool, the author has been able to expose the implications of the sexual abuse and the use of writing as a place to hide and feel safe. The value of autoethnography is illuminated by demonstrating that poignant and potent data can be collected and then shared in a way that has more impact than other research methods. Second, the value of the researcher as the researched can be viewed as an authentic way of analysing difficult and taboo societal issues such as CSA, where hopefully the results can lead to more insightful and honest discussions about how to confront this problem.

Teaching About Sexualized Violence in Educational and Clinical Institutions: Evaluation of an Interdisciplinary University Curriculum

IntroductionSexualized violence is still a rather avoided topic in teaching at German universities, even though a remarkable proportion of the German population experienced child sexual abuse, including many in institutional settings (e.g., schools, clubs of leisure activities). This study examines the effectiveness of an interdisciplinary university curriculum about sexualized violence in educational and clinical institutions.MethodsStudents participated in seminars about sexualized violence, sexual socialization and education, and professionalism and ethics. In 2017/2018, n = 156 students assessed the curriculum before, immediately after and/or 6 months after participating. The assessment covers knowledge about and confidence in handling issues of sexualized violence and attitudes toward sex-related myths. The same questionnaires were used in a control group (n = 54).ResultsIn the curriculum group, self-assessed and declarative knowledge improved, the students were more confident in their abilities to handle issues of sexualized violence in a professional way, and sex-related myths were rejected even more strongly after the curriculum.ConclusionThe findings suggest that awareness and knowledge about sexualized violence in institutions can be increased and sustained through the use of the curriculum “Sexualized Violence in Institutions.” These encouraging results suggest that the curriculum should be taught in pedagogical and clinical disciplines at more universities.Policy ImplicationsIn view of the decentralized education system in Germany and the freedom of research and teaching at German universities, the curriculum can only be implemented on a voluntary basis. However, in terms of education policy, such an implementation could be supported by state-funded programs that provide lecturers both with necessary qualifications and necessary resources.

How Do Childhood and Parental Anxiety Features Affect the Consequences of Child Sexual Abuse?

ABSTRACTThe purpose of the study was to investigate the anxiety features of children who experience child sexual abuse (CSA) and their parents, along with the features and consequences of sexual abuse in the environment of Child Advocacy Centers (CAC). The sample of this study comprised 150 children affected by CSA and one of their parents who were admitted to İzmir CAC between June 2016 and November 2016.The children-age range 9 to 13 years-and one of their parents were asked to complete the State-Trait Anxiety Inventory separately. The children also completed the Childhood Anxiety Sensitivity Index (CASI). During psychiatric evaluations of the children, sociodemographic characteristics and features of sexual abuse were noted and all psychiatric conditions were examined. The statistical analyses yielded significant correlations between the STAI scores of the parents and STAI-C and CASI scores of the children. There were statistically significant differences between the CASI scores, STAI-C subscale scores, and STAI subscale scores according to some variables of CSA along with their psychiatric diagnosis. Our findings showed that having higher anxiety sensitivity and trait anxiety levels and having parents with higher trait anxiety might be considered as risk factors for being diagnosed as having a psychiatric disorder due to CSA.

Childhood sexual abuse perceptions and experience among college students of Panchkula.

Background and Objective:Child sexual abuse (CSA) is a global public health and human rights concern. Hence, the present study was conducted to assess childhood sexual abuse perception and experience among college students of Panchkula.Methodology:A self-administered anonymous questionnaire which assessed perception and experiences of childhood sexual abuse was given to a convenient sample of 1000 college students. Using descriptive statistics and Chi-square test, perception and the experience of childhood sexual abuse were calculated.Results:The study showed that 18% (boys = 20%, girls = 16%) of the students were exposed to CSA, with boys more often affected than girls. The student's perception about abuse was not very clear. Myths and cultural beliefs justified abuse.Conclusion:Although preliminary in nature, the present findings are among the first to demonstrate the nature of CSA among students of Panchkula. Further, the study revealed that CSA manifests both as contact and noncontact forms. More boys than girls are exposed to most forms of abuse.

Driving Improvements in Child Protection and Safeguarding Practice

Driving Improvements in Child Protection and Safeguarding Practice

A Developmental Perspective on the Relationship between Child Sexual Abuse and Depression: A Systematic and Meta‐Analytic Review

It is essential to examine child sexual abuse (CSA) and depression from a developmental perspective. Two meta‐analyses were conducted to examine the relationship between CSA and depression pertaining to the age at onset. English and Chinese databases were searched for articles on the association between CSA and depression that were published before December 2016. Random effect models were used in the meta‐analyses (35 studies with 37 effect sizes altogether). The result of the first analysis showed that CSA experiences were related to an earlier onset of depression among adult patients with depression with a moderate effect size. This relationship was found to be robust as it was not influenced by any of the moderators except for gender composition of the sample, and no publication bias was detected. The second analysis showed that CSA at a younger age was significantly related to a higher risk for depression in studies with female, adult or clinical/community samples, or where CSA onset was measured as a continuous age variable. The mixed findings between the age at CSA onset and depression caution against the use of a simple linear model.‘Two meta‐analyses were conducted to examine the relationship between CSA and depression pertaining to the age at onset’Key Practitioner Messages Screening for child maltreatment experiences should be done routinely for the treatment of depression. Preventive treatment is recommended for young CSA victims even if they do not present with depressive symptoms. Clinicians who work with sexually abused children should consider abuse‐specific treatment to reduce the negative effect of earlier depression onset.

THE EFFECTS OF CHILDHOOD SEXUAL ABUSE ON ADULT LIFE AND COPING PROCESS

This study is about the own child sexual abuse experience of a participant followed by a critical literature review, case presentation, method and conclusion. The literature review firstly presents definitions about abuse, sexual abuse, prevalence of childhood sexual abuse and then focuses on effects of child sexual in childhood and adulthood. Case presentation includes parts from own narrative of the research participant and principally outlines the effects of sexual abuse experience from childhood to adult life. The study was designed in a phenomenological pattern that is rooted in qualitative research. As a result of the analysis, emotions after sexual abuse, need of support, injuring of sense of trust, memories and flashbacks, coping with and managing negative effects of sexual abuse themes were obtained. In line with the findings, sources of the participant are related to sexual abuse in childhood was determined, and the contents of the themes were presented in detail

Beauty is in the eye of the offender: Physical attractiveness and adolescent victimization

ObjectivesThis research considered physical attractiveness as a potentially victimogenic individual characteristic. Based on target congruence, the theoretical model predicts direct effects of physical attractiveness on violent victimization and, based on routine activities theory, indirect effects on both violent and non-violent victimization. MethodUsing data from the 2013 wave of the Finnish Youth Victimization Survey (n = 5095) we estimated a structural equation model to examine the hypothesized associations. Physical attractiveness was measured using a novel self-report instrument asking respondents to report how other people react to their physical appearance. ResultsWe found consistent support for the theoretically expected pathways. The direct and indirect associations of physical attractiveness on sexual victimization were particularly strong. For example, highly attractive boys were five times more likely than other boys to have experienced child sexual abuse. ConclusionsScholars and practitioners should consider physical attractiveness as an individual characteristic that may substantially increase the risk of interpersonal victimization, both directly and through its impact on routine activities. More research is needed to understand the mechanisms producing the observed associations.

Daughters Inside: Toward a Theory of Structural Sexual Violence Against Girls Through Male Mass Incarceration.

Indigenous women constitute the fastest growing segment of the prison population. Women inside have disproportionately experienced childhood sexual abuse (CSA). A key protective factor against CSA is living with both biological parents. Imprisonment removes fathers from daughters' homes. Yet, the link between male incarceration and girls' risk of CSA remains unexamined. A quantitative exploration of this risk in Aotearoa New Zealand, indicates that the disproportionate incarceration of Māori fathers in the 1980s exposed Māori daughters to a 5.5 times greater CSA risk. A theory of sexual structural violence through male mass incarceration may help explain high CSA victimization rates among Māori girls and incarcerated women, and the sudden increase of young Indigenous women behind bars. More qualitative research is required to verify this empirical exploration.

Childhood sexual abuse characteristics, abuse stress, and PTSS: Ties to sexual behavior problems

BackgroundSexual behavior problems (SBPs) are present in a subset of sexually abused children and are associated with more severe childhood sexual abuse (CSA) experiences; however, few studies have investigated abuse characteristics and SBPs. Children’s reports of abuse stressors have not been previously examined and may provide novel information. Posttraumatic stress symptoms (PTSS) have also been linked with SBPs but have not been consistently accounted for in prior studies, which may obscure the true relationships between abuse characteristics and stressors with SBPs. Moreover, the term SBP consists of a range of behaviors, including interpersonally-focused SBPs (ISBPs), and the relationships between abuse characteristics and stressors may differ in the context of ISBPs. ObjectiveThe present study determined whether caregiver-reported abuse characteristics, child-reported abuse stressors, and PTSS, were associated with both SBPs and ISBPs. Participants and settingTwo-hundred and fifty-four sexually abused children (ages 2–12; M = 7.69, SD = 2.67; 58.7 % female; 52.8 % white) participated in the study. ResultsChild- and caregiver-reported level of PTSS were related to SBPs, and trends were noted for greater caregiver-reported abuse severity and child-reported abuse-related stressors. When ISBPs were examined, boys, younger children, greater CSA severity, and higher levels of PTSS were associated with higher levels of ISBPs. ConclusionsLevel of PTSS may be important in identifying children at risk for SBPs and ISBPs, and CSA severity may be more relevant in the development or maintenance of ISBPs specifically.

Parents' Knowledge, Attitudes, and Experiences in Child Sexual Abuse Prevention in El Salvador.

Childhood sexual abuse (CSA), a global public health problem, is often underreported especially in low-income countries such as El Salvador, and prevention efforts are needed. The purpose of this study was to examine knowledge, attitudes and experiences of CSA prevention and characteristics related to greater knowledge and openness to engaging in child abuse prevention among Salvadoran parents. Salvadoran parents (N = 478) completed questionnaires regarding demographics, definition and signs and symptoms of child abuse, personal experiences of CSA, CSA prevention training, and knowledge, attitudes and practices about preventing CSA. Most parents were knowledgeable about CSA, viewed CSA prevention as their responsibility, and had talked with their children about CSA, although 65.7% incorrectly believed that children are more likely to be abused by strangers. Parents with lower income were less knowledgeable and willing to participate in CSA prevention. CSA programing needs to involve parents and specifically target low-income parents.

Compulsive Sexual Behavior and Dysregulation of Emotion.

Dysregulation of emotion (DE) is commonly seen in individuals suffering from compulsive sexual behavior (CSB), as well as represents a crucial element of its common comorbidities like mood, anxiety, and substance use disorders. To investigate the links between CSB and DE. A review of pertinent literature on CSB and DE was performed using EBSCO, PubMed, and Google Scholar databases. Patterns of DE were evaluated as a common clinical feature, underlying mechanisms, as well as a target for psychological and pharmacological interventions in CSB. Across different conceptualizations of CSB, DE represents the core element of a failure to cope with sexual impulses, thoughts, urges, or resulting uncontrolled sexual behaviors. DE may contribute to the occurrence of CSB while for individuals affected by this condition, sexual arousal and release act as an easier/learned (yet uncontrolled and leading to negative consequences) way of coping with negative mood states. CSB may represent a delusive form of self-regulation. Experience of child sexual abuse and insecure attachment patterns are considered risk factors for CSB (likely to be mediated by DE) but require further investigation. DE is also positively associated with CSB symptom severity. Pharmacological treatments affecting mood regulation, anxiety, impulsivity, and regulation within the brain reward system have been reported to help people with CSB achieve better control over their sexual urges and behavior. However, the available data are scarce and well-powered randomized controlled trials are needed to support these observations. Although improvement in one's emotional self-regulation is considered as an important healing factor in treatment, its benefit in psychological therapies specific to CSB requires further investigation. DE represents a core symptom of compulsive sexual behavior disorder and related comorbidities as well as a predisposing factor to the development of compulsive sexual behavior disorder. Addressing DE may facilitate better treatment outcomes for patients with CSB. Lew-Starowicz M, Lewczuk K, Nowakowska I, etal. Compulsive Sexual Behavior and Dysregulation of Emotion. J Sex Med 2020;8:191-205.