History Of Sexual Abuse Research Articles

Daily reciprocal relations between emotion dysregulation and non-suicidal self-injury among individuals with a history of sexual assault: The influence of posttraumatic stress symptoms.

Non-suicidal self-injury (NSSI) is a serious public health concern that can be understood within an emotion dysregulation framework. The current study adds to the literature by utilizing a micro-longitudinal design and novel statistical modeling to test reciprocal associations between emotion dysregulation and NSSI, as well as the potential moderating effect of posttraumatic stress symptoms (PTSS). Participants were 81 individuals with a history of sexual assault and NSSI (Mage =33.80; 67.9% women; 80.2% white) recruited from the community who self-reported on symptoms of emotion dysregulation and NSSI thoughts/behaviors once daily for 7 days. Average compliance rate was 72.8% (SD=31.3%) and 34 participants (42.0%) endorsed NSSI thoughts/behaviors over the course of the study. Findings revealed a significant positive effect of NSSI thoughts/behaviors on subsequent abilities to regulate negative emotions. Furthermore, while results did not detect a moderating influence of baseline PTSS on the relation between emotion dysregulation and NSSI thoughts/behaviors over time, individuals with higher baseline PTSS were found to experience heightened levels of NSSI thoughts/behaviors and emotion dysregulation on average. Information from this study may be useful for future research and intervention development focused on the intersection of NSSI, PTSS, and emotion dysregulation.

An analysis of child sexual abuse seen in a teaching hospital of a developing country

BackgroundChild sexual abuse (CSA) continues to expand in scope and character and in developing countries is fuelled by poverty, poor policies, and cultural perceptions and practices. It is poorly studied or under-reported in sub-Saharan Africa. This may be due to the taboo placed on sex and ignorance of the consequences of child sexual abuse. The objective of this study was to analyze the characteristics of CSA seen in our environment. An interviewer-administered questionnaire was used to obtain information about children attending a forensic clinic with a history of sexual abuse. Information was obtained from the child and/or an accompanying adult. Descriptive statistics were performed on obtained data.ResultsIn the study period, CSA cases represented 72.4% of sexual assault; 98.4% of victims were females. Victims’ average age was 10.2±4.2 years (95% CI 9.47–10.93), most (61.1%) lived with both parents, and most presented for care after 72 h of the incident. Most parents/guardians were low-income earners with only secondary education. Most perpetrators (75.6%) were known to their victims and were predominantly artisans (36.6%), while most (43.5%) were aged from 21 to 30 years and 18.3% were adolescents; a greater proportion was unmarried or widowed (52%). The abuse occurred mostly in the perpetrator and victim’s home (56.4%). Inducement with gifts and promises (65.1%) was the most means of procuring CSA; in 21.4% of cases, victims were exposed to pornography before the act. Penis (64.3%) and finger (26.2%) were mostly used. Most victims did not sustain injuries (68.6%) and presented without symptoms (64.3%), while 35 (27.7%) had genitourinary symptoms.ConclusionsIn our environment, sexual abuse of children is commoner than that of adults and has characteristics that make it potentially more problematic than usual including a proportionately high number of adolescent perpetrators and involvement of pornographic materials. Preventive measures should be geared towards these and other aspects of the problem.

Yes, It's that Common and Yes, It's that Bad: An Estimation of the Prevalence and Psychological Correlates of Rape and Sexual Assault in College Women.

Rape myths play a role in rape denialism, in which individuals deny the prevalence and severity of sexual assault. This project aimed to address two common rape myths: that rape is uncommon and its effects are exaggerated. To test these claims, we explored two archival samples consisting of undergraduate women. Study 1, a 5-year chart review of university counseling center intake forms (n = 883), demonstrated that 30.2% of clients had experienced "sexual violence," "sexual contact without consent," or both. Study 2, a re-analysis of an emerging adulthood resilience survey dataset (n = 359), demonstrated that 20.6% of subjects had a history of sexual assault, and that those women reported lower life satisfaction and more severe psychological symptoms than those who did not. These findings are in line with previous literature debunking harmful rape myths that contribute to the perpetuation of rape culture. Our data help validate these rape notions as mythical; rape is indeed common and devastating.

Street Hawking or Street Walking in Dahomey?: Debates about Girls’ Sexual Assaults in Colonial Tribunals, 1924–41

AbstractBetween the judicial reorganizations of 1924 and 1941, the colonial tribunals in Dahomey heard more than two hundred cases of rape. Teenage or younger girls engaged in street hawking were the most common victims of rape who reported their assaults to these tribunals. Many of the cases stand out because market women played the dominant role in transforming girl hawkers’ experiences of sexual assault into formal grievances. The history of sexual assault in colonial Africa has largely focused on how ‘customary’ and colonial courts have or have not punished the crime of rape. This approach privileges masculine authorities’ views of sex, consent, and gender violence. This article focuses on the investigative processes in cases of sexual assault. In doing so, two gendered histories emerge: firstly, a history of elder female caregiving to girls suffering the aftereffects of sexual assaults and, secondly, a history of the vulnerability of hawkers to quotidian sexual violence.

Differences in Sexual and Physical Abuse History by Presenting Chief Complaint in an Outpatient Urogynecology Population.

One in 3 women experience sexual or physical violence in their lifetimes. Health consequences for survivors are numerous, including urogynecologic symptoms. We aimed to determine prevalence and factors that predict a history of sexual or physical abuse (SA/PA) in outpatient urogynecology, specifically whether the chief complaint (CC) predicts a history of SA/PA. This cross-sectional study analyzed 1,000 newly presenting patients to 1 of 7 urogynecology offices in western Pennsylvania from November 2014 to November 2015. All sociodemographic/medical data were retrospectively abstracted. Univariable and multivariable logistic regression analyzed risk factors based on known associated variables. One thousand new patients had a mean age of 58.4 ± 15.8 years with a body mass index (BMI) of 28.8 ± 6.5. Nearly 12% reported a history of SA/PA. Patients with CC of pelvic pain were more than twice as likely to report abuse compared with all other CCs (odds ratio [OR], 2.690; 95% confidence interval [CI], 1.576-4.592). Prolapse was the most common CC (36.2%) but had the lowest prevalence of abuse (6.1%). Nocturia was an additional urogynecologic variable predictive of abuse (OR, 1.162 per nightly episode; 95% CI, 1.033-1.308). Increasing BMI and decreasing age both increased the risk of SA/PA. Smoking conferred the highest likelihood of abuse history (OR, 3.676; 95% CI, 2.252-5.988). Although those with a CC of prolapse were less likely to report abuse history, we recommend routine screening for all women. Pelvic pain was the most common CC among women reporting abuse. Special efforts should be made to screen those at higher risk with complaints of pelvic pain who are younger, smokers, with higher BMI, and with increased nocturia.

How Does that Make You Feel? Development and Pilot Testing of Two New Instruments Measuring Emotional Attributions to Experiences of Childhood Sexual Abuse

ABSTRACT Though prior research has demonstrated that survivors of childhood sexual abuse may experience a range of negative emotions following the abuse, studies have failed to consider the conflicting, ambivalent, or positive emotions being attributed to the experiences by survivors. The current study describes the development and piloting of two new scales to capture the positive and negative emotions that youth may attribute to experiences of childhood sexual abuse. A sample of youth (N = 136) were recruited and surveyed from community corrections and residential treatment centers in a Midwestern state. Item Response Theory was used to test the performance of the measures and their individual items with the subsample of youth who reported a history of childhood sexual abuse (n = 40). Both new measures demonstrated high internal consistency reliability and appropriately captured the range of positive and negative emotions youth may experience following childhood sexual abuse. Findings indicate that youth who have experienced childhood sexual abuse may have conflicting positive and negative emotions associated with the experiences. Implications for measurement refinement, future research directions, and clinical practice are discussed.

A laboratory-based examination of a standardized sexual assault script

ABSTRACT Background and Objective: Idiographic script-driven imagery is core to both research and treatment related to posttraumatic stress disorder (PTSD), including among individuals with a history of sexual assault. However, there may be benefit in having alternatives to such idiographic techniques. The current study therefore examined multimodal responding to a standardized audio-recorded narrative of a sexual assault. Design and Method: In this experiment, 105 women (Mage = 19.09, SD = 2.24) were recruited from the community and randomly assigned to listen to a depiction of sexual assault (trauma condition) or a similar experience without sexual assault (control condition). Results: As hypothesized, relative to the control group, participants in the trauma condition reported greater (a) increases in anxiety, anger, and disgust from pre- to post- manipulation, and (b) distress across the duration of the recording. In contrast to hypotheses, heart-rate did not differ across groups. Conclusions: Results suggest listening to a standardized sexual assault narrative, compared to a non-traumatic narrative, effectively increases negative affect. This indicates standardized sexual assault narratives have potential as a traumatic event cue presentation method both for trauma-focused treatment and studying reactions to sexual assault cues.

Uptake of USPSTF recommendation to refer pregnant individuals for therapy or counseling to prevent perinatal depression.

Perinatal depression is the most common complication of pregnancy and childbirth, and it is associated with adverse consequences. The United States Preventive Services Task Force (USPSTF) recommends that pregnant and postpartum (i.e., perinatal) individuals at risk for depression be referred for therapy or counseling interventions; however, it is unclear to what extent this recommendation has been implemented. Pregnant individuals were recruited via advertisements on a pregnancy app and a separate study on sleep. Respondents completed the initial screening questions to determine their risk for perinatal depression, defined as self-reported history of depression; recent stressors; history of emotional, sexual, or physical abuse; mild depressive symptoms; anxiety symptoms; single; diabetes diagnosis; or unwanted pregnancy. Eligible respondents reported their providers' recommendations for preventing depression, and their utilization of interventions to prevent depression (n = 303). Fewer than 15% of participants reported that a provider referred them for therapy or counseling to prevent depression; recommendations included cognitive behavioral therapy (4%), interpersonal psychotherapy (2.3%), mindfulness-based cognitive therapy (4.3%), or other/unknown (6.6%). Approximately 12% reported that a provider recommended medication to prevent depression. Provider referral rates varied by risk factor, but not by patient demographics. Nearly 20% of participants reported using therapy or counseling to prevent depression, and nearly 13% reported using medication to prevent depression. We explore potential factors affecting the uptake of the USPSTF recommendation and underscore the importance of preventing perinatal depression.

Risk Factors of Running Away in Young Iranian Girls: A Cross-sectional Study

Background: The present study explored the risk factors for the running away behavior in young Iranian girls. Objectives: This study explored the role of conflictual familial relationships, history of sexual or physical abuse, low socioeconomic status, low self-esteem, dysfunctional coping strategies, depression symptoms, and poor religious beliefs in predicting the running away behavior among Iranian young girls. Patients and Methods: This cross-sectional study recruited 95 young girls who ran away from home and 135 girls as the control group. They responded to several self-reported measures to assess sociodemographic characteristics, the household’s economic status, the strength of the family, religious beliefs, history of substance abuse, experiencing physical, emotional, or sexual abuse, self-esteem, coping styles, and depression. We used the independent t-test, chi-square also used logistic regression. Results: Girls who came from low-income and moderate-income families had significantly higher odds of running away than girls belonging to high-income families. Girls who had a history of using illicit drugs had higher odds of running away from home. Moreover, low family strength and weak religious beliefs significantly predicted running away from home. Conclusion: The findings suggested that the family’s economic status, history of substance use, familial relationships, and weak religious beliefs were key factors in understanding the behavior of running away from home in Iranian adolescent girls.

Adverse childhood events and health-related quality of life among women undergoing hysterectomy for uterine leiomyoma

Background and Aim Psychosocial stress may increase fibroid risk, but associations with symptom severity, which often influence clinical management decisions, have been underexamined. Our objective is to examine associations between adverse childhood experiences (ACE) and symptom severity and symptom impact on health-related quality of life (HRQL) among women undergoing hysterectomy for treatment of their leiomyomas (fibroids). Methods We recruited 103 premenopausal women into the Fibroids, Observational Research on Genes and the Environment (FORGE) study who were seeking evaluation of fibroids at the Medical Faculty Associates in Washington D.C. and intending to undergo hysterectomy at the George Washington University Hospital. For exposure classification, we assessed eight ACE categories related to child abuse and household challenges. For outcome classification, we used the Uterine Fibroid Symptom and Quality of Life (UFS-QOL). The five-level Likert scale responses were summed to create composite scores; a lower symptom severity score indicated fewer symptoms, while a higher HRQL score indicated better quality of life. We ran quasi-poisson regressions (log-link) to examine associations between ACE scores and UFS-QOL composite scores adjusting for age, race/ethnicity, and education (N=89). Results The majority of participants were Black (73%); about half had private insurance (55%) and a college degree (49%). Cumulative ACE and symptom severity scores were higher among Black compared to non-Black women (p ≤ 0.03). History of substance abuse in the household was associated with greater symptom severity (relative risk (RR) = 1.31, 95% CI: 1.07, 1.61), and worse HRQL (RR = 0.74, 95% CI: 0.55, 1.00). History of sexual abuse was also associated with worse HRQL (RR = 0.67, 95% CI: 0.48, 0.92). Conclusions Our study adds to the growing evidence that early life exposures to chronic stress may influence gynecologic health, including symptom-related quality of life. Keywords. Women’s health, gynecological health, health disparities, social-structural stressors

Longitudinal associations of psychosocial stressors with menopausal symptoms and well-being among women in midlife.

We examined longitudinal associations of psychosocial stressors with menopausal symptoms and well-being of women in midlife in a longitudinal cohort. This study is based on 682 women from Project Viva, a prospective cohort enrolled in 1999 to 2002 during pregnancy (median age = 33.3 y) and followed for almost two decades. In pregnancy, women self-reported psychosocial stressors (history of physical and sexual abuse and financial instability, from childhood to the current pregnancy). In 2017 to 2021 (median age, 51.6 y), they reported their menopausal symptoms (0-44 point scale) and well-being (general health [good/fair/poor vs excellent/very good], generalized anxiety symptoms, and depressive symptoms [both-more than minimal levels vs none/minimal]). We performed multivariable and logistic regression models to examine associations of psychosocial stressors with outcomes, adjusting for covariates. History of physical abuse (reported by 37.3%) was associated with worse menopausal symptoms in the somatovegetative (odds ratio [OR], 0.46 points; 95% confidence interval [CI], 0.04-0.87 points) and psychological (OR, 0.52 points; 95% CI, 0.07-0.97 points) domains and with worse general health (OR, 1.73; 95% CI, 1.17-2.55) and greater depressive symptoms (OR, 1.74; 95% CI, 1.05-2.87). History of sexual abuse (7.7%) was associated with worse menopausal symptoms (OR, 2.81 points; 95% CI, 1.05-4.56) and worse general health (OR, 2.04; 95% CI, 1.04-4.03) but not with depressive symptoms. History of financial instability (10.8%) was associated with worse menopausal symptoms (1.92 points; 0.49 to 3.34), worse general health (OR, 2.16; 95% CI, 1.24-3.75), and greater depressive symptoms (OR, 2.68; 95% CI, 1.44-4.98). We observed no association between psychosocial stressors and generalized anxiety symptoms assessed at midlife. Psychosocial stressors were associated with worse menopausal symptoms and well-being decades after initial report.

Institutional Betrayal and Closeness Among Women Veteran Survivors of Military Sexual Trauma: Associations with Self-Directed Violence and Mental Health Symptoms

ABSTRACT Institutional betrayal is defined as harm caused by an institution to an individual in the context of trust and dependence. High institutional betrayal is associated with poorer health outcomes, and high levels of trust, dependence, or identification with the institution (institutional closeness) may exacerbate the negative effects of institutional betrayal. While military sexual trauma is prevalent among women Veterans and associated with high rates of institutional betrayal, studies of the impact of military sexual trauma-related institutional betrayal have been limited in size and scope and have not examined the potential role of institutional closeness. We conducted a secondary analysis of national survey data collected from women Veterans who screened positive for military sexual trauma (n = 229). Hierarchical logistic and linear regression were used to examine associations between predictor variables (institutional betrayal, institutional closeness, and their interaction) and outcomes of interest and adjusted for age, education, and military sexual assault history. Institutional betrayal was associated with increased odds of suicidal ideation and suicide attempt during or following military service, as well as more severe symptoms of depression and posttraumatic stress disorder (PTSD). Institutional betrayal was not associated with non-suicidal self-injury or lifetime substance misuse. Counter to hypotheses, institutional closeness did not moderate relationships between institutional betrayal and mental health symptoms or self-directed violence. Results underscore the necessity of preventing and addressing institutional betrayal among women Veterans who experience military sexual trauma.

Mental Health Response to Disasters: Is There a Role for a Primary Care-Based Clinician?

Following natural disasters, rural general practitioners (GPs) are expected to undertake several roles, including identifying those experiencing psychological distress and providing evidence-informed mental health care. This paper reports on a collaborative mental health program developed to support a rural GP practice (population <1,500) and a disaster response service. The program provided specialized disaster mental health care via the placement of a clinician in the GP facility. In collaboration with the GP practice, the program offered opportunistic screening using the Primary Care Posttraumatic Stress Disorder (PTSD) Scale (PC-PTSD) for probable PTSD as the primary measure and the Kessler 6 (K6) as a secondary measure. Those scoring higher than two on the PC-PTSD scale were referred to the mental health clinician (MHC) for further assessment and treatment. Sixty screening assessments were completed. Fourteen patients (male = 3; female = 11) scored higher than two on the PC-PTSD. The referred group PC-PTSD mean score was 3.14 and K6 mean score of 19. Those not referred had a PC-PTSD mean score = 0.72 and K6 mean score = 7.30. The treatment and non-treatment groups differed significantly (PC-PTSD: P <.00001 and K6: P <.00001). A prior history of trauma exposure was notable in the intervention group. Eight reported a history of domestic violence, seven histories of sexual abuse, five childhood sexual abuse, and eight intimate partner violence (IPV). A post-disaster integrated GP and mental health program in a rural community can assist in identifying individuals experiencing post-disaster psychological distress using opportunistic psychological screening. The findings indicate that collaborative mental health programs may effectively support rural communities post-disaster.

Schizophrenia in a Young Female with History of Childhood Sexual Abuse and Same Sex Relationship: A Case Report

Introduction: Severe mental disorders in adulthood have various risk factors and causes. Childhood sexual abuse (CSA) is a risk factor that triggers developmental disorders and causes mental disorders in adulthood. This case report aims to present a patient with schizophrenia with a history of childhood sexual abuse and same-sex relationship.&#x0D; Case presentation: A young woman, a college student, came to the psychiatric unit of Cattleya Mental Health Center with her partner. Patients present with complaints of frequent self-harm and attempted suicide. The patient often feels voices telling her to scratch her hands and bang her head, saying that everyone in the world is trying to threaten her life. A mental state examination revealed that the patient's self-care was very poor and tended to be apathetic. Patients tend to be indifferent to the examiner, occasionally laughing and talking without direction (tangential). Her mood was elevated, affect was inappropriate. The patient experienced an auditory hallucination. Her risk factors include being born into a broken family, being an unwanted child, and was taken care of by a distant family (grandmother). As a child, the patient was raped by her uncle (a law enforcer) and was threatened if she told other family members. The patient was then treated with the oral antipsychotic olanzapine 5 mg daily and asked for a weekly follow-up. Patients are allowed to outpatient with supervision from her boarding friends and her girlfriend.&#x0D; Conclusion: Handling schizophrenia patients involves a multidisciplinary team starting from the introduction of risk factors to the selection of psychopharmacology and psychotherapy.

Association of Dissociation with Suicide Attempt and Non-Suicidal Self Injury in Adolescents with a History of Sexual Abuse

Objective: Dissociative symptoms are considered risk factors for suicide and non-suicidal self-injury (NSSI). In this study, the relationship between suicidal behaviors and NSSI with dissociative symptoms in adolescents with a history of Child Sexual Abuse (CSA) was investigated. Methods: A total of 100 adolescents with a history of CSA were evaluated with a detailed forensic psychiatric interview. Dissociative symptoms were measured with the self-report Adolescent Dissociative Experiences Scale (A-DES) and the parent-reported Child Dissociative Checklist (CDC). Results: While dissociative symptoms did not differ between adolescents with and without suicide attempts (CDC; p = .068 and A-DES; p = .060), they were significantly higher in adolescents with non-suicidal self-harming behavior (CDC; p < .001 and A-DES; p = .001). Suicide attempts and NSSI were more common in those who reported genital touching as a type of sexual abuse (respectively, p = .003; p = .048). In regression analysis; history of psychiatric treatment (OR = 9.09 [95% CI = 1.52, 54.29]) and NSSI (OR = 8.18 [95% CI = 2.01, 33.23]) were independently associated with suicide attempts. In addition, parent-reported dissociative symptoms (CDC scores) (OR = 1.27 [95% CI = 1.06, 1.53] and suicide attempt (OR = 8.09 [95%CI = 1.96,33.42] showed independent association with NSSI. Conclusions: Dissociative symptoms may be predictive factors for NSSI and should be considered in risk assessment of adolescents with a history of CSA.

Genital Examination of the Prepubertal Female: Essentials for Pediatric Nurse Practitioners.

Genital Examination of the Prepubertal Female: Essentials for Pediatric Nurse Practitioners.

Reintegration Services for Homeless Female Living with Severe Mental Illness and History of Sexual Abuse

Reintegration Services for Homeless Female Living with Severe Mental Illness and History of Sexual Abuse

Gender and Patient Satisfaction in a Veterans Health Administration Outpatient Chemotherapy Unit.

Our objective was to explore whether differences in patient satisfaction based on gender exist at the Veterans Affairs Portland Health Care System (VAPHCS) outpatient chemotherapy infusion unit. Veterans who received outpatient infusion treatments at the VAPHCS outpatient chemotherapy infusion unit from 2018 to 2020 were invited to take an anonymous survey. Response differences were analyzed using Fisher exact and Welch t tests. Male and female patient lists were first generated based on Computerized Patient Record System designation, then defined and results reported based on gender self-identification from survey responses. The survey was conducted over a 2-week period during January and February of 2021. In total, 69 veterans were contacted: 21 (70%) of 30 female and 20 (51%) of 39 male veterans completed the survey. Most (62%) female patients were aged < 65 years, and 52% were treated for breast cancer. Most (90%) male patients were aged ≥ 65 years, and most commonly treated for prostate cancer (20%) or a hematologic malignancy (20%). Using our survey, patient satisfaction (SD) was 8.7 (2.2) on a 10-point scale among women, and 9.6 (0.6) among men (P = .11). History of sexual abuse or harassment was reported by 86% of women compared with 10% of men (P < .001). Women reported feeling uncomfortable around other patients in the infusion unit compared with men (29% vs 0%; P = .02) and discomfort in relaying uncomfortable feelings to a clinician (29% vs 0%; P = .02). Gender seems to be related to how veterans with cancer perceive their ambulatory cancer care. This may be due to the combination of a high history of sexual abuse and/or harassment among women who represent a minority of the total infusion unit population, the majority of whom receive treatment for a primarily gender-specific breast malignancy. Analysis was limited by the small sample size of women, many with advanced malignancy.

Caregiver-reported psychological and behavioural functioning of children with suicidal thoughts and behaviour: A case-control design.

This exploratory project aims to provide an empirical understanding of the caregiver-reported emotional and behavioural functioning of children 12 and under who present to an inpatient psychiatric unit with suicidal ideation and/or attempts. A retrospective chart review was conducted, including all patients (n=573) aged 12 and under admitted to a psychiatric inpatient unit between September 2011-December 2015 for suicidal ideation without proximal attempt (n=155) or a suicide attempt (n=37). Inpatients without suicidal thoughts and behaviour in the same age range (n=381) served as a control group. The three groups were compared on a range of variables, including patient history/demographics, caregiver-reported emotional/behavioural functioning, and discharge diagnoses. Children who were admitted to a psychiatric inpatient unit following suicide attempts and/or ideation demonstrated clinically significant levels of externalizing and internalizing symptoms. Children with suicidal thoughts and behaviour (STB) were more likely to be female and older than their peers without STB, more likely to report a history of sexual abuse and non-suicidal self-injury, and to be diagnosed with a depressive disorder. Children with STB differ demographically, symptomatically, and diagnostically from their peers without STB with comparable levels of psychiatric impairment (i.e., necessitating inpatient admission). Results provide provisional information on this concerning group of children, which can be used to aid identification of risk factors, inform treatment, and stimulate future work.

Posttraumatic Cognitions and Condomless Sex Among Men Who Have Sex with Men (MSM) with a History of Childhood Sexual Abuse: The Role of Avoidance Coping.

This study explicated associations between trauma-related cognitions and condomless sex, examining avoidance coping style and behavior (i.e., substance use) as intermediate variables, among a group disproportionately affected by both trauma and HIV. Two hundred and ninety HIV-negative MSM with a history of childhood sexual abuse (CSA) completed a cross-sectional psychosocial battery. Trauma-related cognitions were positively associated with more acts of condomless sex. Indirect associations on condomless sex were driven by avoidance coping, but not substance use. Findings indicate a need to address trauma-related cognitions and avoidance coping within interventions for reducing HIV risk among MSM with a history of CSA.