Past Sexual Abuse Research Articles

Midwifery practice and sexual abuse

Women may have been subjected to unwanted sexual experiences. This can have a lasting emotional and psychological impact. The intimacy associated with pregnancy and childbirth may provoke particular fear and anxiety in these cases. This may be further exacerbated by midwifery and obstetric practice. Ultimately, previous personal experiences combined with those encountered when accessing maternity care may have the potential to influence the utilization of all health care in the future. Having awareness and understanding of past sexual abuse can enable healthcare professionals to adopt a sensitive approach and prevent unknowingly re-traumatizing the woman. This article outlines some simple strategies that health professionals may consider to reduce the trauma associated with intimate procedures for all women.

Predicting the willingness to disclose childhood sexual abuse from measures of repressive coping and dissociative tendencies.

Although it is generally agreed that the verbal disclosure of past childhood sexual abuse (CSA) experiences can be beneficial, CSA survivors are often reluctant to reveal such experiences. Bonanno et al. found that women with documented CSA histories who did not disclose abuse when provided an opportunity to do so were more likely to show nonverbal expressions of shame and polite smiling, relative to disclosing CSA survivors or nonabused controls. Disclosing CSA survivors, in contrast, showed greater facial expressions of disgust. The current study extended this paradigm by showing that among the same participants, CSA disclosure was associated with chronic dissociative experiences, whereas nondisclosure was associated with repressive coping. Further, repressive coping and dissociative experiences were inversely related and showed opposite patterns of facial expressions and adjustment. Repressors expressed greater negative and positive emotion and were relatively better adjusted, whereas dissociators expressed little emotion and had relatively poorer adjustment.

Risk factors for alcohol use during pregnancy in a multistate area

A substance use screening instrument was used to select persons into two risk categories for drinking during pregnancy. About one-fourth (23.8%) of the survey participants were classified as high-risk women and the others were classified as low risk for drinking when pregnant. The participants ( N=4676) for the study were sampled from four states (Montana, Minnesota, South Dakota, and North Dakota) that are a part of the Four-State Fetal Alcohol Syndrome (FAS) Consortium. Clinic sites for the administration of the prenatal screening instrument were selected in each state, based on geographic and known population characteristics. Univariate and multivariate statistical procedures were used to determine factors predictive of alcohol use. The purpose of the study was to assess risk factors for alcohol use in pregnant women. Women at high risk for alcohol use when pregnant tended to be younger, less educated, single, and unemployed. Demographic factors that were protective of drinking when pregnant were being married and full-time housewife status. Other variables associated with high-risk status for maternal alcohol use were past sexual abuse, current or past physical abuse, using tobacco, using other drugs, living with substance users, and having mates who were substance users. Other contributing factors for high-risk classification included feeling sad, believing that drinking any amount of alcohol while pregnant was acceptable, and being able to hold four or more drinks. Intervention programs that ameliorate risk factors and enhance protective attributes of high-risk pregnant women are needed.

Gender, Race, Childhood Abuse, and Body Image among Adolescents

The research presented in this article examines the influences of race, gender, and sexual or physical abuse on unhealthy eating and dieting practices among Black and White adolescents. Specifically, the project considers the intersection of race and gender on actual and perceived body size. The impact of past sexual or physical abuse emerges as a significant predictor of unhealthy dieting and eating behaviors for Whites but not for Blacks. Although girls are more likely to have distorted body images and to engage in disordered eating and dieting, these differences are further explained with race and past sexual or physical abuse.

Anogenital injuries in child pedestrians run over by low-speed motor vehicles: four cases with findings that mimic child sexual abuse.

Differentiating between child sexual abuse and nonintentional causes of anogenital injury can be challenging, and a misdiagnosis can have a profound impact on the child and family. This case series documents an important nonintentional mechanism of anogenital injury that mimics the physical findings of child sexual abuse. Four children were examined after being run over by a slow-moving motor vehicle. In each case, the wheel of the vehicle passed longitudinally over the child's torso. Two children had perianal lacerations, and 2 had hymenal lacerations. One child with hymen injuries was followed for 4 weeks and developed findings identical to those seen in healed sexual abuse. Children run over by motor vehicles should be evaluated for anogenital injury. If such injury is suspected, it should be fully delineated and documented with colposcopy and follow-up examination. Although the possibility of sexual abuse must be considered, awareness of the occurrence of anogenital injuries in children run over by motor vehicles may prevent the misdiagnosis of acute sexual abuse in children. Conversely, children presenting for evaluation of acute or past sexual abuse should be questioned as to whether they were ever run over by a motor vehicle.

An Elaboration on Causation and Positive Cases in Child Sexual Abuse.

Sbraga and O'Donohue (2003, this issue) argued that backward reasoning from current symptomatology to past child sexual abuse (CSA), often done by experts in court cases, is flawed in several important ways. Backward reasoning, or postdiction, is usually based on models that assume that CSA invariably causes symptoms and that it is always negatively experienced. They demonstrated the weaknesses in these assumptions. The present commentary expands on causation and positive reactions. Statistical research is reviewed that shows that causation cannot be safely inferred in the typical case. Prevalence of positive reactions is discussed. Case studies are presented to illuminate these issues. It is concluded that Sbraga and O'Donohue are correct in disputing post-diction in CSA and the models it is based on.

Perceived abuse and disability in a sample of Ohio's women's correctional population.

The Abuse Disability Questionnaire was administered to 435 female inmates at a state prison in Ohio. Analysis indicated that 69% of the women reported some type of past physical, sexual, or psychological abuse, which is consistent with other reports for state prisons. Both the amount of abuse reported as well as the extent of associated psychological impairment was less in comparison to scores for women in domestic violence shelters. While all women in the prison were screened, those who met criteria for psychiatric diagnoses had significantly higher Abuse Disability Questionnaire scores than those who were not so diagnosed by a mental health professional. As in prior studies with the questionnaire, a significant relation between reported exposure to prior abuse and perceived impairment was found.

Risky Sexual Behavior in American White College Women: The Role of Sex Guilt and Sexual Abuse

Ninety-five sexually active White American female college students participated in a questionnaire study about their sexual behavior in the past 12 months. A path model was tested in order to assess specific hypothesized predictors of risky sexual behavior. As predicted, participants with greater sex guilt reported using condoms more and having had fewer sexual partners. The findings of this study suggest that White American female college students are at some degree of risk due to risky sexual behavior. Taking into account attitudes about sexuality and past sexual abuse along with the requisite training in condom use self-efficacy may enhance the success of interventions designed to reduce risky sexual behavior among White American female college students.

Effect of abuse on health: results of a national survey.

The magnitude of risk would be highest for those reporting both types of abuse compared with those reporting 1 type or none. To examine the independent associations between physical or sexual abuse or both and self-reported health status, mental health, and health-risk behaviors among a national school-based sample of adolescent girls. A secondary data analysis of a cross-sectional survey. A nationally representative sample of 3015 girls in grades 5 through 12 from 265 public, private, and parochial schools (with an oversampling of urban schools) completed an anonymous survey conducted by the Commonwealth Fund Adolescent Health Survey. Girls were eligible for this study if they responded to 2 questions assessing past physical and sexual abuse. Among the respondents, 246 (8%) reported a history of physical abuse; 140 (5%), sexual abuse; and 160 (5%), both. Logistic regression controlling for grade, ethnicity, family structure, and socioeconomic status found that those who reported both types of abuse compared with those who did not report any were significantly more likely to experience moderate to severe depressive symptoms (adjusted odds ratio [AOR], 5.10), moderate to high levels of life stress (AOR, 3.28), regular smoking (AOR, 5.90), regular alcohol consumption (AOR, 3.76), use of other illicit drugs in the past 30 days (AOR, 3.44), and fair to poor health status (AOR, 1.74). Finally, girls who reported both types of abuse were 2.07 times more likely to report moderate to high depressive symptoms compared with those reporting only sexual abuse (95% confidence interval, 1.14-3.74). The magnitude of risk for adolescents reporting both types of abuse compared with no abuse is much greater than that for either abuse type alone. However, compared with both types, no significant increase in risk was detected in those reporting physical abuse only, and only depressive symptoms increased in those reporting sexual abuse only.

Psychiatrists Urged to Ask About Domestic Violence

Psychiatrists Urged to Ask About Domestic Violence

An Integrative Approach to Industrial Trauma Within Emergency Service Occupations

Two cognitive-behavioral approaches to the reduction of emotional trauma were combined and used successfully to treat a police officer in eight individual sessions. Elements of critical incident stress management were added to a constructive narrative approach, yielding a therapeutic frameworkthat helped the officer view traumatic events experienced in the line of duty as formative. Several educational factors also characterized this case. These include the need to understand first responder professions within a quasicultural context, the impact of past physical and sexual abuse, and factors to consider when working with children of deaf parents.

Current or Past Physical or Sexual Abuse as a Risk Marker for Sexually Transmitted Disease in Pregnant Women

Previous studies suggest that a history of physical or sexual violence is positively associated with a history of sexually transmitted disease (STD). It is important to determine whetherabuse is also a risk factor for current STD infection. Data were collected from 744 clients of an urban Midwestern prenatal clinic who gave birth in 1991-1996. Multiple logistic regression analyses were conducted to determine how the odds of having a history of STD or a current STD infection are affected by the experience of abuse. Overall, 30% of the women had a history of STD, and 18% had a current STD infection. Results of multivariate analyses showed that compared with nonabused women, those who had experienced any type of abuse had nearly twice the odds of having a history of infection and of currently having an STD. In separate analyses by abuse type, women with a history of only sexual abuse had twice the odds and those with a history of both physical and sexual abuse had nearly three times the odds of having a current STD, compared with women who reported no abuse. Abused women are at significantly increased risk of having a history of STD; abuse is also associated with an increased risk of current infection, especially among those with any history of sexual abuse. Future studies should be undertaken to better understand the role that abuse may play in relation to STD risk.

"Keep a blank face. I need to tell you what has been happening to me.

To explore adolescents' experiences of abuse in the year before and during pregnancy. This prospective study used structured and focused interviews and content analysis. Forty teens' stories of abuse were extracted from focused interview questions during a larger study of pregnant adolescents aged 18 to 20. Elements of the stories were coded and categorized according to content and meaning. Seven themes were identified using a generalized qualitative approach that blended content and thematic analysis. Teens reported abuse from a variety of individuals, including intimate partners, former partners, and family members. Thirteen of the 40 teens reported being pregnant in the year before the index pregnancy, with 11 of the pregnancies ending in miscarriage, elective abortion, or fetal demise. Four of the pregnancy losses were directly attributed to abuse. Seven themes were identified that reflected the teens' stories of violence: seeking safety (self-protection with risks and benefits); losing faith (negative experiences with police and social justice institutions); experiencing loss (compromised reproductive health); living on the edge (substance abuse concerns); taking the next step (developmental concerns); crying out for help (suicide attempts); and changing and temporary relationships (loss of family bonds and serial monogamy). Routine screening for violence prior to and during pregnancy should include questions about past pregnancies, sexual abuse, and multiple perpetrators, as well as perpetrators other than intimate partners. Adolescent developmental concerns should be incorporated in safety planning and advocacy interventions.

Abuse history and nonoptimal prenatal weight gain.

The purpose of this study was to examine the differences between women who reported current and past physical or sexual abuse and those who did not in terms of mean total prenatal weight change, the odds for inadequate prenatal gain, and the odds for excessive prenatal gain. This study used a matched retrospective cohort design. Data were from the charts of 578 clients of an urban prenatal care clinic. Multiple regression analyses, stratified by maternal age, were conducted to examine the association of past and current abuse with total prenatal weight change and with adequacy of prenatal weight gain for Body Mass Index category. For teens, abuse was not associated with prenatal weight change. For adults, mean total gains were 6.9 pounds greater for those who reported current abuse than for those who reported no abuse. Compared to women who reported no abuse, adults who reported only a history of physical abuse had 3.1 times the odds, and those who reported a history of sexual abuse (with or without physical abuse) had 3.0 times the odds for inadequate prenatal weight gains. Adults who reported a history of sexual abuse were 2.4 times as likely to have excessive prenatal weight gains as adults who reported no abuse. The relationship of abuse and prenatal weight gain was different in adults and teens. This study may be the first to report an association between abuse and excessive prenatal gains, suggesting that addressing the psychosocial needs of women may help optimize prenatal weight gain.

Abuse, addiction, and depression as pathways to sexual risk in women and men with a history of substance abuse.

In this paper, we develop and test a model for predicting sexual risk for HIV and other STDs. Researchers interviewed 528 women and men with a history of substance abuse about their past experiences of physical and sexual abuse, symptoms, and sexual risk behavior (number of partners, trading sex for drugs or money, unprotected intercourse, and sexual orientation). The model explores direct and indirect associations of physical abuse and sexual abuse with sexual risk. Depression and severity of problems with drugs and alcohol were expected to mediate associations between abuse and sexual risk. However, analyses did not substantiate any indirect effects. Being female, more severe drug problems and, among men, past sexual abuse were significant predictors of sexual risk. Prevention interventions would do well to address not only drug addiction, but also past sexual abuse in men and depression in women.

Abuse and Suicidal Issues in Older Women

Physical and sexual abuses are traumatic experiences for women. Many older women who suffer from depression and express suicidal ideation are victims of past and/or present abuse. This study reports the results of a study of 364 women aged fifty-five years and older who were former patients in one of three psychiatric facilities in Virginia. Detailed chart reviews provided the data to determine the relationship between abuse and suicidal issues in these older women. Results of the study show that women with identified suicidal issues (attempts and/or ideation) had significantly more prior victimization (child abuse, rape, battering) than women without suicidal issues. Review of existing literature and results of the present study suggest the importance of assessing for past and/or present physical and sexual abuse in older suicidal women. Assessment issues are discussed.

Beneath Contempt

Summary There is a need for increased awareness of the vulnerability of non-traditional/gender atypical (NTGA) boys to be physically, sexually and emotionally abused. Non-traditional/gender atypical male behavior refers to behavior that society usually labels as “sissy” and inappropriate for boys to display. Because NTGA behavior in boys and men is despised in our society, males who behave in feminine-identified ways are at high risk for being stigmatized, ostracized, and abused. A major factor that contributes to this unsafe environment is a patriarchal system that enforces sexist and misogynist attitudes. Because patriarchy devalues and denigrates females and things feminine-identified, boys who display NTGA are looked at as breaking male gender role boundaries. Violence is often used against these boys as a way to punish the misbehavior and also to teach other boys “the rules” for socially acceptable male behavior. The assessment of past physical, sexual, and emotional abuse with NTGA males must include sensitive questions regarding the response to their NTGA behavior. Adults, especially men, need to become allies for these boys and intervene on their behalf when the boys are being abused or mistreated. Men need to overcome the process of fear and intimidation associated with the devaluing of things feminine-identified which prevents them from identifying and empathizing with NTGA boys. Men will benefit from understanding that rigid adherence to gender behavior stereotypes limits their ability to identify with NTGA boys and prevents men from protecting NTGA boys.

Rorschach Correlates of Sexual Abuse: Trauma Content and Aggression Indexes

This study compared Rorschach records of nondissociative outpatients with histories of (a) definite sexual abuse (n = 22), (b) suspected but unconfirmed sexual abuse (n = 13), or (c) no sexual abuse (n = 43) on selected variables hypothesized to be associated with sexual abuse. As predicted, clients with definite sexual abuse scored significantly higher than clients known not to be sexually abused on Armstrong and Loewenstein's (1990) Trauma Content index (TC/R), with an effect size greater than 1 SD. Contrary to prediction, there was no significant difference in the frequency of their Aggressive Past (AgPast; Gacono & Meloy, 1994) scores. AgPast scores, however, did positively correlate with sexual abuse that was violent or sadistic. As a test of discriminant validity, we hypothesized that 2 Rorschach variables (PER and Sc) would be unrelated to sexual abuse. This was supported by our data. Although TC/R was strongly associated with the presence and severity of sexual abuse, it could not discriminate sexually abused from nonsexually abused clients with great accuracy. The TC/R score is 1 factor among many that can be used to assess the validity of clients' claims of past sexual abuse.

Race, age, and back pain as factors in completion of residential substance abuse treatment by veterans.

Variables associated with successful completion of residential substance abuse treatment were identified. The records of 340 veterans admitted to a 120-day substance abuse treatment program were retrospectively analyzed. The likelihood of successful treatment completion was calculated as a function of race, age, gender, psychiatric diagnosis, past suicide attempts, homelessness, legal history, childhood physical or sexual abuse, parental history of addiction, multiple substance dependence, medical problems, and the race of the therapist. Univariate analysis and logistic regression analysis were used to identify variables that were significant predictors of treatment completion. Overall, 66 percent of veterans completed the program. Eighty-two percent of the veterans admitted to the program were black, and 16 percent were white. The completion rate of black veterans (71 percent) was significantly higher than that of white veterans (49 percent). Veterans completing treatment were significantly more likely to be older, by an average of two years, than those who did not complete treatment. The association between younger age and failure to complete the program was largely accounted for by younger black veterans. Veterans with back pain were significantly less likely to complete treatment than those without back pain. Completion rates did not vary by the other variables examined. In the regression analysis that included age, race, and back pain, each variable, when adjusted by the other variables, was a significant predictor of completion. White patients were less likely to complete residential substance abuse treatment in a program in which the majority of both therapists and patients were black. Younger black veterans and those with back pain were also less likely to complete treatment.

Quality of Life in Adult Survivors of Childhood Sexual Abuse Who Have Undergone Therapy

ABSTRACT This study examined perceptions of past sexual abuse experiences and quality of life among adult survivors of childhood sexual abuse. Fifty-two adult survivors (15 men, 37 women) of childhood paternal sexual abuse who had completed therapy were interviewed about their past and current life. A qualitative analysis of the interviews revealed three types of explanations for the offenders' abusive behavior (fathers and/or mothers in terms of compliance): characteristics of the offender-parent (incestuous father), the victim's characteristics, and circumstantial conditions. The results indicated that a higher percentage of survivors who attributed the abuse to the offender's characteristics managed to keep their self-esteem fairly intact and had a higher quality of life, in contrast to survivors who took full blame on themselves or blamed situational factors. The results further revealed that male survivors judged their quality of life as less satisfactory than did female survivors.