Prior Sexual Abuse Research Articles

HUMAN IMMUNODEFICIENCY VIRUS-INFECTED ADOLESCENTS: THE FIRST 50 PATIENTS IN A NEW YORK CITY PROGRAM

This study identifies a large cohort of HIV-infected adolescents cared for in a multidisciplinary program. Since the subjects were selected because of their risk of HIV-infection, differences between the HIV-positive and -negative groups were minimized. Rates of STDs, drug use, and prior sexual abuse were much higher in both groups than those reported in population-based studies of adolescents; thus, behavior profiles can play a role in identifying high-risk adolescents. In adolescents, sexual behavior and sexual identity are often not the same, and thus AIDS prevention programs designed for the homosexual community are often not recognized as relevant by adolescents engaging in same-sex encounters. Virtually all HIV-positive females in this study apparently contracted HIV through heterosexual intercourse. None of the females were able to consistently convince their partners to use a condom. The majority of the HIV-positive adolescents reported more than 10 life-time sexual partners. There was a strong association between crack/cocaine use and increased numbers of sexual partners, termed "survival-sex." Traditional safer-sex messages are unlikely to reach teens attempting to survive on the street. Comprehensive drug treatment programs must be developed as a component of HIV prevention in adolescents. Medically, 80% of seropositive adolescents were asymptomatic by history and physical, yet by CD4 counts, nearly half were eligible for antiretroviral treatment. Adequate referral sources for comprehensive medical care should be linked to HIV counseling and testing programs for youth. After being informed of their seropositivity, most adolescents assumed they were going to die within a year. With a realistic message of hope, many of the adolescents were able to make positive changes in their lives, and the HIV infection became an organizing force in their lives.

Sexual Harassment and Prior Sexual Trauma Among African-American and White American Women

This study examined the relationship between sexual harassment in work, educational, and social settings and sexual abuse in childhood and/or adulthood in a stratified community sample of 248 African-American and white American women. The cumulative impact of sexual victimization on women's sense of general well-being was also examined. Those most likely to be sexually harassed in work and social settings were women with contact sexual abuse histories, regardless of ethnicity. The work status of harassers of women with sexual abuse histories differed significantly by ethnic group. Although women with prior sexual abuse experiences from both ethnic groups most frequently reported a response to sexual harassment at work, they least frequently did so in social settings. A history of childhood sexual abuse was more negatively associated with African- American women's well-being than were repeated experiences of sexual violence. Future research should address the implications of ethnic and cultural issues on the cumulative impact of incidents of sexual violence on women of color.

SEXUAL VICTIMIZATION AND CHRONIC PELVIC PAIN

Women with chronic pelvic pain are frequently found to have histories of sexual victimization. The authors review the evidence supporting this association and examine related questions regarding the association of chronic pelvic pain with other forms of abuse as well as the relationship of sexual victimization with other physical sequelae. Practical strategies are offered for the office management of patients with both chronic pelvic pain and sexual trauma.

Nonepileptic seizures and childhood sexual and physical abuse.

Nonepileptic seizures (NES) must be distinguished from epilepsy to avoid the adverse effects of unnecessary antiepileptic drugs and to initiate appropriate psychiatric treatment. A higher frequency of prior sexual abuse has been suspected in NES, although no prospective controlled study has compared patients with NES and epilepsy. A series of patients with conversion disorder presenting as epilepsy and 140 patients with complex partial epilepsy (CPE) without evidence of conversion were selected from a series of consecutive admissions to a comprehensive epilepsy center. The groups did not differ with respect to age, years of education, race, or marital status, but the percentage of women was greater in the conversion NES group (73.2%) than in the CPE control group (50.7%; p < 0.002). The frequency of a history of sexual or physical abuse was greater in the NES group (32.4%) than in the CPE controls (8.6%; p < 0.000). Severity of sexual but not physical abuse was significantly greater in the NES group relative to controls (p < 0.05). There was a trend for a closer relationship of the perpetrator of sexual abuse to the victim among the NES patients compared with CPE controls (p < 0.1). These results support the impression that childhood abuse is more common among patients with conversion NES than with epilepsy, and suggests that in some cases childhood abuse may be a contributory pathogenetic factor.

Health Risk Behaviors and Attempted Suicide in Adolescents Who Report Prior Maltreatment

We hypothesized that high school students who experienced prior maltreatment would be more likely than their peers to report health risk behaviors and suicide attempts. Before the establishment of an urban public high school-based clinic, an anonymous needs assessment survey was completed by 600 adolescents (grades 9-12). Sociodemographic information was obtained and questions were asked about physical and sexual abuse, health-related behaviors and habits, and suicide attempts. The mean age of the students was 15.8 years; 52 percent were girls; 23 percent were from families on welfare; and 56 percent from single-parent families or other living arrangements (e.g., with grandparents). Thirteen percent of the adolescents had been maltreated: 5.2 percent reported prior physical abuse, 5.4 percent sexual abuse, and 2.7 both physical and sexual abuse. Multivariate statistical techniques were used to clarify how previous abuse was related to adolescent risk-taking behaviors and suicide. Students with a history of physical abuse were 3.3 times more likely (CI 95% : 1.2-9.6; p≤0.01) than nonabused peers to drink alcohol and smoke cigarettes, almost twice as likely (CI 95% : 1.0-5.1; p=0.05) to use illicit drugs, 5.8 times more likely (CI 95% : 1.3-26.1; p&lt;0.01) to self-induce vomiting, and 5.2 times more likely (CI 95% : 1.8-15.4; p≤0.01) to attempt suicide. A student with a history of prior sexual abuse had a 3.5 times greater chance of being sexually active and was more than three times more likely to attempt suicide. These data on a nonclinical, nondeviant population of adolescents indicated that physical or sexual abuse in childhood may have a significant impact on adolescent health risk behaviors and suicide attempts.

Sex Attitudes and Prior Victimization as Predictors of College Student Sex Offenses

A sample of 796 college student volunteers in Human Sexuality and Introductory Psychology classes were surveyed anonymously about sexual attitudes, experience, and knowledge. The survey measured attitude variables found previously to predict attitudes toward forcible date rape (Fischer, 1986) and behavioral measures, such as sexual experience and sexual abuse as a child, teenager, or adult. Survey variables wre related to two types of self-reported sexual offenders: (a) those who admitted to use of lies or false promises to have sex (N=69) and/or (b) those who admitted to use of threat or force to have sex (N=16). Logistic regression and discriminant analyses revealed that male gender, a tendency to blame society, rather than the male, in a date rape vignette, more accepting attitudes toward forcible date rape, having used threat or force to have sex and greater sexual experience, including same gender sexual experience, identified 71% of students admitting to having lied or made false promises to have sex. Only two variables (blaming society or the situation, rather than the male, in a date rape vignette and some likelihood of rape, if sure of not being caught) identified 73% of forcible male sex offenders. Prior victimization did not relate to either type of sex offending. Thus, Groth's (1979) explanation of forcible sexual assault as an expression of internal developmental crisis (resulting from prior sexual abuse) was not supported.

Repeated Sexual Victimization and Trauma Change During the Acute Phase of the Sexual Assault Trauma Syndrome

Victimization studies indicate that the risk of sexual assault is significant for women in America today and that sizable numbers of women are sexually assaulted more than once during their lives. This study proposed and tested alternative hypotheses about repeated sexual victimization and trauma change during the acute phase of the sexual assault trauma syndrome. Panel interview data were collected during a two-year period on 184 female victims (14 years and older) admitted to a sexual assault treatment center for initial and follow-up services. Controlling for initial trauma level and time between assessments, prior assault victims were more traumatized than first assault victims at follow-up. Prior and first assault victims had different patterns in short-term trauma change, with only the first assault victims decreasing in trauma. Prior mental health or substance abuse problems partially explained the observed effect of prior sexual assault on trauma change. Prior sexual assault, however, continued to affect trauma significantly in the condition where the repeated assault victim also had prior mental health or substance abuse problems at the time of the current assault.

Effects of statutes requiring psychiatrists to report suspected sexual abuse of children

Reporting of child sexual abuse is mandatory in all 50 states. Conceptual distinctions between privileged communications and mandatory reporting are reviewed, and the impact of recent changes in Maryland's reporting laws is examined. Beginning in 1964 Maryland law required reporting if abuse was suspected when a physician examined a child. In 1988 reporting of disclosures by adult patients about child sexual abuse that occurred while they were in treatment was mandated. In 1989 all patient disclosures, even about such abuse that occurred before treatment, became reportable. During the period of statutory changes, the Johns Hopkins Sexual Disorders Clinic had kept track of adult patients who referred themselves for treatment and adult patients' disclosures of child sexual abuse. This allowed analysis of the impact produced by changes in the reporting requirements. 1) Mandatory reporting of disclosures about prior child sexual abuse deterred undetected adult abusers from entering treatment. The rate of self-referrals when such reporting became mandatory in 1989 dropped from approximately seven per year (73 over a 10-year period) to zero. This may have caused some unidentified children to remain at risk. 2) Mandatory reporting deterred patients' disclosures about child sexual abuse that occurred during treatment. In 1988 the disclosure rate during treatment dropped from approximately 21 per year to zero. This deprived clinicians of information important for early intervention. 3) Mandatory reporting failed to increase the number of abused children identified. The number identified secondary to such disclosures was zero. Optimal protection of children, as well as treatment for adult patients, may be better accomplished by legislation that supports options other than reporting.

The Role of Sexual Provocativeness, Rape History, and Observer Gender in Perceptions of Blame in Sexual Assault

To assess joint influence of sexual provocativeness and prior sexual assault on perceptions of rape victims, males and females read rape reports presented in a factorial design that completely crossed levels of these variables. Multivariate analysis of variance indicated main effects for the independent variables but no interactions. Observers attributed more blame to victims whose preassault behavior was more provocative and who had a prior rape history. Relative to males, females were generally more empathic toward victims. Observers' perceptions were discussed in terms of attributions of causal and moral responsibility for assault.

Relation of sexual abuse and bulimia in college women

This study investigated the relation between self-report of prior sexual abuse and self-report of current eating behaviors consistent with bulimia. The subjects were 340 college women who completed the Bulimia Test and a modified version of Finkelhor's Life Events Questionnaire, which inquires about experiences of sexual abuse. Bulimic women did not report a higher incidence of past intrafamilial sexual abuse than did the comparison group. However, bulimic women did report both significantly more experiences of extrafamilial sexual abuse after age 12 and that they had narrowly missed being sexually assaulted more often than did the comparison group of women. The findings provide limited support for the clinical belief that sexual abuse is associated with bulimia. It may be that perception of control is a mediator for the possible sexual abuse-bulimia relation.

Health risk behaviors and attempted suicide in adolescents who report prior maltreatment

We hypothesized that high school students who experienced prior maltreatment would be more likely than their peers to report health risk behaviors and suicide attempts. Before the establishment of a high school-based clinic, an anonymous needs assessment survey was completed by 600 adolescents (grades 9 to 12). Sociodemographic information was obtained and questions were asked about physical and sexual abuse, health-related behaviors and habits, and suicide attempts. Thirteen percent of the adolescents had been maltreated: 5.2% reported prior physical abuse, 5.4% sexual abuse, and 2.7% both physical and sexual abuse. Multivariate statistical techniques were used to clarify how previous abuse was related to adolescent risk-taking behaviors and suicide. Students with a history of physical abuse were three times more likely than non-abused peers to drink alcohol and smoke cigarettes, almost twice as likely to use illicit drugs, six times more likely to self-induce vomiting, and five times more likely to attempt suicide. A student with a history of prior sexual abuse had a three and one-half times greater chance of being sexually active and was more than three times more likely to attempt suicide. These data on a nonclinical, nondeviant population of adolescents indicate that physical or sexual abuse in childhood may have a significant impact on adolescent health risk behaviors and suicide attempts.

Prior physical and sexual abuse in women with chronic headache: clinical correlates.

SYNOPSISPhysical and/or sexual abuse in women with chronic headache has never been addressed. This pilot study addressed differences in women with chronic headache who reported such a history, compared to a control group of women with chronic headache without a traumatic history. Thirty women were divided into two groups, based on self‐report of abuse, and all women given an MMPI as part of their assessment. Sixty‐six percent of women reported significant traumatic histories, with a mean of 8 years of abuse; headache pain developed after trauma in 100% of these cases. Abused women had shorter chronicity of headache but reported greater psycho‐social distress and significantly more headaches. Results lend support to a model of life stress etiologically involved in the development of headache. Variables related to personality prior to headache development may be more important than the chronicity determinant. Assessment and identification of abuse early in the cycle may prevent long‐term adjustment problems.

Sexual Assault and Harassment: A Campus Community Case Study

EDITORS' NOTE: Howz serious and widespread a problem is sexual harassment in our universities? What means will effectively diminish its incidence without violating the rights of individuals? Each of thefollowing essays answers one of these two questions. In the first, Bernice Lott, Mary Ellen Reilly, and Dale Howard describe the results of a 1979 survey that examined a sample of the entire University of Rhode Island population. Its purpose was to determine how many of the respondents in the sample group had personal knowledge of or had experienced any form of sexual assault, intimidation, or insult; how they had responded to assault; and their beliefs about harassment in general. In the second essay, Judith Berman Brandenburg delineates a response to the problem worked out at Yale University: the establishment of a grievance procedure administered through a specially selected board. The process of this honest search for answers uncovers other questions: Do we have a definition of sexual harassment upon which most people will agree? Is power thefactor that transforms what may be cajolery into harassment? If so, power in what forms? Do these forms make the problem invulnerable to any solution? With these essays we open a dialogue on such questions. We invite your letters in response, in the hope that through the exchange we canfurther advance feminist efforts to analyze-and to overcome-this pernicious form of sexual injustice.

Prior incest in mothers of abused children

Previous studies have shown that most abusing parents have a history of physical abuse or neglect in their own childhoods. There is little data on the frequency of prior sexual abuse among parents who physically or sexually abuse their children. Many case reports describe the uncovering of a prior incest experience in a parent during the investigation of the child's current incest accusation, but it is unclear how frequently this occurs. One hundred mothers of abused children were asked about sexual incidents that occurred before age 18; the control group consisted of 500 normal women from the same community who were surveyed during meetings of various voluntary organizations. Age and ethnicity did not differ in the two groups. Of the mothers of abused children, 24% reported a prior incest experience, whereas only 3% of the control women reported prior incest. This eightfold difference was highly significant. The 34 mothers from families where sexual abuse was occurring were no more likely to report prior incest than were the 66 mothers from families where physical abuse occurred. The one case of genital mutilation of a child occurred in a family where both parents had been incest victims. Case studies indicate that the parent who has been an incest victim has inhibitions and fears about tenderness, traceable to the childhood incest experience, which are important in the development of either physical abuse or sexual abuse in the family.