Severe Sexual Abuse Research Articles

Perceptions of caregivers and adolescents of the use of telemedicine for the child sexual abuse examination.

Childhood sexual abuse is a common cause of morbidity and mortality. All victims should receive a timely comprehensive medical exam. Currently there is a critical shortage of child abuse pediatricians who can complete the comprehensive child sexual abuse examination. Telemedicine has emerged as an innovative way to provide subspecialty care to this population. Despite the growing popularity of telemedicine, no literature exists describing patient and caregiver perceptions of telemedicine for this sensitive exam. To explore caregiver and adolescent perspectives of the use of telemedicine for the child sexual abuse examination and discover factors that drive satisfaction with the technology. Caregivers and adolescents who presented for a child sexual abuse medical evaluation at our county's child advocacy center. We completed semi structured interviews of 17 caregivers and 10 adolescents. Guided by the Technology Acceptance Model interviews assessed perceptions about: general feelings with the exam, prior use of technology, feelings about telemedicine, and role of the medical team. Interviews were audio-recorded, transcribed, coded and analyzed using content analysis with constant comparative coding. Recruitment ended when thematic saturation was reached. There was an overwhelming positive response to telemedicine. Participants reported having a good experience with telemedicine regardless of severity of sexual abuse or prior experience with technology. Behaviors that helped patients and caregivers feel comfortable included a clear explanation from the medical team and professionalism demonstrated by those using the telemedicine system. Telemedicine was widely accepted by adolescents and caregivers when used for the child sexual abuse examination.

Avoidant Coping as a Moderator of the Association Between Childhood Abuse Types and HIV/Sexual Risk Behaviors.

Women who experience intimate partner violence (IPV) report high rates of HIV/sexual risk behaviors. Childhood abuse has been linked to HIV/sexual risk behaviors among IPV-victimized women; however, limited research has examined factors that may influence this association. The current study tested the moderating role of avoidant coping in the relation between childhood abuse types (physical, emotional, and sexual) and HIV/sexual risk behaviors. Participants were 212 community women currently experiencing IPV (mean age = 36.63 years, 67.0% African American). Higher levels of avoidant coping were related to more severe childhood abuse types. Severity of childhood abuse types was associated with greater HIV/sexual risk behaviors. Avoidant coping moderated the relation between childhood sexual abuse severity and HIV/sexual risk behaviors, such that this association was significant for IPV-victimized women with high (but not low) levels of avoidant coping. Findings suggest the utility of targeting avoidant coping in interventions aimed at preventing or reducing HIV/sexual risk behaviors among IPV-victimized women with a history of childhood sexual abuse.

Reducing Heavy Episodic Drinking, Incapacitation, and Alcohol-Induced Blackouts: Secondary Outcomes of a Web-Based Combined Alcohol Use and Sexual Assault Risk Reduction Intervention.

Heavy episodic drinking, alcohol-induced blackouts, and incapacitation are associated with sexual assault among college women. Therefore, reducing heavy episodic drinking, alcohol-induced blackouts, and incapacitation among college women may reduce sexual assault victimization risk. The current study examined the indirect effect of a combined alcohol use and sexual assault risk reduction program on sexual assault severity through heavy episodic drinking, alcohol-induced blackouts, and incapacitation ( n = 264). An alcohol use reduction program, sexual assault risk reduction program, and combined alcohol use and sexual assault risk reduction program were compared with a control condition. The sexual assault risk reduction content reduced alcohol-induced blackouts and incapacitation, and the combined alcohol use and sexual assault risk reduction program reduced alcohol-induced blackouts. Only incapacitation was associated with reduced sexual assault severity at follow-up. Reducing incapacitation and alcohol-induced blackouts is possible with a brief, web-based intervention, and reducing incapacitation may be one viable strategy within larger sexual assault prevention programming efforts.

Early life abuse and risk of endometriosis.

Is there an association between physical and sexual abuse occurring in childhood or adolescence and risk of laparoscopically-confirmed endometriosis? Early life sexual and physical abuse was associated with an increased risk of endometriosis. Previous studies have reported that physical and sexual abuse are associated with chronic pelvic pain (CPP). However, only one study has examined the association between childhood physical abuse and laparoscopically-confirmed endometriosis, and did not observe an association with endometriosis risk. Prospective cohort study using data collected from 60 595 premenopausal women from 1989 to 2013 as part of the Nurses' Health Study II cohort. Participants completed an exposure to violence victimization questionnaire in 2001. Cases were restricted to laparoscopically-confirmed endometriosis. Cox proportional hazards models were used to calculate rate ratios (RR) and 95% confidence intervals (CI). Three thousand three hundred and ninety-four cases of laparoscopically-confirmed endometriosis were diagnosed during 24 years of follow-up. Compared to those reporting no physical or sexual abuse, the risk of endometriosis was greater among those who experienced severe physical abuse (RR = 1.20; 95% CI = 1.06, 1.37) or severe sexual abuse (RR = 1.49; 95% CI = 1.24, 1.79). There was a 79% increased risk of laparoscopically-confirmed endometriosis for women reporting severe-chronic abuse of multiple types (95% CI = 1.44, 2.22). The associations between abuse and endometriosis were stronger among women presenting without infertility, a group that was more likely to have been symptomatic with respect to pain. The violence exposure was recalled by the study participants and thus is subject to misclassification as well as recall bias for the cases who were diagnosed prior to 2001. However, our results were similar in a sensitivity analysis including only endometriosis cases incident after their violence history report. In addition, residual or unmeasured confounding is a possibility; however, we were able to adjust for a variety of potential early life confounders. Finally, selection bias is also a possibility if those who chose to return the violence questionnaire did so based jointly on abuse history and endometriosis risk. Early life sexual and physical abuse was associated with an increased risk of endometriosis. Severity, chronicity and accumulation of types of abuse were associated with greater risk. Understanding the mechanisms underlying these relations may better define the biologic impacts of abuse and the related pathophysiology of endometriosis. This work was supported by National Institute of Child Health and Human Development [Grant numbers HD48544, HD52473, HD57210 and CA50385] and the Atlanta Clinical and Translational Science Institute [Grant number ULRR025008]. The Nurses' Health Study II is supported by the National Institutes of Health grant UM1 CA176726 from the National Cancer Institute. H.R.H. is supported by the National Cancer Institute, National Institutes of Health [Grant number K22 CA193860]. Authors report no conflict of interest.

Index de contenu traumatique au Rorschach (TCI) et diagnostic de l’abus sexuel chez l’enfant

ObjectivesThe article has two aims. The first objective is to present to French clinicians working in forensic field a translation of an index built and validated using Rorschach Inkblot method by Armstrong and Loewenstein (1990), called Trauma Content Index (TCI). TCI was codified inside the Comprehensive System and integrated in recent R-PAS. The Rorschach indicators that constitute TCI, namely responses related to blood, anatomy, sex, aggressive movement and morbid content can be easily translated in French Parisian School system. For us, these indicators are highly relevant because they refer, according to our conception, to the attack of the image of the body and the representation of self which are the first indicators to be degraded in case of sexual abuse. The second objective is to study if American validated TCI cutoff to identify sexual abuse has the same usefulness when applied to a cohort of French children suspected of sexual abuse than in American sample and using Parisian School Rorschach codifying system. MethodsWe compared TCI of 50 children aged from 5 to 12 evaluated with Rorschach Inkblot A methodology in double-blinded-scoring where the two experts were both convinced of probability child sexual abuse diagnosis. We have obtained a high fidelity score of interrater agreement (0.92). These data were compared to TCI index of 50 children matched control group with samples stratified according to socio-economic level of parents as well as age. Chi square method was used to compare the two groups. ResultsA TCI cutoff of 0.25 allows us to differentiate statistically the two groups (Chi2: 19.01; P<0.001). Such a cutoff enables us to identify 72 % of the clinical group and only 6 % of the control group as false positives, showing the interest of TCI index applied to children suspected of sexual abuse. We agree with point of view issued from Kamphuis-Kugeares and Finn research (2000) upon adults in their own samples (n=100). That study compared Rorschach records of non-dissociative outpatients with histories of (a) definite sexual abuse, (b) suspected but unconfirmed sexual abuse or (c) non-sexual abuse. They conclude that, although TCI was strongly associated with the presence and severity of sexual abuse, the TCI is one factor among many that can be used to assess the validity of clients’ claims of past sexual abuse. French and South America studies on children with projective tests (Condamin 2006, Mazoyer-Roques, 2014, Scortegagna and de Villemor-Amoral 2012) are more qualitative oriented than Anglo–Saxons researches (Leifer et al., 1991, Kikuchi et al., 2010), but they end up at the same conclusion. That is the reason why we compared our two groups with as second projective tool: the ant's tales test (Royer 1978, de Tychey 2010) used to study child's body image whose usefulness was recently suggested to identify child sexual abuse (Kabuth et al., 2017). Joined use of TCI and indicators issued from that tool allow us to identify 94 % (instead of 72 % with TCI single use) of our clinical group. ConclusionTCI and projective tools are useful in forensic field to undertake child sexual abuse diagnosis. It would be important for future research to make comparative studies to approach TCI cutoff scores derived from subjects confronted to various post-traumatic situations and their psychiatric disorders forms. So it would perhaps possible to highlight specific cutoff values to child sexual abuse diagnosis.

T104. ASSESSING THE UTILITY OF COPULA FUNCTIONS FOR RISK PREDICTION OF PSYCHOSIS

BackgroundStudies which have attempted to assess the predictive potential of socio-environmental risk factors for psychosis have used such a variety of datasets and methodologies. As a result, it is not possible for policy-makers to understand how different models compare, or might inform evidence-based policy-making. Thus, the cumulative predictive potential of non-genetic risk factors for psychosis has not yet been studied systematically. An important question which has not been considered previously is whether correlation structure between multivariate risks can be detrimental to the goal of prediction, particularly across different populations. Model fitting to locally-relevant correlation structures can limit the generalizability of a prediction model. Copulas are mathematical functions which allow the joint risk function of two or more correlated variables to be modelled in spite of this inherent bias. The copula approach is a foundation methodology with applications in the fields of finance, insurance and banking, where it is used for risk-management purposes. This study examines the impact of copulas on the stability of prediction power for psychosis across different populations.MethodsThe data used in this work comes from work package 2 (WP2) (entitled “Functional Enviromics”) of The European Union (EU)-funded European Network Study of Gene-Environment Interactions (EUGEI). The total dataset available consists of 1180 cases of first episode psychosis (ICD10 diagnostic criteria F20-F29 or F30-F33) and 1528 healthy controls recruited by 16 centres across 6 countries (United Kingdom, Holland, Spain, France, Italy, Brazil). We sought to compare the predictive performance of copulas against that of summary risk scores for formulating disease risk for a common set of socio-environmental risk factors. The copula methodology allows joint risks to be modelled as a distribution whilst summary scores convey the number of risk factors encountered by an individual, weighted by literature-derived odds ratios for association. Gaussian copula with non-Gaussian marginal distributions were used to capture the correlation structure of 9 discrete variables in total. These incorporated: Lifetime Cannabis Use, frequency of Cannabis Use, Household discord, severity of psychological abuse, severity of physical abuse, severity of sexual abuse, severity of bullying, number of adverse adult life events and intrusive adult life events. We applied a fully Bayesian approach which uses Markov Chain Monte Carlo to simulate latent variables from multivariate ordered probit model and also estimate the threshold parameters and parameters from copula model. The resulting joint distribution (a copula) mapped the relationship between cumulative exposure to these factors and risk of psychosis.ResultsA proportion of subjects were withheld from the copula, so that the performance of the finished function could be evaluated on unseen data. The performance of the 2 prediction methods was compared within and between recruitment centres and are conveyed in terms of:• Sensitivity and false positive rates (The area under the Receiver Operating Characteristic curve)• Percentage of variance explained (Nagelkerke R2)• Calibration (whether predicted risks were correct)• Discrimination (whether high risk subjects could be distinguished from low risk ones)• Reclassification (model behaviour close to specific thresholds)DiscussionThe application of the copula methodology to the multi-centre EUGEI dataset provides us with the opportunity to tackle a major limitation of the summary scoring approach which is the default method for aggregating risks across most areas of health research.

Dissociation fully mediates the relationship between childhood sexual and emotional abuse and DSM-5 PTSD in a sample of treatment-seeking adults

IntroductionChild abuse and neglect are associated with increased risk of adult PTSD and dissociation. Recent research suggests that dissociation mediates the relationship between child maltreatment and PTSD, however, there is a lack of clarity regarding the mediating role of dissociation for different types of child abuse. ObjectiveThe aim of the current study was to investigate dissociation as a mediator between 5 typologies of child maltreatment and posttraumatic stress severity. MethodIn a sample of highly symptomatic, treatment-seeking females (n=99), structural equation modelling was used to test 3 different models of mediation: direct effect, indirect effect, and direct and indirect effect. ResultsThe 5 typologies of child maltreatment were significantly related to dissociation and posttraumatic stress. Dissociation mediated the effect of childhood sexual abuse and childhood emotional abuse on posttraumatic stress severity. The indirect effect model fit the data best. ConclusionDissociation fully mediated the relationship between childhood sexual and emotional abuse and posttraumatic stress severity. The results are limited by the use of retrospective self-report measures and a small sample size.

Familial Sex Trafficking of Minors: Trafficking Conditions, Clinical Presentation, and System Involvement

It is well documented in the literature that child sex trafficking can be perpetrated by family members, though limited research has focused on describing this type of sexual exploitation. This pilot study addresses this gap by providing an analysis of familial sex trafficking considering trafficking dynamics, and rurality. Using a sample of 31 child welfare-involved children referred for behavioral health assessment and treatment, this mixed methods study explores: (1) victim and trafficker characteristics, the trafficking situation, law enforcement classifications of trafficking, clinical profiles of victims, and system involvement of children and youth involved in familial sex trafficking; (2) gender differences in clinical outcomes in sex-trafficked children; and (3) geographical differences in severity of the victimization experience. Major findings document high rates of family members trafficking children for illicit drugs; high severity of abuse as measured with the Sexual Abuse Severity Score, with higher severity of abuse for children living in rural communities; clinical threshold level scores on the Child Behavior Checklist (CBCL), and the Trauma Symptom Checklist for Children (TSCC-A). Boys and girls had similar clinical profiles except boys had higher CBCL externalizing scores, and females had higher TSCC depression scores. Additionally, more than half of the children in this sample had attempted suicide in their lifetime. This formative study sheds light on the phenomenon of familial sex trafficking, thereby creating the context for further investigations. Implications for identification and effective responses to familial sex trafficking, with specific attention to gender and geography are discussed.

Population attributable risk of factors associated with the repetition of self-harm behaviour in young people presenting to clinical services: a systematic review and meta-analysis.

The repetition of hospital-treated self-harm by young people is common. However, little work has summarised the modifiable factors associated with this. A thorough understanding of those factors most strongly associated with repetition could guide the development of relevant clinical interventions. We systematically reviewed four databases (EMBASE, Medline, PubMed and PsycINFO) until 15 April 2016 to identify all observational studies of factors for the repetition of self-harm or suicide reattempts (together referred to as 'self-harm behaviour') in young people. We quantified the magnitude of association with odds ratios (OR) and 95% confidence intervals (CIs) and calculated the population attributable risk (PAR) and population preventable fraction (PPF) for modifiable factors to provide an indication of the potential impact in reducing subsequent self-harm behaviour in this population. Seventeen studies were included comprising 10,726 participants. Borderline personality disorder (OR 3.47, 95% CI 1.84-6.53; PAR 42.4%), any personality disorder (OR 2.54, 95% CI 1.71-3.78; PAR 16.3%), and any mood disorder (OR 2.16, 95% CI 1.09-4.29; PAR 42.2%) are important modifiable risk factors. Severity of hopelessness (OR 2.95, 95% CI 1.74-5.01), suicidal ideation (OR 2.01, 95% CI 1.43-2.81), and previous sexual abuse (OR 1.52, 95% CI 1.02-2.28; PAR 12.8%) are also associated with repetition of self-harm. We recommend that clinical services should focus on identifying key modifiable risk factors at the individual patient level, whilst the reduction of exposure to child and adolescent sexual abuse would also be a useful goal for public health interventions.

Intimate partner violence: Factors and types of abuse women face in and around Coimbatore District, Tamilnadu

Intimate partner violence has become an important global public health problem. It is the most common form of violence against women in all over the world and is prevalent both urban and rural areas. Intimate partner violence is also termed as domestic violence. Women end up suffering severe physical, emotional and sexual abuse by their partner. Women suffer silently due to the fear of retaliation, lack of economic support, lack of support from family and friends and majorly due to the concern of their children. The risk factors of IPV operates at 4 levels, individual, relationship, community and societal. This study aims in understanding the risk factors influencing IPV and other types of abuse women undergo due to violence in and around the district of Coimbatore. We surveyed around 200 women out of which 78 women voluntarily agreed to participate in the one to one interview where a structured questionnaire was prepared to interview the women. The questionnaire consisted of questions to identify the socio economic and demographic status and causes of intimate partner violence. This study aims to find out and understand the effects of IPV the women face in our society and cohere it with social norms and values. The findings indicate that women suffer long term mental and physical health problems caused by intimate partner violence. If a woman has faced severe abuse it ends up having mental and physical impact over the women over a longer period of time.

Responding to safety concerns and chronic needs: trends over time

BackgroundFor the past 20 years, the Ontario child welfare sector has made significant legislative and policy changes. Changes to legislation and policy can impact the public and sector’s response to child maltreatment and inform identified trends. Using an investigative taxonomy of urgent protection and chronic need this paper examines the shift in the nature of investigated maltreatment over time.MethodsData from five cycles of the Ontario Incidence Studies of Reported Child Abuse and Neglect (1993, 1998, 2003, 2008 and 2013) were used. Provincial incidence rates were calculated by dividing the weighted estimates by the child population 15 years of age and under and then multiplying by 1000 in order to produce an annual incidence rate per 1000 children. Investigations were divided into urgent (severe physical harm, sexual abuse, neglect and physical abuse of children under 4) and chronic (risk only, exposure to intimate partner violence, emotional maltreatment, neglect and physical abuse of children four or over). Tests of statistical significance were calculated to assess changes in subtypes between cycles.ResultsBetween 1993 and 2013, the rate of child maltreatment related investigations completed in Ontario has increased from 20.48 per 1000 children to 53.27 per 1000 children. Overall there has been a decline in the incidence of urgent investigations from 9.31 per 1000 child maltreatment investigations in 1993 to 5.94 per 1000 maltreatment investigations in 2013. There has been a fourfold increase in the incidence of chronic investigations from 11.18 per 1000 child maltreatment investigations in 1993 to 47.33 per 1000 maltreatment investigations in 2013.ConclusionThe nature of child protection work using the urgent-chronic taxonomy shows a dramatic shift in the types of concerns identified without a corresponding shift in the way families are assessed for need. The provision of a forensic investigation to all families does not distinguish between urgent safety concerns and needs that may require prolonged engagement. Effective service provision requires more precision in our response to these diverse concerns.

Associations of childhood maltreatment with pre-pregnancy obesity and maternal postpartum mental health: a cross-sectional study

Pre-pregnancy obesity and postpartum mental disorders are prevalent health risks to both the mother and the offspring. The objective of our study was to examine whether a history of childhood maltreatment is associated with pre-pregnancy obesity and postpartum mental health and whether childhood maltreatment and pre-pregnancy BMI independently predict postpartum mental health. We obtained self-reported data from 741 postpartum women before 16 weeks after delivery (M = 8.1 weeks, SD = 3.2). Childhood sexual, physical, and emotional abuse and physical and emotional neglect were assessed with the Childhood Trauma Questionnaire. Depression and anxiety were assessed using the BDI and SCL-90-R. We conducted logistic regression models adjusted for demographic covariates and co-occurrence of different types of maltreatment. 7.6% of the included women entered pregnancy with obesity. Forty-six percent reported any type of childhood maltreatment. 6.4% displayed at least moderate postnatal depressive symptomatology and 20.5% scored above the 75th percentile for postpartum anxiety. Severe physical abuse, moderate emotional abuse and severe physical and emotional neglect were associated with pre-pregnancy obesity. After controlling for the presence of all other types of childhood maltreatment, only severe physical abuse was still predictive for pre-pregnancy obesity (adj.OR = 5.24, 95% CI = 1.15-23.75). Pre-pregnancy obesity was associated with an increased risk of postpartum depression (adj.OR = 2.55, 95% CI = 1.08-6.00) but not with elevated anxiety. Pre-pregnancy obesity and severe childhood sexual abuse independently predicted postpartum depression. After controlling for histories of different types of childhood maltreatment, the association between pre-pregnancy obesity and postpartum depression attenuated to non-significance. To our knowledge, this is the first study examining empirical relations between childhood maltreatment, pre-pregnancy BMI and postpartum mental health controlling for the co-occurrence of other maltreatment types. Childhood maltreatment has been found being associated with both pre-pregnancy obesity and impaired postpartum mental health and may at least partly account for the association between pre-pregnancy obesity and postpartum depression. Therefore childhood maltreatment is related to two common risk conditions during pregnancy and postpartum which bear several health risks for the mother and the child, and routine screening for histories of childhood maltreatment among pregnant women is warranted.

Gender differences in pathways from physical and sexual abuse to early substance use

Early substance use (i.e., before age 14) is a known risk factor for substance use disorder, but scarce research has examined gender differences in pathways to early substance use. This study applies a developmental traumatology perspective to examine the relations between child physical and sexual abuse and early substance use among youths investigated by child protective services (CPS), a population with high risk for substance use disorder. Drawing from the first National Survey of Child and Adolescent Well-Being (NSCAW), a sample of 11–13year olds (n=467 girls, n=329 boys) was examined. Multiple group path analysis assessed gender differences in the relations between physical and sexual abuse severity and early substance use and indirect effects via internalizing problems, externalizing problems, and posttraumatic stress. Focal measures included the child-reported Parent-Child Conflict Tactics Scale (physical abuse severity), the Trauma Symptom Checklist for Children (posttraumatic stress), the Youth Self-Report (internalizing and externalizing problems), and the NSCAW's caseworker-alleged abuse (sexual abuse severity) and child substance abuse modules (any current alcohol, marijuana, hard drug, inhalant, or nonmedical prescription drug use). Significant indirect effects of physical abuse severity to early substance use were found through externalizing behavior problems in girls only (β=0.068; 95% CI=0.029, 0.130; p=0.004), with a significantly stronger relation between externalizing problems and early substance use in girls. Results suggest gender differences in the sequelae of trauma as they relate to early onset substance use and the need to integrate mental health and substance use services.

Child maltreatment in Germany: prevalence rates in the general population

BackgroundChild maltreatment and its consequences are considered a major public health problem. So far, there is only one study from Germany reporting prevalence rates on different types of maltreatment.MethodsA representative sample of the German general population was examined for experiences of child maltreatment using the Childhood Trauma Questionnaire (CTQ) between September and November 2016. A total of 2510 (53.3% female) participants between 14 and 94 years (M = 48.8 years) were enrolled. Besides the CTQ, a range of sociodemographic information was collected. The interrelatedness of different types of maltreatment was examined using configuration analysis and predictors for maltreatment were identified by performing binary logistic regression analyses.ResultsOverall, 2.6% (f: 3.9%, m: 1.2%) of all participants reported severe emotional abuse, 3.3% (f: 3.4%, m: 3.3%) severe physical abuse, 2.3% (f: 3.7%, m: 0.7%) severe sexual abuse, 7.1% (f: 8.1%, m: 5.9%) severe emotional neglect and 9% (f: 9.2%, m: 8.9%) severe physical neglect. Women were more likely to report at least moderate sexual and emotional abuse than men. The largest difference between age groups was reported for physical neglect, with participants aged over 70 years reporting the highest rates. Participants who reported childhood maltreatment were more likely to be unemployed or have lower educational outcomes. The most common combination of maltreatment types were physical and emotional neglect, all five types of maltreatment combined and physical and emotional neglect and physical abuse combined.ConclusionsChild maltreatment, especially physical neglect is common in the German population. Women seem to be at greater risk for sexual and emotional abuse than men. Knowledge about different types of maltreatment based on the Childhood Trauma Questionnaire (CTQ) can help to put findings of future studies into an epidemiological and societal context.

How is childhood emotional abuse related to major depression in adulthood? The role of personality and emotion acceptance

Accumulated evidence provides support that childhood emotional abuse (CEA) is related to adult major depressive disorder (MDD) outcomes. However, the psychological mechanisms of this relation are still not well understood. Changes in personality and emotion regulation are indicated to play a mediating role what should be examined in this paper. A sample of 123 MDD inpatients was examined in a prospective observational study with two times of measurement. Patients provided data on childhood trauma history, personality disorder (PD) traits and emotion acceptance. Self- and expert-ratings of depressive symptoms were assessed at baseline and at the end of treatment. Treatment duration as an objective indicator of treatment outcome was additionally considered. Partial correlation analyses revealed associations between CEA and self-ratings of MDD symptom severity and symptom improvement independent of sexual and physical abuse. Expert-ratings of depression and treatment duration were not related to CEA. Mediation analyses revealed that particularly the factors borderline psychopathology as well as acceptance of pleasant emotions mediated the association of CEA and self-rated MDD symptoms. Passive-aggressive PD traits mediated the link between CEA and a lower self-rated symptom improvement. CEA affect specific personality traits and acceptance of emotions. This association may play a critical role for self-reported depressive symptoms with implications for prevention, psychoeducation, and treatment of MDD.

Experiences of severe childhood maltreatment, depression, anxiety and alcohol abuse among adults in Finland.

Childhood maltreatment increases the risk of subsequent depression, anxiety and alcohol abuse, but the rate of resilient victims is unknown. Here, we investigated the rate of victims that do not suffer from clinical levels of these problems after severe maltreatment in a population-based sample of 10980 adult participants. Compared to men, women reported more severe emotional and sexual abuse, as well as more severe emotional neglect. For both genders, severe emotional abuse (OR = 3.80 [2.22, 6.52]); severe physical abuse (OR = 3.97 [1.72, 9.16]); severe emotional neglect (OR = 3.36 [1.73, 6.54]); and severe physical neglect (OR = 11.90 [2.66, 53.22]) were associated with depression and anxiety while only severe physical abuse (OR = 3.40 [1.28, 9.03]) was associated with alcohol abuse. Looking at men and women separately, severe emotional abuse (OR = 6.05 [1.62, 22.60] in men; OR = 3.74 [2.06, 6.81] in women) and severe physical abuse (OR = 6.05 [1.62, 22.60] in men; OR = 3.03 [0.99, 9.33] in women) were associated with clinical levels of depression and anxiety. In addition, in women, severe sexual abuse (OR = 2.40 [1.10, 5.21]), emotional neglect (OR = 4.78 [2.40, 9.56]), and severe physical neglect (OR = 9.86 [1.99, 48.93]) were associated with clinical levels of depression and anxiety. Severe emotional abuse in men (OR = 3.86 [0.96, 15.48]) and severe physical abuse in women (OR = 5.18 [1.48, 18.12]) were associated with alcohol abuse. Concerning resilience, the majority of severely maltreated participants did not report clinically significant levels of depression or anxiety (72%), or alcohol abuse (93%) in adulthood. Although the majority of severely abused or neglected individuals did not show clinical levels of depression, anxiety or alcohol use, severe childhood maltreatment increased the risk for showing clinical levels of psychopathology in adulthood.

Effects of sexual assault on alcohol use and consequences among young adult sexual minority women.

The purpose of this study was to examine effects of sexual assault victimization on later typical alcohol use and alcohol-related consequences among young sexual minority women (SMW). Data were collected over 4 annual assessments from a national sample of 1,057 women who identified as lesbian or bisexual and were 18- to 25-years-old at baseline. Marginal structural modeling, an analytic approach that accounts for time-varying confounding through the use of inverse probability weighting, was used to examine effects of sexual assault and its severity (none, moderate, severe) on typical weekly number of drinks consumed and number of alcohol-related consequences 1-year later as well as 2-year cumulative sexual assault severity on alcohol outcomes at 36-month follow-up. Findings showed that compared with not experiencing any sexual assault, severe sexual assault at the prior assessment was associated with a 71% higher number of typical weekly drinks (count ratio [CR] = 1.71; 95% confidence interval [CI] [1.27, 2.31]) and 63% higher number of alcohol-related consequences (CR = 1.63; 95% CI [1.21, 2.20]). Effects were attenuated when comparing moderate to no sexual assault; however, the linear trend across sexual assault categories was statistically significant for both outcomes. There were also effects of cumulative levels of sexual assault severity over 2 years on increased typical drinking and alcohol-related consequences at end of follow-up. Sexual assault may be an important cause of alcohol misuse among SMW. These findings further highlight the need for strategies to reduce the risk of sexual assault among SMW. (PsycINFO Database Record

Trauma-symptom profiles of adolescents in child welfare

In the province of Ontario (Canada), over 28,900 adolescents are investigated by child welfare agencies each year because of suspected maltreatment. Exposure to childhood maltreatment represents a major threat to the psychological well-being of young people, particularly in terms of trauma-related stress. The present study investigated trauma symptom profiles among 479 adolescents (13–17 years) involved with the Canadian child welfare system between 2003 and 2010. Latent profile analysis identified three profiles using self-report data from the Trauma Symptom Checklist for Children. Most adolescents (59%, n=281) were classified into the profile depicting minimal trauma-related symptoms, 30% (n=144) were characterized by moderate trauma-related symptoms, and 11% (n=54) were in the profile reflecting severe trauma-related symptoms. Several variables predicted profile membership. Greater severity of sexual abuse and female sex were associated with a greater likelihood of belonging to the severe trauma symptom profile than both the moderate and the minimal trauma symptom profiles. In addition, having society ward status (compared to crown ward) was related to an increased likelihood of belonging to both the severe and moderate symptom profiles relative to the minimal symptom profile. This study provides some insight into the typologies of trauma experienced among child-welfare-involved adolescents and the set of factors which relate to the specific profiles. Findings are important for informing psychological assessment practices, as well as tailored interventions, for adolescents in the child welfare system.

Childhood Sexual Abuse and Fear of Abandonment Moderate the Relation of Intimate Partner Violence to Severity of Dissociation

ABSTRACTBetrayal trauma theory proposes a relation between intimate partner violence (IPV) and dissociation, suggesting that dissociation among victims of IPV may function to restrict awareness of abuse in order to preserve attachments perceived as vital. We investigated two factors that may moderate the relation between IPV and dissociation—childhood sexual abuse (CSA) severity and fear of abandonment—among 348 women currently in a relationship. The relation between frequency of IPV (sexual and physical) and dissociation (amnesia and depersonalization) was moderated by CSA severity and fear of abandonment. Specifically, among women with clinically relevant fear of abandonment, the strength of the relation between IPV and dissociation became stronger as CSA severity increased. This study is the first to demonstrate the moderating roles of fear of abandonment and CSA history in the relation between IPV and dissociation among women. Findings suggest that it may be important to target fear of abandonment in interventions with IPV victims who have a CSA history. Results suggest that fear of abandonment warrants greater attention in research on IPV revictimization.

The neural correlates of childhood maltreatment and the ability to understand mental states of others

ABSTRACTBackground: Emotional abuse and emotional neglect are related to impaired interpersonal functioning. One underlying mechanism could be a developmental delay in mentalizing, the ability to understand other people’s thoughts and emotions.Objective: This study investigates the neural correlates of mentalizing and the specific relationship with emotional abuse and neglect whilst taking into account the level of sexual abuse, physical abuse and physical neglect.Method: The RMET was performed in an fMRI scanner by 46 adolescents (Age: M = 18.70, SD = 1.46) who reported a large range of emotional abuse and/or emotional neglect. CM was measured using a self-report questionnaire (CTQ).Results: Neither severity of emotional abuse nor neglect related to RMET accuracy or reaction time. The severity of sexual abuse was related to an increased activation of the left IFG during mentalization even when controlled for psychopathology and other important covariates. This increased activation was only found in a group reporting both sexual abuse and emotional maltreatment and not when reporting isolated emotional abuse or neglect or no maltreatment. Functional connectivity analysis showed that activation in the left IFG was associated with increased activation in the right insula and right STG, indicating that the IFG activation occurs in a network relevant for mentalizing.Conclusions: Being sexually abused in the context of emotional abuse and neglect is related to an increase in activation of the left IFG, which may indicate a delayed development of mirroring other people’s thoughts and emotions. Even though thoughts and emotions were correctly decoded from faces, the heightened activity of the left IFG could be an underlying mechanism for impaired interpersonal functioning when social situations are more complex or more related to maltreatment experiences.