Severe Sexual Abuse Research Articles

Co-morbid depression and sexual abuse during childhood as confounding factors in the analysis of glucocorticoid-receptor supersensitivity in patients with posttraumatic stress disorder

INTRODUCTION Evidence shows that posttraumatic stress disorder (PTSD) patients have low basal cortisol levels and glucocorticoid-receptor (GR) supersensitivity following a pharmacological challenge. These findings, however, are controversial, partially due to the presence of confounding factors, such as co-morbidity with major depressive disorder (MDD) and childhood trauma. In the present study, salivary cortisol levels of victims of violence with and without PTSD were assessed following a prednisolone suppression test (PST), controlling for the presence of MDD and sexual abuse during childhood. METHOD The sample was nested in an epidemiological study performed in Sao Paulo City. The subjects with a diagnosis of PTSD (PTSD+) and a matched control group (PTSD-) were submitted to SCID-I; after which Early Trauma Inventory (ETI), Clinician-Administered PTSD Scale (CAPS), Beck Depression (BDI) and Anxiety Inventory (BAI) and the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) were used. Saliva samples were collected before and after 1,5 mg of prednisolone, administered at 10 PM. Discussion These results confirm previous findings that PTSD patients have lower cortisol levels by showing a blunted response to exogenous GC), which is likely due to increased GR responsiveness. Separating the patients with PTSD alone from those with co-morbid MDD showed that hypocortisolism is specific to PTSD, and the presence of MDD counterbalances PTSD-related dysfunction to “normalize” the curve of patients with both diagnoses. The presence of sexual abuse during childhood correlated negatively with lower the salivary cortisol concentrations. Early sexual abuse, but not other types of trauma such as general, physical, and psychological traumas, was correlated with cortisol dysfunction. The presence of sexual abuse during childhood is a potent risk factor for developing an Axis I diagnosis during adulthood [1]. Some authors find a correlation between early abuse and lower cortisol concentrations after a psychosocial stressor test and pharmacological challenge, an effect that is independent of the presence of an Axis I diagnostics [2-3]. The question raised here is whether the presence of severe sexual abuse during childhood and HPA axis response to stress is an endophenotype. Another aspect to consider is whether subjects with a particular type of HPA axis response are at a greater risk for PTSD development after a severe adulthood stressor. PTSD related to increased GR supersensitivity should be investigated further. Research also should address whether the presence of different endophenotypes depends on the timing of the trauma (considering epigenetic phenomenon). Interestingly, we did not find differences between controls and PTSD patients. Despite the fact that 40% of our sample had PTSD+MDD, the presence of PTSD symptoms had a predominant effect on HPA axis by lowering cortisol concentrations, as demonstrated by our comparison of PTSD+ (either with or without MDD) with controls.

Avoiding Experiences: Sexual Dysfunction in Women with a History of Sexual Abuse in Childhood and Adolescence

Women with a history of sexual abuse during childhood/adolescence experience a high rate of sexual dysfunction. Evidence also suggests that they often use avoidant coping strategies, such as substance abuse, dissociation, and emotional suppression, which are likely factors implicated with their psychopathology. There is a dearth of information on potential psychological mechanisms affecting the sexuality of these women. Therefore, it is relevant to investigate whether avoidance, an important cognitive mechanism associated with anxiety disorders, relates to sexual functioning in this population. In this study, participants with (N = 34) and without (N = 22) a history of sexual abuse prior to age 16 years completed questionnaires on severity of sexual abuse, sexual functioning, and a tendency to avoid experiences. A three-step hierarchical regression investigated the effects of childhood/adolescent sexual abuse and avoidance tendencies on different aspects of sexual functioning. A significant interaction between childhood/adolescent sexual abuse and avoidance tendencies was found for orgasm function, with the combination of sexual abuse and avoidance tendencies explaining lower orgasm function. These findings suggest that, for women with a history of early sexual abuse, the tendency to avoid interpersonal closeness and avoid emotional involvement predicts orgasm functioning.

Childhood sexual abuse and substance abuse treatment utilization among substance-dependent incarcerated women

Incarcerated women have high rates of substance abuse problems and trauma. A variety of variables may influence whether these women seek help or are referred for substance abuse problems. This study reports an exploratory project on service utilization among incarcerated substance-dependent women ( N = 40) in southeastern Idaho. Using self-report and interview tools, most participants reported some substance abuse treatment history, although extent and types of treatment varied. Most of the women also reported some type of childhood abuse. Age, income, and consequences of alcohol and other drug use related positively to substance abuse treatment. However, severity of childhood sexual abuse and current trauma symptoms were negatively correlated with substance abuse treatment episodes. These women may use substances to cope with childhood trauma or may not perceive the substance abuse system as responsive to their co-occurring trauma symptoms.

Early Marriage, Rape, Child Prostitution, and Related Factors Determining the Psychosocial Effects Severity of Child Sexual Abuse in Ethiopia

This study was aimed at identifying factors that determine the psychosocial effects severity of child sexual abuse. Data were collected from 318 female children in Ethiopia using the Children's Impact of Traumatic Events Scale–Revised and the Rosenberg Self-Esteem Scale. The results revealed that respondents who survived rape and child prostitution were more symptomatic than those who were married early. Respondents for whom less time had elapsed since their first experience of abuse demonstrated a significantly higher level of post-traumatic stress disorder symptoms, negative reactions by others, self-blame, and guilt than those for whom more time had elapsed since such an experience. The respondents in an intact marital relationship were found to be less symptomatic than their never married and divorced counterparts. Implications for intervention and further investigations are discussed.

Maltreatment in childhood and adolescence: results from a survey of a representative sample of the German population.

There are no up-to-date, representative studies on the frequency of maltreatment (abuse or neglect) among children and adolescents in Germany. In a cross-sectional study, standardized questionnaires were administered to persons aged 14 and older in a representative sample of the German population. Statistics on maltreatment in childhood and adolescence were collected with the German version of the Childhood Trauma Questionnaire. Regression analysis was used to detect potential associations of maltreatment with demographic variables including sex, age, place of birth, and social class. 2504 of the 4455 persons contacted (56%) completed the study. Severe emotional abuse in childhood and/or adolescence was reported by 1.6% of persons in the overall sample, severe physical abuse by 2.8%, and severe sexual abuse by 1.9%. Severe emotional neglect was reported by 6.6% and severe physical neglect by 10.8%. Female sex was a predictor for severe sexual abuse, while belonging to a low or middle social stratum was a predictor for severe physical abuse and neglect. Being older at the time of the survey was a predictor for severe physical neglect. All types of maltreatment were significantly correlated with each other (p<0.001). The frequencies of various types of abuse and neglect of children and adolescents that were retrospectively determined in this up-to-date study by questionnaire of a representative sample of the German population, and the correlations between them, correspond to those found in a German population-based study in 1995 and in recent American studies.

Psychosocial factors influencing competency of children's statements on sexual trauma

Objectives The objectives of this study are to assess children's competence to state their traumatic experience and to determine psychosocial factors influencing the competency of children's statements, such as emotional factors of children and parents and trauma-related variables, in Korean child sex abuse victims. Methods We enrolled 214 children, who visited “Sunflower Children's Center” for sexual abuse. The children were aged 8–13 years. The children's parent were surveyed using questionnaires [Beck Depression Inventory (BDI), State-Trait Anxiety Inventory(STAI)] to obtain demographic information, traumatic event profiles and self-report scale. Children completed psychological measures as follows: Children's Depression Inventory (CDI), Revised Children's Manifest Anxiety Scale (RCMAS), Traumatic Symptom Checklist for Children (TSCC). The modified-Criteria-Based Content Analysis (CBCA) was used to assess children's statements. ANOVA, independent t-test, Pearson correlation were used. All statistics were demonstrated using SPSS 12.0. Results Modified-CBCA scores did not differ according to children's level of depression and anxiety. Children with parents who showed supportive reactions, scored significantly higher on the modified-CBCA scores than those with unsupportive parents. Children with severely depressed parents had lower modified-CBCA scores than those with less depressed parents. Modified-CBCA scores were significantly higher in participants who experienced a single traumatic event than those who had multiple events. However, the severity of sexual abuse, relationship with the perpetrator, types of disclosure, and duration of initial disclosure did not show significant differences in capability of statement. Conclusion In conclusion, the competence of statements in Korean sexually child sex abuse victims is related to parental emotional states and support rather than children's factors such as psychopathology or age, and appears to be more reliable with a single traumatic experience. Therefore, promoting parental support through psychoeducation is one of the most important things to be done to help children overcome psychologic trauma but also enhance the accuracy of their statement.

Genetic moderators and psychiatric mediators of the link between sexual abuse and alcohol dependence

Background/objective This study used a case–control female sample to test psychiatric mediators and genetic moderators of the effect of sexual abuse on later alcohol dependence. The study also tested differences between alcohol dependent women with or without a history of sexual abuse on variables that might affect treatment planning. Methods A case–control design compared 192 treatment-seeking alcohol dependent women with 177 healthy population controls. All participants were assessed for alcohol-related behaviors, sexual abuse history, psychiatric problems, and personality functioning. Markers were genotyped in the CRHR1, MAO-A and OPRM1 genes. Results The association of sexual abuse with alcohol dependence was limited to the most severe category of sexual abuse involving anal or vaginal penetration. Of the five psychiatric disorders tested, anxiety, anorexia nervosa, and bulimia met criteria as potential mediators of the abuse-alcohol dependence association. Severe sexual abuse continued to have an independent effect on alcohol dependence status even after accounting for these potential mediators. None of the candidate genetic markers moderated the association between sexual abuse and alcohol dependence. Of alcohol dependent participants, those with a history of severe abuse rated higher on alcoholism severity, and psychiatric comorbidities. Conclusion Sexual abuse is associated with later alcohol problems directly as well as through its effect on psychiatric problems. Treatment-seeking alcohol dependent women with a history of abuse have distinct features as compared to other alcohol dependent women.

Profiles of adult survivors of severe sexual, physical and emotional institutional abuse in Ireland

AbstractAdult survivors of institutional abuse were interviewed with a comprehensive assessment protocol which included the Childhood Trauma Questionnaire, the Institutional Child Abuse Processes and Coping Inventory, the Structured Clinical Interviews for Disorders of the Diagnostic and Statistical Manual of Mental Disorders IV axis I disorders and personality disorders, the Trauma Symptoms Inventory, a Life Problems Checklist, the Experiences in Close Relationships Inventory and the Kansas Marital Satisfaction Scale. Profiles were identified for subgroups that described severe sexual (N = 60), physical (N = 102), or emotional (N = 85) abuse as their worst forms of maltreatment. Survivors of severe sexual abuse had the most abnormal profile, which was characterised by higher rates of all forms of child maltreatment and higher rates of post‐traumatic stress disorder, alcohol and substance abuse, antisocial personality disorder, trauma symptoms and life problems. Survivors of severe emotional abuse were better adjusted than the other two groups. The profile of survivors of severe physical abuse occupied an intermediate position between the other two groups. A thorough assessment of abuse history and current functioning should be conducted when providing services to adult survivors of institutional abuse, since this may have important implications for the intensity of services required. Survivors of severe sexual abuse may require more intensive services. Copyright © 2009 John Wiley &amp; Sons, Ltd.

Gender differences in internalizing problems among sexually abused early adolescents

Objective The purpose of this study was twofold. First, we determined whether sexually abused adolescent boys or girls were more likely to have internalizing behavior scores in the clinical range. Second, after determining boys were more likely than girls to have an internalizing behavior problem, we tested whether this relationship would persist after several other variables were accounted for: characteristics of the sexual abuse, exposure to domestic violence, self-efficacy, and their peer and caregiver relationships. Methods A national probability sample of children investigated by child protective services for child maltreatment was used. The sample consisted of 127 girls and 31 boys, ages 11–14. Results Sexually abused boys were more likely than girls to have an internalizing behavior problem in the clinical range even after controlling for several variables. Exposure to domestic violence, more severe sexual abuse, sexual abuse by a non-relative, and the amount of autonomy support provided by caregivers also increased the likelihood internalizing problem. Conclusions During early adolescence, sexually abused boys may be more likely than sexually abused girls to have a clinically significant internalizing behavior problem. Researchers need to continue to investigate whether sexually abused boys are as likely as girls or more likely than girls to have an internalizing behavior problem in later adolescence. Practice implications Internalizing symptoms warrant careful screening and assessment with sexually abused boys and girls who experience more intrusive sexual abuse, who are sexually abused by a non-relative, who are exposed to domestic violence, and who receive lower autonomy support from their caregivers.

Variability and predictors of negative mood intensity in patients with borderline personality disorder and recurrent suicidal behavior: Multilevel analyses applied to experience sampling methodology.

Variability in mood swings is a characteristic of borderline personality disorder (BPD) and is associated with suicidal behavior. This study investigated patterns of mood variability and whether such patterns could be predicted from demographic and suicide-related psychological risk factors. Eighty-two adults with BPD and histories of recurrent suicidal behavior were recruited from 3 outpatient psychiatric programs in Canada. Experience sampling methodology (ESM) was used to assess negative mood intensity ratings on a visual analogue scale, 6 random times daily, for 21 days. Three-level models estimated variability between times (52.8%), days (22.2%), and patients (25.1%) and supported a quadratic pattern of daily mood variability. Depression scores predicted variability between patients' initial rating of the day. Average daily mood patterns depended on levels of hopelessness, suicide ideation, and sexual abuse history. Patients reporting moderate to severe sexual abuse and elevated suicide ideation were characterized by worsening moods from early morning up through evening, with little or no relief; patients reporting mild sexual abuse and low suicide ideation reported improved mood throughout the day. These patterns, if replicated in larger ESM studies, may potentially assist the clinician in determining which patients require close monitoring.

Childhood Sexual Abuse Severity and Disclosure Predict Posttraumatic Stress Symptoms and Biomarkers in Ethnic Minority Women

Objective: Adult posttraumatic stress symptoms and a biomarker index of current health risk in childhood sexual abuse (CSA) survivors were investigated in relation to CSA severity, disclosure, and other peri- and post-trauma factors. Method: A community sample of 94 African American and Latina female CSA survivors was assessed. Results: Severe CSA predicted posttraumatic stress symptoms overall, avoidance/numbing symptoms, and greater biomarker risk and was not mediated by post-trauma variables. Moderate CSA severity was mediated by post-trauma disclosure, predicted reexperiencing symptoms, but was unrelated to biomarker risk. No overall ethnic differences were found. Conclusion: Results suggest targets for interventions to improve the well-being of minority women CSA survivors

High‐risk behaviors and drinking‐to‐cope as mediators of lifetime abuse and PTSD symptoms in clients with severe mental illness

Face-to-face interviews with 276 community mental health clients (56.2% women; 42.8% men) diagnosed with schizophrenia spectrum disorders (44.6%) and major mood disorders (55.4%) were used to examine mediating relationships among physical and sexual abuse, high-risk behaviors, drink-to-cope motives, and posttraumatic stress disorder (PTSD) symptom severity. Structural equation modeling revealed that both high-risk behaviors and drinking-to-cope significantly mediated the relationship between lifetime abuse and PTSD symptom severity with an excellent fit of model to data. Alternative models using PTSD symptom level as mediator were also tested, but did not meet optimal goodness-of-fit standards. Implications of findings call for vigilant screening for trauma, substance abuse, and high risk behaviors in clients with severe mental illnesses to inform treatment, and the need for longitudinal studies to test causal pathways.

History of Childhood Abuse Is Accompanied by Increased Dissociation in Young Mothers Five Months Postnatally

Background: Dissociation has been recognized as a relevant factor within the context of traumatization. Since childhood maltreatment as well as child birth can be regarded as a potential trauma, this study examined dissociation in a sample of 58 young mothers with a history of abuse in comparison to a control group. Methods: All women with newborn children were contacted by mail and presented with the Childhood Trauma Questionnaire. Women who reached a cutoff for moderate or severe sexual and/or physical abuse and whose children were term babies with Apgar scores >7 were included in the study to form the index group (n = 58); the control group was formed by matching mothers with no reported experiences of physical and/or sexual abuse (n = 61). Dissociative experiences were assessed by the Scale of Dissociative Experiences (German version of the Dissociative Experiences Scale). Results: The results show that mothers with a history of physical or sexual abuse – matched for infant gender, maternal education, marital status, number of infants and birth weight – had significantly more dissociative experiences. Conclusions: Maternal history of abuse significantly increases maternal dissociative experiences, which has frequently been postulated but never empirically shown in a prospective design in a sample of young mothers. As maternal psychopathology has been found to have a profound impact on child development, specifically in the first year of life, these data are of immediate relevance for preventive efforts when targeting at-risk mother-infant dyads.

Factors Associated with the History of Attempted Suicide

The present study examines a population of criminal justice clients for suspected substance-related problems. It aims to identify variables associated with a history of suicide attempt (SA). 6,836 clients were interviewed with the Addiction Severity Index (ASI). Attempters were compared to nonattempters regarding substance use, medical/psychiatric status, family history, and social relationships in a stepwise forward logistic regression. Attempters (21%) were more likely to report binge drinking, intake of illicit drugs, injection of drugs, physical and mental illness, problematic family history, and history of being abused. After logistic regression, SA was independently associated with older age, female gender, binge drinking, delirium tremens, injection, overdose, medical problems, psychiatric symptoms, family history of alcohol or psychiatric problems, and sexual, physical, and emotional abuse. The psychiatric and family/social domains (including being abused) most strongly separated attempters from nonattempters. Family background factors, psychiatric symptoms, severity of substance use, and sexual, physical, and emotional abuse appear to be factors associated with SA among criminal justice clients.

Sexual Abuse and Sexual Risk Behavior: Beyond the Impact of Psychiatric Problems

This study examined the association between sexual abuse (SA) and sex risk in girls and boys placed in alternative and therapeutic school settings while controlling for psychiatric problems. Adolescents were recruited from alternative and therapeutic schools. Youth completed audio computer-assisted self-interviews assessing childhood abuse, sexual behaviors, sexual attitudes, and psychiatric symptoms. Of the 162 youth with available data, 23% reported a moderate or severe SA history. After controlling for gender and the presence of a psychiatric diagnosis, youth with a SA history were significantly more likely to have engaged in sex, had sex in the last 90 days, and engaged in unprotected sex. Adolescents with a history of SA also endorsed fewer advantages of using condoms. SA is uniquely associated with sexual behavior and attitudes even when adjusting for the presence of a psychiatric diagnosis. These data have implications for interventions for those with SA histories.

The Brain-Derived Neurotrophic Factor (BDNF) Val66Met polymorphism modulates the effects of serious life events on impulsive aggression in patients with Borderline Personality Disorder

Introduction: A recent study reported the frequency of violent suicide attempts being higher in subjects reporting severe sexual abuse and carrying the BDNF Val/Val genotype. This finding might be of particular importance for studies in patients with Borderline Personality Disorder (BPD), because up to 71 percent of BPD patients report the experience of severe childhood trauma and „self-injury/suicide attempts“ is an important diagnostic criterion for BPD. Methods: 159 BPD patients were included in the study. Impulsive aggression was assessed by the Buss-Durkee-Hostility Inventory (BDHI), SLEs by the PTSD-section included in the Munich-Composite International Diagnostic Interview (M-CIDI). We analyzed 1) modulating effects of the BDNF Val66Met polymorphism on the effects of SLEs on impulsive aggression, and 2) modulating effects of the BDNF Val66Met polymorphism on the association between SLEs and impulsive aggression in the subgroup of female BPD patients. Results/Discussion: Childhood sexual abuse explained a 28.6% increment in variance account of BDHI sum score in BDNF Val/Val carriers, as well as a 32.5% increment in variance account in female BDNF Val/Val carriers. The study analyzing a specific gene x environment interaction in BPD patients suggests an interaction between SLEs and the BDNF Val66Met polymorphism in the regulation of impulsive aggression in BPD patients, specifically in females.

Childhood Emotional Neglect Related to Posttraumatic Stress Disorder Symptoms and Body Mass Index in Adult Women

The relationships among the severity of childhood abuse and neglect, posttraumatic stress disorder (PTSD), and adult obesity were investigated. 207 women (M age = 26.5 yr., SD = 6.7) completed the Childhood Trauma Questionnaire, Millon Clinician Multiaxial Inventory, and a demographic questionnaire. Analyses of variance indicated that women who reported moderate-to-extreme emotional neglect (n = 71) had significantly higher PTSD scores and increased BMI compared to women who reported low emotional neglect (n = 84). Women who reported severe sexual or emotional abuse also had higher PTSD scores, but no relationship was found with BMI when other factors were controlled. Although PTSD scores and self-reported severity of childhood emotional neglect were strongly correlated (r = .61, p < .001), PTSD was not found to be a mediating factor in obesity in women who reported childhood emotional neglect, although depression was.

Child maltreatment as a risk factor for opioid dependence: Comparison of family characteristics and type and severity of child maltreatment with a matched control group

Objective To examine the prevalence, characteristics and risk factors for child maltreatment among opioid-dependent persons compared to a community sample of similar social disadvantage. Method The study employed a case-control design. Cases had a history of opioid pharmacotherapy. Controls were frequency matched to cases with regard to age, sex and unemployment and were restricted to those with a lifetime opioid use of less than five times. The interview covered child maltreatment, family environment, drug use and psychiatric history. Results This study found a high prevalence of child maltreatment among both cases and controls. Despite the elevated prevalence among controls, opioid-dependent males had a higher prevalence of physical and emotional abuse; female cases had a higher prevalence and greater severity of sexual abuse. The prevalence of neglect was similar for both groups. Early parental separation was more prevalent among female cases compared to female controls; otherwise the prevalence of the risk factors was comparable for both groups. The risk factors significantly associated with child maltreatment were also similar for both cases and controls. Conclusions Given the documented association between child maltreatment and adult mental disorder, child maltreatment may be an important antecedent of current psychological distress in persons presenting to treatment for opioid dependence. Apart from a possible association between early parental separation and sexual abuse among female cases, the increased prevalence of child maltreatment associated with opioid dependence did not appear to be related to differences in early childhood risk factors considered in this paper. Other risk factors may be more pertinent for those with opioid dependence. Practice implications The high prevalence of child maltreatment among the opioid-dependent sample has implications for the assessment and treatment of clients presenting with opioid dependence. Assessment of child maltreatment history could help inform the development of individual treatment plans to better address those factors contributing to the development and maintenance of opioid dependence. Specifically, management of co-morbid mental disorder associated with child maltreatment could be the focus of relapse prevention programmes and also have a positive influence on treatment retention.

Posttraumatic stress symptoms as a mediator between sexual assault and adverse health outcomes in undergraduate women

This study investigated the links between sexual assault experiences, posttraumatic stress symptoms, and adverse physical health outcomes among undergraduate women. Existing research has demonstrated that posttraumatic stress disorder mediates the relationship between trauma exposure and physical health in general, but this has yet to be tested for sexual assault specifically. Using structural equation modeling, support was found for a model in which posttraumatic stress symptom severity partially mediates the association between sexual assault severity and self-reported health outcomes. An alternative model using depression symptoms did not meet the criteria for mediation. Implications for the physical health of sexual assault survivors are discussed.

Measurement of victimization in adolescence: Development and validation of the Childhood Experiences of Violence Questionnaire

Objective This study presents evaluative data on the Childhood Experiences of Violence Questionnaire (CEVQ), a brief, self-report measure of youth victimization. Methods Literature reviews, expert consultations and qualitative interviews informed the development of the CEVQ. Test–retest reliability of the preliminary and final versions of the CEVQ was examined. Child welfare workers ( n = 11) assessed content validity. Construct validity was assessed by comparing levels of emotional and behavioral problems of youth with self-reports ( n = 177) of victimization. Criterion validity was tested by comparing clinicians’ judgment of child physical abuse (PA) and child sexual abuse (SA) with youths’ self-reports ( n = 93). Results In general, test–retest intra-class correlations (ICCs) for the preliminary version of the questionnaire were good to excellent. Reliability estimates for the stem questions in the final version of the CEVQ were excellent, except for peer violence items which showed fair to good agreement. ICCs for PA, severe PA, SA, and severe SA of the CEVQ were .85, .77, .92, and .87, respectively. Youth with self-reported victimization had significantly higher scores for most categories of emotional and behavioral disorders. Experts classified victimization items as relevant. Kappa coefficients comparing clinician's judgments and youth's self-reports for PA, severe PA, SA, and severe SA were .67, .64, .70, and .50, respectively. Conclusions The present findings provide preliminary evidence that the CEVQ is a brief, reliable, valid and informative instrument for assessing exposure to victimization and maltreatment among youth. Practice implications Although this instrument is not appropriate for clinical use at this time, its psychometric properties will make it useful in conducting further epidemiological research and studies evaluating interventions aimed at reducing victimization.