Sexual Abuse Trauma Research Articles

Quality and use of trauma histories obtained from psychiatric outpatients through mandated inquiry

A growing awareness of the sequelae of trauma has prompted clinical and administrative mandates that psychiatric assessments must include inquiry about whether patients have experienced trauma or abuse. This study was designed to assess how a trauma history obtained through mandated inquiry is recorded and how it is used in diagnostic formulation and treatment planning. Histories of physical and sexual abuse and other trauma were reviewed in the charts of 180 outpatients receiving psychotherapy at an urban teaching hospital clinic. The extent and variety of traumatic experiences and the quality of clinicians' assessment of trauma histories were measured by a rating instrument developed for the study. Mandated inquiry led to the detection of histories of traumatic experiences for 72 patients (40 percent). The recognition of trauma did not trigger appropriate evaluation. Only 11 percent of clinicians mentioned posttraumatic stress disorder symptoms. Only one in ten charts of patients with histories of trauma contained diagnostic assessments or treatment plans that adequately incorporated the trauma history as a factor in the patient's presentation for treatment. Although mandated inquiry led to the detection of substantial abuse and trauma, this information was rarely used in assessment and treatment planning. Implementation of mandated inquiry should be accompanied by relevant education and supervision to ensure that clinicians understand the diagnostic and treatment implications of past trauma.

Identification and trauma: An integrative-developmental approach

The present paper addresses the effects of sexual abuse trauma on the developmental process of identification. Childhood victims of family violence often experience profound character changes as adults. One primary adaptation utilized by survivors of sexual abuse trauma is termed identification with the aggressor.Both pathological and adaptive manifestations of this operation exist in children and adults. Clinical case material is presented which clarifies the impact of trauma on the process of identification in children and adults. Individual, group, and family dynamics all provide important contextual information for the processing of sexual abuse trauma in psychotherapy. Clients may co-create, with their therapist, interactions which resemble their original traumatizations. During these therapeutic re-creations, clients exhibit behavior which represents an identification with their offender, hence expressing unresolved aggression toward the therapist. The effective psychotherapist is able to tolerate her own aggression, and remain empathically connected to her client.

Modifications in service delivery and clinical treatment for women diagnosed with severe mental illness who are also the survivors of sexual abuse trauma.

Sexual abuse trauma and chronic revictimization are central to the experience of many women diagnosed with severe mental illness. The high reported prevalence rates of sexual abuse trauma among these women necessitate that program planners and clinicians be prepared to adapt their treatment interventions for use with trauma survivors. This article describes how current treatment approaches for women diagnosed with severe mental illness can be adapted to accommodate the special needs and vulnerabilities of sexual abuse trauma survivors. A history of trauma added to the clinical picture of longstanding and severe mental illness poses new diagnostic and treatment considerations, which are discussed. The full range of rehabilitation services--case management, residential placement and supervision, inpatient hospitalization, medication management, network intervention, and social skills training--must be grounded in an understanding of the trauma experience, informed by accurate assessment of the trauma, and accommodated to the woman's specific history of sexual abuse trauma.

Posttraumatic Stress Disorder in Children and Adolescents

In recent years researchers and clinicians have paid increasing attention to posttraumatic stress disorder (PTSD) in children and adolescents. Issues of definition and evaluation are discussed and studies of children subsequent to natural disasters, accident, war, sexual abuse and human-made traumas are reviewed. Issues relating to treatment and “debriefing” are also discussed.

Patterns of coping and characteristics of high-functioning incest survivors

An exploratory study using a phenomenological approach was designed to examine methods of coping and adaptation that may facilitate a healthy adjustment after sexual abuse. In-depth interviews were conducted with a sample of 15 high-functioning adult female incest survivors. The results identify the capacity of sexually abused children to use avoidance strategies and use psychological escape mechanisms to cope with the abuse; and helped explicate the adult process of separation, self-discovery, and revisiting the past trauma. The victirn's cognitive appraisals and responses emerged as important variables in managing the trauma of sexual abuse. The capacity to protect the integrity of the self appeared central to the adult developmental process of integrating the incest experience.

A Cross-Validation Study of the Trauma Symptom Checklist

The study examines the responses to the Trauma Symptom Checklist (TSC) of college women (n = 654) sexually abused as children, sexually assaulted as adults, sexually assaulted as children and adults, and nonabused. Also investigated was the role of mediating variables: parental support, attributional style, and coping. Subjects completed a series of self-report measures in small groups. Sexual abuse was associated with more symptoms and more recent assaults, and revictimized women reported the most symptoms. The hypothesized mediating variables were predictive of scores on the Dissociation, Anxiety, Depression, Sexual Abuse Trauma Index, and Sexual Problems subscales. The interaction of low levels of parental support and a nonexpressive coping style was predictive of Anxiety and Depression scores. The results support the validity of the TSC as a measure of sexual abuse trauma and point to family patterns associated with prolonged symptomatology.

Memories of Childhood Sexual Abuse: Remembering and Repressing

Women involved in out-patient treatment for substance abuse were interviewed to examine their recollections of childhood sexual abuse. Overall, 54% of the 105 women reported a history of childhood sexual abuse. Of these, the majority (81%) remembered all or part of the abuse their whole lives; 19% reported they forgot the abuse for a period of time, and later the memory returned. Women who remembered the abuse their whole lives reported a clearer memory, with a more detailed picture. They also reported greater intensity of feelings at the time the abuse happened. Women who remembered the abuse their whole lives did not differ from others in terms of the violence of the abuse or whether the violence was incestuous. These data bear on current discussions concerning the extent to which repression is a common way of coping with childhood sexual abuse trauma, and also bear on some widely held beliefs about the correlates of repression.

Sandplay Is Meant for Healing

- Sandplay is meant for healing, not for diagnosis. - Sandtrays show how the sandplayer is coping with distress and pathology. - Therapist provides freedom, protection, and empathy so the twin urges toward health and growth can activate healing and individuation. - Two levels in the process may overlap. (a) Healing. Therapist needs to be alert to possible emotional or sexual abuse and other trauma and to be empathic in allowing sandplayers to move at their own pace. (b) Growth. Therapist recognizes stage and aspects of individuation, etc. with eventual shift of energies from preoccupation to creativity. - It is the sandplayer's experience, not the therapist's understanding of the process that heals. - The therapist's understanding of what is happening is essential, to facilitate empathy, in offering protection, if and when to make referrals or to seek consultation, and in a later review of the process.

Clinical considerations related to victimization dynamics and post-traumatic stress in the group treatment of sexually abused boys

Clinical considerations inherent in the development of a boy's time-limited psychoeducational sexual abuse trauma group are described. The sexually abused boy's impact struggles are divided into two categories: victimization dynamics and post-traumatic stress. Within each category, five impact-specific dynamics are presented. The victimization dynamics are: victim/victimizer identity struggle; abandonment fear; accelerated sexual arousal; body conflict and shame. The post-traumatic stress dynamics are: psychophysiological dysregulation; post- sexual abuse re-enactment potential; post- sexual abuse triggers; intrusion and numbing. These dynamics are central to the group's development and purpose. Within this framework, group structure, confidentiality limitations, role of caretakers, role of group therapists, and impact-specific group activities are also examined.

Season of light/season of darkness: The effects of burying and remembering traumatic sexual abuse on the sense of self

This paper considers the disruptive effects of defensively forgetting childhood sexual abuse on the sense of self. Defense analysis, leading to access to and control of affects and associated recall of forgotten events is a crucial aspect of understanding and treating the resulting self disorders. The defenses of dissociation, denial and repression will be considered with regard to some of the basic effects on the sense of self which come from employing them. A case discussion illustrates the strengthening of the sense of self of a patient with a profoundly traumatic past when these defenses are systematically disrupted through psychotherapy.

Turning Symptoms into Allies: Utilization Approaches with Posttraumatic Symptoms

Adult patients with symptoms connected to the trauma of childhood sexual abuse often present in therapy with multiple symptoms and life difficulties and offer a challenge to even the most experienced clinician. In this paper, I describe my work with three such patients who were crippled in different ways by symptoms that had proved resistant to years of various therapeutic interventions. In every case, I accepted and utilized these symptoms as positive resources for successful and rapid change. Patients were then taught self-utilization approaches which allowed them to sustain and extend initial improvements. I conclude that the indirect utilization principle introduced by Milton Erickson provides an effective method to use in approaching some of the more persistent patterns of posttraumatic symptomatology related to childhood sexual abuse.

Supervision in the face of no cure— working on the boundary

Abstract This paper considers how the trauma of child sexual abuse and the roles of victim and abuser affect not only those directly involved in the abuse but also those who work with it, their institutions and the wider network. It suggests that the emotional impact of such work should not be underestimated and that good supervision which considers the emotional impact of this and similar life crisis interventions, is vital for everyone working in this field

The Memory Retrieval Process in Incest Survivor Therapy

The resolution of sexual abuse trauma requires the retrieval of memory and the working through of associated affect. This article provides information about amnesia, repression, and dissociation in the aftermath of childhood trauma and about the storage and retrieval of memory, including Ihe necessary conditions for retrieval. Specific sfrategies are suggested for use according lo the phase of the traumatic stress response and according to the needs and defenses of fhe individual survivor.

Sexual abuse trauma among professional women: Validating the Trauma Symptom Checklist-40 (TSC-40)

This study examines the usefulness of the Trauma Symptom Checklist (TSC-40) in measuring the longterm sequelae of sexual abuse. In a national survey of 2,963 professional women, the TSC-40 was found to be reliable and to display predictive validity with regard to childhood sexual victimization. Women who reported a sexual abuse history scored significantly higher than did women with no history of abuse on each of the six subscales and on the overall TSC-40 score. Various aspects of childhood victimization were associated with the subscale scores, with the Sexual Abuse Trauma Index and Dissociation subscales being more sensitive to the specific components of the abuse.

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.

The Sexual Assault Symptom Scale: Measuring self-reported sexual assault trauma in the emergency room.

To test the utility of a new self-report measure of trauma in the immediate aftermath of sexual assault, 253 women were interviewed with the 32-item Sexual Assault Symtom Scale (SASS) in a hospital emergency room within 72 hr of assault

Predictors of Long-Term Sexual Assault Trauma among a National Sample of Victimized College Women

Several multivariate studies have attempted to delineate the major predictors of long-term, sexual assault-induced aftereffects. The present study was an attempt to extend previous work by supplementing known preassault, assault, and postassault predictors of trauma with cognitive measures. The data were cross-sectional and included responses from 1,213 victims of sexual assault who were recruited from a national sample of higher education students. Utilizing hierarchical multiple regression analyses and a cross-validation procedure, the results suggested that the prior mental status of the victims, the forcefulness of the assaults, as well as two cognitive variables related to a victim's beliefs about sex and relationships predicted victims' scores on standardized measures of anxiety and depression. The relationships were such that the most traumatized victims were those women who had evidenced a history of mental health problems, who had experienced the more aggressive assaults, who tended to believe that people in relationships are not trustworthy, and tended to place conservative restrictions on the sexual acts and circumstances under which sex should occur. Taken together these variables accounted for between 9%-14% of the variance in sexual assault aftereffects. The discussion emphasizes the contribution of cognitive processes to the understanding of sexual assault trauma.

Homelessness as psychological trauma: Broadening perspectives.

Most mental health literature on homelessness has focused on characteristics that may be risk factors for homelessness. The authors of this article argue that homelessness itself is a risk factor for emotional disorder and use the construct of psychological trauma--focusing on social disaffiliation and learned helplessness--to understand the potential effects of homelessness. Psychological trauma is likely among homeless individuals and families for three reasons. (a) The sudden or gradual loss of one's home can be a stressor of sufficient severity to produce symptoms of psychological trauma. (b) The conditions of shelter life may produce trauma symptoms. (c) Many homeless people--particularly women--become homeless after experiencing physical and sexual abuse and consequent psychological trauma. Research suggests that negative psychological responses to traumatic events can be prevented or mitigated by a supportive and empowering posttrauma environment. The implications of trauma theory for improving the psychosocial conditions of homeless people are discussed.

The Sexual Assault Symptom Scale: Measuring self-reported sexual assault trauma in the emergency room.

The Sexual Assault Symptom Scale: Measuring self-reported sexual assault trauma in the emergency room.

A Case of Sibling Incest: A Balancing Act

This case demonstrates addressing the multiple needs of family members when sexual abuse of a child within the family is disclosed. Insuring that proper reporting takes place, focusing the pacing of treatment based on the observed needs of family members, overcoming old tensions to involve family members in creating new responses and tailoring treatment based on the child's mode of communication are utilized. The conclusion of service assists the family in facing new developmental challenges with a minimum of encumbrance from the sexual abuse trauma.