Sexual Traumatization Research Articles

A laboratory examination of risky sexual behavior among female sexual trauma survivors.

Sexual violence against women is highly prevalent on college campuses. Survivors of sexual violence often engage in coping strategies such as risky sexual behavior. The present study used a behavioral task to measure sexual risk-taking following experiences of positive or negative affect and an emotion suppression experimental manipulation. Sexually active adult female undergraduates (N = 175) completed measures of sexual traumatization and affective experiences as well as an autobiographical recall task and a delay discounting task for hypothetical sexual outcomes. Half of the participants (n = 87) were asked to suppress their emotional response to the autobiographical recall task. The findings indicate that sexual traumatization had a significant effect on risky sexual decision-making, F(1, 167) = 23.27, p < .001, ηp 2 = .12, but affective condition, F(1, 167) = .57, p = .451, and emotion suppression, F(1, 167) = .69, p = .412, exhibited no significant associations with sexual risk-taking. These findings suggest other factors may underlie the association between sexual trauma and risky sexual behavior, but further research is warranted.

Borderline Personality Disorder and Military Sexual Trauma: Analysis of Previous Traumatization and Current Psychiatric Presentation

Military sexual trauma (MST) increases vulnerability for posttraumatic stress disorder (PTSD). Sexual trauma is also associated with increased risk for developing borderline personality disorder (BPD). Research has also documented a significant link between PTSD and BPD; however, there is a paucity of information examining this relationship among veterans with MST-related PTSD. In particular, we sought to examine whether comorbid BPD-PTSD compared with veterans with PTSD and no BPD resulted in increased PTSD and depression symptomatology. We also examined psychiatric, previous sexual trauma, and demographic factors to determine what-if any-factors were associated with comorbid BPD diagnosis. Using data from a recently conducted randomized clinical trial, we examined electronic medical records of the local Veterans Affairs Medical Center. Data from 90 veterans with MST-related PTSD were obtained. More than 22% ( n = 20) of the sample had a historical diagnosis of BPD. Participants were administered measures to assess psychiatric symptomatology (PTSD and depression), trauma-related negative cognitions (NCs), and previous sexual traumatization (e.g., childhood and civilian sexual exposure). An analysis of variance was conducted, which found that veterans with comorbid MST-related PTSD and BPD had significantly greater PTSD criterion B (avoidance) symptoms, depressive symptomatology, and NC scores than participants without comorbid BPD. In addition, a binary stepwise logistic regression found that veterans' BPD was also positively associated with NCs about self and the world; however, self-blame, depression, PTSD, sociodemographic variables (e.g., gender, age), and previous sexual traumatizations were not significant predictors. Implications are discussed with regard to clinical care and future research directions.

Cultural considerations in the treatment of mental illness among sexually abused children and adolescents: the case of Bali, Indonesia.

Childhood and adolescence sexual abuse can have long-lasting and devastating effects on personal and interpersonal growth and development. Sexually abused children tend to exhibit higher rates of poor school performance, aggressive behavior, PTSD (posttraumatic stress disorder), or depressive symptomatology, as well as social and relational deficits (e.g., age-inappropriate sexual behaviors). The trauma following such abuse can further affect neurodevelopment and physiology, aggravating mental or physical problems in adulthood. Early symptom recognition and appropriate interventional applications are important factors in successfully treating or even preventing the development of mental disorders in such cohorts. A central element of effective treatment is the selection of treatment targets. Cultural considerations are rarely or peripherally considered in sexual abuse treatment strategies. Western-trained psychiatrists and clinical psychologists tend to overlook or underestimate such factors in cross-cultural settings, resulting in interventional efforts that may interfere with traditional approaches to healing, and potentially contributing to a transgenerational cycle of trauma. By using Bali (Indonesia) as a focal culture, in this article we discuss the effects of cultural elements and showcase their potential contribution and systematic implementation into a holistic and sensitive interventional model for the treatment of mental illness in childhood and adolescence sexual traumatization.

Etiological Role of Childhood Emotional Trauma and Neglect in Adolescent Anorexia Nervosa: A Cross-Sectional Questionnaire Analysis

Background: Most studies on the relationship between childhood trauma and anorexia nervosa (AN) have focused on the role of childhood sexual and physical trauma in adult patients. Little is known about the role of emotional trauma and eating disorders. The aim of the present study was to examine childhood sexual, physical, and emotional traumatization in adolescents with anorexia nervosa restricting type (AN-R) in comparison to those with anorexia nervosa binge-eating/purging type (AN-BP) and a healthy control group. Sampling and Methods: The sample included 50 patients with AN-R (mean age = 15.8 ± 1.6 years), 27 with AN-BP (mean age = 16.1 ± 1.1 years), and 44 healthy female control participants (mean age = 15.7 ± 1.3 years). AN diagnosis was confirmed by the Structured Inventory for Anorexic and Bulimic Syndromes (SIAB-EX). Childhood sexual, physical, and emotional traumatization was assessed by a self-report questionnaire (Childhood Trauma Questionnaire; CTQ). Results: The results indicated higher rates of sexual, physical, and emotional abuse and physical and emotional neglect in patients with AN-BP than in patients with AN-R and healthy control participants. No significant differences in childhood traumatization were found between patients with AN-R and control participants. Conclusions: Our results underline the importance of detecting the full range of possible childhood traumatic experiences in adolescents with AN, rather than focusing simply on childhood sexual traumatization. Sexual, physical, and emotional childhood traumatization are particularly important in the history of adolescent patients with AN-BP, in contrast to patients with AN-R, and should be screened for in the diagnosis and therapy of eating disorders.

The Scoring and Interpretation of the SDQ-20 and SDQ-5

Abstract The 20-item Somatoform Dissociation Questionnaire (SDQ-20; Nijenhuis, Spinhoven, Van Dyck, Van der Hart, &amp; Van-derlinden, 1996) evaluates the severity of somatoform dissociation. The SDQ-20 items were derived from a pool of 75 items describing clinically observed somatoform dissociative symptoms that in clinical settings had appeared upon reactivation of particular dissociative parts of the personality and that could not be medically explained. The SDQ-20 scores were best predicted by self-reported physical and sexual traumatization in patients with dissociative disorders and psychiatric controls (Nijenhuis et al., 1998c), even after statistically controlling for self-reported emotional traumatization (emotional neglect and emotional abuse). These traumatization scores were composed of four factors, i.e. presence of trauma, duration of trauma, relationship to perpetrator, and subjectively rated impact of trauma.

Association of nonsexual and sexual traumatizations with body image and psychosomatic symptoms in psychosomatic outpatients

Objective A coherent body image is constituted in an interpersonal process during early development. Violations of body self-boundaries (e.g., sexual traumatizations during childhood) could alter the development of a coherent body image and promote symptoms of dissociation and somatization. Method A total of 240 psychosomatic outpatients underwent a clinical diagnostic interview and a psychometric evaluation including the Posttraumatic Stress Scale (PDS), the Body Image Questionnaire (FKB-20), an inventory of somatoform symptoms (SOMS-7), the Brief Symptom Questionnaire (BSI) and the Dissociative Experiences Scale (DES). Subjects were assigned to one of the following subgroups according to their self-reported trauma status: “nontraumatized,” “nonsexually traumatized” and “sexually traumatized”. Results Nonsexual traumatizations were more often reported by men (53.4% vs. 35.9%), whereas women more often reported sexual traumatization (9.6% vs. 33.5%). Women reporting sexual traumatizations showed a significantly higher negative validation of their own body and significantly more psychological symptoms (BSI-GSI), whereas both men and women with sexual traumatizations reported significantly more somatoform complaints and more dissociative symptoms when compared with nonsexual or nontraumatized patients. Conclusion Victims of sexual trauma suffer from a more complex symptom pattern including a more negative perception of their own body compared with patients with nonsexual trauma or no trauma.

Impaired Sexual Function in Patients with Borderline Personality Disorder is Determined by History of Sexual Abuse

Patients suffering from a Borderline Personality Disorder (BPD) display altered sexual behavior, such as sexual avoidance or sexual impulsivity, which has repeatedly been linked to the sexual traumatization that occurs in a high percentage of BPD patients. Until now, no empirical data exists on whether these patients concomitantly suffer from sexual dysfunction. This study investigates sexual function and the impact of sexual traumatization on this issue in women with BPD as compared to healthy women. Sexual function was measured using the Female Sexual Function Index. Additionally, diagnoses were made with SCID II Interviews for Axis II and with the Mini International Neuropsychiatric Interview for Axis I disorders. The Post-traumatic Stress Diagnostic Scale for trauma evaluation was used. Sexual orientation was assessed by self-evaluation. Forty-five women with BPD as diagnosed according to DSM-IV criteria and 30 healthy women completed questionnaires on sexual function and sexual abuse history, as well as interviews on axis I and II disorders and psychotropic medication. The BPD group showed a significantly higher prevalence of sexual dysfunction. Subgroup analyses revealed that BPD with concomitant sexual traumatization, and not BPD alone, best explains impaired sexual function. Sexual inactivity was mainly related to current major depression or use of SSRI medication. In sexually active participants, medication and symptoms of depression had no significant impact on sexual function. Not BPD alone, but concomitant sexual traumatization, predicts significantly impaired sexual function. This may have a therapeutic impact on BPD patients reporting sexual traumatization.

Effective practices for sexually traumatized girls: Implications for counseling and education.

Abstract The sexual traumatization of female adolescents is becoming increasingly visible in the counseling field. This paper will outline the prevalence of sexual abuse on female adolescents with emphasis on effective practices used in the field. In addition, implications for counselors and counselor educators will be discussed. Multicultural considerations are also reviewed. Keywords: sexual traumatization, symptomatology, survivors, adolescents. ********** The sexual traumatization of female adolescents has become increasingly visible in the counseling field. The effects of sexual abuse on mental health have gained public attention over the past decade and enticed research for practical application in counseling. Countless studies have confirmed that sexual abuse facilitates high levels of psychological and behavioral symptomatology among adolescents (Boney-McCoy & Finkelhor, 1995) and has strong associations of interpersonal and psychological problems. As counselor or counselor educator, it is essential to have an awareness of effective practices and interventions for use in treatment with sexual abuse survivors, as encountering such issues is inevitable. With growing sexual abuse and traumatization cases, the need for knowledge, understanding, and implementation of effective practices becomes evident. Counselors and researchers are both aware of the gap that separates research from practice. A frequent point of contention is that treatments are not supported by research to support their efficacy. However, the effectiveness of some limited interventions among adolescent female survivors of sexual abuse has been examined. The authors have synthesized the literature regarding effective interventions utilized in the treatment of sexually abused adolescent females, in order to bridge the gap between research and practice. First, some terms and definitions will be examined. One term that is frequently used in the literature is sexual traumatization. This term encompasses the effects of a child's premature and inappropriate experience with sexuality (Brown, 2004, p. 28). Additionally, the effective treatments refer to treatments that have been tested and have proven to be effective in reducing the symptomatology of female adolescent survivors. Survivors of sexual abuse may experience single or multiple incidents impacting physical, behavioral, cognitive, or emotional functioning (Green, 1996; Stauffer & Deblinger, 1996). In general, adolescents experience higher rates of victimization than adult victims (Menard, 2002) and subsequently, after traumatic experience, females are more likely to develop psychological disorders (Foa & Rothbaum, 1998; Rowan, Foy, Rodriguez, & Ryan, 1994). Females who are sexually abused have heightened risk of developing posttraumatic stress disorder (McLeer, Callaghan, Henry, & Wallen, 1994) but this disorder does not encompass all symptoms experienced in sexually traumatized survivors (Rowan & Foy, 1993). Additional symptoms can include low self-esteem, feelings of guilt, and depression. The risk of developing chronic disorders such as borderline personality and dissoicative identity disorder also increases after being sexually traumatized (Murray, 1993). Adolescents are at greater risk for developing all of these problems. Research reveals that many of these females are suffering much at the hands of perpetrators. According to national survey by Tjaden and Thoennes (2000), 32.4% of female sexual assault cases were between the ages of 14 and 17. An analysis of sexual assault crimes reported to law enforcement between 1991 through 1996 revealed that juveniles (under the age of 18 at the time of assault) formed the majority of victims with high rates of forcible fondling (84%), forcible sodomy (79%), and sexual assault with an object (75%) (Snyder, 2000). Other forms of sexual abuse exist throughout the literature, such as unforced verbal manipulation, being asked to pose in sexually positions or undress provocatively, fondling the perpetrator's genitals, oral manipulation (Berliner & Elliott, 1996; Rowan, Foy, Rodriguez, & Ryan, 1994). …

Sexual trauma and pregnancy: a conceptual framework.

In this paper, we propose that a history of sexual traumatization is associated with pregnancy complications and poor pregnancy-related outcomes. We further hypothesize that this relationship is mediated by the sequelae of trauma (psychopathology, health problems, and increased negative health behaviors). We review the literature linking sexual trauma with psychopathology, health, and health behavior and then outline the impact of these variables on pregnancy. Based on this review, we draw conclusions about the potential impact of sexual trauma on pregnancy outcomes. We suggest future directions for this area of research and discuss the clinical implications of this association, including the development of prenatal intervention and prevention programs.

Personality disorders and psychopathology following trauma. Reflection on diagnostic classification

Pervasive personality disorders have been shown to be long-term sequelae of cumulative childhood physical and sexual traumatization. This finding is not reflected in DSM-IV and ICD-10 classifications where post-traumatic stress disorder is confined to intrusions, avoidance, numbing, and hyperarousal. However, there is growing evidence that trauma etiology should be taken into account in planning treatment for personality disorders. It is not yet clear whether childhood traumatization is more strongly associated with borderline personality disorder than with other personality disorders. The finding of a substantial overlap between borderline personality disorder and dissociative identity disorder gives rise to discussions concerning the relationship of these two pathologies.

Boundaries and Boundary Violations in Psychoanalysis

Back to table of contents Previous article Next article Book Forum: PsychotherapyFull AccessBoundaries and Boundary Violations in PsychoanalysisAARON H. ESMAN, M.D., AARON H. ESMANSearch for more papers by this author, M.D., New York, N.Y.Published Online:1 Nov 2003https://doi.org/10.1176/appi.ajp.160.11.2074AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Originally published in 1995 as a guide to the perplexed psychoanalyst, this book has now been reissued in accessible paperback format by American Psychiatric Publishing in recognition of its relevance to general psychiatrists and, indeed, to all mental health professionals. The issue of boundaries and boundary violations transcends disciplinary lines; all professionals who assume a therapeutic or fiduciary position are inevitably confronted by the ethical, legal, and technical questions that govern their relations with those whom they serve. It is these questions that Drs. Gabbard and Lester address in this thoughtful, scholarly, and humane volume, which should be required reading for all who seek to care for persons in distress.The authors begin with a general discussion of the concept of boundaries as developed in the psychoanalytic literature over the years since first adumbrated by Freud himself. They consider both internal (or intrapsychic) boundaries and external (interpersonal) ones; it is, of course, the latter that will be of greater importance to the practitioner. They devote a chapter to the exposition of what they call the “psychoanalytic frame”—that is, the formal structures and conditions under which the therapeutic relationship is (or should be) conducted and that would be pertinent to any psychotherapeutic situation.The bulk of the book is given over to extended consideration of specific types of boundary violations, both sexual and nonsexual, each instructively illustrated by clinical vignettes taken from actual psychoanalytic experience. The authors delineate four types of therapists who may be prone to such violations: the psychotic; the predatory, psychopathic, or perverse; the “lovesick”; and the masochistic. It is in the interaction with particular kinds of patients, especially those who have suffered experiences of sexual traumatization or severe deprivation in their earlier lives, that such violations are most likely; therapists who are themselves suffering from personal losses or other disruptions in their lives are particularly susceptible.Above all, the authors emphasize the ubiquity of countertransference phenomena in all therapeutic encounters and the fact that all of us are potentially at risk. The need for careful and constant self-scrutiny and for timely and appropriate consultation with colleagues is underscored. They emphasize that the use of supportive techniques neither requires nor justifies the erosion of professional boundaries. Further, they make a strong case for the maintenance of such boundaries in the posttermination period; in their words, “ posttermination sexual relationships should be regarded as unethical and clinically ill-advised in virtually every situation” (p. 149).Finally, the book offers a well-considered discussion of the difficulties encountered in attempts to deal with such situations when they are brought to external attention. They propose a set of guidelines for their management that, though specifically tailored for the psychoanalytic community, can readily be extended and applied by other professional groups. The aim, in all cases, is to adjudicate the matter as humanely as possible so as to protect the interests of the patient while seeking appropriate therapeutic or disciplinary management of the offending therapist.Ultimately, the authors remind us that we are not dealing here with “good guys” versus “bad guys”; violations of boundaries are not respecters of gender, sexual orientation, or even quality of training. They recommend the institution of courses in professional ethics in training programs and decry the alarming decline in the quantity and quality of teaching and supervision of psychotherapy in psychiatric residency programs. This book should be carefully studied by every psychiatrist, psychiatric educator, and psychotherapist, both for the protection of their patients and students and for their own self-interest.By Glen O. Gabbard, M.D., and Eva P. Lester, M.D. Arlington, Va., American Psychiatric Publishing, 2003, 222 pp., $29.95 (paper). FiguresReferencesCited byDetailsCited ByNone Volume 160Issue 11 November 2003Pages 2074-2074 Metrics History Published online 1 November 2003 Published in print 1 November 2003

Dissociative Phenomena Among Recovering Heroin Users and Their Relationship to Duration of Abstinence

ABSTRACT This study is an investigation of trauma and dissociation in 100 Israeli recovering patients with drug use disorder. The respondents showed more emotional, physical and sexual traumatization than an Israeli clinical sample, and their levels of dissociation were similar to those previously measured in Israeli patients diagnosed with Posttraumatic Stress Disorder and Acute Stress Disorder (Somer, Dolgin, & Saadon, 2001). Male respondents with higher trauma scores were more likely to report dissociative experiences during their drug use (chemical dissociation). Drug-free high-dissociators were more likely to report depersonalizing and derealizing experiences when they had been using drugs. Stronger dissociative experiences during drug-use related to more psychological distress during inter-use craving. A relationship between psychological distress during inter-use craving and psychological dissociation measured in a detoxified state was also established. Length of abstinence from illicit substances was best predicted by lower levels of psychogenic dissociation and by longer durations of psychosocial treatment. While findings imply that tenacity in treatment could be a sustaining process associated with abstinence from drug use, they also suggest that without a thorough resolution of trauma-related dissociation, successful treatment outcome is less likely.

Prediction of Abstinence from Heroin Addiction by Childhood Trauma, Dissociation, and Extent of Psychosocial Treatment

This study is an investigation of trauma and dissociation in 93 Israeli patients recovering from drug use disorder. The respondents showed more emotional, physical and sexual traumatization than consecutive admissions to an Israeli outpatient stress clinic, and their levels of dissociation were similar to those previously measured in Israeli patients diagnosed with Posttraumatic Stress Disorder and Acute Stress Disorder. It was posited that the level of trauma-related dissociation can make an independent contribution to explaining variance in recovery from a drug use disorder. The finding of structural equation analyses supported this model and suggests that childhood traumatization is related to the proclivity of chemically-dependent respondents to participate in psychosocial treatment and that duration of psychosocial treatment can positively predict duration of abstinence. Dissociation levels made an independent negative contribution to the prediction of abstinence. While our findings imply that tenacity in treatment could be a sustaining process associated with abstinence from drug use, they also suggest that without a thorough resolution of trauma-related dissociation, optimal treatment outcome is compromised.

Sexual Trauma, Posttraumatic Stress Disorder, and Health Behavior

The authors tested whether sexual traumatization is associated with poorer health behavior and also evaluated the role of posttraumatic stress disorder (PTSD) in this relationship. They mailed questionnaires to 419 women who had visited a San Diego Veterans Administration primary care clinic in 1998 and received 221 responses, a 56% return rate. They found that a history of sexual assault was associated with increased substance use, risky sexual behaviors, less vigorous exercise, and increased preventive healthcare. They then used regression-based techniques to test whether PTSD mediates the relationship between a history of sexual assault and health behaviors and discovered support for this hypothesis in relation to substance use. PTSD symptoms were also associated with less likelihood of conducting regular breast self-examinations. Findings from the study highlight the value of programs designed to (1) identify trauma victims, (2) screen for problematic behaviors, and (3) intervene to improve long-term health outcomes.

“A Commemoration of Wounds Endured and Resented”: Margaret Atwood's The Blind Assassin as Feminist Memoir

Aptly described as “grand storytelling on a grand scale” and as a “beautiful puzzle,” a story-within-a-story-within-a-story in which “every piece fits” (Dirda, Puckett), Margaret Atwood's The Blind Assassin is at once an intricately designed literary puzzle featuring a classic Atwoodian narrator—the elderly memoirist Iris Chase Griffen, who is a master storyteller and illusionist—and an unsettling cautionary tale that, like Atwood's other novels, focuses attention on the power politics of gender relations. At the center of The Blind Assassin, as Atwood has commented, is the “concept of human sacrifice—in Zycron, in Iris's behavior and in Laura's” (Sylge). In pointedly connecting the traumatic sexual sacrifice of the two sisters, Iris and Laura Chase, to the sacrifice of the virgin in “The Blind Assassin” science fiction tale, Atwood, through repetitive retellings of the story of women's sexual victimization, probes the cultural—and historical—repetition of sexual violence against women, showing the link between institutionalized misogyny and the sexual traumatization of women. Atwood also underscores the damage that can result from the cultural and literary idealization of female self-sacrifice as she illustrates not only the historical oppression of women in a patriarchal system but also women's cultural blindness to, and thus collusion with, their own victimization as well as the victimization of other women.

The Hamburg Model: Couples Therapy at Century's End

Since the Hamburg Model of couples therapy was first used at the beginning of the 1970s, a great deal has changed. Gender relations are, at least in Western countries, in a state of upheaval, and family structures have become more complex and varied. A large proportion of the women, and some of the men, who seek help at this facility because of sexual problems have undergone some form of sexual traumatization. Fewer than before have the classical sexual dysfunctions, and more—mainly women but men too—complain of so-called lack of sexual desire. Even the main paradigm, heterosexuality, shows signs of becoming shaky. When working out this therapeutic concept of treating heterosexual couples in the 70s, this model drew on the ideas of several American researchers including Masters and Johnson, Lobitz, LoPiccolo, Kaplan, and others. The evaluation and the results proved practicable and effective for the mainly urban West German clientele at that time. This article describes the ways that the changes mentioned above were tackled; the personal and social issues inherent in treating couples; and some of the latest perspectives, modifications, and new emphases designed to meet clients' needs at the start of a new century. Selected new empirical data on the effectiveness of this method of couples therapy are also presented.

Descriptive and psychodynamic re-evaluation of ‘therapy-resistant’ psychotic patients can open new therapeutic possibilities:A case report

Chronic disabling psychotic disorders like schizophrenia are often considered to be relatively treatment-resistant. Drugs and psychosocial support is often prescribed for such patients. In this case study we present a patient for whom psychodynamic assessment of the symptoms suggested that the psychosis was partly developed and achieved a chronic status as a result of an inadequate comprehension of underlying sexual traumatization. Systematic reevaluation of the symptoms with a structured psychiatric interview and assessment of somatic comorbidity further supported the presence of a non-schizophrenic disorder with partly trauma-related etiology which had not been identified previously. The discussion underlines the need for comprehensive descriptive and psychodynamic assessments of chronic psychotic patients. Such assessments of seemingly chronic and hopeless patients may reveal therapeutic potentials not previously identified.

Twenty years of trauma:Psychological Abstracts 1970 through 1989

The present study represents an objective assessment of the growth in trauma literature, and of the thematic trends which have been part of its historical evolution. For these purposes a systematic, manual search ofPsychological Abstracts from 1970 to 1990 was conducted to identify literature on trauma-related topics. Fifteen hundred and ninety-six (1596) citations between 1970–1990 were identified, and a trend showing increasing numbers of trauma publications was in evidence. This increase was most apparent in literature involving war- and sexual abuse-related traumatization, but not in publications about natural and technological disaster. These findings reflect a dynamic and growing field, and will provide an important benchmark for assessing the changing status of the PTSD literature.