Peritraumatic Tonic Immobility and Trauma-Related Symptoms in Adult Survivors of Childhood Sexual Abuse: The Role of Posttrauma Cognitions

Tonic immobility is a set of involuntary motor responses elicited under conditions of extreme fear and perceived inescapability, and it is one type of peritraumatic distress reported by survivors of child sexual abuse. Experiencing tonic immobility during child sexual abuse is associated with increased risk for developing symptoms of post-traumatic stress disorder, although less is known about relations between tonic immobility and other established risk factors for post-traumatic stress disorder. We investigated posttraumatic cognitions as a potential mediator of the relations between peritraumatic fear, perceptions of inescapability, tonic immobility, and post-traumatic stress disorder symptoms. Specifically, we tested posttraumatic negative beliefs about the self, the world, and self-blame as pathways that might increase risk for post-traumatic stress disorder symptoms in child sexual abuse survivors who had experienced tonic immobility. Forty-six women with a history of unwanted childhood sexual contact completed questionnaires measuring peritraumatic tonic immobility, posttraumatic cognitions, and current posttraumatic stress symptoms. Negative beliefs about the self independently mediated the relation between peritraumatic perceptions of inescapability and post-traumatic stress disorder symptoms, but the data did not support similar path model for the physical symptoms of tonic immobility and post-traumatic stress disorder. We discuss ways in which treatment of survivors and future research on CSA can benefit from attention to the impact of peritraumatic distress on posttraumatic beliefs.     

Impact of Traumatic Events on Posttraumatic Stress Disorder among Danish Survivors of Sexual Abuse in Childhood

Childhood sexual abuse can be extremely traumatic and lead to lifelong symptomatology. The present study examined the impact of several demographic, abuse, and psychosocial variables on posttraumatic stress disorder severity among a consecutive sample of treatment-seeking, adult child sexual abuse survivors (N = 480). The child sexual abuse sample was characterized by severe trauma exposure, insecure attachment, and significant traumatization, with an estimated 77% suffering from posttraumatic stress disorder, more than twice the level of the comparison group. Regression analyses revealed risk factors associated with the development of posttraumatic stress disorder in which the strongest predictors being additional traumas, negative affectivity, and somatization. The findings add to existing research confirming the stressful nature of child sexual abuse and the variables that contribute to the development and severity of posttraumatic stress disorder.     

The Relationship Between Perceptions of Response to Disclosure of Childhood Sexual Abuse and Later Outcomes

This study assessed whether perceptions of others’ reactions to disclosure are related to psychological and physical outcomes among individuals with a history of child sexual abuse. Eighty-six female undergraduates completed a series of questionnaires assessing child sexual abuse, nonsexual trauma, depression, anxiety, posttraumatic stress disorder, somatic symptoms, disclosure, and social reactions to disclosure. Those who reported child sexual abuse endorsed higher levels of psychological and physical symptoms than those who reported a nonsexual traumatic event. Child sexual abuse survivors who reported more hurtful responses to disclosure had higher levels of posttraumatic stress disorder, anxiety, and physical symptoms than nonsexual trauma survivors. These findings suggest that many survivors of CSA may need psychological services, and an important focus of treatment may be assessing and strengthening social support.     

Acute Stress Disorder Symptoms Among Female Sexual Abuse Survivors Seeking Treatment

ABSTRACT

This exploratory study examined relationships between acute stress disorder (ASD) symptoms and sexual abuse history, distress, and social support among sexual abuse survivors seeking treatment. Participants were 32 women recruited for a pilot study of group treatment for sexual abuse survivors who completed self-report and interview measures. Many participants (37.5%) met criteria for all ASD symptoms. Also, ASD symptoms were significantly related to seeing the self as the causal locus of the abuse, forgetting the abuse for a period of time, and the number of abusers, the distress of a recent life event, other forms of distress, and poor social support, Acute stress disorder may occur among many sexual abuse survivors seeking treatment, requiring special intervention to help these patients to manage their reactions to ongoing stresses.     

Exploring Posttraumatic Outcomes as a Function of Childhood Sexual Abuse

There is sparse systematic examination of the potential for growth as well as distress that may occur for some adult survivors of childhood sexual abuse. The presented study explored posttraumatic growth and its relationship with negative posttrauma outcomes within the specific population of survivors of childhood sexual abuse (N = 40). Results showed that 95% of the participants experienced clinically significant post-traumatic stress disorder symptomatology related to their childhood sexual abuse. In conjunction with these high levels of negative symptoms, the population evidenced posttraumatic growth levels that were comparable to other trauma samples. This research has clinical relevance in terms of adding to the knowledge base on sexual abuse and the usefulness of this knowledge in therapeutic interventions and relationships.     

The Long-Term Consequences of Childhood Incestuous Victimization upon Adult Women's Psychological Symptomatology

Current estimates of the prevalence of incest suggest that 16-20% of the women in the United States may be victims of such sexual abuse by the age of 18. The long-term consequences of incestuous victimization appear lo be numerous, producing in its victims feelings of powerlessness, stigmatization, and betrayal many years after the abuse. Some of the diagnostic consequences of childhood sexual abuse include affective disorders, substance abuse, eating disorders, anxiety disorders, dissociative disorders, post-traumatic stress disorder. and sexual dvsfunction. Therefore. the vumse of the present study was to comp&e adult women who were'viciims of childhood incest to various control groups to determine whether there were differences in psychological symptomatology. The results of this study suggest that the long-term consequences of incest are numerous and varied. Adult incest survivors reported greater levels of psychological distress as well as more types of symptomatology when compared to all three control groups. Overall. the data describing the incest survivors indicated that they were significantly more dcpressed, alienated, inhibited. socially introverted, and yet interpersonally more sensitive than other groups studied.     

Training Knowledge of Professionals on Specific Topics in Child Sexual Abuse

This exploratory study examined the training background and self-reported level of knowledge of a group of professionals on specific topics in child sexual abuse. The results show that while the vast majority of those working with adult victims, female victims, and incest victims have received training, many professionals working in the area of child sexual abuse treatment have not had training on topics directly related to their work. It was found that fewer than 40% of those working with female offenders, victims and offenders who are gay or lesbian, victims and offenders who have developmental disabilities, or in cases where cultural issues are relevant, have had training in working with these types of cases. Those professionals who had received training reported feeling more knowledgeable on these topics than did those without training. It is recommended that graduate degree programs and continuing education programs examine their offerings in the area of child sexual abuse.     

Contributions of Child Sexual Abuse,Self-Blame,Posttraumatic Stress Symptoms,and Alcohol Use to Women’s Risk for Forcible and Substance-Facilitated Sexual Assault

Child sexual abuse and adult sexual assault have been linked to increased self-blame, posttraumatic stress symptoms, and alcohol use. The current study aims to examine (a) whether these constructs explain women’s risk for later adult sexual assault and revictimization, (b) whether such factors differentially confer risk for specific types of adult sexual assault (i.e., substance-facilitated and forcible), and (c) if self-blame confers risk indirectly through other risk factors. Multiple types of self-blame, posttraumatic stress, and alcohol use were examined among 929 female college students as serial mediators of the relationship between child sexual abuse and adult sexual assault and as risk factors for sexual revictimization among child sexual abuse survivors. In the model predicting risk for substance-facilitated adult sexual assault, child sexual abuse indirectly predicted greater risk for substance-facilitated adult sexual assault mediated through two separate paths: global blame-to-posttraumatic-stress and global blame-to-alcohol use. In the model predicting risk for forcible adult sexual assault, child sexual abuse directly predicted greater risk for forcible adult sexual assault, and this relation was mediated by the global blame-to-posttraumatic-stress path. Among child sexual abuse survivors, child sexual abuse specific characterological and behavioral self-blame directly predicted greater risk for forcible and substance-facilitated revictimization, but the pathways were not mediated by posttraumatic stress or alcohol use. Results emphasize the importance of assessing different types of self-blame in predicting posttraumatic stress symptoms as well as examining risk for sexual victimization and revictimization. Findings did not support hypotheses that increased posttraumatic stress would predict increased alcohol use but did indicate that heightened self-blame is consistently associated with heightened posttraumatic stress and that heightened global self-blame predicts increased alcohol use. Implications for future research and intervention are discussed.     

What women talk about. Sexuality issues of chemically dependent women

1. In group discussions on sexuality, the topics discussed most often by recovering chemically dependent women were incest and sexual child abuse; rape; sex while sober; values regarding sex; battering; women's health concerns; and coping strategies. 2. Addressing sexuality in an unstructured format allows the women time to deal with these issues as they are able, since strong emotions are evoked. 3. The group leader needs to be knowledgeable about sexuality and be comfortable with explicit sexual and abuse talk.     

The Nature of Posttraumatic Growth in Adult Survivors of Child Sexual Abuse

Potential negative sequelae for survivors of child sexual abuse is well documented. However, growing evidence suggests that some individuals who actively cope with traumatic events can progress from a negative trajectory toward positive psychological change, often termed posttraumatic growth. Current posttraumatic growth theories may be of limited applicability to developmental considerations involved in child sexual abuse. This explorative study examines posttraumatic growth among adult female survivors of child sexual abuse. In-depth interviews were conducted with six participants who believed they had grown through coping with their abuse. Data was analyzed using interpretative phenomenological analysis. Three superordinate and nine subordinate themes were identified and explored. Some participants reported experiencing growth and distress simultaneously. Theoretical and clinical implications are examined in relation to the study’s findings.     

Group issues and activities for female teen survivors of sexual abuse

The impact of sexual abuse can be devastating, especially for young girls at the crucial stage of adolescent development. Ramifications for these survivors of incest and extrafamilial abuse are addressed. Group therapy as an effective means of intervention is described. Group considerations discussed include group name; member and leadership selection; confidentiality; contracting and closed nature; parent meetings; self-disclosure; and objectives.Twelve weeks of group topics, activities, and homework are detailed. These topics are applicable to most female teen survivors of sexual abuse, independent of the age or gender of their perpetrators.     

Identification of Sexually Abused Female Adolescents at Risk for Suicidal Ideations: A Classification and Regression Tree Analysis

This study explored the clinical profiles of 77 female teenager survivors of sexual abuse and examined the association of abuse-related and personal variables with suicidal ideations. Analyses revealed that 64% of participants experienced suicidal ideations. Findings from classification and regression tree analysis indicated that depression, posttraumatic stress symptoms, and hopelessness discriminated profiles of suicidal and nonsuicidal survivors. The elevated prevalence of suicidal ideations among adolescent survivors of sexual abuse underscores the importance of investigating the presence of suicidal ideations in sexual abuse survivors. However, suicidal ideation is not the sole variable that needs to be investigated; depression, hopelessness and posttraumatic stress symptoms are also related to suicidal ideations in survivors and could therefore guide interventions.     

Exposure to child abuse and risk for mental health problems in women

Risk for adult mental health problems associated with child sexual, physical, or emotional abuse and multiple types of child abuse was examined. Logistic regression analyses were used to test study hypotheses in a population-based sample of women (N = 3,936). As expected, child sexual, physical, and emotional abuse were independently associated with increased risk for mental health problems. History of multiple types of child abuse was also associated with elevated risk for mental health problems. In particular, exposure to all three types of child abuse was linked to a 23-fold increase in risk for probable posttraumatic stress disorder (PTSD). Findings underscore relations between child emotional abuse and adult mental health problems and highlight the need for mental health services for survivors of multiple types of child abuse.     

Differentiating Children with and without a History of Repeated Problematic Sexual Behavior

Although the issue of dissociative amnesia in adult survivors of child sexual abuse has been contentious, many research studies have shown that there is a subset of child sexual abuse survivors who have forgotten their abuse and later remembered it. Child sexual abuse survivors with dissociative amnesia histories have different formative and therapeutic issues than survivors of child sexual abuse who have had continuous memory of their abuse. This article first discusses those differences in terms of the moderating risk factors for developing dissociative amnesia (e.g., age, ethnicity, gender, etc.) and then mediating risk factors (e.g., social support, trait dissociativity, etc.). The differences between the two types of survivors are then explored in terms of treatment issues.     

Self Psychology and Male Child Sexual Abuse: Healing Relational Betrayal

The prevalence of male child sexual abuse (MCSA) is higher than initially thought with up to 26 % of men in community samples reporting sexual abuse in childhood, and up to 36 % of men in clinical samples reporting childhood sexual abuse. Disclosure of MCSA is complex because of men’s difficulties in viewing themselves as victims, especially of sexual violence. This difficulty is exacerbated by societal attitudes that sexual abuse rarely occurs with boys, and is further complicated with the taboo of victimization by same sex perpetrators. Too often, the response to disclosure is disbelief and minimization. For these reasons disclosure is often delayed or withheld thus prolonging the abuse. The negative effects of child sexual abuse are well documented and far reaching with depression, anxiety, post-traumatic stress disorder, addictions, sexual dysfunction and impaired interpersonal relations as common presenting issues in therapy. Treatment is indicated for significant numbers of male survivors. This paper identifies aspects of interpersonal relational difficulties commonly experienced by male sexual abuse survivors, and describes self psychology as guiding a clinical approach to address these interpersonal difficulties. The application of self psychology with male sexual abuse survivors is traced and discussed through the use of a clinical case study with Adam.     

Compassion-Focused Therapy as an Intervention for Adult Survivors of Sexual Abuse

Child sexual abuse can have long-term negative impacts across psychological, physical, and interpersonal domains. Some of the common issues for survivors of sexual abuse include shame and self-blame, attachment-based difficulties, avoidant coping strategies, and reduced capacity for self-compassion. Compassion-focused therapy is a transdiagnostic intervention that specifically responds to these concerns. Compassion-focused therapy was originally developed for clients who experience high levels of shame and self-criticism and aims to strengthen the soothing and affiliative system through the cultivation of compassion. This article will highlight the theoretical alignment between some of the common issues and impacts associated with experiences of sexual abuse, with the core underlying principles of compassion-focused therapy. This includes (a) the capacity of the therapy’s evolutionary framework to reduce perceptions of self-blame, (b) the cultivation of compassion to respond to feelings of shame, (c) acknowledgment of the role of early attachment experiences and facilitation of corrective affiliative experiences, (d) regulation of the threat-based system following trauma, and (e) provision of an alternative to avoidant-based coping by responding to distress with compassion. It is proposed that the theoretical framework and core focus and aims of compassion-focused therapy are highly applicable for survivors of sexual abuse and therefore holds significant promise as a treatment option for this client group.     

The Effectiveness of Group Treatment for Female Adult Incest Survivors

Very few clinicians receive training in the treatment of sexual abuse, yet during their careers many will encounter victims of sexual abuse. This article discusses the incidence of child sexual abuse, defines incest, and discusses treatment options. A review of group treatment is explored, with results being documented providing support for the effectiveness of the group treatment process.     

Impact Evaluation of a Cognitive Behavioral Group Therapy Model in Brazilian Sexually Abused Girls

This study evaluated the impact of a cognitive behavioral group therapy model in Brazilian girls who had experienced sexual abuse. The effect of the waiting period before treatment and the enduring effectiveness of the treatment after six and 12 months were also evaluated. Forty-nine female sexual abuse victims between the ages of 9 and 16 completed instruments measuring depression, anxiety, stress, and post-traumatic stress disorder before, during, and after the group therapy. The group therapy had a positive impact on their psychological functioning, significantly reducing symptoms of anxiety, stress, and post-traumatic stress disorder. The therapeutic effects lasted six to 12 months after the treatment ended. The model proved effective for treating young female victims of sexual abuse.     

Predatory Priests: Sexually Abusing Fathers

The media, the public, and the Church have spotlighted the effects of the scandals on the Church rather than the effects of priest abuse on its victims. Child sexual abuse has ominous relational implications for its victims. It often results in distrust of authority; seeing relationships in hierarchical, exploitative terms; distance and isolation; and fear of relating. Dissociation, an adaptive response to trauma, can become a characteristic, dysfunctional response to stress. Boys often have particular problems because of socialized masculine-gender norms that men are not victims and concerns about the implications of same-sex abuse for their sexual orientation. To these aftereffects, sexual abuse by a priest adds betrayal of spirituality, unconscious feelings that incest has occurred, and a crisis of faith arising from a sense that one has betrayed God. Examples from film, clinical practice, and an interview with a mental health professional sexually abused as a boy illustrate these points.     

Correlates of Sexual Abuse in a Sample of Adolescent Girls Admitted to Psychiatric Inpatient Care

We examined correlations of child sexual abuse among 300 adolescent girls in psychiatric inpatient treatment. Diagnostic and Statistical Manual of Mental Disorders (4th ed.)-based psychiatric diagnoses were obtained from the Schedule for Affective Disorder and Schizophrenia for School-Age Children—Present and Lifetime and from data on family and behavioral characteristics from the European Addiction Severity Index (EuropASI). A total of 79 girls (26.3%) had experienced child sexual abuse during their lifetime. Child sexual abuse was associated with an adolescent’s home environment, sibling status, smoking, posttraumatic stress disorder diagnosis, self-mutilating behavior, and suicidal behavior. At least 62% of the perpetrators were acquaintances of the victims. Correlates of child sexual abuse can be used to identify child sexual abuse victims and persons at heightened risk for child sexual abuse.