Further understanding the systemic effects of childhood sexual abuse: a comparison of two groups of clinical couples

This study addressed the impact of traumatic experiences on dyadic relationships by comparing general stress and trauma symptoms and relationship impairment measures between two clinical groups: female childhood sexual abuse (CSA) survivors (n=15) and their male partners, and a control group of couples who reported no CSA (n=17). Both female CSA survivors and their partners reported higher symptoms of stress, suggesting support for the theory of secondary traumatic stress. Relationship impairment results did not support the hypothesis that CSA would negatively impact the dyadic functioning of couples. Clinical implications and recommendations for future research are provided.     

Emotionally Focused Therapy for couples and childhood sexual abuse survivors

This study explored Emotionally Focused Therapy (EFT) for couples with childhood sexual abuse survivors (CSA) and their partners. Half of the couples in this study reported clinically significant increases in mean relationship satisfaction and clinically significant decreases in trauma symptoms, and thematic analyses identified numerous areas where trauma survivors were challenged in fully engaging in the therapy process. In particular, trauma symptoms such as affect dysregulation and hypervigilance were identified to play a role in the challenges that survivors experienced in fully engaging in the EFT process. Results of these thematic analyses yielded clinical recommendations for working with CSA survivors and their partners in EFT for traumatized couples. Recommendations for future study were articulated.     

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.     

Maternal victimization and child trauma: The mediating role of mothers' affect

This study examined the effects of maternal childhood and adult victimization on child trauma symptomatology both directly and indirectly via three types of maternal affective problems as mediators (depression, anxiety, and hostility). A high proportion of mothers in the sample reported a history of childhood or adulthood physical and sexual abuse and findings showed that these experiences impacted how victimized women may function as parents. Mothers' adult victimization had a stronger effect on children compared to maternal childhood victimization. The relationship between maternal adult victimization and child trauma symptoms was mediated by maternal depression. Maternal anxiety mediated the relationship between both maternal childhood and adulthood victimization and child trauma symptoms, but anxiety played a buffering role. Maternal hostility was associated with both childhood and adulthood victimization, but did not serve as a mediator. Implications for practice with victimized mothers and their children are discussed.     

The risk of Telling: A Dyadic Perspective on Romantic Partners’ Responses to Child Sexual Abuse Disclosure and Their Associations with Sexual and Relationship Satisfaction

Among 70 community couples who reported childhood sexual abuse (CSA) and disclosure to their partner, this study examined associations between survivors’ perception of partner responses to their disclosure, and both partners’ sexual and relationship satisfaction. Participants completed self‐report questionnaires online. Results of path analyses within an actor–partner interdependence model indicated that survivors’ perceived partner responses of emotional support to disclosure were associated with their own and their partners’ higher sexual satisfaction. Survivors’ perceived responses of being stigmatized/treated differently by the partner were associated with their own and their partners’ poorer relationship satisfaction. Findings suggest that survivor‐perceived partner responses to the disclosure of CSA can have a positive and a negative impact on the sexual and relationship satisfaction of both partners.     

Exploring the Relationship Between Adverse Childhood Experiences and Hope

ABSTRACT

To explore the relationship between adverse childhood experiences and hope, a convenience sample of caregivers bringing in children for medical investigation of child abuse at a regional child advocacy center were surveyed for adverse childhood experiences and dispositional hope. Hope in this sample had a significant negative correlation to the adverse childhood experiences subscale “abuse” (r = –.19; p < .05). The relationship between hope and the other adverse childhood experiences subscales “neglect” (r = –.14) and “dysfunctional family” (r = –.16) was not statistically significant. An analysis of variance was performed to determine if caregivers who have experienced both sexual and physical abuse (M = 29.67; SD = 15.96) have lower hope scores compared to those caregivers who have experienced neither physical nor sexual abuse (M = 42.64; SD = 18.44). This analysis (F (1, 84) = 5.28; p < 0.05) showed that caregivers who experienced both physical and sexual abuse scored significantly lower on hope compared to their counterparts who experienced no adverse events, with an estimated effect size of moderate strength (d = 0.70). Higher adverse childhood experiences scores are associated with lower hope. This result was especially true for those adult caregivers who reported experiencing both physical and sexual abuse when compared to adults who did not experience either form of child trauma. While the empirical literature continues to demonstrate the negative consequences of adverse childhood experiences across the life span, hope offers a compelling new line of inquiry in child maltreatment research especially for studies targeting prevention or intervention.     

Treatment issues for survivors of physical and sexual abuse*

Many clients who participate in family therapy have experienced trauma such as physical and sexual abuse in their families of origin. Extensive literature suggests that abusive experiences can result in post-traumatic stress disorders, depression, anxiety, personality disorders, and other long-term effects. Without recognition of the effects that abuse can have on individuals, it is possible to misdiagnose clients or fail to provide them with adequate assistance. This study is an attempt to compare the symptomology of nonabused clients with physically and sexually abused clients using an empirically sound measure. The results demonstrate that the majority of clients who experienced physical and/or sexual abuse in their backgrounds scored in the clinical range on scales from the Millon Clinical Multiaxial Instrument (MCMI) (Millon, 1984). In contrast, clients who did not report abuse had significantly lower scores than the abused clients, and the majority of the nonabused clients scored in the nonclinical range on the scales of the MCMI. Treatment and theoretical implications surrounding the issues of abuse are discussed, and recommendations for marriage and family therapists are provided.     

Vicarious trauma: an exploratory study of the impact of providing sexual abuse treatment on clinicians' trust and intimacy

This study examined vicarious trauma effects in male and female clinicians who treat sexual abuse survivors (n = 111) and sexual offenders (n = 272). The national survey was conducted using a random sample of clinical members of two professional organizations. Analyses tested the relationships between demographic variables, maltreatment history, client population served, and cognitions about trust of and intimacy with others, using the Trauma Stress Institute Belief Scale (TSIBS-R-L, Pearlman 2003), the Childhood Trauma Questionnaire (CTQ, Bernstein & Fink, 1998), and author-generated questions. Respondents reported high rates of multiple forms of childhood maltreatment; however there was no relationship between history of child sexual abuse and vicarious trauma effects. Scores for self-reported disruption in cognitions about intimacy with others exceeded norms for mental health professionals. Sequential regression analyses were used to examine theoretically-derived variables. Implications for practice and research are detailed.     

Differences in childhood sexual abuse experience between adult Hispanic and Anglo women in a primary care setting

The literature on racial and ethnic factors in childhood sexual abuse is limited. The purpose of this exploratory study was to document Hispanic-Anglo differences in childhood sexual abuse experiences and assess whether these differences may be explained by socio-demographic and family environmental differences. Adult Hispanic (n = 69) and Anglo (n = 19) women from a family medicine clinic waiting room reporting a history of childhood sexual abuse completed an in-depth survey concerning the sexual abuse experience and their childhood environment. In this study, Hispanics were more likely to report a family member as the perpetrator and to experience more self-blame as a result of the abuse. Hispanics were also more likely to take action in response to the abuse, especially those who were more acculturated to U.S. culture. However, most of the observed differences in this study could be explained by socio-demographic or family environment variables, not by ethnic background. Qualitative research on the family environments of Hispanic victims of child sexual abuse may further explicate the dynamics and risk factors for abuse by family members.     

Stress From Daily Hassles in Couples: Its Effects on Intradyadic Stress,Relationship Satisfaction,and Physical and Psychological Well‐Being

According to the systemic‐transactional stress model (STM; G. Bodenmann, European Review of Applied Psychology, 1997; 47: 137), extradyadic stress from daily hassles can have a negative impact on the individual psychological and physical health and the couple's relationship. This study is the first one to test the STM propositions in a model that includes both partners’ individual and relational outcomes simultaneously. The model also includes actor and partner effects as well as the interdependence between partners’ processes. Cross‐sectional, self‐report data were collected from 110 community couples in Switzerland. Consistent with STM predictions, results from the path model analysis indicate that for actor effects extradyadic stress from daily hassles relates directly to lower psychological (increase in anxiety symptoms) and physical well‐being and only indirectly to lower relationship satisfaction through increased intradyadic stress from relationship problems and also through more depressive symptomatology in men. The female extradyadic stress and intradyadic stress had partner effects on the male intradyadic stress and the male relationship satisfaction, respectively. Limitations as well as research and clinical implications for marriage and family therapists are discussed.     

Sexual coercion within mixed-sex couples: the roles of sexual motives, revictimization, and reperpetration

Research suggests that a history of childhood sexual abuse, and previous experiences of sexual coercion, may predict sexual coercion victimization and perpetration. More recently, sexual motivation has been found to correlate with both consensual and non-consensual sexual activity. However, sexual motivation has not been examined in association with previous experiences of abuse and sexual coercion. The aim of this study was to investigate childhood sexual abuse, previous sexual coercion experiences, and sexual motives of both partners as possible risk factors for current sexual coercion victimization and perpetration within a sample of 209 mixed-sex couples. This study examined whether power, stress relief, partner pressure, and imposition motives contributed unique variance to the prediction of sexual coercion beyond that accounted for by past childhood sexual abuse and sexual coercion events. Using hierarchical logistic regressions, four predictive models were examined for both male and female sexual coercion perpetration and victimization. Results show that childhood sexual abuse was only a significant predictor of female sexual coercion perpetration, whereas male sexual coercion victimization and perpetration were predicted by sexual coercion victimization and perpetration in previous relationships. Power motives were also significant predictors of sexual coercion perpetration, and imposition was a significant predictor of sexual coercion victimization for both genders.     

Sexual Coercion within Mixed-Sex Couples: The Roles of Sexual Motives,Revictimization, and Reperpetration

Research suggests that a history of childhood sexual abuse, and previous experiences of sexual coercion, may predict sexual coercion victimization and perpetration. More recently, sexual motivation has been found to correlate with both consensual and non-consensual sexual activity. However, sexual motivation has not been examined in association with previous experiences of abuse and sexual coercion. The aim of this study was to investigate childhood sexual abuse, previous sexual coercion experiences, and sexual motives of both partners as possible risk factors for current sexual coercion victimization and perpetration within a sample of 209 mixed-sex couples. This study examined whether power, stress relief, partner pressure, and imposition motives contributed unique variance to the prediction of sexual coercion beyond that accounted for by past childhood sexual abuse and sexual coercion events. Using hierarchical logistic regressions, four predictive models were examined for both male and female sexual coercion perpetration and victimization. Results show that childhood sexual abuse was only a significant predictor of female sexual coercion perpetration, whereas male sexual coercion victimization and perpetration were predicted by sexual coercion victimization and perpetration in previous relationships. Power motives were also significant predictors of sexual coercion perpetration, and imposition was a significant predictor of sexual coercion victimization for both genders.     

Couples therapy for women survivors of child sexual abuse who are in addictions recovery: a comparative case study of treatment process and outcome

Treatment for women who are survivors of child sexual abuse and who have a history of substance abuse has largely involved gender-specific interventions. This study examines the use of conjoint couple therapy with a cohort of women who were survivors of child sexual abuse and who are in addiction recovery and with their partners. A comparative case study analysis incorporated standardized clinical measures with client and therapist interviews. Brief conjoint therapy was found to assist couples in the specific relationship skill areas of communication and mutual problem solving. Further, substantive gains were found in the realm of affective relations. The women reported an increase in support from their male partners, and the men reported a decrease in negative emotional atmosphere in the relationship.     

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.     

Vicarious trauma:predictors of clinicians' disrupted cognitions about self-esteem and self-intimacy

This study examined vicarious trauma in clinicians who provide sexual abuse treatment (N = 383). A random sample of clinical members from the Association for the Treatment of Sexual Abusers and American Professional Society on the Abuse of Children were surveyed. Vicarious trauma was measured using the Trauma Stress Institute Belief Scale (Pearlman, 2003). Maltreatment was measured using the Childhood Trauma Questionnaire (Bernstein & Fink, 1998). Respondents reported high rates of childhood maltreatment. Simultaneous multiple regression analyses were used to examine relationships between gender, age, maltreatment history, and vicarious trauma. Male gender predicted greater disrupted cognitions about self-esteem and self-intimacy. Clinician age and childhood emotional neglect predicted greater disrupted cognitions about self-intimacy. Implications for education, practice, and research are discussed.     

Long‐Term Physical Health Consequences of Adverse Childhood Experiences

This study examined associations between adverse childhood family experiences and adult physical health using data from 52,250 U.S. adults aged 18 to 64 from the 2009 to 2012 Behavioral Risk Factor Surveillance System. We found that experiencing childhood physical, verbal, or sexual abuse, witnessing parental domestic violence, experiencing parental divorce, and living with someone who was depressed, abused drugs or alcohol, or who had been incarcerated were associated with one or more of the following health outcomes: self‐rated health, functional limitations, diabetes, and heart attack. Adult socioeconomic status and poor mental health and health behaviors significantly mediated several of these associations. The results of this study highlight the importance of family‐based adverse childhood experiences on adult health outcomes and suggest that adult socioeconomic status (SES) and stress‐related coping behaviors may be crucial links between trauma in the childhood home and adult health.     

Complex trauma and mental health in children and adolescents placed in foster care: findings from the National Child Traumatic Stress Network

Many children in the child welfare system (CWS) have histories of recurrent interpersonal trauma perpetrated by caregivers early in life often referred to as complex trauma. Children in the CWS also experience a diverse range of reactions across multiple areas of functioning that are associated with such exposure. Nevertheless, few CWSs routinely screen for trauma exposure and associated symptoms beyond an initial assessment of the precipitating event. This study examines trauma histories, including complex trauma exposure (physical abuse, sexual abuse, emotional abuse, neglect, domestic violence), posttraumatic stress, and behavioral and emotional problems of 2,251 youth (age 0 to 21; M = 9.5, SD = 4.3) in foster care who were referred to a National Child Traumatic Stress Network site for treatment. High prevalence rates of complex trauma exposure were observed: 70.4% of the sample reported at least two of the traumas that constitute complex trauma; 11.7% of the sample reported all 5 types. Compared to youth with other types of trauma, those with complex trauma histories had significantly higher rates of internalizing problems, posttraumatic stress, and clinical diagnoses, and differed on some demographic variables. Implications for child welfare practice and future research are discussed.     

A Dyadic Perspective on Childhood Maltreatment for Women With Provoked Vestibulodynia and Their Partners: Associations With Pain and Sexual and Psychosocial Functioning

Childhood maltreatment is robustly associated with adult-onset vulvodynia, a common form of female genito-pelvic pain/penetration disorder. However, little is known about the impact of childhood maltreatment on current sexual, psychological, and relationship adaptation for couples with provoked vestibulodynia (PVD). This study examined the associations between childhood maltreatment and sexual and psychosocial functioning and pain in women with PVD, the most common subtype of vulvodynia, and their partners. A total of 49 couples (M_age women = 27.80, SD = 6.05; M_age men = 30.04; SD = 6.48) with PVD completed the Childhood Trauma Questionnaire (CTQ), as well as measures of sexual functioning, couple satisfaction, and anxiety. Women also reported on their pain during intercourse. Analyses were guided by the actor–partner interdependence model. Women’s higher reports of childhood maltreatment were associated with their lower sexual functioning and higher anxiety. Partners’ higher reports of childhood maltreatment were associated with their lower sexual functioning, lower couple satisfaction, and higher anxiety, as well as women’s lower couple satisfaction and higher anxiety. Both women’s and partners’ higher reports of childhood maltreatment were associated with higher affective pain for women. Findings suggest childhood maltreatment experienced by women with PVD and their partners should be considered as part of treatment planning.     

Relational Ethics,Depressive Symptoms,and Relationship Satisfaction in Couples in Therapy

The purpose of this study was to examine depressive symptoms and relationship satisfaction as problems related to relational ethics in one's family of origin and current partner relationships in a sample of 68 other‐sex couples seeking therapy at a large university clinic. We used the Actor Partner Interdependence Model to analyze dyadic data collected prior to beginning therapy. Specifically, we found significant actor effects between relational ethics in one's family of origin and depressive symptoms, as well as between depressive symptoms and low relationship satisfaction for both male and female partners. We also found significant partner effects for relational ethics in current partner relationship, depressive symptoms, and low relationship satisfaction. Clinical application of contextual therapy theory is discussed.     

Childhood sexual and physical abuse and adult vulnerability to PTSD: the mediating effects of attachment and dissociation

Two hundred and eighty-four adults from the metropolitan New York area reported on their history of childhood sexual abuse (CSA), childhood physical abuse (CPA), and on the nature of their exposure to the terrorist attack on the World Trade Center. The respondents also completed the Impact of Events Scale-Revised (IES-R), the Attachment Style Questionnaire (ASQ) and the Dissociative Experiences Scale (DES). Those reporting histories of CSA and/or CPA were found to endorse more serious symptoms of PTSD, as did those who witnessed the terrorist attack live. The presence of secure attachments and dissociative symptoms were related significantly to both CSA and CPA, and to scores on the IES-R. Adult attachment and dissociation were found to mediate the relationship between childhood abuse and severity of PTSD.