(Mis) Representations of the Long-Term Effects of Childhood Sexual Abuse in the Courts

SUMMARY

This study addresses the (mis) representations made by pro-false memory attorneys and expert witnesses in court regarding the long-term effects of childhood sexual abuse (CSA). Five pro-false memory positions were identified: (1) there is no causal connection between CSA and adult psychopathology; (2) the evidence is insufficient; (3) CSA does not cause specific trauma-related outcomes like borderline and dissociative identity disorder; (4) other variables than CSA explain the variance of adult psychopathology; and (5) the long-term effects of CSA are general and non-specific. Examining the testimony revealed that such pro-false memory testimony was based solely on a partial understanding of retrospective data and that pro-false memory experts do not cite the more recent prospective data. Reviewing the totality of the scientific evidence demonstrates that such pro-false memory testimony is inaccurate and has the potential of misleading the jury. Prospective studies provide sufficient evidence to causally link CSA to a number of areas of adult psychopathology including multiple, co-morbid psychiatric conditions, and possibly to link early parent-infant attachment pathology to the development of borderline and dissociative identity disorder.     

Errors of Logic and Scholarship Concerning Dissociative Identity Disorder

The author reviewed a two-part critique of dissociative identity disorder published in the Canadian Journal of Psychiatry. The two papers contain errors of logic and scholarship. Contrary to the conclusions in the critique, dissociative identity disorder has established diagnostic reliability and concurrent validity, the trauma histories of affected individuals can be corroborated, and the existing prospective treatment outcome literature demonstrates improvement in individuals receiving psychotherapy for the disorder. The available evidence supports the inclusion of dissociative identity disorder in future editions of the Diagnostic and Statistical Manual of Mental Disorders.     

Sexual and physical child abuse and the developtnent of dissociative personality traits. Canadian and British evidence from adolescent child welfare and child care populations

An attempt was made to construct a measure of dissociative personality traits from file review of 61 Canadian adolescents with a known history of sexual abuse before the age of six. The study was then extended to 55 British adolescents in residential care and therapy centres. Between 18 and 29% of adolescents displayed several features of dissociative personality, implying the possibility of multiple personality disorder. Those with two or more indicators of dissociative personality style tended to have more problematic behavioural histories, including a particularly high prevalence of deliberate self-harm. In the UK group the Dissociative Experiences Scale (Bernstein and Putnam, 1986) completed by 55 adolescents correlated 0.67 with the dissociative personality trait index constructed from case file review. Implications for treatment of abused children are discussed.     

(Mis) representations of the long-term effects of childhood sexual abuse in the courts

This study addresses the (mis) representations made by pro-false memory attorneys and expert witnesses in court regarding the long-term effects of childhood sexual abuse (CSA). Five pro-false memory positions were identified: (1) there is no causal connection between CSA and adult psychopathology; (2) the evidence is insufficient; (3) CSA does not cause specific trauma-related outcomes like borderline and dissociative identity disorder; (4) other variables than CSA explain the variance of adult psychopathology; and (5) the long-term effects of CSA are general and non-specific. Examining the testimony revealed that such pro-false memory testimony was based solely on a partial understanding of retrospective data and that pro-false memory experts do not cite the more recent prospective data. Reviewing the totality of the scientific evidence demonstrates that such pro-false memory testimony is inaccurate and has the potential of misleading the jury. Prospective studies provide sufficient evidence to causally link CSA to a number of areas of adult psychopathology including multiple, co-morbid psychiatric conditions, and possibly to link early parent-infant attachment pathology to the development of borderline and dissociative identity disorder.     

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.     

Learning from extremism in the history of mental health. The example of multiple personality disorder

This article reviews some of the history of the cultural forces that shaped the diagnosis of multiple personality disorder/dissociative identity disorder and the subsequent abuses that occurred at the time of its popularization. Some of the implications that can be drawn from these kinds of historical excesses in the field of mental health will be discussed. The article concludes by underscoring the ethical obligation inherent in maintaining healthy professional skepticism toward ideas driven by ideology and fad, rather than scientific empiricism.     

Post-Traumatic Stress Disorder,Dissociation, and Neuropsychological Performance in Latina Victims of Childhood Sexual Abuse

This study compared the memory, attention/concentration, and executive functioning of 12 women with histories of child sexual abuse with a control group of 12 women without childhood abuse. Participants completed a neuropsychological test battery and various instruments assessing post-traumatic stress disorder and dissociation. The child sexual abuse group had lower performance than the control group on long- and short-term visual and verbal memory and presented more limited performance on executive functioning tasks. Functioning in these areas showed a negative correlation with post-traumatic stress disorder and dissociative symptoms. These findings suggest that child sexual abuse is associated with memory and executive functioning deficits and supports the idea that people with trauma histories and increased post-traumatic stress disorder and dissociation symptoms may have alterations in neuropsychological functioning.     

Transference and countertransference in the treatment of adult survivors of abuse with a somatoform disorder

The understanding of transference and countertransference has changed a great deal since Freud introduced the terms. A case example indicates one way the patient’s and clinician’s past experiences and expectations interact to create a here and now relationship that is highly influenced by transference/countertransference. The understanding of both terms as aspects of a mutually constituted interaction has practice implications for the treatment of adult survivors of abuse who have a somatoform disorder.     

Family environment and adult attachment as predictors of psychopathology and personality dysfunction among inpatient abuse survivors

The current study explored the role of early family environment and adult attachment style in explaining long-term outcomes among child abuse survivors. Adult patients (N = 80) in a trauma treatment program were assessed for clinical diagnosis and administered a multiscale questionnaire. Hierarchical regression analyses were significant for dissociative identity disorder (DID), substance abuse, anxiety disorder, posttraumatic stress, somatization, and six personality disorder dimensions. Adult attachment styles were significant predictors of most outcome variables. Of particular note was the strong contribution of attachment avoidance to DID. Five family environment scales (Independence, Organization, Control, Conflict, Expressiveness) also contributed to various psychopathological outcomes. Evidence emerged supporting a mediating role for attachment style in the link between family independence and five personality disorder dimensions.     

Clinical Management of Gender Dysphoria in Young Boys

In this study the clinical management of young boys (average age 6) who are gender identity disordered and who present with genital self injurious behavior is discussed. It is argued that the symptom of genital mutilation is often missed because it is not asked for in the clinical interview. A review of the literature, and case history material, suggests that the symptom of genital self injurious behavior is only found among children who are gender dysphoric. Young boys who experience severe gender dysphoria also have a serious affective disorder which must be addressed. In order to address the clinical emergency and to assist the families in getting the necessary treatment for their children specific recommendations for interventions are made.     

THE PARENTING EXPERIENCES OF MOTHERS WITH DISSOCIATIVE DISORDERS

This article presents a qualitative analysis of the experience of parenting of mothers with dissociative disorders. This analysis was performed to complement the quantitative analysis of problems of mothers with dissociative disorders that Benjamin, Benjamin, and Rind (1996) presented previously. They found that the functioning of these mothers, as well as their subjective experience of mothering, was poorer that that of either clinical or nonclinical control mothers. Our goal was to provide a clearer, richer picture of their problems in parenting. Using the mothers' own words, we describe how the five symptom areas of dissociation (amnesia, depersonalization, derealization, identity confusion, and identity alteration) impeded their parenting efforts. We conclude with a discussion of the necessity of addressing parenting in the treatment of client-mothers with dissociative disorders.     

Filling the psychic gap: Understanding psychosomatic problems in a multi-cultural clinic

This paper describes an analytic approach I used some years ago when working in a multi-cultural clinic to understand psychosomatic difficulties in an Asian Muslim woman who suffered from recurring headaches and dizzy spells. Her symptoms revealed and concealed a much needed psychic equilibrium aimed at producing a stalemate in her mental growth and development. The headaches occurred when she began to think about herself, particularly conflicting thoughts and feelings which she found intolerable because it represented signs of psychic movement and separation. The dizzy spells acted like a psychic switch that closed her mind down and enabled her to escape into a phantasy of fusion with her mother which would have posed another type of psychic threat--the potential loss of her identity. Adopting others both literally and metaphorically had the aim of filling a psychic gap left by a failure of internalisation resulting in an 'addictive' way of relating to others such as her husband and the wider system of health care professionals who ultimately failed her.     

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.     

Researching Sexual Revictimisation: Associated Ethical and Methodological Issues,and Possible Solutions

This paper has been inspired by the processes of preparing for ethical scrutiny and seeking ethical approval for a series of studies examining causal mechanisms that might facilitate sexual revictimisation. The focus here is on just four of the issues that arose in the context of the first study: a web‐based survey. One of the aims of the survey is to test whether victims of child sexual abuse who experienced a period of psychogenic or dissociative amnesia demonstrate an exaggerated risk for adolescent/adult sexual assault during this amnesic phase. That is, cases where survivors report ‘suddenly remembering’ in adulthood that they were abused as children, but state that prior to this ‘remembering’ they had no prior knowledge of their abuse. The study design is considered to be the first ethical issue. To enhance the methodological robustness a strategy has been employed to reduce the erroneous inclusion of currently amnesic participants in the non‐abused comparison group. Secondly, consideration is given to the likely harms and benefits that might be incurred or bestowed upon the participants. Thirdly, problems of both re‐traumatisation and vicarious traumatisation in relation to the researcher are contemplated and juxtaposed against the possibility of the facilitation of post‐traumatic growth and a personal shift towards wisdom and generativity. Finally, the survey title was originally criticised as negating ‘fully’ informed consent and a defence is therefore offered that ultimately gained ethical approval. It is hoped that these deliberations and insights may prove useful to others in planning their own research and ethics proposals.     

Taiwan's identity in formation: in reaction to a democratizing Taiwan and a rising China

The formation of Taiwanese identity is a good example to make sense of the theoretical debate between primordialism and constructivism. Based on the two-level multinomial logit results, this paper proves that primordial ethnicity in Taiwan becomes less salient; rather, changing sociopolitical contexts turn out to be the dominant factor in shaping ethnic identity. Specifically, it indicates how the democratic transition has brought about various types of mechanisms, which smoothly disenchant the dominant Chinese identity. As the Taiwanese renaissance emerges to take a leading role in Taiwan's political platform, ethnic identity might be reshaped in accordance with this mainstream Taiwanese ideology. This study also shows that reformation of ethnic identity in Taiwan relies as much on cognition of state boundaries as on the evaluation of political-economic conditions on both sides of the Taiwan straits.     

Acquired disability in young women: a challenge for identity?

ABSTRACT

Youth can be described as a transitional phase for the formation of identity. As young people often hold taken-for-granted assumptions regarding their future, disability may pose a challenge for their identity development. This paper analyses the retrospectively written autobiographical narratives by three young women who became disabled during their adolescence. The structure of the narratives is approached with sociologist Arthur Frank’s typology of illness narratives and identity through data-driven content analysis. This paper suggests that chaotic stories may hinder the development of identity, as the identity is described as delayed, hidden, silenced or neglected.     

Social mobility and the well‐being of individuals

Several papers published in recent years have revived interest in Sorokin's dissociative thesis: the view that intergenerational social mobility has detrimental effects on the social relationships and wellbeing of individuals. In this paper, I test the dissociative thesis using data from the British Household Panel Survey and Understanding Society. On a wide range of indicators that measure participation in civic associations, contact with parents, close personal relationships, social support, subjective wellbeing, etc. individuals who have achieved long‐range upward mobility (i.e. those who move from working class origin to salariat destination) tend to fare better than those who are immobile in the working class. Those who have experienced long‐range downward mobility (moving from salariat origin to working class destination) do about as well as second‐generation members of the working class. Overall, there is no support for Sorokin's thesis.     

The Role of Maintaining Telephone Contact with Parents During the Teaching of a Personal Safety Program

Although recent evidence suggests that parents can be effective instructors of a personal safety program, the extent to which these results depend on maintaining contact with parents during program implementation has yet to be determined. This study examined the effectiveness of a program when taught by parents who either were or were not contacted during the teaching of the program. Preschool-aged children in both groups demonstrated enhanced knowledge and skill gains relative to children assigend to a delayed treatment control group. Low-income preschoolers learned prevention concepts and skills without being upset by the program, and their parents also appeared to benefit from teaching the program. However, the probability of completing the program was higher for parents who were contacted throughout program implementation, suggesting that personal contact may enhance motivation for some parents. Implications of the study for the child sexual abuse prevention field are discussed.     

Applying an Ecological Framework to Understanding Drug Addiction and Recovery

ABSTRACT

A new conceptual model of drug addiction and recovery, the Acculturation Model, is presented, with “addiction” and “recovery” understood as distinct sociocultural phenomena with their unique prescribed behaviors, rituals, symbols, and language that serve to construct and consolidate a cultural identity. The model suggests that individuals in recovery from drug addiction will need to make a cultural transformation in order to maintain sobriety. Examples of specific rituals that may help facilitate movement from addiction to recovery are detailed.     

Perception vs. Circumstances of the Child Sexual Abuse Event in Relation to Depression and Post-traumatic Stress Symptomatology

The study examined the impact of the circumstances of childhood sexual abuse on post-traumatic stress symptoms and depression among female adult survivors of childhood sexual abuse. The sample consisted of 225 Israeli women divided into two groups according to the identity of the perpetrator (nonfamily perpetrator versus a family member perpetrator). A self-report questionnaire was used consisting of the following scales: demographic variables, the Traumatic Events Questionnaire, Childhood Sexual Experiences Scale, Post-Traumatic Stress Disorder Symptom Scale, and Depression Scale. The findings indicated that the identity of the offender significantly differed between groups only if intercourse had occurred. Women who experienced coerced intercourse scored significantly higher on depression and post-traumatic stress compared to those who experienced other forms of childhood sexual abuse.