Self‐Mutilation and Homeless Youth: The Role of Family Abuse,Street Experiences,and Mental Disorders

Self‐mutilation, which is the act of deliberately harming oneself, has been overlooked in studies of homeless and runaway youth. Given their high rates of abuse and mental health disorders, which are associated with self‐mutilation, homeless and runaway youth provide an ideal sample in which to investigate factors associated with self‐mutilation among a nonclinical population. Based on interviews with 428 homeless and runaway youth aged 16 to 19 years in 4 Midwestern states, the current study revealed widespread prevalence of self‐mutilation among these young people. Multivariate analyses indicated that sexual abuse, ever having stayed on the street, deviant subsistence strategies, and meeting diagnostic criteria for depression were positively associated with self‐mutilation. The findings are interpreted using stress theory and affect‐regulation models.     

Mental disorder,subsistence strategies,and victimization among gay,lesbian, and bisexual homeless and runaway adolescents

This study compares participation in deviant subsistence strategies, street victimization, and lifetime prevalence of five mental disorders (conduct disorder, major depressive disorder, post‐traumatic stress disorder, alcohol abuse, and drug abuse) among heterosexual males and females (n = 366) and gay, lesbian, and bisexual (n = 63) homeless and runaway adolescents from the first wave of a longitudinal study of homeless youth in four Midwestern states. The results indicate that gay, lesbian, and bisexual adolescents were more likely to have been physically and sexually abused by caretakers, were more likely to engage in risky survival strategies when on their own (including survival sex), were more likely to be physically and sexually victimized when on the streets, and were more likely to meet criteria for mental disorder than were their heterosexual counterparts.     

Mental disorder, subsistence strategies, and victimization among gay, lesbian, and bisexual homeless and runaway adolescents

This study compares participation in deviant subsistence strategies, street victimization, and lifetime prevalence of five mental disorders (conduct disorder, major depressive disorder, post-traumatic stress disorder, alcohol abuse, and drug abuse) among heterosexual males and females (n = 366) and gay, lesbian, and bisexual (n = 63) homeless and runaway adolescents from the first wave of a longitudinal study of homeless youth in four Midwestern states. The results indicate that gay, lesbian, and bisexual adolescents were more likely to have been physically and sexually abused by caretakers, we more likely to engage in risky survival strategies when on their own (including survival sex), were more likely to be physically and sexually victimized when on the streets, and were more likely to meet criteria for mental disorder than were their heterosexual counterparts.     

Mental Disorders,Comorbidity, and Postrunaway Arrests Among Homeless and Runaway Adolescents

This study examined the associations between lifetime mental disorder, comorbidity, and self‐reported postrunaway arrests among 428 (187 males, 241 females) homeless and runaway youth. The analysis examined the pattern of arrests across five lifetime mental disorders (alcohol abuse, drug abuse, conduct disorder, major depressive episode, and posttraumatic stress disorder). The adolescents, ranging from 16 to 19 years old, were interviewed directly on the streets and in shelters in four Midwestern states using computer‐assisted personal interviewing. Extensive self‐reports of early life history, behaviors since running away from home, and diagnostic interviewing (UM‐CIDI and DISC‐R) were used to estimate possible disorders. There was a high level of postrunaway arrests reported by the youth; more than half were arrested at least once after the initial runaway, with the average of 4.4 times. Consistent with the hypotheses, there were differential associations between individual mental disorders and involvement with the criminal justice system. Only externalizing disorders such as substance abuse and conduct disorder were related to arrest. Street youth with multiple externalizing and internalizing disorders were more likely to be arrested than nondisordered youths.     

Child Sexual Abuse,Post-Traumatic Stress Disorder,and Substance Use: Predictors of Revictimization in Adult Sexual Assault Survivors

This study examined the unique effects of child sexual abuse simultaneously with post-traumatic stress disorder symptom clusters, problem drinking, and illicit drug use in relation to sexual revictimization in a community sample of female adult sexual assault victims. Participants (N?=?555) completed two surveys a year apart. Child sexual abuse predicted more post-traumatic stress disorder symptoms in adult sexual assault victims. Post-traumatic stress disorder numbing symptoms directly predicted revictimization, whereas other post-traumatic stress disorder symptoms (reexperiencing, avoidance, and arousal) were related to problem drinking, which in turn predicted revictimization. Thus, numbing symptoms and problem drinking may be independent risk factors for sexual revictimization in adult sexual assault victims, particularly for women with a history of childhood sexual abuse.     

Post-Traumatic Stress Disorder Among College Student Victims of Acquaintance Assault

Summary

Post-traumatic stress disorder symptomatology was evaluated among 316 college women who reported coercive sexual experiences. History of victimization, attributions of blame, and current symptoms were assessed. Acquaintance assault victims reported significantly higher levels of Post-Traumatic Stress Disorder (PTSD) symptoms than non-victims, and one-third exceeded criteria for clinical levels of distress. Situational variables, including the type of assault, were not associated with PTSD status or symptoms. Cognitive appraisals, however,'were significantly associated with PTSD symptomatology. Attributions of blame were all associated with PTSD status, with characterological self-blame also being associated with level of current symptomatology. The results document the negative psychological consequences of acquaintance assaults among college students and help to focus the efforts of treatment programs for acquaintance assault victims. In addition, the results highlight the importance of cognitive appraisals in mediating effects of sexual victimization.     

Exploring Mental Health Adjustment of Children Post Sexual Assault in South Africa

Large numbers of children are affected by child sexual abuse in South Africa. This study aimed to assess psychological adjustment of children post sexual assault. In-depth, semistructured interviews were conducted with caretakers, and structured interviews using mental health assessment screening tools were given to children at three intervals over a five-month period after presentation at a sexual assault center. Almost half of the children met clinical criteria for anxiety, and two-thirds met criteria for full symptom post-traumatic stress disorder two to four weeks post disclosure. With standard care, we observed some recovery; 43.3% of children still met full symptom post-traumatic stress disorder nearly six months postdisclosure. Our findings indicate that current practice in South Africa does not promote adequate recovery for children.     

Abuse, support, and depression among homeless and runaway adolescents

This study examines the effectiveness of social support networks on psychological well-being among 602 homeless and runaway adolescents. The respondents were interviewed in shelters, drop-in centers, and on the streets in cities of four Midwestern states (Missouri, Iowa, Nebraska, and Kansas). The path model was used to test the direct effect of family abuse and precocious independence on adolescent depressive symptoms and indirect effects through social support networks. Results indicate that although abusive family origins contribute directly to depressive symptoms there are indirect effects of family abuse and early independence through social support networks. Family abuse and early independence drive homeless adolescents to rely on peers for social support. While support from friends on the street reduces depression, association with deviant peers increases depression.     

The Impact of Childhood Sexual Abuse on Later Sexual Victimization among Runaway Youth

Path analysis was used to investigate the impact of childhood sexual abuse on later sexual victimization among 372 homeless and runaway youth in Seattle. Young people were interviewed directly on the streets and in shelters by outreach workers in youth service agencies. High rates of both childhood sexual abuse and street sexual victimization were reported, with females experiencing much greater rates compared with their male counterparts. Early sexual abuse in the home increased the likelihood of later sexual victimization on the streets indirectly by increasing the amount of time at risk, deviant peer affiliations, participating in deviant subsistence strategies, and engaging in survival sex. These findings suggest that exposure to dysfunctional and disorganized homes place youth on trajectories for early independence. Subsequently, street life and participation in high‐risk behaviors increases their probability of sexual victimization.     

Coping,Emotion Regulation,and Self-Blame as Mediators of Sexual Abuse and Psychological Symptoms in Adult Sexual Assault

This study examined whether coping, emotion regulation, and self-blame mediate relationships of trauma histories with post-traumatic stress disorder and depression in adult sexual assault victims (N = 1863). A path analysis showed that theorized mediators partially mediated associations between trauma history variables and psychological symptoms. Specifically, child sexual abuse severity was related to greater post-traumatic stress disorder and depression indirectly through maladaptive coping and decreased emotion regulation but not self-blame. Other traumas had direct relationships with symptoms and partially mediated effects through maladaptive coping and emotion regulation. Child sexual abuse was unrelated to self-blame, but other traumas were related to greater self-blame. Results differed according to whether women had counseling post-assault. Implications are drawn for future research and clinical treatment of adult sexual assault victims.     

The relationship between childhood sexual abuse, complex post-traumatic stress disorder and alexithymia in two outpatient samples: examination of women treated in community and institutional clinics

Relationships between trauma variables, complex post-traumatic stress disorder (complex PTSD), affect dysregulation, dissociation, somatization, and alexithymia were studied in 70 women with early-onset sexual abuse treated in community-based private (n = 25) or clinic outpatient settings (n = 45). Measures were the Toronto Alexithymia Scale-20 and the Psychological Trauma Assessment Program. Compared with the community sample, the clinic sample (1) met diagnostic criteria for both lifetime and current complex PTSD; (2) showed correlations between current affect dysregulation, dissociation, and somatization with alexithymia; and (3) higher levels of alexithymia. Results suggest the clinic sample continued to experience current forms of suffering, risk, and vulnerability associated with early-onset sexual trauma. The findings may have implications regarding types of treatment available in community versus clinic settings.     

The effects of a high-risk environment on the sexual victimization of homeless and runaway youth

Based on the structural-choice theory of victimization, the current study examines the effects of a high-risk environment on the sexual victimization of 311 homeless and runaway youth. Results from logistic regression revealed that survival sex, gender, and physical appearance were significantly associated with sexual victimization. Results from a series of interactions also revealed that the effects of deviant behaviors on sexual victimization varied by gender and age. Although males and females engaged in similar activities, young women were more likely to be victims of sexual assault. These findings suggest that engaging in high-risk behaviors predispose some people to greater risks but it is the combination of these behaviors with gender and/or age that determines who will become victimized.     

Childhood Sexual Abuse,Adult Psychiatric Morbidity,and Criminal Outcomes in Women Assessed by Medium Secure Forensic Service

There is little literature on childhood sexual abuse in women seen by forensic services. A cohort of 225 cases of women seen by forensic services in a medium secure unit in the UK were examined, and childhood sexual abuse and non–childhood sexual abuse cases were compared. Over half the sample had a history of childhood sexual abuse, and 5.6% of this group were victims of a subsequent sexual assault in adulthood. The perpetrators were all male. The majority of intrafamilial cases resulted in victims being raised in environments outside the family home. Childhood sexual abuse was associated with later relationship, educational, and occupational difficulties. Significant associations were also seen with personality disorder, self-harm, and substance misuse. Treating services need to recognize the potential importance of childhood sexual abuse in their models of care given the complexity of the association between childhood sexual abuse and psychosocial needs and its impact on successful rehabilitation.     

Comparing gang and individual rapes in a community sample of urban women

Little research has compared victims of gang and individual rapes, with only a few studies of college and police samples. This study compared gang (e.g., multiple offender) and individual (e.g., single offender) rapes in a large, diverse sample of female victims from the community. Comparisons of trauma histories (e.g., child sexual abuse), assault characteristics (e.g., offender violence) and outcomes (sexual acts, physical injuries), and current functioning (e.g., posttraumatic stress disorder, lifetime suicide attempts) showed that gang rape victims were worse off overall compared with victims of single offenders. In terms of help seeking, there were few differences in informal support seeking, but gang rape victims perceived their social networks more negatively. Gang rape victims reported to police, medical, and mental health sources more often than single-offender victims and received more negative social reactions from those they told about their assaults. Suggestions for future research and intervention with gang rape victims are provided.     

Correlates of comorbid PTSD and polysubstance use in sexual assault victims

A diverse sample of community-residing women in a large metropolitan area who had experienced adult sexual assault was surveyed using standardized measures in an NIAAA-funded study (2003-2004). Four groups (N = 503) of victims: (1) post-traumatic stress disorder (PTSD)-only, (2) PTSD and illicit drug use, (3) PTSD and drinking problems, and (4) PTSD and polysubstance use were compared using bivariate analyses. Victims with PTSD/polysubstance use had lower socioeconomic status, more extensive trauma histories, worse current psychological functioning, more problematic post-assault psychosocial experiences, and more sexual revictimization at follow-up than those with PTSD only. Implications for future research are discussed.     

A comparison of drug involvement between runaways and school youths

Problems related to homeless/runaway youths have received increased attention in recent years. Homeless/runaway youths manifest many problems in addition to being absent from home and without supervision of a parent or guardian. The purpose of the study was to determine drug use and abuse patterns of homeless/runaway youths and to compare those patterns, along with attitudes toward selected illicit behaviors, with similar data collected from adolescents in school. Data were collected from persons (n = 253) in homeless/runaway shelters in the southeast United States. Comparisons made with data from other studies of runaways and of youths in school indicate that drug use and abuse is two-three times more prevalent for runaways than with the school youths. Runaways' attitudes toward selected illicit behaviors are more tolerant than those of school youths. Intervention programs for runaway/homeless youths should reflect an understanding of the complexity of the psycho-social and behavioral history of the clients which is much different than that of those who are in school.     

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.     

Age and gender differences and predictors of victimization of the older homeless

Using data from the National Survey of Homeless Assistance Providers and Clients (NSHAPC) and an application of Felson's Routine Activities Theory, this paper examines gender and age differences in victimization experiences of a sample of more than 4,200 homeless and near-homeless people, mostly adults. Results suggest that there are no differences in victimization experience by homelessness status and that the negative relationship between age and victimization rates found in the general population is also found in the homeless population. However, the relationship is relatively weak and erratic, suggesting that homeless older adults who are at least 50 years old are at increased risk of becoming victims, a finding consistent with Routine Activities Theory. In addition, similar to research with other populations, younger homeless males are statistically more likely to report being victims of theft and physical assault while females of all ages are more likely to report being victims of sexual assault. However, for older homeless adults, the gender difference in likelihood of victimization disappears. Perhaps because older homeless women are labeled as easy targets, they were equally as likely as men to be victims of physical assault and theft in old age. This is also consistent with Routine Activities Theory.     

Trends in the prevalence and characteristics of sexual violence: a cohort analysis

Although recent statistics hint that rates of reported rape and child sexual abuse began to decline in the 1990s, little is known about changes in the characteristics of victimizations over time or about the implications of these changes for policy and services. This investigation uses data from a general population survey to examine sexual assault trends in two ways: by age cohort and by historical era in which a first sexual assault experience occurred. Findings suggest that the lifetime prevalence of sexual assault has not significantly changed across cohorts of women in their 20s to 50s. Characteristics of women's experiences across cohorts may be shifting, however, with early childhood experiences of sexual victimization showing a slight decline, accompanied by increases in assault rates during adolescence. Additionally, although help-seeking among victims has increased, women's perceptions of their community's responsiveness have worsened slightly. Research and intervention implications are discussed.