History of sexual abuse and parental alcohol misuse: Risk,outcomes and protective factors in adolescents

This study examined the school performance, suicidal involvement, disordered eating behaviors, pregnancy risk and chemical use of teenagers with a history of sexual abuse or parental alcohol misuse and found that they had higher rates of these adverse outcomes than among a comparison group of teenagers without such background risk factors. Adolescents with dual-risk background reported higher levels of suicide risk, disordered eating, sexual behaviors and chemical abuse than teenagers with only one background risk factor. Among index group members, protective factors against these adverse outcomes included a high degree of religiosity and the ability to discuss problems with family or friends. Risk factors that increased the likelihood of adverse outcomes included depression, perceived substance use in school and worries about family financial security.The first author was supported in the preparation of this article by a grant from the Lois and Samuel Silberman Fund of New York.     

Appropriate Terminology for the Alcohol,Eating, and Physical Activity Relationship

Abstract

“Drunkorexia” merges prior literature identifying positive relationships between (a) alcohol use/abuse and disordered eating/eating disorders, (b) alcohol use/abuse and physical activity, and (c) disordered eating/eating disorders and physical activity. The term, highlighting an individual's proactive and/or reactive weight management behaviors (ie, disordered eating, physical activity) in relation to alcohol consumption, originated in news editorials and has recently gained recognition via use in scholarly publications. The purpose of this commentary is to recommend discontinuing use of the term “drunkorexia” due to (a) inconsistent definitions of drunkorexia across investigations, (b) drunkorexia being a misnomer, and (c) the medical community's lack of recognition/acceptance of drunkorexia. Because the behaviors encompassed by drunkorexia are of concern to researchers and health professionals, future investigations are still warranted. However, until a medically recognized term/phrase is accepted, scholars should utilize more appropriate characterizations such as “weight-conscious drinkers,” “weight management behaviors of drinkers,” or “Eating Disorders Not Otherwise Specified” (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision).     

Eating Disorders and Additional Psychopathology in Women

Eating disordered individuals are often found to exhibit additional psychopathology such as depression, anxiety, substance abuse, and "borderline symptoms" such as self-injury and suicidality. This pilot study examined 535 female subjects with eating disorders to determine the relationship between such additional psychopathology and a prior history of sexual abuse. While few differences were found on general psychiatric/psychological symptoms as measured by the SCL-90-R, subjects that reported a history of sexual abuse were found to have more prior suicide attempts and hospitalizations, and more frequent self-injury and alcohol problems. These findings suggest that symptoms seen in some eating disorder patients that are frequently described as "borderline" may be indicators for a history of sexual abuse.     

Laxative abuse: a hazardous habit for weight control

Laxative abuse is an increasingly popular weight-loss method on college campuses, particularly for individuals with eating disorders. It is a dangerous habit, which many mistakenly believe will prevent caloric absorption and weight gain. Serious medical problems that may occur with laxative abuse include electrolyte and fluid imbalance, structural and functional colonic changes, and allergic reactions. Because patients are often secretive about abusing laxatives, laxative abuse should be considered if there is suspicion about the use of potentially destructive weight-control methods or about an eating disorder. A complete history and physical exam are essential parts of an assessment that should also include questions about diet, eating and exercise habits, and body image. Laboratory tests may provide additional supportive data. Treatment includes education, discontinuation of laxatives, medical follow-up as necessary, and psychotherapy. A college campus is an ideal forum for education, referral, and prevention programs.     

Symptoms of Eating Disorders Among Females in Drug Addiction Treatment

The aim of this study is to measure and describe symptoms of eating disorders among females in treatment for drug addiction in Norway. Previous clinical and epidemiological studies have revealed coprevalence between eating disorders and substance use or abuse. However, few studies have measured eating disorders in drug-using samples and even fewer within the context of drug treatment. In this study, 29 females with drug use disorder in residential treatment were tested with the Eating Disorder Inventory–2. A subgroup of 9 females (31%) with significant symptoms of eating disorders was identified. The characteristics of this group and possible clinical consequences are discussed.     

Enhancing Health-Conscious Behaviors Among Clients in Substance Abuse Treatment Programs

The physical health of substance abuse clients significantly deteriorates because of the client’s prolonged abuse of alcohol and other drugs and accompanying behaviors. The purposes of this study are (a) to understand how substance abuse clinicians think about the health needs of their clients, (b) to identify the mechanisms through which clinicians seek to enhance health-conscious behaviors among their clients, and (c) to identify how substance abuse clinicians view their role in enhancing health-conscious behaviors among their clients. A qualitative study was conducted using in-depth, semistructured interviews with substance abuse clinicians (N = 16) from 4 substance abuse treatment centers. Using the theory of planned behavior as a framework for understanding the promotion of health-conscious behaviors in substance abuse treatment, the findings suggest that substance abuse clinicians are capable of enhancing health-conscious behaviors among clients in substance abuse programs.     

Evaluating the effectiveness of a school drug and alcohol prevention curriculum: a new look at "Here's Looking at You, Two"

The article reports on the results of an evaluation of a school drug and alcohol prevention curriculum marketed under the title, "Here's Looking at You, Two." Previous evaluations, unreported in the literature and having unresolved methodological problems, have found that while the program appears effective at transmitting information regarding drug and alcohol abuse, it has not been effective at changing the underlying attitudes and behaviors that, in part, explain substance abuse. Employing a more rigorous methodology, our examination of a relatively large sample across five school districts provides support for previous findings. Over the short-term of one year, the program was particularly effective at transmitting substance information to primary and middle school students. The program, however, produced very little of the expected effect on the underlying attitudes that are critical to changing substance abuse behaviors.     

Food-Related Behaviors of Women in Substance Abuse Recovery: A Photo-Elicitation Study

The aim of this multi-method qualitative study was to explore the eating behaviors and food choices of nine purposively sampled low-income women aged 29 to 40 years who were engaged in a residential substance use disorders recovery program. Findings were limited to photo-elicitation interviews with the women that focused on nutritional choices and issues outside their family context. Consensual data analysis revealed a recovery process that began with cognitive reawakening and an increased focus on and desire for healthier nutrition-related decisions and lifestyle, particularly in the area of weight gain that many of the women experienced.     

Transsexualism,Dissociation,and Child Abuse

Forty-five selfdefined female-to-male transsexuals were interviewed as part of a wide ranging sociological field study about female-to-male transsexuals. The data in this study are unusual in that they were obtained outside of any clinical settings. Questions were asked about childhood experiences of physical, sexual and emotional abuse. Sixty percent reported one or more types of severe child abuse. In the course of discussing other issues, participants also reported having experienced many of the commonly cited initial and long-term effects of child abuse, including fear, anxiety and depression, eating disorders, substance abuse, excessive aggression, and suicide ideation and attempts. It was not possible to determine to what extent the sources of these complaints lay in child abuse, in gender dysphoria, in some combination of the two, or elsewhere. While no information was solicited about dissociative responses to child abuse, I have speculated, as have some of the participants themselves, that, in some cases, transsexualism may be an adaptive extreme dissociative swival response to severe child abuse.     

Vulnerability and Comorbidity Factors of Female Problem Gambling

This study helps to address a deficiency of gender-specific research into problem gambling. It focuses on the gambling behaviors, family and personal histories and comorbid psychological disorders of 365 female gamblers from across Ontario, Canada, who responded to a mail-in survey. Specifically, this study looks at rates of depression and anxiety, concurrent struggles with other behaviors (such as alcohol and drug use, disordered eating, overspending and criminal activity) and abuse history reported by female gamblers. The reported rates are considerably higher than for the general female population. The findings of this study agree with previous research. They suggest that prevention strategies and treatment practices for female problem gamblers should take into account women’s mental health, addiction and trauma history as contributing factors in the development of problematic gambling.     

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.     

Repeated suicide attempts

Attempted suicide is an act associated with childhood sexual abuse, depression, bipolar illness, substance abuse, and other diagnoses, as documented in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) (American Psychiatric Association [APA], 1994). Three women, who attended a group to decrease their depression and increase their self-esteem and who had histories of multiple suicide attempts, agreed to participate in interviews designed to determine the common factors associated with their suicide attempts and to examine the assertion that their suicide attempts were an addiction, similar to their addictions to alcohol and drugs. The common factors found were depression, substance use disorders with early abuse and risky behaviors, history of sexual abuse, faulty relationships, alteration of mood with a suicide plan, and distorted and illogical thinking and motivation. The similarities to addiction also were described. Based on the complexity of factors that emerged and the addictive nature of the suicide attempts, treatment for similar patients needs to be multidimensional and ongoing to allow sufficient time to monitor progress and address the numerous factors involved.     

Profiles of adult survivors of severe sexual,physical and emotional institutional abuse in Ireland

Adult survivors of institutional abuse were interviewed with a comprehensive assessment protocol which included the Childhood Trauma Questionnaire, the Institutional Child Abuse Processes and Coping Inventory, the Structured Clinical Interviews for Disorders of the Diagnostic and Statistical Manual of Mental Disorders IV axis I disorders and personality disorders, the Trauma Symptoms Inventory, a Life Problems Checklist, the Experiences in Close Relationships Inventory and the Kansas Marital Satisfaction Scale. Profiles were identified for subgroups that described severe sexual (N = 60), physical (N = 102), or emotional (N = 85) abuse as their worst forms of maltreatment. Survivors of severe sexual abuse had the most abnormal profile, which was characterised by higher rates of all forms of child maltreatment and higher rates of post‐traumatic stress disorder, alcohol and substance abuse, antisocial personality disorder, trauma symptoms and life problems. Survivors of severe emotional abuse were better adjusted than the other two groups. The profile of survivors of severe physical abuse occupied an intermediate position between the other two groups. A thorough assessment of abuse history and current functioning should be conducted when providing services to adult survivors of institutional abuse, since this may have important implications for the intensity of services required. Survivors of severe sexual abuse may require more intensive services. Copyright © 2009 John Wiley & Sons, Ltd.     

Physical abuse after child protective services investigation and adolescent substance use

The longitudinal pathways connecting physical abuse and substance use in child welfare-involved adolescents, a population with multiple risk factors for substance use problems, remain unclear. This study examined the relation between self-reported physical abuse among adolescents investigated by Child Protective Services (CPS) and later substance use, with a particular focus on exposure to physical abuse after CPS investigation as a potential contributing factor to this relation. Using data from the first National Survey of Child and Adolescent Well-being (NSCAW-I), a path analysis was conducted on a sample of 1079 adolescents aged 11–15 years who had recently been investigated by CPS. At baseline and 18-month follow-up, youths self-reported past-year physical abuse using the Parent-Child Conflicts Tactic Scale and past 30-day substance use frequency. At baseline, youths self-reported current internalizing and externalizing problems to the Youth Self Report. Path analysis revealed no significant relation between physical abuse at baseline and substance use at 18 months. Physical abuse at baseline was associated with higher levels of concurrent substance use and externalizing problems, which in turn predicted higher substance use at 18 months. Furthermore, physical abuse and externalizing problems at baseline predicted physical abuse at 18 months, which in turn was related to higher substance use at 18 months. The findings suggest that physical abuse after CPS investigation contributes to the development of adolescent substance use behaviors. Results indicate a need for innovative efforts to prevent physical abuse after CPS investigation, as well as assessment and treatment of substance use and externalizing problems at the point of investigation, to reduce future substance use in child welfare-involved adolescents.     

Multiple sexual victimizations among adolescent boys and girls: prevalence and associations with eating behaviors and psychological health

The purpose of this study was to assess the prevalence of sexual abuse, including multiple victimizations, among adolescents and to examine associations among history of sexual abuse, disordered eating behaviors and psychological health. The sample included 81,247 students (40,946 girls and 40,301 boys) in 9th and 12th grade in Minnesota public schools. Sexual abuse was reported by 14.7% of girls and 6.2% of boys. Sexual abuse was associated with unhealthy eating behaviors, suicidal thoughts and attempts, and lower emotional well-being and self-esteem. Students who reported a single or multiple forms of sexual abuse were more likely than their non-abused peers to binge-eat (Odds Ratio: girls = 1.93-2.32; boys = 2.26-5.61), fast (OR: girls = 1.68-2.34; boys = 1.33-2.32), use diet pills (OR: girls = 1.50-4.30; boys = 2.99-17.29) or laxatives (OR: girls = 1.87-5.11; boys = 3.89-29.22), vomit (OR: girls = 1.75-4.06; boys = 2.82-24.16), and have suicidal thoughts/attempts (OR: girls = 3.01-6.12; boys = 3.35-9.46). Boys and girls reporting multiple sexual victimizations and had the highest odds ratios for disordered eating behaviors. Future research should explore strategies for primary prevention of revictimization and secondary prevention of detrimental effects of abuse.     

Multiple Family Group Therapy in a Drug and Alcohol Rehabilitation Centre

In the last decade there has been increasing interest in working systemically with groups of families. Multiple family groups (MFGs) have been used in mental health settings with schizophrenia, eating disorders and drug and substance abuse. This article describes the MFG program used in Higher Ground Alcohol and Drug Rehabilitation Trust, a rehabilitation centre in Auckland, (New Zealand). Higher Ground provides an 18‐week residential therapeutic program for people with a severe substance abuse disorder. The MFG in Higher Ground focuses on developing better communication patterns and better boundaries between family members, fostering mutual support, and promoting self‐responsibility.     

Childhood sexual abuse, dissociation, and adult self-destructive behavior

Female college students reporting a history of childhood sexual abuse (N=175) and not reporting a history of childhood sexual abuse (N=260) were compared on indices of six self-destructive behaviors, including drug use, alcohol abuse, binge eating, self-mutilation, risky sex, and suicidality. The samples were also compared on two measures of dissociation, the Trauma Symptom Checklist dissociation subscale and the Dissociative Experiences Scale. The CSA group had significantly higher mean scores on all the indices of self-destructive behavior except self-mutilation (where the mean difference approached significance), and on both measures of dissociation. One or both dissociation measures were related significantly to each index of self-destructive behavior except binge eating. Multiple regression mediation analyses provided support for the hypothesis that dissociation mediates the relationships between CSA and both drug use and alcohol abuse. Dissociation also explained significant variability when added to the regressions of risky sex and suicidality on CSA.     

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.     

Private Pain,Public Choices: Influence of Problems in the Family of Origin on Career Choices Among a Cohort of MSW Students

This study draws on a survey of 126 graduate social work students from a large school of social work in the United States to investigate the impact of family problems on career choices. Sixty‐nine percent of the students indicated they had a family history of problems related to substance abuse (44%), psychopathology (43%), compulsive disorders (17%), and/or violence (35%). Students who report more indicators of psychopathology and violence were more likely to see their family history as influential in their career choice. These students were also more likely to select mental health/health as a practice area. However, no differences were found between students without a family history of problems and those who did not see their family history as influential. Students' history of family problems and their perceptions of its influence on career choice did not affect the likelihood of selecting a practice method. The authors discuss the implications of these findings and conclude with a series of recommendations for social work education.     

Physical,sexual and psychological abuse in high school dating relationships: Prevalence rates and self-esteem issues

The present study examined the rates of victimization by physical, sexual and psychological abuse in adolescent dating relationships, with self-esteem being explored as a mediating variable. Subjects included 257 students from a coed, ethnically diverse, religiously affiliated high school. Information was obtained using a self-report questionnaire on teenage dating behaviors. Of the 114 male and 118 female subjects who had dating experience, 59% had been victimized at least once in some past or current dating relationship by physical violence, 96% had experienced some form of psychological maltreatment and 15% had been forced to engage in sexual activity. Significantly more males than females reported experiencing physical abuse overall. Significantly more males than females experienced acts of moderate physical abuse, while there was no significant gender difference in the experience of acts of severe physical abuse. Thirteen percent of the subjects stated they had remained in a physically abusive relationship at one time, with females being more likely to remain than males. Self-esteem was not a factor in the level of physical abuse sustained in dating relationships, nor was there a significant difference in the levels of self-esteem between subjects who remained in, terminated, or never were involved in, physically abusive dating relationships. For all subjects, self-esteem negatively correlated with the level of psychological maltreatment sustained in dating relationships, but separate analysis by gender found the correlation was significant only for female subjects.