Chronic Avoidance Helps Explain the Relationship Between Severity of Childhood Sexual Abuse and Psychological Distress in Adulthood

ABSTRACT

Recent studies have found that chronic avoidance of unpleasant internal experiences (e.g., thoughts, emotions, memories) is a maladaptive means of affect regulation often adopted by women with a history of sexual victimization in childhood. The primary aim of this study was to replicate and extend previous findings suggesting that higher levels of experiential avoidance may account for the relationship between childhood sexual abuse (CSA) and psychological distress in adulthood. It was hypothesized that, in a sample of undergraduate females (n = 151), the relationship between severity of CSA (e.g., frequency, nature of victimization) and trauma-related psychological distress would be mediated by avoidance. Results supported this hypothesis. Findings are consistent with previous studies, and further suggest that the general tendency to avoid or escape from unpleasant internal experiences may be a specific factor that exacerbates psychological distress among women with a history of sexual victimization in childhood.     

Experimental avoidance as a mediator of the effects of adolescent sexual victimization on negative adult outcomes

The study examined experiential avoidance as a mediator between sexual victimization and negative adult outcomes. Baron and Kenny's (1986) regression analyses were performed on a sample of 304 undergraduate women to assess direct and indirect effects of sexual victimization on depressive, psychological distress, and alcohol abuse symptoms. Experiential avoidance accounted for statistically significant, but modest effects of victimization on depressive and distress symptoms. Child sexual abuse was not directly associated with experiential avoidance or negative outcomes, but increased vulnerability for adolescent sexual victimization. Adolescent sexual victimization contributed to increased experiential avoidance, which was associated with greater negative outcomes. These results uniquely contribute to the existing literature linking experiential avoidance to psychological problems.     

Alcohol and substance use disorders as predictors of child to adult sexual revictimization in a sample of community women

Alcohol- and substance-related diagnoses were examined as factors in child to adult sexual revictimization. Three hundred community women completed interviews and self-report instruments to obtain information regarding victimization and to diagnose substance use disorders (alcohol and substance abuse/dependence). Childhood sexual abuse (CSA) survivors were more likely than nonvictims to meet criteria for both substance use disorders and to report rape (e.g., unwanted intercourse due to threat or use of force, or due to the inability to consent due to the respondent's alcohol or drug use) and coerced intercourse (e.g., unwanted intercourse due to verbal coercion or misuse of authority by the perpetrator) by acquaintances, strangers, and husbands. In general, both CSA and substance use disorders were predictive of adult sexual victimization, but there were no significant interactions between these factors. Overall, substance use disorders were related to rape for all women; this relationship was not unique to CSA survivors. Alcohol- and substance-related diagnoses predicted rape by all three types of perpetrators, but CSA was predictive of rape only by acquaintances and strangers and not husbands. In contrast, CSA predicted coerced intercourse by all three perpetrators, while alcohol- and substance-related diagnoses predicted coerced intercourse by acquaintances and strangers, but not husbands. Results highlight the need to continue the study of revictimization of CSA survivors, including examination of both rape and sexually coercive experiences by different types of perpetrators. Findings support continued research of substance use disorders as risk factors for sexual victimization among all women.     

Experimental avoidance and high-risk sexual behavior in survivors of child sexual abuse

While many long-term correlates of child sexual abuse (CSA) have been identified, theories to explain the development of these correlates have received little empirical validation. The process of experiential avoidance is one theory that has been proposed to account for many of the correlates of CSA. The purpose of the current study was twofold: (1) To attempt to develop a more complex measure of experiential avoidance in women with and without a CSA history, and (2) to explore variables related to two of the long-term correlates of CSA, general psychological distress and high risk sexual behavior. Levels of current distress, high-risk sex, and experiential avoidance were examined in 257 undergraduate females (mean age 20.0) using self-report questionnaires. The results of the current study indicate that CSA survivors report higher levels of experiential avoidance and high-risk sexual behavior with persons other than their primary partners. Implications of these findings for theory development, therapy with CSA survivors, and HIV prevention programs 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 Victimization and Sex-Related Drinking Motives: How Protective is Emotion Regulation?

One in five college women experience sexual victimization (SV), and SV severity is associated with subsequent psychological distress, including sex-related distress. SV severity may also be associated with drinking motives to cope with sex-related distress and to enhance sex (sex-related drinking motives [SRDMs]), particularly if individuals suffer from emotion regulation (ER) difficulties. College women (N = 151) completed a survey assessment of ER, SV history, childhood sexual abuse (CSA), and SRDMs. Twelve regression models assessed six facets of ER as moderators between SV severity and SRDMs. Among women with no or low levels of prior SV severity, women with greater access to ER strategies were less likely to endorse drinking to cope SRDMs. At higher levels of SV severity, women at all levels of access to ER strategies were equally likely to endorse drinking to cope SRDMs, suggesting that access to ER strategies did not mitigate motivations to drink to cope with sex-related distress for these women. Women with severe SV histories may benefit from interventions that build on existing ER strengths or address other factors. However, greater access to ER strategies may serve as a protective factor against SRDMs when SV severity is low.     

The Relationship between a History of Childhood Sexual Abuse and Gender Role Attitudes

This study explored the relationship between childhood sexual abuse and gender role attitudes. Female university students rated themselves and their parents on gender role attitudes and history of childhood sexual abuse. Traditional participant gender role attitude and social isolation were associated with reporting being sexually abused as a child and may thus be risk factors for, or the result of a history of, CSA in women. Traditional participant gender role attitude and low income were associated with victim distress and therefore may be detrimental to coping with a history of childhood sexual abuse. Although replication of these results is needed, discovery of attitudinal and demographic variables associated with CSA may be important in the prevention and treatment of CSA.     

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.     

Early abuse experiences and subsequent gender differences in couple adjustment

The main purpose of the current study was to evaluate the relationship between early abusive experiences (sexual abuse, parental violence, and witnessing parental violence) and subsequent couple adjustment with a theoretical model that incorporates attachment and psychological distress as mediator variables. We specifically examined the variability in long-term psychosocial characteristics of child abuse survivors across women and men. A representative sample of French-Canadian couples composed of 632 men and women completed measures of child abuse, attachment, psychological distress, and dyadic adjustment. Structural equation analyses showed that, for both women and men, sexual abuse was related to dyadic adjustment through anxiety about abandonment and psychological distress. For men, experiencing physical or psychological violence was associated with dyadic adjustment through psychological distress. For women, there was an indirect relationship between witnessing physical violence and dyadic adjustment through abandonment anxiety. Differences between men and women in the long-term adjustment to childhood sexual abuse were small and not consistent with a gender-specific model of psychosocial repercussions.     

Childhood Maltreatment,Bullying Victimization,and Psychological Distress Among Gay and Bisexual Men

Sexual minority men report higher psychological distress than heterosexual men, including depression and anxiety. Research suggests that these health disparities may be due to the heightened stressors that gay, lesbian, and bisexual individuals experience. Some of these stressors occur early on in life, such as childhood abuse and bullying, and may include stressors that are topically related to sexual minority status, such as anti-gay bullying and teasing for gender nonconformity to masculine gender norms. We tested a structural equation model on the association between negative childhood experiences and adult psychological distress among 304 gay and bisexual men. The model fit the data well, and demonstrated an indirect effect of negative childhood experiences on adult psychological distress via dysfunctional thoughts toward oneself. The results integrate the childhood abuse and anti-gay bullying victimization literatures by showing that both forms of adverse childhood experiences are associated with adult psychological distress. The findings suggest the benefit of treatments to reduce negative, dysfunctional thoughts among gay and bisexual men who have experienced adverse childhood events.     

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.     

Characteristics of Sexually Abused Children and Their Nonoffending Mothers Followed by Child Welfare Services: The Role of a Maternal History of Child Sexual Abuse

Considering the importance of mother’s support in the adaptation of a sexually abused child, it is relevant to determine if the mothers and children involved in an intergenerational cycle of child sexual victimization differ from dyads in which only the child has been abused. The purpose of this study was to compare mother–child dyads with sexually abused children according to whether the mother had herself been victim of child sexual abuse. The sample included 87 dyads with sexually abused children aged 3–18 years old and their mothers (44 reporting maternal and child abuse), followed by social welfare services of the province of Quebec (Canada). The two groups of mothers were compared on their past family abuse experiences and past family relations, their mental health history, their current psychological distress, their parenting behaviors, and their current levels of family functioning. Children were compared on their adaptation. Multivariate analyses indicated that mothers reporting child sexual abuse were more likely to report more other maltreatments in their childhood and greater prevalence of lifetime history of alcohol abuse disorders, dysthymia, and panic disorder compared with mothers who had not experienced CSA. Compared to children whose mothers had not experienced CSA, those whose mothers had experienced CSA showed higher rates of problems behaviors and were more likely to report having been sexually abused by a trusted person. These results highlight the specific clinical needs for the assessment and treatment for sexually abused children whose mothers experienced child sexual abuse.     

Cumulative victimization, psychological distress, and high-risk behavior among substance-involved women

This research addressed two questions: (a) What is the relationship between different patterns of cumulative victimization and psychological distress? And (b) How does the pattern of cumulative victimization and psychological distress influence women's engagement in substance- and sex-related risk behavior? Data were analyzed from interviews with 149 sexually active, crack-using women who completed a follow-up interview after participating in the Kentucky National Institute on Drug Abuse (NIDA) AIDS Cooperative Agreement. Findings from the multivariate analyses indicated that victimization accounted for 5% and 39% of the variance in psychological distress and high-risk behavior, respectively; cumulative victimization and psychological distress accounted for 6% to 11% of the variance in the high-risk behaviors. Results highlight the affects of childhood and adult victimization on psychological distress and the associations between different types of psychological distress and risk behavior.     

The impact of childhood sexual abuse and intimate partner violence on sexually transmitted infections

Childhood sexual abuse (CSA) and adult intimate partner violence (IPV) have both been found to be associated with sexually transmitted infections (STIs) independently, but studies of STIs have rarely looked at victimization during both childhood and adulthood. This paper examines the relationship between CSA, IPV and STIs using data from a nested case-control study of 309 women recruited from multiple health care settings. Overall, 37.3% of women experienced no violence, 10.3% experienced CSA only, 27.3% experienced IPV only, and 25.0% experienced both CSA and IPV. Having ever been diagnosed with an STI was associated with violence (CSA only, odds ratios [OR] = 2.8, 95% confidence intervals [CI] = 1.0-7.5; IPV only, OR = 2.2, 95% CI = 1.0-4.9; CSA and IPV: OR = 4.0, 95% CI = 1.7-9.4), controlling for demographic characteristics. Women who experienced CSA were younger when they were first diagnosed. Understanding how both childhood and adult victimization are associated with diagnosis of STIs is important to reducing the incidence and prevalence of STIs, as well as the associated consequences of STIs.     

Still stressful after all these years: a review of lesbians' and bisexual women's minority stress

This article reviews the conceptualization of, and empirical literature on, lesbians' and bisexual women's sexual minority stress. In much of the early research, the experiences of sexual minority women and men were considered together (or women's experiences were inferred from men's), obscuring important differences. There is empirical and theoretical justification to consider the experiences of women and men separately and to develop and evaluate comprehensive models of sexual minority stress for women. Existing conceptualizations of sexual minority stress that include assessment of discrimination, victimization, harassment, concealment, internalized homonegativity may be applied, and perhaps adapted, to facilitate understanding of the unique stressors associated with women's sexual minority status. Future research must include mediators of the relationship between stressors and outcomes such as individual (e.g., coping and resilience) and group (e.g., social support, identification with a sexual minority community) resources. It is also essential to understand what factors may buffer the deleterious effects of these stressors.     

Sexual assault and alcohol use: exploring the self-medication hypothesis

Though a link between sexual victimization and alcohol use has been well documented, the mechanisms underlying this relationship remain unclear. The current study used path analysis to examine the role of self-reported levels of psychological distress and the function of alcohol use as indirect pathways between adult sexual assault and alcohol use. Participants were 318 undergraduate female victims and nonvictims of adult sexual assault. Results showed that a history of sexual assault was associated with increased psychological distress, which in turn contributed to alcohol use via negative reinforcement. Taken together, these findings provided support for the hypothesis that women who have been sexually assaulted consume alcohol, in part, to self-medicate. The implications for future research are discussed.     

Women's Unprotected Sex Intentions: Roles of Sexual Victimization,Intoxication, and Partner Perception

Sexually victimized women may make sexual decisions differently than nonvictimized women. This study used an eroticized scenario and laboratory alcohol administration to investigate the roles of victimization history, intoxication, and relationship context in women's perceptions of a male partner and their subsequent intentions for unprotected sex. A community sample of 436 women completed childhood sexual abuse (CSA) and adolescent/adult sexual assault (ASA) measures. After random assignment to an alcohol or control condition, participants read and projected themselves into a sexual scenario that depicted the male partner as having high or low potential for a lasting relationship. Participants rated their perceptions of his intoxication, sexually transmitted infection (STI) risk level, and anticipated reactions to insistence on condom use. They then indicated their likelihood of allowing the partner to decide how far to go sexually (abdication) and of engaging in unprotected sex. Structural equation modeling (SEM) analyses revealed that intoxication predicted greater unprotected sex likelihood indirectly via abdication. CSA and ASA predicted partner perceptions, which in turn predicted unprotected sex likelihood. These findings indicate that, compared to their nonvictimized counterparts, sexually victimized women may respond differently in sexual encounters partly as a function of their perceptions of partners' STI risk and anticipated reactions to condom insistence.     

Types of female orgasm

This study was designed to evaluate the relationship between child sexual abuse (CSA), family violence, and other negative childhood experiences within the home and adult adjustment (TSC‐40 and Rosenberg's Self‐Esteem Scale) in a sample of first‐year female psychology students (n = 199). An experience of CSA was reported by 23.6% of women. Results of a discriminant function analysis revealed that level of family violence, father's traditional family values and mother's and father's sexual punitiveness were the variables that best discriminated between sexually abused and nonabused women. After other differences in family background were accounted for by using hierarchical multiple regression, level of family violence significantly improved the prediction of adult psychological adjustment. Standard multiple regression revealed that characteristics and severity of CSA were not significant predictors of adult adjustment. These results were interpreted as support for the use of an integrated risk‐sequelae model of CSA in evaluating the relationship between CSA and adult adjustment. Within this model, the interrelationships among CSA, violence, and dysfunctional familial environments should be simultaneously assessed.     

Intimate sexual victimization among women with protective orders: types and associations of physical and mental health problems

Intimate sexual violence was examined among a sample of women who had recently obtained protective orders against male partners using three groups: no sexual victimization (n = 368), sexual insistence (n = 114), and threatened and/or forced sex (n = 117). Differences in childhood sexual abuse as well as types of partner psychological abuse, stalking, and severe physical violence experiences were found across the groups. Multivariate analysis showed that women with no sexual victimization had significantly fewer mental health problems than women who had experienced sexual insistence and women who had been threatened or forced to have sex. Findings from this study underscore the importance of health, mental health, and criminal justice professionals assessing for a range of sexually abusive acts when working with victims of partner violence.