Trauma Violence & Abuse

Published by SAGE Publications
Online ISSN: 1552-8324
Print ISSN: 1524-8380
An unresolved but clinically important issue in the literature on juvenile delinquency is to what extent juvenile sex offenders resemble non-sex offenders with respect to individual, familial, and environmental characteristics. The current article reviewed published studies (1995-2005) comparing sex offenders with non-sex offenders. The 17 articles meeting the inclusion criteria suggest that differences exist between sex offenders and non-sex offenders on personality characteristics, behavioral problems, history of sexual abuse, nonsexual offending, and peer functioning. Inconsistent results were found for demographic factors, family functioning and background, antisocial attitudes, and intellectual and neurological functioning. Although it is likely that sex offenders can be differentiated from nonsex offenders on a number of characteristics, caution is warranted because of methodological differences between studies and small samples size. Also, studies show that sex offenders are a heterogeneous group. Further research should take into account this heterogeneity by including sex offenders from clearly circumscribed groups and investigating characteristics specifically related to sexual behavior.
In April 2011, the Academy on Violence Abuse ( convened a network of experts for its second annual conference, "Developing the Science of Violence and Abuse: Toward a New Understanding." The conference served as a forum for highlighting the growing body of research regarding the biological consequences and adverse health consequences of abuse. In doing so, it underscored an important scientific premise: By evaluating the impact of violence and abuse from birth to death, one can better evaluate the social, behavioral, psychological, and biological context and pathways that result in the morbidity, mortality, and quality of life of all affected individuals and communities. In this article, we summarize content presented by the conference's keynote speakers and provide citations that speakers have submitted to support their statements.
The World Health Organization (2009) implicates deep-rooted cultural and social norms as influential contributing factors toward physical and intimate partner violence against women. The dowry system is a social practice that perpetuates the oppression, torture, and murder of women in India. The practice of dowry is an expected part of marriage in cultures where arranged marriages are the norm. Violence can occur when the dowry or bride-price is deemed unsatisfactory by the recipient. In India, in spite of laws prohibiting the practice, not much has changed over the last 30 years. The National Crime Records Bureau of India, recorded a total of 8,618 female deaths related to dowry disputes in 2011, and the Asian Women's Human Rights Council (2009) estimates that the practice of dowry is implicated in 25,000 deaths and maiming of women between the ages of 15-34 in India every year. The current review of literature reveals that despite efforts on the part of the Indian government, social activists and feminists organizations in India, not much has changed over the past decade, in fact, the problem has increased, resulting in an unprecedented amount of mortality and morbidity among women in India.
'Headline' findings on child sexual abuse 
This paper reviews the literature on the nature and incidence of child sexual abuse, explores the link between child sexual abuse and later sexual exploitation, and reviews the literature on prevention strategies and effective interventions in child sexual abuse services. Our understanding of the international epidemiology of child sexual abuse is considerably greater than it was just 10 years ago, and studies from around the world are examined. Childhood sexual abuse can involve a wide number of psychological sequelae, including low self-esteem, anxiety, and depression. Numerous studies have noted that child sexual abuse victims are vulnerable to later sexual revictimization, as well as the link between child sexual abuse and later engagement in high-risk sexual behaviour. Survivors of child sexual abuse are more likely to have multiple sex partners, become pregnant as teenagers, and experience sexual assault as adults. Various models which attempt to account for this inter-relationship are presented; most invoke mediating variables such as low self-esteem, drug/alcohol use, PTSD and distorted sexual development. Prevention strategies for child sexual abuse are examined including media campaigns, school-based prevention programmes, and therapy with abusers. The results of a number of meta-analyses are examined. However, researchers have identified significant methodological limitations in the extant research literature that impede the making of recommendations for implementing existing therapeutic programmes unreservedly.
Women who experience intimate partner violence (IPV) victimization are more likely to struggle with substance abuse problems than are women who do not experience IPV. Given the connection between IPV victimization and substance abuse, recommended practices urge collaboration between domestic violence service agencies and substance abuse treatment agencies to provide comprehensive services for women with these co-occurring problems. However, domestic violence and substance abuse services have unique histories of development that have led to distinct ways of service delivery. To promote successful collaborations, service providers and researchers are developing strategies to foster relationships across the two service sectors. The authors conducted a review of this emerging body of knowledge with the aim of assembling recommendations for strategies to foster collaboration between domestic violence and substance abuse services. The authors identified 15 documents for review inclusion and our analysis established 5 categories of documents. Findings yield key collaboration strategies and recommended service models. In addition, the review determined the existence of considerable challenges to promoting collaborative relationships between domestic violence and substance abuse treatment service sectors.
The curiosity and the natural tendency to explore the environment put young children at an increased risk of poisoning over older children and adults. Poisonings are a significant area of concern from 1 year of age and progressively contribute more to overall rates of morbidity and mortality until children reach adulthood. Particularly, the abuse of children by poisoning is also highly common with thousands of fatalities. A practical strategy is presented that aims to alert health, forensic, and law enforcement professionals to this problem and to demystify the preconception that it is a rare form of abuse or neglect. Compounds that are foreign to a living organism (xenobiotics) and those present within body (endobiotics), mainly involved in children intoxications and contextual examples related to exposure are also reviewed. Particular concern is given to concepts in the field of children poisoning. The described history and the clinical and toxicological evaluation are discussed, and harmonized protocols regarding correct procedures for sample collection to forensic toxicological analysis are proposed. Since children are particularly vulnerable to the toxic effects of high doses of xenobiotics and endobiotics, special consideration on the preparation of the environment that surrounds children in order minimize all possible risks will be also considered.
A history of childhood sexual abuse (CSA) is a risk factor for adult emotional distress, including symptoms of depression, anxiety, dissociation, and trauma. However, CSA is likely associated with adult distress indirectly through an impact on mediating variables. In a review of the empirical literature, the authors found support for the roles of shame or self-blame, interpersonal difficulties, and avoidant coping strategies as mediators. In addition, emotional distress appears to mediate links between CSA and other adverse outcomes, such as alcohol abuse and revictimization. The authors conclude with a number of methodological and conceptual recommendations.
Important physiologic regulators of the hypothalamic-pituitary-adrenal axis are shown below. In addition, specific structures, neurochemicals, or somatic systems that are known to be influenced by violence/abuse are highlighted in red. 
Although the extant evidence is replete with data supporting linkages between exposure to violence or abuse and the subsequent development of medical illnesses, the underlying mechanisms of these relationships are poorly defined and understood. Physiologic changes occurring in violence- or abuse-exposed individuals point to potentially common biological pathways connecting traumatic exposures with medical outcomes. Herein, the evidence describing the long-term physiologic changes in abuse- and violence-exposed populations and associated medical illnesses are reviewed. Current data support that (a) specific neurobiochemical changes are associated with exposure to violence and abuse; (b) several biological pathways have the potential to lead to the development of future illness; and (c) common physiologic mechanisms may moderate the severity, phenomenology, or clinical course of medical illnesses in individuals with histories of exposure to violence or abuse. Importantly, additional work is needed to advance our emerging understanding of the biological mechanisms connecting exposure to violence and abuse and negative health outcomes.
Summary of Study Characteristics and Protective Factors. 
Objective. This review article summarizes empirical research on resilience in survivors of child sexual abuse (CSA) and discusses protective factors that are associated with adaptive functioning in spite of sexual victimization. Methods. A literature search to identify studies published up to November 2013 was performed within the databases PsycINFO, MEDLINE/PubMed, Web of Science, and PSYNDEXplus. Additional relevant studies were retrieved using a snowball technique. A total of 37 articles met the inclusion criteria and were included in the final sample. Results. In the studies included in this review, the percentage of CSA survivors who were found to have a normal level of functioning despite a history of sexual abuse ranged from 10% to 53%. The protective factors that had the best empirical support were found to be education, interpersonal and emotional competence, control beliefs, active coping, optimism, social attachment, external attribution of blame, and most importantly, support from the family and the wider social environment. Conclusions. Preventive and clinical interventions for survivors of CSA should utilize psychoeducation and cognitive strategies that are adapted to the developmental level of the victim and that seek to enhance social support from significant others. Future research should focus on longitudinal research designs considering resilience rather as a dynamic process with multiple dimensions in a social and developmental context.
A selective literature review of dissociation in women abuse survivors was under-taken from a feminist, constructivist perspective. Dissociation has been conceptualized many ways historically. Current understandings of dissociative phenomena are diverse, as reflected in the research and treatment literature. Dissociation has been linked to physical and psychological problems, including major mental illnesses, pelvic pain, somatization disorders, and eating disorders. There has been a preoccupation with rare but fascinating extremes of dissociation, such as multiple personality disorder, with less emphasis on more frequently seen types of dissociation, such as depersonalization and derealization. Views of dissociation as it occurs in women child abuse survivors affect their autonomy and perceived credibility and determine treatment trajectories. Questions remain as to what aspects and types of dissociation are "pathological." There is evidence that dissociation may be a commonplace human experience in the general population. Implications for theory, research, and practice are included.
Studies Examining the Projective Drawings of Sexually Abused Children 
Studies Examining the Projective Drawings of Physically Abused Children 
Clinical observations have suggested that children who experience physical or sexual abuse may provide indicators in their drawings that can distinguish them from nonabused children. Some have even suggested that a child's drawings and the interpretive testimony of a trained mental health clinician should be admissible in court as evidence of a child's abuse status. Many of these comments, however, may reflect a limited consideration of the available research. The current article provides a comprehensive literature review of the controlled research to determine whether any graphic indicators (e.g., genitalia, omission of body parts) or predefined scoring system can reliability and validly discriminate abused from nonabused children. Results indicate that, although individual studies have found support for various indicators or scoring systems, these results are rarely replicated, many times studies finding significant results suffer from serious methodological flaws and alternative explanations for findings (e.g., mental illness) are often present. No graphic indicator or scoring system possessed sufficient empirical evidence to support its use for identifying sexual or physical abuse. A discussion of the legal ramifications of these results is provided.
The primary goals of this article are to review the evidence that links sexual and physical abuse and intimate partner violence (IPV) with functional gastrointestinal (GI) symptoms and disorders and to explore physiological mechanisms that might mediate these health effects. The literature cited in this review has shown strong and consistent relationships of sexual and physical abuse history and IPV with functional GI symptoms and disorders. Among patients with these disorders, abuse history is associated with worse health-related quality of life, more health care utilization, and more pain. Although research has not determined what mechanisms might account for these associations, alterations in psychophysiological and cortico-limbic pain modulatory systems have been suggested. Given the high prevalence of abuse and long-lasting health consequences, referral for psychiatric and psychological treatment makes sense for many patients with abuse history seen within medical settings.
Women are subject to high rates of interpersonal violence. One frequent co-occurring issue is substance abuse, which may arise posttrauma as a way to cope. In this article, psychosocial therapies for co-occurring trauma and substance abuse are reviewed. Description of empirically studied models is provided, as well as results of the empirical studies. Overall, this area of work suggests positive growth in the availability of new models but very limited empirical work thus far for all but one model. Directions for the future include the need for greater study of treatments in this area, as well as the need to address issues beyond specific models (e.g., workforce issues, access to care, and changing the culture of treatment systems). Policy implications are also offered.
Measures That Capture Components of Treatment Motivation and Related Concepts 
Perpetrators of abuse and violence against women and children are often reluctant participants in intervention programs. They frequently fail to attend scheduled appointments, are sometimes openly hostile to intervention staff, and often judge program materials as irrelevant to their situation. Recognizing this problem, researchers and practitioners have begun to develop models and tools to more appropriately assess and intervene with reluctant clients. Unfortunately, the resulting proliferation and inconsistent application of terms and theories have led to considerable confusion in characterizing reluctant clients and have significantly hampered research on strategies that may be helpful to better meet the needs of this client group. The purpose of this review is to help standardize the definition and measurement of treatment reluctance as it applies to violence perpetration and to review evidence for the importance of these aspects of client reluctance to intervention. Recommendations for assessing reluctance in research and clinical practice are also provided.
This paper highlights the importance of recognising forced marriage as a form of violence and draws attention to the interventions that are developing in Europe as a response to forced marriage. The paper highlights the difficulties of conflating all child marriages as forced marriage and discusses the different contexts of childhood in different parts of the globe. The UK is reputed to have the widest range of policy interventions and practice guidance to tackle forced marriage and is therefore used as a case study in this paper, but reference is also made to other countries thus ensuring a wider relevance. The paper's analysis of UK based research studies on forced marriage identifies three key themes: i) lack of adequate reporting of incidents of forced marriage; ii) lack of professional knowledge of forced marriage and their fear of intervention; iii) the tension between conceptualizing forced marriage as purely cultural or as a form of gender based violence. It also highlights the largely legislative responses to forced marriage in Europe; Civil Protection for victims of forced marriage in the UK is discussed and a critical analysis is offered of the increase in marriage and sponsorship age in the UK and in many European countries. Health and clinical issues related to forced marriage are highlighted and the paper calls for further research globally to i) better understand the extent and nature of forced marriage; ii) to evaluate current interventions; iii) to investigate the clinical and potential mental health implications of forced marriage.
Published Works in Disabilities and Abuse. 
While studies suggest that the rate of abuse of women with disabilities is similar or higher compared to the general population, there continues to be a lack of attention to this issue. Women with disabilities are at particularly high risk of abuse, both through typical forms of violence (physical, sexual, and emotional) and those that target one's disability. In an effort to highlight the need for increased attention to this issue, this article reviews the current peer-reviewed research in this field. The authors outline recommendations for future research goals and provide implications for research, practice, and policy.
There is consensus that an integrated approach which addresses the clinical needs of individuals who have histories of substance abuse and psychological trauma concurrently is an acceptable and preferred approach to treatment. Several integrated models have emerged in recent years. In this paper we first define the concepts of substance abuse and psychological trauma, investigate the relationship between both and proceed to discuss why an integrated approach is most compelling. Finally, we review and critically examine the different integrated models that have been developed in terms of efficacy, effectiveness and empirical evidence. The paper concludes with suggestions on how the field can be improved.
Boxplots of Rates for Criminal Justice Decisions NOTE: Black lines represent the median. Boxes represent the middle half of the distribution. Lines extending from boxes ("whiskers") represent the remainder of the distribution except for outliers and extremes, which are represented by O and asterisk (*), respectively. The study number for each outlier and extreme is shown. 
This study meta-analyzed rates of criminal justice decisions in 21 studies of prosecution of child abuse. Rates of referral to prosecution, filing charges, and incarceration varied considerably. Rates of carrying cases forward without dismissal were consistently 72% or greater. For cases carried forward, plea rates averaged 82% and conviction rates 94%. Compared to national data, child abuse was less likely to lead to filing charges and incarceration than most other felonies but more likely to be carried forward without dismissal. Diversion, guilty plea, and trial and conviction rates were about the same for child abuse and all violent crimes. Thus, prosecuting child abuse is generally neither feckless nor reckless. Rates can be misleading and cannot be the sole measure of prosecution success.
To elucidate the significance, nature, and direction of the potential relationship between child sexual abuse and conduct disorder, all the pertinent studies were reviewed. Ten databases were searched. Blind assessments of study eligibility and quality were performed by two independent researchers. Thirty-six studies including 185,358 participants and meeting minimum quality criteria that were enough to ensure objectivity and to not invalidate results were analyzed. Across the majority of studies, conduct disorder was significantly and directly related to child sexual abuse, especially repeated sexual molestation and abuse involving penetration, even after controlling for various sociodemographic, family, and clinical variables. The association between child sexual abuse and conduct disorder was not confounded by other risk factors, such as gender, socioeconomic status, school achievement, substance problems, physical abuse, parental antisocial behavior or substance problems, parent-child relationships, and family disruption, conflict, or violence. Evidence for a significant interactive effect between child sexual abuse and monoamine oxidase A gene on conduct disorder was scant. Early sexual abuse might predispose to the subsequent onset of conduct disorder which, in turn, may lead to further sexual victimization through association with sexually abusive peers or involvement in dangerous situations or sexual survival strategies.
Sexual abuse and sexual assault are serious public health concerns. Although almost all of the research shows that the majority of sexual perpetrators are males, there is growing evidence that female-perpetrated sexual abuse is not rare and that the consequences of female-perpetrated sexual abuse can be just as traumatic as male-perpetrated sexual abuse. Despite this, there has been very little research published that has focused on female sex offending. Furthermore, although there have been some efforts in the past decade to stop sexual offenses by targeting potential perpetrators, few efforts have specifically focused on preventing females from becoming sex offenders. In an attempt to fill this gap, this article describes common characteristics of female sex offenders; and, based on these characteristics, suggestions are given of possible ways to intervene in the lives of at-risk females before they offend.
Objectives: Aging is a rising phenomenon globally and elder abuse is becoming increasingly recognized as a health and social problem. This review aimed to identify the prevalence of elder abuse in community settings, and discuss issues regarding measurement tools and strategies to measure elderly abuse by systematically reviewing all community-based studies conducted worldwide. Method: Articles on elder abuse from 1990 to 2011 were reviewed. A total of 1,832 articles referring to elders residing at home either in their own or at relatives' houses were searched via CINAHL and MEDLINE electronic databases, in addition to a hand search of the latest articles in geriatric textbooks and screening references, choosing a total of 26 articles for review. Results: Highest prevalence was reported in developed countries, with Spain having 44.6% overall prevalence of suspicion of abuse and developing countries exhibiting lower estimates, from 13.5% to 28.8%. Physical abuse was among the least encountered, with psychological abuse and financial exploitation being the most common types of maltreatment reported. To date, there is no single gold standard test to ascertain abuse, with numerous tools and different methods employed in various studies, coupled with varying definitions of thresholds for age. Conclusion: Current evidences show that elder abuse is a common problem in both developed and developing countries. It is important that social, health care, and legal systems take these findings into consideration in screening for abuse or reforming existing services to protect the health and welfare of the elderly.
For more than a decade, professional medical and nursing associations have recommended universal screening for intimate partner abuse (IPA). This review of 44 studies examines IPA screening during this period. The purposes of the review are to (a) identify mutable influences on IPA screening, (b) summarize what is known about altering these influences, and (c) outline an agenda for improving IPA screening. Evidence to date indicates that screening is not universal. Promising approaches to improvement start with provider training and relatively simple environmental adjustments. Unanswered empirical questions include "What are the essential components of effective training? Which health care providers are best positioned to screen under which circumstances? Which of the untested mutable influences will further improve IPA screening practice?" The review leads to the following practice recommendations: (a) Interventions should focus on clinicians in training (e.g., medical residents), and (b) screening approaches must be tailored to various practice settings.
There is now conclusive evidence of the major and long-lasting negative effects of physical and sexual abuse on children. Within Africa, studies consistently report high rates of child abuse, with prevalence as high as 64%. However, to date, there has been no review of factors associated with physical and sexual child abuse and polyvictimization in Africa. This review identified 23 quantitative studies, all of which showed high levels of child abuse in varying samples of children and adults. Although studies were very heterogeneous, a range of correlates of abuse at different levels of the Model of Ecologic Development were identified. These included community-level factors (exposure to bullying, sexual violence, and rural/urban location), household-level factors (poverty, household violence, and non-nuclear family), caregiver-level factors (caregiver illness in particular AIDS and mental health problems, caregiver changes, family functioning, parenting, caregiver-child relationship, and substance abuse), and child-level factors (age, disability, physical health, behavior, and gender). These findings identify key associated factors that are potential foci of child abuse prevention interventions. In addition, there is a clear need for further rigorous longitudinal research into predictive factors and culturally relevant interventions.
This systematic review analyzes empirically based medical literature relevant to the experiences of adult survivors of sexual abuse in the health care setting and what is known about providing sensitive care to this population. Effects of this trauma may impact the adult survivor's experience of care, health behaviors, and outcomes. The 10 articles reviewed in this study provide patient-based information on the experience of child sexual abuse and its impact on health and health care for patients. Suggestions are made for health care providers in two main areas: facilitation of communication and disclosure issues, and improving the experience of the health care encounter for survivors. Specific strategies are offered to assist in providing nonthreatening care encounters for adults who have been affected by childhood sexual trauma. Implications for research, practice, and policy for patients, health care providers, and social workers in the health care setting are discussed.
This article reviews and summarizes the extant literature regarding child physical abuse (CPA). Literature is summarized that describes the wide range of short- and long-term effects of CPA on children as well as the documented characteristics of parents/caregivers who engage in physically abusive parenting practices. Although the reviewed research documents that interventions geared only toward the parent have been found to produce significant improvements with respect to parenting abilities, parent-child interactions, and children's behavior problems, there is a paucity of research examining the efficacy of interventions developed specifically to target the child's emotional and behavioral difficulties. Based on the few studies that have shown emotional and behavioral gains for children who have participated in treatment, an integrated parent-child cognitive-behavioral therapy (CBT) approach is proposed here to address the complex issues presented by both parent and child in CPA cases. The direct participation of the child in treatment also may improve our ability to target posttraumatic stress disorder (PTSD), depressive symptoms as well as anger control and dysfunctional abuse attributions in the children themselves. Implications for practice, public policy, and research are also addressed.
In this article, the sociological and historical approaches and literatures are synthesized to present the historical background of the treatment that child-abusing and child-killing parents are receiving in the legal system today. The roots of the formation of contemporary institutional responses to severe child abuse and child homicide are traced and latest developments are examined critically. Durkheim's insights regarding the functions of law are highlighted by pointing out how, throughout history, crimes against children become stand-ins for larger societal problem. The latest innovations in the criminal branch of child protection consist of the specialized prosecution bureaus and court parts dealing with physical and sexual violence against children. Integral to the new developments in child protection are ''multidisciplinary,'' comprehensive approaches to the processing of criminal cases, involving teams consisting of representatives from the police, the prosecution, public and private social work and child protection agencies, and psychiatric, pediatric, and other medical practitioners and community partners. These developments exemplify heightened focus on criminal prosecution of parental crimes against children, inevitably leading to questions and policy concerns regarding resources geared toward punishment rather than prevention.
This systematic review analyzes eleven empirically based articles relevant to evaluating treatments and interventions for perpetrators of child physical abuse. The articles provide a clear picture of the limited research available in this area. The review describes current themes in research and interventions, common challenges in working with families in which child physical abuse has occurred, gaps in the current research, and suggestions for practice, policy, and future research.
This review addresses research on the overlap in physical child abuse and domestic violence, the prediction of child outcomes, and resilience in children exposed to family violence. The authors explore current findings on the intersection of physical child abuse and domestic violence within the context of other risk factors, including community violence and related family and environmental stressors. Evidence from the studies reviewed suggests considerable overlap, compounding effects, and possible gender differences in outcomes of violence exposure. The data indicate a need to apply a broad conceptualization of risk to the study of family violence and its effects on children. Further testing of competing theoretical models will advance understanding of the pathways through which exposure leads to later problems in youth, as well as protective factors and processes through which resilience unfolds.
Key Methodological Quality Factors Identified 
Outline of Seven Meta-Analyses on the Effects of Child Sexual Abuse (CSA) 
Meta-Analyses of 25 Symptoms or Disorders Associated With Child Sexual Abuse 
This review evaluates the quality of recent meta-analyses on child sexual abuse and adult psychopathology. Using systematic review methods, seven recently published, English-language meta-analyses met the inclusion criteria of assessing outcome of child sexual abuse. Some methodological weaknesses were identified, such as failure to assess the validity of the primary studies. Child sexual abuse was found to be a nonspecific risk factor in the development of adult mental health difficulties, but the effect sizes varied (partly related to sample type and size). No gender difference was consistently found on adult mental health difficulties but was for victims' perceived mental health consequence. Future meta-analyses need to consider their methods of assessing primary studies to allow for an evidence-based model of adult psychopathology.
Debate has ensued regarding the appropriate assessment and diagnosis for school-age children who display severe behavioral problems as a result of previous abuse and neglect within the primary attachment relationship. The current nomenclature recognizes reactive attachment disorder and some clinicians have suggested broader categories of attachment disorder. These attempts at classification are often criticized on empirical grounds; however, often lost in these criticisms is the fact that that these diagnostic approaches often misapply attachment theory and research. This article summarizes the original contributions of John Bowlby and other attachment researchers to our understanding of child development, examines misguided attempts to apply attachment theory to the diagnosis and assessment of maltreated children, and offers a diagnostic conceptualization and assessment recommendations consistent with the available attachment research.
This article reviews the research relevant to seven practices considered by many to be among the most progressive approaches to criminal child abuse investigations: multidisciplinary team investigations, trained child forensic interviewers, videotaped interviews, specialized forensic medical examiners, victim advocacy programs, improved access to mental health treatment for victims, and Children's Advocacy Centers (CACs). The review finds that despite the popularity of these practices, little outcome research is currently available documenting their success. However, preliminary research supports many of these practices or has influenced their development. Knowledge of this research can assist investigators and policy makers who want to improve the response to victims, understand the effectiveness of particular programs, or identify where assumptions about effectiveness are not empirically supported.
Recent years have witnessed a growing debate about the role of attachment theory in the treatment of maltreated children. Many professional organizations have issued statements against physically restraining children as some attachment therapists promote; however, often lost in these debates is the fundamental issue of what attachment theory and research proposes as the appropriate form of treatment. Given that these attachment therapies are often directed toward maltreated children, it becomes critical for clinicians working with abused and neglected children to understand these issues and recognize unethical and dangerous treatments. This article provides a summary of the theoretical and empirical bases for the use of attachment theory in the treatment of maltreated school-age children, an examination of the ways questionable approaches to treatment have misinterpreted and misapplied attachment theory, and a conceptualization of attachment-based intervention grounded in current theory and research.
There is considerable controversy about the role of child sexual abuse in the etiology of anxiety disorders. Although a growing number of research studies have been published, these have produced inconsistent results and conclusions regarding the nature of the associations between child sexual abuse and the various forms of anxiety problems as well as the potential effects of third variables, such as moderators, mediators, or confounders. This article provides a systematic review of the several reviews that have investigated the literature on the role of child sexual abuse in the etiology of anxiety disorders. Seven databases were searched, supplemented with hand search of reference lists from retrieved papers. Four meta-analyses, including 3,214,482 subjects from 171 studies, were analyzed. There is evidence that child sexual abuse is a significant, although general and nonspecific, risk factor for anxiety disorders, especially posttraumatic stress disorder, regardless of gender of the victim and severity of abuse. Additional biological or psychosocial risk factors (such as alterations in brain structure or function, information processing biases, parental anxiety disorders, family dysfunction, and other forms of child abuse) may interact with child sexual abuse or act independently to cause anxiety disorders in victims in abuse survivors. However, child sexual abuse may sometimes confer additional risk of developing anxiety disorders either as a distal and indirect cause or as a proximal and direct cause. Child sexual abuse should be considered one of the several risk factors for anxiety disorders and included in multifactorial etiological models for anxiety disorders.
Exposure to interpersonal violence or abuse affects the physical and emotional well-being of affected individuals. In particular, exposure to trauma during development increases the risk of psychiatric and other medical disorders beyond the risks associated with adult violence exposure. Alterations in the hypothalamic-pituitary-adrenal (HPA) axis, a major mediating pathway of the stress response, contribute to the long-standing effects of early life trauma. Although early life trauma elevates the risk of psychiatric and medical disease, not all exposed individuals demonstrate altered HPA axis physiology, suggesting that genetic variation influences the consequences of trauma exposure. In addition, the effects of abuse may extend beyond the immediate victim into subsequent generations as a consequence of epigenetic effects transmitted directly to offspring and/or behavioral changes in affected individuals. Recognition of the biological consequences and transgenerational impact of violence and abuse has critical importance for both disease research and public health policy.
Childhood sexual abuse (CSA) has been linked to adult mental health problems and indicators of severity of psychiatric illness. There exist large, unexplained individual differences in the presentation of mental health problems following CSA. Complex statistical methodologies allow researchers to examine models of response to CSA and its impact on mental health. Two early models are presented and critiqued. Two more recent models are then presented. It is concluded that whereas no single variable can, on its own, account for individual variation in symptom development, empirically tested models point toward a complex interaction between abuse-related factors, interactions with others (e.g., responses to disclosure, attachment), and individual factors (e.g., attributions, emotion-focused coping) as mediators and moderators of outcome. The implications of increased understanding of the complex interaction of these factors in understanding clinical presentations and in the formulation of treatment plans are explored.
The number of older victims of domestic violence is expected to increase drastically in Asia as many countries are experiencing rapid population aging. In 2012, 11% of the population in Asia were aged 60 years and over. This is expected to rise to 24% by 2050. This article discusses the unique features of Asian cultures that are relevant to the understanding of elder abuse and summarizes the existing literature looking at the prevalence and risk factors of such abuse in Asian populations.
Violence against women affects millions of women, including women who are pregnant or have recently given birth. During pregnancy, a woman's history of past abuse increases her risk of depression and posttraumatic stress disorder. And these increase the risk of pregnancy and neonatal complications. Women who have experienced past or current abuse are also at high risk for postpartum depression, which can affect their relationships with other adults and their babies. Violence against women can also affect women's ability to breastfeed, although abuse survivors often express an intention to breastfeed and are more likely to initiate breastfeeding than their nonabused counterparts. Current abuse, depression, posttraumatic stress disorder, social isolation, lack of social support, and cessation of breastfeeding all have negative health effects for mothers and babies.
For women, any one type of abuse rarely occurs in isolation of other types, and a single abusive experience is often the exception rather than the norm. The importance of this concept of the cumulative nature of abuse and its negative impact on health has been well recognized within the empirical literature, however there has been little consensus on what to call this phenomenon or how to study it. For the most part researchers have operated on the premise that it is the sheer number of different types of cumulating abuse experiences that is primarily responsible for worse health outcomes among women. And although this simplistic 'more is worse' approach to conceptualizing and operationalizing cumulative abuse has proven to be a powerful predictor of poorer health, it contradicts growing empirical evidence that suggests not all victimizations are created equal and that some victimizations may have a more deleterious effect on health than others. Embedded in abuse histories are individual and abuse characteristics as well as other life adversities that need to be considered in order to fully understand the spectrum and magnitude of cumulative abuse and its impact on women's health. Furthermore, given the long-term and persistent effects of abuse on health it becomes imperative to not only evaluate recent abusive experiences, but rather all abuse experiences occurring across the lifespan. This review highlights and evaluates the conceptual, operational, and methodological challenges posed by our current methods of studying and understanding the phenomenon of cumulative abuse and suggests that this phenomenon and its relationship to health is much more complex than research is currently portraying. This paper calls for the urgent need for interdisciplinary collaboration in order to more effectively and innovatively study the phenomenon of cumulative abuse.
Postdisclosure caregiver support has long been considered a key factor in the functioning of children after their disclosure of sexual abuse, and numerous studies and reviews support this relationship. Yet, a closer look at this literature suggests that support for this relationship might not be as strong or consistent as reported. The purpose of this article is to review studies assessing the relationship between caregiver support of sexually abused children and postdisclosure functioning of their children. Studies were collected using various search engines, and the tables of contents of certain child maltreatment journals were reviewed. To be included, studies had to be published prior to 2012 and to quantitatively capture the bivariate relationship between a quantified assessment of nonoffending caregiver (NOC) support anytime after the child's sexual abuse disclosure and a quantified assessment of at least 1 of the 11 types of postdisclosure functioning in the children. Twenty-nine studies met the criteria to be included. In the meta-analysis, Pearson's Product Moment Correlation, transformed to a Fisher's Z, was used as the effect size. Potential moderators of effect size were also coded and assessed. Postdisclosure caregiver support was significantly related to 3 of the 11 different types of postdisclosure functioning in children. However, the largest effect size was .170, and 8 of the 11 types of postdisclosure functioning in children had effect sizes smaller than ±.100. Few moderators of the relationship between NOC support and postdisclosure functioning in children were found. Minimal support for the relationship between caregiver support of sexually abused children and children's postdisclosure functioning was found. At this time, it is impossible to determine whether this weak relationship can be attributed to the many methodological weaknesses in the measurement of caregiver support or whether caregiver support is not related to postdisclosure functioning in children.
Until recently, the sexual offending literature focused on male perpetrators and neglected to examine the characteristics of female perpetrators. As a result, treatment provision for female sexual abusers has been either nonexistent or inappropriately adapted from programs designed for males. What we do know is that male and female sexual abusers share similarities; however, there remain distinct differences that warrant empirical and theoretical study. The current review systematically examines the literature on offense-supportive cognition in female sexual abusers. The aim of this systematic review is to aid clinical practitioners who work with female sexual abusers by providing an evaluation of current available research regarding implicit theories, rape myth acceptance, violence-supportive cognition, gender stereotypes, beliefs about sex, and empathy. We conclude that further research examining the offense-supportive cognition of female sexual abusers is needed in order to facilitate more effective empirically driven clinical practice.
Four facets of leaving an abusive relationship are reviewed: (a). factors related to initially leaving an abusive partner; (b). the process of leaving an abusive relationship; (c). the psychological well-being of survivors after leaving; and (d). the predictors of this well-being. The conceptual and methodological limitations of studies in each of these areas are presented. Consistently found predictors of leaving include both material and psychological factors. Because battered women typically undergo several shifts in their thinking about the abuse before leaving permanently, research on leaving as a process is highlighted. A stress-process framework is used to explain the seemingly paradoxical finding that some women just out of the abusive relationship may have greater psychological difficulties than those who are still in it. For those experiencing the most stress, psychological health can worsen over time. Researchers and practitioners need to pay more attention to the plight of women who have left abusive partners.
The literature has documented the widespread nature of sexual assault victimization among college women. While the aftermath of violence against university women has also received focus, that is, documenting trauma-related sequelae; risk factors; reporting patterns; and legal interventions, the impact on academic performance has not received adequate attention in the literature. The primary purpose of this study was to explore the association of rape and sexual assault with academic performance among college women. Its specific aims included the following: to compare high school and college sexual assault experiences with collegiate grade point averages (GPAs) at key points in time; to examine any differences in GPA by type of sexual assault; to urge researchers studying retention and persistence patterns or sexual assault among college students to ensure that the relationship between the two is included in research designs; and to recommend that academic institutions expand programming on retention to include rape and sexual assault among the risk factors associated with a lack of persistence.
Mindfulness- and acceptance-based conceptualizations of PTSD implicate experiential avoidance and non-mindful behavior in the etiology and maintenance of the disorder. If experiential avoidance is associated with vulnerability to PTSD, then a mindful and accepting orientation toward experience may confer psychological resilience following exposure to trauma. This article examines how mindfulness- and acceptance-based theories of psychopathology relate to risk of and resilience to PTSD. Research is reviewed dealing with the impact of experiential avoidance, avoidant coping, dissociation, acceptance, and mindfulness on PTSD symptom severity and posttraumatic functioning. This review suggests that trait mindfulness and acceptance are associated with greater psychological adjustment following exposure to trauma, while experiential avoidance, persistent dissociation, and coping strategies involving emotional disengagement are associated with greater PTSD symptom severity and related psychopathology. Methodological challenges are explored and suggestions for future research and PTSD prevention programs are discussed.
Research is clear that violence against college women is a problem that warrants alternative prevention approaches to addressing and reducing its prevalence and creating safer campuses for women and men. Banyard's presentation gave us food for thought as we consider what such novel approaches may look like. New and innovative approaches that are multifaceted, comprehensive, and informed by theory are key. The ecological model can inform our understanding of the issue, the risk and protective factors associated, and the design and implementation of prevention efforts. It is critically important to engage college students in these efforts to create interventions that are culturally appropriate for college students. We must also meet students where they are, utilizing social marketing campaigns and capitalizing on social media and the use of communication technologies. Together, such efforts will facilitate our ultimate goal of reducing, if not eliminating, violence against women on college campuses.
Although millions of women receive injuries from intimate partner violence (IPV) each year in the United States alone, there has been only limited research of acute injury patterns and the types, locations, and mechanisms of IPV injuries. The mechanism of being punched to the face with a fist resulting in blunt trauma-related injuries is most commonly reported. Strangulation, especially manual strangulation, is a frequently cited mechanism of injury; however, less is known about the types of injuries that result from strangulation. In general, clinicians should assess all patients who present for treatment of head, neck, and face injuries for IPV. There is little consistency between and much inaccuracy with medical terms used to describe types of injuries. To increase the accuracy and generalizability of findings from studies of acute IPV injuries, researchers need to use more standardized medical forensic terminology.
A compelling body of literature suggests that negative appraisal may be associated with adverse reactions to traumatic stress. However, very few studies have examined how appraisal influences posttraumatic adaptation in people with serious mental illness (SMI) despite evidence of disproportionately high prevalence rates of trauma exposure and Posttraumatic Stress Disorder (PTSD) in this population. The purpose of this article is to provide a critical analysis of the theoretical and empirical literature on cognitive appraisal and psychological adaptation to traumatic stress with a specific focus on individuals diagnosed with SMI. It will be argued that appraisal is a key correlate that may partially account for higher rates of PTSD in people diagnosed with major mood and schizophrenia-spectrum disorders, meriting special consideration for future research.
This review brings together both the legal literature and original empirical research regarding the advisability of amending the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act or creating new Department of Education regulations to mandate that all higher education institutions survey their students approximately every 5 years about students' experiences with sexual violence. Legal research conducted regarding the three relevant federal legal regimes show inconsistent incentives for schools to encourage victim reporting and proactively address sexual violence on campus. Moreover, the original research carried out for this article shows that the experience of institutions that have voluntarily conducted such surveys suggests many benefits not only for students, prospective students, parents, and the general public but also for schools themselves. These experiences confirm the practical viability of a mandated survey by the Department of Education.
Items Used to Measure Competence by Domain 
The authors review the literature on resilience following childhood maltreatment and describe how variation in the measurement of outcomes at various developmental stages affects research findings, practice implications, and policy recommendations. Although the 21 studies reviewed considered competent functioning in similar domains as evidence of resilience following maltreatment, few provided prevalence estimates for specific indicators or across domains of functioning. Using the National Survey of Child and Adolescent Well-Being (NSCAW), the authors explored different ways of operationalizing resilience. The number of children demonstrating competence following maltreatment varied greatly by the indicators used; furthermore, competence in one domain (behavioral, emotional, or educational) did not guarantee competence in another. About one in five children were functioning poorly in all three domains. Because findings vary according to the operational definition of resilience, researchers must use caution in conceptualizing their analytic variables and interpreting findings. Furthermore, given the lack of cross-domain competence, services to maltreated children and their families should be comprehensive.
This review summarizes a growing number of methodological concerns emerging from research on child witnesses of intimate partner violence (IPV). A brief summary of various psychological, biological, and cognitive impairments associated with witnessing IPV is presented. Directions for future research in this area are explored with particular attention paid to experimental design. Advantages and disadvantages of retrospective, cross-sectional, and longitudinal designs are evaluated. Suggested improvements include the use of multiple informants, behavioral observations, and prospective, longitudinal assessment.
Top-cited authors
Katie Edwards
  • University of Nebraska at Lincoln
Victoria Banyard
  • University of New Hampshire
Michael Ungar
  • Dalhousie University
Louise Dixon
  • Victoria University of Wellington
Emily F Rothman
  • Boston University