No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Self-mutilation as expressed in self-figure drawings in adolescent sexual abuse survivors
Abstract
Given the detrimental long-term physical and emotional effects of self-mutilation (SM) coupled with the tendency not to disclose suffering and the shortcomings of current diagnostic techniques, early detection of the phenomena utilizing an external tool such as a projective drawing test (not a medical examination) might provide an opportunity to identify and consequently assist self-mutilators.This study aimed to determine if and to what extent indicators of self-mutilating behaviors are expressed in self-figure drawings of female adolescents who were sexually abused. Researchers used a version of (draw yourself) Machover's Draw A Person (DAP) Test, because it is an easy to administer and non-intrusive screening tool, hypothesizing that it will improve the detection of SM. This will facilitate practitioners’ future location of adolescent females at risk for SM as well as assist in prioritizing accessibility to treatment.A convenience sample of 92 adolescent girls was recruited for this study. Participants completed the DAP test in addition to a previously validated self-report questionnaire, the Traumatic Events Questionnaire (TEQ).Findings include positive correlations between psychometric assessments and two indicators of self-mutilation in the DAP test (body line and sexual signs). The study also provides validation of four indicators of sexual abuse previously documented in research: face line, eyes, hands/arms, and genitals.
... This technique is designed to gain insights into a person's emotional and cognitive functioning and elicit impulses, anxieties, and conflicts (Furth, 1988;Gillespie, 1994;Kaplan, 1994). For example, numerous studies have identified indicators in selffigure drawings that point to forms of abuse (Girish et al., 2023;Jaroenkajornkij et al., 2022; Author), depression (shaded eyes, detailed clothing other personal belongings) (Deng et al., 2022), child sexual abuse (Face Line -shaded or emphasized cheek or chin), Eyes -hollowed, shaded or omitted, Hands and Arms -emphasized, disconnected or omitted, and shaded, blocked off, disconnected or omitted lower body) (Kissos et al., 2020;Lev-Wiesel, 1999), eating disorders (Guez et al., 2010) (Neckomitted, doubled or disconnected, the mouth is emphasized or omitted, and the feet are missing or disconnected), Suicidality (slash lines on the body, empty face or omission of head or face, and shading or X's over the body figure (Jacobs-Kayam et al., 2013;Zalsman et al., 2000). ...
... These scores also ranged from 1 to 12, with a higher score indicating a higher risk of having an eating disorder. The Suicidal Attempts/Ideations score (SUID) was constructed by summing the scores of indicators related to the face/head (shadowed or omitted), shading the body contour, and adding X's on the whole figure face or body organs (for the indicators, see Jacobs- Kayam et al., 2013;Zalsman et al., 2000). These scores ranged from 1 to 12, with a higher score suggesting a greater risk of suicidal attempts or thoughts. ...
... Previous cross-cultural studies using self-figure drawing have provided evidence for the reliability and validity of these scores (e.g. Girish et al., 2023;Jacobs-Kayam et al., 2013, Jaroenkajornkij et al., 2022Kissos et al., 2020;Lev-Wiesel et al., 2022). ...
Childhood sexual abuse is a significant risk factor for adverse psychological outcomes such as eating disorders, as well as suicidal attempts and ideation. Detecting these phenomena at an early stage is crucial for improving prognosis. The current study investigated indicators of childhood sexual abuse, eating disorders, and suicidal tendencies as reflected in the self-figure drawings of 130 Slovakian adolescents treated for eating disorders or hospitalized after attempted suicide and a group of healthy controls. Kruskal Wallis test findings indicated that the drawings made by the hospitalized adolescents contained a higher number of indicators associated with childhood sexual abuse, eating disorders, and suicidal tendencies than those from the healthy control group. Similarly, the hospitalized adolescents had higher somatic dissociation scores on the MSDQ than the healthy controls. Logistic regression and decision tree models indicated that child sexual abuse could be predicted by both the drawing indicators and the somatic dissociation scores.
... There is a consensus in regarding drawings as a non-intrusive technique (Jacobs-Kayam et al., 2013;Kissos et al., 2020), given that drawing is a natural and spontaneous language for children, as it is ontologically and genetically more primitive than writing and does not require special training (Ballús and Viel, 2007). This study has used drawings of human figures by children as a graphic projective tool within the conceptual framework of psychoanalysis to facilitate non-verbal expression of the children's traumatic experiences. ...
... Previous studies have suggested that the omission or distortion of body parts in self-figure drawings implies conflictive relationship with the part and are associated with trauma and abuse (Koppitz, 1968;Dyer et al., 2015). For instance, in trauma and abused victims' self-figure drawings, the whole body or certain body parts are omitted or distorted (Jacobs- Kayam et al., 2013;Dyer et al., 2015;Goldner and Frid, 2021), and there are other indicators as well, such as the head detached or disconnected from the body (Faller, 2003;Handler and Thomas, 2013;Goldner and Frid, 2021). Moreover, other studies also provide validation of four indicators of sexual abuse (Jacobs- Kayam et al., 2013) that have previously been documented (Lev-Wiesel, 1999;Amir and Lev-Wiesel, 2007): (1) the face line, (2) the eyes, (3) the hands and arms, and (4) the genitals. ...
... For instance, in trauma and abused victims' self-figure drawings, the whole body or certain body parts are omitted or distorted (Jacobs- Kayam et al., 2013;Dyer et al., 2015;Goldner and Frid, 2021), and there are other indicators as well, such as the head detached or disconnected from the body (Faller, 2003;Handler and Thomas, 2013;Goldner and Frid, 2021). Moreover, other studies also provide validation of four indicators of sexual abuse (Jacobs- Kayam et al., 2013) that have previously been documented (Lev-Wiesel, 1999;Amir and Lev-Wiesel, 2007): (1) the face line, (2) the eyes, (3) the hands and arms, and (4) the genitals. The presence of three or more of these features is considered to indicate sexual abuse. ...
Reality shows us that situations of mistreatment and sexual abuse in childhood are still seldom visible, despite their high prevalence around the world. It is essential to detect and address them, especially among children in situations of dire risk or neglect. The purpose of this study is to determine if graphic emotional indicators are expressed in the drawings of the projective Draw-a-Person (D.A.P) test, made by children in situations of dire risk or neglect. The sample is made up of 34 children, between the ages of 5 and 11 (17 girls and 17 boys), attended by Specialised Child and Adolescent Care Services of the Barcelona Town Hall (Spain). The drawings were coded quantitatively. The results indicated that most of the drawings show a frequency of graphic emotional indicators, as well as graphic indicators common to experiences of mistreatment and/or abuse, which confirm the existence of emotional problems. However, no significant differences based on gender and age were found, except for one indicator of sexual abuse (body omitted/distorted), which is significantly more common in the boys. Results also revealed that the drawings of human figure enable the children to express their experiences of traumatic situations which are difficult to verbalize. These findings have important implications for professionals, as the use of this projective technique can help to early identification and design treatment strategies in situations of mistreatment and/or abuse in children and their families.
... Drawing oneself or drawing a human figure is a frequently used projective technique for psychological assessment [31]. Healthcare providers use the self-figured drawing analysis for evaluation and therapeutic purposes [32]. ...
... Based on the above review, (1) ESRD is a disease that negatively affects the person's psychological and physical well-being [6,8,22], (2) body image is associated with selfperception [24][25][26], and (3) self-figure drawing can be used to assess self-perception and well-being [32]. The main research question was how individuals who undergo chronic dialysis due to ESRD perceive their bodies before (retrospectively) and currently as reflected in drawings and narratives. ...
... This tool was later developed extensively by [46], who popularized the DAP as a personality assessment, and [47], who studied the utilization of the DAP to reflect self-image among children as adolescents. The purpose of analyzing self-figure drawing is to investigate further the issues a client is dealing with [32]. We used self-figure drawing to assess to what extent indicators that were previously found to indicate deterioration in well-being (such as facial expression [48], disconnected or shaking body line [49], and disconnection of arms and hands [32] would be found in these population, too. ...
Chronic kidney disease (CKD) and the dependency on dialysis is an abrupt life-changing event that harms a patient’s life (e.g., social relationships, work, and well-being). This study aimed to examine how individuals who undergo chronic dialysis due to failure end-stage renal disease perceive their bodies, as reflected in drawings and narratives. Following ethical approval and signing a consent form to participate in the study, 29 adults between the ages of 20 and 85 who have undergone dialysis filled out an anonymous questionnaire that consisted of the following measures: The Center for Epidemiological Studies—Depression (CES-D), The Multidimensional Body-Self Relations Questionnaire (MBSRQ), and The MOS 36-Item Short-Form Health Survey (SF-36). After completion, they were asked to draw their self-figure before and after being diagnosed and narrate it. The data were quantitatively and narratively analyzed. The results revealed high levels of depression and concerns regarding body fitness and weight. Few significant differences were noted between self-figured drawings before and after the diagnosis, such as the body line and gender markers. Additionally, Fitness Evaluation and Overweight Preoccupation were significant among the participants.
... We propose that self-figure drawings, which have been used to detect and identify different traits and experiences including sexual abuse, can become such a tool. Several previous studies show that there are specific indicators in self-figure drawings that can identify CSA survivors (Amir & Lev-Wiesel, 2007;Jacobs-Kayam et al., 2013;Lev-Wiesel, 1999). The current study attempts to find out to what extent self-figure drawings of children who were sexually abused differ from those who were physically abused and others who were neither sexual nor physically abused yet were emotionally abused. ...
... Self-figure drawing is a version of the DAP that is used to evaluate specific psychological characteristics such as self-injurious behaviors (Jacobs- Kayam et al., 2013), learning difficulties (Borsa, 2019), and dissociative disorders (Amir & Lev-Wiesel, 2007). Researchers such as Borsa (2019) showed that self-figure drawing is a useful tool to evaluate mental health in children. ...
... The results showed four indicators of having been sexually abused -face line (double, hollow, or shaded), eyes (drawn as dots, omitted, shaded, hollow), hands and arms (cut off/clinging/detached/omitted), and genitals (shaded/blocked off from the rest of the body). These results were substantiated in studies that examined indicators of dissociative identity disorder (Amir & Lev-Wiesel, 2007) and self-mutilation behaviors among adolescents who were sexually abused (Jacobs- Kayam et al., 2013). McIness (2019) who examined hundreds of self-figure drawings of sexually abused children found that the victimized child is often pictured as small, incomplete, lacking facial features, missing arms or legs, and floating in limbo. ...
Based on the lack of validated assessment tools to detect past physical or sexual abuse, the current study examines to what extent the experience of either sexual or physical abuse is reflected in self-figure drawings of adolescents at-risk. A convenience sample consists of 93 adolescents at risk between the ages of 12–17 recruited from Welfare institutes divided into three groups: Group 1 included adolescents who experienced sexual abuse, Group 2 included adolescents who experienced physical abuse but not sexual abuse, Group 3 included adolescents who experienced neither sexual abuse nor physical abuse. A self-report anonymous questionnaire that consisted of demographics, traumatic events questionnaire, and the Medical Somatic Dissociation Questionnaire (MSDQ) was administered following Ethical approval and signing of consent forms. Participants were asked to draw themselves on an A4 sheet of paper using a pencil. Five social workers who were unaware of participants’ experiences assessed the drawings independently for the level of obviousness of the following indicators: face line, eyes, nose, ears, hair stand, forehead, lower body, arms, and hands. Results yielded differences in pictorial indicators (nose, hair stand, lower body) among the groups. MSDQ score was found significantly higher among sexually abused victims.
... Indeed, child sexual abuse in all its forms (unwanted sexual touching, completed or attempted penetration) is one of the most difficult experiences a child or a young person may sustain. [4] Studies among youth have shown the deleterious impacts associated with sexual abuse affecting both the mental [4][5][6][7] and physical health of victims. [8] Scholarly reports have also underscored the greater vulnerability of victims of child sexual abuse to other forms of interpersonal victimizations including sexual harassment, [9] teen dating violence, [10] and adult partner violence. ...
... Indeed, child sexual abuse in all its forms (unwanted sexual touching, completed or attempted penetration) is one of the most difficult experiences a child or a young person may sustain. [4] Studies among youth have shown the deleterious impacts associated with sexual abuse affecting both the mental [4][5][6][7] and physical health of victims. [8] Scholarly reports have also underscored the greater vulnerability of victims of child sexual abuse to other forms of interpersonal victimizations including sexual harassment, [9] teen dating violence, [10] and adult partner violence. ...
... Maternal Support. The Inventory of Parent and Peer Attachment (IPPA) questionnaire was used to assess the participant's relationship with their mother at Wave 1. [32] The three questions (e.g., My mother cares about me) are on a five-point Likert scale ranging from Never (0) to very often (4). The questionnaire showed good reliability (Cronbach α = 0.83). ...
Background: Child sexual abuse is associated with adverse outcomes, including heightened vulnerability that may translate into risk of revictimization. The aims of the study were: (1) to explore the direct and indirect links between child sexual abuse and cyberbullying, bullying, and mental health problems and (2) to study maternal support as a potential protective factor.
Methods: Teenagers involved in the two first waves of the Quebec Youths' Romantic Relationships Survey (N = 8,194 and 6,780 at Wave I and II, respectively) completed measures assessing child sexual abuse and maternal support at Wave I. Cyberbullying, bullying, and mental health problems (self-esteem, psychological distress, and suicidal ideations) were evaluated 6 months later.
Results: Rates of cyberbullying in the past 6 months were twice as high in sexually abused teens compared to nonvictims both for girls (33.47 vs. 17.75%) and boys (29.62 vs. 13.29%). A moderated mediated model revealed a partial mediation effect of cyberbullying and bullying in the link between child sexual abuse and mental health. Maternal support acted as a protective factor as the conditional indirect effects of child sexual abuse on mental health via cyberbullying and bullying were reduced in cases of high maternal support.
Conclusions: Results have significant relevance for prevention and intervention in highlighting the heightened vulnerability of victims of child sexual abuse to experience both bullying and cyberbullying. Maternal support may buffer the risk of developing mental health distress, suggesting that intervention programs for victimized youth may profit by fostering parent involvement.
... Some challenges in reporting and addressing corporal punishment may be more common in some areas. Self-Figure drawing serves as an assessment tool for specific psychological traits such as self-injury tendencies [64], learning challenges [65], and dissociative disorders [66]. Studies have demonstrated its efficacy in evaluating children's mental health, with features like "clawed fingers," "visible teeth," and "exaggerated shoulder width" potentially indicating aggression [65]. ...
... Lev-Wiesel [21] utilized the DAP test to identify common indicators in drawings of adults sexually abused during childhood, revealing features like facial lines (double, hollow, or shaded), eyes (dots, omission, shading, hollowness), hands and arms (cut off, clinging, detached, omitted), and genitals (shaded, blocked off). These indicators were supported in studies examining dissociative identity disorder [66] and self-mutilation behaviors among sexually abused adolescents [64]. McIness [67] observed that drawings of sexually abused children often depict them as small, incomplete, lacking facial features, missing limbs, and appearing suspended. ...
Background/Objectives: The current study compared Self-Figure drawings from Thai and Indian adolescents to assess the cross-cultural applicability of a child abuse assessment tool. The research aims to understand the extent to which distinctions or similarities arise in Self-Figure drawings among adolescents from two culturally similar yet distinct backgrounds characterized by differences in religious affiliations, socioeconomic contexts, and political environments. Methods: Employing a mixed-methods approach, the study utilized quantitative measures, including the Traumatic Events Checklist (TEQ-5) and Medical Somatic Dissociation Questionnaire (MSDQ), alongside a qualitative analysis of Self-Figure drawings. Ethical approval was obtained with waived informed consent, and a convenience sample of 386 adolescents aged 13–18 years (193 from Thailand [M = 14.8, SD = 1.73; 135 females (69.9%) and 58 males (30.1%)], and 193 from India [M = 15.2, SD = 1.64; 135 females (69.9%) and 58 males (30.1%)]), who reported experiencing child abuse, participated in the study by completing questionnaires and drawing themselves. Results: The analysis revealed that Thai adolescents had higher MSDQ scores, while Indian adolescents exhibited more prominent pictorial indicators. Indian participants reported experiencing a broader range of event types, whereas Thai adolescents predominantly depicted verbal or emotional abuse. Variations in pictorial indicators were found significant, except for hair, cheek or chin, omitted legs or feet, and omitted eyes. Conclusions: These findings contribute to the understanding of how cultural factors influence adolescents’ self-representations through drawing. The differences in pictorial indicators highlight the nuanced variations within similar cultures, emphasizing the cultural specificity of self-expression.
... For example, specific areas of the body in self-figure drawing are associated with trauma and abuse and linked to highly aversive emotions (Dyer, Feldmann, & Borgmann, 2015). For instance, in trauma and abused victims' self-figure drawings, the whole body or body parts are omitted or distorted (Allen & Tussey, 2012;Dyer et al., 2015;Jacobs-Kayam, Lev-Wiesel, & Zohar, 2013;Lev-Wiesel & Liraz, 2007;Veltman & Browne, 2002); and the head is often detached or disconnected from the rest of the body (Dillenburger, 2005;Faller, 2003;Handler & Thomas, 2013;Sidun & Rosenthal, 1987;Sidun, 1986). Lev-Wiesel (1999) developed a modified version of the Draw-A-Person test devolved to detecting child abuse. ...
... No other instructions are given. Interpretation is based on four clinical indices (Amir & Lev-Wiesel, 2007;Jacobs-Kayam et al., 2013;Lev-Wiesel, 1999): the face line (double, hollow, or shaded chin or cheek and eyes that are in the form of a dot/hollowed/shaded/omitted), hands and arms that are depicted as clinging/detached/cut off/omitted, and genitals drawn as shaded, or blocked off from rest of body. The presence of three or more of these features is considered to indicate sexual abuse. ...
This study reports the four stages in the development of a Convolutional Neural Network (CNN) system designed to detect abuse in self-figure drawings: (1) A preliminary study to build a Gender CNN; (2) Expert-level performance evaluation, (3) validation of the CSA CNN, (4) testing of the CSA CNN model. The findings indicate that the Gender CNN achieved 88 % detection accuracy and outperformed the CSA CNN by 19 percentage points. The CSA CNN achieved 72 % accuracy on the test set with 80 % precision and 79 % recall for the abuse class prediction. However, human experts outperformed the CSA CNN by 16 percentage points, probably due to the complexity of the task. These preliminary results suggest that CNN, when further developed, can contribute to the detection of child sexual abuse.
... Lev-Wiesel (1999) developed a version of the Draw-A-Person test with the instruction of "draw yourself" built on four indicators. The indicators were found promising in identifying sexual abuse victims (Amir & Lev-Wiesel, 2007;Jacobs-Kayam, Lev-Wiesel, & Zohar, 2013;Lev-Wiesel, 1999). Due to the simple features of this test (based on the recognition of four indicators only), an online version can be easily taught to interdisciplinary allied and mental health professionals, with widespread distribution. ...
... A correct response was rated with one point added, and a wrong answer with one point removed. The test was developed by the first and second authors based on the second author's studies of the four indicators for detecting sexual abuse in self-figure drawings (Jacobs-Kayam, Lev-Wiesel, & Zohar, 2013;Lev-Wiesel, 1999). The pre-and posttest were equivalent versions. ...
Sexual abuse is a common worldwide phenomenon, with severe physical and mental consequences. Yet its detection remains challenging due to a variety of factors. Sexual abuse detection through drawing shows promising results for the detection of sexual abuse. This study aims to evaluate the contribution to practice of a sexual abuse detection through drawing workshop, and to compare online and face-to-face versions of this program in term of skills and knowledge. The results of the study show that the detection of sexual abuse through drawing was improved through both the online and face-to-face formats of the workshop. There was no difference between the two formats of the workshop. Long-term contributions to practice were moderate. There was a decline in skills and knowledge in the three-month follow-up reports, emphasizing the need for further practice. The study concludes with the advantages of the e-learning format to sexual abuse detection training.
... The validity of the Self-Figure drawing has been explored in various studies, wherein positive correlation with other validated psychometric assessments such as the Eating Attitudes Test, Body Shape Questionnaire, Traumatic Events Questionnaire, and Medical Somatic Dissociation Questionnaire (Guez et al., 2010;Jacobs-Kayam et al., 2013;Lev-Wiesel et al., 2022) has been found. Additionally, an artificial intelligence system has also been developed to detect sexual abuse with the use of Self-Figure drawings (Kissos et al., 2020). ...
The present mixed-methods study aims to understand the extent to which emotional, physical and sexual abuse is reflected in the Self-Figure drawings of Indian street children by identifying pictorial indicators unique to each form of abuse. Following ethical approval and informed consent, 357 children across different states residing in shelter homes with a background of abuse were asked to draw themselves, complete the Medical Somatic Dissociation Questionnaire (MSDQ) and a life events scale in their regional language. Based on the rating of two art therapists on the level of obviousness, pictorial characteristics belonging to the specific form of abuse were ascertained. Results showed that nose, forehead and cheek/chin were significantly profound for physical and sexual abuse whereas eyes, arms/hands and genital area stood out for emotional abuse (p < 0.001). Significantly low somatization and depression were seen for emotional abuse (p < 0.001). Positive correlation was seen between MSDQ subscales of somatization, depression, total MSDQ score and indicators of forehead and cheek/chin (p < 0.01). Depression and total MSDQ score had a positive correlation with the indicator of ears. These differences reflected in the drawings can assist professionals in screening abused children reluctant to disclose aiding assessment and intervention.
... Ekspresja plastyczna może przynieść ulgę w cierpieniu, zastępować radzenie sobie z emocjami w destrukcyjny sposób, jakim jest np. samookaleczanie się (Jacobs-Kayam, Lev--Wiesel, Zohar, 2013;Kay, Wolf, 2017). ...
„Edukacja integracyjna to złożony i wieloaspektowy proces czerpiący
swe źródła z idei normalizacji i autonomii życia osób z niepełnosprawnością.
Idee te wyznaczyły koncepcję wspólnego kształcenia uczniów
wymagających specjalnej realizacji potrzeb edukacyjnych z ich sprawnymi
rówieśnikami. Wspólna edukacja stwarza korzystne warunki realizacji «dobrej
szkoły dla wszystkich». Urzeczywistnienie idei edukacji integracyjnej
wymaga zaangażowania wszystkich podmiotów, w tym uczniów, nauczycieli,
rodziców, społeczności lokalnych oraz organizacji i instytucji państwowych.
Złożoność i wielowymiarowość procesu edukacji integracyjnej, jak też
jej znaczenie dla kształtowania nowego modelu życia społecznego, wskazuje
na potrzebę i rangę ponowionej debaty w gronie teoretyków i praktyków”
(https://konferencje.aps.edu.pl/osoba/?lang=pl).
Społeczność Instytutu Pedagogiki Specjalnej w Akademii Pedagogiki Specjalnej
im. Marii Grzegorzewskiej w Warszawie nie tylko dostrzegła potrzebę
takiej debaty, lecz także ją zainicjowała i zorganizowała w dniach 26–27
września 2019 r. w ramach naukowych spotkań z cyklu OSOBA. Dyskurs teoretyków
i praktyków toczył się wokół tematu Jedność w różnorodności – idea
i rzeczywistość. 30 lat edukacji integracyjnej, a prezentowana publikacja jest jego
pokłosiem – namysłem nad stanem polskiej edukacji integracyjnej. Przedstawia
także działania wdrażające ideę inkluzji i dążenia do zbudowania modelu
edukacji wysokiej jakości dla wszystkich uczących się podmiotów.
8
Wstęp
Opracowanie składa się z dwóch tomów. W pierwszym tomie zamieszczone
zostały teksty analizujące podstawy prawne, teoretyczne konteksty
i modele koncepcyjne edukacji inkluzyjnej (dziewięć tekstów – część pierwsza),
a także uwarunkowania wspólnej i rozłącznej edukacji (11 tekstów –
część druga). Tom drugi (17 tekstów zestawionych w trzech częściach) został
zaprojektowany z myślą o prekursorach wychowania i nauczania uczniów
pełnosprawnych i z niepełnosprawnością w jednej przestrzeni edukacyjnej.
Snują oni interesujące – często osobiste i emocjonalne – refleksje, przedstawiają
trudności, jakie musieli pokonać, dzielą się swoimi doświadczeniami
i przede wszystkim pasją oraz optymizmem pedagogicznym.
Do zapoznania się z publikacją, zarówno z tomem pierwszym, jak i drugim,
zachęcamy naukowców, doktorantów, studentów, nauczycieli, rodziców,
decydentów, słowem: te osoby, którym na sercu leżą dobrostan każdego
ucznia i „dobra szkoła dla wszystkich”.
... Empirical and clinical work in art therapy and allied fields has shown that drawings enable the expression of hidden or repressed thoughts and feelings in a relatively fast and straight forward way (Lev-Wiesel and Shvero, 2003;Jacobs-Kayam et al., 2013;Woolford et al., 2013;Snir et al., 2020). Regarding children, researchers and therapists posited that drawings could shed light on children's internal and outer worlds and their perception of their families and parents in a way that communicates feelings and ideas of their environment (Goldner and Scharf, 2012). ...
Child abuse is an underreported phenomenon despite its high global prevalence. This study investigated how child abuse is perceived by children and adolescents as manifested in their drawings and narratives, based on the well-established notion that drawings serve as a window into children’s mental states. A sample of 97 Israeli children and adolescents aged 6–17 were asked to draw and narrate what child abuse meant to them. The drawings and narratives were coded quantitatively. The results indicated that participants did not perceive a distinction between abuse and violence and referred to them interchangeably. Almost half of the participants focused on emotional abuse. The most frequent type of abuse within the family was between parents and children, and the most frequent abuse outside the family was peer victimization. Most of the drawings were figurative and realistic and half of the drawings included words suggestive of the participants’ attempts to be heard and fully understood. The vast majority of drawings did not include the figure of the artist, about a third of the drawings employed dissociative techniques (i.e., included positive objects, were unrelated to abuse, used words alone, or did not follow the instructions), and almost half of the narratives were dissociative or characterized by negative resolution, describing feelings such as sadness, humiliation, and loneliness. These findings suggest the emotional pain associated with the abuse or violence and the use of dissociative mechanisms to bypass the pain. The findings are discussed in light of the literature on children’s disclosure.
... For researchers as well as therapists, drawings can shed light on individuals' internal worlds (Gantt and Anderson, 2009) and their perceptions of their families, parents, siblings, or spouses (Goldner and Scharf, 2012). Drawings are considered to tap into conscious and unconscious content in way that communicates feelings and ideas in a safe environment (Malchiodi, 1997;Lev-Wiesel and Shvero, 2003;Jacobs-Kayam et al., 2013). The assumption is that by using colors, shapes, and motifs, as reflected in visual content, the unconscious can be expressed (Goldner and Scharf, 2012). ...
Polygamy is associated with lower marital satisfaction and is known to involve sexual, physical, and emotional abuse on the part of the husband. Less is known about the experience of mothers in polygamous families. This study was designed to shed light on the experiences of women in polygamous families in a sample of 80 Israeli Arab mothers living in polygamous families who use social services, domestic violence agencies, and health centers. Mothers were asked to draw their experiences in their families and to provide narratives for the drawings. A phenomenological approach was used to analyze the drawings, and yielded five different pictorial phenomena: (1) pseudo-sweetness, (2) houses, (3) the absentee father and the estranged mother, (4) incorporation of graphic symbols and lettering that represented distress, and (5) growth and development. Most of the drawings were restricted and shallow, indicating a complex emotional state of despair and distress. The central feelings that emerged from the drawings were negative emotions of anger, sadness, loneliness, and powerlessness. While some women longed for romantic relationships with their husbands, others expressed the desire for revenge and justice. Dissociation and parentification, as central coping strategies, emerged from the drawings and the narratives. The findings are discussed theoretically and clinically.
... Indicators included an incomplete or emphasised face line, often missing features, blank eyes, missing hands and arms, and with emphasised genitals. 31 Shiakou's research found that family drawings by maltreated children ages five to eleven showed evidence of insecure attachment, with the child depicted alone or apart from their family in contrast to the drawings by non-maltreated children, who always drew themselves with their family. 32 Patterson and Hayne researched whether drawing about an event increased the amount of information children provide during an interview. ...
... The disparity observed in the narratives was that of presence and absence of the body, expressing more than anything the perceived threat of being feminine and beautiful in the face of the ban to appear so outwardly and preserve modesty in public. These conflicts were more prominent among the ultra-Orthodox, whose drawings often expressed severe distress, such as depression (36). ...
Background:
We investigated the correlation between eating-related pathology and the Superwoman ideal among ultra-Orthodox (Haredi) and National-Religious women in Israel using self-figure drawings and related narratives.
Method:
A sample of 55 women filled out self-report eating attitudes questionnaire (EAT-26), the Superwoman Ideal questionnaire, and a self-drawing followed by a narrative.
Results:
No significant difference in eating pathology was found between the ultra-Orthodox and NationalReligious women. A gap was found between the selfdrawings and the narratives, which was greater among the ultra-Orthodox women. Exposed body parts were more significant than sexual signs, which are almost completely covered in these societies.
Conclusion:
There was no significant difference in the eating disorders' level among ultra-Orthodox and NationalReligious women. The percentage of risk of developing eating problems was similar to that of the secular population. The self-drawings with narratives was found to be an effective tool for researching these societies.
Deliberate self harm (DSH) refers to the intentional, direct injury of one's own body tissue without suicidal intent. This behavior is a significant mental health concern, particularly among adolescents and young adults. Understanding the measurement and theoretical aspects of DSH is crucial for effective assessment, intervention, and prevention efforts. Regarding measurement, the focus of this narrative, several self-report and clinical assessment tools have been developed to evaluate the prevalence, severity, and characteristics of DSH. These instruments assess various dimensions of DSH, such as frequency, methods, motivations, and associated psychosocial factors. Theoretically, DSH has been conceptualized within several frameworks, including the behavioral, beurologcal, socio-cultural, phenomenological, biological and eclectic respectively-although these are nnot te concerns in this paper. Clinicians should be trained to assess and address DSH using evidence-based practices, such as cognitive-behavioral therapy, dialectical behavior therapy, and medication management. Thereby, we can better support individuals struggling with this complex and often misunderstood behavior.
The current study explored the extent to which sexually assaulted survivors' self-drawings can serve as an efficient tool to assess their mental states and psychopathology as characterized in the DAP-SPED (Naglieri et al., 1991, 1992). The sample was composed of 83 SA Israeli adult survivors. Hypothesis 1 (H1) predicted frequent distortions and omission of body parts, a disconnection between body parts, and a poor-quality line. Hypothesis 2 (H2) predicted a positive correlation between the number of indicators in the women's self-drawings and their levels of post-traumatic stress symptoms. Hypothesis 3 (H3) predicted a negative association between the number of indicators and women's levels of post-traumatic growth. Analysis of the drawings confirmed H1. The drawings lacked integration, tended to have a shadow around the body contour and/or were off-center. The figures were missing the torso, hands or feet with emphasized eyes or necks and chin. H2 and H3 were partially confirmed in that women whose drawings were characterized by omissions, cut-offs, and detached body parts scored higher on post-traumatic stress symptoms and evidenced a lower level of post-traumatic growth. Phenomenologically, the drawings were categorized into six groups (adapted, dramatic, strange, childish, unease, loneliness, and sad). Women in the dramatic drawings group had higher post-traumatic stress symptoms and post-traumatic growth. Women in the unease drawings group had the most elevated post-traumatic stress symptoms. Since SA survivors often turn to therapy without revealing the assault, draw oneself can provide the clinician with important insights into the physical and emotional aspects of the client.
Child sexual abuse is present in all strata of Israeli society. However, there is scant research on the emotional experiences of non-abusing mothers after disclosure. In particular, no studies have examined the experiences of these mothers from the Jewish Ultra-Orthodox community in Israel. The current study analyzed the drawings and short narratives of 21 Israeli Ultra-Orthodox mothers to explore the effects of the disclosure of their child's sexual abuse. A phenomenological approach was used to analyze the drawings and yielded four different phenomena: (1) squiggles that represented distress, (2) the mother-child relationship, (3) pseudo-sweet houses, and (4) split drawings. The drawings were either colorful, sweet or shallow, or alternatively were in black and white. As confirmed by the narratives, these drawings primarily expressed the negative emotions of shock, sadness, distress, guilt, and failure as mothers. While some mothers reported breaking down and that pain had permeated their daily lives others coped by dissociating the painful experience, putting up a façade of normalcy, or splitting their lives into two parts corresponding to before and after the disclosure.
Le dessin est une activité grapho-motrice typique de l’enfance qui a régulièrement été l’objet de recherches dans le domaine de la psychologie. Dans cet article, nous nous attachons à dégager les principales questions de recherche qui sont actuellement posées en psychologie sur le dessin. Pour cela, notre méthodologie consiste (i) à rassembler les articles scientifiques publiés en langue anglaise dans des revues internationales à comité de lecture de 2011 à 2013 (inclus) qui comportent le mot « dessin » dans leur titre, puis (ii) à catégoriser ce corpus en un ensemble limité de thématiques récurrentes afin de dégager les principaux axes de recherche actuels sur le dessin. Enfin, (iii) nous procédons à une analyse qualitative et quantitative de ce corpus et illustrons chaque axe de recherche identifié par la présentation d’études représentatives de leur catégorie.
This article provides a summary for advocacy, court testimony, assessment, treatment, prevention, and further research studies in the field of childhood sexual abuse.
A literature review identifies the psychiatric, social, and disease disorders to which this population is predisposed. Adult survivors experience more depression, obesity, autoimmune disorders (irritable bowel syndrome, asthma, fibromyalgia), eating disorders, and addictions.
A holistic perspective allows understanding of health consequences for survivors. A model through which to consider these phenomena is presented.
The long-term consequences of childhood sexual abuse must be assessed and addressed by healthcare professionals.
The National Institutes of Health (NIH) Clinical Research Center is a government facility that has a long history of groundbreaking research. Art therapy research began at NIH in 1958 with Hanna Kwiatkowska, whose work contributed to the foundation of art therapy with families, and with Harriet Wadeson, who conducted psychodynamic art therapy research. This article describes the early history of art therapy research at NIH, its loss of salience at the institute as government funding priorities shifted, art therapy's reestablishment there as a clinical practice in palliative care, and possible directions for future research.
The purpose of this study was to examine a broad range of childhood experiences associated with risk for sexual assault victimization in adulthood. Childhood experiences hypothesized to enhance vulnerability for adult sexual victimization, including maltreatment experiences perpetrated by adults and children as well as family composition variables, were examined. A community sample of 277 women attending outpatient clinics at an urban hospital provided retrospective self-report regarding family composition and cohesion, childhood maltreatment experiences perpetrated by adults and peers, and adulthood victimization. Results of logistic regression analysis indicate that early sexual experiences with peers, childhood sexual abuse by adults, father or father figure's absence as a primary caregiver in childhood, perceived level of closeness to father in adolescence, and neglect by mother pose significant risk for subsequent adult victimization
This study aimed to examine the impact of stoma on the psychological well-being of colorectal cancer patients as reflected in their self-figure drawings. Twenty-four colorectal cancer patients referred to surgery were administered self-report questionnaires and were asked to draw themselves, 12 of these patients were administered the same questionnaire and drew a second self-figure drawing 3 months later. Results indicated a significant decrease in level of satisfaction in family domain after 3 months, and shakier body lines and specific additional features representing the stoma patch and the tumor were noted in the drawings.
In recent years, non-suicidal self-injury (NSSI) among adolescents has been identified as alarmingly common place. Some studies have suggested that more than one in eight adolescents have engaged in self-cutting or other self-injuring behaviors. Even more of a concern is that self-injury often foreshadows suicide or suicide attempts. With self-cutting common in middle and high schools, understanding the antecedents and correlates of such behavior may help counselors and others public health officials identify troubled students and initiate preventative measures. This study utilizes data from 2,639 high school students from the Delaware Youth Risk Behavior Survey to investigate the gender differences in NSSI and suicidal ideation. Overall, 13% reported engaging in NSSI within the past year, with females reporting significantly higher rates (17%) of NSSI than males (9%). Results indicate that there are significant gender differences in NSSI and suicidal thoughts based upon previous victimization experiences, reported substance use, depression, health behaviors, and sexual orientation.
This paper argues that admonishing art therapists to engage in research in order to secure their survival in the contemporary managed care culture sets up the unintended consequence of accepting an identification with powerlessness as a primary motivation for expanding the knowledge base of the profession. In agreement with research findings that suggest art therapists may feel intimidated, alienated, and ambivalent regarding participation in research, this paper presents an archetypal teaching model that contemplates research as a contemporary form of an ancient hunting and gathering tradition all humans share. Basic assumptions about research activity are reframed from the perspective of the hunt, which offers a potent symbol of risk, survival, and spiritual searching that engages the imaginations of art therapists in order to connect with primary questions that arise naturally out of their art and professional pursuits.
Self-injury behavior is the nonsuicidal, deliberate infliction of a wound to oneself in an attempt to seek expression. Self-injury is more prevalent in the adolescent population, and often emergency and advanced practice nurses are the health professionals who encounter this phenomenon. The purpose of this study was to explore self-injury by cutting as experienced by adolescent females. The researcher utilized phenomenology to discover the participants' descriptions of their experiences with cutting. Research was guided by the theoretical framework of the Humanistic Nursing Theory. The Giorgi method of data analysis was utilized to discover the themes that emerged from the participants' stories. The themes which emerged from the raw data were living with childhood trauma, feeling abandoned, being an outsider, loathing self, silently screaming, releasing the pressure, feeling alive, being ashamed, and being hopeful for self and others.
The lifetime prevalence of traumatic events and their psychological impact were assessed in 440 undergraduate students. Eighty-four percent of the subjects reported experiencing at least one event of sufficient intensity potentially to elicit Post- Traumatic Stress Disorder (PTSD). One-third of the sample had experienced four or more traumatic events. Subjects who had experienced trauma reported higher levels of depression, anxiety, and PTSD symptomatology than nontraumatized subjects, and these symptoms were more intense in subjects who experienced multiple traumas. Events that were particularly negative in their impact included unwanted sexual experiences and events that subjects reported were too traumatic to discuss openly. Males and females differed in their probability of experiencing some types of events and in the psychological response to certain events.
This study examines self-harm in a community sample of adolescents. More specifically, the study identifies the prevalence
and types of self-harm, elucidates the nature and underlying function of self-harm, and evaluates the relation of psychological
adjustment, sociodemographic, and health-risk variables to self-harm. Self-report questionnaires assessing self-harm, adjustment,
health behaviors, suicide history, and social desirability were completed by 424 school-based adolescents. Overall, 15% of
the adolescents reported engaging in self-harm behavior. Analyses revealed gender differences across behaviors and motivations.
Adolescents who indicated harming themselves reported significantly increased antisocial behavior, emotional distress, anger
problems, health risk behaviors, and decreased self-esteem. Results provide support for the coping or affect regulation model
of self-harm. Findings suggest that self-harm is associated with maladjustment, suicide, and other health behaviors indicative
of risk for negative developmental trajectories.
Social workers have a unique interest in understanding diversity in patterns of human adaptation to adverse circumstances. This paper draws social workers' attention to empirical research on sociocultural variations in adolescent girls' expressions of distress. Focusing on internalizing and externalizing modes of expression, the author summarizes current studies that investigate ethnic/race and socioeconomic influences on adolescent girls' behavioral and psychological symptoms of underlying distress. This review of existing literature points to the need for a more refined understanding of multiple and interacting influences on adolescent female patterns of expression and draws several implications for social work practice with this diverse population group.
Research to date has failed to identify a unique syndrome describing the sequelae of child sexual abuse (CSA). Recently, however, some researchers have suggested Post-Traumatic Stress Disorder as the diagnosis which best fits the syndrome commonly seen in CSA survivors. Research examining the consequences of CSA in terms of the applicability of a PTSD diagnosis is reviewed. Additionally, based on findings of significant relationships between PTSD and traumatic exposure in other trauma groups, this review also examines studies which have investigated relationships between exposure and symptom development among CSA survivors. Finally, conclusions regarding the applicability of PTSD to CSA survivors and suggestions for future research are offered.
Currently little research exists examining self-mutilation (SM) in community samples of adolescents, despite tentative findings suggesting that self-harming behaviors, including SM may be increasing. The present study provides a comprehensive review of previous literature on the frequency of SM as well as preliminary epidemiological data concerning the frequency of SM in a community sample of high schools students. The relationship between SM, anxiety, and depressive symptomatology was also assessed. Four hundred and forty students from two schools, an urban and a suburban high school, were given a screening measure designed to assess for SM. Students who indicated that they hurt themselves on purpose also participated in a follow-up interview. Based on interviews it was found that 13.9% of all students reported having engaged in SM behavior at some time. Girls reported significantly higher rates of SM than did boys (64 vs. 36%, respectively). Self-cutting was found to be the most common type of SM, followed by self-hitting, pinching, scratching, and biting. Finally, students who self-mutilate reported significantly more anxiety and depressive symptomatology than students who did not self-mutilate. Results are also presented concerning demographic information and patterns of SM behavior.
Background:
Despite differences in how it is defined, there is a general consensus amongst clinicians and researchers that the sexual abuse of children and adolescents ('child sexual abuse') is a substantial social problem worldwide. The effects of sexual abuse manifest in a wide range of symptoms, including fear, anxiety, post-traumatic stress disorder and various externalising and internalising behaviour problems, such as inappropriate sexual behaviours. Child sexual abuse is associated with increased risk of psychological problems in adulthood. Cognitive-behavioural approaches are used to help children and their non-offending or 'safe' parent to manage the sequelae of childhood sexual abuse. This review updates the first Cochrane review of cognitive-behavioural approaches interventions for children who have been sexually abused, which was first published in 2006.
Objectives:
To assess the efficacy of cognitive-behavioural approaches (CBT) in addressing the immediate and longer-term sequelae of sexual abuse on children and young people up to 18 years of age.
Search methods:
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2011 Issue 4); MEDLINE (1950 to November Week 3 2011); EMBASE (1980 to Week 47 2011); CINAHL (1937 to 2 December 2011); PsycINFO (1887 to November Week 5 2011); LILACS (1982 to 2 December 2011) and OpenGrey, previously OpenSIGLE (1980 to 2 December 2011). For this update we also searched ClinicalTrials.gov and the International Clinical Trials Registry Platform (ICTRP).
Selection criteria:
We included randomised or quasi-randomised controlled trials of CBT used with children and adolescents up to age 18 years who had experienced being sexually abused, compared with treatment as usual, with or without placebo control.
Data collection and analysis:
At least two review authors independently assessed the eligibility of titles and abstracts identified in the search. Two review authors independently extracted data from included studies and entered these into Review Manager 5 software. We synthesised and presented data in both written and graphical form (forest plots).
Main results:
We included 10 trials, involving 847 participants. All studies examined CBT programmes provided to children or children and a non-offending parent. Control groups included wait list controls (n = 1) or treatment as usual (n = 9). Treatment as usual was, for the most part, supportive, unstructured psychotherapy. Generally the reporting of studies was poor. Only four studies were judged 'low risk of bias' with regards to sequence generation and only one study was judged 'low risk of bias' in relation to allocation concealment. All studies were judged 'high risk of bias' in relation to the blinding of outcome assessors or personnel; most studies did not report on these, or other issues of bias. Most studies reported results for study completers rather than for those recruited.Depression, post-traumatic stress disorder (PTSD), anxiety and child behaviour problems were the primary outcomes. Data suggest that CBT may have a positive impact on the sequelae of child sexual abuse, but most results were not statistically significant. Strongest evidence for positive effects of CBT appears to be in reducing PTSD and anxiety symptoms, but even in these areas effects tend to be 'moderate' at best. Meta-analysis of data from five studies suggested an average decrease of 1.9 points on the Child Depression Inventory immediately after intervention (95% confidence interval (CI) decrease of 4.0 to increase of 0.4; I(2) = 53%; P value for heterogeneity = 0.08), representing a small to moderate effect size. Data from six studies yielded an average decrease of 0.44 standard deviations on a variety of child post-traumatic stress disorder scales (95% CI 0.16 to 0.73; I(2) = 46%; P value for heterogeneity = 0.10). Combined data from five studies yielded an average decrease of 0.23 standard deviations on various child anxiety scales (95% CI 0.3 to 0.4; I(2) = 0%; P value for heterogeneity = 0.84). No study reported adverse effects.
Authors' conclusions:
The conclusions of this updated review remain the same as those when it was first published. The review confirms the potential of CBT to address the adverse consequences of child sexual abuse, but highlights the limitations of the evidence base and the need for more carefully conducted and better reported trials.
This study investigated (a) whether childhood sexual abuse (CSA) was uniquely associated with adult sexual risk behavior, after controlling for other types of childhood maltreatment and (b) whether there were additive or interactive effects of different types of maltreatment on adult sexual risk behavior. Participants were 414 women (M age = 28 years) attending a publicly funded STD clinic. All women completed a computerized survey assessing childhood maltreatment (sexual, physical, psychological abuse, and neglect) and sexual risk behavior. Analyses showed that sexual abuse, physical abuse, psychological abuse, and neglect were associated with adult sexual risk behavior. Multivariate analyses that controlled for all other forms of child maltreatment showed that only CSA was uniquely associated with adult sexual risk behavior (i.e., percentage of episodes of unprotected sex in the past 3 months and number of lifetime partners). The authors found little support for an additive or an interactive model of the effects of different types of childhood maltreatment on adult sexual risk behavior; CSA alone was the best predictor of adult sexual risk behavior. Sexual risk reduction interventions are needed for women who were sexually abused as children. Continued research on the effects of multitype maltreatment on adult sexual risk behavior is needed.
Therapeutic alliance has been associated with better treatment engagement, better adherence, and less dropout across various treatments and disorders. In treatment of posttraumatic stress disorder (PTSD), it may be particularly important to establish a strong early alliance to facilitate treatment adherence. However, factors such as childhood sexual abuse (CSA) history and poor social support may impede the development of early alliance in those receiving PTSD treatment. We sought to examine treatment adherence, CSA history, and social support as factors associated with early alliance in individuals with chronic PTSD who were receiving either prolonged exposure therapy (PE) or sertraline.
At pretreatment, participants (76.6% female; 64.9% Caucasian; mean age = 37.1 years, SD = 11.3) completed measures of trauma history, general support (Inventory of Socially Supportive Behaviors), and trauma-related social support (Social Reactions Questionnaire). Over the course of 10 weeks of PE or sertraline, they completed early therapeutic alliance (Working Alliance Inventory) and treatment adherence measures.
Early alliance was associated with PE adherence (r = .32, p < .05) and overall treatment completion (r = .19, p < .05). Only trauma-related social support predicted the strength of early alliance beyond the effects of treatment condition (β = .23, p < .05); CSA history was not predictive of a lower early alliance.
Given the associations with adherence, clinicians may find it useful to routinely assess alliance early in treatment. Positive trauma support, not CSA history, may be particularly important in the development of a strong early therapeutic alliance.
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.
Objective: To provide clinicians with current information on prevalence, risk factors, outcomes, treatment, and prevention of child sexual abuse (CSA). To examine the best-documented examples of psychopathology attributable to CSA. Method: Computer literature searches of Medline and PSYCInfo for key words. All English-language articles published after 1989 containing empirical data pertaining to CSA were reviewed. Results: CSA constitutes approximately 10% of officially substantiated child maltreatment cases, numbering approximately 88,000 in 2000. Adjusted prevalence rates are 16.8% and 7.9% for adult women and men, respectively. Risk factors include gender, age, disabilities, and parental dysfunction. A range of symptoms and disorders has been associated with CSA, but depression in adults and sexualized behaviors in children are the best-documented outcomes. To date, cognitive-behavioral therapy (CBT) of the child and a nonoffending parent is the most effective treatment. Prevention efforts have focused on child education to increase awareness and home visitation to decrease risk factors. Conclusions: CSA is a significant risk factor for psychopathology, especially depression and substance abuse. Preliminary research indicates that CBT is effective for some symptoms, but longitudinal follow-up and large-scale "effectiveness" studies are needed. Prevention programs have promise, but evaluations to date are limited.
A manualised trauma-focused cognitive behavioural therapy (TF-CBT) programme was developed for multiply-abused children diagnosed with posttraumatic stress disorder (PTSD; Feather & Ronan, 2004). It was piloted with 4 children (aged 9-14 years) referred to a specialist clinic of the statutory child protection agency. The locally developed programme built on efficacious treatments for childhood anxiety and PTSD as a result of sexual abuse. It comprises psychosocial strengthening, coping skills training, gradual exposure using creative media, and special issues relevant to trauma and abuse. A multiple baseline design was used to demonstrate the controlling effects of the treatment. The results indicate a good deal of promise. PTSD symptoms generally decreased and child coping increased. Gains improved over 3, 6, and 12 month follow-ups. Results are discussed in terms of the value of clinicians engaging in local research aimed at increasing outcomes for their clients.
Objective: To determine the prevalence of deliberate self harm in adolescents and the factors associated with it. Design: Cross sectional survey using anonymous self report questionnaire. Setting: 41 schools in England. Participants: 6020 pupils aged 15 and 16 years. Main outcome measure: Deliberate self harm. Results: 398 (6.9%) participants reported an act of deliberate self harm in the previous year that met study criteria. Only 12.6% of episodes had resulted in presentation to hospital. Deliberate self harm was more common in females than it was in males (11.2% v 3.2%; odds ratio 3.9, 95% confidence interval 3.1 to 4.9). In females the factors included in a multivariate logistic regression for deliberate self harm were recent self harm by friends, self harm by family members, drug misuse, depression, anxiety, impulsivity, and low self esteem. In males the factors were suicidal behaviour in friends and family members, drug use, and low self esteem. Conclusions: Deliberate self harm is common in adolescents, especially females. School based mental health initiatives are needed. These could include approaches aimed at educating school pupils about mental health problems and screening for those at risk. What is already known on this topic What is already known on this topic Deliberate self harm is a common reason for presentation of adolescents to hospital Community studies from outside the United Kingdom have shown much greater prevalence of self harm in adolescents than hospital based studies
This article examines the syndrome of self‐mutilation with specific attention given to self‐mutilation in female adolescents and young adults. Causes, symptoms, types, definitions, and treatments are discussed. Included is an explanation of the lexical and conceptual confusion that accompanies self‐mutilation. Implications and recommendations for counselors are addressed.
This article examines the diagnosis and assessment of self‐injurious behaviors. A classification model for conceptualizing self‐injury is discussed, and the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision; American Psychiatric Association, 2000) diagnoses associated with self‐injury are addressed. Assessment questions and issues to consider when assessing clients who self‐injure are provided.
Based on in-depth interviews, this study utilizes grounded theory, interpretive poetics, and voice-centered analytic methods to investigate how six college women stop self-injuring. Findings illuminate that this process involves multiple factors beyond whether or not a woman desires to stop. These include: subjective meanings of the behavior, a decrease in psychological catalysts, self-initiative, life engagements, relational ties, professional treatment, disclosure experiences, motivators, and momentum. Treatment implications suggest that a woman's attitude toward stopping may point toward particular interventions.
This paper presents a systematic review that aims to identify studies using drawing techniques with maltreated children. The paper first introduces the relevant developmental theory relating to children's drawings and its application to practice. Studies using drawing techniques with maltreated children were identified from both the research and practice literature. These were summarized and compared. The evidence from the studies appears relatively inconclusive as to the value of children's drawings for the identification of possible maltreatment, although they do apparently help in aiding recall of important events. Drawings are widely used to assess maltreatment and neglect of children. However, researchers advocate caution in generalizing and interpreting drawings from children with differing experiences. Copyright © 2002 John Wiley & Sons, Ltd.
This paper continues the debate about the merits of formal versus informal art therapy assessments. The author enumerates specific problems with projective drawings and makes suggestions to correct those problems. She contends that art therapists should study these problems carefully and learn from the mistakes of previous investigators. She maintains that art therapists can and must develop their own art-based assessments that meet the psychometric requirements of reliability and validity.
Research may provide some answers regarding theoretical underpinnings of art therapy (theory building research); the efficacy of various art therapy assessments, approaches, and techniques utilized with consumers (practical research); and aspects of art therapy as a profession (institutional research). However, despite recent increases in art therapy research reported in the literature and greater emphasis on research at AATA conferences, most art therapists are reluctant to engage in research. This paper includes basic descriptions and examples of quantitative and qualitative approaches to art therapy research, and suggests ideas to bridge the gap between research and practice. Numerous research topics in four areas of art therapy are suggested: the therapeutic relationship, assessment, intervention, and art therapy as a profession.
This article examines the tension between the particular and the general in art therapy and makes a case that the art therapist's concern with particularity does not obviate the need for research in the field. Fertile areas for scientific inquiry are then reviewed including description of a population through art, assessment of a population or individual through art, treatment of a population through art, and art as a mode of knowing. Finally, consideration is given to two frequent stumbling blocks for beginning researchers: the use of statistics and the possibility of obtaining negative results. The conclusion is that neither of these presents a serious obstacle to undertaking research.
Most research on posttraumatic stress disorder (PTSD) has been conducted on war veterans; little is known about the incidence of traumatic events, PTSD, and posttraumatic symptoms among other populations. This study was undertaken to assess the incidence of traumatic events of sufficient intensity to potentially cause PTSD among a sample of 440 college students. Subjects completed the Traumatic Events scale, the Purdue PTSD Scale, the Impact of Events Scale, the Mississippi Scale for PTSD, the Beck Depression Inventory, the State-Trait Anxiety Inventory, and the Alcohol Questionnaire. Only 17% of the respondents reported experiencing no traumatic event. One-third of the sample had experienced four or more separate events, and 9% of the sample had experienced seven or more events. Unexpected deaths, accidents, and other life-threatening situations were reported frequently. Males reported more accidents and life-threats; females reported more rape or abuse. The findings suggest that these traumatic events often result in significant psychological symptoms, and people who are survivors of rape, abuse, crime, or an event they cannot talk about are at particular risk. Experiencing multiple events appeared to increase the risk for psychological symptoms. A relationship was found between traumatic experiences and later anxiety, depression and PTSD symptomatology. (NB)
Evaluated the strengths and weaknesses of projective drawing techniques (PDTs). 17 empirical articles were reviewed and grouped by the type of the test used in the study: human figure drawings (HFDs), House-Tree-Person (HTP), kinetic family and school drawings, and idiosyncratic PDTs. The HFD was found to be reliable as a measure of learning disabilities and as a predictor of the performance of learning-related behaviors. The HTP was found to be free of cultural bias. The kinetic family drawings had solid test-retest and concurrent reliability, whereas the kinetic school drawings had strong concurrent validity when correlated with achievement measures. Idiosyncratic PDTs were found to be the weakest of the tests reviewed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Discusses indicators of sexual abuse (SAB) in children and the use of a nonconfrontational approach such as art techniques in conjunction with behavioral observations to enable teachers and counselors to make an assessment of SAB without causing the child to retreat further into inner denial of the SAB. Types of formalized art-therapy projective techniques include the Draw-a-Person test, the Kinetic Family drawing, and the House-Tree-Person test. Evidence of SAB may be seen in the routine art products of children, such as their focus on the genital area, and the way they draw other body parts such as eyes, nose, mouth, and neck. The artwork and verbal description should be integrated to get a complete picture of the SAB child. The artistic progression of the normal development of children must be understood to accurately use artwork to diagnose emotional and cognitive abnormalities in children. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Obtained an indication of how a normal population that is going through a difficult change would draw a bridge going from one place to another. Ss were 150 normal adolescents aged 14–18. 12 variables found most helpful in the interpretation of the drawings are presented: directionality, placement of self in the picture, places drawn on either side of the bridge, solidarity of bridge attachments, emphasis by elaboration, bridge construction, type of bridge depicted, matter drawn under the bridge, vantage point of the viewer, axis of the paper, consistency of gestalt, and written associations to the drawing. Also discussed is how bridge drawing can be used to enhance communication and therapeutic change in the therapy session. (11 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Argues that the field of art therapy is philosophically and epistemologically aligned with the empirical research tradition out of its perception of the need to validate its theory and methods within the prevailing framework. Art therapists, however, find that their affinities for research and practice do not lie within such a rigid, quantitative framework. Therefore, 9 cultures of inquiry indicating a diversity of research philosophies and paradigms are outlined. These are phenomenological, heuristic, hermeneutic, ethnographic, and empirical/analytical studies; and action, comparative/historical, theoretical, and evaluation research. These types of investigations will enable art therapists to preserve their natural tendencies to work intuitively and metaphorically and not sacrifice those qualities in the interests of scientific rigor. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Violent behaviors by and toward children have become an increasing concern within the American school system, with a good deal of energy devoted to developing profiles about which children are likely to exhibit these behaviors (Goldstein & Huff, 1993). Unfortunately, much less publicity has been devoted toward children who are sexually abused, despite the fact that over 300,000 children and adolescents are sexually abused annually in this country (National Center of Child Abuse and Neglect, 1996). As such, this figure reflects about a 600% increase in actual reported cases since 1980 (Burgdoff, 1980). These data suggest that a large number of school-aged children are experiencing this kind of personal assault and professional educators are likely to encounter these children in the routine course of the educational process. This article provides a summary of the issues involved in the determination of sexual assault against a child and reviews the empirical literature describing the symptoms which may be manifested by a child who has been sexually abused. © 2001 John Wiley & Sons, Inc.
Eating disorders (ED) are an increasing problem in children and young adolescents. This paper examines the use of self-figure drawing in the assessment of eating disorders. We combined the use of self-figure drawing as a short and non-intrusive tool with the administration of previously validated questionnaires (EAT-26 and the BSQ). Seventy-six women (thirty-six were diagnosed as having eating disorders according to DSM-IV criteria, either anorexia nervosa or bulimia nervosa, 20 were overweight, 20 had no eating disorders and were of normal weight) were recruited for this study. Objective and quantifiable methods of assessment in analysis of the self-figure drawing were used. The results indicated that self-figure drawing scores were clearly differentiated among groups. The results also indicated significantly high correlation between the self-figure drawing and the two validated psychometric assessments of eating disorders. The findings' implications and possible interpretations are discussed. Findings indicate that using self-figure drawing as a tool to assess ED or a tendency to develop ED would be valuable for practitioners.
• Few papers address the issue of deliberate self-mutilation other than from clinical perspectives.• This paper advocates a user-perspective and discusses some of the issues which might attend such a change.• The occurrence of self-mutilation is placed within a cultural framework so as to enlarge the debate beyond the confines of medical/nursing responses.• It is suggested that nurses abrogate their attachment to such responses and embrace more collaborative approaches to care.• In particular, nurses are asked to review their (moral) responses to self-mutilation, an activity which, too often, has been responded to with scorn and derision.
This study explored the predictors and consequences of sexual assault occurring after the age of 16 years in a nonclinical sample of women. Child sexual abuse occurring before the age of 16 years was the only predictor of later sexual assault among comorbid risk factors. Peer sexual abuse, number of perpetrators, age at time of sexual abuse, and severity of sexual abuse did not increase the risk for later sexual assault. Adult sexual assault victims showed lower levels of mental health functioning than did survivors of child or peer sexual abuse. We discuss a specificity model of revictimization and the differential effects of child, peer, and adult sexual trauma on the developmental trajectory of sexual violence and psychosocial functioning.
There are many benefits to justify the use of art therapy assessment techniques and rating instruments. However, methodological, theoretical and philosophical problems abound. These problems are explored, in relation to art therapy assessments and their corresponding rating tools. Information about the various types of rating scales is provided, including a comparison of the Diagnostic Drawing Series (DDS) rating system and that of the Person Picking an Apple From a Tree (PPAT) assessment, i.e., the Formal Elements Art Therapy Scale (FEATS). The most effective approach to assessment in the field of art therapy appears to incorporate objective measures such as standardized evaluation procedures (formal assessments; behavioral checklists; portfolio evaluation), and subjective approaches such as the client's interpretation of his or her artwork.
Recent years have ushered a growing understanding and a broadening knowledge base of the complexities of child sexual abuse. These complexities are acerbated by the need to account for the specific problem of child sexual abuse (CSA) in the larger context of multi-problem intervention, requiring coordinated multi-disciplinary team efforts as well as sensitive and focused attention to CSA itself. The aim of this paper is to critically examine the literature on several treatment modalities that are utilized by professionals from a range of disciplines treating victims of childhood sexual abuse. Acknowledging recent findings that dissociative disorders among CSA survivors are high compared to survivors of other forms of trauma and that about 80% of adult CSA survivors who were diagnosed with posttraumatic stress disorder actually suffer from dissociative disorders, the author discusses the phenomena of dissociative identity disorder among survivors who were sexually abused. The implications for the development of a therapeutic model are described, including a delineation of the model components.
Drawing techniques involving human figures have been a part of psychologists' test batteries for most of this century. One of the earliest and most popular of these techniques is the Draw A Person test (DAP). Recently, Draw A Person: A Quantitative Scoring System, a new drawing technique, was published. This article reviews the concurrent validity data for this new measure and many of its predecessors, and concludes that the latest DAP is strikingly similar to its forebears. While the DAP is the best drawing technique available, its concurrent validity evidence does not support the use of such instruments as measures of intelligence.
Self-injurious behavior (SIB) is common among adolescents, and has been shown to be associated with eating disorders (ED). This study examines the prevalence of SIB and SIB screening in adolescents with ED, and associations with binge eating, purging, and diagnosis.
Charts of 1,432 adolescents diagnosed with ED, aged 10-21 years, at an academic center between January 1997 and April 2008, were reviewed.
Of patients screened, 40.8% were reported to be engaging in SIB. Patients with a record of SIB were more likely to be female, have bulimia nervosa, or have a history of binge eating, purging, co-morbid mood disorder, substance use, or abuse. Patients who engaged in both binge eating and purging were more likely to report SIB than those engaged in restrictive behavior or either behavior alone. Providers documented screening for SIB in fewer than half of the patients. They were more likely to screen patients who fit a profile of a self-injurer: older patients who binge, purge, or had a history of substance use.
SIB was common in this population, and supports extant literature on associations with bulimia nervosa, mood disorders, binge eating, purging, abuse, and substance use. Providers may selectively screen patients.