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Is religiosity related to reduced abuse in childhood? A community study of ultra-Orthodox and Secular Jewish women
Abstract
PurposeAlthough childhood abuse is internationally recognized as a major problem, there is a dearth of data concerning potentially protective resources, including religiosity. While studies document religiosity’s positive association with general health outcomes, little is known about its relevance to abuse in childhood. A unique opportunity to explore the relationship is provided by a community-based study of religiously diverse, adult women within a single religious denomination, Judaism. A distinctive aspect of this research, which places women’s voices and experiences center stage, is the context within which it was conducted. Israel is a deeply gendered society dominated by two patriarchal institutions, the military and religious establishments.
MethodologyDetailed telephone interviews with a large, demographically diverse sample assess a broad range of women’s health issues including childhood sexual, physical, and emotional abuse. Prevalence rates are compared for observance groups at opposite ends of the religiosity spectrum, rigorously devout ultra-Orthodox (Haredi) (n = 261) and nonreligious Secular Jews (n = 181).
FindingsUnexpectedly, no significant differences between observance groups are found for any childhood abuse (45%), physical abuse (24%), or emotional abuse (40%). Childhood sexual abuse has the lowest frequency (4.8%) of all abuse categories with more reported by Secular than Haredi respondents (7.7% vs. 3.1% p = .05).
Research implicationsThis study addresses a critical research gap with empirical evidence from adult women within a single religious denomination. To enhance generalizability, replication with other denominations and the inclusion of males is warranted.
Social implicationsMore religious involvement apparently does not mitigate the most prevalent forms of childhood maltreatment. These preliminary, yet persuasive findings warrant more policy and prevention efforts focused on childhood abuse in all families, religious as well as nonreligious.
... None of the abuse terms were defined; rather, the format was designed to obtain responses that represent interviewees' perceptions and interpretations of what they considered abusive events and experiences (Levitt, 2007). Only unequivocal yes answers are included (Feinson & Meir, 2014). ...
... Mean scores and standard deviations are 2.31 (0.83) for binge eating; 1.55 (0.40) for self-criticism; 3.68 (4.06) for BSI depression; and 4.89 (4.31) for BSI anxiety. It should be noted that a previous analysis revealed that the independent variable, CEA, is the most prevalent form of childhood abuse reported by 40% of respondents in this sample (Feinson & Meir, 2014). Among those with serious binge eating behaviors, 53% report childhood emotional abuse compared to 29% and 6.5% reporting childhood physical (CPA) and sexual abuse (CSA) respectively. ...
Empirical studies have identified emotional abuse in childhood (CEA) as a risk factor with long-term implications for psychological problems. Indeed, recent studies indicate it is more prevalent than behavioral forms of abuse, (i.e. childhood sexual and physical abuse) and the childhood trauma most clearly associated with subsequent eating pathology in adulthood. However, relatively little is understood about the mechanisms linking these distal experiences. This study explores three psychological mechanisms – self-criticism (SC), depression and anxiety symptoms – as plausible mediators that may account for the relationship between CEA and binge eating (BE) among adult women. Detailed telephone interviews conducted with a community-based sample of 498 adult women (mean age 44) assess BE, CEA and SC along with the most frequently researched psychological variables, anxiety and depression. Regression analyses reveal that BE is partially explained by CEA along with the three mediators. Bootstrapping analysis, which compares multiple mediators within a single model using thousands of repeated random sampling observations from the data set, reveals a striking finding: SC is the only psychological variable that makes a significant contribution to explaining BE severity. The unique role of punitive self-evaluations vis-à-vis binge eating warrants additional research and, in the interim, that clinicians consider broadening treatment interventions accordingly.
... None of the abuse terms were defined; rather, the format was designed to obtain responses that represent interviewees' perceptions and interpretations of what they considered abusive events and experiences (Levitt, 2007). For this analysis, only unequivocal 'yes' answers to the verbal abuse question are included in the CEA category (Feinson & Meir, 2014) . ...
... The analysis includes 476 respondents with complete data on all variables. A previous analysis revealed that the independent variable, CEA, is the most prevalent form of childhood abuse reported by approximately 40% of all respondents, a rate within the range of CEA rates reported by other studies (Feinson & Meir, 2014). Among women with any childhood abuse, the vast majority (90%), reported emotional abuse (CEA), with or without physical or sexual abuse. ...
Recent studies reveal that childhood emotional abuse (CEA) is the trauma most clearly associated with adult eating pathology. Yet, relatively little is understood about psychological mechanisms linking these distal experiences. Anger's mediational role in the relationship between CEA and adult binge eating (BE) is explored in a community-based sample of 476 adult women (mean age 44). Detailed telephone interviews assess BE (7 items), CEA (single item), and unresolved anger (single item) along with self-criticism (modified Rosenberg self-esteem scale), depression and anxiety symptoms (BSI sub-scales). Statistical analyses include Pearson correlations, Baron and Kenny's steps for mediation, and Preacher and Hayes bootstrapping method to test proposed multiple mediators simultaneously. Findings reveal significantly more respondents with serious BE behaviors report a history of CEA compared to women with considerable and/or minimal BE (53% vs 37%, p = 0.002 respectively). Significant correlations are found among all study variables. Mediation analyses focus on anger together with self-criticism, depression and anxiety. Findings reveal that anger and self-criticism fully mediate the CEA-BE relationship. In contrast, depression and anxiety symptoms are not significant mediator in a model that includes anger and self-criticism. Although additional research is warranted to more fully understand complex causal processes, in the interim, treatment interventions should be broadened to include assessments of anger among adult women with BE behaviors, especially those with histories of childhood abuse. Additionally, prevention strategies that incorporate learning how to express anger directly and positively may be particularly effective in reducing various disordered eating behaviors among women and girls.
... In terms of sexual abuse, there is a small yet growing body of research focused on abuse within the Orthodox Jewish community. Reliable estimates of the prevalence of abuse within the Orthodox Jewish community are not available and existing estimates drawn from self-selected or convenience samples vary widely (Feinson & Meir, 2014;Rosmarin et al., 2018;Vega & Tuval Mashiach, 2023;Yehuda et al., 2007). Consistent with the religious cultural context discussed above, a recent review of this body of literature identified three key themes (Lusky-Weisrose et al., 2021). ...
Objective: Previous research suggests that generalized shame is an important consequence of sexual abuse, and that it maintains symptoms and hampers recovery. Orthodox Jews view sexuality as a powerful experience that is sacred within a loving marriage yet profane and damaging outside of that context. Sexual abuse may, therefore, be perceived as a shameful violation of modesty and spiritually degrading. Accordingly, we hypothesized that abuse would be more strongly related to shame among Orthodox Jews and that this would at least partially mediated resulting distress. Method: We assessed sexual abuse history, shame, and distress in a convenience sample of 628 adult patients completing an intake process for outpatient psychotherapy, of which 109 reported an Orthodox Jewish religious affiliation. Results: Among Orthodox patients, 43% reported a history of sexual abuse and this group reported substantially higher levels of shame compared to both Orthodox patients without a history of sexual abuse and non-Orthodox patients with a history of abuse. Moreover, elevated shame fully mediated the relationship between abuse and depressive symptoms, life satisfaction, and spiritual struggles. Conclusions: Results suggest that treatment of Orthodox survivors of sexual abuse requires particular attention to shame and that further research is warranted.
... Jews. The UO community, the "Haredi Society" occupies the otherreligiousend of the Israeli Jewish continuum (Feinson & Meir, 2014). UO Jews differ significantly from general society by their look, which is determined according to the court or affiliation to which they belong. ...
The main question of this study was whether the socio-cultural background of
PWS is associated with the experience of stuttering. A combined-approach
methodology was obtained, including both a quantitative research (QUAN) and a
qualitative research (QUAL). In the former, 32 ultra-Orthodox (UO) and 31 seculartraditional
(ST) men who stutter filled self-report questionnaires, in order to assess
levels of the experience of stuttering in various scales (e.g. perceived stuttering
severity, impact on quality of life, cognitive and emotional responses). In the latter,
four UO and four ST men who stutter were interviewed. QUAN results showed that
the impact of stuttering on quality of life was smaller among the UO, but stuttering
was reported as more severe among the UO participants. Stuttering severity did not
correlate to any of the above measures among the UO group, but did so among the
ST. QUAL results yielded three main dimensions: the experience of stuttering across
the life span, coping strategies and the experience of therapy. Analysis demonstrated a
greater emotional content, different anxious experiences and special speech roles
among UO interviewees in comparison to the ST interviewees. Generally, similar
coping strategies and therapy experiences were identified, with some differences.
Overall, the study findings demonstrate similarities in the experience of stuttering
among groups, which point out the universality of the stuttering phenomenon. In
contrast, the differences between groups may suggest the possible role of society and
religion on the experience of stuttering. Results will be discussed in the context of the
socio-religious background, the implications for therapy and suggestions for future
research.
Studies dealing with the experiences of non-offending mothers from the general population and minority groups after their child’s disclosure of sexual abuse are scarce, and studies on mothers from the Jewish ultra-Orthodox community are non-existent. This study takes an initial step in filling this gap by exploring how the normalization of sexual abuse shapes these mothers’ experiences. A qualitative phenomenological study was conducted on a sample of 21 mothers from the ultra-Orthodox sector whose children had been sexually abused. It consisted of in-depth, semi-structured interviews of the mothers followed by a drawing task on their experience. The analysis of the interviews yielded four central themes: the role of social stigmatization and religion on the mother’s ability to share her child’s abuse; the effect of the disclosure on the mothers’ mental state and maternal competency; the mothers’ ongoing experience in the shadow of this unprocessed/unresolved trauma; and the mothers’ coping strategies, including acceptance, faith, and meaning making. The findings highlight the influence of the tension between the need to adhere to religious norms and preserve the social fabric and the need to enhance mothers’ and children’s well-being.
Purpose
This groundbreaking research compares the experience of stuttering among adult male People Who Stutter (PWS) from the ultra-Orthodox (UO) Jewish community in Israel to those from Secular/Traditional (ST) backgrounds.
Methods
Participants were 32 UO and 31 ST PWS, aged 18–67 years. Self-report questionnaires utilized: Perceived Stuttering Severity (PSS); Overall Assessment of the Speaker's Experience of Stuttering (OASES-A); Students’ Life Satisfaction Scale (SLSS); Situation Avoidance Behavior Checklist (SABC). Demographic, religious, and stuttering information was collected. Groups were compared on scales, and correlations between scales and the PSS.
Results
Subjective stuttering severity ratings were significantly higher among the UO. A significant group effect was found for the OASES-A quality of life subscale, but not other subscales. Significant positive correlations were found between: 1) PSS and OASES-A Total Impact; 2) PSS and 3 OASES subscales; and 3) PSS and SABC (indicating increased avoidance with increased stuttering severity rating). A significant negative correlation was found between the PSS and SLSS, indicating lower life satisfaction with higher rates of stuttering severity among the ST. Interestingly, when tested by group, significant correlations between the PSS and all other study measures were observed only among the ST.
Conclusion
UO participants showed higher subjective stuttering severity ratings, yet less impact on quality of life, and no correlation between subjective stuttering and other measures of stuttering experience. These novel findings may result from the combined protective effect of religiosity and socio-cultural characteristics on UO PWS’ well-being, despite heightened concern about social consequences of stuttering within UO society.
Although childhood abuse is an established risk factor for mental health problems in adulthood, there is relatively little empirical evidence concerning intervening factors that may mitigate the risk. One potentially protective factor is religiosity. A unique opportunity to explore religiosity’s relevance exists with a community-based sample of adult Jewish women that includes sizable subsamples of both rigorously devout ultra-Orthodox (Haredi) and nonreligious Secular Jews. A global measure of any childhood abuse (ACA) includes sexual, physical, and/or emotional abuse. Mental health is assessed with the Brief Symptom Inventory (BSI distress) and a single item reflecting unresolved anger about the past. Predictors of distress severity are examined with separate hierarchical regressions for each religious observance (RO) group. Despite being located at opposite ends of the religiosity spectrum, several surprising similarities emerge including no significant RO group differences in distress among abuse survivors. Moreover, ACA emerges as the strongest predictor of BSI distress within both groups and regressions explain similar amounts of variance. In contrast, two important differences emerge regarding unresolved anger and any recent abuse (ARA). Anger makes a strong contribution to explaining Haredi distress severity, less so for Secular respondents (6.1% vs. 2.9% respectively) while ARA is significant only for Haredi respondents. These initial findings suggest that abusive traumas in childhood may seriously compromise religiosity’s potentially protective role. Broadening the research agenda to focus on resilient survivors would expand our understanding of healing resources—both within and outside of a religious framework. Moreover, a better understanding of unresolved anger would likely enhance interventions with greater potential for mitigating the suffering of those abused in childhood.
Religious beliefs can foster, encourage, and justify child abuse, yet religious motivations for child abuse and neglect have been virtually ignored in social science research. In this paper, we compare victims' retrospective reports of religion-related child physical abuse to other reported cases of child physical abuse. We describe in statistical detail the nature and circumstances of the abuse, characteristics of victims and perpetrators, and the spiritual and psychological impact of the abuse. Results indicate that although the basic characteristics of religion-related physical abuse are similar to non-religion-related physical abuse, religion-related abuse has significantly more negative implications for its victims' long-term psychological well-being.
One hundred twenty-nine women with previously documented histories of sexual victimization in childhood were interviewed and asked detailed questions about their abuse histories to answer the question "Do people actually forget traumatic events such as child sexual abuse, and if so, how common is such forgetting?" A large proportion of the women (38%) did not recall the abuse that had been reported 17 years earlier. Women who were younger at the time of the abuse and those who were molested by someone they knew were more likely to have no recall of the abuse. The implications for research and practice are discussed. Long periods with no memory of abuse should not be regarded as evidence that the abuse did not occur.
In a large, nationally representative survey of 2,626 adult Americans, men and women who reported a history of childhood sexual abuse involving penetration were also more likely to report a disrupted marriage, dissatisfaction in their sexual relationship, and a tendency to be a religious nonpractitioner. Victims of abuse were also more likely to have read or talked about the problem recently and tended to see it as a more common occurrence than nonvictims. These findings are generally consistent with other studies on the long-term impact of abuse and add to the sense of this as a social problem with important social and psychological ramifications.
Revictimization is defined as the experience of both childhood sexual abuse and later sexual or physical abuse as an adult. Although clinically it is generally well accepted that women with a history of childhood sexual abuse are more likely than women without such a history to experience adult assault, little systematic investigation of this question has been conducted and no review of the literature on this topic is available. Several theoretical models have been suggested to account for the revictimization phenomena. This review outlines the theoretical positions that have been formulated to account for revictimization in women, examines the literature available concerning revictimization both in the form of adult sexual and physical assault, and considers impact of revictimization on women's later adjustment. Research in the area reveals that women who were sexually abused as children are significantly more likely to experience abuse as adults as compared to women who have not had such an experience in childhood. Conclusions about the state of the literature are discussed, and clinical and research implications are examined.
Previous studies have shown that exposure to parental verbal abuse in childhood is associated with higher rates of adult psychopathology and alterations in brain structure. In this study the authors sought to examine the symptomatic and neuroanatomic effects, in young adulthood, of exposure to peer verbal abuse during childhood.
A total of 848 young adults (ages 18-25 years) with no history of exposure to domestic violence, sexual abuse, or parental physical abuse rated their childhood exposure to parental and peer verbal abuse and completed a self-report packet that included the Kellner Symptom Questionnaire, the Limbic Symptom Checklist-33, and the Dissociative Experiences Scale. Diffusion tensor images were collected for a subset of 63 young adults with no history of abuse or exposure to parental verbal abuse selected for varying degrees of exposure to peer verbal abuse. Images were analyzed using tract-based spatial statistics.
Analysis of covariance revealed dose-dependent effects of peer verbal abuse on anxiety, depression, anger-hostility, dissociation, "limbic irritability," and drug use. Peer and parental verbal abuse were essentially equivalent in effect size on these ratings. Path analysis indicated that peer verbal abuse during the middle school years had the most significant effect on symptom scores. Degree of exposure to peer verbal abuse correlated with increased mean and radial diffusivity and decreased fractional anisotropy in the corpus callosum and the corona radiata.
These findings parallel results of previous reports of psychopathology associated with childhood exposure to parental verbal abuse and support the hypothesis that exposure to peer verbal abuse is an aversive stimulus associated with greater symptom ratings and meaningful alterations in brain structure.
Despite evidence that childhood adversities (CAs) are associated with increased risk of mental disorders, little is known about their associations with disorder-related impairment. We report the associations between CAs and functional impairment associated with 12-month DSM-IV disorders in a national sample.
We used data from the US National Comorbidity Survey Replication (NCS-R). Respondents completed diagnostic interviews that assessed 12-month DSM-IV disorder prevalence and impairment. Associations of 12 retrospectively reported CAs with impairment among cases (n=2242) were assessed using multiple regression analysis. Impairment measures included a dichotomous measure of classification in the severe range of impairment on the Sheehan Disability Scale (SDS) and a measure of self-reported number of days out of role due to emotional problems in the past 12 months.
CAs were positively and significantly associated with impairment. Predictive effects of CAs on the SDS were particularly pronounced for anxiety disorders and were significant in predicting increased days out of role associated with mood, anxiety and disruptive behavior disorders. Predictive effects persisted throughout the life course and were not accounted for by disorder co-morbidity. CAs associated with maladaptive family functioning (MFF; parental mental illness, substance disorder, criminality, family violence, abuse, neglect) were more consistently associated with impairment than other CAs. The joint effects of co-morbid MFF CAs were significantly subadditive. Simulations suggest that CAs account for 19.6% of severely impairing disorders and 17.4% of days out of role.
CAs predict greater disorder-related impairment, highlighting the ongoing clinical significance of CAs at every stage of the life course.
Although depression appears to decrease in late life, this could be due to misattribution of depressive symptom to physical disorders that increase in late life.
We studied age differences in major depressive episodes (MDE) in the National Comorbidity Survey Replication, a national survey of the US household population. DSM-IV MDE was defined without organic exclusions or diagnostic hierarchy rules to facilitate analysis of co-morbidity. Physical disorders were assessed with a standard chronic conditions checklist and mental disorders with the WHO Composite International Diagnostic Interview (CIDI) version 3.0.
Lifetime and recent DSM-IV/CIDI MDE were significantly less prevalent among respondents aged 65 years than among younger adults. Recent episode severity, but not duration, was also lower among the elderly. Despite prevalence of mental disorders decreasing with age, co-morbidity of hierarchy-free MDE with these disorders was either highest among the elderly or unrelated to age. Co-morbidity of MDE with physical disorders, in comparison, generally decreased with age despite prevalence of co-morbid physical disorders usually increasing. Somewhat more than half of respondents with 12-month MDE received past-year treatment, but the percentage in treatment was lowest and most concentrated in the general medical sector among the elderly.
Given that physical disorders increase with age independent of depression, their lower associations with MDE in old age argue that causal effects of physical disorders on MDE weaken in old age. This result argues against the suggestion that the low estimated prevalence of MDE among the elderly is due to increased confounding with physical disorders.
This article describes obstacles encountered and strategies devised in planning and conducting a national telephone health survey (n = 459) of an insular, deeply traditional religious population, haredi (ultra-Orthodox Jewish) Israeli women. The paper discusses how special characteristics of this population influenced study design, sampling, data collection, and interpretation. Sampling employed polling data to identify haredi concentrations. Despite haredim's reputation for low survey participation, we achieved a 71-74% response rate (depending on the unknown eligibility of 24 phones never answered) in interviews conducted in 2003-2004. We describe our systematic attention to special aspects of haredi culture such as: modesty and speech codes; the need for rabbinic endorsement; and the importance of female, haredi interviewers. This research was initiated and managed by a community-based women's health non-governmental organization, in partnership with trained researchers. Our experiences can guide others surveying insular communities, such as traditional Muslim and Christian societies.
Research in religion and health has spurred new interest in measuring religiousness. Measurement efforts have focused on subjective facets of religiousness such as spirituality and beliefs, and less attention has been paid to congregate aspects, beyond the single item measuring attendance at services. We evaluate some new measures for religious experiences occurring during congregational worship services. Respondents (N=576) were religiously-diverse community-dwelling adults interviewed prior to cardiac surgery. Exploratory factor analysis of the new items with a pool of standard items yielded a readily interpretable solution, involving seven correlated but distinct factors and one index variable, with high levels of internal consistency. We describe religious affiliation and demographic differences in these measures. Attendance at religious services provides multifaceted physical, emotional, social, and spiritual experiences that may promote physical health through multiple pathways.
This study sought to determine if rates of childhood sexual, physical, psychological, and multiple abuse (i.e., abuse in more than one form) differed between women with a lifetime history of bulimia nervosa and women with no history of eating disorders.
Subjects were 80 women, aged 18-35, with a lifetime history of bulimia nervosa (40 women who had recovered for a year or more and 40 women currently suffering from bulimia nervosa) and 40 women who had never had an eating disorder or related difficulties. The cohort was obtained primarily by newspaper advertisement. Subjects participated in structured diagnostic interviews and completed paper-and-pencil questionnaires related to abusive experiences in childhood.
Women in the bulimia nervosa group reported higher levels of childhood physical, psychological, and multiple abuse. Contrary to expectation, rates of sexual abuse did not distinguish the groups, except in combination with other forms of abuse.
The higher rates of psychological, physical, and multiple abuse found among women with a lifetime history of bulimia nervosa than among comparison subjects underscore the importance of examining the full range of possible abusive experiences in women with eating disorders, rather than focusing simply on sexual abuse.
This study examined the relationship between child sexual abuse (CSA) and subsequent onset of psychiatric disorders, accounting for other childhood adversities, CSA type, and chronicity of the abuse.
Retrospective reports of CSA, other adversities, and psychiatric disorders were obtained by the National Comorbidity Survey, a nationally representative survey of the United States (n = 5877). Reports were analyzed by multivariate methods.
CSA was reported by 13.5% of women and 2.5% of men. When other childhood adversities were controlled for, significant associations were found between CSA and subsequent onset of 14 mood, anxiety, and substance use disorders among women and 5 among men. In a subsample of respondents reporting no other adversities, odds of depression and substance problems associated with CSA were higher. Among women, rape (vs molestation), knowing the perpetrator (vs strangers), and chronicity of CSA (vs isolated incidents) were associated with higher odds of some disorders.
CSA usually occurs as part of a larger syndrome of childhood adversities. Nonetheless, CSA, whether alone or in a larger adversity cluster, is associated with substantial increased risk of subsequent psychopathology.
Most samples of adult women will contain a significant proportion who have been or are currently in abusive relationships. While past research has linked childhood abuse of girls to adult health concerns, little is known about the process through which women retrospectively reconcile these experiences. This article reports on data collected in an ongoing project on midlife women's health. Twenty-seven of 50 urban, middle-class participants in this phase of the project reported childhood abuse experiences. In the analysis, several aspects of these experiences were identified: definitions of abuse; recontextualizing abuse; responsibility for abuse; abuse avoidance; and experiences of multiple abuse. The women's discourse reflected a number of ideologies that provide a context in which women negotiate their understandings of these childhood experiences. This article provides insight into our understanding of abuse. It addresses the fundamental issue of promoting a worldview that precludes child abuse while leaving adult survivors with options for "moving on."
The authors assessed lifetime psychopathology in a general population sample and compared the rates of five psychiatric disorder categories between those who reported a childhood history of either physical or sexual abuse and those who did not.
A modified version of the Composite International Diagnostic Interview and a self-completed questionnaire on child abuse were administered to a probability sample (N=7,016) of Ontario residents 15 to 64 years of age.
Those reporting a history of childhood physical abuse had significantly higher lifetime rates of anxiety disorders, alcohol abuse/dependence, and antisocial behavior and were more likely to have one or more disorders than were those without such a history. Women, but not men, with a history of physical abuse had significantly higher lifetime rates of major depression and illicit drug abuse/dependence than did women with no such history. A history of childhood sexual abuse was also associated with higher rates of all disorders considered in women. In men, the prevalence of disorders tended to be higher among those who reported exposure to sexual abuse, but only the associations with alcohol abuse/dependence and the category of one or more disorders reached statistical significance. The relationship between a childhood history of physical abuse and lifetime psychopathology varied significantly by gender for all categories except for anxiety disorders. Although not statistically significant, a similar relationship was seen between childhood history of sexual abuse and lifetime psychopathology.
A history of abuse in childhood increases the likelihood of lifetime psychopathology; this association appears stronger for women than men.
A community-based prospective longitudinal study was conducted to investigate the association between childhood adversities and problems with eating or weight during adolescence and early adulthood.
A community-based sample of 782 mothers and their offspring were interviewed during the childhood, adolescence, and early adulthood of the offspring. Childhood maltreatment, eating problems, environmental risk factors, temperament, maladaptive parental behavior, and parental psychopathology were assessed during childhood and adolescence. Eating disorders and problems with eating or weight in the offspring were assessed during adolescence and early adulthood.
A wide range of childhood adversities were associated with elevated risk for eating disorders and problems with eating or weight during adolescence and early adulthood after the effects of age, childhood eating problems, difficult childhood temperament, parental psychopathology, and co-occurring childhood adversities were controlled statistically. Numerous unique associations were found between specific childhood adversities and specific types of problems with eating or weight, and different patterns of association were obtained among the male and female subjects. Maladaptive paternal behavior was uniquely associated with risk for eating disorders in offspring after the effects of maladaptive maternal behavior, childhood maltreatment, and other co-occurring childhood adversities were controlled statistically.
Childhood adversities may contribute to greater risk for the development of eating disorders and problems with eating and weight that persist into early adulthood. Maladaptive paternal behavior may play a particularly important role in the development of eating disorders in offspring.
Empirical studies have identified significant links between religion and spirituality and health. The reasons for these associations, however, are unclear. Typically, religion and spirituality have been measured by global indices (e.g., frequency of church attendance, self-rated religiousness and spirituality) that do not specify how or why religion and spirituality affect health. The authors highlight recent advances in the delineation of religion and spirituality concepts and measures theoretically and functionally connected to health. They also point to areas for areas for growth in religion and spirituality conceptualization and measurement. Through measures of religion and spirituality more conceptually related to physical and mental health (e.g., closeness to God, religious orientation and motivation, religious support, religious struggle), psychologists are discovering more about the distinctive contributions of religiousness and spirituality to health and well-being.
The investigation of spiritual/religious factors in health is clearly warranted and clinically relevant. This special section explores the persistent predictive relationship between religious variables and health, and its implications for future research and practice. The section reviews epidemiological evidence linking religiousness to morbidity and mortality, possible biological pathways linking spirituality/religiousness to health, and advances in the assessment of spiritual/religious variables in research and practice. This introduction provides an overview of this field of research and addresses 3 related methodological issues: definitions of terms, approaches to statistical control, and criteria used to judge the level of supporting evidence for specific hypotheses. The study of spirituality and health is a true frontier for psychology and one with high public interest.
This study examined the prevalence of a history of various combinations of childhood maltreatment types (physical abuse, sexual abuse, and witnessing of maternal battering) among adult members of a health maintenance organization (HMO) and explored the relationship with adult mental health of the combinations of types of childhood maltreatment and emotional abuse in the childhood family environment.
A total of 8,667 adult members of an HMO completed measures of childhood exposure to family dysfunction, which included items on physical and sexual abuse, witnessing of maternal battering, and emotional abuse in the childhood family environment. The adults' current mental health was assessed by using the mental health scale of the Medical Outcomes Study 36-item Short-Form Health Survey.
The prevalences of sexual abuse, physical abuse, and witnessing of maternal violence were 21.6%, 20.6%, and 14.0%, respectively, when the maltreatment types were considered separately. Among respondents reporting any of the maltreatment types, 34.6% reported more than one type of maltreatment. Lower mean mental health scores were associated with higher numbers of abuse categories (mean=78.5, 75.5, 72.8, and 69.9 for respondents with no, one, two, and three abuse types, respectively). Both an emotionally abusive family environment and the interaction of an emotionally abusive family environment with the various maltreatment types had a significant effect on mental health scores.
Childhood physical and sexual abuse, as well as witnessing of maternal battering, were common among the adult members of an HMO in this study. Among those reporting any maltreatment, more than one-third had experienced more than one type of maltreatment. A dose-response relation was found between the number of types of maltreatment reported and mental health scores. In addition, an emotionally abusive family environment accentuated the decrements in mental health scores. Future research examining the effects of childhood maltreatment on adult mental health should include assessments of a wide range of abusive experiences, as well as the family atmosphere in which they occur.
This study examined the prevalence and psychological sequelae of childhood sexual and physical abuse in adults from the general population.
A national sampling service generated a geographically stratified, random sample of 1,442 subjects from the United States. Subjects were mailed a questionnaire that included the Traumatic Events Survey (TES) [Traumatic Events Survey, Unpublished Psychological Test, Harbor-UCLA Medical Center, Los Angeles] and the Trauma Symptom Inventory (TSI) [Trauma Symptom Inventory Professional Manual, Psychological Assessment Resources, Odessa, FL]. Of all potential subjects, 935 (64.8%) returned substantially completed surveys.
Sixty-six men and 152 women (14.2% and 32.3%, respectively) reported childhood experiences that satisfied criteria for sexual abuse, and 103 males and 92 females (22.2% and 19.5%, respectively) met criteria for physical abuse. Twenty-one percent of subjects with one type of abuse also had experienced the other type, and both types were associated with subsequent adult victimization. After controlling for demographics, adult history of interpersonal violence, and other child abuse, childhood sexual abuse was associated with all 10 scales of the TSI, and physical abuse was related to all TSI scales except those tapping sexual issues. Sexual abuse predicted more symptom variance than did physical abuse or adult interpersonal victimization. Various aspects of both physical and sexual abuse experiences were predictive of TSI scores. Abuser sex, however, both alone and in interaction with victim sex, was not associated with additional TSI symptomatology.
Childhood sexual and physical abuse is relatively common in the general population, and is associated with a wide variety of psychological symptoms. These relationships remain even after controlling for relevant background variables.
Israel’s constitutional structure purports to combine strong establishment of the Orthodox Jewish religion in the state with
respect for liberal values such as pluralism equality and liberty. Whereas the establishment of the Orthodox Jewish religion
is achieved through laws regulations and administrative power, liberal values that are only partially enshrined in law, are
mostly defended and articulated by the Israeli Supreme Court. Focusing on the internal conflicts within the Jewish majority
the article will show how the power granted to the Orthodox Jewish religion by the state has been used to circumvent liberal
values and will examine the role of the Israeli Supreme Court in ameliorating this problem. It will argue that although in
countries in which religion and the state are separated a ‘hands-off’ approach to pluralism may be sufficient to protect liberal
values, in a country such as Israel with a strong religious establishment a more activist approach, which will be termed ‘egalitarian
pluralism’ is required. The article will argue that an egalitarian pluralist approach is needed in order to maintain Israel’s
dual commitment to its nature as a ‘Jewish and Democratic’ state and will assess and critique the partial implementation of
this approach by the Israeli Supreme Court.
The purpose of this investigation was to test the associations between physical and sexual victimization in childhood with seven measures of health problems in adulthood. Data were gathered from 8,000 women interviewed in the National Violence Against Women Survey, a nationally representative survey conducted from November 1995 to May 1996. Results indicated that both physical and sexual victimization in childhood were significantly associated with poor perceptions of general health, sustaining a serious injury, acquiring a mental health condition, using drugs, and using alcohol daily in adulthood. Women who experienced both physical and sexual victimization as children were at increased risk of health problems in adulthood compared with women who experienced only one type of victimization. These associations could not be attributed to victim demographics or to revictimization in adulthood. Results suggest that intervening with child abuse victims at an early stage may reduce children's likelihood of developing longterm health problems.
The major effect of militarization on the status of women and gender equality derives from the centrality accorded the army in Israeli society. In a society engaged in war or protracted armed conflict the army assumes an essential and critical role in the lives and views of its citizens. Insofar as the army is a patriarchal institution, it is these patriarchal values, norms and stereotypes that will be promulgated and reinforced as the young citizen moves from adolescence to adulthood in his and her obligatory military service. The different nature (and length) of this service for men as distinct from women, combined with the different way in which the military service of the two sexes is perceived both by the military and the society at large, and the advantages accrued to the men, as distinct from the women, all contribute to the inequality of women in Israeli society. The essentiality of the male-because of his dominant role in the army (as distinct from the female's merely subordinate role) and the attributes achieved by the male through his combat service (from which women are barred), render the male more “valued” by a society at war, that is, a society for which military security is the central preoccupation. How this effects women's interest in peace is a controversial question, only partially addressed by research and women's peace activism in Israel.
The 22 women interviewed in this study were in a high-risk group for low self-esteem, depression, shame, and other long-term interpersonal difficulties due to their survival of childhood sexual abuse. Unlike many of their contemporaries, they have been able to have relationships, stable careers, and healthy personalities. This paper explores the variables and patterns gathered from their interviews. The resiliency themes extracted included: the ability to find emotional support outside the family; self-regard or the ability to think well of oneself; spirituality; external attribution of blame and cognitive style; and inner-directed locus of control.
There is increasing research evidence that religious involvement is associated both cross-sectionally and prospectively with better physical health, better mental health, and longer survival. These relationships remain substantial in size and statistically significant with other risk and protective factors for morbidity and mortality statistically controlled. In this article, we review the social and psychological factors that have been hypothesized to explain the health-promoting effects of religious involvement. The four potential psychosocial mechanisms that have received empirical attention are health practices, social support, psychosocial resources such as self-esteem and self-efficacy, and belief structures such as sense of coherence. Evidence concerning these potential mediators is mixed and inconsistent, suggesting there is more to be learned about the pathways by which religion affects health. Other possible explanations for the salubrious effects of religious involvement on health and longevity are discussed.
Purpose and methodology – Many adult women struggle with serious eating problems (EPs) and obesity is increasing, yet, little is known about the origins of EPs, which often begin in childhood. Personal Narratives with 25 Israeli Jewish women in recovery from EPs explore (a) types of childhood experiences, (b) the connection between childhood experiences and subsequent EPs, and (c) why food!
Findings a.Analyses of personal narratives uncover a broad range of emotionally abusive experiences in childhood (CEA) including continuous criticism about body shape and weight, emotional neglect and abandonment, death or illness in the family in the absence of a nurturing adult, conflict and tension surrounding parental divorce or dysfunctional marriage, geographic dislocation, and aftermath of the Holocaust.b.Interviewees explicitly identified CEA as the cause of their turning to food for comfort in childhood and subsequently developing lifelong EPs.c.Why food! It was easily accessible, its sweetness took away the pain - temporarily, children replicated parents' unhealthy relationship with food, it was abundant and central in Jewish cultural, ethnic and religious traditions.
Research Implications – This research documents the critical contribution of emotionally abusive experiences in childhood to the development of EPs and confirms the need for additional research.
Practical Implications – The findings warrant a shift in policies and practices to address the role of emotional abuse in the development and maintenance of EPs. Moreover, policies focused on obesity, particularly among youth, need to recognize the contribution of CEA – in addition to poor dietary choices and lack of exercise.
Survey responses of 5,417 women were studied to obtain information about childhood sexual abuse, religion, and mental health. There were 653 (13%) who reported being sexually abused while growing up. When studying those who were sexually abused, it was found that this childhood experience was associated with less emotional maturity, lower self-esteem, more instability in their relationships with partners, and higher levels of depression. The highest scores on the mental health indicators were found for women who were not abused and highly religious, then highly religious and abused, and the lower scores for no abuse and low religiosity, low religiosity and abuse, and medium religiosity and abuse. These findings were interpreted as demon- strating that religion could help ameliorate negative mental health outcomes associ- ated with childhood sexual abuse.
The present study examines the attitudes towards physical punishment (PP) and its actual use as reported by Christian Arab parents and their children in Israel. Participants were parents and one child (of at least two) in 50 Christian Arab families. Three questionnaires based on semi-structured interviews were developed for the study. Results show no difference in family members’ attitudes towards the use of PP. Whereas, the mean scores indicate ambivalent acceptance of this practice, the great majority of participants reported its frequent use. Mothers’ and fathers’ attitudes were found to be highly correlated and significant predictors of such behaviour. All three groups reported that mothers use PP much more than fathers do, although it was the fathers whom the children feared most. The results also show that the parents’ most frequent reaction to seven categories of children’s misbehaviour was verbal violence and the second most frequent reaction was PP. These and other results are discussed in the context of Arab culture in Israel, the social situation model and relevant research.
This study evaluated structural equation models of the associations among family functioning, childhood abuse, depression, anxiety, alexithymia, and eating disorder symptomatology in a sample of 412 European American and 192 African American female undergraduates. Additionally, the specific roles of anxiety, depression, and alexithymia as mediators were assessed. Each of these variables was a significant mediator of the association between childhood abuse and disordered eating. Finally, a test of invariance between the African American and European American subsamples was significant, highlighting the need for additional cross-cultural eating disorder research.
Although most scholars find that religious involvement is negatively related to depression, questions still remain regarding how individuals benefit from such involvement and evidence from nationally representative samples is rare. In this paper, I expand upon previous research by considering three types of general religious involvement (attendance at religious services, religious salience, and spiritual help-seeking) and three types of effects (linear, curvilinear, and stress-buffering). Using Americans' Changing Lives (House 1989)—a large, nationally representative, and longitudinal data set—I find a U-shaped effect of religious salience on depression, no significant independent effect of service attendance, and a positive effect of spiritual help-seeking. I also find that spiritual help-seeking and religious salience exhibit significant stress-buffering effects, but that these occur only when individuals experience multiple negative life events, and not when they experience any single type of discrete event. The theoretical implications of these effects are discussed, both as they contribute to research on the life stress paradigm and research on the psychology of religion.
A meta–analysis was performed in an attempt to clarify the proposed relationship between religiosity and psychological adjustment. Specific focus was given to the issue of definition, namely, whether differences in researchers’ conceptualizations of religiosity and mental health could account for the various contradictory findings by psychologists of religion. Analysis of 34 studies conducted during the past 12 years revealed that the definitions of religiosity and mental health utilized by psychologists in this field were indeed associated with different types and strengths of the correlations between religiosity and mental health. Discussion of results assesses the fit between relevant theory and the pattern of change in effect size across categories of religion and adjustment, and concludes with implications for therapeutic uses of religious involvement.
Objective The public view of the severity of social problems and their perceptions of how effectively they are being addressed have a major impact on public policies and resource allocation. The present study focuses on public attitudes toward child maltreatment. It examines perceptions of child maltreatment as a social problem, and attitudes toward prevention and treatment strategies in cases of child abuse and neglect.Methods A survey was conducted among a representative sample of 812 Israeli adults: 688 Jews, and 124 Arabs. Fifty additional Ultra-Orthodox Jews were added for comparisons among Jewish participants.Results The participants tend to view violence and alcohol consumption among youth as a more serious problem than parental maltreatment of children. Low-income participants tend to view child maltreatment as a more serious problem than did high-income participants. Jewish participants (except for ultra-Orthodox Jews) view child maltreatment as a significantly more serious problem than did Arabs and Ultra-Orthodox Jews. Most of the participants believe that parents who maltreat their children should be punished, but they should be taught how to refrain from maltreatment, and learn to change their behavior. Many participants believe that the courts do not sufficiently punish parents who maltreat their children. In their assessments of the quality of professional work, the highest evaluations are given to services provided by physicians and social workers, whereas the lowest evaluations are given to judges and police. Most of the participants (70%) believed that social workers play an important role in protecting children.Conclusions The survey findings have implications for enhancing public awareness of child maltreatment as well for policy making in the area of child abuse and neglect. The differences in the perceptions of participants based on their religious, cultural and economic background toward child maltreatment should be further studied and addressed in policy and interventions in this area.
In the last decade, one can note among secular Israelis the growing interest in Jewish texts and non-orthodox Jewish ritual.
This interest is manifested in the increasing numbers of secular Batei- Midrash (Houses of Learning), Batei-Tfila (Houses of Prayer), and Jewish secular mass events taking place seasonally. Common to these grassroots activities is the
attempt to reconstruct the Jewish secular identity and include new Jewish dimensions within it. These activities have been
named by scholars, media and activists as the Jewish Renewal phenomenon: Hitchadshut Yehudit. In this paper, we propose that
the various Jewish renewal activities lead to collective action that alters the conception of secular Jewish identity. Using
the prism of the ‘New Social Movements’(NSM) theory we argue that the Jewish Renewal Movement is a NSM with a shared narrative
and vision. The paper will present the characteristics of the various Jewish Renewal organizations that identify them as a
New Social Movement and the movement’s historical development from the 1960’s to the present.
KeywordsJewish renewal–New social movements–Jewish identity–Secular Judaism
The link between sexual assault and disordered eating has yet to be clarified, especially for ethnic minority populations. Asian women, in particular, report low rates of both sexual assault and eating disorders compared to their Western counterparts, and studies suggest that these rates may be conservative. The literature indicates that there are cultural attitudes that contribute to non- and underreporting of sexual assault by Asian women and that these sociocultural factors may have an important role in the development of eating disorders as a response to sexual victimization. Research illustrates a relationship between sexual assault and eating disorders; eating disorders may serve as coping mechanisms for survivors of sexual assault by providing a mechanism for comfort, numbing, and distracting in an effort to rid the painful feelings in response to the assault. To stimulate future research, this article reviews the current literature on the development of eating disorders following a sexual assault and on the sociocultural factors linking both phenomena in Asian women, and offers avenues for investigation to increase our understanding of these relationships.
We sought to estimate prevalences of childhood emotional abuse (CEA) in bulimic and normal-eater control groups, and to replicate previous findings linking CEA to severity of eating symptoms in BN. We also examined potential mediators of the link between CEA and disordered eating.
Women diagnosed with a bulimic disorder (n = 176) and normal-eater women (n = 139) were assessed for childhood traumata, eating-disorder (ED) symptoms and psychopathological characteristics (ineffectiveness, perfectionism, depression, and affective instability) thought to be potential mediators of interest.
CEA was more prevalent in the bulimic than in the nonbulimic group, and predicted severity of some eating-symptom indices. Ineffectiveness and affective instability both mediated relationships between CEA and selected ED symptoms.
We found CEA to predict eating pathology through mediating effects of ineffectiveness and affective instability. CEA might influence severity of ED symptoms by impacting an individual's self-esteem and capacity for affect regulation.
This article aims to conceptualize spiritual abuse as an additional dimension to physical, psychological, sexual, and economic abuse. Growing out of an interpretivist participatory action research study in a therapeutic Haredi (Jewish ultraorthodox) group of eight abused women, spiritual abuse has been defined as any attempt to impair the woman's spiritual life, spiritual self, or spiritual well-being, with three levels of intensity: (a) belittling her spiritual worth, beliefs, or deeds; (b) preventing her from performing spiritual acts; and (c) causing her to transgress spiritual obligations or prohibitions. The concept and its typology are illustrated by means of examples from the women's abusive experiences and may be of theoretical and therapeutic worldwide relevance.
This study aims to examine competing explanations of the relationship between religious and political ideology commitment with posttraumatic growth.
Subjects were Israeli youth who were exposed to terror (n = 2,999) aged 13-15. Measures included: posttraumatic growth inventory, religious orientation, ideological commitment, objective and subjective exposure to terror.
Both religiosity and political ideology mediated the effects of exposure and fear on growth. Political ideology but not religiosity, had a moderating effect, such that subjective fear was positively associated with growth only among those with stronger ideologies.
Results support the contention of Terror Management Theory that cultural beliefs have beneficial effects on well being in the face of adversity and emphasize the role of cultural world as effecting growth, beyond trauma.
Research on the epidemiology of bulimia nervosa has focused largely on the prevalence of the disorder. As methods have improved, consensus has increased regarding the prevalence rate among adolescent and young adult women--about 1%. However, the accuracy of this figure and its clinical significance must be questioned. In this synthesis of the epidemiological work to date, the authors review the literature from a clinical and research perspective. They recommend a shift in emphasis away from studies of the distribution of the disorder toward studies of the determinants of the whole spectrum of the disturbance that exists in the community.
This study reports childhood sexual assault data collected as part of a community-based population study on mental health. A household sample, stratified by catchment area, was selected using a two-stage probability technique. A total of 3,132 adults (18 years or older) were interviewed between January 1983 and August 1984. The sample was 46% Hispanic and 42% non-Hispanic white, 47% male and 53% female. Childhood sexual assault was defined as incidents before age 16 years which involved pressure or force for sexual contact. The prevalence (weighted for sampling design and nonresponse) of childhood sexual assault for the total sample was 5.3%. Rates were higher for non-Hispanic whites (8.7%) compared with Hispanics (3.0%), women (6.8%) compared with men (3.8%), and younger persons at the time of interview (6.5%) compared with older persons (3.9%). Most assaults were by an acquaintance and occurred for the first time around age 10 years. Data from a subsample of assaulted respondents show that childhood sexual assaults are not usually accomplished through physical aggression, but rather through persuasion, and through the psychological threat of the assailant being bigger or stronger. Research is needed on the natural history and sequelae of childhood sexual assault.
We examined the hypothesis that the degree of religious orthodoxy is an independent risk factor for coronary heart disease incidence in a study of 454 men and 85 women who experienced a first myocardial infarction. They were compared with a control group of 295 men and 391 women. All were Jewish residents of Jerusalem. The degree of religious orthodoxy was ascertained by interview of participants. Among the cases, 51% of the men and 50% of the women defined themselves as secular compared with 21% and 16%, respectively, among the controls. In a multivariate logistic model (including terms for age, ethnicity, education, smoking, physical exercise, body mass index and religious orthodoxy), the coefficients for age and smoking were positive and statistically significant, and those for education negative and significant. The risk for European born subjects was greater than for the other ethnic origin groups (statistically significant only in men). Secular subjects had a significantly higher risk of myocardial infarction compared to orthodox subject (odds ratio of 4.2 (95% confidence interval 2.6-6.6) for men and 7.3 (95% confidence interval 2.3-23.0 for women). This relationship was independent of the other variables in the model. The relation persisted in a subsample of cases who were examined 2-3 months after the acute phase of the infarction upon controlling for plasma cholesterol, high density lipoprotein cholesterol and hypertension. This finding should be substantiated. It would appear important to identify the components of religiosity associated with reduced risk.
Approximately 150,000 confirmed cases of child sexual abuse were reported to child welfare authorities in the United States during 1993. This number represents about 15% of the more than one million confirmed cases of all child abuse and neglect. But the true scope of this problem is better reflected in retrospective surveys of adults, and this article summarizes data from 19 of these surveys. Considerable evidence exists to show that at least 20% of American women and 5% to 10% of American men experienced some form of sexual abuse as children. The rates are somewhat lower among people born before World War II, but there is little evidence of a dramatic increase for recent generations. The studies provide little evidence that race or socioeconomic circumstances are major risk factors. They do show elevated risk for children who experienced parental inadequacy, unavailability, conflict, harsh punishment, and emotional deprivation. Adult retrospective studies are also good sources of information about the characteristics of abuse. Most sexual abuse is committed by men (90%) and by persons known to the child (70% to 90%), with family members constituting one-third to one-half of the perpetrators against girls and 10% to 20% of the perpetrators against boys. Family members constitute a higher percentage of the perpetrators in child protective agency cases because the mandate of these agencies generally precludes their involvement in extrafamily abuse. Around 20% to 25% of child sexual abuse cases involve penetration or oral-genital contact. The peak age of vulnerability is between 7 and 13. Studies of the criminal justice processing of sexual abusers suggest that, compared with other violent criminals, slightly fewer are prosecuted, but of those prosecuted, slightly more are convicted. Studies conducted in the 1980s also showed that, once convicted, relatively few sexual abusers receive sentences longer than one year, while 32% to 46% serve no jail time. Overall, there is little evidence to suggest that either the child welfare system or the criminal justice system abandons its usual standards of operation and acts hysterically when confronted with sexual abuse.
The long-term health effects of physical, sexual, and emotional abuse during childhood were studied in a sample of 668 middle class females in a gynecologic practice who responded to a self-administered, anonymous questionnaire covering demographic information, family history, physical and psychological health, as well as stressful events and abusive experiences as a child. Half (53%) of the sample reported childhood abuse, with 28.9% recounting exposure to one type of abuse, 18.7% to two types of abuse, and 5.4% to all three types of abuse. In comparison to women not abused during childhood, the abused reported significantly more hospitalizations for illnesses, a greater number of physical and psychological problems, and lower ratings of their overall health. The greater the number of childhood abuses, the poorer one's adult health and the more likely one was to have experienced abuse as an adult. Thus, in addition to the deleterious psychological consequences of abuse described in the literature, physical health also appears to be adversely affected in women abused as children.
This study assessed the association of Jewish religious observance with mortality by comparing religious and secular kibbutzim. These collectives are highly similar in social structure and economic function and are cohesive and supportive communities.
In a 16-year (1970 through 1985) historical prospective study of mortality in 11 religious and 11 matched secular kibbutzim in Israel, 268 deaths occurred among 3900 men and women 35 years of age and older during 41347 person-years of observation.
Mortality was considerably higher in secular kibbutzim. Cox proportional hazards analysis was used to adjust for age and the matched design; rate ratios were 1.67 (95% confidence interval [CI]=1.17, 2.39) for men, 2.67 (95% CI=1.55, 4.60) for women, and 1.93 (95% CI=1.44, 2.59) overall. Kaplan-Meier survival analysis of birth cohorts confirmed the association. The lower mortality in religious kibbutzim was consistent for all major causes of death.
Belonging to a religious collective was associated with a strong protective effect not attributable to confounding by sociodemographic factors. Elucidation of mechanisms mediating this effect may provide etiologic insights and leads for intervention.
The associations between giving a history of physical, emotional, and sexual abuse in children and a range of mental health, interpersonal, and sexual problems in adult life were examined in a community sample of women. Abuse was defined to establish groups giving histories of unequivocal victimization. A history of any form of abuse was associated with increased rates of psychopathology, sexual difficulties, decreased self-esteem, and interpersonal problems. The similarities between the three forms of abuse in terms of their association with negative adult outcomes was more apparent than any differences, though there was a trend for sexual abuse to be particularly associated to sexual problems, emotional abuse to low self-esteem, and physical abuse to marital breakdown. Abuse of all types was more frequent in those from disturbed and disrupted family backgrounds. The background factors associated with reports of abuse were themselves often associated to the same range of negative adult outcomes as for abuse. Logistic regressions indicated that some, though not all, of the apparent associations between abuse and adult problems was accounted for by this matrix of childhood disadvantage from which abuse so often emerged.
This paper explores the issues that arise when psychotherapists and patients do not share a common value system. Using three case studies of ultra-Orthodox Jewish patients who hold religious values and beliefs, the paper illustrataes and defines a strategy of "value-sensitive therapy." It argues for treating patients without demeaning or discounting their values and beliefs.
The relationship of health risk behavior and disease in adulthood to the breadth of exposure to childhood emotional, physical, or sexual abuse, and household dysfunction during childhood has not previously been described.
A questionnaire about adverse childhood experiences was mailed to 13,494 adults who had completed a standardized medical evaluation at a large HMO; 9,508 (70.5%) responded. Seven categories of adverse childhood experiences were studied: psychological, physical, or sexual abuse; violence against mother; or living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned. The number of categories of these adverse childhood experiences was then compared to measures of adult risk behavior, health status, and disease. Logistic regression was used to adjust for effects of demographic factors on the association between the cumulative number of categories of childhood exposures (range: 0-7) and risk factors for the leading causes of death in adult life.
More than half of respondents reported at least one, and one-fourth reported > or = 2 categories of childhood exposures. We found a graded relationship between the number of categories of childhood exposure and each of the adult health risk behaviors and diseases that were studied (P < .001). Persons who had experienced four or more categories of childhood exposure, compared to those who had experienced none, had 4- to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt; a 2- to 4-fold increase in smoking, poor self-rated health, > or = 50 sexual intercourse partners, and sexually transmitted disease; and 1.4- to 1.6-fold increase in physical inactivity and severe obesity. The number of categories of adverse childhood exposures showed a graded relationship to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life.
We found a strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults.
We interviewed a U.S. national sample of women, aged 18 years and older to determine the prevalence and characteristics of childhood sexual abuse. We also examined which family and background variables were predictive of CSA in this sample.
The study employed a series of detailed descriptive questions regarding childhood sexual experiences that were administered in a highly structured format by trained female interviewers. CSA prevalence rates were calculated using two definitions of CSA, one of which was slightly more inclusive.
Prevalence rates for the more inclusive CSA definition ranged from 21% to 32%, depending on how respondents who provided incomplete information about their sexual experiences were classified. The less inclusive CSA definition resulted in prevalence rates ranging from 15% to 26%. Additional information about the types of abuse experienced, perpetrator characteristics, age at first abuse, and physical and affective consequences of the abusive experiences are reported. The risk of CSA was related to higher scores on a measure of father's rejection, and the interaction between parental drinking status and whether the respondent had lived with both parents during childhood. Further analysis of this interaction suggests that when respondents reported living with both biological parents, they were most at risk for CSA when their father was a nondrinker and their mother was a drinker.
To determine the prevalence of a history of child sexual abuse (CSA) in a random sample of adult patients presenting for routine health care to family practice clinics in Israel.
One thousand and five randomly selected patients aged 18 to 55, attending 48 clinics, participated in this questionnaire study.
Twenty-five percent indicated that they had been sexually abused as children. More women reported CSA (p < .0001 ) than men, as did women originating from Western countries (p = .02) and those with more than 12 years of education (p = .01). There were no significant associations between CSA and the other socio-demographic variables examined. Fondling was the most common and intercourse the least common activity experienced. Forty-five percent of the perpetrators were previously known. The mean age at which the child sexual abuse began varied between 10 and 14. Only 45% of the subjects had ever told anyone about the experience.
Since no other prevalence study has been reported to date in Israel, these findings suggest that as in other Western countries CSA is a relatively common problem. Family physicians and other health professionals should be aware of this high prevalence and its known potential for initial and long-term deleterious outcomes.
This study compared two common questionnaire formats for eliciting retrospective child abuse reports. Self-defined formats ask participants whether they were abused, using that term. Researcher-defined formats ask about particular abuse-related events, allowing researchers to specify criteria for identifying abuse histories. Adjustment was measured by self-report inventories of depressive and posttraumatic symptoms and global self-esteem. Participants were 542 college women and men. Significantly less abuse was reported on the self- versus researcher-defined formats. Self-defined abuse was more frequent if participants met criteria for researcher-defined sexual or dual abuse versus physical abuse and if they reported relatively frequent childhood physical violence, severe sexual acts, and marginally, sexual perpetrators who were incestuous. Relationships of adjustment with researcher-defined versus self-defined abuse were stronger, and relationships between adjustment and researcher-defined abuse were independent of self-defined abuse. Discussion addressed methods of eliciting retrospective abuse histories for research and for clinical purposes.
We evaluated associations between childhood physical and sexual abuse in bulimic women and eating disturbances, psychiatric symptoms, and likelihood of later abuse in adulthood.
Fifty-one bulimics and 25 normal eaters participated in this study. Semistructured interviews and self-report measures were used to assess eating symptoms, comorbid psychiatric disturbances, personality pathology, and childhood and adulthood abuse.
Compared with the normal eaters, bulimic women reported higher levels of childhood abuse. Although bulimic women showed more psychopathology than nonbulimic women, there was a correspondence between the presence and severity of abuse and the severity of concurrent psychopathologic symptoms. Results linked dissociation and submissiveness to most severe forms of abuse. Abuse in adulthood was almost always preceded by earlier abuse during childhood.
Our findings suggest an association between certain psychopathologic traits and the likelihood of abuse (especially when occurring both in childhood and adulthood). Observed associations could implicate causal effects of childhood abuse on personality development, influences of personality traits in heightening the risk of abuse, or both.
Corporal punishment of children constitutes a human rights violation and has mental health consequences, yet it is frequently practiced in many countries. The objectives of this study were to identify attitudes and opinions with regard to corporal punishment among urban Jewish Israelis. Corporal punishment was defined as the means to discipline children by the use of physical force. A short battery of questions exploring attitudes and opinions on the use of corporal punishment of children was added to a periodic survey conducted by a private polling organization. The sample included 1,000 urban Jewish Israeli community residents. Most respondents did not endorse corporal punishment. However, when confronted with a question tapping the readiness of adults to comply with a ruling by the Supreme Court that prohibits the use of corporal punishment at home, most respondents expressed skepticism that the public will comply. Forty percent thought that most parents would agree to undergo training in the use of alternative means of discipline. Fifty-seven percent experienced physical punishment when growing up, a variable which was associated with all responses favoring its use as a means of discipline. The results of the study provide the bases for public health action, including training programs on alternative methods of discipline. Further research targeting other population groups not yet explored is needed.
Influential studies have cast doubt on the validity of retrospective reports by adults of their own adverse experiences in childhood. Accordingly, many researchers view retrospective reports with scepticism.
A computer-based search, supplemented by hand searches, was used to identify studies reported between 1980 and 2001 in which there was a quantified assessment of the validity of retrospective recall of sexual abuse, physical abuse, physical/emotional neglect or family discord, using samples of at least 40. Validity was assessed by means of comparisons with contemporaneous, prospectively obtained, court or clinic or research records; by agreement between retrospective reports of two siblings; and by the examination of possible bias with respect to differences between retrospective and prospective reports in their correlates and consequences. Medium- to long-term reliability of retrospective recall was determined from studies in which the test-retest period extended over at least 6 months.
Retrospective reports in adulthood of major adverse experiences in childhood, even when these are of a kind that allow reasonable operationalisation, involve a substantial rate of false negatives, and substantial measurement error. On the other hand, although less easily quantified, false positive reports are probably rare. Several studies have shown some bias in retrospective reports. However, such bias is not sufficiently great to invalidate retrospective case-control studies of major adversities of an easily defined kind. Nevertheless, the findings suggest that little weight can be placed on the retrospective reports of details of early experiences or on reports of experiences that rely heavily onjudgement or interpretation.
Retrospective studies have a worthwhile place in research, but further research is needed to examine possible biases in reporting.