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Childhood Sexual Abuse and Sexual Motivations -The Role of Dissociation
The Journal of Sex Research
Abstract
The present study sought to examine the relations between a history of childhood sexual abuse (CSA) and sexual motivations and to explore the moderating role of dissociation within these relations. The study was conducted among 889 men and women (ages 18-70). Results indicated a history of CSA was significantly related to higher scores on self-affirmation, coping, partner approval and peer pressure sexual motivations. Interactions between CSA and gender in explaining sexual motivations, were not significant. Among participants with a history of CSA (n = 365), dissociation was significantly related to sexual motivations, so that participants who had dissociation scores above the cutoff (reporting high levels of dissociation) scored higher on intimacy, self-affirmation, coping, and partner approval than did those with a history of CSA who reported low levels of dissociation. Analyzes revealed significant moderating effects for dissociation within the relations between CSA and intimacy, coping, and partner approval sexual motivations. The present study suggests CSA survivors and those who report high levels of dissociation in particular, utilize sex for intimacy, for coping with negative emotions, and for partner approval. Therapists working with CSA survivors should be aware of the potential effects the abuse has on the survivor's reasons to engage in sex.
... To date, however, current understanding of associations between CM and motivations driving individuals' engagement in sexual activity within romantic relationships remains limited. Notably, the handful of studies investigating CM-sexual motivation associations focused on individuals, not couples, and used a cross-sectional design (Dugal et al., 2023;Gewirtz-Meydan & Lahav, 2021). Further examining sexual motivations in connection with CM in couples is essential to further enrich current perspectives on trauma's role in sexuality and relationship dynamics, pinpointing the potential mechanisms driving this relationship. ...
... CM holds the potential to shape a person's cognitive schemas about themselves, others, and the world, thereby predisposing victims towards specific psychological responses, interpersonal patterns, and motivations (Briere & Runtz, 2002;Glaser, 2000). Limited research, primarily on childhood sexual abuse, suggests that victims tend to lean toward nonautonomous sexual motivations, namely by using sex to bolster self-esteem and regulate emotions (Gewirtz-Meydan & Lahav, 2021;Wekerle et al., 2017). Using a crosssectional and individual-focused design, one study showed that CM was related to higher controlled sexual motivations, particularly introjected motivation (Dugal et al., 2023). ...
... Specifically, individuals with higher levels of CM and their partners reported higher levels of external motivation and amotivation through their own and their partners' lower levels of autonomy and relatedness. These results are in line with previous research showing that individuals who experienced CM, particularly sexual abuse, were likely to engage in sexual activities driven by external pressure such as to gain partner approval, peer pressure or to avoid conflict (Gewirtz-Meydan & Lahav, 2021;Layh et al., 2020). A lack of selfdetermination over one's sexual activities appears even more salient when partners in the relationship feel uncared for and experience the relationship as non-autonomy supportive. ...
Childhood maltreatment (CM) has been consistently associated with negative sexual outcomes in couples. Yet, its link with sexual motivation, which plays a key role in relational and sexual well-being, remains elusive. Based on self-determination theory, sexual motivations encompass intrinsic motivation, extrinsic motivation (i.e., integrated, identified, introjected, and external), and amotivation. This study examined the dyadic longitudinal associations between CM and these six sexual motivations, while considering the satisfaction of basic psychological needs (i.e., autonomy, competence, and relatedness) as potential mediators. Data from 309 cohabitating couples (50.8% cisgender women, M = 32.64 years, SD = 9.59), collected at three time points over 1 year, were analyzed using actor-partner interdependence mediation models. CM was not significantly related to intrinsic motivation. However, overall, a person’s CM was indirectly associated with their own and their partner’s extrinsic motivation (i.e., integrated, identified, introjected, and external) via their own satisfaction of basic psychological needs for autonomy, competence, and relatedness in the romantic relationship. A person’s CM was also indirectly associated with their own amotivation via their own and their partner’s satisfaction for autonomy and relatedness. Findings suggest that catering to basic psychological needs of couples with a CM history may facilitate healthier sexual dynamics through their associations with sexual motivation.
... Dissociation is highly prevalent in survivors of traumatic events, including CSA survivors (Dorahy et al., 2022;Kate et al., 2021;Lassri et al., 2023). The connection between trauma and dissociation is well-established in research, leading some experts to conceptualize dissociation as an adaptive response to mostly interpersonal forms of trauma (such as abuse and violence) in a way that can help the survivor cope with the intense psychological and/or physical pain they are being subjected to (Dorahy et al., 2022;Gewirtz-Meydan & Lahav, 2021). Not only has dissociation been consistently associated with CSA, but it has also been found to act as a mediator between CSA and other psychologically related phenomena, such as revictimization (Lassri et al., 2023). ...
... Different explanations can account for why relationship to perpetrator might plays a role in the consequences of CSA. According to betrayal trauma theory, when abuse is perpetrated by someone close to the victim, it results in overwhelming affect and distress, compared to when the abuser doesn't have a close relationship with the victim (Gewirtz-Meydan & Lahav, 2021). This closeness of the abuser threatens the attachment bonds of the victim; therefore, the isolation of the knowledge of the abuse becomes necessary for survival (Freyd et al., 2001). ...
Childhood sexual abuse (CSA) is a major social problem with various negative outcomes for a person’s life, such as dissociation. Previous research has shown that insecure attachment styles, especially disorganized attachment, play a role in mediating the effect of childhood sexual abuse on dissociation. However, most of these studies have not considered several abuse characteristics, such as relationship to the perpetrator, to play a role in determining the effect of childhood sexual abuse on outcomes such as dissociation. Our study borrows from betrayal trauma theory that states the effects of a traumatic event vary considerably based on one’s relationship to perpetrator, with more severe consequences for those traumatized at the hands of someone close to them. Therefore, this study aimed to analyze the mediating role of attachment styles on the relationship between child sexual abuse and dissociation in terms of the relationship to the perpetrator. A sample of 258 adult men and women between the ages of 18 to 55 years was selected via convenience sampling. Individuals completed questions from Childhood Trauma Questionnaire, Dissociative Experiences Scale, and Relationship Scales Questionnaire. Based on their relationship to perpetrators, participants were divided into two groups. Two mediation analyses were performed in each group to evaluate the mediating effects of attachment styles on the association between childhood sexual abuse and dissociation. Mediation analyses showed that fearful avoidant (disorganized) attachment partially mediated the relationship between CSA and dissociation (indirect = 0.10, 95% CI [0.0284–0.1833]) only in participants whose perpetrator was someone within their family. Results are discussed in terms of the role of victim-perpetrator relationship and attachment styles in pathways to dissociation.
... According to the trauma model of dissociation, dissociation is an important aspect of the psychobiological response to threat and danger that allows for automatization of behavior, analgesia, depersonalization, and isolation of horrible experiences to enhance survival during and in the aftermath of the abuse (Dalenberg et al., 2012). Dissociation is prevalent among adult CSA survivors (Bird et al., 2014, Gewirtz-Meydan & Lahav, 2021Kong et al., 2018;Vonderlin et al., 2018). High levels of dissociation may predict why certain male CSA survivors experience elevated levels of sexual concerns. ...
... Research has highlighted the lasting impact of CSA on adult sexuality in women, but less is known about the impact on male survivors (Brotto et al., 2012, Gewirtz-Meydan & Lahav, 2021Leonard & Follette, 2002;Noll et al., 2003;Pulverman et al., 2018;Pulverman & Meston, 2020;Gewirtz-Meydan & Opuda, 2022). This study aims to address these gaps by investigating the link between dissociation and sexual concerns among male CSA survivors in a clinical context, while also examining the role of identity cohesion in this association. ...
Research on male survivors of childhood sexual abuse is notably deficient when it comes to addressing their sexual concerns, such as experiences of sexual distress, negative thoughts, and feelings related to their sexuality. Dissociation, a known consequence of childhood sexual abuse, could be associated with higher sexual concerns through identity cohesion. Precisely, dissociation can potentially be related to lower identity cohesion (e.g., not knowing what you want or need). In return, lower identity cohesion may be related to higher sexual concerns by impeding the capacity to know and accept oneself, which tends to promote a positive and healthy sexuality. This study aimed to examine the role of identity cohesion in the link between dissociation and sexual concerns in 105 men consulting for their history of childhood sexual abuse. Men completed questionnaires assessing dissociation, sexual concerns, and identity cohesion at admission in a community setting. Results of a path analysis revealed an indirect association between dissociation and higher sexual concerns through lower identity cohesion. The model explained 27.6% of the variance in sexual concerns. This study highlights the relevance of interventions targeting dissociative symptoms to improve identity cohesion and sexual health in male survivors of childhood sexual abuse.
... Namely, PTSD has been suggested as a possible mechanism to explain the association between childhood abuse and sexual dysfunction (Bornefeld-Ettmann et al., 2018;Gewirtz-Meydan & Lahav, 2020;Kratzer et al., 2022) and between childhood abuse and hypersexuality (Blain et al., 2012). However, as mentioned above, hyposexual and hypersexual behaviors that evolved following childhood trauma may appear similar (according to the DSM or ICD diagnosis), despite the fact that the source of these behaviors as well as the motives to engage in them are assumed to be different, and tied to the trauma response (Bornefeld-Ettmann et al., 2018;Gewirtz-Meydan & Lahav, 2021;Kelley & Gidycz, 2018). ...
... Sexual motivations are defined as various goals and needs that people seek to fulfill by engaging in sex (Cooper et al., 1998;Meston & Buss, 2007). Although to date research on the relation between childhood abuse, trauma, and sexual motives has been limited, researchers have suggested that survivors of childhood abuse may use sex to cope with the trauma by regulating their negative affect and psychological distress (Orcutt et al., 2005;Schwartz, 2010;Stappenbeck et al., 2016), affirm their self-worth (Tirone, 2014), gain the approval of others (Gewirtz-Meydan & Lahav, 2021;Layh et al., 2019;Wekerle et al., 2017), gain a sense of control within interpersonal relationships (Gewirtz-Meydan, 2022; Gold & Heffner, 1998), numb emotional pain, cry out for help, receive attention, rebel or discharge anger, reenact past abuse and maintain helplessness, self-punish or punish their body, purify the self, avoid intimacy, or release tension built up from hypervigilance (Schwartz et al., 1995). ...
In the current study we sought to identify sexual behavior profiles and examine the levels of childhood abuse history and trauma measures in each profile. The study was conducted among a large non-clinical sample of men and women (n = 806). Latent profile analysis was employed to identify distinct profiles of sexual behaviors and then childhood abuse, posttraumatic stress disorder (PTSD), depression, and anxiety, and motives for engaging in sex were assessed in each profile. Four distinct profiles of sexual behavior were identified: hyposexual individuals, hypersexual porn users, porn users, and within usual ranges (WURs). Hypersexual porn users had significantly more childhood trauma (emotional, physical, and sexual) than WURs, significantly greater PTSD symptom than WURs and hyposexual individuals, and significantly greater anxiety and depression as compared with all other groups. The hyposexual individuals had significantly lower scores on all motives for engaging in sex than did porn users or hypersexual porn users. Hypersexual porn users and porn users reported coping and peer-pressure as motives for engaging in sex more than did WURs or hyposexual individuals. Clinicians working with survivors of childhood abuse should consider directly targeting these different maladaptive sexual behaviors by addressing PTSD symptoms, affective disorders, and motives for engaging in sex.
... This pattern is similar to the sexual motive of "partner approval," which is defined as the use of sex to please or appease one's partner (Cooper et al., 1998). However, in the current study, pleasing was not seen as a sexual motivation but rather as a reenactment of an early trauma response (fawning, as discussed in the Introduction; Walker, 2013) or as an interpersonal dynamic, which in a previous study was found to be associated with dissociation (Gewirtz-Meydan & Lahav, 2021). This finding supports results of previous studies demonstrating that partner approval sexual motivation is associated with increased sexual dysfunction (Impett et al., 2005;Muise et al., 2013;Watson et al., 2017) and that distraction during sex tends to manifest as worries about pleasing one's partner (Brotto et al., 2016). ...
Background:
Childhood sexual abuse (CSA) is a significant risk factor for sexual difficulties in adulthood.
Objective:
In the current study we aimed to expand the understanding of the association between CSA and sexual difficulties by examining the moderating role of traumatic sexuality in the association between CSA and sexual difficulties among a sample of CSA survivors.
Participants and setting:
The hypothesized moderation model was examined among a sample of 393 CSA survivors.
Methods:
Significant interactions were probed using simple slopes tests using the interactions R package.
Results:
The results indicated main effects of traumatic sexuality on survivors' sexual difficulties: Greater severity of dissociation during sex was linked with greater sexual dysfunction and higher compulsive sexual behavior disorder (CSBD), and greater intrusiveness during sex and pleasing the other during sex were linked with higher CSBD. Experiencing higher sex-related guilt and/or shame and hypervigilance with regard to sex were associated with greater sexual dysfunction. As for the moderations, intrusiveness during sex and pleasing the other during sex moderated the association between CSA and sexual dysfunction. Intrusiveness during sex and sex-related guilt and/or shame moderated the association between CSA and CSBD. Intrusiveness during sex, pleasing the other during sex, and/or hypervigilance with regard to sex moderated the association between CSA and problematic pornography use.
Conclusion:
This study points to the potential contribution of traumatic sexuality symptoms to sexual difficulties among survivors of CSA and lends support to the idea of offering trauma-focused therapy when treating the sexual difficulties of CSA survivors.
... Childhood abuse is a pervasive, global problem that substantially hampers the well-being of millions of children around the world (Stoltenborgh et al., 2015). The long-term ramifications of childhood abuse are multifaceted and include posttraumatic stress disorder (PTSD), anxiety, dissociation, substance use disorders, eating disorders, non-suicidal self-injury, sexual dysfunction, poor physical health, and depression (Ford & Gómez, 2015;Gewirtz-Meydan & Lahav, 2020a, 2020bLindert et al., 2014;Messman-Moore & Bhuptani, 2017;Nelson et al., 2017;Vonderlin et al., 2018;Wegman & Stetler, 2009). ...
Childhood abuse puts individuals at risk for psychopathology and psychiatric symptoms such as posttraumatic stress disorder (PTSD) and anxiety symptoms. At the same time, research has indicated that some survivors report positive transformations in the aftermath of their trauma, known as posttraumatic growth (PTG). Yet the essence of PTG reports is questionable, and some scholars claim that it may reflect maladaptive illusory qualities. Furthermore, according to a recent theoretical model, PTG might be dissociation-based and related to survivors' bonds with their perpetrators. This study aimed to explore these claims by assessing PTG, dissociation, and identification with the aggressor (IWA), as well as PTSD and anxiety symptoms. An online survey was conducted among 597 adult childhood abuse survivors. Study variables were assessed via self-report measures. Analyses indicated positive associations between PTG, dissociation, and IWA. Three distinct profiles were found, reflecting high, medium, and low scores on PTG, dissociation, and IWA. Profile type explained PTSD and anxiety symptoms above and beyond gender, age, and abuse severity. These findings suggest that whereas some childhood abuse survivors might experience a positive transformation subsequent to their trauma, others' PTG reports might reflect dissociative mechanisms and pathological attachments to their perpetrators , and thus might be maladaptive. ARTICLE HISTORY
... In the current study, dissociation was not associated with either sexual revictimization or psychological dating violence. Individuals with dissociative symptoms may feel emotionally numb, distant from their surroundings and forget certain events which could lead them to misidentify acts of sexual (Gewirtz-Meydan & Lahav, 2020), and psychological dating violence (Zerubavel et al., 2017). Physical marks of abuse (ex. ...
Interpersonal revictimization, through sexual violence and psychological or physical dating violence, is one of the many consequences of childhood sexual abuse (CSA). This study examined how childhood maltreatment, sociodemographic characteristics, mental health, relational factors, and community factors are associated with 1) sexual revictimization 2) psychological dating violence victimization, and 3) physical dating violence victimization in a sample of young adults reporting a history of CSA. A sample of 190 young adults (18–25 y.o.) with self-reported experiences of CSA completed an online survey measuring childhood maltreatment (e.g. neglect, physical abuse, witness to domestic violence), sociodemographic characteristics (e.g. material deprivation, education), mental health (dissociation, posttraumatic stress symptoms), relational factors (e.g. insecure attachment style), and community factors (e.g. neighborhood disadvantage). Hierarchical logistic regressions indicated that once all risk factors were entered in the models, PTSD was positively associated with psychological dating violence, while dissociation was positively associated with physical dating violence. Physical abuse in childhood was positively associated with sexual revictimization. The present study shows the importance of simultaneously considering the impact of multiple characteristics surrounding CSA survivors when evaluating risks of revictimization. Additionally, it highlights the importance of providing CSA survivors with adequate mental health support for trauma-related disorders, as it may be crucial to prevent revictimization.
... With regard to attachment anxiety, a different pattern was found, with attachment anxiety predicting higher levels of sexual functioning (specifically arousal). The abovementioned study suggests that survivors who are avoidantly attached are more likely to avoid sex as well, while survivors who are anxiously attached are more likely to use sex as a means for reassurance (Gewirtz-Meydan & Lahav, 2021). ...
Various studies have established the association between child sexual abuse and sexual dysfunction. Although sexual dysfunction can be a distressing and undesirable condition for survivors of child sexual abuse, the current article suggests viewing sexual dysfunction not solely as a negative outcome but as a condition with a potent psychological function in regulating various psychological and relational needs among survivors. The main question addressed in the current paper is: What are the functional aspects of sexual dysfunction among child sexual abuse survivors? Four main protective purposes for sexual dysfunction among survivors of child sexual abuse are proposed: avoiding re-traumatization, regulating closeness within the relationship, gaining a sense of power and control and avoiding vulnerability, and restoring a positive sense of self. Although healthy sexual functioning is a desirable long-term goal for survivors, therapists need to view sexual dysfunction within the context of trauma, and to understand the protective functions of dysfunctions, before attempting to restore sexual function.
Background: Childhood maltreatment (CM), experienced by about 40 % of adults, is associated with romantic relationship challenges like instability, sexual dissatisfaction, and dysfunction. While CM has been linked to lower sexual desire and higher distress, its impact within couples and underlying mechanisms remain underexplored. Touch aversion, where partner touch feels unpleasant, may explain how CM relates to lower sexual desire and higher sexual distress. Objective: This study explores the mediating role of touch aversion in the associations between CM, sexual desire and sexual distress in couples. Methods: A sample of 363 adult couples completed self-reported online questionnaires on CM, partner-focused sexual desire, sexual distress and touch aversion. Results: A person's CM is indirectly associated with their own lower sexual desire (b = − 0.07, 95 % bootstrap CI = [− 0.08, − 0.02]), their partner's higher sexual desire (b = 0.01, 95 % bootstrap CI = [0.000, 0.02]), and both their own (b = 0.06, 95 % bootstrap CI = [0.01, 0.03]) and their partner's higher sexual distress (b = 0.02, 95 % bootstrap CI = [0.003, 0.013]) through their own higher touch aversion. Conclusions: These findings provide theoretical support for the role of touch aversion in the sexual dynamics of couples reporting CM, underscoring the interdependent nature of partners' sexual desire and distress. Clinically, understanding how individuals with a CM history respond to touch may highlight a modifiable psychological process that could help couples navigate their sexual desire and distress.
Background: Childhood abuse (CA) is a risk factor for trauma-related disorders including post- traumatic stress disorder (PTSD) and complex posttraumatic stress disorder (CPTSD). This severe
form of interpersonal trauma may result in “identification with the aggressor” (IWA), in which the individual may take on the beliefs, perspectives, and behaviors of the perpetrator. Although previous evidence suggests that IWA may be particularly related to CPTSD as compared to PTSD, there has been no study that investigated this hypothesis.
Objective: The current study explored the relations between IWA and PTSD and CPTSD symptoms, and the contribution of IWA to the excess probability of PTSD and CPTSD classifications, as compared to no classification.
Participants and setting: This cross-sectional study was conducted among 320 Israeli adult CA survivors aged 21–63 (M = 42.04, SD = 10.81).
Methods: An online survey was completed by a convenience sample of adult CA survivors.
Results: Replacing one's agency with that of the perpetrator as part of IWA had a significant effect
on both PTSD and CPTSD symptoms (ES = 0.36 and 0.24, respectively), and served as a risk factor for both PTSD and CPTSD classifications. Moreover, analysis of the models' predicted values rקveals that the predicted probability of CPTSD classification was 3 to 5 times higher than on the probability of PTSD classifications, for low to high values of the replacing one's agency scale, respectively.
Conclusions: The current findings suggest that IWA may describe some of the deep and long- lasting detriments of CA on self, and may contribute to the development of CPTSD symptoms.
Adverse childhood experiences (ACEs) are well-established risk factors for psychotic symptoms. This study replicated the relationship between ACEs and positive symptoms of psychosis in the Asian context and explored the moderating effect of dissociation. We analyzed data from 1439 high school students in China who completed validated measures of ACEs, positive symptoms of psychosis, and dissociative symptoms. The positive relationship between ACEs and psychotic symptoms was confirmed in our sample (r = .244, p < .001). Among different ACEs, childhood emotional neglect (β = .139, p < .001) and emotional abuse (β = .125, p < .001) had the strongest relationship with psychotic symptoms. Dissociative symptoms were also found to be a statistically significant moderator. We provide cross-cultural evidence for the relationship between ACEs and psychotic symptoms. Dissociative symptoms may exacerbate such effects. These results highlight the importance of child protection to prevent psychotic symptoms. Individuals with higher levels of dissociation may be at higher risk of developing psychotic symptoms when exposed to adversities. A trauma-informed approach to addressing psychotic symptoms in the community is recommended.
Keywords: Psychosis; Positive symptoms of psychosis; Childhood trauma; Dissociation; Cross-cultural psychiatry
Despite the continued prevalence of HIV and condoms’ proven effectiveness in HIV prevention, many young men continue to engage in condom use resistance (CUR). Research shows that sexual compulsivity and childhood sexual abuse (CSA) victimization are risk factors for CUR. Given that sexual activity between men is the most common method through which HIV is transmitted, and that men who have sex with men and women (MSMW) are up to five times as likely to contract or transmit HIV as men who have sex with women only (MSWO), understanding the CUR behaviors of MSMW is uniquely important. Young, single men who had had sex with a woman in the past year (N = 623) completed questionnaires assessing their previous sexual experiences with men and women, history of CSA, sexual compulsivity, and CUR to determine how MSMW classification may moderate the associations between these variables. Results revealed full, moderated mediation, such that CSA was significantly associated with sexual compulsivity among MSMW, but not MSWO. Furthermore, sexual compulsivity was subsequently associated with CUR, in a model accounting for 5.35% of CUR variance. Such findings suggest that exposure to CSA may render MSMW especially susceptible to maladaptive, sexually compulsive desires and behaviors. As a result, MSMW may be more likely to disregard the inherent risks associated with condomless sexual activity and engage in CUR. Thus, intervention programs seeking to reduce the transmission of HIV and other STIs should prioritize targeting MSMW who experienced CSA to reduce sexual compulsivity and increase condom use.
Sexual Interest/Arousal Disorder (distressing, long-lasting impairments in sexual desire and/or arousal) is common in women, but few have access to efficacious psychotherapies, including cognitive-behavioral therapy (CBT) and mindfulness-based therapy (MBT). eSense, an online program meant to maximize treatment access, has been shown to be a feasible, satisfactory, and potentially efficacious intervention. However, subpopulations such as sexual assault survivors may find the program less usable or efficacious. The current study compared women with and without a history of sexual assault (SA) regarding their ability to use and benefit from eSense. Forty-four women (22 with a history of SA; M age = 34.20 years) used eSense (CBT or MBT) and completed validated self-report scales of sexual function, sexual distress, treatment satisfaction, and homework compliance. A history of SA did not predict differences in attrition or changes in clinical outcomes. Exploratory analyses suggested that women with a history of SA reported slightly higher difficulty completing homework assignments, but also slightly higher treatment satisfaction. These preliminary results suggest that eSense may be usable and helpful for women with a history of SA. We discuss ways to maximize the acceptability and efficacy of online programs for women with a history of SA.
Sexual-related post-traumatic stress symptoms (sexual-related PTSS) refers to the traumatic reactions that are replicated during sexual activity among survivors of child sexual abuse (CSA). However, the construct of sexual-related PTSS have been adapted from clinical work with survivors, and research with limited examination of the scales themselves. Given this gap, the current study offers the development of a new measure (PT-SEX) that examines sexual-related PTSS. The study was conducted online, among two convenience samples of women survivors of CSA (study 1 included 451 women and study 2 included 330 women). Six reliable PT-SEX factors emerged from Study 1: Dissociation during sex, intrusiveness during sex, shame and guilt in regard to sexual aspects, pleasing the other during sex, interpersonal distress, and hypervigilance during sex. Study 2 revealed survivors of CSA had significantly higher sexual-related PTSS levels as compared to participants without such a history. Also, post-traumatic stress disorder and sexual-related PTSS made unique and unshared contributions to the observed data, including sexual self-esteem, sexual motives, relationship satisfaction, compulsive sexual behavior, and mental health. CSA significantly moderated the associations between sexual-related PTSS and sexual self-esteem, sexual motivations of self-affirmation and coping, and depression and anxiety. Findings from the current study show that over time, the trauma of CSA seems to be implicated in survivors’ sexual experience. As sexual difficulties are accompanied by sexual-related PTSS, these symptoms are unlikely to resolve by trauma-focused therapy and must be actively targeted in therapy.
Objective. The objective of this study was to examine some dimensions of personality encountered among people with difficulties in controlling sexual impulses, depending on the gender of the aggressor, as well as to highlight the main predictors regarding the probability of committing sexual abuse.
Material and methods. 48 studies were analyzed, of which 13 qualitative and 35 quantitative. The qualitative researches were mainly based on observation or semi-structured interview, and the quantitative ones were based on descriptive statistics, correlational tests. The size of the samples ranged from 51 to 2950 participants. The search covered the period from 1997 to 2020.
Results. Men and women who have committed sexual offences have both common characteristics such as mental disorders, inadequate sexual style, lack of remorseful or empathetic feelings towards the victim, tendency towards criminal behavior, and differences. These were represented by the way they approach the victim, while men tend more towards the use of manipulation, women choose dissimulation. The risk factors in the occurrence of this crime were: the close relationship between the aggressor and the victim, the age specific to the aggressor’s youth stage, spatio-temporal factors correlated with the time of year and the time of day, the existence of a preferential pattern and dysfunctions of the social environment.
Conclusions. A customized intervention is required, depending on the specificity of the clinical frame, on the type of socioeconomic and educational environment of origin and on the experiential history of each person in this criminal category. In the case of men, the approach must keep in mind the relational-value side, and in the case of women the affective sphere, taking into account the involvement of a wide range of emotions.
The implications of a functionalist perspective for understanding sexual risk taking are explored. Key motivational dimensions thought to underlie human behavior (viz., approach vs. avoidance, autonomy vs. relatedness) were used to identify 4 broad domains of sexual motivations and to develop a measure of specific motives within each of these domains. Data from both college student and community samples are used to demonstrate the psychometric adequacy of these scales and to show that having sex for different reasons predicts distinctive patterns of sexual risk taking both cross-sectionally and longitudinally; that selection into specific types of sexual relationships partially mediates these effects; and that these needs may be differentially expressed, or even suppressed, depending on relationship context. Results provide strong support for the functionalist perspective on behavior and indicate that an adequate understanding of sexual risk-taking behavior must take into account the various needs and goals that such behavior can serve.
Debate exists in the trauma literature regarding the role of dissociation in traumatic stress disorders. With the release of the new ICD-11 diagnostic guideline for posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD), this issue warrants further attention. In the current study, we provide a preliminary assessment of the associations between ICD-11 CPTSD and dissociative experiences. This study is based on a sample (N = 106) of highly traumatized clinical patients from the United Kingdom who completed measures of traumatic stress and dissociative experiences. The majority of participants met the diagnostic criteria for CPTSD (69.1%, n = 67), with few patients qualifying for a diagnosis of PTSD (9.3%, n = 9). Those with CPTSD had significantly higher levels of dissociative experiences compared to those with PTSD (Cohen’s d = 1.04) and those with no diagnosis (Cohen’s d = 1.44). Three CPTSD symptom clusters were multivariately associated with dissociation: Affective Dysregulation (β = .33), Re-experiencing in the here and now (β = .24), and Disturbed Relationships (β = .22). These findings indicate that dissociative experiences are particularly relevant for clinical patients with CPTSD. Future longitudinal work will be needed to determine if dissociation is a risk factor for, or outcome of, CPTSD.
Dissociation is a lack of the normal integration of thoughts, feelings, and experiences into the stream of consciousness and memory. Dissociation occurs to some degree in normal individuals and is thought to be more prevalent in persons with major mental illnesses. The Dissociative Experiences Scale (DES) has been developed to offer a means of reliably measuring dissociation in normal and clinical populations. Scale items were developed using clinical data and interviews, scales involving memory loss, and consultations with experts in dissociation. Pilot testing was performed to refine the wording and format of the scale. The scale is a 28-item self-report questionnaire. Subjects were asked to make slashes on 100-mm lines to indicate where they fall on a continuum for each question. In addition, demographic information (age, sex, occupation, and level of education) was collected so that the connection between these variables and scale scores could be examined. The mean of all item scores ranges from 0 to 100 and is called the DES score. The scale was administered to between 10 and 39 subjects in each of the following populations: normal adults, late adolescent college students, and persons suffering from alcoholism, agoraphobia, phobic-anxious disorders, posttraumatic stress disorder, schizophrenia, and multiple personality disorder. Reliability testing of the scale showed that the scale had good test-retest and good split-half reliability. Item-scale score correlations were all significant, indicating good internal consistency and construct validity. A Kruskal-Wallis test. and post hoc comparisons of the scores of the eight populations provided evidence of the scale's criterion-referenced validity. The scale was able to distinguish between subjects with a dissociative disorder (multiple personality) and all other subjects.
Identifying with the aggressor is a process wherein victims of abuse, particularly during childhood, take on their perpetrator’s experience. The victim defers to the perpetrator and adopts the perpetrator’s experience, learns the perpetrator’s desires and needs, and gratifies them. Although the clinical and theoretical literature suggests that identification with the aggressor occurs in the aftermath of abuse and has negative long-term implications, to date this concept has not been empirically investigated. To facilitate an exploration of this subject, the current study evaluated the psychometric properties of a new measure: the Identification With the Aggressor Scale (IAS). The study was conducted among convenience samples of students using online surveys. In Study 1, the IAS was administered to 318 students. In Study 2, the IAS, and a battery of questionnaires assessing features of abuse, dissociation, posttraumatic stress disorder (PTSD) symptoms, and posttraumatic guilt were administered to a convenience sample of 368 students. Four reliable IAS factors emerged from Study 1: Adopting the perpetrator’s experience concerning the abuse, identifying with the perpetrator’s aggression, replacing one’s agency with that of the perpetrator, and becoming hypersensitive to the perpetrator. In Study 2, a confirmatory factor analysis confirmed the scale’s underlying factor structure. A history of childhood abuse, recurrence and severity of abuse, and the perpetrator being a parental figure were all associated with higher IAS scores. In addition, IAS scores were correlated with dissociation, PTSD symptoms, and posttraumatic guilt. The present findings indicate that the IAS has good psychometric properties, making it useful as an assessment tool in future research.
Introduction:
Childhood sexual abuse (CSA) has been identified as a potent risk factor for sexual dysfunction. Certain characteristics of the abuse experience, such as repeated abuse, appear to affect the risk of developing sexual dysfunction. Despite the robust findings that CSA can be detrimental to sexual function, there is little consensus on the exact mechanisms that lead to these difficulties.
Aim:
To summarize the most up-to-date research on the relation between CSA and women's sexual function.
Methods:
The published literature examining the prevalence of sexual dysfunction among women with CSA histories, various types of sexual dysfunctions, and mechanisms proposed to explain the relation between CSA and later sexual difficulties was reviewed.
Main outcome measures:
Review of peer-reviewed literature.
Results:
Women with abuse histories report higher rates of sexual dysfunction compared with their non-abused peers. The sexual concerns most commonly reported by women with abuse histories include problems with sexual desire and sexual arousal. Mechanisms that have been proposed to explain the relation between CSA and sexual dysfunction include cognitive associations with sexuality, sexual self-schemas, sympathetic nervous system activation, body image and esteem, and shame and guilt.
Conclusion:
Women with CSA histories represent a unique population in the sexual health literature. Review of mechanisms proposed to account for the relation between CSA and sexual health suggests that a lack of positive emotions related to sexuality, rather than greater negative emotions, appears to be more relevant to the sexual health of women with CSA histories. Treatment research has indicated that mindfulness-based sex therapy and expressive writing treatments are particularly effective for this group. Further research is needed to clarify the mechanisms that lead to sexual dysfunction for women with abuse histories to provide more targeted treatments for sexual dysfunction among women with abuse histories. Pulverman CS, Kilimnik CD, Meston CM. The Impact of Childhood Sexual Abuse on Women's Sexual Health: A Comprehensive Review. Sex Med Rev 2018;X:XXX-XXX.
Objective:
Dissociation is a complex, ubiquitous construct in psychopathology. Symptoms of dissociation are present in a variety of mental disorders and have been connected to higher burden of illness and poorer treatment response, and not only in disorders with high levels of dissociation. This meta-analysis offers a systematic and evidence-based study of the prevalence and distribution of dissociation, as assessed by the Dissociative Experiences Scale, within different categories of mental disorders, and it updates an earlier meta-analysis.
Method:
More than 1,900 original publications were screened, and 216 were included in the meta-analysis, comprising 15,219 individuals in 19 diagnostic categories.
Results:
The largest mean dissociation scores were found in dissociative disorders (mean scores >35), followed by posttraumatic stress disorder, borderline personality disorder, and conversion disorder (mean scores >25). Somatic symptom disorder, substance-related and addictive disorders, feeding and eating disorders, schizophrenia, anxiety disorder, OCD, and most affective disorders also showed mean dissociation scores >15. Bipolar disorders yielded the lowest dissociation scores (mean score, 14.8).
Conclusions:
The findings underline the importance of careful psychopathological assessment of dissociative symptoms in the entire range of mental disorders.
Treatment of survivors of childhood sexual abuse (CSA) poses difficult challenges for therapists. This is, namely, because of the wide array of powerful countertransference (CT) reactions. A vast amount of literature exists which describes these patterns. However, discussion until now has predominantly focused on the reaction of therapists to the negative effects of the trauma.
The present chapter addresses an aspect of CT that, to the best of the authors’ knowledge, has yet to receive any attention in the literature on trauma: countertransference in response to reports of gains or positive changes after trauma. This has been defined in the literature as posttraumatic growth (PTG). Exploring countertransferencial reactions to PTG and the mutual effects that occur between the two, will provide further insight into the phenomenon of PTG. It will also assist therapists in assuming responsibility for their part in the appearance of PTG and the ways it unfolds in therapy. Five distinct positions of countertransference will be presented: dissociated therapist; therapist as perpetrator; therapist as neglectful parent; therapist as rescuer; and mourning therapist. The authors argue that these positions should be considered as reenactments of dissociated self-states and relational dynamics, rooted in the original trauma, that must be worked through in psychotherapy in order to foster integration and healing.
Objective:
Prior research on the effects of sexual trauma has examined dissociation but not emotional numbing during sex and has relied exclusively on retrospective surveys. The present experiment examined associations among distal factors of childhood sexual abuse (CSA), adolescent/adult sexual assault (ASA), and trauma symptoms and the proximal factor of acute alcohol intoxication on in-the-moment dissociation, emotional numbing, and sexual risk intentions.
Method:
Young adult female drinkers (N = 436) at elevated sexual risk were randomized to receive alcohol (target peak breath alcohol concentration = .10%) or no alcohol. They then read an eroticized sexual scenario and reported on their dissociation and emotional numbing experiences, unprotected sex refusal self-efficacy, and unprotected sex intentions.
Results:
Path analysis revealed that CSA was indirectly associated with increased unprotected sex intentions through increased ASA severity, increased trauma-related symptoms, increased emotional numbing, and decreased unprotected sex refusal self-efficacy. Further, alcohol intoxication was indirectly associated with increased unprotected sex intentions through increased emotional numbing and decreased unprotected sex refusal self-efficacy.
Conclusions:
Emotional numbing, but not dissociation, was associated with unprotected sex intentions and may be one potential target for interventions aimed at reducing HIV/STI-related risk among women with a history of sexual trauma.
Research indicates that childhood sexual abuse (CSA) produces lasting alterations in interpersonal relatedness, identity, and affect regulation, often referred to as self-capacity disturbance. CSA also has been shown to negatively impact sexual functioning. This study examined the role of altered self-capacities in mediating the relationship between CSA and sexual responses. Path analysis revealed that CSA was related to sexual anxiety and decreased sexual satisfaction through its association with reduced self-awareness and a propensity to be involved in difficult interpersonal relationships.
Interpersonal power. Who has it? Who doesn't have it? What happens when power is used to abuse? These are central questions for feminist psychology. Implicit in these considerations of power are questions of interpersonal trust and betrayal: who trusts whom, and why is trust required? What happens when trust is betrayed? How does interpersonal power influence interpersonal trust? How does a person respond when a more powerful person betrays? Interpersonal power, interpersonal trust and betrayal are also fundamental components of betrayal trauma theory (Freyd, 1994, 1996). Betrayal trauma theory addresses the motivations for, and mechanisms resulting in, amnesia for childhood abuse. In this article I will briefly summarize some aspects of betrayal trauma theory (focusing mostly on the motivations, not the mechanisms). I will then discuss some issues relevant to feminist psychology.
Women with a history of childhood sexual abuse (CSA) experience dissociative symptoms and sexual difficulties with greater frequency than women without a history of CSA. Current models of sexual dysfunction for sexual abuse survivors suggest that dissociation may mediate the relationship between CSA and sexual arousal difficulties. Dissociation, however, is often conceptualized as a single construct in studies of CSA and not as separate domains as in the dissociation literature. In the present study, women with (CSA, N = 37) and without (NSA, N = 22) a history of CSA recruited from the community were asked to indicate the frequency and intensity of their experience in two dissociation subgroups, derealization and depersonalization, during sex with a partner and in their daily life. Findings showed that, in the NSA group, more depersonalization during sex with a partner was associated with lower sexual arousal functioning. However, for both the NSA and CSA groups, more derealization during sex was associated with higher sexual arousal functioning. No measure of dissociation was significantly associated with sexual responses in the laboratory. These findings highlight the importance of distinguishing between different forms of dissociation (i.e., derealization and depersonalization) in the study of sexual arousal functioning. In addition, the findings challenge the notion that dissociation is a main predictor of sexual arousal problems in survivors of CSA and suggest that a more nuanced relationship may exist.
This article examines two models of the traumatic impact of child sexual abuse, the Post-Traumatic Stress Disorder Model and the Four Traumagenic Dynamics Model. PTSD, in spite of its salutary contributions, has three major problems when applied to sexual abuse. It fails to account for all the symptoms. It does not apply to all victims. And its explanation for the source of trauma does not fit with many types of sexual abuse. The alternative, Four Traumagenic Dynamics Model is more complex and accounts for more of the variety of effects. It posits four dynamics—traumatic sexualization, betrayal, stigmatization, and powerlessness—that cause trauma by distorting a child's self-concept, worldview, and affective capacities. The four dynamics are described, and are matched to specific symptoms that have been noted in the literature.
Across three studies, we demonstrate that pursuing sex for approach goals, such as to enhance intimacy, fuels satisfaction and pursuing sex for avoidance goals, such as to avoid disappointing a partner, detracts from satisfaction. In Study 1, we use hypothetical scenarios to provide experimental support for the associations between sexual goals and sexual and relationship satisfaction. In Study 2, a dyadic daily experience study of dating couples, we demonstrate that daily sexual goals are associated with both partners' daily relationship and sexual satisfaction. In Study 3, a dyadic daily experience study, we replicate the daily associations between sexual goals and satisfaction in a sample of long-term couples, and demonstrate that sexual goals impact partner's relationship and sexual quality 4 months later. In all studies, the associations between sexual goals and enhanced satisfaction as reported by both partners were mediated by sexual desire. Implications for research on sexual motivation and close relationships are discussed.
Context While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men. Objective To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders. Design Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults. Participants A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. Main Outcome Measures Risk of experiencing sexual dysfunction as well as negative concomitant outcomes. Results Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall wellbeing. Conclusions The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
Women with histories of child sexual abuse (CSA) are at risk for additional sexual trauma and disrupted interpersonal functioning. To date, however, little empirical attention has focused on CSA survivors' risk for nonviolent, unwanted sexual interactions with romantic partners or how such interactions impact adult sexual functioning. In the present study, women with CSA histories were expected to report more frequent sexual compliance with and post refusal sexual persistence from current romantic partners compared to other women. Both compliance and persistence, in turn, were expected to predict poorer sexual satisfaction. A sample of 173 young women in exclusive heterosexual relationships anonymously completed self-report measures of these constructs. About 24% of the sample reported CSA. As expected, past CSA predicted greater sexual compliance with partners and more frequent partner use of manipulation to persist in sexual contact after women's stated refusals. CSA, sexual compliance, and partner sexual manipulation each independently and negatively predicted women's sexual satisfaction. A more comprehensive understanding of the effects of CSA on adult sexual functioning may require broader conceptualizations of possible revictimization experiences that encompass both forcible assault and nonviolent, unwanted sexual encounters. (PsycINFO Database Record (c) 2010 APA )(chapter)
Objectives:
Systematic reviews on prevalence estimates of child sexual abuse (CSA) worldwide included studies with adult participants referring on a period of abuse of about 50 years. Therefore we aimed to describe the current prevalence of CSA, taking into account geographical region, type of abuse, level of country development and research methods.
Methods:
We included studies published between 2002 and 2009 that reported CSA in children below 18 years. We performed a random effects meta-analysis and analyzed moderator variables by meta-regression.
Results:
Fifty-five studies from 24 countries were included. According to four predefined types of sexual abuse, prevalence estimates ranged from 8 to 31 % for girls and 3 to 17 % for boys. Nine girls and 3 boys out of 100 are victims of forced intercourse. Heterogeneity between primary studies was high in all analyses.
Conclusions:
Our results based on most recent data confirm results from previous reviews with adults. Surveys in children offer most recent estimates of CSA. Reducing heterogeneity between studies might be possible by standardized measures to make data more meaningful in international comparisons.
Introduction:
The literature shows a discrepancy in the association between child sexual abuse (CSA) and adult sexual function. One of the proposed explanations for this discrepancy is the different ways in which CSA is assessed. While some studies explicitly ask potential participants whether they are sexual abuse survivors, others ask whether participants experienced specific unwanted sexual behaviors.
Aim:
This study investigated the differences between women who self-identified as CSA survivors, women who experienced similar unwanted sexual experiences but did not identify as CSA survivors (NSA), and women with no history of sexual abuse (control). CSA was defined as unwanted touching or penetration of the genitals before the age of 16.
Methods:
A sample of 699 college students anonymously completed a battery of questionnaires on sexuality and sexual abuse history.
Main outcome measures:
Sexual function was measured with the Female Sexual Function Index (FSFI), and sexual satisfaction was measured with the Sexual Satisfaction Scale-Women. History of CSA was measured with a modified version of Carlin and Ward's childhood abuse items.
Results:
Differences emerged between women who experienced sexual abuse before age 16 and women who never experienced sexual abuse (control) on the personal distress subscale of the Sexual Satisfaction Scale. The CSA group (N = 89) reported greater sexual distress compared to the NSA (N = 98) group, and the NSA group reported more distress than the control group (N = 512). No significant group differences were observed in the FSFI. Characteristics of the abuse that predicted whether women identified as CSA survivors included vaginal penetration, fear at the time of the abuse, familial relationship with the perpetrator, and chronic frequency of the abuse. These abuse characteristics were associated with sexual satisfaction but not with sexual function.
Conclusions:
Differences in levels of sexual satisfaction between women with and without a history of CSA were associated with the type of CSA definition adopted. It remains unexplained why the CSA group showed more personal distress about their sexuality but not more sexual dysfunction.
In this grounded theory study, a theoretical framework that depicts the process by which childhood sexual abuse (CSA) influences the sexuality of women and men survivors was constructed. Data were drawn from interview transcripts of 95 men and women who experienced CSA. Using constant comparison analysis, the researchers determined that the central phenomenon of the data was a process labeled Determining My Sexual Being, in which survivors moved from grappling with questions related to the nature, cause, and sexual effects of the abuse to laying claim to their own sexuality. Clinical implications are discussed.
The current article examines how close relationships combine with individual differences in sex motives (Cooper, Shapiro, & Powers, 1998) to shape sexual experience. We first provide an overview of the motivational approach as it relates to sexual behavior and then describe 2 broad mechanisms (1 transactional, the other interactional) by which motives and relational context combine to shape behavior. Drawing on our past research, we review evidence showing that people select relationship contexts based partly on their motives and that these contexts in turn shape future motives and behavior; that partner motives shape sexual experience above and beyond one's own motives; and that both the broader relationship context and partner motives moderate the effects of one's own motives on sexual experience. We conclude that the nature of motivational pursuits cannot be adequately understood in the abstract, but rather we must take into account the relational context in which one's needs are pursued.
Accumulating evidence points to the mediating effects of sexual self-schemas on the sexual difficulties of women with a history of childhood sexual abuse (CSA). The following study adds to the extant literature by investigating (1) sexual function and (2) sexual satisfaction utilizing validated measures, and reporting on the relationship between sexual self-schemas and physiological (vaginal photoplethysmography), subjective, and affective responses during laboratory exposure to sexual stimuli. In a community sample of women with (N = 48) and without (N = 48) a history of CSA, we tested (1) the mediation of negative affect on the relation between sexual self-schemas and sexual function/satisfaction, (2) the mediation of negative affect in the relation between CSA and sexual function/satisfaction, and (3) the mediation of sexual self-schemas in the relation between a history of CSA and negative affect prior to sexual stimuli. We found that more Embarrassed/Conservative and less Romantic/Passionate sexual self-schemas predicted negative affect prior to exposure to sexual stimuli which, in turn, predicted levels of sexual satisfaction. The lower sexual satisfaction of CSA survivors was partially mediated by higher reports of negative affect prior to sexual stimuli. However, negative affect prior to sexual stimuli was not mediated by the sexual self-schemas of CSA survivors. Thus, although sexual self-schemas predicted sexual satisfaction, they did not predict variance in negative affect prior to sexual videos experienced by women with a history of CSA.
The current study examined emotion dysregulation as a mechanism underlying risky sexual behavior and sexual revictimization among adult victims of child sexual abuse (CSA) and child physical abuse (CPA).
Participants were 752 college women. Victimization history, emotion dysregulation, and risky sexual behavior were assessed with anonymous, self-report surveys utilizing a cross-sectional design.
Approximately 6.3% of participants reported CSA, 25.5% reported CPA, and 17.8% reported rape during adolescence or adulthood. CSA and CPA were associated with increased risk for adolescent/adult rape; 29.8% of CSA victims and 24.3% of CPA victims were revictimized. Path analytic models tested hypothesized relationships among child abuse, emotion dysregulation, adolescent/adult rape and three forms of risky sexual behavior (e.g., failure to use condoms, contraception, or having sex with someone under the influence of alcohol/drugs), including frequency of risky sexual behavior with a regular dating partner, with a stranger, and lifetime number of intercourse partners. Emotion dysregulation mediated revictimization for both CSA and CPA. Emotion dysregulation also predicted lifetime number of sexual partners and frequency of risky sex with a stranger, but not frequency of risky sex with a regular dating partner.
Findings suggest that emotion dysregulation is a distal predictor, and risky sex, particularly with lesser known partners, is a proximal predictor of sexual revictimization. Because emotion dysregulation also maintained a significant direct path to revictimization, risky sexual behavior appears to be one of several proximal risk factors for revictimization.
Findings confirm that emotion dysregulation is a critical pathway to more proximal risk factors such as risky sexual behavior, and suggest that clinical interventions aimed at improving emotion dysregulation may help reduce risky sexual behavior and risk for revictimization.
Past research suggests that sexual satisfaction may be partially dependent on sexual motives (the reasons people have sex). The primary goal of this study was to determine which of a wide range of empirically derived sexual motives were related to sexual satisfaction, and whether gender differences existed in these relationships. Examining data from 544 undergraduate participants (93 men, 451 women), we found that certain types of motives predicted levels of sexual satisfaction for both genders. However, a greater number of motive categories were related to satisfaction for women than for men, and sexual motives were a more consistent predictor of satisfaction in general for women than for men. We also found that empirical categories of motives predicted more variance in satisfaction ratings than did previously used theoretical categories. These findings suggest that a wide range of sexual motives are related to sexual satisfaction, that these connections may be moderated by gender, and that empirically-constructed categories of motives may be the most effective tool for studying this link.
The purpose of the present article was to systematically review the literature investigating the long-term physical health consequences of childhood sexual abuse (CSA).
Literature searches yielded 31 studies comparing individuals with and without a history of CSA on six health outcomes: general health, gastrointestinal (GI) health, gynecologic or reproductive health, pain, cardiopulmonary symptoms, and obesity. Exploratory subgroup analyses were conducted to identify potential methodological moderators.
Results suggested that a history of CSA was associated with small to moderate group differences on almost all health outcomes assessed, such that individuals with a history of CSA reported more complaints for each health outcome. Suggestive trends in moderating variables of study design and methodology are presented.
Results highlight the long-term physical health consequences of CSA and identify potential moderators to aid in the design of future research.
Studies conducted internationally confirm that child sexual abuse is a much more widespread problem than previously thought, with even the lowest prevalence rates including a large number of victims that need to be taken into account.
To carry out a meta-analysis of the prevalence of child sexual abuse in order to establish an overall international figure.
Studies were retrieved from various electronic databases. The measure of interest was the prevalence of abuse reported in each article, these values being combined via a random effects model. A detailed analysis was conducted of the effects of various moderator variables.
Sixty-five articles covering 22 countries were included. The analysis showed that 7.9% of men (7.4% without outliers) and 19.7% of women (19.2% without outliers) had suffered some form of sexual abuse prior to the age of eighteen.
The results of the present meta-analysis indicate that child sexual abuse is a serious problem in the countries analysed.
Studies have reported high rates of childhood abuse in people with psychiatric illness. This study examined whether dissociative symptoms are specific to patients with histories of abuse. Ninety-eight female psychiatric inpatients completed self-report instruments that focused on childhood history of trauma, dissociative symptoms, and psychiatric symptoms in general. Sixty-three percent of the subjects reported physical and/or sexual abuse. Eighty-three percent had dissociative symptom scores above the median score of normal adults, and 24% had scores at or above the median score of patients with posttraumatic stress disorder. Subjects with a history of childhood abuse reported higher levels of dissociative symptoms than those who did not.
Background
Despite the fact that childhood sexual abuse can affect a survivor's sexual functioning in adulthood, few studies have examined survivors' adult sexual functioning from the perspective of attachment theory.
Aim
The present study sought to examine how sexual abuse in childhood might shape the associations between attachment insecurities and sexual functioning among adults.
Methods
The study sample consisted of 265 participants (166 women and 99 men), 45 (16.9%) of whom were classified as survivors of childhood sexual abuse. Participants completed an online questionnaire about their history of childhood sexual abuse, attachment insecurities, and sexual functioning over the past 6 months.
Outcomes
The findings of the present study suggest that attachment insecurities may have unique implications for sexual functioning among survivors of childhood sexual abuse.
Results
Findings indicated that a history of childhood sexual abuse significantly moderated the associations between attachment insecurities and sexual functioning. Whereas the effect of attachment avoidance in predicting sexual desire was not significant among nonabused participants, it was significant among survivors; specifically, higher levels of attachment avoidance predicted lower levels of sexual desire. A different pattern was found for attachment anxiety. Although attachment anxiety did not predict vaginal lubrication/penile erection among nonabused participants, it had significant effects among survivors; specifically, higher levels of attachment anxiety predicted higher levels of vaginal lubrication/penile erection.
Clinical Translation
Findings from the present study may help facilitate sex therapy interventions for childhood sexual abuse survivors, from an attachment theory perspective.
Strengths & Limitations
The study included a nonclinical, convenience sample and used self-report measures, which are highly subjective and increase the possibility of social-desirability biases. However, on the plus side, it relied on simple, short, self-report questionnaires that are accessible and can be easily used by professionals to examine a survivor's current condition relative to any of the variables, establish intervention goals, and evaluate treatment.
Conclusion
A history of childhood sexual abuse is related to 2 opposite patterns of association between attachment insecurity (depending on type) and sexual functioning.
Gewirtz-Meydan A, Lahav Y. Sexual Functioning Among Childhood Sexual Abuse Survivors From an Attachment Perspective. J Sex Med 2020;XX:XXX–XXX.
Rape survivors engage in more risky sexual behavior and report more sexual dissatisfaction and dysfunction than those without a rape history. However, little research has examined possible mechanisms to explain the relation between rape and sexual health outcomes. Therefore, the current study examined sexual motives as one mechanism to explain why survivors engage in more risk behavior and report lower sexual satisfaction. We hypothesized that rape survivors would be more likely to report engaging in sex for a variety of potentially maladaptive motives, including to reduce their negative affect, improve their self-esteem, and obtain approval or avoid censure from their peers and sexual partners. Engaging in sex for these reasons was then hypothesized to mediate the relation between rape history and sexual risk behavior as well as sexual satisfaction. These hypotheses were tested among 1,534 sexually active college women. Results supported that all four sexual motives mediated the relation between rape history and risky sexual behavior and sexual satisfaction. In both cases, the size of the standardized indirect effect was larger for the models including the two affect regulation motives as mediators, as compared to the models including peer and partner approval motives as mediators. Thus, survivors who endorse affect regulation motives for sex are more likely to engage in risky sexual behavior and more likely to report feeling dissatisfied with their sex lives. This suggests that sexual motives may be an important area to target for future sexual health research and intervention programs targeting survivors.
Childhood sexual abuse (CSA) poses a risk for sexual revictimization.
Additionally, according to theory CSA may lead to
identification with the aggressor, expressed by adopting the
perpetrator’s experience concerning the abuse; identifying
with the perpetrator’s aggression; replacing one’s agency
with that of the perpetrator; and becoming hyper-sensitive to
the perpetrator. Although clinical impressions suggest that
identification with the aggressor underlies reenactment of
trauma, this linkage between identification with the aggressor
and sexual revictimization remains largely uninvestigated. This
study assessed (a) the relationship between identification with
the aggressor (total score and four subscales) and sexual revictimization;
(b) the unique associations between identification
with the aggressor (total score and four subscales) and sexual
revictimization, above and beyond chronicity of abuse and
PTSD symptoms. Participants were Israeli women students
who reported a history of CSA (n = 174). Analyses indicated
significant correlations between two subscales of identification
with the aggressor – replacing one’s agency with that of the
perpetrator and becoming hyper-sensitive to the perpetrator –
and sexual revictimization. These subscales of identification
with the aggressor were associated with sexual revictimization,
above and beyond the effects of chronicity of the abuse and
PTSD symptoms. Nevertheless, these associations were in
opposite directions – while replacing one’s agency with that
of the perpetrator was related with higher occurrence of sexual
revictimization, becoming hyper-sensitive to the perpetrator
was related with lower levels of revictimization. These results
imply that identification with the aggressor may serve as
a multifaceted phenomenon in the context of sexual revictimization,
comprised of both adaptive and maladaptive aspects.
Childhood abuse and neglect are associated with dissociative symptoms in adulthood. However, empirical studies show heterogeneous results depending on the type of childhood abuse or neglect and other maltreatment characteristics. In this meta-analysis, we systematically investigated the relationship between childhood interpersonal maltreatment and dissociation in 65 studies with 7352 abused or neglected individuals using the Dissociative Experience Scale (DES). We extracted DES-scores for abused and non-abused populations as well as information about type of abuse/neglect, age of onset, duration of abuse, and relationship to the perpetrator. Random-effects models were used for data synthesis, and meta-regression was used to predict DES-scores in abused populations from maltreatment characteristics. The results revealed higher dissociation in victims of childhood abuse and neglect compared with non-abused or neglected subsamples sharing relevant population features ( MAbuse = 23.5, MNeglect = 18.8, MControl = 13.8) with highest scores for sexual and physical abuse. An earlier age of onset, a longer duration of abuse, and parental abuse significantly predicted higher dissociation scores. This meta-analysis underlines the importance of childhood abuse/neglect in the etiology of dissociation. The identified moderators may inform risk assessment and early intervention to prevent the development of dissociative symptoms.
Childhood sexual abuse (CSA) is associated with multiple negative outcomes, including increased risky sexual behavior. To date, the majority of research on the relationship between CSA and risky sex in adolescence has been limited, with a lack of focus on males and youth receiving child welfare services. Participants in the current study were 297 youth (mean age = 15.98; SD = 1.01, 57.6% female) from the child welfare system who reported being sexually active at the time of the survey. CSA was associated with severity of other types of maltreatment for both genders, and exposure to intimate partner violence for females only. In general, males engaged in more sexual risk behaviors than females. Males with CSA had stronger motives to have sex for: (1) coping, (2) peer approval and (3) partner approval, as compared to non-CSA males; as well as (4) greater motives for partner and peer approval compared to females with CSA. Males with no CSA had stronger sexual motives for enhancement (e.g., feeling pleasure) compared to females with no CSA. Mediation analyses revealed a significant indirect effect for coping motives for males: CSA was associated with increased motives to use sex for coping which was associated with increased sexual risk-taking. These findings provide important information regarding the relationship between CSA and sexual risk-taking for child welfare sample and highlight coping with negative affect as a potential mechanism that underlies the CSA-risky sex relationship. It also encourages further consideration of motives for risk and resilience behaviors among youth.
Betrayal traumas (Freyd, 1996), abuses that violate trust or dependency, predict numerous negative outcomes, including dissociation and revictimization (DePrince & Freyd, 2007; Gobin & Freyd, 2009; Goldsmith, Freyd, & DePrince, 2012). No previous empirical research examines the relation between betrayal and sexual health, including dissociation during sex. This article addresses this gap with 2 studies, which provide support for a multiple mediation model where high betrayal in childhood predicts worsened sexual communication in adulthood through trait dissociation and sexual dissociation in serial. In both studies, the direct path between betrayal and sexual communication was nonsignificant; only when accounting for trait dissociation overall and sexual dissociation in particular does childhood betrayal predict diminished communication with sex partners in adulthood.
Previous correlational research has demonstrated an association between people's reasons for having sex (i.e., their sexual goals) and their sexual desire and sexual and relationship satisfaction. Across two studies of people in romantic relationships (N = 396) we extend previous research and demonstrate, for the first time, that manipulating the salience of approach sexual goals (i.e., engaging in sex to pursue positive outcomes, such as enhanced intimacy) compared to avoidance sexual goals (i.e., engaging in sex to avert negative outcomes, such as a partner's disappointment) or a control condition leads people to feel higher sexual desire for their romantic partners and to report higher sexual and relationship satisfaction. In addition, in Study 2 we demonstrate that focusing on approach sexual goals over the course of a week leads people to report more satisfying sexual experiences during that week, as well as higher desire and overall relationship satisfaction, compared to a control group. The current findings advance approach-avoidance theory by providing evidence that it is possible to manipulate people's sexual goals and, in turn, impact their feelings of desire and satisfaction. Results are promising for the development of interventions to promote sexual and relational well-being.
A thematic analysis of the reported experiences of childhood sexual abuse (CSA) survivors in disclosing their CSA history to romantic partners was completed with the goal of learning about the experience of their disclosure and to consider role partners may play in the disclosure experiences of CSA survivors. Transcripts of 19 survivors were analyzed using a standard thematic analysis methodology. Two global themes emerged; Reasons for Disclosing, Impact of Response and these were highly interrelated by shame. A preliminary theory of disclosing to romantic partners was posited.
Previous research indicates that women with sexual problems may have different reasons for engaging in sex than women who are not experiencing sexual problems. The current study investigated whether reasons for sex differed by women reporting high versus low overall sexual functioning, as assessed by the FSFI. As low desire and inability to achieve orgasm are the two most commonly reported sexual problems for women, the study also investigated whether women with and without problems specifically related to sexual desire or orgasm cited different reasons for sex. The sample was comprised of 446 heterosexual women between the ages of 18 and 61 who completed an online questionnaire assessing reasons for sex and sexual functioning. Women with low sexual functioning overall were more likely to endorse insecurity reasons for sex, while women with high sexual functioning overall were more likely to endorse physical reasons for sex. Women experiencing low desire specifically were less likely to endorse emotional and physical reasons for sex than women without desire difficulties. Women experiencing orgasm difficulties specifically were more likely to endorse insecurity reasons for sex than women without orgasm difficulties. The variance accounted for was low in all cases. This research offers insights into the important but limited role sexual functioning may play in the broader context of women's sexual motivations.
This study examined influences of alcohol intoxication, attentional control, and CSA severity on sex-related dissociation. Sex-related dissociation is defined here as dissociation (e.g., feeling as if the world is unreal and feeling disconnected from one's body) during sexual activity or in the presence of sexual stimuli. Women (N = 70) were randomized to a 2 (alcohol condition: none, .10% peak breath alcohol concentration) x 2 (attentional control instructions: none, "relax and maximize" sexual arousal) experiment and exposed to sexual stimuli. Alcohol intoxication was positively associated with sex-related dissociation. CSA severity and sex-related dissociation were positively associated in the no instruction condition but not in the "relax and maximize" condition. For some women, efforts to relax and maximize sexual arousal may buffer the association between CSA and sex-related dissociation.
Although having a sexual victimization history is associated with engaging in sexual risk behavior, the mechanisms whereby sexual victimization increases risk behavior are unclear. This study examined use of sex as an affect regulation strategy as a mediator of the relationship between
depressive symptoms and sexual risk behavior among 1,616 sexually active college women as well as examined having a history of child sexual abuse (CSA), adolescent/adult sexual assault (ASA), or both (CSA/ASA) as moderators. Results supported the mediated model as well as moderated mediation,
where depressive symptoms were more strongly associated with use of sex as an affect regulation strategy among ASA victims, and sex as an affect regulation strategy was more strongly related to sexual risk behavior for CSA/ASA victims.
The New View recognizes that people may be dissatisfied with any emotional, physical or relational aspect of sexual experience and thus invites men and women with abuse histories to discuss sexual issues that are distressing. There are numerous pathways by which child sexual abuse (CSA) can lead to sexual dissatisfaction in adulthood. In addition to those outlined by learning theory and trauma formulations, the New View adds several important and hitherto neglected paths: anxiety about being `normal' or living up to perceived cultural standards, power imbalance in the sexual relationship, stress (because of the consequences of low socioeconomic status), and limited access to both quality health care and sexual information. Assessment of both sexual difficulties and treatment must address these kinds of economic, social and relational factors. How the New View contributes to our ability to understand and treat the sexual concerns of men and women with histories of childhood sexual abuse will be presented in this article and illustrated with clinical case material.
Research shows that many adult sexual behaviors may be related to childhood sexual abuse (CSA), ranging from withdrawal and dysfunction on one end of the spectrum to hypersexuality and compulsion on the other, but it is unclear why some individuals respond to CSA by withdrawal, fear and anxiety, while others respond with impulsiveness and acting-out behavior. This literature review finds that there are two distinct factors which account for differences in sexual behavior among adult survivors of CSA: (a) the gender of the victim, and (b) the age at onset of victimization. Based on this data, an integrative framework is proposed, incorporating elements of social learning theory and psychoanalytic concepts, to explain the etiology of problematic adult sexual behaviors, as well as corresponding implications for clinical treatment.
Despite the fact that humans have a deep motivation to pursue and maintain close relationships, little research has examined social relationships from a motivational perspective. In the current paper, we argue that any model of close relationships must simultaneously account for people’s tendencies to both approach incentives and avoid threats in close relationships. To that end, we review research stemming from Gable’s (2006) social and relationship model of motivation on both the antecedents and the consequences of approach and avoidance goal pursuit in the context of close relationships. We conclude with recommendations for future research in this area.
This research provides the first empirical investigation of how approach and avoidance motives for engaging in sex in intimate relationships are associated with personal well-being and relationship quality. A 2-week daily experience study of college student dating couples tested specific predictions from the theoretical model and included both longitudinal and dyadic components. Whereas approach sex motives were positively associated with personal and interpersonal well-being, avoidance sex motives were negatively associated with well-being. Engaging in sex for avoidance motives was particularly detrimental to the maintenance of relationships over time. Perceptions of a partner's motives for sex were also associated with well-being. Implications for the conceptualization of sexuality in relationships along these two dimensions are discussed.
The study examined whether and how characteristics of childhood sexual abuse and disclosure influenced three dimensions of
psychosexual functioning—emotional, behavioral and evaluative—during adulthood. The sample included 165 adults who were sexually
abused as children. The General Estimating Equation was used to test the relationship among the predictors, moderators and
five binary outcomes: fear of sex and guilt during sex (emotional dimension), problems with touch and problems with sexual
arousal (behavioral), and sexual satisfaction (evaluative). Respondents who were older when they were first abused, injured,
had more than one abuser, said the abuse was incest, and told someone about the abuse were more likely to experience problems
in at least one area of psychosexual functioning. Older children who told were more likely than younger children who told
to fear sex and have problems with touch during adulthood. Researchers and practitioners should consider examining multiple
dimensions of psychosexual functioning and potential moderators, such as response to disclosure.
KeywordsSexual functioning-Child sexual abuse-Adult survivors-GEE
Little attention has been given to the occurrence of dissociative symptoms during sexual behavior in adults who have experienced childhood sexual abuse (CSA). For this study, 57 adults living with HIV infection who had experienced CSA and were entering a treatment study for traumatic stress completed study assessments and clinical interviews, including a 15-item scale of dissociative experiences during sexual behavior. Predictor variables included Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnoses of posttraumatic stress disorder (PTSD) and dissociative disorders, rape by an intimate partner, duration of CSA, number of perpetrators of CSA, and current sexual satisfaction. A multiple regression analysis was conducted to identify significant associations between predictors and dissociation during sex. Mean differences by clinical diagnosis were also examined. Results indicated that PTSD, dissociative disorders, rape by an intimate partner, duration of CSA, and number of perpetrators of CSA were associated with increased dissociation during sexual behavior. Dissociation during sex likely increases vulnerability to sexual revictimization and risky sexual behavior. Standard behavioral prevention interventions may be ineffective for sexual situations when dissociation occurs, and prevention efforts should be integrated with mental health care for those who have experienced CSA.
Objectives:
To examine the prevalence of childhood maltreatment and adult revictimization in migraineurs and the association with sociodemographic factors, depression and anxiety.
Background:
Population and practice-based studies have demonstrated an association of childhood abuse and headache in adults, although further details on headache diagnoses, characteristics, and comorbid conditions are lacking. There are mounting data suggesting substantial impact of early maltreatment on adult physical and mental health.
Methods:
Electronic surveys were completed by patients seeking treatment in 11 headache centers across the United States and Canada. Physicians determined the primary headache diagnoses based on the International Classification of Headache Disorders-2 criteria and average monthly headache frequency. Self-reported information on demographics (including body mass index), social history, and physician-diagnosed depression and anxiety was collected. The survey also included validated screening measures for current depression (Patient Health Questionnaire-9) and anxiety (The Beck Anxiety Inventory). History and severity of childhood (<18 years) abuse (sexual, emotional, and physical) and neglect (emotional and physical) was gathered using the Childhood Trauma Questionnaire. There were also queries regarding adult physical and sexual abuse, including age of occurrence. Analysis includes all persons with migraine with aura, and migraine without aura.
Results:
A total of 1348 migraineurs (88% women) were included (mean age 41 years). Diagnosis of migraine with aura was recorded in 40% and chronic headache (>or=15 days/month) was reported by 34%. The prevalence of childhood maltreatment types was as follows: physical abuse 21%, sexual abuse 25%, emotional abuse 38%, physical neglect 22%, and emotional neglect 38%. Nine percent reported all 3 categories of childhood abuse (physical, sexual, and emotional) and 17% reported both physical and emotional neglect. Overlap between maltreatment types ranged between 40% and 81%. Of those reporting childhood abuse, 43% reported abuse in adulthood, but infrequently (17%) over the age of 30 years. In logistic regression models adjusted for sociodemographic variables, current depression was associated with physical (P = .003), sexual (P = .007), and emotional abuse (P < .001), and physical and emotional neglect (P = .001 for both). Current anxiety was also associated with all childhood abuse and neglect categories (P < .001 for all). A graded relationship was observed between the number of childhood maltreatment types and remote or current depression and anxiety. In adjusted logistic regression analysis, migraineurs reporting 3 or more categories of childhood trauma were more likely to have received diagnoses of both depression and anxiety (odds ratios [OR] = 6.91, 95% confidence interval [CI]: 3.97-12.03), or either depression or anxiety (OR = 3.66, 95% CI: 2.28-5.88) as compared with those without childhood abuse or neglect.
Conclusion:
Reports of childhood maltreatment, especially emotional abuse and neglect, are prevalent in outpatients with migraine. There is extensive overlap of maltreatment types and a high rate of revictimization in adulthood. All types of childhood abuse and neglect are strongly associated with remote and current depression and anxiety, and the relationship strengthens with an increasing number of maltreatment types.
Religious beliefs are among the many factors that determine whether sexually dysfunctional persons will seek out a sex therapist. These beliefs may also generate resistance to therapy or influence patients to drop out of treatment before it is complete. Therapists who are sensitive to patients' religious beliefs enhance the likelihood of a successful treatment process. The authors present six case examples from their practice in which religious beliefs played an important role. They urge sex therapists to become more aware of the religious dynamic and to help address the paucity of clinical case material in the literature.