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Assessing historical abuse allegations and damages
Abstract
Practitioners may be called upon to assess adults who have alleged child abuse as a minor and are seeking reparations. Such assessments may be used by the courts to determine harm and assess damages related to their claim or testimony. Our clinical/research team has conducted many such evaluations and reported the findings pertaining to the psychological harm stemming from historical abuse in published studies. We use the opportunity provided by this new section on Practical Strategies to describe the role of the assessor, and to provide details concerning our methods for preparing these assessments and reporting the findings for the purpose of civil or criminal actions. Specific recommendations for wording of written reports are provided.
... They are asked to provide opinions to assist the trier of fact to determine (a) the nature and severity of the plaintiff's psychological injuries; (b) related impairment; (c) the evolution of the plaintiff's functioning over time including pre-morbid functioning; (d) the relationship between the plaintiff's current mental health condition and the defendant's alleged wrong-doing; (e) the likely prognosis, and recommendations for treatment (Piechowski-Drago, 2020;Wygant & Lareau, 2015). These assessments require the careful consideration of a multitude of factors across a plaintiff's entire developmental trajectory (Barnes & Josefowitz, 2014a, b;Wolfe et al., 2010). ...
... The plaintiff's peritraumatic and posttraumatic reactions during and immediately following the alleged abuse must be examined and a chronology of their academic, vocational, relational, physical, and psychological functioning should be explored in order to evaluate the impact of the alleged abuse on these domains (Barnes & Josefowitz, 2014b). Ultimately, evaluators are tasked with providing opinions about the nature and severity of the psychological injuries and functional consequences of the historical abuse, and also must render an opinion about causation, i.e., the degree to which the event that is the basis of legal action contributed to the plaintiff's symptoms and impairments (Wolfe et al., 2010). These evaluations are made more challenging when abuse occurred decades earlier, due to the impact of subsequent trauma and life events, and reduced availability of collateral information. ...
... Plaintiffs being assessed for harms related to childhood abuse can be particularly vulnerable (Wolfe et al., 2010) . These individuals commonly experience difficulties with trusting, especially people in authority. ...
The COVID-19 pandemic has brought to the fore the question of whether psycho-legal assessments can be executed remotely in a manner that adheres to the rigorous standards applied during in-person assessments. General guidelines have evolved, but to date, there are no explicit directives about whether and how to proceed. This paper reviews professional, ethical, and legal challenges that experts should consider before conducting such an evaluation remotely. Although the discussion is more widely applicable, remote forensic psychological assessment of adults alleging childhood abuse is used as an example throughout, due to the complexity of these cases, the ethical dilemmas they can present, and the need to carefully assess non-verbal trauma-related symptoms. The use of videoconferencing technology is considered in terms of potential benefits of this medium, as well as challenges this method could pose to aspects of interviewing and psychometric testing. The global pandemic is also considered with respect to its effects on functioning and mental health and the confounding impact such a crisis has on assessing the relationship between childhood abuse and current psychological functioning. Finally, for those evaluators who want to engage in remote assessment, practice considerations are discussed.
... The broad literature demonstrates that individuals who have experienced trauma can be prone to emotional dysregulation and can be at higher risk for self-harm and suicide (Wolfe et al., 2010), which can be a risk during the FMHA process. Although FMHA is not intended to be therapeutic, this goal of avoiding activation to the point of decompensation and/or re-traumatization is in keeping with American Psychological Association's (APA, 2016) code of ethics, which emphasize beneficence and non-maleficence, and respect for people's rights, dignity, and safety. ...
Institutional abuse of children (IA-C) is a significant social problem that can have deleterious life-long consequences for survivors. This abuse occurs in settings including but not limited to sports organizations, religious institutions, schools, recreational settings, and foster care. A number of jurisdictions in Commonwealth countries and the United States have dropped or amended the statute of limitations for plaintiffs to bring forward claims related to institutional abuse. This means that mental health professionals are increasingly being retained as experts to assess adult plaintiffs seeking remedy for childhood abuse that occurred in the context of institutions decades prior. This article first reviews some of the distinct harms that can arise from IA-C. We suggest how a trauma-informed approach could be applied to these assessments with respect to an evaluator’s interpersonal stance and assessment procedures. We also discuss interpretive considerations related to psychological testing and diagnoses. Finally, we discuss challenges in rendering opinions related to causality and suggest ways that evaluators can systematically consider a plaintiff’s developmental trajectory in order to weigh in about the impact of this phenomenon.
... Trauma survivors can be prone to emotional dysregulation and are at higher risk for self-harm and suicide (Wolfe et al., 2010). A question arises about whether and how to intervene if an examinee becomes significantly dysregulated during a FMHA. ...
The need for trauma-informed practice is well recognized across mental health and legal settings; however, relatively little has been written about its application in forensic mental health assessment. This article focuses on trauma-informed assessment of criminal justice involved individuals, given the high rates of trauma exposure and related sequelae in this population. A trauma-informed lens allows forensic mental health examiners to assess examinees in the context of their developmental histories and lived experience. Such a lens also has implications for the entire assessment process in terms of interviewing, psychological testing, diagnostic conclusions, feedback, and the provision of testimony and educating triers of fact. Being adequately compassionate is not only ethical, but also likely to enhance data quality. We identify tensions with respect to maintaining the role clarity necessary for forensic practice, and examiner self-awareness is discussed as a way to manage emotional reactions and to reduce bias and role conflict. We examine these issues through the framework of therapeutic jurisprudence; the principles of this framework and trauma-informed forensic mental health assessments are aligned and could (and should) synergistically lead to important changes to psycho-legal practice.
Psychologists are frequently retained to assess adult plaintiffs seeking remedy for harms stemming from childhood abuse. Interpersonal traumas that occur during formative periods in childhood and adolescence can leave a complicated legacy. Biologically, childhood abuse can affect brain development and functioning across the lifespan and can lead to altered states of arousal during assessments. Psychologically, this abuse can lead to complex symptom presentations that do not always fit squarely into current diagnostic nosologies. Interpersonally, the legacy of childhood abuse can lead to distrust of people in positions of power that can extend toward forensic mental health professionals, requiring skillful navigation by the evaluator during assessments. This chapter discusses the biopsychosocial impacts of childhood abuse and the utility of using a trauma-informed approach to assessment. Recommendations are made with respect to procedural and interpersonal aspects of the assessment and considerations when formulating opinions on causality.
The need for trauma-informed practice is well recognized across mental health and legal settings; however, relatively little has been written about its application in forensic mental health assessment. This paper focuses on trauma-informed assessment of criminal justice involved individuals, given the high rates of trauma exposure and related sequelae in this population. A trauma-informed lens allows forensic mental health examiners to assess examinees in the context of their developmental histories and lived experience. Such a lens also has implications for the entire assessment process in terms of interviewing, psychological testing, diagnostic conclusions, feedback, and the provision of testimony and educating triers of fact. Being adequately compassionate is not only ethical, but also likely to enhance data quality. We identify tensions with respect to maintaining the role clarity necessary for forensic practice and examiner self-awareness is discussed as a way to manage emotional reactions and to reduce bias and role conflict. We examine these issues through the framework of therapeutic jurisprudence; the principles of this framework and trauma-informed forensic mental health assessments are aligned and could (and should) synergistically lead to important changes to psycho-legal practice.
In deze studie worden de meldingen over seksueel misbruik van pleegkinderen in pleeggezinnen geanalyseerd, die binnenkwamen bij de commissie-Samson. Doel was om misbruik in pleeggezinnen uit het (nabije) verleden te onderzoeken (periode 1945-2010). De onderzoeksvragen betroffen de context van uithuisplaatsing, aard en ernst van het misbruik, hoe pleegkinderen overleefden en bij wie ze het misbruik konden melden. Er werd een kwalitatieve inhoudsanalyse gemaakt van 140 meldingen over 149 slachtoffers. De resultaten lieten zien dat de context van uithuisplaatsing vooral werd bepaald door problemen bij de ouder of opvoeder(s). Het seksueel misbruik werd door veel slachtoffers ervaren als ernstig. De dader was vaak de pleegvader en de seksuele handelingen waren intrusief. Pleegkinderen overleefden vooral door middel van passieve strategieën. Vele slachtoffers meldden niets over het misbruik als kind. Vanaf de jaren tachtig werd meer gevolg gegeven aan meldingen en steeg het aantal aangiften bij politie en justitie. Deze studie geeft een eerste inzicht in het fenomeen ‘seksueel misbruik van pleegkinderen in pleegzorg’. Meer studies zijn nodig, in het bijzonder over karakteristieken van daders en gezinnen en gezinsprocessen en -dynamieken.
This text will consider the impact of maltreatment on the developing child and youth in terms of psychopathology, as well as treatment and prevention practices. We will overview the epidemiology, definition, and etiology of maltreatment. From the collective clinical experiences of the authors, clinical manifestations and case examples are described, although some aspects of the descriptive details have been altered. The aim of this book is to provide an evidence-based discussion of the key clinical realities in working with children and youth with a background of childhood maltreatment. Intervention directed at their caregivers and at the adult partnership system are important arms of an overall intervention package. This text, however, will deal primarily with knowledge directly related to child and youth victimization and intervention. We limit our discussion of maltreatment-related intervention to those cases in which only the parent is the intervention target. Unfortunately, professionals have learned little about maltreating parents to prevent recidivism. Earlier reviews identified cognitive behavioral parent training as the most promising intervention (see Wolfe & Wekerle, 1993). This book reviews parent-focused intervention primarily from a prevention model and highlights the most promising programs of service delivery. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This article examines psychometric characteristics of the 100-item Trauma Symptom Inventory (TSI) in a sample of 370 psychiatric inpatients and psychotherapy outpatient men and women. The 10 clinical scales of the TSI had a mean α of .87, with αs ranging from .74 for Tension Reduction Behavior to .90 for both Depression and Intrusive Experiences. A self-reported history of interpersonal trauma (in child- or adulthood) was associated with elevations on all TSI scales relative to those not reporting victimization. Post hoc multiple regression analyses indicated that client age, sex, inpatient versus outpatient status, childhood sexual and physical abuse, and adult sexual assault were unique predictors of various TSI raw scale scores. Sex interacted with other predictors in several instances; women with sexual- or physical-assault histories scored higher on Depression and Intrusive Experiences, and men battered in a relationship scored higher on Sexual Concerns and Dysfunctional Sexual Behavior.
This commentary on the article by Sbraga and O'Donohue (2003, this issue) discusses the proper role of expert testimony in relation to child sexual abuse in criminal and civil proceedings, the use of opinion evidence in court, and the specific role of mental health experts. We argue that, due to faulty assumptions about the role of mental health experts in the courtroom, much of the information in the article is misleading. Mental health experts would not, ethically or legally, be permitted to offer an opinion (post hoc or otherwise) as to whether or not someone had been sexually abused. Rather, their appropriate role is to offer sound scientific and clinical opinion on the consistency and/or inconsistency of presenting symptoms, complaints, and/or behavior patterns relating to child sexual abuse in order to educate or inform the court. Expert witnesses are distinct from other witnesses (e.g., victim advocates, therapists) and must offer unbiased and objective information that does not usurp the role of the trier of facts.
Although child abuse by family members has received considerable scientific and professional attention, knowledge on the impact of abuse committed by perpetrators in (nonfamilial) community organizations and institutions is lacking. We present a conceptual framework derived from child abuse studies, the authors’ collective clinical experience with adult survivors of nonfamilial abuse, and two independent panels of abuse survivors, practitioners, and researchers familiar with the impact of such abuse. The framework identifies abuse-related factors that contribute to harmful outcomes, and dimensions of harm associated with such acts. Implications of the conceptual framework are discussed in relation to professional education and practice guidelines, policy and prevention initiatives, and research needs.
This study was designed to examine predictors of psychopathology in non-clinically referred, sexually abused (SA) children, ages 6-16 years, 30-60 days following abuse disclosure and termination.
Eighty SA children were administered a structured diagnostic interview and a variety of rating-scale instruments. Several forms of psychopathology were assessed, including posttraumatic stress, global functioning, anxiety, depression, and externalizing behavior. Abuse interviews also were used to guide the collection of demographic (victim age, gender) and abuse-related information (e.g., frequency of abuse).
Abuse-related factors and demographic variables accounted for greater than half of the variance predicting global functioning, and accurately predicted posttraumatic stress disorder (PTSD) status for 86% of the participants. Also, analyses yielded significant predictors of parent-reported attention problems and sexual behavior. Of additional importance, none of the abuse-related and demographic variables predicted scores on measures of general anxiety, depression, and externalizing behavior.
Specific demographic and sexual abuse information may, to some extent, be used to identify children who are at increased risk for short-term post-abuse psychopathology. Although the present findings suggest that such information may not be useful in the prediction of general anxiety, depression, and externalizing behavior, demographic and abuse-related variables importantly appear to account for significant variance in the prediction of global functioning, posttraumatic stress, attentiveness, and sexual behavior. Additional research is needed to improve mental health professionals' ability to identify SA children who are at high risk for psychopathology.
This article describes the Inventory of Altered Self-Capacities (IASC), a 63-item standardized
measure of disturbed functioning in relation to self and others. The seven scales of the
IASC are Interpersonal Conflicts, Idealization-Disillusionment, Abandonment Concerns,
Identity Impairment, Susceptibility to Influence, Affect Dysregulation, and Tension Reduction
Activities. The psychometric properties of the IASC were examined in general population,
clinical, and university samples. The IASC was found to have internal consistency/
reliability and validity in all three samples. Generally as predicted, IASC scales were associated
with existing measures tapping borderline and antisocial personality features, depression,
suicidality, substance abuse, somatization, and dysfunctional sexual behavior.
To describe the long-term impact of physical and sexual abuse of boys by someone in a trusting, non-familial relationship. This clinical study reports on the psychological functioning of men (N = 76) with substantiated claims against a residential religiously-affiliated institution for multiple and severe incidents of sexual, physical, and/or emotional abuse during childhood. The abuse was perpetrated by several adults in positions of authority and trust at the institution.
Each participant received a clinical interview and was administered psychological tests and a structured interview for DSM-IV diagnoses. The same clinician completed all of the assessments.
DSM-IV criteria were met for current PTSD (42%), alcohol (21%), and mood-related disorders (25%). Over one-third of the sample suffered chronic sexual problems, and over one half had a history of criminal behavior.
The clinical findings provide direction for assessing victims of historical abuse, and underscore the importance of awareness, prevention, and treatment needs for those who have been abused in institutional settings. Conclusions are limited due to participants' involvement in civil action, unknown pre-existing conditions, and the lack of a suitable comparison group.
The purpose of this study was to determine the long-term effects of child abuse and neglect on alcohol use in middle adulthood.
Individuals with documented cases of childhood physical and sexual abuse and/or neglect (n = 500) and matched controls (n = 396) from a metropolitan county in the Midwest were followed and interviewed in middle adulthood. Outcomes were Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, diagnoses of alcohol abuse or dependence in young adulthood (age 29) and excessive drinking in middle adulthood (age 40).
Women with documented histories of child abuse or neglect reported higher past-year typical quantity (p < .01) and past-month number of days drinking eight or more drinks (p < .05) than nonabused/nonneglected women. Controlling for parental alcohol/drug problems, the effect of child maltreatment on excessive drinking in middle adulthood was not significant for women. For women, the final structural equation model revealed an indirect path through alcohol diagnosis in young adulthood (p < .05) to excessive drinking in middle adulthood (p < .001) but no direct path from child abuse and neglect to excessive drinking in middle adulthood. For men, there were no significant paths from child abuse and neglect to alcohol diagnosis in young adulthood or excessive drinking in middle adulthood. For men and women, parental alcohol/drug problems had a significant indirect effect on the offspring's drinking in middle adulthood (p < .001) through young adult alcohol diagnosis (p < .001).
Consequences of abuse and neglect persist into middle adulthood for women, through continuation of earlier alcohol problems, suggesting the need for interventions throughout the life course. The influence of parental alcohol and drug problems warrants further attention.
Child maltreatment has been linked to negative adult health outcomes; however, much past research includes only clinical samples of women, focuses exclusively on sexual abuse and/or fails to control for family background and childhood characteristics, both potential confounders. Further research is needed to obtain accurate, generalizable estimates and to educate clinicians who are generally unaware of the link between childhood abuse and adult health. The purpose of this project is to examine how childhood physical abuse by parents impacts mid-life mental and physical health, and to explore the attenuating effect of family background and childhood adversities.
We analyzed population-based survey data from over 2,000 middle-aged men and women in the Wisconsin Longitudinal Study using self-reported measures of parental childhood physical abuse, mental health (depression, anxiety, anger), physical health (physical symptoms and medical diagnoses), family background, and childhood adversities.
Parental physical abuse was reported by 11.4% of respondents (10.6% of males and 12.1% of females). In multivariate models controlling for age, sex, childhood adversities, and family background, we found that childhood physical abuse predicted a graded increase in depression, anxiety, anger, physical symptoms, and medical diagnoses. Childhood physical abuse also predicted severe ill health and an array of specific medical diagnoses and physical symptoms. Family background and childhood adversities attenuated but did not eliminate the childhood abuse/adult health relationship.
In a population-based cohort of middle-aged men and women, childhood physical abuse predicted worse mental and physical health decades after the abuse. These effects were attenuated, but not eliminated, by age, sex, family background, and childhood adversities.
A narrative study of thriving adult female survivors of childhood maltreatment was undertaken to discover how they had achieved success. Life trajectory patterns, turning points, and setbacks were identified. Data consisted of 81 interview transcripts derived from a series of three interviews, spaced over 6 to 12 months, with 27 survivors. The childhood abuse was intrafamilial, beginning as early as infancy and continuing, in most cases, until participants left home. The onset and pace of the healing trajectory were quite variable, including a roller-coaster pattern as well as patterns of slow, steady progress and continued struggle. Four types of redemption narratives were delineated. Survivors had not been spared depression but had made achievements in work and education and displayed remarkable generativity, parenting their own children well, and mentoring other young girls, especially victims of abuse.
This article examined links between childhood maltreatment and risky sexual behavior (early sexual contact, promiscuity, prostitution) and HIV in adulthood.
Using a prospective cohort design, physically and sexually abused and neglected children (ages 0-11) with documented cases during 1967-1971 were matched with nonmaltreated children and followed into adulthood.
Early sexual contact, promiscuity, and prostitution were assessed through in-person interviews and official records (prostitution) at approximate age 29 (N=1196). HIV tests were conducted at approximate age 41 (N=631).
Child maltreatment was associated with prostitution (OR=2.47, 95% CI=1.35-4.50) and early sexual contact (OR=1.73, 95% CI=1.24-2.40). Prevalence of HIV in the abuse/neglect group was twice that in controls (OR=2.35, 95% CI=.64-8.62), although this difference did not reach conventional levels of statistical significance. SEM provided significant support for a model linking child abuse and neglect to prostitution through early sexual contact and a marginal link to HIV through prostitution.
These findings provide prospective evidence that maltreated children are more likely to report sexual contact before age 15, engage in prostitution by young adulthood, and test positive for HIV in middle adulthood.
This study examined the co-occurrence of childhood sexual abuse, adult sexual assault, intimate partner violence, and sexual harassment in a predominantly African American sample of 268 female veterans, randomly sampled from an urban Veterans Affairs hospital women's clinic. A combination of hierarchical and iterative cluster analysis was used to identify 4 patterns of women's lifetime experiences of violence co-occurrence. The 1st cluster experienced relatively low levels of all 4 forms of violence; the 2nd group, high levels of all 4 forms; the 3rd, sexual revictimization across the lifespan with adult sexual harassment; and the 4th, high intimate partner violence with sexual harassment. This cluster solution was validated in a theoretically driven model that examined the role of posttraumatic stress disorder (PTSD) as a mediator of physical health symptomatology. Structural equation modeling analyses revealed that PTSD fully mediated the relationship between violence and physical health symptomatology. Consistent with a bio-psycho-immunologic theoretical model, PTSD levels more strongly predicted pain-related physical health symptoms compared to nonpain health problems. Implications for clinical interventions to prevent PTSD and to screen women for histories of violence in health care settings are discussed.
Foreword - Lucy Berliner Preface - David Finkelhor Introduction PART ONE: INCIDENCE OF CHILD ABUSE Type and Forms of Child Maltreatment PART TWO: THE LONG-TERM IMPACTS OF CHILD ABUSE: INTEGRATION OF RESEARCH AND THEORY Long-Term Impacts of Child Abuse I Psychological Responses Long-Term Impacts of Child Abuse II Behaviors and Relationships PART THREE: EXPLORING THE SOLUTION: ABUSE-FOCUSED PSYCHOTHERAPY Philosophy of Treatment Parameters of Treatment I Process Issues Parameters of Treatment II Intervention Approaches Special Issues in Abuse-Focused Therapy Summary Appendix The Child Maltreatment Interview Schedule
This volume considers the unique and overlapping long-term effects of all major forms of child maltreatment. The author integrates information on seven types of child abuse and neglect - ranging from sexual and physical abuse to mistreatment by alcoholic or drug-addicted parents - and outlines the complex ways in which abuse impacts on later psychosocial functioning.
Briere reframes traditional notions of psychopathology and describes treatment approaches to abuse-related Post-Traumatic Stress Disorder, interpersonal dysfunction, self-destructive behaviour, impaired self-reference and borderline personality disorder. Child Abuse Trauma will be an invaluable resource for abuse specialists and for general therap
Despite the increasing awareness of sexual victimization involving males, there remain a number of factors (e.g., stigma of homosexuality, male ethic of self-reliance) that continue to contribute to the underreporting of such cases. Nonetheless, there appears to be growing recognition of male sexual abuse as a serious problem with potentially numerous debilitating consequences. The clinical and research literature presently contains a number of articles on issues pertaining to males who have experienced sexual abuse during childhood. The purpose of the present paper is to review some of the more recent literature on the short- and long-term effects commonly found among sexually abused males. These effects, which include depression, self-blame, low self-esteem, anger, anxiety, and sexuality problems, are also compared with findings commonly reported among sexually abused females. In addition to sexual abuse effects, the present paper also reviews a number of important sexual abuse characteristics (e.g., age of abuse onset, duration of the abuse, nature of the sexual activity), examines the relationship of these characteristics to later psychological functioning, and explores gender similarities and differences. Finally, the implications of the findings with regard to treatment interventions are briefly discussed.
Despite the increasing awareness of sexual victimization involving males, there remain a number of factors (e.g., stigma of homosexuality, male ethic of self-reliance) that continue to contribute to the underreporting of such cases. Nonetheless, there appears to be growing recognition of male sexual abuse as a serious problem with potentially numerous debilitating consequences. The clinical and research literature presently contains a number of articles on issues pertaining to males who have experienced sexual abuse during childhood. The purpose of the present paper is to review some of the more recent literature on the short- and long-term effects commonly found among sexually abused males. These effects, which include depression, self-blame, low self-esteem, anger, anxiety, and sexuality problems, are also compared with findings commonly reported among sexually abused females. In addition to sexual abuse effects, the present paper also reviews a number of important sexual abuse characteristics (e.g., age of abuse onset, duration of the abuse, nature of the sexual activity), examines the relationship of these characteristics to later psychological functioning, and explores gender similarities and differences. Finally, the implications of the findings with regard to treatment interventions are briefly discussed.
Research addressing the sexual assault of men is a fairly recent development in the medical, health care, psychological and sociological literature. Research in both community and institutionalized populations has focused on documenting the existence of this phenomenon and establishing prevalence or incidence rates, however, understandings of effects on male victims lag behind those regarding women. Only recently have the consequences of sexual assault victimization for men been thoroughly addressed. This review summarizes the research literature concerning the physical, mental health, and sexual consequences of sexual assault victimization for men. The literature suggests a range of possible/occasional consequences, but no well-established patterns of injuries, psychological/emotional reactions or sexual responses/adjustments for male sexual assault victims.
The literature on sexual abuse and alcohol problems has been reviewed. Various methodological issues are relevant in determining whether there is merely an association or also a causal relationship. These include the definition of sexual abuse, the degree and timing of abuse, the methods of data collection, sample selection, the presence or absence of control groups, possible recall bias, difficulties with prospective studies for this subject, and the definition of alcohol misuse or dependence. Results with community and victim samples are conflicting, but studies on samples of problem drinkers suggest an association between severe alcohol problems and previous sexual abuse, at least in women. The association may be especially strong for earlier and more severe forms of sexual abuse. Possible mechanisms for an association were examined and are: (1) sexual abuse as a cause of alcohol misuse; (2) alcohol misuse predisposing people to sexual assault; (3) sexual assault and alcohol misuse both resulting from another factor; (4) sexual abuse predisposing to other conditions associated with alcohol misuse; and (5) an artefactual association. Regardless of the role of sexual abuse in causing alcohol problems, the available evidence suggests that victims of sexual abuse may present to services with more problematical patterns of drinking and more concurrent psychiatric disorder.
The relationships among interpersonal functioning, symptomatology, and childhood abuse were examined in 315 university women. Women reporting childhood abuse had lower quality of past interpersonal relationships, greater fear of intimacy, and greater trauma symptomatology than nonabused women had. Regression analyses indicated that experiencing both sexual and physical abuse, more extensive psychological abuse, and current sexual concerns, defensive avoidance, dissociation, and intrusive experiences were significant predictors of fear of intimacy. Dysfunctional sexual behaviors, impaired self-reference, and depression were significant predictors of the quality of current interpersonal relationships, whereas sexual abuse or multiple abuse experiences in childhood and anger/irritability were predictors of the quality of prior interpersonal relationships. Implications for future research and treatment are discussed.
There has been little previous research about histories of child maltreatment and psychological symptoms in adolescent psychiatric patients. This study investigated whether type and characteristics of child physical and/or sexual abuse predicted individual differences in symptoms. Participants were 187 patients in day or residential treatment facilities. Abuse was assessed using structured interviews with the adolescent, the therapist, and the caseworker. Participants completed a standardized, self-report measure of internalizing and externalizing symptoms. Adolescents with histories of dual abuse (i.e., sexual and physical abuse) had elevated depression and anxiety compared with nonabused patients. Histories of any type of abuse were associated with elevated posttraumatic symptoms. Among physically abused patients, severity and duration of abuse predicted individual differences in depression and anxiety, whereas severity and concomitant sexual abuse predicted elevated posttraumatic symptoms. Among sexually abused patients, the characteristics of sexual abuse did not predict individual differences in symptoms. Thus, child abuse, particularly dual abuse and severe physical abuse, predicted elevated internalizing symptoms, even in comparison with other adolescent psychiatric patients. The need for replication is discussed.
Resolution of the trauma of childhood sexual abuse (CSA), and the current adjustment of 60 adult female CSA survivors were
explored through qualitative and quantitative analyses of their coping strategies, perceived benefits, and meaning-making
attempts. While the majority of the women (87%) perceived at least some benefit resulting from coping with the CSA experience,
many (29%) found it impossible to make any meaning of their trauma. Specific benefits that were associated with various aspects
of positive adjustment (marital satisfaction, better physical health, less isolation) included improved relationships with
others, religious or spiritual growth, and improved parenting skills. Some perceived benefits were actually associated with
a negative outcome. Increased knowledge of sexual abuse was associated with more isolation and lower marital satisfaction.
When positive meaning could be derived from the coping process, the women reported less isolation. Avoidant coping was strongly
associated with more depressive symptoms and poorer resolution of abuse issues. Results highlight the importance of considering
coping strategies and cognitive restructuring efforts in designing therapeutic interventions with this population.
A total of 41 articles examined the social and emotional outcomes of childhood sexual abuse. The outcomes examined included suicide and substance use, gang involvement, pregnancy, running away, post-traumatic stress disorder (PTSD), risky sexual behavior, and behavioral problems. Results for each of these outcomes tended to vary by developmental period. However, problems of internalizing and externalizing behavior appeared to be specific to sexually abused children of all age groups. Some studies found differences in outcome according to gender, race, and age. Although findings related to abuse characteristics were found to vary from study to study, severity of the abuse, use of force, and victim's relationship to the perpetrator were found to be especially important. Other factors, such as family support and parental monitoring, were found to mitigate a negative outcome. Limitations are discussed along with suggestions for future research.
Child abuse is an important risk for adult psychiatric morbidity. However, not all maltreated children experience mental health problems as adults. The aims of the present study were to address the extent of resilience to adult psychopathology in a representative community sample, and to explore predictors of a good prognosis.
Data are drawn from a follow-up of the Isle of Wight study, an epidemiological sample assessed in adolescence and at midlife. Ratings of psychiatric disorder, peer relationships and family functioning were made in adolescence; adult assessments included a lifetime psychiatric history, personality and social functioning assessments, and retrospective reports of childhood sexual and physical abuse.
Ten percent of individuals reported repeated or severe physical or sexual abuse in childhood. Prospective measures revealed increased rates of adolescent psychiatric disorders in this group. Rates of adult psychopathology were also high. A substantial minority of abused individuals reported no mental health problems in adult life. Resilience of this kind was related to perceived parental care, adolescent peer relationships, the quality of adult love relationships, and personality style.
Good quality relationships across childhood, adolescence and adulthood appear especially important for adult psychological well being in the context of childhood abuse.
To clarify the definition of sexual abuse of boys, update estimates of its prevalence, and explore critically its reported correlates, sequelae, and management.
Studies from 1985 to 1997 were identified using OVID-MEDLINE and OVID-CINAHL. The search terms used were sexual abuse, sexual victimization, and sexual assault. Constraints applied included English language, human male subjects, age younger than 19 years, and North American samples.
Publications were included for review if they appeared in peer-reviewed journals; had clear research designs; reported results for at least 20 male subjects; and were not reviews, perspectives, theoretical treatises, editorials, or letters.
Study types and sampling methods were categorized using well-established definitions. Preference was given to studies with large samples, with case-control or cohort designs, and/or with adjustment for effect modifiers or confounders.
We identified 166 studies representing 149 sexual abuse samples. Studies were methodologically limited and definitions of sexual abuse varied widely. Prevalence estimates varied widely (by definition used and population studied), ranging from 4% to 76%. Boys at highest risk were younger than 13 years, nonwhite, of low socioeconomic status, and not living with their fathers. Perpetrators tended to be known but unrelated males. Abuse frequently occurred outside the home, involved penetration, and occurred more than once. Sequelae included psychological distress, substance abuse, and sexually related problems. Evaluation of management strategies was limited.
Sexual abuse of boys appears to be common, underreported, underrecognized, and undertreated. Future study requires clearer definitions of abuse, improved sampling, more rigorous data collection, more sophisticated data analyses, and better assessment of management and treatment strategies. Regardless, health care professionals should be more aware of and sensitive to the possibility of sexual abuse in their male patients.
The literature on sexual abuse and alcohol problems has been reviewed. Various methodological issues are relevant in determining whether there is merely an association or also a causal relationship. These include the definition of sexual abuse, the degree and timing of abuse, the methods of data collection, sample selection, the presence or absence of control groups, possible recall bias, difficulties with prospective studies for this subject, and the definition of alcohol misuse or dependence. Results with community and victim samples are conflicting, but studies on samples of problem drinkers suggest an association between severe alcohol problems and previous sexual abuse, at least in women. The association may be especially strong for earlier and more severe forms of sexual abuse. Possible mechanisms for an association were examined and are: (1) sexual abuse as a cause of alcohol misuse; (2) alcohol misuse predisposing people to sexual assault; (3) sexual assault and alcohol misuse both resulting from another factor; (4) sexual abuse predisposing to other conditions associated with alcohol misuse; and (5) an artefactual association. Regardless of the role of sexual abuse in causing alcohol problems, the available evidence suggests that victims of sexual abuse may present to services with more problematical patterns of drinking and more concurrent psychiatric disorder.
The purpose of this study was to examine patterns of change in attributions for childhood sexual abuse (CSA) over a 6-year period and whether such patterns were related to abuse severity, age, gender, and subsequent symptoms of depression and PTSD.
One-hundred and sixty children, 8-15 years old, were interviewed within 8 weeks of the time the CSA was reported to child protective services (i.e., the time of abuse discovery). Follow-up interviews were conducted 1-year later on 147, and 6 years later on 121 of the original participants. Abuse-specific attributions were obtained using two methods. Participants first responded to an open-ended interview question about why they believed the CSA had happened to them and then completed a rating scale about the extent to which possible attributions for the CSA applied to them (e.g., "Because I was not smart enough").
Over time, perpetrator-blame attributions were consistently more common than self-blame attributions for CSA (using both interview and rating measures). Youth were more likely to report self-blame attributions on the rating measure than the open-ended interview question. The interview method indicated that youth often felt confused about why the abuse happened up to a year following discovery but this response diminished by the third assessment. On average, ratings of perpetrator-blame attribution remained high over time (p<.05), whereas ratings of self-blame decreased (p<.01). Penetration was related to more self-blame (p<.05) and less perpetrator-blame (p<.05), and the use of force was related to more perpetrator-blame. The initial level of self-blame attribution ratings predicted subsequent symptoms of depression (p<.05) and intrusive experiences (p<.05) after controlling for age at abuse discovery, gender, and self-blame attributions for common events. Perpetrator-blame attributions were not related to symptoms.
The findings of this study suggest that assessing responses to open-ended interview questions about the perceived reasons for the abuse and ratings of attributions are important for understanding how youth make sense of their abuse. Abuse-specific self-blame attributions at abuse discovery have a persistent effect on internalizing symptoms and should be assessed and the target of treatment as soon as possible after CSA has been reported to the authorities.
This study examined differences between self-harmers who had and who had not been sexually abused in childhood with regards to other risk factors and associated behaviours commonly identified in the research literature as being related to self-harm. Participants (N = 113, mean age = 19.92 years) were recruited via self-harm Internet discussion groups and message boards, and completed a web questionnaire assessing measures of body satisfaction, eating disorders, childhood trauma and suicide ideation. Self-harmers who reported a history of childhood sexual abuse scored higher on measures of body dissatisfaction, eating disorders, suicide ideation, physical abuse, physical neglect, emotional abuse and emotional neglect. These findings implicate sexual abuse as a powerful traumatic event that can have severe repercussions on an individual, not only in terms of self-harming behaviour but also in terms of developing a wide range of maladaptive behaviours in conjunction with self-harm.
WRAT 4: Wide Range Achievement Test professional manual
- G S Wilkinson
- G J Robertson
Wilkinson, G. S., & Robertson, G. J. (2006). WRAT 4: Wide Range Achievement Test professional manual. Lutz, FL: Psychological Assessment Resources.
Childhood maltreatment Advances in psychotherapy: Evidence-based practice Long-term effects of child abuse and neglect on alcohol use and excessive drinking in middle adulthood
- C Wekerle
- A Miller
- D A Wolfe
- C B Spindel
Wekerle, C., Miller, A., Wolfe, D. A., & Spindel, C. B. (2006). Childhood maltreatment. In D. Wedding (Series Ed.), Advances in psychotherapy: Evidence-based practice. Cambridge, MA: Hogrefe & Huber. Widom, C. S., White, H. R., Czaja, S. J., & Marmorstein, N. R. (2007). Long-term effects of child abuse and neglect on alcohol use and excessive drinking in middle adulthood. Journal of Studies on Alcohol and Drugs, 68(3), 317–326.
Context, culture and the law of expert evidence. The Advocates' Quarterly
- D M Paciocco
Paciocco, D. M. (2001). Context, culture and the law of expert evidence. The Advocates' Quarterly, 24.
Sexual abuse and the subsequent development of alcohol problems
- Moncriff
Context, culture and the law of expert evidence
- Paciocco