MEDLINE Abstracts: Violence Against Women - Consequences of Child Abuse

November 19, 2003

This easy-to-navigate collection of recent MEDLINE abstracts focuses on the health consequences of child abuse, particularly sexual abuse, in women.
 

Childhood Family Violence History and Women's Risk for Intimate Partner Violence and Poor Health

Bensley L, Van Eenwyk J, Wynkoop Simmons K
Am J Prev Med. 2003;25:38-44

Background: There is growing evidence for associations between generations in family violence and between family violence in both childhood and adulthood and women's health. Most studies focus on a subset of family violence (child abuse, witnessing intimate partner violence [IPV] as a child, and/or adult IPV), and few examine possible differences associated with the nature of abusive experiences, such as physical versus sexual abuse.
Methods: A population-based telephone survey, the 1999 and 2001 Washington State Behavioral Risk Factor Surveillance System, asked a representative sample of 3527 English-speaking, non-institutionalized adult women whether they had been physically or sexually assaulted or witnessed interparental violence in childhood, and whether they had experienced physical assault or emotional abuse from an intimate partner in the past year. The survey also asked about current general health and mental distress in the past month.
Results: The risks associated with childhood family violence experiences varied depending on the nature of those experiences. Women reporting childhood physical abuse or witnessing interparental violence were at a four- to six-fold increase in risk of physical IPV, and women reporting any of the experiences measured were at three- to four-fold increase in risk of partner emotional abuse. In contrast, women reporting childhood sexual abuse only were not at increased risk of physical IPV. Women reporting childhood physical abuse were at increased risk of poor physical health, and women reporting any type of childhood family violence were at increased risk of frequent mental distress. Approximately one third of women reporting poor general health and half of women reporting frequent mental distress also reported at least one of the childhood experiences measured.
Conclusions: These findings underscore the role of childhood experiences of abuse and of witnessing family violence in women's current risk for IPV, poor physical health, and frequent mental distress.

Coping With Incest: The Relationship Between Recollections of Childhood Coping and Adult Functioning in Female Survivors of Incest

Brand BL, Alexander PC
J Trauma Stress. 2003;16:285-293

One hundred and one adult female survivors' recollections of coping with childhood incest, abuse characteristics, and current functioning in adulthood were studied. Analyses controlling for characteristics of the trauma indicated that recollections of using avoidance coping and seeking social support were related to poor adult functioning whereas recollections of using distancing coping were related to better functioning. As a set of variables, abuse characteristics also predicted a significant amount of variance in adult functioning. Implications for future research were discussed.

Perceptions of Sexuality as Related to Sexual Functioning and Sexual Risk in Women With Different Types of Childhood Abuse Histories

Schloredt KA, Heiman JR
J Trauma Stress. 2003;16:275-284

Perceptions of one's sexuality, self-reported sexual functioning, and sexual risk were examined in a community sample of 148 women with histories of either childhood sexual abuse (n = 26), both childhood sexual and physical abuse (n = 44), and neither form of abuse (n = 78). Controlling for depression and anxiety, the groups did not differ on sexual desire, arousal/orgasm, sexual pain, or masturbation. Women with abuse histories reported more negative affect during sexual arousal and reported more lifetime vaginal intercourse partners than nonabused women. In addition, the abuse samples reported more negative perceptions of their sexuality in their worst psychological states using the Structural Analysis of Social Behavior (SASB) method than did women with no abuse history. An interpersonal focus and more precise abuse labeling are recommended, potentially revising our assumptions about symptom clusters and treatment.

A Prospective Investigation of the Impact of Childhood Sexual Abuse on the Development of Sexuality

Noll JG, Trickett PK, Putnam FW
J Consult Clin Psychol. 2003;71:575-586

The sexual attitudes and activities of 77 sexually abused and 89 comparison women (mean age = 20.41, SD = 3.38) were assessed 10 years after disclosure in a longitudinal, prospective study of the long-term effects of childhood sexual abuse. Abused participants were more preoccupied with sex, younger at first voluntary intercourse, more likely to have been teen mothers, and endorsed lower birth control efficacy than comparison participants. When psychological functioning earlier in development was examined, sexual preoccupation was predicted by anxiety, sexual aversion was predicted by childhood sexual behavior problems, and sexual ambivalence (simultaneous sexual preoccupation and sexual aversion) was predicted by pathological dissociation. Findings also indicate that biological father abuse may be associated with greater sexual aversion and sexual ambivalence.

Neurobiological Effects of Childhood Abuse: Implications for the Pathophysiology of Depression and Anxiety

Penza KM, Heim C, Nemeroff CB
Arch Women Ment Health. 2003;6:15-22

Mood and anxiety disorders are highly prevalent psychiatric disorders, especially in women, and they are associated with significant morbidity and mortality. A considerable literature indicates that vulnerability to depression and anxiety disorders is markedly increased by childhood abuse, e.g., physical, sexual, and psychological abuse, as well as adulthood stressors, e.g., death of a spouse. Little is known about the developmental neurobiological mechanisms by which childhood abuse increases the susceptibility of women to the development of depression and anxiety disorders in adulthood. Recent research on the effects of adverse early life experiences on central nervous system (CNS) stress systems has provided a greater understanding of the link between childhood abuse and susceptibility to mood and anxiety disorders. Specifically, early life traumatic events, occurring during a period of neuronal plasticity, appear to permanently render neuroendocrine stress response systems supersensitive. These physiological maladaptations likely represent long-term risk factors for the development of psychopathology after exposure to additional stress.

Psychological Assessment of Adult Survivors of Childhood Sexual Abuse Within a Naturalistic Clinical Sample

Callahan KL, Price JL, Hilsenroth MJ
J Pers Assess. 2003;80:173-184

This study investigates the long-term effects of childhood sexual abuse (CSA). Differences between abused and nonabused individuals in psychiatric symptomatology, interpersonal functioning, social and occupational functioning, personality dynamics, and therapeutic alliance were examined. The relationship between abuse severity and long-term effects was also analyzed. Data were gathered from 51 patients seeking individual psychotherapy at a community outpatient clinic. Findings suggested that CSA survivors tend to experience greater psychiatric distress and poorer interpersonal functioning than nonabused clinical controls. No significant differences were found in social and occupational functioning or in alliance developed by the end of the therapeutic assessment process. Abuse severity was significantly related to increased symptomatology and poorer interpersonal functioning. Findings support and extend existing literature and are especially useful for clinicians working with abuse survivors.

MRI And PET Study of Deficits in Hippocampal Structure and Function in Women With Childhood Sexual Abuse and Posttraumatic Stress Disorder

Bremner JD, Vythilingam M, Vermetten E, et al
Am J Psychiatry. 2003;160:924-932

Objective: Animal studies have suggested that early stress is associated with alterations in the hippocampus, a brain area that plays a critical role in learning and memory. The purpose of this study was to measure both hippocampal structure and function in women with and without early childhood sexual abuse and the diagnosis of posttraumatic stress disorder (PTSD).
Method: Thirty-three women participated in this study, including women with early childhood sexual abuse and PTSD (N=10), women with abuse without PTSD (N=12), and women without abuse or PTSD (N=11). Hippocampal volume was measured with magnetic resonance imaging in all subjects, and hippocampal function during the performance of hippocampal-based verbal declarative memory tasks was measured by using positron emission tomography in abused women with and without PTSD.
Results: A failure of hippocampal activation and 16% smaller volume of the hippocampus were seen in women with abuse and PTSD compared to women with abuse without PTSD. Women with abuse and PTSD had a 19% smaller hippocampal volume relative to women without abuse or PTSD.
Conclusions: These results are consistent with deficits in hippocampal function and structure in abuse-related PTSD.

Chronic Pain Syndromes and Their Relation to Childhood Abuse and Stressful Life Events

Lampe A, Doering S, Rumpold G, et al
J Psychosom Res. 2003;54:361-367

Objective: Childhood abuse, stressful life events, and depression have been repeatedly reported to correlate with chronic pain, but little is known about the mutual relationships among these variables.
Methods: Forty-three women with chronic pelvic pain (CPP), 40 female patients with chronic low-back pain (CLBP), and a female pain-free control group (n=22) were investigated by means of a semistructured interview assessing childhood sexual and physical abuse as well as stressful life events. Additionally, the Beck Depression Inventory (BDI) was used. For multivariate analyses, structured equation modeling was applied.
Results: Childhood physical abuse, stressful life events, and depression had a significant impact on the occurrence of chronic pain in general, whereas childhood sexual abuse was correlated with CPP only. Moreover, childhood sexual abuse was related to depression. Both childhood sexual and physical abuse showed a close relationship to an increased occurrence of stressful life events.
Conclusion: There are complex mutual interactions among childhood abuse, stressful life events, depression, and the occurrence of chronic pain. Therefore, clinicians should take into consideration these psychosocial factors while treating chronic pain patients.

Nightmares and Dissociative Experiences: The Key Role of Childhood Traumatic Events

Agargun MY, Kara H, Ozer OA, Selvi Y, Kiran U, Kiran S
Psychiatry Clin Neurosci. 2003;57:139-145

In order to examine the co-occurrence of nightmares with dissociative experiences in the adolescent population and to demonstrate the impact of childhood traumatic events in this association, 292 undergraduate students were interviewed for childhood traumatic events. The Van Dream Anxiety Scale (VDAS) and Dissociative Experiences Scale (DES) were also administered to the subjects. For nightmares a 7.5% prevalence of 'often' and a 58.2% prevalence of 'sometimes' was found for college students. Nightmare prevalence was higher in women than in men. The rate of childhood traumatic experiences was higher in nightmare sufferers than in those who did not have nightmares. The subjects who had undergone physical and sexual abuse had higher VDAS global scores and item scores. When the DES scores of the subjects with nightmares were compared with that of those who had never reported nightmares, the subjects with nightmares had significantly higher scores on DES. The DES scores were also negatively correlated with duration of nightmares in subjects who had childhood traumatic experiences. These findings suggest that the subjects with childhood traumatic events failed to psychologically integrate their traumatic experiences and used dissociation as a coping strategy.

A Prospective Study of Memory for Child Sexual Abuse: New Findings Relevant to the Repressed-Memory Controversy

Goodman GS, Ghetti S, Quas JA, et al
Psychol Sci. 2003;14:113-118

Previous research indicates that many adults (nearly 40%) fail to report their own documented child sexual abuse (CSA) when asked about their childhood experiences. These controversial results could reflect lack of consciously accessible recollection, thus bolstering claims that traumatic memories may be repressed. In the present study, 175 individuals with documented CSA histories were interviewed regarding their childhood trauma. Unlike in previous studies, the majority of participants (81%) in our study reported the documented abuse. Older age when the abuse ended, maternal support following disclosure of the abuse, and more severe abuse were associated with an increased likelihood of disclosure. Ethnicity and dissociation also played a role. Failure to report CSA should not necessarily be interpreted as evidence that the abuse is inaccessible to memory, although inaccessibility or forgetting cannot be ruled out in a subset of cases.

Sexual and Physical Abuse During Childhood and Adulthood as Predictors of Hallucinations, Delusions and Thought Disorder

Read J, Agar K, Argyle N, Aderhold V
Psychol Psychother. 2003;76(Pt 1):1-22

In light of recent studies indicating a relationship between child abuse and the positive symptoms of schizophrenia, this study investigated the hypotheses that childhood sexual and physical abuse are related to hallucinations, delusions, and thought disorder in adults, and that those relationships are greater in those who have suffered abuse during adulthood as well as childhood. In 200 community mental-health-centre clients, the clinically evaluated symptomatology of the 92 clients whose files documented sexual or physical abuse at some point in their lives was compared with that of the 108 for whom no abuse was documented. In the 60 patients for whom child abuse was documented, hallucinations (including all six subtypes), but not delusions, thought disorder or negative symptoms, were significantly more common than in the non-abused group. Adult sexual assault was related to hallucinations, delusions, and thought disorder. In linear regression analysis, a combination of child abuse and adult abuse predicted hallucinations, delusions, and thought disorder. However, child abuse was a significant predictor of auditory and tactile hallucinations, even in the absence of adult abuse. Possible psychological and neurobiological pathways from abuse to symptoms are discussed, along with research and clinical implications.

Psychopathology and Sexual Trauma in Childhood and Adulthood

Thompson KM, Crosby RD, Wonderlich SA, et al
J Trauma Stress. 2003;16:35-38

This study evaluates the occurrence of psychopathology among 97 women who (1) experienced sexual abuse in childhood only, (2) were raped in adulthood only, (3) experienced both childhood sexual abuse and rape in adulthood, or (4) experienced no sexual trauma. Women were recruited from advertisements and assessed using the Structured Clinical Interview for DSM-IV (SCID-I/P) and the Modified PTSD Symptom Scale Self-Report. Women who reported sexual trauma were significantly more likely to exhibit psychopathology than controls. Being sexually victimized in childhood and raped in adulthood was associated with a particular risk for substance dependence.

Psychological Assessment of Adult Survivors of Childhood Sexual Abuse Within a Naturalistic Clinical Sample

Callahan KL, Price JL, Hilsenroth MJ
J Pers Assess. 2003;80:173-184

This study investigates the long-term effects of childhood sexual abuse (CSA). Differences between abused and nonabused individuals in psychiatric symptomatology, interpersonal functioning, social and occupational functioning, personality dynamics, and therapeutic alliance were examined. The relationship between abuse severity and long-term effects was also analyzed. Data were gathered from 51 patients seeking individual psychotherapy at a community outpatient clinic. Findings suggested that CSA survivors tend to experience greater psychiatric distress and poorer interpersonal functioning than nonabused clinical controls. No significant differences were found in social and occupational functioning or in alliance developed by the end of the therapeutic assessment process. Abuse severity was significantly related to increased symptomatology and poorer interpersonal functioning. Findings support and extend existing literature and are especially useful for clinicians working with abuse survivors.

Exposure to Abuse, Neglect, and Household Dysfunction Among Adults Who Witnessed Intimate Partner Violence as Children: Implications for Health and Social Services

Dube SR, Anda RF, Felitti VJ, Edwards VJ, Williamson DF
Violence Vict. 2002;17:3-17

Intimate partner violence (IPV) damages a woman's physical and mental well-being, and indicates that her children are likely to experience abuse, neglect and other traumatic experiences. Adult HMO members completed a questionnaire about adverse childhood experiences (ACEs) including childhood abuse, neglect, and household dysfunction. We used their responses to retrospectively assess the relationship between witnessing intimate partner violence and experiencing any of the 9 ACEs and multiple ACEs (ACE score). Compared to persons who grew up with no domestic violence, the adjusted odds ratio for any individual ACE was approximately two to six times higher if IPV occurred (p < 0.05). There was a powerful graded increase in the prevalence of every category of ACE as the frequency of witnessing IPV increased. In addition, the total number of ACEs was increased dramatically for persons who had witnessed IPV during childhood. There was a positive graded risk for self-reported alcoholism, illicit drug use, i.v. drug use and depressed affect as the frequency of witnessing IPV increased. Identification of victims of IPV must include screening of their children for abuse, neglect and other types of adverse exposures, as well as recognition that substance abuse and depressed affect are likely consequences of witnessing IPV. Finally, this data strongly suggest that future studies, which focus on the effect of witnessing IPV on long-term health outcomes, may need to take into consideration the co-occurrence of multiple ACEs, which can also affect these outcomes.

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