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EFFECT OF CHILDHOOD SEXUAL ABUSE ON ADULTS.
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Proposes a study design to assess impact of childhood abuse on adult adjustment.... More...
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Paper Abstract:
Proposes a study design to assess impact of childhood abuse on adult adjustment Relationships between early sexual abuse and adult problems (depession, anxiety, drug abuse, attempted suicide, psychiatric disorders. Depression & anxiety in women and men.. Research questions & hypotheses. Methodology. Nonclinical random sample using only self-reports. Data analysis. Review of literature.
Paper Introduction:
EFFECTS OF CHILDHOOD SEXUAL ABUSE ON FEMALE & MALE ADULTS
I. INTRODUCTION
Statement of the Problem
Childhood sexual abuse continues to be prevalent and prevention or intervention efforts are considered a failure ("Child," 1999; Gelles, 1998). Childhood sexual abuse results in effects that continue into adulthood. Relationships between this sexual abuse and adult problems such as depression, anxiety, drug abuse, attempted suicide, and psychiatric disorders, have been found (McCauley, Kern, Kolodner, Dill, Schroeder, DeChant, Ryden, Derogatis, & Bass, 1997). Studies of the effects of childhood sexual abuse on women are more prevalent than those regarding male victims. Those regarding male victims tend to focus on sexual identity issues (Ferren, 1998). Effects of this abuse on
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Procedures All subjects will be randomly chosen from a public sample, throughphone solicitation, and asked to voluntarily participate in the study.Fifty female adults and fifty male adults, will be chosen to participate inthe study. 1). Relationships betweendifferent types of maltreatment during childhood and adjustment inadulthood. Effects of this abuse on female victimshas been compared to effects on male victims, on issues of depression andstress, with conflicting results. Study Purpose The purpose of this study will be to investigate the effects ofchildhood sexual abuse on female and male adults, in an equal group,nonclinical sample. Theserelationships were consistent regardless of family background factors (pp.261, 268). By the end on the senior year, 5 % of thosesexually abused, 35% of those who experienced multiple abuse, and 6 % ofnonvictims remained (Duncan, 2 , p. In a studycomparing 168 women with 2 men, the relationship was greater for thewomen. 1 9). 825). Childhoodsexual abuse as a risk factor for depression in women: Psychosocial andneurobiological correlates. Results showed that thosewho suffered from childhood abuse (physical, sexual, and neglect) were overfour times as likely to suffer from diagnosed personality disorders. The Information Questionnaire,constructed by the investigator, consists of demographic questions as wellas a systematic inquiry to determine childhood sexual abuse. (1997). Child abuse has become a problem demanding professional, pubic, andpolicy attention. (1998). It covers the whole range of depressive symptoms inthe DSM III. (1999). However, findings conflict and studies withequal sample sizes are lacking. A., & Feinauer, L. International Journal of OffenderTherapy and Comparative Criminology, 41(4), 31 -324. The BrownUniversity Child and Adolescent Behavior Letter, 14(8), 1-3. Schneider, J. The cycle of violence:Revisited 6 years later. This lack of effective prevention and interventionprograms indicates a further need for effects assessment for different agegroups. Previousstudies have examined effects for both clinical and normal populations,with an emphasis on clinical. A., Desmond, D. Self-mutilating behavior of sexually abused female adults in Turkey. Diagnostic sensitivity is considered to be over 8 % regardinglevels of depression (Zimmerman, Coryell, Corenthal, & Wilson, 1986). R., Anderson, G., Hazen, A. It is hypothesizedthat childhood sexual abuse is an early stressor, effecting the HPA axis,which may increase vulnerability to depression in adulthood. Effects of Childhood Sexual Abuse. For the third subject, the abuse andinternalized homophobia were factors leading to lifelong sexual-identityconfusion (p. McCauley, J.., Kern, D. Weiss, Longhurst, and Mazure (1999) reviewed studies regardingeffects of childhood sexual abuse as a risk factor for depression andstress, comparing women to men. JAMA, 277(17), 362-369. W. The child may care for the abuser andbecome trapped between the need for that person and the need to be rid ofthe abuse. This study further attempts to explain differences in levels ofdepression between women and men by considering the contribution of thehypothalamic-pituitary-adrenal (HPA) axis function. The hypotheses are as follows: Hypothesis 1: There will be a significant difference between thechildhood sexual abuse group and the non-sexual abuse group, for femalevictims, regarding scores on the IDD. Silvern, L., Waelde, L. A group of 25 females withprior childhood sexual abuse will be compared to a group of 25 females withno prior childhood sexual abuse on effect variables. They may have difficulty relating to others on termsother than sexual which can develop into serious adult problems ("Child,"1999, p. (1998). 822). Cheasty, M., Clare, A. Hudson, W. Significance of the Study Research shows effects of depression and anxiety for both female andmale childhood sexual abuse victims, however a large portion of theliterature is derived from a clinical population and unequal sample sizesfor women and men. Gelles, R. 1362). The CAS is a self-reporting, 25-itemscale used to measure amounts, degrees, and severity of clinical anxiety.Items are based on anxiety disorder criteria in the DSM III. & Forde, D. (1996). In a study of 16 psychiatric inpatients, results showedthat all the experiences were interrelated; sexual and physical abuse wererelated to early parental separation and sexual abuse was not related towitnessing violence. Success rates of home visits can be found with theunmarried teenage mother population; those receiving visits duringpregnancy and for two years following, show less cases of child abuse(Gelles, 1998, p. In a study of 9 8 participants with court records of child abuse orneglect, the criminal or violent results of this abuse were studied.Results showed that this group was more likely than controls to havejuvenile or adult arrests for nontraffic offenses and for violent crimes,with the emphasis on arrests for violence. Theystudied self-reports of 175 adults from a community sample regardingchildhood sexual abuse, physical abuse, psychological maltreatment,neglect, and witnessing family violence. 17 8). Interviews were conducted from 1975 to 1993, and abuse evidence wasobtained from state records and self-reports. Stein, M. A clinical sample of 125 patients withanxiety disorders (panic disorder, social phobia, and obsessive-compulsivedisorder) was examined for a background in childhood physical or sexualabuse. Ferren, D. The long-term effects of this abuse are far reaching and devastating. Results showed that 29 patients werediagnosed with anxiety disorder, 4 had dissociative disorder, 5 hadborderline personality disorder, three others suffered one each fromdepressive, somatoform, and organic psychotic disorder, and one wasmentally retarded. TheAmerican Journal of Family Therapy, 27(2), 1 9-12 . E., Kolodner, K., Dill, L., Schroeder, A. Summing ofscores produces a range with higher scores indicating greater anxiety.Internal consistency is excellent with a coefficient alpha of .94. W. Concurrentvalidity is excellent, correlating with the Beck Depression Inventory andothers. III. Two-week test-retest correlations range from .64 to .74 indicating goodstability. Studiessuggest that this axis is more reactive to stress in women than men.Therefore the neurochemical changes that result from the childhood stressmay differ for men and women, creating a greater biological vulnerabilityfor women (Weiss, Longhurst, & Mazure, p. Hypothesis 4: There will be a significant difference between thechildhood sexual abuse group and the non-sexual abuse group, for malevictims, regarding scores on the CAS. It is also possible that behaviors are measuredinaccurately, or that maltreating caretakers are inaccurately assessed aswanting change. Studies of the effects ofchildhood sexual abuse on women are more prevalent than those regardingmale victims. Sexual abuse of children: Strengths andweaknesses of current criminology. Higgins, D. (2 ). 515). In a study comparing questionnaire formats for the gathering ofretrospective reports of child abuse, results demonstrated that researcher-defined abuse was more likely to be associated with unfavorable adultadjustment than self-defined abuse indices. Since prevention and intervention effortsregarding childhood sexual abuse and its effects, has resulted in failedattempts, an understanding of these effects on an equal group, nonclinicalfemale and male population will provide additional information needed toassist with future directions for the mental health care system. Instruments Information Questionnaire. (1999). 6 ). Hypothesis 3: There will be a significant difference between thechildhood sexual abuse group and the non-sexual abuse group, for malevictims, regarding scores on the IDD. % of womenwith panic disorders, compared to women with other anxiety disorders(3 .8%). Child maltreatment prevention programs arestill largely ineffective, after 3 years of research. in another study of 3,132 adults, female victimsshowed greater lifetime prevalence of depression than nonvictims, and malevictims did not show higher rates for major depressive disorder than malenonvictims (p. Ferren (1998)reported that numerous studies of male childhood sexual abuse have foundhigher numbers of homosexuals being represented, which may or may notsuggest that the abuse may lead to homosexual tendencies. Children are not in aposition to cope with sexual stimulation or the psychological ramificationsinvolved with the interaction. Baral, I., Kora, K., Yuksel, S., & Sezgin, U. Ignore child abuse now, attend to adultsocial problems later. (1996). All social classes were represented. Maxfield, M. Hypothesis 2: There will be a significant difference between thechildhood sexual abuse group and the non-sexual abuse group, for femalevictims, regarding scores on the CAS. M., Karyl, J., & Kaersvang,L. M. Ketring, S. L., Longhurst, J. Prevention programs remain ineffective even after 3 years of ongoing research. II. Philips, B. Medrano, M. Data Analysis A quasi-experimental design will be used to investigate therelationship between the independent variable (childhood sexual abuse) andthe dependent variables (depression and anxiety). (2 ). P., Zule, W. Study Design Silvern, Waelde, Baughan, Karyl, and Kaersvang (2 ) report that aneffect of childhood abuse, is the sleeper effect. For this study effects ofchildhood sexual abuse will be depression, measured by the Inventory toDiagnose Depression (IDD), and anxiety as measured by the Clinical AnxietyScale (CAS). G., Mazure, C. Child sexual abuse. Limitations Since this study utilized a nonclinical random sample with only self-reports of symptoms, it is possible that the findings may not generalize toa larger or clinical population. Levels of dissociative symptoms were significantlyrelated to sexual and physical abuse but not to separation. Any lewd or lascivious act upon or with thebody, or any part or member thereof, of a child (up to 14 years), with theintent of arousing, appealing to, or gratifying the lust or passions orsexual desires of such person or of such child by an adult (Schneider,1997). G., & Widom, C. Stein, Walker, Anderson, Hazen, Ross, Eldredge, and Forde (1996)reported on their matched case-control study of the effects of childhoodsexual abuse and adult anxiety. The WALMYR assessment scales scoring manual.Tempe, AZ: WALMYR Publishing. (1997).Clinical characteristics of women with a history of childhood abuse:Unhealed wounds. An information survey will be used to determine prior childhoodsexual abuse and the CAS and the IDD will be used to measure currentsymptomatic effects of depression and anxiety. Childhood maltreatmentincreases risk for personality disorders during early adulthood. Johnson, J. Known-groups validity is described as good with significantdiscrimination between groups with anxiety and controls (Hudson, 1992). The abuse maytake place in various situations, to include within the family, in aschool, at a neighbors, or with a random molester. Weiss, E. (1998). Extensive reviews of prevention programs, haveshown that home health visiting programs are the most effective. 987). It remains unclear if thedissociation is a response to the sexual or physical abuse or whether itincludes parental factors such as loss of parents, witnessing violence, orchronic neglect. Although the studyprovided information, the male sample was considerably smaller than thefemale sample, which may have affected results (p. Foundonline on infotrac at: www.lapl.org Duncan, R. It has also been found that aquestionnaire with researcher-defined criteria is more effective thanreporting of self-defined criteria regarding childhood trauma. Gilgun, J. Zimmerman, M., Coryell, W., Corenthal, C., & Wilson, S. Effects of depression are typicallyreported to be higher for female victims than male victims, and effects ofstress are hypothesized to result in differences in hypothalamic-pituitary-adrenal (HPA) axis functioning (Weiss, Longhurst, & Mazure, 1999). Archives ofGeneral Psychiatry, 43, 1 76-1 81.----------------------- 17 Child Maltreatment, 5(3), 236-25 . Specific Effects of Depression and Anxiety Cheasty, Clare, and Collins (1998) studied the effects of childhoodsexual abuse on adult depression in a case controlled study. However the small sample size of men makes the methodology of thisstudy questionable. Child Maltreatment, 5(3), 261-272. K., Ryden, J., Derogatis, L. Perpetrator-victimrelationship: Long-term effects of sexual abuse for men and women. G., Cohen, P., Brown, J. Subjects will be informed that theirparticipation is voluntary and they may withdraw from the study at anytime, and that confidentiality will be maintained. J. Baral, Kora, Yuksel, and Sezgin (1998) studied 42women of this population, in Turkey. Thus a survey with researcher-defined questions is more likely to illicit a more accurate assessment ofchildhood abuse (pp. Descriptive statisticswill be used to describe demographic information. These children develop a loss of self-esteem with feelings ofworthlessness and they become withdrawn, mistrustful, and have an abnormalsexual perspective. (1992). 1 ). Ketring and Feinauer (1999) examined emotional and familialrelationships of 465 victims and perpetrators of childhood sexual abuse.Of this sample, 419 female victims and 56 male victims were studied.Findings showed no statistically significant differences based on gender.The most severe effects of the abuse were found in those who were abused bya father figure and those who were severely abused. L., Ross, C. Previous literature has shown acorrelation between reported abuse and adult-onset of depression, however,findings conflict, and tendencies are greater for women. (1999). 262). Serious emotional and socialconsequences are detrimental to development of the child and they becomeless able to function adequately as adults (Phillips, 1998, p. R., & Bass, E. A., & Hatch, J. J., & McCabe, M. Inaddition, effects of this abuse have been associated with both the femaleand male victim population. Childhood maltreatment is associated with college drop-out rates. The IDD is a self-reporting,22-item scale used to measure major depression and diagnose majordepressive disorder. Journal of InterpersonalViolence, 15(9), 987-995. Ina longitude study of 21 freshmen and their four years of college, it wasfound that those who had experienced more than one type of abuse inchildhood, and those sexually assaulted were more likely to drop out beforetheir second semester. All ofthose who were severely molested, defined as including penetration orattempted penetration, were depressed. Childhood sexual abuse results in effects that continue intoadulthood. Resultsshowed that out of 237 women interviewed, 132 were depressed and 37% of thedepressed women had been sexually molested prior to age 16 years. P. Clinical Reference Systems, 262. Definition of Terms Childhood Sexual Abuse. What are the gender differences? B. W., & Collins, C. In a study of 1,931 women, those who reported childhood physical orsexual abuse (1 %) were found suffer more from depression, anxiety, drugabuse, attempted suicide, and psychiatric disorder hospitalization, thanthose not reporting the prior abuse (McCauley, Kern, Kolodner, Dill,Schroeder, DeChant, Ryden, Derogatis, & Bass, 1997, p. Relation betweensexual abuse in childhood and adult depression: Case-control study.British Medical Journal, 316(7126), 198-2 2. Further examples of adult problems due to childhood sexual abuse aredemonstrated by a longitudinal study of community youths and their mothers. METHODOLOGY Subjects The subjects for the study will be 5 females and 5 males, ages 18years and older, randomly chosen from a public sample, and volunteering toparticipate in the study. A study investigating the effects ofchildhood sexual abuse on depression and anxiety in women and men, in anonclinical, equal group sample, is needed. P. The development of sexualidentity among men sexually abused as children. T-Tests for independentsamples will be used to empirically test the hypotheses. Dissociation is another problem associated with adults who havesuffered childhood trauma. D. Alternatively, one difference found between male victims and femalevictims, is the tendency for sexual identity confusion. Relationships between this sexual abuse and adult problems suchas depression, anxiety, drug abuse, attempted suicide, and psychiatricdisorders, have been found (McCauley, Kern, Kolodner, Dill, Schroeder,DeChant, Ryden, Derogatis, & Bass, 1997). Other reports found that cutting arms or wrists was the mostfrequent behavior, however this study found hitting oneself to be the mostfrequent. (1986). Behaviors such as substance abuse,gang and criminal activities, mental illness, prostitution, runawaybehavior, school failure, unemployment, teen pregnancy, sexual offenses,physical ailments, and suicide are found. Symptoms disrupt consciousness in areas ofmemory, identity, and environmental perception. Families in Society,71(9), 515-523. Score summing yields a quantitative description of depression.Internal consistency is excellent with an alpha of .92. INTRODUCTION Statement of the Problem Childhood sexual abuse continues to be prevalent and prevention orintervention efforts are considered a failure ("Child," 1999; Gelles,1998). C., Baughan, B. (1999). Archivesof General Psychiatry, 56, 6 -6 6. In conclusion, research has demonstrated that childhood sexual abuseresults in many adult problems, to include depression and anxiety. Childhood physical and sexual abusein patients with anxiety disorders and in a community sample. Subjects ranged from age 18 to 87years, 67% were married, 5 % were housewives and 27% were employed fulltime, and 8 % had at least one child. R. Studies with clinical populations appear to be more prevalent thanthose with nonclinical populations, and studies tend to have larger samplesizes for women compared to men. Findings of their studydemonstrated that sexual abuse and psychological maltreatment were stronglyassociated to trauma symptomatology and self depreciation. The American Journal of Psychiatry, 156(6),816-828. EFFECTS OF CHILDHOOD SEXUAL ABUSE ON FEMALE & MALE ADULTS I. Aself-report scale to diagnose major depressive disorder. A one-day test-retest correlation of .98 demonstrates excellent stability. Tenof the 12 categories of personality disorder symptoms categorized by theDSM-IV were related to this abuse (Johnson, Cohen, & Brown, 1999, p. Childhood sexual abuse was found in 45.1% of women with anxietydisorders compared to controls (15.4%), and it was found in 6 . (2 ). F., & Reiser, E. Inventory to Diagnose Depression (IDD). Childhood Sexual Abuse Sexual abuse of children has been reported 8 , times a year andthe numbers of unreported cases is considered to be even greater. Hypothesis 5: There will be a significant difference between femalevictims and male victims, regarding scores on the IDD. 972). 236, 239). It assesses symptom duration, severity, and presence ofsymptoms. American Journal of Drug and Alcohol Abuse,25(4), 593-6 8. The use of an equal group, nonclinical population willprovide unique results. Childhood maltreatment and college drop-outrates: Implications for child abuse researchers. AmericanJournal of Psychiatry, 153(2), 275-278. Self-mutilating behavior (SMB) is also found in childhood sexuallyabused female adults. Childhood trauma and dissociation in adulthood.American Family Physician, 6 (3), 972. (1998). Those regarding male victims tend to focus on sexualidentity issues (Ferren, 1998). The male survivor: The impact of sexual abuse.The Canadian Journal of human Sexuality, 7(2), 17 -173. JAMA, 275(22), 7 8. Clinical Anxiety Scale (CAS). In a case studyof three men who were sexually abused as children, Gilgun and Reiser (199 )found that although sexual orientation was not affected by the abuse in twosubjects, silent suffering was a part of the process of coming to termswith heterosexual sexual identity. L. Research demonstrated that child abuse results in adult socialproblems, beginning with adolescence. The Brown University Child and Adolescent BehaviorLetter, 14(8), 1 . Therefore, a study is needed toinvestigate specific effects of depression and anxiety for the nonclinicalfemale and male adult population, with equal sample groups representingeach population. References Apgar, B. (199 ). (1998). Effects of Childhood Sexual Abuse Higgins and McCabe (2 ) report that different types of childhoodmaltreatment result in different adjustment problems in adulthood. (1999).Histories of childhood trauma and the effects on risky HIV behaviors in asample of women drug users. Research Questions & Hypotheses The research questions are as follows: What are the effects ofchildhood sexual abuse on levels of depression and anxiety in female andmale adults? S. Additional limitations of this study maybe volunteer bias, subject group size, and geographic location. By age 32 years, nearly half ofthe abuse victims had been arrested for a nontraffic offense (Maxfield &Widom, 1996, p. Highestdissociative scores were associated with those sexually abused by familymembers, non-family members, and combined sexual and physical abuse; thosewho had mothers who drank heavily had the most significant levels ofsymptoms (Apgar, 1999, p. Journal ofInterpersonal Violence, 13(4), 427-438. B., Walker, J. A group of 25 maleswith prior childhood sexual abuse will be compared to a group of 25 maleswith no prior childhood sexual abuse on effect variables. Thus adults may not beaware of what they have experienced as a child, and they may not be able toreport it. F.,DeChant, H. It isunclear whether programs are simply inappropriate, too small, or beingimplemented improperly. (1999). LITERATURE REVIEW This review of the literature concerning the effects of childhoodsexual abuse on adult females, will address the following areas relevant tothe study: an overview of childhood sexual abuse; effects of childhoodsexual abuse, female and male; specific effects of depression and anxiety,and study design. A.,Eldridge, G. It was also found that SMB was correlated with sexualabuse, to the extent that it may be considered a signal for the presence ofthis abuse. Two formats for eliciting retrospective reports of childsexual and physical abuse: Effects on apparent prevalence and relationshipsto adjustment. L. Hypothesis 6: There will be a significant difference between femalevictims and male victims, regarding scores on the CAS. Female victimswill be compared to male victims.
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