"Eat more protein, build more muscle": A grounded theory study of muscle-building behaviors among Canadian adolescents and young adults.

Unique risk factors for the development of muscle dissatisfaction and engagement in muscle-building behaviors have been described by theoretical frameworks and supported by empirical research. What remains unknown are the unique processes, including catalysts and facilitators, which underpin engagement in muscle-building behaviors. Therefore, this study used a grounded theory methodology to elucidate the process of engagement in muscle-building behaviors. Thirty-three individual semi-structured interviews with Canadian adolescents and young adults ages 16-30 years were conducted. Transcripts were analyzed using initial and focused coding to identify themes that explained the grounded theory. The core theme underpinning the grounded theory was balancing aesthetic, health, and functional goals in relation to participants' engagement in muscle-building behaviors. Participants described experiences that encompassed several unique phases of muscle-building engagement, including the initiation phase, beginner phase, preservation phase, and intensification phase. Participants also described unique methods of gathering information on muscle-building behaviors, and their own analysis and decision-making processes driving their behaviors. Findings from this study extend prior theory and research by conceptualizing a novel process theory of engagement in muscle-building behaviors among adolescent and young adults, resulting in important implications for research and practice.

The Legacy of Shame following Childhood Sexual Abuse Disclosures.

Shame has been recognized as a barrier to child sexual abuse (CSA) disclosures, but there has been less focus on the impact of shame on post-disclosure. This study explores how shame is experienced by CSA survivors following disclosure. Semi-structured interviews were conducted with eleven CSA survivors aged 14-25 years on their CSA disclosure experiences. Thematic analysis of the transcripts produced four themes that highlight the various impacts of shame post-disclosure: 1) struggles with identifying as a sexual abuse survivor; 2) manifestations of shame; 3) shaming responses to disclosures; and 4) strategies to overcome shame. Clinical implications are presented using a social ecological perspective.

Bringing Shame Out of the Shadows: Identifying Shame in Child Sexual Abuse Disclosure Processes and Implications for Psychotherapy.

Child sexual abuse (CSA) has been described as a highly stigmatizing experience. Despite the recognition of shame as a significant contributor to psychological distress following CSA, an inhibitor of CSA disclosure, and a challenging emotion to overcome in therapy, limited research has explored the experience of shame with young people who have been sexually abused. This study is unique in examining the transcripts of 47 young people aged 15-25 years from a large-scale study conducted in Ireland and Canada and exploring manifestations of shame in CSA disclosure narratives. Using a thematic analysis of both inductive and deductive coding, the data were examined for implicit, as distinct from explicit, manifestations of shame. Three key themes were identified in this study: languaging shame, avoiding shame, and reducing shame. The study supports previous authors in highlighting the need for nuanced measures of shame in research that takes account of the complexity of this emotion. Conceptualizations in the literature of the distinction between shame and guilt are challenged when these emotions are explored in the context of CSA. Finally, recommendations for working therapeutically with young people who have experienced CSA are offered with a view to addressing shame in therapeutic work.

"It's Complicated Because We're Only Sixteen": A Framework for Understanding Childhood Sexual Abuse Disclosures to Peers.

The process of disclosing childhood sexual abuse (CSA) is very difficult for young people. Researchers have consistently found that young people disclose CSA to other youth at much higher rates than to familiar adults or authorities and indicate that CSA remains largely unknown to adults. However, no study to date has focused exclusively on understanding the process of youth-directed disclosures from young people's perspectives. Using grounded theory methodology, this qualitative study aimed to understand the process of CSA disclosures to peers based on interviews with 30 young people from Canada and Ireland who have experienced CSA. The findings reflect the iterative and dialogical nature of the peer disclosure process and provide a framework for youth-directed disclosures that is centered on the theme of uncertainty. An underlying sense of uncertainty permeated the entire disclosure experience as participants' narratives reflected six stages that were interrelated in a cyclical process: experiencing internal conflict, needing to tell and choosing to confide in peers, expecting emotional support from peers, gradual telling and making sense of the abuse, burden on peers, and assessing peer responses and further disclosures. In addition, this model was not static, as with time, participants reinterpreted their peers' responses. The presented framework is consistent with previous conceptualizations of CSA disclosures, but the focus on youth-directed disclosures from the perspective of young people also allowed for a model that explains processes that are unique to peer disclosures. Practice and policy implications as well as limitations and future research directions are discussed.

Intersectional and Trauma-Informed Approaches to Employment Services: Insights From Intimate Partner Violence (IPV) Service Providers.

This article presents qualitative findings from a constructivist grounded theory study that examines intimate partner violence and employment-seeking from the perspectives of 10 service providers. Three distinct themes emerge through analysis: (a) understanding the intersecting barriers to employment faced by survivors, (b) integrated approaches to employment services, and (c) barriers to providing employment services. Findings have important theoretical implications on the intersectional nature of employment-seeking and provide insight into IPV service responses.

"How many times did I not want to live a life because of him": the complex connections between child sexual abuse, disclosure, and self-injurious thoughts and behaviors.

BACKGROUND: Meta-analyses have confirmed an association between child sexual abuse (CSA) and non-suicidal and suicidal self-injurious thoughts and behaviors (SITB), yet the mechanisms linking these factors are, to date, poorly understood. The goal of the current study is to explore one potential influencing factor acting in the association between CSA and SITB, which is the disclosure experience. Disclosure has been identified as a prominent factor in the healing process of survivors, with a lack of support following disclosures heightening negative outcomes. Exploring the impact of CSA disclosure on SITB is necessary to build effective prevention and intervention strategies. METHODS: This qualitative study is part of a larger initiative spanning diverse research sites in Canada and in Ireland and aiming to lend voice to young people who were sexually abused in childhood/adolescence. Participants were recruited from community-based sexual abuse/assault agencies, hospital-based specialized clinics and child advocacy centres. The Long Interview Method, based on a branch of phenomenology, was used to guide research design and data collection. The current thematic analysis, informed by a stress-diathesis model, is based on a sample comprised of 21 ethnically diverse youth aged 15 to 25 who self-reported a sexual abuse experience in their childhood or teenage years and who, as part of the interview on their disclosure processes, revealed past or current SITB. RESULTS: The thematic analysis led to the identification of four main themes that both confirmed past research and conceptual models on SITB, and provided new insights. Participants perceived a clear link between their CSA experience and SITB and other mental health issues. They offered their views on the meanings of SITB for CSA victims: to cope with abuse; to end the abuse; to express self-hatred and loneliness; and to let people know about their suffering. They described how negative disclosure experiences led to more nonsuicidal and suicidal SITB. Yet, participants also revealed that receiving support for their SITB created opportunities for CSA disclosure and support. CONCLUSIONS: This study showed complex connections between CSA experiences, disclosure and nonsuicidal and suicidal SITB. Understanding the reciprocal influences between SITB, CSA disclosure and help-seeking could better equip mental health professionals and caregivers to provide support and foster healing and recovery in CSA victims.

A scoping review on psychosocial consequences of pandemics on parents and children: Planning for today and the future.

The COVID-19 worldwide pandemic has forced individuals into an unnatural way of life. Families with children experience unique stressors, such as school closures, disrupted childcare arrangements, requirement of parents to uptake additional responsibilities such as homeschooling, possible financial strain, and lack of breathing space between family members. The adjustments required of parents and children during a pandemic presumably impacts the psychosocial wellbeing of parents and children in different ways. To better under the psychosocial consequences of pandemics on parents, children, and youth, this scoping review used Arksey and O'Malley (2005) five-stage framework to examine the existing research literature on Severe Acute Respiratory Syndrome (SARS), Influenza Type A virus (H1N1), and COVID-19 to answer the following two research questions: (1) What are the psychosocial consequences of pandemics on parents of children and youth? (2) What are the psychosocial consequences of pandemics on children and youth? With the application of inclusion criteria, 29 articles were selected for analysis. Four major themes, including sub-themes emerged: 1) Each family members' emotions influence one another; 2) Parents experience greater levels of psychosocial problems than adults without children; 3) During a pandemic, parents require informal (social) and formal (specialized professional) support and; 4) Psychosocial consequences of pandemics on children/youth are understudied, indicating the need for more research on children/youth under the age of 20 years. Clinical prevention and intervention suggestions to support the psychosocial wellbeing of parents, children and youth during a pandemic are discussed.

Achieving Recovery Through Resilience: Insights From Adults in Midlife Living With Anorexia Nervosa.

Despite the high percentage of adults living with anorexia nervosa (AN) over the life course, there is limited understanding of what it means to be living with AN in midlife when the majority of research has focused on adolescents and young adults. As such, clinical practice for individuals in midlife is informed by a severe and enduring AN (SE-AN) framework, which assumes that recovery is not necessarily feasible past young adulthood. This study used constructivist grounded theory methodology to understand the experiences of adults in midlife living with AN. In-depth analyses of 19 participant narratives in midlife show that individuals face barriers to seeking help or remaining in recovery; however, midlife can also act as a significant catalyst toward recovery. Subsequently, there is merit in revisiting the utility of the SE-AN framework in the context of life course theory and exploring resilience-informed approaches in supporting recovery from AN.

"Like Opening Up Old Wounds": Conceptualizing Intersectional Trauma Among Survivors of Intimate Partner Violence.

Despite increasing acknowledgment of intimate partner violence (IPV) as a potentially traumatic experience, there is a gap in research investigating women's perspectives of trauma related to their experiences of IPV from an intersectional lens. Intersectionality, which illuminates interconnected inequalities due to constructions of race, gender, sexuality, class, and culture, is particularly important for exploring the broader contexts of women's experiences of IPV and trauma. In response to this dearth in research, this paper presents qualitative findings from a constructivist grounded theory study of 15 women's experiences of IPV and trauma. To conceptualize IPV-related trauma from an intersectional lens, this study addressed the following research questions: (a) How do women who have experienced IPV understand and view trauma? (b) What do women who have experienced IPV indicate are experiences of trauma? and (c) How do women's differing identities, experiences of oppression, or other hardships or adversities relate to their experiences of IPV? Through analysis, six distinct themes were identified: (a) changing perceptions of trauma; (b) the pain of trauma; (c) fear, anxiety, and triggers; (d) lasting impact of trauma; (e) struggle for acceptance; and (f) growth and insight. Implications from these findings illustrate the pervasiveness of IPV and other forms of trauma among women who have been abused by a partner, the long-lasting traumatic impacts of IPV, and the multiple experiences of being blamed and not believed that many women have experienced. These findings represent first steps in understanding the relationship between IPV and trauma from the perspectives of women who have survived IPV, offering an important contribution to previous knowledge on IPV. As well, this study provides first steps in understanding the interacting, intersectional effects of multiple forms of adversity, oppression, and IPV, and their relationships to trauma.

"I never told anyone until the #metoo movement": What can we learn from sexual abuse and sexual assault disclosures made through social media?

BACKGROUND: Social media is providing new avenues for survivors to disclose sexual abuse and/or assault. Since the creation of #MeToo (2017), and the larger MeToo movement founded by American activist Tarana Burke in 2006, millions are disclosing sexual assaults and past childhood sexual abuse on-line. OBJECTIVE: Social media for disclosing the highly stigmatized problem of sexual abuse/assault was studied to build knowledge about on-line disclosures. PARTICIPANTS AND SETTING: Participants were tweeters and posters on Twitter and Reddit. Purposive sampling captured on-line sexual abuse/assault disclosures from September 28, 2018 to October 16, 2018 for thematic analysis. METHOD: Using a phenomenological design 171 social media posts were analyzed for deeper understanding into new options for disclosing sexual abuse and/or sexual assault. Posts were independently coded by the authors. Sampling was stopped when categorical saturation was reached with no new information coming forward on the research question. RESULTS: Themes that emerged showed the MeToo/#MeToo movement is precipitating sexual abuse/assault disclosures on social media in unprecedented ways; posters identified internal barriers, mixed responses from family, and friends/peers, as well as variable responses from professionals. While some conditions for sexual abuse/assault disclosures have improved, barriers still exist. CONCLUSION: Social media represents an environmental shift for disclosing sexual violence. Sexual abuse/assault survivors have found voice through social media after periods of silence and being silenced, turning to posting on-line when people and systems have failed to validate and support them. Further investigation is needed on the impacts of on-line sexual abuse and/or assault disclosures.

Disclosure among victims of elder abuse in healthcare settings: a missing piece in the overall effort toward detection.

Elder abuse remains a largely hidden problem in our society and only a small minority of victims are connected to formal support/protective services. Healthcare settings have been identified as a critical milieu to uncover cases of elder abuse; however, under-detection in these settings is a major issue. Victimization disclosure is an important component within the overall detection effort, yet it has received little attention in the elder abuse literature. Drawing on relevant literature from other domains of family/interpersonal violence, this article highlights the disclosure process, as well as disclosure barriers, facilitators, and competencies to consider when working with older adults.

Facilitators and Barriers to Child Sexual Abuse (CSA) Disclosures: A Research Update (2000-2016).

Identifying and understanding factors that promote or inhibit child sexual abuse (CSA) disclosures has the potential to facilitate earlier disclosures, assist survivors to receive services without delay, and prevent further sexual victimization. Timely access to therapeutic services can mitigate risk to the mental health of survivors of all ages. This review of the research focuses on CSA disclosures with children, youth, and adults across the life course. Using Kiteley and Stogdon's literature review framework, 33 studies since 2000 were identified and analyzed to extrapolate the most convincing findings to be considered for practice and future research. The centering question asked: What is the state of CSA disclosure research and what can be learned to apply to practice and future research? Using Braun and Clarke's guidelines for thematic analysis, five themes emerged: (1) Disclosure is an iterative, interactive process rather than a discrete event best done within a relational context; (2) contemporary disclosure models reflect a social-ecological, person-in-environment orientation for understanding the complex interplay of individual, familial, contextual, and cultural factors involved in CSA disclosure; (3) age and gender significantly influence disclosure; (4) there is a lack of a life-course perspective; and (5) barriers to disclosure continue to outweigh facilitators. Although solid strides have been made in understanding CSA disclosures, the current state of knowledge does not fully capture a cohesive picture of disclosure processes and pathways over the life course. More research is needed on environmental, contextual, and cultural factors. Barriers continue to be identified more frequently than facilitators, although dialogical forums are emerging as important facilitators of CSA disclosure. Implications for practice in facilitating CSA disclosures are discussed with recommendations for future research.

From Freud to Feminism: Gendered Constructions of Blame Across Theories of Child Sexual Abuse.

Most theories of child sexual abuse are, to some degree, gendered, with nonoffending mothers bearing the burden of blame, ideologically and legally, for the transgressions of predominantly male offenders. This article explores the social construction of blame for child sexual abuse via critical analyses of evolving theoretical perspectives on maternal culpability for the inception and maintenance of abuse dynamics. Drawing on selected conceptual and research knowledge that supports and refutes anecdotal claims, this synthesis of the literature culminates in the proposal of an evidence-informed, feminist-grounded, multitheoretical child sexual abuse framework that disrupts dominant mother-blaming discourse and guides socially just and ethically responsive policy, practice, and research.

Sexual abuse images in cyberspace: expanding the ecology of the child.

Cyberspace has added a new dimension to the ecology of children made the subjects of sexual abuse images distributed online. These images cannot be permanently removed and can continue to circulate in cyberspace forever. A review of the current literature suggests that helping professionals are not consistently aware of or do not probe possibilities of online sexual victimization in the investigation, assessment, and treatment of child sexual abuse. Nor is this issue adequately addressed in their education and training. There are gaps in the literature regarding how to identify and provide treatment for these children. New assessment and treatment targets are needed to enhance existing practice approaches. A contemporary ecological model that incorporates an explicit consideration of the cybersystem is provided as a starting point for practitioners to be aware of the possibility that images of child sexual abuse were recorded and distributed online.

An ecological analysis of child sexual abuse disclosure: considerations for child and adolescent mental health.

OBJECTIVES: Research continues to indicate a concerning number of children and youth, between 60-80%, withhold disclosure until adulthood suggesting that many children endure prolonged victimization or never receive necessary intervention. The study aim was to qualitatively identify factors that impede or promote child sexual abuse (CSA) disclosure. METHODS: Using a phenomenological design, forty adult survivors of CSA were interviewed about their disclosure experiences to provide retrospective accounts of their childhood and adolescent abuse experiences, disclosure attempts, and meaning-making of these experiences. RESULTS: Findings show that disclosure is multiply determined by a complex interplay of factors related to child characteristics, family environment, community influences, and cultural and societal attitudes. An ecological analysis is offered to understand these complexities. Unless barriers to disclosure are eradicated, negative effects of CSA can persist manifesting in serious mental health issues. CONCLUSIONS: Practitioners can expect to work with children, adolescents and adults who have withheld disclosure or attempted to tell over time having experienced a wide range of responses. Multi-level intervention is recommended at the individual, community and macro-levels. Future investigations should focus on how to identify and measure the impact of community and macro level factors on disclosure, aspects that have received much less attention.

Intimate partner violence and immigration laws in Canada: how far have we come?

Immigrant women face numerous, and sometimes insurmountable, barriers in reporting and seeking services for intimate partner violence (IPV). A number of these obstacles relate to immigration laws, policies and legal processes they encounter due to their immigration status and sponsorship relationship. The present study was conducted in Canada, in an urban centre that boasts one of the largest immigrant populations in the world. Using a focus group methodology within a participatory action research framework, this investigation sought to identify factors that facilitate or impede women from coming forward and disclosing IPV, and traced their help-seeking actions. Qualitative data from helping professionals and women reveal that in cases of sponsorship breakdown due to IPV, the criteria required for a viable immigration application are unrealistic, and in many cases impossible to meet in situations of domestic abuse. These data indicate that despite claims to the contrary, laws and policies related to immigration have remained stable for over a decade. Systemic and structural barriers that these create for abused women are still clearly present in immigration laws and policies. The result is that many women stay in abusive relationships, often with their children, for prolonged periods of time accruing serious negative mental health effects. Implications are discussed to help inform policy and practice.

And justice for all? Aboriginal victims of sexual violence.

Concern for the recognition, support, and rights of victims within the criminal justice system has grown in recent years, leading to legislative and procedural changes in the administration of justice that have improved the experiences of victims. What is not clear is whether all victims have benefited from changes in the system regardless of race and social class. This study investigates the experiences Aboriginal people who are victims of sexual violence have with the Canadian criminal justice system. The authors seek to explore perspectives about their encounters with the judicial system from the point of first contact with the police through involvement with the court and community service providers, utilizing grounded theory qualitative methodology. They conclude that race is a key determinant in the manner in which a victim will be perceived by the people in the justice system and the manner in which the victim will approach the judicial process.

Against the odds: the impact of woman abuse on maternal response to disclosure of child sexual abuse.

Although the co-occurrence of woman abuse and child sexual abuse is high little research exists exploring the impact of woman abuse on maternal response to child sexual abuse (CSA). Findings from two qualitative studies indicate the form of woman abuse to have differential impact on maternal response. Mothers who were abused in non-physical ways, psychological, or emotional, displayed more ambivalent, less supportive responses. Mothers who were physically abused by their partners more often acted supportively to their children and displayed less ambivalence about separating from the perpetrator. Some survivors reported non-disclosure as children because of their fear of the perpetrator due to the woman abuse they were exposed to while being sexually abused. Practice and research implications are discussed.

Many ways of telling: expanding conceptualizations of child sexual abuse disclosure.

OBJECTIVE: The aim of this study was to explore influences that inhibit or promote child sexual abuse (CSA) disclosure. METHOD: Face-to-face in-depth interviews of 24 female and male survivors of CSA were conducted, using the Long-Interview method to trace disclosure processes. Verbatim transcriptions of the interviews were analyzed by hand and by using a computerized data analysis system (N*Vivo). The results of this investigation identified several patterns of disclosure. Prolonged engagement, persistent observation, negative case analysis, and peer debriefing were among the techniques used to ensure the trustworthiness of data. RESULTS: Through analysis of the interview data, previously undefined dimensions of disclosure emerged. First, three frequently used categories of 'accidental, purposeful, and prompted/elicited' disclosure types accounted for 42% of disclosure patterns in the study sample. However, over half the disclosure patterns described by research participants did not fit these previously established definitions. Results of the study facilitated expanding conceptualization of additional disclosure patterns to include behavioral and indirect verbal attempts, disclosures intentionally withheld, and disclosures triggered by recovered memories. CONCLUSIONS: The author concludes that these supplementary definitions integrate complex facets of disclosure derived within the context of human development, memory and environmental influences. This expanded conceptualization provides professionals with a broader framework to understand and respond to child victims and adult survivor's disclosures more effectively.