Attachment, Sense of Entitlement in Romantic Relationships, and Sexual Revictimization Among Adult CSA Survivors.

Insecure attachment orientations are disproportionately frequent in child sexual abuse (CSA) survivors and have been found to mediate some of the effects of CSA on adult interpersonal and romantic difficulties, including sexual revictimization (SR). A sense of relational entitlement (SRE) has received growing attention in psychological discourse and research in recent years. It reflects both adaptive (assertive) and pathological (restricted or inflated) attitudes to the assertion of needs and rights and has not been studied in adult CSA survivors. The purpose of this study was to examine associations between CSA, attachment orientations, SR, and SRE. Sixty-seven Israeli women aged 25 ± 3.95 years (30 adult CSA survivors and 37 healthy female controls with no history of CSA) completed a demographic questionnaire and self-reported measures of adult attachment orientations, sense of entitlement in romantic relationships, and adult SR. CSA survivors reported greater attachment anxiety and attachment avoidance, more restricted SRE, and higher revictimization rates than control women. No difference was found between the groups in inflated SRE. In the CSA but not the control group, anxious and avoidant attachment orientations were significantly and negatively associated with assertive SRE. Insecure (anxious and avoidant) attachment fully mediated the association between CSA and restricted SRE. Our findings suggest that the interplay between insecure attachment and CSA is related to a sense of impaired assertive entitlement and elevated restricted entitlement in adult CSA survivors. This entitlement pattern can be destructive to survivors' romantic relationships and should be addressed in therapy.

Predictors of Clinical Outcomes in Sexually Abused Adolescents.

This cross-sectional, case control study examines the association between child sexual abuse and interpersonal and intrapersonal outcomes among 54 adolescents, examining specific clinical measures (depression, anxiety, dissociation, and posttraumatic stress disorder, attachment patterns, self-esteem, self-disclosure, and family environment characteristics). The research results point to a correlation between sexual abuse and higher levels of the clinical measures. In addition, a correlation was found between sexual abuse and level of avoidant attachment, self-esteem, and family environment characteristics. Stepwise hierarchical regressions were conducted to examine how adolescent attributes predicted depression, anxiety, and dissociation beyond the prediction based on sexual abuse. A combination of self-esteem, anxiety attachment, and family cohesiveness made sexual abuse insignificant when predicting levels of depression, anxiety, and dissociation. This study contributes to characterizing the emotional, personal, and family attributes of adolescents who experienced sexual abuse. It also raises questions about the clinical outcomes usually associated with sexual abuse.

Psychophysiological Reactivity in Child Sexual Abuse.

Sexual abuse has physiological and emotional implications. The purpose of this study is to evaluate the neurobiological sequels of childhood sexual trauma by monitoring physiological variables among sexually abused girls and women compared to controls. We assessed posttrauma and traumatic life events of 35 females sexually abused in their childhood (age range 7-51 years) and 25 control females (age range 7-54 years). Electroencephalography, frontalis electromyography, electrodermal activity, and heart rate parameters were recorded while watching sets of pictures representing neutral and trauma-suggestive stimuli. A minority of participants met the Diagnostic and Statistical Manual of Mental Disorders criteria for post-traumatic stress disorder. Abused females displayed significant elevations in heart rate, electromyography, and electroencephalography while viewing allusive stimuli and elevated heart rate while viewing neutral stimuli. The dysfunctional regulation of the physiological stress system associated with child sexual abuse may endanger the victims with various stress and anxiety disorders.

Sexual revictimization: the impact of attachment anxiety, accumulated trauma, and response to childhood sexual abuse disclosure.

It has been proposed that a complexity of personal, interpersonal, and environmental factors is related to sexual revictimization among childhood sexual abuse survivors. In this study, we investigated the relations between attachment dimensions, exposure to accumulated childhood traumas, reaction to childhood sexual abuse disclosure, and adult sexual revictimization. Participants were 60 Israeli women with histories of childhood sexual abuse. Seventy percent of the women reported adult sexual revictimization. Revictimization was related to higher attachment anxiety but not to higher attachment avoidance. Revictimization was also related to emotional and physical child abuse but not to emotional and physical child neglect. Revictimization rates were higher among women who had received negative environmental responses following childhood sexual abuse disclosure than among women who had received supportive reactions and those who had not disclosed childhood sexual abuse at all. Findings were significant even after controlling for severity of childhood sexual abuse. The findings emphasize the role of various contextual-interpersonal factors on revictimization vulnerability among the survivors of childhood sexual abuse.

Brief parent-child group therapy for childhood anxiety disorders: a developmental perspective on cognitive-behavioral group treatment.

The use of cognitive-behavioral group psychotherapy in treating childhood anxiety disorders has become widespread. This paper examines the dynamic processes underlying cognitive-behavioral group treatment for children with anxiety disorders and for their parents, with particular focus on the process of separation-individuation. Both children and their parents were empowered through processes of sub-grouping and thus helped to differentiate and separate. We consider this parallel dynamic process an important factor that can enhance cognitive-behavioral treatment.

Reboxetine maintenance treatment in children with attention-deficit/hyperactivity disorder: a long-term follow-up study.

OBJECTIVE: This open-label study assessed the long-term effectiveness and tolerability of reboxetine maintenance treatment in children with attention-deficit/hyperactivity disorder (ADHD). METHODS: Six children aged 9-13 (mean +/- standard deviation, SD, 10.7 +/- 1.6) years, diagnosed with ADHD and successfully treated with reboxetine for 6 weeks were enrolled in a long-term (18-36 months) follow-up study. Assessments included rater-administered scales (ADHD Rating Scale; Clinical Global Impressions Scale) and a parent-administered scale (the Abbreviated Conners' Rating Scale). The safety and tolerability were evaluated by documenting spontaneous self-reported adverse effects as well as by vital signs, electrocardiogram, body weight, and routine blood screen. Reboxetine was maintained at a dose of 4 mg/day. RESULTS: The children were followed up to 36 months (mean +/- SD, 24 +/- 6.6; range, 18-36). The significant decrease in ADHD symptoms achieved in the short-term phase (first 6 weeks) was maintained throughout the study. No new onset adverse effects was detected during this follow-up period. No suicidal attempt or ideation was noted. CONCLUSIONS: The results suggest the long-term effectiveness and safety of reboxetine maintenance treatment in children with ADHD. Future large-scale, long-term, placebo/comparator-controlled studies should assess the benefit/risk ratio of reboxetine in ADHD children.

Is elective surgery traumatic for children and their parents?

AIM: The emotional consequences of elective surgery to children and to their parents have not been sufficiently studied. The aim of the present study was to prospectively assess the prevalence and severity of post-traumatic, anxiety and depressive symptoms in this population. METHODS: Forty children and adolescents consecutively admitted for elective surgery in a general hospital participated in the study. Their parents were also assessed. The assessments were made on the day of admission and surgery, and 1 and 6 months after the surgery. RESULTS: Minor post-traumatic symptoms of the children were noted at the first and second assessments, decreasing significantly at the 6-month assessment. Further, the prevalence of children with elevated post-traumatic symptoms decreased significantly between the first and second assessments. Parents scored highest for anxiety and depression at the first assessment. Their symptoms, however, decreased significantly within 1 month. A significant decrease between the first and second assessments was also noted in the prevalence of parents with elevated anxiety symptoms. At the 1- and 6-month follow-up assessments, there was a significant correlation between the children's symptoms and their parents'. CONCLUSION: Mild post-traumatic symptoms may accompany paediatric elective surgery and persist for at least 1 month. Parents may also manifest anxiety and depressive symptoms, which may diminish earlier, that is, immediately after the surgery or within 1 month.