Memory of childhood sexual abuse among clinicians: characteristics, outcomes, and current therapy attitudes.

This paper reports preliminary data on a sample of therapists with memory of childhood sexual abuse. Therapists who reported experiencing childhood sexual abuse (CSA, n = 131) were compared with therapists who suspected sexual abuse but had no memories (n = 24) on variables related to abuse characteristics, outcomes, and perceived difficulties working with clients with a CSA history. Therapists who suspected abuse, in contrast to those who made definite reports, were more likely to report that the perpetrator was a family member, that their CSA did not involve physical contact, that there was alcoholism in their families of origin, and that the CSA had negative effects on their relationships with their own children, ability to trust others, sexual satisfaction, and work life. Therapists who suspected abuse also reported more difficulty treating CSA clients because of interpersonal pulls during sessions, arousal without memories of abuse, and some countertransferential behaviors. These findings indicate that issues related to personal trauma should be addressed during training and practice.

Labeling partner violence: when do victims differentiate among acts?

Domestic violence professionals have debated whether all physical assaults by partners should be labeled abuse. This study examined the use of labels such as "abuse," "victim," and "battered woman" in a sample of women (n = 78) who had sustained at least one physical assault in their current or most recent relationship. Self-labeling followed a differentiating strategy, that is, women experiencing more frequent and more severe assaults were more likely to apply labels. Lower partner income, being Black, lower relationship commitment, and having ended the relationship also were associated with increased self-labeling. Labeling of hypothetical acts followed an inclusive strategy, that is, all assaults were considered abusive. These results suggest that contextual factors influence labeling. Prevention and intervention programs may be able to increase their effectiveness by including more situational context in their messages.

The importance of community in a feminist analysis of domestic violence among American Indians.

There are over 500 native communities in the United States alone. Although popular conceptions in the majority culture commonly refer to these as a single American Indian group, native communities are in fact extremely diverse and heterogeneous. Issues of gender, class, and power are discussed from a feminist perspective with an emphasis on the diversity among native communities. Available evidence, while sketchy, suggests that male authority, male restrictiveness, and socioeconomic stress are associated with violence, but that the levels of these factors vary widely across native groups. For example, some native tribes practice matrilineal descent while others are patrilineal. This diversity has far-reaching implications for the community context in which domestic violence occurs. An approach that integrates both feminist and community approaches seems best suited to address the problem of domestic violence in native North America.

The victimization of children: recommendations for assessment and instrument development.

The study and treatment of juvenile victimization would greatly benefit from instruments that are comprehensive, methodologically sound, and relevant to settings such as health and mental health clinics, criminal justice institutions, and child protection agencies. Toward these ends, this article makes 20 recommendations. Among other things, instruments should (1) allow victimization to be mapped onto conventional crime and child protection system categories; (2) adequately assess victimization by family and other nonstranger perpetrators; (3) ask about crimes specific to childhood, such as nonviolent sexual offenses and neglect; (4) allow for comparisons between juvenile and adult victimizations; (5) collect self-report data with children as young as age 7 years; (6) use simple, behaviorally specific language; (7) protect privacy during data collection; (8) attend to potential ethnic, class, and gender differences; and (9) prepare procedures to assist children in danger. Comprehensive and well-researched instrumentation could greatly advance the study and treatment of juvenile victimization.

Identification of child maltreatment with the Parent-Child Conflict Tactics Scales: development and psychometric data for a national sample of American parents.

OBJECTIVE: To create a parent-to-child version of the Conflict Tactics Scales, the CTSPC. METHOD: Description of the conceptual and methodological approaches used and psychometric data for a nationally representative sample of 1,000 U.S. children. RESULTS: (1) Improved Psychological Aggression and Physical Assault scales. (2) New Nonviolent Discipline scale, supplementary scale for Neglect, and supplemental questions on discipline methods and sexual abuse. (3) Reliability ranges from low to moderate. (4) Evidence of discriminant and construct validity. CONCLUSIONS: The CTSPC is better suited to measuring child maltreatment than the original CTS. It is brief (6 to 8 minutes for the core scales) and therefore practical for epidemiological research on child maltreatment and for clinical screening. Methodological issues inherent in parent self-report measures of child maltreatment are discussed.

Sexually abused children in a national survey of parents: methodological issues.

In a national survey of 1,000 parents, which primarily concerned disciplinary practices and violence toward their children, two questions were asked about whether the children had been sexually abused. This was to assess the feasibility of epidemiological research on contemporaneous sexual abuse using parental interviews rather than the usual adult retrospective approach. From these questions, rates of sexual abuse for children currently 0-17 were estimated at 1.9% in the last year and 5.7% ever. The cases making up these rates included a nearly equal number of boys and girls and no female victims between the ages of 9 and 12, a distribution different from those generally obtained by other epidemiological methods, but due possibly in this case to normal sampling variation. Cases were more likely to be disclosed for children whose parents had themselves been sexually abused, who were from lower income households, or who were living with only one biologic parent. Although some of the findings suggest caution in generalizing about child sexual abuse from survey samples of parents, the method is worthy of exploration if only to gain better epidemiologic data about parent knowledge, reaction, reporting, and coping strategies.

Neuropsychological assessment of relatively intact individuals: pychometric lessons from an HIV+ sample.

The assessment of relatively intact individuals poses special problems for neuropsychologists, because fine discriminations are often needed to identify subtle deficits or gradual declines in performance. Many neuropsychological tests, however, are not well-suited for making such exact discriminations. 117 HIV+ individuals were administered 26 different neuropsychological tests that produce 48 scores. Measures of skewness and kurtosis were used to identify nonnormal sampling distributions. While many tests showed good sampling distributions, several demonstrated ceiling effects and other restrictions of range. This included some tests, such as Boston Naming and Lafayette Grooved Pegboard, that are not ordinarily considered screening instruments. Such nonnormal distributions distort the interpretation of clinical and research data, and indicate a need to use tests that are suited to the abilities of the population being assessed.

The Dominance Scale: preliminary psychometric properties.

Dominance may be the most widely mentioned risk factor for physical assaults on an intimate partner, but empirical studies have found mixed results. A new measure, the Dominance Scale, operationalizes a reconceptualization that examines three different forms of dominance: Authority, Restrictiveness, and Disparagement. Preliminary psychometric characteristics demonstrated good distributions and internal consistency in a sample of 131 undergraduates. In a comparison of Dominance Scale scores with related constructs of interest, Authority was found to be most closely related to a measure of decision-making power and to social desirability. Of the three, Restrictiveness appears to be most closely associated with partner violence, including psychological aggression, physical assault, and injury. Differences among forms of dominance may partially explain the mixed results of past research. Further validation of the Dominance Scale is planned.

The correlation between neuropsychological and neuroanatomic changes over time in asymptomatic and symptomatic HIV-1-infected individuals.

To determine the relationship between neuroanatomic and neuropsychological changes in both asymptomatic and symptomatic HIV-1-infected individuals, we conducted a longitudinal study of 47 HIV-infected individuals, 15 of whom were asymptomatic and 32 of whom had either AIDS-related complex or AIDS. To measure neuroanatomic change over a 30-month period, we conducted quantitative MRI measures of bicaudate/brain ratio (BCR) and bifrontal/ brain ratio. A comparison of change over time between BCR and neuropsychological performance showed a correlation between increase in atrophy and worsening in certain cognitive functions. The correlation held for both asymptomatic and symptomatic groups, with more pronounced changes in the symptomatic group.

Neuro-ophthalmic complications of intracranial catheters.

We report four patients who sustained direct injury to the brain after insertion of intraventricular shunts and pressure monitoring lines, which resulted in permanent neuro-ophthalmic deficits. These included hemianopsia from an optic tract lesion, esotropia and residual bilateral facial paresis from dorsal pontine injury, unilateral blindness from damage to the optic nerve, and dorsal midbrain syndrome from catheter compression in the region of the posterior commissure. Although presumably rare, such injuries should be considered in diagnosing patients with neuro-ophthalmic complaints after insertion of such devices.

Orbital compliance in Graves' eye disease.

Thirty-three patients with Graves' eye disease (GED) and 68 normal subjects had their orbital compliance measured by determining the force generated on retropulsing the eye and also estimated on digital retropulsion, and their eye position determined with an exophthalmometer. Patients with compressive optic neuropathy showed significantly higher mean forward force on retropulsion than other Graves' eye disease patients or normal subjects, supporting the theory that the tissue is compressed in these orbits. There is a suggestion that orbital compliance testing of a GED patient without compressive optic neuropathy may be of value in predicting the risk of the patient developing compressive optic neuropathy. There is no association between the force on ocular retropulsion and the exophthalmometer reading. The digital estimation of the resistance to retropulsion did not reliably suggest the measured forces.