Sensitivity of the Addiction Severity Index physical and sexual assault items: preliminary findings on gender differences.

OBJECTIVE: Evaluation of the Addiction Severity Index (ASI) as a screen for identifying sexual and physical assault histories. METHOD: The sensitivity and specificity of the ASI assault items were examined in 146 alcoholic patients with the assault questions of the Composite International Diagnostic Interview posttraumatic stress module as external criterion. RESULTS: The sensitivity of the ASI items was lower than their specificity for both physical (sensitivity = 0.35, specificity = 0.83) and sexual abuse (sensitivity = 0.69, specificity = 0.94). These findings indicate an underestimation of such abuse histories in male patients due to screening for a narrow range of possible perpetrators. CONCLUSION: The ASI method as a screen for sexual and physical assault histories could be improved, considering that men clearly outnumber women in persons applying for alcohol treatment.

Childhood trauma and perceived parental dysfunction in the etiology of dissociative symptoms in psychiatric inpatients.

OBJECTIVE: Research on the etiology of dissociation in adults has focused primarily on childhood sexual abuse. The role of co-occurring childhood stressors and of more chronic adverse conditions such as neglect is less clear. This study examined the level of dissociation in relation to childhood trauma (sexual/physical abuse, witnessing interparental violence), early separation from a parent, and perceived parental dysfunction. METHOD: One hundred sixty inpatients consecutively admitted to a general psychiatric hospital were administered the Dissociative Experiences Scale and the Structured Trauma Interview. RESULTS: The mean Dissociative Experiences Scale score was 17.4; 18.0% of the patients scored beyond 30. Early separation was reported by 26.4% of the patients; 30.1% had witnessed interparental violence; 23.6% reported physical abuse; 34.6% reported sexual abuse; 11.7% reported rape before age 16; and 42.1% reported sexual and/or physical abuse. The level of dissociation was primarily related to reported overwhelming childhood experiences (sexual and physical abuse). When sexual abuse was severe (involving penetration, several perpetrators, lasting more than 1 year), dissociative symptoms were even more prominent. Highest dissociation levels were found in patients reporting cumulative sexual trauma (intrafamilial and extrafamilial) or both sexual and physical abuse. In particular, maternal dysfunction was related to the level of dissociation. With control for gender and age, stepwise multiple regression analysis indicated that the severity of dissociative symptoms was best predicted by reported sexual abuse, physical abuse, and maternal dysfunction. CONCLUSIONS: These findings indicate that dissociation, although trauma-related, is neglect-related as well. This implies the importance of object relations and attachment in the diagnosis and treatment of patients with dissociative disorders.

Child sexual and physical abuse and alcoholism: a review.

OBJECTIVE: To examine possible relations between child sexual or physical abuse and adult alcoholism. METHOD: Studies reviewed included prospective studies, retrospective studies on the prevalence of child sexual or physical abuse in alcoholics and nonalcoholics, and retrospective studies in mental health clients and in population samples comparing the prevalence of alcohol use disorders in abused and nonabused subjects. RESULTS: Prospective studies do not indicate a significant association between child sexual or physical abuse and alcoholism. In contrast, studies among alcoholic women do suggest a relationship. Also, a significantly higher prevalence of alcohol problems in abused women than in nonabused women is found in population samples. The results of studies among mental health clients are inconclusive. In addition, several methodological limitations should be taken into consideration when evaluating results of the available studies. CONCLUSIONS: Current evidence is insufficient to draw conclusions about relationships between child sexual or physical abuse and alcoholism among men. Among females, however, there is a higher likelihood of alcohol problems if they were sexually or physically abused as children.