The impact of child sexual abuse and stigma on methods of coping with sexual assault among undergraduate women.

OBJECTIVE: The aim of the current study was to determine whether a prior history of child sexual abuse increased the likelihood of using disengagement methods of coping with a sexual assault that had occurred within the past year. Once this was established, a mediational model was tested in which it was hypothesized that specific traumagenic dynamics and changed world views would mediate the association between child and/or adolescent sexual abuse and increased use of disengagement coping methods in response to a recent sexual assault. METHOD: One thousand and fifty women undergraduates from a New England state university completed a survey for research credit. Respondents were asked detailed questions regarding experiences of sexual assault within the past year, histories of child and/or adolescent sexual abuse, traumagenic dynamics, and world assumptions. Analyses were based on 106 participants who had experienced a sexual assault within the past year. RESULTS: Sexually assaulted young women with a history of child sexual abuse used more disengagement methods of coping to deal with the adult sexual assault than women without this history. In addition, the relationship between prior sexual abuse and the use of disengagement coping strategies was mediated by feelings of stigma, but not by feelings of betrayal and powerlessness or beliefs in the meaningfulness and benevolence of the world. CONCLUSIONS: This is the first study to find that sexually revictimized young women may be particularly at-risk of relying on disengagement methods of coping with sexual assault. Furthermore, this association is mediated by feelings of shame or stigma. Directions for further research and clinical implications are discussed.

Child sexual abuse prevention programs: do they decrease the occurrence of child sexual abuse?

OBJECTIVE: The primary goal of the current study was to determine whether rates of child sexual abuse differed among undergraduate women who either had or had not participated in a sexual abuse prevention program during childhood. A secondary goal was to determine whether differences emerged in sexual satisfaction or avoidance of sexual activity between those women who had or had not participated in such a program. METHOD: Eight hundred and twenty-five women undergraduates from a New England state university filled out a survey on "sexual experiences" for research credit. Respondents were asked detailed questions regarding past histories of child sexual abuse and participation in school-based prevention programs during childhood. Additionally, they responded to questions about their current sexual satisfaction and sexual behaviors. RESULTS: Sixty-two percent of the sample reported having participated in a "good touch-bad touch" sexual abuse prevention program in school. Eight percent of respondents who reported ever having had a prevention program also reported having been subsequently sexually abused, compared to 14% of respondents who did not ever have a prevention program. No differences were found in adult sexual satisfaction or on behavioral measures of sexual activity between those respondents who had and had not participated in a prevention program. CONCLUSIONS: This is the first study to find that school-based child sexual abuse prevention programs are associated with a reduced incidence of child sexual abuse. Additionally, contrary to concerns voiced in the literature, there was no evidence that prevention programs are associated with decreased sexual satisfaction or avoidance of sex in adulthood. Implications of the results for further study are discussed.

A statewide survey of age at first intercourse for adolescent females and age of their male partners: relation to other risk behaviors and statutory rape implications.

In a statewide survey of a representative sample of adolescent girls in 8th-12th grades (N = 4201), information was obtained on age at first intercourse and age of their male partners. Excluding intercourse experiences where physical force was threatened or used, 31% had intercourse by age 15 and 45% by age 16. Contrary to the impression left by studies of teenage mothers, girls who first had sex between age 13 and age 15 or between age 16 and age 18 did not have a large percentage of much older partners (5 or more years older; 12 and 7%, respectively). The percentage of much older partners was higher, however, for girls who had sex in very early adolescence, ages 11-12 (34%). Much older male partners were associated with greater problem behaviors for girls who first had intercourse in very early adolescence (11-12), but less so for those who first had intercourse between age 13 and age 15 (truancy only) and not at all for those who first had intercourse at between 16 and 18. Regardless of partner's age disparity, earlier age at first intercourse during adolescence was associated with a greater number of other problem behaviors. The implications of these findings for recent calls to enforce statutory rape laws more stringently to reduce teenage pregnancy were discussed.

Sampling of empirically supported psychological treatments from health psychology: smoking, chronic pain, cancer, and bulimia nervosa.

Interventions in health psychology and behavioral medicine represent an integral area of research for the development of psychological therapies to enhance health behaviors, manage symptoms and sequelae of disease, treat psychological symptoms and disorders, prolong survival in the face of a life-threatening illness, and improve quality of life. A sampling of interventions in health psychology and behavioral medicine is offered that meet the criteria for empirically supported treatments for smoking cessation, chronic pain, cancer, and bulimia nervosa. Evidence for empirically supported treatments is identified, along with promising interventions that do not yet meet the criteria as outlined by D. L. Chambless and S. D. Hollon (1998). Evidence for the effectiveness and clinical significance of these interventions is reviewed, and issues in this area of research are outlined.

Long-term psychological adjustment to witnessing interparental physical conflict during childhood.

A retrospective survey of undergraduate students was used to examine the long-term psychological impact of witnessing interparental physical aggression during childhood. Two hundred and three of 1,452 young adults surveyed (14%) reported witnessing as children at least one incident of physical aggression between their parents. Both men and women who witnessed interparental physical conflict reported higher levels of current psychological distress than a comparison group of young adults who never observed physical aggression between their parents. This group difference remained even after controlling for parental divorce, parental SES, physical abuse of the child, parental alcoholism, and nonphysical discord witnessed between parents. Additional analyses found that the negative effect of witnessing interparental aggression was intensified when the aggression was serious enough to warrant some type of outside assistance for the victim and when the parent of the same-sex was seen being victimized. Although these findings provided support for the theory that witnessing interparental physical aggression is a traumatic experience that may have long-term psychological ramifications, we also found that a substantial proportion of the variance accounted for in adult adjustment by interparental physical conflict was mediated through decreased parental caring and warmth during childhood. Implications for these results, limitations of the present study, and directions for further research are discussed.

The relation between methods of coping during adulthood with a history of childhood sexual abuse and current psychological adjustment.

With a community sample of 192 women who had been sexually abused during childhood, the investigators determined if methods of coping in adulthood with the aftermath of child sexual abuse were associated with current symptoms of psychological distress. Multiple regression analyses indicated that disengagement methods of coping with the sexual abuse accounted for unique variance in general psychological distress even after controlling for characteristics of the abuse and methods of coping with other stressors. Disengagement methods of coping were also used more often to deal with the stressful aspects of having been sexually abused than to deal with other stressful events. In contrast, engagement methods of coping were used more often to deal with the other stressors than with sexual abuse.

Dating violence: the association between methods of coping and women's psychological adjustment.

The present study examined the psychological impact of dating violence and the relationship between methods of coping with dating violence and psychological adjustment in a nonclinical female student population. Analyses revealed that women who experienced dating violence were at significantly greater risk than a comparison group for experiencing psychological distress. More symptoms of psychological distress were observed even after controlling for differences between the groups in histories of sexual aggression since age 16 and violence experiences in childhood including physical abuse, sexual abuse, and witnessing physical conflict between one's parents. The dating violence group was also more prone to use disengagement methods of coping to deal with nondating violence stressful life events than was the comparison group. In addition, disengagement methods of coping with the dating violence per se accounted for unique variance in psychological adjustment even after controlling characteristics of dating violence and methods of coping with other stressors.

Mediators of the long-term impact of child sexual abuse: perceived stigma, betrayal, powerlessness, and self-blame.

Using a community sample of 192 adult women who had been sexually abused during childhood, the present study tested the hypothesis that perceived stigma, betrayal, powerlessness, and self-blame mediate the long-term effects of child sexual abuse. A path analysis indicated that the level of psychological distress currently experienced by adult women who had been sexually abused in childhood was mediated by feelings of stigma and self-blame. This result provides partial support for Finkelhor and Browne's (1985) traumagenic dynamics model of child sexual abuse. The limitations of the study are discussed.

Sexual fantasy.

This article reviews the research literature on sexual fantasy, a central aspect of human sexual behavior. Topics include (a) gender similarities and differences in the incidence, frequency, and content of sexual fantasies and how they relate to sociocultural and sociobiological theories of sexual behavior; (b) the association between frequency or content of sexual fantasies and variables such as age, sexual adjustment and satisfaction, guilt, sexual orientation, personality, and sexual experience; and (c) "deviant" sexual fantasies (i.e., what they are, whether they play a role in the commission of sexual crimes, and whether they can be modified). The article ends with a summary of major findings and suggestions for future research.

Resting metabolic rate in women with bulimia nervosa: a cross-sectional and treatment study.

Two studies on resting metabolic rate (RMR) in bulimia nervosa were conducted. The first study compared RMR before treatment in 25 normal-weight women with bulimia nervosa and 20 control subjects of similar height, weight, body composition, age, and activity level. No significant difference in RMR adjusted for fat-free weight was observed. The second study sought to determine whether RMR in women with bulimia nervosa changed if they ceased vomiting and resumed eating in a more normal fashion after cognitive-behavioral treatment. There was no differential change in RMR from pre- to posttreatment for the "improved" bulimics (9 of 12 subjects who received treatment) relative to 13 control subjects who were also tested twice at the same time intervals as the treated bulimia nervosa subjects. These findings do not support the hypothesis that normal-weight women with bulimia nervosa have a suppressed RMR, nor is it altered with treatment compared with matched control subjects.

Relationship between alcohol consumption and victim behaviors immediately preceding sexual aggression by an acquaintance.

A survey of 942 female college students (85% return rate) from four New England colleges and universities indicated that 25% had been victims of sexual aggression by an acquaintance since the age of 16. Fifty-five percent of the victims indicated they were at least somewhat drunk at the time of the sexual aggression. Those who felt they were at least somewhat drunk reported engaging in higher levels of consensual sexual activity with the aggressor immediately prior to the assault and reported lower levels of resistance than those who were not at all drunk. The implications these results may have for increased vulnerability to sexual aggression are discussed.

Comparison of cognitive-behavior therapy and desipramine in the treatment of bulimia nervosa.

A comparison of cognitive-behavior therapy alone, desipramine alone, and cognitive-behavior therapy combined with desipramine was made in the treatment of bulimia nervosa. The study was terminated early with an N of only 7 subjects per condition because of a high drop-out rate and lack of positive response in the desipramine alone group compared to the other two groups. By this time it was also apparent that at posttreatment and at 6 months follow-up no benefit was being realized from combining cognitive-behavior therapy with desipramine.

The use of mental health professional consultants to police hostage negotiation teams.

Three hundred law enforcement agencies in the United States that employ a negotiator in hostage incidents responded to a survey regarding the use of mental health professionals as consultants to the negotiation team. Thirty-nine percent of the agencies with a negotiator use a mental health professional consultant to the negotiation team. Police agencies that use a mental health professional as a consultant on negotiation techniques reported more hostage incidents ending by negotiated surrender and fewer hostage incidents ending by tactical team assault and arrest of the perpetrator. Also, police agencies that use a mental health professional as a consultant on the assessment of the perpetrator reported fewer hostage incidents resulting in the serious injury or death of a hostage. Although these results are only correlational, they raise the possibility that the use of mental health professionals as consultants to police hostage negotiation teams may decrease the risk of hostage injury and death.

Gender differences in masturbation and the relation of masturbation experience in preadolescence and/or early adolescence to sexual behavior and sexual adjustment in young adulthood.

A comparison of male and female masturbation practices was undertaken in a sample of university students to determine if the long-standing finding that young adult men in this country masturbate more than young adult women was still evident in the 1980s. Despite the efforts in the past quarter century to encourage women in our society to take greater responsibility for their own bodies and their own sexuality and to engage in more sexual self-exploration and self-stimulation, results show that women continue to masturbate much less than men. Twice as many men as women had ever masturbated and the men who masturbated did so three times more frequently during early adolescence and young adulthood than the women who masturbated during these same age periods. A second purpose of this study was to determine whether having masturbation experience during preadolescence and/or early adolescence was related to intercourse experience, sexual satisfaction, sexual arousal, or sexual difficulties in relationships during young adulthood. No such linkage was observed, suggesting that early masturbation experience is neither beneficial nor harmful to sexual adjustment in young adulthood.

Sexual aggression by an acquaintance: methods of coping and later psychological adjustment.

The main purpose of the present study was to determine if methods of coping with sexual aggression by acquaintances were associated with psychological adjustment beyond what could be predicted by characteristics of the attack itself and beyond what could be predicted by methods of coping used to deal with other stressors. Out of 401 undergraduate women respondents (mean age = 19), 106 or 26% had been victims of sexual aggression by an acquaintance since the age of 16. Two years on average after the assault, these women reported more psychological problems on the Brief Symptom Inventory (Derogatis & Spencer, 1982) than a comparison group who had not been assaulted since age 16. Respondents who had survived sexual aggression were asked to indicate on the Coping Strategies Inventory the methods they had used to cope with this experience and the methods they had used to cope with a separate nonsexual stressful event which also had occurred since age 16. Multiple regression analyses indicated that disengagement methods of coping with sexual aggression per se accounted for unique variance in general psychological distress as measured by the Global Severity Index of the Brief Symptom Inventory and in posttraumatic stress disorder symptoms as measured by a DSM-III-R derived checklist.

A retrospective study of long-term methods of coping with having been sexually abused during childhood.

Methods of coping with childhood sexual abuse were retrospectively studied in a community sample of 54 adult women who had been sexually abused in childhood. From the time the abuse ended until the present, "denial" and "emotional suppression" were the coping methods most commonly employed of the nine methods measured. One purpose of this study was to determine if the methods used to cope with the aftermath of being sexually abused during childhood were associated with current psychological adjustment beyond what could be predicted by the characteristics of the abusive experience per se. A partial correlation analysis and a multiple regression analysis suggested that avoidant/emotion suppressing coping strategies although frequently used and rated by subjects as helpful, were in fact associated with poorer adult psychological adjustment.

Guilt reactions to sexual fantasies during intercourse.

This study explored how guilt feelings about having sexual fantasies during intercourse are related to frequency of fantasizing, to sexual satisfaction and sexual dysfunction, and to different beliefs about the cause, transgressive nature, and consequences of such fantasizing behavior. Drawing from a sample of 178 men and women with intercourse experience (means age = 27), 84% reported that they fantasized at least some of the time during sexual intercourse. From this sample, those who reported feeling most guilty about having sexual fantasies during intercourse (1 SD or more above the mean, n = 39) were compared to those who felt least guilty (1 SD or more below the mean, n = 43). Those subjects who felt guilty reported having significantly fewer sexual fantasies during intercourse than those who felt the least guilty. They also reported higher levels of sexual dissatisfaction and dysfunction. The high-guilt subjects believed that sexual fantasies during intercourse were significantly more abnormal, immoral, uncommon, socially unacceptable, and harmful to themselves, their partner, and their relationship regardless of whether their partner knew that such fantasies occurred. They also reported that the cause of their fantasizing during intercourse reflected significantly more negatively on their sexual behavior and their general character than did the low-guilt group. No statistically significant differences were found between groups on the causal attribution dimensions of internality, stability, or globality of such fantasies. In general, these findings suggest that guilt reactions about sexual fantasies during intercourse are related to beliefs that such fantasies are deviant and harmful and that such guilt reactions are negatively related to sexual satisfaction and adjustment.

Negatively biased recall in children with self-reported symptoms of depression.

This study investigated differences in depressed and nondepressed children's recall of positively and negatively reinforced behavior. Twenty-six children with self-reported symptoms of depression in the fourth through sixth grades were compared with a matched sample of 26 nondepressed children to determine if there was a negative bias in depressed children's recall. Subjects first generated guesses of the most common associations to each of a series of 40 words. Later, when compared with their nondepressed peers, the children with depressive symptomology were less accurate in recalling which words they had answered correctly and remembered fewer of their own correct responses. They also did more poorly when asked to recall the correct answers that had been provided by the investigator. The two groups did not differ, however, in their recall of which items had been answered incorrectly or in their recall of their previous wrong responses. These results suggest that children with self-reported depressive symptomology do not remember negative experiences more than do nondepressed children; rather, they recall positive experiences less well. Selective forgetting of positively reinforced behavior could be a serious handicap for depressed children in school. It could also play an important role in the maintenance and perhaps even the etiology of depressive symptomatology in children.

Childhood sexual abuse: long-term effects on psychological and sexual functioning in a nonclinical and nonstudent sample of adult women.

The purpose of this study was to explore how the experience of childhood sexual abuse is related to long-term psychological and sexual functioning in a nonclinical and nonstudent community sample of women. Questionnaires were distributed to 1,500 nurses and returned anonymously. Fifty-four women who had been sexually abused as children (age 15 or younger) responded. These subjects were then matched with 54 nonabused control subjects. Although there was no difference on a measure of self-esteem, the abused group reported more symptoms of distress on the Global Severity Index and on seven out of nine subscales of the Derogatis Brief Symptom Inventory. They also reported more disturbance on a scale which examined psychological symptoms that have been commonly reported in the literature to be particularly associated with sexual abuse. These differences between the abused and nonabused groups were evident even after controlling for differences in subjects' perceptions of parental emotional support. Unlike the results for psychological adjustment, however, the abused subjects did not differ from the control subjects on self-reported levels of sexual satisfaction or sexual dysfunction.