A STUDY ON THE INFORMATION TRANSFER AND LONG-TERM PSYCHOLOGICAL IMPACT OF CHILD SEXUAL ABUSE.

Children who experience sexual abuse often face severe challenges in seeking help and disclosing their traumatic experiences. Objectives - to investigate critical aspects of information transfer, help-seeking behavior and the long-term psychological impact of child sexual abuse. This was a pilot study done on 114 victims of child sexual abuse. The study participants filled a semi-structured proforma through social media using Google forms. It was a descriptive cross-sectional study carried out using SPSS (Statistical Package for Social Sciences) version 28. This pilot study on 114 child sexual abuse victims reveals critical insights. Only 15.8% confided in parents, while 37.7% turned to friends. Shockingly, 46.5% kept their ordeal hidden. Disturbingly, only 8.8% sought professional help. The impact on adult life was profound, with 70.2% reporting personal effects. Regrettably, 24.6% resorted to self-harm. Insights on reasons were stark: 63.1% felt defenseless, 23.7% lacked awareness, and 5.3% blamed lax legislation. Encouragingly, 86% actively raised awareness. The study provides a compelling view of child sexual abuse survivors, and emphasizes the need for improved communication within families, accessible support services, and educational initiatives.

Hyperbaric oxygen therapy vs. pharmacological intervention in adults with fibromyalgia related to childhood sexual abuse: prospective, randomized clinical trial.

Fibromyalgia syndrome (FMS) is a chronic pain syndrome characterized by disruptions in pain processing within the central nervous system. It exhibits a high prevalence among patients with a history of traumatic experiences, notably childhood sexual abuse (CSA). This study compared the efficacy of hyperbaric oxygen therapy (HBOT) to the current pharmacological standard of care for individuals suffering from CSA-related FMS. Forty-eight participants diagnosed with FMS and a history of CSA were randomly assigned to either the HBOT group (60 sessions of 100% oxygen at 2 ATA for 90 min, with air breaks every 5 min) or the medication (MED) group (FDA-approved medications, Pregabalin and Duloxetine). The primary endpoint was the Fibromyalgia impact questionnaire (FIQ) score, while secondary endpoints encompassed emotional status and daily functioning questionnaires, as well as pain thresholds and conditioned pain modulation tests. Brain activity was evaluated through single photon emission computed tomography (SPECT). Results revealed a significant group-by-time interaction for the FIQ score favoring HBOT over MED (p < 0.001), with a large effect size (Cohen's d = - 1.27). Similar findings were observed in emotional symptoms and functional measures. SPECT imaging demonstrated an increase in activity in pre-frontal and temporal brain areas, which correlated with symptoms improvement. In conclusion, HBOT exhibited superior benefits over medications in terms of physical, functional, and emotional improvements among FMS patients with a history of CSA. This associated with increased activity in pre-frontal and temporal brain areas, highlighting the neuroplasticity effect of HBOT.

Evaluating the association of childhood sexual abuse with the development of irritable bowel syndrome later in life: A systematic review.

Objective: To review available medical literature to elucidate the association between childhood sexual abuse and the development of irritable bowel syndrome later in life. METHODS: This systematic review was conducted from January to August 2022 and comprised a literature search on Medline (via PubMed), Scopus, Embase, Web of Science, and Google Scholar databases for relevant studies published between 2001 and 2021. The Newcastle-Ottawa scale was used to determine the quality of the studies. Data on the prevalence of irritable bowel syndrome were meta-analysed using a Mantel-Haenszel random-effects model in RevMan 5.4.1. RESULTS: Of the 7 observational studies analyzed in detail, 5 (71.4%) had a case-control design, and 2 (28.6%) were crosssectional studies. Overall, there were 3156 subjects. The prevalence of irritable bowel syndrome in the childhood sexual abuse group was 51.86% (334/644), while it was 36.74% (923/2512) in the non-childhood sexual abuse group. The pooled odds ratio, indicating the association between childhood sexual abuse and irritable bowel syndrome, was 1.87 (95% confidence interval: 1.56-2.26). The study quality was rated as good in 3 (42.8%) cases, fair in 3 (42.8%), and poor in 1 (14.3%). Conclusion: Childhood sexual abuse was found to be significantly associated with the development of irritable bowel syndrome later in life, further strengthening the argument that childhood sexual abuse can lead to long-term detriments extending into adulthood. However, there was no existing literature found that stratified other aspects of irritable bowel syndrome, including symptom severity and childhood sexual abuse being the exclusive cause of irritable bowel syndrome.

Adaptation of the Child sexual abuse myth scale to Turkish culture: A reliability and validity study.

This study aims to analyze the reliability and validity of the Child Sexual Abuse Myth Scale (CSAMS) in Turkish society. This methodological and cross-sectional study was conducted with 334 individuals between the ages 19 to 65. Data were collected through the Personal Information Form and the Child Sexual Abuse Myth Scale. Content Validity Ratio values of the scale items in the study ranged between 0.500 and 1.00, and the Content Validity Index was found to be 0.68. Exploratory Factor Analysis was appropriate based on Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO = 0.809) and Barlett's Test of Sphericity (X2 = 1269, p < 0.001). Factor Analysis resulted in 4 sub-scales (Accusation, Causality, Normalization, and Sexist Approach). Item factor loads of the scale were found to range between 0.501 and 0.839, and the total explained variance was 59.4 %. Pearson correlation coefficients of all the items ranged between 0.32 and 0.60, and Cronbach's alpha coefficient was 0.81. Accusation, Normalization, and Sexist Approach sub-scale scores were found to increase with age. Sub-scale scores were found to demonstrate significant differences by gender, marital status, education level, working or not, income level, family type, number of siblings, and number of children (p < 0.05). The findings of this study show that the CSAMS is valid and reliable for Turkish culture in its 14-item and 4 sub-scale form.

Executive functioning in child victims of sexual abuse: A multi-informant comparative study.

BACKGROUND: Research examining the association between child sexual abuse and executive functions is limited. Yet, exposure to traumatic situations at a young age has been associated with changes in the prefrontal cortex, which hosts executive functions (Wesarg et al., 2020). These functions are crucial for social adaptation, as they make it possible to inhibit maladaptive behavior and respond flexibly to the demands of the environment. As middle childhood is a sensitive period for the development of self-regulatory abilities, exploring executive functioning in school-age children could provide potential intervention targets (Dajani & Uddin, 2015). OBJECTIVE: Using multiple informants, this study compared executive functioning of sexually abused children to that of non-sexually victimized children and examined whether the differences were moderated by sex. METHODS: The sample consisted of 225, 6-to-12 years old children with a history of child sexual abuse (CSA) and 97 children without a history of CSA. Children completed two executive functioning tasks measuring cognitive flexibility and inhibition. Parents and teachers completed questionnaires evaluating children's executive functioning. RESULTS: In comparison to non-abused children, children with a history of CSA displayed greater executive functioning difficulties as assessed by both informant-reported questionnaires and self-completed tasks. Significant interaction effects were found, such as CSA predicting lower inhibition and executive functions at school in boys but not in girls. CONCLUSION: This study is a first step in understanding the association between CSA and executive functioning and offers a clearer picture of the differential impact of sexual trauma according to children's sex.

Trauma behind the keyboard: Exploring disparities in child sexual abuse materials exposure and mental health factors among investigators and forensic examiners - A network analysis.

BACKGROUND: Despite acknowledging the detrimental impact of child sexual abuse material (CSAM) exposure on the mental and physical well-being of investigators and forensic examiners, there is a need for comprehensive exploration into the complex relationship between CSAM exposure, its various dimensions, mental health (i.e., anxiety, depression, and PTSD), and burnout, as well as the presence of positive attitudes towards the job. OBJECTIVE: To understand how CSAM exposure, mental health and burnout interconnect and cluster within distinct networks of police investigators and forensic examiners. PARTICIPANTS AND SETTING: Police investigators and forensic examiners from across the United States who were exposed to CSAM as part of their professions (N = 470). METHODS: Participants, recruited through connections with the National Criminal Justice Training Center, completed an anonymous online survey. RESULTS: The network analysis revealed differences in centrality between investigators and forensic examiners, particularly in their associations with exposure factors and mental health variables. Edges invariance tests showed differences in the strength of these associations, with some factors being more strongly linked to PTSD avoidance symptoms among investigators and others among forensic examiners. Stability analyses suggested potentially greater heterogeneity among investigators, while both groups displayed high stability in other centrality indices. CONCLUSIONS: This study contributes to our comprehension of the distinct experiences and challenges faced by CSAM investigators and forensic examiners, and specifically the nuanced disparities between CSAM investigators and forensic examiners in terms of their exposure to CSAM content and the associated mental health factors. These insights highlight the imperative need for tailored support mechanisms and interventions that can effectively address the unique challenges encountered by individuals working tirelessly in this critical field.

Sexual exploitation of young men: Background characteristics and needs from a life-course perspective.

BACKGROUND: Sexually exploited young men are prevalent, yet underrepresented in clinical practice, policy and research. There are multiple barriers that often prevent young men to disclose and to seek or receive support, such as gender norms, limited awareness of victimization and feelings of guilt and shame. OBJECTIVE: By gaining more insight into the background characteristics of young men who experienced sexual exploitation and their needs, this study aims to raise awareness and to better inform policymakers, care- and educational professionals on adequate prevention and intervention efforts. METHODS: Twenty-six young men (age 14-32) who experienced sexual exploitation or other forms of sexual violence in their youth or were at high-risk, participated in this qualitative study that was conducted in The Netherlands. By means of semi-structured interviews and case-file analyses, data was collected to identify risk and protective factors in their life-course and support needs. RESULTS: Several vulnerabilities (e.g. previous experiences of abuse and neglect, household dysfunction, social rejection, running away, substance use) and a lack of positive and supportive relationships led young men into high-risk situations. Among these were involvement in pay dates, criminality and having to survive from day to day, which contributed to victimization. Prevailing gender norms and experiences of stigmatization were often a barrier to express vulnerabilities and to disclose victimization. There was a wide variety in support needs, including peer-to-peer support, therapy, support with day-to-day practices and anonymous support. CONCLUSIONS: These results will contribute to adequate prevention and trauma-informed intervention strategies that meet the unique needs of young men at risk for, or victim of sexual exploitation.

Online sexual abuse and exploitation of children in the Philippines: An exploratory study of outcomes after reintegration into the community.

BACKGROUND: This study examined psychosocial outcomes for Filipino survivors of online sexual abuse and exploitation of children (OSAEC). OBJECTIVE: This study aimed to identify relationships between demographic variables, self-reported and caregiver-reported trauma symptoms, and psychosocial functioning among Filipino youth who have experienced OSAEC. PARTICIPANTS AND SETTING: This study utilized inclusion criteria of survivors of OSAEC between ages 12 and 18 who received residential care and were reintegrated into the community for at least one year (N = 48). Participants were in care at shelters associated with Project PAVE in the Philippines. METHODS: As measured by three assessment tools, relationships between demographic variables and psychosocial functioning were explored for risk and protective factors of trauma symptoms and psychosocial functioning to better understand this population's needs post-integration. RESULTS: Results suggest survivors continue to experience psychosocial symptoms after reintegration. Caregivers reported survivors reintegrated outside the home had significantly higher externalizing symptoms (MR = 6.67; H(3) = 14.85, p = .002, η2 = 0.27) compared to survivors reintegrated within the home and survivors who trafficked themselves to have higher internalizing symptoms (MR = 16.79; H(3) = 11.80; p = .008, η2 = 0.20) than survivors trafficked by a relative. Caregivers reported survivors who resided in the shelter for one month or less to have higher internalizing symptoms (MR = 20.12; H(2) = 11.06; p = .004; η2 = 0.20) than survivors who resided in the shelter for six months or longer. CONCLUSION: This study highlights the importance of further research to better understand the needs of this vulnerable population in order to guide the most effective intervention, aftercare, and reintegration programs to support survivors and their caregivers.

PTSD Symptoms Among College Students: Linkages with Familial Risk, Borderline Personality, and Sexual Assault.

College students have high rates of post-traumatic stress disorder (PTSD) symptoms as well as high rates of sexual assault. What is less clear, however, is whether different sexual assault types (e.g. coercive, physically forced, and incapacitation) are associated with greater PTSD symptoms. Moreover, understanding early familial and mental health histories of college students is important for explaining PTSD symptoms. As such, we use a social stress framework to examine the relationships between early familial risk (i.e. child abuse, perceived maternal rejection), borderline personality (BP) symptoms, and three sexual assault types with PTSD symptoms among college students. A total of 783 undergraduate students (65.4% female) completed paper and pencil surveys in fall 2019 and spring 2020 at a large public university. Results revealed that females were more likely to experience child sexual abuse and all three forms of sexual assault, while males experienced higher rates of child physical abuse. OLS regression results showed positive associations between child sexual abuse, perceived maternal rejection, BP symptoms and all three types of sexual assault with PTSD symptoms. Females also experienced more PTSD symptoms compared to males. Findings have implications for targeted interventions to improve mental health outcomes.

Childhood sexual abuse, adult sexual assault, revictimization, and coping among sexual minority women.

BACKGROUND: Compared with heterosexual women, sexual minority women experience higher rates and greater severity of sexual victimization. Little is known about how childhood sexual abuse (CSA), adult sexual assault (ASA), and revictimization impact coping in this population. Few studies have examined the effects of recency, developmental stage, and revictimization on coping. OBJECTIVE: To improve psychosocial outcomes following sexual victimization, it is important to understand whether different patterns of exposure differentially impact coping over time. To do so, we investigated associations between CSA, ASA, and revictimization (both CSA and ASA) and adult sexual minority women's coping strategies. PARTICIPANTS AND SETTING: Data are from a longitudinal community-based sample of 513 sexual minority women of diverse ages and races/ethnicities. METHODS: Participants reported CSA (

Associations Among Online Social Reactions to Disclosure of Sexual Victimization, Coping and Social Isolation.

Social reactions to the disclosure of sexual victimization are critical to post-assault recovery. The popular social media hashtag "#MeToo" resulted in numerous survivors of sexual victimization disclosing their experience online. Whereas previous research has examined the association between social reactions to in-person disclosure of sexual victimization and factors commonly associated with adjustment among survivors - such as coping and social support - research is needed to examine correlates of social reactions to online disclosure of sexual victimization. Accordingly, the current study investigated the relationship between online social reactions to the disclosure of sexual victimization via #MeToo and engagement in various coping strategies (problem-focused coping, emotion-focused coping) and social isolation among a sample of 195 adults with a history of sexual victimization. Results indicated that the provision of online resources was associated with lower use of problem-focused and emotion-focused coping strategies. Receipt of online emotional and informational support was associated with increased use of emotion-focused coping strategies. Further, receipt of online social reactions that turned against the survivor and receipt of online social reactions that "made fun of you, insulted you, or said something to hurt you" were associated with higher levels of social isolation. Lastly, online unsupportive acknowledgment and "sharing your tweet with other people" were associated with lower levels of social isolation. Results highlight how online social reactions to disclosure of sexual victimization via #MeToo intersect with coping and social support among survivors of sexual victimization and help to give context to the experience of online disclosure of sexual victimization.

Feasibility Trial of a Newly Developed Brief Psychological Trauma Intervention for Children Surviving Sexual Abuse in India.

Given the alarming increase in incidences of child sexual abuse (CSA), the present study was conceived to conduct a feasibility trial for a brief CSA-focused cognitive-behavioral intervention for children. A quasi-experimental single-group pre-post design with convenient sampling was adopted. The intervention module was administered to 20 children aged 7-13 years (M = 10.4, SD = 1.3) with a CSA history. The intervention was spread across a minimum of six required sessions and a maximum of 12 sessions held weekly for approximately 90 to 120 minutes' duration to restore the child's functioning and to assist the child in processing and managing trauma effectively along with initiating the process of growth. Child PTSD Symptom Scale (CPSS), Children's Impact of Events Scale-13 (CRIES-13), Developmental Psychopathology Checklist (DPCL), Multidimensional Scale for Child Sexual Abuse (MSCSA) and Children's Global Assessment Scale (CGAS) were used to measure the impact of the intervention on the children. Estimation of improvement was done using Wilcoxon signed rank test, effect size and subjective feedback from children. Feasibility assessment was done across five parameters: recruitment, data collection, attrition, adherence and improvement. We found that the intervention led to significant improvement in scores of all scales with a large effect size of .50 for MSCSA and CRIES-13 and medium effect size for CGAS, CRIES-13 (Intrusion & Avoidance), CPSS, and DPCL. Feasibility was estimated to be high across all five parameters of the assessment. Thus, the newly developed intervention was found to be helpful in restoring the child's functioning, and assisting the child in processing, and managing trauma effectively.

The prevalence of child sexual abuse with online sexual abuse added.

BACKGROUND AND OBJECTIVE: Research efforts are measuring various forms of online sexual abuse. There is a need to incorporate such measures of online sexual abuse into the calculation of overall prevalence rates for child sexual abuse. PARTICIPANTS: A sample of 2639 respondents aged 18-to-28 was recruited from a nationally representative online panel. METHODS: Using an online questionnaire, respondents were assessed via self-report about 9 types of online sexual abuse in childhood and were also assessed with 2 questions that have been used to assess generic child sexual abuse prevalence in previous surveys. RESULTS: The addition of the online abuse to the generic questions about child sexual abuse raised the overall prevalence rate from 13.5 % to 21.7 %. The rate for females increased from 19.8 % to 31.6 % and for males from 6.2 % to 10.8 %. The largest independent contribution to the overall combined increase were the offenses involving non-consensual image sharing and voluntary online sexual interactions with an impermissibly older adult partner. The inclusion of the online sexual abuse exposures also increased the ability to identify the survivors with the highest levels of current psychological distress. CONCLUSION: The study highlights the importance of counting and including online sexual abuse in efforts to estimate the overall prevalence of childhood sexual abuse. The paper proposes 2 or 3 questions that could be added to sexual abuse questionnaires to assess these online offenses efficiently.

Differences Between Girls and Boys in the Disclosure of Sexual Violence.

This article addresses the differences between girls and boys in the disclosure of sexual violence. The dataset combines data from the Finnish Child Victim Survey (FCVS) of 2008 (N = 13,459) and 2013 (N = 11,364), focusing on victims of sexual violence, ages 11 to 17 years, from the perspectives of disclosure and gender. Frequency and percentage analysis, cross tabulation, and a Chi-square test were used in the analysis. In the FCVS for both years, around 85% of the victims were girls. In almost two-thirds of the cases, the offender was a relative, friend, or some other known person, while in more than one-third of the cases, the offender was unknown to the victim. The second most common case was that the victim knew the offender, who was not, however, a friend. Sexual violence was found to be, in many ways, gendered. Most of the victims were girls, and most of the offenders were men. There was also a gender difference in the disclosure of experiences. Twenty-one percent of the girls and 45% of the boys reported that they had not told anyone about their experiences. Irrespective of the type of offender, the victims most often (63%) told a peer about their experiences, while 23% told parents, and only 10% told authorities. Moreover, victims reported shame and fear, distrust toward adults, and disbelief that disclosure would be helpful as reasons for not disclosing their experiences. To address this problem, raising awareness of the phenomenon, promoting an atmosphere that supports disclosing experiences of sexual violence, and improving readiness to address them are required.

Child and Adolescent Exposure to Sexual Harassment: Relationship to Gender, Contact Sexual Abuse, and Adult Psychological Symptoms.

In contrast to adults, there is considerably less research on childhood or adolescent exposure to sexual harassment (CAESH), its lasting psychological correlates, and whether such experiences should be included in definitions of childhood sexual abuse. The current study examined the prevalence and symptomatic sequels of unwanted flirting, being "checked out" sexually, unwanted sexual attention, sexual comments, propositions, and related noncontact behaviors that occurred before age 18, as well as the multivariate relationship between CAESH and contact child sexual abuse (C-CSA) in a diverse online sample of 528 individuals. CAESH was very common, with over 95% of women and 64% of men reporting at least one experience of noncontact sexual harassment before age 18. When childhood sexual abuse was operationalized as the presence of either C-CSA or a total CAESH score of 18 or higher (corresponding to an average score of "3-5 times" prior to age 18), the prevalence was 67% for women and 26% for men, more than three times higher than C-CSA alone. This expanded definition was associated with significantly more anxiety, depression, and posttraumatic stress relative to C-CSA alone. These results suggest that CAESH is a significant source of symptoms in adults and support the emerging perspective that childhood sexual abuse may be best understood as including both contact and noncontact events.

Factors related to delayed disclosure among victims of child sexual abuse in Singapore.

BACKGROUND: Delayed disclosure is a prevalent and serious issue among victims of child sexual abuse (CSA). Identifying the factors associated with delayed disclosure can identify the profile of children who are at risk of delaying disclosures and inform measures to facilitate timely disclosure. OBJECTIVE: The current study represented a pioneering effort to investigate factors that are related to disclosure of CSA in Singapore. It examined the influence of various victim and abuse characteristics on the time taken for a victim to disclose CSA. PARTICIPANTS AND SETTING: A total of 252 CSA cases that were referred to the psychology department of Singapore's Ministry of Social and Family Development (MSF) from 2017 to 2021 were analyzed. METHODS: Cases were coded for the study variables and multivariate Cox regression was conducted to analyze the impact of each variable of interest on the time taken to disclose the abuse. RESULTS: It was found that the following sub-populations of CSA victims were associated with delayed disclosure: younger victims, female victims (as compared to male victims), victims with higher severity of sexual abuse (e.g., forced intercourse), and victims who were abused by in-home caregivers (as compared to acquaintances). CONCLUSIONS: The findings from the study generated practical implications to help reduce the time victims take to disclose CSA in the Singaporean context.

Empowering Young People with Special Educational Needs to Recognize and Report Child Sexual Exploitation and Abuse: A Mixed-Methods Review.

Young people with special educational needs (SEN), such as intellectual disability and/or autism, are particularly vulnerable to child sexual exploitation and abuse (CSEA). This mixed-methods systematic literature review consolidates findings in respect to how young people with SEN are currently being taught about CSEA in the UK, incorporating empirical and practice-based findings to counteract publication bias. Key databases were searched, and relevant organizations were contacted regarding studies published between 2015 and 2022 (inclusive). Thirteen articles met the inclusion criteria. Of these, 10 adopted a qualitative methodology, and three a mixed-methods approach. The thematic synthesis of the qualitative studies identified the following themes: (a) beliefs and stereotypes about CSEA, vulnerability. and risk have led to young people with SEN being misinformed and misunderstood, and (b) anxiety about the topic of sex and abuse creates polarized views regarding CSEA education in adult guardians of young people with SEN. Themes are discussed in the context of societal biases in respect to vulnerability and risk, and these biases are considered to have a negative effect on how young people with SEN are supported. The findings of this review encourage providers of CSEA awareness education to be mindful of not endorsing harmful stereotypes, and to involve parent-carers as much as possible. This review additionally encourages services and organizations to increase focus on practitioner reflexivity and regular training to counteract potential biases in respect to gender, vulnerability, and risk.

Victims of Technology-Assisted Child Sexual Abuse: A Scoping Review.

Over the past two decades, technology-assisted child sexual abuse (TA-CSA) has become the focus of attention in politics, legislation, society, as well as research. However, the majority of literature and studies focus primarily on the offenders. This scoping review therefore aims to illustrate how victims of TA-CSA are represented in studies as primary participants. The databases Embase, PsychInfo, PSYNDEX, Cochrane Library, and Web of Science as well as reference lists were searched. Studies needed to be published between 2007 and 2021 and obtain data directly from and about victims to be included in this review. A total of 570 articles were identified from which 20 studies met inclusion criteria. The analysis showed that data can be obtained via different samples like adult and minor victims or other data such as legal documents or sexualized images. The studies researched different types of TA-CSA including exposure to pornographic material, online grooming leading to both online and offline sexual abuse, sexting and sexualized images, and the visual depiction of sexually explicit content. Consequences due to the abuse were of an emotional and psychological nature, medical or physical or impacted relationships, and the social environment. Even though the impact of the abuse on the victims appeared to be similar between different types of TA-CSA, much remains unknown. In order to gain further and more detailed insight into victims of TA-CSA, a universally accepted definition of TA-CSA as well as its different types and their distinctions needs to be established.

Relationships Between Early Maladaptive Schemas and Emotional States in Individuals With Sexual Convictions.

This study seeks to add to the existing knowledge and available literature on schema therapy elements in forensic inpatient samples. Early maladaptive schemas and emotional states were assessed in Dutch individuals with sexual convictions and compared to individuals with nonsexual violent convictions. Self-ratings of the Young Schema Questionnaire and the Schema Mode Inventory of 95 patients with either convictions for child sexual abuse (N = 30), sexual violence against adults (N = 34), and nonsexual violent convictions (N = 31) were examined using one-way multivariate ANOVAs. Regardless of victim type, forensic patients convicted for sexual offending, and patients with convictions for nonsexual violent offending, seem to make equal use of specific maladaptive cognitive schemas and schema modes during mandated inpatient care. Other studies have shown that people with sexual offense histories are typically characterized by insecure attachment, overvigilance towards women, or a child-like self-concept. Our study indicates that forensic patient in Dutch mandated care may be qualitatively different from typical patients with sexual offense histories and that Dutch patients with violent or sexual offense histories are more similar than they are dissimilar.