Download Journal of Child Sexual Abuse Abuse and Parental Characteristics

This article was downloaded by: [University of Colorado]
On: 03 March 2014, At: 12:45
Publisher: Routledge
Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered
office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Journal of Child Sexual Abuse
Publication details, including instructions for authors and
subscription information:
http://www.tandfonline.com/loi/wcsa20
Abuse and Parental Characteristics,
Attributions of Blame, and Psychological
Adjustment in Adult Survivors of Child
Sexual Abuse
a
b
c
d
Heidi Zinzow , Puja Seth , Joan Jackson , Ashley Niehaus &
Monica Fitzgerald
a
e
Clemson University , Clemson, South Carolina, USA
b
Emory University , Atlanta, Georgia, USA
c
University of Georgia , Athens, Georgia, USA
d
Veterans Affairs Medical Center , Boston, Massachesetts, USA
e
Medical University of South Carolina , Charleston, South Carolina,
USA
Published online: 19 Jan 2010.
To cite this article: Heidi Zinzow , Puja Seth , Joan Jackson , Ashley Niehaus & Monica Fitzgerald
(2010) Abuse and Parental Characteristics, Attributions of Blame, and Psychological Adjustment
in Adult Survivors of Child Sexual Abuse, Journal of Child Sexual Abuse, 19:1, 79-98, DOI:
10.1080/10538710903485989
To link to this article: http://dx.doi.org/10.1080/10538710903485989
PLEASE SCROLL DOWN FOR ARTICLE
Taylor & Francis makes every effort to ensure the accuracy of all the information (the
“Content”) contained in the publications on our platform. However, Taylor & Francis,
our agents, and our licensors make no representations or warranties whatsoever as to
the accuracy, completeness, or suitability for any purpose of the Content. Any opinions
and views expressed in this publication are the opinions and views of the authors,
and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content
should not be relied upon and should be independently verified with primary sources
of information. Taylor and Francis shall not be liable for any losses, actions, claims,
proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or
howsoever caused arising directly or indirectly in connection with, in relation to or arising
out of the use of the Content.
This article may be used for research, teaching, and private study purposes. Any
substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,
systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Downloaded by [University of Colorado] at 12:45 03 March 2014
Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Journal of Child Sexual Abuse, 19:79–98, 2010
Copyright © Taylor & Francis Group, LLC
ISSN: 1053-8712 print/1547-0679 online
DOI: 10.1080/10538710903485989
Abuse and Parental Characteristics,
Attributions of Blame, and Psychological
Adjustment in Adult Survivors
of Child Sexual Abuse
1547-0679
1053-8712
WCSA
Journal
of Child Sexual Abuse,
Abuse Vol. 19, No. 1, Dec 2009: pp. 0–0
Downloaded by [University of Colorado] at 12:45 03 March 2014
Attributions
H.
Zinzow etofal.Blame
HEIDI ZINZOW
Clemson University, Clemson, South Carolina, USA
PUJA SETH
Emory University, Atlanta, Georgia, USA
JOAN JACKSON
University of Georgia, Athens, Georgia, USA
ASHLEY NIEHAUS
Veterans Affairs Medical Center, Boston, Massachesetts, USA
MONICA FITZGERALD
Medical University of South Carolina, Charleston, South Carolina, USA
The purpose of this study was to examine the influence of abuse and
parental characteristics on attributional content and determine the
relative contribution of different attributions of blame in predicting
psychological symptomatology among adult survivors of childhood
sexual abuse. One hundred eighty-three female undergraduates
with a history of childhood sexual abuse completed self-report questionnaires. Abuse characteristics were significantly related to attributions. Family- and perpetrator-blame accounted for significant
variability in psychological symptomatology, beyond the contributions of abuse characteristics, family environment, and self-blame.
Implications for research and treatment are discussed.
KEYWORDS childhood sexual abuse, internal attributions, external
attributions, family, posttraumatic stress
Received 18 May 2009; revised 10 November 2009; accepted 13 November 2009.
Address correspondence to Heidi Zinzow, Department of Psychology, 418 Brackett Hall,
Clemson University, Clemson, SC 29634. E-mail: [email protected]
79
Downloaded by [University of Colorado] at 12:45 03 March 2014
80
H. Zinzow et al.
A history of childhood sexual abuse (CSA) has been consistently related to
adult psychological symptomatology in women, including anxiety, depression, posttraumatic stress, interpersonal difficulties, sexual dysfunction, and
somatization (see reviews by Beitchman et al., 1992; Briere & Runtz, 1993;
Neumann, Houskamp, Pollock, & Briere, 1996). However, wide variability
among the presence and severity of negative outcomes has been observed.
Factors that have been found to account for some of this variation in adult
adjustment include abuse characteristics (e.g., severity, number of incidents;
Briere & Elliott, 2003; Steel, Sanna, Hammond, Whipple, & Cross, 2004) and
family characteristics such as parenting style and parental psychopathology
(Fossel, 1995; Whealin, Davies, Shaffer, Jackson, & Love, 2002). Furthermore, an emerging body of research has demonstrated a link between cognitive mechanisms, such as attributions for the abuse, and psychological
outcomes in abuse survivors (see review by Valle & Silovsky, 2002). The
majority of these studies has concentrated on internal attributions, or selfblame for the abuse. Some studies have also examined the relationship
between external attributions, such as blaming the perpetrator or family
members, and psychological symptomatology (e.g., Feiring, Taska, & Chen,
2002; McMillen & Zuravin, 1997). However, little is known about the influence
of abuse and parental characteristics on attributional content. Moreover, the
relative contribution of self-blame, family blame, and perpetrator blame to
the sequelae of CSA is poorly understood.
CSA is known to occur within the context of parental dysfunction. The
families of intrafamilial and extrafamilial abuse victims have been characterized
by patriarchal and unavailable parenting styles, more parental rejection, and
high levels of parental psychopathology (Fossel, 1995; Paradise, Rose,
Sleeper, & Nathanson, 1994; Vogeltanz et al., 1999; Whealin et al., 2002;
Williamson, Borduin, & Howe, 1991). CSA is often perpetrated by a known
and trusted individual, and poor parenting may set the stage for such abuse
to occur. For example, unavailable parents may not monitor their children
or respond appropriately once sexual abuse has occurred (Vogeltanz et al.,
1999). Furthermore, dysfunctional family experiences may function as stressors
that impact the CSA victim’s psychological adjustment well into adulthood
(Brock, Mintz, & Good, 1997; Fassler, Amodeo, Griffin, Clay, & Ellis, 2005).
In addition to parental and abuse characteristics, attributions may
account for individuals’ responses to CSA. Attribution theory posits that
causal inferences about an event, or the perceived reason why an event has
occurred, can be linked to resulting emotional experiences and actions. For
example, an individual who attributes a negative event to internal causes
tends to experience feelings of shame or guilt and to withdraw from others
or attempt restitution for wrongdoing (Weiner & Graham, 1999). Feelings of
guilt and shame have been associated with negative mental health outcomes, such as depression and post-traumatic stress disorder (PTSD),
among survivors of CSA (e.g., Feiring et al., 2002).
Attributions of Blame
81
Downloaded by [University of Colorado] at 12:45 03 March 2014
ATTRIBUTIONS AND MENTAL HEALTH
Internal attributions, or self-blame, represent the primary focus of studies
examining attributions for CSA. Internal attributions for CSA have been consistently associated with long-term maladjustment. A number of studies of
adult survivors of CSA have documented significant associations between
internal attributions and low self-esteem, interpersonal difficulties, posttraumatic
stress symptoms, suicidality, and general symptomotology (Barker-Collo,
2001; Coffey, Leitenberg, Henning, Turner, & Bennett, 1996; McMillen &
Zuravin, 1998; Steel et al., 2004).
Few studies have described the role of external attributions in psychological adjustment to CSA. External attributions can be defined both generally
as “other blame” and specifically as family blame or perpetrator blame. Family
blame can consist of blaming family members for allowing a situation in
which abuse could occur, for not taking protective action after learning of
the abuse, and for not believing or supporting the survivor. Family blame
has been associated with relationship anxiety among female adult CSA survivors (McMillen & Zuravin, 1997) and posttraumatic symptoms among children
and adolescents (Feiring et al., 2002). In reference to perpetrator blame,
most studies involving child and adult survivors of CSA have found it to be
associated with better adjustment (e.g., higher self-esteem, fewer depressive
symptoms) in comparison to individuals making more internal attributions
(Feiring et al., 2002; Hoagwood, 1990; Lev-Wiesel, 2000). Although perpetrator blame may be associated with better outcomes than self-blame, it
remains unclear whether perpetrator blame is generally positively or negatively related to maladjustment among CSA survivors. For example, one
study of sexually abused children and adolescents found a positive relationship between perpetrator blame and sexual anxiety (Feiring et al., 2002),
while another study on adult CSA survivors failed to find a significant main
effect for perpetrator blame on self-esteem and relationship styles (McMillen &
Zuravin, 1997).
Relationships among Abuse Characteristics, Parental Characteristics,
and Attributions
It seems likely that abuse and parental characteristics play a role in determining attributional content. The literature relating abuse characteristics to
the tendency to make internal attributions has demonstrated mixed findings.
Some studies have concluded that a close relationship with the perpetrator
(e.g., a family member) predicts increased internal attributions for the abuse
(Barker-Collo, 2001; Quas, Goodman, & Jones, 2003), while another study
reported the opposite effect, in that closer child-perpetrator relationships
were associated with lower self-blame (Wyatt & Newcomb, 1990). Age of
Downloaded by [University of Colorado] at 12:45 03 March 2014
82
H. Zinzow et al.
abuse onset has also been associated with self-blame, with some studies
finding earlier onset of the abuse to be positively related to self-blame
(Barker-Collo, 2001; Quas et al., 2003) and others finding the reverse to be
true (Steel et al., 2004). Perhaps the most consistent finding has been that
severity and chronicity of CSA, including duration, type, and frequency of
abuse, is related to a greater tendency to make internal attributions (Beitchman
et al., 1992; Quas et al., 2003; Steel et al., 2004). Regarding external attributions, a consistent relationship has been established between greater use of
physical force or coercion and external attributions (Chaffin, Wherry, &
Dykman, 1997; Hunter, Goodwin, & Wilson, 1992; Wyatt & Newcomb,
1990). Further research is necessary to understand the relationships among
abuse characteristics (e.g., duration, frequency, age of onset, relationship to
perpetrator), external attributions, and psychological sequelae.
Prior studies suggest that family characteristics, such as parenting style
and parental psychopathology, affect children’s cognitive and attributional
style (e.g., Bruce et al., 2006; Garber & Flynn, 2001; McGinn, Cukor, &
Sanderson, 2005; Rodriguez, 2006). For example, parenting characterized by
criticism, low caring, and harsh discipline has been linked to depressogenic
cognitive and attributional styles among children (i.e., internal, stable, global attributions for negative events; Bruce et al., 2006; Garber & Flynn, 2001;
McGinn et al., 2005; Rodriguez, 2006). However, little is known about the
impact of parental characteristics on attributions among CSA survivors.
In addition to lack of knowledge about factors influencing specific
forms of attributions for CSA, prior studies have been limited in their measurement of attributions. Many studies measure internal and external attributions on a bipolar continuum, although these two types of attributions have
been shown to represent separate, coexisting constructs (Feiring et al.,
2002). Furthermore, attributions are often measured with a single item. This
form of measurement does not take into account the multiple forms that
attributions may take (e.g., blaming oneself for causing the abuse, blaming
oneself for not recognizing or disclosing the abuse). Similarly, few studies
have assessed multiple forms of blame simultaneously (e.g., self-blame,
family blame, perpetrator blame) or the factors that contribute to these different forms of blame. Finally, no known studies have assessed the relative
contribution of abuse characteristics, parental characteristics, and various
forms of attributions to psychological symptomatology in adult survivors of
CSA. Therefore, the purpose of the current study was to expand on prior literature by examining the potential determinants of CSA survivors’ attributions
for the abuse as well as the relative contributions of parental factors, internal
attributions, and external attributions in predicting long-term psychological
sequelae.
Two sets of research questions were investigated in this study. First, the
influence of abuse and parental characteristics on attributions for CSA was
analyzed. Based on the literature relating abuse characteristics to attributions,
Downloaded by [University of Colorado] at 12:45 03 March 2014
Attributions of Blame
83
it was expected that both internal and external attributions would be positively associated with greater abuse severity and chronicity (i.e., duration,
frequency, type). No predictions were made regarding the potential association
between age of onset or type of perpetrator and attributions, as the literature has diverged on this point. It was expected that self-blame for the
abuse would be predicted by higher parental impairment and authoritarian
parenting styles, given evidence that depressogenic cognitive styles, or
internal attributions for negative events, have been predicted by these familial
characteristics.
Second, the additive value of self-blame, family blame, and perpetrator
blame in predicting adult psychological symptomatology was examined. A
wealth of literature has established the connections among CSA characteristics, or measures of abuse severity, and psychological adjustment. Therefore, these characteristics (type, duration, frequency, age of onset, type of
perpetrator) were entered as control variables. Based on prior literature
establishing a relationship among parental factors and psychological outcomes among CSA survivors, it was expected that parental factors would
account for variance in psychological symptomatology, beyond the contribution of abuse characteristics. Because the relationship between self-blame
and psychological symptomotology has been well established, it was
expected that of the three forms of attributions measured in this study, internal attributions would predict the most variance in psychological outcomes,
beyond the effects of abuse and familial characteristics. Family blame and
perpetrator blame were expected to account for additional variance. Family
blame was predicted to contribute to increased symptomotology. No predictions were made regarding perpetrator blame, as findings from previous
studies have been equivocal.
METHOD
Participants and Procedure
Participants were female undergraduates enrolled in introductory psychology
courses. They were recruited through the research participant pool and
received course credit for their participation. The study was approved by
the Institutional Review Board at the University of Georgia, and informed
consent was obtained from all participants. A total of 1,406 individuals completed self-report questionnaires. Within the questionnaires, individuals
who endorsed histories of CSA (n = 183; 13%) were asked follow-up questions regarding the nature of the CSA and attributions for the abuse. For the
multiple regression and additive effects models, participants missing data on
study variables were excluded, resulting in sample sizes of n = 155 and n = 157,
respectively. Participants with missing data did not differ significantly on
demographic variables from participants included in the study.
Downloaded by [University of Colorado] at 12:45 03 March 2014
84
H. Zinzow et al.
CSA was defined as sexual activities occurring before age 18 that were
perceived as coercive, unwanted, or that involved an individual who was
significantly older. Sexual activities included kissing, fondling, exhibitionism,
voyeurism, oral intercourse, vaginal intercourse, and/or anal intercourse.
For women reporting sexual experiences before the age of 13, a 5-year age
difference was considered abusive. For women reporting sexual experiences between age 13 and 17, the experience was labeled as abusive if the
perpetrator was at least 10 years older and/or if the experience was perceived to be unwanted or coercive (Finkelhor, 1979). Similar criteria have
been used in prior studies (e.g., Russell, 1983; Vogeltanz et al., 1999; Wyatt,
1985).
Abuse survivors included as participants in this study ranged in age
from 17 to 32 years (M = 19.1, SD = 1.7). Participants were predominantly
Caucasian (73%), while 12% were Asian American, 10% were African American,
and 5% identified as multiracial, Hawaiian or Pacific Islander, or Latino. The
majority of participants had never been married (95%). Participants were
predominantly upper-middle class, as indicated by their parents’ occupational status (72% of participants’ fathers and 51% of participants’ mothers
held professional positions).
In terms of childhood abusive experiences, 59% endorsed childhood
sexual experiences with someone at least 5 years older (adult-perpetrated
abuse) and 58% endorsed experiencing unwanted and/or coercive sexual
contact with someone less than 5 years older (peer-perpetrated abuse). The
majority (77%) reported their abusive experiences to be perpetrated by a
non–family member. Participants’ ages during their first abusive experiences
ranged from 1 to 17 (M = 12.1, SD = 4.5). The most frequent form of abuse
was fondling (31%), followed by vaginal intercourse (19%), oral sex (16%),
forced fondling of the perpetrator (13%), exhibitionism (6%), anal intercourse (4%), voyeurism (3%), and kissing (3%). Of women who reported
CSA, 17% indicated that they experienced at least two independent episodes
of abuse (i.e., involving different perpetrators). The majority (79%) reported
that the abuse involved pressure or coercion (e.g., threats of disclosure,
threats of violence).
MEASURES
Life Experiences Questionnaire (LEQ)
The LEQ (Ray, 1993) is a self-report instrument that assesses demographic
information, histories of childhood and adolescent sexual and physical
abuse, and abuse characteristics. The items were adapted from structured
interviews developed by Jackson, Calhoun, Amick, Maddever, and Habif
(1990) and Resick, Calhoun, Atkeson, and Ellis (1981). This instrument has
demonstrated significant test-retest reliability among victims’ reports across
Downloaded by [University of Colorado] at 12:45 03 March 2014
Attributions of Blame
85
a two-week period. Pearson product moment correlations for abuse characteristics assessed on continuous variables ranged from r = .83 to .93; Kappa
coefficients for categorical abuse characteristics ranged from .60 to .96 (Ray,
1993).
Participants were asked “As a child or adolescent (under age 18), did
anyone who was at least 5 years older than you involve you in any kind of
sexual contact with him/her?” and “During your childhood or adolescence
(under age 18), did anyone involve you in any unwanted and/or coercive
sexual contact that was not covered in [prior section] (that is, anyone other
than persons at least 5 years older than you, such as a peer/someone closer
to your age)?” The items were followed by a list of activities that could be
considered sexual contact, ranging from exhibitionism to intercourse. Participants were then asked to identify their relationship to the perpetrator
(non–family member or family member). Examples of family members
were provided, ranging from nuclear to extended family members. Participants were then asked to indicate age of abuse onset, age of perpetrator at
abuse onset, abuse duration, abuse frequency, and abuse type. Duration of
abuse was assessed on a scale ranging from 1 (one incident) to 8 (more
than 10 years). Frequency of abuse was assessed on a scale ranging from 1
(one incident) to 8 (daily). The mode in the current sample was 1 for both
variables. Participants checked each type of abuse that occurred from a list
of activities, ranging from exposure to intercourse. Abuse type was coded
into 3 categories according to a typology outlined by Russell (1983). Noncontact abuse, kissing, and sexual touching were coded as 1, genital fondling
was coded as 2, and oral sex and intercourse were coded as 3. The highest
code for any abusive experiences endorsed by the participants was used
(mode = 3).
Parental Unavailability
Parental unavailability was assessed based on a scale developed by Whealin
and colleagues (2002). Four items assessed whether the parent was depressed,
anxious, substance abusing, and/or ill, using a 5-point scale ranging from 1
(never) to 5 (almost always). These items were summed, resulting in a
range of 4 to 20. Among female undergraduates in a prior study, Cronbach’s
alpha was .67 and the scale was positively correlated with intrafamilial
unwanted sexual attention (Whealin et al., 2002). In the current study,
means were 8.7 for mother unavailability (SD = 3.4; a = .71) and 7.8 for
father unavailability (SD = 3.1; a = .61).
Parental Authority Questionnaire (PAQ)
Subscales from the PAQ (Buri, 1991) were used to assess authoritarian
parenting style in mothers and fathers during the years the participant spent
Downloaded by [University of Colorado] at 12:45 03 March 2014
86
H. Zinzow et al.
in the family home. Examples of items from this scale include: “My mother/
father has always felt that more force should be used by parents in order to
get their children to behave in the way they are supposed to” and “My
mother/father felt that wise parents should teach their children early just
who is the boss in the family.” Respondents rated the items on a 5-point
scale ranging from 1 (strongly disagree) to 5 (strongly agree). Scores ranged
from 10 to 50, and participants completed a scale for both mothers (or stepmothers) and fathers (or stepfathers). Participants without a mother or
father figure were instructed to skip the respective scale. In the current
study, high Cronbach alpha values of .88 and .92 were obtained for mother
and father authoritarianism subscales, respectively. The mean score on the
mother authoritarianism scale was 30.4 (SD = 8.5) and on the father authoritarianism scale was 32.5 (SD = 10.2).
Attributions of Responsibility and Blame Scales (ARBS)
The ARBS (McMillen & Zuravin, 1997) measures the extent to which individuals attribute blame to the self or to others for experiences of CSA. Item
analysis and multiple groups confirmatory factor analysis have revealed
three subscales: self-blame, family blame, and perpetrator blame. Examples
of items from these scales include: “I blame myself for allowing the sexual
contact to occur,” “I blame my family for not doing more to protect me from
the sexual contact,” and “I think the person who had the unwanted sexual
contact with me intended to do these things.” Participants were asked to
identify attributions made at the time that the abuse took place. This decision was based on evidence that adult CSA survivors’ retrospective reports of
attributions made during childhood are more strongly related to symptoms
than reports of attributions made during adulthood (Barker-Collo, 2001).
Respondents rated the items on a 5-point scale ranging from 1 (strongly
disagree) to 5 (strongly agree). In the current study, Cronbach alpha coefficients were .92 for self-blame (20 items), .88 for family blame (10 items),
and .87 for perpetrator blame (10 items). The means for each subscale were
53.1 for self-blame (SD = 17.9; range = 20-90), 17.7 for family blame (SD = 8.6;
range = 10–48), and 32.1 for perpetrator blame (SD = 9.8; range = 10–50).
Mean item responses (ranging from 1 to 5) indicated that perpetrator blame
was endorsed at the highest levels (M = 3.2, SD = .98), followed by selfblame (M= 2.6, SD = .90) and family blame (M = 1.8, SD = .86).
Symptom Checklist-90-Revised (SCL-90-R)
The SCL-90-R (Derogatis, 1983) is a self-report instrument designed as a
screening tool for psychopathology among nonpatient, medical, and psychiatric populations. Participants rated items on a five point Likert-type scale
indicating the extent that each problem caused distress during the past
Attributions of Blame
87
seven days. For this study, the Global Severity Index (GSI) was used as a
general measure of psychological distress. The GSI is obtained by calculating the mean response to the 90 items. Cronbach’s alpha for the 90 items in
the current study was .97. The mean GSI was .78 (SD = .58), which is indicative of significant symptoms in comparison to nonpatient adult female
norms (mean = .24–.26).
Downloaded by [University of Colorado] at 12:45 03 March 2014
Purdue PTSD Scale–Revised (PPTSD-R)
The PPTSD-R (Lauterbach & Vrana, 1996) was used as a measure of PTSD
symptoms among the sample population. The PPTSD-R is a self-report measure comprised of 17 items that assess reexperiencing, avoidance, and arousal
symptoms in response to a specific traumatic event. Respondents rate the
frequency of occurrence within the previous month of each item on a 5-point
scale ranging from 1 (not at all) to 5 (often). Participants were asked to anchor
their responses to their experiences of unwanted sexual contact. Continuous
scores are obtained by summing the 17 items, for a total score ranging from 17
to 85. In the current sample, the mean score was 33.7 (SD = 14.4), which is
consistent with the norm among nonclinical undergraduate populations.
The PPTSD-R has demonstrated excellent internal consistency overall
among a sample of undergraduate students (a = .91; Lauterbach & Vrana,
1996). In the current sample, Cronbach’s alpha was .92. In terms of validity,
the PPTSD-R has exhibited a stronger relationship with other measures of
PTSD symptomatology (r = .50 to r = .66) than with measures of anxiety
(r = .37) and depression (r = .39). Furthermore, students who experienced
at least one traumatic event scored higher than those who did not report
any traumatic events (Lauterbach & Vrana, 1996). In addition, individuals
with a history of sexual abuse have scored significantly higher than nonvictims (Timmons-Mitchell, Chandler-Holtz, & Semple, 1996).
RESULTS
Factors Associated with Self-, Family, and Perpetrator Blame
To explore the relationships among abuse characteristics, familial factors,
and attributions of blame, Pearson’s correlations were examined. In addition,
three multiple regression equations including abuse and family characteristics
as predictors of each type of attribution were conducted (see Tables 1 and 2).
Self-blame was positively correlated with abuse frequency, duration, type,
and age of onset. Within the multiple regression equation, duration, type,
age of onset, and peer-perpetrated abuse emerged as the strongest predictors of self-blame. Correlations revealed that family blame was positively
related to abuse duration, intrafamilial abuse, and mother unavailability, and
88
−.20*
−.17*
.25**
.17*
.15*
.03
−.10
.10
.27**
.00
−.08
.16*
.03
.25**
.22**
.11
.15
−.03
−.24**
.26**
−.07
.28**
.17*
.00
.02
.66*
−.10
.19*
.00
.16*
.08
.03
−.02
3
.14
.21**
.12
.00
.12
−.04
.06
.04
.02
2
.19*
−.21**
−.27**
−.03
−.09
−.01
−.33**
.22*
−.19*
−.14
−.18*
−.03
4
−.08
.21**
−.13
.02
.00
−.05
−.08
.20**
.12
.00
−.04
−.75**
−.07
−.16*
−.02
6
−.01
−.10
.18*
.23**
.10
.19*
5
Extrafamilial abuse was coded “0” and intrafamilial abuse was coded “1.”
*p < .05; **p < .01.
a
Abuse type
Abuse frequency
Abuse duration
Age of onset
Intrafamilial abusea
Peer-perpetrated abuse
Adult-perpetrated abuse
Mother unavailability
Father unavailability
Mother authoritarian
parenting style
11. Father authoritarian
parenting style
12. Self-blame
13. Family-blame
14. Perpetrator-blame
15. PTSD
16. SCL-90-R
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
1
TABLE 1 Correlations among Study Variables (N = 183)
−.08
.11
.02
.07
.03
.12
.12
.18*
.05
7
.07
.28**
.09
.13
.21**
.03
.61**
.04
8
−.01
.10
.04
.04
.16*
.08
−.09
9
.13
.13
.10
.18
.13
.40**
10
Downloaded by [University of Colorado] at 12:45 03 March 2014
.05
−.04
.02
.16*
.20*
11
.14
.04
.24**
.19**
12
.41**
.25**
.18*
13
.20**
−.07
14
.41**
15
89
Attributions of Blame
TABLE 2 Regression Results for Abuse and Family Characteristics Predicting Self-Blame,
Family Blame, and Perpetrator Blame (N = 155)
Self-Blame
Independent variables
b
Abuse type
Abuse frequency
Abuse duration
Age of onset
Intrafamilial abusea
Peer perpetrated
Adult perpetrated
Mother unavailability
Father unavailability
Mother authoritarian
parenting style
Father authoritarian
parenting style
.15*
.16
.21*
.18*
−.08
.24*
.06
.09
.03
.13
Model
R2adj
Family blame
b
Downloaded by [University of Colorado] at 12:45 03 March 2014
.20***
.08
Model
R2adj
.09**
.03
.03
.13
−.11
−.01
−.29*
−.14
.25**
−.07
.12
−.10
Perpetrator blame
b
−.06
.17
−.07
−.26**
.00
.08
.02
.06
−.06
.04
Model
R2adj
.02
.01
a
Extrafamilial abuse was coded “0” and intrafamilial abuse was coded “1.”
*p < .05; **p < .01; ***p < .001.
negatively related to age of onset. However, within the multiple regression
equation, family blame was significantly predicted only by mother unavailability and peer-perpetrated abuse in the context of other abuse and family
characteristics. Finally, perpetrator blame was positively correlated with
abuse frequency and type and negatively correlated with age of onset.
Within the multiple regression equation, only age of onset remained significant. Father unavailability, father authoritarian parenting style, and mother
authoritarian parenting style were not significantly related to attributions.
Additive Effects of Self-, Family, and Perpetrator Blame
Hierarchical regression analyses were used to examine the potential additive effects of self-blame, family blame, and perpetrator blame in relation to
psychological outcomes, beyond the contributions of abuse and family
characteristics. Two types of psychological outcomes were examined: symptoms of PTSD and general symptomatology (SCL-90-R). In these analyses,
abuse characteristics (abuse type, duration, frequency, intrafamilial abuse,
and age of onset) were entered as control variables in the first step. Familial
factors (mother unavailability, father unavailability, and father authoritarian
parenting style) were entered in the second step. Mother authoritarian
parenting style and adult-perpetrated abuse were not included due to lack
of significant relation with attributions or psychopathology in this study (see
Table 1). Of the attributions variables, self-blame was anticipated to account
90
H. Zinzow et al.
for the most variance and therefore entered in the third step. Because prior
empirical support was stronger for family blame, it was entered in the step
prior to perpetrator blame.
Downloaded by [University of Colorado] at 12:45 03 March 2014
PTSD SYMPTOMS
Table 3 presents the hierarchical regression results for the outcome of PTSD
symptoms. Abuse characteristics and familial factors did not account for a
significant portion of the variance in PTSD symptoms. Additive effects were
found for self-blame, family blame, and perpetrator blame. In the final step,
when perpetrator blame was added to the model, the standardized beta
coefficients for self- and family blame were no longer significant. All three
forms of blame exhibited a positive relationship with PTSD symptomotology.
SCL-90-R
Table 3 presents the hierarchical regression results for the outcome of SCL90-R. Additive effects were found for familial factors, self-blame, and perpetrator blame, but not for family blame. However, when perpetrator blame
TABLE 3 Hierarchical Regression Analyses for Abuse Characteristics, Parental Factors, and
Attributions Predicting Psychological Symptomatology (N = 157)
PTSD Symptoms
Independent variables
Step 1
Abuse type
Abuse frequency
Abuse duration
Age of onset
Intrafamilial abusea
Peer abuse
Step 2
Mother unavailability
Father unavailability
Father authoritarian
parenting style
Step 3
Self-blame
Step 4
Family blame
Step 5
Perpetrator blame
a
b
ΔR
2
R2adj
.00
SCL-90-R
F
Δ R2
1.04
.16
−.11
.15
.03
−.03
−.05
R2adj
F
.00
.90
.09***
.07*
2.34
.03*
.10**
2.65**
.01
.13
.03*
.10**
2.65**
.13***
2.90***
.07
−.15
.04
−.10
−.06
−.07
.04
.02
1.34
.08
.00
.18*
.19*
.06
.21**
.04*
.05
1.82
.21*
.19*
.03*
.19*
.03*
.21*
b
.07*
2.13*
.10**
2.51**
−.19*
Extrafamilial abuse was coded “0” and intrafamilial abuse was coded “1.”
*p < .05; **p < .01; ***p < .001.
Attributions of Blame
91
was added to the model in the final step, the standardized beta coefficient
for family blame achieved significance (b = .21, p < .05). Both self- and family
blame exhibited a positive relationship with general symptomotology, whereas
perpetrator blame was associated with lower symptomotology on this measure.
DISCUSSION
Downloaded by [University of Colorado] at 12:45 03 March 2014
Relationships among Abuse Characteristics, Family Characteristics,
and Attributions
As expected, self-blame was positively associated with measures of abuse
severity (duration and type). While external attributions were correlated
with measures of abuse severity, these measures did not emerge as significant predictors within multiple regression analyses. Peer-perpetrated sexual
abuse was positively associated with self-blame and negatively associated
with family blame. It is possible that victims perceived themselves as having
more control over or inviting the abusive experiences when the perpetrator
was closer to their age. The relationship to family blame may be partially
explained by the fact that, among CSA survivors endorsing peer-abuse, the
relationship to the perpetrator was most likely to be a non–family member
(86%). Previous research has indicated that when children disclosed abuse
by a non–family member they were less likely to receive an unsupportive
reaction from their parents than when they disclosed abuse by a family
member (Hershkowitz, Lanes, & Lamb, 2007). Victims of peer-perpetrated
abuse may be less likely to attribute blame to their family due to the support they receive and due to their greater likelihood of attributing responsibility to themselves.
Self-blame was predicted by older age of abuse onset, while external
blame was associated with younger age of onset. These findings support the
notion that survivors assume more responsibility for sexually abusive
encounters as they age. It has been well-established in the literature that
older CSA survivors are attributed more blame than younger ones (e.g.,
Back & Lips, 1998; Maynard & Wiederman, 1997). Studies suggest that older
CSA survivors are perceived as being less sexually naive and more able to
use physical force to defend themselves (Back & Lips, 1998; Maynard &
Wiederman, 1997). As a result, older CSA survivors may begin to engage in
self-blame due to others’ perceptions and reactions toward them.
Contrary to predictions, parental characteristics were not related to
internal attributions. The only significant relationship between parental variables and attributions was the finding that mother unavailability predicted
greater family blame. Maternal disability or illness has emerged as a risk factor
for CSA in prior studies (Finkelhor, 1984). It is possible that CSA survivors
discern a connection between mother unavailability and increased risk of
victimization, thereby leading to increased mother blame for the abuse
92
H. Zinzow et al.
when they perceive their mothers to be impaired. At least one prior study
has also noted that adult survivors of CSA are more likely to blame the
female parent in comparison to male family figures (Croghan & Miell, 1995).
Taken together, these findings suggest that family blame often takes the
form of attributing responsibility to the mother and that this form of blame
may be increased when mothers are psychologically or physically unavailable.
Downloaded by [University of Colorado] at 12:45 03 March 2014
Additive Value of Self-, Family, and Perpetrator Blame in Predicting
Psychological Distress
Consistent with hypotheses, family and perpetrator blame accounted for
additional variability in PTSD symptoms, beyond the anticipated contribution of self-blame, abuse characteristics, and parental characteristics. Only
perpetrator blame accounted for significant change in variance when added
to the model predicting general symptoms. However, family blame attained
significance upon the addition of perpetrator blame to the model. An
intriguing finding emerged upon examining the relationships between perpetrator blame and symptom outcome measures. While increased perpetrator blame was associated with higher PTSD symptoms, the opposite was
true for general symptomatology (as measured by the SCL-90-R). It is possible
that specific features inherent to posttraumatic stress account for its divergence from general symptomatology in this case. For example, PTSD has
been associated with hostility and anger (e.g., Orth & Wieland, 2006; Riggs,
Dancu, Gershuny, Greenberg, & Foa, 1992). The fact that external attributions for negative events have generally been related to expressions of
aggression and anger (e.g., Carmony & DiGiuseppe, 2003; Neumann, 2000;
Petrocelli & Smith, 2005) may help explain the specific positive association
between perpetrator blame and PTSD symptoms. On the other hand, hostility
attributions have been associated with fewer internalizing symptoms among
physical child abuse survivors (Lansford et al., 2006). Since the SCL-90-R
includes an assessment of multiple internalizing symptoms, this effect could
help explain the negative relationship between perpetrator blame and general
psychological symptomatology. These results, in addition to contradictory
findings in the literature, suggest that the relationship between perpetrator
blame and symptom outcome is complex.
Limitations
There are several methodological limitations of the current study that should
be noted. First, the data were obtained through retrospective reporting. It
may have been difficult for participants to report accurately on prior attributions
and childhood abuse experiences. A related limitation is that potentially
distal relationships between variables were examined. As a result, multiple
Downloaded by [University of Colorado] at 12:45 03 March 2014
Attributions of Blame
93
intervening variables may have exerted an effect on outcome variables, thus
reducing the ability to detect relationships among study variables. In addition, the time elapsed since the abusive incident(s) and the administration
of the survey may differ among participants, thus adding to variability in the
potential influence of intervening factors and to the error variance.
Due to the correlational nature of the study, causal linkages between
variables cannot be established. Furthermore, the influence of confounding
variables (e.g., social support, socioeconomic status) is difficult to anticipate
or control. It is likely that the model proposed in this study was not fully
specified and that inclusion of other variables may have allowed for a
clearer understanding of relationships among the variables of interest.
Further limitations to this study involve the nature of the current sample.
Since the sample consists of a convenience population of undergraduate
students, the participants are likely more homogeneous and asymptomatic
than a community population of CSA survivors. The prevalence of CSA (13%)
was also low in comparison to the average prevalence among college women
(27%; Rind, Tromovitch, & Bauserman, 1998). In addition, the majority of
participants reported abusive experiences that were infrequent. As a result,
relationships between variables of interest may have been attenuated, as
suggested by the small effect sizes obtained in this study. Furthermore, the
ability to generalize the results to the larger population of female trauma
survivors is limited.
Implications
The findings from this study have several implications for research and
practice with adult survivors of CSA. Empirical studies have already demonstrated the effectiveness of techniques that restructure distorted trauma-related
beliefs (e.g., Resick & Schnicke, 1992). It is possible that such interventions
could be improved by including components geared toward restructuring
specific maladaptive attributions. The unique contributions of self-, family,
and perpetrator blame in predicting psychological symptoms in this study
suggest that interventions could benefit from focusing on each of these
forms of attributions.
These findings also indicate that interventions may need to be tailored
based on the types of symptoms exhibited among adult survivors of CSA. In
the case of survivors who present with symptoms of PTSD, it may be most
efficacious to focus on decreasing all three forms of blame. For survivors
exhibiting other types of symptoms, treatment may be enhanced by
decreasing self-blame and increasing the client’s recognition of perpetrator
responsibility. Results from the current study additionally suggest that clinicians may wish to explore the role that abuse severity, age of onset, and
maternal characteristics play in the development of maladaptive attributions.
For example, survivors who exhibit high family blame in connection with
Downloaded by [University of Colorado] at 12:45 03 March 2014
94
H. Zinzow et al.
perceived maternal unavailability could be encouraged to reevaluate their
understanding of maternal responsibility. Finally, assessing for maternal
unavailability and paternal authoritarian parenting style among abuse survivors
could help determine which individuals may be most at risk for mental
health problems. Assessing for abuse characteristics (i.e., severity, type of
perpetrator, and duration) could add to clinicians’ understanding of who
may be predisposed to make maladaptive attributions and would therefore
benefit from psychoeducational and cognitive interventions. Addressing
these factors during adulthood would be of particular value not only because
of the documented persistence of CSA-related sequelae but also because
adults have developed a more sophisticated conceptualization of their trauma.
Adults may therefore possess a greater ability than children to manipulate
their cognitions about the abuse.
Several avenues for further research are suggested by this study. While
the current study prompted participants to describe attributions at the time
of abuse (preceding recent symptoms), longitudinal research is necessary to
support the causal relations between attributions and symptoms. This
research, in addition to treatment outcome studies, is essential to determining the utility of restructuring specific attributions for CSA. In addition, our
findings should be replicated within a more representative population of
adult CSA survivors. In particular, the contradictory relationship between
perpetrator blame and symptom outcome deserves further investigation and
confirmation within other samples. Future studies may wish to evaluate the
influence of potential mediators or moderators of this relationship, such as
hostility and relationship to the perpetrator. Furthermore, research could
extend on present findings by investigating the influence of other aspects of
family environment, such as cohesion, child physical abuse, and neglect.
In conclusion, the current study underscores the unique contributions
of family and perpetrator blame, above and beyond the influence of abuse
features, family characteristics, and self-blame, in predicting posttraumatic
stress and general psychological adjustment in adult survivors of CSA. Abuse
characteristics were significantly related to attributional content, whereas
parental features seemed to play a lesser role. These findings imply that
both family and perpetrator blame may represent important targets for treatment and future research. Furthermore, an understanding of abuse and
familial factors could help inform both assessment and interventions that
concentrate on maladaptive attributional processes.
REFERENCES
Back, S., & Lips, H. M. (1998). Child sexual abuse: Victim age, victim gender, and
observer gender as factors contributing to attributions of responsibility. Child
Abuse and Neglect, 22, 1239–1252.
Downloaded by [University of Colorado] at 12:45 03 March 2014
Attributions of Blame
95
Barker-Collo, S. L. (2001). Adult reports of child and adult attributions of blame for
childhood sexual abuse: Predicting adult adjustment and suicidal behaviors in
females. Child Abuse & Neglect, 25, 1329–1341.
Beitchman, J. H., Zucker, K. J., Hood, J. E., daCosta, G. A., Akman, D., & Cassiva, E.
(1992). A review of the long-term effects of child sexual abuse. Child Abuse &
Neglect, 16, 101–118.
Briere, J., & Elliott, D. M. (2003). Prevalence and psychological sequelae of selfreported childhood physical and sexual abuse in a general population sample
of men and women. Child Abuse & Neglect, 27, 1205–1222.
Briere, J., & Runtz, M. (1993). Childhood sexual abuse: Long-term sequelae and
implications for psychological assessment. Journal of Interpersonal Violence, 8,
312–330.
Brock, K. J., Mintz, L. B., & Good, G. E. (1997). Differences among sexually abused
and nonabused women from functional and dysfunctional families. Journal of
Counseling Psychology, 44, 425–432.
Bruce, A. E., Cole, D. A., Dallaire, D. H., Jacquez, F. M., Pineada, A. Q., & LaGrange, B.
(2006). Relations of parenting and negative life events to cognitive diatheses for
depression in children. Journal of Abnormal Child Psychology, 34, 321–333.
Buri, J. R. (1991). Parental authority questionnaire. Journal of Personality Assessment, 57, 110–119.
Carmony, T. M., & DiGiuseppe, R. (2003). Cognitive induction of anger and depression: The role of power, attribution, and gender. Journal of Rational-Emotive &
Cognitive Behavior Therapy, 21, 105–118.
Chaffin, M., Wherry, J. N., & Dykman, R. (1997). School age children’s coping with
sexual abuse: Abuse stresses and symptoms associated with four coping strategies.
Child Abuse & Neglect, 21, 227–240.
Coffey, P., Leitenberg, H., Henning, K., Turner, T., & Bennett, R. T. (1996). Mediators
of the long-term impact of child sexual abuse: Perceived stigma, betrayal, powerlessness, and self-blame. Child Abuse & Neglect, 20(5), 447–455.
Croghan, R., & Miell, D. (1995). Blaming our mothers, blaming ourselves: Women’s
accounts of childhood abuse and disruption. Feminism & Psychology, 5, 31–46.
Derogatis, L. R. (1983). SCL-90-R: Administration, scoring and procedures manual-II.
Towson, MD: Clinical Psychometric Research.
Fassler, I. R., Amodeo, M., Griffin, M. L., Clay, C. M., & Ellis, M. A. (2005). Predicting
long-term outcomes for women sexually abused in childhood: Contribution of
abuse severity versus family environment. Child Abuse & Neglect, 29, 269–284.
Feiring, C., Taska, L., & Chen, K. (2002). Trying to understand why horrible things
happen: Attribution, shame, and symptom development following sexual
abuse. Child Maltreatment, 7(1), 26–41.
Finkelhor, D. (1979). Sexually victimized children. New York: The Free Press.
Finkelhor, D. (1984). Child sexual abuse: New theory and research. New York: The
Free Press.
Fossel, R. (1995). Childhood sexual abuse: Moderating effects of attachment style on
adjustment. Unpublished doctoral dissertation, University of Georgia, Athens,
Georgia.
Garber, J., & Flynn, C. (2001). Predictors of depressive cognitions in young adolescents. Cognitive Therapy and Research, 25, 353–376.
Downloaded by [University of Colorado] at 12:45 03 March 2014
96
H. Zinzow et al.
Hershkowitz, I., Lanes, O., & Lamb, M. E. (2007). Exploring the disclosure of child
sexual abuse with alleged victims and their parents. Child Abuse and Neglect,
31, 111–123.
Hoagwood, K. (1990). Blame and adjustment among women sexually abused as
children. Women & Therapy, 9, 89–110.
Hunter, J. A., Goodwin, D. W., & Wilson, R. J. (1992). Attributions of blame in child
sexual abuse victims: An analysis of age and gender influences. Journal of
Child Sexual Abuse, 1(3), 75–89.
Jackson, J., Calhoun, K., Amick, A., Maddever, H., & Habif, V. (1990). Young adult
women who experienced childhood intrafamilial sexual abuse: Subsequent
adjustment. Archives of Sexual Behavior, 19, 211–221.
Lansford, J. E., Malone, P. S., Stevens, K. I., Dodge, K. A., Bates, J. E., & Pettit, G. S.
(2006). Developmental trajectories of externalizing and internalizing behaviors:
Factors underlying resilience in physically abused children. Development and
Psychopathology, 18, 35–55.
Lauterbach, D., & Vrana, S. (1996). Three studies on the reliability and validity
of a self report measure of posttraumatic stress disorder. Assessment, 3,
17–25.
Lev-Wiesel, R. (2000). Quality of life in adult survivors of childhood sexual abuse
who have undergone therapy. Journal of Child Sexual Abuse, 9, 1–13.
Maynard, C., & Wiederman, M. (1997). Undergraduate students’ perceptions of
child sexual abuse: Effects of age, sex, and gender-role attitudes. Child Abuse
and Neglect, 21, 833–844.
McGinn, L. K., Cukor, D., & Sanderson, W. C. (2005). The relationship between
parenting style, cognitive style, and anxiety and depression: Does increased
early adversity influence symptom severity through the mediating role of cognitive style? Cognitive Therapy and Research, 29, 219–242.
McMillen, C., & Zuravin, S. (1997). Attributions of blame and responsibility for
child sexual abuse and adult adjustment. Journal of Interpersonal Violence,
12, 30–48.
McMillen, C., & Zuravin, S. (1998). Social support, therapy, and perceived changes
in women’s attributions for their child sexual abuse. Journal of Child Sexual
Abuse, 7(2), 1–15.
Neumann, D. A., Houskamp, B. M., Pollock, V., & Briere, J. (1996). The long-term
sequelae of childhood sexual abuse in women: A meta-analytic review. Child
Maltreatment, 1(1), 6–26.
Neumann, R. (2000). The causal influences of attributions on emotions: A procedural priming approach. Psychological Science, 11, 179–182.
Orth, U., & Wieland, E. (2006). Anger, hostility, and posttraumatic stress disorder in
trauma-exposed adults: A meta-analysis. Journal of Consulting and Clinical
Psychology, 74, 698–706.
Paradise, J., Rose, L., Sleeper, L., & Nathanson, M. (1994). Behavior, family function,
school performance, and predictors of persistent disturbance in sexually
abused children. Pediatrics, 93, 452–459.
Petrocelli, J. V., & Smith, E. R. (2005). Who I am, who we are, and why: Links
between emotions and causal attributions for self- and group discrepancies.
Personality and Social Psychology, 31, 1628–1642.
Downloaded by [University of Colorado] at 12:45 03 March 2014
Attributions of Blame
97
Quas, J., Goodman, G., & Jones, D. (2003). Predictors of attributions of self-blame
and internalizing behavior problems in sexually abused children. Journal of
Child Psychology & Psychiatry, 44(5), 723–736.
Ray, K. C. (1993). Childhood sexual abuse: Direct and buffering effects of family support on women’s long-term adjustment. Unpublished master’s thesis, University of
Georgia, Athens, Georgia.
Resick, P. A., Calhoun, K. S., Atkeson, B. M., & Ellis, E. M. (1981). Social adjustment
in victims of sexual assault. Journal of Consulting and Clinical Psychology, 49,
705–721.
Resick, P. A., & Schnicke, M. K. (1992). Cognitive processing therapy for sexual
assault victims. Journal of Consulting and Clinical Psychology, 60, 748–756.
Riggs, D. S., Dancu, C. V., Gershuny, B. S., Greenberg, D., & Foa, E. B. (1992).
Anger and post-traumatic stress disorder in female crime victims. Journal of
Traumatic Stress, 5, 613–625.
Rind, B., Tromovitch, P., & Bauserman, R. (1998). Meta-analytic examination of
assumed properties of child sexual abuse using college samples. Psychological
Bulletin, 124, 22–53.
Rodriguez, C. M. (2006). Attributional style as a mediator between parental abuse
risk and child internalizing symptomatology. Child Maltreatment, 11, 121–130.
Russell, D. E. (1983). The incidence and prevalence of intrafamilial and extrafamilial
sexual abuse of female children. Child Abuse and Neglect, 7, 133–146.
Steel, J., Sanna, L., Hammond, B., Whipple, J., & Cross, H. (2004). Psychological
sequelae of childhood sexual abuse: Abuse-related characteristics, coping strategies, and attributional style. Child Abuse & Neglect, 18(7), 785–801.
Timmons-Mitchell, J., Chandler-Holtz, D., & Semple, W. E. (1996). Post-traumatic
stress symptoms in mothers following children’s reports of sexual abuse: An
exploratory study. American Journal of Orthopsychiatry, 66(3), 463–467.
Valle, L. A., & Silovsky, J. F. (2002). Attributions and adjustment following child
sexual and physical abuse. Child Maltreatment, 7(1), 9–25.
Vogeltanz, N., Wilsnack, S., Harris, T., Wilsnack, R., Wonderlich, S., & Kristjanson, A.
(1999). Prevalence and risk factors for childhood sexual abuse in women:
National survey findings. Child Abuse & Neglect, 23(6), 579–592.
Weiner, B., & Graham, S. (1999). Attribution in personality psychology. In L. Pervin
& O. John (Eds.), Handbook of personality: Theory and research (pp. 605–628).
New York: The Guilford Press.
Whealin, J. M., Davies, S., Shaffer, A. E., Jackson, J.L., & Love, L. C. (2002). Family
context and childhood adjustment associated with intrafamilial unwanted
sexual attention. Journal of Family Violence, 17, 151–165.
Williamson, J. M., Borduin, C. M., & Howe, B. A. (1991). The ecology of adolescent maltreatment: A multilevel examination of adolescent physical abuse,
sexual abuse, and neglect. Journal of Consulting and Clinical Psychology, 59,
449–457.
Wyatt, G. E. (1985). The sexual abuse of African American and White American
women in childhood. Child Abuse & Neglect, 9, 507–519.
Wyatt, G. E., & Newcomb, M. (1990). Internal and external mediators of women’s
sexual abuse in childhood. Journal of Consulting and Clinical Psychology, 58,
758–767.
98
H. Zinzow et al.
AUTHOR NOTE
Heidi Zinzow, PhD, is an assistant professor in the Department of Psychology
at Clemson University, Clemson, South Carolina. Her research focuses on
cognitive and contextual factors associated with psychological symptomatology among trauma victims.
Downloaded by [University of Colorado] at 12:45 03 March 2014
Puja Seth, PhD, is currently an APTR-CDC fellow in the Division of STD
Prevention at the Centers for Disease Control and Prevention, Atlanta, Georgia.
Her research interests involve psychosocial and behavioral aspects of sexual
risk-taking and HIV/STI prevention among women and adolescents.
Joan Jackson, PhD, is an associate professor in the Department of Psychology
at the University of Georgia, Athens, Georgia. Her research focuses on adult
outcomes of individuals with histories of sexual abuse and other forms of
abuse, neglect, and trauma.
Ashley Niehaus is currently completing a postdoctoral fellowship in posttraumatic stress disorder and women’s health at the Boston VA Healthcare
System in Boston, Massachusetts.
Monica Fitzgerald is an assistant professor at the Kempe Center for the
Prevention and Treatment of Child Abuse & Neglect in the University of
Colorado Denver School of Medicine, Denver, Colorado. Her research focuses
on effective dissemination, training, and implementation methods used to
transport evidence-supported treatments into community-based settings.