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TRAVMA IN POSAMEZNIK
PREVALENCA TRAVME
In a recent review of studies investigating civilian-related trauma and PTSD, Resnick,
Falsetti, Kilpatrick, and Freedy (1995) reported that lifetime exposure to a variety of
traumatic events is relatively common (40-70%), with prevalence rates of PTSD ranging from
18% to 28% for individuals exposed to some type of civilian trauma. In the largest study on
the prevalence of traumatic events and PTSD conducted to date (The National Cormorbidity
Survey), Kessler, Sonnega, Bromet, Hughes, and Nelson (1995) surveyed a representative
U.S. sample of 8,098 individuals 15 to 54 years of age and found that 60% of men and 51% of
women reported experiencing at least one traumatic event in their lifetime, with 8% of the
sample estimated to have a lifetime diagnosis of PTSD.
Several studies have examined prevalence of traumatic events among college students. These
studies report that exposure to traumatic events among college students also is relatively
common. Vrana and Lauterbach (1994) found that 84% of college students reported
experiencing at least one traumatic event during their lives, and over one third experienced
four or more lifetime traumatic events. Green (1995) found a similarly high rate (>90%) of
lifetime exposure to at least one traumatic event among members of a college sample.
However, in both studies of college students, no attempts were made to examine rates of
PTSD, and limited attempts were made to examine predictors of PTSD symptomatology.
The current study is the largest to date to examine the prevalence of lifetime traumatic events
and PTSD symptoms in a college sample. These results indicate that having experienced one
or more traumatic events is common among college students. Consistent with previous data
(e.g., Green, 1995; Vrana & Lauterbach, 1994), approximately 67% of participants reported
experiencing at least one traumatic event during their lifetime. Differential reporting rates in
the experience of traumatic events were evident, with men more likely to have been in more
serious accidents, to have been physically assaulted, and to have witnessed more serious
injury or death. Women reported a greater proportion than men of adolescent and adult
experiences of sexual coercion and sexual assault. These results are consistent with the
findings of Norris (1992), who studied the prevalence of traumatic events among a
community sample of adults. She found that women were more likely to have been sexually
assaulted, but men were more likely to have been in motor vehicle crashes, to have been
nonsexually physically assaulted, or to have experienced some violent event. In the present
study, the high prevalence rates of childhood sexual abuse and adolescent and adult sexual
assault, particularly among women, are consistent with previous research with college (e.g.,
Gidycz, Coble, Latham, & Layman, 1993) and community samples (e.g., Finkelhor, Hoatling,
Lewis, & Smith, 1990; Kilpatrick & Resnick, 1993).
The finding that a significant proportion of individuals (12% of traumatized respondents; 4%
of the full sample) met PTSD criteria within the past week is also important given that this is
a college sample. Although it might be argued that this estimate overrepresents the true
prevalence of PTSD diagnosis because of the use of self-report methodology, this rate is very
similar to estimates obtained in large-scale epidemiological studies that have assessed PTSD
diagnosis with structured clinical interviews. For example, Resnick, Kilpatrick, Dansky,
Saunders, and Best (1993) studied a national probability sample of 4,008 women, using a
comprehensive traumatic event inventory (similar to the one used in this study) and PTSD
interview format. The researchers estimated that 7% of women with a history of any type of
traumatic event (5% of the full sample) met criteria for current PTSD diagnosis.
In terms of exposure to violence, Jenkins (2001) found in a literature review of
selected studies that between 26% and 70% of inner city children have been
exposed to severe violence, such as witnessing a shooting.
Bryant-Davis, T. (2005). Coping Strategies of African American Adult Survivors of Childhood Violence. Professional
Psychology: Research and Practice, 36(4), 409–414.
In a study conducted 52 years after the Dresden bombing, we explored pathogenetic and
salutogenetic aspects of the psychological consequences of the bombing night trauma in a
population now aged between 57 and 95. The assumption guiding the investigation was that,
although a traumatic incident like the Dresden bombing has pathological long-term
aftereffects, the processing of the traumatic experiences may also contribute to personal
growth (cf. Antonovsky, 1987; Frankl, 1973). Whereas pathogenetic factors contribute to the
symptoms of posttraumatic stress disorder (PTSD), salutogenetic factors are associated with
the successful processing of the trauma and a nonsymptomatic and/or a positive outcome in
terms of personal growth.
Maercker, A. in Herrle, J. (2003). Long-Term Effects of the Dresden Bombing: Relationships to Control Beliefs, Religious Belief,
and Personal Growth. Journal of Traumatic Stress, 16(6), 579-587.
Accidents, suicides, and homicides are the three leading
causes of death among young people in the United
States (U.S. Bureau of Census, 1999).
(The Prevalence of PTSD Following the Violent Death of a Child and Predictors of
Change 5 Years Later, Shirley A. Murphy,1;3 L. Clark Johnson,1 Ick-Joong Chung,2
and Randal D. Beaton1
Journal of Traumatic Stress, Vol. 16, No. 1, February 2003, pp. 17–25 ( C ° 2003))
PREVALENCA TRAVME – RAZLIKE MED SPOLOMA
Gender is one potentially very powerful risk factor for victimization. In
general, men are more likely to be exposed towar combat, nonsexual assaults
between strangers, and to be victimized in public places (Craven, 1997; U.S.
Census Bureau, 2003), whereas women are more likely to be sexually
abused, injured by an intimate partner, and victimized in a private home (Craven,
1997; Finkelhor, 1994; Straus, 2001).
A recent community survey revealed a number of gender differences in
exposure to various kinds of trauma (Goldberg & Freyd, under review).
Women were much more likely to report having been emotionally or psychologically
mistreated by someone close as adults (approximately 40% compared
to less than 12% of men) and as children (approximately 30% compared
to less than 14%). Women also reported more sexual abuse in
adulthood and in childhood than did men. However, men were much more
likely to report having witnessed someone who they were not close to being
killed, committing suicide, or being injured, in adulthood and childhood.
Overall, women reported more events involving someone close to them, and
men reported more events that did not involve other people, and events
involving others who were not close to them.
These data suggest that victims of betrayal-related events are more likely
to be women than men, whereas victims of nonbetrayal events are more
likely to be men. Exposure to different types of trauma may be one form of
gender-based socialization that affects a range of psychological, social, and
physical health outcomes (DePrince & Freyd, 2002; Freyd, 1999).
Boys and girls reported anger as their primary reason for violence, however girls were more
likely to report using violence as selfdefense, whereas boys reported using violence to exert
control over their
dating partner.
DATING VIOLENCE AMONG ADOLESCENTS Prevalence, Gender Distribution, and
Prevention Program Effectiveness
LAURA J. HICKMAN, LISA H. JAYCOX, RAND Corporation. JESSICA ARONOFF,
Break the Cycle
TRAUMA, VIOLENCE, & ABUSE, Vol. 5, No. 2, April 2004 123-142
More boys reported perpetrating sexual abuse than girls (37% and 24%, respectively) and
more girls reported perpetrating physical abuse than boys (28% and 11%, respectively).
DATING VIOLENCE AMONG ADOLESCENTS Prevalence, Gender Distribution, and
Prevention Program Effectiveness
LAURA J. HICKMAN, LISA H. JAYCOX, RAND Corporation. JESSICA ARONOFF,
Break the Cycle
TRAUMA, VIOLENCE, & ABUSE, Vol. 5, No. 2, April 2004 123-142
PREVALENCA TRAVME – SPOLNA ZLORABA IN
POSILSTVO
Women in the CSA group experienced a first episode of abuse at a mean
age of 8.8 years (SD = 3.9); Table 2 describes ages and types of abuse. More
than one third of the women were victims of two or more perpetrators, and
58% were victims of incest at some point in their childhood. The majority of
women were first abused by an unrelated male, a category that includes people
who were familiar to the victim (e.g., mother’s boyfriend) and people
who were unfamiliar to the victim (e.g., a stranger). Most victims were 15 or
more years younger than their perpetrator. The duration of abuse was generally
either a single incident or more than 2 years, and nearly one half of the
women experienced penetration.
Gorey and Leslie (1997) reviewed surveys involving North American community samples
and estimated that 15% of women and 7% of men had experienced contact sexual abuse when
they were children. Rates in Europe, Latin America, Africa, Australia, and New Zealand
appear comparable to those in North America (Fergusson, Lynskey, &Horwood, 1996a;
Finkelhor, 1994).
More than one half of all respondents reported having been previously sexually assaulted (see
Humphrey & White, 2000), with most victims being assaulted by people they knew,
providing additional evidence to discount the stereotype of sexual assault being commonly
committed by so called strangers (Crime Victims Research Treatment Center, 1992;
Fieldhaus, Houry, &
Kaminsky, 2000).
Many women experience sexual assault at some time in their lives. Prevalence studies
suggest that one third of women (32% to 34%) have experiencedchildhood sexual abuse
(CSA; Vogeltanz et al., 1999; Wyatt, Loeb, Solis, Carmona, & Romero, 1999), whereas the
prevalence of rape in adult women ranges from 14% to 25% (Koss, 1993). Humphrey and
White (2000) found that 50% of college-bound women experience sexual assault prior to
college, with 24% to 31% reporting sexual assault during each year of college. Women with
victimization histories are at elevated risk of revictimization. Across several studies, 44% of
survivors of CSA experienced adolescent or adult sexual assault (Breitenbecher, 2001).
Merrill et al. (1999) found that survivors of CSA are 4.8 times as likely to experience adult
victimization, and Humphrey and White (2000) found that women who experienced
adolescent victimization were 14 times as likely to experience victimization during college.
The Rape Abuse and Incest National Network (1998) reported that one woman is raped every
2 minutes in the United States.
Estimates of the prevalence of child sexual abuse (CSA) in the general female population
range from 15% to 33% (for review, see Kendall-Tackett, Williams, & Finkelhor, 1993).
Approximately 20% of women are victims of rape each year (Russell, 1983; Wyatt, 1985),
and it is estimated that between 25% (Straus & Gelles, 1990) and 50% (Stark & Flitcraft,
1988) of women are physically abused by their husbands. The Revictimization of Child
Sexual Abuse Survivors: An Examination of the Adjustment of College Women With Child
Sexual Abuse, Adult Sexual Assault, and Adult Physical Abuse , CHILD
MALTREATMENT / FEBRUARY 2000)
Partner abuse against women is a serious public health problem in the United States.
Approximately 4.4 million women are estimated to suffer from partner abuse each
year (Misra, 2001).
Russell’s (1983, 1984) landmark study of community women in San Francisco
revealed that 24% of women had experienced a completed rape and
44% had experienced a completed or attempted rape. Koss and her colleagues
conducted a national random survey of college women and found
that 1 in 4 women had experienced rape or attempted rape in their lifetimes
and 84% of the women knew their attacker (Koss, Gidycz, & Wisniewski,
1987). Rape was not rare, and it was not primarily a stranger-in-the-bushes
phenomenon. Itwas a violent crime committed against millions ofwomen by
men they knewand trusted.
(REBECCA CAMPBELL, SHARON M. WASCO, Understanding Rape and Sexual
Assault, JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 20 No. 1, January 2005
127-131)
Over the past two decades, the study of CSAwithin the family
and its sequelae has been recognized as a significant issue for
many women. Estimates vary as to its prevalence, ranging from
about one third (31%) (Russell, 1983) (33%) (Wheeler & Walton,
1987) to 16% (Russell, 1983, 1984; Sedney & Brooks, 1984)
Duration. The average duration of the CSA for the mutilators
was almost double that of the nonmutilators. With a range of
duration from less than 1 year to 22 years, the mutilators’ CSA
began at the mean age of 6.06 years (SD = 3.91) and stopped at the
mean age of 13.33 years (SD = 5.87). For the nonmutilators, the
CSA started at the mean age of 7.64 years (SD = 4.30), and the
mean age when it ended was 11.66 (SD = 6.36). Duration ranged
from less than 1 year to 34 years. Duration of the CSAappeared to
differentiate between the two groups and was included as a
potential variable in the model-building phase of the analysis.
Childhood sexual abuse (CSA) occurs in the lives of about 1 in 4 girls
(Finkelhor, Hotaling, Lewis,&Smith, 1990; Russell, 1983).
Thirteen percent of the 4,008 women surveyed in the National Women’s
Study (National Victim Center and Crime Victims Research and Treatment
Center, 1992) reported having experienced at least one completed, forcible
rape in their lifetime. The investigators estimate that 638,000 American
women were raped in the year before the survey was conducted. Rape was
defined in the study’s preface as “an event that occurred without the
woman’s consent, involved the use of force or threat of force, and involved
sexual penetration of the victim’s vagina, mouth, or rectum.” Sexual assaults
that did not involve force, threat of force, or penetration were not included in
the prevalence and incidence estimates. (Women’s Responses to Sexual Violence by Male Intimates
Claire Burke Draucker Phyllis Noerager Stern Western Journal of Nursing Research, 2000, 22(4), 385-406)
Russell’s (1983, 1984) landmark study of community women in San Francisco
revealed that 24% of women had experienced a completed rape and
44% had experienced a completed or attempted rape. Koss and her colleagues
conducted a national random survey of college women and found
that 1 in 4 women had experienced rape or attempted rape in their lifetimes
and 84% of the women knew their attacker (Koss, Gidycz, & Wisniewski,
1987). Rape was not rare, and it was not primarily a stranger-in-the-bushes
phenomenon. Itwas a violent crime committed against millions ofwomen by
men they knewand trusted. Comparable prevalence rates have been obtained
by multiple independent research teams, and 20 years later it is still clear that
sexual assault is far too prevalent. (Understanding Rape and Sexual Assault 20 Years of Progress and Future
Directions REBECCA CAMPBELL,SHARON M. WASCO
JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 20 No. 1, January 2005 127-131)
Despite prevalence estimates that 15% of males in the United States and
Canada have a history of child sexual abuse (CSA) (Bagley,Wood,&Young,
1994; Finkelhor, Hotaling, Lewis, & Smith, 1990), research on male victims
of CSA continues to lag behind that research on female victims (KendallTackett, Williams, & Finkelhor, 1993).
Definitions of masculinity tend not to allow expression of the fear, vulnerability, and helplessness that accompany the experience of sexual abuse
(Dimock, 1988; Hunter, 1991; Lisak, 1994; Nasjleti, 1980).
Agrowing body of literature has documented that the sequelae of CSA for
male victims are much the same as for female victims (see reviews in
Finkelhor, 1990; Urquiza & Capra, 1990).
Data from the National Child Abuse and Neglect Data System indicate that
2.8 per 1,000women experienced childhood physical abuse and 2.3 per 1,000
experienced childhood sexual abuse in 1998 (United States Department of
Health and Human Services, 2000). In terms of prevalence, national data
reveal that approximately one and one half million children have experienced
physical abuse (Straus & Gelles, 1990) and almost one half million children
are sexually abused prior to age 18 (Sedlak, 1991).
ALTHOUGHTHETRUEPREVALENCEof sexual abuse is unknown, research suggests that a
significant proportion ofwomenin today’s society have experienced this trauma (e.g., Ganley,
1981, 1989; Mullen, Martin, Anderson, Romans, & Herbison, 1993; Pence & Paymar, 1986).
In general medical practice, sex therapy, and institutional psychiatry, it is estimated that 25%,
50%, and 51% of women, respectively, report a history of sexual abuse (Craine, Hensen,
Colliver, & MacLean, 1988).
PREVALENCA TRAVME – DOMAČE NASILJE
Domestic violence has reached epidemic proportions in the United States.
Each year at least 4 million women are victimized, 2 million suffer serious
injury, and 3,000 women suffer fatal injuries (Tjaden & Thoennes, 2000).
Underscoring the seriousness of domestic violence is that 30% of women
killed in the United States die at the hands of a husband or boyfriend (Russell,
1995). Studies estimate that between 33% and 50% of women in the general
population are physically abused by their husbands, ex-husbands, or live-in
partners during their lifetime (Canadian Abilities Foundation, 2002; Tjaden
& Thoennes, 2000). Annually, approximately 1.5%, or 4.8 million, women
are raped or physically assaulted by an intimate partner in the United States
(Tjaden & Thoennes, 2000).
(MRUGAYA W. GORDE, CHRISTINE A. HELFRICH, MARCIA L. FINLAYSON
Trauma Symptoms and Life Skill Needs of Domestic Violence Victims, JOURNAL OF
INTERPERSONAL VIOLENCE, Vol. 19 No. 6, June 2004 691-708)
Violence against women and children is a serious problem in this country.
Estimates of the prevalence of child sexual abuse (CSA) in the general female
population range from 15% to 33% (Kendall-Tackett,Williams,&Finkelhor,
1993). The national crime victim survey found that one out of eight women
are victims of rape during their lifetime (National Victim Center, 1992), and
Koss (1993) estimated rape and sexual assault prevalence among adult
women to be between 15% and 25%. Approximately 25% (Straus & Gelles, 1990) to 50%
(Stark & Flitcraft, 1988) of women are physically battered by
their husbands. Women who have been raped or battered may experience a
wide range of effects that may manifest in symptoms of depression, anxiety,
posttraumatic stress disorder (PTSD), and sexual dysfunction (Goodman,
Koss,&Russo, 1993). The psychological sequelae ofCSAare similar and may
persist into adulthood (Kendall-Tackett et al., 1993; Polusny&Follette, 1995).
Moreover, in a recently studied community sample of
close to 10,000 individuals, more than 26% reported having been victims
of childhood physical violence, whereas only approximately 8%
reported having experienced childhood sexual abuse (MacMillan
et al., 1997).
PREVALENCA TRAVME – ZANEMARJANJE
However, as has been
noted frequently, research on neglect is only a small
fraction of research on child maltreatment (National
Research Council, 1993). Cross-cultural comparative
studies of neglect are even more rare.
There are grounds for believing that neglect is as
detrimental or more detrimental than physical or sexual
abuse. Neglect, especially of the child’s emotional
needs for love and support, may be the form of maltreatment
with the greatest risk of serious social and
psychological problems to children (Bowlby, 1982;
Robbins, 1966; Spitz, 1959).
PREVALENCA TRAVME – SMRT BLIŽNJEGA
However, due to the limited
availability of national data, it remains unclear how prevalent deaths of
family members and friends are among adolescents.
Perhaps most important, prevalence data for the current study oˇer
information on experience of loss in a nationally representative sample of
adolescents.
Results of this study indicate that adolescents’ exposure to death is high,
with one in three adolescents reporting the death of a family member in the
past year and one in ˘ve adolescents reporting the past-year death of a close
friend. Several demographic factorswere associated with higher prevalence of
past-year death of a familymember.Girlsweremore likely thanboys to report
experiencing the death of a family member in the past year. In addition,
adolescents with lower household incomes were more likely than adolescents
with higher household incomes to report the past-year death of a family
member.
PREDIKTORJI
PREDIKTORJI – SPOLNA ZLORABA, POSILSTVO
Rape victims with a history of child sexual abuse were found to have higher levels of
trauma symptoms, made greater use of nervous and cognitive coping strategies, and were
more likely to make attributions of blame towards themselves or society. Current symptoms
were related to types of coping and attributions of blame, with history of child sexual abuse
having an indirect relationship to these variables. The results suggest the importance of
attributional and coping variables, as well as child sexual abuse history, as mediators of
postrape adjustment.
Sex role socialization theory proposes that there are developmental
processes by which individuals learn what is appropriate for their
gender. Through these processes, both women and men form expectations
concerning acceptable behaviors in sexual interactions (Bridges, 1991).
According to this theory, those who adhere to extremely traditional sex role
socialization beliefs may viewacquaintance rape as an extreme and appropriate
version of male-female sexual interactions. In general, the theory holds
that the process of sex role socialization promotes the formation of rape-supportive
beliefs, or false beliefs about rape, that can serve to mitigate the seriousness
of rape. Rape-supportive beliefswould include beliefs such as rape is
not psychologically damaging to victims as well as stereotypical beliefs
about the victim’s role in her sexual assault (e.g., victim’s control over,
enjoyment of, and responsibility for her assault).
Results of the current study revealed that individuals made significantly
less rape-supportive attributions when the victim-perpetrator relationship was
dissolving than when the relationship was intact. Consistent with these findings,
several states more fully support the prosecution of husband perpetrators
if the couple is separated, living apart, seeking divorce, or divorced
(Augustine, 1991). The legal community appears to consider sexual assaults
that occur within dissolving marital relationships to more closely meet the
nonconsensual criteria for rape. However, contrary to expectation, attributions
regarding sex role stereotypical victim blame were not found to differ
among the relationship conditions. This finding may be an indication that there
has been a reduction in the societal tendency to blame the married victim.
Adult rape victims with a history of child sexual abuse are reported to
have longer recovery times (Burgess&Holmstrom, 1978) and poorer global
social adjustment (Frank, Turner, & Stewart, 1980). In addition, repetitive
victims have been found to have higher initial levels of distress and longer recovery
times from the most recent episode when compared to first-time victims
(Ruch, Arnedeo, Leon, & Gartrell, 1991).
Research on adult women with histories of child sexual abuse have also
documented the importance of self-blame and coping variables as mediators
of adjustment.
Why does childhood sexual abuse have a different impact on different individuals?
One of the most supported
explanations reported in etiological theories and studies of sexual abuse
suggests that some variables may have an effect on the impact of childhood sexual
abuse on victims’ development. Such variables could be organized along two
principal axes: (a) “sexual abuse factors,” such as the variables related to the sexual
contacts per se (nature, duration, frequency), those relative to the adult perpetrator
(gender, age, tie to child), and those regarding the child victim (gender, age,
emotions felt at time of contacts, dysfunctional, negligent, or violent family setting);
(b) “later” or “iatrogenic factors,” such as the reaction of family and friends
to the disclosure, whether the case is in the hands of the judicial or medical
system, and number of interveners.
According to the literature, the use of violence versus its absence during sexual
abuse have an effect on victims’ feelings and perception with regard to the abuse.
When sexual abuse is accompanied by physical force or verbal threats, victims of
such contacts have reported feeling manipulated, betrayed, and humiliated. They
have also indicated experiencing a profound sense of distress, relational difficulties
(lack of trust in others and excessive wariness), poor self-esteem, feelings of
guilt and helplessness (Doll et al., 1992; Gartner, 1999; Haugaard&Emery, 1989;
Stein, Jacobs, Ferguson, Allen, & Fonagy, 1998; Urquiza & Capra, 1990), and
sexual problems in adulthood (Mendel, 1995; T. G. M. Sandfort, 1992).
In contrast, when sexual abuse occurred in a context
of subtle manipulation and exempt of violence, certain victims have reported
being consenting at the time of these experiences and even having initiated them
(Okami, 1991; T. G. Sandfort, 1984). These victims qualified these events as positive
experiences, discoveries, and sources of physical and sexual pleasure
(Okami, 1991). In other words, it appears that the child’s consent at the time of
such sexual contacts with an adult and the absence of force or threats are related to
the victim’s positive perception. In this regard, T. G. M. Sandfort (1992) reported
that victims who had nonconsensual contacts were more likely to present with
poor adaptation and sexual dissatisfaction in adulthood than were those who
reported consensual contacts.
Where victims’ emotions at time of abuse are concerned, most studies have
pointed out the existence of links between the presence of negative emotions
associated
with sexual abuse and the development of feelings of guilt, shame, and
betrayal, which brought about depression and self-destructive behaviour over the
medium and long term (Finkelhor & Browne, 1985; Gartner, 1999; Hauggard &
Emery, 1989; Newberger & DeVos, 1988; Okami, 1991; Stein et al., 1998).
Meanwhile, according to some etiological theories and studies, the symptoms
observed among certain victims are more the result of the victim’s familial problems
and dysfunctions (parental alcoholism, physical violence, negligence) than
of the sexual contacts per se (Berliner, 1991; Hansen, Hecht, & Futa, 1998).
In this regard, when families failed to respond to the needs
and distress of victims, the latter have reported being as much disturbed by this
absence of family support as by the sexual abuse per se (Bernard, 1981; Browne&
Finkelhor, 1986; Faller, 1993; Finkelhor, 1990; Ingram, 1981; Kendall-Tackett,
Williams, & Finkelhor, 1993; Rind & Bauserman, 1993; Sauzier, 1989). Similarly,
children who did not enjoy a reassuring family or structured social support
(e.g., school, therapy) have been found to be at higher risk of developing
psychological
or behavioural problems in adulthood (Falshaw, Browne, &Hollin, 1996;
Kendall-Tackett et al., 1993). However, it has also been reported that invasive
interventions could be just as harmful as the absence of family and structured
support
to the victim’s development (Elwell & Ephross, 1987; Van Gijseghem,
1998).
Furthermore, it is important to note that certain variables have not been studied
much with male samples despite having proved crucial in the psychosocial
adjustment
ofwomen victims of childhood sexual abuse. Among these variables, the literature
points out the importance of the family constellation and of the victim’s
attachment style (Alexander, 1992; Alexander & Lupfer, 1987; Finkelhor, 1990;
Harter, Alexander,&Neimeyer, 1988; Levang, 1989; Zeanah&Zeanah, 1989).
The results of the present study suggest that the investigation of the impact of
childhood sexual abuse requires that a multitude of variables be considered at the
same time. These include variables related to the sexual abuse scenario, family
context, attachment style, and possibly, to other types of victimization (negligence and verbal, physical, or psychological abuse) and to the circumstances of
disclosure, which were not included in our analyses on account of their low frequency
in our sample. Furthermore, the results suggest that similar childhood
experiences do not elicit one and the same reaction in adulthood. Moreover, similar
adjustment problems may arise from different sources. Finally, it does not
seem possible to establish an exclusive causal link between childhood sexual
abuse and an individual’s psychosocial adjustment in adulthood.
In the majority of previous studies, abuse-related factors (e.g., proximity to the abuser,
frequency and duration of the abuse, severity of the acts) were not found to be predictive of
children’s or adolescents’adjustment following sexual abuse (Dubowitz, Black, Harrington,
&Verschoore, 1993; Manion et al., 1998; Mannarino et al., 1991; Tebbutt et al., 1997). Some
evidence was found for the predictive value of negative appraisals, symptomatology at initial
assessment, and social support. In their study on 56 sexually abused children and adolescents,
Manion et al. (1998) found that negative appraisals of guilt and blame predicted emotional
functioning at 12 months postdisclosure. Also, and consistent with the results of Freedman,
Brandes, Peri, and Shalev (1998), the authors show that internalizing symptoms, such as
dissociation, depression and anxiety, and 3-month postdisclosure, are associated with more
symptomatology at 12 months postdisclosure. They suggest that early internalizing symptoms
and their concomitant negative appraisals of the traumatic event may reduce the victim’s
ability to recover (Freedman et al., 1998). Social support also has a predictive value in
recovery after sexual abuse (seeKendall-Tackett et al., 1993).
Lynskey and Fergusson (1997) identified factors that discriminated sexually abused
youngsters who developed a psychiatric disorder or adjustment difficulties from sexually
abused youngsters who did not develop such problems. Results showed that parental support
was an important factor protecting against the development of adjustment difficulties.With
increasing reports of support, affection, and nurture, the occurrence of later adjustment
difficulties decreased. This is consistent with Joseph (1999) who argued that crisis support
immediately after the traumatic event is influential on later functioning. In his study on
adolescent survivors of a ship disaster, greater direct crisis support was predictive of fewer
feelings of depression and anxiety 18 months later.
While numerous risk factors associated with the development of PTSD symptoms have been
studied, there is still considerable confusion about why some individuals develop PTSD, and
others remain relatively unscathed. Risk factors for the development and maintenance of
PTSD symptoms include general vulnerability and severity of trauma exposure. Vulnerability
factors related to PTSD include female gender, with women more likely to develop PTSD
than men (Breslau et al., 1991; Norris, 1992), and history of exposure to traumatic events
(Kilpatrick, Resnick, Saunders, & Best, 1998; Vrana & Lauterbach, 1994). Trauma severity
indices associated with PTSD include threat to life, injury, and witnessing serious injury or
death of another person. These factors indicate the degree of threat posed to an individual and
are associated with the development of PTSD (e.g., Green, 1990; Kilpatrick et al., 1989;
Kilpatrick & Resnick, 1993).
More recent research has suggested that individual response characteristics are also important
predictors of PTSD symptoms. Specifically, peritraumatic reactions, immediate reactions
experienced at the time of the trauma, such as dissociation, extreme anxiety, panic, and/or
negative emotions, may be important predictors of subsequent PTSD symptoms. One reaction
at the time of the trauma that has received considerable attention is dissociation. Marmar and
his colleagues, have shown that peritraumatic dissociation is predictive of PTSD symptoms
over and above the contribution of level of stress exposure and general dissociative tendencies
in both male (Marmar et al., 1994) and female Vietnam veterans (Tichenor, Marmar, Weiss,
Metzler, & Ronfeldt, 1996). The finding that peritraumatic dissociation is a robust predictor
of PTSD symptoms has been found in other trauma populations as well. Weiss and colleagues
(Weiss, Marmar, Metzler, & Ronfeldt, 1995) studied predictors of PTSD symptomatic
responses among a group of emergency services personnel. After controlling for demographic
variables, severity of exposure to a critical incident, adjustment, social support, locus of
control, and general dissociative tendencies, peritraumatic dissociation remained strongly
predictive of PTSD symptoms. In a study of the survivors of the Oakland/Berkeley, California
firestorm, Koopman, Classen, and Spiegel (1994) found that individual dissociative
symptoms occurring immediately after the fire predicted PTSD symptoms 7 to 9 months later.
Moreover, in a recent prospective study of 51 injured trauma survivors, Shalev, Peri, Cannetti,
and Schreiber (1996) found that peritraumatic dissociation reported 1 week after the trauma
explained approximately 30% of the variance in PTSD symptoms at 6-month follow-up,
above and beyond the contribution of demographic variables, event severity, and initial
symptoms of intrusion, avoidance, depression, and anxiety. Despite the fact that immediate
responses other than dissociation have received limited attention, several studies suggest that
emotional and physical reactions experienced at the time of the trauma may be important
predictors of PTSD symptomatic distress. Resick, Churchill, and Falsetti (1990) examined a
range of immediate within-assault cognitive and emotional reactions experienced by rape
victims. These authors found that emotional and dissociative reactions during the rape
accounted for 46 to 79% of the variance in PTSD symptoms. In another study, Resnick,
Falsetti, Kilpatrick, and Foy (1994) examined acute panic and emotional responses among a
group of rape victims interviewed within 72 hr postrape during an emergency room postrape
exam. Almost all (90%) of the women seen at the emergency room reported having a panic
attack at the time of the rape. Longitudinal data further indicated that initial panic symptoms
were predictive of PTSD intrusion symptoms at 3-month follow-up (Resnick, 1997).
Additionally, Moleman, van der Hart, and van der Kolk (1992) reported a link between panic
symptoms and dissociation in women who were undergoing extremely complicated
childbirth. During childbirth, these women experienced a progression from initial panic
symptoms to dissociation, and the majority of the women subsequently developed full-blown
PTSD. From these studies, it appears that peritraumatic fear and attendant physiological
arousal may lead to cognitive disruption in the form of peritraumatic dissociation and
subsequent PTSD.
The theoretical frameworks of early literature on battered women assumed pathology of the
women and focused little or no attention on the consequences of experiencing violent acts
(Gelles & Harrop, 1989; Walker & Browne, 1985). Yet research over the past decade
indicates that the behaviors battered women demonstrate are primarily the result of the
severity of threat and harm experienced (Follingstad, Brennan, Hause, Polek, & Rutledge,
1991; Ochberg, 1991; Walker & Browne, 1985).
Although we did not find evidence that posttraumatic symptomatology is an
underlying mechanism through which previous victimization leads to subsequent
victimization (i.e., a mediator variable; Baron & Kenny, 1986),
our data do highlight the importance of taking into account current levels of
posttraumatic symptomatology when examining the link between child and/or
adolescent sexual victimization and subsequent sexual victimization . Individuals with
a history of previous sexual victimization who are experiencing PTSD symptoms are
likely to have difficulty recognizing, attending to, or responding to danger cues
appropriately (van der Kolk & McFarlane,
1996). They might have trouble discriminating threatening from nonthreatening
information or make unwise decisions based on incomplete or inaccurate information.
Moreover, perpetrators could identify these individuals
as easy targets. As a result, they are at increased risk for sexual revictimization.
ZAŠČITNI FAKTORJI
Persistent unresolved anger or related negative feelings might serve to
promote posttrauma symptoms, whereas forgiveness may be accompanied by less
severe symptoms.
Higher levels of anger were strongly associated with health status, emotional
distress, and PTSD symptom severity.
A growing body of evidence suggests that the personality trait of hardiness (Kobasa, Maddi,
& Kahn, 1982) helps to buffer exposure to extreme stress. Hardiness consists of three
dimensions: being committed to finding meaningful purpose in life, the belief that one can
influence one's surroundings and the outcome of events, and the belief that one can learn
and grow from both positive and negative life experiences. Armed with this set of beliefs,
hardy individuals have been found to appraise potentially stressful situations as less
threatening, thus minimizing the experience of distress. Hardy individuals are also more
confident and better able to use active coping and social support, thus helping them deal with
the distress they do experience (e. g. , Florian, Mikulincer, & Taubman, 1995).
In an attempt to address this, they suggested
that the negative sequelae of childhood sexual abuse
could be viewed as a form of PTSD.
From studies of adults who were sexually abused in childhood, it was suggested that
individual differences in response to the abuse were related
to three mediating variables including: severity of the abuse,
availability of social support, and attributional styles regarding
the cause of negative life events (Gold, 1986; Seidner and
Calhoun, 1984; Silver et al., 1983). These three variables have
also been shown to act as risk factors for onset of PTSD when
exposed to negative life events such as rape or exposure to war
(Baker and Peterson, 1977; Steketee and Foa, 1987; Cluss
et al., 1983; Foy et al., 1984). Similar mediating factors in
childhood sexual abuse have been presented by KendallTackett et al. (1993).
Finkelhor and Berliner (1995) report that research has
clearly demonstrated that certain elements are consistent predictors
of the level of distress in children and the speed of their
recovery. These influencing factors include parental support
(Everson et al., 1991), maternal upset (Deblinger et al., 1990;
Newberger et al., 1993), help-seeking in response to family
crisis (Waterman, 1993) and also general elements of family
functioning such as cohesion and healthy conflict management
(Conte and Schuerman, 1987).
The findings support the assumption that people
who felt adequately informed would show better psychological adjustment.
One should note that this aspect of cognitive coping at the first
assessment (1989) had the strongest relationship with later symptoms.
These findings suggest that assisting traumatized persons in their
search for verifiable information may be important in early intervention
efforts.
The hypothesis that viewing the accident as
a random incident would be associated with better psychological adjustment
was supported.
Whether antisocial youth become violent
adults is determined by multiple risk and protective factors (Rutter,
Giller, & Hagell, 1998). Such factors include individual strengths and vulnerabilities,
family characteristics, and features of the wider community
(including the peer group, school, and neighborhood). Learning difficulties,
difficult temperament, and problems with regulating negative emotions are
examples of individual risk factors, whereas easy temperament and good
problem-solving skills are examples of individual protective factors. Examples
of family-based risk factors include insecure attachment, family violence,
and family disorganization, whereas examples of protective family
factors include secure attachment, parental cooperation, and effective discipline
practices. Membership of deviant peer groups and a low level of family
support are examples of community-based risk factors. In contrast, involvement
with nondeviant peers and a high level of family support are examples
of protective factors.
This study suggests that not all sexually abused children have the same perceived level of
self-concept, social support, or traumatic symptoms. This indicates that there are variations to
sexually abused childrens' response to the trauma and supports the examination of individual
differences among this heterogeneous population. Perceived parental, classmate, and friend
support were associated with higher global self-concept. This suggests that sexually abused
children who felt better about themselves also perceived a higher level of social support.
Children who reported high levels of posttraumatic stress indicated feeling worse about their
behavior; children who reported high levels of dissociation reported more negative feelings
about their social acceptance. The stability of these relationships will be reexamined with the
larger sample of children when data are available.
Sexually Abused Children's Perceptions: How They May Change Treatment Focus , By: Carla J. Reyes, Anna M. Kokotovic, Merith A.
Cosden, Professional Psychology: Research And Practice, 0735-7028, December 1, 1996, Vol. 27, Issue 6
One important element
of coping identified by Joseph et al. (1995) is crisis support. Crisis support
has been defined by Joseph et al. (1995) as involving both the availability of
others and their reactions to disclosures of trauma. The evidence suggests
that, in general, individuals who receive higher levels of crisis support experience
better psychological outcome (Joseph, Andrews, Williams, & Yule,
1992). Joseph et al.’s (1995) model indicates that crisis support is thought to
influence appraisals, coping, and emotional states.
A Cognitive-Behavioral Model of Post-Traumatic Stress for Sexually Abused Females SUZANNE L. BARKER-COLLO, WILLIAM T. MELNYK, LESLIE MCDONALD-MISZCZAK JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 15 No. 4, April 2000 375-392
In their discussion,
the authors noted general agreement in the literature (Jones & Barlow,
1990; Joseph et al., 1996; S. D. Solomon, 1986) that increased availability of
crisis support is predictive of external event appraisals (i.e., attribution of
blame to others) and reduced PTSD symptomatology. However, some traumatic
events (e.g., sexual abuse) can be stigmatizing and elicit shunning,
avoidance, and blaming of the victim by crisis supports (Wortman & Lehman,
1985). Shunning, avoidance, and blaming by the support network and
failure to engage the network may be particularly evident where the abuser is
known to the survivor due to increased efforts to deny or hide the occurrence
of the abuse (Meichenbaum, 1994).
A Cognitive-Behavioral Model of Post-Traumatic Stress for Sexually Abused Females SUZANNE L. BARKER-COLLO, WILLIAM T. MELNYK, LESLIE MCDONALD-MISZCZAK JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 15 No. 4, April 2000 375-392
FAKTORJI TVEGANJA
As expected, people with increased exposure and higher identification with the
victims
encountered higher stress (Schuster et al., 2001).
In particular, evidence suggests that individuals who are vulnerable to faulty regulation of
negative emotion may be at increased risk for aggressive and/or violent behavior (Davidson,
Putnam, & Larson, 2000).
Although age is clearly an important factor in placing girls and young
women at risk for sexual assault, life course stage is also likely to shape the
mental health consequences of those violent events. Adolescence is a period
of self-exploration, a stage in which girls acquire a sense of self-worth and
when self-esteem develops and becomes more stable (Steinberg & Sheffield
Morris, 2001). Given that adolescence is a period in the life course that
requires adjustment to a number of major social, cognitive, and psychological
changes (Lerner & Galambos, 1999), exposure to violence may disrupt
children’s progression through age-appropriate developmental tasks
(Margolin & Gordis, 2000). Egan and Perry (1998) suggested that poor selfconceptions
are risk factors and consequences of victimization during adolescence,
diminishing self-regard over time and solidifying a child’s status as
a victim.Violent victimization during this time period may, therefore, be particularly
consequential. Experiences in adolescence will not only shape the
direction the life course will take but also will, in large part, determine theavailability and
stability of adult social roles (Clausen, 1991). Although
Loeber and Hay (1997) pointed out that early stressful life events may lead to
a variety of consequences including the development of negative behaviors,
Recent nation wide studies established that the major predictors of post-traumatic stress disorder
were the objective severity of the violence inflicted, the subjective fear of death or serious injury,
and whether penetration of the body occurred (Epstein, Saunders, & Kilpatrick,1997). Also important
were how much awoman blamed herself for what happened and how threatening the rape was to her
worldview (Frazier,1990; Frazier & Schauben, 1994; Koss, Figueredo, Prince,&White, 2000;
Norris&Kaniasty, 1991).
A number of studies have shown that trauma symptoms are related to the
severity of stressful life events. This has been found in research on various
kinds of traumatic events, including among victims of motor vehicle accidents
(Ehlers, Mayou, & Bryant, 1998), Vietnam veterans (Green, Grace,
Lindy, Gleser, & Leonard, 1990), Cambodian refugees (Carlson & RosserHogan, 1991), and survivors of a firestorm (Koopman, Classen, & Spiegel,
1994). (Recent Stressful Life Events,Sexual Revictimization, and Their
Relationship With Traumatic Stress Symptoms Among Women Sexually Abused in ChildhoodCATHERINE CLASSEN
RUTH NEVO,CHERYL KOOPMAN,KIRSTEN NEVILL-MANNING,CHERYL GORE-FELTON
DEBORAH S. ROSE,DAVID SPIEGEL
JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 17 No. 12, December 2002 1274-1290)
Tveganje za spolno zlorabo in navezanost
Children with insecure patent-child relationships,
aswehave seen, will have low self-esteem,
poor relationship skills, and a desperate need
for attention. As a consequence, they will readily
respond to attention from any adult. Being unable
to form relationships themselves and lacking
confidence that anyone will like them, these
children will be especially vulnerable to attention
fromothers. They can be expected to be particularly
responsive to physical attention.
However, children who experienced anxious/
ambivalent relations with their parents will be
more likely to be responsive to attention from
others because they have a positive view of others
and strongly desire closeness. Avoidant children
do not trust others and may be repelled by
adults who display physical affection. Thus,
any adult who pays attention to an anxious/
ambivalent child can expect to get a strongly
positive response. In fact, such a vulnerable child
may bewilling to tolerate even sexual advances
in exchange for feeling close to an adult. Thus,
anxious/ambivalent children may be more
likely to be sexually abused.
(THE ORIGINS OF SEXUAL OFFENDING, WILLIAM L. MARSHALL, LIAM E.
MARSHALL, TRAUMA, VIOLENCE, & ABUSE, Vol. 1, No. 3, July 2000 250-263)
Specifically,
engagement of crisis support has been linked to amount of force used by the
perpetrator.As indicated byWyatt et al. (1991), increasing level of force used
by a perpetrator is significantly related to increasingly negative reactions of
others to the victim when sexual abuse is disclosed.
A Cognitive-Behavioral Model of Post-Traumatic Stress for Sexually Abused Females SUZANNE L. BARKER-COLLO, WILLIAM T. MELNYK, LESLIE MCDONALD-MISZCZAK JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 15 No. 4, April 2000 375-392
clinical and research data suggest that prior traumatic experiences, such as
prior sexual victimization, predict greater psychological distress following
sexual assault (Burgess & Holmstrom, 1978; Frank, Turner, & Stewart,
1980). Adult rape victims with a history of child sexual abuse are reported to
have longer recovery times (Burgess&Holmstrom, 1978) and poorer global
social adjustment (Frank, Turner, & Stewart, 1980). In addition, repetitive
victims have been found to have higher initial levels of distress and longer recovery
times from the most recent episode when compared to first-time victims
(Ruch, Arnedeo, Leon, & Gartrell, 1991).
Coping With Rape The Roles of Prior Sexual Abuse and Attributions of Blame - CATALINA M. ARATA - University of
South Alabama - JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 14 No. 1, January 1999 62-78
Kako izolacija od emocij in relacij privede do nasilja
They propose that men are particularly socialized to suppress this emotion: the sense of being
weak, inadequate, powerless, helpless, impotent, or incompetent. Rather than experience these
painful feelings or let others see them undergoing them, men usually become blank or angry.
Shame itself is harmless, indeed, necessary. Shame is a prime component of conscience,
modesty, and morality. It becomes a problem only if covered. That is, one ingredient of
violence, its incredible energy, is produced by masking shame with blankness or anger.
Dva odziva na sram
However, patients had two different, seemingly opposite responses in the shame context.
 In one, the patient seemed to be suffering psychological pain, but failed to identify it
as shame. Lewis called this form overt, undifferentiated shame. A patient would
usually refer to an emotion or feeling, but the reference misidentified the shame
feeling (‘This is an awkward moment for me.’)
 In a second type of response, the patient seemed not to be in pain, revealing an
emotional response only by rapid, obsessional speech on topics that seemed slightly
removed from the dialogue. Lewis called this second response bypassed shame.
Razlika moški ženske
In her study of differences in the way men and women manage emotions, Lewis (1976) cites
studies suggesting that the overt, undifferentiated form of unacknowledged shame is more
characteristic of women than of men, and the bypassed form more characteristic of men than
of women. She uses this difference in the management of shame to explain the higher
rates of depression in women than in men, and the higher level of aggression in men.
Trije vzroki za agresijo in nasilje
 The first is social: isolation, the absence of affectional attachments.
 The second is cognitive: obsessive preoccupation.
 The third is emotional: complete repression of shame in the form of shame/anger
spirals.
Zanka ponavljajočih se emocionalnih epizod
Although not stated explicitly by Tomkins or Lewis, both seem to imply that emotions can
form closed loops, a self-perpetuating emotional episode that refuses to subside. A familiar
example are people who are ‘blushers.’ They are so self-conscious about their blushing that
they are ashamed of it. But their shame about blushing increases the blush, and so on. This
particular example suggests a loop that is not mentioned by either Tomkins or Lewis:
shame/shame. But it is this loop, I believe, that gives rise to the most prevalent form of shame
spirals, those that lead to blankness and withdrawal. The two kinds of shame spirals give rise
to two different paths: withdrawal and silence (shame/shame) and anger, aggression and
violence (shame/anger).
»Emotional/relational« teorija nasilja
The emotional/relational theory of violence outlined here would seem to be particularly
applicable to instances involving long-term violence on a massive scale. suggest the three
conditions for violence suggested by the theory outlined here: isolation from others, a single,
overarching obsession, and complete repression of shame.
MEDIATOR ZA POSLEDICE PRI SPOLNI ZLORABI –
NAVEZANOST
Oneway that attachment difficulties might be manifested in later relationships
is through the development of the self. The development of the self can
be seen to unfold in the context of attachment and the internalization of
important others’ perceptions and expectations; sustained and early trauma
arising from abuse can produce long-standing dysfunctions of self (Briere,
1992). Exactly how the “self” should be defined has not been clearly demonstrated,
even by object relations and self psychology theorists for whom it is
central (Briere, 1992). In general, the self can be understood as “the agent of
actions, the experiencer of feelings, the maker of intentions, [and] the architect
of plans” (Stern, 1985, p. 6), the development of which occurs in the context
of attachment. Self-dysfunctions, or those related to this internal base,
are purported to lead to difficulties such as identity confusion, boundary
issues, and the inability to soothe oneself. Attachment theory (Ainsworth,
1985; Bowlby, 1973, 1980, 1982, 1988) suggests that early childhood experiences
of parental support, nurturance, consistency, and responsiveness produce
a secure attachment.Warm and responsive parenting, according to this
model, is expected to result in positive models of both the self and others and
hence to result in secure and fulfilling adult relationships.
Adult Attachment - A Mediator Between Child Sexual Abuse and Later Psychological
Adjustment - DIANE N. ROCHE, MARSHA G. RUNTZ., MICHAEL A. HUNTER JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 14 No. 2, February 1999 184-207
TRAVMA IN POSAMEZNIK – RAZVOJ NEVARNE NAVEZANOSTI BOLJ POVEZAN
Z ZLORABAMI IN ZANEMARJANJEM
Insecure attachment has been observed to a much greater degree among
children who have experienced physical abuse and neglect than in cases
where abuse and neglect are absent (Carlson, Cicchetti, Barnett, & Braunwald,
1989; Egeland & Sroufe, 1981). It is estimated that between 70% and
100% of maltreated children exhibit insecure attachment (versus a base rate
of about 30% in general population samples) and that these children are more
likely to demonstrate an impaired sense of self and an impaired ability to
share information about their thoughts, feelings, and intentions (Cicchetti,
1987). Similarly, insecure attachment has been noted via clinical observations
of sexually abused children (Friedrich, 1990, 1996) and in research conducted
with adult women. For example, a much higher proportion of insecurely
attached women was found in a group of women who were sexually
abused within their families than the proportion that would be expected
according to Bartholomew and Horowitz’s (1991) normative sample (Alexander,
1993).
Adult Attachment - A Mediator Between Child Sexual Abuse and Later Psychological
Adjustment - DIANE N. ROCHE, MARSHA G. RUNTZ., MICHAEL A. HUNTER JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 14 No. 2, February 1999 184-207
TRAVMA IN POSAMEZNIK – NAVEZANOST – +/- MODEL SEBE/DRUGEGA
Patterns of adult attachment, or ways of being in relationships, can be
organized in terms of Bowlby’s (1982) conception of internal working models
(Bartholomew, 1990, 1993). As Bartholomew describes them, models of
the self can be dichotomized as either positive (positive self-concept, the self
as worthy of love and attention) or negative (negative self-concept, the self as
unworthy of love and attention). Similarly, models of the other can be viewed
as positive (the other as trustworthy, caring, and available) or negative (the
other as rejecting, uncaring, and distant (see Figure 1). The degree of positivity
of one’s self-model is associated with the degree of emotional dependence
on others for self-validation; a positive self-model can be understood as an
internalized sense of self-worth that is not dependent on others for validation.
Apositive other-model is reflective of expectations of others’availability and
supportiveness; a positive other-model facilitates actively seeking out intimacy
and support in close relationships, whereas negative other-models lead
to avoidance of intimacy and support (Bartholomew, 1990). Each working
model of the self in combination with each working model of the other is
hypothesized to define a particular adult attachment style (Secure, Fearful,
Dismissing, and Preoccupied; see Figure 1).
Adult Attachment - A Mediator Between Child Sexual Abuse and Later Psychological
Adjustment - DIANE N. ROCHE, MARSHA G. RUNTZ., MICHAEL A. HUNTER JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 14 No. 2, February 1999 184-207
TRAVMA IN POSAMEZNIK – NAVEZANOST – POJASNILO
ODNOSA MED OTROŠKO SPOLNO ZLORABO IN
ODRASLO PSIHOLOŠKO PRILAGODITVIJO
In this examination of the relationship between child sexual abuse, adult
attachment style, and adult psychological adjustment, we have demonstrated
that attachment appears to mediate the relationship between CSA and psychological
adjustment. Specifically, we found that CSA predicts both adult
attachment style and psychological adjustment and that attachment also predicts
psychological adjustment. In addition, attachment style continues to
predict adjustment when the effects of CSA are controlled, whereas CSA no
longer predicts adjustment when the effects of attachment are controlled,
thus indicating that adult attachment style mediates the relationship between
CSA and psychological adjustment.
Adult Attachment - A Mediator Between Child Sexual Abuse and Later Psychological
Adjustment - DIANE N. ROCHE, MARSHA G. RUNTZ., MICHAEL A. HUNTER JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 14 No. 2, February 1999 184-207
TRAVMA IN POSAMEZNIK – OTROŠKA SPOLNA ZLORABA
– OBLIKA NAVEZANOSTI NAPOVEDUJE SIMPTOME PTSM
Because
sexual abuse is strongly associated with adult attachment style, the role of
attachment in adjustment is particularly salient for sexually abused women.
Contrary to Alexander’s (1993) suggestion that attachment predicts basic
personality structure but not symptoms associated with post-traumatic stress
disorder (such as intrusive thoughts, avoidance, and depression), the present
study indicates that attachment is of central importance in predicting these
symptoms. In particular, the most important attachment dimension for predicting
the severity of symptoms is one’s model-of-self. In addition, these
results provide support for Bartholomew’s (1990) conceptualization of the
two dimensional nature of attachment and the implication of Bowlby’s theory
that the intersection of the underlying models of self and other is the basis
for the four basic attachment styles.
Adult Attachment - A Mediator Between Child Sexual Abuse and Later Psychological
Adjustment - DIANE N. ROCHE, MARSHA G. RUNTZ., MICHAEL A. HUNTER JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 14 No. 2, February 1999 184-207
TRAVMA IN POSAMEZNIK – OTROŠKA SPOLNA ZLORABA
ZNOTRAJ DRUŽINE IMA TEŽJE POSLEDICE
Although not all researchers agree about which characteristics of CSA are
most likely to be associated with a poorer prognosis, one trend in the research
suggests that abuse by fathers/stepfathers may lead to greater long-term
effects (Beitchman et al., 1992). In the present study, when the degree of
relatedness between victim and perpetrator is examined, it is apparent that the
relationship between sexual abuse and adjustment is a function of the
influence of intrafamilial sexual abuse; women who were abused within the
family reported significantly more difficulties than women who were abused
by someone outside the family. Women abused by a family member were
especially likely to report problems in the following areas: depression, posttraumatic
stress (i.e., intrusive thoughts and defensive use of avoidance),
anxiety, and an inadequate sense of self and personal identity.
Adult Attachment - A Mediator Between Child Sexual Abuse and Later Psychological
Adjustment - DIANE N. ROCHE, MARSHA G. RUNTZ., MICHAEL A. HUNTER JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 14 No. 2, February 1999 184-207
VRSTE TRAVME IN TRAVMA
Although there is no universally accepted definition of trauma, it is generally understood as a
state of being negatively overwhelmed both physically and psychologically: it is the
experience of terror, loss of control and utter helplessness during a stressful event that
threatens one’s physical and/or psychological integrity. PTSD symptoms include reexperiencing the traumatic event in the form of flashbacks, nightmares, intense bodily or
emotional sensations, obsessional preoccupations and behavioural re-enactments. Trauma
victims inadvertently tend to re-enact the trauma compulsively by either acting selfdestructively, harming others or becoming revictimised. Re-experiencing traumatic events
causes persons to alternate between persistent forms of emotional numbing and hyperarousal.
Irritability, angry outbursts, restlessness, difficulty concentrating and difficulty sleeping are
also common signs. In their attempts to ward off hyperarousal, sexual abuse victims
experience withdrawal and detachment from emotions. Such post-traumatic stress symptoms
can fragment one’s sense of self and agency and one’s ability to relate to others
constructively.
J. Beste; RECOVERY FROM SEXUAL VIOLENCE AND SOCIALLY MEDIATED
DIMENSIONS OF GOD’S GRACE: IMPLICATIONS FOR CHRISTIAN COMMUNITIES; [SCE
18.2 (2005) 89–112]
Neither clinicians nor researchers have had an effective system for assessing
the extent of traumatic experience. Alarcon (1997) proposed a typology of PTSD
consisting of six clinical types: depressive, dissociative, somatomorphic, psychotomorphic,
organomorphic, and “neurotic-like.” In addition, he suggests that
substance abuse and personality disorders need to be considered. This classification
appears to be problematic due to extensive overlap; many clients could easily
fit into several categories.
(Eldra P. Solomon, Kathleen M. Heide. Type III Trauma: Toward a More Effective
Conceptualization of Psychological Trauma, International Journal of Offender Therapy
and Comparative Criminology, 43(2), 1999 202-210.)
Terr (1991) proposed that there are two basic types of trauma, which she called
Type I and Type II. Type I trauma results from a single event, such as a rape or witnessing
a murder. Survivors of Type I trauma who are 3 years old or older at the
time of the event generally retain complete memory of their experience. These
individuals struggle to make sense out of what happened. They may experience
perceptual errors such as visual hallucinations or time distortions.
According to Terr (1991), Type II trauma results from “repeated exposure to
extreme external events” (p. 15). Survivors of Type II trauma generally have at
least some memory of their experience. Children who sustain Type II trauma use
massive denial, repression, dissociation, identification with the perpetrator, and
aggression against themselves as coping mechanisms. These children are often
diagnosed as having Conduct Disorder, Attention Deficit Disorder, depression, or
a dissociative disorder.
We suggest this distinction because, based on our clinical
experience and those of our colleagues, individuals who survive Type III trauma
suffer more severe psychological effects requiring different treatment strategies.
Examples of Type II trauma include such experiences as repeated fondling by a
neighbor or uncle, or growing up with parents who engage in moderate psychological
or physical abuse.
Type III trauma is more extreme. It results from multiple and pervasive violent
events beginning at an early age and continuing for years. Typically, the childwas
the victim of multiple perpetrators, and one or more are close relatives. The abusive
events were likely frequent, yet unpredictable. Generally, force is used and
the abuse has a sadistic quality. The child may have been threatened with torture or
death, or death of a loved one. Both sexual and physical abuse may have been perpetrated.
Examples would include enduring sadistic ritual abuse by an organized
group or repeated violent physical and sexual abuse by caretakers.
(Eldra P. Solomon, Kathleen M. Heide. Type III Trauma: Toward a More Effective
Conceptualization of Psychological Trauma, International Journal of Offender Therapy
and Comparative Criminology, 43(2), 1999 202-210.)
Very few studies have examined the interaction
between emotional abuse or neglect and
sexual abuse on PTSD symptomatology, although
studies suggest that these types of child
maltreatment frequently co-occur (Higgins &
McCabe, 2000).
Definicija travme in PTSD
Although there is no universally accepted definition of trauma, it is generally understood as a
state of being negatively overwhelmed both physically and psychologically: it is the
experience of terror, loss of control and utter helplessness during a stressful event that
threatens one’s physical and/or psychological integrity. PTSD symptoms include reexperiencing the traumatic event in the form of flashbacks, nightmares, intense bodily or
emotional sensations, obsessional preoccupations and behavioural re-enactments. Trauma
victims inadvertently tend to re-enact the trauma compulsively by either acting selfdestructively, harming others or becoming revictimised. Re-experiencing traumatic events
causes persons to alternate between persistent forms of emotional numbing and hyperarousal.
Irritability, angry outbursts, restlessness, difficulty concentrating and difficulty sleeping are
also common signs. In their attempts to ward off hyperarousal, sexual abuse victims
experience withdrawal and detachment from emotions. Such post-traumatic stress symptoms
can fragment one’s sense of self and agency and one’s ability to relate to others
constructively.
Beste, J. (2005). Recovery from sexual violence and socially mediated dimensions of God's grace: Implications for Christian
communities. Studies in Christian ethics, 18, 89-112.
VRSTE TRAVME – TRAVME V NAVEZANOSTI
VRSTE TRAVME – TRAVME OB IZGUBI (SMRTI)
Theoretically, a number of
authors have focused on loss as a defining feature of trauma. For example, Lifton
(1988) referred to the “death imprint” (the “radical intrusion of an image or
feeling of threat, or end, to life,” p. 18) as an important aspect of the (trauma) survivor
syndrome. This imprint or intrusion makes it impossible for the survivor to
deny the reality of death and brings him or her face-to-face with feelings of personal
vulnerability and consequent anxiety.
In the empirical literature on grief and bereavement, certain types or modes
of death have been associated, at least in some studies, with bereavement that is
prolonged or has more pathologic outcomes. These include (a) death that is
unexpected, sudden, or untimely; (b) death that is horrific (grotesque) or painful;
(c) death that is violent or stigmatized in some way (e.g., homicide, suicide, or
AIDS); (d) death involving multiple losses; and (e) death of a child (e.g.,
Sanders, 1988, 1993).
In a community study of individuals who experienced conjugal
bereavement, Schut, DeKeijser,Van Den Bout, and Dijkhuis (1991) specifically
examined PTSD symptoms (via self-report) and estimated the proportion of
participants
who had “probable” PTSD. They found that 20% to 31% of participants
could be labeled as having probable PTSD during at least one follow-up
point between 4 and 25 months following the death, although most spouses in
this study had died of natural causes.
Kaltman and Bonanno (2000) addressed the dimensions of traumatic loss
that might be associated with elevated depression and PTSD symptoms in
spousal survivors.
Suicide of a family member or friend, more specifically, has been associated
with elevated symptoms. Farberow, Gallagher-Thompson, Gilewski, and
Thompson (1992) followed surviving spouses of individuals who committed
suicide for several years and compared them to survivors of spouses who died of
natural causes and to nonbereaved controls.
To summarize, there is weak support for the hypothesis that unanticipated
death alone meets a “traumatic” stressor criterion (i.e., sufficient to be associated
with PTSD; Kaltman&Bonanno, 2000; Schut et al., 1991). There is stronger
support, however, for the conclusion that violent death is associated with
both PTSD symptoms and enduring distress, especially regarding grief and
depression (Farberow et al., 1992; Kaltman & Bonanno, 2000; Zisook et al.,
1998).
Data gathered in a number of studies indicate that people with one traumatic
event in their histories are likely to have experienced multiple prior and/or
subsequent
events (e.g., Green et al., 2000). Furthermore, studies have shown that
multiple exposure to traumatic events, either within the same type of event or
across event types, is associated with higher levels of symptoms than single
exposure (e.g., Follette, Polusny, Bechtle, & Naugle, 1996; McCauley et al.,
1997; Miranda, Green,&Krupnick, 1997).
Njihova raziskava: In conclusion, traumatic loss, defined as loss of a close friend or
familymember by suicide, homicide, or accident, was associated with high levels of
intrusion
and reexperiencing symptoms and high rates of acute stress disorder. These
differences were evident in the absence of other life traumas that could account
for these symptoms, in a relatively low-risk, high-resource group. Traumatic
loss was also associated with high levels of subjective distress relative to other
life events. Violent loss seems to precipitate traditional traumatic
stress-response symptoms and to be appropriately classified as a traumatic
stressor. Symptoms may continue for prolonged periods and could potentially
be reduced by psychological interventions.
VRSTE TRAVME – ZLORABA IN NADLEGOVANJE
Sexual assault is any sexual act forced on a person against his or her will (Bowker, 1983).
Child sexual abuse is a heterogeneous label,
including single incident stranger assaults, in
addition to cases of intrafamilial abuse lasting
for years (Kendall-Tackett, Williams, &
Finkelhor, 1993; Rowan & Foy, 1993). Sexual
abuse may include a wide range of Criterion-A
traumatic events including fondling, coercive
sexual contact, and penetration (KendallTackett et al., 1993; Rowan & Foy, 1993).
Sexual harassment has become a major social, legal, and mental health problem because of its high
prevalence and its negative consequences for victims. These consequences can include decreased
productivity, loss of job, decreased income, and impaired psychological and physical well-being. Despite
evidence from empirical studies that victims often exhibit posttraumatic stress disorder (PTSD)
symptoms, some have argued that sexual harassment does not constitute legitimate trauma.We argue
that many forms of sexual harassment meet the diagnostic Criteria A1 and A2 of PTSD. Finally, the
DSM-IV trauma criterion is explicated, and its relationship with sexual harassment and its effects are
discussed.
Sexual harassment has become an increasingly important
issue over the past two decades. Over 10,000 people
made complaints of sexual harassment in 1992, and
complaints bywomen have nearly more than doubled from
5,603 in 1989 to 14,420 in 1994 (Andrew&Andrew, 1997;
Simon, 1996). Sexual harassment occurs in many different
settings: 51% of family practice female resident physicians,
64% of females in the U.S. military, 70% of female
officeworkers, and88%of female nurses report having experienced
sexual harassment (Dan, Pinsof,&Riggs, 1995;
Piotrkowski, 1998; Pryor, 1995; Vukovich, 1996).
Definicije spolnega nadlegovanja:
Legal and Regulatory Definitions
The law proscribing sexual harassment derives from
Title VII of the Civil Rights Act of 1964.Title VII prohibits
discrimination “with respect to : : : terms, conditions, or
privileges of employment : : :” because of an individual’s
sex, race, religion, and so forth. (Title VII, Civil Rights Act
x2000-2(a). Although sexual harassment is not explicitly
mentioned in the Act, courts later interpreted sexual harassment
to be subsumed because it is gender-related.
According to the U.S. Equal Employment Opportunity
Commission (1980), sexual harassment is defined as
Unwelcome sexual advances, requests for sexual favors,
and other verbal or physical conduct of a sexual nature;
when cooperation or submission was an implicit or explicit
condition of employment; was used as a basis for
the employment-related decisions; or when the conduct
has the purpose or effect of unreasonably interfering with
a person’s work performance or creating an intimidating,
hostile or offensive working environment. (p. 74676)
Psychological Definitions of Sexual Harassment
A psychological definition does not focus on the incident
itself but rather, attends to the victim’s evaluation
of the situation such that the victim’s evaluation is influenced
by factors like ambiguity, perceived threat, and loss
(Fitzgerald, Swan, & Fischer, 1995). Fitzgerald, Swan,
et al. (1997) defined sexual harassment psychologically as
“unwanted sex-related behavior at work that is appraised
by the recipient as offensive, exceeding her resources, or
threatening her well-being” (p. 15).
DSM-IV Criteria for Posttraumatic Stress
Disorder (PTSD)
Harassment victims have been described as suffering
from a “posttrauma syndrome” (Hamilton, Alagna,
King, & Lloyd, 1987). A PTSD model of the sequelae of
sexual harassment has been used to attempt to account
for effects such as flashbacks, sleep disturbances, and
emotional numbing (Gutek & Koss, 1993; Koss, 1990).
Clinical researchers have reported that sexual harassment
victims are frequently meeting the symptom criteria for
PTSD (Dansky & Kilpatrick, 1997). The Diagnostic and
Statistical Manual of Mental Disorders (DSM-IV; American
Psychiatric Association, 1994) criteria for PTSD are
(A) The person has been exposed to a traumatic
event in which both of the following were
present:
(1) the person experienced, witnessed, or was
confronted with an event or events that involved
actual or threatened death or serious
injury, or a threat to the physical integrity of
self or others;
(2) the person’s response involved intense fear,
helplessness, or horror (pp. 427–428);
(B) Reexperiencing the event and severe distress;
(C) Avoidance of associated stimuli; and
(D) Hyperarousal.
VRSTE TRAVME – ZANEMARJANJE
Definition of Neglect
There is little agreement on the definition and
measurement of neglect (Costin, Karger, & Stoesz,
1996; National Research Council, 1993). One of the
most important points of disagreement concerns
whether neglect should be defined and measured in a
way that includes injury or harm to a child as compared
to definition and measurement solely on the
basis of the behavior of the caregiver (Straus &
Kaufman Kantor, 2005). Another unresolved issue is
whether the neglectful behavior must be intentional.
VRSTE TRAVME – KOMPLEKSNA TRAVMA
DEFINICIJA KOMPLEKSNE TRAVME IN SIMPTOMOV
Complex trauma refers to a type of trauma that occurs repeatedly and cumulatively, usually
over a period of time and within specific relationships and contexts. The term came into
being over the past decade as researchers found that some forms of trauma were much
more pervasive and complicated than others (Herman,1992a, 1992b).
The diagnostic conceptualization of CPTSD/DESNOS as defined for the field trial consisted
of seven different problem areas shown by research to be associated with early interpersonal
trauma (Herman, 1992a, 1992b):
1. alterations in the regulation of affective impulses, including difficulty with modulation of
anger and self-destructiveness. This category has come to include all methods used for
emotional regulation and self-soothing, including addictions and self-harming behaviors that
are, paradoxically, often life saving;
2. alterations in attention and consciousness leading to amnesias and dissociative episodes
and depersonalization. This category includes emphasis on dissociative responses different
than those found in the DSM criteria for PTSD. Its inclusion in the CPTSD conceptualization
incorporates the findings regarding dissociation that were mentioned earlier, namely, that
dissociation tends to be related to prolonged and severe interpersonal abuse occurring
during childhood and, secondarily, that children are more prone to dissociation than are
adults;
3. alterations in self perception, such as a chronic sense of guilt and responsibility, and
ongoing feelings of intense shame. Chronically abused individuals often incorporate the
lessons of abuse into their sense of self and self-worth (Courtois, 1979a, 1979b; Pearlman,
2001);
4. alterations in perception of the perpetrator, including incorporation of his or her belief
system. This criterion addresses the complex relationships and belief systems that ensue
following repetitive and premeditated abuse at the hands of primary caretakers;
5. alterations in relationship to others, such as not being able to trust and not being able to
feel intimate with others. Another “lesson of abuse” internalized by victim/survivors is that
people are venal and self-serving, out to get what they can by whatever means including
using/abusing others;
6. somatization and/or medical problems. These somatic reactions and medical conditions
may relate directly to the type of abuse suffered and any physical damage that was caused
or they may be more diffuse. They have been found to involve all major body systems;
7. alterations in systems of meaning. Chronically abused individuals often feel hopeless
about finding anyone to understand them or their suffering. They despair of ever being able
to recover from their psychic anguish.
OTROK in TRAVMA, MLADOSTNIK in TRAVMA, ODRASEL
in TRAVMA
Child hood trau mas include phys i cal mal treat ment (Boney-McCoy & Finkelhor,
1995), sex ual assault or moles ta -tion (Boney-McCoy & Finkelhor, 1995; Neumann,
Houskamp, Pollock, & Briere, 1996), life-threat ening acci dents (Winje & Ulvik,
1998), the unex pected death of close friends or fam ily mem bers (Appelbaum &
Burns, 1991), life-threat ening ill ness (Stuber, Nader, Houskamp, & Pynoos, 1996),
disas ter (Green et al.,1994; LaGreca, Silverman, Vernberg, & Prinstein, 1996),
domes tic vio lence (Famularo, Fenton, Kinscherff, Ayoub, & Barnum 1994), and com
mu nity vio lence (Cooley, Turner, & Beidel, 1995; Nader, Pynoos, Fair banks, & Fred
er ick, 1990).
Child Mal treatment, Other Trauma Ex po sure, and Posttraumatic Symptomatology Among Children With Oppositional De fi ant
and At tention Def i cit Hy peractivity Dis or ders
Julian D. Ford (University of Con necticut School of Med icine), Robert Racusin, Cynthia G. Ellis, Wil liam B. Daviss, Jessica
Reiser, Amy Fleischer (Dartmouth Med i cal School), Julie Thomas (Youngs town State Uni ver sity).
TRAUMA DURING CHILDHOOD
To date, much of the research in the area of traumatic stress has
focused specifically on events that arise during childhood. Although
trauma can arise at any point in the life cycle (Janoff-Bulman, 1992),
many investigators believe that exposure to trauma during childhood
may be especially harmful. The importance of events that occur in
childhood is suggested both by the work of Brown and Harris (1978)
on early parental loss and Bowlby’s (1980) research on attachment
theory.
According to Brown and Harris (1978), early childhood is an
exceptionally salient developmental period. In particular, they argued
that during early life, a child’s parents are often the primary source for
learning effective ways of exercising personal control. This is important
because a strong sense of control helps people to anticipate potentially
stressful experiences or conditions, take preventive steps to
avoid them, and confront and deal with the adversity that does occur
(Ross, Mirowsky, & Goldsteen, 1990). Consequently, the lessons
learned during this early period of interaction between parents and
children may have lasting effects on one’s ability to handle adversity.
Bowlby (1980) also considered childhood a particularly important
and vulnerable developmental stage. According to him, childhood is
an important period for determining the nature of one’s social relationships
later in life. Specifically, he maintained that a child’s relationship
with his or her parents serves as a prototype for the development
of social ties in adult years. Parent-child relationships that are
intimate and caring tend to foster a sense of trust and security that
facilitates the development of interpersonal closeness throughout the
life course (for a recent reviewof this perspective, also see Reis&Patrick,
1996). Therefore, children may be particularly vulnerable to
traumatic events, especially those of an interpersonal nature such as
exposure to physical violence from one’s parents because they could
have lasting effects on one’s ability to form and maintain meaningful
and supportive social relationships throughout life.
In studying the consequences of childhood trauma in general and
childhood physical violence specifically,much of the current research
has focused on immediate or short-term effects of exposure to violence
on childhood behavior and psychosocial adjustment (e.g.,
Conaway & Hansen, 1989; Lamphear, 1985). Recently, however,
investigators have become increasingly interested in the potential
long-term consequences of childhood exposure to traumatic events.
Profound loss covers a broad spectrum of childhood experiences.
It can come from separation from parents or family through death,
divorce, foster care placement, or the adverse political and economic
circumstances that are associated with emigration.Recent data suggest
that childhood loss of a parent from natural causes is as strongly
associated with PTSD symptoms as children’s reactions to natural
disasters (3). Profound loss can occur as an outcome of parental mental
illness, sometimes quietly and without acknowledgment as when a
parent is lost to depression, or with violent upheaval, as is often the
case with alcohol or other substance use disorders. Today, abandonment
and neglect due to these addictions are the most common reasons for
foster care placement (4). Loss can include physical injury to the self, in
which a part of the body is, or is believed to be, damaged or altered. The
initial loss frequently sets off a series of events (e.g., hospitalization,
relocation, foster care placement) which in turn lead to further loss.
TRAVMA IN SPOMIN
TRAVMA IN KONCENTRACIJA
ZNAČILNOSTI STORILCA – SPOLNA ZLORABA
Osebe, ki spolno zlorabljajo in navezanost
In support of the contention that sexual offenders
had poor parent-child attachments,
there is a considerable body of literature indicating
a variety of disruptive experiences in the
childhood of these offenders. Langevin et al.
(1984), for instance, found that rapists had quite
inadequate parents with whom they failed to
identify. Various other researchers (Awad,
Saunders, & Levene, 1984; Bass & Levant, 1992;
Finkelhor, 1984; Knight, Prentky, Schnieder, &
Rosenberg, 1983; Lang & Langevin, 1991;
Protter & Travin, 1987; Saunders, Awad, &
White, 1986; Tingle, Barnard, Robbins,
Newman, & Hutchinson, 1986) have reported
disruptive and abusive family environments in
the childhoods of sexual offenders. Drunkenness,
physical and sexual abuse, inconsistency,
emotional neglect or rejection, hostility, criminal
activities, social isolation, and various other
problematic circumstances were found to characterize
the family backgrounds of sexual offenders.
More specifically, Marshall, Serran,
and Cortoni (2000) found poorer attachments to
fathers than to mothers among child molesters,
and Smallbone and Dadds (in press) showed
that insecure attachments to fathers led to the
enactment of coercive sexual behavior in adulthood.
In a more recent study, Smallbone and
Dadds (2000) again demonstrated that insecure
childhood attachments were significantly associated
with coercive sexual behavior. These results
remained true even after the influences of
antisociality and aggression were partialed out.
Clearly, sexual offenders have experienced a
significant incidence of problematic relations
with their parents during their childhood, and
these experiences appear to be causally significant
in the development of their offensive
behaviors.
(THE ORIGINS OF SEXUAL OFFENDING, WILLIAM L. MARSHALL, LIAM E.
MARSHALL, TRAUMA, VIOLENCE, & ABUSE, Vol. 1, No. 3, July 2000 250-263)
Zlorabljeni zlorabljajo?
It has certainly been demonstrated that sexual
offenders report far higher rates of personal
experience with being sexually victimized as
children than do other males (Hanson & Slater,
1988). However, much of these data result from
rather simple questions put to the offenders
whomay have a vested interest in exaggerating
childhood sexual abuse; for example, they see
this as diminishing their responsibility for their
ownoffending.
Bentovim and Williams (1998) found that the
majority of children who were sexually abused
came from homes where they had been abused
or neglected.
(THE ORIGINS OF SEXUAL OFFENDING, WILLIAM L. MARSHALL, LIAM E.
MARSHALL, TRAUMA, VIOLENCE, & ABUSE, Vol. 1, No. 3, July 2000 250-263)
Although the majority of children who are
subject to sexual abuse suffer both immediate
and long-term consequences (Beitchman et al.,
1992; Conte, 1988), these effects are not always
seen by the victim as resulting from the abuse.
Indeed, we might expect vulnerable children
who lack a sense of self-worth to blame themselves
for these effects and, as a consequence, to
judge the abuse to not have harmed them.Many
child molesters who were sexually abused as
children claim that it did them no harm, and so,
they see their own abusive behavior as not
harmful to the victim.
If sexual offenders have greater experience
with being sexually molested as children, and if
this satisfies their need for attention, they may
construe the abuse as positive at least in some
respects. Their low self-esteem may cause them
to attribute any unfortunate consequences not
to the abuse or the abuser but rather to some defect
in their own character. Both their need for
attention and their low self-esteem may allow
these children to perceive the abuse in positive
terms. Insofar as they perceive the abuse in this
way, it may encourage them to see sex between
an adult and a child as nonharmful and even
beneficial, thereby removing one significant
constraint against sexual offending later in their
life. In addition, if they did derive pleasure from
their own abuse, subsequently during masturbation
they may fantasize about sexual contact
between an adult and a child. In these fantasies,
they may initially portray themselves in the role
of the victim and then later see themselves as the
offender.
(THE ORIGINS OF SEXUAL OFFENDING, WILLIAM L. MARSHALL, LIAM E.
MARSHALL, TRAUMA, VIOLENCE, & ABUSE, Vol. 1, No. 3, July 2000 250-263)
Consistent with this line of reasoning,
Smallbone and McCabe (2000) found that those
sexual offenders whowere themselves sexually
abused as children reported a significantly earlier
onset of masturbation than did offenders
who were not sexually abused. The results of
this study by Smallbone and McCabe are consistent
with some important links in our theory.
Their data revealed that insecure parent-child
attachments among sexual offenders led to a
marked increase in the likelihood that these
boys would be sexually abused, which in turn
resulted in an early onset of masturbation
among these boys. In addition, because
Smallbone and Dadds (2000, in press) had
shown that insecure attachments in childhood
lead to adult sexual offending, it is reasonable to
suggest that there is a pathway involving insecure
attachments ® a greater risk to be sexually
abused ® heightened sexualization (most particularly
masturbation) ® which finally results
in adult sexual offending. The next two sections
attempt to fill in the gap between early masturbation
(i.e., sexualization) and adult sexual
offending.
(THE ORIGINS OF SEXUAL OFFENDING, WILLIAM L. MARSHALL, LIAM E.
MARSHALL, TRAUMA, VIOLENCE, & ABUSE, Vol. 1, No. 3, July 2000 250-263)
Deviantna spolna aktivnost
Abel and Rouleau (1990) found that
between 40% and 50% of child molesters and
30% of rapists reported an interest in sexually
deviant activities before the age of 18 years, and
other reports are consistent with this early origin
of deviant sexuality.
(THE ORIGINS OF SEXUAL OFFENDING, WILLIAM L. MARSHALL, LIAM E.
MARSHALL, TRAUMA, VIOLENCE, & ABUSE, Vol. 1, No. 3, July 2000 250-263)
SEX AS A COPING STRATEGY (Spolnost- kot strategija »soočanja« s težavami)
Children who are deprived of love and affection,
as most sexual offenders seem to have
been, are quite likely to turn to self-stimulation
as a way of making themselves feel better.
Children learn quite early to masturbate and
that this behavior is pleasurable (Goldman &
Goldman, 1982, 1988; Masters, Johnson, &
Kolodny, 1985). Anything that is pleasurable
can readily serve as a distraction from problems.
If deprived children find solace in masturbation,
they will likely soon recognize that this
is a way to avoid facing other problems; it will
serve as an escape, albeit temporarily, from difficult
issues. Because masturbation is a highly
reliable source of pleasure guaranteed to divert
attention away from difficulties, the criteria for
defining an issue as a problem and using masturbation
to relieve it can be expected to progressively
expand to all manner of problems
and to less and less intense problems.
As we have seen, sexual offenders display an earlier
onset of masturbation and a higher frequency
during adolescence, and we consider this to be a
result of them having learned to use sex as away
of coping initially with their deprived experiences
and later with awhole range of issues. Sex
can, therefore, be expected to be used as a primary
coping strategy by sexual offenders.
If we are correct that vulnerable young males
who are to become adult sexual offenders find,
in masturbating, the comfort and relief they
cannot otherwise obtain, then escape from dis-tress by masturbating should be negatively
reinforced.
(THE ORIGINS OF SEXUAL OFFENDING, WILLIAM L. MARSHALL, LIAM E.
MARSHALL, TRAUMA, VIOLENCE, & ABUSE, Vol. 1, No. 3, July 2000 250-263)
Negativno, pozitivno pogojevanje in spolnost
Negative reinforcement, to remind
readers, occurs when a behavior leads to the
cessation of a noxious state (Skinner, 1969).
When a person has a panic attack on an elevator
and flees from the elevator at the next floor, the
consequent reduction in panic reinforces avoiding
elevators, and an elevator phobia may become
entrenched. Each time a child or teenaged
boy uses masturbation to avoid having to confront
a difficult situation or to escape temporarily
from distress, he is inadvertently engaging
in a procedure that will negatively reinforce
masturbation as a response to any and all upsetting
events. As a result, masturbation, or for that
matter any sexual activity, will become an established
coping response. As we have seen, recent
evidence suggests that sexual offenders do,
indeed, use sex as a coping strategy.
However, it is not just that masturbating negatively
reinforces the use of sex as a coping strategy.
Masturbation clearly induces a pleasurable
state, and anything (e.g., the content of fantasies)
that is consistently associated with this
state is likely to acquire a positive valence. That
is, masturbation also functions as a positively
reinforcing experience just as the early conditioning
theorists claimed.
(THE ORIGINS OF SEXUAL OFFENDING, WILLIAM L. MARSHALL, LIAM E.
MARSHALL, TRAUMA, VIOLENCE, & ABUSE, Vol. 1, No. 3, July 2000 250-263)
Negativno, pozitivno pogojevanje, spolnost in vedenje
Although the early
conditioning theorists (Abel & Blanchard, 1974;
McGuire et al., 1965) may have been wrong
about the precise outcome of their theory (i.e.,
the entrenchment of a highly specific sexual
preference), they were probably correct in suggesting
that the content of masturbatory fantasies
had some guiding influence on behavior.
These early theorists, however, focused exclusively
on the particular sexual elements of the
fantasies because they appear to have believed
that sexually deviant behaviors were motivated
exclusively by sexual desire. Laws and Marshall
(1990), on the other hand, describe a far more
complex conditioning theory that allows a
broader inclusion of stimuli (e.g., the exercise of
power and control, the humiliation of the victim,
the expression of aggression) into the content
of masturbatory fantasies. Any repeated
content (whether sexual or otherwise) of
masturbatory fantasies is likely to become entrenched
as a result of both the negatively reinforcing
effects of escape from distress and the
positively reinforcing properties of the pleasurable
experience of sexual arousal.
Very few, if any, human behaviors are motivated
by a single desire; almost all behaviors have
multiple motives. Sexual activities in particular
seem to serve many purposes (Neubeck, 1974).
Amongother things, sexmaybe sought to achieve
feelings of intimacy or to obtain affection, to alleviate
boredom or a sense of frustration (nonsexual),
as a way to obtain self-affirmation, to
achieve a sense of conquest, or as we have suggested,
to escape from problems.
Deviant sex may also be driven by or associated
with a need to exercise power and control
over another person, a chance to explore “forbidden”
acts (e.g., anal sex occurs at an unusually
high rate in sexual abuse), and as a chance to
vent anger or to humiliate someone. Gratuitous
physical abuse appears to be common in sexual
assaults (Christie, Marshall, & Lanthier, 1979;
Marshall & Christie, 1981), and rapists typically
indicate that their primary motive in sexually
assaulting a female is to degrade and humiliate
her as a symbol of either all women or a particular
woman who has offended them (Darke,
1990; Marshall & Darke, 1982). Groth (1979;
Groth&Burgess, 1977a) has been an advocate of
the view that rape is a pseudo sexual behavior.
He believes it is the expression of power and the
exercise of control over women, rather than the
satisfaction of sexual desires, that drives a rapist.
To support this account, Groth and Burgess
(1977b) point to the fact that sexual dysfunctions
occur in the offender quite frequently during
rapes, and many of our clients have told us that
they are rarely satisfied by the sexual release
they obtain from raping a woman.
(THE ORIGINS OF SEXUAL OFFENDING, WILLIAM L. MARSHALL, LIAM E.
MARSHALL, TRAUMA, VIOLENCE, & ABUSE, Vol. 1, No. 3, July 2000 250-263)
Doživljanje, čustvovanje
Child molesters, on the other hand, appear to
experience strong sexual satisfaction from molesting
children. This does not mean, however,
that other aspects of the abuse are irrelevant.
Howells (1979), for example, found that child
molesters feel emotionally congruent with children
but afraid of potential adult partners and
threatened by sex with an adult. Araji and
Finklehor (1985) propose in their more general
theory that emotional congruence with children
is essential for child molesters to offend. One
important consequence of this is that child molesters
feel in control when they have sex with
children, a feeling they do not experience in sex
with adults, or for that matter, in most other aspects
of their life. This feeling of control is emphasized
by the fact that the molester has the
power to direct the child to engage in whatever
activities he wishes. This power derives both
from the fact that he is an adult and children are
trained to follow the orders of adults and from
the likelihood that the child will feel threatened
by amanwhois sexually assaulting him or her.
(THE ORIGINS OF SEXUAL OFFENDING, WILLIAM L. MARSHALL, LIAM E.
MARSHALL, TRAUMA, VIOLENCE, & ABUSE, Vol. 1, No. 3, July 2000 250-263)
We suggest that the higher frequency of
masturbatory activities during adolescence increases
the likelihood that sexual offenders will
incorporate other elements (e.g., forbidden sexual
acts, power and control, the expression of
aggression) into their sexual fantasies. This may
be done to avoid boredom with the same content
of frequently repeated fantasies, but it is
also likely to occur given their experience as a
rejected or neglected child. Such children, as we
have seen, lack a sense of self-worth and are deficient
in interpersonal skills. They are unlikely,
therefore, to find satisfaction in peer-aged appropriate
relationships and will turn more and
more to fantasy to fulfill their needs. Some of
these children, as a result of their feelings of inadequacy,
may feel capable of relating to weaker
people, and they will thus feel emotionally congruent
only with children. Therefore, the sexual
fantasies of these adolescents may incorporate
children over whom they exercise control and
whom they portray in their fantasies as willing
and eager to have sex with adults. Other vulnerable
adolescents may feel angry about the way
their parents have treated them, and they may
blame women for their lack of intimate affection
and sexuality. We (Garlick, Marshall, &
Thornton, 1996) have, indeed, found that some
sexual offenders blame women for the loneliness
they experience. These adolescents will
likely incorporate the expression of their anger
into their sexual fantasies. This may take the
form of excessive control over the sexual partner
in their fantasies and may, over time, becomemore
cruel and include elements of humiliation
and degradation. It is easy to see how
such a process and an associated severe lack of
self-confidence might make such a male begin
to interpret various behaviors by women as rejection,
leading to the conclusion that all women
are contemptuous of him.
Rapists certainly hold negative and hostile
views of women (Burt, 1980; Marshall &
Hambley, 1996), and child molesters, aswehave
seen, feel emotionally comfortable only with
children (Howells, 1979).
Wright and Schneider claim that sexual
offenders progressively incorporate elements
into their sexual fantasies that serve to bolster
their self-esteem and justify their sexually offensive
behaviors or desires. In an examination of
this account, Wright and Schneider found that
the fantasies of sexual offenders did, indeed,
contain portrayals of victims as compliant,
strongly sexually motivated, and as sexually
provocative. Although Wright and Schneider
did not specifically examine this, it could be that
sexual offenders also include elements of violence,
degradation, and the enactment of forbidden
sexual acts into their fantasies.
(THE ORIGINS OF SEXUAL OFFENDING, WILLIAM L. MARSHALL, LIAM E.
MARSHALL, TRAUMA, VIOLENCE, & ABUSE, Vol. 1, No. 3, July 2000 250-263)
FROM A DISPOSITION TO ENACTMENT
Two sets of factors seem to be important: disinhibiting
influences and an opportunity to
offend.
Disinhibiting Factors
Araji and Finkelhor (1985) propose that for a
man to commit a sexual offense, he must overcome
whatever inhibitions he has against these
behaviors. Similarly, Barbaree (1990) suggests
that sexual arousal to deviant acts occurs only in
those men whose constraints against sexual
arousal are disinhibited. Intoxication is the
disinhibitor most familiar to the ordinary citizen.
Alcohol ingestion disinhibits social constraints
(Firestone, Keyes, & Korneluk, 1999),
encourages the expression of aggression
(Bushman & Cooper, 1990), and facilitates sexual
arousal (Wilson, 1981).
We (Barbaree, Marshall,
Yates, & Lightfoot, 1983) demonstrated
that alcohol intoxication increased sexual
arousal to rape cues in nondeviant males, and it
has been found that as many as 50% or more of
the sexual offenders were intoxicated at the time
of their offense (Amir 1967; Christie et al., 1979;
Johnson, Gibson, & Linden, 1978).
(THE ORIGINS OF SEXUAL OFFENDING, WILLIAM L. MARSHALL, LIAM E.
MARSHALL, TRAUMA, VIOLENCE, & ABUSE, Vol. 1, No. 3, July 2000 250-263)
Kognitivna distorzija in zloraba
According to
Wright and Schneider’s analysis, sexual fantasies
are the primary source of the cognitive
distortions (see Ward, Hudson, Johnston, &
Marshall, 1997, for a description of these distortions)
that clinicians and researchers report so
commonly in sexual offenders and that some
see as serving to justify and maintain sexual offending.
These cognitive distortions, then, feed
back into the processes that lead to sexual offending
and are elaborated further during
masturbatory fantasies. It is the conditioned enhancement
of these elements of the fantasies of
sexual offenders, rather than the strictly sexual
elements, thatwebelieved entrench the disposition
to offend.
Abel and his colleagues (Abel,
Becker, & Cunningham-Rathner, 1984; Abel
et al., 1989) have described the typical cognitive
distortions of child molesters. These involve a
belief that children are sexually disposed, behave
sexually provocatively toward adult
males, initiate sexual acts with adults, enjoy
such activities, and are not harmed by sex with
an adult.
Abel sees these distortions as serving
to justify sexual abuse and as allowing the offender
to continue his abusive behavior free of
guilt and remorse. More specifically, Hartley
(1998) describes how the cognitive distortions
of incest offenders serve to overcome internal
inhibitions about molesting. In other words,
these distortions are thought to function as
disinhibitors of child molesting tendencies.
Similarly, rapists have been shown to hold
views of women and their sexuality that can be
expected to facilitate rape (Bumby, 1996; Burt,
1984; Dewhurst, Moore, & Alfano, 1992; Marshall
& Hambly, 1996; Scott & Tetreault, 1987).
Attitudes condoning violence toward women,
feelings of hostility toward women, support for
rape myths, and distorted perceptions of
women have all been found to be common
among rapists. Again, these distortions can be
understood as facilitating sexual abuse and justifying
continued offending. As such, the distortions
of rapists serve to disinhibit constraints
against rape. Sundberg, Barbaree, and Marshall
(1991) demonstrated that blaming the victim in
a rape led men to show significant increases in
sexual arousal to rape depictions, thereby demonstrating
that victim blame served to disinhibit
responses to rape.
Anger has been found to precede rapes
(Pithers, Beal, Armstrong, & Petty, 1989), and
we (Yates, Barbaree, & Marshall, 1984) showed
that when angered by females, nondeviant
males subsequently displayed very strong
arousal to rape scenes. When not angered, these
same nondeviant males showed little arousal to
rape. Thus, anger toward females served to
disinhibit sexual arousal to rape. Similarly,
Proulx and his colleagues (McKibbon, Proulx,&
Lusignan, 1994; Proulx, McKibbon,&Lusignan,
1996) have shown that various mood states trigger
deviant sexual fantasies in sexual offenders
whose fantasies are otherwise absent or normal.
Looman (1999) essentially replicated Proulx’s
findings.
Priložnost in zloraba, zlorabljanje
However, it is important to note that it is
the probability of deviant, rather than normative
fantasies and acts that increase in sexual offenders
when they are experiencing stress or
negative emotions. Once in a disinhibited state,
a sexual offender will only offend when he has
the opportunity to.
Negative mood states appear to trigger deviant
fantasies in sexual offenders, which in turn
lead them to seize or seek to create an opportunity
to offend. Pithers et al. (1989) showed that
deviant fantasizing often preceded sexual offending,
and Abel and Rouleau (1990) reported
that sexual offenders typically developed their
deviant sexual fantasies prior to offending.
The confluence of the variety of factors we
have outlined (i.e., a history of childhood neglect
or abuse, the consequent lowered sense of
self-worth, an incapacity to meet various needs
in prosocial ways, along with the tendency to
turn to sexwhenin distress, a conditioned desire
for deviant sex, and the presence of a disinhibited
state) will lead amale to seek or take advantage
of an opportunity to sexually offend. It is
clear that some and possibly most sexual offenders
deliberately create opportunities to offend.
Some do this with full awareness; they
plan to offend, manipulate situations to get others
out of the way and to get access to a victim
alone, and groom victims or coerce them into
complying. Others operate at a lower level of
awareness, whereby they either actually develop
an opportunity to offend or simply to allow
events to unfold in a way that produces an
opportunity. Ward, Hudson, and Marshall
(1995) illustrate how this diminished awareness
(called cognitive deconstruction) permits the generation
of an opportunity while allowing the offender
to maintain that he did not deliberately
create the opportunity.
We have also seen numerous
sexual offenders who have stumbled on
an unexpected opportunity to offend. For many
of them, these unplanned opportunities oc
occurred
after their offending had already been
established and they simply seized the chance
to offend. In some but few, fortuitous opportunities
presented themselves as the first chance
to offend.
In whatever way opportunities occur, the
critical point is that however strongly disposed
a man is to rape a woman or molest a child, he
cannot do so unless an opportunity is present.
When an opportunity occurs, the cognitive distortions
developed during fantasizing (i.e., that
children enjoy sex with adults, that all women
secretly desire to be raped) facilitate, along with
other disinhibiting influences, the decision to
seize the change to offend. Once the man has
offended, and particularly if he avoids detection,
it is likely that the experience will feed subsequent
masturbatory fantasies, further entrenching
his disposition to engage in sexually
offensive behaviors. No doubt, somemen are so
shocked, fearful, or distressed over their initial
offense that they do not offend again. This
would be most likely to occur in those men for
whom the disposition to offend is weakest. For
those whose disposition is strong,wecan expect
that subsequent to the initial offense, conditioning
processes, occurring as a result of masturbating
to fantasies of the offense, will further entrench
the tendency to sexually offend.
(THE ORIGINS OF SEXUAL OFFENDING, WILLIAM L. MARSHALL, LIAM E.
MARSHALL, TRAUMA, VIOLENCE, & ABUSE, Vol. 1, No. 3, July 2000 250-263)
(THE ORIGINS OF SEXUAL OFFENDING, WILLIAM L. MARSHALL, LIAM E.
MARSHALL, TRAUMA, VIOLENCE, & ABUSE, Vol. 1, No. 3, July 2000 250-263)
(THE ORIGINS OF SEXUAL OFFENDING, WILLIAM L. MARSHALL, LIAM E.
MARSHALL, TRAUMA, VIOLENCE, & ABUSE, Vol. 1, No. 3, July 2000 250-263)
POSLEDICE TRAVME
The psychological sequelae of CSA often persist into adulthood and include general
psychological distress, anxiety, depression, posttraumatic stress disorder (PTSD), and
somatization. Difficulties in social and interpersonal functioning, fear and distrust of others,
low self-esteem, and feelings of hostility are also common in CSA survivors (for review, see
Browne & Finkelhor, 1986; Polusny & Follette, 1995). Reactions following sexual assault in
adulthood are similar and may manifest in symptoms of depression, fear, anxiety, and PTSD
as well as problems with social adjustment and self-esteem (Goodmanet al., 1993; Kilpatrick,
Saunders,Veronen, Best,& Von, 1987; Koss, 1993). Women who have been physically
assaulted exhibit similar symptomatology including high levels of depression, fear, anxiety,
and PTSD-like symptoms including chronic fatigue and tension, intense startle reactions,
disturbed sleeping and eating patterns, and nightmares (Goodman et al., 1993; Stark &
Flitcraft, 1988). Physical violence also undermines a woman’s sense of trust and has a
dramatic impact on her social interactions (Goodman et al., 1993) (The Revictimization of
Child Sexual Abuse Survivors: An Examination of the Adjustment of College Women With
Child Sexual Abuse, Adult Sexual Assault, and Adult Physical Abuse, CHILD
MALTREATMENT / FEBRUARY 2000)
The available data have revealed that there is a dual effect of adversity including opportunities for
growth apart from symptoms (Somerfield & McCrae, 2000). Correlational research has indicated a
broad array of changes following negative events, including HIV/AIDS, cancer, marrow
transplantation, newborn intensive care, impaired fertility, rape, and child sexual abuse (Affleck,
Tennen, & Rowe, 1991; Armeli, Gunthert, & Cohen, 2001; Burt & Katz, 1987; Collins et al., 1990;
Curbow, Somerfield, Baker, Wingard, & Legro, 1993; Ebersole & Flores, 1991; Lechman et al., 1993;
McMillen, Zuravin, & Rideout, 1995; Mendola, Tennen, Affleck, McCann, & Fitzgerald, 1990; Park,
Cohen, & Murch, 1996; Siegel & Schrimshaw, 2000; Thompson, 1985). Longitudinal studies have
shown follow-up benefits of positive views following crisis, especially in patient outcomes (Affleck,
Allen,Tennen, McGrade,&Ratzan, 1985; Affleck, Tennen, Croog, & Levine, 1987; Bower et al., 1998,
2003; Tennen, Affleck, Urrows, Higgins, & Mendola, 1992). Very fewstudies have examined the
positive gains from violent events, in particular those involving killing and massive destruction. A
survey found that, mediated by negative religious coping,war trauma contributed to diminished hope
inKosovar refugees in the United States (Ai, Peterson,&Huang, 2003).
Recent literature has suggested that many of the psychological effects of
childhood sexual abuse, such as self-destructive behaviors, post-traumatic
stress disorder (PTSD), anxiety, interpersonal difficulties, and sexual dysfunction,
may begin with cognitive distortions about the self and the world
that become part of a child’s cognitive schema (Smucker, Dancu, Foa, &
Niederee, 1995). Further research proposes that these schema distortions
may contribute to the emotional distress experienced by many adult survivors
of sexual abuse (Briere & Elliott, 1994).
For more than two decades, research has consistently found that childhood
sexual abuse (CSA) is associated with poor psychological outcome in adult
populations. This is especially true of research that has investigated the relationship
between mental illness and a history of CSA (e.g., Bryer, Nelson,
Miller,&Krol, 1987; Chu&Dill, 1990; Fry, 1993; Mancini,Van Ameringen,&
MacMillan, 1995; Ogata et al., 1990). Although no abuse-specific syndrome
has been discovered, post-traumatic stress disorder (PTSD) symptomatology
and sexualized behaviors are consistently shown to have a strong association
with CSA (for literature reviews, see Beitchman et al., 1992; Browne &
Finkelhor, 1986; Kendall-Tackett, Williams, & Finkelhor, 1993).
Finkelhor, 1986; Kendall-Tackett, Williams, & Finkelhor, 1993). To date,
there has been a dearth of empirical investigation on the long-term psychological
consequences associated with childhood physical abuse (CPA)
(Malinosky-Rummell&Hansen, 1993), although research on the short-term
effects of CPA has been extensive (see Ammerman, Cassisi, Hersen, & Van
Hasselt, 1986). The Relationship Between Adult Psychological Adjustment and Childhood Sexual Abuse, Childhood Physical
Abuse, and
Family-of-Origin Characteristics SHANE KAMSNER MARITA P. MCCABE
Research over the past two decades supports the relationship between child
abuse and a variety of long-term intrapersonal difficulties including depression,
anxiety, substance abuse, anger, dissociation, low self-esteem, and suicidality
(Jumper, 1995; Neumann, Houskamp, Pollock, & Briere, 1996).
Quite predictably, women with a history of IPV as compared to women
who were nontraumatized had higher levels of psychopathology, reported
more current relational aggression, and functioned more poorly. Childhood
maltreatment also appears to have a significant impact on women’s current
functioning. CSA was associated with increased anxiety sensitivity, which
has been identified as a risk factor for the development of panic disorder
(Schmidt, 1999). Emotional neglect during childhood was associated with
more dissociative and depressive symptoms in this sample. Similar findings
about emotional neglect have been reported in relation to major depression
(Bernet & Stein, 1999), and psychological maltreatment has been linked to
self-depreciation (Higgins & McCabe, 2000b). This group also showed a
pattern of increasing difficulties with experience of more types of childhood
maltreatment. Although childhood physical and sexual abuse have typically
received more attention in the literature, these findings underscore the importance
of attending to multiple types of childhood maltreatment and to the
cumulative effect of such experiences.
As with adults, traumatised children exhibit a spectrum
of psychological consequences of the trauma, including
altered attentional processes, deficits in cognitive systems
necessary for learning, inefficient memory systems, deficits in affective responsiveness, and so on. However,
there are very few research studies of generic memory in
traumatised children.
Research has demonstrated that exposure to traumatic events during childhood
and adolescence is associated with severe and devastating emotional and
behavioral outcomes. While the majority of trauma victims do not go on to
develop chronic psychopathology, traumatic events such as child sexual abuse,
physical abuse=assault, and witnessing violence increase the risk for the
development of posttraumatic stress and other anxiety symptoms (Kilpatrick,
Ruggiero, et al., 2003; McLeer, Deblinger, Atkins, Foa, & Ralphe, 1988;
McLeer et al., 1998), depression (Kilpatrick, Ruggiero, et al., 2003; Tebbutt,
Swanston, Oates, & O’Toole, 1997; Wozencraft, Wagner, & Pellegrin, 1991),
suicide attempts (Oddone Paolucci, Genuis, & Violato, 2001), substance abuse
(Kilpatrick, Ruggiero, et al., 2003), and delinquent behavior (Kilpatrick,
Saunders, & Smith, 2003).These emotional and behavioral difficulties can be
associated with significant and lasting disruption in children’s normal development,
as well as dysfunction and distress well into adulthood (Beitchman
et al., 1992; Briere & Elliott, 1994; Browne & Finkelhor, 1986; Polusny &
Follette,1995; Saunders et al.,1999).
Abstract: There are very few re search stud ies that have eval u ated the re lationships be tween mul ti ple forms of child hood mal treat ment and psy chological ad justment in adult hood. This study
eval u ates the in ter re la tion ships be tween five dif fer ent types of
child mal treatment (sex ual abuse, phys ical abuse, psy cho log
ical mal treat ment, ne glect, wit ness ing fam ily vi o lence) in a
community sam ple of women and men (N = 175). The re la tion ships be tween the re ported ex perience of these forms of
mal treat ment in child hood, fam ily char ac ter is tics dur ing
child hood, and cur rent psy cho log i cal ad justment (trauma
symptomatology and self-de preciation) were as sessed. As hy poth e sized, fam ily char ac ter is tics pre dicted mal treat ment
scores and ad justment, and mal treat ment scores pre dicted
adjustment af ter con trol ling for fam ily en vi ron ment. There
were high cor re la tions be tween scores on the five mal treat ment
scales. Re sults high light the need to as sess all forms of mal treatment when look ing at re lationships of mal treatment to
adjustment and the im por tance of child hood fa mil ial en vi
ronment for the long-term ad justment of adults.
Multitype mal treat ment refers to the coex is tence of
one or more mal treat ment types (Hig gins & McCabe,
1998, in press-b). A review of stud ies in which adult
respon dents reported hav ing expe rienced mul tiple
forms of child mal treatment showed that multitype
mal treat ment is gen er ally asso ci ated with greater
impair ment than sin gle forms of child mal treat ment
(Higgins & McCabe, in press-b). Researchers have
now begun to high light the impact of multitype mal treatment and the impor tance of assess ing more than
one form of mal treat ment (e.g., Rorty, Yager, &
Rossotto, 1994; Sanders & Becker-Lausen, 1995).
Two major issues have been iden ti fied recently by
research ers: (a) the comorbidity of mul tiple forms of
child abuse and neglect and (b) the poten tial inde pendent or interactional con tri bu tion of fam ily fac
tors. How ever, even when research ers acknowl edge
the poten tial con tribution of other fac tors to the
adjust ment prob lems observed in mal treated pop u la
tions, they tend to look at only one of these two issues.
The con tri bu tion of the cur rent study is its dual focus:
the role of both fam ily fac tors and all forms of child
maltreatment to the adjust ment prob lems of adults. A
large pro por tion of the child mal treatment lit erature
is focused on the del eterious effects of sex ual abuse.
REZULTATI:
The results of this study sup ported the hypoth eses
that fam ily char ac ter is tics would pre dict both reports
of child hood mal treatment and cur rent adjust ment;
the degree of mal treating behav iors reported would
pre dict adjust ment; mal treat ment would pre dict
adjust ment after con trol ling for fam ily envi ron ment;
and that there would be a high degree of over lap
between reports of expe riencing sex ual abuse, phys i cal abuse, psy cho log i cal mal treat ment, neglect, and
wit ness ing fam ily vio lence. Paren tal sex ual puni tiveness
(the fre quency with which adults reported that
their par ents had responded puni tively or neg a tively
with regard to sex ual issues and behav iors) stood out
as an impor tant pre dictor of all types of child mal treat ment except for wit ness ing fam ily vio lence.
Expe ri ences of mal treat ing behav iors in child hood
were asso ciated with both trauma symptomatology
and self-depre ciation in adult hood. Sex ual abuse and
psy cho log i cal mal treatment were the types of mal treatment most strongly related to trauma symp tomatology
and self-depre ci a tion. These asso ci a tions
were still pres ent even after allow ing for fam ily back ground fac tors. Con sis tent with the find ings of some
research ers (e.g., Nash, Hulsey, Sex ton, Harralson, &
Lambert, 1993; Nash, Neimeyer, Hulsey, & Lam bert,
1998), this sug gests that child mal treatment is not just
an expres sion of a neg a tive fam ily envi ronment but is
also an inde pendent source of trauma with long-term
negative cor relates.
The results indi cated that there was a high degree
of over lap between adults’ reports of sex ual abuse,
physical abuse, psy chological mal treat ment, neglect,
and wit ness ing fam ily vio lence. Prob lems tend to
occur together. Children who are rid iculed or sub jected to ver bal attacks are also likely to be phys i cally
pun ished or harmed, have their phys i cal or emo tional
needs neglected, and wit ness vio lence being directed
toward other mem bers of the fam ily. Con sistent with
the find ings of Bernstein et al. (1994), all mal treat ment types were strongly asso ciated with each other.
Fam ilies in
which chil dren expe rience mal treat ing behav ior are
more likely to be char ac ter ized by paren tal sex ual
punitiveness toward chil dren, low fam ily cohe sion
and adapt abil ity, and poor qual ity interparental rela tion ships; how ever, paren tal divorce did not pre dict
child mal treat ment.
Studies from a variety of literature support the premise that avoidance
and escape behaviors play fundamental roles in the development
and maintenance of PTSD and trauma-related problems.
Acceptance and Commitment Therapy in the Treatment of Posttraumatic Stress Disorder SUSAN M. ORSILLO, SONJA V. BATTEN - BEHAVIOR MODIFICATION, Vol. 29 No. 1, January 2005 95-129
Proces prilagoditve v normalni situaciji, ki je za nas stresna
The restriction in the capacity for conscious information processing, and the greater
prominence given to processing by an automatic, imaginal memory system, would appear to
be advantageous. In normal circumstances, with the resumption of safety, flashbacks operate
to transfer information from one memory system to the other, and rapidly decline in
frequency after a few hours or days.
Proces prilagoditve v situaciji, ko reagiramo s PTSD
In PTSD, however, this process seems to be blocked, either because of too great a discrepancy
between the contents of the VAM and SAM systems, or because the flashbacks are too
aversive and have to be avoided. The absence of detailed verbally accessible memories
prevents the inhibition of flashbacks, and high levels of negative emotions such as guilt and
shame can, additionally or alternatively, prevent the inhibition of conscious thoughts and
memories concerning the trauma. Further progress in developing what are already moderately
effective treatments for PTSD is likely to depend on an integration of our knowledge about
the phenomenology, underlying cognitive mechanisms, and neurobiology of the disorder.
Although some individuals who have experienced traumatic life events do not seem to suffer from
acute or chronic psychological distress, most individuals do report a range of psychological symptoms
(e.g., anxiety, fear, phobic responses, and depression) following a traumatic experience (Classen,
Koopman, & Spiegel, 1993; Neville & Heppner, 1999). Research has indicated that factors that
influence an individual’s reaction to trauma include the nature and severity of the event and the
individual’s ability to cope with stress and trauma in his or her life (e.g., Snyder & Ford, 1987).
In fact, in the past 20 years, a substantial body of research indicates that applied problem solving and
coping play a crucial adaptive role in dealing with stressful life events and often mediate or moderate
the relationship between stress and both psychological and physical health (e.g., Heppner &
Hillerbrand, 1991; Heppner& Lee, 2002; Heppner, Witty, & Dixon, 2004; Snyder & Ford, 1987;
Summerfeldt & Endler, 1996; Zeidner & Endler, 1996).
(P. Paul Heppner and Mary J. Heppner, Development and Validation of a Collectivist Coping Styles Inventory, Journal of
Counseling Psychology, 2006, Vol. 53, No. 1, 107–125)
POSLEDICE TRAVME – REVIKTIMIZACIJA IN
KOMPULZIVNO PONAVLJANJE
Recent studies have noted a relationship between the experience of CSA and an increased
vulnerability for assaults in adulthood (for review, see Messman & Long, 1996; Polusny &
Follette, 1995). Several factors appear to heighten a woman’s vulnerability to revictimization.
Factors such as learning processes (Wheeler & Berliner, 1988), denial (Roth, Wayland, &
Woolsey, 1990), substance abuse (Briere & Runtz, 1987), low self-esteem (Finkelhor &
Browne, 1985; Jehu & Gazan, 1983), dissociation (Sandberg, Matorin, & Lynn, 1999), sexual
attitudes (Smith, Whealin, Davies, & Jackson, 1996), learned helplessness (Finkelhor &
Browne, 1985; Peterson & Seligman, 1983;Walker&Browne, 1985), and choices regarding
relationships (Jehu & Gazan, 1983) may contribute to increased risk for adult assaults.
Studies of revictimization with community women suggest rates of revictimization ranging
from 37% to 68% (Gorcey, Santiago, & McCall-Perez, 1986; Russell, 1986; Wyatt, Guthrie,
& Notgrass, 1992). In one such study, CSA survivors were 2.4 times more likely than
nonvictims to be revictimized as adults (Wyatt et al., 1992).
Current findings do suggest that the revictimization of CSA survivors is associated with
increased psychological distress.
Sexual revictimization has been explained as resulting from poor risk recognition in women
who have been previously victimized (Breitenbecher, 2001; Gold, Sinclair,&Balge, 1999).
…studies suggest that women with a history of sexual assault may have difficulties
responding effectively to sexual assault risk, rather than in recognizing it.
studies suggest that revictimization is the result of inappropriate or ineffective behavioral
responses to risk rather than risk recognition (Meadows et al., 1997; Naugle, 1999). VanZileTamsen et al.
… women hold about sources of harm and their susceptibility to that harm determine how
they interpret environmental stimuli and prepare to respond. In social interactions with male
acquaintances (e.g., at parties or on dates), risk perception processes compete withwomen’s
goals for entertainment, friendship, and intimacy, which dominate working cognitive
processing. In these situations, sexual advances from a known perpetrator will likely be
interpreted as sexual interest rather than aggression. Women may either miss or dismiss
threat-related cues while focusing on having fun, finding a potential partner, or maintaining a
current relationship (Livingston & Testa, 2000; Norris, Nurius, & Dimeff, 1996; Nurius,
2000). (The Impact of Sexual Assault History and Relationship Context on Appraisal of
and Responses to Acquaintance Sexual Assault Risk 814 JOURNAL OF
INTERPERSONAL VIOLENCE / July 2005)
…findings offer support for previous research suggesting thatwomen are less likely to
appraise a situation as risky when the perpetrator is known (Hickman & Muehlenhard, 1997;
Nurius, 2000). Women are more likely toperceive rape-related threat when the perpetrator is
someone with whom they do not have an expectation of sexual intimacy. This effect of degree
of intimacy on behavioral responses is largely mediated through appraisal. Hence, by failing
to recognize advances from an acquaintance as sexual assault threat, women fail to engage in
direct resistance, which is most likely to thwart the advances. The Impact of Sexual Assault
History and Relationship Context on Appraisal of and Responses to Acquaintance Sexual
Assault Risk 814 JOURNAL OF INTERPERSONAL VIOLENCE / July 2005)
- unexpected finding was that women are more likely to use indirect resistance when the
perpetrator is a friend or date, regardless of the degree of risk perceived in the situation. The
Impact of Sexual Assault History and Relationship Context on Appraisal of and Responses
to Acquaintance Sexual Assault Risk 814 JOURNAL OF INTERPERSONAL VIOLENCE /
July 2005)
…this finding is consistent with the fact that behavioral responses are guided not just by risk
appraisal or assertiveness but by concerns for the relationship, as well. Women in such
situations may be ambivalent. On one hand, they may not want to engage in sexual activity;
however, they may be focused on preserving the relationship or saving the man’s feelings
(Livingston & Testa, 2000; Norris et al., 1996) and, thus, respond nonassertively and less
effectively. The Impact of Sexual Assault History and Relationship Context on Appraisal of
and Responses to Acquaintance Sexual Assault Risk 814 JOURNAL OF
INTERPERSONAL VIOLENCE / July 2005)
Another barrier to direct resistance involves the social embarrassment of accusing an
acquaintance of sexual assault. Research has shown that people commonly blame the victim
in situations of acquaintance sexual assault believing that the woman must have done
something to encourage the man’s advances (Hammock & Richardson, 1997). The Impact of
Sexual Assault History and Relationship Context on Appraisal of and Responses to
Acquaintance Sexual Assault Risk 814 JOURNAL OF INTERPERSONAL VIOLENCE /
July 2005)
… results suggest that women can resist unwanted sexual advances through the development
of assertiveness skills and effective resistance strategies; however, responses to acquaintance
sexual assault depend on the interpretation of the situation according to schemata that are
heavily influenced by relation- ship to the perpetrator.
Substantial empirical evidence suggests that women with a prior
experience of sexual assault are at greater risk for sexual victimization
than women without this experience. Across studies, rates
of sexual victimization in adulthood range from 28% to 38% for
women not sexually victimized in childhood, whereas childhood
sexual assault survivors’ rates of adult victimization range
from 48% to 66% (Banyard, Williams, & Siegel, 2001; Maker,
Kemmelmeier, & Peterson, 2001). Approximately two thirds of
adult victims of sexual assault report a history of earlier victimization
(Arata, 2002; Stermac, Reist, Addison,&Millar, 2002; Urquiza
& Goodlin-Jones, 1994). In a review of sexual revictimization literature,
Arata (2002) concludes that girls who are sexually victimized
in childhood are 1.5 to 2.5 times more likely to be sexually
assaulted in adolescence or adulthood than their nonvictimized
peers. (ERIN A. CASEY PAULA S. NURIUS,Trauma Exposure and Sexual
Revictimization Risk, Comparisons Across Single, Multiple Incident,
and Multiple Perpetrator Victimizations, VIOLENCE AGAINST WOMEN, Vol. 11 No. 4,
April 2005 505-530
research suggests that revictimized women
have poorer long-term psychological and emotional outcomes
than their singly victimized or nonvictimized counterparts
(Arata, 1999b; Banyard et al., 2001; Maker et al., 2001).
(ERIN A. CASEY PAULA S. NURIUS,Trauma Exposure and Sexual
Revictimization Risk, Comparisons Across Single, Multiple Incident,
and Multiple Perpetrator Victimizations, VIOLENCE AGAINST WOMEN, Vol. 11 No. 4,
April 2005 505-530)
Mostprominently, adult victims of sexual assault who have histories
of child sexual abuse have significantly higher levels of posttraumatic stress symptoms than nonsurvivors or than women
with child-only or adult-only victimizations (Arata, 1999b;
Gidycz et al., 1993; Maker et al., 2001). (ERIN A. CASEY PAULA S. NURIUS,Trauma
Exposure and Sexual Revictimization Risk, Comparisons Across Single, Multiple Incident,
and Multiple Perpetrator Victimizations, VIOLENCE AGAINST WOMEN, Vol. 11 No. 4,
April 2005 505-530)
Additionally, women victimized
by different perpetrators at different time points have
been shown to suffer greater levels of depression and anxiety
than women victimized only in childhood or only in adulthood
(Banyard et al., 2001; Gibson & Leitenberg, 2001; Gidycz et al.,
1993). Previously victimizedwomen take longer to recover froma
subsequent assault, experience more postassault PTSD symptomatology,
and use less effective coping methods to heal (Arata,
1999a; Gibson & Leitenberg, 2001). (ERIN A. CASEY PAULA S. NURIUS,Trauma
Exposure and Sexual Revictimization Risk, Comparisons Across Single, Multiple Incident,
and Multiple Perpetrator Victimizations, VIOLENCE AGAINST WOMEN, Vol. 11 No. 4,
April 2005 505-530)
Revictimization may also exacerbate long-term sequelae such
as substance use and diminished physical health, although little
literature to date has specifically examined the impact of multiple
sexual assaults on these factors. Increased likelihood of alcohol
and other drug abuse has been consistently linked with childhood
sexual assault (Briere & Runtz, 1993). (ERIN A. CASEY PAULA S. NURIUS,Trauma
Exposure and Sexual Revictimization Risk, Comparisons Across Single, Multiple Incident,
and Multiple Perpetrator Victimizations, VIOLENCE AGAINST WOMEN, Vol. 11 No. 4,
April 2005 505-530)
Numerous researchers have suggested that the sheer accumulation
of traumatic experiences is responsible for the increased
psychological distress found among revictimized women.
Women who experience sexual assault are at greater risk of experiencing
nonsexual traumas both in childhood and adulthood
(Banyard et al., 2001; Messman-Moore & Long, 2000; Stermac
et al., 2002).
Increasing numbers
of experiences of child sexual abuse, adult sexual assault, and
adult partner violence were accompanied by concomitant increases
in anxiety, depression, and posttraumatic symptoms. (ERIN A. CASEY PAULA S.
NURIUS,Trauma Exposure and Sexual Revictimization Risk, Comparisons Across Single,
Multiple Incident, and Multiple Perpetrator Victimizations, VIOLENCE AGAINST
WOMEN, Vol. 11 No. 4, April 2005 505-530)
Alternatively, impaired psychological
functioning resulting from trauma may impede women’s
self-protective capacities in the face of later assault threats. Subsequent
revictimization then further erodes psychological wellbeing.
Forgetting or repressing a sexually assaultive experience
may play a role in this cycle.Women victimized by multiple perpetrators
were more likely to forget some or all of their initial
assault experience, and forgetting was a marginal predictor of
sexual revictimization. Forgetting may contribute to vulnerability
by preventing a woman from actively processing her experience,
from challenging self-blame or other self-defeating
schemas, and from developing coping skills that reduce vulnerability. (ERIN A. CASEY
PAULA S. NURIUS,Trauma Exposure and Sexual Revictimization Risk, Comparisons
Across Single, Multiple Incident, and Multiple Perpetrator Victimizations, VIOLENCE
AGAINST WOMEN, Vol. 11 No. 4, April 2005 505-530)
it appears that earlier experiences of
sexual abuse create an initial vulnerability that is exacerbated by
subsequent childhood or adolescent victimizations.
(ERIN A. CASEY PAULA S. NURIUS,Trauma Exposure and Sexual
Revictimization Risk, Comparisons Across Single, Multiple Incident,
and Multiple Perpetrator Victimizations, VIOLENCE AGAINST WOMEN, Vol. 11 No. 4,
April 2005 505-530
The age at which initial sexual assaults occur and their accompanying
severity may increase women’s vulnerability by exacerbating
the psychological impact of an early victimization experience.
Evidence suggests that psychological distress, more
generally, and posttraumatic stress symptomatology (PTSD), in
particular, are likely mechanisms through which revictimization
vulnerability builds. PTSD-related symptoms have been shown
to moderate the relationship between early assault experiences
and revictimization (Sandberg, Matorin, & Lynn, 1999) as well as
the severity of childhood sexual abuse experiences and revictimization
in adulthood (Arata, 2000). Thus, for women with a
history of sexual victimization, high levels of current PTSD
symptomatology can exacerbate vulnerability, decrease selfprotective
capacity, or may constitute a vulnerability that potential
perpetrators seek out and exploit (Messman-Moore & Long,
2003)
(ERIN A. CASEY PAULA S. NURIUS,Trauma Exposure and Sexual
Revictimization Risk, Comparisons Across Single, Multiple Incident,
and Multiple Perpetrator Victimizations, VIOLENCE AGAINST WOMEN, Vol. 11 No. 4,
April 2005 505-530)
A complementary framework for understanding the link
between experiences of child sexual abuse and vulnerability to
revictimization is offered by Finkelhor and Browne (1985). These
authors theorized that the experience of sexual abuse damages a
young person’s self-concept and worldview through “trauma-genic dynamics,” which include
a sense of betrayal, powerlessness,
stigmatization, and traumatic sexualization. Vulnerability
to reassault is posited to be exacerbated by psychological and
emotional impact consistent with these dynamics. Aspects of an
initial assault or its aftermath that intensify its psychological or
traumatic effect may therefore increase risk for revictimization
partially through the presence of traumagenic impact or previously
mentioned posttraumatic symptoms. (ERIN A. CASEY PAULA S. NURIUS,Trauma
Exposure and Sexual Revictimization Risk, Comparisons Across Single, Multiple Incident,
and Multiple Perpetrator Victimizations, VIOLENCE AGAINST WOMEN, Vol. 11 No. 4,
April 2005 505-530)
Finally, the presence of nonsexual trauma during childhood
can also increase young women’s risk of sexual revictimization. (ERIN A. CASEY PAULA
S. NURIUS,Trauma Exposure and Sexual Revictimization Risk, Comparisons Across
Single, Multiple Incident, and Multiple Perpetrator Victimizations, VIOLENCE
AGAINST WOMEN, Vol. 11 No. 4, April 2005 505-530)
Thus, young people
whose early environments are characterized by risk of exposure
to multiple types of trauma appear to be at greater risk of increased
vulnerability. The nature of the environment’s response
to disclosures of abuse can also impact young people’s vulnerability.
Research has consistently demonstrated that supportive
responses to a child’s disclosure of sexual abuse are associated
with more positive mental health outcomes and more rapid healing
(Everson, Hunter, Runyon, Edelson, & Coulter, 1989; Gries
et al., 2000). Additionally, negative reactions fromformal or informal
helping systems have been associated with poorer mental
health outcomes following an assault (Filipas & Ullman, 2001).
The nature of and reaction to help seeking by victims therefore
appears to impact postassault functioning and, by extension, risk
of exposure to repeated sexual victimization. (ERIN A. CASEY PAULA S.
NURIUS,Trauma Exposure and Sexual Revictimization Risk, Comparisons Across Single,
Multiple Incident, and Multiple Perpetrator Victimizations, VIOLENCE AGAINST
WOMEN, Vol. 11 No. 4, April 2005 505-530).
The results suggest that
singly victimized women differ from women with repeat victimizations
both in terms of the characteristics of their initial sexual
assault and with respect to the long-term psychological and
health consequences of their traumatic experiences. Both survivors
of ongoing abuse and survivors of multiple assaults by different
perpetrators were more likely to be younger at the time of
their first assault and to experience more severe initial assaults
(characterized by injury or degree of threat).
Within these differences,
a trend emerged in which victims of multiple perpetrators
were even younger and experienced a higher number of
severe aspects of victimization than women who were repeatedly
victimized by the same perpetrator throughout time. Additionally,
women victimized by multiple perpetrators were more
likely to have ever forgotten some or all of their initial assault
experience and to find the response of informal supports unhelpful
in response to disclosure compared to their singly victimized
counterparts.
Women victimized by multiple
perpetrators experienced significantly more nonsexual traumas
during their lifetime than either singly victimized women or
survivors of ongoing abuse. Additionally, multiply victimized
women experienced more types of sexually assaultive acts during
the course of their lives than women revictimized by the same
perpetrator throughout time. Thus, although both groups of
repeatedly victimized women may have more severe initial experiences
than singly victimized women, women hurt by multiple
offenders appear to face an added layer of exposure to both sexual
and nonsexual trauma.
This differential exposure to trauma is further reflected in the
findings related to the long-term outcomes of women with different
assault experiences. Consistent with expectations, women
victimized by multiple perpetrators were struggling with significantly
more current posttraumatic-stress-related symptoms,
more depression symptoms, and poorer self-rated health than
both the singly victimized group and the ongoing victimization
group. Additionally, the multiple perpetrator victimization
group was the only group of sexually assaulted women to have
significantly higher past month drug use than nonsexually victimized
respondents. Taken together, these results suggest that
although repeated victimization by the same perpetrator is associated
with greater psychological impact than a single assault experience,
a new assault by a different perpetrator may be a more
damaging form of revictimization than ongoing abuse by the
same offender.
(ERIN A. CASEY PAULA S. NURIUS,Trauma Exposure and Sexual Revictimization
Risk, Comparisons Across Single, Multiple Incident, and Multiple Perpetrator
Victimizations, VIOLENCE AGAINST WOMEN, Vol. 11 No. 4, April 2005 505-530).
Rather than
being independent traumatic events, a number of
studies have found that women with a history of child
sexual abuse are at increased risk for adult victimization
compared to women who do not report histories
of child sexual abuse (Ellis, Atkeson, & Calhoun,
1982; Fromuth, 1986; Miller et al., 1978; Urquiza &
Goodlin-Jones, 1994).
Women who have been sexually abused in childhood appear to be at greater
risk for revictimization as adults. In a community sample of 930 women,
Russell (1986) found that approximately 60% of the women who had been
abused in childhood also reported being raped or having experienced
attempted rape after the age of 14 compared with 35% ofwomen with no history of childhood abuse. A prospective study of 857
female college students conducted by Gidycz and colleagues (Gidycz, Coble,
Latham, & Layman, 1993) examined the relationship between childhood
sexual abuse and revictimization in adolescence and adulthood and showed
that childhood sexual abuse predicts revictimization in adulthood. A recent metaanalysis of 38 studies confirmed that women
with histories of childhood sexual abuse are more likely to be revictimized as
adults (Neumann, Houskamp, Pollock, & Briere, 1996).
In addition to these problems, previous research has revealed a link
between CSA and increased vulnerability for assaults in adulthood (Browne&
Finkelhor, 1986; Messman & Long, 1996; Polusny & Follette, 1995). This
phenomenon is called revictimization and may occur in the form of adult sexual
assault, physical abuse, or psychological maltreatment. Several factors
associated with CSA may increase a woman’s vulnerability to revictimization.
CSA may result in learned maladaptive behaviors, beliefs, and attitudes
and a failure to learn adaptive behaviors (Wheeler & Berliner, 1988). This
may result in inappropriate dating and sexual behavior, acceptance of rape
myths, and sex-role stereotypes in adulthood. Low self-esteem (Finkelhor &
Browne, 1985; Jehu & Gazan, 1983), learned helplessness (Finkelhor &
Browne, 1985; Peterson & Seligman, 1983), and relationship choices
(Jehu &Gazan, 1983) may also contribute to revictimization. Other psychological
difficulties associated with CSA may also be important. Both dissociation
and substance abuse have been linked to CSA (Briere, 1992). It has
been theorized that CSA survivors (CSAS) use substances to avoid unpleasant
affect and memories of the childhood abuse that may place them at risk for
subsequent assault (Briere, 1992; Polusny & Follette, 1995).
Studies with college and clinical
samples find that CSAS are more likely than nonvictims to experience
sexual victimization as adults (Briere & Runtz, 1987; Gidycz, Hanson, &
Latham, 1995; Koss & Dinero, 1989; Urquiza & Goodlin-Jones, 1994). One
study found that 32.1% of CSAS experienced adult victimization compared
with 13.6% of nonvictims (Gidycz, Coble, Latham,&Layman, 1993). Studies
of revictimization with communitywomen reveal rates of revictimization
ranging from 37% to 68% (Gorcey, Santiago,&McCall-Perez, 1986;Wyatt,
Guthrie,&Notgrass, 1992). Fergusson, Horwood, andLynskey (1997) found
that CSAS were 11 times more likely than nonvictims to experience rape or
attempted rape.
This studywas designed to overcome shortcomings of previous studies. First,
a well-operationalized definition ofCSAsimilar to those used by other researchers
and commonly used assessment measures to detect adult abuse experiences
were employed. A large sample was obtained with an appropriate comparison
group. The study of sexual revictimizationwas improved by examining unwanted
sexual contact with acquaintances and strangers as well as by investigating the
method of coercion involved. A dimensional measurement of unwanted sexual
contact (i.e., fondling, oral-genital contact, and penetration by objects in addition
to intercourse) also strengthened this investigation, as it is the first study to examine
these experiences. This study extends previous findings by examining all
three forms of revictimization simultaneously.
Evidence here suggests that revictimization not only occurs as
unwanted sexual contact but also as physical and psychological abuse.
Research is needed to explain howand why revictimization occurs.With a
few exceptions (e.g., Finkelhor & Browne, 1985; Polusny & Follette, 1995;
Walker & Browne, 1985; Wheeler & Berliner, 1988), theoretical conceptualizations of
revictimization are lacking. Information regarding methods of
coercion, especially verbal coercion and use of alcohol and drugs as well as
physical force, may become important in developing such theories. Given the
results from this study, it appears that CSAS are more vulnerable to verbal
coercion or pressure from individuals in authority. This may be because the
experience of CSA has instilled fear of authority figures. Previous CSA may
have resulted in the development of certain coping strategies, such as “going
along” with uncomfortable experiences, as the adoption of these strategies
has in the past minimized physical harm. These strategies, however, may
actually increase the woman’s risk for additional victimization. Research
regarding the psychological adjustment of women who are revictimized is
also needed. One may speculate that revictimized women will experience
poorer psychological adjustment than nonvictimized women or women with
only adult victimization experiences (see, e.g., Follette, Polusny, Bechtle, &
Naugle, 1996).
Revictimization further increases the risk of psychopathology for survivors
of childhood abuse. Combat veterans with PTSD were more likely to
have a history of CPA than those without PTSD (Bremner, Southwick,
Johnson, Yehuda, & Charney, 1993). Battered women with PTSD had a
higher rate of CSA(but not CPA) than batteredwomen without PTSD (Astin,
Ogland-Hand, Coleman, & Foy, 1995). Survivors of combined CSA and
CPA who were subsequently retraumatized (by rape, domestic violence, or
criminal victimization) had significantly higher rates of PTSD than those
without a history of childhood abuse or with CSA alone (Breslau, Chilcoat,
Kessler, & Davis, 1999; Molnar, Buka, & Kessler, 2001; Rodriguez, Ryan,
Rowan, & Foy, cited in Rodriguez et al., 1998). Retraumatization of those
with a history of CSA as compared to traumatization only in adulthood has
also been associated with more dissociative symptoms, alexithymia, lifetime
suicide attempts, and interpersonal problems (Cloitre, Scarvalone,&Difede,
1997).
Sexual abuse in childhood is a major risk factor for later sexual
revictimization (Chu, 1992; Koss & Dinero, 1989) and may lead to greater
sexual problems (Wyatt, Guthrie, & Notgrass, 1992) as well as other trauma
symptoms (Koverola, Proulx, Battle, & Hanna, 1996). These trauma symptoms
among women sexually abused in childhood may be exacerbated by
recent life stressors, such as problems at work or in the family (Koopman,
Gore-Felton, & Spiegel, 1997). (Recent Stressful Life Events,Sexual Revictimization, and Their
Relationship With Traumatic Stress Symptoms Among Women Sexually Abused in ChildhoodCATHERINE CLASSEN
RUTH NEVO,CHERYL KOOPMAN,KIRSTEN NEVILL-MANNING,CHERYL GORE-FELTON
DEBORAH S. ROSE,DAVID SPIEGEL
JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 17 No. 12, December 2002 1274-1290)
For a substantial minority of women, however, revictimization occurs.
Numerous studies have found that women with a history of sexual victimization
are at greater risk for future victimization (Gidycz, Hanson, & Layman,
1995; Himelein, 1995; Humphrey & White, 2000; Nishith, Mechanic, &
Resick, 2000). It has been speculated that such prior victimization may
reduce a woman’s ability to appraise risk and to set appropriate boundaries
(Nishith et al., 2000). Indeed,Wilson, Calhoun, and Bernat (1999) found that
women with a victimization history exhibited poorer risk recognition (i.e.,
judging when a man’s sexual advances place her at risk).Women with a history
of repeated sexual victimization took longer to indicate potential danger
in an audiotaped date rape scenario. These women appear to experience a
delay in recognizing sexually aggressive behaviors that may pose a threat.
(The Role of Sexual Victimization
in Women’s Perceptions of Others’ Sexual Interest,PATRICIA L. N. DONAT,BARRIE BONDURANT
JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 18 No. 1, January 2003 50-64)
Abstract: Lifetime trauma histories were ascertained for females with confirmed histories of
childhood sexual abuse and comparison females participating in a longitudinal, prospective
study. Abused participants reported twice as many subsequent rapes or sexual
assaults (p = .07), 1.6 times as many physical affronts including domestic violence
(p = .01), almost four times as many incidences of self-inflicted harm (p =
.002), and more than 20% more subsequent, significant lifetime traumas (p = .04)
than did comparison participants. Sexual revictimization was positively correlated
with posttraumatic stress disorder symptoms (PTSD), peritraumatic dissociation,
and sexual preoccupation. Physical revictimization was positively correlated with
PTSD symptoms, pathological dissociation, and sexually permissive attitudes. Selfharm
was positively correlated with both peritraumatic and pathological dissociation.
Competing theoretical explanations for revictimization and self-harm are discussed
and evaluated.
Research over the past decade has documented a prospective link between
rape and subsequent revictimization in short-term follow-up studies of adult
victims (e.g., Gidycz, Hanson, & Layman, 1995; Kilpatrick, Acierno,
Resnick, Saunders, &Best, 1997). The link between childhood sexual abuse
and subsequent victimization that occurs later in adolescence or adulthood is
less well understood. A growing body of research has documented associations
between childhood sexual abuse and subsequent sexual victimization
(see Messman&Long, 1996, and Briere&Runtz, 1987, for reviews; see also
Arata & Lindman, 2002; Chu & Dill, 1990; Kessler & Bieschke, 1999; Koss
& Dinero, 1989; Merrill et al., 1999; Messman-Moore & Long, 2000) and
between childhood sexual abuse and laterphysical victimization including
domestic violence (Arata, 1999; Collins, 1998; Gilbert, El-Bassel, Schilling,
& Friedman, 1997; Krahe, Scheinberger-Olwig, Waizenhofer, & Kolpin,
1999; McClosky, 1997; Messman & Long, 1996). Otherstudies have documented
higher rates of self-abuse or self-harm in childhood sexual abuse victims
(Boudewyn & Liem, 1995; Romans, Martin, Anderson, Herbison, &
Mullen, 1995; Van der Kolk, Perry, & Herman, 1991; Winchel & Stanley,
1991; Yeo & Yeo, 1993). Further, it appears that the co-occurrence of multiple
types of child maltreatment (e.g., sexual abuse, physical abuse, child
neglect) puts children at considerable risk for revictimization in adulthood
(Briere, Woo, McRae, Foltz, & Sitzman, 1997; Dutton, Burghardt, Perrin,
Chrestman, & Halle, 1994; Hillis, 2001).
We operationally define victimization
(either sexual or physical) as harm perpetrated by an outside source that
serves as a reenactment of the initial abuse. Self-harm, on the other hand,
implies a direct reenactment inflicted by the survivor herself and represents a
certain internalization of the trauma. Therefore, self-harm is not considered
a category of revictimization but will be studied as a separate and distinct
phenomenon.
REZULTATI:
Analyses showed that, compared to nonabused participants, sexually
abused participants were twice as likely to have been raped or sexually
assaulted, almost fourtimes as likely to have inflicted subsequent self-harm
(in the form of suicide attempts or self-mutilation), reported significantly
higher rates of physical revictimization (including domestic violence), and
reported a greater number of significant subsequent lifetime traumas than
comparison participants. When alternative forms of childhood maltreatment
were taken into account, childhood sexual abuse was a unique predictor of
self-harm.
Concurrent pathological dissociaton was shown to be predictive of physical
victimization when in the company with variables from several theoretically distinct domains. These results indicate that a persistent reliance on dissociation
as a coping mechanism can place participants at increased risk for
physical harm. Thus, victims who adopt pathological dissociation as the primary
defense strategy in adolescence or adulthood may be less able to engage
in self-protection when physically threatened. Dissociation has been thought
to be associated with suicide and self-injurious behaviors, and these results
confirm this association (Brodsky, Cloitre, & Dulit, 1995). Self-harm may
not be a direct response to sexual abuse but to the dissociative experiences
that result from efforts to cope with the abuse.
Results also indicate that being sexually active orbelie ving that sexual
activity is permissible can increase one’s vulnerability for physical victimization.
The incidence of self-harm in sexual abuse victims was quite dramatic.
Being sexually abused was, by far, the strongest predictor of self-harm even
when in company with other forms of child maltreatment.
Abstract: This study investigated the relationship between the severity of childhood trauma and proneness
to victimization in adulthood in a sample of 155 Australian women. A tendency for both violent
and nonviolent revictimization was observed. The classical “repetition compulsion” theory of
revictimization is less able to accommodate these findings than theories that implicate an effect
of childhood abuse on self-concept. Additionally, the factors of peritraumatic dissociation, coping
styles, and attachment styles were examined as possible intervening variables in the revictimization
relationship. The findings of the study suggest that some coping styles mediate the
relationship between childhood abuse and victimization in adulthood, whereas aspects of
attachment styles may serve to moderate this relationship.
Severe abuse and neglect in childhood can have diverse effects on functioning
in adulthood, but one effect that has received the increasing attention of
researchers in recent years is proneness to revictimization. That is, adults
with a history of childhood trauma appear to have an enhanced likelihood of
becoming victims of various types of violence such as rape and other sexual
assaults, physical assault, battery, and domestic violence (Cloitre, Tardiff,
Marzuk, Leon,&Portera, 1996; Messman&Long, 1996; Sappington, Pharr,
Tunstall, & Rickert, 1997).
The classical explanation of revictimization appeals to the psychodynamic
notion of a “repetition compulsion” (Freud, 1920/1955). According to this
account, people who fail to accommodate to a traumatic experience may be
subconsciously driven to reenact that experience in an endeavor to achieve a
sense of mastery over the original trauma. The theory can be criticized for its
imputation that if abuse victims actually “want to be revictimized,” the perpetrators
of violence against these people can be absolved from at least some
personal responsibility for their actions. The issue of apportioning blame
nevertheless has no bearing on the validity of the theory.
Although the repetition compulsion theory continues to have its advocates
(Chu, 1992; van der Kolk, 1989) contemporary commentators on revictimization
tend to interpret the phenomenon as overdetermined, that is, as reflecting
several distinct processes in varying degrees (Sandberg, Lynn, & Green,
1994). Among the processes that might be pivotal in this context are dissociative
mechanisms, coping styles, and attachment styles.
OBRAMBNI MEHANIZMI:
Dissociation is one of the most primitive of defense mechanisms. As children
develop, they tend to acquire more sophisticated coping styles by virtue
of which they may eventually be able to accommodate to past traumas. Thus,
child abuse survivors who have refused to dwell on their abusive experience
or who have positively reframed their experience do tend to be more resilient
(Himelein & McElrath, 1996) and thereby may be less liable to revictimization,
although the reverse might be the case for those who rely on an escapist
coping style (Proulx, Koverola, Fedorowicz, & Kral, 1995). A study by
Myall and Gold (1995), however, failed to find support for coping style as a
mediator between childhood sexual abuse and sexual victimization in adulthood.
Nonetheless, there is scope for examining this issue in relation to childhood
trauma and revictimization as more broadly conceived.
REZULTATI:
The sample of Australian women evidenced the revictimization phenomenon
in a relatively broad context, namely, in relation to a range of childhood
trauma and various instances of victimization in adulthood.
Abstract: Recent investigations of risk factors for adult sexual assault have focused on a varietyof behavioral
and cognitive variables, including victim risk-taking behaviors. In this study, cognitive
appraisals of riskyactivities, behavioral intentions to engage in risk-taking behaviors, and alcohol
use were examined in relation to future involvement in risk-taking behaviors and the incidence
of sexual assault in a sample of college women. At Time 1, 50 (26%) participants reported
a historyof sexual victimization and at Time 2, 16 (12.7%) reported new sexual victimizations.
Discriminant function analysis indicated that alcohol use and expected involvement in risky
activities at Time 1 were associated with new sexual victimizations at Time 2. Hierarchical
regression analysis revealed that alcohol use and expected involvement in risky activities at Time
1 were predictive of frequencyof involvement in riskyse xual activities at Time 2. The implication
of these findings for future research is discussed.
Routine activities theory provides an overarching framework for howcertain
behaviors may be associated with increased risk of assault. This theory
proposes that activities involving greater exposure to potential assailants are
associated with increased risk of victimization (Miethe & Meier, 1990;
Mustaine & Tewksbury, 1998). Moreover, risk may be greater in certain
social settings, such as bars, where alcohol is consumed and aggression is
more likely (Parks & Miller, 1997). Research has shown that a combination
of behavioral factors (e.g., alcohol use) and leisure activities (e.g., going to
the mall, eating out) are associated with increased risk of criminal victimization
among collegewomen (Mustaine&Tewksbury, 1998). Therefore, exposure
to potential assailants serves as a risk factor for future sexual victimization,
particularly in interpersonal contexts where a woman is likely to be
perceived as a vulnerable target (e.g., Parks & Miller, 1997). Although routine
activities theory predicts that exposure to “strangers” is salient, the application
of this theory to acquaintances is particularly relevant in the case of
sexual assault, given that the majority of sexual assaults are perpetrated by
someone known to the victim (Koss, Dinero, Seibel, & Cox, 1988).
In addition to risk of assault associated with exposure to potential perpetrators
in specific contexts, research has demonstrated that certain behaviors
and activities are associated with increased risk of victimization. Studies
investigating the phenomenon of revictimization have examined sexual risktaking
behaviors as potential risk factors. Theorists have suggested that sexual
risk-taking behaviors, such as promiscuous and unprotected sexual activities,
may increase risk for sexual assault (Koss & Dinero, 1989). Koss and
Dinero (1989) hypothesized that Finkelhor and Browne’s (1985) concept of
traumatic sexualization may explain increased sexualized behaviors among
previously victimized women. More frequent sexual activity, an earlier age
of onset of sexual intercourse, and a higher number of sexual partners have
been found to strongly correlate with sexual assault (Alexander & Lupfer,
1987; Koss & Dinero, 1989; Mayall & Gold, 1995; Wyatt, Guthrie, &
Notgrass, 1992). Furthermore, victims report greater involvement in sexual
risk-taking behaviors in comparison to nonvictims, including promiscuous
and indiscriminate sexual activities as well as unsafe sexual behaviors that
place them at risk for contracting sexually transmitted diseases (STDs) and
human immunodeficiency virus (HIV) (see Polusny & Follette, 1995, for a
review).
Alcohol use has also received considerable attention as a risk factor for
sexual victimization (Koss & Dinero, 1989; Muehlenhard & Linton, 1987;
Testa & Parks, 1996). Alcohol use has been found to correlate with risk for
sexual assault in retrospective studies (Koss & Dinero, 1989), to be more
prevalent among sexual assault victims (Stewart, 1996; Testa & Dermen,
1999), and to predict future victimizations (Gidycz, Hanson, & Layman,
1995).
REZULTATI:
Of the study variables, alcohol use and behavioral
intentions to engage in risk-taking behaviors were strongly related to new
victimizations and engagement in risky sexual activities. Alcohol use consistently
played a strong role in the predictive analyses andwas found to relate to
both the occurrence of new victimizations and frequency of involvement in
risky sexual activities. Moreover, the quantity of alcohol use was an important factor in that newly victimized women reported more than 3 times as
many average binge-drinking days at Time 1 in comparison to women who
were not victimized during the study.
In addition, behavioral intentions to engage in risk-taking behaviors were
strongly associated with future risk-taking behavior, providing support for
the theory of reasoned action.
Substantial empirical evidence suggests that women with a prior
experience of sexual assault are at greater risk for sexual victimization
than women without this experience. Across studies, rates
of sexual victimization in adulthood range from 28% to 38% for
women not sexually victimized in childhood, whereas childhood
sexual assault survivors’ rates of adult victimization range
from 48% to 66% (Banyard, Williams, & Siegel, 2001; Maker,
Kemmelmeier, & Peterson, 2001). Approximately two thirds of
adult victims of sexual assault report a history of earlier victimization
(Arata, 2002; Stermac, Reist, Addison,&Millar, 2002; Urquiza
& Goodlin-Jones, 1994). In a review of sexual revictimization literature,
Arata (2002) concludes that girls who are sexually victimized
in childhood are 1.5 to 2.5 times more likely to be sexually
assaulted in adolescence or adulthood than their nonvictimized
peers. Additionally, research suggests that revictimized women
have poorer long-term psychological and emotional outcomes
than their singly victimized or nonvictimized counterparts
(Arata, 1999b; Banyard et al., 2001; Maker et al., 2001).
FAKTORJI, KI POJASNJUJEJO RANLJIVOST: Zlorabe v otorštvu- začetna starost,
težavnost napada, skupna teža psihološkega pritiska
PREDICTORS OF SEXUAL REVICTIMIZATION
Factors such as age, severity, and mental health consequences
may linkwomen’s early victimization experiences to later vulnerability
to new sexual assaults. Age at an initial sexual assault
experience has received attention within the revictimization literature,
with somewhat mixed results. Some research suggests that
women who are first sexually assaulted during childhood are at
greater risk of subsequent victimization than women first victimized
during adolescence (Maker et al., 2001). Alternatively, child
sexual abuse can increase vulnerability to new victimizations
during adolescence, which, in turn, increases risk of exposure to
sexual assault in adulthood (Gidycz, Coble, Latham, & Layman,
1993; Humphrey & White, 2000). Other research has found no
effect for age at first assault (Jankowski, Leitenberg, Henning, &
Coffey, 2002). On the whole, it appears that earlier experiences of
sexual abuse create an initial vulnerability that is exacerbated by
subsequent childhood or adolescent victimizations.
Severity of initial assault experiences is also suggested to impact
risk of revictimization. Early victimizations characterized by
greater degrees of threat, force, and invasiveness may differentially
predict revictimization above the experience of sexual abuse
alone (Arata, 2000; Collins, 1998; Irwin, 1999). Furthermore, some
evidence suggests that seriousness of initial experiences creates
risk for more severe later assault experiences (Humphrey &
White, 2000). In a prospective study of college women, Gidycz
et al. (1993) found that severity of sexual assaults during childhood
and adolescence predicted the severity of revictimization in
early adulthood. Similarly, Mayall and Gold (1995) found that
narrower definitions of child sexual abuse, including only physical
contact forms of assault, were predictive of revictimization,
whereas more broad conceptualizations of child sexual abuse
were not.
The age at which initial sexual assaults occur and their accompanying
severity may increase women’s vulnerability by exacerbating
the psychological impact of an early victimization experience.
Evidence suggests that psychological distress, more
generally, and posttraumatic stress symptomatology (PTSD), in
particular, are likely mechanisms through which revictimization
vulnerability builds. PTSD-related symptoms have been shown
to moderate the relationship between early assault experiences
and revictimization (Sandberg, Matorin, & Lynn, 1999) as well as
the severity of childhood sexual abuse experiences and revictimization
in adulthood (Arata, 2000). Thus, for women with a
history of sexual victimization, high levels of current PTSD
symptomatology can exacerbate vulnerability, decrease selfprotective
capacity, or may constitute a vulnerability that potential
perpetrators seek out and exploit (Messman-Moore & Long,
2003).
RAZVOJ RANLJIVOSTI ZA PONOVNO SPOLNO TRAVMATIZACIJO
Pojasnjevalni model za razvoj ranljivosti na podlagi zgodnje travme
A complementary framework for understanding the link
between experiences of child sexual abuse and vulnerability to
revictimization is offered by Finkelhor and Browne (1985). These
authors theorized that the experience of sexual abuse damages a
young person’s self-concept and worldview through “traumagenic dynamics,” which include a sense of betrayal, powerlessness,
stigmatization, and traumatic sexualization. Vulnerability
to reassault is posited to be exacerbated by psychological and
emotional impact consistent with these dynamics. Aspects of an
initial assault or its aftermath that intensify its psychological or
traumatic effect may therefore increase risk for revictimization
partially through the presence of traumagenic impact or previously
mentioned posttraumatic symptoms.
FAKTORJI, KI POJASNJUJEJO RANLJIVOST: Prisotnost multiplih travm v otroštvu
Finally, the presence of nonsexual trauma during childhood
can also increase young women’s risk of sexual revictimization.
Revictimized women are more likely to report neglect or physical
abuse by caretakers in childhood, witnessing parental violence in
childhood, and physical violence by a dating partner during adolescence
than singly or never-victimized women (Banyard et al.,
2001; Collins, 1998; Stermac et al., 2002). Thus, young people
whose early environments are characterized by risk of exposure
to multiple types of trauma appear to be at greater risk of increased
vulnerability. The nature of the environment’s response
to disclosures of abuse can also impact young people’s vulnerability.
Research has consistently demonstrated that supportive
responses to a child’s disclosure of sexual abuse are associated
with more positive mental health outcomes and more rapid healing
(Everson, Hunter, Runyon, Edelson, & Coulter, 1989; Gries
et al., 2000). Additionally, negative reactions from formal or informal
helping systems have been associated with poorer mental
health outcomes following an assault (Filipas & Ullman, 2001).
The nature of and reaction to help seeking by victims therefore
appears to impact postassault functioning and, by extension, risk
of exposure to repeated sexual victimization.
LONG-TERM OUTCOMES OF REVICTIMIZATION
Almost as consistent as the finding that previously victimized
women are at greater risk of sexual assault is evidence that multiply
victimized women have worse psychological outcomes than
their nonvictimized or singly victimized counterparts. Most
prominently, adult victims of sexual assault who have histories
of child sexual abuse have significantly higher levels of posttraumatic stress symptoms than nonsurvivors or than women
with child-only or adult-only victimizations (Arata, 1999b;
Gidycz et al., 1993; Maker et al., 2001). Additionally, women victimized
by different perpetrators at different time points have
been shown to suffer greater levels of depression and anxiety
than women victimized only in childhood or only in adulthood
(Banyard et al., 2001; Gibson & Leitenberg, 2001; Gidycz et al.,
1993). Previously victimized women take longer to recover froma
subsequent assault, experience more postassault PTSD symptomatology,
and use less effective coping methods to heal (Arata,
1999a; Gibson & Leitenberg, 2001). Diminished psychological
health appears to be connected specifically to multiple interpersonal
traumas, such as sexual assault; noninterpersonal traumas,
such as serious illness or accidents, do not generate the level of
psychological distress present for many sexually revictimized
women (Green et al., 2000).
Revictimization may also exacerbate long-term sequelae such
as substance use and diminished physical health, although little
literature to date has specifically examined the impact of multiple
sexual assaults on these factors. Increased likelihood of alcohol
and other drug abuse has been consistently linked with childhood
sexual assault (Briere & Runtz, 1993).
PRIMERJAVA ZNAČILNOSTI ENKRAT NASPROTI VEČKRAT SPOLNO
NAPADENIM ŽENSKAM (s ponavljajočim ali z večimi različnimi napadalci)
The results suggest that singly victimized women differ from women with repeat victimizations
both in terms of the characteristics of their initial sexual assault and with respect to the long-term
psychological and health consequences of their traumatic experiences. Both survivors of ongoing
abuse and survivors of multiple assaults by different perpetrators were more likely to be younger at the
time of their first assault and to experience more severe initial assaults (characterized by injury or
degree of threat). These results echo the findings of previous studies that connect revictimization to
initial assault severity and earlier victimizations (Arata, 2000; Humphrey & White, 2000; Maker et al.,
2001). Within these differences, a trend emerged in which victims of multiple perpetrators were even
younger and experienced a higher number of
severe aspects of victimization than women who were repeatedly victimized by the same perpetrator
throughout time. Additionally, women victimized by multiple perpetrators were more
likely to have ever forgotten some or all of their initial assault experience and to find the response of
informal supports unhelpful in response to disclosure compared to their singly victimized
Even more marked were the results related to the cumulative exposure to trauma throughout
time.Women victimized by multiple perpetrators experienced significantly more nonsexual traumas
during their lifetime than either singly victimized women or survivors of ongoing abuse. Additionally,
multiply victimized women experienced more types of sexually assaultive acts during the course of
their lives than women revictimized by the same perpetrator throughout time. Thus, although both
groups of repeatedly victimized women may have more severe initial experiences than singly
victimized women, women hurt by multiple offenders appear to face an added layer of exposure to
both sexual and nonsexual trauma.
Within the multivariate framework in this analysis, only a younger age at the time of an initial sexual
victimization and exposure to physical abuse in childhood emerged as significant predictors of sexual
victimization by different perpetrators throughout time.
Thus, women whose early environments are characterized by both physical and sexual trauma
risks may be most vulnerable to subsequent sexual assaults. Additionally, the univariate relationship
between membership in the multiple perpetrator victimization group and more unhelpful responses
from informal sources of support to disclosures of an initial sexual assault experience suggests that
these repeatedly victimized women’s early environments may be more likely to be generally
unsupportive of young women’s safety
These findings echo previous research in highlighting the importance of early remedial intervention
and attention to the presence or lack of supports in a young person’s environment.
Victimized youth in environments characterized by risk of exposure to multiple types of violence or
trauma may be at elevated risk for revictimization and the compounding psychological impact of
multiple traumas (Banyard et al., 2001; Follette et al., 1996; Green et al., 2000).
Recent work points to the impairing effects of early violence exposure on victims’ self-concept and
identity health, which, in turn, carry cognitive consequences for subsequent psychological well-being
and life functioning (Kellogg, Hoffman, & Taylor, 1999; Nurius, Casey, Lindhorst, &
Macy, 2004).
Definicija ponavljanja
For the purposes of this paper, repetition phenomena are defined as contemporaneously
observed or reported reactions, manifested as behaviors, feelings, cognitions, memories, or
physical sensations, expressed on their own or in combination, that involve some degree of
reexperiencing of significant past events (e.g., intrusive reexperiencing of trauma, recreation
of trauma, transference, recurrent dreams, and acting out).
Kompulzivno ponavlanje
Psychodynamic theory links contemporaneous reactions to formative influences, the origins
of which may lie in the distant past and of which a person may have no conscious recall.
Reactions observed in therapy, or reported by patients, may repeat in substantial detail the
behaviors, cognitions, and affects associated with particular events. Some repetition
phenomena are referred to as acting out, recreation, or reenactment. They may be manifest as
simple momentary responses or highly elaborate sequences of reactions that recreate and
reenact complex traumatic and developmentally disruptive experiences.
Ponavljanje in PTSD
These particular repetitions are recognised by DSM-IV (APA, 1994) and ICD-10 (WHO,
1992) symptom lists for PTSD but without reference to notions of acting out, recreation, and
reenactment. For instance, a person may “: : : act or feel as if some aspect of the trauma were
recurring : : :” (DSM-IV, B3), and may experience “: : : intense psychological distress at
exposure to internal or external cues : : :” (DSM-IV, B4). These are valuable operational
definitions for acting out, reexperiencing, and recreation under conditions where the
precipitating trauma is known.
Ponavljanje travme v sanjah
In support of more individually tailored perspectives these authors refer to research indicating
that the repetition of trauma in dreams takes at least three different and distinct forms: anxiety
dreams with trauma-related content, traumatic nightmares, and traumatic reenactment.
Each of these forms of dreaming is known to be mediated by different neurophysiological and
psychophysiological processes (Mellman, Kulick-Bell, Ashlock, & Nolan, 1995; Shalev, Orr,
& Pitman, 1993)
Anksiozne sanje
Patients with acute stress disorder or PTSD (APA, 1994) precipitated by a single recent
traumatic event of moderate severity are likely to experience dreams containing images that
repeat aspects of what happened. The phenomenology of these dreams is unlikely to differ
significantly from anxiety dreams reported by individuals who do not have PTSD.
Characteristically, such dreams do not waken up the dreamer; they occur during REM sleep
phases; and dream episodes are recalled at the end of a major sleep period. Although dream
images can be distressing, manifest dream content is amenable to interpretation, review, and
discussion that promote insight and therapeutic progress as well as lead to a reduced
frequency of repetitions over time.
Travmatične nočne more
Traumatic nightmares, on the other hand, share some of the phenomenological features of
anxiety dreams but, in other respects, are quite different. These are terrifying repetitive
dreams of reexposure to traumatic events. They are known to occur during both REM and
non-REM sleep, and, in chronic PTSD, they are often persistent, intrusive, and treatmentresistant. Nonetheless, Schreuder (1996) argues that traumatic nightmares can contain
symbolic representations of anxieties rooted in pretrauma and posttrauma phases of a person’s
life. Typically, such anxieties
concern existential issues, especially those involving threat to life, threat of abandonment and
death.
Podoživljanje travme med spanjem
Posttraumatic reenactment during sleep defines an extreme end point of the continuum of
dream repetitions. It is characterized by a subjective impression of reliving traumatic
experiences. Schreuder (1996) describes these repetitions as exact and explicit recreations of
traumatic incidents. Unlike other types of dreams, they constantly recur in a form that is
largely unaltered and unelaborated, and they appear to be impervious to the effect of time.
Anxieties and sensory perceptions experienced during posttraumatic reenactment repeat the
most evocative reactions originally provoked by initial traumatic experiences. Triggers for
posttraumatic reenactment are typically unrelated to anxieties associated with earlier
developmental life phases, existential threats, or current reality-based conflicts or worries.
The initial trauma that is reexperienced remains an isolated experience that has not been
processed, and the reexperiencing has no symbolic or other relationship with anxieties and
conflicts in later life (Schreuder, 1996).
Dinamična psihoterapija, psihotravmatologija in ponavljanje
 As indicated above, the field of dynamic psychotherapy has a long and distinguished
tradition of recognizing, both in theory and in clinical practice, the subtle, compelling,
diverse, and compulsive nature of repetition phenomena.
 Psychotraumatology has, from a perspective of positivistic science, confirmed that
significant past life
experiences do evoke reactions that repeat some aspects of formative experiences. It is also
clear that conscious recall of precipitating events is not a precondition for repetitions, but
some representation of the experience in memory is.
Manifestacije ponavljanja
It must be accepted that repetitions manifest as a compulsion to acting out, recreation,
transference, reenactment, and dreaming share some phenomenological features but, on closer
examination, they are revealed to be much more diverse than generally realized. Any therapist
treating patients with PTSD, or its related disorders, has to be clear about the conceptual
implications of the differentiating phenomenological features of reported repetitions, and to
plan treatment accordingly. Similarly, researchers will do well to recognize that all repetitions
are not the same and should not be studied as if they were.
POSLEDICE TRAVME – PRIMERJAVA RAZLIČNIH TRAVM
During the past 20 years, we have learned how similarly harmful are experiences of
terror, violence, and abuse, whether they occur on the combat field or at home. The
field of family violence has gained much fromthe field of traumatic stress, and collaborations
between these two previously separate fields have yielded important new
answers, as well as new research questions. The field of traumatic stress is poised to
integrate, more fully than in the past, a variety of aspects of trauma such as social
betrayal, as well as outcomes of trauma such as depression, criminality, and physiological
harm that go beyond posttraumatic stress. The field of family violence has
much to offer in this process.
The battered
woman syndrome characterized for the first time the trauma symptoms of
women in battered women’s shelters (Walker, 1983). As understanding of
posttraumatic stress disorder (PTSD) among Vietnam veterans grew, it was
becoming clear that women exposed to violence and terror in their homes
responded in much the same asVietnam veterans exposed to the violence and
terror of war. As Herman (1992) explained,
Only after 1980, when the efforts of combat veterans had legitimized the concept
of posttraumatic stress disorder, did it become clear that the psychological
syndrome seen in survivors of rape, domestic battery, and incest was essentially
the same as the syndrome seen in survivors of war. (p. 32)
Multiple Abuse Experiences
Several methodological limitations exist in empirical efforts directed at evaluating
the impact of child abuse. The majority of studies target the correlates of
childhood sexual abuse, with only moderate research interest in the outcome of
physical abuse and psychological abuse (Claussen & Crittenden, 1991; Mullen,
Martin, Anderson, Romans, & Herbison, 1996). Additionally, the failure to assess
for the co-occurrence of various types of abuse or the impact of experiencing several
types of abuse concurrently is even more problematic. Those studies that have
assessed for the presence of multiple types of abuse (e.g., sexual, physical, and psychological)
have found that they often co-occur and that different types of abuse
are associated with unique patterns of adult symptomatology (Briere & Runtz,
1990; Claussen & Crittenden, 1991; Elliott & Briere, 1994; Moeller, Bachmann,
& Moeller, 1993; Ney, Fung, &Wickett, 1994;Wind & Silvern, 1992). For example,
when assessing the impact of childhood physical, sexual, and psychological
abuse on adult functioning, Briere and Runtz (1990) found that psychological
abuse was associated with low self-esteem, sexual abuse with dysfunctional sexual
behavior, and physical abuse with anger/aggression. In another sample, Mullen
et al. (1996) found trends for unique abuse–outcome relationships between sexual
abuse and sexual difficulties, emotional abuse and low self-esteem, and physical
abuse and marital difficulties. Additionally, all types of abuse were associated
with increased psychopathology, interpersonal problems, sexual difficulties, and
decreased self-esteem. Thus, both common and unique symptomatic responses to
child abuse may occur.
Investigators have also found that individuals who experienced multiple types
of abuse report greater symptomatology than do individuals who experienced a single
type of abuse (Mullen et al., 1996;Wind&Silvern, 1992). Although the results
have not been consistent across studies with respect to the pattern and magnitude
of symptomatology reported, it appears that different types of abuse, considered
separately and in combination, have differential impact on adult psychological
functioning. These studies support the necessity of concurrent assessment of multiple
types of child abuse.
POSLEDICE TRAVME – ZDRAVJE
Childhood victimization not only is prevalent but also is associated with
negative long-term psychological and physical health problems. Documented
psychological problems include posttraumatic stress disorder,
depression, anxiety, somatization, substance abuse, eating disorders, personality
disorders, and suicidal behavior (Beitchman et al., 1992; Boudewyn &
Liem, 1995; Briere & Runtz, 1990; Brown & Anderson, 1991; McCauley
et al., 1997; Miller,Downs, Gondoli,&Keil, 1987; Polusny&Follette, 1995;
Romans, Martin, Anderson, Herbison,&Mullen, 1995; Rowan&Foy, 1993;
Saunders, Villeponteaux, Lipovsky, Kilpatrick, & Veronen, 1992; Silverman,
Reinherz, & Giaconia, 1996; Thompson, Kaslow, Lane, & Kingree, 2000;
Wyatt, 1985; Zlotnick, Zakriski, Shea, & Costello, 1996). Poor social and
academic outcomes have also been documented among survivors of childhood
victimization (Kaplan, Pelcovitz,&Labruna, 1999; Polusny&Follette,
1995).
Twenty years following the abuse, female victims were significantly
more likely than were nonvictims to evidence aggressive behaviors
(Weiler & Widom, 1996), posttraumatic stress disorder (Widom, 1999b),
substance abuse (Widom & White, 1997), poorer academic and intellectual
outcomes (Perez & Widom, 1994), and personality disorders (Widom,
1999a).
Research also has focused on the long-term physical health outcomes of
childhood victimization. Most of these studies have been based on clinical
samples and thus cannot be generalized to the population (Drossman et al.,
1990; Harrop-Griffith et al., 1988; Kimerling & Calhoun, 1994; Lechner,
Vogel, Garcia-Shelton, & Leichter, 1993; Leserman et al., 1996; Moeller,
Bachmann, & Moeller, 1993).
These studies found that women who had experienced
childhood maltreatment (sexual abuse, physical abuse, emotional abuse,
emotional neglect, or physical neglect) had significantly higher median
annual health care costs, lower perceptions of their overall health, greater
physical and emotional functional disability, a greater number of physical
health symptoms, and a greater number of health risk behaviors than did
women with no history of maltreatment.
REZULTATI:
Using data from a nationally representative sample of 8,000 women, we
found that physical and sexual victimization experienced in childhood were
associated with several health problems in adulthood. Physical and sexual
childhood victimization showed similar associations to the health measures.
Both physical and sexual victimization in childhood were significantly associated
with perceived general health, serious injury, chronic mental health
condition, and drug use, but neither physical nor sexual victimization was
associated with chronic physical health conditions. Although physical
victimizationwas
associated with daily alcohol use but not miscarriages or stillbirths,
sexual victimization was associated with miscarriages or stillbirths
but not daily alcohol use.
Several mediating variables may explain why childhood victimization is
associated with health problems in adulthood. One possibility is that the
association is mediated by psychological variables, such as depression.
POSLEDICE TRAVME – PSIHOPATOLOGIJA
There is an increasing recognition that sexually abused adolescents show a
heterogeneity of consequences (Bennett, Hughes,&Luke, 2000;Bal,VanOost,
De Bourdeaudhuij, & Crombez, 2003). Anxiety, depression, dissociative
complaints, posttraumatic stress disorder (PTSD), anger, delinquency, and
sexual problems are some of the most reported symptoms in these adolescents
(Kendall-Tackett, Williams, & Finkelhor, 1993).
Not only the relationship of the abuser to the child but also the
functioning of the family can contribute to symptom variety. Considerable
evidence indicates that a cohesive, supportive family environment may serve
as a buffer against the negative effect of sexual abuse (Ray&Jackson, 1997).
Until now, little research focused on family functioning in families with an
extrafamilial sexually abused adolescent. The aim of this studywas to look at
differences in trauma-specific symptoms and family functioning in intra- and
extrafamilial sexually abused adolescents.
In a follow-up study of young adults abused or neglected as children, almost 80% of the
sample failed to meet criteria for successful psychosocial functioning (McGloin &Widom,
2001). A longitudinal community study of young adult abuse survivors found approximately
the same proportion meeting clinical criteria for one or more psychiatric disorders (Silverman,
Reinherz, &Giaconia, 1996). Child abuse has been linked with some of the most severe and
intractable psychiatric and social problems, including borderline personality disorder,
dissociative identity (multiple personality) disorder, suicidality, substance abuse, sociopathy,
and violence (Herman, Perry, &van der Kolk, 1989; Johnson, Cohen, Brown, Smailes,
&Bernstein, 1999; Kluft, 1996; National Research Council, 1993).
The inner protector model provides an elegant explanation for a range of problems
experienced by abuse survivors. The phenomenon of dissociative identity disorder (DID) is
particularly instructive. More than 90% of North Americans diagnosed with DID report
histories of child abuse (see Kluft, 1996, for a review). Because of the severity of their
symptoms and the extreme abuse they report, "clinicians in the dissociative disorder field, by
consensus, regard DID as the paradigmatic example of the psychological response to severe,
chronic childhood trauma" (Ross, 1996, p. 16). Patients with this disorder experience a
fragmented identity in which distinct personality states (alters), often separated by amnesic
barriers, take executive control of their behavior (American Psychiatric Association, 2000).
The three most common alter types are inadequate or confused protectors, terrified children,
and persecutors who act out violently and drive patients to injure themselves (Putnam, 1989;
Ross, 1997). These alter types closely match the three internal roles proposed here.
A common clinical symptom among abuse survivors is depression, characterized by low selfesteem, guilt, and intense shame (Ammerman et al. , 1986; Browne &Finkelhor, 1986). It is
best understood, I believe, not as the expression of a single role but of interaction among all
three.
Child abuse is also associated with disorders of dissociation in later life (Briere, 1992).
Generally speaking, theoretical, clinical, and empirical studies concur that men’s
childhood sexual
abuse may present varied long-term outcomes. The three major ones boil
down to the following: (a) some of these men manifest in adulthood various
symptoms or disorders, such as posttraumatic stress disorder, behavioural problems,
or emotional problems (Boudewyn & Liem, 1995; Fondacaro, Holt, &
Powell, 1999; Gold, Lucenko, Elhai, Swingle,&Sellers, 1999; Holmes, Offen,&
Waller, 1997); (b) others manifest specific pathologies of a sexual nature, such as
pedophilia, adult sexual aggression, or other types of paraphilia (Lenderking
et al., 1997; Lodico, Gruber, & Diclemente, 1996; McCellan, McCurry, &
Ronnei, 1997); and (c) certain men manifest no major pathology in adulthood
(Finkelhor, 1990; Laumann, Gagnon, Michael,&Michaels, 1994; Okami, 1991).
It is important to note that the first two groups are not independent of one another
and may overlap.
Internalizing problems, such as anxiety, depression, dissociative complaints and problems
related to posttraumatic stress disorder, and externalizing symptoms, such as sexual problems
and anger, are among the most frequently reported symptoms (Bal, Crombez, Van Oost, & De
Bourdeaudhuij, 2003; Wolfe & Birt, 1997). In their review of longitudinal and follow-up
studies on child and adolescent sexual abuse, Kendall-Tackett et al. (1993) concluded that for
one half to two thirds of all children and adolescents, postabuse symptoms decreased with
time, whereas 10% to 24% of symptoms intensified. However, this pattern of recovery
seemed to be different for different symptoms. In their follow-up study with sexually abused
children and adolescents, Gomes- Schwartz, Horowitz, Cardarelli, and Sauzier (1990) found
that anxiety problems tended to decrease, whereas problems of anger and sexual
preoccupation seemed to persist or worsen. This is consistent with Mannarino, Cohen, Smith,
and Moore-Motily (1991), who found that at 6- and 12-month followups, sexually abused
children improved significantly on internalizing problems but not on externalizing problems.
Other studies, however, did not find significant improvements in symptomatology with time.
Sexual assault is associated with psychological morbidity including depression, posttraumatic
stress disorder (PTSD), and anxiety (Ackerman, Newton, McPherson, Jones, & Dykman,
1998; Boney-McCoy & Finkelhor, 1995; Ellis, 1983; Roth & Lebowitz, 1988; Ullman &
Filipas, 2001). Long-term effects of child sexual abuse include suicidal behavior, personality
disturbances, substance abuse, eating disorders, and revictimization (Brier & Runtz, 1987;
Chandy, Blum, & Resnick, 1996; Dube et al., 2001; McCauleyet al., 1997; Wonderlich et al.,
2001). (The Experience of Sexual Assault. Findings From a Statewide Victim Needs
Assessment)
Although fewer than half of all chil dren exposed to sin gle-inci dent trau mas suf fer
posttraumatic
symptomatology (PTSD symp toms) suf fi cient to war -rant a clin ical diag nosis of
PTSD (Green et al., 1994;LaGreca et al., 1996; Nader et al., 1990), chil dren sub jected to mal treatment (Cuffe et al., 1998; Famularo et al., 1994; Neumann et al.,
1996; Steiner et al., 1997), dev as tat ing emo tional loss (Appelbaum & Burns,
1991; Green et al., 1994; Nader et al., 1990; Winje & Ulvik, 1998), or to the cumu la
tive effect of mul tiple trau mas (Cuffe et al., 1998; Neumann, et al., 1996; Steiner et
al., 1997) are at high risk for PTSD. Sev eral ODD etiologic fac tors, forexam ple, pov
erty, fam ily con flict, and paren tal psychopathology (Biederman, Newcorn, & Sprich,
1991; Frick, Lahey, Loeber, Stouthamer-Loeber, 1992; Web ster-Stratton, 1996), also
are risk fac tors for PTSD (Flisher et al., 1997; Green et al., 1994; Steiner et al.,
1997). Our find ings indi cate that not only vic timization trauma in gen eral (Ford et
al., 1999) but more specifically trau matic phys i cal and sex ual mal treatment are
prev a lent among chil dren diag nosed with ODD and sec ond arily among chil dren
diag nosed with ADHD.
Children with a diagnosis of ADHD were never theless at risk for past exposure to
mal treatment trauma but less so than children diagnosed with ODD: 25% had been
exposed to physical mal treat ment, and one in nine had been exposed to sexual mal
treatment. ADHD is heterogeneous with regard to psychiatric mor bid ity, with most
severe impair ment associated with antisocial families (Faraone, Biederman, &
Milberger, 1995).
Child Mal treatment, Other Trauma Ex po sure, and Posttraumatic Symptomatology Among Children With Oppositional De fi ant
and At tention Def i cit Hy peractivity Dis or ders
Julian D. Ford (University of Con necticut School of Med icine), Robert Racusin, Cynthia G. Ellis, Wil liam B. Daviss, Jessica
Reiser, Amy Fleischer (Dartmouth Med i cal School), Julie Thomas (Youngs town State Uni ver sity).
Research on the impact of sexual
violence, whether in childhood or later in the life course, suggests that sexual
assault is associated with a number of short- and long-term mental health
consequences including depression, PTSD, and substance abuse (Campbell
& Soeken, 1998, 1999; Cascardi, Riggs, Hearst-Ikeda, & Foa, 1996;
Jasinski,Williams, & Siegel, 2000; Ullman & Brecklin, 2002). Research by
Boudreaux, Kilpatrick, Resnick, Best, and Saunders (1998) suggests that
sexual assault is more strongly related to PTSD and major depressive episodes
as compared to other types of violent victimization. Violence, particularly
sexual violence, also increases the risk for substance abuse, alcohol
dependency, problem drinking, and alcohol-related difficulties (Clark&Foy,
2000; Downs & Harrison, 1998; Jasinski et al., 2000; Lurigio, 1987). For
example, Harrison, Fulkerson, and Beebe (1997) identified the earlier initiation
of substance use among victims who were children and adolescents. Not
only are adolescentswith a history of sexual abuse at increased risk formultiplesubstance
use (Harrison et al., 1997) but also girls who are abused are significantly
more likely to have alcohol or drug arrests in adulthood (National
Institute of Justice, 1995). Alcohol and drugs may be used by victims in an
attempt to cope with the trauma of violence, alleviating the symptoms and
anxiety associated with victimization, thereby increasing feelings ofmastery
and control (Banaji & Steele, 1989; Flannery, Singer, Williams, & Castro,
1998; Runtz & Schallow, 1997). Saunders et al. (1999) suggested that given
the higher rates of depressive symptomatology associated with violent victimization
alcohol abuse is potentially a coping strategy for those dealing
with the symptoms associated with various mental health disorders. This
suggests that victims may use alcohol and drugs as a form of self-medication
(Jasinski et al., 2000; Spatz Widom, Ireland, & Glynn, 1995).
POSLEDICE TRAVME – PSIHOPATOLOGIJA – PTSD
Empirical findings indicate that the avoidance criterion of the DSM-IV diagnosis of PTSD
(American Psychiatric Association [APA], 1994) may be too exclusive. Across study groups,
the percentage of participants meeting the reexperiencing criterion or the hyperarousal
criterion is much greater than the percentage meeting the avoidance criterion (e.g., Kilpatrick
& Resnick, 1993; Schutzwohl & Maercker, 1997). Thus, it appears likely that, by using the
criteria of the DSM-IV, some people with otherwise genuine PTSD symptoms are excluded
from the diagnosis because they do not exhibit the required three avoidant symptoms
(Davidson& Foa, 1993b). Perhaps the most prominent definition of partial PTSD was
proposed by Blanchard et al. (1994, 1995). According to this definition, partial PTSD is
diagnosed if the minimum number of symptoms for the reexperiencing criterion, and either
the avoidance criterion or the hyperarousal criterion are met.
Giaconia et al. (1995) have maintained that PTSD interferes with and impairs adolescent
psychosocial functioning and places them at a higher risk for other psychological disorders.
Anger, rage, absence of feeling, impulsive behavior, or attention problems are associated with
PTSD, but these symptoms can be misdiagnosed and seen as conduct disorders, attention
deficit disorders, depression, or dissociative disorders (Terr, 1991). Failure to accurately
diagnose PTSD could interfere with successful rehabilitation (Cauffman et al.).
Pathological dissociation has not been examined adequately within the female juvenile
offender population. Pathological dissociation in adolescents can interfere with the
construction of a sense of self; it can also contribute to their failure to integrate their sense of
self and their ability to integrate sexual, aggressive, and relational feelings (Armstrong,
Putnam, Carlson, Libero, & Smith, 1997).
A diagnosis of PTSD emphasizes the unusual nature of a stressor followed by a pattern of
distressing physical and psychological responses. Characteristic features of PTSD include
reexperiencing the traumatic event, emotional numbness or avoidance, and increased arousal
(American Psychiatric Association, APA, 1994). Since the diagnosis of PTSD emphasizes
both the stressor and patterns of response, PTSD theoretically can occur in any person placed
in similar circumstances, thereby alleviating individual pathology or blame (Ochberg, 1991;
Walker, 1991).
Stressor Criterion PTSD may occur as a result of traumatic events that have either natural or
human origins (APA, 1994). The traumatic event or sequence of events triggering a
posttraumatic response is “... overwhelming, and dangerous to one’s self...” (Figley, Scrignar,
& Smith, 1988, p. 113). Events arising from intentional human action tend to be more severe
and destructive than those of natural origin. Events that are human in origin are characterized
by deliberateness, negligence, or malice that destroys trust and security in human
relationships (Green, 1990; Karl, 1989; Ochberg, 1991; Silvern & Kaersvang, 1989). Debate
exists in the literature about classifying the ongoing, deliberate acts of battering of women by
male partners as a traumatic event that may be responsible for the development of PTSD
(Campbell, 1990; Figley, 1992; Kemp, Rawlings, & Green, 1991; Walker, 1991). Possible
traumatic events noted for PTSD are a serious threat or harm to one’s life or physical integrity
and prolonged physical or sexual abuse (APA, 1994). Yet, there is confusion with the stressor
criterion in that the boundaries of a traumatic event are not always clear.
Researchers have been interested in the phenomenon of human responses to traumatic events
since the beginning of the century. Over the past several decades, posttraumatic stress
research has extended beyond combat veterans to include victims of rape or other violent acts
(Burgess & Holmstrom, 1974; Saunders, Arata, & Kilpatrick, 1990), incest (Goodwin, 1985;
Herman, 1993; Lindberg & Distad, 1985), child abuse (Green, 1985; Terr, 1990), and natural
disasters (Frederick, 1985; Murphy, 1986; Steinglass &Gerrity, 1989; Weinrich, Hardin, &
Johnson, 1990).
Goldberg and associates (1990) confirmed this assertion noting that PTSD was a normal
response to abnormal stress and not a reflection of underlying pathology. Using a matched
comparison group of 2092 identical twins who were combat veterans, Goldberg et al. found
that the severity and length of PTSD symptoms, which ranged from 15 to 30 years in some
instances, were related to the intensity of the conflict experienced. Furthermore,
reexperiencing the trauma, through intrusive thoughts, nightmares, and flashbacks, comprised
the most significant cluster of PTSD symptoms.
The frequency and severity of traumatic experiences was cited as a major contributor to PTSD
symptomatology across several trauma survivor groups (Foy & Card, 1987; Gallers, Foy,
Donahoe, & Goldfarb, 1988; Greenwald & Leitenberg, 1990; Kilpatrick, Saunders, AmickMcMullen, Best, & Veronen, 1989; McLeer, Deblinger, Atkins, Foa, & Ralphe, 1988;
Solkoff, Gray, & Keill, 1988; Wolfe, Gentile, & Wolfe, 1989).
Many theoretical accounts of PTSD have emphasized the centrality of intense fear as the
emotional experience associated with symptoms of intrusive memories, avoidance of eventrelated stimuli, and increased hyperarousal (Lee, Scragg, & Turner, 2001). Recent research on
trauma has implicated shame in the development of PTSD symptoms for rape survivors, war
veterans, and adult victims of violent crime with an abuse history (Andrews, Brewin, Rose, &
Kirk, 2000; Jaycox, Zoellner, & Foa, 2002; Fontana & Rosenheck, 1994).
Although there is considerable variation depending on gender, race, and
the type of trauma, it has been estimated that 5–11% of trauma victims will
develop posttraumatic stress disorder (PTSD) (7).
PTSD is an anxiety disorder including three symptom clusters: reexperiencing the
trauma through nightmares, flashbacks, or intrusive memories; autonomic
hyperactivity, such as exaggerated startle response, night sweats, and irritability; and
avoidance
symptoms, including social isolation, restricted range of emotion, and absence
of intimacy in relationships (8).
Posttraumatic stress disorder (PTSD) is a recognized psychiatric experience
following an external traumatic event (Mezey & Robbins, 2001). This diagnostic
category describes common symptoms experienced by individuals highly exposed to
an event involving death or injury, with resultant fear and helplessness. PTSD occurs
more often in women, people with more direct, traumatic disaster exposure, and
those with a history of psychiatric illness. PTSD is highest in populations exposed to
extreme violence, such as prisoners of war, concentration camp victims, and crime
victims, suggesting that disasters caused by human aggression cause more
psychological damage than natural disasters.
Of the three categories of diagnostic PSTD symptoms, the numbness symptom
cluster is particularly diagnostic of a more severe reaction: Feeling numb,
experiencing emotional withdrawal, or avoiding all reminders of the event (McMillen,
North, & Smith, 2000; North et al., 1999; Shariat, Mallonee, Kruger, Farmer, & North,
1999; Ursano, Fullerton, Kao,&Bhartiya, 1995). The remaining two symptom clusters
include: (1) re-experiencing the traumatic event or uncontrollable intrusive thoughts
about the event and (2) arousal symptoms, which describes a hyper-alert state
exhibited by being easily startled, increased irritability, difficulty concentrating, or
sleep disturbances. Both intrusionand hyper-arousal reactions have been found to be
almost universal reactions
to trauma, beginning in the hours and days following an event and often lasting
months, particularly following disasters (McMillen, North, & Smith, 2000; North et al.,
1999; Shariat et al., 1999
Areviewof the studies of PTSD symptomatology in children finds that about
25% to 40% of children of all ages exposed to traumatic events fit diagnostic
criteria for PTSD, according to the DSM-IV (Fletcher, 1996).
(ALYTIA A. LEVENDOSKY, ALISSA C. HUTH-BOCKS, MICHAEL A. SEMEL,
DEBORAH L. SHAPIRO Trauma Symptoms in Preschool-Age Children
Exposed to Domestic Violence, JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 17
No. 2, February 2002 150-164)
Furthermore, in this study, symptoms of PTSD were associated with
increased severity of the four types of violence. In particular, symptoms of
reexperiencing were positively associated with all four types of violence and
symptoms of hyperarousal were positively associated with all but the severe
violence category. These findings mirror studies on older children (GrahamBermann & Levendosky, 1998b) and battered women (Kemp et al., 1995)
finding that more abuse toward the mother is associated with higher levels of
trauma symptoms in both children and their mothers. Thus, it is not merely
the presence of violence in the parental relationship but also the extent and
frequency of it. The lack of association of avoidant symptoms with any of the violence
types lends further support to the hypothesis that the avoidant symptoms
are not as reflective of trauma in this age group.
(ALYTIA A. LEVENDOSKY, ALISSA C. HUTH-BOCKS, MICHAEL A. SEMEL,
DEBORAH L. SHAPIRO Trauma Symptoms in Preschool-Age Children
Exposed to Domestic Violence, JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 17
No. 2, February 2002 150-164)
Following traumatic violence, about one third of individuals develop posttraumatic
stress disorder (PTSD), a syndrome characterized by reexperiencing
the traumatic event, the use of avoidant coping strategies to cope with
traumatic memories, emotional numbing, and hyperarousal (American Psychiatric
Association, 2000;World Health Organization, 1992). Reexperiencing
of the traumatic event may present as recurrent flashbacks or nightmares
and intensification of distress when exposed to reminders of the event.With
avoidance, cognitive and behavioral strategies are used to avoid thoughts,
feelings, activities, or situations associated with the trauma. Attempts to
avoid external situations associated with the trauma may lead to a constricted
lifestyle.
As understanding of
posttraumatic stress disorder (PTSD) among Vietnam veterans grew, it was
becoming clear that women exposed to violence and terror in their homes
responded in much the same asVietnam veterans exposed to the violence and
terror of war. As Herman (1992) explained,
DEFINICIJA TRAVME
Clarifying our definition of trauma should be one of our primary goals for
the next 10 years. At present, the Diagnostic and Statistical Manual (DSMIV,
American Psychiatric Association, 1994) criteria for PTSD drew heavily
on aspects of terror.We now know that few traumatic events that cause longlasting
harm involve solely or even mostly terror. Sexual abuse can be highly
terrifying, as in the case of most stranger rape, or involve virtually no immediate
fear for life, as in the case of children who are groomed by perpetrators
to view the abuse as acceptable. Social betrayal is a potent dimension of
events that cause harm (see Figure 1) and very likely to be present in all forms
of family violence (Freyd, 1996, 2001). DePrince (2001) found that the
amount of betrayal in an event was more predictive of most negative symptoms
than the amount of terror and fear. Evenwar combat may include significant
elements of grief, shame, and betrayal (Shay, 1994).
Overall, family violence is still highly stigmatized
and difficult to prove in court (American Prosecutors Research Institute,
2003; Browne & Finkelhor, 1986). Survivors’ experiences of loss,
betrayal, shame, stigma, and isolation have yet to be considered as rigorously
as terror.
Clarifying our definition of trauma will lead to a clarification and expansion
of the effects of trauma. A whole class of difficulties following trauma
have received relatively little research attention, including relationships with
siblings, extended family, partners, and children. Sexual and sleep difficulties
are common among survivors and may have implications for mental and
physical well-being (e.g., Maltz, 2001; Matsakis, 1996).
Finally, it is becoming very clear that victimizations are not unrelated, and
multiple forms of victimization must be taken into account when assessing
the impact of victimization (Finkelhor, Ormrod, Turner,&Hamby, 2004). In
a report on the victimization experiences of a national representative sample
of 2,030 children, 288 (14%) reported experiencing between four and six
kinds of victimization, and 118 (9%) reported experiencing seven or more
kinds of victimization (Finkelhor, Ormrod, & Turner, 2004). Victimization
kinds were defined as endorsing any of the items comprising the following
scales: sexual victimization, physical assault, property victimization, maltreatment,
peer or sibling victimization, and witnessing or indirect victimization.
Controlling for several possible confounding variables, the number of
different kinds of victimization predicted anger, depression, and anxiety
better than chronic victimization of any one kind.
Gender is one potentially very powerful risk factor for victimization. In
general, men are more likely to be exposed towar combat, nonsexual assaults
between strangers, and to be victimized in public places (Craven, 1997; U.S.
Census Bureau, 2003), whereas women are more likely to be sexually
abused, injured by an intimate partner, and victimized in a private home (Craven,
1997; Finkelhor, 1994; Straus, 2001). Thus, the scope of traumas assessed and the categories
used to produce categories of experiences that are
added together to form a measure of multiplicity of trauma experiences make
a great deal of difference.
A recent community survey revealed a number of gender differences in
exposure to various kinds of trauma (Goldberg & Freyd, under review).
Women were much more likely to report having been emotionally or psychologically
mistreated by someone close as adults (approximately 40% compared
to less than 12% of men) and as children (approximately 30% compared
to less than 14%). Women also reported more sexual abuse in
adulthood and in childhood than did men. However, men were much more
likely to report having witnessed someone who they were not close to being
killed, committing suicide, or being injured, in adulthood and childhood.
Overall, women reported more events involving someone close to them, and
men reported more events that did not involve other people, and events
involving others who were not close to them.
Different kinds of traumas are associated with particular outcomes. Traumas
that involve high levels of threat are often associated with PTSD while
secretive, family violence is more likely to be associated with dissociative
symptoms (Freyd, 1996; Herman, 1992). Thus, although the number of kinds
of traumas may predict general mental health outcomes, exposure to particular
kinds of victimization may predict memory difficulty, dissociation, and
PTSD. To the extent that exposure to violence is gendered, and outcomes differ
by type of trauma, trauma-related psychological, social, and physical outcomes
will be gender related. Understanding gender may be highly important
for designing prevention and intervention strategies.
UNLIKE MOST OTHER DSM-IV diagnoses,
posttraumatic stress disorder (PTSD) requires a
specific, identifiable event to occur to qualify for
the diagnosis (American Psychiatric Association,
1994).
Of the characteristics of various
traumatic events, one that has been described
as important is the period of time over
which traumatic events occur (Baum, O’Keefe,
& Davidson, 1990).
When compared to singleincident
traumatic events, chronic traumatization
has been associated with higher levels of
PTSD symptoms (Herman 1992a). Chronic
traumatization is characterized by repeated exposures
to traumatic stressors within the same
overall context over time. In the case of
chronic traumatization, the environment contains
an implied risk of danger even when there
is no actual traumatic incident occurring (Smith,
Smith,&Earp, 1999). Chronic traumatization may be damaging, not just because of the specific and repeated
traumatic incidents but because of the effects of
living in a state of constant danger (Baum et al.,
1990; Herman, 1992b; Smith et al., 1999).
PTSD is one of the most common negative
outcomes associated with histories of child sexual
abuse among child and adult survivors
(Neumann, Houskamp, Pollock, & Briere, 1996;
Oddone, Genuis, & Violato, 2001). Rates of
PTSD in clinical samples of sexually abused
children have ranged from 21% to 74%,with the
majority of studies reporting rates between 40%
and 50% (Rodriguez, Van de Kemp, & Foy,
1998).
The rate of current PTSD associated with childhood
sexual abuse (CSA) ranges from 70% to 73% in help-seeking samples to 6%
to 12% in the community (Rodriguez et al., 1998). Similarly, women with a
history of childhood physical abuse (CPA) are 10 times as likely to currently
have PTSD than those without such a history (Duncan, Saunders, Kilpatrick,
Hanson, & Resnick, 1996). Combined CSA and CPA may be more likely
than either alone to lead to PTSD (Schaaf & McCanne, 1998).
Accordingly, the American Psychiatric Association
(1987) defined traumatic events as incidents that are “outside the
range of usual human experience” and are of such serious magnitude
that they can be expected to be “markedly distressing to almost anyone.”
Within this general definition, particular forms of trauma can be
further distinguished. For instance, Wheaton (1996) suggested that
traumatic life experiences can range from sudden events (e.g., parental
loss and natural disasters) to events that are more chronic in nature
(e.g., repeated physical and sexual abuse and war combat). Traumatic
events can also be characterized by their scope of influence. For
instance, certain traumatic events, such as war or natural disasters,
affect entire groups of people simultaneously and thus can be considered
macro-level traumas. Other forms of trauma, such as exposure to
physical violence or parental loss, primarily affect individuals in isolation
and thus can be thought of as micro-level traumas.
Roughly a decade ago, the de˘nition of
a traumatic event was expanded in the DSM-IV (APA, 1994) to include
learning about unexpected death or threat of death experienced by a family member. Since this change
in criteria, greater attention has been given in the
empirical literature to psychopathology in relation to the death of a loved one.
POSLEDICE TRAVME – PSIHOPATOLOGIJA – PTSD –
FAKTORJI TVEGANJA
This study examined the prevalence of trauma, PTSD, and dissociation between genders
within the same setting among juvenile offenders and referrals for a court-ordered
psychological evaluation. The findings from this study are consistent with similar studies,
which examined trauma and PTSD in an offender population and found high prevalence rates
(Burton et al., 1994; Cauffman et al., 1998; Steiner et al., 1997). These findings are also
consistent with research conducted within the general population. In a study of two samples
of 2,000 women in each sample, Duncan, Saunders, Kilpatrick, Hanson, and Resnick (1996)
found that victims of childhood physical assault were about 5 times more likely to have a
profile of lifetime PTSD (53% vs. 11.2%). Furthermore, victims were 10 times more likely to
be currently experiencing PTSD (32% vs. 3.8%) than were nonvictims. Breslau et al. (1998)
studied 2,181 people in the Detroit area and found a lifetime prevalence rate of 89.6% of
exposure to one or more traumatic events. The conditional probability of developing PTSD
subsequent
to the trauma was 9.2%, with PTSD being twice as high in women. Assaultive violence
resulted in the greatest risk for developing PTSD, according to Breslau et al. (1998). In a
similar study, Breslau, Chilcoat, Kessler, and Davis (1999) found that any previous exposure
to trauma was associated with a greater risk for developing PTSD, and experiencing more
than one traumatic event yielded a higher risk for PTSD. These authors also note that their
data indicated that a trauma experienced in childhood did not place the individual at any
greater risk for developing PTSD than did a trauma experienced later in life. Breslau et al.
(1998) did suggest that trauma experienced in childhood could make one more vulnerable for
PTSD if another trauma were experienced in adulthood.
POSLEDICE TRAVME – PSIHOPATOLOGIJA – PTSD –
KRITIKA DIAGNOZE PTSM
In DSM-IV-TR (American
Psychiatric Association, 2000), the PTSD diagnosis consists of
Criterion A, which specifies a preceding traumatic event and an
initial response; Criteria B, C, and D, which articulate clusters of
“symptoms”—otherwise referred to as “the disturbance”; and Criteria
E and F, which function to further delimit the use of the diagnostic
category. Criterion A reads,
The personwas exposed to a traumatic event in which both of the following
were present:
the person experienced, witnessed, or was confronted with an event
or events that involved actual or threatened death or serious injury,
or a threat to the physical integrity of others.
The person’s response involved intense fear, or helplessness, or horror.
(p. 467)
Bonnie Burstow 431
In this regard, note Kirk and Kutchins’s
(1997) revelations: “There are 175 combinations of symptoms by
which PTSD can be diagnosed” and “it is possible for two people
who have no symptoms in common to receive a diagnosis of PTSD”
(p. 124)
Following the recognition that posttraumatic stress disorder (PTSD) may follow
a variety of stressors, including combat, torture, incarceration, physical and
sexual assault, and life-threatening illness and accidents, there has been considerable
debate among researchers and clinicians about how best to characterize the
kind of event that may reasonably attract a diagnosis of PTSD. In the American
Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders,
3rd ed.-revised (DSM-III-R, APA, 1987), it was suggested that such an event
would be outside the range of usual human experience and would be markedly
distressing to almost everyone. This formulation, known as the stressor criterion
or Criterion A, was an integral part of the diagnosis of PTSD.
Faced with criticisms that this formulation of Criterion A was insufficiently
precise, and evidence that traumatic events involving threats to life and health were
rather more usual than had hitherto been assumed (e.g., McFarlane&de Girolamo,
1996), the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV, APA, 1994) changed Criterion A to require that a person experienced,
witnessed, or was confronted with events involving actual or threatened death,
physical injury, or other threats to the physical integrity of the self or others (new
Criterion A1). In addition, it attempted to specify the subjective impact of the
trauma with greater precision in a new Criterion A2 by requiring that the person’s
response had to involve intense fear, helplessness, or horror (March, 1993). The
DSM-IV field trial confirmed a strong association between retrospective reports
of subjective distress at the time of the trauma and subsequent PTSD (Kilpatrick
et al., 1998).
The addition of this subjective criterion implies that, during exposure to a
traumatic event, individuals reliably experience certain intense emotions. This
may seem reasonable, but it would not be surprising if some victims reported being
numb or in a daze during the event, or reported absence of memory for the
event, which might be expected to attenuate emotional intensity (see also Kilpatrick
et al., 1998). Alternatively some events, such as motor vehicle accidents and some
physical assaults, may happen too quickly for intense emotions to be registered
at the time. A third factor to consider is the distinction between “primary” emotions
occurring at the time of the trauma and “secondary” emotions arising out
of subsequent cognitive appraisal, which could also act as potential risk factors
for the development of PTSD (Brewin, Dalgleish, & Joseph, 1996). For example,
there is recent evidence that both anger with others and shame, which may reflect
secondary cognitive appraisal, are also strong predictors of PTSD symptoms
longitudinally (Andrews, Brewin, Rose, & Kirk, 2000).
In DSM-IV-TR (American
Psychiatric Association, 2000), the PTSD diagnosis consists of
Criterion A, which specifies a preceding traumatic event and an
initial response; Criteria B, C, and D, which articulate clusters of
“symptoms”—otherwise referred to as “the disturbance”; and Criteria
E and F, which function to further delimit the use of the diagnostic
category. Criterion A reads,
The personwas exposed to a traumatic event in which both of the following
were present:
the person experienced, witnessed, or was confronted with an event
or events that involved actual or threatened death or serious injury,
or a threat to the physical integrity of others.
The person’s response involved intense fear, or helplessness, or horror.
(p. 467)
Bonnie Burstow 431
In this regard, note Kirk and Kutchins’s
(1997) revelations: “There are 175 combinations of symptoms by
which PTSD can be diagnosed” and “it is possible for two people
who have no symptoms in common to receive a diagnosis of PTSD”
(p. 124)
POSLEDICE TRAVME – PSIHOPATOLOGIJA –
BORDERLINE IN DRUGE OSEBN. MOTNJE
Results indicate
that BPD cannot be distinguished from other personality disorders
on the basis of traumatic life events. The authors highlight the
findings that individuals with BPD were no more likely to have
reported childhood sexual abuse or adult victimization than were
individuals with other personality disorders.
Individuals with BPD were more likely to have PTSD than
non-BPD participants, but PTSD rates were actually higher among
individuals with paranoid personality disorder, suggesting no
unique relationship between BPD and PTSD. Path analysis supported
these results; direct and indirect relationships between BPD
and PTSD were not significant in the models tested. Path analysis
indicated that childhood abuse was significantly related to both
BPD and PTSD directly and to PTSD indirectly through a history
of assault in adulthood. In summary, the authors state that BPD has
no unique claim among personality disorders as a trauma-spectrum
disorder. (Trauma Is Not Specifically Related to Borderline
Personality Disorder, Briefings in Behavioral Science Volume 22/Number 3
March 2004)
The recent literature on the relationship between childhood abuse and personality
disorders (PDs) appears relatively restricted to borderline and antisocial personality disorders
and has focused mainly on clinical or incarcerated
samples. Despite the importance of establishing the etiological association
between childhood trauma and these disorders, broader investigations
of PDs, particularly among more heterogeneous samples, are also needed.
Research on the correlates of child abuse, as reviewed, for example, in Briere
(1992) and Trickett and McBride-Chang (1995), has demonstrated a link
between childhood abuse and a wide range of psychosocial difficulties.
Against these findings we hypothesized that men with any history of childhood
sexual or physical abuse would score higher on a measure of PD symptoms
than men with no such history. Also, we hypothesized that men with
more than one type of abuse would score higher than men with only one type
of abuse. This would occur because of a greater frequency of abusive events,
some sort of synergy between the types of abuse, or the possibility that families
that create, or allow for, this level of abuse are more pathogenic in
general.
METODE, VPRAŠALNIKI
In addition to a brief demographic information questionnaire,
each packet included the Home Experiences History (HEH), a six-item
checklist of typically disruptive family situations, including parental abuse of
alcohol and drugs, physical and sexual abuse of a sibling, battery of a parent
by another adult, and removal from the home by child protective services.
The HEH was designed by Lisak and has been used in his research program
(e.g., Altschuler, 1997; Hopper, 1997; Lisak et al., 1996; Smith, 1997). The
Family Relationship Index (FRI) assesses perhaps more subtle aspects of
family functioning and is composed of the Cohesion, Expressiveness, and
(reverse-scored) Conflict subscales of the Family Environment Scale (FES), Form R (Moos &
Moos, 1984). The FES is a widely used instrument, has
demonstrated construct validity in a range of applications, and has strong internal
consistency (Holahan & Moos, 1982; Moos & Moos, 1984). In what
seems to be a relatively common revision (e.g., Sines, 1984), the items were
recast in the past tense and participants were asked to respond in terms of
their family while they were “growing up.”
The Abuse-Perpetration Inventory (API) assesses histories of sexual and
physical abuse. The abuse items of the API list a series of potentially abusive
situations and ask subjects to respond regarding whether these happened to
them before age 16. For each item, if subjects answer positively, they are then
asked a short series of questions that assess the characteristics of the experience(
s). The situations are stated in strictly behavioral terms (e.g., “someone
had you fondle them,” “someone beat you with an object”); participants are
not asked whether they were “abused,” “molested,” and so forth. The API has
been used in six studies and has demonstrated validity with college male samples
(Lisak, Conklin, Hopper, Miller, & Smith, 1997).
Personality disorder symptoms were measured using the Schizoid, Antisocial,
Borderline, Narcissistic, Avoidant, Dependent, and PassiveAggressive subscales from the Personality Diagnostic QuestionnaireRevised (PDQ-R) (Hyler & Rieder, 1987), an instrument designed to assess
personality disorders as defined by DSM-III-R criteria. The full PDQ-R was
not used primarily because of concerns about the length of the packet. In
addition to using Hyler and Rieder’s subscales, we constructed a composite
scale (PDQTOT), which is composed of the total number of responses indicating
pathology across the seven subscales. Note that results for PDQTOT
cannot be compared directly with other reports of PDQ-R composite scores
because of the deletion of several subscales.
KRITERIJI
The criteria for physical abuse consider the nature of the relationship, the
presence of injury, the threat of death, and the chronicity and frequency of the
experience(s). First, with rare exception, physical abuse is restricted to intrafamilial
relationships. Exceptions include relationships in which the other
party appears to have chronic proximity to, and power over, the subject,
beyond that afforded by the violent acts themselves. Moreover, the subject
must have apparently fewmeans of escape or recourse from the abusive situation
(e.g., a student-teacher relationship). Second, if the subject reports
physical injuries greater than mild bruises or scratches or thought, or was
told, that he was going to die, then the item is coded as abuse. Third, if these
injury criteria were not met but the event occurred at least 10 times and for at
least 1 year, then the item is coded as abuse as well. Note that the coding procedure
for physical abuse allows for aggregation of data across items. That is,
if a participant does not meet the duration or frequency criteria for an item but
if his responses would meet criteria if this item were restated to include subtypes
of physical abuse (e.g., kicking, hitting, stabbing) from another item(s) as well, then these
combined itemswould be coded as abuse for the last of the
items aggregated (i.e., representing a total of one “item’s worth” of physical
abuse). This procedure was initiated to avoid categorizing as “not abused”
individuals whose physical abuse characteristics were not well represented
by the distribution of behaviors over the abuse items. In practice, however,
abuse designations based on aggregated items were infrequent compared to
those based on the more straightforward criteria.
Both hypotheses were supported. Compared to nonabused men, men with
any history of sexual or physical abuse indicated a greater degree of personality
psychopathology associated withAvoidant, Borderline, Dependent,
and general PD (i.e., PDQTOT) symptoms. Moreover, men with both
types of abuse indicated greater symptomatology than men with one type of
abuse on PDQTOT, Borderline, and Dependent. In addition, Schizoid scores
exhibited trends consistent with both hypotheses. No differences were found
on the Antisocial, Narcissistic, or Passive-Aggressive subscales.
One interesting feature of these data is the absence of an association
between childhood abuse and symptoms of antisocial personality disorder
(APD). Although clinical levels of this disorder are less likely to be found in a
relatively high functioning college sample, this lack of any association whatsoever
was unexpected, given reports such as Luntz and Widom (1994) in
which histories of abuse and/or neglect predicted APD symptoms and diagnostic
status in adults when controlling for sex, race, age, socioeconomic
status (SES), and criminal history. The reason for this lack of significant findings
is unclear. One possible explanation is that DSM-III-R criteria (and
therefore the PDQ-R’s criteria) for APD are weighted in the direction of
criminality per se and away from personality characteristics such as callousness,
low frustration tolerance, lack of moral development, and so forth,
which are also associated with APD (Hare, Hart,&Harpur, 1991;Widiger&
Corbitt, 1995). Thus, this emphasis on antisocial behavior may be achieved at
the expense of sensitivity toward personality attributes, attributes that may be
of greater relevance when assessing a college sample. Yet this explanation is
weakened by findings that sexual or physical abuse histories predict antisocial
behaviors in community and college samples (Fergusson & Lynskey,
1997; Malinosky-Rummell & Hansen, 1993; Trickett & McBride-Chang,
1995).
POSLEDICE TRAVME – PSIHOPATOLOGIJA – SAMOMOR
Stressful events have long been acknowledged as important risk factors for
suicidal behavior. Although suicide research has generally focused on less
severe stressful events, a long-standing vulnerability for suicidal behavior may
be a sequela of prolonged traumatic stressors. The present paper discusses the
relationship between prolonged traumatic stress and subsequent suicidality by
reviewing studies that have examined suicidal behavior in relationship to child
abuse and combat trauma. Traumatic stress is conceptualized according to a
person-environment interactional paradigm, and this paradigm is used to
discuss the characteristics of traumatic events, recovery environments, and
individuals that may contribute to subsequent suicidality.
Research examining the relationship between traumatic
stress and suicide has primarily come from two areas of study: child
abuse trauma and combat trauma. Both child abuse and combat trauma
appear related to suicidal behavior, with the risk for suicidal behavior often
persisting for many years following the traumatic experience.
Stressful events have long been acknowledged as important risk factors
for suicidal behavior (Paykel, Prusoff, & Myers, 1974; Rich, Warsradt,
Nemiroff, Fowler, & Young, 1991). Both acute and chronic stressors are
related to suicidal behavior, and stressful events have an additive effect,
with the risk of suicidal behavior increasing as the number of stressful
events experienced by an individual increases (Adams, Overholser, &
Spirito, 1994).
Child abuse trauma and combat trauma differ greatly in populations
affected, events involved and adjustment demands placed on the individual.
However, they are similar in that both frequently represent Type II trauma
(Terr, 1992), a form of trauma that is prolonged and repeated (Herman,
1992).
Traumatic stress is a difficult construct to operationalize (Escobar,
1987; Lindy, Green, & Grace, 1987). Previous definitions of trauma focused
on the traumatic event as being "outside the range of usual human experience"
(American Psychiatric Association [APA], 1987), implying a categorical
difference between traumatic events and less severe stressful events
(Breslau & Davis, 1987). Recent definitions of trauma are more consistent
with theoretical models of stress (Lazarus & Folkman, 1984) in emphasizing
the interaction between person and environment. Currently (APA, 1994),
the essence of a traumatic stressor is in the threatening nature of the event
and in its ability to overwhelm normal human adaptive capacities.
Physical and sexual abuse are acknowledged childhood traumatic
events. The potential for suicidal behavior has been observed among child
abuse survivors in clinical settings, with survivors often reporting a chronic
preoccupation with death and dying that accompanies feelings of helplessness,
hopelessness, and anger at self and others (Briere, 1989; Courtois,
1988). In research, a relationship between a history of child abuse trauma
and subsequent suicidal behavior has been observed in a variety of populations.
In a study with 1,040 psychiatric inpatients (Brown & Anderson, 1991),
suicidality was the most common admitting symptom for those patients who
had experienced child abuse trauma. Seventy five percent of the child abuse
survivors presented with suicidal behavior, compared with 57% of the nonabused
patients. A study with female psychiatric inpatients (Bryer, Nelson,
Miller, & Kroll, 1987) indicated a similar relationship between child abuse
trauma and suicidality. Patients presenting with suicidal ideation, gestures
or attempts were three times as likely to have a history of child abuse as
nonsuicidal patients.
The rate of suicidal behavior is also high among psychiatric outpatients
with a history of child abuse. One study (Anderson, Yasenik, & Ross, 1993)
reported that 49% of women seeking outpatient therapy for sexual abuse
reported having made one or more suicide attempts. In other studies, the
rate of suicide attempts among sexually abused women was 55% at a crisis
counseling center (Briere & Runtz, 1986) and 66% at a psychiatric emergency
room (Briere & Zaidi, 1989). In contrast, for depressed patients, a
23% to 35% rate of suicide attempts has been found (Adams & Overholser,
1992; Tanney, 1992).
Among college students, both suicidal ideation and suicide attempts
have been shown to be related to a history of child abuse. Suicidal ideation
was a coping mechanism self-reported by college students who experienced
sexual abuse as children (Runtz, 1993), and suicide attempts were more
likely given a history of physical abuse (Briere & Runtz, 1987) and sexual
abuse (Sedney & Brooks, 1984).
"Chronic suicidality" refers to recurrent suicidal episodes rather than
a persistent suicidal state (Motto, 1992). Chronic suicidality among trauma
survivors is described in clinical reports, with some survivors tracing their
suicidal preoccupation to their first incident of child abuse or to their combat
experience (Briere, 1989; Hendin & Haas, 1984). The chronicity of suicidality
following child abuse or combat trauma has not been directly examined
in empirical studies, but indirect research evidence suggests a long-term vulnerability
to suicidal behavior following child abuse or combat trauma.
Interactional paradigms of stress emphasize both environmental and
individual factors in defining stress (Lazarus & Folkman, 1984). Applying
this paradigm to traumatic stress, the factors defining a traumatic stressor
would include characteristics of: (1) the event, (2) the recovery environment
following the event, and (3) the individual (Wilson, 1989). Considering
these components separately could help clarify the relationship
between traumatic stress and suicidal behavior (i.e., which characteristics
of the event and recovery environment contribute to increased suicide
risk).
An increased number of traumatic stressors is related
to a greater likelihood of negative outcomes (Bryer et al., 1987; Solkoff,
Gray, & Keill, 1986).
As stress theory is being applied to traumatic stress, the recovery environment
is increasingly being recognized as a key element in the traumatic
stress process. Stress theory incorporates the role of environmental
social support in the stress process and posits a stress buffering effect for
social support (Cohen & Wills, 1985). According to stress theory, social
support buffers the effects of a stressful event in two ways: (1) by intervening
between the event and the stress reaction, thus reducing the appraised
threat or (2) by intervening between the experienced stress and a
potential pathological process by providing solutions or facilitating adaptive
behaviors. Studies of less severe stressful events have shown that environmental
social support reduces the likelihood of subsequent psychopathology
and suicidal behavior (Kessler & McLeod, 1985; Overholser, Norman, &
Miller, 1990).
…9 stran se ne vidi! …suggested that an individual's response to a traumatic event occurs in
three stages: initial reactions, ongoing accommodation, and long-term
elaboration. At each stage, the individual interacts with various dimensions
of the traumatic event and the recovery environment (Wilson, 1989).
Dissociation may be one mechanism that underlies the relationship between
traumatic stress and suicidality. Dissociation as a coping mechanism
often originates with traumatic experiences (Spiegel, 1993).
Guilt may also be a mechanism underlying the relationship between
trauma and suicidality. For some individuals, feelings of guilt, shame, responsibility
and complicity may originate with a traumatic event and become
integrated into the experience of self (Briere, 1989; Courtois, 1988).
Both child abuse trauma and combat
trauma are related to multiple psychiatric diagnoses, with psychiatric
symptoms often becoming chronic or recurrent (Green et al., 1989; Newman,
Orsillo, Herman, Niles, & Litz, 1995).
Among the diagnoses most frequently named in relation
to suicidal behavior are depressive disorders, substance abuse disorders,
PTSD, generalized anxiety disorder, and panic disorder. Psychiatric co-morbidity
often typifies the clinical presentation of child abuse and combat
trauma survivors (Beitchman et al., 1992; Green et al., 1989) which may
further increase the risk of suicidal behavior (Beautrais et al., 1996).
Manetta (1999) examined the relationship between different types of abuse (partner
abuse, childhood physical and sexual abuse, and rape) and suicidal tendencies (as a
symptom of depression) among African American women seen at medical
and psychiatric facilities (N= 91). The most frequent type of abuse reported among
those who were suicidal was partner abuse (24.2%).
In several studies, suicidal behavior has been found to relate to trauma
exposure. For example, Lundin (1984), in a study of familial morbidity following
50 cases of sudden and unexpected death, found 10% of the surviving
bereaved to have committed suicide. Kilpatrick, Best, and Veronen
(1985) found the rate of attempted suicide to be 8.7 times higher among
victims of completed rape than among nonvictims. In a study among former
WW II prisoners of war (POWs), it was found that 57% of POWs imprisoned
by the Japanese harboured suicidal thoughts and that 7% of POWs
under the Germans had attempted suicide (Miller, Martin, & Spiro, 1989).
Somasundaram (1993) reported that suicidal thoughts were present in 38%
of a group of 160 former POWs subjected to torture in Sri Lanka.
The principal aim of the present study was to assess (a) the prevalence
of PTSD and psychiatric comorbidity, (b) the incidence suicidal behavior
among refugees with history of exposure to severe trauma, and c) the possible
difference between the different diagnoses with respect to modes of
suicidal behavior.
In this study of 149 traumatized refugees, the prevalence of PTSD
among all cases in which a principal psychiatric diagnosis was established
was 83%. A significant overrepresentation of suicidal behavior was found
in the group of refugees with PTSD diagnoses in comparison with the no
PTSD cases. Among the traumatized refugees in our study (all diagnoses
included) assessed with suicidal behavior, 40% (30/74) had made at least
one previous suicide attempt.
Besides paramount ethnic and cultural factors which have been reported
as potential risk for suicide among refugees (Ferrada-Noli, 1994;
Ferrada-Noli, Asberg, Ormstad, & Nordstrom, 1995; Ferrada-Noli, Asberg,
& Ormstad, 1996; Ferrada-Noli & Sundbom, 1996), new epidemiological
findings have disclosed the highly significant nation-wide overrepresentation
of immigrants in the Swedish suicide statistics, x2(1, N = 10,225) =
44.7, p = .0001).
The idea of a principal impact of PTSD (and also of reactive posttraumatic
depression) in the pathogenesis of suicidal behavior among tor-
tured victims may find indirect support in investigations describing the nature
and prevalence of PTSD symptoms, since some of these symptoms
have been reported earlier as being clinically associated with suicide risk
factors. In the study of Basoglu et al. (1994) 'restricted expectations' was
found to be three times more frequent among tortured than among nontortured
subjects. Ginsberg (1989) regarded the level of the patient's feelings
of hopelessness the most frequent association with attempted suicide
in patients suffering from depression, and the previous early findings in
suicidology on a high correlation between sense of hopelessness and inability
to see into the future and future suicide (Cavanough, 1986), are also to be
related with the very formulation of PTSD diagnostic criterion C-7 (sense
of a foreshortened future) in DSM-IV (American Psychiatric Association
[APA], 1994).
A preliminary finding on an association between the suicide method
contained in the patient's suicidal ideation and the torture method to which
he or she recounted have being subjected was reported by Ferrada-Noli
(1993) at a CTD symposium at the Karolinska Hospital.
The principal aim of the present study was to ascertain whether relationships
existed between the type of torture stressors and suicidal ideation,
the hypothesis being that the nature of the torture methods would be
reflected in the content of posttraumatic self-destructive ideation.
POSLEDICE TRAVME – PSIHOPATOLOGIJA – DEPRESIJA
Research has demonstrated that youth who are sexually orphysically abused are at
greater risk for developing depression. Although the association between depression
and child maltreatment has been well documented, much less is known about the
potential differences in the clinical presentation of
depressive symptomatology among these victims. The current study examines
differences in symptoms of depression in adolescents based on differing histories of
abuse (i.e., sexual
abuse only, physical abuse only, sexual and physical abuse, and no history of sexual
or physical abuse), abuse incident characteristics, and gender.
The presence of depression in adolescence is a significant risk predictor for major
depression in adulthood (Harrington, Fudge, Rutter, Pickles, & Hill, 1990). In
addition, depressed youth are at a significantly higher risk for suicide, which is the
third leading cause of death in adolescents (Brent, 1995; Brent, Bridge, Johnson, &
Connolly, 1996; Centers for Disease Control [CDC], 2002).
Research has demonstrated that children and adolescents who are sexually or
physically abused are at greater risk for developing depression (Boney-McCoy &
Finkelhor, 1996; Kilpatrick, Ruggiero, et al., 2003).
Research has emphasized that CSA is a risk factor for depression (e.g., Hill, 2003;
Kilpatrick, Ruggiero, et al., 2003; Mannarino & Cohen, 1996). CPA also recently has
been recognized as a risk factor for mood disorders (e.g., Brown&Kolko, 1999; Clark,
De Bellis, Lynch, Cornelius, & Martin, 2003; Johnson, Kotch, et al., 2002; Runyon &
Kenny, 2002). Despite the consistent findings that there is a strong link between
depression and child maltreatment, little is known about the specific role of child
abuse in the development and course of depression or how differences in abuse
history may be associated with the clinical presentation of depressive
symptomatology.
In another study comparing symptom differences in children who had been physically
abused, neglected, or who had no abuse history, researchers found that children
who were physically abused were more likely to be suicidal than children who were
neglected as well as the children who were nonmaltreated (Finzi, Har-Even, Shnit, &
Weizman, 2002).
Several studies have examined the perpetrator-victim relationship with regard to
sequelae of the abuse, often finding that intrafamilial victims suffer greater physical
and emotional injury (e.g., Faust, Runyon, & Kenny, 1995; Fischer&McDonald, 1998;
Ruggiero et al., 2000). It is thought that the violation of a trusting intrafamilial
relationship contributes to negative sequelae as a result of the abuse, particularly
PTSD.
Thus, related depressive symptoms (i.e., problems with sleep, appetite, and energy)
may be especially prevalent in children who experience abuse by the hand of a
caretaker or in the home.
In addition, endorsements of several specific symptoms differed among the groups.
Particularly noteworthy is that guilt and thoughts of hurting oneself were endorsed
most by female adolescents in either group (abuse or no abuse history), indicating
that these are particularly prevalent symptoms for female adolescents who are
depressed. Some researchers have begun to examine how differences in normal
adolescent development between boys and girls may affect such differences in
depression, such as differences in coping styles (Nolen-Hoeksema, 1994), which may
help to explain why suicidal ideation is higher among girls.
Child Maltreatment in Depressed Adolescents:Differences in Symptomatology Based on History of Abuse
Carla Kmett Danielson, Michael A. de Arellano, Dean G. Kilpatrick, Benjamin E. Saunders, Heidi S. Resnick
Medical University of South Carolina
CHILD MALTREATMENT, Vol. 10, No. 1, February 2005 37-48
Depression
is often a co-morbid condition that comes with PTSD (American Psychiatric
Association, 1994) and not surprisingly this is common in many of the cases with
sexual problems following trauma.
Depression is a common correlate of childhood maltreatment as well. A
number of studies have shown increased rates of depression, suicidality, and
lowself-esteem inwomen with a history of CSA (for reviews, see Beitchman
et al., 1992;Weiss, Longhurst, &Mazure, 1999). Duncan et al. (1996) found
thatwomen reporting a history of CPA were two times as likely to have had a
major depressive episode in their lifetime and four times as likely to be currently
experiencing a major depressive episode. Bernet and Stein (1999)
found that histories of childhood abuse among patients who were depressed
were associated with earlier onset of a first depressive episode, more lifetime
depressive episodes, and greater comorbidity. Self-depreciation has been
linked to CSA and childhood psychological maltreatment (Higgins &
McCabe, 2000b). In addition, childhood abuse has been associated with anxiety,
borderline personality disorder, somatization, sleep problems
(McCauley et al., 1997), dissociative symptoms (Chu & Dill, 1990), and
interpersonal and sexual difficulties (Rumstein-McKean&Hunsley, 2001).
POSLEDICE TRAVME – PSIHOPATOLOGIJA – PSIHOZA
Several lines of evidence suggest an association
between trauma and psychosis (1). First, studies
have demonstrated a high incidence of trauma in
the lifetimes of patients with psychosis. Ross et al.
(2) found that positive symptoms of schizophrenia
are related to a history of childhood trauma (2, 3).
Abused patients are particularly likely to experience
positive symptoms, such as hallucinations
(4–6) paranoid ideation, thought insertion, visual
hallucinations, ideas of reading someone else’s
mind, ideas of reference and hearing voices making
comments. In a recent study, childhood abuse was
a significant predictor of hallucinations, even in the
absence of adult abuse (7). Secondly, in patients
with other diagnoses, a history of child abuse has
also been found to _co-occur_ with a high frequency
of auditory hallucinations and delusions. Childhood
sexual abuse has an impact on the later
symptom profile of patients with bipolar affective
disorder, increasing their vulnerability to experience
hallucinations (8). Individuals with posttraumatic
stress disorder manifest increased levels
of positive psychotic symptoms (9). Dissociative
identity disorder, which is assumed to be a disturbance
resulting from severe childhood abuse
(10–12) may present with a great number of
Schneiderian first rank symptoms, particularly in
the form of auditory hallucinations (11, 12). It has
even been suggested that of all diagnostic categories,
psychosis displays the strongest associations
with child abuse (13, 14). Thirdly, according to
Briere (15) childhood sexual abuse is the most
powerful predictor of later psychiatric symptoms
and disorders after controlling for significant
demographic variables. A study of adult outpatients
found child abuse to be a more powerful
predictor of suicidality than a current diagnosis of
depression (16). The more severe the abuse, the
greater the probability of psychiatric disorder in
adulthood (17, 18).
It has been suggested that the experience of
abuse may create a biological (1) or psychological
(19) vulnerability for the development of psychotic
symptoms, including sub-clinical psychotic experiences
such as low-grade delusional ideation and
isolated auditory hallucinations (20). In the general
population, childhood sexual abuse is related to
schizotypy, including perceptual aberrations (21)
which are 10 times more common in adults who
were maltreated as children (22). In both clinical
and non-clinical populations, the diagnostic group
with the highest rate of childhood abuse consistently
reported the most Schneiderian symptoms
(23). Thus, two previous studies found evidence for
an association between abuse and psychotic experiences
in non-clinical samples (21, 24).
For example, subjects who reported
abuse in the highest frequency category had an
estimated 30 times greater chance to develop a
needs-based diagnosis of psychosis compared to
those not exposed to childhood abuse. Less
frequent abuse was associated with an estimated
five times greater risk to develop a need-based
diagnosis of psychosis compared to those without
any exposure to childhood abuse, whereas the risk
was not increased in subjects who reported abuse
in the lowest frequency category.
The results of this study suggest that reported
childhood abuse predicts psychotic symptoms in
adulthood in a dose–response fashion. The association
between childhood abuse and psychotic
symptoms was robust and remained significant
after adjustment for possible confounders.
POSLEDICE TRAVME – PSIHOPATOLOGIJA – ADHD
I want to include some necessarily rather brief thinking about Gary’s
ADHD diagnosis and its relevance to his early history. In ‘Wrestling
with the whirlwind: an approach to the understanding of ADHD’
(Orford, 1998), the author quotes research done by Perry and his coworkers
in 1995.Their approach was neuro-biological, and it has now
been proved that early experience does indeed have an effect on the
development of neural pathways and later brain functioning. They note
that the symptoms of ADHD are very similar to those that occur during
trauma: the hyper-alertness, the need to act quickly, to live in constant
expectation of danger to the exclusion of other thoughts. What they suggest
is that in a critical period in infancy some children experience trauma
which initiates an habitual automatic response, as though to external
threat. As they grow up, these children are hyper-sensitive to threat and
revert to ‘action stations’ in time of crisis. Babies may be exposed to
frightening experiences which cause them to become habituated to feelings
of threat. Perry’s . nding has been that children with ADHD have
established neural pathways on the basis of response to threat and trauma.
In other words, some traumatized children may develop ADHD. As
Schore (1998) also explains, early traumatic events which result in excessive
use of projective identi. cation and then dissociation become
imprinted in the right brain as primitive defence mechanisms which can
potentially affect the regulation (or dysregulation) of feelings throughout
the lifespan. (On being dropped and picked up: adopted children and
their internal objects, JUDITH EDWA RDS )
POSLEDICE TRAVME – PSIHOPATOLOGIJA – ODVISNOST
POSLEDICE TRAVME – PSIHOPATOLOGIJA –
SAMOPOHABLJANJE
In examining the possible connections, researchers
have noticed that incest is often present in the history of selfmutilators.
However, conclusions often go no further than reporting
the correlation. Although the correlation is noteworthy, it
overlooks an important observation: Not all incest survivors
mutilate themselves.Nostudies to date have explored the interrelation
of variables that lead to an understanding ofwhysomeCSA
survivors self-mutilate and others do not.
Of those with sexual abuse histories, 17% had selfmutilated.
None of thewomenwithout a sexual abuse history had
self-mutilated.
Astudy of 45 incest survivors by de Young (1982b) found that
58% had engaged in self-injurious behaviors, all beginning after
the CSA.Of hospitalized adolescent self-mutilators, 56% reported
sexual abuse in a study by C. Simpson and Porter (1981). Studies
by Goldney and Simpson (1975) and Grunebaum and Klerman
(1967) noted the connection between self-mutilation and sexual
abuse perpetrated by parents. In the sexual abuse accommodation
syndrome described by Summit (1983), self-mutilation was
considered one of the adaptive methods developed to survive
and accommodate the secrecy, helplessness, and entrapment of
the abuse. More recently, self-mutilation by CSA survivors has
been conceptualized as a symptom of post-traumatic stress disorder.
In one study, 25% of CSA survivors meeting the criteria for
post-traumatic stress disorder also self-mutilated (Albach &
Everaerd, 1992).
Depression is one emotion often associated with the emotional
sequelae of CSA (Beitchman et al., 1992). Brodsky, Cloitre, and
Dulit (1995) found a strong correlation between depression, selfmutilation,
and CSA histories.
Incorporating many of the above features, the
diagnosis of borderline personality disorder is commonly given
to patients who self-mutilate (Briere&Zaidi, 1989; Grunebaum&
Klerman, 1967; Shapiro, 1987; Walsh & Rosen, 1988).
Parental perpetrator(s). Self-mutilators, in comparison to the
nonmutilators, were sexually abused more often by their fathers
(51.3% to 25.0%) and mothers (10.3% to 2.8%). A parental perpetrator
appeared to substantially differentiate between the two
groups and therefore was included in the log-linear analysis.
Frequency of abuse. Participants were askedhowoften the sexual
experience(s) occurred. Therewas space provided to answer both
a standardized response and a respondent-generated estimate.
Results of this question supported that there is a relationship
between increased frequency and self-mutilation. On average,
self-mutilators remembered 22 nonfamilial sexual incidents and
45 familial ones.Womenwho did not self-injure remembered 10.8
and 38.44 incidents, respectively.
Penetration. The group of self-mutilators experienced less vaginal
intercourse than the nonmutilators in both familial (12.8% to
13.9%) and nonfamilial (37.9% to 47.8%) sexual abuse. However,
slightly more self-mutilators experienced anal (12.8% to 8.3%) or
attempted vaginal (30.8% to 19.4%) intercourse. The presence of
vaginal intercourse did not seem to contribute to the distinction
between self-mutilators and nonmutilators. Therewas some suggestion,
however, that the presence of anal or attempted vaginal
intercourse may indicate a proclivity toward self-mutilation.
However,more of
the fathers of the nonmutilators had died compared to fathers of
the mutilators (14.3% to 9.5%). These results were the opposite of
the suggested findings; therefore, the loss of one’s father was not
included in further analyses.
The loss of one’s mother, however, yielded a different pattern.
During the participants’ childhoods, more mothers of selfmutilators
died compared to mothers of nonmutilators (7.1% to
2.4%, n = 4, combined). Also, the mothers of mutilators were
seriously ill or suffered injuries more often in a comparison to
mothers of nonmutilators (38.1% to 31%, n = 16 and n = 13).
In examining the possible connections, researchers
have noticed that incest is often present in the history of selfmutilators.
However, conclusions often go no further than reporting
the correlation. Although the correlation is noteworthy, it
overlooks an important observation: Not all incest survivors
mutilate themselves.Nostudies to date have explored the interrelation
of variables that lead to an understanding ofwhysomeCSA
survivors self-mutilate and others do not.
Of those with sexual abuse histories, 17% had selfmutilated.
None of thewomenwithout a sexual abuse history had
self-mutilated.
Astudy of 45 incest survivors by de Young (1982b) found that
58% had engaged in self-injurious behaviors, all beginning after
the CSA.Of hospitalized adolescent self-mutilators, 56% reported
sexual abuse in a study by C. Simpson and Porter (1981). Studies
by Goldney and Simpson (1975) and Grunebaum and Klerman
(1967) noted the connection between self-mutilation and sexual
abuse perpetrated by parents. In the sexual abuse accommodation
syndrome described by Summit (1983), self-mutilation was
considered one of the adaptive methods developed to survive
and accommodate the secrecy, helplessness, and entrapment of
the abuse. More recently, self-mutilation by CSA survivors has
been conceptualized as a symptom of post-traumatic stress disorder.
In one study, 25% of CSA survivors meeting the criteria for
post-traumatic stress disorder also self-mutilated (Albach &
Everaerd, 1992).
Depression is one emotion often associated with the emotional
sequelae of CSA (Beitchman et al., 1992). Brodsky, Cloitre, and
Dulit (1995) found a strong correlation between depression, selfmutilation,
and CSA histories.
Incorporating many of the above features, the
diagnosis of borderline personality disorder is commonly given
to patients who self-mutilate (Briere&Zaidi, 1989; Grunebaum&
Klerman, 1967; Shapiro, 1987; Walsh & Rosen, 1988).
Over the past two decades, the study of CSAwithin the family
and its sequelae has been recognized as a significant issue for
many women. Estimates vary as to its prevalence, ranging from
about one third (31%) (Russell, 1983) (33%) (Wheeler & Walton,
1987) to 16% (Russell, 1983, 1984; Sedney & Brooks, 1984)
REZULTATI
Duration. The average duration of the CSA for the mutilators
was almost double that of the nonmutilators. With a range of
duration from less than 1 year to 22 years, the mutilators’ CSA
began at the mean age of 6.06 years (SD = 3.91) and stopped at the
mean age of 13.33 years (SD = 5.87). For the nonmutilators, the
CSA started at the mean age of 7.64 years (SD = 4.30), and the
mean age when it ended was 11.66 (SD = 6.36). Duration ranged
from less than 1 year to 34 years. Duration of the CSAappeared to
differentiate between the two groups and was included as a
potential variable in the model-building phase of the analysis.
Parental perpetrator(s). Self-mutilators, in comparison to the
nonmutilators, were sexually abused more often by their fathers
(51.3% to 25.0%) and mothers (10.3% to 2.8%). A parental perpetrator
appeared to substantially differentiate between the two
groups and therefore was included in the log-linear analysis.
Frequency of abuse. Participants were askedhowoften the sexual
experience(s) occurred. Therewas space provided to answer both
a standardized response and a respondent-generated estimate.
Results of this question supported that there is a relationship
between increased frequency and self-mutilation. On average,
self-mutilators remembered 22 nonfamilial sexual incidents and
45 familial ones.Womenwho did not self-injure remembered 10.8
and 38.44 incidents, respectively.
Penetration. The group of self-mutilators experienced less vaginal
intercourse than the nonmutilators in both familial (12.8% to
13.9%) and nonfamilial (37.9% to 47.8%) sexual abuse. However,
slightly more self-mutilators experienced anal (12.8% to 8.3%) or
attempted vaginal (30.8% to 19.4%) intercourse. The presence of
vaginal intercourse did not seem to contribute to the distinction
between self-mutilators and nonmutilators. Therewas some suggestion,
however, that the presence of anal or attempted vaginal
intercourse may indicate a proclivity toward self-mutilation.
However,more of
the fathers of the nonmutilators had died compared to fathers of
the mutilators (14.3% to 9.5%). These results were the opposite of
the suggested findings; therefore, the loss of one’s father was not
included in further analyses.
The loss of one’s mother, however, yielded a different pattern.
During the participants’ childhoods, more mothers of selfmutilators
died compared to mothers of nonmutilators (7.1% to
2.4%, n = 4, combined). Also, the mothers of mutilators were
seriously ill or suffered injuries more often in a comparison to
mothers of nonmutilators (38.1% to 31%, n = 16 and n = 13).
The nature
of the abuse, the relationship of the perpetrator,
the age when the abuse occurred, and the duration of
the abuse are variables of the abuse that further influence
the likelihood of self-harm.
Little has been written about the psychological determinants
that lead to self-harm as an expression of
the internal distress associated with a history of abuse.
Themore extreme forms of self-harm are defined as purposeful
actions that harm the body and that are outside
the bounds of social acceptability. These include cutting,
burning, abrading, or hitting oneself, inserting
sharp objects in the anus or vagina, pulling out body
hair, or other self-attacking behaviors that are idiosyncratic
to the survivor and his or her abuse history.
However, cutting has been found to be the most common
form of self-harm (Babicker & Arnold). Self-harm
is often an attempt to communicate and relieve pain
and maintain discourse.
Women who self-harm
often hate their bodies and consider their bodies to be
representations of their internalized badness and ugliness.
Cutting the external body symbolically attacks the
internal badness and, because of boundary confusion,
may represent an attack on the abuser.
Cutting, unlike childhood abuse, is within the control
of the trauma survivor. Of course, the relief it brings is
short-lived and often leads to shame and guilt, and the
cycle of pain, relief, and shame starts again.
Abstract: Lifetime trauma histories were ascertained for females with confirmed histories of
childhood sexual abuse and comparison females participating in a longitudinal, prospective
study. Abused participants reported twice as many subsequent rapes or sexual
assaults (p = .07), 1.6 times as many physical affronts including domestic violence
(p = .01), almost four times as many incidences of self-inflicted harm (p =
.002), and more than 20% more subsequent, significant lifetime traumas (p = .04)
than did comparison participants. Sexual revictimization was positively correlated
with posttraumatic stress disorder symptoms (PTSD), peritraumatic dissociation,
and sexual preoccupation. Physical revictimization was positively correlated with
PTSD symptoms, pathological dissociation, and sexually permissive attitudes. Selfharm
was positively correlated with both peritraumatic and pathological dissociation.
Competing theoretical explanations for revictimization and self-harm are discussed
and evaluated.
Research over the past decade has documented a prospective link between
rape and subsequent revictimization in short-term follow-up studies of adult
victims (e.g., Gidycz, Hanson, & Layman, 1995; Kilpatrick, Acierno,
Resnick, Saunders, &Best, 1997). The link between childhood sexual abuse
and subsequent victimization that occurs later in adolescence or adulthood is
less well understood. A growing body of research has documented associations
between childhood sexual abuse and subsequent sexual victimization
(see Messman&Long, 1996, and Briere&Runtz, 1987, for reviews; see also
Arata & Lindman, 2002; Chu & Dill, 1990; Kessler & Bieschke, 1999; Koss
& Dinero, 1989; Merrill et al., 1999; Messman-Moore & Long, 2000) and
between childhood sexual abuse and laterphysical victimization including
domestic violence (Arata, 1999; Collins, 1998; Gilbert, El-Bassel, Schilling,
& Friedman, 1997; Krahe, Scheinberger-Olwig, Waizenhofer, & Kolpin,
1999; McClosky, 1997; Messman & Long, 1996). Otherstudies have documented
higher rates of self-abuse or self-harm in childhood sexual abuse victims
(Boudewyn & Liem, 1995; Romans, Martin, Anderson, Herbison, &
Mullen, 1995; Van der Kolk, Perry, & Herman, 1991; Winchel & Stanley,
1991; Yeo & Yeo, 1993). Further, it appears that the co-occurrence of multiple
types of child maltreatment (e.g., sexual abuse, physical abuse, child
neglect) puts children at considerable risk for revictimization in adulthood
(Briere, Woo, McRae, Foltz, & Sitzman, 1997; Dutton, Burghardt, Perrin,
Chrestman, & Halle, 1994; Hillis, 2001).
We operationally define victimization
(either sexual or physical) as harm perpetrated by an outside source that
serves as a reenactment of the initial abuse. Self-harm, on the other hand,
implies a direct reenactment inflicted by the survivor herself and represents a
certain internalization of the trauma. Therefore, self-harm is not considered
a category of revictimization but will be studied as a separate and distinct
phenomenon.
REZULTATI:
Analyses showed that, compared to nonabused participants, sexually
abused participants were twice as likely to have been raped or sexually
assaulted, almost fourtimes as likely to have inflicted subsequent self-harm
(in the form of suicide attempts or self-mutilation), reported significantly
higher rates of physical revictimization (including domestic violence), and
reported a greater number of significant subsequent lifetime traumas than
comparison participants. When alternative forms of childhood maltreatment
were taken into account, childhood sexual abuse was a unique predictor of
self-harm.
Concurrent pathological dissociaton was shown to be predictive of physical
victimization when in the company with variables from several theoretically distinct domains. These results indicate that a persistent reliance on dissociation
as a coping mechanism can place participants at increased risk for
physical harm. Thus, victims who adopt pathological dissociation as the primary
defense strategy in adolescence or adulthood may be less able to engage
in self-protection when physically threatened. Dissociation has been thought
to be associated with suicide and self-injurious behaviors, and these results
confirm this association (Brodsky, Cloitre, & Dulit, 1995). Self-harm may
not be a direct response to sexual abuse but to the dissociative experiences
that result from efforts to cope with the abuse.
Results also indicate that being sexually active orbelie ving that sexual
activity is permissible can increase one’s vulnerability for physical victimization.
The incidence of self-harm in sexual abuse victims was quite dramatic.
Being sexually abused was, by far, the strongest predictor of self-harm even
when in company with other forms of child maltreatment.
POSLEDICE TRAVME – PSIHOPATOLOGIJA –
SOMATIZACIJE, FIZIČNI PROBLEMI
In addition to posing psychological risks, child abuse can have serious medical consequences
(Berkowitz, 2000; Wharton, Rosenberg, Sheridan, &Ryan, 2000). Many physically abused
children suffer neurological or neuropsychological impairment, severe injuries, or even death
(Ammerman, Cassisi, Hersen, &Van Hasselt, 1986). Teicher et al. (1997) found evidence
suggestive of abnormal cortical development in nearly three quarters of their sample of
sexually and physically abused children.
There are also data about such reactivity among women who have PTSD due to childhood
sexual
abuse (PTSD–CSA). In a recent study, Orr, Lasko, et al. (1998) compared women
with histories of CSA who had full PTSD, partial PTSD, and no PTSD. All three
groups reacted to the trauma-related stimuli, but women with full PTSD showed
significantly greater increases in heart rate (HR) and forehead muscle tension than
did women without PTSD. In a related study, this group found that the CSAexposed
women with current PTSD or lifetime PTSD had greater HR responses
and slower habituation of skin conductance responses to auditory startle stimuli
compared to the CSA-exposedwomen without PTSD (Metzger et al., 1999). These
results suggest thatwomen with PTSD–CSA exhibit patterns of psychophysiological
responding similar to those observed in male combat veterans with PTSD when
confronted either with reminders of their childhood trauma or with startling tones.
In summary, our results with female survivors of CSA are consistent with the
findings in other PTSD subpopulations, that heightened psychophysiological reactivity
is associated with reminders of the trauma and with PTSD symptom severity.
In addition, our finding of a negative association between PTSD symptom severity
and psychophysiological reactivity for the mental arithmetic task is consistent with
other studies of PTSD. Together, these results point to the need to examine how
appraisal processes and other individual differences mediate psychophysiological
responses to laboratory stress tasks.
The physiological response to trauma-related stimuli of up to one third of
participants with posttraumatic stress disorder (PTSD) cannot be discriminated
from that of controls. Psychophysiological measures (heart rate and blood
pressure) of 22 PTSD and 23 control civilian participants, all exposed to
missile attacks during the Gulf War, were recorded while listening to five scripts.
The physiological response of PTSD subjects with high image control (IC) was
lower than that of PTSD participants with low IC and similar to that of
non-PTSD subjects. The physiological response poorly discriminated high
IC PTSD participants from controls, but was successful in discriminating
low IC PTSD subjects from controls with 91% specificity and 92%
sensitivity. Image control is proposed as a function influencing physiological
response in PTSD.
POSLEDICE TRAVME – SPOLNOST, INCEST, SPOLNO
NADLEGOVANJE, POSILSTVO
Victims of sexual assault report loss of interest and satisfaction with daily life and impairment
of functioning (Ellis, Atkeson, & Calhoun, 1981). Other reactions to sexual assault include
altered sleep patterns, sexual dysfunction, eating irregularities, posttraumatic symptoms, and
somatic difficulties (Foa & Riggs, 1994; Nadelson, Notman, Zackson, & Gornick, 1982).
Victims of sexual assault also report intense fear of revictimization and feelings of violation,
vulnerability, hopelessness, loss of control, shame, anxiety, concentration difficulties,
lethargy, and irritability (Becker & Kaplan, 1991; Moscarello, 1991; Nadelson et al., 1982).
Sexual assault impairs a victim’s social functioning by provoking fear of strangers, social
interaction, and people in close proximity, thus promoting avoidance or intense anxiety in
situations similar to the sexual assault event (Steketee & Foa, 1987).
Accord ing to Rind et al. (1998), CSA gen er ally is believed
to cause severe and last ing harm to the major ity of chil dren
who expe ri ence it, and males and females are believed to be
sim i larly affected. Their anal ysis does not sup port these
beliefs for the col lege stu dent pop u la tion.
Jumper (1995) con ducted a meta-analysis of 26 stud ies of
CSA with par tic i pants from com mu nity, stu dent, and clin i cal
pop u la tions and con cluded that stu dents gen er ally emerge
from CSA expe ri ences with less psy cho log i cal adjust ment
difficulties than do CSA sur vivors in clin i cal or com mu nity
pop u la tions.
Com mu nity-Clinical Studies
In study ing women in a com mu nity set ting, Coffey,
Leitenberg, Henning, Turner, and Bennett (1996) report that
the group who reported sex ual abuse in child hood showed
greater psy cho log i cal symptomatology, includ ing higher
clin i cal lev els, than did the com par i son group, who reported
no his tory of CSA.
In another com mu nity study, Mullen, Mar tin, Ander son,
Romans, and Herbison (1995) inter viewed 298 women youn ger than 65 who indi cated per sonal his to ries of sex abuse in
child hood. The authors stated that fam i lies with low socio eco nomic sta tuses have more dis rup tion than do fam i lies with
higher socio eco nomic back grounds; there fore, abuse is
higher in these fam ilies. Mullen et al.
(1995) con cluded that child sex ual abuse is not as influ en tial
on adult psychopathology as pre vi ously thought. It is an indi ca tor of other types of abuse, how ever. Women who reported
more than one form of abuse gen er ally had more adult
sex ual abuse in child hood have been gen er al ized
inac cu rately. prob lems—sex ual prob lems, addic tions, low self-esteem,
eat ing dis or ders, depres sion, and psy chi at ric hos pi tal iza tion.
There are fac tors mod er at ing the abuse that were asso ci ated
with lower neg a tive out comes, such as the fam ily stay ing
intact, con fid ing with one’s mother, and hav ing a close per sonal friend. An exten sion of this find ing is that a child may
suf fer abuse, but close, sup port ive rela tion ships with friends
or fam ily mem bers may alle vi ate some of the long-range
prob lems asso ci ated with abuse.
Pistorello and Follette (1998) exam ined vid eo taped ses sions of CSA sur vivors in group ther apy to develop five cat e go ries of prob lems in inti mate rela tion ships reported dur ing
group ther apy. The five cat e go ries are sex-, sur vivor-, part ner-, rela tion ship-, and atti tude-specific state ments.
Survivors of childhood sexual abuse are more likely to experience a variety
of trauma symptoms in adulthood than adults who have not experienced
childhood sexual abuse (reviewed in Beitchman et al., 1992; Polusny &
Follette, 1995). These symptoms include depression (Pribor & Dinwiddie,
1992), suicidality (Saunders, Villeponteaux, Lipovsky, & Kilpatrick 1992),
anxiety disorders (Pribor & Dinwiddie, 1992), dissociative experiences
(Briere & Runtz, 1987), sexual problems (Davis, Petretic-Jackson, & Ting,
2001), relationship problems (Davis et al., 2001), problems with sleep
(Briere&Runtz, 1987), and borderline personality disorder (Herman, Perry,
& van der Kolk, 1989). Because only some adult survivors experience these
symptoms to a troubling degree in adulthood (Fromoth, 1986), it is possible
that etiological factors such as differences in life stress are associated with
these symptoms.
A number of studies have shown that trauma symptoms are related to the
severity of stressful life events. This has been found in research on various
kinds of traumatic events, including among victims of motor vehicle accidents
(Ehlers, Mayou, & Bryant, 1998), Vietnam veterans (Green, Grace,
Lindy, Gleser, & Leonard, 1990), Cambodian refugees (Carlson & Rosser-
Hogan, 1991), and survivors of a firestorm (Koopman, Classen, & Spiegel,
1994).
It has been noted that a history of exposure to extreme psychological stress
appears to make a person more vulnerable to experiencing psychological distress
when stressors occur later in life (Bremner, Southwick, & Charney,
1995).
Sexual abuse in childhood is a major risk factor for later sexual
revictimization (Chu, 1992; Koss & Dinero, 1989) and may lead to greater
sexual problems (Wyatt, Guthrie, & Notgrass, 1992) as well as other trauma
symptoms (Koverola, Proulx, Battle, & Hanna, 1996).
One model that can explain the vulnerability of some individuals to
trauma symptoms is “sensitization” (Post,Weiss,&Smith, 1995). The idea is
that the original trauma initiates the first episode of symptoms, but as
repeated stressful life events occur, there is a progressive sensitivity to
becoming symptomatic (McFarlane&Yehuda, 1996). Sensitivitywould also
be influenced by the severity of the life events.
Our findings provide evidence that recent life stressors and sexual
revictimization during adulthood are associated with severity of traumatic
stress symptoms in women who have been sexually abused in childhood and
who meet the DSM-IV criteria for current PTSD. Our findings provide some
evidence for the sensitization model that an initial traumatic event renders an
individual vulnerable to becoming symptomatic following subsequent
stressful life events.
Within the past 20 years, we have learned that the mental
health effects of this crime are devastating as rape survivors are the largest
group of persons with post-traumatic stress disorder (PTSD; Foa &
Rothbaum, 1998). (REBECCA CAMPBELL, SHARON M. WASCO, Understanding
Rape and Sexual Assault, JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 20 No. 1,
January 2005 127-131)
…emerging research suggests that rape survivors experience
more acute and chronic physical health problems than do women who
are not victimized (Golding, 1994; Koss, Koss, & Woodruff, 1991). Sexual
assault also affects women’s sexual health risk-taking behaviors and places
some at greater risk for contracting HIV (Campbell, Sefl,&Ahrens, 2004). (REBECCA
CAMPBELL, SHARON M. WASCO, Understanding Rape and Sexual Assault,
JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 20 No. 1, January 2005 127-131)
Research indicates that coping with the aftermath of
rape can cause significant stress for the family, friends, and significant others
of sexual assault survivors (Ahrens & Campbell, 2000; Burge, 1983; Remer
& Elliott, 1988).
(REBECCA CAMPBELL, SHARON M. WASCO, Understanding Rape and Sexual
Assault, JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 20 No. 1, January 2005
127-131)
Accordingly, we suggest that when a rape is committed by a known and trusted other, it is
probably schema discrepant, and assimilation rather than accommodation should be the
more likely outcome. Some support for this notion comes from prior work showing that
women raped by known offenders, compared with those raped by strangers, were more likely
to show evidence of assimilation by 3 months postrape (Mechanic, Resick, & Griffin, 1994).
Assimilation should decrease the likelihood of emotional or information processing of the
trauma experience, increasing the likelihood of recall deficits. Thus, we hypothesized that
women raped by men they knew would be more likely to suffer from memory failure for parts
of the rape compared with women raped by strangers.
More recently,
CPA has been tested as a predictor of sexual/social outcomes. For example,
Widom and Kuhns (1996) investigated the relationship between early childhood
maltreatment and subsequent promiscuity, prostitution, and teenage
pregnancy. Although CPAwas not associated with a higher risk of promiscuity
or teenage pregnancy, it was significantly associated with an increased
risk of prostitution. The Relationship Between Adult Psychological Adjustment and Childhood Sexual Abuse, Childhood Physical
Abuse, and Family-of-Origin Characteristics SHANE KAMSNER MARITA P. MCCABE
Compound abuse, where a victim suffers two or more forms of abuse
either concurrently or separately, is more likely to lead to negative psychological
outcomes than any single form of childhood abuse (Bryer et al., 1987;
Fox & Gilbert, 1994; Mullen, Martin, Anderson, Romans, & Herbison,
1996). For example, Fox and Gilbert (1994) found that women who reported
experiencing more than one form of abuse in childhood also reported they
were significantly more depressed than those who suffered one form of abuse
in childhood. The Relationship Between Adult Psychological Adjustment and Childhood Sexual Abuse, Childhood Physical Abuse,
and
Family-of-Origin Characteristics SHANE KAMSNER MARITA P. MCCABE
In an important finding, the current study indicated that a history of CPA
can contribute to a poor psychological outcome in adult life. Results showed
trauma-related symptomatology to be associated with either CPA or CSA.
This suggests that victimization through the use of violence may result in
numbed responsiveness, withdrawal, reexperience of traumatic events, and
other symptoms consonant with PTSD. Thus, psychological damage is likely
to be as severe among CPA victims as it is among CSA victims, resulting in
similar patterns of post-traumatic symptomatology for both groups. The Relationship Between Adult Psychological
Adjustment and Childhood Sexual Abuse, Childhood Physical Abuse, and Family-of-Origin Characteristics SHANE KAMSNER
MARITA P. MCCABE
A wide array of social, psychological, and somatic problems has been connected with
childhood sexual abuse (CSA). These problems include sleep disorders, eating disorders, selfmutilation, social withdrawal, antisocial behavior, sexual dysfunction, injured sense of self,
and disorders of attachment ( Bagley & Ramsay, 1985 ; Briere & Runtz, 1989 Browne &
Finkelhor, 1986 ; Cohen & Mannarino, 1988; Finkelhor, 1987 ; Herman, 1981; Roth &
Lebowitz, 1988; Young, 1992 ) . The consequences of undetected abuse compound the
immediate trauma in child victims and are associated with grave developmental outcomes
typically characterized by impaired capacities for trust, intimacy, and sexuality, and by a
variety of chronic mental health problems.
(Title: Variables in Delayed Disclosure of Childhood Sexual Abuse , By: Eli Somer,
Sharona Szwarcberg, American Journal of Orthopsychiatry, 0002-9432, July 1, 2001, Vol. 71,
Issue 3)
Using a definition of rape that includes forced vaginal,
oral, and anal sex, the National Violence AgainstWomen Survey found that
one of six U.S. women and one of 33 U.S. men has experienced an attempted or completed
rape as a child and/or adult (Tjaden&Thoennes, 1998).
(The Experience of Sexual Assault Findings From a Statewide Victim Needs Assessment,
LAURA M. MONROE, LINDA M. KINNEY, MARK D. WEIST, DENISE SPRIGGS
DAFEAMEKPOR, JOYCE DANTZLER, MATTHEW W. REYNOLDS, JOURNAL OF
INTERPERSONAL VIOLENCE, Vol. 20 No. 7, July 2005 767-776)
Sexual
assault is associated with psychological morbidity including depression,
posttraumatic stress disorder (PTSD), and anxiety (Ackerman, Newton,
McPherson, Jones, & Dykman, 1998; Boney-McCoy & Finkelhor, 1995;
Ellis, 1983; Roth & Lebowitz, 1988; Ullman & Filipas, 2001). Long-term
effects of child sexual abuse include suicidal behavior, personality disturbances,
substance abuse, eating disorders, and revictimization (Brier &
Runtz, 1987; Chandy, Blum, & Resnick, 1996; Dube et al., 2001; McCauley
et al., 1997; Wonderlich et al., 2001).
(The Experience of Sexual Assault Findings From a Statewide Victim Needs Assessment,
LAURA M. MONROE, LINDA M. KINNEY, MARK D. WEIST, DENISE SPRIGGS
DAFEAMEKPOR, JOYCE DANTZLER, MATTHEW W. REYNOLDS, JOURNAL OF
INTERPERSONAL VIOLENCE, Vol. 20 No. 7, July 2005 767-776)
Posledice
CHILDHOOD SEXUAL ABUSE is readily understood
to be a traumatic event both at time of
occurrence and for years subsequent to the
actual abuse.
Specifically,
a history of childhood sexual abuse has been
associated with consequent mood alteration such
as depression and anxiety; hindered or impaired
cognitive functioning; negative self-evaluation;
difficulty in trusting others/interpersonal relationships;
and behavioral difficulties such as
substance abuse, suicidality, self-harm, delinquent
activity and learning disabilities (American
Psychiatric Association, 1994; Beitchman,
Zucker, Hood, daCosta, & Akman, 1991; Briere
& Elliott, 1994; Browne & Finkelhor, 1986;
Gomes-Schwartz, Horowitz, & Cardarelli, 1990;
Green, 1993; Kluft, 1990; Trickett & Putnam,
1993).
Some research reports that exposure
to traumatic events such as sexual abuse in
childhood, is associated with the leading causes
of death in adulthood, including heart disease,
cancer, chronic lung disease, skeletal fractures
and liver disease (Felitti, Anda, Nordenberg,
Williamson, Spitz, Edwards, Koss, & Marks,
1998).
Literature thus far indicates that individuals
with histories of childhood sexual abuse also
report using health services at significantly
higher rates than non-sexually abused individuals
(Arnow, Hart, Scott, Dea, O’Connell, &
Taylor, 1999; Leserman, Li, Drossman, & Hu,
1998; Walker, Gelfand, Katon, Koss, Von-Korff,
Bernstein, & Russo, 1999).
Physical sequelae to childhood
sexual abuse
Different types of physical conditions appear to
be particularly common in individuals with
histories of childhood sexual abuse. Review of
the literature indicates that documented
physical sequelae to childhood sexual abuse can
be broken down into at least three categories,
including gastrointestinal and gynecological
problems, obesity and somatic complaints.
Gastrointestinal and gynecological problems
A number of studies identify a relationship
between childhood sexual abuse and the
presence of either or both gastrointestinal disorders
and gynecologic problems. Drossman,
Leserman, Nachman, Zhiming, Gluck, Toomey,
and Mitchell (1990) studied female gastroenterology
patients to identify prevalence of
sexual or physical abuse history. Patients with a
functional gastrointestinal disorder (e.g. irritable
bowel syndrome, non-ulcer dyspepsia,
chronic abdominal pain), chronic or recurrent
pelvic pain were more likely to have an abuse
history (Drossman et al., 1990; Drossman,
Talley, Leserman, Olden, & Barreiro, 1995;
Lechner, Vogel, Garcia-Shelton, Leichter, &
Steibel, 1993; Leserman, Drossman, Li, Toomey,
Nachman, & Glogau, 1996; Leserman, Li, Hu, &
Drossman, 1998; Walker, Katon, HarropGriffiths, Holm, Russo, & Hickok, 1988).
This finding is corroborated by studies solely examining
abuse effects, where irritable bowel syndrome
and dyspepsia have been associated with
sexual abuse history (Longstreth & WoldeTsadik, 1993; Tally, Boyce, & Jones, 1998; Talley,
Helgeson, & Zinsmeister, 1992).
Research also consistently supports a
relationship between gynecological disorders
and childhood sexual abuse. Samples from the
general population indicate a relationship
between childhood abuse (physical or sexual)
and ‘severe menstrual problems’ and urinary
tract infections (Plichta & Carmella, 1996).
Other gynecologic problems often
associated with sexual assault history include:
sexually transmitted diseases, pelvic inflammatory
disease, multiple yeast infections, premenstrual
syndrome, early hysterectomy, excessive
menstrual bleeding, genital burning, painful
intercourse, dysmenorrhea, menstrual irregularity,
lack of sexual pleasure and non-specific
gynecologic problems (Bachmann, Moeller, &
Benett, 1988; Golding, 1996).
Obesity Another line of research indicates a
relationship between childhood sexual abuse
and the physical conditions of obesity and
weight gain. This relationship is reported in
various medical patients (Felitti, 1991; Felitti et
al., 1998; Moeller, Bachmann, & Moeller, 1993;
Sansone, Sansone, & Fine, 1995); females
enrolled in weight loss programs (King, Clark, &
Pera, 1996); and in studies of both obese and
non-obese females (Wiederman, Sansone, &
Sansone, 1999). Regrettably, none of these
studies specifically sampled females with a
history of sexual abuse. While obesity may also
be secondary to events other than sexual abuse
(e.g. depression), research consistently supports
the sexual abuse–obesity relationship.
Somatic complaints Lastly, review of the
findings of physical health problems and childhood
sexual abuse would be incomplete without
mention of the more broad-based category—
‘Somatic Complaints’. ‘Somatic Complaints’ is a
categorization of physical symptoms, including
any ‘physical complaints without known biological
cause’ (Briere, 1992) as opposed to a
symptom-related syndrome or disorder as in the
case of gastrointestinal and gynecological problems.
This category is typically used to indicate
an array of physical complaints often associated
with sexual abuse yet differentiated from gastrointestinal
and gynecological disorders, including:
headaches, sleep disturbance, anorexia,
asthma, shortness of breath, chronic muscle
tension, muscle spasms and elevated blood
pressure (Briere, 1992; Felitti, 1991; Lechner et
al., 1993).
Patients with a sexual abuse history report:
greater fatigue; more headaches; increased
back, breast and face pain; increased skin and
respiratory problems; increased shortness of
breath and choking sensations; decreased
appetite; decreased sleep; less satisfaction with
their overall health status; a greater number of
actual somatic symptoms; and increased engagement
in health risk behaviors versus non-abused
patients (Leserman, Li, Drossman, & Hu, 1998;
McCauley, Kern, Kolodner, Dill, Schroeder,
DeChant, Ryden, Derogatis, & Bass, 1997;
Moeller et al., 1993; Walker et al., 1988).
Sexual abuse has also been associated with
reports of poorer overall health; greater functional
limitation; increased chronic disease;
increased medically explained and medically
unexplained complaints; greater general sleep
problems and nightmares; and more pain and
muscular tension including headaches (Bendixen,
Muus & Schei, 1994; Briere & Runtz,
1987; Golding, 1994, 1999; Golding, Cooper, &
George, 1997; Lechner et al., 1993; Springs &
Friedrich, 1992). In some cases where controlled
for, this association remained regardless of individual
characteristics and level of depression
(Golding et al., 1997).
Zdravstvo
Research with HMO enrollees suggests
that females with a history of abuse spend
significantly more money on medical healthcare
costs than females without an abuse history,
even when mental health costs were controlled.
Furthermore, females with an abuse history
have been significantly more likely to use the
emergency room for treatment than females
with a history of physical abuse or neglect
(Arnow et al., 1999; Walker, Gelfand, Katon,
Koss, Von-Korff, Bernstein, & Russo, 1999).
Among general medical, gastrointestinal and
gynecological patients, patients with a history of
childhood abuse (sexual and physical) report
higher rates of hospitalization; more days in bed
due to disability; more doctor visits; and a
greater number of lifetime surgeries than nonabused
patients (Drossman et al., 1990, 1995; Felitti, 1991;
Leserman et al., 1996; Leserman,
Li, Drossman, & Hu, 1998; Leserman, Li, Hu, &
Drossman, 1998; Moeller et al., 1993).
In addition, data from samples more specific
to sexual abuse indicate a higher incidence of
medical healthcare in abused patients. Studies of
victims of adult sexual assault indicate that
females who experience sexual assault crimes
report significantly poorer general and mental
health, endorse more physical symptoms and
report more outpatient visits than did nonassaulted
females (Golding, Stein, Siegel,
Burnam, & Sorenson, 1988; Koss, Koss, &
Woodruf, 1991).
Leserman et al.’s (1996) study found that the
severity of sexual and physical abuse history
(injury during abuse, having multiple perpetrators,
being raped) explained adult health
status. Subsequently, Leserman, Li, Drossman
and Hu (1998) found that females with more
severe sexual abuse (penetration versus other
contact) reported more: physical symptoms,
functional disability and healthcare visits than
less severely abused or non-abused females.
Similarly, Leserman, Li, Hu and Drossman
(1998) found that level of severity, as defined by
the type of sexual contact (penetration versus
other contact), was the strongest predictor of
current health status in gastrointestinal patients
with childhood sexual abuse history.
In summary, a consistent relationship has
been found between history of childhood sexual
abuse and the presence of certain adult physical
problems. It appears that females with a history
of childhood sexual abuse are more likely: to
experience increased physical health problems,
including gastrointestinal and gynecological disorders,
obesity and miscellaneous somatic complaints;
to report decreased satisfaction with
overall physical health; and to require increased
health services utilization relative to non-abused females.
Nevropsihološke posledice
Several studies of maltreated individuals have
found significant dysregulation of the hypothalamicpituitary-adrenal (HPA) axis, most
prominently increased cortisol levels, ACTHblunting
to corticotrophin releasing hormone
and flattening of the normal circadian rhythm
for cortisol (DeBellis, Baum, Birmaher, Heshaven,
Eccard, Boring, Jenkins, & Ryan, 1999;
DeBellis, Chrousos, Dorn, Burke, Helmers,
Kling, Trickett, & Putnam, 1994; Gunnar,
Morrison, Chisholm, & Schuder, 2001; Kaufman,
Birmaher, Perel, Dahl, Moreci, Nelson,
Wells, & Ryan, 1997). Heightened sympathetic
nervous system activity manifested by increased
24-hour urinary catecholamines has been noted
in two samples of traumatized children (DeBellis, Baum, Birmaher, Heshaven, Eccard,
Boring, Jenkins, & Ryan, 1999; DeBellis, Lefter,
Trickett, & Putnam, 1994).
There is also preliminary evidence for
immune system compromise in sexually abused
girls (De Bellis, Burke, Trickett, & Putnam,
1996).
Most recently, magnetic resonance imaging (MRI)
has identified structural abnormalities in the
brains of traumatized children that correlate
with post-traumatic stress disorder and dissociative
symptoms (DeBellis, Keshavan, Clark,
Casey, Giedd, Boring, Frustaci, & Ryan, 1999).
(The Long-term Physical Health and Healthcare Utilization of Women Who Were
Sexually Abused as Children, JOURNAL OF HEALTH PSYCHOLOGY 7(5))
Negative environmental factors such as family conflict and stress can contribute
to the development of psychopathology in insecurely attached individuals,
whereas securely attached individuals who experience stress fail to develop
psychopathology or pedophilia (Finkelhor, 1990; Lewis, Feiring, McGuffog, &
Jaskir, 1984; Rind et al., 1998). From this perspective, an individual can develop a
vulnerability to environmental problems depending on the nature of their early
attachment experiences. Disturbances in the developmental continuity of attachment
may limit an adult’s ability to have their needs met appropriately, regulate
their emotional well-being, respond empathically to the needs of others, and seek
assistance to ameliorate abusive behaviours. The above personal characteristics
have been found to be lacking in individuals who sexually abuse children (Pithers,
Kashima, Cummings, Beal, & Buell, 1988).
Early deviant sexual experiences may serve as a template for later deviant sexual
behaviours, and inconsistent caregiving serves to undermine the security of
attachment; all this contributes to disturbances in an individual’s ability to form
intimate relationships (Hudson&Ward, 1997; Marshall, 1989). An adult who has
not developed a secure attachment system may construe early abusive sexual
experiences as enticing because they represent a form of intimacy regardless of
their deviant nature. Consequently, males who have not experienced secure
attachment may be vulnerable to placating intimacy needs by engaging in
pedophilic behaviour(Ward, Hudson,&Marshall, 1996), particularly when interpersonal
stressors such as relationship dissolution, rejection, and separation
threaten their intimacy needs (Marshall, 1989). In contrast, those who have developed
a secure attachment in childhood may be more resilient to interpersonal
trauma and intimacy problems (Masten & O’Connor, 1989). A securely attached
sexual abuse victim may not become a child sexual abuser because resilience in
the form of secure attachment may contribute to an individual’s ability to deal
with relationships and stressors.
The victims and the pedophiles came from similar, self-reported, abusive
backgrounds (see Table 3) but the results of this study indicated that the controls
and victims were both more securely attached than the pedophiles, who were
found to be insecurely attached on two constructs, namely, high on Relationships
as Secondary and lowon Confidence (lowsecure attachment). The finding for the
controls and pedophiles is in line with the research of Ward et al. (1996). Currently,
there are no published results relating to the quality of attachment for male
nonoffending victims of sexual abuse. The findings reported here provide some
support for the ASQ as a measure of attachment and as a clinical tool to measure
differences in attachment style.
These results support the notion that an insecure
attachment style may make a man vulnerable to developing pedophilic behaviours.
Conversely, those men with a secure attachment style are more resilient to
participating in pedophilic behaviour, even if they have experienced neglect
and/or abuse as children.
The current findings are consistent with the suggestion (Hudson & Ward,
1997) that insecure attachment represents a vulnerability with intimate relationships.
It isworth considering, however, that there are likely to be individual differences
between insecure styles of attachment, and these variations may not be congruent
with specific offending behavior. This has implications for treatment, as
attachment style may provide a better basis for understanding the psychological
processes associated with offenders and victims rather than categories of
psychopathology and criminality.
These findings may be underscored by the finding that both
groups experienced significant childhood victimisation, with 64% of pedophiles
and 68% of victims reporting a “severely stressful” childhood. In contrast, controls
indicated that they had not experienced childhood sexual activity with an
adult and none reported that their childhood was “severely stressful.”
Both victims and pedophiles reported that prior to the age of 14 they had
engaged “very often” in sexual activity with an adult (43% and 43%, respectively).
This finding may bring into question the contribution of sexual abuse as a
discrete factor in the development of pedophilic behavior (Finkelhor, 1986,
1990). Pedophiles reported more sexual abuse experiences with a relative (82%)
in comparison with victims (37%). This “stranger” factor is thought to mitigate
against the adverse effects of sexual abuse (Briggs & Hawkins, 1996; Finklehor,
1990). In this study, both the controls and victims were found to have secure
attachments, even though the pedophiles and the nonoffending victims had experienced
similar levels of neglect and abuse.
“children with sexual behavior problems”
Further support of the relationship between childhood
sexual abuse and SBP is found in the work of
Johnson (1988, 1989). The relationship between sexual
victimization and demonstrating SBP may be
stronger in preschool-age children than in school-age
children for boys. In a study of 47 boys with SBP, Johnson
(1988) found that 72% of the 4- to 6-year-olds had
a history of being sexually abused, whereas 42% of the
7- to 10-year-olds and 35% of the 11- and 12-year-olds
had such a history. Girls with SBP may be more likely
to have a history of child sexual abuse than boys. In a
sample of 13 female children with SBP (ages 4 to 12
years), Johnson (1989) found that 100% of the children
had a history of child sexual abuse.
The intense and wide range of problems that
these young children exhibited was quite striking. In
addition to having a mean level of SBP at the 99th percentile
on the CSBI, the children had a complex array
of other behavior and emotional symptoms and experienced
multiple stressful events, including changes
in caregivers and home placements. As hypothesized,
on the PSI, the caregivers reported significant stress
associated with raising the children and during interviews
also reported distress specifically associated with
observing and responding to the sexual behaviors.
Furthermore,
the rate of depressive symptoms was quite
remarkable, with 6 children reaching full criteria for
MDD. Symptoms of depression and anxiety in childhood
are often overlapping and interrelated. The
relationship between internalizing symptoms and
SBP remains unclear. Furthermore, assessment and
diagnosis of PTSD in children is complicated by developmental
factors, social factors, and comorbid conditions
(March, 1999). Caregivers may not be aware of
the thoughts and internal reactions young children
are experiencing and thus have difficulty responding
to standard questions about PTSD symptoms. A subgroup
of these children demonstrated verbal delays,
which would further inhibit the identification of
internal distress. In addition, the avoidance symptoms
may be reduced in many of children who were
no longer living in the homes in which they experienced
the trauma.
Furthermore,
experiencing physical abuse may increase the
likelihood of demonstrating interpersonal SBP in
young children who have been sexually abused, perhaps
by the impact on feelings of anger and shame and
beliefs about use of control with others (Hall et al.,
1998). Another potentially critical factor that was not
assessed in the current study is child neglect. Childhood
neglect has been found to be associated with significant
behavior problems, including increased risk
of sex crimes as an adult (Widom & Ames, 1994).
Poor impulse-control skills, other aggressive
behaviors, and inaccurate perceptions of social stimuli
in some children with SBP further hinder social
relationships and cause problems at school (Araji,
1997; Friedrich & Luecke, 1988; Gil & Johnson, 1993;
Horton, 1996). In addition, poor boundaries and
indiscriminate friendliness often found in young children
with SBP may place them at increased risk of
being victimized. Raising children with SBP is often
stressful for the caregiver and may lead to dysfunctional
adult-child interactions and disruptions in the
child’s residential placement. Indeed, in the present
study, caregivers reported stress associated with raising
these young children with SBP, and many of the
children had already experienced changes in their
residential placements.
In particular,
parents of asymptomatic sexually abused
children express concerns about whether their
children need to get out their feelings to prevent
future difficulties or that their children will
grow up to be molesters themselves.
Mannarino, A. P., Cohen, J. A., Smith, J. A., & MooreMotily, S. (1991). Six and twelve-month follow-up of
sexually abused girls. Journal of Interpersonal Violence, 6,
494-511.
Animportant issue with regard to this topic is
whether existing assessment measures are adequately
detecting all of the psychological problems
that sexually abused children may exhibit.
Some examples are Friedrich’s Child
Sexual Behavior Inventory and Briere’s Trauma
Symptom Checklist for Children, which assess
abuse-related sequelae, and Mannarino and
Cohen’s Children’s Attributions and Perceptions
Scale, which measures cognitive variables
that are correlated with psychological symptomatology.
One study (Mannarino,
Cohen, Smith, & Moore-Motily, 1991) found
during a 1-year follow-up that sexually abused
girls who had been subjected to intercourse had
significantly more emotional and behavioral
symptoms than thosewhohad experienced fondling
only. This finding suggests that there may
be a sleeper effect related to the type of sexual
abuse that manifests itself over time. Unfortunately,
the length of the follow-up in this study
was relatively brief and may not have been adequate
to assess more long-term problems.
It should be noted that although the child
maltreatment field has come a long way in
terms of the development of more sophisticated
assessment measures that tap abuse-related
sequelae, we still know very little about
whether traumatic experiences cause subtle
vulnerabilities in children that do not reach the
level of symptoms but which, in combination
with other factors, may have an adverse impact
in later developmental periods.
Despite this lack of empirical data, many clinicians
provide short-term interventions for
asymptomatic sexually abused children,
including body awareness training and safety
education. In addition, some sessions with par192 TRAUMA, VIOLENCE, & ABUSE / April 2000
ents of asymptomatic children can be invaluable
in terms of normalizing common parental reactions
to disclosure, providing reassurance, and
discussing what potential problems parents can
be looking out for in the future.
The extensive literature on the sequelae of rape
provides a wealth of evidence that the experience of rape often leads to frank sexual
dysfunction as well as general intimacy dif. culties in the victims (e.g. Becker et al.,
1986; Feldman-Summers et al., 1979). Loss of libido, anorgasmia and sexual
aversions and phobias are common among the sexual effects. There is an extensive
literature which shows that sexual abuse in childhood can have serious negative
consequences for a person’s later sexual functioning (e.g. Courtois, 1979; Finkelhor,
1990; Jehu, 1988). Further, there is strong evidence that those who have been
sexually tortured (e.g. forced penetration with objects; infliction of pain on the
genital organs) can develop sexual dysfunction (e.g. Lunde & Ortmann, 1990).
Further, there is strong evidence that those who have been
sexually tortured (e.g. forced penetration with objects; in• iction of pain on the
genital organs) can develop sexual dysfunction (e.g. Lunde & Ortmann, 1990).
Recent research has implicated emotional abuse as a strong, possibly stronger,
predictor than physical
abuse of internalizing disorders, externalizing disorders, social impairment, low selfesteem, suicidal
behavior, psychiatric diagnoses, psychiatric hospitalizations, and long-term
psychological functioning
(Kaplan et al., 1999; McGee, Wolfe, & Wilson, 1997; Mullen, Martin, Anderson,
Romans, & Herbison,
1996; Vissing, Straus, Gelles, & Harrop, 1991).
Emotional Abuse in Children: Variations in Legal Definitions and Rates Across the United
States
Stephanie Hamarman, New Jersey Medical School, Kayla H. Pope, American Academy of Child and Adolescent Psychiatry
Sally J. Czaja, New Jersey Medical School
CHILDMALTREATMENT,Vol. 7, No. 4, November 2002 303-311
DOI: 10.1177/107755902237261
Women in the study who had been
raped were more likely to experience posttraumatic stress disorder, major
depression, attempted suicide, and drug and alcohol problems than were
women who had not been victims of violent crimes. Other studies have
shown that women who have been raped also report more physical problems,
such as chronic pelvic pain, gastrointestinal disorders, headaches, general
pain, psychogenic seizures, and premenstrual symptoms (Koss &
Heslet, 1992). (Women’s Responses to Sexual Violence by Male Intimates
Claire Burke Draucker Phyllis Noerager Stern Western Journal of Nursing Research, 2000, 22(4), 385-406)
Survivors of childhood sexual abuse are more likely to experience a variety
of trauma symptoms in adulthood than adults who have not experienced
childhood sexual abuse (reviewed in Beitchman et al., 1992; Polusny &
Follette, 1995). These symptoms include depression (Pribor & Dinwiddie,
1992), suicidality (Saunders, Villeponteaux, Lipovsky, & Kilpatrick 1992),
anxiety disorders (Pribor & Dinwiddie, 1992), dissociative experiences
(Briere & Runtz, 1987), sexual problems (Davis, Petretic-Jackson, & Ting,
2001), relationship problems (Davis et al., 2001), problems with sleep
(Briere&Runtz, 1987), and borderline personality disorder (Herman, Perry,
& van der Kolk, 1989). (Recent Stressful Life Events,Sexual Revictimization, and Their
Relationship With Traumatic Stress Symptoms Among Women Sexually Abused in ChildhoodCATHERINE CLASSEN
RUTH NEVO,CHERYL KOOPMAN,KIRSTEN NEVILL-MANNING,CHERYL GORE-FELTON
DEBORAH S. ROSE,DAVID SPIEGEL
JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 17 No. 12, December 2002 1274-1290)
Approximately one in four women are raped in their adult
lifetime, which causes severe psychological distress and long-term physical health
problems. The impact of sexual assault extends far beyond rape survivors as their
family, friends, and significant others are also negatively affected. Moreover, those
who help rape victims, such as rape victim advocates, therapists, as well as sexual
assault researchers, can experience vicarious trauma. Future research and advocacy
should focus on improving the community response to rape and the prevention of
sexual assault. (Understanding Rape and Sexual Assault 20 Years of Progress and Future Directions
REBECCA CAMPBELL,SHARON M. WASCO
JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 20 No. 1, January 2005 127-131)
From that founding research on the prevalence of rape, other researchers
began to document the widespread deleterious effects that sexual assault has
on women’s lives.Within the past 20 years, we have learned that the mental
health effects of this crime are devastating as rape survivors are the largest
group of persons with post-traumatic stress disorder (PTSD; Foa &
Rothbaum, 1998). The inclusion of PTSD into the Diagnostic and Statistical
Manual of Mental Disorders (DSM) in 1980was a major conceptual development
in the study of trauma associated with sexual violence. Although this
framework may be limited in its ability to capture fully the nature of sexual
assault (see Wasco, 2003), it has spawned a proliferation of research documenting
the psychological injury caused by rape. Beyond this focus on psychological
impact, emerging research suggests that rape survivors experience
more acute and chronic physical health problems than do women who
are not victimized (Golding, 1994; Koss, Koss, & Woodruff, 1991). Sexual
assault also affects women’s sexual health risk-taking behaviors and places
some at greater risk for contracting HIV (Campbell, Sefl,&Ahrens, 2004).
(Understanding Rape and Sexual Assault 20 Years of Progress and Future Directions
REBECCA CAMPBELL,SHARON M. WASCO
JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 20 No. 1, January 2005 127-131)
Establishing appropriate role boundaries
with sexually abused children and their families
is a challenging ethical issue for all practicing
clinicians who provide services to this population.
This can best be accomplished prior to any
clinical contact with a family. For example, a
parent may call with concerns that his or her
child has been sexually abused and about possible
associated behaviors/symptoms such as
sexually inappropriate behaviors, separation
anxiety, or sleep problems. This parent may
want to know whether the child has been
abused, how to deal with visitation and custody
issues, and also how to deal with the presenting
behavioral difficulties. (TREATING SEXUALLY ABUSED
CHILDREN AND THEIR FAMILIES
Identifying and Avoiding Professional Role Conflicts
ANTHONY P. MANNARINO,JUDITH A. COHEN
TRAUMA, VIOLENCE, & ABUSE, Vol. 2, No. 4, October 2001 331-342)
Women who have been raped experience
a range of cognitive, emotional, and behavioral symptoms. They are more
likely to meet the diagnostic criteria for a number of mental disorders than
women who have not experienced violence, including posttraumatic stress
disorder, anxiety disorders, depression, and drug and alcohol abuse (Burnam
et al., 1988; Kilpatrick et al., 1985; Winfield, George, Swartz, & Blazer,
1990). Victims of a sexual assault also are at increased risk for suicide
attempts (Bridgeland, Duane, & Stewart, 2001; Kilpatrick et al., 1985). In
addition to acute medical symptoms (Resnick, Acierno, Holmes, Dammeyer,
& Kilpatrick, 2000), victimization also can affect long-term health and sexual
functioning (Becker, Skinner, Abel, & Treacy, 1982; Ellis, Calhoun, &
Atkeson, 1980; Golding, 1994; Koss, Koss, & Woodruff, 1991). Rape can
shatter awoman’s feelings of safety and security, leaving her feeling vulnerable
and helpless (Janoff-Bulman, 1985). The woman may find herself in a
state of disequilibrium and struggle to come to terms with her victimization,
to define her experience, and to reconstruct her beliefs about the world
(Janoff-Bulman, 1985; Lebowitz & Roth, 1994). (The Role of Sexual Victimization
in Women’s Perceptions of Others’ Sexual Interest,PATRICIA L. N. DONAT,BARRIE BONDURANT
JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 18 No. 1, January 2003 50-64)
Women who have been sexually victimized through force or threat of
force differ from nonvictimized women when rating women’s target behavior.
Women who have been sexually victimized perceived less sexual interest
when rating women’s target behaviors than women who have not been victimized.
The lower ratings of sexual interest for women’s behaviors may be
the result of self-protective attributions by women who have been assaulted
and have experienced victim blame following their own sexual assault. In
addition, it may be that victimized women perceive a wider range of behaviors
as not indicating sexual interest. Thus, victimized women may not
believe that their behavior is communicating an interest in sexual activities
even when others would interpret the behavior in this manner. As a result,
sexually victimizedwomen may underestimate the sexual connotativeness of
their behavior. (The Role of Sexual Victimization
in Women’s Perceptions of Others’ Sexual Interest,PATRICIA L. N. DONAT,BARRIE BONDURANT
JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 18 No. 1, January 2003 50-64)
Women who have
experienced sexual aggression may be more alert for signs of sexual interest
so they can avoid unwanted sexual advances. Because sexually victimized
women report more experiences with having their sexual intent misperceived
(Abbey et al., 1996), they may be alert for potentialmisperceptions. Sexually
victimized women may view men’s behavior more sexually as a protective
measure. Women’s increased vigilance may be a way that victims assert
agency. Through increased awareness,women may feel better able to protect
themselves and to make decisions about their sexual safety. (The Role of Sexual Victimization
in Women’s Perceptions of Others’ Sexual Interest,PATRICIA L. N. DONAT,BARRIE BONDURANT
JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 18 No. 1, January 2003 50-64)
The finding that women who have been victimized through force or threat
of force are more vigilant appears to contradict the finding that victimization
increases the risk of future victimization. Although women who have been
victimized appear to be more vigilant of signs of men’s sexual interest, they
may not be able to effectively detect risk at a stage early enough in the interaction
to permit escape from a sexually aggressive man. Women who have
experienced repeated victimization did respond more slowly to sexually
threatening situations in an analogue study (Wilson et al., 1999) and also may
be slower to respond in circumstances that pose a danger of revictimization.
(The Role of Sexual Victimization
in Women’s Perceptions of Others’ Sexual Interest,PATRICIA L. N. DONAT,BARRIE BONDURANT
JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 18 No. 1, January 2003 50-64)
Past
research has found that, on average, victimized women have a history of a
greater number of sexual partners and sexual experiences (Himelein, Vogel,
&Wachowiak, 1994; Koss, 1985; Koss & Dinero, 1989). Generalizing these
results, we might predict that victimized women with a history of sexual
experience may be better able to accurately recognize sexual interest in a
partner than women with little sexual experience. Indeed, in this study,
women who reported sexual victimization experiences also reported a greater
number of sexual partners. This finding of increased sexual activity, however,
may be a consequence of prior victimization (Koss & Cleveland, 1997). In
addition, increased sexual activity may place a woman at greater risk for
encountering a sexually aggressive man. This finding is compatible with
other research that has found that sexually conservative women (Himelein,
1995) and women who regularly attend religious services (Mynatt&Allgeier,
1990) are less likely to be sexually victimized. In Himelein’s study, sexually
conservative women also scored higher on scales assessing adversarial sexual
beliefs and acceptance of rape myths. In addition, these women reported
fewer consensual sexual experiences and less assertiveness. Thus, it may be
that sexual conservativism reduces women’s risk through their greater wariness
and mistrust of men’s sexual motives and through their decreased
involvement in sexual activity.
(The Role of Sexual Victimization
in Women’s Perceptions of Others’ Sexual Interest,PATRICIA L. N. DONAT,BARRIE BONDURANT
JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 18 No. 1, January 2003 50-64)
Depression is the symptom most commonly
reported by adult survivors of CSA (Beitchman et al., 1992; Browne
&Finkelhor, 1986; Polusny&Follette, 1995). Indeed, numerous studies find
a relationship between CSA and depression or depressive symptoms (Braver,
Bumberry, Green, & Rawson, 1992; Briere & Runtz, 1988; Hunter, 1991;
Jackson, Calhoun, Amick, Maddever, & Habif, 1990; Roland, Zelhart, &
Dubes, 1989;Yama, Tovey,&Fogas, 1993).A majority of investigations also
report a higher prevalence of major depressive disorder among sexually
abused than nonabused participants (Polusny & Follette, 1995).
CSA survivors
also report chronic and recurrent depression during adulthood
(Andrews, 1995) and longer depressive episodes in comparison to nonabused
participants (Zlotnick, Mattia,&Zimmerman, 2001). Thus, the accumulated
evidence points to depression and depressive symptoms as significant
long-term correlates of CSA.
Researchers have commonly conceptualized CSA as a major risk factor for the development of
depression and other difficulties in adulthood (Briere, 1992; Browne &
Finkelhor, 1986; Polusny & Follette, 1995).
Given these difficulties, it is not surprising that adult CSA survivors also
frequently report social isolation (Harter, Alexander, & Neimeyer, 1988),
poor social adjustment (Follette, Alexander, & Follette, 1991; Harter et al.,
1988; Jackson et al., 1990), and considerable distress and dissatisfaction in
their relationships (e.g., Briere, 1988; DiLillo& Long, 1999; Feinauer et al.,
1996; Herman, 1992; Hunter, 1991). CSA survivors report difficulties in
forming trusting, intimate relationships (Gorcey, Santiago,&McCall-Perez,
1986; Mullen, Martin, Anderson, Romans, &Herbison, 1994), being distant
and controlling in relationships (Whiffen et al., 2000), and avoiding the
development of close adult relationships due to fears of rejection (Alexander,
1993).
Thus, the first generation of research has shown that
CSA is a risk factor for various forms of emotional
distress, particularly depression, anxiety,
PTSD, and dissociation. Having documented
this association, researchers have moved onto a
second generation of research, the aim of which
is to understand the causal mechanisms
underlying this association; that is, why are
CSA survivors at risk for emotional distress?
Children who are sexually abused may be at
risk for feelings of shame and self-blame, especially
when the abuse was prolonged or when
the perpetrator or significant others blamed the
child for the abuse.
Individuals with a history ofCSAare likely to
abuse alcohol as adults; researchers conceptualize
alcohol use in this population as a form of
coping with the distress generated by the CSA
or as an attempt to self-medicate (Briere, 1988;
Ireland & Widom, 1994; Lindberg & Distad,
1985; Moeller, Bachmann, & Moeller, 1993).
History of childhood sexual abuse (CSA) has been linked to increased risk for long-term
consequences on the lives of survivors (e.g., Adams-Tucker, 1982;
Briere & Runtz, 1988; Brooks, 1983; Browne & Finkelhor, 1986; Peters, 1988; Spaccarelli,
1994; Trickett & Putnam, 1993). For example, CSA survivors are more likely to experience
symptoms related to posttraumatic stress disorder (PTSD), such as moments of increased
arousal and extreme affective reactivity, and alternatively, a general predisposition toward
numbing of responsiveness, and emotional experiencing (American Psychiatric Association
[APA], 1994). There has been considerable focus in recent years on developing therapeutic
interventions that target the cognitions and emotional experiences associated with traumatic
symptoms experienced by CSA survivors. Treatments of choice typically focus on helping
CSA survivors gain a greater sense of emotional stability around the traumatic episode
through a variety of interventions, such as support and corrective processing of the cognitions
around the event, imaginary or actual exposure (with the goal of increased habituation or
decreased anxiety), and stress management, among others (e.g., Deblinger, McLeer, & Henry,
1990; Foa et al., 1999; Rothbaum, Meadows, Resick, & Foy, 2000). Although there is a
growing consensus by scholars and practitioners in the identification and treatment of PTSD
symptoms in cases of CSA, until lately, little attention had been given to investigating
emotional coherence among this group. Specifically, there is an imperative need for further
research to clarify how physiological, experiential, and expressive response domains in
emotional experiencing (e.g., Ekman, 1992; Levenson, 1994) may inform psychological
functioning and response
to treatment.
Womenwho are exposed to childhood sexual abuse (CSA)may experience a number of
negative outcomes, some of which are evident in high rates of CSA histories in women
accessing inpatient and outpatient psychiatric services (Goodman, Rosenberg, Mueser, &
Drake, 1997; Mitchell, Grindel, & Laurenzano, 1996; Read, 1997). In terms of general
measures of psychological disturbance, psychiatric patients who have experienced abuse are
symptomatic and receive psychiatric care at an earlier age (Briere & Zaidi, 1989; DarvesBornoz, Lemperiere, Degiovanni, & Gaillard, 1995; Goff, Brotman, Kindlon, Waites, &
Amico, 1991; Read, 1998), experience more frequent/longer hospitalizations and more
frequent relapses (Darves- Bornoz et al., 1995; Goff et al., 1991; Read, 1998), and are more
likely to be prescribed psychotropic medications (Sansonnet-Hayden, Haley, Marriage, &
Fine, 1987). In addition, childhood abuse has been specifically linked to a number of clinical
problems in adulthood including suicidal ideation and attempts (Read, Agar, Barker-Collo,
Davies, & Moskowitz, 2001; Resnick & Newton, 1992); eating disorders and self-mutilation
(Briere&Runtz, 1989); addictive behaviors (Cameron, 1994); poor social adjustment,
depression, and anxiety (Briere & Runtz, 1989); low self-esteem (Jehu, 1989); somatization
(Gelinas, 1983); psychosis (Neria, Bromet, Sievers, Lavalle, & Fochtman, 2002; Read, Agar,
Argyle, & Aderhold, in press; Read &Argyle, 1999; Read, Perry,Moskowitz,&Connolly,
2001; Ross, Anderson, & Clark, 1994); and post-traumatic stress disorder (PTSD) (Kiser,
Heston, Millsap, & Pruitt, 1991). In light of the huge range of difficulties that have been
linked to CSA, it is apparent that there exist large, unexplained individual differences in the
presence and presentation of mental health problems following CSA.
Outcome assessment
Povezanost med spolno zlorabo in PTSD
For example, given the prevalence of CSA, abuse survivors may constitute the largest single
group of PTSD sufferers (Foa, Steketee, & Rothbaum, 1989). However, the proportion of
sexual abuse survivors developing clinical symptoms of PTSD is estimated at only 50%
(Kiser et al., 1991). In populations of sexual abuse survivors referred for psychiatric
examination, estimated prevalence of PTSD rises to 73% (O’Neil & Gupta, 1991). Thus,
although exposure to a traumatic stressor such as sexual abuse is by definition necessary in
the etiology of PTSD, the evidence suggests that experiencing sexual abuse is not sufficient to
cause PTSD symptomatology. There exist large unexplained individual differences in the
presence, severity, and persistence of PTSD symptomatology following abuse.
POSLEDICE TRAVME – FIZIČNA ZLORABA
Among the various types of child maltreatment, physical abuse has been studied
most frequently and is defined by the World Health Organization (1999) as “all forms
of physical ill-treatment . . . resulting in actual or potential harm to the child’s health,
survival, development or dignity in the context of a relationship of responsibility,
trust, or power” (p. 15). In addition to physical injuries, physical child abuse often
leads to serious cognitive and socioemotional problems, including cognitive
impairments and poor school performance (Eckenrode, Laird, & Doris, 1993),
aggression, impulsiveness (Dodge, Pettit, & Bates, 1997), poor peer relations,
delinquency, later substance abuse (e.g., Azar & Wolfe, 1998; Erickson & Egeland,
2002), and greater likelihood of continuing the cycle of abuse as a parent
POSLEDICE TRAVME – SMRT BLIŽNJEGA
Specifically, children and adolescents who have experienced the death of a
close relative are at greater risk for sleep problems, depressive symptoms,
isolation, school performance problems, and suicidality (Harris, 1991;
Lewinsohn, Rohde, & Seeley, 1996; Silverman & Worden, 1992; Valente,
Saunders, & Street, 1988; Weller, Weller, Fristad, & Bowes, 1991; Worden,
1996;Worden, Davies, & McCown, 1999). In addition, death of a loved one
during adolescence increases the risk of depression and suicidal behavior
during adulthood (Adams, Overholser, & Lehnert, 1994; Fikelstein, 1988;
Parker & Manicavasagar, 1986).
Familial loss research has focused primarily on the deaths of parents, with
relatively less attention being given to deaths of other close relatives and
friends. Only a few studies have examined adolescent bereavement after the death of a
close friend.
Unfortunately, the majority of bereavement
studies with adolescents have examined the effects of parental death,
with few investigating peer death. Among the studies that have examined
peer death, findings typically have been based on small community samples.
Bereavement reactions including shock, numbness, sadness,
anger, insomnia, survivor guilt, nightmares, loneliness, fear of own death,
substance abuse, suicidal ideation, and school problems have been associated
with the death of a peer during adolescence (McNeil, Silliman, & Swinhart,
1991; Sklar & Hartley, 1990; Ringler & Hayden, 2000).
POSLEDICE TRAVME – EMOCIONALNA ZLORABA
(1992)Herman stated that the main dialectic of emotional trauma is the conflict between the
need to deny unbearable experiences and the need to give testimony.
(Title: Variables in Delayed Disclosure of Childhood Sexual Abuse , By: Eli Somer,
Sharona Szwarcberg, American Journal of Orthopsychiatry, 0002-9432, July 1, 2001, Vol. 71,
Issue 3)
POSLEDICE TRAVME – MEDOSEBNI ODNOSI
If, as Finkelhor and Browne
(1985) suggested, early sexual trauma can profoundly “alter a child’s cognitive
and emotional orientation toward the world and cause trauma by distorting
the child’s self concept,world view, or affective capacities” (p. 531), then
there is reason to suspect thatCSAmay disrupt survivors’ long-term interpersonal
adjustment as well.
These theories suggest that one of the consequences of having been sexually
abused in childhood is the development of aberrant relationship models
that in turn lead to interpersonal difficulties.
More recently,
research has begun to examine the impact of childhood abuse within an interpersonal
context (Polusny&Follette, 1995). Although such studies typically focus on
subsequent adult social adjustment, parenting, sexual functioning, high risk sexual
behavior, and revictimization experiences, a limited number of studies (Ducharme,
Koverola & Battle, 1997; Roche, Runtz, & Hunter, 1999; Whiffen, Judd, & Aube,
1999) have investigated the partner relationships (e.g., intimacy functioning) of
childhood abuse survivors.
Interpersonal Functioning
Research suggests that survivors of childhood sexual abuse may experience
difficulties in a number of interpersonal relationship contexts. Such findings were
incorporated into recent theoretical models of the dynamics of child sexual abuse
and its long-term correlates (Briere, 1992; Cole & Putnam, 1992; Finkelhor &
Browne, 1985; Polusny&Follette, 1995;Westerlund, 1992). For example, Polusny
and Follette (1995) developed a theoretical model that highlights the function of
emotional avoidance (Hayes, 1987) in determining the long-term correlates of child
sexual abuse. This model suggests that individuals with histories of child sexual
abuse attempt to diminish negative thoughts, affective states, and memories of
abuse through various coping behaviors including dissociation, substance abuse,
casual sexual relationships, and avoidance of intimate relationships. Although
these behaviors are hypothesized to initially relieve pain by reducing or suppressing
intense emotional responses associated with abuse, their use may result in longterm
negative effects, such as feelings of social isolation, dissatisfaction with
relationships, sexual dysfunctions, and revictimization.
The few investigations that have examined the relationship between child
physical abuse and adult interpersonal relationships indicate that physically abused
children may be more aggressive (Alessandri, 1991; Kolko, 1992) or more interpersonally
sensitive than are nonabused children (Briere & Runtz, 1988; Bryer,
Nelson, Miller, & Drol, 1987; Chu & Dill, 1990).
Disturbances in
intimacy and inability to trust also arise and in turn cause, and contribute to,
relationship difficulties.
This is partly a secondary effect of frank sexual
dysfunction, and partly the result of other trauma-induced factors such as irritability,
inability to trust, fear of getting close to someone, etc. This lack of sexual interest or reduced
ability to function, however, further erodes the man’s already impaired self-con. dence and
sense of masculinity. Many get confused, leading to confusion in the wife, too.
Traumatic experiences can lead to various changes in the emotional relationship of the couple,
with factors such as over-protectiveness, holding back, impaired trust, guilt, feelings of being
let down and of letting the partner down, fears for the future, over-sensitivity and fear of
rejection coming into
play (see Matsakis, 1998).
Young adults who were victims of childhood bullying have also been found to be
more introverted than nonvictims (Swain, 1996), which may play a role in their
heightened experience of loneliness. This loneliness is also reflected in the results
found by Gilmartin (1987) in his study of “love shy” adult men (persons whose
shyness with the opposite sex leaves them unable to date or marry)
Maltreatment by Parents and Peers: The Relationship Between Child Abuse,
Bully Victimization, and Psychological Distress, Renae D. Duncan, Murray State University
CHILD MALTREATMENT, Vol. 4, No. 1, February 1999 45-55
CSA is thought to have a negative impact on
interpersonal relations because it occurs in the
context of an interpersonal relationship, typically
one where a degree of safety and trust has
developed. Thus, the experience of CSA may
impede the development of trusting relationships
subsequently, particularly with romantic
partners. Furthermore, the experience of CSA
may compromise the development of a positive
sense of the self, which will inherently influence
social relationships (Cole & Putnam, 1992).
Abstract: Traumatic events can have a major impact on attachment behavior and interpersonal
relationships. In addition to the detrimental effects of post-trauma symptomatology, the traumatic
experience can become embedded in the memory structure of the individual causing a progressive
avoidance of interpersonal triggers. The traumatic experience may also have detrimental effects on
self-awareness, intimacy, sexuality and communication all of which are key elements to the
maintenance of healthy interpersonal relationships. Investigations into the effect of PTSD on
interpersonal relationships should focus on a longitudinal model of attachment. Pre-traumatic coping
mechanisms may be altered by the traumatic experience, and the relationship between pre-traumatic,
epi-traumatic and post-traumatic attachments should be addressed.
The impact of a major stressor on an individual’s relationships needs to be
considered from a longitudinal perspective. There are three windows during which
attachment patterns need to be considered when analysing the impact of disasters on
relationships: pre-traumatic, epi-traumatic and post-traumatic. Every individual has
a mode of dealing with relationships which will pre date their traumatic exposure
and is indicative of developmental experiences. Ultimately, changes that traumatic
events bring will be superimposed on these pre-traumatic ways of managing
relationships.
Particularly in those who develop post-traumatic stream disorder (PTSD) the
emerging symptoms come to have a highly detrimental effect on their personal
relationships. If the individual has developed PTSD con• ict at these times will spark
the irritability which is one of the most disruptive symptoms in terms of family
relationships. In this regard, embedded in the relationship can be a frequent
re-enactment of the fears of a recurrence of the trauma compounded by the
individual’s irritability. Paradoxically, the detrimental effects of this pattern of
reaction can be further exacerbated by the numbing and attachment disruption
which are also recognized as part of the symptomatology of PTSD. The numbing is
often experienced by individuals as a loss of a sense of empathy and as hardening.
Thus, while at one level the individual will be behaving in an increasingly agitated
and anxious way, at other times this will be mirrored by a state of apparent
detachment and affectlessness. The effects of this increasing con• ict on the family
will become reinforced because of the individual’s progressive loss of social contact
and decreasing social circle. Often these external relationships serve to mitigate
against the disruptions caused by post-traumatic consequences so that, if they are
lost, it further compounds the disruption of the homeostasis within the family.
In this way, traumatic memories have the capacity to disrupt attachments and
lead to the progressive distancing and avoidance of the interpersonal triggers that are
the stimulus for the traumatic re-enactments. If some element of the traumatic event
has involved being let down by a colleague, this can similarly evoke the involvement
of issues of trust in the traumatic memory structure. Moments of dependence and
reliance on a partner can become in. ltrated and similarly corrupted by these
experiences. Following disasters it is recognized that there is an increased incidence
of domestic violence and the abuse of children (Goenjian, 1993). This is a practical
demonstration of the capacity for these events to have signi. cant detrimental effects
on the lives of those exposed.
The rami. cations of trauma extend through the family and can have
multi-generational effects (Forman & Havas, 1990; Yehuda et al., 1998) through the
way in which trauma ruptures attachment bonds (Lifton, 1983; Allen & Bloom,
1994). Although clinical experience attests to this view, it is surprising to . nd that
few research studies have directly examined the impact of trauma on intimacy and
sexuality. Although scant, the research literature supports the notion that trauma
markedly affects relations with partners. Studies of war veterans report that they
have serious dif. culties maintaining intimate relationships and a high degree of
negative emotionality directed at spouses (Escobar et al., 1983; Carroll et al., 1985;
Jordan et al., 1992; Solomon et al., 1987; Johnson et al., 1996; Riggs et al., 1998).
Similar, . ndings are reported in studies of people who develop PTSD following
motor vehicle accidents (Blanchard et al., 1995).
POSLEDICE TRAVME – MEDOSEBNI ODNOSI - INTIMNOST
Two characteristic features of PTSD speci. cally damage intimacy. These are
avoidance and hyperarousal (criteria C and D in DSM-IV). Avoidance includes:
· markedly diminished interest or participation in signi. cant activities;
· feelings of detachment or estrangement from others;
· restricted range of affect;
· sense of a foreshortened future.
All of these features of avoidance are the results of loss of intrapsychic intimacy
and will inhibit recovery through interpersonal intimacy. Hyperarousal damages
intimacy because of increased irritability and outbursts of anger.
Intimacy
There are two broad categories of intimacy.
Intrapsychic intimacy (Sheehan, 1994) is the result of an individual achieving
adequate self-knowledge and self-acceptance which in turn foster the willingness to
share these thoughts and feelings with another. It measures the extent to which an
individual knows himself or herself and will undoubtedly in• uence the degree of
impact of a traumatic event. Resilience and vulnerability can be seen as aspects of
intrapsychic intimacy. Intrapsychic intimacy represents the capacity to develop
intimate relationships with others.
Interpersonal intimacy is seen as the result of interaction and can occur only
between people who share something meaningful with each other. It will predictably
POSLEDICE TRAVME – NAVEZANOST
Ward, Hudson in McCormack so opisali tri različne stile navezanosti in predstavili hipoteze ki
vodijo do pomanjkanja intimnosti v odraslem obdobju.
Zaskrbljen stil opisujejo kot negativni pogled samega sebe in pozitiven na druge. Pri omenjeni
navezanosti bo pri posamezniku moč opaziti visoko stopnjo osamljenosti ter spolno
zaskrbljenost. Pri navezanosti strahu ima posameznik negativen pogled nase in na druge. Pri
njem bo prisotna želja po socialnem stiku in intimnosti kot tudi strah pred zavrnitvijo ki ga
vodi v izogibanje bližini in odnosom. Zadnji stil, odpuščujoč vsebuje pozitiven pogled nase in
negativen na druge. V varno navezanost lahko uvrstimo nenasilni in nespolni napad ki
vključuje pozitiven poged nase in druge.
Terapevt bo v terapevtski obravnavi spodbudil klienta da sprejme odgovornost ter se
osredotočil na žrtev in pri tem skušal povečati samozavest.
Early experiences with a traumatizing caregiver are well known to impact negatively the
child’s attachment security, stress coping strategies, and sense of self (Crittenden and
Ainsworth, 1989; Erickson, Egeland, and Pianta, 1989). (Advances in Neuropsychoanalysis,
Attachment Theory, and Trauma Research: Implications for Self Psychology, ALLAN
N. SCHORE, PH.D.)
With increasing interest in adult attachment, researchers began to develop and
examine various models of adult attachment styles (Bartholomew, 1990; Hazan &
Shaver, 1987; Main et al., 1985). Hazan and Shaver (1987) fashioned their model
of adult attachment in romantic relationships on Ainsworth’s childhood attachment
styles of “secure,” “avoidant,” and “ambivalent.” Main and colleagues developed
a model of adult attachment that described four categories of attachment style
including “secure-autonomous,” “dismissing,” “preoccupied,” and “unresolveddisorganized”
(Main et al., 1985).
Bartholomew has proposed a four-category model of attachment that empirically
validates Bowlby’s theory of internalworking models of self and other among
adults (Bartholomew & Horowitz, 1991). The self model and the other model can
each be viewed as either positive or negative. Bartholomew’s attachment measure,
the Relationship Scales Questionnaire (RSQ), allows for the measurement of the
four attachment categories, as well as the two continuous underlying attachment
poles, view of self and view of other. The four attachment categories include the
secure pattern, which reflects a positive self and other model. Someone with a
secure attachment pattern has an integrated sense of self-worth and is comfortable
forming intimate relationships. The preoccupied pattern reflects a negative
self and a positive other model. A preoccupied person seeks a sense of safety by
gaining the acceptance and approval of others. The dismissing pattern reflects a
positive self and a negative other model. Someone with a dismissing attachment
style dismisses dependency needs and emphasizes independence as a means of
maintaining positive self-regard. The fearful pattern reflects a negative self and
a negative other model. Fearful individuals avoid intimacy to avoid the pain of
rejection or loss.
Attachment theorists (Bartholomew & Horowitz, 1991;
Bowlby, 1980) postulate that insecure attachments result from interactions that
cause individuals to doubt the trustworthiness, responsivity, and accessability of
others, and to question the integrity of the self. Similarly, PTSD comprises feelings
of distrust of others, and reflects a state of anxious apprehension that impedes
an individual’s ability to have satisfying interpersonal relationships (Stewart,
1996).
Another reason to suggest a link between attachment style and posttraumatic
stress symptomatology is that both are related to problems of affect regulation.
Alexander (1992) asserted that, in infancy, individuals develop specific affect regulation
strategies as a result of interactions with their primary caregivers. These
strategies represent the infant’s attempts to cope with anxieties arising from their
initial attachment relationships, and these coping strategies subsequently continue
into adulthood. Because PTSD can be conceptualized as a disorder of affect regulation
that results from an inability to cope with a stressful event, it is plausible that
certain attachment styles may create a vulnerability for the development of PTSD,
whereas others may act as a protective factor to guard against the development of
PTSD. As such, Alexander (1992) predicted that individuals who have a fearful
attachment style will be most at risk for the development of the more profound
disorders of affect, including PTSD.
Some empirical investigations have been conducted examining the relationship
between attachment and posttraumatic stress symptomatology (Alexander
et al., 1998; Mikulincer, Florian, &Weller, 1993). Results of these studies suggest
that individuals who possess an insecure attachment style endorse more symptoms
of posttraumatic stress than individuals with secure attachments.
REZULTATI:
This study examined the relationship between adult attachment style and
posttraumatic stress symptoms among high-risk adults who reported experiencing
childhood abuse. Results indicated that 76% of individuals in this sample had
an insecure attachment style. This finding is consistent with studies suggesting
that an abused population is more likely to have insecure attachments (Alexander
et al., 1998).
According to attachment theory (Bowlby, 1969), experiences
in close relationships can profoundly influence
perceptions of the social world. In particular, individual
differences in attachment quality have been proposed as an
important moderator of the extent to which attachmentrelated information is attended to and processed (e.g.,
Fraley, Garner, & Shaver, 2000; Main, Kaplan, & Cassidy,
1985). Avoidant individuals, who are uncomfortable
with closeness and intimacy, are theorized to limit the
processing of potentially distressing information, with
the goal of preventing activation of the attachment system
(e.g., Edelstein & Shaver, 2004; Fraley, Davis, &
Shaver, 1998). Anxious individuals, on the other hand,
who are preoccupied with relationship partners and
attachment-related concerns, are theorized to be hypervigilant
to information that could result in attachmentsystem
activation (e.g., Cassidy, 1994, 2000).
Findings from the few studies of attachment-related
differences in attention and memory are consistent with
these theoretical ideas, suggesting that avoidant compared
to nonavoidant individuals are less attentive to
material with emotional, attachment-related themes
(e.g., pictures depicting close relationships; Kirsh &
Cassidy, 1997; Main et al., 1985) and, perhaps as a result,
have greater difficulty recalling such material (Edelstein,
2005; Fraley et al., 2000; Mikulincer & Orbach, 1995). In
addition, although evidence is somewhat mixed, anxious
individuals appear to be particularly vigilant to
emotional, attachment-related information (e.g.,
Mikulincer, Gillath,&Shaver, 2002), which may enhance
later recall (Mikulincer & Orbach, 1995).
Individual differences in adult attachment are generally
assessed by a person’s placement on two relatively
independent continuous dimensions, avoidance and
anxiety (Fraley & Waller, 1998). Individuals with high
scores on the avoidance dimension are characterized by
chronic attempts to “deactivate” or minimize activation
of the attachment system (Cassidy, 2000; Edelstein &
Shaver, 2004): In stressful situations, avoidant individuals
tend to minimize expressions of distress (Fraley &
Shaver, 1997) and are unlikely to turn to or provide support
for others (e.g., Edelstein et al., 2004; Fraley &
Shaver, 1998; Simpson, Rholes, & Nelligan, 1992). They
dislike physical and emotional intimacy (Brennan,
Clark, & Shaver, 1998; Fraley et al., 1998) and grieve less
following a breakup compared to nonavoidant adults
(Fraley & Shaver, 1999).
Attachment anxiety, in contrast, appears to reflect
“hyperactivation” of the attachment system (Cassidy,
2000): Individuals scoring high on the anxiety dimension
report fears of being alone and are preoccupied
with intimacy and relationship partners. They are hypervigilant
to attachment figures and attachment-related
concerns (e.g., Mikulincer, Birnbaum, Woddis, &
Nachmias, 2000; Mikulincer et al., 2002) and are easily
distressed by even brief separations from attachment figures
(Feeney & Noller, 1992; Fraley & Shaver, 1998). In
this two-dimensional framework, individuals who score
low on both dimensions are considered secure.
Although any kind of unwanted sexual experience is
likely to be emotional and possibly traumatic, the most
severe cases are presumably experienced most negatively
and, due to their potentially threatening nature,
should be most likely to activate attachment-related concerns
and defenses (e.g., Mikulincer, Florian, & Weller,
1993).
Bowlby (1969, 1973, 1980, 1988) proposed that the quality of attachment
between an infant and caregiver formed a template for the development of
relationships in later life. Specifically, he proposed that secure early attachment
to caregivers, associated with an attuned responsive parenting style,
leads in later life to positive peer relationships, fulfilling romantic relationships,
and productive parental relationships. In contrast, insecure or disorganized
early attachment, associated with unresponsive, neglectful, or abusive
parenting, leads in adulthood to problematic, neglectful, abusive, or violent
romantic and parental relationships, and to problematic relationships with
peers.
Abusive experiences during childhood are thought to disrupt the attachment
process. As a result, the interpersonal schemas that those with a history
of abuse bring with them to adulthood tend to be negative and unwavering
across different relationships. Such schemas (e.g., abuse is a way of connecting
with another person) may motivate behavior that increases the likelihood
of subsequent victimization (Cloitre, Cohen, & Scarvalone, 2002).
Revictimization, including intimate partner violence (IPV), is well documented
among survivors of childhood abuse (Rodriguez et al., 1998; Schaaf
& McCanne, 1998). In some early work, Briere and Runtz (1987) found that
women who were sexually abused were more likely than their counterparts
who were nonabused to be victims of physical abuse by a partner. Coid et al.
(2001) found two to three times the risk of domestic violence among women
who reported CPA or CSA. Whitfield, Anda, Dube and Felitti (2003) found
approximately three times the likelihood of current IPV in women who
reported CPA and approximately two times the likelihood in women who
reported CSA or witnessed their mother being battered. Risk of victimization
increased with the number of types of childhood maltreatment. This study
was limited, however, because the measure of IPV consisted of a single
screening question.
Another way of looking at interpersonal difficulties
is through the lens of attachment theory,
which proposes that early relationships between
children and their caregivers shape the
development of children’s internal working
models of the self and others. Working models
are cognitive schemas that reflect a child’s sense
of self-worth and his or her expectations about
the emotional responsiveness of significant others.
For instance, children who experience
warmth and consistency in their relations with
their caregivers will develop a working model
of the self as lovable and a working model of
others as loving and reliable. Children who are
sexually exploited may develop negative working
models of both the self and others. Specifically,
these children may form a working model
of the self as shameful and a working model of
others as untrustworthy, unresponsive to their
emotional needs, and abusive.
Navezanost (vrste, kako se kaže)
Bowlby (1969, 1973, 1980) pointed to the important
role of parent-child bonds for the
healthful development of the child. He observed
that when parent-child relationships
were poor, children suffered. Such children often
become anxious, angry, or depressed. Subsequent
research has demonstrated quite clearly
that all manner of problems result from inade-quate parenting (Bretherton, 1985; Kolvin,
Miller, Fletting, & Kolvin, 1988; Loeber, 1990;
Paterson & Moran, 1988).
Ainswoth and her colleagues (Aisworth,
Blehar, Waters, & Wall, 1978) distinguished
three types of parent-child attachments: secure,
anxious/ambivalent, and avoidant.Whenthese
early attachment bonds are secure, the child develops
the self-confidence and skills necessary
to form effective relationships with children
outside the family.
Bowlby (1969) suggested
that parent-child relationships provided the developing
child with a template for all future relationships.
In secure bonds, the child learns that
he or she has the qualities to be loved and that
other people can be loving. This gives the child
not only self-confidence but also confidence in
others. These secure bonds instill a resiliency in
the child such that he or she can cope adequately
with the ups and downs of life.
Insecure parent-child attachments, on the
other hand, typically fail to produce these features
of resilience. Where parents offer little or
no support to their children and are inconsistent
in their responses, they are said to form anxious
ambivalent bonds with their children. Children
who are products of this type of relationship
have negative views of themselves and are desperate
to be close to others, but at the same time,
they are afraid of closeness for fear they will be
rejected. When parents are cold and distant and
lack emotional expressiveness, children will develop
an avoidant style. Avoidant children see
others as untrustworthy and will attempt to
maintain a safe distance from other people to
protect themselves. Both anxious/ambivalent
and avoidant children are likely to have low selfesteem,
poor relationship skills, and be unable
to handle life’s daily problems. These children
are vulnerable to stress because they have no
confidence in their capacity to deal with problems
and because they feel they have no one to
rely on whom they can trust. This incapacity to
deal with problems leads to the development of
an inadequate coping style by which the child,
and later the adult, either avoids facing difficulties
or simply responds by being emotionally
overwrought and withdrawn. Both these inadequate
coping styles lead to self-indulgence as a
way to deal with problems. In addition, these
children will be readily responsive to the attention
of others, even though they are wary, if not
afraid, of closeness.
(THE ORIGINS OF SEXUAL OFFENDING, WILLIAM L. MARSHALL, LIAM E.
MARSHALL, TRAUMA, VIOLENCE, & ABUSE, Vol. 1, No. 3, July 2000 250-263)
POSLEDICE TRAVME – OSEBNOST, SAMOPODOBA,
VIDENJE DRUGIH
If, as Finkelhor and Browne
(1985) suggested, early sexual trauma can profoundly “alter a child’s cognitive
and emotional orientation toward the world and cause trauma by distorting
the child’s self concept,world view, or affective capacities” (p. 531), then
there is reason to suspect thatCSAmay disrupt survivors’ long-term interpersonal
adjustment as well.
Abused children do not receive protection when they need it. As noted by Herman (1997), "At
the moment of trauma the victim is utterly helpless. Unable to defend herself, she cries for
help, but no one comes to her aid. She feels totally abandoned. The memory of this
experience pervades all subsequent relationships" (p. 137). For child abuse survivors,
problems with protection persist into adulthood. They often have difficulty setting limits in
interpersonal relationships, defending themselves in conflict situations, and guarding against
repeated victimizations (Briere, 1992). In addition, many have trouble protecting their own
children from abuse (Goodwin, McCarthy, &DiVasto, 1981; McCloskey &Bailey, 2000;
Oates, Tebbutt, Swanston, Lynch, &O'Toole, 1998; Spieker, Bensley, McMahon, Fung,
&Ossiander, 1996).
Many trauma researchers have recognized a connection between receiving protection in
childhood and feeling protected in later life. For example, according to van der Kolk, van der
Hart, and Marmar (1996).
Theories of the long-term impact of child abuse typically stress concepts such as affect
regulation, identity, cognitive schemas, and interpersonal trust (e. g. , Alexander, 1992;
Briere, 1996; Cole &Putnam, 1992; Horowitz, 1997; Janoff-Bulman, 1992; Linehan, 1993;
van der Kolk &Fisler, 1994). I know of no theories of child abuse that emphasize the
development of self-protection.
This article presents a case for interpersonal protection as an organizing construct in abuse
research and treatment.
Sexual assault upsets perceptions of safety and may significantly affect a victim’s future
ability to feel safe.
Marital sexual assault poses a greater threat to a victim’s sense of security and safety in the
world than do other forms of sexual assault because it violates one’s safety expectations (Foa
& Riggs,1994) and may reduce one’s confidence to judge others and to form safe
relationships (Finkelhor&Yllö, 1982; Goodman, Koss,& Russo, 1993; Kilpatrick, Best,
Saunders,&Veronen, 1988; Whatley, 1993).
Lachmann and Beebe (1997) point out that an event becomes traumatic when it ruptures the
individual’s selfobject tie, without opportunity for repair, thereby dramatically altering her
self-state.
With trauma, personal responsibility is distorted due to the lack of control one feels
when the trauma is happening. This confronts the patient with the disparity between
what he wanted to happen and the tragic events that actually occurred.
In the comprehensive review carried out
by Kendall-Tackett et al. (1993), the authors conclude that
the impact of sexual abuse upon children does not necessarily
yield a distinct identifiable syndrome. Instead, the experience
manifests itself in a variety of symptomatic and pathological
behaviours. These problems may not remit but may result in
lifelong impairments that include fear, depression, substance
abuse, dissociative disorders and sexual dysfunction (Browne
and Finkelhor, 1986). Furthermore, it has been suggested that
childhood abuse often disrupts children’s development by
stimulating primitive coping strategies and by creating cognitive
distortions of self, others and the future (Briere, 1992).
The
self-loathing that many traumatized women experience
may generalize into thinking of both the self and the
body as bad and ugly (Hyman, 1999; Miller, 1994). The
body, the site of the original abuse, was violated, and
this abuse included both emotional and physical
boundary violations. These boundary violations may
lead to self-harm, which temporarily helps define the
body boundaries.
Self-image and self-esteem also appear to be key factors in some.
The overall negative self-image thus caused can lead to predictions of failure in all
matters, including sex, and to a sense that one is not attractive even when there is
no physical dis. gurement.
PROCESI, KI RAZLAGAJO POSLEDICE
–SPOMIN IN OBLIKOVANJE SHEM O SEBI, SVETU
vpliv travme na razvoj shem, motnje spomina, pomankljiva integracija izkušenj, manjkajoč
občutek konstantnosti
When considering the psychological impact of trauma, much has been written about possible
effects on memory and self representation. Clinical case studies and theoretical literature
describe disturbances such as amnesia for early autobiographical memories, instability of self
image, disturbed cognitions relating to self; lack of a sense of a self; identity confusion; and
poor or negative internal self-representations (Briere 1989, 1992; Herman and van der Kolk,
1987; McCann and Pearlman, 1990; Parkin, 1987; Putnam, 1990; Reviere, 1996; Schetky,
1990; Schultz, 1990; van der Kolk, 1987; Zelikovsky and Lynn, 1994). In general, the
presence of trauma in childhood is presumed to create a disruption in the continuity and
stability of experience theoretically necessary for normative development of schematic
representations of self and the world, at least in part, through autobiographical memories
(McCann and Pearlman, 1990; Stern, 1985). More specifically, the sustained attention that
traumatized children devote to physical and/or emotional survival is thought to interfere
(through any of various mechanisms in the memory processes) with encoding or retention of
early autobiographical memories. Such a narrowing of attention has been theorized to result in
distortions in memory and thus, impairment in development of a coherent, well developed self
schema.
It has been posited that the memory impairment often observed in trauma may be linked to an
underlying motivation to preserve the integrity of nascent schemas and psychological wellbeing in a child. Specifically, the inclusion of trauma in an autobiographical narrative may
threaten basic schematic structures and assumptions (e.g. of safety); thus, one adaptation may
be to leave the traumatic material unassimilated, thereby disrupting memory and basic schema
formation (Bartlett, 1932; Fine, 1990; Horowitz, 1991; Janoff-Bulman, 1989; Piaget, 1967;
Schachtel, 1959; Singer and Salovey, 1991). Further, if trauma is encountered during child
hood, at a time when schemas and beliefs about the self and world are forming, traumatic
experience may interfere with development of supraordinate, general schemas that create a
sense of continuity in self, memory, and meaning (Fine, 1990; Horowitz, 1991). For a child
who has not yet achieved the internal stability afforded by adequate schematic development,
such disruption could have significant affects. The attempt to resolve this disruption may
result in significant distortions in self-experience as the child attempts to organize experience
and self in a way that allows some degree of perceived control. Since schemas are likely not
available for assimilation of traumatic information, and accommodation of developing
schemas to include traumatic material precludes a basic sense of mastery of self and eorld,
dissociation of traumatic events and resulting memories may provide for the preservation
safety needed by traumatized child (Horowitz, 1991; van der Kolk et al., 1989). As such, the
consolidation of memories related to self may be disrupted. This may lead to a self schema
that remains unintegrated with subsequent experience, or the trauma can become an
organizing frame frame for potentially impaired self development (Barclay, 1986; Barclay
and DeCooke, 1988; Barsalou, 1988; Brewer, 1986; Bruhn, 1990; Schachter et al., 1989).
If large segments of autobiographical memory are separated from personal identity, in part
due to schematic disruptions, the usual frame of reference for continual calibration and
definition of self is lost. Thud trough the a process of mutual influence, the disruption of
consistency in life experience may create a propensity for disruption in development of
schemas and a disruption in a development of a coherent autobiographical memory system
(Barclay, 1986, 1988; Bartlett, 1932; Bruhn, 1990; Neisser, 1988).
POSLEDICE TRAVME – SOOČANJE S KASNEJŠIM
STRESOM
It has been noted that a history of exposure to extreme psychological stress
appears to make a person more vulnerable to experiencing psychological distress
when stressors occur later in life (Bremner, Southwick, & Charney,
1995). This was demonstrated in a study of female and male Vietnam veterans
that found that stressful life events occurring after the war were associated
with greater PTSD (King, King, Fairbank, Keane, & Adams, 1998).
Among Holocaust survivors, both cumulative and recent stressful life events
were significantly related to PTSD (Yehuda et al., 1995). Similarly, among
Israeli soldiers who suffered combat stress reactions during the 1982 Lebanon
War, additional negative life events were found to be associated with
greater PTSD and recovery from PTSD (Solomon, Mikulincer, & Flum,
1989). Furthermore, among survivors of a firestorm, stressful life events
occurring prior to, during, and after the firestorm were each found to have
independent relationships in predicting later PTSD symptoms (Koopman
et al., 1994). (Recent Stressful Life Events,Sexual Revictimization, and Their
Relationship With Traumatic Stress Symptoms Among Women Sexually Abused in ChildhoodCATHERINE CLASSEN
RUTH NEVO,CHERYL KOOPMAN,KIRSTEN NEVILL-MANNING,CHERYL GORE-FELTON
DEBORAH S. ROSE,DAVID SPIEGEL
JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 17 No. 12, December 2002 1274-1290)
POSLEDICE TRAVME – EMOCIJE IN AFEKTI
Attempts to suppress negative affect associated with the trauma
may lead to generalized constricted affect, an inability to have tender or loving
feelings, and problems with making and maintaining relationships. Drug
and alcohol abuse may also occur as a way of avoiding trauma-related affect.
With hyperarousal, a variety of difficulties may occur including an exaggerated
startle response, hypervigilance, poor concentration, irritability or outbursts
of anger, and difficulty falling or staying asleep.
Being alone invites the overwhelming pain
and affect associated with the trauma and self-badness
to be experienced. Abused women, many of whom
have been victims of male perpetrators as children,
report fear of being alone (Lobel, 1992). The fear of
being alone is related to the isolation in which the
abuse took place—no one saw or heard and certainly
no one stopped the assault. Lobel found that 63% of
women who had been sexually abused as children
reported feelings of self-hatred, worthlessness, and
guilt when they were alone.
That is, numbing may involve suppression of the expression
of emotions (at least some components of emotional
responding), which would lead to an increase in
emotional experiencing (in other components). Since theories
propose numbing to occur in response to trauma
cues (e.g., Foa, Zinbarg, & Rothbaum, 1992; Litz, 1992),
emotional suppression and incongruities in emotional experiencing would
be most likely to occur subsequent to exposure
to trauma cues. This pattern may therefore account
for the difficulties in processing of traumatic experiences
in individuals with PTSD as well as the maintenance of
PTSD symptomatology.
The theories proposed to account for the change in
self-report of emotional experiencing and increased physiological
arousal that accompany emotional inexpressivity
and suppression emphasize the physical and psychological
effort required to inhibit emotions (e.g, Cacioppo et al.,
1992; Notarius & Levenson, 1979).
Trauma leaves in its
wake a loss of trust, of faith, of safety, of connection. It is often a
frightening confrontation with helplessness, with the fear and rage that
helplessness induces, and with a numbness that mutes these painful
states of mind. It is perhaps for these reasons that successful treatment
of people who have been traumatized often uses multiple modalities,
occurs in stages, and extends over a lengthy period of time (1).
(THE TRAUMA OF PROFOUND CHILDHOOD LOSS: A PERSONAL AND
PROFESSIONAL PERSPECTIVE
Francine Cournos, M.D., Psychiatric Quarterly, Vol. 73, No. 2, Summer 2002)
Symptoms of emotional numbing are a core feature
of posttraumatic stress disorder (PTSD) in the nomenclature
of the Diagnostic and Statistical Manual of
Mental Disorders (4th ed. [DSM–IV]; American Psychiatric
Association, 1994). In DSM–IV, emotional
numbing is assessed in symptom cluster C. Criteria for
cluster C include symptoms of avoidance and emotional
numbing, whereas cluster B assesses symptoms
of re-experiencing and cluster D symptoms of hyperarousal.
Emotional numbing involves diminished interest
in activities, feelings of detachment from others,
and the restriction of affect (Foa, Davidson,&Frances,
1999). Such features of emotional numbing have salient
clinical impact, as they are likely to produce personal
distress and impairment in interpersonal functioning
(Carrion & Steiner, 2000). Moreover, the
symptoms of emotional numbing are closely associated
with features of major depression and dysthymia.
A Prospective Test of the Association Between Hyperarousal and Emotional Numbing in Youth With a History of
Traumatic Stress - Carl F. Weems, Kasey M. Saltzman, Allan L. Reiss, and Victor G. Carrion - Journal of Clinical
Child and Adolescent Psychology 2003, Vol. 32, No. 1, 166–171
Research employing adult samples has shown that
symptoms of emotional numbing are strongly associated
with symptoms of hyperarousal (e.g., Flack, Litz,
Hsieh, Kaloupek,&Keane, 2000; Litz et al., 1997), and
theorists (Litz, 1992; Litz et al., 1997) have hypothesized
that emotional numbing may result from emotional
exhaustion produced by prolonged periods of
arousal. More specifically, symptoms of emotional
numbing are thought to be caused by the depletion of
cognitive and emotional resources due to prolonged
hyperarousal. Support for this theory comes from a
variety of sources, including animal models of inescapable
shock and humans exposed to traumatic events (see
Flack et al., 2000; Litz, 1992; Litz et al., 1997; Van der
Kolk, Boyd, Krystal, & Greenberg, 1984).
A Prospective Test of the Association Between Hyperarousal and Emotional Numbing in Youth With a History of
Traumatic Stress - Carl F. Weems, Kasey M. Saltzman, Allan L. Reiss, and Victor G. Carrion - Journal of Clinical
Child and Adolescent Psychology 2003, Vol. 32, No. 1, 166–171
Results in this sample provided support for the theory
that emotional numbing may develop as a result of
chronic hyperarousal in youth.
The
prospective design used in this study added to an understanding
of the association between hyperarousal
and emotional numbing by showing that emotional
numbing was not a robust prospective predictor of
hyperarousal. Such findings suggest the direction of
the association. That is, hyperarousal is associated
with later emotional numbing, but emotional numbing
does not robustly predict later hyperarousal. Taken together,
these results provide preliminary support for
the theory that emotional numbing may result from
emotional exhaustion or the depletion of cognitive and
emotional resources due to prolonged hyperarousal in
youth.
A Prospective Test of the Association Between Hyperarousal and Emotional Numbing in Youth With a History of
Traumatic Stress - Carl F. Weems, Kasey M. Saltzman, Allan L. Reiss, and Victor G. Carrion - Journal of Clinical
Child and Adolescent Psychology 2003, Vol. 32, No. 1, 166–171
POSLEDICE TRAVME – EMOCIJE IN AFEKTI – KRIVDA IN
SRAM
Self-blame following sexual assault has been studied extensively, particularly
in relation to Janoff-Bulman’s theory (1979). In general, this research
has found that many victims of sexual assault use both characterological selfblame
and behavioral self-blame; however, both types of attributions are
associated with higher distress both immediately postrape and over time
(Arata, 1994; Frazier, 1990; Frazier&Schauben, 1994; Hill&Zautra, 1989;
Katz & Burt, 1988; Mandoki & Burkhart, 1989). Furthermore, engaging in
self-blame is associated with greater use of maladaptive coping strategies
(Arata & Burkhart, 1998; Arata, 1994) and higher rates of posttraumatic
stress disorder (Arata & Burkhart, 1996).
The research on self-blame following adult sexual assault has focused primarily
on the distinction between behavioral and characterological selfblame
and, more recently, whether there are differences in feelings of blame
versus responsibility or avoidability (Abbey, 1987).
Women with a history of child sexual abuse were more likely to
engage in self-blaming attributions regarding the rape. That is, they were
more likely to blame themselves for the rape, including seeing themselves as
having deserved the rape, being a victim type, being a bad person, or not
being able to take care of one’s self. At the same time, women with a history
of child sexual abuse also reported more societal blame. They tended to feel
that theworld is unsafe forwomen, that there are many emotionally disturbed
individuals around, and that no one is ever available to help when it is needed.
The fact that thesewomen also
report greater use of cognitive strategies is more difficult to interpret. Presumably,
cognitive strategies are more adaptive, however, this finding is consistent
with Burt and Katz’s (1987) description of rape victims alternating
between emotion-focused (such as nervous) coping and problem-focused
(such as cognitive) coping, with use of all coping strategies decreasing as
symptoms decrease. Additionally, the results suggest that women may continue
to use the same maladaptive coping strategies for dealing with adult
assault as were employed for their childhood abuse. Coffey et al. (1996b) and
Leitenberg et al. (1992) found that disengagement or avoidant coping strategies
were the types of coping most frequently employed bywomen abused as
children. One issue to consider is whether these coping strategies might also
serve as vulnerability factors to revictimization.
Shame is a negative and disturbing emotional experience involving feelings of selfcondemnation and the desire to hide the damaged self from others (Lewis, 1992; Tangney,
1995). It is a state in which the whole self feels defective, often as a result of a perceived
failure to meet social and self-imposed standards. Clinical, theoretical, and empirical work
have emphasized shame as a common consequence of child sexual abuse (Feiring, Taska, &
Lewis, 1996, 2002; Finkelhor & Browne, 1987; Nathanson, 1989).
Previous results from this study showed that shame for the abuse is common at the time of
discovery and generally decreases during 1 year’s time (Feiring et al., 2002).
It is a self-conscious emotion that requires the cognitive ability to have a sense of self and
evaluate one’s behavior against a standard (Lewis, 2000). Shame, as measured by body
posture and facial expression, can be observed in children as young as 3 years of age (Lewis,
Alessandri, & Sullivan, 1992). It is not until later, around the age of 8 years, that children are
able to generate appropriate examples of shame experiences (Ferguson & Stegge,1995).
Guilt, like shame, is a self-conscious emotion. Both emotions focus on the self and involve
negative feelings. However, guilt focuses on specific aspects of the self that are perceived as
causing failure, whereas shame focuses on the whole self. Guilt concerns one’s actions.
Shame concerns one’s entire being. Guilt motivates taking action to repair the perceived
failure (e.g., being on time rather than late for dinner dates with a close friend), whereas
shame motivates hiding the self from exposure and inaction (Tangney & Dearing, 2002).
A consistent finding in shame research is that this self-conscious emotion often motivates an
avoidance response such that the individual wants to hide the exposed self (Barrett, ZahnWaxler, & Cole, 1993; Tangney, 1995). Strong negative emotions associated with traumatic
events are aversive. They promote cognitive and behavioral avoidance, which, in turn,
prolong PTSD symptoms (Berliner & Wheeler, 1987; Foa &Riggs, 1994). Earlier abuserelated shame was expected to show longterm consequences for the experience of PTSD
symptoms. Individuals with high abuse-related shame during the 1st year following abuse
discovery were expected to be most at risk for experiencing clinically significant levels of
PTSD symptoms 6 years following abuse discovery.
Findings for individual patterns of persistence in shame across time showed that high levels of
shame are likely to abate. This suggests that although abuse-related shame was common at
abuse discovery, there was a good chance that such high levels of shame would not become
characteristic of the individual across several years. For individuals low in shame at abuse
discovery and for those low in shame 1 year later, the prognosis was very good.
Feedback from significant others about one’s failure to be good and lovable should be a
primary contributor to shame and its persistence across time.
Higher levels of shame in children are associated with parental hostility, rejection, negative
affective displays and comments during learning, and minimal recognition for good behavior
(Alessandri & Lewis, 1996; Ferguson & Stegge, 1995; Stuewig & McCloskey, 2005). It has
been suggested that the more the child hears and internalizes deficiency messages that he or
she is not and never will be good enough or lovable, the greater the likelihood of shame
(Potter-Efron, 1989).
It is not just fear that motivates avoidance of thinking about traumatic events. Our findings
suggest that to cognitively and emotionally process traumatic experiences, therapists must
help clients to confront both shame and fear. Although clients may not spontaneously
volunteer feelings of shame, shame can readily be observed in a client’s use of language,
reluctance to disclose, and nonverbal behavior (e.g., avoidance of eye contact, covering the
face, head down, body collapsed, body hidden with a pillow or coat).
(The Persistence of Shame Following Sexual Abuse: A Longitudinal Look at Risk and
Recovery) - vsi odstavki
ABSTRACT:Guilt about surviving a traumatic event is thought to be an associated feature of posttraumatic stress
disorder (PTSD). Shame is an emotion closely related to guilt but is a distinct affective state. Little is
known regarding the role of shame in PTSD and there are no studies of PTSD where shame and guilt
are examined simultaneously. We used a measure of shame- and guilt-proneness in 107 community
residing former prisoner of war veterans all of whom had been exposed to trauma. The measure of
shame-proneness was positively correlated with PTSD symptom severity whereas guilt-proneness
was not. This study provides the first empirical data regarding a possible role for shame in PTSD and
may have important therapeutic and theoretical implications.
Many combat veterans experience profound feelings
of guilt following the survival of a trauma and guilt can
be related to painful wartime memories (Glover, 1984;
Kubany, 1994).
Although guilt and shame are
terms that are often used interchangeably, current theoretical
and empirical literature underscores that these are distinct
affective experiences (Lewis, 1971; Lindsay-Hartz,
1984; Tangney, 1990, 1991). Lewis (1971) defined guilt
as the self’s negative evaluation of particular behaviors
while shame involves the self’s negative evaluation of the
entire self.
In contrast, shame is conceived of as a more devastating
and painful emotion in which the entire self, not just the
behavior, is negatively evaluated (Tangney, 1991). Shame
theoretically involves painful self-scrutiny, and feelings of
worthlessness and powerlessness (Lindsay-Hartz, 1984;
Tangney, 1990). Also hypothesized is an associated sense
of sudden and unexpected exposure, which renders the
individual feeling diminished or defective (Lewis, 1971).
Shame conceptually, therefore, may lead to a global and
debilitating painful affective reaction with a desire to hide
or escape from others (Gramzow & Tangney, 1992).
Stone (1992) hypothesized
that traumatized individuals with PTSD suffer from
symptoms of both guilt and shame. In a largely conceptual
article, he points out that in combat an example of
guilt is the troubling feeling that one survived when others
did not, whereas shame is the feeling of doubting the
right to exist. Theoretically, therefore, guilt may be related
to actions performed and shame to perception of oneself
(Janoff-Bulman, 1979).Wong and Cook (1992) conducted
the only empirical study on shame in those with PTSD.
Veterans with PTSD scored higher on measures of shame
than veterans with substance abuse or depression. Neither
trauma exposure nor severity of PTSD symptoms was ascertained
and, therefore, limited conclusions can be drawn
from this study.
REZULTATI:
Contrary to our initial hypothesis, only shameproneness
and not guilt-proneness, as measured by the
TOSCA, correlated positively with severity of PTSD
symptoms. Those withPTSDhad higher shame-proneness
scores than those without.
Self-blame as a consequence
of sexual abuse has received a great deal of attention
in the literature, although much of this research has
focused on self-blame following adult sexual assault. In studies of women with histories of
child sexual
abuse, self-blame and self-denigratory beliefs have
been found as frequent effects (Courtois, 1988; Herman,
1992; Jehu, 1988).
Females who blame themselves for their
child victimization may have feeling of guilt, shame,
and low self-worth with subsequent increases in sexual
behavior because the victim perceives herself as only
being worthy of relationships if sex is offered.
Cutting, unlike childhood abuse, is within the control
of the trauma survivor. Of course, the relief it brings is
short-lived and often leads to shame and guilt, and the
cycle of pain, relief, and shame starts again.
The negative reactions caused by a traumatic
even often lead to shame, self-loathing and self-blame, even when the individual had
no responsibility for the event.
Feelings of guilt also seem to be a relevant factor. Guilt about the accident
itself, however irrational, is common. There is also guilt, commonly felt by these
trauma victims, about letting down one’s family or partner, being a burden on the
partner or family, and being ‘worthless’.
Children who are sexually abused may be at
risk for feelings of shame and self-blame, especially
when the abuse was prolonged or when
the perpetrator or significant others blamed the
child for the abuse.
POSLEDICE TRAVME – EMOCIJE IN AFEKTI – SRAM IN
GNUS
V raziskavi so Dumbn in Marshall ter Langton predvidevali, da izkušnja sramu ki je
posledica spolnega napada v otroškem obdobju v otroku poveča osebno stisko, občutje
krivde, poveča kognitivne motnje s tem pa poraste tveganje ponovne obnovitve.
Krivda in sram sta opisana kot samega sebe zavedajoče občutje. Skrivanje pred drugimi je
dejanje, ki je bilo v empiričnih raziskavah opisano s strani Barlowa in drugih zopet drugi pa
so sram opisali kot pozunanjenost graje. ž
Priznavanje oziroma izpoved sta Mascolo in Fischer opisala kot krivdo in pripravljenost
obnoviti prvotno stanje ki vključuje opravičilo. Pri krivdi je v ospredju dejanje samo medtem
ko je pri sramu na prvem mestu oseba. Zato je razumljivo, da ob krivdi pride do izraza
empatija do misli in dejanj bolj kot do osebe. Razkritje samega sebe je mejnik v katerem
razlikujemo med krivdo in sramom. Izkušnja sramu vključuje obsojanje samega sebe kot
nesposobnega ali slabega ali da razmišlja o sebi na način kako ga drugi obsojajo.
Zunanji sram odseva skrb kako je posameznik viden s strani drugega. Od slednjega je tudi
odvisno kako pomembna je druga oseba v našem življenju.
SHAME AND GUILT
Shame and guilt are often cited as two different but
related moral emotions that regulate social behavior.
Although the terms are often used interchangeably,
there are important conceptual differences
(Tangney, 1990, 1991; Tangney, Wagner, &
Gramzow, 1992). Both shame and guilt are “negative”
or uncomfortable emotions and as such are usually
correlated. Both also deal with self-evaluative judgments,
in that we judge ourselves, and our actions,
according to internal standards. H. B. Lewis (1971)
theorized, however, that the key difference between
shame and guilt concerns the distinction between
“the self” and “behavior.” Shame focuses less on specific
behaviors and more on the evaluation of the
entire self against internalized standards. Guilt, on
the other hand, reflects feelings about actions that are
inconsistent with internalized standards. The two
emotions have been shown to lead to different “action
tendencies” (Lindsay-Hartz, 1984; Tangney, Miller,
Flicker, & Barlow, 1996). When guilt is experienced,
people are motivated to make reparations for the
behavior. When shame is felt, people feel awful about
themselves; they want to hide or disappear. Although
guilt is an uncomfortable emotion, shame can be
more debilitating. Phenomenological reports of
shame describe people feeling powerless and insignificant
(Wicker, Payne, & Morgan, 1983).
The
self-loathing that many traumatized women experience
may generalize into thinking of both the self and the
body as bad and ugly (Hyman, 1999; Miller, 1994). The
body, the site of the original abuse, was violated, and
this abuse included both emotional and physical
boundary violations. These boundary violations may
lead to self-harm, which temporarily helps define the
body boundaries.
Marital violence, for instance, is related to more depression and anxiety in school-age
children (Hughes & Luke, 1998; McCloskey et al., 1995). Harsh punitive parenting
and low parental warmth predict adolescent delinquency (Loeber & Dishion, 1983;
McCord, 1997; Sampson & Laub, 1993; Simons, Wu, Johnson, & Conger, 1995), as
does sexual abuse, especially among girls (Herrera
&McCloskey, 2003; Paolucci et al., 2001; Siegel &Williams, 2003).
Retrospective reports of parental emotional abusiveness, but not physical
abusiveness, were related to shameproneness, whereas neither was related to
guiltproneness (Hoglund & Nicholas, 1995).
In the past 20 years, the majority of research examining shame and guilt using the
self- versus behavior distinction has focused on psychological adjustment.
Researchers have found that after controlling for guilt, shame tends to be highly
related to a variety of psychopathology, including PTSD, obsessive- compulsiveness,
psychoticism, anxiety, and depression (Andrews et al., 2000; Ferguson, Stegge, Eyre,
Vollmer, & Ashbaker, 2000; Harder, Cutler, & Rockart, 1992; Quiles & Bybee, 1997;
Tangney et al., 1992).
Shame-proneness showed no association with criminal behavior but was linked to
ensuing depression.
Guilt-proneness, on the other hand, showed little relation to depression but seemed
to inhibit
engagement in criminal activities. Shame-proneness in early adolescence was
associated
with symptoms of depression in late adolescence even when controlling for childhood
symptoms of
depression. Although researchers have often found a concurrent relationship
between shame-proneness and depression (Tangney et al., 1992), very few studies
have looked at this prospectively.
The Relation of Child Maltreatment to Shame and Guilt Among Adolescents: Psychological Routes to Depression and
Delinquency
Jeffrey Stuewig, George Mason University, Laura A. McCloskey, University of Pennsylvania
CHILDMALTREATMENT,Vol. 10, No. 4,November 2005 324-336
A common assumption is
that shame arises from thoughts that one has done something
bad or shameful, and the relationship between
abuse-specific internal attributions and shame is indeed
significant, both at the time of initial disclosure and 1 year
later (C. Feiring, personal communication, July 2001).
However, it is also possible for shame to arise from the
belief that one simply is bad or unworthy, independent of
any actions one has or has not taken. For example, abuserelated
shame could occur even in the absence of selfblame,
if children believe that the mere fact of having
been abused makes them bad, dirty, or shameful.
Addressing Attributions in Treating Abused Children - Judith A. Cohen, Anthony P. Mannarino - CHILD
MALTREATMENT, Vol. 7, No. 1, February 2002 81-84
The articles in this special section on child maltreatment
and shame are efforts to elucidate the role of
shame as a contributor to child abuse consequences.
As many of the authors mention, most of the research
attention on emotions in child maltreatment—
especially with reference to posttraumatic stress—has
focused on fear as the negative emotion that produces
psychological distress in the aftermath of trauma.
More recently, researchers have begun to explore
other negative emotions that might arise during
or after abuse and that might factor into understanding
outcomes. Shame has emerged as a leading
candidate.
Although shame is the specific target of the investigations,
the primary contribution of these articles
may be in confirming that strong negative emotional
responses to abuse experiences beyond fear are
important in explaining outcomes. For example, why
does child sexual abuse produce such high rates of
post-traumatic stress disorder (PTSD) when most situations
do not involve fear-inducing events? While part
of the explanation may lie in the perception of life
threat as opposed to objective danger (a known predictor
for PTSD), perhaps there is something about
the nature of sexual trauma that is more likely to produce
other intense negative emotions. Because
shame and anger are associated with PTSD in adult
samples experiencing a variety of traumas (Andrews,
Brewin, Rose, & Kirk, 2000), more attention to these
emotions in child research is warranted. In addition,
of course, clinicians have long observed that strong
negative emotional responses that are not fear related
seem to be just as troubling for children who are traumatized.
POSLEDICE TRAVME – EMOCIJE IN AFEKTI –
REGULACIJA EMOCIJ IN AFEKTOV
All key participants talked about their use of alcohol and drugs to numb their emotional
pain from difficult and often painful life experiences and practices. All of the
key participants shared that they had discovered early on that alcohol and drugs
helped them to numb painful feelings from a past they had desperately tried to
escape.
The Mediating Effect of Emotion Regulation
Coinciding with the manifestation of other temperamental
characteristics, emotion regulation comprises a set of
competencies to modulate affective states (Shields & Cicchetti,
1998). Examples of emotion regulatory strategies
include self-soothing, reframing upsetting events and provocative
stimuli (Schwartz & Proctor, 2000), and inhibiting
or initiating emotionally driven behavior (Eisenberg et al.,
2001). These abilities are formed in the family context and
transferred to the peer realm (Fabes, Eisenberg, & Miller,
1990). Parents shape children’s acquisition of regulation
skills through parent– child interactions (Parke et al., 1992)
or by coaching and modeling (Carson & Parke, 1996; Davies
& Cummings, 1994). As noted by Eisenberg et al.
(1999), “parental coaching helps children to develop the
ability to inhibit negative affect, to self-sooth, and to focus
attention (including attention in social contexts)” (p. 514).
“Parents who exhibit hurtful and hostile negative emotions
frequently may model dysregulated behavior for children to
imitate” (Eisenberg et al., 2001, p. 488).
A number of empirical studies support the link between
the emotion regulatory abilities of parents and their children.
The available evidence suggests that there is a clear link
between parenting styles and children’s capacities for emotion
regulation.
Variously described as harsh, overreactive, emotionally
negative, coercive, and controlling and authoritarian (Arnold,
O’Leary, Wolff, & Acker, 1993; Deater-Deckard &
Dodge, 1997), the specific acts comprising a cluster of harsh
parenting behaviors include yelling, frequent negative commands,
name calling, overt expressions of anger, and physical
threats and aggression. These harsh parenting descriptions
can be summarized into categories of coercive acts and
negative emotion expressions. In other words, sometimes
parents hit their children when they are angry or emotionally
out of control (Patterson, 1982).
Studies
by emotion researchers also suggest the mediating effect of
children’s emotion regulation in channeling the effect of
emotion-related negative parenting practices on children’s
social adjustment.
A large number of
studies suggest that coercion and harshness from mothers’
parenting behaviors have a stronger effect on children than
do fathers’ behaviors (e.g., Denham et al., 2000).
The social learning
theory (e.g., Bandura & Walters, 1959) postulates that the
role modeling effect is facilitated by gender identification.
Thus, parenting behaviors should have stronger effects on
same-sex than opposite-sex children. A socialization theory
on gender role differentiations also predicts that parents in
general feel greater responsibility for the socialization of
same-sex children (Huston, 1983) and thus exert closer
control over them (Power & Shanks, 1989). However, because
most children spend more time with their mothers
than fathers (Russell & Russell, 1987) and because girls are
less rigid in gender stereotyping than boys (Ruble & Martin,
1998), the potential gender identification effect is expected
to be more evident with fathers and sons than with mothers
and daughters (Lytton & Romney, 1991). In relation to
harsh parenting and child aggression, a biological approach
would also predict different arousals and responses from
same-sex than opposite-sex parent–child pairings (Fabes,
1994).
Other mechanisms may also affect parent–child relations.
One that is also pertinent to the emotional channeling of
harsh parenting is that of attachment. Existing research
suggests that attachment security does not vary as a function
of a child’s gender (Ainsworth, 1973), especially in early
childhood involving child–mother attachment (Rosen &
Burke, 1999). Gender differences in attachment to fathers
and in related child–father relationships also do not seem to
appear until late childhood to adolescence (Lieberman,
Doyle, & Markiewicz, 1999). This attachment research is
also consistent with Davies and Cummings’s (1994) child
emotional security hypothesis. The emotional security theory
does not postulate gender differences in young children’s
emotional responses to inter-adult conflict (Davies &
Cummings, 1994). Cognitive differences in boys’ and girls’
coping with parental conflict have been observed only in
older children and adolescents (Davies & Cummings,
1994).
One of the most enduring problems associated with childhood abuse is difficulty in affect regulation. Under ideal
circumstances, the emergence of emotion regulation skills is guided in development by caretakers through activities, such as
labeling and interpreting emotional experiences, soothing activities, and role modeling of effective mood regulation (e.g.,
Malatesta & Haviland, 1982). Unfortunately, these important socializing experiences are disturbed in caretaking
environments characterized by sustained physical and/or sexual abuse. Substantial research has shown that maltreated
children, compared with nonmaltreated children, have more difficulty managing their emotions adaptively throughout
childhood (e.g., Shields & Cicchetti, 1998; Shipman & Zeman, 2001). Similarly, as adults, victims of childhood abuse show
difficulties in emotion regulation, especially in the context of interpersonal relationships. Several studies have demonstrated
that, compared with women who have suffered first-time traumas as adults (e.g., rape, physical assault), childhood abuse
victims have been found to have more difficulty managing anger, hostility, anxiety, and depression (Browne & Finkelhor,
1986) and report significantly more problems in interpersonal functioning in work, home, and social domains (Zlotnick,
Zakriski, Shea, & Costello, 1996).
Survivors often experience uncontrolled
emotion as the most salient indicator that something is
deeply wrong.
Van der Kolk et al.
(1996) confirmed that affect dysregulation is a central
symptom for survivors. Feelings are enemies that arrive
unannounced, create havoc in the survivor’s internal
and external world, and then leave behind a dark hole
of nothingness that can feel even worse than the storm
that preceded it. The intense stress of the early trauma
can lead to overstimulation of the central nervous system.
In turn, this stimulation can cause permanent
neural changes that negatively affect learning and stimulus
discrimination (van der Kolk, 1994).
Alterations in biological functioning (easy to startle, chronic hyperarousal,
hypervigilance, and diffuse physical complaints)
are the hallmarks of many trauma survivors
(van der Kolk, 1994). Researchers have shown that individuals
with a history of trauma react to stimuli with conditioned
autonomic responses, such as increased heart rate and
increased blood pressure (Bremner, 1999). These responses
mimic the responses at the time of trauma.
POSLEDICE TRAVME – EMOCIJE IN AFEKTI – OBRAMBNI
MEHANIZMI
The findings described thus far are consistent with
Bowlby’s (1980, 1987) notion of defensive exclusion.
Bowlby proposed that some individuals may selectively
and defensively regulate the processing of material that
could result in attachment-system activation. Such
defensive behavior may serve to prevent the negative
affect associated with reminders of attachment-related
loss. Avoidant individuals are thought to rely on these
kinds of defensive strategies to regulate attention to
attachment-related information: If potentially upsetting
information is not fully processed, the attachment system
is less likely to be activated, thus preventing further
rejection and distress and, of relevance to the present
study, impairing memory.
POSLEDICE TRAVME – VEDENJE (ACTING OUT),
DELINKVENTNOST, NASILJE
Studies have found a possible link between an individual experiencing trauma and later
developing delinquent behaviors. Burton, Foy, Bwanausi, Johnson, and Moore (1994)
reported a significant level of PTSD in male juvenile delinquents adjudicated for felony
crimes. Similarly, Steiner et al. (1997) reported a significantly high prevalence rate for PTSD
within an incarcerated group of male juvenile delinquents when compared with males from a
local high school who were not incarcerated. PTSD in male criminal youth was found to be
associated with exposure to a malevolent environment such us domestic violence, living in
unsafe neighborhoods, substance abuse, and criminal behavior among family members (Erwin
et al., 2000).
There is strong evidence that child maltreatment (physical abuse, sexual abuse, and neglect)
can increase risk for a range of negative adolescent behaviors, including delinquency,
substance use, and violence (Fergusson, Horwood, & Lynskey, 1996; Fergusson & Lynskey,
1997; Hawkins et al., 1998; R. C. Herrenkohl, Egolf, & Herrenkohl, 1997; Smith &
Thornberry, 1995;Widom, 1989a, 2000;Wolfe, 1999). Violence as an outcome of physical
child abuse is, perhaps, most well studied, although results are inconsistent (Hawkins et al.,
1998; Widom, 1989a, 1989b). In their comprehensive review of the research literature,
Hawkins et al. (1998) found that effect sizes vary notably across studies linking maltreatment
to official and self-reported violence in youths. Widom (1989a, 1989b) suggested that
research design and measurement problems are common in studies on child maltreatment and
that these problems explain, in part, why results differ.
In several longitudinal studies, the relation between physical child abuse and later violence
does indeed appear to hold (Widom, 1989a). For example, in Widom’s (1989a, 1998a, 2000)
longitudinal cohorts design study, results
show a strong link between physical child abuse and youth (and adult) violent crime arrests.
In that well-designed studies have shown a developmental link between physical child abuse
and youth violence, a next step is to determine why. Several explanations for why abuse
places children at risk for violence have been offered. One hypothesis is that youths simply
reenact some version of the behavior to which they fell victim at the hands of an abusive
parent, having learned the uses of violence (Widom, 2000). Dodge and colleagues (Dodge,
Bates, & Pettit, 1990; Dodge, Pettit, & Bates, 1997; Dodge, Price, Bachorowski,&Newman,
1990) hypothesized instead that children who areabused suffer deficits in social information
processing, which make them prone to violence. Their research suggests that abused children,
through repeated exposure to severe punishment, develop a tendency to overattribute hostile
intentions to others and to misread social cues in instances in which threats are unclear or
even unintended. In this process, a youth assumes the role of an aggressor against a perceived
hostile target.
Results of the prospective abuse model showed that the parental attachment and school
commitment variables played lesser a role in the mediation of abuse on later violence than did
violent attitudes and peer involvement. In this model, abuse predicted violent attitudes, which,
in turn, predicted involvement with antisocial peers, which, in turn, predicted violent behavior
in youths. The link between earlier abuse and violent attitudes in youths is indeed suggestive
of a cognitive/social learning perspective on the transmission of violence, in which youths
incorporate into their own cognitive and social interactional styles ways of relating that
resemble those used by their parents toward them.
POSLEDICE TRAVME – NEVROPSIHOLOŠKE POSLEDICE
Early experiences with a traumatizing caregiver are well known to impact negatively the
child’s attachment security, stress coping strategies, and sense of self (Crittenden and
Ainsworth, 1989; Erickson, Egeland, and Pianta, 1989). (Advances in Neuropsychoanalysis,
Attachment Theory, and Trauma Research: Implications for Self Psychology, ALLAN
N. SCHORE, PH.D.)
Current studies in developmental traumatology conclude that “the overwhelming stress of
maltreatment in childhood is associated with adverse influences on brain development” (de
Bellis et al., 1999, p. 1281). And so it is now thought that specifically a dysfunctional and
traumatized early relationship is the stressor that leads to PTSD, that severe trauma of
interpersonal origin may override any genetic, constitutional, social, or psychological
resilience factor, and that the ensuing adverse effects on brain development and alterations of
the biological stress systems may be regarded as “an environmentally induced complex
developmental disorder” (de Bellis, 2001). (Advances in Neuropsychoanalysis, Attachment
Theory, and Trauma Research: Implications for Self Psychology, ALLAN N. SCHORE,
PH.D.)
During the first two years of life, chronic and cumulative states of overwhelming,
hyperaroused affective states, as well as hypoaroused dissociation have devastating effects on
the growth of psychic structure. The survival mode of conservation-withdrawal induces an
extreme alteration of the bioenergetics of the developing brain. In critical periods of regional
synaptogenesis this would have growth-inhibiting effects, especially in the right brain, which
specializes in withdrawal. This is because the biosynthetic processes that mediate the
proliferation of synaptic connections in the postnatally developing brain demand, in addition
to sufficient quantities of essental nutrients, massive amounts of energy. An infant brain that
is chronically shifting into hypometabolic survival modes has little energy available for
growth (see Schore, 1994,
1997a, 2001b).
Recent neurobiological studies in developmental traumatology indicate that the infant’s
psychobiological response to trauma is comprised of two separate response patterns,
hyperarousal and dissociation (Perry et al., 1995; Schore, 1998d, 1999b, c, 2001b, e, f,
2002e). In the initial stage of threat, an alarm reaction is initiated, in which the sympathetic
component of the ANS is suddenly and significantly activated, resulting in increased heart
rate, blood pressure, and respiration. Distress is expressed in crying and then screaming. This
state of fear-terror is mediated by sympathetic hyperarousal, and it reflects increased levels of
the major stress hormone corticotropin releasing factor, which in turn regulates noradrenaline
and adrenaline activity (see Schore, 1997a, 2001b, 2002e). But a second later-forming,
longer-lasting traumatic reaction is seen in dissociation, in which the child disengages from
stimuli in the external world and attends to an “internal” world. The child’s dissociation in the
midst of terror involves numbing, avoidance, compliance,
and restricted affect. Traumatized infants are observed to be “staring off into space with a
glazed look.” This parasympathetic dominant state of conservation-withdrawal occurs in
helpless and hopeless stressful situations in which the individual becomes inhibited and
strives to avoid attention in order to become “unseen” (Kaufman and Rosenblum, 1967;
Schore, 1994). This primary regulatory process for maintaining organismic homeostasis
(Engel and Schmale, 1972) is characterized by a metabolic shutdown (Schore, 2001b, in press
a) and low levels of activity (McCabe and Schneiderman, 1985). (Advances in
Neuropsychoanalysis, Attachment Theory, and Trauma Research: Implications for Self
Psychology, ALLAN N. SCHORE, PH.D.)
Very recent basic research indicates that maternal deprivation increases cell death in the infant
brain (Zhang et al., 2002). Is this the death instinct? Recall, the state of conservationwithdrawal, a primary regulatory process of decreased metabolic energy is accessed when
active coping (flight or fight) is not possible, occurs in hopeless and helpless contexts, and is
behaviorally manifest as feigning death (Engel and Schmale, 1972; Powles, 1992).
(Attachment Theory, and Trauma Research: Implications for Self Psychology, ALLAN
N. SCHORE, PH.D.)
Functions of the mind that spoil what we call ‘intimacy’ will deepen and darken the
‘black hole of trauma’ (van der Kolk & McFarlane, 1996). It is also known that
secondary stressors play an increasingly in• uential role in the development of a
trauma reaction progressively over time and damaged capacity for intimacy
represents an important potential secondary stressor.
C
Posttraumatic stress effects on child witnesses have also been studied but, again, not
as frequently as one might expect. Witnessing domestic violence between parents
has been said to qualify as a traumatic stressor insofar as it entails the deliberate
harm or threat of serious harm to a loved one and a profound sense of helplessness
for child witnesses.
CHILDREN EXPOSED TO INTIMATE PARTNER VIOLENCE
Research Findings and Implications for Intervention
BONNIE E. CARLSON
State University of New York at Albany
TRAUMA, VIOLENCE, & ABUSE, Vol. 1, No. 4, October 2000 321-342
Research findings do not support hippocampal shrinkage in children, although there
is some
evidence of generalized lower brain volumes. DeBellis and colleagues (DeBellis,
Baum, et al., 1999; DeBellis,Keshavan, et al., 2002) failed to find hippocampal
volume loss in maltreated children and adolescents compared with controls but did
find other brain differences such as lower overall cerebral
volume, lower corpus callosum volume, and greater ventricular and cerebral fluid
volumes in the maltreated group. Similar results were found by Carrion, Weems,
Eliez, et al. (2001) who observed significantly smaller overall brain and cerebral
volumes in children with a history of repeated exposure to trauma compared with
controls. Trauma-exposed children had smaller intracranial, cerebral, and prefrontal
cortex, and prefrontal cortical white matter, as well as greater frontal lobe fluid
volume than controls.
Advances and Future Directions in the Study of Children’s Neurobiological Responses to Trauma and Violence Exposure
KATHERINE BEVANS, Tulane University, ARLEEN B. CERBONE, Louisiana State University, STACY OVERSTREET, Tulane
University
JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 20 No. 4, April 2005 418-425
Stress response is largely mediated by two interrelated systems, the locus coeruleusnorepinephrine (LC/NE) system and the hypothalamic pituitary adrenal (HPA) axis (Lupien
& McEwen, 1997). However, most neurobiological research on child exposure to violence
and trauma concerns HPA-axis
stress response (Cicchetti & Rogosch, 2001; Hart, Gunnar, & Cicchetti, 1996). The HPA axis
is a complex system of interrelated, multiple structural regions and neuromodulators in the
brain designed to mediate the fight-flight response. Basal activity of the HPA axis, which is
essential for normal brain growth and metabolic activity, follows a circadian rhythm with high
earlymorning cortisol levels declining to low levels around the onset of sleep (McEwen,
1998).
Neuroimaging is another promising area of research into the effects of violence and trauma on
the developing brain. Magnetic resonance imaging (MRI) can be used to identify gross
pathological abnormalities as well as to quantify sizes of various brain regions. MRI is
superior to computed tomographic (CT) scanning because of the relatively inferior soft tissue
resolution seen in CT.
Advances and Future Directions in the Study of Children’s Neurobiological Responses to
Trauma and Violence Exposure
KATHERINE BEVANS, Tulane University, ARLEEN B. CERBONE, Louisiana State
University, STACY OVERSTREET, Tulane University
JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 20 No. 4, April 2005 418-425
One of the most exciting developments to emerge from the field in the past 20 years is the
increasing attention to neurobiological responses to violence and trauma exposure. Although
researchers have yet to identify a consensual pattern of neurobiological response to violence
and trauma exposure, it does appear that some type of alteration in the hypothalamic pituitary
adrenal (HPA) axis is likely. This article briefly reviews the multiple moderating factors that
help account for the divergent patterns in HPA function as well as methodological advances
that will continue to improve the assessment of HPA function in youth exposed to violence
and trauma.
Advances and Future Directions in the Study of Children’s Neurobiological Responses to
Trauma and Violence Exposure
KATHERINE BEVANS, Tulane University, ARLEEN B. CERBONE, Louisiana State
University, STACY OVERSTREET, Tulane University
JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 20 No. 4, April 2005 418-425
A number of researchers maintain that these two criteria preclude PTSD and
amnesia from coexisting, and some empirical studies support this position [7± 10].
Sbordone [7] noted that the typical PTSD patient cannot erase the traumatic event
from his/her mind and suffers recurrent intrusions and re-experiencing of the event,
symptoms that are incompatible with amnesia. He further argued that amnesia,
commonly resulting from cerebral contusion, is an impairment of the ability to
process and record ongoing events. Therefore, in the aftermath of the trauma,
there are no memories of the event for the amnesic patient to re-experience.
Despite the theoretical arguments against co-occurring PTSD and amnesia, a
number of case reports and empirical studies have indicated that amnesic victims can
develop PTSD [1, 11± 13]. The present study prospectively examined the incidence
of PTSD in amnesic and non-amnesic MVA victims.
BIOLOŠKE ZNAČILNOSTI
Recent studies have demonstrated that PTSD patients differ in basal neuroendocrine
levels from trauma victims without PTSD. For example, PTSD patients
have exhibited greater levels of 24-hour urinary catecholamine excretion than
controls [14± 16], and a majority of studies (for exceptions see [17, 18]) have
found lower 24-hour urinary cortisol excretion in patients with PTSD compared
to trauma victims without PTSD and controls [14, 19± 23]. Heightened basal levels
of catecholamines suggest a general hyperarousal of sympathetic nervous system
(SNS) activity, while lower cortisol levels indicate an accompanying down-regulation
of the hypothalamic-pituitary-adrenal (HPA) axis. In addition, combining SNS and
HPA hormone levels into a NE/cortisol ratio has demonstrated greater diagnostic
specificity for PTSD than either hormone alone [24]. These findings have led
researchers to suggest that greatly increased catecholamine levels without the
compensatory effect of accompanying cortisol increases at the time of a traumatic event could lead
to the formation of `superconditioned’ memories that may become
the basis of intrusive thoughts and the re-experiencing symptoms of PTSD [25].
The majority of these studies have examined neuroendocrine abnormalities in
chronic PTSD patients who have often been symptomatic for over 20 years and
suffered comorbid drug or alcohol abuse. More recent research has reported that
MVA victims who met PTSD criteria 1 month following the accident excreted
significantly lower levels of cortisol in 15-hour urine samples collected upon admission
to the trauma unit than non-PTSD victims [2]. This suggests that initial
physiological responses to trauma may contribute, in part, to the development of
PTSD following a traumatic event. If amnesic patients experience the traumatic
event differently from non-amnesics, this may provide a mechanism through which
amnesia could buffer post-traumatic stress. The present study examined initial
neuroendocrine
response and the development of PTSD symptomatology in amnesic and
non-amnesic MVA victims. It was hypothesized that amnesic patients would be less
likely to meet PTSD diagnostic criteria 1 month after their accident and would
display lower catecholamine levels and higher basal cortisol than non-amnesic
victims. Further, it was hypothesized that initial hormone levels would mediate
the relationship between amnesia and PTSD.
REZULTATI
Of the 53 participants who were assessed at the 1-month follow-up, nine
individuals (17%) met full PTSD diagnostic criteria. Chi-square analyses revealed
that non-amnesics were more likely to meet diagnostic criteria than amnesics
(À2…1; n ˆ 53† ˆ 4:85; p < 0:05). None of the amnesic subjects met criteria for
PTSD.
The present study provides partial support for the hypothesis that amnesia for a
traumatic event can serve as a buffering function in the development of subsequent PTSD
among MVA victims. None of the amnesic patients in the sample met PTSD
criteria due to their accident, and amnesic patients reported fewer symptoms of
PTSD on the IES and on the SCID. Additionally, amnesics and non-amnesics
differed in their initial physiological responses to the MVA, with amnesics having
lower NE/cortisol ratios than non-amnesics. These results suggest that amnesics
may physiologically experience the accident differently from non-amnesics, and
that amnesics have lower subsequent PTSD incidence. However, urinary hormones
did not mediate the effects of amnesia on PTSD, although this may have been due
to the lack of power afforded by the small sample size.
The findings of lower NE/cortisol ratio in amnesics compared to non-amnesics
may provide some insight into the protectiveness of amnesia in subsequent PTSD
development. Prior research has found that heightened catecholamine levels are
associated with greater memory retention of stressful stimuli in animal and
human studies [38, 39]. In addition, other researchers have hypothesized that
high levels of catecholamines without the compensatory effects of cortisol could
lead to aberrant memory formation or `supermemories’ [25]. These results support
this hypothesis, as it was found that amnesics who had a combination of low NE
and high cortisol (without differences in either alone) also had a lower incidence of
PTSD, and fewer PTSD symptoms, than non-amnesics.
Traumatic experiences cause traumatic stress, which disrupts homeostasis.
During the past few years, we have dramatically increased our understanding
of the effects of traumatic stress on the brain, sympathetic nervous
system, and endocrine system. Through a physiological domino effect, these
changes affect many other body systems, including the cardiovascular system,
respiratory system, and muscular system.
The endocrine system works closely with the nervous system to regulate
the body’s physiology. Traumatic experience causes both immediate and
long-term endocrine changes that affect metabolism and neurophysiology.
The sympathetic nervous system is immediately affected by any perception
of danger and signals the adrenal medulla to greatly increase its output of epinephrine and norepinephrine. These hormones rapidly affect many body systems
leading to a fight-or-flight response. If neither response is possible, the
person freezes.
During stress, the hypothalamic-pituitary-adrenal system is also activated,
leading to increased levels of cortisol, a glucocorticoid released by the
adrenal cortex that modulates the physiologic response to stress and helps
activate effective coping strategies. Cortisol concentration has been the focus
of several recent studies because abnormally high levels of cortisol, associated
with stress, can damage neurons in the hippocampus.
Abnormal concentrations of adrenal hormones depress the immune system
and contribute to the physiological hyperarousal (e.g., exaggerated startle
response, hypervigilance) characteristic of PTSD. Chronic physiological
hyperarousal makes it very difficult to regulate autonomic responses to internal
or external signals and decreases the ability to respond appropriately to
emotional signals (van der Kolk, 1996). In chronic stress and in Post-Traumatic
Stress Disorder (PTSD), cortisol concentrations are lower than would
be expected, and exposure to new stressors elicits lower levels of cortisol
secretion.
To understand the problems presented by traumatic memories, we will
first review how nontraumatic memories are processed. Memories of ordinary
experiences are temporarily stored in the limbic system as episodic
memories, memories of personal experience and events. Episodic memories
are autobiographical; they include a sense of time and self. Cognitive aspects
are stored in the hippocampus and the associated emotion is stored in the
amygdala. As the brain processes these memories over time, aspects of them
are abstracted and transferred to the neocortex, particularly the association
areas of the frontal lobes, for long-term storage. These memories are semantic, or factual, memories. (Episodic and semantic memories are two types of
explicit memory.)
The memories of moderately disturbing experiences apparently remain in
the right limbic system for a longer period of time than the memories of neutral
events.We process disturbing memories by thinking, talking, and sometimes
dreaming about the experience. As the brain slowly processes the
memory, it is abstracted and transferred into the left neocortex where it is
filed away along with other memories and becomes part of the narrative of
one’s life. The stored information can be retrieved when needed to understand
future events.
Traumatic events overwhelm the brain’s capacity to process information.
The episodic memory of the experience may be dysfunctionally stored in the
right limbic system indefinitely and may generate vivid images of the traumatic
experience, terrifying thoughts, feelings, body sensations, sounds, and
smells. Such unprocessed traumatic memories can cause cognitive and emotional
looping, anxiety, PTSD, maladaptive coping strategies, depression,
and many other psychological symptoms of distress. Because the episodic
memory is not processed, a relevant semantic memory is not stored and
the individual has difficulty using knowledge from the experience to guide
future action.
Because traumatic experiences are terrifying, the survivor avoids thinking
and talking about what happened. This avoidance prevents processing.
Trauma alters physiology and gives rise to images, feelings, sensations, and
beliefs that may persist throughout life. Only after the traumatic memory is
fully processed and integrated can homeostasis be restored.
Traumatic memories can be triggered by stimuli that are in some way
associated with the traumatic event. Terrifying memories, including the
affect associated with them, may be reexperienced with their original intensity.
Survivors feel the terror and may lose their sense of time and place. One
client stated, “Part of me knows it’s not really happening now, but it feels so
real that I get mixed up.”
Brain scan technology enables us to study the brain in action. Using PET
scans, researchers have demonstrated some of the neurophysiological effects
that take place when traumatic memory is triggered. In one study, participants
were asked to write detailed narratives of their traumatic experience
(Rauch et al., 1996). Then, each participant was asked to read the narrative
during brain scanning. The results were dramatic. Activity increased in the
right brain, primarily in the limbic system and in the visual cortex (the site
of vivid images of the event). Activity decreased in the anterior cingulate
cortex (ACC), which normally modulates the limbic system. Activity also
decreased in Broca’s area, an area of the brain important in semantic processing
and articulation of language. This decrease in activity may be the
neurophysiological basis for the “speechless terror” that many individuals
experience both during a traumatic event and when processing trauma in
therapy.
In the United States, child abuse and neglect are the most common causes
of Type III trauma, extreme trauma characterized by multiple traumatic experiences
that typically begin at an early age (Solomon & Heide, 1999). An
infant’s relationship with its primary caregiver has a direct effect on the hard
wiring of neural circuits in the developing brain. Many of the neural circuits
affected by early experience connect areas of the brain critical for emotional,
physiological, psychological, and social development. Some of these circuits
are necessary for adaptive coping in emotional and stressful situations
(Schore, 2003).
The orbitofrontal cortex helps regulate emotional states and responses. By
way of its connections with the hypothalamus and limbic system, it regulates
autonomic responses to social stimuli and mediates emotionally “attuned
communication.” This part of the cortex helps us understand other people’s
emotional experience, enabling us to respond empathically, a capacity necessary
for moral judgment. Normal development of the right brain and later
emotional and social development depend on healthy attachment between
infant and caregiver (Schore, 1994, 1996, 2003).
Children who are severely neglected experience chronic traumatic stress
that compromises right brain development, resulting in neuron damage and
atrophy. Impairment of the orbitofrontal cortex and the circuits connecting it
with subcortical areas can diminish the child’s sense of self, leading to disconnection
from other people. Severely neglected children do not deal well
with stress and do not develop the ability to regulate the intensity and duration
of their affect (Schore, 2002; van der Kolk & Fisler, 1994). Because
these children have difficulty understanding emotion expressed by other people,
they may not develop empathy.
Many studies conclude that impaired development of the orbitofrontal
cortex and its neural connections with the limbic system decreases capacity
to regulate affect. For example, the orbitofrontal cortex normally inhibits
areas in the hypothalamus that are associated with aggression and thus is central
in the regulation of aggressive impulses. Abnormal development of the
neural circuits linking the orbitofrontal cortex and ACC with the amygdala
interferes with normal inhibition of rage responses.Without the normal corSolomon, Heide / THE BIOLOGY OF TRAUMA 55
tical modulating effect, the amygdala’s responses are exaggerated. When
aggressive impulses are not inhibited, an individual may act out violently.
This lack of inhibition is part of the pattern of sociopathy (Best,Williams,&
Coccaro, 2002; Schore, 2003). Studies suggest that trauma caused by neglect
and abuse can lead to antisocial behavior (Heide, 1992, 1999).
Many long-term changes in the brain have been associated with Type III
trauma, including abnormal concentrations of certain neurotransmitters,
changes in EEG patterns, and a decrease in integration between right and left
hemispheres. Measurable size decreases have been found in the cerebral volume,
the corpus callosum, amygdala, and hippocampus. Whether or not
these changes are reversible with treatment is an important question for
future study.
NEVROPSIHOLOŠKE RAZLIKE MED SPOLOMA
Fig. 1. The amygdala (red region), a small almond-shaped
structure located deep in the anterior temporal lobe, plays a
critical role in a variety of emotional processes including emotional
memory and adaptive responses to emotional stimuli.
Recent work suggests that several differences between men
and women in emotional responses arise in part from sex differences
in amygdala responses. Reprinted with permission by
Digitial Anatomist Project, Department of Biological Structure,
University of Washington.
In addition to functional differences in amygdala
response, such as in emotional memory and in
responses to sexually arousing stimuli, the amygdala
in men and women differs in terms of structure and in
aspects of brain development. These structural and
developmental differences likely contribute to the
functional differences observed in neuroimaging
studies.
One major difference between the sexes is the size
of the amygdala. In the adult human brain, the male
amygdala is significantly larger than the female
amygdala, even when total brain size is taken into
account (Goldstein and others 2001). Although the
specific consequences of this sex difference in amygdala
size are not known, structural differences in brain
anatomy often are associated with differences in brain
function and response. For example, one recent study
found a relation between the size of the amygdala in
patients with epilepsy and sexual drive; patients with
greater residual amygdala size after undergoing neurosurgery
reported greater sexual drive and motivation
(Baird and others 2004). Interestingly, the brain
regions that differ in size between men and women
tend also to be the same regions that contain high
concentrations of sex hormone receptors, suggesting
that male and female hormones play a role in determining
the size of specific brain regions such as the
amygdala during brain development (Goldstein and
others 2001). Consistent with this idea, neuroimaging
studies have found that amygdala, which contains relatively
high concentrations of sex hormone receptors,
develops structurally at different rates in human males
and females. Other structural differences in areas that
receive strong neuronal connections from the amygdala,
such as the hypothalamus, which is larger in men
than women, may also contribute to sex differences in
brain response that involve the amygdala. Circulating
levels of sex hormones in the bloodstream constitute
an additional influence on amygdala response through
their action on receptor sites. Future work will be necessary
to elucidate the complex relationship between
structural, developmental, and functional aspects of
amygdala sex differences.
Memory for emotional events is generally better than
memory for emotionally neutral events (Hamann 2001).
Several psychological studies have reported that men
and women differ substantially with respect to emotional
memory (Hamann and Canli 2004). For example,
women can recall emotional memories more quickly, can
recall more emotional memories in a given period of
time, and report that the emotional memories they recall
are richer, more vivid, and more intense. In general,
then, women tend to experience greater enhancement of
their memory by emotion (Seidlitz and Diener 1998).
The stronger effect of emotion on women’s memories is
not entirely beneficial, however. As described below,
emotion can also impair memory in some situations, and
this impairment is accentuated in women. In addition,
the fact that emotional memories tend to be stronger for
women may be linked to the greater prevalence of
depression and some types of anxiety disorders in
women (Davidson and others 2002).
The three neuroimaging studies that have examined
the brain correlates of these differences in emotional
memories have found a remarkably consistent pattern of
sex differences in the role of the left and right amygdala
in emotional memory. These studies have focused on the
effects of emotional arousal on declarative memory,
memory for facts or events that can be brought to mind
through a conscious, voluntary effort to retrieve the
memory (Squire and Zola 1996). Each of these studies
examined differences in brain activity occurring during
memory encoding (i.e., memory formation) that were
predictive of subsequent successful emotional memory
retrieval. That is, one can examine which items are successfully
retrieved on a later test and then go back to
determine which brain areas were more active when
those items were originally encoded in the brain scanner.
Cahill and others (2001) used PET to image brain
activity while men and women watched either highly
aversive films or neutral films. The level of amygdala
activity at encoding predicted later emotional memory
performance for both males and females. However, for
females, this relation was found in the left amygdala
whereas for males it was in the right amygdala. A later
study by Canli and others (2002) examined brain activity
in men and women during the encoding of emotional
and neutral scenes in photographs, using fMRI.
Consistent with the prior PET study, amygdala activity
during the encoding of the most emotionally arousing
photographs was strongly related to later recognition
memory for the emotional pictures, but again this relationship
was seen in the left amygdala for women and
the right amygdala for men. The strength of an emotional
experience, referred to as emotional arousal, is currently
thought to be the most important factor that determines
the degree of memory enhancement associated
with an emotional event (Hamann and others 1999;
Canli and others 2000). In this study, participants’ ratings of emotional arousal correlated with left amygdala
activity in both men and women. Thus, in females the
brain regions involved in emotional reactions coincide
with those involved in encoding memory for the experience,
whereas in males these processes occur in different
hemispheres. The authors suggested the greater overlap
between the neural correlates of emotional experience
and emotional memory in women as a possible explanation
for the greater vividness and accuracy of their emotional
memories.
In the third study, Cahill and others (2004) examined
memory for emotionally arousing photographs in men
and women using a similar fMRI task as was used by
Canli and others (2002) and again found that later levels
of emotional memory were strongly correlated with left
amygdala activity in women but right amygdala activity
in men. In summary, these studies have found a consistent
sex difference between the role of the left and right
amygdalas (Fig. 2). Speculations regarding the origin of
these sex differences have included sexually dimorphic
brain development (Goldstein and others 2001), the
influence of sex hormones both during development and
during adulthood, and possible differences in the cognitive
style used by men and women in encoding emotional
experiences.
Strange and others (2003) examined the effect of
inserting an emotional event (an emotionally arousing
word) into a sequence of neutral events (a list of neutral
words). As expected, memory for the arousing word was
better than memory for the neutral words. Interestingly,
however, memory for words presented just before the
emotional word was also affected, but instead of
enhancement, memory was impaired. This impairment
was not found in a patient with bilateral amygdala
lesions, strongly suggesting that the effect is amygdaladependent.
In addition, the size of the emotion-induced
memory impairment was found to be twice as large for
women than for men. The specific mechanisms responsible
for this memory impairment are yet unknown, but
these findings are noteworthy in that they suggest that
both the enhancing and the impairing effects of emotion
are magnified in women.
MERJENJE
Life Experiences Questionnaire (LEQ)
The LEQ is a self-report instrument developed by the second author
(Long, 1999), which includes questions regarding demographics and childhood
sexual experiences. Participants were instructed to report all sexual
experiences occurring before the age of 17.
Modified Sexual Experiences Survey (MSES)
The MSES is a modified version of the 10-item Sexual Experiences Survey
(SES) (Koss&Gidycz, 1985) andwas used to assess adult unwanted sexual
contact. The MSES asks a series of yes/no questions assessing whether
specific types of sexual activities had been attempted or completed with the
participant since the age of 17.
Conflict Tactics Scales (CTS)
The CTS Form N developed by Straus (1979) was used to assess the presence
and extent of intimate violence among dating partners and spouses.
Psychological Maltreatment of Women Inventory (PMWI)
Tolman’s (1989) PMWI was used to assess psychological abuse and contains
two subscales.
Abuse questionnaire
The next questions are about forms of childhood abuse to
which you may have been exposed to before 16 years of age.
1. Do you think that there was any kind of emotional neglect?
(This means for example that people at home didn’t listen to
you, that your problems were ignored, that you had the
feeling of not being able to find any attention or support
from the people in your house).
2. Do you think there was any kind of psychological abuse?
(This means for example; being sworn at, lesser treatment
compared to brothers or sisters, unjustified punishment,
blackmail).
3. Do you think there was any kind of physical abuse?
(That is, were you ever beaten, kicked, punched or did you
experience any other kind of physical abuse?
4. Were you ever approached sexually against your will?
(This means: were you ever been touched sexually by
anyone against your will or forced to touch anybody,
were you ever pressured into sexual contact against your
will?)
INSTRUMENTI ZA MERJENJE SIMPTOMOV KOMPLEKSNE TRAVME
Posttraumatic symptoms, PTSD, and CPTSD.
The following instruments are recommended at this time: Clinician-Administered PTSD Scale
(CAPS; Blake et al., 1996), Impact of Event Scale—Revised (IES–R; Weiss & Marmar,
1997), Detailed Assessment of Posttraumatic States (DAPS; Briere, 2001), and
Posttraumatic Stress Diagnostic Scale (PDS; Foa, 1995). Perhaps the two most useful in the
identification of CPTSD are the Trauma Symptom Inventory (TSI), an instrument developed
to assess trauma symptoms proper but that assesses domains of the self and relations with
others (Briere, 1995; Briere, Elliot, Harris, & Cotman, 1995), and the Structured Interview for
Disorders of Extreme Stress (SIDES), developed for the DSM–IV field trial (Pelcovitz et al.,
1997; van der Kolk, 1999; Zlotnick & Pearlstein, 1997). Additionally, the Inventory of Altered
Self Capacities (IASC; Briere, 2000b) assesses difficulties in relatedness, identity, and affect
regulation and is therefore very pertinent to this population, as do the Cognitive Distortion
Scales (CDS; Briere, 2000a) and the Trauma and Attachment Belief Scale (Pearlman, 2003),
measures of trauma-related beliefs and cognitive distortions.
NEOPREDELJENO