What happens to maltreated boys and girls when they grow up? A higher-order model of trauma using a community sample

Neglect, abuse, and negative life events (NLEs) can be traumatic, distressing, and debilitating. Our understanding of these kinds of trauma in the general community is limited, as most of the extant research relies on clinical samples, uses constrained sets of outcomes, and lacks agreement on appropriate measures. This thesis presents research designed to overcome some of these limitations. Two new measures of abuse and NLEs were developed, allowing separate measurement of the frequency and severity of trauma across different life stages. The measures, and the SCL-90-R were administered in a random community survey (220 females, 168 males), with a 62% response rate. The abuse scale revealed three discrete factors: psychological abuse, sexual abuse, and physical abuse. Derived subscales produced from two of these factors were all internally reliable, as was the total abuse scale. The Psychological Abuse Scale produced three subscales: Emotional Neglect, Belittlement, and Judgmental. The Physical Abuse Scale produced two subscales: Subjugation and Physical Violence. The Sexual Abuse Scale was not differentiable any further. When the scales and subscales were tested using structural equation modeling, all models performed well, with minimal amounts of unexplained variance. All scales and subscales contributed to a reliable and valid higher-order model of maltreatment. Prevalence rates of abuse, especially psychological abuse, were high for both males and females. Males reported higher lifetime histories of psychological abuse than did females. Importantly, the genders showed different symptom patterns and cumulative effects among the types and subtypes of abuse. Psychological abuse was the most severe form of abuse, followed by physical abuse. The most common symptoms following maltreatment were paranoid ideation, interpersonal sensitivity, hostility, somatisation, and psychoticism. Sexual abuse was the least reported form of abuse, with only weak associations with symptom measures, though females showed more severe effects than did males. The frequency with which NLEs are experienced was moderately associated with various symptoms, was more dysfunctional for males, and the associated distress increased in intensity through the life stages for males only. Including NLEs into a higher-order structural equation model of trauma significantly increased the model‟s adequacy. The severity of the experience of NLEs predicted psychological dysfunction, particularly for males, and more strongly when experienced during adulthood than in other life stages. For females, psychological abuse was the strongest predictor of dysfunction, particularly Emotional Neglect when experienced during adulthood, and Physical Violence and Subjugation during childhood. The two measures developed in this thesis add important tools to allow further non-clinical research on the experience of abuse and NLEs. They could also be useful clinically as assessment-guided therapy tools. This thesis demonstrates the value of using a community sample, rather than a clinical sample, as it allowed estimates of community prevalence rates, and was able to include more males than would present in clinical samples. Future research needs to further investigate the interplay between the severity and frequency of the experience of abuse and NLEs (possible now with the new tools developed here which measure frequency and severity separately). It is also important that future research, on how males and females experience abuse and NLEs, makes comparisons within each gender rather than between the genders.