UvA-DARE ( Digital Academic Repository ) Long-term effects of childhood sexual abuse : Objective and subjective characteristics of the abuse and psychopathology in later life

This study investigates the association between objective and subjective characteristics of childhood sexual abuse and psychopathology in later life. The sample consists of 404 Dutch female adults who had been sexually abused in their childhood or adolescence. The participants were recruited by means of articles about childhood sexual abuse in major Dutch newspapers. The characteristics and severity of the sexual abuse were assessed with the Questionnaire Unwanted Sexual Experiences in the Past (QUSEP). General psychopathology was measured with the Symptom Checklist (SCL-90), the degree of dissociation was measured with the Dissociation Questionnaire (DIS-Q). Stepwise multiple regression analyses showed a moderate association between psychopathology and objective characteristics of the abuse, such as number of different types of abusive events and the duration of the abuse. However, more strongly associated with later psychopathology were variables reflecting coping style, such as the degree of self-blame, and circumstantial factors, such as the emotional atmosphere in the family of origin and the reactions following disclosure. Whether or not the abuse was incestuous did not explain additional variance in later psychopathology. Alfred Lange et al. Childhood Sexual Abuse and Psychopathology 3 Introduction There is abundant evidence that victims of childhood sexual abuse are highly at risk of developing physiological and psychological problems (Beitchman et al., 1991; Briere and Runtz, 1988; Brown and Anderson, 1991; Browne and Finkelhor, 1986; Feinauer, 1989; Lange et al., 1995; Nash et al., 1993 a; Palmer et al., 1993; Russell, 1986; Surrey et al., 1990; Williams, 1993; Wozencraft et al., 1991). A review by Finkelhor and Browne (1988) on the long term effects of childhood sexual abuse demonstrated increased risk of sexual disorders, depression, anxiety disorders, auto-mutilation, alcoholand substance abuse, eating disorders, feelings of isolation and stigmatization, deficiencies in self-esteem, anger towards parents, and prostitution. Furthermore, associations have been found between childhood sexual abuse and sleeping disorders, excessive distrust, borderline personality disorder, dissociative disorders, and psychotic symptoms (Boon and Draijer, 1993; Breyer et al., 1987; Kihlstrom et al., 1993; Surrey, et al., 1990). Various studies provide evidence that the effects of childhood sexual abuse depend on individual characteristics of the victims and interpersonal factors at the age of the abuse and later in life (Finkelhor, 1990; Russell, 1986). Several variables are hypothesized to play a role in the association between childhood sexual abuse and psychopathology. These include the characteristics of the abuse, the way it is experienced and processed, family factors, and individual characteristics of the victim. At present, little is known about the relative contributions of various aspects of sexual abuse to the development of psychological symptoms and re-victimization later in life. Several studies have identified factors that are predictive of adult psychopathology. These factors include the nature of the sexually abusive events, the age at the onset of the abuse, the duration, the frequency, the relationship with the perpetrator, the difference in age, the number of perpetrators, and the degree of pressure experienced by the victim to cooperate with the abuser (Beitchman et al., 1991; Briere Alfred Lange et al. Childhood Sexual Abuse and Psychopathology 4 and Runtz, 1988; Follette et al., 1991; Nash et al., 1993 b; Russell, 1986; Williams, 1993). However, these findings are based on relatively small clinical samples (Finkelhor and Browne, 1988; Mennen and Meadow, 1994; Messman and Long, 1996; Williams, 1993). In addition to these objective characteristics of the abuse, the subjective experiences of the abuse and related coping behavior appear to be important. Morrow and Sorell (1989) demonstrated that the victims of sexual abuse, who blamed themselves for the abuse, suffered more symptoms of psychopathology than victims who did not blame themselves. The negative effects of self-blame were confirmed in a meta-analysis by Weaver and Clum (1995). Furthermore, a review by Faust et al. (1995) indicated that the emotional atmosphere in the family of origin is related to both the prevalence of abuse and later processing of the traumatic experiences (Nash et al., 1993 a). Most of the studies mentioned so far focus on a single variable, or on a small number of variables, so that the relative importance of individual variables is hard to gauge. Binder et al. (1996) carried out multivariate analyses to identify variables that predict psychological well-being of female adults who had suffered childhood sexual abuse. Absence of perceived pressure, a short duration of the abuse, and the absence of family conflict emerged as important predictors of well being in spite of past sexual abuse. However, their sample (N=30) was too small to carry out multivariate analyses. Spaccarelli and Fuchs (1997) investigated a sample of 48 girls between 11 and 18 years who were referred for therapy after disclosing sexual abuse. Multivariate analyses showed that reactions to disclosure was the best predictor of the severity of internalizing problems (depression and anxiety). The aim of the present study is to establish which factors are predictive of psychological functioning in later life in a large sample of respondents. We include a large number of variables relating both to the objective and the subjective characteristics of the abuse. The large number of Alfred Lange et al. Childhood Sexual Abuse and Psychopathology 5 respondents and the comprehensive assessment of the abuse allow for multivariate analyses in which the relative importance of each variable is assessed.