History of childhood abuse in Portuguese parents.

The study examines the self-reported prevalence of childhood physical and sexual abuse in a large sample of Portuguese parents.



Nearly 1,000 parents (506 mothers and 426 fathers) were selected through public primary schools from the Northern area of Portugal. All completed the Portuguese version of the Childhood History Questionnaire (CHQ) .



Results show that the prevalence of abuse was 73%, but more severe physical abuse involving sequelae/injury was reported by 9.5%. Most physical abuses began prior to age 13, with half continuing after age 13. No gender differences were found for rates of physical abuse. However, among the milder physical abuse without sequelae/injury, those women who experienced "whipping" or "slapping/kicking" were more likely to do so from their mothers than fathers. Among men who were "slapped/kicked" this was more likely to be from their fathers. Low rates of sexual abuse were found at 2.6% with no gender or age differences. Lack of a supportive adult in childhood related to the more severe abuses, but only in adolescence. Portuguese rates of abuse were consistently lower than those reported in USA and Spanish studies using the CHQ.



This is the first retrospective, self-report study of childhood abuse in a large sample of Portuguese parents and, even with a participation rate of 69%, shows lower rates than in US and Spanish samples.

Related papers:

title: Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study.
abstract: Suicide is a leading cause of death in the United States, but identifying persons at risk is difficult. Thus, the US surgeon general has made suicide prevention a national priority. An expanding body of research suggests that childhood trauma and adverse experiences can lead to a variety of negative health outcomes, including attempted suicide among adolescents and adults.



To examine the relationship between the risk of suicide attempts and adverse childhood experiences and the number of such experiences (adverse childhood experiences [ACE] score).



A retrospective cohort study of 17 337 adult health maintenance organization members (54% female; mean [SD] age, 57 [15.3] years) who attended a primary care clinic in San Diego, Calif, within a 3-year period (1995-1997) and completed a survey about childhood abuse and household dysfunction, suicide attempts (including age at first attempt), and multiple other health-related issues.



Self-reported suicide attempts, compared by number of adverse childhood experiences, including emotional, physical, and sexual abuse; household substance abuse, mental illness, and incarceration; and parental domestic violence, separation, or divorce.



The lifetime prevalence of having at least 1 suicide attempt was 3.8%. Adverse childhood experiences in any category increased the risk of attempted suicide 2- to 5-fold. The ACE score had a strong, graded relationship to attempted suicide during childhood/adolescence and adulthood (P<.001). Compared with persons with no such experiences (prevalence of attempted suicide, 1.1%), the adjusted odds ratio of ever attempting suicide among persons with 7 or more experiences (35.2%) was 31.1 (95% confidence interval, 20.6-47.1). Adjustment for illicit drug use, depressed affect, and self-reported alcoholism reduced the strength of the relationship between the ACE score and suicide attempts, suggesting partial mediation of the adverse childhood experience-suicide attempt relationship by these factors. The population-attributable risk fractions for 1 or more experiences were 67%, 64%, and 80% for lifetime, adult, and childhood/adolescent suicide attempts, respectively.



A powerful graded relationship exists between adverse childhood experiences and risk of attempted suicide throughout the life span. Alcoholism, depressed affect, and illicit drug use, which are strongly associated with such experiences, appear to partially mediate this relationship. Because estimates of the attributable risk fraction caused by these experiences were large, prevention of these experiences and the treatment of persons affected by them may lead to progress in suicide prevention.

title: Psychiatric profile and sociodemographic characteristics of adults who report physically abusing or neglecting children.
abstract: In this study the authors measured the number of adults in three U.S. communities who reported abusing and neglecting children in their lifetime and assessed the relative impact of sociodemographic characteristics and lifetime diagnosis of mental disorders on both child abuse and child neglect.



A total of 9,841 respondents, identified through a household sampling procedure for the National Institute of Mental Health (NIMH) Epidemiologic Catchment Area study, were included in the analysis. Self-reported lifetime histories of abuse and neglect of children were measured in the antisocial personality module of the NIMH Diagnostic Interview Schedule.



In the study sample, 147 adults (1.49%) stated that they had abused children, and 140 adults (1.42%) stated that they had neglected children. A total of 58.5% of those who reported abuse of children, and 69.3% of those who reported having neglected a child, had a lifetime diagnosis of a mental disorder. Increased odds of reports of both abuse and neglect were associated with having a greater number of children in the household. Low socioeconomic status was a risk factor for neglecting, but not abusing, children. In multivariate analyses, a lifetime history of alcohol disorder was associated with abuse and neglect, affective disorders with abuse, and anxiety disorders with neglecting children.



In light of the associations between mental disorders and mistreatment of children, public health policies designed to prevent child abuse and neglect might be enhanced by an increased focus on interventions targeted at individuals with mental disorders.

title: Childhood abuse and lifetime psychopathology in a community sample.
abstract: The authors assessed lifetime psychopathology in a general population sample and compared the rates of five psychiatric disorder categories between those who reported a childhood history of either physical or sexual abuse and those who did not.



A modified version of the Composite International Diagnostic Interview and a self-completed questionnaire on child abuse were administered to a probability sample (N=7,016) of Ontario residents 15 to 64 years of age.



Those reporting a history of childhood physical abuse had significantly higher lifetime rates of anxiety disorders, alcohol abuse/dependence, and antisocial behavior and were more likely to have one or more disorders than were those without such a history. Women, but not men, with a history of physical abuse had significantly higher lifetime rates of major depression and illicit drug abuse/dependence than did women with no such history. A history of childhood sexual abuse was also associated with higher rates of all disorders considered in women. In men, the prevalence of disorders tended to be higher among those who reported exposure to sexual abuse, but only the associations with alcohol abuse/dependence and the category of one or more disorders reached statistical significance. The relationship between a childhood history of physical abuse and lifetime psychopathology varied significantly by gender for all categories except for anxiety disorders. Although not statistically significant, a similar relationship was seen between childhood history of sexual abuse and lifetime psychopathology.



A history of abuse in childhood increases the likelihood of lifetime psychopathology; this association appears stronger for women than men.

title: Childhood sexual abuse and current suicidality in college women and men.
abstract: In previous research, adults who reported childhood sexual abuse have been more suicidal than nonabused adults, but no research has examined their cognitive deterrents to suicide. Strict definitions of sexual abuse in these studies have excluded (a) unwanted sexual experiences with peers, and (b) exploitive experiences not involving genital contact (i.e., unwanted sexual invitations or suggestions, unwanted exposure to others' genitals via exhibitionism, unwanted kissing or hugging in a sexual way). The present study compared suicidal behavior and cognitive deterrents to suicide in 266 college students using both a strict and a liberal definition of sexual abuse. Both women and men abused by adults or peers were more suicidal as adult college students than were women and men with no such history. Women reported similar degrees of suicidality as men, but greater survival and coping beliefs and more fear of suicide. Those whose sexual abuse involved touching were more suicidal, and felt less able to cope, and less responsibility for their families, than nonabused adults. Implications are that adults who experienced childhood sexual abuse that involved touching are more suicidal and have less cognitive deterrents to suicide than adults who have not, regardless of whether they are men or women or whether they were abused by adults or by peers.

title: Impact of childhood abuse history on psychological symptoms among male and female soldiers in the U.S. Army.
abstract: The long-term psychological effects of four different types of childhood maltreatment were examined among 1,072 male and 305 female soldiers on active duty in the United States Army. The predictor variables included four subscales from the Childhood Trauma Questionnaire (CTQ)-(1) physical-emotional abuse, (2) sexual abuse, (3) emotional neglect, and (4) physical neglect. An additional sexual abuse variable based on the four screening questions developed by Finkelhor, Hotaling, Lewis, and Smith (1990) was also included. Outcome was measured by the Brief Symptom Inventory and a dissociation scale developed by Briere and Runtz (1988). MANOVAs were conducted for each outcome measure. Physical-emotional abuse contributed to most of the effects. However, sexual abuse contributed additional significant effects to all of the subscales. In general, males and females showed similar outcomes, but certain gender differences were noted.

title: The relation of childhood abuse and early parenting experiences to current marital quality in a nonclinical sample.
abstract: This study examines the relation between adults' reports of the nature of the early parenting they received, including abuse, and the quality of their marital relationship. This community sample of 159 married women and men experienced relatively low levels of abuse. The regression analyses indicated that for women verbal abuse in childhood was predictive of marital conflict, and the caring parenting they experienced predicted the depth of their marital relationship. For men, the abuse variables did not predict any dimension of their current marital relationship. Of the parenting variables, overprotection was significantly predictive of conflict in their marriage. No demographic variable--income, education, and number of siblings--predicted any dimension of marital quality for either men or women. Given the skew of the abuse data for this nonclinical sample, log transformations were performed on the data and the regression analyses were reported. One change was noted: that for men, physical abuse and overprotection were equally predictive of marital conflict. The results suggest that abuse and early parent experiences are predictive of marital functioning in a nonclinical sample, but that differences exist in the pattern for men and women.

title: Evidence for specific effects of childhood sexual abuse on mental well-being and physical self-esteem.
abstract: Women who are sexually abused are at increased risk for having mental health problems long after the abuse. Other nonexploitive experiences can also be psychologically detrimental, may coexist with sexual abuse, and may explain some portion of subsequent mental health problems. This study addresses the association between childhood sexual abuse and a woman's psychological functioning, independent of the quality of parental nurturance received during childhood and other variables which may influence mental health. Of 609 women completing mental health and self-concept measures, 98 reported sexual abuse; 110 of the remaining women were selected as comparisons. Women sexually abused as children scored lower on measures of mental health status. Both sexual abuse and fewer years of education were related to lower scores on a psychological well-being scale after variance accounted for by family and demographic variables was removed. Sexual abuse was not a predictor of general self-concept scores after the removal of family and demographic variables, but sexual abuse was independently associated with the subscale measuring the physical aspect of self-concept. These findings lend support to theorized causal links between child sexual abuse and some aspects of later psychological difficulties.

title: Childhood Physical Abuse, Perceived Social Support, and Socioemotional Status in Adult Women
abstract: This study investigated the extent to which an interactional model, relative to a main effect model, predicts the relationship between childhood physical abuse, perceived social support, and various aspects of socioemotional functioning in adult women. The results indicated that perceived social support during childhood was significantly related to subsequent levels of adult depression, trait anxiety, and child abuse potential in a manner consistent with a main effect model. Childhood history of physical abuse was related only to adult child abuse potential. Implications and study limitations are discussed.

title: Pregnancy and delivery for women with a history of child sexual abuse.
abstract: To study whether women with a history of child sexual abuse are at increased risk of delivering low birth weight infants. Secondary aims were to study smoking habits, obstetric complications, health care use, and health complaints during pregnancy among women with a history of child sexual abuse.



In a case control study, 82 women with birth of a low birth weight infant (< 2500 g) (cases) and 91 women with birth of a normal birth weight infant (controls) were interviewed about experiences of child sexual abuse.



Fourteen percent of the women disclosed a history of child sexual abuse involving at least genital touch. Birth of a low birth weight infant was not associated with a history of child sexual abuse (OR 1.03, 95% CI .44-2.40). More women with a history of child sexual abuse were smokers during pregnancy (56% vs. 31%) compared with nonabused women. Abused women reported lower age at menarche and sexual debut. Nonscheduled contacts with the antenatal care clinic and discomfort during pregnancy were more frequent among abused women when controlled for low birth weight.



Women who delivered low birth weight infants were not more likely to have experienced child sexual abuse than women who delivered nonlow birth weight infants. Abused women were unemployed and daily smokers more often than nonabused women. Some of the abused women reported more health complaints, and more use of health care services during pregnancy, but did not have more obstetric complications during pregnancy and delivery.

title: Childhood history of abuse and adult child abuse potential
abstract: The experience of aversive interactions within the family of origin is believed to increase the probability of parental physical child abuse. To test this hypothesis, 375 subjects were given a Childhood History Questionnaire (CHQ) and the Child Abuse Potential (CAP) Inventory. The CHQ contained a series of questions about the presence and frequency of various abusive behaviors and associated sequelae that were received and/or observed before and/or after puberty. The CAP Inventory was used to measure adult physical child abuse potential. As expected, a childhood history of physical abuse was significantly related to adult physical child abuse potential; and, as chronicity increased, so did abuse potential. The experience of physical abuse prior to puberty produced higher abuse scores than the experience of physical abuse after puberty. The study provides preliminary data indicating the childhood experience of a caring adult and / or caring friend moderates adult child abuse potential.

title: Memories of childhood sexual abuse: a survey of young adults.
abstract: To explore the prevalence of, characteristics of, and factors associated with forgetting of childhood sexual abuse memories in a large non-clinical sample (N = 1712).



Using an anonymous survey, we asked respondents about (a) the nature and severity of their childhood abuse; (b) the continuity of their abuse memories; and (c) their experiences with others suggesting to them that they might have been abused.



A substantial minority of victims in our sample reported having temporarily forgotten their childhood sexual abuse. Forgetting was largely unassociated with victim or abuse characteristics. Compared to individuals who always remembered their abuse, however, individuals who temporarily forgot were more likely to report that someone had suggested to them that they might have experienced abuse. Those who received such suggestions were particularly likely to suspect that they may have experienced childhood sexual abuse that they do not yet remember.



Forgetting may be less common than implied by earlier estimates from clinical samples, yet it is not uncommon. Also, a sizable minority of the population is wondering whether they have experienced unremembered abuse, and these suspicions are linked to having encountered suggestions from others. We discuss the implications of these findings for understanding the phenomenon sometimes labeled repression.

title: Childhood abuse recollections in a nonclinical population: forgetting and secrecy.
abstract: This study investigated the relationship of interrupted memories of childhood abuse with the secrecy of the abuse.



Fifteen hundred people were randomly selected from the membership of the American Counseling Association and sent a questionnaire regarding childhood abuse history. Four hundred and twenty-three usable questionnaires were returned and analyzed.



Thirty-two percent of the sample reported childhood abuse. Fifty-two percent of those reporting abuse also noted periods of forgetting some or all of the abuse. On the two survey items assessing secrecy, 76% of respondents reporting childhood abuse indicated there had been a time when no one but themselves and their abuser knew about the abuse; 47% indicated that an abuser tried to get them to keep the abuse secret. Forty percent endorsed both secrecy items. Respondents who reported forgetting abuse also reported one or both elements of secrecy more frequently than those who reported continuous memories of abuse.



These findings are consistent with those of other studies that suggest that, among adults reporting childhood abuse, the experience of forgetting some or all abuse is common. Secrecy of the abuse appears to be associated with the experience of forgetting childhood abuse for many individuals.

title: Physical Violence Between Young Adults and Their Parents: Associations with a History of Child Maltreatment
abstract: This study investigated the relationship between maltreatment during childhood, parental conflict tactics and the tactics employed by young adults during a disagreement with their parents. Four hundred and sixty nine university students completed the Conflict Tactic Scale and a Childhood History Questionnaire giving details on tactics employed during the previous year and information about their childhood respectively. Overall, 14.5% of students reported using violent tactics with their mother and/or father and 3.8% of them admitted to being severely violent to one or both of their parents. The conflict tactics used by the respondent were found to be significantly related to the reported tactics of their parents and the experience of being maltreated by parents in earlier years.

title: Physical Punishment by Mothers and Fathers in British Homes
abstract: The relative extent to which mothers and fathers administer physical punishment sheds light on family relationships, parental roles and, perhaps, the identity of potential abusers. In this study, British mothers (n = 362) and fathers (n = 103) of randomly selected children from 366 two-parent families were interviewed. According to self-reports, the proportions of mothers and fathers who had used physical punishments were similar, as were the frequencies with which they used them. About 50% more mothers than fathers smacked or hit their children weekly or more often, whereas fathers were more prone to restrain or push their children. A (nonsignificantly) higher proportion of fathers than mothers had used severe punishments. Fathers who took an equal share in caretaking used no more frequent or severe physical punishments than did mothers. These findings are compared with those of previous studies and discussed in terms of mothers' and fathers' caretaking and disciplinarian roles in different families.

title: Current Controversies on Family Violence
abstract: ISSUES IN CONCEPTUALIZATION - Abridged Contents Through a Psychological Lens - K Daniel O'Leary Personality Traits, Personality Disorders, and Levels of Violence Through a Sociological Lens - Richard J Gelles Social Structure and Family Violence Through a Feminist Lens - Kersti A Yllo Gender, Power, and Violence ISSUES IN DEFINITION AND MEASUREMENT Violence by Women Physical Assaults by Wives - Murray A Straus Physical Assaults by Husbands - Demie Kurz Date and Acquaintance Rape Facing the Facts - Mary P Koss and Sarah L Cook Date and Acquaintance Rape Are Widespread Forms of Violence Examining the Facts - Neil Gilbert Advocacy Research Overstates the Incidence of Date and Acquaintance Rape The Controversies Over the Consequences of Violence Toward Women The Battered Women Syndrome Is a Psychological Consequence of Abuse - Lenore E A Walker A Battered Woman's Problems Are Social, Not  H Bowker ISSUES IN CAUSES Alcohol and Addictive Drugs   Agents of Violence - Jerry P Flanzer  Are Associated with Violence - They Are Not Its Cause - Richard J Gelles Child Abuse A History of Abuse Is a Major Risk Factor for Abusing the Next Generation - Byron Egeland The Intergenerational Transmission of Abuse Is Overstated - Joan Kaufman and Edward Zigler Abused Elderly and Their Abusive Offspring The Abused Elderly Are Dependent - Suzanne K Steinmetz Abuse Is Caused by the Perception of Stress Associated with Providing Care The Abused Offspring Are Dependent - Karl Pillemer Abuse Is Caused by the Deviance and Dependence of Abusive Caregivers ISSUES IN SOCIAL INTERVENTION Child Abuse and Neglect What is the Problem with Reporting Laws Overreporting and Underreporting Are Twin Problems - Douglas J Besharov The Main Problem Is Still Underreporting, Not Overreporting - David Finkelhor Child Sexual Abuse Prevention Programs Prevention Is Appropriate, Prevention Is Successful - Carol A Plummer Problems with Child Sexual Abuse Programs - N Dickon Reppucci and Jeffrey J Haugaard Wife Abuse Offenders Arrest What the Scientific Evidence Shows - Richard A Berk On the Average, We Can Do No Better Than Arrest The Scientific Evidence Is Not Conclusive - Eve S Buzawa and Carl G Buzawa Arrest Is No Panacea Conclusion Social Problems, Social Policy, and Controversies on Family Violence  Examining and Evaluating Controversies on Family Violence PART ONE: ISSUES IN CONCEPTUALIZATION Through a Psychological Lens - K Daniel O'Leary Personality Traits, Personality Disorders, and Levels of Violence Through a Sociological Lens - Richard J Gelles Social Structure and Family Violence Through a Feminist Lens - Kersti A Yllo Gender, Power, and Violence PART TWO: ISSUES IN DEFINITION AND MEASUREMENT A. Violence by Women A Social Problem? Physical Assaults by Wives - Murray A Straus A Major Social Problem Physical Assaults by Husbands - Demie Kurz A Major Social Problem B. Date and Acquaintance Rape An Exaggerated Problem? Facing the Facts - Mary P Koss and Sarah L Cook Date and Acquaintance Rape Are Widespread Forms of Violence Examining the Facts - Neil Gilbert Advocacy Research Overstates the Incidence of Date and Acquaintance Rape C. Controversies Over the Consequences of Violence Toward Women The Battered Women Syndrome Is a Psychological Consequence of Abuse - Lenore E A Walker A Battered Woman's Problems Are Social, Not  H Bowker PART THREE: ISSUES IN CAUSES A. Alcohol and Addictive Drugs  Agents of Violence?  Agents of Violence - Jerry P Flanzer  Not Its Cause - Richard J Gelles B. Child Abuse Intergenerationally Transmitted? A History of Abuse Is a Major Risk Factor for Abusing the Next Generation - Byron Egeland The Intergenerational Transmission of Abuse Is Overstated - Joan Kaufman and Edward Zigler C. Abused Elderly and Their Abusive Offspring Who Is Dependent? The Abused Elderly Are Dependent - Suzanne K Steinmetz Abuse Is Caused by the Perception of Stress Associated With Providing Care The Abused Offspring Are Dependent - Karl Pillemer Abuse Is Caused by the Deviance and Dependence of Abusive Caregivers PART FOUR: ISSUES IN SOCIAL INTERVENTION A. Child Abuse and Neglect What Is the Problem With Reporting Laws? Overreporting and Underreporting Are Twin Problems - Douglas J Besharov The Main Problem Is Still Underreporting, Not Overreporting - David Finkelhor B. Child Sexual Abuse Are Prevention Programs Appropriate and Effective? Prevention Is Appropriate, Prevention Is Successful - Carol A Plummer Prevention May Not Be Appropriate, Prevention Success Is Not Proven - N Dickon Reppucci and Jeffrey J Haugaard C. Wife Abuse Offenders Is It Good Policy to Focus on Arrest? What the Scientific Evidence Shows - Richard A Berk On the Average, We Can Do No Better Than Arrest The Scientific Evidence Is Not Conclusive - Eve S Buzawa and Carl G Buzawa Arrest Is No Panacea Conclusion Social Problems, Social Policy, and Controversies on Family Violence

title: Long-term correlates of child sexual abuse: Theory and review of the empirical literature
abstract: Since Browne and Finkelhor's (1986) seminal review of the impact of child sexual abuse, there has been a dramatic increase in the child sexual abuse literature. Because of this tremendous growth in the literature, a more current review is warranted. The focus of this paper is a review of the long-term correlates of child sexual abuse published since 1987. Sexually abused subjects report higher levels of general psychological distress and higher rates of both major psychological disorders and personality disorders than nonabused subjects. In addition, child sexual abuse survivors report higher rates of substance abuse, binge eating, somatization, and suicidal behaviors than nonabused subjects. Adult survivors of child sexual abuse report poorer social and interpersonal relationship functioning, greater sexual dissatisfaction, dysfunction and maladjustment including high-risk sexual behavior, and a greater tendency toward revictimization through adult sexual assault and physical partner violence. The long-term correlates of child sexual abuse are conceptualized within a theoretical framework based on a theory of emotional avoidance. Although more recent empirical findings have demonstrated improved designs and methodology, these studies continue to be limited in their generalizability. Recommendations for future research are discussed.

title: Sexual dysfunctions: relationship to childhood sexual abuse and early family experiences in a nonclinical sample.
abstract: Studies investigating a possible relationship between childhood sexual abuse and adult sexual dysfunction have reported highly discrepant results. The purpose of the present study was to examine 202 female university students for early familial experience and childhood sexual abuse in relation to adult sexual disorders. Each student was asked to complete three questionnaires on victimization, sexual dysfunction, early familial experiences. Results indicated that: (a) victims of multiple CSA more frequently reported sexual desire disorders and orgasm disorders than did single-incident victims and nonvictims; (b) single-incident victims and nonvictims reported no significantly different rates for any kind of sexual dysfunction; (c) negative early familial experiences were significantly related to any kind of sexual disorder; and (d) women who reported orgasm disorders more often reported an inadequate sex education than did women with another or no sexual dysfunction. The data suggest that both family dysfunction and sexual victimization contribute to sexual disorders in adulthood, and that later sexual disorders are to a large extent the result of sexual abuse-related factors in particular and family dysfunction in general.

title: Contextualizing the effects of childhood sexual abuse on adult self- and social functioning: an attachment theory perspective.
abstract: This retrospective survey study explored the hypothesis that multiple maltreatment and loss experiences in early childhood would interfere with the formation of secure attachments, creating (1) an increased vulnerability to childhood sexual abuse (CSA), and (2) adult problems in self- and social functioning.



Data were collected from 687 undergraduates on an urban, commuter campus. They were analyzed by means of between group (individuals with and without CSA histories) and within group (individuals with CSA histories) path analytic models.



The number of maltreatment and loss experiences encountered in early childhood predicted greater CSA frequency in childhood and increased maltreatment in adulthood in the form of more frequent reports of sexual, physical, and emotional abuse. Childhood maltreatment and loss experiences also predicted poor adult self-functioning in the form of higher levels of depression and lower levels of self-esteem. Self-blame in response to CSA and maltreatment in adult relationships also predicted poorer adult self- and social functioning for individuals with CSA histories.



Findings support both direct and mediational effects of childhood maltreatment and loss experiences on adult self- and social functioning and are consistent with predictions derived from attachment theory.

title: Factors protecting against the development of adjustment difficulties in young adults exposed to childhood sexual abuse.
abstract: The aims of this study were to identify the factors which discriminated young people exposed to childhood sexual abuse (CSA) who developed psychiatric disorder or adjustment difficulties in young adulthood from those young people exposed to CSA who did not develop psychiatric disorder or adjustment difficulties by age 18.



Data were gathered on a birth cohort of 1,025 New Zealand children studied from birth to the age of 18 on (a) exposure to CSA; (b) patterns of psychiatric disorder and adjustment difficulties at age 18 years; (c) factors that may have influenced responses to CSA including characteristics of the abuse, parental bonding, parental characteristics, and adolescent peer affiliations.



Just over 10% of the cohort reported CSA. Those reporting CSA were at increased risks of a range of difficulties at age 18 (depression, anxiety, conduct disorder, alcohol abuse/dependence, other substance abuse/dependence, post sexual abuse trauma, attempted suicide). However, not all of those exposed to CSA developed difficulties and approximately a quarter of those exposed to CSA did not meet criteria for any adjustment difficulty. Further analysis suggested that the extent of adjustment difficulties in those exposed to CSA was influenced by two additional factors: (a) the extent of affiliations with delinquent or substance using peers in adolescence; and (b) the extent of paternal care or support in childhood.



The findings of this study suggest that while young people exposed to CSA are at increased risks of psychiatric disorder and adjustment difficulties in young adulthood, not all individuals exposed to CSA will develop adjustment difficulties. Important factors protecting against the development of adjustment difficulties in young people experiencing CSA appear to be the nature and quality of peer and family relationships.

title: Clarifying the effects of parental substance abuse, child sexual abuse, and parental caregiving on adult adjustment.
abstract: Parental alcoholism, childhood sexual abuse, and other forms of child maltreatment are generally viewed as contributing to adult adjustment problems. The long-term effects of these various factors, however, are actually not well understood. The present study found that the largest amount of variance in college students' psychological distress was explained by parental emotional abuse and neglect, with child sexual abuse, parental substance abuse, and other factors explaining additional but smaller amounts of variance in distress. This suggests that comprehensive conceptualizations of family influences on development will result in a more complete understanding of long-term adjustment outcomes than merely focusing on particular childhood risk factors. Parental alcoholism and childhood sexual abuse (CSA) have received a tremendous amount of research, clinical, and policy attention in the past two decades, and there have been significant advances in knowledge regarding the effects of each of these factors (for reviews, see Briere, Berliner, Bulkley, Jenny, & Reid, 1996; Brown & Schmid, 1999). Large numbers of adult children of alcoholics NOT THE PUBLISHED VERSION; this is the author’s final, peer-reviewed manuscript.  Research and Practice,  No. 1 (February 2000): pg. 64-69.  Association does not grant permission for this article to be further copied/distributed or hosted elsewhere without the express permission from American Psychological Association. 2 (ACOAs) and CSA survivors have also benefited from mental health services and support groups (for reviews, see Baer, Marlatt, & McMahon, 1993; Wolfe, McMahon, & Peters, 1997). Despite these developments, there is still a great deal about the consequences of parental alcoholism, CSA, and other forms of child maltreatment that remains unclear. In particular, there are limited data to help explain why particular ACOAs and child abuse victims suffer from a variety of adjustment problems, whereas some others apparently do not. A better understanding of the diverse outcomes associated with these risk factors would be very helpful for informing clinical assessment, treatment planning, prevention efforts, and theory development. Though Freud actually wrote little about the effects of different approaches to parenting (Symonds, 1949), a major legacy of the psychoanalytic approach (e.g., Horney, 1933; Levy, 1931) has been a focus on the effects of parental acceptance (and its obverse, rejection or emotional abuse) and parental responsiveness (and its obverse, emotional neglect). Parental approaches to behavioral control also figured prominently in several early models of child socialization (e.g., Baldwin, 1949). Since that time, other aspects of parenting have also received extensive examination. Kempe, Silverman, Steele, Droegemueller, and Silver (1962) were the first researchers to bring widespread professional attention to the problem of child physical abuse. CSA and parental alcoholism also began receiving widespread attention somewhat later (cf. Armstrong, 1978; Black, 1981). The long-term consequences of each of these factors are not yet well understood, however, despite significant empirical investigation. In particular, the effects of the more recently investigated variables (physical and sexual abuse and parental alcoholism) relative to other aspects of parental caregiving are not clear. For example, many studies have found that parental alcoholism is correlated with a variety of psychological symptoms in ACOAs, including depression, anxiety, substance abuse, relationship problems, and antisocial behavior (Sher, 1997; Steinhausen, 1995). It is also clear, however, that many ACOAs function well and do not show signs of serious maladjustment.  this is the author’s final, peer-reviewed manuscript.  Research and Practice,  No. 1 (February 2000): pg. 64-69.  Association does not grant permission for this article to be further copied/distributed or hosted elsewhere without the express permission from American Psychological Association. 3 A variety of theories have been proposed to explain these findings (e.g., Collins, Leonard, & Searles, 1990), but the specific effects of parental substance abuse on children's development, independent of other aspects of family functioning, have received relatively little empirical attention. Most of the studies that have examined this question have found that parental alcoholism does not explain additional variance in maladjustment after the effects of general family dysfunction are partialled out (e.g., Harrington & Metzler, 1997; Werner & Broida, 1991). Other studies, however, have found the opposite result (e.g., Buelow, 1995; Rubio-Stipec, Bird, Canino, Bravo, & Alegria, 1991). Researchers have found that a history of CSA is also associated with a variety of negative psychosocial consequences (Kendall-Tackett, Williams, & Finkelhor, 1993). Posttraumatic stress disorder and low self-esteem are relatively common outcomes associated with this form of abuse, though a wide range of symptomatic and pathological behavior has been associated with CSA. Studies have also found, however, that up to 40% of sexually abused children are seemingly not symptomatic at all (Berliner & Elliott, 1996). As with parental substance abuse, other aspects of family dysfunction may account for the adverse outcomes associated with CSA. The research on these questions also provides inconsistent findings. For example, Nash, Hulsey, Sexton, Harralson, and Lambert (1993) found that no additional variance in level of adjustment was explained by a history of CSA after the effects of general family dysfunction had been partialled out, whereas the findings of Harter, Alexander, and Neimeyer (1988) supported the opposite conclusion. The inconsistent research findings regarding the previously mentioned questions present a significant difficulty for practitioners because of the high prevalence of childhood risk factors such as CSA, parental alcoholism, and other types of family dysfunction in the clinical population. Explanations for adult maladjustment and treatment planning in these cases often must rely on clinical experience and theoretical approaches to psychotherapy without the clear support of empirical evidence. Theory and clinical experience obviously are valuable tools for mental health practice, but empirical support for our assessments and treatments is also steadily increasing NOT THE PUBLISHED VERSION; this is the author’s final, peer-reviewed manuscript.  Research and Practice,  No. 1 (February 2000): pg. 64-69.  Association does not grant permission for this article to be further copied/distributed or hosted elsewhere without the express permission from American Psychological Association. 4 in importance. Therefore, finding answers to these questions is a matter of some import. Some of the inconsistent findings in this research are likely to have resulted from the manner in which the risk factors were defined. With regard to the consequences of CSA, for example, most studies have combined intrafamilial and extrafamilial abuse when participants were divided into treatment and control groups. It appears, however, that intrafamilial sexual abuse has greater negative effects than extrafamilial abuse (Briere & Elliott, 1993; Finkelhor & Baron, 1986). Much of the research has also combined unwanted sexual contact with willing sexual contact as well as unwanted and willing noncontact sexual experiences (e.g., exhibitionism). Definitions of CSA are unclear and controversial, but certainly unwanted and forced sexual contact are abusive. There is less agreement regarding the abusiveness of some willing noncontact sexual experiences, particularly with nonrelatives. No clear boundaries between these categories of sexual experience may exist, but there are important distinctions between them nonetheless. Much of the research regarding the consequences of CSA has lumped together diverse categories of sexual experience, and the associations found between CSA and adjustment outcomes have been weakened as a result (see Rind, Tromovitch, & Bauserman, 1998). Most of the studies that have examined the independent effects of CSA and parental substance abuse beyond the effects of general family dysfunction have also used global measures of family functioning such as the Family Adaptability and Cohesion Evaluation Scale (Olson, Russell, & Sprenkle, 1983; see Harter et al., 1988) or the average score from the Family Environment Scale (Moos & Moos, 1986; see Briere & Elliott, 1993). Global measures of family functioning are obviously useful for some purposes, but it can be difficult to infer what specific aspects of parental caregiving and family functioning are assessed by these measures. For example, parental substance abuse and CSA are presumably dysfunctional for families, and it is unclear which aspects of this dysfunction may be partialled out by global measures of family functioning before the independent effects of CSA or parental substance abuse are

title: Adolescent survivors of childhood sexual abuse: the mediating role of attachment style and coping in psychological and interpersonal functioning.
abstract: To examine attachment style and coping strategies as potential mediating variables between childhood sexual abuse (CSA) and psychological and interpersonal functioning in an attempt to explain variability in extent of disorder and level of functioning.



Eighty adolescent females, aged 14-16 years, answered questions regarding abuse history, attachment style, coping with an interpersonal stressor, depression and trauma symptomatology, and conflict with a best friend.



Structural equation modeling analyses indicated that attachment style mediates the effects of CSA and child abuse and neglect on coping and psychological distress. The indirect effects of CSA and other abuse through attachment accounted for most of the effects on coping and psychological distress. Avoidant and cognitive coping strategies also served as mediators in the models, accounting for most of the effects of the other variables on interpersonal conflict.



The findings indicate that attachment style and coping strategies influence psychological and interpersonal functioning, mediating the direct effects of CSA and other types of child abuse and neglect. These results have implications for therapeutic intervention with children and adolescents who have experienced child abuse.

title: The international epidemiology of child sexual abuse.
abstract: Surveys of child sexual abuse in large nonclinical populations of adults have been conducted in at least 19 countries in addition to the United States and Canada, including 10 national probability samples. All studies have found rates in line with comparable North American research, ranging from 7% to 36% for women and 3% to 29% for men. Most studies found females to be abused at 1 1/2 to 3 times the rate for males. Few comparisons among countries are possible because of methodological and definitional differences. However, they clearly confirm sexual abuse to be an international problem.

title: Childhood Experience of Care and Abuse (CECA): a retrospective interview measure.
abstract: The development of a retrospective, investigator-based interview measure of Childhood Experience of Care and Abuse (CECA) used with two community samples of adults in London is described. The component ratings are shown to have satisfactory inter-rater reliability and also validity as determined by agreement between sisters' independent accounts. The association between the different childhood scales is explored as well as the relationship of childhood experiences to adult depression. Methodological issues concerning investigator-based versus respondent-based measures of childhood are discussed and a case made for use of the former. Advantages of using the CECA, a retrospective, time-based measure of childhood, are outlined.

title: Moderating effects of physical abuse and perceived social support on the potential to abuse.
abstract: This study investigated the moderating effects of perceived prepubertal social support on the relationship between prepubertal childhood physical abuse and child abuse potential as well as on the relationship between a childhood history of abuse and conflict and depth in adult relationships. Three hundred and sixty-nine undergraduate men and women were classified as abused or nonabused based on their responses to the Childhood History Questionnaire. Multiple regression analyses revealed interactions of social support and a childhood history of physical abuse on both the potential to abuse and the quality of participants' relationships with their parents. Differences between abused and nonabused individuals were obtained only under conditions of low perceived social support. When social support was perceived to be high, abused and nonabused individuals did not differ in the potential to abuse or in the ratings of the depth of their relationships with parents. Implications of these findings for the intergenerational transmission of abuse are discussed.

title: Childhood maltreatment, childhood social support, and child abuse potential in a Basque sample.
abstract: The present study obtained data on childhood physical and sexual abuse in a Basque sample in order to compare abuse rates with a similar study conducted in the United States. The study also examined the relationships between childhood physical and sexual abuse, childhood social support, and abuse potential in the Basque sample. Although the overall rates of physically abusive behaviors were similar in the Basque and US samples, the rates of physical abuse sequelae (bruises/welts, cuts/scratches, dislocations, burns, and/or bone fractures) were lower in the Basque sample. In addition, while the rates of sexual abuse were similar for females, the sexual abuse rates for Basque males were more than double the rates reported for US males. As expected, a childhood history of physical and sexual abuse were directly related to child abuse potential. Childhood social support, especially father support, was inversely associated with abuse potential. An interaction between a childhood history of physical abuse and father support was found where those with a history of abuse and low levels of father support had the highest level of abuse potential and those with a history of abuse and high levels of father support had the lowest level of abuse potential.

title: The predictive impact of domestic violence on three types of child maltreatment.
abstract: This exploratory study investigated the co-occurrence of domestic violence and three types of child maltreatment: physical child abuse, psychological child abuse, and child neglect.



A sample of 2544 at-risk mothers with first-born children participated in a home-visiting child abuse prevention program. A longitudinal design using multiple data collection methods investigated the effect of domestic violence during the first 6 months of child rearing on confirmed physical child abuse, psychological child abuse, and child neglect up to the child's first 5 years.



Logistic regressions revealed significant relationships between domestic violence and physical child abuse, psychological child abuse, and child neglect. These effects were significant beyond the significant effects of known risks of maltreatment, as measured by the Kempe Family Stress Inventory (KFSI). Domestic violence occurred in 59 (38%) of the 155 cases of confirmed maltreatment. Domestic violence preceded child maltreatment in 46 (78%) of the 59 cases of co-occurrence, as indicated by independent home observations and child protective service records.



The findings indicate that domestic violence during the first 6 months of child rearing is significantly related to all three types of child maltreatment up to the child's fifth year. Domestic violence and risks factors measured on the KFSI continue to contribute to all three types of maltreatment up to the child's fifth year. Prevention programs would be wise to provide services to at-risk families until the child is at least 5 years old. Addressing concurrent problems during treatment may enhance intervention.

title: Child maltreatment: the United States Air Force's response.
abstract: Families in the military are not immune to problems of child abuse and neglect, but few data have been disseminated which describe child maltreatment in the military. This article reports on the incidence of child maltreatment in the United States Air Force by presenting descriptive data on over 19,587 substantiated cases of child abuse and neglect which occurred over a 6-year period. Annual percentage increases in child maltreatment reports are discussed, as are substantiation rates for child abuse and neglect. This article also describes the United States Air Force programs serving military personnel and their families throughout the world. A subset of cases are analyzed and offenders' and spouses' perceptions of the services received and the benefits derived are reported.

title: Childhood sexual abuse and mental health in adult life.
abstract: The relationship between childhood sexual abuse and mental health in adult life was investigated in a random community sample of women. There was a positive correlation between reporting abuse and greater levels of psychopathology on a range of measures. Substance abuse and suicidal behaviour were also more commonly reported by the abused group. Childhood sexual abuse was more frequent in women from disrupted homes as well as in those who had been exposed to inadequate parenting or physical abuse. While elements in the individual's childhood which increased the risks of sexual abuse were also directly associated to higher rates of adult psychopathology, abuse emerged from logistic regression as a direct contributor to adult psychopathology. Severity of abuse reported was related to the degree of adult psychopathology. The overlap between the possible effects of sexual abuse and the effects of the matrix of disadvantage from which it so often emerges were, however, so considerable as to raise doubts about how often, in practice, it operates as an independent causal element. Further, many of those reporting childhood sexual abuse did not show a measurable long-term impairment of their mental health. Abuse correlated with an increased risk for a range of mental health problems, but in most cases its effects could only be understood in relationship to the context from which it emerged.

title: Risk of child abuse or neglect in a cohort of low-income children.
abstract: The purposes of this research were to identify risk factors for reported child abuse or neglect and to examine the roles of stress and social support in the etiology of child maltreatment. Mothers of newborn infants with biomedical and sociodemographic risk factors were recruited from community and regional hospitals and local health departments in 42 counties of North and South Carolina selected for geographic distribution and for large numbers of such newborns. For every four such mothers, the next mother to deliver an otherwise normal newborn was sought. Mothers were interviewed shortly after giving birth, and state Central Registries of Child Abuse and Neglect were reviewed when each infant was 1 year of age. Eight hundred forty-two of 1,111 recruited mothers were successfully interviewed in their homes between March 1986 and June 1987. Seven hundred forty-nine North Carolina births who resided in the state more than 6 months were eligible for inclusion in the analysis. Logistic regression with backward elimination procedures was used in the analysis. Maternal education (p < .01), number of other dependent children in the home (p < .01), receipt of Medicaid (p < .01), maternal depression (p < .05), and whether the maternal subject lived with her own mother at age 14 years (p < .05) were the best predictors of a maltreatment report. Further examination revealed an interaction effect between stressful life events, as measured by life event scores, and social well-being (p < .01). For children born at risk for social and/or medical problems, extreme low income (participation in public income support programs), low maternal education, maternal depression, the presence of any other young children in the home, and a mother's separation at age 14 years from her own mother significantly predict child maltreatment reports in the first year of life. In addition, stressful life events, even if perceived positively, may increase or decrease the risk of maltreatment reports, depending upon the presence of social support.