Journal of Traumatic Stress, Vol. 18, No. 3, June 2005, pp.

253–261 (

C 2005)

Posttraumatic Symptoms and Self-Dysfunction as

Consequences and Predictors of Sexual Revictimization

Terri L. Messman-Moore,1,2 Amy L. Brown,1 and Lori E. Koelsch1

Posttraumatic symptomatology (PTS) and self-dysfunction (SD) were examined as correlates and
predictors of sexual revictimization in a prospective study of 339 college women. Both PTS and
SD were associated with a history of child and adult sexual victimization. Compared to a history
of child victimization, a history of adult victimization was associated with greater self-dysfunction.
Both PTS and SD predicted revictimization during the study; however, self-dysfunction also predicted
victimization in the absence of prior victimization. In a multivariate model, PTS did not directly predict
victimization during the study, although SD mediated the relationship between PTS and victimization.
Sexual victimization (child or adult) prior to the study predicted PTS, which predicted SD, which
predicted victimization during the study. Findings suggest that prior child and adult victimization are
directly related to later sexual victimization, and are indirectly related to later sexual victimization
via the impact of PTS on SD.

It is widely accepted that child and adolescent sex-
ual abuse increases risk for later sexual victimization (for
reviews, see Arata, 2002; Breitenbecher, 2001); however,
less is known about the underlying mechanisms responsi-
ble for the increased vulnerability of abuse survivors. One
theory is that the psychological distress resulting from
prior victimization experiences such as PTSD, dissocia-
tion, and interpersonal dysfunction increases vulnerabil-
ity for later victimization. Sexually aggressive individuals
may notice and act upon this psychological vulnerability,
targeting child sexual abuse (CSA) survivors for further
abuse (Messman-Moore & Long, 2003).
Recently, the literature on sexual revictimization has
focused mostly on psychopathology associated with prior
victimization such as PTSD or dissociation. Much less is
known about how other forms of dysfunction, including
difficulties in relation to self, might impact risk for revic-
1 Department
of Psychology, Miami University, Oxford, Ohio.
2 Towhom correspondence should be addressed at Department of
Psychology, Benton Hall, Miami University, Oxford, Ohio 45056;
e-mail: messmat@muohio.edu.
timization. Self-dysfunction includes maladaptive efforts
to regulate affect, disturbances in intimate and sexual re-
lations, and disrupted sense of self, all of which may op-
erate to increase risk for further victimization (Briere &
Runtz, 1993). Such problems may be more instrumental
than PTSD symptoms in the process of revictimization be-
cause self-dysfunction strongly impacts social function-
ing and interpersonal behavior. Given the few studies that
have investigated these factors, this study aims to exam-
ine posttraumatic symptomatology and self-dysfunction
to determine whether such difficulties increase vulnera-
bility for revictimization.
Posttraumatic Stress Symptomatology
PTSD and dissociation are common reactions to
sexual victimization in both childhood and adulthood
(Polusny & Follette, 1995; Rothbaum, Foa, Riggs,
Murdock & Walsh, 1992; Saunders, Villeponteaux,
Lipovsky, Kilpatrick, & Veronen, 1992). Dissociation and
certain aspects of PTSD symptomatology, particularly
numbing symptoms, may contribute to revictimization

253


C 2005 International Society for Traumatic Stress Studies • Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jts.20023
254
by reducing the ability to notice and process danger
cues (Sandberg, Matorin, & Lynn, 1999). Reexperienc-
ing symptoms also may interfere with a survivor’s ability
to judge the safety of a situation or respond in a self-
protective fashion. Arata (2000) found that PTSD symp-
toms were one factor that moderated the relationship
between CSA and revictimization. A prospective study
(Sandberg et al., 1999) also indicated that CSA survivors
with posttraumatic symptoms were more likely to be re-
victimized; however, in a treatment-seeking sample, rates
of PTSD were roughly equivalent for revictimized and
singly victimized women, although revictimized women
were more likely to meet criteria for a dissociative disor-
der (Cloitre, Scarvalone, & Difede, 1997).
Disruptions in Sense of Self and Self-Regulation
Abuse sequelae also may function to increase risk
for revictimization via self-dysfunction. Briere and Runtz
(1993) described the multitude of difficulties often found
among abuse survivors, including disturbed relatedness,
tension-reducing behavior, and impaired self-reference,
and elucidated the purposes that seemingly dysfunc-
tional behavior may serve. The different forms of self-
dysfunction overlap with aspects of complex PTSD,
which describes the impact of traumatic experience on
self-regulation, identity, interpersonal functioning, and
coping (Herman, 1992). Unfortunately, these adaptations
may operate to increase risk for further victimization.
Disturbed Relatedness
It is widely acknowledged that CSA impacts so-
cial functioning, including intimate and sexual relations
(Briere & Runtz, 1993). The experience of CSA may in-
terfere with the development of self-concept and sexual
identity, and may distort basic beliefs about trust, safety,
and control in significant relationships (for review, see
DiLillo, 2001). These factors may lead women to be un-
willing or unable to protect themselves from future victim-
ization by putting the needs of others before their own. In
one study, Classen, Field, Koopman, Nevill-Manning, and
Spiegel (2001) found that CSA survivors who had been
revictimized reported greater interpersonal problems; par-
ticipants indicated that they were overly nurturing, had
difficulty being assertive, were too responsible, and were
socially avoidant. Cloitre, Cohen, and Scarvalone (2002)
reported that revictimized women tended to assume that
negative interpersonal relationships would continue from
childhood to adulthood, and anticipated that others would
Messman-Moore, Brown, and Koelsch
treat them in a hostile, controlling, and domineering man-
ner; however, women who were sexually abused during
childhood but not revictimized did not generalize these
beliefs to their current adult relationships.
Not surprisingly, CSA survivors are particularly
likely to experience difficulties relating to others in a sex-
ual manner. CSA survivors are more likely to engage in
high-risk sexual behavior, including an increased number
and frequency of sexual relationships, as well as report
lower levels of sexual satisfaction and other sexual diffi-
culties (DiLillo, 2001). Further, CSA survivors appear to
be more likely to sexualize relationships and experience
difficulties regarding boundaries in relationships (Davis
& Petretic-Jackson, 2000).
Affect Dysregulation and Tension-Reducing Behavior
Sexual abuse during childhood may interfere with
normal development of affect regulation, often resulting
in an inability to manage painful emotions (van der Kolk,
1996). Briere and Runtz (1993) noted that CSA sequelae
such as binge eating, self-mutilation, substance abuse, and
indiscriminate sexual behavior may function as a means
to cope with overwhelming affect. Unfortunately, some
forms of tension-reducing behavior such as substance
abuse or compulsive sexual behavior may increase risk
for future abuse. Use of alcohol by both victim and per-
petrator increases risk for rape and other forms of sexual
assault (Marx, Van Wie, & Gross, 1996). A number of
studies have examined the role of alcohol use in sexual
revictimization, although it is not entirely clear if such
problems explain the relationship between prior and later
victimization (Messman-Moore & Long, 2003); however,
several prospective studies have indicated that sexual be-
havior is a predictor of sexual revictimization (Gidycz,
Hanson, & Layman, 1995; Himelein, 1995).
Impaired Self-Reference
According to Briere and Runtz (1993), sexual abuse
interferes with a child’s later ability to “. . . refer to, and
operate from, an internal awareness of personal existence
that is relatively stable across contexts, experiences and
affects” (p. 323). Furthermore, this confusion regarding
sense of self may leave the CSA survivor vulnerable to
boundary violations and feelings of emptiness. Impaired
self-reference may interfere with the ability to separate
one’s self from others, and consequently the needs of self
and other, leaving individuals with impaired self-reference
more vulnerable to potentially dangerous interpersonal
situations.
Self-Dysfunction and Revictimization
Posttraumatic Stress Symptomatology and
Self-Dysfunction
It is not entirely clear how posttraumatic symp-
toms and self-dysfunction may be related to one an-
other in distressed individuals. One possibility is that
self-dysfunction may actually occur in response to PTSD
symptomatology, especially in the absence of healthier
coping strategies. According to Briere (2002), abuse sur-
vivors must cope with “two interacting sets of difficulties:
the triggering of sudden abuse-related memories, cogni-
tions, and painful affects in the interpersonal world and
the relative absence of affect regulation capacities that
might otherwise allow regulation and resolution of these
triggered responses” (p. 181). This suggests that symp-
toms of PTSD may elicit dysfunctional or maladaptive
responses among individuals with poor affect regulation
or coping skills.
Purpose
This study examined the role of two clusters of symp-
toms in relation to sexual revictimization. A prospective
design spanning 8 months was used to explore how each
cluster of problems may be both a response to earlier
traumatic events as well as a potential antecedent of later
victimization. It was expected that victimization prior to
the study would be associated with greater levels of dis-
tress in both domains: posttraumatic symptoms (PTS) and
self-dysfunction (SD). Furthermore, it was hypothesized
that PTS would lead to increased SD, which in turn would
impact vulnerability for future sexual victimization. In
this way, both PTS and SD were hypothesized to me-
diate the relationship between prior victimization (child
or adult) and victimization during the study; however, it
was hypothesized that SD would mediate the relationship
between PTS and revictimization.
Method
Participants
Participants were 339 women attending a midsized
public university in the Midwest, ranging in age from
18 to 22 years (M = 19.18, SD = 1.07). Women were
recruited through newspaper advertisements, flyers, and
class announcements to participate in a four-part prospec-
tive study on “College Women’s Life Experiences.” Of
these, approximately two thirds (n = 217) received mon-
etary payment for participation. The remaining partici-
pants received class research participation credit for the
255
first two sessions.1 The sample was more than 90%
Caucasian, 1.8% African American, 0.6% Hispanic, 1.2%
Native American, 2.1% Asian American, 2.4% “biracial,”
and 0.9% “other.” Most participants came from middle-
to upper class, well-educated backgrounds. Of those who
knew their family income, 58.7% reported an annual fam-
ily income of over $70,000.2 The sample was almost en-
tirely (99.4%) single and never married.
Measures
Life Experiences Questionnaire (LEQ; Long, 1999)
The LEQ is a retrospective, self-report instrument
that assesses demographic information and adult and
childhood sexual experiences. Childhood victimization
(i.e., child sexual abuse, or CSA) was defined as unwanted
sexual contact meeting at least one of the following crite-
ria: (a) abuse perpetrated by a relative, or (b) more than
5-year age difference between victim and perpetrator, or
(c) if less than 5-year age difference between victim and
perpetrator, threat or force was involved (Wyatt, Loeb,
Solis, & Carmona, 1999). Other studies (e.g., Saunders,
Kilpatrick, Hanson, Resnick, & Walker 1999; Vogeltanz
et al., 1999) assessing the prevalence of CSA used age
18 as a cutoff; however, the present study limited CSA
to activities prior to age 17 to investigate revictimization
among the young college sample. The LEQ has demon-
strated reliability and validity in previous studies with
college women (Messman-Moore & Long, 2000). The
LEQ was administered at Time 1 to assess demographic
factors and CSA experiences.
Sexual Experiences Survey (SES; Koss & Gidycz, 1985)
A modified version of the 10-item SES was used to
assess rape after age 17. The modified version extends
the number of questions from 10 to 18, including ques-
tions regarding kissing and fondling, oral–genital contact,
and unwanted sexual intercourse. The modified SES was
1 Students enrolled in Introduction to Psychology in the fall semester
received 2 hr of research credit in the fall semester and $15 per ses-
sion in the spring semester. All data were anonymous; due to a cler-
ical oversight, participants were not coded regarding payment status.
Comparison to other samples obtained solely from the Introduction to
Psychology research pool found no differences in victimization rates
or levels of psychological distress across samples; however, the present
sample is significantly older than participants from the general research
pool.
2 These demographics are representative of the undergraduate population
in which data were collected.
256
administered at Time 1 to assess prior adult victimiza-
tion (i.e., rape), and then at 10-week intervals to assess
victimization during the academic year. Adult sexual vic-
timization was defined as completed vaginal, anal, or oral
penetration due to threats, use of force, or because the re-
spondent was unable to resist or consent due to her use of
alcohol or drugs. Victimization prior to the study was as-
sessed at Time 1; women were classified as experiencing
prospective victimization if they reported victimization at
any point during the academic year. Women were counted
only once, even if they reported victimization on more
than one occasion. Separate analyses were conducted ex-
amining revictimization prior to the study (i.e., a history
of both child and adult victimization prior to the study)
and revictimization that occurred during the study (which
involved at least one form of sexual victimization prior to
the study and during the study).
Trauma Symptom Inventory (TSI; Briere, 1995)
The TSI evaluates posttraumatic stress and other
psychological effects of traumatic events. The measure
consists of 100 items on a 4-point frequency scale, and
includes 10 subscales, which can be clustered into three
factor scales: trauma, self, and dysphoria. For purposes
of the study, only the Trauma and Self scales were
examined. The Trauma scale consists of the follow-
ing subscales: intrusive experiences, defensive avoidance,
dissociation, and impaired self-reference. The Self scale
consists of the following subscales: dysfunctional sexual
behavior, sexual concerns, tension-reducing behavior, and
impaired self-reference. Trauma subscales are correlated
with corresponding scales on the Impact of Events Scale
and the Symptom Checklist 90-Revised PTSD scale, and
the trauma scale accurately classified 92.3% of individuals
with a PTSD diagnosis (Briere, 1995). Elevations on Self
scales may indicate difficulties with identity and affect
regulation associated with personality dysfunction, and
accurately classified 89% of individuals with a borderline
personality disorder diagnosis. Both the Trauma and Self
scales may include the impaired self-reference (ISR) sub-
scale; however, in the TSI manual, the ISR factor loadings
were highest for the Trauma factor (.75 for trauma vs. .48
for self). Based on this information, the ISR subscale was
included only on the Trauma scale.3 The TSI has demon-
3 Inan earlier version of this article, the impaired self-reference (ISR)
subscale was included on the SD factor for theoretical reasons; however,
when the structural equation model was conducted, the ISR subscale
had stronger loadings with the PTS factor than the SD factor (consistent
with the TSI manual). Given this, the ISR subscale was included in the
PTS factor.
Messman-Moore, Brown, and Koelsch
strated construct, convergent, and discriminant validity.
The scales demonstrated good internal consistency in the
current sample: Trauma scale, α = .95, and Self scale,
α = .91. The TSI was administered at Time 1 to assess
psychological distress preceding victimization during the
academic year.
Procedure
Data were collected on four occasions during the
academic year. Time 1 data were collected early in the
fall semester, with follow-up sessions (Times 2–4) at ap-
proximately 10-week intervals. All data were collected
in large-group sessions. The LEQ was administered at
Time 1 only while the TSI and SES were administered at
all four sessions. All data were anonymous. Participants
generated a unique ID code at the first session, which they
included in all subsequent data packets so that responses
could be linked across sessions. Names and contact in-
formation were stored separately and were not connected
to ID codes. Upon completing each session, participants
were given either payment or research credit, and were
provided with contact information for the researchers and
local counseling/rape crisis services. Retention rates for
the 8-month study were good: A total of 327 participants
(96%) returned for Time 2, 301 (89%) women partici-
pated at Time 3, 289 (85%) women completed Time 4,
and 276 women (81%) completed all four sessions of
the study. Twenty-nine women provided incomplete pro-
files at Time 1 and were dropped from analyses. Analyses
based upon retrospective data only are thus based on a
sample of 310 women. Prospective analyses are based on
the 254 women who provided usable data on all variables
at all time periods.
Results
Nine percent (n = 28) of the sample reported a
history of child victimization at Time 1, 13.2% (n = 41)
reported a history of adult victimization prior to the study,
and 9.4% (n = 24) reported victimization on at least
one occasion during the 8-month study. Half (n = 12)
of the women who were raped during the study had a
history of child or adult victimization prior to the study.
Child victims were more likely than nonvictims, χ 2 (1,
N = 310) = 9.60, p < .01, to report a history of adult
victimization (32.1 vs. 11.3%) and were more likely to
report prospective victimization compared to nonvictims
(22.7 vs. 8.2%), χ 2 (1, N = 254) = 4.96, p < .05.
Women with histories of adult victimization also were
more likely than their nonassaulted peers to report new
Self-Dysfunction and Revictimization 257

Table 1. Correlations Among Victimization History, Victimization compared to nonvictims ( p < .05). Some trends also were
During the Study, and Symptom Clusters
present. Revictimized women reported marginally higher
Variable 1 2 3 4 5 levels of PTS compared to child-only victims ( p = .10)
1. Child Victimization 1.0 .15* .16* .23** .14* and adult-only victims (p = .06), which may indicate
2. Prior Adult Victimization 1.0 .29** .28** .36** a cumulative impact of victimization. A slightly differ-
3. Rape During the Study 1.0 .22** .28**
4. PTS Symptoms 1.0 .65**
ent pattern emerged for SD, however. Although all three
5. Self-Dysfunction Symptoms 1.0 groups differed from nonvictims, interestingly, adult-only
victims reported greater levels of SD than child-only vic-
*p < .01. **p < .001. tims. Despite theories linking self-dysfunction to child
maltreatment, adult-only victims may report greater lev-
els of distress simply because less time has passed since
victimization during the study (29.4 vs. 6.4%), χ 2 (1,
victimization, which also may explain why revictimized
N = 254) = 18.28, p < .001. Victimization status (both
women and women with adult victimization only did not
prior to and during the study) was significantly related
differ in terms of SD.
to PTS and SD symptoms (see Table 1 for correlations
To determine the extent to which the two different
among all variables).
clusters of symptoms might increase risk for sexual vic-
Multivariate analysis of variance (MANOVA) was
timization and revictimization during the study, another
used to examine the relationship between sexual victim-
MANOVA was conducted to compare distress among
ization status prior to the study (revictimization: n = 9,
four groups: revictimization during the study (n = 12),
adult victimization only: n = 32, child victimization only:
prospective victimization only (n = 12; rape during the
n = 19, or no victimization: n = 250) and symptom pre-
study without previous victimization), prior victimization
sentation. Results of the MANOVA were significant,
only (n = 39), and no victimization prior to or during the
Wilks’s  = .805, F(6, 610) = 11.67, p < .001. Both
study (n = 191). Results of the MANOVA were signifi-
symptom clusters (PTS and SD) were associated with
cant, Wilks’s  = .820, F (6, 500) = 8.67, p < .001 (see
sexual victimization prior to the study (see Table 2 for
Table 2 for means and standard deviations). Post hoc tests
means and standard deviations). Post hoc tests indicated
indicated that all victimization groups reported higher lev-
that all victimization groups reported higher levels of PTS
els of PTS compared to nonvictims ( p < .05). Some trends
also were present. Women revictimized during the study
Table 2. Posttraumatic Symptomatology (PTS) and Self-Dysfunction reported marginally higher levels of PTS compared to
as a Function of Victimization Status women raped but not revictimized during the study (p =
PTS Self-Dysfunction .16) and women with a history of prior victimization who
Victimization Status Symptoms Symptoms were not victimized during the study (p = .10). A simi-
Victimization prior to the study lar pattern emerged for SD; all three victimization groups
Revictimization (n = 9) 53.56a 23.22a differed from nonvictims. Furthermore, women revictim-
(17.34) (13.71)
Adult victimization only (n = 32) 40.63b 27.25b
ized during the study reported marginally higher levels of
(19.75) (15.07) SD compared to women who were raped during the study
Child victimization only (n = 19) 41.47c 17.89b,c but not revictimized (p = .14) and women with a history
(24.74) (17.20)
No victimization (n = 250) 27.51a,b,c 12.00a,b,c
of prior victimization who were not victimized during the
(16.99) (10.82) study (p = .08). These findings suggest that individuals
Victimization during the study with trauma histories may be revictimized because of their
Revictimization (n = 12) 48.83a 29.00a
(18.16) (12.91)
high levels of distress. Although not significant at conven-
Adult victimization only (n = 12) 38.25b 21.92b tional levels (possibly due to the small number of revic-
(19.01) (12.96) timized individuals in the present study), several trends
Prior victimization only (n = 39) 39.60c 22.15c
(21.32) (16.35)
lend support for the hypothesis that psychological dis-
No victimization (n = 191) 26.89a,b,c 11.47a,b,c tress (both PTS and SD) increases risk for revictimization
(17.40) (10.55) among survivors of child and adult sexual victimization.
Note. Within each column, means with the same subscripts differ at
p < .05. For victimization prior to the study, revictimization = adult and
child victimization. For victimization during the study, revictimization Post Hoc Mediation Analyses
= rape during the study in the context of a history of child or adult
victimization prior to the study; adult victimization only = rape during
the study in the absence of a history of child and adult victimization To further examine revictimization that occurred be-
prior to the study. fore the study, several multiple regression analyses were
258
conducted to determine whether PTS mediated the re-
lationship between prior child victimization and prior
adult victimization. Mediation was determined using the
guidelines established by Baron and Kenny (1986). First,
PTS was regressed on child victimization; prior child
victimization significantly predicted PTS (β = .23, p <
.001). Next, PTS was shown to significantly predict prior
adult victimization (OR = 1.04, p < .001). Third, child
victimization was shown to directly predict prior adult
victimization (OR = 3.13, p < .01). Finally, prior adult
victimization was regressed on PTS and child victimiza-
tion. The relationship between child victimization and
prior adult victimization became nonsignificant (OR =
1.78, p > .05) when the effects of PTS were accounted
for, which indicated that PTS mediated the relationship
between child victimization and prior adult victimization.
Model Statistics
To simultaneously examine the relationships among
prior victimization (in childhood or in adulthood) symp-
tom clusters (PTS and SD) and victimization during the
study, a structural equation model was analyzed using
LISREL 8.30 (Jöreskog & Sörbom, 1999). The hypothe-
sized model included paths from both child and prior adult
victimization to both PTS and SD clusters as well as to
subsequent victimization. PTS was presumed to predict
SD, and SD was presumed to predict subsequent victim-
ization. For the first model, the ISR scale was included on
the PTS factor, as it was for previous analyses. Because
of the possible conceptual ambiguity of including ISR on
the PTS scale, a second model was run in which the ISR
scale was excluded from analyses.
The first model (Fig. 1) fit the data moderately
well, χ 2 (29, N = 254) = 256.12, p < .001; NFI = .83;
CFI = .84. The second model, which excluded the ISR
scale from the analysis, was a good fit with the sam-
ple data and an improvement over the first model, χ 2
(21, N = 254) = 125.08, p < .001; NFI = .89; CFI =
.91. For both models, child victimization and prior adult
victimization predicted PTS, but only prior adult victim-
ization predicted SD. Both child victimization and prior
adult victimization also predicted subsequent victimiza-
tion, although the effect was stronger for prior adult vic-
timization. Finally, PTS was related to SD, and SD was
related to subsequent victimization.4 In addition to the di-
4Adifferent version of this model was run including a direct path from
PTS to subsequent victimization. This version fit the data no better
or worse than the model presented, χ 2 (28, N = 254) = 256.05, p <
.001; NFI = .83; CFI = .84, and the path between PTS and subsequent
victimization was virtually nonexistent (β = .01).
Messman-Moore, Brown, and Koelsch
rect paths presented in Fig. 1, both child victimization and
prior adult victimization had significant indirect effects on
SD, and PTS had an indirect effect on subsequent victim-
ization. This implies that PTS mediated the relationships
between child victimization and SD and between prior
adult victimization and SD; likewise, SD mediated the
relationship between PTS and subsequent victimization.
Finally, the indirect effect of prior adult victimization on
subsequent victimization was significant, but the indirect
effect of child victimization on subsequent victimization
was not significant.
Discussion
This study focused on two clusters of symptoms:
reexperiencing, avoidance, and dissociative symptoms in-
dicative of “classic” PTSD and self-dysfunction or self-
regulation difficulties. These problems were examined as
correlates of prior victimization as well as factors that
may increase vulnerability for further abuse. As hypothe-
sized, both types of symptoms were related to prior sex-
ual victimization. Women with histories of child or adult
sexual victimization, or both child and adult victimization
(i.e., sexual revictimization), reported higher levels of PTS
and SD compared to nonvictims. Revictimized women
reported somewhat greater levels of PTS symptoms com-
pared to women reporting either adult or childhood vic-
timization only. Although these findings are consistent
with earlier work documenting a cumulative impact of
different forms of interpersonal violence on psychologi-
cal distress (Banyard, Williams, & Siegel, 2001; Follette,
Polusny, Bechtle, & Naugle, 1996), there are alternative
explanations for these relationships. It is possible that PTS
developed in response to child sexual victimization and
that high levels of distress operated to increase risk for
adult victimization prior to the study (for a similar expla-
nation, see Arata, 2000). Our results were consistent with
this explanation, but because PTS was not directly related
to rape during the study, we cannot rule out alternative
explanations.
The impact of victimization on self-dysfunction also
was examined. Contrary to findings regarding PTS symp-
toms, self-symptoms did not appear to increase follow-
ing accumulation of abuse, and were associated with
all three forms of victimization (child, adult, and revic-
timization) when they were analyzed separately. In the
present study, women reporting adult sexual victimization
reported more problems indicative of self-dysfunction
compared to child victims. Child victimization was re-
lated to self-dysfunction only indirectly via the impact of
PTS. It is unclear why child victimization did not impact
Self-Dysfunction and Revictimization
Fig. 1. Structural equation model with ISR subscale on PTS factor.
self-dysfunction as was expected based upon previous
empirical studies and theories of the impact of child mal-
treatment, but there are a few possible reasons. Adult vic-
timization may have a stronger direct relationship with SD
compared to child victimization due to the recency of the
adult victimization experience, due to the inclusion of ado-
lescent abuse experiences among those labeled with child
victimization, or because only more severe forms of abuse
(i.e., rape) were considered adult victimization whereas
childhood victimization included less severe events. An-
other important factor is the nature of the college-student
sample, which may have affected how self-dysfunction
was expressed. The college women in our sample may not
have experienced significant impairment because those
with more severe difficulties might have been forced to
leave school if they could not function. Another possi-
bility is that self-dysfunction may not have been ade-
quately assessed in the present study. Overall, the three
TSI scales comprising this factor (sexual concerns, dys-
functional sexual behavior, and tension-reducing behav-
ior) seem to reflect maladaptive or risky behavior that may
be better conceptualized as dysfunctional coping strate-
gies. Furthermore, the one scale designed to measure dis-
ruptions in sense of self and boundaries with others, the
impaired self-reference (ISR) scale, did not correlate as
highly with the SD factor as it did with the PTS factor.
Findings suggest that the ISR construct may be distinct
from both PTS and self-dysfunction as measured by the
259
TSI. Among college women, ISR may be more reflective
of general levels of distress rather than disruption in iden-
tity. In the present study, the Self scale of the TSI appeared
to reflect behavior, possibly coping responses, rather than
disruptions in sense of self and affect dysregulation.
Symptoms also were examined in relation to sexual
victimization that occurred during the 8-month prospec-
tive study. Findings support the argument that psycho-
logical distress, presumably related to prior victimiza-
tion, increases risk for revictimization. When the types of
symptoms were examined separately, women who were
revictimized during the study reported marginally greater
levels of PTS symptoms and self-dysfunction prior to their
most recent victimization compared to those with only a
single victimization experience. Furthermore, the severity
of PTS symptoms at the outset of the study was greater for
all individuals reporting victimization during the follow-
ing 8 months; however, in the multivariate model, PTS did
not directly predict subsequent rape—any association was
due to the relationship between PTS and SD. Thus, PTS
alone did not appear to increase risk for revictimization;
it was only in conjunction with self-dysfunction that PTS
served as a risk factor.
Although the PTS symptoms did not necessarily in-
dicate a diagnosis of PTSD, these problems did appear
to impact functioning and vulnerability for later abuse,
and findings are consistent with another prospective study
examining PTSD (Sandberg et al., 1999); however, in the
260
present study, hyperarousal symptoms were not measured.
This may be important because there is preliminary evi-
dence that hyperarousal symptoms may serve to increase
risk perception and function as a “protective” mechanism
(Wilson, Calhoun, & Bernat, 1999). Future studies ex-
amining PTSD and related symptoms as risk factors for
revictimization may need to examine symptom clusters
rather than PTSD as an entity to determine whether certain
aspects of the disorder impact vulnerability more than oth-
ers. Given the cyclic nature of this disorder, women may
be more or less vulnerable to revictimization depending
on the prominence of numbing or hyperarousal symptoms
at any given point in time.
Findings from the models tested shed more light
on the nature of the relationships between PTS, self-
dysfunction, and later sexual victimization. Prior adult
victimization may increase risk for revictimization be-
cause of the direct effects of self-dysfunction and due
to the indirect effects of PTS. On the other hand, prior
child sexual victimization had a small direct effect on re-
victimization that occurred over the course of the study.
The mediating impact of PTS did not explain this rela-
tionship above and beyond the direct path, which implies
that other variables are important in understanding the re-
victimization of child victims. The model suggests that
self-dysfunction may increase vulnerability for victim-
ization or revictimization to a greater extent than PTS,
although among individuals with histories of child vic-
timization, PTS plays a critical role because of its im-
pact on SD. Compared to PTS, problems in self- and
social functioning may have a greater direct impact on
subsequent victimization because of the relational nature
of revictimization. Self-dysfunction may be more salient
to the context of victimization for women during their
college years (e.g., acquaintance rape). Tension-reducing
behaviors, including alcohol use, also are strongly tied
to sexual victimization among college women. The Col-
lege Alcohol Study surveys have indicated that 72% of
college women who were raped were intoxicated at the
time of assault (Mohler-Kuo, Dowdall, Koss, & Wechsler,
2004). Future research, particularly of a prospective or
longitudinal nature, may further explain the complicated
interactions between PTS and self-dysfunction. More re-
search examining both forms of psychological distress in
older, more diverse samples may address some of these
questions.
The concept of self-dysfunction may provide a use-
ful explanation for the link between risky sexual behavior
and revictimization. Although sexual behavior is one of
the factors most consistently associated with revictim-
ization (Messman-Moore & Long, 2003), less is known
about the function or purpose of this behavior. Both re-
Messman-Moore, Brown, and Koelsch
searchers and clinicians need to ascertain a better under-
standing of the purpose of dysfunctional sexual behavior
to successfully intervene with treatment or risk-reduction
programming. The present findings suggest that tension-
reducing and maladaptive sexual behavior may function
as a strategy to cope with posttraumatic symptoms re-
lated to previous victimization experiences. The current
findings suggest that risk for revictimization may be re-
duced through psychotherapy that successfully addresses
issues of self-dysfunction and PTS; however, future re-
search should seek to determine what factors relevant to
self-dysfunction appear salient to issues regarding vulner-
ability for rape and revictimization.
There are limitations to the current study. First, the
sample was comprised mostly of Caucasian, upper class,
young women, and findings may not generalize to other
populations. Moreover, examination of clinical phenom-
ena with college students may be problematic. We cannot
assume that those identified as experiencing PTS actually
met criteria for PTSD. Despite this concern, psycholog-
ical distress predicted victimization in this sample and
therefore warrants attention. Future studies would benefit
from using separate measures to assess PTSD symptoms
and self-dysfunction, and additional measures appropri-
ate for the study of self-dysfunction should be identified
and included in future research. Despite inclusion of an
8-month follow-up period, the directional nature of the
relationship among symptoms and victimization prior to
the study are unknown, and as such, are open to multiple
interpretations. Furthermore, findings should be consid-
ered in light of the number of women victimized during
the study, particularly the small number of women who
were revictimized. Ideally, larger, more diverse samples
can be used with prospective or longitudinal designs in
the future. Despite these problems, the current investiga-
tion has provided greater understanding into the process
of revictimization and more insight into how certain prob-
lems such as risky sexual behavior or substance abuse may
increase risk for revictimization. One of the most impor-
tant aspects of the study, the prospective design, allows
for the conclusion that such problems precede victimiza-
tion rather than are correlates of prior experiences. Only
through prospective and longitudinal studies can we truly
distinguish antecedents and correlates of revictimization,
which is essential if findings are to be applied to preven-
tion programming.
Acknowledgments
The authors acknowledge numerous research assis-
tants, without whom this project would not be possible:
Stephanie Calmes, Diana Hickey, Ryan McLaughlin, Sara
Self-Dysfunction and Revictimization
Nelson, Rob Pace, Allison Scheer, Jaclyn Tooley, and
Kyleigh Turner. This project was supported by grants
awarded to the first author from the Committee for Faculty
Research and the College of Arts & Sciences at Miami
University. We thank the anonymous reviewers for their
helpful comments on earlier versions of this article.
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