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Anna C. Salter, Ph.D.
Effects of Sexual Abuse
³Lasting psychological injury . . . is not very common.´ (Brunold, 1964, p. 8) Brunold,
Effects of Sexual Abuse
³Relatively minor effect on adult adjustment.´ (Gagnon, 1965, p. 177)
Effects of Sexual Abuse
³Diminishes the subject¶s chance of psychosis and allows better adjustment to the external world.´ (Rascovsky & Rascovsky, 1950, p. 45) Rascovsky,
Effects of Sexual Abuse
³May be either a positive, healthy experience of, at worse, neutral and dull.´ (DeMott, 1980) DeMott,
³Children Not Severely Damaged by Incest with a Parent´
Setting Fires Vandalism Disrupting Other Children Stealing Aggression Against Girls
Sexually Abusing Boys Exhibitionism Fearing Calamity Suicidal Ideation ³Manipulative´ and ³Smooth (Yorukoglu & Kemph, 1966)
Impact of Child Sexual Abuse
Silence
10 Retrospective Studies
Revealed abuse to anyone as children 1/3 Cases reported to authorities 10% - 18% (London et al., 2005)
Percentage of Sexual Abuse Reported to Authorties
6 to 12% (Elliott, 1993; Russell, 1984; Saunders et al., 1992; Smith et al., 2000)
Delayed Disclosure of Childhood Rape
N = 388
W/in 24 hours > 5 years Never before survey
18% 47% 47% 28% 28%
(Smith et al., 2000)
Delayed Disclosure
N = 156 < One Week < One Year
24% 21% 17%
Five Years Never
39% (Sauzier, 1989)
Percent Who Never Disclosed
22% 28% 31% 33% 46%
Bottoms et al., 2007 Smith et al., 2000 Arata, 1998 Arata, Finkelhor et al., 1990 Ussher & Dewberry, 1995
Silence
39% Never told anyone as children (O¶Leary et al., 2010)
Progressive Disclosure
Elliott & Briere 1994
N = 118 External evidence of abuse Perpetrator confession Witness Pornographic pictures
Elliott & Briere 1994
Many children initially disclosed only fondling Later penetration
Partial Disclosure
21 studies of children with gonorrhea gradual disclosure common (Lyon, in press)
(Elliott and Briere, 1994)
When Did Child Rarely Disclose
Natural Parent Never Later Immediately 55% 30% 17%
Short Vs. Long Delays
Short
Long 5% 48%
Strangers Related to Victim
22% 22% 24% 24%
(Smith et al., 2000)
Children Who Deny
Less likely to disclose the closer the relationship (DiPetro et al., 1997; Smith et al., 2000)
Family Members as Perps
Lower rates or Longer delays (Goodman(Goodman-Brown, et al., 2003; Hershkowitz et al., 2005; Sjoberg & Lindblad, 2002; Lindblad, Smith et al., 2000)
Age
Adolescents abused for the first time as adolescents more likely to disclose than younger children Disclose first to another adolescent (Olafson & Lederman, 2006)
Whom They Told
Mother Best Friend No one
21% 21% 23% 28% (Smith et al., 2000)
Whom They Told Mattered
Children who disclosed to someone other than mother Poorer mental health (Ruggiero et al., 2000)
Response of Mother
Mothers who believed and supported Children had fewer mental health problems (Browne & Finkelhor, 1986; Luster & Small, 1997; Merrill et al., 2001)
Response of Listener
If person disclosed to tells someone else without permission Children have more mental health problems (Gold, 1986; O¶Leary, 2010)
Recantation
Cases where offender confessed 24.5% recanted fully or partially (Malloy, Lyon, Quas, & Forman, 2005) Quas,
Recantation
Predictors Lack of maternal support Abuse by male caretaker
Impact of Disclosure
Adolescents and children who disclosed Greater psychological distress Than those who didn¶t (Feiring et al., 2002; O¶Leary et al., 2010)
Impact of Disclosure
Adolescents who disclosed Felt less supported Perceived others¶ reactions as negative Blamed selves for abuse (Feiring et al., 2002)
Discussion of Abuse
Those who discussed abuse Not just disclosed Within one year of abuse Better mental health (O¶Leary et al., 2010)
Fantastic Elements in Disclosures
Gold Standard Perpetrator Confessed Medical Evidence Consistent ³Persuasive evidence,´ e.g. Eyewitness (Dalenberg, 1996) Dalenberg,
Fantastic Elements in Disclosures
Severe Abuse Perpetrator Family Member Force or Threat Repeated Molestation Intercourse or Oral-Genital Oral(Dalenberg, 1996) Dalenberg,
Fantastic Elements in Disclosures
Accounts with Fantastic Elements Severe Gold Standard (52) 15% Nonsevere Gold Standard (8) 2% Nonsevere Questionable (90) 0% Severe Questionable (52) 4% (Dalenberg, 1996) Dalenberg,
Cognitive Distortions of Sadistic Offenders
This child is bad, evil, sick or perverted. She deserves it.
Cognitive Distortions of Sadists
³I think young girls and boys are meant to be sex slaves or sex playthings for adults.´ (Sex offender letter to another pedophile -in reality, a federal marshal in a sting operation.)
Type of Offender
Emotional Visibility? Emotional Invisibility? Where Does Safety Lie?
Sequelae of Sexual Abuse
PTSD Depression Anxiety Disorders Dissociation Sexual Problems Re-Victimization Re Affective Flashbacks
PostPost-Traumatic Stress Disorder
Intrusive Symptoms Avoidant Symptoms Arousal Symptoms
Intrusive Symptoms
Intrusive Memories Affective Flashbacks Physical Responses to Triggers Nightmares
Triggers
Smell of aftershave Footsteps on the stairs Alone in the room with a male Bathroom Dental appointments
Avoidant Symptoms
Refusal to talk or think about abuse Avoidance of reminders Numbing PostPost-traumatic decline
Arousal Symptoms
HyperHyper-startle Lack of concentration Irritability Difficulty sleeping
Correlates of PTSD in Rape Victims
Life Threat Physical Injury Completed Rape 8.5 x (Kilpatrick et al., 1989)
Characteristics of Assault
% 29 58 69 79
Rape Alone Rape/Physical Injury Rape/Life Threat Rape/Injury/Life Threat
(Kilpatrick et al., 1989)
PTSD in Adults Exposed to Violence as Adults
Risk of severe PTSD higher if also sexual abuse after 12 Risk of depression higher if also sexual abuse before 12 (Schoedl et al., 2010)
Sequelae of Sexual Abuse
PTSD Depression Anxiety Disorders Dissociation Sexual Problems Re-Victimization Re Affective Flashbacks
Home Grown Solutions to Chronic Pain
Drug Addiction - Prostitution Alcoholism Cutting Suicidality Crisis addiction
Types of Coping
Avoidant Most common Related to severity of abuse Practical in short-term shortBad outcomes in the long-term long-
Active Coping
Proactive coping Behavioral changes Cognitive reframing Support-seeking Support Self-acceptance Self
Decreased symptoms (Phanicbrat & Townshend, 2010)
Affective Sequelae
Affective Flashbacks Secondary to Cognitions Internalizing Sex Offender Thinking Errors TraumaTrauma-Based World View
Secondary to Current Realities
Implicit Versus Explicit Denial
Contact with Offender
Court appearances Supervised visitation Apology sessions Unsupervised visitation Reunification
Blame is Not the Only Issue
Powerlessness Loss of agency Loss of faith in ability to control fate External locus of control View of world as malignant
Affective Sequelae
Affective Flashbacks Secondary to Cognitions Internalizing Sex Offender Thinking Errors TraumaTrauma-Based World View
Secondary to Current Realities
Nontraumatized Beliefs
³I have a guardian angel that looks after me.´ ³Everything happens for a reason.´ ³Things turn out for the best.´
Positive Illusions
Matlin & Stang. Stang. The Pollyanna Principle. 1978 Summarized over 1000 studies
NonNon-Traumatized Beliefs
Above average Things will work out Underestimate chances of negative events Overestimate chances of positive events Overestimate personal efficacy
Rated Selves More Positively than Peer of Same Sex and Age 87% (Taylor, Lerner et al., Submitted for Publication)
One¶s Strengths
Important Rare
One¶s Failings
Unimportant Common (Campbell, 1986; Marks, 1984)
Time is on Our Side
Poor Performance Remember as Better 20 Minutes Later (Greenwald, 1980)
Not Recent Phenomena
One month Rated mood each day compared to Own typical mood Almost everybody Typically happier than they typically are (Johnson, 1938)
Lifetime Probabilities of Experiencing Trauma
Type
Fire Car wreck w/ injury Robbery Loved one die from homicide, suicide or accident 30 Some sort 69 (Norris, 1992)
% 10 23 25
TraumaTrauma-Based World View
Shattered Assumptions Belief in Personal Invulnerability Belief the World is Meaningful Belief in Personal Efficacy (Janoff(Janoff-Bulman, 1992)
FallFall-Out from Chowchilla Kidnapping
³Massive interferences with Optimism & Trust´ (Terr, 1985) Terr,
FallFall-Out from Chowchilla Kidnapping
Age 9 Russians ruining ozone layer Everybody killed World end in 2000 Live in Mountains: Towns Not Safe
Age 10
FallFall-Out from Chowchilla Kidnapping
23 of 25 Afraid of the Future
TraumaTrauma-Based World View
Shattered Assumptions Belief in Personal Invulnerability Belief the World is Meaningful Belief in Personal Efficacy (Janoff(Janoff-Bulman, 1992)
World View and Sexual Abuse
³When you get old, you die. I have grandparents who are sixty or sixty-nine sixtyand I don¶t think they are ready to die. But I sometimes think I am going to die sooner than other people ± I don¶t know why I think this. I think bad people will hurt me. I may be killed instead of dying.´ (Terr, 1990 p. 31) Terr,
Worse Outcome
Intrusiveness Injury Physical Violence (E.g., Banyard et al., 2004; Collings, 1995; Collings, O¶Leary, 2010)
Worse Outcome
Parent (Kendall(Kendall-Tackett, 1993)
Worse Outcome
More severe More frequent and longer lasting
(Banyard et al., 2004; Boudewyn & Liem, 1995) Liem,
Worse Outcome
Multiple abusers
(Briere & Runtz, 1988; O¶Leary et al., 2010) Runtz,
Sequelae of Sexual Abuse
ReRe-Victimization PTSD Depression Anxiety Disorders Dissociation Sexual Problems Affective Flashbacks
Revictimization
College is Risky
Some sort of sexual victimization 50% Attempted or completed rape 25% (Fisher et al., 2000; Koss et al., 1987)
Risk Recognition
Women abused as children 1) Less likely to recognize risky situations 2) Perceived fewer situations to be high risk 3) Stayed in risky situations longer (Soler-Baillo et al., 2005; Yeater et Soleral.,2010; )
Impact of Rape Myths
Women who accept rape myths Believed they were less vulnerable to rape & Viewed rape-related info as less relevant to rapethem (Bohner & Lampridis, 2004) Lampridis,
Attributions
Internal ± My fault External ± Perpetrator fault Family¶s fault
Cost of Attributions
Internal Shame, guilt Withdraws from others Negative mental health outcomes Depression; suicidality, low self-esteem; selfinterpersonal problems; PTSD (Zinzow, 2010; Weiner Graham, 1999; Feiring et al., 2002)
Cost of Attributions
Perpetrator Blame Generally better outcomes (Feiring et al., 2002; Hoagwood, 1990; LevHoagwood, LevWiesel, 2000) But Anger, outrage, unjust world Helplessness
What Causes Internal Versus External Attributions?
More severe abuse (Duration, type, frequency) More physical force or coercion
internal external
(Chaffin et al., 1997; Hunter, et al., 1992; Wyatt & Newcomb, 1990; Zinzow et al., 2010)
Role of Age
Self Blame External Blame Older age of onset Younger age of onset (Zinzow et al., 2010)
Peer Abuse
More self blame Less family blame (Zinzow et al., 2010)
