Measurement of Women's Child Sexual Abuse Experiences: An Empirical Demonstration of the Impact of Choice of Measure on Estimates of Incidence Rates and of Relationships with Pathology

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Studying child sexual abuse (CSA) is a difficult task due to factors such as the sensitivity of the topic; the related legal, ethical, and practical restrictions; and the difficulty of determining the reliability and validity of data provided years after a sometimes traumatic childhood event. In general, there is little that researchers can do about these challenges. However, researchers have contributed to the problems of conducting research in this area and interpreting research results through the proliferation of methods used to define and measure CSA. For instance, reports of the incidence of CSA have ranged from 5% (Stein. Golding, Siegel, Burnam, & Sorenson, 1988) to 66% (Boyer & Fine, 1992) due primarily to variations in the measures used.

In addition to determining incidence rates, many investigators are interested in whether CSA is related to adult adjustment. Several studies have reported a relationship between CSA and adult adjustment among women, including depression (e.g., Ernst, Angst, & Foldenyi, 1993: Fromuth, 1986; Gidycz & Koss, 1989; Mullen, Martin. Anderson, Romans, & Herbison, 1993; Roesler & McKenzie, 1994; Saunders, Villeponteaux, Lipovsky, Kilpatrick, & Veronen, 1992; Stein et al., 1988). Despite this common finding, the strength and nature of the relationship between CSA and adjustment remains unclear, and studies have contradicted each other regarding whether CSA is related to adult mental health problems (Beitchman et al., 1992), in part due to the wide variety of measures used in researching this question. In particular, the broad variations in definitions of CSA used in research have made it difficult to interpret results or to compare one study to another (Beitchman, Zucker, Hood, DaCosta, & Akman, 1991; Beitchman et al., 1992; Briere, 1992; Haugaard & Emery, 1989).

There is accumulating evidence that the relationship between CSA and adult adjustment may not be a causal relationship but may be due to common background factors that place some women at risk for both sexual abuse and adjustment problems (e.g., Finkelhor, Hotaling, Lewis, & Smith, 1990; Higgins & McCabe, 1994; Rind & Tromovitch, 1997). The argument is that a variety of background factors, such as a hostile, nonsupportive family environment, greatly increase the likelihood that a child will be sexually abused as well as the likelihood that she will have adjustment problems as an adult. Thus, the relationship of CSA to adjustment may be spurious due to common risk factors. However, because of the variations in definitions of CSA, the nature of this relationship remains unclear.

Much of the argument that CSA may not be related to adult adjustment is based on research that defines CSA solely by the ages of the "partners" in a sexual event without regard for characteristics of the event (e.g., whether the female wanted the event to occur; whether force was threatened or used; whether the event involved penetration). Although such status definitions reflect legal definitions of sexual abuse with minors, there is little theoretical or empirical reason to expect desired or voluntary, sexual experiences during childhood or adolescence to be related to adult adjustment. Beitchman et al. (1992) argued that CSA may be related to adult adjustment only when force, threat of force, or penetration are involved, we empirically explored the implications of several measurement issues for estimates of the incidence of CSA and for understanding the relation of CSA to depression among young women. We considered only definitions of CSA that involve unwanted sexual events.

Sexual abuse has been operationalized in a wide variety of ways. Most commonly, researchers have dichotomized women into those who have been sexually abused, however defined, and those who have not. Other researchers have measured sexual abuse in ways that take into account the severity of the experience (e.g., differentiate between molestation and rape). In other studies, forced or unwanted sexual events with similar-aged peers have not been considered sexual abuse experiences. Finally, some studies have included noncontact experiences (e.g., being seen nude against one's wishes, exhibitionism) in their definitions, whereas others have not. Readers of the CSA literature are faced with the considerable challenge of trying to interpret and compare the results of studies using these and other very different measures of this variable.

In one of the simplest approaches (see Table 1, column 1), researchers ask women, often with a single question, whether they have had unwanted sexual experiences, such as touching or fondling, that made them feel uncomfortable (e.g., Alexander & Lupfer, 1987) or sexual touching or intercourse that involved force (e.g., Laumann, Gagnon, Michael, & Michaels, 1994; Stein et al., 1988). These and similar approaches then dichotomize respondents into those who were abused and those who were not abused. In these studies, women who had been touched against their will are categorized along with women who had been raped as victims of sexual abuse with no consideration For differences in the severity of their experiences.

Table 1. Examples of Variations in Definitions of Childhood Sexual Abuse Across Studies

                  Dichotomous

Any Sexual Abuse               Age of Perpetrator a
vs. None                       Factor

Alexander & Lupfer,            Ernst et al., 1993
1987                           Finkelhor. 1984
Bendixen, Muus, &              Fromuth, 1986
Schei, 1994                    Gold, 1986
Conte & Schuerman, 1987        Greenwald, Leitenberg.
Stem et al., 1988              Cado, & Tartan, 1990
                               Higgins & McCabe, 1994
                               Nash, Hulsey, Sexton,
                               Harralson & Lambert, 1993
                               Parker & Parker, 1991
                               Peters, 1988
                               Wyatt, 1985
                               Yama, Fogas, Teegarden,
                               & Hastings, 1993

                  Multilevel

Contact Molestation            Noncontact Molestation
to Rape                        to Rape

Baler, Rosenzweig,             Anderson, Martin
& Whipple, 1991                Mullen, Romans, &
Gidycz & Koss. 1989            Herbison, 1993
                               Boyer & Fine. 1992
                               Finkelhor et al., 1990
                               Mullen et al., 1993
                               Rew, Esparza, & Sands, 1991
                               Saunders et al., 1992

Another dichotomous approach to measuring CSA takes into account the victim's age, the perpetrator's age, or both (see Table 1, column 2). Although there are a number of variations within this status definition approach, CSA is typically defined as sexual events occurring before the female reaches a particular age and in which the male involved is an adult (over age 16 or 18) and/or a certain number of years older than the female (e.g., Briere & Runtz, 1993; Finkelhor, 1984; Parker & Parker, 1991). For instance, any sexual event between a female who is less than 12 or 13 (depending on the study) and a male who is 3 or 5 years older than the female (depending on the study) is considered CSA. …