Typology of Child Sexual Abuse: The Interaction of Emotional, Physical and Sexual Abuse as Predictors of Adult Psychiatric Sequelae in Women

Article excerpt

ABSTRACT: Several recent studies have indicated that child sexual abuse (CSA) only atypically occurs independently of family dysfunction and other kinds of abuse or neglect (physical or emotional). Psychological adjustment problems in adulthood appear to be more common in women who experienced child sexual abuse (CSA) in combination with aspects of family pathology and with other kinds of childhood abuse. These findings suggest the existence of sub-groups with varied adult outcomes within the population that has experienced CSA. These ideas are explored in further analysis of childhood memories of family life and abusive events in childhood by 735 women aged 18 to 27 in a community mental health survey. Cluster analysis does identify clearly delineated sub-groups which have different outcomes in terms of psychiatric problems in adulthood. The frequency and severity of psychological adjustment problems in adulthood varied between these sub-groups according to their reports of either physical, emotional or sexual abuse in childhood or combinations of these.

Key words:  Child sexual abuse  Child physical abuse  Child emotional abuse
            Adult psychological adjustment     Cluster analysis

ACKNOWLEDGEMENTS: This paper was presented at the 1995 Canadian Sex Research Forum in Banff, Alberta, October, 1995. The author is grateful to Dr. C-K. Cheung of the City University of Hong Kong for programming assistance with the cluster analysis.

INTRODUCTION

Child sexual abuse (CSA) is sexual contact of a child with an adult, a relative or peer who, in the face of the young person's unwillingness or naivete, uses force, threat of force or the misuse of authority to gain physical sexual contacts with the child or young person (someone who is younger than 17). Such abuse is ipso facto wrong (and illegal) for a number of reasons including: (a) the young person often cannot give informed consent to the relationship; and (b) the sexual relationship may interfere with, and possibly cause grave harm to, the normal psychosocial tasks which the child has to master at various stages of development.

The clinical literature of the 1980s (reviewed in Bagley & King, 1990) gave the impression that unwanted sexual contacts in which adult or peer sexuality is imposed on a child always results in problems in long-term mental health adjustment in adulthood. Many of us, in describing the life-long harm which the imposition of sexuality, and incestuous relationships in particular, could impose on victims, thought there was a direct causal link between such abuse and inevitable negative sequelae in adulthood. Recent studies suggest that such outcomes are not invariably the case, although there is evidence for the frequent association of adult adjustment problems following CSA. For example, in random samples of community adults in Canada (Bagley, 1995) in which we defined sexual abuse as unwanted sexual encounters in childhood (i.e., up to the age of 16) with a person of any age (Bagley, 1989, 1991; Bagley, Wood & Young, 1994), we found that sexual encounters so defined had quite strong links with adult adjustment problems (depression, suicidality and psychoneurosis). In reappraising these studies, however, this link might be tautological since our respondents' self-schema might link current distress with seemingly significant childhood stressors. Another possibility which might confound the causal nature of the frequently established link between earlier childhood trauma and current depression is the finding that depressed individuals may experience intrusive thoughts and guilt feelings about earlier events (Kuyken & Brewin, 1994). In this model, depressed affect causes some individuals to construe childhood events negatively. One longitudinal study (Bifulco, Brown, & Adler, 1991) is available suggesting that this is not the case, and that women's recall of child sexual abuse is stable at different points in time, regardless of current affective state. …