Academic journal article European Journal of Psychotraumatology

Prevalence and Predictors of Axis I Disorders in a Large Sample of Treatment-Seeking Victims of Sexual Abuse and Incest

Academic journal article European Journal of Psychotraumatology

Prevalence and Predictors of Axis I Disorders in a Large Sample of Treatment-Seeking Victims of Sexual Abuse and Incest

Article excerpt

Childhood sexual abuse (CSA) is not a rare occurrence. Lalor and McElvaney (2010) summarised the findings from many surveys of child sexual abuse across European countries and reported prevalence rates of 13.9% (Sweden), 15.8% (Denmark), and 19% (Spain) for females and 6.7% (Denmark), 15.2% (Sweden), and 15.5% (Spain) for males. Further, a recent metaanalysis estimated the global prevalence of CSA to be 11.8% based on 217 studies (Stoltenborgh, Van Ijzendoorn, Euser, & Bakermans-Kranenberg, 2011). The variability Eoin McElroy et al. in estimates of CSA is due to inconsistent definitions of what constitutes abuse, different sampling methods, and the types of data that are used (e.g., self-report or secondary data).

CSA is a robust predictor of adult psychopathology (Anda et al., 2006; Hillberg, Hamilton-Giachritsis, & Dixon, 2011; Kendall-Tackett, Williams, & Finkelhor, 1993; Maniglio, 2009). The nature of this relationship, however, remains remarkably non-specific. Indeed, CSA has been linked with the development of a wide variety of adult psychiatric disorders, including mood and anxiety disorders, substance dependence, posttraumatic stress disorder, and psychosis (Bebbington et al., 2011; Cutajar et al., 2010; Fergusson, Boden, & Horwood, 2008; Fergusson, Horwood, & Lynskey, 1996; Fergusson, McLeod, & Horwood, 2013; Kessler, Davis, & Kendler, 1997; Molnar, Buka, & Kessler, 2001; Read, Agar, Argyle, & Aderhold, 2003; Varese et al., 2012). The relationship between CSA and adult psychopathology is further complicated by the influence of a variety of demographic factors (e.g., gender and age when abused) and abuse characteristics (e.g., duration, number of abusive acts, number of abusers, concurrent physical abuse and neglect). The common and / or shared effects of such factors are yet to be firmly established.

Indeed, a large body of research has examined the influence of gender on the relationship between CSA and adult psychopathology, yet the findings have been contradictory. Some studies have suggested that the effects of CSA are more serious for men (Garnefski & Diekstra, 1997; Gold, Lucenko, Elhai, Swingle, & Sellers, 1999) while others have suggested women experience more negative outcomes (Putnam, 2003). Moreover, a number of reviews and meta-analyses have found no effect of gender (Chen et al., 2010; Fergusson et al., 2013; Hillberg et al., 2011). The equivocal role that gender plays could be due to the influence of other variables. For example, in their analysis of the British Adult Psychiatric Morbidity Survey, Jonas et al. (2011) found that gender moderated the impact of CSA on a variety of common mental health disorders only in cases where the most severe form of CSA (penetrative sex) had occurred. In this case, odds ratios (ORs) for a variety of common mental health disorders were significantly higher for females (Jonas et al., 2011). This finding suggests that gender may play a role, however, only when combined with certain abuse characteristics. It is important to note, however, that abuse characteristics vary depending on gender. For example, Maikovich-Fong and Jaffee (2010) found that girls were more likely to experience penetrative sexual abuse. As such, it is possible that gender effects are attributable to the increased likelihood of penetrative sex associated with being female. Further research is required to understand the interplay between these factors.

The age at which a child is first abused is another demographic factor that has been proposed to have an impact on adult psychopathology. Again, studies have produced mixed findings. A common assumption is that abuse at an earlier age is associated with greater psychological dysfunction in adulthood (Cutajar et al., 2010). In actuality, the opposite pattern has been observed in research. Indeed, a number of studies suggest that the negative outcomes associated with CSA are greatest when abuse occurs in adolescence (Cutajar et al. …

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