Childhood Sexual Abuse

This study examined the association between childhood sexual abuse (CSA) and parenting outcomes including parenting stress, feelings of competence and discipline strategies. Maternal depression and current partner violence were hypothesized to be mediators of the association between CSA and parenting. This study is based on secondary data analysis of archived data. The participants were 263 primiparous mothers (107 with a history of CSA and 156 comparison mothers recruited from a prenatal clinic prior to the birth of their first child. Mothers were interviewed twice: once when they were between 28 and 32 weeks gestation and again when their child was between 2 and 4 years of age. During the first interview, women were asked about childhood experiences of sexual abuse. During their second interview, they were asked about current symptoms of pathology and experiences with partner violence and parenting beliefs and practices. Structural Equation Modeling indicated that the relationship...

This study examined the co-occurrence of childhood sexual abuse, adult sexual assault, intimate partner violence, and sexual harassment in a predominantly African American sample of 268 female veterans, randomly sampled from an urban Veterans Affairs hospital women's clinic. A combination of hierarchical and iterative cluster analysis was used to identify 4 patterns of women's lifetime experiences of violence co-occurrence. The 1st cluster experienced relatively low levels of all 4 forms of violence; the 2nd group, high levels of all 4 forms; the 3rd, sexual revictimization across the lifespan with adult sexual harassment; and the 4th, high intimate partner violence with sexual harassment. This cluster solution was validated in a theoretically driven model that examined the role of posttraumatic stress disorder (PTSD) as a mediator of physical health symptomatology. Structural equation modeling analyses revealed that PTSD fully mediated the relationship between violence and physical health symptomatology. Consistent with a bio-psycho-immunologic theoretical model, PTSD levels more strongly predicted pain-related physical health symptoms compared to nonpain health problems. Implications for clinical interventions to prevent PTSD and to screen women for histories of violence in health care settings are discussed.

This 18-month follow-up study builds on the findings of a randomized experimental evaluation that found qualified support for He has authored or coauthored over 100 publications, most of which deal with research methods or with empirical evaluations of practice in such areas as domestic violence, severe and persistent mental illness, the assessment and treatment of traumatized children, engagement and retention in substance abuse treatment programs, and the effectiveness of eye movement desensitization and reprocessing (EMDR).

This questionnaire study investigated the prevalence of, and interrelationships among, self-reported same-sex sexual orientation, childhood sexual abuse, and suicidal behavior in 1262 university students in Turkey. Approximately 7% of the sample reported lifetime or current same-sex sexual attractions, 5% reported that they engaged in same-sex sexual behavior, and almost 2% self-identified as either homosexual or bisexual. Overall, almost 10% of the sample acknowledged some form of a same-sex sexual orientation. Twenty-eight percent of the participants reported at least one instance of sexual abuse during their childhood. Almost 42% of the students reported suicidal ideation during the past 12 months or lifetime, and 7% reported that they attempted to kill themselves during their lifetime or in the past 12 months. Five hypotheses about the interrelationships among same-sex sexual orientation, childhood sexual abuse, and suicidal behavior were developed and tested in the study. Self-reported childhood sexual abuse was associated with same-sex sexual behavior. Participants who engaged in same-sex sexual behavior and those who identified themselves as homosexual or bisexual perceived more distance between themselves and their fathers than those who did not. Being sexually abused by someone of one's own sex was related to same-sex sexual orientation in male participants but not in female participants. Childhood sexual abuse was found to be an independent predictor of both suicidal ideation and attempts during the past 12 months. Only identifying oneself as homosexual or bisexual was associated with an increased risk for suicidal ideation during the past 12 months.

MAMUN, ABDULLAH A., DEBBIE A. LAWLOR, MICHAEL J. O'CALLAGHAN, WILLIAM BOR, GAIL M. WILLIAMS, AND JAKE M. NAJMAN. Does childhood sexual abuse predict young adult's BMI? A birth cohort study. Obesity. 2007;15:2103-2110. Objective: The objective was to identify the extent to which childhood sexual abuse (CSA) is associated with BMI and overweight status in young adulthood and to examine whether any associations differ by gender.

The Dissociative Experiences Scale was administered to a non-clinical sample in Shanghai, China (N = 618) and the results were compared with a previous sample of the general population from Winnipeg, Canada (N = 1055). The Dissociative Disorders Interview Schedule was administered to the 618 Chinese participants and results were compared with those of the Canadian participants (N = 502). In addition, both measures were administered to a sample of Chinese psychiatric inpatients (N = 423) and outpatients (N = 304). Rates of childhood trauma and dissociation were far lower in the Chinese non-clinical sample than in the two Chinese psychiatric patient groups, and far lower than in the

The present Best Practices Guide, is a collection of existing best practices across the EU and beyond, aiming to tackle sexual harassment in sports. The purpose of this publication is to:
- provide best practices in preventing and responding to sexual harassment in sport
- assist sport clubs in establishing and implementing internal policies and procedures tackling sexual harassment and the identification of the various roles individuals (athletes, coaches and other sport professionals) can play in preventing and responding to sexual harassment
- assist policy makers to create policies preventing and combating sexual harassment in sport
- contribute to a knowledge base already available for linking action to eliminate sexual harassment in sport
- serve as an inspiration for the replication of the best practices identified and contribute to the work of researchers, practitioners and policy-makers on the field worldwide
- be able to reach the necessary outcomes, the partners will carry out a desk research, through which they will aim to identify best practices in terms of Design and development process / Categories of Activities implemented / Legal and regulatory compliance / Institutional involvement / Level of Governance involved / Procedures and processes / Target Groups / Results and promote their use.

There is now widespread empirical evidence that child sexual abuse (CSA) survivors are at greater risk for sexual revictimization in adulthood, but less is known of the mechanisms underlying this relationship. Despite the lack of a conceptual framework to guide research, there has been a recent influx of studies examining explanatory variables, with most focusing on the psychological sequelae of CSA: alcohol and drug use, sexual behavior, dissociation, posttraumatic symptomatology, poor risk recognition, and interpersonal difficulties. With the exception of sexual behavior, the studies reviewed here provide limited or mixed support for the role of intrapersonal factors in revictimization. Future research may benefit from a focus on the function of psychological distress that is expressed as psychological vulnerability, as opposed to individual forms of psychopathology or maladaptive behavior. An ecological framework may be useful as a guide to future investigations, as this model focuses on factors outside of the victim, including childhood factors such as family environment, contextual factors including the behavior of the perpetrator, and societal and cultural factors that impact revictimization. Future investigations should focus on the interaction between victim vulnerability and perpetrator behavior. Implications for prevention programming, clinical intervention, and future research are discussed. D

Past and current memory for childhood sexual abuse reported by a clinical sample of 160 women survivors was assessed utilizing a structured clinical interview. Response alternatives for memory were ordered along a continuum. To minimize treatment effects, ...

Several studies have shown deficits in verbal declarative memory function in posttraumatic stress disorder (PTSD). Most of these studies have been performed in men with combat-related PTSD compared with healthy subjects; relatively little is known about memory function in women with abuse-related PTSD, or whether these effects are specific to PTSD or are a nonspecific outcome of exposure to early abuse. The purpose of this study was to assess declarative memory function in women with and without a history of early childhood sexual abuse and PTSD. Forty-three women with and without a history of early childhood sexual abuse and PTSD underwent neuropsychological testing with subtests of the Wechsler Memory Scale-Revised for measurement of verbal and visual memory and subtests of the Wechsler Adult Intelligence Scale for measurement of IQ, and behavioral ratings of PTSD and other psychiatric symptoms. Abused women with PTSD had deficits in verbal declarative memory as measured with the subtests of the Wechsler Memory Scale-Revised compared with women with early abuse without PTSD and nonabused women without PTSD. There were no significant differences in IQ. These findings suggest that early abuse with PTSD is associated with deficits in verbal declarative memory, and that these effects are not related to the nonspecific effects of childhood abuse. a PTSD group less than abused non-PTSD and nonabused non-PTSD groups by Duncan Multiple Range Test (p Ͻ .05). b PTSD less than nonabused non-PTSD, but not abused PTSD (p Ͻ .05) Bremner et al.

This qualitative study investigated personal constructs of survival and coping by 11 women who have survived childhood sexual abuse. In-depth interviews, a 10-week focus group, documentary evidence, and follow-up participant checks and collaborative analysis were used. Over 160 individual strategies were coded and analyzed, and a theoretical model was developed describing (a) causal conditions that underlie the development of survival and coping strategies, (b) phenomena that arose from those causal conditions, (c) context that influenced strategy development, (d) intervening conditions that influenced strategy development, (e) actual survival and coping strategies, and (f) consequences of those strategies. Subcategories of each component of the theoretical model were identified and are illustrated by narrative data. Implications for counseling psychology research and practice are addressed.

This study explored the predictors and consequences of sexual assault occurring after the age of 16 years in a nonclinical sample of women. Child sexual abuse occurring before the age of 16 years was the only predictor of later sexual assault among comorbid risk factors. Peer sexual abuse, number of perpetrators, age at time of sexual abuse, and severity of sexual abuse did not increase the risk for later sexual assault. Adult sexual assault victims showed lower levels of mental health functioning than did survivors of child or peer sexual abuse. We discuss a specificity model of revictimization and the differential effects of child, peer, and adult sexual trauma on the developmental trajectory of sexual violence and psychosocial functioning.

The relationship between the dissociative and somatic symptoms in a clinical sample of 216 women and 35 men survivors of childhood sexual abuse (CSA) was examined. Symptom patterns were measured by the Dissociative Experiences Scale, the Somatization Scale of the Symptom Checklist 90-Revised (SCL-90-R), and the Hypochondriasis, Hysteria, Health Concerns, and Harris-Lingoes Somatic Complaints Scales of the Minnesota Multiphasic Personality Inventory-2. Somatization and dissociation were related, but not at a great enough magnitude to suggest that somatic symptoms as a generic category are an integral component of dissociation. With the exception of one of the measures of somatization, the SCL-90-R somatization scale, no significant differences were found between men and women CSA survivors in symptom levels. However, the relationship between somatization and dissociation was stronger in women than in men. The findings of this study should be considered preliminary and interpreted with considerable caution, since the scales used probably are of limited validity.

Objective: This is the second in a series of articles that describe the prevalence, correlates, and consequences of childhood sexual abuse (eSA) in a birth cohort of more than 1,000 New Zealand children studied to the age of 18 years. This article examines the associations between reports of eSA at age 18 and OSM-/V diagnostic classifications at age 18. Method: A birth cohort of New Zealand children was studied at annual intervals from birth to age 16 years.

The present article focuses on the impact of childhood sexual abuse on inducing neuroendocrine and immunological response. The sources used in this article to investigate studies that showed association between childhood sexual abuse and activation of immunological and neuroendocrine response were from the MedLine-PubMed databases from 1991 to 2008. From 34 articles were selected 17 studies on the influence of childhood sexual abuse on the activation of immunological and neuroendocrine response. Furthermore, other publications on the effects of early stress on the hypothalamic-pituitary-adrenal (HPA) axis, cytokines, and amygdala-hippocampus complex were also selected. Childhood sexual abuse may result in hyperactivation of the HPA axis, with amygdala hyperfunction, and decreased activity of the hippocampus (defective glucocorticoid-negative feedback). The early stress has been associated with increased plasma concentrations of proinflammatory cytokines, increased, and prolonged secretion of CRF (corticotropin releasing factor), and excessive or insufficient cortisol. Childhood sexual abuse has been associated with dysfunction of immunological and neuroendocrine response. There are activations of the HPA axis, the proinflammatory cytokine (IL-1, IL-6, and TNF-α) production from macrophages, the autonomic nervous system, and the amygdala-hippocampus complex.

Several studies have shown deficits in verbal declarative memory function in posttraumatic stress disorder (PTSD). Most of these studies have been performed in men with combat-related PTSD compared with healthy subjects; relatively little is known about memory function in women with abuse-related PTSD, or whether these effects are specific to PTSD or are a nonspecific outcome of exposure to early abuse. The purpose of this study was to assess declarative memory function in women with and without a history of early childhood sexual abuse and PTSD. Forty-three women with and without a history of early childhood sexual abuse and PTSD underwent neuropsychological testing with subtests of the Wechsler Memory Scale-Revised for measurement of verbal and visual memory and subtests of the Wechsler Adult Intelligence Scale for measurement of IQ, and behavioral ratings of PTSD and other psychiatric symptoms. Abused women with PTSD had deficits in verbal declarative memory as measured with the subtests of the Wechsler Memory Scale-Revised compared with women with early abuse without PTSD and nonabused women without PTSD. There were no significant differences in IQ. These findings suggest that early abuse with PTSD is associated with deficits in verbal declarative memory, and that these effects are not related to the nonspecific effects of childhood abuse. a PTSD group less than abused non-PTSD and nonabused non-PTSD groups by Duncan Multiple Range Test (p Ͻ .05). b PTSD less than nonabused non-PTSD, but not abused PTSD (p Ͻ .05) Bremner et al.

Individuals who report to have recovered memories of childhood sexual abuse (CSA) almost by definition believe that these memories were previously inaccessible for them. We examined whether poor autobiographical memory specificity for all kinds of events (i.e., events not necessarily related to CSA) may underlie such impressions of amnesia. Thus, we examined whether people who report recovered memories of CSA (n ¼ 44) would exhibit more difficulty retrieving specific autobiographical memories compared to people who never forgot their abuse experiences (continuous memory group; n ¼ 42) and people without a history of abuse (controls; n ¼ 26). The standard Autobiographical Memory Test (AMT) was administered to these 3 groups along with measures of depression and posttraumatic stress disorder symptomatology. Controls were significantly better at retrieving specific autobiographical memories relative to individuals with continuous and recovered CSA memories, who did not differ from each other. Thus, reduced autobiographical memory specificity was not particularly pronounced in people with recovered memories of CSA. Poor autobiographical memory specificity is unlikely to explain the impression of amnesia reported by this group.

Pedophilia is characterized by sexual attraction to prepubescent children. Despite the extensive literature documenting the pervasive and pernicious effects of childhood sexual abuse, there is surprisingly little psychiatric literature on pedophilia and its etiology remains enigmatic. In recent years, the psychiatric literature on the phenomenology, neurobiology, and treatment of impulsive-aggressive disorders has grown significantly. As some investigators have conceptualized pedophilia as an impulsive-aggressive disorder, it is of interest whether recent advances in the study of impulsive-aggressive disorders might shed light on pathological mechanisms underlying pedophilia. In the following study, 20 male subjects with a DSM-IV diagnosis of pedophilia, heterosexual type were recruited from an outpatient facility for sexual offenders and compared to 24 demographically simi-lar control subjects. Groups were compared on three personality instruments-the Millon Clinical Multiaxial Inventory-II (MCMI-II), the Temperament and Character Inventory (TCI), and the Dimensional Assessment of Personality Impairment-Questionnaire (DAPI-Q)-to assess for select impairment in impulsive-aggressive personality traits. Pedophiles showed severe and pervasive personality impairment relative to controls. Although there was evidence of impulsivity, the findings do not suggest a predominance of impulsive-aggressive traits, and in fact provide evidence of inhibition, passive-aggression, and harm avoidance. The notion of "compulsive-aggression" in pedophilia is proposed.

A history of childhood sexual abuse (CSA) is a risk factor for adult emotional distress, including symptoms of depression, anxiety, dissociation, and trauma. However, CSA is likely associated with adult distress indirectly through an impact on mediating variables. In a review of the empirical literature, the authors found support for the roles of shame or self-blame, interpersonal difficulties, and avoidant coping strategies as mediators. In addition, emotional distress appears to mediate links between CSA and other adverse outcomes, such as alcohol abuse and revictimization. The authors conclude with a number of methodological and conceptual recommendations.

Some trauma-memory-oriented psychotherapists advise clients to review old family photo albums to cue suspected "repressed" memories of childhood sexual abuse. Old photos might cue long-forgotten memories, but when combined with other suggestive influences they might also contribute to false memories. We asked 45 undergraduates to work at remembering three schoolrelated childhood events (two true events provided by parents and one pseudoevent). By random assignment, 23 subjects were also given their school class group photos from the years of the to-be-recalled events as memory cues. As predicted, the rate of false-memory reports was dramatically higher in the photo condition than in the no-photo condition. Indeed, the rate of falsememory reports in the photo condition was substantially higher than that of any previously published study.

Objective: The Trauma Symptom Checklist for Young Children (TSCYC) is a 90-item caretakerreport measure of children's trauma-and abuse-related symptomatology. It contains two reporter validity scales and eight clinical scales [Post-traumatic Stress-Intrusion (PTS-I), Post-traumatic Stress-Avoidance (PTS-AV), Post-traumatic Stress-Arousal (PTS-AR), Post-traumatic Stress-Total (PTS-TOT), Sexual Concerns (SC), Dissociation (DIS), Anxiety (ANX), Depression (DEP), and Anger/Aggression (ANG)], as well as an item assessing hours per week of caretaker contact with the child. This paper introduces the TSCYC and describes its psychometric properties in a multisite validity study. Method: A total of 219 TSCYCs administered by six clinician/researchers across the United States were analyzed for scale reliability and association with several types of childhood maltreatment. Results: The TSCYC clinical scales have good reliability and are associated with exposure to childhood sexual abuse, physical abuse, and witnessing domestic violence. The PTS-I, PTS-AV, PTS-AR, and PTS-TOT scales were most predictive, followed by SC in the case of sexual abuse and DIS in the case of physical abuse. There were a small number of age, sex, and race effects on TSCYC scores. Conclusions: The TSCYC appears to have reasonable psychometric characteristics, and correlates as expected with various types of trauma exposure. Subject to continued validation and the development of general population norms, its use as a clinical measure is supported.

Despite an extensive literature on the links between childhood sexual abuse (CSA) and posttraumatic stress disorder (PTSD), our knowledge on the effects of gender in relation to the risks for sexual victimization and subsequent PTSD is limited. We review current knowledge of gender differences in prevalence of CSA and the role of gender in subsequent development of child and adolescent PTSD with specific attention to rates, phenomenology, biological correlates, and risk factors. Despite the heavy bias toward female representation in studies, the literature supports increased rates of CSA and heightened vulnerability to PTSD in girls, as well as possible gender differences in the biological correlates and psychiatric sequelae of CSA. Further work is needed to explore the mechanisms that underlie these differences.

Pedophilia is characterized by sexual attraction to prepubescent children. Despite the extensive literature documenting the pervasive and pernicious effects of childhood sexual abuse, there is surprisingly little psychiatric literature on pedophilia and its etiology remains enigmatic. In recent years, the psychiatric literature on the phenomenology, neurobiology, and treatment of impulsive-aggressive disorders has grown significantly. As some investigators have conceptualized pedophilia as an impulsive-aggressive disorder, it is of interest whether recent advances in the study of impulsive-aggressive disorders might shed light on pathological mechanisms underlying pedophilia. In the following study, 20 male subjects with a DSM-IV diagnosis of pedophilia, heterosexual type were recruited from an outpatient facility for sexual offenders and compared to 24 demographically simi-lar control subjects. Groups were compared on three personality instruments-the Millon Clinical Multiaxial Inventory-II (MCMI-II), the Temperament and Character Inventory (TCI), and the Dimensional Assessment of Personality Impairment-Questionnaire (DAPI-Q)-to assess for select impairment in impulsive-aggressive personality traits. Pedophiles showed severe and pervasive personality impairment relative to controls. Although there was evidence of impulsivity, the findings do not suggest a predominance of impulsive-aggressive traits, and in fact provide evidence of inhibition, passive-aggression, and harm avoidance. The notion of "compulsive-aggression" in pedophilia is proposed.

Research on childhood sexual abuse has often examined, in isolation of one another, such highly correlated risk factors as parental substance abuse, domestic violence, and pathological family functioning. Investigating comorbid antecedents separately does not allow accurate specification of the predictors of abuse. Moreover, sexual trauma research has tended to neglect parental sociopathy as a risk factor. Given the limitations of past research, the present study examined the relationships among parental sociopathy, parental substance use, marital violence, poor family functioning, and childhood sexual abuse. We administered a battery of questionnaires to a nonclinical sample of 130 college women and replicated previous findings by showing that parental substance use predicted sexual abuse when examined in isolation. However, when parental sociopathy and the other risk factors were included in a regression model, parental sociopathy was the only significant predictor. Mother's ...

This study discloses existential temporality as the core to understand the lived experience of sexually abused girls with broken family relationship. Through a phenomenological analysis of 8 participants' interview data, the result indicates that, for the girls who had been sexually abused, as their primary parent-child relationship were destroyed, they lost the connections with the adult world and fell out into the "wild world." The "wild world," in contrast with the "mainstream world" which is ruled by and composed of social orders, is full of spontaneous actions and events without plan and order. The modes of time lived are the keys to understand the differences between these two worlds. The time lived in the wild world can be called as flowing temporality, in which spontaneous actions are most obvious. While in the mainstream world, social orders and values are founded on the temporality of linear causality. To the girls lived in the wild world, all the desired goals in the mainstream world were set in accordance with the linear temporality and thus with no significance. Living in the wild world, peer relationships on the street appeared to be the pathway for the girls to earn their own linear-causal temporality, which would develop into a "new world" for the girls to live in. This study indicates the importance of peer relationships for the girls to rebuild the linear-causal temporality in their lives. The significance of existential temporality as a research framework to understand the experiences of girls with childhood sexual abuse is thus demonstrated.

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According to the poet Elias Canetti, "All the things one has forgotten / scream for help in dreams." To the ancient Egyptians they were prophecies, and in world folklore they have often marked visitations from the dead. For Freud they were expressions of "wish fulfillment," and for Jung, symbolic representations of mythical archetypes. Although there is still much disagreement about the significance and function of dreams, they seem to serve as a barometer of current mind and body states.

In this volume, Deirdre Barrett brings together the study of dreams and the psychology of trauma. She has called on a distinguished group of psychiatrists, psychologists, and social workers--among them Rosalind Cartwright, Robert J. Lifton, and Oliver Sacks--to consider how trauma shapes dreaming and what the dreaming mind might reveal about trauma. The book focuses on catastrophic events, such as combat, political torture, natural disasters, and rape. The lasting effects of childhood trauma, such as sexual abuse or severe burns, on personality formation, the nature of memories of early trauma, and the development of defenses related to amnesia and dissociation are all considered. The book also takes up trauma and adult dreams, including Vietnam veterans and Post-Traumatic Stress Disorder, Holocaust survivors and perpetrators, rape victims, and firestorm survivors. Finally, this volume concludes with a look at the potential "traumas of normal life," such as divorce, bereavement, and life-threatening illness, and the role of dreams in working through normal grief and loss.

Taken together, these diverse perspectives illuminate the universal and the particular effects of traumatic experience. For physicians and clinicians, determining the etiology of nightmares offers valuable diagnostic and therapeutic insights for individual treatment. This book provides a way of juxtaposing the research in the separate fields of trauma and dreams, and learning from their discoveries.

Kasus kekerasan seksual terhadap anak terus meningkat dari waktu ke waktu. Multifactor diyakini sebagai penyebab dari peristiwa tersebut. Salah satu factor yang erat kaitannya dengan keberadaan anak di lingkungan social adalah ketersediaan ruang personal dan keterpenuhan kebutuhan anak akan privacy. Kedua hal tersebut terkait dengan tinjauan Psikologi Lingkungan dalam memandang terjadinya transaksi antara perilaku manusia dengan lingkungan fisiknya. Tulisan ini bertujuan untuk menganalisis terjadinya kekerasan seksual ditinjau dari sudut pandang Psikologi Lingkungan terutama mengenai ketersediaan ruang personal dan keterpenuhan kebutuhan privacy anak.

The controversy over recovered memories of childhood sexual abuse (CSA) is whether such experiences can be forgotten for long periods and retrieved later in therapy or in response to cues or triggers from the environment. False memory syndrome (FMS) is caused by memories of a traumatic experience-most frequently CSA-which are objectively false, but in which the person strongly believes. Personality factors often play a role in the development of FMS. Because CSA is such a devastating experience, false accusations of sexual abuse have enormous, if not shattering, consequences for families. We present three case reports to illustrate features of the FMS. FMS should be listed for further study to establish valid criteria for making the diagnosis under the category of "factitious disorders," and a subcategory of "false memories/beliefs of abuse," with a further subdivision of "induced by therapy." The FMS controversy occurred in the context of a general moral panic about sexual abuse in the early 1980s. Psychiatrists should have a high degree of scepticism to moral panics.

The association between trauma and personality disorders (PDs), while receiving much attention and debate, has not been comprehensively examined for multiple types of trauma and PDs. The authors examined data from a multisite study of four PD groups: schizotypal, borderline (BPD), avoidant, and obsessive-compulsive, and a major depression comparison group. Rates of traumatic exposure to specific types of trauma, age

Objective: With a prevalence of around 20%, childhood sexual abuse (CSA) is a relevant problem in obstetric care. The aim of our systematic review was to present the current knowledge on the influence of CSA on pregnancy, delivery, and early parenthood. Data Sources: All English, French, or German primary and secondary literature from the reference lists found after screening the data banks Pubmed, PsycInfo, and Psyndex for publications that include the terms CSA or childhood traumatization and pregnancy, birth, delivery, labor, childbearing, breast feeding, or postpartum, and published after 1970 were reviewed for relevant data. Methods of Study Selection: Investigations of psychological/medical data banks and cross references revealed 43 relevant studies. Given the paucity of data on this important subject, we opted to review all of these studies. Tabulation, Integration, and Results: Although research projects on this topic are rare and the methodological quality of studies published to date is generally poor, women with a history of CSA seem to present a variety of long-term sequelae referring to pregnancy, delivery, and early parenthood. These sequelae include risk behaviors during pregnancy and disturbance of delivery by sudden memories of sexual abuse situations. Prenatal care is often complicated by the tendency to avoid situations that can trigger memories. Conclusions: As effective treatment programs to improve sequelae of CSA are available today, the question of such abuse experiences should be raised as early as possible and adequate interdisciplinary models to care for victimized patients should be established. However, to improve knowledge on the long-term effect of sexual abuse experiences in obstetrical care, methodologically well-designed research projects focusing on the kind and incidence of sequelae, mediating factors as well as prophylactic and therapeutic options are needed. D

Suicidal behaviours are one of the most important contributors to the global burden of disease among women, but little is known about prevalence and modifiable risk factors in low and middle income countries. We use data from the WHO multi-country study on women's health and domestic violence against women to examine the prevalence of suicidal thoughts and attempts, and relationships between suicide attempts and mental health status, child sexual abuse, partner violence and other variables. Population representative cross-sectional household surveys were conducted from 2000e2003 in 13 provincial (more rural) and city (urban) sites in Brazil, Ethiopia, Japan, Namibia, Peru, Samoa, Serbia, Thailand and Tanzania. 20967 women aged 15e49 years participated. Prevalence of lifetime suicide attempts, lifetime suicidal thoughts, and suicidal thoughts in the past four weeks were calculated, and multivariate logistic regression models were fit to examine factors associated with suicide attempts in each site. Prevalence of lifetime suicide attempts ranged from 0.8% (Tanzania) to 12.0% (Peru city); lifetime thoughts of suicide from 7.2% (Tanzania province) to 29.0% (Peru province), and thoughts in the past four weeks from 1.9% (Serbia) to 13.6% (Peru province). 25e50% of women with suicidal thoughts in the past four weeks had also visited a health worker in that time. The most consistent risk factors for suicide attempts after adjusting for probable common mental health disorders were: intimate partner violence, non-partner physical violence, ever being divorced, separated or widowed, childhood sexual abuse and having a mother who had experienced intimate partner violence. Mental health policies and services must recognise the consistent relationship between violence and suicidality in women in low and middle income countries. Training health sector workers to recognize and respond to the consequences of violence may substantially reduce the health burden associated with suicidal behaviour.

No definitive relationship between the underlying causes of the PoP have thus far been established. Paedophilia is becoming an increasing criminological issue. The identity of a paedophile is one who is susceptible to paraphilias, specifically prepubescent children. However, the majority of paedophiles do not act accordingly to their sexual desires. Nonetheless, in recent years, there has been an escalation in the reporting of victims of CSA in the UK. This paper uses secondary quantitative data to create a Literature Review which explores the implementation of criminological, bio-sociological, psychological and sociological theories, and a further Systematic Review of the current understandings of the PoP, and treatment methods and techniques associated with decreasing paedophilic offending. Results indicate that biological factors such as the role of hormones and the brain are the underlying causes of the PoP, with the influence of sociological elements. Contemporary treatment methods are perceived as unethical, except those practiced within the UK. Therapeutic approaches are the suggested methods for decreasing paedophilic offending. Further suggestions into the underlying causes of the PoP involve the integration of criminology and science, specifically into the biological underlying causations of the PoP, to increase public and scientific understandings.

The present study examined the parent-child attachments, typical coping styles, and childhood sexual abuse among 30 child molesters, 24 nonsexual offenders, and 29 nonoffenders. The results indicated that all subjects reported greater security in their attachments to their mothers than to their fathers and the insecure patterns of childhood attachments were related to ineffective adult coping. The only difference observed in characteristic coping showed that child molesters were more likely to engage in emotion focused strategies. Child molesters reported having experienced high levels of childhood sexual abuse and these experiences appear to have been more distressing to them than to other subjects. The results are discussed in terms of their implications for theory and treatment.

My presentation today, "Sibling Sexual Abuse: Principles of practice for supporting families in the aftermath of discovery", is based on my qualitative PhD and 25 years of experience working with children, young people and their families where child sexual abuse or harmful sexual behaviour have occurred. I would like to acknowledge the courage of these families and of survivors of child sexual abuse and other forms of child abuse in surviving their experience, and for many, in sharing their experience as they seek for meaning in it.

This in-depth qualitative study explores how 16 resilient male survivors of serious childhood sexual abuse, representing a range of racial, ethnic, and socioeconomic backgrounds, made meaning from their abuse experiences. Three main types of meaning making styles were identified in the narratives: meaning making through action, using cognitive strategies, and engaging spirituality. Meaning making through action included helping others and using creative expression to describe and process the abuse. Reasoning systems that helped survivors to understand why the abuse happened included developing a psychological framework for understanding the abuser or the role of the self in the abuse, using a sociocultural explanation, or developing a philosophical view. A few men made meaning through their spirituality. Meaning making styles seem to be related to experiences with therapy; the more experience these men had had with specialized trauma therapy, the more likely they were to make meaning by attempting to understand their perpetrators. In this study, men of color, regardless of socioeconomic class, were less likely than Caucasian men to have received specialized trauma therapy.

Objective: This study examined the relationships between reported history of childhood sexual abuse (CSA), psychological distress, and medical utilization among women in a health maintenance organization (HMO) setting. Methods: Participants were 206 women aged 20 to 63 years who were recruited from an HMO primary care clinic waiting area. Participants were classified, using screening questionnaires and the revised Symptom Checklist 90, as 1) CSA-distressed, 2) distressed only, 3) CSA only, or 4) control participants. Medical utilization rates were generated from the computerized database of the HMO for 1) nonpsychiatric outpatient, 2) psychiatric outpatient, 3) emergency room (ER), and 4) inpatient admissions. Results: CSA-distressed and distressed only groups both used significantly more nonpsychiatric outpatient visits than CSA only and control participants but were not different from one another. CSA only and control participants did not differ on nonpsychiatric outpatient utilization. CSA-distressed participants used significantly more ER visits and were more likely to visit the ER for pain-related complaints than other participants. Among CSA-distressed participants, those who met criteria for physical abuse had significantly more ER visits than those who did not. There were no differences among the four groups in inpatient utilization rates. Conclusions: Psychological distress is associated with higher outpatient medical utilization, independent of CSA history. History of CSA with concomitant psychological distress is associated with significantly higher ER visits, particularly for those with a history of physical abuse. History of CSA without distress is not associated with elevated rates of medical utilization. Screening for psychological distress, CSA, and physical abuse may help to identify distinct subgroups with unique utilization patterns. Key words: sexual abuse, medical utilization, psychological distress, pain.

Disclosure is a prominent variable in child sexual abuse research, but little research has examined male disclosure experiences. Sixteen male survivors of childhood sexual abuse were interviewed regarding experiences of disclosure. Analytic techniques included a grounded theory approach to coding and the use of conceptually clustered matrices. Participants described distinct personal (e.g., lack of cognitive awareness, intentional avoidance, emotional readiness, and shame), relational (e.g., fears about negative repercussions, isolation), and sociocultural (e.g., lack of acceptance for men to experience or acknowledge victimization) reasons for their struggles with disclosure. These results highlight that barriers to disclosure exist in multiple domains of experience and are encountered across the lifespan. Implications for future research and clinical interventions are discussed.

The following paper is a three pronged analysis of Cognitive Behavioral Therapy in relationship to childhood sexual abuse. The first prong focuses on addressing the extent and ramifications of childhood sexual abuse in the United States. As a result of the far-reaching effects of childhood sexual abuse the next portion of the paper briefly describes the essentials of Cognitive Behavioral Therapy in an effort to provide a frame of reference for the last portion of the paper. To conclude the paper the first two sections are consolidated as the research from five different sources is brought together to form a treatment model for childhood sexual abuse using empirically validated methods from Cognitive Behavioral Therapy. The treatment model incorporates a non-offending caregiver into therapy and involves them in the child’s treatment process. The specific treatment model implements three broad therapeutic interventions that could be considered therapeutic goals: (1) coping skills training, (2) gradual exposure and processing, and (3) psychoeducation about childhood sexual abuse, healthy sexuality, and body safety skills. Included in the discussion are brief comments regarding diversity issues and Biblical integration in the midst of sound therapeutic approaches.