Pathways to PTSD, part II: Sexually abused children.

OBJECTIVE The goal of this research was to develop and test a prospective model of posttraumatic stress symptoms in sexually abused children that includes pretrauma, trauma, and disclosure-related pathways. METHOD At time 1, several measures were used to assess pretrauma variables, trauma variables, and stress reactions upon disclosure for 156 sexually abused children ages 8 to 13 years. At the time 2 follow-up (7 to 36 months following the initial interview), the children were assessed for posttraumatic stress disorder (PTSD) symptoms. RESULTS A path analysis involving a series of hierarchically nested ordinary least squares multiple regression analyses indicated three direct paths to PTSD symptoms: avoidant coping, anxiety/arousal, and dissociation, all measured during or immediately after disclosure of sexual abuse. Additionally, age and gender predicted avoidant coping, while life stress and age at abuse onset predicted symptoms of anxiety/arousal. Taken together, these pathways accounted for approximately 57% of the variance in PTSD symptoms. CONCLUSIONS Symptoms measured at the time of disclosure constitute direct, independent pathways by which sexually abused children are likely to develop later PTSD symptoms. These findings speak to the importance of assessing children during the disclosure of abuse in order to identify those at greatest risk for later PTSD symptoms.

[1]  L. Furby,et al.  A Conceptual Framework for the Long-Term Psychological Effects of Traumatic Childhood Abuse , 1997 .

[2]  William L. Baker,et al.  Childhood trauma, the neurobiology of adaptation, and "use-dependent" development of the brain: How "states" become "traits." , 1995 .

[3]  Patricio Cumsille,et al.  Methods for Handling Missing Data , 2003 .

[4]  M. Himelein,et al.  Resilient child sexual abuse survivors: cognitive coping and illusion. , 1996, Child abuse & neglect.

[5]  L. A. Valle,et al.  Attributions and Adjustment Following Child Sexual and Physical Abuse , 2002, Child maltreatment.

[6]  J. Noll,et al.  Disclosure patterns of sexual abuse and psychological functioning at a 1-year follow-up. , 1997, Child abuse & neglect.

[7]  Lynda A. King,et al.  Pathways to PTSD, part I: Children with burns. , 2005, The American journal of psychiatry.

[8]  C. Classen,et al.  Predictors of posttraumatic stress symptoms among survivors of the Oakland/Berkeley, Calif., firestorm. , 1994, The American journal of psychiatry.

[9]  L. Canetti,et al.  Predictors of PTSD in injured trauma survivors: a prospective study. , 1996, The American journal of psychiatry.

[10]  W. Friedrich,et al.  Dissociative and Sexual Behaviors in Children and Adolescents With Sexual Abuse and Psychiatric Histories , 1997 .

[11]  C. Zlotnick,et al.  Differences in dissociative experiences between survivors of childhood incest and survivors of assault in adulthood. , 1996, The Journal of nervous and mental disease.

[12]  S. Porges,et al.  Emotion: An Evolutionary By‐Product of the Neural Regulation of the Autonomic Nervous System a , 1997, Annals of the New York Academy of Sciences.

[13]  M. Rutter.  Continuities and discontinuities from infancy. , 1987 .

[14]  T. Roesler,et al.  Effects of Childhood Trauma on Psychological Functioning in Adults Sexually Abused as Children , 1994, The Journal of nervous and mental disease.

[15]  Andrea M Hussong,et al.  The use of latent trajectory models in psychopathology research. , 2003, Journal of abnormal psychology.

[16]  F. Putnam.  Dissociation in Children and Adolescents: A Developmental Perspective , 1997 .

[17]  Colin Bateman,et al.  Cycle of Violence , 1995 .

[18]  T. Achenbach.  Manual for the Youth Self-Report and 1991 profile , 1991 .

[19]  L. Brody,et al.  Gender, emotional expression, and parent–child boundaries. , 1996 .

[20]  J. Pennebaker.  Putting stress into words: health, linguistic, and therapeutic implications. , 1993, Behaviour research and therapy.

[21]  B. Perry,et al.  Incubated in terror: Neurodevelopmental factors in the "cycle of violence." , 1997 .

[22]  R. R. Abidin,et al.  Perceptions of abuse: effects on adult psychological and social adjustment. , 1996, Child abuse & neglect.

[23]  B. J. Myers,et al.  Adolescent Self-Esteem and Gender: Exploring Relations to Sexual Harassment, Body Image, Media Influence, and Emotional Expression , 2001 .

[24]  S. Porges.  Orienting in a defensive world: mammalian modifications of our evolutionary heritage. A Polyvagal Theory. , 1995, Psychophysiology.

[25]  R. Yehuda.  Risk factors for posttraumatic stress disorder , 1999 .

[26]  J. Crouch,et al.  The Trauma Symptom Checklist for Young Children (TSCYC): reliability and association with abuse exposure in a multi-site study. , 2001, Child abuse & neglect.

[27]  W. Yule,et al.  Emotional processing in survivors of the Jupiter cruise ship disaster. , 1995, Behaviour research and therapy.

[28]  B. Egeland,et al.  A Developmental View of the Psychological Consequences of Maltreatment. , 1987 .

[29]  A. Harvey,et al.  Two-year prospective evaluation of the relationship between acute stress disorder and posttraumatic stress disorder following mild traumatic brain injury. , 2000, The American journal of psychiatry.

[30]  A. Morral,et al.  Influence of emotional engagement and habituation on exposure therapy for PTSD. , 1998, Journal of consulting and clinical psychology.

[31]  D. Fergusson,et al.  Childhood Sexual Abuse: An Evidence-Based Perspective , 1999 .

[32]  Daniel W. Smith,et al.  Measuring Reactions to Sexual Trauma among Children: Comparing the Children's Impact of Traumatic Events Scale and the Trauma Symptom Checklist for Children , 1999 .

[33]  L. Peterson,et al.  Coping by children undergoing stressful medical procedures: some conceptual, methodological, and therapeutic issues. , 1989, Journal of consulting and clinical psychology.

[34]  D Finkelhor,et al.  Impact of sexual abuse on children: a review and synthesis of recent empirical studies. , 1993, Psychological bulletin.

[35]  D. Wolfe,et al.  The impact of sexual abuse on children: A PTSD formulation * , 1989 .

[36]  M. Hébert,et al.  Coping strategies and social support as mediators of consequences in child sexual abuse victims. , 1999, Child abuse & neglect.

[37]  E. Foa,et al.  Dissociative experiences and posttraumatic stress disorder among female victims of criminal assault and rape , 1996, Journal of traumatic stress.

[38]  R. Dykman,et al.  School age children's coping with sexual abuse: abuse stresses and symptoms associated with four coping strategies. , 1997, Child abuse & neglect.

[39]  M. Liebowitz,et al.  Review and critique of the new DSM-IV diagnosis of acute stress disorder. , 1999, The American journal of psychiatry.

[40]  P. Costanzo,et al.  Posttraumatic symptomatology in children and adolescents after an industrial fire. , 1997, Journal of the American Academy of Child and Adolescent Psychiatry.

[41]  C. Widom.  Posttraumatic stress disorder in abused and neglected children grown up. , 1999, The American journal of psychiatry.

[42]  J. Chu,et al.  Correlates of dissociative symptomatology in patients with physical and sexual abuse histories. , 1993, Comprehensive psychiatry.

[43]  Judith Cohen.  Practice Parameters for the Assessment and Treatment of Children and Adolescents With Posttraumatic Stress Disorder , 1998 .

[44]  E. Foa,et al.  Relationship Between Trauma Narratives and Trauma Pathology , 1998, Journal of traumatic stress.

[45]  Dave Sells,et al.  Gender and Modality Differences in Experiencing and Emotional Expression , 2001 .

[46]  D S Weiss,et al.  Peritraumatic dissociation and posttraumatic stress in male Vietnam theater veterans. , 1994, The American journal of psychiatry.

[47]  C. Brewin,et al.  Acute stress disorder and posttraumatic stress disorder in victims of violent crime. , 1999, The American journal of psychiatry.

[48]  A. Levendosky,et al.  Adolescent survivors of childhood sexual abuse: the mediating role of attachment style and coping in psychological and interpersonal functioning. , 1999, Child abuse & neglect.

[49]  E. Deblinger,et al.  Cognitive behavioral treatment for sexually abused children suffering post-traumatic stress: preliminary findings. , 1990, Journal of the American Academy of Child and Adolescent Psychiatry.