Elsevier

Child Abuse & Neglect

Volume 27, Issue 10, October 2003, Pages 1205-1222
Child Abuse & Neglect

Prevalence and psychological sequelae of self-reported childhood physical and sexual abuse in a general population sample of men and women

https://doi.org/10.1016/j.chiabu.2003.09.008Get rights and content

Abstract

Objective: This study examined the prevalence and psychological sequelae of childhood sexual and physical abuse in adults from the general population.

Method: A national sampling service generated a geographically stratified, random sample of 1,442 subjects from the United States. Subjects were mailed a questionnaire that included the Traumatic Events Survey (TES) [Traumatic Events Survey, Unpublished Psychological Test, Harbor-UCLA Medical Center, Los Angeles] and the Trauma Symptom Inventory (TSI) [Trauma Symptom Inventory Professional Manual, Psychological Assessment Resources, Odessa, FL]. Of all potential subjects, 935 (64.8%) returned substantially completed surveys.

Results: Sixty-six men and 152 women (14.2% and 32.3%, respectively) reported childhood experiences that satisfied criteria for sexual abuse, and 103 males and 92 females (22.2% and 19.5%, respectively) met criteria for physical abuse. Twenty-one percent of subjects with one type of abuse also had experienced the other type, and both types were associated with subsequent adult victimization. After controlling for demographics, adult history of interpersonal violence, and other child abuse, childhood sexual abuse was associated with all 10 scales of the TSI, and physical abuse was related to all TSI scales except those tapping sexual issues. Sexual abuse predicted more symptom variance than did physical abuse or adult interpersonal victimization. Various aspects of both physical and sexual abuse experiences were predictive of TSI scores. Abuser sex, however, both alone and in interaction with victim sex, was not associated with additional TSI symptomatology.

Conclusions: Childhood sexual and physical abuse is relatively common in the general population, and is associated with a wide variety of psychological symptoms. These relationships remain even after controlling for relevant background variables.

Résumé

Objectif: Cette étude a voulu examiner la prévalence et les séquelles psychologiques des agressions sexuelles et des mauvais traitements physiques dans la population en général.

Méthode: Un échantillon aléatoire et géographiquement stratifié comprenait 1.442 sujets vivant aux États Unis. Ils ont reçu un questionnaire par la poste contenant le Traumatic Events Survey (TES; Elliott, 1992) et le Trauma Symptom Inventory (TSI; Briere, 1995); 935 individus (64.8%) l’ont retourné, généralement bien rempli.

Résultats: Soixante-six hommes et 152 femmes (14.2% et 32.3% respectivement) ont relaté des expériences qui rencontraient les critères pour agressions sexuelles; et 103 hommes et 92 femmes (22.2% et 19.5% respectivement) ont satisfait les critères pour les mauvais traitements physiques. Vingt-et-un pour cent des individus qui avaient connu au moins un type de mauvais traitements avaient aussi connu l’autre type, et pour les deux catégories de mauvais traitements, on note que les individus deviennent victimes d’agressions en âge adulte. Ayant contrôlé les facteurs démographiques ainsi que la présence de violence durant la vie adulte et autres types de mauvais traitements en enfance, les auteurs ont noté que les abus sexuels s’associent aux dix échelles du TSI tandis que les mauvais traitements physiques s’associent à toutes les échelles du TSI sauf celles qui mesurent les agressions sexuelles. La présence d’expériences d’agressions sexuelles prédit une plus grande variance de symptômes que la présence de mauvais traitements physiques ou d’agressions subies durant la vie adulte. Divers aspects des expériences sexuelles et physiques prédisent des scores du TSI. Cependant, on n’a remarqué aucun lien entre des symptômes additionnels du TSI et la présence d’actes sexuels des agresseurs, en soi, ou combiné avec la présence d’expériences sexuelles de la victime.

Conclusions: On retrouve communément la présence d’agressions sexuelles et physiques en enfance dans la population en général, et celles-ci s’accompagnent d’une gamme de symptômes psychologiques. Ces liens persistent même après avoir contrôlé diverses variables.

Resumen

Objetivo: Este estudio examina la prevalencia y las secuelas psicológicas del maltrato y el abuso sexual en la infancia en adultos de la población general.

Método: Un servicio estadı́stico nacional generó una muestrea aleatoria geográficamente estratificada de 1.442 sujetos de USA. A todos los sujetos de les envió por correo un cuestionario que incluyó la Encuesta de Acontecimientos Traumáticos (TES; Elliot, 1992) y el Inventario de Sı́ntomas Traumáticos (TSI; Briere, 1995). De todos los potenciales sujetos, un total de 935 (64.8%) devolvieron las entrevistas cumplimentadas.

Resultados: Sesenta y seis varones y 152 mujeres (14.2% y 32.3%, respectivamente) notificaron experiencias infantiles que satisfacen los criterios para abuso sexual. Además, 103 varones y 92 mujeres (22.2% y 19.5%, respectivamente) notificaron experiencias infantiles que cumplieron los criterios de maltrato fı́sico. Un 21% de los sujetos con un tipo de maltrato también habı́a experimentado el otro tipo y ambos tipos de maltrato estaban asociados con posterior victimización como adultos. Después de controlar el efecto de las variables demográficas, la historia adulta de violencia interpersonal y otros tipos de maltrato, se observó una asociación del abuso sexual infantil con el total de las 10 escalas del TSI y una asociación del maltrato fı́sico con todas las escalas del TSI, excepto con aquellas relacionadas con cuestiones sexuales. El abuso sexual tiene un mayor valor predictivo de la varianza de los sı́ntomas que el maltrato fı́sico o la victimización adulta interpersonal. Varios aspectos de las experiencias de maltrato fı́sico y abuso sexual fueron predictivos de las puntuaciones en el TSI. El género del abusador sexual, ni de manera aislada ni en interacción con el género de la vı́ctima, estuvo asociada con sintomatologı́a adicional en el TSI.

Conclusiones: El maltrato fı́sico y el abuso sexual infantil es relativamente frecuente en la población general y están asociados con una amplia variedad de sı́ntomas psicológicos. Estas relaciones permanecen incluso después de haber controlado variables históricas relevantes.

Introduction

Although the incidence and long-term effects of childhood sexual and physical abuse are thought by most clinicians and researchers to be significant, some have suggested that the methodology and samples used in such studies may obscure or confound the actual relationship between child maltreatment and its potential effects. Among criticisms offered are (a) the fact that most studies examine clinical samples (Rind, Tromovitch, & Bauserman, 1998) or, alternatively, focus on university students (Wyatt & Peters, 1986), neither of which may provide a clear picture of the rates and impacts of child abuse in the general population, (b) the generic (i.e., not trauma-specific) measures used in many studies may underevaluate the actual symptomatology arising from childhood trauma (Carlson, 1997, Elliott, 1994), (c) the failure of many studies to examine both physical and sexual abuse as separate variables may overestimate the effects of sexual abuse where physical abuse is also present (Briere, 1992), and (d) background factors such as demographic and socioeconomic variables, family environment, and non-abuse-related traumas may confound what otherwise appear to be abuse-related effects (Fromuth, 1986, Rind et al., 1998).

Some controversy has arisen regarding the last of these points, that is, the possible confounding of abuse effects with the potential impacts of other variables that correlate with abuse. In this regard, there are significant statistical issues associated with controlling for abuse-correlated variables when abuse is antecedent to such variables (Davis, 1985, Pedhazur, 1982) or when the abuse variable is, itself, logically inseparable from the controlled variable (Briere & Elliott, 1993). For example, in the case of family environment, child abuse may further disrupt an already dysfunctional family, and a dysfunctional family may be an important aspect of child abuse (especially intrafamilial sexual and physical abuse). As a result, controlling for family environment when examining the relationship between abuse and later psychological symptoms may be a highly conservative, or even nonsensical procedure (e.g., examining the effects of incest after removing variance associated with living in a disturbed or dysfunctional family environment) (Briere & Elliott, 1993).

Despite these concerns, statistical control procedures can be helpful in assessing potential child abuse effects, especially when the control variables are less confounded with child maltreatment than is the case for concurrent family environment. In this regard, researchers have found it helpful to control for race or family income when examining potential risk factors for adult psychopathology, although this has been done rarely in child abuse research. Similarly, although other forms of child maltreatment and later (adult) victimization experiences may also covary with a given form of child abuse, controlling for such events can provide a clearer—albeit more conservative—view of the unique mental health sequelae of child abuse. For this reason, the current authors have advocated for the application of multivariate research strategies in the study of potential child abuse effects, while, at the same time, warning of the potential problems associated with partialing out “family dysfunction” in such research (Briere, 1988, Briere, 1992, Briere & Elliott, 1993).

Despite these methodological concerns, over two decades of research suggest with relative unanimity that childhood physical and sexual abuse have a wide number of psychological sequelae. Among these are low self-esteem, anxiety, depression, anger and aggression, posttraumatic stress, dissociation, substance abuse, sexual difficulties, somatic preoccupation and disorder, self-injurious or self-destructive behavior, and most of the various symptoms and behaviors seen in those diagnosed with borderline personality disorder (see reviews by Berliner & Elliott, 2002, Briere & Runtz, 1993, Finkelhor, 1990, Kolko, 2002; Neumann, Houskamp, Pollock, & Briere, 1996; Polusny & Follette, 1995). Given this wide range of findings, an important goal of current research in this area is to determine the mediators and potential confounds associated with these abuse-symptom relationships. Equally important is the determination of the extent to which such symptom correlates occur in the general population, as opposed to solely in the university and clinical contexts where most studies in this area have been conducted.

Beyond the issue of possible abuse effects, also unresolved is the actual prevalence of childhood sexual and physical abuse in the general population. Reported sexual abuse rates for women, for example, have ranged from 8% to 32% in retrospective general population samples, whereas the rates for men range from 1% to 16% (Finkelhor, 1994). Among the possible reasons for such variability include differences in abuse definitions, survey methods, and representativeness of the samples collected. Controversy has occurred especially for male abuse rates, with several writers suggesting that the reported rates for males who were sexually abused as children are serious underestimates of their actual prevalence in the general population (e.g., Mendel, 1995).

In response to these continuing issues, the present paper reports on the prevalence and mental health correlates of child abuse in a random sample of the general population. In order to boost the external validity/generalizability of this study, special efforts were made to insure a relatively high response rate, so that concerns about representativeness could be addressed. In addition, in response to concerns about measurement sensitivity, the present study used the Trauma Symptom Inventory (TSI; Briere, 1995), a standardized test that may be more likely than some other measures to be responsive to the specific impacts of childhood abuse. Finally, the present study controlled for important demographic variables, and accounted for non-abuse-related traumas that otherwise might confound abuse-symptom analyses, while at the same time considering the statistical and interpretive implications of such a conservative procedure.

Section snippets

Procedure

A national sampling service generated a geographically stratified, random sample of 1,442 subjects with deliverable addresses, based on records of registered owners of automobiles and/or individuals with listed telephones. According to the 1990 U.S. Census, over 95% of all households have telephones, allowing this sample to tap the majority of individuals in the United States. These subjects were mailed a questionnaire that included, among other measures, the Traumatic Events Survey (TES;

Sexual abuse

A total of 66 men and 152 women (14.2% and 32.3%, respectively) reported childhood experiences that satisfied the current criteria for sexual abuse. This sex difference was statistically significant, χ2(1)=41.6, p<.001. Of these cases, a number of abuse characteristics did not differ according to sex of subject. These were incest (abuse within the immediate or extended family: 46.8%), oral, anal, or vaginal penetration by a penis or other object (52.8%), number of incidents (mode=2–5, 32.2%),

Discussion

The results of this study are discussed below in terms of prevalence, associations with current symptomatology, and methodological issues.

Conclusion

The current report on the prevalence and symptomatic correlates of self-reported child abuse in the general population suggests that not only is child maltreatment relatively common, it also is associated with a variety of types of psychological dysfunction years later. Because this study was based on self-report, retrospective data, the relationship between childhood abuse and adult symptoms cannot be assumed to be causal. Nevertheless, in combination with a variety of other studies, the

Acknowledgements

This research was conducted when the second author was affiliated with Biola University, La Mirada, California.

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