Prevalence and psychological sequelae of self-reported childhood physical and sexual abuse in a general population sample of men and women
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.
References (37)
- et al.
Differential adult symptomatology associated with three types of child abuse histories
Child Abuse & Neglect
(1990) - et al.
Sexual abuse in a national survey of adult men and women: Prevalence, characteristics, and risk factors
Child Abuse & Neglect
(1990) - et al.
Long term correlates of child sexual abuse: Theory and review of the empirical literature
Applied & Preventive Psychology
(1995) The sexual abuse of Afro-American and White American women in childhood
Child Abuse & Neglect
(1985)- et al.
Methodological considerations in research on the prevalence of child sexual abuse
Child Abuse & Neglect
(1986) The prevalence and mental health sequels of child sexual abuse in a community sample of women aged 18 to 27
Canadian Journal of Community Mental Health
(1991)- et al.
Sexual abuse in childhood: Psychosocial outcomes and implications for social work practice
Journal of Social Work and Human Sexuality
(1986) - Berliner, L., & Elliott, D. M. (2002). Sexual abuse of children. In J. E. B. Myers, L. Berliner, J. Briere, C. T....
Controlling for family variables in abuse effects research: A critique of the “partialing” approach
Journal of Interpersonal Violence
(1988)Methodological issues in the study of sexual abuse effects
Journal of Consulting and Clinical Psychology
(1992)
Sexual abuse, family environment, and psychological symptoms: On the validity of statistical control
Journal of Consulting and Clinical Psychology
Clinical utility of the Impact of Event Scale: Psychometrics in the general population
Assessment
Child sexual abuse: Long-term sequelae and implications for psychological assessment
Journal of Interpersonal Violence
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