Impact of Sexual Abuse on Victims

Anna C. Salter, Ph.D.

Agenda

Impact on Disclosure Symptoms and syndromes PTSD & revictimization Worse outcomes Attributions: Whose fault is it? Beyond blame: Issues of powerlessness Mechanisms of transmission Impact of offender contact Trauma-based world view Offender/victim dynamics Risks in apology sessions

www.annasalter.com

Effects of Sexual Abuse

Lasting psychological injury . . . is not very common. (Brunold, 1964, p. 8)

Effects of Sexual Abuse

Relatively minor effect on adult adjustment. (Gagnon, 1965, p. 177)

Effects of Sexual Abuse

Diminishes the subjects chance of psychosis and allows better adjustment to the external world.
(Rascovsky & Rascovsky, 1950, p. 45)

Effects of Sexual Abuse

May be either a positive, healthy experience of, at worse, neutral and dull. (DeMott, 1980)

Children Not Severely Damaged by Incest with a Parent

Setting Fires Vandalism Disrupting Other Children Stealing Aggression Against Girls

Sexually Abusing Boys Exhibitionism Fearing Calamity Suicidal Ideation Manipulative and Smooth (Yorukoglu & Kemph, 1966)

Impact of Child Sexual Abuse

Silence

10 Retrospective Studies
Revealed abuse to anyone as children 1/3 Cases reported to authorities 10% - 18% (London et al., 2005)

Percentage of Sexual Abuse Reported to Authorties

6 to 12% (Elliott, 1993; Russell, 1984; Saunders et al., 1992; Smith et al., 2000)

Delayed Disclosure of Childhood Rape

N = 388

W/in 24 hours

18%

> 5 years
Never before survey

47%
28%

(Smith et al., 2000)

Delayed Disclosure
N = 156 < One Week < One Year

24% 21% 17%

Five Years Never

39% (Sauzier, 1989)

Percent Who Never Disclosed

22% 28% 31% 33% 46%

Bottoms et al., 2007 Smith et al., 2000 Arata, 1998 Finkelhor et al., 1990 Ussher & Dewberry, 1995

Silence
39% Never told anyone as children (OLeary et al., 2010)

Progressive Disclosure

Elliott & Briere 1994

N = 118 External evidence of abuse Perpetrator confession Witness Pornographic pictures

Elliott & Briere 1994

Many children initially disclosed only fondling
Later penetration

Partial Disclosure

21 studies of children with gonorrhea gradual disclosure common (Lyon, in press)

(Elliott and Briere, 1994)

When Did Child Rarely Disclose

Natural Parent Never Later Immediately 55% 30% 17%

Short Vs. Long Delays

Short

Long 5% 48%

Strangers Related to Victim

22% 24%

(Smith et al., 2000)

Children Who Deny

Less likely to disclose the closer the relationship (DiPetro et al., 1997; Smith et al., 2000)

Family Members as Perps

Lower rates or Longer delays (Goodman-Brown, et al., 2003; Hershkowitz et al., 2005; Sjoberg & Lindblad, 2002; Smith et al., 2000)

Age

Adolescents abused for the first time as adolescents more likely to disclose than younger children

Disclose first to another adolescent (Olafson & Lederman, 2006)

Whom They Told

Mother

21%

Best Friend
No one

23%
28% (Smith et al., 2000)

Whom They Told Mattered

Children who disclosed to someone other than mother Poorer mental health (Ruggiero et al., 2000)

Response of Mother
Mothers who believed and supported Children had fewer mental health problems (Browne & Finkelhor, 1986; Luster & Small, 1997; Merrill et al., 2001)

Response of Listener
If person disclosed to tells someone else without permission Children have more mental health problems (Gold, 1986; OLeary, 2010)

Recantation
Cases where offender confessed 24.5% recanted fully or partially (Malloy, Lyon, Quas, & Forman, 2005)

Recantation
Predictors Lack of maternal support Abuse by male caretaker

Impact of Disclosure
Adolescents and children who disclosed Greater psychological distress Than those who didnt (Feiring et al., 2002; OLeary et al., 2010)

Impact of Disclosure
Adolescents who disclosed Felt less supported Perceived others reactions as negative Blamed selves for abuse (Feiring et al., 2002)

Discussion of Abuse
Those who discussed abuse Not just disclosed Within one year of abuse Better mental health (OLeary et al., 2010)

Fantastic Elements in Disclosures

Gold Standard Perpetrator Confessed Medical Evidence Consistent Persuasive evidence, e.g. Eyewitness (Dalenberg, 1996)

Fantastic Elements in Disclosures

Severe Abuse Perpetrator Family Member Force or Threat Repeated Molestation Intercourse or Oral-Genital (Dalenberg, 1996)

Fantastic Elements in Disclosures

Accounts with Fantastic Elements Severe Gold Standard (52) 15% Nonsevere Gold Standard (8) 2% Nonsevere Questionable (90) 0% Severe Questionable (52) 4% (Dalenberg, 1996)

Type of Offender
Emotional Visibility?
Emotional Invisibility? Where Does Safety Lie?

A 50 Minute Vial of Water

Thinking Errors of Nonsadistic Sex Offenders

The child wanted me to do those things to her. She enjoyed it as much as I did. She was just a little flirt. He knew what he was doing. He came on to me.

Sadistic Behavior
A man shot off a teenage girls arm for the sexual thrill it gave him. ( Abel, 1981)

Sadistic Behavior
A rapists of thirteen-year girls preferred to anally rape them on cement floors so that the rapes would be more painful. (Abel, 1977)

Definition of Sadism

Recurrent, intense sexual fantasies, sexual urges or behavior involving sexual arousal to the infliction of pain or humiliation to another person Occurred over a period of at least 6 months Causes subjective distress or impairment in social or occupational functioning

Sadistic Sexual Arousal

Type of Stimuli Percentage of Full Sexual Arousal 17 61 79 (Abel, 1977)

Consenting Sex Rape Nonsexual Violence

Percentage of Sex Offenders Who are Sadists

2 to 5% (Langevin, 1990)

Whom Sadists Target

Age of Victims Adults Adolescents & Adults Children Percent of Sadists 87 9 2 (Freund, 1990)

First Im going to torture you in the most horrible and painful manner I can think of. Then Im going to abuse you sexually in the most degrading way I possibly can think of. Then Ill kill you in the slowest and most painful way I can conceive. . . Do you have any questions? (Heilbroner, 1993, p. 147)

The picture in my mind was one of torturing a victim with everything from matches and cigarette butts to a propane torch, electrical stimulation, needles, and so forth. . . The first victims were female, because I had an impulse to rape and hurt. The last three were female for rape reasons, but with more emphasis on hurting and humiliation. . . And, on a few occasions, there have been concepts of taking a dry run or a practice run using a small child as victim, male or female. (Groth, 1979, p. 56)

Female Sadists
I just cant explain the feeling it gave me. . . You couldnt understand, nothing compares to the high, nothing, no drink, drugs nothing. Its power I think, I feel really strong, powerful and important nothing and no one can hurt me. The high is incredible. Theres nothing, there just arent words to describe it. (Female sadist; Saradjiam, 1996)

Sister disclosed sexual abuse of Kevin, age 14

Questioned by a professional, Ive never seen a kid look so frightened. He actually wet himself. He became hysterical and babbled. He was convinced this was his end and his mother would now torture him to death.
Abuse age 3 14 (Saradjian, 1996, p. 34)

Cognitive Distortions of Sadistic Offenders

This child is bad, evil, sick or perverted. She deserves it.

Cognitive Distortions of Sadists

I think young girls and boys are meant to be sex slaves or sex playthings for adults. (Sex offender letter to another pedophile -in reality, a federal marshal in a sting operation.)

Sequelae of Sexual Abuse

PTSD Depression Anxiety Disorders Dissociation Sexual Problems Re-Victimization Affective Flashbacks

Worse Outcome
Intrusiveness Injury Physical Violence (E.g., Banyard et al., 2004; Collings, 1995; OLeary, 2010)

Worse Outcome
Parent (Kendall-Tackett, 1993)

Worse Outcome
More severe More frequent and longer lasting

(Banyard et al., 2004; Boudewyn & Liem, 1995)

Worse Outcome
Multiple abusers

(Briere & Runtz, 1988; OLeary et al., 2010)

Sequelae of Sexual Abuse

Re-Victimization PTSD Depression Anxiety Disorders Dissociation Sexual Problems Affective Flashbacks

Revictimization

College is Risky
Some sort of sexual victimization 50% Attempted or completed rape 25% (Fisher et al., 2000; Koss et al., 1987)

Risk Recognition
Women abused as children 1) Less likely to recognize risky situations 2) Perceived fewer situations to be high risk 3) Stayed in risky situations longer (Soler-Baillo et al., 2005; Yeater et al.,2010; )

Impact of Rape Myths

Women who accept rape myths Believed they were less vulnerable to rape & Viewed rape-related info as less relevant to them (Bohner & Lampridis, 2004)

Post-Traumatic Stress Disorder

Intrusive Symptoms Avoidant Symptoms Arousal Symptoms

Intrusive Symptoms
Intrusive Memories Affective Flashbacks Physical Responses to Triggers Nightmares

Triggers

Smell of aftershave Footsteps on the stairs Alone in the room with a male Bathroom Dental appointments

Avoidant Symptoms
Refusal to talk or think about abuse Avoidance of reminders Numbing Post-traumatic decline

Arousal Symptoms

Hyper-startle Lack of concentration Irritability Difficulty sleeping

Correlates of PTSD in Rape Victims

Life Threat Physical Injury Completed Rape
8.5 x (Kilpatrick et al., 1989)

Characteristics of Assault
% 29 58 69 79

Rape Alone Rape/Physical Injury Rape/Life Threat Rape/Injury/Life Threat

(Kilpatrick et al., 1989)

PTSD in Adults Exposed to Violence as Adults

Risk of severe PTSD higher if also sexual abuse after 12 Risk of depression higher if also sexual abuse before 12 (Schoedl et al., 2010)

Sequelae of Sexual Abuse

PTSD Depression Anxiety Disorders Dissociation Sexual Problems Re-Victimization Affective Flashbacks

Home Grown Solutions to Chronic Pain

Drug Addiction - Prostitution Alcoholism Cutting Suicidality Crisis addiction

Types of Coping
Avoidant Most common Related to severity of abuse Practical in short-term Bad outcomes in the long-term

Active Coping
Proactive coping Behavioral changes Cognitive reframing Support-seeking Self-acceptance

Decreased symptoms (Phanicbrat & Townshend, 2010)

Affective Sequelae

Affective Flashbacks Secondary to Cognitions Internalizing Sex Offender Thinking Errors Trauma-Based World View

Secondary to Current Realities

Implicit Versus Explicit Denial

Contact with Offender

Court appearances Supervised visitation Apology sessions Unsupervised visitation Reunification

Attributions

Internal My fault External Perpetrator fault Familys fault

Cost of Attributions
Internal Shame, guilt Withdraws from others Negative mental health outcomes Depression; suicidality, low self-esteem; interpersonal problems; PTSD (Zinzow, 2010; Weiner Graham, 1999; Feiring et al., 2002)

Cost of Attributions
Perpetrator Blame Generally better outcomes (Feiring et al., 2002; Hoagwood, 1990; LevWiesel, 2000) But Anger, outrage, unjust world Helplessness

What Causes Internal Versus External Attributions?

More severe abuse (Duration, type, frequency) More physical force or coercion

internal

external

(Chaffin et al., 1997; Hunter, et al., 1992; Wyatt & Newcomb, 1990; Zinzow et al., 2010)

Role of Age
Self Blame External Blame Older age of onset Younger age of onset (Zinzow et al., 2010)

Peer Abuse
More self blame Less family blame (Zinzow et al., 2010)

Blame is Not the Only Issue

Powerlessness Loss of agency Loss of faith in ability to control fate External locus of control View of world as malignant

Affective Sequelae

Affective Flashbacks Secondary to Cognitions Internalizing Sex Offender Thinking Errors Trauma-Based World View

Secondary to Current Realities

Nontraumatized Beliefs

I have a guardian angel that looks after me. Everything happens for a reason. Things turn out for the best.

Positive Illusions

Matlin & Stang. The Pollyanna Principle. 1978 Summarized over 1000 studies

Non-Traumatized Beliefs
Above average Things will work out Underestimate chances of negative events Overestimate chances of positive events Overestimate personal efficacy

Rated Selves More Positively than Peer of Same Sex and Age 87%

(Taylor, Lerner et al., Submitted for Publication)

Ones Strengths

Important Rare

Ones Failings

Unimportant Common (Campbell, 1986; Marks, 1984)

Time is on Our Side

Poor Performance Remember as Better 20 Minutes Later (Greenwald, 1980)

Not Recent Phenomena

One month Rated mood each day compared to Own typical mood Almost everybody Typically happier than they typically are (Johnson, 1938)

Lifetime Probabilities of Experiencing Trauma

Type

Fire Car wreck w/ injury Robbery Loved one die from homicide, suicide or accident 30 Some sort 69 (Norris, 1992)

% 10 23 25

Trauma-Based World View

Shattered Assumptions Belief in Personal Invulnerability Belief the World is Meaningful Belief in Personal Efficacy (Janoff-Bulman, 1992)

Fall-Out from Chowchilla Kidnapping

Massive interferences with Optimism & Trust (Terr, 1985)

Fall-Out from Chowchilla Kidnapping

Age 9 Russians ruining ozone layer Everybody killed
World end in 2000 Live in Mountains: Towns Not Safe

Age 10

Fall-Out from Chowchilla Kidnapping

23 of 25 Afraid of the Future

Trauma-Based World View

Shattered Assumptions Belief in Personal Invulnerability Belief the World is Meaningful Belief in Personal Efficacy (Janoff-Bulman, 1992)

World View and Sexual Abuse

When you get old, you die. I have grandparents who are sixty or sixty-nine and I dont think they are ready to die. But I sometimes think I am going to die sooner than other people I dont know why I think this. I think bad people will hurt me. I may be killed instead of dying. (Terr, 1990 p. 31)