The impact of individual forms of childhood maltreatment on health behavior

OBJECTIVE: This study examines the unique contribution of five types of maltreatment (sexual abuse, physical abuse, emotional abuse, physical neglect, emotional neglect) to adult health behaviors as well as the additive impact of exposure to different types of childhood maltreatment. METHOD: Two hundred and twenty-one women recruited from a VA primary care clinic completed questionnaires assessing exposure to childhood trauma and adult health behaviors. Regression models were used to test the relationship between childhood maltreatment and adult health behaviors. RESULTS: Sexual and physical abuse appear to predict a number of adverse outcomes; when other types of maltreatment are controlled, however, sexual abuse and physical abuse do not predict as many poor outcomes. In addition, sexual, physical, and emotional abuse and emotional neglect in childhood were all related to different adult health behaviors. The more types of childhood maltreatment participants were exposed to the more likely they were to have problems with substance use and risky sexual behaviors in adulthood. IMPLICATIONS: The results indicate that it is important to assess a broad maltreatment history rather than trying to relate specific types of abuse to particular adverse health behaviors or health outcomes.     

Pathways from childhood abuse to prospective revictimization: Depression,sex to reduce negative affect,and forecasted sexual behavior

Research suggests that adverse events in childhood, such as childhood physical, sexual, and emotional abuse, confer risk for later sexual assault. Psychological distress, coping strategies, and sexual behavior may help explain the path from childhood abuse to revictimization. The present study explored how the use of sex to regulate negative affect (SRNA) operates independently, and in combination with other psychosocial factors to increase college women's (N = 541) risk of experiencing prospective adult sexual assault (ASA). Sequential multiple mediator models in Mplus were used to assess the effect of three different forms of childhood abuse on prospective ASA, both independently and while controlling for other forms of childhood abuse. The indirect effect of adolescent sexual assault (AdolSA), depressive symptoms, SRNA, and participants’ response to a sex-related vignette was tested using bias-corrected bootstrapping. In the full path model, childhood emotional abuse and AdolSA predicted ASA, while childhood physical and sexual abuse were directly associated with AdolSA, but not ASA. Additionally, depressive symptoms and participants’ estimate of their likely behavior in a sex-related vignette directly predicted prospective ASA. Results using bootstrapping revealed that a history of childhood abuse predicted prospective ASA via diverse direct and indirect paths, as well as through a similar multiple mediator path. Overall, findings suggest that a combination of affective, coping, and sexual expectancy factors contribute to risk for revictimization in adult survivors of childhood abuse. Future research directions and targets for risk-reduction programming are discussed.     

Neuroticism as a risk factor for child abuse in victims of childhood sexual abuse

Findings on the relationship of experienced sexual abuse and abuse behavior in adulthood are ambiguous. However, associations between experienced abuse and neuroticism as well as between neuroticism and active child abuse have been reported repeatedly. In our study, we compared pedosexual child abusers with consumers of internet child pornography and control subjects with adult-sexual preference with regard to traumatic childhood experience (Childhood Trauma Questionnaire, CTQ), personality traits (NEO – Personality Inventory – Revised, NEO-PI-R), and sexual abnormalities (Multiphasic Sex Inventory, MSI). In an initial analysis, sexual abuse experienced in childhood was not directly linked to sexual abuse behavior in adulthood. However, this relationship was mediated by neuroticism. In a second step, the CTQ scales were conflated and, using a structural equation model, direct links between the overall level of abuse experienced in childhood (generally high CTQ levels) and sexual abuse behavior in adulthood revealed again the mediation by neurotic personality. We conclude that the overall level of abuse experienced in childhood in general, and less sexual abuse experience in particular, modulates the tendency for child sexual abuse behavior in adulthood. Data suggest that, depending on the resilience of an individual, abuse experience during childhood increases the likelihood of developing neurotic personality traits in later life, which are in turn considered to increase the risk of child sexual abuse in child sex offenders.     

Childhood adversity, poly-substance use, and disordered eating in adolescent Latinas: mediated and indirect paths in a community sample

OBJECTIVE: Although many studies have identified associations between childhood maltreatment and later substance use and disordered eating, few have examined causal or explanatory pathways, and whether victim characteristics predict the development of one versus the other of these outcomes remains uninvestigated. Furthermore, relatively little childhood maltreatment research has examined Latino samples. To address these gaps, this study examined among Latina adolescents the effects of sexual abuse, physical/emotional abuse, neglect, disconnection from family, and parental alcohol problems on poly-substance use and disordered eating, and whether five individual characteristics explain or differentiate these outcomes. METHOD: Data from a community sample of 361 Latina adolescents were analyzed using structural equation modeling. RESULTS: Physical/emotional abuse predicted poly-substance use and weight concerns, and these associations were mediated by impaired current attachment. Disconnection from family predicted bulimic behaviors, and this association was mediated by dysphoria. One indirect path also emerged: Disconnection from family predicted low social conformity, and low social conformity predicted poly-substance use. Childhood sexual abuse did not uniquely predict any adverse outcome or individual characteristic examined. CONCLUSIONS: Dysphoria and impaired current attachment appear to play important roles in the development of substance use and disordered eating in Latina adolescents when physical/emotional abuse or disconnection from family predicts these outcomes. Dysphoria and low social conformity may differentiate the development of bulimic behaviors and poly-substance use, respectively, when family disconnection predicts these outcomes.     

Child abuse potential in parents with histories of substance use disorder

OBJECTIVE: To examine the relationship between parental history of substances use disorders (SUDs) and abuse potential. METHOD: Milner's (1986) Child Abuse Potential Inventory (CAPI) was administered to fathers and mothers (with and without histories of SUDs) of 10- to 12-year-old boys. RESULTS: Fathers and mothers with lifetime histories of SUDs had higher Abuse Scale scores and were more likely to score in the Elevated range (as determined by clinically significant cutoff scores) than parents without such histories. No differences were found between parents with current diagnoses of SUD and those with past (but not current) histories of SUD. Fathers and mothers with a partner who had a history of SUD were more likely to score in the Elevated range, regardless of their own SUD histories. Separate regression models revealed that, for both fathers and mothers, emotional dysregulation (positive and negative affectivity) predicted Abuse Scale scores. Additional contributors to Abuse Scale scores were SUD status in fathers, and lack of involvement with the child in mothers. CONCLUSIONS: History of SUDs in both fathers and mothers increases abuse potential. Contributors to abuse potential differed in fathers and mothers, underscoring the importance of examining parents separately in child maltreatment research.     

Association between maltreatment and polydrug use among adolescents

Different studies have related sexual and physical abuse during childhood and adolescence to the development of substance abuse disorders. Nevertheless, we are not aware of the role that other more common maltreatment types, such as neglect, will play among the most risky pattern of consumption: the polydrug use. A clinical sample of 655 adolescents, divided into two groups: polydrug users and non-polydrug users, were assessed on their pattern of drug consumption, history of childhood maltreatment, current psychopathology and their family history of alcoholism. Polydrug users had a greater prevalence of all types of maltreatment, although the most associated to this group were sexual abuse and emotional neglect. Other relevant variables to adolescent consumption were: the diagnosis of depressive disorder, the presence of anxiety traits and the family history of alcohol dependence. Polydrug users have higher risks of having had problems during infancy and adolescence, such as maltreatment and other psychopathological conditions, with the addition of family history of alcoholism. Accordingly, practitioners should take into account that those variables may influence polydrug abuse because it is the most risky pattern for subsequent dependence of substances, and they should always be considered during treatment.     

Maternal history of child maltreatment and maternal depression risk in the perinatal period: A longitudinal study

Existing research is limited, with only a few studies considering each single type and multiple types of child maltreatment (CM) as well as multiple assessments of maternal depression throughout the perinatal period. The purpose of the study was to assess each type and accumulative types of CM in relation to the risk of maternal depression throughout the perinatal period. In total, 276 pregnant women were recruited from the prenatal clinic at a general hospital in China. Maternal CM history and depression risk were assessed at late pregnancy, postpartum week 1, and postpartum week 4 using the Childhood Trauma Questionnaire (CTQ) and Edinburgh Postnatal Depression Scale (EPDS). The GEE showed that physical and emotional neglect and multiple types of CM were associated with higher overall depression risk across the perinatal period. The multinomial regression models showed physical neglect and multiple types of CM predicted higher risk of both antepartum and postpartum depression. Emotional and sexual abuse and emotional neglect predicted antepartum depression risk, while none of the three types of CM predicted postpartum depression risk. Physical abuse did not predict antepartum and postpartum depression risk. The findings suggest that maternal history of child physical and emotional neglect play significant roles in perinatal depression risk with physical neglect as the most important predictor. Routine screening for maternal CM history and depression risk in prenatal clinics is needed to aid in the early detection and treatment of depression.     

Impact of childhood abuse history on psychological symptoms among male and female soldiers in The U.S. Army

The long-term psychological effects of four different types of childhood maltreatment were examined among 1,072 male and 305 female soldiers on active duty in the United States Army. The predictor variables included four subscales from the Childhood Trauma Questionnaire (CTQ)—(1) physical-emotional abuse, (2) sexual abuse, (3) emotional neglect, and (4) physical neglect. An additional sexual abuse variable based on the four screening questions developed by Finkelhor, Hotaling, Lewis, and Smith (1990) was also included. Outcome was measured by the Brief Symptom Inventory and a dissociation scale developed by Briere and Runtz (1988). MANOVAs were conducted for each outcome measure. Physical-emotional abuse contributed to most of the effects. However, sexual abuse contributed additional significant effects to all of the subscales. In general, males and females showed similar outcomes, but certain gender differences were noted.     

A longitudinal study on the relationship among childhood emotional abuse,gratitude, and suicidal ideation of Chinese adolescents

Background and objectiveSuicidal ideation is a significant predictor of suicidal attempt. Based on the developmental psychopathology perspective and the resilience theory, this study examines whether trait gratitude mediates the relationship between childhood emotional abuse and adolescent suicidal ideation.Participants and settingA sample of 909 Grade 8 to Grade 9 adolescents aged 12–18 years in Hong Kong, a Special Administrative Region in China, was recruited from six secondary schools.MethodA two-wave longitudinal study was conducted. Participants completed the same measures on Gratitude Quesitonnaire-6, Suicidal Ideation Scale, emotional subscale of Child Abuse and Trauma Scale at two time points 12 months apart.ResultsResults of cross-lagged analyses showed that adolescents’ suicidal ideation was positively associated with childhood emotional abuse and negatively associated with gratitude; further, the association between childhood emotional abuse and suicidal ideation was mediated by gratitude.ConclusionsFindings of this study implied that while exposure to parental emotional abuse might have an adverse impact on the development of gratitude, adolescents’ current level of gratitude still exerts its protective effect by directly reducing their suicidal ideation. Gratitude or other resilience factors that might comprise additional mediating mechanisms from childhood emotional abuse to mental health problems in later life is worthy of further investigation.     

Differential adult symptomatology associated with three types of child abuse histories

Using scales specifically developed for this purpose, the present study examined university women's retrospective reports of childhood sexual, physical, and psychological abuse as they related to three types of current psychosocial dysfunction. Multivariate analysis revealed that, as hypothesized, history of psychological abuse was uniquely associated with low self-esteem, physical abuse was linked to aggression toward others, and sexual abuse was specifically related to maladaptive sexual behavior. This analysis also indicated that although there were unique effects of each type of abuse, physical and emotional abuse were often present together--a combination associated with generalized psychosocial problems.     

Sexual abuse trauma among professional women: validating the Trauma Symptom Checklist-40 (TSC-40).

This study examines the usefulness of the Trauma Symptom Checklist (TSC-40) in measuring the long-term sequelae of sexual abuse. In a national survey of 2,963 professional women, the TSC-40 was found to be reliable and to display predictive validity with regard to childhood sexual victimization. Women who reported a sexual abuse history scored significantly higher than did women with no history of abuse on each of the six subscales and on the overall TSC-40 score. Various aspects of childhood victimization were associated with the subscale scores, with the Sexual Abuse Trauma Index and Dissociation subscales being more sensitive to the specific components of the abuse.     

Childhood emotional abuse and neglect as predictors of psychological and physical symptoms in women presenting to a primary care practice

OBJECTIVE: There were two aims to this study: first to examine whether emotional abuse and neglect are significant predictors of psychological and somatic symptoms, and lifetime trauma exposure in women presenting to a primary care practice, and second to examine the strength of these relationships after controlling for the effects of other types of childhood abuse and trauma. METHOD: Two-hundred and five women completed the Childhood Trauma Questionnaire (Bernstein et al., 1994), Trauma History Questionnaire (Green, 1996), the Symptom Checklist-revised (Derogatis, 1997), and the Revised Civilian Mississippi Scale for posttraumatic stress disorder (Norris & Perilla, 1996) when presenting to their primary care physician for a visit. Hierarchical multiple regression analyses were conducted to examine unique contributions of emotional abuse and neglect variables on symptom measures while controlling for childhood sexual and physical abuse and lifetime trauma exposure. RESULTS: A history of emotional abuse and neglect was associated with increased anxiety, depression, posttraumatic stress and physical symptoms, as well as lifetime trauma exposure. Physical and sexual abuse and lifetime trauma were also significant predictors of physical and psychological symptoms. Hierarchical multiple regressions demonstrated that emotional abuse and neglect predicted symptomatology in these women even when controlling for other types of abuse and lifetime trauma exposure. CONCLUSIONS: Long-standing behavioral consequences may arise as a result of childhood emotional abuse and neglect, specifically, poorer emotional and physical functioning, and vulnerability to further trauma exposure.     

Role of emotion dysregulation in the relationship between childhood abuse and probable PTSD in a sample of substance abusers

This study examined associations among childhood abuse, emotion dysregulation, and probable posttraumatic stress disorder (PTSD) within a sample of 93 substance use disorder (SUD) patients in residential treatment. SUD patients with probable PTSD (vs. non-PTSD) reported (a) greater severity of childhood sexual, physical, and emotional abuse and (b) significantly higher levels of overall emotion dysregulation and the specific dimensions of difficulties engaging in goal-directed behavior when upset, difficulties controlling impulsive behaviors when distressed, limited access to effective emotion regulation strategies, and lack of emotional clarity. Additionally, significant positive associations were found between both childhood physical and emotional (but not sexual) abuse on the one hand and dimensions of emotion dysregulation on the other. Further analyses indicated that difficulties controlling impulsive behaviors when distressed accounted for the associations of both childhood physical and emotional abuse with probable PTSD status. Findings of the present study highlight a potential mechanism underlying the relationships between both childhood emotional and physical abuse and PTSD in SUD patients.     

Prevalence and demographic correlates of childhood maltreatment in an adult community sample

PURPOSE: This study had two aims: (1) to determine the prevalence of five categories of retrospectively reported childhood maltreatment in an adult community sample and (2) to examine relationships between three theoretically and practically chosen demographic variables and childhood maltreatment. METHOD: Participants were a representative sample of 967 adult men and women in the metropolitan Memphis, Tennessee area. They completed a telephone survey that included a reliable, valid questionnaire assessing five types of childhood maltreatment (i.e., emotional abuse, emotional neglect, physical abuse, physical neglect, and sexual abuse) and demographic questions. Simultaneous logistic regression analyses were used to identify demographic correlates of specific trauma types. RESULTS: Prevalence of childhood maltreatment ranged from approximately 30% for women to over 40% for men. Approximately 13% of participants reported multiple forms of maltreatment. The most common forms of trauma for both men and women were physical abuse, physical neglect, and emotional abuse, all of which were highly likely to co-occur. Race, sex, and current educational level were each associated with an increased likelihood of childhood maltreatment; differential relationships with particular maltreatment types were also observed. IMPLICATIONS: These findings highlight the importance of research on the prevalence of and risks for multiple types of childhood maltreatment, particularly in the somewhat neglected area of emotional abuse and neglect. These findings can be used to highlight the need for preventive interventions aimed at the negative sequelae of childhood maltreatment and to tailor preventive interventions to the needs and expectations of those at high risk.     

Childhood trauma and suicide risk in a sample of young individuals aged 14–35 years in southern Brazil

Suicide is among the main causes of death of people aged between 15 and 44 years old. Childhood trauma is an important risk factor for suicide. Hence, the objective of this study was to verify the relationship between childhood trauma and current suicide risk (suicidal behavior and ideation) in individuals aged 14–35 years, in the city of Pelotas, Brazil. This is a cross-sectional, population-based study. Sample selection was performed by clusters. Suicide risk was evaluated using the Mini International Neuropsychiatric Interview (MINI) and Childhood trauma was assessed with the Childhood Trauma Questionnaire (CTQ). Moreover, the participants responded to a questionnaire concerning socioeconomic status, work, and substance use. The sample was composed of 1,380 individuals. The prevalence of suicide risk was 11.5%. The prevalence figures of childhood trauma were 15.2% (emotional neglect), 13.5% (physical neglect), 7.6% (sexual abuse), 10.1% (physical abuse), and 13.8% (emotional abuse). Suicide risk was associated (p < .001) with gender, work, alcohol abuse, tobacco use, and all types of childhood trauma. The odds of suicide risk were higher in women (OR = 1.8), people who were not currently working (OR = 2.3), individuals who presented alcohol abuse (OR = 2.6), and among tobacco smokers (OR = 3.4). Moreover, suicide risk was increased in all types of trauma: emotional neglect (OR = 3.7), physical neglect (OR = 2.8), sexual abuse (OR = 3.4), physical abuse (OR = 3.1), and emotional abuse (OR = 6.6). Thus, preventing early trauma may reduce suicide risk in young individuals.     

Emotion dysregulation mediates the relationship between child maltreatment and psychopathology: A structural equation model

The present study investigated the mediating effects of emotion dysregulation on the relationship between child maltreatment and psychopathology. An adult sample (N = 701) from diverse backgrounds of psychopathology completed the Childhood Trauma Questionnaire (CTQ), the Difficulties in Emotion Regulation Scale (DERS), the Brief Symptom Inventory (BSI), and the negative affect subscale of the Positive and Negative Affect Schedule (PANAS) in a cross-sectional online survey. Correlational analyses showed that all types of child maltreatment were uniformly associated with emotion dysregulation, and dimensions of emotion dysregulation were strongly related to psychopathology. Limited access to strategies for emotion regulation emerged as the most powerful predictor. Structural equation modeling analyses revealed that emotion dysregulation partially mediated the relationship between child maltreatment and psychopathology, even after controlling for shared variance with negative affect. These findings emphasize the importance of emotion dysregulation as a possible mediating mechanism in the association between child maltreatment and later psychopathology. Additionally, interventions targeting specific emotion regulation strategies may be effective to reduce psychopathology in victims of child maltreatment.     

Effects of childhood trauma on personality in a sample of Chinese adolescents

Childhood trauma is a major public health problem which has an impact on personality development, yet no studies have examined the association between exposure to trauma and personality in a sample of Chinese adolescents. Four hundred eighty-five students completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF) and the Eysenck Personality Questionnaire (EPQ). The CTQ-SF cut-off scores for exposure were used to calculate the prevalence of trauma. The possible associations between specific types of trauma and the EPQ subscale scores were examined. The rates of emotional abuse (EA), physical abuse (PA), sexual abuse (SA), emotional neglect (EN), and physical neglect (PN) were 18.76%, 11.13%, 27.01%, 49.48%, and 68.66%, respectively. Individuals subjected to EA, PA, and SA had significantly higher neuroticism (EPQ-N) and psychoticism (EPQ-P) scores on the EPQ compared with those who had not experienced EA, PA, or SA (all p values < 0.05). Significant positive correlations existed between CTQ-SF subscale scores for EA, SA, CTQ-SF total scores, and EPQ-N, EPQ-P scores (all p values < 0.05). Significant number of subjects in this adolescent sample reported experience of childhood abuse and neglect. Exposure to childhood trauma is associated with personality development in Chinese adolescents.     

The effects of early sexual abuse on adult risky sexual behaviors among persons with severe mental illness

OBJECTIVE: There were two aims: first, to examine the relationship between prior sexual abuse and three types of adult risky sexual behaviors [(1) ever traded sex for drugs or money, (2) had unprotected sex in the past 6 months, and (3) frequency of unprotected sex in the past 6 months] among persons with severe mental illness (SMI), and second, to examine the potential mediating effects of adult rape, substance use, and PTSD. METHOD: Using a pooled sample of individuals with SMI (N=609), logistic and negative binomial regression analyses were used to investigate the impact of prior sexual abuse on these adult risky sexual behaviors. RESULTS: Childhood sexual abuse was associated with having ever traded sex for money and having engaged in unprotected sex in the past 6 months. However, childhood sexual abuse was inversely associated with the number of times males had unprotected sex in the past 6 months. Results differed between males and females and the impact of potential mediators also varied by gender and type of outcome studied. CONCLUSION: These findings suggest a complex link between childhood sexual abuse and adult risky sexual behaviors in persons with SMI. Clinical assessments of child abuse sequelae should include a variety of indicators and parameters of adult risky sexual behavior, as persons with SMI are at an increased risk of engaging in high-risk sexual behaviors and tend to have a higher exposure to childhood sexual abuse than does the general population.     

Characteristics of child physical and sexual abuse as predictors of psychopathology

Childhood physical and sexual abuse victims are at increased risk for developing depression, anxiety, and post-traumatic stress disorder (PTSD) in adulthood. Prior findings suggest abuse onset, duration, and severity moderate relationships between victimization and psychopathology. However, because these abuse characteristics are highly intercorrelated, their unique, individual effects on mental health outcomes remain unclear. To address this gap, the present study examined relationships between physical and sexual abuse characteristics and mental health outcomes and whether these relationships differed by sex. A diverse community sample of late adolescents and emerging adults (N = 1270; mean age = 19.68; 51% female) self-reported the onset, duration, and severity of physical and sexual abuse, as well as their depressive, anxiety, and PTSD symptoms. Results of a multivariate regression model (simultaneously evaluating all physical and sexual abuse characteristics) indicated that physical abuse onset in middle childhood and sexual abuse onset in middle childhood or adolescence were associated with all forms of psychopathology; and physical abuse onset at any time was uniquely linked with PTSD. Duration and severity of physical or sexual abuse did not predict psychopathology after accounting for time of onset. Multigroup analyses indicated that adolescence-onset and duration of sexual abuse respectively predicted anxiety and PTSD in females but not males, whereas sexual abuse severity predicted fewer PTSD symptoms in males but not females. Overall, results suggested that abuse occurring after age 5 may have the most deleterious impact on mental health.     

Childhood abuse and neglect in body dysmorphic disorder

OBJECTIVE: No published studies have examined childhood abuse and neglect in body dysmorphic disorder (BDD). This study examined the prevalence and clinical correlates of abuse and neglect in individuals with this disorder. METHODS: Seventy-five subjects (69.3% female, mean age=35.4+/-12.0) with DSM-IV BDD completed the Childhood Trauma Questionnaire and were interviewed with other reliable and valid measures. RESULTS: Of these subjects, 78.7% reported a history of childhood maltreatment: emotional neglect (68.0%), emotional abuse (56.0%), physical abuse (34.7%), physical neglect (33.3%), and sexual abuse (28.0%). Forty percent of subjects reported severe maltreatment. Among females (n=52), severity of reported abuse and neglect were .32-.57 standard deviation units higher than norms for a health maintenance organization (HMO) sample of women. Severity of sexual abuse was the only type of maltreatment significantly associated with current BDD severity (r=.23, p=.047). However, severity of sexual abuse did not predict current BDD severity in a simultaneous multiple regression analysis with age and current treatment status. There were other significant associations with childhood maltreatment: history of attempted suicide was related to emotional (p=.004), physical (p=.014), and sexual abuse (p=.038). Childhood emotional abuse was associated with a lifetime substance use disorder (r=.26, p=.02), and physical abuse was negatively associated with a lifetime mood disorder (r=-.37, p=.001). CONCLUSIONS: A high proportion of individuals with BDD reported childhood abuse and neglect. Certain types of abuse and neglect appear modestly associated with BDD symptom severity and with gender, suicidality, and certain disorders.