Trauma: The Impact of Child Sexual Abuse, Adult Sexual Assault, and Spouse
Priscilla Schulz, LCSW
from an article of the same title by:
Victoria M. Follette, Melissa A. Polusny, Anne E. Bechtle,
and Amy E. Naugle
Journal of Traumatic Stress, V. 9 (1), 1996
What is the scope of this study?
To test the theory that multiple traumas of these types (child sexual
abuse, adult sexual assault, and spouse abuse) have a cumulative effect,
researchers analyzed the responses of 210 women who reported histories
of child sexual abuse, adult sexual assault, and spouse abuse, as well
as current trauma symptoms. The sample comprised two groups, which were
expected to have different rates of abuse and/or assault.
Violence against women is common and harmful. Previous studies have tied
posttraumatic stress disorder (PTSD) symptoms to childhood sexual abuse,
adult sexual assault, and physical abuse by a partner. Evidence of a cumulative
effect from repeated traumas of these types is scarce, yet it is well
known that after these types of traumas women are more vulnerable to being
revictimized. One study showed that women who reported both childhood
sexual abuse and sexual victimization as adults had worse trauma symptoms
than women who reported one or the other. Prior investigations into the
relationship between battering and PTSD did not report cumulative effects
of repeated trauma.
Childhood sexual abuse was defined as "any forced or pressured sexual
contact between the subject and someone older before the age of 18". Adult
sexual assault was defined as "forced or pressured sexual contact involving
penetration that occurred after the subject's 18th birthday".
In both instances sexual contact was explained further to subjects. Physical
abuse was defined as "the presence of at least one incident of physical
aggression by a partner as measured by the Conflict Tactics Scales", which
uses behaviorally specific criteria.
Seventy-two women seeking services from psychological clinics or community
advocacy agencies were recruited for the study. This group was expected
to have higher rates of abuse and/or assault than the second group of
138 women who were recruited from an undergraduate subject pool. Ages
ranged from 17 to 52 with an average of 24. Eighty-six percent of the
subjects were white, and two thirds were single. All subjects provided
standard demographic information and a history of victimization. They
also completed the Trauma Symptom Checklist-40 to measure anxiety, depression,
dissociation, sexual problems, and sleep disturbance. Their responses
The differences between the two groups are detailed, as are the cumulative
effects of different types of traumas. In brief:
- The more types of abuse/assault these women reported, the worse their
current symptoms were.
- Victimization of at least one type was reported by 73% of women in
the sample: 49% reported child sexual abuse, 17% reported adult sexual
assault, and 55% reported physical abuse by a partner.
- Women seeking services reported more types of traumas and higher levels
of trauma symptoms than the comparison group of undergraduate students.
When clients are assessed clinically, a history of multiple victimizations
should be noted. Current symptoms may derive from recent traumas as well
as from traumas experienced much earlier in life. How problems present,
the effectiveness of particular therapies and recovery rates may all be
affected. Since victims of multiple traumas are likely to be at risk for
revictimization, the mechanisms of vulnerability should be explored. Greater
vulnerability may be due to specific skill deficits, habitual substance
abuse or a tendency to dissociate.
Reviewed by Priscilla Schulz, October 1999