Cumulative Trauma: The Impact of Child Sexual Abuse, Adult Sexual Assault, and Spouse Abuse

Reviewed by
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 were analyzed.

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

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