Prior Interpersonal Trauma: The Contributions to Current PTSD Symptoms in Female Rape Victims Reviewed by Priscilla Schulz, LCSW from an article of the same title by: Pallavi Nishith, Mindy B. Mechanic, and Patricia A. Resick, University of Missouri, St. Louis Published: Journal of Abnormal Psychology (in press) How do childhood and adult experiences of interpersonal violence differentially affect PTSD in recent rape survivors? This study statistically characterizes the relationships that childhood sexual abuse, childhood physical abuse and adult interpersonal violence each have with both adult victimization and current Posttraumatic Stress Disorder in recent, adult, rape survivors. A theoretical model that maps these effects is offered and tested. Why is this important? A history of interpersonal violence poses a risk for survivors in a several ways. Numerous authoritative studies document that not only do prior experiences of interpersonal violence, from childhood or as an adult, increase a person's risk of becoming a victim later in life, but they also contribute to vulnerability for PTSD. In addition, a history of trauma can have a cumulative effect on survivors, increasing PTSD vulnerability. When mental health providers understand how the different, prior, traumatic experiences affect PTSD severity and threaten recovery for recent rape survivors, they can design care to address these issues. How did the study disentangle and demonstrate the effects of childhood and adult victimizations on current PTSD? Each of 117 recent rape survivors referred by local police, hospitals and victim service agencies completed the History of Victimization Questionnaire (HVQ) and the PTSD Symptom Scale-Self Report (PSS-SR). Their responses on the HVQ were analyzed along several subscales that distinguished between childhood sexual abuse, childhood physical abuse, and adult victimization experiences. These were then analyzed along with their PSS-SR scores. A statistical technique known as "path analysis" was applied to demonstrate the relationship among the different kinds of interpersonal violence histories to participants' current PTSD symptoms. What did this study discover about interpersonal violence histories' effects on recent rape survivors' PTSD? Childhood sexual abuse posed a significantly greater risk for subsequent victimization and psychological problems than childhood physical abuse. Childhood sexual abuse (CSA): Higher rates of CSA were related to higher rates of later adult victimization. CSA contributed to post-rape PTSD through its link with adult interpersonal violence. CSA alone did not significantly affect PTSD in recent rape survivors. Childhood physical abuse (CPA): CPA alone did not significantly contribute to PTSD in recent rape survivors in the study. CPA did not predict later adult victimization. Adult victimization: Post-rape PTSD was attributable to the cumulative impact of CSA and adult victimization in the study's participants. What makes child sexual abuse survivors vulnerable to adult victimization? The study's authors offer several possible answers: CSA diminishes survivors' abilities to appraise risk in interpersonal situations and to make decisions that protect them because of misperceptions of safety, mistrust of self and difficulty judging trustworthiness in others. Lingering, common, psychological problems of CSA survivors such as depression, dissociation, anxiety, PTSD and substance abuse both interfere with making good decisions in potentially risky situations and lessen their ability to defend themselves when in danger. Other common results of CSA such as difficulty regulating feelings, using inappropriate ways to soothe oneself, and difficulty setting healthy interpersonal boundaries set the stage for involvement in situations that place the individual at risk. What are policy and future research implications of this study? The majority of the study's participants had incomes below $5,000 annually. It is possible that the low-income environment in which most of these women lived may have contributed to the amount of violence they experienced as adults. Policy makers and the public could consider poverty as a public health concern in that it seems to influence risk for interpersonal violence. Future research could focus on sorting out the role of poverty in CSA and subsequent victimization as adults. What are the treatment implications of this study? The assessment of prior trauma histories and symptoms of recent trauma survivors can help clinicians identify clients at higher risk for subsequent victimization and the development of PTSD. The presence of childhood sexual abuse in the history of a recent trauma survivor would suggest the possibility of dysfunctional thinking around issues of safety and trust. These issues should be addressed in treatment to help prevent future victimization. Reviewed by Priscilla Schulz, August 1999

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