Eighty-nine adult female survivors of childhood sexual abuse, presenting for psychological treatment, were assessed for self-reported rates of self-injurious behaviors (SIB), health complaints, and posttraumatic stress disorder (PTSD) symptoms of physiological arousal. A composite measure of current SIB was significantly and positively associated with health complaints, PTSD arousal, and three measures of sexual abuse severity: age of onset for sexual abuse, injury experienced during the sexual abuse, and perceived life threat. Tests of mediation revealed that symptoms of PTSD arousal mediated the relationship between earlier age of onset for sexual abuse and SIB. PTSD arousal moderated the relationship between sexual-abuse-related injury and SIB. SIB was a unique predictor of health complaints, even after controlling for sexual abuse severity and PTSD arousal.
Get full access to this article
View all access options for this article.
References
1.
Anonymous. (2000). Community indicators of health-related quality of life—United States, 1993-1997 . MMWR Morbidity & Mortality Weekly Report, 49, 281-285 .
2.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author .
3.
Bosch, J., Van Dyke, D. C., Smith, S. M., & Poulton, S. (1997). Role of medical conditions in the exacerbation of self-injurious behavior: An exploratory study . Mental Retardation, 35(2), 124-130 .
4.
Brosschot, J. F., & Thayer, J. F. (1998). Anger inhibition, cardiovascular recovery, and vagal function: A model of the link between hostility and cardiovascular disease . Annals of Behavioral Medicine, 20, 326-332 .
5.
Buchwald, D., Pearlman, T., Kith, P., Katon, W., & Schmaling, K. (1997). Screening for psychiatric disorders in chronic fatigue and chronic fatigue syndrome . Journal of Psychosomatic Research, 42, 87-94 .
6.
Chard, K. M. (2003). An evaluation of cognitive processing therapy for the treatment of posttraumatic stress disorder related to childhood sexual abuse. Manuscript under review.
7.
Chard, K. M., Weaver, T. L., & Resick, P. A. (1997). Adapting cognitive processing therapy for child sexual abuse survivors . Cognitive & Behavioral Practice, 4, 31-52 .
8.
Everly, G. S. (1993). Neurophysiological considerations in the treatment of posttraumatic stress disorder: A neurocognitive perspective. In J. P. Wilson & B. Raphael (Eds.), International handbook of traumatic stress syndromes. The Plenum series on stress and coping (pp. 795-801). New York: Plenum .
9.
Falsetti, S., Resnick, H. S., Resick, P. A., & Kilpatrick, D. G. (1993). A brief self-report measure of posttraumatic stress disorder . The Behavior Therapist, 16, 161-162 .
10.
Favaro, A., & Santonastaso, P. (1999). Different types of self-injurious behavior in bulimia nervosa . Comprehensive Psychiatry, 40, 57-60 .
11.
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study . American Journal of Preventive Medicine, 14(4), 245-258 .
12.
Foa, E. B., Riggs, D. S., Dancu, C. V., & Rothbaum, B. O. (1993). Reliability and validity of a brief instrument for assessing post-traumatic stress disorder . Journal of Traumatic Stress, 6, 459-473 .
13.
Goldberg, D. P., & Hillier, V. F. (1979). A scaled version of the General Health Questionnaire . Psychological Medicine, 9, 139-145 .
14.
Golding, J. M. (1999). Sexual assault history and long-term physical health problems: Evidence from clinical and population epidemiology . American Psychological Society, 8(6), 191-194 .
15.
Holmbeck, G. N. (1997). Toward terminological, conceptual, and statistical clarity in the study of mediators and moderators: Examples from the child-clinical and pediatric psychology literatures . Journal of Consulting and Clinical Psychology, 65(4), 599-610 .
16.
Kahng, S. W., Iwata, B. A., & Lewin, A. B. (2002). The impact of functional assessment on the treatment of self-injurious behavior. In R. Schroeder, M. L. Oster-Granite, & T. Thompson (Eds.), Self-injurious behavior: Gene-brain-behavior relationships (pp. 119-132). Washington, DC: American Psychological Association .
17.
Kendall-Tackett, K. A., Williams, L. M., & Finkelhor, D. (1993). Impact of sexual abuse on children: A review and synthesis of recent empirical studies . Psychological Bulletin, 113, 164-180 .
18.
Kimerling, R., & Calhoun, K. S. (1994). Somatic symptoms, social support, and treatment seeking among sexual assault victims . Journal of Consulting and Clinical Psychology, 62, 333-340 .
19.
Koss, M. P., & Heslet, L. (1992). Somatic consequences of violence against women . Archives of Family Medicine, 1, 53-59 .
20.
Koss, M. P., Koss, P. G., & Woodruff, W. J. (1991). Deleterious effects of criminal victimization of women’s health and medical utilization . Archives of Internal Medicine, 151, 342-347 .
21.
Mayne, T. J. (1999). Negative affect and health: The importance of being earnest . Cognition & Emotion, 13, 601-635 .
22.
McDonagh-Coyle, A., McHugo, G. J., Friedman, M. J., Schnurr, P. P., Zayfert, C., & Descamps, M. (2001). Psychophysiological reactivity in female sexual abuse survivors . Journal of Traumatic Stress, 14(4), 667-683 .
23.
Metzger, L. J., Orr, S. P., Berry, N. J., Ahern, C. E., Lasko, N. B., & Pitman, R. K. (1999). Physiologic reactivity to startling tones in women with posttraumatic stress disorder . Journal of Abnormal Psychology, 108(2), 347-352 .
24.
Norton, P. J., & Asmundson, G. J. G. (2003). Amending the fear-avoidance model of chronic pain: What is the role of physiological arousal? Behavior Therapy, 34, 17-30 .
25.
Orr, S. P., Lasko, N. B., Metzger, L. J., Berry, N. J., Ahern, C. E., & Pitman, R. K. (1998). Psychophysiologic assessment of women with posttraumatic stress disorder resulting from childhood sexual abuse . Journal of Consulting and Clinical Psychology, 66(6), 906-913 .
26.
Resick, P. A., Jordan, C. G., Girelli, S. A., Hutter, C. K., & Marhoeffer-Dvorak, S. (1988). A comparative outcome study of behavioral group therapy for sexual assault victims . Behavior Therapy, 19, 385-401 .
27.
Resnick, H. S., Acierno, R., & Kilpatrick, D. G. (1997). Health impact of interpersonal violence: II . Behavioral Medicine, 23, 65-78 .
28.
Resnick, H. S., & Weaver, T. (1994). Habit Questionnaire. Unpublished measure, Medical University of South Carolina, Charleston .
29.
Romans, S. E., Martin, J. L., Anderson, J. C., Herbison, P. G., & Mullen, P. E. (1995). Sexual abuse in childhood and deliberate self-harm . American Journal of Psychiatry, 152(9), 1336-1342 .
30.
Ruehlman, L. S., Lanyon, R. I., & Karoly, P. (1999). Development and validation of the multidimensional health profile, Part 1: Psychosocial functioning . Psychological Assessment, 11, 166-176 .
31.
Russ, M. J. (1992). Self-injurious behavior in patients with borderline personality disorder: Biological perspective . Journal of Personality Disorders, 6(1), 64-81 .
32.
Santa Mina, E. E., & Gallop, R. M. (1998). Childhood sexual and physical abuse and adult selfharm and suicidal behaviour . Canadian Journal of Psychiatry, 43, 793-800 .
33.
Schroeder, S. R., Oster-Granite, M. L., & Thompson, T. (2002). Self-injurious behavior: Gene-brain-behavior relationships. Washington, DC: American Psychiatric Association .
34.
Simeon, D., & Favazza, A. R. (2001). Self-injurious behaviors: Phenomenology and assessment. In D. Simeon & E. Hollander (Eds.), Self-injurious behaviors: Assessment and treatment (pp. 1-28). Washington, DC: American Psychiatric Publishing .
35.
Simeon, D., Stanley, B., Frances, A., Mann, J.J., Winchel, R., & Stanley, M. (1992). Self-mutilation in personality disorders: Psychological and biological correlates . American Journal of Psychiatry, 149, 221-226 .
36.
Suyemoto, K. L. (1998). The functions of self-mutilation . Clinical Psychology Review, 18, 531-554 .
37.
Symons, F. S. (2002). Self-injury and pain: Models and mechanisms. In S. Schroeder, M. L. Oster-Granite, & T. Thompson (Eds.), Self-injurious behaviors: Gene-brain-behavior relationships (pp. 223-234). Washington, DC: American Psychiatric Association .
38.
Waigandt, A., Wallace, D. L., Phelps, L., & Miller, D. A. (1990). The impact of sexual assault on physical health status . Journal of Traumatic Stress, 3, 93-102 .
39.
Weems, C. F., Saltzman, K. M., Reiss, A. L., & Carrion, V. G. (2003). A prospective test of the association between hyperarousal and emotional numbing in youth with a history of traumatic stress . Journal of Clinical Child and Adolescent Psychology, 32(1), 166-171 .
40.
Wiederman, M. W., Sansone, R. A., & Sansone, L. A. (1999). Bodily self-harm and its relationship to childhood abuse among women in a primary care setting . Violence Against Women, 5, 155-163 .
