A history of childhood sexual abuse (CSA) is a risk factor for adult emotional distress, including symptoms of depression, anxiety, dissociation, and trauma. However, CSA is likely associated with adult distress indirectly through an impact on mediating variables. In a review of the empirical literature, the authors found support for the roles of shame or self-blame, interpersonal difficulties, and avoidant coping strategies as mediators. In addition, emotional distress appears to mediate links between CSA and other adverse outcomes, such as alcohol abuse and revictimization. The authors conclude with a number of methodological and conceptual recommendations.
Alexander, P. C. (1992). Application of attachment theory to the study of sexual abuse. Journal of Consulting and Clinical Psychology, 60, 185-195.
2.
Andrews, B. (1995). Bodily shame as a mediator between abusive experiences and depression. Journal of Abnormal Psychology, 104, 277-285.
3.
Andrews, B. (1998). Shame and childhood abuse. In P. Gilbert & B. Andrews (Eds.), Shame: Interpersonal behavior, psychopathology and culture (pp. 176-190). New York: Oxford University Press.
4.
Bal, S., Van Oost, P., De Bourdeaudhuij, I., & Crombez, G. (2003). Avoidant coping as a mediator between self-reported sexual abuse and stress-related symptoms in adolescents. Child Abuse and Neglect, 27, 883-897.
5.
Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173-1182.
6.
Becker-Lausen, E., Sanders, B., & Chinsky, J. M. (1995). Mediation of abusive childhood experiences: Depression, dissociation, and negative life outcomes. American Journal of Orthopsychiatry, 65, 560-573.
7.
Belt, W., & Abidin, R. R. (1996). The relationhood of child abuse and early parenting experiences to current marital quality in a non-clinical sample. Child Abuse and Neglect, 20, 1019-1030.
8.
Bloch, J. P. (1991). Assessment and treatment of multiple personality and dissociative disorders. Sarasota, FL: Professional Resource Press.
9.
Bowman, M. (1997). Individual differences in posttraumatic response: Problems with the adversity-stress connection. Mahway, NJ: Lawrence Erlbaum.
10.
Briere, J. (1988). The long-term correlates of childhood sexual victimization. Annals New York Academy of Sciences, 528, 327-334.
11.
Briere, J. (1989). Therapy for adults molested as children: Beyond survival. New York: Springer.
12.
Briere, J. (1992). Child abuse trauma: Theory and treatment of the lasting effects. Newbury Park, CA: Sage
13.
Briere, J., & Runtz, M. (1988). Symptomatology associated with childhood sexual victimization in a nonclinical adult sample. Child Abuse and Neglect, 12, 51-59.
14.
Browne, A., & Finkelhor, D. (1986). Impact of child sexual abuse: A review of the research. Psychological Bulletin, 99, 66-77.
15.
Butzel, J. S., Talbot, N. L., Duberstein, P. R., Houghtalen, R. P., Cox, C., & Giles, D. E. (2000). The relationship between traumatic events and dissociation among women with histories of childhood sexual abuse. Journal of Nervous and Mental Disease, 188, 547-549.
16.
Coffey, P., Leitenberg, H., Henning, K., Turner, T., & Bennett, R. T. (1996). Mediators of the long-term impact of child sexual abuse: Perceived stigma, betrayal, powerlessness, and self-blame. Child Abuse and Neglect, 20, 447-455.
17.
Cohen, J. A., & Mannarino, A. P. (1998). Factors that mediate treatment outcome of sexually abused preschool children: Six-and 12-month follow-up. Journal of the American Academy of Child & Adolescent Psychiatry, 37, 44-51.
18.
Cole, P., & Putnam, F. (1992). Effect of incest on self and social functioning: A developmental psychopathology perspective. Journal of Consulting and Clinical Psychology, 60, 174-184.
19.
Draucker, C. B. (1995). A coping model for adult survivors of childhood sexual abuse. Journal of Interpersonal Violence, 10, 159-175.
20.
Elliott, A. N., & Carnes, C. N. (2001). Reactions of nonoffending parents to the sexual abuse of their child: Areview of the literature. Child Maltreatment, 6, 314-331.
21.
Epstein, J. N., Saunders, B. E., Kilpatrick, D. G., & Resnick, H. S. (1998). PTSD as a mediator between childhood rape and alcohol use in adult women. Child Abuse and Neglect, 22, 223-234.
22.
Finkelhor, D., & Baron, L. (1986). Risk factors for child sexual abuse. Journal of Interpersonal Violence, 1, 43-71.
23.
Folkman, S., & Lazarus, R. S. (1988). The relationship between coping and emotion: Implications for theory and research. Social Science and Medicine, 26, 309-317.
24.
Fromuth, M. E. (1986). The relationship of childhood sexual abuse with later psychological and sexual adjustment in a sample of college women. Child Abuse and Neglect, 10, 5-15.
25.
Hammen, C. (2003). Interpersonal stress and depression in women. Journal of Affective Disorders, 74, 49-57.
26.
Harter, S., Alexander, P. C., & Neimeyer, R. A. (1988). Longterm effects of incestuous child abuse in college women: Social adjustment, social cognition, and family characteristics. Journal of Consulting and Clinical Psychology, 56, 5-8.
27.
Hovdestad, W. E., & Kristiansen, C. M. (1996). Afield study of “false memory syndrome” construct validity and incidence. Journal of Psychiatry and Law, 24, 299-338.
28.
Ireland, T., & Widom, C. S. (1994). Childhood victimization and risk for alcohol and drug arrests. International Journal of the Addictions, 29, 235-274.
29.
Johnson, B. K., & Kenkel, M. B. (1991). Stress, coping, and adjustment in female adolescent incest victims. Child Abuse and Neglect, 15, 293-305.
30.
Johnson, D. M., Pike, J. L., & Chard, K. M. (2001). Factors predicting PTSD, depression, and dissociative severity in female treatment-seeking childhood sexual abuse survivors. Child Abuse and Neglect, 25, 179-198.
31.
Johnson, S. M. (2004). An antidote to posttraumatic stress disorder: The creation of secure attachment in couples therapy. In L. Atkinson (Ed.), Attachment Issues in psychopathology and intervention (pp.207-298). Mahwah, NJ: Erlbaum.
32.
Kraemer, H. C. (2003). Current concepts of risk in psychiatric disorders. Current Opinion in Psychiatry, 16, 421-430.
33.
Kraemer, H. C., Stice, E., Kazdin, A., Offord, D., & Kupfer, D. (2001). How do risk factors work together? Mediators, moderators, and independent, overlapping, and proxy risk factors. American Journal of Psychiatry, 158, 848-856.
34.
Levitan, R. D., Rector, N. A., Sheldon, T., & Goering, P. (2003). Childhood adversities associated with major depression and/or anxiety disorders in a community sample of Ontario: Issues of co-morbidity and specificity. Depression and Anxiety, 17, 34-43.
35.
Lindberg, F. H., & Distad, L. S. (1985). Survival responses to incest: Adolescents in crisis. Child Abuse and Neglect, 9, 521-526.
36.
Merrill, L. L., Thomsen, C. J., Sinclair, B. B, Gold, S. R., & Milner, J. S. (2001). Predicting the impact of child sexual abuse on women: The role of abuse severity, parental support, and coping strategies. Journal of Consulting and Clinical Psychology, 69, 992-1006.
37.
Mian, M., Marton, P., LeBaron, D., & Birtwistle, D. (1994). Familial risk factors associated with intrafamilial and extrafamilial sexual abuse of three to five year old girls. Canadian Journal of Psychiatry, 39, 348-353.
38.
Moeller, T., Bachmann, G., & Moeller, J. (1993). The combined effects of physical, sexual, and emotional abuse during childhood: Long-term health consequences for women. Child Abuse and Neglect, 17, 623-640.
39.
Rind, B., Tromovitch, P., & Bauserman, R. (1998). A meta-analytic examination of assumed properties of child sexual abuse using college students. Psychological Bulletin, 124, 22-53.
40.
Roberts, J. E., Gotlib, I. H., & Kassel, J. (1996). Adult attachment security and symptoms of depression: The mediating roles of dysfunctional attitudes and low self-esteem. Journal of Personality and Social Psychology, 70, 310-320.
41.
Roche, D. N., Runtz, M. G., & Hunter, M. A. (1999). Adult attachment: A mediator between childhood sexual abuse and later psychological adjustment. Journal of Interpersonal Violence, 14, 184-207.
42.
Rodriguez, N., Vande Kemp, H., & Foy, D. W. (1998). Posttraumatic stress disorder in survivors of childhood sexual and physical abuse: A critical review of the empirical research. Journal of Child Sexual Abuse, 72, 17-45.
43.
Rodriguez-Srednicki, O. (2001). Childhood sexual abuse, dissociation and adult self-destructive behavior. Journal of Child Sexual Abuse, 10, 75-90.
44.
Rowland, D. L., Zabin, L. S., & Emerson, M. (2000). Household risk and child sexual abuse in a low income, urban sample of women. Adolescentand Family Health, 1, 29-39.
45.
Rumstein-McKean, O., & Hunsley, J. (2001). Interpersonal and family functioning of female survivors of childhood sexual abuse. Clinical Psychology Review, 21, 471-490.
46.
Runtz, M. G., & Schallow, J. R. (1997). Social support and coping strategies as mediators of adult adjustment following childhood maltreatment. Child Abuse and Neglect, 21, 211-226.
47.
Schuck, A. M., & Widom, C. S. (2001). Childhood victimization and alcohol symptoms in females: Causal inferences and hypothesized mediators. Child Abuse and Neglect, 25, 1069-1092.
48.
Shapiro, D. L., & Levendosky, A. A. (1999). Adolescent survivors of childhood sexual abuse: The mediating role of attachment style and coping in psychological and inter-personal functioning. Child Abuse and Neglect, 23, 1175-1191.
49.
Spaccarelli, S., & Fuchs, C. (1997). Variability in symptom expression among sexually abused girls: Developing multivariate models. Journal of Clinical Child Psychology, 1, 24-35.
50.
Styron, T., & Janoff-Bulman, R. (1997). Childhood attachment and abuse: Lont-term effects on adult attachment, depression, and conflict resolution. Child Abuse and Neglect, 21, 1015-1023.
51.
Talbot, N. C. (1996). Women sexually abused as children: The centrality of shame issues and treatment implications. Psychotherapy, 33, 11-18.
52.
Tangney, J. P., Wagner, P. E., & Gramzow, R. H. (1992). Proneness to shame, proneness to guilt, and psychopathology. Journal of Abnormal Psychology, 101, 469-478.
53.
Terr, L. C. (1981). Psychic trauma in children: Observations following the Chowchilla school-bus kidnapping. American Journal of Psychiatry, 138, 14-19.
54.
Terr, L. C. (1990). Too scared to cry: Psychic trauma in childhood. New York: Harpur & Row.
55.
Weissmann Wind, T., & Silvern, L. (1994). Parenting and family stress as mediators of the long-term effects of child abuse. Child Abuse and Neglect, 18, 439-453.
56.
Whiffen, V. E., Benazon, N. R., & Bradshaw, C. (1997). Discriminant validity of the TSC-40 in an outpatient setting. Child Abuse & Neglect, 21(1), 107-115.
57.
Whiffen, V. E., Judd, M. E., & Aube, J. A. (1999). Intimate relationships moderate the association between childhood sexual abuse and depression. Journal of Interpersonal Violence, 14, 940-954.
58.
Whiffen, V. E., Thompson, J. M., & Aube, J. A. (2000). Mediators of the link between childhood sexual abuse and adult depressive symptoms. Journal of Interpersonal Violence, 15, 1100-1120.
59.
Wyatt, G. E., & Newcomb, M. (1990). Internal and external mediators of women’s sexual abuse in childhood. Journal of Consulting and Clinical Psychology, 58, 758-767.
60.
Yama, M. F., Tovey, S. L., Fogas, B. S., & Teegarden, L. A. (1992). Joint consequences of parental alcoholism and childhood sexual abuse, and their partial mediation by family environment. Violence and Victims, 7, 313-325.
61.
Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173-1182.
62.
Kraemer, H. C. (2003). Current concepts of risk in psychiatric disorders. Current Opinion in Psychiatry, 16, 421-430.
63.
Kraemer, H. C., Stice, E., Kazdin, A., Offord, D., & Kupfer, D. (2001). How do risk factors work together? Mediators, moderators, and independent, overlapping, and proxy risk factors. American Journal of Psychiatry, 158, 848-856.
