The long-term sequelae of sexual abuse: Support for a complex posttraumatic stress disorder

Abstract

This study examined the relationship between childhood sexual abuse and symptoms of a newly proposed complex posttraumatic stress disorder or disorder of extreme stress not otherwise specified (DESNOS). Compared to 34 women without histories of sexual abuse, 74 survivors of sexual abuse showed increased severity on DESNOS symptoms of somatization, dissociation, hostility, anxiety, alexithymia, social dysfunction, maladaptive schemas, self-destruction, and adult victimization. In addition, a logistic regression found that a complex of symptoms representing DESNOS was significantly related to a history of sexual abuse. Consistent with other studies, the results of this study provide support for the idea that symptoms of DESNOS characterize survivors of sexual abuse.

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References

  1. Bernstein, E. A., & Putnam, F. W. (1986). Development, reliability, and validity of a dissociation scale.Journal of Nervous and Mental Disease, 174 727–735.

    PubMed  Google Scholar 

  2. Briere, J., & Runtz, M. (1986). Suicidal thoughts and behaviors in former sexual abuse victims.Canadian Journal of Behavioral Science, 18 413–423.

    Google Scholar 

  3. Browne, A., & Finkelhor, D. (1986). Impact of child sexual abuse: A review of the research.Psychological Bulletin, 99 66–77.

    PubMed  Google Scholar 

  4. Bryer, J. B., Nelson, B. A., Miller, J. B., & Krol, P. A. (1987). Childhood sexual and physical abuse as factors in adult psychiatric illness.American Journal of Psychiatry, 144 1426–1430.

    PubMed  Google Scholar 

  5. Carlson, E. B., & Putnam, F. W. (1993). An update on the Dissociative Experience Scale.Dissociation, 1 16–27.

    Google Scholar 

  6. Carlson, E. B., Putnam, F. W., Ross, C. A., Torem, M., Coons, P., Dill, D. L., Loewenstein, R. J., & Braun, B. G. (1993). Validity of the Dissociative Experiences Scale in screening for multiple personality: A multicenter study.American Journal of Psychiatry, 150 1030–1036.

    PubMed  Google Scholar 

  7. Courtois, C. (1979). The incest experience and its aftermath.Victimology: An International Journal, 4 337–347.

    Google Scholar 

  8. Derogatis, L. R. (1977).SCL-90: Administration, scoring, and procedure manual-I for the R (revised) version. Baltimore: Johns Hopkins University School of Medicine.

    Google Scholar 

  9. Finkelhor, D. (1990). Early and long-term effects of child sexual abuse: An update.Professional Psychology: Research and Practice, 21 325–330.

    Google Scholar 

  10. 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, 40 5–15.

    Google Scholar 

  11. Gold, E. R. (1986). Long-term effects of sexual victimization in childhood: An attributional approach.Journal of Consulting and Clinical Psychology, 54 471–475.

    PubMed  Google Scholar 

  12. Harter, S., Alexander, P. C., & Neimeyer, R. A. (1988). Long-term effects of incestuous child abuse in college women: Social adjustment, social cognition, and family characteristics.Journal of Consulting and Clinical Psychology, 56 5–8.

    PubMed  Google Scholar 

  13. Herman, J. L. (1993). Sequelae of prolonged and repeated trauma: Evidence for a complex posttraumatic syndrome (DESNOS). In I. R. T. Davidson & E. D. Foa (Eds.),Post-traumatic stress disorder: DSM-IV and beyond (pp. 213–228). Washington, DC: American Psychiatric Press.

    Google Scholar 

  14. Krystal, H. (1988).Integration and self-healing. Affect, trauma, alexithymia. Hillsdale NJ: The Analytic Press.

    Google Scholar 

  15. Lindberg, F. H., & Distad, L. J. (1985). Posttraumatic stress disorders in women who experienced childhood incest.Child Abuse and Neglect, 9 329–334.

    PubMed  Google Scholar 

  16. Meiselman, K. C. (1978).Incest. San Francisco: Jossey-Bass.

    Google Scholar 

  17. Mullen, P. E., Romans-Clarkson, S. E., Walton, V. A., & Herbison, G. P. (1988). Impact of sexual and physical abuse on women's mental health.Lancet, I 841–845.

    Google Scholar 

  18. Pribor, E. F., Yutzy, S. H., Dean, J. T., & Wetzel, R. D. (1993). Briquet's syndrome, dissociation, and abuse.American Journal of Psychiatry, 150 1507–1511.

    PubMed  Google Scholar 

  19. Putnam, F. W., Guroff, J. J., Silberman, E. K., Barban, L., & Post, R. M. (1986). The clinical phenomenology of multiple personality disorder: A review of 100 cases.Journal of Clinical Psychiatry, 47 285–293.

    PubMed  Google Scholar 

  20. Rowan, A. B., & Foy, D. W. (1993). Post-traumatic stress disorder in child sexual abuse survivors: A literature review.Journal of Traumatic Stress, 6 3–20.

    Google Scholar 

  21. Russell, D. E. H. (1986).The secret trauma. New York: Basic Books.

    Google Scholar 

  22. Saunders, B. E., Villeponteaux, L. A., Liposvsky. J. A., Kilpatrick, D. G., & Vernon, L. J. (1992). Child sexual assault as a risk factor for mental disorders among women.Journal of Interpersonal Violence, 7 189–204.

    Google Scholar 

  23. Saxe, G. N., van der Kolk, B. A., Berkowitz, R., Chinman, G., Lieberg, G., & Schwartz, J. (1993). Dissociative disorders in psychiatric inpatients.American Journal of Psychiatry, 150 1037–1042.

    PubMed  Google Scholar 

  24. Schmidt, N. B. (1994). The Schema Questionnaire and the Schema Avoidance Questionnaire.The Behavior Therapist, 90–92.

  25. Schmidt, N. B., Joiner, T. E., & Young, J. (1992). The Schema Questionnaire: Investigation of psychometric properties and the hierarchical structure of a measure of early maladaptive schemas. Poster presented at the Association for Advancement of Behavior Therapy.

  26. Surrey, J., Swett, C., Michaels, B.A., & Levin, S. (1990). Reported history of physical and sexual abuse and severity of symptomatology in women psychiatric outpatients.American Journal of Orthopsychiatry, 60 412–417.

    PubMed  Google Scholar 

  27. Taylor, G. J., Bagby, R. M., Ryan, D. P., Parker, J. D. A., Doody, K. F., & Keefe, P. (1988). Criterion validity of the Toronto Alexithymia Scale.Psychosomatic Medicine, 50 500–509.

    PubMed  Google Scholar 

  28. Taylor, G. J. (1984). Alexithymia: Concept, measurement, and implications for treatment.American Journal of Psychiatry, 141 725–732.

    PubMed  Google Scholar 

  29. van der Kolk, B. A., Perry, J. C., & Herman, J. L. (1991). Childhood origins of self-destructive behavior.American Journal of Psychiatry, 148 1665–1671.

    PubMed  Google Scholar 

  30. Weissman, M. M., & Bothwell, S. (1976). Assessment of social adjustment by patient self-report.Archives of General Psychiatry, 33 1111–1115.

    PubMed  Google Scholar 

  31. Weissman, M. M., Prusoff, B. A., Thompson, W. D., Harding, P. S., & Myers, J. K. (1978). Social adjustment by self-report in a community sample and in psychiatric outpatients.The Journal of Nervous and Mental Disease, 166 317–326.

    PubMed  Google Scholar 

  32. 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.

    PubMed  Google Scholar 

  33. Young, J. (1990).Cognitive therapy for personality disorders: A schema-focused approach. Sarasota, FL: Professional Resource Exchange, Inc.

    Google Scholar 

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Zlotnick, C., Zakriski, A.L., Shea, M.T. et al. The long-term sequelae of sexual abuse: Support for a complex posttraumatic stress disorder. J Trauma Stress 9, 195–205 (1996). https://doi.org/10.1007/BF02110655

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Key words

  • childhood sexual abuse
  • complex posttraumatic stress disorder
  • disorder of extreme stress