Revictimization and information processing in women survivors of childhood sexual abuse

Abstract

This study examined the effect of sexual revictimization on information processing of trauma-related stimuli in a sample of child sexual abuse (CSA) survivors diagnosed with posttraumatic stress disorder (PTSD). Fifty-one treatment-seeking women participated in this study. Participants completed the Sexual Experiences Survey regarding sexual revictimization in the last 6 months and performed a modified emotional Stroop task in which they named the colors of neutral words (e.g., apple), general threat words (e.g., malignant and death), and sexual/victimization words (e.g., penis and abuser). As predicted, the revictimized participants (n=16) took significantly longer to color-name sexual/victimization words than did the nonrevictimized participants. These results suggest that revictimization serves to prime preexisting “trauma” memory networks, thereby amplifying the impact of childhood sexual trauma on selective attention toward trauma-related stimuli.

Introduction

The modified color-naming Stroop paradigm has been usefully applied in the investigation of processing of trauma-related information in posttraumatic stress disorder (PTSD; e.g., Cassiday et al., 1992, McNally et al., 1990). It involves presenting trauma-related stimuli, such as the word “rape” in rape trauma, in place of the color-names traditionally employed with this task (Stroop, 1935). Previous research has shown that emotionally threatening Stroop stimuli automatically attract participants' attention, despite attempts to ignore the meaning of the word, thereby resulting in a delay in color-naming relative to nonthreatening words. For example, in the context of rape trauma, rape victims with PTSD exhibited significantly longer reaction times in the color-naming of rape-related words than rape victims without PTSD Cassiday et al., 1992, Foa et al., 1991. The present study extends this previous work on sexual trauma by examining the relationship between sexual revictimization and Stroop color-naming interference for sexual trauma words within a group of adult survivors of childhood sexual abuse who meet DSM-IV criteria for current PTSD.

Cognitive perspectives on PTSD explain reexperiencing symptomatology such as intrusive perceptions, images, thoughts, and memories involving the trauma as expressions of highly cognitively accessible representations associated with the trauma (Creamer et al., 1992, Foa et al., 1989; Horowitz, 1986). Given their lower activation thresholds, these representations apply readily in processing trauma-related information. The accessibility of these representations can account for intrusion symptoms elicited by internal and external cues that only partly match the stimulus features of the original traumatic event, such as the sound of a helicopter activating a flashback of a battlescene in a Vietnam veteran with PTSD. This also can explain the increased color-naming latencies of words related to a trauma in the modified Stroop paradigm. In effect, selective attention to the trauma-related words leaves less processing resources available for color-naming (for a review, see Williams, Mathews, & MacLeod, 1996).

In previous research applying the Stroop paradigm to examine cognitive processing of trauma-related information in PTSD, there is abundant evidence across a range of traumatic events showing that those with PTSD show greater color-naming interference than those with a prior history of exposure to the same stressor but without PTSD (Williams et al., 1996). Although the Stroop paradigm has been successfully applied in distinguishing those exposed to traumatic events with PTSD from non-PTSD survivors, there has been no attempt to apply the Stroop paradigm to investigate the impact of revictimization on cognitive processing of trauma-related stimuli, however.

Adult women with a history of childhood sexual abuse are known to experience greater distress in response to sexual assault than those who have been sexually assaulted without a prior history of childhood sexual abuse Murphy et al., 1988, Roth et al., 1990. These results can been explained from an information-processing viewpoint in terms of a priming effect of revictimization. Adult survivors of childhood sexual abuse with PTSD are assumed to possess elaborate, tightly knit “trauma” memory networks derived from earlier traumatic experiences (Foa et al., 1991). Because recency of exposure is known to be an important factor contributing to the accessibility of related information in memory (Higgins, 1989), revictimization should function as a prime in boosting the activation level of preexisting trauma memory networks. Therefore, we hypothesize that among adult survivors of childhood sexual abuse with PTSD, those who have been recently sexually revictimized will show greater interference in color-naming of sexual trauma-related Stroop words relative to nonrevictimized survivors.