Elsevier

Child Abuse & Neglect

Volume 29, Issue 8, August 2005, Pages 915-930
Child Abuse & Neglect

The roles of peritraumatic dissociation, child physical abuse, and child sexual abuse in the development of posttraumatic stress disorder and adult victimization

https://doi.org/10.1016/j.chiabu.2004.11.008Get rights and content

Abstract

Objective:

Previous research has indicated that women who experience childhood physical abuse or childhood sexual abuse are at increased risk for posttraumatic stress disorder (PTSD) and adult victimization. Recently, peritraumatic dissociation (PD) has been suggested as another possible risk factor for PTSD and adult victimization. The purpose of the present study was to investigate the effects of childhood physical and sexual abuse and PD on PTSD and adult victimization.

Method:

A sample of 467 female college students completed questionnaires about childhood and adult sexual and physical abuse experiences, PD, and PTSD symptoms.

Results:

The combined sexual and physical abuse (CA) and sexual abuse only (SA) groups reported significantly higher numbers of PTSD symptoms than the physical abuse only (PA) and no abuse (NA) groups. The CA and PA groups reported significantly more adult sexual and physical victimization than the SA and NA groups. Across all four groups, higher levels of PD were associated with higher levels of PTSD and adult sexual and physical victimization.

Conclusions:

The results of the current study suggest that different types of childhood abuse may lead to different adult problems. The results also indicated that PD may have a broad effect on PTSD development and adult victimization.

Résumé

French-language abstract not available at time of publication.

Resumen

Spanish-language abstract not available at time of publication.

Introduction

The possible long-term consequences of childhood sexual abuse and childhood physical abuse have been well documented (e.g., Beitchman et al., 1992; Browne & Finkelhor, 1986; Malinosky-Rummell & Hansen, 1993). Children who endure either sexual abuse or physical abuse appear to be at risk of developing a number of adult problems, including depression, low-self-esteem, posttraumatic stress disorder (PTSD; Roesler & McKenzie, 1994) and adult victimization (Messman & Long, 1996). Research on childhood trauma has also suggested that children who experience a combination of both sexual and physical abuse may be at higher risk of developing adult psychological problems than children who experience only one form of childhood abuse (Briere & Runtz, 1990; Schaaf & McCanne, 1998).

Schaaf and McCanne (1998) examined the relationship between different types of childhood abuse (sexual, physical, and combined sexual and physical) and the development of posttraumatic stress disorder (PTSD) and adult victimization in a sample of college women. Schaaf and McCanne found that women who experienced combined sexual and physical abuse as children were at greater risk of developing PTSD than women who had not been abused. Women who experienced either childhood sexual abuse or childhood physical abuse were at a greater risk of developing PTSD than women who had not been abused; however, these women were at a lower risk of developing PTSD as an adult than women with combined childhood abuse experiences. Schaaf and McCanne's results also showed that both the child physical abuse group and the combined childhood abuse group experienced higher levels of adult physical and/or sexual victimization than women who had not experienced any child abuse. A number of other studies have reported results similar to those of Schaaf and McCanne (e.g., Hanson et al., 2001; Wind & Silvern, 1992; Windle, Windle, Scheidt, & Miller, 1995).

There exist a number of possible mechanisms and pathways by which multiple forms of abuse can lead to poorer adult outcomes. First, multiple victimization may be partially due to a more general vulnerability to victimization (Mandoki & Burkhardt, 1989). Second, further victimization may maintain or exacerbate the impact of an initial trauma (Proulx, Koverola, Fedorowicz, & Kral, 1995). Third, dual abuse could be interpreted as a distinctive type of abuse associated with unique features, such as a lack of familial social support (Wind & Silvern, 1992). Rodriguez, Vande Kemp, and Foy (1998) suggested that to establish dual abuse as an independent antecedent to the development of poorer adult outcomes, researchers should compare rates of adult problems between groups with dual abuse and groups experiencing only sexual abuse, only physical abuse, and no abuse. Fourth, multiply victimized women may represent individuals who have not yet learned to cope successfully with their initial victimization (Mandoki & Burkhardt, 1989). Proulx et al. (1995) established that coping strategies appear to be powerful predictors of distress and suggested that coping styles could carry over from one incident of victimization to another. Proulx et al. also found that individuals with multiple victimization may be more prone than individuals with single abuse experiences to use escapist coping strategies, which can be associated with increased emotional distress.

One possible coping mechanism by which childhood physical and/or sexual abuse could lead to both PTSD and adult victimization is dissociation. Dissociation is a structured compartmentalization of mental processes (such as thoughts, feelings, or memories) that are normally integrated (Spiegel & Cardena, 1991). Dissociative experiences are common and normal occurrences during childhood (Putnam, 1993), and children are more likely than adults to use dissociation as a defense mechanism. Dissociation has been associated with sequelae of abuse (Browne & Finkelhor, 1986). Several studies have shown that higher levels of dissociation experienced after childhood sexual abuse (e.g., Briere & Runtz, 1988; Chu & Dill, 1990) or childhood physical abuse (e.g., Sanders, McRoberts, & Tollefson, 1989; Swett & Halpert, 1993) are associated with poorer adult outcomes.

When faced with physical or sexual abuse, a child may try to maximize his or her ability to function and make sense out of the world by utilizing dissociation (Siegel, 1996). Classen, Koopman, and Spiegel (1993) have suggested that a child may use dissociative strategies to feel relief and protection from the abuse experience. The child may not be able to control the traumatic event, but may be able to control his or her perception of the event.

Shalev (1993) has suggested that the initial dissociative reactions utilized by the victims of child abuse may lead to the development of a more chronic state of PTSD. Unlike normal, non-stressful events, traumatic situations may cause a significant amount of strain on cognitive processing. The individual may not be able to assimilate the cognitive and emotional information associated with the trauma (Greenberg, 1995; Resick & Schnicke, 1993). Dissociation, utilized by the individual because of the amount of panic and physiological arousal caused by the trauma, may prevent the individual from emotionally processing the external cues associated with the trauma (Shalev, 1997). Thus, dissociation may lead to the development of pathological fear structures and symptoms of PTSD (Foa & Kozak, 1986; Lang, 1979).

Dissociation may also lead to increased risk of adult victimization in survivors of child sexual and physical abuse. Becker-Lausen, Sanders, and Chinsky (1995) assessed female and male undergraduate students and proposed that dissociation would mediate the relationship between any type of child abuse and adult victimization. Their results indicated that child abuse (both sexual and physical) was significantly associated with adult victimization and that dissociation was a significant mediator of this relationship. Becker-Lausen et al. suggested that individuals who experience a dissociation of their perception in response to child maltreatment do so in an attempt to survive the pain of the abuse experience. However, the dissociative reaction may lead abuse victims to learn to dismiss clues that would otherwise warn them to be wary of more dangerous situations. Becker-Lausen et al.'s interpretation is supported by Cloitre, Scarvalone, and Difede (1997), who suggested that dissociation may decrease awareness of environmental cues in an individual who was abused in childhood, causing confusion and distraction that may lead to increased vulnerability.

One type of dissociation that has received a significant amount of attention in recent years is peritraumatic dissociation, or dissociation that occurs during or immediately following a traumatic event (Marmar et al., 1994). Peritraumatic dissociation has been found to be positively associated with PTSD in Vietnam veterans (Tichenor, Marmar, Weiss, Metzler, & Ronfeldt, 1996), motor vehicle accident victims (Ehlers, Mayou, & Bryant, 1998; Ursano et al., 1999), natural disaster survivors (Marmar, Weiss, & Metzler, 1997), civilian trauma victims (Shalev, Peri, Canetti, & Schreiber, 1996), victims of violent assault (Birmes et al., 2001), rape victims (Griffen, Resick, & Mechanic, 1997; Zoellner, Alvarez-Conrad, & Foa, 2002), and college students who have experienced trauma (Bernat, Ronfeldt, Calhoun, & Arias, 1998). The results of the current research on peritraumatic dissociation call into question the commonly held belief that dissociative reactions that occur during or immediately after a traumatic event usually resolve themselves quickly (Putnam, 1999).

Only one study to date has investigated the relationships between peritraumatic dissociation, child abuse, and PTSD. Johnson, Pike, and Chard (2001) examined the relationship between various childhood sexual abuse-related variables (e.g., presence of injury, age of onset, etc.) and peritraumatic dissociation. Johnson et al. found that the presence of penile penetration, the presence of injury during child sexual abuse, and believing that you or someone else would be killed were associated with a higher degree of peritraumatic dissociation. Johnson et al. also found that peritraumatic dissociation was a significant predictor of PTSD symptoms.

To date, no published study has examined the extent to which peritraumatic dissociation may occur after childhood physical abuse. Although Johnson et al. (2001) found that peritraumatic dissociation experienced after childhood sexual abuse was associated with greater self-reported PTSD symptoms, they did not examine the influence that childhood physical abuse may have on the development of adult psychopathology. Previous research has shown that experiencing multiple forms of abuse (sexual and physical) may lead to more serious adult outcomes (e.g., Schaaf & McCanne, 1998; Wind & Silvern, 1992). The present study sought to examine the contributions of single and multiple forms of abuse and peritraumatic dissociation on the development of PTSD.

The current research also attempted to determine the role that peritraumatic dissociation may play in adult revictimization. Past research has determined that abuse in childhood increases the risk of adult victimization (e.g., Gidycz, Coble, Latham, & Layman, 1993; Messman-Moore, Long, & Siegfried, 2000). Therefore, a second goal of the present study was to investigate the role of childhood physical abuse, childhood sexual abuse, and peritraumatic dissociation experienced after childhood abuse on adult victimization.

Section snippets

Participants

Participants for this study were obtained from a sample of female undergraduate college students enrolled in an introductory psychology class at a Midwestern university. Seven hundred and forty-six introductory psychology students completed an initial screening from which participants for the current experiment were selected.

Inclusion requirements for the child physical abuse (PA) group were based on the CPEQ, an adapted form of Milner, Robertson, and Roger's (1990) Childhood History

Description of the child abuse groups

The final sample consisted of 151 female college students between the ages of 18 and 21 who had experienced physical and/or sexual abuse before the age of 15 and 316 females who had experienced no abuse before the age of 15. Mean ages of the groups were as follows: 19.8 years (SD = 5.5) for the CA group, 19.1 years (SD = 2.5) for the SA group, 18.8 years (SD = 1.9) for the PA group, and 19.2 years (SD = 4.1) for the NA group. The four abuse groups did not differ significantly from one another in age, F 

Discussion

Peritraumatic dissociation that occurs during or immediately following a childhood abuse experience appeared to be strongly and consistently related to the presence of PTSD symptoms in adulthood (see Table 1). Childhood sexual abuse, whether experienced by itself or in combination with childhood physical abuse, also appeared to be significantly associated with reported symptoms of adult PTSD. Analyses of covariance indicated that these relationships between abuse history, peritraumatic

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