Gender differences in social reactions to abuse disclosures, post-abuse coping, and PTSD of child sexual abuse survivors☆
Introduction
A large body of research has documented many negative psychological and social impacts of child sexual abuse (CSA) experiences in samples of adult survivors (see Beitchman et al., 1992; Browne & Finkelhor, 1986; Cahill, Llewelyn, & Pearson, 1991; Neumann, Houskamp, Pollock, & Briere, 1996; Polusny & Follette, 1995; Putnam, 2003 for reviews). Various investigators have reported that abuse characteristics, such as more severe abuse, of longer duration, or by trusted perpetrators, are associated with poorer mental health outcomes (Banyard & Williams, 1996; Bennett, Hughes, & Luke, 2000; Kendall-Tackett, Williams, & Finkelhor, 1993; Mullen, Martin, Anderson, Romans, & Herbison, 1993). Features of the aftermath of abuse, such as self-blame attributions (Hoagwood, 1990; McMillan & Zuravin, 1997; Owens & Chard, 2001; Ullman, 1996), avoidance/disengagement coping strategies (Coffey, Leitenberg, Henning, Turner, & Bennett, 1996; Long & Jackson, 1993; Merrill, Thomsen, Sinclair, Gold, & Milner, 2001; Runtz & Schallow, 1997), and negative social reactions from others to abuse disclosures (Ullman, 2003), have also been found to be associated with poorer adjustment.
CSA occurs within a “gendered” social context in which males have more power than females in our society. Therefore, it is critically important to consider the role of gender in examining correlates of post-abuse adjustment. Sexual abuse is more prevalent and severe among women (Putnam, 2003). Although CSA has psychological effects on both men and women, some evidence suggests more trauma symptoms in women experiencing severe abuse than men (Ketring & Feinhauer, 1999). On the other hand, both sexes appear to be more symptomatic if abused by father figures, so abuse characteristics and possibly post-abuse responses may vary in their effects by gender. Banyard, Williams, and Siegel (2004) compared hospital records of adult survivors of CSA victims and found similarity in context and consequences of CSA by gender, although females had more symptoms. For males, number of incidents, injury by a caretaker, and other adult traumas explained their mental health symptoms, whereas analyses of female data (Banyard & Williams, 1996; Banyard, Williams, & Siegel, 2001) showed that physical force, closer victim-offender relationship, older age at the time of abuse, and other lifetime traumas explained their mental health symptoms. It is possible that more severe CSA cases and/or more selective samples are associated with fewer gender differences in CSA than populations with better or more variability in functioning, such as community or college samples. In these latter samples, however, the bias of males underreporting CSA and its consequences may also be likely and may increase the appearance of greater effects of CSA on females. Few studies of gender differences in nonclinical samples exist, but Runtz and Schallow (1997) tested several structural equation models in a sample of 302 male and female college students. They found a good model fit for both genders which showed that coping and social support mediated the associations of child sexual and physical abuse. However, these models included victims and nonvictims and used more general measures of support and coping (see Merrill et al., 2001 for a similar study). Studies of gender differences are also needed within samples of victims to understand factors that differentiate varying degrees of recovery, which may then be targeted in treatment and prevention efforts.
Researchers have indicated the prevalence of CSA in the general population to be between 13 and 16% in males (Polusny & Follette, 1995) and 15–33% for females (Kendall-Tackett et al., 1993). No studies to date have examined gender differences in coping strategies used to cope with aftermath of CSA at the time of the abuse, but some suggest externalizing behavior as a coping mechanism is more common in males than females. In a review of the initial outcome of CSA, Gomes-Schwartz, Horowitz, and Cardarelli (1990) found that boys tend to act out aggressively more often than girls. Similarly, Urquiza and Crowley's (1986) study of college students showed men were more likely to report a desire to hurt others as a consequence of CSA. Other research on female populations shows that adult female college students with CSA histories are more likely to engage in social withdrawal and avoidance coping generally (Gibson & Leitenberg, 2001), than women without such histories, though it is unclear if this differs for males. Research has examined substance use as a coping mechanism, and shows more substance use disorders in male than female violent crime victims (defined as childhood or adulthood sexual/physical abuse) selected from substance abuse treatment programs (Saladin et al., 2003). These results accentuate the scarcity of research in the area of gender differences in coping strategies used by CSA survivors.
Another common consequence for female CSA survivors is the development of PTSD symptoms (Kendall-Tackett et al., 1993). Few studies have examined gender differences in PTSD symptoms following CSA. Rowan and Foy (1993) reviewed studies on the CSA-PTSD link and found that between 21 and 50% of CSA survivors develop PTSD symptoms. However, gender differences were not examined separately in these studies. Davis and Siegel (2000) reviewed studies of PTSD in children and adolescents and found that girls are at higher risk of developing PTSD than boys exposed to trauma, but no studies specifically examined gender differences for CSA survivors. Hence, research is clearly needed to understand the psychological sequelae of male versus female CSA survivors.
Few studies have analyzed gender differences in either victims’ experiences of disclosure and/or in others’ reactions to disclosures of CSA (see Romano & DeLuca, 2001 for a recent review of research on male sexual abuse victims). Although research clearly shows the detrimental impact of negative reactions from others on abuse survivors (Ullman, 2003), less is known about experiences of abuse disclosure and the role of others’ reactions on recovery outcomes than about abuse characteristics and survivors’ individual responses (e.g., coping strategies, attributions of blame). In a recent review of studies of social support and/or social reactions to adult survivors of CSA, unsupportive responses or negative social reactions were shown to be both common and associated with a range of negative effects including psychological symptoms, somatic and health symptoms, incomplete memory, and problems in adult relationships (Ullman, 2003). Some have argued that an ecological/contextual perspective is needed to understand better the impact of sexual victimization on recovery outcomes (Grauerholz, 2000, Spaccarelli, 1994, Ullman, 1999). This perspective implies that the social context of abuse disclosures must be studied to understand impact of abuse and to develop treatment and intervention strategies.
Many studies have examined social support and social reactions in relation to sexual abuse disclosure (see Ullman, 2003 for a review), but most have only used general measures of supportiveness of others to victims or assessed whether responses to disclosure were positive or negative. Despite this limitation, a few published empirical studies of adult survivors have focused primarily on characteristics of abuse disclosures and/or on the specific types of social reactions received from others in detail (Arata, 1998; Jonzon & Lindblad, 2004; Lamb & Edgar-Smith, 1994; Roesler & Wind, 1994). Studies show disclosure of abuse varies in its association with functioning, but that timing of abuse disclosure may be related to its impact. Arata's (1998) study of 204 college women with a CSA history showed abuse disclosure was unrelated to current functioning, but related to less PTSD symptoms of intrusion and avoidance. Disclosure was less likely by survivors of more severe assaults and those perpetrated by persons related to the victim. Studies of adult survivors of CSA recruited through media advertisements (Lamb & Edgar-Smith, 1994) and treatment-seekers (Roesler & Wind, 1994) have shown that childhood disclosures of abuse are often met with more negative reactions than adult disclosures, whereas adult disclosures yield more positive reactions. This pattern may be partially due to differences in support sources told, with more victims telling parents in childhood and more telling friends in adulthood. For example, using a general measure of helpfulness of reactions, Arata (1998) found that reactions to disclosure were generally positive regardless of who college women told, and others’ reactions were not related to current functioning. However, negative reactions from friends were related to more symptoms in survivors and older women received more negative reactions from mothers. Roesler and Wind (1994) found that even controlling for age at disclosure, parents’ reactions to female incest survivors’ abuse disclosures were worse than those of others, and younger age at disclosure was related to worse reactions whoever was told. Lamb and Edgar-Smith (1994) found that male survivors disclosed less often than females and that not being blamed was perceived as the most supportive response received from others. They found no difference in helpfulness of male and female disclosure recipients, but specific responses to disclosures differed with females more likely to believe, cry, and say they were also survivors and males more likely to respond protectively. Finally, Jonzon and Lindblad's recent (2004) study of 122 media-recruited adult female CSA survivors victimized by someone close to them (e.g., relatives, family, authority figures) showed that women who actively disclosed CSA in childhood had more violent abuse, which was related to receiving more negative social reactions from one's social network. Current support was related to receiving positive, but not negative, social reactions.
Clearly, these studies show that the type of abuse, the timing and nature of abuse disclosure, and the disclosure recipient all affect the social reactions experienced by survivors. Unfortunately, little can be discerned about gender differences from these studies as three samples were all female and one had only 12 male survivors. In all of these studies, only about one-third of victims first told someone in childhood and two-thirds first disclosed in adulthood. Except for less disclosure by men in one study (Lamb & Edgar-Smith, 1994), these convenience samples describe women's experiences. These studies also did not examine other mediating variables, such as coping and attributions of blame, nor did they assess PTSD symptoms, which are commonly observed in survivors.
Most studies of CSA's psychological impact have not examined social reactions to disclosure, and have instead focused on abuse characteristics, coping, and attributions. The few studies using more comprehensive measures of social support/reactions to abuse disclosures have not included abuse characteristics, coping, and attributions. Finally, most studies of adult survivors have focused on women and have not compared them to men, especially studies of social reactions to abuse disclosures. The present study was exploratory and was designed to address several gaps in the field by examining social reactions to disclosures of CSA in a large sample of male and female college students, in combination with other factors known to affect adjustment. We examined (1) hypothesized gender differences in abuse characteristics, post-abuse cognitions and coping strategies, and social reactions, (2) whether negative social reactions contributed in addition to all of these factors to PTSD symptom severity, and (3) explored how these aforementioned factors and gender were related to negative and positive reactions received upon disclosing abuse. Compared with males, we hypothesized that females would have greater abuse prevalence, more severe abuse, greater self-blame, more use of all coping strategies (both positive and negative), greater PTSD symptom severity, and be more likely to disclose abuse and receive more negative and positive reactions. Second, we hypothesized that negative social reactions would contribute to PTSD symptoms controlling for gender, abuse characteristics, coping, and attributions.
Section snippets
Sample
College students were recruited through the Psychology Department Subject Pool and through classroom announcements in Criminal Justice Department classes at an urban research university for over a year for a study on personal experiences in childhood following procedures approved by the University Institutional Review Board. Students participated either through the Psychology Department subject pool (N = 635) or through announcements in Criminal Justice classrooms (N = 98). All students voluntarily
Sample characteristics
Our sample was mostly female (71%), unmarried (95%), and childless (96%). All participants were currently in college (46% freshmen, 33% sophomore, 15% junior, 6% senior), and 59% were also employed. The sample was racially diverse reflecting the urban university population with 36% White, 29.6% Asian American, 18.5% Hispanic, 11.3% Black, and 4.7% other. The average age was 19.57 (SD = 2.44). Less than one-fourth of students reported CSA (22.8%) overall, while 28.2% of females and 13.3% of males
Discussion
As hypothesized, this study showed that gender differences exist not only in the prevalence of CSA, but also in the likelihood and nature of abuse disclosures, in social reactions received from others, in coping responses, and in PTSD symptom severity of adult survivors. Consistent with past research, female students reported greater prevalence and severity of CSA (Putnam, 2003) than male students. The only national data on college men, now almost 20 years old, used fewer screening questions
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An earlier version of this paper was presented at the 2002 meeting of the International Society for Traumatic Stress Studies in Baltimore, MD.