Gender differences in internalizing problems among sexually abused early adolescents☆
Introduction
Sexual abuse appears to affect most children negatively—at least in the short-term (Finkelhor & Berliner, 1995). Sexually abused children score higher than non-sexually abused children on several negative attributes, including internalizing behavior problems (Hunter, 2006). Internalizing behaviors, such as withdrawal and depression, represent an over-controlled and inner-directed pattern of behavior (Compton, Burns, Egger, & Robertson, 2002). Although sexual abuse and internalizing behavior problems among girls may go unnoticed by caregivers, teachers and other professionals, they may be less likely to suspect sexual abuse and internalizing problems among boys because boys report sexual abuse less frequently than girls (Holmes & Slap, 1998) and because boys are less likely to internalize than girls (Leadbeater, Kuperminc, Blatt, & Hertzog, 1999). Consequently, fewer sexually abused boys may be referred for assessment and treatment.
Despite research showing that boys are less likely to experience internalizing behavior problems than girls in the general population, research has not consistently shown that sexually abused girls are more likely to have an internalizing problem than sexually abused boys. Several researchers have found that sexually abused adolescent boys were more likely than girls to think about killing themselves or to try to kill themselves (Bagley et al., 1995, Garnefski and Arends, 1998, Nelson et al., 1994). Because of these findings, one might expect boys to have higher scores on internalizing behavior, such as depression. Yet, researchers have either found no differences between sexually abused adolescent boys and girls on internalizing behavior (Garnefski and Diekstra, 1997, Hibbard et al., 1990), or they have found conflicting results. In Darves-Bornoz, Choquet, Ledoux, Gasquet, and Manfredi's (1998) study of sexually abused adolescents, the girls reported more somatic complaints and depression than the boys. However, in Bagley et al.’s (1995) study, the adolescent girls did not differ from the boys on somatization.
Although the research on sexually abused adolescent boys and girls and internalizing behavior is mixed, and leaning toward few or no differences, most of these studies did not control for other important variables, such as characteristics of the sexual abuse and whether the adolescent was exposed to other types of victimization. These variables may be more potent predictors of internalizing behavior problems than gender, or gender may interact with these and other variables in ways that may explain the effect of sexual abuse on behavior more fully.
Considerable, although not consistent, research shows that sexual abuse that persists, more frequent sexual abuse, sexual abuse by a relative, or sexual abuse that involves penetration is more likely to result in poorer outcomes (see Bauserman and Rind, 1997, Kendall-Tackett et al., 1993, for reviews). We were only able to identify one study that examined how an abuse characteristic influenced internalizing behavior among sexually abused adolescents. Bagley et al. (1995) found that adolescents who were touched often were more likely to report somatization, an emotional disorder, or a suicide gesture or attempt.
Experiencing another type of victimization may explain internalizing behavior problems among sexually abused adolescents. Garnefski and Diekstra (1997) and Hibbard et al. (1990) found that adolescents who were sexually and physically abused had higher internalizing scores than adolescents who were sexually abused alone or physically abused alone. Boney-McCoy and Finkelhor (1995) also reported that experiencing more than one type of victimization predicted PTSD symptoms among adolescents. Findings from these studies are consistent with developmental, neurobiological, and trauma theories that assert that multiple victimizing experiences place a greater demand on children's coping resources and may result in poorer development (Finkelhor et al., 2007, van der Kolk, 1996, Wolfe and Jaffe, 1991). Exposure to domestic violence and physical abuse may also intensify feelings of shame and decrease expectancy of control among sexually abused adolescents, which, in turn, may increase internalizing behavior (Feiring, Taska, & Lewis, 2002).
Finally, we rely on Connell and Wellborn's (1991) theory of self-system processes to generate hypotheses that might explain internalizing behavior problems among sexually abused adolescents more fully. According to their theory, people have a fundamental psychological need for competence, relatedness and autonomy. Connell and Wellborn (1991) definition of competence is similar to Kovacs (1992) definition of self-efficacy: the extent to which children feel they are able to do things the right way or as well as other children. Autonomy support refers to, for example, the extent to which adolescents feel their caregivers give them a choice in what they do and are supported in doing something that is connected to their personal goals or values, whereas relatedness includes feeling connected to others and “worthy and capable of love and respect” (Connell, 1990, p. 63). Although the relationship between these factors and internalizing behavior have not been examined empirically among sexually abused adolescents, they seem especially salient as children enter adolescence and as they respond to sexual abuse. Adolescents who have more personal and social resources to draw on should experience fewer internalizing symptoms.
The literature suggests that sexually abused adolescent boys and girls may not differ on internalizing behavior. Accordingly, we predict no difference between boy and girls on internalizing behavior. If we find that girls are more likely to have internalizing behavior symptoms in the clinical range, then this difference will disappear after we account for characteristics of the sexual abuse, physical abuse, and exposure to domestic violence. Moreover, based on Connell and Wellborn's theory, we predict that adolescents who are supported in their choices by caregivers, feel connected to other people and who perceive themselves as effective in their daily lives will be less likely to internalize their abuse.
Section snippets
Participants
Data from the National Survey on Child and Adolescent Well-Being (NSCAW)—a national probability sample of children and their caregivers investigated by CPS systems in the US—were used to test the study hypotheses for children ages 11–14. The NSCAW was the first national study to provide detailed information about families reported to CPS for alleged physical abuse, neglect or sexual abuse. The NSCAW researchers selected 5501 children, ages 0–14 who were living in the home between October, 1999
Results
Table 2 shows that gender, more intrusive sexual acts, a non-relative abuser, exposure to domestic violence, relatedness, and autonomy support were related to internalizing behavior problems. Twice as many adolescent boys (52%) as girls (24%) were in the clinical range on internalizing behavior [X2(1, N = 155) = 6.75]. Adolescents who experienced more intrusive sexual acts were more likely to have an internalizing behavior problem than adolescents who were fondled alone [X2(1, N = 155) = 13.66]. If
Discussion
We predicted boys and girls would not differ on internalizing behavior, and, if there was a difference, the difference could be accounted for by characteristics of the abuse, multiple victimization, efficacy, relatedness, and autonomy. Not all of these hypotheses were supported. Boys were more likely to be in the clinical range for internalizing behavior than girls in the bivariate analysis, and the effect of gender on internalizing behavior was not altered when other factors were entered into
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This article includes data from the National Survey on Child and Adolescent Well-Being, which was developed under contract with the Administration on Children, Youth, and Families, US Department of Health and Human Services (ACYF/DHHS). Data were provided by the National Data Archive on Child Abuse and Neglect. The information and opinions expressed herein reflect solely the position of the author. Nothing herein should be construed to indicate the support or endorsement of its content by ACYF/DHHS.