Sexual Abuse and Psychopathology in Hospitalized Adolescents

doi:10.1097/00004583-198709000-00023

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 26, Issue 5, September 1987, Pages 753-757

https://doi.org/10.1097/00004583-198709000-00023 Get rights and content

Fifty-four consecutive admissions to an inpatient adolescent psychiatric unit were studied within 2 weeks of hospitalization. Of 54 subjects, 17 acknowledged a history of sexual abuse, intra- or extrafamilial (37.9% of girls, 24% of boys). Although the two groups did not differ in age, IQ, or occurrence of parental death, the sexually-abused group was of lower socioeconomic status and had had higher scores on psychosocial stressors in the past year. These patients had significantly greater severity of depressive symptoms, more hallucinations, had more suicide attempts, and were more likely to be referred for long-term inpatient treatment. Compared with the non-sexually victimized patients, the abused group also showed trends toward more conduct symptoms and more often required neuroleptic medication and longer hospital stays for acute management. The authors emphasize the importance of eliciting a history of sexual abuse from disturbed adolescents in an inpatient unit, especially when severe depressive symptoms are noted.

References (44)

J.M. Carper
Fmergeneies in adolescents: runawaysand father daughter incest
Pediat Clin. N. Amer.
(1979)
A. Green
True and false allegations of sexual abuse in child custody disputes
This Journal
(1986)
P. Krener
After incest: secondary prevention?
This Journal.
(1985)
D. Russell
The incidence and prevalence of intrafamilial and extrafamilial sexual abuse of female children
Child Abuse Negl.
(1983)
G.E. Wyatt et al.
Methodological considerations in research on the prevalence of child sexual abuse
Child Abuse Negl.
(1986)
A. Yorukoglu et al.
Children not severely damaged by incest with a parent
This Journal.
(1966)
C. Adams-Tucker
Proximate effects of sexual abuse in childhood: a report of 28 children
Amer. J. Psychiat.
(1982)
Anderson, C. S., Bach, M. C. & Griffith, S. (1981, April), Psychosocial sequelae in intrafamihal victims of sexual...
Badgley, R. F. (1984), Sexual offences against children in Canada: summary Report of the Committee on Sexual Offences...
C. Bagley et al.
Adult mental health sequels of child sexual abuse. physical abuse and neglect in maternally-sepa-rated children
Canad J. Comm Hlth.
(1984)

L. Bender et al.

The reaction of children to sexual relations with adults

Amer. J. Orthopsychiat.

(1937)

L. Bender et al.

A follow-up report on children who had atypical sexual experiences

Amer. J. Orthopsychiat.

(1952)

J. Bigras et al.

Endeca et au dela de Finceste chez l'adolescente

Rev. Assoc. Psychiat. Canad.

(1966)

B.R. Blishen et al.

Revised socio-economic index for occupations in Canada

Canad. Rev. Soc. Anthrop.

(1976)

A. Browne et al.

Impact of child sexual abuse. a review of the research

Psychol. Bull.

(1986)

Costello, A. J., Edelbrock, C. S., Dulean, M. K., Kalas, R. & Klarie, S. H. (1984), Report on the NIMH Diagnostic...

C. Edelbrock et al.

Age differences in the reliability of the psychiatrie interview of the child

Child Develpm.

(1985)

C. Edelbrock et al.

Parent-child agreement on child psychiatric symptoms assessed via structured interview

J. Child Psychiat. Psychol.

(1986)

N. Ellerstein et al.

Sexual abuse of boys

Amer. J. Dis Child.

(1980)

G.J. Emslie et al.

Incest reported by children and adolescents hospitalized for severe psychiatric problems

Amer. J. Psychiat.

(1983)

K.C. Finkel

Sexual abuse of children in Canada

Canad. Med. Assoc. J.

(1984)

D. Finkelhor

Sexually Victimized Children

(1979)

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The relationship between self-reported childhood adversities, adulthood psychopathology and psychological stress markers in patients with schizophrenia
2017, Comprehensive Psychiatry
Citation Excerpt :
Some studies have shown that patients with schizophrenia and a history of childhood adversities are more likely to have poorer functional outcomes [22] and a more severe course of illness [3,16,23–25] than patients with schizophrenia and no history of childhood adversities. When investigating a possible specific effect of type of adversity, some researchers find a strong association between CPA or CSA and auditory hallucinations (AH) [10,15,23,26,27]. In contrast, while both Varese et al. [7] and Trauelsen et al. [12] concluded that childhood adversities clearly increase the risk of psychosis, there was no evidence that any specific type of trauma is a stronger predictor of psychosis than any other [7,12].
Childhood adversity is a well-established risk factor for the development of schizophrenia. In particular, there is evidence that childhood adversity increases the occurrence of positive symptoms, possibly through glucocorticoid influences on dopaminergic neurotransmission.
To compare levels of childhood trauma in schizophrenia patients vs. healthy control persons, and to study the association between childhood adversity and the symptomatology of adulthood schizophrenia, as well as subjective and biological markers of psychological stress.
Thirty-seven patients fulfilling ICD-10 criteria for schizophrenia and 39 healthy control persons filled out the comprehensive Childhood Abuse and Trauma Scale (CATS). Data were analyzed after a data-driven dichotomization into two groups of either high or low CATS score in patients and controls, respectively. The psychopathology of the patients was measured by the Positive and Negative Syndrome Scale (PANSS) and analyzed by a five-factor PANSS model. Measures of perceived stress (Perceived Stress Scale) and hypothalamic-pituitary-adrenal (HPA)-axis activity (9 AM plasma cortisol and daytime salivary cortisol output) were recorded.
As expected, patients had significantly higher total CATS scores than the control persons (>3-fold, P < 0.001), reflecting significantly higher scores across all subscales of the CATS. In patients, the total PANSS score did not significantly differ between the high and the low CATS score group (P = 0.2). However, there was a statistically significant higher level of positive symptoms in the high CATS group (P = 0.014), and no difference in other psychopathological domains. Correspondingly, when using the CATS score as a continuous variable, a strong association with positive PANSS scores was found (P = 0.009). The high CATS score group showed higher levels of perceived stress (P = 0.02), but there was no difference between the high vs. low CATS group in HPA-axis activity.
Although causal inferences cannot be made from this cross-sectional study, the study adds support to the suggestion that childhood adversity specifically increases the occurrence of positive symptoms in adulthood schizophrenia in a manner that appears to leave HPA-axis activity unaltered.
Prevalence and impact of childhood abuse in people with a psychotic illness. Data from the second Australian national survey of psychosis
2014, Schizophrenia Research
Citation Excerpt :
A history of child abuse has also been associated with greater likelihood of positive symptoms (Ross et al., 1994), particularly hallucinations (Janssen et al., 2004) in people with psychosis. The association appears strongest between physical or sexual abuse and auditory hallucinations (Sansonnet-Hayden et al., 1987; Heins et al., 1990; Read and Argyle, 1999; Read et al., 2003). This association has also been reported in individuals with bipolar affective disorder (Hammersley et al., 2003).
Child abuse has been associated with risk of mental illness, including schizophrenia and other psychotic disorders and, among those with mental illness, with a more severe clinical profile. Using an extensively characterised and epidemiologically representative sample of 1825 Australians with a psychotic illness aged 18–64 years and in contact with mental health services, we estimated the proportion of individuals with psychotic disorders who self-reported child abuse and examined its relationship with clinical and other characteristics. The prevalence of child abuse in this nationally representative sample of people with psychotic illness was 30.6%. Women were almost three times more likely to report child abuse compared to males (OR, 2.8, 95% CI 2.3–3.4). When adjusted for age at interview and socio-economic status, there was no significant relationship between self-reported child abuse and type of psychosis or course of illness. Participants with child abuse were significantly more likely to have subjective thought disorder, lifetime suicide attempt and premorbid personality disorder (females only) and anxiety (males only). Our findings demonstrate that child abuse is relatively common across the range of psychotic disorders, with an elevated risk for women in particular, compounding the already high burden associated with psychotic illness. Clinicians need to inquire routinely about child abuse in order to develop appropriate treatment plans tailored to individual needs.
The association of child abuse and neglect with adult disability in schizophrenia and the prominent role of physical neglect
2009, Child Abuse and Neglect
Citation Excerpt :
A recent review reported a large number of studies showing an association between childhood trauma and adulthood hallucinations (Read et al., 2005). Only one study revealed a strong association of child abuse with both delusions and hallucinations (Janssen et al., 2004), in contrast to several other studies which failed to reveal this association (Famularo, Kinscherff, & Fenton, 1990; Read, Agar, Argyle, & Aderhold, 2003; Sansonnet-Hayden, Haley, Marriage, & Fine, 1987). While the majority of the studies addressed the association of early trauma and adult psychosis with different psychiatric disorders, for example bipolar disorder (Hammersley et al., 2003), few studies addressed specific effects in schizophrenia (Read, Goodman, Morrison, Ross, & Aderhold, 2004), and very few addressed the effect of childhood trauma (mostly sexual abuse) over psychosocial functional outcomes, such as impairment and disability (Lysaker, Beattie, Strasburger, & Davis, 2005; Lysaker, Meyer, Evans, Clements, & Marks, 2001; Lysaker, Nees, Lancaster, & Davis, 2004).
To assess long-lasting effects of childhood trauma on the functional outcome of adult patients diagnosed with schizophrenia.
Ninety-nine stable patients with schizophrenia followed in an outpatient program at a public university hospital in Porto Alegre, southern Brazil, were investigated for childhood traumatic experiences by the Childhood Trauma Questionnaire (CTQ) and for functional impairment by the World Health Organization Disability Assessment Schedule (WHO/DAS). The schizophrenia diagnosis was assessed by ICD-10 and DSM-IV criteria according to the Operational Criteria Checklist for Psychotic Illness (OPCRIT).
Childhood trauma in general was associated with increased disability in adulthood, reflected by impaired Overall Behavior (p = .023) and Global Evaluation (p = .032). Analysis of specific traumatic domains revealed that increased childhood physical neglect was associated with functional impairment in Overall Behavior (p < .000), Social Role Performance (p = .037) and Global Evaluation (p = .014). Higher emotional abuse was associated with impaired Overall Behavior (p = .026), and higher emotional neglect with poor Global Evaluation (p = .047). Additionally, earlier onset of illness was associated with lower level of functioning evidenced by impairment in Overall Behavior (p = .042). Linear regression using WHO/DAS sections (Overall Behavior, Social Role Performance and Global Evaluation) as dependent variables and CTQ subscales indicated that only physical neglect had an effect on adult functionality.
Childhood trauma was associated with functional and social impairment in adult patients with schizophrenia. Specific types of abuse and neglect, such as physical neglect and emotional abuse and neglect, influenced disability, and the most robust association was physical neglect. Studies involving more patients, with normal controls and additional measurements of biological liability, should be conducted to confirm this association and to increase the understanding of gene-environment relationship in schizophrenia and pathways to disability.
Further investigation is warranted to clarify the association between childhood trauma and disability in schizophrenia, as well as to develop standardized instruments for the assessment of trauma and earlier detection of risk along with education of patients and families about adequate care, in an effort to reduce the incidence of disability in schizophrenia.
Child sexual abuse consequences in community samples of Latino and European American adolescents
2009, Child Abuse and Neglect
Citation Excerpt :
Romantic relationships and the ability to form satisfying friendships are also negatively impacted by the shame and self-blame associated with CSA (Feirling, Rosenthal, & Taska, 2000). Further, behaviors such as truancy, running away, chemical abuse, and sexual aggression have been associated with sexual abuse, as well as early and more frequent sexual activity and promiscuity, sexual aversion, and social isolation (Browning & Laumann, 1997; Downs, 1993; Gomes-Schwartz, Horowitz, & Sauzier, 1985; Kisiel & Lyons, 2001; Runtz & Briere, 1986; Sansonnet-Hayden, Haley, Marriage, & Fine, 1987). However, researchers have also noted that some CSA victims report little or no effects (Rind, Tromovitch, & Bauserman, 1998; Sanford, 1990; Waterman & Kelly, 1993).
Research investigating the impact of child sexual abuse (CSA) in community samples of adolescents has been limited. This study aims to identify sexual abuse among ethnically diverse high school adolescents of both genders and evaluate their psycho-emotional consequences.
Through the use of self-report instruments, a sample of 223 Latino and European American 16–19-year-old high school students were identified as either victims of CSA or as nonabused. The emotional impact of sexual abuse was also investigated among these ethnically diverse adolescent males and females.
Initial findings revealed that those adolescents who gave inconsistent responses to CSA assessments questions were much more similar in patterns of psychological distress to CSA victims compared to nonabused teenagers. Prevalence analyses revealed that females (45%) were nearly two times more likely to report CSA than males (24%). Latinos (44%) were significantly more likely to experience CSA compared to European Americans (27%), and Latinas (54%) had the highest prevalence overall. Other findings indicated substantial differences in type of perpetrator. While female victims of CSA identified male perpetrators in 91.9% of cases, male victims of CSA identified female perpetrators in 52.9% of cases. Consistent with past research, sexually abused adolescents reported significantly greater psychological distress than their nonabused peers, regardless of gender or ethnic group. Gender differences emerged with females reporting greater psychological symptoms, but these differences were substantially reduced when CSA was controlled. European Americans reported greater anxious arousal symptoms compared to Latinos.
Our findings suggest that the prevalence of CSA among adolescents is higher than existing research has noted for both males and females and particularly higher for Latinos compared to European Americans. Perpetration by females upon males may also be higher than research has noted. Our findings also revealed many ethnic and gender similarities and fewer differences in the psychological impact and circumstances of sexual abuse in this diverse sample of adolescents.
The high prevalence of CSA among adolescent males and particularly Latinas emphasize the need to intervene on a community level and with parents for both prevention and intervention regarding issues of sexual victimization. The numbers of female perpetrators, especially when boys are the targets of abuse, may be higher than previously imagined and thus must be assessed tactfully and thoroughly. This study found that adolescents who reported CSA inconsistently had similar symptoms as those with confirmed CSA and therefore warrant greater attention and more persistent intervention. When treating victims of CSA, the Trauma Symptom Inventory (TSI) is effective in identifying specific areas of emotional distress to treat in sexually abused ethnically diverse male and female adolescents. Culturally relevant prevention efforts are needed for ethnically diverse children of both genders.
Childhood trauma and auditory verbal hallucinations
2012, Psychological Medicine
Sexual Abuse and Its Impact on Suicidal Ideation and Attempts and Psychiatric Illness in Children and Adolescents With Posttraumatic Stress Disorder
2023, Primary Care Companion for CNS Disorders

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SCIENTIFIC PAPERSSexual Abuse and Psychopathology in Hospitalized Adolescents

Pediat Clin. N. Amer.

This Journal

This Journal.

Child Abuse Negl.

Child Abuse Negl.

This Journal.

Proximate effects of sexual abuse in childhood: a report of 28 children

Amer. J. Psychiat.

Adult mental health sequels of child sexual abuse. physical abuse and neglect in maternally-sepa-rated children

Canad J. Comm Hlth.

The reaction of children to sexual relations with adults

Amer. J. Orthopsychiat.

A follow-up report on children who had atypical sexual experiences

Amer. J. Orthopsychiat.

Endeca et au dela de Finceste chez l'adolescente

Rev. Assoc. Psychiat. Canad.

Revised socio-economic index for occupations in Canada

Canad. Rev. Soc. Anthrop.

Impact of child sexual abuse. a review of the research

Psychol. Bull.

Age differences in the reliability of the psychiatrie interview of the child

Child Develpm.

Parent-child agreement on child psychiatric symptoms assessed via structured interview

J. Child Psychiat. Psychol.

Sexual abuse of boys

Amer. J. Dis Child.

Incest reported by children and adolescents hospitalized for severe psychiatric problems

Amer. J. Psychiat.

Sexual abuse of children in Canada

Canad. Med. Assoc. J.

Sexually Victimized Children

SCIENTIFIC PAPERS
Sexual Abuse and Psychopathology in Hospitalized Adolescents