Penelope Trickett, PhD, is Professor of Social Work and Psychology at the University of Southern California. Frank Putnam, MD, is Professor of Pediatrics and Psychiatry and Director of the Mayerson Center for Safe and Healthy Children at Cincinnati Children's Hospital Medical Center, and Jennie Noll, PhD is Associate Professor in the Division of Behavioral Medicine and Clinical Psychology and the Mayerson Center for Safe and Healthy Children at Cincinnati Children's.
Eighty four females were referred by child protective service agencies within six months after the disclosure of childhood sexual abuse along with 82 non-abused matched comparison females. This relatively large and racially diverse sample was interviewed three times in childhood (approximately once per year for three consecutive years), twice in adolescence, and most recently, when the sample was embarking on the tasks of young-adulthood (i.e., emancipation from parents, formation of identity, romantic partner selection, reproductive decisions, initiation of career, transition to motherhood).
Findings from this longitudinal study have provided some of the most definitive evidence for the unique ways in which childhood sexual abuse impacts on the bio-psych-social development of females across distinct developmental stages. Approximately 40 peer-reviewed journal articles have been generated from this longitudinal study reporting on a host of behavioral, psychological, and physiological effects in both childhood and adolescence.
In general, results from the study show that there are striking differences between sexual abuse victims and girls on a "normal" developmental course when taking into account possible confounds. While there are several identifiers of resilience in the lives of these women, there is also disturbing evidence that survivors of childhood sexual abuse continue to suffer throughout development. This suffering may manifest acutely, in childhood, immediately following the disclosure of abuse, or may emerge or be revisited later in life as developmentally salient issues reminiscent of the abuse surface or resurface.
Analyses done in childhood suggest that sexual abuse victims have lower social competence, lower academic performance, and higher school avoidant behaviors then their peers. Victims are also more depressed, more dissociative, exhibit more sexual acting-out behaviors, and have lower self-esteem. Behavior problems in this period include higher rates of delinquency, immaturity, and aggressivity or bullying. Overall there is less family cohesion and a greater level of depression in their own mother (47% of whom report also being sexually abused in childhood!). Sexually abused victims are also less healthy physiologically with higher rates of obesity and evidence for some hormonal disruption.
Later in childhood and in early adolescence, findings not only show that many of these problems persist, but many new problems begin to emerge. There are still higher levels of depression, dissociative symptoms, immaturity, aggressivity, and obesity, but abuse victims at this stage of development are also exhibiting higher PTSD symptoms, lower IQ scores, greater hormonal disruption, and report younger ages of voluntary intercourse than do their same-aged peers. Effects later in adolescence suggest that the types of problems exhibited by sexual abuse victims go beyond those of the simple behavior problems or poor psychological adjustment detected in childhood and become increasingly indicative of patterns of revictimization and disturbed sexuality.
Analyses, based on an impressive retention rate of over 96%, show that abuse victims in this stage exhibit persisting depression and PTSD symptoms, but are now reporting pathological levels of dissociative symptoms. Physiologically, there are still problems with obesity, but victims are also reporting more sleep disturbances, have more gastrointestinal complaints, and poorer overall health and health care utilization. Disturbingly, sexual abuse victims report twice as many subsequent rapes or sexual assaults, almost twice as many physical affronts or domestic violence episodes, four times as many self-harm events or suicide attempts, and over 20% more subsequent significant lifetime traumas as compared to their same-aged peers. Sexual abuse victims also report more sexual preoccupation, lower birth control efficacy, younger ages at the birth of first children, and report having children by different men at a greater rate than their same-age peers. Abused females also reported significantly higher rates of teen pregnancy (39% versus 15%) and teen motherhood (29% versus 4%) than comparison females.
Research on PTSD aims to find the biological, psychological, and environmental factors that appear to play a causal role in the development of the disorder and to understand the ways in which people with PTSD respond differently to events than do people without the disorder. We know that some people who experience a traumatic event develop PTSD while others are able to “put the event behind them.” Therefore, research often compares responses to stimuli that act as trauma reminders in people with and without PTSD. These responses may be brain changes, changes in other biological factors such as levels of particular chemicals in the body, or differences in the ability to perform tasks that require memory or concentration either during or after experiencing a reminder of a trauma.
Even though our knowledge of the causes and the physiological changes that contribute to PTSD is still incomplete, there are treatments available for the disorder and some research looks at the effects of different types of treatment in order to see how effective they are. Such research may compare different drugs, or psychological therapies, and it may also be combined with the research described above in order to help us to better understand how the treatments work. In summary, research on PTSD, like research on other medical conditions, spans a wide range of approaches and techniques. Together, these diverse areas of research will give us a better understanding of the “whole picture” of this disorder.
Ruth Lanius, MD, PhD, FRCPC