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LIBRARY

Mlchigan State
University

 

 

 

 

This is to certify that the

dissertation entitled

AN ATTACHMENT THEORETICAL PERSPECTIVE ON
CHILDHOOD SEXUAL ABUSE AND ADULT
PSYCHOLOGICAL ADJUSTMENT

presented by

Kimberly M. Thomas

has been accepted towards fulfillment
of the requirements for

Ph.D. degree in Counseling Psychology

 

 

16¢an

Major Professor I i ‘

 

Date January 8, 1999

MS U i: an Affirmative Action/Equal Opportunity Institution 0- 12771

PLACE IN REFURN Box to remove this checkout from your record.
TO AVOID FINES return on or before date due.
MAY BE RECALLED with earlier due date if requested.

 

DATE DUE

DATE DUE

DATE DUE

 

"0 {AN 0

 

lafilfi 8% 5
9200
06

 

JAN 04 2008
I .i J i

 

 

 

 

 

 

 

 

 

 

 

 

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AN ATTACHMENT-THEORETICAL PERSPECTIVE ON
CHILDHOOD SEXUAL ABUSE AND ADULT PSYCHOLOGICAL ADJUSTMENT
by
Kimberly Marie Thomas

A DISSERTATION

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

Department of Counseling and Educational Psychology
and Special Education

1999

UMI Number: 9936618

 

UMI Microform 9936618
Copyright 1999, by UMI Company. All rights reserved.

This microform edition is protected against unauthorized
copying under Title 17, United States Code.

 

UMI

300 North Zeeb Road
Ann Arbor, MI 48103

ABSTRACT

AN ATTACHMENT-THEORETICAL PERSPECTIVE ON CHILDHOOD SEXUAL
ABUSE AND ADULT PSYCHOLOGICAL ADJUSTMENT

BY
Kimberly M. Thomas

The present study sought to advance our understanding
of why some survivors of childhood sexual abuse exhibit
severe psychological symptoms in adulthood, while others
remain relatively symptom-free. Using attachment theory as
the theoretical framework, the following three groups of
survivors were compared: 1) women abused by primary
caregivers (i.e., father, mother, step-parent), 2) women
abused by other family members (i.e., uncle, brother,
grandparent), and 3) women abused by non—family perpetrators
(i.e., neighbor, babysitter, stranger). The groups were
compared on a number of variables, including severity of
abuse, parent-child emotional bonds, adult attachment
orientations, and current psychosocial adjustment. Results
indicate that women abused by a primary caregiver reported
experiencing a more severe history of abuse and the weakest
emotional bonds with caregivers, as compared to their
counterparts. In addition, findings suggest that adult
attachment orientations differ among groups and mediate the
relationship between abuse and psychological adjustment in

adulthood.

ACKNOWLEDGMENTS

Several people have contributed greatly to the
development and completion of this project. Above all else,
I want to thank my advisor and committee chair, Frederick
Lopez, Ph.D., for providing me with years of invaluable
support and guidance. The amount of time and energy he has
devoted not only toward this project, but also toward my
training and development as a professional in this field is
extraordinary; I will be eternally grateful.

I would also like to thank my other committee members,
Ken Rice, Ph.D., Ellen Strommen, Ph.D., Ann Flescher, ACSW,
and Ruth Worthington, D.O., for their statistical expertise,
conceptual guidance, theoretical knowledge, and
encouragement along the way. Given the diversity of
disciplines, each member offered something unique and
valuable to this process for me.

Finally, I would like to thank my friends and family
for their continued support. Completing this process would
not have been possible without the encouragement of my
parents, brother, and cohort. My friendships with Karyn
Boatwright, Eric Sauer, Judy Ferris, and Jim Wyssmann, in
particular, have been essential to my life and to completing

this process.

iii

TABLE OF CONTENTS

LIST OF TABLES ............................................ iv
CHAPTER I: INTRODUCTION .................................... 1
Problem Statement .......................................... 7
CHAPTER II: REVIEW OF THE LITERATURE ...................... 9
Definition of Childhood Sexual Abuse ...................... 10
The Effects of Childhood Sexual Abuse ..................... 10
Short and Long-Term Effects of Sexual Abuse .......... 11
Victims of Sexual Abuse with No Symptoms ............. 12
Applying Theory to the Study of Sexual Abuse .............. 13
Attachment Theory and Research ............................ 14
Internal Working Models...L .......................... 14
Patterns of Attachment in Infancy/Childhood .......... 15
Patterns of Attachment in Adulthood .................. 18
Characteristics of Childhood Sexual Abuse ................. 20
Characteristics of Sexually Abusive Families .............. 22
How Family Functioning Influences Adjustment ......... 24
Quality of Parent-Child Bonds ............................. 27
Attachment and Childhood Maltreatment ..................... 29
Attachment Measured in Child Samples ................. 30
Attachment Measured in Adult Samples ................. 32
CHAPTER III: PROBLEM STATEMENT ........................... 44
CHAPTER IV: METHOD ....................................... 47
Definition of Childhood Sexual Abuse ...................... 47
Childhood Sexual Abuse (CSA) Groups ....................... 47
Participants .............................................. 48
Procedures ................................................ 49
Instruments ............................................... 51
Demographic and History of Sexual Abuse
Questionnaire ........................................ 51
Parental Bonding Instrument .......................... 52
Relationship Questionnaire ........................... 53
Adult Attachment Index ............................... 54
Brief Symptom Inventory .............................. 55
Hypotheses ................................................ 56
Analyses .................................................. 57
CHAPTER V: RESULTS ....................................... 61
Preliminary Analyses ...................................... 61
Sample Descriptives: Demographic and Abuse
Variables ........................................... 61
Correlational Analysis ............................... 64
CSA Groups: Preliminary Comparative Analysis ......... 66

iv

Construction of a Composite Severity Index ................ 72

Analysis of CSA Groups and Psychological Adjustment ....... 76
Analysis of CSA Groups and Attachment Measures ............ 77
Family Bonds ......................................... 78
Adult Attachment Orientations ........................ 79
Attachment Style Classifications ..................... 81
Summary .............................................. 81
Regression Analyses ....................................... 83

Contributions of Abuse Severity, Parental Bonds,
and Adult Attachment Orientations to Psychological

Adjustment ........................................... 83
Mediational Analysis ................................. 87
Post-Hoc Analyses ......................................... 9O
Symptomatology Scores Across Groups .................. 90
The Impact of Additional Social Support .............. 93
CHAPTER VI: DISCUSSION .................................... 96
Overview of Findings ...................................... 96
Severity of Abuse .................................... 97
Early Emotional Bonds with Parents ................... 99
Symptomatology Reported in Adulthood ................ 104
Adult Attachment Orientations ....................... 109
The Prediction of Survivors' Psychological
Adjustment .......................................... 114
Major Contributions of the Current Study ................. 118
Classifying Survivors into Three Groups ............. 118
The Contribution of a Composite Severity Index ...... 119
Limitations of the Study ................................. 121
Clinical Implications for Counseling Psychology .......... 123
Applying Findings to the Therapy Relationship ....... 125
Conclusions and Directions for Future Research ........... 126
APPENDICES ............................................... 131
REFERENCES ............................................... 145

LIST OF TABLES

Table 1: Intercorrelations of abuse severity
characteristics, PBI care and overprotection scales,
Simpson adult attachment scales, and total BSI scores ..... 65

Table 2: Means, standard deviations, and ANOVA (F-test)
analyses for abuse characteristics among three groups of
survivors ................................................. 68

Table 3: Between group frequencies in reporting childhood
physical abuse, emotional abuse, and/or neglect ........... 71

Table 4: Between group frequencies in reporting therapy
experience and means and standard deviations of number of
sessions attended ......................................... 73

Table 5: Factor analysis of demographic variables
assessing abuse severity .................................. 75

Table 6: Abuse group means and standard deviations of
scores on the Parental Bonding Inventory (PBI) and
Simpson’s Adult Attachment subscales ...................... 80

Table 7: NUmber of participants endorsing secure,
dismissive, preoccupied or fearful style of attachment....82

Table 8: Summary of hierarchical regression analysis of
severity and care variables in predicting BSI scores ...... 84

Table 9: Summary of hierarchical regression analysis of
severity, care, severity X care interactions, and adult
attachment anxiety and avoidance scores in predicting BSI
scores .................................................... 86

Table 10: Summary of regression analyses of the role of
adult attachment orientations in mediating the relations
between childhood sexual abuse and psychological

adjustment ............................................. 88-89

Table 11: Post hoc analysis: Between groups means and
standard deviations on nine BSI symptom subscales ......... 92

vi

INTRODUCTION

Researchers have estimated the incidence of childhood
sexual abuse to be alarmingly high. Prevalence rates for
sexual abuse occurring to a child before the age of 18 range
from 6% to 62% for females and 3% to 31% for males,
depending on the population studied and the definition of
child sexual abuse used (Peters, Wyatt, & Finkelhor, 1986;
Wyatt & Peters, 1986a; 1986b; Wyatt, 1985). According to
Finkelhor (1979), among the general population, as many as
one out of three girls, and one out of six boys, are thought
to experience some form of unwanted sexual contact before
the age of 18.

In the last decade considerable research on the long-
term impact of childhood sexual abuse has been published.
Thusfar, much of the research has focused on the experience
of abuse to female victims, however, research on male
victims is increasing. Results suggest that victims of
abuse frequently display serious psychological symptoms and
diagnoses in adulthood. Specifically, adult female
survivors tend to report higher rates of depression,
anxiety, post-traumatic stress disorder, borderline
personality disorder, low self-esteem, substance abuse,
sexual maladjustment, revictimization, feelings of
powerlessness, relationship difficulties, eating disorders,

and suicidality, as compared to non-abused women (Braver,

Bumberry, Green, & Rawson, 1992; Browne & Finkelhor, 1986;
Briere & Runtz, 1988; Green, 1993; Kinzl & Biebl, 1992;
Mallinckrodt, McCreary, & Robertson, 1995; Paris, Zweig—
Frank, & Guzder, 1994; Russell, 1986).

This literature indicates that a history of sexual
abuse is often associated with serious long-term sequelae;
however, it also demonstrates that a significant minority of
individuals (20-40%) exhibits normal adult functioning
and/or no symptomatology at the time of assessment, despite
the experience of childhood sexual abuse (Finkelhor, 1990;
Kendall-Tackett, Williams, & Finkelhor, 1993). According to
Finkelhor (1990), "almost every study of the impact of
sexual abuse has found a substantial group of victims with
little or no symptomatology" (p. 327). Thus, in the long-
run, it appears that some individuals are less affected
overall by the experience of childhood sexual victimization
than are others.

Speculations about why these individuals remain
symptom-free or are able to adjust adequately to sexual
trauma are numerous. The explanation which has received the
most empirical support, however, is that asymptomatic or
resilient individuals are more likely than maladjusted
survivors to have been abused for a shorter period of time,
by someone other than a primary caregiver, and without force
or penetration (Browne & Finkelhor, 1986; Finkelhor, 1990;

Kendall-Tackett et al., 1993). In addition, asymptomatic or

adjusted individuals tend to have received more support from
family members and/or to have lived in healthier family
environments than symptomatic victims (Browne & Finkelhor,
1986; Fromuth, 1986; Harter, Alexander, & Neimeyer, 1988;
Wyatt & Mickey, 1987). Therefore, past research has found
that both characteristics of abuse and characteristics of
the victim's family are related to the impact of abuse.

Attempts to identify which factors best explain the
variation in symptoms reported by survivors are numerous and
consistent. Based on the findings, researchers have
declared the family environment of the victim to be a better
predictor of later adjustment than the abuse itself.
Findings specifically indicate that the occurrence of sexual
abuse is only minimally related to later psychosocial
adjustment. Family variables, on the contrary, are
significantly related to adjustment and explain more
variance in survivor functioning than any other assessed
predictor (Conte & Schuerman, 1987; Everson, Hunter, Runyon,
Edelsohn, & Coulter, 1989; Friedrich, Urquiza, & Beilke,
1986; Fromuth, 1986; Harter et al., 1988). Consequently,
researchers have concluded that family variables may mediate
the relationship between sexual abuse and future adjustment,
and therefore, may potentially mitigate or nullify the
harmful effects of abuse (Alexander, 1992; Brock, Mintz, &
Good, 1997; Fromuth, 1986; Harter et al., 1988).

Regardless of whether a victim is sexually abused by a

family member (intra-familial abuse) or a non—relative
(extra-familial abuse), studies indicate that families of
victims are frequently rated as more dysfunctional than
families of non-abused individuals (Long & Jackson, 1991;
Mian, Marton, LeBaron, & Birtwistle, 1994; Ray, Jackson, &
Townsley, 1991). Consequently, it has been suggested that
family dysfunction or disruption (1) increases a child’s
risk for sexual victimization, (2) follows the disclosure of
sexual abuse, and (3) interferes with a victim’s ability to
cope and heal from sexual trauma (Alexander, 1992; Finkelhor
& Baron, 1986). Regardless of whether family dysfunction
precedes or follows the occurrence of sexual abuse, studies
indicate that many families are unable to function as a
source of support to the victim (Everson et al., 1989;
Herman, 1981; Wyatt & Mickey, 1988). This is especially
true of incestual families, whereby some of the victim’s
closest social supports are the cause of her/his distress
(Cole & Putnam, 1992).

The current study continues to explore the relationship
between family characteristics and victim adjustment in
adulthood, with a specific focus on the victim's early
emotional bonds with parents and current adult attachment
orientations. Attachment theorists have predicted that a
secure bond between a child and his/her caregiver(s) may
serve to protect the child from serious maladjustment.

Specifically, Bowlby (1988) asserted that children raised in

favorable conditions are expected to follow a path of
normal, healthy, and resilient development, while children
born into unfavorable conditions (e.g., sexually abusive
family environment) may deviate toward a more disturbed or
vulnerable path of development.

In the case of a sexually abused child, access to a
meaningful attachment relationship may allow him/her to work
through sexual trauma, escaping severe pathology in the
long-run (Bowlby, 1988; Fonagy, Steele, Steele, Leigh,
Kennedy, Mattoon, & Target, 1995). The outcome is expected
to be more harmful, however, for victims without access to a
secure emotional base or supportive attachments. Such is
the case for many victims, particularly victims of incest or
those abused by trusted caregivers. Mallinckrodt et al.
(1995) found adult incest survivors reported poorer early
bonds with caregivers and more current symptomatology than
did either non-abused women or participants with a history
of extra-familial childhood sexual abuse.

The current study also examines the relationship
between survivors' current adult attachment orientations and
present psychosocial functioning. Bowlby (1973) argued that
attachment patterns formed in childhood tend to persist into
adulthood, remaining relatively stable over time. More
recently, however, Bowlby (1988) also acknowledged that
significant life experiences, positive or negative, can

potentially lead to modifications in an individual’s

attachment orientation. In support of this, several
researchers have found current circumstances or
relationships to play a more significant role in adult
functioning than early experiences (Carnelley, Pietromonaco,
& Jaffe, 1994; Lopez, 1996; Parker, Barrett, & Hickie,
1992). Consequently, rather than focusing solely on the
predictive value of childhood bonds, it seems propitious to
consider the influence of both early and current attachment
orientations on adult functioning in this population.

Given the high prevalence of child sexual abuse and the
risk of ensuing psychological distress, this field of study
deserves significant attention. Yet research in this area
has just recently begun to flourish and continues to lag
behind other research domains in terms of conceptual and
methodological sophistication (Briere, 1992; Buetler & Hill,
1992). To date, research on childhood sexual abuse has been
tuimarily atheoretical and descriptive. This is expected
given the recency of scientific interest in this domain;
however, Briere (1992) argues that "it is time for the
second wave" of sexual abuse research (p. 202).

Specifically, there is demand for theory-driven research,
(finch employs more advanced methodological and design
gnocedures (Briere, 1992).

Researchers continue to debate over which theoretical

iiamework offers the best conceptualization of sexual abuse

amiits consequences. Some experts argue for the

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application of a developmental theoretical perspective (Cole
& Putnam, 1992; Kendall-Tackett et al., 1993), while others
argue for theory which also considers the family context
(Alexander, 1992). Attachment theory, developed by John
Bowlby (1973), addresses both familial and developmental
issues, and therefore has recently served as a powerful
theoretical base for conducting abuse research. Few
empirical studies, however, have applied this theory to the
study of childhood sexual abuse specifically.

Problem Statement

Research has demonstrated that the long-term effects of
sexual abuse are best measured on a continuum, ranging from
udnimal symptomatology to severe psychopathology. The fact
that not all victims suffer serious consequences, and that
this population tends not to exhibit a unique set of
snmptoms, suggests that factors other than the abuse play a
role in later adjustment and functioning (Alexander, 1992).
This study sought to advance our understanding of why some
individuals are able to escape the harmful effects of
dfildhood sexual abuse, while others are not.

It was proposed that early emotional bonds and ensuing
adult attachment orientations would mediate the relationship
between sexual abuse and long-term adjustment. Thus, a
lmmlthy emotional bond between the victim and a caregiver
mmvbr secure adult attachment orientations should serve to

Emotect the victim from the potential long—lasting effects

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of childhood sexual trauma. More generally, this study also
explored the relationships between childhood sexual abuse,
parent-child bonds, adult attachment, and current
psychological adjustment within a sample of sexually abused
participants. Based on prior research findings and the
tenets of attachment theory, survivors were divided into the
following three groups and compared: 1) women abused by
primary caregivers (i.e., father, mother, step-parent), 2)
women abused by other family members (i.e., uncle, brother,
grandparent), and 3) women abused by non-family members
(i.e., neighbor, babysitter, stranger).

In conclusion, the specific purposes of the present
study were to a) extend attachment theory to the study of
childhood sexual abuse, b) to examine the attachment
characteristics of adult survivors of sexual abuse, c) to
compare three groups of survivors’ of childhood sexual abuse
(i.e., women abused by primary-caregivers, other family
members, or non-family members) on the following variables:
severity of abuse, parent-child emotional bonds, adult
attachment orientations, and current psychosocial
adjustment, and d) to examine the respective contributions
cm parent-child emotional bonds and adult attachment

cuientations to current psychological adjustment.

REVIEW OF THE LITERATURE

Childhood sexual abuse is occurring at a significant
rate. Current prevalence rates for sexual abuse occurring
to a child before the age of 18 range from 6% to 62% for
females and from 3% to 31% for males (Peters, Wyatt, &
Finkelhor, 1986; Wyatt & Peters, 1986a; 1986b; Wyatt, 1985).
The rates tend to vary significantly from study to study
depending on the population under investigation and the
definition of childhood sexual abuse used (Briere, 1992;
Wyatt & Peters, 1986a; 1986b).

Among the general population, Finkelhor (1979) contends
that as many as one out of three girls, and one out of six
boys, are sexually abused before the age of eighteen.
Stinson and Hendrick (1992) estimate that 30-40% of women
who seek services at university counseling centers have
experienced some form of sexual abuse during childhood or
adolescence. Furthermore, among adult female psychiatric
populations, the prevalence of sexual abuse is reported to
be as high as 50% or more (Bryer, Nelson, Miller, & Krol,
1987).

The definition of "childhood sexual abuse" employed by
researchers also affects prevalence rates (Briere, 1992;
Wyatt & Peters, 1986a; 1986b). While some researchers have
usedIaIbroad definition (i.e., any unwanted sexual

emperience before the age of 18), others have defined this

type of abuse more conservatively (i.e., sexual contact
between family members; genital contact before the age of 14
with someone at least 5 years older). Obviously, the
broader the definition used, the higher the incidence rate
of sexual abuse reported (Briere, 1992).
Definition of Childhood Sexual Abuse

Experts have not agreed upon a standard definition of
"childhood sexual abuse;" therefore, this construct has been
defined in a variety of ways across studies. A myriad of
factors are associated with the experience of sexual abuse
making it difficult to establish boundaries around this
construct. Variables such as (1) the type/nature of abuse
(i.e., exhibitionism to intercourse), (2) the duration and
frequency of abuse, (3) the age of the victim at the time of
abuse, (4) the relationship between the victim and
perpetrator, and (5) whether or not force/aggression was
need are considered to be important to the definition and
measurement of childhood sexual abuse (Browne & Finkelhor,
1986; Courtois, 1988). In order to capture the experience
cfi'sexual victimization in its entirety, all of these
variables must be assessed.

The Effects of Childhood Sexual Abuse

Studies describing the initial and long-term effects of
dfildhood sexual abuse have recently been reviewed (Browne &
Rhmelhor, 1986; Green, 1993; Kendall-Tackett et al., 1993).

Ifindings indicate that samples with a history of sexual

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abuse frequently display more symptoms, more
psychopathology, and lower functioning than non-abused
samples. It is important to note, however, that there is no
unique set of symptoms associated with the experience of
sexual abuse. Survivors display a variety of symptoms, with
a wide range of severity. Moreover, some victims (between
20-40%) have shown no symptoms or harmful effects at the
time of assessment (Caffaro-Rouget, Lang, & vanSanten, 1989;
Conte & Schuerman, 1987). Therefore, the effects of sexual
abuse are best measured on a continuum, ranging from no
symptomatology to severe psychopathology (Browne &
Finkelhor, 1986; Courtois, 1988).
Shgrt- and Long-Term Effects of Sexual Abuse

Children who have experienced sexual abuse frequently
display more anxiety, fear, post-traumatic stress disorder,
depression, somatic complaints, aggression, delinquent
behavior, sexualized behavior, school problems, withdrawn
behavior, and self-destructive behavior, as compared to non-
abused children (Kendall-Tackett et al., 1993). In
addition, adults with a history of childhood sexual abuse
tend to report higher rates of depression, anxiety, fear,
anger, guilt, substance abuse, eating disorders, sexual
disinterest and dissatisfaction, low self-esteem,
relationship difficulties, borderline and multiple
Fmrsonality disorders, somatoform disorders, post-traumatic

smress disorder, phobias, panic disorder, and suicidality in

11

 

adulthood (Briere & Runtz, 1988; Browne & Finkelhor, 1986;
Bryer, et al., 1987; Kinzl & Biebl, 1992; Mallinckrodt et
al., 1995; Russell, 1988). The present study will continue
to examine the long-term impact of childhood sexual abuse,
focusing solely on adult women with a history of this type
of abuse.

Although this area of research indicates that a history
of sexual abuse is often associated with serious long-term
sequelae, this same line of inquiry also demonstrates that
some victims display no symptoms or relatively few symptoms
at the time of assessment. According to Finkelhor (1990),
"almost every study of the impact of sexual abuse has found
a substantial group of victims with little or no
symptomatology" (p. 327).

\Hctims of Sexual Abuse With No Symptoms

Studies have shown that an average of 20-40% of victims
terticipating in research are symptom free at the time of
assessment. Explanations for this phenomenon have been
cmfered. Some authors argue that asymptomatic individuals
sue more likely to have experienced less trauma or less
severe abuse than maladjusted victims (Finkelhor, 1990;
Kendall-Tackett et al., 1993). Other researchers contend
that asymptomatic individuals received more support from
cmhers and/or possess more psychological and social
resources to cope with the abuse, as compared to symptomatic

Persons (Fromuth, 1986; Harter et al., 1988; Kendall-Tackett

12

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et al., 1993; Wyatt & Mickey, 1987). Research regarding the

impact of abuse will be explored throughout this paper with

a specific focus on adult survivors and the variables which

significantly influence their adjustment.
Applying Theory to the Study of Sexual Abuse

A major limitation with current sexual abuse literature

is that much of it is atheoretical. Researchers continue to

debate which theoretical framework offers the most accurate
1990).

 

conceptualization of sexual abuse (Finkelhor,
Alexander (1992) argued for the application of attachment

theory, suggesting that it may explain the occurrence of

sexual abuse, as well as help to predict the short- and

long-term consequences of abuse. In this theoretical

article, she specifically hypothesized that incest is

.preceded by insecure parent-child attachments and that the

.1ongeterm effects of sexual abuse are mediated by early

attachment experiences.

In keeping with Alexander's proposal, the present study
Eflftends attachment theory to the study of childhood sexual

abuse. To date, few researchers have applied this theory

Speeifically to the study of sexual abuse; however, numerous
empirical studies have found attachment theory to be
Valuable in understanding the effects of other types of

childhood maltreatment, particularly physical abuse and

neSilect. In the following paragraphs, a brief review of the

main tenets of attachment theory and research regarding

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parent-child relationships and adult romantic relationships

will be presented.
Attachment Theory and Research

According to Bowlby (1973; 1977), human beings are
innately programmed to seek and form attachments to others.

The attachment process starts at birth and serves an

evolutionary purpose. In order to survive, infants depend

on caregivers to meet their basic needs, to provide them

Children also yearn to

 

with security, safety, and support.

explore the world around them, to gain mastery and autonomy.

Therefore, if encouraged by parents, children will engage in

exploratory behavior, as well as seek proximity to

caregivers, throughout childhood and adolescence.

Caregivers may respond adequately or inadequately to an

infant’s needs, which subsequently affects the quality of

tine attachment bonds. Responsive, nurturant and sensitive

ENarental care provides the child with a sense of felt
Children who receive this type of

security and comfort.

Cfiire usually form "secure" attachments to parents. On the

CHDntrary, inconsistent, unresponsive or neglectful care
hinders the attachment process, leading children to form

"idnsecure" attachments to parents (Ainsworth, Blehar,

Walters, & Wall, 1978) .

lgfllaernal Working Models

An important aspect of Bowlby’s theory is his concept

of the "internal working model" (Bowlby, 1973). Based on

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early attachment experiences, children form cognitive and
emotional expectations about their own self worth (self

model) and the accessibility or responsiveness of others

(other model). Bowlby proposed that these mental models of

"self" and "other" consequently organize and guide a child’s

internal thoughts, interpersonal behaviors, and social

experiences throughout life.

In general, if the primary caregiver is available and

responsive to the child’s needs, the child will internalize

a basic view of others as trustworthy and dependable and a

view of self as worthy of love and attention. On the

contrary, if the primary caregiver is unavailable, rejecting

or inconsistent, the child may internalize a view of others

as undependable and untrustworthy and/or a view of self as

unlovable. It has been proposed that these internal working

mumdels form gradually throughout infancy and childhood and

tend to persist into adulthood (Bowlby, 1977) .

Patterns of Attachment in Infanc Childhood

In order to measure infant-mother attachment bonds,

Ainsworth developed the "Strange Situation" observational
mEthodology whereby the infant’s emotional and behavioral
reaetions were recorded during the following situations: (1)
mother and child are separated and reunited, (2) child is
e3(posed to a strange adult figure, and (3) child is left

a1One briefly with no one else present. Through these

Controlledobservations, Ainsworth et al. (1978) were able

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to identify three principal styles of attachment: secure,

anxious-avoidant, and anxious-ambivalent. Other researchers

have replicated the original study and have identified

similar patterns of attachment between mother and child

(Egeland & Sroufe, 1981; Main, 1990; Matas, Arend, & Sroufe,

1978); however, others have added a fourth category of

attachment, the Type D or disorganized style (Carlson,

Chechetti, Barnett, & Braunwald, 1989; Main & Solomon,

 

1990).
"Secure" infants tend to experience the caregiver as

accessible and responsive and view the self as worthy and

competent. During the Strange Situation, secure infants

engage in exploratory activity with or without the presence

of the caregiver, show minimal distress when left alone or

with.a stranger, and accept mother’s comfort upon reunion.
Bowlby and Ainsworth concluded that secure infants
eXperience the attachment relationship as a "secure base"

flxmn which to gain support during periods of exploration and

emotional distress.

"Anxious-ambivalent" infants, on the other hand,

eerrience the caregiver as inconsistently responsive. The
caregiver who responds to the infant’s needs erratically or
gi‘Ves the infant "conditional" love and attention, forces

tZTLe child to view her/himself as unworthy and others as

L111Predictable or potentially unreliable. During the Strange

Sltuation, ambivalent infants are unable to engage in

16

exploratory behavior without mother’s presence, are

seriously distressed when left alone, and exhibit clingy

behavior upon reunion. In summary, anxious-ambivalent

infants are dependent on mother for comfort and are unable

to manage their emotions in her absence.

"Anxious-avoidant" infants experience the caregiver as

emotionally cold and unavailable. Efforts to solicit the

support and attention of mother are often ignored or

 

rebuffed, promoting a view of others as rejecting. During

the Strange Situation, avoidant infants are uninterested in

mother’s presence or absence, play/explore independently of

her whereabouts, and do not seek proximity to her upon

reunion. Bowlby and Ainsworth concluded that avoidant

children learn to deactivate attachment needs and
consequently adopt compulsive self-sufficient behaviors.
The fourth category of attachment is the "disorganized/

(iisoriented" style. Infants classified as disorganized

Commonly evidence a history of maltreatment or abuse

(<2arlson et al., 1989). Consequently, these infants exhibit

behaviors and emotions marked predominantly by fear and
apprehension, and experience caregivers as threatening
(Eibusing parent) or incompetent (non-abusing parent).
DiAsorganized children possess no coherent coping mechanisms;

rather, they blend contradictory features of all insecure

Strategies. During the Strange Situation, these infants

deanIonstrate slow and incomplete movements, depressed affect,

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and proximity seeking mixed with avoidance.

In conclusion, secure infants are exposed to high—
quality care allowing the infant to form a positive view of
self and other. Subsequently, healthy personality
development is promoted. Anxious-ambivalent, anxious-
avoidant, and disorganized infants, on the contrary, are
exposed to inconsistent, rejecting or abusive parental care
leaving them.particularly vulnerable to undesirable
developmental outcomes.

Patterns of Attachment in Adulthood

Recently, a plethora of studies exploring adult
attachment have been published. Some of these investigators
employ a three category model of attachment (i.e. secure,
ambivalent, & avoidant), however, many have moved to the
four category model developed by Bartholomew and Horowitz
(1991). These researchers have proposed that adult views of

"self" and "other" can be conceptualized dichotomously
(INDSitive or negative), and consequently, adults can be
c=1assified into one of the following four categories:
Secure, dismissive, preoccupied, or fearful.

Secure individuals internalize a positive model of self
and other, allowing them to be comfortable with both
czlJDSeness and separateness in interpersonal relationships.
Dismissive individuals internalize a positive view of self,
but a negative view of others. They prefer greater

lIldependence in relationships and feel uncomfortable with

18

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high levels of intimacy. Preoccupied adults, on the
contrary, internalize a positive view of others, but a

negative view of self. They prefer to maintain close

proximity to their romantic partners and often exhibit
clingy and dependent behavior in order to maintain
closeness. And finally, fearful individuals incorporate a
negative view of both self and other. They exhibit low
mflf-esteem, little trust of others, and a fear of intimacy

in relationships.

Recent research has focused on the application of

attachment theory to the study of adult relationships.

Researchers believe that adult relationships, especially

those involving romantic love, can be conceptualized as an

attachment process similar to the bond between a parent and

child (Hazan & Shaver, 1987). Findings indicate that secure

individuals report higher levels of trust, self-confidence,
arui relationship satisfaction than insecure persons (Collins
5E Read, 1990; Pistole, 1989a; Simpson, 1990). Dismissive

and fearful individuals, in particular, report lower levels

(If trust and intimacy in relationships (Bartholomew, 1990),
While preoccupied individuals report higher levels of
arrXiety in the absence of intimacy (Kobak & Sceery, 1988).
The present study drew heavily from the attachment
literature, as well as from the body of research regarding
Seknal abuse. Three groups of survivors of childhood sexual

ak>11Se were compared on measures of severity of abuse,

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parent-child emotional bonds, adult attachment orientations,
and current psychosocial functioning. Therefore, studies
exploring (1) the relationship between characteristics of
sexual abuse and victim adjustment, (2) the relationship
between the victim’s family environment and victim
adjustment, (3) the role early emotional bonds with parents
mdght play in functioning, and (4) the relationship between
attachment and child abuse are germane to the current study
and will be reviewed.

Characteristics of Childhood Sexual Abuse
Researchers have determined that various types of
sexual abuse impact victims differently. The relationship
between impact and the following characteristics of sexual
abuse has been investigated: (1) the nature of abuse (i.e.

intercourse, fondling, exhibitionism), (2) the duration
aand/or frequency of abuse, (3) the age of the victim at the
t:ine of abuse, (4) the relationship between perpetrator and
Knictim, (5) the use of force or aggression, (6) victim
Ciisclosure of abuse, and (7) parental/familial reaction to
disclosure (Browne & Finkelhor, 1986).

In a review of the literature on long—term effects and
ter'pes of abuse, Browne and Finkelhor (1986) concluded that
‘3116 most damaging experience of sexual abuse involves a
Iffither figure, penetration, and force. Variables such as
Eisre of onset, duration of abuse, and disclosure of abuse

were not consistently related to a traumatic outcome. In a

20

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more recent literature review, however, Kendall-Tackett et
al. (1993) concluded that molestations involving a close
perpetrator, a high frequency or long duration of abuse, the
use of force, and penetration were all significantly related
to increased symptomatology. The variables age at onset and
number of perpetrators were not related to impact in this
review.

It appears that the relationship between the victim and
abuser is particularly important. Research shows that abuse
perpetrated by a father-figure is more often related to a
negative outcome than abuse perpetrated by either an
extended family member (i.e. uncle, grandfather) or a non-
family member (i.e. teacher, neighbor). According to Browne
and Finkelhor (1986), father-daughter incest is often the
anSt traumatic type of abuse due to (1) the high degree of
loetrayal felt by the victim and (2) the extreme severity of
abuse. Abuse occurring between fathers and daughters,
taking place inside the home, frequently lasts longer,
iJTvolves a higher frequency of sexual activity and starts
earlier than abuse occurring outside the home (Courtois,
1988; Wyatt & Newcomb, 1990) .

Because the relationship between the perpetrator and
'Vfiictim is critical, the present study utilized this
IPEirticular variable to categorize participants. While prior
Studies have examined the differences between survivors of

intra-familial and extra-familial abuse, the present study,

21

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in adherence with the principles of attachment theory,
examined the differences between three groups of survivors:
1) women abused by primary caregivers (i.e., mother, father,
step-parent), 2) women abused by other family members (i.e.,
brother, uncle, grandparent), and 3) women abused by non-
family members (i.e., neighbor, babysitter, stranger).

In summary, empirical findings regarding impact and the
severity of sexual abuse have yet to identify many variables
which are consistently associated with a worse prognosis
(Browne & Finkelhor, 1986). Although a preponderance of
studies has indicated that forced intercourse by a father—
figure is often the most traumatic type of abuse, this has
not been true in all cases or studies. Consequently,
researchers have looked to factors other than the abuse to
gpredict degree of impact. The family environment of the
trictim has proven to play a significant role in later
éuijustment; relevant studies will be reviewed below.

Characteristics of Sexually Abusive Families

Families characterized by incest or intra-familial

Sflaxual abuse have been studied extensively. Incestual
families have long been described as traditional and
patriarchal (Herman, 1981), chaotic and enmeshed (Will,
14983), controlled and inflexible (Alexander & Lupfer, 1987;
Alexander, 1985), and isolatory (Finkelhor, 1979).
Incestual families have also demonstrated patterns of role

reVersal or parentification, whereby one or more of the

22

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children is expected to fulfill a parental role in the
family system (Gelinas, 1983; Levang, 1989). And lastly,
Mian et al. (1994) found parents of incestual families to
report more personal inadequacies (i.e., alcohol abuse,
maternal history of sexual abuse in childhood, paternal
history of physical abuse as a child and violent behavior as
an adult, and maternal disapproval of daughter) than a
control group of parents.
Much less has been written about the families of

victims of extra-familial sexual abuse or abuse perpetrated
by a non-family member. Finkelhor (1979; 1984) found
marital conflict, poor mother-child relations, and the
absence of a parent (particularly mother) to increase a
child’s risk for victimization outside of the home.
.Although there is a trend for incestual families to be rated
:38 slightly more dysfunctional than families associated with
eaxtra-familial abuse, the two types of families have been
found to share some common characteristics. Regardless of
tflne perpetrator, victim families have been described as less
Cnohesive and expressive (Alexander & Lupfer, 1987; Long &
Jackson, 1991), less harmonious and stable (Mian et al.,
1£994), less adaptable (Harter et al., 1988), more
benflictual (Edwards & Alexander, 1992; Ray et al., 1991),
Eirni less organized (Long & Jackson, 1991) than families of

IlCJn—abused children.

In summary, existing studies suggest that family

23

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disruption is significantly associated with the occurrence

of sexual abuse, both inside and outside of the home. It is

suggested that family dysfunction precedes the abuse, and

therefore, poses as a risk factor for sexual victimization

(Alexander, 1992; Finkelhor & Baron, 1986). In addition,

researchers have also argued that family functioning

influences the impact of abuse.

How Family Functioning Influences Adjustment

Research has recently shown that family functioning may

mediate the relationship between sexual abuse and

symptomatology (Alexander, 1992; Briere & Elliott, 1993).

The initial and long—term effects of sexual abuse have been
shown to be significantly related to the victim’s family

environment, as well as to the amount of support she/he

receives from family after the abuse is revealed. In short,

:Lndividuals who receive more support from family members and
lgive in more functional family environments are better
aufljusted psychologically than other victims (Adams-Tucker,
1987; Everson et al., 1989;

1982; Conte & Schuerman,

Ffiromuth, 1986; Herman, 1981). Empirical studies supporting

tile relationship between family functioning and the impact

of abuse will be reviewed below.

Measuring Short-Term Effects. Adams—Tucker (1982)

found that sexually abused children who received support
from adult family members were diagnosed with fewer

emotional disturbances than non-supported children.

24

Similarly, Conte and Schuerman (1987) found that young
victims surrounded by supportive relationships and living
with families rated as less pathological were rated as less
traumatized than other victims. In fact, supportive
relationships with others and family environment variables
explained more of the variance in victim functioning than
the sexual abuse itself (Conte & Schuerman, 1987).

Everson et al. (1989) found children who received low
levels of support or no support at all to display
significantly higher levels of psychopathology than children
receiving more support. Moreover, level of maternal support
was a better predictor of psychological adjustment than the
type of abuse, the length of abuse, or the relationship
between perpetrator and victim. Clearly, this line of
research suggests that family and other forms of social
:aupport play powerful roles in reducing the initial impact
(Dr short-term effects of sexual abuse on children.

Measuring Long-Term Effects. Researchers have also
iJIvestigated the role that family characteristics and
Support play in the adjustment of adult survivors of
Cflaildhood sexual abuse. Fromuth (1986) explored the
Inelationship between childhood sexual abuse, family
eITVironment, and psychological and sexual adjustment among
female college students. She determined that parental
Supportiveness was a better predictor of psychological

adjustment than was the history of sexual abuse. She

25

 

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concluded that survivor maladjustment is likely due to the
lack of parental supportiveness, which frequently
characterizes the home of the sexually abused, rather than
to the abuse itself.

Wyatt and Mickey (1988) recruited adult women from the
community with a history of childhood sexual abuse and
hypothesized that support from a non-abusing parent would
ameliorate the effects of abuse. Results showed that a
mejority of the women who received positive support from
family members had no negative lasting effects, again
suggesting that the harmful effects of abuse are alleviated
by the support of others. Interestingly, severity of abuse
was not significantly related to the victims' overall
adjustment.

Peters (1988) assessed the contributions of maternal
inarmth and severity of abuse to psychological outcome
rneasures among a sample of adults who had experienced
txnwanted sexual contact as a child. In a stepwise
IREgression, maternal warmth emerged as the strongest
Eiredictor of psychological difficulties in adulthood.
Eharation of abuse and number of incidents were also added to
tflle equation, in order to explain more of the variance.

Finally, Harter, Alexander, and Neimeyer (1988)
<3<3mpared incest survivors and non—abused college women on
tneasures of social adjustment, family characteristics, and

Social cognition. Results indicate that abused subjects

26

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reported less cohesive families—of-origin, greater social
isolation, and poorer social adjustment than non-abused
peers. Consistent with prior findings, family
characteristics were found to be more predictive of social
maladjustment than were abuse characteristics. Only abuse
by a paternal figure and abuse involving intercourse
contributed significantly to maladjustment, after family
structure was controlled.

In conclusion, empirical research suggests that while
the victim's family environment is primary, severity of
abuse should also be considered when examining the impact of
childhood sexual abuse. There is a trend, however, for
family variables to explain the largest amount of variance
in adjustment, as compared to other assessed predictors.
Continued theoretical and empirical research regarding the
:relationship between family variables and adjustment is
Jaeeded. One aspect of the family environment which has
received little attention thusfar is the parent-child bond
(Dr attachment. The role that parent-child attachment may
Eilay in the adjustment to sexual trauma will be discussed
laelow.

Quality of Parent—Child Bonds

According to Bowlby (1988), the development and
C>Irg'anization of the parent-child bond is a major determinant
CXE the child’s future mental health. As mentioned

IPIflaviously, responsive, nurturant and sensitive parental

27

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care provides the child with a sense of security and
comfort. Healthy parental care involves caregivers who
promote and tolerate both independence and dependence,
whereby the child is encouraged to explore the world around
him/her but is also prompted to return to the "secure base"
for support as needed.

A person’s need for attachment is expected to increase
during times of crisis or stress (Bowlby, 1973). Thus, it
can be assumed that after experiencing sexual trauma, a
(dctim might attempt to return to the "secure base" in order
to seek reassurance and support. The role that a primary
caregiver plays when a victim discloses that he/she has been
sexually abused is critical. A supportive initial reaction,
as well as ongoing or long-term support, has been shown to
ameliorate the harmful effects of abuse (Adams-Tucker, 1982;
(Conte & Schuerman, 1987; Everson et al., 1989; Fromuth,
21986; Harter et al., 1988; Wyatt & Mickey, 1988). Yet,
EStudies show that many caregivers respond with disbelief,
rejection or blame to the disclosure of abuse (Herman,
31981), and still others offer little to no support after
EiCknowledging that abuse has occurred (Everson et al., 1989;
WYatt 5. Mickey, 1987).

Another tragic situation occurs when the victim chooses
QEHQL to disclose the abuse to anyone. This may be primarily
Sikhs to fear as some perpetrators threaten and intimidate

‘Vfiictims to remain silent (i.e. perpetrator tells victim he

28

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will hurt/kill someone if victim reveals abuse); however, in
some cases, it may be that the victim does not regard the
parent-child "base" as a secure or supportive one to which
to return. Perhaps, some victims sense that the
caregiver(s) responsible for her/his well-being is(are)
incompetent to some degree (Mian et al., 1994) .

"The extent to which an individual becomes resilient to
stressful life events is determined to a very significant
degree by the pattern of attachment he/she develops during
the early years" (Bowlby, 1988, p. 7). Thus, in theory,

children who are raised by caring and responsive parents and
who are provided with a "secure base" to which they can
return during stressful times are more likely to prevail and
adjust, despite the experience of childhood sexual abuse.
On the contrary, children who are raised by rejecting,
inconsistent, or unresponsive parents are more likely to
become and/or remain vulnerable after experiencing sexual
trauma, resulting in mental illness. Thus, secure parental
bonds may serve as a protective mechanism for children
Suffering traumatic events.
Attachment and Childhood Maltreatment
Few empirical studies regarding attachment and sexual
abuse exist. To date, researchers have more commonly
eJ'Catnined the relationship between attachment and other forms
of Child abuse (i.e., physical abuse and neglect). Results

coInsistently indicate that individuals with a history of

29

 

 

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abuse exhibit insecure attachments to others more often than
non-abused individuals. Studies focusing on attachment
patterns and abuse will be reviewed below.
Attaghment Measured in Child Samples
A relationship between childhood maltreatment and
insecure attachment has been established by numerous
researchers. Egeland and Sroufe (1981) found populations of
physically abused and/or neglected children to exhibit
insecure attachment styles more often than children exposed
to adequate parental care. Additionally, Carlson, Barnett,
Cicchetti and Braunwald (1989) found that maltreated infants
were more likely than matched comparison infants to be rated
as insecurely attached. A majority of the maltreated
infants demonstrated the disorganized (type D; fearful)
Style of attachment, in particular.

In a recent study, Lyons-Ruth and Block (1997) examined
the relationships between maternal childhood experiences of
physical and/or sexual abuse, adult caregiving behaviors,
and infant affect and attachment. Participants were 45
mOthers and their 18 month-old infants from primarily low-
income family backgrounds. Although a majority of the
infants were rated as "insecure," the form of observed
insecure behavior was significantly different between
groups. Insecure infants raised by mothers with a history
of abuse were more likely to display a disorganized

( fearful) style of attachment, whereas infants raised by

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mothers with a "benign" history (i.e. no history of abuse or
violence) were more likely to display avoidant strategies.

A particular strength of the above study is that the
nethodology used to measure child attachment and parental
caregiving was naturalistic; mother-infant interactions were
videotaped and rated by experts. A critical limitation is
that the sample size was small; only nine percent (N=4) of
the mothers were found to have a "benign" childhood, making

this comparison group extremely small. Thus,

generalizability is limited. Results should best generalize

tr) similar low-income mother-infant dyads.
To date, only two empirical studies exploring
aitrtachment within a sexually abused population of children
Ileaxle been published. Both studies examine the impact of

previous sexual abuse on the adjustment of children in

Eicflxaptive placement. Groze and Rosenthal (1993) found that

(zlagildren with a history of physical and/or sexual abuse
(before the adoption) experienced greater attachment
<3difficulties than did children without such a history. In
Eitidition, Livingston—Smith and Howard (1994) found sexually
El1311sed adoptees to resist attachment or exhibit more
Eltitach‘ment difficulties in adoptive placement than did non-
ablised children.

The prior two studies must be considered within the
‘:=<>Iltext of some serious limitations. First, Livingston—

ESITlith and Howard (1994) gathered data from case records;

31

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thus, the results are directly dependent on the accuracy and
completeness of the social worker's documentation.
Secondly, both studies examine attachment specifically
within a special needs adoptee sample. Although the results
are important and interesting, they Cannot be generalized
outside of this population given the uniqueness of this
group. Finally, one cannot conclude that the experience of
sexual abuse is the sole or primary cause of attachment
disturbances; too many other variables which tend to
influence attachment exist and were not measured or
controlled (e.g., birth family environment, adoptive family
environment) .

The studies discussed thusfar have examined the
relationship between childhood maltreatment and attachment
in infancy or childhood. Numerous studies focusing on the
relationship between childhood abuse and adult attachment
have recently been published and will be presented below.
$1: tachment Measured in Adult Samples

Clark and Shaver (1994) explored the relationship
between adult attachment, self-concept, and a history of
c1'Zlild abuse. Results indicated that a history of severe
punishment, parental violence, psychological abuse and/or
SeJ-cual abuse was significantly correlated with a fearful
style of attachment, especially among female participants.
The authors concluded that females experiencing childhood

abUSe are more likely to exhibit fearful styles of

32

attachment and poor self-concept structure, as compared to

non-abused women.
A limitation of the above study is that a very narrow

definition of sexual abuse was used. Participants were

simply asked to indicate whether or not they had been

exposed to an adult’s genitals during childhood. No other

information regarding a past history of sexual abuse was
collected, making it difficult to determine if varying

eaxperiences of sexual abuse affected adult attachment

indexes differently .

Schachere (1988) also examined the relationship between

(:knild abuse and adult attachment. He surveyed a sample of

)rratxng adults to determine their past history of childhood

ailbllse, and subsequently, categorized participants into one

(:15 the following five groups: no abuse, physical abuse,

eenncational abuse, sexual abuse, and physical & sexual abuse.

'171163 study sought to determine if individuals who reported
c311.:‘lehood sexual abuse differed in their attachment and
83EBparation responses from individuals who reported other

tllrjpes of abuse or no abuse.

Overall, the five groups did not differ significantly

jLIJ. their attachment/separation responses. In fact,

'j—IIIiividuals who reported sexual abuse only (without physical
£3leFuse) perceived themselves similarly to the no abuse group.
ScZl‘lachere noted that a majority of the sexually abused only

participants reported a relatively less severe history of

33

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abuse (e.g., fondling on one occasion). Thus, future
research is needed to determine if the magnitude or severity
of sexual abuse influences adult attachment. Secondly, a

majority of the sexually abused respondents indicated

experience in therapy. It is possible that the influence of

therapy may explain the apparent lack of pathology among the
sexually abused participants.

Schachere’s study is limited in several respects. Most
importantly, his operational definition of sexual abuse
appears to be inadequate or unsuitable. Victims exposed to
exhibitionism on one occasion were clustered into the same
sgznoup as victims forced to have intercourse over a period of

several years. Including such a broad variety of sexual
Gazczperiences under the rubric of "sexual abuse" may conceal
escanne distinct results. Future studies should consider more
refined definitions of sexual abuse.

In a theoretical article, Alexander (1992) proposed
tiliiat attachment theory would be a useful framework for
£3tudying the antecedents and consequences of sexual abuse.
I§5iarst, she proposed that the occurrence of sexual abuse is
frequently preceded by insecure parent-child attachments.
SIDecifically, insecure attachment "precludes impulse control
:j—Ii. the abuser, interferes with protectiveness and
It?€3£sponsivity of the non—abusive parent(s), or increases the
“’TJJLnerability of the child to abuse in and outside the home"

(p - 189). Secondly, she hypothesized that attachment

34

 

 

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mediates the long-term effects associated with abuse. She
suspected that effects such as interpersonal problems, poor
affect regulation, and disturbances of "self" are better
explained by the attachment relationships surrounding the
abuse than from the actual abuse itself.

Subsequently, Alexander (1993) empirically tested the
second hypothesis described above, predicting specifically
that sexual abuse and family variables "would each have
saignificant but distinct effects on the long-term
firnctioning of incest survivors" (p. 346). Participants,

rzecruited from the community, tended to report severe cases
()1? abuse (i.e. two or more perpetrators, forced intercourse,
EillCi/Or father-figure perpetrator). Results indicated that a
majority (86%) of the abused participants described
t:11£3mselves as insecure, with 58% reporting a Fearful style
'C>15 attachment, in particular. Regression analyses indicated
t111£it post—traumatic stress disorder (PTSD) symptoms such as
Ciéalpression and intrusive thoughts were predicted by abuse
c311aracteristics (age of onset, in particular), while
I;>€31:sonality dysfunction was predicted by adult attachment
(iifeearful attachment, in particular). Thus, Alexander
‘C:<>Ilcluded that symptoms associated with PTSD are best
1;’1?€edicted by abuse severity, while basic personality
£3”t11?ucture is best predicted by adult attachment.

The previous study offers compelling information

regarding the relationship between a history of sexual abuse

35

 

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and adult attachment. Further, it is a strong empirical
study with few limitations. The primary weakness is that
adult attachment was measured retrospectively and by survey,
leaving room for self-report bias and/or error. In
addition, the sample was limited to the experience of
incestuous abuse (i.e., perpetrator and victim living in
same household), and thus, the results may not be
generalizable to women experiencing extra-familial abuse.

Stalker and Davies (1994) also explored the

:relationship between adult attachment organization, current

.fixnctioning, and childhood sexual abuse in a sample of 40

Ifennale psychiatric patients. Consistent with Alexander

(1993) , a majority (60%) of the women were classified as
I?eeairful or Unresolved in respect to loss/trauma.
I?111:thermore, 88% of the subjects met the criteria for an
.Zkacxis II personality disorder, with over half of the
IEDEiirticipants being diagnosed with avoidant/self—defeating
IEDeezrsonality disorder.

This study offers important information regarding adult
'Eitltzachment within a sexually abused psychiatric population.
39* Iparticular strength of the study is that attachment was
tt1€BEisured using the Adult Attachment Interview (AAI), which
has been deemed a more sensitive assessment of attachment
Stlllles than self-report measures. Limitations of the study
trutlsst also be noted. Most importantly, the authors did not

use a control group; future researchers need to compare

36

abused and non-abused psychiatric groups to determine how

the groups differ in attachment and if differences are due

to abuse or other characteristics. Further, the results of

this study cannot be generalized to non-psychiatric

populations with confidence. Lastly, the small sample size

(n=40), or more specifically the small number of subjects

per cell, restricts the study’s statistical power.

Mallinckrodt, McCreary and Robertson (1995) examined

the relationships among history of sexual abuse, eating

disorders, family environment, parent-child attachment, and

social competencies. Participants were selected from both

liniversity and clinical settings and were initially

cfilassified into one of the following three groups: no abuse,

<leildhood sexual abuse (extra-familial abuse only), or
incestual abuse. A comparison of these groups indicated
€323t2ing disorder rates of 17%, 18%, and 39%, respectively.

1E3EE<2ause women in the childhood sexual abuse (CSA) group
Eslixowed eating disorder rates almost equal to the non-abused

‘SJJCTDUP, the authors excluded the CSA group from further

anDialysis to compare incest survivors and non-abused women

(:NrIJLy. This analysis revealed that incest survivors reported

ttl‘C>:I:e dysfunctional family environments, less emotional

‘V°?El1:mth from.parents, and lower social competencies than the

1”I-CIDI‘l—abused group. Furthermore, the incest survivors who

It‘sizported the poorest parent-child bonds and the lowest level

‘:>jEr social competencies also reported the highest number of

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eating disorder symptoms.

The limitations of this study are limitations inherent
in most sexual abuse studies. First, retrospective methods
were used to assess history of sexual abuse, family
environment and parent—child bonds and thus are suspect due
to self-report bias and error. The authors also warn
readers against generalizing results, stating the sample is
small and selective.

Anderson and Alexander (1996) sought to demonstrate a
relationship between fearful attachment patterns and
dissociation among a sample of incest survivors.
Participants were recruited through a newspaper
advertisement and all had been abused by a family member. A
semi-structured interview, as well as several paper and
pencil surveys were administered to the study participants.
Women were categorized into one of the four attachment
categories: 51% fearful, 20% preoccupied, 12% dismissing,
and 9% secure.

It was predicted that individuals with a fearful
attachment style would exhibit more dissociation than
;participants in the other three categories; the hypothesis
‘was supported. Furthermore, attachment style explained 14%
(of the variance in dissociation, while the abuse variables
(i.e., age of onset, duration, nature of abuse, etc.) did
rust significantly predict dissociation when entered into the

enquation alone. The authors concluded that "dissociation

38

 

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may be explained by the family context (specifically, the
attachment relationship which the child experienced), as

well as by specific aspects of the abuse experience" (p.

249).

This study demonstrated a significant relationship
between dissociative symptoms and a fearful style of
attachment, both of which are characteristic of an abuse
survivor. Particular strengths of this study are that a
semi—structured interview was conducted, increasing the
reliability of responses, and the sample size was adequate
(n=92). The results are generalizable to women abused by
family members only; thus, study limitations include limited
generalizability, as well as the possibility of memory
and/or self-report bias.

Brock, Mintz, and Good (1997) reported that to date the
research on the effects of childhood sexual abuse has
neglected to acknowledge a hidden group of survivors, those
who report positive perceptions of their family environment.
Brock et al. focused on whether the psychological problems
reported by adult survivors are related to the abuse itself
(Ir more to the experience of growing up in a dysfunctional
fandjyu They examined the differences among four groups:
iibused women from functional families (N=19), abused women
frtmldysfunctional families (N=20), non-abused women from
functional families (N=20) , and non-abused women from

<1ysfunctional families (N=21). Participants, 80 female

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university students, were compared on measures of
depression, anxiety, interpersonal problems, and overall
distress.

The two abuse groups did not differ in terms of abuse
or perpetrator characteristics reported. On all four
amasures the abused-dysfunctional group reported the highest
level of psychological distress. Most importantly, no
differences were found between abused-functional and non-
abused functional groups. Thus, if participants perceived
that their families were functional, the experience of
sexual abuse did not make a difference with regards to
symptomatology.

The authors concluded that "having a functional family,
or at least the perception that one's family environment is
functional, serves as a protective factor with respect to
psychological symptomatology, even if one is sexually
abused" (p. 430). Limitations of the study were offered by
the authors. Most importantly, childhood physical abuse and
adulthood sexual trauma (i.e., rape) were not assessed,
‘which might have confounded the results. In addition, the
(muestionnaires were not administered in a counterbalanced
order and the sample size was considered to be small.

Most recently, Schreiber and Lyddon (1998) applied
aittachment theory to the study of childhood sexual abuse and
annducted a study very similar to the current investigation.

Tflney examined the parental bonds and psychological

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functioning among a group of childhood sexual abuse
survivors. Specifically, the authors hypothesized that
survivors of sexual abuse reporting optimal bonding with
parents in childhood (i.e., high parental care and low
parental overprotection scores on the Parental Bonding
Instrument) would exhibit significantly better psychological
functioning in adulthood than those reporting weaker bonds
with parents.

Results indicated that high paternal care was
significantly associated with better functioning. In other
words, women who perceived their fathers to be more caring
indicated less psychological disturbance in adulthood, as
compared to women reporting low father care. Surprisingly,
no significant effects were found for maternal care,
maternal overprotection, or paternal overprotection.

Optimal bonding with mother, therefore, was not related to
better psychological functioning.

Limitations of Schreiber and Lyddon’s study (1998) were
'mentioned by the authors. First, cause and effect
conclusions cannot be inferred from the data because all
”variables were assessed at the same time. In addition, the
(external validity of the study was limited given that all
{marticipants were female undergraduate students and thus not
representative of the larger survivor population.

Finally, in the last three years several doctoral

sstudents have applied attachment theory to the study of

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sexual abuse as a dissertation focus. A brief description
of the most relevant studies will be outlined here. Fossel
(1997) investigated attachment style as a potential
nwderator of the relationship between abuse severity and
adjustment among a large sample of female undergraduate
students. Both severity of abuse and attachment were found
to be consistent predictors of adjustment. Specifically,
women with a more severe history of childhood sexual abuse
and/or women who endorsed a more insecure attachment
orientation (i.e., fearful, in particular) also demonstrated
poorer adjustment and more symptomatology in adulthood.

MacNab (1996) examined key relationships between
variables associated with childhood incest and adult
psychosocial functioning. Incest survivors were compared to
a group of women without a history of sexual abuse on the
following variables: childhood experiences, adult attachment
patterns, adult interpersonal problems, and adult
psychological symptoms. The incest group reported more
physical and emotional abuse in childhood, less healthy
attachment bonds with mother, less comfort with emotional
intimacy in adulthood, decreased ability to trust others in
adulthood, and more psychological symptoms in adulthood, as
compared to the no incest group.

Finally, using qualitative methods, Kane (1997)
eaxplored the "working models" or representations of self and

(other of 12 women with a history of childhood sexual abuse.

42

 

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During an interview, participants were asked to describe
their childhood relationships with adults, past and present
romantic relationships, and past and present views of self.
A.majority of the participants reported having had problems
with trust, respecting others, intimacy difficulties,
insecurity, and poor self-esteem in adulthood. With regards
to internal working models, Kane reported that many
participants were "ambivalent" (not positive or negative)
when discussing their views of self and other, making it
difficult to assign them to one of four attachment styles.
The author concluded that although attachment theory served
as a useful framework to understand the participants’
interpersonal relationships, the four category model of
attachment (Bartholomew and Horowitz, 1991) proved to be
inadequate, unable to capture the attachment history and
experience of the participants in her study.

The most recently published studies (1997-present), as
well as the dissertation papers, were only available for
review after the current study had been conducted.
Therefore, this researcher was not privy to these results
lxefore forming and testing the following hypotheses.
Iflowever, reviewing these recent relevant studies provides an
opportunity to compare findings and draw comprehensive

conclusions .

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THE PROBLEM STATEMENT

The present study sought to explore the parent-child
tmnds and adult attachment patterns of women with a history
of childhood sexual abuse. The three following groups were
analyzed: 1) women abused by a primary caregiver(s), 2)
women abused by other family members, and 3) women abused by
non-family perpetrators. These groups of survivors were
compared on measures of abuse severity, symptomatology,
early parent-child bonds, and adult attachment orientations.

Past studies have shown that victims of incest are
often abused more frequently, for a longer duration, or to a
greater degree than victims abused by non-relatives.
Therefore, it was hypothesized that the three groups of
survivors’ would report differences in the severity of their
abuse histories. Specifically, women abused by a primary
caregiver were expected to report the most severe history of
abuse (i.e., more cases of intercourse, higher frequency,
more incidents, longer duration, etc.) followed by women
abused by other and non-familial perpetrators, respectively.
If confirmed, a severity index was to be created in order to
control for severity of abuse in subsequent analyses.

Researchers have argued that abuse perpetrated by a
<:lose or trusted adult often results in a more devastating
(Mitcome than abuse perpetrated by an unknown or less trusted

individual. In the present study, therefore, it was

44

 

 

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hypothesized that women abused by a primary caregiver would
exhibit lower levels of psychological adjustment as compared
to their peers in the other abuse groups. Specifically,
controlling for abuse severity, women abused by a primary
caregiver were expected to exhibit more symptomatology at
the time of assessment, followed by women abused by other
and non-familial perpetrators, respectively. Furthermore,
it was expected that, controlling for abuse severity,
survivors of parental sexual abuse would report more
difficulties with attachment in adulthood and more overall
insecurity than their counterparts in the other abuse
groups.

The present study was also designed to explore the
early parent-child emotional bonds reported by a group of
childhood sexual abuse survivors. Studies have shown that
victim families in general are commonly described as
dysfunctional; however, there is still a trend for incestual
families to be rated as slightly more dysfunctional than
families of victims of extra-familial sexual abuse. In the
;present study, it was expected that women abused by a
;prinmry caregiver would report the weakest early emotional
txonds with caregivers, followed by women abused by other and
Inon-familial perpetrators, respectively. Survivors of non-
famfilial abuse were expected to report the
:strongest/healthiest bonds with parental caregivers.

Lastly, it was hypothesized that a healthy emotional

45

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bond with a caregiver might buffer or protect a victim from
some of the long-lasting harm associated with abuse.
Specifically, it was predicted that parent-child emotional
bonds would moderate the relationship between a history of
childhood sexual abuse and survivors' current psychological
adjustment. Furthermore, prior research has shown that
adult attachment orientations often predict outcome measures
better than early emotional bonds. Thus, it was also
hypothesized that adult attachment orientations would
mediate the relationship between early parent-child
emotional bonds and current psychological adjustment

reported by survivors.

46

 

 

METHOD

The methodological procedures associated with this
study will be outlined in the following section. First, the
operational definition of childhood sexual abuse will be
discussed. Next, a detailed description of the research
participants surveyed, the data collection procedures
followed, and the questionnaires/instruments employed will
be offered. Finally, a description of the statistical
analyses conducted will be summarized.

Definition of Childhood Sexual Abuse (CSA)

In the present study, childhood sexual abuse was
operationally defined to include the following: (1) a victim
younger than 15 years of age, (2) experiencing any unwanted
sexual contact (i.e., kissing to forced intercourse), (3) of
any magnitude, duration, or frequency (i.e., one time
occurrence to abiding abuse), (4) by any perpetrator (i.e.,
family member to stranger) who was at least five years older
than the victim at the time of abuse. Following Briere and
Runtz (1988), this definition excludes aversive experiences
occurring between same-age peers, victimization during later
adolescence, and non-contact events (i.e., exhibitionism).

Childhood Sexual Abuse (CSA) Groups

Given that many participants were abused by multiple

perpetrators, the following system was used to categorize

individuals. If a participant indicated abuse by any

47

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parental figure (i.e., mother, father, step-parent) she was
placed into the "parental abuse" group, regardless of her
relationship to any other perpetrator(s). Participants who
indicated abuse by a sibling or extended family member
(i.e., uncle, grandfather, or cousin), but denied abuse by a
parental figure, were placed into the "other-familial abuse"
group. And finally, those women who indicated abuse outside
of the family only, denying any experience of familial
sexual abuse, were assigned to the "non-familial abuse"
group.
Participants

A total of 80 female adults with a history of childhood
sexual abuse volunteered to participate in the study.
Thirty-eight percent (N=31) of the participants were abused
by a primary caregiver or parental figure (71% abused by
father; 19% by step-father; 10% by mother); 34% (N=27) were
abused by another family member; 28% (N=22) were abused by a
non-family member. Participants were recruited from four
different sources: therapists, newspaper advertisements,
undergraduate courses, and an email listserve advertisement.

The age of participants ranged from 19 to 76 years old
(M=34, SD=13). The racial—ethnic breakdown of the sample
was 83% Euro-American/Caucasian, 9% African-American/Black,
1% Asian-American, 3% Latina/Hispanic/Chicana, and 4% Multi—
racial. Twenty-nine percent of the participants were

married, 5% living with a partner, 18% divorced or

48

 

separated, 48% never married, and 1% widowed. Of those not
married or living with a partner, 53% were not dating and
47% were either dating or in a committed relationship.
Procedures

The recruitment and data collection procedures were
managed in the following way. Approximately 70 therapists
were contacted by letter to request assistance in recruiting
research participants. Interested therapists were then
asked to contact this researcher to discuss procedures for
selecting clients and to make arrangements for obtaining
survey packets; questions and concerns were addressed during
this conversation as well. Most importantly, therapists
were instructed to use their ethical and clinical judgment
when selecting and approaching potential participants.

Qualified clients were given the option of
participating "in an anonymous and voluntary study regarding
sexual abuse, relationships, and current adjustment".
Interested clients were given a survey packet. To minimize
the risk that clients would feel pressured to participate
and to preserve their option to simply discard the packet if
desired, therapists were specifically instructed not to
follow up with clients or to inquire about completion of the
packet.

Many of the therapists who agreed to participate in the
study were interested in receiving information regarding the

final results of the study. Therefore, a letter of

49

appreciation was mailed to all participating therapists at
the completion of the study. This letter included a
discussion of the major results with a specific focus on the
application of findings to a client population.

Second, the investigator obtained permission to recruit
qualified volunteers from several undergraduate classes. A
brief overview of the study was provided to all students,
along with a flyer including the researcher’s name, phone
number, and e-mail address. Women interested in
participation were given the choice of obtaining a survey
packet anonymously at the university library reference desk
or by mail.

Third, several advertisements were posted in local city
and student/campus newspapers (See Appendix A), as well as
on an email list serve for women in the field of psychology
(entitled POWER), to request the participation of qualifying
women. Volunteers were instructed to contact the researcher
by phone or email to obtain a survey packet.

All survey packets included an informed consent and
five survey instruments (see Appendix B). Given the
potential for participants to feel some discomfort while
completing the survey packet, a listing of phone numbers for
several local mental health agencies, therapists, and 24-
hour crisis hotlines was also included in the packet (see
Appendix C). All participants were instructed to return

completed packets to the researcher by mail in a self-

50

 

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addressed, stamped envelope provided by the researcher.

Twenty one percent of the sample was recruited by their
own therapist, 16% were enrolled in undergraduate courses in
counseling, nursing, or women’s studies at either a
midwestern or southwestern university, 51% responded to a
newspaper advertisement in either a college campus or local
city newspaper, and 11% responded via email to a message
sent out to female POWER listserve subscribers.

Instruments

Demographic and History of Sexual Abuse Questionnaire

This brief questionnaire was designed to gather
background information on the participants’ age,
ethnic/racial membership, marital or partnership status,
present or past experience in psychotherapy, current stress
level, and history of childhood sexual abuse. Rather than
using an existing instrument to measure childhood sexual
abuse, past researchers have more often asked participants
to answer specific questions regarding their history of
abuse. Subsequently, the sexual abuse characteristics
measured in this study were chosen to match the variables
measured in relevant prior studies. Items regarding the
number of perpetrators, the relationship(s) between victim
and perpetrator(s), the nature of abuse, the duration and
frequency of abuse, the victim’s age at the onset and
conclusion of abuse, the use of harm/coercive tactics, and

the disclosure of abuse were included.

51

 

 

 

 

 

At this time, there is no psychometric information
available on the sexual abuse questionnaire (as is true for
other instruments measuring sexual abuse).

Parental Bonding Instrument (PBI)

This 50-item questionnaire was designed to measure the
quality of childhood bonds with parents based on
participants' memories of the first 16 years of life
(Parker, Tupling, & Brown, 1979). Statements describing
parental behavior are presented and participants are asked
to rate how much each statement describes each parent on a
four point Likert scale (1=very like, 4=very unlike). Two
dimensions of parental behavior are assessed, Care and
Overprotection. The Care scale contrasts warm, responsive
care with indifferent, unresponsive care. The
Overprotection scale contrasts a controlling and intrusive
parenting style with parental behavior that encourages
autonomy and independence. Separate ratings for each
parental relationship are made, yielding four subscale
scores: mother care, father care, mother overprotection and
father overprotection. Higher scores on the Care scale
indicate greater levels of parental care and warmth, while
higher scores on the Overprotection scale indicate greater
parental intrusiveness and control.

"Studies investigating the psychometric properties of
the PBI have found support for its validity as a measure of

both perceived and actual parenting over time" (Parker et

52

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al., 1992, p. 883). Factor analyses support the two-factor
model. The Care and Overprotection scales have yielded
test-retest reliabilities of .76 and .63 and split half
reliabilities of .88 and .79, respectively (Parker, et al.,
1979). Additionally, this measure has shown adequate
concurrent validity; PBI scores have been highly to
moderately correlated with mothers’ and independent judges’
ratings of parental behaviors and parent-child bonds
(Parker, 1981; Parker, et al., 1979). In the current study,
the Cronbach alphas for Care and Overprotection Scales were
.92 and .77, respectively.

Relationship Questionnaire

This self-classification measure of adult attachment is
based on the four category model of adult attachment styles
proposed by Bartholomew and Horowitz (1991). Participants
are asked to choose one of four descriptive paragraphs that
best describes their level of comfort with closeness or
intimacy in romantic relationships. The four paragraphs
represent secure, preoccupied, dismissive and fearful
attachment styles.

Bartholomew and Horowitz (1991) found the four
attachment styles to correlate in theoretically consistent
ways with self and other reports of respondents’ self-esteem
and sociability ratings. Scharfe and Bartholomew (1994)
found this measure to demonstrate moderate stability over an

eight month time period. And finally, Griffin and

53

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Bartholomew (1994) found evidence to support the validity of
the self- and other models which underlie the four-group
classification system.

In the current study, participants endorsed the
following attachment styles, 11% secure, 19% dismissive, 14%
preoccupied, and 56% fearful. The fact that a majority of
these survivors endorsed a fearful style of attachment is
consistent with past research on this population.

Adult Attachment Indexes

This 13-item self-report form measures adult attachment
on two factor-analytically-derived subscales (Simpson,
1990). Participants rate statements regarding romantic
relationships on a seven point Likert scale ranging from
"strongly disagree" (1) to "strongly agree" (7). The
avoidance/security subscale assesses the individual’s level
of comfort with interpersonal closeness and dependence
(i.e., "I’m somewhat uncomfortable being too close to
others."). Higher subscale scores indicate greater
avoidance. The Cronbach alpha for this subscale has been
reported at .81 (Simpson et al., 1992), .77 (Lopez, 1996)
and .80 (Lopez et al., 1997).

The anxiety subscale measures the level of tension an
individual experiences in romantic relationships (i.e., "I
rarely worry about being abandoned by others"). Higher
scores indicate higher levels of anxiety. The Cronbach

alpha on the anxiety index has been reported at .58 (Simpson

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et al., 1992), .74 (Lopez, 1996), and .71 (Lopez et al.,
1997). The Cronbach alphas in the present study were .81
and .79 for the avoidance/security and anxiety indices,
respectively.

Brief Symptom Inventory (BSI)

This 53-item questionnaire was designed to measure the
psychological symptoms of either psychiatric patients or
normal, non-clinical individuals (Derogatis, 1975). It
constitutes a short form of the Symptom Distress Checklist
(SCL-90; Derogatis) and is an adequate substitute. The
inventory assesses the following nine symptom patterns:
hostility, anxiety, somatization, depression, obsessive-
compulsive, interpersonal sensitivity, paranoid ideation,
psychoticism, and phobic anxiety. In addition, the
instrument provides information regarding a participant’s
overall level of functioning or symptomatology. This index,
entitled the Global Severity Index, is the overall mean
score. Higher scores suggest more disturbances in
functioning or more symptomatology.

Respondents are asked to rate their level of distress
on a five-point Likert scale (0=not at all; 4=extremely
distressed) in regards to the 53 listed symptoms (e.g.
"thoughts of ending your life," "trouble falling asleep").
The BSI is a reliable and valid measure. Derogatis and
Melisaratos (1983) reported a test-retest coefficient of .90

for the Global Severity Index and test-retest reliability

55

 

 

 

ranging from .68 to .91 across the nine subscales.
Convergent validity has also been established by showing
high correlations between BSI subscales and like dimensions
of the MMPI. Finally, Cronbach alphas for the nine
dimensions of the BSI were found to range from .71
(psychoticism) to .83 (depression) (Derogatis & Melisaratos,
1983). In the current study, the Cronbach alpha for the
Global Severity Index was .96, indicating excellent internal
consistency.

Hypotheses

It was hypothesized that the three groups of survivors
would report differences with regard to the level of abuse
severity they experienced. Specifically, women abused by a
primary caregiver (Group 1) were expected to report the most
severe history of abuse (i.e., more perpetrators, longer
duration, more incidents, earlier onset and later conclusion
of abuse, etc.), followed by women abused by other family
members (Group 2) and non-family perpetrators (Group 3),
respectively.

Secondly, it was hypothesized that, controlling for
abuse severity, women abused by primary caregivers would
indicate receiving the least amount of care from parents,
followed by women in Groups 2 and 3, respectively.
Additionally, it was hypothesized that women abused by a
primary caregiver would exhibit more current symptomatology

and report more insecure attachment orientations in

56

 

adulthood, as compared to their counterparts. More
specifically, Group 1 women were expected to report higher
levels of avoidance and anxiety in their adult
relationships, as compared to women in Groups 2 and 3.

It was also proposed that parent-child emotional bonds
'would moderate the relationship between abuse severity and
current adjustment, with those participants recollecting
Inore favorable early bonds demonstrating higher current
adjustment levels. Finally, given that prior research has
shown that adult attachment orientations often predict
outcome measures better than early bonds, it was
hypothesized that adult attachment orientations would
significantly and uniquely predict symptomatology and would
mediate observed relationships between early bonds and
survivors’ current adjustment scores.

Analyses

First, descriptive statistics were calculated for the
entire sample. Frequencies for all variables related to
demographics and childhood sexual abuse were calculated. In
addition, a correlational matrix was computed in order to
examine the relationships between abuse variables and
symptomatology.

Second, a comparative analysis was conducted to
determine if the three groups of survivors differed on
demographic and sexual abuse variables. Several chi-squared

and ANOVA tests were completed. It was decided that if the

57

 

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groups differed significantly on a majority of the abuse
characteristics a "severity index" would be created. To
create this index, a factor analysis was conducted, a factor
accounting for a majority of the variance was identified,
and factor scores were calculated for each participant.
Subsequently, severity of abuse was controlled in the
remaining analyses.

A between groups comparison was then conducted to

determine if the three groups exhibited different levels of

 

symptomatology. An ANCOVA was run; severity of abuse was
controlled, group membership served as the independent
variable and BSI scores as the dependent variable. It was
expected that participants abused by a primary caregiver
would exhibit higher scores on the BSI than their
counterparts.

A series of tests was then conducted to determine if
the three groups differed in their responses to attachment
related measures. First, a MANCOVA was run to determine if
the three groups reported significantly different emotional
bonds (care, overprotection) with parents; severity of abuse
was controlled, group membership was the independent
variable and mother care, father care, mother overprotection
and father overprotection served as the dependent variables.
It was expected that women abused by a parental figure would
report less warmth/care from caregivers, followed by those

abused by another family member and by non—family,

58

 

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respectively. Between group differences on the
overprotection scales were not predicted.

Following these analyses, another MANCOVA was conducted
to determine if the three groups differed in their responses
on the two adult attachment orientations subscales,
controlling for the severity of abuse. It was expected that
women abused by a primary caregiver would display lower
security and higher anxiety scores, followed by survivors of
other familial abuse and non-familial abuse, respectively.

Next, a chi-squared analysis was conducted to compare
the number of participants endorsing a secure, dismissive,
preoccupied, or fearful style of attachment between groups.
Although a majority of women in all three groups were
expected to report a fearful style of attachment, it was
predicted that survivors of non-familial abuse would endorse
a secure style of attachment more frequently than women
abused by either primary caregivers or other family members.

Finally, two regression models were tested to determine
if early parental bonds moderated the relationship between
abuse severity and adjustment in adulthood. Prior to their
entry in the model, predictors were transformed into
standardized scores. Severity of abuse, parental care
scores, and an interaction of the two were then sequentially
entered into the regression model to predict symptomatology.
It was expected that, controlling for severity, parental

care would best predict BSI scores.

59

 

 

 

 

 

Furthermore, to determine if adult attachment
orientations mediated the relationship between early
emotional bonds and current symptomatology, another series
of regression equations was conducted. Initially, mother
and father care scores were entered as a block into a
regression predicting BSI scores, controlling for severity.
Secondly, separate regressions were conducted to determine
if parental care predicted adult attachment avoidance and
anxiety scores, again controlling for severity of abuse.
And lastly, early parental care and adult attachment
avoidance/anxiety scores were entered into a final
regression equation to predict BSI scores, controlling for
severity. It was expected that early parental care would
have no effect on symptomatology (BSI scores) when adult

attachment scores were controlled.

60

RESULTS

In the following section a detailed description of the
data analyses conducted and subsequent findings will be
presented. Specifically, sample descriptives are offered,
followed by a correlational matrix of selected demographic
variables and the key measures under investigation, and a
comparative analysis of the three groups of survivors.
Finally, the key hypotheses are addressed by presenting the
findings associated with several regression models.

Preliminary Analyses
Sample Descriptives: Demographic and Abuse Variables

Living Arrangements. Participants were asked whom they
lived with while growing up; 71% lived with both parents,
13% with mother only, 15% with a parent and step-parent, and
1% of the sample was raised by an extended family member.
Fifty—five percent of the sample lived with their abuser at
the time of abuse; this obviously differed between groups
with incest survivors living with an abuser more often than
others.

NUmber of Perpetrators. Overall, this sample indicated
a severe history of abuse with 38% of the sample reporting
abuse by multiple perpetrators. Number of perpetrators
ranged from one to five (M = 1.6).

Natpre of Abuse. Information on five types of sexual

contact was gathered: intercourse, oral contact with

61

genitals, fondling over clothes, fondling under clothes, and
kissing; Respondents were asked to mark all types of
contact endured. Forty-three (43%) percent of participants
reported abuse that included intercourse, 43% indicated oral
contact with genitals, 80% reported stimulation/fondling of
genitals under clothes, 64% noted fondling over clothes, and
45% reported kissing.

In addition, participants were assigned an overall
"contaCt score" by coding type of contact (intercourse=5,
oral contact=4, fondling under clothes=3, fondling over
clothes=2, and kissing=1) and summing items for a total
score (range 1-15). This variable was created in order to
compare groups on type of contact endured, as well as to
include this abuse characteristic in the overall severity
index. It should be noted, however, that there is no prior
research to support categorizing sexual contact
hierarchically; thus, this variable should be interpreted
with caution.

Age at Onset and Conclusion of Abuse. Participants

were asked to indicate their age both at the time the abuse
started and ceased. The age of onset for victims ranged

from 1 to 14 years old (M = 5.88, SD = 3.13) and the age

when abuse concluded ranged from 5 to 22 (M - 11.96 SD

3.98).
Duration and Frequency of Abuse. The average duration

of abuse was 6.1 years (SD = 5.1) with considerable

62

variation among participants. In addition, the average
estimated number of incidents reported was 50 (SD = 69.7),
with similar variation.

HarmZThreat= Of all survivors, 53% indicated that they

were threatened, harmed or coerced by their perpetrator(s).

Other Types of Abuse. In terms of other types of

 

abuse, 39% of the sample indicated a history of physical '

abuse, 33% felt neglected during childhood, and 78% reported Ff

emotional abuse. E
2QEQQ12§Q_§§X§£l£¥_9£_A22§§1 All participants were ~L

asked to rate the severity of their abuse on a scale from
one (not too severe) to five (very severe) in order to gain
an understanding of each participant’s perception of
severity. The average rating for all participants was 3.5
indicating moderate severity (S2 = 1.2).

Disclosure of Abuse. Forty—four percent (44%) of the
sample disclosed the abuse to an adult figure; a majority of
the victims told their mother, followed by father and/or a
trusted adult figure (i.e., teacher, family friend). These
survivors received a range of reactions, from very
supportive/protective (18%) to somewhat supportive (27%) to
unsupportive/rejecting (22%) to very unsupportive/blamed/
abandoned (32%).

Experience with Therapy. A majority of the sample
(81%) indicated that they had received or were receiving

professional counseling or therapy, with an overall average

63

of 145 sessions attended (SD = 194) and a range from six to
1000 sessions.
Correlational Analysis

Table 1 presents a correlation matrix, showing the
relationships between relevant abuse variables, PBI Care and
Overprotection scores, Adult Attachment avoidance and
anxiety scores, and BSI/symptomatology scores. As expected
a majority of the abuse characteristics were strongly
correlated with one another. Nature of abuse (i.e., contact
scores) was correlated with all other abuse variables. Age
of onset and age of conclusion were significantly correlated
with number of incidents reported and duration of abuse, as
well. Finally, participants’ perception of severity was
significantly correlated with all abuse characteristics
except age of onset.

Symptomatology or BSI scores were correlated with some
abuse variables. Specifically, BSI scores were
significantly correlated with duration of abuse and
participants’ perceptions of abuse severity. In short, the
longer the abuse lasted and the more severe participants
rated their abuse history, the higher the BSI scores or more
symptomatology reported.

Similar to past studies, parental care scores were
negatively correlated with adult attachment avoidance and
anxiety scores, while overprotection scores were positively

related to these adult attachment indexes. Overall, higher

64

 

 

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65

care scores were related to lower avoidance, lower anxiety,
and lower BSI scores; in contrast, higher overprotection
scores were related to more attachment avoidance and anxiety
and more symptomatology (higher BSI scores).

CSA Gropps: Preliminapy Comparative Analysis

To determine if and how the three groups differed on
the measured variables, a series of Chi-squared and ANOVA
analyses were conducted.

Dempgraphic Variables. The three groups of survivors
did not differ significantly on the following demographic
variables: age, race, marital and dating status, or source
of referral (i.e., therapist, newspaper ad, classroom,
listserve). Groups did differ significantly, however, on
childhood living arrangements, X2 (10, N = 80) = 22.06, p <
.015). A majority of women in all three groups indicated
living with both parents; however, women abused by a primary
caregiver were more likely to report living with mother and
step-father and women abused by an other/extended family
member were more likely to indicate living with mother only
during childhood, as compared to the other groups.

Number pf Peppetrators. Consistent with prior research
there was a significant difference between groups on the
number of perpetrators reported, X2 (2, N = 80) = 22.16, p <
.001); 68% (N = 21) of the women included in the parental—

abuse group reported multiple perpetrators as compared to

33% (N 9) in the other familial and 4% (N = 1) in the non-

66

familial abuse groups.

Nature of gpuse. The three groups did not differ
significantly in reported cases of intercourse or fondling
over or under clothes; however, experiences of oral contact,
X2 (2, N = 80 ) = 7.8, p < .02), and kissing, X2 (2, N = 80)
= 6.33, p < .04), differed significantly between groups.
Fewer women abused by a parental figure reported oral
contact as compared to their counterparts. Furthermore,
women in the other-familial abuse group reported kissing
more frequently than other group members. It was expected
that those abused by a primary caregiver would report a more
severe history of abuse, which would specifically include
more cases of intercourse; this was not supported.

It does appear, however, that the three groups differed
significantly in overall contact scores, E(2, 77) = 6.946, p
< .002 with those abused by primary caregivers (Group 1)
reporting the highest score, followed by women abused by
non-family (Group 2) and other family (Group 3),
respectively. Results of Scheffe’s post-hoc group
comparison indicates significant differences between Group 1
and Groups 2 and 3 (See Table 2).

As mentioned, this variable should be interpreted with
caution as some would argue that sexual contact should not
be rank ordered hierarchically; however, with this
precaution in mind, the above results are in line with the

expectation that women abused by a parental figure endured a

67

Table 2

Means, standard deviations, and ANOVA (F-test) analyses for abuse
characteristics among three groups of survivors

 

 

Group 1 Group 2 Group 3
(n=31) (n=27) (n=22)
Scheffe’s )
M SD M SD M SD F (2, 77) Tests
Onset Age
(years) 4.80 3.57 5.50 2.09 7.70 2.83 6.56** 1 & 2 < 3
Termination

 

Age (years) 14.34 3.35 10.63 3.95 10.25 3.26 11.48** 1 > 2 8 3

Contact

Score 10.19 4.21 6.63 3.62 7.23 3.74 6.95** 1 > 2 8 3
Duration

(Years) 9.67 5.25 4.80 3.60 2.50 2.33 20.99** 1 > 2 8 3
Number of

Incidents 82.30 94.50 29.30 37.80 28.90 ’33.10 6.06** 1 > 2 & 3
Perceived

Severity 4.00 1.06 3.15 1.30 3.27 1.08 4.62** 1 > 2

 

Note: Significant differences were found between three groups on each
variable.

"5.01

68

history marked by more intrusive sexual contact than the
other survivors.

Age of OnsetZConclusion. There were significant
differences between groups in terms of age of onset, 3(2,
77) = 6.56, p < .002. Scheffe’s post-hoc test indicated
that those abused by parents and other family members were
significantly younger than those abused by non-family
perpetrators (See Table 2). Additionally, the groups
differed significantly in age of conclusion, F(2, 77) =
11.48, p < .001. Scheffe’s multiple group comparison
demonstrated that women abused by a parental figure were
considerably older when the abuse stopped as compared to
Groups 2 and 3 (See Table 2).

DurationZFregpency. As can be inferred from the above
information, the three groups differed significantly in
terms of duration of abuse, 3(2, 77) = 20.99, p < .001.
Scheffe’s post-hoc test indicated significant differences
between Group 1 and Groups 2 and 3; individuals victimized
by a parent were abused for a longer period of time as
compared to those abused by other family and non-family (See
Table 2). Additionally, there were significant differences
between the three groups in terms of number of incidents
reported, £(2, 77) = 6.058, p < .004. Again, Scheffe’s
group comparison demonstrated significant differences
between Group 1 and Groups 2 and 3; women abused by a

parental figure indicated experiencing a higher number of

69

abusive incidents as compared to those abused by other
family or non—family perpetrators (See Table 2). It should
be noted that participants may have had a difficult time
remembering or estimating the exact number of incidents
endured, thus this variable should be interpreted with
caution.

Nappy The three groups did not differ significantly in
their reports of experiencing harm, threat, or coercion by
the perpetrator(s).

Other Types of Abuse. Although groups did not differ
in their reports of parental neglect, the three groups
differed significantly with regards to reports of physical

abuse X2 (2, N = 80) = 13.07, p < .001) and emotional abuse

X2 (2, N = 80) 9.19, p < .01). Survivors abused by
primary caregivers and other family members reported
.physical and emotional abuse more frequently than did those
abused by non-family members (See Table 3).

Perceived Severity. As mentioned, participants were
asked to rate the severity of their experience on a scale
from one to five. The three groups differed significantly
in their perceptions of severity, F(2, 77) = 4.62, p < .01.
Scheffe’s test indicated significant differences between
Group 1 and Group 2 participants; women abused by parental

figures rated their overall experience as more severe than

those abused by other family members (See Table 2).

7O

 

Table 3

Between group frequencies in reportingichildhood physical abuseL
emotional abuse, and/or neglect

 

 

Group Physical Emotional Neglect
Abuse Abuse
Group 1 (N=31)
n 18 27 14
% (58%) (87%) (45%)
Group 2 (N=27)
n 11 23’ 8
% (41%) (85%) (30%)
Group 3 (N=22)
n 2 12 4
% (9%) (55%) (18%)

 

71

7 '"I .ll

 

4

Disglosure. The groups did not differ with regard to
nmaking a disclosure, however, the reactions received
ffiollowing a disclosure were significantly different between
gyroups, 3(2, 34) = 3.79, p < .03. Scheffe’s post-hoc test
jxndicated significant differences between Group 1 and Group
:3 . Consistent with prior research, individuals abused by a
parental figure reported receiving the least supportive
:Ireaction whereas women abused by non-family received the
most supportive response.

TherapyZSessions. The three groups differed
ssignificantly with regard to seeking out therapy, X2 (2, N =
£30) = 8.28, p < .02). Women abused by a primary caregiver
(97%) were more likely to indicate experience with
czounseling/therapy as compared to their peers abused by
(other family (74%) and non—family perpetrators (68%),
:respectively. Differences between groups on the number of
<:ounseling sessions attended approached but did not reach
statistical significance, £(2, 60) = 2.985, p < .058,
indicating a trend for women abused by a primary caregiver
'to report more therapy experience as compared to the other
two abuse groups (See Table 4). Standard deviations
associated with this variable did not appear to be equal
(across groups, possibly hindering our ability to detect
laetween group differences on sessions attended.

Construction of a Composite Severity Index

As expected, the three groups differed significantly

72

Table 4

Between group frequencies in reporting therapy experience and
means and standard deviations of number of sessions attended

 

Group Experience in Number of Sessions

 

Therapy Attended

n % M SD
Group 1

30 97% 210 255
Group 2

20 74% 98 124
Group 3

15 68% 87 74

 

73

with regard to severity measures (See Table 2) . Women

abused by a primary caregiver reported a higher number of

perpetrators, an earlier age of abuse onset and later age of

conclusion, a longer duration of abuse, a higher number of

incidents, a higher score on types of sexual contact,

a
higher self—rating of severity, more blaming and

unsupportive reactions to a disclosure, and more cases of

physical and emotional abuse, as compared to the other two

groups. As expected, it appears that women abused by a

parental figure endured the most severe history of abuse

followed by women abused by other family members and by non-

family perpetrators, respectively.

In order to more sensitively test the remaining
hny190theses it was deemed desirable to control for these

between group differences with regard to abuse severity;

therefore, a "composite severity index" was created. A

principal components factor analysis was conducted to

determine whether one or more factors explained significant

variation among these demographic items. Five severity

variables were entered into the analysis: age of onset,
duration, number of incidents, contact scores, and perceived
severity. The results indicated that all variables loaded
Significantly onto one factor and this factor accounted for

51% of the total variance (See Table 5) .

According to Stevens (1996), the critical value for

testing the significance of a loading for a sample of 80 is

74

Table 5

Factor analysis of demogpaphic variables assessing abuse severity

Descriptive Statistics for all groups

 

 

 

 

Age Start # of Duration Contact. Perceived
(years) Incidents (years) Score Severity
(1-16) (1-5)
1!! 5.90 49.84 6.17 8.30 3.49
SD 3.17 69.66 5.13 4.14 1.21
‘Vfiariable Component Matrix (weights)
Age Start . - . 668
ll Incidents . 774
Duration . 832
Contact Score . 64 6
Perceived Severity . 635

 

75

.572 . All five variables loaded strongly onto Factor 1

(range: Age of onset = .832 to Perceived Severity = .635).
Furthermore, item loadings indicated that this factor was
characterized by an earlier onset, more incidents or a
higher frequency of abuse, a longer duration, higher contact
scores, and higher perceived severity ratings. As a result,
factor-derived weights were assigned to each variable and a
factor score representing a composite severity score for
each participant was created.

Composite severity scores were significantly different
between groups, E(2, 74) = 16.99, p < .001. Scheffe’s post-
hoc test indicated significant differences between Group 1
participants and participants in Groups 2 and 3; in other

Words, women abused by primary caregivers demonstrated

Significantly higher severity scores (N = .69, SD = 1.06) ,
than either women abused by other family (N = -.32, $2 =
.66) or non-family perpetrators (N = -.59, SD = 1.00).

Based on these findings, severity scores were used as a
Covariate in the following analyses.

Analysis of CSA Groups and Psychological Adjustment

It was hypothesized that the three groups would differ
in levels of symptomatology reported; specifically,
Survivors of parental abuse were predicted to report the
highest BSI scores, followed by women abused by other family
and non-family members, respectively. An ANCOVA was

COIlducted with group membership serving as the independent

76

variable, composite severity scores as the covariate, and

BSI scores as the dependent measure.
an ANCOVA showed no

Holding abuse severity constant,
72)

significant differences between groups on the BSI, E(2,

— - 637, p < .53; therefore, the above hypothesis was not

supported .
Analysis of CSA Groups and Attachment Measures

A series of tests was run to compare the three groups
on their responses to the attachment-related measures. It
was expected that the three groups would differ in their
reports of early bonds with primary caregivers. Women

abused by a primary caregiver were expected to report the

weakest bonds with caregivers followed by women abused by
other family and non-family perpetrators, respectively.
More specifically, it was hypothesized that women in the

parental abuse group would report lower Care scores than the

other two groups; no differences in Overprotection scores

were predicted.

In addition, adult attachment orientations were
eXpected to differ between groups. It was expected that
survivors of parental abuse would display the highest levels
Of attachment-related avoidance and anxiety scores, followed

by survivors of other-familial and non-familial sexual
abuse, respectively. Additionally, it was expected that a
maj ority of the participants overall would report a fearful
Style of attachment; however, fewer survivors abused by

77

.4"

primary care-givers and/or other family members were

expected to report a secure style of attachment as compared

to participants abused by non-family perpetrators.

Famil Bonds

A MANCOVA was conducted to determine if the groups

reported differences in their emotional bonds with

caregivers. Group membership was the predictor variable,

the four scales on the Parental Bonding Inventory (PBI) were

the dependent measures (mother care, father care, mother

overprotection, father overprotection) , and composite

severity scores served as the covariate. Due to missing

data, only 71 participants were included in this analysis;
it appears that several participants had no relationship

with a father figure and were unable to complete this

portion of the PBI.

As predicted, the MANCOVA produced a significant

multivariate effect, Wilks’ E (8, 128) = 2.56, p < .013.

Univariate tests indicated that the three groups differed

Significantly on parental care scores: mother care, E(2, 67)

— 3.51, p < .035, and father care, 3(2, 67)

= 5.97, p = <
.004.

Results of Scheffe’s post-hoc test indicated
Participants in Groups 1 and 2 scored significantly lower
than Group 3 participants on mother care; in other words,
wOmen abused by a parent or other family member reported
receiving less maternal warmth and care than women abused by

non-family members. On father care, Scheffe’s test

78

demonstrated significant differences between Group 1 and
Group 3 only; women abused by a parental figure indicated
receiving less paternal warmth and care than women abused by
other familial and/or non-family perpetrators (See Table 6).
As expected, no differences between groups were noted

on Overprotection scores: mother overprotection, 13(2, 67) =
and father overprotection, E(2, 67) = 1.16, p
< - 32 (See Table 6) .

-01, p < .99,

Itfiitilt.Attachment Orientations

To compare the three groups of survivors with regard to

t:rieair adult attachment orientations, another MANCOVA was run

(ESeee Table 6). Group membership was the predictor variable,

<2<>nnposite severity scores were held constant, and each

attachment score on the Adult Attachment Survey (i.e.,
avoidance and anxiety) served as a dependent measure.

Results of the second MANCOVA indicate another

sixgnificant multivariate effect, Wilks’ E (4, 142) = 2.42, p

< .05. A univariate test indicated significant between

ginoup differences on the anxiety scale, F(2, 72) = 4.18, p <

.432; however, the direction of this difference was not

liredicted. Scheffe’s post-hoc test indicated significant

clifferences between Group 2 and Group 3 only; women abused
tb’ a non-family perpetrator indicated more attachment-
Irilated anxiety than women abused by an other family member

(See Table 6).

No significant differences between groups were found on

79

Table 6

ibuse grouLmeans and standard deviations of scores on the
Parental Bonding Inventory (P31) and Simpson Adult Attachment

 

 

 

 

 

 

gubscales
Group 1 Group 2 Group 3
(n-30) (n-27) (8'22)
Scheffe's
M SD M SD M SD E (2,67) Test

PARENTAL

BONDING

INVENTORY
’i‘other

Care 27.32 9.77 27.1511.01 35.73 8.77 3.51M 1 £2<3
Father

Care 23.29 9.48 28.6211.54 31.5511.11 5.97" 1<3
Mother

Protection 29.58 8.23 30.85 9.67 29.82 7.63 .01 ns
Father

Protection 33.87 9.08 28.29 8.42 28.9114.36 1.16 ns
SIMPSONAAI
Avoidance

35.68 9.74 36.50 9.17 34.77 8.89 .25 ns

Mariety

20.19 7.04 17.92 6.41 22.59 7.39 4.18** 2<3

 

Note: n-71. The multivariate analysis of variance examining PB]: scores is
E ( 8, 128) =- 2.56, p < .013 and the multivariate analysis of variance
Examining Adult Attachment Indexes is _E_'(4, 142) a 2.42, p < .05.

* *2<.01

80

the avoidance/security measure, F(2, 72) = .25, p < .78. It
was expected that groups would differ on this measure of
attachment security, as well as on the anxiety subscale.
Therefore, this hypothesis was not supported.
Lastly, a Chi—squared analysis was conducted to compare
the number of secure, dismissive, preoccupied, and fearful
participants within each abuse group. The results of the
chi—squared test showed no significant differences between
the three groups X2 (6, N = 79) = 6.22, p < .40. However,
consistent with prior studies, a majority (56%) of the
participants overall endorsed a fearful style of attachment.
Furthermore, 18% of women abused by non-family endorsed a
secure style of attachment as compared to only 6% of the
Parental abuse and 12% of the other familial abuse groups
(See Table 7).
5 War
A series of hypotheses was tested to determine if the
three abuse groups differed in their responses to
attaC1}:lt1:1ent-related measures. As expected, women abused by a
primary caregiver(s) reported receiving the least amount of
Care and/or having the weakest early emotional bonds with
caregivers, followed by survivors of other familial and non-
faunilial abuse. With regard to adult attachment
orientations, the three groups did not report different

avoidance scores, but did differ significantly with regard

81

{reflble 7

Number of participants endorsing secure, dismissive, preoccupied'or
fearful style of attachment

 

If

 

 

group Secure Dismissive Preoccupied Fearful Row
Total
group 1 2 4 5 20 31
Group 2 3 8 2 13 26
Group 3 4 3 4 11 22
Column 9 15 11 44 79
Total (11.4%) (19%) (13.9%) (55.7%) (100%)

 

82

to anxiety scores. Women abused by non-familial

perpetrators reported the most anxiety interpersonally,

followed by women abused by a primary care-giver and other

family, respectively. Lastly, a majority of participants

(56%) endorsed a fearful style of attachment, which is
consistent with prior research findings.

Regression Analyses
gontributions of Abuse Severity. Parental Bonds. and Adult

Attachment Orientations to Psycholo<_Lical Adjustment
Three final statistical tests were conducted to answer

the following questions: 1) "Do early parental bonds protect

or buffer victims from the long-lasting effects of childhood

sexual abuse?," 2) "Do adult attachment orientations predict

survivors’ adjustment in adulthood?," and 3) "Do adult

attachment orientations mediate the relationship between

early bonds and current symptomatology?".
Table 8 presents the results of the first regression

equation. Severity of abuse, care (mother care and father

Care) and their interaction were entered into the equation

to Predict symptomatology. Following the recommendations of

HOlInbeck (1997) , all predictors were transformed into
StarIdardized scores prior to their entry into regression
eq'uations. Results indicate that the regression model
including both abuse severity and parental care best
predicted psychological adjustment, explaining 17% of the

Variance in symptomatology, E(3, 69) = 4.49, 2 < ~01.

83

Table 8
summary of hierarchical regression analysis of severity
and care variables in predicting BSI scores (N = 69)

 

 

 

Variable B Standard Beta
Error
VStep l:
Severity of
Abuse 9.35 4.28 .26
Step 2:
Mother Care -7.21 4.48 -.20
Father Care -4 . 93 4 . 24 - . 14
Step 3:
Severity X
Mother Care -1.72 4.47 -.05
Severity X
l . 33 4 . 14 . 04

 

Fa ther Care
- .073 for

Note: 32 = .096 for step 1 (g<.01). 32 change
step 2 (p<.10), and 52 change = .003 for step 3 (n.s.).

84

Specifically, severity of abuse accounted for 10% of the
variance in symptomatology (p<.01) and parental care
explained another seven percent (7%) of the variance
(p< - 06) .

Overall, severity of abuse was the best sole predictor
of BSI scores. Parental care scores marginally increased
the prediction of psychological adjustment, enhancing the
overall predictive power of the model. It should be noted,
however, that the unique contribution of parental care
scores approached but did not meet the conventional .05
level of significance. Furthermore, the interactions of
care and severity scores did not incrementally enhance the

prediction of adjustment .

Table 9 presents the results from the second regression
equation which examined the role of adult attachment
orientations in predicting psychological adjustment. Adult
attaChment scores (i.e., anxiety and avoidance) were
transformed into standardized scores and added to the prior
eqmat-ion to determine if their inclusion increased the
predictive power of the model. Results indicated that adult
at-t-achment: significantly predicted adjustment, accounting
for 20% of the variance in BSI scores (p < .001) .
Therefore, the final model (severity, care, care x severity,
and adult attachment indexes) accounted for 36% of the

variance in current adjustment, £(7, 69) = 5.28. p < .001.

85

Table 9

summary of hierarchical regression analysis of severity, '
carehseverity X care interactions, and adult attachment
anxiety and avoidance scores in predicting BSI scores

 

 

 

 

(N = 69)
Variable 8 Standard Beta
Error
Step 1:
Severity of
Abuse 7.94 3.85 .22
Step 2:
Mother Care -6.15 4.02 -.17
Father Care .77 4.00 .02
Step 3:
Severity X
Mother Care -l.12 4.03 —.03
Severity X
Father Care .13 3.68 .01
Step 4: .
Avoidance 7.74 4.32 .21*
Anxiety 13.42 4.04 .37***

 

 

Note : 52 = .096 for step 1 (p<.01), 52 change = .073 for
step 2 (2<.10), 32 change = .003 for step 3 (n.s.), 52
change = .201 for step 4 (p<.01) .

*-05<3<.1o; **E<.05; ***E<.01

86

M iational Anal ses

It was also expected that the adult attachment indexes

would mediate the relationship between early emotional bonds

and current symptomatology. In order to explore this

hypothesis a series of regression equations was tested based

on the recommendations of Baron and Kenny (1986) .

Initially, mother and father care scores were entered

as a block into a regression equation of BSI scores,
controlling first for severity of abuse. Results indicated
that parental care marginally enhanced the prediction of

= .07; p < .06) (See Table 10 -

symptomatology (R2 change

Model 1). Secondly, separate regressions were conducted to

determine if parental care predicted adult attachment
avoidance and anxiety scores, again controlling for severity

In these equations, parental care significantly
= .144,- p <

of abu se .

enhanced the prediction of avoidance (R2 change

-01) . but did not predict anxiety scores (R2 change = .062;

9 < - 12) (See Table 10 - Model 2a and 2b).

C2<3ntrolling for severity, early parental care and adult

attachment avoidance/anxiety scores were entered into the

thirci and final equation to predict BSI scores (See Table 10

‘ Model 3) . Results indicated that adult attachment

O“sientations significantly predicted BSI scores (R2 change
= .03; p

’25 z p < .01) , while care scores did not (R2 Change

< - 26) . Consequently, once adult attachment orientations

were controlled, parental care no longer predicted

87

Table 10

summary of regression analyses of the role of adult
attachment orientations in mediating the relations between
childhood sexual abuse and psychological adjustment (N=69)

 

 

*—

 

 

Model 1. Severity of abuse and parental care effectson
BSI scores.
Variable B Standard Beta
Error
Step 1:
Severity 9.01 4.15 . .25**
Step 2:
Mother Care -.72 .41 -.21*
Father Care -.45 .38 -.14

 

Note: 52 = .096 for step 1 (p<.01); 52 change = .073 for

step 2 (p<.10) .

 

Model 2a. Severity of abuse and parental care effects on

aVOi dance .

 

\
Var-i able

 

B Standard Beta

.\ Error

Step 1:

SeVerity of

AbuSe 1.62 1.03 .18

Step 2:

Mother Care -.11 .10 -.13
W1.- Care -.27 .09 -.33***

 

Note: R2 = .050 for step 1 (E<.10); 32 change = -144 for

step 2-(E<.01).

88

 

Table 10 (continued)

 

’i

baodel 2b. Severity of abuse and parental care effects on

 

 

 

 

anxiety.
Variable B Standard Beta
Error
Step 1:
Severity of
Abuse -1.12E-02 .85 -.01
Step 2:
Mother Care 7.63E-03 .08 .01
Father Care -.16 .08 -.25**
Note 52 .001 for step 1 (n.s.); 52 change = .062 for

 

Model 3. Severity of abuse, adult attachment
orientations, and parental care effects on BSI scores.

 

 

Va ri abl e B S tandard Be ta
Error

Step 1:

Severity of

Abuse 7.87 3.74 .22**

Step 2:

Avoidance .82 .45 .20*

AHXiety 1.92 .55 .37***

Step 3:

MOther Care -.61 .37 -.18*

Father Care 7.212-02 .36 .02

 

 

Note: 52 = .096 for step 1 (p<.01); 52 = .250 for step 2
(E<-01); R2 = .027 for step 3 n.s.).
*.05<p<.10; **p<.05; ***p<.01

89

Symptomatology. The modest relationship observed in the
first equation between care and BSI scores is explained
entirely by the mediator. Thus, the hypothesis that adult
attachment orientations mediate the relationship between
early bonds with caregivers and long-term adjustment for
surVivors is confirmed for this sample.

In conclusion, of all the assessed variables, adult
attachment was the best predictor of survivor adjustment,
explaining the largest portion of variance. Furthermore,
adult attachment orientations functioned as a significant
mediator, mediating the relationship between early bonds and
long—term adjustment.

Post-Hoc Analyses

In light of the above findings, two series of post-hoc
analyses were conducted in the hopes of further illuminating
unexpected results. The first series continued to explore
BSI scores among the three abuse groups. The second series
0f post-hoe tests examined the impact that additional
Support from an adult figure had on certain variables.
ms tomatglogy Scores Across Groups

The finding that the three groups did not differ with
regards to BSI scores was surprising and not expected. As
mentioned, the three groups reported similar total scores or
Similar scores on the Global Severity Index of the BSI. The
BSI also consists of the following nine subscales:

somatization, obsessive—compulsive, interpersonal,

90

 

depression, anxiety, hostility, phobia, paranoia, and
psychoticism. To determine if the three groups differed on

any of the nine symptom dimensions, nine additional ANOVA’s

were conducted.
Results indicated that groups did not differ
Significantly on any of the symptom subscales: Somatization,

_F_ (2, 76) = 2.33, p < .10; Obsessive-Compulsive, _F_ (2, '76) =

.202, p < .82,- Interpersonal, E (2, 76) = .365, p < .70;
Depression, E (2, 76) = .525, p < .43,- Anxiety, E (2, 76) =
.610, p < .546,- Hostility, E (2, 76) = 1.05 = p < .36,-

Paranoia, E (2, 76) = 1.04, p < .36; Psychoticism, E (2, 76)
= -721, p_ < .50 (See Table 11).

In continuing to explore the reported symptomatology
scores among this sample of survivors, a second post-hoe
analysis was conducted. Participants were separated into
LOW and HIGH severity groups to determine if severity of
abuse was directly related to symptomatology scores. The
median score on the composite severity index variable was
identified (M_dn_ = -.23052) and two new groups were created:
Low and High severity groups.

Next, an ANOVA was conducted to test for differences on
the BSI between LOW and HIGH severity groups. Results
indicate that the differences between groups approached but
did not reach statistical significance, EU, 74) = 3.70, p <
.058, indicating a trend for the participants assigned to

the high severity group to report higher BSI scores than

91

Table 11

Post-hoe analysis:
nine BSI symptom subscales

_———

Between groups means and standard deviations on

 

 

 

 

Interpersonal, DEP 8 Depression, ANX = Anxiety, HOS =- Hostility, PHO =
None of the between

Phobia, PAR a Paranoia, and PSY - Psychoticism.

group comparisons were significant.

 

92

Group 50M OBS INT DEP ANX HOS PHO PAR PSY
Grpl
x 14.77 16.00 10.97 16.06 14.55 10.26 9.06 12.03 11.16
SD 6.67 5.23 4.18 5.71 5.86 3.75 3.97 4.04 4.13
64592 ,
H 12.08 15.12 10.08 13.96 13.23 9.54 7.73 10.58 9.96
SD 3.19 5.32 3.79 5.76 3.84 4.32 2.61 3.26 3.07
Grp3
H 12.14 15.81 10.86 14.68 14.36 10.86 8.09 10.86 10.41
SD 5.37 5.77 4.56 7.12 5.25 4.53 4.03 4.82 4.15
Note : $0M =- Somatization, 085 =- Obsessive-Compulsive, INT =-

tlnose women assigned to the low severity group.

Finally, the relationship between severity of abuse and
symptomatology was examined within w of the three abuse
groups. Simple correlations of severity and BSI scores were
Calculated (Group 1: p = .45, p > .01; Group 2: g = .23, p >
.217; Group 3: p = —.18, p > .45). A strong relationship
between severity and symptomatology was noted for Group 1
cu1137. Next, correlations were transformed into z-scores and
between group comparisons of transformed scores were
conducted using Fisher's exact tests. These results
revealed a significant difference between Groups 1 and 3, (z
= :2.:19, p < .05). Thus, the relationship between severity
and symptomatology was significantly stronger for women
abused by primary caregivers relative to those abused by
non— familial perpetrators.

The Impact of Additional Social Support

.Aunother series of post-hoc analyses was conducted to
explxalre the impact of receiving additional social support.
AS “Raritioned previously, access to meaningful attachment
relationships in childhood is associated with better
security and adjustment in adulthood. Although parents
Often serve as the primary attachment figure in most
children’s lives, grandparents, neighbors, and teachers can
also serve as a supportive attachment or a "secure base" for

In the present study, participants were asked to answer

93

the following question: "Besides your parents, was/were
there any other adult figure(s) who you felt especially
close to or who cared for you and supported you consistently
during your childhood?". It was hypothesized that access to
a supportive/caring adult figure, in addition to or besides
a parent, should facilitate the healing process, resulting
in higher adjustment scores and more security
interpersonally.

Two groups were created, those who indicated a
supportive relationship with a non-parental adult figure (N
= 44) and those who did not endorse this item (N = 36) . The
two groups were compared on numerous measures, including
severity of abuse, adult attachment anxiety and avoidance
scores, and symptomatology scores. Results indicate that

the two groups did not differ significantly on any of the

mentioned measures. Specifically, groups reported similar

scores on severity of abuse, E (1, 75) = .64, p < .43,
attachment-related anxiety, E (1, 78) = .80, p < .37,
attachment-related avoidance, E (1, 78) = .1.32, p < .26,
and BSI scores, E (1, 78) = .12, p < .73.

Lastly, correlations between severity and
SYII‘PtZOmatology were calculated for women who received
additional support (; = .41, p < .01) and those who did not
(I. = . 07, p < .71) . A strong relationship between severity
and Symptomatology was found for the additional support

group, Next, correlations were transformed into z-scores

94

and a between group comparison of transformed scores was

conducted using a Fisher exact test. Results indicate no

Significant differences between groups on correlation
figures (; = 1.54, p = n.s.).

In conclusion, having access to a supportive non-
parental adult figure was not related to experiencing a less
severe history of abuse for this sample, nor did it

significantly influence participants’ level of attachment or

adjustment in adulthood. Furthermore, although severity of

abuse and symptomatology were correlated within the
supported group (i.e., women who received additional non-

parental support), this relation was not statistically

different across the two groups.

95

 

DISCUSSION

This study explored the contributions of parent-child
bonds and adult attachment orientations to the psychological
adjustment of women with a history of childhood sexual
abuse. It was predicted that women abused by a primary
caregiver would report a more severe history of abuse,
weaker emotional bonds with parents, more symptomatology in
adulthood, and more adult attachment insecurity, followed by
their peers in the other familial and non-familial abuse
groups, respectively. It was also proposed that a healthy
emotional bond with a primary caregiver would serve to
buffer or protect a victim from the long—term effects of
abuse. Furthermore, survivors’ adult attachment
orientations were expected to mediate the relationship
between their early bonds with parents and current
psychological adjustment.

In this section a summary of the overall findings, as
well as possible explanations for certain findings will be
offered. In addition, the distinctive characteristics of
the current sample and the unique contribution of a
"composite severity index" presented in this study are
discussed. Lastly, limitations of the study and
recOmmendations for future research will be offered.

Overview of Findings

Although not all of the original hypotheses were

96

Supported, this study offers some unique and interesting
details regarding the psychological adjustment of childhood
sexual abuse survivors. Specifically, the findings
contribute to our understanding of the role early emotional
bonds and adult attachment orientations play in the long-
term adjustment of survivors. A discussion of each of the
major findings is offered below.

Severity of Abuse

A majority of the women who volunteered to participate
in this study recalled experiencing a very serious history
of childhood sexual abuse as compared to many other survivor
samples. Overall, 38% reported having been abused by
multiple perpetrators, 43% experienced intercourse, 53%
experienced harm/threat, the average duration of abuse was
more than six years, and 39% also indicated a history of
physical abuse. Given that this particular sample tended to
report a relatively severe history of abuse, the results of
this study should generalize to individuals with a similar
history.

As expected, women abused by a primary caregiver
reported experiencing the most severe history of abuse, as
comPared to the other two abuse groups. Specifically, they
indicated more perpetrators, an earlier age of onset and

later age of conclusion, a longer duration and higher
frequency of abuse, higher scores on type of contact, and

more cases of physical and emotional abuse, as compared to

97

their counterparts.
The above finding is consistent with prior studies

comparing intra-familial and extra-familial abuse survivors

on abuse characteristics. Gregory-Bills and Rhodeback
(1995) , for example, found participants in an intra—familial

abuse group to be younger at the time of initial abuse and

to be abused for a longer period of time than women in an

extra-familial abuse group. Furthermore, several

researchers have observed that abuse occurring between

fathers and daughters frequently starts earlier, lasts

longer, and involves a higher frequency of sexual activity
than abuse occurring between other victims and perpetrators
(Courtois, 1988; Finkelhor, 1990,- Wyatt & Newcomb, 1990).

Consequently, it can be concluded that the potential for

abuse to start earlier, to last longer, and to escalate over

time is more likely when the perpetrator lives under the
same roof as the victim or has greater access to the victim
by being a relative.

As mentioned, women sexually abused by a primary

Caregiver were also more likely to report a past history of

thSical and emotional abuse, as compared to their

counterparts. This is consistent with prior research as

Well which has indicated that incest survivors tend to

reE><:>:l:‘t more physical and emotional abuse than non-incest
and/or control groups (Briere & Runtz, 1990; Edwards &

Alexander, 1992,- MacNab & Bieschke, 1997). According to

98

 

Briere and Runtz (1990), sexual abuse (incest, in
particular) seldomly occurs in a vacuum, but rather co-
occurs with other types of abuse and neglect. Overall, the
sexually abusive parent (i.e., more commonly, the father),
as well as the non-offending parent (i.e., more commonly,
the mother), are both more prone to exhibiting other types
of abusive behavior in comparison to parents heading non-
incestual families.

Given the high incidence of physical and emotional
abuse among this sample, caution should be used when drawing
conclusions and making interpretations about the long-term
effects of abuse. Experiences of physical and/or emotional
abuse have their own distinct effects and have been linked
to a variety of problems and psychological symptoms in
adulthood (Briere & Runtz, 1990) . Thus, in the present
study, considering the participants’ overall abuse history
when exploring relationships between background and reported
maladjustment, rather than focusing solely on the
Participants’ experience of sexual trauma is critical.
Consistent with Briere's (1992) recommendations, future
researchers are encouraged to consider all forms of
maltreatment simultaneously when studying the long-term
efifects of abuse.

Early Emotional Bonds with Parents
As expected, women abused by a primary caregiver (Group

1) indicated receiving the least amount of care from parents

99

overall and/or having the weakest early emotional bonds with
parents, as compared to their peers in the other abuse
groups. Findings regarding parental care and overprotection
scores among the three groups will be discussed.

Parental gare

Qrogp 1: Women abused by a primary caregiver did not
perceive themselves as having received adequate care or
nurturance from either parent during childhood.
Specifically, Group 1 women recalled their fathers to be the
least warm and nurturing of all three groups. This finding
is not surprising given that a majority (71%) of these
fathers were also named as the perpetrator by this group of
women.

Group 1 women also rated their mothers low on care;
this is consistent with prior research. For example, Mian
et al. (1994) found mothers from an incest group to be more
likely to abuse alcohol, to have been sexually abused
themselves, and to perceive their daughters more negatively
than mothers from an extra-familial abuse group, as well as
a control group. Therefore, although a causal relationship
Cannot be inferred, one can conclude that a strong
relationship between the occurrence of sexual abuse by a
primary caregiver and low parental care/high parental
neglect exists.

Group 2: Women abused by a family member other than a

Primary caregiver rated their mothers relatively low on

100

 

nuaternal care, as well. In fact, Groups 1 and 2 rated their
anathers similarly; they indicated receiving significantly
leess maternal care than did their peers who were abused by
nrxnrfamily perpetrators (Group 3). With regards to father
CEiIE, Group 2 women rated their fathers more positively on
caire than Group 1 women, but less caring than Group 3 women.

What is most interesting about the care scores for
women abused by an other family member is that a significant
number of these women indicated living with their mother
cunly during childhood. It has been stated elsewhere that
busing raised in a single parent home may put some children
at: risk for sexual victimization (Courtois, 1988; Finkelhor,
1990; Mian et al., 1994) . It might be that this group of
mothers may have been less able to provide care and
nrurturance on a consistent basis and/or less able to protect
their daughters from sexual victimization due to the
diJEficulties and added stressors associated with being a
single parent.

Additionally, a significant number of women in this
group indicated that they did not have a close relationship
Witli their father. In fact, a few participants left some or
all <of the father—related items on the FBI blank, remarking
in tflne margin that they did not know their father well
enough to respond to certain items. Furthermore, of those
PartiJcipants who were able to complete all of the items,

many still seemed to perceive their fathers as uninvolved or

101

distant. This fits with the dynamics associated with some
divorced families; distance between the non-custodial parent
and child is not uncommon. Consequently, this group of
feathers overall was rated relatively low on paternal care.

Group 3: As predicted, women abused by a non-family
member recalled both parents to be more nurturing, as
compared to their peers in the other abuse groups. Thus,
this third group of women, despite an experience of extra-
familial sexual abuse, felt more cared for during childhood.
This finding is consistent with prior research which
suggests that extra—familial abuse survivors commonly
perceive their family environments to be slightly more
healthy than intra-familial abuse survivors (Mian et al.,
1994) .
Parental Overprotection

As expected, there were no significant differences
among the three groups on parental overprotection scores.
Although women abused by a primary caregiver perceived their
fathers to be slightly more controlling than women from the
other abuse groups, this difference was not statistically
Significant. Furthermore, all groups rated their mothers
Similarly with regards to controlling and intrusive
behavior.
@mbining Past and Present Research on Survivors'

Perce tions of Earl Emotional Bonds with Parents

To date, only three other studies have specifically

102

examined the early attachment bonds (PBI scores) between

victims of sexual abuse and their parents. MacNab and

Bieschke (1997) compared women with a history of incest to
women indicating no prior sexual abuse by a family member on

PBI scores. Women in the incest group recalled their

mothers as being less nurturing and more controlling than

did women in the no-incest group. Attachment bonds with

fathers, however, did not differ between groups.

Mall inckrodt, McCreary and Robertson (1995) found incest

survivors to report significantly poorer bonds with parents,

as compared to non-abused women. Specifically, incest

survivors recalled both parents to be less emotionally
expressive and more intrusively controlling, as compared to

a non-abused group. And finally, Schreiber and Lyddon

(1998) found that survivors who perceived their fathers to
be more caring reported fewer psychological symptoms in
adL‘llthood than those women reporting lower paternal care.
Surprising to the authors, father overprotection, as well as

mother care and overprotection scores, were not

Significantly related to psychological functioning.

To summarize, two past studies, as well as the current

study, found intra-familial abuse survivors to rate their
mot31'1ers as less caring in comparison to varying control
groups (i.e., women abused by a non-family perpetrator, no-
anesg; group, and a non-abused group). With regards to

Pa .
JTel'ltal overprotection and father care, however, the

103

results have been more inconsistent. Two studies found

father care to be significantly related to psychological

adjustment and two studies did not. In addition, two of the

four studies discovered significant relationships to exist

between parental overprotection and assessed variables; the

other studies did not. Overall, results may be inconsistent

due to the different ways survivors have been grouped within

studies .
The present study offers a detailed look at the early

emotional bonds reported among varying groups of survivors.

Specifically, it adds to our understanding of how survivors’

perceptions of their early attachments to parents are

affected by or related to the victim’s relationship to the

perpetrator. In conclusion, there is some preliminary
support for the hypothesis that incest survivors demonstrate

Significantly weaker or more insecure attachment bonds with

Parents than do other survivor groups. However, further

research is needed to confirm this hypothesis and to clarify

the nature of the attachment relationships existing between

S“we‘rivors and certain family members.

Symptomatology Reported in Adulthood

The finding that the three groups did not differ in

their reports of symptomatology was not expected. What is

mo . . . . .
St surprising is that women abused by a primary caregiver

re .
ported the most severe history of sexual abuse and

rec .
e:L‘fed the least amount of care from parents as compared

104

to their counterparts, yet they did not report more

symptomatology at the time of assessment. This is contrary

to prior research which has found both abuse severity and

perceived family dysfunction to be strongly correlated with

increased symptomatology in adulthood (Alexander, 1993;

Brock et al., 1997; Finkelhor, 1989) .

A possible explanation for this finding is that a

majority of the women abused by a primary caregiver had a

positive therapeutic experience. Ninety seven percent (97%)

of the women in this group indicated a past experience in

therapy, with an average of 210 sessions attended. These

figures are remarkable; survivors from the other two abuse

groups indicated a less intensive therapy history in

comparison. Thus, it seems possible that the first group of

survivors learned to cope with the long-term effects of
abuse and to manage post-traumatic symptoms associated with

abuse while in therapy.
It is also possible that the instrument used to measure

adjustment, the Brief Symptom Inventory, was not the best

instrument to use in this study. A few researchers studying

the long-term effects of sexual abuse have argued that some
SL13=‘\rivors do not exhibit PTSD symptoms or a disturbance in
functioning in adulthood (Green, 1993; Murphy et al., 1988);
re”:11er, they tend to suffer more from interpersonal problems
(Conte & Schuerman, 1987) and/or more from pervasive

Cii
St—L1:rbances of the self (i.e., Axis II personality

105

disorders) (Herman & vanderKolk, 1987). The BSI was

designed to measure the overall level of distress or
psychosocial symptoms reported by an individual; therefore,
this particular instrument is more likely to tap into PTSD

symptoms and less likely to tap into interpersonal or Axis

II problems. Although other researchers have used the BSI,

or a version of the original symptom checklist developed by

Derogatis, as an outcome measure when studying the long—term
1992;~

effects of abuse (Alexander, 1993,- Braver et al.,

1998), alternative

Fromuth, 1986; Schreiber & Lyddon,

measures of adjustment might be more appropriate to use with

this population.
Post-hoc Explorations of Symptomatology Across Groups

To further understand why differences were not found

between the three abuse groups with regard to reported
S)VTt‘tptomatology, several post-hoc analyses were conducted.
First, the three groups of survivors were compared on each
the nine BSI symptom subscales; no between group

Of
It is most surprising that the

differences were found.
t3-1'13:"ee groups did not differ on the BSI Interpersonal
Subscale, given that the groups did, in fact, differ
significantly on Simpson's anxiety subscale, measuring
interpersonal anxiety.

Items associated with each subscale were examined

cJ—Osely. Overall, it appears that the two subscales tap

i I o s a
111:0 different interpersonal characteristics or concerns.

106

 

Simpson’s anxiety index, which measures the amount of
tension and worry felt in romantic relationships (i.e., I
rarely worry about my partner leaving me), taps primarily

into a participant’s fear of abandonment. The BSI

Interpersonal dimension, on the contrary, appears to

highlight a participant’s level of self-consciousness or

perceived inferiority in interpersonal relationships (i.e.,

Feeling inferior to others; Feeling very self-conscious with

others). Therefore, it appears that the groups differ with

respect to abandonment issues, but do not differ with regard

to inferiority concerns.

In another related post-hoe analysis, survivors with

high severity index scores were compared to those with low

Severity scores on reported symptomatology. There was a

trend for those with higher severity scores to report higher

this difference was not

SYmptomatology scores; however,
Neither of these post-hoc

Significant at the .05 level.
tZests added much to our understanding of why the three

groups of survivors reported similar levels of adjustment in

adulthood, despite significant differences in their

experiences of abuse; thus, a third and final post—hoc test

wa S conducted .
The relation of severity to symptomatology was explored

among the three abuse groups; a significant difference was
Cs-etected between Groups 1 and 3. Specifically, the

correlation was strong and positive for women abused by a

107

 

primary caregiver (i.e., as severity increases,

symptomatology increases), whereas the relationship between

severity and BSI scores was weak for those abused by non-

family perpetrators. It might be concluded that the closer

a victim is to the perpetrator, as in the case of parental

abuse, the more strongly severity of abuse is related to

adult adjustment .

ggmparing BSI Scores to Standardized Norms

In a continued effort to simply understand the levels

of symptomatology reported by this sample, current BSI

scores were compared to standardized norms. Presently, four

major norms have been developed for the BSI, developed from

four distinct normative samples: 1,002 adult psychiatric in-

974 adult non-patients, 423 adult psychiatric out-

patients,
The BSI scores

IPEitzients, and 2,408 adolescent non-patients.

(i -e., Global Severity Index, in particular) of the present

Sample were compared with those scores reported by the adult

psychiatric outpatient and adult non-patient normative

Samples .
the present sample scored much higher on

= 1.34;

Interestingly,

the Global Severity Index of the BSI (GSI: Group 1

Cglfoup 2 = 1.10; Group 3 = 1.21) than the female adult non-

patient sample (GSI = .35) and similarly to the sample of

female adult psychiatric outpatients (GSI = 1.40) . This

indicates that the present sample was experiencing a level

Of distress that is close to what most clients seeking

108

outpatient therapy report. Thus, regardless of group

assignment, survivors in the current study reported

experiencing a significant level of distress at the time of

assessment. This makes sense given that this sample tended

to report a severe history of sexual abuse and past

experience in therapy .

In conclusion, the three groups of survivors in the

present study did not report differences in symptomatology,

despite group differences in abuse severity. Nevertheless,

a relationship between several abuse characteristics and

symptomatology was noted. BSI scores were significantly

correlated with duration of abuse, perceived severity,
Furthermore, the

and

composite severity index scores.

relationship between composite severity scores and
Symptomatology was especially strong for women abused by a
primary caregiver. Overall, it can be concluded that
experiencing a severe history of abuse is frequently

associated with more symptomatology in adulthood and that

t?—11:i_s relationship depends in part on the relationship

between victim and perpetrator.
Adult Attachment Orientations

\Adiilt Attachment Styles

In the past, researchers have found a high proportion

( 5 8 -60%) of sexually abused women to be classified as
fearfully attached, in comparison to non-clinical and/or

r1(Din—abused populations (Alexander, 1993; Stalker & Davies,

109

1994). Non—clinical samples, for example, typically break

down in the following manner: 46% secure, 18% dismissive,

14% preoccupied, and 20% fearful (Bartholomew & Horowitz,

1991) . Consistent with prior research, a majority of the
current participants (56%) endorsed a "fearful" style of

adult attachment. Fearful individuals incorporate a

negative view of both self and other and tend to exhibit low
self-esteem, little trust of others, and a fear of intimacy
in relationships.

For decades, clinicians and researchers have agreed

that two of the most common long-term effects exhibited by

victims of sexual trauma are: (1) a poor self-concept and

(2) a decreased sense of trust in others (Alexander &

1987; Courtois, 1988; Finkelhor, 1990; Stalker &

Lupfer,
Given that these two common long-term

Davies, 1995) .
effects of sexual abuse are identical to the two primary

Characteristics of a fearful style of attachment (negative
View of self and other), it is not surprising that this

population frequently self-identifies as fearfully attached

i 1:1 adulthood .
It was also expected that women abused by a non-family

perpetrator would be the most likely of the three groups to
e3|:1ciorse a "secure" style of attachment; this finding was

SI-Il-E>ported though not at a statistically significant level.

To review, 6% of women abused by primary caregiver, 12% of

women abused by other family, and 18% of women abused by

110

 

non-family indicated a secure style of attachment.
Interestingly, Group 3 women rated their parents as more

caring and/or perceived their attachment bonds with parents

to be healthier than their counterparts. Thus, a

relationship, albeit weak, between the perception of having

had positive childhood bonds with parents and endorsing a

secure style of adult attachment in adulthood was found.

Adult Attachment Avoidance
It was also expected that the three groups would

display different attachment-related avoidance and anxiety

scores. The avoidance subscale specifically measures the

level of comfort one feels with intimacy and closeness in

relationships. Contrary to predictions, the three groups

did not report significantly different avoidance scores.
This means that group members indicated experiencing similar

levels of discomfort with closeness in their interpersonal

re lationships .

In a comparable study, MacNab and Bieschke (1997) found

incest and no-incest groups to differ significantly on two

Similar attachment—related variables: comfort with intimacy

and trust. The incest group scored lower than the no-incest

group on both variables, indicating less comfort with

eIt'lotional intimacy and trust. This finding is consistent

wi th clinical observations, as well as a body of research,
recognizing that emotional intimacy and trust are strongly

influenced by a history of sexual abuse (Alexander, 1992;

111

 

Finkelhor et al., 1989).

Courtois, 1988;
The fact that the three groups of survivors in the

present study did not differ on Simpson's avoidance subscale

was not predicted, but is explainable. Upon close

examination of the group means, it was noted that all three

groups scored particularly high on this scale, higher than

previously assessed samples. (Higher scores indicate more

discomfort with intimacy and closeness in relationships.)

For example, Lopez, Fuendeling, Thomas, and Sagula (1997)

surveyed a sample of non-clinical college students on
These students

several attachment related measures.
= 26.03) as

reported considerably lower avoidance scores (M

compared to all three groups of survivors in the present

- 35.68, 36.50, 34.77, respectively).

Sample (_M. -
Thus, consistent with past research, a majority of all

survivors in the current study indicated discomfort with

interpersonal intimacy. Regardless of the victim’s
childhood sexual abuse is

relationship to the perpetrator,

jdrlxiariably associated with being misled, violated, or

eJ-Cfizdoited by someone who "should be" safe and trustworthy;
tlifterefore, it makes sense that this population as a whole
w(:rL1ld.struggle with trust and intimacy in adulthood,

regardless of the victim’s relationship to perpetrator.

Adu l t Attachment Anxiet

As expected, the three groups of survivors in the

p3'5‘esent study responded differently to the adult attachment

112

 

anxiety-related items. The anxiety subscale specifically
measures the amount of tension and worry felt in romantic
relationships. Findings demonstrated that women abused by a
non-family member indicated the most anxiety
interpersonally, as compared to their counterparts. The
direction of this finding was unexpected; it had been
hypothesized that women abused by a primary caregiver would
report the most tension and worry in their adult
interpersonal relationships. A possible explanation for
this disparity is offered.

Some prior research indicates that victims abused by
strangers can experience more post-traumatic fear and
anxiety than other victims. According to Browne and
Finkelhor (1986), "whereas abuse by a trusted person
involves betrayal, abuse by a stranger or more distant
person may involve more fear, and thus be rated more
negatively at times" (p. 73). Specific to the current
findings, one might further speculate that victimization by
an unknown individual (especially a stranger) can prompt a
victim to feel less empowered and less in control of her own
safety. This may subsequently prohibit a victim from
trusting any unknown person, leaving her feeling more
anxious interpersonally, overall.

Again, it also appears that all three groups of
survivors reported higher scores on the anxiety scale than

past non-clinical samples. (Higher scores indicate more

113

 

 

 

'1‘

In

I"?

LI)

(D

tension and worry in interpersonal relationships.) The
aforementioned group of college students, surveyed by Lopez
et al. (1997), reported lower attachment-related anxiety (M
= 16.40) as compared to the three groups of survivors in the
current study (M = 20.19, 17.92, 22.59). Overall, the
present sample reported more attachment-related anxiety and
avoidance than past non-survivor samples.

The Prediction of Survivors’ Psychological Adjustment

The final analyses may offer the most compelling
information. Several regression equations were conducted in
order to determine the role that severity of abuse, parental
care, and an interaction of the two played in predicting the
current psychological adjustment for a group of childhood
sexual abuse survivors.

Initially, results indicated that severity of abuse was
the best predictor of psychological adjustment, as defined
by BSI total scores. Parental care, on the contrary, only
marginally enhanced the prediction of adjustment after
severity scores were controlled. Consequently, it can be
concluded that, for this particular sample, early parental
bonds did not significantly protect a victim from the long-
term effects of abuse. Rather, experiencing a less severe
history of abuse was more closely linked to reporting better
adjustment in adulthood.

This finding was unexpected and is difficult to

explain. In past studies, receiving ample parental care and

114

 

 

Ch

nurturance from a primary caregiver has been significantly
related to better psychological adjustment for survivors.

As mentioned earlier, Schreiber and Lyddon (1998) found that
incest survivors who perceived their fathers as more caring
reported fewer symptoms in adulthood. Furthermore, Brock et
a1. (1997) found survivors who rated their families as more
"healthy" also reported fewer psychological symptoms than
did women who perceived their families as less healthy.
Thus, having positive perceptions of early familial
relationships seems to have served as a protective factor
against some of the long-term effects of childhood sexual
abuse for some samples.

As mentioned, in the current study severity of abuse
was a better predictor of current adjustment than
recollections of early parental care. Although this was not
predicted, the finding that severity of abuse best predicted
adjustment has been supported previously. Alexander (1993),
for example, found characteristics of abuse severity to
significantly predict symptomatology in adulthood. More
specifically, upon examining the predictive power of both
abuse and attachment variables, Alexander found that PTSD
symptoms were best predicted by abuse characteristics, while
personality dysfunction was best predicted by adult
attachment patterns.
W

The results of Alexander’s (1993) study are consistent

115

 

 

 

with the findings of our first regression equation; however,
contrary to her findings, adult attachment orientations
(i.e., avoidance and anxiety) were found to significantly
predict BSI scores in our second regression equation.
Remarkably, attachment-related avoidance and anxiety scores
were the most efficient predictors of adjustment, explaining
an additional 20% of the variance in symptomatology after
abuse severity and parental care scores were controlled.
Furthermore, adult attachment orientations were found to
mediate the modest relationship between early bonds and BSI
scores in this series of regression analyses.

This finding is consistent with several other studies
examining the predictive power of attachment—related
measures (Carnelley et al., 1994; Lopez, 1996; Parker et
al., 1992). These authors all found that adult attachment
orientations predicted current outcomes better than did
measures of early emotional bonds with parents.
Specifically, the effects of childhood emotional bonds on
certain assessed variables (i.e., constructive thinking,
depression) were indirect, and effectively mediated by
current adult attachment orientations. Similarly, in the
present study, it appears that current adult attachment
orientations play a more significant role in predicting
adult survivor adjustment than do early attachments with
parents.

The information gleaned from the regression analyses

116

 

 

can be applied directly to practice or counseling with this
population. Findings suggest that counselors may be able to
facilitate improvements in adjustment and functioning by
first exploring and assessing the quality of a client’s
current adult attachments with others, including family,
friends and partners. Women reporting higher levels of
attachment-related anxiety and/or avoidance in their current
relationships may be at risk for exhibiting lower levels of
functioning and for possessing fewer skills to cope with the
long-term effects of sexual trauma. In addition, given that
severity of abuse was also significantly related to
adjustment, exploring the client’s history of abuse also
seems critical. Allowing a survivor to verbalize her
history of abuse at an appropriate pace, connecting emotion
with memory, should also facilitate the healing process and
produce symptom reduction for the client.

In conclusion, counseling interventions designed to
reduce post-traumatic symptoms and enhance current
relationships with attachment figures may prove to be the
best type of intervention to utilize with survivors in
therapy. Given that past and present research in this area
is somewhat inconsistent, continued research is needed in
order to better understand which family and/or abuse
variables best predict adjustment, and specifically for

which outcome measures.

117

 

 

 

Major Contributions of the Current Study
Classifying Survivors into Three Groups

One way in which this study differs from past studies
is in how the sample of survivors was organized; survivors
were categorized into three groups based on their
relationship to the perpetrator(s). The three groups
included women abused by a primary caregiver(s), women
abused by any other family member, and women abused by a
non-family perpetrator. Prior researchers have tended to
compare either abused and non-abused populations or intra-
familial versus extra-familial abuse survivors.

Organizing survivors into three groups appears to offer
several benefits, as well as several drawbacks. An obvious
benefit is the ability to compare survivors with varying
histories of sexual abuse on several measures.
Specifically, it permitted exploration of the relationship
between a critical abuse characteristic (i.e., the victim's
relationship to the perpetrator) and observed attachment
patterns and adjustment levels in adulthood. Researchers
have documented the relationship between victim and
perpetrator to be critical when exploring the long-term
sequelae of sexual abuse. Furthermore, attachment theory
underscores the importance of the early bond between a
parent and child, making it especially important to
distinguish those participants who had been abused by a

parental figure from those who had not. Thus, attending to

118

 

 

 

the victim’s attachment to the perpetrator, not just whether
or not the victim is related to the abuser, offers
additional information to this domain of research.

The most obvious drawback to creating three groups of
survivors is that it becomes more difficult to compare the
results of the present study to past studies. In short,
between group comparisons and between study comparisons are
more complicated, which may hinder the process of blending
results or offering a comprehensive discussion of related
findings. Given that this is the first study to categorize
survivors using a three group method, future researchers are
encouraged to continue to explore the value of this method
over others.

The Contributign of a Composite Severity Index

As mentioned earlier, the three groups of survivors
differed significantly with regard to severity of abuse.
Therefore, it was deemed necessary to control for abuse
severity in the subsequent analyses in order to adequately
compare the three groups on measures of attachment and
adjustment. This was done by creating a "composite severity
index".

The utilization of a severity index is new to this
domain of research. A literature review indicates that
severity has not been controlled in past studies. In fact,
some researchers have failed to even describe the severity

of sexual abuse endured by their samples (Green, 1993). In

119

 

 

recent studies, it seems that most researchers tend to
acknowledge between group differences in severity (often
between intra- and extra-familial abuse survivors) when
interpreting results, but do not control for these

differences statistically. Although other researchers

 

(MacNab & Bieschke, 1997) have recommended using a severity
index, to date this is the first study to do so. The
numerous benefits, as well as some potential drawbacks, to

creating a severity index will be outlined below.

 

Most importantly, creating a composite severity index
allowed variations in the experiences of sexual abuse to be
quantified. By aggregating several relevant abuse
characteristics into a combined index, we were able to
conduct between group comparisons while controlling for the
confounding effects of abuse severity. Given that abuse
histories among the survivor population tend to vary
drastically, controlling for severity when making between
group comparisons seems like a necessary and critical
statistical procedure.

Drawbacks to creating a severity index should be
mentioned, as well. First, the experience of childhood
sexual abuse is subjective, making it extremely difficult to
quantify. Assigning participants a "score" that accurately
reflects their experience or captures the seriousness of
past trauma is difficult, to say the least. The system used

to quantify severity in the current study is quite

120

rudimentary and should be refined. In order to partially
account for the subjective nature of abuse, however,
participants were asked to offer their own perception on
severity by rating their experience on a scale from one to
five. This score was included in the composite severity
index score, increasing its overall validity.

In summary, given that the use of an index is novel, it
is recommended that the current findings be interpreted with
caution until this or similar indexes achieve appropriate
validation through confirmed usage. The eventual
development and use of more refined and sensitive severity
indexes should enhance future research in this domain.

Limitations of the Study

There are several limitations associated with this
study. First, the sample size is rather modest, entirely
female, and therefore may not be representative of the
larger population of childhood sexual abuse survivors. As
mentioned, this sample tended to report a severe history of
abuse. In addition, those who volunteered to participate in
this study had full or partial memory of the abuse and also
self-identified as survivors of childhood sexual abuse.
These characteristics may distinguish this sample from the
general survivor population, limiting the external validity
of this study. Overall, the results of this study should
best generalize to females with similar characteristics

and/or a comparable history of abuse.

121

 

 

 

In addition, some of the sampling procedures employed
may have limited the external validity of this study.
Although all of the participants were volunteers, some of
these women were recruited by their therapist. Therapists
were instructed to use their clinical judgment when
considering who to approach about the nature of the study.
It is likely that those who were approached 1) had discussed
their history of abuse with their therapist, 2) were
considered to be well adjusted enough (i.e., functioning and
coping at adequate levels) to complete a packet without
decompensating, and 3) had been working with their therapist
for a longer period of time, in order for the therapist to
feel comfortable in broaching the topic of research. This
method of selection is somewhat biased, but was implemented
for ethical purposes. Consequently, the results may not
generalize to all survivors in therapy.

A third limitation of this study is the possibility of
self-report bias, which is inherent in all survey studies.
Some participants may overestimate, underestimate, or
minimize their past experiences of abuse. In addition, the
experience of repression or other defenses may hinder a
participant’s ability to recall complete or accurate
memories of abuse.

Fourth, the retrospective methods used to assess
history of abuse and parental bonds are less than optimal.

There is no simple way to corroborate the information

122

 

reported by participants; thus, there is no guarantee that
participants’ recollections are in fact entirely congruent
with past events and relationships.

Lastly, limitations of this study result from the
choice of instruments used. For example, the Brief Symptom
Inventory may not have been the best measure of
psychological adjustment to utilize. Although prior
researchers have used versions of this instrument when
examining survivor adjustment (Alexander, 1993; Braver et
al., 1992; Fromuth, 1986), others have widened the
definition of "adjustment" to include measures of social
adjustment (Harter et al., 1988), social competency
(Mallinckrodt et al., 1995), and interpersonal relationship
concerns (Brock et al., 1997; Edwards & Alexander, 1992), as
well as measures of symptom distress. It might have been
beneficial to include several dependent variables or
measures of adjustment, in order to detect some of the
unique differences in long-term adjustment among groups.

Clinical Implications for Counseling Psychology

The findings from the current study support the
application of attachment theory as a framework for both
research and psychotherapy with survivors of childhood
sexual abuse. According to Alexander (1992), "any attempt
to predict the onset of abuse and its long-term effects must
include a consideration of the family context that mediates

the experience of the abuse" (p. 185). Attachment theory

123

 

 

 

speaks directly to the relational antecedents and
consequences of sexual abuse, and therefore, is a useful
conceptual framework when studying this research domain.

For decades, clinicians and researchers have agreed
that survivors of childhood sexual abuse frequently struggle
in their ability to maintain interpersonal relationships, to
develop a secure sense of self, and to manage intense
emotions or regulate affect. Attachment theory speaks
directly to these three areas of concern. Specifically,
researchers applying attachment theory to the area of sexual
abuse have found that survivors frequently internalize a
working model that incorporates a negative view of self and
other (Alexander, 1993; Stalker & Davies, 1993). A negative
view of other is subsequently associated with decreased
trust and difficulty maintaining interpersonal
relationships. Additionally, a negative view of self is
related to low self-worth and/or more clinical disturbances
of the self (Axis II diagnoses).

Finally, the affective coping strategies displayed by
survivors have yet to be examined empirically, however, we
do know that the strategies used by an adult are closely
related to the strategies developed and used during
childhood (Kobak & Sceery, 1988). Thus, we can speculate
that experiencing a history of childhood abuse might
significantly influence a victim’s ability to cope

effectively throughout life. In conclusion, attachment

124

 

hal-

 

theory speaks directly to the salient problems and patterns
displayed by survivors, making it an excellent base from
which to conduct therapy and research.

Applying Findings to the Therapy Relapipnship

The findings from the current study are relevant to
clinicians working with survivors of sexual abuse. Most
importantly, many survivors are fearfully attached in
adulthood, indicating low self—esteem and low trust of
others. This may make it more difficult to establish trust
or to develop a strong working alliance with this type of
client. Survivors may experience the therapeutic process as
intimidating, threatening, and/or overwhelming. Thus,
moving at a slow pace and attending to the therapeutic
relationship is critical (Pistole, 1989b).

The relationship between client and therapist is an
important attachment relationship and a valuable source of
information. The manner in which a client attaches to her
therapist, for example, is dependent on the client’s
internal working model of self and other, as well as her
attachment history. According to Alexander (1994), "by
bringing to the therapist the fears and anxieties associated
with other important attachment relationships, the client
acts out her/his internal working model through the process
of transference and attempts to fit the therapist to that
unconscious working model" (p. 667).

During the process of psychotherapy. the therapist

125

 

 

 

should serve as a "secure base," from which the client is
invited to explore past and current attachment experiences
and losses. From an attachment perspective, the long-term
goal of therapy is to help the client develop a more
favorable internal working model of self and other and to
experience an increased sense of felt security (Alexander,
1994; West, Sheldon, & Reiffer, 1990). Specifically, the
therapist hopes to "help the client increase the
permeability and complexity of these working models by
revising them both cognitively and affectively on the basis
of new information" (Alexander, 1994, p. 667).

Therapists working with survivors of childhood sexual
abuse, relying on a long-term therapy model, may choose to
focus on the survivor’s abuse history, as well as her past
and present attachments to significant others. Given the
recent trend towards time-limited therapy, however, many
clinicians are forced to limit the scope of therapy, which
tends to frustrate the process of deep exploration with some
clients. Therefore, focusing primarily on the client’s
current attachments, including her attachment to the
therapist, may prove to be the most effective type of
intervention when using a brief therapy model.

Conclusions and Directions for Future Research

This investigation set out to examine the contributions

of parent-child bonds and adult attachment orientations to

psychological adjustment within a female sample of childhood

126

 

 

 

sexual abuse survivors. Most importantly, it was determined
that women abused by a primary caregiver indicated
experiencing a more severe history of abuse and receiving
less care and more neglect from parents, as compared to
their peers in the other abuse groups. Additionally, it was
determined that survivors’ adult attachment orientations
significantly predicted their current symptomatic distress,
after controlling for abuse severity and early emotional
bonds with parents.

The present study provides support for using attachment
theory as a framework to conceptualize the long-term effects
of childhood sexual abuse. The application of attachment
theory to this research domain, however, is a relatively new
practice. Thus, future researchers are encouraged to
continue to explore and expand our understanding of this
population from an attachment-theoretical perspective.

More specifically, future researchers are encouraged to
further explore the attachment patterns displayed among
abuse survivors and their families. Overall, empirical
evidence regarding the early parental bonds and adult
attachment patterns measured among samples of survivors has
been somewhat inconsistent. There is some support for the
notion that incest survivors demonstrate significantly
weaker or more insecure attachment bonds with parents, as
well as more attachment-related insecurity in adulthood, as

compared to control groups. However, this is not consistent

127

 

 

 

 

across the board; further research is needed to confirm past
and future hypotheses. Additionally, in order to clarify
which family and/or abuse variables best predict long-term
adjustment, and specifically for which outcome measures,
further investigations are needed.

It also seems important to further explore the value of
utilizing a "severity index". To date, this is the first
study to employ such a procedure. As mentioned, creating a
severity index allowed this researcher to hold severity of
abuse constant when comparing groups of survivors on
attachment and adjustment-related variables. The severity
index used in the current study, however, is far from
polished or complete. As mentioned, a study focused solely
on the creation of the finest and most objective severity
index is needed and should enhance future research in this
area.

Another possibility for future research is to consider
the use of different measures. For example, past research
indicates that the Adult Attachment Interview (AAI)
developed by Kaplan and Main (1984), which is a one-hour
semi-structured interview, is a better measure of adult
attachment than most self-report inventories. During the
AAI, participants are asked to describe their childhood
relationships with parents, focusing specifically on any
experiences of rejection, loss, abuse, and/or separation.

Subsequently, researchers rate participants on attachment-

128

 

 

 

related variables and assign participants to one of four
attachment categories. Given that participants completing a
self-report inventory may be unable to rate themselves
accurately or may rate themselves in more socially
acceptable ways, interviewing procedures are recommended.
Past studies should be replicated using the AAI and compared
with present findings.

Finally, as mentioned, it may be beneficial to use
additional and/or alternative outcome measures in future
studies. Some of the more popular assessment instruments
may not be particularly sensitive to many of the symptoms
reported by survivors (Green, 1993) and should be used with
caution. Given that survivors struggle with interpersonal
relationships, self-esteem issues, and affective symptoms,
Ineasures that are sensitive to these types of concerns are
recommended. Furthermore, several researchers have
recommended using multiple measures to overcome the
limitations of individual measures (Briere, 1992; Green,
1993).

In conclusion, it has been shown that attachment theory
is a useful framework from which to conceptualize some of
the long-term effects of childhood sexual abuse. Continued
research is needed to confirm past findings and to explore
additional hypotheses. To the extent that predictions are
supported empirically, this attachment-theoretical

perspective on abuse should allow researchers and clinicians

129

 

 

to develop theory-based counseling interventions to use in

therapy with adult survivors of childhood sexual abuse.

 

 

 

130

APPENDIX A

TO ANY FEMALE:

IF YOU WERE SEXUALLY ABUSED As A CHILD AND ARE WILLING TO
PARTICIPATE IN A COMPLETELY ANONYMOUS AND CONFIDENTIAL
STUDY, PLEASE CALL 886-3687 or EMAIL
“thomaski@pilot.msu.edu".

If you are an adult woman who was molested or sexually
abused during your childhood (0 to 15 years old) by an adult
(someone who was at least five years older than you), your
voluntary participation is requested. The study is designed
to explore your past history of sexual abuse, past and
current relationships, and current level of adjustment. If
you volunteer to participate, you will be asked to complete
several surveys taking approximately 30 minutes of your
time. Your answers will be totally anonymous. After
completing the surveys in your own home, you will be asked
to return the packet to Kim Thomas in a self-addressed
stamped envelope enclosed in the packet. If you are
interested please call Kim Thomas at 886-3687 or email
"thomaski@pilot.msu.edu" to obtain a survey packet.

*This study has been approved by the University’s Committee
for Research Involving Human Subjects (UCRIHS).

131

 

 

APPENDIX B

Dear Participant:

Thank you for your expressed interest in this study
regarding experiences of childhood sexual abuse and current
psychological health and adjustment. This research is being
performed to fulfill the requirements for a doctoral degree
in counseling psychology. The study is being conducted by
Kim Thomas, M.A. and supervised by Frederick Lopez, Ph.D. at
Michigan State University.

The purpose of this study is to explore the early parent-
child relations, the current psychological adjustment, and
current interpersonal relationships among a group of female
survivors' of childhood sexual abuse. If you choose to
participate in this study, you will be given a packet
containing several self-report questionnaires to complete.
Some questionnaires will ask about your experiences of
childhood sexual abuse and early relationships with parents;
others will ask about your current relationships and overall
psychological health and adjustment.

It should take you about 30 minutes to complete all of the
questionnaires in this survey packet. Please answer all
questions as honestly as possible. Your responses to this
survey will be kept completely anonymous. DO NOT put your
name on any of the questionnaires. This way your name
cannot be connected to any of your answers and your
anonymity can be assured. After completing the survey
packet, please return it to Kim Thomas in the self-addressed
stamped envelope which has been provided to you.

Your participation in this survey is strictly on a volunteer
basis. You are free to withdraw your consent and stop
participating at any time. Returning this questionnaire
will be considered your consent to participate.

The phone numbers for several agencies, 24-hour crisis
lines, and therapists in the Phoenix area are being provided
to you in case you should wish to talk to a professional
about your responses to this survey. If answering the
survey items causes you any emotional discomfort, please
contact one of the names or numbers provided. If you have
any questions regarding the purpose or nature of this
research study, please contact the researcher, Kim Thomas,
at 820-3125 or Fred Lopez at 355-8502.

132

 

 

Demographic and History of Sexual Abuse Questionnaire

Thank you for deciding to participate in this project. The following questions
ask about your background. Please circle the appropriate number under each of
the items below or enter the correct information in the blank spaces provided.

1. Your sex: (circle one) 2. Your age:
(1) Male
(2) Female

3. Your ethnic/racial background:
(1) African-American
(2) Asian-American or Pacific Islander
(3) Hispanic/Latina/Chicana
(4) Euro-American/Caucasian
(S) Native-American
(6) Bi-racial

4. What is your current marital or partnership status:
(1) Married
(2) Living with partner in fully committed relationship
(3) Divorced or separated
(4) Never married and not currently living with partner
(5) Widowed

5. If you are not married or living with.a partner, what is your current dating
status:

(1) Not involved in a dating relationship

(2) Dating different people

(3) Seeing only one person, but without a commitment

(4) In a committed relationship (including engagement)

6. Who did you live with (adults only) during most of your childhood?
(1) Both parents (biological or adoptive)
(2) mother only
(3) father only
(4) mother and step-father
(S) father and step-mother
(6) parent and his/her boyfriend/girlfriend or partner
(7) other extended family members (Please specify: )
(8) Other (Please specify: )

7. How would you rate your current stress level?

Not at all Moderately Extremely
Stressed Stressed Stressed
1 2 3 4 S 6 7

8. How well are you managing your stress?

 

Not at all Moderately Extremely
well well well
1 2 3 4 S 6 7

133

Demographic Questionnaire, continued, pg. 2

Please answer the following questions about any past experiences of unwanted
sexual contact which occurred to you before age 15 by any adult or individual
who was at least 5 years older than you at the time of abuse.

9. At what age were you firs; sexually abused?
years old

10. How old were you when the/all the abuse stopped?
years old

11. What type of sexual activity were you exposed to or expected to perform?
(circle all that apply)

penetration or intercourse with perpetrator

oral contact with genitals '

touching or stimulation of genitals under clothes
touching or fondling over clothes

kissing

other (Please specify: )

 

mmbUNH

12. Who sexually abused you? (circle all that apply)

1. father

2. step-father

3 brother (including biological,

step or half sibling)

. mother

step-mother

sister (including biological,
step or half sibling)

7. other male relative (e.g. uncle,

OlUlnb

 

grandfather) specify:
8. other female relative (e.g. aunt,
cousin) specify:

 

9. other known individual (e.g. teacher,
babysitter, neighbor, my mother’s boyfriend,
my father’s girlfriend) specify:

10. unknown person/stranger

 

13. Did this person live with you during the time of abuse?
1. yes
2. no

 

14. How many times were you abused? (please estimate if unsure e.g. 1 time, 10
times, over 100 times, etc.)

approximately times

.134

 

Demographic Questionnaire, continued, pg. 3

15.

16.

17.

18.

20.

21.

22.

23.

How long did the/all abuse last? (please estimate if unsure)

approximately years and/or months

Did the abuser(s) ever harm you or threaten to harm you or anyone
else if you did not comply during/after sexual contact and/or
if you did not keep the abuse a secret?

(1) yes
(2) no

Did you tell or disclose the abuse to an adult during your childhood?

(1) yes
(2) no

If you answered yes to #17 (disclosed the abuse to someone) who did you
tell and what was his/her reaction?

18. Who did you tell?
19. What was his/her reaction? (circle one)
(1) very supportive, protected me from further harm
(2) somewhat supportive and protective
(3) unsupportive, but did not blame or reject me
(4) very unsupportive, blamed or abandoned me

 

How would you rate the severity of your abuse. "On a scale from 1 to 5 my
experience of sexual abuse was....".
Very Severe Moderately Severe Not too severe

1 2 3 4 5

Are you currently in therapy or have you ever seen a counselor to
discuss the abuse?

(1) yes
(2) no

If you answered yes to #21, approximately how many sessions did you attend
or have you attended?

approximately sessions
Besides your parents, was/were there any other adult figure(s) who you
felt especially close to or who cared for you and supported you
consistently during your childhood?

(1) yes
(2) no

1135

 

 

 

 

Demographic Questionnaire, continued, pg. 4

24. If you answered yes to #23, please specify who the individual was (or
your relation to him/her) and tell us briefly what that relationship meant

to you.

 

 

 

At any time during your childhood, do you also consider that you were:

YES NO

25. Physically abused? (e.g. physically injured

by another by non-accidental means)
26. Neglected? (e.g. left alone for

long periods of time without care)

i

27. Emotionally/verbally abused? (e.g. €

regularly threatened or demeaned) h

136

 

 

RQ

Directions: Please read each of the descriptive paragraphs below and
place a mark (X) next to the ONE that best describes how you
feel about close relationships. Secondly, please rate on a
scale from 1 (very much like me) to 7 (not at all like me) how
much EACH of these paragraphs describes you.

Most descriptive
of me
(Mark one)
1. It is easy for me to become emotionally close to others.
I am comfortable depending on others and having others
depend on me. I don't worry about being alone or having
others not accept me. 1,

Very much like me Somewhat like me Not at all like me
1 2 3 4 5 6 7

2. I am comfortable without close relationships. It is very
important to me to feel independent and self—sufficient,
and I prefer not to depend on others or have them depend

on me. 2.
Very much like me Somewhat like me Not at all like me

1 2 3 4 5 6 7

3. I want to be completely emotionally intimate with others,
but I often find that others are reluctant to get as close
as I would like. I am uncomfortable being without close
relationships, but I sometimes worry that others don't
value me as much as I value them. 3.

Very much like me Somewhat like me Not at all like me
1 2 3 4 S 6 7
4. I am uncomfortable getting close to others. I want
emotionally close relationships, but I find it difficult
to trust others completely, or to depend on them. I

worry that I will be hurt if I allow myself to become
too close to others. 4,

Very much like me Somewhat like me Not at all like me

1 2 3 4 S 6 7

137

 

 

 

S-AAS

Directions: Using the scale adjacent to each of the items below,
indicate (by circling the appropriate number) to
what extent the item describes how you have typically

felt toward ppmantig partners in genegal.
Strongly Strongly
Disagree Agree

1. I find it relatively easy to
get close to others ........ 1 2 3 4 5 6 7

2. I'm not very comfortable having
to depend on other people ...... 1 2 3 4 S 6 7

3. I'm comfortable having others
depend on me .................. 1 2 3 4 S 6 7

4. I rarely worry about being
abandoned by others ........... l 2 3 4 5 6 7

S. I don’t like people getting
too close to me ............... 1 2 3 4 S 6 7

 

6. I’m somewhat uncomfortable
being too close to others ..... 1 2 3 4 5 6 7

7. I find it difficult to trust
others completely ............. l 2 3 4 5 6 7

8. I’m nervous whenever anyone
gets too close to me .......... 1 2 3 4 S 6 7

9. Others often want me to be more
intimate than I feel comfortable
being .......................... l 2 3 4 5 6 7

10. Others are often reluctant to
get as close as I would like.. 1 2 3 4 5 6 7

11. I often worry that my
partner(s) don't really love
me ............................ 1 2 3 4 5 6 7

12. I rarely worry about my
partner(s) leaving me ......... 1 2 3 4 5 6 7

13. I often want to merge with

others, and this desire some-
times scares them away ........ 1 2 3 4 5 6 7

138

 

PBI

Directions: This questionnaire lists various attitudes and behaviors of parents. Using the
rating scale below, indicate to what extent each item describes how that parent was like in the
first 16 years of your life. Circle the appropriate scale number for each of the items below.

 

 

 

Items 1-25 regarding your mother: Items 26-50 regarding your father:
Scale: 1 - very like her 1 - very like him
.2 - moderately like her 2 . moderately like him
3 - moderately unlike her 3 - moderately unlike him
4 - very unlike her 4 - very unlike him
During my first 16 years of life. VERY MODERATELY MODERATELY VERY
my mother. . . . . LIKE LIKE UNLIKE UNLIJCE
1. Spoke to me with a warm and
friendly voice .................. 1 2 3 4
2. Did not help me as much as I
needed ........................... 1 2 3 4
3. Let me do things I like doing.... 1 2 3 4
4. Seemed emotionally cold to me.... 1 2 3 4
S. Appeared to understand my problems
and worries ...................... 1 2 3 4
6. Was affectionate to me .......... l 2 3 4
7. Liked me to make my own
decisions ........................ 1 2 3 4
8. Did not want me to grow up ....... 1 2 3 4
9. Tried to control everything I did. 1 2 3 4
10. Invaded my privacy ............... 1 2 3 4
11. Enjoyed talking things over with
me ............................... l 2 3 4
12. Frequently smiled at me .......... 1 2 3 4
13. Tended to baby me ................ 1 2 3 4
14. Did not seem to understand what I I
needed or wanted ................. 1 2 3 4
15. Let me decide things for myself.. 1 2 3 4
16. Made me feel I wasn’t wanted ..... 1 2 3 4
17. Could make me feel better when I
was upset ........................ 1 2 3 4
18. Did not talk with me very much... 1 2 3 4
19. Tried to make me dependent on
her .............................. 1 2 3 4
20. Felt like I could not look after
myself unless she was around ..... 1 2 3 4

139

 

PBI, continued, pg. 2

During my first 16 years of life. VERY MODERATELY MODERATELY VERY
my mother ......... LIKE LIKE UNLIKE UNLEE
21. Gave me as much freedom as I

wanted ........................... 1 2 3 4
22. Let me go out as often as I

wanted ........................... 1 2 3 4
23. Was overproteccive of me ......... 1 2 3 4
24. Did not praise me ............... 1 2 3 4

25. Let me dress in any way I
pleased .......................... 1 2 3 4

'26. When answering the above questions, who were you rating?
1) my biological mother
2) my adoptive mother
3) my foster mother
4) my Step-mother

 

 

 

5) another maternal figure (please specify: )

During my first 16 years of life. VERY MODERATELY MODERATELY VERY
my father. . . . . LIKE LIKE UNLIKE UNLIKE
1. Spoke to me with a warm and

friendly voice .................... 1 2 3 4
2. Did not help me as much as I

needed ............................ 1 2 3 4
3. Let me do things I like doing ..... 1 2 3 4
4. Seemed emotionally cold to me ..... 1 2 3 4
S. Appeared to understand my problems

and worries ....................... 1 2 3 4
6. Was affeCtionate to me ........... 1 2 3 4
7. Liked me to make my own decisions. 1 2 3 4
8. Did not want me to grow up ........ 1 2 3 4
9. Tried to control everything I did. 1 2 3 4
10. Invaded my privacy ............... 1 2 3 4
11. Enjoyed talking things over with

me ............................... l 2 3 4
12. Frequently smiled at me .......... 1 2 3 4
l3. Tended to baby me ................ l 2 3 4
14. Did not seem to understand what I

needed or wanted .................. 1 2 3 4
15. Let me decide things for myself... 1 2 3 4

14 0

 

PBI. continued. pg. 3

During my first 16 years of life. VERY MODERATELY
w:‘th.=000000000000000 hm hm
16. Made me feel I wasn't wanted ...... 1 2
17. Could_make me feel better when I

was upset.......... ............... 1 2
18. Did not talk with me very much.... 1 2
19. Tried to make me dependent on him. 1 2
20. Felt like I could not look after

myself unless he was around....... 1 2
21. Gave me as much freedom as I

wanted ................. . .......... l 2
22. Let me go out as often as I

wanted........ .................... l 2
23. Has overprocective of me .......... 1 2
24. Did not praise me ................ 1 2

25. Let me dress in any way I
pleased ........................... 1 2

'26. When answering the above questions, who were you rating?
1) my biological father
2) my adoptive father
3) my foster father
4) my step-father
5) another paternal figure

141

HDDERAISLY VERY
UNLIKR 1 ‘ lnEJIE
3 4

3 4

3 4

3 4

3 4

3 4

3 4

3 4

3 4

3 4

 

 

 

INSTRUCTIONS:

On the next page is a list of problems people sometimes have. Please
read each one carefully, and blacken the circle that best describes
HOW MUCH THAT PROBLEM HAS DISTRESSED OR BOTHERED
YOU DURING THE PAST 7 DAYS INCLUDING TODAY. Blacken the
circle for only one number for each problem and do not skip any items.
If you change your mind, erase your first mark carefully. Read the
example before beginning, and if you have any questions please ask
them now.

 

EXAMPLE

 

 

 

 

 

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o

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4 \ 0‘0 (x Q~
V 0 0° (’p
(a) v Nervousness or shakiness Inside

 

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Faintness or dizziness

The idea that someone else can control your thoughts
Feeling others are to blame for most of your troubles
Trouble remembering things

Feeling easily annoyed or irritated

Pains in heart or chest

Feeling afraid in open spaces or on the streets
Thoughts of ending your life

Feeling that most people cannot be trusted

Poor appetite

Suddenly scared for no reason

Temper outbursts that you could not control

Feeling lonely even when you are with people

Feeling blocked in getting things done

Feeling lonely

Feeling blue

Feeling no interest in things

Feeling fearful

Your feelings being easily hurt

Feeling that people are unfriendly or dislike you
Feeling inferior to others

Nausea or upset stomach

Feeling that you are watched or talked about by others
Trouble falling asleep

Having to check and double-check what you do
Difficulty making decisions

Feeling afraid to travel on buses. subways. or trains
Trouble getting your breath

Hot or cold spells

Having to avoid certain things. places. or activities because they frighten you
Your mind going blank

Numbness or tingling in parts of your body

The idea that you should be punished for your sins
Feeling hopeless about the future

Trouble concentrating

Feeling weak in parts of your body

Feeling tense or keyed up

Thoughts of death or dying

Having urges to beat. injure. or harm someone
Having urges to break or smash things

Feeling very self-conscious with others

Feeling uneasy in crowds, such as shopping or at a movie
Never feelingclose to another person

Spells of terror or panic

Getting into frequent arguments

Feeling nervous when you are left alone

Others not giving you proper credit for your achievements
Feeling so restless you couldn't sit still

Feelings of worthlessness

Feeling that people will take advantage of you if you let them
Feelings of guilt

The idea that something is wrong with your mind

 

143

 

 

 

APPENDIX C

RESOURCES

Hotlines & Crisis Intervention

Listening Ear ...................................... 337-1717
Emergency Services @ Community Mental Health ....... 346-8460
Sexual Assault Hotline (MSU) ....................... 372-6666

Local Psychotherapists and Counseling Agencies

Council Against Domestic Assault .................... 372-5572
Community Mental Health ............................. 374-8000
Cristo Rey Community Center ......................... 372-4700
Comprehensive Psychological Services ................ 337-2900
Frank & Associates .................................. 332-3557
MSU Psychological Clinic ............................ 355-9564
MSU Counseling Center (free for students) ....... ,...355-8270
Professional Psychological & Rehabilitation Svcs....321-5900
Samaritan Counseling Center ......................... 337-2338
Sparrow Sexual Assault Counseling ................... 483-2385
Women’s Personal Growth and Therapy ................. 347-2126

**If you have insurance, you may want to call your insurance
company to determine which mental health providers in the
area the company will pay for or reimburse.

144

 

 

 

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153