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| Understanding the Impact of Childhood Sexual Abuse on Women's Sexuality, ♥ psychologia - inne (książki, ... |
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[ Pobierz całość w formacie PDF ] Volunte 34INumber I/January 20H/Pages 14-37 PRACTICE Understanding the Impact of Childhood Sexual Abuse on Women's Sexuality James J. Colangelo Kathleen Keefe-Cooperman The relationship between child sexual abuse and adult sexual functioning is well-established. Given the documented high incidence of childhood sexual abuse (CSA) and negative conse- quences for adult sexuality, many mental health counselors will encounter and provide thera- peutic services to members of this population. Counselors must have a good understanding of how sexual victimization during childhood impacts a woman's sexuality and sex life. We discuss the prevalence of CSA among women in different populations and the significant impact it has on women's sexuality. Generalized practice issues are applied using a case study and phase-ori- ented approach. CHILDHOOD SEXUAL ABUSE OE WOMEN This article examines the prevalence of childhood sexual abuse (GSA) among women, its potential long-term negative psychological and emotional impact on them, and the effect it has on a woman's sexuality. It also offers sug- gestions for counselors working with women who have a history of GSA. Depending on the definition used, GSA prevalence rates vary substan- tially (Butcher, Mineka, & Hooley, 2010), making comparisons difficult. The major definitional difference is whether the abuse was physical or also involved noncontact behaviors. The World Health Organization (2003) definition refers to "the inducement or coercion of a child to engage in any unlawful sexual activity; the exploitative use of a child in prostitution or other unlawful sexual practices; the exploitative use of children in pornographic performance and materials." The WHO definition incorporates concepts of power differentials and social taboos. The 2010 Federal Ghild Abuse Prevention and Treatment James J. Colangelo and Kathleen Keefe-Cooperman are affiliated with Long Island University C.W. Post Campus. Correspondence concerning this article should be directed to Dr. James J. Colangelo. Long Island University C.W. Post Campus, 720 Northern Blvd, Brookville. NY 11548-1300. E-mail: James.Colangelo@liu.edu. I 4 ^ Joumal of Mental Health Counseling Co/onge/o and Cooperman I CHILDHOOD SEXUAL ABUSE AND WOMEN'S SEXUAUTY Aet (GAPTA) sets out minimum standards that states must ineorporate in statu- tory definitions of ehild abuse and negleet; they eover any aet that is sexual or produces or indicates a visual representafion of a sexual aet, as well as sueh tra- difional GSA areas as rape, ineest, statutory rape, prosfitution, and sexual exploitation. The problem in establishing GSA prevalenee rates is that both the defin- ition and the age range eovered in studies has varied substantially (Buteher, Mineka, & Hooley, 2010; MeGregor, 2008; Rodriguez-Srednieki & Twaite, 2006). Even 25 years ago Waterman and Lusk (1986) reported many defini- fional variations of GSA and a laek of precision in many definifions. There may have also been differences in methodology and subjeets' pereeptions of sexual abuse even though there is now a U.S. government definition of GSA. Rodriguez-Srednieki and Twaite (2006) noted that "little progress has been made toward the adoption of a universal definifion of ehild sexual abuse" (p. 6). They stated that while invesfigators have tended to define GSA more speeifieally, different definifions are employed even within studies. For exam- ple. Green (1996) defined CSA as "the use of a ehild under 18 years of age as an objeet of gratification for adult sexual needs and desires" (p. 73). He sug- gested that CSA eould entail both eontaet and noneontaet behaviors, from exhibifionism through gentle fondling to foreible rape, noting that the most fre- quent forms of sexual viefimizafion girls experienced were exhibitionism, fondling, masturbation, and vaginal, oral, and anal intereourse by males. On the other hand Korte, Horton, and Graybill (1998) restricted their definifion to physieal eontaet behaviors, sueh as fondling and intereourse. Studies using def- inifions that include noneontaet behaviors will find higher prevalenee rates. In 2007 in the Unites States it was estimated that 60,344 ehildren out of 794,000 vietims of maltreatment were sexually abused —a 7.6% prevalenee rate (U.S. Department of Health and Human Serviees, 2009). The rate was deter- mined by state laws and polieies, whieh may vary beeause GAPTA's minimum standards (2010) allow for differenees. In 2009, the numbers of sexually abused ehildren had inereased to 68,400 out of 720,000 maltreatment viefims, a 9.5% prevalenee rate (U.S. Department of Health and Human Serviees, 2010). Finkelhor, Turner, Ormrod, Hamby, and Kraeke (2009) eondueted phone interviews with ehildren 10-17 and adult earegivers of ehildren 9 and under; 6.1% of ehildren reported victimization within the last year, and 10% of both boys and girls (12.5% of the girls) reported having been viefimized at some point by rape or attempted rape, sexual assault, flashing or sexual expo- sure, harassment, and statutory sexual offenses. The definifion this study used did not inelude exploitafion. Pereda, Guilera, Forns, and Gomez-Benito (2009) eompared interna- fional GSA rate studies with Finkelhor's 1994 findings. These studies also var- ied in GSA definifions, eut off ages, and methodologies. The percentage of 15 women in the U.S. found to have experienced GSA ranged from 16.5% to 50.8%; the Finkelhor 1994 study had found prevalence rates of 7% to 36%. Generally, prevalence estimates based on retrospective reports by adults are higher than those based on official reports (Rodriguez-Srednicki & Twaite, 2006), and rates in clinical populations higher than in community samples (Leonard & Follette, 2002). Gosentino and Gollins (1996) found that 25% to 33% of U.S. women reported having been sexually abused before 18. Noting that GSA prevalence rates are difficult to establish, after a litera- ture review Roland (2002) concluded that 28% to 30% of adult women had experienced some type of sexual abuse during childhood or adolescence. The Adverse Ghildhood Experiences (AGE) Study in the United States found that 25% of women reported some form of GSA before 18 (Dube, Anda, Felitti, Edwards, & Groft, 2005). In a study of New Zealand women Fanslow, Robinson, Grengle, and Perese (2007) found that 24% to 28% reported being sexually touched or made to do something sexual against their will before they were 15. According to Freyd et al. (2005), about 20% of women worldwide reported sexual contact with an adult during their childhood. Other studies found ranges from 10.9% to 13% (Oakford & Frude, 2001; Plant, Miller, & Plant, 2004; Sidebotham, 2000) to 27.2% to 33% (Boles, Joshi, Grella, & Wellisch, 2005; Feerick & Snow, 2005; Freeman, Parillo, Gollier, & Rusek, 2001). Methodological and definitional variations led to the differences in statisties. LONG TERM NEGATIVE CONSEQUENCES CSA can be emotionally damaging and severely traumatizing, causing long-term negative eonsequences (Miner, Flitter, & Robinson, 2006; Noll, Triekett, & Putnam, 2003; Putnam, 2009), such as adult mental disorders (Katerndahl, Bürge, & Kellogg, 2005); marital dissatisfaction (Liang, Williams, & Siegel, 2006); disturbed interpersonal relationships (DiLillo, 2001); adoles- cent pregnaney and sexual problems (Noll et al., 2003; Roosa & Tein, 1997); high-risk sexual behaviors (Ginq-Mars, Wright, Gyr, & McDuff, 2003; Testa, VanZile-Tamsen, & Livingston, 2005); post-traumatic stress disorder (PTSD; Feerick & Snow, 2005; McDonagh et al., 2005); higher risk of suicidal behav- ior (Martin, Bergen, Richardson, Roeger, & Allison, 2004; Oates, 2004); acci- dental fatal drug overdose (Gutajar et al., 2010); self-mutilation (Lipschitz et al., 1999; Nijman, Dautzenberg, Merkelback, Jung, Wessel, & Gampo, 1999); disordered eating behaviors and clinical eating disorders (Aekard, Neumark- Sztainer, Hannan, French, & Story, 2001; Hund & Espelage, 2005; Johnson, Gohen, Kasen, & Brook, 2002; Romans, Gendall, Martin, & Mullen, 2001); alcohol and substance disorders (Dube et al., 2002; Plant et al, 2004; Rodriguez-Srednicki, 2001); and depression, anxiety, and low self-esteem (Hill, 16 Colangeh and Cooperman I CHILDHOOD SEXUAL ABUSE AND WOMEN'S SEXUALITY Pickles, Rollinson, Davies, & Byatt, 2004; Leonard, Iverson, & Follette, 2008; Meston, Rellini, & Heiman, 2006; Roberts, O'Gonnor, Dunn, & Golding, 2004). Resilience can help prevent mental disorders, and different factors are believed to contribute to resilience. For example, family characteristies were found to contribute 13%-22% of the differences in well-being outcomes in 177 college females who had experienced GSA (McGlure, Ghavez, Agars, Peacock & Matosian, 2008). Good coping and support compensation were also found to contribute to resiliency (Jonzon & Lindblad, 2006). The findings on resiliency offer hope that the negative impacts of GSA can be ameliorated. Unfortunately, there has been periodic controversy about negative GSA outcomes, usually based on flawed researeh. For instance, the meta-analysis by Rind, Tromovitch, and Bauserman (1998) of studies using college samples con- cluded that researchers had greatly overstated the harmful effects of CSA and that GSA does not damage children. They recommended that willing encoun- ters be classified as "adult-child" or "adult-adoleseent" sex rather than sexual abuse. The study was rejected outright as methodologically unsound by the first set of peer reviewers, who recommended against resubmission to the Psychological Bulletin. After a change of editors it was published, though at least one reviewer had again rejected it (Olafson, 2004). Other research over- whelmingly attests that GSA inflicts significant damage. Given the doeumentation of prevalence rates and long-term negative con- sequences, it is highly likely that some women elients of counselors will have been sexually abused in childhood or adolescence. Because GSA is often a fac- tor in later sexual difficulties or dysfunctions, it is important that counselors have a good understanding of how it affects a woman's sexuality. EFFECTS OF CSA ON WOMEN'S SEXUALITY Women seek out a mental health counselor for numerous reasons. Difficulfies related to sexuality may not even be the presenting problem; feel- ings of despair, depression, or anxiety may be cited as the difficulfy. The coun- selor may only discover the GSA and resultant impact on sexual functioning through a thorough psychosocial history or relafional issues. The impact of GSA on a woman's sexual functioning can be seen in both internalized feelings and externalized behaviors. Schloredt & Heiman (2003) found that women recruited through communify adverfisements who had a history of GSA were more likely than nonabused women to report difficulties in sexual satisfacfion and functioning and to engage in sexually risky behaviors. Internalizing Behaviors Women with a history of GSA report more negative feelings about sex and 17 experience less sexual satisfaction than do nonabused women (Leonard et al., 2008; Meston et al., 2006). A close link has been found between GSA and sex- ual difficulties in adulthood and youth (Lemieux & Byers, 2008; Najman, Dunne, Purdie, Boyle, & Goxeter, 2005; Simon & Feiring, 2008). Forming intimate adult relationships is often difficult for GSA victims (Rumstein- McKean & Hunsley, 2001; Vandeusen & Garr, 2003). When relafionships are formed, sexual and emotional fulfillment is often lacking (Feiring, Simon, & Gleland, 2009; Leonard et al., 2008). The most prevalent sexual problems women with histories of GSA reported were disorders of desire, arousal, orgasm, and less often dyspareunia (painful coitus) and vaginismus (Leonard & Follette, 2002; Westerlund, 1992). Since these studies drew upon populations self-selected through advertisements, electoral polls, or university affiliation, they may have attracted those who experienced more negative GSA impacts. However, the consensus that GSA often results in sexual difficulties should not be overlooked. Women with a GSA history experienced less frequent orgasms and less sexual responsiveness (Walker et al., 1999). Some also displayed more sexual aversion and promiscuity (Leonard & Follette, 2002; Loeb et al., 2002); higher rates of current and past sexual dysfunctions (Sarwer & Durlak, 1997); and dis- ruptive patterns in to sexual satisfaction, adjustment, and functioning (Meston, Heiman, & Trapnell, 1999). Schloredt and Heiman (2003) noted that studies using clinical or community samples generally found a relationship between GSA and adult sexual problems. Studies with college samples typically found fewer associations, perhaps because college samples represented more resilient women (McGlure et al., 2008). However, not all women with histories of GSA suffer sexual difficulties in adulthood (Alexander & Lupfer, 1987; Rind, Tromovitch, & Bauserman, 1998). The relative strengths and mental health predispositions of each individual influence the degree to which GSA affects sexuality. Externalizing Behaviors Women abused as children are more likely than nonabused women to engage in such high-risk sexual behaviors as multiple sexual partners (Fergusson, Horwood, & Lynskey, 1997); earlier consensual sexual activity, teenage pregnancy, and unprotected intercourse (Fergusson et al., 1997; Raj, Silverman, & Amaro, 2000; Walker et al., 1999); and increased rates of abortion and anal sex (Wingood & DiGlemente, 1997). Female adolescents who reported GSA also reported having three times as many sexual partners as nonabused adolescents (Luster & Small, 1997). 18 [ Pobierz całość w formacie PDF ] |