Jennie G. Noll

A prospective investigation of the impact of childhood sexual abuse on the development of sexuality.

The sexual attitudes and activities of 77 sexually abused and 89 comparison women (mean age = 20.41, SD = 3.38) were assessed 10 years after disclosure in a longitudinal, prospective study of the long-term effects of childhood sexual abuse. Abused participants were more preoccupied with sex, younger at first voluntary intercourse, more likely to have been teen mothers, and endorsed lower birth controlefficacy than comparison participants. When psychological functioning earlier in development was examined, sexual preoccupation was predicted by anxiety, sexual aversion was predicted by childhood sexual behavior problems, and sexual ambivalence (simultaneous sexual preoccupation and sexual aversion) was predicted by pathological dissociation. Findings also indicate that biological father abuse may be associated with greater sexual aversion and sexual ambivalence.

The impact of sexual abuse on female development: Lessons from a multigenerational, longitudinal research study

This is a report on the research design and findings of a 23-year longitudinal study of the impact of intrafamilial sexual abuse on female development. The conceptual framework integrated concepts of psychological adjustment with theory regarding how psychobiological factors might impact development. Participants included 6- to 16-year-old females with substantiated sexual abuse and a demographically similar comparison group. A cross-sequential design was used and six assessments have taken place, with participants at median age 11 at the first assessment and median age 25 at the sixth assessment. Mothers of participants took part in the early assessments and offspring took part at the sixth assessment. Results of many analyses, both within circumscribed developmental stages and across development, indicated that sexually abused females (on average) showed deleterious sequelae across a host of biopsychosocial domains including: earlier onsets of puberty, cognitive deficits, depression, dissociative symptoms, maladaptive sexual development, hypothalamic-pituitary-adrenal attenuation, asymmetrical stress responses, high rates of obesity, more major illnesses and healthcare utilization, dropping out of high school, persistent posttraumatic stress disorder, self-mutilation, Diagnostic and Statistical Manual of Mental Disorders diagnoses, physical and sexual revictimization, premature deliveries, teen motherhood, drug and alcohol abuse, and domestic violence. Offspring born to abused mothers were at increased risk for child maltreatment and overall maldevelopment. There was also a pattern of considerable within group variability. Based on this complex network of findings, implications for optimal treatments are elucidated. Translational aspects of extending observational research into clinical practice are discussed in terms that will likely have a sustained impact on several major public health initiatives.

Revictimization and Self-Harm in Females Who Experienced Childhood Sexual Abuse Results from a Prospective Study

Lifetime trauma histories were ascertained for females with confirmed histories of childhood sexual abuse and comparison females participating in a longitudinal, prospective study. Abused participants reported twice as many subsequent rapes or sexual assaults (p = .07), 1.6 times as many physical affronts including domestic violence (p = .01), almost four times as many incidences of self-inflicted harm (p = .002), and more than 20% more subsequent, significant lifetime traumas (p = .04) than did comparison participants. Sexual revictimization was positively correlated with posttraumatic stress disorder symptoms (PTSD), peritraumatic dissociation, and sexual preoccupation. Physical revictimization was positively correlated with PTSD symptoms, pathological dissociation, and sexually permissive attitudes. Self-harm was positively correlated with both peritraumatic and pathological dissociation. Competing theoretical explanations for revictimization and self-harm are discussed and evaluated.

Attenuation of cortisol across development for victims of sexual abuse

Inconsistencies exist in literature examining hypothalamic-pituitary-adrenal (HPA) axis activity in children and adults who have experienced childhood abuse. Hence, the extent and manner to which childhood abuse may disrupt HPA axis development is largely unknown. To address these inconsistencies, the developmental course of nonstress cortisol in a long-term longitudinal study was assessed at six time points from childhood through adolescence and into young adulthood to determine whether childhood abuse results in disrupted cortisol activity. Nonstress, morning cortisol was measured in 84 females with confirmed familial sexual abuse and 89 nonabused, comparison females. Although dynamically controlling for co-occurring depression and anxiety, hierarchical linear modeling (HLM) showed that relative to comparison females, the linear trend for abused females was significantly less steep when cortisol was examined across development from age 6 to age 30, t (1, 180) = -2.55, p < .01, indicating attenuation in cortisol activity starting in adolescence with significantly lower levels of cortisol by early adulthood, F (1, 162) = 4.78, p < .01. As a more direct test of the attenuation hypothesis, supplemental HLM analyses of data arrayed by time since the disclosure of abuse indicated that cortisol activity was initially significantly higher, t (1, 425) = 2.18, p < .05, and slopes were significantly less steep t (1, 205) = -2.66, p < .01, for abused females. These findings demonstrate how the experience of childhood abuse might disrupt the neurobiology of stress, providing some support for the attenuation hypothesis that victims of abuse may experience cortisol hyposecretion subsequent to a period of heightened secretion.

Obesity Risk for Female Victims of Childhood Sexual Abuse: A Prospective Study

OBJECTIVE. Efforts are under way to articulate environmental, psychosocial, and biological conditions that may predispose the development and maintenance of obesity. There is increasing evidence that adverse childhood experiences such as childhood abuse may be implicated in the development of obesity. Given the dearth of prospective evidence for this link, the objective of this study was to track body mass across development (from childhood, through adolescence, and into young adulthood [ie, ages 6–27]) in a prospective, longitudinal study of abused and nonabused female subjects. METHODS. Height and weight were obtained for 84 female subjects with substantiated childhood sexual abuse and 89 demographically similar comparison female subjects at 6 points during development. Obesity status was examined at various stages during development, and body-mass growth trajectories were contrasted across the 2 groups. It was hypothesized that, in comparison with their nonabused peers, abused female subjects would be more likely to (1) manifest obesity by early adulthood and (2) manifest high-risk growth trajectories throughout development. RESULTS. Obesity rates were not different across groups in childhood or adolescence. By young adulthood (ages 20–27), abused female subjects were significantly more likely to be obese (42.25%) than were comparison female subjects (28.40%). Hierarchical linear modeling growth-trajectory analyses indicated that abused female subjects, on average, acquired body mass at a significantly steeper rate from childhood through young adulthood than did comparison female subjects after controlling for minority status and parity. CONCLUSIONS. Psychosocial difficulties (eg, depression) and psychobiological conditions (eg, hypothalamic-pituitary-adrenal axis dysregulation) that have been shown to be related to both childhood abuse and obesity may help to explain these results. The identification of high-risk growth trajectories may improve health outcomes for victims. Systematic study of the mechanistic pathways and mediating processes that would help to explain the connection between childhood sexual abuse and later obesity is encouraged.

Grief Processing and Deliberate Grief Avoidance: A Prospective Comparison of Bereaved Spouses and Parents in the United States and the People's Republic of China.

In this study, the authors measured grief processing and deliberate grief avoidance and examined their relationship to adjustment at 4 and 18 months of bereavement for 2 types of losses (spouse, child) in 2 cultures (Peoples Republic of China, United States). Three hypotheses were compared: the traditional grief work assumption, a conditional grief work hypothesis, and a view of grief processing as a form of rumination absent among resilient individuals. Although cultural differences in grief processing and avoidance were observed, the factor structure of these measures proved invariant across cultures. Consistent with the grief work as rumination hypothesis, both grief processing and deliberate grief avoidance predicted poor long-term adjustment for U.S. participants. Furthermore, initial grief processing predicted later grief processing in both cultures. However, among the participants in the Peoples Republic of China, neither grief processing nor deliberate avoidance evidenced clear psychological consequences.

Childhood Sexual Abuse and Adolescent Pregnancy: A Meta-analytic Update

OBJECTIVE Recent increases in adolescent pregnancies have sparked a renewed impetus to identify risk factors, such as childhood sexual abuse (CSA), associated with adolescent pregnancy. Given mixed evidence regarding the strength of the relationship between CSA and adolescent pregnancy (Blinn-Pike, Berger, Dixon, Kuschel, & Kaplan, 2002), our objective was to provide an estimate of the effect size of this relationship using updated literature and meta-analytic techniques. METHODS Meta-analyses of 21 studies were conducted using a random effects model of binary outcomes to determine aggregate effect-size estimates controlling for study heterogeneity. RESULTS CSA significantly increased the odds of experiencing an adolescent pregnancy by 2.21-fold (95% CI: 1.94-2.51). A supplemental analysis suggested that 4.5 out of 10 pregnant adolescents may have a prior history of CSA. CONCLUSIONS CSA places females at increased risk for subsequent adolescent pregnancy. Addressing conditions associated with CSA might impact the overall adolescent pregnancy rate.

Psychosocial Functioning Improves Following Adolescent Bariatric Surgery

The aims of the present study were to examine changes in health‐related quality of life (HRQOL) and depressive symptoms in adolescents with extreme obesity undergoing Roux‐en‐Y gastric bypass (RYGBP) across the first postoperative year. A prospective longitudinal observational study of 31 adolescent patients undergoing RYGBP at a pediatric medical center (mean = 16.4 years; 64.5% females, mean BMI 63.5; 97% of study eligible and consecutive patients) was conducted. Participants completed two adolescent HRQOL measures, the PedsQL (generic) and the IWQOL‐Kids (weight‐related), the Beck Depression Inventory (BDI), and height and weight were measured at three time points: baseline, and 6 and 12 months following RYGBP. Prior to RYGBP, significant impairments in HRQOL were documented and 38.7% reported depressive symptomatology in the clinical range. As expected, BMI and depressive symptoms decreased and HRQOL improved from baseline to 12 months post‐RYGBP. Linear mixed modeling analyses detected several nonlinear slopes in BMI, depressive symptoms, and the majority of HRQOL domains over time with deceleration in these postoperative changes beginning at the 6th month time point. In contrast, the rate of change in weight‐related social relations was linear (e.g., no deceleration), indicating continued improvement across the first postoperative year. Adolescent RYGBP results in significant improvement in HRQOL and depressive symptomatology over the first postoperative year. Longer‐term follow‐up will be critical to determine adolescent weight and psychosocial trajectories, their interrelations, and what role psychosocial status plays in continued weight loss, maintenance, and regain.

Predicting the willingness to disclose childhood sexual abuse from measures of repressive coping and dissociative tendencies.

Although it is generally agreed that the verbal disclosure of past childhood sexual abuse (CSA) experiences can be beneficial, CSA survivors are often reluctant to reveal such experiences. Bonanno et al. found that women with documented CSA histories who did not disclose abuse when provided an opportunity to do so were more likely to show nonverbal expressions of shame and polite smiling, relative to disclosing CSA survivors or nonabused controls. Disclosing CSA survivors, in contrast, showed greater facial expressions of disgust. The current study extended this paradigm by showing that among the same participants, CSA disclosure was associated with chronic dissociative experiences, whereas nondisclosure was associated with repressive coping. Further, repressive coping and dissociative experiences were inversely related and showed opposite patterns of facial expressions and adjustment. Repressors expressed greater negative and positive emotion and were relatively better adjusted, whereas dissociators expressed little emotion and had relatively poorer adjustment.

The motivations for self-injury in psychiatric inpatients

Nonsuicidal self-injurious behavior (SIB) occurs in both culturally appropriate and culturally inappropriate forms. It is one of the diagnostic criteria for borderline personality disorder, but it occurs in several psychiatric and neurological populations. The personal intent of SIB in psychiatric populations is incompletely understood. A self-report scale (Self-Injury Motivation Scale; SIMS) to assess motivation for self-injury was developed. Relationships among motivation for SIB, characteristics of SIB, and psychopathology were explored. A semistructured interview and the SIMS, Dissociative Experiences Scale, Beck Depression Inventory, Davidson Trauma Scale, and Millon Clinical Multiaxial Inventory-II were given to 99 consecutively admitted inpatients. The SIMS had good reliability and validity. A high SIMS score suggested distinct psychopathology. Several factors on the SIMS differentiated motivations for SIB. Patients with different SIMS factor profiles had different psychopathology.