Child Abuse & Neglect 29 (2005) 1373–1394

Child and adolescent abuse and subsequent victimization: A prospective study Cindy L. Rich a , Christine A. Gidycz b,∗ , Jennifer B. Warkentin b , Catherine Loh c , Paul Weiland d a

b

Christian Counseling Center, Grand Rapids, MI, USA Department of Psychology, Ohio University, 200 Porter Hall, Athens, OH 45701, USA c VA San Diego Health Care System, San Diego, CA, USA d Department of Psychology, University of Toledo, Toledo, OH, USA

Received 6 October 2003; received in revised form 21 June 2005; accepted 15 July 2005

Abstract Objective: We investigated the possible reciprocal relationship between victimization experiences and psychological functioning by assessing abuse experiences in childhood, adolescence, and during a 2-month follow-up period. Method: At the beginning of the study (Time 1), abuse histories, trauma and depressive symptoms, and interpersonal functioning were assessed in 551 college women. Subsequent victimization experiences and psychological outcomes were assessed at the follow-up (Time 2). Results: Path analyses indicated that verbal abuse by the mother and father were predictive of various psychological outcomes as measured at Time 1 and emerged as the only significant predictors of adolescent dating violence. Adolescent dating violence subsequently predicted the experience of dating violence during the 2-month follow-up period. Paternal physical abuse predicted adolescent sexual victimization which subsequently predicted all symptom measures at Time 1. Conversely, the experience of adolescent physical dating violence was not predictive of any of the symptom measures at Time 1. For those women who experienced dating violence during the follow-up, however, the severity of their abusive experiences was related to both depression and interpersonal problems assessed at Time 2. In comparison, for those women who experienced sexual victimization during the follow-up period, the severity of their abusive experiences was related to trauma symptoms. Interpersonal problems emerged as both an aftereffect of adolescent sexual victimization experience and a predictor of a subsequent sexual victimization experience during the follow-up. ∗

Corresponding author.

0145-2134/$ – see front matter © 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.chiabu.2005.07.003

1374

C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 1373–1394

Conclusions: Given that emotional abuse emerged as a predictor of adolescent dating violence and psychological outcomes, researchers and clinicians need to continue to explore this problem. Further, it is important to assess how interpersonal problems contribute to the risk of subsequent sexual victimization and to try to break the cycle between adolescent abuse experiences and subsequent physical and sexual assaults. © 2005 Elsevier Ltd. All rights reserved. Keywords: Child abuse; Sexual assault; Revictimization

Introduction The true pervasiveness of violence and abuse is difficult to determine due to the low reporting rate of such behaviors and the dearth of representative samples. Prevalence studies conducted on community and university samples indicate widespread, and relatively stable, rates of sexual and physical aggression against women and children; however, rates of emotional abuse are typically not reported in these studies. In recent telephone studies with nationally representative samples of community women, between 12.7% and 14.8% of women surveyed reported having experienced a completed rape at some point during their lives (Kilpatrick, Edmond, & Seymour, 1992; Tjaden & Thoennes, 2000). Estimates obtained from studies with college students have been remarkably consistent with those derived from community women, with a recent nationally representative sample of college students finding that 20% of the women surveyed had experienced a rape at some point in their life (Brener, McMahon, Warren, & Douglas, 1999). Similarly, the widespread occurrence of physical abuse has been substantiated by studies conducted with nationally representative samples of community women, one of which found that 52% of women reported that they had been physically assaulted at some point in their life (Tjaden & Thoennes, 2000). While the vast majority of research in the area of physical abuse in adult relationships has focused on marital relationships, there is an increasing body of research documenting the occurrence of physical violence in unmarried intimates, particularly among college students where it is estimated that one in five students have experienced partner violence (Makepeace, 1981; Pedersen & Thomas, 1992). Evidence also suggests that both sexual and physical victimizations are not randomly distributed in the population; that is, having one victimization experience places an individual at an increased risk of future victimization (Boney-McCoy & Finkelhor, 1995; Gidycz, Coble, Latham, & Layman, 1993; Gidycz, Hanson, & Layman, 1995; Himelein, 1995). Studies have documented that an early sexual abuse experience increases one’s risk of adult sexual victimization (Gidycz et al., 1993) and a relationship between childhood physical abuse and subsequent dating and spousal violence (Riggs & O’Leary, 1996; Smith & Williams, 1992). Specifically, Gidycz et al. (1995) found that women with a history of sexual victimization were between 1.5 and 2 times more likely to be sexually victimized during a 3-month follow-up period than women without a history of victimization. Moreover, women who experienced a victimization during the first 3 months of the study were three times more likely to be assaulted during the subsequent 3-month follow-up period than women who did not experience such a victimization (Gidycz et al., 1995). Finally, in a recent meta-analysis examining sexual revictimization, Roodman and Clum (2001) found a moderate effect size of .59, indicating that a positive relationship exists between the presence of sexual abuse in childhood, and subsequent adult sexual victimization. Studies investigating the link among physically abusive experiences have also found that a past history of physical abuse is correlated with subsequent violence in adult relationships. Evidence regarding the

C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 1373–1394

1375

relationship between physical violence in childhood and subsequent violence in dating relationships indicates that individuals who experienced physical abuse in childhood were more likely to both experience and perpetrate physical dating violence in adolescence and adulthood (Bernard & Bernard, 1983; Riggs & O’Leary, 1996). Tjaden and Thoennes (2000) found that men and women who were physically assaulted by an adult caretaker in childhood were twice as likely as those without a history of childhood physical assault to be physically assaulted as an adult. Similar trends have been found in physical dating violence among college couples, such that prior experience with intimate violence among college students is a significant predictor of involvement with intimate violence in the current or most recent relationship (Deal & Wampler, 1986; Lueken & Gidycz, 2002). Lacking among the vast majority of previous studies, however, is an investigation of the relationship between the different types of child and adolescent abuse, and various forms of revictimization in adulthood. With few exceptions, investigators have typically focused on one type of abusive experience in their studies and failed to explore various other forms of abuse. This is problematic, as various forms of abuse tend to co-occur. For example, research has demonstrated that physically and sexually abused children almost always experience emotional abuse (Claussen & Crittenden, 1991; Gross & Keller, 1992), and approximately 90% of all physical abuse victims in one study also experienced some form of psychological abuse (Claussen & Crittenden, 1991). When specific types of abuse are studied in isolation, it is impossible to ascertain whether there are unique effects associated with each type of abuse or whether experiencing one type of abuse also places one at risk for other types of abuse throughout one’s life. Researchers have recently begun to investigate the effects of multiple forms of abuse. In a recent study examining the relationship between violent childhood experiences and subsequent adult intimate partner violence, Whitfield, Anda, Dube, and Felitti (2003) found that the risk of being a victim of partner violence for women was increased if the woman had a history of contact sexual abuse in childhood. Results indicated that women with a childhood physical or sexual abuse history were 3.5 times more likely to experience intimate partner violence in adulthood. Research has also indicated that women with physical abuse histories are more likely to participate in risky sexual behavior than women without a history of child physical abuse (Morrill, Kasten, Urato, & Larson, 2001). While these authors did not investigate the rates of sexual victimization in adulthood among these women, the risky sexual behaviors that were reported may put these women at risk of a subsequent sexual assault experience. Likewise, it is also possible that some of the psychological effects of early abusive experiences may put one at risk of future abusive experiences of various types. While the strength of these studies is that they focused on various forms of abuse, the retrospective nature of the design limits their generalizability. The high rates of abuse reported both in childhood and adolescence as well as the substantial rates of sexual and physical revictimization are particularly alarming in light of the interpersonal consequences associated with physical and sexual victimization. There is ample evidence to suggest that these various forms of abuse are detrimental to the subsequent psychological, physical, and sexual health of both children and adult survivors (for reviews see Arata, 2002; Beitchman, Zucker, Hood, DaCosta, & Akman, 1991; Beitchman et al., 1992; Jumper, 1995; Kendall-Tackett, Williams, & Finkelhor, 1993; Weaver & Clum, 1995). For instance, increased levels of depression and trauma symptoms have been found in samples of children who have experienced physical (Allen & Tarnowski, 1989; Kazdin, Moser, Colbus, & Bell, 1985; Kiser, Heston, Millsap, & Pruitt, 1991) and sexual abuse (Browne & Finkelhor, 1986; Kendall-Tackett et al., 1993; Putnam, 2003) compared to nonabused children. Increased levels of depression and trauma symptoms have been also been found to occur among adolescent and adult survivors of child physical (Chu & Dill, 1990; Kiser et al., 1991) and sexual (Browne & Finkelhor, 1986; Chu & Dill, 1990; Conte &

1376

C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 1373–1394

Schuerman, 1987; Putnam, 2003) abuse. Further, difficulties with interpersonal functioning have also been identified among abuse victims both as children and as adults (for review see Davis & Petretic-Jackson, 2000). Currently, the literature is fairly inconsistent regarding the pattern of aftereffects associated with varying types of abuse. While there are some data to suggest that the aftereffects of child physical and sexual abuse are quite similar (Braver, Bumberry, Green, & Rawson, 1992), other data suggest that symptoms may be manifested differentially as a function of the type of abuse (Meyerson, Long, Miranda, & Marx, 2002). In a recent study with female adolescents, for example, Meyerson et al. (2002) found that sexual abuse was more predictive of negative psychological outcomes than was physical abuse. Missing from Meyerson et al.’s (2002) study, however, was an investigation of psychological abuse. Braver et al. (1992) studied physical, sexual, and emotional abuse in a small sample of university counseling center clients and concluded that all three groups of abused clients evidenced greater psychological symptomatology than the comparison group of nonabused women and that none of their abused groups differed from each other. Whereas there is ample evidence linking sexual and physical abuse to trauma, research investigating the temporal relationship between victimization and psychological functioning has been scarce due to the retrospective nature of the majority of research in this area. Rather, researchers have typically conceptualized interpersonal difficulties, depression, and trauma symptoms as aftereffects of victimization experiences. Though such independent conceptualizations are enlightening, an exploration of the temporal relationship between functioning and abuse would be a more informative avenue of research, as it is likely that each variable serves as a risk factor for the other (Acierno, Resnick, Kilpatrick, Saunders, & Best, 1999). Granted, theories accounting for revictimization are still in their infancy (and have primarily focused on sexual revictimization), it is possible that the trauma and psychological symptoms that are associated with early abuse might make a woman more vulnerable to subsequent abuse experiences. Some researchers have argued, for example, that perpetrators are particularly skilled at identifying victims’ psychological and social vulnerabilities that might result from a history of abuse, such as feelings of low self-esteem and powerlessness (Grauerholz, 2000), or the adverse impact of emotional numbing on a victim’s ability to respond to dangerous situations (Cloitre, 1998; Cloitre, Sacarvalone, & Difede, 1997). Prospective analyses would allow the researcher to assess the possible reciprocal relationship between trauma and violence. Additionally, the literature is limited by the fact that the vast majority of researchers have focused on one specific type of abuse and not controlled for the existence of other forms of abuse. As suggested by Meyerson et al. (2002), a thorough understanding of the relationship between abuse and psychopathology may not be adequately achieved until various types of abuse are considered together. The present study investigated childhood, adolescent, and college victimization experiences, which included verbally, physically, and sexually abusive experiences. Additionally, depression, trauma, and interpersonal functioning were investigated both retrospectively (until the time of the study) and prospectively (during the 2-month follow-up) to determine the possible interaction of victimization and psychological functioning. Unlike the majority of prior studies, this research prospectively investigated the relationship between various forms of abuse and psychological symptomatology, and the prospective nature of the design allowed for an assessment of the reciprocal relationship between symptoms and abuse. Three separate models were tested (focusing on depression, trauma, and interpersonal functioning), where for each symptom measure, the best fitting model was identified.

C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 1373–1394

1377

Method Participants Participants were a convenience sample of 551 college women from a mid-sized Midwestern University. Participants were enrolled in psychology courses and volunteered for the study through sign-up sheets, receiving experimental credit in their course for their participation. Ninety-five percent (N = 524) of the women returned for the 2-month follow-up. The majority of participants (88.4%) were between 18 and 19 years of age, and participants reported their ethnicity as Caucasian (91.3%), African American (4.4%), Asian (1.8%), Hispanic (1.1%), or Native American (.5%). Three-fourths of the participants were in their first year of college (75.7%), and although about half reported dating casually (52.5%), other participants reported being in a long-term relationship (39.2%), not dating (5.3%), or being engaged or married (2.9%). Given that participants were recruited from the psychology subject pool, first-year students were over-represented in the sample; however, the ethnic breakdown of the participants was representative of the university population.

Measures Assessment of verbal and physical abuse in childhood The Conflict Tactics Scale (Straus, 1979) was developed to measure intrafamilial conflict resolution. Three versions of the conflict scales were used in this study to assess the participants’ perception of conflict resolution both in their family of origin and in their dating relationships. The Mother-Child scale and the Father-Child scales were used to assess intrafamilial conflict resolution during childhood, while the Dating Conflict Scale was used to assess dating conflict resolution for the participant and the participant’s partner during both adolescence and the 2-month follow-up period. The Conflict Tactics Scale consists of 18 statements for each version, progressing in order of severity for both aggressiveness and coerciveness. Participants respond to each item by indicating the frequency of its occurrence on a 7-point scale ranging from “never” to “always.” For this study, two of the conflict resolution subscales were utilized: (1) the Verbal Aggression scale assesses the use of threats to hurt a person and the use of verbal and nonverbal behaviors which are symbolically hurtful to a person and (2) the Violence scale measures the use of physical force to resolve conflict, with higher scores indicative of more frequent abuse (Straus, 1979). These two scales measured verbal and physical abuse in relationships, respectively. High reliability was found for the Verbal Aggression (coefficient alpha = .77–.88) and Violence (coefficient alpha = .62–.88) scales. Based on a review of studies using the Conflict Tactics Scale, Straus (1979) concluded that adequate construct validity was evidenced. Based on their responses to the Verbal Aggressiveness and Violence subscales, participants were divided into three categories to investigate frequencies of verbal and physical child abuse experiences as well as later dating violence experiences. These categories were also utilized in the path and χ2 analyses for assessing the relationships between abuse experiences. The parent/child version was used to assess maternal and paternal abuse in childhood, while the dating conflict version was used to assess physical dating violence during adolescence and the follow-up period. For physical abuse the categories included: (a) no abuse (no physically abusive experiences), (b) moderate physical abuse (less severe forms of

1378

C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 1373–1394

physical abuse, ranging from throwing something to pushing), and (c) severe physical abuse (more severe forms of physical abuse, ranging from slapping to the use of a gun). For verbal abuse the categories included: (a) no abuse (no verbally abusive experiences), (b) moderate verbal abuse (less severe forms of verbal abuse, such as saying something spiteful), and (c) severe verbal abuse (more severe forms of verbal abuse, such as threatening to hit or throw something at someone). Assessment of child sexual victimization The Child Sexual Victimization Questionnaire. To assess child sexual victimization (i.e., victimization before age 14), participants responded to the Child Sexual Victimization Questionnaire, an 18-item selfreport measure adapted from Finkelhor (1979). Respondents were asked to answer “yes” or “no” to whether they had sexual experiences during childhood, with items increasing in severity from “Another person showing his/her sex organs to you” to “Another person had intercourse with you.” Participants were also asked their age and the age of the other person at the first and last time they had the sexual experience. An individual was considered to be sexually victimized in childhood if she reported a sexual experience before the age of 14, occurring with a person 5 years or older than that person, or with the use of force or threats of force. Participants were assigned to one of three categories of increasing severity of child sexual victimization: (a) no sexual victimization, (b) some sexual victimization (ranging from unwanted sexual contact to attempted rape), and (c) rape (vaginal, oral, or anal penetration). The Sexual Experiences Survey (SES; Koss & Oros, 1982) was used to assess various levels of sexual victimization. The 10-item self-report instrument includes a “yes-no” format, and participants were asked to indicate whether they had a variety of sexual victimization or assault experiences by asking about behavioral experiences, without using the word “rape.” The SES follows the Ohio Revised Code definition of rape (Ohio Revised Code §§28907.01–2907.02, 1998), and is widely used in sexual assault research. For this study, adolescent sexual victimization was defined as any unwanted sexual contact (fondling to intercourse) from age 14 years to the assessment at Time 1. Victimization during the follow-up period was defined as any unwanted sexual contact (fondling to intercourse) that occurred during the 2-month follow-up period. Three categories of increasing severity were created: (a) no victimization, (b) moderate sexual victimization (ranging from unwanted sexual contact to attempted rape), and (c) rape (vaginal, oral, or anal penetration through the use of force or threats of force) and corresponded to the highest category in which a participant had an experience. Research on the instrument indicates that it has good internal consistency (Cronbach’s alpha = .74) and good 1-week test-retest reliability (r = .93; Koss & Gidycz, 1985). Assessment of psychological functioning The Impact of Event Scale (IES; Horowitz, Wilner, & Alvarez, 1979). Trauma and subjective stress, occurring from a specific event, was measured by the Impact of Event Scale. The measure consists of 15items, and includes two subscales reflecting intrusion and avoidance, which are major symptom clusters of post-traumatic stress disorder (PTSD). Respondents were asked to think of the most stressful event they have ever experienced, and using a 5-point scale, ranging from “not at all” to “often,” to rate how often the statements were true for them over the last 7 days. The total possible score ranges from 0 to 75, with higher numbers indicating higher levels of subjective stress. For the purpose of this study, a total score was used. Split-half reliability was found to be good (r = .86) for a group of psychiatric outpatients

C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 1373–1394

1379

and internal consistencies for each subscale are high (Cronbach’s alpha = .78 and .82 for intrusion and avoidance, respectively; Horowitz et al., 1979). The Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996). The BDI-II is a 21-item measure designed to assess the symptoms and attitudes associated with depression, according to criteria found in the Diagnostic and Statistical Manual of Mental Disorders-IV. The scale score is obtained by summing the weighted ratings of each individual item. The total score for this measure ranges from 0 to 63, with higher scores reflecting more severe depression. Alpha estimates have been high with various samples, and have ranged from between .84 for college students (Tanaka-Matsumi & Kameoka, 1986) to .87 for high school students (Teri, 1982). Inventory of Interpersonal Problems (IIP; Horowitz, Rosenbery, Baer, Ure˜no, & Villase˜nor, 1988). The IIP was used to measure the types of interpersonal problems that people experience and the level of distress associated with those interpersonal problems. The 64-item measure has eight subscales that assess the following types of interpersonal problems: dominance, intrusiveness, nurturance, exploitaveness, assertiveness, avoidance, coldness, and vindictiveness. Participants are asked to rate each item on a 5point scale ranging from “not at all” to “extremely,” to reflect the extent of distress associated with each interpersonal difficulty. The total score on this scale was chosen as a measure of interpersonal distress for this study. Normative data are available for both psychiatric and non-psychiatric college student samples (Hansen & Lambert, 1996), and the internal consistency of the subscales is high, with scores ranging from .82 to .93 (Horowitz et al., 1988).

Procedure Participants signed up for the study on an experimental sign-up board in the Department of Psychology. Participants were asked to complete questionnaires at two sessions. After obtaining informed consent, the surveys were administered to small groups during each 2-hour session. Time 1 was conducted at the beginning of the 10-week academic quarter while Time 2 was conducted approximately 2 months later, towards the end of the academic quarter. The 2-month timeframe was utilized so that participants could be reassessed while they were still enrolled in psychology courses, in order to minimize the attrition rate. Time 1 measures were used to determine childhood and adolescent sexual victimization, childhood verbal and physical abuse, familial and physical dating conflict, and current symptomatology (see Table 1). Approximately 2 months later, participants completed surveys to determine their experiences and functioning during the interim period. Informed consent was again obtained, and participants completed surveys assessing physical and sexual victimization during the interim, as well as psychological functioning. At the completion of the second assessment, all participants were provided debriefing forms, which included resources within the community, should they desire assistance with relationship issues. All procedures were reviewed and approved by the Institutional Review Board at the Midwestern University where the data were collected. Data analysis Recursive path analyses, using AMOS 4.0 (Arbuckle, 1999), were conducted to investigate the causal relationships among victimization experiences and adjustment at Time 1 and during the follow-up period. Three separate analyses were conducted on victimization experiences and the BDI-II, the Impact of Event

C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 1373–1394

1380

Table 1 Variables assessed and measures included at Time 1 and Time 2 Variable

Measure

Time 1 Childhood sexual victimization Childhood verbal abuse Childhood physical abuse Adolescent sexual victimization (age 14 to present) Adolescent dating violence (age 14 to present) Depression Trauma symptoms Interpersonal functioning

Child Sexual Victimization Questionnaire Conflict Tactics Scale Conflict Tactics Scale Sexual Experiences Survey Conflict Tactics Scale Beck Depression Inventory-II Impact of Event Scale Inventory of Interpersonal Problems

Time 2 Sexual victimization (during 2-month follow-up) Dating violence (during 2-month follow-up) Depression Trauma symptoms Interpersonal functioning

Sexual Experiences Survey Conflict Tactics Scale Beck Depression Inventory-II Impact of Event Scale Inventory of Interpersonal Problems

Scale, and the Inventory of Interpersonal Problems, respectively. These analyses estimate the strength of the relationship between variables, and can then be used to estimate the underlying causal processes. Successive regression analyses were performed to obtain the main path coefficients, and each endogenous variable was regressed upon those preceding variables that directly affected it. For each of the three analyses, various fit indices were employed to determine the model fit: χ2 tests, Comparative Fit Index (CFI), Tucker–Lewis Index (TLI), and Root Mean Square Error of Approximation (RMSEA). These indices have been widely used in path analytic procedures to clarify the causal relationships within the model. The χ2 test, however, can be problematic at larger sample sizes in that it is highly reactive to sample size. Therefore, we will also report the indices of model fit mentioned above. For the CFI and TLI, values close to .95 and higher are considered desirable, and an RMSEA value of .08 or lower indicates acceptable fit (Loehlin, 1998). Results Rates of sexual abuse and sexual victimization In this sample, 6.2% (N = 34) reported a moderate sexual victimization experience, and 1.4% (N = 8) reported a rape in childhood. Regarding experiences with adolescent sexual victimization, 26.7% (N = 147) reported experiencing moderate sexual victimization, and 7.6% (N = 42) reported rape. During the followup period, 8.4% (N = 44) reported experiencing moderate sexual victimization and 2.8% (N = 15) reported rape. Rates of physical abuse and physical dating violence Analyses regarding rates of physical abuse from the mother, 16.7% (N = 92) of the sample reported moderate physical abuse and 7.4% (N = 41) severe physical abuse. Similarly, 21.8% (N = 120) reported

C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 1373–1394

1381

moderate and 6.2% (N = 34) severe physical abuse from their fathers. Regarding dating violence in adolescence, 18.1% (N = 100) reported incidents of moderate severity and 3.3% (N = 18) reported severe incidents of physical dating violence. During the 2-month follow-up period, 4.2% of the sample (N = 22) reported dating violence incidents of moderate severity and 1.3% (N = 7) reported severe incidents. Rates of verbal abuse experiences in childhood An analysis of the frequency data regarding verbally abusive experiences in childhood revealed that 67.3% (N = 371) of the participants indicated that they had experienced some form of verbal abuse from their fathers, with 18% (N = 99) of the participants reporting that they experienced moderate levels of abuse and 49.4% (N = 272) reporting severe forms of verbal abuse. Regarding verbal abuse from their mothers, 53.7% (N = 296) of the participants indicated that they had experienced severe verbal abuse and 26.5% (N = 146) reported moderate verbal abuse. Path analyses The results of the three path analyses with the separate symptom measures are summarized below. Given that the direct effects of earlier abuse experiences on subsequent abuse experiences remain constant throughout the various paths, the results related to the relationship among abuse experiences will only be reported in the first path analysis. Thus, all subsequent path analyses will highlight the unique effects associated with the analyses. Numerous intercorrelations were found among the various forms of abuse across time (see Table 2) and between symptoms and abuse experiences across time (see Table 3). The prediction of victimization and depressive symptoms during the 2-month follow-up. The first path (Figure 1) predicted victimization and depressive symptomatology during the follow-up period by previous victimization history and the magnitude of depressive symptoms at Time 1. Initial results revealed some unsatisfying fit indices: χ2 (12, N = 551) = 562.75, p < .001; CFI = .95; TLI = .73; RMSEA = .29; 90% confidence interval of RMSEA = .27–.31. The model was then analyzed removing all nonsignificant path links (see Figure 1). Although the chi-square test remained highly significant, χ2 (45, N = 551) = 604.87, p < .001, the other fit indices improved (CFI = .95; TLI = .93; RMSEA = .15; 90% confidence interval of RMSEA = .14–.16), suggesting that the significant causal path links are of import. Maternal verbal abuse was predictive of both dating violence during adolescence (β = .19, critical ratio = 4.67, p < .001) and depressive symptomatology at Time 1 (β = .19, critical ratio = 3.77, p < .001). Similarly, paternal verbal abuse predicted adolescent dating violence (β = .09, critical ratio = 2.07, p < .05) and depressive symptomatology at Time 1 (β = .15, critical ratio = 3.77, p < .001). Paternal physical abuse predicted adolescent sexual victimization (β = .23, critical ratio = 5.40, p < .001). Sexual victimization experiences during adolescence were predictive of both a sexual victimization experience during the follow-up period (β = .14, critical ratio = .14, p < .01), and depressive symptomatology at Time 1 (β = .25, critical ratio = 6.01, p < .001). Adolescent physical dating violence predicted physical dating violence during the follow-up (β = .13, critical ratio = 3.03, p < .01). Lastly, depressive syptomatology at Time 2 was predicted by both depressive symptomatology at Time 1 (β = .67, critical ratio = 20.14, p < .001), and dating violence during the follow-up period (β = .08, critical ratio = 2.50, p < .05).

1382

Table 2 Correlations between abuse experiences in childhood, adolescence, and the 2-month follow-up

Moth verba Fath verbb Moth phyc Fath phyd Child sexe Adol phyf Adol sexg Follow phyh Follow sexi a b c d e f g h i * **

–

Fath verbb

Moth phyc

Fath phyd

Child sexe

Adol phyf

Adol sexg

Follow phyh

Follow sexi

.32** –

.40** .24** –

.31** .41** .42** –

.05 .05 .20** .10* –

.16** .14** .09* .11** .04 –

.11** .11* .10* .24** .04 .02 –

.10* .00 .05 −.00 .12** .15** −.04 –

.02 −.06 −.00 −.04 .05 .03 .13** .10* –

Mother verbal abuse. Father verbal abuse. Mother physical abuse. Father physical abuse. Childhood sexual abuse. Adolescent physical victimization. Adolescent sexual victimization. Follow-up physical victimization. Follow-up sexual victimization. p < .05. p < .01.

C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 1373–1394

Moth verba

C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 1373–1394

1383

Table 3 Correlations between symptom measures and abuse experiences in childhood, adolescence and the 2-month follow-up Symptom measures a

IES (Time 1)

IES (Time 2)

b

BDI (Time 1)

BDI (Time 2)

Abuse experiences during childhood Verbal (mother) .12** Verbal (father) .05 Physical (mother) .09* Physical (father) .09* Sexual .06

.07 .04 .08 .09* .05

.20** .23** .22** .23** .09*

.19** .16** .22** .22** .04

Abuse experiences during adolescence Dating violence −.01 Sexual victimization .39**

.08 .13**

.14** .28**

.11* .25**

Abuse experiences during 2-month follow-up Dating violence −.04 Sexual victimization .07

.02 .27**

.06 .06

.12** .10*

a b c * **

IIPc (Time 1) .11* .08 .10* .08 −.01 .08 .13** −.01 .10*

IIP (Time 2) .09* .08 .05 .03 .05 .07 .12** .02 .12**

Impact of Event Scale. Beck Depression Inventory-II. Inventory of Interpersonal Problems. p < .05. p < .01.

The prediction of victimization and trauma symptoms during the 2-month follow-up. The second path (Figure 2) predicted victimization and trauma symptoms during the follow-up period by previous victimization history and trauma symptoms at Time 1. Similar to depressive symptomatology, initial path analyses for trauma symptoms revealed some unsatisfying fit indices: χ2 (12, N = 551) = 561.86, p < .001; CFI = .95; TLI = .74; RMSEA = .29; 90% confidence interval of RMSEA = .27–.31. After removing all nonsignificant path links (see Figure 2), the chi-square test remained highly significant, χ2 (45, N = 551) = 590.99, p < .001, but the other fit indices improved (CFI = .95; TLI = .93; RMSEA = .15; 90% confidence interval of RMSEA = .14–.16), suggesting that the significant causal path links are of import. Trauma symptomatology at Time 1 was predicted by paternal verbal abuse (β = .08, critical ratio = 1.93, p < .05), and a sexual victimization during adolescence (β = .38, critical ratio = 9.16, p < .001). Also, trauma symptomatology at Time 2 was predicted by paternal physical abuse (β = .09, critical ratio = 1.98, p < .05), trauma symptomatology at Time 1 (β = .11, critical ratio = 2.34, p < .05), and a sexual victimization experience during the follow-up period (β = .25, critical ratio = 5.83, p < .001). The prediction of victimization and interpersonal functioning during the 2-month follow-up. The third path (Figure 3) predicted victimization and interpersonal problems during the follow-up period by previous victimization history and interpersonal problems at Time 1. Similar to the prior analyses, initial path analyses on interpersonal functioning revealed some unsatisfying fit indices: χ2 (12, N = 551) = 561.10, p < .001; CFI = .96; TLI = .78; RMSEA = .29; 90% confidence interval of RMSEA = .27–.31. After removing all nonsignificant path links (see Figure 3), the chi-square test remained highly significant, χ2 (44, N = 551) = 591.75, p < .001, but the other fit indices improved (CFI = .96; TLI = .94; RMSEA = .15; 90% confidence interval of RMSEA = .14–.16), suggesting that the significant causal path links are of import.

1384

C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 1373–1394

Figure 1. Path predicting victimization and symptoms of depression.

Interpersonal problems at Time 1 was predicted by maternal verbal abuse (β = .13, critical ratio = 3.02, p < .01), and a sexual victimization during adolescence (β = .09, critical ratio = 2.03, p < .05). Interpersonal problems at Time 1 predicted a sexual victimization during the follow-up period (β = .11, critical ratio = 2.61, p < .05). Also, interpersonal problems at Time 2 were predicted by child sexual abuse (β = .09, critical ratio = 2.64, p < .05), interpersonal problems at Time 1 (β = .71, critical ratio = 23.06, p < .001), and dating violence during the follow-up period (β = .07, critical ratio = 2.13, p < .05). Chi-square analyses between significant forms of abuse. In order to better assess the relationships between the various forms of abuse, five χ2 analyses were conducted on the abuse measures that were found to be significant predictors in the path analyses. Maternal verbal abuse was significantly related to dating violence during adolescence, χ2 (4, N = 550) = 15.53, p < .01 (Table 4). Among women who had experienced severe verbal abuse from their mothers, 23% experienced moderate and 4% experienced severe dating violence in adolescence compared to the women without histories of verbal abuse from their mothers where 7.4% experienced moderate and 1.9% experienced severe dating violence in adolescence. In addition, paternal verbal abuse was significantly related to dating violence during adolescence, χ2 (4, N = 549) = 14.65, p < .01 such that for those women who experienced either moderate or severe verbal abuse from their fathers, 4% of them experienced severe dating violence in adolescence compared to 1.7% of women who experienced severe dating violence in adolescence who had not experienced verbal

C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 1373–1394

1385

Figure 2. Path predicting victimization and trauma symptoms. Table 4 Relationship between adolescent physical dating violence and maternal and paternal verbal abuse Dating violence during adolescence

Maternal verbal abuse None Moderate Severe

None

Moderate

Severe

98 (90.7%) 118 (80.8%) 216 (73.0%)

8 (7.4%) 24 (16.4%) 68 (23.0%)

2 (1.9%) 4 (2.7%) 12 (4.0%)

Total Paternal verbal abuseb None Moderate Severe

432

151 (84.8%) 84 (84.8%) 196 (72.1%)

Total a b

χ (4, N = 550) = 15.53, p < .01. χ2 (4, N = 549) = 14.65, p < .01. 2

Total

a

431

100

24 (13.5%) 11 (11.1%) 65 (23.9%) 100

18

3 (1.7%) 4 (4.0%) 11 (4.0%) 18

108 146 296 550

178 99 272 549

C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 1373–1394

1386

Figure 3. Path predicting victimization and interpersonal problems.

abuse from their fathers (Table 4). Further, dating violence during adolescence was significantly related to dating violence during the 2-month follow-up, χ2 (4, N = 518) = 34.22, p < .01 (Table 5). For those women who experienced severe dating violence in adolescence, 27.8% of them were revictimized during the follow-up (all moderately victimized) compared to 2.2% of the women without histories of dating violence who were moderately victimized and 1.2% who were severely victimized during the 2-month follow-up. Table 5 Relationship between adolescent physical dating violence and follow-up dating violence Dating violence during 2-month follow-up None Dating violence during adolescence None 395 (96.3%) Moderate 81 (89.0%) Severe 13 (72.2%) Total χ (4, N = 518) = 34.22, p < .01. 2

489

Moderate

Severe

9 (2.2%) 8 (8.8%) 5 (27.8%)

5 (1.2%) 2 (2.2%) 0 (0.0%)

22

7

Total 409 91 18 518

C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 1373–1394

1387

Table 6 Relationship between paternal physical abuse and sexual victimization in adolescence, and between sexual victimization in adolescence and during follow-up None

Moderate

Rape

Total

Sexual victimization in adolescence Paternal physical abusea None Moderate Severe

285 (72.0%) 62 (51.7%) 15 (44.1%)

Total

362

94 (23.7%) 40 (33.3%) 12 (35.3%) 146

Sexual victimization during 2-month follow-up Sexual victimization in adolescenceb None 317 (91.1%) 22 (6.3%) Moderate 122 (87.1%) 15 (10.7%) Rape 25 (71.4%) 7 (20.0%) Total a b

464

44

17 (4.2%) 18 (15.0%) 7 (20.6%)

396 120 34

42

550

9 (2.6%) 3 (2.1%) 3 (8.6%) 15

348 140 35 523

χ (4, N = 550) = 34.39, p < .01. χ2 (4, N = 523) = 14.04, p < .01. 2

Additionally, a sexual victimization experience in adolescence was significantly related to both paternal physical abuse, χ2 (4, N = 550) = 34.39, p < .01, and to a sexual victimization experience during the 2month follow-up, χ2 (4, N = 523) = 14.04, p < .01 (Table 6). For those women who experienced severe physical abuse from their fathers, 20.6% of them were raped in adolescence compared to the women without histories of paternal physical abuse or histories of moderate abuse where 4.2% and 15% of them were raped, respectively. Among those women with a history of adolescent sexual victimization, 8.6% of those with a history of rape compared to 2.1% with a history of moderate adolescent sexual victimization, and 2.6% of the women without adolescent sexual assault histories were raped during the brief 2-month follow-up period.

Discussion Overview of major findings Early victimization experiences as predictors of subsequent sexual victimization. Correlational analyses of the various forms of abuse in childhood suggested, as expected, that different forms of abuse were related to each other. A significant correlational relationship was found between physical abuse by both parents and the occurrence of childhood sexual abuse. In addition, verbal abuse by both the mother and the father were significantly correlated with physical abuse by both parents. In all cases, the more likely a child was to experience one type of abuse in childhood, the more likely it was that the child also experienced other types of child abuse. Further, the present study retrospectively examined the relationship between various forms of childhood abuse and sexual assault in adolescence, and also prospectively examined possible relationships between

1388

C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 1373–1394

a history of sexual victimization and a sexual assault during the follow-up period. Although verbal and physical abuse by the mother and father were significantly correlated with a sexual assault in adolescence, the only childhood victimization experience that was predictive of adolescent sexual victimization in the path analysis was a history of physical abuse by the father. While a number of studies have indicated that physical abuse during childhood increases a woman’s vulnerability to being physically abused in adulthood, our data indicated that early physical abuse may be a greater risk factor for future sexual assault. In a recent study, data indicated that women with childhood physical abuse histories were more likely to report risky sexual behavior than women without such histories (Morrill et al., 2001). It is possible that women who experience physical abuse by their parent may participate in risky sexual behavior thus rendering them at a higher risk for sexual assault. Results also replicated past prospective investigations (e.g., Gidycz et al., 1995) that have found a relationship between sexual victimization experiences. Although sexual assault occurring in childhood did not predict either adolescent sexual assault or a sexual victimization during the 2-month follow-up, sexual assault in adolescence did predict a sexual assault during the 2-month follow-up period. Specifically, women were more likely to be victimized during the academic quarter if they had a history of adolescent sexual victimization. In addition, the severity of a sexual victimization experience during adolescence predicted the severity of a subsequent sexual victimization, such that the more severe the adolescent sexual victimization, the more severe the sexual victimization during the 2-month follow-up period. In fact, women who had experienced a rape in adolescence were four times more likely than women with no history of abuse, or histories of sexual abuse other than rape, to be raped during the brief follow-up interval. The only victimization variable that was related to a sexual assault during the 2-month follow-up was a sexual victimization in adolescence. These data support other prospective investigations that have shown that the strongest predictor of a future sexual assault is a past sexual assault (Gidycz et al., 1993, 1995). Early victimization experiences as predictors of subsequent dating violence. The current study was the first to both retrospectively and prospectively assess physical dating violence among college students. A striking percentage of college women appear to be victims of physical dating violence both prior to entering the study and during the 2-month follow-up period. Twenty-one percent of women reported experiencing moderate or severe physical dating violence in adolescence and 5.5% of the women reported moderate or severe physical dating violence during the 2-month academic quarter. Both physical and verbal abuse by both parents is significantly correlated with being the victim of physical dating violence in adolescence. The only variables, however, that predicted adolescent experiences of physical dating violence were verbal abuse by the mother and verbal abuse by the father. While researchers are beginning to separate physical and sexual abuse in their analyses (Whitfield et al., 2003), our data further indicated a need to investigate the relationships between multiple forms of child abuse and to include emotional abuse as well when investigating the risk of subsequent abuse throughout the developmental periods. In addition, the only variable that predicted physical dating violence during the follow-up period was having a history of physical dating violence during adolescence. In fact, results indicated that women who experienced severe physical dating violence in adolescence were over twice as likely as women who previously experienced a moderate physical dating violence experience, and nine times more likely than women without histories of physical dating violence, to experience a physical victimization during the follow-up.

C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 1373–1394

1389

Predictors of psychological symptoms. Physical and verbal abuse experiences by both the father and mother were correlated with depression as measured at Time 1 and Time 2, and child sexual abuse was correlated to depression at Time 1 as well. However, in the path analysis many of these relationships did not remain significant. While physical abuse by the father and the mother were not found to predict any psychological symptoms, verbal abuse by the father and the mother did predict depression as measured at the beginning of the study. Further, verbal abuse by the father predicted trauma and verbal abuse by the mother predicted interpersonal problems as measured at Time 1. The present results are consistent with some past work that suggested that emotional abuse may be equally, or in some instances more traumatic, than physical abuse (Braver et al., 1992; Mullen, Martin, Anderson, Romans, & Herbison, 1996). While we explored whether the gender of the perpetrator might be related to the severity of reactions, our data suggested that emotional abuse from either parent led to psychological aftereffects. While none of the other childhood victimization experiences predicted initial symptoms, the experience of an adolescent sexual victimization predicted depression, trauma, and interpersonal difficulties as measured at Time 1. Conversely, physical dating violence in adolescence was not predictive of any of the psychological variables as measured at the start of the study. However, it is important to note that a physical dating violence experience during the follow-up period was predictive of both interpersonal problems and depression as measured at Time 2 and a sexual victimization experience during the follow-up period was predictive of trauma symptoms at Time 2. Additionally, there appears to be some long-lasting trauma associated with a father’s physical abuse as this type of childhood abuse was significantly correlated with trauma symptoms at Time 1 and was predictive of trauma symptoms during the follow-up period. Trauma symptoms did not predict any other victimization variable, indicating that trauma is more likely to be an aftereffect of a sexual victimization than predictive of a subsequent victimization over short intervals. The only significant reciprocal relationship between a victimization experience and symptoms was the relationship between sexual victimizations that occurred in adolescence, sexual assaults during the 2-month follow-up, and interpersonal problems as measured at Time 1. The path analysis indicated that an adolescent sexual victimization was predictive of interpersonal problems at Time 1 and interpersonal problems as measured at Time 1 subsequently predicted a sexual victimization at the follow-up. Therefore, interpersonal difficulties may be both an aftereffect of sexual assault as well as predictive of a future assault. Implications Given that physical abuse by a woman’s father was the only childhood abuse variable that rendered women more vulnerable to an adolescent sexual victimization, these findings underscore the need to educate child physical abuse victims about protective strategies against subsequent physical and sexual assaults. Future research is needed to elucidate better the processes by which paternal physical abuse may render a woman more vulnerable to sexual victimization experiences. The associations found between adolescent and adult sexual victimization experiences also highlight the need to address multiple victimizations and sexual revictimization in risk reduction efforts, even with populations, such as college students, that typically possess greater resources than other samples of sexual assault survivors. Although there is some evidence that risk reduction programs targeting general college student audiences do not address, or are not effective for, these high-risk women (Hanson & Gidycz, 1993), Calhoun et al. (2001) recently addressed issues related to sexual revictimization. Their program targeting college women with assault histories was found to reduce significantly program participants’ risk for sexual revictimization

1390

C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 1373–1394

relative to their waiting-list control group. The results of the present investigation underscore the need for further programming efforts with high-risk groups of women. Given the high rates of dating violence and the finding that the most significant predictor of physical dating violence in this sample is a past experience with physical dating violence, this study also underscores the need for further investigation into the dynamics of physical dating violence. These results also highlight the need to address physical dating violence with teens in order to prevent a cycle of violence from developing. Programs such as the Safe Dates program (Foshee et al., 1998) are important efforts along these lines. Our findings also imply that, in some respects, early emotional abuse by one’s parents, compared to early physical or sexual abuse, may be more predictive of greater psychological symptoms. It is possible that the psychological abuse by one’s parents might be more damaging than physical abuse as it might be more consistent and more indicative of the quality of the relationship between the parents and child. Meston, Heiman, and Trapnell (1999) suggested that emotional abuse can be as traumatic, if not more traumatic, than physical abuse because it can thwart the needs for love, self-esteem, and feelings of belonging. If this is the case, it may help to explain why women who were emotionally abused in childhood were more likely to be involved in dating relationships in adolescence where violence was present. The path analysis findings suggest that during adolescence sexual assaults may lead to greater psychological symptoms than physical assaults. While it may be that the closer proximity between the dating violence experiences during the follow-up and the Time 2 assessments accounts for the significant relationships between dating violence during the follow-up and psychological outcomes, it is also possible that the dating violence experiences that occurred during adulthood are qualitatively different and possibly more severe than the experiences that occurred during adolescence. Although this is speculative, it is possible that the relationships that occurred during the follow-up period were of longer duration and more serious than the adolescent relationships. Past research has suggested that more severe abuse is likely to occur in relationships that are more serious and of longer duration (e.g., Ray & Gold, 1996). Therefore, further longitudinal analyses are needed to explore the psychological impact of abuse over time, especially what happens to women as they stay in or reengage in physically abusive relationships. The findings suggesting that interpersonal problems associated with earlier abuse experiences may increase the risk of subsequent sexual victimization experiences underscore the necessity of investigating how these ontogenic factors increase a woman’s chances of being revictimized. Grauerholz (2000) suggests that ontogenic factors do not inherently lead to revictimization but rather they shape a woman’s relationship with potential abusers and other people who might have the potential to otherwise protect her. Future studies should explore the mechanisms through which interpersonal difficulties might make a woman more vulnerable to a sexual assault. Finally, it was interesting to note that few of the child abuse experiences predicted the psychological outcome measures as assessed at Time 2. While this seems contradictory to past work with college students that have found that those abused in childhood evidence higher symptom levels across a variety of measures (e.g., Briere & Runtz, 1990), it is important to keep in mind that virtually all of the past data have been retrospective in nature. Thus, child abuse status, as well as current symptoms, have typically been measured at the same time. In this study, however, child abuse status was ascertained two months prior to participants filling out the symptom measures at the follow-up assessment. Further, it is important to note that some of the symptom measures assessed at Time 2 were in fact significantly correlated with past childhood abuse experiences, the relationships were just not strong enough to come out significant in the path analyses when all other variables were in the model. In most instances, the more proximal

C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 1373–1394

1391

variables (abuse during the follow-up) predicted psychological outcomes at Time 2 and the early child abuse experiences, when significant, predicted the psychological outcomes at Time 1. Limitations Given the young age of the present sample, it is likely that the vast majority of these women have been involved in these abusive relationships for a relatively short period of time. Additionally, since college women likely possess a number of resources that may not be typical of other populations, one should not generalize these findings to non-college student samples. However, future studies should extend the length of the follow-up period in order to explore more fully the reciprocal nature between symptoms and abuse and to more accurately assess the rates of victimization and revictimization over time. Since follow-up data included only those victimizations that occurred in a 10-week academic quarter, it is probable that many more women will be victimized during their college years. Therefore, longer follow-up intervals may demonstrate even higher rates of victimization and more incidents of revictimization. Low correlations indicating weak relationships were also considered to be limitations of this study. Other possible mediators of both physical dating violence and sexual assault that should be included in future studies include substance use, contextual variables (e.g., predilection of the man to perpetrate violence), and family functioning. Conclusions In conclusion, our findings indicate that various forms of abuse tend to co-occur, with early emotional abuse by both parents predictive of subsequent dating violence and early physical abuse by the father predictive of adolescent sexual abuse. Both sexual and dating violence appear to recur over time, as adolescent dating violence was predictive of dating violence over the follow-up period and sexual victimization during adolescence was predictive of sexual violence over the follow-up. In addition, interpersonal problems appeared to be both an aftereffect of sexual victimization in adolescence, as well as act as a risk factor for abuse during the follow-up. Finally, our data also suggested that emotional abuse by both parents was more predictive of initial levels of psychological symptoms than overt types of abuse. Thus, subtler forms of abuse can be equally or more traumatic and set the stage for subsequent abuse experiences. References Acierno, R., Resnick, H., Kilpatrick, D. G., Saunders, B., & Best, C. L. (1999). Risk factors for rape, physical assault, and posttraumatic stress disorder in women: Examination of differential multivariate relationships. Journal of Anxiety Disorders, 13, 541–563. Allen, D. M., & Tarnowski, K. J. (1989). Depressive characteristics of physically abused children. Journal of Abnormal Child Psychology, 17, 1–11. Arata, C. M. (2002). Child sexual abuse and sexual revictimization. Clinical Psychology: Science and Practice, 9, 135–164. Arbuckle, J. L. (1999). Amos 4.0 user’s guide. Chicago, IL: Small Waters Cooperation. Beck, A. T., Steer, R., & Brown, G. K. (1996). Manual for Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation. Beitchman, J. H., Zucker, K. J., Hood, J. E., DaCosta, G. A., & Akman, D. (1991). A review of the short-term effects of child sexual abuse. Child Abuse & Neglect, 15, 537–556.

1392

C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 1373–1394

Beitchman, J. H., Zucker, K. J., Hood, J. E., DaCosta, G. A., Akman, D., & Cassavia, E. (1992). A review of the long-term effects of child sexual abuse. Child Abuse & Neglect, 16, 101–118. Bernard, M. L., & Bernard, J. L. (1983). Violent intimacy: The family as a model for love relationships. Family Relations: Journal of Applied Family and Child Studies, 32, 283–286. Boney-McCoy, S., & Finkelhor, D. (1995). Prior victimization: A risk factor for child sexual abuse and for PTSD-related symptomatology among sexually abused youth. Child Abuse & Neglect, 19, 1401–1421. Braver, M., Bumberry, J., Green, K., & Rawson, R. (1992). Childhood abuse and current psychological functioning in a university counseling center population. Journal of Counseling Psychology, 39, 252–257. Brener, N. D., McMahon, P. M., Warren, C. W., & Douglas, K. A. (1999). Forced sexual intercourse and associated health-risk behaviors among female college students in the United States. Journal of Consulting and Clinical Psychology, 67, 252–259. Briere, J., & Runtz, M. (1990). Differential adult symptomatology associated with three types of child abuse histories. Child Abuse & Neglect, 14, 357–364. Browne, A., & Finkelhor, D. (1986). Impact of child sexual abuse: A review of the research. Psychological Bulletin, 99, 66–77. Calhoun, K. S., Gidycz, C. A., Loh, C., Wilson, A., Lueken, M., Outman, R. C., & Marioni, N. L. (2001, November). Sexual assault prevention in high-risk women. Poster presented at the annual meeting of the Association for the Advancement of Behavior Therapy, Philadelphia, PA. Chu, J. A., & Dill, D. L. (1990). Dissociative symptoms in relation to childhood physical and sexual abuse. American Journal of Psychiatry, 147, 887–892. Claussen, A. H., & Crittenden, P. M. (1991). Physical and psychological maltreatment: Relations among types of maltreatment. Child Abuse & Neglect, 15, 5–18. Cloitre, M. (1998). Sexual victimization: Risk factors and prevention. In V. M. Follette, J. I. Ruzek, & F. R. Abueg (Eds.), Cognitive-behavioral therapies for trauma (pp. 278–304). New York: Guilford Press. Cloitre, M., Scarvalone, P., & Difede, J. (1997). Posttraumatic stress disorder, self- and interpersonal dysfunction among sexually retraumatized women. Journal of Traumatic Stress, 10, 437–452. Conte, J. R., & Schuerman, J. R. (1987). Factors associated with an increased impact of child sexual abuse. Child Abuse & Neglect, 11, 201–211. Davis, J. L., & Petretic-Jackson, P. A. (2000). The impact of child sexual abuse on adult interpersonal functioning: A review and synthesis of the empirical literature. Aggression and Violent Behavior, 5, 291–328. Deal, J. E., & Wampler, K. S. (1986). Dating violence: The primacy of past experiences. Journal of Social and Personal Relations, 3, 457–471. Finkelhor, D. (1979). Sexually victimized children. New York: Free Press. Foshee, V., Bauman, K. E., Arriaga, X. B., Helms, R. W., Koch, G. G., & Linder, G. F. (1998). An evaluation of safe dates, an adolescent dating violence prevention program. American Journal of Public Health, 88, 45–50. Gidycz, C. A., Coble, C. N., Latham, L., & Layman, M. J. (1993). Sexual assault experience in adulthood and prior victimization experiences: A prospective analysis. Psychology of Women Quarterly, 17, 151–168. Gidycz, C. A., Hanson, K., & Layman, M. J. (1995). A prospective analysis of the relationships among sexual assault experiences: An extension of previous findings. Psychology of Women Quarterly, 19, 5–29. Grauerholz, L. (2000). An ecological approach to understanding sexual revictimization: Linking personal, interpersonal, and sociocultural factors and processes. Child Maltreatment: Journal of the American Professional Society on the Abuse of Children, 5, 5–17. Gross, A. B., & Keller, H. R. (1992). Long-term consequences on childhood physical and psychological maltreatment. Aggressive Behavior, 18, 171–185. Hansen, N. B., & Lambert, M. J. (1996). Brief report: Assessing clinical significance using the Inventory of Interpersonal Problems. Assessment, 3, 133–136. Hanson, K. A., & Gidycz, C. A. (1993). Evaluation of a sexual assault prevention program. Journal of Consulting and Clinical Psychology, 61, 1046–1052. Himelein, M. J. (1995). Risk factors for sexual victimization in dating: A longitudinal study of college women. Psychology of Women Quarterly, 19, 31–48. Horowitz, L. M., Rosenberg, S. E., Baer, B. A., Ure˜no, G., & Villase˜nor, V. S. (1988). Inventory of interpersonal problems: Psychometric properties and clinical applications. Journal of Consulting and Clinical Psychology, 56, 885– 892.

C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 1373–1394

1393

Horowitz, M. J., Wilner, N., & Alvarez, W. (1979). Impact of Event Scale: A measure of subjective stress. Psychosomatic Medicine, 41, 209–218. Jumper, S. A. (1995). A meta-analysis of the relationship of child sexual abuse to adult psychological adjustment. Child Abuse & Neglect, 19, 715–728. Kazdin, A. E., Moser, J., Colbus, D., & Bell, R. (1985). Depressive symptoms among physically abused and psychiatrically disturbed children. Journal of Abnormal Psychology, 94, 298–307. Kendall-Tackett, K. A., Williams, L. M., & Finkelhor, D. (1993). Impact of sexual abuse on children: A review and synthesis of recent empirical studies. Psychological Bulletin, 113, 164–180. Kilpatrick, D. G., Edmonds, C. N., & Seymour, A. K. (1992). Rape in America: A report to the nation. Arlington, VA: National Victim Center. Kiser, L. J., Heston, J., Millsap, P. A., & Pruitt, D. B. (1991). Physical and sexual abuse in childhood: Relationship with post-traumatic stress disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 776– 783. Koss, M. P., & Gidycz, C. A. (1985). Sexual Experiences Survey: Reliability and validity. Journal of Consulting and Clinical Psychology, 53, 422–423. Koss, M. P., & Oros, C. J. (1982). Sexual Experiences Survey: A research instrument investigating sexual aggression and victimization. Journal of Consulting and Clinical Psychology, 50, 455–457. Loehlin, J. C. (1998). Latent variable models: An introduction to factor, path, and structural analysis (3rd ed.). Mahwah, NJ: Lawrence Erlbaum Associates. Lueken, M. A., & Gidycz, C. A. (2002, November). Partner violence among college women. A comparison of women who stay in violent relationships to those who leave. Poster presented at the annual meeting of the Association for the Advancement of Behavior Therapy, Reno, NV. Makepeace, J. M. (1981). Courtship violence among college students. Family Relations, 30, 97–102. Meston, C. M., Heiman, J. R., & Trapnell, P. D. (1999). The relation between early abuse and adult sexuality. Journal of Sex Research, 36, 385–395. Meyerson, L. A., Long, P. J., Miranda, R., & Marx, B. P. (2002). The influence of childhood sexual abuse, physical abuse, family environment, and gender on the psychological adjustment of adolescents. Child Abuse & Neglect, 26, 387–405. Morrill, A. C., Kasten, L., Urato, M., & Larson, M. J. (2001). Abuse, addiction, and depression as pathways to sexual risk in women and men with a history of substance abuse. Journal of Substance Abuse, 13, 169–184. Mullen, P. E., Martin, J. L., Anderson, J. C., Romans, S. E., & Herbison, G. P. (1996). The long-term impact of the physical, emotional, and sexual abuse of children: A community study. Child Abuse & Neglect, 20, 7–21. Ohio Revised Code, 2907 §§ 28907.01-2907.02 (1998). Pedersen, P., & Thomas, C. D. (1992). Prevalence and correlates of dating violence in a Canadian university sample. Canadian Journal of Behavioural Science, 24, 490–501. Putnam, F. W. (2003). Ten-year research update review: Child sexual abuse. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 269–278. Ray, A. L., & Gold, S. R. (1996). Gender roles, aggression, and alcohol use in dating relationships. Journal of Sex Research, 33, 47–55. Riggs, D. S., & O’Leary, K. D. (1996). Aggression between heterosexual dating partners: An examination of a causal model of courtship aggression. Journal of Interpersonal Violence, 11, 519–540. Roodman, A. A., & Clum, G. A. (2001). Revictimization rates and method variance: A meta-analysis. Clinical Psychology Review, 21, 183–204. Smith, J. P., & Williams, J. G. (1992). From abusive household to dating violence. Journal of Family Violence, 7, 153– 165. Straus, M. A. (1979). Measuring intrafamily conflict and violence: The Conflict Tactics (CT) Scales. Journal of Marriage and the Family, 41, 75–88. Tanaka-Matsumi, J., & Kameoka, V. A. (1986). Reliabilities and concurrent validities of popular self-report measures of depression, anxiety and social desirability. Journal of Consulting and Clinical Psychology, 54, 328–333. Teri, L. (1982). The use of the Beck Depression Inventory with adolescents. Journal of Abnormal Child Psychology, 10, 277–284. Tjaden, P., & Thoennes, N. (2000). Prevalence and consequences of male-to-female and female-to-male intimate partner violence as measured by the National Violence Against Women Survey. Violence Against Women, 6, 142–161.

1394

C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 1373–1394

Weaver, T. L., & Clum, G. A. (1995). Psychological distress associated with interpersonal violence: A meta-analysis. Clinical Psychology Review, 15, 115–140. Whitfield, C. L., Anda, R. F., Dube, S. R., & Felitti, V. J. (2003). Violent childhood experiences and the risk of intimate partner violence in adults: Assessment in a large health maintenance organization. Journal of Interpersonal Violence, 18, 166–185.

R´esum´e French-language abstract not available at the time of publication. Resumen Spanish-language abstract not available at the time of publication.