Benutzer:Benedikt~dewiki/Fakten Kindesmissbrauch
Putnam FW.
Children's Hospital Medical Center, Cincinnati, Ohio, 45229-3039, USA. Frank.Putnam@chmcc.org
OBJECTIVE To provide clinicians with current information on prevalence, risk factors, outcomes, treatment, and prevention of child sexual abuse (CSA). To examine the best-documented examples of psychopathology attributable to CSA.METHOD Computer literature searches of and for key words. All English-language articles published after 1989 containing empirical data pertaining to CSA were reviewed.RESULTS CSA constitutes approximately 10% of officially substantiated child maltreatment cases, numbering approximately 88,000 in 2000. Adjusted prevalence rates are 16.8% and 7.9% for adult women and men, respectively. Risk factors include gender, age, disabilities, and parental dysfunction. A range of symptoms and disorders has been associated with CSA, but depression in adults and sexualized behaviors in children are the best-documented outcomes. To date, cognitive-behavioral therapy (CBT) of the child and a nonoffending parent is the most effective treatment. Prevention efforts have focused on child education to increase awareness and home visitation to decrease risk factors.CONCLUSIONS CSA is a significant risk factor for psychopathology, especially depression and substance abuse. Preliminary research indicates that CBT is effective for some symptoms, but longitudinal follow-up and large-scale "effectiveness" studies are needed. Prevention programs have promise, but evaluations to date are limited. Quelle: [1]
Relationship Between Sexual Abuse, Gender, and Sexually Inappropriate Behaviors in Seriously Mentally Ill Youths. Journal of the American Academy of Child & Adolescent Psychiatry. 36(7):959-965, July 1997. McClellan, Jon MD; McCurry, Chris PhD; Ronnei, Marilyn PhD; Adams, Julie PsyD; Storck, Michael MD; Eisner, Andrea MD; Smith, Cindy MD
Abstract: Objective: To examine gender differences in sexual abuse histories and in the development of inappropriate sexual behaviors in a sample of seriously mentally ill youths.
Method: A retrospective chart review was completed for all patients from 1987 through 1992 at a tertiary care public sector psychiatric hospital for youths (N = 499). Subjects were categorized by gender, sexual abuse status, and whether they had sexually reactive or victimizing behaviors.
Results: Girls were more likely to have been sexually abused, and their abuse histories were more severe. Sexual behavior problems in girls were almost exclusively associated with sexual abuse, whereas 29% of boys with victimizing behaviors had no sexual abuse history. Among sexually abused youths, boys were more likely to display victimizing behaviors, whereas both genders displayed similar rates of sexually reactive behaviors. Of the 19 girls who displayed victimizing behaviors, 95% were chronically sexually abused and one third had also received a major injury due to physical abuse.
Conclusions: Boys appear to have a lower threshold of abuse exposure required to develop sexually inappropriate behaviors and are significantly more likely to display victimizing behaviors. Conversely, victimizing behaviors in girls may require a catastrophic maltreatment history. These gender differences should be incorporated into treatment interventions directed at sexual abuse victims. J. Am. Acad. Child Adolesc. Psychiatry, 1997, 36(7):959-965.
Copyright 1997 (C) American Academy of Child and Adolescent Psychiatry Quelle: [2]
Child Sexual Abuse and Emotional and Behavioral Problems in Adolescence: Gender Differences. Journal of the American Academy of Child & Adolescent Psychiatry. 36(3):323-329, March 1997. Garnefski, Nadia MSc; Diekstra, Rene F.W. PhD
Abstract: Objective: To compare sexually abused boys with sexually abused girls and with their non-sexually abused counterparts with regard to (1) the type of mental health problems they experience; and (2) the number and patterns of such problems.
Method: The sample comprised 745 secondary school students, aged 12 to 19 years, with a self-reported history of sexual abuse (151 boys and 594 girls) and 745 matched students without such a history. Sexually abused and non-sexually abused boys and girls were compared with regard to four problem categories: emotional problems, aggressive/criminal behaviors, addiction-risk behaviors, and suicidality.
Results: A larger proportion of sexually abused adolescents than nonabused adolescents reported problems in the separate categories and in a combination of problem categories. Sexually abused boys had considerably more emotional and behavioral problems, including suicidality, than their female counterparts. There were differences between the specific combinations of problem categories reported by sexually abused girls and boys. These differences could not be attributed to the finding that sexually abused boys were more often the victim of concurrent physical abuse than sexually abused girls.
Conclusions: The results suggest that although there was a strong association between being sexually abused and the existence of a multiple problem pattern in both sexes, the aftermath for boys might be even worse or more complex than for girls. J. Am. Acad. Child Adolesc. Psychiatry, 1997, 36(3):323-329. Quelle: [3]
Depressed Adolescents with a History of Sexual Abuse: Diagnostic Comorbidity and Suicidality. Journal of the American Academy of Child & Adolescent Psychiatry. 35(1):34-41, January 1996. Brand, Elena F. PhD; King, Cheryl A. PhD; Olson, Eva MD; Ghaziuddin, Neera MD; Naylor, Michael MD
Abstract: Objective: To determine the nature of comorbid psychopathology and suicidality associated with a history of sexual abuse in depressed adolescents.
Method: Twenty-four depressed adolescent inpatients with a history of sexual abuse were compared with a matched control group of 24 depressed adolescent inpatients on measures of depression, suicidal ideation and behavior, and posttraumatic stress disorder (PTSD) symptoms.
Results: Depressed adolescents with a history of sexual abuse had a higher prevalence of comorbid PTSD than did those without such a history. Chronicity and severity of abuse were significant contributors to a PTSD diagnosis. No differences were found in depression severity, specific depressive symptoms, or suicidal behavior.
Conclusion: Comorbidity of depressive disorders and PTSD are common among adolescent inpatients with a history of chronic sexual abuse. The need for thorough assessment of depression and PTSD with appropriate interventions for sexually abused adolescents is clear. J. Am. Acad. Child Adolesc. Psychiatry, 1996, 35(1):34-41. Quelle: [4]
Influence of Sexual Abuse on HIV-Related Attitudes and Behaviors in Adolescent Psychiatric Inpatients. Journal of the American Academy of Child & Adolescent Psychiatry. 36(3):316-322, March 1997. Brown, Larry K. MD; Kessel, Shari M. ScB; Lourie, Kevin J. PhD; Ford, Harriet H. PhD; Lipsitt, Lewis P. PhD
Abstract: Objective: To investigate the associations between sexual abuse and human immunodeficiency virus (HIV)-related attitudes and behaviors of adolescents with a psychiatric disorder.
Method: HIV-related knowledge, attitudes, and behaviors were examined by self-report assessment of adolescents admitted to a psychiatric hospital (N = 100). A subsample (n = 30) completed a role-playing exercise regarding HIV-preventive behavior that was scored for the degree of effective communication by raters blind to the subjects' abuse history.
Results: HIV-related risk behaviors were prevalent, including unprotected sexual intercourse (67%) and multiple partners (27%) among the sexually active (71% of the total). Also frequent were alcohol and drug use (25%) and sharing cutting instruments (22%) among those engaged in self-cutting behavior (62%). The 38% of the sample identified as having a history of sexual abuse indicated significantly poorer self-efficacy concerning condom use than their peers. Abused females scored significantly lower on the self-efficacy of condom use scale and reported significantly more frequent alcohol use than nonabused females (p = .003). A hierarchical multiple regression that controlled for consistency of condom use and tolerance of people with acquired immunodeficiency syndrome found that abuse history uniquely accounted for 16% of the variance in condom use self-efficacy. Analysis of the videotaped role-play found that abused adolescents were significantly less competent and had more difficulty in effective communication than their peers (p = .003).
Conclusion: A history of sexual abuse is associated with impaired safe sexual decision-making and HIV-preventive communication skills, even in this already at-risk group. This study also underscores the importance of actively addressing these issues in the context of clinical care. J. Am. Acad. Child Adolesc. Psychiatry, 1997, 36(3):316-322. Quelle: [5]
Sexual Abuse and Suicidal Behavior: A Model Constructed From a Large Community Sample of Adolescents. Journal of the American Academy of Child & Adolescent Psychiatry. 42(11):1301-1309, November 2003. Bergen, Helen A. Ph.D. ; Martin, Graham M.D. , F.R.A.N.Z.C.P; Richardson, Angela S. B.Psych. ; Allison, Stephen M.B.B.S. , F.R.A.N.Z.C.P. ; Roeger, Leigh B.A. (Hons.)
Abstract: Objective: To investigate relationships between self-reported sexual abuse, depression, hopelessness, and suicidality in a community sample of adolescents.
Method: In 1995, students (mean age 13 years) from 27 high schools in Australia (n = 2,603) completed a questionnaire including measures of depressive symptoms (Center for Epidemiologic Studies Depression Scale), hopelessness, sexual abuse, and suicidality. Data analysis included logistic regression.
Results: Sexual abuse is associated with suicidality, both directly and indirectly through hopelessness and depressive symptoms in the model developed. High suicide risk (behavior exceeding thoughts such as plans and threats, or deliberate self-injury) is strongly correlated with suicide attempts (odds ratio 28.8, 95% CI 16-52, p < .001). Hopelessness is associated with high suicide risk only, whereas depressive symptoms are associated with high suicide risk and attempts. Hopelessness is more strongly associated with sexual abuse in boys than girls. Depressive symptoms are more strongly associated with high suicide risk in girls than boys. Controlling for other variables, sexual abuse is independently associated with suicide attempts in girls but not boys.
Conclusions: Clinical assessment should consider gender differences in relationships between sexual abuse, depressive symptoms, hopelessness, and suicidality. Sexually abused girls may be at increased risk of attempting suicide, independent of other psychopathology. Quelle: [6]
Relationship of Childhood Sexual Abuse and Eating Disorders. Journal of the American Academy of Child & Adolescent Psychiatry. 36(8):1107-1115, August 1997. Wonderlich, Stephen A. PhD; Brewerton, Timothy D. MD; Jocic, Zeljko MD; Dansky, Bonnie S. PhD; Abbott, David W. MD
Abstract: Objective: To review the literature that has examined the relationship between childhood sexual abuse and the eating disorders.
Method: Each of the five authors reviewed all identified empirical studies to be certain that inclusion/exclusion criteria were met. Two teams of raters then independently reviewed each study to determine whether it supported any of a series of six hypotheses that had been tested in this literature.
Results: This review indicates that childhood sexual abuse is a nonspecific risk factor for bulimia nervosa, particularly when there is psychiatric comorbidity. There is some indication that childhood sexual abuse is more strongly associated with bulimic disorders than restricting anorexia, but it does not appear to be associated with severity of the disturbance.
Conclusion: Childhood sexual abuse is a risk factor for bulimia nervosa with significant comorbidity. Further study of the nature of this relationship is warranted. J. Am. Acad. Child Adolesc. Psychiatry, 1997, 36(8):1107-1115. Quelle: [7]
