The purpose of this study was to assess the relative contributions of childhood physical and sexual abuse in the prediction of prior adult victimization history and current posttraumatic symptomatology following a recent sexual assault. Path modeling procedures were used to test the relationships among these variables, and the final model met criteria for an ideal fit. The results showed that a higher rate of childhood sexual abuse was related to higher rates of subsequent adult sexual and physical victimization, which in turn contributed to the level of PTSD symptomatology following a recent rape. Childhood sexual abuse, but not childhood physical abuse, predicted subsequent exposure to high-impact, high-magnitude traumatic events, such as physical and sexual assault during adulthood. Apart from its link to subsequent adult victimization, childhood sexual abuse alone was not a significant independent predictor of current postrape PTSD symptomatology but was linked only indirectly to PTSD through its relationship with adult sexual and physical victimization. Childhood physical abuse alone was neither directly nor indirectly related to current postrape PTSD symptomatology.
These data are consistent with the emergent body of research highlighting the relationship between childhood sexual trauma and vulnerability to sexual and physical victimization during adulthood. Second, it appears that postrape PTSD symptomatology is attributable to the cumulative impact of childhood sexual trauma stressors and prior adult victimization rather than the impact of childhood sexual abuse alone. Finally, childhood sexual abuse posed a significantly greater risk for subsequent victimization and symptomatology than childhood physical abuse.
A critical question then is, What makes child sexual abuse survivors vulnerable to subsequent victimization during adulthood? On the basis of the clinical and descriptive literatures on childhood sexual abuse survivors, we can offer several hypotheses. One possible explanation is that survivors of childhood sexual abuse have dysfunctional interpersonal schemas affecting perceptions of trust and safety that affect judgment and decision making with regard to risk appraisal in interpersonal situations. It is also possible that symptoms of unresolved traumatic stressors, including depression, dissociation, anxiety, posttraumatic stress symptoms and substance abuse may interfere with the cognitive appraisal of risk in potentially vulnerable situations or lessened ability to resist and defend themselves once in a situation. Further, depression, dissociation, and anxiety may very well moderate PTSD symptomatology independent of unresolved trauma issues. Common sequelae of childhood sexual abuse, such as difficulty modulating affect, engaging in inappropriate forms of self-soothing, and setting healthy interpersonal boundaries may set the stage for involvement in situations that increase the risk of victimization. It should also be noted that the majority of the sample in this study made less than $5,000 per annum. Environmental stressors related to a low income level (e.g., unsafe housing) may have influenced the rates of revictimization in this study. Future studies could focus on delineating the role of these potential variables in mediating the link between childhood sexual abuse and subsequent victimization during adulthood.
One limitation of the present study was a lack of a large enough sample size to include these other important variables in the model that may mediate the increased vulnerability of child sexual abuse victims to adult interpersonal victimization. Also, the prior victimization data are retrospective and may suffer from recall bias leading to state-dependent overreporting of prior trauma (Sandberg, Lynn, & Green, 1994
). Research has shown that emotion experienced at the time of retrieving a traumatic event influences what is remembered to a greater extent than the strength of the original emotion (Wessel & Merckelbach, 1994
). Because the participants were recent rape victims, it is entirely possible that their current emotions at the time of assessment led to an overreporting of prior trauma experiences. However, other literature suggests that self-reports of past emotion are not always an accurate reflection of emotion actually experienced during the original event (Neisser & Harsch, 1992
) and that past emotion correlates more strongly with remembering trauma details than does present emotion (Christianson & Loftus, 1990
). Moreover, retrospective assessment using self-report measures of childhood victimization history has been found to be generally reliable, but when errors occur, they occur in the direction of underreporting of previous trauma (Widom & Morris, 1997
; Widom & Shepard, 1996
). Further, it had been reported that there is little evidence to link current psychiatric status with less reliable or less valid recall of early experiences (Brewin, Andrews, & Gotlib, 1993
). Although it might be argued that our results have limited generalizability to a long-term posttrauma period, it has been demonstrated that most postassault recovery takes place within the first 3 months (Rothbaum, Foa, Riggs, Murdock, & Walsh, 1992
), thus making the study of short-term posttrauma period important.
Limitations of this study notwithstanding, the results of our study are consistent with other research (Follette et al., 1996
) suggesting that to the extent that prior trauma history contributes to PTSD symptomatology in recent rape victims, its effects appear to be a cumulative result of child sexual abuse and adult interpersonal victimization. Thus, an assessment of prior trauma history symptoms can help clinicians identify clients at higher risk for subsequent victimization and development of PTSD.