This study tested indirect pathways of a host of risk factors in an effort to better understand the links between maltreatment, psychological dysregulation, and risky sexual behaviors. The results support an association between psychological dysregulation and a host of key variables that can place adolescent females at risk for further developmental disruption. These include behavior problems, lack of parental connectedness, risky peer affiliations, substance use, and sexual preoccupation. All of these variables were associated with risky sexual behaviors at the zero-order, correlation level. These associational patterns suggest that dysregulation likely plays an important role in the development of risky sexual behaviors at the level of affective, behavioral and cognitive processing.
Associated risk factors were then simultaneously assessed in a multiple mediator analysis to determine unique pathways to risk sexual behaviors. Sexual preoccupation was the most potent predictor of sexual risk-taking when evaluated along with risky peers, parental connectedness, behavior problems, substance use. Out of all these risk factors, only sexual preoccupation helped explain the process by which psychological dysregulation operates on adolescent risky sexual behavior. Indeed, the results suggest that psychological dysregulation and sexual preoccupation function together to illuminate an important indirect pathway to sexual risk-taking above and beyond other plausible avenues. Female adolescents who have difficulty regulating their emotions, cognitions, and behaviors may be unable to effectively compartmentalize these preoccupations to a degree that keeps them from acting on sexual impulses and resisting the propensity to engage in sexual behaviors.
The inability to effectively regulate emotions, cognitions, and behaviors, coupled with a preoccupation with sexual thoughts and stimuli, can help explain why maltreated adolescent females are at risk for engaging in risky sexual behaviors. According to the Traumagenics Dynamics model (Finkelhor & Browne, 1986
), childhood maltreatment may result in cognitive distortions around sexuality stemming from the severe boundary violations, betrayal, stigma, shame, and powerlessness that characterize extreme traumatization. Hence, when faced with sexual impulses, especially those that are difficult to regulate, maltreated adolescents may act accordingly and adopt risky sexual behaviors. Theses results suggest that maltreatment might dysregulate one’s ability to modify or alter cognitions, putting those who have higher sexual preoccupation—a cognitive process itself—at risk for further disruption and for engagement in risky sexual behaviors.
As such, this study offers potential implications for prevention efforts and clinical interventions in the pediatric setting. These data suggest that psychological dysregulation increases the risk for engagement in risky sexual behavior. However, further examination of this relationship indicated that sexual preoccupation, including frequent masturbation, pornography consumption, and intrusive sexual thoughts, fully mediated the relationship between psychological dysregulation and risky sexual behavior even when accounting for other associated risk factors. Pediatric psychologists should assess the presence of psychological dysregulation, sexual preoccupation, and sexual activity when working with female adolescents with a maltreatment history. In turn, interventions should focus on addressing current sexual thoughts, attitudes, and behaviors in order to reduce engagement in risky sexual activity. This can be accomplished through cognitive-behavioral interventions or even education about safe sex hygiene for those not yet engaging in sexual activity. Parents and pediatric practitioners should emphasize ways in which adolescents can field sexual thoughts and feelings and should discuss various healthy means of sexual expression. Being especially vulnerable, female adolescents who have been maltreated may need augmented interventions regarding effective strategies to deal with sexual thoughts and warding-off sexual advances.
These findings are considered in light of several limitations of the current study. First, the cross-sectional nature of the data precludes strong causal inferences and the indirect pathways reported should not be interpreted as temporally-ordered mediation. The testing of indirect pathways is one approach to parsing out variability according to sound theory. The model tested provides a means by which we can examine a theoretically plausible representation of a multivariate system of interrelationships and pathways that, when included in the same equation, can advance knowledge by allowing variability to be parsed in meaningful ways that are not possible when these variables are examined in isolation. Second, although there is some good evidence and sound theory to suggest that, due to its explicit nature, sexual abuse would constitute the highest risk for aberrant development, we are unable to speak to whether or not the model we tested fits the data better for one specific type of abuse versus another. Sub-sample size limitations preclude multiple group SEM, however we did examine, on an experimental basis, zero-order correlations for sexually abused, physically abused and neglected adolescents separately. Although interrelationships among key constructs were generally stronger for the sexual abuse sub-sample, no obvious appreciable differences across sub-samples were found. Future research should be aimed at articulating (a) the unique roles that different forms of childhood maltreatment might play in the development of adolescent sexuality; and (b) how the experience of multiple types of maltreatment might exacerbate vulnerability for risky behavior. Third, we utilized a sample of victims with substantiated maltreatment. While this method constitutes rigor in terms of objective confirmation of maltreatment, it may inherently decrease sensitivity by excluding cases of unreported or unsubstantiated maltreatment and, accordingly, may limit generalizability. Fourth, we are unable to comment on how effects might be different for males as compared to females. Although there is some recent evidence to suggest that trajectories to risky sexual behaviors do not necessarily differ for males versus females (Jones et al., 2010
), male sexual development has been largely understudied (Senn, Carey, & Vanable, 2008
) and we recognize that moderation analyses would be preferable to simply controlling for gender. Such a design would require relatively large samples of both male and female adolescents in order to adequately describe the unique pathways to risky sexual behaviors experienced by both. Finally, we are unable to speak to emerging evidence that dysregulation in maltreated adolescents may be in part due to the dynamic interplay of multiple physiological systems. Studies have linked various childhood maltreatment and violence exposures to changes in the hypothalamic–pituitary–adrenal axis (Cicchetti & Rogosch, 2001
), cardiovascular (Cooley-Quille, Boyd, Frantz, & Walsh, 2001
), and sympathetic-adrenomedullary systems (El-Sheik, Cummings, & Goetsch, 1989
), as well as dysfunctional coordination among multiple physiological systems (Gordis, Granger, Susman, & Trickett, 2008
) all of which have implications for stress modulation, vigilance and action-oriented behaviors.
Female victims of childhood maltreatment exhibit a host of behaviors and attitudes with consistent deviations in normal sexual development such as early coital initiations, (Fergusson, Horwood, & Lynskey, 1997
) more sexual partners, (Luster & Small, 1997
) risky sexual behavior, (Chandy et al., 1996
), and teen pregnancy (Noll et al., 2009
). Although one longitudinal, prospective study reported how sexual preoccupation played a key role in later risky sexual behaviors (Noll et al., 2003
), there has been scant empirical devotion to the mechanisms and processes by which sexual preoccupation operates to place victims at inordinate risk. These results suggest that the concept of psychological dysregulation may be a key element that should be included in future permutations of mechanistic research and in models of aberrant sexual development.