Presentation on theme: "Stigmatization as a Pathway to Disrupted Self-Development in Sexually Abused Youth Candice Feiring, The College of New Jersey Charles Cleland, National."— Presentation transcript:
Stigmatization as a Pathway to Disrupted Self-Development in Sexually Abused Youth Candice Feiring, The College of New Jersey Charles Cleland, National Development & Research Institutes Abstract: Youth with a history of childhood sexual abuse (CSA) are at risk for problems in self-development. Despite empirical support for an association between CSA and problems in self development, the mechanisms through which the phenomena are related are not well understood. Using a within-group longitudinal design, this study examined how abuse-specific stigmatization (shame and self-blame for the abuse) following CSA discovery placed youth at risk for subsequent disrupted self-development. Results from structural equation modeling showed direct and indirect effects of initial stigmatization on subsequent problems in self-development. Expectations The longitudinal sample was first seen when they were 8-15 years of age, and were followed over a 6-year time period. Participants were assessed within 8 weeks of abuse discovery, prior to receiving any treatment for sexual abuse (T 1, n=160), one year later (T 2, n=147), and six years following the initial assessment (T 3, n=121). Participants were interviewed by a trained clinician and completed questionnaires about abuse-specific Stigmatization (shame and self-blame attributions), General Self-blame attributions for common events, and Dissociative Symptoms and Impaired Self-Reference. Participants were all confirmed cases of sexual abuse by at least one of the following criteria: abuse validated by an expert, substantiated by child protective services, specific medical findings, confession of the offender or conviction of the offender in family or criminal court. Measures Abuse Characteristics: At T 1 abuse characteristics were obtained by project staff who reviewed records from child protective services and law enforcement agencies. A checklist was used to record information on such characteristics as the type of abusive acts (e.g., fondling, penetration), identity of the perpetrator and the use of physical force. Stigmatization : Measures of abuse-specific shame and self-blame developed for this study were used to index stigmatization at T 1 and T 2.. Examples of items include for shame- “When I think about what happened I want to go away by myself and hide” and for self-blame- “I was not smart enough to keep the abuse from happening.” Both of these measures showed good internal consistency at each assessment (shame α range=.85-.86; self-blame α range=.75-.80). To create stigmatization scores at each assessment point, both the abuse-specific shame and self-blame measures were scored as percentage of maximum possible (POMP; Cohen, Cohen, Aiken, & West, 1999) and then the two scores were averaged. For each assessment point, this yielded a stigmatization score that could range from 0 to 100, with higher values indicating more stigmatization. General Self-blame Attributions : The Children’s Attributional Style Questionnaire (CASQ, Thompson, Kaslow, Weiss, & Nolen-Hoeksema, 1998) was used to measure general self-blame at T 1 and T 2 (α =.72 for each time point).. Dissociation and Impaired Self-Reference: The Trauma Symptom Inventory (TSI) was used to index these indicators of disrupted self- development at the T 3 assessment (Briere, 1995; Briere, Elliott, Harris, & Cottman, 1995). These two measures of self-development were highly correlated ( r =.80, p <.001), therefore the T-scores for the dissociation (α =.86) and impaired self-reference scales were used (α =.85) as indicators of a single latent variable - disrupted self-development. Conclusions: 1.Youth high in stigmatization at the time of abuse discovery (T 1 ) and a year later (T 2 ) were expected to be at greater risk for experiencing disrupted self- development, as indicated by dissociative symptoms and impaired self-reference, six years following discovery (T 3 ). 2.The relation of T 1 stigmatization to T 3 disrupted self- development was expected to be indirect working through T 2 stigmatization. 3.Abuse-specific stigmatization was expected to predict variation in subsequent disrupted self-development even when the effects of general self-blame attribution style were taken into account. Methods Results Analytic Strategy Direct and indirect effects of stigmatization on the disrupted self- development latent variable, controlling for age, gender, abuse characteristics and general self-blame, were estimated using structural equation modeling (SEM; Kline, 2004). Missing data were handled by the full information maximum likelihood (FIML; Schafer & Graham, 2002) method in Mplus (Muthén & Muthén, 1998-2007). PEN FORCE STIGMA T 1 STIGMA T 2 DISRUPTED SELF T 3.17 *.43 **.23 *.22* FIGURE 1. Pathways to Disrupted Self -Development through Stigmatization: SEM Results (numbers are standardized path coefficients) The indirect pathway from stigmatization at T 1 through stigmatization at T2 on Disrupted Self-development was significant (β=.06*, 95% CI=.01-.13). NOTE: * p <.05, ** p <.01; Pen = Penetration, Force = the use of force during abuse, Stigma = Stigmatization Youth with CSA histories who experience stigmatization as indexed by abuse-specific shame and self-blame at the time of abuse discovery and one-year later are at greater risk for subsequent disruptions of self, as indicated by dissociation and impaired self- reference, even when controlling for general self-blame. In addition to abuse-specific processes, the use of force during abuse is important for understanding which CSA youth develop subsequent disruptions of self. Abuse-specific stigmatization is an important target for therapeutic intervention. Cognitive Behavioral Therapy may help in reducing these negative self-relevant emotional and cognitive processes.