Johnson D M, Pike J L, Chard K M
Department of Educational and Counseling Psychology, University of Kentucky, Lexington 40506-0017, USA.
Child Abuse Negl. 2001 Jan;25(1):179-98. doi: 10.1016/s0145-2134(00)00225-8.
Two main questions were asked: (1) what abuse characteristics relate to PTSD, depressive, and dissociative severity in adult survivors of child sexual abuse (CSA); and (2) what abuse characteristics influence the severity of dissociation during CSA.
89 female CSA survivors' current symptoms of PTSD, depression, and dissociation were assessed with standardized measures. Additionally, abuse characteristics (e.g., age of onset, peritraumatic dissociation) were assessed with a structured interview.
Correlational analyses indicated that peritraumatic dissociation was most strongly related to all three types of symptom severity. Additional posthoc correlational analyses revealed that women who experienced penile penetration, believed someone/thing else would be killed, and/or were injured as a result of the abuse exhibited more severe peritraumatic dissociation. Regression analyses indicated that peritraumatic dissociation was the only variable to significantly predict symptom severity across symptom type or disorder. Furthermore, different abuse characteristics predicted adult symptom severity and peritraumatic dissociation.
The relation between peritraumatic dissociation and adult symptomatology was most intriguing and has two main clinical implications: (1) teaching engagement strategies to some CSA survivors in hopes of containing dissociative symptoms immediately following the abuse and (2) the inclusion of exposure-based interventions in the treatment of some adult CSA survivors where indicated.
提出了两个主要问题:(1)在成年儿童性虐待(CSA)幸存者中,哪些虐待特征与创伤后应激障碍(PTSD)、抑郁和分离症状的严重程度相关;(2)哪些虐待特征会影响CSA期间分离症状的严重程度。
采用标准化测量方法评估89名女性CSA幸存者目前的PTSD、抑郁和分离症状。此外,通过结构化访谈评估虐待特征(如发病年龄、创伤期间分离)。
相关性分析表明,创伤期间分离与所有三种症状严重程度的相关性最强。额外的事后相关性分析显示,经历过阴茎插入、认为会有人/物被杀和/或因虐待而受伤的女性表现出更严重的创伤期间分离。回归分析表明,创伤期间分离是唯一能显著预测不同症状类型或障碍的症状严重程度的变量。此外,不同的虐待特征可预测成年后的症状严重程度和创伤期间分离。
创伤期间分离与成年症状之间的关系最引人关注,有两个主要临床意义:(1)向一些CSA幸存者传授应对策略,以期在虐待后立即控制分离症状;(2)在有指征的情况下,对一些成年CSA幸存者采用基于暴露的干预措施进行治疗。