Department of Interdisciplinary Studies, University of New Brunswick, Fredericton, NB, Canada.
Trauma Violence Abuse. 2011 Jul;12(3):135-50. doi: 10.1177/1524838011404253. Epub 2011 Apr 20.
For women, any one type of abuse rarely occurs in isolation of other types, and a single abusive experience is often the exception rather than the norm. The importance of this concept of the cumulative nature of abuse and its negative impact on health has been well recognized within the empirical literature, however there has been little consensus on what to call this phenomenon or how to study it. For the most part researchers have operated on the premise that it is the sheer number of different types of cumulating abuse experiences that is primarily responsible for worse health outcomes among women. And although this simplistic 'more is worse' approach to conceptualizing and operationalizing cumulative abuse has proven to be a powerful predictor of poorer health, it contradicts growing empirical evidence that suggests not all victimizations are created equal and that some victimizations may have a more deleterious effect on health than others. Embedded in abuse histories are individual and abuse characteristics as well as other life adversities that need to be considered in order to fully understand the spectrum and magnitude of cumulative abuse and its impact on women's health. Furthermore, given the long-term and persistent effects of abuse on health it becomes imperative to not only evaluate recent abusive experiences, but rather all abuse experiences occurring across the lifespan. This review highlights and evaluates the conceptual, operational, and methodological challenges posed by our current methods of studying and understanding the phenomenon of cumulative abuse and suggests that this phenomenon and its relationship to health is much more complex than research is currently portraying. This paper calls for the urgent need for interdisciplinary collaboration in order to more effectively and innovatively study the phenomenon of cumulative abuse.
对于女性来说，任何一种类型的虐待很少是孤立存在的，而且单次的虐待经历往往是例外而不是常态。这种虐待的累积性质及其对健康的负面影响的概念在实证文献中已经得到了充分的认识，然而，对于如何称呼这种现象以及如何研究它，还没有达成共识。在大多数情况下，研究人员的前提假设是，女性健康状况恶化的主要原因是累积的不同类型的虐待经历的数量。尽管这种将累积虐待简化为“数量越多越糟糕”的概念化和操作化方法被证明是预测健康状况不佳的有力指标，但它与越来越多的实证证据相矛盾，这些证据表明并非所有的受害都是平等的，而且有些受害可能对健康的影响比其他受害更大。在虐待史中，需要考虑个人和虐待特征以及其他生活逆境，以便充分理解累积虐待的范围和程度及其对女性健康的影响。此外，鉴于虐待对健康的长期和持久影响，不仅要评估最近的虐待经历，还要评估整个生命周期中发生的所有虐待经历，这一点变得至关重要。本综述强调并评估了我们目前研究和理解累积虐待现象的概念、操作和方法学挑战，并表明这一现象及其与健康的关系比研究目前所描绘的要复杂得多。本文呼吁迫切需要跨学科合作，以便更有效地和创新性地研究累积虐待现象。
