Childhood sexual abuse and attachment insecurity: Associations with child psychological difficulties.

Abstract

Although research documents that childhood sexual abuse (CSA) and insecure attachment are associated with psychopathology in children, to date no studies have delineated the unique and interactive contributions of these two risk factors. The aims of this study were to examine attachment in sexually abused children and a comparison group and to assess the contributions of each risk factor to child psychological difficulties. Participants were 111 children aged 7-13, of which 43 were CSA victims. In addition, in the service of enhancing understanding regarding CSA, we sought to compare among children experiencing different subtypes of CSA-children whose abusers were members of the family (intrafamilial CSA) versus outside of the family (extrafamilial CSA). We anticipated that intrafamilial CSA would be associated with greater psychopathology risk given that it may involve disruption in children's primary attachment relationships as well as trauma exposure. Children completed an attachment interview and reported on their depressive symptoms. Their mothers reported on children's externalizing symptoms, internalizing symptoms, dissociation, and sexualized behaviour. The findings indicate that, as hypothesized, children with (intrafamilial or extrafamilial) CSA were more likely to be classified as insecure and disorganized. In general, children experiencing intrafamilial CSA showed the most compromised psychological adjustment, followed by children experiencing extrafamilial CSA and then the comparison group. More fine-grained analyses revealed that CSA history was uniquely associated with children's externalizing problems, sexualizing problems, and dissociation, whereas insecure attachment was uniquely associated with child-reported depressive symptoms. Insecure attachment appeared to be protective for internalizing symptoms in the context of CSA, while generally associated with greater risk for psychopathology. Patterns of psychopathology symptoms differed among children exposed to intrafamilial CSA. Public Policy Relevance: Both childhood sexual abuse and insecure and particularly disorganized attachment are associated with enhanced risk for psychopathology in childhood, CSA AND ATTACHMENT IN MIDDLE CHILDHOOD 3 rendering treatment decision-making difficult for children presenting with multiple sources of risk. The findings of this study suggest that children presenting with sexual abuse histories are more likely to have insecure or disorganized attachment. Further, when children have experienced CSA, particularly CSA that has been perpetrated by a family member, their risk for psychopathology is higher regardless of attachment. Policy makers should prioritize the prevention or treatment of insecure/disorganized attachment among samples of non-abused youth, and the prevention or treatment of trauma-related symptoms among abused children.

Post-traumatic Stress Disorder in Sexually Abused Children: Secure Attachment as a Protective Factor

“…The findings that child CSA survivors with secure attachment have a lower risk of manifesting PTSD and other trauma related symptoms, while child CSA survivors with insecure attachment appear particularly at risk, adds to our knowledge and helps to elucidate the processes that mediate and moderate the associations between CSA and a range of child psychological difficulties. It extends previous findings with school aged children showing that insecure attachment is a risk factor for child reported depressive symptoms in both child CSA survivors as well as in non-abused children (Ensink et al, 2020). In that study, school aged CSA survivors were found to be more likely to have insecure and disorganized attachments to parents than non-abused children, and that insecure attachment was the only factor associated with higher selfreported depressive symptoms in both child survivors of CSA and the comparison group.…”

Adolescent abuse victims displayed physical health complaints and trauma symptoms during post disclosure interviews

“…Characteristics of the offences included in the study prominent in sexual abuse victims. Our findings confirm the existing literature, which reported that child abuse victims had higher levels of trauma symptoms such as post-traumatic stress reactions, depression and dissociation [17][18][19]. Consistent with findings from a previous study, we found that sexually abused adolescents had more physical health complaints, such as headaches, stomach aches, nausea and general bodily pain 20.…”

The attachment video-feedback intervention (AVI) combined to the trauma-focused cognitive behavioral therapy (TF-CBT) for sexually abused preschoolers and their parents: A pilot study examining pre- to post-test changes

“…likely to show behavior problems reaching clinical levels than victims of SA with a secure attachment (Beaudoin et al, 2013). In addition to showing greater internalizing and externalizing problems, Ensink et al (2020) reported higher levels of dissociative symptoms in SA children in comparison to children with no history of SA. Ensink and colleagues (2020) also reported that SA children were more likely to show insecure or disorganized attachments than children with no history of SA.…”