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Introduction: Childhood abuse is linked to poorer well-being, yet some survivors show no prolonged effect, suggesting multifinality. Men and women also differ in the experience and sequelae of abuse supporting gender-specific analyses. To assist in circumventing poor outcomes associated with child abuse, this study examined fear of self (FoS) and self-compassion (SC) as risk and protective factors between child abuse and well-being., Method: Australian women (N = 1302, M age  = 47.28 [13.63]) completed an online assessment of childhood abuse, psychological distress, perceived quality of life, SC, FoS. Moderated-moderation examined the different abuses as predictors of psychological distress and quality of life (QoL) and FoS and SC as primary and secondary moderators, respectively., Results: Physical abuse did not predict psychological distress or QoL. FoS and SC were independent predictors of distress and QoL. Similarly, childhood sexual abuse was not found to predict distress or QoL. FoS and SC were independent predictors of distress and QoL. There was also an interaction between childhood sexual abuse and SC in predicting QoL. A moderated-moderation was found for the relationship between child sexual abuse and distress. Psychological abuse predicted distress and QoL, and FoS and SC both moderated this relationship. Moreover, a moderated-moderation was observed for the relationship between psychological abuse and QoL., Conclusions: Greater FoS is associated with poorer outcomes for child abuse survivors; SC may mitigate this impact. Psychological abuse was the strongest predictor of well-being. Interventions that increase SC and raise awareness of psychological abuse and its impacts are needed., Competing Interests: Declaration of competing interest All authors declare they have no conflicts of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Although the impact of child sexual abuse (CSA) is well documented in the international literature, little is known about the critical points of recovery across the life course for survivors of institutional CSA. The aim of this study was to identify critical points, or events across the life course that may increase, or decrease, a survivor's vulnerability to the complex traumatization of institutional CSA (ICSA). The sample consisted of two hundred and forty-eight witness statements extracted from the 56 publicly available case studies presented to the Australian Royal Commission into Institutional Responses to Child Sexual Abuse during 2013-2016 (Commonwealth of Australia, 2017). A content analysis and thematic coding of the statements identified seven main themes in the witness statements (Gender, Organization, Triggers, Trauma, Mental Health, Intervention and Compensation), that appeared to be critical events across the life course. The themes were transformed into variables for further analysis using SPSS. Significant Likelihood Ratios were found between associations with the organization where the abuse occurred and between triggers and breastfeeding/sensory, breast feeding/childcare, emotional and physical distress, and mental health ( p < 0.01). Significant associations were also found between receiving compensation for the CSA and triggers, trauma, breast feeding-sensory and childcare ( p < 0.05) and gender and breast feeding ( p < 0.05). Overall, the findings showed that triggers can be random across the life course occurring mainly through indirect association, or in situations that evoke memories of the CSA, and that receiving compensation can assist survivors in their recovery journey. The findings also indicate the need for health care professionals to be aware of the critical points in a CSA survivor's recovery and how triggers may impact on their mental welling throughout the life course.

Like in many countries, the Australian Government has conducted an inquiry into child sexual abuse that occurred in institutional settings (The Royal Commission into Institutional Responses to Child Sexual Abuse). Drawing on the findings from a qualitative study commissioned by the Royal Commission, this paper explores the perceptions of victim/survivors 1 1 The term 'victim' is used within the criminal justice system and the term 'survivor' can be used as to denote recovery and empowerment, so we use them interchangeably throughout. of the ways in which institutions (or individuals within them) responded supportively when sexual abuse was reported. While researchers and inquiries have reported on inadequacy of institutional responses, this paper addresses a research gap by investigating responses that victims/survivors perceived as helpful, while mindful of the overwhelmingly negative nature of their experiences. The paper contributes to the literature on institutional responses to child sexual abuse methodologically - by reporting on the challenges of a study of this type - and theoretically, by proposing a framework indicating how different helpful elements of an institutional response to child sexual abuse relate to each other in the victim/survivors' experiences. The findings are relevant for research on best practice in institutional responses to child sexual abuse.

Background: Limited attention has been paid to the long-term physical health consequences experienced by CSA survivors. Research has found that CSA is often associated with increased health burden in adulthood. However, research in this area is plagued by a range of methodological difficulties, rendering it difficult to draw conclusions regarding the health status of CSA survivors., Objective: This research sought to investigate associations between child sexual abuse (CSA) victimisation and rates of subsequent healthcare utilisation., Method: The forensic medical records of 2759 cases of CSA between 1964 and 1995 were linked to commonwealth Australian medical data recorded between 2010 and 2015. Differences in rates of health service utilisation during this five-year period were compared between CSA victims and a age and gender matched comparison cohort without known abuse history., Findings: CSA was associated with increased levels of attendance at health professionals (OR = 1.51, p < .001) for medical care and for consultations related to dental (OR = 1.28, p < .001) and chronic disease (OR = 1.23, p <.001). CSA was associated with lower mean rates of attendance at gynaecologists. Gender and age at abuse significantly influenced the relationship between CSA and frequency of health service utilisation., Conclusions: Experiencing CSA was associated with increases in rates of contact with health professionals. Abused females and victims abused after 12 years of age demonstrated the greatest elevations in rates of service utilisation. These findings have significance for both researchers in this field, and medical practitioners providing primary care., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Media reports and government enquiries have shone a spotlight on institutional child sexual abuse (CSA) globally. With youth-serving organizations seeking to identify how to improve policies and procedures developed to protect children, a gap exists in research and organizational quality assurance procedures. A new tool is needed to measure the capability of workers to implement and support effective child-safeguarding policies and practices. To address this, our aim was to develop the Safeguarding Capabilities in Preventing Child Sexual Abuse Scale. Participants ( n = 345) from a range of youth-serving sectors in Australia answered 128 questions. Using exploratory factor analysis to assess the underlying factor structure and refine the item pool, items loaded onto four factors. Reliability coefficients ranged from .68 to .95. Results showed that knowledge, attitudes, self-efficacy to take action, and awareness are all key capabilities related to creating conditions of safety for children and young people and preventing CSA in youth-serving organizations.

This article examines how particular understandings of trauma as a systemic form of psychosocial harm framed the establishment of the Australian Royal Commission into Institutional Responses to Child Sexual Abuse, informed its successful investigatory process, and shaped its recommendations and outcomes. In so doing, the Royal Commission makes an important contribution to the field of trauma studies, which has been characterized by contested histories and is subject to continuing debate in clinical and academic research. For much of the twentieth century, trauma and its impacts have been typically articulated through a bio-medical discourse of individual harm and health outcomes. We argue that the establishment of the Royal Commission reflected an expanded understanding of trauma, constitutive of moral, political and psychological arenas as evidenced in its methodology, conceptual approach and treatment of survivor testimony. We also argue that the institutionalization of an historically situated and politically engaged approach to trauma within the Royal Commission itself was effective in contesting narrow psychological or juridical concepts of harm by developing approaches to trauma as a system of harm with complex impacts on families, communities and indeed the nation. We evaluate the implications and consequences of this shift in the work of the Royal Commission, with particular attention to the development of an interdisciplinary relational approach to the study of trauma as a key principle in the emergence of a trauma-informed culture., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Aims: Associations between childhood abuse and various psychotic illnesses in adulthood are commonly reported. We aim to examine associations between several reported childhood adverse events (sexual abuse, physical abuse, emotional abuse, neglect and interpersonal loss) among adults with diagnosed psychotic disorders and clinical and psychosocial outcomes., Methods: Within a large epidemiological study, the 2010 Australian National Survey of Psychosis (Survey of High Impact Psychosis, SHIP), we used logistic regression to model childhood adverse events (any and specific types) on 18 clinical and psychosocial outcomes., Results: Eighty percent of SHIP participants (1466/1825) reported experiencing adverse events in childhood (sexual abuse, other types of abuse and interpersonal loss). Participants reporting any form of childhood adversity had higher odds for 12/18 outcomes we examined. Significant associations were observed with all psychosocial outcomes (social dysfunction, victimisation, offending and homelessness within the previous 12 months, and definite psychosocial stressor within 12 months of illness onset), with the strongest association for homelessness (odds ratio (OR) = 2.82). Common across all adverse event types was an association with lifetime depression, anxiety and a definite psychosocial stressor within 12 months of illness onset. When adverse event types were non-hierarchically coded, sexual abuse was associated with 11/18 outcomes, other types of abuse 13/18 and, interpersonal loss occurring in the absence of other forms of abuse was associated with fewer of the clinical and psychosocial outcomes, 4/18. When adverse events types were coded hierarchically (to isolate the effect of interpersonal loss in the absence of abuse), interpersonal loss was associated with lower odds of self-reproach (OR = 0.70), negative syndrome (OR = 0.75) and victimisation (OR = 0.82)., Conclusions: Adverse childhood experiences among people with psychosis are common, as are subsequent psychosocial stressors. Mental health professionals should routinely enquire about all types of adversities in this group and provide effective service responses. Childhood abuse, including sexual abuse, may contribute to subsequent adversity, poor psychosocial functioning and complex needs among people with psychosis. Longitudinal research to better understand these relationships is needed, as are studies which evaluate the effectiveness of preventative interventions in high-risk groups.

The recent Australian Royal Commission into Institutional Responses to Child Sexual Abuse provided some insight into manifestations of child sexual abuse within an ultra-orthodox Jewish community. This paper extends the analysis by the Royal Commission (RC) to another Australian ultra-orthodox community that of Adass Israel, whereby a former school headmistress allegedly abused multiple students and then fled to the State of Israel in 2008. That case is unusual given that both the perpetrator and victims were female. Attention is drawn to a number of components similar to the RC findings pertaining to the particular vulnerability of children within ultra-orthodox communities given the absence of sex education and entrenched patriarchal authority, the reluctance of such communities to report child sexual abuse (CSA) allegations to secular authorities and associated cultural and religious factors, the failure of community leaders within or beyond Australia to support or compensate CSA survivors, and the absence of formal child protection protocols. Additionally, some conclusions are drawn about the key role played by advocacy groups such as Jewish Community Watch in exposing the global travel of child sex offenders, and the problematic legal protection provided to many such offenders by the State of Israel's Law of Return.

Evidence suggests that tens of millions of children and adolescents are involved in youth-serving organizations (YSOs) outside of their homes on a daily basis. Children's involvement with YSOs clearly offers a broad array of emotional, social, and personal development benefits. This involvement can, however, also be associated with a variety of safety risks, including the potential for child sexual abuse (CSA) victimization and the myriad short- and long-term consequences to its victims and their families. Recognizing the significance of CSA within YSOs, the Australian Royal Commission into Institutional Responses to Child Sexual Abuse funded a comprehensive review of the literature on risk and protective factors related to CSA in institutions. This yielded more than 400 primarily research articles from the United States, United Kingdom, and Australia, examining institutional CSA victims, perpetrators, and settings. Findings were provided regarding six specific types of institutional settings, including faith-based, early childhood education, childcare and schools, health care, out-of-home/foster care, and sport. This article is based on the findings of Kaufman and Erooga's comprehensive literature review and Royal Commission findings. It provides a brief review of critical risks associated with CSA victims, perpetrators, and organizational settings, as well as highlights risks particular to specific types of YSOs and risks that are present across these organizations. Optimal prevention directions and strategies are outlined in response to identified patterns of organizational risk. Recommendations for YSO policy enhancements are also provided to complement the article's prevention focus. Finally, suggestions are offered for future research directions to foster the development of an evidence-based foundation for work in this area.

Background and Objectives: There are well established links between child sex abuse (CSA) and a range of mental health adversities in the literature. However, there has been very limited examination of mental health care needs of CSA survivors, indicated by contacts with mental health professionals. Similarly, no existing research has examined rates of prescription of psychopharmacology to CSA survivors. Service utilisation is a vital component of the health landscape, and a clear understanding of the mental health care needs of CSA survivors is central to policy formation regarding mental health funding. Therefore, this study aimed to assess differences in rates of mental health care utilisation and rates of prescription of psychopharmacology during adulthood between individuals with a history of CSA and a comparison sample from the general population without a known abuse history., Participants, Setting, and Method: The forensic medical records of 2433 CSA victims identified between 1964 and 1995 were linked to Australian medical and medication-use data accessed between 2010 and 2015, when victims were, on average, aged between 28.78 and 33.78 years. CSA cases were compared to a matched comparison cohort on rates of contact with mental health professionals and prescriptions for mood stabilisers, anxiolytics, antipsychotics, stimulants, analgesics and addiction treatment medication., Results: CSA was associated with increased levels of attendance at psychiatrists (OR = 1.29, p < .001), psychologists and clinical social workers (OR = 6.68, p < .001) and general practitioners (OR = 1.76, p < .001) for mental health care. CSA was also associated with increased frequency of prescription of all categories of psychopharmacology (ORs ranging from 1.40 to 6.18). Outcomes differed by victim gender and age at abuse. Abused females demonstrated greater overall service and medication utilisation than abused males. Females abused after puberty (age 12 years) had more frequent contacts with general practitioners for mental health care and greater frequency of prescription of psychopharmacology than females abused under age 12 years, including elevated frequency of analgesic and mood stabiliser use. Males abused after puberty also demonstrated higher frequency of service utilisation, including inflated rates of antipsychotic and anxiolytic prescriptions and visits to psychiatrists., Conclusions: Experiencing CSA was associated with increased use of psychopharmacology and contact with health professionals for mental health care. Abused females and participants abused after age 12 demonstrated most inflated use of services. These findings have important implications for policy decisions regarding the provision of mental health care to CSA survivors deemed to be at risk of developing mental health difficulties., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Childhood maltreatment (CM) has consistently been linked with adverse outcomes including substance use disorders and adult sexual revictimization. Adult sexual victimization itself has been linked with psychopathology but has predominately been studied in women. The current investigation examines the impact of CM and co-occurring psychopathology on adult sexual victimization in men and women, replicating findings in three distinct samples., Method: We investigated the association between continuous CM factor scores and adult sexual victimization in the Childhood Trauma Study (CTS) sample (N = 2564). We also examined the unique relationship between childhood sexual abuse (CSA) and adult sexual victimization while adjusting for co-occurring substance dependence and psychopathology. We replicated these analyses in two additional samples: the Comorbidity and Trauma Study (CATS; N = 1981) and the Australian Twin-Family Study of Alcohol Use Disorders (OZ-ALC; N = 1537)., Results: Analyses revealed a significant association with CM factor scores and adult sexual victimization for both men and women across all three samples. The CSA factor score was strongly associated with adult sexual victimization after adjusting for substance dependence and psychopathology; higher odds ratios were observed in men (than women) consistently across the three samples., Conclusions: A continuous measure of CSA is independently associated with adult sexual trauma risk across samples in models that included commonly associated substance dependence and psychopathology as covariates. The strength of the association between this CSA measure and adult sexual victimization is higher in magnitude for men than women, pointing to the need for further investigation of sexual victimization in male community samples.

Drawing on data from a larger research study, this paper explores intersecting and competing social relations that influenced the romantic desires of women who became intimately involved with men who molested children. Through a feminist poststructuralist lens, women's narratives were analysed with the use of feminist interpretations of Foucauldian discourse theory. Analysis informed of a discursive power over participants that made the attainment of romantic desires an imperative for ensuring social respect, worth and credibility as women. When all was not ideal, these same romantic desires compelled women to fix and hold onto their relationships--even when with men that attract damning societal responses towards them. Even upon acknowledgement of their partners' sexual transgressions, the fear of relationship breakdown meant that romantic desires again featured as imperatives for the women. The imagined pleasure of achieving romantic desires is discursive; so powerful that it outweighed women's fears and dangers of precarious intimate life with men who commit abhorrent acts.

A sample of males who had first committed sexual offences against children in either adolescence (n=230; M=14.0 years, SD=1.5) or adulthood (n=280; M=34.4 years, SD=11.7) were compared on measures relating to the circumstances of their first known sexual abuse incident. Considerable diversity in the circumstances of these first incidents was observed for both groups. However, adulthood-onset sexual abuse most often occurred following a long-standing familial relationship with a female victim, and in a home setting. The first incident for adolescence-onset offenders also tended to occur in the context of a long-term relationship and against a female child in a home setting, but more commonly against a nonfamilial victim. Adulthood-onset offenders abused older children, were more likely to engage in penetrative sexual behaviors, and went on to abuse over a longer duration than adolescence-onset offenders. Adolescence-onset offences were more likely to be witnessed by a third party. Findings and their implications for prevention are considered from a situational crime prevention perspective., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

The aim of this study is to understand how parents manage the risk of child sexual abuse, including prevention as well as early intervention and detection strategies. Using a social constructivist theoretical foundation and grounded theory methods, qualitative in-depth interviews were conducted with Australian parents between 2006 and 2008. Based on the data, a balance theory was developed, which explains how parents attempt to balance the type of information given to children in order to protect their children from sexual abuse without scaring them as well as how parents manage sexual boundary crossing incidents experienced by their children in the context of complex social relationships. Implications for prevention programs as well as reporting of child sexual abuse are discussed.

Child sexual abuse cases have one of the lowest conviction rates across all charges. While research has investigated the impact of attitudes and beliefs in judicial decision makers, little is known about the influence of medical evidence. The aim of this study was to examine how the presence or absence of evidence impacts on conviction. A sample of 113 child sexual abuse cases from Australia were coded for the types of evidence that were presented as well as other relevant descriptive data. The most significant predictor of verdict was the behavior of the child rather than the presence of medical evidence. This finding suggests that greater attention might be given to the collection and reporting of this evidence in future trials.

Objective: To examine whether notified child maltreatment is associated with adverse psychological outcomes in adolescence, and whether differing patterns of psychological outcome are seen depending on the type of maltreatment., Methods: The participants were 7,223 mother and child pairs enrolled in a population-based birth cohort study in Brisbane, Australia. Exposure to suspected child maltreatment was measured by linkage with state child protection agency data. The primary outcomes were the internalizing and externalizing scales of the Youth Self Report (YSR) at approximately 14 years of age., Results: The YSR was completed by 5,172 subjects (71.6%), with increased attrition of cases of notified maltreatment. After adjustment for potential confounders, notified maltreatment was significantly associated with both internalizing behavior and externalizing behavior at 14. When evaluated as non-exclusive categories of maltreatment, physical abuse, neglect, and emotional abuse were each significantly associated with both internalizing and externalizing behavior after adjustment. When evaluated using an expanded hierarchical scheme that included combinations of multi-type maltreatment, the following groups had significantly higher internalizing behavior after adjustment: emotional abuse (with or without neglect), and multi-type maltreatment including physical (but not sexual) abuse with neglect and/or emotional abuse. The following groups were associated with externalizing behavior after adjustment: emotional abuse (with or without neglect), and multi-type maltreatment including physical abuse (with neglect and/or emotional abuse), or sexual abuse (with neglect and/or emotional abuse, and/or physical abuse)., Conclusion: This study suggests that child neglect and emotional abuse have serious adverse effects on adolescent mental health and warrant the attention given to other forms of child maltreatment. Additionally, it confirms that young people who are notified for more than one type of maltreatment are at particular risk of adolescent mental health problems., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

The study used publicly available data on post-traumatic stress disorder in a sample of the Australian population with a history of sexual abuse to demonstrate how this evidence can inform economic analyses. The 2007 Australian Mental Health Survey revealed that 8.3% of 993 adolescents experienced childhood sexual abuse, of which 40.2% were diagnosed with post-traumatic stress disorder. Post-traumatic stress disorder diagnosis corresponded to a significant loss of quality of life. Survival analysis was used to estimate the lifetime persistence of post-traumatic stress disorder symptoms. The average time between post-traumatic stress disorder onset and remission was 11.4 years. Results suggest that successful treatment of post-traumatic stress disorder will save 2.05 quality adjusted life years per child or adolescent with post-traumatic stress disorder.

Confidential self-report data obtained on 107 adult male child sexual abusers were analyzed to test theoretical propositions concerning the role of attachment problems in the onset of sexual offending. Offenders' parent-child attachment relationships were most frequently characterized by affectionless control, reflecting low parental care and high overprotection and control. Offenders reported significantly less secure attachment with their fathers than with their mothers. Overall, weak continuity from childhood attachment to trait (general) adult attachment was found, with insecure attachment more stable than secure attachment. Childhood attachment problems, particularly with fathers, were more clearly reflected in state adult attachment (i.e., in the month preceding sexual offending onset) than in trait adult attachment. Offenders who were in an adult intimate relationship prior to their onset sexual offense reported significant state increases in attachment avoidance, and their onset offenses were more likely to involve a female familial victim. Offenders who were not in a relationship prior to offending onset were younger, and their onset sexual offenses occurred in much more diverse circumstances. These findings provide tentative evidence that directly and indirectly implicates offenders' attachment problems specifically in the onset of their sexual abuse behavior. Implications for developmental prevention and early intervention, situational prevention, and offender treatment are discussed.

Images of child sexual abuse survivors have been strongly mediated by professional and self-help ideologies that espouse 'healthy' and 'unhealthy' responses to trauma. Drawing on interviews taken with five self-identified survivors of child sexual abuse, this paper maps the impact of psychological and popular discourses on victim/survivor identities and, in particular, the centrality of themes such as disclosure and 'healing' in accounts from survivors. Investment in these particular versions of recovery has operated to shift the focus of the survivor movement away from its political beginnings, such that private healing has replaced public discontent. As the excerpts from survivors in this paper suggest, the language commonly captured in both therapeutic and popular accounts of trauma may guide and delimit the subject positions available to survivors. Utilising the concept of 'wounded attachment', this paper identifies some of the outcomes associated with internalised notions of healing for survivors, as well as the dilemmas that might be impeding disclosure.

Objective: The objective of this study was to examine whether maternal factors such as socioeconomic status (SES), attitudes towards the baby, and mental health at 6 months or earlier, are associated with non-penetrative and penetrative childhood sexual abuse (CSA) in her offspring., Methods: This was a prospective birth cohort study followed up to 21 years. Set in one of two obstetric hospitals in Brisbane, Australia, the Mater-University of Queensland Study of Pregnancy (MUSP) involves a prospective birth cohort from a population based sample of 7223 singletons whose mothers were enrolled between 1981 and 1984 at the first antenatal visit. The present cohort consisted of 2664 participants who provided CSA data, and whose mothers had responded to all relevant questions., Results: About 16% of young adults reported non-penetrative sexual abuse before the age of sixteen and 9% reported penetrative abuse. After adjusting for all variables in the model, an increased risk for non-penetrative CSA was associated with the child being female, unwanted pregnancy, mother being a heavy smoker, and maternal anxiety. Increased risk for penetrative CSA was associated with the child being female, the mother having failed to complete a high school level education, living in an alternative arrangement other than marriage, and being either a moderate or heavy smoker. We found no associations between maternal age and CSA after correcting for other predictors., Conclusion: CSA was not uncommon in this cohort with one in four reporting some form of sexual abuse before 16. The results suggest that several early factors may predict later CSA and that the associations are different according to type of CSA.

The use of self-protection strategies and related situation in rape has been studied by several scholars. The circumstances in which children are more likely to resist sexual victimization have, however, not been studied. This study examines the association between offence-related factors-specifically, the preoffence situation, the modus operandi strategies adopted by offenders, and victim characteristics-and victim resistance in sexual offences against children.The sample consisted of 94 adult offenders convicted of having committed a sexual offence against a child (or adolescent) of 16 years of age or younger and who agreed to provide confidential self-report data concerning their offending behavior and victim resistance actions. Victim resistance strategies were regrouped into three categories, namely, physical resistance, forceful verbal resistance, and nonforceful verbal resistance. The total number of resistance strategies was also used in the analyses. Overall, the age of the victim was found to be related to nonforceful verbal resistance, and violence was related to all forms of resistance.Younger girls were found to be more likely to employ nonforceful verbal resistance than older girls and to use a greater number of strategies as well. To provide reliable knowledge to build on for reducing the risk of child sexual abuse, this study suggests the need for prevention programs to include empirical findings regarding the circumstances in which children are more likely to resist sexual victimization.

The current study assessed if childhood sexual abuse (CSA) can be meaningfully classified into classes, based on the assumption that abuse by a close family member differs in important ways from other abuse, and whether abuse classes were differentially associated with couple relationship problems. The childhood experiences and adult relationships of 1335 Australian women (18-41 years) were assessed. Latent class analysis identified three classes of CSA: that perpetrated by a family member, friend, or stranger, which differed markedly on most aspects of the abuse. Family abuse was associated with the highest risk for adult relationship problems, with other classes of CSA having a significant but weaker association with adult relationship problems. CSA is heterogeneous with respect the long-term consequences for adult relationship functioning.

Background: Childhood sexual abuse is a common experience of Australian women with 1 woman in 3 reporting unwanted sexual activity, and 1 in 10 reporting attempted or penetrative sexual abuse before 16 years of age. The objective of this study was to explore women's responses to perinatal professional touch and examination of themselves and their babies., Methods: Eighteen women were interviewed using an in-depth semistructured qualitative method. Interviews were recorded and transcribed. The interviews were coded and thematically analyzed, using NVivo to assist with data management. To ensure rigor, four initial interviews were coded by a second researcher and discrepancies resolved., Results: Two key themes were identified by childhood sexual abuse survivors as important in improving service provision: safety issues for survivors and their babies in the clinical encounter and ways of making service provision safer., Conclusions: Childhood sexual abuse survivors experienced pain, dissociation, fear, blame, helplessness, and guilt in their encounters with health care practitioners. These experiences led to the development of a set of "Universal Precautions" for perinatal professionals responding to women and their children.

Although childhood sexual abuse (CSA) is associated with a wide range of health problems later in life, there is also evidence of substantial individual differences. This study describes the mental and physical health of a population sample of Australians, randomly selected from the Commonwealth electoral roll, who have reported their CSA histories. Some 58% of those located from the electoral roll agreed to a telephone interview (n=1,784). Health status was measured using the Short Form 36 questionnaire. Men who had experienced non-penetrative and penetrative sexual abuse in childhood had 2.25 (95% CI=1.32-3.82) and 5.93 (95% CI=2.72-12.95) times respectively the rate of impaired mental health, but no higher rates of impaired physical health. Women who had experienced non-penetrative and penetrative sexual abuse in childhood had 1.87 (95% CI=1.19-2.95) and 3.15 (95% CI=1.87-5.33) times respectively the rate of impaired mental health and 1.87 (95% CI=1.19-2.92) and 2.31 (95% CI=1.34-3.97) times respectively the rate of impaired physical health. However, participants who had experienced CSA were no less likely than those who had not experienced CSA to be in optimum physical and mental health. None of the possible confounding or moderating variables tested appeared to mitigate the impact of CSA on health outcomes. Those with the highest levels of mental and physical health appear to be unaffected by the experience of CSA.

This article comments on the Najman, Dunne, Purdie, Boyle, and Coxeter (2005) study on the relationship between childhood sexual abuse (CSA) and later sexual functioning in an Australian national sample. We note the value of the Najman et al. study, being well conducted and using a generalizable sample, but critique Najman et al.'s interpretation that their study showed "significant impairment" due to the CSA. We computed effect sizes to show that the "effects" were small, and then show using meta-analysis that these small effects were consistent with results in a series of national samples from other countries. We argue that Najman et al.'s causal statement about CSA's "impairment" effect was unwarranted given their lack of causal analysis, the well-established fact in other research that CSA is often confounded with third variables, and the fact that CSA was confounded with a key third variable in Najman et al.'s study. Given the hyperbole that surrounds the issue of CSA, we emphasize the need for researchers to adhere to valid scientific principles in inference and precision when reporting the results of CSA research.

Background: This study examined the relationships between self-reported childhood sexual abuse (CSA) and drug-related outcomes in an Australian twin panel., Method: A semi-structured psychiatric interview was conducted in 1996-2000 by telephone with young adult Australian twins (mean age 29.9 years). Data reported here are from 6050 twins who responded to both CSA and drug-related items., Results: A history of CSA was associated with significant risk for subsequently occurring regular smoking and use of each illicit drug class. Further CSA-associated risk was found among regular users, for nicotine and alcohol dependence, and among illicit drug users, for abuse/dependence of most drug classes. In same-sex discordant pairs, significant risk for regular smoking and illicit drug use was found in twins with a history of CSA compared to their non-abused co-twins. Similar analyses for abuse/dependence found significant risk for opioids, any illicit drug, and any non-cannabis illicit drug. CSA was associated with significantly earlier drug use. Despite the association of CSA with risk for early-onset cannabis use and regular smoking, risks for illicit drug outcomes associated with CSA and with either form of early-onset use combine in near-additive fashion., Conclusions: CSA is associated with risk for subsequently occurring regular smoking and illicit drug use and abuse/dependence. Risks for drug use are mildly attenuated with control for familial contributions; similar risks for abuse/dependence remain significant for opioids and for illicit drugs combined across classes. Although we found evidence of earlier onset drug use with CSA, risks associated with CSA and with early-onset use combine in a largely additive manner.

This article applies methods of latent class analysis (LCA) to data on lifetime illicit drug use in order to determine whether qualitatively distinct classes of illicit drug users can be identified. Self-report data on lifetime illicit drug use (cannabis, stimulants, hallucinogens, sedatives, inhalants, cocaine, opioids and solvents) collected from a sample of 6265 Australian twins (average age 30 years) were analyzed using LCA. Rates of childhood sexual and physical abuse, lifetime alcohol and tobacco dependence, symptoms of illicit drug abuse/dependence and psychiatric comorbidity were compared across classes using multinomial logistic regression. LCA identified a 5-class model: Class 1 (68.5%) had low risks of the use of all drugs except cannabis; Class 2 (17.8%) had moderate risks of the use of all drugs; Class 3 (6.6%) had high rates of cocaine, other stimulant and hallucinogen use but lower risks for the use of sedatives or opioids. Conversely, Class 4 (3.0%) had relatively low risks of cocaine, other stimulant or hallucinogen use but high rates of sedative and opioid use. Finally, Class 5 (4.2%) had uniformly high probabilities for the use of all drugs. Rates of psychiatric comorbidity were highest in the polydrug class although the sedative/opioid class had elevated rates of depression/suicidal behaviors and exposure to childhood abuse. Aggregation of population-level data may obscure important subgroup differences in patterns of illicit drug use and psychiatric comorbidity. Further exploration of a 'self-medicating' subgroup is needed.

This study examined self-reported adult sexual functioning in individuals reporting a history of childhood sexual abuse (CSA) in a representative sample of the Australian population. A sample of 1793 persons, aged 18-59 years, were randomly selected from the electoral roll for Australian states and territories in April 2000. Respondents were interviewed about their health status and sexual experiences, including unwanted sexual experiences before the age of 16 years. More than one-third of women and approximately one-sixth of men reported a history of CSA. Women were more likely than men to report both non-penetrative and penetrative experiences of CSA. For both sexes, there was a significant association between CSA and symptoms of sexual dysfunction. In assessing the specific nature of the relationship between sexual abuse and sexual dysfunction, statistically significant associations were, in general, evident for women only. CSA was not associated with the level of physical or emotional satisfaction respondents experienced with their sexual activity. The total number of lifetime sexual partners was significantly and positively associated with CSA for females, but not for males; however, the number of sexual partners in the last year was not related to CSA. CSA in the Australian population is common and contributes to significant impairment in the sexual functioning of adults, especially women. These consequences appear not to extend to the other areas of sexual activity considered in this study.

This retrospective study explores, through quantitative and qualitative methods, the relationship of two variables (perpetrator relationship and perpetrator methodology) to posttraumatic and dissociative symptomatology. The quantitative sample comprised a nonpsychiatric group (N = 39) of Australian adults reporting sexual abuse histories. A MANOVA revealed that current levels of posttraumatic and dissociative symptomatology were significantly higher in the group reporting sexual abuse by a perpetrator in a relationship of trust, guardianship, or authority. The qualitative sample comprised a purposively selected subgroup of the quantitative sample (n = 20). Thematic content analyses of perpetrator methodology suggest that perpetrator strategies involving emotional manipulation, rather than the perpetrator relationship per se, appear to differentiate between groups with clinical or nonclinical levels of post traumatic and dissociative symptomatology. The combination of qualitative and quantitative methods provides integrated, contextualized data with implications for future research and clinical practice.

Background: Increased risk for serious adverse outcomes has been associated with a history of childhood sexual abuse (CSA). Whether these risks are directly attributable to CSA rather than family background remains controversial., Methods: Structured psychiatric telephone interviews were conducted from February 1996 to September 2000 with both members of 1991 same-sex pairs (1159 female and 832 male pairs) from a young adult Australian volunteer twin panel (mean [SD] age, 29.9 [2.5] years). A binary composite CSA variable was constructed from responses to 5 component questions. The association between CSA and adverse psychosocial outcomes was examined, controlling for family background., Results: A history of CSA, reported by 16.7% of the women and 5.4% of the men, was more common among those reporting parental alcohol-related problems. Significantly increased risk was observed in women reporting a history of CSA for subsequently occurring major depression, suicide attempt, conduct disorder, alcohol dependence, nicotine dependence, social anxiety, rape after the age of 18 years, and divorce; most similar risks reached statistical significance in men. The greatest risks were associated with CSA involving intercourse. Childhood sexual abuse-negative twins (ie, those who denied having experienced CSA) from CSA-discordant pairs compared with other CSA-negative individuals had increased risk for many adverse outcomes suggesting correlated family background risk factors. Childhood sexual abuse-positive members (ie, those who reported having experienced CSA) of CSA-discordant pairs had significantly greater risk for all 8 examined adverse outcomes than their co-twins., Conclusions: Self-reported CSA was associated with increased risk for adverse outcomes, controlling for family background. Family background risk factors also were associated with adverse outcome risk. Discordant pair analysis seems to provide an effective means of controlling for family background risk factors.

Objective: To determine the incidence of re-abuse in children known to have been sexually abused and to find factors that increase the risk of re-abuse., Method: The study group consisted of 183 children with substantiated sexual abuse who presented to two children's hospitals' Child Protection Units in Sydney, Australia during 1988 through 1990. At intake, when the children were aged between 5 years and 15 years, data about the child, the family, and the nature of the index sexual abuse were collected. Six years after presentation for the abuse, records of the Department of Community Services were checked to see if any of the young people had been the subject of substantiated notifications for abuse/neglect before and after intake to the study. Predictors of notifications for abuse/neglect after presentation for the index sexual abuse were identified., Results: Of the sexually abused young people, nearly one in three were the subject of subsequent substantiated notifications to the Department of Community Services for some form of child abuse and neglect or behavior which placed them at risk of harm. Later notifications for abuse/neglect were predicted by notifications for emotional abuse before the index sexual abuse (adjusted RR = 4.88, CI: 1.43 to 16.65), severity of the index sexual abuse (p = .03), and the number of changes in the child's primary caregivers before intake (p = .03). Approximately one in six of the sexually abused young people were notified for sexual abuse after intake to the study. One in 10 also had prior notifications for sexual abuse. Sexual abuse notifications after study intake were predicted by caregiver changes before intake (p = .01) and whether or not there were notifications for emotional abuse before the index sexual abuse (adjusted RR = 3.40, CI: 1.05 to 11.02)., Conclusions: Revictimization of children appears to be a marker of ongoing family dysfunction. Intervention in child sexual abuse needs to consider a range of risk factors associated with re-abuse and, in particular, should focus on family functioning if further abuse is to be prevented.

The present research examined gender differences in community corrections officers' (CCOs') attributions for child sexual offending. Eighty-five CCOs were asked to write down the reasons why they thought men sexually abused children, and then rate their reasons using Benson's Attributional Dimensions Scale. The results found that CCOs' reasons regarding why men sexually abuse children strongly paralleled current scientific theories on the etiology of child sexual abuse. Also, significant gender differences were found regarding the frequency with which participants cited certain types of reasons for child sexual abuse. Female CCOs were more likely to cite power and control as a reason, while male CCOs were more likely to cite psychopathology as a reason for child sexual abuse. No other gender differences were found. The research, clinical, and educational implications pertaining to these findings are discussed.

The modification of deviant cognitions and the enhancement of victim empathy are central components in many treatment programs for sex offenders. There appear to be three broad problems with self-report measures of these factors: variations in the psychometric evaluation of measures; the transparency of items and thus the likely influence of social desirability; and the difficulty of determining which measures are specific to particular types of sex offenders. The aim of this study was to investigate these three issues among child molesters (CMs), and men convicted of sex offences against adults (ASOs). Data were collected from 36 CMs and 31 ASOs and from two comparison groups (33 men convicted of nonsexual offences and 40 nonoffenders from the community), to assess the reliability (internal and test-retest) and validity (discriminant, construct, and face) of measures, the influence of sexual social desirability on responding and the specificity of measures to both sex offender groups. Collectively, the results raise issues related to the assessment of sex offenders that require further investigation. They also have theoretical implications about the relationship between cognitive and emotive processes among sex offenders.

Objectives: To determine current and lifetime rates of the experience of partner abuse and sexual violence in a community-based sample of middle-aged women and compare these to figures obtained in a general practice setting., Design and Methods: This research was part of the Melbourne Women's Midlife Health Project (MWMHP), an observational, longitudinal, population-based study of 438 Australian-born women conducted over nine years. In 1996, during the sixth year of the study, we asked the MWMHP participants to complete a self-administered "violence questionnaire", incorporating a modified Conflict Tactics Scale and questions on sexual abuse experienced during childhood and adult life., Results: Of the 395 women remaining in the sixth year of follow-up of the MWMHP, 362 (92%) completed the questionnaire. Overall, 28.5% (n = 101) of the women had experienced some form of domestic violence (physical, sexual or emotional) during their lifetime; 5.5% (n = 15) of women had experienced severe physical abuse in the past year at the hands of a partner; and 11.8% (n = 42) of the women had experienced rape or attempted rape between the age of 16 and the time of our survey. Regarding abuse in childhood, 8.9% (n = 32) of women had experienced physical abuse, 42.3% (n = 152) had experienced non-contact sexual abuse, and 35.7% (n = 128) contact sexual abuse. Compared with the general-practice-based study, rates of childhood physical abuse and penetrative sexual abuse were similar, but rates of less intrusive child sexual abuse were significantly higher in our study., Conclusions: Doctors in all areas of medicine who are dealing with middle-aged women need to be aware of the levels of violence sustained by women throughout their lives. Such experiences may have a substantial impact on women's physical and mental wellbeing.

Background: We examined the relationship between childhood sexual abuse (CSA), and interviewees' recollections of pathogenic parenting, testing for possible retrospective biases in the recollections of those who have experienced CSA., Methods: Information about CSA, parental divorce and interviewees' recollections of parental rejection, parental overprotection and perceived autonomy (as assessed through a shortened version of the Parental Bonding Instrument) was obtained through telephone interviews with 3626 Australian twins who had also returned self-report questionnaires several years earlier. Recollections of parental behaviours were compared for individuals from pairs in which neither twin, at least one twin, or both twins reported CSA., Results: Significant associations were noted between CSA and paternal alcoholism and between CSA and recollections of parental rejection. For women, individuals from CSA-discordant pairs reported levels of parental rejection that were significantly higher than those obtained from CSA-negative pairs. The levels of parental rejection observed for twins from CSA-discordant pairs did not differ significantly from those obtained from CSA-concordant pairs, regardless of respondent's abuse status. For men from CSA-discordant pairs, respondents reporting CSA displayed a tendency to report higher levels of parental rejection than did respondents not reporting CSA. Other measures of parenting behaviour (perceived autonomy and parental overprotection) failed to show a clear relationship with CSA., Conclusions: The relationship between CSA and respondents' recollections of parental rejection is not due solely to retrospective bias on the part of abused individuals and, consistent with other studies, may reflect a pathological family environment with serious consequences for all siblings.

Aims: The aim of this paper was to examine the association between reporting childhood sexual abuse (CSA) and alcohol abuse in a community sample of women using multivariate analysis which took into account a range of potential confounding variables (such as a family history of alcoholism) and effect modifiers (such as having an alcoholic partner)., Design: A two-stage retrospective case-control study was used to investigate the relationship between reporting CSA and alcohol abuse in women., Participants: Seven hundred and ten women randomly selected from the Australian federal electoral rolls., Measurements: The Alcohol Use Disorders Identification Test (AUDIT) was used to measure alcohol abuse. A series of questions based on those developed by Wyatt (1985) were used to ascertain the prevalence of CSA., Findings: The final model showed that the relationship between a history of CSA and alcohol abuse reflected a complex interaction between CSA and a range of other factors in a woman's background. CSA was not by itself a significant predictor of alcohol abuse (OR = 0.61; 95% CI = 0.31-1.20). However, a history of CSA became significant in combination with co-factors which included: having a mother who was perceived as cold and uncaring; having an alcoholic partner; and believing that alcohol is a sexual disinhibitor., Conclusion: This study indicates that CSA alone is not a causative factor in the development of alcohol abuse among women and highlights the importance of examining the family background of women with alcohol problems.

Objective: The aim of this study was to critically review the literature concerning the nature ane prevalence of paedophilia., Method: The literature of the past 30 years was examined in relation to the author's clinical experience and with emphasis on methodologically appropriate empirical studies., Results: Concern and reporting of child-adult sexual activity has increased markedly in the last decade, although its prevalence has not increased at least since the 1960s. The prevalence in women can be as high as 60%, depending on the definition and method of enquiry used, and female compared to male victims report more negative effects, although a percentage of both men and women report the experience as positive. Validation of effects requires multivariate statistical analysis. Current pro-active procedures to identify paedophiles detect those who victimise boys but do not detect the much greater number of paedophiles who victimise girls. Perpetrators are known to the majority of their female and male victims, and those reported are almost all male; most boys do not consider their prepubertal experiences with older women abusive. Relapse prevention, the current most popular treatment, has been shown to be ineffective for incarcerated child molesters., Conclusions: Child-adult sexual activity should be opposed as an infringement of children's rights rather than requiring a false belief that it is invariably harmful; whether it should be mandatory for therapists to report it requires examination. Scientifically appropriate evaluation should be an essential component of current treatment programs.

A study was conducted to examine the relationships among eating pathology, weight dissatisfaction and dieting, and unwanted sexual experiences in childhood. An unselected community sample of 201 young and 268 middle-aged women were administered questionnaires assessing eating behaviors and attitudes, and past and current sexual abuse. Results showed differential relationships among these factors for the two age cohorts: for young women, past sexual abuse predicted weight dissatisfaction, but not dieting or disordered eating behaviors, whereas for middle-aged women, past abuse was predictive of disordered eating, but not dieting or weight dissatisfaction. Current physical or sexual abuse was also found to be predictive of disordered eating for the young women. These findings underscore the complexity of the relationships among unwanted sexual experiences and eating and weight pathology, and suggest that the timing of sexual abuse, and the age of the woman, are important mediating factors.

The author advances a taxonomy of expert evidence in relation to the responses of sexually abused children to their assaults. He analyses a series of Australian and New Zealand cases in the context of Summit's publicly stated recent views on the use to which Child Sexual Abuse Accommodation Syndrome ("CSAAS") can be put. He argues that expert evidence that goes further than dispelling myths or disabusing triers of fact of misperceptions generally held within the community should not be permitted. He contends that CSAAS is an illegitimate description of such information and that such "syndrome evidence" should not be permitted, particularly before juries. He maintains, moreover, that further rigour will be (and should be) required of prosecutors and mental health professionals alike if such counterintuitive evidence is to be admitted. This will entail proof of the existence of community misunderstanding of the phenomenon, establishment that the field of expertise from which child sexual abuse accommodation evidence emanates is sufficient for the purpose, as well as proof of the expert's expertise in the field. However, he argues against abandoning attempts to use counterintuitive evidence merely on the basis of a number of adverse Australasian determinations, whose reasoning is dependent on the quality of the evidence hitherto advanced and the overly limited perceptions of the evidential framework within which such evidence should be evaluated.

Research aimed at identifying risk factors for childhood sexual abuse (CSA) is crucial for the development of preventative strategies. This study examined the relationship between a number of possible risk factors and CSA in a community sample of women using multivariate analysis and carefully operationalized variables. The variables significantly associated with CSA were physical abuse, having a mother who was mentally ill, not having someone to confide in, and being socially isolated. With the exception of physical abuse, different predictors emerged for abuse before and after age 12. Social isolation and experiencing the death of a mother were significant predictors for abuse before age 12, while the predictors of CSA after age 12 were physical abuse and a mentally ill mother. For abuse perpetrated by a family member, the significant predictors of CSA were physical abuse, having no one to confide in, having no caring female adult, and having an alcoholic father. For girls abused by someone outside of the family, the significant predictors were physical abuse, social isolation, mother's death, and having an alcoholic mother. While CSA can happen to any child, this study highlights circumstances that may increase the chances of abuse and should form the basis of prevention and intervention strategies.

Increasing numbers of adults have been seeking help for childhood sexual abuse in recent years. Dearth of services led to the formation of a resource network from a range of health and welfare services in an inner region of Melbourne. Information gathered through the network indicates that adult survivors presented to primary health agencies in distinct ways. Some sought help primarily for sexual abuse, while others sought help for physical or emotional problems, with sexual abuse remaining masked. Yet others were prevalent in welfare settings, such as women's refuges. Generalist workers in such settings had varied levels of expertise in providing adequate help. When seeking to refer their patients because of concerns about suicide, they found appropriate referral difficult. Public sector mental health workers did not readily undertake work in childhood sexual abuse, and medical practitioners were relatively unaware about the relevance of childhood sexual abuse to physical and emotional ill-health.

This paper addresses child sexual abuse and its consequences for adult survivors. Research is presented which demonstrates the increased incidence of child sexual abuse in adult psychiatric populations and the relevance of child abuse for mental health nursing practice is explored. Discussion then focuses on the personal and interpersonal difficulties confronted by survivors of abuse. Strategies that mental health nurses can use when working with survivors on abuse issues are discussed.

Objective: That sexual abuse in therapy occurs predominantly with male perpetrators and female patients is a phenomenon that requires analysis in terms of gender relations. Such an analysis is undertaken here from the perspective of feminist psychoanalytic and psychosocial theories., Method: Data informing the analysis are derived from assessments of 40 women who experienced sexual abuse in therapy. These women had mostly presented depression, 68% had a history of childhood abuse, and one half were themselves helping professionals., Results: The majority were seriously damaged by the abusive therapy. Offenders were chiefly male (90%) and most were senior, well-qualified therapists of high status: some were charismatic leaders or teachers. Such a group cannot be dismissed as marginal, deviant, or ill-informed; a more systemic analysis is necessary to understand how the professions spawn and sometimes protect offenders., Conclusion: It is concluded that the professional culture mirrors fundamental problems of gender relations that inhere in the larger socio-cultural context where they are expressed in various forms of sexual abuse and violence. A cultural change requires better education on issues of power and sexual politics.