Date of Degree

9-2016

Document Type

Dissertation

Degree Name

Ph.D.

Program

Psychology

Advisor

Cathy Spatz Widom

Committee Members

Maureen Allwood

Geraldine Downey

Valentina Nikulina

Deryn Strange

Subject Categories

Clinical Psychology

Keywords

childhood sexual abuse, child maltreatment, disclosure of childhood abuse, psychiatric symptoms

Abstract

Research has shown that the relationship between childhood sexual abuse (CSA) and psychiatric symptoms is quite varied, with some victims experiencing severe and lasting symptoms and others appearing well-adjusted. Disclosure of childhood sexual abuse has been associated with reduced psychiatric symptoms. Thus, the current study sought to examine the potential moderating effects of disclosure. It was hypothesized that disclosure of childhood maltreatment would be associated with fewer symptoms of depression, anxiety, PTSD, and alcohol- and drug-related disorders and that this relationship between disclosure and psychiatric symptoms would remain consistent over time. In addition, it was hypothesized that the moderating effects of disclosure would be strongest for individuals who were sexually abused compared to those who were physically abused or neglected. Sex differences were also examined. Data was from a prospective cohorts design study in which children with documented cases of abuse or neglect were matched with non-abused and non-neglected children on the basis of age, sex, race, and family social class at the time of maltreatment and followed up into adulthood (N = 1,196). Disclosures were operationalized through self-reports of childhood maltreatment. Both self-reports of maltreatment and psychiatric symptoms were assessed through standardized self-report measures at several different points in time throughout early to middle adulthood. Results indicated that disclosure did not moderate the relationship between childhood maltreatment and later psychiatric outcomes. In contrast to the hypotheses, disclosure of CSA was significantly associated with increased psychiatric symptoms, depression and PTSD in particular. There was also a great deal of variability across time regarding disclosures, and females were more likely to disclose compared to males. Numerous differences were found when effects of CSA were compared to those of childhood physical abuse and neglect, but disclosure of all three types of childhood maltreatment increased risk for symptoms of depression and PTSD throughout early and middle adulthood. In most cases, the effect of disclosure remained even after controlling for official records of abuse or neglect, suggesting that disclosing childhood maltreatment may have a stronger and more consistent effect on development of psychiatric symptoms throughout adulthood compared to official records alone. Both methodological and clinical implications of the results are discussed, with a particular focus on 1) encouraging future work that incorporates both official records and self-reports of CSA, and 2) the benefits of teasing apart the precise role of disclosure in psychotherapeutic treatments of individuals with histories of childhood maltreatment.

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