Sexual Abuse Characteristics and Psychological Functioning among Male Survivors of Childhood ...

279 Pages·2017·2.82 MB·English

by  Jennifer Lyons

Sexual Abuse Characteristics and Psychological Functioning among Male Survivors of
Childhood Sexual Abuse

Jennifer Lyons

Thesis submitted to the
Faculty of Graduate and Postdoctoral Studies
in partial fulfillment of the requirements
for the Doctorate in Philosophy degree in Clinical Psychology

School of Psychology
Faculty of Social Sciences
University of Ottawa

© Jennifer Lyons, Ottawa, Canada, 2018
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Abstract
Childhood sexual abuse among males has been associated with many negative psychological
outcomes. Studies have attempted to identify which sexual abuse characteristics (e.g., duration,
age of onset) are associated with mental health difficulties. While informative, this research has
been mostly limited to variable-centered analyses, which do not capture the heterogeneity in
males‘ abuse experiences and psychological presentations. This two-part dissertation advances
our understanding of how best to measure childhood sexual abuse and how to account for the
diversity of sexual abuse experiences and outcomes among men using a person-centered
approach. Given that there are few validated measures of childhood sexual abuse, the first study
examined the psychometric properties of a commonly-used measure in the sexual abuse
literature, the Sexual Victimization Survey (SVS; Finkelhor, 1979). Once the validity and
reliability of the SVS were established, the SVS was used to generate profiles on the basis of
abuse characteristics (Study 2). Data for both studies were drawn from a sample of 302 males
(85% Caucasian) aged 18 to 65 years seeking support for childhood sexual abuse. Participants
completed a modified version of the SVS as well as the sexual abuse subscale of the Childhood
Experiences of Violence Questionnaire-Short Form (CEVQ-SF; Tanaka et al., 2012). Twenty-
one males completed the SVS again one week later for test-retest purposes. The SVS showed
high inter-rater reliability on sexual abuse status and sexual abuse characteristics. Most males
(85%) who endorsed sexual abuse on the SVS did so on the CEVQ-SF, resulting in fair
concurrent validity. The SVS showed perfect one-week test-retest reliability on abuse status, as
well as good to excellent agreement on sexual abuse characteristics between the initial and one
week time points. Given the strong psychometric properties of the modified SVS, it was then
used to generate childhood sexual abuse profiles in Study 2. Once participants with significant
MALE CHILDHOOD SEXUAL ABUSE iii
missing data were deleted, 215 men remained and were included in the generation of profiles.
Latent profile analyses revealed three distinct profiles which varied in the severity of abuse
experiences. The Severe profile (n = 56, 26%) depicted sexual abuse which began in mid-
childhood and consisted of a one or two time fondling by an unfamiliar extrafamilial perpetrator.
Men in the More Severe profile (n = 71, 33%) also experienced abuse in mid-childhood by an
extrafamilial perpetrator, but experienced more severe sexual acts that spanned several months to
several years. Men in this profile were emotionally closer to their perpetrators prior to abuse
onset than males in the Severe profile. The Most Severe profile (n = 88, 41%) depicted abuse
which began in early childhood and consisted of very severe sexual acts by trusted individuals
both within and outside of the family. Men in the Most Severe were significantly more likely to
concurrently have experienced child emotional and physical abuse as well as a greater number of
non-victimization adversities, compared with men in the other two profiles. Profiles varied with
respect to psychological outcomes. Males in the More Severe and Most Severe profiles reported
significantly more internalizing problems than men in the Severe profile, and men in the Most
Severe profile reported significantly more trauma symptoms than men in the Severe profile.
Certain contextual variables were also associated with greater psychological difficulties, namely
greater present-day use of avoidant coping predicted more internalizing and externalizing
problems, as well as greater trauma symptoms. Worse childhood family functioning was
associated with more internalizing and externalizing problems, and disclosure of the abuse
(compared to non-disclosure) was associated with more externalizing problems and trauma
symptoms. These results have several research and clinical implications, including tailoring
assessment and treatment to meet the individual needs of male survivors.
Keywords: male sexual abuse; child maltreatment, profiles, psychological outcomes
MALE CHILDHOOD SEXUAL ABUSE iv
Acknowledgements
I would like to extend my sincerest appreciation and gratitude to the following people,
who have been instrumental in my journey in the doctoral program. First, I would like to thank
my supervisor, Dr. Elisa Romano. In addition to helping me become a better researcher, she
taught me the importance of advocacy for children and adults in need. She is an excellent
professional and personal role model, and I feel grateful to have had the opportunity to work
with her for the last 7 years. I wish to also express my gratitude to Dwayne Schindler for our
innumerable consultations, and to the members of my committee, Drs. Aubry, Lalumière, and
Lebel, for their expertise and helpful suggestions that greatly improved this project.
Thank you to my friends and family for their patience, support, and unwavering
confidence in me. To team ―JAC‖ and my incredible lab mates and fellow residents: thank you
for filling these last 7 years with laughter and happiness, providing respite when I needed it most,
and for your unwavering support and encouragement during moments of frustration and
discouragement. To my family, my biggest cheerleaders, who instilled in me the importance of
empathy, hard work, and perseverance. And thank you to my best friend and husband, Dave,
and our two cats, who provided a safe haven from the inevitable stressors that arose during this
long journey. Dave: I am forever grateful for your unconditional love and confidence in me.
Finally, to the brave men who generously volunteered their time to the project and shared
their difficult experiences with me, thank you. I hope that this study is one of many that will let
your voices be heard.
MALE CHILDHOOD SEXUAL ABUSE v
Table of Contents
Abstract…………………………………………………………………………………………..ii
General Introduction…………………………………………………………………………….1
Frequency of male childhood sexual abuse……………………………………………….2
Impact of male childhood sexual abuse…………………………………………………...5
Theoretical models of sexual abuse ……………………………………………………..15
Sexual abuse characteristics…………………...…………………………………………21
Families of males with sexual abuse histories…………………………………………...30
Disclosure among males with sexual abuse histories.………………………..……..…...32
How do males cope with sexual abuse?…..……………………………………………...35
Summary and thesis objectives ………………………………………………………….36
Study 1: Evaluating the Psychometric Properties of the Sexual Victimization Survey……39
Methodological problems in studying sexual abuse…………..………………………....39
Common measures of sexual abuse……………………………………………………...47
Study 1 summary and objectives………………………………………………………...56
Method…………………………………………………………………………………………..59
Participants……………………………………………………………………………….59
Measures…………………………………………………………………………………62
Procedure………………………………………………………………………………...66
Data analysis………………………………………………………………………….…68
Results…………………………………………………………………………………………...70
Inter-rater reliability of the modified SVS……………………………………………….69
Concurrent validity of the modified SVS………………………………………………..70
Test-retest of the modified SVS………………………………………………………….73
MALE CHILDHOOD SEXUAL ABUSE vi
Discussion…………………………………………………………………………….................74
Research and clinical implications……………………………………………………….80
Limitations……………………………………………………………………………….81
Summary…………………………………………………………………………………82
Link between Study 1 and 2……………………………………………………………………83
Study 2: The Relationship between Childhood Sexual Abuse Profiles and Adult
Psychological Functioning……………………………………………………………………...84
Sexual abuse profiles…………………………………………………………………….84
Profiles and co-occurring maltreatment and adversity…………………………………..95
Profiles and psychological outcomes…………………………………………………….97
Profiles and contextual variables………………………………………………………...98
Present-day coping……………………………………………………………….99
Childhood family functioning………………………………………………......101
Disclosure experiences………………………………………………………….103
Study 2 summary and objectives……………………………………………………….105
Method…………………………………………………………………………………………109
Participants……………………………………………………………………………..109
Measures………………………………………………………………………………..109
Procedure……………………………………………………………………………….116
Data analysis……………………………………………………………………………117
Results………………………………………………………………………………………….121
Latent Profile Analysis…………………………………………………………………123
Profiles and co-occurring maltreatment and adversity…………………………………132
MALE CHILDHOOD SEXUAL ABUSE vii
Profiles and outcomes…………………………………………………………………..135
Moderators of profiles and outcomes…………………..………………………………135
Discussion……………………………………………………………………………………...153
Identification of profiles………………………………………………………………..154
Profiles and co-occurring maltreatment and adversity…………………………………157
Profiles and outcomes…………………………………………………………………..159
Moderators of profiles and outcomes…………………………………………………..162
Research and clinical implications……………………………………………………...166
Limitations……………………………………………………………………………...169
Summary…………………………………………………………………………….….170
General Discussion…………………………………………………………………………….172
Major findings…………………………………………………………………………..172
Theoretical applications ………………………………………………………………..174
Research applications..………………………………………………………………….175
Practical applications…………………………………………………………………...177
Conclusions……………………………………………………………………………..181
References……………………………………………………………………………………...182
MALE CHILDHOOD SEXUAL ABUSE viii
List of Tables
Table 1. Comparisons Between the Original and Modified SVS………………………………52
Table 2. Socio-demographics of males who completed the SVS……………………………….61
Table 3. Inter-rater Reliability of Abuse Status and Characteristics from the SVS…………….71
Table 4. Chi-square of the SVS and the CEVQ-SF……………………………………………..71
Table 5. Agreement in Abuse Characteristics across Initial and Test-Retest…………………....74
Table 6. Summary of Studies Identifying Profiles on the Basis of Abuse Characteristics………86
Table 7. Socio-demographics of Males Included in LPA……………………………………....110
Table 8. Model Fit Indices and Average Posterior Probabilities……………………………….125
Table 9. Abuse Characteristics of 3-profile Solution…………………………………………...128
Table 10. Co-occurring Child Maltreatment and Adversity among Profiles…………………..133
Table 11. Means and SD‘s on Predicted Variables by Profile………………………………….137
Table 12A. Regression for Predictors of Internalizing Problems (1st Set)…………………..…139
Table 12B. Regression for Predictors of Internalizing Problems (2nd Set)……………………..141
Table 13A. Regression for Predictors of Externalizing Problems (1st Set)…………………….144
Table 13B. Regression for Predictors of Externalizing Problems (2nd Set)……………………146
Table 14A. Regression for Predictors of Trauma Symptoms (1st Set) …..…………………….149
Table 14B. Regression for Predictors of Trauma Symptoms (2nd Set)…..……………………..151
MALE CHILDHOOD SEXUAL ABUSE ix
List of Figures
Figure 1. Recruitment Flow Chart for Study 1…………………………………………………60
Figure 2. Sample Flow Chart for Study 2……………………………………………………..119
MALE CHILDHOOD SEXUAL ABUSE x
List of Appendices
Appendix A. Sexual Victimization Survey……………………………………………………..226
Appendix B. Modified Sexual Victimization Survey…………………………………………..237
Appendix C. Socio-Demographic Questionnaire………………………………………………246
Appendix D. Childhood Experiences of Violence Questionnaire – Short-Form……………….249
Appendix E. Ethics Approval…………………………………………………………………..250
Appendix F. Study Notice………………………………………………………………………251
Appendix G. Consent Form for Initial Time Point……………………………………………..252
Appendix H. Relaxation Exercise………………………………………………………………255
Appendix I. Crisis Lines………………………………………………………………………..256
Appendix J. Consent Form for Test-Retest……………………………………………………..258
Appendix K. Adverse Childhood Experiences Questionnaire………………………………….261
Appendix L. Non-victimization Adversity Scale……………………………………………….263
Appendix M. How I Deal With Things Scale…………………………………………………..265
Appendix N. Family Relationships Index………………………………………………………266
Appendix O. Adult Self-Report………………………………………………………………...267
Appendix P. Post-traumatic Stress Disorder Checklist…………………………………………268