"Finding My Worth as a Sexual Being": A Qualitative Gender Analysis of Sexual Self-Concept and Coping in Survivors of Childhood Sexual Abuse.

Childhood sexual abuse (CSA) is likely to have impacts on adult survivors' sexuality, particularly on their sexual self-concept. However, little is known about how survivors cope with CSA-related sexual impacts, including sexual self-concept impairments. Thus, this study aimed to examine the interplay between sexual self-concept and coping strategies in CSA survivors by (1) documenting the manifestations of their impaired sexual self-concepts; (2) identifying their strategies to cope with the sexual impacts of CSA; and (3) examining gender differences on sexual self-concept impairments and coping strategies. Content analysis was conducted on semi-structured interviews with 25 women and 26 men adult survivors of CSA recruited via social networks and victim support organizations. Analyses yielded three conceptual categories: (1) Developing an unconsolidated and unfavorable sexual self-concept following CSA; (2) Avoiding CSA-related sexual impacts and impaired sexual self-concept; (3) Approaching CSA-related sexual impacts with more authenticity. Men often managed their suffering and compensated for their impaired sexual self-concept by engaging in sexual dominance and over-investment, by accepting their sexual difficulties and relying on medication to overcome them. Women tended to restrict themselves and disconnect sexually to avoid suffering, complied with their partners' sexual demands out of a sense of duty, prioritized sexual intimacy over orgasm, and seek professional help. Interventions with survivors should promote the development of approach strategies to cope with sexual difficulties, including self-concept impairments, and foster sexual authenticity.

Dissociation and Sexual Concerns in Male Survivors of Childhood Sexual Abuse: The Role of Identity Cohesion.

Research on male survivors of childhood sexual abuse is notably deficient when it comes to addressing their sexual concerns, such as experiences of sexual distress, negative thoughts, and feelings related to their sexuality. Dissociation, a known consequence of childhood sexual abuse, could be associated with higher sexual concerns through identity cohesion. Precisely, dissociation can potentially be related to lower identity cohesion (e.g., not knowing what you want or need). In return, lower identity cohesion may be related to higher sexual concerns by impeding the capacity to know and accept oneself, which tends to promote a positive and healthy sexuality. This study aimed to examine the role of identity cohesion in the link between dissociation and sexual concerns in 105 men consulting for their history of childhood sexual abuse. Men completed questionnaires assessing dissociation, sexual concerns, and identity cohesion at admission in a community setting. Results of a path analysis revealed an indirect association between dissociation and higher sexual concerns through lower identity cohesion. The model explained 27.6% of the variance in sexual concerns. This study highlights the relevance of interventions targeting dissociative symptoms to improve identity cohesion and sexual health in male survivors of childhood sexual abuse.

"I Just Want to Feel Good Without Making You Feel Bad": Sexual Assertiveness Negotiation in Adolescent Romantic Relationships.

Sexual assertiveness is often conceptualized as an individual's ability to express one's own sexual needs, desires, and limits. Given that sexual assertiveness is embedded in interactions and can affect not only both partners' sexual well-being but also relationship satisfaction, dyadic approaches are needed to investigate sexual assertiveness negotiation within adolescent romantic relationships. This qualitative study aimed to document adolescents' ability to negotiate their sexual needs, desires, and limits with their partners during interactions where they discussed their sexual concerns. A directed content analysis, based on the life positions of the transactional analysis theory, was conducted on the interactions of 40 adolescent romantic dyads aged 14-19 years (M = 16.65; SD = 1.49). The results revealed four categories of strategies: (1) mutual assertiveness: negotiation of one's own sexual needs, desires, and limits with those of the partner; (2) singular passiveness: repression of one's own sexual needs, desires, and limits to privilege those of the partner; (3) singular aggressiveness: prioritization of one's own sexual needs, desires, and limits over those of the partner; and (4) mutual lack of negotiation skills: neglecting both partners' sexual needs, desires, and limits. Among other things, adolescents' ability to be sexually assertive was hindered by anticipations, including assumptions leading to disregarding one's own sexual needs, desires, and limits or fearing to ignore the partner's. To promote mutually rewarding sexual activities and prevent sexual violence, sexual education initiatives should support adolescents' ability to assertively negotiate their sexuality with their partner and avoid passiveness, aggressiveness, and lack of negotiation.

"I felt imprisoned": A qualitative exploration of controlling behaviors in adolescent and emerging adult dating relationships.

INTRODUCTION: First dating relationships can elicit intense emotions that youth may attempt to alleviate by using control tactics that negatively impact the quality of their relationship and their partner's well-being. Despite the breadth of research on dating violence, studies examining control tactics in youth relationships are limited. The current qualitative study documented control tactics from the perspective of youth who are currently in dating relationships. METHOD: Individual semistructured interviews were conducted with 39 participants aged 15-22 years old to gather information regarding conflict management strategies used in their dating relationships. The participants were recruited from high schools and junior colleges across the province of Quebec, Canada. RESULTS: Direct content analysis revealed three categories of control tactics, including, isolation, domination, and emotional manipulation. These findings highlight the importance of further examining control dynamics in adolescent and emerging adult dating relationships to improve dating violence prevention programs. CONCLUSIONS: Educational programs can help prevent control from escalating to more direct forms of violence by supporting youth in identifying unhealthy relationship dynamics and providing them with tools to either safely end the relationship or communicate their concerns with their partner.

Adapting Adolescent Dating Violence Prevention Interventions to Victims of Child Sexual Abuse.

Considering the increased risk of revictimization, adolescents who have experienced child sexual abuse (CSA) are a priority subpopulation for the prevention of dating violence. Yet, intervention programs often focus on psychological symptomology associated with CSA; few tackle issues specific to relational violence. Addressing the relational traumatization of adolescents with a history of CSA is essential to prevent their revictimization. Given specific CSA sequelae related to intimacy and engagement in sexual behaviors, there is a need for tailoring interventions to boy and girl survivors. A case study of a group intervention designed for adolescent girls with a history of CSA was conducted. The context adaptation, based on intervention mapping proposed by Bartholomew and colleagues, served as a theoretical framework. Four steps were taken to ensure that the intervention addressed CSA youth needs: (a) needs assessment, (b) analysis of the conceptual framework of the original program, (c) selection of interventions and developing new interventions, and (d) validation with a committee of practitioners. This approach provided an understanding of risk factors and intervention priorities using the problem logic model. The original program was enhanced by adding four interventions addressing the prevention of dating violence. These interventions were then validated by practitioners before implementation in the setting. The approach underscores the relevance of understanding the needs of the clientele and of adopting a collaborative approach to ensure the proposed interventions are relevant.

Intergenerational Continuity of Child Sexual Abuse: Comparison of Mother and Emerging Adult Dyads.

Sexual abuse trauma can have long-term implications for individuals in terms of psychological functioning, relationships, and socio-environmental circumstances, all of which are elements that could explain the CSA intergenerational continuity phenomenon. There are few empirical studies drawing comparisons between families to identify factors associated with the intergenerational (dis)continuity of CSA. The objectives of this study are to compare mother and emerging adult dyads to determine differences between cycle maintainers, cycle breakers, cycle initiators, and a control group in terms of maternal maltreatment histories, mental health, attachment, and socio-environmental characteristics. A sample of 186 dyads was recruited across Canada to participate in an online study. The study represents a cross-sectional design and bivariate and multivariate analyses were used. The results support prior research that there is a higher risk of CSA in dyads where the mother experienced CSA (OR = 1.38). Compared to cycle initiators, maintainers reported greater psychological distress (M = 27.23; 35.18), and lower mother-rated parent-child attachment (M = 115.83; 111.43). Maintainers reported more post-traumatic stress symptoms only in comparison to the control group (M = 24.82; 10.13). Mothers in cycle maintaining dyads were exposed to more acts of domestic violence than those in cycle breaking dyads (OR = 2.43). No group differences were observed for intimate partner attachment. Findings should be replicated using robust methodological designs (e.g., longitudinal, mixed methods). Preventative efforts should target at-risk families to reduce the chance of intergenerational CSA.

Diversity of Profiles and Coping Among Adolescent Girl Victims of Sexual Dating Violence.

Sexual dating violence (DV) is common among female adolescents, and victims may experience other forms of DV (physical, psychological, and cyberviolence) and report a history of child sexual abuse (CSA). Heterogeneity of these victimization experiences could influence how adolescent girls' cope. We aimed to identify distinct profiles of victimization experiences among adolescent girls who reported sexual DV and to explore if these profiles were associated to their coping strategies. Of an initial sample of 1,300 female adolescents who completed online questionnaires, 835 (Mage = 16.8 years) reported at least one experience of sexual DV and were included in the analyses. Hierarchical classification with the Two Step analysis revealed four distinct profiles of victimization. A first cluster named Moderate CSA & Cyber-sexual DV (21.4%) is characterized by moderate percentage of all forms of victimization. The second cluster CSA & DV excluding cyber-sexual DV (34.4%) included victims of traditional DV, moderate rates of CSA and no experience of cyber-sexual DV. A third cluster CSA & DV Co-occurrence (20.6%) regrouped victims who have experienced different forms of DV in co-occurrence and CSA. Finally, the fourth cluster, named No CSA & DV Co-occurrence (23.6%) involved victims who have experienced different forms of DV in co-occurrence, but did not report a history of CSA. Analyses revealed significant differences between the profiles on the use of avoidance coping, in their perceived social support, and on help-seeking strategies deployed toward a partner and a health professional. These findings offer cues for prevention and intervention efforts for victimized female adolescents.

Youth's Experiences of Cyber Violence in Intimate Relationships: A Matter of Love and Trust.

Adolescents and young adults are particularly at risk of experiencing or perpetrating cyber dating violence (CDV) in their romantic relationships. However, it remains difficult to understand the motivations behind tolerating or perpetrating CDV in romantic relationships. Romantic attachment and beliefs may be an interesting avenue to explore among youth victims of CDV. The current study aims to 1) document the association between romantic attachment and CDV victimization and perpetration while controlling for age, gender and other forms of DV, and 2) explore beliefs youth attribute to the use of technology in their romantic relationships. A total of 332 self-identified heterosexual youth, with an age range of 14 to 25 years old, completed a survey. A subgroup of 14 youth who reported experiencing cyber dating violence also participated in a semi-structured interview. Logistic regressions were used to assess the contribution of romantic attachment (anxious and avoidant) to each form of CDV (stalking, psychological and sexual CDV) followed by a thematic analysis exploring beliefs about the use of technology in romantic relationships. Anxious attachment significantly predicted psychological CDV as well as stalking victimization and perpetration. Avoidant attachment significantly predicted psychological CDV victimization and perpetration as well as sexual CDV victimization. In their narratives, youth reported that controlling, monitoring, harassing behaviors, especially credentials sharing, constitute proof of love and trust rather than manifestations of CDV. The results support the relevance of developing tailored interventions based on attachment and romantic beliefs, which appears to be a promising avenue for preventing various forms of DV.

A Hierarchical Cluster Analysis of Childhood Interpersonal Trauma and Dispositional Mindfulness: Heterogeneity of Sexual and Relational Outcomes in Adulthood.

The current mixed-method study aimed to 1) identify different childhood interpersonal trauma (CIT) and dispositional mindfulness (DM) profiles in an adult sample; 2) illustrate these profiles with qualitative data documenting childhood sexual abuse (CSA) and CIT survivors' perceptions of their own DM; and 3) examine profile differences on sexual and relational outcomes. Participants were 292 adults who completed an online questionnaire. A subsample of participants having reported a history of CSA (n = 51) also completed semi-structured interviews. Hierarchical cluster, comparison, and content analyses were performed. Analyses yielded three profiles: 1) Lower victimization, high mindfulness; 2) Psychological victimization, low mindfulness; and 3) Multi-victimization, low mindfulness. Participants in profile 1 presented the lowest frequency of CIT experiences and the highest levels of DM and sexual and relational well-being. Profile 2 participants presented higher sexual and relational well-being (i.e., higher sexual satisfaction, lower sexual depression, and fewer interpersonal conflicts) than those in profile 3. By documenting distinct CIT and DM profiles and tying them to different levels of relational and sexual well-being, this study could guide practitioners in designing tailored interventions.

"It Made Me so Vulnerable": Victim-blaming and Disbelief of Child Sexual Abuse as Triggers of Social Exclusion Leading Women to Homelessness.

Although the association between child sexual abuse (CSA) and homelessness among women is well documented, few studies have investigated this topic from a feminist standpoint, examining the impact of sociocultural factors such as rape culture. Based on a qualitative life course approach, individual interviews were conducted with 21 women who experienced both CSA and homelessness. Participants were between 29 to 60 years old (M = 45 years of age). Analyses revealed that CSA disclosure experiences were characterized by victim-blaming and disbelief. Women's traumatic experiences were further aggravated by these types of reactions. Finally, CSA and negative social reactions to women's disclosures of CSA were perceived as the onset of social exclusion, which lead to their homelessness. This study shows how traumatic CSA experiences and negative social reactions to their disclosure can both contribute to social exclusion and isolation, and to homelessness through the internalization of rape myths. These findings support the importance of focusing on CSA prevention to reduce social exclusion and homelessness.

A cluster analysis of dynamics in adolescent romantic relationships.

INTRODUCTION: While several studies involving adolescents have addressed issues related to romantic relationships and dating violence, there is a limited understanding of adolescent romantic relationship dynamics. Typological analyses have been useful to provide targeted interventions and to simplify our understanding of complex phenomena. METHODS: This study explored dynamics in adolescent romantic relationships, considering the interaction between romantic partner characteristics to identify dyadic profiles. A sample of 90 heterosexual dyads of Canadian adolescents (Mage = 18.44 years, SD = 1.47) completed a self-reported questionnaire. A hierarchical cluster analysis was conducted based on the dimensions of the Circumplex Model of Marital and Family Systems (i.e., cohesion, flexibility, and communication; Olson & Gorall, 2003). RESULTS: Analysis revealed four profiles of romantic relationship dynamics: 1) balanced dynamic (51.0% of the sample); 2) hampered dynamic (8.3%); 3) entangled dynamic (20.8%); and 4) rigid dynamic (13.5%). Taking into account the variations between and within dyads, results highlight the diversity of romantic experiences and offer a better understanding of the intricacies of different adolescent romantic relationship dynamics. Correlates indicated that the profiles can be distinguished by different personal and interpersonal characteristics. CONCLUSION: This study emphasizes the importance of integrating a more person- and dyad-oriented framework in our understanding of adolescent romantic dynamics, since a unique approach to prevention and intervention may not address the needs of all adolescents. The results provided important insight into the identified profiles, guiding dating violence prevention efforts and programs and promoting harmonious and egalitarian romantic relationships.

Gender-Specific Patterns of Teen Dating Violence in Heterosexual Relationships and their Associations with Attachment Insecurities and Emotion Dysregulation.

Teen dating violence is a complex issue associated with several deleterious consequences. Previous studies emphasize the importance of considering the heterogeneity of teen dating violence experiences to better understand this issue and its correlates. In this perspective, the present study aimed to identify gender-specific patterns of teen dating violence in heterosexual relationships based on directionality (victimization and perpetration) and forms of violence (psychological, physical and sexual). In addition, this study aimed to investigate how these patterns are differentially associated with attachment insecurities and emotion dysregulation. A total of 3100 adolescents who reported being in a heterosexual romantic relationship (mean age = 15.92 years; 60% girls) completed questionnaires on teen dating violence, romantic attachment and emotion dysregulation. Latent class analyses revealed four distinct patterns of teen dating violence. The first three patterns, namely Low dating violence (40% of girls and 54% of boys), Mutual psychological dating violence (34% of girls and 33% of boys) and Mutual psychological and physical dating violence (14% of girls and 5% of boys), were found for both genders. The last pattern differed greatly based on gender and was labeled Mutual psychological dating violence and sexual victimization in girls (12%) and Multiple dating violence victimization in boys (8%). Higher levels of emotion dysregulation and attachment insecurities were found in adolescents experiencing more complex patterns of dating violence. This study contributes to the development of teen dating violence prevention and intervention programs by identifying gender-specific patterns of teen dating violence and documenting their associations with important trauma-informed correlates.

Experiences of Disclosure and Reactions of Close Ones from the Perspective of Child Sexual Abuse Survivors: A Qualitative Analysis of Gender Specificities.

The disclosure of child sexual abuse (CSA) is a complex process that remains partially understood, despite its crucial role in survivors' recovery. Gender specific experiences of disclosure have been little investigated while this information is crucial to better tailor interventions for survivors. This qualitative study aims to 1) explore survivors' experiences in disclosing to close ones, and 2) contrast experiences of male and female survivors. Fifty-one CSA survivors (25 women and 26 men) aged 18 years or older were recruited via community services for survivors. Two main categories emerged from thematic content analysis: 1) experiences of disclosure hindering CSA recovery or 2) ones fostering CSA recovery. Men felt ignored when their close ones were focused on their own emotions of indifference, helplessness and guilt toward CSA. Men felt guilty when confronted with reactions of blame for their own inaction or disempowered when pressured to remain silent or to forgive. Women felt ignored when their close ones showed anger toward their perpetrator. Women felt guilty when they were held accountable for CSA events or disempowered when pressured to take legal actions. Women, but not men, reported feeling considered through caring and heart-to-heart discussions. Recommendations for awareness messages and practitioners are discussed.

Interaction Patterns in Adolescent Romantic Relationships: A Typological Analysis.

While several studies in adolescents have addressed issues related to romantic relationships and dating violence, there is a limited understanding of their interaction patterns. This study aims to document interactions in conflict situations by identifying profiles of adolescent romantic relationships. Qualitative analysis based on the dimensions of the Circumplex Model of Marital and Family Systems was used to investigate the interaction task of 40 dyads. A typological analysis revealed four profiles: (1) rigid, (2) entangled, (3) hampered, and (4) balanced. Results highlight the diversity of romantic experiences and offer a better understanding of the intricacies of different interaction profiles. Dating violence prevention efforts and programs promoting harmonious and egalitarian romantic relationships could benefit from the insights of the identified profiles.

Decision-making about motherhood among women living with HIV in Canada: a negotiation of multidimensional risks.

Little research in Canada has examined the perspectives of women living with HIV on decision-making across the stages of motherhood. In 2004-2005, semi-structured interviews were conducted with 42 African, Caucasian and Haitian HIV-positive women recruited in Montreal. All were or wished to be biological mothers. Transcripts underwent thematic analysis organised by three culturally informed models of motherhood described by the participants, which influenced decision-making and perceived risks. For women who saw motherhood as 'self-fulfilment and completeness', vertical HIV transmission was a primary concern. It threatened their identity as a 'good mother', which also meant adhering to antiretrovirals. For women who viewed motherhood as a 'social realisation' (all African or Haitian), fears of compromised fertility dominated. Not becoming pregnant threatened their social status and presumed health within their community. Antiretrovirals were abandoned after delivery, fearing they would reveal their HIV status. For women endorsing a 'personal growth' model of motherhood (all Caucasian), threats to personal health were paramount. Pregnancy meant purifying body and soul. Antiretrovirals, seen as pollutants, were stopped after delivery. These findings can inform current research and sensitise health providers to the complex biological, psychological, social and spiritual risks that HIV-positive women negotiate in motherhood-related decision-making, towards more patient-centred care.

Maternal Emotional Support following the Disclosure of Child Sexual Abuse: A Qualitative Study.

Non-offending maternal (NOM) support is considered one of the most important protective factors in facilitating better victim adjustment following the disclosure of child sexual abuse (CSA). However, recent findings have led authors to conclude that NOM support has yet to be properly conceptualized and operationalized within the CSA literature. Emotional support is one dimension that has consistently emerged in studies attempting to reconceptualize NOM support but is a concept which also requires further theoretical investigation. Researchers interviewed 22 mothers of children aged 6-12 years about their experience and provision of emotional support following their child's disclosure of CSA. Data were analyzed using a method inspired by grounded theory. Mothers reported feeling initially overwhelmed and lost about how to emotionally support their child but described an improvement in their support capabilities following conjoint therapy. Furthermore, three overarching categories emerged outlining maternal emotional support strategies, each serving a specific emotional function: (a) elaborating, encouraged children to talk about their CSA experience; (b) soothing, attempted to comfort children's distress; and (c) orienting, attempted to guide children's recovery process. Authors discuss implications for offering improved and more rapid clinical services following the disclosure of CSA, and considerations for the operationalization of NOM emotional support.

Stigma Management Trajectories in Youth with Perinatally Acquired HIV and Their Families: A Qualitative Perspective.

This study explores how family, secrecy and silence contribute to the adoption of stigma management strategies among youth with perinatally acquired HIV (PAHIV). A qualitative method was used. Eighteen youths with PAHIV aged 13-22 years old took part in a semi-structured interview. An exploratory content analysis was performed. Analyses of interviews allowed identification of two HIV stigma management trajectories, both sensitive to the family context: [1] a consolidation of family ties, which contributes to solidarity in stigma management; and [2] a weakening or dissolution of family ties, which contributes to solitary stigma management strategy. Family conditions that support the children in their efforts to develop active stigma management strategies are described. Children likely to experience weakening or dissolution family ties must build strong bonds in the clinical environment and maintain these into adulthood so as to afford them the support they need.

Conflict resolution patterns and violence perpetration in adolescent couples: A gender-sensitive mixed-methods approach.

This study used a sequential two-phase explanatory design. The first phase of this mixed-methods design aimed to explore conflict resolution strategies in adolescent dating couples, and the second phase to document, from both the perspective of the individual and of the couple, dyadic interaction patterns distinguishing youth inflicting dating violence from those who do not. A sample of 39 heterosexual couples (mean age 17.8 years) participated in semi-structured interviews and were observed during a 45 min dyadic interaction. At phase 1, qualitative analysis revealed three main types of conflict resolution strategies: 1) negotiating expectations and individual needs; 2) avoiding conflicts or their resolution; 3) imposing personal needs and rules through the use of violence. At phase 2, we focused on couples with conflictive patterns. Results indicate that couples who inflict violence differ from nonviolent couples by their tendency to experience conflicts when in disagreement and to resort to negative affects as a resolution strategy. In addition, while at an individual level, they show a tendency to withdraw from conflict and to use less positive affect, at a dyadic level they present less symmetry. Results offer important insights for prevention programs.

Barriers to health-care and psychological distress among mothers living with HIV in Quebec (Canada).

Health-care providers play a major role in providing good quality care and in preventing psychological distress among mothers living with HIV (MLHIV). The objectives of this study are to explore the impact of health-care services and satisfaction with care providers on psychological distress in MLHIV. One hundred MLHIV were recruited from community and clinical settings in the province of Quebec (Canada). Prevalence estimation of clinical psychological distress and univariate and multivariable logistic regression models were performed to predict clinical psychological distress. Forty-five percent of the participants reported clinical psychological distress. In the multivariable regression, the following variables were significantly associated with psychological distress while controlling for sociodemographic variables: resilience, quality of communication with the care providers, resources, and HIV disclosure concerns. The multivariate results support the key role of personal, structural, and medical resources in understanding psychological distress among MLHIV. Interventions that can support the psychological health of MLHIV are discussed.

Family quality of life in families affected by HIV: the perspective of HIV-positive mothers.

The HIV infection of a family member can impact family quality of life (FQoL). The objectives of this study are to (1) describe patterns of FQoL among mothers living with HIV (MLHIV) and (2) identify key factors associated with FQoL in families affected by HIV. Recruitment took place in HIV-specialized clinics and community organizations. A 100 MLHIV and 67 of their children participated in this study. Mothers were on average 40.8 years old and reported having an average of two dependent children at home (M = 2.1, SD = 1.0). Participating children were 16.2 years old, on average. Half of the children were boys (50.8%). More than half were aware of their mother's positive HIV status (68.2%) and 19.7% were diagnosed with HIV. All HIV-positive children were aware of their status. A latent profile analysis was performed on the five continuous indicators of FQoL, and three main profiles of self-reported FQoL among MLHIV were established: high FQoL (33%), moderate FQoL (58%), and low FQoL (9%). Among the mothers' characteristics, education, physical functioning, social support, and resilience increased FQoL, while anxiety and irritability decreased FQoL. Among the children's characteristics, resilience followed the FQoL profile. A trend was observed toward children's greater awareness of the mother's HIV status in high and low FQoL profiles. Additionally, irritability tended to be higher within the lower FQoL profile. FQoL profiles can be used to identify families needing special care, particularly for family interventions with both parents and children. Other relevant indicators must be studied (e.g., closeness and support between family members, availability and accessibility of care, family structure, father-child relationships, and medical condition of the mother) and longitudinal research conducted to estimate the direction of causality between FQoL profile and individual family member characteristics.