The Medical Somatic Dissociation Questionnaire Assessment For Childhood Sexual Abuse: A Brief Report.

Child sexual abuse is a prevalent phenomenon worldwide. However, a gap exists between its incidence and its disclosure rate. Furthermore, assessment tools and techniques capable to identify the source of symptoms are lacking. This study investigates the extent to which the validated Medical Somatic Dissociation Questionnaire (MSDQ) can differentiate between sexually and non-sexually abused children. A total of 794 children and youth between the ages of 8 and 18 (mean age: 12.2 (SD = 2.3); 42% female, 58% male) were recruited from the general population; other participants were residents of boarding schools and children who were referred to medical treatment. The anonymous online questionnaire included queries about demographics, a condensed version of the Traumatic Life Events Questionnaire, and the MSDQ. Findings indicate strong internal consistency, reliability, incremental validity, and predictive validity of the instrument, indicating the superiority of the MSDQ's ability to predict sexual abuse compared to physical abuse or the loss of a family member. It is concluded that the MSDQ can be integrated into the evaluation process performed by healthcare professionals in the diagnosis of minors with unexplained symptomatology.

The mediating role of parental embodied mentalizing in the longitudinal association between prenatal spousal support and toddler emotion recognition.

Emotion recognition is an important developmental achievement in early childhood. Grounded in theoretical concepts of family systems theory and the spillover effect, the goal of the current study was to examine whether prenatal spousal support predicts toddler emotion recognition at 24 months, and whether this association is mediated by parental embodied mentalizing (PEM) at 6 months. PEM refers to the parent's capacity to understand the infant's mental states from his or her whole-body kinesthetic expressions and adjust their own kinesthetic patterns accordingly. One hundred and five families expecting their first child were included in the study. Results indicated that maternal PEM mediated the relationship between prenatal dyadic positive and overall support and toddler emotion recognition. Paternal PEM was not found to be related to either dyadic support or to toddler emotion recognition, and it did not mediate the relationship between the two. The findings of the current study support the importance of including both parents' embodied mentalizing and a systemic approach to illuminate child development. A significant clinical implication from this study is the usefulness of prenatal couple interventions to improve mutual support and communication as it can promote parents' parental mentalizing and ultimately the child's emotion recognition capacity.

Introduction to the Special IssueThe Use of Creative Art Therapies in the Prevention, Screening, and Treatment of Child Sexual Abuse.

The significant gap between the prevalence of child sexual abuse and disclosure underscores the need for new, innovative, and creative screening tools to identify victims to end the abuse and provide these victims with appropriate treatment. This article presents the cumulative efforts of a series of innovative studies dealing with sexually abused survivors and offenders that concentrates on preventing, assessing, screening, and treating Child Sexual Abuse (CSA). We start by describing the need and rationale for using the arts for purposes of identification and treatment. We discuss how these arts help bypass censorship and dissociation mechanisms involving the body as a critical factor during the assessment and the treatment. Each of the articles is then presented. The introduction is organized to show how non-verbal techniques for the prevention, screening, assessment and treatment of sexual abuse in chidren can move beyond verbal techniques that are known to be limited in their effectiveness.

Physical Versus Sexual Abuse as Reflected in Adolescents' Self-Figure Drawings: A Preliminary Study.

Based on the lack of validated assessment tools to detect past physical or sexual abuse, the current study examines to what extent the experience of either sexual or physical abuse is reflected in self-figure drawings of adolescents at-risk. A convenience sample consists of 93 adolescents at risk between the ages of 12-17 recruited from Welfare institutes divided into three groups: Group 1 included adolescents who experienced sexual abuse, Group 2 included adolescents who experienced physical abuse but not sexual abuse, Group 3 included adolescents who experienced neither sexual abuse nor physical abuse. A self-report anonymous questionnaire that consisted of demographics, traumatic events questionnaire, and the Medical Somatic Dissociation Questionnaire (MSDQ) was administered following Ethical approval and signing of consent forms. Participants were asked to draw themselves on an A4 sheet of paper using a pencil. Five social workers who were unaware of participants' experiences assessed the drawings independently for the level of obviousness of the following indicators: face line, eyes, nose, ears, hair stand, forehead, lower body, arms, and hands. Results yielded differences in pictorial indicators (nose, hair stand, lower body) among the groups. MSDQ score was found significantly higher among sexually abused victims.

A Novel Screening Tool for Assessing Child Abuse: The Medical Somatic Dissociation Questionnaire-MSDQ.

Somatic dissociation is known to be associated with childhood abuse, particularly with childhood sexual abuse (CSA). Currently, the diagnosis of CSA is hampered by the lack of a validated questionnaire. While some questionnaires are excellent research tools, there is no suitable applied measure for the assessment of distress due to CSA. The current study's objective was to validate a novel questionnaire, designated the Medical Somatic Dissociation Questionnaire-MSDQ, for evaluating somatic dissociation in the healthcare system setting. A total of 541 adults, 160 (30%) male and 381 (70%) female, of average age 35 years were recruited from the general population via the Internet. The Life Events Checklist for DSM-5 (LEC-5) was used for screening subjects for reporting a history of CSA. Our examination of the MSDQ indicated powerful internal consistency, reliability, and convergent validity of the instrument, with high correlations between the MSDQ and the SDQ-20 and also between the MSDQ and psychological symptomatology. In addition, there was known-groups validity when differences between adults who experienced CSA and those who did not were compared. Importantly, the MSDQ can be easily integrated into the evaluation process performed by medical professionals in the diagnosis of adult patients with apparently unexplained symptomatology.

Edutainment as a Strategy for Parental Discussion With Israeli Children: The Potential of a Children's Play in Preventing Sexual Abuse.

Edutainment is a communication strategy to influence attitudes and behaviors through the use of the media. Through the children's play "Yael Learns to Take Care of Her Body," designed for joint viewing by children aged 5-8 and their parents, sexual abuse is raised. This qualitative study findings indicate that parents from low socioeconomic subgroups from the secular sector reported that their awareness had been raised by viewing the play and that they received tools for holding a conversation. Conversely, parents from high socioeconomic subgroups in the secular sector and parents from the national-religious sector were more ambivalent regarding the play's effectiveness. In order to make the conversation meaningful, the play has to tailor different messages to different audiences. A single program is not enough but should be part of a series of customized intervention programs for different subpopulations and separate programs for parents and children accompanied by professionals.

Seriously clowning: Medical clowning interaction with children undergoing invasive examinations in hospitals.

This qualitative study examined the subjective experience of children undergoing an invasive examination in the hospital when accompanied by a medical clown. In-depth semi-structured interviews were conducted with nine such children and nine of their accompanying parents. The children were patients in two outpatient departments (Pediatric Gastroenterology and a Center for the Sexually Abused) in a hospital in Israel. Interviews were coded thematically using an Atlas.ti software program. Analysis of the interviews indicated that the intervention of the clown positively changed the children's perceptions of the hospital, of experiencing the examination, and of their life narrative. Medical clowns thus appear to be a central, meaningful, and therapeutic source for children undergoing invasive examinations in hospital, as well as for their parents. Therefore, it may be advisable to incorporate medical clowns as an integral part of medical teams performing invasive procedures and to include the clowns in all stages of the hospital visit.

The relationship between self-injurious behavior and self-disclosure in adolescents with eating disorders.

PURPOSE: The aim of the current study is to examine the association between self disclosure and self-injurious behaviors among adolescent patients diagnosed with an eating disorder. METHODS: Sixty three female patients who fulfilled the DSM-IV diagnostic criteria of eating disorders were included (i.e. anorexia, bulimia, binge eating disorder and eating disorders not otherwise specified). Participants' age ranged from 11.5 to 20 years (M = 15.42, SD = 1.82). Participants completed self- report questionnaires about eating disorders, self-disclosure, self-injurious behaviors (FASM) and depression (BDI-II) RESULTS: 82.5% of the sample endorsed severe self-injurious behaviors. A moderate negative relationship was found between general disclosure to parents and self-injurious behaviors indicating that patients who generally self-disclose to their parents (on different topics, apart from suicidal ideation) engage less frequently in self-injurious behaviors. In addition, the more patients self-disclose their suicidal ideation to others, the more they tend to self-injure. CONCLUSION: Self-disclosure to parents on any topic may buffer against self-injurious behaviors and therefore it is important to work with adolescents suffering from eating disorders on effective self disclosure. In addition, self-disclosure about suicidal ideation to others by adolescents suffering from eating disorders should always be taken seriously, since it may be related to self-injurious behaviors.

Dissociation: adjustment or distress? Dissociative phenomena, absorption and quality of life among Israeli women who practice channeling compared to women with similar traumatic history.

This study aimed to explore the relationship between traumatic history, dissociative phenomena, absorption and quality of life among a population of channelers, in comparison with a population of non-channelers with similar traumatic history. The study sample included 150 women. The measures included Traumatic Experiences Scale, Dissociative Experience Scale, Absorption Scale, Brief Symptom Inventory and Quality of Life (QOL) Assessment. Channelers presented significantly higher levels of dissociation, absorption and psychological health compared to the other group. Dissociation and absorption were trauma-related only among the comparison group. Hence, dissociation has different qualities among different people, and spiritual practice contributes to QOL.

The role of dissociation in self-injurious behavior among female adolescents who were sexually abused.

The study aimed to examine the role of dissociation (persistent versus peritraumatic) in self-injurious behavior among at-risk Israeli female adolescents. In addition, the relationship between childhood sexual abuse, depression, dissociation, and potency was investigated. A convenience sample of 93 female adolescents aged 12 years to 18 years were recruited from institutions for at-risk adolescent girls in Israel. Participants were administered an anonymous self-report questionnaire that included six measures: Demographics, Dissociative Experiences Scale, Center for Epidemiologic Studies Depression Scale, the Peritraumatic Dissociative Experiences Questionnaire, the Traumatic Events Questionnaire, and the Potency Scale. Results indicated that childhood sexual abuse increases the risk for self-injurious behavior more than threefold. Higher levels of persistent dissociation were found among girls who reported child sexual abuse compared to those who did not. Self-injurious behavior was predicted by persistent dissociation. Girls who engaged in self-injurious behavior had lower potency and higher depression levels, regardless of childhood sexual abuse history.

Comparison between Thai and Indian Adolescents' Self-Figure Drawing as Child Abuse Art-Based Assessment.

BACKGROUND/OBJECTIVES: The current study compared Self-Figure drawings from Thai and Indian adolescents to assess the cross-cultural applicability of a child abuse assessment tool. The research aims to understand the extent to which distinctions or similarities arise in Self-Figure drawings among adolescents from two culturally similar yet distinct backgrounds characterized by differences in religious affiliations, socioeconomic contexts, and political environments. METHODS: Employing a mixed-methods approach, the study utilized quantitative measures, including the Traumatic Events Checklist (TEQ-5) and Medical Somatic Dissociation Questionnaire (MSDQ), alongside a qualitative analysis of Self-Figure drawings. Ethical approval was obtained with waived informed consent, and a convenience sample of 386 adolescents aged 13-18 years (193 from Thailand [M = 14.8, SD = 1.73; 135 females (69.9%) and 58 males (30.1%)], and 193 from India [M = 15.2, SD = 1.64; 135 females (69.9%) and 58 males (30.1%)]), who reported experiencing child abuse, participated in the study by completing questionnaires and drawing themselves. RESULTS: The analysis revealed that Thai adolescents had higher MSDQ scores, while Indian adolescents exhibited more prominent pictorial indicators. Indian participants reported experiencing a broader range of event types, whereas Thai adolescents predominantly depicted verbal or emotional abuse. Variations in pictorial indicators were found significant, except for hair, cheek or chin, omitted legs or feet, and omitted eyes. CONCLUSIONS: These findings contribute to the understanding of how cultural factors influence adolescents' self-representations through drawing. The differences in pictorial indicators highlight the nuanced variations within similar cultures, emphasizing the cultural specificity of self-expression.

"Being My Own Pillar of Support": How Palestinian-Arab Women Citizens of Israel Cope With IPV.

Studies on the ways in which women implement coping strategies to recover from intimate partner violence have primarily focused on Western, non-collectivistic societies. To contribute to the scant literature on coping strategies among women in traditional-collectivistic societies, the current study applied the principles of Clinical Ethnographic Narrative Interview to analyze the experiences of 15 Palestinian-Arab citizens of Israel as these women confronted violence within marriage. This exploration is situated within the backdrop of entrenched collectivistic traditional norms and the broader context of the enduring Israeli-Arab conflict. An Interpretative Phenomenological Analysis revealed three themes that translated into a transformative three-phase coping model. The first theme covers navigating violent relationships through avoidance, emotional encapsulation, and cognitive reframing. The second theme describes strategies to mitigate violence and its consequences, including escapist and immediate departure, sustained fulfillment of duties, and maintaining hope amid adversity. The third theme characterizes strategies aimed at achieving self-care and self-empowerment. The findings highlight the importance of acknowledging women's definition of coping and recovery within their cultural constraints as they chart their coping trajectories.

Hyperbaric oxygen therapy vs. pharmacological intervention in adults with fibromyalgia related to childhood sexual abuse: prospective, randomized clinical trial.

Fibromyalgia syndrome (FMS) is a chronic pain syndrome characterized by disruptions in pain processing within the central nervous system. It exhibits a high prevalence among patients with a history of traumatic experiences, notably childhood sexual abuse (CSA). This study compared the efficacy of hyperbaric oxygen therapy (HBOT) to the current pharmacological standard of care for individuals suffering from CSA-related FMS. Forty-eight participants diagnosed with FMS and a history of CSA were randomly assigned to either the HBOT group (60 sessions of 100% oxygen at 2 ATA for 90 min, with air breaks every 5 min) or the medication (MED) group (FDA-approved medications, Pregabalin and Duloxetine). The primary endpoint was the Fibromyalgia impact questionnaire (FIQ) score, while secondary endpoints encompassed emotional status and daily functioning questionnaires, as well as pain thresholds and conditioned pain modulation tests. Brain activity was evaluated through single photon emission computed tomography (SPECT). Results revealed a significant group-by-time interaction for the FIQ score favoring HBOT over MED (p < 0.001), with a large effect size (Cohen's d = - 1.27). Similar findings were observed in emotional symptoms and functional measures. SPECT imaging demonstrated an increase in activity in pre-frontal and temporal brain areas, which correlated with symptoms improvement. In conclusion, HBOT exhibited superior benefits over medications in terms of physical, functional, and emotional improvements among FMS patients with a history of CSA. This associated with increased activity in pre-frontal and temporal brain areas, highlighting the neuroplasticity effect of HBOT.

Barriers to Adolescents' Adherence to Medical Advice after Metabolic Bariatric Surgery: A Statistical Analysis.

Background: Adolescent obesity has markedly increased worldwide, and metabolic bariatric surgery is an effective treatment option. A major predictor of the outcomes of this procedure is adherence to post-surgery lifestyle changes and medical recommendations. While adolescents generally have more difficulty adhering to medical advice than adults, their failure to do so could adversely affect their physical and psychological health, the cost-effectiveness of medical care, and the results of clinical trials. To our knowledge, this is the first attempt to identify the characteristics associated with the adherence of adolescents and their families to medical advice after bariatric surgery. Methods: We investigated potential variables influencing adherence to medical advice in adolescents diagnosed with severe obesity enrolled in a nutritional and behavior-oriented bariatric program-a 3-month pre-surgical outpatient intervention and a 6-month post-surgical follow-up. The program monitored weight, program attendance, diet compliance, lifestyle changes, and daily activities. All participants and parents completed a standard battery of questionnaires, provided demographic information, and participated in a semi-structured interview about their lifestyle. Results: The study group consisted of 47 adolescents: 34 girls and 13 boys, aged 13-18 years. Over time, three groups emerged with different degrees of adherence-high, low, and delayed low adherence. The analyses showed that adolescents' depression, autonomy, and independence from their family had strong, significant effects on adherence across the groups. Conclusions: Using adherence typologies, practitioners may be able to identify, predict, and tailor interventions to improve adolescent adherence to post-surgery recommendations. Parents have an important role in ensuring that adolescents undergoing metabolic bariatric surgery follow medical advice after the procedure.

Perception vs. circumstances of the child sexual abuse event in relation to depression and post-traumatic stress symptomatology.

The study examined the impact of the circumstances of childhood sexual abuse on post-traumatic stress symptoms and depression among female adult survivors of childhood sexual abuse. The sample consisted of 225 Israeli women divided into two groups according to the identity of the perpetrator (nonfamily perpetrator versus a family member perpetrator). A self-report questionnaire was used consisting of the following scales: demographic variables, the Traumatic Events Questionnaire, Childhood Sexual Experiences Scale, Post-Traumatic Stress Disorder Symptom Scale, and Depression Scale. The findings indicated that the identity of the offender significantly differed between groups only if intercourse had occurred. Women who experienced coerced intercourse scored significantly higher on depression and post-traumatic stress compared to those who experienced other forms of childhood sexual abuse.

"I'm in a Bloody Battle without Being Able to Stop It": The Dissociative Experiences of Child Sexual Abuse Survivors.

Dissociation in child sexual abuse (CSA) survivors remains under-recognized and diagnosed, partly because of the difficulties involved in identifying dissociative symptoms. Qualitative research can contribute to a better understanding of the lived experiences of dissociation. This study focused on the experiences of dissociation in the context of CSA. In all, 22 female incest survivors, all diagnosed with different dissociative disorders, provided narratives about their experiences of dissociation. The narratives were analyzed using interpretative phenomenological analysis. The narrative analysis revealed four central themes. The first theme deals with reliving the experience of the abuse. The second theme refers to the experience of disconnection from the body, the self, and the surroundings. The third theme covers the lack of coherence in the narrative, and the fourth theme describes the bridge between voluntary controlled and nonvoluntary uncontrolled use of dissociation. The data are discussed in light of several traumagenic constructs, including a lack of self-sense, being entrapped in a victim-aggressor relationship, and distorted time perception. It is suggested that the extent to which participants can control their dissociation and the coherency of their narratives reflects the severity of their dissociation. Clinicians can consider helping clients use dissociation as an adaptive defense mechanism.

Poverty, Somatisation Tendency and Potency in Low-Income Adolescent Groups of India and Israel: Explorations from the Field.

Poverty increases vulnerability towards somatisation and influences the sense of mastery and well-being. The present study on adolescents living in relative poverty in a high-income group country (Israel) and a low-middle-income group country (India) explored the nature of somatisation tendency (ST) and its relationship with potency and perception of poverty (PP). Potency, a buffer against stress-induced negative health effects, was hypothesized to be negatively related to ST and mediate the link between PP and ST. Purposive sampling was used to collect questionnaire-based data from community youth (12-16 years) of two metropolitan cities-Kolkata (India, N = 200) and Tel-Aviv (Israel, N = 208). The nature of ST, PP and potency was analysed using descriptive and inferential statistics and correlation-regression statistics and mediation analysis were used to understand the relationship among them. A clinically significant level of ST was reported by both Indian and Israeli youth experiencing 5-7 somatic symptoms on average. Potency was found to be a significant predictor of ST in both countries (p < 0.05) and emerged as a significant mediator (p < 0.001) in the PP and ST relationship among Indian adolescents. The present study highlights potency as a protective buffer in economically vulnerable community adolescents and re-establishes a high prevalence of ST among them, irrespective of their country's global economic position.

Adult Survivors of Child Sexual Abuse Draw and Describe Their Experiences of Dissociation.

The paper examined how dissociation is experienced and manifested in the drawings and narratives of female survivors of childhood sexual abuse (CSA) diagnosed with dissociative identity disorder. Fifteen Israeli women filled out a self-report questionnaire consisting of demographics, traumatic events, and dissociation severity. Then, they were asked to draw a dissociation experience and provide a narrative. The results indicated that experiencing CSA was highly correlated with indicators such as the level of fragmentation, the figurative style, as well as with the narrative. Two main themes emerged: a constant movement between internal and external worlds, and distorted perceptions of time and space.

The use of hyperbaric oxygen for veterans with PTSD: basic physiology and current available clinical data.

Post-traumatic stress disorder (PTSD) affects up to 30% of veterans returning from the combat zone. Unfortunately, a substantial proportion of them do not remit with the current available treatments and thus continue to experience long-term social, behavioral, and occupational dysfunction. Accumulating data implies that the long-standing unremitting symptoms are related to changes in brain activity and structure, mainly disruption in the frontolimbic circuit. Hence, repair of brain structure and restoration of function could be a potential aim of effective treatment. Hyperbaric oxygen therapy (HBOT) has been effective in treating disruptions of brain structure and functions such as stroke, traumatic brain injury, and fibromyalgia even years after the acute insult. These favorable HBOT brain effects may be related to recent protocols that emphasize frequent fluctuations in oxygen concentrations, which in turn contribute to gene expression alterations and metabolic changes that induce neuronal stem cell proliferation, mitochondrial multiplication, angiogenesis, and regulation of the inflammatory cascade. Recently, clinical findings have also demonstrated the beneficial effect of HBOT on veterans with treatment-resistant PTSD. Moderation of intrusive symptoms, avoidance, mood and cognitive symptoms, and hyperarousal were correlated with improved brain function and with diffusion tensor imaging-defined structural changes. This article reviews the current data on the regenerative biological effects of HBOT, and the ongoing research of its use for veterans with PTSD.

Social rejection by peers: a risk factor for psychological distress.

AIMS: The study examined the relationship between social rejection by peers, personal resources (potency and perceived social support) and psychological distress among Israeli adolescents. METHODS: Five hundred and eleven adolescents aged 12-17 (high-school students from two rural Israeli schools) completed self-report questionnaires consisting of the following measures: peer rejection (PR; ranged from having been ignored, cursed, assaulted, bullied, to having been physically attacked), posttraumatic symptoms (PTS), social avoidance, depression symptoms, potency and perceived social support. RESULTS: Thirty-five percent of the students reported experiencing some kind of social rejection (SR). One-way ANOVA and stepwise linear regression tests showed that those who experienced SR had higher levels of depression, PTS symptoms, and social avoidance compared to those who had no such history. In addition, personal resources, potency in particular was found to mediate the distress. CONCLUSIONS: Findings indicated that adolescents who reported experiencing peer rejection had higher levels of psychological distress. In addition, the lower the personal resources were, the higher the levels of psychological distress. Potency buffered the level of distress resulting from social rejection by peers. Compared to boys, rejected girls had lower potency levels.