Blame, shame, and community: justice responses to violence against women.

Justice processing for crimes against women is reviewed. The data reveal conviction rates for partner violence and rape by known acquaintances are miniscule; mandatory arrest, protection orders, and diversion programs inadequately deter rebattering; few losses are compensated; and the adversarial justice process is retraumatizing, exacerbating survivor's self-blame. To better address crimes against women, several nations and tribal communities use communitarian approaches, forms of restorative justice. The offense is framed to include the perpetrator, victim, and community. The process forgoes incarceration to have family, peers, and advocates design perpetrator rehabilitation, victim restoration, and social reintegration of both victim and perpetrator. Evaluations suggest communitarian justice may increase victim satisfaction, raise the social costs of offending, multiply social control and support resources, and open a new avenue to targeted prevention.

Adult health status of women with histories of childhood abuse and neglect.

PURPOSE: Several recent studies have found associations between childhood maltreatment and adverse adult health outcomes. However, methodologic problems with accurate case determination, appropriate sample selection, and predominant focus on sexual abuse have limited the generalizability of these findings. SUBJECTS AND METHODS: We administered a survey to 1,225 women who were randomly selected from the membership of a large, staff model health maintenance organization in Seattle, Washington. We compared women with and without histories of childhood maltreatment experiences with respect to differences in physical health status, functional disability, numbers and types of self-reported health risk behaviors, common physical symptoms, and physician-coded ICD-9 diagnoses. RESULTS: A history of childhood maltreatment was significantly associated with several adverse physical health outcomes. Maltreatment status was associated with perceived poorer overall health (ES = 0.31), greater physical (ES = 0.23) and emotional (ES = 0.37) functional disability, increased numbers of distressing physical symptoms (ES = 0.52), and a greater number of health risk behaviors (ES = 0.34). Women with multiple types of maltreatment showed the greatest health decrements for both self-reported symptoms (r = 0.31) and physician coded diagnoses (r = 0.12). CONCLUSIONS: Women with childhood maltreatment have a wide range of adverse physical health outcomes.

Costs of health care use by women HMO members with a history of childhood abuse and neglect.

BACKGROUND: Early childhood maltreatment has been associated with adverse adult health outcomes, but little is known about the magnitude of adult health care use and costs that accompany maltreatment. We examined differences in annual health care use and costs in women with and without histories of childhood sexual, emotional, or physical abuse or neglect. METHODS: A random sample of 1225 women members of a health maintenance organization completed a 22-page questionnaire inquiring into childhood maltreatment experiences as measured by the Childhood Trauma Questionnaire. Health care costs and use data were obtained from the automated cost-accounting system of the health maintenance organization, including total costs, outpatient and primary care costs, and emergency department visits. RESULTS: Women who reported any abuse or neglect had median annual health care costs that were $97 (95% confidence interval, $0.47-$188.26) greater than women who did not report maltreatment. Women who reported sexual abuse had median annual health care costs that were $245 (95% confidence interval, $132.32-$381.93) greater than costs among women who did not report abuse. Women with sexual abuse histories had significantly higher primary care and outpatient costs and more frequent emergency department visits than women without these histories. CONCLUSION: Although the absolute cost differences per year per woman were relatively modest, the large number of women in the population with these experiences suggests that the total costs to society are substantial.

Childhood abuse and sexual revictimization in a female Navy recruit sample.

To examine effects of childhood abuse on adult rape, 1,887 female Navy recruits were surveyed. Overall 35% of recruits had been raped and 57% had experienced childhood physical abuse (CPA) and/or childhood sexual abuse (CSA). Controlling for CPA, rape was significantly (4.8 times) more likely among women who had experienced CSA than among women who had not. In contrast, CPA (controlling for CSA) was unrelated to likelihood of adult rape. Alcohol problems and number of sex partners were examined as mediators. Although both variables predicted rape, their effects were independent of the effects of CSA. Finally, despite ethnic group differences in the prevalence of victimization, the predictors of rape did not differ significantly across ethnic groups.

Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study.

BACKGROUND: The relationship of health risk behavior and disease in adulthood to the breadth of exposure to childhood emotional, physical, or sexual abuse, and household dysfunction during childhood has not previously been described. METHODS: A questionnaire about adverse childhood experiences was mailed to 13,494 adults who had completed a standardized medical evaluation at a large HMO; 9,508 (70.5%) responded. Seven categories of adverse childhood experiences were studied: psychological, physical, or sexual abuse; violence against mother; or living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned. The number of categories of these adverse childhood experiences was then compared to measures of adult risk behavior, health status, and disease. Logistic regression was used to adjust for effects of demographic factors on the association between the cumulative number of categories of childhood exposures (range: 0-7) and risk factors for the leading causes of death in adult life. RESULTS: More than half of respondents reported at least one, and one-fourth reported > or = 2 categories of childhood exposures. We found a graded relationship between the number of categories of childhood exposure and each of the adult health risk behaviors and diseases that were studied (P < .001). Persons who had experienced four or more categories of childhood exposure, compared to those who had experienced none, had 4- to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt; a 2- to 4-fold increase in smoking, poor self-rated health, > or = 50 sexual intercourse partners, and sexually transmitted disease; and 1.4- to 1.6-fold increase in physical inactivity and severe obesity. The number of categories of adverse childhood exposures showed a graded relationship to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life. CONCLUSIONS: We found a strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults.

Prevalence of premilitary adult sexual victimization and aggression in a Navy recruit sample.

U.S. Navy recruits (n = 3,776) were surveyed for premilitary histories of adult sexual assault. They completed a survey designed to estimate rates for experiences as victims (women) and perpetrators (men) of attempted and completed rape since the age of 14. The results show that 45.5% of the women reported being the victim of attempted (9.4%) or completed rape (36.1%) before entering the Navy. Male recruits' self-reports indicated that 14.8% admitted perpetrating attempted (3.5%) or completed rape (11.3%) before entering the Navy. A high percentage of recruits in this study reported histories of sexual assault. Female victims of sexual assault are at high risk of incurring somatic and/or psychological problems that require treatment by health care professionals. Male perpetrators of sexual assault are at high risk of repeating their behavior. The results of this study suggest that it may be cost-effective to develop treatment education, and prevention programs for military recruits.

Intimate violence and black women's health.

After reviewing the literature on health effects of intimate violence, we report secondary analyses of responses of 439 black women who participated in the Commonwealth Fund's national survey on women's health. Lower income women were more likely to experience partner violence but not childhood abuse; and income group was related to self-esteem, depressive symptoms, and perceived health status. Childhood physical and sexual abuse and partner violence were intercorrelated; both abuse history and partner violence were related to greater risk for depressive symptoms, lower life satisfaction, and lower perceived health care quality. Partner violence was also related to lower self-esteem and perceived health status. Sexually abused women had more difficulties in interpersonal relationships, including lower perceived health care quality even with self-esteem and depressive symptoms controlled. Implications for prevention, training, and future research as well as methodological issues in research on violence against black women are discussed.

Traumatic memory characteristics: a cross-validated mediational model of response to rape among employed women.

In a cross-validated mediational model, the authors examined characteristics of memories formed in response to rape and other intense unpleasant and pleasant experiences. Data were responses to a mailed survey of women medical center and university employees. Measurement models of memory and symptom factors and a structural model with pathways among cognitive appraisal, emotional valence, memory characteristics, and health outcomes were developed in Sample 1 (N = 1,307) and confirmed in Sample 2 (N = 2,142). Rape had substantial direct effects on 2 memory factors (Clarity and Affect) and indirect effects through the construal of victimization. Rape was associated with memories described as more emotionally intense but less clear and coherent and less often thought of or talked about. Most effects on physical symptoms were nonsignificant. Implications of findings for neurohormonal and multiple representation models of emotional memory and to cognitive avoidance are discussed.

Athletic participation, fraternity membership, and date rape. The question remains -- self-selection or different causal processes?

PIP: This article discusses the contribution of athletic participation and fraternity membership to the prediction of date rape on campus. The article points on issues that make it difficult to weigh the available evidence, including methodological and conceptual problems. The issue that was addressed is demonstrated to be provocative and complex. Data suggest that the field is currently unable to answer definitively whether athletes and fraternity members are typically more sexually aggressive, whether some groups in some locations are, or whether these men may differ from others in the forms of sexual aggression they favor. This article suggested some guidance for future research that might enlighten an issue with practical relevance for college campuses, and could result in information that directly informs about rape education and prevention. Such studies are highly prioritized because of the significance of information on shaping prevention programs for date rape on campus.^ieng

The effects of systemic family violence on children's mental health.

This study examines the link between different forms of family aggression and children's symptoms of psychopathology. The goal of the study was to understand what forms children's problems might take in violent homes and whether close ties within the family (to the mother or a sibling) buffered children. Interviews with 365 mothers and 1 of their children between the ages of 6 and 12 about abuse in the home, support and closeness within the nuclear family, and mother's and children's mental health formed the basis of this study. Families were recruited from battered women's shelters and the community. We found that different forms of abuse in the home were highly interrelated and that children of battered women were at risk for child abuse. Domestic violence predicted children's general psychopathology, but we uncovered little evidence for the presence of specific sorts of disorders as a result of family dysfunction. Although mothers experiencing conjugal violence were more likely to have mental health problems, their mental health did not mediate the children's response to family conflict. Finally, there was less sibling and parental warmth in families marked by aggression, although when it was present, family social support failed to buffer children. Although the general pattern of results was consistent across respondents (mother and child), there was low agreement on symptoms of child psychopathology.

Are rape memories different? A comparison of rape, other unpleasant, and pleasant memories among employed women.

The study examined empirically-measured memory characteristics, compared pleasant and unpleasant intense memories as well as rape and other unpleasant memories, and determined whether rape memories exhibited significantly more "flashbulb" characteristics. Data consisted of responses to a mailed survey of women employees of a medical center (N = 1,037) and a university (N = 2,142). Pleasant and unpleasant memories were differentiated by feelings, consequences, and level of unexpectedness. The most powerful discriminator of rape from other unpleasant memories was the degree to which they were less clear and vivid, contained a less meaningful order, were less well-remembered, and were less thought and talked about. Few "flashbulb" characteristics discriminated among memory types. Implications for clinical work with rape survivors were discussed.

Medical and psychiatric symptoms in female gastroenterology clinic patients with histories of sexual victimization.

Several recent retrospective reports have associated prior sexual victimization and long-term medical sequelae such as increased medical clinic utilization and reports of physical symptoms. However, methodological constraints have limited the generalizability of these findings. Our study was designed using structured interviews with a sequential sample of 89 female gastroenterology clinic patients, who were classified by severity of sexual trauma and studied for differences in lifetime psychiatric diagnoses, physical abuse, and medically unexplained symptom patterns. Compared with the 46 women who had experienced less severe or no prior sexual trauma, the 43 patients with severe victimization had significantly higher life-time and current rates of several selected psychiatric disorders as well as significantly higher mean numbers of lifetime psychiatric disorders, medically unexplained physical and anxiety symptoms, greater harm avoidance and dissociation scores, and increased functional disability. A logistic regression showed that the main predictors of a history of severe sexual abuse were the number of medically unexplained symptoms, adult physical abuse, and lifetime dysthymic disorder. We concluded that women with prior severe sexual trauma episodes may express medically unexplained physical symptoms as part of the long-term adaptation to their victimization.

Grandmother dishonored: violence against women by male partners in American Indian communities.

Extensive and scrupulously conducted research during the past decade has established the issue of violence against women by male partners as both an international human rights issue and a public health problem of national concern. This research has rarely been extended into communities of color, and, in particular, to American Indian women. This article presents conceptual and methodological factors involved in conducting research with American Indian women, a comprehensive literature review of available data, assertions regarding abuse of women by male partners in American Indian communities, and directions for future research.

Effects of sexual harassment on women and organizations.

This chapter focuses on the consequences of sexual harassment of women, including the effects on the victim's work and health and the organization for which she works as well as the woman's attempts to cope with harassment when confronted with it. The responses of victims are influenced by the amount of support and understanding they receive from significant others and employers. The extent of emotional, physical, and psychological damage depends on the responsiveness of other people and the organization for which the woman works.

Male violence against women. Current research and future directions.

This Psychology in the Public Forum section, authored by the American Psychological Association's Committee on Women in Psychology's Task Force on Male Violence Against Women and by Senator Joseph Biden, examines the prevalence, impact, and public policy dimensions of physical assault, sexual assault, and sexual harassment of women. This introduction reviews common themes that emerge from the articles that follow. It concludes by emphasizing that the problem of violence against women cannot be fully understood, let alone solved, by focusing exclusively on individual psychology. Only by changing the social and cultural institutions that have given rise to the problem can a lasting solution be achieved.

Rape. Scope, impact, interventions, and public policy responses.

There are many ways for women to be victimized by strangers and by people they know, but rape is the crime women fear most. The research on the frequency, psychological aftereffects, somatic consequences, and immediate as well as delayed interventions for rape is reviewed; a brief consensus of the literature within each of these areas is developed; and the implications of the research for public policy are considered. Among the suggested policy responses are improvements in the databases on rape frequency, increased attention to measurement, a higher priority for teaching about rape in the education of health care providers, increased funding and technical assistance to rape crisis centers, and more diversity of interventions and research on their effects.

The prevalence rate of sexual trauma in a primary care clinic.

BACKGROUND: Despite the high prevalence rate of sexual victimization in the general population, little is known about the characteristics of abuse victims in primary care. We studied the prevalence rate of childhood and adult sexual trauma in a primary care clinic, associated psychological distress, and patients' attitudes about physician inquiry into past sexual victimization. METHODS: Self-report questionnaires were given to 162 women in a primary care clinic inquiring about past episodes of childhood sexual abuse, adult sexual assault, and patients' desire that their physicians be aware of their sexually traumatic experiences. The women also completed the Trauma Symptom Checklist-40 (TSC-40), a measure of psychological distress. RESULTS: The rates of childhood sexual abuse (37 percent) and adult sexual assault (29 percent) in this primary care clinic were comparable with, but somewhat above, the rates reported for the general population. Although most of the women (61 percent) believed it was appropriate for their physician to ask about previous victimization, only 4 percent had been asked. Women who had experienced sexual trauma were more distressed when compared with nonvictimized women, as measured by the TSC-40. Childhood sexual abuse was associated with greater distress than was adult sexual assault, and combinations of childhood and adult trauma were associated with the highest distress levels. CONCLUSIONS: A history of sexual abuse or assault can be a relatively common finding in primary care clinics. Patients might benefit from routine physician inquiry into histories of childhood and adult sexual victimization, and physicians should be mindful of the long-term medical and psychological sequelae that frequently result from this trauma.

Somatic consequences of violence against women.

The rapidly growing literature on the somatic, nonpsychiatric effects of violence on women's health is reviewed, including rape, battery, and the adult consequences of child sexual abuse. The sequelae of these victimizations are summarized with consideration of acute effects (genital and nongenital injuries, sexually transmitted disease, and pregnancy), late consequences (chronic pelvic pain and other forms of chronic pain, gastrointestinal symptoms, premenstrual symptoms, and negative health behaviors), and long-term increases in the use of medical services. A recurrent theme across the literature is that the medical treatment of all types of victimized women can be improved by providing attention to the underlying cause of their symptoms. Achievement of this goal requires that physicians identify victimization history and provide access to appropriate support services. Because all forms of violence against women are prevalent among primary care populations, and victimization is clearly linked to health, health care providers cannot afford to miss this relevant history. The article concludes with suggestions for fostering and responding to disclosures of victimization.

Characteristics of aggressors against women: testing a model using a national sample of college students.

Structural equation modeling was used to study the characteristics of college men (N = 2,652) who aggressed against women either sexually, nonsexually, or both. According to the model, hostile childhood experiences affect involvement in delinquency, leading to aggression through two paths: (a) hostile attitudes and personality, which result in coerciveness both in sexual and nonsexual interactions, and (b) sexual promiscuity, which, especially in interaction with hostility, produces sexual aggression. In addition, sexual and nonsexual coercion were hypothesized to share a common underlying factor. Although its development was guided by integrating previous theory and research, the initial model was refined in half of the sample and later replicated in the second half. Overall, it fitted the data very well in both halves and in a separate replication with a sample for whom data were available about sexual but not about nonsexual aggression.