Described as epidemic in United States, childhood maltreatment encompasses a variety of forms of harm, such as childhood sexual abuse (CSA), childhood emotional and physical abuse, and childhood emotional and physical neglect. Although prevalence rates are unreliable due primarily to definitional inconsistencies among studies, in a meta-analysis Bolen and Scannapieco (1999) discovered CSA rates of 30 to 40% for girls and 13% for boys.
However, because of the coercive secrecy and threatening nature surrounding sexual abuse, it must be noted that these figures are likely conservative. In addition, boys may underreport CSA for two reasons: first, socialization may preclude a male child from perceiving CSA as a negative and abusive experience, and second, there is considerable shame attached to CSA (Herman, 1992), which may challenge social constructs of masculinity; boys and men may perceive themselves as weak if they are unable to cope with the psychological consequences of maltreatment.
In a report published by Prevent Child Abuse America (Fromm, 2001), conservative estimates placed the direct costs incurred from child abuse and neglect at over $24 billion annually in the United States. Hospitalization accounted for over $6 billion of the estimate, chronic health problems for about $3 billion, and the child welfare system accounted for $14 billion. A large body of evidence has strongly associated the occurrence of SIV with earlier childhood maltreatment (Briere, 1992; Chu, 1998; MacMillan et al.
, 2001; Romans et al. , 1995; Santa Mina & Gallop, 1998; Shapiro, 1987; Weaver, Chard, Mechanic, & Etzel, 2004; van der Kolk et al. , 1991; Walsh & Rosen, 1988; Wiederman, Sansone, & Sansone, 1999). A rare exception: Two empirical studies by the same research group concluded that no such connection existed between CSA and SIV behavior among female inpatients diagnosed with borderline personality disorder (BPD) (Zweig-Frank, Paris, & Guzder, 1994a) and male inpatients diagnosed with BPD (Zweig-Frank, Paris, & Guzder, 1994b).
Although the researchers found evidence that a relationship might exist between CSA and SIV, they concluded that there was no unique association between CSA and SIV. However, these studies had some weaknesses. First, because borderline personality is correlated with childhood sexual abuse (Briere & Gil, 1998; Chu, 1992; Linehan, 1987; Herman, Perry, & van der Kolk, 1989), the inclusion of BPD as a predictor of SIV removes the variance that may be attributable to the association between CSA and SIV.
Second, the power of CSA as a predictor of SIV in this study is reduced because SIV is one of the criteria for BPD. It is important to note that the bulk of theoretical literature and empirical research has established a strong association, relationship, and connection between CSA and SIV behavior. Research has consistently shown that traumatic childhood experiences leave a negative set of beliefs, perceptions, emotions, and sensations that often continue to operate and affect an individual’s present experiences.
A primary effect of trauma is the experience of disconnection in the individual (Conners, 1996; Herman, 1992), which is evidenced in a number of dissociative skills such as disconnection from a sense of self, from one’s body and ordinary life, from others, and with gaps in memory. The results of these disconnections are often described as isolation, emotional numbing, emptiness, and sense of difference from others (Briere, 1992; Chu, 1992; Courtois, 1996; Herman).
Another aspect of trauma is the physiological and emotional over-stimulation that occurs during the traumatic event. Trauma overwhelms the capacity of the body and mind to make sense of and process the experience. During a traumatic event, survivors often experience an overload of physiological and emotional arousal, which can be stored and subsequently re-experienced in times of stress or in response to specific triggering events (Bremner, 2005; Chu, 1992; Herman, 1992; van der Kolk, 1994).
These over-stimulating episodes may result in an inability for individuals to modulate their affect. They feel flooded by anxiety and panic; struggle with an inability to identify specific sensations; and experience psychological and physical tension followed by an impetuous need to release the tension and/or express strong feelings (Bremner, 2005; Briere, 1992; Herman, 1992).