Symptom Presentation of Sexually Abused Youth: Associations with Abuse Attributions

Child sexual abuse (CSA) outcomes are heterogeneous. Some victims display a combination of externalizing behaviors (e.g., aggression) and internalizing symptoms (e.g., depression), while others present with minimal symptoms (Domhardt, Munzer, Fegert, & Goldbeck, 2015). Among the factors that have been explored as relating to CSA outcomes are child characteristics (e.g., age; Dube et al., 2005), abuse-specific variables (e.g., abuse severity; Stroebel et al., 2012), and family variables (e.g., familial social support; Ryan, Kilmer, Cause, Watanabe, & Hoyt, 2000). Although much of the literature supports these factors as contributing to outcomes following CSA, conclusions have been inconsistent. Research has begun to investigate cognitive factors, such as abuse attributions, to attempt to explain differences in outcome. Attributions specific to sexual abuse include attributions of self-blame and guilt, personal vulnerability, dangerous world, and empowerment. Understanding how abuse attributions relate to symptom presentation can provide information about how the attributions can be targeted in treatment. The purpose of the current study was to (a) determine subgroups of CSA survivors based on patterns of symptom presentation, (b) examine differences between each group on endorsements of abuse attributions (e.g., self-blame/guilt), and (c) examine how changes in internalizing and externalizing symptoms associate with changes in sexual abuse attributions over the course of treatment for the groups. Participants included 153 sexually abused youth and their non-offending caregivers presenting for treatment. The study utilized self-report and caregiver-report measures administered at differing time points throughout treatment. Findings showed four distinct cluster groups, providing evidence for diversity in CSA outcomes (i.e., Subclinical, Marginal Self-Reported Distress, Parent-Reported Child Distress, and Highly Distressed). Results indicated that there were significant differences between cluster groups regarding overall attributions, self-blame and guilt, personal vulnerability, and dangerous world. Groups did not significantly differ on empowerment. Findings demonstrated a positive relationship between changes in emotional distress and changes in attributions at post-treatment, indicating that as CSA youth reported greater improvements in emotional distress, they also reported greater reductions in negative abuse attributions