Beyond PTSD: Predictors of Psychological Comorbidities in Sexually Abused Children

Several studies have found a number of internalizing (i.e., depressive and anxiety disorders) and externalizing (i.e., attention-deficit/hyperactivity disorder, conduct disorder, oppositional-defiant disorder) disorders to be prevalent among youth who have experienced child maltreatment. Several studies have also demonstrated that aspects of the maltreatment experiences and family environment may potentially predict the severity or magnitude of psychopathology among maltreated children. The purpose of this study was to determine potential abuse-related (i.e., frequency, severity, relation to perpetrator, age at onset, other forms of maltreatment) and family environment (i.e., cohesion, adaptability) predictors of psychological comorbidity in sexually abused children with posttraumatic stress disorder (PTSD). Participants included 75 (56 female) clinically-referred children and adolescents aged 5.89-17.12 years (mean=10.95, SD=3.114) and their parents. Measures included the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Epidemiological Version, the Family Adaptability and Cohesion Scales, third edition, and a questionnaire assessing demographic and abuse-related information. Based on diagnostic status, participants were assigned to the Simple PTSD group (no comorbid diagnoses), the Internalizing group (met criteria for a depressive or anxiety disorder but no externalizing disorders), or the Global group (met criteria for an externalizing disorder and may or may not have met criteria for an internalizing disorder). Multinomial logistic regression models were estimated and odds ratio cutoff values were utilized to determine clinically significant predictors of comorbidity group. Results indicated that males were more likely to be in one of the comorbid groups (either Internalizing or Global groups) than females, and those who were abused multiple times were more likely to be in one of the two comorbid groups than participants who experienced one incident of abuse. Similarly, participants who had lower levels of family cohesion and adaptability were more likely to be in one of the comorbid groups than those who had higher levels of family cohesion and adaptability. Younger participants and those who had experienced penetration were more likely to have an externalizing diagnosis (i.e., be in the Global group) than older participants and those who had experienced less physically invasive forms of sexual abuse. Results are discussed in light of previous research and theoretical models of heterogeneous presentations of childhood traumatic stress