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Child Abuse & Neglect 29 (2005) 13731394

Child and adolescent abuse and subsequent


victimization: A prospective study
Cindy L. Rich a , Christine A. Gidycz b, , Jennifer B. Warkentin b ,
Catherine Loh c , Paul Weiland d
a
Christian Counseling Center, Grand Rapids, MI, USA
b
Department of Psychology, Ohio University, 200 Porter Hall, Athens, OH 45701, USA
c
VA San Diego Health Care System, San Diego, CA, USA
d
Department of Psychology, University of Toledo, Toledo, OH, USA
Received 6 October 2003; received in revised form 21 June 2005; accepted 15 July 2005

Abstract

Objective: We investigated the possible reciprocal relationship between victimization experiences and psycho-
logical functioning by assessing abuse experiences in childhood, adolescence, and during a 2-month follow-up
period.
Method: At the beginning of the study (Time 1), abuse histories, trauma and depressive symptoms, and interpersonal
functioning were assessed in 551 college women. Subsequent victimization experiences and psychological outcomes
were assessed at the follow-up (Time 2).
Results: Path analyses indicated that verbal abuse by the mother and father were predictive of various psychological
outcomes as measured at Time 1 and emerged as the only significant predictors of adolescent dating violence.
Adolescent dating violence subsequently predicted the experience of dating violence during the 2-month follow-up
period. Paternal physical abuse predicted adolescent sexual victimization which subsequently predicted all symptom
measures at Time 1. Conversely, the experience of adolescent physical dating violence was not predictive of any of
the symptom measures at Time 1. For those women who experienced dating violence during the follow-up, however,
the severity of their abusive experiences was related to both depression and interpersonal problems assessed at Time
2. In comparison, for those women who experienced sexual victimization during the follow-up period, the severity
of their abusive experiences was related to trauma symptoms. Interpersonal problems emerged as both an aftereffect
of adolescent sexual victimization experience and a predictor of a subsequent sexual victimization experience during
the follow-up.


Corresponding author.

0145-2134/$ see front matter 2005 Elsevier Ltd. All rights reserved.
doi:10.1016/j.chiabu.2005.07.003
1374 C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 13731394

Conclusions: Given that emotional abuse emerged as a predictor of adolescent dating violence and psychological
outcomes, researchers and clinicians need to continue to explore this problem. Further, it is important to assess
how interpersonal problems contribute to the risk of subsequent sexual victimization and to try to break the cycle
between adolescent abuse experiences and subsequent physical and sexual assaults.
2005 Elsevier Ltd. All rights reserved.

Keywords: Child abuse; Sexual assault; Revictimization

Introduction

The true pervasiveness of violence and abuse is difficult to determine due to the low reporting rate
of such behaviors and the dearth of representative samples. Prevalence studies conducted on community
and university samples indicate widespread, and relatively stable, rates of sexual and physical aggression
against women and children; however, rates of emotional abuse are typically not reported in these studies.
In recent telephone studies with nationally representative samples of community women, between 12.7%
and 14.8% of women surveyed reported having experienced a completed rape at some point during their
lives (Kilpatrick, Edmond, & Seymour, 1992; Tjaden & Thoennes, 2000). Estimates obtained from studies
with college students have been remarkably consistent with those derived from community women, with
a recent nationally representative sample of college students finding that 20% of the women surveyed had
experienced a rape at some point in their life (Brener, McMahon, Warren, & Douglas, 1999). Similarly,
the widespread occurrence of physical abuse has been substantiated by studies conducted with nationally
representative samples of community women, one of which found that 52% of women reported that
they had been physically assaulted at some point in their life (Tjaden & Thoennes, 2000). While the
vast majority of research in the area of physical abuse in adult relationships has focused on marital
relationships, there is an increasing body of research documenting the occurrence of physical violence in
unmarried intimates, particularly among college students where it is estimated that one in five students
have experienced partner violence (Makepeace, 1981; Pedersen & Thomas, 1992).
Evidence also suggests that both sexual and physical victimizations are not randomly distributed in
the population; that is, having one victimization experience places an individual at an increased risk
of future victimization (Boney-McCoy & Finkelhor, 1995; Gidycz, Coble, Latham, & Layman, 1993;
Gidycz, Hanson, & Layman, 1995; Himelein, 1995). Studies have documented that an early sexual abuse
experience increases ones risk of adult sexual victimization (Gidycz et al., 1993) and a relationship
between childhood physical abuse and subsequent dating and spousal violence (Riggs & OLeary, 1996;
Smith & Williams, 1992). Specifically, Gidycz et al. (1995) found that women with a history of sexual
victimization were between 1.5 and 2 times more likely to be sexually victimized during a 3-month
follow-up period than women without a history of victimization. Moreover, women who experienced a
victimization during the first 3 months of the study were three times more likely to be assaulted during the
subsequent 3-month follow-up period than women who did not experience such a victimization (Gidycz
et al., 1995). Finally, in a recent meta-analysis examining sexual revictimization, Roodman and Clum
(2001) found a moderate effect size of .59, indicating that a positive relationship exists between the
presence of sexual abuse in childhood, and subsequent adult sexual victimization.
Studies investigating the link among physically abusive experiences have also found that a past history
of physical abuse is correlated with subsequent violence in adult relationships. Evidence regarding the
C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 13731394 1375

relationship between physical violence in childhood and subsequent violence in dating relationships indi-
cates that individuals who experienced physical abuse in childhood were more likely to both experience
and perpetrate physical dating violence in adolescence and adulthood (Bernard & Bernard, 1983; Riggs &
OLeary, 1996). Tjaden and Thoennes (2000) found that men and women who were physically assaulted
by an adult caretaker in childhood were twice as likely as those without a history of childhood physical
assault to be physically assaulted as an adult. Similar trends have been found in physical dating violence
among college couples, such that prior experience with intimate violence among college students is a
significant predictor of involvement with intimate violence in the current or most recent relationship (Deal
& Wampler, 1986; Lueken & Gidycz, 2002).
Lacking among the vast majority of previous studies, however, is an investigation of the relationship
between the different types of child and adolescent abuse, and various forms of revictimization in adult-
hood. With few exceptions, investigators have typically focused on one type of abusive experience in their
studies and failed to explore various other forms of abuse. This is problematic, as various forms of abuse
tend to co-occur. For example, research has demonstrated that physically and sexually abused children
almost always experience emotional abuse (Claussen & Crittenden, 1991; Gross & Keller, 1992), and
approximately 90% of all physical abuse victims in one study also experienced some form of psycho-
logical abuse (Claussen & Crittenden, 1991). When specific types of abuse are studied in isolation, it is
impossible to ascertain whether there are unique effects associated with each type of abuse or whether
experiencing one type of abuse also places one at risk for other types of abuse throughout ones life.
Researchers have recently begun to investigate the effects of multiple forms of abuse. In a recent
study examining the relationship between violent childhood experiences and subsequent adult intimate
partner violence, Whitfield, Anda, Dube, and Felitti (2003) found that the risk of being a victim of partner
violence for women was increased if the woman had a history of contact sexual abuse in childhood.
Results indicated that women with a childhood physical or sexual abuse history were 3.5 times more
likely to experience intimate partner violence in adulthood. Research has also indicated that women with
physical abuse histories are more likely to participate in risky sexual behavior than women without a
history of child physical abuse (Morrill, Kasten, Urato, & Larson, 2001). While these authors did not
investigate the rates of sexual victimization in adulthood among these women, the risky sexual behaviors
that were reported may put these women at risk of a subsequent sexual assault experience. Likewise, it
is also possible that some of the psychological effects of early abusive experiences may put one at risk
of future abusive experiences of various types. While the strength of these studies is that they focused on
various forms of abuse, the retrospective nature of the design limits their generalizability.
The high rates of abuse reported both in childhood and adolescence as well as the substantial rates of
sexual and physical revictimization are particularly alarming in light of the interpersonal consequences
associated with physical and sexual victimization. There is ample evidence to suggest that these various
forms of abuse are detrimental to the subsequent psychological, physical, and sexual health of both children
and adult survivors (for reviews see Arata, 2002; Beitchman, Zucker, Hood, DaCosta, & Akman, 1991;
Beitchman et al., 1992; Jumper, 1995; Kendall-Tackett, Williams, & Finkelhor, 1993; Weaver & Clum,
1995). For instance, increased levels of depression and trauma symptoms have been found in samples of
children who have experienced physical (Allen & Tarnowski, 1989; Kazdin, Moser, Colbus, & Bell, 1985;
Kiser, Heston, Millsap, & Pruitt, 1991) and sexual abuse (Browne & Finkelhor, 1986; Kendall-Tackett
et al., 1993; Putnam, 2003) compared to nonabused children. Increased levels of depression and trauma
symptoms have been also been found to occur among adolescent and adult survivors of child physical
(Chu & Dill, 1990; Kiser et al., 1991) and sexual (Browne & Finkelhor, 1986; Chu & Dill, 1990; Conte &
1376 C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 13731394

Schuerman, 1987; Putnam, 2003) abuse. Further, difficulties with interpersonal functioning have also been
identified among abuse victims both as children and as adults (for review see Davis & Petretic-Jackson,
2000).
Currently, the literature is fairly inconsistent regarding the pattern of aftereffects associated with varying
types of abuse. While there are some data to suggest that the aftereffects of child physical and sexual
abuse are quite similar (Braver, Bumberry, Green, & Rawson, 1992), other data suggest that symptoms
may be manifested differentially as a function of the type of abuse (Meyerson, Long, Miranda, & Marx,
2002). In a recent study with female adolescents, for example, Meyerson et al. (2002) found that sexual
abuse was more predictive of negative psychological outcomes than was physical abuse. Missing from
Meyerson et al.s (2002) study, however, was an investigation of psychological abuse. Braver et al. (1992)
studied physical, sexual, and emotional abuse in a small sample of university counseling center clients
and concluded that all three groups of abused clients evidenced greater psychological symptomatology
than the comparison group of nonabused women and that none of their abused groups differed from each
other.
Whereas there is ample evidence linking sexual and physical abuse to trauma, research investigating
the temporal relationship between victimization and psychological functioning has been scarce due to
the retrospective nature of the majority of research in this area. Rather, researchers have typically con-
ceptualized interpersonal difficulties, depression, and trauma symptoms as aftereffects of victimization
experiences. Though such independent conceptualizations are enlightening, an exploration of the tempo-
ral relationship between functioning and abuse would be a more informative avenue of research, as it is
likely that each variable serves as a risk factor for the other (Acierno, Resnick, Kilpatrick, Saunders,
& Best, 1999). Granted, theories accounting for revictimization are still in their infancy (and have
primarily focused on sexual revictimization), it is possible that the trauma and psychological symp-
toms that are associated with early abuse might make a woman more vulnerable to subsequent abuse
experiences.
Some researchers have argued, for example, that perpetrators are particularly skilled at identifying
victims psychological and social vulnerabilities that might result from a history of abuse, such as feelings
of low self-esteem and powerlessness (Grauerholz, 2000), or the adverse impact of emotional numbing
on a victims ability to respond to dangerous situations (Cloitre, 1998; Cloitre, Sacarvalone, & Difede,
1997). Prospective analyses would allow the researcher to assess the possible reciprocal relationship
between trauma and violence. Additionally, the literature is limited by the fact that the vast majority of
researchers have focused on one specific type of abuse and not controlled for the existence of other forms
of abuse. As suggested by Meyerson et al. (2002), a thorough understanding of the relationship between
abuse and psychopathology may not be adequately achieved until various types of abuse are considered
together.
The present study investigated childhood, adolescent, and college victimization experiences, which
included verbally, physically, and sexually abusive experiences. Additionally, depression, trauma, and
interpersonal functioning were investigated both retrospectively (until the time of the study) and prospec-
tively (during the 2-month follow-up) to determine the possible interaction of victimization and psy-
chological functioning. Unlike the majority of prior studies, this research prospectively investigated the
relationship between various forms of abuse and psychological symptomatology, and the prospective
nature of the design allowed for an assessment of the reciprocal relationship between symptoms and
abuse. Three separate models were tested (focusing on depression, trauma, and interpersonal function-
ing), where for each symptom measure, the best fitting model was identified.
C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 13731394 1377

Method

Participants

Participants were a convenience sample of 551 college women from a mid-sized Midwestern University.
Participants were enrolled in psychology courses and volunteered for the study through sign-up sheets,
receiving experimental credit in their course for their participation. Ninety-five percent (N = 524) of the
women returned for the 2-month follow-up. The majority of participants (88.4%) were between 18 and
19 years of age, and participants reported their ethnicity as Caucasian (91.3%), African American (4.4%),
Asian (1.8%), Hispanic (1.1%), or Native American (.5%). Three-fourths of the participants were in their
first year of college (75.7%), and although about half reported dating casually (52.5%), other participants
reported being in a long-term relationship (39.2%), not dating (5.3%), or being engaged or married
(2.9%). Given that participants were recruited from the psychology subject pool, first-year students were
over-represented in the sample; however, the ethnic breakdown of the participants was representative of
the university population.

Measures

Assessment of verbal and physical abuse in childhood

The Conict Tactics Scale (Straus, 1979) was developed to measure intrafamilial conflict resolution.
Three versions of the conflict scales were used in this study to assess the participants perception of
conflict resolution both in their family of origin and in their dating relationships. The Mother-Child
scale and the Father-Child scales were used to assess intrafamilial conflict resolution during childhood,
while the Dating Conflict Scale was used to assess dating conflict resolution for the participant and the
participants partner during both adolescence and the 2-month follow-up period. The Conflict Tactics
Scale consists of 18 statements for each version, progressing in order of severity for both aggressiveness
and coerciveness. Participants respond to each item by indicating the frequency of its occurrence on a
7-point scale ranging from never to always. For this study, two of the conflict resolution subscales
were utilized: (1) the Verbal Aggression scale assesses the use of threats to hurt a person and the use
of verbal and nonverbal behaviors which are symbolically hurtful to a person and (2) the Violence scale
measures the use of physical force to resolve conflict, with higher scores indicative of more frequent abuse
(Straus, 1979). These two scales measured verbal and physical abuse in relationships, respectively. High
reliability was found for the Verbal Aggression (coefficient alpha = .77.88) and Violence (coefficient
alpha = .62.88) scales. Based on a review of studies using the Conflict Tactics Scale, Straus (1979)
concluded that adequate construct validity was evidenced.
Based on their responses to the Verbal Aggressiveness and Violence subscales, participants were
divided into three categories to investigate frequencies of verbal and physical child abuse experiences as
well as later dating violence experiences. These categories were also utilized in the path and 2 analyses
for assessing the relationships between abuse experiences. The parent/child version was used to assess
maternal and paternal abuse in childhood, while the dating conflict version was used to assess physical
dating violence during adolescence and the follow-up period. For physical abuse the categories included:
(a) no abuse (no physically abusive experiences), (b) moderate physical abuse (less severe forms of
1378 C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 13731394

physical abuse, ranging from throwing something to pushing), and (c) severe physical abuse (more severe
forms of physical abuse, ranging from slapping to the use of a gun). For verbal abuse the categories
included: (a) no abuse (no verbally abusive experiences), (b) moderate verbal abuse (less severe forms
of verbal abuse, such as saying something spiteful), and (c) severe verbal abuse (more severe forms of
verbal abuse, such as threatening to hit or throw something at someone).

Assessment of child sexual victimization

The Child Sexual Victimization Questionnaire. To assess child sexual victimization (i.e., victimization
before age 14), participants responded to the Child Sexual Victimization Questionnaire, an 18-item self-
report measure adapted from Finkelhor (1979). Respondents were asked to answer yes or no to
whether they had sexual experiences during childhood, with items increasing in severity from Another
person showing his/her sex organs to you to Another person had intercourse with you. Participants
were also asked their age and the age of the other person at the first and last time they had the sexual
experience. An individual was considered to be sexually victimized in childhood if she reported a sexual
experience before the age of 14, occurring with a person 5 years or older than that person, or with the use
of force or threats of force. Participants were assigned to one of three categories of increasing severity
of child sexual victimization: (a) no sexual victimization, (b) some sexual victimization (ranging from
unwanted sexual contact to attempted rape), and (c) rape (vaginal, oral, or anal penetration).
The Sexual Experiences Survey (SES; Koss & Oros, 1982) was used to assess various levels of sexual
victimization. The 10-item self-report instrument includes a yes-no format, and participants were asked
to indicate whether they had a variety of sexual victimization or assault experiences by asking about
behavioral experiences, without using the word rape. The SES follows the Ohio Revised Code definition
of rape (Ohio Revised Code 28907.012907.02, 1998), and is widely used in sexual assault research.
For this study, adolescent sexual victimization was defined as any unwanted sexual contact (fondling
to intercourse) from age 14 years to the assessment at Time 1. Victimization during the follow-up period
was defined as any unwanted sexual contact (fondling to intercourse) that occurred during the 2-month
follow-up period. Three categories of increasing severity were created: (a) no victimization, (b) moderate
sexual victimization (ranging from unwanted sexual contact to attempted rape), and (c) rape (vaginal,
oral, or anal penetration through the use of force or threats of force) and corresponded to the highest
category in which a participant had an experience. Research on the instrument indicates that it has good
internal consistency (Cronbachs alpha = .74) and good 1-week test-retest reliability (r = .93; Koss &
Gidycz, 1985).

Assessment of psychological functioning

The Impact of Event Scale (IES; Horowitz, Wilner, & Alvarez, 1979). Trauma and subjective stress,
occurring from a specific event, was measured by the Impact of Event Scale. The measure consists of 15-
items, and includes two subscales reflecting intrusion and avoidance, which are major symptom clusters
of post-traumatic stress disorder (PTSD). Respondents were asked to think of the most stressful event
they have ever experienced, and using a 5-point scale, ranging from not at all to often, to rate how
often the statements were true for them over the last 7 days. The total possible score ranges from 0 to 75,
with higher numbers indicating higher levels of subjective stress. For the purpose of this study, a total
score was used. Split-half reliability was found to be good (r = .86) for a group of psychiatric outpatients
C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 13731394 1379

and internal consistencies for each subscale are high (Cronbachs alpha = .78 and .82 for intrusion and
avoidance, respectively; Horowitz et al., 1979).
The Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996). The BDI-II is a 21-item
measure designed to assess the symptoms and attitudes associated with depression, according to criteria
found in the Diagnostic and Statistical Manual of Mental Disorders-IV. The scale score is obtained by
summing the weighted ratings of each individual item. The total score for this measure ranges from 0 to
63, with higher scores reflecting more severe depression. Alpha estimates have been high with various
samples, and have ranged from between .84 for college students (Tanaka-Matsumi & Kameoka, 1986) to
.87 for high school students (Teri, 1982).
Inventory of Interpersonal Problems (IIP; Horowitz, Rosenbery, Baer, Ureno, & Villasenor, 1988).
The IIP was used to measure the types of interpersonal problems that people experience and the level of
distress associated with those interpersonal problems. The 64-item measure has eight subscales that assess
the following types of interpersonal problems: dominance, intrusiveness, nurturance, exploitaveness,
assertiveness, avoidance, coldness, and vindictiveness. Participants are asked to rate each item on a 5-
point scale ranging from not at all to extremely, to reflect the extent of distress associated with each
interpersonal difficulty. The total score on this scale was chosen as a measure of interpersonal distress for
this study. Normative data are available for both psychiatric and non-psychiatric college student samples
(Hansen & Lambert, 1996), and the internal consistency of the subscales is high, with scores ranging
from .82 to .93 (Horowitz et al., 1988).

Procedure

Participants signed up for the study on an experimental sign-up board in the Department of Psychology.
Participants were asked to complete questionnaires at two sessions. After obtaining informed consent,
the surveys were administered to small groups during each 2-hour session. Time 1 was conducted at the
beginning of the 10-week academic quarter while Time 2 was conducted approximately 2 months later,
towards the end of the academic quarter. The 2-month timeframe was utilized so that participants could
be reassessed while they were still enrolled in psychology courses, in order to minimize the attrition
rate. Time 1 measures were used to determine childhood and adolescent sexual victimization, child-
hood verbal and physical abuse, familial and physical dating conflict, and current symptomatology (see
Table 1). Approximately 2 months later, participants completed surveys to determine their experiences
and functioning during the interim period. Informed consent was again obtained, and participants com-
pleted surveys assessing physical and sexual victimization during the interim, as well as psychological
functioning. At the completion of the second assessment, all participants were provided debriefing forms,
which included resources within the community, should they desire assistance with relationship issues. All
procedures were reviewed and approved by the Institutional Review Board at the Midwestern University
where the data were collected.

Data analysis

Recursive path analyses, using AMOS 4.0 (Arbuckle, 1999), were conducted to investigate the causal
relationships among victimization experiences and adjustment at Time 1 and during the follow-up period.
Three separate analyses were conducted on victimization experiences and the BDI-II, the Impact of Event
1380 C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 13731394

Table 1
Variables assessed and measures included at Time 1 and Time 2
Variable Measure
Time 1
Childhood sexual victimization Child Sexual Victimization Questionnaire
Childhood verbal abuse Conflict Tactics Scale
Childhood physical abuse Conflict Tactics Scale
Adolescent sexual victimization (age 14 to present) Sexual Experiences Survey
Adolescent dating violence (age 14 to present) Conflict Tactics Scale
Depression Beck Depression Inventory-II
Trauma symptoms Impact of Event Scale
Interpersonal functioning Inventory of Interpersonal Problems
Time 2
Sexual victimization (during 2-month follow-up) Sexual Experiences Survey
Dating violence (during 2-month follow-up) Conflict Tactics Scale
Depression Beck Depression Inventory-II
Trauma symptoms Impact of Event Scale
Interpersonal functioning Inventory of Interpersonal Problems

Scale, and the Inventory of Interpersonal Problems, respectively. These analyses estimate the strength
of the relationship between variables, and can then be used to estimate the underlying causal processes.
Successive regression analyses were performed to obtain the main path coefficients, and each endogenous
variable was regressed upon those preceding variables that directly affected it.
For each of the three analyses, various fit indices were employed to determine the model fit: 2 tests,
Comparative Fit Index (CFI), TuckerLewis Index (TLI), and Root Mean Square Error of Approxima-
tion (RMSEA). These indices have been widely used in path analytic procedures to clarify the causal
relationships within the model. The 2 test, however, can be problematic at larger sample sizes in that it
is highly reactive to sample size. Therefore, we will also report the indices of model fit mentioned above.
For the CFI and TLI, values close to .95 and higher are considered desirable, and an RMSEA value of
.08 or lower indicates acceptable fit (Loehlin, 1998).

Results

Rates of sexual abuse and sexual victimization

In this sample, 6.2% (N = 34) reported a moderate sexual victimization experience, and 1.4% (N = 8)
reported a rape in childhood. Regarding experiences with adolescent sexual victimization, 26.7% (N = 147)
reported experiencing moderate sexual victimization, and 7.6% (N = 42) reported rape. During the follow-
up period, 8.4% (N = 44) reported experiencing moderate sexual victimization and 2.8% (N = 15) reported
rape.

Rates of physical abuse and physical dating violence

Analyses regarding rates of physical abuse from the mother, 16.7% (N = 92) of the sample reported
moderate physical abuse and 7.4% (N = 41) severe physical abuse. Similarly, 21.8% (N = 120) reported
C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 13731394 1381

moderate and 6.2% (N = 34) severe physical abuse from their fathers. Regarding dating violence in
adolescence, 18.1% (N = 100) reported incidents of moderate severity and 3.3% (N = 18) reported severe
incidents of physical dating violence. During the 2-month follow-up period, 4.2% of the sample (N = 22)
reported dating violence incidents of moderate severity and 1.3% (N = 7) reported severe incidents.

Rates of verbal abuse experiences in childhood

An analysis of the frequency data regarding verbally abusive experiences in childhood revealed that
67.3% (N = 371) of the participants indicated that they had experienced some form of verbal abuse from
their fathers, with 18% (N = 99) of the participants reporting that they experienced moderate levels of
abuse and 49.4% (N = 272) reporting severe forms of verbal abuse. Regarding verbal abuse from their
mothers, 53.7% (N = 296) of the participants indicated that they had experienced severe verbal abuse and
26.5% (N = 146) reported moderate verbal abuse.

Path analyses

The results of the three path analyses with the separate symptom measures are summarized below.
Given that the direct effects of earlier abuse experiences on subsequent abuse experiences remain constant
throughout the various paths, the results related to the relationship among abuse experiences will only
be reported in the first path analysis. Thus, all subsequent path analyses will highlight the unique effects
associated with the analyses. Numerous intercorrelations were found among the various forms of abuse
across time (see Table 2) and between symptoms and abuse experiences across time (see Table 3).

The prediction of victimization and depressive symptoms during the 2-month follow-up. The first path
(Figure 1) predicted victimization and depressive symptomatology during the follow-up period by pre-
vious victimization history and the magnitude of depressive symptoms at Time 1. Initial results revealed
some unsatisfying fit indices: 2 (12, N = 551) = 562.75, p < .001; CFI = .95; TLI = .73; RMSEA = .29; 90%
confidence interval of RMSEA = .27.31. The model was then analyzed removing all nonsignificant path
links (see Figure 1). Although the chi-square test remained highly significant, 2 (45, N = 551) = 604.87,
p < .001, the other fit indices improved (CFI = .95; TLI = .93; RMSEA = .15; 90% confidence interval of
RMSEA = .14.16), suggesting that the significant causal path links are of import.
Maternal verbal abuse was predictive of both dating violence during adolescence ( = .19, critical
ratio = 4.67, p < .001) and depressive symptomatology at Time 1 ( = .19, critical ratio = 3.77, p < .001).
Similarly, paternal verbal abuse predicted adolescent dating violence ( = .09, critical ratio = 2.07, p < .05)
and depressive symptomatology at Time 1 ( = .15, critical ratio = 3.77, p < .001). Paternal physical
abuse predicted adolescent sexual victimization ( = .23, critical ratio = 5.40, p < .001). Sexual vic-
timization experiences during adolescence were predictive of both a sexual victimization experience
during the follow-up period ( = .14, critical ratio = .14, p < .01), and depressive symptomatology at
Time 1 ( = .25, critical ratio = 6.01, p < .001). Adolescent physical dating violence predicted physical
dating violence during the follow-up ( = .13, critical ratio = 3.03, p < .01). Lastly, depressive syp-
tomatology at Time 2 was predicted by both depressive symptomatology at Time 1 ( = .67, critical
ratio = 20.14, p < .001), and dating violence during the follow-up period ( = .08, critical ratio = 2.50,
p < .05).
1382
Table 2
Correlations between abuse experiences in childhood, adolescence, and the 2-month follow-up

C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 13731394


Moth verba Fath verbb Moth phyc Fath phyd Child sexe Adol phyf Adol sexg Follow phyh Follow sexi
Moth verba .32** .40** .31** .05 .16** .11** .10* .02
Fath verbb .24** .41** .05 .14** .11* .00 .06
Moth phyc .42** .20** .09* .10* .05 .00
Fath phyd .10* .11** .24** .00 .04
Child sexe .04 .04 .12** .05
Adol phyf .02 .15** .03
Adol sexg .04 .13**
Follow phyh .10*
Follow sexi
a
Mother verbal abuse.
b
Father verbal abuse.
c
Mother physical abuse.
d
Father physical abuse.
e
Childhood sexual abuse.
f
Adolescent physical victimization.
g
Adolescent sexual victimization.
h
Follow-up physical victimization.
i
Follow-up sexual victimization.
*
p < .05.
**
p < .01.
C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 13731394 1383

Table 3
Correlations between symptom measures and abuse experiences in childhood, adolescence and the 2-month follow-up
Symptom measures
a b
IES (Time 1) IES (Time 2) BDI (Time 1) BDI (Time 2) IIPc (Time 1) IIP (Time 2)
Abuse experiences during childhood
Verbal (mother) .12** .07 .20** .19** .11* .09*
Verbal (father) .05 .04 .23** .16** .08 .08
Physical (mother) .09* .08 .22** .22** .10* .05
Physical (father) .09* .09* .23** .22** .08 .03
Sexual .06 .05 .09* .04 .01 .05
Abuse experiences during adolescence
Dating violence .01 .08 .14** .11* .08 .07
Sexual victimization .39** .13** .28** .25** .13** .12**
Abuse experiences during 2-month follow-up
Dating violence .04 .02 .06 .12** .01 .02
Sexual victimization .07 .27** .06 .10* .10* .12**
a
Impact of Event Scale.
b
Beck Depression Inventory-II.
c
Inventory of Interpersonal Problems.
*
p < .05.
**
p < .01.

The prediction of victimization and trauma symptoms during the 2-month follow-up. The second path
(Figure 2) predicted victimization and trauma symptoms during the follow-up period by previous vic-
timization history and trauma symptoms at Time 1. Similar to depressive symptomatology, initial path
analyses for trauma symptoms revealed some unsatisfying fit indices: 2 (12, N = 551) = 561.86, p < .001;
CFI = .95; TLI = .74; RMSEA = .29; 90% confidence interval of RMSEA = .27.31. After removing
all nonsignificant path links (see Figure 2), the chi-square test remained highly significant, 2 (45,
N = 551) = 590.99, p < .001, but the other fit indices improved (CFI = .95; TLI = .93; RMSEA = .15; 90%
confidence interval of RMSEA = .14.16), suggesting that the significant causal path links are of import.
Trauma symptomatology at Time 1 was predicted by paternal verbal abuse ( = .08, critical ratio = 1.93,
p < .05), and a sexual victimization during adolescence ( = .38, critical ratio = 9.16, p < .001). Also,
trauma symptomatology at Time 2 was predicted by paternal physical abuse ( = .09, critical ratio = 1.98,
p < .05), trauma symptomatology at Time 1 ( = .11, critical ratio = 2.34, p < .05), and a sexual victimiza-
tion experience during the follow-up period ( = .25, critical ratio = 5.83, p < .001).

The prediction of victimization and interpersonal functioning during the 2-month follow-up. The third
path (Figure 3) predicted victimization and interpersonal problems during the follow-up period by previ-
ous victimization history and interpersonal problems at Time 1. Similar to the prior analyses, initial path
analyses on interpersonal functioning revealed some unsatisfying fit indices: 2 (12, N = 551) = 561.10,
p < .001; CFI = .96; TLI = .78; RMSEA = .29; 90% confidence interval of RMSEA = .27.31. After remov-
ing all nonsignificant path links (see Figure 3), the chi-square test remained highly significant, 2 (44,
N = 551) = 591.75, p < .001, but the other fit indices improved (CFI = .96; TLI = .94; RMSEA = .15; 90%
confidence interval of RMSEA = .14.16), suggesting that the significant causal path links are of import.
1384 C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 13731394

Figure 1. Path predicting victimization and symptoms of depression.

Interpersonal problems at Time 1 was predicted by maternal verbal abuse ( = .13, critical ratio = 3.02,
p < .01), and a sexual victimization during adolescence ( = .09, critical ratio = 2.03, p < .05). Interper-
sonal problems at Time 1 predicted a sexual victimization during the follow-up period ( = .11, critical
ratio = 2.61, p < .05). Also, interpersonal problems at Time 2 were predicted by child sexual abuse ( = .09,
critical ratio = 2.64, p < .05), interpersonal problems at Time 1 ( = .71, critical ratio = 23.06, p < .001),
and dating violence during the follow-up period ( = .07, critical ratio = 2.13, p < .05).

Chi-square analyses between signicant forms of abuse. In order to better assess the relationships between
the various forms of abuse, five 2 analyses were conducted on the abuse measures that were found to
be significant predictors in the path analyses. Maternal verbal abuse was significantly related to dating
violence during adolescence, 2 (4, N = 550) = 15.53, p < .01 (Table 4). Among women who had expe-
rienced severe verbal abuse from their mothers, 23% experienced moderate and 4% experienced severe
dating violence in adolescence compared to the women without histories of verbal abuse from their moth-
ers where 7.4% experienced moderate and 1.9% experienced severe dating violence in adolescence. In
addition, paternal verbal abuse was significantly related to dating violence during adolescence, 2 (4,
N = 549) = 14.65, p < .01 such that for those women who experienced either moderate or severe verbal
abuse from their fathers, 4% of them experienced severe dating violence in adolescence compared to
1.7% of women who experienced severe dating violence in adolescence who had not experienced verbal
C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 13731394 1385

Figure 2. Path predicting victimization and trauma symptoms.

Table 4
Relationship between adolescent physical dating violence and maternal and paternal verbal abuse
Dating violence during adolescence

None Moderate Severe Total


a
Maternal verbal abuse
None 98 (90.7%) 8 (7.4%) 2 (1.9%) 108
Moderate 118 (80.8%) 24 (16.4%) 4 (2.7%) 146
Severe 216 (73.0%) 68 (23.0%) 12 (4.0%) 296
Total 432 100 18 550

Paternal verbal abuseb


None 151 (84.8%) 24 (13.5%) 3 (1.7%) 178
Moderate 84 (84.8%) 11 (11.1%) 4 (4.0%) 99
Severe 196 (72.1%) 65 (23.9%) 11 (4.0%) 272
Total 431 100 18 549
a
(4, N = 550) = 15.53, p < .01.
2
b
2 (4, N = 549) = 14.65, p < .01.
1386 C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 13731394

Figure 3. Path predicting victimization and interpersonal problems.

abuse from their fathers (Table 4). Further, dating violence during adolescence was significantly related
to dating violence during the 2-month follow-up, 2 (4, N = 518) = 34.22, p < .01 (Table 5). For those
women who experienced severe dating violence in adolescence, 27.8% of them were revictimized during
the follow-up (all moderately victimized) compared to 2.2% of the women without histories of dating
violence who were moderately victimized and 1.2% who were severely victimized during the 2-month
follow-up.

Table 5
Relationship between adolescent physical dating violence and follow-up dating violence
Dating violence during 2-month follow-up

None Moderate Severe Total


Dating violence during adolescence
None 395 (96.3%) 9 (2.2%) 5 (1.2%) 409
Moderate 81 (89.0%) 8 (8.8%) 2 (2.2%) 91
Severe 13 (72.2%) 5 (27.8%) 0 (0.0%) 18
Total 489 22 7 518
(4, N = 518) = 34.22, p < .01.
2
C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 13731394 1387

Table 6
Relationship between paternal physical abuse and sexual victimization in adolescence, and between sexual victimization in
adolescence and during follow-up
None Moderate Rape Total
Sexual victimization in adolescence
Paternal physical abusea
None 285 (72.0%) 94 (23.7%) 17 (4.2%) 396
Moderate 62 (51.7%) 40 (33.3%) 18 (15.0%) 120
Severe 15 (44.1%) 12 (35.3%) 7 (20.6%) 34
Total 362 146 42 550

Sexual victimization during 2-month follow-up


Sexual victimization in adolescenceb
None 317 (91.1%) 22 (6.3%) 9 (2.6%) 348
Moderate 122 (87.1%) 15 (10.7%) 3 (2.1%) 140
Rape 25 (71.4%) 7 (20.0%) 3 (8.6%) 35
Total 464 44 15 523
a
(4, N = 550) = 34.39, p < .01.
2
b
2 (4, N = 523) = 14.04, p < .01.

Additionally, a sexual victimization experience in adolescence was significantly related to both paternal
physical abuse, 2 (4, N = 550) = 34.39, p < .01, and to a sexual victimization experience during the 2-
month follow-up, 2 (4, N = 523) = 14.04, p < .01 (Table 6). For those women who experienced severe
physical abuse from their fathers, 20.6% of them were raped in adolescence compared to the women
without histories of paternal physical abuse or histories of moderate abuse where 4.2% and 15% of them
were raped, respectively. Among those women with a history of adolescent sexual victimization, 8.6% of
those with a history of rape compared to 2.1% with a history of moderate adolescent sexual victimization,
and 2.6% of the women without adolescent sexual assault histories were raped during the brief 2-month
follow-up period.

Discussion

Overview of major ndings

Early victimization experiences as predictors of subsequent sexual victimization. Correlational analyses


of the various forms of abuse in childhood suggested, as expected, that different forms of abuse were
related to each other. A significant correlational relationship was found between physical abuse by both
parents and the occurrence of childhood sexual abuse. In addition, verbal abuse by both the mother and
the father were significantly correlated with physical abuse by both parents. In all cases, the more likely
a child was to experience one type of abuse in childhood, the more likely it was that the child also
experienced other types of child abuse.
Further, the present study retrospectively examined the relationship between various forms of childhood
abuse and sexual assault in adolescence, and also prospectively examined possible relationships between
1388 C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 13731394

a history of sexual victimization and a sexual assault during the follow-up period. Although verbal and
physical abuse by the mother and father were significantly correlated with a sexual assault in adolescence,
the only childhood victimization experience that was predictive of adolescent sexual victimization in the
path analysis was a history of physical abuse by the father. While a number of studies have indicated
that physical abuse during childhood increases a womans vulnerability to being physically abused in
adulthood, our data indicated that early physical abuse may be a greater risk factor for future sexual
assault. In a recent study, data indicated that women with childhood physical abuse histories were more
likely to report risky sexual behavior than women without such histories (Morrill et al., 2001). It is possible
that women who experience physical abuse by their parent may participate in risky sexual behavior thus
rendering them at a higher risk for sexual assault.
Results also replicated past prospective investigations (e.g., Gidycz et al., 1995) that have found a
relationship between sexual victimization experiences. Although sexual assault occurring in childhood
did not predict either adolescent sexual assault or a sexual victimization during the 2-month follow-up,
sexual assault in adolescence did predict a sexual assault during the 2-month follow-up period. Specifically,
women were more likely to be victimized during the academic quarter if they had a history of adolescent
sexual victimization. In addition, the severity of a sexual victimization experience during adolescence
predicted the severity of a subsequent sexual victimization, such that the more severe the adolescent
sexual victimization, the more severe the sexual victimization during the 2-month follow-up period. In
fact, women who had experienced a rape in adolescence were four times more likely than women with
no history of abuse, or histories of sexual abuse other than rape, to be raped during the brief follow-up
interval. The only victimization variable that was related to a sexual assault during the 2-month follow-up
was a sexual victimization in adolescence. These data support other prospective investigations that have
shown that the strongest predictor of a future sexual assault is a past sexual assault (Gidycz et al., 1993,
1995).

Early victimization experiences as predictors of subsequent dating violence. The current study was the
first to both retrospectively and prospectively assess physical dating violence among college students.
A striking percentage of college women appear to be victims of physical dating violence both prior to
entering the study and during the 2-month follow-up period. Twenty-one percent of women reported expe-
riencing moderate or severe physical dating violence in adolescence and 5.5% of the women reported
moderate or severe physical dating violence during the 2-month academic quarter. Both physical and
verbal abuse by both parents is significantly correlated with being the victim of physical dating violence
in adolescence. The only variables, however, that predicted adolescent experiences of physical dating
violence were verbal abuse by the mother and verbal abuse by the father. While researchers are begin-
ning to separate physical and sexual abuse in their analyses (Whitfield et al., 2003), our data further
indicated a need to investigate the relationships between multiple forms of child abuse and to include
emotional abuse as well when investigating the risk of subsequent abuse throughout the developmental
periods.
In addition, the only variable that predicted physical dating violence during the follow-up period was
having a history of physical dating violence during adolescence. In fact, results indicated that women
who experienced severe physical dating violence in adolescence were over twice as likely as women who
previously experienced a moderate physical dating violence experience, and nine times more likely than
women without histories of physical dating violence, to experience a physical victimization during the
follow-up.
C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 13731394 1389

Predictors of psychological symptoms. Physical and verbal abuse experiences by both the father and
mother were correlated with depression as measured at Time 1 and Time 2, and child sexual abuse was
correlated to depression at Time 1 as well. However, in the path analysis many of these relationships did
not remain significant. While physical abuse by the father and the mother were not found to predict any
psychological symptoms, verbal abuse by the father and the mother did predict depression as measured
at the beginning of the study. Further, verbal abuse by the father predicted trauma and verbal abuse by the
mother predicted interpersonal problems as measured at Time 1. The present results are consistent with
some past work that suggested that emotional abuse may be equally, or in some instances more traumatic,
than physical abuse (Braver et al., 1992; Mullen, Martin, Anderson, Romans, & Herbison, 1996). While
we explored whether the gender of the perpetrator might be related to the severity of reactions, our data
suggested that emotional abuse from either parent led to psychological aftereffects.
While none of the other childhood victimization experiences predicted initial symptoms, the experi-
ence of an adolescent sexual victimization predicted depression, trauma, and interpersonal difficulties as
measured at Time 1. Conversely, physical dating violence in adolescence was not predictive of any of the
psychological variables as measured at the start of the study. However, it is important to note that a physi-
cal dating violence experience during the follow-up period was predictive of both interpersonal problems
and depression as measured at Time 2 and a sexual victimization experience during the follow-up period
was predictive of trauma symptoms at Time 2. Additionally, there appears to be some long-lasting trauma
associated with a fathers physical abuse as this type of childhood abuse was significantly correlated
with trauma symptoms at Time 1 and was predictive of trauma symptoms during the follow-up period.
Trauma symptoms did not predict any other victimization variable, indicating that trauma is more likely
to be an aftereffect of a sexual victimization than predictive of a subsequent victimization over short
intervals.
The only significant reciprocal relationship between a victimization experience and symptoms was
the relationship between sexual victimizations that occurred in adolescence, sexual assaults during the
2-month follow-up, and interpersonal problems as measured at Time 1. The path analysis indicated that
an adolescent sexual victimization was predictive of interpersonal problems at Time 1 and interpersonal
problems as measured at Time 1 subsequently predicted a sexual victimization at the follow-up. Therefore,
interpersonal difficulties may be both an aftereffect of sexual assault as well as predictive of a future assault.

Implications

Given that physical abuse by a womans father was the only childhood abuse variable that rendered
women more vulnerable to an adolescent sexual victimization, these findings underscore the need to
educate child physical abuse victims about protective strategies against subsequent physical and sexual
assaults. Future research is needed to elucidate better the processes by which paternal physical abuse may
render a woman more vulnerable to sexual victimization experiences. The associations found between
adolescent and adult sexual victimization experiences also highlight the need to address multiple vic-
timizations and sexual revictimization in risk reduction efforts, even with populations, such as college
students, that typically possess greater resources than other samples of sexual assault survivors. Although
there is some evidence that risk reduction programs targeting general college student audiences do not
address, or are not effective for, these high-risk women (Hanson & Gidycz, 1993), Calhoun et al. (2001)
recently addressed issues related to sexual revictimization. Their program targeting college women with
assault histories was found to reduce significantly program participants risk for sexual revictimization
1390 C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 13731394

relative to their waiting-list control group. The results of the present investigation underscore the need
for further programming efforts with high-risk groups of women.
Given the high rates of dating violence and the finding that the most significant predictor of physical
dating violence in this sample is a past experience with physical dating violence, this study also under-
scores the need for further investigation into the dynamics of physical dating violence. These results also
highlight the need to address physical dating violence with teens in order to prevent a cycle of violence
from developing. Programs such as the Safe Dates program (Foshee et al., 1998) are important efforts
along these lines.
Our findings also imply that, in some respects, early emotional abuse by ones parents, compared to early
physical or sexual abuse, may be more predictive of greater psychological symptoms. It is possible that
the psychological abuse by ones parents might be more damaging than physical abuse as it might be more
consistent and more indicative of the quality of the relationship between the parents and child. Meston,
Heiman, and Trapnell (1999) suggested that emotional abuse can be as traumatic, if not more traumatic,
than physical abuse because it can thwart the needs for love, self-esteem, and feelings of belonging. If
this is the case, it may help to explain why women who were emotionally abused in childhood were more
likely to be involved in dating relationships in adolescence where violence was present.
The path analysis findings suggest that during adolescence sexual assaults may lead to greater psycho-
logical symptoms than physical assaults. While it may be that the closer proximity between the dating
violence experiences during the follow-up and the Time 2 assessments accounts for the significant rela-
tionships between dating violence during the follow-up and psychological outcomes, it is also possible
that the dating violence experiences that occurred during adulthood are qualitatively different and pos-
sibly more severe than the experiences that occurred during adolescence. Although this is speculative, it
is possible that the relationships that occurred during the follow-up period were of longer duration and
more serious than the adolescent relationships. Past research has suggested that more severe abuse is
likely to occur in relationships that are more serious and of longer duration (e.g., Ray & Gold, 1996).
Therefore, further longitudinal analyses are needed to explore the psychological impact of abuse over
time, especially what happens to women as they stay in or reengage in physically abusive relationships.
The findings suggesting that interpersonal problems associated with earlier abuse experiences may
increase the risk of subsequent sexual victimization experiences underscore the necessity of investigat-
ing how these ontogenic factors increase a womans chances of being revictimized. Grauerholz (2000)
suggests that ontogenic factors do not inherently lead to revictimization but rather they shape a womans
relationship with potential abusers and other people who might have the potential to otherwise protect
her. Future studies should explore the mechanisms through which interpersonal difficulties might make
a woman more vulnerable to a sexual assault.
Finally, it was interesting to note that few of the child abuse experiences predicted the psychological
outcome measures as assessed at Time 2. While this seems contradictory to past work with college
students that have found that those abused in childhood evidence higher symptom levels across a variety
of measures (e.g., Briere & Runtz, 1990), it is important to keep in mind that virtually all of the past data
have been retrospective in nature. Thus, child abuse status, as well as current symptoms, have typically
been measured at the same time. In this study, however, child abuse status was ascertained two months
prior to participants filling out the symptom measures at the follow-up assessment. Further, it is important
to note that some of the symptom measures assessed at Time 2 were in fact significantly correlated with
past childhood abuse experiences, the relationships were just not strong enough to come out significant
in the path analyses when all other variables were in the model. In most instances, the more proximal
C.L. Rich et al. / Child Abuse & Neglect 29 (2005) 13731394 1391

variables (abuse during the follow-up) predicted psychological outcomes at Time 2 and the early child
abuse experiences, when significant, predicted the psychological outcomes at Time 1.
Limitations

Given the young age of the present sample, it is likely that the vast majority of these women have been
involved in these abusive relationships for a relatively short period of time. Additionally, since college
women likely possess a number of resources that may not be typical of other populations, one should not
generalize these findings to non-college student samples. However, future studies should extend the length
of the follow-up period in order to explore more fully the reciprocal nature between symptoms and abuse
and to more accurately assess the rates of victimization and revictimization over time. Since follow-up
data included only those victimizations that occurred in a 10-week academic quarter, it is probable that
many more women will be victimized during their college years. Therefore, longer follow-up intervals
may demonstrate even higher rates of victimization and more incidents of revictimization.
Low correlations indicating weak relationships were also considered to be limitations of this study.
Other possible mediators of both physical dating violence and sexual assault that should be included
in future studies include substance use, contextual variables (e.g., predilection of the man to perpetrate
violence), and family functioning.

Conclusions

In conclusion, our findings indicate that various forms of abuse tend to co-occur, with early emotional
abuse by both parents predictive of subsequent dating violence and early physical abuse by the father
predictive of adolescent sexual abuse. Both sexual and dating violence appear to recur over time, as
adolescent dating violence was predictive of dating violence over the follow-up period and sexual victim-
ization during adolescence was predictive of sexual violence over the follow-up. In addition, interpersonal
problems appeared to be both an aftereffect of sexual victimization in adolescence, as well as act as a risk
factor for abuse during the follow-up.
Finally, our data also suggested that emotional abuse by both parents was more predictive of initial
levels of psychological symptoms than overt types of abuse. Thus, subtler forms of abuse can be equally
or more traumatic and set the stage for subsequent abuse experiences.

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