Ensink, K; Borelli, JL; Normandin, L; Target, M; Fonagy, P; (2019) Childhood sexual abuse and attachment insecurity: Associations with child psychological difficulties. American Journal of Orthopsychiatry 10.1037/ort0000407. (In press).

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Abstract

Although research documents that childhood sexual abuse (CSA) and insecure attachment are associated with psychopathology in children, to date no studies have delineated the unique and interactive contributions of these two risk factors. The aims of this study were to examine attachment in sexually abused children and a comparison group and to assess the contributions of each risk factor to child psychological difficulties. Participants were 111 children aged 7-13, of which 43 were CSA victims. In addition, in the service of enhancing understanding regarding CSA, we sought to compare among children experiencing different subtypes of CSA – children whose abusers were members of the family (intrafamilial CSA) versus outside of the family (extrafamilial CSA). We anticipated that intrafamilial CSA would be associated with greater psychopathology risk given that it may involve disruption in children’s primary attachment relationships as well as trauma exposure. Children completed an attachment interview and reported on their depressive symptoms. Their mothers reported on children’s externalizing symptoms, internalizing symptoms, dissociation, and sexualized behaviour. The findings indicate that, as hypothesized, children with (intrafamilial or extrafamilial) CSA were more likely to be classified as insecure and disorganized. In general, children experiencing intrafamilial CSA showed the most compromised psychological adjustment, followed by children experiencing extrafamilial CSA and then the comparison group. More fine-grained analyses revealed that CSA history was uniquely associated with children’s externalizing problems, sexualizing problems, and dissociation, whereas insecure attachment was uniquely associated with child-reported depressive symptoms. Insecure attachment appeared to be protective for internalizing symptoms in the context of CSA, while generally associated with greater risk for psychopathology. Patterns of psychopathology symptoms differed among children exposed to intrafamilial CSA. Public Policy Relevance: Both childhood sexual abuse and insecure and particularly disorganized attachment are associated with enhanced risk for psychopathology in childhood, rendering treatment decision-making difficult for children presenting with multiple sources of risk. The findings of this study suggest that children presenting with sexual abuse histories are more likely to have insecure or disorganized attachment. Further, when children have experienced CSA, particularly CSA that has been perpetrated by a family member, their risk for psychopathology is higher regardless of attachment. Policy makers should prioritize the prevention or treatment of insecure/disorganized attachment among samples of non-abused youth, and the prevention or treatment of trauma-related symptoms among abused children.

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