Journal of Youth and Adolescence, Vol. 14, No. 5, 1985
Self-Concept of Adolescent Sexual Abuse Victims Donald
P. Orr mand Maureen
C. D o w n e s 2
Received August 20, 1984; accepted July 17, 1985
To assess the self-concept and psychological profile associated with sexual abuse, 20 young female victims evaluated in a sexual abuse clinic completed the Offer Self-Image Questionnaire (OSIQ). The alleged assault was intrafami6al in 13 cases, lasting f r o m several months to lO years. Extrafamilial abuses were isolated events. Intercourse was alleged in 18 o f the 20 instances. OSIQ group mean scores were in the poorly adjusted range f o r three scales, indicating serious problems with sexual attitudes, family relations, and feelings o f inability to master the external environment. While the mean Overall Adjustment scale score was within normal limits, 10 girls had scores in the range indicating severe problems in adjustment; 7 were incest victims. Compared to nonsexually abused adolescent patients f r o m a general adolescent clinic, sexually abused youth had significantly more problems with vocational~educational goals, psychopathology, and ability to master the environment (p < O.05). The self-concept problems identified in these sexually abused youth (a) are similar to those reported by women seeking psychiatric care long after their childhood sexual abuse occurred and (b) share some features reported among physically abused adolescents.
This work was supported in part by grants from the Robert Wood Johnson Foundation ( # 7278) and the Indiana State Board of Health, Maternal and Child Health Division. LDirector of Adolescent Medicine, Department of Pediatrics/Adolescent Medicine, Indiana University School of Medicine, Received M.D. from Case Western Reserve University. Research interests are psychosocial effects of chronic illness on children and adolescents, compliance and cognitive developments. 2University of California Irvine Medical Center, Received M.D. from Georgetown University. aCorrespondence should be sent to Donald P. Orr, Indiana University, James Whitcomb Riley Hospital, 702 Barnhill Drive, Indianapolis, Indiana 46223. 401 0047-2891/85/10(~04M01504.50/0 9 1985 Plenum Publishing Corporation
402
Orr and Downes
INTRODUCTION Sexual abuse of children and adolescents is increasingly recognized as a common occurrence. In a survey of 796 New England college students, Finkelhor (1979) found that 19.2~ of the females and 8.6o70 of the males reported having been sexually victimized as children. Kinsey et al. (1953a, 1953b), Gagnon (1965), and Landis (1956) indicate a similar prevalence. Childhood sexual abuse reports account for approximately 12% of all reported child abuse in the United States: up to 360,000 cases per year (Greenberg, 1979). Despite the increasing numbers of reports, little is known about the immediate and long-term psychological effects of sexual abuse on children and adolescents. This paper presents data on a small number of young adolescent sexual abuse victims seen in a children's sexual abuse clinic. Self-image (concept) was the dependent variable under investigation. Self-concept is an important personality dimension in adolescence (Blos, 1961; Masterson, 1967; Block, 1971) which has been empirically directly correlated with the mental health and adjustment of adolescents (Offer and Offer, 1975; Rosenberg, 1965). Self-concept has been shown to be a relatively stable personality trait from adolescence onward (Offer et al., 1981; Engel, 1959; Vaillant and McArthur, 1972).
METHOD
The University of California Irvine Medical Center Department of Pediatrics performs the majority of physical examinations for children and adolescents who are sexual abuse victims in Orange County, California. The initial examination is performed in the Pediatric Emergency Room by a resident and social worker. Children and adolescents return within a 10-day period to a Children's Sexual Abuse Clinic, where medical problems are treated and psychological support provided. Adolescents are asked to complete the Offer Self-Image Questionnaire for Adolescents (OSIQ), a self-assessment measure designed to assess self-concept. The results are expressed as scores standardized for age and sex (with a mean of 50 and a standard deviation of 15). Scores of less than 35 are indicative of severe problems in an area. Eleven scales examine important areas of adolescent life. The twelfth scale, Overall Adjustment, is an average of 10 scales (Sexual Attitude is not included) and assesses overall psychological adjustment. With the exception of the Sexual Attitudes scale, the scales correlate significantly with one another. However each scale is thought to tap a different aspect of self-concept (Offer et al., 1977). Female adolescents with acute medical problems attending our general medical adolescent clinic during the same period were used as a comparison group. All adolescents attending this clinic are routinely asked if they have
403
Sexual Abuse and Self-Concept
(are being) been sexually or physically abused; all in the comparison group denied it. Comparison adolescent patients were of the same ethnic and socioeconomic groups as the abused youth (largely White and receiving Medicaid benefits). However they were older (14.1 _+ 1.2 years) than the abused girls. Institutional Human Subjects Review Board approval and informed consent were obtained. OSIQ scores of the acutely ill sample were compared to the published normal values to determine the appropriateness of the measure for our population; sexual abuse victims'OSIQscores were compared both to normal values and those of the acutely ill. A one-tailed Student's t test was used in statistical analysis. Our hypothesis was that adolescent sexual abuse victims (ASAV) would have poorer self-concepts than adolescent patients seen for acute self-limited medical problems.
RESULTS
Twenty sexually abused girls aged 9 to 15 years, seen from January 1978 through December 1979, completed the Offer Self-Image Questionnaire. The average age was 12.9 • 1.7 years (9-15). Five patients were less than 12 years old. All were at least Tanner Stage II. The alleged abuse was intrafamilial (the offender was a member of the nuclear family) in 13 cases: f a t h e r - 7 , stepfather-4, mother's live-in b o y f r i e n d - 1, " u n c l e " - 2 , u n k n o w n - 1. There was abuse by multiple offenders in 2 cases. The duration of the abuse was from several months to 10 years in 7 instances, of unknown length in 5, and an isolated single occurrence in 1 case. The extrafamilial abuses were isolated events in all 7 instances. These were committed by strangers in 5 cases and acquaintances in 2. The abuse consisted of various acts ranging from molestation (genital fondling) to oral copulation to intercourse or attempts at such. Intercourse was alleged by 18 of the 20 adolescents. The mean OSIQ scale scores are shown in Table I. Mean OSIQ scores for the acutely ill adolescents were within the normal limits ( > 35) on all scales; they were not statistically different from published normal values (Offer et al., 1977), indicating that the OSIQ may be used in our patient population. Compared to the adolescents presenting with acute medical problems, ASAVs had significantly lower scores (p < 0.05) on three s c a l e s - M a s t e r y of the External World (33.0 • 18.6), Vocational-Educational Goals (39.9 • 18.6) and Psychopathology (37.5 • 17.5). While not reaching statistical significance, there was a trend for ASAVs to have lower scores on Family Relations (34.6 • 22.0) compared to the other adolescents ( p = 0.064). However, when ASAVs' scores were compared to published normal values, they scored significantly lower on eight scales-Sexual Attitudes (33.0 • 21.6), Family Relations (34.6 • 22.0), Mastery of the External World (33.0 • 18.6), Vocational-Educational Goals (39.9 • 18.6), Psychopathology (37.5
404
Orr and Downes
ZZZZZOOOOOzO
II
~r~
o.~ 8.'-' r~.=
N m~ ~~ ~d m~ M m m~ m4 ~d m
d ~
"~
b.
(Y
Self-Concept of Adolescent Sexual Abuse Victims Donald
P. Orr mand Maureen
C. D o w n e s 2
Received August 20, 1984; accepted July 17, 1985
To assess the self-concept and psychological profile associated with sexual abuse, 20 young female victims evaluated in a sexual abuse clinic completed the Offer Self-Image Questionnaire (OSIQ). The alleged assault was intrafami6al in 13 cases, lasting f r o m several months to lO years. Extrafamilial abuses were isolated events. Intercourse was alleged in 18 o f the 20 instances. OSIQ group mean scores were in the poorly adjusted range f o r three scales, indicating serious problems with sexual attitudes, family relations, and feelings o f inability to master the external environment. While the mean Overall Adjustment scale score was within normal limits, 10 girls had scores in the range indicating severe problems in adjustment; 7 were incest victims. Compared to nonsexually abused adolescent patients f r o m a general adolescent clinic, sexually abused youth had significantly more problems with vocational~educational goals, psychopathology, and ability to master the environment (p < O.05). The self-concept problems identified in these sexually abused youth (a) are similar to those reported by women seeking psychiatric care long after their childhood sexual abuse occurred and (b) share some features reported among physically abused adolescents.
This work was supported in part by grants from the Robert Wood Johnson Foundation ( # 7278) and the Indiana State Board of Health, Maternal and Child Health Division. LDirector of Adolescent Medicine, Department of Pediatrics/Adolescent Medicine, Indiana University School of Medicine, Received M.D. from Case Western Reserve University. Research interests are psychosocial effects of chronic illness on children and adolescents, compliance and cognitive developments. 2University of California Irvine Medical Center, Received M.D. from Georgetown University. aCorrespondence should be sent to Donald P. Orr, Indiana University, James Whitcomb Riley Hospital, 702 Barnhill Drive, Indianapolis, Indiana 46223. 401 0047-2891/85/10(~04M01504.50/0 9 1985 Plenum Publishing Corporation
402
Orr and Downes
INTRODUCTION Sexual abuse of children and adolescents is increasingly recognized as a common occurrence. In a survey of 796 New England college students, Finkelhor (1979) found that 19.2~ of the females and 8.6o70 of the males reported having been sexually victimized as children. Kinsey et al. (1953a, 1953b), Gagnon (1965), and Landis (1956) indicate a similar prevalence. Childhood sexual abuse reports account for approximately 12% of all reported child abuse in the United States: up to 360,000 cases per year (Greenberg, 1979). Despite the increasing numbers of reports, little is known about the immediate and long-term psychological effects of sexual abuse on children and adolescents. This paper presents data on a small number of young adolescent sexual abuse victims seen in a children's sexual abuse clinic. Self-image (concept) was the dependent variable under investigation. Self-concept is an important personality dimension in adolescence (Blos, 1961; Masterson, 1967; Block, 1971) which has been empirically directly correlated with the mental health and adjustment of adolescents (Offer and Offer, 1975; Rosenberg, 1965). Self-concept has been shown to be a relatively stable personality trait from adolescence onward (Offer et al., 1981; Engel, 1959; Vaillant and McArthur, 1972).
METHOD
The University of California Irvine Medical Center Department of Pediatrics performs the majority of physical examinations for children and adolescents who are sexual abuse victims in Orange County, California. The initial examination is performed in the Pediatric Emergency Room by a resident and social worker. Children and adolescents return within a 10-day period to a Children's Sexual Abuse Clinic, where medical problems are treated and psychological support provided. Adolescents are asked to complete the Offer Self-Image Questionnaire for Adolescents (OSIQ), a self-assessment measure designed to assess self-concept. The results are expressed as scores standardized for age and sex (with a mean of 50 and a standard deviation of 15). Scores of less than 35 are indicative of severe problems in an area. Eleven scales examine important areas of adolescent life. The twelfth scale, Overall Adjustment, is an average of 10 scales (Sexual Attitude is not included) and assesses overall psychological adjustment. With the exception of the Sexual Attitudes scale, the scales correlate significantly with one another. However each scale is thought to tap a different aspect of self-concept (Offer et al., 1977). Female adolescents with acute medical problems attending our general medical adolescent clinic during the same period were used as a comparison group. All adolescents attending this clinic are routinely asked if they have
403
Sexual Abuse and Self-Concept
(are being) been sexually or physically abused; all in the comparison group denied it. Comparison adolescent patients were of the same ethnic and socioeconomic groups as the abused youth (largely White and receiving Medicaid benefits). However they were older (14.1 _+ 1.2 years) than the abused girls. Institutional Human Subjects Review Board approval and informed consent were obtained. OSIQ scores of the acutely ill sample were compared to the published normal values to determine the appropriateness of the measure for our population; sexual abuse victims'OSIQscores were compared both to normal values and those of the acutely ill. A one-tailed Student's t test was used in statistical analysis. Our hypothesis was that adolescent sexual abuse victims (ASAV) would have poorer self-concepts than adolescent patients seen for acute self-limited medical problems.
RESULTS
Twenty sexually abused girls aged 9 to 15 years, seen from January 1978 through December 1979, completed the Offer Self-Image Questionnaire. The average age was 12.9 • 1.7 years (9-15). Five patients were less than 12 years old. All were at least Tanner Stage II. The alleged abuse was intrafamilial (the offender was a member of the nuclear family) in 13 cases: f a t h e r - 7 , stepfather-4, mother's live-in b o y f r i e n d - 1, " u n c l e " - 2 , u n k n o w n - 1. There was abuse by multiple offenders in 2 cases. The duration of the abuse was from several months to 10 years in 7 instances, of unknown length in 5, and an isolated single occurrence in 1 case. The extrafamilial abuses were isolated events in all 7 instances. These were committed by strangers in 5 cases and acquaintances in 2. The abuse consisted of various acts ranging from molestation (genital fondling) to oral copulation to intercourse or attempts at such. Intercourse was alleged by 18 of the 20 adolescents. The mean OSIQ scale scores are shown in Table I. Mean OSIQ scores for the acutely ill adolescents were within the normal limits ( > 35) on all scales; they were not statistically different from published normal values (Offer et al., 1977), indicating that the OSIQ may be used in our patient population. Compared to the adolescents presenting with acute medical problems, ASAVs had significantly lower scores (p < 0.05) on three s c a l e s - M a s t e r y of the External World (33.0 • 18.6), Vocational-Educational Goals (39.9 • 18.6) and Psychopathology (37.5 • 17.5). While not reaching statistical significance, there was a trend for ASAVs to have lower scores on Family Relations (34.6 • 22.0) compared to the other adolescents ( p = 0.064). However, when ASAVs' scores were compared to published normal values, they scored significantly lower on eight scales-Sexual Attitudes (33.0 • 21.6), Family Relations (34.6 • 22.0), Mastery of the External World (33.0 • 18.6), Vocational-Educational Goals (39.9 • 18.6), Psychopathology (37.5
404
Orr and Downes
ZZZZZOOOOOzO
II
~r~
o.~ 8.'-' r~.=
N m~ ~~ ~d m~ M m m~ m4 ~d m
d ~
"~
b.
(Y
