Title: A Meta-Analytic Review of Findings from National Samples on Psychological Correlates of Child Sexual Abuse
Author(s) and Affiliation(s):
Bruce Rind, Department of Psychology, Temple University, Philadelphia
Philip Tromovitch, Graduate School of Education, University of Pennsylvania
Citation: Rind, B. & Tromovitch, P., “A Meta-Analytic Review of Findings from National Samples on Psychological Correlates of Child Sexual Abuse,” Journal of Sex Research, vol. 34, no.3, 1997 pp. 237-255.
In response to the availability of a growing literature on the psychological correlates of child sexual abuse (CSA), numerous researchers have conducted literature reviews of these correlates. These reviewers have generally reported that CSA is associated with a wide variety of adjustment problems, and many have additionally implied or concluded that, in the population of persons with CSA experiences, (a) CSA causes psychological harm, (b) this harm is pervasive, (c) this harm is intense, and (d) boys and girls experience CSA equivalently. However, with few exceptions, these reviewers have included in their reviews mostly studies using clinical and legal samples; these samples cannot be assumed to be representative of the general population. To evaluate the implications and conclusions of these reviewers, we conducted a literature review of seven studies using national probability samples, which are more appropriate for making population inferences. We found that, contrary to the implications and conclusions contained in previous literature reviews that were focused on biased samples, in the general population. CSA is not associated with pervasive harm and that harm, when it occurs, is not typically intense. Further, CSA experiences for males and females are not equivalent: a substantially lower proportion of males reports negative effects. Finally, we found that conclusions about a causal link between CSA and later psychological maladjustment in the general population cannot safely be made because of the reliable presence of confounding variables. We concluded by cautioning that analysis at the population level does not characterize individual cases: When CSA is accompanied by factors such as force or close familial ties, it has the potential to produce significant harm.
This study begins by examining 15 reviews of the literature on CSA published between 1986 and 1995. The authors write:
Among the literature reviews just cited, the authors typically have concluded that CSA is associated with a wide range of psychological problems, including anger, relationship difficulties, depression, inappropriate sexual behavior, aggression, anxiety, self-mutilation, eating disorders, suicide, alcohol and drug abuse, low self-esteem, dissociation, and post traumatic stress disorder among others. Additionally, the typical literature review has asserted or implied that (a) CSA causes these problems, (b) these problems occur pervasively throughout the population of persons who have experienced CSA, (c) these problems are generally intense (i.e., severe), and (d) the CSA experiences of boys and girls are equivalent in terms of pervasiveness and intensity of harm.
However, many of the literature reviews relied heavily on studies with clinical or legal samples which are not representative of the general population. College samples are likely to be more representative, and studies using college samples are widely available, yet most of these studies were excluded from the reviews.
Earlier, Okami (1991) had found that clinical subjects suffered from a variety of adjustment problems that were substantially more pronounced compared to other subjects, including nonclinical subjects who had experienced CSA negatively. Similarly, Jumper (1995) showed that while CSA accounted for nearly 10% of the adjustment variance in the clinical samples, it accounted for only 0.5% of the adjustment variance in the college samples.
Furthermore, clinical or legal studies incorrectly imply that the existence of correlations is a sufficient basis to claim causation. However, the possible presence of “confounding variables” renders such a conclusion invalid. Nineteen studies published since 1987 found that CSA tends to be confounded with other factors that are likely to affect later psychological adjustment.
Researchers who have statistically controlled for variables such as emotional neglect, physical abuse, psychological abuse, and general family disruption have tended to find that the relationship between CSA and maladjustment disappears.
In addition, most of the past reviews of the literature have been narrative and qualitative, but as Jumper (1995) noted, conclusions drawn from this method are vulnerable to being subjective and imprecise. In fact, some authors, when finding no negative effects, have attempted to explain why they might still exist.
To rectify the shortcomings of reviews conducted so far, the authors of this study conducted a quantitative analysis of the statistical findings of studies using national samples.
The authors searched as widely as possible for all studies of the effects of CSA using national samples. Seventeen such studies were found, but only seven were available for analysis and met the following criteria: (a) the study had to include both male and female respondents, (b) the study had to present either summaries of self-reported effects or measures of psychological or sexual adjustment, (c) these summaries had to be reported separately for male and female respondents, (d) researchers who reported results of measures of adjustment had to have included a control group, and (e) the self-reported effects or the adjustment data had to be presented quantitatively. These seven studies came from four countries (four from the U.S. and one each from Canada, the U.K., and Spain).
Three of the seven studies directly asked subjects to report the effects of CSA on their lives. The study by Badgley et al. (1984) involved 1002 men and 1006 women. It reported the following results:
Baker and Duncan's (1985) study involved 834 male subjects and 923 female subjects.
Laumann et al. (1994) studied 273 women and 134 men who had been sexually touched.
The authors conclude:
Five studies measured psychological and sexual adjustment in adulthood. Bigler's (1992) study examined 140 men and 174 women, and found that:
Boney-McCoy and Finkelhor (1995) found that “respondents who reported unwanted sexual experiences with peers or older persons showed poorer adjustment compared to controls in all four areas measured: post-traumatic stress disorder (PTSD) related symptomatology, sadness, lifetime depression, and trouble with teachers.”
Laumann et al. (1994) found the following:
López et al. (1995) found:
Finkelhor et al. (1989) found:
The authors summarize the results of the five studies as follows:
The results of the meta-analyses show that, in the national samples that included measures of psychological or sexual adjustment, CSA was related to adjustment problems for both genders, but the magnitudes of these relations were small. Therefore, if these CSA-adjustment relations reflected effects, rather than just correlates, of CSA, then the effects were on average of low intensity.
Based on the studies in this review, 11% of males and 19% of females experience CSA. A consistent finding was that females had higher levels of negative responses to CSA than males did; about two thirds of females and 2 in 5 males reported negative effects.
Males were far less likely to be coerced in their CSA experience, females were far more likely to experience incest, and females were more likely to be younger during their first CSA experience. Thus, males and females may have different responses to these experiences because they typically do not have the same type of experience.
In addition, self-reported effects data contradict the implications of previous literature reviews that harmful effects of CSA are pervasive and intense among those who experience it. These findings are consistent with those of studies using college samples, but not with those of clinical studies. Therefore, clinical samples cannot be used to make valid estimates of psychological correlates of CSA in the general population.
There is also reason to doubt that a correlation between CSA and adjustment problems is necessarily evidence of a causal connection. Other research has shown that CSA often occurs along with physical abuse or emotional neglect and that when these other experiences are held constant, CSA-symptom relations frequently disappear.
There were some limitations to the studies used in this meta-analysis. Some subjects may have been unaware of negative effects of CSA on their lives and thus were unable to report it. On the other hand, other subjects might have inaccurately attributed negative effects to CSA experiences when, in fact, there were other causes for those effects. Thus there may be as much reason to believe that current studies overestimate effects as there is to believe they underestimate them.
The authors conclude:
Results from psychological adjustment measures imply that, although CSA is related to poorer adjustment in the general population, the magnitude of this relation is small. Further, data on confounding variables imply that this small relation cannot safely be assumed to reflect causal effects of the CSA.
Browne and Finkelhor (1986, p. 178) cautioned “advocates not [to] exaggerate or overstate the intensity or inevitability of [CSA] consequences,” because such exaggeration has iatrogenic potential. Despite this caution, child abuse researchers have tended to depict CSA as a “special destroyer of adult mental health” (Seligman, 1994, p. 232). McMillen, Zuravin, and Rideout (1995, p. 1037) recently commented that the “experience of child sexual abuse is a traumatic event for which there may be few peers.”
Results of analyses of the national samples show that such characterizations are exaggerated at the population level. This exaggeration may stem from our culture’s tendency to equate wrongfulness with harmfulness in sexual matters (Money, 1979). CSA is violative of norms and laws in our culture; these facts, however, do not imply its harmfulness in a scientific or psychological sense (Kilpatrick, 1987).
It is important to add to this discussion of exaggeration that understatement is also problematic. CSA is potentially harmful for young persons because of their vulnerability to being misused. The current findings should thus not be interpreted by lay persons as condoning abusive behavior.
When CSA is accompanied by particular dispositional or situational factors, including variables such as temperamental vulnerability, the use of force, or the presence of close familial ties between participants, then CSA might produce intense harm; on the other hand, if temperamental factors are favorable, if the child or adolescent perceives his or her participation to have been willing, or if the sexual experience is essentially trivial or transient, then harm may be absent (Constantine, 1981).
Combining the former and latter types of experiences into one category labeled CSA is problematic, because both negative and neutral effects can become obscured. By moving beyond socio-legal definitions of CSA and employing strictly scientific definitions (cf. Ames & Houston, 1990; Rind & Bauserman, 1993), researchers can better describe psychological correlates of the heterogeneous collection of experiences currently labeled as CSA.