Annotated Bibliography

Alaggia, R. (2001). Cultural and religious influences in maternal response to intrafamilial child sexual abuse: Charting new territory for research and treatment. Child Sexual Abuse, 10 (2), 41-60. Retrieved July 15, 2005, from PubMed database. (PMID: 15149935)
Reports findings from interviews with ten mothers. Describes their emotional and behavioral response to child’s disclosure of sexual abuse and reveals cultural and religious beliefs that affect maternal support. Discusses barriers to providing effective treatment for mothers with rigid patriarchal beliefs.

Alaggia, R. (2002). Balancing acts: Reconceptualizing support in maternal response to intra-familial child sexual abuse. Clinical Social Work Journal, 30 (1), 41-57. Retrieved June 8, 2005, from ProQuest Psychology Journals database. (Document ID: 15293944) 
Analyzes interviews with ten mothers of sexually abused children. Expands evaluative model regarding mother’s belief and support of child. Views maternal support as multidimensional and fluid. Discusses professional judgments, countertransference, engagement strategies, and interventions.

Alaggia, R., & Kirshenbaum, S. (2005). Speaking the unspeakable: Exploring the impact of family dynamics on child sexual abuse disclosures. Families in Society, 86 (2), 227-234. Retrieved August 13, 2005, from ProQuest Psychology Journals database. (Document ID: 846327251)
Utilizes interviews with 20 male and female child sexual abuse survivors to obtain retrospective data. Reveals disclosure barriers for children: rigid, patriarchal family, family violence, closed communication, and isolation. Stresses importance of identification of these barriers during assessment and suggests interventions.

Allers, C.T., Benjack, K.J., & Allers, N.T. (1992). Unresolved childhood sexual abuse: Are older adults affected? Journal of Counseling and Development 71(1), 14-17.
Discusses characteristics of unresolved childhood sexual abuse in adults over 65 years old. Continued effects include: chronic depression, elder abuse, and misdiagnosis of dementia or mental illness.

Armsworth, M.W., & Stronck, K. (1999). Intergenerational effects of incest on parenting: Skills, abilities, and attitudes. Journal of Counseling and Development, 77(3), 303-314.
Discusses posttraumatic stress symptoms and other effects related to childhood sexual abuse, including developmental effects, impairment in attachment, and failure to acquire competence in interpersonal relating, negatively affecting parenting ability. Learning relational patterns are passed down through generations. Describes malevolent socializing environments that include shame, humiliation, abandonment, lack of protection, and observed abuse. Resulting disorders include anxiety, depression, memory loss, panic attacks, self-mutilation, suicidal thoughts and attempts.

Banerjea, P. (2001). The relationship between non-offending mothers of female incest victims and the perpetrators: A qualitative study. Dissertation Abstracts International, 61 (10), 5550B. Retrieved June 11, 2005, from PsycINFO Database with Full Text database. (Document ID: 200195008340)
Reports findings from interviews of five nonoffending mothers whose daughters were sexually abused by their partners. Reveals that all five had Post-Traumatic Stress Disorder and felt powerless, isolated, stressed, and over-responsible. Four of five had experienced domestic violence. Stresses that despite mother’s vulnerability, all took protective action towards their daughters.

Banyard, V.L., Englund, D.W., & Rozelle, D. (2001). Parenting the traumatized child: Attending to the needs of nonoffending caregivers of traumatized children. Psychotherapy, 38 (1), 74-87. Retrieved from Biblioline Basic database:
Reviews intervention model for working with caregivers of traumatized children and discusses stress incurred by caregiver. Useful in recognition of mother’s stress following disclosure and generalizes to mothers as primary caregiver of child who has experienced sexual trauma.

Bell, P. (2002). Factors contributing to a mother’s ability to recognize incestuous abuse of her child. Women’s Studies International Forum, 25 (3), 347-357. Retrieved from ProQuest database:
Reports findings from research conducted with mothers in incestuous family systems. Discusses professional blaming of mother for lack of recognition of sexual abuse of child. Identifies relationship with perpetrator and effect of domestic violence as factors contributing to lack of awareness that sexual abuse occurring. .

Bolen, R.M. (2001). Child sexual abuse: Its scope and our failure. New York: Kluwer Academic.
Discusses nonoffending guardians in chapter 10. Makes recommendations for treatment needs of nonoffending guardians. Discusses normative response of ambivalence and need for systemic understanding of stressors on nonoffending guardians.

Bolen, R. M. (2003). Nonoffending mothers of sexually abused children: A case of institutionalized sexism? Violence Against Women, 9 (11), 1336-1366. Abstract retrieved June 8, 2005, from PsycINFO Database with Full Text database. (Document ID: 200309981003)
Discusses recent studies reporting higher percentage of female offenders. Explores contradiction and historical representation of mother as nonoffending. Examines overidentification of mothers in current sexual abuse cases, provides insight, and suggests corrective action.

Bolen, R.M., & Lamb, J.L. (2002). Guardian support of sexually abused children: A study of its predictors. Child Maltreatment, 7 (3), 265-276. Retrieved from ProQuest Psychology Journals database:
Reports research findings in study of guardians of sexually abused children. Presents variables that predict lack of support available to child as stressors on guardians and communication patterns in family. Discusses complexity in guardian reaction.

Bolen, R.M., & Lamb, J.L. (2004). Ambivalence of nonoffending guardians after child sexual abuse disclosure. Journal of Interpersonal Violence, 19 (2), 185. Abstract retrieved June 15, 2005, from ProQuest Psychology Journals database. (Document ID: 608275181)
Examines maternal support following disclosure in a study of 30 mothers whose partners sexually abused their children. Associates attachment to the child and to perpetrator and cost of disclosure to ambivalence in support.

Bolen, R.M., & Lamb, J.L. (2007). Can nonoffending mothers of sexually abused children be both ambivalent and supportive? Child Maltreatment, 12(2), 191-197.
Studies 29 nonoffending mothers whose partners sexually abused their children to determine if post-disclosure maternal ambivalence and support could coexist. Findings showed that increased security in attachment is related to increased predisclosure stress, increased maternal support, and less ambivalence; attachment security is related to attachment type; preoccupation with attachment is related to increased distress and ambivalence; predisclosure stress is related to decreased maternal support; postdisclosure stress is related to increased maternal support an ddistress; and distress is related to increased ambivalence and less maternal support. Authors recommend understanding that post-disclosure responses in nonoffending parents are complex and interrelated to multiple factors and that more strength-based response to non-offending parents be developed.

Breckenridge, J., & Baldry, E. (1997). Workers dealing with mother blame in child sexual assault cases. Journal of Child Sexual Abuse, 6(1), 65-80.
Provides a feminist analysis of power relationships in evaluating workers and their blaming of mothers for CSA. Workers apply their beliefs and attitudes to cases, and research shows that a majority believe that mothers knew about the abuse. They remove children from mothers' care based on belief and judgment of negligence, and, when mother reports, in not knowing or reacting sooner. Mother blame shifts responsibility away from the perpetrator the sexual abuse. Feminist analysis analyses the power differential between adults and children and men and women and how this influences relationships.

Bremner, J.D., Narayan, M., Staib, L.H., Southwick, S.M., McGlashan, T., & Charney, D.S. (1999). Neural correlates of memories of childhood sexual abuse in women with and without posttraumatic stress disorder. The American Journal of Psychiatry, 156(11), 1787-1795.
Reports results of study examining long-term effects of child sexual abuse on brain function. Showed that memories of child sexual abuse were associated with specific brain images. Comparisons between women with and without PTSD showed dysfunction of the medial prefrontal cortex, hippocampus, and visual association cortex in women with PTSD.

Briere, J.N., & Elliott, D.M. (1994). Immediate and long-term impacts of child sexual abuse. Sexual Abuse of Children, 4(2), 54-69.
Summarizes literature regarding long-term impact of CSA. Concludes that CSA is a major risk factor for posttrauamtic stress symptoms, cognitive distortions, emotional pain, depression, anxiety, anger, avoidance, dissociation, addictions, suicide, self-mutilation, compulsive sexual acting-out, eating disorders, impaired sense of self, and interpersonal relationship difficulties. Manifests in somatic symptoms, including headaches, stomach pain, asthma, bladder infections, and chronic pelvic pain. Mediating factors include age, period of abuse, incest, use of force, number of perpetrators, other types of abuse, revictimization, family characteristics, parent response, and attachment.

Brohl, K., & Potter, J.C. (2004). When your child has been molested: A parent’s guide to healing and recovery. San Francisco: Jossey-Bass.
Provides information and advice to parents whose children have been sexually abused. Includes recent research, effects of sexual abuse, and suggestions for therapy and recovery. Offers strategies for supporting child and parent. Presents suggestions for parents to use in coping with aftermath of disclosure.

Carter, B. (1993). Child sexual abuse: Impact on mothers. Affilia, 8(1), 72-90.
Carter's qualitative study is one of the first to explore post-disclosure consequences to mothers and examine effect of blaming the mother for the abuse. The study included (a) in-depth interviews with 24 mothers following disclosure of their children's sexual abuse; (b) interviews with 15 experts in the field of sexual abuse, child welfare, and women's studies; and (c) analysis of case records in child welfare agency. The majority of these mothers did not know about the abuse and after disclosure experienced fear that they would lose the children. All but one mother initially believed the disclosure. Anger was intense. The process of disclosure was ongoing. Although the majority of mothers reported the abuse to authorities, they perceived professional responses to be punitive and disrespectful. Mothers also received negative and punitive treatment from family members, friends, and employers. The effect of disclosure included trauma and negative psychological, social, and economic consequences. They experienced shock, difficulty with day-to-day function, sadness, confusion, ostracizing, isolation, lack of support, and loss. The author views treatment of mothers as sexist and discriminatory and considers this phenomenon to be consequence of larger social, economic, and political contexts.

Classen, C., Nevo, R., Koopman, C. Nevill-Manning, K., Gore-Felton, C., Rose, D.S., et al. (2002). Recent stressful events, sexual victimization, and their relationship with traumatic stress symptoms among women sexually abused in childhood. Journal of Interpersonal Violence, 17, 1274-1290.
Conducts a cross-sectional study of fifty-eight women, sexually abused as children, and meeting criteria for PTSD. Survivors of CSA are likely to experience trauma symptoms in adulthood, such as depression, suicidality, anxiety disorders, dissociative experiences, relationship problems, sleep problems, and borderline personality disorder. A history of exposure to extreme psychological stress increases vulnerability to psychological distress during adult stressful events. The model of “sensitization” (p. 1276) posits that the trauma experience initiates symptoms, and repeated stressful events during the lifetime cause progressive sensitivity to being symptomatic. Findings showed significant relationships between recent life stress and total ASD severity. Anxiety, dissociation, sexual problems, and sleep disturbance were each related to recent life stress. Dissociation and re-experiencing were significantly related to recent life stress. Re-experiencing, avoidance, and hypervigilance were significantly related to recent life stress. Results support the sensitization hypothesis that traumatic stress symptoms are exacerbated by other life stressors among women who have PTSD as consequence of CSA. A cumulative effect of life stress on stress symptoms due to sensitization may increase emotional and behavioral reactions to later life stressors. These results are informative and show the need to assist CSA survivors in reducing and managing daily stressors. Study limitations include the potential that current symptoms may have affected subjects' report, lack of control group, and lack of representative sample.

Coohey, C., & O'Leary, P. (2008). Mothers' protection of their children after discovering they have been sexually abused: An information-processing perspective. Child Abuse & Neglect, 32(2), 245-259.
Investigates reasons that some non-offending mothers did not protect their children after sexual abuse was disclosed. Maternal support is a predictor of the psychological adjustment of child victims. Eighty-five mothers involved in child protective services were compared in two groups: 48 mothers who were consistent in protecting their children and 37 mothers who did not protect their children. The authors present a conceptual framework for understanding a mother’s protection of her child. Crittenden’s (1993) Cognitive Theory of Information-Processing states that information-processing begins when the child signals an unmet need. Mothers may receive messages of child sexual abuse from many sources. Protectiveness was defined as “actions that minimize contact between the abuser and the child” (p. 250). Measurements assessed (a) time, source of, and mother’s response to disclosure of abuse; (b) mother and child’s relationship to offender, (c) mother’s beliefs and attributions, (d) mother’s substance abuse, mental health, and domestic violence; and (d) characteristics of the abuse. Fifteen variables were related to whether mother protected her child, and fourteen of these variables were included in a stepwise regression. Seven variables explained 47-63% of the variance (depending on statistic). The model fit was good (model chi-square = 53.1, p = .0001; -2 likelihood = 62.2; positive prediction; 87%). All odds ratios were large. The strongest predictor of consistent protection was if the mother believed the child’s disclosure of abuse. If belief was present, mothers were 8.48 times more likely to provide consistent protection. The next most significant predictor was domestic violence. If mothers were not in violent relationships, they were six times more likely to protect the child. Other variables providing significant variance included whether the mother asked the child about the abuse, did not see or hear the abuse, and did not ask the abuser about the abuse. Mothers who asked their children about the abuse were six times more likely to protect them consistently. Mothers who did not see or hear abuse were five times more likely to provide consistent protection. Mothers who did not talk to the abuser were four times more likely to protect the child. If the mother attributed the responsibility for the abuse to the abuser, she was five times more likely to protect the child. Mothers were more likely to protect children when they had known about the abuse for less time. 

Corcoran, J. (1998). In defense of mothers of sexual abuse victims. Families in Society, 79(4), 358-369.
Reviews empirical and clinical literature related to mothers of sexual abuse victims. The importance of maternal support was emphasized, and factors contributing to maternal belief at the time of disclosure, explored. At that time, the most recent literature challenged earlier work that emphasized the mother's culpability. Corcoran discusses societal biases that contributed to mother-blaming and its effect on mothers and their ability to protect their children. The article reviews literature since 1979 that focused on maternal culpability. It explores literature outlining the short and long-term consequences of sexual abuse and presents risk factors for increased negative effects. Literature regarding maternal distress and post-disclosure adjustment is reviewed. Short and long-term consequences in mothers following disclosure are explored, with a significant body of literature reflecting the stress, trauma, negative social, emotional, and economic consequences, somatization, and psychological symptoms and disorders. Literature is reviewed regarding maternal support, with most mothers believing the disclosure, supporting the victim, being appropriately protective, and supporting the victim. In Everson et al.'s use of the Parental Reaction to Incest Disclosure Scale (PRIDS), support is comprised of belief, emotional support, and protective action. 44% were found to be consistently supportive, and 32% found to be ambivalent. The mother's relationship to the offender is the associated variable. More recent studies of the relationship between ambivalence and support, this finding does not reflect upon the mother's ability to protect as much as it reflects the internal distress and conflict she experiences. Studies also found that maternal disbelief was associated with the offender's denial, increasing the mother's conflict and internal struggle. "Nonoffending mothers of sexually abused children are victims in their own right from biased social expectations as well as societal conditions that incapacitate their abilities to protect their children" (p. 367). Corcoran reviewed other factors associated with sexual abuse including child characteristics, mother's history of victimization (e.g., domestic violence, childhood sexual abuse), and other family problems (e.g., substance abuse). In the discussion, Corcoran emphasizes societal biases and simplistic generalizations regarding mothers and the growing body of literature that challenges these assumptions.

Corcoran, J. (2004). Treatment outcome research with non-offending parents of sexually abused children: A critical review. Journal of Child Sexual Abuse, 13 (2), 59-84. Retrieved from Biblioline Basic database:
Reviews treatment outcomes with nonoffending parents. Organizes studies according to child’s age and makes recommendations for services to nonoffending parents. Discusses importance of maternal support to sexually abused child and need for effective interventions to improve mother’s adjustment and ability to support child after disclosure.

Courtois, C.A. (2000). The sexual after-effects of incest/child sexual abuse. Siecus Report, 29(1), 11-16.
Reviews sexual effects of CSA, including negative attitudes about sex, dissociation, and compulsive sexual behaviors. Sexual behaviors are found to be a major trigger for abuse survivors. Dissociation keeps compulsive sexual behaviors out of awareness. Sexual consequences in adults include: aversion to sex, difficulty in sexual function, and negative connotations regarding sex,  

Cross, W. (2001). A personal history of childhood sexual abuse: Parenting patterns and problems. Clinical Child Psychology and Psychiatry, 6(4), 563-574.
Reviews studies addressing parenting problems in mothers of sexually abused children and conducts a survey of new patients at an outpatient mental health facility. Approximately 22% of the 114 respondents identified with histories of CSA. A focus group with these patients revealed common themes, including trust, questions of normal childhood development, boundaries, effective parenting, and jealousy. The study concludes that distressed mothers are not the identified patient when children present as CSA victims or mental health problems. Therefore, their history and its effect on parenting are not discovered or treated. The prevalence of CSA in the United States is "shockingly common" (p. 564), and mothers play a primary role in caring for children. These mothers are often unaware of the effects of their own CSA on care of children when they are sexually abused. The article addresses the transgenerational cycles of CSA and the increased likelihood of victims' children experiencing CSA. The case history illustrates the stress and health effects occurring in the mother the child discloses CSA. The mother's ensuing illness results in the child victim having to care for the mother. Only after further inquiry does it surface that this mother had also been a CSA victim. Cross provides recommendations for interventions with mothers which include consideration of the family context when children are being treated, assessment instruments, parenting skills-training, and group treatment for mothers.

Crowley, M. S., & Seery, B. L. (2001). Exploring the multiplicity of childhood sexual abuse with a focus on polyincestuous contexts of abuse. Journal of Child Sexual Abuse, 10 (4), 91-110. Retrieved June 8, 2005, from ProQuest Psychology Journals database (Document ID: 148173101)
Studies 88 adult women and reports sexual abuse prevalence rates. Reveals significant percentage of sample who experienced multiple abuse episodes or polyincest (intrafamilial incest involving more than one family perpetrator or more than one victim).

Cyr, M., Wright, J., Toupin, J., Oxman-Martinez, J., et al. (2003). Predictors of maternal support: The point of view of adolescent victims of sexual abuse and their mothers. Journal of Child Sexual Abuse, 12 (1), 39-65. Retrieved June 8, 2005, from ProQuest Psychology Journals database. (Document ID: 569259431)
Reports study of 120 adolescent sexual abuse victims and their mothers. Evaluates characteristics of mother, victim, abuse, and disclosure as predictors of maternal support. Stresses importance of maternal support for improved function of child. Claims predictors of maternal support as mother and victim’s psychological health and family environment. Stresses need for professional evaluation of these variables.

Deblinger, E., Stauffer, L.B., & Steer, R.A. (2001). Comparative efficacies of supportive and cognitive behavioral group therapies for young children who have been sexually abused and their nonoffending mothers. Child Maltreatment, 6 (4), 332-343. Retrieved June 9, 2005, from PubMed database. (PMID: 11999103)
Discusses findings of study involving mothers and children in support or cognitive behavioral treatment groups. Assigns 44 sexually abused children and their nonoffending mothers to groups and analyzes effect of participation. Reports positive effect of cognitive behavioral treatment. Claims reduction in mothers’ intrusive thoughts and negative parenting responses. Reports improvement in children’s knowledge of body safety skills.

Deblinger, E., Steer, R.A., & Lippmann, J. (1999). Maternal factors associated with sexually abused children's psychosocial adjustment. Child Maltreatment, 4(1), 13-20.
Studies factors associated with maternal support of children who had disclosed CSA and its effect on the child’s psychosocial adjustment. A battery of measures was administered to 100 children and their nonabusing mothers. Findings showed that maternal characteristics contributed variance to child adjustment scores. Maternal depression scores were positively related to the child’s PTSD symptoms and internalizing behaviors. Children’s perceptions of the mother’s parenting style contributed to depression symptoms in the child.

Deblinger, E., Taub, B., Maedel, A.B., Lippmann, J., & Stauffer, L.B. (1997). Psychosocial factors predicting parent reported symptomology in sexually abused children. Journal of Child Sexual Abuse, 6(4), 35-49.
Studies factors associated with mothers' reports of symptoms experienced by their children who had experienced CSA. They also explored mothers' belief of the allegations and their symptom distress. The sample consisted of 96 mothers, and alleged perpetrators were identified as fathers or stepfathers (31%), trusted adults (53%), and siblings or older peers (16%). Mothers reported complete belief of sexual abuse allegations (78%) and some aspects of allegations (85%), while 15% doubted veracity of allegation. In cases in which partner was the perpetrator, 49% were already separated or divorced, and 29% separated after the allegations. Findings showed that maternal belief in the sexual abuse allegations was directly related to the number of PTSD symptoms mothers observed in their children. When mothers believed, they reported higher number of observed symptoms. Findings suggest the importance of maternal belief.

DiLillo, D., & Damashek, A. (2003). Parenting characteristics of women reporting a history of childhood sexual abuse. Child Maltreatment, 8(4), 319-333.
Reviews literature on the parenting characteristics of mothers who have history of CSA. The authors consider the following aspects of parenting: childbearing patterns, intergenerational transmission of CSA, maternal reactions to disclosure of CSA, parenting skills and behaviors, parental violence towards children, attitudes towards parenting, and adjustment of the children (whose mother is CSA survivor). The literature is contradictory on all parenting aspects, and the authors conclude that research of mothers is in a nascent stage. Some evidence points to parenting deficits in the areas reviewed, but findings are neither consistent nor robust. One finding of note: mothers with a history of chronic CSA have a 25:1 increased odds ratio of involvement with CPS, and mothers with history of even one incident of CSA are 2.6 times more likely to have contact with CSA. Other notable comments: these mothers tend to report less balanced perception of parenting than mothers without CSA history and have greater anxiety and apprehension about parenting. Children of mothers with CSA histories also experience increased problems, including greater psychopathology.

Edwards, C.N. (2008). Feelings and health effects experienced by non-offending mothers whose prepubescent daughters disclosed sexual abuse by a known perpetrator (Doctoral dissertation, Texas Women's University, School of Nursing). AAT 3347059.
Conducts a qualitative study of 12 nonoffending mothers of daughters who experienced CSA. Both feelings and health effects were examined. The author discusses mother-blaming, secondary victimization, and emotional consequences to mothers following disclosure. Research questions were: (a) what are initial feelings experienced by mothers? (b) what effect did these feelings have on mothers' health? (c) how did these feelings change over time? The author states that there is a "void of information on the perceived health effects for non-offending mothers resulting from their child's sexual abuse" (p. 12). Literature review includes: (a) parental response to CSA, (b) health effects on non-offending mothers, and (c) mother/child relationships after disclosure of sexual abuse. Only one study has examined health effects of disclosure (De Jong, 1988). In this study of 12 mothers, the author identifies an overarching theme: Process of Surviving and three patterns: Mixed Feelings, Changed Health, and Resolution. Each pattern contained themes and sub-themes (p. 38). These included intense feelings toward the sexual assault, toward the perpetrator, and toward self; feelings included: shock and disbelief, anger, violent impulses, hate, fear, and self-blame; effects on psychological, physical, and behavioral health; and living through the abuse, moving on with life, letting go, and finding peace. In this study all but three women experienced physical health changes

Elbow, M. & Mayfield, J. (1991). Mothers of incest victims: Villains, victims, or protectors? Families in Society, 72, 78-86.
Reviews expectations and professional judgments of mothers of CSA victims and explore alternative views. Although most mothers exhibit crisis symptoms, they are expected to immediately take protective action, and "failure to act decisively may contribute to characterization of mothers of incest victims as passive, weak, dependent, or even collusive" (p. 78). The authors, workers in child protective and family services, reviewed 24 cases of validated father-daughter incest that included chain of reporting and maternal responses to CSA disclosure. The review revealed that mothers do believe their children's reports, and that workers need to consider the possibility that mothers attempted to protect and may be capable of protecting their children in the future. The authors discuss crisis theories: the effect of events requiring sudden changes in thinking and behavior patterns, stress, and the effect on coping abilities. When a mother learns of a child's sexual abuse, she must assess accuracy of the information, determine the meaning of the event to herself and family, decide what to do, and locate and use resources. She must be able to interpret clues. Attribution of meaning of sign or symptom tends to be to familiar or explainable source. "That a parent would sexually abuse a child may be incomprehensible to a mother who has no reason to suspect that her husband would harm his child" (p. 81).

Elliott, A. N., & Carnes, C. N. (2001). Reactions of nonoffending parents to the sexual abuse of their child: A review of the literature. Child Maltreatment, 6 (4), 314-331. Retrieved June 8, 2005, from ProQuest Psychology Journals database. (Document ID: 84656262)
Reviews literature regarding nonoffending parent’s response to disclosure of child’s sexual abuse. Argues that most common maternal response to sexual abuse disclosure by child is to believe the report, either partially or completely.

Ensink, B.J., Van Berlo, W., & Winkel, F.W. (2000). Secrecy and persistent problems in sexual assault victims. International Criminal Justice Review, 10(1), 81-97.
Examines correlations between postponed disclosure and health problems. Postponed disclosures predicted psychosomatic complaints and use of medication. Disclosure is more common when the perpetrator is a stranger. Emotional processes such as shame, numbness, and alexithymia are barriers to reporting. Ninety-one percent of sexual assault survivors experience shame (Dahl, 1993). Numbness following trauma is a transient emotional constriction that may interfere with reporting. Alexithymia is a more permanent emotional constriction that inhibits the ability to identify and communicate emotional experiences. Secrecy is the deliberate withholding of emotional information and the most severe impairment. It may create obsessive preoccupation with the event. Not sharing severe trauma may lead to negative health outcomes. Short-term inhibition of strong negative emotions results in increased autonomic nervous system activity. Long-term inhibition is a general biological stressor. Nondisclosure may result in "emotional faking," (p. 82) with victims pretending nothing has happened, resulting in social isolation, detachment, and alienation. Studied 36 sexual assault victims, investigating sharing and long-term problems. Questions included topic areas and instruments: assault characteristics, perpetrator, postponed sharing, intensity of shame, constriction of emotions, PTSD symptoms, health problems, and lack of empathic relationships. Notable was finding that frequency of contact with perpetrator predicted disclosure. Postponed sharing predicted frequency of medical visits. Initial numbness predicted use of medication. Initial feelings of shame predicted frequency of doctor visits. In a second study, subjects (n = 33) reported on events occurring eight years prior. Instruments assessed traumatic memories, somatization, medical visits, medication use, empathic relationships, and satisfaction with support. Variation in postponed sharing differed by type of perpetrator. Factors that impaired sharing included intensity of shame, numbness, and alexithymia. Persistent intrusions of traumatic memories was associated with postponed sharing. Numbness contributed significantly to this outcome. Postponed sharing, numbness, alexithymia, and intensity of feelings of shame were associated with postponed sharing. Postponed sharing predicted somatization and use of medication. Postponed sharing predicted medical problems. Findings are robust, suggesting that the time interval between assault and disclosure is important variable predicting health problems. Secrecy is viewed as stressor inhibiting expression of feelings and impacting health. Long-lasting inhibition predicts chronic health problems. Neurohormonal processing linked to numb feelings are linked to neurohormonal processes hampering physical health of assault survivors. Results show the importance of disclosure as early as possible as traumatic event.

Esparza, D. (1993). Maternal support and stress response in sexually abused girls ages 6-12. Issues in Mental Health Nursing, 14(1), 85-107.
Examines two groups of mother-daughter pairs to determine differences between groups and relationships between maternal support, maternal stress, and variables related to child. Group I contained 20 mother-daughter pairs in which child was victim of CSA. Group II contained 50 mother-daughter pairs with no disclosure of CSA. Results indicate that when victims receive maternal support, they experience significantly lower levels of stress. Daughters' appraisals of their mothers were mediated by their perceptions of support from their mothers, allowing them to respond more adaptively to the stress of CSA.

Everson, M.D., Hunter, W.M., Runyon, D.K., Edelsohn, G.A., & Coulter, M.L. (1989). Maternal support following disclosure of incest. In Annual progress ihn child psychiatry and child development (pp. 292-305). New York: Brunner/Mazel.
Reports a cross-sectional analysis with the objectives: to determine whether maternal support is associated with child or case characteristics, to determine whether social and institutional response is related to maternal support, and to investigate the relationship between maternal support and child mental health. The sample included 88 victims of intrafamilial CSA and mothers. Children were evaluated within two weeks of disclosure. Measures included the Child Assessment Schedule, Child Behavior Checklist, Parent Form, Parental Reaction to Incest Disclosure Scale (PRIDS). The PRIDS was developed by the authors for this study and included ratings of parental support in three areas: emotional support, belief of child, and action toward perpetrator. The mother did not always participate in completion of the PRIDS, rather the child report and referring child protective services worker provided information for the parental measure. Statistical analysis examined relationships among child, family, and perpetrator characteristics; child disposition and prosecution decisions; and maternal support using t-tests and ANOVA. Results showed that only 44% of mothers were categorized as providing consistent support. Biased reporting on PRIDS can be assumed if parent did not complete measure as child belief and professional belief both assume maternal knowledge of abuse and culpability in CSA. Analyses confirmed the importance of maternal support which was second only to gender (female) as the best single predictor of total psychopathology. Other variables affecting this study include disruption of mother-child relationship due to child's removal from home. Analysis showed that children separated from mother had higher psychopathology. The authors assert the need for increased emphasis on the mother's role in child's recovery, rather than her role in the occurrence of the CSA.

Falerios, L.S. (2001). Mothers of daughters subjected to incest: Differential psychosocial factors affecting maternal supportiveness of the child. Dissertation Abstracts International, 61 (10), 4178A. Retrieved June 11, 2005, from PsycINFO Database with Full Text database. (Document ID: 2001195007154)
Reports findings of study of 98 mothers of sexually abused children. Focuses on identifying factors in mother’s history and current function level that influence maternal support. Seventy-six variables about mothers studied, including demographic data, parenting skill, financial dependence on offender, history of childhood abuse, support system, attitudes of supportiveness, and belief of daughter. Results in only one significant variable: financial dependence on offender.

Faller, K.C. (1988). The myth of the "collusive mother": Variability in the functioning of mothers of victims of intrafamilial sexual abuse. Journal of Interpersonal Violence, 3(2), 190-196.
Describes decision-making in cases involving incest and offers guidelines based on the experience of over 300 cases of sexual abuse. Certain parental characteristics are said to be crucial to decisions about intervention, especially removal of the child from the parental home. For mothers, they are (a) the level of dependency, particularly upon the perpetrator; (b) the degree to which she loves and is nurturing to her children, including victim; and (c) the extent to which she was protective when sexual abuse was disclosed. The mother's independence, her ability to confront the father, to be assertive, and to act on behalf of the children against the father's wishes are critical to the mother's ability to provide safety and protection. Assessment of the relationship with child victim is necessary to predict whether mother and child should stay together. The reaction of the mother at disclosure, whether she believed and acted to protect, are predictive of her ability to provide continuing protection.

Feiring, C., Taska, L., & Chen, K. (2002). Trying to understand why horrible things happen: Attribution, shame, and symptom development following sexual abuse. Child Maltreatment, 7(1), 26-41.
Reports on study of attributions regarding sexual abuse and relationship to psychological symptoms. Self-blaming attributions are related to less self-disclosure, more severe abuse, increased depression and anxiety, and lower self-esteem. Negative appraisals result in increased depression and PTSD. When victims feel blame-worthy, they experience stigmatization, negative feelings and thoughts about themselves. PTSD symptoms are related to victim perception of maternal awarenessof abuse. External perpetrator attritubutions result in lower depression. High levels of shame result in continued vulnerability and increased risk of psychopathology.

Finkelhor, D. (1984). Child sexual abuse: New theory and research. New York: Free Press.
Finkelhor writes about sexual abuse as a social, moral, and psychological issue. He discusses offender and victim, family, effects, consequences, and outlines a model of four preconditions for sexual abuse. In discussing the importance of the mother, he reports the importance of mothers in protecting their daughters. Girls living without their mother are three times more likely to be sexually abused. Other factors in the mother's relationship to daughter place the child at higher risk (e.g. emotionally distant, unaffectionate). Finkelhor states a connection between oppression of wives and abuse of daughters. He explores the criticisms of family therapy's approach to sexual abuse and family therapy's removal of responsibility from the offender and displacing it to victim, mother, or society as a whole. In the family systems model, mothers are seen as unsupportive and unprotective, and they are criticized for mother-blaming. Finkelhor studied the reactions of parents to disclosure of sexual abuse and reported that the predominant immediate reaction was anger at the perpetrator, fear, and guilt. Finkelhor discusses the necessity of removing victim from perpetrator after disclosure to prevent further abuse and retaliation. Finkelhor's four-precondition model is: Precondition I - factors related to motivation to sexually abuse (e.g., emotional congruence, sexual arousal, blockage); Precondition II - Factors predisposing to overcoming internal inhibitors (e.g., alcohol, drugs, impulse disorder); Precondition III - Factors predisposing to overcoming external inhibitors (e.g., mother absent or ill, social isolation, lack of child supervision); and Precondition IV - Factors predisposing to overcoming child's resistance (e.g., child's emotional insecurity or deprivation, child's lack of knowledge about sexual abuse; unusual trust between child/offender; coercion).

Forbes, F., Duffy, J.C., Mok, J., & Lemvig, J. (2003). Early intervention service for non-abusing parents of child sexual abuse. [Electronic version]. British Journal of Psychiatry, 183, 66-72.
Reports results of study of early intervention, assessment, and services to parents of children following sexual abuse disclosure. Confirms high rate of psychological symptoms in parents following disclosure. Recommends treatment interventions.

Ford, H.H., Schindler, C.B., & Medway, F.J. (2001). School professionals’ attributions of blame for child sexual abuse. Journal of School Psychology, 39 (1), 25-44. Retrieved June 8, 2005, from PsycINFO Database with Full Text database. (Document ID: 200114998002)
Reports results of 2 studies examining school professionals’ assignment of blame for sexual abuse to victim, nonoffending mother, and father-offender. Some degree of blame attributed to both victim and nonoffending mother. Recommends professionals be educated about child sexual abuse and importance of not assigning blame.

Gavey, N. Florence, J., Pezaro, S., & Tan, J. (1990). Mother-blaming, the perfect alibi:Family therapy and the mothers of incest survivors. Journal of Femist Therapy, 2(1), 1-25.
Discusses mother-blaming and its incidence among professionals. They specifically identify how family systems approaches continue to take this approach and do not integrate non-family factors into models. The authors present feminist perspectives, noting that the family is not an isolated system. Traditional views of mothers are reviewed (e.g., disordered, mother's role in etiology of CSA, mother playing collusive role, maternal collaboration, failure of mother). One of the many repercussions to this therapeutic stance is that it creates alienation between nonabusive parent and victim and negatively affects maternal support. It also perpetuates sexist views that the mother is responsible for the emotional and physical well-being of all family members and to protect them from abuse and trauma, minimizing the role of fathers as responsible or protective, and over-burdening women. The authors discuss issues faced by mothers of CSA victims, including difficult of coping with knowledge that partner has abused child, including need to cope with emotional reactions (e.g., sadness, guilt, shock, disbelief, denial, anger, disgust, self-blame, helplessness, betrayal); need to cope with effects on self-esteem and self-image; need to cope with feeling for and about abused child (e.g., sadness, grief, empathy, anger, shattering of hopes and dreams); need to cope with personal feelings about abuser; need to care for abused child and needs of others in the family; need to cope with victim's behavioral reactions (e.g., withdrawal, crying, depression, fears, nightmares, bed-wetting, temper tantrums, school problems, conflict with siblings, inappropriate sexual behavior, self-destructive behaviors, such as suicide attempts and substance abuse); need to cope with what to tell family members and interactions with social workers, teachers, counselors, doctors, lawyers, other workers involved in case; need to cope with police and court appearances; need to cope with changes brought about by leaving partner (e.g., moves, changes in finances, changes in jobs, school, community supports); and need to cope with stressor of being secondary victim of the incest. Although it is critical that mothers provide support to the victims, mothers are dealing with extraordinary pressures. Family system approaches need to factor in all relevant variables, provide support to mothers, and hold perpetrators responsible for their behaviors.

Goldsmith, R.E. (2005). Physical and emotional health effects of betrayal trauma: A longitudinal study of young adults, 2004. Dissertation Abstracts International, 65, 4829B.
Conducts a longitudinal study of physical and emotional health effects related to betrayal trauma. Traumatic sequelae (i.e., dissociation, depression, anxiety, and alexithymia) of physical, emotional, or sexual abuse or maltreatment by individuals close to them were investigated. A sample of 185 college students completed baseline surveys at Time 1. The survey contained the scales: Toronto Alexythymia Scale-20 (TAS-20), Brief Betrayal Trauma Survey (BBTS), Child Abuse Trauma Scale (CAT), Trauma Symptom Checklist-40 (TSC-40), Pennebaker Inventory of Limbic Languidness (PILL)m and Relational Health Indices (RHI). Ninety-six subjects completed surveys containing the same scales plus additional questions at Time 2, 18-28 months later. Ordering of the measures was intentional with symptom measures presented before abuse measures. The researcher hypothesized that cognitions regarding abuse would influence symptom endorsement. The victim's relationship to the offender is associated with memory disturbances. Goldsmith discusses chronicity and associated symptom clusters (i.e., persistent sadness, denial, dissociation, rage, self-hypnosis). The literature review outlines cognitive, emotional, physical, social, and neuroanatomical consequences of abuse and discusses complex PTSD. Trauma perpetrated by a person close to the victim results in increased anxiety, depression, and dissociation. These trauma effects were highly positively correlated. At Time 2, abuse perceptions were associated with health complaints and medical help-seeking, anxiety, and depression.  Negative home environments and alexythymia (i.e., difficulty identifying feelings) predicted physical health status at both Time 1 and Time 2. Betrayal trauma is a complex event that results in an array of negative mental and physical health consequences.

Green, J. (1996). Mothers in "incest families": A critique of blame and its destructive sequels. Violence Against Women, 2(3), 322-348.
Discusses attitudes towards mothers in cases of father-daughter incest and mother-blaming. Mothers are portrayed as collusive, submissive, dependent, and abandoning, and is assigned responsibility for the abuse. The mother's "defective personality" (p. 324) has been stated to have driven the husband to incestuous behavior. Her dependency needs and reverse roles with the daughter have been said to motivate her to "delegate her sexual responsibilities to her daughter" (p. 324). She is accused of being "willing to sacrifice her children for spousal affection and support" and has a "masochistic need to be a martyr" that is a factor in the "genesis of incest" (p. 325). Another repetitive theme in the literature is the mother's abandonment of her daughter, in which she fails to nurture her family, leaves her husband and children feeling emotionally abandoned, and creates their vulnerability to incest. It has been postulated that she did these things because she was ill, has a baby, seeks fulfillment outside the home, or works long hours. An accusation of sexual inadequacy is present in the literature, alluding to the mother's frigidity, indifference, and deprivation of satisfaction for the husband. It appears that mothers are responsible for incest partly because "young girls are unsafe in their own homes with their own relatives without an adult female to protect them" (p. 325). When intergenerational transmission of incest is discussed in the literature, the prior victim of incest (mother) is said to "unconsciously replicate the abusive pattern" and her lack of awareness serves the "denial she maintains about her own painful childhood" (p. 326). It has been stated that "the core of the problem" is the mother's sexual abuse although no findings support the majority of mothers having CSA histories. Mothers are re-stigmatized for having been victimized as children. If mothers have been sexually abused, they are accused of insecure attachment to their children as a consequence of their abuse, promoting initiation of incest in her adult home. Mothers are also accused of being "incapable of intimacy" (p. 326) because of their childhood. Mothers are also blamed for not responding adequately or appropriately to their child's disclosure of sexual abuse. Allegations include denial and not taking steps to protect their child because of financial threat, guilt, disbelief, and continued need for reversal role with daughter. Denial is viewed to be the link to the mother's "collaborative stance" (p. 327) concerning incest. The family systems approach views the mother as playing a "pivotal role" (p. 327) in the incest, as family therapists believe it to be the mother's role to protect the child from incest. What is not asked is: what is the father's responsibility? To hold the mother responsible assumes that her only role is constant surveillance of her children. Family therapists also view incest serving to reduce or regulate conflict in the marital dyad. Feminist theory focuses on the social context of the incest, blaming patriarchal system in which men hold the power and women are relatively powerless. Green discusses victims' anger at mothers, their having more negative feelings toward mother than father and more able to have forgiving feelings towards father than mother. The deep rage of daughters is ascribed to the perception of power that the mother has, with the mother imagined by the child to be "source of everything good and bad" (p. 332). Many daughters believed that their mothers knew about the incest prior to the disclosure. The mother is viewed as "apparently omnipotent" and, because she did not protect, she "committed an unforgivable act of betrayal" (p. 332). Green asserts that mothers of sexually abused daughters are "oppressed by the therapeutic community" (p. 333) as worker views continue to maintain mother blaming. In this environment, mothers are revictimized, and no effective intervention can occur. Green also discusses the "inordinate responsibility on the mother for regulating the behavior of another and societally more powerful adult" (p. 336). The result of mother blaming is often that the mother's grief experience is unrecognized, ignored, or interpreted in negative terms by clinicians.

Greene, S., Haney, C., & Hurtado, A. (2000). Cycles of pain: Risk factors in the lives of incarcerated mothers and their children. The Prison Journal, 80(1), 3-23.
Reports findings from study of 102 incarcerated women to assess risk factors and family consequences related to incarceration. 55% of the women had been sexually abused as children, twice the rate of sexual abuse in the normal population (27%). Approximately one-third of the women had never told anyone about their sexual abuse. 83% of mothers reported that their children had been sexually or physically abused or had observed domestic violence. Results show "cycles of pain."

Hall, J.M. (2003). Dissociative experiences of women child abuse survivors: A selective constructivist review. Trauma, Violence, & Abuse, 4(4), 283-308.
Reviews the literature of dissociation in women abuse survivors from a feminist, constructionist perspective. Reviews historical and current conceptualizations of dissociation. Braun (1988) defined dissociation as “separation of a thought or idea from the mainstream of consciousness” (p.284) and describes four types: dissociation of behavior, affect, sensation, and knowledge. Dissociation occurs on a continuum from simple absorption to dissociative identity disorder (DID). Studies have linked higher levels of dissociation to more frequent abuse, combined physical and sexual abuse, more perpetrators, early age onset of abuse, and other characteristics of the abuse. The author defines and discusses types of dissociative experiences (i.e., amnesia, depersonalization, derealization, identity confusion, identity alteration, low dissociators, and high dissociators). Steinberg (1995) categorized dissociative experiences and posits that amnesia, the attempt to block awareness of the traumatic memory, is the foundation for all forms of dissociation.  Depersonalization is defined as a “feeling of being divorced from the body or feeling like one is moving through life like a robot or automaton”, or for women survivors, “like a doll or a shell of a person” (p. 289). Derealization is defined as “feeling alienated from the environment,” when “people or things around the survivor seem unreal” (p. 289). Past experiences “take the center focus in a flashback” (p. 289). Identity confusion is a “sense of conflict, sexual ambiguity, or uncertainty about identity” (p. 289). Dissociative fugue is defined as “period of time loss when one acts and perhaps even relocates for a time, shifting into a markedly new role or identity,” the person later “awakens” and realizes this occurred” (p. 289). Identity alteration includes DID. Other authors also divide dissociation into high and low categories (i.e., high dissociators, low dissociators). The authors discuss the link between CSA and alexithymia, the “inability to recognize or express feelings” (p. 289). Alexithymia and dissociation are linked to “not feeling safe in the family of origin,” and the “family lacks emotional support,” contributing to development of dissociative symptoms (p. 289). The author discusses the phenomenological understanding of memories, stating that “part of what may be dissociated in ‘forgetting’ abuse are the meanings communicated in the trauma: shame, terror, betrayal, sadism, torture, negation of self-worth, and/or sexualization of nearly all interactions” (p. 293). The authors discuss somatic links to dissociation including somatization disorders that are chronic, painful, and may affect many body systems for years. These disorders are highly associated with trauma histories. Sax et al. (1994) found that 64% of patients with dissociative disorders also had somatization disorders, and no patients without dissociative disorders met criteria for somatization disorders. Studies show women with CSA having more hospitalizations, more ER visits, more health problems, and more unexplained symptoms than patients without CSA histories. It has been concluded that “somatization is either a form of dissociation or that there is a high concurrent incidence of the two.” The author discusses chronic pelvic pain, pain syndromes, eating disorders, pseudoseizures, and self-harm, citing studies linking these disorders to CSA and dissociation. Brain chemistry (i.e., neurotransmitters and memory pathways) is involved in both dissociation and trauma. Dissociation “likely has a psychobiologic basis” (p. 297).

Hebert, M., Daigneault, I., Collin-Vezina, D., & Cyr, M. (2007). Factors linked to distress in mothers of children disclosing sexual abuse. The Journal of Nervous & Mental Disease 195(10), 805-811.
Investigates factors associated with increased distress in mothers of sexually abused children. Abuse-related variables, CSA history, adult domestic violence, coping style, and sense of empowerment were measured in 149 mothers. Assessed whether factors were associated with clinical distress level. More than half (57.9%) have clinical levels of psychological distress. Prevalence of CSA history (51%) and partner violence (26.8%) is considerably higher than community samples and predicts increased levels of distress. Relationship with the perpetrator is linked to distress level. Approach, rather than avoidance-style coping, predicts less maternal distress. Empowerment (i.e., sense of control and self-efficacy in parenting) is important factor in reduced maternal distress.

Hebert, M.,Parent, N., Daigneault, I.V., & Tourigny, M. (2006). A typological analysis of behavioral profiles of sexually abused children. Child Maltreatment, 11(3), 203-216.
Reports results of study with 123 children reporting child sexual abuse when compared to 123 nonabused children. Children were grouped according to test results, with the first group having multiple perpetrators, none the biological father, and physical violence; the second group having short-duration sexual abuse by someone other than biological father and no violence; and the third group having chronic abuse perpetuated by father. Group 3 had more negative outcomes (e.g., delinquency, aggression, depression). The third group was labeled the "severe distress" group.

Hiebert-Murphy, D., & Richert, M. (2000). A parenting group for women dealing with child sexual abuse and substance abuse. [Electronic version]. International Journal of Group Psychotherapy, 50 (3), 397-405.
Describes solution-focused, 12-week parenting group for 29 women whose children have been sexually abused. Reports that women perceived increase in self-esteem, parenting esteem, and improvement in parental attitudes and satisfaction. Stresses women’s strengths and provides positive frame for parenting focus. Suggests discussion of barriers to attendance at group. Recommends goal of balance between validation of mothers and supporting their responses to children’s needs.

Hiebert-Murphy, D. (2000). Factors related to mothers' perceptions of parenting following their children's disclosures of sexual abuse. Child Maltreatment, 5 (3), 251-260. Retrieved June 10, 2005, from ProQuest Psychology Journals database. (Document ID: 57387734)
Reports study of 102 mothers of children who have been sexually abused and disclosed within past year. Examines factors that predict satisfaction and efficacy as a parent: child’s conduct and behavior, support system, and coping strategies.

Hill, A. (2001). "No-one else could understand.": Women's experiences of a support group run by and for mothers of sexually abused children. British Journal of Social Work, 31(3), 385-397.
Describes a study involving women in a peer support group for mothers of sexually abused children. The study had been ongoing for five years and involved 65 women. Eleven of the women participated in unstructured interviews. Findings include maternal response following disclosure as shock, then the universal feeling of guilt, and a sense of failure as mothers. Hill reviews the impact on women: "finding out about the sexual abuse of their children is serious, long lasting and consistently under-estimated by professionals" (p. 385). Women experience multiple losses and have varied emotional reactions, including anger, guilt, and pain. "The effects were something that would never entirely go away" (p. 386) because "it represents a fundamental crisis for women that threatens to be overwhelming and which has seriously disruptive long-term effects on their lives" (p. 386). Most mothers had difficulties in accepting help from family and friends. Nine out of 11 mothers stated that interactions with professionals were not helpful. They felt scrutinized and judged, were unable to be honest with workers about their feelings due to fear of having children removed. Women who attended the support group report relief in finding other people who had experienced similar experiences. They found the groups safe, non-judgmental, and supportive, and felt that the group indirectly helped their children by giving them strength to listen to and support their children and deal with their reactions. They also described the group as an opportunity to give to other women.

Hooper, C.A. (1989). Alternative to collusion: The response of mothers to child sexual abuse in the family. Educational and Child Psychology, 6(1), 22-30.
Describes a research project that explored responses of mothers to disclosure of a child's sexual abuse by her partner or another male family member. The study did not evaluate contributing factors or explanations; rather, it examined the meaning of the CSA to the mother, factors that contributing to ability to believe or disbelieve the report, and her response. The study involved in-depth interviews with 15 mothers whose children had been sexually abused by partners or another male family member. The research was designed within a sociological, rather than a psychological, context. The sample is not representative, but the purpose of the study was to add to the understanding of factors influencing maternal response. When a mother was asked to tell her story, she said, "there's not really a beginning, and there's no end really..." (p. 23). The author discusses the concept of threatened identity, the loss of self, ideas about family and future, role of mother and wife. The author discusses the disclosure process, stating that it was "rarely straightforward and often chaotic, involving for some suspicions, confrontation and denial, conflict over the meaning of behavior, self-doubt, and sometimes uncertainly over who the abuser was" (p. 25). The author discusses maternal coping strategies and action responses, including relationship with the abuser and attempting to understand the decision process from the mother's perspective. Therapeutic strategies are suggested, including focus on mother's perception and experience, self-esteem, information, and group support.

Hsu, E. (2003). Parallel group treatment for sexually abused children and their nonoffending parents: An examination of treatment integrity and child and family outcome and satisfaction. Dissertation Abstracts International, 64 (5), 2390B. Retrieved June 13, 2005, from ProQuest Digital Dissertations database. (Document ID: 765983671)
Examines effects of parallel treatment of nonoffending parent and sexually abused child. Targets areas of self, relationships, sexual knowledge, and abuse with focus on reduced symptoms in child.

Hudson, M.R. (2003). Understanding and treating the non-offending mother in the incest family: A feminist analysis. Dissertation Abstracts International, 64 (5), 2390B. Retrieved June 9, 2005, from PsycINFO Database with Full Text database. (Document ID: 200395022046)
Reviews literature and proposes model of treatment for mothers in incestuous family systems. Provides feminist perspective and critiques traditional models of evaluating these mothers. Explores family of origin, current family, and disclosure issues. Discusses disclosure point as a traumatic event which requires professionals to use non-blaming techniques. Highlights importance of assessment, referral, and treatment. Recommends treatment phases, components, and goals.

Humphreys, J.M. (2004). “Is there a word for extra shock?”: Exploring mothers’ response to their daughters’ disclosure of sexual abuse by mothers’ partners: A project based upon an independent investigation. Unpublished thesis, Smith College, Northampton, MA. Retrieved June 13, 2005, from WorldCat database.
Reports findings of independent research project. Explores responses of mothers whose children have been sexually abused. Discusses effects of disclosure, maternal response, and relationship with offender.

Hunter, J.A., & Figueredo, A.J. (2000). The influence of personality and history of sexual victimization in the prediction of juvenile perpetrated child molestation. Behavior Modification, 24(2), 241-263.
40% to 80% of juvenile sex offenders report history of child sexual abuse. This report gives findings of study of 235 male juvenile offenders. The sample was divided into groups: 1) juvenile sex offenders with history of child sexual abuse; 2) juvenile sex offenders without history of sexual abuse; and 3) juveniles with history of emotional/behavioral maladjustment with no history of sex offending and no history of childhood sexual abuse. Results showed juvenile sex offenders to have deficits in self-esteem, independence, assertiveness, and self-satisfaction. Author concludes that the younger the child at the time of sexual abuse and the more severe the abuse, the more detrimental the effects to the child. They suggest that a younger age of offending behavior may be related to delayed detection and reporting of abuser's own sexual abuse.   

Hunter, S.V. (2006). Understanding the complexity of child sexual abuse: A review of the literature with implications for family counseling. The Family Journal, 14(4), 349-358.
Reports literature review related to scope and long-term consequences of child sexual abuse, gender differences, ad models of child sexual abuse, including theory, mechanism, and effects on adult health. Reports prevalence rates ranging from 2% to 62% of population. States that prevalence rates for men are underestimated. Long-term effects include psychological distress and adult psychopathology, including depression, substance abuse, antisocial behavior, suicide risk, sexual dysfunction, relationship problems, low self-esteem, and revictimization risk. Consequences of child sexual abuse are associated with age of victim, relationship to offender, use of force, other types of abuse, frequency and duration, disability, sexual orientation, family environment, social support, poverty, parenting competence, parental employment status, and parental use of substances. A "dose-related" effect (p. 35) exists between sexual abuse and consequences. Gender affects ability to disclose. Male victims have more depression, anxiety, antisocial personality disorder, and alcohol problems.   Effective coping strategies and resilience buffer negative consequences. Author discusses treatment strategies and emphasizes need for providers to use strength-based rather than deficit model of counseling.  

Jensen, T.K. (2005). The interpretation of signs of child sexual abuse. Culture & Psychology, 11(4), 469-498.
Discusses the interpretation of signs of sexual abuse. A sign is "something present that can stand for something absent on the grounds of a previously established social convention" (p. 471-472). Signs may be words, expressions, tokens, symptoms, or silence, all interpreted within a cultural context. Historically, literature has focused on the responsibility of the mother to report suspicions of child abuse and, if not done, the interpretation of mother's collusion in the abuse. Theories of collusiveness are flawed, however, because of the nature of signs and their interpretation. The cultural situation in which signs are found contraindicates the nature of the suspicion. Jensen states that the discovery of child abuse is both a cultural activity and an individual act of interpretation. Meaning-making is cultural. Jensen's study involved 23 girls and 9 boys and a suspicion of child abuse. Caregiver actions, feelings, and beliefs were examined. The parent's position as sign-interpreter is examined. Nothing is a sign unless it is interpreted to be a sign, containing meaning. Possible signs of sexual abuse may be bodily (e.g., stomach aches, head aches, enuresis); affective (e.g., fear, anxiety, bizarre behaviors); sexual (e.g., sexualized play with toys or other children, excessive masturbation); and verbal (e.g., more or less explicit disclosure). Many parents report seeing several of these signs; however, the signs may have pointed in a different direction. The connection between sign and interpretation is arbitrary. For example, a child may show dislike for yogurt or throw up after eating it. The parent may interpret this as allergy instead of sexual abuse. Verbal utterances may be vague and open to multitude of interpretations. Parent and child have experience in interpreting each other's signs and lean on these experiences when interpreting new signs. The sign of not wanting to visit a parent may be interpreted as something is wrong at parent's home or a sign of autonomy and independence. Sign interpretation is personal, relational, subjective, arbitrary, and changing. Signs can have multiple, contradictory meanings. Jensen outlines interpretive repertoires as a way of analyzing signs. These may be thought of as a lexicon of terms drawn upon to characterize actions, events, and signs. The significance of an action or statement is produced from underlying conventions that people use to decode meaning. Silence is sign but not easy to interpret. Six major types of interpretive repertoires include (a) age repertoire, based on normal child development; (b) personality repertoire, the child's stable personality traits; (c) agency repertoire, the child's strategies, explaining the will or motivation of child; (d) socialization repertoire, links sign to child's everyday learning experiences and child being influenced by what he has seen or heard; (e) parental conflict repertoire, the child's response to adult influence and consequence of parental conflict; (f) parental deficiency repertoire, in which caregivers view their own deficiencies and interpret child's behavior as signs of unhappiness/discontent. Parents use the knowledge of the context of signs and knowledge of child to interpret signs. Sexual abuse is not a normative interpretation for a sign and is outside culturally constructed conventions and ordinary locus of meaning. Caregivers struggle to understand children's behavior, and changes in interpretation are normal. The interpretation of sexual abuse is outside this range of normal interpretation, however, and contains a sense of "horror" (p. 487) because it is both stigmatizing to the child and family and portends severe lifetime consequences (i.e., compare to signs of individual having cancer and desiring alternative interpretation, albeit outside the conscious process). There are culturally sustainable reasons for interpretations other than sexual abuse. Contradictory signs include: (a) children show signs of affection toward alleged perpetrator; (b) apparent virtues of suspected perpetrator; (c) professionals offer alternative interpretations; and (d) the risk of being blamed for stating false accusations. In Jensen's study, caregivers did not adhere to one interpretation but pointed to one or more, with frequent changes of interpretation. Inconsistent interpretations occur when sign has alternative meanings. Interpretation is a complex process, and caregivers struggle to make sense of signs, seeking new information to clarify sign. The process is, therefore, "active, back-and-forth, cyclic information-seeking" (p. 490-491). The result is ambivalence, normal fluctuation in interpretation, and expected. Something that may seen to be obvious sign of CSA retrospectively does not seem so obvious when viewed prospectively. Jensen emphasizes increased understanding of caregivers. Accusations of pathology and collusiveness need to be replaced with understanding of cultural embeddedness of sign interpretation.

Johnson, C.F. (2004). Child sexual abuse. The Lancet, 364, 462-470.
Disusses child sexual abuse, definition, incidence, consequences (e.g., psychological, emotional, physical) physician's role, court appearances, and controversy about child sexual abuse. States that sexual abuse is a worldwide concern and affects 2-62% of women and 3-16% of men in the U.S. Outlines negative consequences in adolescence (e.g., academic performance, depression, dissociation, emotional problems, runaway, hostility, sexualized behavior, somatic problems, substance abuse, PTSD, and suicide attempts) and negative consequences in adulthood (e.g., anxiety, attachment disorder, eating disorders, depression, dissociation, divorce, physical illness, panic disorder, revictimization, sexual dysfunction, STDs and HIV/AIDS, substance abuse, suicide ideation and attempt, and sexual offending), .

Johnson, T.C. (2000). Sexualized children and children who molest. Siecus Report, 29(1), 35-39.
Discusses diagnosis and treatment of children who molest. Of children 12 and younger: 50%-75% of boys have history of child sexual abuse, and 100% of girls have history of child sexual abuse. Children are described as using sex as a way to cope with feelings of abandonment, sadness, anxiety, and despair.

Jonzon, E., & Lindblad, F. (2005). Adult female victims of child sexual abuse: Multitype maltreatment and disclosure characteristics related to subjective health. Journal of Interpersonal Violence, 20(6), 651-666.
Examines the impact of child sexual abuse on adult psychopathological and psychosomatic symptoms. Early trauma results in vulnerability to subsequent stress leading to symptom development through neuroendocrine mechanisms. Victims of child sexual abuse commonly report psychosomatic symptoms (e.g., back pain, pelvin pain, gastrointestinal disorders). Factors related to abuse, such as age at onset, perpetrator relationship, use of violence, severity, frequency, duration, number of perpetrators influence long-term negative influence of abuse. Authors studied 123 adult women reporting child sexual abuse. Results showed that disclosure-related factors had more influence on negative consequences than abuse-related factors. Two variables were significantly related to psychological and psychosomatic symptoms in adulthood: positive reaction from present partner (fewer symptoms) and negative reactions from adult friends (increased symptoms).

Joyce, P.A. (1997). Mothers of sexually abused children and the concept of collusion: A literature review. Journal of Child Sexual Abuse, 6(2), 75-92. 
Discusses past speculations regarding the mother's contribution to incestuous sexual abuse. The term collusion has been widely used, referring to the mother's role in the development of incest and her attitude toward the child after disclosure. An alternative conceptualization has been recommended, one that is not "a disservice to a population which is already stigmatized and underserved" (p. 75). Research with adult survivors shows that mothers usually play a key role in protecting the child victim, and this support has been shown to reduce the negative consequences of sexual abuse. The author reviews prior descriptions of mothers which include collusive, oblivious, helpless, denying, hostile, frigid, passive, masochistic, dependent, and subservient to their husbands. Feminist perspective places less emphasis on the mother's psychological and personality variables and more on societal influences that keep women oppressed. The author reports that the alleged collusion of mothers was a constructed myth, and that patriarchal forces constructed how mothers were viewed. Feminist models examine issues of power and control, showing that mothers are often victims themselves. Research findings do not support allegations of mothers having serious emotional problems and do not demonstrte significantly higher levels of mental health disorders than normal population. Prior research showed denial as the primary response of mothers to incest. However, recent research reveals various ways in which mothers respond and supports view that initial response of denial is normal grief reaction, followed by guilt, depression, anger, and acceptance. Recent studies show that the overwhelming majority of mothers believe their children (78%) (Sirles and Frank, 1989). If the abuser was extended family member, 92.3% believe victims, and, if biological father, 85.9% believe. Other studies found up to 84% of mothers believing at time of disclosure. Some evidence exists that mothers are least protective and most angry when the abuser was not natural father. Findings show that the initial disclosure is traumatic for mothers. Joyce reviews literature about mother's relationship to victim and reports that most abuse victims view their mothers with anger and hostility, blaming them for the abuse. However, if the mother is no longer living with the perpetrator, relationships with victimized children are better. Studies exploring the mothers' personalities show that mothers do not display levels of psychopathology greater than comparison groups. Regarding initial belief and support at disclosure, studies show that most (around 80%) believe the child victim and support the child after disclosure. The author asks why clinicians cling to old conceptualizations about mothers and concludes that countertransference and patriarchal attitudes contribute to this phenomenon.

Joyce, P.A. (2007). The production of therapy: The social process of construction of the mother of a sexually abused child. Journal of Child Sexual Abuse, 16(3), 1-18.
Describes a qualitative study involving clinical social workers and their perspectives towards mothers of sexually abused children. Findings revealed that although professionals did not use “collusion” to explain mothers’ behaviors, they did view mothers in negative ways. Reports that the agency practiced these negative constructions of mothers in multiple contexts. History of negative perceptions of mothers of sexually abused children is reviewed. The collusive mother in incestuous families is defined as “one who disbelieved her child at disclosure, and who provided no post-disclosure support” (p. 2). Recent literature reflects mothers’ belief and support of their children post-disclosure and explains ambivalence in normative manner. Joyce’s study uses grounded theory methods, inductive approaches to derive concepts from data and capturing emergent concepts and patterns. Clinicians in social work construct “images of people (victims or villains)” (p 4). Participants in the study were 15 Master’s level social workers in an urban child treatment program. The author observed 100 hours of case conferences and read and evaluated treatment summaries. Findings showed that social factors (e.g., budget cuts, managed care mandates, court-ordered treatment) impact agency practice. Clinicians expected mothers to control situations over which they had no control. Processes occurring within the clinical team included anger at external restraints on professional autonomy, humor as a coping mechanism, vicarious traumatization when working with incestuous families, similar conceptualization of all incest cases (no differentiation or recognition of complexity). Because of external restraints on their own work, they viewed themselves and mothers as victims of the larger society.

Kim, K., Noll, J.G., Putnam, F.W., & Trickett, P.K. (2007). Psychosocial characteristics of nonoffending mothers of sexually abused girls: Findings from a prospective, multigenerational study. Child Maltreatment, 12(4), 338-351.
Conducts a longitudinal, multigenerational study of 72 mothers of sexually abused girls, comparing them to 55 mothers of nonabused girls. The mother's developmental and childhood abuse history, depression, state-trait anxiety, dissociation, and parenting were measured. Current family functioning and stress were analyzed. Results showed that more mothers of abused children had histories of childhood abuse, increasing the level of maternal distress and the likelihood of dissociative tendencies.

Knauer, S. (2000). No ordinary life: Parenting the sexually abused child and adolescent. Springfield, IL: Charles C. Thomas.
Provides help to caregivers; includes recognition of signs of sexual abuse, what to do when sexual abuse suspected or disclosed, and how to deal with behavioral symptoms of sexually abused child.

Lafir, K. (2000). Review of the literature regarding nonoffending caregivers of sexually abused children: An emphasis on parallel group treatment. Unpublished doctoral dissertation, Rosemead School of Psychology, Biola University, La Mirada, CA. Retrieved June 13, 2005, from WorldCat database.
Reviews literature of sexually abused children and their parents. Identifies studies which focus on group treatment involving both the nonoffending caregivers and their sexually abused children.

Leifer, M., Kilbane, T., & Grossman, G. (2001). A three-generational study comparing the families of supportive and unsupportive mothers of sexually abused children. Child Maltreatment, 6 (4), 353-364. Retrieved June 8, 2005, from ProQuest Psychology Journals database. (Document ID: 84656265)
Reports findings of study involving 199 nonoffending African American mothers, half of whom had sexually abused children and half who did not, and 106 maternal grandmothers, half of whom had sexually abused grandchildren ad half who did not. Analyzes data regarding abuse, attachment, and function of mother and grandmother. Results in three factors that predict risk of child sexual abuse: current functioning of mother, current relationship between mother and grandmother, and childhood history of mother.

Leifer, M., Kilbane, T., & Skolnick, L. (2002). Relationship between maternal attachment security, child perceptions of maternal support, and maternal perceptions of child responses to sexual abuse. Journal of Child Sexual Abuse, 11 (3), 107. Retrieved August 13, 2005, from ProQuest Psychology Journals database. (Document ID: 404071921)
Compares 96 mothers of sexually abused children to 100 mothers of nonabused children. Studies factors of mothers’ attachment style, child’s perception of maternal support, mother’s perception of child’s functioning. Stresses that supporting parent-child attachment lowers the risk for child behavioral problems.

Leifer, M., Kilbane, T., & Kalick, S. (2004). Vulnerability or resilience to intergenerational sexual abuse: The role of maternal factors. Child Mistreatment, 9 (1), 78-91. Retrieved June 8, 2005, from ProQuest Psychology Journals database. (Document ID: 616349851)Studies 196 mothers and their children. Forms four groups based on mother’s history of sexual abuse and child’s history of sexual abuse. Evaluates factors of vulnerability and resilience.

Levenson, J.S., & Morin, J.W. (2001). Treating non-offending parents in child sexual abuse cases: Connections for family safety. Thousand Oaks, CA: Sage.
Describes structured group treatment for nonoffending parents; includes discussion of denial, effects of sexual abuse on child and family, and family safety plans. Discusses family sessions with child and couple sessions with offender. Discusses family reunification and describes reunification assessment and plan. Provides information to professionals regarding reporting and responsible recommendation. Offers companion manual, the Connections Workbook, for nonoffending parents and partners. Supportive and understanding of trauma and symptoms of nonoffending parent.

Lewin, L., & Bergin, C. (2001). Attachment behaviors, depression, and anxiety in nonoffending mothers of child sexual abuse victims. Child Maltreatment, 6 (4), 365-375. Retrieved June 8, 2005, from ProQuest Psychology Journals database. (Document ID: 84656266)
Studies psychological well-being of nonoffending mothers of sexually abused children. Evaluates attachment, depression, and anxiety in nonoffending mother. Stresses importance of mother in providing support to sexually abused child.

Lipovsky, J.A., Saunders, B.E., & Hanson, R.F. (1992). Parent-child relationships of victims and siblings in incest families. Journal of Child Sexual Abuse, 1(4), 35-49.
Studies parent-child relationships of victims and siblings in incest families. The sample consisted of 36 victims, 41 non-abused siblings, and parents. Findings showed that mothers in the sample were supportive of their children following disclosure, and no significant problems emerged between mothers and victims. The victims' appraisal of the stress of sexual abuse was mediated by her perception of the mother's support.

Loeb, T.B., Williams, J.K., Carmona, J.V., Wyatt, G.E., Chin, D., & Et, A. (2002). Child sexual abuse: Associations with the sexual functioning of adolescents and adults. Annual Review of Sex Research, 134, 307-345.
Reviews literature in past 20 years regarding sexual abuse and negative consequences in sexual functioning. Significant associations between child sexual abuse and HIV-risk behaviors. Reports estimate of child sexual abuse as approximately 33% in community samples of women under age 18. Discusses physiological effects of trauma, with biochemical abnormalities assoicated with early chronic sexual abuse, including dysregulation of stress response systems and increased urinary catecholamine excretion. Describes chronic sexual abuse as repetititive stressful event that activates hormonal markers of stress repsonse (e.g., elevated cortisol, androstenedione, and dehdroepiandrosterone levels, and decreased luteinizing and testosterone levels). Hypothesized that female victims of sexual abuse have hormonal levels associated with increased sexual behaviors. Cites common physical complaints (e.g., genital infections, STDs, recurrent urinary tract infections) of child sexual abuse. Exacerbates adolescent developmental difficulties regarding sexual behaviors, impairs sexual decision-making and increases sexual risk-taking. Results in negative sexual outcomes, including adolescent pregnancy, STDs/HIV infection, and prostitution. Abuse survivors also perpetrate sexual abuse. Research shows 100% of female offenders have history of sexual abuse. Child sexual abuse related to adult sexual dysfunction (e.g., arousal disorders, erectile dysfunction). Sexual abuse victims are 7 times more likely to engage in certain HIV-risk behaviors, such as IV drug use, STDs, and anal sex without condoms. Sexual abuse victims 2.4 times more likely to experience revictimization (sexual abuse) as adults. 25% of male sexual abuse survivors report sexual dysfunction. Males are less likely to disclose. High rates of child sexual abuse among prisoners and among sex offenders (32%-90%).     

London, K., Bruck, M., Ceci, S.J., & Shuman, D.W. (2005). Disclosure of child sexual abuse: What does the research tell us about the ways that children tell? Psychology, Public Policy, and Law 11(1), 194-226.
Evaluates the child sexual abuse accommodation syndrome (CSAAS), a theoretical model positing that sexually abused children display secrecy, tentative disclosure, and retractions of allegations. "Abuse disclosure is a process, not an event" (Carnes, 2000, p. 21). Reluctance is commonplace, difficult to overcome, and the majority of abused children do not reveal abuse during their childhood. The authors used two data sources: (a) retrospective accounts by adults reporting CSA and (b) child examinations during sexual abuse evaluations. In retrospective studies, the modal childhood disclosure is approximately 33%. Predictors of nondisclosure include familial perpetrators, age of victim, severity of abuse, use of threats; however, studies are not consistent in findings. In retrospective studies, 60-70% of adults do not recall disclosing as a child, and only 10-18% recall authorities being involved in their case. In studies of children involved in sexual abuse evaluations, disclosure rates varied with older children more likely to disclose. An inverted U-pattern of disclosure is evident: an increase in disclosure between pre-school and school-age, followed by decrease in disclosure among adolescents. Consistency of disclosure is common among older children (i.e., prior disclosure predicts continued disclosure). Evidence in the studies does not substantiate notion that denials, tentative disclosures, and recanting characterizes disclosure process.

Lovett, B.B. (2004). Child sexual abuse disclosure: Maternal response and other variables impacting the victim. Child and Adolescent Social Work Journal, 21(4), 355-371.
Summarizes literature regarding the response of mothers to disclosure of CSA and the importance of maternal response. Protection and support are associated with improved child mental health and social outcomes. Children who received support experienced fewer traumatic symptoms and were abused for a shorter period of time. Abuse ended more quickly if the child disclosed to the mother, rather than another adult, including professionals. Maternal support is a predictor for children who testify in court against the perpetrator. The mother experiences crisis at disclosure but is the "single most important factor is the outcome for the child" (p. 367).

McCallum, S. (2001). Nonoffending mothers: An exploratory study of mothers whose partners sexually assaulted their children. Violence Against Women, 7 (3), 315-334. Retrieved June 8, 2005, from ProQuest Psychology Journals database. (Document ID: 68943158)
Describes experiences and perceptions of three women whose partners sexually abused their children. Reports events from point of disclosure and includes agency involvement. Stresses importance of nonoffending mothers in process.

McCloskey, L.A., & Bailey, J.A. (2000). The intergenerational transmission of risk for child sexual abuse. Journal of Interpersonal Violence, 15(10), 1019-1035.
Conducted a study of 179 preadolescence girls to assess risk factors for sexual abuse. In literature review, the authors discuss risk factors previously identified (i.e., female, age between 8-12, sociodemographic variables, psychological dynamics, parental psychopathology, past perpetrator abuse history. They cite Bronfenbrenner's 1977 description of ecological layers of influence: macrosystems (i.e., culture, political economy), exosystems (i.e., community), microsystems (individual family member characteristics). Sources of influence contribute independently and also intersect to determine child's environment, and the child's characteristics exerts a strong influence. The authors further review this model, explaining the links between macrosystem, mesosystem, microsystem, and CSA. The sample was drawn from a pool of 363 families interviewed in 1990-1991. Measured domestic violence, tmaternal psychopathology, maternal and partner alcohol and drug use, and demographic variables (e.g., child's relationship to maternal partner, employment, social support, ethnicity, number of moves). Results showed that 18% of the girls were CSA victims. Only maternal CSA history and combination of maternal CSA history and alcohol or drug use contributed unique variance in multivariate statistics. When mothers had CSA histories, girls were at 3.6 times the risk for CSA.

McCurdy, K. (2005). The influence of support and stress on maternal attitudes. Child Abuse & Neglect, 29 (3), 251-268. Retrieved July 24, 2005, from PubMed database. (PMID: 15820542)
Examines effects of support on parental attitudes. Claims that increased stress results in more punitive parenting , but increased support moderates parental distress. Discussion of stress response and support indirectly linked to maternal response to disclosure of child sexual abuse.

McGee, R.E. (2004). Controversial maternal roles of intrafamilial child sexual abuse cases. Dissertation Abstracts International, 65 (4), 1548A. Retrieved from ProQuest Dissertations and Theses database:
Studies maternal roles as recorded in sexual abuse case files to determine most common role: protector, co-victim, co-perpetrator, or perpetrator. Evaluates demographics, maternal characteristics, relationship of mother and child, maternal support, and case outcome in 41 cases in Kalamazoo, Michigan. Reports most common role as co-perpetrator and least common as protector.

Molnar, B.E., Beka, S.L., & Kessler, R.C. (2001). Child sexual abuse and subsequent psychopathology: Results from the national comorbidity survey. American Journal of Public Health, 9(15), 753-760.
Examines relationship between child sexual abuse and subsequent onset of psychiatric disorders. Study utilized data from sample of 8098. Child sexual abuse was reported by 13.5% of females and 2.5% of males. Childhood sexual abuse was significantly associated with the development of 14 mood, anxiety, and substance abuse disorders among women and 5 among men. 78% of females reporting sexual abuse had a psychiatric disorder. 

Nelson, M.Y. (2000). The reaction of the nonoffending mother/spouse to the disclosure of incest. Unpublished Master’s thesis, Briercrest Biblical Seminary, Caronport, Saskatchewan, Canada. Retrieved June 10, 2005, from WorldCat database.
Studies responses of nonoffending parents to the disclosure of incest. Projects goal of debunking myth of collaborative spouse in child sexual abuse. Encourages professional support of nonoffending parent.

Newberger, C.M., Gremy, I.M., Waternaux, C.M., & Newberger, E.H. (1993). MOthers of sexually abused children: Trauma and repair in longitudinal perspective. The American Journal of Orthopsychiatry, 63(1), 92-102.
Discusses the importance of parental psychopathology and its effect of children’s mental health and view mothers as secondary victims to their children’s sexual abuse. Forty-two subjects, mothers of sexual abuse victims, participated in a one-year study. Seventy-two percent of the child subjects were female. Seventy-six percent were white. Sixty-one percent of the child victims experienced abuse on more than one occasion. The mean period of abuse was seven months. Force or threat was used with the majority (i.e., 46% overpowered, 22%, threatened). Results found that mothers experienced significant distress following disclosure of CSA, including somatization, obsessive compulsive, depression, hostility, phobic anxiety, paranoid ideation, psychoticism. Symptom dimensions included criteria for diagnosis of PTSD. Two variables related to child victimization increased symptoms: severity of CSA and perpetrator’s use of force. Mothers in this study experienced severe and extensive emotional disclosures. It is possible that the protective and legal processes to impact the family.  

Ng, C.K., Staid (2003). MRI and PET study of deficits in hippocampal structure and function in women with childhood sexual abuse and posttraumatic stress disorder. THe American Journal of Psychiatry, 160(5), 924-932.
Measures hippocampal structure and function in women with and without history of child sexual abuse. Memory alterations are common in victims of sexual abuse. The hippocampus plays a primary role in memory. Study included 33 women. When compared to subjects with histories of abuse but no PTSD, women with sexual abuse history having PTSD had 16% smaller hippocampal volume. Results showed a significant relationship between higher dissociative symptoms and smaller left hippocampal volume, as measured by the MRI. 

Ostis, C.M. (2002). Social support and treatment for nonabusing parents of abused and abusing children: Evaluation of a metaphor-enhanced psychoeducational group curriculum. Dissertation Abstracts International, 63 (11), 4096A. Retrieved August 13, 2005, from ProQuest Dissertations and Theses database. (Document ID: 765047281)
Evaluates psychoeducational treatment for nonoffending parents of sexually abused children. Explores role and effect of social support on both mandated and non-mandated clients. Describes use of metaphor in treatment process. Shows increase in mother’s mastery, understanding and attitude toward treatment, and motivation to change self and support child. Stresses importance placed by mothers on social support and having relationships with other mothers with similar experiences.

Paolucci, E.O., Genuis, M.L., & Violato, C. (2001). A meta-analysis of the published research on the effects of child sexual abuse. The Journal of Psychology, 135(1), 17-36.
Reviews 37 studies involving 25,367 participants to confirm short and long-term consequences of child sexual abuse. Six dependent variables were analyzed: PTSD, depression, suicide, sexual promiscuity, sexual perpetration, and academic achievement. Child sexual abuse had a substantial effect on all outcomes. Gender, SES, abuse type, age of abuswe, relationship to perpetrator, and number of incidents did not mediate effects. Results support a multi-faceted model of traumatization that emphasizes profound trauma of child sexual abuse and complexity of effects.

Paredes, M., Leifer, M., & Kilbane, M. (2001). Maternal variables related to sexually abused children’s functioning. Child Abuse & Neglect, 25 (9), 1159. Retrieved from PsycINFO with Full Text database: 
Studies 67 mothers and their children to assess mother’s childhood history, mother’s current functioning, and child’s current functioning. Finds relationship between mother’s childhood and experience of abuse and child’s level of function following disclosure of sexual abuse. Finds relationship between mother’s current function and ability to support child and child’s level of function following disclosure. Stresses importance of mother’s well-being to child’s emotional and behavioral functioning.

Pintello, D., & Zuravin, S. (2001). Intrafamilial child sexual abuse: Predictors of postdisclosure maternal belief and protective action. Child Maltreatment, 6 (4), 344-352. Retrieved June 8, 2005, from ProQuest Psychology Journals database. (Document ID: 846556264)
Studies nonoffending, biological mothers of children who were sexually abused. Identifies mothers who believed and supported the child at point of disclosure and describes predictors of maternal protection.

Plummer, C.A. (2004). Nonabusive mothers of sexually abused children: The role of rumination in maternal outcomes (Doctoral dissertation, University of Michigan, Social Work an dPsychology, 2004). Dissertation Abstracts International, 65.
Conducts a study of mothers of sexually abused children, evaluating post-distress disclosure and contributors to level of distress. The author states that mothers have been called "incest carriers" (p. 1); "martyrs," "masochistic," and "collusive (p. 2) and studies have often blamed mothers for the abuse. Mothers have "largely been seen as appendages to either the victim or the perpetrator and evaluated more as variables than as persons" (p. 2). The author reviews literature related to mothers having secondary trauma (p. 2), feeling "psychologically assaulted by the perpetrator" and struggling with their own reactions (p. 2), and having to respond to the reactions of their children. Research questions evaluate abuse-specific characteristics predictive of maternal outcome, distal predictors of maternal outcome (e.g., childhood abuse), other life problems (e.g., family deaths, financial difficulties, divorce/job changes, daily life "hassles," social support (personal and professional, and rumination. Denial is discussed as normative. The author studies rumination as both mediating and predictor variable. CSA of mother was significant factor related to negatives changes in relationship with child since abuse disclosure, insecure parenting style, negative emotional outcomes, and externalizing anger. Adult abuse was not significant correlation. Life stressors were significantly correlated with externalizing anger, insecure parenting, relationship changes, and negative emotional states. Support (personal and professional) was not significantly related. Rates of distress in mothers was found to be significant. Describes mothers' pain, confusion, and shock, their suffering from professional biases, limited services offered to mothers. Reviews history of dichotomization of mothers, stereotyping, and perpetuation of negative characteristics and part of the problem rather than persons needing services. Unique internal and external factors confronted by each mother affects/influences outcome subsequent to disclosure. States prior ill treatment of mothers, with biases resulting in inferior services to families, legal decisions resulting in children's removal, and public perceptions that perpetuate misinformation about mothers.

Plummer, C.A. (2006). The discovery process: What mothers see and do in gaining awareness of the sexual abuse of their children. Child Abuse & Neglet, 30, 1227-1237.
Discovery of CSA is a process requiring mothers to "piece together a puzzle of facts, hunches, and fragments" (p. 1228). Plummer explored the discovery process of 125 mothers, analyzing how they learned about the abuse, actions taken, and barriers to recognition. Results showed that 42% were told by the child, and 15% suspected CSA because of child behaviors. Half of the mothers felt that "something wasn't quite right" (p. 1232) prior to disclosure and responded with 301 distinct actions. The most common actions were: talking to child (66.7%), watching more closely (46.7%), trying to get more information (37.1%), and confronting suspected perpetrator (35.2%). Mothers reported 159 barriers to belief. Common responses were: "I would/should have known" (41%), perpetrator denial (33.3%), knowledge of abuser (32%), change in child's report (22.2%), and family not believing (19.2%).

Plummer, C.A., & Eastin, J.A. (2007). System intervention problems in child sexual abuse investigations: The mothers' perspectives. Journal of Interpersonal Violence, 22(6), 775-787.
Conducts a qualitative study that included three focus groups (n=19) and survey questions (n=40) regarding mothers' experiences with professionals (i.e., police, CPS, prosecutor, medical, court) after the disclosure of CSA. Mothers report a lack of support, poor services, criticism from professionals, insensitivity about their concerns, being accused of making false allegations, and difficulty in seeing the "system" as helpful. Mothers are often scrutinized to determine what and why CSA occurred. The conceptual framework for this study was based in feminist, coping, and trauma theories. Focus group was based on exploratory and grounded theory methods. A total of 59 women participated in focus groups and questionnaires. Emergent themes included system issues, mother's coping strategies, mother-child relationship, and child's behavior issues. Results showed negative experiences with professionals, and mothers reported being treated like they were either "guilty of something or were simply 'crazy.'" Mothers reported feeling helpless, feeling unprepared for interventions and the treatment they received, and being angry ("incensed," p. 778) about the insensitivity shown to their victimized children. Mothers were told that they should have known about the abuse and that they were not supportive to their children. They were blamed by professionals for a variety of reasons (e.g., not home with child). Mothers were judged if they believed that abuse occurred, and professionals did not. They were judged if they did not believe, and professionals did. Some were called names (i.e., "hysterical, crazy, a prostitute, or nut case") by CPS personnel, police, or judge. They stated the strongest outrage when their children were treated in this manner. Professionals stated what they defined as a "good mother" (p. 780) and were impatient with mothers who did not act according to their perception of appropriateness. Mothers were given "mandates to not discuss child abuse issues, even when the child raised the topic, and not to take the child to the doctor 'repeatedly' for suspected abuse" (p. 780). Mothers were told about consequences they might suffer if they disobeyed, including losing custody of their children. This contributed to feelings of helplessness. When a mother reported CSA the second time, she reported that they "started treating me like I was some kind of nut case. They were treating me disrespectfully, very confrontive toward me" (p. 780). Mothers reported costs following disclosure (e.g., loss of family support, identity, financial strain). Mothers lived with uncertainty, frustrated regarding legal process (especially if child young and no evidence). Some thought about running away, going underground, in order to keep their children safe. Most struggled with how to cope with "untenable situation" (p. 780), believing abuse occurred and being court ordered to send their child to a potential offender. Mothers were charged with encouraging false allegations. One mother reported being treated respectfully when her child was abused by a neighbor, but when it was a family member ( her father), she was treated with disregard. One mother reported that when she was upset (sibling incest had occurred), the caseworker called her hysterical. Mothers were counseled to monitor their emotional responses to please professionals, and this became a central concern. One said that showing anger, you are judged as hysterical; showing no emotions, you are judged as not caring. Other problems listed included unexplained delays, communication problems, blaming, mutual distrust, judgment of parenting, disappointment that advice was not practical, little support, intense stress due to prolonged evaluations, disruptions to family life, financial strains, being perceived as unreliable reporter, not being taken seriously, and accused of promoting false reports. The authors recommend that all professionals recognize that mothers are in acute crisis, and they need support, direction, and respect. "Mothers will predictably be emotional, initially fearful, and defensive. Mothers should be treated empathically....Professionals need to combat powerful countertransference" (p. 786).

Plummer, C.A., & Eastin, J.A. (2007). The effect of child sexual abuse allegations/investigations on the mother-child relationship. Violence Against Women, 13, 1053-1071.
Examines changes in the mother/child relationship following CSA disclosure. They conducted a qualitative study using grounded theory methodology and two focus groups of ten. The impact of CSA on child and mother, system issues, changes in mother/child relationship, parenting insecurity, exhaustion, guilt and self-blame, system interference, advocacy and protection, child behavior problems, and finding meaning in the experience emerged as major topics emerged. All mothers reported altered relationships with children. Most mothers reported parenting insecurity and uncertainty. Tentativeness affected confidence and effective response to the child. Parenting insecurity was exacerbated by emotional exhaustion, sense of helplessness, and the unfamiliar challenges in dealing with external authorities. Guilt and self-blame affected the mother/child relationships. Child behaviors challenged the already damaged relationship as mothers needed to address aggression, belligerence, sexualized behavior, and posttraumatic effects of CSA, while feeling unprepared, anxious, and afraid. 

Reynolds, L.L., & Birkimer, J.C. (2002). Perceptions of child sexual abuse: Victim and perpetrator characteristics, treatment efficacy, and lay vs. legal opinions of abuse. Journal of Child Sexual Abuse, 11 (1), 53-74. Retrieved June 8, 2005, from ProQuest Psychology Journals database. (Document ID: 232903501)
Evaluates perceptions of child sexual abuse. Presents undergraduate students with vignettes involving variety of ages and relationships between a man and a girl in order to determine abuse responses. Suggests need for increased understanding of laws pertaining to child sexual abuse.

Renk, K., Liljequist, L., Steinberg, A., Bosco, G., & Phares, V. (2002). Prevention of child sexual abuse: Are we doing enough? Trauma, Violence, & Abuse, 3(1), 68-84.
Discusses efforts to prevent CSA, evaluating programs and making recommendations. CSA in 2000 was reported to affect 12% of children in the United States, more than a half-million children being sexually abused each year. Studies regarding prevalence have lacked specificity and uniformity. CSA affects children of all ages, SES, ethnic and racial groups, and is associated with a wide variety of symptoms and resulting pathology. Primary prevention, focusing on the general community, has sought to prevent CSA before it occurs. Secondary prevention has focused on individuals at risk and interrupting current CSA and CSA familial cycles. Tertiary prevention includes treatment for survivors and offenders. The burden of preventing CSA, however, has been placed on children, as school-based programs and parent programs stress the child's understanding of potential risks. Although this may lower risk of victimization, it still places focus on developing children to protect themselves, and these efforts themselves contain risks. Children are told that it is "never the child's fault" and yet the energy is put into teaching children how to avoid being victims (p. 80). The focus of attention to change should be elsewhere. Further educating teachers and those that work with children is recommended, so that signs may be observed more effectively. More broad-based society rejection of CSA as adult activity will increase potential barriers to adult acting out on these urges. The authors suggest media messages that state clearly that it is "always wrong to have sexual contact with children for an adult's pleasure," hopefully having a culturewide effect and changing the way society thinks about CSA (p. 80).

Romans, S., Belaise, C., Martin, J., Morris, E., & Raffi, A. (2002). Childhood abuse and later medical disorders in women. Psychotherapy and Psychosomatics, 71(3), 141-150.
Conducts a longitudinal study, interviewing a community sample of 3000 women in New Zealand. Two groups were selected, half reporting CSA (n = 252), and the other half, a comparison group not reporting CSA (n = 225). Data was collected regarding CSA (e.g., severity, relationship to perpetrator, length of abuse); other abuses; physical illness experiences; coping style; and psychopathology. Results showed significant correlations between childhood and adult experiences and medical conditions (e.g., chronic fatigue, bladder problems, pelvic pain, headache, chronic pain, diabetes, and cardiovascular problems). Findings include significant association with immature coping skills and dissociation.

Romans, S.E., Martin, J.L., Anderson, J.C., Herbison, G.P., & Mullen, P.E. (1995). Sexual abuse in childhood and deliberate self-harm. The American Journal of Psychiatry, 152(9), 1336-1342.
Investigates the association between history of CSA and subsequent incidents of self-harm in women. The authors interviewed a random community sample of women (n = 252) that reported being sexually abused as child and a similar sized group (n = 225)  that did not report history of CSA. The group of women disclosing CSA and self-harm were contrasted with women having histories of CSA and no self-harm. A clear statistical difference was present between sexual abuse and self-harm that was most marked in those having the most intrusive and frequent sexual abuse. 8.7% of women with CSA histories reported self-harm, and 95.7% of self-harming women reported CSA history.

Sachs-Ericsson, N., Plant, E.A., Blazer, D., & Arnow, B. (2005). Childhood sexual and physical abuse and 1-year prevalence of medical problems in the national comorbidity survey. Health Psychology, 24(1), 32-40.
Examines the independent effects of childhood sexual abuse and physical abuse on adult health status in a large community sample of men and women (n = 5,877). Sexual and physical child abuse results in long-term consequences, including psychiatric disorders and medical problems in adulthood. Medical problems are often overrepresented among individuals who have experienced childhood sexual and physical abuse. Studies have found relationships between childhood abuse history and generalized pain, pelvic pain, fibromyalgia, diabetes, gastrointestinal problems, obesity, and IBS, and between lifetime sexual abuse and measures of overall health. Specifically, certain health problems (i.e., gynecological problems, headaches, diabetes, arthritis, breast cancer) for women and thyroid disease for men are more common among those who have sexual abuse histories. Several studies show an additive effect of abuse history in predicting severity of negative health histories. The implications are complex. For example, one childhood adversity increases the probability of another approximately 80% p. 33) (i.e., revictimization). The current study predicted that participants with childhood abuse history would have greater number of health problems compared with those without history of abuse. Participants were asked about childhood experiences of abuse, specific abuse items about abuse, health problems, family-of-origin variables. family history of psychiatric symptoms, and participants' psychiatric diagnoses. Among the sample 0.5% reported history of childhood abuse, 2.8% reporting physical abuse and 5.3% reporting CSA. Chi-square analyses and hierarchical logistic regression analyzed the data. Results showed that childhood abuse independently influence health status after the researchers controlled for psychiatric disorders. The authors describe the biological mechanism connecting childhood abuse and adult health problems.

Sadowski, H., Trowell, J., Kolvin, I., Weeramanthri, T., Berelowitz, M., & Gilbert, L.H. (2003). Sexually abused girls: Patterns of psychopathology and exploration of risk factors. European Child & Adolescent Psychiatry, 12(5), 221-230.
Studies the patterns of psychopathology in sexually abused girls and explores environmental risk factors for psychopathology, including abuse characteristics and environmental experiences. Data are derived from baseline assessment of 81 sexually abused girls in the London Child Abuse Psychotherapy Outcome Study. Parents or foster parents were interviewed. Results showed that significant predictors of Major Depressive Disorder were seriousness of abuse, relationship to perpetrator, and recency. The only significant predictor of Separation Anxiety Disorder was that the perpetrator was not parent figure. Impairment of general functioning was strongly predicted by increased seriousness of abuse. PTSD was present in 73% of the sample.

Salmon, P., Skaife, K., & Rhodes, J. (2003). Abuse, dissociation, and somatization in irritable bowel syndrome: Towards an explanatory model. Journal of Behavioral Medicine, 26(1), 1-18.
Investigates a model showing associations between dissociation and somatization and irritable bowel syndrome (IBS). The study was designed to test the prediction that dissociation can account for the link between abuse and IBS. Subjects were patients at a gastroenterology clinic and diagnosed with either IBS or physical disease (Crohn’s disease or ulcerative colitis), age 16 or older, and possessing language capacity to complete questionnaire. Assessed sexual, physical, and psychological abuse; parental care and bonding; dissociation; somatization; and emotional distress. Responses were analyzed to evaluate associations between childhood or adult abuse and current dissociation, somatization, and emotional distress. Results showed that IBS patients tend to experience diffuse physical symptoms, explaining the relationship of abuse to IBS. Increased dissociation was associated with abuse and accounted for the link between abuse and somatization. Results initiate a causal model, with dissociation as the key component. The path model showed adult psychological abuse, child sexual abuse, and parental care contributing to dissociation, somatization, and IBS. 

Sar, V., Akyuz, G., Kundakci, T., Kizltan, E., & Dogan, O. (2004). Childhood trauma, dissociation, and psychiatric comorbidity in patients with conversion disorder. The American Journal of Psychiatry, 161(12), 2271-2276.
Conducts a longitudinal study of 38 patients diagnosed with conversion disorder, 34 with pseudoseizures, and four with paralysis, to determine association with childhood trauma, dissociation, and psychiatric comorbidity. Patients were interviewed at three points. Almost all patients presenting with conversion disorder (89.5%) had comorbid psychological conditions. The most prevalent was anxiety disorders. Somatoform, affective, and dissociative disorders were also common. High rates of abuse histories were found in patients with conversion disorder.  

Saunders, B., & Meinig, M. (2000). Immediate issues affecting family resolution of cases of parent-child sexual abuse. In R.M. Reece (Ed.), Treatment of child abuse: Common ground for mental health, medical, and legal practitioners (pp.36-53). Baltimore: The Johns Hopkins University Press. Retrieved June 11, 2005, from ebrary database.
Discusses response of nonoffending parent. Details common responses, complications, and responsibilities of these parents. Stresses traumatic impact of disclosure on nonoffending parent and the need for professional understanding. Elaborates treatment needs, intervention strategies, and long-term family resolution goals. Supportive of parent and other family members affected by disclosure of sexual abuse.

Schechter, D.S., Brunelli, S.A., Cunningham, N., Brown, J., & Baca, P. (2002). Mother-daughter relationships and child sexual abuse: A pilot study of 35 dyads. [Electronic version]. Bulletin of the Menninger Clinic, 66 (1), 39-60. Retrieved June 15, 2005, from ProQuest Psychology Journals database.
Discusses results of pilot study examining 15 inner-city Latino mother-daughter relationships. Hypothesizes that mothers would have impaired relationships with partners, their own mothers, and their daughters. Supports previous findings of poor attachment and parenting skills as risk factors for child sexual abuse. Includes one case study. Limitations of study: Small sample, not culturally responsive, literature review historically biased, and self-report questionnaire. Not empathic towards nonoffending mothers and tends to blame and generalize. Suggests professional assessment of attachment.

Scheinberg, M., & Fraenkel, P. (2001). The relational trauma of incest: A family-based approach to treatment. New York: Guilford Press.
Addresses complexities of incestuous family system. Discusses collaborative therapeutic approach with focus on strengthening safe family system. Provides case studies. Examines nonoffending mother’s influence on child’s functioning, relationship with child, bond to offender, parenting beliefs and challenges, and abuse history and intergenerational factors. Provides thorough systemic evaluation and discussion of factors intrinsic to family system in which incest has occurred.

Scheller, S.M. (2001). A phenomenological analysis of the mother-daughter relationship among female incest survivors. Dissertation Abstracts International, 62 (2), 1098B. Retrieved from ProQuest Dissertations and Theses Database:
Explores relationships of six adult incest survivors with their mothers. Reports themes of survivor’s anger and hostility toward mother, inability to trust mother, reversal with mother of nurturing role, belief that mother knew about abuse, and impaired differentiation from and identification with mother. Identifies additional themes of loss of mother, empathy for mother, and desire to care for mother. Discusses clinical interventions with incest survivors.

Schneider, H.J. (2001). Victimological developments in the world during the past three decades: A study of comparative victimology - Part 2. International Journal of Offender Therapy and Comparative Criminology, 45(1), 539-555.
Presents a comprehensive overview of current discussion regarding criminological victimization research over past three decades. Part 1 discusses risk and causes of victimization, while Part 2 discusses negative psychological and social effects suffered by victims and damage suffered by indirect victims (covictims). The author discusses disclosure of CSA and precipitation of victim’s mother into an identity crisis, "characterized by severe self-appreciation problems and greater self-doubt" (p. 541). The mother develops feelings of uncertainty and doubt regarding maternal competence. The term secondary victimization refers to "the phenomenon of renewed victimization due to an inadequate response to the primary act of victimization, namely, becoming a victim by the criminal act itself" (p. 541). Both victim and covictim are affected by secondary victimization. The author asserts that this concept is well recognized and states that "it is established knowledge that an inappropriate response to the offense can lead to both victim and covictim becoming victimized a second time" (p. 541.

Sela-Amit, M. (2002). Intra-familial child sexual abuse: The experience and effects on non-offending mothers. Dissertation Abstracts International, 64 (06), 2259A. Retrieved July 15, 2005, from ProQuest Dissertations and Theses database. (Document ID: 765954751)
Includes qualitative and quantitative results from study of 62 mothers involved in treatment in Los Angeles Child Protective Services following disclosure of child’s sexual abuse. Examines effects on mothers and includes socio-demographic characteristics, overall effects of disclosure on mothers’ lives, and risk factors related to distress. Suggests factors that increase mothers’ well-being and discusses barriers to supportive services. Written from a feminist perspective.

Stock, J.W. (2002). Investigation of long-term symptoms associated with childhood sexual abuse from the perspective of mental health professionals working in the field. Dissertation Abstracts International, 6, 1576B.
Examines the perceptions of 30 mental health professionals who work with survivors of CSA to determine symptoms most frequently observed. Literature review identified symptoms most frequently mentioned, including anger, anxiety, depression, fear, hopelessness, helplessness, loneliness/isolation, low self-esteem, PTSD, relationship problems, sexual problems, shame/guilt, suicidal ideation, self-destructive behaviors, trust problems. Mental health professionals in Stock's study identified depression, low self-esteem, and trust difficulties as three most frequently observed symptoms. Author provides extensive review of literature.

Strand, V.C. (2000). Treating secondary victims: Intervention with the nonoffending mother in the incest family. Thousand Oaks, CA: Sage.
Outlines a model for intervention and treatment of nonoffending mothers and offers suggestions for therapeutic strategies. Discusses context of mother’s life and multiple systems involved with families; provides clinical case studies.

Stubenbort, K., Greeno, C., Mannarino, A. P., & Cohen, J. A. (2002). Attachment quality and post-treatment functioning following sexual trauma in young adolescents: A case series presentation. Clinical Social Work Journal, 30 (1), 23-40. Retrieved August 8, 2005, from ProQuest Psychology Journals database. (Document ID: 115293309)
Examines link between prior attachment to nonoffending caregiver and functioning of four adolescents following sexual abuse disclosure. Observes child’s relationship to caregiver and therapist in context of three stages of attachment theory, severity of abuse, distress of caregiver and protective functioning, and post-treatment functioning. Stresses importance of caregiver to child’s ongoing functioning and makes recommendations for treatment interventions with nonoffending caregivers.

Tamraz, D.N. (1996). Nonoffending mothers of sexually abused children: Comparisoin of opinions and research. Journal of Child Sexual Abuse, 5(4), 75-104.
Reviews literature on nonoffending mothers of sexually abused children and dichotomized studies into opinion-based and research-based prior to analysis. Substantial literature exists that is opinion-based; however, research-based literature is sparse, and the author reviews 32 studies. Tamraz argues that historically, opinions have been given the same validity as research results. The feminist perspective is applied to opinion-based literature (i.e., mother-blaming), and PTSD framework is utilized for interpretation of research literature. Opinion-based literature includes information about mothers suffering from physical illnesses or physical disabilities. No research-based literature examines physical problems in nonoffending mothers. Opinion-based literature discusses maternal psychological problems, including depression, psychosis, alcoholism, suicidal tendencies, emotional dependency, passivity, submissiveness, and powerlessness. Nine research-based studies assess maternal psychological functioning, including depression, anger, attachment, and personality characteristics. Research findings are inconsistent. The marital role, maternal role, history of maternal sexual abuse, domestic violence, disclosure reaction are compared in opinion-based and research-based literature and studies are critiqued. Opinion-based studies report mothers having interpersonal and sexual dysfunctions, to lack mothering skills, to be victims of CSA, subject to battering, collusive, condoning the abuse, aware if the abuse and not protecting. Opinion-based literature is based on reports, perceptions, interpretations, and assumptions of mental health workers, victims, perpetrators, and family members and are often anonymous. Information is vague, ambiguous, biased, and results in pervasive stereotypes. Research-based literature shows mothers to be a heterogeneous group and provide understanding of the mother's social difficulties, psychological difficulties, and trauma following the disclosure. The author suggests PTSD as a workable diagnosis to use in interpreting research in which mothers had experienced CSA or battering. Research-based literature varies substantially and suffers methodological limitations.    

Timmons-Mitchell, J., Chandler-Holtz, D., & Semple, W. E. (1996). Post-traumatic stress symptoms in mothers following children's reports of sexual abuse: An exploratory study. American Journal of Orthopsychiatry, 66(3), 463-467.
Conducts a two-group study of posttraumatic stress symptoms (PTSS) in 28 mothers following CSA disclosure. Mothers were assigned to group based on childhood history of sexual abuse. Assessed somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic avoidance, paranoid ideation, and psychoticism; and three global severity scales. All subjects experienced higher levels of PTSD symptoms than normative samples, with significant differences in subscale means for avoidance, reexperiencing, and arousal. Mothers with histories of CSA experience more PTSD symptoms than mothers without CSA history. Limitations include small sample size, procedure for determining abuse history, narrow focus, and large potential for confounding variables.

Timmons-Mitechel, J., Chandler-Holtz, D., & Semple, W.E. (1997). Post-traumatic stress disorder symptoms in child sexual abuse victims and their mothers. Journal of Child Sexual Abuse, 6(4), 1-14.
Conducts a follow-up study of the 28 mothers, subdivided into two groups based on maternal CSA histories. The study’s purpose was to explore relationships among CSA, child’s PTSD symptoms, mother’s CSA, and the mother’s PTSD symptom in the post-disclosure period. The correlation between domestic violence and PTSD was not significant. Mothers with childhood abuse histories suffered PTSD when their children’s CSA was disclosed. The small sample may have been responsible for lack of findings. Treatment recommendations include the need to assess PTSD in parents and children at the point of disclosure in order to provide effective treatment planning.   

Triarhos-Suchlicki, S. (2008). Psychological functioning of nonoffending caregivers: THe roles of attachment, parenting competence, child psychological functioning, and goodness-of-fit, 2007. Dissertation Abstracts International, 68.
Conducts a cross-sectional study of psychological functioning in nonoffending caregivers (NOC). The sample of 82 females and 9 males was enrolled in outpatient group therapy services. Data collected included (a) demographic, social support, and mental health history; (b) sexual abuse history; (c) child’s sexual abuse history, including relationship to perpetrator, severity, and duration; (c) caregiver belief and support; (d) stress in relationship; (e) attachment; and (f) parenting competence. Psychological symptoms and parenting stress were measured. Attachment security was found to be a moderator between parenting competence and psychological functioning. Perpetrator relationship moderated the relationship between attachment security and psychological functioning. The interactions between child characteristics, maternal characteristics, and social support were not significant. Attachment theory addresses the complex relational aspects of caregivers' psychological distress post-disclosure. parenting competence, and relationship with the perpetrator. 

Wadsworth, R., Spampneto, A.M., & Halbrook, B.M. (1995). The role of sexual trauma in the treatment of chemically dependent women: Addressing the relapse issue. Journal of Counseling and Development, 73(4), 401-406.
Reviews the literature regarding sexual abuse and chemical dependence, finding a high incidence of sexual trauma among women who seek treatment for substance abuse. Additionally, clients with history of CSA are more susceptible to relapse and return to substance abuse. The authors report the rate of incest alone among substance abusing women as 40-80%, compared to a rate of 20-25% in the general population. Other complaints often reported for sexual trauma victims: self-doubt, guilt, low self-esteem, depression, role confusion, feelings of isolation and despair, anxiety, perceived helplessness, eating disorders, dissociative and somatization disorders, sexual problems, unsatisfactory relationships, extreme difficulty with trust and intimacy, suicidal ideation and attempt. These same problems are likely to be reported by substance-abusing women. Relapse is high in all chemically dependent clients. However, it is higher in those who have history of sexual trauma, up to 90% of relapse-prone women have been sexually abused (p. 402). Depression, anxiety, and somatization are potential relapse risks for substance abusers, and these are likely to be present in clients with a history of CSA.

Walker, J.L., Carey, P.D., Mohr, N., Stein, D.J., & Seedat, S. (2004). Gender differences in the prevalence of childhood sexual abuse and in the development of pediatric PTSD. Archives of Women's Mental Health, 72, 111-121.
Reviews studies to determine gender differences in the prevalence of CSA and childhood PTSD. Recent literature continues to show CSA affecting a significantly larger number of girls than boys. Myths continue to affect the interpretation of sexual abuse by male children (e.g., toughness). Males are less likely to disclose because of perceived loss of power and masculinity and fear of label of homosexual. Consequences of CSA are manifest in diverse and devastating ways for both girls and boys, and sexually abused boys may experience more emotional and behavioral problems and suicidality than girls. PTSD rates are higher in girls than boys. Gender differences are present in biologic and brain volume consequences to childhood CSA in boys and girls.

Willingham, E.U. (2008). Maternal perceptions and responses to child sexual abuse. Dissertation Abstracts International, 69.
Conducts a phenomenological study of 14 mothers of sexually abused children and two key informants using constructivist grounded theory methods. Findings demonstrate that mothers experience traumatic distress following disclosure. Mothers described feeling "overwhelmed, disconnected, and tainted" (p. 48) and experienced both acute and chronic distress. Maternal reactions were both cognitive and emotional and were categorized into the central themes: shock, confusion, guilt, anger, fear, shame, betrayal, distrust and isolation, grief and loss, and depression. All of the mothers experienced shock, guilt, fear, and distrust, with a significant percentage experiencing other reactions, as well as depression, nightmares, and physical illness. Although the mothers in this study described being in crisis and experiencing significant distress, they all believed, protected, and supported their children. A finding relevant to the proposed research involves mothers’ description of physical symptoms. These included migraine and trips to the emergency room.   

Womack, M. E. (1995). The effects of teaching adaptive defense mechanisms to non-offending mothers in incestuous families. Unpublished master's thesis, Appalachian State University, Boone, NC.
Examines the effects of teaching adaptive defense mechanisms and providing social support in a group therapy setting to non-offending spouses in incestuous families. It was hypothesized that group therapy intervention would enhance positive coping strategies, decrease denial, and increase maternal support. Mothers were recruited from current case files of offenders being treated in a sexual abuse intervention agency. The group met for eight weeks, and self-observation, affiliation, assertiveness, humor, sublimation, anticipation, suppression, and altruism were the subject areas. The Ways of Coping Questionnaire and Index of Parental Attitudes were administered at pretest and posttest time intervals. Group member responses were positive, reflecting beliefs that coping strategies and group process had been helpful.

Womack, M.E., Miller, G., & Lassiter, P. (1999). Helping mothers in incestuous families: An empathic approach. Women & Therapy, 22(4), 17-34.
Reviews the literature about mothers of sexually abused children and examined biases of researchers and professionals. Historically, mothers have been blamed for the sexual abuse of their children, described in pejorative terms, and treated in negative, punitive ways. Empathic approaches view mothers as secondary victims, experiencing significant crisis and turmoil in their lives, and in need of support. Mothers' experience is similar is one of grief and loss. Maternal support is critical to the well-being of the victim. Professionals have treated mothers as if they are "on trial" (p. 25) and are considered to have been silent partners in families in which incest occurred. Mothers are in a Catch-22 situation because if she admits to believing the child, she may be seen as unable to protect. Recommendations are made for effective treatment with mothers.

Wonderlich, S.A., Wilsnack, R.W., Wilsnack, S.C., & Harris, T.R. (1996). Childhood sexual abuse and bulimic behavior in a nationally representative sample. American Journal of Public Health, 86(8), 1082-1086.
Conducts a study of 1099 women in the United States, investigating history of CSA and lifetimes prevalence of bulimic behavior. Logistic regression was used to calculate contribution of CSA to bulimic behavior. Results showed that victims of CSA were significantly more likely to display bulimic behavior. CSA is a risk factor for bulimia with between one-sixth and one-third of cases attributed to CSA. The authors discuss findings and state that CSA may be a traumatic experience that results in long-term affective dysregulation and bodily shame, increasing risks for overt coping behaviors such as alcohol abuse, self-destructive behavior, and bingeing and purging.

Worrall, J. (2002). Who’s to blame? Child sexual abuse and non-offending mothers. [Review of the book Who’s to blame?: Child sexual abuse and non-offending mothers]. International Social Work, 45 (4), 529-530. Retrieved from ProQuest Psychology Journals database:
Reviews book about child sexual abuse and nonoffending mothers and discusses mother-blame. Explores why mothers are routinely held responsible for sexual abuse and presents evidence of institutional sexism. Reports study of 24 mothers whose children disclosed sexual abuse and details their experiences with community agencies, co-workers, and family members.




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