The Role of Childhood Abuse and Gender of the Abuser on Depression and Posttraumatic Stress Disorder

1
The Role of Childhood Abuse and Gender of the
Abuser on Depression and Posttraumatic Stress
Disorder

• Panagiota Zorbas, George Mason University 
• Jessica A. Chen and Marylene Cloitre,
• New York University Child Study Center

2
Past Research

• Negative childhood experiences and their relation
  to the development of later psychopathology have
  been well documented (Putnam, 2003), particularly
  as related to outcomes such as PTSD and
  Depression (Brewin et al., 2000 Kessler, 1997) 
• Differential outcomes have been associated with
  different types of childhood abuse (Briere,
  1990). While the effects of childhood sexual and
  physical abuse have been studied extensively,
  less attention has been given to parental
  emotional abuse. Nonetheless, emotional abuse
  may have a strong relationship to later
  depression symptoms (Gibb et al., 2003)
• It is not clear whether the gender of the abuser
  could influence the relationship between type of
  abuse and outcome.  

Purpose

• The purpose of this study was to assess how
  childhood emotional, sexual, and physical abuse
  influence the development of PTSD and depression
  symptoms, and whether emotional abuse plays a
  unique role. We also examined how the effects of
  abuse differ as a function of the gender of the
  perpetrator (mother or father).

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Participants

• 327 women with histories of child physical or
  sexual abuse exhibiting symptoms associated with
  PTSD
• Age range 21-64 (M37.24, SD 10.80)
• Exclusionary criteria included
  suicidal/self-injurious behavior, current eating
  disorders, substance abuse, Borderline
  Personality Disorder, thought disorder, and
  dissociative or psychotic symptoms

Measures

• Semi-structured interview
• Child Maltreatment Interview Schedule (Briere,
  1992)
• Assesses history of childhood maltreatment,
  including emotional abuse
• Clinician-Administered PTSD Scale (Blake et al.,
  1995)
• Structured Clinical Interview for the DSM-IV I
  (Spitzer et al., 1994) 
• Self-report measures
• Becks Depression Inventory (Beck, Ward,
  Mendelson, 1961)

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Sample Characteristics

• 66 Diagnosable Anxiety Condition
• 74 PTSD, 32 GAD, 23 Social Phobia, 23
  Specific Phobia
• 34 Major Depressive Disorder, 25 Dysthymia
• High Rates of Abuse
• 79 Emotional, 74 Sexual, 60 Physical

Results How does type of abuse relate to
outcome?

• Emotional, sexual, and physical abuse explained
• 17 of the variance in PTSD symptoms, F (3, 309)
  18.95, p lt .001
• 4 of the variance in depression symptoms, F (3,
  267) 3.74, p lt .01
• When controlling for sexual and physical abuse,
  emotional abuse was still related to PTSD and
  Depression symptoms.
• Emotional abuse explained 6.9 of the unique
  variance in PTSD and 2.9 in depression symptoms.
• Sexual abuse uniquely contributed to PTSD symptom
  severity, ß .31, t 5.63, p lt .001. However,
  after controlling for physical and emotional
  abuse, sexual abuse was not related to
  Depression.
• When controlling for emotional and sexual abuse,
  physical abuse had no relationship to PTSD,
  depression, or any other Axis I disorders

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Results How do types of abuse relate to each
other?

• Severity of emotional abuse was significantly
  related to physical abuse severity (r .42, p
  lt.001) and had a negative correlation with
  severity of sexual abuse (r -.25, p lt .001)
• Emotional and physical abuse tend to co-occur and
  to be perpetrated by the same parent, ?2
  158.26, p lt .001

Results Does the gender of the abuser affect
outcome?

• Physical abuse by the mother, but not by the
  father, was a unique and significant predictor of
  PTSD, ß .13, t 2.42, p lt .05
• There was no significant difference between
  emotional abuse by the father and emotional abuse
  by the mother.
• Our sample did not include enough cases of sexual
  abuse by the mother to determine whether the
  abusers gender influenced the relationship
  between sexual abuse and PTSD or Depression.

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Discussion

• Emotional and physical abuse tend to co-occur,
  with the perpetrator most often being the same
  parent.
• Emotional abuse has a significant and unique
  relationship to PTSD and Depression, over and
  above the contribution of sexual and physical
  abuse. In this sample, emotional abuse was more
  highly related to PTSD than to Depression.
• Physical abuse has no unique relationship to PTSD
  or Depression, unless the physical abuse was
  perpetrated by the mother.
• The cross-sectional nature of the design does not
  allow for causal interpretations.

Implications

• Though childhood sexual and physical abuse are
  often thought to contribute to the development of
  posttraumatic and depression symptoms, we have
  found that childhood emotional abuse is also
  significantly associated with adult
  psychopathology.
• When treating individuals with a significant
  history of abuse or assault, the specific
  influence of emotional abuse should not be
  underestimated.
• Furthermore, clinicians should not overlook the
  possibility that the psychological sequelae of
  childhood abuse may differ depending on who the
  abuser is.