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TYPES OF VIOLENCE Childhood Sexual Abuse in the Lives of Black Women:

Risk and Resilience in a Longitudinal Study Victoria L. Banyard Linda M. Williams Jane A. Siegel Carolyn M. West Victoria L. Banyard, PhD, is affiliated with the Department of Psychology, University of New Hampshire.Linda M. Williams, PhD, is affiliated with The Stone Center at Wellesley College. Jane A. Siegel, PhD, is affiliated with the Department of Sociology, An- thropology, and Criminal Justice at Rutgers University, Camden. Carolyn M. West, PhD, is affiliated with the Department of Interdisciplinary Arts and Sciences, University of Washing- ton, Tacoma.

The research was supported by National Center on Child Abuse and Neglect (90-CA-1406) and Recovery from Sexual Abuse (90-CA-1552).

Address correspondence to: Victoria L. Banyard, PhD, Department of Psychology, Uni- versity of New Hampshire, Conant Hall, 10 Library Way, Durham, NH 03824 (E-mail:

vlbcisunix.unh.edu).

[Haworth co-indexing entry note]: “Childhood Sexual Abuse in the Lives of Black Women: Risk and Resil- ience in a Longitudinal Study.” Banyard, Victoria L. et al. Co-published simultaneously inWomen & Therapy (The Haworth Press, Inc.) Vol. 25, No. 3/4, 2002, pp. 45-58; and:Violence in the Lives of Black Women: Battered, Black, and Blue(ed: Carolyn M. West) The Haworth Press, Inc., 2002, pp. 45-58. Single or multiple copies of this article are available for a fee from The Haworth Document Delivery Service [1-800-HAWORTH, 9:00 a.m. - 5:00 p.m. (EST). E-mail address: [email protected]]. 2002 by The Haworth Press, Inc. All rights reserved.45 SUMMARY.Childhood sexual abuse (CSA) is associated with long-term mental health consequences. This article reviews the results of one longitu - dinal study, whose sample consisted primarily of African American women. The purpose is to give voice to an understudied group of CSA sur - vivors and tohighlight the variability in risk and protective factors. Key find - ings related to mental health consequences, re-traumatization, and resilience are reviewed and set within the broader context of research on African Ameri - can women and child sexual abuse. Implications for future research and clini - cal practice are discussed. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address:

Website: © 2002 by The Haworth Press, Inc. All rights reserved.] KEYWORDS.Blacks, trauma, mental health, re-victimization Childhood sexual abuse (CSA) has been documented in all segments of society (e.g., Finkelhor, Hotaling, Lewis, & Smith, 1990) with docu- mented long-term consequences for women’s psychological functioning and well-being (e.g., Fergusson & Mullen, 1999). Black feminist survi- vors (Wilson, 1994) have documented many painful personal accounts of childhood sexual abuse. Empirical researchers have also discovered child sexual abuse in this population. For example, Wyatt, Loeb, Solis, and Carmona (1999) reported a 10-year comparison of prevalence rates of child sexual abuse in a community sample of African American and Euro- pean American women. There were no significant changes in reported rates of abuse over 10 years and no racial differences in the characteristics of the abuse experience. However, 29% of the African American women in the sample reported child sexual abuse in the 1994 survey. Although this was lower than the 39% prevalence rate for European American women, it is still a substantial rate of victimization. Research has also doc- umented the wide-ranging negative mental health consequences associ- ated with experiencing child sexual abuse (e.g., Beitchman et al., 1992).

These findings suggest that CSA is an important element in understanding Black women’s health (Lawson, Rodgers-Rose, & Rajaram, 1999).

Kenny and McEachern (2000) reviewed findings related to ethnicity and child sexual abuse, including patterns of prevalence, disclosure, and consequences. They called for further research that explores the experi- ences of ethnically diverse individuals. Feminist scholars, particularly Black feminist researchers, have asserted the need to reexamine notions of 46 VIOLENCE IN THE LIVES OF BLACK WOMEN difference and to move beyond treating all women as a homogenous group (Collins, 2000; Hare-Mustin & Marecek, 1990; West, 2002). Such cri - tiques have important implications for the study of child sexual abuse, calling for greater attention to how child sexual abuse is experienced in the lives of understudied groups of women. Moreover, in order to understand variability among survivors, researchers need to move beyond simply com - paring survivors to non-survivors (West,Williams, & Siegel, 2000).

In response to such feminist critiques, this article will describe the find - ings of a longitudinal study of women, primarily African American, as a focal point for examining patterns of risk and resilience in the lives of CSA survivors. The study’s findings have been discussed in detail else - where (McCahill, Meyer, & Fischman, 1979; Banyard & Williams, 1996; Banyard, Williams, & Siegel, 2000c). The purpose of this article is to summarize and review these findings in the context of other studies of child sexual abuse, particularly studies that focus on African American survivors.

THE WOMEN’S STUDY Participants The Women’s Study, which began in the early 1970s, has followed a group of female childhood sexual abuse survivors and a comparison sam- ple for more than 25 years. Participants were drawn from a sample of 206 victims of child sexual abuse who were examined in the emergency room of a large city hospital from 1973 to 1975. They and/or family members were interviewed at the time as part of a larger study on the consequences of sexual assault (McCahill et al., 1979). The sample was composed pri- marily of African American girls (84%) who ranged in age from 10 months to 12 years at the time of the abuse. The reported sexual abuse in- volved sexual contact by force, threat of force, misuse of authority, or by a person who was five or more years older than the child, whether or not force was used.

The abuse ranged from genital fondling to sexual intercourse and was perpetrated by a wide range of individuals–fathers, stepfathers, other fam- ily members, friends, acquaintances, and strangers (all males). Soon after each girl was seen in the hospital, consent to participate in the study was obtained from the children and/or their caregivers, and then the child and caregiver were interviewed. Types of Violence 47 An average of 17 years after the abuse, 136 women (66% of the original sample) were located through phone directories, official and government records, and neighborhood canvassing. The survivors were reinterviewed in 1990 or 1991 as part of a follow-up study on the consequences of child sexual abuse. The mean age for the sample at the time of reinterview was 25.5 years. Most (86%) were African American, and most (61%) had never been married. Fifty percent of the women had a high school diploma or GED equivalent. Although 29% were working full- or part-time, the majority of women were unemployed (64%). Their median personal in - come was less than $8,000 in the year before the interview.

In 1997, which was 23 years after the abuse, 87 of the original 206 girls were recontacted and reinterviewed. In order to make comparisons, we also contacted 87 women who were seen, but not for sexual abuse, at the same city hospital in the early 1970s. On average, the women were 31.6 years old at this time, and 89% identified themselves as African Ameri- can. Women interviewed at wave 2 were more likely to have been sexu- ally abused by a family member than non-interviewed women and, at wave 3, a greater proportion of interviewed women were African Ameri- can. Overall, however, interviewed and non-interviewed women did not differ on demographic variables or characteristics of their abuse.

Procedures Institutional review board procedures were followed for obtaining con- sent. Before each interview, informed consent was obtained, which in- cluded a description of the sensitive nature of the interview material.

Participants were advised that they could stop the interview at any time.

The caregivers who were interviewed in the early 1970s were not reinter- viewed.

All waves of the data were collected through face-to-face interviews.

The interviewers were two women, one European American and one Afri- can American, who had received training and supervision to ensure that they were able to establish rapport with the women and conduct inter- views with sensitive and potentially upsetting personal topics. Although the interviewers knew the purpose of the study, they were blind to the de- tails of the women’s histories of victimization.

Although a few participants were interviewed in their own homes, al- most all were interviewed in a private office. Each interview began with questions about more neutral aspects of the woman’s life, such as educa- tion and employment status. After sufficient rapport had been established, the interviewers asked questions about other topics such as relationships 48 VIOLENCE IN THE LIVES OF BLACK WOMEN in her family of origin, drug and alcohol use, sexual history, psychological functioning, and detailed questions about sexual victimization.

On average, the interviews lasted three hours and were followed by a debriefing period, which gave the women an opportunity to ask questions.

There was also a discussion of how she was feeling about the interview.

Interviews were suspended if the interviewer determined that the partici - pant was in any distress. Counseling services from a local sexual abuse treatment center were made available to participants if they were inter - ested.

REVIEW OF THE RESEARCH The participants’ voices in the Women’s Study revealed the negative consequences associated with child sexual abuse, including a variety of mental health problems, difficulties functioning as a parent, and elevated rates of aggressive behavior. The women also demonstrated how re- sponses to trauma might vary based on the number and types of traumatic experiences. Equally as important, the Women’s Study discovered that survivors, despite their trauma, could be very resilient.

Consequences of Child Sexual Abuse Several articles, based on data from The Women’s Study, point to the negative impact of child sexual abuse on the health and well-being of Afri- can American women. Banyard, Williams, and Siegel (2001b) used wave 3 of the study to investigate the adult mental health functioning of CSA survivors and the comparison group. When compared to the non-abused group, survivors of child sexual abuse experienced higher levels of anxi- ety, depression, dissociation, sexual concerns, intrusive symptoms, and an impaired sense of self.

The size of the sample in the Women’s Study also permitted the exami- nation of variations among survivors. Banyard, Williams, and Siegel (2001d) discovered that some survivors experienced negative reactions when they disclosed their abuse. For example, the person they told was unsupportive, blamed the survivor, called the survivor a liar, or punished the survivor. These survivors reported higher levels of dissociative symp- toms.

Other analyses examined the association between mental health func- tioning and characteristics of the child sexual abuse, such as the use of force, the survivor’s relationship with the perpetrator, and level of Types of Violence 49 invasiveness (Banyard & Williams, 1996; Jasinski, Williams, & Siegel, 2000). Survivors who had experienced force reported higher levels of such problems as depressive symptoms, anxiety, and sleep disturbance.

Women who were abused by a family member, when compared to survi - vors who were victims of extrafamilial abuse, were more likely to report an array of mental health symptoms. Higher levels of anxiety and heavy drinking in adulthood also were found among survivors who were older at the time of the abuse and among survivors who had experienced multiple instances of CSA. These findings fit with both the broader literature on the negative effects of child sexual abuse and itslinks to a broad array of men - tal health effects across the life span (see Jumper, 1995; Kendall-Tackett, Williams, & Finkelhor, 1993; Neumann, Houskamp, Pollock, & Briere, 1996; Polusny & Follette, 1995 for reviews) and studies that specifically ex - amine the experiences of AfricanAmerican women (e.g., Rhodes, Ebert, & Meyers, 1993; Russo, Denious, Keita, & Koss, 1997; Thompson, Kaslow, Lane, & Kingree,2000;Wyatt &Newcomb, 1990; West, 2002).

Measures used in the Women’s Study also permitted examination of the impact of child sexual abuse on specific behaviors, including the abil- ity to function as a parent and adult aggressive behavior. Banyard, Wil- liams and Siegel (2001a) discovered that adult sexual assault and partner violence, but not CSA, were associated with more negative parenting out- comes. This differs from other studies that found links between child sex- ual abuse and parenting difficulties, such as negative perceptions of one’s self as a parent and greater use of physical punishment (Banyard, 1997; DiLillo, 2001). Future research should explore the impact of CSA on Afri- can American women’s family roles.

Other areas of behavior examined in the Women’s Study included criminality and aggression. Several feminist scholars have posited that child sexual abuse is an important factor in the onset of delinquency be- cause it can lead girls to run away, which, in turn, forces them to engage in criminal behavior for survival (Belknap, Holsinger, & Dunn, 1997; Chesney-Lind, 1997). Richie (1996) has shown that victimization plays an important role in what she has referred to as thegender entrapmentof African American women in which women’s criminal behavior is inextri- cably tied with their involvement in violent relationships with their part- ners. In addition, sexual victimization has been associated with aggression in children (Kendall-Tackett et al., 1993); however, before the Women’s Study, there had been few attempts to determine if this relationship per- sisted beyond childhood.

Analyses of official arrest records by Siegel and Williams (2001) found that the child sexual abuse victims were at higher risk of arrest than were 50 VIOLENCE IN THE LIVES OF BLACK WOMEN the women in the comparison group as adults, but not as juveniles. How - ever, the victims of abuse were significantly more likely to have been ar - rested for violent offenses in both adolescence and adulthood. African Americans were no more likely to have been arrested than White women, either as juveniles or adults, except for violent offenses; in that case, the African American women faced a substantially higher risk of arrest than the White women.

The increased risk of violence faced by victims of sexual abuse was re - flected as well in self-reports of extensive aggressive behavior in the form of physical fighting, with both intimate partners and others (Siegel, 2000).

Women with a history of repeated sexual victimization and exposure to other forms of violence, such as witnessing violence, experiencing beat - ings in childhood, and having family members or close friends who were murdered, were at significantly greater risk of perpetrating violence.

Those who were victims of violence at the hands of their intimate partners were also more likely to report engaging in physical fighting. Thus, the women’s own violence was coupled with another troubling aspect of their lives: vulnerability to repeat victimization.

Re-Victimization Linkages between a history of child sexual abuse and re-victimization in adulthood, defined as the occurrence of at least one incident of sexual abuse during childhood followed by a subsequent incident of adult physi- cal or sexual victimization, have been reported in several studies, includ- ing those with samples of African American women (e.g., Roodman & Clum, 2001; Wyatt, Notgrass, & Gordon, 1995). Almost all of these stud- ies, however, have been based on retrospective reports by adults. In addi- tion to experiencing violence in intimate relationships, many Black women are exposed to a broad array of traumatic experiences, including community violence (Jenkins, 2002). Re-victimized Black survivors are espe- cially vulnerable to mental health problems (Russo et al., 1997). For exam- ple, almost one-quarter of the re-traumatized women surveyed by Hien and Bukszpan (1999) met diagnostic criteria for lifetime posttraumatic stress disorder.

The Women’s Study extends our knowledge of re-victimization be- cause it assessed for various forms of trauma in adulthood, including wit- nessing violence, experiencing a serious accident, the traumatic loss of a friend or family member, and various forms of physical and sexual as- saults over the life span. Siegel and Williams (2001) found that the risk of adult re-victmization was not shared equally among all those in the Types of Violence 51 Women’s Study who experienced child sexual abuse. Women whose only experience of youthful sexual victimization occurred when they were un - der age 13 were not at increased risk of adult sexual re-victimization com - pared to those who experienced no child sexual abuse. However, a small group of women were at extremely high risk of adult sexual and physical victimization if they had been victimized as young children (i.e., under age 13) and again in adolescence. In addition, West, Williams, and Siegel (2000) found that survivors who had experienced sexual abuse in both childhood and adulthood were also at increased risk for partner violence in their adult intimate relationships.

Furthermore, sexual re-victimzation had an adverse impact on Black women’s reproductive and sexual health. Specifically, when compared to women sexually abused in childhood only, re-victimized women experi - enced more problems with conceiving, repeated vaginal infections, sexu - ally transmitted diseases, and painful intercourse (West et al., 2000).

Banyard, Williams, and Siegel (2001b) found that exposure to multiple traumatic events (broadened beyond exposure to sexual re-victimization) across the life span were associated with higher levels of psychological distress. Furthermore, the relationship between child sexual abuse and such outcomes as depressive symptoms, anxiety, and negative feelings about self was mediated by reports of exposure to this variety of other traumatic events. Thus, for some symptoms, the links between child sex- ual abuse and adult mental health symptoms are explained by links be- tween child sexual abuse and re-traumatization. Taken together, with the aforementioned risk of self-reported aggression for those exposed to other forms of violence, these findings underscore the need for careful addi- tional attention to the links between child sexual abuse and a web of other traumatic events.

The longitudinal nature of the Women’s Study also permitted examina- tion of risk and protective factors for repeated trauma exposure within the sample of child sexual abuse survivors. West et al. (2000) found that child sexual abuse survivors whose abuse involved physical force were at greater risk for reexperiencing abuse in the form of adultsexual assault.

Banyard, Williams, and Siegel (2001c) found increased risk for a wide range of trauma re-exposure in adulthood for women who also experienced extreme poverty, family-of-origin difficulties, depression and dissociation, and sub- stance abuse. Social support was a protective factor. These findings fit with earlier work on risk factors by researchers, such as Koss and Dinero (1989), but extend the findings to a community sample of women, most of whom were African American. These findings further support the need to attend to important differences among women–not only differences between Black 52 VIOLENCE IN THE LIVES OF BLACK WOMEN women and other survivors, but also variability in the experiences of African American women themselves.

Resilience In addition to documenting the ways in which child sexual abuse places African American women at risk for re-traumatization and psychological distress, the Women’s Study also sought to examine the complex phe - nomenon of resilience. Despite having experienced childhood sexual abuse, resilient women are functioning relatively well in many aspects of their lives. Hyman and Williams (2001) defined resilience as “physical health, mental health, interpersonal relationships, adherence to commu - nity standards, and economic well being” (p. 203).

However, 40 survivors (29% of the sample) had high scores on the re - silience scale, and 25 women (18% of the sample) demonstrated what the researchers referred to asexcellent resilience, which was characterized by competent functioning in nearly all areas assessed. The highly resilient women were less likely to have experienced incest or severe child physi- cal abuse. In addition, they were more likely to have been reared in stable homes, which meant that they experienced fewer moves or foster care placements and less parental drug abuse. Income level of family of origin was not related to resilience. Receiving abuse-specific therapy was not significantly related to resilience, though it should be noted that a rela- tively small portion of the sample of women received this type of profes- sional intervention. Graduation from high school was also predictive of resilience for this sample.

For this group of women, social support in the form of receiving sup- port from someone special and significant in their lives was an important protective factor characteristic of the more resilient women. In a similar vein, Siegel (2000) found that women who reported a strong feeling of at- tachment to their mothers were less likely to be in abusive relationships, which, in turn, lowered the risk that they themselves would engage in vio- lence. These results suggest the need to attend not only to strengths within the survivor, but also to building strengths and supports around the survi- vor–including stabilizing the family of the abused child and strengthening informal support networks.

These findings fit with the broader literature on understanding compe- tent outcomes following child sexual abuse (e.g., Spaccarelli & Kim, 1995; Valentine & Feinauer, 1993). Harvey (1996), for example, dis- cusses the importance of understanding a variety of ecological factors that may predict recovery from sexual abuse. She highlights the fact that many Types of Violence 53 survivors do not seek professional help but may find other paths to recov - ery. The Women’s Study supports this notion in that only a minority of the study’s participants was in psychotherapy, yet many were able to find paths toward healing through other connections. This study extends dis - cussions of resilience that have more often focused on European Ameri - can women’s experiences, and illustrates the important strengths of African American female survivors.

SUGGESTIONS FOR INTERVENTION In summary, a variety of research points to the importance of understand - ing child sexual abuse in the lives of African American women. The voices of participants in the Women’s Study remind us of the negative conse - quences of CSA, including the ways in which it places survivors at greater risk for mental health concerns, such as depression, anxiety, traumatic intru- sions, and impaired views of the self, as well as increased contact with the criminal justice system and concerns in relationships with others. These women also tell us of the variability in survivors’ responses to trauma as not all women experienced the same constellation of effects. Furthermore, these survivors remind us of the strengths of survivors of child sexual abuse, and of Black women in particular. Furthermore, although a relatively small portion of the women used therapy to address their history of abuse (Hyman & Williams, 2001), practitioners should be prepared to assist African Amer- ican survivors of childhood sexualabuse. The following suggestions are made for clinical practice:

Establish competence. Therapists should become familiar with a vari- ety of topics, including the psychobiology of trauma; research on memo- ries for trauma, dissociation, and posttraumatic stress disorder; and variables associated with resilience and coping (Enns et al., 1998).

Conduct a thorough assessment. Service providers should consider us- ing self-report measures, such as the Trauma History Screen, which is de- signed to enable clinicians to gather information about a broad range of traumatic experiences (Allen, Huntoon, & Evans, 1999). Black women are also at risk for community violence and racial trauma, such as racial profiling by the police (Daniel, 2000; Jenkins, 2002). These forms of trauma should not be overlooked. Assessment and treatment strategies need to consider the complex web of trauma exposure that maycharacter- ize the experiences of some survivors.

Treatment plan. It is especially important to be attentive to how the experi- ence of child sexual abuse is influenced by the client’s race, social class, and 54 VIOLENCE IN THE LIVES OF BLACK WOMEN sexual orientation (Enns, 1996). A culturally sensitive treatment plan for Af - rican American survivors may involve addressing such topics as spirituality or stereotypes about Black women’s sexuality (Robinson, 2000; Wilson, 1994). Future work should focus on merging the growing fields of culturally sensitive therapeutic intervention and trauma treatment, work that is being done by Black feminist scholars (Daniel, 2000).

Develop a support system. A strong support system has been shown to improve the psychological functioning of victimized Black women and to reduce their likelihood of suicidal behavior (Young, Twomey, & Kaslow, 2000). If necessary or appropriate, the service provider may need to educate relatives, friends, and community members about the risk factors and symp - toms associated with childhood sexual abuse (Fontes, Cruz, & Tabachnick, 2001). Tully (1999) encourages practitioners to recognize the ways in which traditional strengths of African American communities may help the survivor cope in the aftermath of victimization.

In conclusion, the Women’s Study provides further evidence of the im- portance of understanding child sexual abuse in the lives of African Amer- ican survivors. The Women’s Study helps document both the long-term negative effects of CSA as well as the fact that despite these life chal- lenges, many survivors are resilient and develop effective coping strate- gies. The voices of participants from the Women’s Study encourage us to continue to develop interventions that appreciate the complex differences among women and to support research that gives voices to the perspec- tives of various survivors of child sexual abuse.

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