Reading Analyses
AffiliaSummer 2001Hyman, Williams Resilience Among Women Survivors of Child Sexual Abuse Batya Hyman and Linda Williams Research has paid little attention to survivors of childhood sexual abuse who do not exhibit long-term negative consequences or who manifest resilience. This study investigated resilient outcomes, that is, competence in the face of adversity, and the factors associated with these outcomes in 136 women who were sexually abused as children.
This article presents a study of women who appeared to func- tion competently despite their experience of child sexual abuse (CSA). The article provides a review of the literature on the meaning of resilience–competence and well-being, the factors that may contribute to this outcome, the range of long-term consequences of CSA, and models for analyzing the predictors of competent functioning.
REVIEW OF THE LITERATURE Definitions Scholars have long debated the meaning of the termresilience.
Some have defined it as a trait a child exhibits, like hardiness Authors’ Note: The research reported in this article was supported by Grant No. CA-90-1406 from the National Center on Child Abuse and Neglect; Linda Williams, principal investigator. AFFILIA, Vol. 16 No. 2, Summer 2001 198-219 © 2001 Sage Publications, Inc. 198 (Anthony, 1987; Murphy & Moriarty, 1976; Rhodewald & Zone, 1989) or invincibility (Neiman, 1988; Werner & Smith, 1982) following exposure to a known risk factor, such as living with a mentally ill mother. Others have acknowledged that resil - ience comprises many factors in interaction (Hauser, Vieyra, Jacobson, & Wertlieb, 1985; James, O’Toole, & Liem, 1993; Neiman, 1988).
In their discussion of resilience in maltreated children, Mrazek and Mrazek (1987) proposed 12 characteristics and skills that may foster resilience and warrant research. For example, they suggested that resilient children are intelligent, vigilant, and able to inhibit their affect—skills that enable them to avoid or escape potentially explosive or otherwise danger - ous situations. Furthermore, some of these children can dissoci- ate from intense feelings and not dwell on the abusive events because they are too painful. Resilient children also acquire as much information as possible about the triggers that stimulate abusive behavior in their abusers and may demonstrate altruis- tic behavior; that is, they often try to protect their younger sib- lings from abusive experiences and sometimes help their schoolmates.
Mrazek and Mrazek (1987) discussed the need for abused but resilient children to believe they are worthy enough to be loved and noted that children who are loved by younger sib- lings or who are treated sensitively by teachers and social workers may gain this conviction. They also addressed some of the life circumstances that may foster resilience, such as receiv- ing attention from a mentor or another significant person in their lives who encourages them and helps them view the future with hope that it will be better than the present or past abusive circumstances. To date, little research (Romans, Mar- tin, Anderson, O’Shea, & Mullen, 1995) has tested Mrazek and Mrazek’s hypotheses.
Garmezy (1985, 1993) demonstrated that important aspects of the person, the environment, the stressful event, and avail- able supports combine to determine positive and adverse out- comes. In addition, Rutter (1990) identified four main protec- tive processes in children who were removed from their Hyman, Williams199 families, placed in institutions, and followed up as young adults: the reduction of the impact of risk, the reduction of neg - ative chain reactions, the establishment and maintenance of self-esteem and self-efficacy, and the opening up of opportuni - ties. In Rutter’s study, the impact appeared to be reduced by altering the meaning of the adversity for the child and eliminat - ing the child’s exposure to the risk factor, such as maternal depression. On the basis of his hypothesis that negative chain reactions heighten the likelihood of adverse long-term conse - quences, Rutter proposed that two types of experiences are especially important in stemming these chain reactions and developing self-esteem and self-efficacy: secure attachment to loving figures and the accomplishment of tasks, such as sports, schoolwork, and the attainment of positions of authority, throughout childhood and adulthood. With regard to the final mechanism, opening up opportunities or turning points in peo- ple’s lives may either positively affect resilience (such as com- pleting high school and entering college or the workplace) or have an adverse affect on it (for example, becoming a teenage mother, which may foreclose some options, including the pros- pect of a successful marriage and the completion of high school).
Women’s Well-Being Resilience has been treated as a psychological construct, yet, researchers in several fields (such as family studies, sociology, and economics) have demonstrated that individuals’ well- being consists of multiple and highly correlated features, includ- ing functioning in the workplace, psychological well-being, family relationships, and health, and that these features are highly correlated (Barnett & Marshall, 1991; Hyman, 2000; Kessler & McLeod, 1985; Verbrugge, 1983; Voydanoff & Don- nelly, 1989). Life satisfaction and well-being are dependent, to some degree, on people’s belief that their resources are ade- quate for their needs (Antonovsky, 1987; Benham & Benham, 1981). Access to physical and mental health resources is often determined by income and occupational status (Anson & 200AffiliaSummer 2001 Anson, 1987). Furthermore, the ability to work is often affected by physical and/or mental health limitations (Barnett & Mar - shall, 1991; Chirikos & Nestel, 1985; Waldron, 1980), and women who work outside the home may remain healthy and derive satisfaction from increased social contacts and opportu - nities for success (Verbrugge, 1987). These effects may differ by ethnicity and social class. Ill health and/or economic strains are often identified as factors in the disruption of interpersonal relationships (Barnett & Baruch, 1987; Larson, Wilson, & Beley, 1994; Voydanoff & Donnelly, 1989).
Studies have examined the extent to which the relationships among these outcomes are contingent on coping resources and social supports (Baruch, Biener, & Barnett, 1987; Kessler & McLeod, 1985; Long & Kahn, 1993; Pearlin, 1989; Robertson, Elder, Skinner, & Conger, 1991). Investigators of the associa- tions among stress and the health, well-being, and efficiency of female workers have delineated a model for portraying these stress–health interactions (Berkman, 1986; Frankenhaeuser, 1991; Waldron & Jacobs, 1989). This theoretical and empirical model identifies the stressors (or behavioral demands), the individual and social resources available (skills, experience, genetic factors, and social supports), the individual’s cognitive assessment and bodily reactions to the stress, and the outcomes of health, well-being, and efficiency. It is similar to Garmezy’s (1983, 1985) model for understanding the predictors of resilience.
Functioning of Adult Survivors of CSA In the past 20 years, much research has documented the ad- verse long-term psychological sequelae of CSA, the mechanisms by which they occur, and methods of intervention (Briere & Runtz, 1988, 1993; Mullen, Martin, Anderson, Romans, & Herbison, 1993; Peters, 1988; Stein, Golding, Siegel, Burnam, & Sorenson, 1988). However, little attention has been paid to the survivors of CSA who do not exhibit negative consequences or who manifest resilience (Draucker, 1995; Harvey, 1996; James et al., 1993; Neiman, 1988; Romans et al., 1995). Studies of the Hyman, Williams201 short-term impact of CSA have found that 21% to 49% of the children studied suffered no symptoms (Kendall-Tackett, Wil - liams, & Finkelhor, 1993; McLeer, Deblinger, Henry, & Orvaschel, 1992). Less information on resilience in adult CSA survivors is available, although Russell (1986) reported that 22% of her representative sample had no long-term effects. The lack of data on the one fifth of survivors who appear to be resil - ient may have implications for both policy makers and practitioners.
METHOD Sample The sample for this study was first interviewed from 1973 to 1975 regarding their CSA experiences. All reported victims of sexual abuse in a major northeastern city were brought to the city hospital emergency department for treatment and the col- lection of forensic evidence, at which time details of the sexual assault were recorded. In 1990 and 1991, 136 of the original 206 girls, now ages 18 to 31, were located and reinterviewed (Wil- liams, 1995). The majority of the girls (86%) were African Amer- ican. Because African American children are more likely than White children to come to the attention of child protection authorities (Hampton, 1991), this study provides a unique opportunity to gain insight into the recovery processes of this population.
The sexual abuse these women experienced in childhood ranged from sexual intercourse to touching and fondling, all by male perpetrators. Sexual penetration was reported in 60% of the cases, and some type of physical force (pushing, shoving, slapping, beating, or choking) by the perpetrators was reported in 62% of the cases. The perpetrator was a member of the imme- diate or extended family in 34% of the cases, an acquaintance or friend of the family in 27%, a peer in 14%, and a stranger in 25%.
Medical evidence of some physical trauma was present in 34% of the cases. For the purposes of the study, CSA was defined as 202AffiliaSummer 2001 sexual contact that was against the child’s wishes, involved force or coercion, and was perpetrated by a male who was 5 or more years older than the victim (Williams, 1995).
The Model The theoretical perspective of this study was informed by the theoretical and empirical work of researchers in the field of resilience (Garmezy, 1985; Mrazek & Mrazek, 1987; Rutter, 1985, 1991), as well as of those who have identified the intercon - nections among five essential elements of a woman’s well-being (Barnett & Marshall, 1991; Voydanoff & Donnelly, 1989). The study investigated the factors and mechanisms that predict competent functioning by examining features of the child; her family environment; the abuse she experienced; the supports available to her at various times following the abuse; her opportunities for accomplishing tasks as an adolescent and adult; her experiences, such as teenage pregnancy, that may have foreclosed some choices; and evidence of turning points.
Table 1 presents the authors’ conceptual model and the cate- gories of variables that were measured. The independent vari- ables in columns 1 and 2 were drawn from studies of resilience and the authors’ knowledge of factors that influence the adverse outcomes in survivors of CSA. The third column of Table 1 shows the five spheres of adult life and functioning, which have been shown to be affected by CSA, combined to cre- ate a measure of resilience.
Resilience Scale Resilience, competent functioning in several interrelated spheres despite adversity, is operationalized as well-being in five essential spheres: physical health, mental health, interper- sonal relationships, adherence to community standards, and economic well-being. To analyze the data, the authors devel- oped a scale to measure “competent outcomes” in these women.
Several dilemmas were addressed while developing the scale. First, at what age can it be said that an individual Hyman, Williams203 demonstrates a resilient response to a traumatic experience?
Several studies have measured the resilience of children who were exposed to a variety of risk factors for poor outcomes, but few have done so in adults who experienced a traumatic event during their childhood (James et al., 1993). The passage of time between the event and the measurement of resilience leads to 204AffiliaSummer 2001 TABLE 1: Variables Used to Examine Resilience Features of Childhood Years Intervening Years Resilience in Adulthood Characteristics of the Availability and use of Psychological child social supports well-being Health Abuse-specific therapy TSC-40 score Closeness to mother A special relationship Self-esteem Number of moves Opportunity to feel special Foster care or institutionalization Experienced physical abuse Characteristics of the Educational status Health family Graduation from high school Severe illness or Race surgery Income Good in school Use of alcohol and/or Parents abused alcohol drugs or drugs Parental violence Parents’ levels of education Whether mother worked Type of discipline used Characteristics of the sexual Possible adverse outcomes Interpersonal abuse Teenage pregnancy relationships Age of the child Alcohol or drug use Intimate relationships Perpetrator was/was not Arrest during teenage years Parenting a family member Friendships Penetration Participation in the Physical force community Revictimization Economic well-being Sexual Personal earnings Battering Labor force participation Adherence to community standards Arrests in adulthood NOTE: TSC-40 = Trauma Symptom Checklist–40 (Briere & Runtz, 1989). the second dilemma: Should women who demonstrated a less adaptive response at some point during the intervening years but who now exhibit competent functioning be defined as resil - ient? The authors decided to consider women who exhibited competent functioning at the time of the study to be resilient, whatever their previous functioning. The notion of “compe - tent” is the root of the third dilemma: How can one know whether a woman considers her behavior to be competent and whether she developed an adaptive pattern of disguising her problems to appear healthy and functional? Clearly, the authors could not know whether women who appeared to be resilient were disguising their pain, but by designing a measure that took into account the women’s functioning in five spheres, they hoped to distinguish women who appeared outwardly competent in one or two spheres from those who were compe- tent in a range of areas.
Most studies of survivors of CSA, including this one, have asked their respondents about the adverse consequences of the childhood victimization, rather than about competent out- comes. Transforming these measures of adverse effects into a scale that is valid in the study of resilience was complicated, and the authors recognize that they may not be able to present a full picture of the factors that contribute to competent function- ing. Nonetheless, five domains of resilient functioning for women were identified: psychological well-being, good health, successful interpersonal relationships, the absence of arrests as an adult, and economic well-being; and a 13-point scale (alpha = .65) was created by assigning 1 point for the resilient response on each of the 13 variables.
FINDINGS The frequency distribution of the women’s scores on the resil- ience scale indicated that 71 (52%) of the 136 women demon- strated poor (a score of 2-5 points) or fair (a score of 6-7 points) resilience, and hence for them, the adverse consequences of the abuse predominated. The 40 women (29%) who exhibited good Hyman, Williams205 resilience (a score of 8-9 points) may have overcome some, but not all, of the adverse consequences of the CSA. Finally, 25 women (18%) demonstrated excellent resilience (competent functioning) in the majority of the domains explored; that is, they scored 10 or more points on the 13-point resilience scale.
Table 2 presents the differences between the highly resilient (10-13 points) and nonresilient (2-9 points) women on the five domains as derived from chi-square cross tabulations.
Five Domains of Resilience Psychological well-being. The women’s psychological well- being scores were measured on two scales—the Trauma Symp- tom Checklist-40, a measure of the psychological sequelae of childhood trauma (TSC-40; Briere & Runtz, 1989), and the self- 206AffiliaSummer 2001 TABLE 2: Aspects of Resilience: Highly Resilient Versus Nonresilient Women (in percentages) (N= 136) Highly Resilient Nonresilient Variable Women (n= 25) Women (n= 111 ) Psychological well-being Low TSC-40 score (below sample median) 84**** 40 High self-esteem score (above sample median) 88**** 40 Health status No severe illness or surgery after age 17 68 54 No current drug or alcohol use 88**** 53 Interpersonal relationships Has male friends/few problems with men 72**** 36 High sexual functioning score (above the sample median) 92**** 35 All her biological children live with her 100*** 78 Has never been reported for child abuse 92 88 Has female friends 100*** 75 Is socially active (belongs to an organization or is socially active several times a year) 80**** 38 Social deviance Has not been arrested as an adult 96** 74 Economic well-being Earns above the sample median 72**** 27 Works full-time 44**** 10 NOTE: TSC-40 = Trauma Symptom Checklist–40 (Briere & Runtz, 1989).
**p≤.05. ***p≤.01. ****p≤.001. esteem scale of the Middlesex Hospital questionnaire (Bagley, 1980). A low score on the TSC-40 indicates the absence of psy - chological symptoms, but, as Wortman (1983) noted, this is only a starting point when exploring resilience; therefore, the authors also included a measure of positive self-perception. Of the 25 resilient women, 84% (n= 21) scored low (had fewer problems) on the TSC-40, and 88% (n= 22) scored above the median on the self-esteem scale. In contrast, only 40% (n= 44) of the 111 nonresilient women obtained similar scores on these two measures.
Physical health. Health was measured in two ways. One mea - sure was whether the women experienced any severe illness or surgical procedure after age 17. According to this measure, the health of the resilient and nonresilient women did not differ significantly; 68% (n= 17) of the 25 resilient women and 54% (n= 60) of the 111 nonresilient women were in good health.
The other measure of physical health was the use of alcohol or drugs, which is also a well-documented adverse conse- quence of CSA (Briere & Runtz, 1990; Najavits, Weiss, & Shaw, 1997; Peters, 1988) and an indicator that a woman may have dif- ficulty caring for herself and her children. Of the 136 women, 41% (n= 56) reported a current problem with drugs or alcohol.
However, of the 25 resilient women, 88% (n= 22) did not report a substance abuse problem at the time of the interview, com- pared with 52% (n= 58) of the 111 nonresilient women.
Interpersonal relationships. Resilience in the domain of inter- personal relationships was measured in several spheres: rela- tionships with partners, success as a parent, relationships with female friends, and participation in social activities. Because all the women identified themselves as heterosexual, having “very few problems with men” and having “one or more good male friends” were considered resilient responses with regard to relationships with partners. Whereas 72% (n= 18) of the 25 resilient women met this criteria, only 36% (n= 40) of the nonresilient women did so. In relation to sexual functioning, 92% (n= 23) of the 25 resilient women but only 35% (n= 39) of Hyman, Williams207 the 111 nonresilient women scored above the sample median on the measure of sexual functioning derived from an adaptation of Greenwald’s scale (Greenwald, Leitenberg, Cado, & Tarren, 1990).
In the area of parenthood, 120 (88%) of the 136 women had children. The 25 highly resilient women had an average of 1.6 children, and the 111 nonresilient women had an average of 2 children—a difference between these two groups that is not significant. With regard to the women’s success as parents, the authors addressed whether a woman replicated her abusive childhood with her children and was reported to the authori - ties for child abuse. Women who were not reported for child abuse obtained one point on the resilience scale and, so as not to penalize them, women who did not have children were also assigned one point.
All of the 25 highly resilient women, but only 78% (87) of the 111 nonresilient women were living with their children. Of the 136 women, only 15 said they had been reported for child abuse, and there was no significant difference between the resilient and nonresilient women on this dimension. Only 2 of the 15 were resilient women.
In relation to friendships with other women, any woman who reported one or more friendships with other women scored one point. All the resilient women reported female friends, but only 75% (n= 83) of the 111 nonresilient women did so.
Because women who are resilient are not socially isolated, either “belonging to an organization” or “participating in social activities several times a year” constituted a resilient response.
Of the 25 resilient women, 80% (n= 20) met one of these criteria, versus 38% (n= 42) of the 111 nonresilient women.
Arrests. Being arrested as an adult may be viewed as an indi- cator of deviant behavior. Of the 136 women, 22% (n= 30) had been arrested as adults. However, only 1 resilient woman ver- sus 29 of the nonresilient women (26%) had been arrested dur- ing their adult years.
208AffiliaSummer 2001 Economic well-being. In this society, an important measure of one’s worth is the capacity to support oneself and one’s chil - dren. Thus, earning above the sample median and working full- time were considered to be indicators of resilience. Because the authors were interested in a woman’s ability to support herself, they used her personal earnings in this variable, not the earn - ings of all the adults in her household. However, they recognize that they may have understated the resources available to the women and their children.
Of the 25 resilient women, 72% (n= 18) earned more than the sample median versus only 27% (n= 30) of the nonresilient women. Because the median income of the sample was $8,500, it may be assumed that women who earned less were having difficulty supporting themselves or were relying on the sup- port of someone else.
Only 22 of the total of 136 women— 44% (n= 11) of the 25 resilient women and 10% (n= 11) of the 111 nonresilient women—were working full-time. Because many factors may influence whether a woman works full-time, such as the pres- ence of young children in the home, the condition of the local labor market, and the woman’s level of skills, in future assess- ments, the authors may include women who work part-time but are still able to support themselves in the resilient category. Characteristics Associated With Resilience In Table 3, the highly resilient women are compared with the nonresilient women on the explanatory variables in the model.
Characteristics of the CSA. All 136 women in the sample expe- rienced CSA. Although 54% (n= 73) of them were abused by family members, only 32% (n= 8) of the 25 highly resilient women were. Similarly, 58% (n= 79) of the sample, but only 28% (n= 7) of the highly resilient women, experienced severe physical abuse. Neither age at the time of the abuse nor whether the woman experienced genital penetration was asso- ciated with being highly resilient.
Hyman, Williams209 Characteristics of the survivor and her family of origin. Resilience was apparent across the racial groups; that is, there was no sig- nificant association between being African American and exhibiting highly resilient behavior. However, three features of a woman’s family of origin were associated with high resil- ience: the absence of severe physical abuse, parents with no substance abuse problems, and a stable family. Thus, 72% (n= 210AffiliaSummer 2001 TABLE 3: A Comparison of the Highly Resilient and Nonresilient Women (in percentages) (N= 136) Resilient Nonresilient Variable Women (n= 25) Women (n= 111 ) Characteristics of the child sexual abuse Abused prior to age 9 64 57 Abused by family member 32*** 59 Abused by someone outside the family 88 82 No physical force 52* 33 No genital penetration 29** 13 Childhood/family characteristics African American race 75 86 Absence of severe physical abuse 72**** 35 Parents did not abuse drugs or alcohol 60*** 28 Child experienced fewer than three changes in caregivers 80**** 44 Stable family: composite score of foregoing three items 80**** 33 Parent completed high school 68 60 Never in foster care or institution 92**** 65 Healthy 96 95 Not poor 84 70 Close to mother 72 73 Mother worked 68 69 Received positive discipline 44 42 Absence of parental violence 80 75 Status in the years since the child sexual abuse Received support and opportunity to feel special 80** 58 Graduated from high school 56** 32 No teenage pregnancy 52 37 No teenage alcohol/drug problems 48 33 Arrested as a teenager 8** 26 Received abuse-related therapy 16 23 Sexually victimized as an adult 12** 35 *p≤.10. **p≤.05. ***p≤.01. ****p≤.001. 18) of the highly resilient women versus 42% (n= 57) of the total sample of 136 did not experience severe physical abuse as chil - dren; 60% (n=15) of the highly resilient women, but only 28% (n= 38) of the total sample, grew up with parents who did not have an alcohol or drug problem; 80% of the highly resilient women, compared with 44% (n= 60) of the total sample, moved fewer than three times; and only 8% (n= 2) of the highly resil - ient women, versus 65% (n= 88) of the total sample, had ever lived in a foster home or institution.
Some of the most important findings regarded variables that were not significantly associated with resilience. Neither a girl’s health status before the abuse nor her health during the remainder of her childhood was significantly associated with high resilience. Furthermore, resilience was not associated with whether a girl was poor during childhood, had a close relation- ship with her mother, received positive discipline (discussion and time-out), witnessed parental violence, was kicked out of the family home, or had a mother who worked outside the home.
Social support. Many clinicians have long theorized that vari- ous forms of support buffer the developing child from the potential adverse effects of CSA. Although this theory may be true, this study found that two forms of support are not signifi- cantly associated with high resilience—abuse-specific therapy and having an opportunity to feel special—whereas one form is associated with being highly resilient— receiving support from a special person, at some point during her life. These findings appear to contradict Garmezy’s (1983, 1985) work on support as a protective factor in children’s lives, but they may have cap- tured the fact that the protective effect of support during child- hood diminishes over the years. In addition, one irony in the recovery from trauma is that the traumatic experience can dis- rupt the support networks at the precise moment they are most needed. This disruption may be especially likely when the abuse is perpetrated by a family member, when institutional services interfere with the child’s support network, or when the child’s hardy personality prevents her from eliciting support.
Hyman, Williams211 The authors also evaluated the association between the women’s current use of social supports and current levels of resilience. When asked whether they had considered seeking help with their personal problems during the past year, 75 (55%) of the 136 women said no, and 21 women (15%) said they had considered seeking help, but had not actually pursued it.
Of the 39 women (29%) who sought assistance, 12 turned to friends; only 3 of the 12 women were highly resilient (p= .10).
Neither seeking help from a member of the clergy nor seeking help from a family member was significantly associated with being highly resilient. It is interesting to note, however, that when the women were asked, “Is there anyone who lives out - side your household whose opinion you would consider seri - ously in making an important decision, ” 77% of the sample said yes. Of this group, 21% were highly resilient, compared with only 10% of those who would not turn to someone outside their household.
Education. The resilient women were significantly more likely than the nonresilient women to have graduated from high school (56% vs. 32%). Furthermore, the highly resilient women were more likely to report that they did well in school and got along well with the teachers (48% vs. 26%). One must wonder to what extent these positive relationships bolstered the likelihood that the woman completed high school. In addi- tion, completing high school is an important predictor of an individual’s annual earnings and labor force status (Pindyck & Rubinfeld, 1991), two of the variables that were used to mea- sure resilience.
Teenage pregnancy. In light of the apparent importance of completing high school for these survivors, the authors exam- ined whether pregnancy during high school might explain the differential graduation rates. It was found that 63% (n= 70) of the nonresilient women and 48% (n= 12) of the resilient women were pregnant as teenagers. The trend in these statistics, although not significant, may help explain who finished high school. 212AffiliaSummer 2001 Revictimization during adulthood. Two forms of victimization during adulthood were explored: rape and battering. Of the 25 highly resilient women, 12% (n= 3) experienced sexual victim- ization as adults compared with 35% (n= 39) of the nonresilient women. Furthermore, 40% (n= 10) of the resilient women and 60% (n= 67) of the nonresilient women reported an episode of battering by a boyfriend at some point in their lives. Although the difference in the two groups’ experiences in this regard was not significant (p= .07), clearly, those who were less likely to experience battering tended to demonstrate resilience. Factors That Predict Resilience Table 4 presents the predictive strength of factors from the sur- vivors’ childhoods and adolescence for resilience in adulthood.
Building on the results of bivariate analyses, the authors identi- fied six variables that explain the resilience of these women:
growing up in a stable family, not experiencing incest (perpe- trator not a family member), not experiencing physical force as a part of sexual abuse, not being arrested as a juvenile, graduat- ing from high school, and not being revictimized as an adult. To create a parsimonious model, the authors reduced three family- related variables (parents did not abuse alcohol or other sub- stances, the child did not experience severe physical abuse, and Hyman, Williams213 TABLE 4: Predictors of Resilience in Women Who Were Sexually Abused in Childhood: Regression Summary Table (N= 119) VariableB SE Bβ During childhood Stable family 1.19 .41 .24*** No incest –.94 .41 –.19** No physical force .91 .44 .18** During adolescence/adulthood Ever arrested as a juvenile –1.14 .46 –.19** Graduated from high school 1.35 .40 .26**** No sexual victimization after age 18 .87 .44 .16** R 2(Adjusted) = .34 F= 11.07,p< .00001 **p≤.05. ***p≤.01. ****p≤.001. the child did not experience more than two changes in care - givers) into a new variable, stable family, on the premise that the women who lived in stable families as children were more likely to be resilient adults.
All the women in the sample were survivors of CSA, but those who experienced incest or CSA accompanied by physical force were less likely to be resilient, as were those who were arrested as teenagers. The strongest predictor of resilience was whether a woman graduated from high school, given that 56% of the highly resilient women, but only 32% of the nonresilient women did so. In the model, the final predictor of resilience was whether the woman was revictimized as an adult. Because this variable measured an event that may have been contempo - raneous with the resilience measure, it was not surprising to find that women who had been recently raped were less likely to be resilient.
DISCUSSION The highly resilient women benefited from growing up in more stable homes, characterized by fewer moves and less parental drug abuse, were less likely to have experienced incest or severe physical abuse, and were more likely to have graduated from high school. The significance of the number of changes in caregivers may be an indicator that there is a threshold beyond which children who have also experienced additional stressors (such as an alcoholic parent and CSA) begin to have significant difficulties. The strength of the stable family variable in all the multivariate analyses indicates that family context plays a role as important as CSA in predicting a resilient outcome.
Social support received since the CSA did not appear to explain the women’s resilience, but it is difficult to disentangle the association between support and resilience. For example, resilient girls may be more likely to reach out for support or may exhibit characteristics that draw support to them, leading to resilient adult outcomes.
214AffiliaSummer 2001 Paradise, Rose, Sleeper, and Nathanson (1994) suggested that the child’s existing psychosocial circumstances determine, at least in part, the nature of the functional outcome. As is char - acteristic of research on the consequences of CSA, the authors cannot provide this baseline data, although they were able to control for social class, family circumstances, and race at the time of the abuse.
Some researchers seem to be interested in studies of resil - ience as a way of searching for a trait or factor that can be bot - tled and doled out to all survivors of CSA. Although the unique set of intrapsychic, social, and timing factors that may allow one person to successfully navigate the wake of trauma cannot be bottled, the types of skills that may be taught or enhanced to increase the likelihood of a successful outcome can be identi- fied. Thus, for example, social workers should direct their ener- gies toward helping students complete high school. In addi- tion, they must be careful not to use the findings of research on competent functioning to reinforce the idea that nonresilient children and adults are failures. One way to avoid this use of the findings is to focus on environmental factors that can be influenced, such as social support, rather than on individual factors that are less amenable to intervention.
Researchers need to sharpen their understanding of resil- ience as a complex construct and to design studies that capture the richness of the processes during the years following the abuse. As they develop a more sophisticated understanding of the processes involved in resilience, they will be able to create new measures of resilience that are not predicated on the notion that resilience is the absence of pathology. Therefore, future research should investigate the factors associated with resilient outcomes in women who experience more than one childhood stressor. For example, is there an interaction effect between the CSA experiences and other childhood traumas that decreases the likelihood of a resilient outcome? Or, instead, do girls who survive more than one childhood trauma develop skills to cope with these experiences that foster resilience in adulthood?
Among the many other questions for future research are these: Should the examination of competence be limited to Hyman, Williams215 particular domains, such as psychological functioning? Are there cultural differences in defining competent functioning, and, if so, how can these differences best be captured? Do resil - ient women follow a different developmental trajectory from that of nonresilient women after CSA? What will happen to the women in this study who were identified as resilient when they face future life stresses if, as the authors have argued, resilience is a function of a particular point in a woman’s life?
The findings of this study lay a foundation for future exami - nations of competent functioning in adult survivors of CSA. In feminist research, it is important to recognize and represent women as agents in their own lives. Therefore, feminist researchers need to find ways to capture those parts of women’s experiences that are attributable to proactive behav- ior, rather than solely to a passive response to trauma. By iden- tifying particular intervening variables that suggest the more complex processes, this study has begun that work.
REFERENCES Anson, O., & Anson, J. (1987). Women’s health and labour force status: An enquiry using a multi-point measure of labour force participation.Social Science and Medicine,25(1), 57-63.
Anthony, E. J. (1987). Risk, vulnerability, and resilience: An overview. In E. J.
Anthony & B. J. Cohler (Eds.),The invulnerable child(pp. 3-48). New York:
Guilford.
Antonovsky, A. (1987).Unraveling the mystery of health: How people manage stress and stay well. San Francisco: Jossey-Bass.
Bagley, C. (1980). The factorial reliability of the Middlesex Hospital Question- naire in normal subjects.British Journal of Medical Psychology,53, 53-58.
Barnett, R. C., & Baruch, G. K. (1987). Social roles, gender, and psychological distress. In R. C. Barnett, L. Biener, & G. K. Baruch (Eds.),Gender and stress (pp. 176-190). New York: Free Press.
Barnett, R. C., & Marshall, N. L. (1991). The relationship between women’s work and family roles and their subjective well-being and psychological distress. In M. Frankenhaeuser, U. Lundberg, & M. Chesney (Eds.), Women, work, and health: Stress and opportunities(pp. 111-136). New York:
Plenum.
Baruch, G. K., Biener, L., & Barnett, R. C. (1987). Women and gender in research on work and family stress.American Psychologist,42, 130-136. 216AffiliaSummer 2001 Benham, L., & Benham, A. (1981). Employment, earnings and psychiatric diagnosis. In V. Fuchs (Ed.),Economic aspects of health(pp. 203-220). Chi - cago: University of Chicago Press.
Berkman, L. F. (1986). Social networks, support, and health: Taking the next step forward.American Journal of Epidemiology,123, 559-562.
Briere, J., & Runtz, M. (1988). Symptomatology associated with childhood sexual victimization in a nonclinical adult sample.Child Abuse and Neglect, 12, 51-59.
Briere, J., & Runtz, M. (1989). The Trauma Symptoms Checklist (TSC-33):
Early data of a new scale.Journal of Interpersonal Violence,4, 151-163.
Briere, J., & Runtz, M. (1990). Differential adult symptomatology associated with three types of child abuse histories.Child Abuse and Neglect,14, 357-364.
Briere, J., & Runtz, M. (1993). Childhood sexual abuse: Long-term sequelae and implications for psychological assessment.Journal of Interpersonal Vio - lence,8, 312-330.
Chirikos, T. N., & Nestel, G. (1985). Further evidence on the economic effects of poor health.Review of Economics and Statistics,67, 61-69.
Draucker, C. B. (1995). A coping model for adult survivors of childhood sex- ual abuse.Journal of Interpersonal Violence,10, 159-175.
Frankenhaeuser, M. (1991). The psychophysiology of sex differences as related to occupational status. In M. Frankenhaeuser, U. Lundberg, & M. Chesney (Eds.),Women, work, and health: Stress and opportunities(pp. 39- 61). New York: Plenum.
Garmezy, N. (1983). Stressors of childhood. In N. Garmezy & M. Rutter (Eds.), Stress, coping, and development in children(pp. 43-84). New York:
McGraw-Hill.
Garmezy, N. (1985). Stress-resistant children: The search for protective fac- tors. In J. Stevenson (Ed.),Recent research in developmental psychopathology.
Oxford, UK: Pergamon.
Garmezy, N. (1993). Vulnerability and resilience. In D. C. Funder, R. D. Parke, C. A. Tomlinson-Keasey, & K. Widaman (Eds.),Studying lives through time:
Personality and development(pp. 377-398). Washington, DC: American Psy- chological Association.
Greenwald, E., Leitenberg, H., Cado., S., & Tarren, M. J. (1990). Child sexual abuse: The long-term effects on psychological and sexual functioning in a non-clinical and non-student sample of adult women.Child Abuse and Neglect,14, 503-514.
Hampton, R. (1991). Race, ethnicity, and child maltreatment: An analysis of cases recognized and reported by hospitals. In R. Staples (Ed.),The Black family: Essays and studies(pp. 178-191). Belmont, CA: Wadsworth.
Harvey, M. R. (1996). An ecological view of psychological trauma and trauma recovery.Journal of Traumatic Stress,9, 3-23.
Hauser, S. T., Vieyra, M.A.B., Jacobson, A. M., & Wertlieb, D. (1985). Vulnera- bility and resilience in adolescence: Views from the family.Journal of Early Adolescence,5, 81-100.
Hyman, B. (2000). The economic consequences of child sexual abuse for adult lesbian women.Journal of Marriage and the Family,62, 199-211. Hyman, Williams217 James, J. B., O’Toole, J., & Liem, J. (1993).Assessing psychological resilience in survivors of childhood sexual abuse(Final report). Palo Alto, CA: Spring Foundation for Research on Women in Contemporary Society.
Kendall-Tackett, K. A., Williams, L. M., & Finkelhor, D. (1993). Impact of sex - ual abuse on children: A review and synthesis of recent empirical studies.
Psychological Bulletin,11 3, 164-180.
Kessler, R. C., & McLeod, J. D. (1985). Social support and mental health in community samples. In S. Cohen & S. I. Syme (Eds.),Social support and health(pp. 219-240). New York: Academic Press.
Larson, J. H., Wilson, S. M., & Beley, R. (1994). The impact of job insecurity on marital and family relationships.Family Relations,43, 138-143.
Long, B. C., & Kahn, S. E. (1993). A theoretical integration of women, work, and coping. In B. C. Long & S. E. Kahn (Eds.),Women, work, and coping(pp.
296-312). Montreal: McGill-Queen’s University Press.
McLeer, S. V., Deblinger, E. B., Henry, D., & Orvaschel, H. (1992). Sexually abused children at high risk for post-traumatic stress disorder.Journal of the American Academy of Child and Adolescent Psychiatry,31, 875-879.
Mrazek, P. J., & Mrazek, D. A. (1987). Resilience in child maltreatment victims:
A conceptual exploration.Child Abuse and Neglect,11, 357-367.
Mullen, P., Martin, J., Anderson, C., Romans, S. E., & Herbison, G. P. (1993).
Childhood sexual abuse and mental health in adult life.British Journal of Psychiatry,163, 721-732.
Murphy, L. B., & Moriarty, A. E. (1976). The development of a vulnerable but resilient child. InVulnerability, coping, and growth(pp. 295-333). New Haven, CT: Yale University Press.
Najavits, L. M., Weiss, R. D., & Shaw, S. R. (1997). The link between substance abuse and posttraumatic stress disorder in women: A research review.
American Journal of Addictions,6, 273-283.
Neiman, L. (1988). A critical review of the resiliency literature and its rele- vance to homeless children.Children’s Environments Quarterly,5, 17-25.
Paradise, J. E., Rose, L., Sleeper, L. A., & Nathanson, M. (1994). Behavior, fam- ily function, school performance, and predictors of persistent disturbance in sexually abused children.Pediatrics,93, 452-459.
Pearlin, L. (1989). The sociological study of stress.Journal of Health and Social Behavior,30, 241-256.
Peters, S. D. (1988). Child sexual abuse and later psychological problems. In G. E. Wyatt, & G. J. Powell (Eds.),Lasting effects of child sexual abuse (pp. 101-117). Newbury Park, CA: Sage.
Pindyck, R. S., & Rubinfeld, D. L. (1991).Econometric models and economic fore- casts. New York: McGraw-Hill.
Rhodewald, F., & Zone, J. B. (1989). Appraisal of life change, depression, and illness in hardy and nonhardy women.Journal of Personality and Social Psy- chology,56, 81-88.
Robertson, E. B., Elder, G. H., Skinner, M. L., & Conger, R. D. (1991). The costs and benefits of social support in families.Journal of Marriage and the Family, 53, 403-416.
Romans, S. E., Martin, J. L., Anderson, J. C., O’Shea, M. L., & Mullen, P. E.
(1995). Factors that mediate between child sexual abuse and adult psycho- logical outcome.Psychological Medicine,25, 127-142. 218AffiliaSummer 2001 Russell, D.E.H. (1986).The secret trauma: Incest in the lives of girls and women.
New York: Basic Books.
Rutter, M. (1985). Resilience in the face of adversity: Protective factors and resistance to psychiatric disorder.British Journal of Psychiatry,147, 5498-5611.
Rutter, M. (1990). Psychosocial resilience and protective mechanisms. In J. Rolf, A. S. Marten, D. Cicchetti, K. H. Nuechterlein, & S. Weintraub (Eds.),Risk and protective factors in the development of psychopathology (pp. 181-214). New York: Cambridge University Press.
Rutter, M. (1991). Protective factors: Independent or interactive?Journal of the American Academy of Child and Adolescent Psychiatry,30, 151-152.
Stein, J. A., Golding, J. M., Siegel, J. M., Burnam, M. A., & Sorenson, S. B.
(1988). Long-term psychological sequelae of child sexual abuse: The Los Angeles Epidemiologic Catchment Area Study. In G. E. Wyatt & G. J.
Powell (Eds.),Lasting effects of child sexual abuse(pp. 135-154). Newbury Park, CA: Sage.
Verbrugge, L. M. (1983). Multiple roles and physical health of women and men.Journal of Health and Social Behavior,24, 16.
Verbrugge, L. M. (1987). Role responsibilities, role burdens, and physical health. In F. J. Crosby (Ed.),Spouse, parent, worker: On gender and multiple roles(pp. 154-166). New Haven, CT: Yale University Press.
Voydanoff, P., & Donnelly, B. W. (1989). Economic distress and mental health:
The role of family coping resources and behaviors.Lifestyles,10, 139-162.
Waldron, I. (1980). Employment and women’s health: An analysis of causal relationships.International Journal of Health Services,10, 435.
Waldron, I., & Jacobs, J. A. (1989). Effects of multiple roles on women’s health:
Evidence from a national longitudinal study.Women and Health,15(1), 3-19.
Werner, E. E., & Smith, R. S. (1982).Vulnerable but invincible: A study of resilient children. New York: McGraw-Hill.
Williams, L. M. (1995). Recovered memories of abuse in women with docu- mented child sexual victimization histories.Journal of Traumatic Stress,8, 649-673.
Wortman, C. B. (1983). Coping with victimization: Conclusions and implica- tions for future research.Journal of Social Issues,39, 195-221.
Batya Hyman, Ph.D., is an assistant professor in the Department of Social Work, College of Human Services, Arizona State University West, 4701 Thunderbird Road, P.O. Box 37100, Phoenix, AZ 85069-7100; e-mail:
Linda Williams, Ph.D., is the codirector of the National Violence Against Women Prevention Research Center, Centers for Research on Women, Wellesley College, 106 Central Street, Wellesley, MA 02481; e-mail: lwilliams@ wellesley.edu.
Hyman, Williams219
