Acknowledging complexity in the impacts of sexual victimisation trauma

ACSSA Issues No. 16 – February 2014

The pathway to complex trauma - revictimisation, and poly-victimisation

The relationship between complex trauma and sexual victimisation requires consideration of the extent and type of traumatic experiences that are linked to the presence of complex trauma. Throughout the literature are descriptions of severe victimisation histories that indicate the cumulative and devastating impact of repeated abuse and multiple forms of abuse.

The particular experience of sexual victimisation that is highlighted by the research as linked to complex trauma is extensive re-victimisation over the lifespan and poly-victimisation (co-occurrence of different forms of abuse). Multi-type or poly-victimisation includes multiple types of abuse, including sexual abuse, physical abuse, neglect or psychological abuse, and emotional abuse. Poly-victimisation has been shown to link to greater impairment than single forms of child maltreatment (Higgins & McCabe, 2000). Revictimisation later in the lifespan is likely to compound the effects of prior abuse experiences (Briere & Jordan, 2004; Fortier et al., 2009). Severe and repeated victimisation experiences are strongly related to a range of mental health outcomes that often take the form of depression, addictive and self-harming behaviour, substance abuse, and dissociative and personality disorders. Moreover, these adverse outcomes are rarely singular - co-occurring disorders are extremely prevalent among traumatised populations.

Attempts to classify a type of abuse such as sexual or physical as associated with particular consequences for the victim seems to be less useful than looking at the frequency and severity of child abuse (Higgins, 2004). In an extensive review of the literature on sexual revictimisation, Classen, Palesh, and Aggarwal (2005) found a link between the severity of previous sexual victimisation and individuals who are then revictimised. This review also found a correlation between being sexually victimised in adolescence and adult revictimisation and that for women, being abused in adolescence had a stronger correlation to adult revictimisation than the correlation between child sexual abuse alone as a revictimisation risk factor. There was also evidence that the victim/survivor's relationship to the perpetrator can impact on the likelihood of sexual revictimisation, with intrafamilial abuse being the highest risk for adult victimisation (Classen et al., 2005).

It is clear that experiencing childhood abuse creates an increased risk of revictimisation. In the Australian Component of the International Violence Against Women Survey, Mouzos and Makkai (2004) found that the risk of sexual violence is almost double for women who were sexually abused in childhood (54%) compared to other women (26%). The results also indicated women who suffered childhood abuse, regardless of type, experienced higher levels of violence compared to women not suffering childhood abuse. This finding accords with the 1996 Women's Safety Australia Survey (Australian Bureau of Statistics [ABS], 1996), that a history of victimisation strongly predicts future victimisation regardless of other potentially protective factors such as education and income.

Although not inevitable, there is a strong link between sexual and other types of violence occurring in the developmental phase of an individual (childhood), and their later experiences of victimisation. There are many negative effects for those who suffer repeated sexual victimisation, including evidence of links to mental and physical health problems, and high-risk behaviours (Noll & Grych, 2011). Sexual revictimisation is also associated with greater distress and more psychiatric problems including difficulties with interpersonal function and addiction (Classen et al., 2005).

Although there is consistency in the research indicating the phenomenon of revictimisation, there is still a lack of understanding about the exact causes and mechanisms underlying the relationship (Ullman, Najdowski, & Filipas, 2009). It is not clear why abuse victims are more vulnerable to further victimsations. One perspective suggests that revictimsation becomes an issue of the broader social context in which psychological and interpersonal functioning increases vulnerability to perpetrators, for example, by self-soothing with alcohol or other substances or engaging in compulsive sexual behaviour (Messman-Moore, Brown, & Koelsch, 2005). This view reflects an ecological approach2 to understanding sexual victimisation. In accordance with this, Grauerholz (2000) noted that the victimisation can be multifaceted, can occur over time, may include childhood and adult instances of abuse, and may co-exist with other factors in the social environment that the person is situated. It is important to understand the interacting factors in order to see the complete picture of revictimisation over the lifespan. Grauerholz (2000) hypothesised that individual experiences (e.g., the initial victimisation) combine with factors in the microsystem (such as a victim's decreased ability to be assertive) and the macrosystem (such as perpetuation of victim blaming culture) to create an environment ripe for revictimisation of the individual. Using an ecological conceptualisation of lifespan victimisation, the process of the individual being shaped into a victim by the perpetrator as well as social and personal factors is more comprehensively understood.

The increasing focus on trauma in the revictimisation literature indicates that the collection of coping mechanisms that can be viewed as part of the complex PTSD concept is an important consideration for sexual assault, mental health, and drug and alcohol services to utilise when aiming for prevention of revictimisation.

Footnote

2 For a more detailed explanation of the ecological model see ACSSA Wrap 11, What is Effective Primary Prevention in Sexual Assault? (Quadara & Wall, 2012)