Early Childhood Sexual Abuse/Extended Trauma and High-Risk Sexual Behavior

1. Early Childhood Sexual Abuse/Extended Trauma and High-Risk Sexual Behavior David J. Martin, Ph.D. Harbor-UCLA Medical Center Geffen School of Medicine at UCLA

2. Child Sexual Abuse &Childhood Sexuality • Compared to non-sexually abused children, sexually-abused children display more: • Fear • PTSD • Mental Illness • Cruelty • Tantrums

3. Child Sexual Abuse &Childhood Sexuality • Compared to non-sexually abused children, sexually-abused children display more: • Enuresis • Encopresis • Self-injurious behavior • Low self esteem • Inappropriate sexual behavior

4. Childhood Sexual Abuse &Childhood Sexuality • Psychiatric symptoms may be related to: • Presence of penetration • Force • Duration • Frequency of abuse • Perpetrator’s relationship to child • Maternal support

5. Childhood Sexual Abuse &Childhood Sexuality • Sexual behavior problems occur in 26-38% of children & adolescents • About a third of victims are asymptomatic • About two thirds recover in 12-18 months • 10-25% may get worse • No specific syndrome

6. Childhood Sexual Abuse &Adult Sexuality • Long-term correlates of childhood sexual abuse include: • Depression • Anxiety • Borderline personality disorder • Self-destructive behavior • Dissociation • Eating disorders

7. Childhood Sexual Abuse &Adult Sexuality • Long-term correlates of childhood sexual abuse include: • Hostility • Low self esteem • Somatization • Social maladjustment • Adult sexual revictimization

8. Childhood Sexual Abuse &HIV Risk • Among women with HIV infection, 31-53% have histories of childhood sexual abuse • Among women treated for STDs, 32-45% have histories of childhood sexual abuse • Among female commercial sex workers, childhood, over 50% have histories of childhood sexual abuse • Childhood sexual abuse is associated with injection-drug use among women

9. Childhood Sexual Abuseand Gay Men • As many as 25% may have been sexually abused as children • Childhood sexual abuse may be higher among ethnic minority men who have sex with men than among non-minority gay men

10. Childhood Sexual Abuseand Gay Men • Childhood sexual abuse has been related to: • Involvement in prostitution • Increased multiple partners • Anonymous partners • Sexual revictimization • Unprotected sex • Sex in conjunction with drugs & alcohol • Higher rates of STDs

11. Childhood Sexual Abuseand Gay Men • Childhood sexual abuse has been related to: • More substance abuse • More dissociative disorders • More trauma-related anxiety • More Borderline Personality Disorder traits

12. Early Childhood Trauma and the Brain

13. Brain Mediators of ProlongedChildhood Stress • Corticotropin Releasing Factor (CRF) mediates stress response • CRF causes release of Adrenococorticotropin (ACTH) & ß endorphin • ACTH cause release of glucocorticoids • Two types of adrenal steroid receptors: • High affinity mineralocorticoid reseptors in hippocampus • Low-affinity glucorticoid receptors located throughout the brain

14. Brain Mediators of ProlongedChildhood Stress • Prolonged exposure to glucocorticoids may cause hippocampus to atrophy • Atrophied hippocampus may cause increased vulnerability to depression/anxiety and/or aggressive/abusive behavior • Recent research suggests that adults with histories of prolonged childhood stress and depression have smaller hippocampuses • Frontal lobe function may be impaired in adults with depression and prolonged childhood stress

15. Martin, Chernoff et al. (2007) • Recent evidence suggests that rates of new HIV infections are rising among gay men • Rising rates of other STDs also suggest that high-risk behavior may be increasing among gay men

16. Martin, Chernoff et al. (2007) • Early efforts at promoting risk reduction among gay men were largely based on existing health-behavior change theory • Theory of Reasoned Action • Health Belief Model • AIDS Risk Reduction Model

17. Martin, Chernoff et al. (2007) • Quadland & Shattls (1987) described a behavioral cycle characteristic of high-risk sex • Negative affect is recast as “feeling horny” • “Feeling horny” leads to behaviors to result in a sexual encounter • Negative reinforcement derives from reduction in negative affect • Positive reinforcement derives from orgasm and social affirmation

18. Martin, Chernoff et al. (2007) Negative Affect Recode as “horny” Guilt/Remorse Seek Sex Partner Sexual Encounter cf. Quadland & Shattls (1987)

19. Martin, Chernoff et al. (2007) • Childhood sexual abuse is a predictor of adult high-risk sexual behavior • Childhood sexual abuse is also a predictor of substance abuse and concurrent substance abuse and high-risk sexual behavior

20. Martin, Chernoff et al. (2007) • Childhood sexual abuse has also been implicated in the development of Borderline Personality Disorder • People with Borderline Personality Disorder are frequently sexually impulsive and abuse drugs and alcohol

21. Martin, Chernoff et al. (2007) • Linehan (1993) has suggested that suicidal, parasuicidal, and impulsive behavior may reduce negative affect, resulting in negative reinforcement of the behavior for individuals with Borderline Personality Disorder

22. Martin, Chernoff et al. (2007)

23. Martin, Chernoff et al. (2007) Negative Affect Recode as “horny” Guilt/Remorse Seek Sex Partner Sexual Encounter cf. Quadland & Shattls (1987)

24. Martin, Chernoff et al. (2007) • Recruited 49 self-identified “high-risk” gay men • Asked each to recall most recent high-risk sexual encounter • Used functional “chain” analysis (cf. Linehan, 1993) to enumerate chain of events leading to high-risk encounter

25. Martin, Chernoff et al. (2007) • Used Grounded Theory to code interview data and to transform them into quantitative (nominal) form • Inter-rater reliability on final variables ranged from • Imported into SPSS • Calculated Interval-level data for stress and mood measures

26. Martin, Chernoff et al. (2007) • Demographics • Age: 38.53 (9.25) • Race/Ethnicity: • White/Caucasian: 27 • African American: 4 • Black Hispanic/Latino 1 • White Hispanic/Latino 13 • Asian/Pacific Islander 1 • Multi-Ethnic 3

27. Martin, Chernoff et al. (2007) • Demographics • Education: • Less than High School 1 • High School/GED 8 • Some College 24 • BA/BS 12 • More than BA/BS 4 • Employment Status: 19 employed

28. Martin, Chernoff et al. (2007) • Demographics • Partner status: 35 not partnered • HIV Status: 32 HIV+

29. Martin, Chernoff et al. (2007) • Degree of “Outness” (5-point scale)” • To Family: 4.00 (1.38) • To Friends: 4.49 (1.08) • At Work: 3.90 (1.60)

30. Martin, Chernoff et al. (2007) • Sexual Risk: • Number of sex partners last 90 days: 27.31 (41.36) • Number of times anal sex last 90 days: 25.55 (34.26) • Number anonymous sex partners last 90 days: 22.90 (37.55) • Number non-steady partners last 90 days: 27.16 (41.73) • Condoms Not Used: 83.41% (27.90) of times

31. Martin, Chernoff et al. (2007) • Drug Use: • ETOH: 3.92 (8.45) • Marijuana: 10.59 (24.72) • Methamphetamine: 15.37 (26.56) • Designer Drugs: 2.43 (11.45) • Inhalants: 9.10 (18.22) • Erectile Drugs: 4.03 (8.39)

32. Martin, Chernoff et al. (2007) • Age at time of first sexual encounter with a male: 13.84 (5.80) • 29 had first encounter prior to age 15 • 11 had first encounter prior to age 10 • Consent to first sexual encounter: • No: 11 • Yes: 41

33. Martin, Chernoff et al. (2007)

34. Results

35. Discussion • Childhood sexual abuse may lead to affective dysregulation • Affective dysregulation appears related to high-risk behavior in persistently high-risk gay men • Future risk-reduction programs may need to address the role of affect/mood in risky behavior

36. Discussion • Future HIV risk-reduction efforts may need to identify and target antecedents to high-risk sex to achieve reduced risk • For some individuals, interventions may need to target negative affect • e.g., mindfulness • Alternative strategies for coping with negative affect

37. Discussion • Limitations • No comparison • Nominal nature of the data • Future Directions • Need for additional quantitative research • Need for theory-based intervention