Today let’s talk about predation and prey. When we’ve been previously victimized, we’re unfortunately likely to experience it again. For what reasons?
In this episode, we summarize the paper:
In this episode, we get into the details of the paper:
Childhood maltreatment and adulthood victimization: An evidence-based model
Fatemeh Fereidooni et al
Journal of Psychiatric Research
2023
On the psychological reasons why revictimization tends to occur.
For the full details and study excerpts, jump into the long-form followup episode. You’ll find it, just check that patreon.
Thanks for being here to nerd out with me and support the show. For lovers of precise, carefully chosen, scientific language – we enjoy the excerpts.
Now here’s what we can say from the research work.
Childhood maltreatment and adulthood victimization: An evidence-based model
Fatemeh Fereidooni et al
Journal of Psychiatric Research
2023
Childhood maltreatment is shockingly common – with rates estimated between 6 and 75% depending on region and gender. CM is correlated with higher levels of depression, anxiety, eating disorders, impulsivity, suicidality, and cardiovascular disease.
It also correlates with interpersonal victimization in adulthood. CSA is linked with adult sexual victimization with an increased 2-3 fold risk compared to children without sexual abuse. This danger extends beyond sexual abuse, though; CM elevates the risk of physical and emotional abuse in adults, as well.
Childhood maltreatment (CM) is a common worldwide problem defined as abuse (emotional, psychical, and sexual), neglect (emotional and physical) or other exploitations that harm children's survival, health, and development (World Health Organization [WHO], 2020). The rate of physical and/or emotional abuse is approximately three in four among children at the age of two to four (United Nations Children's Fund [UNICEF], 2017). A systematic review showed that the median prevalence of childhood sexual abuse in girls was between 9% in Asia and 28.8% in Australia. This rate was lower for boys ranging from 6.1% in Australia to 26.5% in South America (Moody et al., 2018). CM has adverse effects on mental and physical health in adulthood. Meta-analytic studies show that CM is related to higher levels of depression, anxiety, eating-related disorders, impulsivity, and suicidality (Angelakis et al., 2019; Gallo et al., 2018; Liu, 2019; Molendijk et al., 2017).
A systematic review showed high rates of cardiovascular diseases, ranging from 61.5% to 91.7%, across studies of people with CM (Basu et al., 2017). In addition, there is extensive evidence that CM increases the risk of interpersonal victimization (i.e., physical, emotional, and sexual abuse) in adulthood. For instance, previous studies reported that childhood sexual abuse increased the chance of adulthood sexual victimization by two-to three-fold (Arata, 2002; Jankowski et al., 2002; Van Bruggen et al., 2006; Walker et al., 2019, Walker and Wamser-Nanney, 2023), a phenomenon called revictimization, which is defined as victimization in two developmental stages (i.e., childhood and adulthood; Walker et al., 2019, 2022).
there is evidence that each form of childhood maltreatment increases the chance of victimization in adulthood independent of the specific type of (re)victimization. For instance, a prospective study showed that childhood sexual abuse not only increases the risk of sexual victimization in adulthood, but also elevates the risk of adulthood physical and emotional abuse (Frugaard Stroem et al., 2019). Therefore, in the present study, revictimization is defined as any form of maltreatment in childhood accompanied by any form of victimization in adulthood to have a more comprehensive definition of revictimization.
Theoretical accounts of revictimization
One theory is that adults unconsciously repeat past traumatic events to “redo” them. The mind wants a chance to try again, with a heightened degree of control and empowerment, to rewrite history.
To explain the link between CM and adulthood victimization, psychodynamic theories propose that CM survivors unconsciously repeat past traumatic events to achieve control and mastery over past trauma, a phenomenon called Repetition-Compulsion (van der Kolk, 1989), which is a broad term that can reflect various processes (Sandberg et al., 1994).
Common psychological theories also suggest that there’s a certain familiarity, predictability, and comfort to replaying traumatic events. We’ve lived through them before and the mind is, in a way, validated by living through them again. Limiting self-beliefs, negative world views, and low self-worth, for instance, appear to be confirmed by recurrences of abuse.
Another potential explanation is the maltreated child learns to disassociate from the abuse to survive. Upon later instances of abuse, the adult instinctively disassociates again. This protective mechanism causes the individual to miss important informational and bodily cues, so that they don’t recognize the abuse is taking place. The person “exits the building” of their own meat jacket, and in doing so, doesn’t experience what they’re experiencing, or therefore learn the lesson of these repetitive abuse experiences to move away from the danger.
This has the added benefit of protecting the abuser.
Other theories have tried to explain revictimization with more specific mechanisms. For instance, Betrayal Trauma Theory assumes that dissociative amnesia is the underlying mechanism of revictimization (Freyd et al., 2007). When a caregiver maltreats a child, the betrayal cannot be effectively processed with the assistance of avoiding interaction with the perpetrator as the child needs them for physical and mental survival. Therefore, dissociation, as an adaptive response in that context, may support the attachment between the child and caregiver. However, habitual dissociation lasting into adulthood might interfere with information processing, including the detection of danger cues in similar interpersonal situations, resulting in a higher risk of revictimization (Messman-Moore and Long, 2003).
Starting in childhood, we often need to see the other person as “good” because they are our lifeline. As an adult, we might continue to unconsciously protect the people around us when we feel we depend on them in some way. By disassociating during abuse, they retain their “good” image, and the maltreated individual may have no idea why they (and their life) feel so “bad.”
Annnnd let’s not overlook the PTSD that could result from CM.
Post traumatic stress symptoms themselves might confuse the situation. Being under constant stress as a baseline condition means you don’t know when you’re stressed out by another person’s behaviors. And the added stresses and symptoms might make a person more likely to stay in a bad relationship due to overwhelm; when you just need things to be calm, and sometimes another person helps to foster relaxation, you could be willing to overlook all the things they do that foster chaos and pain.
Plus…. Those PTSD symptoms? Might encourage a person to engage in escapist behaviors that put them in risky situations. Such as drinking, drugging, or risky sexual behaviors to numb the pain or to feel at all. In this way, delivering them TO dangerous circumstances and humans, in their attempts to cope with the prior dangerous circumstances and humans who left a lasting mark on their brains and bodies.
Another hypothesis introduces two underlying mechanisms for revictimization that also consider the impact of the victim's behaviors on potential perpetrators. As a first mechanism, victim's increased vulnerability due to psychological factors, such as posttraumatic stress disorder (PTSD) symptoms, might interfere with risk recognition and/or reaction to risk, and signal vulnerability to potential perpetrators. The second mechanism, exposure to risk, consists of factors increasing the chance of contact with perpetrators, such as engagement in intoxicated sex (Messman-Moore and Long, 2003).
All this being said… there’s a need to study the layering, complex and nuanced, psychological factors that results from childhood maltreatment which, together, might increase the likelihood of encountering or permitting adult maltreatment.
Inconsistent findings related to risk factors might be due to the majority of studies testing only one risk factor in isolation, and not in the context of other factors (Hébert et al., 2021).
More comprehensive models are needed that consider interrelations between risk factors in order to develop evidence-based theories for revictimization, particularly for intrapersonal factors potentially malleable to change and, thus, proper as targets for interventions. To reach this aim, we built a comprehensive pathway model that consists of a series of candidate mediators between childhood maltreatment and adulthood victimization. We addressed two research questions: a) what mediators and their associations explain the relationship between CM and victimization in adulthood? and b) which mediators and relations between mediators show the strongest associations with revictimization?
Procedure and design
And so, these authors sampled first-year female psychology students over 16 years of age from the Netherlands and New Zealand; interviewing and questionnaire-ing them four times within an academic year from 2017 to 2021. The intent? To gather information on their childhood maltreatment and later adult victimization of the emotional, physical, and sexual types, with the purpose of understanding mediating factors linking one to the other.
They specifically looked at mediators of PTSD symptoms such as disassociation, substance use, sexual risk-taking, sexual motives and assertiveness, coping, emotional dysregulation, early maladaptive schemas (AKA fucked up core beliefs and representations of the world), attachment styles, self-blame, risk detection capabilities, post trauma growth, resilience, distress tolerance, emotional reactivity, meaning in life, sexual sensation seeking, impulsivity, emotion recognition, and loneliness.
The data were collected as a part of a multi-wave, multi-session study (four sessions within an academic year) running from 2017 to 2021. The sample consisted of first-year female psychology students (>16 years of age) from the Universities of Groningen, Amsterdam, Utrecht, Leiden, and Maastricht in the Netherlands, and Canterbury in New Zealand. Due to the Covid-19 pandemic, the data were collected using three methods: online, in lab, and hybrid. After providing informed consent, the participants responded to a battery of questionnaires in each session.
Childhood maltreatment, defined as the occurrence of abuse and/or neglect before the age of 15, was assessed in the first session. Adulthood victimization, defined as emotional, physical, and sexual victimization after age 14, was also assessed in the first session. The candidate mediating variables were assessed in sessions one to four.
Model building
And began to develop a model, explaining how these factors amplify each other and correlate with adult victimization.
Discussion
Findings include the verification that CM severity is directly related to victimization in adulthood. The most highly implicated factors were peritraumatic disassociation, PTSD symptoms, trauma load, loneliness, and drug use.
Secondary mediators (factors that build on each other to result in adult victimization) include attachment styles, early maladaptive schema, and meaning in life.
And some networking factors were also determined: these included first and second order mediators. Anxious attachment, PTSD symptoms, and loneliness.
But. Interestingly. What I just told you isn’t accurate.
Because peritraumatic disassociation was found to be a first, second, and networking mediator of adult victimization. It is a direct and indirect cause of later abuse, and also networks with the other previously mentioned factors to increase chances of adult victimization experiences. That seemed easier to discuss now, rather than to list peritraumatic disassociation under every category.
Now let’s run through the factors.
The observed pathways will now be discussed.
Peritraumatic dissociation
The mediating effect of peritraumatic dissociation on revictimization in the current study can be explained by assuming that dissociation at the time of trauma interferes with information processing and integration of memories, a process that does not allow an individual to learn from past traumatic experiences or have access to relevant information in similar situations, thereby leaving the victims with further risk of abuse (Chu, 1992; Irwin, 1999). This finding is also consistent with Betrayal Trauma formulation (Freyd et al., 2007).
Peritraumatic dissociation doesn’t allow an individual to learn from previous traumatic (abuse) events, because it interferes with information acknowledgement, processing, and integration. If you “leave the house” (being your body and broader psychological schema) every time abuse is taking place, you don’t notice or respond appropriately to the abuse. And because disassociation becomes a widely applied coping skill not only for trauma, but also for the unpleasant outcomes of trauma, it is implicated more heavily than any other factor in repeat adult victimization experiences. We have to be present to care for ourselves. Disassociation makes this impossible.
PTSD symptoms
One explanation is that PTSD, particularly hyperarousal, might compromise risk detection (Messman-Moore and Long, 2003; Fragkaki et al., 2017), which is supported by two studies showing a positive relationship between PTSD, particularly re-experience and hyperarousal, and risk detection (Wilson et al., 1999, Marx and Soler-Baillo, 2005). The role of risk detection was not supported in our study… Another explanation of the link between PTSD and revictimization is that PTSD might prevent a proper reaction in threatening situations (Messman-Moore and Long, 2003), in a way that protective responses such as assertiveness or escape (Chu, 1992) are not applied, possibly due to the intensity of negative emotions and physiological reactions at the time. Finally, PTSD symptoms influencing verbal and non-verbal cues might signal vulnerability to potential perpetrators (Cloitre et al., 1997), hence making these individuals more prone to revictimization.
PTSD symptoms such as hyperarousal might make it difficult to notice real threats. Operating at a stress level 10/10 means you don’t notice when a predator is bumping up the measure to 12/10; you’re already maxed out and also likely to consider this sensation “the feeling of being alive,” so a person doesn’t even notice the abuse or their own discomfort. Another possible explanation is that negative emotions and physiological reactions are so high at a baseline level or under abuse duress that an individual becomes stagnated, frozen, or unresponsive and cannot move away from the threat. And lastly, PTSD symptoms might cause verbal and non-verbal cues that signal vulnerability to predators – indicating viability as a target.
Trauma load
Similarly, trauma load or ongoing psychological distress can affect mental health cyclically and place an individual in harm’s way in a recurrent manner. When they get low, chance of revictimization gets high, due to coping behaviors and unconscious cues of disempowered status sent to others.
A possible explanation for the observed mediating effect of trauma load is that people with CM might suffer from higher general psychological distress (Lindhorst et al., 2009; Orcutt et al., 2005), which might enhance the likelihood of exposure to non-interpersonal trauma (i.e., leading to higher trauma load), which consequently can affect mental health in a cyclical pattern and result in further vulnerability to interpersonal victimization in adulthood.
Loneliness
People with a history of CM might experience loneliness due to insecure attachment styles (Akdoğan, 2017), which might make them less selective in choosing dating partners or result in staying in an abusive relationship due to stronger need to connect to others (Cava et al., 2018).
Loneliness might make individuals less selective in who they spend time or partner with. It also might increase tolerance of abusive behaviors. When the alternative option is being alone and suffering, a human mind is surprisingly willing to accept negative treatment instead. Especially in the context of high PTSD symptoms and/or trauma load.
Drug use
The mechanisms linking drug use to revictimization are not yet well analyzed, but it may well be that substance use serves as a coping mechanism to deal with negative emotions originating from CM and could subsequently increase exposure to potential perpetrators and consequently the risk of revictimization. In addition, intoxicated individuals might be perceived as more vulnerable to perpetrators (Messman-Moore and Long, 2003).
Substance use is a method of coping with trauma and the negative emotions it spurs. Unfortunately, placing traumatized people in dangerous situations with potentially dangerous (generally also traumatized) persons, during which they won’t be as mentally sharp as is required to detect or navigate the situation safely. And of course, substance dependency makes an individual more likely to accept maltreatment to secure their drug of choice.
Impaired autonomy schemas
Maladaptive schemas such as impaired beliefs about autonomy affect the individual’s thoughts and therefore ability to dream of alternative options or plan to secure them. If you don’t believe you’re allowed to function independently or that the world is a pervasively dangerous place to be alone, then a person is more likely to get “stuck” in an abusive set of circumstances, assuming they’re trapped and helpless. Or, even feeling “safer” through the very act of being partnered.
The mediating influence of impaired autonomy schemas in the present study, which indicated a negative association with adulthood victimization, is inconsistent with Young's theory (Young et al., 2003), and prior studies (Atmaca and Gençöz, 2016; Gay et al., 2013). Therefore, it is assumed that the negative mediational role could actually be a statistical artefact, and that these schemas do not have an inverse relationship with adulthood victimization.
Second-order mediators
Attachment styles
Anxious attachment is implicated as a secondary mediating factor for adult revictimization because it contributes via routes of loneliness, risky sexual behaviors, peritraumatic disassociation, maladaptive beliefs about rejection, emotional dysregulation, and PTSD symptoms. Anxious attachment might encourage tolerating abusive relationships due to fear of rejection. i.e. it’s better to be abused than to feel unloved or unlovable. And, at the same time, predatory men might prefer anxious attachment styles, due both to the positive and stabilizing effect it has on their (the man’s) ego and the increased acceptance of poor treatment that it fosters in the other person. In this way they can feel good about themselves while putting in very little effort or using their partner as a punching bag. Lastly, under the spell of anxious attachment, the desire to be “chosen” in order to cope with loneliness and negative self-regard is so strong that risky sexual behavior and peritraumatic disassociation are likely, and are likely to lead to acceptance of abusive relationships.
Unlike the avoidant attachment style, which did not show any association with revictimization, anxious attachment was an intervening variable between CM severity and adulthood victimization via loneliness, risky sex behavior, peritraumatic dissociation as well as a pathway that included the rejection schema domain, emotion dysregulation, and PTSD in a consecutive order. The role of anxious attachment in revictimization found in this study is in line with the findings of a study reporting that anxious, but not avoidant, attachment was related to sexual revictimization (Brenner and Ben-Amitay, 2015).
Two important hypotheses about the role of anxious attachment versus avoidant attachment on revictimization are proposed. One implies that anxious attachment, characterized by excessive proximity seeking to attachment figures, might encourage tolerating abusive relationships due to fear of rejection, while avoidant attachment is associated with more distant relationships (Hocking et al., 2016). Another possibility is that abusive men might have partner preference for women with anxious attachment, as supported by the study of Zayas and Shoda (2007) showing that men with perpetration experiences had a preference for women with an anxious attachment style. Furthermore, based on our findings, anxious attachment seems to be linked to revictimization through maladaptive coping strategies including peritraumatic dissociation and risky sex behavior as well as feelings of loneliness.
Early maladaptive schemas
Early maladaptive schemas (we can call them fucked up core beliefs or low estimations of self-empowerment) foster insecure attachment and destructive cognitive and emotional patterns. People (mis)interpret and underestimate their self-worth versus others' behaviors, permitting negative treatment because “they deserve it” or “aren’t good enough to receive better.” This, again, can boost anxious attachment or promote the prioritization of others’ thoughts, feelings, and needs in order to receive approval or any semblance of nurturance. Core beliefs about rejectability, specifically, correlate with themes of unreliable support and connection, mistrust, low self-worth, impaired autonomy, dependence and enmeshment with others. All of this promotes insecure attachment and inability to self-regulate negative emotions, both of which increase risk of victimization. Moral of the story being, if we don’t believe we’re worthy or capable – if we believe someone else is necessary to make us valid - everything spirals from there.
Based on Young's Schema Theory (Young et al., 2003), individuals have various emotional needs such as secure attachment. Early life experiences, such as CM, hinder meeting of these basic psychological needs and influence the way people see others and themselves. Therefore, it is assumed that CM fosters insecure attachment, destructive cognitive and emotional patterns through which people (mis)interpret their self-worth and others' behaviors.
In one pathway, CM severity was associated with higher anxious attachment, which led to the schemas of other-directedness (with themes of dependence on others, and prioritizing others' needs and feelings to receive approval and nurture).
Two other pathways through which anxious attachment was linked to revictimization consisted of both rejection and impaired autonomy domains, which were linked to emotion dysregulation and then to PTSD. These pathways imply that the rejection domain (with the themes of lack of reliable support and connection, mistrust, and low self-worth) and impaired autonomy (with the themes of dependence on and enmeshment with others), derived from an insecure attachment, might result in difficulties to regulate negative emotions (i.e., limited access to emotion regulation strategies) and developing PTSD, which is a subsequent risk factor for revictimization.
Meaning in life
In examining Meaning in life our researchers found that CM decreases perception of it existing. Coherence of life experiences, setting of goals, and considering one’s life important are decreased following CM, and this limits the capacity for negative emotional regulation. This increases PTSD symptoms, which increases chances of adult revictimization. Believing you are an unwanted accident or life is purposeless doesn’t instill the self-esteem or self-comforting skills required to leave dangerous situations. Rather, they are accepted as “part of life.”
One pathway in the model implied that CM severity decreases perceived meaning in life, (i.e., cognitions about coherence of life experiences, having life's goals, and considering one's life as important; George and Park, 2016), which limits access to strategies for regulating negative emotions. This, in turn, is related to increases in PTSD symptoms and then an increased risk for revictimization. Based on our findings, CM might shatter basic assumptions about the self (invulnerable, worthy), and the world (word as comprehensible, orderly and predictable), which in turn can challenge the perceived meaning in life of these victims (Janoff-Bulman, 1985).
Now let’s talk about a few unexpected research findings.
Drug use
Considering the high rate of drug use among university students in social gatherings (Bennett and Holloway, 2017; Nichter et al., 2010), this factor might lead to revictimization by increased exposure to potential perpetrators in such settings, especially when both parties (i.e., victims and potential perpetrators) might be under the influence of drugs.
Peritraumatic Dissociation
It seems that peritraumatic dissociation increases PTSD symptoms (a link that was also previously supported; Breh and Seidler, 2007; Lensvelt-Mulders et al., 2008), which in turn are related to using sexual activity as an emotion regulation strategy. Then, people with such a tendency are more likely to engage in risky sex behavior increasing the likelihood of (sexual) revictimization.
Factors without observed mediating effects
We did not find support for the effects of specific risky sex behaviors (i.e., sex with strangers, a high number of sexual partners, and sexual assertiveness) given all other factors in the model. The small numbers related to the frequency of sex with strangers and the number of sexual partners (between one and two on average), in the current sample might explain these findings. In addition, having different forms of adulthood victimization might explain the results since risky sex behaviors are more specific to sexual victimization.
Somewhat surprisingly, risky sexual behavior such as having sex with strangers, engaging with a large number of people, or being highly sexually assertive did not seem to increase the chance of adult revictimization. However, the authors note that this could be due to the relatively safe behaviors of study participants or the study’s focus on broad victimization experiences, rather than specifically on sexual victimization.
The absence of an association between sexual sensation seeking and CM severity in the present model is in line with traumatic sexualization theory that proposes that sex is used for non-sexual goals, such as attention or approval seeking, in people with a history of childhood sexual abuse (Finkelhor and Browne, 1985). Sexual sensation seeking is more focused on sexual pleasure, which might not be the main aim of sexual engagement for people with a history of sexual abuse in childhood based on this theory.
Also somewhat surprisingly, somatic disassociation (leaving the body) might be less dangerous than cognitive disassociation (losing oneself in time-space or disconnecting from one’s full autobiographical recall). The researchers note that bodily disassociation might place individuals in less risky situations than mental disassociation, explaining the discrepancy. We need to have our wits about us to make good decisions about where we go and who we engage with in order to avoid predators.
Findings regarding somatoform dissociation are similar to another study (Dietrich, 2007). Although it is very early to reach any conclusion about this variable due to the scarcity of evidence, this factor might not be related to revictimization because manifesting dissociative symptoms through the body might not increase exposure to potential perpetrators or victims’ vulnerability. Furthermore, peritraumatic (psychological) dissociation which was a first-order mediator might be better suited to test the association between dissociation and revictimization.
Coping was defined as using strategies such as wishful thinking and self-blame. Unlike previous studies that provided evidence on the association between coping strategies and revictimization (Arata, 1999; Gibson and Leitenberg, 2001; Mayall and Gold, 1995), we did not find such an association. Other concepts related to coping, namely using sex to reduce negative affect, and limited access to emotion regulation strategies, might be better in explaining the association between strategies used for dealing with negative emotional states and revictimization. They represent factors at the behavioral level, such as involvement in sexual activity, or using a passive approach towards emotions, like wallowing in negative emotions, that could directly increase the risk of further victimization, while wishful thinking or self-blame might not have such a proximate effect on revictimization. This hypothesis applies to null findings on the role of distress intolerance too.
Also, coping strategies such as wishful thinking and self-blame were not implicated in revictimization, running counter to previous studies. The authors note that these could be less direct factors contributing to adult abuse, whereas coping strategies like using sex for emotional regulation might more strongly promote adult revictimization. I would note that wishful thinking and self-blame might be more potent factors for increasing the acceptance of abuse in an already established relationship, rather than putting one at risk for attracting or encountering predators. Wishing for the best and holding negative events against oneself don’t assist with making decisions to leave a victimizing situation, but they might not put one directly in harm’s way.
What can be determined from this research?
Revictimization model at a glance
Taking a broader perspective on the model, three important observations stand out.
First, it seems that the relationship between childhood maltreatment and revictimization is not straightforward. In other words, a combination of factors, each with small effects, contribute to the increased risk of revictimization among survivors of childhood maltreatment.
Second, a large number of pathways with a combination of various factors in the model points to potential individual differences in risk factors for revictimization.
Third, although we assumed that we would find some factors and pathways with the strongest effects on revictimization, our results show that the contribution of all pathways/risk factors are equally small. Nevertheless, some factors that functioned as networks might be more influential in revictimization since they connect other risk factors.
Fourth, the variables more proximal to CM were cognitive factors and/or patterns about the self and others (insecure attachment and negative schemas), while the variables positioned in the middle of the model were related to emotional domains, such as emotion dysregulation and reactivity. Variables pointing towards adulthood victimization at the bottom of the model referred to the behavioral level, such as drug use and risky sex behavior. Therefore, the model indicates that CM may result in the development of cognitive patterns that elicit emotional difficulties, for which people might then rely on maladaptive coping strategies that may potentially lead to revictimization.
The relationship between CM and AR is not straightforward – a cocktail of factors with relatively small effects build on each other to increase the likelihood of revictimization. There is not one answer to the question “how does childhood abuse lead to adult abuse?” and there are many pathways this network of risk factors can take reach this end result. The combination could be different for each one of us.
However, the symptoms and psychological outcomes of childhood trauma and abuse are implicated as the materials that construct these pathways.
And lastly, negative views of self, emotional dysregulation and reactivity, and behavioral copings, together, seem to create the multi-nodal pathways from CM to AR. When we feel poorly about ourselves, we don’t know how to comfort ourselves, and therefore develop risky or maladaptive coping skills… and this brings us into the lairs of predators. People who, unfortunately, can pick up signals of the poor self-regard and previous abuse experience that underlies it all.
In conclusion, the authors state:
General conclusion
The current study indicates that PTSD symptoms, loneliness, and drug use might be among the most significant risk factors for revictimization albeit they all showed small effects. In addition, peritraumatic dissociation emerged as a first and second-order mediator and it functioned as a network in the model, which highlights the importance of this factor in revictimization. Therefore, considering these factors as the first targets in preventive interventions might enhance the efficacy of such programs. In addition, the general impression of the model is that childhood maltreatment severity is associated with anxious attachment style and early maladaptive schemas, general cognitive patterns used for processing information about the self and others. These cognitive patterns are in turn related to emotion dysregulation and emotional reactivity, factors that probably lead to intense negative emotions, while people with a history of childhood maltreatment have limited sources to regulate them adaptively. Therefore, CM-survivors may employ dysfunctional strategies such as drug use and risky sex behavior, increasing the risk of further victimization. It should be acknowledged that focusing on intrapersonal risk factors of revictimization does not imply that victims are responsible for the violence inflicted on them and it does not overlook the salience of interventions targeting perpetrators. However, understanding individual risk factors for revictimization can help us design effective programs with the aim of women's empowerment and help prevent/mitigate the consequences of CM.
And although it is not your fault if you’re revictimized – childhood maltreatment and ongoing trauma have laid the groundwork via emotional deficits and self-damning belief systems - if you want to help yourself help yourself to avoid future revictimization…. you might focus on targeting:
Cognitive disassociation
Low self-regard and sense of meaning in life
Poor emotional regulation skills
Maladaptive coping techniques
Low social connection
As the factors to improve now, as empowered and autonomous adults who don’t depend on abusers to stay alive the way we did as children.
The most direct way? Working with a trauma trained therapist who can coach you through, yes, DBT and CBT. But also, someone who understands the deep self-damaging beliefs (I’m worthless, the world is a terrifying and unfair place, there is no meaning in my life) created by childhood maltreatment, rather than focusing on individual ailments spawned by those maladaptive schemas, such as anxiety.
Clinical implications
The involvement of various factors highlights the importance of interventions at different levels (cognitive, behavioral, and emotional). In addition, it seems that changes at behavioral levels (i.e., reducing risky behavior such as sexual-risk taking and drug use) requires interventions at cognitive and emotional levels. For instance, interventions on early maldaptive schemas might decrease vulnerability to revictimization by reducing PTSD symptoms, emotion dysregulation, and consequently sexual risk-taking.
As discussed above, interventions on networking factors (i.e., anxious attachment, meaning in life, rejection and impaired autonomy domains, PTSD symptoms, and loneliness) might mitigate the risk of revictimization as well, since these factors seem to connect other factors. In a similar vein, since the model indicates that childhood maltreatment is linked to disruptions in emotion dysregulation, interventions focused on emotion regulation such as Dialectical Behavior Therapy (Linehan, 2018) could be potentially effective, a hypothesis that needs to be tested in future research. In line with this assumption, a review conducted on the effects of childhood maltreatment on PTSD and its comorbidities, such as substance use disorder and eating disorders concluded that emotion regulation might be a “coalescent factor in the nexus of child maltreatment, PTSD, and other comorbidities” (Messman-Moore and Bhuptani, 2017)…
Get to the bottom of it – childhood maltreatment – not the myriad of complicating factors that emerge from it. With support, time, and corrective experiences, you’ll learn to think better of yourself, navigate difficult emotions, and engage in healthy coping skills. All of which dismantle the CM to AR model by keeping you out of the territories of predators, helping you to become aware of adult maltreatment through emotional recognition, and enabling you to put a new plan into practice via cognitive remembrance of where you’ve been so far, what you’ve already experienced, event processing and thought integration.
When you realize you’ve seen it enough before, you aren’t worthless or helpless, and your life DOES have meaning… the compounding factors that allow adult abuse will be neutralized. And your journey towards something better can begin or re-start with renewed power.
And with that, lettuce
WRAP
This episode has been based on the article
Childhood maltreatment and adulthood victimization: An evidence-based model
Fatemeh Fereidooni et al
Journal of Psychiatric Research
2023
Many thanks to the authors for their investigation and analysis.
Many thanks to you for being here, being motivated to have a better life, and being better than the people who came before you.
And I’ll talk to you soon.