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Evaluation and treatment of the assaultive adolescent is an important but difficult process. From a psychodynamic perspective, the author reviews factors associated with adolescent violence, including alcohol and substance use, depression and suicidality, overstimulation, sociocultural and family ambience, property damage, threats of violence, and alexythymia. Management and treatment issues are surveyed, such as the necessity to recognize that in some adolescents violence erupts not from narcissitic rage but from strong wishes for affectionate contact. Violent adolescents have little awareness of an inner psychological world, cannot name affects or differentiate one from another, and often confuse thought, feeling, and deed. In psychodynamic treatment, adolescents are helped to experience affect as part of themselves and to develop the capacity to manage affect and use it as a basis for communication and self-understanding.
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PMID:Management of the assaultive adolescent. 160 6

Investigated the buffering properties of six types of social support (three perceived, three received) with regard to four psychological consequences (depression, anxiety, fear of crime, hostility) of criminal victimization (violent crime, property crime). These relationships were examined using longitudinal data collected from a sample composed of representative subsamples of victims and nonvictims. Effects of the perceived support measures (perceived appraisal support, perceived tangible support, self-esteem) were more pervasive than those of the received support measures (received informational support, received tangible support, received emotional support). Perceived support consistently exhibited buffering effects, protecting both violent and property crime victims against various symptoms they would have otherwise experienced. The stress-buffering capabilities of received support were limited to informational and tangible help protecting victims of violence from experiencing excessive fear. These findings are discussed in the context of recent theoretical developments concerning the stress-support matching hypothesis.
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PMID:Social support and victims of crime: matching event, support, and outcome. 160 34

Considerable evidence exists that the limbic system and the hypothalamus play an important role in the HPA axis disturbances found in depressive disorders. Evidence also exists that the limbic system plays a role in the modulation of aggressive behavior. Yet the HPA function of individuals with a disordered regulation of aggression has received little scrutiny. Because aggressive behavior has been observed to be extensively correlated with heavy alcohol use, we explored the HPA function of alcoholics who had had a life-long history of violence. Basal 0700h cortisol was measured in 4 consecutive wk following cessation of drinking in 19 alcoholics with a history of depression, and 17 alcoholics with a history of violent behavior, eight of whom had been incarcerated because of the severity of their violent acts. When compared with alcoholics with no problem in mood or aggression regulation, significant cortisol increases were found in the group of patients who had been incarcerated for violent acts and not in any other group. This increase persisted for 4 wk after cessation of drinking. A variety of variables, including several measures of alcohol consumption, amounts of benzodiazepines used for detoxification, and liver function tests, failed to show significant associations with cortisol. Data are interpreted as indicating that individuals displaying severe forms of violence could have a dysregulated HPA function revealed by exposure to excessive amounts of alcohol.
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PMID:Cortisol in alcoholics with a disordered aggression control. 160 16

Sexual assault of women in the United States may have a prevalence rate of 25% or more. Moreover, the majority of survivors of sexual assault know their assailants. Consequences of assault may be severe and long-term, including fear and anxiety, depression, suicide attempts, difficulties with daily functioning and interpersonal relationships, sexual dysfunction, and a whole range of somatic complaints. Recent evidence implicates societal factors, such as acceptance of rape myths, rigid sex role stereotyping beliefs, and acceptance of violence as a legitimate means for obtaining compliance in interpersonal relationships, in the etiology of sexual violence against women. I present a model for primary, secondary, and tertiary prevention of rape. Primary prevention represents a program of anticipatory guidance in a developmental framework. Secondary prevention entails identification of and early intervention in dysfunctional families. Tertiary prevention consists of the appropriate treatment of the survivor of sexual assault to prevent or minimize subsequent physical and psychological problems. This preventive framework may be incorporated into the practice of clinical preventive medicine and primary care.
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PMID:Sexual violence against women: prevalence, consequences, societal factors, and prevention. 179 44

Several multivariate studies have attempted to delineate the major predictors of long-term, sexual assault-induced aftereffects. The present study was an attempt to extend previous work by supplementing known preassault, assault, and postassault predictors of trauma with cognitive measures. The data were cross-sectional and included responses from 1,213 victims of sexual assault who were recruited from a national sample of higher education students. Utilizing hierarchical multiple regression analyses and a cross-validation procedure, the results suggested that the prior mental status of the victims, the forcefulness of the assaults, as well as two cognitive variables related to a victim's beliefs about sex and relationships predicted victims' scores on standardized measures of anxiety and depression. The relationships were such that the most traumatized victims were those women who had evidenced a history of mental health problems, who had experienced the more aggressive assaults, who tended to believe that people in relationships are not trustworthy, and tended to place conservative restrictions on the sexual acts and circumstances under which sex should occur. Taken together these variables accounted for between 9%-14% of the variance in sexual assault aftereffects. The discussion emphasizes the contribution of cognitive processes to the understanding of sexual assault trauma.
Violence Vict 1991
PMID:Predictors of long-term sexual assault trauma among a national sample of victimized college women. 181 16

Sexual abuse in childhood and adolescence was studied in 286 working-class mothers living in Islington, who were contacted on three occasions over a two-year period. The sample was collected primarily to study current vulnerability factors in the onset of depression, but childhood measures were also included to look at longer-term risk factors. Twenty-five women - 9% of the sample - reported sexual abuse involving physical contact before age 17 and, of these, 64% had case depression in a three-year period (which included the year before first interview). While such abuse was related to other earlier stressful experiences such as parental indifference, violence to the child and institutional stay, it was associated with an increased risk of depression over and above these factors. Sexual abuse before age 17 also related to having been divorced/separated or never having married/cohabited.
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PMID:Early sexual abuse and clinical depression in adult life. 188 57

Sexual assault as a major psychological trauma and a crime of violence evokes immediate symptoms of posttraumatic stress and, for many victims, long-term posttraumatic psychological sequelae. The victim, as the recipient of the rapist's anger and need to control, experiences terror, fear of death, and helplessness. This results in classic posttraumatic symptoms of haunting, intrusive recollections, numbing or constriction of feelings and focus, and increased arousal. When this psychological trauma is not integrated, anxiety, depression, phobias, impaired sexual and social adjustment, negative self-image, and diminished capacity to enjoy life follow. Concepts of posttraumatic stress are reviewed and a definition of sexual assault is offered. The posttraumatic stress response to sexual assault is considered under the phases of response and symptoms, followed by the psychodynamics of this particular psychic trauma. A brief overview of treatment is outlined.
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PMID:Posttraumatic stress disorder after sexual assault: its psychodynamics and treatment. 193 84

This is the first of a two-part report that critically evaluates empirical studies on the short- and long-term effects of child sexual abuse. With the exception of sexualized behavior, the majority of short-term effects noted in the literature are symptoms that characterize child clinical samples in general. Among adolescents, commonly reported sequelae include sexual dissatisfaction, promiscuity, homosexuality, and an increased risk for revictimization. Depression and suicidal ideation or behavior also appear to be more common among victims of sexual abuse compared to normal and psychiatric nonabused controls. Frequency and duration of abuse, abuse involving penetration, force, or violence, and a close relationship to the perpetrator appear to be the most harmful in terms of long-lasting effects on the child. The high prevalence of marital breakdown and psychopathology among parents of children who are sexually abused makes it difficult to determine the specific impact of sexual abuse over and above the effects of a disturbed home environment. Given the broad range of outcome among sexual abuse victims, as well as the methodological weaknesses present in many of the studies reviewed, it is not possible at this time to postulate the existence of a "post-sexual-abuse-syndrome" with a specific course or outcome.
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PMID:A review of the short-term effects of child sexual abuse. 195 86

Sexual assault, as a crime of violence, induces a life crisis which inflicts major psychological and physiological trauma upon the victim. Lack of mutual consent is present in all sexual assaults. Post-traumatic symptoms occur immediately and for a large percentage of victims this trauma is not integrated for many years. Symptoms include the classic triad of post-traumatic stress symptoms of haunting, intrusive recollections, numbing or constriction of feelings and focus and lowered threshold of anxious arousal subsequent to experiencing intense fear, terror and loss of control. Long term effects include anxiety, depression, phobic reactions to situations reminiscent of the sexual assault, sexual dysfunction, impaired social adjustment and diminished capacity to enjoy life. Post-traumatic stress responses, symptomatology, psychodynamics and management of the victim of recent and nonrecent sexual assault are reviewed.
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PMID:Psychological management of victims of sexual assault. 218 May 47

Continuous economic development and evolving social systems have created unique challenges for school health personnel in Taiwan. Due in part to economic growth and an improving health care system, average life expectancy has increased markedly for males and females since 1950. Traditional leading causes of death such as pneumonia, tuberculosis, and gastroenteritis have been replaced by accidents, neoplasms, and cardiovascular diseases. Schoolchildren suffer from various disorders that include hepatitis B, dental caries, and health problems related to scholastic pressure such as myopia, anxiety, and depression. However, new problems such as violence, substance use, and teen-age pregnancy may develop in the future. In response to the challenge, an extensive school health program has emerged that emphasizes school health instruction, school health services, and a healthful school environment. Increased attention has focused on teacher preparation in health education, and a cooperative approach to school health promotion emphasizes school, community, and interagency cooperation. Prompted by the establishment in 1980 of the Graduate Institute of Health Education, National Taiwan Normal University, school-based research initiatives have increased dramatically. Eighteen recommendations for further improvement are offered.
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PMID:Taiwan, R.O.C.: perspectives in school health. 224 77


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