DISTURBANCE
Females Transitioning Out of Care: Understanding the Role of Early Maladaptive Schemas in the Association between Child Sexual Abuse and Sexual Disturbance in Emerging Adulthood
Master thesis Forensic Child and Youth Care Sciences Graduate School of Child Development and Education University of Amsterdam P. L. G. Versteegh 6067050 University of Amsterdam (Amsterdam, The Netherlands) University of Sherbrooke (Montréal, Canada) First supervisor: Dr. E.S. van Vugt Second supervisor: Dr. N. Lanctôt Amsterdam, September 2016
Table of contents Abstract ... 3 Introduction ... 4 Method ... 8 Results ... 13 Discussion ... 18 References ... 22 Appendix ... 26
Abstract
Aim: The current study aims to advance the knowledge about the underlying
mechanism in the association between child sexual abuse and sexual disturbance. Therefore, the potential mediating role of early maladaptive schemas was investigated. Additionally, for a better understanding of the experience, the potential mediating role of early maladaptive schemas in the relation between sexual abuse characteristics (i.e. severity, variety, chronicity, identity of the perpetrator, frequency and age of onset) and sexual disturbance was examined.
Method: The sample was composed of 132 young adult females who transitioned out of
residential care. Child sexual abuse was assessed with an adjusted version of a sexual abuse survey (Finkelhor, Hotaling, Lewis, & Smith, 1990). Sexual disturbance was measured with the Trauma Symptom Inventory-2 (Brière, 2011) and early maladaptive schemas were determined with the Young Schema Questionnaire-Short3 (Young, Pascal, & Cousineau, 2005). Results: Young adult females with child sexual abuse experiences reported more sexual disturbance and more early maladaptive schemas than females without these experiences. The emotional deprivation schema appeared to fully mediate the association between child sexual abuse and sexual disturbance, while several other schemas resulted in partial mediation. Young adult females reporting exposure to various types of sexual abuse, including rape experiences, displayed more emotional deprivation and mistrust/abuse
schemas, successively resulting in more sexual disturbance symptoms. Conclusion: Trauma-focused cognitive-behavioral therapy, with a multidimensional phase-oriented approach and attention for cognitions and characteristics of the experience, is recommended for child sexual abused young adult females.
Keywords: child sexual abuse, sexual disturbance, early maladaptive schemas, females, residential care
The Role of Early Maladaptive Schemas in the Association between Child Sexual Abuse and Sexual Disturbance in Emerging Adulthood
Child sexual abuse is a worldwide problem of considerable extent. Stoltenborgh, Van IJzendoorn, Euser, and Bakermans-Kranenburg (2011) estimated the prevalence rate of child sexual abuse at 12% globally. In certain populations child sexual abuse tends to occur more frequently. For example, average prevalence rates of sexual abuse among females are more than double (18%) compared to rates reported among males (8%; Stoltenborg et al., 2011). Similar patterns but higher rates, are found among youth in residential care. In these residential settings, 63% of the adolescent females report child sexual abuse experiences, while much lower percentages of approximately 17% are reported among adolescent males (Collin-Vézina, Coleman, Milne, Sell, & Daigneault, 2011).
Research on the effects of childhood sexual abuse suggests that these experiences play a role in the development of a range of adverse outcomes in life (Paolucci, Genuis, & Violato, 2001; Collin-Vézina et al., 2011). Sexual abuse has been associated with a number of trauma related symptoms in both affect regulation, cognitions and behaviors, sometimes referred to as complex trauma (Brière, Scott, & Jones, 2014; Courtois & Ford, 2009). One of the most commonly studied symptoms of sexual abuse is sexualized behavior, also believed to be one of the core symptoms of sexual abuse (Kendall-Tacket, Williams, & Finkelhor, 1993). The consequences of sexual abuse in terms of sexual inadequate behavior may vary with age and developmental stage (Kendall-Tacket et al., 1993; Friedrich et al., 2001; Paolucci et al., 2001; Senn, Carey, & Vanable, 2008). General problems among children with sexual abuse
experiences are attachment problems and increased sexual knowledge (Friedrich et al., 2001). More severe forms of sexual abuse, for instance abuse involving rape or multiple perpetrators, or when the perpetrator is a family member and the abuse occurred over a longer period of time, coincide with sexualized behaviors such as overt self-stimulation and inappropriate
sexual propositions towards other children and adults (Friedrich et al., 2001; Kendall-Tacket et al., 1993). In adolescence and adulthood, a number of sexual behaviors among females were found to be associated with child sexual abuse. One of these behaviors is sexual
promiscuity, which refers to early involvement in sexual activity and/or prostitution (Paolucci et al., 2001). Other examples are a larger number of sexual partners and a greater likelihood of having sex without protection (Senn et al., 2008).
In research, the study on sexualized behaviors tends to focus on sexual risk behaviors. Nevertheless, child sexual abuse can also lead to sexual concerns and physical reactions. For instance, the study by Collin Vézina et al. (2011) found an increased risk for sexual concerns among a clinical sample of adolescent females with child sexual abuse experiences, such as a generalized mistrust of people because they might want sex. Brière (2011) integrated these different aspects of sexualized behaviors into one construct, namely sexual disturbance, including both the more impulsive and compulsive sexual risk behaviors as well as the sexual concerns involving sexual conflicts or a general negative reaction to sexual situations, and sexual dysfunction.
To explain the association between a history of sexual abuse and sexual disturbance, Finkelhor and Browne (1985) proposed a traumagenic dynamics model. A central concept used in this theory is traumatic sexualisation, referring to the dysfunctional shaping of the child’s sexual feelings and attitudes as a result of the experienced sexual abuse. More specifically, dysfunctional shaping can occur when a child is repeatedly rewarded for displaying sexual behavior which is inappropriate for its age or when the child associates negative memories with sexual activity (Finkelhor & Browne, 1985). It is likely that these children develop differently in terms cognitions, attitudes, emotions and behavior. For instance, cognitive schemas are developed early in life and derive from individual and
to interpret information, and react to particular situations (Young, Klosko, & Weishaar, 2003). With this in mind, children growing up in an abusive environment develop emotions and cognitions to help them survive in these toxic circumstances. According to Young et al. (2003), this will result in the emergence of self-defeating schemas, also known as “early maladaptive schemas”, which child sexual abuse victims will continue using during different situations in life. Early maladaptive schemas can differ in level of severity and pervasiveness, implying that more severe schemas will cause more and longer lasting negative affects when triggered. The behavior the individual shows, is seen as a response driven by a particular schema, and is not considered to be part of the schema (Young et al., 2003).
A study by Roemmele and Messman-Moore (2011) among college women, showed that it were especially schemas within the Disconnection/Rejection domain, about an individual’s inability to engage in secure and stable relationships with others, that mediated the association between child sexual abuse and sexual risk behavior in terms of the number of lifetime partners. One particular schema in the Disconnection/Rejection domain, about the belief of being abandoned by close people, mediated the relation between child sexual abuse and sexual risk behavior with a well-known partner and condom use. Roemmele and
Messman-Moore (2011) suggested that some victims of child sexual abuse display sexual risk behavior motivated by the need to increase a sense of self-worth or to reduce fears of
abandonment by their romantic partner.
Remarkably, even though early maladaptive schemas are triggered repeatedly by particular circumstances throughout life, their dysfunctional nature usually becomes apparent later in life. This is shown when certain perceptions linked to the schemas, even when these are no longer accurate, are maintained in interaction with others (Young et al., 2003). A possible explanation of this appearance can be found in the emerging adulthood. Emerging adulthood is a transitional period between adolescence and adulthood in the lives of
individuals, aged between 18 and 25, in industrialized societies (Arnett, 2000). In this phase, which is marked by change and exploration on several life aspects (e.g. identity development, autonomy, relationships), young individuals do not yet consider themselves adults and many possibilities in life are still open. This period ends when the individual makes more solid life choices, for example, in romantic relationships (Arnett, 2000). Young and colleagues (2003) state that early maladaptive schemas can repeatedly be triggered by life-events in (emerging) adulthood, which are, unconsciously, perceived as similar to the child sexual abuse
experience.
De Jong, Alink, Bijleveld, Finkenauer, and Hendriks (2015) found that not necessarily the transition to adulthood is difficult for individuals with child sexual abuse experiences, but that the quality of fulfilling the adult role (e.g. being in a romantic relationship) is associated with the child sexual abuse experience. More precisely, a lower quality of the romantic relationship was found to be associated with child sexual abuse. This can be illustrated by the findings that females with child sexual abuse experiences are at increased risk for separation or divorce and sexual intimate partner violence (De Jong et al., 2015). Interestingly, while most studies examined child sexual abuse as a general concept, studies focusing on certain characteristics of the child sexual abuse experience found that females with more severe experiences, i.e. involving penetration, had a lower quality of the romantic relationship and were more often revictimized in adulthood than females with less severe child sexual abuse experiences (De Jong et al., 2015; Whisman, 2006; Lemieux & Byers, 2008). By focusing on the characteristics of the child sexual abuse experience, more detailed knowledge about the sexual disturbance during emerging adulthood can be gained.
The current study aims to advance the knowledge about the role of early maladaptive schemas in the association between childhood sexual abuse and sexual disturbance among young adult females who transitioned out of residential care. This study consisted of two
parts. The first part focused on the potential mediating role of early maladaptive schemas in the relation between child sexual abuse and sexual disturbance, while the second part of the study more thoroughly examined the child sexual abuse experience by focusing on the potential mediating role of early maladaptive schemas in the association between several sexual abuse characteristics (i.e. severity, variety, chronicity, identity of the perpetrator, frequency and age of onset) and sexual disturbance. In this way, we gain more understanding about the origin of sexual disturbance among young adult females who transitioned out of residential care. Besides, this knowledge can be used in the development of suitable forms of treatment to prevent these females from having unhealthy sexual lives.
Method Participants
The present study is part of a larger longitudinal study among adolescent females who were placed in residential care in Montréal in the period of 2007-2008. The total data
collection covers the period from mid- adolescence to emerging adulthood and consists of six data collection waves. The majority of the adolescent females were placed in residential care because of severe behavioral problems compromising their security and development. The females who were admitted to the residential youth centers were placed for a minimum period of three months and for an average period of six months. Placement in a residential center is considered a last resort. For the current study, only data from the sixth wave was included, comprising 134 young adult females (Mean age = 19.40; SD = 1.48). Given that the data points of two females were missing, the final analyses were based on 132 young adult females (Mean age = 19.41; SD = 1.48). All young adult females were out of care at the time of the present study.
The data collection procedure was approved by the Institutional Review Board of the University of Sherbrooke, Canada. At each data collection wave consent was obtained from the participants. Additionally, parental consent was obtained for the participants under the age of 14. The participants completed the questionnaires individually, assisted by an interviewer who received training in research ethics and techniques. Completion of the questionnaires took approximately 90 minutes.
Measures
Independent variable.
Self-reported child sexual abuse. Based on the National Survey on Sexual Abuse
(Finkelhor, Hotaling, Lewis, & Smith, 1990) a self-report questionnaire was developed assessing various types and characteristics of sexual abuse. The participants were asked whether or not they experienced sexual abuse before the age of 18 (i.e. if they were forced to touch someone in a sexual manner, forced to being touched in a sexual manner, or being raped). In addition, a set of sexual abuse characteristics was measured (i.e. severity, variety, chronicity, frequency, age of onset of sexual abuse and the identity of the perpetrator). Severity referred to whether the young adult females reported experiences of rape or not, while variety presented whether the young adult females reported being victim of one type or two or more types of sexual abuse (for example, a combination of rape and molestation). Chronicity was assessed in terms of whether the sexual abuse occurred during a single, or two or more developmental phases (0-5 years, 6-12 years, and 13-18 years). Frequency indicated the number of abuse experiences reported by the young adult females distinguishing between zero to four and five or more experiences. The age of onset referred to the age at which the sexual abuse first occurred, i.e. during childhood (0-12 years) or adolescence (> 12 years). Last, we distinguished among intra- and extrafamilial abuse to describe the identity of the
perpetrator. When the abuse appeared both in intra- and extrafamilial context, we assigned the case to the intrafamilial abuse category.
Dependent variable.
Sexual disturbance. The Trauma Symptom Inventory-2 (TSI-2, Brière, 2011),
consisting of 136 items, assesses posttraumatic stress and other psychological symptoms of traumatic events, among which sexual disturbance. This sexual disturbance subscale contains 10 items measuring respectively, sexual concerns and dysfunctional sexual behavior. Sexual concerns include sexual conflicts, sexual dysfunction and negative reactions to sexual situations (e.g. sexual anxiety, negative thoughts or feelings during sex and shame regarding sexual activities or feelings), while dysfunctional sexual behavior comprises patterns of impulsive or compulsive sexual behavior that is not necessarily enjoyed (e.g. getting into trouble because of sexual behavior, sexual attraction to a potentially dangerous person, and sexual risk-taking). Examples of sexual disturbance items are: “Had negative thoughts or feelings during sex” and “Had sex with someone you barely know”. All items were rated according to their frequency of occurrence in the previous six months, using a four-point Likert scale ranging from ‘1’ «never» to ‘4’ «often». The scores on each item were summed, meaning that higher scores represented higher levels of sexual disturbance. The Cronbach’s α of the sexual disturbance subscale of the TSI-2 was .89 (n = 134).
Potential mediating variable.
Early maladaptive schemas. The early maladaptive schemas were assessed by the
French version of the Young Schema Questionnaire-Short3 (YSQ-S3, 75 items, Young, Pascal, & Cousineau, 2005). The YSQ-S3 assesses the level of early maladaptive schemas, indicating that specific emotional needs were not adequately met during childhood or adolescence. The YSQ-S3 distinguishes in five domains and fifteen early maladaptive schemas. Each early maladaptive schema is composed of five items and each item is rated
using a six-point Likert scale ranging from ‘1’ «completely untrue for me» to ‘6’ «describes me perfectly». A higher score on the questionnaire indicates a stronger endorsement of early maladaptive schemas. Table 1 includes a description of each early maladaptive schemas per domain, examples of associated items and the Cronbach’s α ranging from .69 to .94 (n = 134).
Data Analysis Strategy
For the first part of this study, identifying the relation between sexual abuse, sexual disturbance and early maladaptive schemas, two kinds of analysis were performed. First, ANCOVA’s were conducted while controlling for age, to inspect differences in endorsement of early maladaptive schemas and sexual disturbance among females who did and did not report a history of sexual abuse, using SPSS statistics version 21. Effect sizes (Cohen’s d) were calculated to interpret the magnitude of the differences, in which d = .20 was considered a small, d = .50 a moderate, and d = .80 a large effect (Cohen, 1988). Additionally, mediation analyses were conducted by a structural equational framework using Mplus version 7.2. More precisely, for each early maladaptive schema a single mediation model was estimated to understand the mechanism of the relation between a history of sexual abuse and sexual disturbance.
Subsequently, the second part of the study focused more closely on sexual abuse characteristics (severity, variety, chronicity, frequency, age of onset and identity of the perpetrator) in association with sexual disturbance and early maladaptive schemas, aiming to gain a better understanding of the sexual abuse experience in relation to the level of sexual disturbance in a subsample of 67 young adult females with a history of sexual abuse (Mean Age = 19.15; SD = 1.65). To examine the associations between the sexual abuse
characteristics, a point-biserial correlation was performed. To interpret the strength of the correlations Cohen’s (1988) criteria were used, whereby r = 0.10 – 0.29 was considered small, r = 0.30 - 0.49 moderate and r ≥ 0.50 strong association. Further, similar to the first part of the
study two kinds of analyses were carried out. First, ANCOVA’s were performed to detect differences in the level of sexual disturbance and early maladaptive schemas accounted for by each characteristic of sexual abuse, while controlling for age. In addition, for each early maladaptive schema a single mediation model was conducted to gain a better understanding of the mechanism underlying the association between a specific sexual abuse characteristic and sexual disturbance.
In mediation analysis the direct link between the independent and the dependent variable is indicated by the c-link. The a-link reflects the link between the independent variable (sexual abuse/characteristics of sexual abuse) and each potential mediator (early maladaptive schema), while the b-link refers to the link between each potential mediator and the dependent variable (sexual disturbance). Last, the link between the independent and the dependent variable while taking into account the a- and b-link, is called c’-link. For potential mediation, the a-, b-, and c-link have to be significant (p < .05). A full mediation is
established when the c’-link is not significant (p > .05) anymore, indicating that the entire relation between the independent and the dependent variable can be explained by the mediator. A partial mediation can be found when the c’ is still significant (p < .05), suggesting that a part of the c-link can be explained by the mediator. In case of a partial mediation, the percentage of the association taken by the ab-link was calculated by dividing the estimate of the ab-link by the estimate of the c-link (MacKinnon & Dwyer, 1993;
MacKinnon, Lockwood, & Williams, 2004). When the c-link does not exist but the a- and the b-link do, an indirect effect can be found (Hayes, 2009).
A bootstrapping procedure was used to test for all models, with 500 bootstrapped samples being taken. For the single mediation models the model fit was determined by the following three fit indices: the Chi-squared test, the estimate Root Mean Square Error of Approximation (RMSEA) and the Comparative Fit Index (CFI). The p-value of the
Chi-square test of model fit had to be non-significant (p >.05) to indicate a good fit. For the RMSEA, values less than .06 indicated a good fit and values between .06 and .08 indicated an acceptable fit. The CFI values of .95 or higher indicated a good model fit, while values of .90 or greater indicated an acceptable fit (Hu & Bentler, 1999). When no proper model fit was determined, we correlated the error terms between age and the mediator or we controlled for age on the mediator.
Results
Child Sexual Abuse, Sexual Disturbance and Early Maladaptive Schemas
Differences in level of sexual disturbance and early maladaptive schemas. Table 2
gives an overview of the means, standard deviations, and effect sizes of sexual disturbance and early maladaptive schemas among the young adult females with (n = 67) and without a history of child sexual abuse (n = 65).
A significant difference was found for the level of sexual disturbance in the young adult females with and without child sexual abuse experiences. This is considered a moderate to large effect (d = .63), indicating that young adult females with a history of child sexual abuse showed more sexual disturbance than young adult females without such a history.
As for the schemas, several significant differences (p < .05) across all domains were found, indicating that young adult females with a history of child sexual abuse displayed more maladaptive schemas than young adult females without child sexual abuse experiences. The largest difference was found within the Disconnection/Rejection domain, containing schemas related to a person’s inability to engage in secure and stable relationships with others.
Although all schemas in this domain were found to be significantly more present in young adult females with child sexual abuse experiences compared to those without such
experiences, it was especially the belief of unfulfilled emotional connection (emotional deprivation, d = .86) that stood out. Moderate differences were found for beliefs of being
flawed (defectiveness/shame, d = .50), being used by other people (mistrust/abuse, d = .50) and being abandoned by close people (abandonment, d = .44). A smaller significant difference was found for the belief of being isolated and different (social isolation/alienation, d = .38).
Moderate differences were found within the Impaired Autonomy/Performance
domain, this domain comprised schemas about self-expectations and independent functioning. Precisely, young adult females with child sexual abuse experiences reported, in comparison to the young adult females without these experiences, more feelings of inadequateness compared to peers (failure, d = .51), more need of others to handle their responsibilities
(dependence/incompetence, d = .49) and more catastrophic thoughts (vulnerability to harm or illness, d = .42).
Problems within the Other-Directedness domain only translated in a higher tendency to focus on the needs of others, in expense of one’s own needs (self-sacrifice, d = .51) among young adult females with child sexual abuse experiences. This was considered a moderate difference.
Further, the Overvigilance and Inhibition domain is characterized by schemas
regarding suppression of spontaneity and impulses. In young adult females with child sexual abuse experiences, a small to moderate significant difference was found for the strive for perfection (unrelenting standards/hypercriticalness, d = .40), in comparison to young adult females without these experiences.
Finally, no significant differences were found between young adult females with and without a history of child sexual abuse within the Impaired Limits domain, which reflected difficulties with self-discipline and respecting others.
The mediating role of early maladaptive schemas in child sexual abuse and sexual disturbance. Consistent with the results from the ANCOVA, a direct effect was found for the
that young adult females with a history of child sexual abuse were more likely to show higher levels of sexual disturbance, when compared to young adult females without such a history.
Additionally, it was examined which schema acted as a potential mediator in the association between a history of child sexual abuse and sexual disturbance, by conducting fifteen single mediation models. Within two out of five schema domains mediation effects were found. More precisely, these effects occurred within the Disconnection/Rejection domain and the Impaired Autonomy/Performance domain. A full mediation effect was found for emotional deprivation (b = 1.78; p = .005), while for the other schemas partial mediations were found. The largest contribution to the association was by defectiveness/shame (b = 1.51; p = .015; ab/c = 42%), containing the belief of being flawed. The other partial mediations were found for respectively failure (b = 1.36; p = .025; ab/c = 37%), mistrust/abuse (b = 1.25; p = .013; ab/c = 34%), dependence/incompetence (b = 1.23; p = .025; ab/c = 34%),
vulnerability to harm or illness (b = 1.12; p = .034; ab/c = 31%) and abandonment (b = .86; p = .036; ab/c = 23%). The percentages indicate to what extent the schema contributes to the association between child sexual abuse and sexual disturbance. An overview of the results is given in Table 3.
To summarize, several schemas were found to have a (partial) mediating effect in the relation between child sexual abuse and sexual disturbance.
Sexual Abuse Characteristics, Sexual Disturbance and Early Maladaptive Schemas Associations between sexual abuse characteristics. To examine the associations
between the sexual abuse characteristics, a point-biserial correlation was conducted (see Table 4). Specifically, severity in terms of rape was strongly associated with a larger variety in sexual abuse, referring to combinations of rape and molestation, and moderately related to more chronic forms of sexual abuse, persisting over multiple developmental phases. A larger variety in sexual abuse was moderately related to abuse that occurred more frequently, i.e.
five or more times. Furthermore, more chronic sexual abuse was found to be moderately associated with a higher frequency of sexual abuse, starting at an earlier age, with an intrafamilial perpetrator. Frequent abuse was associated to both sexual abuse starting at an earlier age and intrafamilial abuse. Last, a strong relation was found for an earlier onset of sexual abuse and intrafamilial abuse.
Differences in level of sexual disturbance and early maladaptive schemas. Tables
5a and 5b give an overview of the means, standard deviations, and effect sizes of sexual disturbance and early maladaptive schemas for the sexual abuse characteristics (n = 67).
The level of sexual disturbance was only significantly different (p < .05) for one of the characteristics. More precisely, higher levels of sexual disturbance were found among young adult females with more chronic child sexual abuse experiences, covering two or more developmental phases (chronicity, d = .74). This was considered a large effect.
As for the schemas, significant differences were found for severity, variety and frequency. Young adult females with rape experiences, compared to those without, showed a higher focus on other’s needs instead of their own (self-sacrifice, d = .72), more beliefs of unfulfilled emotional connection (emotional deprivation, d = .71), a stronger strive for
perfection (unrelenting standards/hypercriticalness, d = .71) and more beliefs of being used by other people (mistrust/abuse, d = .61).
Similar results were found for the young adult females with a larger variety of child sexual abuse experiences compared to those with single type experiences regarding beliefs of being used by others (mistrust/abuse, d = .60), unfulfilled emotional connections (emotional deprivation, d = .65), the lack of focus on their own needs (self-sacrifice, d = .54), and the strive for perfection (unrelenting standards/hypercriticalness, d = .54). These effects were considered moderate. In addition, a large variety also led to more catastrophic thoughts (vulnerability to harm or illness, d = .76).
Finally, the belief that close people are not available for support (abandonment, d = .65) was found among the young adult females who have been sexually abused more
frequently (five times or more). A difference in the same direction was found for the belief to meet very high standards (unrelenting standards/hypercriticalness, d = .54). These were all moderate effects. No differences were found for chronicity, age of onset and identity of the perpetrator.
The mediating role of early maladaptive schemas in six characteristics of sexual abuse and sexual disturbance. Further, the underlying mechanism for the association
between each characteristics of sexual abuse (i.e. severity, variety, chronicity, frequency, age of onset and identity of the perpetrator) and sexual disturbance was examined.
The only direct effect was found for the association between chronicity and sexual disturbance (b = 4.92; p = .004), suggesting that mediation could occur. For the remaining characteristics no direct effects were found, indicating that for these models the schemas could only indirectly affect the association.
Indirect effects were found for severity, variety and frequency. First, for severity of sexual abuse a significant effect was found for emotional deprivation (b = 1.76; p = .050), while a marginal effect was found for mistrust/abuse (b = 1.66; p = .055). These findings indicate that sexual disturbance symptoms among young adult females with rape experiences could be explained by the presence of beliefs of unfulfilled emotional connection and beliefs of being used by other people. There were no significant effects found for the other schemas. See Table 6 for an overview of the results for severity.
Similar results were found for young adult females reporting a combination of rape and molestation (i.e. variety). In line with females reporting severe forms of child sexual abuse, the association was directly explained by the emotional deprivation (b = 1.62; p = .042) and the mistrust/abuse (b = 1.68; p = .055) schemas. Additionally, we found that sexual
disturbance among females with a variety of child sexual abuse experiences could be
explained by the vulnerability to harm or illness (b = 1.98; p = .042) schema, reflecting more catastrophic thoughts. There were no significant effects found for the other schemas. See Table 7 for an overview of the results for variety.
For young adult females who reported being sexually abused more frequently, abandonment (b = 1.67; p = .033) was the only early maladaptive schema resulting in an elevated level of sexual disturbance. This schema presents the belief that close people will leave and won’t be able to support the person. In Table 8 an overview of the results is given.
No mediation effects were found for the association between chronicity and sexual disturbance. As for age of onset and identity of the perpetrator, no indirect effects were found. See Table 9-11 for an overview of the results.
Discussion
The current study aimed at advancing the knowledge about the role of early
maladaptive schemas in the association between child sexual abuse and sexual disturbance among young adult females who transitioned out of residential care. In line with earlier research (Paolucci et al., 2001; Senn et al., 2008; Collin-Vézina et al., 2011; Roemmele & Messman-Moore, 2011), this study found that young adult females with a history of child sexual abuse show more sexual disturbance than young adult females without such a history. Besides, when focusing on the endorsement of early maladaptive schemas in child sexual abused young adult females with a residential past, we found similar results as in a study conducted among college women with child sexual abuse experiences (Roemmele & Messman-Moore, 2011), i.e. that young adult females with child sexual abuse experiences showed stronger endorsement of early maladaptive schemas than young adult females without these experiences. In both studies, schemas regarding an individual’s inability to engage in secure and stable relationships with others and a larger tendency to focus on the needs of
others in expense of one’s own showed to be more present in females with child sexual abuse experiences, when compared with females without these experiences. This indicates that young adult females with child sexual abuse experiences in clinical samples, as well as in community samples, show stronger endorsement of early maladaptive schemas and more sexual disturbance than young adult females without such experiences.
When looking at early maladaptive schemas as a potential explanatory mechanism underlying the association between child sexual abuse and sexual disturbance in emerging adulthood, especially the emotional deprivation schema stands out. This implies that sexual disturbance symptoms in emerging adulthood can be explained by the belief of unfulfilled emotional connection, which is developed as a consequence of the sexual abuse experience in childhood. An explanation for this finding can be found in the relation orientation of females, i.e. females tend to focus on relationships with others more than males (Rose & Rudolph, 2006). More precisely, the relational orientation style of females is, for example,
characterized by more connection-oriented goals and more empathy for others, while males endorse more status-orientated goals and focus on their own dominance in groups (Rose & Rudolph, 2006). Additionally, in performing tasks females tend to use strategies that search for social activity and support (Rose & Asher, 2004). This focus on engaging in relationships with others, makes it conceivable that young adult females with a history of child sexual abuse display sexual disturbance symptoms in their search for fulfillment in relationships with others. Also the other early maladaptive schemas that were found to mediate the association between child sexual abuse and sexual disturbance, consecutively the inability to engage in secure and stable relationships with others (i.e. abandonment, mistrust/abuse,
defectiveness/shame) and self-expectations and independent functioning (i.e.
dependence/incompetence, vulnerability to harm or illness, failure), could be explained by this relational orientation perspective, in that these schemas involve a strong orientation on
relationships with others as well. An additional explanation for these findings can be, as Roemmele and Messman-Moore (2011) suggested, that some child sexual abuse victims display sexual risk behavior motivated by the need to increase a sense of self-worth or to reduce fears of abandonment.
This was the first study to examine several characteristics of child sexual abuse (i.e. severity, variety, chronicity, frequency, age of onset and identity of the perpetrator) in relation to sexual disturbance in emerging adulthood among young adult females, in order to more deeply comprehend the child sexual abuse experience. It turns out that the sexual disturbance in young adult females could directly be explained by their child sexual abuse experience during two or more developmental phases (chronicity), while the sexual disturbance in females with child sexual abuse experiences involving rape (severity) and a combination of forms of sexual abuse (variety) is explained by beliefs of unfulfilled emotional connection and being used by other people. Additionally, in females who have experienced a variety of sexual abuse, catastrophic thoughts were found to increase sexual disturbance in emerging adulthood. Young adult females who have been abused more frequently (frequency) show more sexual disturbance symptoms explained by feelings of being abandoned by someone close. Given the correlations between the characteristics, it could be argued that especially the females who experienced complex trauma involving intrusive and frequent child sexual abuse, develop more profound maladaptive cognitions, resulting in more severe forms of dysfunctional sexual behavior and sexual concerns in the emerging adulthood (Brière et al., 2014).
In order to treat the young adult females and their maladaptive cognitions, it is important to take into account that early maladaptive schemas are very persistent since they have developed to help the child survive in the best possible manner while being exposed to sexual abusive circumstances (Young et al., 2003). Trauma-focused cognitive-behavioral
therapy is often suggested as best suitable treatment in case of child sexual abuse (Leenarts, Diehle, Doreleijers, Jansman, & Lindauer, 2013). However, considering the complexity of the trauma experience among these young adult females, a multidimensional phase-oriented approach is suggested, distinguishing three phases of therapy, i.e. stabilization, resolution of the traumatic memory, and personal integration and rehabilitation (Cook et al., 2005; Leenarts et al., 2013). The stabilization phase consists of creating a safe environment and enhancement of regulation, while the resolution of the traumatic memory phase is marked by self-reflectance and integration of the experience. The personal integration and rehabilitation phase is defined by rebuilding and integration of attachment-models in current relationships and enhancement of positive affect (Cook et al., 2005). Based on the findings of the current study, within this multidimensional phase-oriented approach of treatment, attention for cognitions and characteristics of the child sexual abuse experience is recommended.
This study comes with a few limitations. First, we solely focused on a cognitive explanation (i.e. early maladaptive schemas) for sexual disturbance symptoms among young adult females with child sexual abuse histories, while Finkelhor and Browne’s (1985) concept of traumatic sexualisation also suggest adverse development of attitudes, emotions and
behaviors as a consequence of the child sexual abuse. Other approaches, which focus more on the development of these attitudes, emotions or behaviors, might find other mechanisms underlying the association between child sexual abuse and sexual disturbance in emerging adulthood. Second, causal relationships could not be established in this study given the retrospective nature of the study. Retrospective reports might not be explaining why the individual is acting in a certain way in the present (Sobel, Buchanan, Butterfield, & Jenkins, 2010). Third, this study used self-report questionnaires and participants might have faced some difficulties in recalling memories about the sexual abuse experience in childhood or adolescence (Hardt & Rutter, 2004). However, individuals often tend to remember traumatic
events better than events which are not considered traumatic (Alexander et al., 2005). Last, this study is conducted among a sample of young adult females with a history of placement in residential care. Therefore, the findings in this study cannot be generalized to other
populations since, within this population, it is difficult to discriminate between effects of sexual abuse and other emotional and behavioral problems (Brière, 1992). Future research should focus on attitudes, emotions and behaviors in order to explain the association between child sexual abuse and several trauma-related symptoms. In looking for the best suitable treatment for these young adult females it remains important to take the characteristics of their child sexual experience into account.
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Appendix
Table 1
Descriptions of the different early maladaptive schemas (EMS) measured by the YSQ-S3, example items and Cronbach’s α
Domains EMS scale Description Example Item α
(n=134) Disconnection/Rejection Abandonment The belief that close people will leave the person or
won’t be available for support
I need others so much that I fear that I might loose them.
0.87 Mistrust/Abuse The belief that other people will use the person for
their own selfish ends
It is only a matter of time before someone will betray me
0.89 Emotional Deprivation The belief that one’s desire for emotional connection
will not be adequately fulfilled
I never needed a strong person to give me good advice or to guide me when I didn’t know what to do.
0.94
Defectiveness/Shame The belief that one is defective, flawed and unlovable
I don’t deserve other’s people love, attention and respect.
0.91 Social Isolation/Alienation The belief that one is isolated, different and does not
belong
I don’t fit in 0.85
Impaired Autonomy/ Performance
Dependence/Incompetence The belief one needs others to handle their everyday responsibilities
I think of myself as a dependent person, when it comes to everyday functioning.
0.75 Vulnerability to Harm or
Illness
The belief that something catastrophic will happen to oneself
I feel that a disaster (natural, criminal, financial, or medical) could strike at any moment
0.78 Enmeshment/Undeveloped
Self
The belief that one cannot meet an individual identity because of over involvement/closeness to significant others
My parents and I tend to be over involved in each other’s problems
0.78
Failure The belief that one is fundamentally inadequate I'm not as talented as most people are at their school/work
0.94 Impaired Limits Entitlement/Grandiosity The belief that one is superior and entitled to special
rights and privileges
I feel that I shouldn`t have to follow the normal rules and conventions that other people do
0.73 Insufficient
Self-Control/Self-Discipline
The belief that one cannot regulate the expression of their emotions and impulses.
I have trouble finishing daily chores or boring tasks.
0.75 Other-Directedness Subjugation The belief that one’s own desires are of less
importance or invalid
I've always let others make choices for me, so I really don't know what I want for myself
0.78 Self-Sacrifice The tendency to focus on other’s needs at the
expense of one’s own I’m a good person because I think more about others than myself.
0.85 Overvigilance and
Inhibition
Emotional Inhibition The tendency to refrain from spontaneous actions, disinhibit feelings and communication
I control myself so much that people think I am unemotional
0.84 Unrelenting Standards/
Hypercriticalness
The belief that one must strive perfection or meet very high standards
Table 2
Differences in sexual disturbance and early maladaptive schemas among young adult females with and without a history of child sexual abuse (n = 132), controlled for age
Sexually abused No (n = 65) Yes (n = 67) M (SD) M (SD) F d Sexual disturbance 12.83 (4.57) 16.79 (6.73) 12.63*** 0.63 Disconnection/Rejection Abandonment 14.17 (7.30) 17.61 (7.25) 16.19*** 0.44 Mistrust/Abuse 10.60 (6.29) 14.00 (6.71) 17.92*** 0.50 Emotional Deprivation 19.54 (5.93) 15.84 (8.23) 24.06*** 0.86 Defectiveness/Shame 16.60 (3.34) 19.57 (6.69) 18.10*** 0.50 Social Isolation/Alienation 19.86 (5.92) 12.15 (6.24) 14.59*** 0.38 Impaired Autonomy/Performance Dependence/Incompetence 17.49 (3.07) 19.58 (4.65) 17.70*** 0.49 Vulnerability to Harm or Illness 18.88 (5.05) 11.43 (5.80) 15.79*** 0.42 Enmeshment/Undeveloped Self 19.00 (5.57) 19.07 (5.26) 10.06*** 0.00 Failure 16.40 (3.22) 19.12 (5.86) 18.49*** 0.51 Impaired Limits Entitlement/Grandiosity 11.25 (5.41) 12.36 (5.40) 11.01*** 0.18 Insufficient Self-Control/ Self-Discipline 10.09 (5.46) 11.72 (4.80) 12.85*** 0.30 Other-Directedness Subjugation 17.80 (4.35) 18.46 (4.72) 10.47*** 0.13 Self-Sacrifice 18.31 (6.21) 21.57 (6.33) 18.52*** 0.51
Overvigilance and Inhibition
Emotional Inhibition 10.62 (5.93) 10.67 (5.92) 10.03*** 0.00 Unrelenting Standards/
Hypercriticalness
14.11 (5.19) 16.04 (5.30) 15.24*** 0.40 * = p <.05; ** = p <.01; *** = p <.001
Table 3
Potential mediating early maladaptive schemas in the association between a history of sexual abuse and sexual disturbance (n = 132)
Sexual abuse Model fit
Chi-square
Sexual disturbance a-link b-link c'-link ab-link Value df p RMSEA CFI
Disconnection/Rejection Abandonment 3.44*** 0.25*** 2.78*** 0.86** 1.15 1 0.28 0.03 1.00 Mistrust/Abuse 3.40*** 0.37*** 2.39*** 1.25** 0.57 1 0.45 0.00 1.00 Emotional Deprivation 6.30*** 0.28*** 1.81*** 1.78** 0.02 1 0.88 0.00 1.00 Defectiveness/Shame 2.97*** 0.51*** 2.23*** 1.51** 3.79 2 0.15 0.08 0.97 Social Isolation/Alienation 2.29*** 0.35*** 2.77*** 0.80** 0.02 1 0.89 0.00 1.00 Impaired Autonomy/Performance Dependence/Incompetence 2.09*** 0.59*** 2.44*** 1.23** 1.55 1 0.21 0.07 0.99
Vulnerability to Harm or Illness 2.56*** 0.44*** 2.57*** 1.12** 2.17 2 0.34 0.03 1.00 Enmeshment/Undeveloped Self 0.08*** 0.15*** 3.61*** 0.01** 3.49 2 0.17 0.08 0.93 Failure 2.72*** 0.50*** 2.37*** 1.36** 0.00 1 1.00 0.00 1.00 Impaired limits Entitlement/Grandiosity 1.11*** 0.42*** 3.18*** 0.46** 0.80 1 0.37 0.00 1.00 Insufficient Self-Control/Self-Discipline 1.62*** 0.33*** 3.07*** 0.53** 0.29 1 0.59 0.00 1.00 Other-Directedness Subjugation 0.66*** 0.50*** 3.30*** 0.33** 0.59 1 0.44 0.00 1.00 Self-Sacrifice 3.26*** 0.21*** 2.91*** 0.67** 0.00 1 0.96 0.00 0.97
Overvigilance and Inhibition
Emotional Inhibition 0.06*** 0.25*** 3.53*** 0.01** 0.44 1 0.51 0.00 1.00
Unrelenting Standards/ Hypercriticalness
1.94*** 0.32*** 2.90*** 0.62** 1.26 1 0.26 0.04 0.99 * = p <.05; ** = p <.01; *** = p <.001
Table 4
Correlations between sexual abuse characteristics (n = 67)
1 2 3 4 5 6 1. Severity -** 2. Variety -.81*** -** 3. Chronicity -.30*** .24** - 4. Frequency -.22*** .39** .41*** - 5. Age of onset -.05*** .03** .46*** .35** - 6. Identity of perpetrator -.03*** .15** .45*** .40** .53*** - * = p <.05; ** = p <.01; *** = p <.001
Table 5a
Differences in sexual disturbance and early maladaptive schemas among the sexual abuse characteristics in young adult females (n = 67), controlled for age
Severity Variety Chronicity
not raped (n=31) raped (n=36) 1 type (n=24) > 2 types (n=43) 1 phase (n=46) > 2 phases (n=21) M (SD) M (SD) F d M (SD) M (SD) F d M (SD) M (SD) F d Sexual disturbance 15.61 (6.36) 17.81 (6.96) 1.92** 0.35 15.67 (6.90) 17.42 (6.63) 1.44** .30 15.22 (6.01) 10.24 (7.06) 8.70** 0.74 Disconnection/Rejection Abandonment 16.77 (7.05) 18.33 (7.44) 0.79** 0.22 16.29 (6.98) 18.35 (7.37) 1.43** .30 17.39 (7.32) 18.10 (7.24) 0.10** 0.09 Mistrust/Abuse 11.94 (6.00) 15.78 (6.86) 5.90** 0.61 11.54 (6.19) 15.37 (6.67) 5.73** .60 13.28 (6.99) 15.57 (5.92) 1.58** 0.31 Emotional Deprivation 12.90 (6.25) 18.36 (8.95) 8.13** 0.71 12.58 (6.16) 17.65 (8.73) 6.68** .65 14.91 (8.19) 17.86 (8.15) 1.75** 0.33 Defectiveness/Shame 18.77 (6.35) 10.25 (6.98) 0.90** 0.24 18.04 (6.00) 10.42 (6.96) 2.64** .41 18.91 (6.74) 11.00 (6.50) 1.23** 0.28 Social Isolation/Alienation 11.68 (5.67) 12.56 (6.74) 0.33** 0.14 11.33 (5.64) 12.60 (6.57) 0.67** .20 11.57 (6.20) 13.43 (6.28) 1.24** 0.28 Impaired Autonomy/Performance Dependence/Incompetence 19.58 (4.60) 19.58 (4.77) 0.00** 0.00 19.21 (4.59) 19.79 (4.73) 0.49** .18 19.48 (5.03) 19.81 (3.80) 0.02** 0.00 Vulnerability to Harm or Illness 10.03 (5.75) 12.64 (5.64) 3.83** 0.49 18.96 (5.44) 12.81 (5.58) 9.30** .76 10.85 (5.78) 12.71 (5.75) 1.31** 0.29 Enmeshment/Undeveloped Self 19.29 (5.68) 18.89 (4.93) 0.08** 0.06 18.79 (4.57) 19.23 (5.65) 0.24** .13 19.39 (5.92) 18.38 (3.38) 0.70** 0.21 Failure 18.94 (5.63) 19.28 (6.13) 0.08** 0.06 18.38 (4.82) 19.53 (6.39) 1.00** .25 18.61 (5.81) 10.24 (5.96) 0.94** 0.24 Impaired limits Entitlement/Grandiosity 11.03 (4.62) 13.50 (5.81) 3.93** 0.50 11.25 (5.11) 12.98 (5.51) 2.18** .37 11.74 (5.38) 13.71 (5.31) 1.75** 0.33 Insufficient Self-Control/Self-Discipline 12.45 (5.07) 11.08 (4.53) 1.34** 0.29 11.96 (5.30) 11.58 (4.56) 0.04** .06 11.33 (4.85) 12.57 (4.69) 0.84** 0.23 Other-Directedness Subjugation 18.29 (3.25) 18.61 (5.74) 0.09** 0.06 17.83 (3.02) 18.81 (5.45) 1.00** .25 18.35 (4.30) 18.71 (5.64) 0.04** 0.06 Self-Sacrifice 19.32 (5.65) 23.50 (6.32) 8.22** 0.72 19.50 (5.31) 22.72 (6.62) 4.73** .54 21.43 (6.22) 21.86 (6.70) 0.04** 0.06 Overvigilance and Inhibition
Emotional Inhibition 10.16 (5.18) 11.11 (6.53) 0.41** 0.16 19.25 (5.23) 11.47 (6.19) 2.08** .36 10.63 (6.09) 10.76 (5.66) 0.01** 0.00 Unrelenting Standards/
Hypercriticalness
14.16 (5.16) 17.67 (4.92) 7.96** 0.71 14.21 (5.69) 17.07 (4.83) 4.71** .54 15.61 (5.68) 17.00 (4.30) 0.98** 0.25
Table 5b
Differences in sexual disturbance and early maladaptive schemas among the sexual abuse characteristics in young adult females (n = 67), controlled for age
Frequency Age of onset Identity of perpetrator
0-4 times (n=29) > 5 times (n=33) Adolescence (n=21) Childhood (n=46) not intra (n=38) intra (n=29) M (SD) M (SD) F d M (SD) M (SD) F d M (SD) M (SD) F d Sexual disturbance 16.14 (6.79) 17.18 (6.84) 0.42* 0.17 17.63 (6.56) 14.95 (6.89) 1.52 0.31 16.76 (7.48) 16.83 (5.72) 0.03 0.06 Disconnection/Rejection Abandonment 15.38 (7.63) 19.76 (6.32) 6.25* 0.65 15.48 (7.65) 18.59 (6.93) 2.27 0.38 16.66 (7.27) 18.86 (7.16) 1.29 0.29 Mistrust/Abuse 12.93 (6.99) 15.30 (6.80) 1.87* 0.36 13.48 (5.85) 14.24 (7.12) 0.08 0.06 14.47 (6.88) 13.38 (6.55) 0.58 0.19 Emotional Deprivation 14.10 (8.18) 16.79 (8.27) 1.69* 0.34 14.95 (8.02) 16.24 (8.38) 0.21 0.11 15.76 (8.44) 15.93 (8.10) 0.00 0.00 Defectiveness/Shame 19.03 (7.16) 19.94 (6.38) 0.35* 0.16 19.33 (6.77) 19.67 (6.72) 0.03 0.00 19.32 (7.47) 19.90 (5.61) 0.01 0.00 Social Isolation/Alienation 11.66 (6.62) 13.09 (6.23) 0.78* 0.23 10.52 (6.35) 12.89 (6.11) 1.98 0.35 11.68 (6.87) 12.76 (5.35) 0.43 0.17 Impaired Autonomy/Performance Dependence/Incompetence 19.55 (5.52) 19.61 (3.94) 0.01* 0.00 19.10 (4.22) 19.80 (4.87) 0.03 0.06 10.08 (5.14) 18.93 (3.91) 1.78 0.33 Vulnerability to Harm or Illness 10.62 (6.55) 12.42 (5.18) 1.70* 0.34 10.29 (5.24) 11.96 (6.01) 0.55 0.19 10.74 (5.96) 12.34 (5.54) 0.81 0.22 Enmeshment/Undeveloped Self 19.66 (5.86) 19.00 (5.01) 0.20* 0.11 18.76 (4.69) 19.22 (5.54) 0.00 0.00 18.95 (5.40) 19.24 (5.15) 0.00 0.00 Failure 18.45 (6.07) 19.88 (5.95) 1.02* 0.26 17.57 (4.85) 19.83 (6.19) 1.22 0.28 18.95 (6.26) 19.34 (5.40) 0.00 0.00 Impaired limits Entitlement/Grandiosity 12.62 (5.87) 12.64 (5.20) 0.00* 0.00 11.29 (3.45) 12.85 (6.06) 0.58 0.19 12.34 (5.10) 12.38 (5.86) 0.05 0.06 Insufficient Self-Control/Self-Discipline 10.76 (3.99) 12.67 (5.19) 2.64* 0.42 10.00 (4.82) 12.50 (4.63) 3.19 0.44 11.18 (4.49) 12.41 (5.17) 0.76 0.22 Other-Directedness Subjugation 18.31 (5.18) 18.67 (4.50) 0.11* 0.09 17.52 (2.79) 18.89 (5.35) 0.61 0.19 18.61 (5.41) 18.28 (3.71) 0.28 0.13 Self-Sacrifice 20.62 (5.89) 22.45 (6.78) 1.32* 0.30 19.95 (6.74) 22.30 (6.07) 1.48 0.31 21.39 (6.10) 21.79 (6.73) 0.01 0.00 Overvigilance and Inhibition
Emotional Inhibition 10.10 (6.68) 11.48 (5.47) 0.78* 0.23 10.05 (5.79) 10.96 (6.02) 0.44 0.17 10.68 (6.45) 10.66 (5.25) 0.00 0.00 Unrelenting Standards/
Hypercriticalness
14.79 (5.66) 17.48 (4.62) 4.22* 0.54 15.00 (4.57) 16.52 (5.58) 1.22 0.28 16.21 (5.95) 15.83 (4.39) 0.08 0.06
Table 6
Potential mediating early maladaptive schemas in the association between severity and sexual disturbance (n = 67)
Severity Model fit
Chi-square
Sexual disturbance a-link b-link c'-link ab-link Value df p RMSEA CFI
Disconnection/Rejection Abandonment -1.56** 0.29*** 1.77 -0.45* 0.83 1 0.36 0.00 1.00 Mistrust/Abuse -3.84** 0.43*** 0.56 -1.66† 0.82 1 0.36 0.00 1.00 Emotional Deprivation -5.46** 0.32*** 0.50 -1.76* 0.67 1 0.40 0.00 1.00 Defectiveness/Shame -1.52** 0.53*** 1.42 -0.81* 0.01 1 0.91 0.00 1.00 Social Isolation/Alienation -0.88** 0.44*** 1.85 -0.38* 0.11 1 0.75 0.00 1.00 Impaired Autonomy/Performance Dependence/Incompetence -0.04** 0.72*** 2.21 -0.03* 0.01 1 0.91 0.00 1.00
Vulnerability to Harm or Illness -2.65** 0.46*** 1.02 -1.21* 0.01 1 0.91 0.00 1.00
Enmeshment/Undeveloped Self -0.37** 0.37*** 2.37 -0.14* 0.01 1 0.91 0.00 1.00 Failure -0.39** 0.59*** 2.01 -0.23* 0.01 1 0.91 0.00 1.00 Impaired Limits Entitlement/Grandiosity -2.50** 0.37*** 1.30 -0.93* 0.01 1 0.91 0.00 1.00 Insufficient Self-Control/Self-Discipline -1.35** 0.41*** 2.79 -0.55* 0.01 1 0.91 0.00 1.00 Other-Directedness Subjugation -0.35** 0.66*** 2.00 -0.23* 0.01 1 0.91 0.00 1.00 Self-Sacrifice -4.20** 0.28*** 1.05 -1.18* 0.01 1 0.91 0.00 1.00
Overvigilance and Inhibition
Emotional Inhibition -0.95** 0.33*** 1.92 -0.31* 0.16 1 0.69 0.00 1.00
Unrelenting Standards/ Hypercriticalness -3.51** 0.36*** 0.97 -1.26* 0.00 1 0.97 0.00 1.00 † = p <.10; * = p <.05; ** = p <.01; *** = p <.001
Table 7
Potential mediating early maladaptive schemas in the association between variety and sexual disturbance (n = 67)
Variety Model fit
Chi-square
Sexual disturbance a-link b-link c'-link ab-link Value df p RMSEA CFI
Disconnection/Rejection Abandonment -2.06** 0.29*** 1.38 -0.60* 1.00 1 0.32 0.01 1.00 Mistrust/Abuse -3.83** 0.44*** 0.28 -1.68† 1.15 1 0.28 0.05 0.99 Emotional Deprivation -5.07** 0.32*** 0.35 -1.62* 1.01 1 0.31 0.01 0.99 Defectiveness/Shame -2.68** 0.54*** 0.58 -1.44* 0.47 1 0.49 0.00 1.00 Social Isolation/Alienation -1.27** 0.44*** 1.45 -0.55* 0.15 1 0.70 0.00 1.00 Impaired Autonomy/Performance Dependence/Incompetence -0.81** 0.71*** 1.45 -0.57* 0.47 1 0.49 0.00 1.00
Vulnerability to Harm or Illness -4.14** 0.48*** 0.04 -1.98* 0.47 1 0.49 0.00 1.00
Enmeshment/Undeveloped Self -0.65** 0.35*** 1.79 -0.23* 0.47 1 0.49 0.00 1.00 Failure -1.45** 0.58*** 1.18 -0.84* 0.47 1 0.49 0.00 1.00 Impaired Limits Entitlement/Grandiosity -1.97** 0.38*** 1.27 -0.75* 0.47 1 0.49 0.00 1.00 Insufficient Self-Control/Self-Discipline -0.23** 0.37*** 2.11 -0.09* 0.47 1 0.49 0.00 1.00 Other-Directedness Subjugation -1.18** 0.65*** 1.26 -0.77* 0.47 1 0.49 0.00 1.00 Self-Sacrifice -3.41** 0.23*** 1.04 -0.98* 0.47 1 0.49 0.00 1.00
Overvigilance and Inhibition
Emotional Inhibition -2.22** 0.33*** 1.31 -0.72* 0.08 1 0.77 0.00 1.00
Unrelenting Standards/ Hypercriticalness -2.86** 0.37*** 0.97 -1.05* 0.03 1 0.86 0.00 1.00 † = p <.10; * = p <.05; ** = p <.01; *** = p <.001
Table 8
Potential mediating early maladaptive schema in the association between frequency and sexual disturbance (n = 67)
Frequency Model fit
Chi-square
Sexual disturbance a-link b-link c'-link ab-link Value df p RMSEA CFI
Disconnection/Rejection Abandonment -4.38* 0.38*** -0.58 -1.67* 1.39 1 0.24 0.08 0.98 Mistrust/Abuse -2.37* 0.45*** -0.02 -1.08* 0.86 1 0.35 0.00 1.00 Emotional Deprivation -2.68* 0.35*** -0.16 -0.93* 0.98 1 0.32 0.00 1.00 Defectiveness/Shame -0.98* 0.60*** -0.52 -0.58* 0.03 1 0.88 0.00 1.00 Social Isolation/Alienation -1.44* 0.45*** -0.46 -0.65* 0.19 1 0.67 0.00 1.00 Impaired Autonomy/Performance Dependence/Incompetence -0.10* 0.76*** -1.03 -0.08* 0.03 1 0.88 0.00 1.00
Vulnerability to Harm or Illness -1.87* 0.54*** -0.10 -1.01* 0.03 1 0.88 0.00 1.00
Enmeshment/Undeveloped Self -0.60* 0.39*** -1.34 -0.24* 0.03 1 0.88 0.00 1.00 Failure -1.50* 0.61*** -0.19 -0.92* 0.03 1 0.88 0.00 1.00 Impaired Limits Entitlement/Grandiosity -0.07* 0.46*** -1.07 -0.03* 0.03 1 0.88 0.00 1.00 Insufficient Self-Control/Self-Discipline -1.91* 0.43*** -0.27 -0.83* 0.99 1 0.32 0.00 1.00 Other-Directedness Subjugation -0.40* 0.70*** -0.83 -0.28* 0.03 1 0.88 0.00 1.00 Self-Sacrifice -1.83* 0.32*** -0.51 -0.59* 1.01 1 0.31 0.02 1.00
Overvigilance and Inhibition
Emotional Inhibition -1.38* 0.35*** -0.63 -0.48* 0.05 1 0.83 0.00 1.00
Unrelenting Standards/ Hypercriticalness -2.69* 0.46*** -0.14 -1.24* 0.13 1 0.72 0.00 1.00 * = p <.05; ** = p <.01; *** = p <.001
Table 9
Potential mediating early maladaptive schemas in the association between chronicity and sexual disturbance (n = 67)
Chronicity Model fit
Chi-square
Sexual disturbance a-link b-link c'-link ab-link Value df p RMSEA CFI
Disconnection/Rejection Abandonment 0.70 0.29*** 4.69** 0.21 0.77 1 0.38 0.00 1.00 Mistrust/Abuse 2.29 0.40*** 3.98** 0.92 0.61 1 0.44 0.00 1.00 Emotional Deprivation 2.94 0.29*** 4.04** 0.85 0.47 1 0.49 0.00 1.00 Defectiveness/Shame 1.91 0.51*** 3.90** 0.97 0.19 1 0.66 0.00 1.00 Social Isolation/Alienation 1.86 0.40*** 4.12** 0.75 0.07 1 0.80 0.00 1.00 Impaired Autonomy/Performance Dependence/Incompetence 0.19 0.71*** 4.74** 0.13 0.19 1 0.66 0.00 1.00
Vulnerability to Harm or Illness 1.70 0.43*** 4.13** 0.73 0.19 1 0.66 0.00 1.00
Enmeshment/Undeveloped Self 1.83 0.34*** 4.24** 0.62 0.19 1 0.66 0.00 1.00 Failure 1.45 0.55*** 4.06** 0.80 0.19 1 0.66 0.00 1.00 Impaired Limits Entitlement/Grandiosity 1.83 0.34*** 4.24** 0.62 0.19 1 0.66 0.00 1.00 Insufficient Self-Control/Self-Discipline 1.15 0.32*** 4.50** 0.37 0.19 1 0.66 0.00 1.00 Other-Directedness Subjugation 0.24 0.66*** 4.71** 0.16 0.19 1 0.66 0.00 1.00 Self-Sacrifice 0.32 0.30*** 4.77** 0.10 0.19 1 0.66 0.00 1.00
Overvigilance and Inhibition
Emotional Inhibition 0.13 0.34*** 4.81** 0.05 0.17 1 0.68 0.00 1.00
Unrelenting Standards/ Hypercriticalness 1.39 0.34*** 4.39** 0.48 0.00 1 0.95 0.00 1.00 * = p <.05; ** = p <.01; *** = p <.001
Table 10
Potential mediating early maladaptive schemas in the association between age of onset and sexual disturbance (n = 67)
Age of onset Model fit
Chi-square
Sexual disturbance a-link b-link c'-link ab-link Value df p RMSEA CFI
Disconnection/Rejection Abandonment -3.11* 0.29*** 1.34 -0.90 0.38 1 .54 .00 1.00 Mistrust/Abuse -0.76* 0.44*** 1.95 -0.34 0.60 1 .44 .00 1.00 Emotional Deprivation -1.29* 0.32*** 1.85 -0.41 0.43 1 .51 .00 1.00 Defectiveness/Shame -0.31* 0.55*** 2.35 -0.17 2.26 2 .32 .04 0.99 Social Isolation/Alienation -2.37* 0.43*** 1.16 -1.02 0.00 1 .96 .00 1.00 Impaired Autonomy/Performance Dependence/Incompetence -0.22* 0.72*** 2.02 -0.16 2.26 2 .32 .04 0.99
Vulnerability to Harm or Illness -1.13* 0.47*** 1.65 -0.53 2.26 2 .32 .04 0.98
Enmeshment/Undeveloped Self -0.00* 0.36*** 2.18 -0.00 2.26 2 .32 .04 0.97 Failure -1.68* 0.58*** 1.20 -0.98 2.26 2 .32 .04 0.99 Impaired Limits Entitlement/Grandiosity -1.08* 0.39*** 1.76 -0.42 2.26 2 .32 .04 0.98 Insufficient Self-Control/Self-Discipline -2.50* 0.34*** 1.42 -0.85 1.39 1 .24 .08 0.96 Other-Directedness Subjugation -0.97* 0.65*** 1.54 -0.63 2.26 2 .32 .04 0.99 Self-Sacrifice -2.35* 0.29*** 1.58 -0.69 1.02 1 .31 .02 0.99
Overvigilance and Inhibition
Emotional Inhibition -0.91* 0.33*** 1.84 -0.30 0.27 1 0.60 0.00 1.00
Unrelenting Standards/ Hypercriticalness -1.52* 0.37*** 1.59 -0.56 0.05 1 0.83 0.00 1.00 * = p <.05; ** = p <.01; *** = p <.001
Table 11
Potential mediating early maladaptive schemas in the association between identity of the perpetrator and sexual disturbance (n = 67)
Identity of perpetrator Model fit
Chi-square
Sexual disturbance a-link b-link c'-link ab-link. Value df p RMSEA CFI
Disconnection/Rejection Abandonment -2.20 0.31*** -0.94 -0.69 0.57 1 0.45 0.00 1.00 Mistrust/Abuse -1.09 0.45*** -0.27 -0.49 0.86 1 0.35 0.00 1.00 Emotional Deprivation -0.17 0.33*** -0.30 -0.06 0.56 1 0.46 0.00 1.00 Defectiveness/Shame -0.18 0.55*** -0.40 -0.10 1.02 1 0.31 0.02 1.00 Social Isolation/Alienation -1.07 0.45*** -0.77 -0.49 0.05 1 0.82 0.00 1.00 Impaired Autonomy/Performance Dependence/Incompetence -1.48 0.73*** -0.79 -1.09 1.02 1 0.31 0.02 1.00
Vulnerability to Harm or Illness -1.26 0.49*** -0.92 -0.62 1.02 1 0.31 0.02 1.00
Enmeshment/Undeveloped Self -0.01 0.36*** -0.31 -0.00 1.02 1 0.31 0.02 1.00 Failure -0.00 0.59*** -0.30 -0.00 1.02 1 0.31 0.02 1.00 Impaired Limits Entitlement/Grandiosity -0.29 0.40*** -0.18 -0.12 1.02 1 0.31 0.02 1.00 Insufficient Self-Control/Self-Discipline -1.03 0.38*** -0.69 -0.39 1.02 1 0.31 0.02 1.00 Other-Directedness Subjugation -0.61 0.67*** -0.10 -0.41 1.02 1 0.31 0.02 1.00 Self-Sacrifice -0.17 0.31*** -0.35 -0.05 1.02 1 0.31 0.02 1.00
Overvigilance and Inhibition
Emotional Inhibition -0.03 0.34*** -0.32 -0.01 0.17 1 0.68 0.00 1.00
Unrelenting Standards/ Hypercriticalness -0.38 0.39*** -0.15 -0.15 0.00 1 0.98 0.00 1.00 * = p <.05; ** = p <.01; *** = p <.001
