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PubMed1998

Convergent validity of three posttraumatic symptoms inventories among adult sexual abuse survivors.

We examined the convergent validity of three posttraumatic symptoms inventories, the civilian version of the Mississippi Scale for Combat-Related PTSD (CM-PTSD), the Trauma Symptom Checklist-40 (TSC-40), and the Response to Childhood Incest Questionnaire (RCIQ), in a sample of 52 adult sexual abuse survivors. The significant and moderate to strong correlations (r = .6 or higher) among these inventories supported their convergent validity. Comparison with other studies also suggests that these instruments can adequately discriminate clinical from nonclinical populations.

Adult↗
PubMed2003

Oedipus and the oedipal.

Psychoanalysts have assumed that Sophocles can be seen through the lens of Freud, and that the Oedipus complex is about the incest taboo, guilt, and aggression. However, an examination of Sophocles' Oedipus Rex (as well as other plays) suggests that these themes are only a part of the central dynamics of the play, perhaps not the most central part. This article describes discrepancies between what Freud sees of oedipal dynamics and the oedipal dynamics at work in Sophocles and suggests possible explanations. A central theme of my discussion is the shame and blindness of Oedipus.

Conflict, Psychological↗
PubMed1993

Long-term recidivism of child molesters.

We examined the long-term recidivism rates of 197 child molesters released from prison between 1958 and 1974. Overall, 42% of the total sample were reconvicted for sexual crimes, violent crimes, or both, with 10% of the total sample reconvicted 10-31 years after being released. Incest offenders were reconvicted at a slower rate than were offenders who selected only boys, with offenders against girls showing a rate intermediate between these two groups. Other factors associated with increased recidivism were (a) never being married and (b) previous sexual offenses. None of the mental health and personality tests used in this study (e.g., the Eysenck Personality Inventory and the Minnesota Multiphasic Personality Inventory) was significantly associated with recidivism.

Adult↗
PubMed2002

Self-definition as a survivor of childhood sexual abuse among navy recruits.

This study explored how specific childhood sexual experiences (CSEs) might be related to self-identification as a victim of sexual abuse and to gender differences in self-defined victimization. Hierarchical logistic regression was used to estimate the relationship of demographic and CSE characteristics with self-definitions. The characteristics most strongly associated were threats-force, incest, and younger age at the time of the experience. Men were less likely than were women to acknowledge abuse and to report CSE characteristics indicative of abuse. Women were more likely to identify themselves as victims the more CSEs they reported involving sexual penetration. Finally, in an analysis of familial abuse, men were more likely to define themselves as victims if the perpetrator was also male.

Adolescent↗
PubMed2004

Proof of paternity: historical reflections on an andrological-forensic challenge.

Throughout the history of medicine, there have been difficulties in forensic proving of unsolved paternities, making this a major andrological-forensic challenge. In the Roman empire, children procreated by incest, called 'incestuosi', had no rights at all and other illegitimates, e.g. children born of prostitutes or as a result of adultery, could not assert rights towards the father. Only through the 'corpus iuris civilis' of the Roman Emperor Justinian I (6th century ad) could claims of alimony be made in some cases. In later times, evidence of presumable impotence of a potential father was determined by the congressus, where defined juristical 'sexual fights' had to be held before official matrons, surgeons and priests. Men had to demonstrate their erectile and ejaculatory function. A special significance must be attributed to the microscopical discovery of spermatozoa by the medical student Johann Ham in 1677 and the further investigation by Antoni van Leeuwenhoek. After centuries of personally biased and scientifically incorrect concepts of paternity determination, the discovery of the blood grouping system by Karl Landsteiner at the beginning of the 20th century paved the way for sophisticated techniques to prove or rather to disprove paternity. In 1921, Reuben Ottenberg from New York was the first to suggest the application of the system to medico-legal questions, but it was not before the 1950s that legal courts accepted this method. A famous example of disregarding clear blood grouping results was the case of the movie star Charles Chaplin in California in 1946. Modern DNA techniques, today the golden standard in forensic medicine, have also been applied recently for historical investigations. One of the very illustrious examples is the dispute about Thomas Jefferson, third President of the US, fathering a child of one of his slaves.

Andrology↗
PubMed2001

Physical and sexual abuse histories in patients with eating disorders: a comparison of Japanese and American patients.

Physical and sexual abuse among patients with eating disorders has been a focus of attention in Western countries, however, there is no study comparing the incidence of these factors in Western and Asian countries. Japanese subjects consisted of 38 patients with anorexia nervosa restricting type (AN-R), 46 patients with anorexia nervosa binge eating/purging type (AN-BP), 76 patients with bulimia nervosa purging type (BN) and 99 controls. Subjects from the USA consisted of 29 AN-R, 34 AN-BP and 16 BN. The Physical and Sexual Abuse Questionnaire was administered to all subjects. Minor sexual abuse such as confronting exhibitionism or being fondled by a stranger tended to be more prevalent among Japanese subjects, while victimization by rape or incest was more prevalent among USA subjects. Conversely, physical abuse history was similarly distributed across each diagnostic subgroup in both countries. Events related to physical abuse, such as an abusive family background, may contribute whether eating disorder patients are restricting or bulimic and regardless of culture.

Analysis of Variance↗
PubMedDate not supplied

Street music or the blues? The lived experience and social environment of depression.

Life's complexity is a haunting melody of continuously interacting variables .... Professional practice in nursing seeks to promote symphonic interaction between man [sic] and environment. . . (Rogers, 1970, pp. 41, 122). The purpose of this phenomenological study was to explore the lived experience of clinical depression for women in the context of their social relations and environment. Twelve ethnically diverse female friend dyads were interviewed and completed the Beck Depression Inventory (BDI). Seventeen of these women had experienced a major depression in the past or were in treatment for clinical depression at the time of the study. This depression was characterized by dissonance experienced in childhood abuse and incest, uncontrollable moods despite self-medication, abusive or negligent therapy, failed social relationships in adulthood, and a lack of resources in the environment. In contrast, seven healthy women described their social environment as generally resonant and connected. Prevention of childhood abuse and racism, relief from economic hardships, early diagnosis, and safe, effective treatment are essential in helping women to survive clinical depression. Nurses in the community are in a unique position to affect this public health problem.

Adult↗
PubMed1993

An analysis of hypnotherapist-client sexual intimacy.

While sexual interaction between psychologists, physicians, and other health therapists of all kinds and their clients is typically condemned by professional bodies as unethical, the controversy regarding the potential for hypnosis to produce compliant behavior in unwilling or nonconsenting subjects suggests that hypnotherapist-client sex may warrant special attention. Because the experiments required to clarify the potential for hypnosis to potentiate nontrivial compliance are themselves unethical and/or inconclusive, experimental methods cannot be adequately used to clarify this issue. Instead, the matter can be addressed by reference to other forms of evidence, such as the responses of therapists and clients to anonymous surveys and the analysis of cases, that have reached the courts. Consideration of this qualitatively deficient evidence suggests that even if the use of hypnotic suggestion can lead to compliance to sexual demands, overt coercion is seldom used in practice. Social psychological and situational factors are particularly salient in understanding therapist-client sex. The question of whether there are special properties of the dynamics of the hypnotic experience, other than specific coercive suggestion and beyond those typically found in other forms of therapy, is considered. Comparisons are drawn with other examples of socially condemned sex, such as teacher-student sex, sexual harassment in the workplace, incest, and extramarital sex.

Adult↗
PubMed1984

Parental perceptions of children's modesty: a cross-sectional survey of ages two to ten years.

Modesty has been defined as decorum in relation to physical nakedness, and sexual and eliminative behavior (Newson and Newson 1968). The connection between nakedness, sexuality, and modesty with respect to family members dates back millennia. Leviticus prohibited incest with the phrase, "Thou shalt not uncover the nakedness of ..." and then specified a lengthy list of forbidden relatives. We will review contemporary theories and research projects concerning modesty and then discuss the results of a study we designed in order to investigate age trends in the development of modesty.

Age Factors↗
PubMed1993

A critique of conceptual and treatment approaches to borderline psychopathology in light of findings about childhood abuse.

A series of recent research findings has begung to supply strong evidence of a highly significant correlation between borderline psychopathology and experiences of repeated childhood trauma including sexual abuse (especially incest), physical abuse, and the witnessing of severe domestic violence (Bryer et al. 1987; Herman et al. 1989; Western et al. 1990; Zanarini et al. 1989). The replication of these results with different research samples is in contrast to the inconsistent findings associated with earlier etiological theories, in which the roots of borderline pathology were variously linked to schizophrenic or affective illnesses (Akiskal 1981; Akiskal et al. 1985; Klein 1977; Perry 1985), to derailments in the separation-individuation process (Kernberg 1975, 1976; Mahler and Kaplan 1977; Masterson and Rinsley 1975), to actual early losses and separations (Bradley 1979; Paris et al. 1988; Soloff and Millward 1983a, 1983b), to severe empathic failures during the first years of life (Adler and Buie 1979), or to more general family-based pathologies (Frank and Hoffman 1980; Frank and Paris 1981; Grinker et al. 1968; Gunderson and Englund 1981; Gunderson et al. 1980; Links 1990; Walsh 1977; Zinner and Shapiro 1975). Not only do current findings regularly identify 50% to 80% of subjects as victims of childhood abuse and trauma, but also several studies show that factors such as age of onset, severity, and type of abuse reliably discriminate between borderline and other diagnostic groups (Herman et al. 1989; Zanarini et al. 1989).

Adolescent↗
PubMed1993

Sexual abuse and psychopathology.

With the recognition that sexual exploitation of children is far more common than previously thought, a substantial research effort has aimed to describe its acute and long-term effects (Kluft 1990). Most studies have been quantitative and have pursued one of two strategies: Children identified by referral from child protective services as physically victimized are concurrently assessed for psychiatric sequelae; alternatively, adults with or without various psychiatric syndromes are retrospectively asked to recall the presence or absence of traumatic childhood experiences. Descriptive in focus, the results of these research efforts have broadened our understanding of the typical constellation of symptoms experienced by childhood incest victims and have delineated the adult psychiatric diagnostic categories most associated with a history of childhood trauma.

Adolescent↗
PubMed1987

A comparison of sex offenders against female and male minors.

Male sex offenders against minors were grouped according to age and sex of victims, and according to whether they had offended against one or more than one minor. Cases of incest or courtship disorder were not included in the study. Among offenders against female children, the number of one-case offenders was substantially larger than that of multicase offenders. The opposite was true of offenders against male children, and there was no significant difference between one-case and multicase offenders against female or male early adolescents. If these counts reflect corresponding prevalences within sex offenders against minors in a Western cultural setting, some inferences can be made from these comparisons.

Adolescent↗
PubMedDate not supplied

At war in the fields of play: current perspectives on the nature and treatment of adolescent chemical dependency.

While the numbers of adolescents entering drug abuse treatment are not increasing dramatically, those entering treatment are getting sicker, according to clinical reports. Adolescents are entering treatment with multiple problems, including severe learning disorders, borderline personality disorders, multiple diagnoses of addiction, mental health and physical problems (including HIV/AIDS), and issues arising from child abuse and incest. A case study in client-therapist interaction is presented, highlighting the concept of the wounded healer. The disease model of addiction is discussed as it applies to adolescents, as is their need for habilitation, not rehabilitation. Current abuse trends and the drugs involved are also discussed. Multiple diagnoses, physiologic disorders, HIV testing and counseling, surgical problems, and maternal/neonatal complications are reviewed.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Infertility in Jewish couples, biblical and rabbinic law.

The Jewish religion is family orientated, and life is guided by 'Halacha', a code of conduct based on biblical and rabbinic law. There is a duty to have children, in view of the first biblical commandment 'be fruitful and multiply', which sanctions most treatments for infertility. Interpretations vary among Orthodox, Conservative and Progressive rabbis, but it is only rabbis who have authority to advise infertile couples on which procedures concur with Jewish law, and their appraisals tend towards leniency in the interests of domestic happiness. Prohibitions against 'wasting seed', and against marriage to a man with 'wounded testes or severed membrum', may be waived to allow semen collection for analysis and treatment for male infertility. All types of assisted conception are approved, including in vitro and micro-assisted fertilization, provided the gametes are from married couples. In short cycles, artificial insemination can be permitted in the post-menstrual week of 'niddah' when coitus is forbidden. Jewish descent from the mother is automatic but, for Orthodox couples, a technical violation of the law against adultery or incest can spoil the marriage prospects of a child or interrupt the paternal priestly line of Cohen or Levi. Donor gametes are largely unacceptable to Orthodox rabbis, since egg donation confuses the definition of the mother, and because sperm donation creates subterfuge in a child's genealogy and a risk of consanguinity. However, Progressive and Conservative rabbis place more emphasis on the social attributes of parents and frequently approve of gamete donation. The Jewish status of children resulting from surrogacy or adoption can be settled by religious conversion. Objections to treating unmarried couples, single or lesbian women, and to posthumous conception, arise because such households are not traditional families.

Journal Article↗
PubMed2002

Physical and sexual abuse in the lives of HIV-positive women enrolled in a primary medicine health maintenance organization.

Over the past several years, the proportion of all cases of AIDS in the United States among adult and adolescent women has more than tripled from 7% in 1985 to 23% in 1998. Information obtained in the present study suggests that care providers need to be aware of the unique life circumstances of women with AIDS, which may predispose them to a number of negative health and mental health outcomes. Charts of the first 100 women enrolled in an intensive home-based primary medical HMO for people with advanced HIV/AIDS were examined retrospectively for evidence of trauma. Results from a chart review and nursing care assessments of these patients revealed that women with HIV/AIDS were significantly more likely to have had traumatic life experiences compared to the larger population [as measured in a National Comorbidity Survey (NCS)]. In this study, one-half of the patients reported a lifetime history of sexual assault compared to 9% of the general population, one-third reported a history of incest compared to 12% in the NCS, and 83% reported significant physical abuse compared to 4% in the NCS. Such traumatic life experiences are frequently associated with high rates of psychiatric comorbidity, substance abuse, and possible nonadherence to health care. Providers of AIDS care need to be aware of the complex mental health and psychosocial needs of traumatized women with AIDS and make better use of collateral mental health providers and consultation. The ways in which this particular sample of women may be nonrepresentative of women living with AIDS, in general, including the observation that they may be a particularly traumatized and challenging cohort, and other limitations of the data, including the methods used for chart review, are discussed.

Adolescent↗
PubMed1997

Symbolic kinship program.

This paper discusses a computerized algorithm to derive the formula for the likelihood ratio for a kinship problem with any arbitrarily defined relationships based on genetic evidence. The ordinary paternity case with the familiar likelihood formula 1/2q is the commonest example. More generally, any miscellaneous collection of people can be genetically tested to help settle some argument about how they are related, what one might call a "kinship" case. Examples that geneticists and DNA identification laboratories run into include sibship, incest, twin, inheritance, motherless, and corpse identification cases. The strength of the genetic evidence is always described by a likelihood ratio. The general method is described by which the computer program finds the formulas appropriate to these various situations. The benefits and the interest of the program are discussed using many examples, including analyses that have previously been published, some practical problems, and simple and useful rules for dealing with scenarios in which ancestral or fraternal types substitute for those of the alleged father.

Algorithms↗
PubMed2000

Barriers to implementing South Africa's Termination of Pregnancy Act in rural KwaZulu/Natal.

INTRODUCTION: South Africa's Termination of Pregnancy Act, the most liberal abortion law in Africa, took effect early in 1997. In spite of the anticipated benefits to women's health, however, public reaction has been mixed. In the country's most populous province, KwaZulu/Natal, opposition is strong and most health care providers have refused to provide the service. This study explored attitudes and beliefs about abortion and the Termination of Pregnancy Act among primary care nurses and community members in a rural district in order to better understand barriers to implementation of the new law. METHODS: As part of a community survey on women's reproductive health (n = 138), questions on knowledge, attitudes and beliefs about abortion were asked, as well as awareness of the provisions of the Termination of Pregnancy Act. To better understand the perspectives of health care workers, a survey among primary care nurses on duty (n = 25) was also conducted. In-depth interviews were conducted with both nurses and women in the community to further pursue issues raised in the two surveys. RESULTS: Support for the Act was low (11%) among both community members and nurses, and few supported abortion on request (18 and 6%, respectively). Within each group, however, a clear hierarchy of support was observed: a majority of nurses (56%) and community members (58%) supported abortion in the case of rape or incest, or if the continued pregnancy would endanger a woman's health (61 and 56%, respectively), but few supported abortion for social or economic reasons. In-depth interviews revealed that abortion is seen as contrary to prevailing community norms; nurses were poorly informed about the Termination of Pregnancy Act and felt confused in their professional responsibilities. CONCLUSIONS AND RECOMMENDATIONS: Legalization alone cannot ensure implementation of abortion services. In South Africa, extensive media coverage prior to passage of the law ensured almost universal awareness of the Act, but little public education took place at the same time. In spite of general opposition to the law, however, there is an encouraging level of support for abortion in some circumstances. These findings suggest that abortion services can be implemented, even in conservative rural areas, but that a process of information dissemination and community consent prior to implementation is essential. Locating abortion within broader reproductive health services could be an effective way to improve access and acceptability.

Abortion, Legal↗
PubMed1998

The right to an heir in the era of assisted reproduction.

The latest remarkable technological advances in assisted reproduction, which enable cryopreservation of spermatozoa, embryos and ovarian tissue, raise difficult and debatable legal, social, ethical and moral issues concerning the right to posthumous reproduction. Furthermore, reports on the attitudes of the general public and of centres licensed for infertility treatment in the United Kingdom found that the majority of women and centres support the idea of posthumous reproduction. In this paper we review the data published on this issue, and after considering the various aspects, we conclude that each case should be discussed and authorized by a multidisciplinary committee that includes physicians, clergy, psychiatrists, psychologists, sociologists and other appropriate parties. In our opinion, the main principles that should guide this committee would allow posthumous reproduction in the context of marriage when a prior consent exists. For unmarried persons, post-mortem donation of gametes should be done only anonymously, if they are in agreement with existing laws concerning infertility treatments in every country and after appropriate consent and proper counselling. Moreover, any case which involves consanguinity or a possibility of incest should be forbidden, both for ethical and genetic reasons. In a case of pre-existing siblings, they should be consulted and their informed consent should be granted in advance so as to avoid legal problems in the inheritance of property.

Attitude↗