A substantial proportion of sexual abuse victims report repeat sexual victimization within childhood or adolescence; however, there is limited understanding of factors contributing to revictimization for youth. Thus, the present study examined predictors of sexual revictimization prior to adulthood using ecological systems theory. Records of 1,915 youth presenting to a Child Advocacy Center (CAC) were reviewed to identify individual, familial, and community factors as well as initial abuse characteristics associated with risk for revictimization. Results showed that 11.1% of youth re-presented to the CAC for sexual revictimization. At the individual level, younger children, girls, ethnoracial minority youth, and those with an identified mental health problem were most likely to experience revictimization. Interpersonal factors that increased vulnerability included the presence of a noncaregiving adult in the home, being in mental health treatment, and domestic violence in the family. Community-level factors did not predict revictimization. When factors at all levels were examined in conjunction, however, only individual-level factors significantly predicted the risk for revictimization. Findings from this study provide valuable information for CACs when assessing risk for re-report of sexual abuse and add to the field's understanding of revictimization within childhood.

Most survivors of sexual assault disclose their experiences within their social networks, and these disclosure decisions can have important implications for their entry into formal systems and well-being, but no research has directly examined these networks as a strategy to understand disclosure decisions. Using a mixed-method approach that combined survey data, social network analysis, and interview data, we investigate whom, among potential informal responders in the social networks of college students who have experienced sexual assault, survivors contact regarding their assault, and how survivors narrate the role of networks in their decisions about whom to contact. Quantitative results suggest that characteristics of survivors, their social networks, and members of these networks are associated with disclosure decisions. Using data from social network analysis, we identified that survivors tended to disclose to a smaller proportion of their network when many network members had relationships with each other or when the network had more subgroups. Our qualitative analysis helps to contextualize these findings.

This article reviews the literature on sexual revictimization, integrating findings from studies with adult and youth samples and organizing research evidence within a social ecological framework. Multiple victimization experiences are common among children, adolescents, and adults with histories of child sexual abuse; they are associated with negative cumulative effects on the individual and, through these negative sequelae, perpetuate a cycle of victimization. While much of the research has focused on individual factors that promote revictimization, there is emerging evidence that external influences on the individual may influence risk for subsequent victimization. Specifically, family, perpetrators, and engagement with helping professionals may all mediate revictimization risk. Although limited evidence prevents conclusions regarding societal values, public policy, and law, these systems may also impact individual risk for experiencing multiple victimizations.

Psychological distress, including depression and anxiety, has been associated with increased risk for sexual revictimization in youth who have experienced child sexual abuse. The present study utilized assessment information from treatment seeking youth with histories of sexual abuse to explore specific risk indicators for revictimization—risk taking, social problems, maladaptive cognitions, and posttraumatic stress—that may be indicated by self-reported distress. The relationship between initial levels of distress and change in symptoms over a 12-week course of treatment was also explored. Participants were 101 youth referred to a child-focused therapeutic group for victims of sexual abuse, 65 youth referred to an adolescent-focused group, and their non-offending caregivers. Results revealed that when combined into a distress score, depression and anxiety were associated with delinquent behaviors, interpersonal difficulties, maladaptive cognitions, and posttraumatic stress symptoms for child and adolescent group participants at presentation to treatment. Children exhibited improvement on measures of interpersonal difficulties, maladaptive cognitions, and self-reported posttraumatic stress disorder (PTSD) symptoms. Adolescents exhibited less change over time, with significant improvement on self-reported social problems and PTSD only. Higher psychological distress was associated with less improvement in regard to negative expectations of abuse impact for child group participants. The findings suggest that distress indicates the presence of specific revictimization risk indicators, helping to identify targetable symptoms for intervention. Therefore, screening for psychological distress after discovery of sexual abuse may help detect youth at higher risk for revictimization and guide treatment.

High school students exposed to sexual assault (SA) are at risk for negative outcomes like depressed mood and high-risk drinking. Although evidence suggests that both social contexts and internalized stigma can affect recovery from SA, no research to date has directly examined the presence of stigma in social contexts such as high schools as a correlate of adjustment after SA. In the current study, the self-reported rape myth acceptance (RMA) of 3080 students from 97 grade cohorts in 25 high schools was used to calculate grade-mean and school-mean RMA, which was entered into multilevel models predicting depressed mood and alcohol use among N = 263 SA survivors within those schools. Two forms of RMA were assessed: rape denial and gendered expectations. Results indicate that higher grade-mean rape denial was associated with higher risk for depressed mood among high school boys and girls exposed to SA, and higher grade-mean traditional gender expectations was associated with higher risk for alcohol use among girls exposed to SA. Survivors’ own RMA and school-level RMA were not significantly associated with their depressed mood or alcohol use. Although causality cannot be concluded, these findings suggest that interventions that reduce stigma in social contexts should be explored further as a strategy to improve well-being among high-school-aged survivors of SA.

Objectives Comorbidity in diagnosis is quite common and raises critical challenges for psychological assessment and treatment. The Research Domain Criteria (RDoC) Project, put forth by the National Institutes of Mental Health, proposes domains of functioning as a way to conceptualize the overlap between comorbid conditions and inform treatment selection. However, further research is needed to understand common comorbidities (e.g. posttraumatic stress disorder (PTSD) and substance use disorder (SUD)) from an RDoC framework and how existing evidence based treatments would be expected to promote change in the RDoC domains of functioning. To address these gaps, the current study examined change in three RDoC domains of interest (Negative Valence Systems, Arousal/Regulatory Systems, and Cognitive Systems) during concurrent prolonged exposure (PE) and substance use treatment. Method Participants were 85 individuals with co-occurring PTSD and SUD who received PE in a residential substance use treatment facility. They completed an experimental task to assess physiological reactivity to trauma and alcohol cues at pre- and post-treatment. Results Results showed decreased severity in all three RDoC domains of interest across the study period. Pairwise comparisons between domains revealed that Arousal/Regulatory Systems had the lowest severity at post-treatment. Subsequent hierarchical linear regression analyses showed that post-treatment domain scores were associated with post-treatment cue reactivity for trauma and alcohol cues. Conclusions The findings provide preliminary evidence of how the RDoC domains of functioning may change with evidence-based treatments for DSM-5 disorders, and are discussed in terms of the assessment and treatment of mental health problems using the RDoC framework.

The majority of youth living in the United States experience a potentially traumatic event (PTE) by 18 years of age, with many experiencing multiple PTEs. Variation in the nature and range of PTE exposure differentially impacts youth functioning, although this association is poorly understood. We used latent class analysis (LCA) to identify patterns of PTE exposure from caregiver and youth report in a treatment-seeking sample of children and adolescents (N = 701) and examined how these patterns predict youths' behavioral health outcomes. We identified four classes based on both caregiver and youth reports of PTE exposure, with the best-fitting model representing a constrained measurement model across reporters; these included high polyvictimization, moderate polyvictimization (general), moderate polyvictimization (interpersonal), and low polyvictimization classes. Prevalence of classes varied across reporters, and agreement in classification based on caregiver and youth report was mixed. Despite these differences, we observed similar patterns of association between caregiver- and youth-reported classes and their respective ratings of posttraumatic stress disorder and depressive symptoms, as well as both caregiver and therapist ratings of problem behavior, with Cohen's d effect size estimates of significant differences ranging from d = 0.25 to d = 0.51. The PTE exposure classes did not differ with respect to ratings of child functioning. Findings highlight the importance of gathering information from multiple informants.

The co-occurrence of posttraumatic stress disorder and substance use disorder (PTSD-SUD) can pose significant problems for rural pregnant and postpartum women (PPW) and the well-being of their children. Although effective treatments exist, PPW experience limitations in their ability to access and engage in treatment that may be compounded by various aspects of rural settings, so providers must be attentive to these barriers in order to address this pressing public health need. In addition, as part of increasing rural access to care, it is important to consider the costs and benefits to PPW of selecting exposure-based techniques (e.g., prolonged exposure) to disseminate. The current article discusses the treatment of PTSD-SUD in rural PPW in the context of the authors’ experiences providing an exposure-based cognitive behavioral treatment for PTSD in this population. Barriers to treatment access and engagement are discussed and recommendations are provided.