Histories of Childhood Maltreatment and Victimization in Adolescent Girls: The Role of PTSD

Background and Purpose: Histories of childhood maltreatment have been linked to victimization and interpersonal violence, and girls may be more vulnerable than boys. Few studies have examined the association of child maltreatment types with victimization and the potential pathways involved. Social learning theory suggests that the experience of childhood maltreatment or exposure to family violence increases the risk of later violent outcomes due to learned roles, traumatic reactions, and maladaptive coping skills. For most adolescents who were involved with the child welfare system, their victimization began prior to their adolescent years disrupting normal developmental trajectories which may lead to a lack of assertiveness and a sense of powerlessness (Browne & Finkelhor, 1986). In the present study, we posit that there is a mediating relationship between early exposure to maltreatment and vulnerability to re-victimization through trauma responses. Thus, the following questions were addressed: 1) What is the association of child maltreatment types, i.e., physical abuse, sexual abuse, and physical neglect, with current victimization among adolescent girls, and 2) Does PTSD mediate this relationship?

Methods: The study utilized baseline data from a trauma-focused CBT study that included 136 adolescent girls, ages 12-18 years old (mean age=14.8, SD=1.6). The girls were referred by case managers and staff from Child Protective Services. The sample was primarily youths of color—African American  (85 %), and White (15 %).  The girls’ current living situations were as follows: 59% with biological parents, relatives, or adopted parents; 27% in foster homes; and 14% in group homes. Structured face-to-face interviews included the following variables: 1) Frequency of Aggressive Behaviors—As Victims (18 items) assessing how many times they experienced physical, verbal, and relational aggression in the last 3 months; 2) PTSD symptoms (Foa, 2001), 3) Physical Abuse, Sexual Abuse, and Physical Neglect (Bernstein & Fink’s Childhood Trauma Questionnaire), and 4) Demographics (age, race, living situation).  Data analyses included descriptive statistics, simple correlations, and path analysis to evaluate the hypothesis of mediation.

Results: Ninety percent of the girls experienced some form of victimization in the last 3 months. Correlational analyses indicated that girls who reported higher levels of physical abuse experienced higher frequencies of aggressive behaviors as victims (r = .23, p<. 01). In contrast, no significant relationships were found between either sexual abuse and physical neglect and aggressive behaviors. Sixty-six percent of the girls endorsed PTSD symptoms in the borderline-clinical range.  To determine if PTSD mediated this relationship, a path analysis was conducted. Results showed that higher levels of PTSD was significantly related to higher levels of both physical abuse (B = .27, p<.001) and aggressive behaviors (B = .56, p<.0001). Furthermore, the relationship between physical abuse and aggression was no longer significant (B = .08, p<.27). Bootstrapped confidence intervals (Preacher and Hayes, 2004) confirmed the significant mediating (indirect) effect (p<.05).

Conclusions and Implications: One pathway by which physical abuse influences adolescent re-victimization is through PTSD symptoms. Results suggest that trauma treatment to reduce PTSD symptoms may be an important strategy for preventing interpersonal violence in this population.