Dual-Victimization and Trauma Symptoms

Background and Purpose:

A significant portion of children living in the U.S. have experienced trauma. Children are likely to experience more than one type of trauma, in particular, child physical abuse and witnessing intimate partner violence (IPV) often co-occur. Despite the high co-occurrence rate of physical abuse and exposure to IPV, few studies have systematically examined the impact of such dual exposure on young children’s trauma symptoms. We hypothesized in the current study that physical abuse, witnessing IPV, and dual abuse (i.e., both physical abuse and IPV) would all be associated with clinically-significant levels of trauma. Informed by the developmental traumatology model, we explored the effects of physical abuse and witnessing IPV on childhood trauma symptoms in a sample of young children referred for services at a child advocacy center (CAC).

Methods:

The current study utilized secondary data of Trauma Symptom Checklists for Children (TSCC) and Trauma Symptom Checklists for Young Children (TSCYC) completed by guardians of children referred to a CAC for allegations of sexual abuse or severe physical abuse. The total sample (N = 1,234) includes children who received a full medical/mental health visit in the 2015 calendar year at the CAC. The analytic sample for the current study was limited to children who were between 3 and 12 years old (N = 584). There was a very low rate of missing data (i.e., 0.5%) in this analysis and so listwise deletion was used to obtain the final sample (N = 581). We performed a series of binary logistic regression analyses to examine how physical abuse, exposure to IPV, and dual exposure are distinctly associated with six trauma symptoms, including anxiety, depression, posttraumatic stress (PTS), dissociation, anger, and sexual concerns. Physical abuse, witnessing IPV, and dual abuse were dichotomously coded to indicate if the child had or had not experienced them.

Results:

Findings from this study confirm our hypothesis that physical abuse, witnessing IPV, and dual abuse are associated with clinically-significant levels of trauma. The results indicated that dual exposure was predictive of all trauma symptoms, except for dissociation. Children who experienced physical abuse were approximately 2 times more likely to exhibit clinically significant PTS symptoms, anger, and sexual concerns than children who were not exposed to violence (i.e., no physical abuse or IPV exposure). Children who were exposed to IPV were 2.14, 1.87, 1.72  times more likely to experience clinically significant levels of depression, PTS, and sexual concerns respectively, when compared to non-violence exposed children.

Conclusions and Implications:

All three categories of violence experiences predicted higher odds of PTS and sexual concern symptoms. Practitioners serving young children who have experienced physical abuse, witnessed IPV, or both should pay close attention to the trauma symptoms that our findings highlight. For instance, if working with children who experience physical abuse, responses could address trauma symptoms of PTS, sexual concerns, and anger. Further, this study highlights that dual exposure on symptomatology occurs even at a young age, which is important for maintaining a trauma-informed approach with children of all ages.