Dissociation as a Mediator of Psychopathology Among Sexually Abused Children and Adolescents

Am J Psychiatry. 2001 Jul;158(7):1034-9. doi: 10.1176/appi.ajp.158.7.1034.


Objective: This study investigated the role of dissociation as a mediator of mental health outcomes in children with a history of sexual abuse.

Method: The study group consisted of 114 children and adolescents (ages 10-18 years) who were wards of the Illinois Department of Children and Family Services and were living in residential treatment centers. Interviews, provider ratings, and chart reviews were used to assess the relationship of childhood abuse history, dissociative responses, and psychopathology.

Results: Sexual abuse history was significantly associated with dissociation, whereas a history of physical abuse was not. Both sexual abuse and dissociation were independently associated with several indicators of mental health disturbance, including risk-taking behavior (suicidality, self-mutilation, and sexual aggression). Severity of sexual abuse was not associated with dissociation or psychopathology. Analysis of covariance indicated that dissociation had an important mediating role between sexual abuse and psychiatric disturbance. These results were replicated across several assessment sources and varied perspectives.

Conclusions: The findings suggest a unique relationship between sexual abuse and dissociation. Dissociation may be a critical mediator of psychiatric symptoms and risk-taking behavior among sexually abused children. The assessment of dissociation among children may be an important aspect of treatment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Child Abuse, Sexual / diagnosis
  • Child Abuse, Sexual / psychology*
  • Child Abuse, Sexual / statistics & numerical data
  • Child Behavior Disorders / diagnosis
  • Child Behavior Disorders / epidemiology
  • Child Behavior Disorders / psychology
  • Dissociative Disorders / complications*
  • Dissociative Disorders / epidemiology
  • Dissociative Disorders / psychology
  • Domestic Violence / psychology
  • Domestic Violence / statistics & numerical data
  • Female
  • Humans
  • Male
  • Mental Disorders / diagnosis
  • Mental Disorders / epidemiology
  • Mental Disorders / etiology*
  • Psychiatric Status Rating Scales / statistics & numerical data
  • Risk-Taking
  • Severity of Illness Index
  • Surveys and Questionnaires