The co-occurrence of childhood sexual abuse, adult sexual assault, intimate partner violence, and sexual harassment: a mediational model of posttraumatic stress disorder and physical health outcomes

J Consult Clin Psychol. 2008 Apr;76(2):194-207. doi: 10.1037/0022-006X.76.2.194.


This study examined the co-occurrence of childhood sexual abuse, adult sexual assault, intimate partner violence, and sexual harassment in a predominantly African American sample of 268 female veterans, randomly sampled from an urban Veterans Affairs hospital women's clinic. A combination of hierarchical and iterative cluster analysis was used to identify 4 patterns of women's lifetime experiences of violence co-occurrence. The 1st cluster experienced relatively low levels of all 4 forms of violence; the 2nd group, high levels of all 4 forms; the 3rd, sexual revictimization across the lifespan with adult sexual harassment; and the 4th, high intimate partner violence with sexual harassment. This cluster solution was validated in a theoretically driven model that examined the role of posttraumatic stress disorder (PTSD) as a mediator of physical health symptomatology. Structural equation modeling analyses revealed that PTSD fully mediated the relationship between violence and physical health symptomatology. Consistent with a bio-psycho-immunologic theoretical model, PTSD levels more strongly predicted pain-related physical health symptoms compared to nonpain health problems. Implications for clinical interventions to prevent PTSD and to screen women for histories of violence in health care settings are discussed.

MeSH terms

  • Adult
  • Child
  • Child Abuse, Sexual / psychology
  • Child Abuse, Sexual / statistics & numerical data*
  • Cluster Analysis
  • Comorbidity
  • Cross-Sectional Studies
  • Female
  • Health Surveys
  • Humans
  • Middle Aged
  • Midwestern United States
  • Models, Statistical
  • Psychophysiologic Disorders / diagnosis
  • Psychophysiologic Disorders / epidemiology*
  • Psychophysiologic Disorders / psychology
  • Risk Factors
  • Sex Offenses / psychology
  • Sex Offenses / statistics & numerical data*
  • Sexual Harassment / psychology
  • Sexual Harassment / statistics & numerical data*
  • Somatoform Disorders / diagnosis
  • Somatoform Disorders / epidemiology
  • Somatoform Disorders / psychology
  • Spouse Abuse / psychology
  • Spouse Abuse / statistics & numerical data*
  • Stress Disorders, Post-Traumatic / diagnosis
  • Stress Disorders, Post-Traumatic / epidemiology*
  • Stress Disorders, Post-Traumatic / psychology
  • Surveys and Questionnaires
  • Veterans / psychology*
  • Veterans / statistics & numerical data
  • Violence / psychology
  • Violence / statistics & numerical data*