Cumulative childhood trauma, emotion regulation, dissociation, and behavior problems in school-aged sexual abuse victims

J Affect Disord. 2018 Jan 1;225:306-312. doi: 10.1016/j.jad.2017.08.044. Epub 2017 Aug 18.


Background: Child sexual abuse is associated with a plethora of devastating repercussions. A significant number of sexually abused children are likely to experience other forms of maltreatment that can seriously affect their emotion regulation abilities and impede on their development. The aim of the study was to test emotion regulation and dissociation as mediators in the association between cumulative childhood trauma and internalized and externalized behavior problems in child victims of sexual abuse.

Methods: Participants were 309 sexually abused children (203 girls and 106 boys; Mean age = 9.07) and their non-offending parent. Medical and clinical files were coded for cumulative childhood trauma. At initial evaluation (T1), parents completed measures assessing children's emotion regulation abilities and dissociation. At Time 2 (T2), parents completed a measure assessing children's behavior problems. Mediation analyses were conducted with emotion regulation and dissociation as sequential mediators using Mplus software.

Results: Findings revealed that cumulative childhood trauma affects both internalized and externalized behavior problems through three mediation paths: emotion regulation alone, dissociation alone, and through a path combining emotion regulation and dissociation.

Limitations: Both emotion regulation and dissociation were assessed at T1 and thus the temporal sequencing of mediators remains to be ascertained through a longitudinal design. All measures were completed by the parents.

Conclusions: Clinicians should routinely screen for other childhood trauma in vulnerable clienteles. In order to tackle behavior problems, clinical interventions for sexually abused youth need to address emotion regulation competencies and dissociation.

Keywords: Behavior problems; Child; Dissociation; Emotion regulation; Sexual abuse.

MeSH terms

  • Affective Symptoms / psychology*
  • Child
  • Child Abuse, Sexual / psychology*
  • Child Behavior Disorders / psychology*
  • Dissociative Disorders / psychology*
  • Emotional Adjustment
  • Female
  • Humans
  • Male
  • Problem Behavior
  • Schools