by Michael D. Anestis, M.S.
Psychological research aims to answer a variety of questions. Some studies look at which forms of therapy are best able to treat particular mental illnesses. Some studies look at which variables are related to particular outcomes. Other studies answer a question that some might argue is the most important of all: why are certain variables related to one another? This question could be viewed as more important because it shines a light on the mechanisms that drive particular relationships and helps researchers and clinicians identify specific targets that can be addressed in treatment.
Today, I would like to discuss a study that attempted to answer why a history of sexual victimization is related to particular forms of mental illness. Past research has found that a history of sexual victimization is related to a lifetime history of anxiety, depression, substance abuse, suicidal behavior, borderline personality disorder (BPD), and post-traumatic stress disorder (PTSD; Polusny & Follette, 1995). Quite clearly, this indicates that sexual victimization can result in a disastrous series of outcomes for the victim. Information like this, however, does not explain why sexual victimization has such a powerful effect. Certainly, we can all develop theories that seem reasonable; however, untested theories have little value and intuitively appealing ideas are often refuted by objective evidence.
Along these lines, many researchers have made an effort to clarify the reasons for the relationship between sexual abuse and problematic outcomes. In prior PBB articles, we have discussed a study that found dysfunctional family relationships play a pivotal role in explaining the link between childhood sexual abuse (CSA) and mental illness, a study that found negative urgency explained the link between sexual abuse and symptoms of bulimia nervosa, and another study that found more physically painful forms of child abuse exhibited stronger relationships with suicide attempts. The article I will discuss today examined the degree to which experiential avoidance explains the relationship between a history of sexual victimization and mental illness.
Experiential avoidance is defined as the tendency to avoid or escape aversive internal experiences (e.g., negative emotions, intrusive thoughts). Numerous studies have found that experiential avoidance mediates the relationship between sexual victimization and mental illness (Bal et al., 20003; Marx & Sloan, 2002; Polusny et al., 2004). In other words, these studies have found that, while sexual victimization is related mental illness, this relationship is explained by the fact that individuals with a history of sexual victimization tend to develop high levels of experiential avoidance, which in turn leads to mental illness. The problem with these studies, however, is that they all utilized Caucasian samples and, although there is no reason to believe that the situation differs across ethnic groups, directly testing this point would seem to offer significant value.
In an effort to determine whether experiential avoidance would explain the relationship between sexual victimization and mental illness across ethnic groups, Rhonda Merwin, Zachary Rosenthal, and Kimberly Coffey (in press) designed a study soon to be published in Cognitive Therapy and Research in which these variables were examined in two samples: one group of ethnic minority women (n = 190) and one group of Caucasian women (n = 473). The authors looked at two different forms of mental illness - depression and PTSD - and found that experiential avoidance did, in fact, explain the relationship between sexual victimization and these outcomes in both the Caucasian group and the ethnically diverse group.
So, what does this tell us? It seems that individuals with a history of sexual victimization tend to engage in significant amounts of experiential avoidance. In all likelihood, avoiding emotions, thoughts, and environmental cues that remind them of their trauma helps these individuals to reduce acute feelings of discomfort. Unfortunately, a prolonged pattern of avoidance appears to result in significant long term problems, particularly with respect to depression and PTSD. Importantly, Merwin, Rosenthal, and Coffey (in press) found that this is true regardless of an individual's ethnic background. It thus appears that therapeutic interventions that aim to reduce experiential avoidance would be of substantial value to sexually victimized individuals.
It is important to note that several variables can serve as mediators of the same relationship. So, while experiential avoidance explain, in part, the relationship between sexual victimization and mental illness, this does not mean it is the explanatory mechanism for everyone. As noted above, other studies have found that dysfunctional family environments and negative urgency have also been shown to serve as mediators. As such, it is important for researchers to continue searching for additional mediators and to seek to determine whether we can predict which individuals are most likely to experience particular outcomes. In the meantime, research such as this provides a better framework through which to understand the relationship between sexual victimization and mental health outcomes.
If you would like to learn more about these topics, we encourage you to browse our online store, which features a variety of resources based upon empirical research. If you believe that you or somebody you know may require professional help for any of the difficulties outlined above, we encourage you to consult our EST clinics page for a list of service providers in your local area.