Development of an ecological/transactional model of sexual abuse victimization and analysis of its nomological classification system

The purposes of this study were, first, to develop an ecological/transactional model of child sexual abuse victimization and, second, to determine, using its derivative nomological classification scheme, whether child victims of sexual abuse have definable clinical profiles that can be predicted and that group by current attachment classification. It was hypothesized that the child's attachment status would not only be predictive of severity of psychopathology but also type of psychopathology. The study was a cross-sectional survey of child sexual abuse victims ages 7 to 13 entering Cook Children's Medical Center for a medical/forensic evaluation. Children were assessed using measures of attachment, psychopathology, and heart rate. Guardians were assessed on measures of attachment, parenting stress, stressors in the environment, and support after disclosure.;Distinctively, most children suffered severe abuse and were clinically significant on measures of outcome. Guardians also presented with high levels of stress and distress. Attachment was complexly related to psychopathology, although it was a better predictor of severity than type of psychopathology. In a robust structural equation model using global psychopathology as the dependent variable, attachment was the strongest predictor. Greater stressors in the child's environment and a more distant relationship between guardian and offender were also strong direct predictors of psychopathology. As hypothesized, after accounting for other environmental factors, support of the guardian acted only as a nonsignificant mediator of psychopathology. Finally, in a cluster analysis, coherent profiles of clinical presentation emerged that could be predicted by attachment status of the child and that were clearly differentiated by severity of psychopathology and less so by type. When the attachment status of the child entered the analysis, the emergent profiles were again better discriminated by severity than type.