Body Image Among Victims of Sexual and Physical Abuse

Violence and Victims

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With the Compliments of Springer Publishing Company, LLC

© 2013 Springer Publishing Company 259http://dx.doi.org/10.1891/0886-6708.VV-D-12-00015

Violence and Victims, Volume 28, Number 2, 2013

Body Image Among Victims of Sexual and Physical Abuse

Inbar Kremer, PhDDepartment of Management, Bar-Ilan University

Israel Orbach, PhDDepartment of Psychology, Bar-Ilan University

Tova Rosenbloom, PhDDepartment of Management, Bar-Ilan University

This study tries to understand the differences in body experience between victims of sexual abuse and physical abuse. Ninety-eight women completed questionnaires that measured personal information, body-image aberration, body sensitivity and control, and body investment. Findings indicated that victims of sexual abuse demonstrate less body main-tenance and protection in addition to greater injury to body sensitivity and control than victims of physical abuse. Moreover, comparing victims of sexual abuse to physical abuse, findings revealed that only victims of sexual abuse report body-image aberrations. Thus, sexual and physical abuse should be addressed discretely because each has differential effects on bodily attitudes of victims.

Keywords: sexual abuse; physical abuse; body image; Israeli women

The goal of this study was to refine the current understanding of the differences in body experience between victims of sexual abuse and physical abuse in Israeli women. To date, most research of abuse has focused on sexual abuse and physical

abuse as one unit, and many similarities have been found (Franko & Keel, 2006; Ullman & Brecklin, 2003). However, several studies have been conducted that examine the differential effects of each form of abuse. These studies revealed that sexual abuse is perceived as having more severe repercussions than physical abuse (Anne, Nayak, Korcha, & Greenfield, 2011). We hypothesized that victims of sexual abuse suffer more severe injury to body experience (body image, body attitudes, body feelings and behaviors, and body-image aberrations) than victims of physical abuse.

Abuse of women and children is a complex and multifaceted phenomenon as reflected through its many diverse definitions. Physical abuse may include beating, slapping, kick-ing, burns, threats with a weapon, and destruction of a loved object or pet (Straus, 1988). In contrast, sexual abuse may include rape, forced intercourse, attempted rape, unwanted sexual acts that do not include penetration, threat of bodily harm in response to refusing sex (Straus, 1988). Physical and sexual abuse are usually committed by a family member or person familiar to the victim (Korman, 2000). Sexual abuse committed by a family member, or incest, is one of the most traumatizing forms of abuse of children who are at the mercy

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260 Kremer et al.

of their known attackers (MacKinnon & James, 1992). Physical abuse of women is usually referred to as battering, but some researchers only use the term in cases of repeated violent acts. A review of relevant literature in Israel and in other countries shows that at least 7% of women have a history of sexual abuse (Korman, 2000; Pereda, Guilera, Forns, & Gomez-Benito, 2009), whereas physical violence is directed at about 10% (Lown &Vega, 2001). The few studies published in Israel suggest that the prevalence of sexual and physical abuse is similar to other Western countries (Schein et al., 2000; Tzionit & Kedman, 2001).

Physical and sexual abuse deeply affects the physical and mental health of victims. The research and clinical literatures demonstrate that such abuse is often linked to a higher pro-pensity for suicide attempts and self-inflicted damage (Etzel, 2006), eating disorders (Franko & Keel, 2006; Treuer, Koperdak, Rozsa, & Furedi, 2005), addictive drug use (Segal, 2001; Somer, 2003; Zickler, 2002), and somatic disorders (Ullman & Brecklin, 2003).

In addition, studies have shown that women who have undergone physical or sexual abuse have more severe symptoms of depression (Csoboth, Birkas, & Gyorgy, 2005), more dissociative symptoms (Somer, 2003; Sta & Elaine, 2005) and signs of PTSD (Filipas & Ullman, 2006; Sharhabani-Arzy, Amir, Kotler, & Liran, 2003), as well as negative body image and low self-esteem (Eubanks, Kenkel & Gardner, 2006); and more borderline personality disorders (Lobbestael, Arntz, & Bernstein, 2010) than women with no history of abuse. Also, it has been found that victims of physical or sexual abuse have difficulty in establishing social ties (McCaw, Golding, Farley, & Minkoff, 2007), problems in sexual function (Steel & Herlitz, 2005; Wilson, 2004), and often suffer from repeat victimization (Briere, 2004; Whitfield, Anda, Dube, & Felitti, 2003).

Several studies have been conducted that examine the differential effects of each form of abuse. These studies have found that women with history of sexual abuse have significantly more posttraumatic symptoms (Amstadter & Vernon, 2008); more unex-plained medical symptoms; and more symptoms of anxiety, depression, substance depen-dence, and suicide attempts than women who have suffered physical abuse (Anne et al., 2011; Fergusson, Boden, & Horwood, 2008; Techakasem & Kolkijkovin, 2001).

Sexual and physical abuse often occur in various phases during victims’ lifetimes and together cause more trauma than just one form of abuse (Bonomi, Cannon, Anderson, Rivara, & Thompson, 2008). These victims show higher propensity to drug use, more suicide attempts, and a greater feeling of helplessness in their relationships (Wingood, Diclemente, & Raj, 2000, as cited in Tzionit & Kedman, 2001) and more severe PTSD symptoms (Hetzel & McCanne, 2005) than women who suffered physical abuse only.

Therefore, one should refer to sexual abuse, physical abuse, and both sexual and physical abuse as separate phenomena, each with its nature and severity. Thus, this study examines the differential effect of each kind of abuse on the overall experience of body, including body image, body experiences, attitudes, feelings, and behaviors toward the body and body-image aberrations.

There is evidence that sexual and physical abuse cause severe damage to women’s bod-ies and consequently to the way they relate to their bodies (Entrenas-Yepez, 2000; Treuer et al., 2005). Body image is defined as a set of mental representations of the body that reflect the general perceptions, emotions, expectations, cognitions, and behaviors related to the body (Cash, 2004; Lebowitz, 2010; Schilder, 1935).

Straus (1988) describes the fundamental experience of mineness where the body is per-ceived with a sense of ownership, acquired in early development and is based on physical experiences and a clear definition of boundaries between what belongs to me opposed to what belongs to others. It can be marred by pain and physical injury where people often react by feeling alienated from their own bodies (Moss, 1989).


Body Image and Abuse 261

The cognitive behavioral model defined several different characteristics of body image (Freedman, 1990): Body image perception refers to one’s perception of body size, body parts, and the proportion between them. Body image attitude refers to emotions and cognizance one has of one’s body and appearance (such as satisfaction with appear-ance, measure of body attractiveness, love, hate, frustration), and also behaviors related to the body (maintenance, care, and touch). Body image affect refers to feelings and physical experiences that are the primary building blocks of one’s relation to one’s body (Shani-Sela, 2000). From a cognitive perspective, body image disorders develop from irrational thoughts, unrealistic expectations, and incorrect explanations (Cash, Melnyk, & Hrabosky, 2004).

Studies have revealed correlations between body image and eating disorders (Hutchinson, Rapee, & Taylor, 2010), depression (Brausch & Gutierrez, 2009; Xie et al., 2010), and suicidal tendencies (Shani-Sela, 2000; Sheffer, 2001). Also, the body is often perceived as a hated image or as a symbol of pain or of the attacker who caused the pain after sexual or physical abuse. The anger first directed at the attacker may turn inward to one’s own body, even deteriorating to the point of self-destruction (Maltsberger, 1993).

In summary, the issue of the differential effect of each type of abuse has remained unaddressed. The relevant research literature shows that although there are studies that focus on narrower aspects of bodily attitudes, very few examine the overall body-related experiences of victims of sexual and physical abuse (Eubanks, Kenkel, & Gardner, 2006; Murray, Macdonald, & Fox, 2008). In addition, there is no distinction between bodily attitudes prevalent in women who have undergone both sexual and physical abuse, women who were victims to only sexual abuse, and women who were victims to only physical abuse. One could hypothesize that women who suffer physical abuse would suffer in dif-ferent aspects of bodily attitudes (body image, body experience, attitudes, emotions and behaviors toward the body, and body image aberrations) as their bodies were injured, beaten, and attacked. Furthermore, physical abuse may decrease women’s sense of body ownership and boundaries as their bodies became the “punching bags” of another. This use of the woman’s body as an object can also harm the body’s self-preservation mechanisms, concern, and respect of one’s own body. Women who suffered sexual abuse will also expe-rience a similar impairment of various bodily attitude parameters. However, in contrast to women who have suffered physical abuse where the injury is external, one could conjec-ture that victims of sexual abuse would suffer more acute problems in specific aspects of bodily attitude because their bodies are also violated internally through penetration with a foreign object.

It is important to point out that this study focused on the trauma inflicted by long-term and continuous sexual and physical abuse and not on onetime events. In this study, the differences in bodily attitudes were reviewed in the following primary domains: The body image affect factor including control and sensitivity to body clues and body image aber-rations, and the body image attitude factor including body maintenance and protection. Therefore, the first hypothesis of the study states that the damage to bodily attitude among victims of sexual abuse and among women who suffered both sexual and physical abuse is more severe than among women who suffered only physical abuse. In addition, it was hypothesized that damage to bodily attitude would be more severe in all the abuse groups compared to the control group. Furthermore, the research question that was posed referred to the unique contribution of each of the independent variables to the variance of the three bodily attitudes.


https://www.researchgate.net/publication/232572926_Confusions_of_the_body_the_self_and_others_in_suicidal_states?el=1_x_8&enrichId=rgreq-fec04bb5-4ece-4694-818d-c8a97ba48f6f&enrichSource=Y292ZXJQYWdlOzIzNzg0NDEyNTtBUzoxNTUxMTMzNDM2ODg3MTVAMTQxMzk5MzMxMTMwOA==

262 Kremer et al.

METHOD

Participants

Groups of women who suffered sexual abuse and physical abuse were selected using nonprobability sampling of the target sample. This decision was taken because of the difficulties in reaching this target population, which typically suffer severe emotional trauma in all intimate, taboo matters as well as the difficulty in persuading them to participate in the study. Relevant research literature indeed includes circumstances where this method of nonrandomized selection is appropriate, such as cases where the target population is very specific and difficult to sample (Patton, 1990).

In total, 98 women participated in this study, 76 of whom met the criteria determined by the researchers, including a history of long-term and continuous abuse. Other 11 women (10.9%) were not included in the final sample because they did not meet the study criteria examining only those victims of long-term and continuous abuse. The four study groups consisted of (a) 28 women who suffered both sexual and physical abuse, (b) 25 women who suffered sexual abuse only, (c) 23 women who suffered physical abuse only, and (d) 22 women with no history of any abuse who served as the control group. All of the women were adults more than the age of 18 years (M 5 32.68, SD 5 10.88), with 89 of them (90.8%) being native-born Israelis and only 9 (9.2%) are nonnatives.

To compare the categorical demographic variables (marital status and employment), x2 analyses were conducted. In addition, to compare successive demographic variables (age and education), one-way ANOVA analyses were conducted. The results of these analyses are presented in Table 1 and Table 2.

TABLE 1. Distribution of the Study Participants According to Personal Information

Groups

Personal Information ValuesControl N 5 22

Sexual N 5 25

Physical N 5 23

Sexual & Physical N 5 28

Marital status Single N

%1045.5

1664.0

939.1

1242.9

Married N%

1150.0

728.0

939.1

621.4

Divorced N%

14.5

28.0

521.7

1035.7

Employment Not working N

% 522.7

832.0

939.1

1242.8

Part-time N%

940.9

728.0

521.7

932.1

Full-time N%

836.4

1040.0

939.1

75.0


https://www.researchgate.net/publication/44831842_Qualitative_Research_And_Evaluation_Methods?el=1_x_8&enrichId=rgreq-fec04bb5-4ece-4694-818d-c8a97ba48f6f&enrichSource=Y292ZXJQYWdlOzIzNzg0NDEyNTtBUzoxNTUxMTMzNDM2ODg3MTVAMTQxMzk5MzMxMTMwOA==


The results of x2 analysis comparing the four groups showed a significant difference only in reference to marital status (x2[6] 5 13.8, p , .05). As Table 1 indicates, the group of both sexual and physical abuse consisted of more divorced women than the other groups. In terms of employment, the distribution was quite even among women working full-time, part-time, or not working.

As seen in Table 2, there is a significant difference between groups regarding the age variable. When a further analysis (Scheffé) was conducted to determine the source of these variations, results showed a significant difference between the control group and the physical abuse group in terms of age variable with victims of physical abuse being older. In contrast, no significant difference was found between the various groups in education (the general mean was approximately 14 years of education).

Instruments

Personal Information Questionnaire (Demographic Details). This questionnaire included age, ethnicity, education, employment, religion, marital status, and information about which kind of abuse the women experienced over their lifetime: sexual abuse (yes/no) and physical abuse (yes/no); and according to this information, the women were classified into the four study groups. There was also a question about whether the abuse was a one-time act or was long-term and continuous.

The Body Image Aberration Scale (Chapman, Chapman, & Raulin, 1978). This ques-tionnaire addressed the experiential-sensory factor (or affect) of body image. It included 28 items that asked whether the sentence was relevant to the participant on a dichotomous scale (true/false). The entries described body image aberrations, including unclear body boundaries, feeling alienated from certain body parts, and others. The final score was calculated by the total number of answers that testify to body image aberrations the par-ticipants reported as relevant to them. A higher score meant that the participant had more negative and distorted body experiences. The internal consistency of the questionnaire in different populations ranged between a 5 0.88–0.94. When the questionnaire was trans-lated to Hebrew, its internal consistency scored a 5 0.89 (Shani-Sela, 2000), and in this study, internal consistency was also found at a 5 0.89.

Questionnaire of Body Sensitivity and Control (Shani-Sela, 2000). The purpose of this questionnaire was to examine body sensitivity and control. It included 18 items on a 1–5 scale (1 5 disagree completely; 5 5 agree very much) that were divided into two groups: 9 items for assessing sensitivity to body clues and 9 items for assessing body

TABLE 2. Means (M), Standard Deviation (SD), and F of Age and Education According to Group Distribution

Groups

Measurements Control Sexual PhysicalSexual & Physical F(3, 94)

A Age MSD

27.668.14

30.768.17

36.4312.47

35.2512.04

3.5*

E Education MSD

14.042.73

14.242.75

14.083.43

13.442.84

.38

*p , .05.


264 Kremer et al.

control. For each group of items, the calculated score was the average score of all items within that group, indicating that a higher score in each meant more damage in sensitivity to body clues and more damage to sense of body control. The internal consistency of the questionnaire found in previous studies for the section assessing sensitivity to body clues was a5 0.67 and for the section of body control was a 5 0.72 (Shani-Sela, 2000). In this study, correlation between the two questionnaire sections was high (r 5 .70). Therefore, the general score was based on an average of assessments of all the sections in the ques-tionnaire. General reliability in this study was a 5 0.89.

Body Investment Scale (Orbach, 1994; Orbach & Mikulincer, 1998). This question-naire addressed the attitudinal-behavioral component of body image, and it assessed the measure of emotional investment in body and body experience. The short version of the questionnaire (Orbach & Mikulincer, 1998) included 24 items rated on a 1–5 scale (1 5 disagree completely; 5 5 agree very much) divided into four factors. Only the body maintenance and protection factor was used in this study and it included six items. The final score was calculated as the average score of all items. A high score meant greater body maintenance and protection. Internal consistency of the questionnaire in body main-tenance and protection found in previous studies was a 5 0.92 (Orbach & Mikulincer, 1998; Shani-Sela, 2000). Internal consistency of the body maintenance and protection factor in this study was a 5 0.72.

A Pearson correlation test was conducted on the three body image measures to test if there was significant overlap in what these scales measure. A high and significant correla-tion was found between body image aberrations and body sensitivity and control (r 5 .71, p , .001). In addition, significant negative correlations (although low) were found between body sensitivity and control and body maintenance and protection (r 5 2.42, p , .001); and between body image aberrations and body maintenance and rotection (r 5 2.45, p , .001). Because these values did not reach the level of multicollinearity, the decision was made to use all the questionnaires.

Procedure

We received the approval of Helsinki Committee of the University for the research proposal including the participants, instruments, and the procedure before starting to recruit the participants. Most of the women who participated in the study answered advertisements published in university campuses and in various magazines. A very small number of women were referred by Rape Crisis centers and Family Violence Assistance centers because of the nominal cooperation on their part. The control group comprises a random selection of community members (by publishing advertisements in various universities and through acquaintances that passed out questionnaires to people from their workplaces). The partici-pants who were willing to be part of the study contacted the study researcher and received instructions on how they could fill in the questionnaires on their own. After completion of the questionnaires, they sent them back by post in a return envelope that was included in the questionnaire package. The members of the control group received their questionnaires from the researcher. Like the members of the study group, they completed the questionnaires in their home or workplaces and then sent them by post in the supplied return envelope.

The first page of the questionnaire contained a short explanation about the purpose of the study, and a consent form to sign. We noted both in the opening page of the questionnaire and verbally in the telephone that the researchers are available for them for any problem. In addition, telephone numbers of four emergency centers that could



be available for them in a case of a stress were attached. The percentage of returned questionnaires was around 90%. None of the participants was compensated for the time devoted to the study.

RESULTS

To examine the differences between the measures of body image of the various study groups, a 2 3 2 multivariate analysis of variance (MANOVA) was conducted. The indepen-dent variables were sexual abuse (yes/no) and physical abuse (yes/no), and the dependent variables were body image aberrations, body sensitivity and control, and body maintenance and protection. Furthermore, to clarify possible interactions, simple effects tests were con-ducted. Finally, to examine the unique contribution of each of the independent variables to the explanation of body image variance, a hierarchical regression was conducted.

Variations According to Sexual and Physical Abuse

The 2 3 2 MANOVA analysis revealed a statistically significant difference (main effect) between measurements of women who suffered sexual abuse and of women who had not suffered this form of abuse (F[3, 92] 5 7.63, p , .001, h2 5 .20). The means and the standard deviations of body attitude measurements (body maintenance and protection, body image aberrations, and body sensitivity and control) as well as the results of variance analyses of each individual factor are presented in Table 3.

As seen in Table 3, variance analysis of each individual measurement revealed sig-nificant differences between women who were victims of sexual abuse and women who were not. Compared with women with no history of sexual abuse, victims of sexual abuse showed more body image aberrations, more injury to body sensitivity and control, and less body maintenance and protection.

The MANOVA analysis did not reveal significant differences (main effect) between women who suffered physical abuse and those who did not (F[3, 92] 5 2.46, p 5 .07, h2 5 .07). However, the results of the variance analyses that were conducted of each indi-vidual factor revealed statistically significant differences between women who suffered

TABLE 3. Means (M), Standard Deviation (SD), F, and h2 Values of Body Image Measurements Among Women Who Have/Have Not Suffered Sexual Abuse

Measurements

Sexual Abuse

F(1, 94) h2

No Yes

M SD M SD

Body image aberrations

8.77 .82 3.40 .89 19.46*** .17

Body sensitivity and control

2.84 .09 2.30 .10 16.38*** .15

Body maintenance and protection

3.64 .08 4.01 .09 8.74** .08

**p , .01. ***p , .001.


266 Kremer et al.

physical abuse and those who did not in body sensitivity and control and in body main-tenance and protection. The means and standard deviations of various bodily attitude measurements and the results of the different analyses that were conducted for each factor are presented in Table 4.

As seen in Table 4, variance analysis of each individual measurement revealed signifi-cant differences in body maintenance and protection and more injury to body sensitivity and control. The calculation of averages presented in Table 4 revealed that women who were victims of physical abuse showed lower scores of body maintenance and protection and higher scores of injury to sensitivity and control of the body in comparison to women with no history of physical abuse.

Furthermore, a comparison of various body parameters of h2 in women who suffered sexual abuse versus women who suffered physical abuse revealed a significant difference in body maintenance and protection so that women who suffered sexual abuse demon-strated less body maintenance and protection than women who suffered physical abuse. Moreover, significant differences were found between women who suffered sexual abuse and women who suffered physical abuse in injury to sensitivity and control of the body scores: Victims of sexual abuse demonstrated more injury to body sensitivity and control than victims of physical abuse. In addition, it was clear that in body image aberrations, only women who suffered sexual abuse have significant body image aberrations.

The MANOVA analyses also revealed a significant interaction of sexual 3 physical abuse (F[3, 92] 5 5.33, p , .01, h2 5 .15). Variance analysis of each individual measure-ment revealed significant interaction only in the body maintenance and protection factor (F[1, 94] 5 8.78, p , .01, h2 5 .09).

Among victims of sexual abuse, there is no significant difference between those who suffered only sexual abuse (M 5 3.580, SD 5 0.63) and those who suffered both sexual and physical abuse (M 5 3.696, SD 5 0.79). Conversely, women who were not victims of sexual abuse (i.e., women who suffered only physical abuse) scored lower in body main-tenance and protection (M 5 3.696, SD 5 0.56) than women with no history of physical abuse (M 5 4.326, SD 5 0.37). Simple effects analyses that were conducted separately for victims of sexual abuse versus women who did not suffer sexual abuse, while comparing victims of physical abuse and women who did not suffer physical abuse, revealed a significant difference among women who did not suffer sexual abuse (F[1, 43] 5 19.51,

TABLE 4. Means (M), Standard Deviation (SD), F and h2 Values of Body Image Measurements Among Women Who Have/Have Not Suffered Physical Values

Measurements

Physical Abuse

F(1, 94) h2

No Yes

M SD M SD

Body image aberrations 7.10 .84 5.07 .88 2.78

Body sensitivity and control

2.73 .09 2.42 .10 5.49* .05

Body maintenance and protection

3.70 .09 3.95 .09 4.16* .04

*p , .05.



p , .001, h2 5 .312), but no significant difference among women who were victims of sexual abuse (F[1, 51) 5 .35, p . .05).

Regression Analysis to Explain Variance in Bodily Attitudes

One of the study questions addresses the explanation of variance in bodily attitudes. Three separate procedures of hierarchical regression analysis were conducted to examine this question, where the various body image factors constituted dependent variables. The hier-archical regression was conducted in two stages. First, demographic details were included: marital status (married/not married), employment (working full-time/part-time/not work-ing), current age, and years of education. This stage reveals to what degree demographic variables help in explaining variance, and secondly, including these variables in the initial stage allowed us to retain them as constant values so that contribution of the variables in the next stage would prove to be more than that explained by the demographic variables.

In the second stage of the analysis, the two forms of abuse—sexual abuse (yes/no) and physical abuse (yes/no)—were included, as well as the interaction between them. This interaction allowed us to examine the joint contribution of both forms of abuse. The depen-dent variables in the regression included the following body factors: body image aberra-tions, body sensitivity and control, and body maintenance and protection. The insertion of the variables in the two stages was forced. Regression analysis revealed that 27% of vari-ance in injury to body sensitivity and control could be explained, 36% of variance in body maintenance and protection, and 31% of variance in body image aberrations. Hierarchical regression coefficients of these variables are presented in Table 5.

The data in Table 5 indicate that, in general, abuse measurements contribute 19% to explaining variance in injury to body sensitivity and control. In the first stage of the analysis, demographic variables were included and it revealed that demographic variables contribute 8% to explaining variance in body sensitivity and control. In the second stage of the analysis, the two forms of abuse were included, and a significant contribution was found on the measurements of sexual and physical abuse, to the explanation of the variance of body sensitivity and control, and to the interaction between them. One can see that the beta coefficient of sexual abuse is higher than other regression coefficients; that is, sexual abuse makes a greater contribution in explaining variance in injury to body sensitivity and control. Beta coefficients of abuse measurements are negative, indicating that women who suffered sexual and/or physical abuse show more injury to body sensitivity and control than women with no history of abuse.

As mentioned, the regression analysis revealed a significant contribution to the interac-tion between sexual abuse and physical abuse. Variance analysis that was conducted to test the interaction of sexual 3 physical abuse revealed that both victims of sexual and physical abuse show more injury to body sensitivity and control (M 5 2.88, SD 5 0.12) than women who suffered only sexual abuse (M 5 2.80, SD 5 0.13), and victims of sexual abuse dem-onstrate more injury to body sensitivity and control than women who suffered only physical abuse (M 5 2.58, SD 5 0.14). Likewise, each group of abuse shows more injury to body sensitivity and control than women with no history of abuse (M 5 2.0, SD 5 0.14).

The second dependent variable is body maintenance and protection. In the first stage, demographic variables were included and it has been found that demographic variables contribute 13% to explaining variance in body maintenance and protection. In the second stage, abuse variables were included and a significant contribution was found in sexual and physical abuse measurements and the interaction between them. It is clear that the beta


268 Kremer et al.

coefficient of interaction is higher than other regression coefficients; that is, interaction between sexual abuse and physical abuse provides the greatest contribution to explain-ing variance in body maintenance and protection. Beta coefficients of abuse are positive, indicating that women who were victims of sexual and/or physical abuse show less body maintenance and protection than women with no history of abuse.

It has been found that the interaction of sexual 3 physical abuse corresponds to the interaction found in the variance analysis. Among victims of sexual abuse, there is no significant difference in body maintenance and protection between those that suffered only sexual abuse (M 5 3.58, SD 5 0.63) and those that suffered both sexual and physical abuse (M5 3.696, SD 5 0.79). Conversely, women who were not victims of sexual abuse (i.e., women who suffered only physical abuse) scored lower in body maintenance and protec-tion (M 5 3.696, SD 5 0.56) than women with no history of physical abuse (M 5 4.326, SD 5 0.37). The data show that women with no history of abuse (sexual and/or physical) score higher in body maintenance and protection than women who have been abused. One should note that simple effects analyses conducted separately for victims of sexual abuse versus women who did not suffer sexual abuse, while comparing victims of physical abuse and women who did not suffer physical abuse, revealed a significant difference among

TABLE 5. Hierarchical Regression Coefficients (b) to Explain Variance in the Various Body Image Factors

Body Sensitivity and Control

Body Maintenance

and ProtectionBody Image Aberration

Stages Predictors b b b

1 Age .06 .26* 2.13

Education 2.17* 2.02 2.11

Employment 2.20* 2.10 2.14

Marital status 2.01 2.24* 2.18*

R2 .08 .13* 13**

R2 .08 .13* .13**

2 Age 2.05 .41*** 2.23*

Education 2.17* 2.03 2.09

Employment 2.19* 2.11 2.12

Marital status .11 .13 2.08

Sexual abuse 2.37*** .27** 2.39***

Physical abuse 2.19* .30** 2.20*

Sexual 3 Physical 2.19* .31*** 2.02

R2 .27*** .36*** .31***

R2 .19*** .22*** .17***

* p , .05. ** p , .01. *** p , .001.



women who did not suffer sexual abuse (F[1, 43] 5 19.51, p , .001, h2 5 .312), but no significant difference was found among victims of sexual abuse (F[1, 51] 5 .35, p . .005). In general, it has been found that abuse measurements contribute 22% to explaining vari-ance in body maintenance and protection.

The third dependent variable is body image aberrations. In the first stage, demographic variables were included and it has been found that demographic variables contribute 13% to explaining variance in body image aberrations. In the second stage, abuse variables were included and a significant contribution was found in the measurements of sexual and physical abuse. Clearly, beta coefficients of sexual abuse are higher than other regression coefficients, that is, sexual abuse has a greater contribution in explaining variance in body image aberrations. Beta coefficients of abuse measurements are negative, indicating that victims of sexual or physical abuse have more body image aberrations than women with no history of abuse. In general, it has been found that abuse variables contribute 17% to explaining variance in body image aberrations.

DISCUSSION

This study indicates that sexual abuse and physical abuse have a differential impact on vic-tims’ perception of their body and their attitude toward it. Women who experienced physical abuse will suffer injury to various aspects of bodily attitude because during the assault, the body was attacked, battered, and beaten. In addition, physical abuse lessens their sense of ownership over their body and their body boundaries because their body was used as a punch-ing bag by another. This objectification of a woman’s body can damage body maintenance and protection mechanisms and concern over body functions. Women who experienced sexual abuse also suffer similar damage in various aspects of bodily attitude. Nevertheless, in contrast to physical abuse, which may lead to external injury, sexual abuse may lead to both internal and external injury that may yield more severe injury in various aspects of a woman’s bodily attitude. Indeed, the findings of this study confirmed this hypothesis.

Somer (2004) claims that “the inherently negative attitudes towards emotional and physical abuse are obvious. In contrast, sex is an inherently appetitive and rewarding experience” (p. 1). Although sexual abuse may include moments of enjoyment, hatred toward one’s own body increases, the body is perceived as traitorous and unreliable, and so the desire to hurt it or expose it to danger also increases (Walsh & Rosen, 1988). These feelings may exacerbate the body image disorders that result from sexual abuse. Further studies could examine this supposition that women who suffer sexual abuse may at times also experience some measure of physical pleasure in reaction to sexual touch.

No significant difference in bodily attitudes between women who suffered sexual abuse and women who suffered both sexual and physical abuse were found. This finding is in line with the findings of previous studies (Karlin, 1999; Waldinger, Swett, Frank, & Miller, 1994) that have shown that sexual abuse has a higher significant impact on the mental and physical health of women than physical abuse alone.

Likewise, Straus (1988) describes another fundamental experience in relation to one’s body in a sense of mineness: A sense of ownership over one’s own body and clear body boundaries. Because sexual abuse includes both internal and external assault of the body, there is a con-stant sensation of external invasiveness into the internal spaces of the body, something that could prove damaging to the feeling of clear body boundaries. Indeed, as found in this study, only victims of sexual abuse have more body image aberrations that include an undermining of their sense of ownership over their bodies and unclear body boundaries.


https://www.researchgate.net/publication/232452358_Self-Mutilation_Theory_Research_and_Treatment?el=1_x_8&enrichId=rgreq-fec04bb5-4ece-4694-818d-c8a97ba48f6f&enrichSource=Y292ZXJQYWdlOzIzNzg0NDEyNTtBUzoxNTUxMTMzNDM2ODg3MTVAMTQxMzk5MzMxMTMwOA==

270 Kremer et al.

Defining the two forms of abuse as separate phenomena as implemented in this study paves the way to a new research approach. Further studies should examine the specific kind of injury caused by each form of abuse rather than addressing them together.

The findings of this study also have implications for treatment of both forms of abuse. This study maintains that as both forms of abuse produce common and individual symp-toms in the victims, then the clear classification of the repercussions could help focus treatment in the particular characteristics of each injury and the specific symptoms unique to each group (in line with Briere & Jordan, 2004).

The findings of this study show that women who suffered sexual abuse experienced more severe injury to body image and body experience than women who were victims of physi-cal abuse. Thus, when treating victims of sexual abuse, one of the key issues that should be addressed is damage to bodily attitude. Victims of sexual abuse demonstrated less body maintenance and protection, that is, their attitude toward their bodies was less positive, they took less care of their bodies, and they expose themselves to danger more frequently. Moreover, victims of sexual abuse suffered more injury to their sense of body control and were less attentive to body clues. Lastly, these women had more negative and distorted physi-cal sensations and a feeling that their body boundaries were unclear to them.

In view of all this, it is clear that treatment of victims of sexual abuse should help women to cope with the extensive damage to body image that is the consequence of this abuse. Treatment should help women maintain and nurture their bodies, to cope with the rejection they feel regarding it, to deal with the distorted body perceptions they have, and help them restore the sense of ownership and control they should have over their bodies. One of the possible approaches for therapy is Body Focused Intervention (Asselstine, 2000), which associates between sensor feelings that have remained in memory and the internalization of body–soul relationships. This procedure may lead clients to an integra-tive relation to their body. Other therapeutic approaches (Price, 2004; Segal, Williams, & Teasdale, 2002) may be relevant to these cases as well.

There are only few studies in Israel that have examined the psychological implications of physical and sexual abuse. Furthermore, this is one of the few studies on this topic that was conducted for the aim of revealing the differences between bodily attitudes in women abused sexually rather than physically. However, there are number of method-ological remarks that should be taken into consideration. Future studies should compare the groups not only according to the different forms of abuse but also according to the differences in the severity and duration of the abuse. Also, to expand the generalizability of the findings, more representative segment of this population of abused women should be recruited. Future study should classify the groups not only by form of abuse but also by whether the women received therapy; and further examine if women who received therapy show fewer injuries in various aspects of body image in comparison to women who did not receive therapy.

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Correspondence regarding this article should be directed to Inbar Kremer, Department of Management, Bar Ilan University, Ramat-Gan 52900, Israel. E-mail: [email protected]


Body Image Among Victims of Sexual and Physical Abuse

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