Child Abuse, Early Maladaptive Schemas, and Risky Sexual Behavior in College Women

1

Running Head: CHILD ABUSE, EMS & RISKY SEXUAL BEHAVIOR

[IN PRESS, JOURNAL OF CHILD SEXUAL ABUSE]

Child Abuse, Early Maladaptive Schemas, and Risky Sexual Behavior in College Women

Melissa Roemmele and Terri L. Messman-Moore

Miami University

This paper is based upon the undergraduate honors thesis of the first author, supervised

by the second author. The authors would like to acknowledge numerous undergraduate research

assistants, without whom this project would not have been possible: Alicyndra Amundsen, Erin

Bybee, Dasi Ginnis, Sarah Hoskinson, Parker Huston, Julie Krizay, Erin Kupres, Robyn

MacConnell, Jessica Morgan, Jenni Oberlag, and Mai Foerster Shaffner. The authors also

greatly appreciate the support and feedback of Amanda Diekman and Aubrey Coates during this

project.

Correspondence concerning this article should be addressed to Terri L. Messman-Moore,

Ph.D., Department of Psychology, Miami University, 90 N. Patterson Avenue, Oxford, OH

45056; Email: [email protected]; Telephone: 513.529.2403

CHILD ABUSE, EMS & RISKY SEXUAL BEHAVIOR 2

Abstract

Previous research suggests that individuals abused as children are more likely to engage in risky

sexual behavior during adulthood. The present study examined early maladaptive schemas

(EMS) as mediators of the child abuse-risky sexual behavior relationship among 653 college

women. Self-report surveys assessed three forms of child abuse: sexual, physical, and

emotional, as well as EMSs within two domains: disconnection/rejection and other-directedness.

Disconnection/rejection schemas fully mediated the relation between child emotional abuse and

number of sexual partners, and partially mediated the relationship for sexual and physical abuse.

However, when frequency of specific risky sexual acts (i.e., sex without contraception) was

examined in the previous six months, only abandonment was a partial mediator. Implications for

intervention and future research are discussed.

Keywords: child abuse; early maladaptive schemas; psychosexual behavior; college women


Child Abuse, Early Maladaptive Schemas, and Risky Sexual Behavior in College Women

Evidence of the persistent and often devastating impact of child abuse is illustrated by its

numerous problematic long-term outcomes documented in the literature. Among the most

frequently researched clinical conditions tied to child abuse are Posttraumatic Stress Disorder

(Widom, 1999), eating disorders (Mullen, Martin, Anderson, Romans, & Herbison, 1996),

depression (Gibb et al., 2001; Mullen et al., 1996), and suicidality (Mullen et al., 1996).

Researchers have also pinpointed less pathological yet still problematic effects of abuse,

including low self-esteem (Meston, Heiman, & Trapnell, 1999; Mullen et al., 1996),

interpersonal conflict (Messman-Moore & Coates, 2007), and interpersonal aggression

(Crawford & Wright, 2007). Among these common subclinical outcomes is also risky sexual

behavior (Bensley, Eenwyk, & Simmons, 2000; Cunningham, Stiffman, Dore, & Earls, 1994;

Fergusson, Horwood, & Lynskey, 1997; Krahe, Scheinberger-Olwig, Waizenhoffer, & Kolpin,

1999; Lemieux & Byers, 2008; Meston et al., 1999; Noll, Trickett, & Putnam, 2003; Wilson &

Widom, 2008), which entails a variety of behaviors related to sexuality and the risk of unwanted

pregnancy, sexually transmitted diseases, and sexual assault.

Child Abuse and Sexual Behavior

Sexual behavior has most commonly been examined in relation to child sexual abuse

(CSA) independent from other types of child abuse, such as child physical abuse (CPA) and

child emotional (or psychological) abuse (CEA). Researchers have linked CSA to various

elements of sexual behavior. Victims of CSA seem to initiate sexual intercourse at earlier ages

(Fergusson et al., 1997; Noll et al., 2003) and report higher frequencies of intercourse in

adulthood (Meston et al., 1999), as well as a greater number of consensual partners (Cunningham

et al., 1994; Krahe et al., 1999; Meston et al., 1999). Furthermore, some evidence suggests that


victims of CSA are more likely to engage in casual sex (i.e., sex outside of a committed

relationship; Meston et al., 1999) as well as sex without protection against pregnancy or sexually

transmitted diseases (Lemieux & Byers, 2008; Noll et al., 2003). Given that HIV is among the

most dangerous of sexually transmitted diseases, many studies have examined child abuse in

relation to behaviors that increase the likelihood of contracting HIV, such as having other

sexually transmitted diseases, intravenous drug use, prostitution, and sex without contraception

(Bensley et al., 2000; Cunningham et al., 1994). Both Bensley et al. (2000) and Cunningham et

al. (1994) discovered a significant association between CSA and these HIV risk factors.

Additionally, victims of CSA are more likely to experience sexual assault as an adult (Lemieux

& Byers, 2008; Smith, Davis, & Fricker-Elhai, 2004). The possible explanations behind this

increased chance of revictimization are vast and often complex, but many suggest that risky

sexual behavior may be an important factor (e.g., Messman-Moore & Long, 2003; Orcutt,

Cooper, & Garcia, 2005).

Many researchers have referenced Finkelhor and Browne’s (1985) theory of traumatic

sexualization to account for the distinct relationship between CSA and risky sexual behavior

(Lemieux & Byers, 2008; Meston et al., 1999; Noll et al., 2003). Traumatic sexualization posits

that CSA distorts a child’s view of sexuality, leading the child to associate sexuality with

attention and to use his or her sexuality to manipulate others and gain rewards. However,

researchers have not entirely ignored the possibility that other forms of abuse also impact sexual

behavior, and in fact, there is evidence of such a relationship. For example, Wilson and Widom

(2008) reported that in addition to CSA, victims of CPA and childhood neglect initiated sexual

activity earlier and were more likely to engage in prostitution. Moreover, Lemieux and Byers

(2008) found that, like those who had experienced CSA, victims of CPA were more likely to


have casual sex and unprotected sex. More strikingly, Cunningham et al. (1994) found an

apparent reversal of the traumatic sexualization findings: victims of CPA engaged in more sexual

behavior associated with HIV risk compared to non-abused young adults, whereas victims of

CSA did not engage in more HIV risk activity than non-abused individuals. In this study, CSA

was only associated with risky sexual behavior when it occurred alongside other forms of abuse.

That is, CSA seemed to contribute to higher levels of risky sexual behavior, but not if it was the

only type of child abuse experienced. However, Cunningham et al. (1994) still observed that

victims of CSA were more likely to have a high number of sexual partners (i.e., 6 or more per

year). Finally, Smith et al. (2004) found that the risk of sexual revictimization in CSA victims

increased if victims experienced CPA as well. Unlike the findings regarding CSA, findings

regarding CPA cannot be explained by Finkelhor and Browne’s (1985) theory of traumatic

sexualization because it suggests that maladaptive sexual behavior is caused specifically by the

sexual nature of CSA.

Establishing an empirical link between child abuse and risky sexual behavior is merely

the first step in the more important challenge of discovering why this relationship exists. In

addressing this question, many studies of child abuse have focused on characteristics of the

abuse experience, such as the frequency and/or duration of the abuse as well as the child’s

relationship to the perpetrator (Bensley et al., 2000). These features of the abuse experience may

be significantly associated with the severity of behavioral outcomes, but they do not necessarily

reveal the psychological impact of the abuse on the individual. Measures that assess the victim’s

cognition and perception may be better indicators of this impact. Recently, researchers have

explored cognitive variables as mediators between child abuse and adult outcomes associated

with the abuse. For example, Gibb et al. (2001) found that individuals with a negative attribution


style were more likely to have experienced CEA. Similar cognitive paradigms may help explain

why risky sexual behavior is a common consequence of child abuse. For instance, Smith et al.

(2004) discovered that child abuse victims attributed more benefits and less risk to risky sexual

behavior than non-victims. Moreover, individuals’ perceptions of the risks and benefits of

engaging in risky sexual behavior predicted their expectations of future involvement in these

behaviors even more strongly than trauma symptoms. It can be argued that these cognitive

variables more closely approximate the victim’s subjective perception of the abuse than

“objective” indicators such as abuse characteristics, given that individuals could be severely

affected by even a single incident of abuse. It is at least clear from this literature that

psychological constructs are important to consider when attempting to explain the association

between child abuse and maladaptive outcomes. Past events cannot directly explain one’s

current behavior. What may be explanatory, however, are beliefs and expectations arising from

past experiences that remain active in the present.

Early Maladaptive Schema (EMS)

Schemas, a term derived from cognitive and developmental psychology, refer to the

broad organizing principles through which individuals make sense of their experience. Jeffrey

Young and colleagues (Young, Klosko, & Weishaar, 2003) first utilized the term early

maladaptive schema (EMS), to describe dysfunctional schemas that develop in response to what

he termed “toxic childhood experiences” (p. 7) that may involve abuse, neglect, abandonment or

rejection. EMSs encompass not only memories and cognitions, but emotions and bodily

sensations as well, and are the deepest and most unconscious structures by which knowledge of

oneself and others is represented. Young et al. (2003) specifically define EMSs as self-defeating

intrapersonal and interpersonal patterns that originate in childhood and continue to develop


throughout an individual’s lifetime, and identified 18 schemas categorized into five domains:

disconnection and rejection, impaired autonomy and performance, impaired limits, other-

directedness, and lastly, overvigilance and inhibition.

According to Young et al. (2003), adverse childhood experiences interact with

temperament to trigger the emergence of EMSs, with child abuse being one of the most salient

adverse experiences. EMSs that emerge from early trauma and abuse experiences are commonly

from the disconnection/rejection domain (Crawford & Wright, 2007; Messman-Moore & Coates,

2007; Young et al., 2003), which includes the following: abandonment/instability,

mistrust/abuse, emotional deprivation, and defectiveness/shame. In general,

disconnection/rejection schemas are associated with the belief that one’s needs may not be

adequately met. These schemas interfere with establishing stable and satisfying relationships

with others, and can be briefly defined as the following (Young, et al., 2003):

1. Abandonment/instability: the perception that significant others will not be a reliable

support to one in the long term

2. Mistrust/abuse: the expectation that others will take advantage of one for their own

selfish motive

3. Emotional deprivation: the expectation that others will not emotionally connect with one

in a fulfilling way

4. Defectiveness/shame: the perception of oneself as inherently flawed or worthless to

others

Because there is some evidence that child abuse specifically triggers EMSs from the

domain of disconnection/rejection (Crawford & Wright, 2007; Messman-Moore & Coates,

2007), the current study will focus on these EMSs. The link between these schemas and risky

sexual behavior has not been explicitly established by past research. However, it is plausible that

individuals with schemas of abandonment/instability or defectiveness/shame, for example, may


engage in risky sexual behavior to gain feelings of stability or a sense of worthiness,

respectively. Furthermore, individuals with mistrust/abuse or emotional deprivation schemas

may deliberately seek sex with non-intimate partners, a practice that can be considered risky due

to a fear of intimacy related to sex with a monogamous partner.

The current study also will examine whether the domain of other-directedness schemas

may likewise be relevant to child abuse and risky sexual behavior. Other-directedness schemas

generally involve the tendency to pay excessive attention to others at the expense of one’s own

well-being. The other-directedness EMS domain consists of two schemas (Young et al., 2003):

1. Subjugation: the perception that one’s beliefs, wishes, and emotions are inferior to those

of significant others, causing one to relinquish control to others based on fear of their

negative reactions

2. Self-sacrifice: the excessive drive to satisfy the needs of others at the expense of one’s

own self-fulfillment

The other-directedness domain, compared with the disconnection/rejection domain, has

received less attention in regard to child abuse. Yet this domain is conceptually tied to the

disconnection/rejection domain because individuals who endorse schemas from both domains

tend to perceive themselves as inferior. Furthermore, Young et al. (2003) suggest that secondary

schemas such as subjugation and self-sacrifice may develop in order to keep the more painful

disconnection and rejection schemas from awareness. In other words, a person with an

abandonment schema may develop a self-sacrificing schema in order to compensate for fears of

abandonment. Other-directedness schemas also may account for some instances of risky sexual

behavior. For example, an individual affected by these schemas may want to use contraceptive

methods during sexual intercourse, but may submit to a partner’s pressure not to.

Given the novelty of EMSs as a psychological construct, the literature specifically

evaluating their impact is limited. Still, some studies have yielded convincing results for the


validity of EMSs in association with various pathological or maladaptive outcomes, including

depression (Harris & Curtin, 2002; Lumley & Harkness, 2007; Wright, Crawford, & Del

Castillo, 2009), anxiety (Wright et al., 2009), social phobia (Pinto-Gouveia, Castilho, Galhardo,

& Cunha, 2006), panic disorder (Hedley, Hoffart, & Sexton, 2001), eating disorders (Unoka,

Tolgyes, & Czobor, 2007), self-mutilation (Castille et al., 2007), and personality disorders

(Jovev & Jackson, 2004).

As briefly discussed earlier, EMSs have been linked to experiences of child abuse. This

research also reveals that EMSs may be able to explain adult outcomes associated with child

abuse (Lumley & Harkness, 2007). Wright et al. (2009) found that EMSs partially mediated the

relation between CEA and symptoms of anxiety and depression in adulthood. The specific EMS

implicated were vulnerability to harm, self-sacrifice, and defectiveness/shame. Messman-Moore

and Coates (2007) and Crawford and Wright (2007) examined EMSs in regard to CEA and adult

interpersonal functioning. Messman-Moore and Coates (2007) focused upon the

disconnection/rejection domain and found that the mistrust/abuse schema and the abandonment

schema fully mediated the relationship between CEA and adult interpersonal conflict, and the

defectiveness/shame schema partially mediated this relationship. Crawford and Wright’s (2007)

study analyzed CEA and relationship aggression, both in regard to perpetration of aggression as

well as victimization in an intimate relationship. Mistrust/abuse, self-sacrifice, and emotional

inhibition all mediated the association between CEA and adult experiences of victimization by

an intimate partner (i.e., revictimization). Though previous studies examined outcomes that may

vary considerably from risky sexual behavior, findings still suggest that EMSs may be a critical

mechanism underlying the link between child abuse and adult psychological functioning.

Moreover, several of the EMSs that were significant predictors in earlier studies are from the


disconnection/rejection and other-directedness domains, providing support to specifically focus

on these domains in the current study. To our knowledge, the current study will be among the

first to examine CSA and CPA, not merely CEA, in regard to EMSs. Based on the above

findings regarding child abuse and EMSs, and child abuse and risky sexual behavior, we propose

that EMSs serve an explanatory role in the association between various types of child abuse and

risky sexual behavior.

Hypotheses

This study will examine the relationship between child abuse, EMSs, and risky sexual

behavior in adulthood. The central hypothesis is that EMSs mediate the relationship between

child abuse (sexual, physical, and emotional) and risky sexual behavior. Specifically, EMSs

from the domain of disconnection/rejection (abandonment, mistrust/abuse emotional deprivation,

and defectiveness/shame) and the domain of other-directedness (subjugation and self-sacrifice)

are expected to operate as mediators of this relationship.

Method

Participants

Participants were 653 female undergraduate students at a midsized Midwestern

university. The majority were Caucasian (92.6%). The most common non-white participants

were either African-American (2.1%), Hispanic (1.5%) or biracial (1.1%). The mean age of all

participants was 18.77 (SD = .98). Most participants were unmarried (91.7%), and almost half of

the participants (46.5%) came from families with a yearly income of at least $100,000. Women

received introductory psychology course credit in exchange for participation.

Measures


Child Abuse. Child abuse was assessed with the paper-and-pencil version of the

Computer Assisted Maltreatment Inventory (CAMI; DiLillo, et al., 2006; DiLillo, et al., 2010).

CSA was assessed with a series of screener questions that, if answered affirmatively, were

followed by a more detailed set of questions examining the characteristics of the CSA. Those

who reported experiencing (before the age of 14) sexual touching, sexual kissing, or oral, anal, or

vaginal intercourse with a family member, or a person who was five or more years older, were

considered victims of CSA. Additionally, persons who reported experiencing any of these

activities against their will, regardless of age difference or relationship to the perpetrator, were

also classified at CSA victims. Voluntary sexual play with a similar age peer and voluntary

sexual activities with a dating partner were not considered CSA.

The CPA subscale of the CAMI asks if the respondent was the victim of specific acts of

physical violence perpetrated by a parent or adult caregiver before he/she (the participant) was

18. Examples of items include “Did either parent or any other adult caregiver grab or shake you

hard?” or “Did either parent or any other adult caregiver threaten you with a weapon such as a

gun or a knife?” Participants give yes/no responses to each of these items. Women were

identified as CPA victims if they reported that a caregiver inflicted any one of the following acts

on the individual before age eighteen: Spanked them to the point of bruising, hit them with a fist,

kicked them, threw or knocked them down, choked them, burned them intentionally, threatened

them with a weapon, or used a weapon to hurt them.

The CEA subscale of the CAMI evaluates five forms of psychological or emotional

abuse: Emotional unresponsiveness, demandingness, terrorizing/spurning, isolating, and

corrupting. Participants respond to items concerning parental behavior (e.g., “My parents

punished me by confining me to a closet or small space,” or “My parents paid attention to me


when I talked to them”) on a scale of 1 (strongly disagree) to 5 (strongly agree). After reverse

scoring indicated items, participants’ scores were summed; those whose summed score was

equal to or beyond 1 standard deviation above the mean were considered to have been

psychologically abused.

Multiple studies have examined the psychometric properties of the CAMI within college

populations (e.g., DiLillo et al., 2006; DiLillo et al., 2010). Classification of abuse status on the

CAMI shows strong temporal stability (DiLillo et al., 2010) as well as high agreement with the

Childhood Trauma Questionnaire (CTQ; Bernstein & Fink, 1998), a widely used and well

validated measure of prior abuse (DiLillo et al., 2006). Further, participants’ responses to the

CAMI show little to no associations with measures of social desirability (DiLillo et al., 2010).

EMSs. EMSs were assessed with the Young Schema Questionnaire-Short Inventory

(YSQ- SI; Young, 1998), a 75-item self-report survey that evaluates the presence EMSs. It is an

abbreviated version of the original YSQ (Young, 1990), which is now referred to as the YSQ-

Long Inventory. Both the long and short forms measure a total of 16 schemas from five domains

(disconnection/rejection, impaired autonomy, impaired limits, other-directedness, and

overvigilance/inhibition). The present study specifically examined the following EMSs:

abandonment, mistrust/abuse, emotional deprivation, and defectiveness/shame

(disconnection/rejection domain), as well as subjugation and self-sacrifice (other-directedness

domain). For each item, participants assign ratings on a 6-point scale that represent the degree to

which they identify with a particular EMS ranging from 1 (completely untrue of me) to 6

(describes me perfectly). Participants’ scores on each schema are computed by summing the

ratings of all items that apply to that schema. In this study, a sum score for each schema domain

(disconnection/rejection and other-directedness) was also computed. In the current study,


internal reliabilities were good, with internal consistency Cronbach’s alphas ranging from .84 for

subjugation to .93 for defectiveness/shame for the individual EMS, and .94 for the Disconnection

and Rejection domain and .84 for the Other-Directedness domain. Past studies have shown that

the YSQ has adequate test-retest reliability (Schmidt, Joiner, Young, & Telch, 1995).

Sexual behavior. Number of lifetime sexual partners was assessed by one item inquiring

about the total number of partners with whom a participant had engaged in consensual sexual

intercourse. This measure provided a preliminary index of risky sexual behavior in this study.

The Cognitive Appraisal of Risky Events Questionnaire--Revised (CARE-R; Katz, Fromme, &

D’Amico, 2000) was used to assess frequency of recent past involvement in risky behaviors.

Participants reported the number of times they engaged in a particular behavior in the past six

months (e.g., “How many times in the past six months did you have sexual intercourse without

protection against pregnancy with someone you just met or did not know well?”) according to a

scale of 0 times, 1 time, 2-4 times, 5-9 times, 10-20 times, 21-30 times, and 31+ times. The risky

sexual behavior construct was divided into three domains based upon the type of sexual partner

and outcome associated with the risk. Participants provided information about activities they

engaged in with a “regular partner” (as defined by the participant) and with “someone I just met

or did not know well.” Risky sexual behavior items were classified into three groups: health-risk

behavior with a regular partner, health-risk behavior with a stranger, and sexual assault risk with

a stranger (see Table 1 for a list of items, along with the internal reliability alpha for each

subtype). Previous studies have shown that the CARE-R has adequate test-retest reliability

(Fromme, Katz, & Rivet, 1997) and adequate internal consistency (Smith et al., 2004).

[[INSERT TABLE 1 ABOUT HERE]]

Procedure


All measures in this study were anonymous paper-and-pencil surveys. Participants

completed the surveys in a large group appointment that lasted approximately one hour.

Informed consent was obtained from the women before the surveys were administered and they

were debriefed after they turned in all completed surveys to the researchers. All study

procedures were approved by the authors’ institutional review board.

Results

Prevalence of Child Abuse and Sexual Activity

Among the 653 participants in this study, 167 (25.6%) indicated that they had

experienced some form of CPA, 82 (12.6%) indicated they had experienced CEA, and 39 (6.0%)

indicated that they had experienced CSA. Approximately 67% of the sample indicated that they

were sexually active. The mean number of lifetime sexual partners among all respondents was

2.57 (SD = 3.89).

Data Analysis

All statistical analyses were conducted with SPSS 15.0 for Windows. Several sets of

analyses were conducted to test the hypotheses. First, zero-order correlations were calculated to

determine whether variables were associated as hypothesized and to determine whether the basic

requirements were met to test for mediation (Baron & Kenny, 1986). Second, additional sets of

regression analyses were conducted, using the steps outlined by Baron and Kenny (1986) to

determine whether schemas mediated the relationship between child abuse and risky sexual

behavior.

Zero-Order Correlations

Zero-order, bivariate correlations were calculated for all variables of interest (see Table

2). All three forms of child abuse (sexual, physical, and emotional) were positively correlated


with lifetime number of sexual partners. In terms of frequency of risky sexual behavior in the

past 6 months, CSA and CPA were positively correlated with sexual behavior involving health

risk with a regular partner (RSB-HR). It is noteworthy that none of the three forms of child

abuse were correlated with frequency of risky sexual behavior with a stranger, and CEA was not

correlated with frequency of risky sexual behavior with a regular partner. As hypothesized, all

three forms of childhood abuse (CSA, CPA, and CEA) were positively correlated with all EMSs

in the disconnection and rejection domain (emotional deprivation, mistrust/abuse,

abandonment/instability, and defectiveness/shame). In the other-directedness domain, CEA was

positively correlated with both subjugation and self-sacrifice. CSA was positively correlated

with self-sacrifice, but not subjugation. CPA was positively correlated only with subjugation

and not self-sacrifice. Not all EMSs predicted risky sexual behavior. Lifetime number of sexual

partners was positively correlated with all EMSs in the disconnection and rejection domain

(emotional deprivation, mistrust/abuse, abandonment, and defectiveness/shame), but was not

correlated with EMSs in the other-directedness domain (self-sacrifice & subjugation). Only a

few EMSs were associated with frequency of risky sexual behavior in the past 6 months.

Abandonment/instability was correlated with sexual behavior involving health risk with both a

regular partner (RSB-HR) and a stranger (RSB-HS), and with sexual behavior related to risk for

sexual assault by a stranger (RSB-AS). Defectiveness/shame and subjugation were correlated

with both RSB-HS and RSB-AS, but not RSB-HR.

[[INSERT TABLE 2 ABOUT HERE]]

Tests of Mediation

For all of the following analyses, the initial steps to test for mediation as outlined by

Baron and Kenny (1986) were assumed to be met based upon significant bivariate correlations.


For instance, the first mediation criterion, that the independent variable (IV) (e.g., CSA)

predicted the dependent variable (DV) (e.g., lifetime number of sexual intercourse partners), the

second criterion, that the IV (e.g., CSA) predicted the mediator (e.g., the disconnection/rejection

domain), and the third criterion, that the mediator (e.g., the DR domain) predicted the DV (e.g.,

lifetime number of partners), were established in the previous analysis. Only in a minority of

cases were the prerequisites of mediation met (Baron & Kenny, 1986). Three tests were

conducted to examine whether EMSs from the disconnection/rejection domain mediated the

relationship between each type of child abuse and lifetime number of sexual partners. Two tests

were conducted to examine abandonment/instability as a mediator of the relationship between

CSA and risky sexual behavior and CPA and risky sexual behavior, specifically the RSB-HR

subtype.

Child Abuse and Number of Sexual Partners

Child sexual abuse. To evaluate the last condition for mediation, a hierarchical

regression analysis was conducted with CSA on the first step, and CSA and the DR domain on

the second step. In the first step, CSA significantly predicted lifetime number of partners (β =

.20, p < .001). Both CSA and the disconnection/rejection domain (β = .14, p < .01) were

significant predictors of lifetime number of partners in the second step, though the impact of

CSA on lifetime number of partners was slightly diminished (β = .17, p < .001), ANOVA F(2,

472) = 14.27, p < .001, R2 = .06. Results of a Sobel’s test, z = 2.57, p < .01, revealed a

significant reduction in impact of CSA on lifetime number of sexual partners, which suggested

that the disconnection/rejection domain partially mediated the relation between CSA and lifetime

number of partners.


Child physical abuse. To test the last condition of mediation, a hierarchical regression

analysis was conducted with CPA on the first step, and CPA and the DR domain on the second

step. CPA significantly predicted lifetime number of partners in the first step (β = .16, p < .001).

On the second step, both CPA and the DR domain (β = .14, p < .01) were significant predictors

of lifetime number of partners, but the impact of CPA on lifetime number of partners was

lessened (β = .12, p < .01), ANOVA F(2, 472) = 10.37, p < .001, R2 = .042. Results of a Sobel’s

test, z = 2.85, p < .01, showed a significant reduction in impact of CPA on lifetime number of

partners, suggesting that the disconnection/rejection domain partially mediated the relation

between CPA and lifetime number of intercourse partners.

Child emotional abuse. A hierarchical regression analysis, with CEA entered on the

first step and CEA and the DR domain on the second step, was conducted to evaluate the fourth

condition of mediation. CEA was a significant predictor of lifetime number of partners in the

first step (β = .120, p < .01). In the second step, only the DR domain significantly predicted

lifetime number of partners (β = .14, p < .005), ANOVA F(2, 472) = 7.51, p < .01, R2 = .03.

Given that CEA was nonsignificant (β = .06, p = .28) in the second step, findings indicate that

the disconnection/rejection domain fully mediated the relation between CEA and lifetime

intercourse partners.

Abandonment and Frequency of Risky Sexual Behavior-Regular Partner

Child sexual abuse. Next, the schema of abandonment/instability was tested as a

mediator of the relation between CSA and frequency of sexual behavior involving RSB-HR.

The first three steps to evaluate mediation were all previously established. In the last test of

mediation, a hierarchical regression analysis was conducted with CSA entered on the first step,

and CSA and abandonment/instability on the second step. CSA significantly predicted RSB-HR


(β = .21, p < .001) in the first step. In the second step, both CSA and the

abandonment/instability schema (β = .09, p < .05) were significant predictors of RSB-HR,

although the impact of CSA was diminished (β = .20, p = .001), ANOVA F(2,618) = 17.14, p <

.001, R2 = .05. Results of a Sobel’s test, z = 1.94, p < .05, indicated a significant reduction in

impact of CSA on RSB-HR, suggesting that the abandonment/instability schema partially

mediated the relation between CSA and RSB-HR.

Child physical abuse. Finally, the abandonment/instability schema was tested as a

mediator of the relation between CPA and RSB-HR. In the final step to test mediation, a

hierarchical regression analysis was conducted with CPA on the first step, and CPA and

abandonment/instability on the second step. CPA significantly predicted RSB-HR (β = .20, p <

.001) in the first step. In the second step, both CPA and the abandonment/instability schema (β =

.08, p < .05) significantly predicted RSB-HR, but the impact of CPA on RSB-HR was reduced (β

= .18, p < .001), ANOVA F(2,615) = 14.71, p < .001, R2 = .05. Results of a Sobel’s test, z =

2.01, p < .05, showed a significant reduction in impact of CPA on RSB-HR, suggesting that

abandonment/instability partially mediated the relation between CPA and RSB-HR.

Discussion

As previously discussed, prior research has established a link between child emotional

abuse (CEA) and EMSs (Crawford & Wright, 2007; Lumley & Harkness, 2007; Messman-

Moore & Coates, 2007; Wright, Crawford, & Del Castillo, 2009). Results of the present study

add to this research by showing that like CEA, child sexual abuse (CSA) and child physical

abuse (CPA) also are associated with EMSs. The current study also confirms the importance of

EMSs, especially disconnection/rejection schemas, which were more frequently significant

predictors of sexual behaviors, compared to the other-directedness schemas. Among EMSs in


the disconnection and rejection domain, defectiveness/shame and abandonment schemas appear

most relevant to risky sexual behavior, both in terms of lifetime number of partners and

frequency of risky sexual behavior with intimate and non-intimate partners. Such findings

suggest that for some victims of CSA and/or CPA, risky sexual behavior may be motivated by a

need to increase a sense of self-worth or to reduce fears of abandonment, particularly by a

partner in an established relationship.

The number of lifetime sexual partners is often considered one aspect of risky sexual

behavior. A higher number of partners is associated with increased risk for sexual assault (Testa,

VanZile-Tamsen, & Livingston, 2007), as well as elevated risk for contracting a sexual

transmitted disease if contraception is not properly and consistently used. The only case of full

mediation by EMSs occurred with CEA and lifetime number of sexual intercourse partners,

where the relationship between these variables was fully accounted for by EMSs from the

disconnection/rejection domain. However, disconnection/rejection EMS partially mediated the

link between CSA and lifetime number of sexual partners, as well as between CPA and lifetime

number of partners. These findings suggest that EMSs do have a powerful role in explaining the

impact of child abuse on sexual behavior.

This study also examined rates of specific risky sexual behaviors in the past six months.

Having sex without a condom and/or other birth control, having sex with an unknown partner,

having sex under the influence of alcohol, and leaving a social event with an unfamiliar person

were considered instances of risky sexual behavior. When risky sexual behavior was examined

as the frequency of specific behaviors instead of a global measure of lifetime number of partners,

there was less widespread evidence for EMSs as a mediator of the relationship between child

abuse and risky sexual behavior. Only the schema of abandonment/instability emerged as a


mediator, and furthermore, it only appeared relevant to individuals affected by CSA and CPA,

and only for sexual behavior involving health risk (e.g., condom use) with a partner in an

established relationship. This pattern did not generalize to risky sexual behavior with a non-

intimate partner, regardless of whether the risk concerned health or sexual assault.

The factor of time could partly explain the difference in results for predictors of lifetime

number of sexual partners versus sexual behavior that presents a health risk. The latter variable

only included sexual behavior over the six months prior to the study. There is some evidence

that child abuse victims may alternate between periods of sexual promiscuity and abstinence at

different points in time (Lemieux & Byers, 2008). Hypothetically, if this is the case, the total

number of sexual partners across one’s lifetime will account for both periods of elevated sexual

behavior and those of abstention from sexual behavior. On the other hand, data regarding only

recent sexual behavior may not reflect the individual’s more longstanding patterns of sexual

behavior. An individual may have a high lifetime number of sexual partners, for example, but if

she has not been sexually active in the several months prior to the study, she will obviously not

score high on measures of risky sexual activity over the past six months.

All three forms of child abuse (CSA, CPA, and CEA) were associated with aspects of

risky sexual behavior in this study. CSA and CPA predicted health-risk related risky sexual

behavior, and although CEA did not, it was associated with a higher lifetime number of sexual

partners (as were CSA and CPA). Thus, the impact of child abuse on adult sexual behavior is

not exclusive to CSA, which further challenges the theory of traumatic sexualization (Finkelhor

& Browne, 1985). While the results of this study do not particularly warrant EMSs as a

convincing alternative theory to traumatic sexualization, it at least seems likely that some

factor(s) associated with all child abuse, not merely CSA, impact sexual behavior in child abuse


victims. These factor(s) are likely akin to EMSs in that they affect the individual at a global

level, beyond the specific domain of sexuality. Emotion dysregulation may be one such

mechanism, affecting risky sexual behavior among victims of CSA and CPA (Messman-Moore,

Walsh & DiLillo, 2010). Thus, risky sexual behavior may stem from the same psychological

factor(s) or underlying mechanism as other seemingly different behavioral outcomes of child

abuse (e.g., intentional self-injurious behavior).

This study has some important limitations to consider. First, we interpreted our findings

according to the theoretical assumption that EMSs originate early in life before the onset of

sexual behavior. However, given the cross-sectional design, risky sexual behavior and EMSs

were evaluated concurrently; thus it cannot be ruled out that risky sexual behavior influenced

EMSs rather than vice-versa. Second, participants were predominantly White, middle-class

female undergraduates at a Midwestern university, limiting generalization of findings. Perhaps

most relevant is that participants in this study were relatively sexually inexperienced. Average

lifetime number of sexual partners reported by participants was between 2 and 3, and the median

and mode were both 1. There was likewise a restricted range for frequency of specific risky

sexual behaviors. Degree of sexual experience and frequency of sexual behavior were likely

influenced by the sample demographic which was predominantly first-year students, who tend to

have fewer partners than their older peers (Patrick, Maggs, & Abar, 2007). Furthermore, the

Midwestern location of the university also may have been influential. Davidson, Moore, Earle,

and Davis (2008) found that Midwestern college females engaged in sexual activity less

frequently than women at Southern and Southwestern universities, and tended to more often

endorse intimacy-focused, rather than pleasure-focused, motivations for having sex, motivations

which are associated with having fewer partners (Cooper, Shapiro, & Powers, 1998). Given


these issues, replication of this study with an older, more geographically diverse sample may be

beneficial. Finally, memory bias or social desirability concerns may have influenced

participants’ reports of child abuse experiences. It is possible that some participants did not

remember incidents of abuse that were actually present in their childhood. Moreover, even

among participants who did remember being abused, they may have been afraid or ashamed to

admit this experience on the surveys. In both cases, participants would be more likely to

underreport child abuse. Similar social desirability concerns are also expected to be relevant to

sexual behavior, and some items on the sexual behavior measures may have been uncomfortable

for participants to recall or report accurately. The anonymous nature of data collection in the

study should help mitigate these concerns, however.

The current findings warrant continued study of EMSs among child abuse victims,

although results do not suggest that they are the central mechanism underlying risky sexual

behavior. Thus, future research must continue to evaluate other mechanisms (e.g., emotion

dysregulation; Messman-Moore et al., 2010) relevant to understanding the impact of child abuse

on risky sexual behavior. Yet, schema-focused therapy (Young et al., 2003) should be a useful

and productive intervention for adult victims of child abuse, given that EMSs are associated with

a variety of psychological problems, including significant interpersonal difficulties and

revictimization (Crawford & Wright, 2007; Lumley & Harkness, 2007; Messman-Moore &

Coates, 2007; Wright, et al., 2009). These findings suggest it may be helpful for therapists to

focus on EMSs in order to guide child abuse victims towards a lifestyle of safer and healthier

sexual behavior.


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Table 1.

Measures of Sexual Behavior

Construct

Cronbach’s

Alpha

Survey items

Lifetime number of

sexual intercourse

partners

---

“With how many different partners have you had

sexual intercourse (vaginal or anal) when you

wanted to (without force)?”

Risky sexual behavior-

health risk via stranger

α = .78

“How many times in the past six months did you…”

1. “…have sex without protection against

pregnancy with someone you just met or did

not know well?”

2. “…have sex without a condom with someone

you just met or did not know well?”


health risk via regular

partner

α = .71


1. “…have sex without protection against

pregnancy with a regular partner?”

2. “…have sex without a condom with a

regular partner?”


risk of assault by stranger

α = .73


1. “…have sex with someone you just met or

did not know well?”

2. “…have sex while under the influence of

alcohol with someone you just met or did not

know well?”

3. “…leave a social event with someone you

just met or did not know well?”


Table 2. Zero-Order Correlations among Study Variables.

Note. CSA = Child Sexual Abuse; CPA = Child Physical Abuse; CEA = Child Emotional Abuse; ED = Early Maladaptive Schema- Emotional Deprivation; AB

= Abandonment/Instability; MA = Mistrust/Abuse; DS = Defectiveness/Shame; SB = Subjugation; SS = Self-Sacrifice; DR = Disconnection/Rejection Domain;

OD = Other-Directedness Domain; # SP = Lifetime number of sexual intercourse partners; RSB-HS = Risky sexual behavior involving heath risk with a stranger;

RSB-AS = Risky sexual behavior involving risk of assault by a stranger; RSB-HR = Risky sexual behavior involving health risk with a regular partner

*p < .05 ; ** p < .01; *** p < .001

CSA CPA CEA ED AI MA DS SB SS DR OD #SP RSB-HS RSB-AS RSB-HR

CSA - .15** .16** .16** .17** .13** .13** .07 .12** .18** .12** .20** .03 .02 .22**

CPA - - .37** .23** .22** .24** .19** .15** .08 .28** .13** .16** .07 .07 .20**

CEA - - - .44** .30** .33** .36** .30** .14** .43** .27** .12* .06 .06 .04

ED - - - - .50** .49** .55** .43** .23** .78** .40** .13** .04 .01 .06

AI - - - - - .55** .57** .54** .26** .82** .47** .12** .08* .08* .12**

MA - - - - - - .57** .58** .33** .82** .54** .12* .06 .07 .07

DS - - - - - - - .60** .19** .81** .46** .18** .09* .14** .04

SB - - - - - - - - .32** .66** .77** .07 .11** .13** .03

SS - - - - - - - - - .32** .85** .04 .06 .01 .00

DR - - - - - - - - - - .58** .17** .08* .08* .09*

OD - - - - - - - - - - - .07 .10* .06 .02

#SP - - - - - - - - - - - - .53** .48** .27**

RSB-HS - - - - - - - - - - - - - .60**

.09*

RSB-AS - - - - - - - - - - - - - - .02

Child Abuse, Early Maladaptive Schemas, and Risky Sexual Behavior in College Women

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