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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, EMS & RISKY SEXUAL BEHAVIOR 3
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
CHILD ABUSE, EMS & RISKY SEXUAL BEHAVIOR 4
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
CHILD ABUSE, EMS & RISKY SEXUAL BEHAVIOR 5
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
CHILD ABUSE, EMS & RISKY SEXUAL BEHAVIOR 6
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
CHILD ABUSE, EMS & RISKY SEXUAL BEHAVIOR 7
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
CHILD ABUSE, EMS & RISKY SEXUAL BEHAVIOR 8
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
CHILD ABUSE, EMS & RISKY SEXUAL BEHAVIOR 9
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
CHILD ABUSE, EMS & RISKY SEXUAL BEHAVIOR 10
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, EMS & RISKY SEXUAL BEHAVIOR 11
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
CHILD ABUSE, EMS & RISKY SEXUAL BEHAVIOR 12
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,
CHILD ABUSE, EMS & RISKY SEXUAL BEHAVIOR 13
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
CHILD ABUSE, EMS & RISKY SEXUAL BEHAVIOR 14
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
CHILD ABUSE, EMS & RISKY SEXUAL BEHAVIOR 15
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.
CHILD ABUSE, EMS & RISKY SEXUAL BEHAVIOR 16
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 ABUSE, EMS & RISKY SEXUAL BEHAVIOR 17
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
CHILD ABUSE, EMS & RISKY SEXUAL BEHAVIOR 18
(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
CHILD ABUSE, EMS & RISKY SEXUAL BEHAVIOR 19
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
CHILD ABUSE, EMS & RISKY SEXUAL BEHAVIOR 20
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
CHILD ABUSE, EMS & RISKY SEXUAL BEHAVIOR 21
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
CHILD ABUSE, EMS & RISKY SEXUAL BEHAVIOR 22
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.
CHILD ABUSE, EMS & RISKY SEXUAL BEHAVIOR 23
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CHILD ABUSE, EMS & RISKY SEXUAL BEHAVIOR 28
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?”
Risky sexual behavior-
health risk via regular
partner
α = .71
“How many times in the past six months did you…”
1. “…have sex without protection against
pregnancy with a regular partner?”
2. “…have sex without a condom with a
regular partner?”
Risky sexual behavior-
risk of assault by stranger
α = .73
“How many times in the past six months did you…”
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?”
CHILD ABUSE, EMS & RISKY SEXUAL BEHAVIOR 29
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
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