Psychopathology and treatment outcomes in a sample of Danish survivors of childhood sexual abuse

  • Shelley Fletcher

Student thesis: Doctoral Thesis


Childhood sexual abuse (CSA) is a serious problem which affects a significant proportion of the global population. It is a robust predictor of a broad range of psychological disorders including posttraumatic stress disorder (PTSD) and depression. Some CSA survivors may require treatment and studies have demonstrated that psychological treatments can be effective in reducing trauma related symptomology. Research has evidenced that CSA survivors are not a homogenous group and substantial variability relating to psychological outcomes (both type and severity) has been found. Further, there is evidence suggesting that CSA survivors vary in relation to the length of time they spend in treatment and how their symptoms change over time. Social support and coping style have been implicated in explaining variation in outcomes among CSA survivors. Given the high prevalence rates and devastating consequences associated with CSA, increasing understanding of the psychological and treatment outcomes, as well as the factors which can explain the wide variation is vital. The aim of the current thesis was to examine three outcomes in a large sample of sexual abuse survivors attending weekly psychotherapy: 1) psychopathology, specifically patterns of co-occurring PTSD, major depressive disorder (MDD), dysthymia, anxiety and somatoform disorder, 2) length of time spent in treatment and 3) PTSD treatment response trajectories. These outcomes were examined in an attempt to identify potentially modifiable risk and protective factors. Indeed, social support and coping styles were explored in relation to each of the outcomes. Chapter 3 used latent profile analysis (LPA) to examine whether unobservable and meaningful subgroups relating to both disorder type and severity existed within the current sample. Chapter 4 extended on the work in Chapter 3 by examining predictors of the previously identified disorder subgroups. Chapter 5 addressed rates of and predictors of treatment dropout. Chapter iii 6 utilised latent class growth analysis (LCGA) to examine whether multiple trajectories relating to PTSD treatment response existed. Finally, Chapter 7 extended on the work of Chapter 6 by examining predictors of PTSD treatment response trajectories. As expected, the studies revealed the presence of distinct subgroups relating to both psychopathology severity and PTSD treatment response. Additionally, relatively high rates of treatment dropout were found prior to the second assessment. In terms of predictors of the outcomes, social support at the time of the CSA was found to be protective in relation to psychopathology and current social support was found to be associated with less severe PTSD as well as PTSD which improved over the course of treatment. In relation to coping style, emotion focused coping was found to be associated with more severe psychopathology. Emotion focused and detached coping styles were associated with more severe PTSD which did not respond to treatment. A number of factors (low education, male, and the experience of childhood neglect or lifetime rape) were identified as predicting less time spent in treatment. Notably, social support or coping were not predictive of length of time in treatment. Results, implications and limitations of each empirical study are discussed within each of the chapters and an overview is provided in Chapter 8.
Date of AwardDec 2017
Original languageEnglish
SupervisorMark Shevlin (Supervisor) & C Armour (Supervisor)


  • Trauma
  • PTSD
  • Childhood Sexual Abuse
  • Social Support
  • Coping

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