Sexual Assault and Dyadic Relationship Satisfaction: Indirect Associations Through Intimacy and Mental Health

Abstract

Rates of child and adult sexual assault (SA) among women are staggering and place women at risk for intra- and interpersonal difficulties. However, the independent contributions of child and adult SA or the mechanisms of this risk are unknown. This study’s goal was to examine the indirect effects of child and adult SA on women’s own and partner’s relationship functioning through their impact on women’s mental health, emotional intimacy, and sexual intimacy. Results revealed that the association of women’s child SA with both her own and her partner’s relationship satisfaction operated through emotional intimacy. Considerations for the study of women with a history of SA in the context of couple functioning are discussed.

Keywords

sexual assault intimacy mental health relationship functioning couples

Sexual assault (SA) is a traumatic event affecting individuals of all ages across the world. Childhood SA is distressingly common; more than 19.5% of women globally, and 25% of women in the United States, are abused before the age of 18 (Pereda, Guilera, Forns, & Gomez-Benito, 2009). Adult SA, occurring after the age of 18, is similarly frequent, with as many as 22% of women victimized (Elliot, Mok, & Briere, 2004; Tjaden & Thoennes, 2000).

Limited existing research shows the detrimental effect of child SA on marital quality and adjustment (e.g., Godbout, Sabourin, & Lussier, 2009); however, the impact of adult SA on the romantic relationship, perpetrated by someone other than the current partner, is not well understood. In addition, a gap in the extant literature exists in not only if, but how, child and/or adult SA history influences relationship functioning. A review of the literature suggests several putative mechanisms through which SA history may indirectly and negatively affect relationship quality, including mental health, sexual intimacy, and emotional intimacy.

SA and Mental Health

Child and adult SA place victims at risk for developing numerous psychological symptoms, including those associated with posttraumatic stress disorder (PTSD), depression, and anxiety. Both women with a history of child (McLeer, Deblinger, Henry, & Orvashel, 1992) and those with a history adult (Elklit & Christiansen, 2010) SA have a higher likelihood of developing symptoms of PTSD following an assault and these symptoms often persist chronically (Darves-Bornoz et al., 1998; Saunders, Kilpatrick, Hansen, Resnick, & Walker, 1999). Female child SA survivors are also twice as likely to report a lifetime history of depression compared with women without such history and are 3 times as likely to currently experience depressive symptoms in adulthood (Saunders et al., 1999). Among victims of adult SA, research suggests that within 4 weeks of the assault, 43% of women meet criteria for major depression (Frank & Stewart, 1984). Furthermore, these symptoms are often chronic; survivors of adult SA are found to experience higher rates of major depressive symptoms 20 years following the assault (Kilpatrick, Saunders, Veronen, Best, & Von, 1987). Young adults with a history of child (Fergusson, Horwood, & Lynskey, 1996) and adult (Kilpatrick, Resick, & Veronen, 1981) SA are also at increased risk for subsequent generalized anxiety. Women who experienced adult SA are at higher risk for not only generalized anxiety disorder but also agoraphobia, obsessive-compulsive disorder, and social anxiety (Bordreaux, Kilpatrick, Resnick, Best, & Saunders, 1998).

SA and Emotional/Sexual Intimacy

Women who endured SA in childhood are at greater risk for experiencing disruptions in relationship stability and satisfaction (Godbout et al., 2009). Emotional intimacy, including trust in romantic partners, is negatively affected (DiLillo & Long, 1999) as is satisfaction with sexual intimacy (Leonard & Follette, 2002). While there are few studies on the consequences of adult SA on romantic relationships, the limited existing research points to similar consequences for intimacy. Victims of adult SA report greater fear of intimacy and abandonment, less confidence in the dependability of others, and less comfort with closeness (Thelen, Sherman, & Borst, 1998). Furthermore, women with a history of adult SA report higher levels of sexual dissatisfaction compared with nonvictimized women (Bartoi & Kinder, 2008), decreases in sensuality (Norris & Feldman-Summers, 1981), and higher levels of anxiety during sexual activity (Jozkowski & Sanders, 2012).

Relationship Distress

Extant marital and couple research consistently demonstrates the unsettling prevalence of distress and dissatisfaction in relationships in the United States. Indeed, approximately one third of marriages are distressed at any point in time (Whisman, Beach, & Snyder, 2008). Moreover, more than 40% of first marriages are expected to end in divorce (Kreider, 2005), with this rate rising for second and third marriages (Brody, Neubaum, & Forehand, 1988; Cherlin, 1992).

While many factors are associated with declines in relationship functioning, impairments in mental health and intimacy are commonly linked to disruption in the dyad. For example, symptoms of anxiety and depression are shown to predict, longitudinally, lower levels of self and partner relationship satisfaction (Whisman, Uebelacker, & Weinstock, 2004). Furthermore, disruptions in sexual (e.g., Fowers, 1991) and emotional intimacy (Laurenceau, Barrett, & Rovine, 2005) have direct negative influences on the overall health of the romantic relationship.

Present Study

The primary goal of the current study is to better understand whether and how SA history among women affects global dyadic relationship satisfaction. Furthermore, as both assault types are rarely included in a single statistical model, the current study seeks to disentangle the relative contributions of a history of child and/or adult SA among women on self and partner relationship functioning to provide a comprehensive understanding of the direct and indirect effects of SA on relationship satisfaction. Given the existing research demonstrating the negative consequences of SA on women’s mental health as well as sexual and emotional intimacy, this study will also examine the indirect effects of SA on relationship satisfaction through these important factors.

Specifically, the current study aims to extend existing literature by

analyzing whether the prevalence of SA among women currently in romantic relationships is comparable with existing research (i.e., child SA: 25%, adult SA 9-20%);

examining the direct links between women’s SA history and own mental health symptoms, own levels of emotional and sexual intimacy, and own and partner’s relationship satisfaction; and

elucidating indirect associations of SA history on both the woman’s own and her partner’s global relationship satisfaction through women’s mental health, women’s emotional intimacy, and women’s sexual intimacy.

Method

Procedure

Participants in the present study were couples seeking to enroll in an online, relationship-focused, self-help program. Individuals viewed search results and/or associated paid advertisements following keyword searches such as “free marriage counseling.” Links from the search result or advertisement sent participants to a website (www.OurRelationship.com), where information about the larger, web-based couple intervention study was provided. Interested individuals were provided an informed consent form, and, if in agreement, gained access to an online screening measure. Partners within a couple were matched to one another by linking a variety of couple-specific variables (e.g., self and partner name, relationship status, date romantically involved, date married). Data used in the present study were collected before individuals were informed about their eligibility for the self-help program.

Participants

A total of 701 heterosexual couples (1,402 individuals) participated in the present study. Of these couples, 72% were married, 11% engaged, and 17% were cohabiting for at least 6 months. Couples were primarily non-Hispanic White (61% of women, 59% of men), African American (16% of women, 19% of men), or Hispanic White (12% of women, 12% of men) with fewer Asian American (3% of women, 3% of men), Native Hawaiian/Pacific Islander (2% of women, 2% of men), American Indian/Alaska Native (<1% of women, <1% of men), and multiethnic (5% of women, 5% of men) individuals. The sample is generally representative of the United States in terms of race and ethnicity (U.S. Census, 2011), although African American individuals were slightly overrepresented. The average age of the couples was in their mid-30s (Women, M = 34.38, SD = 9.23; Men, M = 36.57, SD = 9.78). Highest education level among the women and men also varied; 28% of women and 40% of men reported a High School diploma or General Educational Development (GED) as their highest degree, another 23% of women and 20% of men had obtained an Associate’s Degree, and 28% of women and 22% of men had earned a Bachelor’s Degree. Fewer participants had a Master’s (16% of women, 12% of men) or Doctoral Degree (5% of women, 6% of men). The median individual income among the sample was US$30,000 (M = $46,171, SD = $67,006). Average relationship satisfaction, measured by the Couple Satisfaction Index–Four Item ( CSI-4; Funk & Rogge, 2007) version, was within the distressed range (sum < 13) for both women (M = 7.82, SD = 4.44, Mdn = 7.00) and men (M = 9.68, SD = 4.54, Mdn = 10.00).

SA history was measured for both men and women; however, only women’s SA history was used in the present study because the rate among men was too low to fully examine. Indeed, only 10% (n = 80) of men reported a history of child SA, and 1.3% (n = 10) reported a history of adult SA. To distinguish between the effects of men’s and women’s SA history, any couples where men reported child or adult SA were excluded from analyses.

Measures

SA history

Child and adult SA were defined as the presence (1) or absence (0) of a history of unwanted forced or threatened touching of genitals, buttocks, breasts, or intercourse. Specifically, women were asked “Did you ever have unwanted sexual contact with someone (e.g., touch their or your genitals, buttocks, breasts, or having intercourse) because you were threatened or physically forced? Check as many as apply” and were presented the following options: “Yes, as an adult (age ≥18)”; “Yes, as a child (age <18)”; “No.” Child SA was defined as assaults occurring before age 18, while adult SA was defined as assaults occurring at age 18 or later. In addition, women reporting an experience of adult SA were asked to indicate the level of fearfulness, horror, and/or hopelessness experienced during the assault on a 7-point Likert-type scale (1 = not at all, 4 = some, 7 = extremely). Women who reported assault that resulted in less than “some” fearfulness, horror, and/or hopelessness were excluded from the present study (n = 4 women).

Current anxiety symptoms

To assess symptoms of generalized anxiety, the Generalized Anxiety Disorder–Seven-Item scale (GAD-7) was used (Spitzer, Kroenke, Williams, & Lowe, 2006). Individuals rated how often they had been bothered by anxiety symptoms over the previous 2 weeks on a 4-point Likert-type scale (i.e., not at all, several days, more than half the days, nearly every day). Sample items include the following: “Over the last 2 weeks, how often have you been bothered by the following problems . . . Feeling nervous, anxious, or on edge? . . . Worrying too much about different things?” The GAD-7 has excellent internal consistency (Cronbach’s α = .92; Spitzer et al., 2006) and also demonstrates good test–retest reliability (intraclass correlation = .83; Spitzer et al., 2006). In the current sample, the reliability was consistent with previous studies (Cronbach’s α = .92).

Current depressive symptoms

Symptoms of depression were measured with the short form of the Center for Epidemiologic Studies–Depression scale (CES-D; Cole, Rabin, Smith, & Kaufman, 2004). The original CES-D has been widely used to measure depression in nonclinical, community samples. The short form includes 10 items scored on a 4-point Likert-type scale (i.e., Rarely or none of the time—less than 1 day, Some or a little of the time—1-2 days, Occasionally or a moderate amount—3-4 days, Most or all of the time—5-7 days) measuring the frequency with which symptoms are experienced during the past week. Sample items include the following: “Below is a list of the ways you might have felt or behaved. Please rate how often you have felt that way during the last week: . . . I felt my life had been a failure . . . I felt that I could not shake off the blues even with the help from my friends or family.” Reliability for the 10-item CES-D in the present study was good (Cronbach’s α = .85).

Emotional and sexual intimacy

Emotional intimacy and sexual intimacy were assessed by two separate subscales from the Personal Assessment of Intimacy in Relationships (PAIR; Schaefer & Olson, 1981). Both subscales demonstrated acceptable internal consistency in the present study (Cronbach’s α: Emotional Intimacy = .82, Sexual Intimacy = .76). Using a 5-point Likert-type scale (strongly disagree, disagree, neither agree nor disagree, agree, strongly agree), participants indicated their agreement with items such as “I often feel distant from my partner” and “I feel neglected at times by my partner” (Emotional Intimacy), and “I am satisfied with our sex life” and “I am able to tell my partner when I want sexual intercourse” (Sexual Intimacy).

Relationship satisfaction

Relationship satisfaction was measured using the CSI-4 (Funk & Rogge, 2007). The CSI-4 is a widely used short-form measure of relationship satisfaction (Sample items: “In general, how satisfied are you with your relationship? How rewarding is your relationship with your partner?” Sample responses: not at all, a little, somewhat, mostly, almost completely, completely). It demonstrated high internal consistency in the present study (Cronbach’s α = .92). Furthermore, previous studies have demonstrated that it is highly correlated with longer measures of relationship satisfaction, provides more precise information, and is able to detect subtle group differences in satisfaction (Funk & Rogge, 2007).

Results

Prevalence of SA

The current study replicated previously reported rates of adult SA in women (i.e., 9-22%); the rate of women’s adult SA in the present study was 14% (n = 98 women). Among these women, 89.5% of the assaults involved oral, vaginal, and/or anal penetration. Prevalence of child SA also replicated existing rates. Extant literature suggests a prevalence rate of child SA in women of approximately 25%; the rate of child SA in women in the current sample was 31% (n = 217 women), exceeding the rate found in the previous research. Consistent with previous revictimization research (Roodman & Clum, 2001), incidence of child and adult SA were related, χ²(1) = 10.10, p = .001, among women in the present sample. Descriptive statistics and correlations between key variables are presented in Table 1.

Table 1.

Within- and Between-Partner Bivariate Correlations and Means of Key Variables.

	1.Relationship satisfaction	2.Emotional intimacy	3.Sexual intimacy	4.Anxiety symptoms	5.Depressive symptoms	6.Child SA	7.Adult SA
1.	.565**	.692**	.493**	—	—	—	—
2.	.745**	.341**	.519**	—	—	—	—
3.	.377**	.380**	.348**	—	—	—	—
4.	−.236**	−.316**	−.132**	—	—	—	—
5.	−.286**	−.350**	−.168**	.778**	—	—	—
6.	−.020	−.199*	−.021	.169**	.184**	—	—
7.	−.087	−.136**	−.032	.184**	.181**	.152**	—
	M (SD)	M (SD)	M (SD)	M (SD)	M (SD)
Men	9.69 (4.53)	11.14 (5.01)	12.88 (5.18)	7.78 (5.89)	11.53 (6.24)
Women	7.88 (4.46)	7.99 (4.82)	13.00 (5.03)	9.98 (6.10)	13.82 (6.65)

Note. Correlations among women’s values are below the diagonal, correlations among men’s values are above the diagonal, and between-partner correlations are in bold on the diagonal. Certain correlations are not available as men’s mental health, and assault history was not assessed. SA = sexual assault.

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

Direct Associations of Child and Adult SA With Relationship Satisfaction

To examine the association between women’s assault history and self and partner relationship functioning, multiple regression analyses were conducted. Results demonstrated that women with a history of adult SA were more likely to report lower relationship satisfaction, b = −1.126, SE = .490, t(680) = −2.298, p = .022. This association was not found among women reporting a history of child SA, b = −0.196, SE = .369, t(680) = −0.530, p = .596. In addition, neither a history of women’s child nor adult SA was significantly associated with their partners’ relationship satisfaction—adult SA: b = −0.783, SE = .497, t(680) = −1.573, p = .116; child SA: b = −0.002, SE = .374, t(680) = −0.005, p = .996.¹

Direct Associations of Child and Adult SA With Mental Health

It was hypothesized that both women with a history of child and/or adult SA would report more symptoms of depression and anxiety compared with women without a history of SA. To test this hypothesis, multiple regression analyses were used to examine the association of each assault type while controlling for the influence of the other. Results indicated that both adult—b = 2.841 (SE = .715), t(679) = 3.974, p < .001—and child—b = 2.331 (SE = .539), t(679) = 4.324, p < .001—SA were significantly independently associated with depressive symptoms. A similar pattern emerged for symptoms of GAD, such that women with a history of adult—b = 2.376 (SE = .660), t(680) = 3.599, p < .001—and child—b = 1.887 (SE = .497), t(680) = 3.797, p < .001—SA reported more anxiety symptoms compared with women without a history of SA.

Direct Associations of Child and Adult SA With Sexual and Emotional Intimacy

It was also hypothesized that women with a history of SA would report lower emotional and sexual intimacy. This hypothesis was supported for emotional intimacy—adult SA: b = −1.246 (SE = .533), t(679) = −2.340, p = .020; child SA: b = −1.074 (SE = .400), t(679) = −2.685, p = .007—suggesting that, controlling for the influence of the other assault type, both adult and child SA are significantly associated with poorer emotional intimacy for women. In contrast, neither was predictive of sexual intimacy—adult SA: b = −0.352 (SE = .561), t(677) = −0.628, p = .530; child SA: b = −0.164 (SE = .422), t(677) = −0.388, p = .698—when controlling for the other type of SA.²

Tests of Indirect Associations

To test the indirect associations of the hypothesized variables in the link between SA history and dyadic relationship satisfaction, a path model was analyzed using Mplus (Muthén & Muthén, 1998-2010). The model included women’s history of child and adult SA as simultaneous independent variables. A composite variable of women’s mental health was created as depression and anxiety were highly correlated in the sample (r = .78), and a similar pattern of associations with assault history was evident for both symptom types. A latent mental health variable comprising the factors for depression symptoms and anxiety symptoms was examined; however, the model fit was insufficient to support using in the present analyses. Therefore, this composite variable was created by combining the standardized z scores for the anxiety and depression variables. In the path model, women’s mental health, women’s emotional intimacy, and women’s sexual intimacy were included as indirect variables. Women’s and men’s relationship satisfaction were included as dependent variables.

The first model tested a fully saturated model (i.e., all paths were modeled) to examine theoretically driven associations. The fully saturated model also allowed the following constructs to correlate: men’s with women’s relationship satisfaction, women’s emotional intimacy with women’s mental health and with women’s sexual intimacy, and women’s sexual intimacy with women’s mental health. Unstandardized coefficients from the saturated model are presented in Table 2. Nonsignificant paths were eliminated, and the resulting empirical model (Figure 1) was estimated to obtain a statistic for model fit. The chi-square test of model fit was not significant, indicating that the proposed empirical model was a good fit for the data, χ²(7) = 12.290, p = .091, and the other fit indices indicated excellent fit (comparative fit index [CFI] = 0.994, root mean square error of approximation [RMSEA] = 0.033, and standardized root mean square residual [SRMR] = 0.028). Results from the final empirical model demonstrated that both child and adult SA were significantly positively associated with mental health difficulties. Interestingly, only child SA predicted lower levels of women’s emotional intimacy. Neither assault type was associated with women’s sexual intimacy. Furthermore, emotional intimacy as reported by women was significantly predictive of both women’s and men’s relationship satisfaction. Sexual intimacy was also significantly associated with women’s relationship satisfaction.

Table 2.

Summary of Saturated Mediation Model.

Predictor	Outcome	Coefficient	SE	p value
Adult sexual assault	W Mental health	0.689	0.100	.000
	W Emotional intimacy	−0.660	0.419	.115
	W Sexual intimacy	−0.055	0.277	.841
	W Relationship satisfaction	0.086	0.261	.742
	M Relationship satisfaction	−0.361	0.264	.170
Child sexual assault	W Mental health	0.682	0.152	.000
	W Emotional intimacy	–1.082	0.401	.007
	W Sexual intimacy	−0.143	0.421	.734
	W Relationship satisfaction	0.591	0.268	.027
	M Relationship satisfaction	0.505	0.348	.146
W Mental health	W Relationship satisfaction	−0.108	0.070	.122
W Emotional intimacy		0.580	0.028	.000
W Sexual intimacy		0.123	0.026	.000
W Mental health	M Relationship satisfaction	0.017	0.091	.851
W Emotional intimacy		0.376	0.037	.000
W Sexual intimacy		0.058	0.034	.083

Note. Direct effects reported as unstandardized coefficients. W =Women, M = Men

Figure 1.

Final structural model.

The current study utilized PRODCLIN asymmetric confidence interval (CI) test, which tests the significance of the indirect effects. Results demonstrated that there was a significant indirect association between child SA and women’s (95% CI = [−1.091, −0.209]) and men’s (95% CI = −[0.732, −0.136]) relationship satisfaction through emotional intimacy.

Discussion

The current study sought to replicate and extend the existing literature on SA against women. Data collected in the present study replicated prevalence rates of both child (31%) and adult (14%) SA among women. This study examined the direct and indirect associations of women’s child and adult SA history on her own and her partner’s relationship satisfaction through its influence on her mental health symptoms, emotional intimacy, and sexual intimacy.

Relationship Satisfaction

Results of direct effect analyses illustrated that adult SA was associated with lower levels of women’s, but not men’s, relationship satisfaction indicating that men’s dissatisfaction was not associated with women’s SA history. As the literature on links between adult SA and relationship functioning is sparse, these results have important treatment implications. Specifically, they indicate that treatment providers working with adult SA victims should anticipate and work to diminish the negative effects of the assault on the victim’s romantic relationship. Similarly, for therapists primarily working with couples, it is important to assess sexual trauma history as it appears to play a role in subsequent relationship functioning.

Contrary to results described in existing studies (e.g., DiLillo & Long, 1999), no direct associations of child SA with either women’s or men’s relationship satisfaction emerged. The lack of a significant association may be due to the lack of an actual link as others have found (e.g., Mullen, Martin, Anderson, Romans, & Herbison, 1996). Alternatively, findings may not have been detected due to the restricted range of relationship satisfaction in the present sample (i.e., the vast majority were experiencing relationship distress) and/or a lack of statistical power to detect the direct association (Fritz & MacKinnon, 2007).

Role of Mental Health Symptoms

Results demonstrated that women with a history of child and adult SA reported higher levels of mental health symptoms. Furthermore, when analyzed independently as an intermediary variable, there was a significant indirect association of child and adult SA history to women’s (child SA: 95% CI = [−0.641, −0.207]; adult SA: 95% CI = [−0.813, −0.246]) and men’s relationship satisfaction (child SA: 95% CI = [−0.382, −0.07]; adult SA: 95% CI = [−0.483, −0.091]) through mental health symptoms. However, when included simultaneously with other variables hypothesized to have an indirect influence, the link between mental health and relationship satisfaction became nonsignificant (due to the shared variance with emotional intimacy). Although not tested directly in the present study, these results suggest that the association between mental health symptoms and marital distress in both partners found in previous studies (e.g., Whisman, 2007; Whisman & Bruce, 1999; Whisman et al., 2004) may operate indirectly through decreases in emotional intimacy.

Role of Sexual Intimacy

In tests of direct associations, neither child nor adult SA were linked to women’s sexual intimacy and thus did not serve an intermediary role in the influence of SA on relationship satisfaction. This pattern remained when sexual intimacy was tested as an independent mediator of the pathways between SA history and relationship satisfaction. In the present sample of distressed help-seeking couples, it may be that other aspects of the relationship (e.g., poor communication, intimate partner violence) operate to mask the negative influence of women’s adult and child SA on sexual intimacy found in previous studies of sexual trauma (Bartoi & Kinder, 2008).

Role of Emotional Intimacy

Results demonstrated that both women’s child and adult SA predicted lower emotional intimacy among women. Dysfunction in this domain, in turn, was related to lower levels of both women’s and men’s relationship satisfaction. Although initial analyses of direct effects may have lacked sufficient power to identify a direct effect of SA on relationship satisfaction, tests of indirect associations (which generally have greater statistical power; Fritz & MacKinnon, 2007) indicated that emotional intimacy served a significant intermediary role in the association between child SA and both women’s and men’s relationship satisfaction. These results expand the limited existing research of not only whether SA history is associated with current relationship functioning but also how and for whom.

Existing literature provides insight into how child SA affects a woman’s emotional intimacy with her current romantic partner. Adult women with a history of child SA exhibit lower overall self-esteem compared with women without a history of child SA (Mullen et al., 1996). Self-esteem, in turn, may be a key component in the ability to self-disclose with one’s partner, thus enhancing emotional intimacy. Indeed, the Intimacy Process Model (e.g., Reis & Shaver, 1988) documents that emotional intimacy develops through a dyadic transaction containing self-revealing disclosure and responsiveness. As one partner reveals information, the other reflects and displays understanding, validation, and caring. Intimacy is achieved when the revealing partner perceives the listening partner’s responsiveness. Relationship distress emerges from dysfunction in emotional intimacy (Fruzzetti, 1996) through the putative mechanisms of invalidation of self-revealing disclosures (Clements, Markman, Cordova, & Laurenceau, 1997) or a general deficit in the ability to identify and disclose emotions (Cordova, Gee, & Warren, 2005). This model may shed light on the present study’s findings; if women with a history of child SA have reduced self-disclosure due to low self-esteem, the level of emotional intimacy with their romantic partner is very likely to be negatively affected.

Moreover, gender differences in perceived emotional intimacy may provide an additional avenue for understanding the role of emotional intimacy in the influence of SA history on current relationship functioning. Research suggests that men’s level of intimacy is predicted more by his own disclosures, while women’s intimacy is predicted by her partner’s empathic response to her disclosure (Mitchell et al., 2008). Among couples in which the woman has experienced child SA, it may be that women’s emotional intimacy is negatively affected due to the fact that she is less likely to self-disclose vulnerable emotional information. As a result, the male partner does not have a chance to empathically respond to that disclosure which, in turn, negatively affects both partners’ relationship satisfaction.

Treatment Implications

Results from the present study demonstrate the wide-reaching negative effects of child and adult SA. For therapists treating depression and anxiety, these data show that properly assessing for the presence of past child and adult SA is important. This point becomes especially important when one considers that these traumatic events are often underreported (see Kilpatrick, Saunders, & Smith, 2003). Within a cognitive-behavioral treatment framework, the therapist may focus on reconstructing maladaptive core beliefs that may have resulted from prior sexual trauma and continue to negatively affect current cognitive styles and assumptions.

The results from the present study also support the inclusion of emotional intimacy as a target for treatment of couple distress and highlight that improvement in this area may be especially important for couples in which the woman has endured a history of child and/or adult SA. Couple therapy has consistently been shown to improve relationship satisfaction (e.g., Shadish & Baldwin, 2005), and many approaches demonstrate emotional intimacy as an important and efficacious change mechanism (e.g., Emotion Focused Therapy, Johnson & Greenberg, 1985; Integrative Behavioral Couples Therapy, Doss, Thum, Sevier, Atkins, & Christensen, 2005).

Limitations, Strengths, and Future Directions

This study is not without important limitations. By relying on self-report data, there is the possibility that responses may have been biased. Participants in the present study were also in the process of seeking outside assistance for relationship problems and were more distressed on average than couples in the community. Therefore, the results from this study may not generalize to couples who are in nondistressed relationships. Furthermore, the restricted range in relationship functioning constructs may have limited the statistical ability to detect significant findings. In addition, specific factors of women’s SA history were not fully assessed or accounted for in the present study. Women’s relationship to the perpetrator of the assault, whether the assault was reported, amount of perceived emotional support, or whether the woman accessed services or resources following the assault (e.g., medical attention, counseling) are important variables that may influence the impact of assault history on current psychological and/or relationship functioning. Future research efforts in this specific domain should be mindful to include these important characteristics. Finally, although both child and adult SA events occurred prior to couples’ reports of current individual and relationship functioning, causal inferences of abuse on functioning cannot be made as data were not collected longitudinally.

However, there are several study strengths worth noting. This is the first study to simultaneously examine the roles of child and adult SA on multiple intrapersonal and interpersonal domains of functioning. By combining multiple consequences of SA into one cohesive model, it was possible to disentangle important influences. Second, this study took an important step forward in understanding the influence of women’s SA history not only on her own relationship satisfaction but also on the relationship satisfaction of her romantic partner. Third, no study to date has investigated indirect associations in examining multiple assault types on both partners’ relationship functioning as the present study has attempted.

Future research in this domain would benefit from simultaneously investigating the influence of men’s, in addition to women’s, SA history on relationship functioning; however, given lower rates of child and adult SA among men, a large sample is needed to be sufficiently powered. Future studies should also assess women’s disclosure of SA history to their romantic partner. Disclosure of child or adult SA history could potentially mitigate the effects of previous abuse on emotional and sexual intimacy. Finally, although the present study identified a direct association between women’s adult SA and their own relationship satisfaction, this association did not operate through any of the variables examined (mental health, sexual intimacy, or emotional intimacy). Therefore, future studies should continue to explore alternative mechanisms through which women’s adult SA affects interpersonal functioning.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award R01HD059802.

Notes

Author Biographies

Emily J. Georgia is a post-doctoral resident at the Miami Veteran’s Administration Medical Center. She received her PhD and MS in Clinical Psychology from the University of Miami. Her research interests include elucidating the influence of traumatic events on couple functioning as well as improving the reach of empirically supported treatments for couple distress.

McKenzie K. Roddy is a clinical psychology doctoral student at the University of Miami. She earned her BS from the University of North Carolina at Chapel Hill. Her research interests include the intersection of couple therapy and psychopathology, as well as serving minority-couple populations.

Brian D. Doss is an associate professor and assistant chair in the Department of Psychology at the University of Miami. He earned a PhD and MS in Clinical Psychology from the University of California, Los Angeles. His research interests include prevention and treatment of relationship distress, web-based intervention, and mechanisms of change.

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