Why Women Are Not Talking About It: Reasons for Nondisclosure of Sexual Victimization and Associated Symptoms of Posttraumatic Stress Disorder and Depression

Abstract

Disclosure of traumatic experiences is typically encouraged and associated with positive outcomes. However, there is limited research on nondisclosure of sexual trauma and consequent symptomology. This online study of undergraduate females examines reasons for nondisclosure and associated symptoms of posttraumatic stress disorder (PTSD) and depression. Of 221 participants who reported sexual victimization, 25% had not previously disclosed it. Four reasons for nondisclosure were identified: shame, minimization of experience, fear of consequences, and privacy. Nondisclosers who minimized the experience and nondisclosers low on shame reported fewer PTSD symptoms than disclosers. These findings suggest that reasons for nondisclosure are associated with symptomology.

Keywords

sexual assault disclosure PTSD

Sexual trauma is a major public health concern in the United States with nearly one in five women experiencing rape and an additional 13% experiencing sexual coercion at some point in their lives (Centers for Disease Control and Prevention [CDC], National Center for Injury Prevention and Control, & Division of Violence Prevention, 2012). In a nationally representative survey of adults, 37% of female rape survivors were first assaulted during the age 18-24 years (CDC et al., 2012). In fact, women in college report sexual victimization at about 54% (CDC et al., 2012; Fisher, Cullen, & Turner, 2000; Jordan, Combs, & Smith, 2014; Karjane, Fisher, & Cullen, 2002; Koss, Gidycz, & Wisniewski, 1987). Women who have experienced sexual victimization are at risk of anxiety, depression, posttraumatic stress disorder (PTSD), substance use, and physical illness (Miller, Canales, Amacker, Backstrom, & Gidycz, 2011; Rothbaum, Foa, Riggs, Murdock, & Walsh, 1992; Sabina & Ho, 2014; Ullman, Townsend, Filipas, & Starzynski, 2007). This emotional and psychological distress, in turn, can influence survivors’ functioning, including academic and career success (Jordan et al., 2014; Wood & Stichman, 2018).

Discussing the details of a traumatic event is encouraged in trauma survivors and thought to lead to more positive psychological outcomes (Pennebaker & Beall, 1986; Pennebaker, Kiecolt-Glaser, & Glaser, 1988; Ullman, 2011). However, little is known about the women who choose to keep experiences of sexual victimization to themselves. Specifically, research has not focused on the reasons why certain women do not disclose these experiences, and few studies have directly examined differences in demographics, symptomology of mood or anxiety disorders, and assault characteristics between disclosers and nondisclosers. The purpose of the current study was to identify reasons for nondisclosure and to examine differences between college women who disclose and do not disclose these experiences. An additional goal was to assess whether specific reasons for nondisclosure are associated with survivor symptomology, as assessed by the number of depression and PTSD symptoms endorsed.

The Disclosure Process and Associated Symptomology

Disclosure of a trauma involves telling someone about the traumatic experience verbally or in a narrative form (Ullman, 2011). Disclosure has been studied to investigate its relative impact on physical and psychological adjustment following a traumatic experience. In a series of studies, Pennebaker and colleagues examined the differences in symptomology of undergraduate students who were asked to write about a traumatic event versus those who were asked to write about trivial events. Using this paradigm, they found that individuals who openly discuss traumatic events may experience negative mood and signs of physical stress (i.e., elevated blood pressure) during and immediately following disclosure; in spite of these symptoms, at a 6-month follow-up, disclosure was associated with fewer visits to a doctor, healthier immune system functioning, and lower levels of subjective distress (Pennebaker & Beall, 1986; Pennebaker et al., 1988).

These findings suggest that disclosure of a traumatic event ultimately leads to positive outcomes. However, research also suggests that the stigma associated with sexual traumas complicates the disclosure process (Ullman, 2011). Studies focusing on only disclosers of sexual victimization have identified a number of factors that influence not only the decision to disclose but also the outcomes of this disclosure. Race has been associated with the decision to disclose sexual assault, with Caucasian women being more likely to discuss the trauma than both African American women (Jacques-Tiura, Tkatch, Abbey, & Wegner, 2010) and Latina women (Ahrens, Rios-Mandel, Isas, & del Carmen Lopez, 2010). In addition, the woman’s age at the time of the assault, the number of victimization experiences, and how well she knew the perpetrator are all factors associated with the likelihood of disclosure of sexual trauma (Hunter, Robinson, & Jason, 2012; Orchowski & Gidycz, 2012). Specifically, women who are older at the time of the assault are more likely to discuss their experience, and as the number of victimization experiences increases, the likelihood of disclosure decreases (Hunter et al., 2012). Furthermore, women who are less acquainted with their perpetrator (i.e., stranger vs. romantic acquaintance) are more likely to discuss the details of their victimization (Orchowski & Gidycz, 2012). Specific assault characteristics have also been identified as increasing the likelihood of disclosure. Women who are involved in a more “stereotypical assault” (i.e., involving a stranger, physical force, or a weapon) are more likely to talk about the experience (Ahrens, Stansell, & Jennings, 2010). Among college women, in particular, the use of alcohol during an assault is associated with an increased likelihood of disclosure (Orchowski & Gidycz, 2012). These characteristics have been identified primarily by research with disclosers of sexual trauma, and the aim of the current study is to see whether these differences remain significant when comparing disclosers with nondisclosers.

Although demographic and assault characteristics can influence the likelihood of sexual victimization disclosure, there are several other factors that can influence the survivor’s symptomology throughout the disclosure process. Brown and Heimburg (2001) applied Pennebaker’s paradigm specifically to women who experienced and disclosed experiences of sexual trauma. Investigators found that written disclosures containing greater detail and moderate level of personalization in the description of the trauma were associated with decreased symptoms of dysphoria and social anxiety 1 month following the task, suggesting that certain aspects of writing about a sexual trauma experience can lead to depression and anxiety symptom reduction in female survivors who disclose their sexual trauma. In reviewing studies with only disclosers of sexual trauma, Ullman (2011) identified several other factors that can influence sexual disclosure outcome, including contextual factors (e.g., private or social setting for disclosure), characteristics of the discloser (e.g., gender, age, culture, personality, attachment style, coping), voluntariness of disclosure, reaction to disclosure, and a history of childhood sexual abuse. In addition, disclosers had fewer PTSD symptoms if they received positive feedback (i.e., providing emotional and informational support) from others following disclosure (Ullman, 2011; Ullman & Peter-Hagene, 2014). However, disclosers who receive negative responses of victim blame, treating the survivors differently, taking control of the situation and recipient-centric responses, were worse off (Ullman, 2011; Ullman & Peter-Hagene, 2014). Findings regarding disclosure of childhood sexual abuse are similar to those of adult victimization, indicating that although disclosure appears to be beneficial and is often associated with lower levels of PTSD, this can be dependent on the type of reactions the child receives in response to disclosure (Bottoms et al., 2014). These findings suggest that although the sharing of certain types of traumatic events may be therapeutic and beneficial, disclosure for sexual trauma survivors is complicated by multiple factors, which can ultimately affect the psychological outcome for the victim.

Characteristics of Nondisclosers

The focus of the aforementioned literature has largely been on the survivors who have disclosed their trauma. Pennebaker’s team and the research that followed studied the consequences of sharing any type of traumatic victimization experience with others. Ullman and colleagues studied factors that influence the outcomes of disclosure for sexual trauma survivors. There remains a dearth of research on survivors who do not disclose their trauma to anyone.

Only one research study known to the authors has examined differences in nondisclosure patterns (nondisclosure, delayed disclosure, immediate one-time disclosure, continual disclosure) on physical and mental health outcomes in female sexual trauma survivors (Ahrens, Rios-Mandel, et al., 2010). The authors reported that nondisclosers were more likely to have experienced a nonstereotypical assault (i.e., not involving strangers, weapons, or serious injury) and were more unlikely to have initially considered the assault to be rape than the other disclosure groups. In addition, Ahrens and colleagues found that nondisclosers endorsed more symptoms of depression and PTSD than the other disclosure groups.

The limited studies that have included rates of nondisclosure among sexual assault victims vary from a 19% nondisclosure rate to a 48% nondisclosure rate (Ahrens, Rios-Mandel, et al., 2010; Jacques-Tiura et al., 2010). The childhood sexual abuse literature provides similar rates of nondisclosure ranging from 23-33% (Bottoms et al., 2014). Given the likely high percentage of sexual trauma survivors who do not disclose and the potential benefits of disclosure, the field would benefit from a better understanding of the barriers to disclosure, including the reasons for nondisclosure. There has been some research focused on reasons for disclosure of sexual victimization, but there is limited research identifying reasons for nondisclosure as it can be challenging to identify and locate survivors who do not disclose this experience to anyone (e.g., friends, family, mental health professionals). However, researchers have been able to investigate the reasons women do not disclose or report sexual victimization specifically to formal sources (e.g., law enforcement, campus police), and these findings can be used to help understand and predict why women would not report this experience to anyone.

Reasons for Nondisclosure to Formal Sources

Approximately 38% of female survivors in the community and fewer than 5% of college female survivors report their sexual assault to law enforcement (Fisher et al., 2000; Karjane et al., 2002). Miller and colleagues (2011) conducted a study with 144 undergraduate female sexual trauma survivors, only one of whom had reported her experience to the police. The remaining women provided reasons as to why they did not disclose the experience to an official authority figure. The authors found five categories of reasons for nondisclosure to law enforcement: (a) minimizing the event or thinking it was not serious enough to report, (b) self-blame or believing the victim should have prevented the trauma, (c) stigma threat or concern for how others would react, (d) not wanting the perpetrator to get into trouble, and (e) believing the perpetrator did not mean to inflict any harm. These findings were further replicated by research examining help-seeking behaviors in sexual trauma survivors. Investigators found that women did not report the trauma to authority figures because they did not identify the experience as rape, wanted to keep it private, did not want their friends and family to find out about it, reported a fear of not being believed, or felt ashamed (Sable, Danis, Mauzy, & Gallagher, 2006; Wood & Stichman, 2018). Although these studies have examined why women do not report these experiences to authority figures, there has not been sufficient research examining why women do not disclose sexual victimization to nonauthority figures, such as family members, close friends, or mental health professionals.

The reasons provided by women for nondisclosure to formal sources are the same as the negative social reactions to victimization (e.g., blaming or stigmatizing the victim–survivor, treating the victim–survivor differently) that have previously been identified and positively associated with PTSD. These themes may provide insight into how anticipated responses to disclosure of sexual victimization influence women’s decisions to share their experiences, as well as predict the levels of emotional and psychological distress they endure (Ullman, 2000; Ullman & Peter-Hagene, 2014; Ullman et al., 2007).

Current Study

Prior research has provided a reasonable framework for how the disclosure process can lead to positive adjustment outcomes for trauma survivors who choose to disclose their experience (Brown & Heimburg, 2001; Pennebaker & Beall, 1986; Pennebaker et al., 1988). In addition, researchers have identified several factors that are likely to lead to more positive outcomes among disclosers of traumatic events (Ullman, 2011; Ullman & Peter-Hagene, 2014). However, few studies to date have examined the differences in symptomology for those who disclose a sexual trauma versus those who do not disclose at all. The current study intends to address these limitations by investigating the characteristics of women who have never disclosed their experience of sexual victimization, using an online methodology that maximizes sample size and reporting (Granello & Wheaton, 2004). This data set is unique in that it was able to capture a group of women who had disclosed information about their victimization for the first time—they had not discussed their trauma previously with anyone. In addition, participants completed an assessment of their reasons for nondisclosure. The purpose of the current study is to examine the reasons for nondisclosure among sexual trauma survivors and to investigate whether there are differences between disclosers and nondisclosers with regard to demographics, assault characteristics, and PTSD and depression symptomology. In addition, we aim to investigate potential differences in symptomology between disclosers and nondisclosers based on the reason for nondisclosure.

Based on the literature with survivors who do not report their experience to formal sources (Miller et al., 2011; Sable et al., 2006; Wood & Stichman, 2018), it is hypothesized that the reasons for nondisclosure of sexual victimization would consist of similar themes, including (a) feelings of self-blame, guilt, and embarrassment; (b) minimizing the event; (c) concerns for the perpetrator; (d) concerns for family members; (e) concerns for stigma associated with sexual assault; and (f) wanting to keep the experience private.

With respect to differences between disclosers and nondisclosers, it is hypothesized that there will be a relationship between race and disclosure status, and ethnicity and disclosure status, with higher rates of nondisclosure expected for African American and Hispanic women than Caucasian women. In addition, there will be a relationship between assault characteristics and disclosure status. Specifically, higher rates of nondisclosure are expected to be associated with lower use of drugs or alcohol, less physical force, and a well-known perpetrator. Furthermore, nondisclosers of sexual trauma are expected to endorse more symptoms of PTSD and depression than disclosers (Ahrens, Rios-Mandel, et al., 2010; Ahrens, Stansell, & Jennings, 2010; Brown & Heimburg, 2001; Campbell et al., 2009; Jacques-Tiura et al., 2010; Orchowski & Gidycz, 2012).

Finally, it was hypothesized that specific reasons for nondisclosure would be uniquely associated with PTSD and depression symptomology (after controlling for key covariates). This research aim is exploratory, and specific a priori hypotheses were not generated as this research question was tested after the qualitative analyses identified the specific nondisclosure themes for these women.

Method

Procedure and Participants

Six hundred and four undergraduate women from two urban universities, one in New York City and one in Miami, Florida, participated in this online study for course credit in 2008 and 2009. They selected the current study among other available studies. All study procedures were approved by the university and institutional review boards. Women who chose to participate in the survey first completed a demographics questionnaire, followed by the Sexual Experiences Survey (SES). Women who endorsed an experience of sexual victimization completed the remaining measures. At the completion of the survey, participants were debriefed, thanked, and given referral information for mental health resources. Of these 604 students, 37% (n = 221) endorsed a history of sexual victimization (i.e., kissing, fondling, petting, attempted intercourse, completed intercourse). Of the 221 participants who experienced sexual victimization, 25% (n = 56) responded “no” when asked whether they had disclosed or talked about the incident with anyone. The participants in this study were a diverse group of undergraduate women in their early twenties. See Table 1 for a demographic breakdown.

Table 1.

Demographics.

	Original sample	History of sexual victimization	History of sexual victimization and disclosed experience	History of sexual victimization and did not disclose experience
N	604	221	165	56
Age, M (SD)	21.12 (4.02)	21.33 (4.23)	21.21 (3.92)	21.65 (5.06)
Race (% White)	51.0	58.4	61.8	48.2
Ethnicity (% Hispanic)	66.1	67.0	68.9	67.3
School location (% Miami)	80.9	82.4	80.6	87.5

Measures

Demographic Questionnaire

A Demographics Questionnaire asked participants to report their age, race, and ethnicity. Participants identified their racial background from a list of available categories and were able to select more than one category (African American or Black, American Indian or Alaskan Native, Asian or Asian American, Caucasian or White, Native Hawaiian or other Pacific Islander, and Other). Of the 221 participants, 58.4% (n = 129) identified as Caucasian, 22.6% (n = 50) identified as “Other,” 10% (n = 22) identified as African American, 6.3% (n = 12) identified as multiracial, and 2.7% identified as Asian (n = 6). Of the 50 participants who identified as “Other,” 90.4% (n = 47) identified as Hispanic. The sample sizes for African American, Asian, and multiracial were very small, particularly when further examining the data in disclosure compared with nondisclosure groups. Therefore, all race categories were collapsed into two groups (White and Other), which parsimoniously represented the data. Ethnicity was also examined, which was a more appropriate way to investigate differences based on the diversity in this sample, with 67.0% of participants identifying as Hispanic and 30.8% identifying as not Hispanic.

The Sexual Experiences Survey (SES)

The SES (Koss & Oros, 1982) is a self-report measure of unwanted sexual experiences. Participants reported whether they experienced a variety of unwanted sexual experiences ranging from “sex play (fondling, kissing or petting)” to “sex (vaginal, anal or oral intercourse)” for multiple reasons, ranging from “because you were overwhelmed by a man’s continual arguments and pressure” to “because a man threatened or used some degree of physical force.” Data on the survivor–perpetrator relationship were also collected (stranger, acquaintance, casual date, romantic acquaintance, spouse, relative, or other). This survey has been tested with a large number of college students (Koss et al., 1987; Koss & Oros, 1982) and in assessment of responses to sexual trauma disclosure (Ullman & Filipas, 2001). Test–retest reliability was assessed in past research and a mean of 93% agreement was reported for the two administrations 1 week apart. This measure also has considerable validity with college women. The Pearson correlation between a woman’s level of victimization as reported on the SES and the level of victimization identified during an interview with a trained psychologist was .73 (p < .001; Koss & Gidycz, 1985).

Nondisclosure themes

Nondisclosure themes were derived from experiences reported on the SES. Participants were asked to identify which sexual experience or experiences they considered to be the most traumatic. They were then asked whether they had disclosed or talked with anyone about these events. Those who did not previously disclose the trauma then responded to the following open-ended question: “If you have not disclosed this to anyone, why did you choose to keep it to yourself?” Qualitative analysis of these reasons for nondisclosure was conducted to derive common themes. The content of these themes and how they were identified is discussed in more detail below in the “Data Analysis” and “Results” sections.

The Beck Depression Inventory

The Beck Depression Inventory–Second Edition (BDI-II; Beck, Steer, & Brown, 1996) is a 21-item self-report assessment of dysphoria that assesses a range of depressive symptoms, including sadness, anhedonia, hopelessness, guilt, and changes in sleep and appetite. Standard administration and scoring guidelines were followed. Participants chose a response for each item that best reflects how they have been feeling in the past 2 weeks from four possible options representing levels of severity of a symptom. Each item is scored on a 4-point scale (0-3) with possible total scores ranging from 0-63, with higher scores indicating higher levels of depressive symptomology. The BDI-II is a widely used measure with considerable reliability and validity (Beck, Steer, & Garbin, 1988; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961), including with survivors of sexual trauma (Cheastey, Clare, & Collins, 2002; Nikulina, Bautista, & Brown, 2016). In the current study, Cronbach’s alpha is equal to .93 and survivors reported an average of 10.54 (SD = 10.3) symptoms, which indicates minimal depression (Beck et al., 1996).

The PTSD Symptom Scale (PSS)

The PSS (Foa, Riggs, Duncan, & Rothbaum, 1993) is a 17-item, self-report measure assessing participants’ symptoms of PTSD over the past 2 weeks. This measure is based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) criteria; for the purposes of this study, the symptomology severity was calculated. Responses are on a Likert-type scale ranging from 0 (not at all) to 3 (five or more times per week/very much/almost always). Participants completed the assessment in reference to the most severe sexual trauma experience reported on the SES. The PSS has considerable validity and reliability, including with survivors of sexual assault (Ahrens, Rios-Mandel, et al., 2010; Foa, Cashman, Jaycox, & Perry, 1997). Total PTSD severity score was used in this study, with higher scores indicating increased symptomology. In the current study, PSS has a Cronbach’s alpha of .91 and survivors reported 8.33 (SD = 8.80) symptoms on average, which is slightly lower than studies with similar populations (Ahrens, Rios-Mandel, et al., 2010).

Data Analysis

To test the first hypothesis and identify reasons for nondisclosure, a qualitative analysis was conducted. Two doctoral students (first and second authors) analyzed the content of the nondisclosure reasons provided by all participants and identified several recurring categories. These were discussed with the other authors and consensus was reached on four common themes that encompassed all recurring categories. The two raters then independently coded each response into one or two of the four categories as some participants provided up to two reasons for nondisclosure. Interrater reliability was calculated on these codes; the kappa coefficient was .80, indicating a substantial interrater agreement on identified themes (Viera & Garrett, 2005). In most cases, the disagreements involved one rater only applying one theme when two applied. In these cases, the codes were changed to reflect both themes after a discussion among the authors. Prevalence rates of reasons for nondisclosure were computed by running frequencies for each of the four categories.

All subsequent analyses were conducted with SPSS v. 24. To test the second hypothesis and identify bivariate differences in demographics, assault characteristics, and symptomology between disclosers and nondisclosers, chi-square and independent-samples t tests were used. To test the third hypothesis and identify bivariate differences in PTSD and depression symptoms based on nondisclosure themes, a series of one-way ANOVAs was used. In these analyses, we compared (a) all the women who disclosed, (b) women who did not disclose and endorsed a specific theme, and (c) women who did not disclose and did not endorse the given theme. Each theme was analyzed separately. Omnibus analyses were followed with Games–Howell post hoc t tests to identify the sources of the differences between the three groups. To further assess whether reasons for nondisclosure are associated with symptomology over and above demographics and assault characteristics, hierarchical ordinary least squares regressions were run, with the nondisclosure theme entered as the predictor and symptomology as the outcome. Step 1 of each regression included relevant covariates (demographic and assault characteristics). Covariates were selected based on past literature on variables associated with victim functioning to establish whether nondisclosure themes predicted symptomology over and above known risk factors (Nikulina et al., 2016). The second step of each regression included two dummy coded variables: (a) the first dummy code compared the nondisclosure group endorsing the specific theme with disclosers and (b) the second compared the nondisclosure group without the specific theme with disclosers.

Results

Reasons for Nondisclosure

The four nondisclosure themes that were identified among the 56 women who did not disclose their victimization are (a) shame or embarrassment, (b) minimization of the experience, (c) fear of consequences, and (d) privacy. These results support our hypothesis that the reasons for nondisclosure of sexual victimization would consist of similar themes as nondisclosure to formal sources, including (a) feelings of self-blame, guilt, and embarrassment; (b) minimizing the event; (c) concerns for the perpetrator, family members, and for the stigma associated with sexual assault; and (d) wanting to keep the experience private. Due to the small sample size and the overlap in content, concerns for the perpetrator, family, and stigma were collapsed into a single category (fear of consequences). The shame or embarrassment code was defined as any response that contained content referring to self-blame, shame, or embarrassment surrounding the sexual trauma experience itself or the act of talking about the trauma (e.g., “I’m ashamed I didn’t walk away” and “It was a shameful event to talk about”). Twenty-seven percent (n = 15) of participants were categorized into this first theme. The minimization of the experience code was defined as any response that minimized either the sexual trauma experience or the perpetrator’s behavior. This was the most prevalent theme with 43% (n = 24) of participants providing responses such as “I feel like it wasn’t of big importance” and “It wasn’t a big deal. He didn’t mean anything wrong by it.” The fear of consequences code was defined as any response that contained content referring to fear of consequences of disclosure for themselves, their families, or the perpetrator. Sixteen percent (n = 9) of participants endorsed this theme with responses such as “I didn’t want to cause the whole family to break apart,” and “I didn’t want him to lose his job.” The privacy code was defined as any responses that emphasized the need for confidentiality and privacy. This theme was the least prevalent with 10.7% (n = 6) of participants endorsing this theme with responses, such as “It’s a private matter” and “It’s nobody else’s business.” Eighty-two percent (n = 46) of participants endorsed one theme only and 18% (n = 10) of participants provided responses that were categorized into two themes (e.g., “I was not hurt, there was nothing to tell. I suppose to some extent it was my fault for putting myself in that position”). All women who provided a nondisclosure reason were categorized into one of the four themes; no data were eliminated. The women who did not provide their reasons for nondisclosure were not included in the aforementioned themes. However, they were still used in the analyses below as “nondisclosers” and later as “nondisclosers who did not endorse a specific theme.” These thematic categories were then used to test the third hypothesis.

Differences Between Disclosers and Nondisclosers

When we tested the second hypothesis that there would be differences between disclosers and nondisclosers on assault characteristics, demographics, and symptomology, significant differences were found on drug/alcohol use during the assault and the survivor–perpetrator relationship, but no other variables. All bivariate differences among disclosure versus nondisclosure groups are presented in Table 2. Participants who did not disclose were less likely to report drug/alcohol use during the assault than those who did disclose, χ²(1, n = 221) = 8.04, p = .005. In addition, participants who disclosed were more likely to report that the perpetrator was an acquaintance than nondisclosers, χ²(1, n = 185) = 15.25, p < .001, whereas nondisclosers were more likely to report that the perpetrator was a romantic acquaintance than disclosers, χ²(1, n = 185) = 8.19, p = .006. These results support our hypotheses that nondisclosers would be less likely to report drug/alcohol use during the assault and more likely to have a close relationship with the perpetrator. There were no significant differences between disclosers and nondisclosers on demographics, type of force, and BDI-II and PSS scores. However, effect size calculations demonstrate that although the t statistic is not significant, there is a medium effect (d = 0.30) of group on PSS scores, with disclosers (M = 8.90) endorsing more PSS symptoms than nondisclosers (M = 6.60). These results are not consistent with our second hypothesis regarding differences in race, ethnicity, force, and symptomology between disclosers and nondisclosers.

Table 2.

Bivariate Differences in Demographics, Assault Characteristics, and Symptomology Between Disclosers and Nondisclosers.

Measure	Disclosers	Nondisclosers	t (df)	Cohen’s d
Age, M (SD)	21.21 (3.92)	21.65 (5.06)	−0.65 (212)	−0.08
PSS score, M (SD)	8.90 (9.03)	6.60 (7.75)	1.70 (219)	0.30
BDI-II score, M (SD)	10.42 (10.17)	10.54 (10.25)	−0.08 (219)	−0.01
			Chi-square value (df, n)	Phi
Race (% White)	61.8	48.2	χ²(1, n = 221) = 3.18	.12
Ethnicity (% Hispanic)	68.9	67.3	χ²(1, n = 216) = 0.05	.02
School location (% Miami)	80.6	87.5	χ²(1, n = 221) = 1.37	−.08
Drug use during assault (% reported)	19.4	3.6	χ²(1, n = 221) = 8.04*	−.19
Assailant use of force (% reported)	20.8	6.3	χ²(1, n = 221) = 0.18	−.03
Perpetrator (% acquaintance)	26.1	1.8	χ²(1, n = 185) = 15.25***	−.29
Perpetrator (% romantic acquaintance)	33.9	51.8	χ²(1, n = 185) = 8.19**	.21

Note. PSS = PTSD Symptom Scale; BDI-II = Beck Depression Inventory–Second Edition.

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

Nondisclosure Reasons and Associated Symptomology

To test our third hypothesis investigating differences in symptomology based on nondisclosure reason, separate bivariate analyses were conducted between the nondisclosers in each of the four categories (i.e., shame or embarrassment, minimization of the experience, fear of consequences, and privacy) and those who shared their sexual trauma experience. There were significant differences in PSS scores for the theme of shame or embarrassment with a small to medium effect size. Levene’s test was significant (p = .006), so a Games–Howell post hoc analysis was conducted. Post hoc tests demonstrate that nondisclosers who were low on shame had lower PSS scores than both disclosers and nondisclosers high on shame.

Significant group differences in PSS scores were also found for the minimization of the experience theme with a small to medium effect size. Games–Howell post hoc analyses demonstrated that nondisclosers who minimized the experienced had lower PSS scores than both nondisclosers who did not minimize the event and women who disclosed the experience. There were no significant differences among the disclosure versus nondisclosure groups by theme on BDI-II scores. These results (see Table 3) support our hypothesis that specific reasons for nondisclosure, specifically shame/embarrassment and minimization of experience, would be associated with PTSD symptomology; however, they do not support our hypothesis that nondisclosure reasons would be associated with depression symptomology.

Table 3.

Differences in Depression and PTSD Symptomology Among Disclosure Versus Nondisclosure by Theme.

	BDI-II				Effect size	PSS				Effect size
	DisclosureM (SD)	Nondisclosure and endorsed themeM (SD)	Nondisclosure and did not endorse themeM (SD)	F (df)	Effect size	DisclosureM (SD)	Nondisclosure and endorsed themeM (SD)	Nondisclosure and did not endorse themeM (SD)	F (df)	Effect size
ShameN (%)	10.42 (10.17)165 (74.7%)	15.07 (10.82)15 (6.8%)	8.88 (9.64)41 (18.6%)	2.06 (2, 218)	η² = .02	8.92 (9.03)165 (74.7%)	11.93 (9.04)^a 15 (6.8%)	4.68 (6.28)^b 41 (18.6%)	5.40 (2, 218)*	η² = .05
MinimizeN (%)	10.42 (10.17)165 (74.7%)	9.63 (10.42)24 (10.9%)	11.22 (10.23)32 (14.5%)	0.17 (2, 218)	η² = .002	8.92 (9.03)^a 165 (74.7%)	3.46 (3.89)^b,c 24 (10.9%)	9.00 (9.04)^b,d 32 (14.5%)	4.30 (2, 218)*	η² = .04
FearN (%)	10.42 (10.17)165 (74.7%)	12.67 (8.03)9 (4.1%)	10.12 (10.64)47 (21.3%)	0.24 (2, 218)	η² = .002	8.92 (9.03)165 (74.7%)	9.22 (4.69)9 (4.1%)	6.13 (8.15)47 (21.3%)	1.92 (2, 218)	η² = .02
PrivacyN (%)	10.42 (10.17)165 (74.7%)	7.5 (4.23)6 (2.7%)	10.90 (10.71)50 (22.6%)	0.30 (2, 218)	η² = .003	8.92 (9.03)165 (74.7%)	6.67 (7.47)6 (2.7%)	6.62 (7.85)50 (22.6%)	1.44 (2, 218)	η² = .01

Note. Percent is out of the 221 women who reported a history of sexual victimization. PTSD = posttraumatic stress disorder; BDI-II = Beck Depression Inventory–Second Edition; PSS = PTSD Symptom Scale.

Significantly higher scores than ^bat p < .05.

Significantly higher scores than ^dat p < .05.

p < .05.

The two significant themes that were associated with PTSD differences for women in the disclosure and nondisclosure groups in bivariate analyses were further analyzed in multivariate models using hierarchical ordinary least squares regressions to assess whether reasons for nondisclosure predict PTSD symptomology over and above known risk factors (i.e., demographic and assault characteristics). In the current sample, participants who were living in New York endorsed higher PTSD and depression symptoms than those living in Miami, so this was included as a covariate. Assault characteristics reflect the type of force used (i.e., pressure, authority, physical force) and the use of drugs or alcohol during the victimization, both measured in the SES. The type of assault (i.e., sex play, attempted intercourse, completed intercourse) did not differ between the groups nor did it predict symptomology in this sample and, therefore, was not included in the analyses. The type of perpetrator (i.e., acquaintance, romantic acquaintance, other) was not included as a covariate in the analyses as it did not predict symptomology in this sample, and existing research has provided conflicting findings regarding the association between the survivor–perpetrator relationship and subsequent psychopathology (Culbertson & Dehle, 2001; Ullman, Filipas, Townsend, & Starzynski, 2006). In both models, school location, being non-White, and the use of force by the assailant were significant predictors of PSS scores. In the first model, the second step of the regression examined the endorsement of shame or embarrassment as a predictor of PTSD symptoms. Those who did not report shame and embarrassment as a reason for nondisclosure endorsed fewer PTSD symptoms than disclosers, after controlling for relevant covariates (see Table 4). There were no differences in PTSD symptomology between women who shared their experience with someone and women who did not disclose for reasons of shame or embarrassment.

Table 4.

Endorsement of “Shame or Embarrassment” and Predicting Symptoms of PTSD.

	PSS scores
	β	95% CI
	β	Lower bound	Upper bound
Step 1
New York	.17*	0.53	11.70
Age	−.009	−0.31	0.27
Non-White	.16*	0.55	5.34
Hispanic	−.08	−4.28	1.18
Drugs use during assault	.09	−1.22	5.53
Assailant used force	.20**	1.33	13.54
Step 2
Nondisclosure with shame and embarrassment^a	.06	−2.66	6.63
Nondisclosure without shame and embarrassment^a	−.18*	−7.00	−0.97
Model summary statistics
F	4.17***
Adjusted R²	.08**
Second step R² change	.04*

Note. PTSD = posttraumatic stress disorder; PSS = PTSD Symptom Scale; CI = confidence interval.

Reference group is disclosers.

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

The second model examined the endorsement of minimizing the experience as a predictor of PTSD. Those who minimized their experience and did not disclose the event to anyone endorsed fewer PTSD symptoms than women who shared their experience with someone after controlling for relevant covariates (see Table 5). There were no differences in PTSD symptomology between the women who disclosed their trauma experience and the women who did not disclose or endorse minimizing the event. None of the nondisclosure themes were associated with depression differences for women in the disclosure and nondisclosure groups and, therefore, were not further investigated.

Table 5.

Endorsement of “Minimization of Experience” and Predicting Symptoms of PTSD.

	PSS scores
	β	95% CI
	β	Lower bound	Upper bound
Step 1
New York	.17*	0.53	7.51
Age	−.009	−0.31	0.27
Non-White	.16	0.55	5.34
Hispanic	−.08	−4.28	1.18
Drug use during assault	.09	−1.22	5.53
Assailant used force	.20**	1.33	6.81
Step 2
Nondisclosure with minimization of experience^a	−.18**	−8.85	−1.44
Nondisclosure without minimization of experience^a	−.007	−3.56	3.19
Model summary statistics
F	4.07***
Adjusted R²	.08**
Second step R² change	.03*

Note. PTSD = posttraumatic stress disorder; PSS = PTSD Symptom Scale; CI = confidence interval.

Reference group is disclosers.

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

Discussion

The goal of the current study was to investigate the reasons why survivors of sexual trauma do not disclose these experiences to others and to examine differences in demographics, assault characteristics, and symptomology between nondisclosers and disclosers in a diverse sample of female college students. Prior research has investigated the effects of disclosure on psychological and physical outcomes and how characteristics of the disclosure process can influence these outcomes, but few studies have compared women who disclose sexual trauma experiences with women who have not previously shared these experiences. Although the current literature indicates that disclosure of traumatic events is often associated with positive psychological and physical health outcomes (Pennebaker & Beall, 1986; Pennebaker et al., 1988), especially in the context of supportive responses from the disclosure recipient (Ullman, 2011; Ullman & Peter-Hagene, 2014), our overall findings suggest that disclosure may not always be more beneficial than nondisclosure for survivors of sexual trauma and that reasons for nondisclosure are associated with survivor symptomology.

Reasons for Nondisclosure

The four themes that emerged for nondisclosure were (a) shame or embarrassment (e.g., “It was a shameful event to talk about”), (b) minimization of the experience (e.g., “It wasn’t a big deal”), (c) fear of consequences (e.g., “I’m afraid of how the information will affect my family”), and (d) privacy (e.g., “It is a private matter”). These themes are similar to what has previously been found in the literature regarding nondisclosure to authority figures, including feeling ashamed, self-responsibility, minimizing the event, minimization of perpetrator’s behavior, fear of trouble for perpetrator, fear of not being believed, and concerns with confidentiality (Fisher et al., 2000; Miller et al., 2011; Sable et al., 2006; Wood & Stichman, 2018). The parallels between the reasons for nondisclosure identified in the current study and those in previous literature on authority figure disclosure suggest that survivors are withholding their sexual trauma experiences from everyone (e.g., social circle, family) for many of the same reasons they report not disclosing the assault to authority figures.

Differences Between Disclosers and Nondisclosers

When examining the differences between the disclosure and nondisclosure groups, we found that participants who disclosed their experience were more likely to report drug and alcohol use during the assault than those who did not disclose. This is consistent with our hypothesis and prior research indicating that women involved in a “stereotypical” assault are more likely to disclose and that college women are more likely to disclose an assault involving alcohol or drug use (Ahrens, Rios-Mandel, et al., 2010; Campbell et al., 2009; Orchowski & Gidycz, 2012). There has been an effort to educate college students on sexual assault and the inability to provide consent while intoxicated; so, it is possible that these educational programs have encouraged female sexual trauma survivors to open up about an assault when drugs or alcohol are involved (Karjane et al., 2002). There were no differences in demographics or type of force between the disclosure and nondisclosure groups, suggesting that the women who choose to disclose these experiences may be similar to those who do not, particularly with regard to ethnicity and assault severity. These findings were surprising and contradicted our hypotheses. In addition, they conflict with prior research, which has found that women who disclose are more likely to be White than Latina and more likely to report a stereotypical assault involving force or weapon (Ahrens, Rios-Mandel, et al., 2010; Ahrens, Stansell, & Jennings, 2010). The fact that these women are very similar to one another suggests that there may be some other relevant variable leading certain women to disclose the trauma and others to keep it to themselves.

Our findings suggest that the relationship between the survivor–perpetrator is associated with a woman’s decision to disclose. Consistent with prior literature, we found that women who were in a distant relationship with the perpetrator were more likely to disclose (Orchowski & Gidycz, 2012). Specifically, nondisclosers were more likely to identify the perpetrator as a romantic acquaintance than disclosers, whereas disclosers were more likely to report that the perpetrator was a nonromantic acquaintance. Furthermore, in the current study, several nondisclosers reported that they feared consequences for the perpetrator and minimized the perpetrator’s actions, and it is possible that these sentiments were associated with the closeness of the relationship between the perpetrator and the survivor. It is estimated that 15% of sexual assaults involving female survivors are committed by their husbands or romantic partners; however, this may be an underestimate given that these women are less likely to disclose their abuse (Russell, 1990; Tjaden & Thoennes, 2000; Ullman et al., 2006). These findings provide further support for research that has identified college-aged women as the highest risk age group for experiencing intimate partner violence (IPV) and also the least likely to report IPV (Hill & Ousley, 2017). In the current sample, more than half of all nondisclosers reported that they had a romantic relationship with the offender, highlighting the need to provide appropriate IPV screenings and psychological interventions with this population.

When examining differences in symptomology across all participants, regardless of reasons for nondisclosure, the findings suggest that sexual trauma survivors who do not disclose their experience are not necessarily worse off than those who do disclose their trauma. These results contradict our hypotheses and prior research demonstrating that nondisclosers had increased depression and PTSD symptoms compared with disclosers (Ahrens, Rios-Mandel, et al., 2010). Ahrens and colleagues used flyers, brochures, and presentations to invite sexual trauma survivors to participate in a confidential interview. These nondisclosers may have decided they were ready to discuss their trauma with someone, encouraging them to volunteer to participate. In the current study, women were unaware that the study was specifically focused on sexual victimization experiences prior to signing up. Of note, the PTSD scores for both the disclosers and the nondisclosers in the current study were significantly lower than the participants’ scores in the previous study. Differences in recruitment techniques as well as sampling (college vs. community women who have identified themselves as survivors of sexual trauma) may explain the disparities in our findings. Our follow-up analyses examining symptomology differences by the nondisclosure theme indicate that the survivor’s specific reason for nondisclosure may be related to subsequent psychopathology and help to explain these findings.

Nondisclosure Reasons and Associated Symptomology

The nondisclosers who did not report feelings of shame or embarrassment reported fewer symptoms of PTSD than the nondisclosers who reported feelings of shame and embarrassment. These results are consistent with prior research reporting that cultural messages of victim blame are often internalized by sexual trauma survivors and can lead to maladaptive coping strategies, an increase in PTSD and depression symptoms, as well as a decreased likelihood of seeking support (Campbell et al., 2009). The levels of PTSD symptoms among nondisclosers who endorse shame or embarrassment suggest they may benefit from support. Difficulty seeking support may be associated with shame, victim blame, self-blame, and anticipatory stigma (a belief that by revealing the details of an assault, one will be stigmatized as blameworthy or lesser), which are consistently seen in survivors of sexual assault (Kennedy & Prock, 2016). These results highlight the importance of educating the general public (including those who are survivors of abuse and those who are not) about sexual victimization and how to appropriately respond to survivors’ disclosures as well as the need for developing ways to reach out to women who are suffering but are not discussing their experience with anyone.

In addition, women who did not disclose the trauma and minimized the experience also endorsed fewer PTSD symptoms than women who disclosed their experience. However, those who did not disclose but did not minimize the experience had similar PTSD and depression symptomology as women who previously disclosed their trauma. Frazier and Burnett (1994) found that keeping busy and distracting oneself from thoughts and feelings about an assault were associated with lower distress levels in rape survivors. They argue that these strategies are effective because they are emotion-focused strategies, which have been found to be helpful in dealing with problems that are uncontrollable, such as sexual assault. Similarly, not feeling as though the event was a “big deal” may potentially be an effective emotion-focused coping strategy for some of the women in the current study. However, although this strategy may be effective in the near term, approach coping strategies are more effective in the long term. Although this strategy may currently appear successful for these women, a follow-up study would be necessary to determine whether a minimization approach remains effective in predicting fewer PTSD symptoms. In addition, it is possible that the women in this group are utilizing a repressive coping strategy, which is the tendency to direct attention away from negative affective experiences. Repressive coping behaviors involve automatic biases and self-deceptive processes, distinguishing these behaviors from avoidant coping behaviors. Repressive coping behaviors have been associated with fewer symptoms of psychopathology, fewer health problems, and fewer somatic complaints in survivors of child sexual abuse as well as individuals who have experienced extremely aversive events (e.g., the death of a spouse; Bonanno, Noll, Putnam, O’Neill, & Trickett, 2003; Coifman, Bonanno, Ray, & Gross, 2007). Responding to a sexual assault survivor’s disclosure by minimizing or dismissing the experience is a type of negative social reaction and can lead to an increase in PTSD symptoms for the survivor. However, these findings suggest that although a minimization reaction may be deleterious for survivors, a minimization coping style may actually be protective for the women who are not talking about their experience or receiving external support.

Endorsement of fear of consequences and privacy themes for nondisclosure was not associated with PTSD and depression symptoms. Although few women endorsed these themes in the current study, the associated effect sizes for the symptom differences were of very small magnitude, suggesting that lack of significant findings is unlikely to result from low power. Even with increased sample size, a similar effect and nonsignificant result may be found.

These findings are not causational, and the direction of the relationship between disclosure and symptomology is unknown. It is possible that the PTSD symptoms are driving certain women to disclose their experience. These symptoms may also influence their perception of the experience as well as increase their negative thoughts surrounding the event. Similarly, the reasons provided for nondisclosure may represent a cognitive response to the symptoms they are experiencing. For example, if someone is experiencing very few symptoms, she may be less likely to view the event as significant and, therefore, choose to not share the experience with anyone. However, someone who is enduring high levels of symptomology may attribute more significance to the experience and feel more inclined to discuss the trauma.

Clinical and Policy Implications

These findings indicate that disclosure may not always be associated with benefit for sexual trauma survivors. The clinical implications of this study highlight the importance of understanding women’s reasons for nondisclosure of sexual victimization experiences. Certain reasons for nondisclosure may be related to positive adjustment (e.g., minimization of the experience or not feeling ashamed or embarrassed), whereas others may put a victim at risk of poor psychological outcomes (e.g., feeling ashamed or embarrassed). Studies have found that women who receive negative feedback following the disclosure of a sexual victimization experience are at a higher risk of experiencing PTSD symptoms than those who experience positive feedback (Ullman, 2011; Ullman & Peter-Hagene, 2014). Negative responses can include victim blame, distractions (e.g., telling the victim to move on with his or her life), taking control of the survivor’s decisions, or treating the victim differently (e.g., stigmatizing). Reasons for nondisclosure in the current study included responses such as “people would believe him over me” and “I feel like if I told someone about it, they would think I was stupid for letting that happen to me.” These responses have considerable overlap with the types of negative feedback, particularly victim blame and treating the victim differently, demonstrating that the fears these women report may not be unrealistic or unfounded. Campbell and colleagues (2009) argue that societal rape myths contribute to self-blame in assault survivors and victim blame in response to sexual trauma disclosure. The current findings support this idea and demonstrate how broad cultural attitudes surrounding sexual trauma experiences and victim blame can be internalized by women, affecting their mental health outcomes and contributing to survivors’ cognitions surrounding the sexual trauma as well as their decreased likelihood of seeking support and disclosing the experience to both authority and nonauthority figures (Campbell et al., 2009). Twenty-seven percent of the nondisclosers endorsed feelings of shame or embarrassment surrounding the experience. These findings demonstrate the importance of working in the community and reaching out to women who may experience feelings of shame or embarrassment after an assault to properly intervene. This also underlines the need for considering the cultural messages surrounding sexual trauma and educating the general public about sexual victimization. Common treatment approaches and interventions for trauma survivors involve discussing details about the traumatic event. It is important to recognize that therapeutic approaches involving exposure to the traumatic experience by developing a trauma narrative may not be the most relevant interventions for all survivors.

Limitations

These conclusions should be considered while taking into account several limitations. The participants in this study were young college women from two urban universities in the Eastern United States and, thus, these results may not generalize to other populations. Another important demographic limitation to note is that this sample had few participants who identified as African American or Asian. Due to the breakdown of the sample, the race categories were collapsed into White or Other. The results do not intend to suggest that all women who identify as non-White have equivalent experiences. It would be helpful for future research to examine a larger sample to identify whether there are differences across races in disclosure versus nondisclosure, particularly because research suggests that African American women are less likely to disclose (Jacques-Tiura et al., 2010).

As mentioned previously, this was a cross-sectional study and the direction of the relationship between disclosure, symptoms, and reasons for nondisclosure cannot be determined. Future research would benefit from longitudinal studies examining similar constructs to better determine the nature of these relationships. The SES was administered with the intention of collecting information on experiences in early adulthood, but it is possible that some participants reported childhood experiences. Few participants reported the timing of the victimization, so this potential limitation could not be controlled for. However, a majority of participants reported that the perpetrator was someone they were dating, a romantic acquaintance, or a spouse, indicating that the trauma occurred when participants were at least of dating age. Furthermore, the data analyzed in this study were collected in 2008 and 2009, and these findings may not be generalizable to the current time, particularly following the #MeToo social movement encouraging survivors of sexual trauma to disclose their experience. However, although there may be different or additional reasons for nondisclosure for women who were victimized after the #MeToo movement, many of the themes identified may still be relevant for women who were assaulted prior to the movement, but were encouraged to disclose following the onset of this social campaign. The themes identified by the current study may actually be used to help understand why many women chose to keep their experiences to themselves for so long prior to this social movement.

In addition, this study was conducted online and consisted solely of self-report measures, limiting the data to the perceptions of each individual participant. However, an online approach was used to increase anonymity and provide an opportunity for women to honestly report their sexual experiences. To ensure the quality of the data collected, a consistency check was employed to identify and screen for implausible demographic combinations (e.g., race, ethnicity, place of birth; Aust, Diedenhofen, Ullrich, & Musch, 2013). No data were excluded following this technique. In addition, this online survey was restricted to undergraduate students who provided their names (unlinked with their responses) to receive course credit. The data were checked in SPSS for duplicate entries and no duplicates were found. Restricting the sample and compensating with college credit reduced the likelihood of participants taking the survey multiple times as well as eliminated participants who search the Internet for paid studies (Aust et al., 2013). Sample size calculation was conducted based on prevalence rates for sexual victimization; however, there are few studies providing consistent base rates for nondisclosure of sexual trauma. Although the overall disclosure and nondisclosure sample sizes are adequate, sample size of two of the individual themes (fear of consequences and privacy) are particularly small. To account for this, effect sizes were examined in addition to the test statistics. The prevalence rates for nondisclosure and the reasons for nondisclosure found in the current study should be used as a guide for sample size calculation in future research regarding nondisclosure.

Despite the limitations mentioned above, this is one of the only studies to examine reasons for nondisclosure as well as differences in demographics, assault characteristics, and PTSD and depression symptomology among women who disclose their experience compared with women who do not. Although the sample was limited to college women, this population has been found to experience sexual victimization at a higher rate and was an appropriate sample for these research questions (CDC et al., 2012; Karjane et al., 2002). In the wake of the recent societal focus on disclosure of sexual victimization, it is especially important to conduct research that can help to further understand the disclosure process for sexual trauma survivors. In conclusion, the current study suggests that the disclosure process is unique for sexual trauma survivors and may not always lead to more positive psychological outcomes. Finally, these results provide additional support that there are reasons for sexual trauma nondisclosure that reflect a broader cultural perspective on sexual victimization.

Footnotes

Acknowledgements

The authors thank the women who participated in this study and shared their victimization experiences with the researchers. The authors also thank the psychology departments of the participating institutions for supporting this study.

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: The authors thank the Graduate Center, City University of New York, who supported the first two authors with fellowship funding while working on this article. There were no other sources of financial support for the research, authorship, and/or publication of this article.

Author Biographies

Kaitlin Walsh Carson is pursuing her PhD in clinical psychology at Queens College and the Graduate Center, affiliates of the City University of New York. She received her bachelor’s degree in psychology from Fordham University and her master’s degree in counseling and clinical psychology from Columbia University’s Teachers College. Her prior research interests include investigating word-finding difficulties in children and adults with epilepsy as well as understanding the impact of maternal trauma on offspring development. Currently, her research focuses on investigating the potential moderating role of coping strategies on the relationship between disclosure status and psychopathology in sexual trauma survivors.

Sara Babad is pursuing a PhD in clinical psychology at Queens College and the Graduate Center, affiliates of the City University of New York (CUNY). While completing her BS at the Macaulay Honors College at Brooklyn College, CUNY, she researched the relationship between stress effects and psychotic-like symptoms in nonclinical individuals with no psychiatric diagnoses. Her current research focuses on elucidating the elevated risk of revictimization observed in survivors of childhood trauma. Most recently, she is exploring the role of attachment styles and psychosocial function in the relationship between childhood trauma and health risk behaviors.

Elissa J. Brown is professor of Psychology and Executive Director of the Child HELP (Heal, Empower, Learn, Prevent) Partnership at St. John’s University. Her primary clinical and research interests include the prevention and treatment of child trauma and posttraumatic stress disorder. She has participated in research on sexual abuse and assault, child physical abuse, domestic violence, and bereavement related to traumatic circumstances (such as September 11, 2001). She is a member of several organizations dedicated to improving mental health services for traumatized children and has served on the Board of the American Professional Society on the Abuse of Children.

Claudia Chloe Brumbaugh is a social-personality psychologist who primarily researches adult attachment. She has used social-cognitive paradigms to determine how experiences in past relationships influence experiences in new and ongoing relationships. She also uses principles from evolutionary psychology to examine how relational decisions and behaviors might be adaptive. A substantial portion of her current research centers on people’s level of self-awareness in relationship initiation processes, as well as how people handle romantic breakups.

Betzabe K. Castillo is a volunteer research assistant for the Dr. Valentina Nikulina’s Laboratory at Queens College. She received a master’s degree in General Psychology from Queens College and a bachelor’s degree in Psychology and minor in Sociology from St. John’s University. She has worked as an outreach coordinator in conjunction with religious organizations for a study that focuses on youth Latino populations who experienced traumatic life events. Her main interests of study are negative effects of corporal punishment in children, cultural factors that impede reporting sexual assault, and the positive effects of cultural integration on psychotherapy.

Valentina Nikulina is an assistant professor in the Psychology Department at Queens College and the Graduate Center at the City University of New York. Her research examines the consequences of traumatic experiences from an ecological perspective. She is also interested in efficacy-based treatment of trauma sequelae.

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