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The role of traumagenic dynamics on the psychological adjustment of

survivors of child sexual abuse

Article in European Journal of Developmental Psychology · November 2012

DOI: 10.1080/17405629.2012.660789

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The role of traumagenic

dynamics on the psychological
adjustment of survivors of child
sexual abuse
a b
David Cantón-Cortés , María Rosario Cortés & José
b
Cantón
a
Facultad de Psicología, University of Málaga, Málaga,
Spain
b
Facultad de Psicología, University of Granada,
Granada, Spain

Available online: 21 Feb 2012

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survivors of child sexual abuse, European Journal of Developmental Psychology,
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 EUROPEAN JOURNAL OF DEVELOPMENTAL PSYCHOLOGY
2012, 1–16, iFirst article

The role of traumagenic dynamics on the psychological

adjustment of survivors of child sexual abuse

David Cantón-Cortés1, Marı́a Rosario Cortés2, and

José Cantón2
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1
Facultad de Psicologı́a, University of Málaga, Málaga, Spain
2
Facultad de Psicologı́a, University of Granada, Granada, Spain

The aim of this study was to analyse the consequences of child sexual abuse
(CSA) on the psychological adjustment of survivors, as well as to determine
the role of the feelings provoked by the abuse, following Finkelhor and
Browne’s traumagenic dynamics model (1985), on the adjustment of CSA
victims. The sample of the study comprised 182 survivors of CSA, and another
182 participants selected as a comparison group. Results showed that CSA
survivors, in contrast with the group of non-victims of CSA, had significantly
higher scores on state anxiety, trait anxiety and depression, and lower on self-
esteem. With regard to the role of traumagenic dynamics, feelings of
powerlessness, self-blame, traumatic sexualization and, to a lesser extent,
betrayal, predicted the scores of the CSA survivors in the four psychological
adjustment variables assessed. To summarize, the results confirm the relation
between CSA and the development of psychological problems in adulthood,
explaining the survivors’ feelings to a substantial extent the variability of
adjustment.

Keywords: Child sexual abuse; Psychological adjustment; Traumagenic

dynamics.

Childhood sexual abuse (CSA) is a worldwide problem that affects children

of all ages, ethnicities, and socioeconomic backgrounds (Pereda, Guilera,
Forns, & Gómez-Benito, 2009; Sapp & Vandeven, 2005). The incidence of
CSA is difficult to calculate, as the abuse usually occurs privately and
victims may be afraid to speak out. The prevalence in Spain (López,

Correspondence should be addressed to David Cantón-Cortés, University of Málaga,

Facultad de Psicologı́a, Campus de teatinos, 29071, Málaga, Spain. E-mail:
david.canton@uma.es

Ó 2012 Psychology Press, an imprint of the Taylor & Francis Group, an Informa business
http://www.psypress.com/edp http://dx.doi.org/10.1080/17405629.2012.660789
 2 CANTÓN-CORTÉS, CORTÉS, CANTÓN

Carpintero, Hernández, Martı́n, & Fuertes, 1995) has been reported to be

18% in the total population, with 15% in males and 22% in females. More
recently, Pereda and Forns (2007) reported a prevalence rate of 14.9% in
Spanish university students (12% in males, 16.2% in females).
The literature contains two generations of psychological research on the
effects of CSA (Merrill, Thomsen, Sinclair, Gold, & Milner, 2001). The first
generation focused on the short- and long-term effects of sexual abuse.
These studies consistently found, in clinical and nonclinical samples, that
CSA was associated with a number of psychological symptoms such as
depression, poor self-esteem, anxiety and sexual disorders, and physical
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symptoms such as gynaecological disorders, gastrointestinal disorder, and

coronary disease (e.g., Havig, 2008; Lemieux & Byers, 2008; Mulvihill, 2005;
Tarren-Sweeney, 2008). At the same time, studies from this generation
indicated that the psychological adjustment to CSA varies widely, and some
individuals may even be well adjusted during adulthood (Jonzon &
Lindblad, 2006).
The second generation of psychological research has focused on identifying
the variables that mediate the relationship between CSA and mental-health
outcomes. Some studies have highlighted the important role of abuse
characteristics, such as the type of acts experienced, the frequency of these
acts, and the type of victim–perpetrator relationship (e.g., Chromy, 2006;
Lemieux & Byers, 2008). Other studies have indicated that sociocognitive
factors outweigh abuse characteristics in determining psychological
adjustment (e.g., Paolucci, Genuis, & Violato, 2001; Quas, Goodman, &
Jones, 2003). These sociocognitive factors include social support (Lowe,
Gibson, & Christie, 2008), attribution of responsibility (Daigneault, Hébert, &
Tourigny, 2006), coping strategies (Cantón-Cortés & Cantón, 2010) and the
emotional response to abuse (Feiring, Simon, & Cleland, 2009). One limitation
of these studies concerns the use of retrospective reports. Retrospective reports
have been associated with certain memory biases, as victims of CSA might
redefine their own behaviours and feelings as they acquire experience and
information (Widom & Morris, 1997). However, previous studies have shown
that the small amount of bias present in these reports is not strong enough to
invalidate research on major adversities (Hardt & Rutter, 2004). As Bifulco
et al. (2002) note, there are certain merits to undertaking a retrospective study.
There are fewer ethical issues in studying abuse that occurred a number of
years prior to the study. Moreover, many victims of CSA disclose tardily, if at
all, more than 90% of CSA victims never reporting the abuse (Cortés &
Cantón, 2008).
Some review articles (e.g., DiLillo, 2001; Rumstein-McKean & Hunsley,
2001) have pointed out that, besides identifying the determinants of the
mental health of CSA victims, psychologists must develop theories
accounting for this health. Theories have indeed been proposed, including
 TRAUMAGENIC DYNAMICS AND PSYCHOLOGICAL ADJUSTMENT 3

the post-traumatic stress model (Wolfe, Gentile, & Wolfe, 1989), the
information-processing model (Burgess, 1988) and the traumagenic
dynamics model (Finkelhor & Browne, 1985). However, as others have
pointed out (e.g., Merril et al., 2001), these theories have scarcely been
tested, leaving a gap between theoretical work, which is wide in scope, and
empirical research, which usually focuses on a few variables in isolation. The
present study attempted to take a step toward closing this gap, conducting
an empirical test of the traumagenic dynamics model of Finkelhor and
Browne (1985), the most popular of the aforementioned theories.
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Traumagenic dynamics model (Finkelhor & Browne, 1985)

Although this model has had a great impact on the field of CSA research,
relatively few studies have tested the model empirically (Kallstrom-Fuqua,
Weston, & Marshall, 2004). The model proposes four traumagenic dynamics
(betrayal, stigmatization, powerlessness, and traumatic sexualization) that
mediate the psychological outcome of CSA victims by distorting their self-
concept, worldview, and affective state.
Looking at each dynamic more closely, betrayal refers to the child’s
discovery that someone whom the child trusted, and was dependent on,
caused the child harm. The disappointment and loss of trust caused by this
discovery may lead to depression, anger, and mistrust of others.
Stigmatization refers to a process in which negative connotations
concerning abuse (badness, shamefulness, guilt) are communicated to the
child and subsequently enter the child’s self-image. Stigmatization may lead
to low self-esteem, self-injurious behaviour, thoughts of suicide, and
identification with other stigmatized behaviours (drug abuse, prostitution).
Powerlessness occurs when the child’s desires, wishes, and sense of
productivity are countered by the repeated invasion of the child’s body
against his or her will, which reinforces the child’s self-perception as a
victim. Feelings of powerlessness may produce fear and anxiety and an
extreme need to control, potentially triggering compensatory responses such
as sexually abusing others. Powerlessness may also have a detrimental effect
on the victim’s coping skills.
Finally, traumatic sexualization refers to the process by which abuse
shapes the victim’s sexual feelings and sexual behaviour in a dysfunctional
and developmentally inappropriate manner. The outcome could be
promiscuity or an aversion to sex.
Although Finkelhor and Browne (1985) focused on these dynamics as
they occur during the childhood sexual abuse, it stands to reason that such
cognitions and emotions in response to CSA could play an important role in
the victim’s long-term mental health. The child may internalize these
perceptions and hold them into adulthood, perhaps in a modified form. The
 4 CANTÓN-CORTÉS, CORTÉS, CANTÓN

status of these dynamics during adulthood may explain individual

differences in the psychological adjustment of adult CSA victims (Coffey,
Leitenberg, Henning, Turner, & Bennet, 1996).
The traumagenic dynamics model has had such an impact on the field
that some authors have proposed developing CSA therapies, assessment
instruments, and research interviews revolving around the four dynamics
(e.g., Celano, Hazzard, Webb, & McCall, 1996; Finkelhor & Browne, 1985;
Pearce & Pezzot-Pearce, 1997). However, most of the studies that have
empirically tested the model have focused exclusively on an isolated
dynamic (e.g., Feiring & Cleland, 2007; Feiring et al., 2009; Kim, Talbot, &
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Cicchetti, 2009). Kim et al. (2009), for instance, found that feelings of shame
in adult female victims predicted partner and family conflicts. Feiring et al.
(2009) found, in a longitudinal study, that stigmatization predicted sexual
disorders and dating aggression in child and adolescent victims.
To date, only a handful of studies, such as those of Hazzard, Celano,
Gould, Lawry, and Webb (1995), Kallstrom-Fuqua et al. (2004), and Coffey
et al. (1996) in the United States, or Dufour and Nadeau (2001) in Canada,
have simultaneously examined the effects of several dynamics. Unfortu-
nately, these studies have produced contradictory results. Hazzard et al.
(1995) found that only powerlessness predicted general psychological
distress, Coffey et al. (1996) found that stigmatization was the only
significant predictor of distress, and Kallstrom-Fuqua et al. (2004) found
that both dynamics predicted distress. Also, none of these studies found a
significant effect of betrayal. Kallstrom-Fuqua et al. (2004), for instance, did
not find the expected link between maladaptive social relationships and
betrayal, finding instead a link between maladaptive social relationships and
powerlessness. Another problem is that virtually none of the studies
conducted to date have examined traumatic sexualization, nor have they
included measures relating to sexual well-being. Several authors (e.g., Tsun-
Yin, 1998) have suggested that traumatic sexualization could have a
negative effect on self-esteem, particularly self-esteem in relation to social
and sexual relationships.
Thus, further research is necessary to understand the complex relation-
ship between traumagenic dynamics and the psychological adjustment of
CSA victims. In the present study, we began by assessing the long-term
effects of CSA, by comparing the psychological adjustment of CSA victims
(measured by trait anxiety, depression, and self-esteem) with a group of non-
victims. Next, the effect of each traumagenic dynamic on the psychological
distress of the victim group was examined. Finally, in line with the
suggestion of Ramos-Álvarez, Moreno-Fernández, Valdés-Conroy, and
Catena (2008), this study should allow us to determine the extent to which
findings derived from studies with American participants generalize to the
Spanish population.
 TRAUMAGENIC DYNAMICS AND PSYCHOLOGICAL ADJUSTMENT 5

METHOD
Sample
The initial sample consisted of 1,968 students of the University of Granada
(320 men and 1,648 women), aged between 18 and 50 years (M ¼ 20.24;
SD ¼ 3.74), 90% under the age of 24.
One hundred ninety-five participants (9.90%) from this sample reported
experiencing some type of sexual abuse prior to age 13. Thirteen participants
were excluded from the analysis because they did not complete all the
questionnaires, thus, the final sample consisted of 182 CSA victims (23 men
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and 160 women), with an average age of 21.11 (SD ¼ 4.61). Of these, 14.28%
had suffered abuse consisting of exhibitionism, 62.08% touching and
23.62% oral sex/penetration. Regarding the relationship with the perpe-
trator, 40.65% were victims of extrafamilial abuse, whereas 59.35% were
victims of intrafamilial abuse. With respect to family structure, 72.70%
came from intact families, 11.50% from a divorced family, 9.80% from a
household with a deceased parent, 4.90% from a household with a
remarried parent, and 1.10% from an adoptive family. Regarding the
highest educational level completed by the victims’ parents, 19.48% of their
fathers and 23.28% of their mothers had completed primary studies; 23.57%
of fathers and 28.90% of mothers had completed compulsory secondary
studies; 9.79% and 7.80% had completed a non-compulsory vocational
training cycle; 14.36% and 17.22% had completed non-compulsory
secondary studies; and 32.80% and 22.80% had received a college degree.
Having acquired the sample of CSA victims, we selected a comparison
group of non-victims composed of the same number of participants from the
same university matched on a series of sociodemographic variables (age,
gender, family structure, number of siblings, parents’ educational level).

Materials
Childhood Sexual Abuse Questionnaire. This questionnaire asks partici-
pants to provide sociodemographic and CSA-related information anon-
ymously. Participants report their age, gender, family structure, and parents’
educational level, and answer a series of questions regarding experiences
with childhood sexual abuse, such as the type of acts experienced, the
number of incidents, the participant’s relationship to the abuser, and the age
at which the abuse began. The questionnaire contained the following
definition of CSA so that participants could identify themselves as victims:
‘‘sexual contact or interactions between a minor and an adult, or between
minors in the event that the age difference between the abuser and victim is
at least 5 years, or less if the abuser is in a position of power over the victim’’
(derived from Hartman & Burgess, 1989). To create a behavioural
 6 CANTÓN-CORTÉS, CORTÉS, CANTÓN

definition, the questionnaire listed a series of sexual activities and asked

participants to indicate which ones they had experienced. The activities
ranged from situations involving no physical contact, to those involving the
touching of erogenous zones, to oral sex and/or penetration. For the present
study, the only participants we considered CSA victims were those for whom
the abuse began before age 13.

Children’s Impact of Traumatic Events Scale-Revised (CITES-R; modified

version of Hazzard et al., 1995; Spanish translation by the authors). This
questionnaire measures the thoughts and feelings victims experience in
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response to CSA, and is structured around the traumagenic dynamics

model of Finkelhor and Browne (1985). The scale derived from an
original pool of 77 items that were piloted on a sample of 56 female
adult sexual abuse survivors (Hazzard, 1993). That measure yielded 11
scales, some of which assess post-traumatic stress disorder (PTSD)
symptoms and others that assess additional affective and cognitive
reactions. The PTSD subscales were not used in the adaptation for CSA
victims by Hazzard et al. (1995) and the other subscales were combined
to yield four measures corresponding to Finkelhor and Browne’s (1985)
model of traumagenic dynamics. The final instrument consists of 56 items
divided into four subscales: Betrayal (10 items—‘‘It is dangerous to trust
in people because they will usually betray you’’); Self-blame/Stigmatiza-
tion (29 items—‘‘The abuse happened to me because I was not smart
enough to prevent it’’); Powerlessness (10 items—‘‘Most things in life
cannot be controlled’’); and Traumatic Sexualization (7 items—‘‘I wish
things like sex did not exist’’). Possible scores range from 0 (Totally false)
to 4 (Totally true). In a sample of 56 adult female sexual abuse survivors,
the total scale had an internal reliability coefficient alpha of .93.
Coefficient alphas for the subscales were as follows: Self-blame/
Stigmatization .89; Betrayal .86; Powerlessness .78; and traumatic
sexualization .87.

State-Trait Anxiety Inventory (STAI; Spielberger, Gorsuch, & Lushene,

1970; Spanish version of Seisdedos, 1982). This inventory consists of two
20-item scales, one measuring state anxiety, and the other trait anxiety. The
state scale (STAI-S) assesses the intensity of anxious feelings or sensations at
a given moment. The trait scale (STAI-T) measures how one feels generally.
The response options range from 1 (Not at all/almost never) to 4 (Very much
so/almost always). The inventory has good validity and test–retest reliability
(.62 for the state scale, .86 for the trait scale; Spielberger et al., 1970).

Beck Depression Inventory (BDI; Beck, Rush, Shaw, & Emery,

1990). This is the most popular self-assessment inventory for measuring
 TRAUMAGENIC DYNAMICS AND PSYCHOLOGICAL ADJUSTMENT 7

depressive symptoms, due to its psychometric qualities. It contains 21 items

with responses ranging from 0 to 3. It has a test–retest reliability of .86 and
an internal consistency of .86.

Rosenberg Self-Esteem Scale (RSE; Rosenberg, 1965; Spanish version by

Echeburúa, 1995). This self-assessment inventory consists of 10 items
probing feelings of self-worth and self-acceptance. Response options range
from 1 (Strongly agree) to 4 (Strongly disagree), with the options inverted on
half the items. It has a Cronbach’s alpha coefficient of .86, and a test–retest
reliability of .85.
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Procedure
The permission of the ethical committee of the University of Granada was
obtained to conduct the study. Participation was voluntary. Participants
signed an informed consent form and were told they could leave the study at
any time if they felt uncomfortable answering the questions in the survey.
The refusal rate from the total of participants (N ¼ 1,968), and based on the
number of students enrolled in each class, was 20.30%.
The study began with a one-hour session during which participants
anonymously completed two questionnaires: the Childhood Sexual Abuse
Questionnaire, intended to identify CSA victims and the nature of their
abuse, and the Children’s Impact of Traumatic Events Scale-Revised,
assessing thoughts and feelings about past abuse in terms of the four
traumagenic dynamics (Betrayal, Self-blame, Powerlessness, and Traumatic
Sexualization). Participants returned for a second session to complete the
surveys assessing state anxiety, trait anxiety, depression, and self-esteem
(STAI, BDI, and RSE, respectively). In order to maintain anonymity of the
CSA victims, non-CSA volunteers completed questionnaires in relation to a
different significant negative experience. We guaranteed the confidentiality
of the data by identifying the surveys with a numerical code. Statistical
analyses were performed with SPSS (Statistical Package for the Social
Sciences) version 16.

RESULTS
Long-term effects of CSA were examined by comparing state anxiety, trait
anxiety, depression, and self-esteem scores between CSA victims and non-
victims (Table 1). The mean difference of each measure was statistically
significant. CSA victims scored higher than non-victims on state anxiety,
trait anxiety, and depression, t(362) ¼ 74.55, p 5 .001; t(362) ¼ 76.14,
p 5 .001; and t(362) ¼ 75.91, p 5 .001, and scored lower than non-victims
on self-esteem, t(362) ¼ 3.58, p 5 .001.
 8 CANTÓN-CORTÉS, CORTÉS, CANTÓN

To examine the role of traumagenic dynamics in the psychological

adjustment of CSA victims, Pearson correlations were calculated between
the four dynamics (Betrayal, Self-blame, Powerlessness, and Traumatic
Sexualization) and the four adjustment variables (state/trait anxiety,
depression, and self-esteem). The resulting matrix is presented in Table 2,
along with the descriptive statistics of the CSA group. A significant
relationship was found between each dynamic and each adjustment variable.
Self-blame and Powerlessness were particularly highly correlated with the
adjustment variables, especially trait anxiety, (r ¼ .48, p 5 .001) and (r ¼ .52,
p 5 .001), and self-esteem, (r ¼ 7.50, p 5 .001) and (r ¼ 7.45, p 5 .001).
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TABLE 1
Differences between victims and non-victims on mean scores of depression,
self-esteem, and anxiety

Group N Mean SD t p

Non-victims 182 15.91 9.97

STAI-S 74.56 .001
Victims 182 21.16 11.97
Non-victims 182 17.81 9.39
STAI-T 76.14 .001
Victims 182 24.66 11.81
Non-victims 182 5.46 4.82
BDI 75.91 .001
Victims 182 9.27 7.28
Non-victims 182 31.75 5.14
RSE 3.59 .001
Victims 182 29.85 5.03

TABLE 2
Descriptive statistics and correlations between the traumagenic dynamics and anxiety,
depression, and self-esteem

Betrayal Self-blame Powerlessness T. sexualization M SD Min. Max.

STAI-S .31*** .36*** .38*** .30*** 21.16 11.97 1 54

STAI-T .48*** .48*** .52*** .39*** 24.66 11.81 3 56
BDI .39*** .42*** .40*** .37*** 9.27 7.28 0 36
RSE 7.42*** 7.51*** 7.45*** 7.41*** 29.85 5.02 15 40
Mean 16.26 37.52 13.33 3.44
SD 7.18 16.13 6.12 4.62
Min. 2 10 1 0
Max. 51 88 28 22

Note: *p 5 .05; **p 5 .01; ***p 5 .001.

 TRAUMAGENIC DYNAMICS AND PSYCHOLOGICAL ADJUSTMENT 9

Correlations within the four traumagenic dynamics and the four adjustment
variables are also presented in Tables 3 and 4.
To compare the relative effects of the four dynamics on each
psychological adjustment variable, and the proportion of the variance
explained by each, a multiple regression was performed for each adjustment
variable. The type of abuse committed (exhibitionism, touching and oral
sex/penetration) was also included in the analyses in order to control its
effects on the psychological adjustment of the victims. Additionally, the
sample was divided into random halves, and cross-validations were done
using the two sets. The results we describe are based on the full sample, but
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we indicate which effects replicated across the random halves of the sample
in the tables. If a predicting variable was either significant or not significant
in both random halves, it was considered cross-validated. Boldface
coefficients in Tables 5, 6, 7, and 8 indicate agreement between both halves
of the cross-validation split sample.
The regression model for state anxiety (Table 5) was statistically
significant, F(4,178) ¼ 11.50, p 5 .000, with an adjusted R2 of .22.
Examining the dynamics, those explaining state anxiety were Traumatic
Sexualization (b ¼ 0.18, p 5 .01), and most strongly, Powerlessness
(b ¼ 0.22, p 5 .003). Betrayal and Self-blame were not significantly related
to state anxiety (b ¼ 0.11, p 5 .13 and b ¼ 0.12, p 5 .13, respectively).
The model for trait anxiety (Table 6) yielded an adjusted R2 of .42,
F(4,178) ¼ 29.45, p 5 .000. All four dynamics explained the variability in

TABLE 3
Correlations within the traumagenic dynamics scales

Betrayal Self-blame Powerlessness T. sexualization

Betrayal 1 .413*** .330*** .355***

Self-blame .413*** 1 .393*** .358***
Powerlessness .330*** .393*** 1 .258***
T. sexualization .355*** .358*** .258*** 1

Note: *p 5 .05; **p 5 .01; ***p 5 .001.

TABLE 4
Correlations within the psychological adjustment variables

STAI-S STAI-T BDI RSE

STAI-S 1 .587*** .685*** 7.548***

STAI-T .587*** 1 .703*** 7.619***
BDI .685*** .703*** 1 7.658***
RSE 7.548*** 7.619*** 7.658*** 1

Note: *p 5 .05; **p 5 .01; ***p 5 .001.

 10 CANTÓN-CORTÉS, CORTÉS, CANTÓN

trait anxiety, with Powerlessness (b ¼ 0.30, p 5 .001) having the most

predictive power.
The model for depression (Table 7) yielded an adjusted R2 of .29,
F(4,178) ¼ 16.02, p 5 .000. Self-blame was the dynamic with the least
predictive power, although it was still statistically significant (b ¼ 0.16,
p 5 .047), while Powerlessness was the most predictive (b ¼ 0.29, p 5 .006).
Finally, the model for Self-esteem (Table 8) yielded an adjusted R2 of .38,
F(4,178) ¼ 22.80, p 5 .000. Betrayal showed the least predictive power
(b ¼ 70.14, p 5 .040), and Self-blame the most (b ¼ 70.29, p 5 .001).
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DISCUSSION
Reducing the incidence of CSA is of course important, but it is equally
important to develop intervention strategies focused on the factors that
modulate the psychological adjustment of CSA victims (Pereda, 2009). The
present study took a step in this direction, examining the relationship

TABLE 5
Regression coefficients for predicting state anxiety from traumagenic dynamics

Adjusted R2 B SE b t p

.22 .001
Type of abuse 2.08 1.39 0.11 1.50 .137
Self-blame 0.09 0.06 0.12 1.50 .135
Betrayal 0.19 0.13 0.11 1.50 .138
Powerlessness 0.44 0.15 0.22 2.99 .003
Traumatic sexualization 0.46 0.18 0.18 2.50 .012

Note: Boldface coefficients indicate agreement between both halves of the cross-validation split
sample.

TABLE 6
Regression coefficients for predicting trait anxiety from traumagenic dynamics

Adjusted R2 B SE b t p

.42 .001
Type of abuse 1.93 1.20 0.10 1.60 .110
Self-blame 0.13 0.05 0.20 2.48 .010
Betrayal 0.38 0.11 0.23 3.43 .001
Powerlessness 0.58 0.13 0.30 4.56 .001
Traumatic sexualization 0.42 0.16 0.17 2.68 .008

Note: Boldface coefficients indicate agreement between both halves of the cross-validation split
sample.
 TRAUMAGENIC DYNAMICS AND PSYCHOLOGICAL ADJUSTMENT 11
TABLE 7
Regression coefficients for predicting depression from traumagenic dynamics

Adjusted R2 B SE b t p

.29 .001
Type of abuse 1.37 0.81 0.11 1.69 .092
Self-blame 0.07 0.03 0.16 2.00 .047
Betrayal 0.19 0.07 0.19 2.58 .011
Powerlessness 0.23 0.09 0.29 2.84 .006
Traumatic sexualization 0.30 0.11 0.20 2.78 .009

Note: Boldface coefficients indicate agreement between both halves of the cross-validation split
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sample.

TABLE 8
Regression coefficients for predicting self-esteem from traumagenic dynamics

Adjusted R2 B SE b t p

.38 .001
Type of abuse 0.12 0.02 0.14 0.23 .821
Self-blame 0.09 0.02 70.29 73.90 .001
Betrayal 70.10 0.05 70.14 72.07 .040
Powerlessness 70.18 0.05 70.22 73.26 .001
Traumatic sexualization 70.23 0.07 70.21 73.25 .001

Note: Boldface coefficients indicate agreement between both halves of the cross-validation split
sample.

between CSA-related feelings and adult psychological adjustment in a

sample of Spanish college students who were victims of CSA. The results
corroborated the finding of other authors (e.g., Gamble et al., 2006; Levitan,
Rector, Sheldon, & Goering, 2003) that CSA victims generally show poor
psychological adjustment in adulthood, presenting higher levels of anxiety
and depression and a lower level of self-esteem than non-victims.
Regarding the role of traumagenic dynamics in psychological adjustment,
the regression models varied considerably depending on the adjustment
variable analysed. While the regression coefficients for trait anxiety and self-
esteem were relatively high (.42 and .38, respectively), for depression and
state anxiety the coefficients were lower (.29 and .22, respectively).
In general, the results suggest the dynamic most strongly related to
psychological adjustment is Powerlessness, as this dynamic best predicted
state anxiety, trait anxiety, and depression. This finding is in line with that of
Hazzard et al. (1995), who found that Powerlessness was the only variable
related to general psychological distress, and with Kallstrom-Fuqua et al.
 12 CANTÓN-CORTÉS, CORTÉS, CANTÓN

(2004), who reported that only Powerlessness and Stigmatization were

related to distress.
Betrayal was the least predictive dynamic. It showed no relationship to
state anxiety, and only a weak (although statistically significant) relationship
to depression and self-esteem. Still, the fact that we found a statistically
significant relationship with the latter two adjustment variables is
noteworthy considering that prior studies did not do so (e.g., Coffey
et al., 1996; Dufour & Nadeau, 2001).
One of the biggest contributions of our study to the literature on the
traumatogenic dynamics model is the finding of a significant relationship
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between the heretofore least studied dynamic, Traumatic Sexualization, and

psychological adjustment, particularly self-esteem. This finding confirms the
prediction of some authors (e.g., Tsun-Yin, 1998) that Traumatic
Sexualization may have a negative effect on self-esteem, particularly as it
relates to social and sexual relationships.
Finally, the results suggest Self-blame has a medium effect on
psychological adjustment, although among the four dynamics it was the
best predictor of self-esteem. Most other studies also have found a
relationship between Self-blame/Stigmatization and psychological adjust-
ment (Dufour & Nadeau, 2001; Feiring et al., 2009; Kim et al., 2009), with
the exception of Hazzard et al. (1995), who found no relationship in sample
of female victims. Interestingly, the variable type of abuse was not related to
any of the four adjustment variables, suggesting that traumagenics dynamics
may be more important in explaining the effects of the abuse than the kind
of acts committed.
These findings have clinical relevance, underscoring the need to take into
account the feelings provoked by childhood sexual abuse when providing
therapy to adult victims. We see a potential benefit of interventions
specifically designed to assess and reduce feelings of self-blame, power-
lessness, traumatic sexualization, and to a lesser degree, betrayal. These
interventions should develop emotional expression skills, gradually expose
victims to negative emotions, and create a therapeutic environment in which
abuse-related feelings may be expressed and re-evaluated.
Kallstrom-Fuqua et al. (2004) proposed an approach to fight feelings of
stigma, powerlessness and betrayal. Following these authors, all therapeutic
approaches should help victims identify positive personal attributes and
strengthen the belief that the abuse was not their fault, in order to reduce the
victim’s perceptions associated with stigmatization. To address perceived
powerlessness, it may be useful to help victims set and meet reasonable
goals, and to identify successes. To address feelings of betrayal, therapy
should help victims to identify positive relationships in their life, or to
initiate them, and to understand their benefit. Finally, to combat the effects
of traumatic sexualization, therapy should target the victim’s confusion
 TRAUMAGENIC DYNAMICS AND PSYCHOLOGICAL ADJUSTMENT 13

surrounding sex (Cantón-Cortés, 2007). In the case of children, therapy

should increase developmentally appropriate parent–child communication
on the topic of sex, and reduce inappropriate sexual behaviour in a non-
stigmatizing manner.
In interpreting our findings, it is important to keep in mind certain
limitations of the study. First, this study was conducted only on adults.
Although we found, in adults, that betrayal played a weaker role than the
other dynamics, perhaps in children the effects of betrayal are more
prominent. Future research should address these possibilities.
Another limitation is the use of a retrospective study, which prevents
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making firm causal inferences (Pereda, 2009; Whiffen & Macintosh, 2005).
Without a prospective design, we cannot know whether the traumagenic
dynamics cause psychological distress, or vice versa. In addition, retrospective
reports have been associated with certain memory biases (Widom & Morris,
1997). However, despite these shortcomings, research involving retrospective
reports has considerable value (Johnson et al., 2006). Also, there is a wide
consensus that most CSA victims reveal information belatedly, if at all,
meaning that retrospective studies could be the only way to obtain information
from these individuals (Helweg-Larsen & Larsen, 2005). Apart from that, data
analyses taking into consideration a measurement model would be of benefit.
Further research should employ structural equation modelling in order to
clarify the causal relationships between the variables in the study.
A final limitation concerns the applicability of these findings to clinical
practice, given that the data were collected from university students. As
Kallstrom-Fuqua et al. (2004) suggested, the psychological impact of CSA
and the traumagenic dynamics may be higher in people actively seeking help.
Nevertheless, given that only a minority of CSA victims tends to reveal their
abuse (Korkman, Santtila, Westeråker, & Sandnabba, 2008), there remains a
clear need for studies involving non-clinical samples (Cortés & Cantón,
2008). Moreover, young adults in other non-clinical settings than university
may show a different result pattern (Salmela-Aroa, Aunolaa, & Nurmi,
2008).
In conclusion, this study builds on previous CSA research examining the
variables mediating the psychological adjustment of victims. Through
simultaneously analysing each of the four traumagenic dynamics in the
model of Finkelhor and Browne (1985), our results confirmed their impact
on the psychological adjustment of adult victims of CSA.

Manuscript received 8 February 2011

Revised manuscript accepted 9 January 2012
First published online 20 February 2012
 14 CANTÓN-CORTÉS, CORTÉS, CANTÓN

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