Approximately 56% of participating women had reported being survivors of childhood physical abuse and 32% reported being survivors of childhood sexual abuse. In terms of time-varying study factors, almost half of study participants reported having unmet subsistence needs at baseline, and 49% had slept in a shelter or public place during the 6 months prior to initial assessment. The median monthly income was $931.50 compared to $5,419 for the City of San Francisco during the same time period . Physical and sexual violence during the 6 months prior to initial assessment was reported by 27% and 9% of participants, respectively . The mean and median DES scores were 52.74 and 38 respectively. DES scores in this sample were positively skewed and 43% had elevated levels of dissociation . DES scores did not change significantly between the study periods measured here . We assessed 1) whether dissociation mediated childhood sexual abuse and recent physical violence six months after initial assessment and 2) whether dissociation mediated childhood sexual abuse and recent sexual violence six months after initial assessment. Bootstrapped estimates did not indicate significant indirect effects of dissociation on childhood sexual abuse and physical violence or sexual violence six months after initial assessment through dissociation .
Based on the strong relationship between violent victimization six months prior to initial assessment and violent victimization at the six-month follow-up,hydroponic racks we examined two additional bootstrapped models to assess whether dissociation mediates between previous and future physical violence and previous and future sexual violence. Bootstrapped estimates did not indicate significant indirect effects of dissociation on physical violence reported six months prior to assessment and physical violence reported at the six month follow up nor did they indicate significant indirect effects of dissociation on sexual violence reported six months prior to assessment and sexual violence reported at the six month follow up. . Results from this study indicate that, in a cohort of vulnerable women where violence is disproportionately common, childhood sexual abuse increases the odds of both physical and sexual violence two and three-fold respectively, even after adjusting for demographic characteristics, psychiatric disorder, and dissociation, while childhood physical violencedoes not. Results further suggest that although dissociation confers a nearly two-fold increase for physical and sexual violence, it does not mediate the effects of childhood physical or sexual abuse on physical or sexual violence. Taken together, results show that childhood abuse and dissociation have independent direct effects on violent victimization, while indirect effects appear to be negligible. Furthermore, our results also suggest that a recent history of violent victimization is a significant predictor of future violent victimization for this cohort of homeless and marginally housed women. Although it is unclear what factors influence dissociation in our sample, according to our results recent exposure to violence during adulthood may be more so associated dissociative symptoms rather than child abuse.
And while our results do not indicate the effects of child abuse influence victimization through dissociation, they do suggest that both childhood abuse and dissociation may be clinically useful predictors of risk for violent victimization in adulthood and the possible need for trauma-informed care to stem this risk. Although recent research has evidenced links between dissociation and childhood sexual abuse , as well as elevated dissociation and violent victimization , our study is the first to indicate that risk for violent victimization may be independently increased by child sexual abuse and dissociative experiences. Our results are consistent with a small but novel and recent study, which found previously sexually victimized women who exhibited blunted or reduced physiological reactivity while being exposed to sexual victimization stimuli of an emotional Stroop task were more likely to report sexual re-victimization at a six-month follow-up even after controlling for prior victimization . More broadly, though our results do not focus on event level data or the chronicity of early trauma, they are consistent with previous epidemiological findings that indicate child abuse and other early childhood stressors are associated with a host of adverse outcomes, which may have a profound impact on mental health and overall well being well into adulthood . We also found that homeless and unstably housed women who reported recent violent victimization were at increased odds of being exposed to future violence. Previous research suggests that violent victimization may alter individual level characteristics that may increase the odds of them being re-victimized . Furthermore, recent evidence suggests that women are more impacted by violent victimization than men . However, the same study did not identify any specific characteristics that increased the likelihood of violent victimization, but found a cluster of risky behavioral characteristics that were associated with violent re-victimization. Moreover, it is unclear what psychological factors might be behind the increase of these risky behaviors following violent victimization. Although dissociation increases the odds of future violent victimization in this cohort, we found no evidence that dissociation mediated past and future violent victimization.
This suggests that some other unknown variable or set of biological, psychological, behavioral, and/or environmental variables may be operating in a complex manner, possibly with dissociation, as a result of recent victimization to put these women at risk for re-victimization.Previous studies by our group and others that have investigated challenges in housing instability have consistently indicated violence is a normative aspect of the environments where homeless women live . While results presented here do not contain enough detail to isolate the mechanism, they are consistent with the hypothesis that childhood sexual abuse and dissociation contribute to increased odds of violent physical victimization by decreasing sensitivity to threats and/or increasing the threshold for enduring situations where physical violence is likely to occur. Taken as a whole, our results suggest dissociative symptoms may be a clinically relevant diagnostic feature within the broader context of traumatic experiences that should be taken into consideration when working with particularly vulnerable populations such as homeless and unstably housed individuals. Specifically, subsequent physical victimization may be reduced by identifying individuals experiencing dissociative symptoms as part of an overall framework of trauma-informed care for homeless and unstably housed persons. These individuals then could be linked to appropriate programs and/or providers that specialize in trauma-informed mental healthcare to help these individuals cope with or reduce their dissociative symptoms and possibly keep them out of harms way. Our findings are consistent with the basic idea of the Chu model where childhood sexual abuse and dissociation are not only associated with, but greatly increase the odds of violent victimization. However, they also differ in important ways as our results did not support dissociation mediating previous and future violent victimization. This difference may be related to the fact that dissociation was extremely skewed in this population. Alternatively,indoor garden table the lack of evidence to support mediation may suggest that while child sexual abuse may put women at risk, possibly due to difficulty distinguishing between threatening and non-threatening situations, the dissociation experienced by homeless women is linked to trauma experienced after childhood. Irrespective of whether dissociation mediates between these two variables, our results confirm significant independent influences on recent violent victimization from childhood victimization and dissociation. While research findings associated with childhood sexual abuse have been relatively consistent in regards to its link to dissociation, childhood physical abuse findings have been more varied. Previous studies report significant associations between physical abuse and dissociative symptoms . In addition, childhood physical and sexual abuse were equally likely to be associated with dissociative symptoms . Others reported non-significant relationships between childhood physical abuse and dissociation . Our finding that childhood physical abuse was not associated with either type of violent victimization in adjusted analysis may be reflective of the idiosyncratic aspects of this cohort compared to other populations. Amphetamine use disorder was also associated with increased odds of being the victim of physical violence. We reported previously that recent sexual violence increased the risk stimulant use six months later, wherein we hypothesized that women may be self-medicating to manage physical and emotional pain related to an ongoing unsafe situation . Our finding that amphetamine use disorder was associated with increased risk for physical violence over time may explicate the other side of this process where either the means required to procure amphetamine or the dangerous situations that may occur while under the influence of amphetamine may put homeless or unstably housed women at an increased risk for violence. However, the lack of event-level data precludes our ability to assess under what circumstances violent victimization occurred.
Future studies may further explore the relationship to amphetamine use and physical violence by ascertaining how specific events increase the likelihood of violent victimization and or engaging in physical violence. We previously reported that the influence of childhood abuse on adult violent victimization is type specific . While the current study was consistent with our previous research in observing that childhood sexual abuse predicted recent sexual violent victimization and childhood physical abuse did not, this consistency did not extend to recent physical violence in the full models. While this may have been due to only including a sub-sample of study participants in the current study, it may also be influenced by different covariates used in each analysis and only the current study included dissociation which also appears to have affected other outcome variables. There are several limitations of note regarding results presented here and their interpretation. First, data in this study were obtained via self-report. While efforts were made to ensure that participants would feel comfortable disclosing personal information , our findings still may be influenced by inaccuracy due to socially desirable responding. Also, while efforts were made to facilitate each participant’s accurate recollection , our findings may still be influenced by limited recall. Under reporting for either reason could have resulted in an underestimation of childhood or recent victimization within our sample; however, this would have biased our results toward the null, indicating observed effects sizes were at least as robust as those reported. Although over-reporting is possible, women in this study were not incentivized for revealing episodes of victimization over the course of the study. Accurate recall could vary as a function of dissociation where elevated dissociative symptoms could have contributed to denial or repression of the victimization episode. Secondly, although the DES has been shown to have excellent reliability and validity in regards to identifying the presence of elevated dissociative symptoms, it does not have the capacity to diagnose or differentiate between dissociative disorders. As a consequence, we were not able to include the diagnosis of a dissociative disorder in our analyses. Future studies that explore dissociation should consider using measures/methods that yield dissociative disorder diagnosis when assessing study participants to increase validity. Additionally, while our results do not provide a systemic strategy for reducing homelessness, interventions based our results have the potential to compliment and/or be integrated into larger systems-focused programs designed to meet this goal . Finally, our sample size may have contributed to the lack of broader findings associated with our mediation analyses. This difference could be the reflection of limited power in the current study due to a relatively small sample of individuals who experienced violent victimization. This is more probable given our odds ratios for dissociation predicting physical violence and sexual violence at the six month follow up suggest only modest effect sizes when converted to Cohen’s d approximations . Thus, with the addition of increased statistical power, a larger sample would also afford us the capacity to explore the magnitude of the relationship between child abuse, dissociation, and recent violent victimization in more detail. Thus, future studies designed specifically to assess which variables, including but not limited to dissociation, mediate childhood abuse and violent victimization in a larger and geographically more diverse sample of homeless and unstably housed individuals may yield more robust findings with larger effect sizes. This study aimed to elucidate the relationship between childhood abuse, dissociation, and adult violent victimization. Results shown here indicate that childhood sexual abuse explains a large and significant amount of variability in both sexual victimization and physical victimization among homeless and unstably housed adult women, while childhood physical abuse does not. They also indicate that while current dissociation explains the longitudinal assessment of future physical violence, it does not mediate associations between childhood victimization and recent victimization, possibly due to limited magnitude of the relationship between childhood victimization, dissociation, and recent violent victimization in this sample.