Examining Child Sexual Abuse in Relation to Complex Patterns of Trauma Exposure: Findings From the National Child Traumatic Stress Network

Chronic, interpersonal traumas within the caregiving system are associated with a range of symptoms, functional impairments, and trauma history profiles. This study utilized data from the National Child Traumatic Stress Network (NCTSN) Core Data Set (CDS) to examine the role of child sexual abuse in combination with other types of caregiver-related trauma (physical abuse, domestic violence, emotional abuse, neglect, and impaired caregiving). These trauma composites were assessed in relation to clinical profiles, including mental health symptoms, risk behaviors, and functional difficulties. Groups included multiply traumatized youth with a documented history of: (a) 3 or more caregiver-related traumas with co-occurring sexual abuse (CR CSA group, N 501); (b) 3 or more caregiver-related traumas without co-occurring sexual abuse (CR group, N 1,108); and (c) 3 or more noncaregiver-related traumas (e.g., medical trauma, natural disaster, physical/sexual assault; non-CR group, N 142). Youth with caregiverrelated traumas had significantly earlier onset and longer duration of traumas compared to other traumatized youth. Child sexual abuse had an additive and potent predictive effect on clinical profiles, even in combination with other caregiver-related traumas. Although youth with caregiver-related traumas exhibited significant attachment problems, youth with sexual abuse in particular had higher levels of posttraumatic stress disorder (PTSD), and received higher ratings for symptoms of depression, suicidality, and sexualized behaviors in comparison with the other 2 groups. Findings suggest that careful mapping of trauma history, including age of onset, duration, and co-occurrence of trauma exposure in childhood, can provide a foundation for a more refined developmental approach to the scientific investigation, clinical assessment, and treatment of children with complex histories of trauma in childhood.