(PS6-44) How Perpetrator Type Influences Mental Health Outcomes in Survivors of Childhood Sexual Abuse

Child sexual abuse (CSA) is common in the United States (U.S.) with an estimated 26% of girls and 5% of boys experiencing sexual abuse before adulthood (Melmer & Gutovitz, 2023). The long-term consequences of experiencing CSA can be devastating and have been well documented throughout literature. Survivors of CSA are more likely to be diagnosed with mental disorders (Afifi et al., 2011). Yet, despite research on CSA increasing over the past few decades (Fergusson et al., 2013), we have yet to examine how the type of perpetrator influences a variety of mental health outcomes in survivors of CSA. Using a sample (N = 117) representative of the U.S. population, all of whom endorsed at least one experience of CSA, participants were asked to briefly describe who the perpetrator(s) of their abuse was. Given that qualitative data was collected, participants could describe the perpetrator in as much detail as they were comfortable with. Responses were then individually coded into distinct perpetrator categories by the researchers to ensure inter-rater reliability. Perpetrator categories including parent, family member (not parent), romantic partner, friend, acquaintance, authority figure (e.g., teacher, healthcare provider, coach), stranger and others were identified. If participants endorsed CSA by multiple perpetrators, this was accounted for in the analyses too. Four different mental health outcomes were considered: past week total symptom severity, interpersonal relations quality, anger/hostility, and psychoticism. Four multiple linear regression models were completed, each with the 8 perpetrator categories entered as dichotomous predictor variables. Covariates included a variable representing the presence or absence of multiple perpetrators, sex assigned at birth, and the severity rating of the CSA events. Three of the four models were significant, with CSA severity as the only significant predictor of worse outcomes. Because CSA severity ratings continually showed up as a significant predictor, a linear regression model was tested to find out if the perpetrator categories predicted CSA severity. The model controlled for the presence of multiple perpetrators and sex assigned at birth. The model was significant (multiple R-squared = 0.440, p < .001). Both authority figure perpetrator (b = 4.739, SE = 1.619, p = .004) and parent perpetrator (b = 2.260, SE = 1.123, p .047) were significant predictors of increased CSA severity ratings. In addition, the presence of multiple perpetrators (b = 3.937, SE = 1.044, p < .001) and being assigned female at birth (b = 2.137, SE = 0.893, p = .018) significantly predicted greater CSA severity ratings. Such results may, in part, be best explained in the context of Freyd’s betrayal trauma theory (1996). Specifically, victims of CSA by perpetrators who were expected to maintain a trusting relationship with the victim (i.e., parents, authority figures) had greater CSA severity ratings in that their trust in the perpetrator was betrayed because of the abuse. Further, indication that the presence of multiple perpetrators had greater significance of CSA severity ratings aligns with previous findings (Cutajar et al., 2010) that victims of CSA by multiple perpetrators had more severe clinical outcomes later in life.