ASSOCIATIONS BETWEEN WITNESSING THE ABUSE OF A SIBLING IN
CHILDHOOD AND EXPERIENCING TRAUMA RELATED SYMPTOMS IN ADULTHOOD
Jennifer S. Williams, M.S.
Dissertation Prepared for the Degree of
DOCTOR OF PHILOSOPHY
UNIVERSITY OF NORTH TEXAS
August 2016
APPROVED:
Patricia L. Kaminski, Committee Chair Shelley A. Riggs, Committee Member Jennifer L. Callahan, Committee Member Kimi King, Committee Member Vicki Campbell, Chair of the Department of Psychology David Holdeman, Dean of the College of Arts and Sciences Victor Prybutok, Vice Provost of the Toulouse Graduate School Williams, Jennifer S. Associations between witnessing the abuse of a sibling in childhood and experiencing trauma related symptoms in adulthood. Doctor of Philosophy
(Counseling Psychology), August 2016, 117 pp., 25 tables, 1 figure, references, 237 titles.
Currently sibling research is burgeoning, yet there is virtually no literature regarding
outcomes associated with witnessing the abuse of a sibling. The present study aimed to address
this gap in the literature. A sample of 284 university students were surveyed regarding traumatic
experiences in childhood and adulthood, the quality of childhood sibling relationships, and the
experience of trauma symptoms in adulthood. Regression and moderation analyses were
conducted to examine the relationship between witnessing the abuse of a sibling in childhood
and trauma symptoms in adulthood and to assess whether sibling relationship quality moderates
the association between witnessing sibling abuse and trauma symptomology. Results showed
that witnessing the abuse of a sibling was associated with depression symptoms in the overall
sample and for females reporting about a brother. Also, sibling conflict moderated the
relationship between witnessed sibling abuse and externalization in sister-sister dyads. These associations should be considered in terms of the systemic abuse to which participants were exposed. Implications for clinical practice for working with sibling-related victimization are discussed. Copyright 2016
by
Jennifer S. Williams
ii TABLE OF CONTENTS
Page
INTRODUCTION 1
Prevalence of Exposure to Abuse 1
Outcomes of Exposure to Abuse 2
Experienced Abuse 2
Witnessed Abuse 5
Witnessing and Experiencing Abuse 8
Adulthood Victimization 10
Trauma Symptomology 12
Posttraumatic Stress 12
Anxiety 14
Depression 17
Anger 19
Externalization 21
The Sibling Relationship 23
Family Systems Theory and Siblings 25
The Sibling Subsystem 25
Witnessing Sibling Abuse 27
The Present Study 29
Objectives 33
Hypotheses 33
METHOD 34
Participants 34
Instruments 35
iii Procedures 44
RESULTS 47
Missing Data Analyses 47
Preliminary Analyses 47
Correlation Matrices 54
Analysis 1- Hierarchical Multiple Regression 57
Hierarchical Multiple Regression 1: Anxious Arousal 58
Hierarchical Multiple Regression 2: Depression 61
Hierarchical Multiple Regression 3: Anger 64
Analysis 2- Moderation: Multiple Regression 67
Moderation 1: Posttraumatic Stress & Sibling Relationship Quality 67
Moderation 2: Externalization & Sibling Relationship Quality 67
DISCUSSION 70
Experience of Sibling-Related Victimization 70
Witnessing the Abuse of a Sibling & Trauma Symptoms 73
Sibling Relationship Quality & Trauma Symptoms 75
Implications for Clinical Practice 78
Limitations 79
Conclusions 81
APPENDIX: ADDITIONAL TABLES 83
REFERENCES 94
iv LIST OF TABLES
Table Page
1. Frequencies (Prevalence) of Childhood Victimization Type in Overall Sample 48
2. Mean Number of Childhood Victimization Incidents in Overall Sample 49
3. Frequencies of Multi-Type Victimization Exposure 51
4. Frequencies of Adulthood Trauma Type in Overall Sample 52
5. Trauma Symptoms in Clinically Problematic or Significant Range 53
6. Summary of Regression Analysis for Anxious Arousal 59
7. Summary of Regression Analysis for Anxious Arousal (significant covariates) 60
8. Summary of Regression Analyses for Anxious Arousal (sibling sex dyad) 60
9. Summary of Regression Analysis for Predicting Depression 62
10. Summary of Regression Analysis for Predicting Depression (significant covariates) 62
11. Summary of Regression Analysis for Predicting Depression (sibling sex dyads) 63
12. Summary of Regression Analysis for Predicting Anger 64
13. Summary of Regression Analysis for Predicting Anger (significant covariates) 65
14. Summary of Regression Analysis for Predicting Anger (sibling sex dyads) 66
A1. Victimization Chronicity Rates for Overall Sample (N = 284) 84
A2. Victimization Chronicity Rates for Females (N = 228) 85
A3. Victimization Chronicity Rates for Males (N = 56) 86
A4. Prevalence and Chronicity Rates for Sibling-Related Victimization 87
A5. Sibling Relationship Quality by Sibling Sex Dyad Combination 88
A6. Correlations for Victimization Type and Trauma Symptoms (Scales) 89
A7. Correlations for Victimization Type and Trauma Symptoms (Overall Sample) 90
A8. Correlations for Victimization Types and Trauma Symptoms for Males (Scales) 91 v A9. Correlations for Victimization Types and Trauma Symptoms for Males (Factors) 92
A10. Correlations for Victimization Types and Trauma Symptoms for Females (Scales) 93
A11. Correlations for Victimization Types and Trauma Symptoms for Females (Factors) 94
vi CHAPTER 1
INTRODUCTION
Prevalence of Exposure to Abuse
In a national survey completed by the U.S. Department of Health & Human Services
Children’s Bureau in 2010, there were 3.6 million reports of child abuse made to Child
Protective Services (U.S. Department of Health and Human Services, 2010). Of these reports the most frequently made were for neglect, physical and sexual abuse, respectively. With child abuse likely being under-reported, it is difficult to determine exact rates. However, a prospective, longitudinal study (N = 15,197) examined prevalence rates among national probability sample of young adults surveyed over 3 waves beginning in adolescence a supervision neglect rate of 41.5%, a physical abuse rate of 28.4%, a physical neglect rate of
11.8%, and a sexual abuse rate of 4.5% (Hussey, Chang, & Kotch, 2006).
Furthermore, prevalence estimates vary considerably for the number of children witnessing violence. Most estimates are for witnessing interparental violence (IPV). Osofsky
(2003) reported that 16-30% of all children in the United States witness domestic abuse. In line with this estimate, a small-scale study by Nguyen and Larsen (2012) found that 32% of 150 children sampled had witnessed IPV. Other studies have cited figures ranging from 3 million to
15 million children exposed to IPV per year (Kernic, Holt, Wolf, McKnight, Heubner, & Rivara,
2002; Kulkarni, Graham-Bermann, Rauch & Seng, 2011; McDonald, Jouriles, Ramisetty-Mikler,
Caetamo,& Green, 2007).
The picture is further complicated by evidence pointing to the frequent co-occurrence of child abuse and domestic violence (Herrenkohl, Sousa, Tajima, Herrenkohl, & Moylan, 2008).
While various studies report a wide range of rates for the co-occurrence of IPV and various forms of childhood abuse, there is not a good understanding of this overlap (Bourassa, Lavergne, 1 Damant, Lessard, & Turcotte, 2006). Currently, estimates of this co-occurrence range from approximately 30-60% and vary according to abuse type (Bourassa et al., 2006). In one national survey, the lifetime prevalence of witnessing partner violence in youth who had been maltreated was 56.8% (Hamby, Finkelhor, Turner, & Ormrod, 2010). Nguyen et al. (2012) found that children from homes where domestic violence occurred were 15 times more likely to experience physical or sexual abuse or be severely neglected than children from homes with no domestic violence. Also, in a national survey of over 6000 families more than half (i.e., 53-70%) of males who abused their wives also abused their children (Straus & Gelles, 1990). Furthermore, previous research shows that women who are victims of intimate partner violence are two times more likely to abuse their children (Child Welfare Partnership, 1995).
Outcomes of Exposure to Abuse
Experienced Abuse
It is well documented that maltreatment in childhood is associated with short-term and long-term adverse social, emotional, behavioral and physical sequelae. Socially, early maltreatment is linked to isolation, attachment insecurity, reactive attachment disorder, and poor conflict resolution skills (Herrenkohl et al, 2008; Perry, 2008). For example, Finzi and colleagues (2000) conducted a study comparing four groups of children 6 to 12 years old: children with drug-using fathers, physically abused children, neglected children, and non- abused/non-neglected children. Findings showed that 52% of the children from drug-using fathers had secure attachments, while the other 48% had insecure attachments. The physically abused children in the sample showed avoidant attachment styles, were at risk for developing antisocial behavior, and were suspicious toward others. The neglected children in the sample were characterized by anxious/ambivalent attachment styles, were at risk for social withdrawal,
2 rejection, and a low sense of competence. These results suggest that abuse type may predict the outcomes that are experienced.
Such findings are particularly important when considering that early relationships strongly influence how one will form relationships later. Bowlby (1988) posited that early attachment to caregivers and close others would generalize over time and create the child’s internal working model of how interactions and relationships with others should be carried out.
Thus, being maltreated, especially psychologically, according to Muller et al. (2012) may directly affect an individual’s expectations of relationships throughout life. Additionally, such early maltreatment seems to impact trauma symptomology into adulthood. Considering the literature, it is not surprising that survivors of child abuse experience difficulty in interpersonal relationships, including problems in the areas of attachment, marital functioning, intimacy, and conflict resolution (Cloitre, Miranda, Stovall-McClough & Hann, 2005; Kim, Talbot & Cicchetti,
2009; Rumstein-McKean & Hunsley, 2001).
Emotional and psychological problems associated with early maltreatment include feelings of shame, guilt, low self-esteem, mood disorders, PTSD, dissociation, eating disorders, recurrent depression, dysphoria, and anger (Buckingham & Daniolos, 2013; Herrenkohl et al,
2008; Perry 2008). For example, results of a community sample of 7,016 individuals by
MacMillan and colleagues (2001) showed that those with histories of childhood physical abuse had higher lifetime rates of anxiety disorders, alcohol dependence and more antisocial behavior.
Also, for women childhood sexual abuse was related to anxiety disorders, major depressive disorder, alcohol and drug dependence, and antisocial behavior (MacMillan, et al., 2001).
Additionally, it is common for survivors of childhood abuse to feel a sense of personal responsibility for their victimization and thus to experience shame and guilt for their abuse
3 (Dorhay & Clearwater, 2012; Negrao, Bonanno, Noll, Putnam, & Trickett, 2005). Shame and guilt may be related to the low self-esteem, low self-efficacy, and negative affect commonly seen in abuse survivors. Furthermore, it is estimated that 26% to 52% of survivors of childhood abuse experience posttraumatic stress symptoms (Kessler, 2000; Kessler, Sonnega, Bromet, & Hughes,
1995; Ulman & Brecklin, 2002). Thus, the psychological impact of early abuse is pervasive and can make recovery difficult for survivors.
In terms of behavioral sequelae, early maltreatment is associated with conduct disorder, violence, substance abuse, self-harm, suicidality and risky sexual behaviors in adolescence and adulthood (Herrenkohl et al., 2008; Perry 2008). Risk factors for self-harm behaviors in college women have included early sexual abuse and emotional neglect (Gratz, Conrad & Roemer,
2002). Results of Noll and colleagues’ (2003) longitudinal, prospective study of 163 females and showed that those with abuse histories were nearly four times as likely to engage in self- harm behaviors as those without abuse histories. Also, the odds of experiencing suicidal ideation and suicide attempts are higher in survivors of abuse compared to those who have not experienced abuse (Afifi, Boman, Fleisher, & Sareen, 2009). Moreover, Lown et al. (2011) surveyed 3,680 women and found that childhood physical and sexual abuse were both significantly associated with increased alcohol consumption over the past year and over the participants’ lifetime. Even after controlling for age, marital status, employment status, education, ethnicity, and parental alcoholism or problem drinking, both forms of childhood abuse were linked with heavy drinking, alcohol dependence and negative alcohol-related consequences
(e.g., getting into altercations, health, legal, work and family problems).
Finally, physical outcomes for adult survivors of childhood abuse include increased risk of heart disease, asthma, diabetes, arthritis, chronic spinal pain, chronic headaches, functional
4 pain disorders, migraines, gynecological and pelvic pain, chronic bronchitis, hepatitis, gastrointestinal disorders, and overall low ratings of physical health (Buckingham & Daniolos,
2013). Brain structure and function are also negatively impacted, with results suggesting that early maltreatment is associated with less gray matter volume in the prefrontal cortex, striatum, amygdala, sensory association cortices, and cerebellum (Buckingham & Daniolos, 2013). These neurological consequences may have corresponding adverse effects upon brain functioning, including decreased ability to filter threat-related information, problems relaying or integrating sensory information appropriately, alterations in memory, emotion dysregulation, and chronic fight/flight activation. It is evident from empirical and anecdotal evidence that early experiences of abuse can have devastating short-term and long-term impacts on physical, neurological, emotional, social and behavioral functioning.
Witnessed Abuse
While outcomes associated with experiencing abuse directly have been studied extensively, research into the sequelae of witnessing abuse is less developed. The literature on witnessing violence has mainly focused on exposure to community violence or interparental violence (IPV), particularly IPV against mothers. Regarding family violence, the findings from research examining the consequences of witnessing IPV suggest that short-term and long-term problems can occur across multiple domains: psychological (e.g., anxiety, post-traumatic stress symptoms, increased arousal, insomnia), emotional (e.g., depression, hostility, agitation, emotional numbing or distress), cognitive (e.g., lowered verbal and mathematical skills, problem solving difficulties) and behavioral (e.g., avoidance, withdrawal, aggression, acting out, obsessive behaviors, revenge seeking; Nguyen et al., 2012).
5 Early exposure to IPV may have different consequences at various points in development. For instance, in infancy and toddlerhood, exposure to IPV is associated with internalizing and externalizing problems (Dejonghe, von Eye, Bogat & Levendosky, 2011;
Nguyen et al., 2012). Very young children may experience increased irritability, sleeping difficulties, emotional anguish, fear of being left alone, regressive toileting and language behaviors, enuresis, decreased trust, and reduced exploratory behaviors (Dejonghe et al., 2011;
Nguyen et al., 2012).
Children exposed to IPV may show externalizing, rebellious and oppositional behaviors, increased anxiety, trouble sleeping and eating, nightmares, loss of interest in social activities, isolation and withdrawal, poor self-concept, and increased attention-seeking behaviors (Nguyen et al., 2012). For adolescents exposed to IPV different problems can occur, such as difficulties making and sustaining peer relationships, engagement in relationship violence, isolation, increased behavioral problems, poor academic performance, and risky behaviors (e.g., alcohol and drug use and unsafe sexual practices; Nguyen et al., 2012; Wood & Sommers, 2011).
Several meta-analyses show that children and adolescents who have been exposed to IPV exhibit more behavioral and emotional problems, internalizing and externalizing behaviors, anxiety and depression, physical aggression, and symptoms of PTSD than controls (e.g., hyper-arousal, exaggerated startle response and re-experiencing; Evans, Davies, & DiLillo, 2008).
In young adulthood the deleterious effects of IPV continue to have an impact. Research suggests that a history of witnessing IPV can predict the level of depression of participants
(Russell, Springer & Greenfield, 2010), and that the violence in young adult participants’ romantic relationships was related to IPV they had recently witnessed (Black, Sussman, &
Unger, 2010). Even into middle adulthood and old age, witnessing IPV earlier in life appears to
6 be influential. In a French cohort study of 3,023 adults, participants had increased risk of psychosocial adjustment problems if they had witnessed IPV as children (Roustit et al., 2009).
Their risk of various negative outcomes increased by: 1.44 for depression, 3.17 for conjugal violence, and 1.75 for alcohol dependence and, adults who witnessed IPV as children made more suicide attempts (Roustit et al., 2009). Similarly, in a national probability sample of 1,498 individuals 65 years of age and older, women were more likely to experience depression and men reported more alcohol consumption if they had ever witnessed violence during the course of their lives (Colbert & Krause, 2009).
Evidence indicates that witnessing IPV is associated with symptoms of posttraumatic stress. In multiple studies, IPV exposure is significantly associated with trauma symptomology after controlling for sex, age, family income, parental education level, and family functioning
(Blumenthal, Neemann & Murphy, 1998; Haj-Yahia, Tishby, & de Zoysa, 2008; Shen, 2009).
Additionally, in some studies IPV exposure has remained a significant predictor of PTSD symptoms even after accounting for childhood abuse and trauma (Blumenthal, Neemann, &
Murphy, 1998; Shen, 2009). For instance, Haj-Yahida, Tishby, and de Zoysa (2008) surveyed
476 Sri Lankan medical students and found that childhood abuse and exposure to IPV uniquely predicted posttraumatic stress symptoms. Moreover, results of a study by Marmion and
Lundberg-Love (2008) showed that while childhood sexual abuse, physical abuse, and exposure to IPV predicted intrusive symptoms and defensive avoidance symptoms of PTSD, IPV exposure had stronger associations with intrusive symptoms, defensive avoidance, anger, irritability, and tension reduction (i.e., the respondent's tendency to turn to external methods of reducing internal tension or distress, such as self-mutilation, angry outbursts, and suicide threats) than either type
7 of childhood abuse. This suggests a relationship between witnessing victimization and the experience of PTSD symptoms.
Moreover, the relationship between family violence and trauma symptoms may be discussed in terms of primary traumatic responses or secondary traumatic responses. A primary traumatic response can be thought of as the development of various symptoms in an individual that result from experiencing a traumatic event themselves. In the case of secondary traumatic stress, which has often been discussed in term of helping professions but is now being extended to family systems, Figley (1995) described the development of a wide range of trauma symptoms as the result of having a caring relationship with someone who has been traumatized and/or is suffering from posttraumatic stress (Baird & Kracen, 2006; Klaric, Kvesic, Mandic, Petrov, &
Franciskovic, 2013). Thus, the former traumatic response is associated with one’s presence during violence, either as a victim or bystander, while the latter traumatic response is associated with the close, compassionate and caring relationship one has with someone who has experienced a traumatic event. Despite this distinction, primary and secondary traumatic stress both include symptoms such as nightmares, intrusive thoughts, flashbacks and other PTSD symptoms (Klaric et al., 2013). The current study is concerned with primary traumatic responses.
Witnessing and Experiencing Abuse
Due to the high rate of co-occurring witnessed IPV and experienced childhood abuse, researchers have tried to determine if there are differential and/or additive effects of exposure to both types of victimization. Previous research suggests that a dose-response, or additive effect
(i.e., “double whammy effect”) may exist whereby exposure to both domestic violence and child abuse are associated with worse outcomes than experiencing just one form of maltreatment
8 (Herrenkohl et al., 2008; Moylan, Herrenkohl, Sousa, Tajima, Herrnekohl & Russo, 2009;
Sternberg et al., 2006). Indeed, Moylan et al. (2009) found that youth who had experienced the combination of child abuse and witnessed domestic violence (i.e., not only child abuse or only domestic violence) experienced increased risk of internalizing and externalizing behaviors in adolescence.
Few studies have examined whether witnessing victimization versus experiencing victimization are associated with differing traumatic reactions and symptoms. One study by
Reid- Quinones and colleagues (2011) surveyed 263 urban youth to determine differences in their cognitive, affective, and behavioral responses to witnessed versus experienced victimization. The adolescents who had been directly victimized reported more anger and concerns about being negatively evaluated by others and themselves, held goals to seek revenge, and used aggression, social support and engagement to cope. Alternatively, the adolescents who witnessed violence experienced more fear, concern about others being hurt, worry about loss of relationships, preoccupation with survival and used avoidant strategies to cope. Other studies examining differential reactions to experienced versus witnessed violence have focused on heavily on community violence and yielded conflicting results regarding internalizing
/externalizing reactions, fear /anger responses, etc. (Reid-Quinones et al., 2011).
Since most studies have examined witnessed community violence versus directly experienced violence to understand different traumatic reactions that may result from each, no studies to date have contrasted or compared individuals who have witnessed and/or experienced family violence. Thus, it is difficult to know if there is a non-specific stress response to directly experienced or witnessed family violence, or if there are more distinct responses that occur.
Studies regarding the effects of witnessing interparental violence versus experiencing childhood
9 abuse have typically not examined differences in symptoms associated with each type of victimization. Rather, researchers have tended to examine whether one or both types of victimization are associated with the same traumatic reaction, such as PTSD.
Some studies have shown only a negligible association between PTSD and witnessing
IPV after controlling for the experience of participants’ own direct experiences of abuse. This suggests that, while witnessing victimization may exacerbate the effects of experiencing abuse, the relationship may not be direct. For example, results from Silven et al. (1995) showed that after controlling for experiences of childhood abuse, the relationship between witnessing IPV and trauma symptomology was not significant. Additionally, Kulkarni et al. (2011) surveyed
1,581 pregnant women in the Northern United States and found that witnessing IPV alone was not predictive of lifetime or current PTSD symptomology, while experiencing abuse directly or in combination with witnessing abuse were both highly predictive of PTSD. Finally, a recent study examined the relationship between witnessing interparental conflict, PTSD, and complex
PTSD in a sample of 340 college students in the Southern United States (Miller, 2011). The results of this study indicated that individuals who witnessed IPV had more severe posttraumatic stress symptoms than those who had not witnessed IPV, but this relationship did not hold for witnessing IPV and symptoms of complex PTSD.
Adulthood Victimization
According to the U.S. Bureau of Justice Statistics (2014), in 6.1% of the population aged
12 years and older experienced violent crime with injury, 7.3% experienced serious violent crime, 1.1% were sexually assaulted, and 2.8% were involved in intimate partner violence in
2013. For years trauma researchers have examined the sequelae of these types of victimizations as they occur in adulthood. This research paints a complex picture in which responses to trauma
10 in adulthood are influenced by trauma experienced earlier in life. Findings from prior research on the effects of adult sexual assault suggest that the experience of previous assaults such as childhood abuse is associated with coping, which in turn shows a relationship with sexual assault trauma symptomology. Specifically, more reported cumulative trauma has been linked with maladaptive coping (e.g., avoidant strategies: self-blame, emotional containment, and passive resignation), and maladaptive coping has been linked with higher levels of depression, anxiety, and PTSD symptoms (Cheasty, Clare & Collins, 2002; Najdowski & Ullman, 2009; Ullman,
Peter-Hagene, Relyea, 2014).
Similarly, being a victim of violent crime in adulthood can predict PTSD symptoms indirectly through the experience of shame and anger (Andrews, Brewin, Rose & Kirk, 2000).
One possible explanation for this comes from the survival mode theory of PTSD, which posits that individuals with PTSD experience increased levels of anger in response to triggering stimuli in the environment, and that this anger elicits survival based defenses and concomitant cognitive distortions, such as (a) increased perceptions of threat cues, (b) reduction in other forms of cognitive processing after threat is perceived , (c) requiring less evidence of threat to engage in action, and (d) loss of self-monitoring (Chemtob, Roitblatt, Hamada, Carlson, & Twentyman,
1988; Kunst, Winkel and Bogaert’s, 2011; Novaco & Chemtob, 2002). There is empirical support for this theory, such as the Kunst et al. (2011) findings that posttraumatic anger was significantly associated with all indices of PTSD in their sample of 177 victims of violent crimes.
Furthermore, evidence exists which substantiates the relationship between the frequency and severity of domestic violence experienced in adulthood and various trauma symptoms, including PTSD (Griffing, Lewis, Chu, Sage, Madry, & Primm, 2006). For example, Coker and colleagues (2002) studied a sample of 6790 women and 7122 men in order to examine the
11 physical and mental health effects of intimate partner violence. Women were significantly more likely to experience intimate partner violence than men, and all forms of intimate partner violence measured were significantly associated with current depressive symptoms for both men and women. Moreover, another study found the severity of current domestic violence reported by participants predicted avoidance and hyperarousal symptoms, and participants with a prior history of violence exposure (e.g., childhood abuse) had higher levels of avoidance and hyperarousal symptoms than those without a prior history (Griffing et al., 2006).
Trauma Symptomology
Posttraumatic Stress
As discussed, the experience of childhood abuse and witnessing the victimization of others are associated with various symptoms and diverse outcomes later in life, which include physical, psychological, interpersonal and behavior difficulties (Buckingham & Daniolos, 2013;
Herrenkohl et al, 2008; Perry 2008; Buckingham & Daniolos, 2013). Arguably one of the most extensively studied sequelae of child abuse is posttraumatic stress disorder (PTSD). In 2013, the
American Psychiatric Association approved revisions to the Diagnostic and Statistical Manual-
5th edition. This included revisions to the posttraumatic stress disorder diagnoses. The diagnostic criteria for PTSD in individuals older than 6 years old have been expanded and refined from the previous DSM-IV-TR criteria, and are described below.
Criterion A requires that the individual experience either direct exposure to the traumatic event, witness it in person, and experience it indirectly via learning of trauma to someone close to them or by repeated or extreme exposure to details of the event. Thus, individuals experiencing abuse directly, witnessing abuse of another persona, or those being impacted less
12 directly by learning of a loved one’s trauma or working as a professional with traumatized populations (e.g., vicarious traumatization) may meet criterion A for PTSD.
Criterion B requires that the individual experience at least one of either recurrent, involuntary and intrusive memories, traumatic nightmares, dissociative reactions such as flashbacks, periods of intense distress following exposure to traumatic reminders/triggers, marked physiological reactivity following exposure to traumatic reminders/triggers.
Criterion C stipulates that the individual must experience persistent and effortful avoidance of trauma related stimuli. Such stimuli can include internal reminders of the trauma, such as thoughts, feelings, and memories. Also, trauma related stimuli can include external reminders such as places, sounds, smells, etc. that have some characteristics similar to some aspect of the environment in which the traumatic event took place.
Criterion D requires the individual experience 2 or more symptoms of changes in thoughts and mood that began or were exacerbated by the traumatic event. These may include the inability to recall key features of the event, persistent negative beliefs and expectations about oneself or the world, persistent distorted blame of self or other for causing the event or the consequences of it, persistent negative trauma related emotions, markedly diminished interest in significant activities, feelings of alienation (e.g., detachment or estrangement) from others, and constricted affect (e.g., inability to experience positive emotions).
Criterion E focuses on trauma related alterations in arousal and reactivity that began or were exacerbated after the event. The individual must experience at least two of the following symptoms: irritable or aggressive behavior, self-destructive or reckless behavior, hyper vigilance, exaggerated startle response, problems with concentration, and/or sleep disturbance.
13
Criterion F stipulates the duration of symptoms from Criteria B, C, D, and E, specifically stating that they must last for a more than one month. Additionally, Criterion G states that the symptoms and related distress must cause significant functional impairment in occupational, social or other domains of life. Finally, Criterion H is related to attribution and requires that the symptoms and distress are due to the traumatic event rather than to medication, substance use or other illness.
Understandably, PTSD symptoms can be quite distressing and often debilitating to trauma survivors. In a recent literature review, Rodriquez, Holowka and Marx (2012) conclude that prior research focused on veteran studies has demonstrated strong associations between
PTSD and functional impairment, with most studies reporting medium to large effect sizes.
Furthermore, evidence shows that the severity of functional impairment, psychiatric comorbidity, and problems with quality of life range from least to worst in individuals without PTSD, with past PTSD, and current PTSD, respectively (Westphal et al., 2011).
Anxiety
Research has established that early traumatic experiences are one of the environmental factors that may contribute to the etiology of anxiety disorders (Maniglio, 2012). Various forms of childhood abuse have been associated in the literature with anxiety disorders. For example,
Maniglio (2012) conducted a systematic “review of reviews” of the relationship between anxiety and childhood sexual abuse. Findings indicated that childhood sexual abuse is a risk factor for anxiety disorders, including PTSD, generic anxiety, obsessive-compulsions and phobic anxiety
(Maniglio, 2012). Also, compared to a control group, physically abused children report more anxiety, especially in response to visual and auditory signs of anger, than non-abused children
(Shackman, Shackman, & Pollak, 2007). Furthermore, there is evidence that emotional abuse is
14 associated with symptoms of General Anxiety Disorder, and this relationship could be mediated by emotion dysregulation resulting from abuse (Soenke, Hahn, Tull, & Gratz, 2009).
Additionally, witnessing violence is likely among the early traumatic experiences associated with anxiety. Previous studies have found that children of battered women exhibit higher rates of various negative outcomes, including non-compliance, aggression, and anxiety
(Mabaglano, 2002). Witnessing violent behavior at home has been linked to aggression and anxiety in children. Moss (2003) surveyed children 4 to7 years old at 2- and 4-year intervals.
They found that children who had witnessed family violence reported higher levels of anxiety over time than children who had not witnessed family violence. For the girls specifically who witnessed family violence, the odds of experiencing anxiety were two times higher than in girls who had not (Moss, 2003).
Due to the fact that many individuals who have witnessed family violence have also experienced childhood abuse, there is not yet a good understanding of whether anxiety is more or less directly or uniquely associated with either form of violence exposure. It becomes even harder to understand this link considering that much of the literature has focused on the broader symptom clusters of internalizing and externalizing behaviors, rather than on specific symptoms or disorders such as anxiety. Internalizing and externalizing behaviors can be measured in various ways and are operationalized differently across studies. Many operational definitions of internalizing behaviors include anxiety and depression as symptoms, while externalizing behaviors often include acting out, risk taking and aggression.
If studies examining internalizing behaviors are taken into account, some researchers have found an association between internalizing behaviors and both childhood abuse and witnessing violence. Early studies found that children of battered women have higher rates of
15 internalizing and externalizing behaviors than children from non-violent homes (Mabaglano,
2002). Moreover, evidence suggests that there may be an additive effect of experiencing both direct and indirect forms of violence in terms of internalizing symptoms (Moylan et al., 2010;
Sternberg et al., 2006). Sternberg et al. (2006) conducted a meta-analysis of 15 studies including
1,870 youth from 4 to 14 years old. Children who were exposed to domestic violence and childhood abuse were 187% more likely to show internalizing behaviors than those in the no- violence group, 117% more likely than youth who experienced child abuse only, and 38% more likely than participants who witnessed domestic violence only.
Other research suggests that witnessing violence is associated with internalizing behaviors, while experiencing abuse is more strongly associated with externalizing behaviors.
For instance, Maikovich and colleagues (2008) assessed a sample of 2,925 youths 5 to16 years old to test whether witnessing home violence and/or experiencing harsh physical punishment were predictive of psychopathology symptoms. They found that harsh physical punishment was predictive of externalizing behaviors in the youth, while witnessing home violence was predictive of internalizing behaviors (Maikovich, Jaffe, Odgers, & Gallop, 2008). Thus, there is not yet a clear picture of exactly how witnessing versus experiencing violence directly are associated with symptoms such as anxiety.
There is only one study to date examining this association regarding witnessing the abuse of a sibling in childhood and symptoms of anxiety in adulthood after controlling for the effects of childhood abuse. Teicher and Vitaliano (2011) found that witnessing the abuse of a sibling was associated with symptoms of anxiety in participants, while witnessing the abuse of a mother or father was not. More information is needed to understand how witnessing the abuse of a sibling specifically is related to the experience of anxiety symptoms in adulthood.
16 Depression
Among the posttraumatic stress symptoms associated with exposure to victimization is depression. The experience of depression as a sequelae of childhood maltreatment is consistent with criterion D for PTSD diagnosis, which relates to persistent changes in mood) American
Psychiatric Association, 2013). For example, there is evidence that childhood maltreatment often precedes the first episode of depression and is a strong predictor of the onset of depression
(Harkness, Lumkey, & Truss, 2008). Other work has linked specific types of childhood abuse to depression. For instance, Manigolio (2010) conducted a review of 160 studies, including 60,000 participants, which showed that childhood sexual abuse is a significant risk factor for depression.
Furthermore, childhood maltreatment may represent a “double threat” regarding vulnerability to depression (Harkness et al., 2008). Research suggests that childhood maltreatment sensitizes the individual to other stressful life events which precede the onset of depression, lowering the individual’s threshold for the amount of stress required to bring about the onset of depression (Hammen, Henry, & Daley, 2000; Harkness, Bruce, & Lumley, 2006;
Rudolph & Flynn, 2007). Harkness and colleagues (2008) point out that this “double threat” for depression is related to the fact that the childhood maltreatment not only sensitizes the individual to other life stressors, but also increases the generation of stressors that can maintain depression or cause it to recur.
The link between exposure to other, less direct types of interpersonal violence and depression has been less clearly defined. There is evidence suggesting that both direct victimization and witnessing victimization are both independently linked to adverse mental health outcomes like depression (Johnson et al., 2002; Margolin, Vickerman, Oliver, & Gordis,
2010; Moffitt et al., 2007). Past research, for instance, demonstrates links between witnessing
17
IPV and higher rates of depression (Forsstrom-Cohen & Rosenbaum, 1985; Gelles & Straus,
1988). Kilpatrick and colleagues (2003) examined the incidence of major depressive episodes,
PTSD and substance abuse disorders in a sample of adolescents exposed to various types of interpersonal violence (e.g., witnessed violence and directly experienced abuse). Results showed that (a) physical assault was associated with episodes of major depression, (b) sexual assault, physical assault and witnessed violence were risk factors for comorbid major depressive episodes and PTSD, and (c) sexual assault and witnessed violence were risk factors for comorbid major depressive episodes and substance abuse disorders.
However, the high rates of overlap between the experience of indirect and direct forms of interpersonal victimization must be accounted for carefully. Some researchers have found that after controlling for the experience of direct victimization (e.g., childhood abuse, parent-child aggression) and other possible confounding variables, the association between indirect exposure to victimization (e.g., witnessing community violence or IPV) and trauma symptoms like depression is negated or disappears. Buka and colleagues (2001) cite early literature suggesting that experiencing violence is associated with depression, while witnessing violence is not. It may be that the link between depression and witnessing victimization is not a direct one. For instance, Kessler and Magee (1994) found that chronic interpersonal stress in adulthood mediates the relationship between exposure to early family violence and adult recurrent depression, such that without the interpersonal stress there is no significant association between them. Also,
Blumenthal et al.’s (1998) survey of 326 undergraduate students showed that exposure to IPV, particularly interparental verbal aggression, was associated with depression in the sample, but this association was no longer significant after controlling for severe stressors and parent-child aggression.
18 Anger
The literature regarding the association between anger and the experience of trauma is fairly well established. Criterion E of the PTSD diagnosis in the DSM-5 encompasses anger related experiences (American Psychiatric Association, 2013). Anger is one of the emotions central to symptomology of complicated traumatic reactions (Fletcher, 2011). Anger is also a key symptom in a range of trauma related disorders (e.g., PTSD, complex PTSD, major depressive disorder, borderline personality disorder) and can even contribute to the maintenance of these disorders (Fletcher, 2011). Furthermore, anger is a very common reaction to highly stressful events, such as interpersonal violence (Cloitre et al., 2009).
The relationship between specific types of trauma, like childhood abuse, and anger has been substantiated. Researchers have found that experiencing sexual abuse can lead to problems managing anger and aggression (Bal, Van Oost, De Boureaudhuij, & Crombez, 2003).
Furthermore, earlier work found both sexual and physical abuse in childhood to be associated with anger and hostility in young adults (Sappington et al., 1997). In other studies, anger has predicted trauma symptoms in individuals with a history of childhood abuse. For instance,
Andrews and colleagues (2000) found that shame and anger directed toward others were independently predictive of PTSD symptoms in individuals with a history of childhood abuse who had recently been the victim of violent crimes. Similarly, Kendra et al. (2012) examined paths through which the experience of childhood abuse may be associated with intimate partner violence in females. Results showed that childhood abuse directly predicted female perpetrated physical and psychological IPV and was indirectly associated with female perpetrated IPV via
PTSD and anger arousal symptoms. Interestingly, when they controlled for anger arousal effects the direct association between PTSD and female perpetrated IPV was no longer significant. This
19 suggests that anger arousal may be part of the mechanism for the relationship between PTSD and
IPV (Kendra, Bell, & Guimond, 2012).
The relationship between witnessing violence and anger has also been examined.
Research shows that when children and adolescents are exposed to community violence they often exhibit anger, aggression, conduct disorder and oppositional defiance disorder (Schwab-
Stone, Chen, Greenberger, Silver, Lichtman, & Voyce, 1999). Moreover, when children are exposed to anger and violence between adults, anger is reported to be among their most common psychological responses (Feerick & Haugaard, 1999). Extant literature suggests that anger mediates and moderates the relationship between indirect exposure to violence and adverse trauma-related outcomes (e.g., IPV, dating violence, anxiety, depression, PTSD; Wolf & Foshee,
2003). Kitamura and Hasui (2006) surveyed 457 junior high school students about the effects of anger and witnessing family violence on anxiety and depression symptoms. Generally, the researchers found that the effects of witnessing family violence on dysphoric mood was mediated by anger feelings. Specifically, after controlling for depression, anxiety was positively predicted by state anger, the expression of anger and control over the expression of anger
(Kitamura & Hasui, 2006). When controlling for anxiety, depression was predicted by state anger, positively by the suppression of anger, and negatively by the expression of anger and control over the expression of anger (Kitamura & Hasui, 2006).
There has not been as much attention paid to whether there are differences in anger responses to witnessed versus experienced violence and abuse. However, Reid-Quinones and colleagues (2011) found different psychological reactions associated with experienced violence versus witnessed violence. These researchers examined 263 inner city youth regarding their cognitive, emotional and behavioral responses to witnessed versus experienced acts of violence,
20 and found that anger, revenge goals, concerns about being negatively evaluated by others, social support and aggressive coping strategies were more often reported in response to experienced violence (e.g., physical victimization) than in response to witnessed violence. Overall, anger was more strongly associated with experienced violence, while fear was more strongly associated with witnessed violence in this sample. As with the other trauma-related symptoms discussed thus far, there is little information available about how anger is associated with witnessing the abuse of a sibling versus experiencing abuse oneself.
Externalization
Although we have discussed externalizing problems briefly (see Anxiety section), it would be useful to review information regarding aspects of externalization in adults, such as suicidality and tension reduction behavior. Suicidality can include both suicidal ideation and suicidal behaviors, while tension reduction behaviors are external activities one engages in to soothe, regulate, interrupt or avoid negative internal states (e.g., thrill seeking, aggression, self- injury, dysfunctional eating, etc.; Briere, 1995). Both externalization symptoms are linked to the experience of trauma in the literature.
Childhood maltreatment is an important predictor of past and present suicidality, including suicidal ideation and behavior (Read, Agar, Barker-Collo, Davies, & Moskowitz,
2001). Various forms of childhood abuse (i.e., emotional, physical and sexual) have been linked directly and/or indirectly to increased suicidality in adulthood (Lee, 2015; Thakker, Gutierrez,
Kuczen, & McCanne, 2000). Emotional abuse in childhood significantly predicts suicidality in adulthood, but the relationship appears to be indirect and mediated by depressive symptoms and emotional abuse in adulthood (Lee, 2015). Additionally, survivors of childhood sexual abuse report higher levels of suicidality than do individuals who have not been sexually abused, with
21 childhood sexual abuse potentially being a better predictor of suicidality than depression (Read et al., 2001). Also, results of a study by Thakker and colleagues (2000) with 707 college women showed that a history of physical and sexual abuse in childhood was associated with their current suicidal ideation.
No studies have examined the relationship between witnessing family violence and suicidality. A search of the literature regarding witnessed violence and suicidal ideation or behaviors yielded only one study regarding exposure to community violence. In this study,
Lambert et al. (2008) surveyed 473 predominantly African American urban youth and found an indirect relationship between witnessing community violence and suicidality over time. That is, youth who were exposed to community violence in 6th grade showed increased depression in 7th grade, which in turn was associated with increased suicidal ideation in 8th grade. For males, increased aggression in 7th grade was associated with suicide attempts in 8th grade. Despite lack of attention to the possible links between exposure to interparental violence/ parent perpetrated sibling abuse and suicidality in adulthood, it is feasible that some association exists.
In terms of tension reduction behaviors, these can take a myriad forms, such as self- injurious behavior, thrill seeking behaviors, aggression, dysfunctional eating, and other forms of acting out, and suggest poor affect regulation and distress tolerance (Briere, 1995). In their review of self-mutilation in females, Zila and Kiselica (2001) noted that the experience of childhood physical and sexual abuse correlated with self-mutilation, and that disturbed childhood attachments (i.e., often resulting from childhood abuse and neglect) are one possible underlying mechanism by which self-injurious behavior is developed. Furthermore, there is evidence that tension reduction behaviors like disordered eating, substance use and self-mutilation do co-occur with some frequency, and that the commonality among these behaviors may be trauma and
22 dissociation (Zila & Kiselica, 2001). This link between tension reduction behaviors and trauma, however, has not always been conclusive. For instance, researchers have found that the experience of trauma per se does not predict self-injurious behaviors, but rather that psychiatric symptoms could serve as a mechanism by which trauma is related to self-injury. Various studies, as reviewed by Smith and colleagues (2014), demonstrated that after controlling for psychiatric and trauma symptoms, the association between trauma and self-injury were no longer significant. However, in a study that compared individuals with borderline personality disorder
(BPD) either with or without comorbid PTSD, results showed that comorbid PTSD and BPD was associated with significantly more self-injurious behavior (Harned, Rivzi, Linehan, 2010).
Violence exposure, including witnessed violence, has been associated with increased tension reduction behaviors (e.g., substance use, aggression and risky sexual behaviors; see
Margolin & Gordis, 2000 for review). Other studies have found that witnessing and/or experiencing violence is linked to earlier age of substance use, greater frequency of use, and increased likelihood of dependence, and is predictive of cigarette, alcohol, and marijuana use/dependence, and sexual risk taking ( Brady & Donenberg, 2006). Moreover, Trocki and
Caetona (2003) demonstrated a link between witnessed IPV and substance use in adulthood.
Thus, there is some support for the relationship between witnessed forms of victimization and engagement in tension reduction behaviors.
The Sibling Relationship
To date almost no research has been conducted on the effects of witnessing the abuse of a sibling (Teicher & Vitaliano, 2011). This is counterintuitive given how influential and almost ubiquitous the sibling relationship is for most individuals. The majority of individuals in the
U.S. grow up with a sibling and are more likely to grow up with a sibling than with a father in
23 their home (Hernandez, 1997; McHale, Kim & Whiteman, 2006). Moreover, siblings often spend more time with each other than with anyone else (McHale & Crouter, 1996; Updegraff,
McHale, Whiteman, Thayer, & Delgado, 2005). Sibling relationships are also among the longest lasting relationships most individuals will have.
Sibling relationships are diverse in structure and function. Their various structures include hierarchical (i.e., with power differentials and differing caretaking responsibilities between them), vertical (i.e., with peer-like interactions, camaraderie and egalitarian properties), and reciprocal (i.e., mutual) (Whiteman et al., 2006). There is the chance for increasingly complex sibling relationships depending on the combination of ages, genders and biological relatedness of each sibling. Moreover, the functions that sibling relationships can serve are diverse and can be very important for individual development. For instance, sibling relationships may shape individual identity formation, provide mutual emotional and behavioral regulation for both siblings, involve engagement in defense and protection of each other, help each other interpret interpersonal experiences, gain interpersonal and social competence, model and teach new behaviors to each other, and provide one another with practical favors (Weaver, Coleman, &
Ganong, 2003).
To add to the complexity, sibling relationships are dynamic and change in relation to familial, developmental and environmental circumstances. Empirical evidence shows that siblings may be close in childhood and adolescence, but less so in early adulthood as more resources are directed toward educational pursuits, work, romantic relationships, and reproduction (Cicirelli, 1995 as cited in Voorpostel, van der Lippe & Flap, 2012). Yet, as individuals enter middle and late adulthood they seem to regain closeness to their siblings
(Voorpostel, van der Lippe & Flap, 2012).
24 Family Systems Theory and Siblings
Despite the lack of empirical research in this area, several theories have been used to conceptualize the sibling relationship. The present study will approach the sibling relationship using family systems theory. Family systems theory states that the family is most appropriately viewed holistically (Whiteman et al., 2006). The basic level of organization in the family system is the subsystem, including the marital subsystem (i.e., romantic relationship between the parental figures), parental subsystem (i.e., relationship devoted to raising children, often comprised of parents), and sibling subsystem (i.e., relationship between brothers and sister combinations; Minuchin, 1974). These subsystems are viewed as having interdependent, hierarchical and reciprocal relationships with each other. Various dynamic processes maintain the integrity and homeostasis of the system, such as power structures, roles, rules, and boundaries (Minuchin, 1974).
In Bowen’s family system theory, processes that facilitate family functioning include differentiation (i.e., balance between intimacy and autonomy of the members), the nuclear family emotional system, triangulation (i.e., projection processes by which a dyad diffuses tension onto a third member), emotional cut off between members, multigenerational transmission of patterns of behavior and interaction, sibling position and the impact of societal norms on the emotional processes within the family (Comella, 2011). From this theoretical perspective, families may be susceptible to external forces which can require adaptation since they are viewed as open systems.
The Sibling Subsystem
The sibling subsystem has a reciprocal and inextricable relationship to the other family subsystems. There are several proposed mechanisms by which these subsystems can affect each
25 other. One of them is via spillover, in which there is transference of emotional or behavioral interaction from one family subsystem to another (Erel & Burman, 1995). As an example of how problems in the marital subsystem could affect (i.e., spill over into) the parental subsystem, consider that a woman who is abused by her husband may have difficulty regulating her negative emotion, which could make her more likely to neglect/abuse her children. Additionally, an example of the marital subsystem affecting the sibling subsystem is that of children witnessing
IPV and then externalizing and acting aggressively with each other. Modeling behavior may also allow one subsystem to impact another. For instance, if a mother is harsh and rejecting toward one child, the child’s siblings may imitate this behavior and reject or mistreat the child as well. Furthermore, while empirical support for the spillover hypothesis has been variable, research demonstrating spillover effects with siblings (Pike et al., 2005), and reciprocal links between sibling relationships, parent-child and marital/romantic relationships cannot be overlooked as a possible explanation for abusive behavior co-occurring in multiple family subsystems (Kim et al., 2006; Yu & Gamble, 2008).
However, an alternative process may occur in which the sibling relationship compensates for support or resources that are lacking in other important relationships, such as those with peers and parents (Milevsky, 2005). Similar to the spillover hypothesis, support for the compensation hypothesis has been variable. Derkman and colleagues (2011) examined bidirectional associations between sibling relationships and parental support in 428 families.
Their findings supported spillover effects from the sibling relationships to parental support, but did not substantiate compensatory effects. On the other hand, Voorpstel and Blieszner (2008) surveyed 1,259 families and found that poor relationship quality with parents and low contact frequency with parents was associated with higher sibling emotional support, suggesting
26 compensation by siblings for low parent-child relationship quality. Additionally, the researchers noted that spillover effects were stronger for females in their study, while compensation effects were stronger for males. This suggests the processes occurring in the family system, specifically involving the sibling subsystem, are complex and may involve either spillover or compensation.
Additionally, empirical work has recently focused on the integration of attachment and family systems theories. Research has shown that siblings can serve as attachment figures for each other (Erdman & Caffrey, 2003). The ability to act as an attachment figure for a sibling does seem to be partially contingent upon sibling ages and positions, but research supports the attachment role for siblings even at very young ages. Siblings often provide support for each other during parental conflict, older siblings can act as a safe base for younger ones, and over the lifespan siblings frequently provide important support and help for each other (Whiteman et al.,
2006). In experimental studies, the Strange Situation has been utilized to assess the roles of multiple family members in attachment, including siblings (Stewart & Marvin, 1984 as cited in
Erdman & Caffrey, 2003). Results showed that when mother and father were not available, siblings as young as 4 years old could provide attachment functions for their infant sibling.
Thus, there is experimental evidence in support of attachment behaviors among siblings.
Witnessing Sibling Abuse
As mentioned earlier, attention to sibling relationships in the literature has been burgeoning. However, there has been almost no attention given to the outcomes associated with witnessing the abuse of a sibling. This is troubling given that the prevalence of this type of victimization exposure is likely high. There are few studies that estimate the prevalence of this type of victimization exposure. H`aj-Yahia and Abdo-Kaloti (2003) conducted a cross-sectional survey to examine the rates of witnessing interparental and parent-to-sibling abuse in a
27 Palestinian sample. Approximately 51.3% of the 1,185 responding adolescents said they had witnessed heated arguments between parents and siblings, 35.3% had witnessed parents make threats of physical violence toward siblings, 18.8% witnessed parents threatening siblings with an injurious or lethal weapon, 38.4% witnessed parents physically assault their siblings, and
31.2% had witnessed a parent attack siblings continuously with a stick, club or other harmful object at least once. Also, approximately half of the adolescents reported witnessing a parent emotionally and verbally abuse a sibling at least once.
While this study gives estimates of rates at which the abuse of a sibling is witnessed, the sample is not generalizable to the U.S. population and it did not examine sequelae or psychosocial consequences for the witnesses/respondents. Only one study could be found which specifically examined outcomes associated with witnessing the abuse of a sibling. Teicher and
Vitaliano (2011) conducted a self-report survey in a community sample of 1,412 young adults.
The researchers assessed history of witnessing threats or actual assaults between mothers and fathers and between parents and siblings. They also asked about participants’ experience of childhood abuse. Teicher and Vitaliano (2011) controlled for the effects of experiencing abuse directly, as well as witnessing IPV, in order to determine the effects associated with witnessing abuse toward siblings, specifically. Their outcome variables included depression, anxiety, somatization, anger-hostility, dissociation and limbic irritability (i.e., symptoms often encountered as ictal temporal lobe epilepsy phenomena). Participants reported witnessing violence toward siblings about as frequently as they did toward their mothers (i.e., 22% vs. 21%, respectively). Notably, witnessing abuse toward their mother was not associated with significant elevations on any of the outcome scales, while witnessing abuse toward siblings was associated with significant elevations on all of the outcome scales. The relative importance of witnessing
28 violence toward siblings was 2.4 to 4.7 fold greater than that for witnessing violence toward mothers or fathers. The highest relative importance of witnessing abuse toward siblings was for symptoms of dissociation. Moreover, the effect of witnessing abuse toward a sibling was as great as that of experiencing sexual abuse directly. Mediation and structural equation models indicated that the effects of witnessing violence toward parents were indirect and mediated by alterations in maternal behavior, while the effects of witnessing sibling abuse were more direct.
Teicher and Vitaliano’s (2011) study provides a very useful contribution to a nascent body of literature, but there is a definite need for more studies to help elucidate the association between witnessing the abuse of a sibling and trauma related-outcomes.
The Present Study
There are several gaps in the literature regarding the outcomes associated with witnessing the abuse of a sibling, which the present study will aim to address. First, there are mixed findings regarding the association between witnessing the abuse of a close other (e.g., IPV) and experiencing trauma symptoms. While some findings suggest that witnessing abuse is a unique predictor of trauma symptoms, other findings show that this relationship is not direct or may be negligible after controlling for directly experienced abuse (Blumenthal, Neemann, & Murphy,
1998; Shen, 2009; Silven et al., 995; Kulkarni et al., 2011). Second, extant research on the outcomes associated with witnessing abuse has primarily focused on IPV, with special focus on the effects of witnessing physical violence toward the child’s mother. This largely ignores outcomes associated with witnessing abuse toward important close others, specifically siblings.
Third, many studies examine circumscribed types of victimization, such as physical abuse, while evidence consistently indicates that poly-victimization is the rule rather than the exception in abusive households (Higgins, 2004). That is, research and anecdotal evidence suggests that
29 domestic violence consists of multiple forms of abuse, and that it is common for children in the home to also experience abuse (Higgins, 2004). Finally, while there has been a wide range of outcomes examined in the literature on exposure to IPV, there is no literature base for understanding the sequelae of witnessing the abuse of a sibling.
There is some extant research that can guide hypotheses and analyses. As discussed previously, empirical evidence does demonstrate adverse effects associated with witnessing IPV, especially when it is experienced along with childhood abuse. However, the association between witnessing victimization and trauma symptoms experienced later in life is unclear. Some researchers have found that when controlling for childhood abuse experiences, witnessing IPV alone was not predictive of PTSD (Kulkarni et al., 2011). Additionally, when Teicher and
Vitaliano (2011) controlled for childhood abuse experiences, witnessing IPV alone was not associated with depression, anxiety, somatization, anger-hostility, dissociation or limbic irritability.
However, Teicher and Vitaliano (2011) did find that when they controlled for childhood abuse experiences and witnessing IPV (i.e., toward mother and father), witnessing the victimization of a sibling alone was significantly associated with adverse outcomes later in life
(e.g., depression, anxiety, somatization, anger-hostility, dissociation or limbic irritability).
Additionally, they found an effect size for witnessing the victimization of a sibling that was comparable to that of directly experiencing sexual abuse. Thus, the literature seems to suggest that witnessing victimization of close others can have a significant impact upon mental health.
Moreover, findings from Teicher and Vitaliano’s (2011) study indicate that there is something perhaps qualitatively different about exposure to this type of victimization. This difference may
30 be associated with more adverse consequences for mental health of the witness than exposure
IPV (Teicher & Vitaliano, 2011).
Though no theories have been developed specifically to address sibling relationships, many can be extended to help understand it better (Caspi, 2011). Theoretically, the sibling relationship is recognized as being important and unique. This is reflected in the fact that family systems theory relegates siblings to their own subsystem within the larger family unit. In attachment literature siblings are increasingly recognized as being able to serve important attachment functions for each other. Moreover, in social comparison theory, which proposes that individuals are likely to be compared (i.e., by self and others) to individuals who are proximate and similar to themselves, siblings are prime candidates for comparison (Feinberg, Solmeyer, &
McHale, 2012). It makes sense that the sequelae of witnessing the abuse of a sibling could be different, if not worse, than that associated with witnessing IPV if one considers that the sibling relationship is qualitatively different than that of the parent-child relationship.
The first important difference may be one of greater identification with a sibling than with a parent. That is, there may be more perceived similarity between one’s sibling and oneself
(e.g., age, gender, size) than between an adult parent and a child. This could increase the horror, fear, and distress associated with witnessing a sibling being abused. Thus, based on the tenets of social comparison theory, the proximity and similarities between siblings may increase the child’s sense of vulnerability to abuse themselves after having witnessed a sibling being abused.
Similarly, exposure to a sibling being abused could increase the subjective level of distress the individual feels as a witness, since it may emphasize the fact that a child like himself or herself is more easily harmed than an adult.
31 Another factor that may make witnessing a sibling being abused different from witnessing IPV is that the child may feel more obligation and responsibility to protect their sibling than they feel for their parent. This could add to negative affect (e.g., feelings of guilt, anger or helplessness) that is experienced after witnessing a sibling’s abuse. Such an inference could be supported by the fact that, as stated earlier, siblings can act as important attachment figures, caregivers, and protectors for one another (Erdman & Caffrey, 2003; Weaver, Coleman
& Ganong, 2003). It is possible that if a sibling is not able to fulfill these functions (e.g., attachment figure, caretaking, defense) in extreme circumstances, like abuse, that the individual who witnessed the abuse may experience negative affect and adverse outcomes later.
Also, when a sibling is abused, one of the child witness’ usual sources of support (i.e., their sibling) may not be available to them since the sibling may be injured or coping via emotional withdrawal. As stated earlier, it is common for siblings to provide support and comfort for one another. This lack of support, coupled with the need to provide the abused sibling with support in a time of great stress, would likely be incredibly taxing. This could make negative outcomes more likely for the witness.
Finally, sex appears to have some effect on sibling relationships. Older siblings are more likely to provide comfort in mixed sex dyads than in same-sex dyads (Whiteman et al., 2011).
Additionally, it seems that same-sex siblings are more attentive to rivalry and competition, making them less responsive to meeting the needs of their same-sex sibling (Whiteman et al.,
2011). Thus, the sex combination of siblings may impact the outcomes associated with witnessing a brother or sister being abused. For instance, it may be that brothers feel a greater need to physically protect their brothers or sisters, while sisters feel a greater responsibility to provide emotional or instrumental support to siblings. This could lead brothers who witness a
32 sibling being abused to feel more helpless and frustrated, while a sister may feel more anxious and fearful.
Objectives
The objectives of the present study are to examine the impact of witnessing the abuse of a sibling after controlling for other forms of child and adult victimization experiences and witnessed IPV. More specifically, the primary objectives will be to (a) assess whether witnessing the abuse of a sibling in childhood predicts trauma symptomology in adulthood after controlling for other forms of victimization, (b) examine how characteristics of the sibling relationship in childhood may impact the association between trauma symptoms in adulthood and witnessing the abuse of a sibling in childhood, and (c) explore possible differences in trauma symptomology depending on type of abuse exposure (i.e., witnessing versus experiencing abuse) and biological sex of the witness (i.e., male versus female).
Hypotheses
1. Witnessing the abuse of a sibling in childhood contributes unique variance to trauma
symptomology (e.g., depression, anxious arousal, and anger) in adulthood beyond that
contributed by witnessing IPV, experiencing childhood abuse or adulthood trauma.
2. a) Participants who perceive high warmth in their childhood relationship with an abused
sibling report more trauma symptoms (i.e., posttraumatic stress and externalization) in
adulthood associated with witnessing abuse of their sibling than participants who
perceive low warmth in the childhood sibling relationship.
b) Participants who perceive low conflict in their childhood relationship with an abused
sibling report more trauma symptoms (i.e., posttraumatic stress and externalization) in
33 adulthood associated with witnessing abuse of their sibling than participants who perceive high conflict in their childhood sibling relationship.
34 CHAPTER 2
METHOD
Participants
Data was collected from 323 undergraduate participants recruited from the University of
North Texas. Participant data was omitted from the final sample if they (a) did not indicate a target sibling (n = 30), (b) failed to answer a significant amount of questions on any measure in order to complete the study rapidly (i.e., atypically short participation time; n = 11), and/or (c) did not indicate male or female biological sex (n = 1). The final sample consisted of 284 participants, and was predominantly female (80.3%, n = 228 females; 19.7%, n = 56 males), with a mean age of 20 years old (range 18 to 56). Approximately half of the sample identified as
White 47.5% (n = 135), while 21.8% (n = 62) identified as Hispanic, 13.7% (n = 39) identified as
Black, 6.3% (n = 18) Biracial, 6.0% (n = 17) Asian, 1.4% (n = 4) Middle Eastern, 1.1% (n = 3)
Native American, and 1.4% (n = 4) other. Regarding sexual orientation, 87.7% (n = 249) of participants identified as heterosexual, 4.9% (n = 14) bisexual, 3.2% (n = 9) gay, 2.5% (n = 7) lesbian, 1.1% (n = 3) other, and 0.7% (n = 2) questioning. The majority of the sample reported being single (43%, n = 122 single not dating; 17.3%, n = 49 single dating casually; 30.3%, n =
86 single dating seriously), while 6.3% (n = 18) reported living with/being engaged to a partner and living together/engaged and 2.5% (n = 7) reported being married/partnered. Less than half of participants were employed (61.6%, n = 175 unemployed; 34.2%, n = 97 part time; 4.2%, n =
12 full time), and the mean yearly family income was approximately $84,000.
Instruments
Demographic Information
The Demographic Information and History is a self-report survey used to collect information regarding age, gender, race/ethnicity, income, marital status, sexual orientation, 35 family of origin socioeconomic status (e.g., parental education and income level), parental marital status and childhood family composition, sibling types (e.g., step, half, biological, adopted, foster), sibling genders, and sibling ages. The form was also used to collect general information related to individual and family psychiatric diagnoses.
Childhood Sibling Relationship Quality
Sibling Relationship Questionnaire (SRQ; Furman & Buhrmester, 1985). This scale was used to retrospectively assess the nature of the participant’s relationship with their target sibling
(see Procedures for selection of target siblings) in childhood. The SRQ is a 48-item self-report measure with 16 scales. The scales contribute to 4 factors: Warmth/Closeness, Status/Power,
Conflict, and Rivalry. Participants indicate on a scale of 1 (hardly at all) to 5 (extremely much) how prevalent various characteristics were in their interactions with the sibling. For the purposes of the present study, the Warmth/Closeness and Conflict factors were used. The
Warmth/Closeness factor score consists of the average scale scores of items for the subscales:
Intimacy, Prosocial Behavior, Companionship, Similarity, Admiration by Sibling, Admiration of
Sibling, and Affection (21 items). The Conflict factor score consist of the average scale scores of items from subscales: Quarreling, Antagonism, and Competition (9 items). Scale scores can range from 1 to 5, and represent levels of a sibling relationship characteristic ranging from 1
(very low) to 5 (very high).
The SRQ has been shown to have good internal consistency and acceptable test–retest reliability, low correlations with social desirability and adequate construct validity (Buhrmester
& Furman 1990; Derkman, Scholte, Van der Veld, & Engels, 2010; Moser & Jacob 2002; East &
Khoo 2005). Previous researchers have obtained Cronbach alphas for the Warmth/Closeness scale ranging from .90-.94, and for the Conflict scale ranging from .68-.93 (Moser & Jacob,
36 2002; Derkman et al., 2010). For the present study, we evaluated internal consistency by calculating Cronbach’s alpha coefficients for each scale. We used the Reliability Analysis function in SPSS and included all items for a given scale in order to obtain the alpha coefficient.
Cronbach alphas were α=.96 for the Warmth/Closeness scale, and α=.88 for the Conflict scale.
Witnessed Interparental Violence
Revised Conflict Tactics Scale (CTS2; Strauss & Douglas, 2004). A modified version of the CTS2 was used to measure retrospective reports of witnessed intimate partner violence between participants’ parents. The items of the CTS2 consist of behaviors toward a partner, but not attitudes, emotional and cognitive appraisals of behaviors. Items are presented in pairs inquiring about how often the mother engaged in the abusive behavior and how often the father engaged in the abusive behavior. Participants indicate the frequency of the behavior on a scale ranging from 0 (this never happened) to 6 (more than 20 times between the ages of 7-15). A score of 7 indicated that the behavior occurred, but not within the specified time frame.
Prevalence scores for psychological aggression (5 items) and physical assault (13 items) subscales were calculated by recoding individual items into dichotomous variables. These variables indicate whether an abuse type occurred or did not occur within the timeframe asked about. First, scores of 0 and 7 were recoded as “0” to indicate that the incident did not occur within the specified timeframe. Second, scores between 1 and 6 were recoded as “1” to indicate that the incident did occur within the specified timeframe. Finally, these recoded items were summed into subscale scores and similarly recoded into “0” to indicate that the type of abuse did not occur or “1” to indicate that the type of abuse did occur.
Chronicity scores for psychological aggression (5 items), moderate physical abuse (4 items) and severe physical abuse (4 items) and physical assault (13 items) subscales were
37 calculated by summing items into continuous variables. These variables indicate approximately how many incidents of an abuse type occurred within the timeframe asked about. First, scores of
0 and 7 were recoded as “0” to indicate that the incident did not occur within the specified time frame. Second, the items scores were added together to create subscale scores, which reflect the relative incidence or chronicity with which participants experienced that type of victimization.
Although scores were calculated for minor, moderate and severe physical aggression, for the purposes of the present study physical assault scores will be used since they encompass all severity levels of violence. Moreover, physical assault and psychological abuse will be combined into a conglomerate sibling abuse variable to reduce difficulties with multicollinearity between these scores.
The CTS2 shows internal consistency reliability ranging from .34-.94. Low alpha coefficients have been found when extreme behaviors measured by the scale were not behaviors that occurred in the sample (Straus, 2005; 2007). Internal consistency in the present study was calculated as indicated above (see Sibling Relationship Questionnaire), and yielded α = .92 (α =
.86 Physical Assault, α = .88 Psychological Aggression.
Experienced Childhood Abuse
Conflict Tactics Scale, Parent-Child version (CTSPC; Straus, Hamby, Finkelhor, Moore,
& Ruuyan, 1998). The CTSPC was used to measure childhood emotional, physical and sexual abuse of the participant perpetrated by both mother and father figures. The CTSPC items consist of behaviors directed toward a child, but not attitudes, emotions and cognitive appraisal of the behaviors. Participants indicate the frequency of this behavior on a scale ranging from 0 (this never happened) to 6 (more than 20 times between the ages of 7-15). A score of 7 indicated that
38 the behavior occurred, but not within the specified time frame. Scores can be obtained to indicate prevalence, frequency and severity of the behaviors reflected in each subscale.
Prevalence scores for psychological aggression (5 items) and physical assault (13 items) subscales were calculated using the procedures described for CTS2. Also, chronicity scores for psychological aggression (5 items), moderate physical abuse (4 items) and severe physical abuse
(4 items) and physical assault (13 items) subscales were calculated using the procedures described for CTS2. Although scores were calculated for minor, moderate and severe physical aggression, for the purposes of the present study physical assault scores will be used since they encompass all severity levels of violence. Moreover, physical assault and psychological abuse will be combined into a conglomerate sibling abuse variable to reduce difficulties with multicollinearity between these scores.
Though there is sparse information available about the internal consistency reliability of the scale, Straus et al. (1998) conducted a Gallup poll survey of 1000 parents with children under
18 years old (mean child age 8.4 years) and found alpha coefficients approaching adequacy:
Physical Assault scale α = .55 and Psychological Aggression scale α = .60. Other analyses of the
CTSPC show alphas ranging from .25-.92, with an average of α = .64 (Straus, 2007). Alpha coefficients lower than .70 occurred in samples in which there were almost no extremely abusive acts reported (Straus, 2007). Although no information is available on the test-retest reliability of the CTSPC, three studies that used the previous CTSPC version showed correlation coefficients of α = .49 (McGuire & Earls, 1993), α = .79 (Johnston, 1988), and α = .80 (Amato, 1991). Due to the similarity of the CTSPC to the CTS original version, these results may be applicable to the
CTSPC (Straus, 2007). Internal consistency in the present study was calculated as indicated
39 above (see Sibling Relationship Questionnaire), and yielded α =.90 (i.e., α= .84 for Physical
Assault, α =.86 Psychological Aggression, α = .86 Sexual Abuse).
Witnessed Sibling Abuse
Conflict Tactics Scale, Parent-Child version (CTSPC; Straus, Hamby, Finkelhor, Moore,
& Ruuyan, 1998). The CTSPC-sibling was adapted for the purposes of the present study to measure physical and psychological childhood abuse perpetrated against a target sibling (see
Procedures for selection of target siblings) by both mother and father figures. The CTSPC- sibling items consist of behaviors directed toward a child, but not attitudes, emotions and cognitive appraisal of the behaviors. Participants indicate the frequency of the behavior on a scale ranging from 0 (this never happened) to 6 (more than 20 times between the ages of 7-15).
A score of 7 indicated that the behavior occurred, but not within the specified time frame. Each item was adapted to inquire about witnessing the abuse of a sibling by replacing each personal pronoun “me” with “my sibling” and “him/her.” For instance, “My mother (or female parent) shook me” would be changed to “My mother (or female parent) shook my sibling.” Scores can be obtained to indicate prevalence, frequency and severity of the behaviors reflected in each subscale.
Prevalence scores for psychological aggression (5 items) and physical assault (13 items) subscales were calculated using the procedures described for CTS2. Also, chronicity scores for psychological aggression (5 items), moderate physical abuse (4 items) and severe physical abuse
(4 items) and physical assault (13 items) subscales were calculated using the procedures described for CTS2. Although scores were calculated for minor, moderate and severe physical aggression, for the purposes of the present study physical assault scores will be used since they encompass all severity levels of violence. Moreover, physical assault and psychological abuse
40 will be combined into a conglomerate sibling abuse variable to reduce difficulties with multicollinearity between these scores.
Given that the scale to measure witnessed sibling abuse was adapted for the present study, no internal consistency scores are available from previous research. However, it is likely that the scores for the CTSPC are applicable (see Experienced Childhood Abuse section above).
Internal consistency in the present study was calculated as indicated above (see Sibling
Relationship Questionnaire), and yielded α = .90 (i.e., α = .86 Physical Assault, α = .86
Psychological Aggression).
Sibling-Sibling Abuse in Childhood
Conflict Tactics Scales 2-SP (CTS2-SP; Straus, Hamby, Finkelhor, Boney- McCoy, &
Sugarman, 1995). A modified version of the CTS2, called the CTS2-SP was used to measure retrospective reports of conflict tactics between the participant and their target sibling. The items of the CTS2-SP consist of behaviors toward a sibling, but not attitudes, emotional and cognitive appraisals of behaviors. Items are presented in pairs inquiring about how often the participant engaged in the abusive behavior and how often the target sibling engaged in the abusive behavior. Participants indicate the frequency of the behavior on a scale ranging from 0 (this never happened) to 6 (more than 20 times between the ages of 7-15. A score of 7 indicated that the behavior occurred, but not within the specified timeframe.
Prevalence scores for psychological aggression (5 items) and physical assault (13 items) subscales were calculated using the procedures described for CTS2. Also, chronicity scores for psychological aggression (5 items), moderate physical abuse (4 items) and severe physical abuse
(4 items) and physical assault (12 items) subscales were calculated using the procedures described for CTS2. Although scores were calculated for minor, moderate and severe physical
41 aggression, for the purposes of the present study physical assault scores will be used since they encompass all severity levels of violence. Moreover, physical assault and psychological abuse will be combined into a conglomerate sibling abuse variable to reduce difficulties with multicollinearity between these scores.
Mackey, Formuth, and Kelly (2009) found an alpha coefficient for CTS Physical Assault was .87 and for the CTS2-SP Psychological Aggression was .78. Internal consistency in the present study was calculated as indicated above (see Sibling Relationship Questionnaire), and yielded α = .94 (i.e., α = .93 Physical Assault, α = .90 Psychological Aggression).
Experienced Trauma in Adulthood
Traumatic Events Scale (TES; Vrana & Lauterbach, 1994). The TES- Civilian is a self- report measure which assesses 9 specific traumatic events: (1) large fires/explosions or serious industrial/farm accidents, (2) sexual assault/ rape (i.e., forced unwanted sexual activity), (3) natural disasters, (4) violent crime, (5) adult abusive relationships, (6) physical/sexual child abuse, (7) witnessing someone being mutilated, seriously injured, or violently killed, (8) other life-threatening situations, and (9) violent or unexpected death of a loved one. There are two non-specific questions included in the scale, “other event” and “can’t tell.” For the purposes of the present study, the sexual assault, violent crime and adult abusive relationship items were selected as covariates due to a well-established body of literature linking them to trauma symptoms. The TES has shown very high test-retest reliability for the total scale and positive relationships between TES scores and PTSD symptoms, anxiety and depression (Lauterbach &
Vrana, 1996, 2001). Further, Crawford, Lang and Laffaye (2008) found strong evidence for the construct validity of the TES in a primary care setting.
42
Trauma Symptomology
Trauma Symptoms Inventory-2 (TSI-2; Briere, 1995). The TSI-2 is a 136-item self- report questionnaire designed to assess symptoms of PTSD and acute stress. It evaluates 12 symptom domains: Anxious Arousal (anxiety, hyperarousal), Defensive Avoidance (behavioral, cognitive avoidance), Somatic Preoccupation (general somatic concerns, pain concerns),
Suicidality (ideation, behavior), Insecure Attachment (relational avoidance, rejection sensitivity),
Tension Reduction Behavior (external means to reduce internal distress like angry outbursts, self- mutilation and suicide threats), Anger, Depression, Impaired Self-Reference (identity confusion, self-other disturbance, and a relative lack of self-support), Dissociation, Sexual
Disturbance (sexual concerns, dysfunctional sexual behavior), and Intrusive Experiences
(flashbacks ,nightmares, intrusive thoughts). These symptom subscales load onto 4 factors:
Somatization, Externalization, Posttraumatic Stress, and Self-Disturbance. For the purposes of the present study, the Anxious Arousal, Depression, Anger/Irritability subscales, as well as the
Externalization, Self-Disturbance, and Posttraumatic Stress factors were used. Validity scales,
Response Level and Atypical Response, were also used.
Participants were asked to rate the frequency of the occurrence of various symptoms over the 6 months prior to test administration on a scale 0 to 3 scale (0 = never, 1 = rarely, 2 = sometimes, 3 = often). T-scores were calculated for subscales and factor scales according to the formula presented in the manual in which means and standard deviations were obtained for males and females in the sample, and then used in the equation ([subscale raw score – subscale mean] / [subscale SD] * 10) + 50.
43
In student and clinical samples the internal consistency of the scales were adequate and estimated using alpha reliability coefficients: Anxious Arousal from .82 to .87; Depression from
.87 to .91; Anger/Irritability from .88 to .90; Intrusive Experience from .87 to .90; Defensive
Avoidance from .87 to .90; Dissociation from .82 to .88; Sexual Concerns from .80 to .89;
Dysfunctional Sexual Behavior from .77 to .89; Impaired Self-Reference from .85 to .88; and
Tension Reduction Behavior from .69 to .76. The average alpha coefficient for all clinical scales and across studies was above .85 (Fernandez & Gebart-Eaglemont, n.d.). This is consistent with the moderate to good internal consistency and reliability found for the clinical scales in a sample of 775 Canadian university women (Runtz & Roche, 1999). Internal consistency in the present study was calculated as indicated above (see Sibling Relationship Questionnaire).α = .98.
Cronbach alpha coefficients were .87 for the Impaired Self –Reference scale, .78 for the
Dissociation scale, .91 for the Intrusive Experiences scale, .90 for the Defensive Avoidance scale, .79 for the Somatic Preoccupation scale, .85 for the Sexual Disturbance scale, .90 for the
Suicidality scale, .87 for the Insecure Attachment scale, .93 for the Depression scale, .87 for the
Anger scale, and .86 for the Anxious Arousal scale.
Procedures
The Institutional Review Board of the principal investigator’s educational institution approved all of the procedures used in the data collection. The investigators collected data using questionnaires administered in-person to participants by trained research assistants. After individuals volunteered to participate in the study, they were directed to the appropriate location in Terrill Hall, where measures all measures were administered. First, informed consent was obtained in writing after research assistants read participants the informed consent form, and explicitly explained the nature of mandatory child abuse reporting laws in Texas. Research
44 assistants then administered study instruments to consenting participants. The instruments (i.e., demographic questionnaire, SRQ, CTS2, CTSPC, CTSPC-sibling CTS2-SP, TES, TSI-2 and the
Family Environment Scale, which was not used in the current study) were administered to participants in 3 random orders to avoid ordering effects. Instruments were administered during
UNT Counseling and Testing Services operating hours as a precautionary measure, so that crisis counseling could be available to participants. If a student were to become distressed as a result of answering trauma questionnaires, a research assistant was trained to manage crisis and contact the principal investigators who were on-call during study hours so that crisis counseling could be provided. Additionally, as participants completed their instruments they were provided with
UNT Counseling and Testing Services contact information and crisis hotline numbers to obtain help if they experienced distress at a later time as a result of answering trauma related questions.
While completing the demographic questionnaire, individuals were asked to provide information about their family constellation to verify the presence of a parental figure and sibling in their childhood household. A parental figure was defined as a caregiving adult with whom the participant lived for at least 5 years between the ages of 7 to 15 years old (e.g., parent, step- parent, foster parent or other caretaker). This age range was chosen to increase the likelihood of adequate autobiographical memory capacity, and ensure that the participant had lived with the parental figure and sibling for a long enough duration for an impactful relationship to have been established. Additionally, before completing the instruments that query about siblings (i.e.,
SRQ, CTS2-SP, and CTSPC-sibling), participants were prompted to select their target sibling based on the following criteria: “You lived with the sibling for at least 5 years when you were between the ages of 7 and 15 years old, AND You saw a parental figure verbally or physically
45 mistreat this sibling the most out of all of your siblings. OR Out of all of your siblings, this sibling had the most conflict with one or both parental figures.”
46
CHAPTER 3
RESULTS
Missing Data Analysis
Data was collected from 323 undergraduate students and missing data analyses were conducted on this original sample. The analyses showed that 3% or less data was missing from major variables and that the data were missing. Listwise deletion was used for 11 participants who had failed to respond to all items on various instruments in an effort to complete the study rapidly, as suggested by their atypically short participation time. Follow up missing value analyses of the final sample determined that 3% or less data was missing completely at random, as indicated by MCAR results for each instrument. Missing data were imputed with expectation maximization (EM) algorithm using Statistical Package for the Social Sciences (SPSS Version
22.0). The imputations were run for each subscale individually in order to increase the accuracy of EM, rather than including all items into a single EM imputation.
Preliminary Analyses
Twenty-seven participants did not indicate a target sibling about whom they would answer sibling related questionnaires, and 3 participants de-selected a target sibling after completing the sibling surveys. These individuals were omitted from the final sample. On average participants in the final sample had 1.74 siblings (range 0 to 6). Among the target sibling dyads, 49.6% (n = 141) of participants selected an older sibling, 46.8% (n = 133) selected a younger sibling, and 3.5% (n = 10) selected a same age sibling (i.e., twin). Biological sex combinations of the sibling dyads were composed of 9.9% (n = 28) male participant-brother,
9.9% (n = 28) male participant-sister, 44.4% (n = 126) female participant-sister, and 35.9% (n =
102) female participant-brother combinations. Finally, the sexual orientation combinations of
47 the sibling dyads were 84.9% (n = 241) both heterosexual, 0.7% (n = 2) both sexual minority,
14.4% (n = 41) mixed orientation (heterosexual-sexual minority).
Prevalence scores from Conflict Tactic Scales ( Table 1) show that the most commonly reported form of abuse that participants witnessed (e.g., abuse of a sibling by parental figures, interparental violence) and experienced (e.g., abuse between siblings, childhood abuse) was psychological abuse, followed by moderate physical abuse, then severe physical abuse.
Additionally, childhood abuse, followed by witnessed sibling abuse, was characterized by the highest mean chronicity for all types of abuse (see Table 2). It is noteworthy that participants also reported very similar rates of psychological aggression and physical assaults perpetrated by their target sibling against them and perpetrated by them against their target sibling (see Table
A1- A3 in Appendix A).
Table 1
Frequencies (Prevalence) of Childhood Victimization Type in Overall Sample
Victimization Type % n Witness Interparental Violence Psychological Aggression 78.5 223 Moderate Physical Abuse 30.6 87 Severe Physical Abuse 9.2 26 Physical Assault 38.7 110
Childhood Abuse Psychological Aggression 94.7 269 Moderate Physical Abuse 52.5 149 Severe Physical Abuse 11.6 33 Physical Assault 86.6 246 Sexual Abuse 18.3 52
Sibling Perpetrated Abuse Psychological Aggression 93.0 264 Moderate Physical Abuse 54.2 154 Severe Physical Abuse 15.5 44 Physical Assault 65.1 185 (table continues)
48
(continued) Victimization Type % n Witness Abuse of Sibling Psychological Aggression 89.8 255 Moderate Physical Abuse 42.6 121 Severe Physical Abuse 9.9 28 Physical Assault 80.6 229
Table 2
Mean Number of Childhood Victimization Incidents in Overall Sample Between Ages 7-15
Victimization Type Mean SD Witness Interparental Violence 19.59 20.46 Psychological Aggression 14.94 13.02 Moderate Physical Abuse 1.83 4.11 Severe Physical Abuse .27 1.13 Physical Assault 4.66 10.40
Childhood Abuse 30.03 24.21 Psychological Aggression 17.28 13.52 Moderate Physical Abuse 2.88 4.89 Severe Physical Abuse .29 .98 Physical Assault 12.75 12.91
Childhood Sibling Perpetrated Abuse 18.54 17.30 Psychological Aggression 11.04 8.15 Moderate Physical Abuse 3.55 5.18 Severe Physical Abuse .56 1.64 Physical Assault 7.50 10.84
Witness Abuse of Sibling 28.75 23.73 Psychological Aggression 16.10 12.98 Moderate Physical Abuse 2.50 4.43 Severe Physical Abuse .31 1.15 Physical Assault 12.77 13.52
When analyzing the mean chronicity rates of childhood abuse and witnessed abuse of a sibling, results show no significant differences when looking at perpetration by both parents combined, suggesting that exposure to both types of victimizations happened at similar rates.
49
However, comparisons of the mean chronicity scores of abuse perpetrated by mothers versus fathers showed significant differences, with mean chronicity scores for child abuse and sibling abuse being higher for mothers than fathers. Non-significant results suggest that interparental violence was perpetrated at about the same rates by mothers and fathers, and that inter-sibling abuse was perpetrated at about the same rates by participants and their target sibling.
Furthermore, no significant differences were found between males and females regarding any form of witnessed sibling abuse, witnessed interparental violence, or childhood abuse and most forms of inter-sibling abuse. Significant differences emerged only regarding severe inter-sibling physical abuse, with males tending to report higher frequency than females. (See Tables A1, A2, and A3 in Appendix A for mean chronicity by victimization type, perpetrator, and participant sex).
In terms of the overlap between childhood victimization experiences, the vast majority of the sample reported multi-type, systemic victimization. For example, when examining frequencies of multi-type victimization, data showed that 99.3% (n = 282) of the participants reported having witnessed and experienced multiple forms of victimization in childhood (i.e., child abuse, sibling perpetrated abuse, witnessing interparental violence, and witnessing a sibling be abused). When physical assaults of “minor” severity were included in analyses, results indicate that within the overall sample, most participants witnessed two or more types of victimization (i.e., psychological or physical abuse of a sibling, psychological or physical interparental violence). Specifically, 32.7% (n = 93) witnessed all four types of victimization,
33.8% (n = 96) witnessed three types of victimization, 23.2% (n = 66) witnessed two types of victimization, while only 8.1% (n = 23) witnessed one type of victimization, and 2.1% (n = 6) did not witness any victimization. Similarly, most participants reported experiencing two or
50 more forms of victimization (i.e., sexual, psychological, or physical childhood abuse, psychological or physical abuse between siblings). Specifically, 11.6% (n = 33) experienced five types of abuse, 57.0% (n = 162) experienced four types of abuse, 20.1% (n = 57) experienced three types of abuse, 7.7% (n = 22) experienced two types of abuse, 3.5% (n = 10) experienced one type of abuse, and 0 participants reported experiencing no types of abuse. (See Table A4 in
Appendix A for rates of sibling-related victimization for each sibling dyad sex combination).
Table 3
Frequencies of Multi-Type Victimization Exposure
No One Type Two Types
% n % n % n
Witnessed Abuse (OF parent or sibling)
Witnessed Moderate Physical Abuse 45.1 128 36.6 104 18.3 52
Witnessed Severe Physical Abuse 83.5 237 14.1 40 2.5 7
Witnessed Psychological Abuse 4.2 12 22.9 65 72.9 207
Experienced Abuse (BY parent or sibling)
Experienced Moderate Physical Abuse 24.6 70 39.4 112 35.6 101
Experienced Severe Physical Abuse 75.4 214 19.4 55 4.9 14
Experienced Psychological Abuse 1.1 3 8.5 24 90.5 257
Experienced Sexual Abuse (by parent) 81.7 232 18.3 52 -- --
The most commonly endorsed forms of adulthood traumas (see Table 4) were witnessing a serious accident, receiving new of the violent or unexpected death of a loved one, natural disasters such as tornadoes and earth quakes, and other life-threatening situations. In the present
51 sample, the rates of adulthood experiences of sexual assault was 10.9% (n = 31), violent crime
16.5% (n = 47), and relationship violence 16.9% (n = 48).
Table 4
Frequencies of Adulthood Trauma Type in Overall Sample ______Victimization Type % n witness serious accident 43.7 124 sexual assault 10.9 31 natural disasters 37.7 107 violent crime 16.5 47 abusive relationship 16.9 48 witnessed violence 12.3 35 other life-threatening situations 20.4 58 news of violent/ unexpected death 43.7 124
In terms of participants’ relationships with their target siblings (see Childhood
Relationship Quality section above for scale calculation methods), warmth and conflict scores suggest that for the most part high levels of warmth and conflict were reported. In particular, ratings of warmth in the sibling relationship for the overall sample were: 7.4% (n = 21) very high, 42.3% (n = 120) high, 34.2% (n = 97) moderate, 14.1% (n = 40) low, 2.1% (n = 6) very low. Ratings for conflict in the sibling relationship in the overall sample were: 2.5% (n = 7) very high, 17.6% (n = 50) high, 42.6% (n = 121) moderate, 32.0% (n = 91) low, 5.3% (n = 15) very low. Differences across sibling sex dyads did occur with regard to patterns of warmth and conflict endorsed (see Table A5 Appendix A). Male participants with a target brother (i.e., brother-brother) showed a wide range of frequencies for warmth and conflict, with comparable frequencies across low, moderate, and high scores. On the other hand, male participants with a target sister (i.e., brother-sister) tended to endorse moderate levels of warmth and conflict. For female participants with a target sister (i.e., sister-sister), moderate conflict and high warmth were reported most frequently, where female participants with a target brother (i.e., sister-
52 brother) reported high warmth and low conflict. Across all sibling sex dyad types, sister-sister dyads seem to have the lowest frequencies of very high conflict and sister-brother dyads seemed to have the highest frequency of very high warmth.
The Trauma Symptom Inventory-2 validity scales were assessed. The Response Level
(RL) scale measures underreporting of symptoms, and elevations above T = 75 suggest defensive or avoidant responding. The Atypical Response (ATR) scale measures over-reporting of symptoms, and a raw score of 15 or more can suggest generalized endorsement of all items, specific over- endorsement of PTSD items, random responding, or high levels of distress. All participant RL and ATR scores were within acceptable limits, indicating that participant TSI-2 scores are valid. For TSI-2 scales and factors, t-scores have a mean of 50 and SD of 10, t-scores between 60-64 indicate problematic symptoms, and t-scores 65+ indicate clinically elevated symptoms. Results suggest that approximately 2.1% to 11.6% of participants experienced trauma symptoms in the problematic range and 7.4% to 10.6% of participants experienced trauma symptoms in the clinically significant range (see Table 5). The frequencies of participants reporting problematic and clinically significant trauma symptoms (i.e., for scales and factors) in the present sample were consistent with those of the TSI-2 standardization sample
(Briere, 1995).
Table 5
Trauma Symptoms in Clinically Problematic or Significant Range ______Trauma Symptom Problematic Clinically Significant % n % n Scale Anxious Arousal 5.6 16 9.9 28 Defensive Avoidance 8.8 25 9.5 27 Somatic Preoccupations 11.6 33 7.7 22 (table continues)
53 (continued) ______Trauma Symptom Problematic Clinically Significant % n % n Sexual Disturbance 6.3 18 9.5 27 Suicidality 2.1 6 7.4 21 Insecure Attachment 8.1 23 8.8 25 Tension Reduction Behavior 6.7 19 8.1 23 Anger 4.9 14 10.6 30 Depression 8.5 24 10.6 30 Impaired Self-Reference 9.5 27 7.7 22 Dissociation 4.9 14 9.2 26 Intrusive Experiences 7.4 21 9.2 26 Factor Externalization 6.3 18 8.1 23 Self-Disturbance 7.7 22 9.2 26 Posttraumatic Stress 8.5 24 9.9 28 Somatization 11.6 33 7.7 22
Correlation Matrices
Correlation matrices, which included demographic variables and all major variables, were created for the overall sample and for sex groups separately. For the overall sample, demographic variables were not moderately or highly correlated with major variables of interest.
Additionally, in the correlation matrix for the overall sample no major variables were found to be very highly inter-correlated. Finally, sibling variables were examined in terms of their correlations with trauma symptom subscale and factor scores (i.e., based on correlation matrices using chronicity scores for abuse variables; see Tables A6- A11 in Appendix A).
Sibling Warmth/Conflict & Trauma Symptoms
When the overall sample was examined, sibling warmth showed weak (i.e., -.13 to -.14) negative correlations with somatic preoccupations, suicidality, and somatization, while sibling conflict showed weak (i.e., .13 to .20) positive correlations with somatic preoccupations, sexual
54 disturbance, insecure attachment, tension reduction behaviors, anxious arousal, anger, externalization, posttraumatic stress and somatization.
For males, no significant correlations were found between sibling warmth and trauma symptoms or sibling conflict and trauma symptoms. However, for females, sibling warmth showed weak (i.e., -.14 to -.16) negative correlations with somatic preoccupations, suicidality, dissociation, and somatization, while sibling conflict showed weak (i.e., .13 to .22) positive correlations with somatic preoccupations, sexual disturbance, insecure attachment, tension reduction behaviors, anxious arousal, anger, dissociation, externalization, and somatization.
Witnessing Sibling Abuse & Trauma Symptoms
The conglomerate variable created for witnessing sibling abuse showed positive and weak correlations (i.e., .16 to .31) with all trauma symptoms except suicidality and intrusive experiences, which there was not significant correlations. For males, witnessing sibling abuse showed positive and weak correlations (i.e., .27 to .31) with anxious arousal, insecure attachment, anger, depression, dissociation, externalization and self-disturbance. For females, witnessed sibling abuse showed weak and positive correlations (i.e., .17 to .27) with all trauma symptoms except suicidality and intrusive experiences.
For the overall sample, witnessing psychological aggression toward a sibling showed weak (i.e., .16 to .31) positive correlations with defensive avoidance, somatic preoccupations, sexual disturbance, insecure attachment, tension reduction behaviors, anxious arousal, anger, depression, dissociation, externalization, somatization, self-disturbance, and posttraumatic stress.
For males, witnessing psychological aggression toward a sibling showed weak (i.e., 28 to .36) positive correlations with sexual disturbance, insecure attachment, tension reduction behaviors, anger, depression, dissociation, externalization, self-disturbance, and post-traumatic stress, as
55 well as a moderate (i.e., .42) positive correlation with anxious arousal. For females, witnessing psychological aggression toward a sibling showed weak (i.e., .17 to .29) positive correlations with defensive avoidance, somatic preoccupations, insecure attachment, tension reduction behaviors, anxious arousal, anger, depression, impaired self-reference, dissociation, externalization, somatization, self-disturbance, and posttraumatic stress.
For the overall sample, witnessing the physical assault of a sibling showed weak (i.e., .15 to .25) positive correlations with insecure attachment, tension reduction behaviors, somatic preoccupations, sexual disturbance, anxious arousal, anger, depression, impaired self-references, dissociation, externalization, self-disturbance, somatization and posttraumatic stress. For males, witnessing the physical assault of a sibling was not significantly correlated with trauma symptoms. For females, witnessing the physical assault of a sibling showed weak (i.e., .13 to
.26) positive correlations with defensive avoidance, somatic preoccupations, sexual disturbance, insecure attachment, impaired self-reference, tension reduction behaviors, anxious arousal, anger, depression, dissociation, externalization, self-disturbance, somatization and posttraumatic stress.
Inter-Sibling Abuse & Trauma Symptoms
For the overall sample, inter-sibling psychological aggression showed weak (i.e., .14 to
.26) positive correlations with defensive avoidance, somatic preoccupations, sexual disturbance, insecure attachment, tension reduction behaviors, anger, depression, anxious arousal, impaired self-reference, dissociation, externalization, self-disturbance, somatization and posttraumatic stress. For males, inter-sibling psychological aggression showed weak (i.e., .27 to .29) positive correlations with defensive avoidance, anxious arousal, and externalization. For females, inter- sibling psychological aggression showed weak (i.e., .15 to .25) positive correlations somatic
56 preoccupation, sexual disturbance, insecure attachment, tension reduction behaviors, anxious arousal, anger, depression, impaired self-references, dissociation, externalization, self- disturbance, somatization, and posttraumatic stress.
For the overall sample, inter-sibling physical assault showed weak (i.e., .12 to .14) positive correlations with defensive avoidance, sexual disturbance, anxious arousal, dissociation, anger, externalization, and posttraumatic stress. For males, inter-sibling physical assault showed weak (i.e., .27 to .28) positive correlations with defensive avoidance and sexual disturbance, while for females there were no positive correlations.
Psychological aggression and physical assaults perpetrated by the target sibling against the participant were also examined without accounting for mutual acts by the participant. The conglomerate sibling perpetrated abuse variable showed weak, positive correlations (i.e., .12 to
.20) with all trauma symptoms except suicidality and intrusive experiences, which showed no significant correlations. For males, sibling perpetrated abuse showed weak, positive correlations
(i.e., .27 to .30) with anxious arousal, defensive avoidance, sexual dysfunction, and posttraumatic stress. For females, sibling perpetrated abuse showed weak positive correlations (i.e., .13 to .20) with all trauma variables except suicidality and intrusive experiences, which showed no significant correlations.
Analysis 1 – Hierarchical Multiple Regression
The first major research question asked whether witnessing the abuse of a sibling in childhood predicts trauma symptoms (e.g., anxious arousal, depression, and anger) in adulthood after controlling for other forms of abuse and trauma. Prior to conducting the hierarchical multiple regressions, the relevant assumptions for the overall sample were tested. A sample of
284 (28 males with target brothers, 28 males with target sisters, 102 females with target brothers,
57 126 females with target sisters) was deemed adequate given 2 independent variables and 8 covariates to be included in the analysis (Tabachnick & Fidell, 2007). The assumption of singularity was met as the independent variables were not a combination of other independent variables. Collinearity diagnostics suggested that multicollinearity existed between the psychological abuse and physical assault variables for each form of victimization (Coakes,
2005). As such, psychological abuse and physical assault for each victimization type were combined into a single variable (ex. CTSc psychological abuse and CTSc physica assault were combined into a single CTSc abuse variable). Furthermore, casewise diagnostics indicate that studentized residuals from extreme cases represented less than 1% of the sample included in the analyses (Field, 2009). Outliers were trimmed to within +/- 3 standard deviations from the mean prior to analyses. Cook’s scores were less than 1, suggesting that no influential data points were affecting results, and Mahalonobis scores were within acceptable limits. Residual and scatter plots indicated that slight violations of homoscedasticity were present for some covariates/independent variables, but the assumptions of normality (i.e., based on skew and kurtosis evaluation; Burdenski, 2000) and linearity were met (Pallant, 2001).
Hierarchical Multiple Regression 1: Anxious Arousal
A two-step hierarchical multiple regression was conducted with anxious arousal as the dependent variable. The covariates entered in the first step of the analysis were witnessed interparental violence (CTS2: Psychological Aggression, Physical Assault), experienced childhood abuse (CTSPC: Psychological Aggression, Physical Assault), childhood sexual abuse, experienced abuse perpetrated by target sibling in childhood, (CTS2-SP: Psychological
Aggression, Physical Assault), and experienced trauma in adulthood (TES: Items 3, 5, 6). The
58 predictor variable entered in the second step of the analysis was witnessing the abuse of a sibling
(CTSPC- sibling: Psychological Aggression, Physical Assault).
Results of step one of the analysis showed that of the covariates included, childhood abuse and childhood sexual abuse, contributed significantly to the regression model, F (7, 276) =
8.13 , p = .000 and accounted for 17.2% of the variance in anxious arousal. Adding witnessed sibling abuse into the regression model did not create a significant change in R2, ΔF (1, 275) =
.01, p = .930 (see Table 6). When only significant covariates were included in the analysis, the first step was significant F (2, 282) = 21.42, p = .000 and accounted for 13.2% of the variance.
However, adding witnessed sibling abuse into the second step of the regression model did not create a significant change in R2, ΔF (1, 281) = .19, p = .661 (see Table 7).
Table 6
Summary of Regression Analysis for Anxious Arousal
Overall Sample R R2 R2 B SE β t Change Model 1 .41 .17 .17*** Witnessed Interparental Violence .04 .03 .08 1.09 Sibling Perpetrated Abuse .03 .04 .05 .80 Childhood Abuse .08 .03 .20 2.71*** Childhood Sexual Abuse 3.17 1.54 .12 2.06* Adulthood Violent Crime 2.18 1.71 .08 1.28 Adulthood Sexual Assault 3.66 1.95 .12 1.88 Adulthood Domestic Violence 1.57 1.58 .06 .99 Model 2 .41 .17 .00 Witnessed Interparental Violence .04 .03 .08 1.07 Sibling Perpetrated Abuse .03 .04 .05 .73 Childhood Abuse .08 .04 .20 2.22* Childhood Sexual Abuse 3.17 1.54 .12 2.06* Adulthood Violent Crime 2.16 1.72 .08 1.26 Adulthood Sexual Assault 3.68 1.96 .12 1.87 Adulthood Domestic Violence 1.57 1.58 .06 .99 Witnessed Sibling Abuse .00 .04 .01 .09 Note. Statistical Significance: p < .05*, p < .01**, p < .001***
59
Table 7
Summary of Regression Analysis for Anxious Arousal (significant covariates)
Overall Sample R R2 R2 B SE β t Change Model 1 .36 .13 .13*** Childhood Abuse .12 .02 .29 5.24*** Childhood Sexual Abuse 4.58 1.44 .18 3.17***
Model 2 .37 .13 .00 Childhood Abuse .11 .03 .27 3.22*** Childhood Sexual Abuse 4.58 1.45 .18 3.17*** Witnessed Sibling Abuse .02 .03 .04 .44 Note. Statistical Significance: p < .05*, p < .01**, p < .001***
Next the analyses were run for each sibling sex dyad combination, and Bonferroni corrections were applied (α = .0125). For each sibling sex dyad combination, adding witnessed sibling abuse into the regression model did not create a significant change in R2 (see Table 8).
Table 8
Summary of Regression Analyses for Anxious Arousal (sibling sex dyad combinations)
Males With Brothers (N = 28) R R2 R2 B SE β t Change Model 1 .66 .44 .44*** Childhood Abuse .29 .07 .68 4.35*** Childhood Sexual Abuse -2.53 5.42 -.07 -.47 Model 2 .67 .45 .01 Childhood Abuse .35 .12 .81 2.99*** Childhood Sexual Abuse -2.96 5.55 -.09 -.53 Witnessed Sibling Abuse -.06 .11 -.15 -.58
Females With Brothers (N = 102) Model 1 .46 .21 .21*** Childhood Abuse .12 .04 .28 3.15*** Childhood Sexual Abuse 7.69 2.11 .33 3.65*** Model 2 .46 .21 .00 Childhood Abuse .09 .05 .22 1.81 Childhood Sexual Abuse 7.75 2.11 .33 3.67*** (table continues) 60 (continued) Females With Brothers (N = 102) Witnessed Sibling Abuse .03 .05 .09 .71
Males With Sisters (N = 28) Model 1 .25 .06 .06 Childhood Abuse .04 .08 .09 .45 Childhood Sexual Abuse -8.09 7.42 -.22 -1.09 Model 2 .25 .06 .00 Childhood Abuse .05 .11 .12 .43 Childhood Sexual Abuse -8.06 7.57 -.22 -1.07 Witnessed Sibling Abuse -.02 .13 -.04 -.15
Females With Sisters (N = 126) Model 1 .31 .10 .10*** Childhood Abuse .10 .04 .24 2.74*** Childhood Sexual Abuse 4.04 2.19 .16 1.84 Model 2 .31 .10 .00 Childhood Abuse .09 .06 .22 1.66 Childhood Sexual Abuse 4.03 2.20 .16 1.83 Witnessed Sibling Abuse .01 .06 .02 .15 Note. Statistical Significance: p < .05*, p < .01**, p < .001***
Hierarchical Multiple Regression 2: Depression
A two-step hierarchical multiple regression was conducted with depression as the dependent variable. The covariates entered in the first step of the analysis were witnessed interparental violence (CTS2: Psychological Aggression, Physical Assault), experienced childhood abuse (CTSPC: Psychological Aggression, Physical Assault), childhood sexual abuse, experienced abuse perpetrated by the target sibling in childhood, (CTS2-SP: Psychological
Aggression, Physical Assault), and experienced trauma in adulthood (TES: Items 3, 5, 6). The predictor variable entered in the second step of the analysis was the witnessed abuse of a sibling
(CTSPC- sibling: Psychological Aggression, Physical Assault).
Results of step one of the analysis showed that the covariates included, specifically childhood sexual abuse, contributed significantly to the regression model, F (7, 276) = 6.43, p =
61 .000 and accounted for 14.1% of the variance in depression. Adding witnessed sibling abuse into the regression model did not create a significant change in R2, ΔF (1, 275) = .49, p = .487 (see
Table 9). When only the significant covariate was included, the first step was significant F (1,
283) = 7.68, p = .000 and accounted for 5.9 % of the variance. Adding witnessed sibling abuse into the regression model did create a significant change in R2, ΔF (1, 282) = 13.75, p = .000 (see
Table 10).
Table 9
Summary of Regression Analysis for Predicting Depression
Overall Sample R R2 R2 B SE β t Change Model 1 .38 .14 .14*** Witnessed Interparental Violence .04 .04 .08 1.17 Sibling Perpetrated Abuse .04 .04 .07 1.05 Childhood Abuse .05 .03 .14 1.76 Childhood Sexual Abuse 4.40 1.57 .17 2.80** Adulthood Violent Crime 2.17 1.74 .08 1.25 Adulthood Sexual Assault 2.98 1.99 .09 1.50 Adulthood Domestic Violence .54 1.62 .02 .33 Model 2 .38 .14 .00 Witnessed Interparental Violence .04 .04 .08 1.07 Sibling Perpetrated Abuse .03 .04 .05 .76 Childhood Abuse .04 .04 .10 1.10 Childhood Sexual Abuse 4.39 1.57 .17 2.79** Adulthood Violent Crime 2.05 1.75 .08 1.17 Adulthood Sexual Assault 3.14 2.01 .10 1.56 Adulthood Domestic Violence .50 1.62 .02 .31 Witnessed Sibling Abuse .03 .04 .06 .70 Note. Statistical Significance: p < .05*, p < .01**, p < .001***
Table 10
Summary of Regression Analysis for Predicting Depression (significant covariates)
Overall Sample R R2 R2 B SE β t Change Model 1 .24 .06 .06*** Childhood Sexual Abuse 6.27 1.50 .24 4.21*** (table continues) 62 (continued) Overall Sample R R2 R2 B SE β t Change Model 2 .32 .10 .04*** Childhood Sexual Abuse 5.72 1.47 .22 3.90*** Witnessed Sibling Abuse .09 .02 .21 3.71*** Note. Statistical Significance: p < .05*, p < .01**, p < .001***
The analyses were run for each sibling sex dyad combination, and Bonferroni corrections were applied (α = .0125). For females reporting about a brother, the first step of the analysis was significant, F (1, 100) = 13.41, p = .000 and accounted for 11.8% of the variance in depression.
Adding witnessed sibling abuse into the regression model created a significant change in R2, ΔF
(1, 99) = 7.21, p = .008. For the remaining sibling sex dyad combinations, adding witnessed sibling abuse into the regression model did not create a significant change in R2 (see Table 11).
Table 11
Summary of Regression Analysis for Predicting Depression (sibling sex dyads)
Males With Brothers (N = 28) R R2 R2 B SE β t Change Model 1 .01 .00 .00 Childhood Sexual Abuse .40 6.63 .01 .06 Model 2 .46 .21 .21** Childhood Sexual Abuse -2.32 6.10 -.07 -.38 Witnessed Sibling Abuse .18 .07 .47 2.58*
Females With Brothers (N = 102) Model 1 .34 .12 .12*** Childhood Sexual Abuse 8.34 2.28 .34 3.66*** Model 2 .42 .18 .06** Childhood Sexual Abuse 8.05 2.21 .33 3.64*** Witnessed Sibling Abuse .10 .04 .25 2.70**
Males With Sisters (N = 28) Model 1 .05 .00 .00 Childhood Sexual Abuse -1.89 7.63 -.05 -.25 Model 2 .11 .01 .01 Childhood Sexual Abuse -1.44 7.80 -.04 -.18 Witnessed Sibling Abuse .05 .10 .10 .48 (table continues) 63 (continued) Females With Sisters (N = 126) Model 1 .26 .07 .07** Childhood Sexual Abuse 6.39 2.12 .26 3.02** Model 2 .29 .09 .02 Childhood Sexual Abuse 5.86 2.14 .24 2.74** Witnessed Sibling Abuse .06 .04 .14 1.57 Note. Statistical Significance: p < .05*, p < .01**, p < .001***
Hierarchical Multiple Regression 3: Anger
A two-step hierarchical multiple regression was conducted with anger as the dependent variable. The covariates entered in the first step of the analysis were witnessed interparental violence (CTS2: Psychological Aggression, Physical Assault), experienced childhood abuse
(CTSPC: Psychological Aggression, Physical Assault), childhood sexual abuse, experienced abuse perpetrated by the target sibling in childhood, (CTS2-PC: Psychological Aggression,
Physical Assault), and experienced trauma in adulthood (TES: Items 3, 5, 6). The predictor variable entered in the second step of the analysis was witnessed abuse of a sibling (CTSPC- sibling: Psychological Aggression, Physical Assault).
Results of step one of the analysis showed that the covariates included, specifically childhood sexual abuse and psychological abuse between siblings, contributed significantly to the regression model, F (7, 276) = 8.93, p = .000 and accounted for 18.5% of the variance in anger. Adding witnessed sibling abuse into the regression model did not create a significant change in R2, ΔF (1, 275) = 2.06, p = .152 (see Table 12). When only significant covariates were included in the analysis, the first step was significant F (2, 282) = 27.45, p = .000 and accounted for 16.3% of the variance. However, adding witnessed sibling abuse into the second step of the regression model did not create a significant change in R2, ΔF (1, 281) = 2.55, p =
.112 (see Table 13).
64 Table 12
Summary of Regression Analysis for Predicting Anger
Overall Sample R R2 R2 B SE β t Change Model 1 .43 .19 .19*** Witnessed Interparental Violence .00 .03 .00 .01 Sibling Perpetrated Abuse .05 .04 .09 1.39 Childhood Abuse .10 .03 .25 3.30*** Childhood Sexual Abuse 5.83 1.52 .23 3.84*** Adulthood Violent Crime -2.04 1.69 -.08 -1.21 Adulthood Sexual Assault 3.14 1.93 .10 1.63 Adulthood Domestic Violence 2.33 1.56 .09 1.49 Model 2 .44 .19 .01 Witnessed Interparental Violence -.01 .03 -.01 -.17 Sibling Perpetrated Abuse .03 .04 .06 .86 Childhood Abuse .07 .04 .18 2.00* Childhood Sexual Abuse 5.81 1.52 .23 3.83*** Adulthood Violent Crime -2.28 1.69 -.09 1.35 Adulthood Sexual Assault 3.44 1.93 .11 1.78 Adulthood Domestic Violence 2.26 1.56 .09 1.45 Witnessed Sibling Abuse .05 .04 .12 1.44 Note. Statistical Significance: p < .05*, p < .01**, p < .001*** Table 13
Summary of Regression Analysis for Predicting Anger (significant covariates)
Overall Sample R R2 R2 B SE β t Change Model 1 .40 .16 .16*** Childhood Abuse .13 .02 .30 5.52*** Childhood Sexual Abuse 5.86 1.41 .23 4.15*** Model 2 .41 .17 .01 Childhood Abuse .09 .03 .21 2.61** Childhood Sexual Abuse 5.86 1.41 .23 4.16*** Witnessed Sibling Abuse .05 .03 .13 1.60 Note. Statistical Significance: p < .05*, p < .01**, p < .001***
Next the analyses were run for each sibling sex dyad combination, and Bonferroni corrections were applied (α = .0125). For each sibling sex dyad combination, adding witnessed sibling abuse into the regression model did not create a significant change in R2 (see Table 14). 65
Table 14
Summary of Regression Analysis for Predicting Anger (sibling sex dyads)
Males With Brothers (N = 28) R R2 R2 B SE β t Change Model 1 .52 .27 .27* Childhood Abuse .20 .07 .54 2.99** Childhood Sexual Abuse -6.08 5.45 -.20 -1.12 Model 2 .52 .27 .01 Childhood Abuse .25 .12 .67 2.18* Childhood Sexual Abuse -6.49 5.58 -.22 -1.16 Witnessed Sibling Abuse -.06 .11 -.16 -.54
Females With Brothers (N = 102) Model 1 .48 .23 .23*** Childhood Abuse .18 .04 .43 4.79*** Childhood Sexual Abuse 4.26 2.11 .18 2.02* Model 2 .50 .25 .02 Childhood Abuse .13 .05 .30 2.47* Childhood Sexual Abuse 4.40 2.10 .19 2.10* Witnessed Sibling Abuse .07 .05 .19 1.56
Males With Sisters (N = 28) Model 1 .32 .10 .10 Childhood Abuse .10 .08 .24 1.22 Childhood Sexual Abuse -7.31 7.92 -.18 -.92 Model 2 .34 .12 .01 Childhood Abuse .05 .12 .12 .44 Childhood Sexual Abuse -7.44 8.02 -.18 -.93 Witnessed Sibling Abuse .08 .13 .17 .62
Females With Sisters (N = 126) Model 1 .47 .22 .22*** Childhood Abuse .07 .03 .17 2.07* Childhood Sexual Abuse 10.21 2.02 .41 5.05*** Model 2 .47 .22 .00 Childhood Abuse .04 .05 .10 .76 Childhood Sexual Abuse 10.16 2.03 .41 5.02*** Witnessed Sibling Abuse .04 .06 .10 .77 Note. Statistical Significance: p < .05*, p < .01**, p < .001***
66 Analysis 2 – Moderation: Multiple Regression
The second major research question asked whether characteristics of the sibling relationship in childhood moderate the relationship between witnessing the abuse of a sibling in childhood and the experience of externalizing symptoms and post-traumatic stress symptoms in adulthood. Prior to conducting moderation analyses, relevant assumptions were tested.
Assumptions for regression analyses were adequately met (see HMR section), and univariate outliers were trimmed to +/- 3 standard deviations to the mean prior to analyses. The predictor variables and interaction terms were centered prior to analyses (Fairchild & MacKinnon, 2009).
Moderation 1: Posttraumatic Stress & Sibling Relationship Quality
In the first step of the moderation regression analysis, sibling perpetrated abuse was included as a covariate. In the second step, witnessed sibling abuse (predictor), sibling conflict and sibling warmth (moderators) were entered. Finally, in the third step interaction terms were entered. In the first step of the analysis, abuse perpetrated by a sibling accounted for 2.9% of the variance in posttraumatic stress, R2 = .03, F(1, 282) = 8.52 , p < .004. The second step of the analysis accounted for 5.5% variance in posttraumatic stress, ΔR2 = .03, F(3, 279) = 2.55 , p =
.056. In the third step, there was a significant main effects for witnessed sibling abuse (β = .09, t
= 2.91, p = .004) but the addition of the interaction terms did not account for a significance in posttraumatic stress, ΔR2 = .01, ΔF(2, 277) = 1.04 , p = .354. The analyses were also conducted for each sibling dyad sex combination and Bonferroni corrections were applied (α = .0125). No significant effects were found in any of the sex based analyses.
Moderation 2: Externalization & Sibling Relationship Quality
In the first step of the moderation regression analysis, sibling perpetrated abuse was included as a covariate. In the second step, witnessed sibling abuse (predictor), sibling conflict
67 and sibling warmth (moderators) were entered. Finally, in the third step interaction terms were entered. In the first step of the analysis, abuse perpetrated by a sibling accounted for 3.9% of the variance in externalization, R2 = .04, F(1, 282) = 11.39, p < .001. The second step of the analysis accounted for 8.3% variance in externalization, ΔR2 = .04, F(3, 279) = 4.51 , p = .004. In the third step, there was a significant main effect for witnessed sibling abuse (β = .11, t = 3.61, p =
.000) but the addition of the interaction terms did not account for a significant amount of variance in externalization, ΔR2 = .10, ΔF(2, 277) = 1.81 , p = .165.
The analyses were also conducted for each sibling dyad sex combination and Bonferroni corrections were applied (α = .0125). For females reporting about a sister, in the first step of the analysis was not significant, R2 = .00, F(1, 124) = .52, p = .470. However, the second step of the analysis accounted for 12.1% of the variance in externalization, ΔR2 = .12, F(3, 121) = 5.34 , p =
.002.In the third step, there was a significant main effect for witnessed sibling abuse (β = .09, t =
3.24, p = .001) and the addition of the interaction terms did account for a significant amount of variance in externalization, ΔR2 = .07, ΔF(2, 119) = 4.79 , p = .010. In particular, the interaction term for witnessed sibling abuse and conflict was significant (β = -.26, t = -2.83, p = .006). The interaction was graphed using techniques recommended by Aiken and West (1991; see Figure 1) and shows that sisters with low sibling conflict had the strongest relationship between levels of sibling abuse witnessed and level of current externalization, followed by those with moderate and high levels of sibling conflict, respectively.
68
Figure 1. Sibling Conflict, Witnessed Sibling Abuse and Externalization
69 CHAPTER 4
DISCUSSION
The current study aimed to extend the sibling and trauma literature by examining the impact of witnessing the abuse of a sibling in childhood on the experience of trauma symptoms in adulthood. Specifically we sought to assess (a) whether witnessing the abuse of a sibling would predict trauma symptoms after controlling for other forms of trauma and abuse, (b) how the quality of the sibling relationship might impact the experience of these trauma symptoms, and (c) explore possible differences in trauma symptoms reported depending on victimization type (e.g., witnessed versus experienced) and the participant’s biological sex.
Psychological abuse was experienced and witnessed by most of the sample and about one-third to one-half of the sample endorsed witnessing and/or experiencing physical abuse.
Results of hierarchical multiple regression support the hypothesis that witnessing the abuse of a sibling predicts trauma symptoms in adulthood, but these effects depend on (a) the type of abuse witnessed, (b) the sex composition of the sibling dyad, and (c) the specific trauma symptom under consideration. In the overall sample, and for females reporting about a brother, witnessing sibling abuse predicted depression symptoms in adulthood over and above the effects of other types of trauma. Additionally, the hypothesis that sibling relationship quality would moderate the relationship between witnessing sibling abuse and trauma related symptoms was upheld in certain circumstances. Moderation effects were not found for the overall sample, but sibling conflict did have moderating effects for females reporting about a sister.
Experience of Sibling-Related Victimization
In the overall sample and in both sex groups, the rates reported for witnessing a sibling’s abuse versus directly experiencing childhood abuse were comparable. Reports of physical and psychological abuse of participants and their siblings were perpetrated significantly more by 70 mothers than fathers. Consistent with previous research, our data also showed that inter-sibling abuse (mutual physical assault and psychological aggression) was the most common form of intra-familial violence reported for both types of abuse (i.e., psychological and physical; Caspi,
2011). Although prevalence rates for inter-sibling violence vary widely throughout the extant literature, ranging from 35% to over 60% in some samples (Goodwin & Roscoe, 1990; Hoffman,
Kiecolt, & Edwards, 2005), the present sample’s prevalence scores for inter-sibling psychological abuse and physical assault (i.e., 94.7% and 71.1%, respectively) were markedly higher. This could have been due to the title used to advertise the study (i.e., “Family
Violence”), leading to self-selection of participants who had experienced higher levels of family violence than the average undergraduate student.
Additionally, inter-sibling violence was reported by participants as surprisingly mutual, meaning participants indicated that they both experienced and perpetrated inter-sibling abuse with their target siblings at similar rates. Indeed, in previous research many participants reported being both offenders and victims of inter-sibling violence (Brody, Stoneman, & Burke, 1987).
This mutual violence between siblings may be due to reciprocal power and control struggles that occur within the sibling relationship, but also to the potentially adaptive nature of defending oneself against sibling aggression (Graham-Bermann, Cutler, Litzenberger, & Schwartz, 1994).
Prior research suggests that siblings tend to be similar in their aggressive behaviors and influence each other’s aggressive behaviors through coercion (Ostrov, Crick & Stauffacher, 2006), and that individuals who defend themselves against a sibling’s aggression may exhibit lower levels of depression and anxiety and have higher self-esteem than those who do not (Graham-Bermann, et al., 1994). Thus, it may have been adaptive for participants to defend themselves against an aggressive sibling. Also, the systemic family violence to which participants were exposed could
71 have increased the likelihood that they used violence, rather than non-violent means of conflict resolution, to defend themselves.
There is no consensus within the sibling violence literature regarding which sex dyads are most at risk for inter-sibling violence. Inter-sibling violence in the present sample was examined by sibling sex dyad combination, in order to learn more about patterns that may emerge between brothers and sisters. Mean chronicity scores showed that brother-brother dyads had the highest chronicity of all forms and severity levels of inter-sibling abuse. This aligns with early research showing that violence is consistently higher in families that have only male children (Straus,
Gelles, & Steinmetz, 1980), and boys are often subject to parental behaviors that escalate, rather than encourage resolution or avoidance of, their engagement in conflict (Caffaro, 2014). In the present sample, sister-sister dyads had the second highest mean chronicity scores for all forms of inter-sibling abuse, except severe physical abuse. Mixed sex dyads had much lower mean chronicity scores for physical assault than did same sex dyads and slightly lower mean chronicity scores for other forms and severity levels of inter-sibling abuse, which is contrary to suggestions by some researchers that the dyad at highest risk for violence may be older brother- younger sister pairs (Graham-Bermann, et al., 1994). However, we did not assess sexual abuse between siblings, a type of violence which likely occurs at higher rates in opposite sex dyads. This should be considered when discussing the chronicity scores for opposite sex dyads in the present sample. In the present study same sex dyads may have higher inter-sibling abuse rates because of power struggles that occurred based on common expectations and roles for males and females within a family. Also, since same sex siblings tend to spend more time together than opposite sex siblings, this could lead to more opportunities for violence to occur between them.
72
Witnessing the Abuse of a Sibling & Trauma Symptoms
We hypothesized that witnessing the abuse of a sibling in childhood would contribute unique variance to symptoms of anxious arousal, depression, and anger experienced in adulthood, after controlling for other forms of childhood and adulthood trauma. The results of hierarchical multiple regression analyses for the overall sample show partial support this hypothesis. In the overall sample, witnessing the abuse of a sibling was associated with depression but not anxious arousal or anger. This finding is important in that it supports the notion that witnessing sibling abuse is, in fact, linked to negative mental health outcomes.
However, our results differ from those of Teicher and Vitaliano (2011) as their results showed that witnessing sibling abuse can be predictive of multiple trauma symptoms even after controlling for other types of victimization while we found a significant relationship only with depression. This may have been due, in part, to methodological differences between the studies.
Specifically, the present study combine witnessed sibling abuse types, which could have masked links between particular types of witnessed sibling abuses (e.g., psychological, physical) and anxious arousal or depression. Also, our study controlled for combined types of sibling perpetrated abuse (pscyologial and physical), while Teichner and Vitaliano (2011) only controlled for sibling verbal aggression. The more inclusive sibling perpetrated abuse variable used in the present study could have accounted for more variance in anxious arousal and anger, leading to a non-significant link between these symptoms and witnessed sibling abuse.
Nevertheless, in controlling for a multitude of childhood and adulthood traumatic experiences, our findings makes a strong case against previous hypotheses that witnessed abuse alone does not predict trauma symptoms, but merely augments or intensifies the effects of directly experienced abuse (Buka, Stichick, Birdthistle, & Earls, 2001).
73
In fact, our findings extend previous research which has linked adverse mental health outcomes (such as depression) with witnessing interparental violence to show that these symptoms are also attributable to exposure to other forms of witnessed family violence (Johnson et al., 2002; Margolin, Vickerman, Oliver, & Gordis, 2010; Moffitt et al., 2007). Notably, witnessing interparental violence did not predict trauma symptoms in our sample, which suggests that witnessing a sibling’s abuse may be more negatively impactful for witnessing siblings. This is again, consistent with findings by Teicher and Vitaliano’s (2011) which showed that witnessed sibling abuse was more strongly associated with trauma symptoms than witnessing violence toward mothers or fathers. It is possible that, since siblings are often compared to each other and spend more time together than other family members, they would perceive greater similarity and closeness with their sibling than a parent (Feinberg, Solmeyer, & McHale, 2012; Updegraff,
McHale, Whiteman, Thayer, & Delgado, 2005). It is possible that this led them to feel more threatened and distressed by their sibling’s abuse. Also, siblings are more likely to be of similar size, age, and developmental level and have fewer overt similarities with parents, which could have increased participants’ perception of their sibling as vulnerable and their abuse as more threatening. Conversely, the participants likely viewed their parents as better able to defend themselves and control the abusive family situations. Thus, they reported more negative mental health outcomes associated with witnessing their sibling’s abuse.
Given the sex effects that were found in the present analyses, it seems imperative to consider the sex combination of sibling dyads within the context of systemic family violence in order to understand how witnessed sibling abuse relates to the development of depression symptoms in adulthood. Females who witnessed a brother’s abuse reported significantly higher levels of depression than did participants in other sibling sex dyads. It is unclear what might
74 have contributed this relationship. In the present sample, for females reporting about a brother high warmth and low conflict were most frequently endorsed than other levels of sibling relationship quality (e.g., very low, low, moderate, high, very high), suggesting that these relationships may been positive. While females reporting about a sister endorsed high warmth most frequently, they also endorsed moderate conflict most frequently. The higher frequency of moderate conflict in sister-sister dyads could be significant in relation to trauma symptoms, since females tend to value harmony and have very negative reactions to conflict in close relationships.
Hence, it should be considered that females in our sample who had positive relationships their brothers and who witnessed their brother’s abuse may have experienced more distress
(helplessness, fear, guilt, and secondary traumatic stress) than participants from other dyads whose sibling relationships were reported to be less frequently positive.
Sibling Relationship Quality & Trauma Symptoms
We hypothesized that participants reporting good relationships (i.e., high in warmth, low to moderate in conflict) with their target sibling would exhibit more posttraumatic stress and externalization symptoms in adulthood as a result of witnessing their sibling’s abuse in childhood. Results showed partial support for our hypothesis. In the overall sample, sibling relationship quality did not moderate the relationship between trauma symptoms and witnessing sibling abuse, but in sibling sex dyad analyses moderation effects were found.
Results showing moderation effects only in sister-sister sibling pairs suggest that these siblings’ relationships may differ in some aspects from other dyads and could influence individual responses to negative life events. Previous studies have found that same sex sibling dyads are distinct in terms of relationship qualities. For example, some evidence suggests that same sex siblings may be more effective teaching and socializing agents and they may provide
75 more encouragement and support to each other than opposite sex siblings (Branje, van Lieshout, van Aken, Haselager, 2004; Tucker, Barber, & Eccles, 1997). Other studies have found higher sibling relationship quality in same sex dyads, especially sister-sister pairs (Buist, 2010). Same sex siblings tend to spend the most time together, and may have stronger identification with each other than opposite sex siblings (Rowe & Gulley, 1992). In terms of same sex siblings’ impact on individual functioning and adjustment, previous literature has shown stronger associations between externalizing behaviors (e.g., delinquent behaviors) for brother-brother and sister-sister pairs than for opposite sex pairs (Buist, 2010).
In the present study, specifically for female participants, sibling conflict moderated the relationship between witnessing abuse of a sister and externalization. Specifically, the lower the perceived conflict females had with their sister in childhood, the higher was their level of externalization in adulthood in relation to witnessing their sister’s abuse as a child. Previous literature has suggested that spillover effects within the family system can be stronger in sister- sister pairs than in other sex dyads (Voorpstel & Blieszner, 2008). The implication is that in a family where abuse is systemic (i.e., as reported by most participants) abusive behavior from the spousal, parental or parent-child subsystems could spillover into the sibling subsystem and increase the likelihood of inter-sibling conflict and abuse. Thus, the buffering effect of low sibling conflict on female participants’ externalization related to witnessing their sister’s abuse could be due to the spillover effect and the consequent negative impact of sibling conflict on the development of trauma symptoms, especially secondary traumatic stress (STS). It would make sense that as conflict between sisters increased, feelings of empathy decreased, and subsequently so would the likelihood of traumatic reactions to witnessing her abuse decrease. Research has
76 shown that the experience of sibling conflict is associated with less discussion of emotions, and may impair empathy and perspective taking (Buist, Dekovic, & Prinzie, 2013).
Moreover, gender socialization may contribute to these results. Whereas males are often socialized to view conflict and assertiveness in relationships as normal, females are often socialized to value and maintain harmony in relationships. Thus, high levels of conflict in the sister-sister relationships may be particularly impactful and have a negative effect on adjustment, whereas it could be less detrimental in dyads involving brothers. Studies have shown that males are more willing than females to reconcile with same-sex peers after a conflict, while females tend to evaluate even low level conflicts as more offensive than males (Benenson et al., 2014).
Benenson and colleagues (2014) conducted a study with 40 college students (i.e., 20 men, 20 women) to examine aspects of conflict resolution with same-sex peers. Results showed that in response to conflict with a same-sex peer, women experienced more intense anger than men, their anger dissipated more slowly, and they would take longer to reconcile. Thus, conflict in sister-sister pairs in the present study may have affected female participants’ reactions to witnessing sibling abuse in a different way than it might for males, such that females who reported higher conflict with a sister could have experienced the sister’s abuse as justified and been less negatively impacted by witnessing it.
Notably, no moderating effects were found in other sibling dyads. It is possible that this is attributable to the sample characteristics and methodology of the present study. First, there were less males in the sample, which resulted in small sibling sex dyads containing male participants. This likely resulted in dyads that were too small to generate an effect even though it is quite possible that such an effect exists. For example, it is possible that for males, sibling warmth could enhance their ability to cope with the negative effects of witnessing a brother’s
77 abuse by providing them with more companionship, intimacy, and affection. One effect of this compensation could actually be a lower likelihood for engagement in externalizing behaviors.
This is consistent with research showing that the compensation effect is stronger in brother- brother relationships than in sister-sister dyads when other relationships are not providing necessary emotional support (Voorpstel & Blieszner, 2008).
Second, a methodological issue that could have resulted in lack of findings regarding moderation effects was the conglomeration of witnessed physical assault and witnessed psychological abuse of a sibling into a single variable. This resulted in an inability to distinguish between the effects of witnessed psychological abuse and witnessed physical assault on trauma symptomology and, by extension, an inability to examine moderation effects associated with each type of witnessed abuse. For example, given the fact that males tend to normalize physical violence and conflict, it is possible that males would have fewer significant associations between witnessed physical assault and sibling conflict than between witnessed psychological abuse and sibling warmth.
Implications for Clinical Practice
Clinicians working with clients who have a history of family violence must acknowledge that sibling relationships may serve as sources of both risk and protection. Our results suggest that the quality of the sibling relationship is an important factor that can influence mental health outcomes associated with exposure to family violence, including witnessing the abuse of a sibling. In practice, especially with individuals who come from abusive or neglectful homes, it may be particularly important to thoroughly explore sibling relationships in order to know how beneficial or detrimental these relationships have been and currently are to clients. Clinicians working with clients that have experienced family violence and sibling-related victimization (i.e.,
78 witnessing sibling abuse and/or less severe forms of inter-sibling abuse), could encourage adaptive compensation effects, particularly between brothers where the effect seems to be the strongest, by facilitating warmth within the sibling relationship. The clinician could also work with clients to minimize negative spillover effects, particularly between sisters where the effect seems to be the strongest, by normalizing non-violent conflict, teaching adaptive conflict management, and addressing problems in other family subsystems in therapy.
In terms of inter-sibling abuse as it may present as a clinical concern, previous research supports the notion that it is the most common and normalized form of violence (Khan &
Rogers, 2015). The findings of the present study indicate that inter-sibling abuse is frequent, may be mutual, and can be part of a larger, systemic problem of family violence. For this reason, it is essential that therapists thoroughly assess for this type of violence, not just evaluate the quality of the sibling relationship, especially with clients who report other forms of family violence. When inter-sibling abuse and its effects are concerning, the clinician can work with clients to challenge beliefs that normalize and perpetuate sibling violence. It may be particularly important to help clients who have experienced inter-sibling abuse (especially at a high level of frequency or severity) to process these experiences and help ensure that the abuse has not continued into adulthood, as empirical evidence suggests does happen (Caffaro, 2014). For males growing up among family violence, and who reported the highest level of inter-sibling violence in the present study, it might be essential to promote non-violent conflict management skills and encourage adaptive expression of emotions such as anger.
Limitations
While extending the trauma, family violence, and sibling literature by examining the effects of witnessing a sibling’s abuse, the present study does have limitations that should be
79 considered. First, the cross sectional design is not optimal for determining causal relationships between family violence exposure and trauma symptoms. Use of a longitudinal, prospective design would allow researchers to identify a direct, temporal relationship between witnessing a sibling being abused and later mental health outcomes.
Second, the retrospective measurement of sibling relationship quality and abuse experiences mean that the participants’ memories regarding these variables could be subject to bias and inaccuracies which occur during recall. It is possible that participants’ memories of sibling relationship quality, for instance, has been influenced by the current state of their relationship with the target sibling. For instance, if the siblings experienced high conflict as children but have become closer and their bond has increased in warmth over time, they may be more prone to recall less conflict between them retrospectively. This may occur in the reverse direction as well, with current conflict in their sibling relationships negatively skewing their memory of the childhood sibling relationship.
Third, only surveying the participant, rather than a sibling dyad or a sibling-parent triad, may have resulted in biased responses to questions about sibling relationship quality. It is possible that siblings have different perceptions of sibling relationship quality, as well as inter- sibling abusive behaviors. These differences may be particularly pronounced in opposite sex sibling dyads, such that brothers may perceive abusive behaviors are more normal manifestations of conflict than females and report lower levels of conflict and inter-sibling abuse than their sisters might. Additionally, parent report can offer a more objective picture of the relationship and any abuse that may have occurred among siblings, or perhaps give the researcher an idea of how normalized violence and aggression may be in the family.
80 Fourth, the uneven sibling dyad sex combinations, specifically the relatively small group of brother-brother dyads, could have increased the chances of error and results should be interpreted with this in mind. It is evident that sex, particularly the combination of sibling sexes in a dyad, is an important factor in how sibling-related victimization is associated with the development of trauma symptoms. Thus, it would be optimal to have had equal numbers of sibling sex dyad combinations in order to avoid statistical errors and ensure a more accurate understanding of how the variables in the present study are related.
Fifth, and perhaps most important, the conglomeration of psychological abuse and physical assault into one abuse variable in order to reduce problems with multicollinearity between separate psychological and physical abuse variables for each victimization type was not optimal. This likely resulted in loss of information by which to understand how witnessing particular types of abuse against a sibling is related to various trauma symptoms. In future studies, this difficulty could be addressed using commonality analyses to determine the amount of shared and unique variance is attributable to each predictor despite multicollinearity in the analysis.
Conclusions
The present study expanded the literature in trauma, family violence and sibling research by examining the association between witnessing a sibling’s abuse in childhood and trauma symptoms in adulthood, a topic that has heretofore been largely neglected by researchers.
Results suggest witnessing sibling abuse is indeed associated with adverse mental health outcomes and that sibling dyad sex combinations can play an important role regarding which outcomes are associated with experiencing sibling related family violence. Moreover, results indicated that conflict between sisters can have important moderating effects on externalization
81 symptoms in adulthood when a female participant witnesses her sister’s abuse, such that low sibling conflict is associated with more externalization.
The significant associations between witnessing a sibling’s abuse in childhood and depression symptoms in adulthood is consistent with findings of previous research by Teicher and Vitaliano (2011). This is notable, especially given the extensive control variables that were included in the present study, specifically a variable to account for psychological abuse and physical assault perpetrated against the participant by the target sibling (while Teichner and
Vitaliano (2011) only accounted for sibling verbal aggression). In any case, future research should aim to achieve a better understanding of the seemingly complex relationship between inter-sibling violence, witnessed sibling abuse and outcomes in youth and adulthood. This could involve the use of prospective, longitudinal designs and multi-source approaches that include parents and both siblings’ reports. It seems essential for future research to address the complex interrelationship among inter-sibling abuse and witnessed sibling abuse, particularly for various sibling sex dyad combinations. Finally, not only should future research seek to replicate or disprove the findings of the current study, but future research should also extend the literature by examining relationships between a variety of unexplored outcomes and witnessing a sibling’s abuse (e.g., participant early adulthood adjustment, social competence, current parenting practices, adult sibling relationship quality, etc.).
82
APPENDIX
ADDITIONAL TABLES
83 Table A1
Victimization Chronicity Rates for Overall Sample (N = 284)
Perpetrator X Mothers Fathers Sibling Participants Either/Both Victimization Mean (SD) Mean (SD) Mean (SD) Mean (SD) Mean (SD) Witness Sibling Abuse Psychological 8.20 (7.80) 7.25 (7.13) 15.45 (14.20) Minor Physical 6.30 (6.25) 4.67 (5.34) 10.89 (10.85) Moderate Physical 1.36 (2.14) .71 (1.47) 2.07 (3.21) Severe Physical .05 (.40) .05 (.39) .11 (.55) Physical Assault 7.71 (7.81) 5.48 (6.01) 13.20 (12.72)
Witness Interparental Violence Psychological 7.23 (7.48) 6.36 (6.93) 13.59 (13.99) Moderate Physical 1.25 (2.61) .89 (2.98) 2.14 (4.95) Severe Physical .09 (.48) .23 (1.25) .32 (1.32) Physical Assault 2.76 (5.71) 2.69 (7.65) 5.43 (12.01)
Experience Childhood Abuse Psychological 9.36 (8.14) 7.89 (8.08) 17.25 (15.14) Minor Physical 7.79 (6.50) 4.05 (4.30) 11.83 (9.75) Moderate Physical 1.55 (2.57) 1.12 (2.60) 2.67 (4.48) Severe Physical .05 (.40) .04 (.19) .09 (.44) Physical Assault 9.39 (8.16) 5.05 (5.48) 14.45 (11.98)
Experience Inter-Sibling Abuse Psychological 11.52 (9.06) 12.14 (8.75) 23.66 (17.57) Minor Physical 5.51 (6.91) 5.63 (6.57) 11.24 (12.88) Moderate Physical 4.69 (6.32) 4.57 (6.07) 9.26 (12.07) Severe Physical 1.06 (2.02) .68 (1.64) 1.74 (3.50) Physical Assault 10.36 (13.74) 10.04 (12.92) 20.39 (25.92)
84 Table A2
Victimization Chronicity Rates for Females (N = 228)
Perpetrator X Mothers Fathers Sibling Participants Either/Both Victimization Mean (SD) Mean (SD) Mean (SD) Mean (SD) Mean (SD) Witness Sibling Abuse Psychological 8.68 (7.39) 7.57 (7.30) 16.25 (12.69) Minor Physical 5.36 (5.70) 4.36 (5.53) 9.69 (9.60) Moderate Physical 1.43 (2.85) 1.18 (2.97) 2.60 (4.68) Severe Physical .13 (.69) .22 (1.00) .36 (1.25) Physical Assault 6.91 (8.29) 5.79 (8.40) 12.67 (13.73)
Witness Interparental Violence Psychological 7.57 (6.92) 7.70 (6.81) 15.27 (12.79) Moderate Physical 1.05 (2.74) .70 (2.00) 1.75 (3.88) Severe Physical .11 (.57) .15 (.69) .26 (1.08) Physical Assault 2.35 (5.73) 2.18 (5.44) 4.48 (10.00)
Experience Childhood Abuse Psychological 9.75 (7.90) 7.54 (7.47) 17.29 (13.05) Minor Physical 6.25 (6.14) 2.89 (4.07) 9.14 (8.58) Moderate Physical 1.68 (2.84) 1.25 (2.87) 2.93 (5.00) Severe Physical .14 (.63) .19 (.75) .33 (1.06) Physical Assault 8.00 (8.68) 4.33 (6.88) 12.33 (13.12)
Experience Inter-Sibling Abuse Psychological 10.92 (7.92) 10.34 (7.23) 21.26 (14.78) Minor Physical 3.86 (5.26) 4.18 (5.23) 7.94 (10.00) Moderate Physical 3.27 (4.84) 3.04 (4.59) 6.31 (9.11) Severe Physical .43 (1.51) .29 (1.06) .72 (2.30) Physical Assault 6.80 (9.91) 6.79 (9.32) 13.60 (18.43)
85 Table A3
Victimization Chronicity Rates for Males (N = 56)
Perpetrator X Mothers Fathers Sibling Participants Either/Both Victimization Mean (SD) Mean (SD) Mean (SD) Mean (SD) Mean (SD) Witness Sibling Abuse Psychological 8.59 (7.46) 7.51 (7.25) 16.10 (12.98) Minor Physical 5.54 (5.81) 4.42 (5.48) 9.93 (9.84) Moderate Physical 1.41 (2.72) 1.08 (2.75) 2.50 (4.43) Severe Physical .12 (.64) .19 (.92) .31 (1.15) Physical Assault 7.07 (.20) 5.73 (7.97) 12.77 (13.52)
Witness Interparental Violence Psychological 7.50 (7.02) 7.44 (6.84) 14.94 (13.02) Moderate Physical 1.09 (2.71) .74 (2.22) 1.83 (4.11) Severe Physical .22 (.55) .17 (.83) .27 (1.13) Physical Assault 2.43 (5.72) 2.28 (5.93) 4.66 (10.40)
Experience Childhood Abuse Psychological 9.67 (7.94) 7.61 (7.58) 17.28 (13.52) Minor Physical 6.55 (6.23) 3.12 (4.13) 9.67 (8.87) Moderate Physical 1.65 (2.79) 1.23 (2.82) 2.88 (4.89) Severe Physical .13 (.59) .16 (.68) .29 (.98) Physical Assault 8.27 (8.59) 4.47 (6.63) 12.75 (12.91)
Experience Inter-Sibling Abuse Psychological 11.04 (8.15) 10.69 (7.57) 21.73 (15.37) Minor Physical 4.18 (5.65) 4.47 (5.54) 8.60 (10.69) Moderate Physical 3.55 (5.18) 3.34 (4.94) 6.89 (9.81) Severe Physical .56 (1.64) 1.20 (3.95) .92 (2.61) Physical Assault 7.50 (10.84) 7.43 (10.19) 14.94 (20.26)
86
Table A4
Prevalence and Chronicity Rates for Sibling-Related Victimization by Dyad Sex Combination
Male Participant- Male Participant- Female Participant- Female Participant- Brother Sister Brother Sister (N = 28) (N = 28) (N = 102) (N = 126)
Prevalence % (n) % (n) % (n) % (n)
Witnessed Sibling 82.1 (23) 85.7 (24) 90.2 (92) 92.1 (116) Psychological Abuse
Witnessed 78.6 (22) 78.6 (22) 82.4 (84) 80.2 (101) Sibling Physical Assault
Inter-sibling 92.9 (26) 92.9 (26) 93.1 (95) 96.8 (122) Psychological Abuse
Inter-sibling 92.9 (26) 96.8 (27) 63.7 (65) 73.8 (93) Physical Assault
Chronicity Mean (SD) Mean (SD) Mean (SD) Mean (SD)
Witnessed Sibling Psychological 16.6 (16.3) 14.3 (11.9) 15.8 (13.9) 16.6 (11.7) Abuse
Witnessed Sibling Physical 14.5 (13.5) 11.9 (12.0) 12.4 (12.8) 12.9 (14.5) Assault
Inter-sibling Psychological 26.4 (18.4) 20.9 (16.6) 19.7 (15.8) 22.6 (13.8) Abuse
Inter-sibling Physical Assault 29.1 (29.9) 11.7 (17.8) 11.5 (17.2) 15.3 (19.3)
87 Table A5
Sibling Relationship Quality by Sibling Sex Dyad Combination
Sibling Warmth Conflict Relationship % (n) % (n) Quality Male Participant-Brother (N = 28) Very Low 0.0 (0) 0.0 (0) Low 32.1 (9) 28.6 (8) Moderate 35.8 (10) 35.7 (10) High 28.5 (8) 32.1 (9) Very High 3.6 (1) 3.6 (1) Female Participant-Brother (N = 102) Very Low 3.9 (4) 6.9 (7) Low 12.8 (13) 42.1 (43) Moderate 37.2 (38) 33.4 (34) High 41.2 (42) 13.7 (14) Very High 4.9 (5) 3.9 (4) Male Participant-Sister (N = 28) Very Low 0.0 (0) 0.0 (0) Low 21.4 (6) 39.3 (11) Moderate 46.5 (13) 42.8 (12) High 21.4 (6) 14.3 (4) Very High 10.7 (3) 3.6 (1) Female Participant-Sister (N = 126) Very Low 1.6 (2) 6.3 (8) Low 9.5 (12) 23.1 (29) Moderate 28.6 (36) 51.6 (65) High 50.8 (64) 18.2 (23) Very High 9.5 (12) 0.8 (1)
88 Table A6
Correlations for Victimization Type and Trauma Symptoms (Scales)
Reference - isturbance Anxious Arousal Defensive Avoidance Somatic Preoccupation Sexual D Suicidality Insecure Attachment Tension Reduction Behaviors Anger Depression Impaired Self Dissociation Intrusive Experiences Witnessed Sibling Abuse .25** .16** .19** .18** .09 .25** .23** .31** .23** .23** .23** .04 Psychological .31** .19** .17** .16** .10 .29** .23** .30** .24** .27** .25** .04 Physical Assault .15* .12 .15** .15* .07 .18** .20** .25** .18** .15* .18** .04 Childhood Abuse .32** .26** .16** .24** .16** .31** .33** .34** .26** .26** .32** .09 Psychological .34** .28** .17** .23** .15* .30** .31** .30** .24** .25** .32** .08 Physical Assault .25** .20** .13** .19** .14* .27** .29** .31** .24** .22** .27** .08 Witnessed Interparental Abuse .24** .20** .15* .21** .10 .29** .20** .20** .21** .20** .27** .06 Psychological .22** .17** .14* .16* .06 .27** .17** .19** .17** .17** .22** .14* Physical Assault .19** .18** .12* .21** .13* .24** .20** .17** .20** .20** .26** -.06 Sibling Perpetrated Abuse .17** .15* .12* .16** .07 .17** .16** .20** .16** .15* .17** -.03 Psychological .21** .15* .14* .17** .10 .24** .21** .26** .20** .18** .18** .02 Physical Assault .12 .12* .09 .12* .04 .09 .10* .12* .10 .09 .13* -.06 Note. Statistical Significance: p < .05*, p < .01**, p < .001***
89 Table A7
Correlations for Victimization Type and Trauma Symptoms for the Overall Sample (Factors)
-
Externalization Self Disturbance Posttraumatic Stress Somatization Witnessed Sibling Abuse .27** .26** .23** .19** Psychological .26** .29** .25** .17** Physical Assault .22** .19** .17** .15** Childhood Abuse .35** .30** .32** .16** Psychological .32** .29** .33** .17** Physical Assault .30** .27** .26** .13* Witnessed Interparental Abuse .24** .26** .24** .15* Psychological .19** .23** .21** .14* Physical Assault .22** .23** .22** .12* Sibling Perpetrated Abuse .20** .17** .17** .12* Psychological .25** .23** .19** .14* Physical Assault .13* .10 .13* .09 Note. Statistical Significance: p < .05*, p < .01**, p < .001***
90
Table A8
Correlations for Victimization Types and Trauma Symptoms for Males (N = 56; Scales)
Reference - isturbance Anxious Arousal Defensive Avoidance Somatic Preoccupation Sexual D Suicidality Insecure Attachment Tension Reduction Behaviors Anger Depression Impaired Self Dissociation Intrusive Experiences Witnessed Sibling Abuse .31* .14 .12 .24 .19 .27* .19 .29* .30* .22 .27* -.15 Psychological .42** .22 .17 .29* .23 .32* .28* .34* .34* .25 .34* -.16 Physical Assault .14 .03 .04 .12 .08 .17 .13 .18 .20 .13 .16 -.10 Childhood Abuse .41** .27* .18 .25 .22 .33* .37** .36** .27* .23 .37** -.02 Psychological .43** .32* .22 .33* .21 .32* .41** .32* .26 .18 .40** -.05 Physical Assault .31* .15 .10 .11 .18 .28* .28* .33* .23 .24 .29* .01 Witnessed Interparental Abuse .34* .19 .09 .44** .15 .32* .19 .23 .21 .11 .28* -.02 Psychological .26 .15 .12 .40** .10 .26 .18 .21 .12 .07 .23 .09 Physical Assault .38** .23 .06 .42** .17 .34* .23 .23 .27* .16 .31* -.15 Sibling Perpetrated Abuse .27* .30* .09 .28* .15 .22 .20 .19 .22 .16 .22 -.06 Psychological .27* .27* .10 .23 .14 .22 .21 .29* .22 .14 .18 .02 Physical Assault .24 .28* .07 .27* .13 .20 .17 .10 .20 .15 .22 -.11 Note. Statistical Significance: p < .05*, p < .01**, p < .001***
91 Table A9
Correlations for Victimization Types and Trauma Symptoms for Males (N = 56; Factors)
Disturbance - Externalization Self Posttraumatic Stress Somatization Witnessed Sibling Abuse .28* .29* .26 .12 Psychological .36** .34* .35** .17 Physical Assault .17 .18 .13 .04 Childhood Abuse .38** .30* .37** .18 Psychological .40** .28* .42** .22 Physical Assault .28* .27* .26 .10 Witnessed Interparental Abuse .33* .24 .27* .09 Psychological .30* .17 .21 .12 Physical Assault .34* .29* .32* .06 Sibling Perpetrated Abuse .25 .22 .27* .09 Psychological .28* .22 .25 .10 Physical Assault .20 .20 .25 .07 Note. Statistical Significance: p < .05*, p < .01**, p < .001***
92 Table A10
Correlations for Victimization Types and Trauma Symptoms for Females (N = 228; Scales)
Reference - isturbance Anxious Arousal Defensive Avoidance Somatic Preoccupations Sexual D Suicidality Insecure Attachment Tension Reduction Behaviors Anger Depression Impaired Self Dissociation Intrusive Experience Witnessed Sibling Abuse .24** .17* .20** .17* .07 .25** .25** .31** .22** .23** .23** .08 Psychological .28* .18** .17** .12 .07 .28** .22** .29** .22** .27** .23** .09 Physical Assault .15* .13* .18** .15* .16 .19** .21** .26** .17** .15* .18** .07 Childhood Abuse .29** .26** .16* .24** .14* .30** .32** .33** .26** .27** .31** .11 Psychological .31** .26** .16* .21** .13* .29** .28** .30** .23** .27** .30** .11 Physical Assault .23** .21** .13* .21** .13 .27** .29** .31** .24** .22** .26** .09 Witnessed Interparental Abuse .21** .20** .17* .14* .09 .29** .21** .20** .21** .23** .27** .08 Psychological .22** .18** .15* .09 .05 .28** .17* .19** .19** .19** .22** .14* Physical Assault .14* .17* .14* .15* .11 .21** .19** .15* .18* .21* .24* -.03 Sibling Perpetrated Abuse .14* .10 .13* .12 .04 .15* .15* .20** .13* .14* .15* -.01 Psychological .19** .11 .15* .15* .09 .25** .21** .25** .19** .20** .18** .03 Physical Assault .07 .07 .09 .07 -.00 .05 .07 .13 .06 .07 .11 -.04 Note. Statistical Significance: p < .05*, p < .01**, p < .001***
93 Table A11
Correlations for Victimization Types and Trauma Symptoms for Females (N = 228; Factors)
Disturbance - Externalization Self Posttraumatic Stress Somatization Witnessed Sibling Abuse .27** .25** .22** .20** Psychological .23** .28** .23** .17** Physical Assault .23** .19** .18** .18** Childhood Abuse .35** .30** .31** .16* Psychological .30** .29** .31** .16* Physical Assault .31** .27** .26** .13* Witnessed Interparental Abuse .21** .27** .23** .17* Psychological .16* .24** .21** .15* Physical Assault .19** .22** .20** .14* Sibling Perpetrated Abuse .18** .16* .14* .13* Psychological .24** .23** .17* .15* Physical Assault .10 .07 .09 .09 Note. Statistical Significance: p < .05*, p < .01**, p < .001***
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